Speech to National Rural Health Conference
13 March 2015
Hon Dr Jonathan Coleman
Minister of Health
Speech to National Rural Health Conference
It’s great to be here at this year’s New Zealand Rural Health Conference.
I’d like to thank the New Zealand Rural General Practice Network, the Rural Health Alliance Aotearoa New Zealand and the New Zealand Rural Hospital Network for organising this conference.
It’s great to see rural organisations working collaboratively and taking a multi-faceted approach to improving the lives of New Zealanders in rural communities.
I’d like to start with a brief overview of the sector. I believe New Zealand’s health sector is in good shape, but there is no doubt that future challenges remain.
It will never feel like there are enough dollars in health. The Government has made health our number one funding priority.
We’ve made available an average of an additional $500 million of new money into health each year. Investment in health has risen from a budget of $11.8 billion in 2008/9, to $15.6 billion in 2014/15.
One of my first priorities as Minister of Health was to travel to all 20 DHBs to talk with the Chairs, CEs and clinical leaders.
The feedback I’ve been getting is that although there are still challenges, we are heading in the right direction.
When I meet with clinicians, I ask them, are things better or worse than they were ten years ago. The feedback I get is that - yes, things are better than ten years ago.
During my conversations with Chairs and CEs, I’ve stressed the importance of talking to clinical leaders and encouraging clinical-led decision-making, as well as continued responsible financial management.
Clinical engagement makes a difference not just to the morale of a DHB but also to its efficiency and the quality of healthcare delivered. It’s also key to delivering better integration across primary, secondary and tertiary care.
In terms of my priorities, I want to see increased focus on moving services into the community. We need to continue to change the way healthcare is delivered, with more people getting the care they need away from hospitals.
To support this we need to further harness the skills of our workforce so we are better utilising the full range of skills of the wider health team.
I want to see continued progress on NCDs, particularly obesity. New Zealand is not unique in its battle with obesity. There is no single solution, and there are a range of possible interventions. We’re currently working on a framework to tackle obesity.
The health targets remain a key focus. The targets are not just about numbers – they are about delivering better and quicker access to important health services. The latest quarterly results show DHBs are making good overall progress.
The new 62 day cancer target is an international benchmark. The first results show two thirds of patients with a high suspicion of cancer received their first treatment within 62 days of referral. I know we’ll see steady improvement towards the target.
Another priority is fulfilling our election commitments. Free GP visits/prescriptions for under 13s comes into effect in July, giving 400,000 more kids a healthier start to life.
We want more New Zealanders to live pain free lives away from hospital. We’re pumping an extra $50 million over three years to reduce pain and increase prevention by delivering 2,550 extra hip, knee and other orthopaedic operations in addition to the usual increases in elective surgery.
Rural primary care
Turning to rural healthcare, I know the rural primary healthcare sector faces a number of challenges. These issues are not unique to New Zealand.
Recruitment and retention of GP’s, access issues for patients because of locality, especially after-hours, and limited resources and training for rural healthcare workers are all common examples of the challenges many of you face.
Despite this, you still manage to provide a high level of services to maintain the health and wellbeing of your rural communities.
I want to take this opportunity to thank you all for your commitment and dedication in providing important health services to our rural communities.
I know that mental health is an important issue in rural communities, and that social and geographic isolation are contributing factors.
Mental health is a priority for the Government. We have increased funding for mental health and addiction services to over $1.3 billion.
There’s a lot of work being done by a range of groups including the Mental Health Foundation, Federated Farmers, and the Ministry of Health.
It’s important to raise awareness, and to encourage people to seek help. There are a range of resources to improve awareness and to guide people on where to seek help - such as the Ministry’s funded version of the depression.org.nz website tailored to rural communities.
I know DHBs are making targeted efforts to reach those in rural areas – for example, Child, Adolescent and Family Mental Health service teams who work closely with schools in rural areas.
The Ministry also works closely with the Ministry of Primary Industries to ensure DHBs and through them, PHOs, are linked into local responses to adverse events such as droughts and floods.
The theme of this year’s conference is accessible quality services ‘close to home’.
This can result in the redesigning of primary and secondary health services and the development of a range of new service models, shifting the balance of care to local settings and reducing pressure on hospitals.
As I’ve travelled around DHBs I’ve noted an increased focus on integration. DHBs are developing stronger links with primary care providers.
I’ve been pleased to hear about things like GPs having direct access to specialist nurse or doctor advice, safety programmes being delivered on medicine management, and nurses leading clinics on diabetes management.
The focus on integrated healthcare needs to continue and grow to deliver the results we need to achieve.
The quality and accessibility of primary health care services within rural communities is a priority for this Government, and ensuring the health sector is supported in moving services closer to home will help achieve this.
I recently outlined my expectations to DHBs to move services closer to home and I expect to see clear evidence of how each DHB plans to achieve this, especially within their rural communities.
E-Health solutions offer better, safer, more efficient healthcare. They are also an important enabler of new models of care and providing care closer to home.
Patient portals are, for example, a key e-health initiative. More than 37,000 people in 97 practices are using a patient portal. The Government is investing $3 million to expand the rollout of patient portals. We’ve also set a clear expectation that rural areas are a priority.
Increasing the use of tele-health is also a key enabler. It can make a huge difference to people living in geographically isolated areas. Last November I visited Tairawhiti DHB and heard about their new diabetes Tele-health Clinic which will make a considerable difference to patients.
Rural Service Level Alliances
The recent change to the way additional funding for rural primary healthcare services is allocated can also support moving services closer to home.
From July last year, rural funding was made available to rural alliances for making local decisions about primary healthcare services and funding, to meet local needs.
This provides another opportunity for service models to be redesigned so that healthcare can be delivered in more effective and efficient ways.
Although there is variability in the rate of development of rural Service Level Alliance Teams, I am confident that through this approach the rural sector will continue to improve primary healthcare services, delivering quality services closer to home.
Providing support for the rural workforce is also a key Government focus.
There’s good evidence the best solution to rural health workforce shortages involves selecting students early from regional and remote centres and maintaining their exposure to the challenges of rural primary healthcare throughout their education.
The Government supports a number of workforce initiatives including:
The Voluntary Bonding Scheme which incentivises graduates to work in hard-to-staff communities or specialties. To date, over 800 health professionals have been funded through the scheme.
Medical immersion programmes where medical students spend an entire senior year in a rural area.
Two world-leading rural immersion and inter professional education programmes in Tairawhiti and Whakatane.
I know there is evidence that medical graduates of the University of Auckland’s long-term rural immersion programme are returning to rural areas after graduation.
Our next challenge is to find ways of encouraging a ‘grow your own’ strategy outside the main centres, to encourage career-changers or mature students into health.
Thank you again for the opportunity to speak to you all today.
Keep up the great work.
You can be confident that the Government will continue to place a top priority on supporting public health services, and meeting the needs of New Zealanders in rural communities.