The New Zealand Health Strategy

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Date of publication: December 2000This is the full text online version of this document. You can also download this publication in PDF format.

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Appendix 2: Other Strategies

Two key strategies set the overarching guide for the development of health and disability services in New Zealand. These are the New Zealand Health Strategy, covering health related issues, and the New Zealand Disability Strategy, which covers disability issues. These strategies will guide the way other, more detailed service, health issue or population group specific strategies and/or action plans are developed and carried out.

The process of strategy development and achievement is ongoing rather than static. At any given time, there are usually strategies that are actively being followed, some that are near completion, and others that are just being developed. The Ministry of Health has several strategies in these various stages at present. Most strategies remain in place until they have been achieved. Others are time limited that may be revisited so a more updated version may be produced.

This section briefly describes strategies that will be developed to help implement the New Zealand Health Strategy.

It also lists existing strategies that form part of the New Zealand Health Strategy.

Planned strategies

The New Zealand Disability Strategy

One in five New Zealanders has a long-term disability. This prevents many from reaching their full potential or participating fully in the community. The aim of the Disability Strategy is to eliminate these barriers wherever they exist.

The Disability Strategy discussion document proposes a vision of a non-disabling society that will enable people who have experienced disability to feel that their capacity to contribute and participate in every aspect of life is continually being extended and enhanced. To advance this, critical action will be needed in several areas.

Those areas include: ensuring rights providing the best education and opportunities for employment and economic development fostering an aware and responsive public service improving services and access to information for people with disabilities promoting the participation of Māori and Pacific peoples experiencing disability valuing families, whanau and carers.

The Strategy will set out ways these objectives can be achieved.

Cabinet has agreed the decision to move the Disability Support Services role to District Health Boards will not be made until the Disability Strategy has been decided. Consultation on the discussion document on the Strategy is occurring in late 2000. A final Strategy will be completed in early 2001.

The New Zealand Primary Health Care Strategy

The Minister of Health released The Future Shape of Primary Health Care, a discussion document on the proposed new Primary Health Care Strategy in March 2000. Over 300 written submissions, many from primary health care providers, were received and 54 meetings were held.

Final advice to the Government on the Primary Health Care Strategy is now being prepared. A Sector Reference Group has been set up to help prepare the final advice. At this point, its proposals are:

• primary health care should be recognised as an integral part of the country’s health system

• District Health Boards will have agreements with Primary Health Organisations for a set of services to an affiliated population within a budget

• Primary Health Organisations will be not-for-profit, involve the community and a range of providers, and develop Māori health plans

• Primary Health Organisations must at a minimum supply health improvement, disease prevention and general first contact services but may become more comprehensive in time

• primary health care services by and for Māori people are important and need separate support and specific capacity-building

• primary health care services by and for Pacific peoples are important and need separate support and specific capacity building

• quality and workforce developments will be essential

• transition to the proposed system will be evolutionary and voluntary, starting with willing organisations in high need areas, and building on existing agreements, relationships and initiatives

• Primary Health Organisations will need to demonstrate good working linkages with public health service providers, hospital services, and non-health sector agencies particularly with respect to their contribution to action on the key New Zealand Health Strategy priorities.
  
  It is vital for Primary Health Organisations to contribute to better co-ordinated programmes to improve the health of the communities they serve and contribute to reducing health inequalities for all New Zealanders, including Māori and Pacific peoples.

Palliative Care Strategy

Until recently, New Zealand has taken an ad hoc approach to the funding and provision of palliative care.

However, from 1997 onwards, the National Health Committee and the Health Funding Authority commenced projects on palliative care and hospice funding.

That work culminated in an interagency project involving the Ministry, Health Funding Authority and National Health Committee and the production of a discussion document, The New Zealand Palliative Care Strategy, which was released in July 2000. This Strategy is currently being redeveloped in the light of the analysis of submissions.

The Strategy will seek to build on current service arrangements but will also create an environment that:

• is needs based

• is responsive to people’s decisions to die at home

• ensures people receive a co-ordinated approach to care.

Māori Health Strategy

The Māori Health Strategy will provide strategic direction and guidance to the sector in implementing the commitments in the New Zealand Public Health and Disability Act.

In acknowledging the special relationship between Māori and the Crown under the Treaty of Waitangi, the health sector will face expectations that extend beyond just improving Māori health and those which have been included in the New Zealand Public Health and Disability Act.

Those expectations will centre around ensuring participation of Māori in decision making on health issues and the delivery of health services and providing opportunities for Māori to meet their aspirations for wellbeing.

As part of the New Zealand Health Strategy, District Health Boards will have to take the Māori Health Strategy into account when developing their strategic district plans and meeting their Māori health objectives and functions. The Māori Health Strategy will:

• build on and further develop the high level health principles, goals, objectives and priorities relating to Māori health in the New Zealand Health Strategy

• provide a means to co-ordinate other work such as the intersectoral work on reducing inequalities and Māori capacity building initiatives, and the primary care, mental health, public health, disability support and other health and disability sector initiatives.

Māori and the wider public will be consulted before the Strategy is finalised. A public discussion document will be published early in 2001 to facilitate consultation, with the final Strategy due for completion in June 2001.

Pacific Health and Disability Action Plan

The Ministry of Health, together with the Ministry of Pacific Affairs and the Pacific health sector, is developing a Pacific Health and Disability Action Plan to help ensure these aims are achieved. The Plan will focus on the principles of the delivery of Pacific peoples’ health by Pacific providers wherever possible.

This will include the following components:

• public health programmes, utilising health promotion and health protection strategies, to address key issues such as childhood infectious disease, diabetes, heart disease, obesity, women’s health, family planning, and injury prevention

• primary care programmes to improve access to quality services for Pacific peoples, especially in areas where they work and live. These will include Pacific provider development support and will focus on improving prevention programmes (for example, well child services) and ensuring they are well co-ordinated with culturally competent, community-based services with leadership by Pacific peoples

• improved specialist services based in the community for key Pacific health issues such as diabetes, ophthalmology, asthma, paediatrics, mental health, and maternity services. These will be well co-ordinated with other types of services for Pacific peoples

• training and support to increase the Pacific health workforce, in liaison with the education sector

• research

• collection of quality Pacific health information

• more culturally competent services delivered by mainstream providers

• more focus on services for Pacific by Pacific.

A first draft of the Plan is being consulted on and there will be a report back to the Minister by the end of December with a draft implementation Plan. The Strategy will be completed by February 2001 for sign off by the Minister of Health.

Health of Older People Strategy

New Zealand’s population continues to grow larger and older. The proportion of the population aged 65 years or over is projected to double over the next 50 years. Those population changes will have a significant impact on health spending and economic growth. In particular, the aging population will require more health care and disability support services.

Most older people prefer to remain in their own homes for as long as they can, but there has been increasing concern over recent years about the fragmentation of health and disability support services for older people and rising rates of admission to long-stay residential care. The Government is developing a Health of Older People Strategy to address these concerns.

The Strategy’s primary aim is to set in place a comprehensive framework for planning, funding and providing preventive, acute and long-term care for older people. It will have a strong focus on integrating services to provide a continuum of care for older people as their needs change over time.

The Strategy will address the health sector implementation of the Positive Ageing Strategy. It will cover a range of health and disability support services for older people and family carers, including health promotion, disease prevention and personal and mental health services at the primary, secondary and tertiary level. The Strategy will provide practical guidance for District Health Boards.

Cabinet is due to consider the Positive Ageing Strategy and its action plans, including a health action plan in February 2001. A draft of the Health of Older People Strategy (which expands on the health component of the Positive Ageing Strategy) will be provided to the Minister for consultation purposes in the winter of 2001.

Youth Health Strategy

The Ministry of Health and Ministry of Youth Dvelopment will be developing a comprehensive Youth Health Strategy for the Government.

While the health of young people is better than that of most age groups, there are significant areas of concern. These include the rates of suicide and attempted suicides, sexually transmitted diseases (STDs) and unintended pregnancies. Young Māori and Pacific peoples have higher rates of unintended pregnancies, suicide and STDs than other New Zealanders. An increase in their health status is vital to assist in reducing inequalities.

Areas the Strategy will focus on include:

• further development of intersectoral work to reduce the rate of youth suicides and suicide attempts

• developing mental health programmes that focus on wellness

• improving the range of accessible and appropriate services for youth, for example, one stop shops and Youth Health Centres

• increasing the range and number of Māori services for youth

• increasing the range and number of Pacific peoples’ services for youth

• encouraging greater co-ordination between different health care providers working with youth and between health sector providers and other agencies whose services affect the health of youth.

New Zealand Health Knowledge Strategy

In an international context, New Zealand is seen as one of the leaders in developing and using health information. The National Health Index (the unique personal identifier for health), the Health Intranet, the extent of electronic health messaging such as electronic results from laboratories to general practitioners, and the general level of information technology penetration in health services are some of the features which put New Zealand in advance of many health systems.

Health systems around the world are shifting their view of the value of health information management and technology from one of administrative cost to one of strategic investment. Information and the technology used to gather, store and disseminate knowledge are fundamental in the provision of effective health and disability support services.

It is increasingly understood that the ability to exchange quality information between partners in health care is vital for the achievement of improved health and disability outcomes important to New Zealand. This can be achieved through, for example:

• empowering individuals and their families to manage their own health better, for example through the provision of consumer health information

• improving the co-ordination and integration of care delivery to and support of the individual, for example by accessing critical information during emergency care

• allowing population health initiatives to occur in timely fashion.

The existing Health Information Strategy was launched in 1996. Many of the directions it signalled and the principles it espoused remain relevant. However, the development of the New Zealand Health Strategy and New Zealand Disability Strategy, rapid uptake of new technology (such as TCP/IP), and the redesign of the health and disability sector, necessitate the need for an update.

The vision for the proposed Health Knowledge Strategy is ‘all the accurate information you could possibly want (and which you are allowed to have), when you want it, and how you want it, to ensure quality care’. The Strategy will provide a list of principles and philosophies to form a set of ‘ground rules’ to help give this vision meaning.

The Ministry of Health, predominantly through its information group, the New Zealand Health Information Service, will be responsible for overseeing the implementation of the New Zealand Health Knowledge Strategy. A discussion document will be completed by January 2001. This will be followed by a consultation round, and the final Strategy will be completed in mid-year.

Oral Health Implementation Plan

Diseases of the teeth and gums are among the most common of all health problems and are experienced by all New Zealanders at some stage of their life. However, public dental services in New Zealand have been under pressure over the last 10 years. Reorganisation has led to fragmentation, and work pressures have meant some child and adolescent dental services have not maintained the levels of access and the provision of preventive services that were available in the past. The Government has therefore developed an Oral Health Implementation Plan.

The key deliverables of the Government’s oral health implementation plan are to:

• re-establish a nationwide dental health system for children and adolescents

• allow dental therapists to perform a greater range of services

• upgrade the training of, and introduce registration for, dental therapists

• investigate greater access to assisted dental care for low income adults

• review the Dental Benefit Scheme

• review the Dental Act 1998.

The Government is placing particular emphasis on the school dental service as the cornerstone of oral health services to children and adolescents and in raising oral status and reducing inequalities within this group. The Government is also interested in extending access to fluoridated water supplies, as it is the most effective method of avoiding tooth decay on a community basis.

Initiatives currently under way by the Ministry of Health include:

• the establishment of a Technical Advisory Group to define appropriate clinical standards and the mix and level of services to be provided by District Health Boards

• the establishment of a Technical Advisory Group to provide advice on the registration, discipline, employment arrangements and range of services provided by dental therapists

• contracting an independent review of the Dental Benefits Scheme. This review will advise on the difficulties associated with the present scheme and on ways of improving it.

Sexual and Reproductive Health Strategy

The Ministry of Health is commencing work to develop and implement a comprehensive Sexual and Reproductive Health Strategy. The Strategy will include:

• sexual and reproductive health services as a public health service

• a comprehensive free specialist sexual health service close to the community

• sexually transmitted disease control to ensure that at-risk groups have access to effective education programmes

• disease control of HIV/AIDS as a sexually transmitted disease

• an emphasis on effective and available services for Maori, Pacific peoples and young people.

Initial work will include: a stocktake of sexual and reproductive health services; a literature review of programme effectiveness for sexual health services (with particular reference to access to services, and including culturally appropriate services for Māori and for Pacific peoples);and a summary of service evaluations undertaken in the previous five years. This information will be provided by the end of December 2000. Strategy development will begin early 2001.

Project teams have been established to manage the process and strategy development.

Existing strategies

Intersectoral strategies (involving health agencies)

• Strengthening Families Strategy (joint Health/Education/Welfare led)

• New Zealand Youth Suicide Prevention Strategy (Health led)

• National Drug Policy (Health led)

• National Road Safety Plan (LTSA led)

• Pacific Vision Strategy (Ministry of Pacific Island Affairs led)

• Crime Prevention Strategy (Ministry of Justice led)

• National Civil Defence Strategy (Ministry of Emergency Management led).

Health issues and services strategies

• The Health and Wellbeing of Older People

• Child Health Strategy

• National Strategic Plan for Māori Health 1998–2001

• Whaia Te Ora Mo Te Iwi

• Tobacco Strategy

• Hepatitis B Strategy

• National Prevention and Control Strategy for Meningococcal Disease

• Physical Activity Joint Policy Statement

• Strategy for Prevention and Control of Diabetes

• National Strategy for Mental Health Services – Looking Forward/Moving Forward

• Blueprint for Mental Health Services

• BreastScreen Aotearoa

• National Cervical Screening Programme Policy

• Strengthening Public Health Action

• Roadside to Bedside: A 24-hour Clinical Integrated Acute Management System for New Zealand

• Health Information Strategy for the Year 2000.

Other work arising from the New Zealand Health Strategy

A range of other strategies and other developments are currently in the early stages. These include:

• the establishment of a Ministerial committee to consider complementary health care

• the establishment of a Ministerial Health Workforce Advisory Committee

• a health needs assessment of refugees, asylum seekers and Asian immigrants

• a work programme for a Cancer Control Strategy.