25 August 2006
Hon Pete Hodgson Speech
National Gerontology Section of NZNO annual conference
Thank you to the New Zealand Nurses Organisation for inviting me to speak this morning.
Five years ago my colleague Annette King spoke at the NZNO conference commemorating the centenary of Nursing
Registration in New Zealand. My colleague had a passion as Minister of Health to maximise New Zealander's access to the
best health and health services possible. Since then we have invested 50 percent more into the health if New Zealanders,
spent $1 billion on new 'bricks and mortar' throughout New Zealand, and most importantly increased the number of people
working within the health sector. An extra 2,000 nurses. I think we are getting there – but we will never arrive.
This Labour-lead Government believes in a health system that is predominantly publicly funded, with a strong core of
secondary and tertiary services being publicly provided as well. Around that core of public provision sits private and
not-for-profit provision, freely interacting with and needing each other. Annette King was the 'midwife' to two
overarching documents shaping the health sector – The NZ Health Strategy and the NZ Disability Strategy.
Many other documents have emerged since. The Health of Older People Strategy was released in 2002. DHBs are required to
implement the strategy by 2010. This year represents the halfway mark. Developing an integrated continuum of care is a
key focus of the strategy.
Such a continuum clearly includes supporting older people to stay longer in their homes, if they wish, and increasingly
they do. That has huge funding implications, which we are making good, but still insufficient, progress in meeting. It
also means new types of service delivery. The era of pilot programmes should soon end and the era of implementing those
new types of delivery, widely, must begin.
However many of you work in the residential sector and so I shall focus my remarks somewhat in that direction. New
Zealanders will always need some level of long-term residential care. That is obvious. It is likely that hospital-based
care and dementia care will continue to grow. But we are also going to see increasing numbers using residential care for
episodes of ill health, and returning home after treatment and rehabilitation. The challenge is to build an aged care
sector that can better support this reality. Many of you will have a strong interest in funding of the aged care
residential sector. So let me spend a few minutes telling you what has been happening from my end.
The government devolved funding of aged residential care to DHBs about 3 years ago, and about 1 year later I became the
Associate Minister of Health with responsibilities in that area.
My predecessor, Ruth Dyson, had recently become anxious at the level of funding that the residential aged care sector
was receiving and on the day she passed the mantle to me, Cabinet passed a 2 per cent increase outside the budget cycle.
That was December 2004.
That summer I read the results of research, funded by the Government and done by the gerontology academics at Auckland
University, including all the source reports. It was sober reading indeed. This research spoke of the pressures being
felt by owners, workers and residents. It quantified the staff turnover rate. It measured the amount of training people
had, or didn't have. And so on.
The following budget, May 2005, a hefty funding increase was made over to DHBs. Just under half of it went no further,
as the devolution of September 2003 had not, it turned out, been fully funded by the Government. However, the other
half, about 4 per cent, made it through to the sector.
Then the nurse's pay jolt arrived. Nurses employed in DHBs received a significant wage settlement; something I was very
proud to be part of.
Inevitably that skewed the market for nurses who are not employed in DHBs, but who are instead employed in the private
sector. There are many of them. In some areas there has been a limited ability to pay and that was reflected in the May
2006 budget, which saw about a 3 per cent increase for rest home beds but about a 6 per cent increase for dementia and
hospital beds, because it is in those facilities where one can expect to find more nurses.
I also changed our administration processes so that the funding flowed from 1 July, not much later in the year, as had
been the practice.
It is unusual to talk too much about budgets yet to be announced, but in the case of the aged residential sector I
freely acknowledge that the catch up, for nurses but also for the many other staff working in the sector is not yet
complete. That is on my mind for the May 2007 budget, and work on that budget has already begun.
So the money has started to flow. The increases over the past couple of years total 9 per cent for rest homes and 12 per
cent for hospital and dementia units. That's progress. But it is not sufficient progress.
I have a cycle to break. I have to ensure that the funding flows adequately, to reduce the turnover so that investments
in training that we are also making, separately and additionally, are not lost by that turnover of staff.
I am part of the way there. But I am only part of the way there.
There is a lot I would like to say in this speech that I shall not because of time constraints. Your organisers have
asked that I leave time for your questions and so I will honour that.
I would have liked to comment on your conference programme because it looks to me to be very exciting and challenging,
but I wont. Nor will I comment on assessment tools or the aspire trials, or on the arrival of corporates into your
sector, or on patient-centredness, or on the role of DHBs in developing continuity of care, or on depression or
dementia.
Instead I want to put on record, again, that nearly all residential care facilities in this country are run to a good or
very good standard by a workforce that has a strong dedication, a strong ethos of care and which can and does bond with
those they care for such that friendship and love is a common, normal and rewarding experience for residents.
I do so for two reasons. The first is personal. I have seen it, first hand, as a relative, for years and years. It is, I
suppose, a personal thank you.
The second is political. In essence the good news is never told. We must never underestimate the value of work in the
health sector. Every person I know can recount stories of unexpected kindness and human connection with health
professionals.
When people tell you these stories they are often intimate, often profound, and often they become the material of their
oral history: the pair of glasses which came via a nurse on her way home, the list of books and references emailed to
family seeking information, or the nurse who rang on the anniversary of a death. When hearing these stories the humanity
is unmistakeable. These stories are not news.
The good news is therefore never told. And the good news abounds. I know because the Ministry audits your sector
endlessly. The language in audits is mostly technical and not given to effusiveness. In fact it is as dry as dust. What
follows is a sample of 'audit-speak':
- There is monitoring and prompt assessment of residents whose condition or dependency needs have changed
- The care plans completed by registered nurses were well-written and individualised
- There is a high level of responsiveness
- There appeared to be strong links with the local community and frequent visits by family
- There was a high degree of family satisfaction
- The facility had a comprehensive activity programme
- All criteria pertaining to care support intervention and primary medical treatment were fully attained
- It appears to be an environment where best-practice and continual quality improvement are sought
- There is a family-like environment.
My assertion is that, try as it might, 'audit-speak' cannot disguise the care and dedication of those who work in the
sector. I've seen it as a citizen; I've seen it as a Minister. Congratulations and thank you.
ENDS