Speech to Royal New Zealand College of General Practitioners Conference 2021

Royal New Zealand College of General Practitioners Conference 2021
Tēnā tātou katoa.
Ki te reo pōhiri, kei te mihi.
Ki a koutou ngā pou o te whare hauora o Aotearoa, kei te mihi.
He taura tangata, he taura kaupapa e hono ana i a tatou katoa i tenei rā,
Mauri ora ki a tatou katoa!
Thank you for the opportunity to join you today.
I would like to begin by acknowledging your president and chair Dr Sam Murton.
The college has always demonstrated a your focus on solutions and a willingness to tackle the complex challenges, and I thank you for that.
I also acknowledge the general practitioners all around the country – thank you for your work, especially over the past 18 months in increasingly difficult circumstances.
COVID-19 has added many additional challenges and layers of complexity. I recognise that and appreciate your on-going service and dedication to care for our people.
The value of general practice
General practice and primary care are fundamental pillars of our health service –  it is the ‘front door’ to the health system for most people.
We know that for a health service to work well, the primary care system must be well supported and in good heart.
But yours is a part of the system that is under pressure – and has been for a long time.
You’ve told me about  the shortage of GPs, the rising levels of workforce burnout and that you’ve got more and more patients coming through the doors with increasingly complicated health conditions.
You’ve told me your concerns about funding for primary health-care and shared your view tht the current formula no longer fits the profile of the work many of you do.
Our primary health system – which is critical to preventing people getting so sick that they need to go to hospital – is so stretched that many practices have closed their rolls and there are no after-hours services.
Your concerns are echoed throughout the health system.
Many of our hospital buildings are crumbling and over-crowded.
Many emergency departments are struggling to cope with the number of people turning up because they need help.
Some of these people could have – and should have – been kept out of hospital with better access to primary care.
People living in rural towns are struggling to see a doctor or nurse practitoner, especially after-hours.
Nurses are telling harrowing stories of working short-staffed shifts, working extended hours and managing more patients than ever before.
Many health workers are overworked and feeling the pressure of heightened demand.
For years, people working in the health system have been trying to hold things together.
They and you perform outstandingly, but they can’t do it forever.
Our population is growing and ageing, which means there’s increasing demand for health services.
More and more people are developing conditions like diabetes, obesity, strokes, heart disease, cancer and chronic obstructuve pulmonary disease.
Problems in our wider society are making problems for our health system – children growing up in cold damp houses and without enough food  are children who are often sick.
At the same time, medical science is making it possible for us to do more than ever – but doing this requires resouces.
Labour’s record
Labour is the party of public health.
We founded the modern public health service in 1938.
Since then, we’ve had to rescue it from ill-advised attempts in the 1990sto make New Zealanders pay when they went to public hospitals.
Right now, we are, in reality, rescuing the public health service from the impacts of nearly a decade of record population growth and under-investment by the previous government.
This Government is spending an extra $1250 per person a year on health than the previous Government did.
Let me break that down, because it’s important.
Over nine years, from Budget 2009 to Budget 2017, when New Zealand’s population grew by more than half a million people, the previous Government increased the annual health budget by $3.7 billion.
This year we are spending $5.8 billion more than was spent in 2017. This year alone we will spend a record $22 billion on public health.
Our record on capital expenditure also stands up well: in the eight years between Budget 2010 and Budget 2017, National put $1 billion into health infrastructure.
In just half that time – between Budget 2018 and Budget 2021 – we’ve committed $3.9 billion, with another $1.4 billion set aside for the new Dunedin Hospital and more than half a billion dollars on upgrading IT systems.
That’s a total spend of around $6 billion on infrastructure in just four years, and there are still more significant hospital builds in the queue which we will consider later this year.
We’ve also increased Pharmac’s budget by 25 per cent to a record $1.1 billion.
You get the picture. We’re putting a lot of money into health – twenty cents in every dollar the Government spends goes on health.
But there’s more to the public health system than money. If we’re going to honour our election promise of better health for all New Zealanders and keeping COVID-19 out of our communities, we’ve got to make sure the system itself is fit-for-purpose.
This is why we are making the changes I announced in April this year.
Before I talk about progress on those health reforms though, it’s important to put them into a larger context.
After all, promoting good health and wellbeing are not solely the preserve of the health system.
Indeed, it’s a number of other social and economic factors that determine good health.
We know that being able to live in a stable housing arrangement that isn’t over-crowded, is warm and dry and not miles from your community, is essential to a healthy life.
That’s why putting in place good-quality modest housing as well as a lot more social housing is such a priority for this Government.
We have prioritised employment. That’s what drove our decision to provide wage subsidies and other business support during the COVID-19 lockdowns last year.
Keeping people attached to their jobs is as much about the wellbeing of people as it is about economic recovery.
We also provided additional economic stimulus to help the economy pick up and keep jobs going.
This week’s employment figures are testament to the wisdom of that approach.
Safe and resilient water and wastewater systems are also long-term health measures, and that is what is driving our massive Three Waters reform programme.
Managing our built environment for a better balance with conservation values, and taking seriously our moral and humanitarian duty to address climate change, are why we’re reforming the Resource Management Act and promoting climate change kaupapa.
Alleviating child poverty, providing lunches in schools and lifting benefits not only help to restore dignity and improve social cohesion, they also have health benefits.
Addressing family and domestic violence, turning Oranga Tamariki into a whanau-centred organisation, improving social integration for our many ethnic and faith communities isn’t just about stronger and more resilient families and communities. These initiatives are also about better health.
The reforms
The theme for this conference is ‘Building for the future- transforming the health sector: Ka mate kāinga tahi, ko ora kāinga rua – from adversity comes opportunity to make change’.
In April I announced the biggest reform of the health system in decades.
Our vision is a truly national health service for New Zealand – a system that focuses on treating people before they get so sick they have to be sent to hospital, that strips away unnecessary bureaucracy and duplication and, for the first time, starts giving effect to tino rangatiratanga in health.
A service in which people get the treatment they need, no matter where they live.
And a service in which doctors, nurses and other healthcare workers can concentrate on doing what they do best – healing people.
Primary healthcare will be central to the success of the reforms.
We’ve allowed the focus of our health system to drift into specialist care, with three-quarters of the Government’s health spending going to hospitals.
It’s time to shift the balance.
In Budget 2021, we added $46.7 million a year to primary healthcare funding, so that as our population grows, GPs can continue to provide affordable healthcare to the people who need it most.
And while we’ve got that massive catch-up job in getting our hospitals up to scratch after years of under-investment, in coming years I expect a growing share of funding to go to primary and community care.
The new system – Health New Zealand, the Māori Health Authority, the revamped Ministry of Health and the new Public Health Agency – will be in place on the first of July next year. Today I want to give you an update on progress.
Next month I will announce the interim boards of both Health NZ and the Māori Health Authority. I was heartened to see more than 300 people have put themselves forward.
I will introduce into Parliament next month the legislation needed to put the new public health system in place. I expect it to be passed in April next year.
Consultation has started on the new public health service, amalgamating the existing public health units.
In the next couple of months, we will be starting extensive consultation with the health workforce on the New Zealand Health Charter. This will outline the values and principles of the national system and provide a shared set of values for everyone working in our health system.
The work to progress the Māori Health Authority is also progressing at pace. At the heart of this is providing Māori with a strong voice in the health system. This work is being done by a steering group led by Tā Mason Durie.
            One of the things being considered at the moment is the way the existing Iwi Māori Partnership Boards will fit into the new system. These operate in different ways across DHBs,              and we’re looking how to adapt the most successful aspects of them.
          Officials and Māori are working together to determine the way we ensure accountability of these back to Māori, and appropriate resourcing to make well-informed decisions.
We are considering forms of operational and clinical leadership, and talking to PHOs, DHBs and kaupapa Māori and Pacific health organisations to help us design services such as local plans, which will tailor health services to local needs.
In early 2022, we will launch the first local plans. I expect primary care and community groups will play key roles in these networks, and I look forward to getting your feedback as they develop.
But what I am particularly pleased to announce here today is the accountability system that will underpin the health reforms, making sure we know whether the health system is delivering what we need.
Health System Indicators
In 2018, the Government announced it was retiring the outdated National Health Targets.
The targets have been in place since 2007 and there’s plenty of evidence – from New Zealand and other countries – that they don’t work.
They are arbitrary and don’t reflect the real priorities of the health system.
Even worse, they led to what can only be described as perverse outcomes.
Under the previous Government, district health boards deemed to be meeting the targets got congratulatory letters from the Minister of Health and were publicly praised in full-page advertisements in newspapers.
Those that did not were publicly shamed.
Hospitals developed behaviours that meant they met the targets without necessarily providing the services the people needed or wanted.
For example, lots of small procedures would be undertaken instead of fewer major ones, so it looked like more people were being treated, despite the fact that it would be much more efficient to do many of those smaller procedures in primary healthcare facilities such as GP clinics.
Clearly, clinical decisions should not be based on meeting meaningless targets and making health managers look good.
Today I am pleased to announce the new accountability system that’s replacing the health targets – Health System Indicators.
These have been developed by the Ministry of Health and the Health Quality and Safety Commission, and this framework will help the health and disability system  focus on the areas that most need to improve –  especially for Māori and Pacific peoples.
The indicators are a new way of thinking, an evolution of the System Level Measures programme developed in consultation with clinicians.
Let me stress – these are indicators, not targets.
They are not measures of every aspect of the performance of a public health service – clinical and management leaders will still actually manage the system.
But the indicators will drive and reflect good-quality management and policy decision-making.
They are a measure of how well our system is functioning as a cohesive unit, and will also allow us to create local solutions to address local health needs.
The indicators reflect the things the Government thinks are the most important priorities – improving child wellbeing, improving mental wellbeing, improving wellbeing through preventative measures, creating a strong and equitable public health system, better primary healthcare and a financially sustainable health system.
They are not fixed in stone and will change and grow as needed. These are indicators to monitor and strive for continuous improvement, and will give us useful information, right down to a local level.
To launch the system, we’ve chosen 12 indicators that will show us whether we’re really achieving our 2020 election promise – to future-proof our health and the economy and to improve the health of all New Zealanders.
Let me use one indicator to illustrate how it can work.
One of our key commitments is to improve child-wellbeing, so we’ve made one of our indicators having fewer children going to hospital for conditions that are preventable or could have been successfully managed through primary or community healthcare.
In some parts of the country, that will mean dealing with the rate of childhood asthma and other respiratory problems.
In other parts, we will need to concentrate on oral health.
The impact of these local actions will be monitored, using the indicator, to see how they are improving performance.
If we find one group of children is being hospitalised more frequently than another, the health system will have the flexibility to work with the local community – including health professionals – to find a local solution that addresses the causes behind the high number of hospital admissions.
The 11 other indicators are:
Immunisation rates for children at 24 months of age.
Whether under-25s can get access to specialist mental health services within three weeks of referral.
Access to primary mental health and addiction services.
The rate of admission to hospital of people aged between 45 and 64 with conditions that might have been prevented or better managed in the community.
Rates of participation in bowel-screening programmes.
The number of days per 1000 people spent in hospitals, including emergencies.
How well hospitals do at getting through their planned surgeries lists.
The percentage of people reporting they are getting primary healthcare when they need it.
The number of people who say they feel involved in decisions about their care and treatment.
And two relating to finances – the amount by which both the public health service’s budget and total income are under-spent or overspent.
These are just a starting point, but it’s important to get the system running now so we’ve got the data we need to monitor the reforms’ success.
This isn’t about loading primary care further to free up space in secondary care. It’s about working smarter and supporting communities.
The health indicators will bring data and people together to improve safe and equitable care whilst also getting the best value for money from the health budget.
The results of the Health System Indicators will be published quarterly in an online dashboard.
Because the COVID-19 pandemic affected the health service so dramatically last year, we have chosen December 2019 quarter as a baseline.
The national-level data for 10 indicators is online now, and the other two indicators are being developed. The local results for July to September 2021 will be published in December.
As a Government, we recognise and value the work that GPs and the primary-care sector do.
I want you to know that I’m listening, that I hear what you say and I value your input.
Our goal is a health system that helps all New Zealanders to live longer, in good health, and have the best-possible quality of life.
For that to happen, we need to have well-trained, well-supported GPs.
The changes we are undertaking with the health reforms, combined with our investment into programmes and technology, will lay the foundations for a better future and good health for all.
Thank you again for the work that you do.
Nō reira, tēnā koutou, tēnā koutou, tēnā tātou katoa

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