Speech to NZ Sepsis Conference 2021

E nga mana,

E nga reo,

E nga iwi,

Tēna kotou katoa.

Ka huri ki nga mana whenua o te rohe nei. Tēna koutou.

He mihi hoki ki a tatou kua tau mai nei I raro I te kaupapa o te rā.

No reira tēna koutou katoa.

Opening

It’s a pleasure to be here among so many former colleagues, delegates, and dignitaries.

I would like to begin by thanking the New Zealand Sepsis Trust and the Australasian Society for Infectious Diseases for hosting this inaugural conference, and for the honour of providing the closing address, as well as the many excellent speakers who have given their time and knowledge.

I mihi also to Kiingi Tuheitia, and members of the Waikato and Te Arawa iwi and tangata whenua here today.

Finally, my appreciation as always goes to Te Ohu Rata o Aotearoa, and ACC.

Over the last two days, you have heard from some of the most accomplished clinicians and experts, and I hope this opportunity to share, korero, and learn, has been valuable for you.

Having worked alongside many of you, sepsis is a familiar problem and as we all know it has widespread and devastating impacts.

It is also a unique and complex critical management problem. Firstly, it’s difficult to diagnose, and secondly treatment requires high performance of community, emergency, laboratory and ward systems and teams.

I know you’ve been busy debating the important - in fact lifesaving - details of antibiograms, crystalloid verse colloid, and the SOFA score. As a Minister, I’ve been focused on related issues of infectious disease prevention. We’re also making important reforms to the health system, which aim to enhance prevention and improve our dissemination of knowledge.

Sepsis prevention

While the last two years have been undoubtedly challenging, we must, at the very least, use them as an opportunity to learn.

The COVID-19 immunisation programme is the largest vaccination programme Aotearoa has undertaken. I’m proud of our efforts, while acutely aware there is plenty more to do.

We all have a part to play in protecting New Zealanders and giving us more options in the future. 

The COVID-19 immunisation programme has shown how the health sector, and indeed the whole country, can mobilise quickly around an issue. So far, we have fully vaccinated more than 80 percent of eligible New Zealanders, and more than 90 percent have had their first dose.

I know many of you have contributed your technical expertise to the program design, or been operational leads in your region. Thank you.

I’ve heard about our health workforce going into milking sheds and visiting shearing gangs to administer the vaccine. They’ve vaccinated in corporate offices, shopping malls, and supermarket carparks, not to mention the ever-popular drive-through model we’ve seen introduced. I am incredibly proud of what the country has achieved, our ingenuity, and how it helps in our fight against sepsis.

The lessons we have rapidly learned during the pandemic around prevention and management of infectious diseases, will be valuable in our fight against sepsis and other infectious diseases. We have developed world class IT to support vaccinations that allows us to identify and target the unvaccinated.

We’ve also learned practical lessons about how to mobilise the community around a vaccination goal. We will apply these lessons to influenza, measles and other childhood diseases.

Vaccination against COVID-19 will undoubtedly help protect New Zealanders from sepsis, by reducing the demand on our hospitals.

Of note, is that Māori and Pacific people face higher rates of sepsis - at least double the rate amongst non-Māori and non-Pacific people.

Infection Prevention and Control

COVID-19 has shown how critically important infection prevention and control is in hospital, healthcare, and community settings.

Before COVID-19, it could be said there was inadequate awareness and emphasis on IPC measures and outcomes, despite the efforts of dedicated professionals.

This included a lack of national consistency for practice, and measurement of outcomes, for both hospital and community services. IPC practices may not have been at the forefront of every service or health worker’s focus, and not valued as a priority component for maintaining patient, whānau and community safety.

Since the pandemic, there is greater attention by everyone when implementing and maintaining IPC practices - as this not only reduces the risk of transmission of COVID-19, but also improves patient outcomes through reducing other healthcare-associated infections.

Ongoing public awareness and education campaigns on basic infection prevention measures such as hand hygiene, covering coughs and sneezes, and staying home when sick, will have a continued impact on reducing the spread of COVID-19 and other communicable diseases.

It will be important to continue to build on what’s been more learnt. Progress will continue through the National IPC Strategy which is currently under development, with a view to implementing it next year.

Our IPC advice has always been based in evidence and, as we’ve seen, what we know can change quickly and is a complex landscape - requiring rapid reconfigurations and changes to protocol.

For example, at the start of the pandemic we were focused on droplet spread, while we now know protection should be focussed on ventilation and reducing airborne spread - via the use of masks and other PPE. This poses challenges in a clinical setting (negative pressure rooms have never been so interesting to the media) as well as in a community setting, where it is much harder to control. We must continue to build on our knowledge, and remain flexible and adaptable.

Thanks again to those who have supported TAGs, or IPC in hospitals, Aged Residential Care, the community, and MIQ.

Antimicrobial Resistance

Given it’s also World Antimicrobial Awareness week, and the critical role antibiotics play in the treatment of sepsis, it’s pertinent to discuss antibiotic resistance.

This year’s theme is “spread awareness, stop resistance”. Antibiotic resistance is happening now, here in Aotearoa and around the world. It can affect anyone, of any age, in any country.

Indeed, it is one of the biggest threats to global health, food security, and the environment today. The World Health Organisation has declared AMR one of the top 10 global public health threats facing humanity.

We published the AMR action plan in 2017, and while progress has been made, there is work to do. The Prime Minister’s Chief Science Advisor selected AMR as their major project for 2021. 

One action that has been delivered on, is the updated Ngā Paerewa Health and Disability Services Standards, published in July and coming into effect in February 2022.

This standard has a strengthened infection prevention and antimicrobial stewardship, which includes learnings from New Zealand’s experience of the COVID-19.

I know many of you have been working with the Prime Minister’s Chief Science Advisor Dame Juliet Gerrard on a report on AMR. I am eagerly awaiting that report, and hope it will reinvigorate our efforts in this important area.

The health and disability system reforms

The reforms we are making to the health system, will ensure prevention is at its core. The health and disability system reforms provide us with a great opportunity to strengthen the public health system, improve population health outcomes, and reduce inequities.

The Public Health Agency will help the system build better links between science and public health, particularly in relation to surveillance and the role of laboratories.

Surveillance and knowledge-driven policy, planning and implementation will be embedded as part of the wider system’s DNA. We will have strong leadership through the Director of Public Health leading a single, national Public Health Unit, that works in partnership to tackle the challenge of communicable diseases.

We have Centres of Excellence such as the Health Quality and Safety Commission that lead the implementation of knowledge-based, quality improvement initiatives to improve infection prevention and control, and reduce the transmission of healthcare associated infections - including central line associated blood stream infections.

Working collaboratively, in partnership in a strengthened public health system is a key factor for our success in reducing inequities and improving prevention and management of infectious diseases in Aotearoa.

HIRA

Historical under-investment in data and digital capability has been holding back the health and disability system from better managing conditions like sepsis.

Health information is currently stored across a range of separate systems. This means relevant information isn’t always shared between providers. It also limits our ability to analyse health data and gain insights into the prevention and management of health conditions.

The Hira programme is one of several significant data and digital programmes underway that will help transform the health and disability system so all New Zealanders receive consistent, equitable and high-quality health services in a sustainable way.

We are investing up to $385 million over four years to implement Hira, formerly known as the National Health Information Platform, as well as improved health sector data and digital infrastructure and capability.

In the first instance, Hira will allow a person’s health information to be brought together to create a virtual electronic health record. This will help lift quality of care by ensuring trusted health providers have secure, easy access to complete patient information, in the right context and at the right time.

Over time, Hira will create an ‘ecosystem’ of trusted data and digital services. This will empower New Zealanders to better manage their own health and wellbeing, and will also enable joined-up delivery of health and wider social services that respond to a person’s whole needs.

Hira will also provide a national view of population health information. This will inform the development and targeting of health promotion and prevention programmes, while enabling commissioning bodies to better focus investment - to improve equity for Māori, Pacific peoples and vulnerable populations.

Hira will continue to evolve as innovators build new data services and functionality, which will be a catalyst for establishing new, digitally-enabled models of care. For example, with the right digital capabilities in place, in-person visits can be increasingly supplemented with telehealth and digital therapeutics, which will make it easier and faster for people to access health advice and services, while allowing providers to better prioritise those most in need of in-person care.

Strategic science investment fund

The pandemic has also highlighted longstanding gaps in our domestic science capabilities, notably the lack of a dedicated infectious diseases research fund.

We want to make sure the new system is informed by the best knowledge.

To address this, we are investing $36 million over three years in a new programme of research to sustain the contribution of cutting-edge science to the response.

The focus will be on major research questions relating to Covid-19, which are common to all infectious diseases.

The first priority area is improving prevention and control, including through better understanding of disease transmission, and further vaccine research. The second is improving our management of infectious diseases, for instance through diagnostics, surveillance, and therapeutics.

Reducing the impact of infectious diseases on Māori and Pacific people, and promoting the development of our next generation of pandemic scientists, are key drivers of this work.

This important investment will enable us to sustain the valuable contribution scientists make to the COVID-19 response, improve capability, and prepare for future pandemics. It will also generate practical collaborations between scientists, the health system, and the pandemic response.

Closing remarks

To conclude - while this is a challenging time for health, it is also a very exciting time.

We have excellent systems in place, and some of the most distinguished experts working across the motu. I’m confident we will tackle every challenge as it comes.

Thank you again for your work and commitment to constant improvement and caring for our people.

Ngā mihi nui.