Speech: Bupa national conference

E aku Rangatira,  Tēnā koutou katoa,  Ka nui te honore ki te mihi ki a koutou       

Good morning, and thank you for inviting me to speak at your conference today. I would particularly like to thank Grainne (Moss) for extending the invitation to me, and for her kind introduction. I would also like to acknowledge your Chairman, Bryan Mogridge.

Fresh Leadership – the secret ingredient. This a theme which certainly got me thinking! I will reflect on the theme of leadership throughout my speech today, including how the Government is leading improvements in the health of our older New Zealanders, but also how organisations like Bupa and the wider health sector can help us achieve our goals in this area.

We know we have a growing number of older people. The number of people aged 65 and over in New Zealand has doubled since 1980, and is likely to double again to around 1.2 million by 2036. Our older people are also living for longer. Today, a 65 year old man can expect to live for another 19 years, and women of the same age can expect to live for another 21 years.

For many older people, these years are active, with many working longer and remaining involved in their local communities. However, an increasing number of people aged 65 and over – and particularly the increasing number of people aged 85 and over – do have health problems that we need to support.

To tackle this issue we need real and enduring leadership, so that our health system can support older people not just today or next year, but in 10, 20, and even 50 years.

The Government cannot do this alone. An ageing population provides organisations like Bupa the chance to show leadership too. From those of you working at head office, to those who work on the front line with our older people, leadership in the way you think and operate will have a lasting positive impact on the lives of older New Zealanders.

Just this month we have seen evidence suggesting that, while challenges lie ahead, our leadership thus far means New Zealand is doing well in supporting our older people.

On 1 October, the International Day of Older Persons, the United Nations released its Global Agewatch Index. New Zealand has done exceptionally well, ranking seventh of 91 countries for overall quality of life of our older people. Even better, we were ranked third for the health status of our older people. This is a fantastic achievement, and one that as Minster for Senior Citizens, Associate Minister of Health, and a New Zealander, gives me great pride.

However, the Index does identify some areas where we need to improve, not just in the health of our older people, but also in making sure our communities are places where older people feel safe, connected, and respected. And making these improvements is where leadership is important.

Government funding for aged care

The Government has continued to increase the funding spent on services for older New Zealanders. In 2012/13, approximately $928 million was spent on aged residential care and almost $270 million was spent on home-based support services.  Most recently, in Budget 2013 the Government announced $70 million of additional funding over the next four years for aged care and dementia.

Demand and funding for aged residential care

The Aged Residential Care Service Review (or the Grant Thornton review as it is often called) estimated that in 2013 we would have between 28,300 and 32,300 residents in aged residential care. The number of residents is now close to the top of that range. But we are coping with that increase and so far the number of residential care beds has increased sufficiently to meet demand.

Since July 2008, 26 new facilities have opened adding over 1800 beds, and 81 existing facilities have expanded adding over 1300 beds. While some facilities have closed, particularly in Christchurch, we actually have 990 more residential care beds now than we did in 2008.

Ensuring quality in aged residential care

Importantly, it is not just Government funding and the number of beds that are increasing. Together, the Government and providers are also leading the way in improving the quality of aged residential care facilities.

I am pleased with the number of improvements in the audit regime over the last few years, including accreditation of auditors, combined DHB and HealthCERT audits, spot audits, and the publishing of audit summaries online.

These improvements were recognised by the Office of the Auditor-General in its 2012 report, which noted that since 2009 good progress had been made in certifying and monitoring rest homes.

But we are always looking for ways to further improve these processes and the quality of our aged care facilities. As part of this improvement process, from November the Ministry of Health will be trialling a new system giving people access to full rest home audit reports in addition to improve audit summaries. 

Previous audits will also be available for people to compare with current audits, and more information will be available about the corrective actions that facilities need to take.

The New Zealand public are asking for more transparency in order to make informed decisions about where to live when they are no longer able to live independently at home.

interRAI in aged residential care

New Zealand is also showing leadership in our aged care sector by adopting the internationally accepted Comprehensive Clinical Assessment framework, otherwise known as interRAI.

Overseas studies have shown that better assessment means older people get better care and consequently better health outcomes.

However, in adopting interRAI nationwide we can ensure that all older people are receiving consistent assessments, using a validated tool, regardless of where in New Zealand they live.

Currently, larger organisations like Bupa are able to compare assessments and ensure quality across their own facilities. But once everyone is using interRAI, comparisons and benchmarking will be able to occur across all aged residential care facilities to help us understand how the sector is performing as a whole.

Finally, using interRAI will provide access to aggregated and comprehensive population data about the needs of older people, with no extra reporting or effort required by nurses or residents. This comprehensive data is important as it will provide us with the opportunity to both fairly and accurately prioritise services, and to contribute to the international research base.

To ease the cost to facilities of introducing interRAI, Budget 2013 provided $1.5 million to contribute to the costs of backfilling nurses while staff members undergo training. For each nurse who is signed up, the Government will contribute $650 towards this cost.

I understand that Bupa is about to embark on its own interRAI journey – utilising expertise from the United Kingdom where interRAI is widely used. This will also ensure that Bupa can take advantage of the backfilling grant which is only available to those who sign up for training before 31 December 2013.

Premium-only aged residential care

As you will be aware, the idea of premium-only residential care was suggested as a way to encourage continued investment in aged residential care. Through the consultation process held late last year, a wide range of informative submissions on the proposal were received, and I thank Bupa for sharing its thoughts on the matter.

Most submissions received were against allowing premium-only facilities. Many were concerned that it would create a divide between those living in standard and premium facilities, and that the supply of beds without an extra charge would reduce. After reflecting on these submissions, I decided not to move ahead with the premium-only proposal.

However, many submissions highlighted that aged residential care providers and residents would benefit from clarity on this matter. Therefore, I asked health of older people sector leaders to look into premium charging and how it is applied across the country.

For example, what features of a resident’s room should be permitted to carry an extra charge? And under what circumstances does a facility with only premium rooms vacant have to take in a resident who will not be paying an additional charge? Another issue is notice periods for residents who wish to cease paying an additional charge.

We know that many new facilities are offering standard beds, as well as premium rooms. But the balance between providers making a return on their investment and standard rooms being available is a matter that needs to be addressed.

Once I receive advice on these issues I look forward to sharing the Government’s thoughts and making sure that all older people continue to receive quality aged residential care, regardless of whether they live in a standard or premium room.

Improvements to dementia care

As more New Zealanders live longer, the number of older people with dementia is likely to increase. Supporting this growing population and ensuring that services are available to help them live the best lives they can is another challenge that we must address if we are to show true leadership in aged care.

The Government has demonstrated its leadership in helping those with dementia since it was elected. New funding has improved and increased the services available to people with dementia.

Residential care services for people with dementia, such as those provided by Bupa, are a crucial part of a health system that looks after our older people. Therefore, it is pleasing to note that since 2008, the number of dementia beds across the country has increased by over 25 percent. The Government’s Budget 2013 commitment of another $12 million over four years to increase the dementia bed price will provide a further boost to residential dementia services.

But, while residential care is, of course, important, equally important is ensuring that care and support is available for people with dementia who are living in the community.

That is why Budget 2013 included $1.2 million for dementia-related training for health care workers and $2 million for dementia awareness programmes and to help primary care professionals detect dementia early.

The Government’s determination to support all people with dementia is also highlighted by the ongoing development of dementia care pathways.  This will ensure people with dementia, and their families, can more easily access the services they need. These pathways also encourage health and social services to work together to provide people with seamless and integrated care.

I encourage you, if you are not already, to become involved in developing and implementing your local dementia care pathways.

Improvements to home-based support services

As our population ages, the Government wants to make sure that older people remain healthy and independent in their own homes for as long as possible. This will not only reduce the pressure on aged residential care and hospital services, but will also ensure older New Zealanders are able to retain their independence and stay connected to their local communities.

In 2012/13, district health boards spent approximately $269 million on home support services ($48 million more than in 2008/09) and DHBs purchased over 10 million hours of home support (over one million more than in 2008).

To increase home-based support services available to older people, in Budget 2013 the Government gave a $20 million funding boost over the next four years.

In addition, all Government-funded home-based support providers are now required to be compliant, or be working towards compliance, with the Home and Community Support Sector Standard. Providers will undergo audits, similar to those undertaken in residential care, to ensure they are meeting the expected quality standards.

Improving the aged care workforce

Workforce development is important. This is what we are doing:

• More money for dementia-related training for health care workers.
• In each DHB geriatricians and gerontology nurse specialists now work with, advise and support health professionals in primary care and aged residential care.
• Health Workforce New Zealand is also working with the Royal New Zealand College of General Practitioners and the Medical Council of New Zealand to include advanced training on care for the elderly as part of general practice training.
• In 2011 aged care was added to the hard-to-staff specialty list for nurses on the Voluntary Bonding Scheme. In 2013, twenty-one percent of nursing graduates who enrolled were either currently working, or intending to work, in aged care.

You may also have seen the Ministry of Health’s recent publication Showcasing Aged Care Nursing. It profiles some of the exciting initiatives that are under way to better support nurses in caring for older people. It also highlights how nurses are leading the way in ensuring that New Zealand’s health care workforce is prepared for the demands that a larger older population will place on it. If you have not already seen this document, and the connected videos, I strongly encourage you to visit the Ministry’s website and have a look.

Closing remarks

To ensure that older people are healthy and independent, both now and in the future, we need leadership from both the Government and the aged care sector.

There is a lot happening to develop aged care, and Bupa teams across the country are in the thick of that. This Government wants to keep working within the sector so there is continuous improvement. I think that by working together in this way, we will all show true leadership in aged care.

Thank you again for inviting me to speak to you today.

No reira, tēnā koutou, tēnā koutou, tēnā koutou katoa.