Speech – New Zealand Government
I am pleased to be with you this morning to open your conference with its theme this year of Self-Care. Self-care is fundamental to good health because it’s about personal responsibility.Hon Tony Ryall
Minister of Health
25 October 2012
Self-Medication Industry Association Conference
I am pleased to be with you this morning to open your conference with its theme this year of Self-Care.
Self-care is fundamental to good health because it’s about personal responsibility.
It’s about what we as individuals and families can do to improve and maintain our health, and to make choices about how we do that.
Today my comments will focus on this theme as well as clinical integration, changes in pharmacy, and the opportunity for patients and families to take greater control of their own health.
Good health is hugely important to New Zealanders. A strong public health service gives families peace of mind – knowing that the care they need will be there, when they need it.
And that’s the priority of our government too.
Protecting and growing the New Zealand public health service.
We have spent the past four years repairing the damage of a decade of wasteful spending, never-ending bureaucracy and a lack of clinical engagement.
And we’re making a lot of progress.
More patients are getting the operations they need, sooner. Our DHBs are employing more doctors and more nurses than ever before. And there’s a greater focus on preventing illness.
We’ve moved resources from the back office to the frontline. There are fewer managers and administrators. We’re harnessing the benefits of bulk purchasing. And our wards are becoming more productive and efficient.
But like health services around the world, we face two major challenges: one financial, the other demographic.
Our country faces a significant fiscal deficit and growing public debt.
Only four years ago the government owed $8 billion. Taking the sharp edges off the recession has seen that debt grow to $55 billion today. In less than three years’ time, we expect that will peak at $72 billion.
To control that growing debt, the government is working towards a balanced budget in 2014/15. That means a strong focus on public spending, and getting the most out of every dollar.
Health is a fifth of all government spending so we in the public health service have an important role to play in that.
And you’re well aware of the demographic challenge.
There are more of us, and we are living longer.
Around the world
Public health services around the world are resorting to wide-reaching reforms, and significant funding cuts in an effort to manage growing cost pressures.
It is reported the Irish Health Service – serving a population the same as New Zealand – is about to make further cuts of about NZD 1.6 billion. This follows a NZD 200 million cost reduction package earlier this year. 600,000 hours of home care has been cut. 6,500 health staff will go.
Last year the Irish government also cut salaries for hospital doctors, who as a group are apparently the highest paid public employees in Ireland.
In England, up to a fifth of National Health Service hospitals are facing closures of emergency departments, maternity wards and paediatric units.
In Australia the New South Wales Health Ministry has been directed to make more than $3 billion in savings. Local health districts will be required to find $775 million dollars in staff savings under what is called a “labour expense cap”. A further $2.2 billion will be cut from the health bureaucracy over the next four years.
In September, the Queensland state government confirmed 2700 jobs would go from its health department before March next year.
In Greece health services are in crisis; some pharmacies can’t provide patients with their medications because the Greek government cannot pay them and it’s reported the lead health provider in Greece hasn’t paid its doctors for at least four months.
In New Zealand, we have not escaped the world’s worsening debt crisis. But our public health service is doing better than many other countries.
The National led Government has lifted health spending by around $2 billion over its four years.
And we have made significant improvements.
However, as a fifth of all government spending goes into health, we need to ensure we are getting the most out of every dollar and provide New Zealanders with quality health care. We need to continuously improve effectiveness to get the most out of every health dollar.
Too much money and too much patients’ time is wasted by a lack of coordination between different parts of the health service.
Too often patients find themselves admitted to hospitals because of a lack of alternative forms of care and support, or because their GP can’t help them with ready access to a hospital specialist or nurse, or to a vital diagnostic test.
Patients with chronic diseases like diabetes and heart disease need access to co-ordinated care instead of shuttling backwards and forwards from hospital to GP and back again.
International evidence shows that integrating primary care with other parts of the health service is vital to better management of long-term conditions, an ageing population and patients in general.
That’s why clinical integration is key to our prudent strategy future-proofing our health service to better deal with those increasing demographic and financial pressures.
That is why we need to integrate care by moving more services to where they are more convenient for patients, closer to home … and that platform is in the community and primary care… general practices and pharmacies….creating greater continuity of care, reducing waste and duplication.
As I indicated earlier, we as individuals and families acknowledge that we should take personal responsibility for our health.
And while we all have different capacities and capabilities, most people prefer to have as much say and choice as is possible.
It is important that we continue to look for innovative new approaches that support the desire of people to take responsibility and play a more active role in their own healthcare.
For example tele-health is helping chronically ill patients to manage their own health – and avoid sudden trips to the hospital.
A telehealth monitor installed in their homes allows patients to measure, among other things, their pulse, blood pressure, lung capacity, lung function, and electrical activity in the heart.
That information is beamed back to the watchful eyes of their case manager – usually a registered nurse at their GP’s.
This regular information helps the patient and their case manager anticipate issues and get treatment before things reach the point where hospitalisation is required.
Patients say this service is hugely empowering.
In another patient-centred innovation, the Midland Integrated Family Health Centres in Hamilton see patients having more control over their own health information and being better able to navigate the entire health system because of the Centre’s new virtual front door – the Patient Access Centre.
Patients phone or email from anywhere, anytime 24/7 and talk first of all to a member of the team at the Patient Access Centre .
The staff actively triage all calls and requests – and give immediate assistance or advice, or arrange for the GP to give the patients a call.
And if the patient does need to come in, their visit will have been carefully planned to ensure they see the right member of the general practice team, having had the necessary scans or tests done beforehand – no long waits, prompt service.
That is indeed a patient centred service – where patients are fully engaged in their own care.
These flexible, innovative approaches are showing up across the health service. Pharmacists, doctors, nurses and patients are increasingly working together in new and different ways.
Pharmacists particularly have a significant contribution to make in this greater integration of primary care.
You’ll be aware that the Community Pharmacy Services Agreement aims to further recognise and maximise the clinical expertise that pharmacists have.
The Government wants to reward pharmacists for their care and for the use of their clinical skills, instead of just paying them for pouring pills into bottles or containers.
The CPSA constitutes a significant service change for pharmacies – but it provides a platform and an opportunity for pharmacists to play a greater, more integrated role in primary care for the benefit of patients.
For example, pharmacists have taken on responsibility for managing some patients on the traditional blood thinning drug Warfarin.
An initial project across 15 pharmacies across the country where pharmacists managed patients on Warfarin has resulted in excellent outcomes for patients and high levels of satisfaction.
Anticoagulant control blood test results improved significantly for those patients selected to take part in the six-month project, meaning less likelihood of health problems such as stroke or bleeding. Patients reported that they were very satisfied with this new model of care which means fewer general practice and laboratory visits.
Pharmacists welcomed the opportunity to make better use of their skills, while GPs and practice nurses reported that the pharmacy management model saved valuable practice time – up to five hours per week.
Around the country, as part of the patient-centred CPSA, many pharmacies are already making medicine management easier for patients with long term conditions.
For example, pharmacists are sending out simple reminders to patients who forget to pick up prescriptions, or get them filled, or take them at the right times.
That is saving a lot of unnecessary trips to the doctor and wasted prescriptions.
The new Long Term Conditions services which is part of the CPSA aims to further improve the medicines management of patients with chronic conditions.
Over time, there is potential for similar development in the area of self-care – helping patients with over the counter medicines.
Your industry has played a central role in facilitating consumer access to non-prescription medicines and I am pleased to see that the topic of “switching” continues to feature prominently on your conference agenda today.
Potential for increased self-care options
Future switches from prescription to over the counter availability will inevitably involve more potent medicines and we have seen a tangible example of this trend in the recent switch involving the antibiotic trimethoprim.
The Medicines Classification committee supported the case put forward by you to give consumers with uncomplicated urinary tract infections access to this medicine through trained pharmacists.
There are more examples of pharmacists increasing access consumer access to medicines.
Suitably trained pharmacists can now access influenza vaccine and vaccinate customers within their pharmacies.
New Zealand remains the only country in the world that allows pharmacists to sell Tamiflu to consumers with influenza during winter.
I understand Natalie Gauld has researched Tamiflu sales in pharmacies and found pharmacists complied with those protocols and behaved as responsibly as any other healthcare professional.
I note that Natalie Gauld will be talking later in the morning about the New Zealand experience with switching and will no doubt comment on the positive outcomes identified in a study recently reported in SelfCare. The study showed that since 2004 New Zealand has become increasingly innovative in allowing switching of medicines to over-the-counter availability and is now one of the more progressive countries in this regard.
Implications and challenges
Increasing access to more potent prescription medicines in this way could only be done safely if the right conditions were in place to ensure accurate diagnosis, appropriate medicine selection, safe use, and adequate patient follow-up.
You’ve heard a few examples today of how the integrated care model is working.
Once you put the patient at the centre of the model of healthcare delivery, a number of exciting new options for partnership in healthcare delivery emerge.
It is therefore very good that for the first time ever, GP and community pharmacy leaders are publicly and formally announcing that they will work closely together for the benefit of patients.
The GP Leaders’ forum and the Community Pharmacy Leaders’ Forum tell me they will be putting out a joint statement in the next few days saying they together support an integrated team approach to health care service provision.
And they commit themselves to work together towards strong clinical partnership at national and local network level to maximise the opportunity presented by the Community Pharmacy Services Agreement.
It is important that suppliers of medicines and healthcare services understand that the emergence of integrated family healthcare is likely to change how patients and healthcare professionals access and prescribe medicines.
Organisations such as the New Zealand Self Medication Industry can be key players in recognising this emerging new model of healthcare and participating in supporting changes in access and prescribing rights.
This is an exciting and challenging environment for your industry and I look forward to seeing developments in this area.
You now have the chance to discuss these and other opportunities and challenges facing your industry and the primary health sector.
I wish you a successful and informative conference.
Increase participation in early childhood education
Education Minister Hekia Parata says that participating in quality early childhood education (ECE) has considerable benefits for children.
“We want children to go to primary school confident, able to engage, and eager to learn. That is why our plan for education has a target of 98 per cent participation in early childhood education in 2016,” Ms Parata says.
“We are investing $1.3 billion in ECE, including $47.9 million in equity funding which supports priority learners and communities. This will assist participation in ECE by vulnerable children who are currently not receiving sufficient support to succeed in education.’’
“To increase participation and reach our 98% target in 2016 we will identify children who are not participating in ECE through improved information collection and information sharing across agencies.
“We will work with communities, ECE providers and other groups to engage with us to support ECE participation and ensure families, whanau and aiga will know about the benefits of ECE, what is available, and how to enrol their children.”
Increase immunisation rates
“One of the best things we can do for children is to have them fully immunised from the common childhood diseases like whooping cough and measles,” Health Minister Mr Ryall said.
‘We now have record immunisation rates for two year olds – 93 per cent fully immunised. But younger babies are most vulnerable and now we’re increasing that target to 95 per cent of eight-month-olds fully immunised with the scheduled vaccinations by 2014,” he said.
“We will support every pregnant woman to have a named GP before birth and every baby is registered with a GP at birth. We will ensure families are promptly reminded of immunisation dates and better link up two family services, WellChild/Tamariki Ora and Family Start.
Reduce the incidence of rheumatic fever
“Rheumatic fever can develop into life threatening heart disease but this third world disease is largely preventable,” Mr Ryall said.
“We’re spending $24 million to reduce the incidence rate of rheumatic fever by two thirds to 1.4 cases per 100,000 by 2017.
“We’re doing that by providing throat swabbing and treatment to children at high risk, raising awareness and knowledge of this disease, and working across government agencies to address risk factors like housing conditions and hygiene in schools.”
Reduce the number of assaults on Children
“Since 2008 this Government has implemented a number of initiatives such as the ‘Education Assist’ package and Child Protection Alert System to help reduce abhorrent acts of violence against children,” said Social Development Minister Paula Bennett.
“The Public Services target formalises our on-going commitment to reducing these violent assaults and acknowledges that more needs to be done to better protect children and give them the start in life they deserve” she said.
“The Green Paper was the beginning of this process and the White Paper to be released in October will mark a significant advancement in the protection of our children, providing detailed far reaching solutions to help achieve this ambitious goal.
Other child protection work underway includes the introduction of social workers in all hospitals and 1-3 decile schools, and changes to the Family Start programme to increase the focus on abuse detection and prevention.”