New Zealand Medical Association –GPCME conference

Hon Tony Ryall
Minister of Health
10 June 2011

Speech

New Zealand Medical Association –GPCME conference

Rotorua

The New Zealand Medical Association is the country’s largest medical organisation. Your members come from all disciplines within the medical profession, and include specialists, general practitioners, doctors-in-training and medical students.

So it’s a real pleasure for me to be here today, the fifth time I’ve joined you at this conference.

Today I am going to cover:

Our recent budget and the international context

Progress in dealing with the health workforce crisis we inherited

The importance of clinical integration and care closer to home

Our focused work on prevention and the wider determinants of health.

Canterbury

First though, may I acknowledge the outstanding work of so many of your members and your organisation in support of the people of Canterbury.

Despite many losing their own homes, Canterbury health professionals and administrators have worked tirelessly caring for the seriously injured and their families particularly in the days following the tragic February quake. That commitment continues today as they work in often challenging conditions to support patients, families and communities.

We really have seen the best of New Zealand in the response to the earthquake, and in particular, the best of our health service.

Public Finances

Just as the earthquake has changed the landscape in Christchurch, so it has changed the landscape of public finances.

The Treasury estimates the total financial cost of damage from the earthquakes at around $9 billion for the taxpayer alone

In addition, the wider economic impact of the earthquake could reduce total tax revenue by $3 billion in the next tax year.

The global financial situation is similarly challenging.

Around the globe, governments are making tough and often unpopular decisions to make ends meet.

And health systems have not been immune from those decisions.

In Britain, many public servants, including doctors and nurses, are facing a two-year wage-freeze.

There are large-scale savings planned within the National Health Service totalling GBP 20 billion. It is estimated 50,000 NHS staff will be made redundant over the next few years.

Already there are reports of cutbacks of almost 1,000 jobs in two London hospitals alone – including significant numbers of nurses and doctors.

In Ireland, the former Health Minister was pelted with red paint by protesters as tempers grew over her Government slashing 5% off the health budget.

The Irish had already cut public service salaries by up to 15%, including doctors, nurses and teachers.

In Canada, the provincial health authorities are now taking tough measures to curb health costs.

Some of these include introducing means testing, halving generic drug prices, and controls on the salaries of top hospital executives and doctors.

Newspapers have reported 2,500 nurses in Ontario are losing their jobs.

Fortunately New Zealand's economy has weathered the storm better than most.

But we are still borrowing an average $300 million a week to protect and grow our important social services.

This year alone the Government's cash borrowing is expected to be around $16 billion.

Health Finances:

And it’s within that context that this year’s Budget makes a remarkable additional $585 million available for health initiatives…the biggest single item and close to half of available funding.

Our commitment to protect and grow the public health service has seen the Government invest $1.5 billion of extra new money into the public health service over the past three years despite the worst economic situation in 80 years.

We’ve been able to maintain and improve key services and infrastructure.

The Budget includes a strong commitment to improving services in a number of key areas: more elective surgery, additional Plunket visits focused on new mums, improvements in maternity safety and quality, more for medicines, higher subsidies for dementia beds, a significant boost for disability services, and $94m more for GP subsidies over 4 years.

The Budget also invests in stamping out rheumatic fever. Eradicating this third world disease from our shores has actually been a health priority since 2001. But nothing ever happened. Except more poor kids got the disease.

A $12 million investment in the budget this year aimed right at this disease will support a massive campaign across high prevalence communities involving school based sore throat clinics for over 22,000 children.

Workforce:

We have invested another $18 million for an additional 40 medical school places…taking us to 120 of the 200 promised extra places over 5 years.

Once those students graduate, the voluntary bonding scheme we introduced offers them student-loan write-offs in return for working in hard to staff areas or specialties. We’ll soon have over 1700 young doctors nurses and midwives on the scheme.

The global financial crisis has had a marked impact on the workforce across the economy.

Staff vacancy and turnover rates in hospitals for example are at an all-time low.

Since November 2008, public hospitals now employ over 500 extra doctors and over 1000 extra nurses.

There are more doctors and nurses employed in the public health service than ever before.

And there are more general practitioners working in primary care than at any other time.

Latest Medical Council workforce data confirms this, as does membership of the Royal College of GPs.

But there are still shortages in some specialties and in many rural areas.

We have also sought to focus on retaining our health professionals through providing more opportunities for clinical leadership and research.

At a time when many other countries are reducing their workforces and their investment in health, we have been growing and protecting our health workforce.

Clinical Integration:

Population ageing, new technology and medicine, and rising costs are putting huge pressure on health services around the globe. To help meet those challenges here with the resources we expect to have… means we need to do things differently … and that means in a practical sense greater clinical integration.

Clinical integration is key to our prudent strategy future-proofing our health service to better deal with those increasing demographic and financial pressures.

If demand for health services is to double over the next 10 years, then we are not in a position to double the number of hospital beds nor double the number of doctors and nurses.

That is why we need to integrate care by moving more services to where they are more convenient for patients, closer to home ... and that platform is in the community…primary care….creating greater continuity of care, reducing waste and duplication.

Too often patients find themselves admitted to hospitals because of a lack of alternative forms of care and support, or because their GP can’t help them with ready access to a hospital specialist or nurse, or to a vital diagnostic test.

Patients with chronic diseases like diabetes and heart disease need access to integrated care instead of shuttling backwards and forwards from hospital to GP and back again.

Solving this means integrating services across hospital and community in ways that put the patients' needs at the centre of how care is provided.

But that doesn't often happen now because the necessary primary care teams and infrastructure do not broadly exist.

And the historical divide between hospital and community clinicians doesn’t make it easy.

That is why the Integrated Family Health Centre concept in particular is pivotal to the future delivery of patient-centred care.

It’s about building capacity to deliver more complex care…in the community…in partnership.

These are happening:

#1. The West Coast primary care initiative which is integrating advanced IT with a geographically distant GP to allow useful real time remote GP consulting.

#2. Integrating busy general practice needs for radiology investigations via IT referrals and direct access to diagnostics to avoid all manner of delays in getting the tests

#3. Using better focused and integrated GP/hospital management of identified complex chronic care patients to prevent hospital readmissions and provide better quality of life for the patient

#4 Establishment of integrated health care centres where many kinds of health care delivery work side by side - GP, physio, pharmacy, minor surgery, x-ray, and in some places the ability for overnight care…all of which function more efficiently in the traditional area between GP and hospitals, makes full use of GP training and knowledge, and will prevent some expensive and time consuming hospital admissions.

These have all been driven by good innovation from the ground up...the ideas and plans of the experts at the coal face…the medical professionals...which is how it should be.

In public hospitals nurses and doctors are leading the drive to lift productivity and time spent with patients on the ward.

And the government has listened and adopted and supported many of these initiatives as the way to go. And we are looking forward to more in this area.

Increasingly local hospital and community clinicians around the country are talking and working together in ways they haven’t before. This alliance leadership approach is our way to encourage this clinical integration.

Yes it’s ambitious. Yes it’s complex. If it was simple it would have happened years ago. But it is the right thing to do and I know your profession wants to make it work.

We are seeing more clinical pathways, more direct referral for diagnostics, more hospital specialists working with GPs in the community.

As I said earlier, this all about preparing the public health service for the future. Building the infrastructure and professional teams we need in order to support clinical integration and better patient care.

Preventive Health targets:

I would like to take this opportunity to thank you for your contribution towards achieving the national health targets. Faster emergency care, more elective surgery, and faster cancer treatment are all about improving the care your patients receive.

But the National Government has also selected a discrete number of high impact, high return preventive health targets.

We’ve deliberately focused on fewer, more achievable goals.

The results have been immediate and successful, even internationally significant.

For example, New Zealand had a poor record for fully immunising its children.

Since we've set a national health target of fully immunising 95% of two-year olds – rates have shot up.

From around 70% only three years ago, to 90% of two year olds now fully immunised –– across all socio economic and ethnic groups. And it's still climbing…on track to meet our goal.

Not one hour from here in the Eastern Bay of Plenty, the Maori immunisation rate is now higher than the general immunisation rate!

On tobacco, this government has created a turning point in the campaign against smoking…with more actions than ever before on a scale never seen before.

The Government has passed an unprecedented 30% increase in tobacco tax…the most effective way to prevent and deter smoking. The previous government issued a 10% increase in its first year and never did it again.

Central to our efforts is the national health target of hospitalised patients who smoke receiving advice and help to quit there and then. This is engaging the public health service like never before. From zero to 90% in six DHBs in less than two years.

In general practice you’re at 71%, and we’ll bring you into the target next year.

And we have backed this effort with massively improved access to smoking cessation treatments…up 82% in 18 months.

Legislation to phase out tobacco displays will soon pass. And plain packaging is inevitable.

Diabetes and cardiovascular disease also affect a growing number of New Zealanders. It’s an important target to better prevent and manage diabetes and heart disease.

Over the next year we are stepping up the effort on CVD risk assessments Thank you again for your support and work on the health targets.

But ladies and gentlemen, Health cannot do it alone.

Wider Determinants of health:

Keeping kiwis healthy also means looking beyond the health service.

We have introduced a significant public subsidy for insulating the homes of tens of thousands of New Zealand families: $360m for 190,000 homes.

We know that warmer, drier homes bring health benefits, especially for those with respiratory illness or other conditions.

We’ve done 100,000 homes in two years.

I am confident that this will come to be seen as the single most significant new public health initiative of the decade.

History will show that this programme made an enormous impact on improving the public health, and the futures of kiwi families.

And of course, the Whanau Ora policy is a major step forward in helping families take responsibility for improving their lives… to work on all the things that impact on family well-being. Whanau Ora aims to end the 5 cars up the drive way syndrome… where endless agencies work on individual problems in isolation of each other and the needs of the whole family.

Already 14,000 whanau members are involved, with over 3,200 whanau assessments already undertaken by the National Hauora Coalition.

Whanau Ora is about a coordinated service meeting the needs of individuals and families. Contracts are integrated and services work together. It’s a model of what the future could look like.

Conclusion:

Ladies and gentlemen, I've got the best job in government. I look forward to going to work everyday. It’s great to work with so many smart and committed people like you. Over the past three years, the government has shown its determination to grow and protect the public health service. We’ve made real progress in services for patients, in tackling the workforce crisis, and in clinical leadership.

Over the next few months we will be presenting our plans for the next three years. And we would value your trust and mandate to keep the health service improving.

Thank you for what you do.

ENDS