This is the time of the year for presenting annual progress reports, and while in health there will always be an element of “could do better”, I am happy to say, from my contact with the health sector generally, that it can rarely be said that it “could work harder”.

I have been impressed throughout my time as Health Minister with the dedication and commitment of so many thousands of people who have taken responsibility for improving the health of New Zealanders.

This report, Implementing the New Zealand Health Strategy 2003, reports on initiatives and activities undertaken throughout the health sector to improve health, reduce disease and injury, and foster innovation and quality.

The report is the face of the strategy working, at national, district and local levels.

The 2003 report also includes national and District Health Board-level reporting on a range of health status and health service indicators, including diabetes, child health, cardiovascular disease and waiting times for elective services.

Notable in the 2003 reports are profiles of local initiatives making a difference in New Zealand communities.

District Health Boards are growing in their roles as funders and providers of health services, and have taken significant steps towards addressing the health needs of their populations.

Much responsibility for implementing key aspects of the strategy lies with DHBs, which are responsible for funding the majority of personal health services (including funding of Primary Health Organisations), mental health services and Maori health services. In 2003, DHBs also took over funding for disability support services for older people.

During 2003, population-based funding was introduced to begin fairly distributing available funding between DHBs, and giving DHBs the same opportunity, in terms of resources, to meet health needs.

DHBs have been responsive to opportunities and challenges as their planning and funding role has developed.

DHB activities to implement the New Zealand Health Strategy

Major advances are being made by DHBs across New Zealand in diabetes. DHBs exceeded the overall target for diabetes detection that they had agreed with the Ministry of Health in 2002. For 2003, DHBs have set targets that would result in further improvement.

DHBs are showing improvements in waiting times for first specialist assessment, and the number of people on residual waiting lists has also decreased. There was, however, an increase in the number of patients waiting more than six months for their treatment, and this has been regularly updated publicly. DHBs are implementing systems to ensure offers of treatment and the ability to provide it are more closely aligned in the future.

With a three-year funding path in place, DHBs have greater certainty about budgets and can undertake long-term planning.

A great many local initiatives to improve health and health services, and foster innovation are being undertaken by DHBs. They include:

• Tairawhiti DHB has implemented a teleradiology service to provide CT scanning services for Tairawhiti cancer patients. The development of this service removes the need for patients to travel to Palmerston North for the CT scan, providing a more timely delivery of services within their own DHB area.

• Auckland DHB is promoting a Food with Attitude programme through local schools to help children grow into their weight, incorporating home visits, advice and help from a dietician, activity programmes and general lifestyle change.
• Waikato DHB has implemented a pre-hospital thrombolysis service, allowing GPs in remote communities treating people with suspected heart attacks to quickly confirm diagnosis on site and immediately offer treatment.

Several DHBs are taking steps to reduce suicide by encouraging and promoting the use of key primary mental health and suicide prevention guidelines by the primary healthcare providers.

Many DHBs are applying workforce retention funding to direct incentives to retain and recruit rural practitioners.

And I am also pleased that many DHBs are fostering Mäori involvement in the health and disability sector through formal governance-level relationships with iwi. Examples include:

• A partnership between the Nelson-Marlborough DHB and the region’s eight manawhenua iwi. An iwi Health Forum has been established to work with the DHB to develop and implement strategies to improve Mäori health.

• The establishment by the Bay of Plenty DHB of a Mäori Health Runanga with representatives of 18 iwi to provide input and direction to the DHB on strategic matters affecting health and disability support services.

Major capital works programmes are also underway or have been completed in many DHBs. They include:

• Completion of Auckland DHB’s $447 million building programme

• $70 million hospital development underway in Invercargill
• Completion of the Waitakere Hospital expansion, part of a $210 million redevelopment in Waitemata DHB
• Completion of a $35 million redevelopment in Nelson Hospital
• Initiation of a $303 million redevelopment of facilities in Capital and Coast DHB.

PHO development

The 2003 report identifies substantial progress in developing PHOs nationally, and presents case studies of innovative PHO activity.

More than 2 million New Zealanders are now enrolled with PHOs, with more than one in four New Zealanders having access to lower-cost primary care. By October 2003, 53 PHOs had been established.

PHO funding is capitated. This means it is flexible and allows a diverse range of professionals to play key roles in delivering primary health care services, such as primary health care and community health nurses working in collaboration with organisations such as schools, marae and community groups.

The Care Plus initiative is being piloted and will roll out nationally across PHOs in 2004. This initiative targets the 5 percent of the population who need intensive management in primary health care.

Thirteen PHOs encompassing rural areas were established during 2002/03, all but one of them funded under the access formula, providing low cost primary health care to their populations.

PHOs are required to involve communities, iwi and individuals in governance processes, and to be responsive to community needs. Initiatives by PHOs to involve local communities include boards elected by the community, community input into PHO business plans, and community representatives on PHO management committees.

PHO activities to implement the New Zealand Health Strategy
Several new PHOs are using their increased funding for ‘services to improve access’ to reach more people at risk of diabetes and offer them early screening to detect diabetes, or the risk of diabetes. This allows earlier lifestyle advice and treatment to be given.

As more PHOs become established and provide improved access to quality services at lower cost, diabetes indicators are expected to progressively improve.

Some Ministry of Health-funded pilot Intersectoral Community Action for Health (ICAH) initiatives are also being carried out in collaboration with PHOs.

These initiatives aim to improve overall health outcomes and to reduce inequalities through community-based intersectoral activities.

The Porirua Healthlinks Trust is working with PHOs, Capital and Coast DHB, the Porirua City Council and other organisations to deliver services to meet community needs, while the Kapiti Community Health Group Trust co-ordinates local input into the Kapiti PHO development and the new Kapiti Health Centre.

Many PHOs are developing innovative means of involving Mäori in PHO development, including:

• PHOs operating as networks, with Mäori providers retaining existing community health contracts;

• Mäori-led PHOs, such as Turanganui Health in Tairawhiti DHB, where Mäori providers join forces to provide a focus for Mäori whänau and patients;and
• PHOs including Mäori in their organisation.

Case studies of local initiatives

The 2003 report features 20 case studies of local initiatives across New Zealand. It is worthwhile summarising just two of these initiatives, the Turanganui PHO, within the Tairawhiti DHB, and Canterbury DHB’s Co-ordinated Services for the Elderly (COSE) Project, as an illustration of breadth of innovative thinking and action.

Turanganui PHO is an Access-funded PHO with an enrolled population of 34,000 people, covering all but two practices in Gisborne, and rural areas south and west of the city. The project is a collaboration including local doctors and Mäori health providers.

People in the city have seen a notable reduction in the cost of payments for health services, according to Project Manager Keriana Brooking, who says the Access model has been “incredibly successful” because it recognises local population demographics.

The PHO is working with community groups to identify the best ways to deliver services, such as during times of high seasonal employment when people may be less able to receive treatment they need.

It is also developing programmes involving closer management of people with poor health. This can include more frequent GP and nurse interaction, agreeing and managing care plans with individuals and their whänau, and referral and support to other organisations that work in areas of nutrition, physical activity and smoking cessation.

The Canterbury Co-ordinated Services for the Elderly (COSE) project, operating since October 2000, is a community-based needs assessment and service co-ordination service funded from Ministry, DHB and ACC funding pools. It aims to avoid duplication in service provision.

A key worker (COSE) is based in primary health care and is assigned to several general practice teams. The model allows the COSE to identify resources and opportunities within communities, both funded and non-funded.

This offers older people a greater choice of service support, enabling them to remain safely in the community as long as they wish to.

Canterbury DHB Planning and Funding Division Project Manager Gill Coe says that health professionals and families are very supportive of the model, and feedback indicates greatly improved communication between service providers.

As a Wellington MP, I am also very pleased to see four Wellington case studies included in the report, and I am sure no one will begrudge me briefly summarising them too.

• Aukati Kai Paipa is a programme to reduce smoking among Mäori women. A positive evaluation of the programme was released earlier in the year. The programme profiled in the report operates from Kokiri marae, serving the Hutt Valley.

• The Wellington IPA Retinal Screening Programme, winner of the supreme award at the Health Innovation Awards 2003, is a free programme saving the sight of people with diabetes in the Wellington region.
• The Rangatahi Unit is a ground-breaking mental health inpatient unit for adolescents, bringing together both mainstream and kaupapa Mäori practices.
• And the Porirua Improving Access to Primary Care Pilots involve six providers collaborating to provide a package of services to improve primary health care access for Mäori, Pacific peoples and those on low incomes.

Indicators for action

The report includes a range of health data, at both national and DHB levels, showing improvement in many areas, including smoking, youth suicide and diabetes, but the data also shows further concerted effort is still needed to address many indicators of child health.

Consistent with other research findings, there are also marked inequalities between the most deprived and least deprived sectors, and between Mäori, Pacific people and other New Zealanders.

This sort of information is vital not only for identifying achievements, but for identifying the challenges that still lie ahead in implementing the strategy. This Government is determined to face such challenges.

That is why we are taking action across a range of areas to improve child health, including implementing the Well Child framework, developing the National Immunisation Register, and a vaccine for Group B meningococcal disease.

And that is why so much activity is taking place, led by the Ministry of Health and guided by the New Zealand Health Strategy, along with He Korowai Oranga: The Mäori Health Strategy and the Pacific Health and Disability Action Plan, to tackle inequalities in health.

This third progress report provides an excellent stocktake. The overall challenge now is to maintain the positive developments, and to continue to strive to improve in areas in which we need to do better. Thank you very much for sharing this important occasion today.