Chadwick: Address to NZ Medical Association
Hon Steve Chadwick
Associate Minister of Health
19 June 2008 Speech
Address to NZ Medical Association, Conference of GPs – Continuing Medical Education
Morena, and warm greetings to you all, it’s a pleasure to be here this morning and to have the opportunity to present, on behalf of Labour, our vision for New Zealand’s health system, and in particular for Primary Health.
I’d like to begin by acknowledging Cameron McIver – CEO of the NZMA, Dr Peter Foley - the NZMA Chair, Dr Mark Peterson – Chair of the GP Medical Council, and of course Mr Tony Ryall - Opposition Health Spokesperson, with whom I look forward to debating some of the issues shortly.
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 competitive 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 recently released New Zealand 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
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.
We’ve backed the Primary Health Care Strategy with the funding to make it a reality – some $2.2 billion over seven years. Since this government took office, Vote Health has increased at a much faster rate than GDP annual growth, on average 9 per cent nominal growth per year. In part, this increase has been to fund services where there was an under-investment in the 1990s.
This year’s Budget announced that health services will receive an additional $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.
There is good evidence this investment is delivering results. The New Zealand Health Survey was released earlier this month – over 17,000 New Zealanders contributed to its results. It found that only 1.7 percent of adults reported that they could not see a GP due to cost.
In terms of outcomes, its this sort of access that, over the last nine years, has seen life expectancy rise 3.5 years for males and 2.2 years for females. Overall, our life expectancy exceeds what one would expect given our GDP, and it 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.
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 per cent 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.
spite of all these achievements, significant challenges
Central to overcoming these changes is taking an integrated approach across the primary health sector and building a 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, Health Minister David Cunliffe is tying part of DHB budgets to improvements in service quality and procurement efficiency.
A vision for the future
The Labour-led government’s team of Health Ministers see three key areas as being crucial in taking forward the gains we have made. Let me deal with two of them briefly, because here I want to focus on the third.
Firstly, New Zealanders expect safe, high quality services will be there for them when they and their families and whanau need them. This government has come to the view that greater co-ordination throughout the entire health system is essential to long term sustainability. We want to ensure that our DHBs are working cohesively together as a whole. There are some excellent recent examples of partnership arrangements being developed, involving arrangements such as joint purchasing and regional clinical networks, and I want to strongly encourage these collaborations to continue. We want to see the best standards rolled out from the leaders to the rest.
Secondly, we’re committed to building a strong, sustainable sector for the longer term. This requires a strategic approach. We have and will continue to invest in a strong and sustainable health sector workforce. But there are other long-term gains to be made for productivity and quality from closer relationships. For example, relevant clinical information should follow the patient wherever possible, to facilitate seamless interaction along the patient care journey. Achieving this requires co-ordinated strategic investment in communications and information systems. This year’s budget provided a big boost in that regard.
The other aspect to building a strong sector is quality. We each have 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
Taking primary and preventative care to the next level
Our third key priority, is taking the Primary Healthcare Strategy to the next level. 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.
These services are key to addressing the burden of long term conditions. 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. That is why better access to screening and development checks, diagnosis, and supporting the continuum of care for long term conditions will continue to be a priority.
We’ll continue to attack underlying social determinants of health; with policies like affordable housing through income-related rents for state house tenants and the Healthy Homes initiative; by promoting healthy eating and action through the HEHA initiative; like leading initiatives on reducing family violence; and by supporting incomes through policies such as Working 4 Families. If our opponents had their way, no-one is quite sure which of these would remain.
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.
The PHO system is delivering results for New Zealanders. However, in stepping up primary care, we also want to ensure that our PHOs are working beyond simply the provision of GPs. We want to encourage you to take in a whole range of wrap-around services so we know that we’ve got the most appropriate clinician delivering the services that patients need.
While I’ve talked about our desire to broaden the capacity of PHO’s, I also want to acknowledge the contribution of GPs to the PHO system. Your work will remain fundamental to the ongoing goal of stepping up New Zealand’s primary health care system. You are hugely valued.
This Labour-led government has always stood for strong, accessible health services – and that is not about to change. There is much to be done, but there is a great platform to build on.
Our vision is and will remain, to build the kind of health system New Zealanders expect, and know they can trust.