Cancer Care at a Crossroads Conference

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Introduction

Thank you, Professor Hayne (Vice Chancellor, University of Otago), for your kind introduction.

And thank you, Blair and Melissa (Vining) for bravely sharing your cancer journey with us today. 
Your speech from a personal perspective is an ideal start to this conference because people must be at the centre of cancer care - and across the whole health and disability sector. 

So thank you again, Blair, for reminding us about who matters most.

It’s my privilege today to formally open this Cancer Care at a Crossroads conference. 

There’s a huge amount of wisdom and experience about cancer in this audience today. 

You’re an influential and diverse group of people and include doctors, nurses, allied health workers, pharmacists, consumers, researchers, community leaders, funders and planners, and others involved in cancer prevention and care. 

I understand this is the biggest cancer conference in this country in 15 years. 

With all 400 seats booked out here at Te Papa’s biggest room, this is a big deal.
Some of you I’ve had the pleasure to meet previously and others I look forward to sitting down with in future.

I’d like to acknowledge and thank you all for your dedication and commitment to cancer prevention and care. 

You’re helping to ensure better outcomes for New Zealanders, and you can rightly feel proud of your important contribution.
I’d like to thank the conference’s co-hosts, the University of Otago and the Cancer Society of New Zealand, supported by the New Zealand Society of Oncology and the Ministry of Health, for putting together an excellent programme.

It’s both inspirational and essential for the sector to collaborate together for the good of all New Zealanders.

I’d like to acknowledge the Cancer Society’s Mike Kernaghan and Dr Chris Jackson and University of Otago’s Professor Diana Sarfati for your gentle friendship; accompanied by vigorous and persistent advocacy and evidence-based lobbying.

A warm welcome to our international guests - Professor Richard Sullivan, Dr Rami Rahal, Professor David Currow and Professor Fatima Cardoso, and to all our national and local guests.

I’d also like to acknowledge and thank the speakers from last night’s event at Parliament – including Professor Sir David Skegg, singer/songwriter Pip Brown – who we know as LadyHawke – and former Black Caps coach Mike Hesson.

Challenges of cancer control

I’ve been asked to speak to you this morning about the challenges of cancer control in Aotearoa New Zealand.

This is an important issue for me. 

There will be few people, if any, in New Zealand who haven’t had their lives touched by cancer, whether they’ve had cancer themselves or had a loved one diagnosed with cancer. 

Overall, New Zealand ranks middle of the pack among 15 comparable countries in terms of the overall impact of cancer. Being a developed country, this means we’re ahead of most of the world. But I wouldn’t think there is a person in this room who doesn’t think we need to do better.

Our overall success has much to do with your hard work and is something you can all rightly feel proud of.
However, we know cancer’s burden is not equally shared by all New Zealanders. 
Maōri are nearly twice as likely to die of cancer compared to non-Maōri and are about 20 per cent more likely to get cancer. 
Maōri are often diagnosed late, which means cancer is more progressed, affecting treatment options and worsening outcomes. 

Cancer outcomes are also worse for people living in poverty, those with chronic health conditions and mental health problems, and those living in rural areas. 
Maōri are over-represented in these categories, as are Pacific peoples.

Responding to the challenges 

I’ve been concerned about the growing inequities that have been apparent in New Zealand for some time and that’s one of the main reasons I got into politics. 

Achieving equity is a strong focus for the Coalition Government, so I’d like to talk about some of the work we’ve been doing over the past 15 months in the health and disability sector, to improve sustainability and access to health care.

Better access to primary health care is at the heart of an effective equitable public health system and putting a greater focus on primary care is one of my priorities.

Cost stopped 585,000 adults from visiting their general practice during 2017/18 - that’s about 15 per cent of our country’s entire adult population – according to the latest annual New Zealand Health Survey. 

For Maōri, it was worse. One in five Maōri adults say they couldn’t go to a GP because of cost, according to the same survey.
Last December 1, the Government extended the Very Low Cost Access scheme to all community service card holders, which lowered the cost of primary care visits by an average of $20 to $30 for an extra 540,000 New Zealanders. 

At the same time, we expanded the zero fees for under 13s for primary care visits to include under 14s, which benefitted a further 56,000 young people.

We believe making primary care visits more affordable to those who need them most will improve access and health outcomes.

Not only does will it make doctors’ visits more affordable, it may mean patients make those appointments when they may otherwise choose not to because of cost.

Better access to timely primary health care assists in maintaining people’s wellness and good health, and can keep them out of hospital.
I have no doubt that for some it will result in the earlier detection and treatment of diseases including cancer.

Improving the state of our hospitals and health facilities is another of my priorities. 

Some of our buildings are earthquake prone, others are no longer fit-for-purpose, and we also need to address growing capacity challenges and demand for services.

In our first budget, we put aside $750 million for capital expenditure and to date, we’ve allocated more than $700 million to funding key projects.

We want facilities that you’re proud to work in and that help you to achieve top health outcomes for people.

Mental health is another of my priorities. 

People with mental health problems have worse outcomes in cancer, so this work is relevant to you all. 

The Government initiated a ministerial inquiry into mental health and addictions within our first 100 days and we received the inquiry panel’s report late last year. 

It’s a substantial and thorough piece of work and it’s important we take time to fully digest and consider its 40 recommendations. I expect to formally respond by the end of March, which gives Cabinet time to take important decisions in time for our Wellbeing Budget in May. 

We can all be justifiably proud of our public health system’s performance, including in cancer control, but we can’t get complacent, or ignore the need to keep doing better. 

I set up the Health and Disability System Review in May last year to future-proof our health and disability services.

This major review, being led by Heather Simpson, is identifying opportunities to improve the performance, structure, and sustainability of our health system with a goal of achieving equity of outcomes, and contributing to wellness for all, particularly Māori and Pacific peoples.

This review is a once-in-a-generation opportunity to improve equity and outcomes for New Zealanders, and will chart a course for a fairer, more sustainable health and disability system that is well-placed to respond to the future needs of all New Zealanders. 

It’s an important opportunity for you all and I encourage you to take the time to engage with this review and to share your solutions for facing the challenges in cancer control.

The panel has gathered initial feedback from a wide range of health and disability sector participants, and has recently opened its online process so all interested parties can contribute their views to how our health and disability system can be improved. 

The review panel’s interim report is due to me by the end of August, and I’ll get their final report by the end of March next year.

The Ministry of Health has a comprehensive programme of work underway to develop people-centred standards of care to support quality improvement across cancer care and treatment. 

The standards will be measured by quality performance indicators and the first one is for bowel cancer, which will be presented later today by Professor Ian Bissett.

We’ve started developing clinical quality indicators with the sector for lung, prostate, melanoma, gynaecological and neuroendocrine tumours, and ultimately plan to have quality performance indicators for all tumour streams.

You’ll also hear from Dr Shaun Costello tomorrow about radiation oncology and a new initiative that collects and presents radiation data, which will help us to understand variations of care around New Zealand.

I acknowledge that it can be uncomfortable and confronting for us all to compare how DHBs perform for cancer, but it’s vital to know where disparities exist around New Zealand so that we can address them and improve our national consistency of care. 

DHBs are already using this radiation oncology information to guide their practice.

Soon after I became Minister of Health, I discovered problems had occurred with the bowel screening pilot programme, which ran from 2011 to the end of 2017, where some people didn’t receive invitations to be screened. 

There was also a series of delays which had concerned me, governance concerns and reports of extraordinarily optimistic roll-out timetables given existing IT constraints.

I initiated an independent review of the National Bowel Screening Programme because of its serious health implications.

I wanted to be sure that everything possible was done to avoid those problems recurring and to prevent further issues – in so far as that is possible in a new programme.

That review looked at a broad range of factors, including information technology, District Health Board capacity, operational management and clinical factors.

The report of the review, led by Professor Gregor Coster, endorsed the ongoing roll-out of the programme around New Zealand, and made a number of wide-ranging recommendations to support its continued improvement.

Those recommendations are helping to ensure the programme is safe and effective. 

We know screening programmes save lives and this review confirmed that despite some issues with the pilot programme, overall it performed well, which should boost public confidence in it.

Since becoming Minister of Health, I’ve taken the opportunity to hear from many of you about how we can improve our country’s cancer control. 

I also asked health officials to engage widely with the sector to develop some options to improve national consistency, equity and health outcomes for cancer control. 

I’ve listened to your feedback to me directly and to health officials. There is widespread agreement that we need stronger leadership of our cancer control.

At the same time, the Ministry of Health has become better placed to provide this stronger stewardship and leadership of cancer prevention and control and delivery of better outcomes at the national level.

I’ve asked the Director-General of Health, Dr Ashley Bloomfield, to take a driving role in this.

The central strand of this work from this point will be the development of a new cancer action plan, with the bold goal of achieving equity of outcomes as a priority.

When my former colleague and former Minister of Health, Dame Annette King, launched New Zealand’s Cancer Control Strategy in 2003, she said the strategy encouraged government and non-government providers to work closely together to achieve long-term change. 

The importance of that collaboration remains today.

I acknowledge there are different opinions on priorities, how changes should be made and who should lead them, but it’s clear we all need to work together on this cancer action plan.

The Director-General will speak to you later this morning about how the Ministry intends to progress this new cancer action plan and how it will work with the sector to strengthen leadership of cancer control.

We’re going to start building the action plan alongside you all through this conference and at the workshops run by the Ministry this Saturday. 
I’m pleased to hear that many of you have eagerly signed up for these workshops – thank you for your enthusiasm to engage.

The Ministry has intentionally used this opportunity so the expertise in this room can be harnessed to debate and discuss as a collective, and jointly determine the best way forward.
 
This is an important early step and I know there will be wider consultation as we work towards changing our whole health system to improve cancer care and outcomes.

Conclusion

This conference is a chance for us all to take a quantum leap in our collective thinking about how to solve our cancer problem together so that we lift New Zealand’s performance on cancer outcomes, particularly for Māori and other New Zealanders who experience the worst outcomes.

My hope is that everyone will share their knowledge and solutions at this important conference to help us better tackle cancer so that all New Zealanders can access appropriate care that they need and deserve, regardless of who they are or where they live.

This is our crossroads. This is our challenge. 

The opportunity in front of us is to design a road map, an action plan, for meaningful change. 

Let’s look to the future and what we want to see there: high-quality, equitable, sustainable, nationally-consistent care for all New Zealanders. 

I’m confident this is achievable and that we will succeed if we work together in partnership.

Thank you.