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Primary Healthcare in New Zealand - Speech

Hon Annette King
28 February 2002 Speech Notes

Primary Healthcare in New Zealand ¡V 2002 and beyond: moving from competition to partnership

The theme of this conference makes it one of the most important health forums that will be held in New Zealand this year.
In fact, the issues that will be canvassed during this conference go to the heart of where the Labour-Alliance Government wishes to take the public health system.
New Zealand is a country of finite resources, and that makes it all the more important that we pool our energies and our enthusiasm to create better primary healthcare. We need to break down the barriers to interdisciplinary and community partnerships; we need to adopt collaborative models; we need to promote teamwork.
Everyone here is realistic enough to know that implementation of the Primary Health Care Strategy cannot happen overnight ¡V it will take eight to 10 years ¡V but we can start to make changes now in terms of leadership and example.
In that respect 2002 is a defining year. Not only will we start to implement the Primary Health Care Strategy, but we are already redefining and refining the way we deliver primary health care.
Before I talk some more about the way ahead, and in particular about the direction of the new primary health care funding package this year, I want to say how great it is to see so many familiar and prominent faces.
People attending this conference include some of the most innovative and enthusiastic primary health care thinkers in this country. And they are not only thinkers. They are doers as well.

I particularly want to thank the organisers of the conference, the Department of Public Health and General Practice of the Christchurch Medical School, University of Otago, and the other sponsors, Pegasus Health and the Royal NZ College of General Practitioners.
I would also like to welcome the overseas visitors, particularly keynote speakers Professor Hugh Barr from the University of Westminister and Professor David Wilkin, from the University of Manchester.
The goals of better access to primary care, more effective primary care and better health outcomes for New Zealanders, remain powerful and relevant.
In New Zealand the tradition in terms of health has been to talk about hospitals. No one disagrees about the importance of hospitals in a public health system, but surely we should be talking in terms of a health system that places its emphasis on keeping people well for as long as possible.

We need to change our priorities. This conference is all about new priorities. It is about wellness in our communities.

The implementation of the Primary Health Care Strategy and the new primary health care funding is about changing priorities as well. In this case, I hope it is really true to say welcome to an exciting new world.

At the risk of repeating everything you already know, I think it is helpful to reiterate a few of the themes in the Primary Health Care Strategy I launched a year ago.

In particular, it is worth repeating the Strategy¡¦s core vision of achieving primary health care services focused on better health for population groups by working to reduce health inequalities.

Reducing inequalities is the single most important challenge for New Zealand¡¦s public health system, and reducing inequalities is also necessary if New Zealand is to achieve a sustainable basis for economic and social progress.

The Strategy proposes a number of ways to achieve this vision:
„X Working more closely with local communities and enrolled populations.

„X Offering better access to comprehensive services.

„X Coordinating care across service areas and promoting an integrated view of patient care.

„X Providing health promotion and outreach services to people from communities at risk of poor health outcomes.

As the Strategy is implemented, these developments should help prevent disease, reduce the number of avoidable hospital admissions, identify unmet health needs, improve efficiency through workforce flexibility, and promote better management of costs such as pharmaceuticals.
I think it is really important to emphasise that the Strategy was written by experts in the health sector, and not by politicians.

Unlike many health changes in health in the last decade, these changes are not based on, or driven by, mantras and slogans.

Instead, they are based on clear international evidence of the clinical benefits of better collaboration, integration and a population approach to care. I am sure Professor Barr and Professor Wilkin will have much more to say on these issues.

The Government made it very clear before it entered office that it believed in taking a population-based approach to primary health care. The implementation is more complicated than the principle, of course.

From the start, it was clear to me that there needed to be three stages to this change in the emphasis on primary health care.

ľ Stage one was development of the Strategy. That occurred in 2000 in the form of a draft document that went out to consultation, and then as a completed document in February last year.

ľ Stage 2 was the implementation plan.

In that respect, last year the Cabinet signed off on the minimum requirements for Primary Health Organisations, which will become the community organisations responsible for carrying out the new approach to primary health care, and the Ministry of Health has prepared guidelines for District Health Boards to use.

I know there have been many meetings now around the country between DHBs and organizations interested in becoming PHOs, and I have also had discussions with such groups. Those organisations do not have to be cast in a uniform mould, and indeed those I have talked to have been as diverse as Pegasus Health, one of the sponsors of this conference, Health Care Aotearoa, First Health, Maori health organizations and Pacific groups.

Provided they meet the minimum requirements, any organization can apply. I am really pleased by the level of interest.

ƒæ Stage 3 is, of course, providing the money. That is clearly the Government¡¦s role and I will be announcing very soon the first four years of funding for implementation of the Strategy. I had hoped to be able to tell you today, but there are a few more details to be worked out.

I can tell you that over the four years the funding will be substantial, although clearly it will need to be phased in. Like all the funding announcements I am making, the money will go into baselines so that there can be certainty of planning over time. It is impossible to plan if organizations do not know from year to year how much money they will get.

Of course, there will be elements of unfairness to the funding at first. That is inevitable. We have got to start somewhere, and that means some people will miss out at first.

The bottom line of the Government¡¦s policy, however, is that we intend all New Zealanders to have access to affordable primary health care when the Strategy is fully implemented.

As I said, I cannot give you precise details of the funding today, but it would be logical to assume that it will be directed first of all to those in greatest need.

That may seem unfair to some, but I believe that New Zealanders generally will accept that that is the right thing to do. The money should go first where it is needed most.

The new approach will mean the eventual replacement of the Community Services Card, though that cannot happen immediately either.

In the meantime we intend to improve the take-up of the CSC, until such time that funding has increased to the level that means that such a blunt and crude instrument is needed no longer, and we also intend to make improvements to the High user Health Card.

The CSC is a reminder of the last decade, in which primary health care was an afterthought, not the priority it must become.

I hardly need to remind you, I am sure, that there are increasing numbers of New Zealanders for whom the cost of primary health care is a significant barrier. Many families, including many who have the Card, remain unable to get the care they need.

I am feeling confident about meeting the challenges ahead of us in 2002 and the years ahead because of the strong support for our primary health goals from so many leaders in the health sector.

For example, Counties-Manukau DHB chief executive David Clarke recently stressed the need to move away from the internecine warfare that has sometimes characterised relations between primary and secondary care health professionals.

David said: ¡§Clinicians are trained to see one patient at a time, but we have to [now] think of the whole population, the whole process.¡¨

His voice is certainly not one in the wilderness. There is, I sense, a growing consensus that a more collaborative and integrated approach is needed, instead of a competitive approach that has the potential, at worst, to undermine patient care.

The need for collaboration and cooperation also reinforces the importance of what Dr Anne Opie will discuss in her address about knowledge-based teamwork.
We need to communicate clearly and share relevant knowledge. This must occur on a long continuum if we are to make true progress in integrating primary and secondary care.

And in that respect I am sure that the WAVE Project initiated by the Ministry of Health will provide great benefits over the years. WAVE stands for Working to Add Value to E-information. New Zealand is already seen as a leader in developing and using health information. The better we can do it, the better it will be for all concerned, particularly patients.

I am sure your discussions over the next couple of days will provide you with new ideas and will also reinforce many things you already know.

After all, it¡¦s not as if we are dealing with anything fundamentally radical, but rather that we are getting back to the fundamentals of providing good health care.

The goals of trying to work together, to communicate better and reduce barriers to access are really just common sense.

What is new is systematically bringing these ideas together and incorporating them in the single robust framework that the Strategy represents.

I am looking forward to receiving copies of the addresses that will be delivered later in this conference.

There are many success stories around the country that we can build on, and many of those responsible for those successes are in this room.

I applaud the work you have already done, and the work I am sure you will do following this conference. Thank you again for inviting me.


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