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Speech: Ryall - Royal College of Surgeons Annual Conference

Hon Tony Ryall
Minister of Health

27 August 2012 Speech
Speech opening the Royal College of Surgeons Annual Conference in Queenstown
Delivered by Dr Paul Hutchison on behalf of Health Minister Tony Ryall

Good health is hugely important to New Zealanders. A strong public health service gives families peace of mind – knowing that the care they need will be there, when they need it.

And that’s the priority of our government too.

Protecting and growing the public health service.

We have spent the past four years repairing the damage of a decade of wasteful spending, never-ending bureaucracy and a lack of clinical engagement.

And we’re making a lot of progress.

More patients are getting the operations they need, sooner. Our DHBs are employing more doctors and more nurses than ever before. And there’s a greater focus on preventing illness.

We’ve moved resources from the back office to the frontline. There are fewer managers and administrators. We’re harnessing the benefits of bulk purchasing. And our wards are becoming more productive and efficient.

But like health services around the world, we face two major challenges: one financial, the other demographic.

Our country faces a significant fiscal deficit and growing public debt.

Only four years ago the government owed $8 billion. Taking the sharp edges off the recession has seen that debt grow to $55 billion today. In three years’ time, we expect that will peak at $72 billion.
To control that growing debt, the government is working towards a balanced budget in 2014/15. That means a strong focus on public spending, and getting the most out of every dollar.

Health is a fifth of all government spending so we in the public health service have an important role to play in that.

And you’re well aware of the demographic challenge.

There are more of us, and we are living longer. If we spent what we do in health now but allowed for the same proportion of people over 65 that we’ll have in 2025, then we would need to be spending $2 billion more today on healthcare than we actually are.

You’ll all be aware of the significant pressure on health budgets around the world. In Greece, there are reports of maternity hospitals refusing to release new born babies to parents if the bill hasn’t been paid!

Ireland has cut what it pays health professionals, frozen recruitment, closed hospital beds and restricted medical subsidies for older people.

Australia’s Federal Budget has stopped $1 billion of health spending to redirect to other priorities. There are signs of workforce over-supply, as the Australian States scramble to find places for several hundred medical graduates.

In South Australia three independent reports into health finances - ordered after a $125 million blow out last year - recommend chopping 308 jobs and 114 beds from Adelaide hospitals and making budget cuts of $83 million per year.

In Queensland it is reported they’re cutting $130 million out of Brisbane Hospital budgets.

In contrast here in New Zealand, despite the world’s worsening debt crisis that sits behind all these measures, the National led Government has lifted health spending by around $2 billion over its four years.

In 2009/10, while other OECD countries were reducing health spending, New Zealand had a 3.4 per cent increase in real health spend, the third highest of 27 nations. As a result, New Zealand has risen to having the fifth equal highest spend on health as a proportion of its GDP.

The challenge of slower spending increases can be expected for the foreseeable future.

We have worked together as a public health service to ensure that slower health expenditure growth has been achieved without reducing service or clinical staff. And we will need to keep working together over the coming years to keep achieving that. Budgets are getting tighter.
Clinicians should care about making the health dollar go further because they have a responsibility to the population of potential patients, not just the patient in front of them. We work together to provide the best care within the resources that the community makes available to the public health service. This is not a job for managers alone.

Last week, we announced another big increase in the number of patients benefiting from elective surgery.

7,500 more patients across the country, a record 153,000 operations.

What’s more, in the last year the number of patients across the country waiting longer than six months has reduced by eighty-five per cent from 5,700 to 840.This includes 690 patients on Canterbury DHB’s list which has been exempted from the target this year.

The vast majority of DHBs have achieved the goal of no patients waiting longer than six months.

This is an outstanding team effort from everyone across the public health service.

I’ve visited three hospitals in the last ten days to thank their teams for this tremendous effort. I was impressed to hear how clinicians, booking staff and managers worked so well together to achieve what many people thought couldn’t be done.

And I would like to particularly acknowledge New Zealand’s surgeons - such as you - who have been at the sharp end – so to speak – of the drive to reduce waiting times. It’s a huge credit to you all. Thank you very much for your engagement, leadership and effort.

Shorter waiting times are great for patients and their families.

And I heard time and time again that this patient-focus is what motivated clinicians and staff towards achieving the six month maxima. Better care for patients. We look forward to working with you towards the four month maximum waiting time goal in 2014.

Elective surgery is great but our government is also strongly focused on preventing illness.

Our $24 million programme to reduce the rate rheumatic fever by two-thirds is receiving tremendous support. Stamping out this third world disease rheumatic fever has been – believe it or not – a health priority since 2001, yet nothing was done. We are rolling out throat-swabbing and treatment across the most affected parts of New Zealand.

The government’s massive home insulation scheme also supports this objective.
The Government has also created a turning point in the fight against tobacco.
Regular price increases coupled with effective interventions in communities and hospitals are making a big difference.

And our new national health target around regular cardio-vascular disease risk assessment and diabetes checks is based on strong evidence that early identification and intervention reduces death and disability.

Your conference is themed “A life of learning”. Given the expertise present in this room, there’s no need to convince you how important quality and safety is to life-long learning.

I’d like to acknowledge the important role the College plays in establishing the framework and expectations around standards for your College members.
And while it is of a high standard, there’s always more we could all do to improve quality in healthcare.

That is why this Government established the independent Health Quality and Safety Commission. This clinically-led organisation is – in the words of its chair Professor Alan Merry – responsible for assisting providers across the whole health and disability sector, private and public, to improve service safety and quality and therefore outcomes for all who use these services in New Zealand.

I’d urge you all to join in the collective work of the Commission.

The Associate Minister of Health Jo Goodhew has ministerial responsibility for the Commission.

In the next few weeks Mrs Goodhew, a former health professional herself, will launch what we’re calling Quality and Safety Markers. These build on the success of the national health targets, by providing focused effort and reporting around a set of key areas of quality improvement.

These markers will be reported publicly and regularly.

They cover in-patients falls, hospital acquired infections, surgery and medication errors. These are key areas for improvement identified by sentinel events and HDC reports.

While not wanting to pre-empt Mrs Goodhew’s announcement, I would like to highlight three particular quality initiatives that the government would welcome the active support and engagement of the College and its members.*

Firstly, the WHO Surgical Safety Checklist: The checklist – just like the checklist airline pilots go through before take-off – is a common sense approach to ensuring the correct surgical procedures are carried out on the correct patient.

*Source for quality initiatives; Health Quality and Safety Commission

As you know, when implemented properly it requires hospital staff to stop and
think what they are doing and why. It involves checking the right people are present and that they all are in agreement about why they are operating.
Thinking about what could go wrong is also important, for example checking for allergies to medicines is part of the checklist.

Going through the Surgical Safety Checklist is a simple process but one which save lives. The WHO says that worldwide implementation would prevent at least half a million deaths per year; new studies have now confirmed these results.

Secondly, surgical site infections: Internationally, one in ten patients admitted to hospital will acquire at least one infection during their stay. This HQSC project aims to reduce infections following surgery. The information gathered will help hospitals and other providers to improve patient safety and reduce infections by improving clinical practices.

The SSI surveillance project is currently being developed by the Commission, and will focus on a number of key surgical procedures.

Reducing Surgical Site Infections will reduce the psychological impacts of prolonged recovery and reduced quality of life for patients. And that’s not counting the financial cost of longer stays away from work.

For example, New Zealand research of surgical site infections from cardiothoracic surgery suggested infections could keep a patient in hospital for an extra 32 days at a cost of well in excess of $50,000! This stuff matters!

Thirdly, hand-hygiene: It’s obvious but hand hygiene is proven to reduce hospital acquired infections, including anti-biotic resistant infections. Some suggest such infections cost the health service some $130m a year, not counting costs to patients.

Fortunately, hand-hygiene rates are improving in New Zealand.

But as Dr Sally Roberts has indicated recently, the big challenge is to boost compliance by doctors. Dr Roberts says senior doctors set the standard in hospitals and she’s urging greater use of alcohol hand gel.

Like so much in healthcare, these are issues of clinical leadership.

Globally, clinical leadership is the proven driver of improved patient outcomes. That is why this government puts so much emphasis on involving clinicians in decision-making, as leaders in the public health service.

You set the standards and expectations of your profession. The Government backs you in the work you are doing to improve the care of patients, and we want to continue working closely with you both individually and collectively.

Our country needs a medical workforce that is fit for purpose now and in the future.

One aspect of that is life-long learning. Doctors must continually learn if we are to have a public health service that provides quality and safe patient care.

You are to be congratulated for the involvement of trainees and faculty from other disciplines in your College’s training programmes. We need to see more of this cross-discipline approach for shared learning across professions.

Thank you for all you do in health in New Zealand. Thank you for your great contribution to shorter waiting times and the culture change the national health targets are producing throughout the public health service.

I wish you well for your conference.

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