Speech to open the Radiation Oncology Horizon Summit 2019

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Thank you, Natalia for that kind introduction.

It’s my pleasure to be invited to officially open the Royal Australian and New Zealand College of Radiologists’ Horizon Summit here in the Grand Hall at Parliament today.
Firstly, I’d like to acknowledge and thank your board of directors, councillors and senior management team.

You’ve demonstrated leadership and advocacy in improving patient care and quality standards in clinical radiology and radiation oncology on both sides of the Tasman.
Your commitment and hard work make a vital contribution towards improving the health and wellbeing of New Zealanders.

You also support more than 500 medical specialist members here as they carry out their important work in our communities.

I understand this is the first time key stakeholders in clinical radiology and radiation oncology have united here in New Zealand.

This represents a unique opportunity to collectively map out better solutions so that people in New Zealand have improved and more fair access to these diagnostic tools and treatments.

It’s a privilege to be here today to see you all join together to share the collective knowledge and experience, which is so important in making these conferences a success.
You’ve put together an excellent programme for today’s conference with some impressive speakers.

I’d like to warmly welcome and thank those of you who are here as speakers today for generously sharing your wisdom with us.
I understand that you’ll hear later today from several consumers who will share their journeys with you.

As we all know, people are at the centre of cancer care, and hearing people’s personal experiences is extremely valuable for us all.

I’d also like to acknowledge your College members here today for your valuable contribution towards helping people around New Zealand to receive the best treatment and care possible.

I’ve had the pleasure of meeting some of you previously and I’m always impressed with your determination and commitment to strive for better health outcomes for New Zealanders.
Finally, I’d like to welcome some of my Parliamentary colleagues here today, including the Honourable Michael Woodhouse.

The focus of your conference today is the future of radiation oncology within the context of cancer care in New Zealand.
Three months ago, I had the honour of formally opening the Cancer Care at a Crossroads Conference. I know some of you here today also attended that conference.

It was one of the largest conferences of its type on our shores in some years with hundreds of people from diverse backgrounds gathering here in Wellington to talk about the future of cancer care.

On the day I spoke, I announced the Government’s commitment to develop a new Cancer Plan, which has the bold goal of achieving equity of outcomes as a priority.
This Cancer Plan will provide a blueprint for the Ministry of Health to coordinate the cancer programme for New Zealand.

In particular, it will identify how we use our resources to reduce the incidence and impact of cancer, and improving the quality of life of those living with cancer within available resources.

The plan will cover the cancer control continuum from prevention, screening and early detection, treatment, support and rehabilitation, palliative care and survivorship.
The Ministry invited conference participants to attend workshops the day after that conference ended, which was an important early step towards collaboratively building that plan.
Some of you may also have attended those workshops.

That was an important early step and I know there will be wider consultation as we work towards changing our whole health system to improve cancer care for the future.
The Director General has assured me there will be an interim Cancer Plan in place by the end of June.

 After that, I understand the Ministry plans to consult with the broader cancer care sector, which will include the College, about its draft Cancer Plan.
I encourage you all to engage with this process. Your expertise and knowledge is valued and vital.

When my friend and former Minister of Health, Annette King, launched New Zealand’s first Cancer Control Strategy in 2003, she said the strategy encouraged government and non-government providers to work closely together to achieve long-term change.

That is very true.

Such collaboration is vital to achieve improvements for the future of cancer care in New Zealand, which is why conferences such as this one today are so crucial.

Overall, New Zealand is ranked middle of the pack among 15 comparable countries in terms of overall impact of cancer. We’re ahead of most of the world, and can rightly feel proud of that achievement.

There is more, however, to be done.

Radiation oncology has a vital role in helping people to fight cancer and is involved in about 40 per cent of all cancer cures.

I understand that about one in two people diagnosed with cancer would benefit from radiation therapy at some point in their cancer journey.

However, it concerns me to learn that only about a third of these people diagnosed with cancer in New Zealand actually receive radiation therapy at some point.
This means many people are missing out on potentially life-saving treatment and could suffer worse health outcomes as a result.

It is particularly concerning that many of those who have been referred for radiation therapy are not receiving it when they should.

In recent days I’ve been advised that far too many New Zealanders are experiencing unreasonable delays in receiving radiation therapy and there is variable performance by DHBs on this.
 
I’ve made my expectations very clear to the Ministry of Health that no patient with cancer should experience these delays in their treatment and I’ve sought urgent advice about how they can work with DHBs to improve the timeliness of radiation therapy.

I’m now advised the Ministry of Health has contacted DHBs to remind them of their responsibility to ensure New Zealanders with cancer receive treatment quickly.

The Ministry has also asked DHBs to examine their performance in radiation therapy and to come up with a plan to address any shortcomings.
 
We have some tools at our disposal to make the required improvements.

The Radiation Oncology National Plan 2017-2021 sets out actions for the Ministry, DHBs, regional cancer networks and other organisations to improve radiation oncology services.
A key action in the Radiation Oncology National Plan was the development of the Radiation Oncology Collection and online tool, which were released last year.

These allow the sector to understand access to radiation oncology services and how patients are being treated.

You’ll also hear from Dr Shaun Costello later this morning about this new initiative, which helps us to understand variations of care around New Zealand.

I acknowledge that it can be uncomfortable and confronting for us all to compare how DHBs perform for cancer, but it’s vital to know where disparities exist around New Zealand so that we can address them and improve our national consistency of care.

DHBs are already using this new radiation oncology information to guide their practice, which I’m pleased to learn.

I’d like to thank those of you who have contributed to this important project.

It is supporting DHBs to provide more equitable and cost effective services across New Zealand, as well as supporting improved capacity planning.

I’d like to turn now to the wider programme of work the Ministry of health has underway to develop people-centred standards of care to support quality improvement across cancer care and treatment.

The standards will be measured by quality performance indicators.

The first one for bowel cancer was presented at the Cancer Care at a Crossroads conference.

We’ve now started developing clinical quality indicators with the sector for lung, prostate, melanoma, gynaecological and neuroendocrine tumours, and ultimately plan to have quality performance indicators for all tumour streams.

We all know cancer’s burden is not equally shared in New Zealand.

Maōri are about 20 per cent more likely to get cancer compared to non-Māori, and nearly twice as likely to die of cancer.

Maōri are often diagnosed late, which means cancer is more progressed, affecting treatment options and worsening outcomes.

Cancer outcomes are also worse for people living in poverty, those with chronic health conditions and mental health problems, and those living in rural areas.
Maōri are over-represented in these categories, as are Pacific peoples.

I want to congratulate the College on its work in improving public awareness about radiation oncology as a treatment option with your Radiation Oncology: Targeting Cancer campaign. It is important that people know about this treatment to improve access.

On a broader scale, we need to do better to address inequities in our health and disability sector, which includes cancer care.
Achieving equity is a strong focus for the Government.

Better access to primary health care is at the heart of an effective equitable public health system and putting a greater focus on primary care is one of my priorities.
Often the first step for cancer detection is through primary care. 

Cost stopped 585,000 adults from visiting their general practice during 2017/18 - that’s about 15 per cent of our country’s entire adult population – according to the latest annual New Zealand Health Survey.

For Maōri, it was worse. One in five Maōri adults say they couldn’t go to a GP because of cost, according to the same survey.

Last December 1, the Government extended the Very Low Cost Access scheme to all community service card holders, which lowered the cost of primary care visits by an average of $20 to $30 for an extra 540,000 New Zealanders.

At the same time, we expanded the zero fees for under 13s for primary care visits to include under 14s, which benefitted a further 56,000 young people.
We believe making primary care visits more affordable to those who need them most will improve access and health outcomes, including keeping people out of hospital.

Not only will it make doctors’ visits more affordable, it may mean patients make those appointments when they may otherwise choose not to because of cost.
I have no doubt that these initiatives will result in the earlier detection and treatment of diseases for some people, including those needing radiation treatment for cancer.

We can all be justifiably proud of our public health system’s performance, including in radiation oncology, but we can’t get complacent, or ignore the need to keep doing better.
I set up the Health and Disability System Review in May last year to future-proof our health and disability services.

This major review, being led by Heather Simpson, is identifying opportunities to improve the performance, structure, and sustainability of our health system.
It has the goal of achieving equity of outcomes, and contributing to wellness for all, particularly Māori and Pacific peoples.

This review is a once-in-a-generation opportunity to improve equity and outcomes for New Zealanders.

It 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.

It’s an important opportunity for you all, and I encourage you to take the time to engage with this review and to share your solutions for facing the challenges in radiation oncology.
The review panel’s interim report is due to me by the end of August, and I’ll get their final report by the end of March next year.

I know that improving the sustainability of New Zealand’s radiation oncology workforce is one of the College’s priorities.

I also recognise the importance of a strong workforce to support high quality radiation oncology services, including radiation oncologists, medical physicists and radiation therapists.
Strengthening our health workforce is a priority of this Government. 

Last December, I announced changes for Health Workforce New Zealand (HWNZ).

As part of the Ministry’s restructure last year, the Director-General of Health has created a stand-alone Health Workforce Directorate, which has greater capability and capacity to focus on health workforce issues.

This new approach means we will take a fresh look at our workforce strategy and planning.

I’d like to conclude by thanking you all again for your dedication and commitment to helping people to better tackle cancer.

And I congratulate you for coming together to jointly find solutions to challenges faced in radiation oncology and cancer care so that all New Zealanders can access appropriate care that they need and deserve, regardless of who they are or where they live.

It’s been a pleasure having the opportunity to speak with you here today and I look forward to hearing about outcomes after this conference ends.