Rotary Club of Dunedin

  • Bill English


Today I want to talk about a viable and secure future for health services in the South. I want to tell you about the aspirations I have for our health services and how they can be realised. Let me say at the outset, there is a positive future and there are plenty of people around with enough of a positive attitude for us to succeed.

First let me give you a picture of our services and the people who use them. Debate about health services concentrates on particular services or issues of the day, and we can lose sight of the scale of health services, and the community they serve.

Here are some basic statistics.

The population of Otago and Southland at the last Census was 282,000 people. It's a widely dispersed population. 160,000 people live in Invercargill and Dunedin and a further 13,000 live in Oamaru. There are 40 other towns in this area with a population of under 10,000 people. The number of people who live in these towns is just under 60,000. The remaining 49,000 people are scattered through the rural areas and small townships like Dipton where I come from. It's too small to show up as a town in the census.

For 282,000 people the Government spends something over $420 million each year on public health services. That amount has risen each year from around $360m in the early 1990s.

That funding represents almost all the services needed by the 282,000 people. Only a very small number travel outside of the area for highly complex services.

Those services include hospitals, mental health, drug and alcohol services, housing and accommodation, home support, medicines, long term care of the elderly, support for people with disabilities, and many more. Thousands of people are involved in the health services - Dunedin hospital alone employs 1700 people. Then add up all the home care workers, GPs, community nurses, rest home workers, and staff of non-government organisations like IHC, CCS and all the others.

Many of our most committed, brightest and best qualified people are involved in health services, so we need to make it work. I believe we have the capacity right here in our own region to realise the potential.

So what is the potential, what we can achieve in health in the South? I want the Otago/Southland area to demonstrate excellence in rural and community health. We certainly want to reach a level of excellence and leadership in New Zealand.

I think we should aspire to excellence within the band of countries with which we compare our health services, particularly Australia, Canada and the United Kingdom. We can be a region where new ideas are generated for better ways to run health services in small communities, close to people and their needs.

We can be a laboratory for forward looking and progressive services. We can assemble a highly skilled workforce in rural and community health and become a place where health professionals and experts want to come to see how it's done well, and to learn the skills they need to so the same.

We can be a place where we can show that how we do it works because people do have better health.

I believe we can achieve these things because we have some particular advantages which mean we have a head start on the rest of the country.

Firstly we have Otago University with its research capacities, its reputation and its linkages to the expertise around the world. The university and the medical school can see that they have to change their orientation if they are to maintain their reputation and enhance their expertise. There simply aren't enough patients to compete across all highly specialised hospital medicine.

So the School is looking to a future more orientated to community medicine. They are increasingly looking outward to the wider region as the environment for their students to train and learn. That means students will spend less time in Dunedin Hospital with the professor, and more time around the city and in the smaller centres learning how health services work in the community, and in rural areas.

A second advantage we have is the leadership and vision of so many people in our smaller communities. Every small community in Otago and Southland has had to deal with major changes in their hospitals. From Oamaru to Tuatapere to Queenstown, the future of the local hospital has been the subject of thorough and fierce debate for several years now, and there have been big changes. In every case we now have or will soon have a modern health service that is secure, which our communities can rely on.

In each community there are people who are now thoroughly familiar with health issues. They have met dozens of officials, read thousands of documents, and gone to years of meetings. In every case their vision has survived and new and better services will be the result.

Oamaru, Ranfurly, Lawrence, Roxburgh, Gore, Balclutha, Winton, Tuatapere, Lumsden, Queenstown, Milton - the same type of thing has happened on every case. So there are people all over our region who are well informed, and who have proven their expertise.

A third advantage is our size. Things can happen here because we can get to know each other, we can have the personal touch that makes a professional or business relationship succeed. A good idea can become a reality fairly quickly if we can get the right people together with a common vision.

So is all of this pie in the sky? No it isn't. We have plenty of examples of people who are starting to make things happen. The medical school is getting on with the job of ensuring it has a relevant future. Our smaller towns are putting together new services which will pull the bits into a coherent whole. Today I will visit the Otago Diabetes project which is a national leader in bringing together everyone who is involved in the treatment of diabetes, getting them to talk and work together to improve the way we treat and manage a disease much better than we used to.

Other groups are looking at how to do a better job of mental health.

We spend most of our political debate on the last few million dollars. These people are getting on with the job of working out how to use the other $420 million better - and it's time they were given public credit for their efforts.

All these people have made a crucial shift in their thinking. They have developed aspirations about how good our health services can be, and they have committed their time and energy to achieving those aspirations. They have become creative rather than reactive.

If there are barriers to achieving these aspirations, then they are government inflexibility and our own attitudes.

Public institutions are slow to progress, because they don't have to, and because progress generates controversy because it usually involves change. I am lucky to have the opportunity as a Minister to do what I can to make government institutions, like the local hospital and the health funding authority, more responsive to people and their needs, to new management and medical ideas, to technology improvements.

But I also have an interest as a local MP in how we can contribute as a community to our own betterment. Here are some suggestions.

There will always be arguments about funding for hospitals. But in fact we don't get a worse deal in Dunedin than the rest of the country, and the rest of the Otago Southland region is less than sympathetic to the view that the health service is here to maintain the infrastructure of Dunedin. It's actually here to serve the people of Otago and Southland, most of whom don't live in Dunedin. When we all recognise that common objective and work together to achieve it, then the future for Dunedin institutions will be secure because they will be doing the job they were meant for.

It's also a habit we have to see every perceived threat that something might change as a dastardly political plot. If you believe the local newspaper, the whole region is about to be ravaged by "monetarist" health policies. That's about as sensible as saying the Highlanders play "Marxist" rugby because they play as a team. In fact health policy in New Zealand is consistent with mainstream health policy around the world, including that of the Labour Government in the UK and the general direction won't change whoever is the government after the next election.

I want to see us aspire to excellence and many people throughout this region are capable of achieving it. But the message we send to the rest of the country is a negative one - if you are smart and progressive this may not be the place for you. If we truly value intellectual and academic capacity, then let's make this an attractive environment for people with those capacities.

The best thinking about health services in this region is going on in the small towns, that is where we find the leadership, the vision and the nitty gritty hard work of making local solution work where Wellington will always fail.

I am ever the optimist. Just two years ago every small community was in uproar over its hospital, now almost all of them are constructively engaged in shaping the future. Last week there were 300 people at a health meeting at 10am in Gore, in my electorate. That meeting unanimously endorsed the concept of a new smaller hospital run by a community trust, and asked the proponents to get on with it. I don't think the ODT covered that meeting.

In just a few more years I hope we will be greeting international visitors to Dunedin to look at our innovative medical school, our leading edge integrated health service, and our models of community developed community driven rural health services. This city has the brainpower, the people and the resources to lead the Otago Southland region and its health services. I intend to do what I can to ensure it happens.

I would like to finish with a quote from a recent editorial in the Otago Daily Times:

"Too often the message is one of cost cutting rather than making sure that New Zealanders have a sustainable public health system, affordable within the budget available, and that the needs of people are placed before the wants of the bean-counters. That is all we ask." (ODT, 20 May 1998)

I agree with that whole-heartedly.