Live well, stay well, get well

After wide consultation, the New Zealand Health Strategy setting out the high level ‘Where to from here?’ direction for the health system for the next decade was released in April. The 50-page document says the following statement captured much of what people told them when asked what they thought a “better, more ‘fit for the future’ system” could look like:

All New Zealanders live well, stay well, get well, in a system that is people-powered, provides services closer to home, is designed for value and high performance, and works as one team in a smart system.

The aligned New Zealand Health Strategy Roadmap of Actions sets out 27 action areas under those five themes. (see examples of some of the strategy action areas in sidebar below)

Nurse leader responses

Jane Bodkin, acting Chief Nursing Officer, Office of Chief Nursing Officer (OCNO), Ministry of Health

Q. Will the New Zealand Health Strategy see major or subtle differences in how nurses currently work?

A. Initially changes may be subtle, but the strategy provides a framework that over time should lead to major changes in the way that everyone in the health sector works. The five themes of the New Zealand Health Strategy work together to give a picture of the major changes coming.

The people-powered theme will resonate with nurses. Nursing in New Zealand has a strong clinical and academic history of partnering with people to understand their needs and the outcomes they desire. Nurses are well positioned to engage with consumers, enable them to express their views and participate as responsive partners in their care.

The closer to home theme will be familiar to the more than 16,000 nurses who already work where people live, work, learn and play. While we will always need hospitals, the balance of services will continue to shift to the home and community. Closer to home is also about shifting the focus to prevention, wellbeing and early intervention and the wider environment that determines the health of people and communities.

The value and high performance theme will see a greater focus on health outcomes, equity and results that really matter to the public across the health system. The continued drive by nurses for safety and quality improvement will help deliver value and high performance. Nurse researchers can contribute by providing the sector with evidence, research and analysis to support improvement.

Nurses delivering universal health services, such as immunisation and the Well Child /Tamariki Ora schedule, have an important role to play in improving access and outcomes for disadvantaged populations, such asMāori, Pacific peoples and people with disabilities.The one team theme will require nurses to make greater links with others in the health and social services and be clear about how they can make best use of their scope of practice to contribute to meeting population health needs. It will also require nurses to be part of the system leadership and talent management.

Smart systems, the final theme, are rapidly changing the way people monitor their own health and wellbeing and engage with the health system. Telehealth services, remote monitoring, patient portals and companion robots are technologies familiar to many nurses. New technologies, such as genomics and nanotechnology, have the potential to solve some of the daily issues that nurses see as affecting people’s lives and care.

Q. In which areas might nurses notice the impact of the New Zealand Health Strategy first?

A. All five themes should be advanced in the next 12–18 months through the 27 actions outlined in the strategy roadmap. Nurses will be able to directly impact and will be impacted by the roadmap actions identified to start first in 2016/17, which include:

  • continue to strengthen the national telehealth service

  • promote and increase use of health information accessible via a patient portal

  • increase the effort on prevention, early intervention, rehabilitation and wellbeing for people with long-term conditions by addressing common risk behaviours

  • develop and implement a monitoring framework focused on health outcomes.

The OCNO will be working with other parts of the Ministry and the wider sector to support many of the actions.

The New Zealand Health Strategy provides growing opportunities for nurses to shape the way they work, where they work and who they work with, as part of the one health team.

Jenny Carryer, Executive Director of the College of Nurses and a spokesperson for the National Nursing Organisation group

Q. Will the New Zealand Health Strategy see major or subtle differences in how nurses currently work?

A. One of the areas in which we most anticipate change is greater freedom for primary health care nurses to align their service more directly with patient or community need, rather than fitting in with employment or contracting models. If the strategy holds true to its promise for greater patient-centred care, then such changes should follow automatically. Whether they do or not is another story.

Continued tight hospital budgets are causing significant rationing of available nursing care and putting many nurses in positions of immense stress. I hope that there will be greater understanding that rationing nursing services creates greater costs down the line and is a poor strategy.

Q. Any general comments on what role nursing might play in implementing the New Zealand Health Strategy? Or what you think could be missing?

A. The current model of general practice is highly illness-focused and largely sees patients in a very undifferentiated manner, regardless of where they are on the continuum of health to end stage illness.

The NNO group would like to see a much greater focus on wellness and wellness preservation focusing particularly on the 0–24 age group. We would like to see better integration of the primary health care nursing team, including well child/tamariki ora nurses and school nurses.

Finally, we would like to see the transformative potential of nurse practitioners (NPs)  to drive the focus towards wellness and span the gaps between primary care and aged care as one potentially productive example.

Kathy Holloway, chair of Nursing Education in the Tertiary Sector (NETS)

Q. Will the New Zealand Health Strategy see major or subtle differences in how nurses currently work?

The exciting shift in focus to co-design and health promotion has the potential to provide a platform for the nursing contribution different from the illness-focused, profession-directed system that exists in many places currently. Nursing students are well prepared for this approach to health service and the strategy signals a clear intent for the system to function differently.

Q. In which areas might nurses notice the impact of the New Zealand Health Strategy first?

The focus on smart systems could fast-track the integration of technology into self-management and patient records, which currently is patchy across the system. For nursing education it is important that confidence and competence around health informatics remains integrated within curricula.

 All the New Zealand Health Strategy areas are of interest to nursing education, which must reflect national health priorities as per the Nursing Council of New Zealand education standards.

Q. Any general comments on what role nursing may play in implementing the New Zealand Health Strategy?

Many of the concepts that underpin the refreshed New Zealand Health Strategy already exist within our undergraduate curricula, e.g. the strategy incorporates a broader focus on cross-sector engagement to address the social determinants of health. The concept of people power or person-centred care is, of course, at the heart of the relational practice that nurses develop as part of their professional discipline.

There is a clear signal that to serve our population well, nurses need to work as one team to the full extent of their education and training. Nurses must therefore be prepared to articulate the value they bring to the health service through their research and leadership – education can provide the tools to support this.

Anne Brebner, president of Te Ao Māramatanga , New Zealand College of Mental Health Nurses

Te Ao Māramatanga , New Zealand College of Mental Health Nurses, has supported the development and publication of the  New Zealand Health Strategy. The concepts of supporting people in their homes where possible for as long as possible is a very desirable goal; how we all work together to ensure that this can occur will need all organisations and workforces to work more closely together.

The tension in the mental health and addictions sector is balancing the need to ensure acute , complex health needs are well funded so that people get immediate support for their acute care, as well as building up a workforce that is well trained in early detection, early intervention in the life and disease course, and based closer to people’s homes and communities.

Nursing leaders across the country are working together to replicate areas of excellence, and in the current constrained environment are looking at ways to share knowledge and skills. It would appear that a key enabler for this is the desire to reduce inconsistencies for service users and enable nurses to work across both district health board and primary/secondary care borders effortlessly.

Ensuring we continue to build on the good work that is improving access for Māori will require attention and focus as we move into the brave new world that is the New Zealand Health Strategy.

New Zealand Health Strategy Roadmap of Actions

Some examples of  the strategy’s 27 action areas

People powered:

  • Use a range of digital technologies to support self-management of health, including social media, interactive computer games, patient portals, mobile apps, and strengthen the National Telehealth Service.

  • Take a more people-centred approach, including fostering genuine ‘two-way’ engagement with health system users and building cultural competence into the system.

Closer to home:

  • Increase the effort on prevention, early intervention, rehabilitation and wellbeing for people with long-term conditions, including electronic care plans and obesity prevention strategies for children.

Value and high performance:

  • Continue to develop the application of the social investment approach to health investment with DHBs, including trialling targeting services where the potential health and fiscal returns are highest.

One team:

  • Ministry of Health facilitates annual forums where clinicians share innovative models for preventing and managing long-term conditions.

Smart system:

  • Ministry of Health establishes a national electronic health record that is accessed through certified systems, including patient portals and health provider portals.

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