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Ryall: Mid Winter Dialogues, University of Otago



Hon Tony Ryall
Minister of Health

01 July 2011 Speech
Mid Winter Dialogues, Speech University of Otago, Christchurch

Good afternoon.

First up, I’d like to thank the many health professionals and students in the room for their outstanding leadership and efforts during and after the series of Canterbury earthquakes.

The way in which you all worked together so effectively to care for your fellow citizens is truly humbling. I know that the challenges remain and the uncertainty persists, but please know that you are admired and appreciated for what you are doing.

We really have seen the best of New Zealand in the response to the earthquake, and in particular, the best of our health service.

Today I'd like to talk in particular about our significant progress in disease prevention and health promotion. Most importantly however I want to acknowledge and thank very much the staff in the public health service who have delivered these gains I am about to share with you.

As a new government minister in 2008 I committed our government to protecting and growing the public health service, to better respond to the patients we care for and serve. By any standards New Zealand has made substantial beneficial improvements.

And it’s appropriate in this forum to celebrate and share some of that progress with you today.

Protecting our public health service
Not every government can do that. Around the globe, governments are making tough and often unpopular decisions to make ends meet.

And health systems have not been immune from those decisions.

In Britain, many public servants, including doctors and nurses, are facing a two-year wage-freeze.

There are large-scale savings planned within the National Health Service totalling GBP 20 billion. It is estimated 50,000 NHS staff will be made redundant over the next few years.

Already there are reports of cutbacks of almost 1,000 jobs in two London hospitals alone – including significant numbers of nurses and doctors.

In Ireland, the former Health Minister was pelted with red paint by protesters as tempers grew over her Government slashing 5% off the health budget.

The Irish had already cut public service salaries by up to 15%, including doctors, nurses and teachers.

In Canada, the provincial health authorities are now taking tough measures to curb health costs.

Some of these include introducing means testing, halving generic drug prices, and controls on the salaries of top hospital executives and doctors.

Newspapers have reported 2,500 nurses in Ontario are losing their jobs.

Fortunately New Zealand's economy has weathered the storm better than most.

But as a government we are still borrowing an average $300 million a week to protect and grow our important social services.

This year alone the Government's cash borrowing is expected to be around $16 billion.

So it is clear that in the future we have to do the best we can, in health policy and everywhere really, within an overall restricted financial horizon.

Only 3 short years ago…
When we came to office there was significant public disquiet about the public health service. Headline after headline underscored a lack of leadership, no focus and bureaucracy out of control.

The whole system was on a track to financial crisis, as DHB deficits rocketed and services failed.

Over 9 years the health budget had more than doubled, but fewer people were getting operations on a population basis. The bureaucracy had grown massively. Staff shortages were rife, with so many of our health professionals leaving. Clinicians were seen as the problem, ignored and marginalised.
Patients were getting a poor deal as so much of the extra money was wasted on bureaucracy and schemes that added no value. Patients languished in hospital ED corridors sometimes for days on end.

Women with breast cancer waited 15 weeks for cancer radiation treatment.

Many patients were sent to Australia for care because of endless and worrying delays in New Zealand. Can you imagine having your treatment delayed if you had the disease?

This was not good for patients nor their families.

It’s easy to forget how isolated clinicians had become and how disenchanted patients were The influence of clinicians on patient outcomes here in New Zealand was at an all-time low.

This failure to engage the very people with the right expertise – doctors and nurses who know the patients' needs best – was seriously eroding your ability to provide patients with the care they needed.

Day after day television, radio and newspapers reflected that widespread concern.

Strong investment in health budget
So we came to office with a mandate to improve services for patients… they wanted us to put the service back into public health. New Zealanders wanted us to re-engage clinicians in decision-making.

And they wanted us to focus on fewer, more important things…to get better value for their tax dollars.

And we have.

Against the backdrop of the worst financial situation in 80 years, we have remained determined to grow and protect the public health service.

This year’s Budget makes a remarkable additional $585 million available for health initiatives…the biggest single item and close to half of available funding.

The government has invested $1.5 billion of extra, new money into the public health service over the past three years...in the most difficult of financial times.

We’ve been able to maintain and improve key services and infrastructure.

This year’s Budget includes a strong commitment to improving services in a number of key areas: more elective surgery, additional Plunket visits focused on new mums, improvements in maternity safety and quality, more for medicines, higher subsidies for dementia beds, a significant boost for disability services, and $94m more for GP subsidies over 4 years.

We’re also investing $12 million to stamp out rheumatic fever. More on this later.

Workforce
We have invested another $18 million for an additional 40 medical school places…taking us to 120 of the 200 promised extra places over 5 years.

Once those students graduate, the voluntary bonding scheme we introduced offers them student-loan write-offs in return for working in hard to staff areas or specialties.

We’ll soon have over 1900 young doctors nurses and midwives on the scheme.

The global financial crisis has also impacted on the NZ health workforce.
Staff vacancy and turnover rates in hospitals for example are at an all-time low.

Since November 2008, public hospitals now employ over 500 extra doctors and over 1000 extra nurses.

There are more doctors and nurses employed in the public health service than ever before.
…500 extra doctors
…1000 extra nurses
… and 1000 fewer administrators!

There are more general practitioners working in primary care than at any other time.

But there are still shortages in some specialties and in many rural areas.

We have also sought to focus on retaining our health professionals through providing more opportunities for clinical leadership and research.

At a time when many other countries are reducing their workforces and their investment in health, we have been growing and protecting our health workforce.

Clinical leadership
And we’ve worked hard to reassert the importance of clinical leadership.
Globally, clinical leadership is recognised as a fundamental driver for better health outcomes.

That’s why we have brought clinicians into the centre of decision-making…clinicians dominate the National Health Board,…they are now leading the vital quality and safety agenda… they are actively leading the work to future-proof the health workforce…and clinicians are driving key policy areas like maternity.

Around the country clinicians are leading improvements in patient services.

Nurses in particularly are driving the improvements in patients care through the productive ward programme and safe staffing initiatives.

Clinicians are working to enhance integration between hospitals and community, so that services move closer to home for patients.

Clinicians are leading big improvements in cardiac care and plan to widen their focus further. And clinicians are delivering even more care for patients.

Health targets improving quality
That can be seen in the very significant progress being made in the Six National Health Targets.

The Health Targets focus on key areas patients want improved. Three are hospital focused, and three are preventive…they focus on disease prevention and health promotion.

The three hospital targets in particular focus on improving timeliness and the quality of care. Quality is a major feature of the targets…because getting care in a timely way means better patient outcomes.

In elective surgery… we have increased patients discharges by over 22,000 since the change of government…from 118,000 a year to over 140,000 a year. That is 400 extra operations every week .

Growth in this level of extra surgery is unparalleled in New Zealand.

More hip replacements…more cataract operations… more hernias… more operations for older New Zealanders. More than ever before.

In hospital emergency departments…more patients are being treated sooner. The six hour target is really working for patients. Waitemata, for example, has gone from 61% in mid 2009 to 95% last month.

Their North Shore ED has gone from being described as the “weeping sore” of the public health system under Labour to being right up there with the best in the country.

Other DHBs have equalled this success. All around the country, patients are getting better and sooner emergency care. And that means better recovery and outcomes.

In cancer radiation treatment…we are now providing world standard treatment times for patients.

Last quarter every cancer patient ready for radiation treatment got that treatment within four weeks, bar one patient in Canterbury who was delayed 3 days because of the June quake.

Only 3 years ago, it was not unusual for patients to wait 15 weeks or be sent to Australia for their radiation treatment.

We set a six week target in 2009, and met that by Christmas 2010. We then tightened it further to four weeks, the world gold standard treatment time according to the Ministry of Health.

And our clinicians have achieved that.

Personally, I consider this one of the most significant achievements of the past two and half years. People said it could not be done. Yet it has been. Resources have moved to this vital area with nine new linear accelerators purchased. And patients are the winners.

Strong focus on prevention that works
As we know, non-communicable diseases, in particular diabetes, heart disease, cancers and chronic respiratory disease are growing significantly across the globe.

The National Government has selected a discrete number of high impact, high return preventive health targets; immunisation, smoking and heart disease/diabetes.

This was intentional as public health dollars had been spread too thinly, on too many projects over ten years with very little health gain to show for it.

The results in our target areas have been immediate and successful, even internationally significant. Focus and accountability achieve results.

Budget and government policy continue to invest heavily in disease prevention and health promotion.

Immunisation rates at all time high
Despite immunisation being one of the most effective ways of preventing a lot of infectious diseases, immunisation rates among New Zealand children had been low for many decades.

So, children have been threatened by recurring outbreaks of illnesses such as measles and whooping cough.

Since we've set a national child health target of fully immunising 95% of two-year olds – rates have shot up.

From around 70% only three years ago, to 90% of two year olds now fully immunised –– across all socio economic and ethnic groups. And it's still climbing…on track to meet our goal.

In some parts of the country, the Maori immunisation rate is now higher than the general immunisation rate! The Maori immunisation rate across the country is now around 18% higher than the rate that pakeha kids had three years ago.

Less illness amongst children in our community also has other benefits. Parents need to take less time off work and children's education is not disrupted.

To reach the next child immunisation target of 95 per cent by 2012 will be a challenge. There's no doubt about that.

We will need a more sophisticated way of finding out why parents make the decisions they do – and more approaches to ensure parents are able to make well informed decisions for themselves and to recognise the benefit for the community.

Smoking at a turning point
On tobacco, this government has created a turning point in the campaign against smoking …with more actions than ever before on a scale never seen before.

The Government has passed an unprecedented 30% increase in tobacco tax…the most effective way to prevent and deter smoking. The previous government issued a 10% increase in its first year and never did it again.

Central to our efforts is the national health target of hospitalised patients who smoke receiving advice and help to quit there and then.

This is engaging the public health service like never before. From zero to 90% in six DHBs in less than two years.

General practice is at 71%, and we’ll bring them into the target next year.
Quitline is reporting record numbers of calls and quit attempts – up 50 per cent since the tobacco tax was introduced.

And we have backed this effort with massively improved access to smoking cessation treatments…up 82% in 18 months.

Legislation to phase out tobacco displays will soon pass. And plain packaging is inevitable.

When it comes to non-communicable diseases, dealing with tobacco offers the best impact for dollars spent. Smoking rates are still too high and we can’t let up on this.

On a minor note please consider that the government is prohibiting smoking in prisons this month. As a consequence thousands of prisoners have taken up the offer to try smoking cessation programmes.

It’s a strong signal that we are trying many measures, in all sorts of contexts, to reduce smoking.

Better heart health
Diabetes and cardiovascular disease also affect a growing number of New Zealanders.

We’re targeting improvements to the detection, risk assessment and management of these diseases. Not only have we increased the number of cardio-vascular risk assessments, there are good improvements in the level of diabetes management.

And, for the first time, a group of registered nurses – specialised in diabetes health care – are now authorised to independently prescribe medication for their patients – under the guidance of a medical practitioner.

This will make life easier for patients, and make better use of nursing skills, leaving medical practitioners with more time to spend on more complex cases.

This year we’ve set a target of 90% of eligible patients having their heart disease risk assessed. And we’re expecting even better performance in this area.

Wider Determinants of health
But ladies and gentlemen, Health cannot do it alone.

Keeping kiwis healthy goes beyond the health service.

Warmer homes = healthier families
New Zealand homes are on average six degrees centigrade below World Health Organisation recommended minimum levels.

Nearly half of these homes are damp and mouldy, and many are full of fungi and dust mites.

National and the Green Party worked together to introduce a significant public subsidy for insulating the homes of tens of thousands of New Zealand families: $360m for 190,000 homes.

We know that warmer, drier homes bring health benefits, especially for those with respiratory illness or other conditions.

We’ve done 100,000 homes in two years. The previous government managed a paltry 4,000 homes a year…talk about a lack of commitment.

I am confident that this will come to be seen as the single most significant new public health initiative of the decade.

History will show that this programme made an enormous impact on improving the public health, and the futures of kiwi families.Every day families tell of lives being turned around by this scheme.

HeatSmart is also be an essential partner to the Government's $12 million rheumatic fever initiative mentioned earlier.

Action on Rheumatic Fever
Maori and Pacific people – mostly children – living in cold overcrowded homes are most likely to get rheumatic fever – and they are 20 and 37 times respectively more likely to be admitted to hospital with first time acute rheumatic fever than anyone else.

Eradicating this third world disease from our shores has actually been a health priority since 2001. But nothing ever happened…except more poor kids got the disease.

This $12 million investment in the budget this year aimed right at this disease will support a massive campaign across high prevalence communities involving school based sore throat clinics for over 22,000 children.

Action on Unhealthy Weight
Physical activity is one of the keys to a healthy life. And it can benefit New Zealanders of all ages.

Amongst a host of health benefits, physical activity reduces the risk of heart disease, several cancers and unhealthy weight.

Research shows young New Zealanders are much less active than they were twenty years ago.

KiwiSport is a government funded initiative to promote sport for school-aged children. It was launched by the Prime Minister in August 2009 and provides an $82 million sporting boost to be invested in school-aged children over four years.

The Education Review Office tells us schools are reporting increased student participation in organised sport. Schools are rapt with the flexibility they’ve been given to get their kids more active and in better health.

Food-free advertising zones doubled
This Government works constructively with commerce in a number of ways including improving public health. One such example is the recent doubling in the number of hours of food advertising restrictions during children’s television time.

The total restricted and advertising-free zones per week across the three major free to air TV channels has more than doubled under this Government to 101 hours and 30 minutes a week.

This is far more than the previous government could ever achieve. And together with several other initiatives including numerous nutrition promotion efforts adds up to a strong contribution to discouraging unhealthy weights.

First Time Mums
Part of our health promotion agenda includes strengthening the support we provide families and children in particular.

This year’s Budget provides $21.3 million over four years for additional WellChild visits has a particular focus on the needs of first time mothers .

The additional funding is expected to deliver an extra 54,000 visits to around 18,000 mothers who need this additional support. For these mothers, this will mean, on average, three additional WellChild visits up to the first two months of a baby’s life.

Currently, WellChild provides two visits during the first two months of life.

Rescuing Before School Checks
And as kids head towards age 5, we need to help them become school ready We’ve put a lot of effort into rescuing the “Before School Checks” programme. This is about identifying health and sensory problems and solving them early.

You’ll recall this was a last-minute panicked election promise by the previous government in 2005 that only delivered checks for 3,000 kids in the following 3 years.

We’ve cranked that up to over 90,000 checks in two years…around 83% of the target population.

Whanau Ora
The Whanau Ora policy is a major step forward in helping families take responsibility for improving their lives… to work on all the things that impact on family well-being. Whanau Ora aims to end the 5 cars up the drive way syndrome… where endless agencies work on individual problems in isolation of each other and the needs of the whole family.

Already 14,000 whanau members are involved, with over 3,200 whanau assessments already undertaken by the National Hauora Coalition.

Whanau Ora is about a coordinated service meeting the needs of individuals and families. Contracts are integrated and services work together. It’s a model of what the future could look like

Conclusion
Ladies and gentlemen, I've got the best job in government. It’s great to work with so many smart and committed people.

Over the past three years, the government has shown its determination to grow and protect the public health service. We’ve built real progress in services for patients, in tackling the workforce crisis, and in clinical leadership.

But let’s be realistic.

There’s a lot more to do. And the job is not finished.

There is more we can do to reduce waiting times.

There is more we can do to deliver care closer to home.

There is more we can do to prevent and treat cancer.

And there is more we can do to engage clinicians in decision-making.

Over the next few months we will be presenting our plans for the next three years. And we would value your trust and mandate to keep the health service improving.


ENDS

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