Mon, 13 Sep 2004
College of Nurses Aotearoa conference
Health Minister Annette King spoke at the College of Nurses Aotearoa Conference in Christchurch, saying the theme of
Diversity, Dialogue, Destiny could not be more timely or appropriate.
---------------------------------
Thank you very much for inviting me once again to open your annual conference.
They say a week in politics is a long time, and whoever they are, they are probably right. And if a week is a long time,
then four years is a particularly long time.
It is worth reflecting, therefore, that the first time I spoke to your annual conference as Minister of Health was in
this very venue four years ago.
Much has certainly happened in health and in nursing since that time. In my speech that day I covered a wide range of
subjects as I discussed the Government's intention to change the health service from a competitive model to a strong
public service based on cooperation and trust.
The first theme I talked about that day was the Government's plans for primary health care. In particular I outlined the
Ministry of Health's progress on drawing up a Primary Health Care Strategy, and discussed the role of nursing within
primary health care. Well, the changes since then have even surprised me, and no one has been keener on advancing
primary health care in this country than I have been.
Since September 2000, we have not only drawn up the Primary Health Care Strategy, but we are well on the way to
implementing it as well. Few people had heard of Primary Health Organisations in 2000, but we now have 73 of them,
catering for more than 3.5 million New Zealanders.
Almost two million of these people are now entitled to cheaper primary health care and $3 prescription costs for many
prescribed medicines, and, even more significantly, two months ago Prime Minister Helen Clark and I announced that all
New Zealanders will become entitled to such benefits by July 2007, up to five years earlier than first anticipated.
I will have more to say about nursing and primary health care shortly, but if I had told you in September 2000 that the
Government would be committing a total of $1.7 billion over six years from 2002-03 specifically for implementing a
primary health care strategy using a PHO model, I am sure you would have been looking at each other and wondering what I
was talking about.
But if the investment in affordable and accessible primary health care perhaps represents the most dramatic advance
since I spoke to you here in 2000, some of the other significant issues I raised that day have also come to fruition, or
made considerable progress anyway.
We didn't have a New Zealand Health Strategy then, but we do now; and the health priorities that strategy has
established are the priorities that guide the activities of our District Health Boards. Of course, we didn't have DHBs
back then either, let alone elected community representation.
One of the most important areas I discussed in 2000 was the need for a single Bill to regulate the practice and
competency of health professional groups, including nurses, of course. Well, later this month the provisions of the
Health Practitioners Competency Assurance Act come into effect --- and your college and nursing in general can take much
credit for providing the impetus behind this long-needed change. Thank you all very much for the support and
encouragement you provided through what has been a complex and sometimes disputatious process.
I touched on many other areas that day that have also progressed --- such as nurse practitioners, nurse prescribing, the
establishment of the Health Workforce Advisory Committee, and the development of a number of policies to encourage
nurses to return to the workforce and to help nurses enhance their skills and qualifications.
Re-reading the speech puts in sharp perspective all that has been achieved, but I want to emphasise today that the
advances for nursing in particular could not have come about without your help and support.
This conference is always a great opportunity for you to discuss new challenges and roles for nurses, and I am pleased
to see the support the conference is getting from you all, especially those of you who have travelled from Australia and
further to be here.
I would like to acknowledge the presence of distinguished overseas and New Zealand-based guests who are attending the
conference: I particularly want to welcome Professor Margarete Sandeloski from the University of North Carolina. I am
sure that you will benefit from her profound research background. At your last conference I emphasised how important
research is in strengthening the profession and contributing to patient outcomes.
I am also sure you will enjoy your other keynote speaker, Massey University's Jenny Phillips, who has extensive
experience in wound care within primary health.
Your conference theme --- Diversity, Dialogue, Destiny --- could not be more timely or appropriate, and I am strongly
impressed to see your programme is placing so much emphasis on nursing developments, the latest research findings and on
innovation in the nursing sector. I look forward to finding out more about research and best practice achievements
presented here at the conference.
This conference not only brings together in one place diverse groups in the nursing community to share ideas and
information and discuss and debate key nursing issues, but it is also an important forum for sharing information and
knowledge between New Zealand and Australia and also with other Pacific countries.
I have already talked about some of the significant achievements of the past four years, but much has also happened
since I spoke to you last year, particularly in respect to the accelerated rollout of the more affordable and accessible
primary health care and the extremely encouraging start of the rollout of the Meningococcal B vaccine.
A number of other initiatives I mentioned last year are also bearing fruit, such as rural scholarships and the work of
the Primary Health Care Nursing Expert Advisory Group. The outlook continues to become more significant for nurse
practitioners and nurse prescribing, and, as I said, implementation of the HPCA Act is now an impending reality. New
initiatives are also underway in areas like the national framework for mental health nursing.
If your conference theme of diversity, dialogue, destiny relates to any part of the health sector more than another, it
is surely primary health care, where great efforts have been made, and are being made, to address the different health
needs of diverse populations within New Zealand.
I am sure everyone here knows how convinced I am of the crucial importance of nursing's role in implementing the Primary
Health Care Strategy, and in helping ensure that PHOs function as effectively as possible, and that is why I am
delighted many nurses want to be involved in PHOs at both a development and governance level. Historically hospital
boards have separated hospital and community services. Most nurses worked in one area or the other, and only a few, like
specialist oncology or diabetes nurses, worked across both. That has begun to change with the advent of DHBs and their
wider health focus. There is excellent potential for more nurses to work across both primary and secondary services to
provide a continuum of care. The setting should not be an issue, and I am confident that the success of the Care Plus
initiative will prove that to be the case.
Approximately $4.2 million went into funding Care Plus in PHOs for a preparatory period from April to June this year,
and the Government then allocated $26 million to the scheme in this financial year. Care Plus offers opportunities to
demonstrate how GPs, nurses and pharmacists can work together to provide optimum care to people with chronic illnesses
and other high health needs so that the patients get the best health outcomes possible.
The new service gives nurses an opportunity to practice in new ways, by developing, for example, plans to provide
co-ordinated and specialised care for people with chronic conditions such as diabetes and cardiovascular disease.
Nurses working across the boundaries between primary health care and secondary services in hospitals will be pivotal in
helping achieve better health outcomes for Care Plus patients and others with chronic conditions.
In fact, research has identified nurses as the health professionals best suited to manage chronic conditions, and it is
not at all difficult to understand why. To start with, nurses have well developed assessment skills, and are skilled at
developing care planning and in care management. They are also able to operate both in teams and autonomously, are
accessible to patients, have a good knowledge of community networks and resources, and can work in a variety of
settings. These are the ingredients that will make Care Plus a really effective initiative, and I know that there will
be many nurses keen to become involved in this innovative role in the primary health environment.
Diabetes offers an excellent example of how well placed PHOs are to target diseases such as diabetes, especially now
that funding is bedded in to primary health care. Nurses have a big part to play in monitoring such conditions and also
in lifestyle education.
Some DHBs have yet to grasp the potential of all this happening, and are still perpetuating separate models of primary
and secondary care despite the new funding. That means much nursing expertise remains trapped in the provider arm,
though I am confident all DHBs will adapt to change sooner rather than later.
Some DHBs are doing particularly well, however, modelling nursing services across boundaries. I don't want to name too
many at the expense of not naming others, but one very good example is Counties Manukau's chronic disease management for
diabetes, where diabetes nurse educators work with inpatients and in PHOs and IPAs alongside GPs and practice nurses.
There is certainly a challenge for all of us to build on all the positive things happening in the new primary care
environment. For nurses, I hope the major challenge is to not only play a strong role in the new environment, but to
continue to foster innovative approaches to meet community and health needs as well.
Many PHOs are now well established, or are based around groups of practices that were already providing a wide range of
services before they joined a PHO. I am encouraging all PHOs to develop as broad a range of services as they can, and
nurses certainly have a key role in creating an environment for this to happen.
Before I finish today, I want to mention briefly a number of other areas, starting with exciting developments in mental
health. The Ministry has established a project to develop a national strategic framework for mental health nursing.
The project will involve integrating advice from professional groups, as well as taking account of mental health
strategies and Government policies. The aim is to develop a sustainable workforce to deliver health care. We already
have a framework for primary health care nursing, and we are now committed to doing the same for mental health.
The Ministry is also focusing on the stability of the rural workforce, including ways of encouraging recent medical and
nursing graduates into rural practice, within a wider primary health care workforce project scoped this year. This
project includes continued support for the Primary Health Care Nurse Practitioner (Rural) Scholarships, workforce
retention and reasonable roster funding: The scholarships continue to help nurses develop their skills and encourage
workforce support and retention, and also increase recognition of the importance of primary health care programmes in
educational institutes. Workforce retention and reasonable roster funding has allowed recruitment of additional nurses
to support rural nurse specialists who provide services in remote areas.
In addition, the contract for the Rural Recruitment Service, won by the New Zealand Rural General Practice Inc, has
already helped rural practices and providers find rural practitioners, including nurse practitioners.
Last September I also announced a second round of Ministry of Health postgraduate nursing scholarships for primary
health care nurses, following the success of the first round in which 183 nurses received study scholarships.
And in August last year my colleague, Associate Education (Tertiary Education) Minister Steve Maharey and I announced
Step Up Scholarships designed particularly to reduce the cost of study for low-income nursing, dentistry and midwifery
students.
We are always looking at new initiatives, and today I had hoped to be able to announce a graduate nurse training
programme in DHBs. Unfortunately, however, that announcement is not quite ready yet, though I promise it is not too far
away. That would have been a really positive note on which to finish today, but there is another encouraging issue on
which I can conclude anyway.
Early in my term I was concerned to see the results of a survey carried out in 2000 that showed that of 2071 registered
nurses and midwives who were not in clinical practice, some 1576 would be encouraged to return if childcare facilities
and return to nursing programmes were available, and if hours were more flexible.
That survey acted as a wake-up call, and I have been delighted to see data from the latest annual nursing and midwifery
workforce survey, showing that between 2001 and 2003 a total of 2807 registered nurses and midwives returned to clinical
practice.
The latest survey showed that the availability of return to nursing programmes and the provision of childcare facilities
were particularly significant factors for registered nurses and midwives returning to practice in Auckland and
Christchurch. There is much in the survey to encourage us all, and also much to learn from.
I wish you well for the rest of your annual conference. I know you will find many of the presentations and debates
inspiring, and I thank you again for asking me to join you. Whatever else happens during the conference, I am sure
Diversity, Dialogue, Destiny will be the winner, and that means we will all be winners too.
ENDS