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National diabetes nurse specialist symposium


Hon Tony Ryall
Minister of Health


13 September 2012 Speech
National diabetes nurse specialist symposium

It is a pleasure for me to join you today here in Wellington for your 20th national diabetes nurse specialist symposium.

I would like to thank the diabetes symposium planning group, in particular Lindsay McTavish and Lorna Bingham, for the invitation to speak to you about what we are doing to support children and adults with diabetes.

In my brief comments today I would like to touch on: the priority that the government gives to diabetes as one of our six national health targets, the diabetes care improvement programme, and action on unhealthy weight including a new emphasis on maternal and new-born nutrition.

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 district health boards (DHBs) are employing more doctors and more nurses than ever before. And there’s a greater focus on preventing illness, and the wider determinants of health.

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.

Non-communicable Diseases

You’re well aware of the challenge that non-communicable diseases (NCDs) present health services around the globe. NCDs include long-term conditions such diabetes, cardiovascular disease, asthma and common cancers.

These are a major cause of disability and suffering. And you know the lifestyle factors behind these diseases.

There’s widespread agreement that current health services are not well-placed to deal with a world where non-communicable diseases account for most of the disease burden.

That’s because our health services were developed for generations when communicable diseases accounted for most of the disease burdens – leading to systems based on episodic, disjointed and hospital based care.[1]

So, like the rest of the world, New Zealand’s health service is tackling the challenge of re-orienting care towards the on-going support and treatment of patients with long-term conditions, in the community, closer to home.

In constrained financial times, health services need to select and well implement a few targeted interventions that will best support the objectives of better health and affordability.

National Health Target

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

Cardiovascular disease (CVD) includes heart attacks and strokes – which are both substantially preventable with lifestyle advice and treatment for those at moderate or higher risk. The indicator monitors the proportion of the eligible population who have had a CVD risk assessment (including the blood tests to screen for diabetes) in the preceding five year period.

Substantial effort is going into this screening approach because we know it works. Around the country DHBs and PHOs are working to support general practices to improve the amount of screening and the resulting follow-up and patient support and management.

Diabetes Nurse prescribing

The Government is continuing to support the managed national roll out of the Diabetes Nurse Specialist project. This follows a successful first trial in 2011 where Health Workforce New Zealand, in collaboration with the New Zealand Society for the Study of Diabetes (NZSSD) established the diabetes nurse specialist prescribing project to demonstrate the effectiveness and safety of diabetes nurse prescribing. This involved 12 diabetes nurse specialists at four DHBs.

Diabetes nurse specialists operate with a high degree of autonomy with significant responsibility for the delivery of diabetes services, and having responsibility for prescribing common medicines for people with diabetes, under supervision and in partnership with medical practitioners, is a natural extension of their current role.

The evaluation undertaken demonstrated the success of the role of the diabetes nurse specialist. Prescribing by diabetes nurse specialists resulted in improved continuity of care for patients, reduced the need for separate appointments for routine prescriptions and reduced pressure on medical staff.

The second stage of the managed roll out is underway with the NZSSD currently seeking registrations of interest for up to a further 20 additional nurses across a maximum of six sites interested in participating in the Diabetes Nurse Specialist 2012 Managed National Roll Out Project.

Diabetes Care Improvement Package

This time last year, following a review of the diabetes Get Checked programme, we announced there would be changes made to the way we support New Zealanders with diabetes.

The Get Checked programme was criticised by many patients and clinicians as being more about box ticking than improving the lives and clinical outcomes of those living with diabetes.

The review cites a study that showed the programme reduced blood glucose levels by just 0.13 per cent which was described as clinically disappointing. It also found that the programme added little clinical value to existing general practice.

So, we ring-fenced the budget and asked DHBs and primary care to work together to design localised responses to best support people with diabetes. Our aim is a localised, integrated approach to delivers clinical improvement.

Initiatives differ between DHBs, depending on the needs in their communities. However many DHBs have chosen to deliver services through innovative nurse-led services.

For example, diabetes nurse specialists from Hawkes Bay DHB are mentoring primary care nurses with the goal of developing a speciality level of knowledge and skill in primary care.

Nelson Marlborough DHB is co-locating diabetes nurse educators within general practices to support primary care teams to deliver better care.

Capital and Coast DHB aim to have 80 per cent of general practices in their area receiving direct diabetes nurse specialist support by the end of the year.

Thank you to everyone who has participated in the local discussions around the improvement programmes. It’s not been easy – change never is.

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.

Green Prescriptions

The benefits to patients from following a green prescription for regular exercise can’t be denied. 73 per cent of patients given such an entreaty to exercise noticed improvements six and eight months afterwards.

Last year, GPs and practice nurses issued 32,000 people with a green prescription to become more physically active – an increase of almost 6,000 on four years ago.

Kiwisport

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. Launched by the Prime Minister in August 2009, it provides an $82 million sporting boost over four years to be invested in school-aged children.

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 last year’s increase 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.

Gluckman report recommendations

Each year the Government spends many millions on prevention programmes to reduce unhealthy weight and improve healthy lifestyles.

We’ve been keen to ensure that our resources focus on the areas where we can make the best long-term investment. So, we’ve been working with the Prime Minister’s Chief Science Advisor Professor Sir Peter Gluckman.

Professor Gluckman suggests that pre-conditions for obesity are set very early and the best intervention point is maternal and new-born nutrition.

He suggested six areas of additional emphasis:
• improving women’s pre-conception health
• supporting healthy weight gain and fetal growth during pregnancy
• screening for gestational diabetes
• promoting breastfeeding
• providing advice on weaning
• providing advice on bottle-feeding.

In light of this advice, we have reviewed the services the Ministry currently fund and agree there is an opportunity to do more to improve healthy weight gain and nutrition education during pregnancy and improve nutrition education and support for babies, infants and pre-schoolers.

A number of public health contracts are and will be expiring over the next few years and this money with be reprioritised towards this priority. A Request for Proposals (RFP) for services will be issued shortly.

This funding is in addition to what the government invests in programmes such as KiwiSport, Green Prescriptions and Fruit in Schools.

There is opportunity to deliver our programmes in a different way and leverage other funding sources and resources to deliver nutrition advice and education support to mothers and new-borns.

Through the RFP process we will look for providers to form alliances and where appropriate involve others including non-government agencies.

We will also be exploring options for using our existing maternity services, Well Child, whānau ora and school-based health services to provide advice and support that better enables women and newborns in this area of focus.

The recently established Health Promotion Agency (HPA) will play an important role in ensuring that the various health services women use have access to consistent and easy to use material about the importance of good nutrition.

Another area the Ministry has identified we could make improvements is providing better support to our health professionals.

There are currently no guidelines in New Zealand to guide practitioners on how women can best manage weight gain during pregnancy. The Ministry of Health will be developing guidelines which can then be used by our maternity services.

The Ministry is also developing evidence-based clinical practice guidance for health professionals to assist in the diagnosis and management of gestational diabetes. These guidelines and a summary resource will be finalised by end of next year.

Gestational diabetes is more common in Maori and Pacific women. A current Ministry project, due to be completed by February 2013, will advise on how young Māori women and their families can be better informed about screening for and management of the condition.

This is an exciting time for diabetes services in New Zealand and I am sure that with your support and clinical expertise we will be able to reduce the rates of obesity and diabetes in New Zealand.


[1] Smith and Corrigan, Global Health Policy Summit.


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[1] Smith and Corrigan, Global Health Policy Summit.

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