NZ College Of Nurses Workshop

  • Wyatt Creech

This is my first formal address as Minister of Health. I want to take advantage of this opportunity to lay out some of my initial thoughts on my new portfolio.

If I can hark bark to my previous life as Minister of Education for a moment. I used to tell people when I was Minister of Education of something that kept spurring me along when the education issues got very difficult and the decisions very tough. I used to say that education was full of thorny issues and problems. When I was trying to get to sleep at night trying to work out this problem or that problem - should I go this way or that on some issue - and it all seemed a bit too much - a little voice inside me would pipe up and whisper - "well it could have been worse, she could have made me Minister of Health"! And now she has!

Already the portfolio has thrown up some difficult challenges for a novice Minister. In Auckland I went into an operating theatre - and I didn't faint. And you may not realise that last Friday was National Employee Exercise Day - that found me at a gym in Wellington doing a demonstration daily dozen. This portfolio can be genuinely hard work!

But those lighter moments to the side, I have to say that I have been pleasantly surprised at how much the health sector has progressed in recent years. Overall it is going well. My predecessor Bill English did a good job in this difficult portfolio - he listened, was practical and realistic. I intend to continue in that sensible moderate direction that Bill English gave to Health. It is working well.

My approach has always been practical and pragmatic. I like to see problems solved - I like an approach that gets a better deal and better services for all New Zealanders. I like to see people working together constructively. Sometimes this means people with very different views listening to each other rather than just standing back and making claims. There are issues concerning nurses that fall in to just this bracket. There are the reported differences between midwives and doctors in the maternity area. You will also know there are doctors who do not agree with some of our initiatives, like for example, the initiatives that will permit nurses to prescribe in certain cases. Clearly, the official advice from Ministry experts on this point is that the fears about the safety of nurse prescribing are not justified. These issues are best addressed by considered dialogue where interest groups set their self-interests aside and work on finding solutions.

We need to give people certainty, security and stability. We need to continue to be realistic. It would always be nice to have more money, but that is not the way the world works. We have to use what we have to maximise health outcomes for people.

It was to promote certainty that we launched the Hospital Services Plan on 16 September last year. The public, especially the public in rural and provincial New Zealand, do want certainty about their health services, especially their hospital services. People need to know what quality and type the services are, where they will be, and that they can be reached in time when needed.

I will shortly be releasing a document called "roadside to bedside" which outlines a plan where patients get the best and most timely emergency and acute care. The approach in "roadside to bedside" has the potential to go beyond just emergency care and provide a framework for making certain our secondary and tertiary health services are being delivered at the right place, at the right time and by the right people.

We are in the middle of a massive programme to modernise our public hospitals. I hate calling them HHS's - I have to say I prefer to call them public hospitals - that actually means something to regular people. $920 million has been invested during the last five years in this modernisation programme. Another $1 billion will be invested over the coming three years. The Prime Minister announced in her speech opening this year's Parliament that decisions will be made on the huge new Auckland Hospital Service Development Plan in April/May and a proposal will be finalised for what all agree is a total replacement hospital for Wellington this year too. Making these decision will be one of the key responsibilities of my early tenure in this portfolio. They are massive exciting decisions. The size alone means they automatically attract attention.

But this should not be at the expense of recognising the myriad of developments that are happening all over New Zealand at the community level. I am a strong advocate of locally developed solutions to local needs such as the many new health centres springing up all over this country. These centres provide a range of different services all worked out in the communities they serve. Some are advanced. In my electorate there is the Dannevirke Community Hospital. I know the people behind that initiative well. Dannevirke was torn apart by Mid Central Health's decision to exit services from the large, old and very out-of-date hospital on the hill. There was real anger in the community for some considerable time. But it is gone now - gone completely. It is replaced by a new optimism, a new commitment in that town. Having seen what the new Community Hospital actually does, and how well it actually meets their needs, and the new confidence that it has given people in their health services in Dannevirke, the mood is totally reversed. The people are totally behind their hospital. In that community there is a palpable sense of pride and achievement because they have made a difference. It is a huge success.

I always refer those who criticise us politically to the Dannevirke example. The initiative for this hospital came from within the community. From some I hear conspiracy theories - the Government wants to privatise everything. It's nonsense. Is the Dannevirke Community Hospital public or private? Well it is all sorts - it is certainly publicly funded. I tell critics that when you criticise that project and similar projects, you are undermining the aspirations of hundreds of health makers providing the services that people need in the way they want it. You see Dannevirke is not a traditional Government owned hospital - and to some driven by ideology that is shock, horror - but it works for people, and that to me is what matters.

The range of these new health centres that are springing up all over this country are almost limitless. I recently signed a $1.4 million contract for primary service provision with Health Care Aotearoa, a community based nation-wide primary care network initiative that incorporates union health clinics. In the north of my electorate I have been impressed with two nurse led rural health clinics. They were not set up as a result of government agency action - they are there as a result community initiatives. And in spite of common prejudices as to how GPs do not approve of such clinics, the local Dannevirke GP I spoke to last week could not have been more fulsome in his praise of how much this centre offered in improving community health outcomes.

These clinics offer real opportunities for the nursing profession. But I don't advocate them just because it suits the nursing profession. By integrating services - seeing them work together for the common benefit of all the community - the whole population's health is better.

Where concerns do arise we must be prepared to look at them. The Maternity Services Review is a case in point. How do expectant mothers decide who will be their Lead Maternity Carer? How can we facilitate shared care? How do we improve the working relationships between midwives and GPs throughout New Zealand? Are our birthing arrangements as good as we would like them to be? Is our post natal care system working as it should? We need these questions answered.

We need to press on with the development of what we all call 'integrated care'. Without it we will see too many false economies. There was some disappointment last year when the Tauranga and Marlborough proposals did not go ahead. I have spoken to Graham Scott of the Health Funding Authority and can say I am not pessimistic about this matter. The HFA is looking at innovative contracting that sees service purchasing issues in a wider context. It makes a lot of sense. I hope we can see some progress over this year.

There seems to be an historic tendency to think of the health system as hospitals, operations, heart surgery, doctors in white coats and nurses in uniforms. The secondary and tertiary services as they call them in health "speak".

We need to turn that on its head.

Currently we tend to look at the health system as if it were a pyramid. It has at its apex the very high-tech tertiary and quartenary services with secondary services the next layer down and at the base a very wide group of mixed and hard to specify primary care services.

It would be nice to turn that pyramid upside down. Because when it comes to benefits for people, it is the health dollar spent on those primary service in the community, those public health services, those information campaigns, those public education programmes, that provide so much benefit to so many.

Ideally we should aim to improve those primary services so those at the bottom are caught before they fall through the primary sieve into the secondary and tertiary services. We need to put the effort in so it that it really does work like a sieve which limits the number of people who end up flowing down through to the secondary health services.

What I want to see at the top of the health shopping list is how to keep New Zealanders fit and healthy. The best health system we can hope for is one where we keep New Zealanders out of hospital. We need to keep people healthy, and stop their health problems getting out of hand.

There has been a lot of discussion about the Government's free visits to the family doctor for under 6 year olds, and whether it will continue. It will continue. But it needs more energy to make it work well. Having the taxpayer fund doctors visits is not enough on its own. To gain the full benefit of the policy we need to make sure all those eligible know about it and take advantage of it. We want more low income families, Maori and Pacific Island parents - those who have statistically poorer health outcomes - to know it is easy to take their child to the doctor, and if they do, they will nip in the bud any problem.

If I could talk specifically about nursing - the Nursing Taskforce and its recommendations were driven by my predecessor Bill English. I have now taken ownership of it, and can assure you of my commitment to seeing it work. The work you have done over the past few days will no doubt help.

The work of the Nursing Taskforce provides a positive forward looking springboard. I have already had the opportunity to meet your Executive Director Jenny Carryer and we have had a discussion about the broad issues that you face. What we all need to do now is to find the best ways of making the recommendations of the Taskforce work to get the health system working better for each and every New Zealander.

A project team to keep an eye on what is being done to make the Nursing Taskforce decisions happen in a way that is real, practical and will work has been set up. I expect the Health Funding Authority to be supporting nursing led initiatives. I would like to see nurses skills and expertise used more effectively. I would like them involved in the governance and management of primary care organisations. The Health Funding Authority should also be making sure the Clinical Training Agency makes advances. If we are to keep moving forward the health workforce needs to keep developing, training and extending itself.

But there are a range of initiatives that only you can make happen to unlock your potential, to make the most of your professional skills, to help with your job satisfaction and to keep nurses at the forefront of moving the provision of health care forward.

You are in the best position to encourage

more nurses in management and governance positions
support for nursing research
support the development of nursing leaders
collaborate with health professionals
develop a framework for specialisation
and to implement the Nursing Council post-graduate framework.
Our health system has changed enormously over the last 50 years. It will continue to change. Lots of other things have changed too. Twenty five years ago if your hip gave out they gave you a walking stick. Now the joint is replaced. Shops were closed all weekend, the idea of Saturday trading was seen as likely to cause the complete breakdown of society as we knew it. You were allowed to buy frozen peas from a dairy in the weekend but you couldn't buy canned peas. Public bars closed at 6pm. The only moonwalking in those days was done by astronauts, Michael Jackson was not even on the scene. And believe it or not, you needed a doctor's prescription to buy margarine.

Often it is hard for people to accept change. In my home town of Masterton I saw some graffiti once which sticks in my mind. Scrawled along the side of an old tin shed were the words "I can cope with anything but change".

But change is inevitable and we have to do as much as we can now to keep astride the momentum and change of the future. I want to see nurses using their skills. I want to see nurses out in the community, and not just in hospitals. Your strengths as an interface with the community, providing primary health care services and promoting healthy living within the community has to be expanded and promoted.

I am still getting familiar with the nursing profession and how to make certain nurses move forward and play an integral part in the health services of the future. This will develop with time and I look forward to being able to discuss with you individually and as a group about how to keeping getting ahead.

I would like my time in the health portfolio to be noted for its lack of ideology and controversy. I want it to be noted for a time when health services only got better, where New Zealanders only got better access to service at the early possible time in their lives and illness.

Thank you for asking me here today. I have already heard that it has been a productive and demanding three days. I look forward to hearing how your work over the past few days can be used to make the Nursing Taskforce recommendations work for everyone's benefit.