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Annette King - The Importance Of Social Inclusion

Alzheimer's Foundation Conference


Thursday, April 13, 2000

Importance Of Social Inclusion



Thank you very much for inviting me here today, and for the welcome I have received.

I am particularly impressed with the theme of social inclusion the Alzheimer's Foundation has taken for this year's conference. It is one I strongly endorse.

In fact, it could be said that although the foundation is specifically concerned that people with dementia should remain socially included within their communities, in a broader sense that is the general thrust of this Government's health strategy. It is important in all areas of health to strive to ensure that there are appropriate community services to allow people who are unwell to live as normal lives as possible.
One of the key elements of the public health system the Government is developing is to empower communities to have a far greater say in the way health services are delivered.

The Foundation has a crucial role to play in the development of that public health system, and I am sure it will play a productive role.

I am well aware that many older people in particular have lost confidence in the ability of the public health system to deliver the care they need when they need it, and are concerned about long waits for elective surgery. That is a particularly sad commentary on the way the health system has developed in the past decade. Our older people should be valued, not made to feel insecure. We should be honouring the diversity of older people, recognising the wealth of contributions they make to family, whanau, community and society.

It is quite clear to me that much work needs to be done to allow people to trust the public health system again, to restore their confidence that the public health system is there for them when they need it, including timely access to surgery and home support services.

The Government's pledges to take decisive action on waiting times and to provide adequate funding to support the increasing need for home support services, to maintain older people in their homes, should begin the process of restoring that confidence.

But more than that, if I have one mission above all others as Health Minister, it is to restore public confidence in the public health system. The competitive model that has been put in place over the past decade has not produced the healthy New Zealand it was supposed to achieve. Right now we have alarming disparities in health care in various parts of the country, and particularly affecting Maori and Pacific people. I want a system that delivers on the rightful expectations New Zealanders should have of it. I want a system that delivers to people on low incomes as well as to people on high incomes. I want a system people can trust when they are in need.

But I should return to the theme of social inclusion. Alzheimer's Disease is the most common form of dementia, and onset of the disease and the person's decline is usually slow. The cause is unknown, and there is no cure. Given those facts, and given the fact an estimated 35,000 to 40,000 New Zealanders, one in five over the age of 80, suffer from Alzheimer's or a related dementia, the need to empower sufferers to live within their communities is compelling.

It will be even more so as the population continues to grow older. The number of people with dementia will continue to increase proportionately. While the general population is expected to increase 25 percent by 2016, in that period the number of people suffering from Alzheimer's Disease and other dementias is projected to double.

Dementia affects not only those who have it but profoundly changes the lives of family members and friends who are close to the person with dementia. Someone they have loved and cared for gradually disintegrates as a person. The whole relationship changes - new unexpected demands are placed on the carer.

Statistics tell us that at least 80 percent of people with dementia are cared for at home. Seventy five percent of dementia carers are female, many of whom are elderly. People with dementia become increasingly dependent on their primary care givers for even basic needs such as dressing and toileting. They may also become frightened and depressed.

The level of care and supervision involved results in substantial demand on the primary care givers who have been shown to have poorer physical health, and higher levels of emotional distress compared to equivalent samples of carers for people with other disabilities.

As I said before, we know that there is generally no cure for Alzheimer’s Disease. However, with good planning, medical and social management and support, the burden of dementia can be eased for both the person and their family/spouse who typically provide most of the care for people with dementia.

When carers are given adequate information and support they are able to care for the person with dementia longer - thus decreasing the use of residential services, and meaning the person with dementia can be cared for in the community among familiar people and surroundings. This has relevance both for resourcing issues and for the wellbeing of the person with dementia.

Awareness of Alzheimer’s Disease and the other conditions that cause dementia has improved significantly in the last 12 years. During the same time an increasing number of information booklets and resource materials have been developed both locally and overseas. Several of these are recommended to families, other carers and health professionals.

Services for people with dementia were historically provided in an uncoordinated and ad hoc way.

This led the National Health Committee to seek advice on ‘best practice’ for the management of dementia in New Zealand. Guidelines for the Support and Management of People with Dementia, released in June 1997, was the result. The guidelines contain advice to improve and foster nationwide consistency in the way people with Alzheimer’s Disease and other dementias are investigated and helped.

Let me assure you that the Government is committed to ensuring that the new public health system it is developing operates from five guiding principles. These principles are:

 respect for individual dignity in health care provision
 equity of access to health care
 community involvement
 priority for health promotion and disease prevention
 a commitment to effective resource use in the health sector.

The Government is particularly concerned that there be extensive consultation with the sector on the proposed changes. That is where the Alzheimer's Foundation can play a significant role.

I need to hear the views of organisations like the foundation, to listen to your experience, as the future of our health system is developed. It is those at the coal face of health who can tell me what is happening in the sector.

Many of you will know the broad outline of the way we plan to improve the health of New Zealanders, but it is probably appropriate I mention briefly some of the more important developments that have occurred so far, or will occur over the coming months.

We want to ensure more effective use of our health resources. We want to reduce the health disparities between different groups in our society. And, as I said, we want to meet the needs of local communities, through increasing community involvement in decision-making about these plans.

We are not embarking on change for change’s sake as some commentators have suggested. We will not be touching the aspects of the present system that have proved effective and that are contributing towards better health gains in the community.

Since before Christmas I have been talking about our plans to merge the Health Funding Authority into the Ministry of Health. We will have done this and established transitional district health boards before the end of this year.

We believe this timeframe is necessary for the sake of the sector – particularly those working for the HFA and the Ministry.

We want a health system that truly promotes population health and preventive measures - so that real and consistent health gains can occur.

We want a framework that will allow district health boards flexibility to provide and/or fund services for their communities.

The health boards will not be companies and will have a majority of elected members. Some members will be appointed by the Minister of Health. The appointed members will reflect the make-up of the community they serve.

The district health boards are still in the process of being developed and will require a full range of services for their communities. Where appropriate they will continue to make use of the private sector where services in the public sector are not available. The provision of primary and community-based care will continue to occur mostly through private/non-government owned providers, and they will be funded by the district health boards.

As these developments are occurring, I am releasing publicly all the cabinet papers relating to them. I want the process of change to be as transparent and open as possible. I want people to feel involved in the change, because if they are involved, they are more likely to have confidence in the public health system that emerges.

This brings me to the New Zealand Health Strategy. You could say it is literally being developed as we speak by the Ministry of Health in conjunction with a wide-ranging health sector group.

The New Zealand Health Strategy will be the most important document produced by me as Minister because in its final form it will show the way forward for the health sector.

Primary health will be central to that plan, as will the mental health and disability support strategies.

The New Zealand Health Strategy will provide a comprehensive framework to deal with New Zealand’s health problems, covering all aspects relating to health including housing, social services, education and poverty.

The strategy will be developed in full consultation with the health sector. It will focus on personal and population health services.

Its overall priority is to raise the health status of all New Zealanders, to address health disparities, and to cut waiting times for elective surgery.

It will be a living document flexible enough to adapt to health sector needs and demands.

I want you to share with me your proposals for the most practical ways to apply that philosophy. That is how together we can make the New Zealand Health Strategy live up to its powerful potential.

Since becoming Minister I have talked to dozens of health sector groups in a variety of forums, and all of them have contributed to my direction on the challenges ahead in reducing health disparities and improving the health outcomes for all New Zealanders.

I am committed to that challenge, but I repeat that I need your help to achieve that goal. I am asking for your involvement and I am confident you will provide it. I wish you all the best for the remainder of the conference.


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