Opening Address - Cutting Edge Conference

Mōrena, it is a pleasure to be here today.

The last two and a half years have been unprecedented. We’ve been faced with, and overcome, many challenges.

We’ve had to change how we live, how we work, and how we connect. While we have become accustomed to seeing each other through screens on Zoom meetings, I am very pleased for us to come together, kanohi ki te kanohi, today.

I would like to recognise dapaanz as an organisation. Specifically, I would like to mihi Executive Director Sam White, the dapaanz Board and wider team, and of course, the entire mental health and addiction workforce, including the many of you here today.

The work you do is life-changing, providing support not only to those in need, but also to entire whānau and communities. It is not easy, and you show incredible commitment and care.

I want to acknowledge the incredible work that dapaanz has done over the last twenty years in supporting and guiding the professionalisation of our addiction workforce. Today, tāngata whai ora living with addiction challenges can access services in a range of settings from a diverse addiction workforce that offers both depth and breadth of addiction expertise.

The development of clinical, cultural and lived experience roles and skills, as well as harm reduction and prevention options, has broadened the population the workforce now serves, as well as destigmatising receiving support from and working within the addiction sector.

I know that COVID-19 has added surmountable challenges and complexities to an already complex job, and I appreciate your continued dedication and adaptability.

The new system

We’re certainly not done with COVID-19 and I have no doubt that it will continue to present challenges for some time yet, however, I am optimistic, and excited about the future of the health system in Aotearoa.

The health system, including the mental health and addiction system, we inherited was under serious pressure from years of neglect and underinvestment. As you know all too well, it wasn’t working for patients, and it wasn’t working for the health workforce.

So, we’ve fronted up to that challenge, and we’re committed to making it right.

We’re only one month into the reformed system, but progress is already underway.

The vision of the reformed health system is a cohesive, unified system, that delivers pae ora for all New Zealanders, no matter who they are or where they live.

The key elements of the future health system include: 

• strengthening of Manatū Hauora | Ministry of Health’s role as chief strategic advisor and kaitiaki (steward) of the health and disability system.
• establishment of a new Public Health Agency within the Ministry, responsible for public health policy, strategy, monitoring and intelligence.
• establishment of a nationally coordinated health system headed by Te Whatu Ora – a Crown entity that replaces the 20 district health boards and will plan, commission and deliver health services.
• prioritising the voice of whānau Māori as direction-setters through Te Aka Whai Ora – an independent statutory entity that ensures planning and delivery of health services that delivers equitable outcomes to Māori.

Through the reforms, we expect there to be real changes in how the health system supports communities including:  

• the shift to a locality approach for primary and community health care – meaning care centred around communities with care providers working in closer partnership to wrap support around whānau.
• a shift towards communities influencing the services available to them, and services joined up across the health and social services spectrum.
• models of care and service models that meet underlying needs of the community, which are sustainable and easy to access for all. 

The shift to a locality approach is fundamental to the health system reforms, describing a new way of delivering health services tailored to the needs of local populations, because we know that what is needed and works in Te Tai Tokerau, won’t always be exactly what is needed or works in Murihiku. 

The locality approach also brings together local health providers, as well as mana whenua, social agencies and local government, to form provider networks that offer communities more seamless, connected care closer to home.

It emphasises a population health approach, providing for greater partnership with communities, integrated health, and social care for those with complex needs, and building relationships to focus on the broader determinants of health.

Essentially, we’re building a system that puts whānau and communities at the centre and is committed to pae ora – healthy futures – for all.

It provides for an approach supported by partnership and cross-agency collaboration. Because we can’t improve people’s health unless we improve their lives overall.

We have services already offering part of the type of support we are talking about here.

Māori with mental health and addiction challenges now have easier access to care thanks to 29 Kaupapa Māori primary mental health and addiction services across Aotearoa.

Over the past few weeks, I have visited 13 of these new services across Te Ika-a-Māui. From Waitematā to Wellington, Tairāwhiti to Tāneatua, it is a heartening experience seeing tailored, culturally competent wellbeing services being delivered by Māori, for Māori and making a real difference in their communities.

From early 2020 until May this year, these growing Kaupapa Māori primary mental health and addiction services have delivered more than 20,000 sessions for those with mild to moderate mental health and addiction issues.

Caring for tāngata whaiora on this scale would not have been possible had it not been for this Government’s record investment in mental health.

Across the motu, I’ve spoken with people who have never interacted with the mental health and addiction system before but now have the support and tools they need to face some tough challenges.

This is a great start, but there is much more to do.

We want full wrap-around services for tāngata whai ora.

It means ensuring they can access the support and care they need, where and when they need it, and in a way that works for them. It means not just treating an illness, but ensuring that all over their wellbeing needs are met.

Ensuring they have access to healthy food, safe housing, employment, education, and are part of supportive communities. It means looking at the big picture, working collaboratively across agencies, and coming up with local solutions. Tomorrow’s panel will hopefully give you more of a sense of how that work will in action.

The reforms strengthen our ability to respond to addiction. As a government, we’re committed to taking a health-based approach to drug use and addiction. In broad terms this includes providing harm reduction or treatment support, non-judgemental approaches that destigmatise people that seek help, approaches that prevent harm and intervene earlier in the development and/or experience of drug harm and addiction, population-level health promotion that supports positive social and cultural norms around drug use and harm.

We also acknowledge that some people do not need to, cannot, or will not (at that time) stop using, and will work with them where they’re at.

As such, reducing stigma and discrimination will also be a key focus and I know that you have some excellent speakers throughout the day and also tomorrow who will be discussing this further.

And for you, the practitioners, clinicians, support workers, and countless others working in the addiction system, it means you are part of a supported, sustainable workforce and part of a system that is underpinned by legislation that compels partnership and collaboration.

Challenges within the addiction workforce

The challenges facing the addiction workforce here in Aotearoa are reflected worldwide, with shortages, retention, and development issues.

These issues aren’t new – they’re longstanding and integrally linked to wider health workforce challenges and system barriers.

They are, however, one of the top priorities for Te Whatu Ora’s mental health and addictions group.

We allocated $77 million from Budget 19 toward mental health and addiction workforce development and added a further $10 million this year. We have three key goals:

• increase the existing workforce
• grow new workforces
• upskill the workforce.

We know that across the mental health and addiction workforce there is a need to grow competence in working with populations with unique needs, such as the Asian population, rainbow communities and deaf and hearing-impaired people. Critically, the workforce now and in the future must be adept at weaving clinical and cultural practice together.

There’s a broad programme of work in place to address these issues – from scholarships to training and development. There is no panacea to fix the current shortages, and this will take sustained effort and investment, which we are committed to.

As part of the focus on the whole health workforce, we are working across agencies to investigate ways to streamline the education pipeline. This has included a joint engagement by education and health officials, with health educators in the nine health professions identified as having acute supply risks, of which Addiction practitioners are one.

This process illuminated a strong desire across both the education and health sectors to better collaborate to create a more effective and sustainable health education system.

From the Addiction practitioner education sector, officials have learned:

• there are more people interested in studying to become Addiction practitioners than can be enrolled, highlighting an area we can address to increase the pool of graduates
• sustainable staffing and getting suitable placements for students are the key constraints on enrolment numbers
• good pastoral support is very important for retention of students
• some students have difficulties navigating education opportunities and registration requirements, with many geographical inconsistencies.

These findings are allowing us to develop cross-sector work that includes:

• improving the way we organise student placements
• improving the way we support students, particularly Māori and Pacific students and addressing institutional racism
• increasing the number of student-centred learning pathways
• planning for meeting future workforce demand using robust data and modelling.

This is just a brief snapshot of the work underway, but rest assured there is significant ongoing and future planned work to invest within the broader addictions portfolio and develop the addictions workforce through multiple avenues.

Closing

Nō reira, I am under no illusion that the challenges across the addiction sector are vast. However, I am firmly and unashamedly optimistic that we’re at a pivotal period of change and transformation.

We’ve got a once-in-a-lifetime opportunity with the health reforms to make transformational change and improve the lives of all New Zealanders, no matter who they are or where they live.

We can’t do this alone, it’s going to take all of us working together, he waka eke noa, but you have our support, and our commitment.

Thank you again for the invitation to speak with you, and for the important mahi you do.