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District Health Boards New Zealand AGM - Speech

Hon Annette King

27 September 2001 Speech Notes

District Health Boards New Zealand AGM

Thank you very much for inviting me to speak to your annual meeting this morning.

This is actually the second major annual meeting I have attended today. Little more than an hour ago I was speaking to the New Zealand Nurses Organisation. Nurses make up the largest professional group in the health system, and as such have a critical role to play in quality health care.

DHBs also have a critical role to play, and are about to become as much of a linchpin in the public health system in their own way as nurses are in their way.

There is a limit, however, in how much I can talk about similarities. And perhaps the most limiting factor has to do with age.

Nursing in New Zealand is celebrating its centenary this year, 100 years of nursing registration.

DHBs, however, are still in their first year, and this is your very first annual meeting. DHBs are still only fledgling organisations, with the first elected members only now going through the process of electioneering and receiving postal votes.

Putting it bluntly, nurses have proved themselves in New Zealand over the course of 100 years. DHBs very much have yet to prove themselves to anyone really, though naturally I have particularly high hopes for them.

There are plenty of people who, if not exactly willing DHBs to fail, will be quick to say "I told you so" if the concept of district health boards fails to meet our expectations.
Well, I have a simple message for you today. DHBs are going to prove themselves. You are going to succeed. But it is going to be hard work. By this time next year I am sure there will be many more New Zealanders who will be starting to appreciate just what a difference DHBs can make to the health of the communities they represent.

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To revert briefly to nursing --- my job is not to nurse you along, but I will certainly be doing all I can to facilitate your success. DHBs are a cornerstone of this Government's determination to restore a public health system people can trust.

We have set DHBs up to make a real difference in dealing with the health disparities that existed when we took office in 1999.

The need to deal with those health disparities, and to improve the health of New Zealanders generally, was a fundamental concern of the health sector reference group responsible for developing the short to medium-term health objectives in the New Zealand Health Strategy.

The New Zealand Health Strategy, which I released in December last year, makes it clear that the role of DHB s in carrying out these objectives is equally as fundamental. If the DHBs don't do their job well, or are not empowered to do their job well, then progress in tackling those objectives will be far slower than any of us want.

The NZHS is a ‘living’ document focussed around improving health outcomes, increasing the quality of care, reducing disparities and inequalities between population groups, increasing participation and cooperation in looking after the health of local communities, and creating a transparent, accountable health sector.

DHBs are about exactly the same issues.

I want to talk briefly about some DHB issues that have been the subject of much media attention. The first concerns the DHB elections, currently taking place by postal vote at the same time as the local body elections.

Various Opposition spokespersons on health explained to the media around the country that New Zealanders would not be interested in standing for the new boards. The theme of what they were saying to the media was --- why sweat blood and tears working for a board that is going to make no difference anyway?

Well, they got many things wrong in health during the 1990s, and they got this wrong too. They got it wrong 1082 times. That is the number of candidates. I always knew a number of existing board members would not be standing in the election for various reasons, but I was more than delighted to discover that 73 of these board members have put their names forward. That is a terrific vote of confidence in the DHB system.

More importantly still, the large number of candidates overall highlights the public’s desire for participation in the health of their local communities.

Another issue that has naturally gained some media prominence has concerned the financial viability of DHBs, particularly in relation to debate around annual plan processes and Crown Funding Agreements.

I have found some of the more alarmist contributions from the Opposition to this debate quite ironic, because not only was the process of settling Crown Funding Agreements notoriously slow under the previous Government, but all funding and planning processes were shrouded in secrecy.

Financial accountability is one element of an open, transparent health sector. The democratic election of boards will reinforce this transparency in the future.

We all know that deficit concerns have dominated the interim transition period. A number of causes have contributed to projected deficits, including increases in personnel costs and supply costs, fluctuations in the $NZ (particularly against the $US), and other operating costs such as recruitment expenses.

The Ministry of Health and other government departments are working hard with DHBs on their annual plans. I am assured the tone of discussions has been positive and productive.

I believe that in future years the district annual plan process will become a more straightforward exercise.

A parallel process of negotiating Crown Funding Agreements with DHBs is nearing an end. Although the process has been smoother than it often was under the former Government, we should all be keen to find ways to improve the process in the future.

I know everyone here understands that the new institutional framework for the public health service is underpinned by a philosophical approach that seeks to create an inclusive, collaborative, non-commercial, and accountable environment.

The Government's commitment to the DHB model is driven by a need to change the incentives in our health system. Achieving local ownership of funding is the key to success for all DHBs.

Unquestioning growth in your hospital-based services may restrict the options you have to improve health outcomes. These issues are now your issues as well. There is now a great deal of common purpose between the Ministry and DHBs.

Leading a mindset change throughout the DHB sector is the responsibility of all of us. Thinking like a DHB, understanding the new incentives and the new relationship with the ministry, is an essential behavioural change.

The way you design your organisational structures will be key to getting the incentives right. Learning is still taking place. The DHB model must not be cut off at the knees by creating strong divisions between the funding and provision arms. That will simply create 21 news HFAs, and that is not this Government's intention.

DHBs can only go where your communities allow. The first step toward getting communities to support new ways of delivering health care is to rebuild trust.
Public consultation and a well-informed and supported community will be the foundation of successful initiatives. As a DHB, if you are not taking your community with you, then you are going nowhere.

You will soon have the privilege of developing a five-year strategic plan. It is a privilege to set the direction of a sector as critical as health. It is an opportunity that does not come to any of us often. I understand the sector's need for good planning signals and medium-term funding certainty, something to which I am committed to doing my best to deliver.

It is important, particularly coming off Quality In Health Week, to talk about the role of DHBs in improving quality health care. Quality is achieved by encouraging a culture of continuous improvement in the delivery of health care.

That point was underlined in New Zealand this week by Dr Donald Berwick, president and chief executive of the Institute for Healthcare Improvement in Boston. He was very positive about the quality of our health system, and urged that quality be kept as a high government priority. I certainly accept that.

You may have heard his most important messages, but they are worth repeating. High quality care is about the performance of the health system, from the perspective of the patient at the local level.

Improvement is about learning. We need a learning culture where people with knowledge and experience can champion ways to improve systems and processes.

Knowledge must be spread around districts and around the country. DHBs can foster a culture of exchange and dialogue with mutual improvement the objective. Efficiencies can be achieved through collaborating better, sharing information, ideas and technology.

In this way mistakes are minimised and avoided because lessons are learned in a culture where the focus is not on blame.

Improvement is also about leadership. Leaders must lead and work together as teams. The champions of change for the better need to be the Chairs and CEOs, It starts with you.

There are too many health goals, Dr Berwick says. By that he means that we should keep things simple. It is better to do a few things now rather than many things never. For example, set a few goals you know you can achieve, and when you have achieved them, move on to fresh ones. I would like to work with DHBs with goals that we can achieve in the short-term like waiting times.

He also says we spend too much time measuring things. He might well be right that there is too much data around, and that we should measure just enough. As DHBs, you can set achievable goals, and measure your progress every three months, and report on progress. That's the data we need.

DHBNZ itself serves a dual role. It facilitates collaborative activities in areas of joint interest and benefit to the DHB sector, and acts as a forum to represent the interests of DHBs.

I applaud work DHBNZ is doing to deliver new tools DHBs require. Joint work on workforce development, service improvement, efficiency projects, benchmarking, the National Service Framework and primary health are excellent examples of the value of coordinating expertise and resources to everyone's benefit.

DHBNZ’s “interest group” role needs careful thought. It must not have the unintended consequence of setting DHBs ‘against’ the Ministry. The NZ Health Strategy is all about a collaborative environment for the health sector.

DHBNZ, working together with DHBs and their communities, with the Ministry of Health, and with the Government, can make a real difference to the health of all New Zealanders.

That is the critical role your organisation has to play. DHBs need time to bring about improvements in the health sector, but I am confident that in the future, just like nurses, they will be able to claim that they have proved themselves, and that New Zealanders are healthier because of what they have achieved. I wish you all the best for the rest of your meeting.


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