Source: New Zealand Government
It’s my pleasure to be here to join the opening of the NZNO AGM and Conference for 2024.
First, I’d like to thank NZNO Kaiwhakahaere Kerri Nuku, NZNO President, Anne Daniels, and Chief Execuitve Paul Gaulter for inviting me to speak today.
Thank you also to all the NZNO members from across the health system who have joined us in person and online.
The theme for this year’s conference, Kotahitanga, is more relevant than ever, as we all come together behind a common goal in the face of significant challenges.
Challenges presented by a growing and ageing population, with more complex health needs.
Challenges presented by poorly implemented health reforms that have moved decision making away from communities and away from the frontline.
These challenges reach across the health system. They’re not exclusive to nursing, or even to New Zealand, as we have seen in the UK recently.
You see for yourselves the impact this has, in your work, most days.
You will also see them in the difficulties you, your loved ones and your communities have in trying to access the healthcare they need, when they need it.
People are waiting too long to see their GP or can’t even get enrolled because their local practice has closed its books.
Our rural hospitals are struggling to recruit and retain staff.
People are waiting too long in emergency departments, on waitlists to see the right people or get the right treatment.
Our Government is committed to turning this around and we’ve already made significant progress.
Earlier this year, I announced an ambitious new direction for health, reinvigorating five targets whose focus had been removed by the previous government.
Clear targets are key to improving the performance of the health system. They focus resources, attention, and accountability. Targets save lives.
The five health targets are tightly focused on things that really matter: faster cancer treatment, increased childhood immunisation, shorter stays in EDs and shorter wait times for assessments and treatment.
Achieving these targets will require a back-to-basics approach to make sure our hospitals and health system work smoothly and efficiently, enabling our greatest asset – our frontline health workers like you – to provide the best possible care.
We’ve already made significant progress with initiatives that will help us achieve our targets.
Last week, I revealed further details of how we will achieve those targets, with Health New Zealand’s implementation plan.
Faster cancer treatment
One in three Kiwis will be affected by cancer in their lifetime, and this Government is committed to improving outcomes for those one in three.
We’ve made a transformational investment of $604 million in Pharmac which will deliver up to 26 cancer treatments from October.
The first of these is Keytruda, which will be funded from 1 October for people with several types of cancer, including triple-negative breast cancer.
Opdivo will also be funded from 1 November for eligible people with kidney cancer.
This means that an estimated 600 eligible people will have access to Keytruda and Opdivo in the first year and that will rise to 2,300 over five years.
These medicines will make a significant difference to people’s lives by slowing the progression of cancer, giving them more precious time with friends and family.
I believe history will look back and see this as a step change in cancer management in New Zealand.
Chemotherapy is but one part of a cancer journey. We’re building a new cancer radiotherapy machine at Whangārei Hospital, so 520 Northlanders a year will no longer have to travel to Auckland for treatment. I want to thank Domain Lodge for many years of service to Northlanders who had to travel.
We’ve boosted the National Travel Assistance scheme by $18 million per year, $72 million over four years, to better support those that need to travel and find accommodation while they receive treatment.
This is the glue that joins cancer treatments and other treatments together.
We are extending breast screening age from 70 to 74 years, which will save an estimated 22 lives per year on current uptake and 65 lives per year at full uptake. We’re also continuing to support other cancer screening programmes, such as bowel and cervical screening.
We want to deliver services closer to the home and closer to the hapū.
Through the Health Targets Implementation Plan, we have signalled that we will look to establish more community infusion centres so patients can access their chemotherapy closer to home.
Improved immunisation
Too many New Zealanders are becoming severely ill with vaccine-preventable disease. Through our target of 95 per cent of children being fully vaccinated at 24 months, we’re aiming to turn that around.
In December, I announced an investment of $50 million over two years for Māori health providers to help lift immunisation rates, particularly among children and older people.
This initiative uses Māori health providers to go and do what mainstream cannot do – especially to reach our remote, rural or vulnerable communities, and when there, to vaccinate a universal audience.
Preliminary data shows this delivered 33,330 vaccinations by 30 June – more than three times the initial target of 10,000 vaccines.
Through the Health Targets Implementation Plan, I’ve signalled that we’re expanding the workforce able to vaccinate children, so people can get vaccinated wherever they go to access healthcare, whether that’s at their GP, pharmacy or through a midwife.
The pilot in Nelson where midwives are vaccinating pregnant women is an excellent example of a workforce that’s expanding their skillset to become vaccinators, and we know that the children of women who are vaccinated are more likely to be successfully vaccinated at 24 months.
Shorter stays in emergency departments
When people do need urgent care, they’re often spending a long time in our emergency departments.
Facilities like the long-overdue Emergency Observation Unit recently opened at Christchurch Hospital will help deliver on shorter stays in emergency departments by providing extended care when more time is needed for stabilisation or to make a decision about whether a patient can be discharged, transferred or admitted.
We’re also making EDs safer for patients and staff, with $31 million through Budget 2024 for increased security at emergency departments, so that it is safer for patients and staff.
The Health Targets Implementation Plan for shorter stays in EDs will also:
- Enable paramedics to treat patients at home, where possible, so they aren’t transferred to an ED unnecessarily, and
- Strengthen multi-disciplinary care teams in community care, so people are less likely to get unwell and require treatment in an ED.
Shorter wait times for assessments and treatment
We know that people are waiting too long on lists to simply see a specialist for the first time, for a diagnosis or to get the treatment they need.
To help people get seen sooner, we’re expanding the workforce able to provide first specialist assessments, such as advanced physiotherapists who, in collaboration with orthopaedic specialists, can see people on the orthopaedic waiting list.
Initiatives like our $30 million investment to level up access to diagnostic radiology services, referred directly by a GP, will help identify issues sooner, so that people can receive a diagnosis and clinicians can determine the right treatment, sooner.
This is us backing GPs as referrers and recognising them as the specialists they are.
We also have initiatives to reduce wait times for planned or elective care.
In July, I opened the new hospital on the North Shore, Tōtara Haumaru, which will significantly lift capacity for planned care locally and across the Northern region.
This is an excellent example of where separating planned from acute care can help our theatres run more efficiently, with fewer same day cancellations for urgent cases.
Overall, the Health Targets Implementation Plan has also committed to:
- Expanding the number of beds and operating theatres in public hospitals.
- Making greater use of capacity in private hospitals.
- Exploring more opportunities to separate acute and planned care and making sure hospital theatres are operating efficiently.
- Actively managing patients who’ve waited more than a year to get them an FSA or treatment as soon as possible.
- Improving communication with people on waitlists, so they know when they can expect to be seen.
The health system has more funding than ever, with around $30 billion per year.
Budget 2024 represented the largest investment in health, with a funding boost of $16.68 billion across three budgets.
This includes $3.44 billion for hospital and specialist services and $2.12 billion for primary, community and public health through Health New Zealand.
The Commissioner of Health New Zealand has assured me the Government’s health targets can and will be achieved within current resources and will come with regular and transparent reporting.
Every dollar spent on health simply must go toward improving health services for New Zealanders.
Of all the challenges the health system is facing, workforce is the greatest.
Our health workforce goes to extraordinary lengths to deliver care to thousands of Kiwis every day, across a multitude of settings. As nurses you are part of the very important front line.
To be successful in our efforts to lift performance, we will need to build our own, home grown, culturally competent workforce, and I have expressed this as a priority to Health New Zealand.
We’ve already made great strides, with increases across all our workforces in the last year.
- There are now more nurses employed by hospitals than ever before, with 29,404 full time equivalent (FTE) nurses employed by Health New Zealand across the country at the end of March.
- That’s an additional 1,198 compared to the previous quarter, and an overall increase of 2,900 over the last year.
- Health New Zealand has also seen significant increases in both its registered medical officers (RMOs) and senior medical officers (SMOs), with 4,950 RMO FTE now employed, an increase of 309 FTE over the last quarter, and 5,452 SMO FTE, an increase of 94 FTE over the previous quarter.
- There is also a record number of midwives employed by Health New Zealand, with a total of 1,117 FTE employed across the districts, an increase of 76 FTE over the previous quarter.
Through Budget 2024, we also invested $22 million to train 25 more doctors each year, taking our medical school placements from 589 in 2024 to 614 from next year.
But there’s still more to do to grow our workforce.
An immense amount of work has already gone into developing sustainable workforce solutions, which I know your leadership have been an integral part of.
While there has been progress, there is still more to do.
It’s not just about the right number of frontline workers but getting the right balance of skills in the right locations, with the rights support and models of care in place to meet local health needs.
In nursing for example, we’ve had huge success recruiting over the past year, to the point where we no longer have the same pressing need for internationally qualified nurses.
However, we still have shortages in community care, rural hospitals, in mental health, critical care and maternity care.
Health New Zealand will soon release their latest Health Workforce Plan, which will outline how they will ease the pressure and make sure we have the right people with the right skills across the country.
We also need some bold new thinking to solve longstanding issues with the way the system supports the growth and development of the workforce.
I will soon begin a review of the Health Practitioners Competency Act, to make sure it is fit for purpose. We need legislation that facilitates growth, ensuring that everyone’s foremost priority is the needs of the health system.
As the largest profession within our health workforce, at more than 81,000 strong, you, as nurses, have an immense opportunity to contribute to the Government health targets and the reforms.
You are a highly diverse, highly educated, degree-prepared, quality workforce.
You do important work and for that I sincerely thank you.
There is a vast diversity of nursing roles in every aspect and layer of the health sector – from clinical roles to research roles, to management at all levels.
In fact, all Health New Zealand’s four new regional Deputy Chief Executives have nursing backgrounds, and indeed one of the three deputy commissioners.
We have nurses in education as lecturers, professors and heads of schools. We have nurses in professional advice and policy. There are non-clinical nursing roles locally, regionally, nationally and internationally.
A career in nursing provides endless opportunities.
I strongly encourage you, whether you’re early in your career or have years of experience under your belt, to consider all the potential opportunities ahead and ways you can increase your scope of practice.
In closing.
You’ve heard from me about the challenges that I see, which are playing out both in New Zealand and overseas.
You’ve also heard about the Government’s vision, our unapologetic commitment to tangible outcomes for New Zealanders through our health targets, and our plan to deliver them.
As I said, turning these outcomes around and developing the health workforce New Zealanders need and deserve was hard for the previous government, and will be hard for me too. I accept that
We have challenges, yes, but we also have opportunities, and at the end of the day, I believe we are all working toward the same collective cause – timely access to quality healthcare for all New Zealanders, that improves life expectancy and quality of life.
I look forward to working with you to achieve these ambitions.
Thank you again and I wish you well for your conference.
