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Annette King Address to Health Workforce Advisory

Annette King Address to Health Workforce Advisory Committee Summit

Dame Silvia Cartwright, Professor Andrew Hornblow, Chair of the Health Workforce Advisory Committee, Dr Karen Poutasi, Director-General of Health, and Ladies and Gentlemen.

Thank you for your welcome Andrew. I am now pleased to welcome you and other members of the Health Workforce Advisory Committee, and leading members of the health sector to Wellington for this historic occasion.

This occasion is made even more significant by the presence of Her Excellency, the Governor General, Dame Silvia Cartwright. Thank you for your thought-provoking speech.

I am delighted to be here. It seems I have been waiting for much of my time as Health Minister to get such a range of health sector representatives in the same room to discuss one of the most important issues affecting the health sector overall.

It is also clear that the health sector has been waiting a long time for this to happen.

How else to explain the fact that the conference has been over-subscribed? That certainly wouldn’t have happened if the sector wasn’t aware of the real need for health workforce planning.

For a decade, health workforce planning was badly neglected. Someone had to take responsibility for developing a strategic approach to creating a unique New Zealand health workforce.

That leadership needed initially to come from the Minister of Health, with the Government committing to taking a long-term strategic approach to workforce issues.

In Opposition, I was convinced of the need for such an approach by people like Dr George Salmond and a group of medical educationists, led by Professor Peter Gluckman and Professor John Campbell. Health workforce planning was an important feature of our 1999 health manifesto.

In 1997, Sir Frank Holmes, Chair of the Committee Advising on Professional Education (CAPE), presented its long-term strategy on educating and developing the health and disability workforce. Nothing was done with that report.

HWAC’s brief is remarkably similar to CAPE’s, the difference being that HWAC’s advice will be heard and heeded by this Government.

It is interesting to reflect on some of the issues that emerged from CAPE’s extensive consultation within the health sector.

It identified inadequate Government attention to workforce planning, short term quick fixes instead of investment in people, a lack of continuity between pre-entry and post-entry and continuing education, and the compartmentalisation of professions.

CAPE also identified the very low percentage of Maori in the health workforce, particularly in mental health.

Since HWAC was established two years ago, it has already taken us towards developing the long-term strategy that was Sir Frank Holmes’ vision for the health and disability workforce.

While individual organisations representing health professionals might be concerned with their own particular patch, New Zealand stands to benefit from open and innovative approaches to solving general workforce issues that affect the delivery of health care in this country.

A health workforce needs to be made up of professionals who work in teams, across disciplines. An over-emphasis on one sector at the expense of another leads to silo-planning and consequently workforce gaps.

A good example is in the treatment of cancer. An emphasis on a specialist medical workforce, without considering radiation therapists, would mean a particular treatment could not be provided.

Workforce gaps, short-term patch-ups, and the continuing stress and morale problems faced by our workforce, have all been identified as issues. Long-term planning was needed to combat these problems, but it had to be combined with short and medium-term actions.

The longest-term strategic approach we are taking in terms of health workforce planning is through HWAC itself.

Long-term planning has also been needed in Tertiary Education in general.

My colleague Tertiary Education Minister Steve Maharey has been instrumental in helping to address the issue of workforce education and development.

The launch of the Tertiary Education Strategy and the establishment of the Tertiary Education Commission will provide a structure in which the education sector will be much more responsive to the present and future needs of the health sector. This is a long over-due improvement.

HWAC’s first job was to compile a stocktake of workforce issues and capacity. This was an essential first step before its second report, Framing Future Directions, which identified the workforce priorities New Zealand needs to address.

That second step has led directly to this summit conference. You are here to discuss, debate and develop the key issues identified in that report.

I look forward to HWAC’s next report incorporating the views and ideas that you discuss and develop during the Summit.

When Framing Future Directions was released, in October last year, some organisations were critical that there hadn’t been enough consultation. Well, that’s what has been happening in the past few months, and that’s what we are doing on a big scale here over the next two days.

If HWAC had actually tried to supply all the answers in its second report, then there would have been justifiable room for criticism. In fact, it was never envisaged that an advisory committee would develop all the answers. So much information and innovation exists within the health sector. The committee’s role is to harness it.

The overall comments on the Framing Future Directions document were extremely positive. Stakeholders welcomed the publication, and considered it a sound platform on which to base further discussion on the development of a long-term health workforce strategy.

The really encouraging thing is that we are actually starting to see things happen. That makes a huge change from the 1990s.

Of course, health workforce planning has been a controversial issue for years, however, and it would be naive to imagine that it suddenly would stop being controversial simply because we are all getting together to try to do something about it.

There will always be people who are going to say things are happening too slowly, there is not enough progress, too little, too late. If we listened to that sort of advice, we would not be here today.

I welcome those people who have taken a forward-looking and constructive approach, and who are here to contribute over the next two days.

As I said earlier, the long-term strategic approach is being developed through HWAC, but it was essential the Ministry of Health, District Health Boards and the wider health sector became involved in short to medium term actions that needed to be taken to counter the deprivations caused by the lack of planning during the 1990s.

Since HWAC came into existence, and we began to take a serious strategic approach, a number of initiatives have been put in place, and a number of immediate hot spots have been addressed.

The provision of primary health care to rural New Zealand was a long-standing problem that required the urgent attention of the Government.

The $32 million funding package we announced in May last year is an example of a short-term initiative, designed to ensure we can begin to turn the tide on workforce retention in rural New Zealand. The Ministry of Health devised this package in conjunction with rural GPs, drawing on their expertise and experience.

We have also addressed a number of other hot spots in various ways:

Dramatically increasing the number of radiation therapists in training, from 16 in first year training in 1999 to 38 in 2002, and another 38 this year. Providing services within international standards had to be achieved. It would not have been possible without such action, which should have been taken in the mid 1990s when the problem was first identified.

Providing an $8 million package to support 11 innovative primary health care nursing initiatives, and to fund primary health care nursing postgraduate scholarships, to ensure we expand the capacity to provide primary health care under the Primary Health Care Strategy.

Supporting the introduction of a new dental therapy course in Auckland to ensure children’s oral health needs can be provided for in the future.

Developing a permanent, annual Maori Provider Development Fund of $10 million, and introducing a similar $5 million Pacific Provider Development Fund, with the funds aimed at expanding services for Maori by Maori and for Pacific people by Pacific people with an appropriate workforce.

Setting up an $11.8 million bridging programme to help overseas-trained doctors pass the NZ General Registration Exam. Hundreds of overseas doctors had been left unemployed, driving taxis, or were under-utilised because of an immigration error from 1991 to 1995.

Building the capacity of the mental health workforce, creating hundreds more full time community clinical and non-clinical positions for adult and child services. According to the Mental Health Commission’s latest progress report on implementing the Mental Health Blueprint, 455 additional full-time clinical positions have been created with another 148 additional positions in community clinical services for children.

Launching the national Werry Centre, based at Auckland University, to provide training for adolescent and child mental health professionals, an area of tremendous need. Reinstating enrolled nursing, now being offered at two tertiary institutions with more to come.

There are other measures that can help to resolve problems in the medium-term.

A medium-term initiative I can announce today also illustrates the positive momentum that is emerging in the HWAC environment.

Steve Maharey has agreed to an increase of 40 in the number of New Zealand-funded medical students from next year. That will take the number of New Zealand medical students from 285 each year to 325.

The Government would like to see an emphasis with the extra students on General Practice and Mental Health, two areas in which we need more people as we implement the Primary Health Care Strategy, and continue implementing the Mental Health Commission’s Blueprint.

We will be working with the universities, the College of GPs, the College of Psychiatrists and others on trying to promote this emphasis.

This initiative belies the comments of some who say that HWAC, the Ministry of Health and District Health Boards are doing little to relieve the medical workforce shortage in this country. On the contrary, these organisations and the Government are committed to trying to ensure we have an adequate health workforce on as many fronts as possible.

I would like to thank the Medical Council, the Ministry and the Deans of the Medical Schools in particular, for their advocacy on this issue.

There is no doubt New Zealand will need more doctors in the future, and that is where the extended medical student cap will prove beneficial.

Our problem at the moment often comes down to where doctors practice. There is an uneven distribution, with low numbers of GPs in rural areas and in some poorer urban areas.

Work has also continued on the vexed question of student loans. This Government is taking a whole-of-Government approach, recognising that the level of student debt has been a barrier to recruitment and retention.

Although we acted quickly to address the problem of interest while studying, there are a number of other complex issues to be resolved. A quick-fix is not available, and those advocating for a quick-fix haven’t thought through the issues.

Ministry of Education officials are completing a comprehensive review of student loans and allowances. It looks to develop a sustainable set of policies for student support, rather than individual band-aid solutions. We have needed to take the time to get this right.

Steve Maharey will publish the outcome of the Review, which will look at issues like bonding and scholarships, in May or June this year.

District Health Boards are also collaborating on a number of workforce projects, particularly around recruitment. And the establishment of a tripartite approach (DHBs, unions and the Government) to workforce issues affecting the health sector has the potential to address long-standing retention issues.

I mentioned earlier that work is being done to ensure the education sector becomes much more responsive to the present and future needs of the health sector, but another key issue that has been consistently identified is the quality of the workforce.

Before the 1999 election, the Labour Party signalled our commitment to reviewing the regulatory environment surrounding the health workforce. Many of the statutes were out of date, and were too inflexible to accommodate service delivery and technology changes.

In June 2002, I introduced the Health Practitioners Competence Assurance Bill in the House of Representatives. The Health Select Committee has been hearing submissions on the Bill, so I cannot comment in detail on its deliberations.

Submissions have certainly been plentiful, and have continued the extensive consultation that has surrounded this piece of legislation.

For example, the HPCA Bill was on the agenda in many of my regular meetings with the New Zealand Medical Association from 2000 to 2002, and Ministry officials met the NZMA on the issue on several other occasions during that period.

I also met other organisations on numerous occasions about the Bill. They included the Royal New Zealand College of GPs, many of the other professional colleges, the New Zealand Nurses Organisation, and the Public Service Association, representing allied health workers.

All these organisations are involved in this forum.

It is intended that the Bill, when enacted, will provide a regulatory environment that does not compartmentalise the health workforce and one which will allow innovation to flourish while at the same time ensuring that the public are protected.

The current workforce mix may not be appropriate to deliver health services in the future. For example, we may need more generalists and fewer specialists, and different health professionals may take on roles traditionally undertaken by another group.

An example is the development of the nurse practitioner. This is well down the track, with, I understand, the first four now in place.

The HPCA Bill’s proposed new regulatory framework is designed not only to ensure the ongoing competence of health professionals, but also to ensure that the very best use is made of all the diverse talents that we have.

Another example of change is the global trend to increase the use of information technology, which can provide services to one part of the country from a completely different part. This has particular relevance in the provision of, say, mental health services.

I believe we are putting the foundations in place to enable a quality and highly-skilled health workforce to develop and flourish.

We have to ensure that our workforce is aligned with our overall strategic health approach, and it is also important for health practitioners themselves to be able to adapt to the rapidly changing health environment. The speed of this change is unlikely to slow down. We must also recognise the fact that health workforce development is an investment rather than a cost and needs to be balanced against the huge costs of recruitment.

Now that we have a secure three-year funding path for health, District Health Boards need to work together, rather than in isolation, to find collaborative ways of investing in workforce development, such as expanded roles for nurses, GPs, and other health workers.

HWAC has a crucial role to play in setting the long-term strategic direction for the sort of workforce we need to provide quality and accessible health services for New Zealanders in the future.

In conclusion, I want to thank the members of HWAC for their commitment and vision, and the Ministry for its support and guidance in taking a strategic approach to workforce planning, and I want to thank you for coming together to get us much closer to where we need to be and want to be.

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