Publications
Addresses & Papers
Annual Conference
15th Annual Conference 2003
PRIME MINISTER RT HON HELEN CLARK: OPENING PROCEEDING
Thank you for your invitation to address the conference this morning.
Ian first wrote to me about this conference at the end of February to make sure I got it in the diary ! So my being here today is a case of the early bird getting the worm.
I would like to offer a special welcome to our international guests, and in particular acknowledge the presence of Sir Brian Jarman, President of the British Medical Association.
I have come today because I want to express my appreciation of the work done by salaried medical specialists in the public hospital system.
Some of you are full timers; others are part timers - but whatever the hours, the public hospital system could not function without your dedication.
I also appreciate that you do your very best within the resource constraints which are always with us. Many years ago, I had the privilege of being Minister of Health, and I know how difficult and complex the issues are.
But I want to say at the outset that almost without exception the New Zealand public is deeply appreciative of what you do, as I am; and that most people who experience treatment in a public hospital come away full of praise for everything that was done for them by all who served them.
In my experience as Minister of Health, 1989/90, there were several key pressure points. They were the mental health system, the costs of primary care to the patient, and the waiting times for attention in our public hospitals.
Those were three key areas we have set out to address since 1999 - but let me acknowledge that it is a lifetime's work, and there is always more to be done.
Mental Health received priority attention in our first budget in 2000 when we committed more than a quarter of a billion over four years to implement the Mental Health Commission's Blueprint for services. This has enabled much to be done, but it will require continued commitment to building a skilled workforce and to building and sustaining quality across the board.
In primary health care, major funding began to roll out for the new Primary Health organisations in 2002.
Around two million New Zealanders are now enrolled in the PHOs, and in around half of those adults have access to low cost fees.
The high level of support for doctors visits by the under six's has been maintained, at a level enabling them to be seen for no fees.
From 1 October all PHOs will e able to charge low fees for all under eighteen year olds; and from 1 July next year, all aged 65 and above enrolled in PHOs will be eligible for both low fees and the three dollar prescription fee.
Our hope is that making primary care more accessible will take pressure off the emergency and secondary services by enabling people to get treatment early.
Then there is the throughput in the public hospitals.
What was previously short term funding to boost output prior to 1999 has been built into baselines.
That has enabled the number of surgical operations to be maintained at an all time high over the last four years.
We have also prioritised giving people more certainty about whether and when they will get treatment.
The aim is to get all patients referred for first assessment to see a specialist within six months.
In the 2002/03 year we achieved that for 93 per cent of patients.
Of those who are assessed as meeting the threshold for treatment, the aim is to give certainty of treatment within six months.
We have met that target for eighty per cent of those booked for surgery.
However, I am the first to acknowledge that there are still a number of pressure points in the system.
The Ministry of Health acknowledges that not all patients who could benefit from orthopaedic surgery for example, can currently receive it, and we clearly have more work to do in this area.
It appears, for example, that while other kinds of high volume elective surgery have significantly increased delivery, with additional funding over recent times, major joint replacement surgery has not increased delivery at the same rate. Delivery of major joint surgery increased from 4570 in 1996/97 to only 4878 in 2001/02; compared to, for example, cataract surgery up from 6593 in 1996/97 to 7782 in 2001/02, and cardiac surgery up from 3090 in 1996/97 to 4975 in 2001/02.
The Minister of Finance will address you later today on health funding.
Total spending on Vote: Health this year has reached an all time high of $9.61 billion.
Health spending will undoubtedly continue to feature very prominently in our budgets, because meeting health needs is a core responsibility for our government, and we will invest as much back in as we can.
But we will also continue to emphasise continual improvement in systems and organisation in our hospital sector, so that we get the most value possible for this sizeable spend.
Recently the pain and stress suffered by one of my constituents waiting for surgery was raised in Parliament by another political party.
Getting to the bottom of what happened was complex, and I am convinced that the specialist involved acted with integrity and good faith. My constituent did have an unrelated medical condition which had contributed to the deferral.
But there were also systems and organisational issues within the hospital and across a number of sites; such as when the theatres were closed for maintenance, and the almost inevitable confusion which arises when the operation is to be done on one board area; the outpatient visit is in another, and the referral for a heart check is a third. In some way each of these factors could contribute to delay.
Throughout 22 years in Parliament I have advocated for elderly people in pain who need treatment. I am as passionate about making the system work for them as I know you are, and I know that we still have work to do.
On the system issues, the Ministry of Health is working on how access to orthopaedic services, and major joint replacement in particular, can be improved.
T that end, it has initiated a Continuous Quality Improvement Pilot to assess the improvement equity of access to orthopaedic services across four DHB sites: Southland, Otago, Nelson/Marlborough, and Counties Manukau. The draft report on the pilot is due at the end of November.
Through the pilot the Ministry aims to get new insights into how to improve the processes required to ensure that patients are treated in priority order, in a timely manner, and are provided early accurate information about whether and when they will be treated.
The pilot emphasises continuous quality improvement of prioritisation processes, and provides a firmer basis for comparisons of clinical consistency within and between DHBs.
Each of the pilot sites has started to implement improvements to treatment decision processes.
The Orthopaedics Association and the pilot sites have agreed to support the refinement of the clinical priority assessment criteria and their application. The Ministry of Health believes that this increased engagement and buy-in will contribute positively to support for improved prioritisation processes more generally across the sector.
The pilot sites have committed to improving processes to better define and reduce variation in the range of clinical judgement in their services.
These continuous quality improvement outcomes provide the basis for assurance that any additional resources devoted to orthopaedic services would help the patients in most need.
As these approaches are more widely implemented within the pilot sites and other DHB, the stress on patients, their families, and general practitioners should be significantly reduced.
And from this process, DHBs and the Ministry should have much better information to strike a right balance between the different kinds of orthopaedic operations, and between orthopaedic surgery and other health services. Achieving that balance, however, will be reliant on DHBs treating patients systematically in priority order.
The Ministry should be reporting back to the Minister of Health next month on this subject.
There are two other initiatives related to quality of service which I want to mention briefly. While emphasising that our health services are of high quality, we all accept that there is always scope for doing better.
Quality was identified as one of the cornerstones of a high-performing system in the New Zealand Health Strategy (NZHS). It is also a dimension of the objectives in the New Zealand Disability Strategy (NZDS).
The Minister of Health recently released the document: Improving Quality (IQ): A Systems Approach for the New Zealand Health and Disability Sector.
The document represents a commitment to supporting continuous quality improvement by each person working within the health and disability system and to the people affected by the system and the system itself.
It recognises the complexity of quality in the health and disability system by adopting the systems approach, with its understanding that quality is the cumulative result of the interactions between people, individuals, teams, organisations and systems.
Credentialling
The second initiative in quality improvement I want to mention is the credentialing system for senior medical officers in DHBs which is being implemented nationally. While it is to protect the patient, it also protects clinicians, by supporting them working within the scope of their competence in a particular setting or service environment.
Also released this year was the document Toward Clinical Excellence: A toolkit to develop consumer participation in credentialing. It provides a resource for the health and disability support sector to meet the requirements for public participation in the national credentialing framework.
At this conference you have a strong focus on industrial relations. As you know, how government gave priority to repealing the Employment Contracts Act in year 2000, and putting new legislation based on the concepts of good faith and building relationships in place.
The legislation has been reviewed, and now three years down the track from its passage we are preparing to introduce amendments to improve its functioning. Changes in this area are always controversial, but I am sure that this Association as a CTU affiliate will find it is able to be positive about the new bill.
This Association is committed to continual improvement in the conditions of work and service of its members.
Having read the Executive Director's annual report I am aware that there are many issues you are taking up in many boards, and that unresolved issues can sap morale. I can't wave a magic wand and resolve all those issues, but I do want to see our government work with you, other health sector unions, and the DHBs in good faith to get the best for the public health system.
Once again, thank you for the contribution you are making.