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King Address To NZNO National Conference

Hon Annette King Speech

NZNO National Conference

Nö reira, tëna tätou katoa. Good morning.

Thank you for your invitation to speak today. As you may have heard me say before, I always take special pleasure in meeting groups of nurses, because nurses experience such a wide range of health issues and consequently have a wealth of ideas and knowledge. I have relied on your membership to help me as we change the health system from a competitive one to a strong public service based on cooperation and trust.

I would like to welcome you all to this conference, and, more importantly, to acknowledge the daily effort and contribution you make to the health sector. Nurses have been called the backbone of the health service, and as Minister of Health I have no argument whatsoever with that assertion.

This Government is committed to improving the public health service, and, with the help of organisations like the NZNO, I am sure we can develop a public health service New Zealanders can trust.

Before I discuss the Government's proposals, however, I should clarify for you my status and role in the current wage negotiations.

My role, as one of two shareholding ministers in the Hospital and Health Services, is strictly limited by the law put in place by the previous Government. My job is certainly not to say nurses should be paid such and such an amount in such and such a region.

I do have a number of responsibilities, but they are divorced from the actual negotiation process. One such responsibility, as a shareholding Minister, was to remind HHSs earlier this year that they must manage their costs, including wage costs, within their business plans.

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I also reminded HHSs of the Government's commitment to being a "good employer", and of its expectation that negotiations should be conducted using good faith bargaining. I also asked them to actively explore innovative means of achieving agreement. And I suggested the HHSs should consider addressing several other matters such as:

 Professional development and further education.
 Development and implementation of career pathways.
 Development of systems and processes for involving all health professionals in the clinical management of clinical issues, including quality standards in the workplace.
 Making a serious effort to assist health workers meet the requirements of updated professional legislation.
 Improved employment conditions.
 And a commitment to participating in sector wide processes relating to issues like quality benchmarking, implementing nationally recognised and portable clinical qualifications, achieving national transferability of career path levels, and establishing clinical standards including staffing standards.

Another responsibility was to put the case in this year's Budget for sufficient funding for HHSs to meet the Government's expectations in terms of issues such as service delivery and constructive wage settlements. I believe the extra funding allocated to HHSs fulfilled that responsibility. Hospitals now receive more than 50 percent of the total health budget of more than $7billion, and this year's increase amounted to six percent across the board in the HHS sector.

In terms of wage negotiations, the Government took another important step earlier this month when we discovered that the previous Government had suspended an Order in Council requiring HHSs to consult with the State Services Commissioner on chief executive employment contracts and collective employment contracts.

It is a puzzle why the former Government chose to do this, during the transition period to the new Government, just a few days before we officially took office, in fact. We have now reactivated those provisions in the Health and Disability Services Act 1993, and the Commissioner has delegated to the Director-General of Health his function relating to collective employment contracts.

This will mean the Government will be better informed than it has been in the past about vital industrial relations issues. HHSs do not have a long lifespan ahead as companies, but for the time they have left, they are now obliged to take account of wider considerations, such as the requirement to bargain in good faith.

The Associate Finance Minister, Trevor Mallard, and I have also met NZNO representatives, and offered to facilitate a move to a national collective agreement. We recognise there are now wage disparities between regions in New Zealand that need to be addressed. Trevor Mallard is undertaking the same process for kindergarten teachers.

That is all I can say about the negotiations, but I can talk in far more depth about the Government's proposals for health in New Zealand.

The first reading of the New Zealand Public Health and Disability Bill last month marked the formal beginning of a return to a genuine public health service. The enormity of the job ahead cannot be overestimated, but I am confident that what we are setting out to achieve will provide New Zealanders with an open, accountable and fair health service – the type of health service I am sure we all want.

I note with interest the theme of this conference is "Nursing - the New Dawn Ka Awatea". That theme provides an ideal opportunity to give you a quick update on the Government's directions for the health service and nursing’s role in the new system. There has already been some great progress made on issues important to the NZNO since the change of government, and we are nowhere near finished yet.

Our primary task is to tackle the problems in the sector and restore public trust and confidence in the health system. I am committed to working with the health sector and other sectors to achieve this.

 Our chief tool will be the New Zealand Health Strategy, which was written by a health sector group including the NZNO. This document is being finalised and should be released by the end of the year. The Strategy sets out the direction for action by providing a unifying nationwide framework within which the health sector will develop. Nurses have indicated support for the Strategy’s broader goals of improving the health status of New Zealanders, reducing inequalities, emphasising public accountability and improving coordination in the health sector.

 Nurses will have a vital role in implementing the Strategy. The NZNO also has a leadership role to play working in collaboration with other nursing groups on key professional strategic issues. The Government is relying on you to contribute your expertise as we develop strategies to boost the health of New Zealanders.

I am encouraged to hear that part of this conference will be dedicated to an open forum with the College of Midwives. The NZNO and the College of Midwives are doing excellent work identifying ways of working with each other. A key aspect of the health reform is the development of a collaborative culture between healthcare providers, to ensure they build from each other's strengths in order to deliver the best possible health and disability outcomes for their patients.

I want to stress the importance of nursing organisations and groups working together. I am heartened to see the steps that NZNO is taking towards building such a collaborative culture, but, to achieve the common goals set out in the Health Strategy, further co-operation will be needed. At the Ministry of Health you have a dedicated Chief Advisor of Nursing in Frances Hughes. I know you will communicate and work with her also at this crucial time in the health system.

Competent staff remain the health sector's most important resource. The sector’s ability to recruit and retain competent staff is very important to the Government and particularly topical at present. Nurses face many workforce issues. We are working on a number of initiatives, with help from nursing bodies, to look at developing effective solutions to these and other health workforce problems.

The profile of nursing has changed considerably in the 1990s. It is very encouraging to see new scopes developing outside hospital walls, in areas like tele-nursing, flight nursing, and many nurse-led community services and initiatives. These new roles show how flexible the nursing workforce can be. As health services change to meet the new and different needs of their communities, the mix of workforce skills may also need to change.

To this end, I am in the process of establishing a Health Workforce Advisory Committee to provide advice on the workforce needs of the health sector and how we should meet those needs.
The terms of reference, put together by a group of experienced health professionals including the NZNO, have been agreed, and I shall seek nominees for the committee shortly. The key objective is to encourage the major players to work more closely together on issues of education, and in the development of the health and disability workforce.

No doubt you feel as aggrieved as I am that nursing workforce issues, identified three years ago, were not addressed by the previous Government. That government believed in a market model that would somehow miraculously produce all the nurses we need. The miracle never happened, of course. In terms of nursing workforce issues I have inherited a legacy I am determined to fix.

The committee's responsibilities will include looking at nursing issues and developing possible solutions. Tasks of the committee will include providing advice to the Ministry of Health on government funding for education and training of the health workforce, in accordance with priorities in health and education policies.

The Ministry has also commissioned a project scope to identify what needs to be done to ensure we have the nursing workforce required to meet future health service needs. NZNO is part of a nursing workforce group helping work through issues this report has raised.

Initiatives to develop the nursing workforce will include analysis of what is necessary to deliver quality health and disability services to Mäori and Pacific people. The presentation of the memorandum of understanding between Te Runanga and NZNO to this conference is another positive step. It is a great indicator of where nursing is heading for Mäori and will work to raise awareness of the Treaty of Waitangi in nursing. This is indeed a great time for us to look at what we have to do to make nursing an attractive profession for Mäori.

The Ministry has also commissioned a survey of non-practising nurses and midwives to assess whether they can be attracted back to the workforce, and what is necessary to achieve this. Meetings have been set up in the regions to inform nursing groups of the survey findings. The aim is that strategies to attract non-practising nurses back to the clinical workforce will also be developed.

Another exciting and long overdue initiative is a single Bill to regulate the practice and competency of health professional groups. The Ministry is developing the Bill in consultation with health professional bodies, such as the NZNO. Drafting instructions will be ready before Christmas, and I anticipate the Bill will be introduced into the House early next year. The Nurses Act will be finally updated 13 years after the process started.

Part of the work on occupational regulation is on issues such as the role of the second tier nurse and the standards, training and monitoring required. As you know, the Government is committed to re-introducing second tier nursing.

You will all know too the Government has agreed to extend prescribing rights to nurses practising in aged care and child family health. Work is proceeding on final lists of generic classes of medicines that nurses practising in aged care and child family health may prescribe.

The Ministry has also asked the Nursing Council to provide an update on progress on nurse prescribing education programmes. It is hoped that the regulations will come into force by the end of this year.

I have also asked the Ministry to work with the sector on developing proposals to extend limited prescribing rights to nurses practising in sexual and reproductive health, palliative care, occupational health and mental health. For people needing such care, a nurse is often the first point of contact. It seems logical to contemplate whether allowing them to prescribe would provide a better service for their patients.

To this end, four working groups have been set up comprising nurses working within the four scopes of practice. The working groups are liaising with other nurses, doctors and pharmacists in the sector, as well as the Nursing Council on defining these scopes of practice.
This includes work on the competency requirements for nurse prescribers in the four scopes of practice, and identifying what prescription medicines may be appropriate for nurses to prescribe within each scope of practice.

The Ministry and Nursing Council are developing a multi-disciplinary consultation framework for the four groups to ensure consultation is consistent and includes key stakeholders. The Nursing Council is also working with nurses in asthma and respiratory care, and diabetes, on developing nurse-prescribing proposals in these two areas.

You may be aware that I am setting up the New Prescribers Advisory Committee. It will be responsible for scrutinising proposed regulations for nurse prescribing in aged care and child family health, and for assessing future applications to extend prescribing rights to other scopes of nursing practice and other registered health professionals.

The New Prescribers Advisory Committee’s role will be to assess:
 costs and benefits of prescribing proposals
 competencies and education requirements for new prescribers
 whether the proposed medicines are appropriate.

This committee, when established, will provide advice to me on the quality of future prescribing proposals.

I want to assure you I am committed to New Zealand's nursing workforce. You deserve a positive working environment with career opportunities and satisfaction. The people you nurse deserve a strong capable workforce to ensure they receive the best possible services.

I need your help in rebuilding a public health system New Zealanders can trust and have pride in. Nurses, in their role as observers, assessors, educators and communicators, are vital in ensuring quality standards for our health service and patient safety. Working in collaboration with each other and the Government, nurses have the opportunity to make a significant contribution to improvements in the health care system. That is what I am determined to achieve. Thank you again for inviting me to your conference.

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