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Clark: Speech to the NZ Nurses Organisation AGM [20/9/18]

20 September 2018

Speech to the NZ Nurses Organisation AGM

Hon Dr David Clark


E ngā mana, e ngā reo, e ngā karanga maha o te wa, tēnā koutou katoa.

Ki mana whenua, Te Ati Awa me Ngāti Toa, anō nei aku mihi ki a koutou.

Nōku te honore kia haere mai ki te whakanuia tēnei huihuinga whakahirahira New Zealand Nurses Organisation Annual Conference.

Nō reira, tēnā koutou, tēnā koutou, huri noai te whare, tēnā rā koutou katoa!

Tēnā koutou katoa, greetings everyone and good morning.

Opening remarks

It is my pleasure to be here at Te Papa today opening your annual conference, and thank you Kerri and Grant for your introduction and the warm welcome.

This year’s theme is of course “Health is a Human Right: Optimising Nursing to make it happen.

I recognise that the work that nurses do, often under great pressure and for modest reward, has a profound and beneficial effect on New Zealanders’ health.

I’d like to acknowledge the efforts of the NZNO in support of nurses’ valuable work throughout our health service.

By the look of this programme in front of me, you’ve got an action packed and very informative day ahead of you, with so many highly experienced and skilled speakers lined up to present.

It’s great to see today’s theme reflected in so many of the presentations, and I will be following the outcomes of today’s conference very closely.

Again, I want to acknowledge the organisation for your longstanding commitment and support of the nursing workforce.

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You are true professionals, passionate, dedicated and loyal to the promotion of nursing and midwifery.

You’ve long been advocating for the sector, way back to 1905 when the organisation was first known as the Wellington Private Nurses Association.

Your growth in the ensuing 113 years has been impressive. NZNO now represents more than 52 thousand nurses and health workers and 550 district health board midwives.

Fast forward 113 years and you’re still advocating….and rightly so. 2018 will undoubtedly be one that all of us in this room will remember for a very long time.

There is no question that nurses have felt undervalued over recent years.

This was the year to listen to your concerns and respond in the interests of nurses and their patients.

And we did.

Not only was an agreement reached that offered better pay, better conditions and more support, but you have also been able to look to the future – to sign the safe staffing accord.

As Health Minister, the one thing I hear over and over again from the public is just how good our nurses are. And I’m pleased that this year we’ve been able to show our commitment to you, our highly valued nursing workforce.

In keeping with today’s theme, when I accepted your invitation to present, I was asked to speak about nursing’s role in addressing a human rights approach to healthcare.

The theme resonates with me. The reason I took up politics – is to make a difference, particularly when it comes to equity and in the Health portfolio that means access to healthcare. As you may know, I have made improving equity something that underpins my key priorities in healthcare.

So with that in mind, I want to talk to you today about ‘Health as a human right’, what this means for our health and disability system and nursing’s role in making this happen.

Health is a human right

Health as a human right is at the forefront of everything the World Health Organization (WHO) does on a daily basis.

The WHO has nine principles which make up its constitution.

The principles reiterate the importance of health to all people and states: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”.

These words are as relevant today as they were when they were first adopted 70 years ago.

New Zealand is one of many countries which have ratified international treaties, covenants, and declarations recognising the right to health.

In Aotearoa New Zealand, Te Tiriti o Waitangi addresses both universal human rights and indigenous rights.

Additional treaties and declarations for Indigenous Peoples including Māori, women, people with disabilities and children have been created to ensure the full realisation of these rights.

The right to attain the highest possible standard of health is a fundamental right of every New Zealander.

This means every New Zealander should have access to the high quality services they need, when and where they need them and without any kind of hardship in receiving them.

Every New Zealander should have the right to control their own health and make informed decisions with access to quality information free from ambiguity and judgement.

Every New Zealander should have the right to privacy, to be treated with respect and dignity, free from discrimination and marginalisation.

One of the first things I did when I became Minister of Health was establish a list of priorities for the Ministry of Health and the wider sector to focus on.

I want a health system where everyone receives great health services and experiences consistently high outcomes.

Someone’s location, age, ethnicity or wealth should not determine the quality of healthcare they receive.

As Minister of Health, I’m determined to make sure everyone has equal access to good quality health care.

New Zealand’s health system doesn’t always serve every part of our diverse population as well as it could. This needs to change.

And to make this change, it’s vital we all work together to deliver the health services that people expect and deserve.

We can be proud of our healthcare system, but it’s important to realise we can do better and it’s important to understand what areas we need to focus on.

I want to see a strong publicly funded health and disability system that delivers the same high-quality health care to all New Zealanders.

In Aotearoa New Zealand, this means no matter where you live, what you have or who you are, you should be able to live to your full potential.

In addition to focussing on achieving equity, my other priorities are underpinened by equity and are: child wellbeing, mental health and primary health care.

NZNO and its members all play an integral part in achieving these priorities.

You as nurses are often a patient’s first port of call and you have the power to make an impact in all of those areas – mental health, child wellbeing, primary health care and across all of these areas in terms of equity.

Investing in the workforce

Quality health care and accessible services are at the heart of an effective health and disability system.

The system cannot be effective without a capable and well-resourced workforce. Nursing has a vital role to play in transforming health care. Optimising nursing to make it happen means investing in our nursing workforce.

The WHO estimates that nurses and midwives make up almost half the entire health workforce. The WHO has set 17 different sustainable development goals for countries to work towards over the next decade.

One of those goals ensures health and wellbeing for all.

For all countries to reach this goal, the WHO says the world will need an additional 9 million nurses and midwives by 2030. These additional jobs represent a global opportunity for investment in health workers.

We all know investing in nurses and midwives is good value for money. Of course as Minister of Health I am not a party to the MECA negotiation, but it was important to me and to this Government to see a MECA settlement which recognises the particular challenges you and your members face every day.

A report by the United Nations High Level Commission on Health Employment and Economic Growth concluded that investments in education and job creation in the health and social sectors result in a triple return of improved health outcomes, global health security, and inclusive economic growth.

By investing in the education and training of more registered nurses, enrolled nurses and nurse practitioners, and developing and growing our Māori nursing workforce, we will have the same triple impact across our communities in New Zealand.

The recent safe staffing accord is looking at how we can invest more in training and the employment of nurses and midwives.

A voice to lead

International Nurses’ Day seems a while ago now, but in May we celebrated with the theme Nurses: A voice to lead – Health is a human right. It seems only right then that the theme of this conference should be similar.

Nurses “know” about patients and they need to be involved in health policy decision making and implementation. They need to continue to be able to lead with their voice, influencing health policy, planning and provision.

When nurses lead with their voice, there are a range of significant outcomes for people and communities, the organisations nurses work for and the health system as a whole.

The more nurses we have and the more highly educated nurses are, the better the outcomes for individuals and their whānau.

The safe staffing accord is an opportunity to look at how we get more nurses working across the system to ensure we achieve those better outcomes and we have more voices in the system.

Review of the health and disability system

I will never tire of saying New Zealand has a public health service that we can all be proud of. We have world-class clinicians and allied health workers and they deliver quality services – but I realise we can always do better.

That’s why in May I announced the details of a major review of the health and disability sector which will be led by Heather Simpson. I’m hoping the review will chart a course for a fairer, more sustainable health and disability system.

I’ve asked for wide-ranging health and disability system recommendations to be presented to the Government. These include recommendations on a sustainable and forward-looking system, which is well placed to respond to future needs of all New Zealanders.

I’m very happy with the expertise and calibre of the review panel.

Nursing interests will be well covered by Dr Margaret Southwick’s inclusion on the panel.

Dr Southwick is a nurse with a wealth of experience in nursing education and nursing regulation and is a strong proponent for equity and cultural diversity in nursing. She will ensure that the nursing voice will be heard on this important review which is a once in a generation opportunity to improve equity and outcomes for New Zealanders.

Others on the panel, joining Ms Simpson and Dr Southwick include Shelly Campbell, Professor Peter Crampton, Dr Lloyd McCann, Dr Winfield Bennett and Sir Brian Roche.

I’m sure you will agree that this panel will serve us well, and will deliver robust and far reaching recommendations. The interim report is due mid next year and the final report by March 31st 2020.

The review will identify opportunities to improve the performance, structure, and sustainability of our health system with a goal of achieving equity of outcomes, and contributing to wellness for all, particularly Māori and Pacific peoples.

The review will consider the overall function of the system to ensure it is better balanced towards wellness, access, equity and sustainability.

Access to health care

Nurses are at the forefront of advocating for access to health care. Ensuring there are enough nurses to increase access to health care is a critical enabler of the human right to health.

Nursing’s role in promoting health and well-being, preventing disease, providing treatment and care is critical.

Often nurses are the first and sometimes the only health professional a person may see.

The quality of nurse’s assessment, care and treatment is vital.

Nurses are also part of local communities – sharing its culture, strengths and vulnerabilities.

Nurses can shape and deliver effective interventions to meet the needs of individuals, whānau and communities and improve access.

We know that nurses who undertake their undergraduate degree programmes close to their home, are more likely to stay in their communities.

Access to health care is not just about cost. Nor is it just about entry into a service. It is also about how people experience health services and the quality of care delivered to them along the way.

The ICN International Nurses report includes a useful framework that identifies factors that impact access at many levels.

From a nursing perspective, access to nursing services and care is about ensuring approachability, acceptability, availability, accommodation and appropriateness.

From a consumer perspective, access is about affordability of care and their ability and opportunity to engage with nurses and nursing care.

We know that not all people in Aotearoa New Zealand are accessing primary care when they need it. But we know there are ways we can improve this.

I know of an example in Auckland where a nurse practitioner working in a secondary school has cut teen pregnancy rates to zero in that school, through effective, timely and youth-friendly, accessible care.

A systematic review looking at nurses and nurse practitioners working in primary health care shows they provide care that is as good as, and some cases better, than their physician colleagues.

We need to be looking at opportunities for registered and enrolled nurses and nurse practitioners in primary health care to be able to provide this care.

Concluding remarks

Without you and your members, addressing the Government’s four priority areas couldn’t be done.

The advantage of having such a large and dynamic nursing workforce is that while many of you specialise in mental health or in child wellbeing, or primary health care, you can all turn your attention quickly and without fanfare to any task asked of you.

There’s a wealth of nursing knowledge right here in this room and as Minister of Health, I recognise the incredibly important and valuable role nurses play in our hospitals and communities.

My hope is that your knowledge, expertise and experience, combined with the conversations you will have today will advance the development of a human-rights-based approach to health in nursing and I look forward to learning about the outcomes.

Nō reira, ka nui te mihi ki a koutou, once again greetings to you all and thank you

Tēnā koutou, Tēnā koutou, Tēnā tātou katoa.

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