Address to New Zealand Council of Christian Social Services Conference

Te Wharewaka o Poneke, Wellington

E aku rangtira, tēnā koutou katoa.  Ka nui te honore ki te mihi ki a koutou.      

Thank you for the invitation to speak at this important conference.

I would like to acknowledge the contribution NZCCSS members make to supporting older people and their families.

Priorities for services to older people
As Minister for Senior Citizens and Associate Minister of Health I am committed to enhancing the lives of older people and encouraging a culture in New Zealand where older people feel valued and respected.

In order to achieve this I will promote wider community understanding of the issues that older people face. Elder abuse and neglect and social isolation are key examples.

Currently the Government is acting to improve public awareness of elder abuse and neglect. We are doing this through:

• supporting community programmes encouraged by the New Zealand Positive Ageing Strategy
• promoting public awareness of the local Elder Abuse and Neglect Prevention services
• supporting the campaign for Action on Family Violence (the “It’s Not OK” Campaign)
• promoting World Elder Abuse Awareness Day on 15 June 2012.

Social isolation is an issue I am keen to address. While the number of socially isolated older people in New Zealand is not clear, we hear stories everyday of lonely older people in our communities. Social isolation is caused by a number of different factors, but the key contributors are living alone, poor health and loss of family and social networks. I am passionate about alleviating social isolation and my officials and I are currently exploring ways to achieve this.

I will also be looking at the New Zealand Carer’s Strategy and in particular at the issues that impact those who care for older or unwell friends and family.
My role as Minister for the Community and Voluntary Sector gives me added interest in the needs and issues of community organisations and volunteers that care for older citizens.  I know from my own experience at the local level what vital work is undertaken by health and social service organisations in the aged care sector.

It’s important that government policy supports the community and voluntary sector and that government agencies form strong and respectful relationships with community providers. That’s why the Government signed the Kia Tūtahi Relationship Accord last year, which outlines principles and expectations about how government and communities can work together.

Implementation of the Accord is focusing on drawing out lessons of good practice in community-government relationships that can be applied more broadly across government agencies and communities.

I am aware too of the importance of volunteering opportunities for connecting older people to their communities and reducing social isolation. Recent findings from the Health and Ageing Research Team at Massey University indicate that the more often people take part in volunteer activities, the higher their happiness. People in greater hardship were more likely to be happier when they volunteered, than those with higher living standards.

I am interested in how to support and encourage volunteering. I have asked officials to consider ways to encourage participation in volunteering, and how we can recognise and validate learning gained through volunteering.

As Associate Minister of Health I am committed to ensuring quality services are available to older people who need them. While I am a new Minister, I am not new to this area.

The government's aged care commitments – some of which I will touch on in my speech today – are part of my vision. My broader vision is of a society where older people are included, have valued roles and access to quality services that maintain and build on their wellbeing.

In particular, I am committed to ensuring respite care services are available so older people can remain at home for as long as it is safe to do so and the wellbeing of their caregivers is considered and protected.

I am also committed to ensuring home based support services are consistently of high quality across the country.

Key government commitments for older people
One of the government’s key expectations for public health services is the delivery of better, sooner, more convenient care so that health outcomes are improved for all New Zealanders, including older people.

This is to be achieved within a constrained economic environment.   We have elected not to make significant cuts to health spending but do have higher expectations of all health funders and providers. 

DHBs are being encouraged to lift productivity yet keep to budget. This will in turn be asked of providers of services within the community.

There is a need for prioritisation and a need to work together more, as the title of your conference “Moving Forward Together” points out.

Service integration is required, especially with primary care. Challenging times also provide opportunity for innovation.

The government has made a number of commitments to older people and service providers.

These commitments are aligned with the theme of this conference. They are about moving support and services for older people forward, through working together to find new, smarter and more integrated ways of doing things.

Organised stroke services
There is an increasing body of evidence that treatment of strokes by an organised stroke service leads to better outcomes for patients.

Increasing numbers of older people will mean that the treatment of strokes will also be increasingly important.

By the end of 2012/13 all large and medium sized DHBs will be expected to have an established stroke unit for acute stroke care.

All smaller DHBs will be required to provide stroke care within an area of organised stroke services.

For NZCCSS, this will mean being prepared to provide advice about services available for people who have had strokes and the provision of community support services to assist both the person and their carers.

Health checks for over 65s
The government is also committed to investigating the provision of free health checks for all people over 65 years, as part of the Confidence and Supply Agreement with United Future.

Health checks would be expected to fit well with the work on reducing hospital admissions by identifying and supporting those at greatest risk.

Service integration
Integrated care is important for the health system, and across other social services, as it provides a focus in efforts to improve the quality and coordination of care as well as reduce duplication of services.

A work programme focussing on wrapping services around older people has been developed.

Health and support services for older people are often delivered by individuals and agencies that work in isolation from one another. Gaps and delays in services often result.

This fragmented approach to aged care tends to be reactive rather that proactive and results in poor outcomes and transfers to residential care that could have been avoided.

The intent is that work, aimed at integrating services, will include the development of dementia care pathways that reflect an integrated service approach across primary, community and hospital care services.

This work will provide an opportunity for you to work with the Ministry and DHBs to improve outcomes for older people and to reduce avoidable admissions to hospital and to residential care.

Home and community-based support services
There is increasing demand for home and community-based support services as a result of our ageing population.  These services are increasingly supporting frail older people who would previously have been admitted to aged residential care. 

National standard for home-based support services
The Auditor General’s 2011 Report: Home Based Support Services for Older People made a number of recommendations to increase confidence that services are of high quality.

A programme of work is currently under way that addresses issues identified in the report. This programme also reflects the government’s commitment to setting a minimum standard for home and community support services.

The Home and Community Support Sector Standard (NZS8158:2003) has recently been revised. The standard is due for release in March/April 2012.

Thank you to all who have contributed to the development of this Standard.
For those of you involved in the provision of services in the community, this Standard will guide the quality of service that you provide.

Smarter home support services
DHBs are being asked to invest in smarter, more intensive services for older people who are living in the community in order to reduce acute admissions and readmissions to hospitals.

Services to reduce acute admissions include discharge management teams to ensure appropriate referrals for community support are made at discharge; and consideration of services to manage acute episodes of need/illness in the community.

Strengthening quality assurance processes
The Ministry is working with DHBs, the Accident Compensation Corporation (ACC) and Home and Community Support Service (HCSS) providers to ensure that HCSS are delivering services that are safe and of high quality to older people.

The work to strengthen quality assurance processes for HCSS includes:

• Working towards making compliance with the Home and Community Support Sector Standard a requirement in all District Health Board (DHB) contracts with HCSS providers.  As I mentioned above, the revised Standard is due to be released March/April 2012 and providers will have a finite time (probably 12 months) to comply with the revised Standard, subject to an assessment of the likely impact the change will have on the sector.
• Developing more consistent HCSS provider monitoring, including auditing and provider reporting requirements.  This will largely be completed by July 2012 and will enable comparisons between providers and across DHBs, and reduce duplication of effort by funders and providers.
• Developing a robust client complaint and satisfaction process by September 2012.
• Roll out of Comprehensive Clinical Assessment (interRAI) for home-based care by June 2012 will provide a more robust basis for assessing need and developing care plans.  The Ministry is also investigating the use of assessment data to develop quality indicators for HCSS providers and within DHB areas.

Aged Residential Care (ARC) interRAI implementation
Some of you may have had the opportunity to attend Martin Taylor’s session on interRAI implementation in aged residential care yesterday.

If so, you will already know that interRAI implementation in Aged Residential Care (ARC) (2011-2015) is a collaborative initiative between DHBs and the aged residential care sector.

The project supports integration as information from the older person’s home care assessment is available to the facility to help complete the initial assessment on admission.  All health providers (including GPs) will be able to access an older person’s information over the internet at each stage of care.

Each resident will receive a Comprehensive Clinical Assessment (CCA) at least twice a year, or when their health status changes.  As soon as there are enough assessments in the database, quality comparisons across providers will be able to be made.

We expect that the first 100 facilities will be using interRAI assessment as their primary means of assessment by June 2012.

The training of nurse assessors is well underway and there is plenty of interest from aged care providers to be involved.

Workforce
The workforce needed to support older people is a critical issue for the future of aged care services.

The future will require people to work differently. Just how this will look is currently being developed by Health Workforce New Zealand.

Expanded scopes of practice, new roles and the skill levels required for a primary care workforce are all being considered.

It is also important to acknowledge the important role of informal care givers in providing care to their frail older family members. Opportunities for education, respite and fellowship for this group will be required.

We need to identify ways to better utilise the existing unregulated workforce and the small number of highly trained professionals in aged care to positively impact on the health and wellbeing of older people.

Conclusion
Thank you for inviting me to speak with you today. As a new Minister, I welcome every opportunity to meet with as many sector groups as possible.

No reira, tēnā koutou, tēnā koutou, tēnā koutou katoa.

I now invite you to ask any questions that you may have for me.