Thank you for the opportunity to speak at this prestigious event.  I am delighted to be able to join you.  There's a great line up of speakers and certainly a huge amount of expertise gathered here.

As for my own part it's been a busy 7 months with various portfolios, including Associate Health with responsibility for mental health and complementary healthcare.  What I can tell you is that being in Government beats being in opposition any day.

I must say at the outset that the title for this address was supplied by the organisers, perhaps somewhat cunningly.  While the current and future demands on the health system might be something all here could reach general consensus on, issues relating to redesign might prove more controversial.

This Government has campaigned on the rather ungrammatical slogan of ‘better, sooner, more convenient' healthcare.  As the Minister of Health Tony Ryall wrote in his Letter of Expectations to District Health Boards, we've stated clearly that we want to see "shorter waiting times, less bureaucracy and a trusted and motivated workforce".

The budget aimed primarily to stabilise the economy, reduce ballooning debt and set the platform for future growth.  However there was still new money for health - an additional $3 billion investment over the next four years, including $750 million in 2009/10.  We have allocated over 40 per cent of all new government funding for Budget 2009 to health priorities.

Increasing the frontline health workforce is a key element for improving access, quality and efficiency of health services and the workforce initiatives we have announced include;

·         60 new medical training places in 2009/10

·         25 extra places for general practitioner training in 2009/10, increasing to 50 extra places per year

·         up to 800 additional health professionals over four years to increase services for New Zealanders needing elective surgery, and

·         more training for health professionals in rural areas to encourage undergraduate and postgraduate health students to complete more of their training in rural health facilities and general practices ($4 million over the next four years).

Just over $2.1 billion extra over the next four years will go directly to District Health Boards for services to their local populations and this will go towards;

·         additional funding for subsidised medicines - including Herceptin

·         devolving some hospital services to primary care

·         improving quality and supervision in aged residential care facilities and respite care for those being cared for by others at home, and

·         of course a range of maternity services with additional funding of $103.5 million over 4 years to support;

·          resources for increased birth rates ($40 million)

·          longer stays in birthing facilities ($38.5 million)

·          support services for parents ($14 million for Plunketline telephone advice service and other advisory and information services to support the Well Child Framework)

·          an extra visit to the GP or Lead Maternity Carer in each trimester for mothers or babies at risk ($9.9 million), and

·          obstetrics retraining for GPs ($1.1million).

And the other areas the Budget announcements cover are;

·                     additional support for hospice and palliative care ($60 million over four years)

·                     investment into capital infrastructure ($245 million over four years), and

·                     additional funding for voluntary bonding for hard to staff health professions and locations ($15.3 million over two years).

However while the financial investment is important and welcomed, it is also imperative that we make sure this investment is spent wisely.  We need to ensure that resources are used efficiently, that waste is minimised and that services are focused clearly on the front line. 

New Health Targets

And in relation to this, our new ‘slimmed down' set of Health Targets, just announced by the Minister of Health are part of the Government's plan to help reduce unnecessary administrative monitoring and reporting requirements for DHBs. 

The six revised and much more focussed Health Targets cover shorter waiting times for emergency department treatment, smoking, immunisation, diabetes and cardiovascular services, as well as reduced waiting times for critical cancer treatment and elective surgery.  Its going to make it much easier for the public to measure the performance of DHBs.   

I have to say this is a much leaner approach than a system that was overburdened with 13 health priorities, 61 objectives, with an additional subset of 13 health objectives; a set of 10 health targets measured through 18 indicators; 25 other indicators of DHB performance; not to mention 4 hospital benchmark indicators assessed through 15 measures; and an outcomes framework with 9 outcomes, measured against 39 headline indicators!

The Future of Health in New Zealand

As we look toward, and plan for, the future of health care in New Zealand we must acknowledge that all publicly funded, and indeed increasingly privately financed health systems, have to manage the growing demand for health care within resource constrained environments. This is not news to any of us here today, and you will be well aware of what this entails. 

While the challenges may appear daunting, bear in mind that necessity is the mother of invention.  We need to be constantly improving systems to promote satisfaction among consumers, and also among health professionals.  We need to be providing the kind of health services that New Zealanders need, against the backdrop of a more resource-constrained environment, hence the relevance and importance of Lean healthcare programmes, that do more with less.   

There's still more room to reduce waste in the public health system - waste such as long waiting lists, errors, and too many serious and sentinel events.   And improvement doesn't necessarily mean wholesale structural changes to our existing system; but it does mean finding ways to improve the system, and ways to do things better.  It means looking carefully at systems and processes, rather than obsessing with the name of the entity on the letterhead.

Our key funders - the taxpayer - expect those of us who work in publicly financed systems to strive constantly to do better with the resources we have.  Techniques and approaches that incorporate Lean thinking to drive out waste should be a focus.  This means that all work should add value and serve the needs of our clients, patients, consumers and customers.  Such thinking is an important step toward a better, more efficient health system.

The approaches that are most likely to work are those that engage the very people who are working with patients.   Programmes such as "Productive Ward", "Optimising the Patient Journey" and others that ask for frontline input into processes and systems are the most valuable. 

Frontline health professionals are often the best source of improvement ideas because they work in the very wards, theatres and health service settings that we are trying to influence.  The most modern hospital in the world will still struggle if there isn't active clinical engagement in all aspects of patient services.

It is the Government's strong belief that clinical staff should have a much greater say in the way health services are delivered.  Internationally, clinical leadership is recognised as a significant driver for better health outcomes.

Another key area identified for improved processes is the coordination of care delivery, and making care more accessible to New Zealand communities.   

Government health strategy is moving toward more cooperative, coordinated care - teams of professionals delivering more health services, in a more timely and accessible manner. 

This is being actioned through:

·         more services gradually being devolved from secondary to primary care settings so that GPs are able to provide more services in their clinics - for example a wider range of minor surgery and a greater level of specialist assessment

·         allied health professionals working together delivering healthcare as multi-disciplinary teams to provide the best possible care for their patients, and

·         the establishment of Integrated Family Health Clinics.

The Relevance of Lean Healthcare

Improving the health system means finding ways of doing things better.  More innovative management techniques make services more efficient, reduce delays, and improve experience all round.

Given the current economic environment it is essential that we constantly seek improvement strategies that are effective and inexpensive, and do not require massive investment in infrastructure or equipment.  Methodologies like Lean Healthcare, and ready-made programmes like Releasing Time to Care and Optimising the Patient Journey fit the bill.  

Lean thinking has produced some staggering results in a variety of sectors all round the world.  We have a tremendous opportunity to increase productivity, reduce waiting times, lower costs and improve services if Lean thinking is successfully applied in healthcare.

I am aware that there are a number of successful Lean health initiatives underway internationally, as well as locally.  I am advised that successes include significant increases in direct time care, reductions in the numbers of steps required at Shift Handover and even a 50 per cent decrease in falls at North Shore Hospital, with improved Quality improvement monitoring. 

This is only the start.  Applying Lean thinking has the potential for extracting the gains in productivity vital for helping to meet future demand.  The ultimate customer in health care is the patient, but health care providers must also be aware of ‘internal customers' such as staff, departments and other health care providers.  By improving processes in both care delivery and management, we can improve satisfaction among health care providers and, more importantly, provide a better experience for our patients, clients and their families when they are in our system.

Close

I wish you well with your information and experience sharing, your learning and your networking over the two days of this Summit.

I look forward to seeing the important and very real benefits for New Zealanders that can be realised from your efforts. 

Thank you again for inviting me to speak with you.