I, Annette King, hereby give the Health Funding Authority notice of the Crown's objectives in relation to the matters described in section 8 of the Health and Disability Services Act 1993.
This statement sets out the Government's priorities for the health and disability support services sector. These priorities will be further developed following consultation on and completion of the New Zealand Health Strategy. These objectives replace those which were previously issued for 1999/00 and 2000/01.
The Government has issued this statement to the Chair of the Health Funding Authority (HFA) and it expects these priorities to be given immediate effect by the HFA and the Ministry of Health.
Health Sector Goals
The health sector is expected to work to achieve the following goals:
? Very good health and independence for all
New Zealanders, and lower disparities in health and disability outcomes;
? Access for all New Zealanders to an acceptable range of health care and disability support services, regardless of ability to pay;
? A high-performing system in which people have confidence.
Service Priorities
Acknowledging the special relationship between Maori and the Crown
The Treaty of Waitangi is recognised as New Zealand's founding document and as a basis of constitutional government in this country. The Government recognises Maori as tangata whenua and is committed to fulfilling its obligations as a Treaty partner.
The HFA will work with the Ministry of Health to identify and account for HFA spending on Maori and will allocate resources to increase Maori participation in service delivery across the health and disability sector. Further, the HFA will include Maori in decision making processes, and will support the empowerment of whanau, hapu, iwi and Maori communities to achieve their goals in the health sector.
Improving the health of New Zealanders
The Government is committed to improving the health of New Zealanders. Because good health is the result of complex inter-relationships, it is important to have a comprehensive approach of both prevention and treatment. This implies particular approaches for specific population groups which have greatest risk. These approaches should be provided within appropriate community settings where practicable.
The HFA should aim to improve health overall by improving the health of population groups which have consistently poorer health than the rest of New Zealanders. To do this, the sector must focus not only on particular diseases or treatments, but also look to the total situation of those population groups. The population groups experiencing consistently poorer health are Maori, Pacific peoples, migrants and refugees.
The HFA should work with the Ministry of Health to implement and further develop comprehensive approaches to improving the health of all New Zealanders. The HFA should ensure that there is co-ordination of programmes across operating groups to ensure integrated effort to improve health.
The most powerful determinants of health are economic and social conditions. At the broadest level, macro social and economic policies that are beyond the direct influence of the health sector are likely to have the greatest impact on health. The HFA should:
? Reduce inequalities in health associated with socio-economic factors through working with other sectors to reduce the risk factors that people are exposed to;
? Reduce the adverse health effects of socio-economic factors through health promotion and early identification and intervention.
The HFA should work with the Ministry of Health to develop and implement the New Zealand Health Goals as part of the New Zealand Health Strategy. This will involve:
? Developing funding plans to control major long-term health issues and risk factors;
? Beginning by reviewing funding plans for existing strategies¹ for health improvement.
Maori health
The Government is committed to improving the health status of Maori and building the capacity of Maori, through provider, workforce and professional development, to deliver health and disability support services. It is also necessary to ensure that mainstream providers continue to develop services which are responsive to the particular needs of Maori.
The HFA should continue work, including allocating resources, on its eight Maori health gain priority areas, with particular priority to immunisation, smoking and diabetes, and others of those priority areas targeted elsewhere in this document. The Government wishes to see the HFA work closely with the Ministry of Health to improve Maori health through promotion and early intervention initiatives in these priority areas. Further, specific responses and new ways of delivering services in disability support services, young people's health (including sexual health), areas of high deprivation and primary health care are sought.
Mental health
The implementation of the Mental Health Commission's Blueprint for Mental Health Services is a high priority for the Government.
In the immediate future, the HFA should work with the Ministry of Health and the Mental Health Commission to prepare an action plan for implementing the Blueprint.
Waiting times for elective surgery
The Government is committed to reducing waiting times for elective surgery. The HFA should work with the Ministry of Health to develop and implement an action plan for:
? Rapid and sustained reduction in waiting times for first specialist assessments;
? Rapid and sustained reduction in waiting times for elective surgery.
In addition, the HFA and the Ministry of Health should collaborate to develop a national management system for elective surgery.
Pacific health
Improving the relatively poor health of Pacific peoples is a high priority for the Government. Improvements in the health of Pacific peoples will come about through health promotion and early intervention initiatives and the greater participation of Pacific peoples at all levels of the health and disability sector, including as service providers. The HFA should work closely with the Ministry of Health to develop and implement plans to improve the health of Pacific peoples.
Rural people's health
The Government is committed to ensuring that an adequate range of services is available to rural communities. Of particular concern to the Government are hospitals such as Masterton, Thames, Kaitaia, Wairau, West Coast, Tairawhiti and Whakatane. In some cases it is appropriate to compensate hospital providers, in the form of a premium, to recognise the additional costs of providing services in rural locations. The development and support of a cohesive rural primary care strategy, including services for Maori, is also a priority.
Children's health
The Government expects to see considerable effort going into improving our children's health. The health sector's key contribution to this is the continuing implementation of the Child Health Strategy. Two specific areas of focus for the immediate future are immunisation and Plunket Line.
Improving New Zealand's childhood immunisation rates is a key aspect of Government policy.
The HFA has recently signed up to immunisation targets and is preparing an implementation plan. It is the Government's expectation that this plan will give effect to the
National Health Committee's recommendations concerning
"hard-to-reach" children.
The HFA's plan is expected to provide the basis for making substantive progress in reducing the incidence of
vaccine-preventable diseases amongst New Zealand children.
The Government will re-consider the targets as part of the New Zealand Health Strategy.
The Government is committed to funding Plunket Line
24 hours a day, seven days a week. The HFA must work closely with the Ministry of Health to resolve immediately any outstanding issues with the current Plunket Line service, robustly cost the expansion of Plunket Line and develop an implementation plan to be considered and approved by the Minister of Health.
Young people's health
A comprehensive strategy for improving young people's health is to be developed. The HFA should work with the Ministry of Health and the Ministry of Youth Affairs to develop and support a strategy to improve the health of
New Zealand's young people.
Women's health
The Government is committed to the development of services for well women. In particular, the HFA should work with the Ministry of Health to assist:
? Completion of the evaluation of the National Cervical Screening Programme by the Ministry of Health;
? In providing advice to the Government on extending the range of women eligible to participate in the National Breast Cancer Screening Programme.
Older person's health
The Government is committed to ensuring that the health system is responsive to the needs of older people. The HFA should work with the Ministry of Health to ensure that older people have access to programmes which help to maintain health and wellbeing.
Disability support services
The HFA should work with the Ministry of Health to develop the Government's strategy for support services for people with disabilities.
A more immediate priority for the HFA is to ensure that caregivers have access to adequate respite care and day care services.
Diabetes
The high prevalence of type-2 diabetes amongst certain groups of New Zealand's population is of great concern to the Government. Also alarming is the risk factor profile within parts of our population. The Government will consider appropriate targets as part of the New Zealand Health Strategy.
New Zealand's diabetes strategy provides a comprehensive approach to addressing the prevention and control of diabetes through controlling risk factors (obesity, smoking, hypertension and hyperlipidaemia), early identification and effective clinical management.
It is important for the HFA to continue to implement its disease state management plan. However, the HFA should also work with the Ministry of Health to develop a comprehensive action plan, based on the Ministry of Health's Strategies for the Prevention and Control of Diabetes, to prevent and control type-2 diabetes in
New Zealand.
Oral health
The Government is committed to restoring New Zealand's comprehensive and successful dental health care system.
The HFA should work with the Ministry of Health to ensure that our dental health services and our oral health status improve significantly, and that disparities between Maori and non-Maori oral health are reduced. A more nationwide co-ordinated approach is needed for the delivery of dental services to children. Revision of the General Dental Benefit also needs to commence.
Sexual and reproductive health
The HFA should work with the Ministry of Health 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 available 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.
Migrants and refugees
The HFA should work with the Ministry of Health to further develop and implement comprehensive approaches to improving the health of migrants and refugees.
Dated at Wellington this 26th day of March 2000.
ANNETTE KING, Minister of Health.
¹Existing strategies that need to be considered during the development of the New Zealand Health Strategy include, Whaia te Ora mo te Iwi, youth suicide prevention strategy, national drug policy, strategies for the control and prevention of diabetes, breast cancer control strategy, child health strategy, sexual and reproductive health strategy, Moving Forward the national mental health strategy, and the maternity services strategy. The listing of these strategies is not intended to imply any specific priority to the identified service areas.