Speech to Ministry of Health Forum 2019

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Mihi
E ngā mana, e ngā reo, e ngā kārangatanga maha o te wa, tēnā koutou, tēnā koutou, tēnā koutou katoa.

Ki ngā mana whenua, ko Te Ātiawa, ko Ngāti Toa, tēnā koutou.

Rau rangatira mā, tēnā koutou.

Nōku te hōnore kia hāere mai ki te whakanuia tēnei huihuinga.

Ko te kaupapa rangatira e tauhere ana i a tātou katoa, ko te whakapiki i te oranga ō ngā tāngata katoa o Aotearoa,
 
Ehara i te mahi māmā, engari mehemea ka mahi tahi tātou, ka taea e tātou

Ko te tūmanako kia angitū tēnei hui.

Nō reira, tēnā koutou, tēnā koutou, huri noa i te whare, tēnā rā tatou katoa.

Introduction

Thank you, Ashley (Bloomfield), for your warm welcome.

Good morning, everyone. It’s my pleasure to be here today to open Forum 2019.

I’d like to thank the Ministry of Health, and particularly, the small team of people who have worked long and hard to make this event a success.

This Forum is an important opportunity for us to share our knowledge and experiences, to reflect on successes and to work together on solutions to tackle future challenges in our health and disability system.

This forum has been convened so that together, we can collaborate and lead our health and disability system towards a brighter and healthier future for all New Zealanders.

So thank you for taking the time to join us here.
 
I’ve met many of you previously in your workplaces around New Zealand. I’m always impressed by your dedication and compassion.

Thank you on behalf of all New Zealanders for making such a difference to their lives.

The Ministry has put together an impressive programme with some excellent speakers.

You’ll hear from about 50 different speakers over the next two days. I’d like to thank all of you for your generosity in sharing your knowledge and insights.

Where we’ve come from

The forum’s theme, Delivering Equity of Health and Wellbeing in Aotearoa - Te Tuku Oranga Hauora e Orite Ana i Roto i Aotearoa, resonates strongly with me.

It’s what this Government is all about. 

But first, I’d like to talk about where we started.

It was just over two years ago that I was sworn in as Minister of Health – in fact it was two years ago on Saturday.

It would be fair to say that there was not a long queue of people putting their hand up for this particular seat at the Cabinet table. 

In Health the need is huge, the resources are not endless and the public expectation is rightly high.

But for me it is just about the perfect job in Government.

I got into politics because I wanted to see a difference in people’s lives, and because I wanted to do something about the growing issue of inequality in our society.

I don’t think I need to tell any of you in this room, about the huge opportunity to make a difference in health. I would hazard that that same opportunity is what has brought most if not all of you here.

That is not to say that change always comes easily in health - far from it.

In taking on this role, I was under no illusions about the scale of the challenges ahead.

I knew that our health and disability system was stretched and strained. Unsustainable.

The system was hurting.

I knew that because I’d listened to people around the country who told me so – people like you. I knew that because every week people would turn up in my electorate office to tell me their stories about their experience of our health service.

And since becoming Minister, officials have also told me so.

We inherited a health and disability system that had been woefully underfunded and neglected.

That has placed a massive strain on the entire system, particularly on staff.

It’s thanks to people like you and thousands of other dedicated and talented health workers that our health and disability system has continued to perform so well in very challenging circumstances.

That legacy of underfunding and neglect was hurting health and disability services nationwide, which were struggling to manage increasing demand, driven by an aging and growing population with increasingly complex needs. 

We know people are living longer, we know obesity rates are rising and we’ve got increasing numbers of people with long term conditions, such as diabetes and cancer.

And there is an expectation that we will keep up with rapid developments in technology and medicines.

We also knew when we became the Government that our mental health and addiction services were hurting.

Demand for services had grown rapidly during the previous decade and some people were missing out on the help they needed.

And behind our high suicide rate lies ongoing grief and many for too many of our whanau.

Our hospitals and health facilities were hurting – crumbling in some cases - because of that lack of investment.

The current Government inherited issues with earthquake-prone hospitals, asbestos, leaks and buildings that have simply come to the end of their useful life.

That legacy of underfunding and neglect was also hurting the people of Aotearoa.

We’d inherited what I called a postcode lottery for health and wellbeing.

Certainly, I was very clear from the start that one of our toughest challenges was achieving equity in Aotearoa.

The reality is that we have avoidable, unfair and unjust differences in health and wellbeing outcomes for some people, particularly Māori and Pacific peoples, people living in poverty and people living rurally.

We must address Māori health and we must improve equity across our entire population.

So what is the Government doing about it?

Turning around this legacy of underfunding and neglect is a massive job and I’ve acknowledged from the start that it will take time.

But from day one, the Government has been crystal clear in our commitment to a strong, sustainable and fair public health and disability system.

That’s because New Zealanders deserve it, our health workforce deserves it and our health and disability services deserve it.

So, when we entered Government just 24 short months ago, we immediately started rolling out our significant health agenda.

Mental Health

For example, we initiated the Inquiry into Mental Health and Addiction in our first 100 days in Government.

In May this year, the Prime Minister and I announced the Government’s response to the panel’s report, He Ara Oranga, which charts a new direction for mental health and addiction in New Zealand.

This year’s Wellbeing Budget delivers on many of its recommendations, investing a record $1.9 billion into mental health and addiction initiatives. 

This significant and sustained investment is across a range of portfolios, including health, education, corrections, justice and housing. 

We’ve started rolling out our $455 million investment over five years to build new frontline services, with a focus on supporting those with mild to moderate needs. Of that, $62 million has been ringfenced for kaupapa Māori services. 

We’ve set up our initial Mental Health and Wellbeing Commission.

We are re-establishing this commission, which was closed in 2012, because it did a good job providing leadership and accelerating progress across the sector.

Just last week I met with the members of the initial Commission, and I can tell you they will make a difference.

Hayden Wano, who has more than 40 years’ experience in mental health, community and medical services, has been appointed its chair, along with four other members. 

I’m pleased to see he’s speaking with you after lunch today at the Enabling Wellbeing plenary.

Suicide Prevention

We’re also establishing a Suicide Prevention Office, led by experienced coroner Carla na Nagara, to coordinate actions to reduce New Zealand’s historically high rate of suicide.

We’ve released Every Life Matters - He Tapu te Oranga o ia Tangata: Suicide Prevention Strategy 2019–2029 and Suicide Prevention Action Plan 2019–2024 for Aotearoa New Zealand.

The strategy is focused on achieving equity for all lives, including for Māori and other population groups that experience disproportionately higher rates of suicide. That includes youth, males, our LGBTQI communities and all those who use mental health and addition services.

These new initiatives complement programmes that are already helping more New Zealanders and filling gaps in our current system.

We’ve got the ‘Piki’ programme in the Greater Wellington region delivering free support to 18-24 year olds, Mana Ake in primary and intermediate schools in Canterbury and Kaikoura and we’ve extended the nurses in schools programme.

Primary Care

We want to make sure people can readily access care when, where and how they need it.

That begins in primary care, which is why in our first Budget we reduced cost barriers for people most in need.

We know access to primary health services is at the heart of an effective and equitable public health system.

But cost stopped nearly 600,000 adults from visiting a general practice during 2017/18, according to the New Zealand Health Survey.

One in five Māori adults said they couldn’t go to their general practice because of cost in the same survey.

So, on 1 December last year we made it much more affordable for nearly 600,000 New Zealanders most in need to visit their primary health care practice.

We’ve lowered the cost of visits for all community service card holders who are enrolled with a primary health organisation, which benefitted 540,000 people. 

That means almost every New Zealanders who hold a community services card is now charged less than $20 to visit their doctor.

So more people will actually visit their GP.

At the same time we extended the zero fees scheme to under 14-year olds, which benefitted a further 56,000 young people and their families. 

Māori and Pacific focus

Supporting Māori and Pacific people’s aspirations was one of the five priorities for this year’s Wellbeing Budget.

We all know that we have much work to do in Health to deliver improved outcomes and equity – and I want to acknowledge here the work of my Associate Ministers, Peeni Henare and Jenny Salesa, who hold responsibility for Māori and Pacific health equity respectively. 

They, along with Julie Anne Genter, who holds the delegation for Women’s health, are absolutely focused on improving outcomes. 

We’re currently in consultation with Māori to develop a Māori Health Action Plan and we’re also consulting with Pacific peoples to refresh our Pacific Health Action Plan. 

And we’re investing in a range of new initiatives to improve equity in health and wellbeing, with a real focus on growing the Māori and Pacific workforce. 

Again, these a long-term challenges. There is no shortcut to developing a more diverse health workforce – it will take years to train up more Māori nurses and doctors.

But if we don’t start now nothing will change. So I make no apologies for targeting funding specifically to Māori and Pacific services and investing in workforce development.

Funding and Sustainability

All of this is part of a big increase in overall funding for the sector.

As Opposition Health spokesperson I pledged that a change of Government would see an extra $8 billion invested into health over four years. 

We knew if we made plain our intentions, our political opponents would shy away, as they have always been more reluctant to pledge support for public delivery of healthcare.

Two years in and we’re ahead of schedule – we’ve put an extra $6.5 billion dollars into health already.

In this year’s Budget we invested an extra $2.8 billion over four years in our District Health Boards. That was on top of the largest investment in DHBs in a decade in our first Budget.

However, it’s not realistic to expect the legacy of underinvestment to be fixed in just one or two Budgets. 

And I acknowledge that DHBs are still under pressure.

Perhaps the most obvious manifestation of that is DHB deficits, which have been on the increase since 2013, a trend which in my view is a direct result of years of underfunding.

Earlier this month you may have seen headlines about DHB deficits topping $1 billion. Hopefully, if you read fuller reports, you might have learned that the majority of that - $666 million, in fact – related to one off costs.

The majority of the deficits - $590 million - relates to one thing, putting right years of underpayment of health workers under the Holidays Act, dating back as far as 2010.

We are committed to putting that right. DHBs and unions are working together to resolve this historic underpayment that we inherited.

Again, that will take time. I don’t need to tell this audience just how complicated DHB rostering arrangements are. However, we will ensure staff are fairly recompensed.

But even leaving aside one-off costs, the combined underlying DHB deficit is $415 million dollars.

As Minister of Health I’ve been clear with DHBs that I expect sound financial management to sit alongside the delivery of quality services.

Just four of our DHBs, Canterbury, Waikato, Counties Manukau and Southern, account for almost two-thirds of DHB deficits.

It is no coincidence that I have appointed Crown Monitors or Commissioner at those same DHBs, and will install a Monitor at Southern as it transitions back to being governed by Board.

I am pleased to observe that each of those DHBs is actively engaged in mapping out a path to sustainability.

I will not shy away from further governance changes in future if required, and you can expect to see a substantial changing of the guard when we announce the latest appointments to DHBs later this year.

At the same time, the Ministry of Health has stepped up its engagement with DHBs to support them with the different challenges each faces.

These can be difficult conversations and there are no simple answers here. You don’t snap you fingers and erase years of underfunding, a lack of workforce development and underinvestment in hospital facilities.

That’s why the work of the Health and Disability System Review is so critical. It is focused on what a sustainable public health service looks like – and not just for one three-year electoral term, but what that might look like in 30 years.

I’ll have more to say about the Review shortly – and even more once we receive the final report.

But in the meantime, we are not waiting around. We’re making changes already that will make a difference.

We’ve refreshed our approach to planned care, so that we make sure people are getting treated in the most appropriate – and cost effective – setting.

Under the previous Government simple procedures such as Avastin injections and skin lesion removals were being done in a surgical theatre in some places to boost elective surgery numbers. Many of those treatments can be performed in outpatients or primary care. We can deliver more procedures for more people – and we will.

DHBs have also borne the costs of aging and increasingly inefficient buildings. 

Too many of our hospital buildings are past their use by date. They don’t support modern models of care and are inevitably less efficient.

That’s a direct result of a lack of planning and investment. 

Investing in our Hospital facilities

As a Government we understand the need to strengthen and invest in our public health services.

Budget 2019 includes an unprecedented investment of $1.7 billion over two years for upgrading our hospitals and health facilities, which is on top of the $750 million investment in our first Budget.

That’s a $2.45 billion investment in just two Budgets – twice as much as the previous government managed in nine years.

This investment gives DHBs the certainty they need to plan for the future and means they can put forward business cases for important projects that have been put off for too long.

Two weeks ago, I had the pleasure of announcing a $300 million redevelopment of Taranaki Base Hospital.

And more recently, the Prime Minister and I announced funding for a new acute mental health facility for Waikato. The $100 million project will replace the aging Henry Rongomau Bennett Centre in Hamilton.

The Wellbeing Budget also contains funding for the single biggest building project currently being progressed in health – the Dunedin Hospital rebuild.

I won’t go through the full list of projects we have funded – we have limited time – but rest assured more will follow because the need is great.

Workforce

Strengthening our health and disability workforce is also an ongoing priority for this Government – and we are making progress.

For example, there are 1458 more DHB nurses since the Government took office, 106 more midwives, 582 more doctors and 531 more allied health workers.

That’s well over 2,500 more staff delivering care in our DHBs at an estimated cost of more than $250 million dollars. That is money well spent.

And there will be more to come. We’re investing an extra $24.5 million over four years to fund more graduate nurses to complete nurse entry to practice programmes. That’s 482 more registered nurses and 130 more enrolled nurses.

We’re also committed to paying our health workers better over time. Last year’s settlement with the Nurses Organisation was worth more than three times more than the three previous settlements under National combined.

Other workforces have received similar settlements, and we’ve substantially increased fees paid to community midwives.

The sustainability of our rural health workforce is very important, which is why we’re specifically investing an extra $18 million over four years in a range of initiatives.

I understand members of the newly established Health Workforce Advisory Board are at this forum and I’m sure they’ll update you further on their work to strengthen our health and disability workforce.

I’m pleased that workforce also has a greater focus in the restructured Ministry.

Improved services

We are already seeing dividends from our investment in the health workforce.

Today I can announce that for the first time ever the number of discharges from our hospitals has topped one million – to be precise 1,005,208 discharges in 2018/19.

That is an incredible achievement across the full range of services – including acute and planned care. 

More and more Kiwis are getting the care they need – that’s great news. And we need to acknowledge and celebrate that success.

Not that there is any room for complacency. Far from it. 

This is an ambitious Government that has placed improving the wellbeing of New Zealanders at the heart of our agenda.

One very tangible sign of that commitment is our plan to improve cancer care and establish a national cancer agency.

We know there are regional disparities for people needing cancer care, and disparities in health and wellbeing for some groups, including Māori and Pacific peoples.

That’s why I was pleased to announce we’re funding the purchase of 12 new linear accelerators, and putting machines into Hawke’s Bay, Taranaki and Northland for the first time ever – so that people in those regions can get the radiation treatment they need without having to travel.

And last month I joined the Prime Minister at Auckland Hospital to launch our Cancer Action Plan, which will steer New Zealand’s cancer action for the next decade. It aims at ending the postcode lottery of cancer care, focusing on achieving equity for all New Zealanders, particularly Māori.  

We’re establishing a new Cancer Control Agency by the start of December this year, and public health physician and cancer epidemiologist Professor Diana Sarfati has already taken on the critical role of National Director of Cancer Control to provide the strong central leadership that has for so long been sought.

And we’ve increased funding for pharmaceuticals, which will allow access to new cancer treatments.

Last month, we announced a $60 million boost to PHARMAC’s funding. That was on top of the $40 million extra over four years that the Government invested in PHARMAC in Budget 2019. 

Earlier this month PHARMAC confirmed it will fund two new cancer drugs from 1 December this year to treat small cell lung cancer and metastatic breast cancer.

And just last week I was pleased to see the National Bowel Screening Programme roll out to Whanganui DHB – because everyone here knows that prevention and early detection are the key to improving our cancer survival rates.

Of course, there’s more to do. But the record shows real progress in cancer care – and I want to thank all of you who have contributed to that.

Strong leadership

We’ve also worked hard to rebuild relationships across the health and disability sector, which were seriously strained when we took office.

Essential to this is strong and capable central leadership. The Director General of Health has brought in a new executive leadership team at the Ministry.

We’ve strengthened central leadership, including a new Director General of Health – Ashley – who started nearly 18 months ago.

He’s brought in a new executive leadership team. 

I’m impressed with the positive feedback I get from around the country that demonstrates they’re making progress in terms of the Ministry’s stewardship of our health and disability system.

Ashley Bloomfield has guided a restructure of the Ministry to ensure it is better able to achieve the Government’s priorities. That includes a new Māori health directorate and an expanded mental health and addictions directorate.

This Forum is a perfect example of how the Ministry wants to work together with the sector to find the best solutions to the many challenges we face.

So what does our future look like? 

Like many countries, we face some big, long-term challenges, such as a growing and aging population and increasing prevalence of chronic diseases, such as diabetes and cancer. And there are rapid advances in technology and pharmaceuticals.

None of these challenges is new. But they are complex and we need to work together to solve them.

We have to work together to solve these issues – to make our health and disability system strong and sustainable. 

So that in the future, all New Zealanders have fair access to quality health care, no matter who they are or where they live. 

So that we deliver on the Prime Minister’s vision that New Zealand should be the best place in the world to grow up and live.

To do that we need to ensure our health services are sustainable and fit for the future – which brings me again to the Health and Disability System Review, which we initiated in May last year.

As I said then, this major review is a once-in-a-generation opportunity to improve equity of outcomes across our populations.

As I have travelled the country, both in Opposition and in Government, I have heard calls for change. Nobody I have spoken with has said there aren’t things we could do better.

The Review will chart a course for a fairer, more sustainable health and disability system that is well-placed to respond to the future needs of all New Zealanders.

The review panel’s interim report was made public last month and its main themes aligned with the Government’s priorities.

It calls for a greater role for primary and community care, the need to deliver better outcomes for Māori and improve equity, and more focus on prevention and early detection.

This interim report is built on significant engagement with the sector and service users by the review panel, which is chaired by Heather Simpson.

I’m sure many of you here today have contributed your wisdom to this review – and I want to thank you for that.

The review panel is seeking further feedback about its interim report for its final report and recommendations, which will be delivered to the Government in March next year. 

You can hear from Heather and members of the panel tomorrow about how their thinking is shaping up.

I expect the March recommendations will be significant and far reaching. Some of them may even be challenging for the sector to hear. But we cannot shy away from tackling the long term challenges we face in Health.

Conclusion

So, in closing, I want to thank you again for gathering here to discuss and collaborate on delivering equity of health and wellbeing in Aotearoa.

I believe together, we can solve the many challenges we face in our health and disability system.

Change takes time, but the initiatives and actions that the Government has put in place are an important start on this journey towards equity of health and wellbeing in Aotearoa. 

I wish you all the best success for this forum and I look forward to hearing about any outcomes from it. 

No reira, tēnā koutou, tēnā koutou, tēnā ra tātou katoa.