Thank you for inviting me to your conference to celebrate NZNO's centennial.  Thanks Marion for the introduction- this must be one of your final duties as NZNO's president.

I understand there are quite a few past presidents, national secretaries and chief executives of the NZNO here today for this auspicious occasion.

Good afternoon everyone.

There are few New Zealanders whose lives have not been touched by the care and reassurance that nurses provide, every hour of the day, every day of the year.

Our hospitals and clinics also depend on your managerial skills, your innovation and your leadership.

Nurses are the backbone of the public health service - and a significant part of its future.

Clinical Leadership

Nursing is a career choice we want to encourage for more and more men and women. We need more leaders and managers and we need more recognition that patients must come first.

Nurses tell me the best part of the job is the time they spend with patients.

The average hospital nurse spends less than a third of his or her time working directly with patients. The rest is spent running up and down the corridor and massaging keyboards.

Little wonder so many people were leaving the profession when they weren't able to do what they were educated to do ... and that's care for people.

I was at Tauranga Public hospital recently and saw first hand what nurses are doing to improve patient care by improving the time the spend with patients.

One ward team had increased their patient-contact time from 32% to 57%. Needless to say the nurses seemed happier and so did the patients.

And that is clinical leadership.

Globally, the leadership of doctors, nurses and other health professionals is recognised as a fundamental driver for a better health service.

Recent research across 126 hospitals in the UK found the real key to a successful hospital was the level of involvement of doctors and nurses in the running of their hospital services. Stronger and more direct involvement by doctors and nurses means more service and better quality.

A group of senior clinicians including one of your Directors of Nursing, Helen Pocknall of Wairarapa DHB, wrote the In Good Hands Report which embeds clinical leadership in our governance structures.

‘In Good Hands' emphasises the importance of listening to practitioners and clinical leaders who really understand what it means to deliver a high quality health care service.

This Government is holding DHBs accountable for implementing  In Good Hands.

Your profession has a vital role to play in health governance because failure to deliver comprehensive care is a much greater risk to any health provider than financial or performance failure.  This means that at the health governance level the quality of care is an imperative.

 

Financial Situation

It is a great privilege being the Minister of Health. That's made even better by having a Prime Minister and Finance Minister both with an equally strong commitment to the public health service. And I am fortunate to also have a strong team of Associate Ministers.

That's significant in this time of economic crisis, the worst since the 1930s - where it is more important than ever that we live within our means while we try to protect and improve the public health service for patients and health workers alike.

Despite the recent encouraging news that we are may be coming out of the recession, the financial crisis has had such a profound effect on our economy that it has replaced the large government surpluses of recent years with equally large deficits.

The truth is the Government will borrow $30 billion dollars to protect vital social services such as health, education and welfare, confident that the New Zealand economy will eventually come right and we will have protected our communities during that time.

Because of the economic crisis, the Government is now in deficit.  New spending has shrunk to $1.5 billion, and we've had to borrow that.

Despite this, such is the priority this government places on protecting and supporting our public health service, Health received half of that in the Budget - the same amount it has received in recent years. 

In other words, Health got a $750 million increase, while the other 30 or so ministries and departments shared the other $750 million.

Next year the new spending allocation for the entire government will be around $1.1 billion.  Maintaining a $750 million dollar share for health will be unlikely unless there is a significant turn-around in our country's finances.  Next year money in health will be even tighter.

The National Government is committed to a strong and enduring public health service but the health service in turn will need - more than ever - to ensure a strong and ongoing focus on value for money, with resources moving from administrative overhead and low priority spending into more important frontline services.

Actions for Nursing

In the last ten months the Government has put considerable resources and effort into improving front line services in Health. 

Voluntary bonding

The biggest issue in Health is workforce, workforce, workforce.

As a result of the recession staff turnover has fallen and there are few vacancies for nursing in the public health system. In fact, some DHBs are over-expectation for nursing numbers.  Many people are entering ‘return-to-nursing' courses, and that is not wasted because we need many more nurses for the future.

We've worked with NZNO to fulfil our election promise to encourage younger nurses to stay in the country after graduation through our voluntary bonding scheme which pays off student loans for nursing, medical, and midwifery graduates who agree to work in hard-to-staff communities and specialties for 3 to 5 years. 

The scheme has proved very popular, with 682 nursing graduates in theatre, intensive care, and cardiothoracic nursing confirmed on the scheme in 2009. 

Enrolled Nursing

The Government has also worked closely with you progressing work around enrolled nursing ... widening the scope and respect for this group of nurses. We have over 3000 enrolled nurses registered to practice across all areas of our health sector, yet we do not let them use their skills as best we might.  The Chief Nurse is advising me as to how we could improve the effectiveness of enrolled nurses. 

We need to press ahead and develop a wider scope of practice, with sound educational underpinning, for a new-wave of enrolled nurses equipped to support the registered nursing workforce in all areas of health care delivery well into the future.  The Nursing Council is currently consulting on the enrolled nurse scope of practice and I am keen to see this finalised as soon as possible.

Nursing in health governance

Greater clinical leadership includes trusting nurses to elect members of their own Nursing Council - which the Government announced earlier this year and you have just voted for.  It is important you have more say in the regulation of your own profession and in the decisions affecting scopes of practice, competence and safety. 

There was a strong list of candidates for the Nursing Council election and the final votes have been counted.  The Nursing Council will be announcing the two successful candidates  tomorrow.

Future Work

The recently released Ministerial Review Group report makes it clear that we need a more integrated approach to service delivery and we need to rapidly adopt a new approach to workforce planning and development.

The new Clinical Training Agency board led by Professor Des Gorman of Auckland University is to become the health workforce leader in New Zealand. Professor Gorman is keen to engage with your profession.

Part of this work will involve opportunities for new models of practice building on the success of the nurse practitioner role, and other specialist nursing functions. 

For example, we can move services currently provided in acute care to primary care, where they can be more appropriately delivered.

There should be a wider development of the role of nurses as case managers and brokers of health information. 

And we will continue to consider more nurses prescribing a wider range of medicines according to their competence, patient need and the requirements of services.

That would fit in with potential Integrated Family Health Centres which the Government would like to see providing a full range of mulit-disciplinary services in the community. 

Such centres  include some services ( like the removal of skin lesions) currently provided in hospitals, some specialist assessments, minor surgery, walk-in access, chronic care management, increased nursing and allied health services, as well as selected social services.

The Ministry of Health has issued an Expression of Interest for proposals from eligible health care providers who are capable of large scale change to make these services a more frequent part of New Zealanders' primary care experience .

We are very keen to see nurses in the community working with their health professional colleagues to put together these proposals.

Conclusion

To conclude, I congratulate NZNO on its centenary.  The last 100 years have seen significant improvement in our country's health care system, and we will see changes over the coming decades that will challenge and amaze us in equal measure. 

Nursing has proved its ability to develop and change with the times and maintain its high standards and core values.

There are around 45,000 nurses currently practising in this country - you are a massive resource which the government is committed to safeguarding and strengthening.

Thank you for the work you do and enjoy the rest of your conference.