Health Minister Annette King
Speech

NZMA Conference --- political session

Health Minister Annette King said in the past four years there had been a considerable sea change in health in New Zealand and, in terms of taking a strategic approach, the most significant developments had been in primary health care.

I am pleased to have the opportunity to return to the New Zealand Medical Association's Wairakei conference.

I have listened to Trish Briscoe's comments with interest, and I look forward to your questions following my speech.

The first thing I suppose I should say today is that the NZMA's Wairakei conference is never dull. I am sure we can all agree on that.

And the second obvious thing I can say, on which we will all also agree, is that much has happened in health in the time since I was last here four years ago.

You should probably cherish that comment. It is an understatement, and, as you know, politicians are not generally given to understatements. I promise there won't be any more today, especially when I am talking about the Government's achievements.

In the past four years there has been a considerable sea change in health in New Zealand, and while that has occurred in all sorts of ways, in terms of taking a strategic approach to meeting New Zealand's most urgent health needs, in terms of providing sustainable and secure health funding, and in terms of workforce development, the most significant developments have been in primary health care.

Since the Government came to power spending on Vote Health has increased by more than $3 billion. This year it will reach almost 10 billion, or about 20 percent of all government spending.

Yet still you hear people described as health experts belittling the investment. I was most disappointed the other day to hear Dr Pim Borren, the commerce dean at the Christchurch Polytechnic Institute of Technology, say on National Radio that the Government needed to bite the bullet and spend more on health in real per capita terms over and above the inflation rate.

Dr Borren is, in fact, creating a myth. The fact is that the real per capita spending of Vote Health in New Zealand from 1998/99 to 2003/04 has increased from $1845 to $2367, an increase of $522 in real terms, or 28.31 percent. If that's not biting the bullet, I would like to know what is.

Governments do not spend that sort of money without expecting to get results, of course, and I have long been convinced that the best way to improve the health of all New Zealanders is to increase our investment in primary health care, the sector most people in this room know most intimately and care most about.

I will shortly talk some more about our future investment plans for implementing the Primary Health Care Strategy, but firstly I want to make the point that by investing in primary health care, in early intervention and in prevention, we are lining ourselves up with the most innovative international thinking.

In May I attended a forum in Slovenia on access to health care, and was taken by an analogy drawn by noted health researcher Professor Martin McKee, of the London School of Hygiene and Tropical Medicine. Dr McKee talked of a shifting balance internationally between treatment and prevention, as countries recognised the growing opportunities for early intervention. Countries needed to find ways to integrate treatment and prevention strategies, he said, and that meant reorienting health care to embed prevention at all stages.

Dr McKee likened a person's lifelong journey through the health system to a traveller in search of a tailor-made holiday, visiting a sequence of destinations suited to his or her individual needs, and using a variety of travel modes.

For such a person, simply visiting the Internet for information was not enough. They needed a navigator, or travel agent, to take them through the maze. In health terms, Dr McKee said, the travel agent is, in fact, the primary health care team. The analogy is a powerful one, particularly with our ageing population. Large numbers of people now have multiple chronic diseases, often because we can keep people alive far longer by controlling rather than curing their conditions.

I certainly see most people in this room having a crucial role in developing a "healthy travel map" for New Zealanders, and, although it is not explicitly stated in such a way, the development of such maps for New Zealanders is fundamental to implementing the Primary Health Care Strategy.

As I am sure you are all aware, there have been some rocky passages during the implementation. That was not unexpected. Primary Health Organisations now cover about 90 per cent of New Zealanders, but the oldest of them are only two years old, and it takes time for everyone to adjust to new ways of organising health care and meeting the health needs of New Zealanders.

Probably the most contentious element of the implementation has been the Government's decision to target increased primary health care funding initially at improving access to low-cost care for particular groups of people with high health needs. Some of our political opponents charged that our policy was race-based, and they argued that extra assistance should be targeted at individuals, not groups.

Their arguments are not only out of touch with the reality of health needs in this country, but are also unreal in the sense that they have been able to show no convincing way in which they can deliver care on an individual basis to individuals who are not accessing it in the first place. I have never denied that the population approach that is at the heart of PHOs may produce some anomalies at first, but it provides us with by far our best chance of targeting those who need help the most.

The charge that funding has been race-based has been the most disappointing. Not only does the National Party appear to be disowning some of the valuable work it did itself in the 1990s in building Maori health providers, but it is seeming to ignore the shocking Maori health statistics that everyone in this room knows only too well.

As noted Wellington School of Medicine and Health Sciences public health researcher Tony Blakely says, need and ethnicity co-habit in the health funding system.

The most fundamental elements of any funding formula are population size, age and gender, but there is no doubt in the New Zealand context that such formulae also have to be weighted with socio-economic deprivation and ethnicity factors as well.

There are clear links internationally between poverty and poor health.

They certainly exist in New Zealand too. But in New Zealand it goes further than that. We all know Maori on average die younger than European New Zealanders, but the even grimmer reality is that Maori people can expect to die earlier than European New Zealanders with similar levels of socio-economic deprivation.

A well-off Maori male will die much earlier than his European friend who earns the same amount and lives next door; while across the tracks in the poorest area of town the disparity is even greater between Maori and European neighbours. I believe most New Zealanders are open-minded enough to understand that we must tackle such health disparities for the sake not only of individuals, but for the sake of wider society as well. The Government makes no apology for having unashamedly targeted the worst health needs first, but we have now moved on, of course, to direct funding toward improving primary health care access for young people and older New Zealanders.

And the even better news is that the rollout of the strategy's implementation has been so successful and speedy that it is now clear that my initial prediction was overly cautious that it would take eight to 10 years to provide cheaper primary health care access for all New Zealanders who belong to PHOs.

I cannot give you the details yet of when the Government will be extending PHO funding for other New Zealanders, but watch this space. I hope it will not be long before I can make announcements, and I am now confident we will extend funding to everyone enrolled in PHOs far more quickly than anyone ever envisaged.

So far, over four years from 2002-03 to 2005-06, the Government has committed a total of $759 million in new funding for primary health care.

Such investment is unparalleled in our history. The National Party is promising to get rid of PHOs. I am looking forward to them telling most New Zealanders that the system that has brought them cheaper health care is going to be stripped from them.

National is simply playing political and ideological games with primary health care and health generally. Political parties do play politics, of course, but our Government has made health a number one priority. Even if you disagree with that claim, I am sure you all agree anyway that working to improve the overall health of all New Zealanders actually makes good politics. And, as far as that is concerned, the health funding the Government is providing tells a compelling story. I was pleased to see a comment from Peter Foley, the head of your General Practitioner Council, that GPs would not welcome National's plan because they do not want to go through more change. I can sympathise with that viewpoint. The pace at which the strategy's implementation is happening is not only exciting. It is also demanding for everyone concerned.

That's why it has been important to strengthen the Ministry of Health, particularly through the appointment of chief advisor (general practice) Dr Jim Primrose, to meet the new challenges, I also believe the creation this year of the Primary Health Care and PHO Taskforce will help the whole sector work together.

We certainly could not have travelled as quickly as we have, however, without the goodwill of health professionals. I have particularly valued the ability to work constructively with IPAC, and I also want to thank members of NZMA who have supported the new emphasis on primary health care. We need to keep the dialogue going, and to continue to work together on the travel maps as the Government commits more and more funding to the sector.

I know that putting the focus on population health and on health promotion and prevention often means thinking about primary health services in a different way, and that is why it is so pleasing to see so many innovative programmes emerging already.

This year's Health Innovation Award winners and finalists all exemplify what is happening. Examples like Auckland DHB and ProCare's streamlined treatment plan for stomach problems and Gore Health's community wellness programme show what can be achieved through collaboration between health professionals in one case, and health professionals working with the community in the other.

It has also been good to hear from GPs who have welcomed the ability to be involved again with mental and reproductive health services, and heartening to speak with PHOs wanting additional funding to develop innovative ways to deal with local access issues.

I recognise that with new opportunities, there are also new pressures, including logistical issues like taking on new administrative and IT systems while continuing to provide quality care for people. We all get frustrated at paperwork, for example, but it is through collecting data that we can examine wider issues affecting our communities and our nation.

I hope that you are all also gaining from developing networks and multi-disciplinary teams where each member is valued for the skills they bring. I know your patients will certainly gain. The final area I want to discuss today is the state of the GP workforce, because I know that a number of you are concerned about this issue.

Firstly, I acknowledge that, in line with international trends, over the past two to three years there has been a decrease in the total number of GPs, but New Zealand still has 323 more GPs than a decade ago.

I am pleased to learn that the Royal New Zealand College of General Practitioners has received an unprecedented number of applications this year for its general practitioner programme, with 90 applications for 50 places. This is a significant change on recent trends, and provides positive signs that workforce issues are being addressed within the college at least.

In terms of training, the numbers sitting Primex, either through the General Practice Education Programme or the practice eligible path, have increased from 118 in 2000 to 134 in 2003, while the numbers completing Advanced Vocational Education have increased from 81 to 165 between 2001 and 2003.

Increased funding has also been made available through the rural funding component of the Primary Health Care Strategy, with $32 million provided over three years for the rural recruitment service, workforce retention and reasonable roster schemes.

None of what we are trying to achieve in health can be achieved without developing a health workforce that can meet specific health needs in New Zealand. That is particularly the case in terms of the primary healthcare workforce.

The medical workforce must be able to deliver services in new ways to meet the challenges thrown up by the changing demographic profile of the population over the next 10 to 20 years, and that is one reason the Government needs to ensure that the tertiary education sector is well aligned to meet health's needs.

The Government announced its Tertiary Education Strategy in May 2002, and the Tertiary Education Commission (TEC) was established in December 2002 charged with implementing the Strategy. The Ministry has been working with TEC, and relevant Cabinet Ministers will shortly receive a briefing on the first phase of a joint project that analyses current health courses, undergraduate and post-graduate education and clinical training. Phases two and three will focus on understanding health workforce needs.

What concerned me when I became Health Minister was the disconnect between the health and tertiary education sectors.

The Health Workforce Advisory Committee (HWAC), which I established in 2001, also places high priority on the interface between health and education. HWAC's Medical Reference Group is now developing terms of reference for a Medical Workforce Roundtable to advise me on the clinical training of junior doctors, the relationship with undergraduate medical education and the environment that supports the development of a trained medical workforce.

In order to increase the supply of New Zealand trained doctors, and hopefully to retain them in New Zealand, the Government has also funded 40 more places in medical schools from this year, the first increase in the medical cap since 1981. The Government hopes that eventually the increased number of graduates will be reflected in the number of doctors wanting to work in rural health and mental health. I make no excuse today for concentrating on primary health care, even though that means ignoring other good news stories like the new orthopaedic project to lower hips and knees waiting times, removal of asset testing of older people in long-term residential care, the rollout of the new vaccine to combat the meningoccoccal B virus, the provision of $26 million for the Care Plus programme this year, and the extension to the breast-screening programme.

The story that is dearest to my heart, however, is that we now have 73 PHOs delivering primary health care to about 3.5 million New Zealanders, with some two million of them, including under-18s and over-65s, having access to more affordable health care.

I am looking forward to the next stage in the rollout, and to continuing to work with the sector throughout the implementation process. General practice, as many of you may have known it, is changing, but the heart of it, restoring, maintaining and improving the health of your patients, continues. Thank you again for inviting me today. I am happy to answer any questions you may wish to ask.

ENDS

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