Waitemata DHB Innovation and Quality Improvement Symposium

  • Annette King

Thank you Pita and members of Ngati Whatua, and thank you very much to Waitemata District Health Board for inviting me to your inaugural Innovation and Quality Improvement Symposium.

One of the aims of this symposium is to profile and promote the DHB’s successes to date in implementing the New Zealand Health Strategy, and as an aside, I must say I am quite proud to have apparently mastered the art of being in two different places at the same time talking on similar subjects.

My colleague Ruth Dyson is delivering this speech for me, and I know she is very pleased also to be involved in your symposium. I would have enjoyed being with you in person, but at this very moment I am in South Auckland, fulfilling a long-standing engagement to present the 2004 report on Implementing the New Zealand Health Strategy. Following that launch I am heading straight back to Wellington to meet elected DHB board members, so I am sorry today is one day I can’t make it across the Bridge.

You can see, however, that while we may be half a city apart in geographical terms, that time-wise we are coinciding pretty well, and subject-wise we are in near enough to perfect harmony.

Firstly today, I want to acknowledge my parliamentary colleague, Ann Hartley, MP for Northcote, Dwayne Crombie, chief executive of Waitemata DHB, all the speakers, commentators and panel members taking part in the symposium, and especially those of you who are here simply because you are so interested in health innovation and quality.

Congratulations to Waitemata’s Innovative Integration for Health team, particularly Mary-Ann Boyd, for their vision and enthusiasm in producing this event. I am pleased to see there are overseas speakers here as well, giving the symposium a global as well as a national and local perspective.

One subject I’m discussing in South Auckland this morning is the first report on implementing the Quality Improvement Strategy that I launched in September last year. That makes it even more significant that quality is such a key theme of this Symposium. I know we place a great deal of emphasis on the fact that New Zealanders deserve services that are accessible and timely. They also deserve services that are of high quality.

We must continue making improvements in quality to support the Government’s overall vision of a health and disability system that is “high-performing” and “in which people have confidence.”

I also wish to speak today on the Primary Health Care Strategy and innovation. The Primary Health Care Strategy is itself a major innovation, and regarded as such not just here in New Zealand, but also overseas.
I am no longer surprised when I attend international health forums that other countries seek New Zealand out to discuss in depth our innovative approach to providing primary health care.

The Government is making a huge financial investment in providing a fair, affordable and accessible public health system, and nowhere is this more apparent than in primary health care.

Since the Government came to power spending on Vote Health has increased by more than 40 percent, this year reaching almost $10 billion, or about 20 percent of all government spending. In primary health care, the Government is spending a cumulative $1.7 billion in new money over six years from 2002-03 in implementing the Primary Health Care Strategy. Such investment is unparalleled in our history.

The Government is investing these amounts because it is convinced that the best way to improve the health of all New Zealanders is to increase our investment in early intervention, prevention and health promotion.

The creation of Primary Health Organisations was seen as radical when the first two started in July 2002, but they have now become widely and enthusiastically accepted around the country.

The Government has already announced the timetable for ensuring that every New Zealander enrolled in a PHO will be entitled to more affordable primary health care by July 2007, much faster than I originally planned.
There are now 77 PHOs around the country, with a total of over 3.7 million people enrolled in them. Almost one in two New Zealanders already have access to cheaper fees when they visit the doctor, and cheaper prescription charges on most items as well.

Cheaper access is only one aspect of PHOs, however, important though it is. PHOs also need to be innovative in terms of the range and relevance of the services they provide in their communities, and I am greatly encouraged in this respect by what is now happening around the country.

DHBs, PHOs and communities are working together, often very successfully within this DHB’s region, to ensure people know what services are available and how to use them, to put services where people are, to ensure services are right for people, and to enable people to develop a clear understanding of how they can look after their own health. You will certainly be seeing and hearing some of the results of this today.

Putting a focus on population health and on health promotion and prevention means thinking about primary health services in a different way, and I am not at all surprised that our health professionals and communities are showing themselves capable of doing just that.

I keep on mentioning communities because communities are vital to implementing the Primary Health Care Strategy successfully by helping determine how PHOs can best cater for local health needs. I believe that community involvement in decision-making makes our health system more responsive and more effective. The processes and achievements that this symposium is exploring and celebrating testify to that.

Those presenting here today have responded with a wonderful range of innovative approaches to making their services more accessible, and their willingness to tackle local health population issues has produced some very effective strategies.

Despite the very short time PHOs have been established -- the oldest PHOs are little more than two years old -- new areas, such as mental health, are constantly being explored, and I am very interested to see you have a presentation on this subject today. It is one area where I hope to see more progress shortly.

One of the objectives of the Primary Health Care Strategy is the need for a range of professionals to be involved in decision-making, rather than one group being dominant. To work most effectively, PHOs need multi-disciplinary teams consisting of a range of practitioners with the skills to communicate and collaborate in the patient’s interest. Teamwork involving nursing and community outreach is crucial.

There is no point denying that there have been occasional rocky passages during the implementation of PHOs, and that has not been unexpected as change has been so rapid. It takes time for everyone to adjust to new ways of organising health care to meet the health needs of their population.

I know Waitemata has taken on board the vision of multidisciplinary teams where each contributor is valued for their contribution. This is not always easy – especially in the area of professional role and disciplinary boundary disputes. Making it happen requires all of you to be truly focussed on the desire to achieve the best for all people using your services.

There are some excellent examples of co-operation happening here and around New Zealand, however, and this is very heartening. Examples such as Tamaki PHO and the Whitecross after-hours project, Hutt Valley’s Cardiac Continuum of Care programme, and HealthWest PHO’s joint ACC injury prevention project are very much in line with the Government’s strategic approach, and show what can be achieved by collaboration between health professionals.

Working together also means many professionals have also been able to expand their roles because of the needs of either primary care policy or the health needs of specific populations. One example on your programme today is that of nurses. The new nurse practitioner role provides an opportunity for nurses to take on a wider role in health care, including prescribing.

I firmly believe that the development of the nurse practitioner workforce provides a pivotal opportunity for DHBs and PHOs to develop new models of care delivery that will improve the health status of their local populations.

I would like to finish today with an announcement that is a tribute to people in this room. North Shore Hospital was a finalist at the national Health Innovation Awards this year, and today I am pleased to announce that your work around Warfarin is going to be taken up by the National Safe and Quality Use of Medicines Project for implementation nation-wide.

What you have done is produce a creative solution to ensuring patients take their heart medication correctly. You have produced a video for Warfarin users that is now a national example of encouraging safe and quality use of medicines. Congratulations to everyone who was involved in an excellent project.

This event makes me feel really positive about what we are achieving together in the health sector through innovation, a quality approach, the development of strong working relationships, leadership and, above all, commitment. I hope the symposium becomes a regular feature.

I am sure that by the end of the day you will feel even more motivated after the experience of so many top speakers and informative displays. Thank you once again for inviting me to be here today, and thank you especially for your continuing progress in implementing innovative and quality initiatives in the health system.