Speech to NZ Nurses Organisation annual conference, Te Papa, Wellington
It’s great to be here to open the New Zealand Nurses Organisation’s conference.
Thanks to Memo Musa, Chief Executive and Kerri Nuku, Kaiwhakahaere. I’d also like to acknowledge incoming President Grant Brookes and thank outgoing President Marion Guy for her dedication and hard work over the past six years.
The theme of your conference – nursing shaping our healthcare – is very relevant to how we can work together to improve healthcare in New Zealand.
Nursing and midwifery contribution
It’s great to see such a high level of attendance here today. I’d like to take this opportunity to thank you all for the substantial and important contribution you make.
As the largest health workforce, nurses are often the first point of contact for people accessing health services. Working in partnership with patients and their whanau you have a unique opportunity to promote health and wellbeing.
You also have a responsibility to advocate for your patients and report safety or quality concerns.
Strong clinical leadership is important, and I know that nursing and midwifery leaders make a significant contribution. I want to see more clinical leadership across the system.
I’d like to start with an update on the sector. I believe our health sector is in good shape. The feedback I’ve been getting on my travels around the country, is that although there are still challenges, we’re heading in the right direction.
My first year overseeing health has required swift, clear decisions to deal with some long standing issues.
We listened to the feedback from DHBs and I decided to close down HBL, moving implementation of the shared services programme to a DHB-owned vehicle.
We acted on Southern DHB. My decision to appoint a Commissioner was based on the need to deal with the clearly deteriorating financial issues, and to move the DHB over time to where we can plan for their overdue hospital rebuild.
We have record performance on our health targets. I know that many of you play a significant role in delivering these results.
Since 2008 we have delivered 50,000 more elective surgeries, 95 per cent of ED patients are seen within six hours, and 93 per cent of children are immunised – thanks largely to the contribution made by nurses.
We also have a record 5,500 more doctor and nurse FTEs working in our DHBs.
In the tightest of budgets where the Government is working hard to make New Zealand one of the world’s first nations to balance its books, we obtained $400 million extra to grow our public health services this year.
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 received the largest share of new funding in Budget 2015 - $15.9 billion, an increase of $4 billion since 2008/09.
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.
In terms of our key priorities. We need to continue to change the way healthcare is delivered, with more people getting the care they need away from hospitals.
We need to further harness the skills of our workforce so we are utilising the full range of skills of the wider health team.
I want to see continued progress on NCDs. Our largest health burden stems from people suffering from chronic conditions. Tackling obesity is a key area.
There will also be a continued focus on the health targets. They’re not just about numbers, the targets are about delivering better, faster access to important services.
It’s important to have a clear focus on the strategic direction. I signalled in November of the need to refresh the Health Strategy which sets the direction for the sector. It’s not been updated since 2000.
I want to set a new vision and road map for the next three to five years for the sector. We need a clear, unified direction based on a shared set of values.
There will be further opportunity to provide feedback on the draft strategy when it’s released for consultation shortly.
Many people have raised concerns with me around Very Low Cost Access funding and how it’s not well targeted.
It’s important to focus funding on those who need it the most. I asked officials to get together a group to advise me on primary care funding, including VLCA.
We need a measurement and accountability system that enables good performance to be rewarded and poor performance to be identified and addressed.
Shifting services closer to home and integration
I’ve made it clear to DHBs that I expect them to move services closer to home, and they need to demonstrate how they plan to do this in their annual plans.
Integration and care closer to home will help develop a more efficient, sustainable health system. It will also provide a better experience for the patient.
E-health solutions offer better, safer, more efficient healthcare. They are also an important enabler of new models of care and providing care closer to home.
Patient portals are, for example, a key e-health initiative. More than 75,000 people in 181 practices are using a patient portal, accessing their personal health information at a time and place that’s convenient to them.
Prevention and early intervention
I want to see greater focus on prevention and earlier intervention. As nurses you have an important role to play.
We extended free GP visits and prescriptions to all children under 13, benefiting over 750,000 children and their families. Uptake has exceeded expectations with 98 per cent of general practices across the country now opted into the scheme.
It is estimated up to a quarter of GP consultations are related to arthritis, lower back pain, orthopaedic or other bone, muscle and joint conditions.
The Government invested $6 million in Budget 2015 to create new community based early intervention teams for diagnosis and management of musculoskeletal conditions.
The new Local Mobility Action Teams will work with a range of community health services including GPs, dietitians and physiotherapists. There will also be links with hospital services such as rheumatology, orthopaedic and pain services.
The first meeting of the Expert Advisory Group met recently to agree the principles, criteria and approach for the new teams.
Tackling obesity is another key area I’m focused on. As Minister of Health and 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 $40 million over four years for Healthy Families NZ. The initiative challenges 10 communities across the country to think differently about how to address the underlying causes of poor health at a local level.
So far there are Healthy Families NZ programmes in East Cape, Invercargill and Waitakere, and I‘ve been impressed at what local community leaders are doing.
Each year over $60 million is invested on a range of initiatives to promote healthy lifestyles, including KiwiSport, Green Prescriptions, and fruit in schools. We’re also adopting a voluntary new Health Star Rating front of package labelling system.
I also have officials looking at what else can be done in this area - particularly on the complex issue of childhood obesity.
Update on nursing issues
I’d like to talk about some of the key issues in your sector.
It was great to see the MECA settlement ratified last month. I think it’s a responsible and constructive outcome - it is affordable, and it is at a time of low inflation.
The deal will benefit around 30,000 nurses, midwives and health care assistants across 20 DHBs.
I want to acknowledge how it’s been a positive agreement which reflects the constructive approach to bargaining from both sides.
Employment of new graduate nurses
Approximately 1,800 registered nurses are graduating each year, that’s around 600 more than prior to 2010.
These graduates are helping to replace our ageing nursing workforce, keep up with the demand of our growing and ageing population, and will reduce our dependence on internationally qualified nurses.
Between 40 and 50 per cent of graduates have jobs before they know the outcome of their Nursing Council State Exam. The nursing Advanced Choice of Employment (ACE) system has made it easier for employers to recruit new graduates.
We know from ACE that within five months around two-thirds of nurses have jobs, and within a year, the vast majority find employment.
The Government has funded 1,232 nurse entry to practice positions in 2015. This includes 225 extra training places, 160 in DHBs, 40 in aged residential care and 25 in VLCA general practices.
There were 52,729 nurses with annual practising certificates registered with the Nursing Council of New Zealand as of 31 March 2015. This represents an increase of 6,764 since 2009.
Working to the full extent of scope of practice
Part of providing care closer to home includes harnessing the full potential of our workforce.
I’m committed to making the best use of nurses’ and midwives’ skills and experience. For nursing this includes all three scopes of practice - enrolled nurses, registered nurses and nurse practitioners.
Kaiawhina or the non-regulated carers and support workers are also an important part of the workforce. I know that Careerforce and Health Workforce New Zealand are working together to develop a workforce action plan.
Registered Nurse Prescribing
People with long term conditions benefit greatly from nurses with the knowledge and skills to help them manage their health. This includes medication management.
I recently agreed to officials progressing an application to allow appropriately skilled and educated nurses in primary and specialty teams to practice as designated prescribers.
Diabetes nurse prescribers have led the way for registered nurses to prescribe medicines. There are already 100 diabetes nurse specialists prescribing or in training to prescribe.
Evidence shows that diabetes nurse specialists bring important benefits to the effectiveness of diabetes services, is acceptable to patients, and is supported by the healthcare team.
We want to continue to build on this and grow the numbers of nurses able to prescribe in primary care and specialty teams.
Clinical Nurse Specialists
Clinical Nurse Specialists lead the development of nursing protocols in their area of practice.
They are a valuable resource, able to grow the capability of the workforce by leading care and offering education for best practice.
There are now 1,449 clinical nurse specialists across the 20 DHBs, almost six per cent of the DHB registered nursing workforce. This is a six per cent increase from last year, and the number has nearly doubled from 744 in 2007.
We have developed a new training programme, which will be available from July next year, for nurses performing endoscopies. This will help to speed up waiting times for screening and diagnostic endoscopy.
We also plan to further increase the number of specialist nurses in palliative care.
Nurse Practitioners and Education Pilot
There are now 145 nurse practitioners in New Zealand. Numbers have steadily increased since the role was established in 2001.
Models of care with nurse practitioners have been shown to have many advantages. In MidCentral for example, nurse practitioners working in aged residential care improved access, contributed towards a more seamless patient journey, and reduced hospital admissions.
It is important to support nurse practitioners in employment once they have completed their qualification.
Next year Health Workforce New Zealand will be funding an initial cohort of nurse practitioner candidates in a revised education programme run by the University of Auckland and Massey University.
Health Practitioners Bill
The role of nurse practitioners will become even more valuable as numbers increase and models of care become more collaborative and integrated.
I’m aware that nurse leaders have described a number of barriers to nurse practitioners and nurses contributing to the full extent of their scopes of practice.
I was pleased to see the Health Practitioners Bill pass its first reading in Parliament last month.
This Bill will enable other health practitioners, especially nurses and nurse practitioners, to carry out many functions that until now only doctors have been permitted to do.
The Bill will improve access to health services and provide more timely and effective treatment. It will be a significant milestone for nurse practitioners and other nurses.
In closing, I want to assure you that the Government will continue to place a top priority on delivering better health services for New Zealanders.
I am confident that together we can meet the challenges we face by working together as a team and making the most of the skills and knowledge of the workforce.
Thanks again for inviting me here, I hope you enjoy your time here today.