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NZ Institute of Health Management Speech

26 June 2008 Speech Notes

NZ Institute of Health Management

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

It’s a pleasure to address you today. The focus of this conference is “The New Zealand Health Management Sector - Alive and Well”.

I think that’s a fairly good description of the current state of not only our health management team but of the wider health sector.

Today I’m going to paint a broader picture of the healthcare journey we have been on and to outline my vision for the health sector. I’m going to talk to you about the investment we’re making in health and the results that have been delivered to date. I also want to spend some time focusing on challenges for the sector and our future direction.

Historical challenges
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.

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

The current health care model focuses on 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 in particular signalled the most significant changes to, and investment in, primary health care services in over 50 years.

Since then we have seen progressive implementation of a new, lower cost, accessible and more integrated health delivery system.

Delivering results

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.

Budget 2008
Budget 2008 continues our massive investment in health care for all New Zealanders with another $750 million in new funding for 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.

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 is 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.

Our numbers of frontline health workers have grown faster than any other group in the health sector. We have done this while the percentage of workers in the management and administration areas have remained unchanged.

As you will know from your own roles, clinical staff need support - you can’t have surgeons working on reception. It’s important that services aren’t compromised by lack of resources.

It’s important that we hold onto our talent so we’ve increased the number of training places available for first year medical students. We’ve also significantly increased wages for nurses.

Government is well aware of all the issues in the health sector and has actively engaged with health sector groups. As a result you know see clinical boards at DHBs. Communities have a say in the running of their health services through democratically elected boards

This government does support 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.

Long term conditions continue to be the most significant contributor to early death and premature disability in New Zealander. 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. These include housing, sanitation, nutrition and lifestyle issues that impact on the need for primary and secondary layer interventions.

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.

I want to re-examine our primary health care service delivery structures and incentives to ensure appropriate “vertical” linkages between DHBs and primary care providers. I also want to look at appropriate “lateral” integration between GPs and other primary providers.

In all cases we need a relentless approach to implementation focused on key health targets 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 medium to long-term. If the DHB system is to continue to succeed we need action across the sector. This means between DHBs, providers, the Ministry of Health and our team of Health Ministers.

There are excellent examples of partnership arrangements being developed, including joint purchasing arrangements and regional clinical networks.

I strongly encourage 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. This could 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 a sector-wide approach 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 enable sharing innovation and practices. This 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. 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.

As I have said today, as a sector we have overcome some significant challenges in the last nine years. We have instigated a number of key initiatives and strategies to improve our health system and we are now seeing positive results.

We are in a strong position to overcome the remaining challenges and make further improvements and gains in health. We must take a holistic approach to do this by working collaboratively across the sector.

We have one of the best health systems in the world. A health system that we can all be proud of and one that can only get better.

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.

You can be proud of the contribution you are making as managers in the sector.

On that note, I wish you all the best for the remainder of your conference.

Thank you.


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