Minister of Health Tony RyallThursday 13 September 2012, 4:23PM
Speech from minister of health Tony Ryall
It is a pleasure for me to join you today here in Wellington for
your 20th national diabetes nurse specialist symposium.
I would like to thank the diabetes symposium planning group, in
particular Lindsay McTavish and Lorna Bingham, for the invitation
to speak to you about what we are doing to support children and
adults with diabetes.
In my brief comments today I would like to touch on: the priority
that the government gives to diabetes as one of our six national
health targets, the diabetes care improvement programme, and action
on unhealthy weight including a new emphasis on maternal and
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 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
And we're making a lot of progress.
More patients are getting the operations they need, sooner. Our
district health boards (DHBs) are employing more doctors and more
nurses than ever before. And there's a greater focus on preventing
illness, and the wider determinants of health.
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.
You're well aware of the challenge that non-communicable diseases
(NCDs) present health services around the globe. NCDs include
long-term conditions such diabetes, cardiovascular disease, asthma
and common cancers.
These are a major cause of disability and suffering. And you
know the lifestyle factors behind these diseases.
There's widespread agreement that current health services are not
well-placed to deal with a world where non-communicable diseases
account for most of the disease burden.
That's because our health services were developed for generations
when communicable diseases accounted for most of the disease
burdens - leading to systems based on episodic, disjointed and
hospital based care.
So, like the rest of the world, New Zealand's health service is
tackling the challenge of re-orienting care towards the on-going
support and treatment of patients with long-term conditions, in the
community, closer to home.
In constrained financial times, health services need to select and
well implement a few targeted interventions that will best support
the objectives of better health and affordability.
National Health Target
The government has selected a discrete number of high impact, high
return preventive health targets: immunisation, smoking and heart
Cardiovascular disease (CVD) includes heart attacks and strokes -
which are both substantially preventable with lifestyle advice and
treatment for those at moderate or higher risk. The indicator
monitors the proportion of the eligible population who have had a
CVD risk assessment (including the blood tests to screen for
diabetes) in the preceding five year period.
Substantial effort is going into this screening approach because
we know it works. Around the country DHBs and PHOs are working to
support general practices to improve the amount of screening and
the resulting follow-up and patient support and management.
Diabetes Nurse prescribing
The Government is continuing to support the managed national roll
out of the Diabetes Nurse Specialist project. This follows a
successful first trial in 2011 where Health Workforce New Zealand,
in collaboration with the New Zealand Society for the Study of
Diabetes (NZSSD) established the diabetes nurse specialist
prescribing project to demonstrate the effectiveness and safety of
diabetes nurse prescribing. This involved 12 diabetes nurse
specialists at four DHBs.
Diabetes nurse specialists operate with a high degree of autonomy
with significant responsibility for the delivery of diabetes
services, and having responsibility for prescribing common
medicines for people with diabetes, under supervision and in
partnership with medical practitioners, is a natural extension of
their current role.
The evaluation undertaken demonstrated the success of the role of
the diabetes nurse specialist. Prescribing by diabetes nurse
specialists resulted in improved continuity of care for patients,
reduced the need for separate appointments for routine
prescriptions and reduced pressure on medical staff.
The second stage of the managed roll out is underway with the
NZSSD currently seeking registrations of interest for up to a
further 20 additional nurses across a maximum of six sites
interested in participating in the Diabetes Nurse Specialist 2012
Managed National Roll Out Project.
Diabetes Care Improvement Package
This time last year, following a review of the diabetes Get
Checked programme, we announced there would be changes made to the
way we support New Zealanders with diabetes.
The Get Checked programme was criticised by many patients and
clinicians as being more about box ticking than improving the lives
and clinical outcomes of those living with diabetes.
The review cites a study that showed the programme reduced blood
glucose levels by just 0.13 per cent which was described as
clinically disappointing. It also found that the programme added
little clinical value to existing general practice.
So, we ring-fenced the budget and asked DHBs and primary care to
work together to design localised responses to best support people
with diabetes. Our aim is a localised, integrated approach to
delivers clinical improvement.
Initiatives differ between DHBs, depending on the needs in their
communities. However many DHBs have chosen to deliver services
through innovative nurse-led services.
For example, diabetes nurse specialists from Hawkes Bay DHB are
mentoring primary care nurses with the goal of developing a
speciality level of knowledge and skill in primary care.
Nelson Marlborough DHB is co-locating diabetes nurse educators
within general practices to support primary care teams to deliver
Capital and Coast DHB aim to have 80 per cent of general practices
in their area receiving direct diabetes nurse specialist support by
the end of the year.
Thank you to everyone who has participated in the local
discussions around the improvement programmes. It's not been easy -
change never is.
Action on Unhealthy Weight
Physical activity is one of the keys to a healthy life. And it can
benefit New Zealanders of all ages. Amongst a host of health
benefits, physical activity reduces the risk of heart disease,
several cancers and unhealthy weight.
The benefits to patients from following a green prescription for
regular exercise can't be denied. 73 per cent of patients given
such an entreaty to exercise noticed improvements six and eight
Last year, GPs and practice nurses issued 32,000 people with a
green prescription to become more physically active - an increase
of almost 6,000 on four years ago.
Research shows young New Zealanders are much less active than they
were twenty years ago.
KiwiSport is a government funded initiative to promote sport for
school-aged children. Launched by the Prime Minister in August
2009, it provides an $82 million sporting boost over four years to
be invested in school-aged children.
The Education Review Office tells us schools are reporting
increased student participation in organised sport. Schools are
rapt with the flexibility they've been given to get their kids more
active and in better health.
Food-free advertising zones doubled
This Government works constructively with commerce in a number of
ways including improving public health. One such example is last
year's increase in the number of hours of food advertising
restrictions during children's television time.
The total restricted and advertising-free zones per week across
the three major free to air TV channels has more than doubled under
this Government to 101 hours and 30 minutes a week.
This is far more than the previous government could ever achieve.
And together with several other initiatives including numerous
nutrition promotion efforts adds up to a strong contribution to
discouraging unhealthy weights.
Gluckman report recommendations
Each year the Government spends many millions on prevention
programmes to reduce unhealthy weight and improve healthy
We've been keen to ensure that our resources focus on the areas
where we can make the best long-term investment. So, we've been
working with the Prime Minister's Chief Science Advisor Professor
Sir Peter Gluckman.
Professor Gluckman suggests that pre-conditions for obesity are
set very early and the best intervention point is maternal and
He suggested six areas of additional emphasis:
women's pre-conception health
healthy weight gain and fetal growth during pregnancy
• screening for
• providing advice
• providing advice
In light of this advice, we have reviewed the services the
Ministry currently fund and agree there is an opportunity to do
more to improve healthy weight gain and nutrition education during
pregnancy and improve nutrition education and support for babies,
infants and pre-schoolers.
A number of public health contracts are and will be expiring over
the next few years and this money with be reprioritised towards
this priority. A Request for Proposals (RFP) for services
will be issued shortly.
This funding is in addition to what the government invests in
programmes such as KiwiSport, Green Prescriptions and Fruit in
There is opportunity to deliver our programmes in a different way
and leverage other funding sources and resources to deliver
nutrition advice and education support to mothers and
Through the RFP process we will look for providers to form
alliances and where appropriate involve others including
We will also be exploring options for using our existing maternity
services, Well Child, whānau ora and school-based health services
to provide advice and support that better enables women and
newborns in this area of focus.
The recently established Health Promotion Agency (HPA) will play
an important role in ensuring that the various health services
women use have access to consistent and easy to use material about
the importance of good nutrition.
Another area the Ministry has identified we could make
improvements is providing better support to our health
There are currently no guidelines in New Zealand to guide
practitioners on how women can best manage weight gain during
pregnancy. The Ministry of Health will be developing guidelines
which can then be used by our maternity services.
The Ministry is also developing evidence-based clinical practice
guidance for health professionals to assist in the diagnosis and
management of gestational diabetes. These guidelines and a summary
resource will be finalised by end of next year.
Gestational diabetes is more common in Maori and Pacific women. A
current Ministry project, due to be completed by February 2013,
will advise on how young Māori women and their families can be
better informed about screening for and management of the
This is an exciting time for diabetes services in New Zealand and
I am sure that with your support and clinical expertise we will be
able to reduce the rates of obesity and diabetes in New