Hon Tony Ryall

Minister of Health

13 March 2014 Speech Notes
Heart Foundation Symposium Keynote Address

Good morning and thank you for inviting me to open your symposium.

Opening remarks

I would like to thank Professor Norman Sharpe for his kind introduction. I would also like to take this opportunity, in front of this primary care audience, to acknowledge the tremendous contribution Norman has made to the prevention and management of heart disease.

This contribution has been made both during his 10 years as Medical Director of the Heart Foundation, and prior to that in his role at Auckland University.

Farewell and thanks to Professor Norman Sharpe

Norman, I would like to thank you for your passion and commitment to improving the heart health of the New Zealand population.

You have brought your clinical leadership, your knowledge of the sector and your years of expertise to bear on the issue of cardiovascular health and you have been a tireless champion for this over the years we have known each other.

You have made a significant contribution over the last 30 years to expert reviews of guidance for assessment and management of heart disease, including being inaugural Chair of the New Zealand Guidelines Group.

You have also provided support to the Ministry and to me by acting as a national clinical leader for the More heart and diabetes checks health target.

The team at the Ministry of Health and I sincerely thank you for your contribution and we know that we will continue to benefit from your wisdom and leadership long after you leave the position as Medical Director at the Heart Foundation.

We wish you well with your new endeavours.

Health targets

The organisation of this symposium actively mirrors the kind of collaboration that is needed to make further inroads into achieving population health through primary care. The relationship between a Primary Health Organisation, a non-government organisation and a government agency provides a unique mix of skills and resources. The product of this mix is the programme provided today which, I am sure, will provide you with inspiration to take back to your work.

We have made great strides in primary care in relation to the particular health target areas you will be discussing today; however, there is still some distance between where we are now and where we could be. It is through innovation and collaboration that we will make further gains.

The priorities I would like to briefly discuss today are two of the primary care based health targets – More heart and diabetes checks and Better help for smokers to quit as well as the work that is underway to prevent rheumatic fever in New Zealand.

Health Targets - More Heart and Diabetes checks

Achievement of the More Heart and Diabetes checks health target is well within reach.

Last year the Government committed $15.9 million over four years to assist DHBs to achieve the More Heart and Diabetes checks health target.

This extra funding is being used to increase the numbers of nurse led clinics, improve practice management systems, establish electronic referral pathways to specialist services, and up skill primary care staff in the use of these tools.

At the end of December 2013 (quarter two) 73.2 percent of the eligible population have received a heart and diabetes check. This quarter’s result has contributed to a 17.6 percent improvement over the country in the last 12 months. While no DHB has yet reached the 90 percent target, there are six over 80 percent.

I am sure that the discussions, case studies and innovation you share and learn about today will contribute to further gain and improved health outcomes for New Zealanders over the next months.

As we get closer to achieving the target, we can renew the efforts we are making to support New Zealanders manage their heart disease and diabetes.

Shared treatment decisions as part of care that is planned in partnership with patients is a feature in the updated cardiovascular risk assessment resource you will be talking about today.

I look forward to hearing about your innovations supporting shared treatment decisions in primary care practice.

Health Targets – Better help for smokers to quit

Tobacco products kill about 5000 New Zealanders each year. Each of these deaths is preventable.

The Government has confronted this issue head on. In 2011, the Government set a goal of reducing smoking prevalence and tobacco availability to minimal levels, thereby making New Zealand essentially a smokefree nation by 2025.

I am proud to say that we have already reduced the prevalence of daily smoking in New Zealand to 15 percent. However, we still have a long way to go to being smokefree.

One of the key contributors towards our success in tackling tobacco use is the excellent progress that we have made with Better help for smokers to quit health target.

Stopping smoking is the best thing a person can do for their health. We have moved to make smoking a medical issue that is addressed by all healthcare professionals.

The target requires that 95 percent of patients who smoke and are seen by a health practitioner in public hospitals, and 90 percent of patients who smoke and are seen by a health practitioner in primary care are offered brief advice and support to quit smoking.

By December 2013, the hospital component of the Better help for smokers to quit target was 95.3 percent and national performance for the primary care target 66.5 percent.

Although the primary care target is still below the 90 percent goal, it represents a significant increase of 23.5 percent since the December 2012 quarter.

Many of you will be familiar with other steps the Government is taking to help achieved the smokefree 2025 goal. These have included:

• Increasing excise tax on tobacco products on a regular basis till 1 January 2016

• Removing tobacco displays from shops

• Raising the fines for retailers who sell tobacco to people under the age of 18; and

• Introduced a Bill to progress plain packaging of tobacco products

Rheumatic Fever

One of the Better Public Services Key Action Areas is to reduce the incidence of rheumatic fever by two-thirds, to 1.4 cases per 100,000 people, by June 2017. This target is ambitious.

And the international experience suggests increased awareness indicates reported prevalence could go up before it comes down.

Rheumatic fever is a serious but preventable illness that can lead to lifelong health problems for children and young people, particularly Māori and Pacific people.

It starts with an easily treated sore throat caused by group A streptococcal bacteria. Improving access for the early treatment of group A streptococcal sore throat in primary care and community settings is a key strategy which we are using to achieve our target.

Making sure that all strep throats are diagnosed and treated appropriately and quickly by primary care practitioners is also essential.

The total funding made available to DHBs to help prevent rheumatic fever is over $45 million. Currently there is a school throat swabbing programme that covers over 200 schools in 10 DHBs. Over 50,000 children are participating in the school throat-swabbing campaign nationwide.

We are also working on increasing awareness of rheumatic fever and reducing household transmission of group A streptococcal bacteria by reducing household crowding.

To improve access for the treatment of strep throat, rapid response services to provide timely and free sore throat assessments and treatment for high-risk young people have been rolled out by the three Auckland metro DHBs and Capital & Coast DHB.

The clinics are designed to reach at-risk 4 to 19-year-olds and so are set up in easy to access locations, such as shopping malls.

Healthy Families NZ (HFNZ)

Tomorrow I will be making an exciting announcement around the government’s anti-obesity and healthy living programme Healthy Families NZ.

Healthy Families NZ is a new initiative that aims to bring together the right mix of leadership, encouragement, information and resources to help people make healthier choices for themselves and their families.

It creates local community areas for intensive action against preventable disease. It’s a complete reform of the way health promotion and disease prevention will work locally.

It’s an approach based on community-level actions; to build a health promotion workforce that can assist communities to create better, longer-lasting improvements.

By working with individuals and families, early childhood centres, schools, workplaces and sports clubs, to prevent and reduce obesity in New Zealand, we can slow the growth of the complications associated with excess weight, and improve the quality of life of those living with obesity-related chronic illness.

The Healthy Families approach is supported by a growing body of evidence – including from Healthy Together Victoria and Colac in Australia, and the EPODE pilots in Europe – which suggests that concentrated, community-led health promotion, tailored to specific community needs and with action where people live, learn, work and play, can be successful in addressing the underlying causes of chronic disease.

Evidence suggests kids will weigh less, have smaller waists and be able to run faster.

In February I visited the Under 5 Energize programme in Waikato which is part of the Healthy Families strategy. The Government has allocated $1.1 million to support good nutrition guidelines and the development of physical exercise programmes in around 130 childhood centres in the Waikato region.

Sport Waikato has been contracted to manage the project and has created an Under 5 Energize team who work alongside local early childhood centres to improve nutrition and activity among the children.

Teachers at the kindergarten told me parents have quickly taken to nutrition guidelines developed for the kindergarten, and there has already been a marked difference in the types of food coming in with the kids. Teachers at the school are now making platters with all the fruit coming in for all the kids to enjoy.

Many of the Early Childhood Centres have also attended workshops run by the Under 5 Energize team which teach children fundamental motor skills like rolls and twists. These skills give them the confidence to take up a broader range of sports later in life.

Under 5 Energize was introduced as a Ministry of Health-funded extension to the wider Project Energize programme already running in Waikato.

Studies have shown this programme has produced fitter, healthier kids who weigh less, run faster, and have a better handle on healthy nutrition than the national average.

By investing in our kids at this young age, and fostering a sense of healthy nutrition and exercise from the get-go, we encourage a broad range of positive health outcomes for these children that will continue into adulthood.

Closing remarks

Before I leave the symposium, I would like to acknowledge the efforts of the organising committee including Tane Cassidy from the Health Promotion Agency, Kim Arcus and Janna Alexander from the Heart Foundation and Phillip Grant from the PHO Alliance. The programme appears to be a stimulating one and I look forward to seeing and hearing about the benefits of the collaboration and innovation being shared today.

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