Ryall: Speech to the PHO Alliance
new-zealand-national-party
Fri Sep 07 2007 12:00:00 GMT+1200 (New Zealand Standard Time)
Ryall: Speech to the PHO Alliance
Friday, 7 September 2007, 1:15 pm
Speech: New Zealand National Party
Hon Tony Ryall MP
National Party Health Spokesman
7 September 2007
Speech to the PHO Alliance
Wellington
Thank you for the invitation to speak with you today.
You’ve asked me to talk about National’s health policy development, and opportunities for the future. I am also particularly keen to learn what you have got to say on the future, and the present.
John Key and National are very positive about the future. The prospects for New Zealand are better than they have been in decades.
New Zealand has a golden opportunity to become a more prosperous country. Demand is booming for the commodities we produce, with much of that demand from countries – particularly China and India – which are getting wealthier all the time.
Those countries have a growing middle class, more and more of whom will want to buy high-quality foods. They want to travel. They want to educate their children. They will want safe places to locate their businesses.
As National Party Leader John Key pointed out recently, we are in the midst of incredibly powerful global trends that are going to sweep us along, whether we like it or not.
Those trends will benefit New Zealand greatly. And that matters to our health system... because wealthier countries spend more on health. The stronger our economy, the stronger our health system.
Update On Policy Development
As Opposition Health spokesman, I am supported by a team of very able new Members of Parliament: Dr Jackie Blue (Pharmacare), Dr Jonathan Coleman (Mental Health), Jo Goodhew (Aged Care, Rural) and Katrina Shanks (Maternity).
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On Wednesday, John Key released National’s discussion paper on aged care. Following a year-long series of 15 nationwide sector meetings, Jo Goodhew has outlined a number of proposals that will improve the choices and quality of care for our older citizens. ‘Choice not Chance For Older New Zealanders‘ is available on the National Party website.
The health team has also travelled the country listening to doctors, nurses, pharmacists, managers, and, most importantly, patients and consumers.
New Zealanders are concerned that our health system is characterised by endless waiting and out of control bureaucracy. People feel powerless as they wait for this, then wait for that, and then wait again.
People tell us they are angry that patients have to be sicker to get elective surgery. And how hard it is to see a hospital specialist. And how long they have to wait at the emergency department. And increasingly, how long they wait to see a GP.
New Zealanders are worried about the standard of service they are getting for the extra $5 billion a year now being spent on health. Public expectations have changed. People expect better.
People want services that are faster and more convenient. They want services that fit their personal needs, rather than having to do whatever the system demands of them. Patients want greater choice, including more convenient opening hours and locations, more ways to get medical advice and support to improve their own health. Patients also want a wider range of services provided closer to home, with much less waiting.
New Zealanders find the health system confusing, as patients often have to navigate their way between remote islands of health care.
National wants more personalised healthcare for New Zealanders. We're interested in individual patients.
Health policy in New Zealand has become so dominated by ‘targeting populations’ that individual patient need is not getting deserved attention.
We want to focus more on personal health – the needs of individuals – how people get looked after. How people can quickly access care and advice.
We have incorporated the vast feedback we have received from the public into a set of health policy principles to guide our policy development:
1. Services focused on the needs of individual patients
Services should be patient-centred. Patients should be in control of their care and be able to make informed choices.
2. Care provided as close to home as possible
More healthcare services should take place as close to home as possible. More complex care should be carried out by the most skilled professionals, with access to the best medical technology.
3. Integrated care
Care should be seamless, bringing together the skills of practitioners and staff from different service areas. Health providers should work in partnership with social and other organisations to promote well-being.
4. Health professionals trusted and valued
Clinical professionalism underpins public trust in the health system. Health professionals will be better motivated, and provide better service when they are trusted, valued, and fully-engaged. This will improve quality and safety.
5. Community, management and health professionals sharing decisions about health services
Effective use of finite resources requires the collaboration and responsibility of all those who provide, manage, and commit resources to patient care. Innovation should be encouraged.
6. Taking responsibility for good health
With access to better health information people will be empowered to take more care of their health. Many ailments are preventable through healthy lifestyles. People with chronic illnesses can be better supported to manage their own health.
National wants a much greater focus on the service New Zealanders are getting. We believe that to improve public confidence in the health system, the health system must be more responsive to the needs of individuals today and in the future. We’ve used these principles in putting together a health discussion paper to be released shortly.
The discussion paper is not an exhaustive examination of every issue in the health sector. It covers the key areas of performance that need improvement if we are to provide New Zealanders with health care that is better, more convenient, sooner.
The document will seek your input on the broad direction that National will take in health, and we will ask your views on a number of proposals.
New Zealanders have told us they don’t want any pointless upheaval of the health system. We agree with that. Pointless change is distracting when we need our health workforce focused on improving patient services. We’re less interested in formal structures, and more interested in giving patients a better deal.
I’ve looked at the health policies of both major parties over the past 18 years. The debate has been centred on structure - when it should be centred on the patients.
Primary Health Care Strategy
For most people, their GP clinic is their regular and important connection with the health system. It is the first point of contact and a gateway to other health care.
Primary care offers the best way to deliver timely health care closer to home for New Zealanders. International research demonstrates that those health systems with strong and vibrant primary care services, have much better health outcomes for a lower cost than those with a focus on specialist or tertiary care.
Other studies have concluded that countries with more primary care doctors per head of population achieve lower rates of death from heart disease, cancer, and stroke, irrespective of socio-demographic factors.
The advantages that strong primary care systems should contribute to improved health outcomes include: better management of chronic disease, more continuity of care, greater accessibility, and earlier intervention.
In 2001, the Labour Government launched its ‘Primary Health Care Strategy’ (PHCS) with a goal of revolutionising primary care services.
Apart from lower fees and the formation of 81 Primary Health Organisations (PHOs), there has been remarkably little progress in achieving other, more quality-focused goals. Too much of the Government’s effort has gone into trying to control general practice and their fees, significantly distracting clinical attention.
The current Health Minister told Cabinet last year that the Primary Health Care Strategy is failing to deliver the “quality improvements” offered by multi-disciplinary teams, and a wider range of services provided in a primary setting. The strong involvement of nurses was expected.
The PCHS also envisaged a wider range of services provided in a primary care setting, such as pharmacy, community nursing, midwifery, hospital follow-ups and Wellchild services. Yet the Minister admitted to the Cabinet that progress here was also weak.
Similarly he acknowledged slow progress in getting primary and secondary (hospital) services working together, and that, in general, performance ‘lags behind the policy direction’.
National believes the future of the PHCS should be directed at improving the quality and performance of the service as a whole, rather than focusing solely on the cost of a GP visit.
Closer Relationship Between Chronic Care and Social Care
National does see a role for Primary Health Organisations (PHOs). National’s Welfare Spokeswoman Judith Collins and I believe there is a good opportunity for there to be a closer relationship between chronic care and social needs.
Chronic diseases account for over 80% of all deaths in New Zealand. It is common for people to have more than one chronic condition, and for others to live with multiple conditions. The National Health Committee estimates that 70% of public sector health funds are spent on chronic disease.
Chronic conditions are largely preventable and share a range of common risk factors – such as inactivity, unhealthy diets, obesity, depression, stress, tobacco use, and alcohol misuse, according to the National Health Committee.
Last year I met with Nigel Edwards, head of the NHS Confederation. He estimates that in Britain people with chronic disease are 80% of the workload of general practice and 60% of hospital workload. It is likely to be similar here. Edwards also states that chronic care services are best delivered across a larger number of patients than a single practice.
The Government’s ‘Care Plus’ programme was designed to provide additional support to general practice to focus on patients with multiple chronic conditions. A recent analysis raised questions about the efficacy of this programme, and noted that while it was a goal to keep patients out of hospital, Care Plus patients ended up being hospitalised 40% more than non-Care Plus patients.
Similarly, the Auditor-General’s recent review of the ‘Diabetes Get Checked’ programme led him to conclude he could not say whether the scheme was working or not!
Evidence shows a multi-disciplinary approach to supporting chronic care patients does improve outcomes, particularly approaches that focus on helping patients self-manage their conditions. This is, of course, consistent with the view that we are all responsible for our own health, and should act in ways that enable us to enhance it.
Focusing on those with multiple chronic conditions is very effective, but does require more infrastructure at the primary care level. Such an approach does need sufficient spaces for nurses and allied services to treat people and operate their own clinics.
Some people with chronic conditions also face considerable social issues, such as welfare dependence and poor housing. These social conditions may cause, or exacerbate, the chronic conditions. Sufferers will be sharing their homes with others, who may also be at risk of developing chronic health conditions. Therefore, it makes sense to deal simultaneously with health and social problems.
The Ministry of Social Development has some programmes like ‘Family Start’ that aim to assist many of these families with sufferers of chronic conditions. Some DHBs are insulating homes to prevent or control respiratory disease.
Specially trained nurses involved with chronic care patients could act as brokers - or case managers - for non-health agencies in supporting many at-risk families. After all, nurses are held in much higher esteem than many other agencies that might be seeking to intervene in a family’s situation. This means PHOs and other health providers could take a greater role in managing social needs funded from Vote Social Services.
This could see these specially trained nurses working inter-sectorally with government agencies, such as Work and Income and CYF.
New Partnership with Health Professions
Our health professionals have too often felt that their commitment is taken for granted. The current health system is running on their goodwill, and that is rapidly evaporating.
National wants a new partnership with the health professions. We will give commitments and, in return, challenge doctors, nurses and the other professions to play a greater role in achieving a patient-centred health service.
We will trust and value our health professionals. They will be fully-engaged in decisions about the future of health services. We will deal with the current neglect of workforce planning. We will improve medical training.
In return, we would challenge the health professions to take leadership in improving the delivery and quality of patient care across all parts of the health system; to work collaboratively with management to meet the changing needs of patients; to deal effectively with poor standards of practice within their own professions.
The “clinical networks” approach from New South Wales offers a lot in this regard.
It is clinical professionalism that underpins the trust the public has in the health system and the people who work in it.
Therefore, we should expect that the management structures that shape the health system should also share that trust in health professionals.
Sadly, doctors and nurses are increasingly marginalised by what’s been termed “managerialism”.
One of the greatest weaknesses of the current health system is that it does not engage the people who have the expertise to make the real difference for patient care.
A new partnership with the health professions will make a real difference: doctors and nurses will be better motivated and will deliver a better service when they are trusted, valued, and fully engaged.
There are clear links between clinical leadership, morale, and efficiency.
Patients want choice. They want faster service. And they rightly want care much closer to home. A truly patient-led service will work to meet reasonable expectations.
In the next few weeks we will be releasing a discussion paper on some of our approach to meet many of the challenges facing us in health today: endless waiting, poor productivity, and workforce shortages.
Our mission is to improve the care and treatment of patients. We will show how we can improve the quality of care by establishing a new partnership with the health professions, by providing more services closer to patients, by integrating health and social services, and by providing real leadership for the years ahead.
ENDS
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