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Speech: Day two of the Integrated Care Conference

16 February 2002 Speech Notes

Opening speech on Day two of the Integrated Care Conference

Delivered by Helen Duncan Labour MP on behalf of Tariana Turia, who is currently in the Wairarapa attending an antivoilence hui and strategy presentation with Maori Affairs Minister Parekura Horomia.

Tena koutou katoa,

It is great to see so many people here today to participate in Integration 2002, Health and Intersectoral Integration Experience in New Zealand.

I note in the flyer for this conference, the phrase 'powerful arguments for stronger partnerships', that you have come to listen and share your ideas and experience, demonstrates that you work smart and you are actively committed to this kaupapa.

Health Minister Annette King was here yesterday and she affirmed her commitment and that of the government to place its faith in working with locally elected DHBs and local communities as the way of the future.

I take special note of the "Experience in New Zealand" title of this conference, if we look at the whakapapa, or the origins, of integrated care in New Zealand, we see that in fact, it was a terminology born of another land and imported to our country.

I would like to spend a little time talking about the value of local initiatives and innovation then explore the lessons I think have been illustrated by the New Zealand experience of Integrated Care.

The term “integrated care” began appearing in the late 1980s and there was a lot of debate during the 1990s about what the term meant. Was it another name for the “managed care’? Was it about co-ordinating the clinical management of a particular disease? Was it about organising health care for particular people or groups around their specific needs?

I think we have seen experimentation with all these manifestations and we have learnt, perhaps, that attempts to transplant overseas models or single disease models, fail to impact in any real way, on the health of populations with high health needs.

Many early “Integrated Care” pilot projects, had minimal participation by tangata whenua, for instance and revolved mainly around standardisation of treatment and improved communication between health services and health professionals.

It seems that a turning point occurred, here in South Auckland, with the decision to call together a “Think Tank” involving community people with managers, hospital staff, community workers and primary care providers. This decision was about looking to local knowledge for direction and planning action, based on local wisdom and experience.

Sometimes the process is as important as the “solution’. Certainly the professionals being guided by community to devise new approaches, trial the ideas, reflect on the outcome and revise the approach, has led to a sense of dynamism and active commitment to better health in this rohe.

Since the early experimentation with different models of “Integrated Care', there has been a lot of progress throughout the country. We can all gain knowledge and inspiration from successful projects and many will be shared here at this conference.

Honest appraisal of what worked, who it worked for and what didn’t work at all, is a vital part of growing our own evidence base and improving health status.

There are many examples of success. I think the most exciting are those where, instead of seeing patients as 'the problem', health care teams have turned the microscope around and taken a good look at the influence their own systems, attitudes and behaviours are having on how patients and their whanau feel, whether they actively participate in healthy changes and whether the whole interaction is disabling or health promoting.

Two examples come to mind. New Traditions in the Waikato, provides an excellent example of long term, cooperative, inclusive processes to effect positive change - with the focus as much on how the hospital and community services can work better for people as on the characteristics of those who use the service.

Similarly, the cardiologist in Hutt Hospital who recognised the limitations of rushed appointments in outpatients, for people wanting to manage their heart failure. This doctor, was impressed with the results, when he took time to really explain things to patients and their families . He decided things needed to be done differently.

With the development of a team approach, a Pacific nurse who spends time with patients and families in their homes and liaising with primary care providers, admission rates for heart failure have dropped by a third.

Overseas research of similar interventions have shown that this kind of approach does not only improve quality of life and decrease admissions, it actually improves life expectancy.

It is quite clear that “more of the same’ is not going to achieve the kind of improvements in health status that this government is seriously committed to.

We, as government, as managers and as health professionals need to build on “best practice’ - in particular, to explore what is best practice here in Aotearoa.

I want to make reference to an example of home grown “best practice’. The Aukati Kai Paipa programme was developed by tangata whenua, for tangata whenua, to address an entrenched and very serious health problem : smoking.

First of all, we needed to decide that it was something that could change, then invest resource and creative energy in developing interactions.

Resources were identified, international literature and experience was noted, but the key to succeed, was starting with an open approach to achieving the desired outcome - smoking cessation.

Tangata whenua with experience and interest in this area, smokers and whanau were allowed to create and pilot smoking cessation programmes, of their own design.

None of them fitted exactly with any international “best practice’, although some elements, such as nicotine replacement therapy were woven in. This programme has been very successful and will be reporting 12 month quit rates in a report, soon to be published.

The lesson from this experience, is the value of whanau working from a positive, strengths based approach.

The success of this approach is generalisable to other settings. I believe this, is the basis of the success we are beginning to see here in South Auckland.

It is the basis of the NZ Health Strategy, with its emphasis on healthy communities, reducing inequalities, recognition of the rights of tangata whenua and the need for active involvement of consumers and communities at all levels. The District Health Boards, the Disability Strategy, the Primary Health Care Strategy and the Maori Health strategy all reinforce participation and partnership as key elements for a healthier future.

It is envisaged that the District Health Boards will be able to align services more closely to the needs of communities, increase the pace of service integration and stimulate intersectoral work to improve the health of whanau and communities.

Initiatives such as Healthy Housing are an excellent example of this beginning to happen.

Pilot projects are something that tangata whenua know intimately. We have for decades, participated in many of these projects, which often continue for years, producing postive results but lack adequate funding to flourish.

This government is committed to supporting local innovation. As the Minister indicated yesterday, there will be increased scope for innovative action across professional groups and across the social sector with the establishment of Primary Health Organisations.

A big part of innovation and positive development is the building and maintaining of relationships and developing a shared vision. This takes longer than the simple imposition of an idea but, in the long run, creates a dynamism and a commitment that outlasts imposed changes and is generally far more effective.

Innovative providers and communities have:

- demonstrated that patients can be kept out of the hospital setting with improved primary health care and home-based services.

- shown that we can reduce the likelihood of patients becoming acutely ill, by providing proactive and effective community based care is right for that population is the way of the future.

Use of technology has greatly expanded over the past few years and South Auckland has been leading much of this exciting development:

- Electronic interchange of patient records, diagnostic results, and hospital discharge information cuts down on duplication, and avoids the frustrating experience of the patient and family being asked the recount personal details and medical histories countless times at each step along the way.

- Electronic referral from General Practitice - will assist with ensuring fair and equitable access to specialist assessment, treatment and elective surgery.

- Patient registers, reminder systems, and clinician task lists mean that it will be easier to deliver a quality service.

There is a role for technology in this knowledge wave we are riding. However, and I agree with Annette King who said yesterday, technology has to be used in the right way to be effective.

Information technology is a tool - just as a knife and a fork help us eat with ease and finesse, but does not influence how delicious the meal is, so, technology can improve efficiency but it is the human interaction that we know is so important in health and healing.

It is the caring or not caring, the respect or arrogance that makes the difference to the experience of our whanau in the health system.

When we visit the health service, we may be the visitor in one sense but in another, the health professional is being invited into our world, our concerns, our bodies and our whanau. It is the health professional who understands this and acts accordingly who truly enters a partnership that is healthy.

Improvements require patience, humility and the ability to be self critical.

For effective integration to occur we must overcome the “silo’ mentality, and help health professionals lead by sharing their expertise more widely, and contributing to the well being of their patients in new ways, utilising new technology and teamwork that crosses traditional boundaries. We, in the centre must also break out of the “silo’ approach and trust whanau, hapu and iwi, communities and providers to find effective ways of working together. District Health Boards and Primary Health Care Organisations are two expressions of the government’s support for this approach.

This conference is a celebration of significant success in advancing healthcare delivery in New Zealand and I want to finish by acknowledging the dedication of the staff at Counties Manukau.

I would particularly like to acknowledge David Clark for, providing leadership and creating a dynamic, environment for the staff and community of South Auckland to begin to realise their dreams. It is opportune for me to mention the passionate, intelligent and powerful commitment David has to health, as he is to speak later this morning.

He has sometimes used unorthodox methods to achieve results and has been brave enough to support the people in this organisation to take risks, to make mistakes, to learn, to experiment and to push the boundaries to achieve improvements.This faith in the knowledge and genuine commitment of the staff and the community, is beginning to bear fruit.

He has left a challenge to the new CE, to Counties Manukau District Health Board and to the New Zealand health sector.

Yesterday Thomas Maniapoto led a workshop on Maori primary care development. I believe this is a critical opportunity for the further development of tangata whenua designed and delivered services.

Many general practitioners, nurses and other health professionals are already working closely with communities, participatiing in whanau and community-led projects and delivering services in different ways. Although, this means moving outside the comfort zone, out of conventional clinical settings and roles. Those that have experienced the partnership have found it energising and exciting.

As health professionals you will know the difference decent housing can make to the health of whanau. Housing is an area that I am passionate about.

I am proud of the government's commitment to decent affordable housing for all and the work that is continuing in partnership with communities to deliver on those promises.

So I was pleased to see housing issues as a topic of one of yesterday afternoon's sessions. I hope that it was productive and I would be very keen to know what issues were raised in that session.

In conclusion, I would like to say that meaningful relationships allow you to overcome many challenges and obstacles. It is the quality of our relationships, and our preparedness to continue working together, which will ensure the whanau and the families whom we come into contact with, are healthier for having been involved with us.

That is our goal as a government, and I know, because you are all here today, that it is your goal.

Na reira, tena koutou, tena koutou, tena koutou katoa.

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