Hon Tony Ryall
Minister of Health

23 October 2009 Speech

Speech - Health Minister Tony Ryall
NZ Emergency Departments Conference
23 October 2009 at 10.30 am Taupo

Introduction:

Good morning, this is the second day of the New Zealand Emergency Departments' Conference. Thank you Midland ECCT for inviting me here to talk – and for organising such a well planned, thought provoking conference.

Thank you also for the generous opportunity you gave me when I was Opposition Health Spokesman to come and talk to this meeting last year.

Today I’d like to talk about some of the significant challenges we face in the public health service: the financial crisis, our health targets, clinical leadership and the exciting future we have in Health as a result of the administrative shake-up announced this week.

It’s almost a year since I became Health Minister. It’s a real privilege to hold this portfolio and to work with so many dedicated people throughout the health sector.

Patients and clinicians alike told me last year how frustrated they were with a system where increasing amounts of money had been invested in recent years, taking up an ever larger proportion of the national income, without commensurate growth or improvement in services.

People were frustrated by unnecessary bureaucracy, long waits for patient assessment and specialist treatment, and an evident deterioration in some services.

The new Government is determined to turn this situation around. The National-led Government wants our public health service to deliver better, sooner, more convenient care for all New Zealanders. We want reduced waiting times, better individual experiences for patients and their families, improved quality and performance, and a more trusted and motivated health workforce.

Financial Situation
We are working to achieve these goals in the context of the worst global economic crisis since the 1930s. It is more important than ever that we live within our means while we try to protect and improve the public health service for patients and health workers alike.

Despite the recent encouraging news that we might be coming out of the recession, its impact has had such a profound effect on our economy that it will replace the large government surpluses of recent years with equally large deficits. New spending has shrunk to $1.5 billion - and we've had to borrow in order to provide for that.

The Government places a high priority on protecting and supporting our public health service. For this reason, Health received half of new spending in the Budget - the same amount it has received in recent years.

In other words: Health got a $750 million increase, while the other 30 or so ministries and departments shared the other $750 million.

Next year the new spending allocation for the entire government will be even less than this year - $1.1 billion.

Maintaining a $750 million dollar share for health is no longer possible. We are heading from a time of 10% annual increases in funding to more modest funding increases. Of 5% or below. Next year Health funding will increase but by nowhere near as much as this year.

There will be a significant time lag between the economy returning to growth and fuller employment and the Government's deficit being reduced by increased tax revenues. In other words, next year's budget will be even tighter. The Government is borrowing $250m a week for the next 4 years. So we have to get maximum value out of every health dollar.

What this means is that the Ministry of Health and District Health Boards will have to focus on getting maximum value for money to afford any new initiatives or new projects next year.

The Government is committed to a strong and enduring public health service but the health service in turn will need - more than ever - to ensure a strong and ongoing focus on value for money, with resources moving from administration and low priority spending into more important frontline services.

Ministerial Review Group Decisions:

As I said earlier, the National Government inherited a public health system that wasn't well placed to cope with the significant financial and clinical challenges facing it. There is too much duplication that has led to poor regional and national performance and a track to financial crisis.

There is clear consensus across the sector – and amongst the public – that change is needed.

That was evident in the conclusions of the Ministerial Review Group report – which canvassed the sector widely and deeply. Led by Dr Murray Horn, the Group included some of the smartest people in the health system. They travelled the country listening and debating with people across Health.

And it was also evident in the large amount of feedback we received on the report - which were largely in support of the proposed changes.
The Ministry of Health needs a clearer focus on working with District Health Boards on improving services for patients.

We need better coordination between District Health Boards (DHBs) and the Ministry of Health.

We need neighbouring DHBs working better together to improve services – and clinical networks guiding and supporting this cooperation.

To better focus on patients, the public health service needs to stop reinventing the wheel 21 times in areas like IT, payroll, procurement and logistics.

The Government plans to do that.

On Wednesday we announced a major administrative shake-up in health.

First there will be a new National Health Board (NHB) set up within the Ministry of Health. The NHB will provide more focused national supervision of the $9.7 billion of public health funding the 21 DHBs spend on hospitals and primary health care.

It will also integrate for the first time infrastructure planning around IT, workforce and capital investment – it will take over these functions that up until now have been fragmented and duplicated across 21 DHBs and other agencies. This will make a huge difference to decision-making

The NHB will also take national responsibility for vulnerable health services such as paediatric oncology, clinical genetics and major burns. Clinical networks will play a large part in supporting and guiding these services.

Work will also start on setting up a shared services establishment board to consolidate the 21 DHBs' back office administrative functions such as payroll and bill payments.
As a package, the changes that would consolidate DHB administration like IT, payroll and harnessing the power of bulk purchasing are estimated to save up to $700 million over five years. That saving will be put straight back into front line health services.

$700 million would buy about 16,000 heart bypass operations or build a couple of large city hospitals – $700 million would also modernise or rebuild all of our 24 EDs to level 3 capacity or higher.

The changes are also expected to reduce the health system administrative staff by up to 500 jobs. That’s an estimated 300 back office administrators in DHBs and 185 in the Ministry of Health itself. Individual DHBs are also planning reductions in their administrative staff, as they move resources from administration into frontline services.

The changes we announced are about making the current system work better – it is about filling in the missing links that have hobbled national and regional cooperation in our public health service for years, and allowed wasteful duplication and constant reinvention of the wheel in the 21 DHBs.

They are an urgent priority and implementation will begin immediately. The health sector is ready for change. And that change will be good for patients and good for health.

Clinical leadership and engagement

There is another fundamental driver for better health outcomes recommended in the Ministerial Review Group Report that also underpins this Government's health policy.

This is a strong commitment to clinical leadership and engagement.

Clinical leadership is about putting our clinicians at the centre of leading our health system. Globally, clinical leadership is recognised as a fundamental driver for better health outcomes, improving job satisfaction, and of course that in turn keeps clinicians in New Zealand.

In contrast this Government inherited a health system where the influence of clinicians on patient outcomes here in New Zealand was less than it had ever been before.

And that is why the new National Government commissioned a significant report called 'In Good Hands' to guide District Health Boards in introducing greater clinical leadership into the public health system.

The 'In Good Hands' report provides strong guidance to DHBs on how they can institute a more engaging and less top down approach for their doctors, nurses and other health professionals.

This Government is serious about re-engaging doctors and nurses in the running of front line health services, not just talking about it, and we have instructed DHBs to act on this report.

I urge you to step up and grab the opportunity clinical leadership provides. This government sees you as part of the solution not part of the problem. DHB managers are getting the message the clinical engagement is fundamental, and you should assert your involvement at every opportunity.

Managers will respond incredibly well to clinicians willing to lead and engage in improving productivity and the way services are provided for patients.

Health Targets

New Zealanders should have timely, high-quality access to healthcare services when they need it. For many, confidence in the health system over recent years has been damaged by excessive waiting and delays.

One of our main priority areas is to improve public hospital services and reduce waiting times for patients.

The Government has introduced a slimmed down set of Health Targets aimed to focus progress on the Government's goal of achieving ‘better, sooner, more convenient' services.

The streamlined goals reflect the Government's desire to simplify the current complex and multi-tiered monitoring and reporting system.

In fact we have slashed the DHB reporting burden to the Ministry of Health by 33%, and we are planning a further 25% reduction this next year.

Of the six Health Targets, three specifically focus attention on the urgent issue of excessive patient waiting times in public hospitals and seek to make improvements to achieve genuine reductions in waiting times for patients: more elective surgery, faster cancer treatment and shorter waits in Emergency Departments.

The ED waiting times target - ‘Shorter Stays in Emergency Departments’ target - which came into effect on 1 July 2009, aims to have 95% of patients admitted, discharged or transferred within six hours It is a clinically-established target that makes a real difference to patient care.

This target finally gives national recognition and importance to emergency departments and the acute care pathway. It also provides a focus around which to drive improvements in quality and performance.

Emergency Departments are barometers of how well their hospitals are doing. Your work as ED professionals is high pressure and challenging – but it is also vital to getting it right throughout the hospital.

So although the target is labelled as the ‘Shorter Stays in Emergency Departments’ be assured this government is acutely aware that achieving it will take more than just the efforts of emergency departments ... its about the whole hospital.

Whole-of-system approaches taken by DHBs, and embedding genuine quality initiatives, will be key to achieving the target.

If you continue to commit to improving the quality of acute patient care, I will ensure that DHBs take the health target seriously- there is no doubt everyone must work together if we are to achieve our goal.

I know many of you will be aware of the experience of the UK National Health Service with its four hour ED length of stay target. It is well known that some ‘gaming’ and ‘shifting of the risk’ occurred in an effort to achieve the target.

I want to make it clear that such behaviour, aiming for compliance without improving quality, will not be acceptable here. The aim of the target is to improve quality of care, not simply to rush people through the ED department: timeliness is just one of a range of factors that makes patients and clinicians happy.

Achieving the target will be challenging and require some effort, but it is the government's expectation that all DHBs will achieve it by 30 June 2011.

The first quarter results against all six of the health targets have just been submitted by DHBs and it is our intention to publish the quarterly health target results in local newspapers and online. This will be in the form of a national league table comparing DHB performance against target.

I am aware that the Health Services ED Target Champion Prof Mike Ardagh is visiting a number of DHBs to discuss what is happening in relation to the target, what’s working well and what could be done to overcome barriers that might prevent progress.

This conference provides the ideal setting for you to expand these discussions
We all share the common aim of reaching the six hour stay target, and I am sure everyone can all learn as well as teach something that will help us achieve this goal over the coming days.

Conclusion:

Finally I would like to commend you all for the hard work you do, everyday, under immense pressure, in EDs across the country.

I have no doubt that at times the work is stressful and exhausting, but at the same time I am sure it is rewarding.

We are all here to put patients first, and I know that most patients are incredibly appreciative of the professionalism, commitment and humanity shown by ED doctors and nurses throughout this country.

The dedication and commitment of doctors and nurses and other health professionals like you make me very optimistic about the future. You are all world class.

Thank you for giving me the opportunity to speak to you here today.

ENDS

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