Speech to the National Rural Health Conference

  • Hon Dr David Clark


Thank you, Dalton (Kelly) for your warm introduction.

It’s a pleasure to be here to open this conference - it’s the second time I’ve had the opportunity to speak with you at your annual conference as Minister of Health, so I want to thank you for welcoming me back.

Firstly, I’d like to acknowledge the tragic events in Christchurch three weeks ago and to express my deepest sympathies to the victims, their families and friends.
They were innocent people who should have been safe to practise their religious beliefs here in New Zealand, but were not, on that terrible day.
Some of you may know people who have been directly affected by this tragedy, or you’ve been affected yourselves. I’d also like to acknowledge the bravery and dedication of all health professionals involved in caring for victims, their families and friends. I'm sure many of you will know colleagues who have been involved in caring for victims and some of you may have been involved directly. I’m sure you can all empathise with the many challenges they’ve faced and continue to face after such an unprecedented attack.

Today, we’re here to talk about rural health. I understand there’s north of 400 people here at this conference from around New Zealand and overseas – doctors, nurses, allied health professionals, practice managers, students and others. Welcome to you all.

I want to acknowledge the hard work done by the New Zealand Rural General Practice Network – thank you.
Special thanks to your Chair, Sharon Hansen, your Chief Executive, Dalton Kelly, and your Committee members for your commitment and leadership in supporting rural health professionals around New Zealand.

I’ve met many of you over the past 17 months and I’m always impressed with your advocacy for rural health and improving health outcomes for rural New Zealanders. I want to thank you for your contributions and acknowledge you face particular challenges because of the geographic isolation of many of your communities.

I also want to thank you for sharing your views openly with me. I know we won’t always perfectly agree, but I welcome and value your input and suggestions. It’s important that we work together to find solutions for improving rural health in New Zealand.

The Network has put together an excellent programme for the next few days and you’ll hear from some of the world’s leaders in rural health. I’m pleased that I’ll have the opportunity shortly to listen to your first keynote speaker Professor Paul Worley – Australia’s first National Rural Health Commissioner and hear what learnings we can take from Australia’s rural health experiences.

Later today, you’ll hear from Dr Ruth Stewart – Senior Medical Officer for the Torres Strait community of Thursday Island and tomorrow, Dr Hine Elder and Dame Tariana Turia will share their knowledge with you.

I want to thank all of you who are here as speakers or to run workshops, along with all participants here. Sharing your wisdom and expertise is vital in making these conferences a success and allows us to learn new ways to improve rural people’s health and wellbeing.

I’d also like to acknowledge your Kaumātua, Bill Nathan and the Te Roopu Group.

Finally, by way of introduction, I’d also like to acknowledge and welcome the students who are attending– I understand there are between 50 to 80 students here. You are our future rural workforce and hopefully this conference will help you to decide or confirm your excellent decision to live and work in a rural community after your training.

Rural Health Workforce
Sustainability of our rural health workforce is an important priority for me, and I know it’s important to you. I agree with you that our rural health workforce is vital for improving health outcomes and wellbeing for people living in rural areas around New Zealand. I look to you, with your hands on experience and insights, to help drive improvements in our rural health workforce.

There’ve been some changes since I spoke about workforce at your conference a year ago. I’ve asked the Ministry of Health’s new Health Workforce Directorate to prioritise rural health workforce development as one of its top three immediate priorities. They acknowledge the work already done in this area and are proceeding with a sense of urgency. I understand a steering group and a joint summit are already under development.

Discussions have occurred with the national rural advisory group, calling for nominations of groups or individuals to sit on the steering group. I hope that members of this group will cover a broad array of rural health expertise from academia to the local community consumers. Current plans are to hold the joint summit in May or June, which reflects my desire for urgent progress in this area and I look forward to hearing more about this in the coming months.

I believe a multi-disciplinary approach is needed to get the best out of a constrained workforce. This also helps to drive further integration across the system, strengthening the system, reducing demand, and improving access and health outcomes for rural people. 

I’ve heard about the multi-disciplinary training hubs you support, which align with my vision of a strong multi-disciplinary workforce.
I want you all here to know of my express support for this approach.

I am announcing today that I will be asking the Rural GP network, the New Zealand College of GPs, Otago and Auckland University rural professors to work together with DHBs to scope a first rural training hub in the New Zealand setting, and then to report back on an implementation path as to how this can be achieved, and  subsequently rolled out to other locations.

I’m sure your discussions among yourselves during this conference, further enlightened by input from overseas experts here, will help to inform discussions at the planned summit in May or June.

PRIME – Primary Response in Medical Emergency
A year ago, I spoke to you about the PRIME Service Review in 2016 and the then newly-established National PRIME Committee.  This Committee has worked diligently over the past year to improve the PRIME service and has begun implementing the Review’s recommendations. I understand the Committee met yesterday where they made constructive progress towards further implementing the review’s recommendations.

I’m encouraged by the introduction of new tasking criteria which have led to a 12.8 per cent reduction in the number of calls despatched to Prime providers. I understand at yesterday’s meeting, the committee agreed to a refined set of tasking criteria which are anticipated to reduce the number of dispatches by over 45 per cent. This work is important as we need to make sure the work load for Prime providers is appropriately managed while ensuring rural populations get the service they need.

I’m told that significant administrative, support, training and equipment recommendations have already been implemented, and further work is planned.

Changes in Primary Health Care
When I spoke to you at last year’s conference, I shared the Government’s plans to introduce new initiatives to improve access to primary health care services by reducing cost barriers for people most at need. Improving access to primary care is at the heart of an effective and equitable public health system, and is one of my main priorities because we know that improved access and early diagnosis means better health outcomes for people.

Cost stopped nearly 600,000 adults from visiting a general practice during 2017/18 – that’s about15 percent of the adult population, according to the latest New Zealand Health Survey. One in five Māori adults said they couldn’t go to their general practice because of cost.

On 1 December last year, the Government extended Very Low Cost Access scheme subsidies to ensure reduced fees for all community service card holders who are enrolled with a primary health organisation. That lowered the cost of general practice visits by an average of $20 to $30 for an extra 540,000 people.

We also extended zero fees for under-13s to under-14s from 1 December last year, which benefitted a further 56,000 young people. Not only is it now cheaper for many people to visit their general practice, but these initiatives also mean some people will go to their general practice who wouldn’t have previously because of cost.

I’m very pleased with the uptake by general practices, with about 91 percent of non-Very Low Cost Access practices opting in to providing this cheaper service for their patients. I understand that 97 per cent of Māori and 98 per cent of Pacific people who are community service card holders are enrolled with practices that offer lower cost fees. 

I want to thank all of you involved for embracing these initiatives and enabling improved access for care for those who need it in your communities. These changes have been a great start in our journey to improve access to primary health services for all New Zealanders, and we must continue to look for new ways to improve access.

In my letter of expectation to district health board chairs, I’ve asked them to raise the profile of rural health services. I’ve asked DHBs to consider the health needs of people living in their rural communities and to also consider the factors that affect health outcomes for rural populations when DHBs make decisions regarding health services.

The Ministry also continues to support a national rural health advisory group, which meets three to four times a year in Wellington. The advisory group brings together different parts of the sector providing rural health services. That includes DHBs, primary health organisations, general practice, nursing, ambulance, pharmacy, Work and Income, ACC, Ministry for Primary Industries, the Ministry of Health, PRIME providers, rural hospitals, the Rural Health Alliance, the College of GPs and others.

I understand the advisory group has two key focus areas for this year. They are better supporting rural service level alliance teams to fulfil the service planning role expected, and working with the Ministry to develop options to strengthen the rural health workforce.

I look forward to the development of strong rural alliances driving improved rural health services with your alliance partners, including DHBs and ambulance services. Every rural community is different and it’s important that local leaders design services to meet local needs.

As you’ll be aware, my colleague, Hon Damien O’Connor, Minister for Rural Communities, launched the rural proofing policy at Fieldays last June. And I can assure you he is assiduous in his own gentle (by which I mean robust) way of reminding cabinet committees of its importance.

The rural proofing policy aims at ensuring rural communities are a key consideration during policy development and the implementation of new initiatives. As the Minister with responsibility for the Ministry of Primary Industries, he has instructed MPI to support government agencies to start using the rural proofing tool. MPI is currently in discussions with the Ministry of Health on how local flexibility can fit within this policy model.

Health and Disability Review update
Another of my top priorities for health is ensuring we have a strong and equitable public health and disability system that works for everyone.  We can all be proud of our public health system and what it achieves, however we also know disparities exist, particularly for Māori, Pacific peoples, people living in rural communities and those on low incomes. The Government is committed to building a truly public health system that delivers the care that all New Zealanders expect and deserve, regardless of who you are or where you live.

That’s why I established the Health and Disability System Review in May last year. This wide-ranging 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 has been gathering input from a wide range of health and disability parties, and I’m aware the Rural GP Network has met with the Review team. I’m confident your specialist rural perspective will add an important lens to their deliberations. They’re also currently seeking feedback via an online consultation portal.

I encourage you all to take the time to engage with this review and share your thoughts on how we can improve the wellbeing of all New Zealanders, particularly for those living in rural communities. The panel’s interim report is due to me by the end of August this year, and the panel will undertake further consultation before completing its full report by the end of March next year. I look forward to seeing the recommendations that you, as a key part of the health system, have helped to inform.

Wellbeing Budget

I want to say a few words about the upcoming Wellbeing Budget. As part of this Government’s commitment to improving wellbeing and living standards for all New Zealanders, the Prime Minister has announced that this year’s Budget will be the world’s first Wellbeing Budget. 

I wish to reiterate what I have already said to many of you that I believe if we can think of health in the broader sense of wellbeing and work together and across sectors, we can achieve the best outcomes for health and wellbeing for all New Zealanders, including those who live rurally

Closing remarks

In closing, I want thank you, again, for inviting me here to speak with you today. This conference is an important opportunity for you all to share your experiences and solutions so that together we can improve New Zealand’s performance on rural health. I wish you all the best for this conference and for your future work in the rural health sector.

Again, I’d like to thank you all for your significant contributions to the health and wellbeing of people in your rural communities, and I look forward to working with you in the future and hearing the ideas that emerge from this conference and from the upcoming joint summit.

Nō reira, tēnā koutou, tēnā koutou, tēnā tātou katoa.