Speech notes - 2011 AUT University Faculty of Health and Environmental Science’s Dean’s Public Lecture Series

Speech notes prepared for 2011 AUT University Faculty of Health and Environmental Science’s Dean’s Public Lecture Series

Professor Abbott, Vice-Chancellor McCormack, distinguished guests, ladies and gentlemen.

Thank you for the invitation to be part of AUT University’s 2011 Faculty of Health and Environmental Science’s Dean’s Public Lecture Series.

And thank you also for AUT University’s commitment to developing health and allied health professionals who enter the workforce having already delivered services at the frontline.

To the AUT University community, I share your sadness at the recent passing of your Chancellor, former Governor-General, Sir Paul Reeves.

 

A few short years ago

This is the second time I’ve had the privilege to address the Dean’s Public Lecture Series as Minister of Health. 

In 2009, when I was last here, I had been Minister of Health for less than a year. 

When the National Government came to office there was significant public discontent with the public health service.

Headline after headline underscored a lack of leadership and focus.

 

The whole system was on a track to financial crisis, as District Health Board (DHB) deficits rocketed and services failed.

Over 9 years the health budget had more than doubled, but we were not getting good value for money from that considerable investment.  The bureaucracy had grown massively. 

Staff shortages were rife, morale was poor and many of our health professionals were leaving for offshore. 

Patients were getting a poor deal, as much of the extra money was wasted on schemes that added little value.  Waiting in hospital emergency department corridors was commonplace.

 

Many women with breast cancer waited 15 weeks for cancer radiation treatment.

Patients were sent to Australia for care because of worrying delays in New Zealand. 

This was not good for patients or their families.

It’s easy to forget how isolated clinicians had become and how disenchanted patients were. 

This failure to engage doctors and nurses – who know patients' needs best – was seriously eroding their ability to provide patients with the care they needed.

 

The Government’s priorities

The Government came to office with a mandate to improve services for patients. 

They wanted us to put the service back into public health.

When I gave my 2009 address, I said that the Government wanted our public health service to deliver better, sooner, more convenient care for all New Zealanders. 

I said we wanted to reduce waiting times, improve quality and performance, and build a more motivated health workforce. 

 

I said we wanted to move resources out of back offices and into frontline services.

I said we wanted to re-engage clinicians in decision-making.

Today is an opportunity to reflect on what the Government has achieved in Health in less than three years.

We have made significant progress.  But the challenges we faced were large.  Realising the objectives we have for the health system requires a long-term focus. 

Today is an opportunity to assure you that we have that focus and are committed to building on the momentum we have generated.

 

Investing in health

Unfortunately, some things have not changed much in the last few years.  The world continues to feel the effects of the global recession.

Around the world, governments are making tough and unpopular decisions to make ends meet.

The United Kingdom’s National Health Service needs to find £20 billion in savings. 

Up to 490,000 public sector jobs will be gone by 2015 including 50,000 NHS staff. Doctors and nurses are facing a two-year wage-freeze.

 

In Ireland, the government slashed 5 percent off the health budget – and the former Irish Health Minister got dowsed with red paint.

Newspapers in Canada have reported that 2,500 nurses in Ontario are losing their jobs.

Fortunately New Zealand’s economy has weathered the storm better than most.

Against the backdrop of the worst financial situation in 80 years, we have remained determined to grow and protect the public health service.

 

This year’s Budget made a remarkable additional $585 million available for health initiatives – the biggest single item and close to half of the available new funding.

The government has invested $1.5 billion of extra, new money into the public health service over the past three years – in the most difficult of financial times.

We’ve been able to maintain and improve key services and infrastructure.

 

This year’s Budget included a strong commitment to improving services in a number of key areas: more elective surgery; additional Plunket visits focused on new mums; improvements in maternity services; more for medicines; higher subsidies for dementia beds; a significant boost for disability services; and $94m more for GP subsidies over 4 years.

Health Targets

A key focus of my 2009 address was three Health Targets: improved access to elective surgery; shorter waiting times for emergency department treatment; and reduced waiting times for critical cancer treatment.

 

The system the government inherited was bloated with targets, priorities, objectives, indicators and measures and some of the previous government's targets were well-meaning but unrealistic. 

There was also excessive waiting and delays. 

 

This Government consulted with the people with the expertise to fix this –clinicians and their DHBs.

 

They said they wanted fewer, clearer, and more focussed targets to aim for.  And that's what we did.
 

 

It is a real pleasure to look back at the progress achieved by clinicians and DHBs since then.

You may have seen the latest results when they were published recently.

Elective surgery

New Zealanders are getting vastly improved access to elective surgery.

Between 2000/01 and 2007/08, elective surgery discharges increased at an average of only 1,400 a year, despite a doubling of the health budget over the same time.

 

We knew DHBs could do better.  We knew clinicians wanted to do better.

So we set a goal of delivering an average extra 4,000 discharges a year over our first three years. 

And we set a goal to reach 130,000 elective operations every year by the end of 2010/11.

We reached that goal two years early.

In 2010/11 we delivered 145,000 operations. That's 27,000 extra operations for New Zealanders – every week 500 more necessary operations like hip replacements, cataract surgeries and grommets for children.

 

Emergency departments

Emergency departments are a key indicator of the overall health and performance of a DHB. 

If emergency departments are working efficiently, so will other parts of the system.

We set DHBs the target of 95 percent of people presenting at an emergency department being admitted, discharged or transferred within six hours.

At the start of 2010/11, we were at 87 percent. 

At the end of the fourth quarter of 2010/11, we reached 92 percent. 

 

So progress is being made – but there remains room for improvement.

Nine DHBs exceeded the 95 percent target.  Auckland DHB reached 95 percent for the first time.

I am pleased to note that Waitemata DHB was the biggest improver this quarter, increasing by 14% to 94 percent. 

Overall, Waitemata DHB’s performance has improved 33 percent since the target was introduced in 2009. 

Waitemata has gone from being bottom of the DHB performance table with 61 percent, to 11th this quarter – only one point short of the target.

 

Waitemata has had a strongly led approach to the target over recent months and the redevelopment of the emergency department at North Shore Hospital in March no doubt contributed to this improvement.

Their North Shore emergency department has gone from being described as the “weeping sore” of the public health system to being right up there with the best in the country.

Once all stages are completed, the $52m investment will have the expanded and redesigned emergency department, including a new assessment and diagnostic unit, and 30 new beds.

 

In addition, the $9.2 million North Shore Dialysis Centre opened last month and provides in-centre renal dialysis for people with kidney failure.

I also recently announced that a $37 million state-of-the-art Elective Surgery Centre will be built at North Shore Hospital. 

Cancer care

We have also targeted reducing the amount of time people wait for cancer treatment, particularly radiation treatment.

Our target was, that by the end of July 2010, every person needing radiation treatment would have it within six weeks – and then within four weeks by December 2010.

 

 We started 2010/11 with 99.5 percent of people needing radiation treatment receiving it within six weeks.

We ended 2010/11 with 100% percent of people needing radiation treatment receiving it within four weeks.

Primary care

Primary care has been a core focus of mine as Minister of Health. 

Not long after we came to office, the OECD noted that the results for the first six years of the Primary Health Care Strategy had been mixed, but “mostly disappointing”. 

 

It found that large increases in funding during the 2000s had not led to commensurate increases in performance or care.

The Government has focused on realising the potential contribution of primary care to the health of the health system, and to the health of New Zealanders.

We are focusing on driving and harnessing innovation in the primary care sector, so that more New Zealanders can access better services, closer to where they live.

A key focus has been on how the primary and secondary sectors can work better together, so that patients, and primary care providers, are better supported when an allied health service or more specialised care is needed.

Primary care also has a crucial role to play in achieving another of our six Health targets – better detection and management of cardiovascular disease and diabetes.

 

 Achieving this target will lead to better health outcomes and reduced pressure on hospitals.

Not only have community clinicians increased the number of cardio-vascular risk assessments, there are good improvements in the level of diabetes management.

This year we set a target of 90% of eligible patients having their heart disease risk assessed.

It’s a challenging target.  We haven’t quite got there yet.

 

While there are innovative things happening around the country for diabetes management, we need to do better. 

 

The Ministry of Health is to work with experts and Diabetes New Zealand to recommend new ways to support people with diabetes.

 

I’m expecting even better performance in this crucial area.

 

Determinants of health

We have been committed to improving health and reducing pressure on both primary care and secondary resources through other ways too.

It is crucial that children get the best possible start to life.

We need to ensure policies aimed at improving outcomes for children are informed by evidence.

Government agencies are currently considering how the report of the Prime Minister's Chief Science Advisor, Professor Sir Peter Gluckman, and his colleagues will inform future policies.

 

We need to invest more in interventions that work.

That’s why Budget 2011 invested a further $21 million to provide more WellChild visits. 

These will target first time mothers, and will more than double the number of visits many receive in the first two months of baby's life.

Immunisation Health Target

When we were elected to office less than three years ago, only around 70 percent of two-year-olds were fully immunised. 

This was another area crucial area where I knew we could – and must – do better.

 

So we set a Health Target for 95 percent of two-year-olds to be fully immunised.

We’ve already reached 90 percent – across all socio-economic and ethnic groups. 

In some parts of our country, the Māori immunisation rate is now higher than the general immunisation rate.

And it’s still climbing.

Child health providers have shown an outstanding ability to reach more people.

 

Getting from 90 percent to 95 percent will be harder than getting from 70 percent to 75 percent.

But I’m confident it will be achieved.

Healthier homes

Keeping Kiwis healthy goes beyond the health service.

New Zealandhomes are on average six degrees centigrade below World Health Organisation recommended minimum levels.

 

The Government worked with the Green Party to introduce a significant public subsidy for insulating the homes of tens of thousands of New Zealand families: $360m for 190,000 homes.

We know that warmer, drier homes bring health benefits, especially for those with respiratory illness or other conditions.

We’ve done 100,000 homes in two years.

History will show that this programme made an enormous impact on improving the public health, and the futures of kiwi families.

I am confident it will come to be seen as the single most significant new public health initiative of the decade.

 

In addition, Budget 2011 announced a $12 million investment to stamp out rheumatic fever. 

Maori and Pacific people – mostly children – living in cold overcrowded homes are most likely to get rheumatic fever.

Respectively, they are 20 and 37 times more likely to be admitted to hospital with first time acute rheumatic fever than anyone else.

The long-term consequences can be severe.

Our $12 million investment is aimed right at this disease and will support a concerted campaign across high prevalence communities involving school-based sore throat clinics for over 22,000 children.

 

Smoking at a turning point

We have also targeted encouraging more New Zealanders to quit smoking – and providing better support when people want to quit.

We have created a turning point in the campaign against smoking – with more actions than ever before on a scale never seen before.

The Government passed an unprecedented 30 percent increase in tobacco tax – the most effective way to prevent and deter smoking.

Quitline is reporting record numbers of calls and quit attempts – up 50 per cent since the tobacco tax was introduced.

 

Central to our efforts is the national health target of 90 percent of hospitalised smokers who smoke receiving advice and help to quit there and then.

This is engaging the public health service like never before. 

From zero to 85 percent in less than two years. 

Eleven DHBs achieved or exceeded 90 percent in June.

Overall, over 96,000 hospitalised patients were offered brief advice and help to quit in 2010/11.

 

We are close to achieving our target of 90 percent.  Some DHBs are already exceeding it.

We are aiming to achieve 95 percent by July next year.

In addition, legislation to phase out tobacco displays has been passed.  And plain packaging is inevitable.

We've also banned smoking in prisons.

It’s a strong signal that we are trying many measures, in all sorts of contexts, to reduce smoking.

 

Workforce and Clinical Leadership

I want to bring my address to a close by highlighting what I consider to be one of the most significant challenges facing the health system, but one where we are making significant progress.

When we were elected to government, clinicians were disconnected from the decision-making processes of the very system that depended on them. 

There were shortages in key roles, amplified by many choosing to leave New Zealand.

Since November 2008, we have invested in strengthening the health workforce, and in ensuring that clinicians have a greater say in how services and the workforce are planned and delivered.

 

We have grown the number of students in medical schools.

We introduced the voluntary bonding scheme to make working in New Zealand more attractive, particularly in hard-to-staff regions and specialities.

Public hospitals now employ over 800 extra doctors and around 2,000 extra nurses.

Staff vacancy and turnover rates in hospitals are at an all-time low.

There are more general practitioners working in primary care than at any other time.

 

There are more doctors and nurses employed in the public health service than ever before.

But there are still shortages in some specialties and in many rural areas.

We have also sought to focus on retaining our health professionals through providing more opportunities for clinical leadership and research.

At a time when many other countries are reducing their workforces and their investment in health, we have been growing and protecting our health workforce.

 

Health Workforce New Zealand

Many of you will know of the leadership Professor Des Gorman is providing through Health Workforce New Zealand (HWNZ).  He is being ably assisted by Professor Abbott.

Professors Gorman and Abbott are working with clinicians to answer a challenging question: how does the health service cope with a doubling of demand over the next 10 years within a constrained funding environment?

AUTUniversityhas a key role to play in answering this question.  The nursing and allied health disciplines, and innovative new roles, will be crucial.

 

Professor Gorman is working actively across the professions to answer that question, and seeks your input.  HWNZ does challenge the status quo.  Des calls it “disruptive change”!  And that thinking is happening on a number of fronts in partnership with the health professions.

Clinical leadership

We’ve worked hard to reassert the importance of clinical leadership.

Globally, clinical leadership is recognised as a fundamental driver for better health outcomes.

 

That’s why we have brought clinicians into the centre of decision-making…they are actively leading the work to future-proof the health workforce…and clinicians are driving key policy areas like maternity.

Around the country clinicians are leading improvements in patient services.

Nurses in particular are driving the improvements in patient care through the productive ward programme and safe staffing initiatives.

Clinicians are working to enhance integration between hospitals and community, so that services move closer to home for patients.

 

Clinicians are leading big improvements in cardiac care, and plan to widen their focus further.

And clinicians are delivering even more care for patients.

Clinicians are also are at the forefront of improving quality and safety.

Health Quality and Safety Commission

We have established an independent and clinician-driven Health Quality and Safety Commission to lead quality and safety improvements in the sector.

 

The new Commission will help health professionals across the whole sector improve patient safety and service quality – including public and private, at secondary, primary and community levels.

Real leadership is expected of the Commission in the key areas of infection control, medicine errors and preventing falls.

Health research and innovation

New Zealandclinicians and health researchers are also growing in status on the world stage.

Clinicians in New Zealand hospitals and universities – including AUT University – are among world-leaders in a number of areas of health research and innovation.

 

Their work attracts more than academic respect – it also makes a crucial contribution to the New Zealand economy.

There is also growing private sector innovation.

There is considerable potential for New Zealand’s health research community to contribute to better outcomes for patients and boost the economy.

I intend to ensure it does both. 

For example, I recently announced that the approval process for clinical trials will be streamlined and simplified, and that the Ministry of Health is looking at developing a national health research strategy.

 

Conclusion

Ladies and gentlemen, I've got the best job in government. 

It’s great to work with so many smart and committed people.

Over the past three years, the government has shown its determination to grow and protect the public health service.

We’ve built real momentum in improving services for patients, in tackling the workforce crisis, and in clinical leadership.

But let’s be realistic.

 

There’s a lot more to do.  The job is not finished.

Over the next few months we will be presenting our plans for the next three years.

We are determined to build the momentum we have created.