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The education–health nexus ...Maharey Speech

24 August 2001 Speech Notes

The education – health nexus
Medical education within a strategic framework

Speech to the New Zealand Medical Students’ Association Annual Conference. Canterbury Horticultural Centre, Christchurch.


I am delighted to be here today to address an important group of people. Of course, every group of people I speak to is important, but as students of medicine you are the people who will play a key part in ensuring the state of the nation’s health in the future. I know that this very institution, the Christchurch School of Medicine and Health Sciences, is an integral part of the health care services in the Canterbury region.

It is, therefore, not surprising that this Government considers investment in your tertiary education to be something very worthwhile. We are committed to making quality tertiary education more affordable to you, as students.

I would like to run through what we have achieved towards this aim, but first of all I would like to step back and address the bigger picture – how the Government is seeking to build a tertiary education system that will meet New Zealand’s future social and economic needs, and propel us forward in our development as a knowledge society. Of course, responsiveness to students will nonetheless remain a critical part of the system.


Since the education reforms based on the Learning for Life reports in 1989-1990, the New Zealand tertiary education system has made significant gains in terms of responsiveness to student needs, and in terms of increasing national participation levels.

The intent of those reforms was to create a balance – with institutions getting the autonomy they had been seeking, and that autonomy being constrained by carefully drawn up Charters setting out complementary institutional missions.

In implementing those reforms, however, instead of the proposed co-operative model, the National government developed a market-place model. This has placed some institutions at risk and resulted in a fragmented system lacking in clear direction and leadership.

Our challenge as government is to provide future-focussed leadership to the tertiary education system. New Zealand now faces new and demanding challenges in a period of rapid global change – in technology, in communications, and in labour market dynamics. I know that in the health sector these challenges are particularly acute; worldwide shortages of doctors and nurses are contributing to recruitment and retention problems on our shores and beyond.

The tertiary sector has a key role to play in equipping New Zealand to meet these challenges and to take advantage of the opportunities they create. The Diploma of Rural Health offered by the Christchurch School of Medicine is just one example of advanced training being provided to meet the needs of rural nurses who are now providing an advanced, expanded role as nurse practitioners carrying out more complex health care. I note that the first ever National Conference of Rural Nurses in New Zealand was held here last month.

The University of Otago’s Health Sciences First Year offers school leavers, or others who have not previously attended a university or tertiary institution, a means of entry to dentistry, medical laboratory science, science, medicine, pharmacy, and physiotherapy. The course also provides an excellent foundation for advanced study in the biological, biomedical and other sciences.

The tertiary education sector also has a fundamental role to play in promoting a vibrant cultural identity, which places value on diversity, achievement and innovation.

Tertiary education is one of this country’s major public investments in building the skills and capability needed for the future. To maximise the benefits of this important investment, a paradigm shift is required.

The tertiary education system will no longer be solely driven by the choices of consumers as it was during the 1990s, when it was too narrowly focussed on student demand as the primary determinant of resource allocation.

Rather, the focus of the tertiary education system will now be to produce the skills, knowledge and innovation that New Zealand needs to:

 transform our economy;

 promote social and cultural development; and

 meet the rapidly changing requirements of national and international labour markets.

This Labour/Alliance Government will lead a shift to a co-operative and collaborative sector, unified by a clear vision for the future, which contributes effectively to New Zealand’s development as a knowledge nation. While maintaining strong levels of participation, the tertiary education system needs to be more explicitly aligned with wider government goals for economic and social development.

The key message is that the tertiary education system can no longer be seen in isolation from the Government’s wider social and economic development initiatives and strategies.


As you may know, the Tertiary Education Advisory Commission (TEAC) was established by the Labour/Alliance Government in April 2000. It was tasked to provide advice on the future strategic direction of the New Zealand tertiary education system.

The Commission’s first report, Shaping a Shared Vision, set out a broad vision that has informed its work ever since. TEAC’s second report, Shaping the System, gave us the steering mechanisms we will need to use our tertiary education capability strategically. These are:

 Charters for publicly-funded providers that are meaningful and set out their special mission and contribution to the system as a whole;

 Provider profiles to avoid duplication and focus each provider on their specialities and the needs of their stakeholders;

 A Centres of Research Excellence Fund to foster excellence in areas of strategic importance; and

 A Tertiary Education Commission (TEC) to bring the administration of the whole system together under one agency, with strong involvement from business and other stakeholders in its governance.

This month we have also announced a $35 million Strategic Change fund to help institutions adapt to the new environment, and a tertiary efficiency study to identify opportunities, in particular from collaborative action between institutions.

Over the next months, further decisions regarding the structure of the TEC, the nature and form of Profiles and Charters, and the funding system will be taken.


The tertiary education system is diverse and complex. To achieve the paradigm shift we need across all areas of the system will require a well-designed Tertiary Education Strategy, which will set out priorities for strategic investment in the system.

Shaping the Strategy, TEAC’s third report, addresses this very subject. It recommends a set of strategic priorities for the tertiary system to ensure that it contributes to the national goals for economic and social development. This is necessary if New Zealand is to compete successfully in a global environment. This marks a new phase for tertiary education policy in this country.

The tertiary system includes learning in workplaces as well as classrooms and laboratories. It includes long-established universities and polytechnics and new training and research establishments. It includes full-time and part-time learners, adults and school leavers, learning in lecture theatres and learning by distance. The Tertiary Education Strategy will cover the whole tertiary education system, and will have linkages with the compulsory education system and the labour market.

All elements of the system need to be performing to the highest standards to ensure we develop the skills, capabilities and knowledge that New Zealand requires for the future.

The Tertiary Education Strategy will outline how the tertiary education system will achieve the paradigm shift from looking inwards at consumers, to looking outwards at how it can:

 contribute to New Zealand’s goals for economic and social development;

 produce the knowledge that New Zealand needs to be a world leader in innovation;

 produce the skills and competencies that New Zealanders need in order to fuel our economic growth; and

 develop the capabilities within the sector to meet the needs and expectations of enterprise and communities.

The Strategy will outline priorities and milestones for the next three to five years and inform policy direction, purchasing decisions and capability building by the TEC, as well as provide a framework within which the tertiary education system can develop.


To enable everyone to participate in quality tertiary education at any and many points throughout their lives is an investment in the future of this country. This is an investment to which the Government is committed.

We realise that there are groups of people who are currently under-represented in tertiary education. These include Mäori, Pacific peoples, people from non-English speaking backgrounds and other disadvantaged New Zealanders. These groups face barriers, such as poverty and financial difficulties, literacy and language needs, in accessing tertiary education, and need additional support to overcome these barriers and achieve their potential. It is in everyone’s interest that disparity is addressed, as our actions will determine our future.

Special supplementary grant funding for Maori and Pacific students

In March this year the Government provided all of our tertiary education institutions with additional funding, in the form of a special supplementary grant, to provide increased support for Maori and Pacific students. The grant was calculated on a per student basis and on the level of study of each Maori and Pacific student enrolled at our institutions.

For 2001, we asked institutions to determine their own set of objectives that would help to build a base for improving Maori and Pacific tertiary education outcomes in the longer term. We stressed that effective, ongoing consultation between institutions and Maori and Pacific students, staff and communities would be important throughout this process.

These grants are focussing institutions’ minds on how best to extend and support access amongst these under-represented populations. Further changes to the funding system may reinforce this.

Of course, it is important that appropriate programmes of study are provided once these students arrive at tertiary institutions. The Certificate in Health Science at the University of Auckland is a one-year foundation course – otherwise described as a pioneer initiative – that prepares Maori and Pacific students for tertiary study in health and medicine, and is achieving results. Nineteen students graduated with this Certificate in March this year, and are now studying in a range of disciplines such as pharmacy, nursing, medicine, physiotherapy and health science. This positive result is perhaps not surprising from a division with a mission “to ensure the best possible standards of health for Maori and Pacific Island people, particularly through teaching, research, advocacy and work-force development.”

The fee stabilisation offer

For nine years, from 1991 to 1999, under the previous Government's policy, student fees escalated. From 1990 when a standard fee of $1,250 was charged, average fees had increased to approximately $3,500. This rapid rise was a concern, for as well as individual students many parents were hit hard by these increases. Further, institutions were put under greater financial pressure, and their time and energy was diverted away from the core task of providing quality tertiary education.

One of the first things we did on becoming the Government was to stop that upward spiral. For 2001 we offered a 2.3% across-the-board supplementary grant in return for an agreement to hold every single fee and every single compulsory course cost at the same level as, or less than, those set in 2000.

The sector revealed its willingness to support the fee freeze, and in 2000 the offer was accepted by every university, polytechnic, college of education and wananga, and most private training establishments.

When putting in place the fee stabilisation offer for 2001, we stated our ongoing commitment to the stabilisation of fees. With both TEAC’s work and the Tertiary Education Strategy still to be completed, we knew that for 2002 we had to come up with an approach that would be fair to students and fair to institutions.

The present fee stabilisation offer represents an increase in equivalent full-time student (EFTS) funding of 5.1 percent over the amount available in 2000. This offer will meet the full cost of current estimates of inflation on both tuition subsidies and tuition fees over the years 2001 and 2002. It allows us to continue our commitment to making tertiary education more affordable for students, while at the same time enabling providers to continue delivering quality tertiary education.

This fee freeze will be of benefit to many of you as students next year, and is going to make tertiary study considerably more attractive for many people. The sector has until the end of this month to decide to agree – or not – to the offer.

Centres of Research Excellence Fund

Linked with the fee stabilisation offer is the Centres of Research Excellence Fund. Our motivation in establishing the fund is the need to encourage a greater concentration of research resources (both intellectual and financial) in the tertiary education sector, as well as greater networking across researchers and research organisations.

I know there is excellent research going on at the Medical Faculties of both the University of Auckland and the University of Otago. This is something we want to encourage. In particular, we want to encourage inter-institutional research networks, with researchers working together on a commonly agreed work programme. I am aware that medical education in particular is increasingly taking an interdisciplinary approach which incorporates aspects of wider health.

We want the Centres of Research Excellence to be involved in knowledge transfer activities to ensure that valuable new knowledge feeds into New Zealand’s innovation system.

At the beginning of this month the Ministry of Education announced its selection of the Royal Society of New Zealand as the purchase agent for managing the Centres of Research Excellence Fund. The Royal Society will be responsible for developing a selection framework for the centres, the selection and funding of the centres, and for their ongoing monitoring.

The final selection criteria and application process will be announced in early October. In the meantime, a list of indicative characteristics outlined in the terms of reference for the Fund, provides a basis for tertiary education institutions to consider and prepare for the application process.

Strategic Change Fund

We appreciate that to achieve a more co-ordinated and coherent tertiary education sector in the post-TEAC environment will involve change. Change comes at a cost, and recognising this, we are making both capital and operating funding available to public tertiary education institutions through the Strategic Change Fund. In the 2002/03 financial year, each institution, whose proposed use of the funding meets the agreed criteria for the Strategic Change Fund, will receive an allocation determined by their proportion of total government EFTS income for 2001.

Changes to the Student Loan Scheme

With around a quarter of a million students each year receiving some form of tertiary education, and the taxpayer as the major funding source, the Student Loan Scheme is important in enabling students to access finance for education related costs.

Recognising the burden of student loan debt, the Government elected to cease charging interest to full-time, full-year students and part-time students earning under $24,596 while they are studying in 2000 and beyond. We have invested significantly in this policy change. We believe that investment will return a good dividend for the country.

Another policy change allows Student Association fees to be borrowed through the Student Loan Scheme, a turnaround on the previous Government’s policy which threatened to turn students against their associations and put the associations’ very survival in jeopardy. We have also passed law removing the bias towards voluntary student associations.

Other changes which will assist students – and their parents – to manage their student loans include freezing the maximum student loan interest rate charged (to those who are required to pay interest) at 7.0 percent, increasing the course cost component entitlement of the Scheme from $500 to $1000, and ensuring that 50 percent of any repayment, after adjustment for inflation, is directed towards the repayment of principal.

The Education and Science Select Committee is soon to report back on a review of all aspects of the Student Loan Scheme and wider tertiary resourcing issues. Analysis of the many submissions received will give us a clear idea of the issues and concerns of interested parties, which will then feed in to help inform further policy work on the Student Loan Scheme.

Extension of medical students’ eligibility for student allowances

At the end of 2000, after listening to your concerns as medical students, we announced a policy change to the Student Allowance Scheme to extend student allowances for medical students.

This change allows for a maximum of 300 weeks of student allowances to be granted to eligible students who have been accepted for entry, and have enrolled, at a medical school even though they have not followed a traditional ‘long programme’ of studies leading to a final medical qualification.

We recognised that previously such students could not qualify for an extension of student allowances of up to 300 weeks, because their first degrees were not listed as part of a recognised long programme for student allowances purposes. Under the new policy, these students, who may for example have done a first degree in nursing or economics, or another discipline, and then the pre-requisites for medicine and then enrolled for an MBChB, may now be considered for an extended student allowance.

We are keen to support students who, through their studies, are working ultimately to improve the health and well-being of New Zealanders.

Health Workforce Advisory Committee

The health sector’s ability to recruit and train competent staff, who remain the sector’s most important resource, is very important to the Government. To address health workforce and training issues, the Health Workforce Advisory Committee has been established, and had its first meeting in May.

While advising the Minister of Health on health workforce issues, one of the Committee’s key tasks is to facilitate co-operation between organisations involved in health workforce education and training to ensure a strategic approach to health workforce supply, demand and development. Rather than short-term measures, the aim is to work towards long-term solutions.

We have, however, had to act quickly to address situations, such as the shortage of radiotherapists. I am pleased with the steps that have been taken to alleviate this particular situation:

 student intake has been increased from 17 to 24 students, with the Wellington School of medicine running the course following the Central Institute of Technology’s exit;

 recruitment drives have been undertaken overseas resulting in recruitment of 10 new staff by February 2002;

 the six Cancer Centre managers are meeting regularly, and

 the MRT Board is also promoting the occupation and looking at attracting overseas practitioners.

Qualifications Evaluations Service

The health workforce is an international workforce, and therefore our health sector depends on the effective verification of international qualifications from other countries. The Qualifications Evaluations Service of the New Zealand Qualifications Authority (NZQA) enables people entering New Zealand to work to have their overseas qualifications checked by NZQA and compared with New Zealand qualifications. NZQA establishes what level the overseas qualification is equivalent to in New Zealand.

NZQA also checks that the qualification has been awarded by a recognised overseas institution and that documents submitted by applicants are not fraudulent.

In the globalising world of the 21st century, the mutual recognition of qualifications between jurisdictions becomes increasingly important. NZQA is currently undertaking a review with a view to defining a world class operating system for the Qualifications Evaluations Service. This will be completed before the end of the year.

Ombudsman support for tertiary students

Of course, while ‘Diversity with Excellence’ is our goal, we recognise there also need to be checks for when reality falls short of that ideal. We will be strengthening the resourcing for, and tertiary focus of, the Ombudsman’s office. I know the student movement has campaigned for this for a long time, recognising that legal remedies – while sometimes tempting – are expensive, divisive, time-consuming and uncertain.

The Ombudsmen currently investigate some complaints about public tertiary education, but this recourse has not been developed. Enabling the Ombudsmen to have a more proactive role regarding the resolution of tertiary education complaints is likely to focus public tertiary institutions on the quality of their processes. This is likely to lead to an associated improvement in the processes of public tertiary education providers.

Three new investigative officers will be appointed from January 2002 to investigate complaints from students and staff regarding tertiary education institutions. In addition, the Ombudsmen will also take on an enhanced role. The Office of the Ombudsman will work with tertiary institutions to develop operational protocols in the latter part of 2001, and Ombudsmen will visit each institution between February and July 2002.


Alongside the considerable amount of talk and thinking on knowledge matters these days, I can assure you that action is being taken. The needs of students must be considered alongside the needs of the system – of course they are different sides of the same coin, after all.

I wish you well with your studies and all the best for the future.


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