New Zealand Health Strategy update 2016

Title: New Zealand Health Strategy Consultation 2015

[Jill Bond, Executive Director, Ministry of Health] We’ve had a fantastic response from people to engage in the consultation process for our draft New Zealand Health Strategy. Consultation has now concluded and we’re really busy having a look at all the feedback and information that we’ve gathered through this important process.

On behalf of the Ministry I’d like to say a huge thank you to everybody who’s been involved in this important work.

As well as more than 400 written submissions received, we’ve heard first hand from more than 2,000 people who have taken part in 100 formal meetings around the country.

[Dr Michael Chen-Xu, New Zealand Medical Association] Wouldn’t it be great if MSD was looking a housing policy, looking at health literacy in education policy and looking at health policies in various other areas of government and their impact on health outcomes – it could be a really good way of ensuring that people not only get well in the health system but live well and stay well.

[Derek Milne, Chair, Wairarapa DHB] I’d like to think we see our over 65s fairly early on to see if they’re actually heading towards diabetes: what’s driving that, are they too obese, not taking enough exercise, heading towards diabetes and actually giving them an early warning about this and saying, hey, you’re going to have a pretty unpleasant end to your life but you can do something about it.

[Mark Peterson, CMO, Hawke’s Bay DHB] You need to do that at 45, not 65 I have to say.

[Derek Milne, Chair, Wairarapa DHB] Well, yeah, yeah.

[Jill Bond, Executive Director, Ministry of Health] The conversation has been mature and thoughtful and the interaction between people has been enthusiastic. This has generated a lot of very useful feedback and worthwhile suggestions, which we are considering as we finalise this Health Strategy.

[Chai Chuah, Director-General of Health] There’s a consistent theme for the Saturday meeting – I haven’t been to all of them, I’ve been to some of them. I think one is the willingness of people to come and contribute and they come and contribute with great passion. So this morning I’ve met someone from public health, I’ve met someone from smoking cessation, I’ve met some board members, I’ve met practice nurses, I’ve met people from other government departments. All these people come with the desire to actually want to contribute and make something different.

If you watch around the discussion in the room there’s no lack of energy and that’s a good indication to me that people actually want to make a difference here and that they want this Strategy to make a difference.

[Jill Bond, Executive Director, Ministry of Health] We’ve also had a big response on-line. More than 6,500 people have visited the consultation website and the consultation documents have been downloaded nearly 7,000 times. Around 2000 people have visited the online discussion and left more than 100 comments on it.

People are enthusiastic about the five themes – people-powered, closer to home, value and high performance, one team and smart system. Here’s some of the comments we’ve received during consultation.

[Dr Margaret Wilsher, CMO, Auckland DHB] So we want the focus to be on the person in the home. We want to focus on health before sickness. We want people to maintain their health for as long as they can but when they become sick we want them to be able to direct their own support and their own care.

[Karen Orsborn, General Manager, Health Quality & Safety Commission] I think we should have consumers involved at all levels of the health system. I think that’s the one thing that would make a difference because it would be a catalyst for driving change to make services be more responsive to consumers.

[Vivien Pole, Manager Service Development and Integration, Alliance Health Plus] I like the five areas of focus of the Health Strategy that they’re looking at and People Powered is exactly what I was referring to in touching peoples’ hearts, because when they own it they feel empowered and they make change because you can’t force somebody to make a change. The People Power will definitely be helpful but you have to deliver it in a way that people will embrace it and support it and take it on board. We need a system that responds to the needs of the community.

[Dr Kathleen Logan, Office of the Children’s Commissioner] I think children’s services should include parenting support information for parents so they can learn about nutrition and the other things that children need to grow up well – behaviour support so their mental health can be supported as well and their cognitive development can proceed well and all those things will make for better childhood.

[Tony Kake, CEO, Papakura Marae] It was really good to hear this morning the intent to drop down those silos, to break into an interactive model. So you know I am encouraged by that. I really want to support that happening. It’s kind of like the approach we have here on a marae anyway. We don’t just deal with the health issues in isolation. My doctors, my nurses up at the clinic interacting with my social services arm, nurses, our driver’s licence programme. Those are the things that our whānau really need. That’s just part of our approach to integration.

[Stephanie Erick, Director, Action on Smoking and Health] I was really excited to hear about the move towards health services in schools and bolstering that up a bit more. Perfect for Pacific communities. You know we come from homes where people are busy. A lot of parents are working. A lot of parents don’t have transport to get to the services they need to get to so if children are able to learn at a younger age to consider their health then perhaps when they turn into young adults they will use health services rather than figure it out from friends or Facebook and so forth. So I think that’s a really good opportunity.

[Boy] Doctors.

[Interviewer] What makes you healthy?

[Boy] Fruit.

[Maioha] Motivate them more, try and get more social sports out there and encourage the young ones to give it a go.

[Te Aho] Make it compulsory for Year 9s or whatever in high school to do sports. You’re able to do more things and play sports when you’re older as well.

[Dr Kathleen Logan, Office of the Children’s Commissioner] Well, the thing I put down was children’s access to Well Child Tamariki Ora services. I think it’s something if all children at access to them - and I mean all children, nobody missing out – it means that you’ve got a better start in life and if you start in life well it means all the other things you spend money on in terms of health care have a better outcome. So that more children can start off with more access to the health care they need because they don’t know when they need to go to the doctor. They always depend on other people to get them the health care they need. So the services need to be quite joined up, culturally competent and delivering to all children.

[James (Hemi) Hokianga, Consumer representative] It came to a point where I’m in a small community and they had all these other places, courses, group sessions I could attend to deal with certain parts of your life. One would be alcohol and other drugs, one was diabetes and by the way that’s awesome, really awesome. I did four. I was really hooked into it because the dietitians were able to explain how food works, and how the body reacts to food as well. So that was a real eye-opener.

[Matiu Rei, Executive Director, Ngāti Toa Rangitira] I think the closer to home services is about knowing who your people are and know your services and if you can get that understanding, know that we’re here to help and we will do it in ways that’s more accessible to them.

[Brendan Boyle, Chief Executive, Ministry of Social Development] So, how are we going to bring ourselves together in a way that we can make it easier for them and given the complexity of a lot of the issues it actually requires much more than one particular agency to solve these kind of problems?

It’s actually information sharing, data analytics, shared ways of describing and understanding our clients, where they cross over the multiple agencies. So structuring information and having that information readily available is very important.

The other component which is probably under-estimated but is probably the biggest issue is cultural. It’s actually people in government agencies being prepared to share, being prepared to work together and in some cases being prepared to let go and allow others to fill a gap where it might currently exist.

[Musa Memo Chief Executive, New Zealand Nurses Organisation] I don’t think it’s particularly one thing – I think there are multiple which would be connected but I think the biggest challenge I see now is actually rethinking the funding model. That in turn results in the way services are either commissioned, purchased and then the workforce to support them.

[Emma Hickson, Nurse Educator, Capital & Coast DHB] Working in the system I see there’s a huge duplication of assessment as an example, which is why it’s so important – there’d be great efficiencies if we could only stop the duplications and share information among clinicians from health to social sectors. You know it’s across the board and so instead of everybody going in and asking the same questions of the poor consumer we should actually share that information and collaborate and know each other’s roles better as a consequence of that.

[Ashley Bloomfield, Chief Executive, Hutt Valley DHB] Oh look, the one thing from where I’m sitting now in a DHB CE role would be for us to really think about the progress we’ve made over the last six years in moving services into primary and community and progress has been quite limited. What is it that we have to do from a policy, funding, a workforce and infrastructure perspective that means over the next 15 years we absolutely are able to make that shift, as we have to speed up that process.

[Dr Mark Peterson, CMO, Hawke’s Bay DHB] The biggest difference? I think it’s actually addressing the social determinants of health and that’s actually income and social welfare and the equity problems we have.

[Sally Faisandier, Principal Research Advisor, ACC] Sign up to this. Get serious about it. Build it into the Statement of Intent, then the targeting, then the KPIs and keep it going and have people who are really championing the approach. And this isn’t just about the Ministry of Health actually. It’s about all other agencies as well so it does need a community to support it.

[Kathryn Cook, CEO MidCentral DHB] One of the things I’m picking up here is the need to challenge some of the established norms, the way we do things, the values and behaviours of our system, leaving behind things that are not making a difference. I think talking about a different way of contributing, working and I think that’s really refreshing.

[Dr Ros Gellatly, Chief Medical Advisor – Primary, Nelson Marlborough DHB] To teach everyone to use the Model for Improvement so that everybody – consumers, providers right across the whole system – are looking at testing and improving things all the time, measuring what we are doing, knowing if we’re making an improvement. It just empowers people to say we’ve got a good idea, let’s test this out, let’s do it.

[Kate Wang, Wellington Free Ambulance] If we can break the boundaries and make some flexible. Of course you measure the outcome of what we’re trying to achieve but I think that’s the most important thing to me.

[Te Puea Winiata, CEO, Turuki Health Centre] I also want to mention that with the Health Strategy, workforce development is of ongoing importance for bringing services to be more culturally competent and more responsive, more whānau-centric.

[Forum attendee] I think a nationalised health IT system. I think everybody would agree on this as being a good idea but I think it has some massive practical challenges.

[James (Hemi) Hokianga, Consumer representative] The main thing is the system. I feel there’s not enough connections to different departments where they can gather this information. A patient comes in and they can only gather information from certain departments.

[Erin Reeves-McMillan, Consumer representative] There’s not enough connection I think across the whole country and between DHBs in terms of medical records and what happens to people and when people move and things. It’s quite hard to access all of that. And I also think that the investment in the information technology is the key thing as well.

[Dr Richard Medlicott, Island Bay Medical Centre] We know that computer algorithms can often come up with better decisions around relatively simple stuff for example warfarin dosing to thin your blood, or managing your diabetes with insulin dosing. So that gives us more time to talk with the patient about what diabetes means to them or why are they on that agent that thins their blood. So it gives us more time to communicating the meaning of it with the patient.

[Jill Bond, Executive Director, Ministry of Health] These are just a few of the many comments that we’ve heard during the course of consultation on the Strategy. We also heard a lot over the consultation period about the need to focus on a better end of life. Shortly we will be releasing new principles and guidelines called Last Days of Life. This is a great example of the sector, the Ministry and consumers working together to produce something that is tangible and clearly needed. This is an example that we expect to see more of in the future and we’ll be able to have these discussions in future forums when we come together to discuss really important things that matter not only to the system but to the people of New Zealand.

[Te Puea Winiata, CEO, Turiki Health Centre] I’m very excited about the Health Strategy and the direction we’re travelling on. I think it is important that the Strategy framework will encourage innovative spaces for whanau and providers and the sector to work in, ensure we understand what success looks like to them, what wellbeing looks like to them. It’s important that the Strategy supports collaborative working together, using resources, wisdom, collective support to encourage better outcomes.

[Jill Bond, Executive Director, Ministry of Health] We’re hearing people want change and they want that change happen with pace. So here at the Ministry we’re making changes so we are better able to lead that Strategy and to work alongside the sector and our colleagues across government to make a difference. Achieving outcomes for all New Zealanders will require us to work really smartly with DHBs, with consumer groups, with PHOs and NGOs and this will require us to build to our strengths, know our roles, responsibilities and accountabilities and make a real difference together.

[Chai Chuah, Director-General of Health] I think one of the things we’ll be looking at is keeping the momentum up so this is not a process that we run just during consultation. Each year we’ll be looking at holding at least one of these so we use the opportunity for people to hear our feedback about what’s gone well, what we’re thinking about for the following year and actually get their feedback as well. I think this is a great success.