Source: New Zealand Government
I begin by thanking each of you for accepting appointment to these boards. You’ve each been on the Ministerial committee that established Te Whatu Ora – Health New Zealand and Te Aka Whai Ora – the Māori Health Authority and I express my appreciation for the enormous task you collectively undertook over the last 10 months to get to this point.
From today, you now assume full responsibility for our publicly-funded health services. Your organisations are either direct providers or direct funders of the vast bulk of the nation’s health services.
You will know the dimensions of your task but the $24 billion (in the current financial year alone) you are charged with shepherding supports:
- 40 public hospitals
- around 82 000 directly employed health workers
- around 950 primary care practices, employing 20,000 staff
- 660 ARC providers, employing 21,000 support workers and 5,000 nurses
- 61,500 home care support workers
- 2,200 ambulance crew and support staff, shortly to increase to 2,366.
The change today is a major one for the system. How health care is provided doesn’t change today, so the system change won’t be visible to the naked eye. But the change is significant.
As a country, we haven’t concentrated responsibility for health service delivery in a single entity since the 1930s.
And we have never before had a dedicated national organisation whose job it is to champion improving Māori health, commission health services to achieve this, work in partnership with the main Crown health service on all aspects of health service delivery, work in partnership with the Ministry of Health to monitor what health services are achieving for Māori, provide leadership for Māori and be accountable to Māori.
We have had health leadership by Māori for Māori before. We only have to look at the work of Sir Māui Pōmare and Sir Peter Buck before and after the 1918 flu pandemic.
But this is the first time we have built an institution to make Māori leadership a foundation stone to our entire health system.
I am confident Te Aka Whai Ora – the Māori Health Authority has a rich wellspring from which to draw around its board table, in the community, in academia – as it undertakes this vital task.
The changes taking effect today follow the recommendations of the HDSR report and the WAI2575 interim report. And the changes follow what we have learnt over the last two very challenging years for the health system.
As I reflect on each of those sources of insight about our system I also draw on what health workers at all levels of the system have said to me over the 20 months I have been Minister of Health.
From this I want to set out some challenges I think the boards will need to deal with if we want to realise the benefits of arrangements now in place, to lay these out in a way that goes beyond the formalities of the interim Government Policy Statement and other formal expressions of government expectation.
Health is, above all, a people business. For example, roughly 65% of hospital base-spending on its people. Striving to create the best environment for our health professionals to work in must be the top priority.
Your principal task is to make the system perform to its best with the resources you’ve got. The focus is on performance. And that naturally includes improving the system’s performance on equity. You now have the chance to bring a dedicated focus to getting the best performance.
Thinking about important challenges the boards must deal with, here are five areas I see as priorities. Each is inter-related:
You will know of the vacancies we have in our system right now. They are chronic and have been for some time.
We have to fill these gaps. This is urgent. You will know that.
Giving urgency to this task is an expression of respect for the incredible workforce which has got this country through the last two years and which is getting us through this most challenging of winters.
Te Whatu Ora – Health New Zealand is the single employer of our hospital nurses and so there should be no barrier to putting together a super-charged programme for recruitment.
It’s an opportunity to draw on the formidable talent throughout the organisation and to harness it wherever it is for the benefit of the whole system, and therefore the whole country. And it’s also an opportunity to supercharge professional and career development across the workforce.
Let Te Whatu Ora – Health New Zealand and Te Aka Whai Ora the Māori Health Authority be the organisations where leaders – clinical and non-clinical – are nurtured and flourish.
We know providing health care is a vital service and is personally demanding on those who provide it. The culture we create from the boards and senior management and through all levels of the organisations must be one that supports front line personnel to provide the best care.
This means a culture of informing, listening and responding.
It also means letting our health workforce get on with their job. We can do this by minimising the hurdles they often navigate to get the job done.
One of the most common complaints I have heard is how bureaucratic some health administration is. We know good and safe care requires good record keeping and there must be strong accountability for the benefit of patients. But meeting these requirements should not be used as a reason to tolerate inefficient systems and processes that do not enhance patient care.
We all recognise that the future will be about doing many things differently to achieve good health care. This means positively embracing innovation, being willing to try new approaches. That innovation will come from all levels of the workforce. Let’s make sure the new organisations foster innovation and allow new ideas and approaches to develop, keeping patients’ interests as the foremost consideration.
The public health system funds many other providers in whole or in part. This is important for access to health care.
The nature of funding contracts is they are transactional. But these funding relationships are long term. They need to be for certainty and stability of patient care.
We are now entering the age of multiyear funding arrangements which means we can think about partner relationships on a longer term basis.
If we want those relationships to be enduring we need to treat our counterparts as partners. We have an interest in our partners’ continuance.
It doesn’t mean we don’t have disagreements with our partners. These relationships will still be subject to the restraints the new organisations and the whole system are under. But we focus on our shared interests and our common objectives.
You have relationships with many organisations and interests. Te Whatu Ora – Health New Zealand is the largest public organisation in the country and Te Aka Whai Ora – the Māori Health Authority its vital partner. You will receive a lot of attention.
Your relationship with each other is crucial. And that has started so incredibly well.
Your relationship with the Ministry of Health is integral. They are the system steward and policy leader. That relationship must work at all levels at all times.
Te Whatu Ora – Health New Zealand’s relationship with the Ministry will be different to the Māori Health Authority’s relationship with them. That reflects the difference in functions each performs.
Te Aka Whai Ora – the Māori Health Authority’s relationship with Māori defines who you are. The set of relationships that make this up with the Iwi Māori Partnership Boards and the Hauora Māori Advisory Committee is the closest we come to a by Māori, for Māori approach for an independent statutory entity. But if the Crown does its job it will leave those relationships to flourish.
Relationships with other essential government agencies will be vital to your ability to work effectively. They will need to be nurtured respectfully and carefully.
Unions in the health sector play a vital role. There is an opportunity to build a relationship that gives health unions a place in the strategic future thinking of health services.
And your relationship with Ministers will always be important. That will be a mutual effort. When decisions are made at the political level those decisions will stand.
Finally, and most importantly, there is the relationship with patients and their whānau. That relationship is expressed through our frontline workforce. And that’s why getting all these elements right is so important.
So, the task is ahead of all of us. There are so many to whom I am grateful for getting us here today. But a new type of hard work begins today. And your job is to lead it.
The time is rich with opportunity. It’s time to seize it.
I wish you well in your work and I look forward to working together for pae ora.