Source: New Zealand Government
Tēnā koutou katoa – it is a pleasure to be here today.
I would like to begin by acknowledging the important leadership role you all play in ensuring a quality health system New Zealanders can trust.
There is enormous clinical expertise in this room covering a wide range of disciplines. I want to particularly acknowledge Angie Smith and Russ Aiton as co-chairs of the consumer advisory group for the HQSC. It’s important that we centre the experience of those receiving healthcare into this forum.
It’s encouraging to see the mix of agencies represented here – the role the National Quality Forum plays in identifying and responding to cross-agency, systemic quality and safety issues is a critical one for New Zealanders. I thank you for your dedication and commitment.
When it was established in 2021 by HQSC, this forum’s aim was “to provide national collaborative leadership and oversight of quality and safety across the Aotearoa New Zealand public health and disability system”.
This forum’s updated terms of reference describe it as the peak body for quality and safety for the public health and disability system in New Zealand.
That is no small task, and particularly when our health system faces significant challenges presented by a growing and ageing population with increasingly complex health needs and following the poorly-implemented health reforms in 2022.
Perhaps the most important thing about this forum is that it provides a unique platform for you as quality and safety leaders to connect with each other to develop relationships across the system.
Health resources will always be finite, so it is vital our health entities work collaboratively – not only to make the system more efficient but also to support continuity and consistency of care for New Zealanders. As you all know, high quality care enables both better outcomes for patients and more efficient use of health resources.
It’s really pleasing to hear about the progress in this forum over the past year. I understand you have recently refreshed your terms of reference and that you’re developing a work programme.
Earlier this year I wrote to Rae, in her role as Chair, to set out my expectations for the HSQC.
These included continuing to drive improvements to the National Quality Forum “to ensure that quality and safety issues discussed in the Forum are appropriately prioritised, and have clear responsibilities, outcomes and actions”. This includes establishing clear links and working relationships with Health New Zealand’s clinical networks and clinical governance.
This forum provides a great opportunity to learn and collaborate across the health system on the key priorities for improvement by using the information from all agencies involved in the forum.
I want to re-iterate the importance of collaboration and coordination of quality and safety initiatives across the health agencies. This includes triangulating quality and safety and workplace health and safety intelligence from organisations such as HQSC, HDC, HealthCert within the Ministry of Health, Health NZ and the wider Ministry of Health.
The recent quality and safety review report requested by the Health NZ Commissioner highlighted the most up to date data available on harm and quality and safety ‘hot spots’ across the country. It also provided a description of the work being undertaken to monitor quality and safety across Health NZ and the collaboration with other organisations to inform this view.
One of the harms identified in the Health NZ report was initially raised by HQSC through this forum – that being the increase in self-discharged ED patient mortality. I understand that this alert was presented to the forum, resulting in Health NZ leading an investigation which will subsequently be presented back to the forum today. This is a great example of the power of this forum in identifying emerging issues and working collaboratively to reduce harm across the system.
Perinatal and Maternal Mortality was identified as an area of harm within the quality and safety report from Health NZ, based on information from what was the Perinatal and Maternal Mortality Review Committee. I understand this forum had also been discussing the quality and safety of care in maternity across the system.
It is pleasing to know that a Maternity focused quality forum was held in Dec 2023, bringing together maternity experts from across the health system to identify solutions. It’s important to ensure that the outcomes of this forum are being implemented. I want to acknowledge the work of the sub-committee of this forum who are now working on implementing the recommendations to improve quality of care in maternity. I look forward to receiving updates on how this work is progressing.
The second part of the quality and safety review from Health NZ focused on working collaboratively to establish a quality and safety monitoring and reporting framework. I am pleased to see that Health NZ and HQSC are working together to triangulate clinical quality and safety information nationally from the HQSC, Health Roundtable, HDC and Te Aho o Te Kahu. I understand work is continuing to add information from ACC as well, and I commend this partnership.
I have also commissioned the Ministry of Health to provide me with an overview of the clinical quality and safety of the system. The Ministry’s framework focuses on the domains of quality and provides an overview of the system, across multiple sources of intelligence. I understand that the Ministry, HQSC and Health NZ have agreed to work together to align and integrate the frameworks where this makes sense. I am supportive of this and look forward to receiving updates about how these frameworks are progressing as well as what the emerging issues are and how these are being mitigated across the system.
It is great to be able to see how emerging issues discussed at this forum are leading to improvements being put in place across the system. I commend the collaboration and partnership approach that everyone in this forum has adopted.
I understand that HQSC are releasing the revised Clinical Governance Framework to be shared with the sector today. Again, I am aware that establishment of effective clinical governance has been a topic of this forum and you have received updates on progress from Health NZ over the past two years.
I know you are all aware of the importance of strong clinical governance principles and structures, which when working effectively, provide clear processes for escalation and improvement. Effective clinical governance ensures that staff work together, with consumers, to oversee and improve the quality and safety of the health and disability services they provide.
As organisations covering the wider health system, with clinical roles embedded, I encourage you all to read and implement the clinical governance framework.
I would like to acknowledge the work already underway between HQSC and Health New Zealand to workshop implementation of this framework into regional clinical governance structures. I will be seeking assurance from HQSC to understand how the framework is being implemented across the system and look forward to hearing about the progress.
This Government is unapologetically focused on outcomes. We have already clearly outlined these outcomes through our five health targets, focused on faster cancer treatment, increasing childhood immunisation, shorter stays in emergency departments and shorter wait times for assessments and treatment. These are things that really matter to New Zealanders.
Targets help the system to focus resources, attention and accountability to improve performance – including the quality of care New Zealanders receive.
I expect the health system will focus on improvements in the areas outlined in the Government Policy Statement on Health. As you know, the GPS is structured around the priorities of access, timeliness and quality, supported by workforce and infrastructure.
The GPS defines quality as health services as safe, easy to navigate, understandable and welcoming to users, that are continuously improving.
Over the next three years, I expect to see a focus on:
- Benchmarking and monitoring quality of care. This includes improving data quality, and benchmarking to best practice among countries New Zealand compares itself to.
- Enabling the use and generation of evidence, information, research and evaluation across the health system by using science principles and concepts.
- Enhancing processes for quality improvement and strengthening the handling of quality concerns. This includes extending the development of patient-centred measures, and making sure New Zealanders are appropriately informed about and involved in their care so they can actively manage their health and wellbeing in ways that work for them.
I see this forum as having a vital role to play in making sure the quality objectives of the GPS are embedded in our health system.
I understand that you have identified three priority areas.
First, improving quality of care for maternity services for all consumers. As previously mentioned, I understand that this was an area that your members proactively identified as one of concern.
Second, improving outcomes through optimal use of medicines. Gaps were identified in national oversight of medicines, an intervention which impacts on all life courses and parts of the health system. As a result, the forum’s first sub-committee, the national medicines steering group (NMSG) was established, to achieve improved health outcomes through optimal use of medicines by identifying system level change.
Third, coordination on system safety reporting. The forum’s role is to coordinate and collaborate on system safety reporting to ensure accurate, timely and consistent information is provided and actioned where appropriate. Coordinating how we report, identify and act on emerging risks is a key priority for the forum.
These three areas align with this Government’s vision for the health system and will make meaningful differences for New Zealanders.
I also want to touch on some other areas where I see potential to improve quality.
I have already signaled I will undertake a review of the Health Practitioners Competence Assurance Act, to make sure it is fit for purpose. To face the challenges ahead, we are likely to need bold new thinking to solve some of the longstanding issues with the way the system supports the growth and development of the workforce.
We will also keep in view the significant potential for digital health to improve the quality of health care New Zealanders receive, supporting person-centric health care. I recently returned from the World Health Organization’s Western Pacific Regional Committee Meeting in Manila, where a new regional framework was agreed for digital health transformation.
As the peak body for quality and safety for the public health and disability system in New Zealand, my expectation is that your membership will drive actions to improve outcomes.
The forum’s role will become more important over time. We all know New Zealanders’ health needs continue to grow and there are significant challenges ahead. These challenges include the needs of an ageing population, which has society-wide implications and impacts the delivery of healthcare.
In 2022, one in every six people in New Zealand was aged over 65. By 2028, this proportion is tracking to change to one in five people.
With our ageing population, we face the increased complexity and burden of long-term conditions such as cancer, diabetes, respiratory disease, heart disease and poor mental health.
This complex picture requires a laser focus on what is most important for the health and wellbeing of our populations. And it requires us to vigorously track our progress to ensure that we’re making a difference.
When we think about quality, it is not just about reducing errors. It is about developing health system New Zealanders trust to deliver timely access to quality care.
There is no question our health system is facing a very challenging time. But I am confident we can shift performance, supported by our dedicated and top-quality workforce, a strong, long-term vision and clear targets. This Forum can will play a key role in this.
The proof will be that New Zealanders will experience improvements themselves in the quality of care they and their families receive.
I trust the rest of your session goes well.
