O nga iwi o te motu; he tangata Manatu Hauora, tena koutou tena koutou tena koutou katoa.  Talofa Lava, malo e lelei, namaste, ni hao ma, warm Pacific greetings to you all.  

Introduction

I would like to acknowledge the Director General, Stephen McKernan, and all of you.  I want to thank you for all the hard work you do to ensure the good health of all New Zealanders.

I’ve flown to Wellington today especially to speak to you at this important Leadership Forum.  I confess that I haven’t done so just to thank you – although I mean that sincerely.  Nor just to celebrate your many achievements to date – although they are considerable.

I am here today to deliver a strong and clear message: I want our role in the health system to change.

I want us to change the way we work – as a Ministry and as Ministers.  Let me explain what and why.

You have recently completed an important and far-reaching internal restructuring – one that puts far more emphasis on innovation, strategy and building analytical capacity.

The time has now come to change the way the Ministry operates within the broader sector:

-          Change from a primarily advisory and monitoring role; to one of stronger central leadership of the sector as a whole;

-          Change from thinking of the Ministry as primarily the Minister’s advisor, to stepping up to the role as the Minister’s and the government’s leading agent of change within the system.

It follows that the government, and I as Minister, will increasingly hold this Ministry accountable, as appropriate, alongside the ongoing statutory accountabilities of DHBs and other health sector entities, for whole-of-system outcomes rather than just for the Ministry’s own outputs.

In saying this, let me acknowledge that since becoming Minister of Health I have observed that the health and disability sector consistently performs at a very high level.  

Our system is internationally recognised as a provider of high quality, trusted services that are delivered in a cost-effective manner.  And that makes it the envy of other countries.  

The system has a hard working and dedicated workforce of which we can be justifiably proud.  And of which you can be proud to be a part of as Ministry of Health employees.

It’s also timely for me to acknowledge the good work all of you are doing collectively within the Ministry and across the sector.  And your continuing hard work and dedication to making a difference in health.

Outline

Today is an opportunity to take stock of the historic and current challenges and the initiatives and strategies to overcome them.  

In my remarks today I will recall the journey that we have been on, the challenges we have faced, and the opportunities that lie ahead.

I will note the underlying purpose of the Government’s broad health policy, and take stock of progress made in implementing it.

I want then to look forward, and to address three areas of opportunity:

-          taking the primary and preventative health strategy to the next level

-          strengthening health services we can trust, including by focusing on quality and building a more regionally and nationally coordinated DHB system; and

-          taking a strategic view of the key underlying enablers – principally workforce, information and finance – that will allow us to more forward further.

Finally, I will consider what this all means for our respective roles and “job descriptions” – as a Ministry and as Ministers in the health sector.

Historical challenges

Put simply, New Zealand’s health system is on a performance improvement journey.  Historically our health system has faced many challenges.  The 2001 reforms, in particular saw our health system inherit some substantial historical challenges.  

The 1990s model of health care was characterised by the fall out of a system that wasn’t working: high entry costs to primary care; few people enrolled in chronic disease management programmes; and excessive waiting times for electives and electives on demand and not based on clinical criteria.

In short, what this resulted in was a noticeable lag in the health of New Zealanders behind that of other developed countries, especially for our Maori and Pacific peoples.

The system lacked a comprehensive focus on population health goals and reducing inequalities, and we noticed that New Zealanders were losing trust and confidence in their health system.

The 2001 reforms

The 2001 health reforms and the establishment of District Health Boards represented a marked change in the provision of health services in order to address these challenges.  The previous model of health care delivery was hospital-centric and focussed on funding contracts, prices and volumes.

Our new model of health care delivery was to emphasise population health improvement, reducing inequalities in health status, better integration of services, and greater community involvement in health system governance.

The 2001 reforms aimed to provide a health system based on cooperation and a health system that puts people at the heart of health care.  The objectives were clear.  As a government we wanted to:

-            raise the health of the population and reduce inequalities

-            ensure better use of resources

-            increase community involvement in decision-making, and

-            create a non-commercial, collaborative and accountable culture in our valuable publicly funded health sector.

Since 2001 we have instigated a number of key initiatives and strategies to address historic challenges in New Zealand’s health system

There is momentum across the entire spectrum of the health sector to realise the goals of the New Zealand Health Strategy.

The launch of the Primary Health Care Strategy in 2001 signalled the most significant changes to, and investment in, primary health care services in over 50 years.  As many countries worldwide are now recognising, harnessing the potential of the primary health care sector is vital to improving health outcomes.

Other major initiatives include the Cancer Control Strategy which spans the continuum from prevention to palliative care; Healthy Eating – Health Action which is our strategic approach to improving nutrition, increasing physical activity and achieving a health weight for all New Zealanders, and He Korowai Oranga – our Maori Health Strategy sets the platform for action in reducing inequalities for Maori.

The momentum for action has not stopped, just last year ten Health Targets were introduced in areas where we need the greatest traction to achieve our goals.  Already the attention the Health Targets have attracted have begun to deliver results.

Investment

This Government has invested significantly in our health system.  Vote Health has increased at a much faster rate than GDP annual growth, on average 9 percent nominal growth per year.  In part, this increase has been to fund services where there was an under-investment in the 1990s.

The historical underinvestment in capital infrastructure was recognised and remedied.  In the last six years over $2.3 billion of capital expenditure has been undertaken and new hospitals have opened in Auckland, West Auckland, Christchurch and Invercargill.  These illustrate this government’s determination to provide first-class hospital and health services throughout New Zealand.

We have invested in more doctors - a growth of just under 8 percent in 2006. We also have increased doctor and nurse salaries in recognition of the fact that we are competing in a world market for health professionals.

We have invested heavily in primary care. Since 2002/03, the additional $2.2 billion in support for the Primary Health Care Strategy has enabled:

-            a move to equitable and universal access to primary care

-            reduced out-of pocket costs for GP visits and prescription items,

-            extra funding for very low cost access for practices charging very low fees

-            extra funding to PHOs for services to improve access for high need populations and population-based health promotion

-            and extra funding for appropriate management of long term conditions in primary care settings.