Implementing the New Zealand Health Strategy 2004

  • Annette King

Thank you very much for joining me today in what is basically a tribute to the work of the health sector throughout 2004.

It is only a week since I was last in the Counties-Manukau area, celebrating the magnificent Pacific health symposium organised by the District Health Board. The DHB’s general manager Pacific health Margie Fepelea’i and chief executive Stephen McKernan could take much credit for an outstanding occasion, and it is great to be able to share the platform with them again today.

The occasion was made even more special for me by having my photograph taken with Ali Lau’ititi. I must admit I approached him rather than the other way around!

Thank you today also to John Clark, Southern Cross School campus director, for making your school available to us for this important stocktaking of where we are going in the health sector. And thank you for your commitment to improving the health of your students.

The title of the report I am launching today, Implementing the New Zealand Health Strategy 2004, leaves nothing to the imagination. It is what it says, a summary of actions this year across the health sector to implement the Strategy, with a special focus on local activities of DHBs and Primary Health Organisations. The report also includes for the first time progress in implementing the Quality Improvement Strategy.

The report is a reaffirmation of the Health Strategy, summarising progress since its release in December 2000, and looking ahead to my priorities for 2005/06. The overarching Strategy remains a robust vision for the health sector, and today’s report confirms that work is happening right across the health system to implement it, with notable progress in key areas.

The major development since the strategy’s launch has been the Government’s funding commitment to primary health care, with a cumulative $1.7 billion in new money over six years from 2002/03 directed toward implementing the Primary Health Care Strategy.

Although the first two PHOs only came into being in July 2002, we now have 77 providing improved primary health care to more than 3.7 million New Zealanders, with some two million people, including over-65s and under-18s, already entitled to cheaper doctors’ visits and lower prescription costs on most items. By July 2007, all New Zealanders belonging to PHOs, and that will be almost all of us, will be entitled to lower-cost care.

It is worth pointing out that we would not be making the progress we are in health and in the wider social sector without a strong, healthy economy.
There is no doubt that falling unemployment and healthy housing, for example, also contribute to health gains, and to the sort of fair, secure society the Government holds so dear. That is why we must continue to take a long-term, sustainable approach to the economy so we don’t put at risk the social advances we are making.

Later today I will tell you a true and heart-warming primary health care story that is not actually included in this report, but that symbolises the vision I have for primary health care in this country. I am delighted at the speed with which we are implementing the Primary Health Care Strategy, and happily admit it exceeds my original expectations.

There are many encouraging facts and figures in the report, and I will now briefly go through just a few of them.

The national roll-out of Healthline, a free 24-hour telephone triage and health advice line, will also contribute to our overall goal of improved access to primary health care services when completed in mid-2005. Accessible primary health care plays a vital role in effective chronic disease prevention and management.

An excellent example is diabetes, of course. A cornerstone of efforts to reduce diabetes in New Zealand is the Get Checked programme, allowing people with diabetes to receive a free annual check with their GP or nurse. In 2003, 61,246 people with diabetes received a free annual check, an increase of 96 percent since 2001.

We continue to do better in terms of tobacco control, and if 2004 is remembered for anything above all else in health, it will be for the Smoke-free Environments Amendment Act coming into force at midnight tonight (December 10). I’d like to pay tribute to my colleagues Steve Chadwick, Judy Keall and Associate Health Minister Damien O’Connor for their work on this. Tobacco consumption has decreased by a third in the last decade, one of the biggest decreases in the OECD. To give one specific example, the average number of year 10 students smoking on a daily basis has fallen from 16 to 12 percent from 1999 to 2003.

Timely and equitable access to elective services remains a key health goal. That is why I am pleased that the number of people waiting more than six months for first specialist assessment and waiting more than six months for treatment have both decreased by more than 20,000 since June 2000.

Clinical priority assessment tools have been introduced to help clinicians make consistent decisions in assessing one patient’s level of need relative to other patients. The orthopaedic initiative, set to double the number of major joint operations performed in public hospitals by 2007/08, was announced in July this year. I am informed that, to date, almost 500 more major joint operations have been done so far this year over last year’s figures.

Reducing inequalities is, of course, an important principle of the New Zealand Health Strategy, and we are continuing to make progress.

Inequalities in life expectancy at birth between Mäori and non-Mäori have reduced; inequalities in outcomes for some cardiovascular diseases have also reduced; access to surgery for Mäori and Pacific people has improved; and PHOs are providing affordable primary health care and working with communities to promote better health. We still need to do better, however, and I know the health sector will continue its efforts to reduce inequalities in years to come.

Each year I set priorities for the health sector within our overall strategic context, identifying areas needing more work following good progress so far, or objectives where progress has been limited. My priorities for 2005/06 are both strategic and implementation priorities.

The strategic priorities for 2005/06 are progressing the New Zealand Disability Strategy, the Maori Health Strategy and the Health of Older People Strategy, reducing inequalities, and improving mental health.

Implementation priorities cover diverse activities, many in primary health care where we want to strengthen PHO health promotion leading to effective chronic disease prevention and management, to develop more effective community input into PHOs, and to create stronger PHO infrastructure, workforce and information management.

Implementation priorities also include developing health infrastructure in areas like workforce, IT, monitoring and improving regional DHB networks; progressing the Meningococcal Vaccine Strategy and achieving improved overall immunisation rates; improving elective services; implementing the Cancer Control Strategy, incorporating prevention, screening, treatment, palliative care and research; and implementing the Healthy Eating, Healthy Action plan.

Other implementation priorities include collaborating across agencies to reduce tobacco, alcohol and other drug abuse, and to minimise family violence, child abuse and neglect.

Initiatives taken to improve New Zealanders’ health in 2004 fall broadly into two categories, national and local.

Examples of national initiatives include the Meningococcal B Immunisation Programme, of course, and I will never forget the day when I saw the first young New Zealander vaccinated in South Auckland against this terrifying disease.

Other national advances have included, as already mentioned, the orthopaedics initiative, cheaper doctors’ visits and pharmaceuticals for many more New Zealanders, and, from tomorrow, all indoor workplaces, including restaurants and bars, become smoke-free.

Many exciting local initiatives are underway. They include, to mention but two, an outreach immunisation service in Gisborne, where two PHOs are providing a service involving vaccinators visiting families in their homes and vaccinating children who might otherwise miss out, and a diabetes prevention strategy launched by Waikato and Lakes DHBs. The DHBs aim to reduce the incidence of new cases of Type 2 diabetes among Mäori by 35 per cent over the next three years.

Today’s report also includes, as I said earlier, the first progress report on the Improving Quality strategy and action plan that I launched in September 2003. The strategy has 11 goals and the action plan identifies 55 actions derived from these goals.

I am very pleased that 45 of these actions have been completed, with highlights including a review of the ACC medical misadventure system, development of ethnicity data protocols for the sector, and the Health Innovation Awards, which promote quality improvement and innovation throughout the health and disability sector.

These awards prove just how resourceful our health professionals are. I promised to tell you a story that symbolises my vision for primary health care in this country, but I must also mention that this report features 17 case studies of local initiatives from across New Zealand. Four of these studies are from the Auckland region, and I understand representatives from each of them have been invited here today so thanks for coming.

Congratulations to Counties Manukau DHB and Workchoice Trust for your work with secondary school students on career opportunities in the health sector; to Auckland DHB and ProCare for your gastroscopy project that won the supreme award at this year’s Health Innovation Awards; to Treasured Older Adults of the Pacific in Mangere; and, finally, to the Free Fruit in Schools pilot project within lower decile Auckland primary schools.

The success stories revealed in all these case studies illustrate one reason I have enjoyed my past five years as Health Minister. With health professionals like those in the case studies all around you, it’s difficult not to feel that you are part of something really special.

That would be a good note on which to finish today, but I think the little story I am about to tell you now is an even better one. It’s something of an oddball story, I suppose, but inspiring nonetheless.

I heard the story the other day from Greg Coyle, head of podiatry at Auckland University of Technology. In a new twist on the theme of health professionals collaborating, he calls the story: See a Podiatrist - Go to the PHO - Get a Lawyer. Or, if you are into even longer titles, it could be called: A hole in a foot, the podiatrist, the lawyer, the employer, the landlord, the police, the wife and the PHO.

It goes like this. A podiatrist at AUT saw a 45-year-old driver who was complaining of a painless ‘hole’ in the bottom of his left foot. He weighed 131kgs, was constantly thirsty, had blurred vision at times and numbness in both feet. He was diagnosed with Type II Diabetes and a non-infected diabetic pressure ulcer, and given remedial care. As the man had no GP, he was referred to a PHO near his home.
Two months later the podiatrist saw the man again and asked which GP he’d seen. The man said he had not seen a doctor. You can imagine the podiatrist’s feelings on hearing that, but not to worry.

The man said he had gone to the PHO, and had asked for a doctor. Before that happened, however, he was interviewed by a community outreach nurse who asked him more general questions about problems in his life. People tend to love opening up on such a subject.

A sorry saga emerged. Apart from the hole in his foot, he was losing his sight and was afraid he might soon not be able to drive, and that was what his job was.
His rent was to go up, and his grandchildren stayed a lot, and he couldn’t afford a rent rise. And he and his wife were worried because a family member was in police trouble.

Not to worry. The nurse told the man that before he saw the doctor, he should see the lawyer who visited the medical centre each week. After he did so, the nurse and the lawyer rang his landlord, who came into the centre too. The landlord said the man had been a good tenant for many years, so he would defer the rent increase at least a year.

The nurse and lawyer then rang the man’s employer, who also came in. They told him about the man’s eye problems, and asked if there was another job in the company. The boss said he didn’t even know that the man was ‘crook’, but he had been such a good employee for so long, he would certainly find another job for him.

The lawyer also rang Police Youth Aid, but failed, I’m sorry to say, to get the family member off charges. At least, however, the family better understood the situation, and had a point of contact with Youth Aid.

Finally, to tackle the man’s weight, the nurse took his wife shopping three times to show her which food and drinks were forbidden, and which were better to lower blood sugar and fat intake. They rang the nurse for dietary advice several times. Both the man and his wife lost weight. The nurse became a guiding force in their lives.

The consequence of all this was that his and his family’s stress and worry levels greatly reduced. He lost 11kgs, his foot ulcer healed, and his blood sugar levels significantly lowered. When he did finally see the doctor, the doctor wanted him to see a diabetes specialist at the hospital. The man said: “What for? I’m better now!”

I strongly suspect that, if it hadn’t been for the PHO, the man would have been simply sent to a hospital specialist, and would now be struggling to pay higher rents and might have had a driving tragedy at work. He would certainly not be nearly as relaxed as he now is, or under ongoing health care.
I guess it’s not Utopia, but vision-wise, you can’t ask for much more than that.

Thank you everyone for coming here today, and thank you to the health sector for all your hard work in 2004. And I often forget to thank my own Ministry of Health staff, so a big thank you to you all for your efforts towards this report and today, which I do appreciate.

I wish you all the best for the festive season, and look forward to seeing even more progress on implementing the Strategy in 2005. Thank you.