Today on Newshub Nation ` as hospitals brace for the winter flu season, we ask Minister David Clark how he plans to fix our ailing health system. We talk to entrepreneur Derek Handley about making the most of tech opportunities and why we should worry about digital inequality. And we look at the social and political factors driving the resurgence of New Zealand's colourful drag scene. Captions were made with the support of NZ On Air. Copyright Able 2018 Kia ora. Good morning. I'm Lisa Owen. Welcome to Newshub Nation. It's not an easy time to be the health minister. Since the Labour-led government took office, there have been revelations of mouldy, damp hospital buildings, serious staff shortages, a lack of medical resources, and increasing demand. Minister David Clark has asked an expert panel to review the entire health system, and an extra $4 billion was allocated to health in this year's budget. Well, David Clark joins me now. Good morning, Minister. Morning, Lisa. Health ` it has the potential to be an absolute bottomless money pit, and a ministry performance review from December last year found that the current model for delivering health services is not fiscally sustainable. So I'm wondering ` despite all your very best intentions, do you accept that there just simply will never be enough money? With health, it is about maximising what we get for the money available, making sure New Zealanders get the health services that they would expect ` and that means it is timely to have a review and look at whether we could do things better and could get more out of every health dollar. So you don't want to just keep throwing more money at it. Absolutely right. We want to make sure we are the best health system in the world, and we compare, actually, relatively well to many of the countries we would compare ourselves to. We have a quality health system and, in many cases, we provide care cheaper, but we've got to look ahead 30 years; we've got a growing and aging population, and we need to prepare for that. So your current spend is about 20% of Government's budget; do you think that's about right? I, of course, would like to see that grow. Western countries` What's the sweet spot? As countries get wealthier, they tend to spend more of their budget on health services, because health is something that's incredibly important to everybody. Without your health, you don't have much. So I'd expect that to gently grow over time. Do you have a percentage in mind? I don't have a particular percentage. OK, well, as part of your health review that you mentioned, there's 20 DHBs that we've got at the moment; they're going to come under scrutiny, obviously. How much does it cost, in total, for all their administration? For the administration across all of the DHBs, I don't have a figure for that. Why not? That's one of the things I'd expect the health review to look at ` what are the costs? Because at the moment, there are some inefficiencies, and I think people ` clinicians, people who access health services ` can see it with all the different DHBs. They duplicate planning functions. They duplicate a whole lot of functions. Unfortunately, one of the alternatives is saying, 'Well, let's put a cap on administration,' which the previous government did, and one of the consequences of that is you've got surgeons, who are paid a phenomenal amount every hour, writing their own case notes, and so there are perverse incentives; you've got to optimise the settings around administration. Do you not think it's bizarre that there is no single figure for administration across these 20 DHBs? It's the kind of thing I'd like to better understand and part of what I'd hope would come from the review. What's your gut feeling? Have you got too many of them? What would be the optimum? I think that the whole system settings are something that need to be reviewed ` whether we actually have DHBs; how do we put more focus on primary care? So you haven't ruled out getting rid of them altogether. I have not ruled that out ` not ruled it in, not ruled it out. That's how fundamental I want this health review to be. I want to look at all of the settings. You've got DHBs billing each other for services. You know, if a patient comes to them, then they charge it back to the other one. It all seems very complicated. Your gut feeling ` should you get rid of them? My gut feeling is that we need to have a good, hard look at it. It is, until now, the best system anybody could think of, and, as I say, we do compare well to other countries, so part of having a detailed review is not throwing the baby out with the bathwater ` trying to preserve the best of what we've got but looking to the future with that aging, growing demographic, more diabetes, more cancer, and other expensive conditions to treat. One of your top priorities that you have identified is addressing health inequalities for particularly Maori and Pasifika. How bad do you think those inequalities are? Well, they're growing. I had a Pharmac report come across my desk not long ago that showed, in the last five years, a significant growth in the inability of Maori and Pasifika to access the medicines they need. So it's growing all the time, and that's something that I think we need to turn around. We've seen rheumatic fever bounce back last year ` up to 160 new cases in the past year, up from 141 the year before ` so we've got to keep a lid on these things. These are things that shouldn't exist in New Zealand in the way that they do now. We should have a first-world health system. We need good housing and so on to make sure that we are improving the quality of life for everybody, not just those who are well-off. Given that you have said that that inequality is something that you simply can't accept, I'm trying to understand your decisions. I understand that you are doing a review of Whanau Ora, but given the seriousness of the problem and the emphasis that you have put on it, how can you justify no cash injection for Whanau Ora and no new targeted funding for Pasifika? Well, Whanau Ora sits outside my mandate. It cross over into primary health. Whanau Ora is having a fundamental review to make sure that the money is getting to where it's supposed to be getting to. In terms of primary care, we're taking steps in the interim; one of the big Budget initiatives was to make sure 540,000 more people with a Community Services Card could access cheaper doctors' visits so that people can get the care early in community. And health workers say, yeah, that is great, but here's the thing ` the promise was cheaper health visits, doctors' visits, for everybody. So when will you fulfil that promise? Well, the doctors tell us that actually there's workforce planning issues ` making sure you ramp up for that kind of change. But that's not why you didn't do it, though. We've got a primary sector review coming up as well. Making sure that we align everything is indeed part of why we push that out. All right, so are you saying that it is a lack of GPs that stopped you giving cheaper visits to everyone? No. One of the key things was listening to the clinicians who said, actually, we want the primary sector review findings on the table before you make those drastic changes, because then it's hard to rearrange things. But the key thing was money, wasn't it, Minister? We've said that we wouldn't achieve everything we promised in our first year. Absolutely that was a factor. Okay, so when is the end date? When will you deliver that? I'm not going to announce next year's budget or the one after that on the show today, Lisa. So, what would your equal health system look like, then? In your mind's eye, what does this equal health system look like? A more equal health system will ensure that Maori and Pasifika are getting the doctors' visits that they need, that they are accessing health services, that health outcomes are vastly improved. I think we want to have a system where everyone can rely on having access to good health services and get good health outcomes. So would you consider, for example, prioritising waiting lists for Maori in order to achieve that equality? I think this is one of the things that the review should look at. I don't want to be cute about that. But this is the kind of thing we do need to fundamentally look at ` how do we achieve those health outcomes? It's not that past governments haven't tried, of any stripe, to try and achieve those outcomes. Exactly. And they haven't managed to. That's right. To me, this is a once-in-a-generation opportunity. We've had the same health system in place since the turn of the century. It's one of the reasons I put my hand up to take on the role ` is that we can actually have a proper look at things. But are you seriously considering some options which some people might consider quite radical, like that ` prioritising Maori on waiting lists? That's not explicitly in the terms of reference, but I would expect that review to consider every option. I really would. I would expect them to consider how do we get to better health outcomes? I'm not suggesting that that's the solution, by any means; instinctively, it doesn't feel like the right answer. But I'm not ruling anything out. I expect them to look at everything. OK, so if you want everyone to have equal access to primary care, let's look at a specific example ` Waipareira Trust says people in West Auckland are paying much more for after-hours doctors' visits than people in South Auckland. Is that fair and equitable? It doesn't feel right to me, and I know that there are negotiations that happen with the DHB about how that care is delivered. Obviously, with the Community Services Card holder changes coming in, that will make things better for many people in that population. Still not going to make it equitable. Even with the Community Services Card, South is getting cheaper after-hours visits than West. You say it doesn't sound right to you. Well, are you going to do anything? Well, we're not going to solve everything in our first year, and not in our first budget. Taxpayers expect us to spend every dollar carefully, and that means not having knee-jerk responses to the many quirks in the system but actually doing a thorough review of the system and coming back with a solution that looks to the next 30 years, not just the next three. Yes, but people have been waiting a very long time, and that sounds like postcode health. Waipareira Trust has been running a five-year campaign to try and get that changed. So, again, are you going to seriously look at that? That is something I would expect to be seriously looked at, yes. In our primary care settings,... And you're going to fix it? ...we need to make sure there is more equitable access to healthcare and more affordable access over time, absolutely. So are they going to get the same subsidies as South Auckland? Look, I wouldn't get into the detail of that. How that's achieved is currently up to the DHBs. And before we make any changes that might result from a review, we're going to try and optimise the existing system. So we're not taking the foot off the pedal, as it were. Taxpayers expect us to spend every dollar carefully, and we're going to. Well, in terms of that ` spending every dollar carefully ` can you see how this is kind of a false economy? Because the hospital out there, the Waitakere Hospital, was handing out vouchers in the last couple of weeks to people in their A&E to get them freebie visits to the doctor because they were turning up at the A&E. Who's paying for those? Well, yes. I mean, I probably should be congratulating the DHB on actually taking the initiative of making sure people do get the healthcare in the setting that they should get it in, rather than being critical. But that's not how it should work. It's not how it should work, Lisa. Please don't hear me saying that I think our health system is optimised yet. We do need to carefully look to the experts. It will be an expert panel that does this review, those people who are the big thinkers in the field, to make sure that we have the best possible settings for the future. But you're the health minister; people are looking to you for answers, not answers that are deferred into the future. And everything seems to be under review. Look, I am encouraged by the fact that the media and the opposition think that the health minister has all of the answers, but I think the public would accept that actually the clinicians and the people that access services need to be listened to too. And we need to, also, if we are going to make changes, we need to take those who will implement them on the journey. They need to have their say. All right. I want to move through a few things quite quickly, because we've got a lot to cover. Middlemore Hospital in Counties Manukau ` it was running at 170% capacity at various points during last winter. What are you doing to make sure that that does not happen this winter? We've set aside money in the budget for a range of capital projects. One of the big things we did in the budget was put $750 million aside. The previous government ` the largest year they put aside was $450 million, and that was for Canterbury earthquake repairs. And part of that money is about capacity. Part of it's remediation, part of it's capacity, and part of it's making sure we've got new models of care. So capital projects are a big issue for us. We've got to accept that we've got a growing population, and we're going to need more capacity in the system. Yes, but it's staffing, serious staffing issues, and that independent panel you set up into the nurses' pay issue told you that as well. How many nurses short are you across all the DHBs? Well, there's not a set number on that but what we have said... Why not? ...is that we will put 2% more nurses in. That's part of the offer that the DHBs have made,... Yes. You're going to do it regardless of the pay? ...which will be about 500 nurses across New Zealand in addition to what's being offered in the pay settlement. So you will do that regardless of whatever the pay settlement is? That's the offer that's on the table, and I expect that's the kind of change that will be needing to be made. They are connected, though. They're connected. This is a part of a negotiation that I can't conduct. So put their wages to one side. Put the pay issue to one side. This is a recommendation that's been made in that document, and it would come in if the deal was ratified. I'm asking you if you will give that extra 2% regardless of the pay settlement. Well, this government has stepped up and put an extra quarter of a billion in for that settlement. We are absolutely committed to addressing the concerns... So is that a no? ...that nurses have raised with us, which include safety. And so this is the kind of thing we would be doing anyway, I think it's fair to say. So are those 500 nurses contingent on them signing the pay deal? Look, I'm not negotiating the pay deal today, Lisa. Because that's what it sounds like. This is something that we have listened to. We've said that health's been underfunded for nine years, and we have stepped up and said we'll put extra money in, and this is one of the things we've signalled we want to do. All right. We've talked to a lot of people, and nurses are telling us that they are suffering anxiety, panic attacks because they are worried they'll make fatal mistakes under these conditions. Are you prepared to take those risks with people's lives? Well, this is one of the reasons we've put that in the offer ` the DHBs have put that in the offer ` because I think it's the kind of thing we should be doing anyway. I agree with you, Lisa. So are you going to do it anyway? I expect that, over time, we will be putting more nurses in, absolutely. But are you going to put 2% ` which equals 500 more nurses ` are you going to do it anyway? I'm not going to negotiate the exact number in the deal today. In terms of the salary stuff, on the nurses' website, there's a calculator they can work out for themselves how much they're going to get. I said put the pay to one side. I'm not asking you to settle that deal. This is about staff numbers. And in terms of the care, we have listened to the nurses, because I've heard the stories as an electorate MP of the nurses running, literally, in the hospitals, the outdated state of their equipment. We've got to put more nurses in there, absolutely, and that's our intention. We've also got to make sure that the capital equipment is upgraded. We need a first-world health service, and whilst this review's going on, we're going to continue to invest. Well, why can't you commit to saying that you will do that ` the 2% and the 500 nurses? You've indicated to me that you think that this is a real issue, so why are you tagging it to the pay? Shouldn't you be doing it anyway? Well, look, as I said, I expect this is the kind of change that will happen in the coming period. All right. There is about $619 million over four years tucked away in what is called 'tagged contingencies' in the Budget. Is that all you've got for the public sector pay increases, or is there another secret hidden stash somewhere? There is money that is put away that is less obvious to see. We've obviously got negotiations around pay equity for mental health workers, we've got negotiations with the nurses, and we've got other things going on. So, when you're in a negotiation, you don't put those numbers out in the front for people to see. We have made provision for those kinds of things. So there's more money than the obvious pot there, is what you're saying. You've got more wiggle room. There's always ways governments can cut things differently. We've put our best offer on the table for the nurses' settlement, and I'm not allowed to recommend that; that's part of the way in which the system works. I'd encourage nurses to have a really good look at it, but if they don't take it, then the DHBs will have to prepare for contingencies, which includes strike action, and I don't think anyone wants that. Very quickly before we go, how do you think that will look, with a Labour government, if you have nurses walking out the door on strike? I don't think anybody wants that. I really don't. The offer that the nurses rejected previously was already more than the average offer under the previous government, and it's nearly doubled since then, so I'm really hopeful that the nurses will have a really good look at that offer and consider their options seriously. All right, Minister, thanks for joining us this morning. That's Health Minister David Clark. If you've got something to say about what you see on our show, do let us know. We're on Twitter, Facebook, and Instagram ` NewshubNationNZ. Our Twitter panel this week is Bevan Chuang and Tim McCready. They're using the hashtag #NationNZ. Or you can email us at... Well, up next ` tech entrepreneur Derek Handley on the digital divide and how technology could be contributing to inequality. Plus ` how changing attitudes and reality TV have contributed to a surge of interest in New Zealand's drag scene. Welcome back. Digital entrepreneur Derek Handley was recently back in New Zealand giving a keynote speech on technology and inequality at Techweek. He says we could be on the cusp of another knowledge wave, but the last digital revolution passed us by because the government of the time failed to grasp the opportunity. Well, I asked him if he's confident that this government is investing enough in New Zealand's digital future. Well, I said we're on the possibility of another knowledge wave. Like, I mean, everyone is at the moment, in terms of where technology is. We're in another revolution, right? The first revolution in our generation was the internet, and we all knew it was coming. We organised ourselves to prepare for it, and then we did nothing. And, you know, a columnist from the Herald looked back 10 years after and said it was one of the biggest missed opportunities of our generation. So the question I'm asking is ` do we want to be written about like that again in the next 10 or 20 years? Because for the last couple of decades, clearly, no government authentically, genuinely committed to creating a pathway for a digital or innovative technology-oriented nation. Now it seems that maybe, just maybe, both of the major parties acknowledge that that has got to be critical to our future. So if nobody put in the right amount of investment over a decade, how far behind the digital eight ball are we? And can we catch up? Well, of course we can catch up, right, (CLEARS THROAT) but it's not really a question of how far behind we are versus everyone else. When I think of New Zealand, I think that we should be at the front. We should be a model nation for showing and illustrating to the rest of the world how we can lead. And if that means leading through innovation and shaping and reinventing the future, rather than just reacting to it, if it means thinking about sustainability and how we move to become environmentally sustainable, socially sustainable, inclusive, an economy that integrates all of those things, that's the opportunity, right? How far are we behind? I mean, there are so many ideas and services and concepts that should exist in New Zealand ` that we should be leading ` that we're not. And to me, I just can't understand why we don't have that aspiration and that vision to lead. So why do we lack aspiration? I don't know. And at what level is it? For example, as a country, why do we not already have a vision and a goal as to when we are going to be running fully electric fleets? Our grid is 85% renewable. Yes. We import about half of Fonterra of petrol into this country, which impoverishes all of us, and we use it to fuel vehicles that are running on combustion engines when we know, in the next three, four, five, seven years, there are going to be an enormous number of lorries, vans, cars, bikes, buses ` electric ` that we should be saying, 'By this date, the entire country will be electric.' So, Derek, are you saying that a brave government would put a moratorium on, say, the importation of petrol cars, effective of 'this date'? Warn you that it's coming, slap a target on it. I don't know what the different tactics would be, but you'd start with the aspiration and say, 'This is where we want to go. How do we get there? 'And how do we realistically look at the nature of what we've got now, 'what's possible in the world, and get there?' And I mean, that's just one example of, you know, electric vehicles. We all know that's coming. Another example that, for me, as someone who's lived in the US for a few years ` I can see a doctor anywhere in the country within 10 minutes on my phone. We talk about the infrastructure challenges we have in New Zealand with the health and medical practices. We're quite a distributed country. Last year, I got diagnosed a kidney stone via a doctor through the video, and I went straight to the hospital. These are the kinds of things` they're not rocket science; they're possible now. You'll be pleased to know, then, that there is a pilot around that ` seeing the doctor on your iPad ` but I'm wondering, when you're talking about a big strategy, an overall strategy, how important is this role that the government has created for a chief technology officer? And is that what that person should be doing? Well, that's why I say I think we're on the cusp of maybe the opportunity that we missed 20 years ago, right? So, the fact that both major parties last year said this was going to be a part of their thing, I think that alone ` the recognition and the acknowledgement of that ` is a hugely positive signal. And then this role, the fact that it is` Whatever you think of the role, whether its scope is too broad or too narrow, or whether it has enough teeth or not enough teeth, the fact that it even exists, the fact that it will be working with the prime minister and the minister, to me, is a symbol and a signal that we get it and that it's important. And I think that means we can open that up and push into that and say, 'OK, we really want to get behind that as a country.' If you can get someone to fill the role, because they've had some difficulty getting the right person. So who do you think the right person is? Well, I think the right person should be able to understand that there is this opportunity, that there is a roadmap that we need to pull together, that there probably is a lot of amazing existing activity within New Zealand ` in the private sector and the public sector ` already happening. But how do you map that, bring it together, stitch it together and then decide what levers are you going to push to make change happen quickly? So it's part futurist; I think it's part communicator. You've got to understand technology in a sense, but you don't have to necessarily be a technologist, like, on the tools. So, you know, all these things I think would be important for this role, but the fact that it even exists and it's being opened up I think is a great signal. Is the right person you? Well, I live in America, so partly, you know, that doesn't help. But... I'm focused on what I'm doing there. I'll be coming home soon. But I'm sure there's plenty of amazing candidates at home here too. Then why haven't they come forward? Is it unattractive to move out of the private sector? I mean, the job offers about $400,000, which is a lot of money, but compared to the circles that those people move in... I don't think you do this job for the money. I think you do it because you want to see and create the change for the future of the country. So I think that whether a package is good enough ` all those are kind of not as important as someone deciding this is what they want to do. So someone with a social conscience in some way? Yeah, deciding that this is their service; it's time for them to contribute. Well, on digital infrastructure, by world standards, we have good infrastructure. The problem is not everybody has access to it here in New Zealand, and if you look at the figures from the 2013 Census, 23% of New Zealand households don't have access to the internet, and it's 33% for Maori households. So what happens if we don't close that digital divide? I mean, this... this is really worrying, right, but also an amazing opportunity. You know, for 500 years, the technology of the book has become the main way we get smart and we learn and we grow. We have had studies the entire last century that link the number of books in homes to people's likelihood of succeeding in life and also staying out of jail and all those kinds of things. So we know that that is tightly connected. We haven't been around the digital space long enough to see all the studies that will come out that will show that gap, if it's not closed on the digital literacy level, will be so much more exacerbated, right? So, my son, navigating freely and creatively across the internet ` last week, learning about the volcanoes in Hawaii, learning about the Hyperloop, learning how to code ` this is all in one week, on his own and in his own aspirations. He's heading towards the space age, right? Kids, in the example that you just mentioned, in homes without internet, don't even know how many books they've got ` those people are being prepared for the Bronze Age. And so this divide continues to expand, and we can't set ourselves up as a nation to be fully digital and fully inclusive. So as a size of a problem, to me, right now, you might think, 'Oh, they'll get over it. They'll get internet in the library.' But this thing, over the next three, four, five, seven years of a child's life, could become such a big handicap that it's too late to even the playing fields. Well, it's $60 or $100 a month for quality internet. I mean, should it be cheaper? Are we being stung? I think, you know` I don't know if it's expensive or not for the average consumer. But for people who clearly can't afford it or don't have the motivation to get it or whatever, actually, it's in the nation's interest to ensure children have internet access in their homes, and we need to find ways to make that happen. I don't know what they are, whether they're public policy or private policy, but we need innovative ways to make sure that this is happening in the same way that everyone can have water. It's that kind of level of seriousness, because we could be sitting here 20 years later, and having not fixed it, we will see a litany of problems that have emerged from us not acknowledging a digital literacy divide could be 10 times worse than a physical books literacy divide. Because you mentioned you don't know whose job it is, but I'm wondering ` you mentioned community, government, charity ` do you have a thought in your head whose job it is? It's probably some kind of combination of them all, right, where you have people coming together to say, 'Look, there is deep need here.' There is not necessarily an economic, financial model that will solve it, or a profitable business model. Yes. We need some sort of a hybrid. Maybe it's a social innovation platform, some kind of social entrepreneurship. I don't know. But clearly, if there's a whole bunch of customers and they don't want to buy this stuff at the moment ` they're not financially profitable customers for a corporate ` then we need some other way to address it. Do you think that our education system here in New Zealand is adapting well enough to equip kids for a workforce that is increasingly reliant on the digital world? So, I'm not familiar enough with all the different levels of education and how they're all equipping themselves. I think my main thought about that would be, in the next 10 to 20 years, the way we teach kids to think and learn will be much more important than what they're being taught. So, at university, where I'm associated with AUT as an adjunct professor, I push heavily that we should be thinking about those skills such as creativity, agility, the ability to adapt, the ability to change, the ability to recognise opportunities and paths, and also the ability to understand what you're best suited to do with your skills. These kinds of skills are going to be the skills for the future, because jobs will change faster and quicker, and some jobs will disappear. New jobs will be created. But those skills will never be out of fashion ` being able to be creative, being able to be analytical, being able to map different ways forward and navigate them without fear. On the other side of things, perhaps the unhealthy reliance on digital technology ` social media apps specifically designed to be addictive in the same way that you pull the handle on a slot machine and it hooks you in ` what responsibility do you think tech companies have to address that? Yeah, I think this has become much more of a big issue in recent years, right, and you have some of the early founders of some of the big social media companies coming out, being very concerned about what they've invented. We are, again, probably on the edge of just figuring out that these are addictive ` in the same way we think cigarettes or gambling or other kinds of things are addictive. So we're not, I think, as a society, yet clear on 'what does that mean?' and, you know, 'how badly are you addicted?' But at the end of the day, if a company is producing something that is designed to be addictive ` which I believe a lot of social media tools are designed that way, with the little responses that they send back to you to kind of give you a hit of endorphins ` the responsibility should go back on to them to figure out ways to ensure that people aren't going down really dark holes and dark places. As a society in New Zealand, you know, we should also be thinking about how we do not get so attached to digital that we become so disconnected from each other and from the environment and the things that are in the real world. Right? From real-world relationships. And you can see that when you go to a bus stop, or you go to a bar and you see people waiting; they can't wait on their own any more. They can't be with themselves. So culturally, we need to kind of decide ` is that OK? Do we want to be constantly digitally connected? And do we want to be 24/7 digitally connected in our work? Or do we want to say, actually, as a country, we will decide that we think it's probably not okay if you're constantly on your devices? And you? Do you think`? What do you think? I don't at all. I mean, I ran an experiment a year ago where I was only checking email once a week. And, you know, there are certain days where I don't have a device at all. And I'm very, kind of, experimental in terms of how I can minimise the way I'm interacting with either a small screen or a big screen. And to now, I've pretty much reduced` minimising with a big computer, you know, down to a small number of hours a week. Amazing. Derek Handley, there is never enough time. Thanks for joining us on Newshub Nation. It's good to see you again. Thanks for having me. And still to come, we dissect the week's political news with our panel. Plus, we go behind the scenes at Wellington's biggest drag competition to find out what's driving a huge surge of interest in the art form. Drag has always been one of the most recognisable parts of gay culture with its flamboyant costumes, vivid makeup and outrageous personas. But it was an art on the decline in New Zealand until now. John-Michael Swannix looks at how politics, reality TV and a shift in attitude have contributed to the rise of drag. (BRIGHT HOUSE MUSIC) They're fierce, fearless, and fabulous. These young men and women are competing as part of the MX Capital Drag competition. (SINGS WITH VIBRATO) (CHEERING AND APPLAUSE) They are part of a new wave of drag queens and kings across New Zealand with more and more young people exploring the art form. There's been a ridiculous explosion. The numbers have just skyrocketed. There's so many more young queens and kings and gender-diverse performers, which is something that we didn't really have before either. Roxy Coervers and Steven Mawhinney, or Miss Cheesecake, manage Ivy Bar, a space that's been instrumental in fostering Wellington's drag talent. They've seen the number of dragsters grow from single figures to more than 50 in the past few years. I think there's been such a surge in just people feeling safe enough to express themselves. And that's come from a wider community with the work that Out Wellington does and all of the work around pride. It's really just been an opportunity for people to not have to hide away any more, you know? They used to come to the bar to learn what the gay world was, and the queer world and everything in between. But now they're coming here, and they're already knowing what the world's like. And they're just coming here and having fun. Social media and TV shows like RuPaul's Drag Race have played a big role in boosting people's access to drag. However, the surge in its popularity also follows big political changes over the past few years. In 2013, gay marriage was legalised in New Zealand in a moment that warmed hearts around the world. (CHEERING AND APPLAUSE) (MAN SINGS 'POKAREKARE ANA') CROWD SINGS: # ...nga wai o Rotorua. We had the most enormous big gay rainbow across my electorate. (LAUGHTER) Former prime minister John Key was a regular at Auckland's Big Gay Out festival. Our current leader, Jacinda Ardern, became the first prime minister to walk in the pride parade. And just a few months ago, Parliament voted to wipe the convictions of gay men charged before 1986. Sorry to those men... who have carried the stigma and shame of doing nothing other than expressing the love for the person that they did love. The vote was unanimous, with even the more socially conservative National Party voting in favour. And I think what has happened is National has become more progressive over time. And I think the expunging of those historical convictions was a very significant moment for us where we were going back in time and trying to support people who had been affected by this appalling state of affairs. Politicians have to be voted in. And there comes a point where if their actions are too out of step with their electorate, they don't get voted in. Queen Olivia St Redfern has been part of the Wellington drag scene for 20 years. She says the societal shifts have been huge, pointing to the recent outcry over rugby player Israel Folau's homophobic comments. And what I noticed was that All Blacks were all of a sudden on our side, saying to this individual, 'Hey, cut it out. This is not the community that we live in. 'These are my friends, my cousins, my aunties that you're talking about.' And that's really different from, you know, 20 years ago. Many of Wellington's drag performers come from parts of New Zealand where queer culture was virtually non-existent, like The Bombay Bombshell, who grew up in Greymouth. I don't remember there being any queer-orientated education or exposure, or any evidence of it there. And, I mean, there's not even, like, good sex education for everyone, heterosexual students, let alone people who are identifying or playing with identity as well. So there's no high quality education for anyone around this whole issue. This is something organisations like Rainbow Youth are trying to change. We're all agreed that we are seeing some positive changes in attitudes and understanding of gender and sexuality. But that doesn't change the way that institutions in our society are structured. Schools, education, healthcare, justice system, you name it ` all of those are set up in a way that doesn't acknowledge or incorporate the diversity of gender and sexuality and intersex status, which leads to exclusion and discrimination against our young people in our community. A survey of 8500 high school students in 2012 found around 15% identified as queer, gay or unsure. They were three times more likely to be bullied every week than their straight classmates, with half having been hit or harmed at school in the previous year. We know that they're at much higher risk of rates of suicide, self-harm, anxiety, depression. In the same 2012 survey, nearly half of LGBT youth had thought seriously about taking their own life. It also found that one in five had attempted suicide compared with one in 20 of their straight peers. We've committed to ensuring that all those between the ages of 18 and 25 have access to counselling services. So that's a $10 million investment over four years. There's also concern that a lack of research on New Zealand's LGBT community is limiting the ability of organisations to address these issues. We've got no nationally representative data available on our community. How are we supposed to, kind of, prove our case to funders and to the government and really see what's happening to our community over time and how it's changing? Statistics Minister James Shaw has promised sexual-orientation questions will be in the next census in 2023. And Louisa Wall says better data on the rainbow community is something the government's committed to. We just have to go through a process to make sure that what we're doing is robust and that the data that we do collect then enables us to give effect to the initiatives that we think should be delivered to the LGBT community. One statistic the Government is hoping to turn around is HIV infection rates. Since 2011, the number of new infections has been growing steadily, with 2016 recording the highest-ever number of diagnoses. So, organisations like the New Zealand AIDS Foundation are working in partnership with the community and government to try and turn that around as soon as possible. The latest data on infection rates for last year is due to be announced later this month. However, those numbers won't take into account a major step forward on HIV prevention. From March this year, Pharmac started funding pre-exposure prophylaxis, or PrEP, for gay men who have unprotected sex. If taken every day, the medication makes it nearly impossible to contract HIV. Everybody is still 100% committed to eradicating HIV. And so when we have tools such as PrEP, to not then ensure that the community that needs that medication has access to it actually didn't make sense to us. So we were really clear that that was our priority, and we've managed to do that as a new government. However, Nikki Kaye says the decision to fund PrEP was actually made by Pharmac, not Labour. In order for Pharmac to make a decision in this area, they had to have additional funding. National provided that additional funding in Budget 2017. Major leaps forward have also been made in treating the 3500 people with HIV in New Zealand. However, Jason Myers says many still suffer due to out-of-date and incorrect information. A lot of current understandings of HIV and AIDS come from those late '80s, early '90s when HIV and AIDS for many people was a death sentence, before those effective treatments came along. The AIDS Foundation is currently working on a campaign to educate Kiwis about medicines that supress the virus down to undetectable levels. If people living with HIV are successfully treated, it's actually impossible for them to transmit HIV to their sexual partners. So there's a huge amount of work to do in educating not only those communities at high risk, but also mainstream Kiwis, because the impact of HIV's stigma and discrimination is serious. Stigma and discrimination are also issues faced by the country's trans community. However, Aych McArdle says protecting gender identity, gender expression and sex characteristics under the Human Rights Act would be a major step forward. It would have a drastically positive impact on our community. It would be a piece of legislation that wouldn't cost any money, but immediately, it would say that trans people have exactly the same rights and responsibilities in a community as their peers. All of a sudden, we couldn't be fired for coming out and deciding to transition on a job, or be denied access to healthcare or housing based on our identity. Those wishing to transition face additional barriers. The last surgeon who performed gender reassignment surgery retired in 2014. And the previous National government came under significant criticism for not filling the vacancy. For any government, you're not perfect on any issue. And I think particularly the access to surgery issue is something that needs to be looked at. And so, you know, I acknowledge we're not perfect, and there is more to do for trans people. Male-to-female surgeries can cost up to $40,000, while female-to-male surgeries can cost up to $180,000. There are currently 105 people on the waitlist, with the total cost of all of their surgeries sitting at around $8 million. However, the Ministry of Health only funds four operations a year, none of which take place in New Zealand. It's a very small amount of money that would be needed to immediately clear our waitlists. And so, in my opinion, it's not about the money; it's actually about discrimination within our system that stops a certain group of people in Aotearoa accessing the healthcare that would help them be able to live their best lives. I know our community is frustrated. But please know that we are actively engaging in a process with our coalition partners to come up with a solution. And yes, this parliamentary term, absolutely. It's important to distinguish between a drag performer and someone who is trans. Drag is something you do; trans is something that you are. If you are performing in drag, you can sort of take that off at the end of the Saturday night. Whereas your trans-ness, you can't really, sort of, peel that off you. However, that doesn't mean trans people can't do drag. One of the most prominent trans queens in recent times, Peppermint, came runner-up in RuPaul's Drag Race last year. And in Wellington, a key focus for the drag community is being more inclusive. One of the reasons Kelly Fornia won MX Capital Drag was thanks to her role in fostering up-and-coming talent as a show producer. And for anyone watching who wants to give drag a go, she had this message. Get out there, go for it. Don't let anyone hold you back. If you wanna put on a wig and dance your heart out, go for it. You'll be amazed at what you can achieve and all the love that's out there. And still to come, social development minister Carmel Sepuloni talks about everything from the culture at Work and Income to singing karaoke with Paula Bennett in this week's Facebook live. But first, we catch up with our panel ` former Act MP Heather Roy, Hapai te Hauora CEO Lance Norman and political commentator David Slack. Welcome back. I'm joined now by our panel ` former Medicines New Zealand chair and Act MP Heather Roy; political commentator David Slack; and Hapai te Hauora CEO Lance Norman. Good morning to you all. Hey. Good morning, Lisa. Lance, if I could come to you first, the health minister has identified inequity in the system as one of his top priorities. He wants to see that Maori and Pasifika people have the same outcomes as everyone else. Did anything he say there give you confidence that that's gonna happen? Well, it's nice he said that, but we've had 178 years of health inequity in New Zealand, and nothing stood out that's gonna address those inequities. And then more so, when you look at it, he's funding population-based models, so everyone gets subsidised under 13 years old. Every DHB gets funding. When you have a health system that looks like this and you have an inequalities gap, if you fund everyone the same, all you've done is you've just raised everyone, but you've still not addressed that inequalities gap. So there's nothing there that looks to address that problem. So you think he should do more targeted funding, then, from what you're saying? He should do more targeted funding, but also recognise that our communities don't go to DHBs or hospitals for community services. So he needs to break out the funding that he's allocated in the health sector to say, 'What's going to hospitals 'to sort out hospital issues?' Some of it's based on population and inflation growth. But what's going back into communities and then what's targeting our at-risk communities, particularly Maori and Pasifika, who are not accessing our health services. Heather, he mentioned the DHBs will come into one of these reviews that is going on at the moment, and there are many. And he hasn't ruled in or out getting rid of them altogether. No, that's right. And look, I can understand him wanting to do these reviews, but what he needs to start doing is articulating his priorities, because without those, it's hard to actually run the reviews really effectively. I've said for a long time I think we have far too many DHBs for a population of 4.5 million people. We have 20 DHBs. That results in cost inefficiencies and replication of work all over the place. Were you surprised he couldn't tell us how much administration costs for those 20 organisations are? No. Would that be a fundamental thing? I would've thought it should be, but it's only possible if they're measuring those things. Is the Ministry of Health measuring them or not? And the NZIER did a report in 2016 saying that that was one of their biggest criticisms. Fewer DHBs would bring greater cost efficiencies and better value for the taxpayer dollar being spent in health, and the desperately needed better transparency to see how much of the cost was going in administration as opposed to treating patients. David, he acknowledges that there's not enough nurses, but he couldn't tell us how many nurses short he was across the DHBs. And also, at the moment, obviously the nurses have pay negotiations going on, but another review he had done suggested that he needs to stump up with 2% more for nurses and midwives, yet he won't commit to that outside of that pay deal. What do you make of that? Well, you could sort of partly see the thing we often get about the argument you have of commercial sensitivity ` 'I can't tell you all of these things 'because then my hand is sort of shown.' But I was quite intrigued that he acknowledged that there are some less visible sources of funding he might be able to... (CHUCKLES) Yes. That was an interesting allowance. That was quite an admission. There's another pot of money under a rainbow that we haven't identified yet. That's right. And I do recall, a few years ago, Laila Harre getting that award for the nurses and how the whole country was rejoicing when it happened. I think there's an awful lot of strong public support for a decent increase, and I think it has to happen, because these tales that you were telling of nurses who are having to run, who worry that somebody's going to die in their care,... Yeah. ...this tells you that there's gotta be a hell of a lot more money for it. And maybe these things can successfully mesh, you know? Maybe there are great inefficiencies to be found in the DHB system, and maybe that can help. But should`? What I'm wondering is this. He says that he sees a once-in-a-generation opportunity to really remake things. I suspect there's a lot of political will right across the spectrum for a substantial remaking. I think this all turns, in the end, on how good the review is and how good a job... the panel` panels can do... to identify something that will really get a lot more bang for the buck with the dollar. But can we wait? Can we afford to wait? No, and Labour had nine years in opposition, and that's when you do your policy formulation too. And so they should've come to the table, I would've thought, with more idea about where they wanted to take healthcare. And look, I agree with Lance. I think that things need to be much more focused on primary care. The big burden in health is chronic disease, and if we can't get on top of diagnosing and treating things like diabetes and cardiovascular disease and cancers ` the three big killers ` really early in the process, then we fail the New Zealand population. And then, to your point ` are we doing enough? We're not doing enough in preventative measures. We should be giving health literacy to our communities to understand how to avoid such issues that you've just described so we're not entering into the health system too late. We're getting our babies immunised. We're cutting back on sugary drinks. We're reviewing tobacco... Does he have to wait for a review to do that, though? Well, I don't understand a) why we have so many reviews, b) why they take so long, and c) why there's no budget allocated. The two ones that I can talk categorically on... Whanau Ora has data that works and that helps people and helps whanau positively move forward and achieve their outcomes. The mental health review` we were talking before ` There's a lack of funding in the system. The funding needs to follow the whanau around. There need to be more culturally appropriate services, and the threshold for accessing mental health services is too high currently. You don't need a six- to 12-month review to tell you that's not` that's what's gotta change. And in the current budget, in the budget just gone, we saw $100 million of money removed from mental health projects that were operating well in the community. And so all of those things don't really gel. I think... Look, if he wants to make significant structural change and reprioritise where healthcare services are accessed from, then, probably, he needs a bit of time to gather that. But I suspect we'll have these reviews, and we won't see that significant change that we need. A couple of points in there about the primary care, and I'm really wondering how clearly the review can engage with this. Lance, we were talking earlier on about Whanau Ora and how you've got this really great case management approach there. And I'm wondering if that is actually better than primary care, which essentially, he seemed to be saying he was hoping they would be able to get more success from. And I see those two in contest, really, and I think the review really needs to figure out which is the more effective, especially for Maori and Pasifika. Which is the best delivery? Can we afford`? We've gotta go to the break, Heather; hold that thought. Stay with us. We'll be back after the break. Welcome back to Newshub Nation and our panel. Working groups ` we've discussed a bit about that in terms of health, but this week, Simon Bridges, the National Party leader, came out and slammed Labour for having 112 working groups, saying it was costing more than $100 million. Is this a weak spot for the government? Are they sensitive about this, do you think, Heather? Oh, I think they're definitely sensitive, and you can tell that by the way they react when the National Party say that. There are a lot of working groups, and a lot of that work in previous governments ` and certainly the one I was involved in ` would have been done by the public service, and so is Labour saying they don't have confidence in the public service to do these things? I think that's a valid question. In terms of the working groups, a lot of the work does need to be done, but there needs to be better integration, I think, and one thing I think of is mental health, particularly. So we've got a mental health inquiry underway. One of the big problems with our prison population is there are far too many people in there with mental health and addiction issues. And those things need to be integrated. In the criminal system, my belief is they should be treated as a health issue. That's primarily the problem these people are there; they commit crimes because they need to feed an addiction or they've got a mental illness, and so we should be looking at these things much more holistically, but I don't see any evidence of that. They're happening in silos still. I should say that Labour says there are about 35 ` 35 reviews or committees that they say could be counted as that ` so they absolutely dispute the figures presented by National. But, Lance, do you think there's a requirement for more integration as well? Oh, there totally is. Firstly, what was Labour doing for the previous nine years in terms of policy development? Secondly, where are the briefing papers from the ministries who have got all this information to say this is actually what's working and what's not working. There's a lot of good data we have, but there needs to be good integration across Whanau Ora, our mental health review, the review of the justice system. You really can't do a mental health review without reviewing the Drugs Act, with respect, because, like Heather was saying, those issues should be dealt with in a health environment rather than a justice environment, so there needs to be some sort of correlation in terms of what some of these recommendations are gonna be coming up with. In principle, though, you do want to have a government working on an informed basis, and you only have to look at the farrago that was the meth-testing thing that we've seen over the last week... Ooh, yeah. ...to see when they're not working well-advised and well-informed. And I look at, for example, the health review being directed by Heather Simpson; I would have pretty good confidence that she can ask the right questions, find the right people, apply the right health economic kind of considerations to it. If you get the right people, you get good data back, so I think it's worth doing. And, as you say, they say it's 30-something, not 100-something, and therefore the cost is less too. I think it's money well-spent. Lance is right; they had nine years, but I think they were, to an extent, trying on different leaders. That's something` Took a lot of time. We've got all these working groups, and we're still getting decisions like the oil and gas one, which was stitched up between three party leaders. Yeah, that was mystifying. There's an inconsistency there, and I think if they're going to progress and make significant change in areas, a consistency needs to be visible to the public. Another story this week was Kelvin Davis, tourism minister ` he was called out and made to apologise after he referred to National MP Jacqui Dean as hysterical. He apologised for that, saying it was sexist language. How is he doing, Lance? Is he performing? I mean, he's at the top of the heap in terms of Labour, but is he performing? He's a great role model for Maori, and I think, with respect, he helped get Labour across the line because of a calibre of being a principal from up north working for the Ministry of Education. He knocked over Serco, if you recall, in terms of that. I do. So he has done some great work in terms of advocating brand Kelvin but also brand Labour. But he is going to make a few mistakes. Unfortunately he's made one here, and he's come round; he's apologised. He is doing a great job, but he didn't think he was going to be in government probably about three or four months ago, and now he's the deputy` Is that his problem, it snuck up on him, Heather? Possibly. I actually have some sympathy for his position, I think. He's the deputy leader of the Labour Party, the major party in government, but he doesn't step in to the prime minister's shoes when she's not there, and so that's problematic. Some people might say that's a good thing, because he hasn't performed that well, but it's a different sort of situation because of the coalition government. He's a very good look, I think, with the prime minister; the two of them are a good look for the Labour Party, but that's not enough, and I think that he would be the first person to say that he doesn't approve of tokenism, if that's what it is. I also think he's been set up to fail by the party in some respects because he came out so strongly in favour of charter schools, which he fervently believes in, and that's a very difficult position for him to be in when those MPs have clearly been forbidden from even saying the word charter schools. David, can I ask you something completely different? We were talking about technology this morning with Derek Handley, who's a millionaire tech developer, and we talked about this chief technology officer that the government's looking for. It's a $400,000 paycheque for that job. What do we need to get out of that for that kind of money? Is it worth it? Totally worth it if you appoint the guy I've got in mind ` Nat Torkington. And I offer this without any expectation of commission from the government for this thing, not like the recruitment people. He's your guy. He's the one who organises the Foo Camps each year. He knows everybody who's doing fascinating things in science and technology. If they get the right person, you think it's worth it. Yeah, because he can then say, 'Here are some great ideas,' and he can absolutely fire up the imagination of the nation. All right. We'll leave it there. Social Development Minister Carmel Sepuloni joined us on Facebook live this week to talk about everything from approving accessibility for the disabled to her secret singing skills, but it turns out she's not keen on a karaoke date with National MP Paula Bennett. I do karaoke as a fundraiser with my Labour team, so I don't know if I'd go if she invited me, but I can say that I am not opposed to going to karaoke and singing a few karaoke songs. I like the dance version of Turn Around. Total Eclipse of the Heart. Oh, Total Eclipse of the Heart. Can you give me a little tease? No, no, no. Not a good idea. I don't want to lose votes. (LAUGHS) OK, all right. And I don't have my back-up dancers. Yeah, of course. Well, yeah, we couldn't ask you to do that. And that's all from us for now. If you didn't catch all of the show, you can watch now on Three Plus One. And we will see you again next weekend. Thanks for joining us. Captions by Alex Walker, John Gibbs, and Madison Batten. www.able.co.nz Captions were made with the support of NZ On Air. Copyright Able 2018 This programme was made with the assistance of the NZ On Air Platinum Fund.