Speech to NZ Rural GP Network Conference, 31 March 2006
New developments in primary health care this year and last year that will be significant for rural communities.
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Kia ora. I'm delighted to be here with you again at your 2006 annual conference. The theme of "others talk about it, we
do it" is very apt in the rural health sector and it's great to see so many delegates here from all over the country.
Since we met last, there has been a General Election and a change - not of Government - but of Minister of Health.
I know that many of you will have met Pete Hodgson - and I'm sorry he is not able to join me here today. As you probably
know, he has impeccable rural credentials (born in Whangarei and a vet by profession).
I think you can be reasonably confident that rural health issues will continue to get a sympathetic hearing around the
Cabinet table, and I will certainly continue to advocate for rural health as both Associate Minister of Health and
Minister for Rural Affairs.
This morning I'm going to be talking about new developments that are happening in primary health care this year, which
will be significant for rural communities.
I'll also be posing some challenges that I hope rural primary health care will rise to.
But first, let me quickly give you a thumbnail sketch of what's happened in rural health this past year. It's an
impressive list of achievements which speaks volumes about this government's commitment to rural health, and which flies
in the face of some of the comments some people have made recently.
·461 rural GPs have qualified for a rural bonus, ranging from $3000 to $20,000 for those in the most isolated areas. In
total, that came to $4.23 million, and the funding is not capped.
·The government-funded NZ Locum Service has provided nearly 200 rural GPs with short-term locums, and recruited 19
overseas GPs to New Zealand rural practices in the last year, providing service to over 80,000 New Zealanders in rural
areas.
·46 PHOs have shared $8.23 million in rural workforce retention funding. Most of which goes through to frontline
practitioners, as it should.
·Late last year a government funded survey of the rural health workforce began. This is being carried out by the
Institute for Rural Health and will provide more data than previous surveys.
·In the past year, PRIME - the rural trauma response service - has undergone a revamp. Funding has been made available
for the initial training of 180 rural GPs and nurses and 120 refresher courses. All clinics now have appropriate kits
and equipment.
·We have committed $60,000 to the rural hospital doctors' working party.
And let's not overlook training: in the past year the Government has funded:
o10 rural scholarships to medical school
o20 rural rotations for trainee doctors
o44 rural primary health care nursing scholarships
·We have renewed the contract for the mobile surgical service and my hope for a second mobile surgical bus is still on
the agenda.
·On top of that, the government has also allocated $110 million of new primary health care funding, which comes on line
from July this year, to reduce the costs of visits to the doctor for the age group 45 to 65 years.
That's quite a list, in anyone's language, and it shows that the government is very much taking the lead in addressing
rural health issues.
In summary I calculate that, together with the $80 million that goes to DHBs to support the provision of rural health
services, the government has provided over $100 million to support rural health communities' access to health services
in the last year.
When you add to that the major new investment the Government is putting into Primary Health Care - it will be an
additional $2.2 billion by 2008 - you can understand our expectation that we should be starting to see some noticeable
changes in the way health services are delivered; followed by improvements in health outcomes.
The risk that the Government faces is this: without clear evidence that this funding has made a difference, the public
and our colleagues in Parliament may well review their support for this level of investment in primary health care.
Which is why, before the next $110 million of funding is rolled out in July this year, the Government is keen to see
some agreement around transparency, and how to maintain the value of the investment. Pete Hodgson talks about 'future
proofing' the Primary Health Care Strategy.
I know that discussions on these issues are happening now around the country. It is encouraging to hear that the
respective parties are confident that they can find solutions that work for everybody.
You will all be aware that the 45 to 65 year olds targeted by the new $110 million funding in July is the baby boom
generation, and they are a pretty lively and well-informed bunch - aware of their 'entitlements' and inclined to be
vocal in their advocacy. And not averse to letter writing, either.
For many rural communities - given their older demographic - this will be the first significant opportunity to benefit
from the new primary health care funding. They'll welcome the reduction in fees - quite rightly so.
But to my mind - and if we think back to the vision of the Primary Health Care Strategy - greater benefits may flow from
the opportunities that capitated funding presents and the impetus it provides to take a more population-focussed
approach to the health care of our communities.
From a business perspective - let alone a health perspective - a systems approach to primary health care makes a lot of
sense:
·By collecting and analysing data to identify and monitor those who need care
·By implementing the latest care guidelines
·And by involving the whole practice in evaluating and improving performance.
But it's not my intention to attempt to teach you how to suck eggs; many of you here are way down this track already and
I acknowledge your efforts in this.
It does bring me, however, to the subject of information technology.
The recent evaluation of the 35 primary health care projects funded from the Reducing Inequalities funding pool found
that good IT infrastructure was a characteristic of most of the successful services.
This doesn't surprise me. New Zealand general practice - rural general practice in particular - has led the world in the
adoption and use of new technology.
I'd like to signal here that Government's next capital investment in Health will be in information technology. Not in
one big project, but in lots of smaller projects.
It is telecommunications infrastructure that's been slower to develop. In particularly out-of-the-way places, such as
South Westland, poor mobile coverage has hindered advances in health care. And, although there have been delays, Telecom
has now advised me that its long-awaited satellite and CDMA phones will be available from the end of next month. I'll be
waiting!
I said at the beginning of my speech today that I see some challenges ahead that I hope you as rural primary health care
professionals will rise to and I have no doubt you will.
The first of these may be big or it may be small, but it's the essence of who we are. It's what distinguishes us from
our urban and provincial counterparts: It's how we define "rural" in 2006.
Changing demographics and changing modes of primary health care delivery are putting pressure on us to review our
conception of what is rural. Do the kind of criteria that currently determine rural ranking make sense any more?
Is distance from a major hospital still a defining characteristic? Maybe it's the distance from a large town? Or the
fact that at large area of your practice is outside of cell phone coverage?
Are there arguments for adopting Statistics NZ's definition of rural - based on the size of communities?
Should rural be defined simply by geography?
The Ministry of Health is inviting all rural health professionals to give their views on this. I understand that letters
to all rural GPS have gone out, and similar letters will go to other rural health professionals. Other stakeholders
including DHBs and perhaps also local authorities will also be asked for their views.
We will be looking for a degree of consensus.
My hope is that each of you who responds to the questionnaire will be able to consider this challenge in a wider context
than you might normally.
If there is to be change, we'll be signalling this well ahead of time. I appreciate that any changes in the definition
of 'rural practice' will have financial implications for some practices.
But when there are scarce resources, we have to get them to where they're needed most. I don't imagine that too many of
you will disagree with that.
The second challenge - and this is a major one for the whole health system - is to make faster progress in reducing
health inequalities.
The greatest health inequalities in New Zealand are borne by the rural poor - particularly among rural Mäori. This is a
tragic statistic that reflects on all of us and we all have to take responsibility for making a difference to it.
All of us have a responsibility for advocating for the most disadvantaged. All of us have to question whether we could
be doing more: listening better, acting faster, being more responsive and being less judgemental.
The evaluation of the reducing inequalities projects that I referred to earlier made the point that while removing the
cost barrier was crucial to improving access, personal engagement was often the critical factor in getting health care
to the hardest- to- reach people.
The third challenge - particularly in relation to the hard-to-reach rural communities is getting ahead of chronic
disease, particularly diabetes and cardiovascular disease.
I've been most impressed by the strategies that some primary health care providers are using to reach people who aren't
particularly comfortable in a clinic setting. Not to mention those who never give a thought about having a health check
up.
Community health workers, kaiawhina and home visiting nurses are beginning to fulfil an important role in making the
link between 'reluctant' patients and the local health centre.
It seems that the rural health workforce is growing at the grassroots level - which makes a lot of sense if you're
shaping your workforce around the needs of your community.
However, the evaluation of the Reducing Inequalities projects raised the issue of the need to provide formalised
training and a clearer scope of practice for this group of community workers.
They clearly are an invaluable resource particularly in bringing in those hard to reach clients. I'd like to see them
better supported.
The 2002 NatMedca survey that looked at rural primary health care suggested that rural people might be diagnosed later
than their urban counterparts for some long term conditions such as diabetes and cardiovascular disease. Why that is,
wasn't clear, although we all might have some theories.
Whether it is question of access to primary health care; whether it reflects a more stoic attitude to symptoms of ill
health; or whether it reflects different diagnostic approaches we simply cannot determine at this point.
Hon Hodgson has signalled that the next phase of the Primary Health Care Strategy will involve giving greater assistance
to the services working with the poorest communities. Many of these will be serving rural communities.
I welcome this news. We have all been working hard to make primary health care services more sustainable and more
accessible. Important as this is, we mustn't lose sight of the greater purpose.
If we can't make a difference for the least well (and the least well off), then we are only increasing the inequalities
that exist in our society. And that is the opposite of what we are about.
As I come to the end of my speech, this seems like the right moment to announce that I am making available in this
financial year and annually from 2005/06 on, a rural innovations funding pool of $200,000.
Any rural primary health care professional will be able to put forward a proposal for one-off funding to enable his or
her practice to develop a innovative approach to the way they deliver care.
While the details of this new fund are being worked through with the Ministry of Health at the moment, I envisage a
number of innovative projects getting some one-off funding to assist with such projects as IT support, management
support, staff training. , or whatever you think is innovative.
Often just a small amount of capital or support makes the difference to whether a project gets off the ground or not.
As soon as the details are worked out, they will be available on the Ministry's web site. I encourage all of you to put
forward proposals - I know there are many innovative people out there in the rural health sector and we want to
encourage others to follow where the bold and the creative have gone before.
I wish you all the best for your conference.
ENDS