Health Minister's speech to World Health Care Networks Conference

Good morning.  

Thank you for inviting me to speak to you today to officially open the inaugural World Health Care Networks Conference; "In Our Hands - Transforming health systems through health care networks"

I'd like to acknowledge Dr Bev O'Keefe, Executive Chair of General Practice New Zealand and Dr Emil Djakic, Chair of the Australian General Practice Network.

I'd also like to extend a welcome to all conference delegates - including our guests from overseas.

Today I'm going to cover why clinical networks - and your leadership and engagement - are a fundamental part of the future of the New Zealand health service.

Why Clinical Leadership?

Globally, clinical leadership is recognised as the fundamental driver for improved patient care.

Engaging the people who have the expertise - the doctors and nurses who keep the public health system going - strengthens the health services' ability to provide patients with the care they need.

As you know, primary care is at the forefront of the evolution of clinical networks internationally. We have a strong tradition of primary care networks here in New Zealand, particularly in the Independent Practitioners Associations (IPAs).

Increasingly, the drive towards clinical networks reflects the need to use resources more efficiently, to reduce duplication and manage growing demand - all in a constrained financial environment.

And that constrained financial environment confronts most countries in the world.  Public services, including health services, are not immune. 

A new austerity drive is sweeping  across Europe.

In Ireland, the Government has cut public service salaries - including doctors, nurses and teachers - by up to 15%.

Spain has announced a 5% pay cut in public sector pay, including Health, and a wage freeze for 2011.

Italy has established a 3 year wage freeze for all public servants and will not replace one in five staff who leaves.   

Canada has frozen wages in the public service for the next two to three years.

The new Coalition Government in Britain says it will freeze public service pay for two years.

Government agencies are facing 25% spending reductions over four years and the sales tax is going up to 20%.

The NHS has to make GBP 20 billion of efficiencies over the next four years.

It is this pressure of a constrained financial environment that presents clinicians with an ideal opportunity; to develop formal co-ordinated care networks that are clinician led and patient centred.

Why Networks?

I think there are potentially three levels of clinical networks with primary care the strong common feature:

• 1. At the community services level engaging primary care, social services and the NGO sector
• 2. Within primary care engaging general practice ,maternity and allied health and pharmacy, and
• 3. integrated across primary and hospital settings.

Networks at the community services level go well beyond the health service. Personal and community wellbeing involves social services and other community organisations.

Networking of these organisations in support of families is a key principle of the Government's Whanau Ora policy.

Whanau Ora is an approach that empowers a family as a whole rather than separately focusing on individual family members and their problems.

It aims to deal with the "five cars up the driveway syndrome" where multiple agencies work with individual family members often in isolation of each other.

The Associate Health Minister Tariana Turia will be talking about this with you tomorrow morning.

So I will comment on the other two types of health networks I've identified; primary care networks and integrated networks across primary and hospital care.

Primary Care Networks

Primary care offers the best way to deliver timely healthcare closer to home for New Zealanders.

International research demonstrates that those health systems with strong and vibrant primary care services have much better health outcomes for a lower cost than those that focus on specialist or tertiary care.

New Zealand's current Primary Health Care Strategy was established in 2001.

But the changes hoped for have not been fully realised. 

Last September, English academic Dr Judith Smith from the Nuffield Trust (who will speak to you next) released a well-considered "Critical analysis of the implementation of the Primary Health Care Strategy" in New Zealand. 

She noted that while the cost of access to services had been reduced, the Strategy had not been able to achieve significant change in models of care at practice and provider level.

In other words, the integrated, multi-disciplinary services had not eventuated to the extent that was hoped for.

Importantly, Dr Smith stressed that the success of the Primary Health Care Strategy depends on the engagement of general medical practice.  

Her message is clear.  For implementation to work, clinicians must be engaged and respected. 

This Government recognises this.

We need primary health care professionals to step up and improve your capacity to deliver better and more health services to New Zealanders.

The Government has actively sought to involve clinical leaders in the change agenda. The new National Health Board is clinically dominated as is the new Health Quality and Safety Commission.

We have put doctors and nurses at the centre of this work.

And seeking your leadership and engagement is part of the motivation behind the Government's request for Expressions of Interest (EOI) for innovation in primary care.

And it is worth me restating the objectives of the government's drive in primary care policy.

If demand for health services is to double over the next 10 years, then we are not in a position to double Auckland Hospital or double the number of nurses.

That is why we need to move services to a lower cost platform that we can deliver care closer to home ... and that is primary care.

The primary care led EOI process and the Integrated Family Health Centre concept in particular are patient centred.

They are also part of a prudent strategy to begin future-proofing our health system to deal with increasing demographic and financial pressures.

The evidence base for this comprehensive multi-disciplinary approach suggests that these will greatly help patients to get the right care in the right place.

That doesn't often happen now because the necessary primary teams and infrastructure do not broadly exist.

That is why we are consolidating PHOs and asserting the importance of leadership by doctors, nurses and pharmacists in those primary care networks.

This is about beginning to prepare the public health service for the future.

And that is why we turned to you. For your ideas. For your leadership.

Our goal in government is to work with you and to provide New Zealanders with better access to a wider range of health services closer to home.  It's a goal many of you share.

These initiatives will commence as they are ready over the coming months, and they will take different forms.

The nine EOI primary health care groupings cover 60% of New Zealand's population, and they are now working with their DHBs to deliver better services closer to home than in the past.

But advances will be made carefully, inclusively and with strong clinical engagement. If you are not involved in these EOI groupings, please don't wait for instructions from Wellington before innovating. I encourage you to work in your locality with your DHB to explore new ways of buiding networks and more integrated services.

Integration across Primary and Hospital

The third level of health networks is integrated across hospital and primary care settings.

British Professor Paul Corrigan said that the failure to integrate healthcare between hospital and primary care in any significant way -  despite its constant restatement as a policy objective -  is one of the greatest puzzles of health policy over the past few decades.

Prof Corrigan suggests that the lack of critical mass in general practice  has been the main barrier. Issues like capital, operating costs, and personnel prove daunting for any small business looking to change its configuration.

Unlike Britain, general practice in New Zealand has evolved over the past 15 years to be strongly networked, with high levels of clinical competence and a wide range of innovative services.

That's why we are putting considerable effort into facilitating primary and hospital integration as part of the new arrangements in primary care.

This is an interface capable of causing much clinical harm and financial waste if done badly, and much benefit, if done well. The feedback is universal from both ends of the axis...both hospital specialists and general practitioners see the opportunity to improve the quality of patient service.

The way to do this is to engage all parties in "boundary-crossing" clinical networks that share knowledge, produce efficiencies, reduce errors, allow for better decisions and options for patients. Most importantly, this improves the day to day communication between different parts of the health system.

The new alliancing approach will put doctors and nurses around the table to design new care pathways for use by doctors and nurses... to benefit patients. Dr McCormack will talk to you about this later in the conference programme.

If we are to make progress in new care pathways we need to break down old barriers and suspicions, to focus on providing patient care in the right place at the right time.

Included in that is direct access to diagnostics.

Last week two Auckland GPs ordered CT scans for their patients without having to consult a specialist.

As you know, GPs previously were required to call the specialist to obtain permission to refer for a CT.

Now, based on a protocol jointly developed by hospital radiologists and primary care doctors - as part of GAIHN - GPs are able to refer patients directly, avoiding the need for an inefficient first approval.

GAIHN will see an additional 4,500 community diagnostic procedures and 16,000 patients accessing radiology sooner through direct referral by a GP.

Patients will also benefit from an extra 5,000 Primary Options referrals to reduce acute demand. 

Over time you will see ever more of these improved care pathways.

Close

We are facing the aftermath of the global financial crisis with growing demand for more comprehensive and high-tech health services. 

We know we need a revitalised primary health care service, and we've made a lot of progress. 

That is why the most important resource is you - the professionals who make our health services work - and only you can lead the changes needed.