Speech: Health Care of NZ Ltd National Leadership Conference

Health Care of NZ Ltd National Leadership Conference

Thursday 6 August 2009; 11.30am

Hon Tariana Turia,

Associate Minister of Health;

Minister for Disability Issues

 

I was fascinated by the theme of this conference – social innovation, navigation and speed of trust.

 

At first glance, I thought I might be attending a conference of astronomers and explorers.

 

In fact it instantly transported me to another time, a time when our ancestors applied all innovation known to them to confront tropical seas in making their way across the Pacific, guided only by the stars, the moods and signs of the sea and sky, the migration patterns of the birds, the movements of the clouds and the great natural environment.

 

Our tupuna made Aotearoa home many thousands of years ago, after epic journeys across Te Moana-nui-a-Kiwa; following the stars and the ocean as people today might follow a road map.

 

For some of us, we were already here – for others; the journey is a distinctive rite of passage in our history.

 

And so, as I thought of the strengths and dynamic energy of the story of survival, the connections to this Healthcare conference came into light.

 

I was asked to focus on the development of a Maori home care workforce.

 

In many ways this will also be a journey across treacherous seas; a journey which will require our greatest intellect and creativity, as we pave the way towards creating a sustainable workforce.

 

Because the location of care services in the home is of course a context fraught with challenge.

 

I want to firstly pay tribute to all of you who work so hard, to improve the quality of life for people with disabilities or long term illnesses.

 

This is hard work; and it is vital work. You are greatly appreciated.

 

International research has proven conclusively that the quality of care services provided in the home and community can dramatically affect the lives of all those who receive this care.

 

It can prolong their lives; it can improve their quality of life; it can help them stay in their own homes, and ultimately it can prevent or delay premature entry to residential care.

 

These are really important aspirations and ones that I fully endorse.

 

But despite the undisputed value of the services, the reality is that the homecare workforce as a whole is largely lowly paid and undervalued; and often workers struggle to access higher training.

 

Maori and non-Maori home care support workers do not receive the remuneration that values them, the workforce they are part of, of the fundamental wellbeing of disabled persons and their families.

 

We are talking about a massive workforce – some 21,500 people are employed in the home support workforce funded by the Ministry of Health - and yet it is a workforce which is largely low-paid and low-skilled with few career advancement opportunities available.

 

I want to lay out these challenges from the outset, because these are the real issues confronting this sector – and they are also the platform for scoping out further opportunities.

 

I want to particularly focus on tangata whenua in this session, because of my persistent concern with the unequal and poorer health outcomes experienced by Maori.

 

We know that there is significant potential for Maori to benefit from home care services, because of the impact such services can make in managing debilitating chronic conditions such as diabetes and asthma which are far more prevalent in Maori.

 

And yet, fewer Maori than non-Maori access home support services – and so we have to start asking why.

 

While the causes of such inequalities are complex, we know that a strong Maori community support workforce is essential in encouraging Maori to make use of the support available.

 

The solutions are frequently simple.

 

I want to make careers in disability services more attractive to Maori. The successful development of a Maori workforce requires the recruitment and retention of Maori workers and managers at every level.

 

In turn, such an approach requires confidence and competence in service development, quality improvement, policy, professional development and training, and governance.

 

But it requires more than excellence in HR development or planning.

 

It requires cultural competency.

 

Training and development of the homecare workforce needs to incorporate the values and learning relating to tangata whenua and to disability culture.

 

Ideally the development of a Maori homecare workforce needs to be in collaboration with disabled Maori and their whanau, to meet the needs and aspirations of this group, and to honour the New Zealand Disability Strategy and the United Nations Convention.

 

I can assure you all that the Ministry of Health will be looking at how best to create employment opportunities for Maori support workers. They will be doing this, in consultation with iwi, Maori organisations, disability support service providers and wananga.

 

And they will also be ensuring that carers working for providers which have previously not had high uptake rates for training – smaller providers, those in rural areas, and those serving Maori and Pasifika communities, are given extra emphasis in new training initiatives.

 

We will be aiming to improve frontline services by addressing recruitment and staffing issues in disability services, and improving training and career pathways for carers.

 

The number of Maori accredited as Equipment and Modification Services Assessors will be increased.

 

I am hoping that this organisation will help to promote the availability of Hauora Maori scholarships which provide the financial assistance to help up to 500 students undertake or complete health and disability studies.

 

I have also asked the Ministry to monitor the uptake of funding available through the Clinical Training Agency for the development of the Maori workforce.

 

All of these ideas, may well stay as ideas, unless we literally put the wind beneath the sails, and get the waka moving.

 

And to do that, conferences like this one, are essential, to provide the reason and the reference point, to demonstrating how we can make the difference.

 

I want to really congratulate Healthcare of New Zealand for the unique model you have illustrated in the kaitautoko concept being piloted in Kawerau.

 

Kawerau, according to the statisticians, is identified as a high health needs, low decile and high deprivation community.

 

Well, after little more than a year of implementation, Kawerau is now being placed on the map as a model of success.

 

When the pilot began, the diabetes rates for both Maori and non-Maori was markedly higher than the national average; it had the highest age-standardised cancer rate in Aotearoa; and there was a traditionally low rate of accessing health services.

 

The majority of the Kawerau population, some 60 percent, are Maori.

 

Within this framework, Healthcare of New Zealand collaborated with Kawerau PHO to offer a community health worker (kaitautoko)-led model of care for the Kawerau community.

 

In essence, the community team consists of a registered nurse and two kaitautoko. This team identifies people who may benefit from their support; and then works with the general practice team to monitor their health and act on any change.

 

The proof of the programme is evident in that the people the community team have been working with – those with long terms conditions or disability – have been able to stay in their own homes for longer.

 

At its most fundamental source, the kaitautoko model aims to enable older people and people with long-term conditions to manage their conditions and remain in their own home as long as possible.

 

I’m really excited by the Kawerau concept.

 

I am absolutely committed to whanau ora – supporting families to achieve optimal health and wellbeing.

 

Being able to stay in one’s own home; to enjoy improved life expectancy and an enhanced quality of life, is the key towards enabling clients to live within their own whanau context.

 

I am really keen at looking at how the Needs Assessment Service Coordination approach currently works. I want to know how the assessed needs of the individuals can also be understood in the context of whanau.

 

I want to know how NASC takes into account the natural and community supports that may be available; particularly how we encourage communities to restore to themselves that sense of collective responsibility for each other.

 

None of this will happen quickly – but it will happen and we must make it happen by being innovative; by creating meaningful maps for our future direction; and by working collaboratively and in close cooperation with each other.

 

Care for Maori in their homes, particularly restorative models and management of chronic health conditions, is a critical step in our journey towards optimal wellness; and I am pleased to be here, to encourage you all to share your insights and experiences in navigating the way ahead.