Launch of Integrated Care Demonstration Projects Age Concern

  • Bill English

Cashel Street, Christchurch

These integrated care pilots signal formally a significant shift in the way we are making health policy.

There is widespread agreement in the health sector that further progress will be about better contracting and funding arrangements rather than further restructuring - so it's all about better care and better service, rather than new structures for their own sake.

These projects are being singled out for the purposes of evaluation, demonstration and close attention from the Health Funding Authority. The projects meet demanding criteria which are widely calculated through the health sector. Many people with good ideas about improving services took the opportunity to put their plans forward to the scheme.

All these plans shared common features - they identified a need which could be better met, they encompassed a range of health providers who wanted to work together, and their plans were centred on the patient or the community and they are local solutions. Each was built by a few leaders who brought so many others with them.

Many of the plans had further work to do. Changing the way we see traditional health services is not simple - professional and parochial interests run deep, but more importantly, the services we have now represent a hard won balance of needs and available resources. Achieving better care and better services than we already have requires a range of clinical and management skills, and a full understanding of the risks involved in providing health services. Most integrated care proposals involve people taking on some sort of budget which can be used more flexibly. My primary obligation is to ensure continuity of services for people who need them, and that obligation falls on anyone who seeks to share that responsibility. Plans for integrated care need to demonstrate an understanding of that responsibility and a capacity to handle it.

So the demonstration projects are just a start, an opportunity to learn by doing. There isn't a lot in being a demonstration project, for those who are - it's hard work and high level of scrutiny by the HFA and the wider health sector. Information about these projects will be readily available so everyone else can learn about the technical and policy issues. Information about proven better outcomes will be crucial to the future direction of integrated care.

Integrated care also has a number of benefits which will fall outside the formal evaluation process, but they are nevertheless very important for our community. Even where these ideas for better service don't come to fruition, the process of development brings together different health professionals and organizations in a community who in many cases have not formally met, or ever worked together for patients - and that has to be good.

These projects are also a vehicle for formal consumer and patient involvement. Services organized around the patient need to listen hard to the people for whom the service exists.

Integrated services also provide opportunity for wider community participation. Projects like Elder Care Canterbury has created a new community on it's own - involving all sorts of people from dozens of organisations. As this and other integrated care projects move ahead, I believe they should consider a community role in governance. There has been a lot of emphasis and political debate on community governance of hospitals. These projects will show that the decision making that actually makes a difference to the health of the community is not those made in the hospital. Rather it is the decisions about how funds are used across the continuum of care which have the biggest impact and will in the future be the best opportunity for community participation.

And finally, to our political critics. Please note that these initiations have come from the sector, not from government. When you criticize these projects you are undermining the aspirations of hundreds of health makers to better care and better service. So forget the conspiracy theories. Is Elder Care Canterbury public or private? Well it's all sorts - but it is certainly publicly funded. The test is whether these ideas mean better care and better service, not whether they are politically correct. And the verdict will come from patients, communities and caregivers - not just politicians.

The evaluation and demonstration process will demonstrate that the innovations in the health sector is driven by better service. It is in fact the critics that are obsessed with ideology.

All up there are 33 integrated care projects around the country. Alongside these are three other larger projects which have not met all the criteria to become demonstration projects, but I am keen to see further substantial negotiation with them. They are Prime Health in Tauranga, a mental health proposal from Auckland and the Marlborough Health Services Trust in Blenheim.

I look forward to the chance to work with thousands of people committed to better health to use the tool of integrated care to achieve our aspirations for the health of New Zealanders.