Rural Health Symposium 2007 -- innovation and lateral thinking

The Labour-led Government has invested significant funding to improve the health status of rural populations and to meet the challenges of reducing health inequalities.

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Kia Ora.

Thank you for inviting me here.

At the symposium today, you will be discussing some of the key issues concerning rural health in New Zealand.

I expect you will have robust discussions and come away with a stronger sense of optimism that, together, we will be able to overcome the remaining challenges.

The Labour-led Government has invested significant funding to improve the health status of rural populations and to meet the challenges of reducing health inequalities.

I know I have said this before, but it is important to be aware that a lot has already been done.

To recap, the Government spends more than $100 million annually to support rural health services.

Of this, $80 million compensates district health boards for the costs of providing hospital and community health care services, and the balance of $20 million supports rural primary health care services.

Recruitment, retention
The Government is very well aware of the additional difficulties in recruiting and retaining the health workforce in rural areas, and recognises this through specific funding support.

Rural doctors can access the rural bonus - about $4 million annually - that is paid to individual GPs.

Also, the rural premium funding - amounting to about $11 million annually - comprises reasonable roster and workforce retention and recruitment funding.

I know that there has been recent interest about how this funding flows through to general practices.

I would like to make it clear that DHBs and PHOs allocate this funding not only to GPs, but also to address the wider areas of workforce retention, including pharmacists, nurses and midwives.

This is entirely appropriate. They must have flexibility, as each district of New Zealand has unique challenges.

As you know, the Rural Ranking Scale is being reviewed, with a number of possibilities being considered. I am looking forward to the outcome of the review and expect an improved approach in the future which better aligns with the implementation of the primary health care strategy.

Training
To help in the recruitment of rural GPs, funding for GP training and the number of rural/primary care placements for postgraduate year two doctors have been increased. These initiatives include 10 rural scholarships to medical school and 20 rural rotations for trainee doctors.

The Ministry of Health has also been working with the Ministry of Education to encourage medical students to specialise in rural primary care to further ensure the provision of appropriate GP services in rural areas.

From February 2008, up to 20 fifth-year medical students from Auckland University will have the opportunity to spend a year working and studying at Whangarei Hospital and smaller hospitals in Northland.

Through this new initiative, we hope to provide medical students with an improved understanding of the health needs of rural communities.

In line with this aim of encouraging medical students to work in rural areas, the University of Otago has been provided $300,000 in funding support to develop a curriculum for a Rural Medical Immersion Programme.

Six undergraduate students are taking part in this pioneering effort. They will be given opportunities to assist with surgery, make home visits to patients, conduct X-ray and laboratory work, and become part of an integrated health care team.

The pilot will run for a year and we hope that with the approval of the Committee on University Academic Programmes, the programme will eventually be incorporated into the undergraduate medical degree.

The Government also has a number of incentives for nurses and midwives to work in rural communities.

This year, six rural nurses were awarded scholarships to complete their Masters programme and register as Nurse Practitioners with prescribing competencies. A number of other postgraduate scholarships have been awarded to primary health care nurses working with rural populations.

There are two new funding schemes that midwives practicing in remote and rural areas of New Zealand can apply for. One is the Remote Rural Midwives Support Scheme, which is a pilot scheme set up for two years whereby eligible midwives receive $2500.

The second scheme is the rural bonus for midwives, which will distribute $2 million annually to midwives that qualify. This funding should assist rural midwives with locum relief and other costs associated with practising in remote and rural areas.

Overseas-trained doctors
All these initiatives are forward-looking and recognise that under the Labour-led Government New Zealand will not lag behind other countries in producing home-grown doctors.

But this government is also pragmatic. We know that all professional groups, including health professionals, are attracted overseas by lifestyle choices and new opportunities, and that we too must attract our share.

We also know that the proportion of rural and provincial doctors who are foreign trained has been high historically.

We want to ensure these overseas-trained doctors are well prepared for clinical practice in New Zealand.

It is with this in mind that I am pleased to announce today that the Government is to provide nearly $1 million annually to ensure overseas-trained doctors who have passed their registration exam are supported through their intern year.

The 30 or so each year who meet the criteria will be funded through their intern year so that they become fully registered.

This assistance will allow them to become work-ready as soon as possible, and will remove barriers that stand in the way of well-trained people joining our health workforce.

Once these doctors are ready to practice in New Zealand they offer a valuable service to our communities, particularly in rural areas where they are very well received.

Innovation

An essential part of the Government's approach to providing quality services, including health, is to encourage continuous innovation.

As you know, the Government introduced the Rural Innovations Fund last year. The fund is a valuable annual resource that can be tapped by health professionals who wish to turn good ideas into reality.

In its initial year, we distributed funding amounting to $300,000 to six applicants throughout rural New Zealand.

The recipients used the funds to develop a local website, employ a hospital liaison manager, fund research, purchase medical equipment and hire persons to assist medical students and locums in engaging with the local community.

Applications for next year's funding are currently being assessed. I encourage your ongoing support for this programme. Most of you here will have great ideas. We'd like to hear them.

Apart from boosting training and recruitment of health professionals in rural areas, and constantly looking to innovate, we have also been working to enhance access to health services to improve overall health outcomes in rural communities.

Under the new contract between the Ministry of Health and Mobile Surgical Services for the period from November 2006 to September 2011, MSS is contracted to provide elective day surgery in rural locations plus remote collaboration sessions via telepresence and a variety of training sessions.

On an annual basis, this translates to some 1500 surgical cases, surgical and advanced skills programmes for rural nurses and GPs and training programmes plus an annual conference for a wide range of health practitioners, and 30 remote collaboration sessions for secondary and tertiary hospitals and educational institutions.

We also hope to address issues relating to after-hours medical cover in rural areas.

The Ministry of Health is currently reviewing the District After-Hours Funding and Strategic Plans which the DHBs are developing in collaboration with Primary Health Organisations and after-hours service providers.

These plans aim to achieve accessible, effective and sustainable primary health care services for each district. DHBs are expected to give particular consideration to after-hours service provision to rural communities.

I believe everyone in this conference hall agrees that an equitable and effective health system translates to better health outcomes for New Zealanders.

It is our shared responsibility to ensure the initiatives I have cited are not only implemented but succeed in improving the health of our rural populations.

A determined approach to problem solving, lateral thinking and use of innovation are key strengths - as you have identified in the theme of this year's symposium.

Thank you once again for having me here today and I look forward to hearing the outcome of your deliberations.

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ENDS

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