New Zealand Aged Care Association conference
Hon Dr Jonathan Coleman
Minister of Health
4 October 2016
New Zealand Aged Care Association conference, Auckland
It’s a pleasure to be here to address the New Zealand Aged Care Association conference.
I’d like to acknowledge NZACA chair Simon O’Dowd, chief executive Simon Wallace, as well as the many members of the board of Association.
The theme of your conference ‘The pursuit of excellence, building on our strengths’ is timely. It’s an exciting time to be part of the aged care sector. I encourage you to take this opportunity to discuss and explore ways the sector can evolve to meet future demands.
No doubt top of mind for most of you will be the TerraNova case relating to pay rates in the aged care sector.
This has been a key area of focus for me, and it is complex work needing careful consideration.
With the negotiations still ongoing I’m limited in what I can say. I encourage you to continue your ongoing constructive involvement. Outcomes that are agreed by all parties are essential to the success and stability of your services into the future.
I hope to have a fuller update for you on this issue in the coming months.
I just want to take a moment to look at the big picture in health. Some of you may have heard this before, but it’s worth reiterating.
Health has remained the Government’s number one funding priority.
Budget 2016 delivers on that by investing an extra $2.2 billion in health over four years for new initiatives and to meet cost pressures and population growth.
The Government’s investment in health will reach a record $16.1 billion in 2016/17 – that’s an extra $568 million this year, the biggest single increase in seven years.
Claims that health funding has been cut are incorrect. Under this Government health expenditure share of GDP has averaged 6.5 per cent – that’s up from the previous Government’s level of under 6 per cent.
Over the last eight years, health funding has kept up with demographic pressure and inflation.
In Budget 2016 we’re investing an extra $124 million to widen drug access through Pharmac, $96 million to provide more elective surgery and $39 million to start the roll-out of a national bowel screening programme.
Health of older people
and aged residential care funding
It’s well known that New Zealand has an ageing population, and funding for the sector has continued to increase in line with our changing demographics.
Currently DHB's spend more than 40 per cent of the $12 billion they manage on providing health and disability services to people aged 65 years and older. This age group makes up around 15 per cent of the population.
Based on the forecast growth of this age group, this spend is expected to rise to 50 per cent of DHB expenditure by 2025/26.
Over the last eight years DHB spend on the health of older people support services, including residential care and in-home support services, has increased from $1.1 billion to $1.6 billion. That's 10 per cent of the Government's annual investment in health.
Over this period the corresponding investment in aged residential care has risen from $710 million to a billion dollars this financial year.
While this increase reflects the number of people in aged residential care, it also highlights a decrease in the proportion of people over 75 requiring care.
New Zealand’s older people are living longer, healthier and increasingly independent lives. We need a healthcare system flexible enough to meet these changing needs.
To successively deliver on the health aspirations of New Zealanders, you’ve got to have a clear direction for the system supported by the right level of funding. Strategy and funding go hand in hand.
You could always pump more money into health, but it’s what you do with that money is what counts.
One of the first things I did as Minister of Health was to ask officials to work on a very clearly laid out direction for healthcare in New Zealand which resulted in the release of the new Health Strategy back in April.
The Health Strategy covers five themes - people-powered, closer to home, value and high performance, one team, and a smart system.
The five themes of the Health Strategy signal a focus on prevention and wellbeing, and more integrated services. At the same time we want to see support for innovation, better collaboration, and new ways of working to reach our most vulnerable. We want to give every child a healthy start, and ensure information and services are more accessible.
Health of Older People Strategy
When I commissioned the Health Strategy I was clear that I didn’t want it to be just some old document which gathers dust on the shelf.
I wanted it to act as a roadmap for a number of other key work streams, including the draft Health of Older People Strategy.
I’d like to thank the NZACA and the individual members who made submissions on the draft Health of Older People Strategy, and have been involved in its development. I’d like to thank you for the positivity, passion and ideas you brought to this process.
Health officials are currently working on draft Strategy’s feedback. I expect the final Strategy to go to Cabinet before Christmas. Once finalised, officials will be working with the sector to develop an implementation plan for the first two years of delivery.
How the two
Strategies are linked
The draft Health of Older People Strategy carries forward the five themes from the Health Strategy. Its vision, is that older people live well, age well and have a dignified end of life stage, all played out in age-friendly communities.
The first theme, ‘people-powered’ is about understanding people’s needs and preferences, enabling informed choices, and enabling them to be an active participant in their own health care.
The ‘closer to home’ theme is of particular relevance to the aged residential care sector in terms of better integration of health and wider with public service.
The ‘value and high performance’ theme places an emphasis on measuring the performance of the whole system and includes the development of an outcomes-based approach to performance measurement.
The Ministry has worked closely with the sector to co-develop a suite of system-level measures that provide a system-wide view of performance. Three of the measures in particular highlight significant opportunities to improve the health outcomes of older people. These include: acute hospital bed-days per capita, patient experience of care and amenable mortality rates.
The ‘one team’ theme relates in part to using our health and disability workforce in the most effective and flexible way.
Widened prescribing rights for registered nurses provides a recent example. New regulations came into effect from September which allows designated registered nurses to prescribe specified medications. This has the potential to deliver faster care, reduce double handling and improve access to medicines for your residents.
The final theme ‘smart system’ is about utilising data and information systems to improve evidence based decision making, management reporting and clinical audits. It is also about having reliable, accurate information available at the point of care. The interRAI assessment tool is a great example of this.
for quality residential care
It’s important that our aged residential care facilities are safe, healthy and positive environments.
A huge amount of work by both the sector and the Government has gone into strengthening the audit process and making it more transparent.
For example, by publishing full audit reports on line for aged care serves to promote transparency and support the ongoing development of quality processes.
It also helps individuals and families to make more informed choices as to which facility they enter.
Audit data shows an increased number of aged residential care facilities being awarded a 4-year certification.
These efforts are paying off, both for the residents and the industry as a whole.
The recently released report titled ‘Improving outcomes in aged care’ found the changes have contributed to better quality care for residents.
We might be living longer, but we’re spending more years dealing with the efforts of chronic illness, and that includes more New Zealanders living with dementia. Dealing with this is a major focus for future-proofing the aged care sector.
In 2011, just over 48,000 New Zealanders were living dementia. By 2026, it’s estimated that figure with reach 78,000.
The Government has invested around $100 million in additional funding specifically for dementia services.
This has supported an increase in people receiving care in secure dementia units by 55 per cent since 2008 (increasing from 2,354 to 3,660). It’s also supported the development and implementation of dementia care pathways across DHBs and communities.
The corresponding demand for secure dementia beds provides an opportunity for the sector. For those looking to renovate or expand, I encourage you to look at the ‘Secure Dementia Care Home Design Information Resource’ released by Associate Health Minister Peseta Sam Lotu-Iiga last month.
Importantly, what the report points out is that older people with dementia who need secure care should be in a safe environment that promotes autonomy and quality of life, and allows for more natural interactions with family members, staff and other residents.
To further help ensure that we’re providing the quality care our older people and their families expect and deserve, there needs to be a continued focus on the use of interRAI to assess the needs of residents.
At an individual level interRAI assessments provide an informed personalised care plan. At a national level, it provide a base for service to be more equitable.
Further realising the value of the interRAI data will enhance the ability of service providers to track where care needs are most pressing for a person and encourage services to suit.
The goal is to use data to develop care for people, and capable support systems across services that are integrated.
As the interRAI database grows, our ability to understand the needs of older people, and how well they are being addressed, also grows.
I’m sure you will agree that service co-ordination and delivery would be enhanced through technology that allows relevant health practitioners to access interRAI assessments.
Digital Health Work
Developing a clear vision for the future of I.T. investment in health has been one of my main priorities.
The Health Strategy also provides a framework for the next phase of the Digital Health Work Programme 2020 which builds on the National Health I.T. Plan.
This will ensure we’re well positioned to take advantage of new technology opportunities by encouraging innovation and providing a supportive policy and regulatory environment.
We want to see more patient-centred healthcare, and better use of current and emerging technology to help patients manage their own health.
Elective surgery & national patient
As New Zealanders live longer, access to elective surgery is becoming more important than ever.
We’re working hard to ensure there are year on year increase to elective surgery rates, including more hips and knees surgery.
The number of patients receiving elective surgery has increased by 45 per cent under this Government. In 2015/2016 over 170,000 operations were carried out across the country.
Over the last eight years the number of joint replacements have also increased – lifting from 8,400 to over 11,000 a year.
The answer to increased demand is to do more – more appointments, more surgeries. This is being supported by the extra $50 million being pumped into orthopaedic and general surgery between 2015/16 and 2017/18.
As well as doing more surgeries, we’re also looking at new ways of helping patients living with pain. The new Mobility Action Teams will focus on helping those with musculoskeletal conditions like arthritis.
The Government invested $6 million in Budget 2015 to create community based multi-disciplinary early intervention teams.
The first Mobility Action Teams projects are now accepting patients in Counties Manukau, South Canterbury and Bay of Plenty.
There are also teams getting up and running in Northland, Hutt Valley/Mid-Central, and Canterbury.
These teams are being phased in, with the Ministry of Health currently considering more than 30 applications for the next waves of teams.
Quality palliative care services make a huge difference. It’s important work ensuring terminally ill people are as free from pain and suffering as possible, as well as providing valuable support for families and friends.
We’re committed to ensuring New Zealanders can access palliative care services when they need them and in the settings they prefer - whether at home, in hospice or aged residential care.
Around 17,000 adults and their families will access palliative care services this year, and this figure is expected to increase as our population grows.
In Budget 2015 the Government invested an extra $76.1 million over the next four years for palliative care services.
$52 million has been pumped directly into hospices’ baseline funding to ensure their sustainability.
The remaining $24 million is being allocated to DHBs to provide new hospice services that improve the quality of palliative care in aged residential care, primary care and community settings.
A review of adult palliative care services has recently been completed and a final report is on its way.
There has been good engagement with the sector on end-of-life and palliative care through the consultation on the Health of Older People Strategy.
I expect to see effective ongoing collaboration between the Ministry and the sector in future implementation of the actions from both the review and the Strategy.
I hope you enjoy the rest of the conference. I see that you will be discussing topics highly relevant to improving the performance of the aged residential care sector and providing the best care possible for residents. I wish you every success.