28 July 2005
Rural Health Summit, Westpac Stadium, Wellington
Good morning and thanks very much for the chance to take part in this, the first ever Rural Health Summit. It's a real
pleasure to be here.
Congratulations to all conference organisers and sponsors – it's a big undertaking to gather a group this diverse and to
tackle issues as significant as those that will be raised over the next two days.
This Summit offers significant opportunities to progress rural health issues; issues that concern me both as Minister
for Rural Affairs and Associate Minister for Health.
What many people in urban centres don't grasp is that New Zealand remains largely dependent on its rural communities,
because it's these communities that drive a large part our economy and create our wealth.
Agriculture and New Zealand's other primary industries are well known as the engine room of our economy. But what fuels
the engine room are rural New Zealanders.
That's why public services in rural areas have to be of the highest standard, and more importantly, accessible. Rural
people are pragmatic, they understand that the challenges they face differ and are possibly more complex than those
faced by their urban counterparts.
But they need to have confidence in their services and infrastructure, and they rightfully expect to be given the same
access to quality health, education and social services as other New Zealanders. As a government we've recognised this
expectation, and worked hard to meet it.
Let me give you a broad picture of the Government’s support for rural health. Most of you will be aware that almost 80
per cent of the almost $10 billion spent on health each year is devolved to the country's 21 DHBs. On top of this
funding, Government provides a ‘rural adjuster’ - $80 million in the last financial year- to DHBs with rural
populations.
This funding acknowledges that many rural DHBs face specific challenges, particularly in more isolated areas.
The additional money goes some way to compensating these DHBs for the costs of maintaining small hospitals and community
services that would otherwise not be viable.
As well, the government earmarks $10. 9m every year for rural retention and reasonable roster funding. A review of this
funding is currently underway to ensure it's getting where it's needed most.
We contracted the Rural General Practice Network to recruit short and long term locum doctors and nurse practitioners.
Representatives from the Network are here today and I'd like to thank them for their ongoing and hard work.
We've established a scholarship scheme for rural nurse practitioners, and a nurse post-graduate programme.
We've raised the cap at Auckland and Otago universities, so there's now an extra 20 places at each university for
students from rural backgrounds.
We've introduced a new National Travel and Accommodation policy to assist thousands more rural New Zealanders who need
to travel for specialist services.
We've extended the Healthline 0800 service to most rural areas.
The Mobile Surgical Bus is out and about in rural New Zealand providing essential surgery.
We've committed $136.9 million to help improve drinking water systems in small New Zealand communities.
Just this week we raised the subsidy levels for projects to upgrade sewage treatment and disposal systems in small,
rural communities.
Our Primary Health Care Strategy has seen the establishment of PHOs in rural areas, meaning cheaper doctors visits and
subsidised prescriptions for rural people. A total of $2.2billion of new money is going into the Primary Health Care
Strategy over the next seven years.
All these initiatives help contribute to the wellbeing of our rural people and our rural economy.
There is more to be done. My wish list for New Zealand rural health includes the continuation and strengthening of
existing initiatives, along with the following:
The expansion of telemedicine and the expansion of the Mobile Surgical Services unit, including a second bus.
Further upskilling of nurses and flexibility of job description, adjustment to standing orders so that nurses and other
allied health workers can complement the work of our rural doctors.
Cellphone coverage for rural GPs, wherever they are, so they're free to do as they like (within reason) while on call.
I've been working closely with Telecom on this. That work saw a preview of the CDMA/Sat phone at Fielddays last month,
where Telecom took a register of interest. The official launch of the phones is expected later this year.
I'd like to see aged care facilities in small rural towns secured so people can retire close to their families. For
this, we need coordinated health care facilities linking primary and secondary care to overcome economies of scale,
along with clever use of technology and innovative staffing.
I want to develop and promote a concept of rural living that will attract and retain young professionals to rural New
Zealand. Rural New Zealand is precious and as I've said, invaluable. We must work to ensure its survival and stimulate
growth by attracting innovative and dynamic people.
On this note, the final wish on my list is a scheme that's going to attract Kiwi graduates to rural New Zealand. Whether
that's by bonding, student loan write off or some other initiative, is yet to be decided. But I certainly think it needs
to be a key plank of rural health policy in this country into the future.
As I've mentioned, primary health is key plank of the government's long-term health strategy, and it requires a range
of health practitioners to work together.
Primary health care is about involving the wider community and as many people as possible to address health issues. It’s
about making health care more accessible in every respect. On the ground, this means improving transport, making
practices “user friendly” and getting services to people who can't get to them. Rural communities are typically very
good at getting together to discuss their needs; they're good at knowing what the problems are and what action is
needed. I've heard some fantastic examples recently of action within rural communities. Manaia Health PHO, in Whangarei,
has successfully quadrupled its number of monthly Green Prescriptions, which are given to people to encourage them to
get active in their daily life. The PHO linked the Green Prescriptions in with the Sport Northland launch of the 10,000
steps programme.
This collaboration got the whole community working together – from the district councils (who labeled the number of
steps on popular walking routes) to the Mäori health provider (who implemented diabetes prevention initiatives). They
developed good relationships with each other so they can look at doing similar projects to increase physical activity in
future.
Last year in Mangakino, Lake Taupo PHO and Taupo District Council initiated joint ventures with the Energy and
Efficiency Conservation Authority and Housing New Zealand. The project tackled one of the contributors to ill health –
damp houses, by retrofitting houses with insulation.
This year, Counties Manakau won the Health Innovations Supreme Award for its insulation and housing project.
And only last week I visited the Himatangi Beach Health Clinic in the Manawatu - a wholly nurse run initiative that's
providing primary health services for a small rural area.
These are only a few examples of primary health care projects in place around the country. Central to all of them is
collaboration and community involvement and it's these things that underpin primary health as a whole.
As such it’s great to see so many of you here today - Federated Farmers, local government representatives, rural GPs and
nurses, rural hospital managers, district health board members and members of the community.
At the same time as investing in primary care, the government is not ignoring acute needs, because no matter how good
your primary care, people will always get seriously sick and people will always have accidents.
New Zealanders have relatively good access to after-hours primary health care. But one model of after-hours service
delivery doesn't fit all.
I recognise that the availability of effective, responsive emergency services is particularly important for rural
communities, who may be some distance away from a major hospital.
Workforce teams in rural communities are usually smaller in size and after-hours responsibilities can become onerous.
This can then impact on workforce recruitment and retention. Reasonable roster and workforce retention funding helps
respond to these issues.
Changes in after-hours service delivery to achieve more effective services have in some cases meant rural people have
needed to travel further to access services. This can be a problem for those without ready access to private transport.
Where this problem arises, some PHOs are using “Services to Improve Access”, or SIA funding, to solve these transport
problems. It's this type of primary care funding that assisted the healthy housing project in Taupo, which I mentioned
earlier, and it's all about making sure services reach the people who need them.
Ambulance services are a vital part of emergency response and in the last three years, considerable additional funding
has been allocated to allow ambulance providers to employ more staff and improve response times.
We also continue to develop the primary response in medical emergencies, or “PRIME” system, which supports rural GPs and
nurses to co-respond with the ambulance service.
The system allows the provision of a higher level of skill for serious emergencies in rural areas. I'm aware that there
has been some inconsistency in the development of PRIME and that it hasn't been implemented smoothly in all parts of the
country. These issues are now being addressed. The Ministry of Health and ACC have agreed to fund a national schedule of
PRIME training, to ensure all rural GPs and nurses in New Zealand have access to training in emergency care.
The Ministry is currently leading work looking at funding incentives for rural primary health care practitioners to
participate in the PRIME scheme. This will occur during the next six months and will involve representatives from the
Ministry, ACC, DHBs, ambulance services and the rural primary health care sector.
The aim of both the training schedule and the funding incentives is to sustain and improve involvement in rural
emergency response throughout New Zealand.
Meanwhile, the ambulance sector is undertaking the Ambulance Communications Project, to improve triage and dispatch
systems and reduce the time taken to dispatch an ambulance.
In my aspirations for New Zealand rural health, I've already touched on technology. New Zealand may be small in
population terms, but it has achieved international recognition for its use of information technology. It continues to
lead the way in primary care computing, for instance.
Telehealth is a concept that's being more widely used in New Zealand. We're referring to more than just a conference
call by video. There are a number of advantages to this, such as providing short-term solutions to workforce shortages
and enhancing the quality of clinical care.
It has direct applications in rural areas in terms of increasing collegiality, diagnostic support and access to ongoing
education.
The Ministry of Health continues to consider the direction for telehealth in New Zealand. There are a number of current
clinical applications which is good, but more work needs to be done on achieving an effective telehealth system for the
whole of the health and disability sector.
The Mobile Surgical Services bus is another unique way we're able to deliver medical services and education to remote
communities. In some cases the bus has become an important component of the social fabric of the community, as
increasing numbers of people appreciate the fantastic potential of the project.
At larger hospitals the bus offers telepresence facilities. These facilities allow surgeons operating onboard the bus to
collaborate with remote colleagues via an interactive video link. I can only describe watching this first hand as truly
extraordinary – the whole process gives you a real sense of possibility.
I expect you will hear more about innovations in telesurgery later today.
I've focussed here on a number of technological achievements and developments. And technology is all well and good, but
we can't forget that it's traditional factors that remain critical for success – like accessibility, availability and
reliability.
The focus of all health technology should be enhanced care delivery, rather than the technology itself.
There are big issues to be tackled during this summit. Solutions won't be found overnight. But a genuine willingness to
find solutions is a good base to begin significant work.
Ladies and gentlemen, rural health initiatives would not have occurred in this country without the direct support of
this government. Talk of tax cuts and a return to more competitive, market driven system would further undermine support
for rural people. We need to acknowledge that rural New Zealand is a minority sector when it comes to infrastructure and
needs a special focus.
The market will not deliver the services people expect and indications are that a change of government will reduce much
of the good work done in this area.
Now is a good time for health and rural sectors to work together, share ideas and seek solutions. With good
communication and good working relationships, we can achieve community-based solutions, which are proven to be the most
effective kind. Thank you and good luck.
ENDS