Address to the Association of Salaried Medical Specialists Annual Conference

  • Jonathan Coleman

President Dr Hein Stander, members of the ASMS.

It’s great to be here today to address your conference.

The last six weeks have been the busiest of my ministerial career.

There’s been plenty of travel – many of you may be aware that I am trying to get around all the DHBs by Christmas.

Fifteen down - five more to go.

It’s been great reconnecting with old med school classmates and former colleagues.

Get your bingo cards ready…

I attended Auckland med school.

I did my house surgeon years in Hawkes Bay and Auckland.

I obtained a Diploma of Obstetrics and went onto specialise as a GP, working both here and over in the UK.

While I was in London I became interested in the wider issues impacting on the health system so did an MBA at the London Business School.

When I returned to New Zealand I worked as a consultant for PricewaterhouseCoopers and continued to practice as a GP in South Auckland one day a week.

I was elected to Parliament in 2005 and am the MP for Northcote.

In 2008 I became a Cabinet Minister.

Today, as well as being Minister of Health, I am also Minister for Sport and Recreation and I am particularly keen to see greater linkage between these two portfolios.

My first six weeks

As I have travelled around the DHBs one thing that has really struck me is that although the hospital buildings are on the same sites to when I was a doctor – the actual health system, what’s going on inside these buildings and what is increasingly happening out in the community, is very different.

I have also been struck by just how committed the health workforce is – it feels as if the politics which used to divide health have diluted and everyone is focused on improving services for patients.

During my visits I have been consistent with my message to Chairs and CEOs.

I believe they need to be talking with the clinical leaders and fostering, encouraging and supporting clinical-lead decision making.

During these conversations it also became apparent that there needed to be changes to the way HBL operates.

DHBs want greater control of the implementation phase.

I’ve taken their proposal on board and we are going through a due diligence process to see what shape the implementation should take.

I have also asked officials to update the NZ Health Strategy and check the Ministerial Review Guidelines.

If any of you have been on the Ministry of Health’s website lately you’ll find something like 140 ‘plans’.

I would like a high level document which sits above these.

Something useful and to the point.

I don’t want a gigantic book which just collects dust.

Financial state of play for health

The New Zealand health sector is in good shape, but there’s no doubt that future challenges remain.

I want to thank you for your commitment to the New Zealand public health system.

It will never feel like there are dollars in health.

On the Government’s side, it’s complex and challenging work to get the books in balance.

But, the result has been that New Zealand has emerged from the world economic downturn and the Christchurch earthquakes with one of the highest growth rates in the world, one of the lowest rates of unemployment, and having protected our important social services like health through the difficult times.

Investment in our public health services has risen from a budget of $11.8 billion in 2008/9, to $15.6 billion in 2014/15.

I acknowledge that the increases aren’t the 10 per cent of a decade ago, but at around three per cent per annum, they were what we can afford.

Health is the only portfolio with those sort of increases.

That’s something in tough times.

My commitment to you is that I will continue to do my best for resourcing our public health service, keeping up with the growth in demand.

My thoughts following DHB visits

First, everyone has a view about how healthcare can be better delivered.

One of the things I really want to focus on today is the concept of ‘team health New Zealand.’

Across the country, across DHB boards and management, and most importantly across clinical staff, we are all committed to the same better health outcomes for New Zealanders.

That doesn’t mean that at times there won’t be tough conversations, but the key is we all have common aspirations for health in New Zealand.

Another point has also become clear to me on these visits: DHBs where clinicians feel engaged are performing better on a range of indicators than those where clinicians feel their views are not being heard.

This isn’t a coincidence.

Clinical engagement makes a difference not just to the morale of a DHB, but also to its efficiency and quality of the health care delivered.

Whenever a Chair or CE wants to discuss a new idea or service change with me my first question is ‘what do the clinicians think?’.

This is the key to delivering better integration across primary, secondary and tertiary care, better services within hospitals and more efficient combinations of service delivery between DHBs.

Our health system is going to continue to face pressures and we are going to need to produce new and innovative ways of addressing those pressures.

I am relying on doctors, nurses and allied health professionals to help come up with the solutions.

You are the people who know your communities and know how to serve their needs.

You are also the people who know the health system and how seemingly small changes to how we do things can make a huge difference to patient outcomes.

A health system that does not engage with its clinicians will be a health system which fails to deliver for the public.

Priorities – immediate

Since taking on this portfolio I have been keen to keep the momentum up.

Two days after I received my Ministerial warrant I travelled to Southern DHB to sit down with the Chair, CEO and clinical leaders.

It’s not news to anyone that there are problems in Southern DHB – but I hope that they are now well on their way to addressing the issues.

I then met with the HBL team.

During my visits to DHBs across the country I have talked with the Chairs and CEOs about HBL.

I recognise the need to make savings from the back office areas to return investment into frontline services – and I appreciate that DHBs want to have a greater role in this process.

So in light of this, it is expected that HBL will be wound down once the appropriate transitional plans have been agreed.

This handover is expected to occur by the end of June 2015.

Medium term - continued importance of Health Targets

We must maintain a strong focus on improving the quality, performance and the financial sustainability of the public health system.

The Health Targets remain key.

They are not just about numbers - they are about better and quicker access to important health services.

  • Shorter stays in ED. Measures the performance of the whole hospital, not just ED
  • Electives – lifted from 118,000 a year in 2008/09, to 162,000 in 2013/14.
  • Having your first cancer radio or chemotherapy within four weeks of being ready.
  • Increased heart and diabetes checks - quite remarkable that over one million heart and diabetes checks have been completed over the last five years.
  • Helping smokers to quit- 95% of smokers in hospitals have had advice to quit.
  • Immunisation – a huge achievement, 92% of 8 month olds immunised.

The targets remain important - they have unarguably lifted focus and performance.

As an example, I want to recognise the great work done by the specialists and their teams who have bought our elective surgery wait times down.

Nearly all patients are now treated within four months.

This has only been achieved by hugely increasing the number of patients being treated each year - while keeping the same average operation complexity.

For those of you not familiar with this improvement, it is only a few years ago that there were around 7,000 patients waiting over six months.

I am pleased to say that we are on track to have no one waiting over four months by the end of this year.

There has been no reductions in access - quite the opposite - 44,000 more patients getting surgery than six years ago.

Election commitments

We are looking at ways we can use targeted funding to deliver better health outcomes for New Zealanders.

Free GP visits and prescriptions for under 13s from July 2015 will cost $30 million a year.

That money will go towards giving 400,000 more kids a healthier start to life.

We have set a new Faster Cancer Treatment target.

90 per cent of patients are to receive their first treatment within 62 days of being referred urgently with a high suspicion of cancer by June 2017.

This is the international gold star standard of care.

We also want more New Zealanders to live pain free lives away from hospitals.

To achieve this, we’re pumping an extra $50 million over three years to reduce pain and increase prevention by delivering 2,550 extra hip, knee and other orthopaedic operations in addition to the usual increases in elective surgery.

We’re going to provide more than 1,500 extra general surgeries such as gallstone, vain operations and we’re investing $6 million dollar to create a multi discipline early intervention team focused on reducing pain. 

In recognition of New Zealand’s ageing population we have also increased Hospice funding $20 million a year.

We want to do more to help support people and their families at this difficult time.

We’re getting more palliative nurses out into the community and into rest homes.

Thirdly- medium to long term settings

As I’ve travelled around the DHBs I have noted the increased focus on integration.

DHBs are developing stronger links with primary care providers.

I have been pleased to hear about things like GPs having direct access to specialist nurse and/or doctor advice, safety programmes being delivered on medicine management, and nurses leading clinics on diabetes management.

The focus on integrated healthcare needs to continue and grow to deliver the results we need to achieve. 

We need to be taking the communities and public with us to ensure healthcare is delivered to the whole population. 

There are still at-risk populations who do not have equitable access to healthcare.

We need to do all we can to ensure coordinated care for patients and to encourage stronger links between services, whether in hospital or in the community. 

Enabling patients to move smoothly between different healthcare providers depending on their treatment needs reduces fragmentation of care, and provides a better patient experience.

This fits with the other long term priority setting - care closer to home. 

It involves the whole concept of self-care, greater support for people to manage their health in their own homes.

Part of care closer to home includes harnessing the full potential of our health workforce, grow the use of our pharmacists to help people manage their long term conditions, grow the use of nurse specialists.

All this helps to free specialists to concentrate on what you are most need for, specialist healthcare.

I want to bring a new emphasis to the treatment and prevention of long term conditions, in particular obesity.

We are seeing concerning increases in the rates of obesity which will soon overtake smoking as the leading risk factor for health loss in New Zealand.  

The Prime Minister has also given me the sport and recreation portfolio with a specific direction to focus on childhood obesity which is exactly what I intend to do. 

We are currently doing a stocktake of ‘what works’ to reduce obesity, as I want to make sure our investment is focused, coordinated and effective. 

From there we will be looking to take those successful programmes and deliver them to as many kids as possible as quickly as we can.

Running parallel to that work we are also looking very hard at the long term causes, consequences and interventions that can have an impact on obesity.

Sir Peter Gluckmann is co-chairing the WHO’s Commission on Ending Childhood Obesity.  This will report early next year. 

We will be carefully considering that report as well as the other evidence on the subject so we can develop New Zealand’s long term response to a very serious complex problem.

We also need to acknowledge that no one particular Government agency or DHB will have all the right answers, or even all the right information, to start tackling complex problems.

This term we are likely to see a marked increase in cross agency initiatives focused, in particular, on children in material hardship.

We are more likely to see to see good ideas and quality implementation when it involves the people who can see all sides of the problem.

That may mean, for example, Ministry of Health working with Ministry of Education to identify kids most in need of better access to physical activity or other anti-obesity initiatives.

This focus on collaboration across Government departments must also extend down into the coalface of our health system where we want to see DHBs talking to each other and sharing their innovative programmes or affect solutions to common problems.

A great example of this I’ve seen recently is Project Energize, a Waikato DHB programme to combat obesity by getting at kids up and actively participating in sport, which has just been rolled out in the Northland DHB.

Closing remarks

As we go ahead I see the whole health service as a team, and that the decisions the Government and I make are all built on delivering a better public health service for all New Zealanders, particularly for those in most need of those services.

As I have been travelling around the country and meeting with DHBs I have been asking people the same questions – are we going in the right direction?

Is New Zealand’s health sector better, the same or worse than it was ten years ago.

The feedback that I am getting is that although there are still challenges, we are heading in the right direction.

This is a different health sector to the one I worked in. Things are better.

And finally, just before I go… I’ve got a copy here of your buzz word bingo.

We can tick off integration, closer to home, clinical leadership, targets and primary. There might be a few more! Anyway – I don’t think there’s a bingo, but give me three more years!