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Speech – National Rural Health Conference, Dunedin

Introduction:

Thanks Sharon. It’s great to be here today at the National Rural Health Conference.
I’d like to thank the New Zealand Rural General Practice Network, the Rural Health Alliance Aotearoa New Zealand and the New Zealand Rural Hospital Network for organising this event.
The conference theme ‘Wai Ora – Healthy Environments’ focuses on providing quality primary healthcare services to rural communities. Delivering high quality and accessible health services to rural communities is a priority for this Government. I’d like to take this opportunity to thank you all for the contribution you make in delivering health services to our rural communities. There’s  many examples of integration, innovation and collaboration being delivered in the rural health sector.

Farming
Clearly many farmers are doing it tough at the moment. New Zealand farmers have historically been used to volatility and are very resourceful. We all know that farming is a cyclical business and always has been – but the dairy industry has a positive outlook in the medium to long term. However, there’s no doubt a lower dairy payout will have an impact on regional economies, but that’s partially offset by the strong performance by other primary industries – especially horticulture, wine, kiwifruit, beef and tourism. We are very aware though of the effect on mental health.

Rural mental health
Increased mental health support in rural regions has been a key focus for the Government. Last year we announced a $500,000 boost for rural mental health. As a result of this funding, the capacity of Rural Support Teams has increased, relationships with mental health providers have been strengthened and there is better national coordination. 60 additional Rural Support Trust facilitators have been recruited and trained to respond to requests from farmers and their families. 14 regional mental health clinical champions and a medical director have been appointed to better enable people to access professional mental health services.  40 suicide prevention training courses are being delivered this financial year to rural health professionals. These workshops are complemented by Dairy NZ’s awareness raising efforts. Work is also taking place to develop a longer term plan to guide the planning, design and delivery of services to achieve better rural mental health outcomes.

Rural workforce
Providing support for the rural health workforce is a key Government focus. We know that recruitment and

Minister of Health Dr Jonathan Coleman

Minister of Health Dr Jonathan Coleman

retention of GPs, access issues for patients because of locality, and limited resources and training for rural healthcare workers are some of the challenges many of you face. There’s good evidence the best solution to rural health workforce shortages involves selecting students early from regional and remote centres and maintaining their exposure to the challenges of rural primary healthcare throughout their education.

The Government supports a number of workforce initiatives including:
The Voluntary Bonding Scheme which incentivises graduates to work in hard-to-staff communities or specialties. To date, over 1,000 health professionals have been funded through the scheme. Medical immersion programmes – where medical students spend an entire senior year in a rural area. Two rural immersion and inter-professional education programmes in Tairawhiti and Whakatane have received additional support from Health Workforce New Zealand until 2019 – this is a reflection of their success. I know there is evidence that medical graduates of the University of Auckland’s long-term rural immersion programme are returning to rural areas after graduation. I also want to recognise the important Rural Recruitment and Locum Support Services that the Network is contracted by the Ministry to provide. This service recognises that rural general practices can struggle to retain GPs and that some GPs work in isolated solo practice settings.

Rural Service Level Alliance Teams
All DHBs with rural populations now have Rural Service Level Alliance Teams. This change to the way additional funding for rural primary healthcare services is allocated supports the delivery of services closer to home, in more effective and efficient ways. Excellent work is being done through Rural Service Level Alliance Teams which work across health and social services. Innovative solutions have been developed across general practice, ambulance and telehealth. In Southern DHB for example, this has meant a reconfiguration of after-hours care which has been agreed more promptly and agreeably. Other regions report similar progress.

General health overview
I’d like to give you an update on wider sector issues. The feedback I get from the sector is that while there are challenges, we’re heading in the right direction. Delivering better health services is a top priority for this Government. We’ve made health our number one funding priority. Despite economic challenges, we’ve increased health funding each year. Claims by Government critics that health funding has been cut are incorrect. Under this Government health expenditure share of GDP has averaged 6.5 per cent – that’s up from the previous Government. We obtained $400 million extra to grow health services this year. Health received $15.9 billion – the largest share of new funding in Budget 2015. We’re investing around $1.7 billion over the next four years for new initiatives and to meet cost pressures and population growth – including more funding for elective surgery, palliative care, and free doctors’ visits for children under 13. I am working hard to ensure health remains a key priority in Budget 2016.

Priorities
In terms of my priorities this year, I will be progressing the updated New Zealand Health Strategy. I want to see more integrated services delivered in the community so people can get the care they need away from hospitals.
I want to ensure speedier access to elective surgery, and we are working to quantify unmet demand to better understand the outcomes of GP referrals to specialists. The health targets continue to be a key focus. They are not just about numbers – they are about delivering better and quicker access to important health services.
I want to see continued progress on non-communicable diseases. Our largest health burden stems from people suffering chronic conditions. Implementing the Childhood Obesity Plan is a key focus. I’m also keen on widening access to medicines, and progressing the bowel cancer screening programme.

Obesity
We’re now one of the first countries in the OECD to have a target and a comprehensive plan to tackle Childhood Obesity. There’s no single solution that will fix obesity. That’s why we implemented a plan with a range of interventions across Government, the private sector, communities, schools and families. Our position on a sugar tax hasn’t changed – it’s not something we’re actively considering. We’ll continue to keep a watching brief on the emerging evidence, including research from the University of Waikato and University of North Carolina.

Health Strategy
Clear strategic direction for the health sector is crucial. The Health Strategy update is a good opportunity to develop a more integrated cohesive health system, better able to meet the demands of the future. The draft Strategy covers five strategic themes – people-powered, closer to home, value and high performance, one team, and a smart system.These themes signal a focus on prevention and wellbeing, more integrated services, support for innovation, better collaboration, new ways of working to reach our most vulnerable, giving every child a healthy start, and ensuring information and services are more accessible. I will be launching the revised Strategy in the coming weeks. Funding and performance management

Funding and performance management
The Health Strategy has implications for primary care – how we fund services and how we measure performance. I’m currently considering the options presented to me to achieve improved targeting of Very Low Cost Access (VLCA). I have asked officials for further modelling work to be done. It’s important to understand all the consequences of any proposed changes to funding models.

Integrated Performance and Incentive Framework (IPIF)
With the Health Strategy refresh it was timely to look at moving performance measurement from a transactional approach to one based on outcomes. The Ministry has worked closely with the sector to develop a suite of measures that provide a system-wide view of performance. A number of new measures are proposed for introduction in 2016/17: acute hospital bed days per capita; ambulatory sensitive hospitalisation rates for 0-4 year olds; patient experience of care; amenable mortality; youth access to and utilisation of youth appropriate health services; and the number of babies who live in smoke-free households at six weeks post-natal.
Three of these new measures – acute hospital bed days, ambulatory sensitive hospitalisation rates and patient experience of care – will be financially incentivised in 2016/17, along with the two primary care national health targets.  Placing some funding at risk is about driving quality improvement. The system level measures and approach to financial incentives will be negotiated into the PHO Services Agreement. I encourage you to work closely with your DHBs through your local alliances to co-develop jointly agreed IPIF Improvement Plans.

E-health initiatives
E-Health solutions offer better, safer, more efficient healthcare closer to home. The Government invested $3 million to support PHOs to expand the rollout of patient portals. Over 107,000 patients in 280 practices are now using a patient portal to manage aspects of their own healthcare. 16 DHBs now use telehealth to deliver services to patients in remote areas and offer guidance and training support to clinicians in far-off locations. This is supported by the ongoing rural broadband initiative rollout. Last year I launched the New Zealand Telehealth Resource Centre in Christchurch. I encourage you to take a look at the website if you’re developing telehealth services.

Closing
In closing, thank you for the opportunity to speak to you all today. Keep up the great work. You can be confident that the Government will continue to place a high priority on delivering high quality health services to New Zealanders in rural communities.

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