Health Minister Dr David Clark interviewed by Corin Dann

Health Minister appoints Crown Monitor at troubled Counties Manukau DHB.

Health Minister Dr David Clark told TVNZ 1’s Q+A programme that Crown Monitor, Ken Whelan will oversee the Counties Manukau District Health Board as it manages a number of difficult issues.

“..they’ve got deficits blowing out. We’ve seen the building issues. We need to have assurance that that’s on track to address the issues.

CORIN So what are we supposed to read into that? You don’t have confidence in them to an extent you have to put in one of your people on the board?

DAVID I want to be really clear that we need to rejuvenate that board. And I make no apology for that. If we have the same people doing the same things, we’re going to get the same results.”

David Clark also named three new DHB chairs for Auckland, Waitemata and Counties Manukau. They are: Pat Snedden, Judy McGregor and Mark Gosche.

When asked whether he would look at changing the DHB model, Minister Clark told Corin Dann, ‘I won’t promise significant change this term, but I want to make sure that we have the best model in place to deliver healthcare at the best price for New Zealanders.’

And when questioned about whether the Budget would deliver on promises to bring GP visits down by $10 on average, Minister Clark said, ‘We’re going to have to phase some of these initiatives. There’s no doubt about that.’

The Health Minister also told Q+A, ‘international evidence suggests that private-public partnerships in health don’t work out as people plan them. You end up paying a lot more over time for the same assets..

CORIN So it is ideology, fair to say?

DAVID No, not ideology. I'm talking about evidence.’

Please find the full transcript attached. Here are the links to Part 1 and Part 2 of that interview.

Q + A
Episode
DAVID CLARK
Interviewed by CORIN DANN

CORIN It is an interesting question because money is a big problem for health. You never have enough. Why not use the private sector, for example, in Dunedin hospital, where you’ve ruled it out, where the last Government was, to save yourself some money?

DAVID Well, international evidence suggests that private-public partnerships in health don’t work out as people plan them. You end up paying a lot more over time for the same assets and often lack the flexibility because, of course, a private business is going to want to cover off risk, and no one knows what the future in health is going to look like.

CORIN So it is ideology, fair to say?

DAVID No, not ideology. I'm talking about evidence. Certainly in London, you ask the mayor, Sadiq Khan there, he describes the hospitals that are privately funded there as a noose around the ratepayers of London’s necks.

CORIN But I guess the point I’m making is that there is a line you’ve drawn between roads and hospitals. You’re saying it doesn’t work?

DAVID Roads are more predictable.

CORIN The problem is Treasury’s identified $14 billion worth of hospitals that are going to have to be built over the next 10 years, fix ups, all that sort of stuff, over the next 10 years. But from what I can see, Grant Robertson’s saying he’s got 10 billion that the Government would contribute, so where does the other 4 billion come from that you’re going to need? Because you can’t borrow any more.

DAVID Yeah, under the status quo, it comes off the balance sheets of the DHBs. Remember, they still carry that value on their balance sheets. It is a long way out. We’re talking over the next 10 years. But there’s no doubt we’ve got a plan for these things, and that’s the reason why I asked for a national asset management plan for our health system.

CORIN So it could be more, couldn’t it?

DAVID Of course it could be more. We don’t know yet.

CORIN But where is the plan to have the money? Because you’ve only got so much capital available. There’s other things that want it. You’ve got light rail and all sorts of other things trying to get capital. How are you going to have enough? It just doesn’t stack up, does it?

DAVID Yeah, the Government’s put aside in the HYEFU $42 billion for capital projects across a range of areas. And the capital allowance for this coming budget will be bigger than we’ve seen for some time. This Government is prepared to tackle those challenges. We will spend more, but we’ve got to make sure every dollar is spent carefully. And so that’s why we’ll be doing everything step by step.

CORIN It’s interesting talking to people in the health sector this week. One in the nursing sector said to me they voted National because even though they were sympathetic to many of the things you’re doing, because they didn’t believe you would have enough money left after making all your promises for the nurses, for their pay settlement. And that’s the reality, isn’t it? The nurses aren’t going to be able to get what they want because you’ve got so many other things to pay for.

DAVID We’ve set aside money across health. We’ve said that we want to spend more money, and we did say we wanted to spend more money than our opponents. But we won’t be able to afford everything straight away. Nobody pretends we can. We won’t be able to afford everything in our first Budget. We’ve got to do it step by step. And there is a backlog of underfunding. We’re going to take steps to address that.

CORIN You went into the election campaign making it clear you would deliver all this money and you would deliver all these promises.

DAVID We will deliver the promises we make.

CORIN In the first term?

DAVID In the first term.

CORIN All of them?

DAVID Corin, all of them, subject to any new information that comes to hand.

CORIN So new hospitals, what about—Let’s just stay back on the nurses’ pay very quickly. Because the issue here seems to be pay equity, isn’t it? That’s the big problem you’ve got looming. Are nurses going to get pay equity this term?

DAVID Pay equity is further down. It was in the negotiated offer that went forward previously, pay equity – a shift towards that. It is huge. Let’s not pretend it’s not. It’s a serious issue, but it does need to be tackled. The offer that was rejected by the nurses was more than the average offer under the last Government. There’s no doubt their expectations are up. But now we’ve got a process in place, and we’ve got to approach that in good faith.

CORIN But why shouldn’t they get pay equity when other parts of the health sector are and we’re hearing stories of nurses who feel like they’re earning less than caregivers when they’re 20 years experienced or whatever. Why shouldn't they be getting pay equity now?

DAVID Well, they should be getting pay equity, but there is a process to work through to work out how we do that.

CORIN It’s money, isn’t it? Because according to the advice given to the Labour Party during the coalition negotiations, the estimated cost from collective bargaining and pay equity, if you join them together, for the health sector over three years is $750 million. You don’t have it, do you?

DAVID Yeah, these are big sums. Of course we have the money. We have budgeted really carefully. Labour Governments and coalitions with Labour in them are held to a higher standard. We know that. And that’s why we did our sums very carefully when we were in opposition, and the promises that have been made in the coalition agreements and the confidence and supply agreements will be kept. We have accounted for them and we will deliver on them.

CORIN It would be a lot easier if your government could borrow more money, wouldn’t it? If you relaxe the rules you’ve set on borrowing.

DAVID Well, yeah, on the one hand, people want us to spend more. On the other hand, they want us to spend less. I’m confident we’ve got the balance right. We need to be prudent. Every taxpayer dollar that is spent needs to be spent carefully, and we’re determined to make sure we do that.

CORIN The other criticism is that you’re manufacturing a crisis. Is there a crisis in health, for a start?

DAVID There are some areas where there is a crisis. I think mental health – people will acknowledge is at a crisis level. But the reason our health system is holding together so well, and it is, is because of the dedicated staff. We have doctors and nurses and allied health workers who have turned up every day in an underfunded environment for years, and they deliver an amazing service, and New Zealanders know that.

CORIN Let’s get to Middlemore. Because the Prime Minister said, ‘Would I call it a crisis? When people hear stories like Middlemore, that’s certainly the impression you’re left with.’ The criticism is that your government in the last few weeks has seized on issues with Middlemore in terms of sewage in the walls and these sorts of things, and beaten it up to give yourself some room because you don’t have the funds or you can’t deliver everything.

DAVID The stories about sewage in the walls came out of the DHB, not from Government. We are determined to address these issues, to fix the problems that are presenting, but we’ve got to do it step by step, and we’re taking steps to do that.

CORIN It might have come out of the DHB, but your government, including at a press conference on a Monday after Cabinet – we saw Grant Robertson and the Prime Minister come down and really push this issue of a big crisis in health and funding.

DAVID It is. You can’t underfund the health system for nine years and expect nothing to happen and expect no consequences. And I think New Zealanders will be concerned when they hear there’s rot and mould and sewage in walls. I have to assure them that the DHB is managing those issues, but it does mean we have a serious programme of work ahead.

CORIN Let’s get to DHBs, because you’ve announced, or I understand you’re going to announce this morning, some changes. You’ve got chairs for those three DHBs in Auckland?

DAVID I have, yes. I’ve appointed Mark Gosche, former Cabinet minister, former Pacific Island Affairs minister and resident in Counties-Manukau to lead that DHB, and alongside him, to support him, there will be Crown monitor. He’s expressed a real desire to have that support because there’s some serious issues--

CORIN So you don’t have confidence in that board? You’ve put in a Crown monitor?

DAVID Put in a Crown monitor because they’ve got deficits blowing out. We’ve seen the building issues. We need to have assurance that that’s on track to address the issues.

CORIN So what are we supposed to read into that? You don’t have confidence in them to an extent you have to put in one of your people on the board?

DAVID I want to be really clear that we need to rejuvenate that board. And I make no apology for that. If we have the same people doing the same things, we’re going to get the same results. So as minister, it’s my responsibility to make sure that we can have public confidence in what’s happening there going forward.

CORIN And do you think you handled the process of effectively pushing out two board members as well as you could have?

DAVID Oh, I can understand that they’re upset. They have put themselves forward for public service. But as Mark Darrow himself said, these appointments are at the minister’s discretion. They’re not an entitlement. And I need to be sure that I can give the public assurance that we have the right people in there going forward to address the issues that are emerging, and I’m confident now that we’ve got those people there.

CORIN The other one’s Judy McGregor, Pat Snedden are the two others for the rest of the Auckland area.

DAVID Yes. Judy McGregor going into Waitemata. She’s a former human rights commissioner. She is a person who is very active at AUT – Associate Dean, head of school. And Pat Snedden is well known in government circles. He supports Ports of Auckland, has chaired DHBs before.

CORIN So you’ve got your people in there now. Will you demand that they, like the last government, will you demand that they deliver surpluses?

DAVID I will expect prudent financial management.

CORIN Surpluses?

DAVID The Chairs of the DHB understand that. I’m focused on making sure New Zealanders get the health services they deserve and that they spend every dollar carefully.

CORIN Surpluses?

DAVID Every dollar carefully. I’m not going to promise surpluses. I am not. I am going to promise that they manage prudently and chairs and those boards are held to account for their financial management.

CORIN Why not promise surpluses? Isn’t it reasonable-?

DAVID No government has delivered surpluses in recent history.

CORIN No, but the expectation should be from you that it’s a surplus. And that’s not unfair, is it, because we want them to be delivering efficient services, and if there’s no consequence…

DAVID I think first and foremost, New Zealanders need to know that the service is there. When the kids get sick, they want to know they can get the care they need in hospital. The next step, and the responsibility of the boards, is to make sure that they’re managing their finances prudently, and I would like to see more of those boards doing better.

CORIN What we’ve seen over the last couple of weeks with Middlemore -- isn’t it a failing of how our DHBs work? We’ve got you squabbling with board members, you bringing in your people you want – fair enough – change of government, we get that. And yet there’s supposed to be a quasi-democratic board that people get to elect some of them, but the government has their people. Now you’re bringing in Crown monitors. They’re not working.

DAVID Let’s not forget we have an amazing health system. We have services that are afforded in New Zealand more cheaply than they’re afforded overseas. We have quality healthcare. New Zealanders trust the service they get from doctors and nurses in our hospitals, but we do need to make sure they’re sustainable. And I do want to look at those issues – I want to have a serious review – I don’t want to throw out the baby with the bath water. The current system delivers good, innovative response--

CORIN Let’s get to the nub of this. Governments have skated around this DHB issues – well, the last couple did for a while. I know it’s an upheaval for the sector, but will you commit to changing the DHBs? There’s 20 of them, isn’t there? It’s far too many for a country of this size, isn’t it?

DAVID I won’t promise significant change this term, but I want to make sure that we have the best model in place to deliver healthcare at the best price for New Zealanders.

CORIN Let’s look at primary healthcare. Is that going to be the big focus for you in many ways? Because that’s what’s going to make the big cost savings, isn’t it?

DAVID Absolutely. Longer-term, it will. In the short term, we’ve got so much unmet need. Last year over 500,000 New Zealanders couldn’t afford to go to their GP. One in four adults in New Zealand now cannot afford to go to their GP in any given year for reasons of cost.

CORIN So will we see in the Budget you deliver on your promises to bring GPs visit down by, what, $10 on average? From $40 to $30?

DAVID We’re going to have to phase some of these initiatives. There’s no doubt about that. I’m not going to skate around that, and I’m not going to make the Budget announcement today, you understand that, Corin.

CORIN But you are signalling that that’s not coming all at once?

DAVID We will make healthcare more affordable, and that includes primary care.

CORIN So when can someone expect to see the average get down to 30?

DAVID Corin, I can’t announce that today. We are phasing our priorities, but we are absolutely committed to the principle of making sure New Zealanders can afford to visit their GP.

CORIN Because you’ve got to clear those DHB deficits as well, don’t you?

DAVID We will make sure DHBs are better funded as well. We have campaigned on that, and you mentioned that at the outset. We do believe that healthcare needs to be appropriately funded and sustainably funded.

CORIN And you’ve got a national cancer agency you’ve got to do?

DAVID Yep, we’ve got lots of things we’ve announced--

CORIN Will we see that this term?

DAVID We will see some progress in that regard. I’m having policy work done now to tell me what the best way is of delivering those things. We’re in government now, and that’s different. I do have access to a lot of researches, to the best international evidence, and I want to make sure that every dollar I spend goes as far as it can possibly go as Minister of Health and of course as Associate Minister of Finance.

CORIN Looking into primary healthcare and the studies and the research done, including your own briefing that you got from the Ministry, the issue really seems to be about the poor health access and outcomes for Maori, Pacific Island and those in disadvantaged groups. It’s clear there that is the problem. Why don’t you have a ‘closing the gaps’ type programme targeted at those groups?

DAVID Absolutely, Corin. I couldn’t agree with you more. This is the reason I got into politics. I’m concerned about the growing gap between rich and poor. So every DHB chair, and I challenge you – I’m pretty sure could repeat back what my priorities are – they’re all about equity, better access to primary care.

CORIN Great. But how will you do it differently? What the research seems to show – if you just put the money in it, it’s the same system. It’s going to go in the same ways. How will you do it differently so that Maori, Pacific Islanders get better health outcomes and everybody benefits?

DAVID DHBs are in no doubt as to my priorities. And the DHB chairs and boards will be held to account on my priorities, and they are equity.

CORIN So what changes? What is the policy? Where is the plan? Where is the detail?

DAVID The way the model works encourages DHBs to find their own solutions to those issues, to make their own prioritisation locally. But there’s some really clear things, like making doctors’ visits more affordable, like making mental health more accessible, like strengthening a public system that delivers for everybody, no matter whose kid it is, no matter how deep their pockets are, every New Zealander can access the care they need.

CORIN But why not specifically a closing-the-gaps type programme where you give those groups perhaps more control?

DAVID I’m sure that will be part of it. It doesn’t have to have a particular brand attached to it. But it is about better access to services for all groups in the population. That’s why I stood for the Labour Party. That’s what I’m here to deliver.

CORIN Right. Fair enough. David Clark, we’ll go to the break now. We’ll come back, talk about mental health, because that’s practically another whole interview in itself. All right. Stay with us. We will back, as I say, with the Health Minister after the break to talk about mental health, also ask some viewer questions that you’ve sent in as well.

[AD BREAK]

CORIN Welcome back to Q+A, the health minister David Clark is still with us. We’re going to talk mental health now. Talking again to people in the health sector this week, one of the things that came up with mental health was actually an ED nurse, who said they are just seeing a massive increase in the number of presentations at emergency departments from people suffering from mental illness. What are you going to do about that?

DAVID We know that we have an aging demographic, which includes dementia, and we have a growing population. As more people get weeded out for care in primary care, we have more acute demand at the emergency level. We’re going to need new approaches, new ideas to tackling these issues. And we’re going to need increased capacity in some areas.

CORIN What does that mean ‘increased capacity’? What does it look like? Are you talking in care or in the community? What do you mean?

DAVID Both. So we do need to get primary care right. That’s one of my key priorities – making sure that people get the care they need. I’ve been told anecdotally by emergency service workers that about a quarter of the people they take to hospital have conditions that are preventable if they get the appropriate care, if people get the appropriate care in their community. That would take a huge slug of demand out of the system. And then at the hospital level, we need to deliver the services that people require when they get there.

CORIN Okay, I know you’ve got an inquiry looking at this issue and presumably that’s going to come up with some big, challenging recommendations for you on mental health, and you’ll deal with that. How quickly can you implement those?

DAVID Yeah. I’m imaging we won’t be able to implement them all at once. We’ll take it budget by budget, step by step. But the purpose of making that inquiry independent is that it will bring forward hard recommendations. It will bring forward challenging recommendations. And we as a government will then have to wrestle with them. But I don’t want to get some watered-down version as minister. My job is to manage the prioritisation and the politics, and I’ll do that.

CORIN Sure. Big picture here, because I know you’ve got an inquiry, what is your feeling about the balance in terms of our mental health? Are we keeping people in the community too much? Are we not putting people in care enough? Where is the balance?

DAVID My gut feeling is we’ve devolved care to the community without putting resource after it. And sometimes it’s been used as a cost-cutting measure. We need to change community attitudes. We need to change the way we’re delivering primary services to some extent. And we need to just make sure that mental health is afforded the priority that it should have. It shouldn’t be possible to cut corners for our most vulnerable.

CORIN You’ve got other promises in mental health, in particular in schools and those sorts of things. Are you going to be able to deliver on those, having nurses or mental health care workers in those sorts of facilities?

DAVID There are some things that have strong evidence behind them. Nurses in schools is one of those things. We will continue to roll out that programme. The cheaper doctor visits is another way of ensuring that those services are more accessible to people. So we will do some things in the interim. I’m not going to announce the budget detail today, Corin.

CORIN Timeframes, though? Timeframes on the nurses? Because you’ve done Canterbury schools, right?

DAVID We have. We have.

CORIN When does the rest of the country see it?

DAVID That will be revealed in the budget.

CORIN Okay, we’ll leave it there. If we could deal with some of the viewers’ questions that have come in. One was on the issue of cancer, from Philip Hope, chief executive of Lung Foundation New Zealand. He says, basically, just to sum up his question, he’s wondering why the money taken from tobacco tax isn’t actually directly – and it’s billions of dollars – targeted at treatment for things like cancer and lung cancer.

DAVID My understanding is a portion of that money goes towards prevention and supporting those who are giving up. You know, the health dollar is spread as we think best, in terms of where we’re going to get the best bang for buck. Let’s face it, those cancer treatments are generally publically funded, so the money is afforded out of our general taxation. Exactly which pot it comes from is up for grabs.

CORIN The other issue he raises is around the backlog of medicines on the waiting list, and this is an interesting question, because are you going to look at these next generation of drugs, the ones that maybe aren’t quite proven, will you have some money put aside to have those ones that aren’t Pharmac funded yet, a bit more risky, but could save lives?

DAVID Yeah. I’m looking at all of that stuff. Again, we’ve got to spend the health dollar carefully, and there are overseas models and I’m getting advice on what the best next steps are.

CORIN Where does it sit in your big priority list? Which is quite big today.

DAVID It is. It is. Making sure New Zealanders can access affordable care, starting with the priorities of primary care, mental health and public delivery of services are my top priorities, getting a better cancer outcome is right up there, because so many New Zealanders face cancer. So that’s why I’m getting good advice on that.

CORIN But it’s a lot of money, though, isn’t it? Jonathan Coleman criticised you over this. He said once you get into government, you’ll see how much it costs to have this fund for new treatments – 60, 90 million bucks. Have you got that sort of money for a fund like that?

DAVID Corin, I’ll face that when I get the advice around it. But we do have money. We do have discretionary money. And I need to push back on this myth that we haven’t set money aside for new initiatives. We will deliver on the promises we’ve made and we’ve set aside head room to deliver on other initiatives.

CORIN All right. Jacqui says, ‘What’s happening to the third medical school proposal and when can we expect a final outcome?’

DAVID That again is an issue that I’m grappling with at the moment. The principles are clear – if you want to address this issue, you need to recruit from rural areas; you need to give those GPs and others going into rural areas opportunities for advancement when they’re in that job; and you need to make sure that the assets that they’re going into, the practises they’re going into, are modern. So we know what the solution looks like. We’ve got to work through a process where we find best to provide that.

CORIN Connor Roberts says, ‘Is he looking at expanding public dental healthcare?’

DAVID Yes, I am. And I can say to your viewers that it’s unlikely we’ll get over the line with that this term. But it doesn’t mean I won’t start scoping it out and working it out, because we are prioritising which initiatives we can deliver now, and which ones later. I’m looking at workforce issues already, because if we do want to be more ambitious in that space, we have to step out a plan to get there.

CORIN So are you looking at sort of long-term subsidies for adults to get dental healthcare?

DAVID We’re right at the start of this, Corin. As I say, that won’t be something we do this term.

CORIN Okay, but look into the future. Would that be your desired goal?

DAVID I would like to see more affordable access. We have a huge unmet need in dental care. We have people struggling with Third World health conditions as a result of bad dental hygiene and inability to access the care and treatment they need. No New Zealander would think that was okay. We have to do better over time.

CORIN All right. Final question from Julian Crawford saying, ‘I thought Labour was supposed to announce the new Dunedin Hospital site this month. Why hasn’t anything been announced?’

DAVID Yes, we did say we would announce around this time, and I can tell you an announcement is pending.

CORIN You’re not going to give us that this morning?

DAVID Not this morning, Corin.

CORIN What does success look like for you as a Health Minister? Just to finish off. We’ve heard this morning that you’ve got so many demands. You can never have enough money. What is it going to look like?

DAVID For me, it’s about more New Zealanders having access to the services they need – addressing unmet need. It shouldn’t be the case that in a First World country, we have so many people who can’t access a GP. To me, success looks like making sure that New Zealanders, when they’re sick, know that they can get the services they need.

CORIN All right. Look forward to having you back on the show and perhaps holding you to account to those comments. Thank you very much for your time, David Clark.

DAVID Thanks very much.



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