From the Minister's Desk

Public Health Advisory Committee Meets for First Time

National Immunisation Register by Next Year

DHB Corner - Taranaki DHB

Quality in Health Week

New Stroke Clinic

New Mobile Surgical Bus

More Certainty for Patients Seeking Elective Services

Increasing Options for Women Seeking Abortion

Proposal to Change Maternity Contracts

UN Declaration on HIV/AIDs

The last few weeks have been exciting for New Zealand's nursing profession, as we celebrate the centenary of Nursing Registration in New Zealand. Nurses can look back with great satisfaction on what has been achieved in the last 100 years, and look forward to the next century.

Nursing in this country boasts a proud tradition. New Zealand is envied around the world for the standards of quality and professionalism in nursing. Our nurses are highly sought-after overseas and other nations look to New Zealand nursing as a benchmark.

The last few years have been a period of particularly intense change in nursing, with the introduction of nurse-led community services, the introduction and rapid growth of information technology and the development of new medical technologies.

And just this month the role of the Nurse Practitioner has been introduced to allow nurses to offer innovative ways of addressing health needs, and there has been the introduction of much-anticipated regulations that will allow Nurse Practitioners to prescribe some medications.

The regulations define the aged care and child family health scopes of practice, and specify the competency and training requirements that nurses must satisfy to be authorised to prescribe. Only nurses who comply with the requirements will be able to prescribe.

I am sure the introduction of nurse prescribing in aged care and child family health has the potential to improve access to services, improve patient education and reduce secondary illnesses and hospital admissions for children and older people.

I am equally confident nurses will continue to show the same unwavering commitment to delivering quality health care to all their patients.

It is important to point out that Nurse Practitioners are not General Practitioners. The role of GPs remains crucial in the provision of primary health care, and is hugely valued.

Hon Annette King
Minister of Health

The 'voice' of public health in New Zealand has been strengthened with the establishment of the new public health advisory committee (PHAC), which held its first meeting in late August.

The PHAC was created with the passage last December of the New Zealand Public Health and Disability Act 2000 when the Government saw a need for independent advice on:

• public health issues, including factors underlying the health of people and communities
• the promotion of public health
• the monitoring of public health.

The PHAC has been established as a sub-committee of the National Health Committee, itself an independent advisory committee to the Minister of Health.

The members of the Public Health Advisory Committee are:

Alistair Woodward (Chair) - Professor of Public Health and Head of Department at the Wellington School of Medicine
Cindy Kiro - General Manager He Kakamo Oranga, Green Lane Hospital/Senior Lecturer
Kevin Hague - Executive Director of the New Zealand Aids Foundation
Lynette Stewart - Chief Executive Te Tai Tokerau MAPO Trust
Robert Logan - specialist physician and Director of Medicine, Hutt Valley DHB.

Hon Annette King says she is determined a National Immunisation Register will be in place next year.

Opening last week's New Zealand Immunisation Conference in Auckland, Mrs King said the register was under development and had great potential to overcome many of the problems with the existing immunisation system.

The Minister said that the register must be robust and reliable from the outset, rather than rushed and beset by problems. By developing the register in a gradual and reliable way, we will end up with the high quality system we all want.

She looks forward to the first day health professionals can call and check their new patient's immunisation history, quickly and reliably.

Taranaki DHB mental health services have taken the lead in a national telemedicine project.

The telepsychiatry trial allows Hawera patients to talk to a psychiatrist at Taranaki Base Hospital through a video screen link-up. The trial started in Taranaki three weeks ago and will run until December.

National sponsor for the project Robyn Shearer said the video link-up was currently limited to psychiatry, but she hopes to tell other medical departments how it could be used for them.

The link is not suitable for all psychiatric conditions, particularly not for people who are paranoid and may be suspicious.

Usually someone, such as a GP or a family member, sat with the person throughout the video consultation.

The link is also being successfully used for mental health management meetings. A major benefit of the technology advance was the saving in time and travel.

The project would also look into what telemedicine was available throughout all the 21 DHBs. Telemedicine is already well advanced in Christchurch.

The New Zealand health sector was given the opportunity to attend workshops led by internationally renowned expert on quality in health care, Dr Donald Berwick, during Quality in Health Week, 17-24 September.

Dr Berwick's visit was a rare chance for the New Zealand health sector to discuss quality improvement with a world expert. Dr Berwick has published over 100 scientific articles relating to health care improvement.

Other activities tied in with Quality in Health included the release of advice on the new Health and Disability Standards and the launch of a workbook for hospital staff on how to investigate events where something has gone wrong and ensure they are not repeated.

The Ministry of Health will shortly be releasing a draft discussion paper Quality Improvement Strategy for Public Hospitals, put together by an ad hoc group of health experts. This discussion paper will also be posted on the Ministry's website: http://www.moh.govt.nz under Forums.

The Royal New Zealand College of General Practitioners also ran a Quality Workshop in Wellington, which provided a setting for discussion and shared learning among those developing or leading quality improvements in general practice.

More information about Quality in Health Week will be provided in the next edition of this newsletter.

The new Acute Stroke Unit at Middlemore Hospital, the first of its kind in New Zealand, will have a significant influence on the way strokes are treated in this country.

Strokes are a major cause of death and disability in New Zealand. More than 650 patients are admitted to Middlemore each year with acute strokes. Throughout the country this figure reaches several thousand, representing a major social and economic cost.

International research strongly supports the concept of specialist stroke units. Clinical trials show they provide better outcomes for patients and their families and a reduced length of stay. As well, specialist units offer the opportunity for more training and education, and for more focused and collaborative research.

The 12-bed specialist unit is staffed by a dedicated multi-disciplinary, team led by internationally-known stroke specialists Professors Craig Andersen and Valery Feigin.

Counties-Manukau DHB chief executive David Clarke said the unit would have strong links with existing rehabilitation and geriatric services, community services and Stroke Foundation of New Zealand field workers. There would also be a specialist neurovascular clinic at Manukau Superclinic.

A $4.5 million project will return surgery to up to 15 rural communities to revitalise the health services in those communities.

Operated by Mobile Surgical Services Ltd, it will have Government funding for up to 1000 procedures a year, through some rural hospitals around the country.

People will be able to undergo day surgery at regional hospitals, instead of having to travel to larger hospitals.

It is envised that the South Island hospitals involved in the project will be at Oamuru, Balclutha, Queenstown, Gore, Clyde and Westport. North Island hospitals that may participate include those at Hawera, Rawene and Te Puia.

The mobile theatre would have the most sophisticated theatre equipment available and would be equipped to perform a range of day surgery, including vasectomies, breast biopsies, grommets, tooth extractions, cataracts, hernias and varicose veins operations.

Steady progress continues to improve waiting times for elective services, according to the Elective Services Third Quarterly Report .

The report, which covers progress in the third quarter between 1 January and 31 March 2001, shows that over 340,000 people received outpatient services (no overnight stay required) in this period. More than 83 percent of those referred to a specialist were seen within the Government's six-month minimum standard.

In the year to 31 March 2001, over 124,000 patients received publicly funded emergency or elective treatment services compared with 118,000 this time last year. An increased number of patients were booked or given certainty of treatment in quarter three, in line with the Government's objectives for elective services.

Strict conditions have been set for the use of the abortion pill mifepristone, which has been approved for use in New Zealand. Mifepristone (also known as Mifegyne) contains the chemical often referred to as RU486.

Although Mifegyne has been approved as a prescription medicine, it will not be available for use by GPs or most other doctors. It will only be available to clinicians who are licensed under the Contraception, Sterilisation and Abortion Act to procure an abortion.

Unlike in some overseas jurisdictions, New Zealand restrictions placed on medical abortions require women to remain on the specially licensed premises until the abortion has occurred.

Lead maternity care practitioners will be paid more following a proposed reshuffle of maternity funding.

The proposed increases would cover services following the birth (29%), ultrasound scans (10.5% each), pregnancy care consultation (30% each), and travel costs incurred during postnatal rural home visits (36%).

There would also be a new fee for 15 or more postnatal home midwifery visits.

The Ministry is doing more policy work on publicly funded specialist services arrangements.

The price increase would encourage maternity practitioners to keep working in the sector.

In June the Minister of Health attended the United Nations General Assembly, sitting to consider the genuine global emergency issue of HIV/AIDS. In December 2000, it was estimated that 36 million people were living with HIV and 22 million had died from the disease. One in four women in their 20s in southern Africa is now HIV positive.

Whilst Oceania has, to date, escaped such high infection rates, this is no cause for complacency. Many small Pacific countries and SE Asian countries exhibit the same risk factors that led to an African pandemic.

The UN Declaration finalised at the General Assembly acknowledges that prevention must be the mainstay of the worldwide response. It was recognised that the keys to successful international, regional and national action are:

s
• trong leadership at all levels of society l
• eadership by government, complemented by full and active participation of civil society (especially community-based organisations) and the private sector
• realisation of human rights and fundamental freedoms for all, including people living with HIV/AIDS and vulnerable groups
• giving priority to vulnerable groups
• empowering women
• addressing HIV/AIDS in the context of sustainable development
• care, support and treatment as fundamental elements of an effective response
• recognising the need for action in areas affected by conflicts and disasters
• developing new and sustained resources for low and middle income countries
• maintaining the momentum and monitoring progress.

The UN Declaration can be accessed on: www.un.org/ga/aids/coverage/FinalDeclarationHIVAIDS.html