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Speech: NZ Primary Health Care Strategy

Hon Annette King Speech Notes

Launch of New Zealand Primary Health Care Strategy

It is a great pleasure to be launching the New Zealand Primary Health Care Strategy today, especially to be launching it on a marae in my electorate.

Ten months ago I released The Future Shape of Primary Health Care as a discussion document. Much has happened since then. If I have discovered one thing, it is that if a week is a long time in politics, then 10 months is a very long time in the health portfolio.

I am only joking, of course. In fact, if time is a problem in health, it is for the opposite reason. It is too short to achieve all that we would all like to achieve. The worst thing we can do is to waste the time that we have.

From that point of view, it is heartening, therefore, that the main principles in the discussion document I released 10 months ago have survived debate and analysis.

New Zealand is about to enter a new era in primary health care. It is an era in which the emphasis will be placed more and more strongly on keeping people well in the first place, rather than on having to treat them in hospitals simply because we have not cared for them as well as we could have, or should have, in the first place.

Over 50 meetings were held and nearly 300 written submissions were received on the discussion document. I am grateful to all those people who contributed, and I am pleased that the revised version of the Strategy has taken account of many of the points raised in the responses.

This revised document also owes much to an excellent reference group of knowledgeable, outspoken, and hard-working people, including community representatives, primary health care consumers, and primary health care providers.

Most of you are here today, and I thank you for your committed contribution to making New Zealand a healthier place in which to live.

Not all the ideas and concepts in the New Zealand Primary Health Care Strategy are new, of course.

There has been a wealth of innovative thinking among our communities and among our health professionals over the years. Such innovative thinking has led to the ad hoc development of visionary and worthwhile projects that have contributed to a healthier New Zealand.

The problem, however, is that while many innovative ideas have been implemented, the efforts have unfortunately been fragmented. Something good might be happening in Dargaville, but if something good is happening in Dargaville, it might be good for Island Bay, and Nelson and Invercargill too.

What is new about this Primary Health Care Strategy is that it is designed to provide a national framework for primary health care. Within this framework District Health Boards can encourage the development of local solutions, but the framework also ensures that development will not be fragmented.

This Strategy encourages DHBs and health providers to work together to meet the needs in their own communities, and to share their successes with other communities. Sometimes, inevitably, they will have to share their failures too, because not every initiative will necessarily work, but that is all part of the learning process.

There are compelling reasons for getting New Zealand's primary health care right.

The first and most compelling reason is the health inequalities that exist in this country. New Zealanders should not have to tolerate the inequalities that have developed. The market has dealt cruel blows to parts of this country, though it is in some of those parts that the most striking examples of vision and caring can be found.

The second compelling reason is that New Zealand cannot afford NOT to provide high standards of health care any longer.

We have limited resources. Our health spending is already huge, and we cannot simply afford to go on adding to Vote Health to meet apparently unending demand.

Of course, there have to be injections of funding, as there were last year, in market-battered areas like mental health services and waiting lists. But we must increasingly focus our attention on taking the heat off the expensive end of health care by keeping New Zealanders well as much as possible and for as long as possible. We must spend our health dollars where they can do the most good.

The early feedback I have had suggests that this Strategy will be generally welcomed in the health sector, though some may be concerned at what they perceive as a lack of detail in the document.

That is a deliberate omission, if you want to call it that. This is a high-level Strategy. It does not tell communities how they must provide primary health care, other than, of course, providing DHBs with a framework for action and for assuming responsibility for the needs of their own populations.

The detail, the how to do it, must emerge from the communities themselves if it is to work for those communities. While certain rules have to be put in place, to ensure Primary Health Organisations are not-for-profit groups and that they have community representation, there must be flexibility to allow these organisations to work the best way they can in their own environment.

The key priorities for health in New Zealand have already been laid down in the New Zealand Health Strategy. Primary health care is one of five priority service areas in the NZHS, and DHBs, who will over time assume responsibility for primary health care in their districts, are charged with achieving the key goals and objectives contained in the NZHS.

I have already mentioned the need to spend our health dollars to the best possible advantage. There will be some in the health sector, who, naturally enough, are concerned about the tight fiscal situation, and that has always been the case. And, of course, we would all like to have lots more money to spend. I urge all health professionals, however, to stand back a little and ask themselves whether a new approach to health care might not achieve far more in the end than simply throwing money at an apparently never-ending supply of problems.

Certainly this Strategy, largely in line as it is with the recommendations in the National Health Committee report, should eventually receive a wide acceptance in the sector. I believe New Zealanders generally will perceive the good sense in re-establishing our health priorities, and placing an emphasis on collaboration across the whole health sector.

Some health professionals may also, again quite understandably, read this Strategy, and say, hang on a moment, it does not give GPs, for example, enough credit for schemes that are currently working. Some non-GP groups might even go the other way, and interpret the proposals as too heavily weighted to existing GP-style organisations.

Both will be wrong. I repeat that this is a high-level document. It does not contain the detail of how it is to be implemented locally. There must be flexibility for communities, including health professionals, to develop cost-effective solutions that work for them, and then to share that information with other communities as well.

There may be some in the health sector who could interpret the proposed Primary Health Organisations as being an unnecessary extra level of bureaucracy. I do not agree, and there is already evidence of such organisations working successfully. I expect Mäori, in particular, to welcome the emphasis on maintaining recent gains that have come from successful primary care level groupings.

Strong primary health care is clearly crucial to achieving most of the New Zealand Health Strategy objectives.

Examples are not difficult to find. Advice from GPs to stop smoking has been shown to make a difference, marae-based nutrition classes can help avoid obesity, joint primary and secondary approaches to diabetes care work.

Community involvement In primary health care is a key development. Some organisations may be community-owned, like existing examples of Dargaville or Ngati Porou Hauora. Some communities may be a partner in governing the organisation, like the Mangere Health Trust. Other organisations may include the community on governing bodies in the same way as a number of Independent Practice Associations have already moved.

Whatever the make-up of the PHO, it will be one based on teamwork and community involvement.

Reducing inequalities between different groups in society is a high priority for this Government. In some ways it could be said that nowhere is reducing inequalities more important than it is in health, except, of course, inequalities in housing, education, employment opportunities and other areas all clearly impact on health statistics too. The Government knows it must act across a broad inter-sectoral front to make a real impact on issues of poverty and inequality.

Primary health care is certainly one area that is in a position to make a real difference. Maori, Pacific, and other primary health providers have targeted groups who have been missing out, for a wide variety of reasons. These providers are not only proving to be popular, but they have identified health problems that may have remained hidden in the past.

The Government also wants to be sure people get the care they need regardless of their ability to pay. There are various barriers that can contribute to a low level of utilisation of primary care services, and associated avoidable admissions to hospital, but cost is certainly one for many people.

As funds become available the Government intends that the cost of getting the right care at the right time will drop. There is international evidence to show that user charges for health services impact more on those who are poorer or sicker, that those with the greatest health need experience the worst health status.

Continuity and coordination of care are key planks of the Strategy, and both objectives will be achieved without coercion, restricting choice or making access to primary health care less convenient.
Rotorua provides a fine example of how the new approach can and does work. The whole of the Rotorua community is now enrolled with one of two organisations providing primary care. There have been very few objections. People still choose their doctor or clinic when they are sick, and good results are being achieved in immunisation levels, cooperation between different providers, enhanced teamwork, and improved information exchange.

Perhaps I can best illustrate the new primary health care culture by stressing just a few key changes.

 The old philosophy focused on care for individuals. The new retains that focus, but looks at the health of populations as well.
 The old system was provider-focused. The new is community and people focused.
 The old system placed its emphasis on treatment. The new places more emphasis on education and prevention as well.
 Under the old philosophy doctors were seen as the principal providers. Doctors remain immensely important, but the new emphasis is on teamwork, with the nursing and community outreach role crucial to turning our worst health statistics around.
 The old system was based on a fee-for-service approach. The new system emphasises needs based funding for population care.
 Under the old system providers tended, often unavoidably, to work alone. The new environment will encourage providers to link to other health and non-health agencies, and to work together in a coordinated way.

There have been positive recent trends in primary health care, in areas like Maori and Pacific provider development, in terms of better-informed consumers, in development of information technology systems, in a focus on providing better management and organisation, and in the growing acceptance of team approaches and the need for an emphasis on preventative and population health.

There will be much work ahead to implement this Strategy in the way it must be implemented if we are to turn our worst health statistics around.

The new DHBs will be critical to the success of the Strategy. So will the new and existing organisations delivering primary health care, and so will the communities they operate in.

Much can be achieved, however, although the full vision for primary health care may take five or more years to realise fully. The process will be one of evolutionary change.

My vision is to see the primary health care sector and communities working together to improve the health of all New Zealanders. It is a vision for a far happier and healthier country. It is one I believe everyone here will endorse.

This launch today is the first major step toward realising that vision.

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