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National Gerontology Section of NZNO conference

National Gerontology Section of NZNO annual conference

Thank you to the New Zealand Nurses Organisation for inviting me to speak this morning.


Five years ago my colleague Annette King spoke at the NZNO conference commemorating the centenary of Nursing Registration in New Zealand. My colleague had a passion as Minister of Health to maximise New Zealander's access to the best health and health services possible. Since then we have invested 50 percent more into the health if New Zealanders, spent $1 billion on new 'bricks and mortar' throughout New Zealand, and most importantly increased the number of people working within the health sector. An extra 2,000 nurses. I think we are getting there - but we will never arrive.

This Labour-lead Government believes in a health system that is predominantly publicly funded, with a strong core of secondary and tertiary services being publicly provided as well. Around that core of public provision sits private and not-for-profit provision, freely interacting with and needing each other. Annette King was the 'midwife' to two overarching documents shaping the health sector - The NZ Health Strategy and the NZ Disability Strategy.

Many other documents have emerged since. The Health of Older People Strategy was released in 2002. DHBs are required to implement the strategy by 2010. This year represents the halfway mark. Developing an integrated continuum of care is a key focus of the strategy. Such a continuum clearly includes supporting older people to stay longer in their homes, if they wish, and increasingly they do. That has huge funding implications, which we are making good, but still insufficient, progress in meeting. It also means new types of service delivery. The era of pilot programmes should soon end and the era of implementing those new types of delivery, widely, must begin.

However many of you work in the residential sector and so I shall focus my remarks somewhat in that direction. New Zealanders will always need some level of long-term residential care. That is obvious. It is likely that hospital-based care and dementia care will continue to grow. But we are also going to see increasing numbers using residential care for episodes of ill health, and returning home after treatment and rehabilitation. The challenge is to build an aged care sector that can better support this reality. Many of you will have a strong interest in funding of the aged care residential sector. So let me spend a few minutes telling you what has been happening from my end.

The government devolved funding of aged residential care to DHBs about 3 years ago, and about 1 year later I became the Associate Minister of Health with responsibilities in that area.

My predecessor, Ruth Dyson, had recently become anxious at the level of funding that the residential aged care sector was receiving and on the day she passed the mantle to me, Cabinet passed a 2 per cent increase outside the budget cycle. That was December 2004.

That summer I read the results of research, funded by the Government and done by the gerontology academics at Auckland University, including all the source reports. It was sober reading indeed. This research spoke of the pressures being felt by owners, workers and residents. It quantified the staff turnover rate. It measured the amount of training people had, or didn't have. And so on.

The following budget, May 2005, a hefty funding increase was made over to DHBs. Just under half of it went no further, as the devolution of September 2003 had not, it turned out, been fully funded by the Government. However, the other half, about 4 per cent, made it through to the sector.

Then the nurse's pay jolt arrived. Nurses employed in DHBs received a significant wage settlement; something I was very proud to be part of.

Inevitably that skewed the market for nurses who are not employed in DHBs, but who are instead employed in the private sector. There are many of them. In some areas there has been a limited ability to pay and that was reflected in the May 2006 budget, which saw about a 3 per cent increase for rest home beds but about a 6 per cent increase for dementia and hospital beds, because it is in those facilities where one can expect to find more nurses. I also changed our administration processes so that the funding flowed from 1 July, not much later in the year, as had been the practice.

It is unusual to talk too much about budgets yet to be announced, but in the case of the aged residential sector I freely acknowledge that the catch up, for nurses but also for the many other staff working in the sector is not yet complete. That is on my mind for the May 2007 budget, and work on that budget has already begun.

So the money has started to flow. The increases over the past couple of years total 9 per cent for rest homes and 12 per cent for hospital and dementia units. That's progress. But it is not sufficient progress.

I have a cycle to break. I have to ensure that the funding flows adequately, to reduce the turnover so that investments in training that we are also making, separately and additionally, are not lost by that turnover of staff.

I am part of the way there. But I am only part of the way there.

There is a lot I would like to say in this speech that I shall not because of time constraints. Your organisers have asked that I leave time for your questions and so I will honour that.

I would have liked to comment on your conference programme because it looks to me to be very exciting and challenging, but I wont. Nor will I comment on assessment tools or the aspire trials, or on the arrival of corporates into your sector, or on patient-centredness, or on the role of DHBs in developing continuity of care, or on depression or dementia.

Instead I want to put on record, again, that nearly all residential care facilities in this country are run to a good or very good standard by a workforce that has a strong dedication, a strong ethos of care and which can and does bond with those they care for such that friendship and love is a common, normal and rewarding experience for residents.

I do so for two reasons. The first is personal. I have seen it, first hand, as a relative, for years and years. It is, I suppose, a personal thank you.

The second is political. In essence the good news is never told. We must never underestimate the value of work in the health sector. Every person I know can recount stories of unexpected kindness and human connection with health professionals. When people tell you these stories they are often intimate, often profound, and often they become the material of their oral history: the pair of glasses which came via a nurse on her way home, the list of books and references emailed to family seeking information, or the nurse who rang on the anniversary of a death. When hearing these stories the humanity is unmistakeable. These stories are not news. The good news is therefore never told. And the good news abounds. I know because the Ministry audits your sector endlessly. The language in audits is mostly technical and not given to effusiveness. In fact it is as dry as dust. What follows is a sample of 'audit-speak':

·There is monitoring and prompt assessment of residents whose condition or dependency needs have changed
·The care plans completed by registered nurses were well-written and individualised
·There is a high level of responsiveness
·There appeared to be strong links with the local community and frequent visits by family
·There was a high degree of family satisfaction
·The facility had a comprehensive activity programme
·All criteria pertaining to care support intervention and primary medical treatment were fully attained
·It appears to be an environment where best-practice and continual quality improvement are sought
·There is a family-like environment.

My assertion is that, try as it might, 'audit-speak' cannot disguise the care and dedication of those who work in the sector. I've seen it as a citizen; I've seen it as a Minister. Congratulations and thank you.


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