In the spotlight today
Hon Peter Dunne's Speech to NZ Healthcare Summit – 2009-10-07 10:16:59.072
Sky City Convention Centre
Wednesday, 7 October 2009 at 9:00 am
Thank you for inviting me to speak at this Healthcare Summit.
I am delighted to see so many who are involved in providing and managing health care resources come together to discuss some of the key issues for the future direction of health care in New Zealand.
Debate about the direction of the health system is one of the great constants in a country like ours.
Other issues are no less pressing, but the state of our health services is always uppermost in the public’s mind, and so it should be.
Health care systems the world over are caught increasingly in an elaborate pincer movement.
On the one hand, there are the challenges imposed by an ageing population, an increasing demand for new technologies and medicines, falling hospital productivity, staff shortages, and the demands of maintaining sustainability, which place considerable pressure upon governments and health care providers from a funding and resourcing perspective.
And on the other hand, an ever better informed and discerning public not only knows what it wants and needs, but also expects to get it.
The upshot is hardly surprising – we all want our health care system to achieve more than just meeting the challenges it faces.
So we properly wrap this up by demanding that our health care system strives towards achieving excellence.
Now that may sound like just one more noble statement, but it is not meant to be.
You see, unlike many other areas, health care systems, while affected by, are not really any respecter of economic crises.
The public expectation is that health care systems will be always improving, always doing better, always striving for excellence, no matter what the external circumstances.
In many senses, governments face an almost impossible task – reconciling the insatiable demand for services and the very real constraints on the resources to provide those services.
So, how this can possibly be achieved?
I suggest the mechanism is via cross-sector collaboration and stakeholder engagement with a common strategic direction, while working within structures and systems that perform well together.
That is quite a mouthful – some might even call it healthspeak jargon.
But it is appropriate, given the complexities around healthcare.
Let me break it down a little further.
In one sense what we have to deliver is very simple – efficient and quality healthcare, for those who need it.
We know and understand that, and there would be little disagreement with the goal.
But our shared experience indicates that the getting there is not always that easy.
Although we all know almost instinctively what the end we are all aiming for, we are not always that good when it comes to setting out clearly our objectives, and how we are going to get there.
Therefore, it is now more important than ever that key industry players, such as you here today, have a coherent, cohesive and strategic approach when working towards meeting the challenges facing our health care system.
We need to acknowledge the parts of our healthcare system that are doing well, identify areas for improvement and work strategically towards making our system better able to cope with the demands we are facing now and in the future.
And we need also to recognise that while health care systems will more than likely be predominantly publicly funded and provided, there is an increasing role for the private sector, to supplement the work of the public health system, and in some cases to take on a primary responsibility for the provision of certain specialist aspects of healthcare.
Lest anyone suggest to the contrary, that is not intended as an ideological statement, but a simple recognition that in an increasingly complex and financially stressed area, partnerships between various providers to deliver key services, albeit under the ambit of a public health system, are simply inevitable.
Central to this theme, is the role medicines play in our health care system.
Medicines are used in many situations throughout the community and hospital setting to treat New Zealanders with a wide range of diseases and conditions.
It goes without saying that they make significant contributions to the health outcomes of many New Zealanders.
For this reason, it is crucial that we do not make the mistake of looking at the use of medicines in New Zealand in isolation from the rest of the health care system.
For too long, in my view, we have viewed medicines as being at a distant end of the healthcare spectrum, rather than a critical part of the continuum of treatment and care.
It is no longer a case of if all else fails, medicate.
Medicines are increasingly an active treatment option, rather than essentially palliative or curative.
It was against this background that I pushed for the development of a national medicines strategy during the term of the previous government, and why I am delighted it has been embraced and given fresh life under the current administration.
Put simply, Medicines New Zealand – the New Zealand medicines strategy – arose from the need for a more coherent approach to the use of medicines within our healthcare system.
Our historic approach had been focused heavily on cost-containment, to curb the burgeoning level of pharmaceutical expenditure in the 1980s and early 1990s.
That was valid as far as it went, but by the early years of this century its limitations were becoming obvious as more and more new, innovative and invariably expensive medicines started coming down the pipeline, and our ability to deal with this was increasingly seen as relying solely on managing costs, rather than achieving good patient care.
I have driven the development of Medicines New Zealand because it is an absolutely crucial component of our future approach to health.
I t is a vital cog in making sure New Zealanders get the most possible benefit from their medicines system.
By this I mean that they get:
medicines that are safe, of high quality and effective,
that New Zealanders have access to the medicines they need, regardless of the individual ability to pay through the government funding provided,
that medicines are used in the best way possible to result in optimal health outcomes.
The strategy is also premised on developing a medicines system that is as transparent and understandable as it can be.
Complexity and opaqueness are not virtues!
Such transparency is necessary so all stakeholders in our medicines system are aware of how funding and prioritisation decisions are made.
New Zealanders must feel secure that our medicines system is fair – even if they do not always agree with the decisions that have been made about particular medicines.
This is especially so in a climate where patients are far more likely than ever before to have looked up their condition on the internet, and discovered there the medicines best suited to their treatment, long before they visit their GP or pharmacist.
And their self-diagnosis is probably right!
Against that background, we will not satisfy them that the decision made about funding a particular medicine is the right one in the circumstances if
the reasons behind decisions are not clearly presented.
The old excuse that these medicines may well be available elsewhere, but are not in New Zealand, does not wash any more.
Our population is more demanding than that, and our system has to develop better ways of responding, within the overall budget constraints that apply.
In recognition of this, one of the actions under Medicines New Zealand is for DHBs and Pharmac to move to a principles-based approach for setting the community pharmaceuticals budget.
This is an approach which aims to maximise health outcomes across pharmaceuticals and other health services.
The intent is that decisions about the overall level of spending on community pharmaceuticals should come from a comparison against other health spending, rather than as residual expenditure when all other funding has been allocated.
More often than not, to date, the community pharmaceuticals budget has been determined by the amount left in the health pot when everything else has been considered, rather than on the basis of realistic need.
The days of that ad hoc approach have gone, and we need a much more integrated approach.
As I said earlier, medicines need to be seen as an integral part of the health system, not just an add-on.
And it was a recognition of this that led the Government to set aside special funding in the Budget this year for high-cost medicines, and to establish a special review group to make recommendations about the best way to address this problem in the future.
We are moving to a different stage in medicines policy in this country.
The previous emphasis which, as I have said, was solely on cost containment of the community pharmaceutical budget and was appropriate for the conditions of the 1980s and 1990s, arguably served us well.
However, today’s emphasis has to be broader.
Cost containment, and getting the best deals for New Zealanders in terms of the particular medicines available will continue to be a strong focus, but so too must be meeting the demands posed by the range of new, innovative, and invariably expensive preparations that are becoming available, more and more rapidly, including the needs of patients.
This has many aspects from managing public expectations about what can be reasonably funded, through to the increasing pressures placed on our professional experts to determine genuine clinical efficacy of a product, rather than simply responding to the latest fad, and the implications for the relative roles of pharmacists, doctors, and nurses, in both prescription, dispensing, and patient management.
In short, our challenge is to ensure that
New Zealanders are able to understand and access information about our medicines system including, where appropriate, information about funding decisions and prioritisation.
Ultimately, Medicines New Zealand and the actions that are occurring beneath it will make a significant contribution to our health care system.
I am delighted at the strong support Medicines New Zealand has received from many quarters: the government, district health boards, pharmacy and general practice, patient groups and the pharmaceutical industry.
As part of our healthcare industry you have a role to play in cross sector collaboration, ensuring structures and systems work well and maintaining a system capable of meeting future demands.
I am committed to building on Medicines New Zealand, and moving it forward.
To that end, I am currently reviewing the Action Plan that sits under Medicines New Zealand, with a view to ensuring that it remains current, and focuses on actions that will best achieve the outcomes of safety and quality; access; and optimal use.
Therefore, against that backdrop let me assure you of the high value I personally – and the Government – place on your skills and your contribution to the well-being of New Zealanders.
I wish you the best for this Healthcare Summit.