'The Network is down!' - World Healthcare Networks

In my workplace, the New Zealand Parliament, there is one phrase that has the capacity to reduce the entire complex to a state of despair - and that is the phrase, "the network is down".

In these times in which we appear to have become universally reliant on access to a network of information technology, the capacity to connect to one another is fundamental to our business.

And so I was pleased to be invited to this prestigious network - to take part in the inaugural conference of World Health Care Networks.

I want to commend this new association, the World Health Care Network for the breadth of your vision and the scope of your mission to work together on sustainable solutions that help improve the health and wellbeing of the world's population. 

You have set us a formidable task, to create the opportunity to inspire the utmost commitment, energy and passion to drive transformational change.

I, for one, look forward to the challenge of working in the nature of a world-wide partnership.

Our faith in networking has rapidly been accepted as a routine expectation of the working day.  

But it is a sophisticated system of networking that has evolved around communication technologies more than the old boys network of previous generations.

We have woven around us, a network of communication organised around digital and broadband technologies, satellite, and transcontinental, high-speed computer intelligence.

In fact, it could be said that the only group that doesn't depend on a complex network of such digital tools and electronic technology, is the psychic network.

But for the rest of us, being digitally literate is no longer a luxury - it is now an essential life skill.

In this land, however, our research tells us that up to 30% of New Zealanders lack access to digital tools or the ability to use them.  Included within this group are people living in rural and isolated areas; Maori, Pacific people and other ethnic groups, as well as people on lower incomes, people with disabilities and older New Zealanders.

And so I come to the focus of my korero to you today - the value of networks in addressing health inequality.

The manifestation of health inequalities in New Zealand, will be known by everyone here - no matter what network you belong to.

Whether you are a clinical specialist, a community leader, a policy strategist or a member of whanau and families, a key issue is about even getting access to healthcare in the first place.

The New Zealand Health Survey for 2006/7 showed that Māori were twice as likely, as non-Māori, to have needed a GP in the past twelve months, and have not had that need met.

That same survey also asked the question whether people had attended a GP when they needed to. 

The survey showed that about three percent of non-Māori women didn't go to the GP when they should have because they lacked transport. 

For Māori women, that figure was about 13% - more than four times higher. 

The issues of access; of fairness; cultural competency; accurate information are universally known as affecting the ability to be healthy and live longer.

Eighteen months ago, WHO Director-General, Dr Margaret Chan told the G8 summit in Tokyo that 

"many health systems have lost their focus on fair access to care, their ability to invest resources wisely, and their capacity to meet the needs and expectations of people" 

She set the challenge upfront, that these conditions of

"inequitable access, impoverishing costs, and erosion of trust in health care constitute a threat to social stability"

I have no desire to itemise the demographics of deprivation that have resulted in the levels of disparity we all know characterise the healthcare experience in New Zealand.

But I do want us to sit up, and to recall the theme of this conference that transformation is in our hands.

As any surgeon will tell us, our hands are the most remarkable tools of the medical profession.

But we are not just thinking about the technical proficiency required for the operating table or the GP clinic.  

We are thinking about the healing power of hands joined together; the handshake that strikes the connection; the hands clasped in unity, in compassion, in strength.

The transformation that we seek for our health system will require all of us to connect to each other in new ways, in binding ways.

So what are these new ways that bind us together?  Will they produce the sustainable solutions to improve the health and wellbeing of our populations?

Yesterday my colleague, the Minister of Health, talked about three levels of clinical networks within the context of primary care.

I understand he was going to talk about two of those levels - primary care networks and integrated networks across primary and hospital care.

I want to focus on the third level - that is at the level of community services, engaging primary care, social services and the non-governmental sector.

And significantly - when we are talking communities, we are talking families and whanau - and the networks we have within these collectives are just as fundamental to our good health as any other network I could belong to.

I am absolutely, profoundly committed to the network that I know best - the network of whanau.

Whānau Ora is about restoring new life into the networks that define us best - the genealogical connections that are fundamental to the essence of who we are. 

Whānau Ora is about being equipping families with the skills and the confidence to be self-sustaining.

It is about restoring the sense of collective responsibility to care for our own; ultimately it is about ensuring the generations to follow inherit the world that we create for them.

In Whānau Ora, we are calling for people to connect; to open doors to ensure that whānau can describe success in their own terms.

A central expectation upon Whānau Ora providers and provider collectives will be to make substantial contributions to whānau outcomes by delivering integrated and coherent services. 

That means taking an all-of-whānau approach; demonstrating a spirit of collaboration between funders, providers, practitioners and whānau to enable coherent service delivery, effective resourcing and competent and innovative provision.

And it is a transformation in every sense of the word.

Those of you who are policy makers, strategists, and planners, will see a transformation from output based, tick-box contracts to output based relational contracts.

Those of you who are consumers of health services and products, will find that you and your whānau are at the centre of the services you receive - because you are the best people to make decisions for yourselves.

Those of you who manage or lead health services, will find the way you interact with government agencies, other providers, and whānau transforming. 

In order to effect real change, a comprehensive range of services will be needed, either provided alone or with other providers, as will responsiveness to individual whānau members as well as the whānau as a whole.

Many health providers will make connections with providers from other sectors, and we all need to consider service models that lead to improved outcomes and more empowered whānau. 

This is outside the traditional model of primary care.  But I expect NGOs and Government agencies to better co-ordinate and align their service settings and priorities - in the interests of outcomes that truly make a difference.

It is about joining hands together, linking into one another, creating connections that cannot be broken.

And it is about believing in the expectation that our strength is in each other.

Finally, I want to share the story of a remarkable man called Monte Ohia.

One day, while reading the paper, Monte was devastated by a front page feature profiling the ten worst criminal families in their city.  Right there and then, he and his wife decided they wanted to invest in these families, to work alongside them in their pathway forward.

So they made a visit to the police; found the contact details, and extended the hand of manaakitanga to families who were wanting to work in a new way.

In one particular family, the situation had been of generations of circumstances which had led to a history of offending.  But by supporting each other, working across the family, they gradually started to turn their life around.

One day, Monte received the call he had been dreading- a crisis had emerged - and would he come?  When he got to the family home, there were over thirty members sitting together, in despair and frustration, over what anyone would think was a relatively minor incident that one of their young people had been involved in.  In all respects they were telling him, the network was down.

But while the family expressed their sorrow at this situation, Monte beamed with pride and with passion - at the strength they were demonstrating in their unity.

He praised them to the max - for their collective courage to care - their capacity to take responsibility, and their determination to stand together, in solidarity.

That to me - is the ultimate example of whanau ora - when the situation of one becomes the responsibility of all.

This story brought home to me, that success in our own endeavours relies very much upon others succeeding in their endeavours. 

We all need providers to succeed because their goal is to help our families and for our communities to succeed. 

We all need the government agencies to succeed because their goals similarly are to foster the success of providers, the service users, and their whānau.

For health services in Aotearoa to succeed, we need to build relationships based on frank exchanges about the real issues, and then we need to determine solutions. 

Communication is the essential ingredient - it is all about the HOW we do this, rather than the WHAT we do.

You have to give families self-belief : belief that they can do these things for themselves, rather than feeling as if they are being judged by you.

We cannot take this journey without you.  And even if we could, that journey would have no useful purpose without you on board.  We need to hear your voices and the voices of those close to you.  We know that our future is as much in your hands, as it is in ours.

Aotearoa's health and social services must be built on more than just providing for the basic needs of one the individual.    It must be built on the context of whānau.

These changes can be as big and exhilarating and as exciting as we wish them to be.

It is a great opportunity to improve the lives of New Zealanders, and I hope that you will join me - and all of our families -  in making this happen.