Address to Royal New Zealand College of General Practitioners, Annual Quality Symposium

Thank you for the opportunity to open the Royal New Zealand College of General Practice Annual Quality Symposium. In welcoming you to our nation's capital, may I start by acknowledging your President Dr Jonathan Fox, my fellow speakers Pat Snedden (Chair National Quality Improvement Committee) and John Wellingham (Chair Board of Quality) and your international speakers Professor Barbara Starfield and Maureen Baker.

Each of you here today is committed to improving the health of all New Zealanders through high quality general practice care. 

Since it was established in 1974, the College has made a significant contribution in ensuring this ongoing quality that remains central to primary health care services in New Zealand.

Quality is a leading issue within the College and within general practice. The College in fact started thinking about re-accreditation in the mid 1990s some years before it became more prominent. At a time when New Zealanders worry about the standard of the health services they receive, general practice stands as a leader determined to take responsibility for improvement and performance. And your QI4GP initiative is part of that.

The new Government

In November last year, New Zealanders voted resoundingly for a change of government. They voted for improved public services and, in particular, better public health services.

From day one, the new government made it clear that we see the restoration of clinical leadership as the fundamental driver of improved patient outcomes in this country. There are clear links between leadership, morale, and quality. This leadership is integral to advancing quality, patient-focused care. We will never improve the nation's or patients' health without the strong and active commitment of our health professionals.

Within 50 hours of taking office, the new government announced we would respect your clinical governance and give the profession direct election of representatives to the NZ Medical Council.

While many health sector leaders have expressed serious concern about ongoing sector "change fatigue", the human, structural and financial cost of sticking with the status quo is unsustainable. It will be critical to re-orient the health service in a way that fosters quality - is patient-centred and provider-friendly.

The public health service is groaning under the pressure of measurement and reporting, with accountability requirements that focus on what is measurable rather than what is meaningful.

The Ministry of Health advises me that we are currently asking you to measure the performance and quality of our public health system through: 13 health priorities and 61 objectives, with an additional subset of 13 health objectives; a set of 10 health targets measured through 18 indicators; 25 other indicators of DHB performance; not to mention 4 hospital benchmark indicators assessed through 15 measures; and an outcomes framework with 9 outcomes, measured against 39 headline indicators. The only thing missing is the partridge and the pear tree.

And that's not counting the PHO performance management reporting.

Clinicians, nurses, and allied health professionals try to do the best job possible with the resources they have. They are also constrained by processes and systems divorced from healthcare delivery that are more focused on political outcomes than clinical transparency. Clinicians have increasingly limited influence on patient outcomes. One of the greatest weaknesses of the current system is not engaging the people who have the expertise or carry the professional, financial, legal and ethical risk.

There is also growing international recognition that patient-focused care is dependent on an infrastructure that supports clinical practice and fosters a culture of learning and teaching.

Despite a plethora of strategies over the past decade little has been done to align policy and purchasing with quality. Functional health systems rely on people who know where the solutions lie. Incentives need to encourage ongoing quality care, innovative solutions and prudent management.

This could be achieved by resourcing and integrating networks of clinicians, at both a primary and a secondary level, into the planning, delivery, and evaluation of services.

Australian research has identified three principles relating to improving the quality and safety of patient care - clinical leadership, networking of services, and clinical information for informed decision-making.

That is why the new Government looks to the health professions and your leadership in the development of clinical networks to improve access and quality throughout the public health system.

The challenges ahead

Within the public health service, we face significant challenges over the next few years. After a decade of strong economic growth and overflowing tax takes, the country now faces a decade of deficits. The public accounts are now tracking Treasury's worst case scenario. Annual tax revenues are expected to fall ... something unimaginable in the past 20 years.

Eighteen of the country's 21 District Health Boards are now in deficit. The outgoing government assessed these at $110 million ... but DHBs have since revealed that these deficits are actually around $160 million.

We are facing a shortfall of over $600 million to meet the capital requirements of the 21 DHBs.

On the brighter side, despite the serious financial crisis unfolding we have secured the annual $750 million increase in the Health budget for each of the next three years. And a commitment that any savings that can be made in cutting bureaucracy will be kept within our vote and moved to the health frontline.

The new government will be spending the same as the previous government had budgeted - but much more wisely.

While health is in a privileged position, we must live within our budget over the next few years. Money will be tight, and that's why the quality agenda will be even more important.

Workforce remains our greatest challenge. We worked with the College to bring forward our policy of funding additional GP training places this year, and we will soon announce details of a voluntary bonding scheme offering incentives for medical graduates to work in hard to staff areas and specialties.

The new government is incorporating clinical leadership into the centrality of the public health system. Information - Quality - Accountability. This is what underpins professionalism.

This government wants a new partnership with the health professions.  We will trust and value our health professionals. We will engage you in decisions about the future of health services. We will not see you as costs, but as a valuable resource.

Along with that we challenge the health professions to become leaders in improving the delivery and quality of patient care across all parts of the health system; to work collaboratively with funders; and to deal effectively with any poor standards of practice where you see it.

You have solutions to problems facing our health service. Come to us and we will work on them together.

Thank you for the opportunity to be here with you and I wish you well for the conference.