Speech to the Association of Salaried Medical Specialists' Annual Conference

  • Hon Dr David Clark


Good morning everyone

Firstly, I would to thank Dr Hein Stander for that introduction and acknowledge your service as the outgoing ASMS President.  Your union is well regarded across the sector and strong leadership has been a crucial part of that.

Thank you all for inviting me to address your conference. 

As the incoming Minister of Health, I’m taking as many opportunities as I can early on to speak with people across the health sector.  It truly is a pleasure to be here. 

It would be remiss of me not to acknowledge the Hon Annette King who is here today.  

Annette is someone who needs no introduction.  You will know her and her significant contributions as the Minister of Health in Helen Clark’s Government.

I was privileged to serve as her understudy for a number of years while in Opposition.  This taught me a lot - but I recognise that there is more to learn.  I aspire to have the breadth of relationships she has and retains with the sector. 

I’m looking forward to the feedback Annette will no doubt give me after delivering this speech, that will further that cause. 

I’d also like to acknowledge all ASMS members, international guests and other speakers at this conference.  I hope you enjoy the programme that has been put together for you. 

I realise that I have not met all of you yet, so I’d like to take a moment to introduce myself.

I’d like to tell you a bit about how I ended up here - standing as a Member of Parliament, and now Minister of Health. 

I took a circuitous route into politics.  I studied for a very long time at university – I guess you could say I was a slow learner. 

I ran because I wanted to make a difference, particularly with inequality.

My choice was to either stand on the side-lines and throw stones, or get stuck in and do something about it. 

I chose to get stuck in. 

Because it wasn’t that long ago when New Zealand was a pretty equal place.  In fact, it’s what we prided ourselves on - our egalitarianism.

Everyone, no matter their background, was able to make the best effort to get ahead.  Each generation did better than the one that came before it.

Growing up, I saw how it was possible for people to improve the best of their lot.  Because my parents did it.

When I was about nine years old, my father started a manufacturing business.

At the same time, my mother went back to high school and then on to medical school.  In fact, I spent my school holidays in medical school lectures.  So she is in fact a real doctor.

For a period of about two or three years, our family had very little income. 

But that was doable back then because even with two kids and a mortgage, my parents were able to save enough to have a couple of years, to take some risks. 

Today, I don’t think all of that is possible.  People might be able to do one of those things: one person might be able to go back to school, at a stretch, or one person in the family might start a business/school/mortgage/kids.

But doing both of those things at the same time would be, I think, just about impossible today. 

That’s a short time for inequality to increase dramatically. 

But an OECD study in 2014 showed this increase had legs.  It showed New Zealand has had the fastest growth in equalities of any Western country in recent decades. 

We should not be a world leader in inequalities. It’s something that we need to change, together.

 We see inequality every day in our health system - but I doubt I need to tell you that.

I see and hear stories most days about people coming into hospital, presenting with conditions that could have been tended to in primary care.

But this isn’t being picked up in primary care in part because many people can’t afford to visit a GP.

Unmet need continues to grow. 

The NZ Health Survey estimates that because of cost, more than half a million adults didn’t visit a GP last year.

More than ¼ million didn’t collect prescriptions for reasons of cost.

And the disparity amongst Maori and Pasifika is even greater.  Maori adults were more than one and half times more likely not to have visited a GP because of cost.

Maori and Pacific adults and children were more than twice as likely as the rest of the population to not collect prescriptions because of cost.

These numbers highlight the individual experiences of some of the most economically challenged people in New Zealand.  The statistics show that more needs to be done. 

Those experiences are real.  My mother saw it frequently when she was a GP in South Auckland serving under-served communities. 

It’s because people living in poverty, often through no fault of their own, are unable to afford the healthcare they need.

This feels wrong to me.  Some people are able to receive better healthcare simply because they can afford to access it.

That isn’t what a fair society is about.  And this isn’t what New Zealand should be about. 

Every New Zealander should be able to have affordable access to quality healthcare.

That’s exactly why our Government will improve access to primary care.

Not only because it’s the right thing to do, but it’s the most effective thing to do from a health perspective.  It costs us less.

Over time, it will free up our emergency departments and hospitals for the most serious cases. 

And it means we’ll take meaningful steps to reduce inequities in primary care. 

Unfortunately, inequalities in our health system stretch beyond primary care.  They exist in secondary care too.

Recently, it has been getting worse. 

Our best estimate is that 300,000 people in New Zealand needed services in secondary care they’re not receiving.                                          

This year, we also learned that 60,000 people who were referred by their GP to a specialist never got the first specialist assessment they needed.

DHBs wrote to them effectively saying they didn’t have the resources to treat them. 

These days, in many specialist areas, people are required to be more disabled to receive the care they need.  Their health problems have to deteriorate before they’re addressed.

Of course, if you have private health insurance, you can access the care you need.  But if you can’t afford that, then you are left with very few choices. 

It’s why people like Doug Pike, who was left waiting for a knee surgery for eight years, sold his house to fund his surgery.

This didn’t happen in the New Zealand that I grew up in.  And it shouldn’t be happening now either. 

It doesn’t have to be this way.

The previous Government made a choice to spend less on public services, including healthcare – contrary to most Western countries, core crown health expenditure dropped as proportion of the economy under their watch.

 This had a detrimental effect, in my view, on those who can least afford it. 

Before the election, Labour commissioned an independent report from Infometrics to analyse Treasury figures.   We found that the previous Government had effectively stripped $2.3B out of our health system.

That was money that was needed just to stand still - to meet cost pressures and deliver the same level of services.

But you know that underfunding is real - it places massive strain on the health system, particularly on staff.

It has been your work - and the efforts of thousands of other hardworking and committed staff that have kept our health system running.  Staff do an incredible job.  I want to acknowledge and thank you all for your dedication. 

We intends to do things differently - and begin to fix our health sector, which was neglected by the previous Government.

We’ll do it because we fundamentally believe in a strong public health system.  We want the best outcome for the public patient. 

Strengthening our public health system will require us to do things differently than the previous Government. 

We will need to demonstrate to the public that services continue to improve as we invest.  While this may be a time for hope, it is not time for complacency.

We’ll first need to rebuild relationships across the health sector. 

They’ve been seriously strained and this has meant that parts of our health system have been increasingly working apart. 

I’m determined to build strong and productive relationships with people across the sector as well as the community.  That’s the leadership role I have as the Minister of Health.  And it is my expectation for the Ministry of Health also.

New Zealanders expect our health system to work together and to improve health outcomes.  And under our Government, it will.

That is why I’ve already visited seven DHBs in three weeks and have committed to visiting as many as I can by Christmas.  I want to make sure that we’re all on the same page and heading in the same direction.

Our Government will also be sure to speak with organisations like yours, to better understand the perspectives of people working at the coalface of our health system.

Because that’s exactly what New Zealanders expect of us.  Doctors, nurses, midwives, Allied Health workers and others all know the issues within the health system.  It’s time the Government listened to you too. 

On the policy front, I make no bones about the fact that we have an ambitious policy programme to implement in health.

Upfront, we have committed to properly funding our health system.  We’ll put a much needed $8B extra into health over the next four years.

This will mean over time we’ll put back in the money the previous Government stripped out.  Our health system can no longer continue to take the back seat.

In our first 100 days, we’ve committed to initiating a ministerial inquiry into mental health.  We know that the system is failing too many New Zealanders at the moment.                                                                                             

And it’s time we changed that.

We have signalled that there will be changes in primary care.  We need to make sure that we are investing in primary care to treat and prevent illness early.  Experts tell us that this is what we need to do better.

So we will.

And when people ask: “What drives these policy decisions?”, our response is simple: We believe that all New Zealanders should have access to quality healthcare.

We know New Zealanders expect a health system that is there for them and their loved ones in their time of need.

They expect a public health system that delivers the care that people require and doesn’t necessitate people selling their houses to afford surgery by going private.

New Zealanders know that health is everything.  And it’s why the systemic neglect by the past Government will not continue under my watch.

It’s time we did better.

Improving this will take all of us - we will need to work together to deliver the health services that the New Zealand public expects.

That means from me, right through to the Ministry of Health, individual DHBs, unions and all staff working in the sector will need to work together towards a common goal: to improve health outcomes of all New Zealanders.

I’d like to acknowledge the work that ASMS has done to build relationships across the sector.  In particular, your longstanding commitment to the Health Sector Relationship Agreement.

But to repair the damage of the last nine years and to achieve the change required in the health system, we need everyone to step-up. 

I have been heartened by the conversations I’ve already had up and down the country, both as the Opposition spokesperson and now as Minister of Health.

People are telling me that they have an appetite to do things differently and that they’re wanting to play their part in that.

My message across the sector has been clear: bring me free and frank advice.  Give me the advice you think I need to hear, not what you think I want to hear.  I may not always agree – but I will listen. 

Because to make changes in our health system, it will require us to challenge each other – in order to reach the best solutions for the New Zealand people.   

I don’t underestimate the task ahead of us.  It really will require our collective efforts.

But I’m optimistic that we can get it done, and that the health sector has its best days ahead of it.

But I know, speaking to people across the sector that we all have the same goal in mind: to provide the best health services to the New Zealand public.  That is the perfect place to start.                                                                                               

I’d like to now turn over for your questions so we can have a conversation about these issues.   I look forward to continuing the conversation.