Hon Dr Jonathan Coleman
Minister of Health

29 July 2016 Speech notes

Royal New Zealand College of General Practice conference, Auckland

Opening
Thanks Tim. It’s a pleasure to be here today.

I would like to acknowledge Dr Tim Malloy, the College’s President and Andrew Connolly from the Medical Council.

Your conference theme, Reflect, Renew, Replenish, is certainly timely given some of the significant developments in the wider health sector over the past year: the refresh of the Health Strategy, the Digital Health Work Programme 2020, the launch of the Pharmacy Action Plan, and new system performance measures.

One thing is clear, while we have a high performing health system, there’s lots more to do and a big agenda of work which I’m keen to see through.

Primary care
Primary care has a key role in driving better health outcomes for New Zealanders.

Sometimes primary care feels like a tough place to work, but collectively we’re making very real progress across the health system, and I want to thank you for your hard work and contribution.

Elective surgery & national patient flow
A key area of focus continues to be lifting elective surgery rates each year. As New Zealanders live longer, access to elective surgery is becoming more important than ever.

We’re also working to quantify unmet demand with the national patient flow system. We’re one of a few countries collecting information of this kind at a national level.

This will allow us to have a complete and consistent view on the number of GP referrals made for elective services and what the outcomes are.

We’ve recently released the next set of DHB data from the National Patient Flow project.

The latest data for First Specialist Assessments shows that between October 1 and December 31, 2015, there were 161,881 referrals for a First Specialist Assessment. Over 141,000 or 87 per cent of referrals were accepted, and around 7,700 or 5 per cent were declined as they did not meet the threshold.

It’s expected that as the data builds the number of patients declined and sent back to their GP for care as they didn’t meet the threshold will rise to around 10-15 per cent.

The only answer to increased demand is to do more – and that’s what we’re continuing to do.

Health strategy
Let’s take a moment to look at the big picture in health. Some of you may have heard this before, but it’s worth reiterating.

I believe to successively deliver on the health aspirations of New Zealanders, you’ve got to have clear direction.

One of the first things I did as Minister of Health was to ask officials to work on a very clearly laid out direction for healthcare in New Zealand which resulted in the release of the new Health Strategy back in April.

The Strategy covers five themes - people-powered, closer to home, value and high performance, one team, and a smart system.

These themes signal a focus on prevention and wellbeing, and more integrated services. At the same time we want to see support for innovation, better collaboration, and new ways of working to reach our most vulnerable. We want to give every child a healthy start, and ensure information and services are more accessible.

Health funding
As well as having a clear strategic direction, we have the funding to support that vision. Health has remained the Government’s number one funding priority.

Budget 2016 delivers on that by investing an extra $2.2 billion in health over four years for new initiatives and to meet cost pressures and population growth.

The Government’s investment in health will reach a record $16.1 billion in 2016/17 – that’s an extra $568 million this year, the biggest single increasein seven years.

Claims that health funding has been cut are incorrect. Under this Government health expenditure share of GDP has averaged 6.5 per cent – that’s up from the previous Government’s level of under 6 per cent.

Over the last eight years, health funding has kept up with demographic pressure and inflation.

In Budget 2016 we’re investing an extra $124 million to widen drug access through Pharmac, $96 million to provide more elective surgery and $39 million to start the roll-out of a national bowel screening programme with thebusiness case due to go to Cabinet very shortly.

VLCA
Since I addressed the Very Low Cost Access (VLCA) issue at the GP CME conference in Rotorua, I’ve had a very positive meeting with General Practice NZ and the Primary Health Alliance.

Around $50 million is spent on VLCA out of a total of around $890 million for primary care – that’s about six per cent of total primary care spend. Primary care funding has increased by $230 million over the past eight years.

1.3 million patients benefit from lower doctors’ visits fees through VLCA (paying a maximum of $18 for a visit), however around half are not low income patients, and conversely around the same number of low income patients who attend non VLCA practices don’t get cheaper visits.

The fundamental problem is that it’s difficult to move resources away from patients already receiving them, which is what’s needed if changes are to be delivered within the money available, given the primary care budget went up $25 million in Budget 2016.

At the same time, shifting funding would significantly disrupt existing business practice models.

In terms of increased access, we’ve extended free under 6s services to cover after hours and weekends. We’ve also brought in free under 13s, with over 780,000 children under the age of 13 benefiting from free doctors’ visits and prescriptions.

The bottom line though is that I’m always open to engagement with the sector on the path forward, and continue to work on ways we can target funding to high needs families not covered by VLCA.

Mental health - overview
In regards to my priorities over the next 12 months, mental health services are right at the top of the list.

I believe that in general the sector currently provides high quality mental health services for New Zealanders across the continuum of care from prevention, through to primary care and specialist services. However, there is always more to do.

As you will be fully aware, most people at some time in their lives experience some degree of distress, worry, and loss of control.

In line with international trends we have seen over the last ten years an increase in demand for mental health and addiction services.

Demand has increased from 2.3 per cent of the population a decade ago, to 3.5 per cent of the population in the last year – that’s an increase from around 96,000 people, up to 164,000.

We also know that one in five New Zealanders experience a mental health issue during their lifetime.

The Government has increased mental health and addiction services funding from $1.1 billion in 2008/09 to over $1.4 billion for 2015/16.

Funding for primary mental health services has increased progressively over time from $5 million in 2005/06 to $29.3 million in 2015/16.

Mental health – changing models of care
In response to the increases in demand mental health services in New Zealand have been on a transformational journey.

We’ve moved from institutions to community care, and widened the range of providers and settings where New Zealanders can receive mental health services.

We’re working increasingly closely with other social sector and justice agencies to recognise the linkages and crossover.

There has also been an increased focus on the expectations of people who use services, as well as their families.

Reducing, and eventually eliminating, seclusion remains one of the sector’s goals.

It should only be used when there is an imminent risk of danger to the individual or others and no other safe and effective alternative is possible. Those held in seclusion include some of New Zealand's most difficult and complex cases.

As a result of the seclusion reduction policy in 2009, events have decreased from 1,075 that same year to 736 last year.

Mental health – access
These changes have had positive impacts for mental health clients as well as helping to address pressures on the system.

Non-urgent child and youth wait times have improved from 86.4 per cent of new clients seen within eight weeks to 91 per cent seen with eight weeks over the last four years.

While the number of inpatients has remained static, we have seen a reduction in number of clients seen for the first time in acute in-patient services. This has dropped from almost six per cent in 2003/04 to 4.9 per cent in 2014/15.

The Ministry of Health has been working closely with Police and DHBs to deliver appropriate responses to those in crisis.

As a result we’ve seen a 38 per cent decrease – or 529 fewer people – receiving a mental health assessment in a police cell for the four months of 2016 compared to the same period in 2015.

As expected this work has resulted in an increase in mental health crisis attendance in Emergency Departments. This means more mental health patients are being treated within a medical setting instead of being treated within a law and order context.

This work will further help to manage the demand for crisis mental health services and increase the effectiveness of early response to people with mental health issues.

$12 million for alcohol and drug support
Also as part of Budget 2016 the Government has invested $12 million over four years to expand a successful programme that provides intensive alcohol and drug support for pregnant women.

Waitemata DHB has successfully been running an early intervention programme for new mothers who are at high risk from alcohol and/or drug harm.

It’s led to the reduction of substance use by mothers and improved the outcomes for unborn babies and infants - foetal alcohol syndrome, reduced family violence.

This funding extends the programme to three new areas, supporting around 100 women a year in each region.

Other initiatives
In addition to these new areas, we have a wide range of initiatives currently underway across the continuum of care.

We have in place a range of specialist promotion and prevention strategies to support improved mental health outcomes, such as Like Minds Like Mine; National Depression Initiative and the Prime Minister’s Youth Mental Health Project.

We also have work underway this year to refresh the Suicide Prevention Strategy and action plan.

We are focussed on improved service delivery, for example through improved perinatal and infant mental health services and increases in youth forensic services, both in the community and at the specialist end.

We are also working with other government agencies, such as Justice, Police and Corrections to reduce the impact of mental health clients on their services.

Corrections is investing close to $14 million from the Justice Sector Fund to enable it to purchase primary mental health services for offenders in prison and in the community over the next two years.

This follows a Corrections study which found that 62 per cent of prisoners had some form of mental health or substance abuse disorder in the last 12 months, and 20 per cent had both these disorders.

This new funding will enable Corrections to better support these offenders by providing access to contracted mental health services.

Mental health – going forward
While we are doing more, there is more we can do to further support people with mild to moderate mental health issues.

We will continue to progress the Government’s social investment approach and work with social and justice sector agencies to address the determinants of wellbeing, such as quality of housing, family relationships, employment opportunities and education.

Post Budget announcement
I can confirm today that additional consultation liaison resources to provide expert advice to primary care, community and social service providers, will be progressively implemented this year.

Budget 2016 includes $12 million of funding over four years to increase support for people to access mental health services at an earlier stage.

This funding is being targeted around three initiatives. The first is to establish a mental health triage system for the national telehealth service (provided by Homecare Medical).

The 24/7 phone service includes Healthline and a range of other mental health support helplines, offering a front-door to the wider health system over the phone and online. Importantly, this also includes 111.

This initiative will help strengthen the system for mental health response to people who reach out to Police, health, social, and community services at a time of mental health crisis or distress, identifying appropriate responses, referrals and support.

This new service is expected to benefit around 45,000 New Zealanders a year.

It will be phased in, starting early in 2017. The intention is that all DHBs will be covered by the end of 2017.

Secondly, the funding boost will support primary care and social services through a virtual mental health expert advice service. This will help them to help people address their mental health issues before they escalate into more serious concerns. This means Police and DHB emergency mental health services can focus resources on urgent situations.

Thirdly, a local mental health pathways programme will map out existing services and better direct people to help in their communities.

This will benefit the many people who seek out local help and advice for themselves or others on mental health issues every day.

Other new initiatives
Also, through the Pharmacy Action Plan, we will be helping more people get well and stay well by supporting people to understand their medication as well as ensuring the best combination of medication for them and making better use of our pharmacist workforce.

Additionally, an on-line resource to support practitioners to access information on medication for mental health is also being progressed.

I believe primary care is a critical part of addressing increased pressure on mental health services. Supporting primary care to do this will be a key focus moving forward.

The Ministry of Health will engage with sector experts to identify where further support is needed.

This work is being led by the Ministry’s Director of Mental Health. I have asked him to ensure that the views of consumers of mental health and addiction services, family, DHBs, Māori and Pacifica, NGO providers and PHOs also feed into this process.

To support this work I have asked the Ministry to set aside an additional five million dollars to invest into primary and community mental health services.

Closing
I want to reassure you that the Government will continue to place a top priority on delivery high quality health services.

The work you do in primary care is crucial to the health system.

I hope you enjoy the rest of the conference.

ENDS

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