Hon Dr Jonathan Coleman
Associate Minister of Health
1 September 2011
Opening of Otago University’s Centre of Performance Measurement and Management and Centre for Health Systems.
Good morning and thank you for inviting me to address the Centre of Performance Measurement and Management’s inaugural
event. It’s good to see you and the Centre for Health Systems jointly looking at improving health system performance. I
look forward to hearing the outcomes of having the ‘bean counters’ and the ‘improvers’ in the same room.
I would like to acknowledge the Directors of your two units, Professor Ralph Adler from the Centre of Performance
Measurement and Management and Associate Professor Robin Gauld from the Centre for Health Systems.
Your symposium offers an ideal opportunity this morning for me to cover the steps the Government has taken to improve
New Zealand’s health system and the various initiatives introduced to monitor and drive performance across the system,
especially across the DHBs.
Ministerial Review Group
This Government is committed to growing and protecting the public health service. On the recommendation of the
Government’s Ministerial Review Group (MRG) we have folded multiple agencies and committees and other entities into
several central agencies to better develop and service the health sector.
Most recently we established the independent Health Quality and Safety Commission to lead quality and safety
improvements in the sector. The MRG reported evidence of substantial human and financial costs associated with medical
errors, the potential to get much better value from the public health dollar and improved health outcomes and experience
The Commission’s work is strongly focussed on introducing systems and processes to ensure the safest and highest quality
care and using proven innovation.
To progress this work, the Commission will develop a set of baseline quality and safety measures and indicators to cover
the wider health system, including public, private, NGO, primary care, hospital, aged care, mental health and disability
support sectors. This information will allow the Commission to report on unwarranted variation in health care outcomes
and practices in New Zealand. Health care variation reporting is a powerful tool for improving appropriateness of care.
The identification of variance, and open debate about its causes, will ensure that quality care leading to health
outcomes is available for all populations in New Zealand.
Importantly, the Commission will also provide advice to the Minister of Health to drive improvement in safety and
quality in health care. Improving the quality of care will provide better value for money and more efficient and
effective use of taxpayers funding which is vital.
When we came into office three years ago we were very clear on what the public wanted from the health service – they
wanted it to be efficient, convenient and led by clinicians. They expected us to deliver high quality health care and to
get better value for their tax dollars, despite the challenging global financial situation.
Investment in Health
The global financial situation is having a real impact on health care in most countries. Despite the serious economic
environment, this Government will have invested an additional $1.5 billion of new resources into health in its first
Budget 2011 acknowledged the importance of protecting and growing our public health services and delivered an extra $2.2
billion to public health services over the next four years, including an additional $585 million in initiatives in
Of that, $420 million is new money, plus around $165 million from savings going straight back into health care.
Some of the key initiatives being funded by the $2.2 billion over four years include:
• $80 million for widened access to medicines. It is expected around 32,000 patients in the first year will benefit from
this extra funding.
• $68 million for more elective surgery, continuing the record increase of 4,000 extra operations a year, and reducing
• A further $54.5 million for maternity initiatives to improve safety and quality and extra WellChild visits with a
particular focus on first time mothers.
• $40 million for mental health, plus another $4 million for dementia-related respite care.
• $80 million extra from DHBs for GP visit subsidies and $14 million for more people qualifying in programmes such as
very low cost access and free under sixes.
• $18 million for 40 extra medical training places – part of the Government’s promise to boost the number of medical
training places by 200 over five years.
• $94 million more for GP subsidies over 4 years.
The Budget also invests in combating rheumatic fever which has been a health priority since 2001. A $12 million dollar
investment in the budget this year will support a huge campaign across high prevalence communities involving school
based sore throat clinics for over 22,000 children.
But new money has not been our only contribution. Over the past three years we have also driven a system change
involving a change in thinking and in service delivery. This is needed to manage the growing demands on the system.
Clinical leadership is crucial to these changes. An ageing population, new technology and medicine, and rising costs are
putting huge pressure on health services. To help meet these challenges we need to work smarter and differently. That
includes a focus on clinical leadership and integration. We need to move health services to where they are convenient
for patients, and closer to homes and communities.
Clinical leadership and integration are also pivotal to the future delivery of patient-centred care. The nine Health
Care Alliances - partnerships between DHBs and the primary health care sector – help local hospital and community
clinicians to collaborate better. These initiatives have been driven by good innovation from the ground up. We are
seeing more clinical pathways, more direct referral for diagnostics and more hospital specialists working with GPs in
The establishment of integrated family health centres (IFHCs), where various health providers work closely together, is
progressing. IFHCs house primary health care services such as GPs, physiotherapists, pharmacists, facilities for minor
surgery and x-rays, and in some places, provide for overnight care. IFHCs bridge the traditional gap between primary
health care and hospitals, making full use of the primary health care sector’s training and knowledge. It also helps to
prevent expensive and time consuming hospital admissions.
Growing the Health Workforce
We have also been growing and protecting our health workforce. Under Professor Des Gorman’s leadership, Health Workforce
New Zealand is working with clinicians to explore how the health service might respond to a doubling of demand over the
next 10 years, within a constrained funding environment.
As I mentioned earlier, $18 million has been invested in an additional 40 medical school places to increase the number
of medical places. When those students graduate, the voluntary bonding scheme we introduced offers them student-loan
write-offs in return for working in hard to staff areas or specialities. There are over 1800 young doctors, nurses and
midwives signed up to the scheme.
There are now more doctors and nurses employed in the public health service than ever before – with over 800 extra
doctors and 1,500 extra nurses employed by DHBs.
For a health system to work well, it needs the right infrastructure, especially in IT. The National IT Health Board,
recommended by the MRG, aims to have electronic access to health information for all New Zealanders by 2014. In addition
they plan to have secure electronic access to patients’ full health information for all health professionals caring for
Information technology plays a crucial role in ensuring our health system offers the best possible care in a timely way.
Many health care organisations are already making good use of technology systems and the National Health IT Board is
working to ensure these proven systems are shared regionally and nationally. We want to share good ideas and make the
best use of solutions that are already in use so we do not reinvent the wheel. Some examples are:
1. A new electronic system – GP2GP – which means a person’s medical records can be transferred immediately if they
2. In the three metro Auckland DHBs, a patient’s current and past laboratory test results are now available in one
place thanks to TestSafe, a confidential online information service.
3. A partnership between East Tamaki HealthCare and Middlemore Hospital’s emergency department that allows ED staff
to access information about patients enrolled in 13 South Auckland primary health care clinics – including their current
medications, health conditions, allergies, immunisations and recent visits to the doctor.
Auckland DHB is piloting a cardiac health project which collects information on patients’ care at specific points to
chart the effectiveness of cardiac services. Long term, this will enable the cardiac services around New Zealand to be
measured against each other and against Australian cardiac services.
Following the implementation of the National Quality and Safety Programme for Maternity Services, we are rebuilding the
Maternity datamart. This rebuild will increase the accuracy of data collected including home birth reports in order to
provide better quality information to assist in the future improvements of maternity services.
A much stronger regional approach to the planning and delivery of health services by DHBs is essential if we are going
to meet increasing demands for health services within the funding available.
Regionalisation was one of the key ‘missing links’ that the MRG identified in the public health system. Under the Public
Health & Disability Amendment Act 2010 DHBs are required to start planning at a regional level – co-operating, sharing resources
and jointly planning to develop affordable and clinically sustainable regional health service arrangements.
DHBs have been asked to focus on:
• A small number of high priorities and the most vulnerable services in each region
• Development of shared back office functions across DHBs, and
• Regionalisation of IT platforms, IT support and workforce development.
The Health Targets are a set of national performance measures specifically designed to improve the performance of health
services and provide a focus for action. There are currently six health targets with each reflecting a priority health
area for the Government.
1. Shorter stays in emergency departments – 95% of patients are seen and treated within six hours
2. Shorter waits for cancer treatment – patients needing radiation treatment receive it within four weeks
3. Increased immunisation
4. Improved access to elective surgery
5. Better help for smokers to quit
6. Better diabetes and cardiovascular services
The results have been immediate and successful, even internationally significant. We gave firm, streamlined health
targets to the organisations that run our hospitals and who fund primary care – our District Health Boards.
Their performance against those targets are published in a league table in the national press four times a year. There
is nothing like competition and sunlight to galvanise action and improve results.
The latest results released on Tuesday by Health Minister Tony Ryall show we are continuing to make good progress.
For the final quarter of the 2010/11 year, record numbers of kiwi patients are accessing elective surgery, with DHBs
delivering more than 145,000 elective surgery discharges in the last financial year - 26,000 more than three years ago.
500 extra patients a week are now getting elective surgery.
Other highlights in the latest results are:
• A record 90 per cent of two year olds are now immunized, which is up from only 73% three years ago.
• All cancer patients ready for radiation treatment started treatment within four weeks except at the Christchurch
cancer centre where one patient waited three days longer than target as a result of earthquakes.
• 92% of emergency department patients were admitted, discharged or transferred within six hours. 14 DHBs are now over
90%. This includes Waitemata DHB's North Shore Hospital...that was at 61% only 2 years ago. All evidence shows better
treatment and recovery for patients seen sooner in EDs.
• 85% of smokers were offered support to quit smoking, compared with 74% in quarter three. Lakes DHB becomes the first
to hit 100% in this preventive health target.
The composite target for better diabetes and cardiovascular services is down 1 per cent to 72 percent. However the
general trend is improving.
DHB performance is monitored to ensure that DHBs deliver on both legislative requirements and Government priorities. The
non-financial monitoring arrangements, which consist of a balanced and focussed range of key performance indicators that
provide qualitative and quantitative information on DHB performance, are part of the wider accountability framework.
This framework is reviewed annually to ensure that the indicators accurately reflect the Government’s priorities and
measure system performance.
The evolution of this framework reflects an increasing focus on productivity and value for money. With a $9 billion
investment it is important that we clearly see the performance of DHB provider arms.
Over the last three years, the Government has shown the determination to grow and protect the public health service.
There has been some real progress made towards improving services for patients, tackling the workforce crisis, and
strengthening clinical leadership.
But we still have more work to do to get a patient-centred, high quality and affordable health service.
Further progress needs partnerships; between primary and secondary health care services, between patients and their
clinicians and between academics, clinicians, politicians and administrators.
I see this inaugural symposium as a very useful beginning to what should be an ongoing dialogue between all parties on
‘improving health system performance’.