1. Creating a common vision… a public sector perspective Kathy Spencer DDG, Sector Policy Ministry of Health

2. Health Issues  Smoking: 5,000 deaths this year Maori Pacific Other

3. Health Issues  Diabetes: affects 200,000 people - only half of them diagnosed – 3 x more prevalent in Māori and Pacific  Cardiovascular disease: 40% of all deaths - burden greatest among Māori and Pacific  Cancer: next leading cause of death – significantly worse outcomes for Māori and Pacific  Mental health: 21% have had a mental disorder in the past 12 months – worse for Māori and Pacific  Smoking: 5,000 deaths this year

4. What are we trying to achieve? Reduce obesity

5. Improve nutrition Increase physical activity Reduce the harm caused by tobacco Reduce cancer waiting times Improve diabetes services Reduce avoidable hospital admissions Improve mental health services Improve immunisation coverage Improve oral health Improve elective services Reduce Ministry administration costs

6. Plus… For all New Zealanders: access acceptable services when needed regardless of ability to pay comprehensive

7. A mixed system Public funding & provision Hospital – acute, electives above thresholds, outpatients, maternity Community nursing Screening Community mental health Public funding, private provision Some elective surgery Most ACC-funded electives Child and adolescent dental Maternity services Mixed funding, private provision Primary care Laboratory services Pharmaceuticals Physiotherapy Aged residential care Private funding & provision Elective surgery below public thresholds Some specialist services Adult dental

8. Provider Selection Protocols  First and foremost, choose the most effective option to achieve health gain  Continue to build Maori & Pacific capacity  Significant shift to a non-govt provider demonstrable benefits to patients engage with health professionals currently delivering service  Include in plans  Information provisions  Conflict of interest provisions

9. Private Involvement Protocols  First and foremost, a direct benefit to publicly-funded patients/people with disabilities  Spare capacity  Patients to be advised of publicly-funded options  If DHB staff involved, needs to be within range of current services  Public disclosure  Conflict of interest provisions

10. The protocols have… Been challenged and modified Are they… Right? Well understood? Being applied?

11. Differences – client groups…. Hospital use in last 12 months % Public Private

12. But also common ground…. We all need energy. But are we consuming too much for our lifestyles? Someone once said that being overweight was “a normal response to an abnormal environment”. In today’s busy world…. Killer - Joules: the calorie curse

13. Areas to work on Clarity of scope of services funded Common understanding of protocols Workforce Recruitment & retention Use flexibly Training Develop new roles Remuneration – form (incentives) and level (costs) Management of dual practice Equity and access issues Effect on demand