Since the establishment of District Health Boards (DHBs), the Ministry of Health has played an important role in implementing the reform process. We have been central to the development and implementation of a wide range of health strategies and action plans. In short, we have made a significant contribution to the devolved health management environment we have now.
After arriving at the Ministry of Health last year I undertook a review of the Ministry. This was important to me because I felt it was necessary that I obtain feedback and the views of stakeholders given the evolution of the sector over the past six years, and where they would like to see the Ministry place greater emphasis for the next three to five years.
It is important to acknowledge and to state up front that New Zealand has a very good health system, our system compares well internationally on a range of comparators. This is a credit to all those who are involved in the planning, prioritisation and, importantly, the delivery of health services. It is also important to acknowledge that any large system, such as the health system, can always improve and this we must do, as we seek to obtain maximum value for New Zealanders for the resources we spend on their behalf. In considering the planning period 2007–2010 and reflecting on the above, I naturally recount my experiences in the DHB environment. There I would frequently come across programmes and initiatives that worked well in some DHBs but were simply not occurring in others, or programmes that were making a difference in improving health inequalities for some populations but, again, were not supported elsewhere. Variations in practice and patient outcomes within our hospitals are all too common. I experienced and observed sensible regional approaches to service planning in some regions which were not taken up by others. My point in highlighting these issues is that I believe the Ministry’s existing plans do not enable us to fulfil our leadership role in getting better system performance, and ultimately value and improve health outcomes for individuals, communities, patients and the New Zealand taxpayer.
In the examples given above I have focused on system performance. This does not detract from the critical importance of good policy development and our traditional monitoring roles. These are core to the Ministry role and always will be. However, we need our policy work to be well complemented by strategy, and ultimately implementation, so that the variation of performance across the system is reduced and our priorities and health and disability outcomes for populations are enhanced.
For these reasons, this Statement of Intent differs from its predecessors. I have shifted emphasis to performance improvement assistance and best practice advice with the health sector, focusing on the Minister’s priorities, improvements in Maori health, and reducing inequalities. The Government has integrated national health targets to lift outcomes in these key priority areas. Working collaboratively and collegially with other sectors will be critical to achieving these targets.
The Ministry is changing as an organisation to ensure we drive ‘harder and faster’ on the priorities. With the Government’s agreement, I have laid the platform for better prioritisation of the Ministry’s resources by restructuring the Ministry’s output classes. I have strengthened the focus on the cost effectiveness of the Ministry’s interventions.
What really matters to me personally and to my staff is whether we make a difference to achieving improvement in the health and wellbeing of all New Zealanders. For this reason I have strengthened the measurement framework that will allow the Ministry to show that progress is being made. A set of headline indicators map to the Ministry’s outcomes that allow focus on better health and reduced inequalities. The 10 health targets map to the Minister’s priorities of chronic disease, child and youth services, elective services, primary health care, health of older people, infrastructure and value for money. The majority of these indicators will be analysed by ethnicity so we can measure progress on improving Maori health and reducing inequalities. Finally, the Statement of Service Performance describes the performance measures for which the Ministry will be held to account.
These initiatives will position the Ministry to strengthen its sector leadership role and achievement of better health and reduced inequalities with and for New Zealanders.
Director-General of Health