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Dunne: Paramedics Australasia International

Hon Peter Dunne
Associate Minister of Health

18 November 2016 Speech

Opening of Paramedics Australasia International
Conference
AUT Campus, Auckland

Kia ora koutou and good morning.

Thank you, Brendan for your introduction.

I do appreciate the invitation from Paramedics Australasia to open this year’s annual conference, not only as Associate Health Minister, but also as someone who has a close relationship with the ambulance and emergency services sector, through my primary portfolio responsibility as Minister of Internal Affairs.

Ambulance services play a key role in improving health, particularly for those who are more acutely unwell but increasingly you are managing more patients at home or in their local communities.

It takes a team approach to deliver health services in a coordinated way and ambulance services are key to this and I would like to take a moment to note the significant contribution of Joy Cooper, who retired from the New Zealand’s Ministry of Health at the end of October.

I understand that there is a cross section of health professionals here at this conference and I would like to acknowledge the work you all do and congratulate you on bringing this conference together to learn from each other.

It is pleasing to note that both here and in Australia, Paramedics are keen to have the profession recognised by the rest of the health sector, and to give public more assurance of professional standards by applying to be registered.

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I will talk more about where the New Zealand application is up to later on.

The theme of your conference is ”Shaping the future: Challenges, Changes and Opportunities”.

The New Zealand health system is strong, but it is not without its challenges.
We are not isolated from the challenges that many health systems internationally face with increasing numbers of older people who are living longer and a there is a growing burden of long-term conditions.

So today’s healthcare model will need to adapt to meet tomorrow’s challenges.
We will need to continue to review the way that we fund and deliver health service as technology moves forward and population demographics change.
We must find sustainable ways to deliver services, focusing our investments so they maximise outcomes.

That said, New Zealand’s health system is a high performer. In 2014, more New Zealanders reported they are in good or excellent health, the highest percent reported by any country in the OECD.

New Zealanders are more likely to report being able to get a doctor’s appointment on the same or next day than people in the United Kingdom or Australia. Waits for emergency department care are the shortest of 11 countries surveyed by the Commonwealth Fund.

Life expectancy for New Zealanders is above the OECD rate. Our health system supports on a per annum basis:
• 12.6 million daytime visits to General Practitioners,
• 2.8 million visits to general practice nurses.
• It dispenses 65 million pharmaceutical items, has 24 million lab tests, 1 million emergency department visits, and more than 400,000 ambulance incidents.
This year the Government released New Zealand’s Health Strategy for the next decade. It is there to guide change in our system and ensure that the current levels high of performance are not just maintained, but enhanced.

The aim is that all New Zealanders live well, stay well, and get well, in a system that is people-powered, provides services closer to home, is designed for value and high performance, and works as one team in a smart system.

The strategy theme of ‘care closer to home’ is clearly demonstrated by the ambulance services managing more patients in their home and increasingly being able to refer them for further treatment in local communities rather than transporting to an emergency department.

Ambulance services are working with the national telehealth service to transfer low acuity calls that can be managed by phone, rather than sending an ambulance.

Ambulance services are frequently called for social reasons and are an integral part of ensuring these people are referred to the right agency. I am told that St John had 1200 referrals made by Paramedics in the last quarter and that every one of these cases were followed up to ensure the referral had been actioned.
It is heartening to see the strategy’s theme of ‘value and high performance’ strongly represented throughout this conference.

Continuous improvement, research and improving patient outcomes all feature strongly on the conference agenda. I understand ambulance services in New Zealand and Australia are involved in several international trials and that some of your speakers for the conference are paramedics presenting their research.

The ‘people powered’ theme from the strategy is, in part, understanding people’s needs and preferences and partnering with them to design services to meet those.

Users provide unique insights into our services and we should continually ask whether we are doing enough to involve them in our service design.
Today people are more informed about their health care and now have greater access with systems, such as patient portals.

Both New Zealand’s road ambulance services have consumer representation on their clinical governance committees to be part of the process of design and delivery of clinical services.

Today’s technologies like patient portals, enable you, as paramedics, to have a more informed conversation with your patient. The patient portal enables the patient to see their list of clinical conditions, list of medications, allergies and alerts and to record information such as their daily blood glucose reading.

With future technology developments, paramedics will be able to see a summary view of the patient’s health record at the point of care. With future smart systems you will be attending people at home who have home monitoring such as blood pressure, blood glucose, and cardiac rhythm where you can Bluetooth the information into your electronic patient report form.

Ambulance services are changing from being an emergency response and transport service to becoming highly-qualified urgent healthcare providers.
They are on a pathway to treat more patients with telephone advice, manage more cases at the scene without transport, and reduce transports to hospital to 55 per cent of all calls by 2020.

Paramedics make up a highly qualified workforce, with a large number now having a degree or post graduate qualification. The workforce is increasingly being involved in research and publishing academic papers that provide insight and recommendations on how the sector can continue to change to improve outcomes for patients.

Ambulance services have embraced new technology by introducing the electronic patient report form. This will enable the sharing of clinical information between clinicians to better enable the right information at the point of care.

This is crucial as the models of care change to ensure the patient receives the most appropriate care and is sent to the right destination first time.
The meta-data from an electronic system will enable future clinical and operational planning.

There will be the ability to know where calls are predominately from, the nature of the cases, the skill level and clinical guidelines to manage the case mix and the stock required to meet this demand. The information is powerful for providing information for planning the most appropriate service to be delivered.

There are numerous clinical pathways being developed nationally such as major trauma destination policy, thrombectomy for stroke, fast-tracking stroke patients, and prehospital thrombolysis for STEMI, that all aim to get the patient to the right destination the first time without multiple transports and delays.

The recent FAST stroke public campaign increased the number of calls to ambulance for someone having a stroke by 30 percent. Being treated in a timely fashion provides a correlating improvement in outcomes.

Paramedics have expanded their practice to include not just emergency work, but are now more involved in screening and preventative work as well such as the falls risk screening and referral pathway.

I am sure many of you are interested on what is happening with the road ambulance funding review. Both of New Zealand’s ambulance services informed the Government that the current arrangements are not sustainable for the future.

Following this discussion, ACC and the Ministry commissioned an independent expert to review the current funding arrangements for the ambulance services and to make recommendations for future funding.

An independent expert has provided feedback earlier this year which has been discussed with the ambulance services and the recommendations and feedback are being actively considered by both ACC and the Ministry.

Ministers expect to see final recommendations from Health and ACC by the end of this year.

The application from Ambulance New Zealand for regulation of Paramedics is progressing and has been evaluated by an expert panel who recommended that the paramedic profession do meet the criteria under the HPCA Act to be regulated.

There are several more steps in the process before a final decision can be made.
These are finding a suitable Registering Authority to add the paramedic profession to, and understand the governance structure and processes.
We also need to know what the fee structure will be and all this information will then be provided to key stakeholders including paramedics and ambulance services as part of a targeted consultation process.

Feedback will be collated and if Cabinet agrees, then an application is made to the Governor-General to have paramedics added to the Act.

This whole process will take the best part of a year to enable people to have plenty of opportunity to have input on any proposed structure.

Many of you will be aware that the government is undertaking a co-design process for future management of emergency air ambulance services.
The co-design is with air ambulance operators and other key stakeholders and will take place over the next 18 months.

This process is to ensure a joined up air ambulance service for New Zealanders that is effective, efficient, and sustainable to meet future demands.

Communities provide significant support and sponsorship for local air ambulance services and it is important that that remains so for the future. This community support is highly valued and air ambulance services need to continue to be linked with, and provide a quality service to, our communities.

Communities feel strongly about air ambulance services and will be closely interested in any possible changes to the service model. It is important that they are kept informed through the process.

With new clinical pathways being developed, it will be important to ensure we have the right resource to meet this demand that is based in the right centres.

A two-year pilot of an air desk will shortly commence at the Northern Emergency Communications Centre to coordinate handling of the country’s emergency air ambulance resources. The findings from this pilot will help inform the co-design of the air ambulance service.

The pilot’s objectives include:
• improving the manner in which air resources are used so that they improve patient outcomes;
• improving the efficiency of air resources by reducing the cases where they don’t add value;
• reducing wasted flight hours, and lastly,
• providing a platform to further develop the coordination of district health boards inter-hospital transfers in the future.
So it is fair to say that there is a lot happening in the ambulance and paramedic space. I have seen the comprehensive conference programme and I am sure that over the next few days there is much to be learnt about recent and new research that has been undertaken, the challenges for the sector, and the opportunities that are available.

The importance of your roles to society, to all parts of society – young and old, rich and poor cannot be overstated. As I noted to the Aeromedical Society of Australasia’s recent conference, your sector brings confidence and a sense of safety and security to those across New Zealand and Australia particularly, but to all countries in which they operate, knowing that wherever they may be, help is really just a phone call away.

I look forward to continuing work with the ambulance and emergency services sector to ensure a healthy and sustainable future for ambulance services.
I thank you for the opportunity to open your conference and wish you all the best with the next few days.

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