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Speech: Allied Health, Scientific & Technical Professionals

Tony Ryall

31 MARCH, 2014

Speech to Allied Health, Scientific and Technical Professionals Conference

(delivered by Tim Macindoe MP)

Thank you for the opportunity to open your fourth national conference, today here in Hamilton.

Having studied your programme, I can see this conference will be a great opportunity to share ideas and to hear evidence about advanced practice by Allied Health Professionals.

At a time when finances remain tight it is vital the public health service uses the skills which the full range of allied health professionals can bring to patient care. It makes sense to ensure the effective use of all staff within the public health service.

I suspect there is no more diverse professional gathering in healthcare than this one bringing together 40 allied health, science and technical professions: podiatrists to psychologists to physiotherapists to medical radiation technologists to audiologists to clinical perfusionists to medical physicists.

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.

Providing better public services within constrained funding increases has been part of the economic reality.

Like virtually all other health systems around the globe, we are facing three major challenges – the first financial, the second demographic, and the third patient expectations.

When we came to office at the height of the global financial crisis, the government inherited a decade of deficits. The 10 years before had seen massive increases in government tax revenues matched by equally significant increases in public spending.

In fact, the health budget doubled in nine years!
Yet fewer people got operations, patients waited longer, key health services struggled for staff, and the bureaucracy ballooned. It was a time of wasteful spending, endless bureaucracy and a lack of clinical engagement.

Because health is a fifth of all government spending, we’ve had to focus on getting better value from our existing investment and the slower growth in additional health funding. Unlike some health systems NZ has enjoyed regular but more constrained funding increases.

Our government has invested an average $500 million a year in additional funding into health. The increase in health funding for 2014/15 will be very similar to this year's increase, so district health boards (DHBs) will need to continue focusing on getting more from every dollar. There is still a lot of scope to move resources from the back office to the frontline.

Our second challenge is demographic. Beside the ageing population, the other major dynamic is population movement and growth. A third of DHBs have growing populations, a third have stable populations and a third have long term declining populations.

Which means in some parts of the country DHBs work hard to provide more and more service to more and more people, yet others have to manage sustaining safe and viable services for a long term declining number of people.

Thirdly, the public have high expectations of our public health service. New technology, new medicines, faster access, smarter prevention, safer care – the public expects this. And why shouldn't they? When taxpayers are investing $14.5 billion in our health system, they are entitled to have their priorities reflected in the services provided.

And it is the public and patients who inform the government's objectives in health care.

Our objectives are built around better, sooner, more convenient care with all the elements that suggests of quality, timeliness and patients at the centre of care. And this makes sense.

We are living longer, more sedentary lives. This means more of us have chronic disease like diabetes, asthma, dementia and cancer. The sooner clinicians can detect, treat or prevent these conditions, the better they can reduce the significant burden these conditions put on patients and the health system.

Our strategy to do this is clinical integration – providing joined-up care across primary and secondary services. With resources and interventions flowing to where they are most effective, so patients get their care sooner and closer to home.

A huge amount of work is happening around the country as community and hospital clinicians work together to redesign how and where care is provided. Clearly if more care can be provided upstream -in the community rather than hospitals - then that contributes to better health for the patient and the overall financial health of the system.

So our public health service is changing the way it delivers care. Step by step. Year by year. And it will look very different in the next ten years.

…Because of three international mega-trends in healthcare across the globe as suggested by health futurist Lord Darzi.

This increasing prevalence of chronic conditions I spoke about earlier means healthcare is moving upstream closer to where patients live, and built on a stronger primary care system.

He says patient care will be less about hospital specialists and more about nurses and allied health professionals delivering and supporting care in patients’ homes and communities.

Shortages of skilled staff in some countries are seeing their health systems moves much more rapidly to this new environment. Examples include the expanding role of community pharmacists to nutrition and exercise advisors.
We are already seeing a smarter use of allied health professionals in supported post-hospital discharge particularly in Canterbury and here in the Waikato.

And many of you will know about the interesting work underway with the Steady As You Go programme involving phys ed students, physios and OTs in the lower South Island.

Second is what’s called self-care - patients taking responsibility for more and more of their own health care and management. You’re seeing this happen in banking and airlines - the customers using technology to do more the work that the banks and airlines used to have staff to provide.

Already patients are using technology here in New Zealand which allows them to monitor their own vital signs and stream this data on their mobile phones to their health professionals.

We’ve got some fantastic IT and medical device manufacturers in New Zealand who are making this happen.

All the evidence shows that improved patient self-care, or expert patients as some call it, does lead to better outcome for patients with chronic disease - and the patients are happier too.

Third mega-trend - and probably a less specific opportunity for allied health professionals - is personalised medicine. As Darzi points out, knowledge of the human genome and other bio-markers will transform healthcare as diagnosis, treatment and prevention will all be shaped around an individual patient’s specific genetic make-up.

In many ways this will be empowering for patients as they will have a better understanding of their risk profile and what they can do to prevent illness. It also raises a whole lot of ethical issues.

One of the constraints on this trend will be the ability of health systems to afford what are likely to be very expensive personalised medicines. This in turn may limit pharmaceutical companies’ ability to advance this frontier further.

Open for better care

Every clinician, every health service, should want to provide patients with a quality service. One built on high standards and respect for patients.
That is why this Government established the independent Health Quality and Safety Commission.

This clinically led organisation – in the words of its chair Professor Alan Merry – is responsible for assisting providers across the whole health and disability sector, public and private, to improve service safety and quality and therefore outcomes for all who use these services in New Zealand.

Patients need health professionals to use their expertise to maintain and improve quality and safety, and assure safe practice within their autonomous practice but also their wider workplace.

This matters because clinical professionalism underpins the trust the public has in the health service and the people who work in it.

I do urge you to learn about the Commission’s “Open for Better Care” campaign which seeks to engage clinicians in improving care for individuals, for populations and for the community.

DHBs throughout New Zealand are signing up to “Open for Better Care” as part of their commitment to continually improving the quality of care in our public health service.

Conclusion

As many of you will know I am leaving politics at the election, and will re-join the real world. I mention this because I want you to know that being Minister of Health is the best job in government – you get to work with quality people who have dedication, and a commitment to improve the lives of others.

Each day you all can make such a difference to people’s lives. Even helping one person is a great thing.

And from the frontline orderly to the most specialised surgeon, each of you in your own way makes such a difference. Thank you.

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