Opening of 2015 RACMA Scientific Conference Langham Hotel, Auckland

Tēnā koutou, tēnā koutou katoa.  Nga mihi nui ki a koutou.

Thank you Dr Gruner for your warm welcome. I appreciate the opportunity to open this important conference.

I would like to also extend a welcome to Dame Tariana Turia and to the other conference presenters and to welcome all RACMA members and supporters. 

Warm greetings to all of you who have travelled to New Zealand specifically for this conference.

I would first like to comment on the important role medical administrators play in our health services. 

In New Zealand and Australia medical administration is a medical specialty in its own right. This acknowledges the valuable skills held by doctors who become administrators and managers.

There is currently a growing focus on improving clinical leadership in all areas of health services. Medical administrators are essential for making this happen.

In accepting this invitation, I was interested to hear that the whole conference has been devoted to the theme of Inequality and Healthcare.

I understand that the reason many doctors give for deciding to become medical administrators is that they want to make a difference. They see being a medical administrator as an opportunity to improve the health of population groups and to influence the health care system.

In other words, medical administration provides an opportunity to look at the health system from a helicopter viewpoint and work out what we can do to improve people’s health and wellbeing.

This conference provides a unique opportunity to discuss in detail what medical administrators can do that will help in identifying and reducing inequalities in healthcare.

I’m told the demographics of our New Zealand trained medical workforce are changing. I am particularly heartened to hear that the proportion of Māori medical students in New Zealand has been steadily increasing. 

Currently fifteen percent of medical students are Māori. This is proportional to the New Zealand population and this is an area where New Zealand is leading the world. 

Having reached this achievement it is important that these students are appropriately supported through their training and continue to be nurtured in their clinical years and medical careers.

I note that the sub-theme of the conference is recognising the healthcare costs of inequality. 

This reflects the growing evidence of the significant costs that inequalities impose not just on healthcare but also on our social sector and economy. Inequalities result in lost opportunities. There are lost opportunities for people to have good health. There are lost opportunities for these people to play active roles in their families and communities.

This generates economic as well as social costs.

Inequalities also create lost opportunities for the health system. Resources are diverted to meeting the additional health care and social support needs of people who have avoidable poor health. 

For instance, treating young children with severe tooth decay; addressing the health problems of prisoners with persistent drug and alcohol addictions and preventing and treating conditions like rheumatic fever.

The current New Zealand Government has taken seriously the unacceptably high rates of rheumatic fever in our Māori and Pacific communities. Reducing rates of rheumatic fever is part of the Government’s 10 Better Public Services Results Area. 

The Government has set the ambitious target of reducing the incidence of rheumatic fever by two-thirds by June 2017. To achieve this we have provided enhanced health services for those young people who are at most risk of developing rheumatic fever.

School-based programmes for assessing and treating children with sore throats are running in more than 200 North Island schools. In addition, there are over 300 drop-in sore throat management clinics in high risk areas of the North Island. These clinics make it easier for families to get prompt treatment for a child’s sore throat before it can develop into rheumatic fever. 

Health care services are just part of the solution. 

Six short films about rheumatic fever have been co‑designed by Auckland young people and are available on YouTube. Young people from four secondary schools and two community youth groups developed the story lines and fronted the short films. The success of these short films has been in young people talking directly to their peers.

Government agencies are also working to reduce household crowding for at-risk families. 

There are eight healthy home initiatives in DHB regions that have high rates of rheumatic fever. These initiatives identify families of children at risk of getting rheumatic fever who are living in crowded households. They then facilitate access to a range of interventions to reduce household crowding.

Significantly reducing the rates of rheumatic fever will help reduce the healthcare costs of inequality as well as improving the lives of some of New Zealand’s most vulnerable young people.

Increasing infant immunisation is also a Better Public Service Results Area. 

The government’s target is that 95 percent of eight-month-olds will be fully immunised by 30 June 2017. Achieving this target will help reduce the lost opportunities for good health. It will have significant benefits for the health system as well as for those babies who are immunised.

Another potential way of helping to address inequalities is through changes to population screening. 

Here in New Zealand we have the National Screening Unit that is responsible for the development, management and monitoring of nationally-organised population-based screening. This includes breast screening, cervical screening and screening during pregnancy and for new-born infants. 

The National Screening Unit is considering making changes to the primary laboratory test for its National Cervical Screening Programme. Currently cervical screening rates differ between ethnic groups. For instance, just over 60 percent of eligible Māori women were screened in the last three years; whereas for Pākehā women this rate was over 80 percent.

They are proposing to use a primary HPV (human papilloma virus) test rather than cervical cytology. The HPV test is safe and more effective. Also, it is potentially more cost effective as women may not need to be screened as often. 

Importantly, there is also the potential to introduce self-sampling which could help engage more Māori, Pacific and Asian women in cervical screening.

I understand that yesterday some of you attended a workshop on the New Zealand Atlas of Healthcare Variation. This initiative by the Health Quality and Safety Commission is a helpful step toward a better understanding about geographical variations in health care delivery. 

The data from the atlas will provide the basis for informed discussions about the changes that are needed and what can be learnt from other regions. It is a catalyst both for improvement in health care services and for identifying specific changes that will help reduce inequalities in healthcare. 

The atlas has the potential to be a powerful tool for medical administrators to use in improving the quality, appropriateness and accessibility of health services.

As you all know there are many factors that contribute to how we provide healthcare.  The decisions made by medical administrators affect people’s lives and health. They help in determining who accesses services and who does not, and whether health services meet the needs of patients and consumers. 

I wish you all the best in your deliberations over the next two days.

I am sure many of the keynote speakers will challenge you and you will have some constructive conversations about inequality and healthcare and the healthcare costs of inequality.