Kiwiblog

The Herald reports:

State Services Minister Tony Ryall yesterday gave an update on the Government’s “cap of core government administration”.

The number of full-time jobs in core administrative roles fell by 1480 or 3.8 per cent last year to 37,379.

At the same time, said Mr Ryall, 540 full-time equivalent jobs had been added in “key frontline agencies outside the cap”, including Child, Youth and Family, Work and Income, and Community Probation.

“National campaigned to cap the size of the core bureaucracy and we’ve done that. This allows us to free up resources for improving frontline services,” Mr Ryall said.

After a 50% increase in the size of the public service under Labour, this is a great achievement.

It is so popular than even Phil Goff was trying to have it both ways. On TV last night he was claiming that Labour would also have capped public sector numbers – just not reduced them. Yeah, Right.

“We would have looked at the quality and the need for the staff, it would have been more about capping and not cutting,” says Labour leader Phil Goff.

I wonder what Grant Robertson thought of his leader’s endorsement of National’s policy of capping the number of staff. Maybe Grant could clarify what Labour’s policy now is? I am sure the PSA have been on the phone to him.

At the last election National campaigned on capping core public service jobs, a policy PSA national secretary Brenda Pilott said was “a farce”.

So is Brenda saying Phil Goff is supporting a farce?

“The Government has been cutting, not capping, jobs at a time when unemployment rose to a 10-year high.”

And the Government is borrowing $240 million a week. Private sector jobs create income for the Government, while public sector ones soak up that money. The fewer jobs we have in the private sector, the fewer we can afford in the public sector. This is why economic growth is rather important.

I’m holidaying in Mt Maunganui, but somehow ended up being a photographer at the announcement of $27 million of government funding for extensions at Tauranga Hospital.

Tony Ryall with Simon Bridges making the announcement in front of the DHB Chair. Tony enthused about being Minister of Health, declaring it is the best portfolio you can have in Government – a sentiment not shared by too many of his predecessors!

See that sign in the background of Simon, being interviewed by the local BOP Times reporter? Yes it does say “We love you Simon”. The (as it happens all female) staff of the pathology lab put the sign up when they realised the announcement was outdoors. Simon didn’t even see it until a reporter pointed it out to him. He of course them popped inside to thank the staff for their sign! I don’t think Simon has to worry about his majority!

And if you wonder how Tony Ryall manages to get such good press – it is because he only allows National MPs to interview him!

Actually it is not as bad as it looks. The camera man was reading out the questions from the reporter (whose voice will no doubt be dubbed in later), but they needed Simon to hold the mike and stand where the reporter normally would, so Tony looks in the right direction.

Apart from my amateur photography, just been enjoying the beach and shops up here. The weather is lovely!

First we have Tony Ryall from last week’s General Debate on Labour’s seven stages of grieving.

And then by popular demand an embedded version of Gerry Brownlee yesterday.

NZ Herald Health Reporter Martin Johnston gives Tony Ryall a 9/10 for his performance to date:

After the 1990s National Administration taught the sector that business-minded managers were in charge, terms like “clinical leadership” and “trusting nurses and doctors” have resonance. Mr Ryall’s speeches are rich with them, reflecting his leg-work in Opposition and the evolution of moves started by Labour. He has instructed health boards to give clinicians more decision-making power.

Overseas he found that “clinical networks” – doctors hooking up across boundaries – make health services more effective. Enhancing the prestige of health workers may also counteract the pull of higher salaries overseas, helping to solve the health workforce crisis without massive pay rises.

There are some risks with greater power for clinicians, but there was little doubt the managerial culture had gone overboard, and the secto was drowning in bureaucracy.

Surely this dream run can’t last for a man in a portfolio which traditionally involves nasty public scraps over strikes, treatment delays from under-funded hospitals, or deaths due to medical mistakes.

Perhaps he will be dragged into a messy pay dispute. Health boards are lining up for what Waitemata DHB has told Mr Ryall will be staff-cost growth “based on a zero per cent increase on all employment agreements expiring during 2009/10″.

The pressures will only get worse.

He has incurred the ire of public health practitioners over cut-backs to anti-obesity funding, but these are in line with National’s philosophy that what we eat and how much we exercise are matters of personal choice and not socially nor environmentally determined.

And National is still funding many public health programmes. What Tony stopped funding was lobby groups to lobby the very Government that funds them.

Tony should also be looking at the funding of Te Reo Marama, as detailed by Whale Oil. They’ve had $1.2 million since 2004 and most of what they do seems to be attend overseas conferences and write letters to the editor.

John Armstrong writes:

It is not that long ago – only a matter of months – that the loss of 500 jobs in a crucial branch of the state sector would have been the major news story of the day. …

The same could not be said about this week’s announcement that the axe will fall on close to 500 positions in the Ministry of Health and across the country’s 21 district health boards over the next 18 months.

The media reaction was very ho-hum despite the layoffs actually being closer to 700 once 200 vacant positions in the Ministry of Health which will not be filled were included in the tally. …

Increasingly, the feeling is that the public has – to borrow from Helen Clark – moved on from the days when it could get outraged by the merest hint of slash-and-burn spending cuts or privatisation. The assumption was that National won last year’s election through John Key positioning his party more to the centre. It is clear now that a large portion of the electorate had already shifted to the right.

John is partly right here, but only partly. The public mood has shifted, but I would not call it a shift to the right. It is the same shift we have seen in the UK, where most of the public now support spending cuts.

It is not a change in political views, but a reaction to the recession. Part of it is a feeling of shared belt-tightening. If businesses and households can tighten their belts, so can the Government. And it is partly that people do understand huge deficits and massive borrowing is not sustainable.

The other aspect I would point out is that it is hard to call what Ryall is doing as slash and burn spending cuts. He has promised that Vote Health will not decrease, but the gains from the bureaucracy reduction will be transferred into frontline services. This changes things considerably.

Well almost the entire health sector seem to be united behind the changes announced by Tony Ryall. This degree of unanimity is very rare. In fact I think the last time it happened was in the early 90s when the Young Nats proposed selling off all 23 CHEs to the private sector (on the basis of there being a funder/provider split, and ownership of providers did not matter), and we got condemned by every health group and political party there was – including National’s own Minister and Under-Secretary

Getting widespread support in favour, rather than against, what you are doing is harder but here is reaction yesterday:

NZMA:

The New Zealand Medical Association (NZMA) today welcomed the announcement by the Government of substantial changes to the health system.

“It makes great sense to rationalise the backroom services of the District Health Boards (DHBs) and to provide much greater coordination of national services and we support the decision to place the National Health Board within the Ministry of Health,” said NZMA Chair Dr Peter Foley.

NZNO:

The New Zealand Nurses Organisation (NZNO) supports announcements made today by the Minister of Health, Hon Tony Ryall, which will see greater collaboration in health across New Zealand’s 21 District Health Boards (DHBs).

“We are pleased that the Government and the Minister have taken heed of the submissions made in response to the Ministerial Review Group report ‘Meeting the Challenge’. We welcome any additional resources to workers at the front line of the health service,” said NZNO President Nano Tunnicliff.

“The changes signalled are a sensible continuation towards a more nationally integrated health service,” Tunnicliff said.

ASMS:

“We are chuffed that the government has listened to advice from us and others on the health proposed by the Ministerial Review Group (Horn Report),” said Mr Ian Powell, Executive Director of the Association of Salaried Medical Specialists, today.

“The Horn Report recommended creating a new bureaucracy, the National Health Board, as a separate, less accountable crown entity, in addition to the Ministry of Health. This would have involved major restructuring, and risked increasing bureaucratic wastage and generating paralysis in decision-making. We supported the functions proposed for the National Health Board but not the recommended structure.”

“We have worked hard lobbying government not to go down this path. Instead we recommended that the functions be allocated to a specific enhanced unit within the Ministry of Health. This is exactly what Health Minister has announced today and we are delighted. It is a relatively novel experience of a government listening to us in such a specific way.

And even the Health Cuts Hurt lobby group:

“Health Cuts Hurt supports the principles behind the Government’s decisions about the public health system announced today but is concerned that the devil is in the so far undelivered detail,”

“How can you oppose more consolidation of the administrative functions like purchasing in bulk and more regional cooperation in service delivery along with returning savings from these things into more operations or hospital beds,” said Heather Carter.

Oh I am sure Labour can, if they try hard enough

HFANZ:

Efficiency gains expected as a result of changes to the public health system announced by the Government today have been welcomed by the Health Funds Association (HFANZ).

Tony Ryall really is doing well with what is traditionally a very dangerous portfolio. If only, the same could be said across the entire Government!

Tony Ryall has announced:

“Cabinet has agreed to a number of proposals from the Ministerial Review Group’s report ‘Meeting the Challenge’ that will greatly improve national and regional cooperation and reduce duplication of back office functions, ” the Minister said.

As a package, the changes will move up to an estimated $700 million in savings over five years to frontline services. That would buy about 16,000 heart bypass operations or build two large city hospitals.  The changes are also expected to reduce the health system bureaucracy by up to 500 administration jobs. These would be managed as much as possible through attrition and voluntary redundancy. …

The major changes include setting up a new National Health Board (NHB) within the Ministry of Health. The NHB will focus on supervising the $9.7 billion of public health funding the 21 DHBs spend on hospitals and primary health care.

The new NHB will manage national planning and funding of all IT, workforce planning and capital investment. It will also take national responsibility for vulnerable health services such as paediatric oncology.

Work will also start on consolidating the 21 DHBs’ back office administrative functions such as payroll and bill payments.

“Officials estimate a one-off cost of between $5 and $10 million to set up the changes and that will be met within the Vote Health budget. Up to an estimated $700 million is expected to be saved in the first five years from coordinating procurement and logistics. All savings will be reinvested back into frontline health services.”

I don’t think anyone can object to the intention of these changes. If they save even a fraction of what the official cite, that will be a good thing freeing up money for frontline services.

The challenge for the Government is to have them go smoothly. INCIS is a prime example of good intentions going astray.

But I’m pleased the Government is prepared to take the risk, in order to make improvements. The status quo is not good enough.

Five words that not even Tony probably thought might go together. NZPA has a fun article on his short reign:

Acting Prime Minister Tony Ryall celebrated his temporary promotion today with one of his infamous fashion ensembles — a black and white striped shirt with a clashing pink tie daubed with multi-coloured spots.

Can’t Kara do something about these?

Mr Ryall formally took over the reins of the country this afternoon when Deputy Prime Minister Bill English left for Australia to join three other colleagues more senior than Mr Ryall.

It is believed the first time someone ranked as low as five in cabinet has made it to the position of acting prime minister.

Unfortunate they all had to be in Australia to attend the rugby very very important trans-Tasman Ministerial Council meetings.

Mr Ryall will be tailed by diplomatic protection squad officers until Saturday evening, when Mr English returns to New Zealand.

Hmmn if Tony was shot, who would be Acting Prime Minister? It would be Nick Smith. Nick could do with DPS protection to handle the unruly locals in Nelson.

They will have to accompany him to a fund-raising event in his Bay of Plenty electorate, which he gleefully told party members was being hosted by the acting prime minister.

Mr Ryall has joked that, from next week, he would like to be referred to as the former acting prime minister.

That would mean more if Winston didn’t have the same title

Tony Ryall announced yesterday $104 million over four years for additional maternity funding:

• Longer stays for new mothers in birthing facilities
• An optional meeting each trimester for at risk mothers, attended by the pregnant woman, their GP, and their lead maternity carer (usually a midwife)
• Obstetric training or refreshers for GPs wishing to return to maternity care
• Fully funding the Plunketline 24 hour telephone advice service

I think the second point may be the most important. The changes made in the late 1980s by then Health Minister Helen Clark have been a disaster for many parents. GPs have abandoned maternity services, and doctors and midwives have often been silos – not talking to each other.

And far far too many babies have died needlessly, because of a lack of competence amongst some (not all) midwives. A refusal to call in a specialist has proven fatal too often.

So the three monthly meetings between mother, GP and leader carer is a commendable initiative.

The NZ Herald editorial favours the new health targets:

Targets can be the bane of any organisation. Unless they are well defined and readily measurable they are worse than useless, create more work than necessary and waste time and money that could be used for something more useful. The Minister of Health, Tony Ryall, has found some classics among the previous Government’s targets for district health boards (DHBs), which he has culled from 10 to six.

Worse than that:

As he put it, “We have inherited a system overburdened with 13 health priorities; 61 objectives, with an additional subset of 13 health objectives; a set of 10 health targets measured through 18 indicators; 25 other indicators of DHB performance; not to mention four hospital benchmark indicators assessed through 15 measures; and an outcomes framework with nine outcomes measured against 39 headline indicators”.

And think of all the administrators needed both at DHB level, but also at the MOH to measure and report on all these.

When Labour scrapped the previous National Government’s business model for hospitals and related services, replacing Crown health enterprises with district health boards, it made much of the democratic element of elected boards. But in fact the boards were set up as branch offices of the Health Ministry, which decided most of what they would do.

Having elected members on DHBs, actually dilutes accountability as it allows the Minister to blame the local DHB and vice-versa.

This Government is content to keep Labour’s administrative structure and the best it can do is try to simplify its procedures. Impractical, largely symbolic declarations on nutrition, obesity and physical activity have gone. As Mr Ryall said, how could a district health board be held responsible for increasing the number of people who ate the recommended daily portions of fruit and vegetables?

The six goals he has set look sharper: shorter stays in emergency departments (95 per cent of patients to be admitted, discharged or transferred within six hours), faster elective surgery (an increase of 4000 a year), shorter waits for cancer treatment (radiation within six weeks by August next year, and four weeks by December).

Those three are treatment targets, the rest are preventive: immunisation for 85 per cent of 2-year-olds by July next year, rising to 95 per cent two years later; help for hospitalised smokers to stop; more people to be assessed for risk of heart disease and more free checks for people with diabetes.

Inevitably, there will be complaints that worthy causes have been ignored. Already the Obesity Action Coalition asks where responsibility for nutrition, physical activity and obesity lies if not with health boards. Well, many could answer that one. It lies with the individual.

You can’t trust individuals – once you start doing that, society will crumble.

The ODT reports that Tony Ryall has set just six targets for DHBs (I presume on top of don’t run out of money). They are:

1. cut emergency department waiting times so 95% treated within six hours
2. deliver faster treatment for cancer patients – all those needing radiation treatment to get it within six weeks by July 2010 and within four weeks by Dec 2010
3. carry out more elective surgery – an extra 4,000 operations per year
4. more immunisations – 85% immunised by July 2010, 90% July 2011 and 95% July 2012
5. better help fro smokers to quit – 95% of smokers in hospital to be given advice and help to quit
6. better diabetes services

What were the targets from the previous Government:

1. 13 health priorities
2. 61 objectives
3. additional subset of 13 health objectives
4. 10 health targets measured through 18 indicators
5. 25 other indicators of DHB performance
6. 4 hospital benchmark indicators assessed through 15 measures
7. an outcomes framework with 9 outcomes, measured against 39 headline indicators

Sounds like doctors may have more time to see patients and be spending less time reporting on priorities, objectives, indicators and outcomes. Also sounds like we may have a few less administrators.

As widely expected Tony Ryall has replaced the Chair of the Otago DHB. His PR said:

This afternoon Mr Ryall announced he has removed Richard Thomson from the position of appointed Chair of the Otago District Health Board.

“During Mr Thomson’s chairmanship, the largest fraud in New Zealand State Services history was taking place at Otago DHB. $17 million was defrauded over 6 years,” said Mr Ryall. …

Mr Ryall also announced that Mr Errol Millar, an appointed member of the Otago District Health Board will take up the role of Chair immediately.

Mr Millar was appointed to the Otago DHB in 2007, having been appointed to the Southland DHB in 2002 and 2004. He was also Chair of the Airways Corporation 2001-2004, and is currently Deputy Chair of the Civil Aviation Authority. …

Mr Thomson remains an elected member of the Otago District Health Board.

This isn’t about blame or responsibility for the fraud – but accountability.

As I blogged a few weeks ago, the Board does have some accountability for this. Their goverance was sub-standard in my opinion. They should have had policies around competitive tenders etc.

The Herald reports:

The Government has found itself in the embarrassing position of jointly financing a $165,000 conference on drug policy with one of the world’s leading advocates of decriminalising marijuana use.

Not sure this is an issue, as the funding does not appear to give any input into the agenda or speakers.

Billionaire currency speculator George Soros’ Open Society Institute has given $35,000 to this week’s symposium, which will be attended by Government ministers, police and a judge and will examine New Zealand’s drug laws.

Mr Soros is known for financing drug reform campaigns, and most recently backed a referendum in the American state of Massachusetts which decriminalised possession of small amounts of marijuana.

Soros needs something to do, now Bush is no longer in office. He spent almost NZ$50 million in 2004 trying to stop Busg get re-elected.

The Ministry of Health confirmed its funding of the symposium last week. This was after Mr Ryall told the ministry to review its involvement with all conferences, and leaned on it to cancel a conference of more than 300 health professionals that would have cost $123,000.

The spokeswoman said Mr Ryall – who was listed on a draft agenda to open the symposium – found out about the ministry’s sponsorship only late last week. She said it would now be opened by associate health minister Peter Dunne, who would be telling those attending “the Government absolutely does not support the decriminalisation of cannabis, and is committed to a strong enforcement of that law”.

Certain Government Departments seem to be having trouble understaning what a “no surprises” policy means.

Personally I think it is a good thing if a drug policy conference debates, ummm well drug policy. But there is a legitimate question about whether Government Departments should fund a conference considering such issues, when the Government is not seeking to change its policy.

Labour leader Phil Goff said he would be concerned if there was “any motivation” by conference organisers to legalise marijuana, which the Labour Party opposed.

That’s an interesting statement, and a sign I think of the Goff leadership. Labour under Clark made some moves towards de-criminalisation, but then ruled it out as part of agreements with United Future. Now they are not constrained by United Future, it is fascinating Goff unilaterally declares the Labour Party position. I suspect a secret poll of the Labour Caucus would find close to half, and maybe more than half, quite open to considering decriminalisation on its merits.

Phil Goff is upset that Tony Ryall may have caused a $350,000 primary health conference to be cancelled.

I think Mr Goff should keep campaigning in defence of taxpayer funded conferences.

Tony Ryall has delivered a nice win-win on the issue of the Hawke’s Bay District Health Board. Letting the judicial review continue of the sacking by David Cunliffe would have been costly. It would have been tempting to let it continue though as the local Councils would have almost beyond doubt won a ruling that the sacking was illegal, and the evidence would have been very embarrassing to the former Minister.

But more important was to move forward and the decision to transform Sir John Anderson from Commissioner to Board Chair, and reappoint the Board Members who were elected in 2007. This means it is not just going back to the past, but using the skills also of Sir John and his team.

Idiot/Savant is sceptical of the planned policy to have maximum waiting times for A&E. He claims that in the UK, the response to such targets was:

The policy is based on UK Labour’s attempts to improve quality in the NHS by introducing these sorts of absurd targets, and Ryall claims that policy was a success, having led to a reduction in the number of patients waiting for than four hours from 23% to 3%. But that success was an illusion. As noted in Adam Curtis’ documentary, The Trap, faced with pressure to improve their statistics, NHS managers created a new and unofficial post, the “Hello Nurse”, whose sole purpose was to greet new arrivals to A&E so they could claim for statistical purposes that the patient had been “seen”. Faced with a similar target aimed at reducing the number of patients waiting on trolleys in corridors, they simply removed the wheels from the trolleys and reclassified them as beds.

I’m not sure whether to be appalled or impressed by the ingenuity – reclassifying trolleys as beds!

The targets were met, but the underlying performance didn’t change one iota. Mangers being managers the world over, the same is likely to happen here. It’s a general problem with this sort of empty managerialism and obsession with statistical targets: the statistical goal – measured patient “waiting time” – ends up taking the place of the real goal – patient care. And doctors and nurses end up spending all their time filling in performance spreadsheets rather than doing what they’re supposed to be doing: seeing patients.

Idiot/Savant arguments would be stronger, if the status quo had not failed so badly. Under Labour we have had $3.5 billion of exra funding for health, no targets for A&E, and the result has been 20% of people waiting for more than eight hours.

Why does he think throwing more money at it, without targets will work? Can he cite an example in the world where it does?

As I said yesterday, the benefits of targets are it creates transparency. DHBs can cost what the cost will be to meet the six hour target. Dedicated funding can be applied for. If the Government refuses, then people can hold the Government accountable.

Rather than clinging to the dead 80’s cult of managerialism, National should target the real problem: lack of resources. The reason people have to wait so long in A&E is because hospitals cannot afford to employ enough medical professionals to deal with demand.

And without a target to aim for, how on earth can one calculate what it would costs to have the extra staff?

The reason they are parked on trolleys in hospital corridors is because there is not enough space. But solving these problems would cost money, which National would rather give to the rich in tax cuts. It’s just a question of priorities – and National clearly rates redistributing wealth to those who need it least well ahead of ensuring that every kiwi has decent access to healthcare.

And now we just get the blind slogans, instead of intelligent analysis. Idiot/Savant is not stupid. He has read National’s fiscal package. He knews that the tax cuts are being funded almost entirely out of changes to KiwiSaver. Not from less spending on Health.

In fact National has pledged significant funding to train up more doctors, to set up 20 new surgicial wards etc etc.

The Herald editorial is supportive of the policy:

It is also all the more reason to welcome Health Minister Tony Ryall’s plan to impose maximum patient waiting times on emergency departments, and to hold district health boards and their management accountable for meeting them. His initiative is sure to attract criticism. Such targets are always something of a crude measure, if only because they fail to give sufficient recognition to quality of care, which should, ideally, be hospitals’ paramount concern.

The target are no silver bullet, but frankly we should be debating why we have never had them before, not be surprised that these minimum measures of accountability are being introduced.

But Mr Ryall can be excused for starting at this point. There is a sense that, while the Labour Government increased the health budget by more than $3.5 billion, too much of this was swallowed with little discernible increase in efficiency. There were neither quantitative nor qualitative improvements. At the very least, targets incorporated into performance agreements will lay the foundation for better results by increasing accountability in emergency department operations.

Indeed. The status quo has seen massive funding and little way to judge how well utilised that funding was. Now that is great if you are Minister of Health, but not good for patients and taxpayers. This si why I said Ryall’s policy was brave – it actually creates an accountability for him as as Minister that was previously lacking.

The Herald reports:

Health Minister Tony Ryall will impose maximum patient waiting times on hospital emergency departments. …

The Herald reported yesterday that a consensus is emerging – in talks among senior physicians and health officials – that the maximum time should be six hours and that no patient should be left waiting in an emergency department corridor. Recommendations are expected to be made to Mr Ryall within weeks.

This is a very brave move by Tony Ryall. Under Labour we saw billions thrown into health, but very little measurable improvements for that money. This means that Labour could talk about how much it cared, but never be measured on success.

Tony is putting in place measures that will introduce better accountability. DHBs will have to front up and specify what resources they need to ensure they can see all A&E patients within six hours. The DHBs can be held to account for that, and also the Minister and central Government an be held accountable if they fail to adequately fund the DHBs.

He cited Britain’s success in reducing emergency department waiting times through a target maximum wait, set in 2004, of no more than four hours from arrival to admission, transfer or discharge. Within several years, he said, the proportion of patients waiting in emergency departments for more than four hours fell from 23 per cent, to 3 per cent.

In New Zealand, Health Ministry data from one large emergency department and two of medium size indicated that while the majority of patients were seen within several hours, up to 20 per cent at one of the hospitals spent more than eight hours in the emergency department.

Looks to be a good plan.

Oh I do like that solid blue look. And in 2002 only a handful were blue.

Hunua is a new seat. The party vote is another 60:20 type solid seat. On the electorate vote Paul Hutchison narrowly beat Jordan Carter by 14,738 votes and Roger Douglas another 2,700 votes behind Jordan.

Waikato is 58% to 22% on the party vote. And Lindsay Tisch drove his majority from 7,000 to almost 12,000.

Coromandel went from 45% to 31% up to 51% to 26%. And Sandra Goudie scored a 13,400 majority for the seat she won in 2005.

The two Hamilton seats are no longer marginal weathervanes. Hamilton East went from a 9% party vote lead for National to a 19% lead. And David Bennett turned a 5,300 majority into one of over 8.000. Hamilton West saw an 11% lead in the party vote for National after being 2% behind in 2005. And Tim Macindoe turned his 1,100 loss in 2005 to a 1,500 victory in 2008.

Bay of Plenty is another 60:20 seat on the party vote. and Tony Ryall got a massive 16,500 majority up from 11,000 in 2005.

In 2005 in Tauranga, National had a 15% lead in the party vote. In 2008 the lead was 32%. Bob Clarkson beat Winston Peters by 730 votes in 2005. This time Simon Bridges beat him by 10,700. Simon will be happy to be the Member of Tauranga for some time.

Rotorua saw National lift the party vote from 43% to 51%, and Todd McClay scored a majority of almost 5,000 over a sitting Minister.

Taupo saw a party vote victory of 15% and Louise Upston beat Mark Burton by almost 6,000 votes. She ran a good campaign and for a big enough majority to make it safe for National. Burton got 2300 more votes than Labour so even harder for any future Labour candidate.  I also heard a rumour that Louise held the first meeting of her 2011 campaign committee at 8.15 am on Sunday morning

The East Coast had a 15% lead in the party vote (the graphic has it wrong) and on the electorate vote Anne Tolley turned a 2,500 majority into a 6,000 majority.

The growing seat of Napier saw National go from a 1% lead in the party vote to a 12% lead. And Chris Tremain drove his 3,300 victory over Russell Fairbrother in 2005 to a 8,400 margin. Remember this is a seat Labour held for all but three years from 1928 to 2005 and Tremain is building John Carter or Nick Smith type majorities as a brilliant local MP who owns his seat.

Over on the west coast, we have the huge Taranaki-King Country seat which is another of those lovely 60:20 seats.  And the 12,000 majority motors up to 14,500.

Finally we have New Plymouth. National was ahead on the party vote last time by 8% and this time it was 20%. And it was too much for Harry Duynhoven who lost the seat by 300 votes. In 2005 he held it by almost 5,000 votes and in 2002 his majority was a staggering 15,000. New candidate Jonathan Young will be watching the special votes though.

Labour will struggle to form a Government again, while so many seats have them getting just 1 in 5 party votes. Every seat in this region had at least an 11% gap in the party vote, with many having a 40% gap.

NZPA reports:

The National Party’s newly-announced ‘life means life’ policy for repeat violent criminals won loud approval in Tauranga today.

Party leader John Key got rousing applause when he talked about National’s plans to get tough on crime in an open-air lunch-time address which attracted a crowd of about 300.

The gathering was reminiscent of the signature rallies former Tauranga MP Winston Peters held during his heyday in Tauranga’s Mid-City Mall, known colloquially as Red Square. …

Despite relentless rain, Mr Key was welcomed warmly and seemed to surrounded by supporters. Not an interjection was heard.

Speaking without notes, an upbeat Mr Key pushed all the right buttons.

“Simon (Bridges) is going to be the next MP for Tauranga and he is going to be there for a very long time,” brought claps and cheers.

Further applause greeted each topic the National leader roamed, ranging from boot camps for young criminals to raising wages.

Winston may make 5% but I don’t think he is ever going to be able to say again that he is happy just to be the MP for Tauranga!

Tony Ryall, National MP for Bay of Plenty, was also on the platform and got a mention but it was his son Llewellyn, kitted out in a pin-stripe suit like his father’s, a National Party name badge in place on the lapel, who was the star. He stepped up to the microphone and exhorted: “Vote for National and John Key.”

The confident seven-year-old was no stranger to accompanying his dad on election campaigns but has not committed yet to becoming a politician.

“I think I might be a pilot,” he told NZPA.

What a sensible chap. A pilot is a far better paying job!

Treasury has been warning for some years about the lack of productivity or lack of increased outputs (let alone outcomes) in health despite the massive increases in funding.

Tony Ryall has pointed out that the number of first specialist appointments in 2007 was in fact 10,000 lower than in 2001 when records begun.

Note primary Y axis starts at 340,000 to align starting point with health spending.

The graph above shows both the level of first specialist appointments (a slight downwards trend) and the level of funding (in real terms) for Vote Health. Health spending has gone up 33% in real terms in six years, yet less people are seeing specialists for first appointments.

Some quotes from Hansard relating to yesterday’s question time in the House:

Hon Tony Ryall: Is the Minister aware of the email that shows that chief executive Chris Clarke instructed staff to send draft tender documents to Mr Hausmann—who had indicated he would be a bidder—some weeks before the tender process opened, and before any other bidder saw the documents; and is this acceptable behaviour?

Surely this is a joke. No CEO would have draft tender documents sent weeks early to a potential bidder, and even more so if they are on your Board.

Hon Tony Ryall: Is he aware of this email that shows that Mr Hausmann, appointed by the Labour Government, having received this confidential draft tender document, proposed changes that would benefit his company, and is that what he would expect of someone being appointed to the board of that very district health board?

If I got inside information on a government tender, I wouldn’t suggest changes to it. I’d delete it unread.

Hon Tony Ryall: Is he aware from this email that the chief executive agreed to alter the tender documents in precisely the terms proposed by Mr Hausmann, at a time when no other bidder had such access, and is that a proper and ethical process?

Now Tony must be kidding again. Surely no CEO would actually let the party planning to put in a bid for the tender, rewrite the tender document to better suit them.

Hon Tony Ryall: Is he aware that the final document that went out to all tenderers incorporated the changes proposed by Mr Hausmann, whose company was the eventual successful party, and does he think that all potential bidders were fairly treated equally in this process?

Maybe he isn’t kidding.

Hon Tony Ryall: I seek leave to table the emails and documents mentioned in my questions.

Leave granted.

Well if the e-mails have been tabled, I guess we can judge for ourselves if Tony was just making this up or these e-mails do actually show what is claimed.

But wait that isn’t all. In the next question, we learn that these harmless e-mails (move on move on nothing to see here – read the official report when we are happy with it) may not quite have been voluntarily handed over the the inquiry team:

Hon Tony Ryall: Is the Minister aware that the material revealing secret emails between Hausmann and the executive, in which Hausmann changed the tender documents to his advantage, was withheld from the inquiry by both parties and came to light only after independent forensic analysis in London of the back-up tapes; and what does that say about the balance of truth in this inquiry?

Now this must be incorrect. Surely a DHB with obligations under the Official Information Act wouldn’t simply delete embarrassing e-mails.

Hon Tony Ryall: Would the Minister have confidence in the chief executive of the Hawke’s Bay District Health Board if it was confirmed to him that this information was withheld and came to light only because of specialised forensic analysis in Britain of the back-up tapes, which were mysteriously damaged?

The back-up tapes were damaged? What an unfortunate coincidence. Please do not connect the dots. The dots have nothing to do with each other.