Speech to Primary Care Symposium, Te Papa, Wellington

Tuesday, June 2, 2015 - 18:34


Thanks John. It’s great to be here today to speak at your second primary caresymposium.

I’d like to thank the Heart Foundation, PHO Alliance and the Health Promotion Agency for organising today’s event.

I know you’re all busy people, so it’s good to see so many of you here to share your ideas on good practice and innovation.

Primary care

Primary care plays a crucial role in improving the health outcomes of New Zealanders, and lifting performance across the health sector.

I would like to take this opportunity to thank you all for your commitment and dedication in providing important health services in our communities.

Health overview

I’d like to start with a brief overview of the sector. I believe New Zealand’s health sector is in good shape.

The feedback I’ve been getting is that although there are still challenges, we are heading in the right direction.

When I meet with clinicians, I ask them, are things better or worse than they were ten years ago. The feedback I get is that - yes, things are better than ten years ago.

However, there’s no doubt that future challenges remain.

It will never feel like there’s enough dollars in health. The Government has made health our number one funding priority despite economic challenges. Health is an important part of our plan to deliver better care for families.

Investment in our public health services has risen from a budget of $11.8 billion in 2008/9, to a record $15.9 billion in 2015/16.

Budget 2015

Health is receiving 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.

I want to see more services being accessed in primary care settings, which is in part why around $35 million extra will be invested in primary care in 2015/16. This is the largest increase for the primary healthcare sector in the last six budgets.

This is on top of the $90 million over three years announced in Budget 2014 for free doctors’ visits and prescriptions for children under 13, which takes effect from 1 July and will benefit around 400,000 children.

Sector update

I’d like to update you on some of the big picture stuff that I know you’ll be keen to hear about.

I’ve asked the Ministry to undertake three major reviews.

Ministry reviews

The New Zealand Health Strategy needs a refresh to set a new vision and road map for the next three to five years for the sector. I know some of you will have had input into this process.

Two other reviews are also taking place concurrently. The funding review is looking at the arrangements needed to support a high quality health sector that integrates across the social sector and is sustainable in the long term.

While the capability and capacity review will ensure we have an adaptable and responsive health and disability sector to support the updated Health Strategy.

I expect to be able to share the findings and recommendations of these reviews in the next couple of months. 

Funding and performance measurement

These reviews will have implications for primary care – how we fund services and how we measure performance.

Many of you have raised concerns with me around Very Low Cost Access funding and how it is not well targeted.

I know it is important to focus funding on those who need it the most.

I’ve asked officials to look at getting together a group to advise me on primary care funding, including VLCA. This group will need to align with the Ministry reviews taking place.

I want clinician input into any potential changes. It’s important to be careful of unintended consequences.

I also want to see a shift to performance measures based on outcomes such as avoiding unnecessary hospitalisations, rather than focusing on transactional outputs and processes.

I am interested in how we move further and faster towards outcome measurement at a national level. We need a system wide view of performance, as well as an ability to measure outcomes for each of the component parts.

Only a small number of measures need to be reported nationally. I am often told by the sector that the burden of reporting is high, and I want to ensure the purpose of any reporting is very well thought through.

I have decided to continue with the current IPIF (Integrated Performance and Incentives Framework) measures focused on health targets in 2015/16, and I will not be introducing new measures at this stage.

Other priorities - health targets

In terms of other priority areas - the national health targets remain a key focus. They’re not just about numbers – the targets are about delivering better and faster access to important health services.

The latest quarterly results show that DHBs are making good overall progress and that’s a tribute to your hard work. However, there is always more work to be done. 

The better help for smokers to quit target has reached 89 per cent and is very close to being achieved. We’re also making steady progress on the more heart and diabetes checks and immunisation targets.

Long term conditions

I want to see continued progress on NCDs. Our largest health burden stems from people suffering from chronic conditions.

Cardiovascular disease is the largest cause of mortality and a leading cause of morbidity in New Zealand, accounting for nearly a third of deaths each year.

The more heart and diabetes checks health target has provided a sharper focus on CVD risk assessments.

The evidence suggests that targeting patients with the highest CVD risk presents the greatest opportunity to improve patient outcomes.

I’ve asked officials to develop a five year strategy for diabetes which will shortly be released for consultation. It will cover the continuum of care from risk assessment to self-management.

Tackling obesity

Tackling obesity is another key area I’m focused on. As Minister of Health and also Minister for Sport, I want to see greater linkages between these portfolios.

New Zealand is not unique in its battle with obesity. The causes are complex and there is no single solution. We already have several initiatives underway.

Budget 2014 allocated $40m over four years for Healthy Families NZ. The programme challenges communities to think differently about how to address the underlying causes of poor health at a local level. I launched Healthy Families East Cape in Gisborne in April, and I was impressed at what local iwi are doing in the region.

Each year over $60 million is invested on a range of programmes to promote healthy lifestyles, including Kiwisport, green prescriptions, and fruit in schools.

The Government is also adopting a voluntary new Health Star Rating front of package labelling system that will help New Zealanders make healthy food choices.

I’ve got officials looking at what else can be done in this area – particularly on childhood obesity.

I’ve asked them to summarise existing Government actions as well as the international evidence for possible interventions.

I’ve also asked for advice on a possible obesity target. If we went down this track the target would have to be meaningful and evidence based. 


Long term conditions such as diabetes and obesity cut across a number of health providers, and are good examples of the need for greater integration.

It is important to ensure coordinated care for patients and to develop stronger links between services.

I have made it clear to DHBs that I expect the focus on integrated healthcare to continue to grow to deliver the results we need to achieve.

I want to see earlier intervention and population based initiatives delivered in the community to improve health outcomes.

I know that DHBs are developing stronger links with primary care providers. These connections are happening.

To support more integration we need to further harness the full range of skills of the wider health team.

I’ve been pleased to hear about things like GPs having direct access to specialist nurse or doctor advice, safety programmes being delivered on medicine management, and nurses leading clinics on diabetes management.

It’s also good to see partnerships forming between health and the wider social sector. For example, Healthy Homes Tai Tokerau in Northland has helped to insulate over 7,000 homes – contributing to fewer children presenting to hospital with respiratory related conditions.

Services closer to home

Shifting services from secondary to primary and community care is a high priority. I have made it clear I expect DHBs to move services closer to home in 2015/16, and they need to demonstrate how they plan to do this.

We need to continue to change the way healthcare is delivered with more people getting the care they need away from hospitals. 

I want the sector working more productively together to ensure the right mix of care for patients are delivered in the right places.

Shifting services will be varied based on local need, context and scalability - ranging from co-locating outpatient clinics into the community, through to the redesign of service structures, resourcing and facilities.

It’s good to see new work going on in this area. For example, the $6 million invested in Budget 2015 to create new community based multi-disciplinary early intervention teams for diagnosis and management of orthopaedic conditions, will make a real difference to patients and their families.


Clinical engagement, a team based approach, and putting patients at the centre of care are fundamental in achieving greater integration and delivering more services closer to home.

I am looking for leadership and ideas from the sector about how to support changes to new models of care and enhance the breadth of services provided in primary and community settings.

Thank you again for the opportunity to speak to you all this afternoon. Keep up the great work. I’m sure you’ll acquire some innovative ideas today to take back to your workplaces.