Maori Health Provider Hui

I thought it was perfectly appropriate that we address the vital issue of primary health care here at Waipuna, in the midst of volcano territory.

Mt Wellington is known as the most recent site of volcanic activity - the last eruption being a mere nine thousand years ago.

Of course, the fact that the Auckland Supercity legislation is going through the House at this very moment might just bring those odds a lot closer, of another one-in-a-nine thousand year event.

And I want to take this moment in the shelter of Maungarei, the watchful mountain, to pay my respects to the mana whenua right throughout Tamaki Makaurau.

Your role as mana whenua is an enduring one.  The generosity of the manaakitanga extended to all who come to Tamaki is appreciated as the sign of a noble people - and that respect will be eternal, no matter what the legislation says.

We are here, then, to consider how best to achieve the revolution in primary healthcare that will achieve the outcomes we all seek for our whanau, and for our communities: that's the volcano.

Against the seismic activity that is rocking the health system as we know it, we must hold on to what we know best - and that is the value of our connections.

Connections with mana whenua; connections and new relationships between organisations; connections that are vital for the achievement of effective outcomes for our whanau.  Connectivity is key to primary health care.

Over three decades ago, the Alma-Ata Declaration set a gold standard for primary health care. 

It set the goalpost high; encouraging maximum community participation in the planning, organization, operation and control of primary health care.

The connections extended far and wide - quality primary health care promoted preventive health alongside health promotion and education; care and rehabilitation; treatment and cure.

Indeed, everything came under the radar of primary care service - food supply and nutrition; supply of safe water and basic sanitation; social services support; prevention and control of disease; housing, education, and community development.

Nowadays they call this Joined Up Thinking or Linked Services.

Or if you're Mr Ryall, you call it Better, Sooner, More Convenient.

For primary health care to be successful, it must reach the people it is destined to serve. 

And there's one more connection to Alma-Ata.  

What really drove that declaration was the knowledge that it didn't matter how flash the intervention was, it wouldn't mean a thing if the community didn't want it.

That sense of connection to the community; real engagement with the families; is central to what also drives me - the journey to whanau ora.

Primary health care is generally the first point of contact with the health system - bringing healthcare as close as possible to the people.

But what all the reports are showing, against rapidly growing health dollar expenditure, is that services are fragmented; overlapping and duplicated; a mixture of activities is being entangled under the heading of health; and outcomes are simply not in the mix.

We may know how many phone calls are made; how many posters are distributed; but do we know how many of our families are living well?

And we should know.

We should not be waiting for the crisis to intervene; or taking a blinkered look at the well-being of the whanau - focusing on what's wrong instead of solutions to make it right.

I am worried that we have put so much effort into addressing the symptoms of underlying problems that we miss the opportunity for transformational change.

The transformation I am talking about is to know that whanau are doing well - not just the individuals within it. 

To know that whanau will be active participants of their story, not passive recipients of someone else's. 

To know that the outcomes they are seeking will enable them to function well in today's world; to be confident within their identity; to be strong in their whakapapa; their history and their spiritual self while having a sense of future possibilities.

These are real outcomes; outcomes which will be seen in good choices; which will be expressed in whanau taking up their roles and responsibilities.

I want to come back to the volcano.

When a volcano erupts, the lava forces its way up through the cracks and explodes through the surface of the Earth. Everything is thrown up for examination.

That's what happening to us in health - we're having a good, hard look at access, performance, unmet need, risk, funding pressures - everything is exposed to the light.

Workforce shortages are affecting all parts of the health system and are expected to increase.  We are facing chronic shortages in many professional fields including doctors, nurses, midwives, psychologists, physiotherapists and other allied health professionals.

At the same time as the health workforce is ageing; there is the growing pressure of a workforce that is more and more mobile; tempted by the lure of overseas to leave these shores, creating more vacancies in their wake.

We are also experiencing a decline in the number of overseas trained doctors, nurses and other health professionals who want to come to New Zealand to work.

We're at a point where we can not rely on a stable workforce to manage our health future.

We have more than doubled the expenditure on health.

And I don't need to tell you all of the statistics around disparities to tell you that what we are currently doing isn't working.

In these times of fiscal restraint, we need, more than ever, to know that every dollar we spend is making a difference.  We need to achieve a more efficient and effective spend, to take the wider view.

You may have seen this week, that one of the major gains we achieved in our negotiations around the Emissions Trading Scheme is the commitment to extend the Government's energy efficiency assistance for low income households.

In the 1990s, EECA (the Energy Efficiency and Conservation Authority) discovered that for every $10 of benefit gained from home insulation $2 could be attributed to energy savings, $6 to averted health costs and $2 to a reduction in absen­teeism from school and work.

These sorts of measures are exactly why we believe that integrated delivery is so much more efficient in getting the results for our communities across a range of indicators.

I heard yesterday, about the story of a whanau from home who had their home insulated; windows fixed, and housing outcomes met.  However the most tangible outcome of progress had been the fact that the woman in that whanau who had been hospitalised twice in the last year; hadn't had another hospital episode since her house was repaired.

But nobody was measuring her health status.  It didn't count.

There's no point in taking the truant back to the school if there's something major happening for the whanau which needs to be addressed before he can ever settle down to his books.

We need to have the courage to examine our weaknesses, to identify what's missing, and most of all to build on our strengths.

One of our greatest strengths is the institutional capability of our Maori health providers.  And I want to acknowledge today, the incredible presence you have in our communities; the lives you have literally saved; the hope you give me, that we can do this.

Tangata whenua have distinguished ourselves as being expert networkers - it's called whakawhanaungatanga.  

We have the credibility and the experience that comes with building on our natural networks; relationships built on trust.

So the challenge that faces us now - to provide services closer to home, to develop a more personalised primary care system, to create universal coverage - is well within our reach.

We can do it - and the Government's challenge must be to trust us in knowing that we can.

That's why I have been so pleased to see the various models coming forward from the national Maori PHO Coalition; the Waipareira Trust and others. 

It's about that cheeky Maori confidence; that entrepreneurial edge that shows us all that Maori designed and delivered services are the best options to truly meet the needs of our whanau.

And so when the Minister of Health called for Expressions of Interest from primary health care organisations which are capable of delivering larger scale and a wider range of health care to their communities, I knew that Maori health providers would be at the front of the line.

The challenge I want to lay down at this hui, is to ensure that whanau centred outcomes drive you in this new change forward, outcomes which are focused on the potential of all our whanau to be successful.

This is not about more of the same.

We can not go wrong if we give responsibility back into the hands of our whanau, to do things differently, to achieve the moemoea they set for themselves.

Whether it is Government; whether we are providers; or whether we are whanau - there is one thing we need to have to move forward and that is trust - to trust that we can and will succeed.

Let's make it happen.