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Address to Waitemata Lecture Series

Hon Tony Ryall

Minister of Health

Address to Waitemata Lecture Series

Good evening and thank you for the invitation to talk about the work we are doing to improve the public health service in New Zealand.

Good health is hugely important to New Zealand families. 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. Protecting and growing the public health service for New Zealand families.

And with your support, the public health service is making a lot of progress.

More patients are getting the treatment they need, sooner. Our district health boards (DHBs) are employing more doctors and nurses than ever before. And there’s a more effective focus on preventing illness.

We’ve moved resources from the back office to the frontline. There are fewer managers and administrators. We are harnessing the power of standardisation and bulk purchasing. And our hospital wards are becoming more productive and efficient.

Our country has come through the global financial crisis in much better shape than most other countries. OECD forecasts have New Zealand as the sixth fastest growing country in the developed world over the next few years.

That’s because of this government’s careful and prudent financial management. Our approach has been to protect the most vulnerable in our society, and rebuild the economy’s capacity to create jobs, higher incomes and security.

Many people underestimate the importance of the health sector in New Zealand which amounts to one-tenth of the economy.

In other words, one in every ten dollars of economic activity in our country relates to the health sector.

There are some 70,000 people employed directly in the public health service. And we have a very vibrant private sector too.

We can be proud of the achievements of New Zealand health ventures such as Fisher & Paykel Healthcare who sell their products in more than 120 countries and employ almost 3,000 people, including 360 R&D staff, around the world.

Beyond this, a wide group of local health IT and medical device producers, have increasingly used home grown innovation and management expertise to develop technologies, products and services which benefit New Zealanders. These companies create employment, export markets and economic wellbeing.

Companies like Orion Healthcare based here in Auckland with over 800 employees in 17 countries. Their products and solutions are implemented in more than 30 countries, used by hundreds of thousands of clinicians, and help to facilitate care for tens of millions of patients.

Twenty years ago hardly anyone had heard the names Ryman, Metlife or Summerset. Yet today these retirement village operators and aged care providers are worth a collective $6 billion on the NZ share market, and are caring for thousands of New Zealanders.

As an American entrepreneur wrote recently… “The opportunities at the intersection of health and technology will enable humanity to create health and wealth on a global scale … seizing huge business opportunities while generating tremendous positive social impact for everyone, everywhere”.

That’s one of the reasons I’ve set up the Health Innovation Hub as a partnership between four of New Zealand’s biggest DHBs: Auckland, Canterbury, Counties Manukau and Waitemata.

Established last year, it works to help grow New Zealand’s health technology industry and to support the adoption of innovations developed within the public and private health sector.

The New Zealand Health Innovation Hub is unique because for the first time, it brings together the public health system and the entrepreneurial spirit of innovators and industry.

As you know the big strategic challenges in health are demography, and finances.

Just under 1 in 6 of our population is now over 65 years of age.

The reality is that part of the reason we are facing an ageing population is that we have made incredible improvements to the longevity of New Zealanders over the past 30 years.

The risk of dying from ischaemic heart disease and decreased by over two-thirds between 1980 and 2010.

Over the same period, the risk of dying from chronic lower respiratory diseases decreased by half and from cancer by a quarter
We can be proud that the mortality rate for each of them has dropped considerably.

In fact, according to the recent Ministry of Health report, Mortality and Demographic Data 2010, Waitemata DHB has the lowest aged-standardised mortality rates associated with cancer and heart disease nationally.

The challenge for us is to help New Zealanders to stay healthier for longer, to support older New Zealanders to be healthy and independent, whether in their own homes or in aged care, and to continue to improve the health of New Zealanders, in the face of the increasing pressure from a growing, ageing population.

The recent NZ Burden of Disease study suggested to us that over the next decade, people will continue to live longer and two-thirds of the life years gained will be lived in good health.

That means that around a third of the extra years gained will be lived in poor health.

Clearly, we need to progress health services upstream, closer to the patient. The government’s health plan is a prudent strategy to develop health system capacity for the future pressures on the health system.

The plan has four major objectives: helping families stay healthy, better performance, best use of every dollar, and a strong, trusted workforce.

Helping families stay healthy

We’re investing strongly in what we call our priorities for prevention. This is a real focus for our government. We know we have to treat people with current health problems, but we also have to engage in longer term approaches that offer some of our best opportunities to help families stay healthy.

We have created a turning point in the campaign against tobacco with more effective action than ever before on an unprecedented scale – annual tobacco excise increases, systematic screening and cessation support, the end of retail displays, and the inevitability of plain packaging.

National introduced the most significant public health initiative of the decade with the Warm Up NZ Heat Smart home insulation programme – $350 million for 235,000 homes. And as you know, warmer, drier homes bring health benefits particularly for those with respiratory conditions.

And this supports our world leading action to deal to New Zealand’s shamefully high rates of rheumatic fever. Our goal is to cut prevalence by two thirds by June 2017. The international research indicates that increased awareness means the number of cases reported will go up before it comes down.

In the community, the Auckland Wide Health Homes Initiative (AWHI) is helping families address housing conditions. And in schools, we have over 50,000 children across the North Island able to access throat checking services for free.

This in-school programme works alongside free sore throat drop-in clinics in high risk areas and face to face contact with at risk families in their homes and communities.

And I will comment soon our diabetes and heart disease prevention work.

Better Performance

Building better public services is a key objective of this government. Because health is a fifth of government spending we have an important role to play here.

The six national health targets are an important way of getting better performance. These focus on areas that patients want improved. They are built on what families worry about. Three relate to disease prevention and health promotion, and three on access and waiting times.

The results have been immediate and remarkably successful. And they are improving quality. A lot of hard work by teams across the whole country has achieved this.

I’ve already talked about tobacco screening. Smoking is at record lows.

We are requiring better performance in immunising children – one of the most effective ways of preventing a lot of infectious diseases.

Six years ago the Maori immunisation rate was a shocking 59 per cent. The overall two year old immunisation rate has risen from 67 per cent five years ago to 93 per cent today across all socio-economic and ethnic groups.

In fact in over half our twenty DHBs, the Maori immunisation rate is now equal to or higher than the European immunisation rate.

As part of the Prime Minister’s drive for Better Public Services we are now aiming to have 95 per cent of all eight month olds fully immunised with the three primary series of vaccinations by 2014. We are currently at 91 per cent.

As I mentioned before, we are also targeting improvements in the detection and management of diabetes and heart disease and backing that up with improved access to Green Prescriptions, particularly for those with pre-diabetes.

The heart and diabetes check is really an entry point for a lot of people. In fact 880,000 people have been assessed in the past 5 years. This is a great opportunity to encourage people to make the lifestyle changes they need to live healthier lives.

The three hospital targets in particular focus on improving timeliness and the quality of care.

Quality is a major feature of the targets because getting care in a timely way means better patient outcomes.

Patients are getting elective surgery faster with procedures up 34 per cent in five years. Delivery has increased from 118,000 in 2008 when we came in, to 158,000 patients treated last financial year. That is more patients, treated sooner.

I’ve had the health service actively working to improve the efficiency of elective services – from new care pathways, to lean thinking, to productive wards, productive operating theatres, smarter post-discharge planning, clinicians have led the way.

So too have they led improving cancer radiation and chemotherapy waiting times now at the world gold standard. Our government has approved ten new linear accelerators over the past five years.

And hospitals are providing emergency care sooner than ever before. This is really a whole of hospital flow target.

There’s been an amazing effort across the country as doctors, nurses and managers have worked together to try new ways to improve the service they provide patients.

Innovation and new approaches have contributed to Waitemata DHB exceeding the ED target with 96 percent of patients admitted, discharged, or transferred within six hours of arriving at your EDs.

This is an impressive improvement when in quarter one of 2009/2010 the figure was just 61%. In fact, here at Waitemata you have consistently exceeded the ED target every quarter since the third quarter of 2011/2012.

Best Use of Every Dollar

The government has continued to invest strongly in the public health service – an average $500 million extra each year. Vote Health is now $14.7 billion.

To better deal with the growing financial demands of the public health service, a lot of effort is going into getting best value from every dollar. And we have had a particular focus on non-clinical and administrative costs.

The Ministry of Health by way of example has reduced from over 1600 positions in 2008/09 to around 1100 today.

The Ministerial Review Group recommended that DHBs should work collectively to harness the power of standardisation and bulk purchasing to free up savings. Savings that can be reinvested back into improving frontline services for patients.

So right across the health service on a district, sub-regional, regional and national basis, teams are working be more efficient and contribute to our financial sustainability.

Part of that is the shared service agency Health Benefits Limited. HBL is working across the health service to support and lead a number of key initiatives. HBL has a Clinical Council which provides direct input and advice on these initiatives.

For example DHBs are collectively gaining $4 million a year from lower bank fees and higher interest payments as a result of moving to one bank nationally. A single contract for non-sterile gloves will save $6 million.

And for the 2013/14 financial year the estimated savings from DHBs working together to secure insurance cover is $6.6 million. These things add up. In fact $200 million over the past three years.

A strong, trusted workforce

It is this Government's firm belief that strong clinical leadership is essential to improving our public health service. There are very clear links between clinical leadership, morale, quality and efficiency.

Globally, clinical leadership is recognised as the fundamental driver of improved patient outcomes. We want to use the wealth of frontline experience nurses and doctors have accumulated to improve quality of care and rebuild confidence in the public health system.

I am particularly grateful for the huge clinical effort behind the clinical networks that underpin so much of the quality and service improvement we’ve seen over the past five years.

We’ve invested strongly in growing our health workforce – there are 1,300 extra doctors and 3,000 extra nurses on the frontline of care.

Technology

One of the best parts of this job is seeing how technology is changing health care delivery dramatically.

There’s still a lot more we can digitise in health.

A patient portal is an online service which allows a patient to securely log in and do things like check their latest laboratory test results, order a repeat prescription, or send a message directly to their GP – all from the convenience of their home.

This gives patients much greater access to their own health information and the ability to manage more aspects of their own care.

The portals also offer huge benefits for doctors in freeing up time, and I’ve already received great feedback from GPs about the benefits of having this service in their practice.

Between 15 to 20 percent of general practices have, or are in the process of implementing patient portals.

With the support of the sector, by the end of the year we want at least half of all general practices in New Zealand to be offering a patient portal.

Increasingly the heath service is providing access to consolidated patient information. Such as in Canterbury, Wairarapa, Lakes and soon to be Wellington. .. on one screen clinicians - with the patient’s permission - can see the patients summary primary care record. Patients don’t have to repeat their story endlessly to every clinician nor have to remember every medication they’re on.

A few weeks ago I saw technology which allows people to monitor their vital signs by mobile phone and transmit this back to their health care provider real time.

And you can see the cost savings and quality improvements from our e-pharmacy project which will remove transcription errors from dispensing.

Conclusion

In my role as Minister of Health I have overseen significant change and improvement in services. The health system has transformed with a great effort by clinicians and motivated teams across the sector.

When I became Minister of Health the health system was on track to financial ruin but we’ve turned that around.

There’s still a lot to do though. Over the coming months, the Government will be setting out its agenda in health for the next three years, if we have the privilege of being re-elected.

That agenda will continue protecting and growing our public health service, and putting families’ priorities at the heart of everything we do.

Ends

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