Hon Tony Ryall
Minister of Health


14 September 2012 Speech notes
Hawera Integrated Family Health Centre opening

Thank you for inviting me to open the newly refurbished SouthCare integrated family healthcare centre in Hawera.

This week Social Development Minister Paula Bennett announced another in a series of plans to put the right incentives into the welfare system. Many of the welfare reforms are about incentivising people to get into work.

It’s fashionable amongst some to see this as unfair...that we shouldn't have a welfare system that wants to help people become independent.

The international research is getting stronger by the day – having a job is good for your health – and being unemployed is not.

If a person has a health condition, or has had an injury, getting back into a work routine sooner, helps them get better faster.

British medical researcher Dame Carol Black* says ‘For most people, their work is a key factor in their self- worth, family esteem and identity. So if they become sick and are not helped quickly enough, they can all too easily find themselves on a downwards spiral into long term sickness and a life on benefits.’

The British 2006 research paper, "Is Work Good for your Health and Wellbeing"*, found strong evidence that unemployment is generally harmful to health – including higher mortality, poorer general health, and poorer mental health.

One of the authors – Gordon Waddell – has argued that ‘a sickness certificate is one of the most powerful, potentially dangerous treatments in a GP’s armamentarium’ (word of the day!)

The report finds that unemployed people visited the doctor more, took more medication and are admitted to hospital more often.

Australian longitudinal studies* back this up. They say once people go off sick for a long time – then they’ve started down the slippery slope that leads to permanent unemployment and poorer health.

Australian academic Dr Debra Dunstan found that after 12 weeks off work the risk of prolonged work absence increases dramatically.

At the same time, the negative effects of ‘worklessness’ start to emerge she says.

People deteriorate – physically and psychologically.

Relationship pressures increase significantly and that sense of self identity and self-worth decreases at a similar rate. Their health or rehabilitation suffers.

In fact long term worklessness has been equated with smoking TEN packets of cigarettes a day.

Evidence shows people with common health conditions can be helped back to work following a few basic principles of good healthcare and workplace management from their GP or practice nurse.

It would be fair to say that most groups – those representing people with disabilities, employers, unions, insurers - agree that encouraging sick, injured or disabled people back to work sooner improves their health, their wellbeing and their personal circumstances.

And health professionals do too. Last year our Royal College of GPs endorsed the Australasian Consensus Statement on the Health Benefits of Work.

The take home message from these findings is there is very good evidence underpinning the work the government is doing – particularly in welfare reform.

By addressing Health, Work and Well-being, we can make a real and substantial difference to the health of individuals and the cost to businesses and the economy.

SouthCare IFHC

It’s great to be here to celebrate this exciting redevelopment with you.

Here in Hawera, the town that is ‘Alive with Opportunity’.

Firstly, I would like to acknowledge my colleague and local MP Chester Borrows.

I would also like to acknowledge the people who have been instrumental in the completion of this project – Taranaki DHB chair Mary Bourke, SouthCare general manager Kevin Simpson, SouthCare Trust chair Ella Borrows, Pharmacy owner Andrew Robertson, and the Midlands Health Network general manager Keriana Brooking.

You and your staff have put considerable effort into redeveloping this center and I thank you for your commitment to meeting the health needs of the Hawera and Manaia communities.

Better sooner more convenient health care

This is a modern and spacious building that provides you with flexibility to cater for a range of staff and services into the future.

But more important than the physical changes made to the building, are the changes made to the way services are delivered.

An exciting aspect of the redevelopment here is the space that has been created for medical care assistants.

I hear that since the three medical care assistants started a few months ago the length of time people wait for their appointments has significantly reduced and your reception area is no longer full with people waiting. This is a great achievement.

As the first point of contact for patients, medical care assistants triage a patient and decide whether they are best treated by a doctor or practice nurse. They also carry out tests prior to their appointment, such as taking blood tests or recording their blood pressure and weight, so the clinician has everything they need when the patient walks in.

This government is committed to delivering New Zealanders with better sooner more convenient healthcare, and this is a great example of this.

You have also expanded the role of nurses by offering patient nurse consultations. This has also increased the number of patients seen.

Nationally, over 2.3 million practice nurse consultations were provided last year, and as the role nurse’s play in the general practice team continues to grow so too will the number of nurse consultations performed.

The practice nurses here run screening and preventative care programmes such as immunisation and cervical screening. They care for patients with long-term conditions like diabetes and asthma and have a significant role around care coordination for patients and their families.

You are also one of the few general practices in the country who has a cardiac nurse practitioner that provides a heart disease programme.

With nurses utilising their full range of skills, doctors have more time to better manage complex patients. It’s a win-win situation for general practice teams and patients.

We need to develop smarter and more practical ways of utilising our health workforce to deliver services, and innovative ways like this are the way forward.

Primary and secondary clinicians working more closely together, is also crucial to our public health service of the future and I have heard some great examples of this already happening here.

I understand a local GP carries out cardio ETT testing for patients at Hawera hospital so they no longer have to travel to New Plymouth. Another GP who is trained in emergency medicine works at the Hawera ED when they are busy or there is staff illness.

Pressure on health budgets

As we all know, the demand for better and more health services grows every year. If demand for health services is to double over the next 10 years as some experts suggest, then we are not in a position to double New Plymouth Hospital or double the number of doctors and nurses.

Population ageing, new technology and medicines, and rising costs are putting huge pressure on health services around the globe.

Internationally, health budgets are being cut dramatically.

Last week, the Irish Health Ministry announced a $200 million cost reduction package in an attempt to reduce their deficit which is expected to reach $800 million by the end of the year.
Some 600,000 home help hours are being cut, the second time this service has been cut this year. They are also cutting a further $15 million from other support services for elderly and disabled people.

Agency staff numbers will be cut by half and overtime will be reduced by 10 per cent. The head of their Ministry has confirmed that hospital beds and theatres will be closed as a result of the significant staff cuts.

In Greece, there are reports of maternity hospitals refusing to release new born babies to parents if the bill hasn’t been paid.

And across the ditch, more than 2,700 jobs will be axed from Queensland Health as part of the State Government's cost-cutting campaign.

In contrast here in New Zealand, despite the world’s worsening debt crisis that sits behind all these measures, the National led Government has lifted health spending by around $2 billion over its four years.

This government is commitment to protecting and growing public health services and is spending $14.12 billion in 2012/13 on health – the biggest investment ever.

In 2009/10, while other OECD countries were reducing health spending, New Zealand had a 3.4 per cent increase in real health spend, the third highest of 27 nations. As a result, New Zealand has risen to having the fifth equal highest spend on health as a proportion of its GDP.

But like health services around the world, the pressure on our health budget is not going to go away. It’s important for everyone working in the public health service to recognise that we all play a role in ensuring we deliver services in the most economic and efficient way.

Primary care in New Zealand is evolving to combine accessible general practice, with the benefits of working at scale with others through co-location or being networked together.

Providing integrated care closer to a patient’s home is pivotal to the future delivery of health services in New Zealand.

We have worked together as a public health service to ensure that slower health expenditure growth has been achieved without reducing service or clinical staff. And we will need to keep working together over the coming years to keep achieving that.

Good health is hugely important to New Zealanders. A strong public health service gives families peace of mind – knowing that the care they need will be there, when they need it.

And that’s the priority of our government too.

I would like to thank you and your teams once again for your hard work and wish you well for the future.

References:
Working for a healthier tomorrow. Dame Carol Black. March 2008 Is Work good for your health and well- being? Gordon Waddell, A Kim Burton 2006 The Research Case for Better at Work. ACC Website. Are sickness certificates doing our patients harm? Dr Debra Dunstan (Australian Family Physician, The Journal of the Royal Australian College of GPs.

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