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Cunliffe: Launch of the NZ Health Survey Results

Hon David Cunliffe
Minister of Health

4 June 2008 Speech Notes

Launch of the NZ Health Survey Results

Tena koutou katoa, and warm Pacific greetings to you all.

(Acknowledge: Hon Damien O’Connor; Stephen McKernan, Director General; DDG Deborah Roche; Sarah Gerritson; the Public Health Intelligence Team)

It’s a pleasure to be here today and be a part of this event. My being here has three purposes. Firstly to release the key results of the 2006/07 New Zealand Health Survey, to note the healthcare journey we have been on; and to outline my vision for the health sector for the next stage.

Heath survey
Let me start by saying that it’s well-known that we cannot manage what we do not measure – and that is why the information in this report is so important.

What the New Zealand Health Survey has given us is a wealth of data from an exceptionally wide ranging survey that provides concrete evidence - not anecdotal - about health services in this country and the health of New Zealanders.

This is the largest survey of New Zealanders’ health to date.

For the first time, we’ve been able to collect detailed information on child health issues, giving us significant insights into the overall health of our children.

It’s essential to have this sort of reliable and up-to-date intelligence if we are to improve and maintain the health of all New Zealanders.

My thanks and congratulations to those who have been involved in this – the fourth national population-based health survey carried out by Public Health Intelligence, the epidemiology group of the Ministry of Health, and the assistance of Dr Clark of the University of Woolongong.

Over 17,000 Kiwis volunteered their health information for the purposes of this survey. They can be assured that the results of the survey will be of huge interest to all.

So what exactly does this snapshot of our overall health tell us?

Encouragingly, the survey shows that most New Zealanders are in good health, have excellent access to health care services and are overwhelmingly positive about their dealings with health professionals. Our children are generally healthy, and nine out of 10 parents rated their child’s health as excellent or very good. Three out of five adults rated their own health as excellent or very good. That’s extremely positive.

I’m also delighted to note that the survey results reflect one of the biggest changes in the health sector since the last health survey in 2002/03. Our major drive to lower the cost of primary health care for all New Zealanders.

As a result of our seven-year, $2.2 billion Primary Health Care Strategy, the cost of seeing a doctor has fallen by around half, and standard prescription charges have been reduced from $15 to $3 per item.

And these cost savings for the public are echoed in the survey results, which is extremely good news indeed.

Only 1.7 percent of adults reported they could not see a GP in the last 12 months due to cost, while less than 1 percent of children were unable to see a GP because of cost. Māori and Pacific peoples are still the most likely to have cost as a barrier to accessing primary health care, though their access has also improved markedly.

Continuity of care is recognised as important because it improves the quality of care a patient receives. The survey shows 80 percent of adults usually see the same GP every time, which is great because it helps to build a medical history which can be important in determining health patterns and picking up underlying illnesses.

I want to briefly mention a few more positive primary health care trends so you can see for yourselves exactly where we are sitting.

We now know that:
• Increasing numbers of children aged under six are seeing a GP for free. And that there was an increase from 56 percent in 1996/97 to 67 percent in 2006/07 in the proportion of under six-year-olds whose last visit to a GP was free. • And fewer adults are NOT collecting their prescriptions because of cost. In the last five years the number NOT picking up their medicication has dropped from 3.4 to 1.5 percent.

These results show the Primary Health Care Strategy and our significant investment in primary care is proving successful.

Significantly, the survey also reports a slowing rate of increase of obesity in adults.

And that’s good news, because obesity is associated with a long list of adult health conditions, including cardiovascular disease, various types of cancer, type 2 diabetes, kidney disease and pulmonary embolism.

There has been no change in obesity for Māori adults since 1997. There was also no change in the prevalence of obesity for children since 2002.

However, smoking which has long been known to be a major cause of death and ill health has seen a significant drop in the rate of people who smoke on a daily basis. This has gone from 23 percent of adults in 2002/03 to 18 percent of adults in 2006/07.

These survey results have given us a number of reasons to celebrate.

To those thousands of people who have been involved in the policies and initiatives aimed at bringing about change in these areas, so more of us can live healthier, longer lives, you can be proud of your efforts.

I want to acknowledge the work of my two predecessors, Hon Annette King and Hon Pete Hodgson, in spearheading these changes, and to commend the work of the Ministry of Health, DHBs and all those involved in growing healthier Kiwis.

It’s not all good news though

Because we’re able to paint such a comprehensive picture of the true health of our nation, we’re also getting good information on the areas where we need to improve.

This will be pivotal in providing clear guidance for the further development, implementation and evaluation of many health policies and programmes, including some of the Health Targets.

It is clear that while much has been and is being done to try to keep all New Zealanders healthy, we still have a lot of hard work ahead of us.

The survey results confirm what many of us may already suspect – it wouldn’t hurt, and may well be of considerable benefit – if we did more physical activity, ate more fruit and vegetables and gave a higher priority to being smokefree.

Of real concern is the persistence of large, underlying health disparities for Māori and Pacific peoples compared with everyone else in New Zealand, and also for those people living in high areas of deprivation. It shows up in obesity-related diseases; in dangerous levels of alcohol; in smoking.

In our society, these are neither fair nor acceptable. It’s something we all need to be concerned about.

ALL sectors of government and the community need to work towards greater health equity.

That is the challenge for us all. We all have a role to play to move us closer to a New Zealand where everyone is able to have a healthy life.

Historical challenges
The survey results I have announced today, confirm that overall our health system is on a very successful performance improvement journey. Historically our health system has faced many challenges. The 2001 reforms, in particular saw our health system inherit some substantial historical hurdles.

The 1990s model of health care was characterised by the fall out of a system that wasn’t working: high entry costs to primary care; few people enrolled in chronic disease management programmes; and excessive waiting times for electives and electives on demand and not based on clinical criteria. On top of that were economic policies that saw the gap between rich and poor worsen markedly.

In short, what this resulted in was a noticeable lag in the health of New Zealanders behind that of other developed countries, especially for our Māori and Pacific peoples. The Health Survey has reconfirmed there is still work to do in this area.

The 2001 reforms
The 2001 health reforms and the establishment of District Health Boards represented a marked change in the provision of health services in order to address these challenges. The previous model of health care delivery was hospital-centric and focussed on funding contracts, prices and volumes.

Our new model of health care delivery has emphasised population health improvement, reducing inequalities in health status, better integration of services, and greater community involvement in health system governance.

The 2001 reforms aimed to provide a health system based on cooperation and a health system that puts people at the heart of health care. The objectives were clear. As a government we wanted to: raise the health of the population and reduce inequalities ensure better use of resources increase community involvement in decision-making, and create a non-commercial, collaborative and accountable culture in our valuable publicly funded health sector.

Since 2001 we have instigated a number of key initiatives and strategies to address historic challenges in New Zealand’s health system. There is momentum across the entire spectrum of the health sector to realise the goals of the New Zealand Health Strategy.

The launch of the Primary Health Care Strategy in 2001 signalled the most significant changes to, and investment in, primary health care services in over 50 years.

Since this government took office, Vote Health has increased at a much faster rate than GDP annual growth, on average 9 percent nominal growth per year. In part, this increase has been to fund services where there was an under-investment in the 1990s.

In this year’s Budget I announced that health services will receive $750 million per annum to focus on key areas within the health sector to ensure co-ordinated enhancement of services. Health services are constantly changing and evolving, and what we are focused on is providing a strategic, cohesive national approach to further health services.

Budget 2008
Budget 2008 continues our massive investment in health care for all New Zealanders: future proofing services, driving for quality, investing upstream in primary and public health, and focussing on children and youth – where early intervention counts the most.

• the sector will receive $2 billion over four years to future proof health services we can trust for population growth and cost increases. There will also be an additional $160 million over four years for more electives

• Actioning the Agenda for Quality will include $172.3 million over four years of investment for strengthened DHB collaboration and $40 million over four years for connected health Information Technology Systems

• Investing in wellness and public health includes $52 million over four years to fight obesity. There will also be an additional $80 million over four years to implement next steps of the primary care strategy. $164.2 million will be invested over five years for HPV vaccinations, $79 million over four years for oral health services, and $40 million for the pneumococcal vaccine. In addition, the government has recently committed to fast-tracking colorectal cancer screening.

Health is not only about ensuring accessible health services exist for those people who fall ill, its also about keeping people well and giving them the information to make healthier decisions.

We have invested in more doctors - a growth of just under 8 percent in 2006. We also have increased doctor and nurse salaries in recognition of the fact that we are competing in a world market for health professionals. And yes, the growth of the medical workforce has exceeded the growth of the non-clinical managers and staff who support them.

Delivering results
There is good evidence this investment is delivering results, I touched on some of those results earlier.

Over the last nine years life expectancy has risen 3.5 years for males and 2.2 years for females. Overall, our life expectancy exceeds what one would expect given our GDP and compares well with other OECD countries. Deaths from cardiovascular disease continue to decline and 5-year survival rates for cancer continue to improve.

The Primary Health Care Strategy has:
- reduced fees – PHOs offering very low cost access, covering more than one million enrolees, charge adults no more than $15 per visit access to GPs improved – consultations increased by 3 million over the first 3 years of the Strategy, and there has been a large fall in the number of adults reporting an unmet need for GP services.

Involvement in long-term conditions management programmes has increased: more and more people are enrolled in Diabetes Get Checked, and in Care Plus, our structured management programme for those with multiple chronic illnesses the uptake of publicly funded statins, to reduce cardiovascular disease risk, is now at levels comparable with Australia.

Indicators of hospital care quality show very positive trends. Hospital mortality rates have been steadily declining and patient satisfaction with hospital services remains high.

There has been growth in electives services volumes while maintaining relatively short waits. Over the last six years we have seen the number of case weighted discharges increase by over 12 percent. And we have delivered over 8000 additional joints and over 4000 additional cataracts since 2004/05.

Investment in mental health has delivered results – we have seen a significant improvement in public attitudes towards and acceptance of those with mental illness, and early detection of mental illness has improved.

In the last year alone the proportion of those with a long-term mental illness who also had a relapse prevention plan in place increased from 35 percent to 64 percent.

Furthermore, health outcomes for children are improving – since 1996/97 there has been a significant increase in the number of under 6’s whose last visit to the GP was free. Use of emergency departments for children has dropped. Over 80 percent of adolescents accessed oral health services in the last year. And we’ve also seen a recent 5 percent increase in the number of two year olds who are fully immunised.

Challenges remain
In spite of all these achievements and gains, significant challenges remain.

Central to overcoming these changes is taking an integrated approach across the primary health sector and seamless interchange between primary and social layers.

Securing a flexible and adequately supplied health workforce will also be critical to the future of health care.

Health expenditure projections indicate we need to continue to improve health outcomes with proportionately smaller increases, even as public expectations of our health system continue to rise.

We will therefore need a real and a sustained focus on value for money and improved productivity to meet these substantial challenges. This year I am tying part of DHB budgets to improvements in service quality and procurement efficiency.

A vision for the future
I see three key areas as being crucial in taking forward the gains we have made.

- taking primary and preventative health care to the next level strengthening health services we can trust And taking a strategic approach to some key enablers of the system.

Taking primary and preventative care to the next level Primary care and prevention services are key to addressing the burden of long term conditions. We have already created an environment of low fees, greater investment in health promotion and services that increase access in the primary health care and community setting.

Long term conditions continue to be the most significant contributor to early death and premature disability among our populations, and our most vulnerable communities bear a greater burden of early onset and faster disease progression than other New Zealanders.

A determined focus on disease management for key disease groups is at the heart of the public health strategy. Better access to screening and development checks, diagnosis, and supporting the continuum of care for long term conditions is a priority.

So too is a broad view of the underlying social determinants of health; like housing, sanitation, nutrition and lifestyle issues that impact inexorably on the need for primary and secondary layer interventions. This week and next, the Health Select Committee is considering key submissions and amendments to the Public Health Bill. I urge the Committee to report the Bill back so we can pass it into law.

The disparities in health outcomes between European, Maori, Pacifica and other migrant New Zealanders have diminished but remain unacceptably high. Our children and young people, and our senior citizens are also among the most vulnerable members of our society.

In all cases we need a relentless approach to implementation and good data to ensure we get the best results possible.

Strengthening health services we can trust New Zealanders expect that the very significant investment they make in health care will be well stewarded. They expect safe, high quality services will be there for them when they and their families and whanau need them.

I have come to the view that greater co-ordination throughout the entire health system is essential to long term sustainability.

As services are becoming more complex and interdependent, planning at a district level will not be sufficient on its own to meet the medium to long-term needs of the system. The continued success of the DHB system requires action across the sector: amongst DHBs themselves, providers, the Ministry of Health and our team of Health Ministers.

There are some excellent recent examples of partnership arrangements being developed, involving arrangements such as joint purchasing and regional clinical networks. I strongly encourage (and in some cases will require) these collaborations to continue, especially where they enable better operational effectiveness through increased clinician input.

The quality agenda
Safety and quality are areas which will be continually placed at the top of the health and disability support sector’s agenda. The whole sector has a role to play in supporting this priority - whether it be DHBs tying part of their budgets to progress on the safety and quality agenda, the Ministry of Health working closely with DHBs to resolve specific blockages, or the whole sector combining their efforts via the National Quality Improvement Committee.

Quality must be a core strategy of any organisation or system, and quality is the core operational responsibility for every person in this system.

Enabling a strong, sustainable health sector for the longer term Closer relationships also enable the spread of innovative ideas and practices, which is vital to performance improvement being achieved. Access to information, resources, tools and systems helps provide the sector with capability needed to capitalise on the innovations.

To achieve this over the longer term, a clear nationwide focus on the key long term enablers will be further developed. Considerable investment has already been made in building a strong and sustainable health sector workforce, but we must take a unified national approach to meeting remaining needs.

Long term productivity and quality gains also depend crucially on improved flows of clinical and operational information between providers. Relevant clinical information should follow the patient wherever possible to facilitate seamless interaction along the patient care journey.

DHBs must be networked with high speed broadband connectivity and interoperability to enable the sharing of data and the benefits of telemedicine. Achieving these gains will require a long term and centrally coordinated approach to investment in information and communications systems, that has just been given a big boost in this year’s Budget.

To sum up, I’m proud of the results of this Health Survey. I’m proud of the gains we have made and those we will make.

I’m proud of the 60,000 health professionals who give their best every day – often under stressful circumstances – to secure the gains of lives saved and of bodies healed that these survey results represent.

I’m proud of the difference this government has made by setting up a Primary Healthcare Strategy that is clearly delivering on its promises; and a DHB network that is consistently improving; and for the ambitions and exciting plans to be realised.

Today the credit belongs to all of you who have participated in and pulled together this health survey. It is my pleasure to officially launch ‘A Portrait of Health: Key Results of the NZ Health Survey’.

Thank you all.


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