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Christchurch School Of Medicine - King Speech

Speech Notes - Hon Annette King

Christchurch School Of Medicine Mid-Winter Dialogue

Thank you for inviting me back to speak at my second Mid-winter Dialogue as Minister of Health.

I am sure everyone here is well aware that while health did better than any other portfolio in terms of new money in this year's Budget, everyone in the Government would have liked to have been able to allocate more money to the sector. Health is capable of absorbing every cent that heads its way. It is the bottomless pit of legend.

I was wondering to myself the other day whether Annette King's Midwinter Dialogues are supposed to bear any resemblance to William Shakespeare's Midsummer Night's Dream.

Well, apart from the fact that Shakespeare had a far greater comic vision than most of us could ever aspire to, the only connection I could find was that at times during the past few weeks I had dreamed wistfully of the happy, carefree days of midsummer. Those were the days, as they say, when opposition political parties and health interest groups all go on holiday, and the only budget anyone had in mind is what they could afford to spend on Christmas.

>From the amount of post-Budget comment there has been from those opposition parties, and from the various interest groups, King's Midwinter Night's Mare might see a more appropriate name for the debate that has followed.

That's not the case, of course. I am proud of the progress the Ministry of Health and the District Health Boards are making in terms of putting the new public health service in place.

There has even been more than a little comedy along the way, sometimes provided, unintentionally, I am sure, by our political opponents.

The most bizarre event, surely worthy even of Shakespeare's Fool, was the so-called District Health Board Chief Executive Gagging Controversy that sparked 24 hours of good old-fashioned and bewildering honest indignation until Television One fell more or less accidentally upon the truth of the matter.

For the very first time the Television One news team showed some interest in attending a DHB meeting, and descended on the Auckland District Health Board intent, no doubt, on exposing the gag for the dastardly government conspiracy it was supposed to be.

Alas, the television crew walked in on a fiery debate, in which honest opinions, voiced by the chief executive as well as board members, were being bandied to and fro with a fierce freedom and passion. There was not a gag in sight, and it would, of course, have been a minor miracle if there had been. A more ungagged environment than a district health board is hard to imagine.

Your invitation to me to speak today referred to my speech last year on the new health environment, and suggested I talk of progress and prospects in relation to the DHB environment.

Seriously, however, I am encouraged by what I have learned of the new district health boards in action. There have been teething problems, of course, but it would have been absolutely astonishing if there had not been a few difficulties.

Let's consider, for a few minutes, just how different the new DHB environment is from the old Hospital and Health Services environment.

To start with, the boards contain a considerable number of new members, and some of them, though very few, have new chairs or new chief executives.

But the real differences lie in the new open environment in which they are operating, and in the new responsibilities that they are gradually assuming, or preparing to assume.

It is probably worthwhile providing you with a summary of the key messages or expectations that I have sent to every DHB. They are expressed somewhat formally, but I have to do it that in my role as one of the ministers responsible. The first key expectation concerns:

Improving the health of the population: The ultimate measure of success of each DHB will be its contribution to the implementation of the New Zealand Health Strategy (and other related strategies such as those for Primary Care and Mäori Health), improving population health outcomes and reducing inequalities in health status. Secondly:

Service continuity: I expect that in assuming service funding responsibilities, DHBs will ensure that there are minimal disruptions to the range and scope of services available to the people of their respective areas. Thirdly:

Clinical quality improvement: I expect that DHBs will ensure services delivered are provided at an appropriate level of care within a culture of continuous quality improvement. Fourthly:

Managing in a capped funding environment: I expect DHBs to manage within a capped budget, although I recognise this may mean that boards have to make some hard decisions. For most DHBs the ability to manage within a capped budget and to continue service delivery at previous levels will be difficult, even with efficiency gains and service re-configurations. And next:

Values and principles of the state sector: I expect that DHBs, in their day-to-day conduct, will reflect the values and principles outlined in the Statement of Government Expectations of the State Sector, implementing Government's decisions effectively and with commitment in a way that demonstrates integrity, responsibility and respect. And lastly, but certainly not least:

Collaboration: The boards are expected to take a collaborative approach to their work with other DHBs, the Ministry and other stakeholders to generate mutual gains in areas of common interest (eg workforce, rural/urban and regional/local links, etc). I will be talking more about collaboration shortly, because it is a hallmark of the new health service, but firstly I will refer back to that first key expectation concerning improving the health of the population.

I know some people take a ho hum attitude to the development and release of various health strategies, but there is, in fact, nothing at all ho hum about the New Zealand Health Strategy, the New Zealand Disability Strategy and the Primary Health Care Strategy.

Quite the contrary, in fact. I'm tempted to say that district health boards don't know how lucky they are. For years there has been a real shortage of strategic planning in terms of public health services in New Zealand. There is still some strategic planning to do, but the most of the basic strategies are now in place, and they provide a guide against which DHBs can measure their performance and progress in achieving the Government's health goals.

The DHBs will also have the advantage of greater knowledge about their own regional population base, and the needs of the people living in their region. Late last year the Ministry issued DHBs with guidance on how to conduct needs assessments in their areas, and that data base will be available to board members who are elected in October.

The Ministry is also doing work to help DHBs by producing 13 toolkits to address the 13 priority health areas of the New Zealand Health Strategy. These toolkits will provide guidance for DHBs on how they can best use their resources to achieve health gain in each area. The toolkits will contain useful information on initiatives that have worked successfully in various parts of New Zealand and overseas. Draft toolkits will be sent to the DHBs for comment in late July.

The New Zealand Health Strategy, with its themes of improving population health, reducing inequalities and improving quality, is the key document for guiding the health sector. The work already done in developing this strategy, and in terms of assisting DHBs to implement it, represents considerable progress from the last time I spoke to you.

And, of course, the very fact that DHBs are now up and running, and assuming increasing responsibility, also represents great progress.

They began operations on January 1 this year, the day after disestablishment of the Health Funding Authority. I know you won't want to hear great detail about all the work that went into DHB establishment planning, and for the drafting and passing of the New Zealand Public Health and Disability Act 2000, but, suffice to say, many, many people well deserved their midsummer Christmas break. DHBs have used the first six months to develop capability in their new role as funders. Many former HFA staff have taken up planning and funding roles, either within DHBs or in their shared support agencies.

The transfer began last week, with the devolution of some 1700 service agreements, and responsibility for managing certain section 88 notices. The devolved contracts were for personal health, mental health and Maori health service agreements. Further devolution will occur in October, but, depending on how well DHBs develop capability, responsibility for agreements with some national providers may remain with the Ministry of Health. Devolution of responsibilities for Disability Services and Public Health services will occur in accordance with Cabinet decisions.

There has been a great deal of media and public debate over funding of hospital services for the 2001/2002, and clearly a number of DHBs, though by no means all, have been nervous or critical about aspects of the funding arrangements.

I realise that the task of developing and managing DHBs in this tight financial environment is difficult, but the task of managing health budgets, of balancing high public demand against available resources, has always been difficult. I understand the issues, particularly those around staffing, but we need to be realistic about what we can achieve with the money the Government has provided.

In my case, it means being realistic about service delivery expectations, not requiring you to do more and more new services without new funding. And from the DHB point of view, it means being realistic about what service re-configuration is acceptable while trying to manage with budgets.

One thing DHBs need to consider is whether it is more effective and efficient to deliver services within a hospital, or whether they should look at assisting an NGO or Primary Healthcare Organisation to provide the service.

I said I would return to the issue of collaboration between DHBs, and I would like to do that now, because this is one area where we have seen some progress, and where, I believe, we can see a lot more. This is even more important given the tight financial environment.

One obvious example of cooperation has been setting up the four shared support agencies, the Northern Districts Health Boards' Shared Agency in the northern region, Healthshare in the Midland region, Central Regions' Technical Advisory Service in the central region, and the South Island Shared Support Agency.

Another example, one that can certainly be developed further, lies in the area of service re-configuration. A good example is the regional focus in Crown Public Health in Christchurch, and Canterbury mental health services.

The new structure of the health sector, in essence, breaks down some commercial aspects that were present under the previous structure. This has opened the way forward for the entire sector to work together in an open, collaborative and transparent environment.

There are several examples of this, such as the DHB Collaborative Initiatives Project, whereby DHBs work in unison on initiatives with each other, with the Ministry and with the wider sector.

Examples of some types of collaborative initiatives include national workforce planning, overseas recruitment of staff, IT development, joint purchasing, particularly of pharmaceuticals, and regional mental health networks.

There are many other areas in which the public health sector can benefit from cooperation and collaboration. In terms of joint purchasing, capital expenditure certainly offers strong possibilities. In the past year we have bought three MRI scanners in different parts of the country. Could we maybe have bought three for the price of two if all the orders had been put in together? We must pursue all these options to use our resources as efficiently as we possibly can. Another example of collaboration is the establishment of the District Health Boards New Zealand organisation to provide a forum and structure to represent the interests of DHBs, to work with the Ministry where appropriate, and to interact productively with other central government agencies.

I must stress this organisation does not exist to usurp in any way the work or views of individual DHBs, but it certainly has the potential to become a vehicle for facilitating collaborative activities in workforce development, mental health, public health and primary care. DHBs can learn so much from each other, and if DHBNZ can facilitate this process, it will do a very valuable job indeed.

The collaborative initiatives so far are just a beginning. Once the new DHBs gain experience and familiarity with their extended roles, then the sky is the limit as to what innovation they bring to the health service.

I have not talked today about fairly technical and often complicated processes such as the development of annual and strategic plans, transitional funding agreements, development of the 2001/2002 Crown Funding Agreement and Statements of Intent, but all these processes represent remarkable progress since I spoke last year.

I have also concentrated on DHBs, and not talked about the Ministry of Health, although there has been considerable progress there in terms of change, particularly in a far more focused emphasis on public health, Maori and Pacific health and mental health.

There is one other area I wish to mention in terms of DHB progress, although, just to be illogical, it is progress that hasn't actually occurred yet. I refer to the DHB elections that will be held in October at the same time as the local body elections.

Planning is well under way, and the first advertisements for the elections have already appeared. I believe it is essential for the sake of our public health service that high-quality candidates stand for every board, so please encourage good people, who are genuinely interested in health, to make themselves available.

That way, I feel sure I will be able to come back next year and report more favourable progress on establishing the new public health service. Thank you very much for inviting me back this year.


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