Tony Ryall speech to Healthcare Providers NZ Annual Conference

Ladies and Gentlemen, and Rangitata MP Jo Goodhew.

Good afternoon and thanks for inviting me to speak at your conference "The Evolution of Care: Bridging the Gaps".

Your conference title encapsulates both the ongoing and future challenges in aged care.

That evolution over the past 20 years has seen dramatic changes in how we care for older people. As has been noted, older people are now encouraged to remain in their homes for as long as possible and rest homes are no longer the inevitable destination for the very old. More and more of aged residential care has shifted to non-government providers.

But there are still gaps that need to be bridged. The care needs - or acuity - of older New Zealanders in aged-residential care is getting higher and higher as Dr Michael Boyd has found . And this is putting considerable pressure on the services you offer older New Zealanders.

Similarly, funding buckets are often too rigidly tied to specific purposes or types of providers rather than meeting the genuine needs of the older person, and their desire to remain independent. That must change.

Planning for the future

Fifty years ago, New Zealand built numerous schools, hospitals and houses to meet the needs of a new generation we now know as "the baby boomers".

As this generation enters retirement, New Zealand faces a new, yet similar, challenge: we do not have the facilities or services to care for these ageing people. 

But that ageing population is not the only driver of change.

One of the most significant demographic factors is the northward flow of population and the growth of greater Auckland. By 2026, it is projected Auckland will grow by 46% compared to a national population increase of just 22%.

Across the country a third of DHB populations will shrink, a third will stay the same, and a third will expand significantly. Most of those with a shrinking population will also have an ageing profile, with fewer workers available to support older people either in care or at home.

People's expectations are also changing. People want greater choice and quality. They want a more personalised service that meets their individual needs.

Most individual New Zealanders have never thought about the likelihood of having to provide personal care for loved ones, and then needing it for themselves.
As I said to you last year New Zealand needs to better anticipate the future demand for aged residential care. And then develop long-term plans to progressively lift the number of beds and services available; making sure they are in the right place at the right time to meet kiwis changing needs and expectations.

I suggested then we needed to start planning now.  Within months of coming to office, we've started in partnership with you. Together with the DHBs you will be modelling and examining costs, future demand and supply, models of care, and workforce.  This work has our full support and is part of a wider plan to ensure the health system can meet the needs of our ageing population. 

Later in this conference you will be meeting some of the team doing this work and the government looks forward to seeing the results of this project when it becomes available.

In that discussion and planning we must consider the role of aged residential care providers in the future.

The recent Ministerial Review Group report on the health service made it clear New Zealand needs to better integrate community and hospital based care in order to provider better, more personalised services closer to home. That's what people and patients want.

It strikes me that there is considerable professional and clinical expertise in the aged residential care sector that can see you play a more active role in providing more services closer to home. In many communities, some of the best expertise for supporting older people and helping them maintain independence and freedom is working in the local rest home.

Yet funding buckets, rules and policies prevent this from happening. In a time of financial restraint and future workforce shortages, we need to look at these constraints and see if they remain relevant.

Improving Quality Care

Modern healthcare is a highly complex business and getting more so all the time. Patients see so many different health professionals during their time in hospital and have so many notes and updates and documents in their medical records, that it's a challenge for any one person to get a handle on that patient's overall health status. The same applies for many in aged care.

That is a point the Health and Disability Commissioner has made on many occasions.

The Government set up the Ministerial Review Group earlier this year to recommend how New Zealand might improve the overall quality and performance of the public health system.

Among its 170 recommendations is a strong theme for improving quality - to both improve outcomes for patients and to reduce costs so that savings made can be put back into more health services.

Here's an example.

Most patients receive good care most of the time. But the Report estimates 44,000 patients admitted to hospital suffer an unintended injury caused in the management of their conditions, rather than the underlying disease - this is a similar rate to other countries. Although most of those people had relatively minor adverse events, about 15% resulted in permanent disability or death.

We would all say that is unacceptable. 

The MRG Report estimates that around $600 million in hospital expenditure goes towards treating potentially preventable adverse events.  That's money we would otherwise be spending on treating more patients or looking after more of our elderly. 

If we can improve quality and safety and prevent even 20% of this it will significantly improve the lives of those patients - and it could free up around 20,000 extra operations in the New Zealand public health system.

The Ministerial Review Group Report recommends an independent national quality agency be established to build on the work initiated by the Quality Improvement Committee. The Government will be considering that seriously.

Your sector is very aware of the public's desire for quality aged residential care. That's why you've worked so constructively and effectively with us towards improving the quality of rest home auditing and monitoring.

A team made up of the Ministry of Health, your association, District Health Boards and aged care advocacy groups is working to introduce what we call spot audits by October 2009. 

And for the first time ever, family members can now see and compare audit summaries of rest homes on the Ministry of Health website. Easily understood colour coding and details of any areas for improvement will give families and older people much more information - and potentially assurance - about their options. Over the next year or so we can work together to refine this.

Other quality work in your area includes progress on the introduction of third-party accreditation of the designated audit agencies and towards the reduction of multiple - and sometimes contradictory - audits in the sector.

It is vital to maintain public confidence in the standard of care being provided in the country's rest homes. Certification and auditing should provide residents and their families with an assurance of quality care.

Financial Situation

Importantly, in this time of economic crisis, the worst since the 1930s - is the need for us to live within our means while we try to protect and improve the public health service for patients and health workers alike.

You will be well aware of the global financial challenges facing the New Zealand economy.  Sadly unemployment is rising and will rise further.

This recession 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, 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 - and has continued to get the same $750 million increase as 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.

Whereas you received comparatively generous funding increases this year in line with our manifesto commitments, you need to be aware of how tight the finances are becoming.

Despite the worst recession in 70 years the government has this year honoured our pre-election policy commitments for the care of the elderly.  

• $18 million of additional funding to improve the quality of supervision and nursing in residential care - to support and retain nursing staff.

• Along with this additional funding for nursing quality, the Budget resulted in a subsidy increase to you of 4.5% for rest homes and dementia and 5.3% for hospital level care as at 1 July 2009. We also had much smoother process for the annual aged care contract review.

• $5 million per year will become available to DHBs to fund dedicated respite-care beds to give carers a break. $2.5 million has been made available for this from 1 January 2010. This will mean more support for older people living in their own homes and for the wellbeing of their caregiver (who is usually a family member).

Workforce

Workforce is the greatest challenge in health for the near future.

The recession is providing some reprieve for staff shortages as nursing and caregiver vacancies fall across the public health service. I visited a medical ward at Hutt Hospital last week where only one nurse has left this year!

Some hospitals are employing more nurses than budgeted as turnover has fallen to very low rates.

In some parts of Australia, nursing staff are being made redundant.

We also think it is important to improve training for your carers. This will allow them to complete qualifications that are appropriate to their care giving roles, and then be remunerated for the skills they have acquired.
Training should be relevant for both the home-based and residential care sectors, and it should be portable.
Aged care is a growing workforce, where training and career pathways will be even more relevant. You will recall that the National Party committed to supporting your efforts for an aged care ITO.

Finally on workforce, you should be aware that the government is working closely with the Nursing Council to restore the role and scope of enrolled nurses.

Conclusion

Thank you for the opportunity to talk to you about the work we are doing with your sector.

These policy changes and initiatives are intended to improve choices for older New Zealanders. They are also intended to support the Government's plan for effective healthcare, more frontline services, and dignity for older New Zealanders.

I wish you well for the rest of your conference.  I look forward to hearing about the opportunities for new ways of working within your sector, which will be vital to improving the lives of the older New Zealanders in your care.