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Ryall: Address to HealthCare Providers NZ

Tony Ryall MP National Party Health Spokesman

13 August 2008

Address to HealthCare Providers NZ Conference

At last year's National Party conference, John Key launched the party's aged-care discussion paper "Choice, Not Chance for Older New Zealanders".

National's Aged Care spokeswoman Jo Goodhew MP travelled the country listening to many of you, your staff, and most importantly, your residents and other older New Zealanders. We gained a clear understanding of the pressures and opportunities facing the aged-care sector and older New Zealanders.

Older people told us they wanted to remain independent as long as possible, and that they wanted to know their caregivers - not have them change all the time.

Families shared these concerns. They also worried about the pressure of caring for their loved ones at home and how this impacts on their health, particularly because of difficulties arranging respite care.

Care providers told us about workforce shortages, never-ending bureaucracy, and constant battles over contracting and finance.

We have received your four policy aims for this year, and I will address those in my speech today, as well as make some additional comments.

Jo Goodhew and I will be releasing National's additional aged care policies closer to the election.


The past 20 years have seen dramatic changes in caring for older people around the world. As has been noted, older people are encouraged to remain in their homes for as long as possible and rest homes are no longer the inevitable destination for the very old. More and more of the residential care has shifted to non-government providers.

The care needs - or acuity - of older New Zealanders in aged-residential care is getting higher and higher. And this is putting considerable pressure on the services you offer older New Zealanders.

By 2026, almost a million New Zealanders will be over 65 years of age. That's more than double the current number of people.

Most importantly, the number of New Zealanders over the age of 85 will increase from nearly 50,000 to more than 125,000.

But the ageing population is not the only challenge facing the health sector.

One of the most significant demographic factors is the northward flow of population and the growth of greater Auckland. By 2026, it is projected Auckland will grow by 46% compared to a national population increase of just 22%.

The Ministry of Health estimates that a third of DHB populations will shrink, a third will stay the same, and a third will expand significantly.

People's expectations are also changing. People want greater choice and quality. They want a more personalised service that meets their individual needs.

Clearly these trends will have a huge impact on the demand for aged care services.

Our ability as a country to meet these demands will depend on two things: how prosperous we are as a country, and how well we use our resources.

Wealthier countries can afford to pay for better aged-care services. Policies that help build a more prosperous future for New Zealand are at the heart of National's blueprint for change.

At the same time, we must get the most out of our existing resources. That means investing in aged care services as wisely and effectively as we can, and making sure that services are responsive to the needs of older New Zealanders.

Planning for the future

Fifty years ago, New Zealand built numerous schools, hospitals and houses to meet the needs of a new generation we now know as "the baby boomers".

As this generation enters retirement, New Zealand faces a new, yet similar, challenge: we do not have the facilities or services to care for these ageing people.

Health policy-makers have not begun preparing for the extent of care and support that our ageing population will need.

Most individual New Zealanders have never thought about the likelihood of having to provide personal care for loved ones, and then needing it for themselves.

But not only is the Labour government failing to make plans for this, neither are most individuals and families.

The greatest challenge ahead will be answering the need for hands-on, personal care for older New Zealanders.

New Zealand needs to anticipate the future demand for aged residential care. And then develop long-term plans to progressively lift the number of beds available; making sure they are in the right place at the right time to meet our changing needs and expectations. We need to start planning now.

* National will work with providers and consumers groups to develop long-term plans to meet the future demand for aged-care services and beds.

And yes, this work should include updating the current costing model.

But we also need to act now to provide more certainty and security for current and future services. Aged residential care is a public-private partnership, where the government - as the principal funder - can do more to create the platform for investment and improved services.

* National will ensure that the subsidy paid to the elderly in aged residential care will be indexed to the health sector's inflation-adjustor the Forecast Funding Track (FFT).

* National will also work towards multi-year contracts with aged-care providers.

We believe these commitments will help build a sustained increase in aged residential care beds into the future.

Standards of care

Recent media reports on the quality of aged care and reports of elder abuse are deeply worrying. Elder-abuse stories leave New Zealanders unsure about their safety in their vulnerable older years.

It is vitally important to maintain public confidence in the standard of care being provided in the country's rest homes. The events of the past few weeks have really shocked the public. And people are looking for greater assurance of quality care for our seniors.

We don't believe there's widespread abuse in your rest homes.

Yet, there is already a significant amount of auditing underway. The Ministry of Health, the DHBs, and occasionally ACC, are all auditing residential care facilities.

We're told there is much unnecessary duplication. And different audits produce contradictory findings with inconsistent approaches by auditors.

Certification and auditing should provide an assurance of quality care for residents and their families. Audits should lead to continuous improvement, better standards and more information for providers, carers and families. What's needed is smarter and more effective auditing.

* National will review the auditing and monitoring of rest homes, introduce spot auditing and public disclosure of audit and compliance reports.

During our consultation we heard many older people talk about receiving care from several different providers at home at the same time. Older people and their families were confused about where to turn to for services like respite care and safety aids.

I should note here that it is increasingly difficult for people to find respite care in many parts of the country. This shortage undermines the health of both the carer and the dependent older person.

Similarly we heard stories from older patients discharged from hospital or sent home from the emergency department without the support or aids they require.

What's needed is a more collaborative approach to providing community based services for older people. Over the past year I've given several speeches on Australia's use of clinical networks across primary and secondary services. Such networks could provide for better co-ordination of older people's care pathways.

* National will improve the co-ordination of care for older people through regional clinical networks across primary care and hospitals.

National's plans around integrated family health centres, with multi-disciplinary teams, will also help improve standards through their focus on prevention and care closer to home.


Workforce and standards of care go together.

A high turnover of staff undermines the safety, quality and sustainability of aged care services. "Continuity of care" is a key driver of quality health outcomes, and a constantly rotating parade of nurses and health care assistants does nothing for residents.

More recently aged residential care providers have faced pressure from higher DHB nurse salaries. Many providers have increased nurse salaries to meet this pressure, and this has a flow-on affect on the ability to meet pay demands from other staff in rest homes.

Caring for our older citizens is hard work. I don't need to tell you about the challenges you and your staff face. But it is important that rest homes provide quality care with good nursing supervision.

* National will be announcing additional funding to assist in maintaining quality care and supervision in the country's rest homes before the election.

We also think it is important to improve training for your carers. This will allow them to complete qualifications that are appropriate to their care giving roles, and then be remunerated for the skills they have acquired.

Training should be relevant for both the home-based and residential are sectors, and it should be portable.

Aged care is a growing workforce, where training and career pathways will be even more relevant. You will recall that in our aged care discussion paper we sought feedback on establishing an aged care sector specific industry training organisation. And yes, we received tremendous support for this idea.

* National will support you in establishing an Aged-Care Industry Training Organisation.


As I said earlier we will be releasing further initiatives to support the care of older New Zealanders closer to the election.

I am not going to pretend that every problem facing the health system can be fixed overnight. Nor should we pretend that the health system is incapable of doing better. Because it can. The National Party's priority for health is simple: It is not a flood of reports, visions, and committees.

It is delivery.

If the health service is to deliver for people it has to focus on what matters to people. Your priorities must be the health service's priorities. Faster service. Higher standards. Better care.

I am very optimistic about the future of the New Zealand public health system. The people I have met have been thoughtful, professional, and dedicated.

When I asked to become Health spokesman after the 2005 general election, I did so because I believed our health service could be doing so much better. A country like New Zealand should be able to lead the world in responsive patient care.

Ladies and gentlemen, the future isn't about turning the health system upside down again. We are not seeking a revolution but a sea change - a sea change of attitude that lets people in health do their jobs better, based on trust and respect. We'll put patients at the centre of the health service.


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