From the Minister's Desk

Primary Health Organisations

Commonwealth Health Ministers Meeting

New Plan for Tackling Infectious Disease

Pharmac to Purchase Drugs for Hospitals

Radiation Oncology Waiting Times

Cervical Screening Six-monthly Update Report Released

Cheaper Help for Giving Up Smoking

Sexual and Reproductive Health Strategy - Phase One Launched

Working to Add Value to E-information

Keeping Workplaces Mentally Healthy

Dr Donald Berwick's Visit

My announcement of a three-year funding package is being warmly welcomed by the health sector. The move is a real achievement for this Government as it is the first time a three-year funding package has been secured.

This funding package also represents a major step forward for health and disability sector planning. It gives District Health Boards (DHBs) the certainty needed to plan their service delivery over the long-term and to develop the best ways of meeting the needs of their local communities. This funding certainty will also allow DHBs and others in the health sector to innovate and prioritise as they implement the New Zealand Health and Disability Strategies.

I'm delighted a major investment in primary health care is included in the package. Investing in this area is the one thing that is most likely to make a significant improvement in the health status of New Zealanders and to reduce inequalities. Most assistance will go to new primary health organisations providing services for the groups that are most in need. The implementation of the Primary Health Care Strategy can begin in 2002/03 although some details are still being discussed. Initial primary health care funding will be directed where it is most needed.

The funding package also lays the groundwork for the elimination of DHB deficits over the next three years as it sets out major additional funding of $2.4 billion for Vote Health over the next three years. We've announced $400 million in new funding for health next year, $800 million the following year and $1.2 billion the year after that. I must emphasise though that wiping out deficits is a partnership between the Government and DHBs. The purpose of this is to get the best mix of health and disability services. It's now up to DHBs to manage their cost growth, including wage pressures.

Hon Annette King
Minister of Health

The first details about primary health organisations (PHOs) - the building blocks of the future public health system - were announced by Mrs King in November.

The public health system must move to a more preventive, behaviour-changing focus to survive, Mrs King says. The existing pressures on funding and the well-publicised shortages and difficulties in a number of areas will be insignificant compared to future pressures if communities, individuals and governments cannot improve the overall level of the health status of New Zealanders.

PHOs will become the organisations on which the new preventative approach is based and will be at the forefront of the shift to:

• population-based funding systems
• adopting a team approach to delivering care
• adopting a community-focus to decision making
• a focus on continuing rather than episodic care.

More than 100 delegates from 32 countries attended the 13th Commonwealth Health Ministers' Meeting (13CHMM) in Christchurch from 25 to 29 November 2001. They deliberated on the main theme of 'Priority Setting in Health Systems'.

Mrs King chaired the meeting, where discussion covered issues such as workforce, HIV/Aids and globalisation. There were also 21 accredited observers from Commonwealth health professional associations and NGOs. Commonwealth Secretary General Don McKinnon led the Commonwealth Secretariat's team to the meeting.

Mrs King says the overwhelming consensus among Commonwealth health ministers was that 13CHMM was an outstanding success.

"Commonwealth nations face a diversity of health experiences and issues, but 13CHMM proved they are able to come together to discuss them in a spirit of cooperation, and that they genuinely care about each other's difficulties."

New Zealand welcomed a draft code of practice for international recruitment of health professionals and commended its timeliness. It was recommended a Working Group - that includes New Zealand - finalise the draft for presentation to Ministers at the next pre-World Health Assembly meeting in May 2002.

New Zealand aims to have 95 percent of all children fully vaccinated at age two by the year 2005, and 75 percent or more of the high-risk adult population vaccinated annually against influenza.

A new action plan Integrated Approach to Infectious Disease: Priorities for Action 2002-2006 has recently been released by the Ministry and has the support of the infectious disease sector.

"Our prime objective is to eliminate vaccine-preventable disease by delivering effective vaccination programmes across all communities," Mrs King said at the launch.

The action plan also addresses other high priority areas for future work, calling for improved surveillance of antibiotic resistant organisms in hospitals, and looking at ways to improve information collected on sexually transmissible infections.

The action plan outlines how all sectors of Government will work together over the next five years to bring about the New Zealand Health Strategy objective of reducing the incidence and impact of infectious diseases in our country.

"Infectious disease disproportionately affects those in society who are already disadvantaged. By controlling infectious disease we lessen inequalities and reduce disability."

Copies of Integrated Approach to Infectious Disease are available from the Ministry of Health, tel (04) 496 2277, website: www.moh.govt.nz

DHBs could potentially save millions of dollars a year, now that Pharmac has been authorised to purchase drugs for their hospitals.

Announcing the move recently, Health Minister Annette King said individual DHBs would in the future no longer have to negotiate directly with pharmaceutical companies for all the drugs used in their hospitals.

"Where Pharmac acts as the sole central negotiating agent there will be nationwide consistency and an opportunity for savings to be made," she said.

Pharmac's purchasing power is expected to lead to national annual savings of around $7 million to $10 million from an estimated national bill of $100 million to $140 million.

Mrs King said because DHBs might have to wait until their existing contracts with pharmaceutical companies expired, the savings were expected to start in 2002 and increase in later years.

Pharmac is expected to gradually take on its new role from December this year. It will take some years before Pharmac has completed all the relevant tenders.

The radiation treatment statistics for November show little change from previous months. Ministry of Health chief medical advisor Dr Colin Feek said the situation hasn't improved but it doesn't appear to have deteriorated either.

In Wellington, a total of 23 patients had to wait longer than six weeks for radiation in October compared with 28 in September and 33 in August.

In Auckland, 69 patients had to wait longer than six weeks for radiation treatment in October compared with 43 in September.

A total of 579 patients began their treatment in October with 310 waiting less than four weeks for treatment, 269 waiting longer than four weeks for treatment and 173 waiting longer than six weeks.

Dr Feek said that the nine or ten additional radiotherapists beginning in Auckland in February should reduce waiting times and it was expected that the situation would then begin to improve.

Health Minister Annette released a Six-Month Summary Report on the Ministerial Inquiry Report's implementation in Gisborne last month.

Expert British Cytopathologist Dr Euphemia McGoogan, who is providing the Minister with an independent assessment of the implementation of the recommendations, also presented a preliminary perspective on progress.

Progress has been made in several key areas during the first six months since the report's release.

Work has been carried out on 45 of the 46 recommendations. In all 37 are under way while 8 have been completed. Some key developments included the following:

This year the NSU took over the important task of carrying out the audit of women with invasive cervical cancer.

Since the audit commenced in April, the initial planning phase identified some 400 women who have developed cervical cancer and who will be included in the audit. The NSU aims to complete this audit in an eighteen-month timeframe.

To better enable the monitoring, audit and evaluation of the programme in the future, Cabinet has approved a number of changes to Section 74A of the Health Act. The changes followed the release of a public discussion document, which subsequently received 101 submissions. Although the proposed changes will meet several key recommendations of the Inquiry Report, consent will still need to be sought to access the clinical records of women held by GPs.

"The message from the submissions was clear. Three-quarters of the submissions were opposed to giving access to medical records without consent. As a result we've developed a process that recognises these concerns while giving us the best possible framework for conducting effective programme monitoring, audit and evaluation," Mrs King said.

When in place the changes will allow information from the NCSP Register to be available for assessing the effectiveness of the NCSP. The consent process only applies to clinical records held by GPs.

From 1 July this year laboratories providing services to the NCSP were required to meet a range of new quality standards. As a result of the new standards the number of laboratories providing services to the programme has reduced to 13, eleven community laboratories and two public hospital laboratories.

July also saw the release of the first quarterly monitoring report for the programme. Routine monitoring is a key factor in ensuring ongoing quality and enabling the identification and resolution of problems at an early stage.

Other key developments include the establishment of the NSU, which is responsible for the management of both cancer screening programmes and will have 33 staff when at full strength. The Unit has sought to build on initiatives that have been taken to strengthen the NCSP in the past two and a half years.

Copies of the Six-Month Summary Report and the Gisborne Ministerial Inquiry Report can be found at website address: http://www.csi.org.nz.

Copies of the cabinet paper, cabinet minute and media material on changes to Section 74A of the Health Act can be found at website address: /minister/king

Smokers who want to quit now pay less after changes to the national subsidised nicotine patches and gum programme were introduced on 1 November.

One month's supply of nicotine replacement therapy now costs $5 for the first four weeks and $10 for the second four weeks. Previously, a smoker trying to quit paid $10 for one month's supply. If the products weren't subsidised, a month's supply could cost up to $125.

The change is part of an ongoing review of the subsidised quit smoking programme, which is delivered through the national freephone service Quitline, or via registered smoking cessation providers in the community.

Since 1 November, all unexpired NRT cards can be redeemed from a pharmacist for a new co-payment price of $5 per product. Any existing $10 exchange cards will be redeemed at the new prices until they have all expired.

Since the Quitline programme started, 66,630 people have registered as wanting to quit and an average of 1400 per month access nicotine replacement therapy.

Health Minister Annette King says New Zealanders must be more open about sexuality and sexual practices.

Launching phase one of the country's first comprehensive Sexual and Reproductive Health Strategy recently, Mrs King said the Government shared community concern about increasing rates of teenage and unwanted pregnancies, abortions and sexually transmissible infections (STIs).

Phase one of the strategy will provide the overall direction the Government wishes to take. The second phase will be developing action plans to address issues such as reducing STIs, HIV/AIDS, and unwanted/unintended pregnancies, and maximising the health of at-risk groups like Mäori and Pacific peoples. Action plans will start to emerge early next year.

Mrs King acknowledged that a strategy document "will not provide the instant answers some seek to long-term problems in sexual and reproductive health. The Government can't stop people having unsafe sex, or ensure that all pregnancies are planned. We can provide leadership, however, working through issues with the sector and with New Zealanders.

"Society needs to accept and value safer sex practices. We need to ensure individuals and groups have access to correct information about risks. We need comprehensive, affordable and accessible services. And we need accurate and consistent data so that we can address gaps in services."

Director-General of Health Dr Karen Poutasi last month launched an implementation plan for improving the management of health information.

From Strategy to Reality examines ways the health sector can better manage information, after Dr Poutasi appointed an advisory board in December 2000 to facilitate the development of an information management and technology plan.

The project became known as WAVE - Working to Add Value to E-information - and looked at aspects of health information, including how it is stored, how it is shared between providers, how medical knowledge can be accessed, how information can be managed more efficiently and how to keep it secure.

The report made 79 recommendations, with 10 of those were identified as top priority - steps that could be taken to immediately improve information management in the health sector. Many of the top 10 recommendations are already under way.'

A chief advisor for health sector information and technology will be appointed shortly, with responsibilities including co-ordinating the implementation or recommendations in From Strategy to Reality.

Among the top 10 recommendations are: collecting reliable ethnicity data, gathering primary care information, and creating consistent messaging standards. There is also a recommendation to launch a health portal to provide a consistent interface to the health and disability sector.

A working group has been formed by the Minister of Health to advise on the first steps that should be taken in the area of information standards, and on the establishment of a non statutory health information standards organisation.

Providing mentally healthy workplaces makes for good business sense, Health Minister Annette King reminded employers during Mental Health Awareness Week last month.

"From an employers' perspective, it is in their interests to have a happy and healthy workplace and this week is an opportune time for both employers and staff to review potential triggers for stress. These include long work hours, poorly managed workloads, poor physical health, lack of guidelines on harassment, or a lack of consultation or appraisal," she said.

"In the global workplace, stress is taking its toll in both human and financial terms, accounting for absenteeism, low productivity, and high staff turnover."

Mrs King said it was known that one in five New Zealanders experienced mental illness at some time in their life. Employers needed to remember that mental illness would impact on their business in some way, either through employees, their own families, customers, clients or suppliers.

She recommended employers implemented good employment practises that don't discriminate, and inviting staff to work on a strategy to maintain good mental health and productivity levels.

Internationally renowned Donald Berwick left an indelible mark on New Zealand health professionals following his visit to New Zealand in October.

The Boston paediatrician, who is President and CEO of an international organisation dedicated to improving quality in health, was charming, inspiring and right down to earth.

He was in Wellington for three days and took part in a number of workshops and discussions set up to coincide with Quality in Health Week.

His message was simple. If a mistake has occurred during health care, a shame, blame and name approach is not the right way to improve things.

"Blame is easy and satisfying but if you think about it, airlines don't get safer by asking pilots not to crash and health care doesn't get safer by asking doctors not to stuff up.

"You will get nowhere by doing this. It's not a strong plan. What's happened here is that we have good people working in a frail system and it's about trying hard to change the system."

Around 300 health professionals attended the workshops. With a resonant radio voice, a swathe of analogies and the ability to transcend national boundaries and organisational arrangements, Dr Berwick was inspirational.