9 Sep 2020

Election 2020 Health Debate: Chris Hipkins and Shane Reti

From Checkpoint, 5:35 pm on 9 September 2020

Ahead of the 2020 General Election, National's health spokesperson Dr Shane Reti and Labour's health spokesperson Chris Hipkins debate the main parties' health policies.

Covid-19 clusters and contact tracing

On Wednesday it was announced that people connected to the Mt Roskill Evangelical Church at the centre of the latest Covid-19 cluster had breached Auckland's level 3 rules. Health Minster Chris Hipkins has asked the police to step in. 

"Police are going to be helping the Auckland Regional Public Health Service with their contact tracing process, making sure that the right people are being identified, making sure that the right people are being tested, so that we can get on top of this new, small group, as quickly as we possibly can," Hipkins said. 

Is it time to start prosecuting people for Covid-19 alert level breaches? 

Hipkins: "What the investigation will show, eventually, is whether or not this was a deliberate act, whether or not people deliberately didn't disclose who they've been in contact with, or whether it was simply an omission.

"It looks like the people who operate at the funeral because all of the things right… It would appear actually that most of the positive cases here may have been associated with other events around the funeral, so people visiting each other at home for example. Those are all of the things that the investigation looks at at the moment."

Shane Reti: "I think in this situation I'm interested in the prosecution being brought forward, I think if you want a good outcome in this situation, it's not clear to me that prosecuting people is the way to get a good outcome. If you want people to reveal where they've been, if you want to do effective contact tracing, I would have thought doing contact tracing in a culturally competent sort of way, get people on board, have them explain where they've been, that sort of thing, that may be more effective than actually bringing forward prosecution

"There may be a place for that, but I'm not sure we should jump into that right now."

Postcode lockdowns or entire regional lockdowns? 

Reti: "I think there could have been a place for that… And people, when I've raised the question of whether the Pokeno border, for example, could have been moved further north maybe to the other side of Waiuku, say where New Zealand Steel is, they raised the question of: 'What about Melbourne? Postcode lottery didn't work from Melbourne'. My response to that would be, well, Melbourne was actually two weeks late doing their lockdown and they didn't carve out the older people like we have. 

"I think there is a place for postcode lockdown. Secondly, if we consider when we had fruit fly, we locked down a suburb, this is not new to Aucklanders. Now it's a different sort of lockdown, not as constrained as we're doing here now, but … it's not foreign to us."

Hipkins: "[Postcode lockdowns] would put us in the same position as Melbourne where they ended up with an ongoing level 4-style lockdown. If you look at where the most recent cluster has spread across Auckland, it is right across Auckland … and if we had just drawn a line on a map and said: 'We're going to take a pick and think it's isolated to this area,' we'd almost certainly be dealing with a much, much larger than we are at the moment."

Easier travel in and out of NZ before a vaccine? 

Reti: Vaccine is a "horizon of hope, because it's a long way away, it's probably going to be maybe 12-18 months, if not longer, so I'm reluctant to consider that an effective tool just here and now in our toolbox. 

"Our Border Protection Agency proposal is that we have exit testing or departure testing from your point of departure, before you come in. 

"I wouldn't [go for a potentially shorter stay in quarantine] because I've seen the Shaun Hendy modelling and what that suggests is that 14 days with a day three and day 12 test is probably the sweet spot."

Purpose-built isolation facilities? 

Hipkins: "I wouldn't go that far at this point. There are likely to be future pandemics, and we need to start thinking about planning for those."

Reti: "I wouldn't disagree with that. They come infrequently. I think we need to have the people response, ready to move quickly."

Prioritising Covid-19 vaccine

Hipkins: "It would depend how many vaccines we were able to get, but obviously we'd be looking at those more susceptible to Covid-19, so looking at who's at greater risk if they do get it. We'd obviously be looking at our border workers and those who work in the health system." 

Reti:  "This would be a risk stratified approach and it would be those who are having the most contact with those who are likely to be carrying, what is the nature of that contact, how long is that contact … That's a good sort of framework to make decisions on. 

"What I haven't heard here is our older people, they can't be too far away from the vaccine because we know they're extremely vulnerable."

Dealing with mental health impacts of Covid-19

Reti: "We'd be bringing frontline services much closer to the community … social cohesion, that's what's going to be important for our recovery. And to do that we're going to need to take mental health services close to the community, designed by the community, it may be specialists, especially, for example, in general practice rooms. We're going to need to utilise tools like elearning, we're going to have to bring in that large cultural capital component to design these sort of mental health programmes."

Hipkins: "What Shane's described is exactly what the government's doing, so we are putting more frontline mental health services into primary practice. We are working closely with communities to make sure that investment is going to the right places, delivering mental health support in ways that meet the needs of different communities, because it's not a one size fits all model here, different communities need different things.

"A big part of the $1.9 billion investment that the government made in mental health in Budget 2019 is designed to build up the capability and the capacity to train more people to get them into those frontline roles where they can provide the extra support.

"You're seeing as a result of Covid-19 the government putting extra investment into our schools, into those primary, intermediate years where young people can start to develop mental health problems and making sure that they're getting access to the sort of support they need."

Reti: "There was a big number put into Budget 2019, $1.9. billion. But the argument is also made that only $125 million of that is being spent… Certainly what's being put to me is that maybe only 4 percent of general practices are getting any frontline services as a consequence of that Budget. So it's fine to apportion the funding, but is it actually being deployed?" 


Hipkins: "In both of the referendum questions I've indicated that I'm not going to publicly disclose how I'm going to vote.

"Ultimately this is New Zealanders' decision and I'm not going to be campaigning for or against either of those questions." 

Reti: "My clinical observation, over many years of practice, is that legalising cannabis is not a good safe and healthy thing to do. That's my personal and professional opinion as well. 

"We're going right from nothing, all the way to legalising. Now a large number of countries have stopped at decriminalisation and various other steps on the way to legal and recreational cannabis. It seems a big jump to go all the way there.

"But if the people of New Zealand decide that this is where they'd like to progress, we will introduce the legislation in our hands and we will take it to select committee."

Simpson Report and the future of DHBs

Hipkins: "I'm not going to be announcing that to you today. It will be in the next few weeks and we will set out our manifesto that will set a clear direction of travel, but the direction of travel will be broadly consistent with what's on the report.

"There would certainly be fewer [District Health Boards]. We haven't landed on an exact number years or what the boundaries of that might be."

Reti: "I do think that if that is the direction of travel, which we're hearing [reduction of DHBs], that needs to be put on the campaign trail. Which DHBs are going, which DHBs are standing? Tell us what it is, if you're late in the piece, show us what your early thinking is anyway. But either way, this is a very important campaign item, and I think the minister should come forward. 

"We've already said that we won't be changing the bricks and mortar DHBs we'll be maintaining them as they are, but there is some aggregation for example around regional planning, where some of the strategy and planning functions might well serve a region where they could come together. So some of the functions might aggregate, but we won't be taking away from any particular areas DHBs as proposed in the Simpson report, and I think [Labour] should put that on the campaign trail."

Better public health service targets? 

Hipkins: "We will have some alternative targets, I think National's targets were too narrow and too prone to be gamed. But we will have some targets."

Reti: "Absolutely [we'll] have those targets. It's interesting to hear the minister, for three years we've heard: 'No we don't believe in targets,' and suddenly we're hearing a few weeks before an election, so maybe they've seen the benefit and focus that targets bring."

Do you have private health insurance? 

Reti: "I do."

Hipkins: "Yes, I do."