• Neil Kirton
Associate Minister of Health

Thank you for the opportunity to speak at this conference. Let me introduce myself. I am Neil Kirton. I am a new MP and a new List MP. With regard to Ministerial portfolios I have been twice blessed. I am Minister of Customs. And of more relevance to my comments today - Associate Minister of Health.

The Ministerial delegations between myself and Health Minister Bill English have now been agreed. I am very pleased that my responsibilities include Disability Support Services and Health & Disability Consumer rights and advocacy services.

I have been asked to speak on lines of responsibility in a changing health and disability sector. It is a changing sector. And I am in part responsible for those changes. These changes are ones agreed as part of the Coalition Agreement.

I am confident the changes are ones that are welcomed by the majority of New Zealanders. One letter Ive received in the short time Ive been in the job said The sick public need your efforts. Id have to say I agree with the sentiment - if not with the choice of words.

I believe we can make the changes while retaining the good features of the previous system and while retaining and motivating the people working in the sector.

Today Id like to talk about those changes. The blueprint for the changes is the Coalition Agreement.

The Coalition Agreement
The Coalition Agreement sets out the Government's policy direction for the health and disability sector.

The Coalition Agreement demonstrates Government's commitment to a flexible, modern, properly funded, accessible health service that meets changing public needs and expectations.

The Coalition Agreement signals an important change in the way the country's health and disability services are managed. It signals a move away from a market driven, competitive sector to an environment where long term co-operative relationships assume priority.
The Government's emphasis for the health and disability sector will be on co-operation and collaboration, rather than competition between health and disability services. The goals will be achieving health outcomes, and improving the health status of the population. Providers will still be required to operate in a businesslike way and be accountable for the services they provide.

I believe that the people of New Zealand want to have access to a quality public health system, one that is delivered with an ethos of public service. One that is accountable to them both as consumers and as taxpayers. Above all, the public want to be assured that they have access to good care when they need it.

And if they dont - this is where the Health and Disability Commissioners role comes into place.

The New Funding Body
The Government's policy direction for health will build on the strengths of the previous system as well as eliminating its shortcomings. We will be retaining the distinction between funder and provider, but will be looking to a strengthened and co-operative relationship and a shared vision for service direction.

Instead of 4 regional health authorities we will have one funding body.

The work that RHAs have done, in developing information to underpin contracting, now provides a basis for a range of tools which help us understand what services are being provided and the interrelationships between them. We can now move beyond simple price/volume contracting to buying packages of care that make sense, and allow for flexibility in clinical decision making. RHAs now have better information than existed in the past. Consolidating the information and the analysis in a single funder will lift funding service provision to the next level.

The funder's performance will be critical to improving health outcomes and the effectiveness of the system.

My vision for the funder is that it is able to:

maintain and improve health status and health outcomes;
develop strategies which enable providers to work together cooperatively and in an integrated way;
have more collaborative and long term relationships with providers;
use a national contracting framework with local application and variation;
hold providers accountable for the quality and levels of services provided;
develop strategies for health service provision which take into account Government funding parameters.
The Provider Role
What do we now expect of providers?

We expect and want the sector to improve on its current performance. We want to see public providers:

operate in a business-like fashion; but public providers will no longer be required to make a profit;

providers will need to make improvement in the quality of care on an ongoing basis;

providers will be expected to respond to their own circumstances with innovation and imagination in service delivery;

providers will have to lift their performance in non-hospital based services with an improved focus on community based assessment and support services;

and share their vision for service development with the funder.
Non-government providers play an important role in the sector, though they are sometime less visible than CHEs, because they are so diverse organisationally and they work in low profile but high value areas like primary, community, mental health and disability service. We want to see the private providers take the opportunities they will have for further diversity and innovation as the funder emphasises:

community-based care and
closer co-ordination between primary and secondary sectors.
The system has to give providers more incentives to provide the most appropriate level and type of care, and to continue to look for ways of providing care more effectively. The system has to remove, rather than create boundaries in the patient's access to primary or secondary care, institutional or community based services, and private, independent or voluntary care.

Consumer Rights
The sector of course includes not only the funder and provider entities but also, most importantly, the people who use services. Quality of service from the consumer perspective will continue to be a key concern in the health and disability sector. It will be important to ensure that new arrangements are responsive to consumer needs and desires.

Management of Change
Over the next few months we will be focussing intensely on establishing the framework for the new health environment.

We want the transition to be evolutionary.

A Steering Group of sector representatives is being appointed to provide advice for the implementation of the Coalition Agreement. The key issues they will report on include:

reviewing the roles, relationships and accountability arrangements between health and disability sector agencies. These include the funding and accountability agency, publicly owned and private providers, the ACC health purchasing arm and The Ministry of Health;
future contracting arrangements between funder and providers;
the timetable for implementating the changes;
changes required to legislation to implement the changes.
We need to learn from what we've done well and poorly in the last few years. We need to minimise the costs of change and the risk of 'reform fatigue'.

Successful management of change is the goal, meaning:

developing structures, roles and relationships that harness the dynamics of the sector;
recognising that people and behaviours are more important than structures;
giving people a clearly identified better way of doing things;

In conclusion over the last 4 years the mindset which has been developed has been one of agencies competing with each other for resources through a market model. This approach has been shown to result in fragmentation, increased costs and reduced trust and cooperation between health sector agencies. We need to change our mindset while still utilising the accountability mechanisms developed over the last 3 years.

Shifting mindsets so we can improve services involves change, and change can be uncomfortable.

It is my intention that any changes which are implemented will result in improvements in the quality of services and health outcomes.

Improving health services in New Zealand requires collaboration, cooperation and commitment from everyone involved in the sector.

I wish you well for what I am sure has been an enjoyable and useful conference.
I understand its normally customary for the Minister to speak at the beginning of the days proceedings. Im here to wrap it up. I hope you had a fruitful day and I look forward to being involved in building a better health service.

It will be an interesting, and challenging time.