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Annette King Speech: Elective Services Forum

Thu, 18 Nov 2004

Elective Services Forum

Venue: The Terrace Conference Centre, The Terrace, Wellington. Health Minister Annette King talked about her vision for electives at the Elective Services Forum in Wellington.


Thank you very much for inviting me here today to share part of your forum.

I am sure that Brenda Bromell's introductory comments and update have already got the meeting off to a good start. Brenda is the Ministry of Health's expert in interpreting elective statistics, and when she speaks I listen!

The subject suggested for me today is my vision for electives. Brenda and the Ministry's chief medical adviser David Geddis are already fulfilling part of that vision with their plans to make website data on electives more user-friendly.

Whether or not making the data more user-friendly will help any of my political opponents actually understand the data is a moot point, but at least when they misuse the data in the future, the media and the public will be able far more easily to check the facts for themselves.

The public availability of meaningful data is, in fact, one of the most important parts of my vision for electives. People, particularly those who need an operation, have a right to know how well we are performing against the targets we set ourselves.

I was flabbergasted the other day when ACT's health spokesperson accused me of keeping data hidden. One thing I am really proud of in the five years I have been Health Minister is the amount of information that is now publicly available. During the 1990s data was often not collected or was unreliable, and it was never possible to have genuine trust in those bits of information that were publicly disclosed.

The ACT spokesperson was badly out of line in her comments about secrecy. She showed herself up very successfully in the overall theme of her media release, which alleged 3803 New Zealanders had died while waiting for hospital surgery under the Labour Government since September 2000.

That media release was not only dishonest, as dishonest as any I have seen from an Opposition health spokesperson, but it also insulted everyone in this room, because all of you care passionately about elective services, and all the health professionals throughout the country who are doing their very best to try to ensure New Zealand has a system of elective services to be proud of.

It insulted you all because it was a misuse of information - it was so blatantly wrong to imply that a person who died waiting for a cataract or dental operation, for example, died because they didn't get the operation.

The data was raw data only. It would be like me saying, when looking at political polls, that the reason ACT is on 2 percent is because of Rodney Hide's leadership, or Donna Awatere Huata. But I don't know that - I just know the statistical evidence is that they have 2 percent of public support.

There are several other analogies that illustrate my point. On average, 41.84 persons die annually during the televising of Lotto results. But can ACT prove that they died because Lotto was on the TV? A total of 28,196 people have died in New Zealand in the last year for which figures are available (up until March 2004). And on average, 233.38 people die annually during the time that the ACT party holds its Caucus meetings.

The other interesting thing about that media release was that the figures supplied also contained data on the greatly increased number of elective procedures carried out in the past four years. Presumably that sort of information should be kept hidden! Well, I don't think it should be, and I thank everyone in this room who has contributed effectively to what we are now achieving.

My vision for electives, or the Government's vision for electives, is effectively summed up in the Government's electives strategy. I will talk in more detail about that strategy shortly, but firstly I need to set the context of where we were when the Government came into office in December 1999, and I began my term as Minister.

Policy in the area of elective services has basically been driven, as you all know, off the number of patients sitting on waiting lists.

In June 1996, according to a statistic we do have, though it is certainly only an estimate of what the situation actually was, 89,000 New Zealanders had been placed on waiting lists with no certainty of when they would receive treatment.

Waiting lists in the 1990s were frequently unfair, with many patients treated in order of their length of wait, instead of their level of need compared with other patients. Waiting times for treatment also differed considerably around the country.

That is why I was determined to move as quickly as I could on electives, and I was very pleased when the Government's strategy, entitled Reduced Waiting Times for Public Hospital Elective Services, was released in March 2000. It set out four principal objectives. I am sure you know them well, but they are worth repeating: · All patients with a level of need which can be met within the resources available are provided with surgery within six months of assessment; · Delivery of a level of publicly funded service which is sufficient to ensure access to elective surgery before patients reach a state of unreasonable distress, ill health, and/or incapacity; · National equity of access to electives --- so that patients have similar access to elective services, regardless of where they live; · A maximum waiting time of six months for first specialist assessment.

There has certainly been much progress. I won't go through all the statistics, because you will no doubt have your fill of numbers over the next two days, but it is certainly worth noting that there are now less than 1500 patients waiting without a plan of care. That's a massive improvement on the 89,000 people waiting without a plan of care in 1996.

The focus in recent times has been on patient flow management through the publishing of Elective Services Patient Flow Indicators (ESPIs).

These eight indicators were developed to help District Health Boards assess whether they are on the right track to meet the Government's targets in respect of patient flow processes.

Good progress has been made on these indicators. Looking at the six months to September, there has been improvement in all of the key indicators, that is, in ESPIs two to seven.

All of you here today have been vital to achieving the progress to date. Unlike my political opponents, I'd like to thank you for your work, and congratulate you on the successes that are occurring.

There is still much work to be done, however, and in particular there is a need to continue work in a number of specific areas.

Firstly, on ESPIs, we need to do still more to ensure that patients are managed through the system and that there is good communication between patients and their GPs.

Secondly, we need even greater focus on the primary/secondary interface and the best use of human resources. This will involve guidelines, and the use of GPs and nurses to deliver services such as Active Review, follow-ups and the like.

And thirdly, we need to do still more work on prioritisation, although New Zealand is already at the forefront of work in this area. Current work is focused in areas such as coronary artery bypass graft and orthopaedics. We must work on the linking of priority to treatment decisions, thereby ensuring that clinicians act on the priority they assign.

Information on hospital surgical activity is about to be published on a website for the public to view. This information includes standardised intervention rates, which will raise questions of equity, and therefore we need to ensure through the prioritisation work that we are intervening for those with the greatest clinical need.

I am sure you are all very well aware of the orthopaedics project I announced in May this year. This is clearly a key area of clinical need. A major joint replacement can dramatically improve a person's quality of life. Over the next four years we plan to double the number of orthopaedic operations, but to make that happen we must ensure hospitals deliver the volumes they have committed to.

Data for the first quarter (July to September) of 2004-05 indicates volumes of major joint replacements are a third up on the same period last year, and this is very pleasing.

Our approach of continuous quality improvement or CQI, taken in developing the orthopaedics initiative, needs to be broadened across other specialties, and I am determined we will achieve that.

Before I finish today, I think it is worth asking ourselves, where do we go from here?

Most of the current work occurring, particularly around ESPIs, addresses two out of the four goals in the Government's vision ---- that all patients with a level of need which can be met within the resources available are provided with surgery within six months of assessment; and a maximum waiting time of six months for first specialist assessment.

We must do more work on our other two goals as well. The third goal, of national equity of access to electives, is designed to ensure that patients have similar access to elective services, regardless of where they live. As I have already noted, some work is being done on this, with the current emphasis being on prioritisation and comparative intervention rates.

The last goal is the delivery of a level of publicly funded services that are sufficient to ensure access to elective surgery before patients reach a state of unreasonable distress, ill health, or incapacity.

The Government's funding of public health has increased over 40 percent while I have been Minister, so there's no doubting our commitment in this area, but this goal needs to be made clearer and more measurable. It does relate to ensuring that elective volumes are maintained and enhanced, and with this in mind, I have asked the electives team in the Ministry to pick up this critical area of work in four key areas:

· We must address disincentives. The current purchasing framework does not encourage innovation or different ways of delivering services. We need to be flexible in how we fund services so that we use our resources most effectively.

· The Ministry is going to look at ways to strengthen service agreements. We need to consider ways to protect elective volumes and reduce the effect that acute presentations have on our ability to maintain elective throughput.

· The Ministry will look to work with you to implement efficiency and quality improvements. Areas such as length of stay, theatre management and pre-admission processes will all help increase the flow of patients through the system.

· The Ministry will also develop a framework for introducing innovative/high cost treatments. Every new thing we add at the "top end" of services has the potential to reduce our ability to deliver lower priority work and this tension needs to be managed.

Thank you again very much for inviting me here today, and thank you for all the hard work you are doing. I am sure the improving statistics provide great encouragement to keep it up. You are all vital to our vision of providing timely and equitable access for all New Zealanders to elective services, and I wish you well for the rest of your conference.


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