From the Minister's Desk

Meningococcal Vaccine

New Food Safety Authority

Going Home Folder

Funding Package to Help DHBs Plan for the Future

Immunisation Schedule Changes

Pharmacists' Key Role in Primary Care

National Pandemic Exercise

Developments in Mental Health

Medical Radiation Therapists Increase

Disability Strategy Progress Report

Initiatives to Reduce Inequalities in Health

The New Zealand Public Health and Disability Act 2000 requires Boards to prepare district strategic plans outlining each of the DHBs' strategic goals and priorities in delivering health services to their regions.

New Zealand's 21 District Health Boards (DHBs) are in the process of releasing their draft strategic plans. All boards have completed Health Needs Assessments and these are incorporated in the draft strategic plans. The Health Needs Assessments have produced key data about needs and access and the draft plans look to how to best address the needs of the population for services.

MidCentral and Otago DHBs are currently calling for public feedback, after recently releasing their draft plans for consultation.

In Otago, the board will produce an information leaflet about the plan, which will be delivered to around 70,000 residents. Many organisations with an interest in health will also be sent a 40-page summary of the draft plan, while about 30 larger organisations that had a stake in the regional health strategy will receive copies of the full 300-page plan.

Public meetings will be held around the country as DHBs release their plans for consultation.

I would encourage you all to attend meetings and provide input as it is important to have community involvement.

Good planning takes time and plans need to be well thought through.

Finalised strategic plans from DHBs are expected to be completed by 1 July this year.

Hon Annette King
Minister of Health

A $100 million-plus initiative to combat New Zealand's ongoing epidemic of meningococcal disease is under way.

This huge investment in health protection - announced last month - will be spent developing a vaccine to immunise more than a million New Zealanders under the age of 20 within the next five years.

New Zealand is in the grip of an 11-year-long epidemic that has so far claimed 184 lives. In 2001, a person died every two weeks on average from meningococcal disease, making it the worst year on record since the epidemic started sweeping through New Zealand.

Clinical studies of a vaccine developed specifically for New Zealand will start this year, and a vaccination programme will get under way if the outcome is successful.

Meningococcal disease causes more hospitalisation and fatalities than any other notifiable infectious disease in New Zealand. There is also a major cost for survivors as the disabling effects can include limb amputations, massive skin grafts or brain damage.

The estimated social cost of the disease is $75 million a year, including hospital and rehabilitation costs of about $29 million a year.

Negotiations with the United States-based vaccine supplier, biotechnology company Chiron Corporation, are currently in progress.

Health Minister Annette King has been appointed as Minister-designate for Food Safety, with the New Zealand Food Safety Authority set to be established by 1 July this year.

Announcing the new authority in January, Ms King said it represented good news for all New Zealanders.

As the authority's Minister-designate, she would be advised by a 10-member advisory board that would assess the authority's performance.

"This board will include consumer representation, as well as producer representation. It is essential that consumers' interests in food safety are effectively addressed," said Ms King.

"While responsibility for food issues has traditionally been shared between the health and agriculture portfolios, food safety is clearly a prime health concern.

"The work I have been doing in the past two years, particularly in relation to food labelling, has reinforced my interest across the whole spectrum of food issues."

Pegasus Health, the Canterbury DHB and Rainbow Children's Trust have combined to launch a unique project aimed at improving the health of the region's children.

The project focuses on providing practical help and information for the parents and caregivers of children being discharged from hospital.

From now on, everyone under 16 years discharged from any of the paediatric services at Christchurch Hospital will have a "Going Home" folder containing a copy of their discharge notes, other medical information relevant to their care, and contact names and numbers for either their regular family practice team or a practice in their area. The folder also guides families on how to use 24-hour general practice services.

Ms King said as parents and caregivers go home from hospital to care for a sick or recovering child, the responsibility can sometimes feel overwhelming, especially if they had a lot of information to remember.

"Anything we can do to support parents in their caregiving role will be of benefit to the child, and this folder is a practical resource to assist parents care for their child and access services when needed," she said.

The three-year health funding package, announced late last year by Health Minister Annette King, lays the groundwork to help eliminate DHB deficits over the next three years.

The Funding Package also allows for implementation of the Primary Care Strategy and improved access through Primary Health Organisations. The package, which sets out all the additional funding for Vote Health over the next three years, comprises $400 million in new funding for health next year, $800 million the following year and $1.2 billion the year after that (the equivalent of $400 million of new funding each year).

Ms King said the funding package will allow DHBs to plan ahead with certainty.

"It will enable the elimination of hospital deficits over time, but DHBs must manage their cost growth, including wage pressures, to be within this total package," she said.

When DHBs are out of deficit they will be able to invest more in the priorities signalled in the New Zealand Health and Disability Strategies."

The funding will enable DHBs to plan innovations to keep the costs of their hospital services down, for example by better integration of primary and secondary care. This will enable more coordinated care, especially for people with chronic illnesses.

From 1 February 2002, there has been a change in the National Immunisation Schedule.

The schedule has been changed as new and safer vaccines have become available, which will assist immunisation coverage and disease prevention in New Zealand. All babies born from mid-December 2001 will start on the new schedule.

The oral polio vaccine will be replaced by the injectable inactivated polio vaccine and given as DTaP -IPV (Diphtheria, Tetanus and acellular pertussis). It is expected that this change will prevent the rare cases of vaccine-associated paralytic polio-myelitis.

A fifth dose of PtaP will be added at the 4-5-year-old visit. This is given before school entry to protect children from pertussis in the early school years and to decrease transmission of the disease to younger children.

Children aged 11 years (Year 7) will continue to receive the Td (Tetanus-diphtheria) vaccine. For children who have not had four doses of polio vaccine, a dose of IPV will be given at this time. These immunisations will be delivered as part of a school programme for Year 7 children in the North Island and Nelson-Marlborough and by general practitioners in the rest of the South Island.

Tetanus-diphtheria boosters will now be given at 45 and 65 years of age to coincide with other preventative health measures at these ages. Tetanus immunisation following wounds remains unchanged.

For more information see: www.moh.govt.nz.

The government is planning to strengthen the role of pharmacists in primary health care and improve access to medicines.

The Pharmacy Act 1970 will be repealed when the proposed Health Practitioners' Competence Assurance Bill is passed this year. "Pharmacy ownership restrictions have been reviewed and pharmacies and pharmacists will have greater flexibility to respond to the changing needs of the health sector," said Health Minister Annette King.

The changes replace a restrictive ownership regime with a licensing approach. This means both pharmacists and non-pharmacists can own pharmacies but must satisfy certain legal requirements to get a licence. Pharmacists will also be registered under the HPCA and will be required to maintain life-long competence to protect the safety of the public.

"These changes will allow pharmacists to integrate with primary health organisations. This should make it easier for discussions on the best medicines for patients and the integration of medical records to take place," said Ms King.

"We also believe this move will give New Zealanders better access to pharmacists," said Ms King.

"In other countries people seeing their doctor or doing their supermarket shopping often have access to a registered pharmacist dispensing medicines from the same site. New Zealand studies indicate that consumers would value similar opportunities."

The changes would be phased in over a three-year period.

DHBs and Public Health Services are responding enthusiastically to a month-long nationwide influenza pandemic response exercise.

Exercise director Robyn Fitzgerald said she was pleased with the commitment shown by DHB and Public Health Service staff to the challenging 30-day exercise. "They have acknowledged the seriousness of the threat of a pandemic and identified the value of being prepared."

The Ministry of Health is evaluating the emergency response capabilities of the health sector by staging an influenza pandemic. Emergency response teams from the 21 DHBs, Public Health Services, the Ministry of Health and the National Pandemic Planning Committee are all taking part.

"The exercise is important, as an influenza pandemic is one of the biggest threats to public health," said Mrs Fitzgerald.

"Influenza pandemics cause high rates of death and illness, can strike with only minimum warning and require a well co-ordinated national and regional response. "By trialling our response methods the public can be reassured New Zealand's health sector will have a robust pandemic plan and be prepared to minimise disruption and death."

Since 14 January, an evolving influenza pandemic scenario has been drip fed to DHBs and Public Health Services mimicking how an influenza pandemic might evolve in New Zealand.

The influenza pandemic exercise was nine months in the planning and Mrs Fitzgerald said it is the first time a National Influenza Pandemic Plan has been tested on a national scale. International interest has been expressed from World Health Organization members from Australia, Europe and the United States of America.

Building strong community-based mental health services as set out in the Mental Health Blueprint is one of the government's top priorities.

DHBs have been making tremendous progress with implementing the Blueprint, says Health Minister Annette King.

In just four years, child and youth community full time equivalents (FTEs) have grown from 323 in 1998/99 to 679 in 2001/02 - a 110 percent increase. Adult community clinical FTEs have grown from 885 in 1993/94 to 1636 in 2001/02.

"I am delighted an additional $50 million is being invested over the next two financial years for more and better mental health services," said Ms King.

The second stage of the 'Like Minds, Like Mine' campaign begins this month. This will be supported by a new set of advertisements to assist in eliminating the unjustified stigma that people with experience of mental illness face every day.

Cancer treatment services continue to improve in New Zealand as the number of medical radiation therapists increase. More medical radiation therapists (MRTs) are being trained than ever before. This year, approximately 37 trainees will commence first year training compared with 17 in 1999.

New Zealand cancer centres are recruiting an increasing number of MRTs and vacancies are being filled. MidCentral Health has a full complement of staff, Capital and Coast Health has only a couple of vacancies and several MRTs will be joining the radiation team at Auckland DHB over the next three months.

Auckland, MidCentral and Waikato DHBs have resolved the industrial problems with their MRTs. MidCentral MRTs are working overtime in an effort to clear some of the patient backlog. MRTs at Capital and Coast DHB have agreed to the same terms and conditions that were accepted by the Auckland, MidCentral and Waikato MRTs.

The 'Progress in Implementing the New Zealand Disability Strategy' report shows real efforts have been made to increase the participation and inclusion of people with disabilities.

The report, recently released by Disability Issues Minister Ruth Dyson, covers the period between 1 July 2001 to 30 September 2001. During this time, a new positive direction for vocational services for people with disabilities was launched by the Department of Labour.

The State Services Commission's E-Government Unit issued the first version of government web guidelines, which require websites to be accessible to people with disabilities.

The report shows government agencies are working to ensure they actively involve people with disabilities through improved communications, employment opportunities and physical access.

Copies of the report are available from the Ministry of Health in a number of formats including large print, Braille and audiotape, or on the New Zealand Disability Strategy website: www.nzds.govt.nz.

New funding from the Inequalities Contingency will help reduce health inequalities by improving access to primary health care services.

Over the next 18 months $2.8 million will be allocated to inequalities in primary care, and $2.4 million will be allocated for the following three years. "The government is committed to reducing health inequalities and this funding will help those most in need to access a range of primary care services to meet these needs," says Health Minister Annette King.

The funding initiative has been allocated and will be available shortly to providers serving populations most in need. This funding will be complemented by other work to implement the Primary Health Care Strategy.

An Intervention Framework for Reducing Inequalities in Health has been developed by the Ministry of Health and a background paper which gives the concepts behind the framework will be available to the sector soon.

An action kit will follow to help DHBs apply the framework practically.

The framework and how it can be applied at DHB level is available on the Toolkits website: www.newhealth.govt.nz/toolkits.htm.