Annette King Speech: Diabetes New Zealand Conference
I am pleased to be at the Diabetes New Zealand annual conference after being unable to attend last year’s conference
because of prior commitments.
There are certainly few annual health conferences as important as this one.
All of you here know how critical it is to reduce the incidence and impact of diabetes, in particular Type 2 diabetes,
in this country.
Before I talk in more detail about those specific challenges, however, today is an appropriate opportunity to make what
I believe is an exciting announcement about further moves to lower the cost of primary health care.
Primary health care offers us our best chance, as you all know, to stem the tide of Type 2 diabetes in this country.
In March last year I announced that the Government was committing $410 million over three years to begin implementing
the Primary Health Care Strategy, chiefly through delivering low-cost, accessible health care through Primary Health
Organisations or PHOs.
When we started out we had hoped to be providing cheaper primary health care for 300,000 New Zealanders by the end of
2002/2003. Well, we have done far better than that. More than 700,000 New Zealanders are already enrolled in ‘Access'
PHOs that give them low patient fees.
The Government now hopes that 1.6 million New Zealanders, 40 percent of the population, will be receiving low cost
primary health care by the end of 2003/04. That will be a huge achievement.
And I am very pleased to announce today that from October 1 we will be extending low fees to all school age children
under 18 within ‘Interim' PHOs, as well as those already within ‘Access’ PHOs.
That means almost 58,000 more young New Zealanders will be receiving low cost primary health care from October 1.
Today I can also announce that during 2003-2004, the Government will be providing low fees and better planned care
through PHOs for people with chronic illness, like diabetes, or a history of being a high user of primary health care
services.
We will be doing this through the Care Plus Initiative. Care Plus is being piloted this year, and I expect it will be
rolled out from January 1 next year through all PHOs. It will cater for many older people with very poor health as well
as those under 65 requiring high levels of care.
The third aspect of the $19.8 million initiative I am announcing today is that from October 1, prescription fees will be
reduced to a maximum of $3 for all children aged between six and 17 enrolled in Interim PHOs, and for patients of all
ages enrolled in Access PHOs.
Targeting these high-need groups of young people and Care Plus patients, and establishing more Access PHOs, will be a
significant step towards achieving our objective of low-cost access to primary health care for all New Zealanders.
I am now more than confident that PHOs will soon be established all over the country.
Another part of today’s announcement is that from July 1, as part of the overall health funding package in 2003-2004,
the Government will be allocating an extra $8 million to provide PHOs with their first regular funding adjustment. This
demonstrates our commitment to GPs to ensure that once patient fees are lowered, they can remain low.
I am also delighted to be able to tell you today, though I cannot provide you with specific details, that I have secured
Cabinet agreement to focus on the next stage of implementation of the Primary Health Care Strategy, which will provide
low cost health care for people aged over 65. I aim to start rolling this out in 2005-2006.
After years of relative neglect during the 1990s, our public health system is now being funded at unprecedented levels
in New Zealand.
This Government promised to restore the public health system in New Zealand. We are not there yet, but we are getting
there faster than even I believed we would in my most optimistic moments.
Now to return more specifically to diabetes - many of you here today are providing critical support as this country
addresses the challenge to reduce the incidence and impact of diabetes.
While much of our attention is of course focused on the more common Type 2 diabetes, we cannot forget that the impact of
Type 1 diabetes on individuals and their families is often vastly greater than for Type 2.
This conference is therefore an appropriate time to announce also that additional funding will soon be forthcoming for
insulin pumps.
This funding, of $60,000 a year, will enable additional pumps to be provided for under-18 year olds. This extends the
additional funding that was made available for pumps from the last financial year onwards.
I am sure you are all aware of the basic facts and figures for diabetes generally. It is estimated that diabetes causes
more than 1500 deaths a year. Complications of diabetes include kidney failure, blindness and heart disease. Rates
overall are projected to increase, with Maori and Pacific people at three times higher risk.
Up to 110,000 people have known diabetes, and as many as 100,000 more people have diabetes but don’t yet know they have
it.
New Zealand’s spending on diabetes and related complications is certainly comparable with other Western countries, and
our investment in primary health care, including health promotion and education, will pay dividends for this country in
the future.
Despite the alarming statistics regarding the increase in diabetes, many initiatives to combat this increase are either
in place or are in progress.
Much of this action fits with the recommendations contained in the 2001 PriceWaterhouseCoopers (PWC) report on Type 2
diabetes. I would like to take this opportunity to look at continuing work being done around the core recommendations of
the report.
As you will know, the report’s first recommendation was for more appropriate, affordable, and accessible services for
people with Type 2 diabetes.
I have already explained how the Government is trying to achieve this on a broad front through establishing primary
health organisations, at a far faster rate than we expected.
PHOs offer the opportunity to pay closer attention to groups most at risk from diabetes, in particular Maori and Pacific
people and lower socio-economic groups. I am confident that closer monitoring of at-risk individuals by PHOs will lead
to more timely interventions.
Not only can PHOs keep track of at-risk New Zealanders effectively, but they are being funded so they can provide more
affordable services, which may range from GP visits to lifestyle advice from nurses and dieticians.
And, as I mentioned earlier in my announcement, we are currently piloting the Care Plus initiative, covering the five
percent of the population who are expected to require intensive management in primary health care.
There is also a ‘Services to Improve Access’ component in both Access and Interim funding formulas for PHOs. They can
use some of this funding to target people with diabetes in their enrolled population. Quality payments will be made in
2004/2005 to PHOs meeting certain performance indicators, with diabetes very likely to be such an indicator.
PWC’s second recommendation centred around more resources to implementation of a fully funded public health strategy,
focusing on diabetes prevention and education. The Government is particularly concerned at preventing type 2 diabetes
through such a method.
That is why I was pleased to launch the Healthy Eating - Healthy Action framework in March, and I must say I was very
pleased to see your President Ross Finnerty at the launch Wellington’s St Anne’s School.
We all had a great morning. It was the first time I have performed aerobics with the Director-General of Health, Dr
Karen Poutasi, and the Deputy Director-General of Public Health, Dr Don Matheson. I can say we had remarkably different
styles.
This framework aims to improve nutrition, increase physical activity and reduce obesity by involving not only the health
sector, but other sectors, such as local government and education.
One of the outcomes of this strategy is the likely reduction in diabetes resulting from people leading healthier
lifestyles.
The next important phase of Healthy Eating - Healthy Action is developing an implementation plan that will provide
priority areas for action over the next three years. The implementation plan will be developed over the next six months
with assistance from an external advisory group.
An industry stakeholder group will also be involved with representatives from the food and physical activity industries,
as these groups have much to contribute to the Healthy Eating - Healthy Action framework.
I was interested to read a newspaper editorial last week, on the subject of obesity, which reinforced the reality that
obesity is not solely a product of inappropriate nutrition, but is also associated with inadequate physical activity.
Clearly, the editorial said, a health strategy to cure the obesity epidemic must focus on lifestyle as well as diet. I
could not agree more.
Another important development has been the revision of the Public Health Bill. I believe this proposed amendment has the
potential to allow for better control of public health factors that can affect diabetes rates, and I am grateful for the
informed and constructive submission put forward by Diabetes New Zealand in response to the discussion document.
PWC also favoured a national screening programme to identify undiagnosed Type 2 diabetes.
DHBs, such as Tairawhiti, are working on opportunistic screening programmes to improve detection rates, and such
programmes, in conjunction with recent screening guidelines produced by the NZ Guidelines Group and Ministry advice, are
now regarded as more effective and beneficial than implementing a full national screening programme.
PWC also recommended the creation of a national diabetes database, and I understand that work is continuing around this,
with the Ministry recently convening a second stakeholder meeting.
I know that Diabetes New Zealand is especially interested in the database, and there is certainly a need both here and
internationally for these sorts of tools to facilitate quality research into diabetes. A number of other diseases such
as cancer and cardiovascular disease would benefit from similar initiatives.
The PWC Report emphasised the need for more diabetes monitoring and research.
Monitoring of service delivery performance is an area that continues to be improved. The Government continues to give
strong support to the ‘Get Checked’ campaign so that PHOs and DHBs can monitor the number of people accessing free
annual checks, the quality of their care, and the prospective impact of diabetes in their enrolled populations.
This programme has shown that the quality of care, when using international benchmarks for Wellington IPA patients, has
improved to the point of being world class.
Such results confirm that funding for DHB Local Diabetes Teams has been worthwhile in terms of the quality of diabetes
care. Their emphasis on community and life-style focus, and on providing opportunities for people living with diabetes
to have a role in decision-making, is crucial for planning and delivering diabetes services.
These teams are a very important part of our fight against diabetes. I commend them for their work they do, and also
value the strong role played by community groups and national organisations such as Diabetes New Zealand.
The PWC Report also cites the importance of improved research. The National Diabetes Research Strategy for developing
and evaluating diabetes prevention is currently looking for proposals for research focusing on strategic partnerships
between DHBs, academic researchers and the community.
The initial funding round was unsuccessful, but already 11 expressions of interest have been received for the second
RFP, and I am hopeful that a quality proposal will be forthcoming that will ultimately lead to the reduction of
incidence of diabetes.
Besides the $1.5 million Government investment in this strategy, support is being given to the Eion Edgar Centre for
diabetes research at Otago University, led by Jim Mann and his team, and to the work that will be carried out by
Professor David Simmons at Waikato DHB, in collaboration with Auckland University.
The final PWC report recommendation was to propose an increase in the number of diabetologists.
This difficult issue cannot be remedied overnight, but the Health Workforce Advisory Committee is working on solutions
to many of our health workforce shortages. I know HWAC will address the issue of maintaining appropriate numbers of
diabetologists as one such area.
We know that the challenge posed by diabetes is difficult, but the initiatives and progress I have just outlined show
that the Government is making an effort to address the problem coherently and effectively.
I know many people here today are also interested in Pharmac’s plan to review the use of blood glucose testing strips.
It will carry out the review because this is an area of high expenditure and high expenditure growth at that. I
understand that the review will include looking at clinical evidence, best clinical practice and commercial
arrangements.
Pharmac has indicated that there will be public consultation before any decision is reached. The Ministry will also
provide advice to Pharmac regarding any decision it proposes.
I want to finish today by assuring you I have great respect for the work of Diabetes New Zealand. The organisation is
notable for the quality and depth of the contributions it makes in many, many areas associated with diabetes, ranging
from legislation to research to advocacy.
Whenever a diabetes issue is raised, I know Diabetes New Zealand’s voice will not be far behind, or will probably be
leading the way, in fact. I hope you will be encouraged by my announcement today, and thank you very much for inviting
me to be part of your conference.