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Speech Notes: Annette King to NZNO

Speech Notes: Annette King to New Zealand Nurses Organisation annual meeting

Thank you very much for inviting me to speak at your annual meeting and conference. When you originally invited me to speak, none of us knew there would be an election in the interim. Nor did any of us know, of course, that I would be reappointed as Health Minister.

It is, of course, by no means common for a minister, willingly or unwillingly, to take on a second term in the health portfolio, but in my case I am certainly more than willing.

In fact, I feel privileged to be serving a second term in the portfolio. I think it is particularly important to do so as a signal that the health sector will benefit from a period of stability and continuity. That is certainly what I hope to ensure occurs over this term of government. It is worth quoting from the document Doing Better for New Zealanders, which summarises advice to me from the Ministry of Health at the beginning of this term of government.

Under the heading Taking stock, the document says that structures, broad policies and funding arrangements put in place over the past three years provide a good foundation for the sector to continue to mature and develop. “They should remain in place,” the document says. “Progress toward healthy New Zealanders can only be sustained if the foundations remain steady.”

I could not agree more. The next three years will be exciting in terms of getting the results we want out of the sound structures we now have in place. No one in the sector wants more policy and structural change; and the good news is that there is no longer any need for such change to occur anyway.

Last year we all celebrated the centenary of the Nursing Registration Act in New Zealand. That was an extremely important occasion, of course, but it is just as important now to look at the challenges that lie ahead for nursing.

I want to talk about those future challenges today, as well as about your 10-point manifesto for the new Government, but before I do so I want to emphasise the importance I place on my relationship with the New Zealand Nurses Organisation.

In particular I want to pay tribute to the work of your chief executive officer, Geoff Annals, your president Jane O’Malley and policy analyst Eileen Brown. I admire the work they do on behalf of nurses, but I also value the contributions they make generally to debate about health workforce issues.

While there will always be points of difference between an organisation like yours and a government, I know I can rely on the NZNO to be a constructive and positive force in the health sector.

That is as good a point as any to start talking about challenges.

You have certainly laid down a series of challenges to the Government with your new manifesto, and I will discuss those shortly, but I have some challenges of my own to put to you first.

The first and foremost is that nursing in New Zealand is at the crossroads as it enters its second 100 years.

There are increasing opportunities for nursing to expand its horizons --- in terms of nurse practitioners, nurse prescribing, nurse anaesthetists, and a whole range of other scopes of practice ---- but it is up to nurses themselves to use these opportunities.

Too often, I believe, nurses have been their own worst enemies, with too many tending to see nursing within narrow confines, or to criticise those nurses who have been prepared to move outside those confines. That should no longer be the case. The implementation of the Primary Health Care Strategy offers ideal opportunities for new, expanded and increasingly influential roles for nurses. Those opportunities will be available particularly through Primary Health Organisations, which are not-for-profit organisations of providers.

As you will know, the first PHOs have already been established in South Auckland, more will be announced shortly in various parts of the North and South Islands, and proposals for more still are well on the way to fruition.

I believe it is a highly exciting time for primary health care in New Zealand, and indeed for the health sector generally, and nurses have the chance to become heavily involved right from the outset.

While PHOs will need the support and participation of many health professionals to achieve their potential, it is clear that in terms of workforce requirements nurses and doctors represent the two key building blocks.

If PHOs are to work as they should do, the partnership between nurses and doctors must be real. It is not about one partner being better than the other, but about both partners working together genuinely.

More than $400 million of new money has been set aside over the next three years to implement the Primary Health Care Strategy, and on June 17 I announced details of the $8.1 million primary health care nursing innovation fund. So the money is there to make the new system work. We just have to make sure it does work. I know that will be simpler to say than to put into practice, but I am greatly encouraged by some of the developments I am hearing about. I know, for example, that your organisation has been interested for some time in consolidating some of its 21 professional groups or colleges or sections and encouraging nurses to form wider scopes of practise. It seems to me that primary health care clearly has the potential to offer one such wider scope of practise. I do not see forming such a wider scope as meaning that nurses have to lose their areas of specialisation, but it would mean that nurses who work in similar areas could come together to form a larger professional group. I am aware that there has been some resentment about this sort of concept in the past, but that is what I mean about the challenge of moving outside narrow confines. I understand a number of nurses, including practice nurses, district health nurses, public health nurses and nurses who work with children and young people, are already talking about the concept of a college of primary health care nurses, and I hope that idea advances further during this conference. I now want to refer to the NZNO manifesto, or the 10-point plan your organisation has delivered to the new Government. Quite clearly I cannot go into great detail on all the points this morning, but I believe the Government is already well down the track in terms of meeting many of the points. For example, the establishment of a tripartite approach to wages and working conditions is underway; and so is the development of MECAs across the health sector. I am personally strongly in favour of promoting clinical nursing leadership within the hospitals and within the community. We are also well down the track in terms of safety legislation, and reinstating minimum nursing requirements in terms of aged care; and I believe the systems are now in place that will allow us to take more flexible and innovative approaches to nursing education. The Ministry of Health and District Health Boards New Zealand are working closely with the new Tertiary Education Commission to ensure that changing health workforce requirements are satisfied. It is already good news that enrolled nurse training has now recommenced. We now have a training course at Northland polytechnic, and it will be followed by one in Canterbury early next year. This will particularly help rural nurses to feel more supported in their work and will also provide safe, quality care. Enrolled nurses is something you fought for. You never gave up on the struggle to restore the concept and the name of enrolled nurses. The next report from the Health Workforce Advisory Committee, due in October, will also provide high-level strategic advice on retention and recruitment issues. In terms of the final point in your 10-point plan, committing to introducing a portable workplace-based superannuation scheme, I can tell you I am personally very interested in this idea, and I believe it needs to be explored through tripartite talks. I am sure everyone here believes in fairness in the workplace. On that basis it is difficult to argue against a portable workplace-based super scheme for nurses when there is already one available for senior doctors, for example. On the issue of recruitment, retention and nursing shortages generally, I know you have already heard today from Belinda Morieson about the safe nursing campaign in Victoria, Australia, to introduce nurse/patient ratios, and the impact of that campaign in terms of reversing Victoria’s apparent nursing shortage. I am certainly interested in what I know so far about the campaign, and I look forward to hearing a lot more when I meet Belinda later this morning. We can learn much from what is happening in other places, and I congratulate you for your initiative in bringing Belinda to this conference. If the Victorian experience is valid in a New Zealand context, and there is not a shortage of nurses, but rather a shortage of nurses willing to nurse, then we need to learn more about it. There is no doubt the issue is serious. Using international comparisons, one estimate is that overall nursing turnover costs in New Zealand may be about $100 million per annum. The Health Research Council has been contracted to undertake a national study on the costs of nursing turnover as part of an international study, and I am sure there is huge potential for cost savings in this area. Nursing shortages are of critical concern to policy makers, managers and registered nurses in hospitals in many countries worldwide. International research has shown that high turnover rates not only can have an adverse effect on staff morale, but may ultimately have a negative impact on patient care as well.

I would now like to refer briefly to the Health Practitioners Competence Assurance Bill, although it deserves more than brief mention, of course. I am really pleased to be able to come to this conference and report that when the Bill was introduced in the House on June 11, it marked the success of your 14-year campaign to have a review of the Nurses Act. I promised a review when I first became Minister in 1999, and I am grateful nurses have been prepared to come under legislation that regulates so many other health professions as well. The purpose of the HPCA is to provide a consistent framework for the registration, competence, complaints and disciplinary processes for all health practitioners who will be registered under the proposed Act. Each registered authority will be responsible for determining the qualifications and competencies necessary before a practitioner can be registered to practise a particular scope of practice. As I said to you earlier today, nursing will continue to offer more and more opportunities in the future, and you will continue to contribute significantly to population health objectives, such as improving immunisation rates and smoking cessation programmes.
The theme of this conference has been leadership in health, and I believe the health sector in New Zealand will increasingly look to nurses to provide such leadership.

Effective leadership is critical to developing teamwork, and teamwork will be essential to implementing the Primary Health Care Strategy.

The vision for the Strategy includes developing a high-quality workforce, a focus on better health for the whole population, and a reduction in health inequalities between different groups.
As all this happens, a different nursing workforce will gradually evolve in New Zealand. The development of the nurse practitioner role in particular offers the potential for more nurses to contribute to health gains, offering a responsive, innovative, effective and collaborative health care service.
If the United States can have thousands of nurse practitioners providing health services efficiently and effectively, there is no reason New Zealand cannot do the same in a way that responds to our particular needs.
And if the United States has been using nurse anaesthetists for something like 25 years, there is surely no reason New Zealand cannot do the same thing efficiently too.

The more New Zealand can accept and cater for new scopes of practice, and the more nurses are prepared to take such opportunities, the better our health service will become.

Thank you again for inviting me to be with you today. I am happy to answer questions, but I would like to finish by congratulating NZNO again on its track record of working collaboratively with other health workforce organisations. It is simply common sense to recognise that nurses and all other health professionals need and complement each other, and that many patients require a complex array of services that depend on the knowledge and skills of a wide range of health professionals working together.

The more that happens in New Zealand, the better our health service will become, and I am sure we are all agreed that we want to make our system as good as we possibly can. Thank you.

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