Ryall: NZ Emergency Departments Conference
Hon Tony Ryall
Minister of Health
11 August 2011 Speech
NZ Emergency Departments Conference - Taupo
This is your fourth annual conference, and the fourth time I have come to speak at it, including the last three times as Minister of Health.
It's good to be here.
I note that your theme this year is “Taking control of our world”.
With the year we have had so far, and the kick off of the Rugby World Cup less than a month away, I can’t think of a more appropriate, but perhaps more challenging, theme to have.
First up I'd like to acknowledge the outstanding work of so many of you during and after the series of Canterbury earthquakes.
The team at Christchurch Hospital’s Emergency Department was obviously in the thick of it, demonstrating the professionalism, courage and kindness of your profession caring for those injured and distressed, particularly in the immediate aftermath of the tragic February quake.
All Canterbury health professionals and administrators have worked tirelessly, often in challenging conditions, to support patients, families and communities during this time.
And this is while many are dealing with difficult or uncertain situations at home.
The support and assistance that they have received from their colleagues across the country has been invaluable and for this I thank you all.
We really have seen the best of New Zealand in the response to the earthquake, and in particular, the best of our health service.
Just as the earthquake has changed the landscape in Christchurch, so it has changed the landscape of public finances.
The Treasury estimates the total financial cost of damage from the earthquakes at around $9 billion for the taxpayer alone.
In addition, the wider economic impact of the earthquake could reduce total tax revenue by $3 billion in the next tax year.
Last year when I spoke to you I talked a lot about the deteriorating global financial situation and the impact of it on us here in New Zealand.
Today the global financial situation remains challenging
Around the world, 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.
The Italians are also curtailing public health spending.
In Canada, the provincial health authorities are now taking tough measures to curb health costs.
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 we borrowed an average $380 million a week in 2010/11 to protect and grow our important social services.
Last year alone the Government's borrowing via the bond programme is expected to be around $20 billion.
It’s within that context that 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.
In fact, as part of its commitment to protect and grow the public health service, this Government has invested $1.5 billion of new money into the public health service over the past three years.
This is despite the worst economic situation in 80 years.
In doing so we’ve been able to maintain and improve key services and infrastructure.
But our focus must remain on getting better and more health care from the resources we already have.
And since we are in these difficult financial times, we must all note that delays in the long run are likely to be more expensive than doing things sooner.
For example, delayed treatment of fractures and other injuries can lead to infections, more pain and DVTs.
That’s one reason why treating ED patients sooner makes sense at both a patient and financial level. Timely care makes sense. It’s better quality care.
Shorter Stays in ED health target
It has now been two years since the Shorter Stays in ED health target was introduced and I thank you for your efforts and commitment towards this target.
As you know, the target is for 95% of patients to be admitted, discharged or transferred from emergency departments within six hours.
"What a difference two years can make" – to quote from Auckland DHB's special health targets edition of their newsletter Nova.
Auckland has reached the 95% shorter stays target – up from 88% last quarter and despite a 21 % increase in patient numbers since 2009.
Their average length of patient stay has almost halved over two years to 3.6 hours.
Auckland has clearly worked hard to find and eradicate delays embedded in the system.
Significantly more Auckland patients are getting to the right place to receive the care they need - sooner.
In June 2009 – before the Health Targets kicked in - 98 Auckland patients waiting waited 24 hours or longer for a bed.
In June 2011 – nobody did.
Over the same period the average wait for a bed for all patients has dropped from 7 hours and 48 minutes to 1 hour 18 minutes.
General surgery patients used to wait on average ten hours 10 minutes for a bed – now they're waiting just over an hour.
Those results are outstanding.
So good, I have to confess I didn't believe them at first.
And all the better considering Auckland has been one of the slower DHBs off the block with the targets – an example of how big DHBs can be like Ocean Liners – slow to turn.
It is particularly encouraging to see the improvement achieved by some of our largest DHBs and hospitals, many of which were among the poorest performing DHBs initially.
Waitemata DHB, for example, started on a performance of just 61 percent in mid 2009 but I am told that it is now close to achieving the 95 percent target.
In doing so, North Shore Hospital ED has gone from being described as the “weeping sore” of the public health system to being right up there with the best in the country.
And, after its major turnaround, I am told that Auckland DHB is currently the ‘go-to’ DHB for other DHBs who want to learn more about what they have done, including their Rapid Rounds and Nurse Facilitated Discharge initiatives.
I have to mention Canterbury DHB again. Despite earthquakes causing the loss of over 100 hospital beds and impacting on primary care and aged residential facilities, the DHB became just the second ‘large’ DHB to achieve the 95% target last quarter.
And despite ongoing disruptions and challenges they haven’t taken the foot off the pedal – they are still working hard to maintain this.
The pressure now looks to be on some of those ‘mid-sized’ DHBs out there. Until now they may have been able to hide in the middle of the table but with the performance of these bigger DHBs improving they will either need to pick up the pace or be left behind.
The Government intends to keep publishing the health target results. The public deserves to know how well (or not) their local DHB is doing. And I’m sure no DHB will want to find itself at the bottom of the table.
Not to be outdone, Australia has now followed our lead and introduced their own national target focussed on ED and acute care.
But, to avoid the risk of being seen to steal another Kiwi icon (like Phar Lap and the pavlova!) they have chosen to closely follow the NHS model. This includes having a four hour timeframe.
While like many of you I will be watching the Australian experience closely, for now I think we have the right target and the right focus on quality.
Next Quarterly Targets
In just a few weeks we will be publishing the fourth quarter results for 2010/11 and I am looking forward to another strong showing in the Shorter Stays in ED target.
Preliminary results suggest that overall national performance is up to 92 percent. This is closing in on the 95 percent goal and a great improvement on the national performance when we started of 80 percent.
All of which means that people all around the country are getting better and sooner emergency care.
And that means better recovery and outcomes. The Shorter Stays in ED target is really working for patients.
It is all about the patients.
Every improvement towards meeting any of the Health Targets – in fact every efficiency and quality improvements in care is for the benefit of your patients.
I am aware that much of the success of the target so far has been down to your support and ownership of it.
As we all know it is important to make the link between improving performance against the Shorter Stays in ED health target and lifting quality hospital-wide. Improvements need to continue, but not at the expense of quality.
This is your target. You designed it. It is driven by you. And so I have confidence that you are making sure that it is done right – that performance is being improved in the right ways and quality is not being sacrificed to achieve it.
Over the past three years, the government has shown its determination to grow and protect the public health service.
We’ve made 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.
But then in Health, we are working with smart and committed people like you.
Your work has always been important to the government, and always will be. Thank you for what you do.