New Zealand Home Health Association (NZHHA)

Introduction

Good morning.  It is a pleasure to be here to open the New Zealand Home Health Association’s Annual Conference and I would like to thank the association for its invitation to speak to you.

First up, I’d like to thank the many health professionals, managers, coordinators and support workers in home care for their outstanding efforts and perseverance during and after the series of Canterbury earthquakes.

After each of the major quakes, services kept operating despite broken roads, no sewage, no water, no phones.

Some providers and carers left their own damaged homes and disrupted families to go to work every day to help others.

A leading home care provider in Christchurch explained to me how support workers were able to visit clients within a day of the first quake courtesy of the Canterbury four-wheel drive club!

Providers have also faced the huge population movements in Canterbury with clients moving in and out and around the region.

The way in which you all worked together so effectively to care for your fellow citizens is truly humbling. I know that the challenges remain and the uncertainty persists, but please know that you are admired and appreciated for what you are doing.

We really have seen the best of New Zealand in the response to the earthquake, and in particular, the best of our health service… public and private.

Just as the earthquake has changed the landscape in Christchurch, so it has changed the landscape of public finances.

The Treasury estimates the total financial cost of damage from the earthquakes at around $9 billion for the taxpayer alone.

In addition, the wider economic impact of the earthquake could reduce total tax revenue by $3 billion in the next tax year.

The global financial situation is similarly challenging.

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

And health systems have not been immune from those decisions.

In Britain, many public servants, including doctors and nurses, are facing a two-year wage-freeze.

There are large-scale savings planned within the National Health Service totalling GBP 20 billion. It is estimated 50,000 NHS staff will be made redundant over the next few years.

Already there are reports of cutbacks of almost 1,000 jobs in two London hospitals alone – including significant numbers of nurses and doctors.

In Ireland, the former Health Minister was pelted with red paint by protesters as tempers grew over her Government slashing 5% off the health budget.

The Irish had already cut public service salaries by up to 15%, including doctors, nurses and teachers.

The Italians are also curtailing public health spending.

In Canada, the provincial health authorities are now taking tough measures to curb health costs.

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

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

But we borrowed an average $380 million a week in 2010/11 to protect and grow our important social services.

Last year  alone the Government's borrowing via the bond programme is expected to be around $20 billion.

Health Finances:

And it’s within that context that the Government is providing stable and reliable financial management during uncertain times.

Our commitment to protect and grow the public health service has seen the Government invest $1.5 billion of new money into the public health service over the past three years despite the worst economic situation in 80 years.

Even at this level, District Health Boards have had to focus on efficiency and productivity. They in turn have sought efficiencies and better value for money from their providers.

I know that it causes providers frustration that some funders offer price adjustments and others don’t.

This is a reflection of local decision-making and financial pressures. And those pressures will remain as the economy turns the corner.

In 2007/08, we spent a total of $194 million on home support services, by 2010/2011 this had increased to around $223 million and is forecast to increase to $240 million in the current financial year.

Future demand

Health experts believe that over the next 10 years demand in health care will double. We can’t double Wellington Hospital and we can’t double the number of doctors or nurses.

So we have to move services to a more affordable platform…and that platform is in the community, closer to home.

And we need to integrate care across hospitals, general practice, the community and home.

This clinical integration is key to our prudent strategy of future-proofing our health service to better deal with those increasing demographic and financial pressures.

And it's in this context into the future that home health will become even more important as part of the team delivering care closer to home.

You’re seeing would I suspect is an early taste of that with the early supported discharge service – CREST – in Canterbury.

With significant pressure on hospital and aged care beds in the province, Canterbury DHB expects to discharge patients early from hospital with short-term intensive home based support for their clients. The focus is on rehabilitation. It’s multi-disciplinary and engages primary care, carers and family.

Similarly the smart use of technology integrated with good home support can see patients better managing their own health at home. In remote parts of the Bay of Plenty, patients are using tele-health to monitor their own vital signs, with the results zooming back to a case manager who can coordinate care for these people.

We’re also pursuing innovation in support services for people with disabilities.

In the next month we expect the one-thousandth person will take up individualised funding…10% of all disabled people eligible for home and community support services. This gives the individual much greater control over how their support funding is best used to suit them.

In 2009/10, we spent a total of $113 million on home support services supporting around 12,500 younger disabled people to live at home. By 2010/2011 this had increased to around $119 million and is forecast to increase to $127 million in the current financial year.

We know that people with disabilities want to live good, everyday lives, just like other people. To help people do that, the Government has developed a new model for supporting disabled people that gives disabled people and their families more choice and control over their lives and the support they receive. The new model introduces Local Area Coordinators who work with disabled people to help people towards their “good life”.  Under this approach, funding is allocated rather than types and levels of service…. with clearly defined rules around what that funding can and cannot be used for.  

The Ministry is currently implementing a demonstration of the new model in Tauranga; working with the local community to make sure the model works well.

I am pleased that our health sector has proactive organisations such as the New Zealand Home Health Association that are so committed to ensuring quality home support services.  The release of the Association’s publication Making the Most of Home Support Services in March this year is a clear indication of this commitment. 

To pick up on three points in your recommendations:

The Ministry has a programme of work with DHBs, which will involve service providers, to look at how we can build on current good practice to improve outcomes for older people. 

This includes looking at how we can strengthen quality assurance processes and improve the type and quality of information we have about the services we fund. 

An example of this is measures to assess the level of satisfaction older people have with the services they receive and to report that feedback.

The Association has also recommended the adoption of minimum training requirements in home based care.  This is an area which Health Workforce New Zealand is currently considering. 

It has completed a review of workforce for care of older people and is now working on an investment strategy which will lead to longer term changes in workforce training, development, and skill mix.

As part of our 2008 election programme a stock take on homecare contracting, provision and auditing has been completed.  It shows considerable variability.

I have asked the National Health Board to work with DHBs to standardise contract documentation and reduce audit duplication.

Finally, a word on sleepovers.

I don’t think the unions know what they are doing.

Year after year they sat with you as employers and managers and negotiated sleepover allowances.

And now because of a legal loophole they expect you – and the government – to pay $500 million in back-pay and increased pay rates. This is unaffordable.

The union demands potentially send some of your businesses to the wall. I recently met a small provider with $8m of contracts caring for disabled people, and this community organisation faces liabilities of over $2m for back-pay alone.

The government has made a very generous offer with a sizeable contribution from you as providers to the back pay.

Thank you for your willingness to work with us to protect the services so important to people with disabilities you support.

Conclusion

The Government is committed to protecting and growing public health and support services and this is reflected in the fact that we have invested an extra $1.5 billion dollars into health over the last three years.  We are committed to investing in frontline services. 

More support services are being delivered to older people and younger people with disabilities.  We are delivering more hours to the people who need it most and we will be increasing our investment in 2011/12.

This investment supports the Government’s commitment to help people stay in their own homes and connected to their community.  It also means helping people to manage their own health conditions and empowering people to stay independent for longer.

I can see that you have a very informative programme ahead of you with a great range of speakers and I wish you all the best for a successful conference.