Tony Ryall

22 AUGUST, 2014

Midwinter Dialogues Speech

Good afternoon.

I’d like to thank you for the invitation to be a part of the Midwinter Dialogues series here at the University of Otago in Christchurch.

It has been three years since I last spoke to you all, and much has happened since then. In 2011, the Christchurch rebuild was forefront in our minds.

Once more, I want to thank the health professionals and students in this room for your leadership and hard work during such a challenging time. And the challenges are still ongoing.

Health systems all over the world face the common challenge of a growing and an ageing population.

In the Christchurch region, this challenge has been made greater by the damage that was done to Canterbury DHB facilities during the earthquakes. Within four years, it is predicted that there will be a spike in services that existing facilities won’t be able to meet.

To manage this demand, the city’s new Acute Services Building will be opened at Christchurch Hospital in early 2018.

The new building is being constructed at the rear of the Christchurch Women’s Hospital and will adjoin the existing hospital. A range of essential health services will be offered and the building will include features such as an expanded intensive care unit and a state-of-the-art radiology department.

Normally, this construction would require extensive and time-consuming consent processes. But we cannot expect people to wait for these essential services.

So I asked Minister Brownlee to exercise his powers under the Canterbury Earthquake Recovery Act 2011 to cut through some of the red tape and speed up an otherwise lengthy process.

He agreed, and we designated the site on the 3rd of July this year, clearing the way for the building to proceed. We are starting work in September this year.

Interest in this fantastic new hospital has come from as far away as Korea, Australia, Britain, the United States, China, and of course New Zealand.

The redevelopment of Christchurch and Burwood hospitals is a $650 million government investment in Canterbury health facilities.

This is the biggest investment in public health facilities that New Zealand has ever seen.

The people of Canterbury have been through a lot, and we are doing our part to continue providing healthcare that is better, sooner and more convenient.

MEGA-TRENDS AND THE FUTURE OF HEALTH CARE

I’ve been asked to speak today on the challenges that face our health system and how we intend to address them.

The major challenge we face is an ageing population, with more people diagnosed with long term conditions such as diabetes. Whilst that presents immense challenges it also creates opportunity to be innovative in how we treat these patients.

Whilst those challenges will be big, the moves we are making to face them mean we are entering quite an exciting time in health.

I’ve spoken before about these five mega-trends which I believe will shape the future of healthcare in this country and across the world.

These five trends are:

1. Care closer to home

2. Anytime, anywhere - Healthcare through transformational technology

3. Big data

4. Knowledge of genome and biomarkers transforming diagnosis, treatment and prevention

5. And focus on value, pay for results. Higher quality, better results, reducing costs

This transformation within the health system is all about putting the patient at the centre of everything we do. However, even the system itself is not an impersonal entity.

Whether we talk about primary, secondary or tertiary care, what it comes down to is people.

WORKFORCE

What is the use of building hospitals if we don’t have a skilled workforce to work in them?

I. General practice training places

To create a patient-centric system, we must keep delivering healthcare closer to home, and to do that we need to continue to grow the number of GPs in New Zealand.

In the past six years, this Government has more than doubled the number of funded training places in the General Practice Education Programme.

In 2008 there were only 74 places under that programme. This National-led Government has invested an extra $3.8 million to increase the number of primary doctor training places.

Thanks to this extra funding up to 170 junior doctors can now be accepted in the General Practice Education Programme.

There have been a record number of applications for this year’s training programme that starts in December. When applications closed in June, there were over 200 applications, compared to 120 at the same time last year.

This represents the biggest intake of government funded training places in this programme so far.

Since 2009 this government has now funded 170 extra medical school places. The funding of these additional medical places is part of the $18 million the government made available for post-graduate education and training of doctors in this year’s Budget

I am pleased to announce that the extra funding brings the total investment from the government for GP training places to $22 million.

That is a great sign of our commitment to moving resources from the back office to frontline services

II. Nurse graduates

We are also working to grow the number of nurses working across the country. With this in mind we recently signed off an extra $1.5 million for scholarships that will assist 25 graduate nurses to work in general practices in some of New Zealand’s most high need communities.

This investment grows on the $2.4 million we invested last year for a one-off scholarship fund that would enable 48 graduate nurses to work in Very Low Cost Access practices. This was the first time scholarships like this have ever been offered.

In July I also announced that the government will fund up to 200 extra training places for nurse graduates next year. This $2.8 million investment will bring the total number of places available under the Nurse Entry to Practice programme to 1,300.

This will add to the extra 3,200 nurses and midwives employed by DHBs than when this National-led Government was elected.

Each of these initiatives will ensure we have a well-qualified and sustainable nursing workforce to meet our future health needs.

III. Extra medical student places

We have also created an additional 34 medical places for students next year at our two medical schools, including more positions earmarked for rural students.

Our research shows that students who grew up in rural areas are more likely to return and work in those areas. It can be a struggle to find adequate workforce in some of the smaller centres. Therefore, creating extra places for rural students is an investment in our rural health workforce.

Half of the positions will be offered to rural students through the Regional and Rural Admissions Scheme at the University of Auckland and the Rural Sub-Category at the University of Otago. The other 17 places will be offered to students through the Universities’ other application routes.

Auckland University will increase the number of students on its Regional and Rural Admissions Scheme from 40 to 52 from 2015. Meanwhile, Otago University has increased its number from 50 to 55 for the same year.

There are record numbers of doctors and nurses working in our public hospitals and we are committed to continuing to increase their numbers.

Since 2009 this government has now funded 170 extra medical school places. The funding of these additional medical places is part of the $18 million the government made available for post-graduate education and training of doctors in this year’s Budget.

These sorts of investments are helping to future-proof healthcare in New Zealand, and ensure we have the capacity to meet the demands of an ageing population that I spoke about earlier.

IV. Voluntary Bonding Scheme

Another way that we have been building workforce across New Zealand is the Voluntary Bonding Scheme. This scheme was launched in 2009, so many of you will already be familiar with it.

Basically, it provides financial incentives for doctors, nurses and midwives to start their careers in hard-to-staff communities and specialties. It has resulted in a more even distribution of skill across New Zealand.

The success of the Voluntary Bonding Scheme has resulted in a total of 3138 current participants, with this number set to grow.

The scheme includes:

• 2,413 nurses

• 370 doctors

• 312 midwives

• 38 radiation therapists

• And five medical physicists.

The number of applicants in the scheme continues to grow. This year 450 people applied for the scheme compared to 385 applicants last year.

This has been a particularly successful initiative for our very important nursing workforce. As you can tell from the numbers, roughly four out of five participants in the scheme are nurses.

TERTIARY CARE

As I mentioned, we are focussed on putting the patient at the centre of healthcare. But it is not always possible to offer every imaginable service in each region. We can’t provide high levels of specialist tertiary care in every part of the country, and we wouldn’t need to because the demand would not exist.

New Zealand is small and we do have trouble retaining the levels of expertise required to offer such high level services. This is why we need to concentrate the right workforce with the right resources in strategic places around the country, where they can build up centres of excellence in certain fields. From there, they can provide coverage to the surrounding regions – this is what we call the ‘hub and spoke model’.

These clinical networks increase connectivity across the national health sector, and will be an increasingly significant feature of our future healthcare system.

We have established a number of key clinical networks -- led by clinicians and supported by the health service as a whole

I. Cardiac Network

When the National Cardiac Surgery Clinical Network was formed in 2009, New Zealanders needing cardiac surgery faced lengthy and distressing delays.

Since it’s introduction the Network, which is led by cardiac surgeons, cardiologists, GPs, nurses and other health professionals, continues to make gains and improve cardiac services in New Zealand.

Significant progress has been made in increasing the volume of cardiac surgery operations, improving the geographic equity of cardiac surgery provision, enhancing the effectiveness of clinical prioritisation, and reducing the number of patients waiting for surgery.

Effective clinical leadership is a fundamental driver of improved front line health care and this network is an excellent example of that.

II. Cancer Networks

There are four regional cancer networks across the country: the Northern, Midland, Central and Southern Cancer Networks.

These regional networks work alongside DHBs to co-ordinate cancer services across the country by bringing together the organisations which are involved in the planning, funding and provision of cancer services, and are a help to join up each of the points all the points in the cancer patient's journey.

III. Spinal Cord Impairment

Last month we also implemented the Spinal Cord Action Plan, and I recently visited Middlemore Hospital to have a look at the service they provide there.

They’ve learned from other regional services, such as the spinal unit here in Christchurch at Burwood Hospital, that patients are less likely to have surgical complications and will recover faster when they are cared for by a team of highly skilled specialists in one location.

Thanks to the spinal surgeons and the team of specialist spinal care nurses, rehabilitation staff and specialist equipment at the regional service, patients and their families are experiencing better outcomes.

Before these centres were set up, a patient would need to be moved around to receive the care they need, but now they can be treated in one place, for the best possible results.

This reduces unnecessary stress for families and is an example of the coordinated care that our system needs to practice.

IV. Major Trauma National Clinical Network

In June I was privileged enough to address the Major Trauma National Clinical Network. The Network is now beginning its third year of operation and I have been advised that good progress has been made to deliver on its key objectives.

They have implemented a structured approach to delivering quality trauma care, which ensures that injured patients throughout New Zealand are managed appropriately wherever they receive their care.

There is now a minimum dataset in place for a national major trauma registry to enable a consistent baseline data collection that will inform ongoing guideline development and quality improvement.

These and many other activities are essential in laying the basis for a comprehensive and patient-centred trauma system.

The government has a clear focus on regional planning and integration through the ‘hub and spoke model’; it brings together DHBs and all services providers to work effectively together, reducing duplication and wastage of resources.

V. Renal transplantation Service

Then last month I was happy to announce an extra $4 million to establish a National Renal Transplant Service. This service will increase the number of live kidney donor transplantations over the next few years

While there were around 110 kidney transplants last year, there are still over 600 people currently waiting for a kidney transplant.

The new service includes donor liaison coordinators who will work at each the three transplanting centres and in the seven larger renal services in the country.

These coordinators will support donors and recipients throughout the transplantation process, from providing education to interested potential donors to organising blood tests and carrying out pre-surgery preparation.

By establishing this service we plan to give more people who need a transplant, renewed lives, and reduce expensive health care costs, such as dialysis.

BETTER SYSTEM PERFORMANCE

A very significant part of our health plan over recent years and one of our main strategies for improving the health of New Zealanders is the Government’s health targets. These targets have been a highly effective tool for improving health system performance in key priority areas.

We currently have a set of six health targets. Three of them focus on patient access whilst the other three focus on prevention. The Ministry of Health and district health boards are collectively responsible for achieving the health targets. Progress is reviewed quarterly and reported publicly in newspapers and on Ministry and DHB websites.

The first three targets focus on improved access to health services.

I. Shorter stays in emergency departments

Since this target was first introduced in 2009, national performance has increased by 14 percent.

In the last quarter, 94 per cent of patients across New Zealand were either admitted, discharged, or transferred from an emergency department within six hours of arriving. This is up on last year and close to the national target of 95 per cent.

Public hospitals are delivering emergency department treatment faster than ever before, and this has been achieved despite the growing demand on emergency departments. DHBs have analysed how patients travel through the system, using that knowledge to reduce delays and duplication.

This has improved care in the community and enhanced the discharge process, which means better, more sustainable care.

II. Improved access to elective surgery

We are also seeing more New Zealanders receiving hip, knee and other elective operations, with public hospitals delivering 162,000 operations this year. That’s an unprecedented 37 per cent increase since 2008.

DHBs across the country are looking at how people access surgery, when and where assessment and treatment is available and who is providing care.

This whole-of-system approach ensures hospitals are better able to match resources with demand.

III. Shorter waits for cancer treatment

This government is committed to improving services for people suffering from Cancer. Waiting for a cancer diagnosis is a very stressful time for people and their families. So it is important health services work hard to ensure cancer patients receive their diagnostic tests, surgery, chemotherapy and radiotherapy as quickly as possible

Specialist cancer treatment and symptom control are essential for reducing the impact of cancer.

Since January 2011, DHBs have worked hard to make sure that everyone who needs radiation treatment receives it within four weeks of the decision to treat. The combined radiotherapy and chemotherapy target has been achieved nationally since its introduction. This is the world gold standard.

In 2012/13 over 11,000 patients who were ready for treatment received radiotherapy or chemotherapy within the four week target. We are now looking at how we can deliver treatments faster for other components of the cancer pathway. It’s the next step in our plan for faster cancer treatment.

These targets are helping to get kiwis the quality care they need as soon as they can.

The next three targets are equally focussed on the patient, but with the angle of prevention. Helping people stay healthy for longer means they have better quality of life now, and it pushes back the time when they will need to access health services in the future.

A vital part of increasing the sustainability of healthcare in New Zealand is helping people stay healthy for longer and delaying the onset of poor health.

It is about shifting healthcare toward a focus on wellness, and to do that, we need to encourage consumers to be active participants in their own healthcare.

IV. Increased immunisation

In recent years there has been significant progress in lifting immunisation rates among young children.

The overall two year old immunisation rate has risen from 67 per cent five years ago to 93 per cent today across all socio-economic and ethnic groups. Six years ago the Maori immunisation rate was a shocking 59 per cent. In fact in over half our twenty DHBs, the Maori immunisation rate is now equal to or higher than the European immunisation rate

Latest results show that 92 percent of eight month olds are now fully immunised, exceeding the interim immunisation target of 90 percent.

This is up from 80 percent in 2009. The current challenge is to ensure that 95 percent of eight month olds are immunised by December 2014, and that this is maintained through to 30 June 2017.

To assist us in reaching our target, a new National Immunisation Schedule commenced on 1 July 2014. A suite of resources to support the schedule change has been released. This includes a new Immunisation Handbook which provides clinical guidelines for the safe and effective use of vaccines.

The rotavirus vaccine has also been introduced to the schedule. Because these vaccines must be started before the baby is 15 weeks, including this in the schedule will support GP registration and infant recall.

These successes reflect the work of the primary care sector, general practice teams and outreach, as well as immunisation staff working in DHBs. General practices are using practice management systems to identify children who are due or late for their immunisations to better engage with their families and enable timely immunisation.

By giving children the best start to life we can encourage them to live healthier lifestyles and reduce health risks later in life.

V. Better help for smokers to quit

There has been good progress in helping smokers to quit, particularly in the hospital setting. Latest results show that 14 DHBs offered health advice on smoking in hospital settings for at least 95 percent of patients who smoke. This compares with 17 percent when the target first began in 2009.

Performance for the primary care target in quarter two of 2013/14 was 66 percent. This represents a 27 percent improvement from quarter one in 2012/13, when the target results were first published by the Ministry. One DHB met the primary care target this quarter, and 15 DHBs have made significant improvements.

VI. More heart and diabetes checks

Long-term health conditions form the largest health burden in New Zealand and the numbers are growing. As the population ages and lifestyles change, this group of conditions is expected to increase substantially unless we take action.

The ‘More heart and diabetes checks’ health target aims to increase the proportion of the population who are checked for their risk of cardiovascular disease and diabetes.

Latest figures show that since 2008:

• 936,059 CVD risk assessments were completed.

• 73 percent of eligible people have had a risk assessment in the last five years, compared to less than 50 percent when the target was introduced in January 2012.

The government is focused on encouraging people to make positive changes to their lifestyles to ensure they live longer, healthier lives.

KEEPING NEW ZEALANDERS HEALTHY

I. Healthy Families NZ

To keep children healthy, including some of our most vulnerable kids, over 95 percent of under-sixes in New Zealand can now access free doctors’ visits during the daytime and after-hours. Building on this success, in Budget 2014 we announced that free doctors’ visits will soon be extended to all children under 13 years of age from July next year.

We are also investing in a number of prevention programmes to reduce unhealthy weight and promote healthy lifestyles.

One such programme that we are pleased to be rolling out is Healthy Families NZ – a new community-level health promotion and prevention strategy inspired by Healthy Together Victoria.

There is a lot of debate about what works best to reduce obesity – and resources are often too thinly spread. But there’s strong evidence that the whole of community approach happening in Victoria is making a difference.

In Colac, for example, the community has focused on reducing childhood obesity. Colac primary school children are now eating more healthily, watching less television and participating in more activities after school. As a result children aged between four and 12 now have lower weight and smaller waists compared with children in nearby towns. These are the kind of results we hope to see in New Zealand.

Healthy Families NZ is a fresh approach to how we address the underlying causes of poor health. It has a particular focus on obesity, smoking and excessive drinking.

The Ministry of Health is leading the establishment of Healthy Families NZ communities in 10 locations across New Zealand. These communities will be the most visible aspect of Healthy Families NZ, bringing together local leadership, information and resources to help people make healthier choices for themselves and their families.

II. Rheumatic fever

Part of our commitment to improving the health of our children has been focused on reducing rheumatic fever. That’s why we have invested more than $65 million over six years to combat this preventable illness.

In June, we launch a TV campaign which shows the impact rheumatic fever can have on the lives of children and their families.

The great thing about this campaign is that it is based on the real life experiences of a family with 11-year old twins. One of the twins avoided rheumatic fever when his strep throat infection was detected by swabbing and he completed a course of antibiotics.

However his brother went on to have open heart surgery as a result of contracting rheumatic fever.

The campaign highlights the importance of getting sore throat checks. We have adverts on the radio in English, Samoan, te reo Māori and Tongan, and they are all delivered by people who have real life experience of rheumatic fever.

Last month I was able to visit a couple of sore-throat drop in clinics doing these throat swabs in Auckland and see for myself the impact they are having on detecting instances of rheumatic fever.

These clinics have been well received by the communities in which they operate, and will be expanded to other areas with high rates of rheumatic fever across the North Island.

Our latest data shows that from March to May this year, more than 3,300 children between the ages of four to 19 who are most vulnerable to rheumatic fever had their sore throat checked at one of the free drop-in clinics in Auckland, Porirua and Hutt Valley. There are now 108 of these free clinics around the country.

By the end of the year, over 200,000 children will be able to get their sore throats checked and be provided with medication for free

III. Auckland-wide Healthy Homes Initiative

One of the initiatives in the rheumatic fever prevention programme is the Auckland-Wide Healthy homes Initiative, or AWHI.

This service identifies low income families with children at risk of rheumatic fever who are living in crowded circumstances and works with them to put together a package of interventions to reduce that crowding.

It’s a cross government initiative and the Ministry of Health works closely with Housing New Zealand, the Ministry of Business Innovation and Employment and the Ministry of Social Development to make this happen.

IV. Drug and alcohol initiatives

Another significant factor that impacts on the health of New Zealanders is how people use drugs and alcohol.

Drinking is part of our culture and there is nothing wrong with that. But as recent campaigns remind us, it is how we drink that matters. Moderating alcohol consumption is also part of the government’s approach to reducing the prevalence and consequences of chronic disease in New Zealand.

In 2012, we enacted the Sale and Supply of Alcohol Act 2012, which replaced the previous Sale of Liquor Act from 1989. Through the Act, we were able to achieve a number of objectives that place more controls around the provision and consumption of alcohol.

We are also focused in reducing the mental and physical health risk that arises from drug use. Methamphetamine or ‘P’ in particular is well known to be a destructive drug and unlike alcohol, there is no responsible way to use it. It has had and continues to have a damaging impact on the health of far too many people.

To reduce the impact of ‘P’ within our community, the Prime Minister introduced the Tackling Methamphetamine action plan in 2009. This plan aims for a significant reduction in methamphetamine use.

Four measurement areas in the Action Plan that have been achieved (or are ongoing) include:

• improving routes into treatment by re-contracting and maintaining 60 residential beds and 20 social detox beds

• removing pseudoephedrine as an over-the-counter drug and reclassifying it as a class B2 drug, to limit the domestic availability of a basic product used to manufacture methamphetamine

• improving access to education through MethHelp

• workforce development via Te Rau Matatini, which provides scholarships and internships for those wishing to develop specialist skills in addiction treatment.

Since the Prime Minister’s action plan was launched in October 2009, over 600 people have been treated through the residential beds.

These services are in addition to those that DHBs already fund. Without these additional services it is likely these people would have faced serious delays in accessing treatment and may not have accessed treatment at all.

Meanwhile, the provision of a free, nationwide, confidential telephone service and the MethHelp website, allows people to obtain accurate information when they want it, in order to manage their own treatment.

We need to continue to support those suffering from addictions and help them to make the drastic changes to lifestyle needed to improve their overall health.

V. Mental health

We know that if young people with mental health issues receive early intervention then the long-term outcome is much better

Latest data shows that young people with mental health or addiction problems are receiving treatment faster than ever before. Nine out of ten young people who need non-urgent mental health or addiction treatment are being seen within our eight-week target.

In the last three years we have made improvements in access to these services:

• 80 percent of young people are seen by alcohol and drug services within 3 weeks – compared to 62 percent in 2011.

• 69 percent of young people are being seen by mental health services within 3 weeks – compared to 62 percent in 2011.

These waiting time improvements are a result of the increased focus provided by the Prime Minister’s Youth Mental Health project.

Earlier this year we announced an extra $3 million to enhance current services and ensure Kiwis receive the support they need.

BEST USE OF EVERY DOLLAR

Many people underestimate the importance of the health sector here in New Zealand. It amounts to one-tenth of the economy. That’s more than dairy, more than meat.

There are more than 75,000 people employed directly in our $15 billion public health service. And we have a very vibrant private sector too.

Spending on health amounts to a fifth of all government spending, and the health budget is increasing more than any other parts of government spending.

The quality and preservation of human of life should be more important than how much it costs. But… healthcare costs money, and so we have a strong focus on getting the most out of every dollar.

I mentioned earlier that we have been moving resources to the front line where they are needed most – we have succeeded in reducing non-clinical and administrative costs; the Ministry of Health for example, has been reduced from over 1,600 positions in 2008/09 to around 1,100 today.

We are putting that money where New Zealanders want it – into direct healthcare delivery.

Some of the healthcare savings we have freed up come from harnessing the power of standardisation and bulk purchasing. These savings can be reinvested in the front line services to provide better, sooner care.

One of the keys to quality, sustainable care is the progress we are making toward more integrated care.

Health systems around the world are increasingly recognising that clinical integration is an important way to keep people healthy, while at the same time improving the quality of care and making the most of every dollar spent on health. Integrating services involves health professionals working together across organisational and professional boundaries to deliver seamless care.

It’s all about coordinated care which makes the patient’s journey through the health service as simple as possible.

In New Zealand, district health boards are already working more closely with primary care providers to plan and deliver care in a way that reflects local priorities and local needs.

And we will see this increasingly in the future, as alliances between DHBs, primary health organisations and other health providers become the new way of working.

USING TECHNOLOGY TO IMPROVE CARE

Now I’d like to talk about an area that is of great interest to me, and that is how we use technology.

I’ve already mentioned these mega-trends which I believe will be so important in shaping the future of healthcare. One of those trends is healthcare through transformative technology which will allow the provision of care to move from location-centric & doctor-centric to patient-centric.

The intersection of health and technology is going to open up new opportunities for curing illnesses, managing ill health and stimulating economic growth in the health sector.

We are seeing a move to what’s called self-care – patients taking responsibility for more and more of their own health care and management. You’re seeing this happen in commercial sectors, such banking and airlines – with technology allowing customers to access services sooner and more conveniently, by doing the work that the banks and airlines used to have staff and branches to provide.

Already patients are using technology here in New Zealand which allows them to monitor their own vital signs and stream this data from their mobile phones to their health professionals.

We’ve got some fantastic IT and medical device manufacturers here who are making this happen.

Sir Ron Avery is developing a piece of technology the size of a wrist watch that measures your temperature, your blood pressure and your pulse. That information is then transmitted to a device that can be monitored by your general practice.

Can you imagine being able to plug your own personal ultrasound device into your cellphone? The data will be transmitted in real time to your GP, medical records updated simultaneously. These incredible advances will change the way that people interact with primary care.

There is also going to be a new single patient information system rolled out across the South Island.

The South Island Patient Information Care System will connect hospitals and health services in the South Island so health professionals can share information securely and provide patients with better care.

Replacing each district health board’s patient information system with a single streamlined regional system will provide health professionals with more accurate information, and allow them to spend less time on administration and more time on caring for patients.

It will also manage a number of patient services for DHBs, including patient appointments, admissions, discharges, and transfers. I’m sure it will be a very welcome initiative.

We are also expanding the use of patient portals – IT systems giving New Zealanders greater access to their health care records, test results, and care booking systems.

This collected information will allow us to build a picture on how health care interventions change people’s lives, and how we can best do that.

I. Personalised medicine

One of the most exciting trends is the evolution of personalised medicine.

Another of these five mega-trends is how knowledge of genome and biomarkers will transform diagnosis, treatment and prevention, which will be shaped around an individual patient’s specific genetic make-up.

In many ways this will be empowering for patients as they will have a better understanding of their risk profile and what they can do to prevent illness. More personalised medicine may open the way to better, more cost-effective targeting of health interventions.

However, it also raises ethical issues, and may be constrained by the ability of health systems to afford what are likely to be very expensive personalised medicines.

Advancing medicine with technology is critical part of improving the health outcomes of New Zealanders, but it is also a large driver of cost.

Even though the Government spends one out of every five tax dollars on health, the cost of technology to support long-term conditions like diabetes and arthritis for example – not to mention the management of diseases like cancer – takes up an increasing amount of this health funding.

So we are faced with difficult decisions. Does the outcome justify the cost?

We always want the newest and best technology, but is this keeping as many New Zealanders healthy as possible? Is money best invested in new machines to treat disease, or in immunisation to keep people health in the first place?

Negotiating this balance needs to be undertaken with great care, because the health of future generations will be affected by our decisions today.

CONCLUSION

The Government’s emphasis on keeping New Zealander’s well is fundamental to the future sustainability of our healthcare system. Complex issues need comprehensive solutions.

We need to continue to be innovative, to get the most out of every health dollar and to ensure our system remains focused on delivering the best results for patients.

In my role as Minister of Health I have overseen significant change and improvement in health services. The system has transformed with a great effort by clinicians and motivated groups across the sector.

There's still a lot to do though. But provided we stick to our plan, I’m confident that the future of our health service and our country will be very bright indeed.

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