From the Minister's Desk

Primary Health Care Funding

Pacific Health and Disability Action Plan

Mental Health Commission privacy review

Access improved to drugs

Exercise Virex

MRSA guidelines

I'm delighted New Zealand is developing a co-ordinated approach to controlling one of our major health problems - cancer.

A Cancer Control Steering Group was formed late last year and charged with developing a National Cancer Control Strategy.

This is a timely development as over the next 30 years, cancer will overtake heart failure as the leading cause of death and disability in New Zealand.

Reducing the incidence and impact of cancer is one of the 13 population health objectives in The New Zealand Health Strategy.

The steering group is a partnership between the Cancer Control Trust and the Ministry of Health, and consists of experts recognised for their work on aspects of cancer control and treatment.

They will develop a long-term direction for cancer control across the whole spectrum of prevention, early detection, treatment, support, rehabilitation and palliative care.

The steering group and five expert working groups will also identify priority actions that can rapidly improve services. Ways in which we can make better use of available resources and reduce the incidence and impact of cancer for New Zealanders will be identified.

I have urged the Cancer Control Steering Group to work swiftly to develop a comprehensive cancer control plan and I am committed to the priority areas being implemented rapidly.

The draft strategy should be out for consultation by early October and the final strategy completed early next year.

Hon Annette King
Minister of Health

The Government will inject more than $400 million in new funding into primary health care over the next three years as part of the nearly $3 billion health funding package Health Minister Annette King announced in December.

Ms King, who announced the new funding on Wednesday with Deputy Prime Minister and Alliance leader Jim Anderton, said the Labour-Alliance Government was committed over time to moving "to a system where everyone gets affordable access to primary health care.

"This funding announcement is the most important development in caring for the health of New Zealanders since the first Labour Government introduced patient subsidies in the 1940s."

Ms King said $50 million was allocated to begin implementing the Primary Health Care Strategy in the 2002/2003 year, rising to $165 million in 2003/2004, and $195 million in 2004/2005.

Ms King and Mr Anderton also announced that although the new funding meant the beginning of phasing out the Community Services Card, the card could not be eliminated immediately.

"That will happen as we implement the Primary Health Care Strategy completely over the next eight to 10 years. In the meantime the income threshold for the CSC will be raised to allow some 23,000 New Zealanders to have or continue to have lower-cost visits and prescriptions, and we will do our best to encourage far better uptake of the card.

"We are also increasing the general medical services subsidy from $32.50 to $35 for all GP services to children under six to adjust for inflation since the subsidy was introduced in 1997."

Ms King said the new funding "will be targeted firstly at low-income people with high health needs. Some may see this as unfair, but we cannot achieve everything for everyone immediately.

"I expect that by the end of 2002/03 we will have reduced the cost of accessing primary health care and improved primary health care services for at least 300,000 New Zealanders."

Health Minister Annette King says more affordable, effective and responsive services will be available for Pacific people when the health and disability sector embraces ideas set out in the Pacific Health and Disability Action Plan.

The Action Plan, developed by the Ministry of Health's Pacific Health Reference Group and the Pacific community, sets out the path and actions District Health Boards and the Ministry will have to take to reduce health inequalities between Pacific and non-Pacific people.

"If we use the opportunities presented in the Action Plan, we can improve health, reduce inequalities and offer higher quality care for Pacific people. Pacific health providers will have a particularly special role to play in achieving these goals," Ms King said.

The health of Pacific people in New Zealand is poorer than that of non-Pacific people. They have a higher death rate and lower life expectancy than other ethnic groups, excluding Maori. Socio-economic factors such as lower incomes, poorer housing and lower education achievements also contribute to relatively poor health in Pacific people.

The Action Plan highlights six priority areas for improvements - child and youth health, promoting healthy lifestyles and wellbeing, primary health care and preventive services, provider and workforce development, promoting participation of disabled Pacific people and health and disability information and research.

Ms King said the Ministry's Pacific Provider Development Fund would be used in part to fund Pacific provider and workforce development, with about $15 million allocated for provider development over the next three years.

Health Minister Annette King has released a review of the ways in which mental health services share information about at-risk people.

The Minister had asked the Mental Health Commission to review the way in which mental health services use the Privacy Act and the Health Information Privacy Code, after widespread concern was expressed following the deaths of Malcolm Beggs and Lachlan Jones in 1999.

Ms King says the review's recommendations "outline a good programme of work to ensure the system performs better in future. I'm pleased the key players involved have recognised the importance of this issue and are working together to make improvements efficiently and soon".

The review looked at whether services have developed their own policies and procedures, in line with the code, on sharing information about care and treatment of service users, and how well these policies are communicated, understood and put in place.

It found wide variations in information-sharing policies across mental health services nationwide, as well as some misunderstandings about using the Privacy Act and Code.

Ms King said the Privacy Act and the Code did not prevent health professionals from sharing information with families and others involved in the care of mental health service users.

"Consent by people who use mental health services to share information about their illness is important, but disclosing information without consent is one of many decisions health professionals have to make to balance the interests of everyone involved. The family's need to know, the clinician's obligation to treat clients and ensure their safety, as well as the community's right to safety, also need consideration."

"There is nothing in the Privacy Act or Code to stop mental health professionals from suitably warning appropriate people, without the individual client's consent, as long as there is a clinical assessment that the client poses a danger to themselves or others."

"The solution is having clear policies on information sharing as well as professionals who are well trained, supported and informed about privacy issues."

The Mental Health Commission will undertake a full-scale review of District Health Boards in 18 months' time to see whether changes have actually been made to practice and are proving effective.

Pharmac has widened access to drugs to treat two of New Zealand's most serious health conditions.

From 1 April thousands more New Zealanders with high cholesterol levels will benefit from Pharmac's decision to widen access to statin drugs, which are used to lower cholesterol levels. At least 50 more people with multiple sclerosis will benefit from the agency's decision to remove the funding cap on beta interferon.

Statins are already available fully funded, but are targeted through the use of Special Authority to those patients who are at high risk of heart disease. The Special Authority will be replaced from April with prescribing guidelines, which will increase the number of eligible people by more than 100,000, to around 300,000.

Statins lower cholesterol levels in the bloodstream. High cholesterol is known to increase the risk of cardiovascular diseases, such as heart attack. Other risk factors include high blood pressure, smoking, lack of exercise, high-fat diets and obesity.

Current practice is for patients to modify their lifestyle to reduce cardiovascular risk, and treatment with statin drugs could be used in addition to lifestyle changes.

The decision to remove the funding cap for beta interferon will initially allow a further 50 patients to be given subsidised beta interferon, with the prospect of more following if they meet the criteria for access to the drug.

Beta interferon is currently subsidised for 180 patients under a funding cap, with further patients meeting the entry criteria placed on a waiting list. From April, fully subsidised beta interferon will be made available without delay to all patients who meet the entry criteria developed by expert neurologists.

The removal of the cap has been made possible through savings in other areas of the pharmaceutical budget. The change is eventually expected to cost an additional $3 million a year.

Valuable lessons about they way to manage a situation in which thousands of people die from a deadly strain of influenza are being learnt by the Ministry of Health and District Health Boards following a month-long nationwide emergency exercise.

"The Ministry of Health mock emergency, known as Exercise Virex, ended on 14 February and involved around 400 participants," said Exercise Director Robyn Fitzgerald.

"The purpose of the exercise was to update New Zealand's Influenza Pandemic Preparedness Plan so the country is as prepared as it can be for an influenza pandemic."

"No one in the world could ever be entirely ready for a pandemic, but after holding this exercise we have identified the areas we need to work on. I am reassured New Zealand's health workforce is now better prepared to minimise disruption and death."

During Exercise Virex, an influenza pandemic scenario was drip-fed to participants over a month, mimicking the way in which an influenza pandemic might evolve in New Zealand. Participants received their last installment of the scenario on 14 February and by then the hypothetical story had reached disaster proportions.

"The scenario didn't paint a pretty picture of the pandemic on 14 February; hundreds of people were dying, hospitals were having to manage large numbers of patients while coping with reduced staff, and various public events were being cancelled."

Mrs Fitzgerald said the new information came with challenging questions for participants and asked how each region would respond to the latest hypothetical events.

DHBs and Public Health Services took the exercise very seriously. "We were very impressed with the sound and innovative ideas submitted by exercise participants. They fully absorbed the potential for disaster," said Mrs Fitzgerald.

Draft guidelines for tackling methicillin resistant Staphylococcus aureus (MRSA) have been drawn up by an expert group convened by the Ministry of Health.

"MRSA is a major quality control problem facing hospitals all over the world," Ministry spokesperson Dr Don Matheson said. "It can slow the recovery of individual patients and force the closure of wards or operating theatres, disrupting the normal daily business of a hospital. We can't eliminate it but we can do our best to minimise its spread and impact."

The group has updated guidelines first promulgated by the Department of Health in 1992. They have been sent to a wider group of people working in infection control to gather feedback. The consultation document will then be released to ensure other interested parties can provide input on the guidelines.

MRSA is increasing in the community, which in turn, increases the chances of someone carrying it into hospital where it can have serious consequences for people whose immune systems are already under stress.

"An outbreak can be triggered by something as simple as someone with the bug who sits on the patient's bed. Lots of us carry staphylococcus in our noses, and wouldn't necessarily be sick or know that we had it," Dr Matheson said.

He said microbiologists now recognised the inevitability of bacteria mutating and developing a resistant strain at some point. "To slow down the need for newer and newer antibiotics, some of the basic hygiene and infection control procedures need reiterating, strengthening and monitoring. Rigorous attention to simple issues such as hand hygiene do make a difference."

Updating the guidelines was a key recommendation of the recent Integrated Approach to Infectious Diseases launched by the Minister in November 2001. The guidelines consultation document will be released in mid-April and the final version will be available mid-year.

Draft Guidelines for the Control of methicillin resistant Staphylococcus aureus will be available on the Ministry of Health web site by 12 April, together with details on how to make a submission. Closing date for submissions is 3 May. Please e-mail Nicola Chapple with contact details if you want to receive a hard copy of the Draft Guidelines (nicola_chapple@moh.govt.nz).

New Ministry of Health forecasts of the type 2 diabetes epidemic over the next decade are a reminder to health agencies of the importance of this mostly preventable disease.

The Ministry of Health has released four bulletins and a summary pamphlet, collectively titled Diabetes in New Zealand: Models and Forecasts 1996 - 2011.

The Ministry's model estimates about 5000 adults were newly diagnosed with type 2 diabetes in 1996, and this may rise to 11,000 in 2011.

The Ministry of Health has known for some time that the epidemic will worsen and has been actively working to minimise its impact.

In early February the ministry released the "Healthy Action - Healthy Eating" consultation draft. Comments are welcome up to 29 March.

Addressing the epidemic of type 2 diabetes in New Zealand, driven by our growing and ageing population and increasing level of obesity, is a top health priority for the health sector and District Health Boards as indicated in the New Zealand Health Strategy.

The Ministry and the Health Research Council have established a research fund for developing diabetes prevention programmes.

Preventing diabetes and providing health care for people living with the disease require sound information about the impact this disease is having on New Zealand as well as accurate forecasts about the way this may change in future.

Diabetes incidence, prevalence and mortality is estimated for 1996 and the model then projects these estimates to 2011, taking into account anticipated trends in population size and structure, obesity and health care.

Maori and Pacific people were about three times more likely to have type 2 diabetes than Europeans in 1996, and will be most severely hit by the worsening epidemic.

Diabetes and obesity are impacting severely on the health of New Zealanders and are contributing to health inequalities between the major ethnic groups.

The model estimated about 1500 adult deaths were caused by type 2 diabetes in 1996 - about twice the number recorded on death certificates - and this could rise to about 2100 in 2011. The model conservatively estimates that in 1996 about 82,000 adults were known to have type 2 diabetes. By 2011 this could increase to more than 145,000 people. At least a third of this increase is driven by increasing numbers of overweight and obese people.

People can suffer severe and disabling complications from diabetes, and for many people, more physical activity and healthier eating can prevent type 2 diabetes from developing.

Type 2 diabetes is New Zealand's most common type of diabetes, accounting for almost 90 percent of cases.

New Zealand is developing a world class diabetes programme that focuses on people with diabetes and their individual needs. If you have diabetes you are entitled to a free annual check for complications each year.

This report is the first in a series of forecasts the Ministry of Health is fronting for the sector. The New Zealand Health Strategy calls for a preventive approach.

The actions we all take today - especially eating healthily and being active - will make a difference to the extent of the epidemic over the next decade.

To respond to this newsletter, receive it, or have your name taken off the mailing list, please e-mail: healthmoves@moh.govt.nz or write to: Annette King, Minister of Health, Health Moves, Parliament Buildings, Wellington.