NZ National Forum on Advance Care Planning, Ellerslie Stand, Auckland

"It gives me great pleasure to be here today to welcome you all to this, the first national forum on advance care planning.

I appreciate the opening words of Dr Barry Snow and Leigh Manson and found Kirstin’s story inspiring – a story that has set the scene for the next couple of days.

As many of you know, advance care planning helps people prepare for the future and provides an opportunity to have a say about treatment planning.

It means people, their families/whānau and health care teams can plan together for future and end-of-life care.

It is a great example of people powered health care – where individuals are enabled to make choices about the care and support they receive. 

People’s needs change as they age, and there may come a time when they are no longer able to make decisions or advocate for themselves. 

Advance care plans and enduring powers of attorney are a means to uphold an individual’s autonomy in relation to their health care and treatment.  

Being able to start a conversation with patients and their family/whānau about the care and treatment they want as they approach the end of their life is a vital skill for clinicians.

Of course, these conversations can be challenging for all involved – but it is very important they take place.

By having these conversations, a shared understanding develops between patients, their family/whānau and clinicians about what is important to them.

This makes it easier for treatment and care decisions to be made by both the family and clinicians on behalf of patients, if and when the situation arises.

This forum has been designed for health professionals, consumers and others already involved in promoting advance care planning.

It is an opportunity to further your thinking, network with colleagues, and create strategies to progress and promote advance care planning in your care setting.

If you are a consumer or family member here today, it is also an opportunity to reflect on what matters to you, and consider what you want to communicate about your care.

I am delighted that consumer experiences feature so prominently in the programme.

I would like to thank consumers for taking the time to share their experiences of advance care planning.

It is not easy to stand in front of an audience and talk about such personal and private matters.

I would also like to acknowledge the work of the Advance Care Planning Cooperative and the Health Quality & Safety Commission in putting this forum together.

The Advance Care Planning programme is now under the umbrella of the Health Quality & Safety Commission which is included in my portfolio as Associate Minister of Health.

The Commission was established in 2010 and has just reached its sixth year of operation.

The role of the Commission is to work with the health and disability sector to ensure that New Zealanders receive the safest, highest quality care possible.

The Commission coordinates many programmes nationally that are designed to meet this goal.

We are seeing positive steps forward to make New Zealand’s health and disability system of higher quality, safer, and more affordable. 

These include a reduction in falls and broken hips, in blood stream infections, infection rates and fewer road accidents involving young people, resulting in saved lives and dollar savings to the health system. 

Although these examples go beyond the remit of this forum, they demonstrate what can be achieved by working collaboratively.

The move to put the Advance Care Planning programme under the umbrella of the Commission has been a positive move and will enable all of us to work together to put an effective plan in place to progress this work.   

The Government’s commitment to advance care planning is documented in the New Zealand Health Strategy, launched earlier this year.

Like many health systems around the world, our health system must respond to the challenges of an ageing population, and a growing number of long-term conditions. 

The New Zealand Health Strategy has been developed to guide the health and disability system’s priority areas and identifies areas for action over the next ten years.

The New Zealand Health Strategy commits to supporting clinicians and people in developing advance care plans and advance directives by building existing national and international resources and networks.

The use of electronic clinical records and shared care plans are fundamental building-blocks to progressing this commitment and are priorities under the New Zealand Health Strategy.

Under the New Zealand Health Strategy, a national strategy to support healthy ageing and older people is currently being finalised.

The strategy includes a vision for the end-of-life phase  -  “that older people live well, age well and have a respectful end-of-life in age-friendly communities”.

The strategy reflects the importance of early conversations around advance care planning and acknowledges that individuals, families and clinical staff need to be supported to engage in discussions about end-of-life planning. 

Key actions under this strategy include: 

• Increasing public and workforce awareness, and use of, advance care planning and enduring powers of attorney across the health sector, government agencies, community organisations, and amongst older people and their carers.
• Improving communication, and integrating information, about assessment and clinical care plans with acute care services alongside those responsible for advance care planning.

The Review of Adult Palliative Care Services is also being linked to this strategy and will reference and support the development of advance care plans and advance directives.

A Commission-hosted forum held last year and headlined by Dr Atul Gawande has contributed to the national conversation about end of life discussions.

In researching for his book, “Being Mortal”, Dr Gawande, a clinician and professor at Harvard Medical School, spoke to many end-of-life care experts and asked them what he should be doing differently when speaking to patients.  

He recalled that it started with “you should stop talking so much.

You should be talking less than 50 percent of the time in these conversations.

They, the patients, should be telling you what matters most to them.”

Dr Gawande paid attention in his clinic and found he was talking more than 90 percent of the time because of his model of thinking – that it was, his job as a clinician to give people the facts and the answers.

He further recalled “I gave them option A and option B and option C and here are the pros and here are the cons and here are the risks and here are the benefits and now what do you want?”

What the end-of-life experts pointed out is that instead, it is important to graduate to an idea of “clinician as counsellor”.

But you also have to ask people what their goals and priorities are and then match what you can offer to what they need, and make a recommendation.

There are a few basic questions that could be asked according to Dr Gawande.

Those basic questions were ones like:

• What is your understanding of where you are with your health or your illness at this time?
• What are your fears and worries for the future?
• What are your goals and priorities if time becomes short?
• What are you willing to sacrifice and what are you not willing to sacrifice in the course of       your care for the sake of your mortality?
• Does your family know the answers to these questions?’

Advance care plans and the discussions around them create an opportunity for people to think and talk about their values, preferences and beliefs.

The work you are doing is both challenging and rewarding and I wish you every success for this forum, and the many conversations and initiatives that will result from the next couple of days".