The Conference on Health Issues of Pacific PeoplesHealth
HYATT HOTEL, AUCKLAND
(Note: The following is a transcipt of the speech)
Greetings and thank you very much for the opportunity to speak to you here this morning.
I regard it as an honour to be invited to speak to this inaugural conference of the Pacifica Health Association for two reasons. Firstly, because my own life and my own family have been greatly enriched by our contact with the Pacific community through the Samoan background of my wife, Dr Mary English, whose here with us today. And secondly because it gives me the opportunity to help repay some of that personal debt to the community.
Another reason is because it gives me the opportunity as a Minister of Health representing the Government of New Zealand to acknowledge the hard work and commitment of so many people who are, as Professor Mantell has said, very much stretched in their day to day work of dealing with problems that can at times seem overwhelming.
It's only because of your commitment that much progress has been made in respect of improving the health status of our Pacific Island communities and I want to take the opportunity today to acknowledge that.
I often get to talk about policies, but I never actually have to do the job. Often when I show up on these sorts of occasions, it's easy to feel something of a fraud because all the hard work has been done before and will be done afterwards. I get the chance to have my say when I guess as a politician we haven't always earned it.
In this country we have been hearing an awful lot of bad news about health - claims of things not working or being in crisis. I think that the work that is being done by you and in the Pacific Island communities is actually very good news. It is good news not because it's some kind of public relations effort to sell health policy; it's good news because the changes that are going on are real changes that will spread and will endure long after this Minister of Health has moved on.
As Pacific Island health providers you have the best motivation and the best knowledge to do your work and that is why I as the Minister of Health and the Government want to help you do more of it.
There are three things I want to talk about this morning. First, to briefly mention a set of principles I have found very useful. They are not really policy, but they're fairly practical ways of looking at how we can improve health care provision.
Then I want to talk about how these principles tie in with changes in health care for Pacific communities and it will be clear that the two fit well together. Finally, I want to share with you my view of the Government's role.
You are doing good work. We need to be encouraging it and you need to understand how far the Government is willing to go. I am happy to answer any questions you may have at the end.
I would like to talk about four basic working principles that I find are assisting us greatly around the country. They can generate and are generating lasting improvements in our health system.
First, we want to organise our health services around the patient and around the community. From my observation traditionally we've expected communities and patients to organise themselves around us. This matters to people in the community on simple issues like their access to a hospital. I know in Auckland this can be quite a complex issue for those who have low incomes and no transport. It's also an issue in the rural areas such as those that I represent where people are a long way from health services. So we need to concentrate on thinking about the service much more than we have from the point of view of the patient and the community, and much less from the point of view of political arguments and traditional institutions.
Secondly, we can improve our health services greatly with no extra money by building better relationships between different health providers. Here I'm talking about the hospital, the GP, the plunket nurse, the district nurse, the mental health community worker, the midwife, the pharmacist. Too often these people have worked very hard, but within their own fences. What we want to do is to pull down those fences so those people, who have in common the patient and the community they're looking after, actually work together. We can't continue to define health services by the professional qualification or the traditional way in which people have been paid because that does not fit with the community's and the patient's needs.
Thirdly, we need local solutions to local problems. That might sound fairly obvious, but often I find as a Minister the expectation is that someone in Wellington will hand down a model of how health care should work and everyone will do it. That has been the traditional way we've done it. I represent a community as different from this one as it could possibly be in New Zealand and that is the far south with an electorate that covers 10 percent of New Zealand's land area. The largest town has a population of 8,000 people. There is virtually no Pacific Island population at all and a very low proportion of Maori population.
The solutions for Tuatapere, which has 800 people on the south coast of New Zealand on the edge of Fiordland National Park, miles from anywhere, are going to be different than for South Auckland or the North Shore. The public health system is acknowledging that and we are getting local solutions to local problems. I want to continue with that approach.
Effective health care requires not just the knowledge of medicine, but a knowledge of local social conditions, community habits, the social environment and the relationships that exist there. We always give speeches about it, but the way we provide our public health services has often been far too ignorant of obvious problems in front of us.
Finally, we want to make sure that clinical and financial decisions are best made by those with good reasons to get them right. That means making those decisions closest to the real need. I've been amazed as a Minister of Health to discover the very detailed decisions that arrive on my desk. Of all the people in this room I'm probably the least competent to make a number of the decisions that I get to make. You would be much better making them and I want to make sure that we move control and responsibility closer to the patient and the community.
I would like to look at how these principles can affect the development of health services for Pacific communities.
Firstly they underline that it is essential for people to be involved in their own health care and for communities and health professionals to be involved in larger decisions about health care. I want to support this involvement and take it as far as you are able to. In recent years we have had better information, more consultation and a growth of interest in Pacific communities in their own health care.
The health needs of Pacific peoples are no longer invisible even in Wellington. What we have seen we can never again ignore. That is why this inaugural conference is so important because we are seeing the light of a new day.
I've been greatly impressed by the initiatives that I've seen so far and I have by no means seen them all. They are showing just how responsive health care can be when the common-sense principles that I've mentioned are actually operating and they show in practice how these principles reinforce each other.
Some of the initiatives I've seen are about Pacific communities and Pacific health professionals taking responsibility themselves and providing a service themselves such as the West Auckland Pacifika Health Services which I visited some time ago. But as has already been pointed out, there are not a lot of Pacific Island health professionals and many of the people who are qualified are fully stretched keeping up with the day-to-day business of providing health care. So it is going to be very important that as a community and as a group of health professionals you do work in partnership with others who already have the infrastructure and the qualifications and the management expertise that is required. But I will emphasise that you should be looking to working in relationships of partnership not relationships of subordination to some larger authority.
For instance the Family Support Service working out of Starship Hospital shows the benefits of a range of different providers working together. This service liaises between the hospital and the GPs in the community. They organise discharge planning and work together with the GPs on how to reduce the number of readmissions through better care of children at home.
The opportunity to do this sort of thing has actually transformed the attitude of some of our traditional providers of health care. I can well remember sitting in a room in West Auckland talking with a GP who said to me that after 30 years of practice he hadn't realised there was so many new and different things he could do as he simply went and talked to people who never actually came in to his surgery. He explained to me how he sat there for 30 years looking after everyone who came in, but didn't even know that there were a lot of other needs out there. He is now involved in some of the joint ventures that have now been set up in that area.
It can be hard work developing the kind of relationships we need.
Often the Government is accused of promoting a competitive environment. I have to say from my experience of knowing health professionals for some time and having some familiarity with the issues, the health sector itself is often the victim of its own politics, its own territorialism, and its own traditional attitudes.
We see a pattern around the country that where people invest a lot of time in actually getting into the same room and talking with each other about what they are doing for children, or doing for a particular community, or doing for someone with a mental illness - when they learn some trust in those relationships, then they can go on to make very significant improvements in the health care.
In recent times there has been excellent examples of this in the initial stages of setting up the breast screening services around the country. Whatever the other problems with the scheme, there's no doubt that it has brought together a whole lot of people who traditionally worked quite separately. In this part of the world the coming together of West Auckland Pacifika Healthcare Services, all the Auckland IPAs and Maori providers in order to set up an organisation to provide breast screening is, insofar as it's gone, a huge step forward for the many communities that those groups serve.
The pattern of more responsive and more accessible health care is growing. It's more sensitive because it's being based on a firm knowledge of the community in which it operates.
What I find particularly heartening is that so many of these initiatives - in fact almost all of them - are focused on preventative and primary care. For many years Health Ministers have given speeches about how important this is and then gone off back to Wellington and caved in to the political arguments that are required to actually make it happen. I can assure you I don't intend to do that. These initiatives are growing in precisely the areas that our traditional emphasis on hospitals have overlooked. As you will know from being close to these communities, while hospitals are a very important part of looking after the seriously ill, they make very little contribution to improving the long term health status of the community. That is where the real differences can be made and where the real differences are being made.
I have to say that if I took advice from our political critics then we would stop most of the initiatives that are going on in health care in Auckland and many others around the country. This is because most of them involve a public organisation working with a private organisation.
Many of the projects you are involved with are apparently, if you believe the critics, the ugly face of privatisation of the public health system. I might say I find that quite ridiculous.
But what's worse about it is that it overlooks the very real needs that our traditional way of organising the system have simply not met. The idea that the traditional public health system has served the Pacific community well is just nonsense and I'm always surprised when people get up and talk about how great it used to be. It wasn't great down in Otara. It wasn't great down in Mangere or out in West Auckland.
The initiatives that are going on now are going to make a difference. I am willing, as a Minister, to take the political flack that's involved with shifting the dollars around so we can make that difference.
If you take one simple example with which many of you will be familiar, and it's somewhat topical, is the issue of diabetes. I can remember the overwhelming impression left on me when I walked into Middlemore Hospital a couple of years ago to see a roomful of relatively young Polynesian males on kidney dialysis. I was quite shocked when it was explained to me why this was the case.
If we are going to make a real difference to that it won't be about spending more money on Middlemore Hospital - it will be about a much more complex and difficult process and that is understanding the link between lifestyle, culture and the health impact that it has on the community with which you are familiar. We'll never actually be able to do that from Wellington. To actually get the real understandings that are required, and a real community awareness about what's needed to make sure that we don't have hundreds of younger Polynesian males on dialysis in the future, we have to go through all the hard work. It's a lot more complicated than just putting in more money, although almost certainly more money will be required.
I've talked here generally about some principles for health care and discussed just some of the new initiatives, how well they are adapted to filling some real needs, and one of the particular challenging areas that you're all familiar with.
I'd like now to talk a bit about how Government sees its role in this process. I recognise the need to build on, strengthen and extend what has been achieved because there is so much more that can be achieved. For that you'd need the Government's support and you certainly have it from me.
Pacific cultures are part of New Zealand's heritage. They belong here. The wisdom of your older people and the energy of your youth will be precious resources in our future. Six percent of our population are now Pacific peoples. Over the next 30 years this will grow considerably with the doubling of the actual numbers and the key feature of that is the sheer youthfulness of the Pacific population.
In health of course from the Government's point of view there is constant pressure to do everything for everyone. That means an awful lot of media attention as you've seen in the last few weeks.
In many ways that's quite understandable because the public of New Zealand have no choice about their public health service. They're stuck with us - they can't take their business elsewhere. One way of expressing their legitimate concerns is through the media or through protest action.
However, we cannot be too distracted by that. We have to keep thinking about how we can actually do the best for all health consumers. Not just some of them, but all of them. Much of our public health debate for instance is dominated by the needs of older people because they have some effective lobby groups. That is quite a legitimate concern, but it is part of my role as a Minister to work with those groups to get them to understand that there are also other needs in our community. While they have needs that are considerable, there are other areas where the need is far greater and you are familiar with many of those needs.
We must constantly evaluate the kind of trade-offs we need to make because we are one society with many different needs. It is simply false to say that if we put another x hundred million dollars in the health system we won't have to make the trade-offs. We always will and we should always be honest about what those are.
We could easily spend another $300 million or $400 million on elective surgery in provincial hospitals. Just quite what that will do for the health status of those in New Zealand who have the greatest health needs I don't know. Actually, I do know and it won't do much good. I am prepared to be part of some robust political debate to make sure that resources are shifted so that we can deal with some of the very real problems that you see.
Serious needs require a serious response, not just speeches that we might do it some day. We have some excellent things going on here in Auckland and I want to make sure that they are supported.
The critical part of the political process, though, will be some support from yourselves. I know that may be asking a bit too much, but if we are to get through the process of public debate about what our real needs are we need to speak up. Too often what happens is that those with real needs do not speak up for themselves. I can tell you that your voice in that public debate is much more credible than the politicians' voice. Because you are doing the work people will believe what you say when sometimes perhaps they will see what I say as an excuse for something I'm trying to hide.
And when you're thinking about how to take part in the political debate just remember this. Keeping things the way they are will not help your communities. As one of my older constituents told me, and I get a lot of advice from my older constituents because I look so young, "if you always do what you always did you always get what you always got".
The status quo has not served your communities well. The only way we will make a difference to your communities is to change the status quo. The political argument and the media treatment of it is inherently conservative. It's all about why we should keep things the way they are and the way they are does not help your people.
There are risks and costs to taking action, but as you know and I know the risks and costs of comfortable inaction are much greater in the longer term. Pacific Islands peoples health care is too important and of too low a quality at the moment to comfortably ignore.
As I said earlier, the Government is very supportive of furthering the direction that Pacific Island health care is taking at the moment. A document called "Making A Pacific Difference" is an example of shared efforts between the Ministry of Health and Pacific Island Affairs. Many of you in this audience will have been working on this document. The strategy it outlines will give further impetus to what you are already doing and provide a mandate. I look forward to its launch in the near future as another crucial step in recognising the profile that Pacific community health ought to have. You are an important part of this work.
So I'm asking you to take heart in your work. The strength of Pacific cultures will help us find solutions. Perhaps too often we have seen them from Government's point of view, or from the point of view of trained professionals who have seen some of the cultural values of Pacific communities some as an obstacle to progress.
Those cultural values are changing, but it is a challenge for us who provide the health services to build on the strengths that those values offer so that we can make a difference in the community.
A lot of fresh ideas are being put into practice but we do need new ideas. I have to say I get tired of people knocking on my door asking for more money for old ideas. I don't get enough people knocking on my door asking for more money for new ones which we know are going to work.
This conference to me offers great hope. In the short time I've been a Minister what has struck me is that the innovation in health care always happens at the margins. It is people like yourselves who see great needs, have few resources and so have to think a whole lot harder about how to use your time and your money, who come up with the good ideas. In time they will eventually seep into the mainstream system and that is why what you do is so important to the future health care of New Zealanders. The seeds for those improvements will come from you rather than from coming from the mainstream itself.
You have achieved much and I believe in the commitment and the capacity of the people in this room to take it further.
If we use your talents and your abilities and your commitments, if we can build on the positive values of the communities of which you are part, and if we can have a genuine partnership between Government and the community, we can help so many more people who have such complex and wide ranging needs.
That, after all, is the common ground. Not so much the policy, not so much the political common ground, but the fact that there are so many people whose needs have not been met and it's really up to you and to me to make sure that they are.