Otago University Medical Forum

Health Minister Annette King outlined the Government's health priorities for the coming year to staff and students from the Dunedin School of Medicine and staff from the Otago District Health Board.

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I am delighted to have this opportunity to talk to staff and students from the Dunedin School of Medicine, and staff from the Otago District Health Board.

In particular, I want to thank your Dean, Dr John Adams, for his invitation to join you today, and for the excellent presentations he and his staff provided earlier today. I have been involved with John in a number of his capacities, particularly as the former chair of the New Zealand Medical Association, while I have been Minister of Health, and I now look forward to working with him in his relatively new role as Dean. I am sure he will have much to contribute to the school.

This forum may be comparatively tame stuff after the understandable euphoria created by events at the 'House of Pain' on Saturday night, but I am sure that between us we will enjoy the Forum anyway. Today's Forum is a somewhat different event, but I am sure it will throw up some challenging issues all the same.

I am happy to try to answer your questions after I have spoken, but I thought it would be useful first to outline this Government's health priorities, for the coming year in particular.

I also want to discuss health workforce issues associated with those priorities, including the retention of New Zealand medical graduates in New Zealand, and to talk about what needs to happen in the tertiary education sector for it to become more closely aligned with health workforce needs.

Under this Government New Zealand has begun taking a highly strategic approach to providing an effective and equitable public health service in this country.

That approach was enshrined in the New Zealand Health Strategy that I launched in December 2000. The new approach followed a decade in which ad hoc market approaches generally dominated the health sector, at the expense of the sort of focused and targeted approach needed to improve the health of all New Zealanders.

That new targeted, strategic approach is reflected in the Government's health priorities in 2004-05 and, naturally enough, were also reflected in the Budget produced by my colleague and Finance Minister Michael Cullen in May.

That budget extended the three-year health funding path with an allocation of $550 million in 2006-07 to take health spending in that year to $10.7 billion, or about 20 percent of all government spending.

When you consider that when this Government came into office in December 1999 Vote Health amounted to much less than $7 billion, you can see how much investment this Government has been prepared to make in providing public health services all New Zealanders can access.

I am not going to discuss today all the health priorities and initiatives made possible by the Budget, but the new orthopaedic or hips and knees project is certainly a good example of the way we are building fair, equitable and sustainable health services.

It is clear that with an ageing population, the need for hip and knee replacements will continue to grow, and that is why we have set out to double the number of such operations within the next four years, and to guarantee continued funding so that the new level of interventions can continue in the future.

Major joint operations are the only treatment option for patients with high levels of immobility and crippling pain, and we know such operations dramatically improve the quality of life and restore independence. The difference between the project that we announced in the Budget, and what has been done in the past is that the funding is guaranteed for year after year after year. It is not a one-off measure that gives false hope to thousands of New Zealanders. It is part of a strategic plan to make our public health system better once and for all.

One of the 13 priority health objectives in the New Zealand Health Strategy is reducing the impact and incidence of cancer. The Budget will enable us to continue to perform strongly in this area.

Within the next few weeks I will be receiving the implementation plan for the New Zealand Cancer Control Strategy, and will be allocating resources to sit alongside the plan, and I have already announced, of course, that from July 1 the national breast-screening programme is being expanded to cover women from their 45th birthday to their 70th birthday.

The strategic approach is nowhere more consistent than in the Government's commitment to funding implementation of the Mental Health Commission's mental health blueprint. We have allocated another $250 million over the next four years into implementing the blueprint, following the first four-year allocation of $257 million made in 2000-01.

As many of you here, particularly John Adams, will be well aware, among the most important constraints we have faced in implementing the blueprint have been health workforce shortages and inequitable funding across the country. Quite simply, you cannot build a relevant workforce and you cannot provide equitable funding unless you plan and unless you have a strategic vision. Those are the big differences with the approaches we are taking. I know many of you will be interested in the rollout soon of New Zealand's meningococcal vaccine. We are in the final stages of approval for this $200 million project, and right from the outset this Government was determined to rid New Zealand of an epidemic that has killed or maimed so many of our young people. I am as proud of this health initiative as any that we have taken. In terms of the Budget and the Government's overall strategic approach to health care, however, and also in terms of this country's need for a strong medical workforce, the most important aspect of Vote Health every year is now the money set aside specifically for implementation of the Primary Health Care Strategy. The primary health care strategy component of Vote Health has increased sharply from $48 million in 2002-03 to $264 million in 2004-05, and will rise to $280 million in 2005-06.

The new Primary Health Organisations now cover more than three out of four New Zealanders, with more than one million New Zealanders now receiving cheaper access to primary health care. That number will increase sharply from July 1 when all over-65s enrolled in PHOs should become entitled to cheaper health care and to $3 pharmaceutical prescriptions.

While we must continue to provide high-quality hospital services, the Government is convinced that primary health care services offer the best path to improving the overall health of all New Zealanders. Our funding has unashamedly been based on meeting the worst health needs first; then on expanding cheaper primary health care to young people and older New Zealanders.

Within the next few years, we will be providing cheaper access to primary health care for all New Zealanders who want it. Watch this space. As I said earlier, none of what we are trying to achieve could be achieved, however, without the development of a health workforce that can meet specific health needs in New Zealand. That is particularly the case in terms of the primary healthcare workforce.

That is why, year in, year out, health workforce development is always going to be one of the Government's priorities. We need a suitably educated and trained health workforce to deliver on all our other health priorities.

The medical workforce must be able to deliver services in new ways to meet the challenges thrown up by the changing demographic profile of the population over the next 10-20 years.

I think it is important, in this regard, to talk briefly about the Government's concern to ensure that the tertiary education sector is well aligned to meet the employment needs of other sectors --- like health, of course. The Government announced its Tertiary Education Strategy in May 2002.

Two key points relevant to the health sector are that the delivery of health education courses should be efficient and that it should be responsive to the needs of the health sector.

The Tertiary Education Commission (TEC) was established in December 2002 charged with implementing the Strategy.

The Ministry of Health has been working with the TEC to establish closer links between the two sectors, both at the local and national level.

The first phase of a joint project, analysing the current provision of health courses, undergraduate and post-graduate education and clinical training, has just been completed, and a briefing is currently being prepared for me and other relevant Cabinet ministers.

Terms of Reference are being prepared for phases two and three of the project, which will focus on understanding the workforce needs of the health sector and achieving alignment with the education sector.

The Ministry of Health has held two workshops involving both sectors on the interface between health and education, and proposes to consult widely on the work to date and future directions.

The purpose of the Ministry's workshops and other consultation processes is to provide a forum for debate and sharing of ideas as to how the challenges of the future can be met, what sort of health workforce will be needed, and how this can be aligned with the education sector.

The Health Workforce Advisory Committee (HWAC), which I established in 2001, also places high priority on the interface between health and education. In its recommendations to me last year in its document Future Directions, it included as a priority a recommendation to "facilitate the evolution and further development of health workforce education". I urge everyone who feels they can participate in this ongoing debate on the interface, to do so.

A closer relationship between the health and education sectors should facilitate the funding for and implementation of initiatives proposed by either sector.

The Tertiary Education Strategy is in the early stages of implementation, and the TEC has been established for only eighteen months. We need to make these initiatives work.

Another issue that I am sure will interest this audience, and that is of high priority worldwide and of particular concern to me, is the question of junior doctor hours and arrangements for clinical training. The European Union's Working Time Directive, limiting the number of hours junior doctors may work, is causing the countries involved to take a radical look at the way services are delivered and the consequences for training their medical workforces. Similar issues face New Zealand, of course.

To assess the current situation in New Zealand, I propose to establish a roundtable to report to me on the short-term issues and propose options for resolving them.

The Medical Reference Group of HWAC is currently developing terms of reference for a Medical Workforce Roundtable to advise me on the clinical training of junior doctors, the relationship with undergraduate medical education and the environment that supports the development of a trained medical workforce. It will be important for the roundtable to consider the views of all groups representing the medical profession, including the perspective of medical students. It goes without saying that there will also be interest in this audience in issues surrounding student debt and the retention of New Zealand graduates.

Many of these issues are, of course, the responsibility of my colleague Steve Maharey, Associate Minister for Education (Tertiary Education), but, like most Health Ministers around the world, I am particularly interested in retaining homegrown graduates.

Mr Maharey has established a joint project involving the Department of Inland Revenue, the Statistics Department and the Ministries of Education and Social Development to provide some reliable data on the impact of student loans and their effect on the retention of graduates in New Zealand.

Any future decisions on student debt would need to take account of the evidence from the project, but I was delighted to be able to announce last year, in association with Steve Maharey, the Step Up scholarships scheme designed to improve participation by low-income people in tertiary education and the retention of skilled graduates. I am sure you are familiar with the details of these bonded scholarships, worth as much as $43,000 a year for some students. They are basically designed to reduce costs for those who are eligible for student allowances.

In order to increase the supply of New Zealand trained doctors, and hopefully to retain them in New Zealand, the Government has also funded 40 more places in medical schools from this year, the first increase in the medical cap since 1981. The Government hopes that eventually the increased number of doctors graduating will be reflected in the number of doctors wanting to work in rural health and mental health. As I said, the migration of health workers is a worldwide issue, and it is one that particularly affects poorer countries. I helped develop the Commonwealth Code of Practice on the International Recruitment of Health Workers, and the issue has now become a concern for the World Health Assembly as well.

The issue was raised during last month's WHA by Senegal and South Africa, and the EU, Canada, Australia and New Zealand have helped draw up a proposal mandating the WHO to develop its own code of practice. We have to be realistic enough to recognise that New Zealanders will always want to travel overseas, but this Government is determined to provide the sort of health sector in New Zealand that our workforce finds attractive and rewarding to work in.

Overseas trained doctors have for many years contributed strongly to the delivery of health services in New Zealand. In today's global market for health practitioners, I am not aware of any country that relies wholly on locally trained doctors, and it is the Medical Council of New Zealand's responsibility to ensure that all those registered to practise medicine here are qualified and competent to do so. In many parts of New Zealand, overseas trained doctors have settled well into sometimes isolated communities, and have become a valued part of those communities.

There is no such thing in the world as a perfect health system, but I believe the strategic, long-term approach New Zealand is taking to developing a fair and accessible public health system will pay big dividends for New Zealanders generally.

We need to keep building a bigger and better health system because the demands on it will grow constantly as our population ages and there is a consequent increase in chronic illnesses. Our health system needs to provide a lifelong health journey for New Zealanders, and I make no apology for placing an emphasis on the primary health care team as the best navigators to help New Zealanders along this journey. I hope many of today's students accept that navigational challenge. Thank you again for inviting me to join you today.

ENDS

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