Opening of Tauranga Campus of BoP Clinical School

Thank you Phil Cammish and Mary Hackett.

Thanks for inviting me to open the Tauranga campus of the Bay of Plenty Clinical School this afternoon.  It is always a pleasure to be a part of an event on my own home ground.  I am sure you will all enjoy the move from temporary to permanent accommodation.

I am particularly pleased to open the Clinical School in Tauranga, knowing the Whakatane campus is soon to open as well. 

These campuses are a good example of how smaller centres like Tauranga and Whakatane can play an important role in achieving many of the goals the country wants in health - like getting more health professionals across the country, encouraging more into hard-to-staff specialties and regions, and getting more clinicians involved in managing and leading our health services.

Earlier this month I announced the establishment of the Clinical Training Agency Board, which will be led by Professor Des Gorman.  This Board will provide a unified approach to health workforce planning across New Zealand.  We need better integration of health education and training with less duplication and a clearer focus if we are to meet our future health workforce and health service needs.

It is clear to all of us that New Zealand needs more health practitioners - doctors, nurses and allied health professionals.  The Government is committed to increasing the health workforce.  In medicine we are increasing the number of medical school places by 200 over the next five years.  The first stage of this increase will begin with 60 additional medical students in the 2010 academic year. 

Increasing the number of medical students is, in many ways, the easy part.  Far harder will be retaining these additional medical graduates, as well as our other health practitioners, in New Zealand, and encouraging them to work outside the major centres like Auckland, Hamilton, Wellington, Christchurch and Dunedin. 

But that is where smaller centres like Tauranga and Whakatane come in. There is interesting research from the University of Auckland that shows that it is significantly more likely for a medical graduate to stay in New Zealand, choose to be a GP and work in a rural area if they were born in New Zealand, into an English speaking family, and outside a metropolitan area.  

Research also shows that the longer a new graduate stays in a community or specialty during their training, the more likely they are to stay in that community after completing their training. 

The Clinical School recognises this principle and was established as a key workforce development initiative for ensuring a future clinical workforce to meet the needs of our region's growing population.

The Clinical School aims to increase student placements in those areas most affected by staff shortages, and to give students a positive clinical placement experience that will encourage them to seek permanent employment in the region. 

Your student exit surveys seem to support this theory, with recent comments like "I will definitely apply here for work after I graduate" and "I really enjoyed Tauranga - very friendly hospital ... and would love to return to the area".  Of course, it does not hurt if, like the Bay of Plenty, you can throw in sun and surf as added enticements!  We should never underestimate the importance of lifestyle for the current and future generations choosing where to live and work. 

The Voluntary Bonding Scheme is intended to encourage our young midwives, nurses and doctors to work in hard-to-staff specialties and regions by offering payments against student loans or cash incentives if the graduate doesn't have a student loan. 

Whakatane is a hard-to-staff region for doctors and general practice is a hard-to-staff specialty under the Voluntary Bonding Scheme.  I note that the Clinical School had 37 medical student placements in general practice in 2008 and 41 planned for this year (excluding GP registrar placements). 

We are aiming to increase the number of GP registrar training places to 154 a year as a short term measure to address New Zealand's GP workforce shortage.  More of this training needs to be in rural and provincial regions to increase the likelihood that more GP trainees will choose to stay in these communities.

Smaller hospitals like Tauranga and Whakatane are critical to the training of health practitioners.  Smaller hospitals expose health practitioner trainees to a broader approach to health care than is often the case in a large hospital.  While there is an international trend towards specialisation, particularly in medicine, there is also international recognition that more generalist skills are needed in our health and disability workforce.  Tauranga and Whakatane hospitals are perfectly placed to show trainees how exciting and rewarding it can be to develop and put to use a wide range of skills. 

Clinical placements in smaller centres like Tauranga and Whakatane also provide the ideal base for multi-disciplinary teams in health and disability care.  This Clinical School caters for medical, nursing and allied health professions.  Much has been said in recent years about the need for the full range of health practitioners to work together to give the patient the best possible care.  If this approach is to succeed it is crucial that we bring the different health professions together right from the start - during training.

I want to take this opportunity right now to thank those of you here who are teaching our trainees - Thank You.  Being a trainer is not always easy.  The availability of time, resources and facilities are all things that challenge those who teach.  And on top of that, many feel their teaching role is undervalued.  Please know that your role as  teachers of our future health practitioners is appreciated. 

The opening of the Tauranga campus of the Clinical School, and the soon to follow Whakatane campus, show that, here in the Bay of Plenty, the importance of those who teach is recognised, and the Clinical School provides access to teaching training courses.  It is your commitment to teaching that will guide trainees in their professional learning and instil in today's trainees a desire to become tomorrow's trainers. 

There is a clear opportunity here for greater emphasis on the apprenticeship nature of learning to be a clinician.  That has fallen by the wayside somewhat over the past few years and the new Clinical Training Agency Board will look at ways to bring it back. We need more on the job training to increase technical skills and knowledge, more mentoring to develop professionalism and more career advice to help students make career choices.  A Clinical School such as Tauranga embedded in a DHB is in a powerful position to do that.

The Government firmly believes that an excellent public health system can only be achieved by clinical leadership in service delivery, management and planning for the future.  I am keen to see frontline health practitioners take a leadership role in local areas as well as nationally.    

Late last year I asked a small group of some of our best doctors and nurses to look at how we can establish strong clinical leadership and governance in the health system, what aspects of leadership are required for good clinical governance, and how good clinical governance can be achieved.  The report In Good Hands was the result. 

A basic principle of this report was that if we want clinicians to be good leaders in our health and disability services we need to equip them for this role.  Which is why this  Clinical School provides access to management courses for clinical and non-clinical staff. 

Before finishing, I would like to congratulate you on a couple of recent initiatives.  One is the Nursing Competency Assessment Programme.  I understand this was originally developed for an individual American-trained nurse wanting to register in New Zealand, and it was so successful that in October the programme will be run with a small group of nurses.

It is this sort of programme, aimed at nurses new to New Zealand and New Zealand-trained nurses wanting to re-enter the nursing workforce, that will help New Zealand meet its future health workforce needs and not lose the valuable skills and experience of nurses trained overseas, or New Zealand-trained nurses who have been out of the workforce for a number of years.

The second initiative I want to mention is one that I am off to visit after this: the "Releasing Time to Care" programme in the surgical ward.  I understand that, over a three month period, this way of doing things increased the time that nurses spend in direct patient contact care from 31 percent to 57 percent, and staff are happier in their work. 

The health care environment is changing all around us through new treatments, increasing age-related conditions and the acuteness of those needing hospital care.  Yet the financial and resource constraints we face are constant: financial and resources.  Doing things differently to get the most out of the resources we have will be key to our success in meeting future demands on services. 

I am keen to hear how the "Releasing Time to Care" initiative works over the next year, and I ask that you take every opportunity to talk about the benefits of "Releasing Time to Care" to health practitioners and managers at other DHBs.  We need everyone to embrace changes that make things better for everyone.

I understand you have refurbished the old Nurses' Hostel to house your new Clinical School. That is noteworthy in these times of constraint when there are DHB bids for over $600 million dollars in capital works and very little money to pay for them. I hope the move into these permanent buildings will enhance the positive environment that the Clinical School seems to exude. 

A positive, vibrant and supportive environment is invaluable for both trainees and trainers, and can have a lasting impact on our future health workforce.

I'd like to take this opportunity to thank everyone at Tauranga Hospital and in the wider District Health Board for all your efforts in looking after the people of the Bay of Plenty. Working in Health can be very rewarding but at times, it is also difficult, stressful and plain hard work. I know that.  And I would like to thank you all for what you do.