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Annette King - ASMS annual conference speech

9 November 2001 Speech Notes

Association of Salaried Medical Specialists (ASMS) annual conference

Thank you for inviting me to speak to you today.

Over the past few months your organization has exchanged various free and frank words with me on a number of health issues.

I hope I have developed an open working relationship with Ian and the ASMS executive, and I particularly value the contribution Ian is making to the informal group of advisers who meet with me on a reasonably regular basis to discuss health issues from a health professional and workforce point of view.

I find these meetings stimulating and provocative, and I hope the informal group of advisers does too.

I always knew that it would be one thing establishing a new public health service, and another thing altogether making it work and achieve to an optimum level, even with the support and goodwill of the Ministry of Health, the District Health Boards and people working throughout the health sector.

I believe that goodwill certainly exists, but because we are in a process of change, and crucial decisions are being made that will affect our future health, it is vital that there are checks and balances in place to ensure we get things right as quickly as possible.

I see the advisory group as one of those checks and balances. The members provide me with a regular and informal snapshot of where they think we are in terms of bringing about improvement, where they think we could be doing it better.

They are also an excellent group for bouncing around ideas. It doesn’t matter if some of the ideas are off the wall, because they won’t go outside the walls unless other people can see some merit in them.

I have also valued the opportunity of meeting with your executive. At those meetings I have been able to float ideas and obtain important feedback.

Today I can announce that one idea that we have been discussing, and to which your association contributed significantly, is close to coming to fruition.

The Director-General of Health is about to advertise a new position in the Ministry, the position of Principal Medical Advisor.

The position will be available for a senior clinician on secondment from a district health board, and the successful applicant will be directly responsible to the director-general, with a personal reporting line to me. The person will become an ex officio member of Karen’s executive team.

I learned of this concept in conversation with the Minister of Health in Australia, and could see how valuable the position could be both to the Minister of Health and the Ministry.

One crucial role of the Principal Medical Advisor will be to provide an independent clinical interface between the Minister, the ministry and DHBs.

The person can act as my agent, or the director-general’s agent, in managing or investigating identified and significant clinical issues, and in communicating what actions need to be taken or have been taken.

If, for example, there appears to be a difficulty in terms of surgical capacity at a particular hospital, or people are waiting significantly longer for certain procedures in one part of the country than they are in another, then the Principal Medical Advisor is the person who can go to the hospital concerned, and discover precisely what the problems are, and what solutions may be needed.

I know it can be argued that the Ministry and DHBs should have the resources already to reconcile any clinical problems that occur, but the reality is that while we are working in a new environment, some people have yet to adjust completely to new ways of doing things, and senior people are already carrying a heavy workload.

And it is also a reality that some in the health sector might still yearn for the old competitive health model, instead of the new model in which people work together collaboratively.

The Principal Medical Advisor will provide a clear insight, unburdened by other onerous administrative responsibilities and unburdened by other loyalties.

The Director-General is also announcing a number of other significant internal changes at the Ministry today.

It is Karen’s role to explain the details, but I can tell you in general that the roles and responsibilities of the personal and family health directorate will be spread through other directorates, including public health, and that a new clinical services directorate is being created. As well, the hospital monitoring directorate and the funding and performance directorates are to be merged.

These changes are designed to reflect the way the new public health service has been developing since passage of the New Zealand +Public Health and Disability Act, and, most importantly, to give an even sharper focus to improving the health of New Zealanders. The focus must be squarely upon delivering the best health services, both hospital and primary, that we can afford.

You know and I know that getting the best value we can out of the finite supply of health dollars is a continuing challenge for Government, and for everyone involved in the health sector. One of the issues in this respect for DHBs is trying to balance the tension between delivering services and meeting employee expectations.

That can come down to particular pay issues, of course. It is not my role to discuss specifics, but one thing I know for certain is that even if New Zealand cannot afford to meet the pay rates of wealthier countries, for example, we can ensure we always recognise and value the contribution of our health workforce.

I know health professionals often say that they feel unrecognised for the contribution they make. I can understand such feelings, but I certainly have no lack of respect for health professionals.

Highly-skilled professionals play a critical role in our public health service. In many ways senior doctors, for example, are the people whose specialist knowledge allows the service to work effectively as it does.

Both the Government and your association endorse the concept of a public health service, and providing the best health care we can afford.

This Government has clearly signalled a shift in focus, from a commercial to a public health emphasis. Community representation on DHBs reflects our intention for meaningful public involvement in decision-making in the public health system.

I know there are many issues you would like me to cover today, although I cannot cover them all in the time available, of course.

There is one issue I should address, however, particularly in terms of the way it impacts on the philosophical switch in the health system from a commercial emphasis to a public health emphasis.

Ian Powell wrote in the 10 October issue of the New Zealand Doctor that many of the people managing the new system are those who were (to quote Ian exactly) “potty trained” in the ideology of the 1990s. Ian wrote: “This included the belief that there was a fundamental tension and conflict between funding and providing. Consequently we had to have what was called the funder-provider split.”

I agree with Ian completely that there has been far too much theoretical emphasis on an arbitrary division between funding and provision of services, and I am sure there are still people working in the sector who are instinctively wedded to the ideology of the past.

Of course, there is inevitably some tension between the two roles, but in a small country like ours we have to learn to work together sensibly, not to create artificial divisions that lead to unnecessary and essentially unproductive layers of bureaucracy.

The sort of culture I want to see develop within DHBs in particular is not one where artificial walls are created, but one where people work together as far as possible in a collaborative, cooperative way.

That does not only refer to the internal workings of individual DHBs. It also refers to the way DHBs interact with each other. If they are constrained by the old competitive model of thinking, they will be limited effectively in the ways they can share experiences and work together to create a better health service for New Zealanders.

There is much worthwhile debate about the best ways in which to create an improved health service, but there is no debate in my mind that the way NOT to do it is to create levels of bureaucracy where we don’t need them.

I would like to finish today by commenting briefly on workforce training and professional issues that I know are of particular interest to your association.

One of the most disastrous health legacies from the previous Government is the lack of a trained workforce in so many parts of the health sector.

One important measure of the National Party’s continuing hypocrisy and insincerity today in terms of health is the regularity with which it tries to criticize this Government in terms of health workforce numbers.

Its attitude is brazen, and calculated to dissemble. I know, however, that health professionals are aware of the facts, and that National will never regain general respect among health professionals until it recognises the long-term damage it has caused.

This Government’s commitment to health workforce and training issues has been evidenced in the establishment of the Health Workforce Advisory Committee (HWAC).

I am delighted that senior doctors are playing an important role on the HWAC, with three out of the ten members, and are thus not only influencing the future of the health workforce, but helping to shape national goals and to recommend strategies to develop them.

Everyone here, I am sure, agrees that professionalism is fundamental to the health sector. It is through the integrity of health professionals, such as yourselves, that the goal of achieving quality healthcare for all New Zealanders can be achieved.

An important area of progress for the health system is development of the Health Professionals’ Competency Assurance Bill. The Government has been working with the sector to reform all health occupational statutes as the current statutes are considered to be inflexible and outdated.

The HPCA will be a framework Act that enables registering authorities to establish the detailed requirements for registration, so that these will not be designated in legislation. It is also proposed that the Act will introduce provisions for monitoring the ongoing competence of health practitioners.

This Act will provide consistency, transparency, simplicity and flexibility to an area that has been bogged down under complex and outdated legislation.

The Bill has a priority four on the 2001 legislative timetable, which means it will be introduced to the House this year. The first paper on the framework, Registration Processes and Competency Provisions, has been approved by the Cabinet and is currently being drafted by Parliamentary Counsel.

The Government understands that New Zealand will not achieve its goal of improving the health of New Zealanders unless we create a system in which health professionals, like yourselves, can do your jobs better, and in which people get the services that best meet their needs.

That is why I have talked about some new developments today. The new health structures have now been created and people have been elected to the new district health boards. From now on the emphasis must be on making the new structure work for New Zealanders.

That is where I rely on people like you. Thank you very much for listening to me today.


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