Speech to NZ Emergency Departments Conference, Taupo

Hon Dr Jonathan Coleman

Minister of Health

31 October 2014

Thank you for inviting me to speak with you at this conference.

I am really looking forward to the challenges of the health portfolio.

Prior to politics I worked in general practice and spent a bit of time in EDs earlier in my career.

I’m pleased to be here today to hear your views, and look at how together we can make the best use of resources, people, facilities and funding.

It is vital that patients are at the centre of our health system, and receive the healthcare they need.

My predecessor the Honourable Tony Ryall, spoke at your last six conferences, and I know that a lot has changed in the past seven years.

Seven years ago, there was a great deal of concern around the country about overcrowding in emergency departments. The newspapers were full of stories about people languishing in ED corridors.

Everyone, patients and staff alike were all too often finding emergency departments an unpleasant and stressful place to be. EDs are of course by their very nature still a place of urgency and at times, stress.

Over the past three weeks I have embarked on a DHB tour – visiting a number of EDs.  And what’s struck me during these tours is that the atmosphere feels substantially different to a few years ago.

I’m struck by the physical reconfiguration of some EDs which is reflected in the reconfiguration of how services are offered. Across the country EDs are vastly improved environments for staff and patients thanks to the hard work of all of you and your colleagues.

As a doctor I know the value of clinicians in helping to drive progress in the health system and this improvement has come about because of all your hard work.

As I have met with the Chairs and CEs of various DHBs I have been quick to stress the importance of clinical involvement. Boards need to be engaging with the doctors, nurses and Allied Workforce.

It might sound trite, but I want the health sector to move towards a “team health” approach – one which sees everyone rowing in the same direction.

Shorter Stays in ED target
I think that you’ll agree, the shorter stays in emergency departments health target which was introduced in July 2009 provided much of the impetus to focus attention on improving acute services.

The target is for 95 per cent of patients to be admitted, discharged or transferred within six hours.

It’s probably fair to say that initially achieving the target was a bit of a struggle. The first quarter’s results in 2009 showed that national performance on the target was 80 per cent. 

Compare that to the latest figures for quarter four 2013/14 which show that our national performance is now 94 per cent which is a 13.8 per cent improvement nationally since the target began.

In 2009/10 only six DHBs were meeting the target, and now 11 DHBs are there. That’s something to really celebrate.

Many of you have achieved these excellent results despite increasing demand on the work of emergency departments. Figures show that the numbers of presentations to emergency departments have grown from just over 230,500 in quarter one 2009/10 to around 265,800 in quarter four 2013/14.

That’s a huge increase of over 35,000 (actual 35,269) more presentations. As I have been visiting DHBs up and down the country it is clear that acute presentations this winter have felt significantly worse than previous years and have included more complex cases.

Many DHBs have commented that patient management has improved in relation to the time patients spend before their issue is addressed. I imagine the situation would have been much worse had improvements to acute patient flow not been addressed.

The health target is a whole of system measure and not just an ED problem, and goes to show that there is greater buy-in from your colleagues outside the emergency department in delivering quality healthcare and experiences of those accessing emergency department services.

I consider the achievement against health targets has been one of the best drivers of change over the last five years, and we are fully committed in continuing with the current ‘shorter stays in emergency departments health target’.

Achieving targets is not an end in itself of course, but they are a barometer of how well the acute care system is functioning and give us a chance to step back and to look at how the patient experience can be improved. 

The target of shorter times in emergency departments is important because length of stay is a crucial measure of the quality of acute care in our public hospitals.

The target was introduced on the advice of clinicians who raised concerns that: overcrowding can lead to compromised standards of privacy and dignity for patients, for instance, through the use of corridor trolleys to house patients long stays in EDs are linked to overcrowding in the ED; medical and nursing literature has linked both long stays and overcrowding in EDs to negative clinical outcomes for patients such as increased mortality and longer inpatient lengths of stay, prolonged length of stay in the ED is a manifestation of problems throughout the acute patient journey.

EDs are designed to provide urgent (acute) health care; the timeliness of treatment delivery (and any time spent waiting) is by definition important for patients.

There is a lot of work still to be done before the improvements made across the system are sustainable.

Quality in healthcare
This government is committed to continuing to improve the quality of healthcare services over the next three years.

As the cost of healthcare increases it is important that we focus on processes to improve quality care so that New Zealanders continue to receive efficient, effective and appropriate health services.

It’s vital that we deliver quality services to those accessing our emergency department services, and why we endorsed the ED quality framework that Professor Mike Ardagh presented to you yesterday. 

We expect that DHBs will continue to improve acute patient flow and ultimately performance against the health target by wrapping the set of quality measures around it.

Performance should be driven by quality improvements so that the health target remains honest and is about better quality outcomes for patients.

Dr Bryn Jones, a Ministry Chief Advisor, talked to you this morning on the changes to He Korowai Oranga and the Equity Framework.

It’s important that emergency department doctors and nurses apply the framework in a manner that is business as usual to drive improved quality and equity of health outcomes for patients, and family and whānau.

Dr Chris Creswell will be talking to you this afternoon on Free Open Access Medical Education and the New Zealand Emergency Medicine (NZEM) closed online discussion group for emergency doctors.

It’s amazing how far medical education has progressed since my training days.

If only there had been resources like this for discussing challenging cases, and sharing resources. I particularly like the idea of being able to use the NZEM resource to find locums, therefore cutting out locum agency fees.

Government investment in health care
The Government is investing in managing acute demand, and in ensuring that primary health care is accessible and affordable for high risk patients.

In Budget 2014 we announced that we would be extending free primary health care and prescriptions to under thirteens.

In addition, we have introduced extra funding to help struggling Very low Cost Access Practices to sustain their low fee services.

We are focused on investing in primary care, screening, early intervention and disease prevention. We also want to make progress on more elective surgery, faster cancer treatment, and shorter stays in emergency departments.

We are investing $50 million over three years to reduce pain in bones, muscles and joints, and we plan to increase hospice funding by $20 million a year.

Finally, I’d like to take this opportunity to say thank you and farewell to Professor Mike Ardagh who is stepping down from the role of National Clinical Director of Emergency Department Services and target champion at the end of December. Professor Ardagh has been the target champion since its inception in 2009.

It’s hard to appreciate the enormity of the task he took on, and the amount of work he has done to make this a successful initiative. In my mind this has benefited emergency patients up and down the country.

It doesn’t matter what ambitions that we in Government might have for healthcare if we don’t have the people and teams at the coal face who work together to make sure that patients and their families get the best quality health service possible.

I am interested in hearing from you about your experiences and any ideas you might have to better manage and support patients coming to and through your emergency departments.

This is something that all of us need to work on together.

The improvements made over the past seven years have been challenging and demanding for all of you. I’d like to put on record my appreciation for the work you do and my awareness of the stressful environments you work in.

Thank you for your contribution.

Media contact: Angela Kenealy 021 220 0129

Last updated: Tuesday, November 4, 2014

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