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NZ Nurses Organisation national conference

Wed, 15 Sep 2004

New Zealand Nurses Organisation national conference

Addressing the NZNO conference on behalf of Health Minister Annette King, Damien O'Connor said that a huge amount had occurred to rebuild the strong public health service model that was gradually being unravelled during the market reforms of the 1990s.


Thank you very much for asking me again to open one of New Zealand's most important annual health conferences. I am very disappointed I am unable to be with you personally, but would like to thank my colleague Damien O'Connor for delivering this address on my behalf.

As your executive is aware, I am in Shanghai attending the 55th session of the World Health Organisation's Western Pacific Regional Committee, where health ministers and officials are focusing on the theme of international cooperation in the face of public health emergencies.

I know nurses will certainly understand only too well the importance of this issue, because nurses were to the forefront, along with doctors and public health officials, of New Zealand's outstanding response to the SARS crisis.

The significance of nursing's input into New Zealand's response cannot be over-emphasised.

In May this year I spoke at a forum at which the lessons from SARS-affected countries were workshopped, and I highlighted the fact that the forum was the first time the professional organisations of nursing and medicine had been brought together to discuss a key emerging health issue at a national level.

Coming together in such a way to exchange ideas and experiences is vital, because if our frontline health workers can not provide the diagnosis, care, treatments, and containment of an infectious disease when it emerges, then not only are they at risk, but the whole health service and the economy is at risk. That was certainly the case with SARS, when the countries affected by the crisis had their economies turned upside down. I am pleased that the key findings lessons from the May forum have now been incorporated in the National Health Emergency Plan:infectious diseases, which has just been released by the Ministry of Health.

This means, of course, that practical nursing knowledge and experience has been incorporated in the final plan, and I think that is the way it should be.

The practical knowledge and experience particularly relates to occupational safety and health issues, the social and mental health impact of national emergency responses and ethical considerations.

Naturally a national clinical action of this sort must provide the greatest possible protection for the population at large and for patients, but it must also provide such protection for all health service workers.

And we must also plan for recovery from the effects of the disease on the health services and ensure that our health professionals and health care workers are supported and helped in coping with the impact on their lives.

I have been reassured both by the May forum and by the plan that these issues are well understood, and I thank nurses for their strong input.

But to return to your conference today, however, I want to congratulate the NZNO organising team for organising yet another excellent conference.

In particular I want to acknowledge NZNO president Jane O'Malley, and to thank her for the strong contributions she continues to make across a wide range of nursing issues, including her favourite rural issues, and your chief executive Geoff Annals for his wisdom and experience.

I would also like to acknowledge Anne McNichol, chair of Te Runanga O Aotearoa NZNO and Te Runanga O Aotearoa NZNO itself for your commitment to representing the concerns and interests of Maori in the health sector

And finally I want to acknowledge your invited guests, Nursing Council chief executive Marion Clarke, and New Zealand Council of Trade Unions secretary Carol Beaumont.

The five years I have been Health Minister have been times of significant change, and I thought it would be interesting today to revisit some of the issues I raised at previous NZNO conferences. They say a week in politics is a long time, and whoever they are, they are probably right. And if a week is a long time, then almost five years is a particularly long time. In my speech to your conference in 2000 the wide range of subjects I canvassed included the Government's intention to change the health service from a competitive model to a strong public service based on cooperation and trust. I hope we can all agree that a huge amount has occurred to rebuild the strong public health service model that was gradually being unravelled during the market reforms of the 1990s.

Just consider some of the advances that have occurred since that conference in 2000.

The New Zealand Public Health and Disability Act in 2000 restored democratically elected health boards. The launch of the New Zealand Health Strategy has signalled the Government's key health priorities. The Primary Health Care Strategy has been well and truly launched, and is being implemented increasingly rapidly through Primary Health Organisations.

The Government has increased spending on health by more than 40 per cent to provide affordable and accessible health care, and has moved to a three-year funding path that provides certainty of health funding. The introduction of population based funding has ensured a fair share of funding through all the country's regions.

Those are just some of the major developments in terms of rebuilding the public health system, and all of them, of course, impact positively on nursing. Another issue I raised in 2000 was a survey commissioned by the Ministry of Health of non-practising nurses and midwives to assess whether they could be attracted back to the workforce, and what was necessary to achieve this.

The survey carried out in 2000 that showed that 2071 registered nurses and midwives were not in clinical practice, and also that some 1576 would be encouraged to return if childcare facilities and return to nursing programmes were available, and if hours were more flexible.

That survey acted as a wake-up call, and I have been delighted to see data from the latest annual nursing and midwifery workforce survey, showing that between 2001 and 2003 a total of 2807 registered nurses and midwives returned to clinical practice.

The latest survey showed that the factors encouraging nurses and midwives back were availability of childcare (14.7 percent), changed family circumstances (35.5 per cent), recently returned from overseas (12.6 per cent), completed a return to nursing practice course (8.8 per cent), completed fulltime study (8.4 percent) and other reasons (a combined 19.8 percent).

The availability of return to nursing programmes and the provision of childcare facilities were particularly significant factors for registered nurses and midwives returning to practice in Auckland and Christchurch. There is much in the survey to encourage us all, and also much to learn from.

One of the most important areas I discussed in 2000 was the need for a single Bill to regulate the practice and competency of health professional groups, including nurses, of course. Well, later this month the provisions of the Health Practitioners Competency Assurance Act come into effect --- and your college and nursing in general can take much credit for providing the impetus behind this long-needed change.

Thank you all very much for the support and encouragement you provided through what has been a complex and sometimes disputatious process.

The issue of nurse prescribing was a key issue of interest in 2000, just as it remains today. In 2000 I told your conference I was in the process of setting the New Prescribers Advisory Committee. The committee is in place, but I am keen to see much more progress in terms of nurse prescribing in particular.

Currently nurse prescribing is limited to aged care and child health, but I want to see generic regulations covering nurse prescribing in areas like chronic disease management, mental health and primary health care. I understand there are some 200 nurses doing prescribing papers at post-graduate level, many of them expected to graduate over the next few months. By then I hope the new regulations are in place.

That is only part of the story, however. If nurse prescribing really is to be a success, then we need providers to be planning now how they can best utilize such highly-trained staff. Among the important issues that we discussed in 2001 were, firstly, the new role of nurse practitioners (I am pleased to say New Zealand now has more than 12, and many more are on the way), and, most importantly for the NZNO, the repeal of the Employment Contracts Act. I am still as proud now at the demise of that particularly ugly and worker-unfriendly piece of legislation as I was then.

If the environment in the health sector has changed markedly in the past five years or so, the same can certainly be said of industrial relations. The bad old days of industrial relations under a National government are just that --- bad and old --- and we must all cherish the enlightened new environment that exists, and ensure we do not place it in jeopardy for the future.

The code of good faith will come into law soon, and I want to thank the NZNO for its work in helping develop it. I also want to say that, from my perspective, the tripartite forum involving the Government, unions and DHBs is working very well, and ensuring there are improved relations between the parties.

And, finally, in 2002, the last time I spoke at this conference, I discussed the first $400 million of funding set aside for implementing the Primary Health Care Strategy, and gave details of the primary health care nursing innovation fund.

That $400 million seemed a lot of money at the time, but if I had told you then that the Government would be committing a total of $1.7 billion over six years from 2002-03 specifically for implementing a primary health care strategy using a PHO model, I am sure that you would have found it difficult to comprehend the size of the investment.

I am sure everyone here knows how convinced I am of the crucial importance of nursing's role in implementing the Primary Health Care Strategy, and in helping ensure that PHOs function as effectively as possible, and that is why I am delighted many nurses want to be involved in PHOs at both a development and governance level. Historically hospital boards have separated hospital and community services. Most nurses worked in one area or the other, and only a few, like specialist oncology or diabetes nurses, worked across both. That has begun to change with the advent of DHBs and their wider health focus.

There is excellent potential for more nurses to work across both primary and secondary services to provide a continuum of care. The setting should not be an issue, and I am confident that the success of the new Care Plus initiative will prove that to be the case.

Approximately $4.2 million went into funding Care Plus in PHOs for a preparatory period from April to June this year, and the Government then allocated $26 million to the scheme in this financial year.

The new service gives nurses an opportunity to practice in new ways, by developing, for example, plans to provide co-ordinated and specialised care for people with chronic conditions such as diabetes and cardiovascular disease. Nurses working across the boundaries between primary health care and secondary services in hospitals will be pivotal in helping achieve better health outcomes for Care Plus patients and others with chronic conditions.

Some DHBs are doing particularly well, however, modelling nursing services across boundaries. I don't want to name too many at the expense of not naming others, but one very good example is Counties Manukau's chronic disease management for diabetes, where diabetes nurse educators work with inpatients and in PHOs and IPAs alongside GPs and practice nurses.

There is certainly a challenge for all of us to build on all the positive things happening in the new primary care environment. For nurses, I hope the major challenge is to not only play a strong role in the new environment, but to continue to foster innovative approaches to meet community and health needs as well.

I am particularly pleased with the way rural Primary Health Organisations are working. Many rural providers already have well developed teams, and the challenge of providing after hours services in rural areas means that many nurses already make an enhanced contribution to service delivery by providing triage and first call after hours services.

PRIME (Primary Response in Medical Emergencies) is an excellent example of rural GPs and nurses in many rural areas working with ambulance services to improve outcomes from rural emergencies. Before I finish today, there are a few other issues or updates I wish to mention, starting with mental health.

The Ministry has established a project to develop a national strategic framework for mental health nursing. The project will involve integrating advice from professional groups, as well as taking account of mental health strategies and Government policies. The aim is to develop a sustainable workforce to deliver mental health care. You will also all be aware that research is underway regarding the cost of nursing turnover. The study is part of an international study to determine the actual costs of nursing turnover, both direct and indirect. Until recently the study was being conducted in surgical and medical units, but it has now been extended to include mental health. A final report is expected halfway through next year.

The next issue I wish to mention, and I am sure it will be of interest to this forum, is the development of a toolkit, produced by the Magnet secretariat. This toolkit is designed to provide information for those DHBs --- and I hope that eventually there are plenty of them --- which want to learn more about Magnet principles.

Interestingly, the Australian Safety and Quality Council has asked for information on the New Zealand approach to Magnet, and has set up a project to look at the application of Magnet principles in Australian settings. I am told that Australia sees New Zealand as a model of a way forward. I welcome NZNO's membership of Magnet NZ, and continue to believe Magnet has enormous potential for New Zealand. United States research provides evidence that Magnet hospitals both attract and retain highly qualified professional nurses, even during a nursing shortage, and deliver consistent and high standards of patient care. And, finally, I hope to be able to make a detailed announcement in the next few days about rolling out a nation-wide programme for a nursing entry to practice education programme for new graduate nurses.

Such a programme will help new graduates develop skills and confidence, and offer significant benefits for safety, quality assurance, recruitment and retention.

DHBs have extra costs when they employ new graduate nurses. This programme will allow the new nurses to have on-the-job support and education. The transition for new graduate nurses involves applying learning obtained in the degree programme, and also involves specific competencies that need to be developed to meet Nursing Council ongoing practice competencies.

The demand and enthusiasm for such a programme is shown by the fact that no fewer than 19 DHBs submitted proposals when the Clinical Training Agency tendered for the pilot programmes.

As I said, final details still have to be agreed, but they will be refined in conjunction with the DHBs, DHBNZ and the Nursing Council.

I hope you agree that is a positive note on which to finish today. Dynamic and effective nursing leadership is critical to improving health outcomes for New Zealanders. Your passion and commitment can and does make a real difference.

I wish you well for your AGM and the remainder of the conference, and thank you again for this opportunity to speak with you.


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