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Annette King Speaks To Nurses

Hon Annette King

College of Nurses, national conference, Christchurch

Thank you for your invitation to speak at your conference today. Last week I spoke to the New Zealand Nurses Organisation national conference in Wellington, and said I always have special pleasure meeting groups of nurses because nurses experience such a wide range of health issues, and consequently have a wealth of ideas and knowledge.

Well, a week has passed since then, and I have no reason to change my mind! I still believe that nurses are the backbone of the health service, and I am still relying on nurses to help me as we change the health system from a competitive one to a strong public service based on cooperation and trust.

This Government is committed to improving the public health service, but we will not be able to do so without your daily contributions to the health of New Zealanders, and your wider role in providing a broad range of primary care services.

Today I will focus on the Government's plans for primary health care, how those plans fit into the new directions for the future of the health service, and on the role of nursing within the new system.

Before I do that, however, I should say I am pleased to report that there has already been good progress made since the change of government on issues important to the College. I will discuss some of these in more detail later, but they include work on introducing nurse prescribing, greater flexibility for the Nursing Council to set scopes of practice to recognise speciality and education, and indicators of safe nursing in relation to the Health and Disability (Services) Safety Bill.


Work has also been done in terms of:
 facilitating the use of mental health nurses as "responsible clinicians"
 nationally recognised training for nurse immunisers
 helping regions develop "return to nursing" strategies
 aligning the practice nurse subsidy to the primary care strategy
 developing guidelines for telenursing
 boosting nursing as part of Maori and Pacific workforce development.

I can assure you there is plenty more progress to come. This Government is committed to tackling the problems we currently face in the sector, and to restore the public’s trust and confidence in the health system. Working together with the health sector and other sectors is the only way we can achieve this.

The New Zealand Health Strategy, due for release in its final form later this year, will play a key role in the changes ahead. The Strategy sets out the direction for action on health by providing a unifying nationwide framework within which the health sector will develop. I am pleased nurses have indicated support for the Strategy’s broader goals of improving the health status of New Zealanders, reducing inequalities, emphasising public accountability and improving coordination in the health sector.

Nurses individually will have a vital role in implementing the Strategy, while the College will have a strong leadership role to play, working in collaboration with other nursing groups on key professional strategic issues. The Government is relying on your ideas as well as your expertise and practical knowledge to make the NZHS and other health strategies effective.

I would like to commend the College on the work it has done to strengthen the role of the independent nurse. I am also very supportive of work the College is doing toward identifying ways for nurses to work cooperatively with each other and other health professionals, particularly in the primary care environment.

One of the key aspects of the health reform is the development of a collaborative culture between health providers to ensure they build on each other's strengths to deliver the best possible health and disability outcomes for their patients.

I want to stress, in particular, the importance of nursing organisations and groups working together as we move toward the new health structure. I am heartened to see the College is starting to build a collaborative culture in nursing, but, in order for us to achieve the common goals set out in the NZHS, still more cooperation between nursing groups and organisations is needed. At the Ministry of Health you have a dedicated Chief Advisor of Nursing in Frances Hughes. I know you will work with her at this crucial time in the health system.

Primary healthcare is a very important issue not only for the College, but also for this Government. The Primary Health Care Strategy, currently being finalised by the Ministry of Health, supports the broad philosophy of the College - emphasising the importance of prevention, with a focus on population health, health education and supporting people to look after themselves.

The Strategy will outline the importance of primary health care to improving health and closing the gaps in health status between Mäori and Pacific peoples and other New Zealanders.

An increase in the number of Mäori primary health care providers and the emergence of Mäori development organisations are essential components of an effective primary health care sector. Priority will be given to ensuring existing successful Mäori providers are consolidated and expanded. This will ensure that options and choices become a reality for Mäori, and that equitable access begins to be addressed.

I note that the College is about to release its own Primary Health Care Nursing Strategy for consultation. It goes without saying this will be a very important document. I am very supportive of any work that aims to ensure that primary health care services are provided as efficiently and effectively as possible in the future. I look forward to learning of the outcome of your consultation and am interested in being involved in the implementation of this strategy.

I am also interested in any proposals for alternative funding and/or organisation of care so that the current employer/employee relationships between GPs and nurses do not restrict the delivery of health care.

As you all know, I launched a primary health care strategy document, The Future Shape of Primary Health Care, myself in March this year. We received nearly 300 submissions on the document from a wide range of individuals and groups. Generally, health professionals and other groups in the health sector are supportive of the changes and willing to work with other providers to offer a wide range of services. This bodes well for the future since primary health care is the cornerstone of the overall health care system.

The Ministry of Health is now developing a definitive Primary Health Care Strategy in the light of the submissions. A reference group has been established to help develop the final strategy, which should be announced later this year. The model that is proposed will see primary health organisations looking after the primary health care needs of a defined population. The organisations would involve various health practitioners and local communities, allowing them to have a say in their governance, and to ensure local views and priorities are taken into account.

The final strategy will explain more about these organisations - the services they will be expected to provide, how they will be governed, how they will be funded and so forth. It is clear from the submissions that have come in that most people wanted flexibility for communities to meet their own needs. I support this, but the Government is clear that organisations will be not-for-profit bodies and that communities and the providers of services must be able to influence the decisions they make. Outside these rules there will be room to move.

Naturally I do not expect everything to change overnight. We are talking about evolution here - and shifting funds or finding new resources is never without difficulties. Once the strategy is released the Government and the District Health Boards will be looking to work with those who are prepared to try to make the new plans a reality.

Nursing has changed considerably over the past decade, and it is encouraging to see new scopes developing for nurses outside of hospital walls, for example in the large number of nurse led community services and initiatives. These new roles show how flexible the nursing workforce can be, and as health services change to meet the new and different needs of their communities the mix of workforce skills may also need to change.

Workforce issues are very topical, of course. Competent staff are the health sector's most important resource, and the Government is vitally interested in the sector's ability to recruit and retain such staff. The issue of recruitment and retention is not limited to nursing, as you well know. It is also topical in terms of GPs, junior doctors, and mental health professionals, to mention just a few. In terms of nursing, however, we are working on initiatives, with cooperation from the nursing sector, to develop effective solutions to workforce problems.

I am establishing a Health Workforce Advisory Committee to provide advice on the workforce needs of the health sector and how we should meet those needs. The terms of reference have been agreed and I shall be seeking nominees for the Committee shortly. The committee will provide advice to the Ministry of Health on government funding for education and training of the health workforce, in accordance with priorities in health and education policies.

You will be well aware that the Ministry of Health has also commissioned a project scope to identify what is needed to ensure we have the nursing workforce required to meet future health service needs. The College is part of a nursing workforce group helping work through issues this report has raised. A survey of non-practising nurses and midwives has also been commissioned to assess whether they could be attracted back to the nursing workforce and what is necessary to achieve this.

Another exciting and long overdue initiative is a single Bill to regulate the practice and competency of health professional groups. The content of this Bill is being developed, in consultation with health professional bodies, such as the College of Nurses. I anticipate that the Bill will be introduced into the House early next year. The Nurses Act will be finally updated 13 years after the process started.

Part of the development of occupational regulation is working on issues such as the role of the second-tier nurse and the standards, training and monitoring required. As you know, the Government is committed to re-introducing second tier nursing. I can understand some of the historic reasons why some may oppose this commitment, but under the new collaborative health system, one that will provide ample checks on quality and standards, all health professionals need to work together recognising and appreciating each other's skills and qualifications.

Another area in which there is considerable activity and development is nurse prescribing. You will all be aware that the Government has already agreed to extend prescribing rights to nurses practising in aged care and child family health. It is hoped that the regulations will come into force by the end of this year. However, nurses will need to complete further education and training to meet the Nursing Council’s competency requirements. The first nurse prescribers are likely to be registered and practising by 2002.

I have also asked the Ministry to work with the sector on developing proposals to extend limited prescribing rights to nurses practising in sexual and reproductive health, palliative care, occupational health and mental health. To this end, four working groups have been set up. They comprise nurses working within the four scopes of practice.

The working groups are presently working with other nurses, doctors and pharmacists in the sector as well as the Nursing Council on defining these scopes of practice. This includes work on the competency requirements for nurse prescribers in the four scopes of practice and identifying what prescription medicines it may be appropriate for nurses to prescribe within each scope of practice.

The Ministry and the Nursing Council are developing a multi-disciplinary consultation framework for the four groups to ensure that consultation is consistent and includes the key stakeholders. The Nursing Council is also working with nurses in asthma and respiratory care, and diabetes, on developing nurse-prescribing proposals in these two areas.

I am also setting up the New Prescribers Advisory Committee. It will be responsible for scrutinising the proposed regulations for nurse prescribing in aged care and child family health, and for assessing future proposals for prescribing rights in new scopes of nursing practice and other registered health professionals.

I want to assure you that I am committed to New Zealand's nursing workforce. You deserve a positive working environment with career opportunities and satisfaction. The people you nurse deserve a strong capable workforce to ensure that they receive the best possible services. You are often the main point of contact patients have with the health service, and patients deserve the best we can all manage to give them.

As I hope I have outlined, the Government has a very clear plan to rebuild the public health system in New Zealand, but I need your help to ensure it happens. Together we can restore New Zealand's health service so that it again becomes one New Zealanders can trust and have pride in.

Thank you again for inviting me to your conference, and I wish you well for the rest of the your time in Christchurch.

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