Speech from health minister Tony Ryall
 
Good morning and thank you for inviting me to open your 65th annual scientific meeting.
 
Since your first meeting when Mabel Howard was Minister of Health, there have been another 24 ministers serving on average two and a half years each.
 
During that time your specialty has changed a lot too… with new ways of treating and caring for patients: Smarter technology, smarter techniques and smarter use of the wider healthcare team. Even your specialty name has changed.
 
Today my comments will focus on important work the public health service is doing with you in elective services and faster cancer treatment.
 
Initially however I would like to take a few minutes to explain the context which this audience, the public at large, and our government, all have to work within to create and manage better health care.
 
Protecting and growing the public health service
 
Good health is hugely important to New Zealanders.
 
A strong public health service gives families peace of mind - knowing that the care they need will be there, when they need it.
 
And that's the priority of our government too.
 
Protecting and growing the New Zealand public health service.
 
We have spent the past four years repairing the damage of a decade of wasteful spending, never-ending bureaucracy and a lack of clinical engagement.
 
And we're making a lot of progress.
 
More patients are getting the operations they need, sooner. Our DHBs are employing more doctors and more nurses than ever before.
 
And there's a greater focus on preventing illness such as our immunisation and rheumatic fever programmes.
 
We've moved resources from the back office to the frontline. There are fewer managers and administrators.
 
We're harnessing the benefits of bulk purchasing. And our wards are becoming more productive and efficient.
 
But like health services around the world, we face two major challenges: one financial, the other demographic.
 
Our country faces a significant fiscal deficit and growing public debt.
 
Only four years ago the government owed $8 billion. Taking the sharp edges off the recession has seen that debt grow to $55 billion today. In less than three years' time, we expect that will peak at $72 billion.
 
To control that growing debt, the government is working towards a balanced budget in 2014/15. That means a strong focus on public spending, and getting the most out of every dollar.
 
Health is a fifth of all government spending so we in the public health service have an important role to play in that.
 
And you're well aware of the demographic challenge.  There are more of us, and we are living longer.
 
Around the world
 
Let's see how we compare around the globe.
 
Public health services are resorting to wide-reaching reforms, and significant funding cuts in an effort to manage growing cost pressures.
 
The Irish Health Service - serving a population the same as New Zealand - is about to make further cuts of about NZD 1.6 billion.
 
This follows a NZD 200 million cost reduction package earlier this year. 600,000 hours of home care have been cut. 6,500 health staff will go.
 
In England, up to a fifth of National Health Service hospitals are facing closures of emergency departments, maternity wards and paediatric units.
 
In Australia the New South Wales Health Ministry has been directed to make more than $3 billion in savings.
 
Local health districts will be required to find $775 million dollars in staff savings under what is called a "labour expense cap". A further $2.2 billion will be cut from the health bureaucracy over the next four years.
 
In September, the Queensland state government confirmed 2700 jobs would go from its health department before March next year.
 
Here at home, we have not escaped the world's worsening debt crisis. But our public health service is doing better than many other countries.
 
The National led Government has lifted health spending by around $2 billion over its four years.
 
However, as a fifth of all government spending goes into health, we need to ensure we are getting the most out of every dollar and provide New Zealanders with quality health care. We need to continuously improve effectiveness.
 
Increase in elective surgery and reduction in waiting times
 
We have made significant improvements for New Zealand patients.
 
This morning I would like to thank you for your contribution to our outstanding elective surgery results.
 
If we look back to the 2007/08 financial year 118,000 surgeries were performed - this financial year 153,000 elective surgeries were performed.
 
This means an extra 95,000 elective surgeries have been performed in the past four years compared with number performed under the previous Government. This includes an extra 6,800 ear, nose and throat procedures, including grommets
 
This is the result of an exceptional focus from everyone involved, including your front line teams as well as hard working staff in the DHBs and Ministry.
 
It is great for patients, and I congratulate you.
 
The challenge now is to lock in zero patients waiting over 6 months, and then bring the maximum waiting time down to 5 months by the end of June 2013.
 
Clinical leadership is again central to achieving this goal - and I'd like to re-state how seriously the Government values clinical leadership and clinical networks. 
 
Clinical prioritisation
 
Even though we are providing more care for patients, we are still working within finite resources.
 
That's why it is clinicians who decide which patients would benefit, and which individuals should get the services available.
 
Clinicians have led the work in developing national criteria to support this decision making.
 
The Ministry of Health is working closely with the professional colleges to develop and implement better clinical prioritisation systems.
 
I'd like to thank your Society and its representatives for developing the new prioritisation criteria and systems for Otorhinolaryngology (ORL) surgery.
 
The efforts to date on the new ORL CPAC tool represent a considerable amount of energy and leadership from the Society and, in particular, the members of the working group.
 
The development of the tool has been completed and trial sites are preparing to begin using the new tool.
 
This is about making sure we get good and relatively even access to ORL services for all New Zealanders, regardless of where they live.
 
This is where implementation of prioritisation tools is so important and it cannot happen without leadership from yourselves and your colleagues. 
They work if clinicians use them.
 
Consistent use of clinical prioritisation tools will also help services further reduce waiting times for elective surgery. 
 
Faster Cancer Treatment
 
The Government has put a lot of effort into improving cancer treatment services in New Zealand.
 
Over the past four years resources have moved to support faster radiation treatment with ten new linear accelerators, with waiting times now at the world gold standard.
 
Chemotherapy waiting times are now part of the National Health Target for faster cancer services too.
 
And in this year's Budget we delivered an additional $33 million over the next four years for better and faster services for cancer patients.
 
This includes funding for dedicated nurses who will coordinate care and support for individual patients throughout the course of their cancer treatment.
Being diagnosed with cancer is a very difficult time for patients and their families. This more personalised service will mean better treatment and a little less stress for patients.
 
Research shows some cancer patients can come into contact with up to 28 doctors and even more nurses throughout their treatment.
 
The new dedicated cancer nurses will act as a single point of contact and assist patients and their families across different parts of the health service.
This expands what is already happening in parts of the country and feedback from patients has been excellent. 
 
We're also working to further reduce waiting times throughout a patient's treatment.
 
Patients want fast access to a specialist once cancer is suspected and then fast access to treatment once there is a confirmed diagnosis.
 
Many of you will be aware of Britain's 62 day maximum wait from when a patient first sees their GP with a high suspicion of cancer to when the patient gets their first treatment.
 
This 62-day standard also includes all patients referred from NHS cancer screening programmes (breast, cervical and bowel) and all patients whose consultants suspect they may have cancer.
 
There they aim for patients to wait no more than two weeks to see a specialist. And to wait no more than 31 days from the decision to treat to their first treatment.
 
In parts of Canada it's a 60 day maximum all up.
 
Clearly, many patients here start their first treatment much sooner than 2 months after first suspicion of cancer. 
 
But for many others that journey takes longer as they wait to see a specialist or wait for a diagnostic test or scan.
 
We are putting in place the building blocks so that the public health service in a few years' time could give cancer patients a similar undertaking … a maximum time to see a specialist and a month maximum to start treatment.
DHBs started in July collecting data at key points along the patient's clinical journey.
 
Standards for quality and timeliness have already been established for lung cancer treatment.
 
Thank you for the contribution your Society is making to standards for the head and neck cancer stream.
 
I expect the draft standards will be out for consultation early next year.
This helps us better understand: the path patients follow, and constraints to the service, and quality benchmarks, and the options to change the way things are done.
 
The more we know, the better we can identify issues that lead to delays and frustrations for patients.
 
For example, instead of a patient visiting hospital on multiple occasions for different tests, departments should coordinate appointments so they are all completed in one day. You can see the obvious role for the cancer co-ordination nurses we have funded.
 
And you can also envisage specialist nurses supporting you and your anaesthetists with some pre-surgical assessments and maybe post-operative follow up as some other specialties already have.
 
On cancer prevention, we remain firmly ahead of the international scene with the turning point this Government has created in the campaign against tobacco.
 
No other government has taken as swift and as effective action to tackle this cause of so many of the cancers you treat in your work.
 
3DHBs
 
Since you are in Wellington, can I acknowledge your local members who are actively involved in the new partnership across the Wellington, Hutt Valley and Wairarapa DHBs.
 
Salaried medical specialists in these DHBs are working positively and proactively to improve patient care by working across geographic boundaries to provide unified services, including in ORL/ENT.
 
This 3DHB approach is a significant step forward. It has strong clinical engagement and leadership. One of the region's most senior salaried medical specialists described it as an early Christmas present for clinicians.
 
Conclusion
 
Your scientific meeting looks very interesting. You have a very impressive line -up of speakers.
 
It is indeed also impressive to be celebrating your 65th annual scientific meeting.
 
Back in 1947, tuberculosis was running rife with 40-50 cases reported each week and 2 to 3 people dying of the disease here every day.
 
Mabel Howard's efforts to control the disease were overtaken by greater access to new drugs and surgical techniques.
 
Medicine changes a lot. And it's great that your profession is such an active part of that ongoing change.
 
Many people think the world debt crisis is likely to get worse. That means health expenditure will be under more pressure in most of the world, especially Britain, Europe, and USA.
 
It will be tight here too. But we are doing comparatively better.
 
Over the next three years, our economic growth rate is in the top quarter of the developed world. 
 
And John Key's government will continue to invest more into protecting and growing our public health service.
 
Thank you for what you do and I wish you all well.