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NATIONAL ADVISORY COMMITTEE

ON

HEALTH AND DISABILITY

(National Health Committee)

NINTH ANNUAL REPORT

TO

THE MINISTER OF HEALTH

DECEMBER 2000

ISBN: 0-478-10492-8 (Booklet)

ISBN: 0-478-10493-6 (Internet)

This document is available on the National Health Committee Website:http://www.nhc.govt.nz.

Copies are available by calling 0800 226 440

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CONTENTS

PART ONE: Overview

Committee Foreword 3

Summary of the Committee’s 2000 work programme 4

Committee Comment: Good Health on Fair Terms 6

PART TWO: Work programme

Introduction to work programme 8

Work completed during 2000 8

Primary Health Care 8

Health Care of Older People 10

Work ongoing during 2000 12

Mäori Health Policy Outcomes 12

Health and Disability Services for Older Mäori 13

Palliative Care 13

New work planned for 2000-2001 14

A Coherent Framework for Quality in Health Care and Health Services 14

Advancing Mäori Health: A review of key health sector interventions to reduce health inequalitiesbetween Mäori and non-Mäori 14

Health Impact Assessment 15

New Technology Assessment 16

Services for People with Intellectual Disability 17

The National Health Committee 17

Public Health and Disability Act December 2000 17

Terms of Reference of the National Advisory Committee on Health and Disability 18

Membership of the National Advisory Committee on Health and Disability (National HealthCommittee) 18

Members of the National Health Committee as at December 2000 19

Secretariat to the National Health Committee as at December 2000 21

Appendix 22

Individuals and organisations that have made submissions to the NHC on projects reported onin this Annual Report

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PART ONE: Overview

Committee Foreword

This is the ninth annual report of the National Advisory Committee on Health and Disability. The Committeeis gratified that successive governments and Ministers of Health have valued the advice the Committeehas provided since 1992 such that our role has not only been re-affirmed but expanded with the passing ofthe Public Health and Disability Act 2000.

In addition to the Committee’s role to advise the Minister of Health on “the kinds and relative priorities ofpublic health services, personal health services and disability support services that should, in theCommittee’s opinion, be publicly funded”, the public health role of the Committee has been strengthened.The Committee is now required to establish a public health advisory committee to provide independentadvice on public health issues, including factors influencing the health of people and communities, thepromotion of public health and the monitoring of public health.

The National Health Committee gratefully acknowledges the participation of members of the public, healthand disability support professionals, and people in government and non-government agencies in ourwork. We also appreciate the interest of the Minister of Health.

With continued support, the Committee will be able to provide an independent and balanced view of thepublicly-funded health system and public health in New Zealand. We remain committed to improving thehealth of New Zealanders and reducing health inequalities.

Robert LoganChairman

Maggie BarryJohn CampbellAlthea Page-CarruthTeuila PercivalLyall ThurstonRay WatsonAlistair Woodward

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Summary of the Committee’s 2000 work programme

The National Health Committee welcomes theexpansion of its role and its strengthened ability toadvise on improving the health of people andcommunities in New Zealand. A broader publichealth perspective is not new for the Committee. InJune 1998 we published The Social, Cultural andEconomic Determinants of Health in New Zealand: Action toImprove Health. This report identified the range offactors that determine the health of New Zealandpeople and communities and actions required toreduce health inequalities.

This work has been the springboard for theCommittee’s strong focus subsequently oninequalities in health and improving health careservices for disadvantaged groups. Our work onimmunisation of ‘hard to reach’ children, publishedin November 1999; our work on reducing inequalitiesin health by investing in primary health care,published in December 2000; our work in progresson Mäori health, looking at both the policy level andthe service delivery level, to advise on howinequalities in health between Mäori and non-Mäorimight be reduced; and our work on Health ImpactAssessment.

The two significant pieces of advice we haveprovided to the Minister of Health in this reportingyear concern primary health care (PHC) and healthcare for older people.

Evidence shows that countries oriented towards astrong primary care infrastructure achieve betterhealth outcomes, as assessed by a variety ofmeasures, and countries with strong PHC-ledsystems have lower overall health care costs, andwhere primary health care is strong, its effect isgreatest in areas of low income.

In New Zealand, an estimated 78 percent of the 9000avoidable early deaths1 in 1996 and 1997 were aresult of health problems that could either beprevented in the first place or would have beenamenable to early intervention – both situationswhere primary health care should have a leadingrole. More effective primary health care could havereduced the number of avoidable hospitable

admissions2 by two thirds. The extent of healthinequalities in New Zealand is demonstrated by therate of avoidable hospitalisations and avoidabledeaths, both of which are two to three times higheramong particular groups, for instance, Mäori, ethnicminorities and people living in deprivedneighbourhoods.

As a result of its research and consultation, theCommittee has advised the Minister of Health topreferentially invest in primary health care with theintention of moving to fully-funded care over thenext five years. We have suggested that this objectivecan be achieved – without necessarily injecting newmoney into the health budget – by allocating aproportion of the ‘sustainable funding pathway’3

money into primary health care each year.

The Committee’s advice on the health care of olderpeople is the culmination of five years of projectwork and the publication, during that time, of ninereports on aspects of the health care of older people.

These reports identified inequity, inefficiency anduneven distribution of publicly-funded healthservices for older people – problems that willintensify as the demand for services increases. Thereis evidence that the ways in which health anddisability services for older people are currentlyfunded and delivered are not providing value formoney. Failure to integrate funds from the variousring-fenced budgets in Vote: Health has led tofragmentation of service provision and cost-shifting.The Committee strongly advised the Minister ofHealth to seize the challenge of creating a coherentpolicy and service delivery framework for an area ofhealth care that absorbs over a third of Vote: Health.

Other work reported on in this annual reportincludes an analysis of submissions on the health

1 A potentially avoidable death is one that, theoretically,could have been avoided given current understanding ofcausation and currently available disease prevention andhealth care technologies. Ministry of Health. Our Health OurFuture 1999. Ministry of Health Wellington 1999. p. 313.

2 Ambulatory sensitive hospitalisations (ASH) are hospitalisationsresulting form diseases sensitive to prophylactic ortherapeutic interventions deliverable in a primary health caresetting (such as vaccine preventable diseases, earlyrecognition and excision of melanoma, effective glycaemiccontrol in people with diabetes). Ambulatory sensitivehospitalisations are sometimes monitored as a performanceindicator or primary health care. Ministry of Health. Our HealthOur Future 1999. Ministry of Health Wellington 1999. p. 326

3 The sustainable funding pathway provides additional fundsto the health system each year to allow for demographicchanges, inflation and new technologies.

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care of older Mäori (a companion project to theHealth Care of Older People) and a project focusingon the last decade of public policy development inrelation to Mäori health. The latter project – due tobe completed mid 2001 – will identify anyshortcomings, internal contradictions, andinconsistencies evident in Mäori health policy overthis period. In addition, the project is examiningwhat factors have facilitated and constrained Mäorihealth policy in the past, lessons that may be learntfor the future, and how these lessons can be appliedto the development of Mäori health policy in thefuture.

Looking further ahead, the Committee is turning itsattention to quality and how a common languageand understanding of quality might be agreed andadopted by the sector. The numbers of peopletreated, their access to care and the quality of carethey receive are the three essential componentsdetermining how well a country’s health care systemperforms. Of these three, quality is often the leastdeveloped, in part because it is the hardest tomeasure.

The Committee is interested in promoting a culturechange within the health sector towards greaterconsideration and valuing of quality. In manyrespects, this is closely related to the Committee’sconsistent push for more explicit and transparentdecision-making throughout the sector inpartnership with communities and consumers. TheCommittee’s work on evidence-based guidelinesexemplifies this push for a culture change amonghealth professionals towards one that valuesevidence for effectiveness, partnership withconsumers, life-long learning, value for money andequity. Many of these principles are equallypertinent to quality and underpin a change towardsa quality culture.

The assessment of new health technologies isanother area of upcoming Committee work. Pressureto introduce new technologies comes from a numberof sources including health professionals, increasingconsumer awareness and expectations, the use ofnew technologies in the privately-funded sector andcommercial interests. Work carried out to dateindicates that there is considerable potential andsupport from other agencies to improve theprocesses whereby new technologies are identified,assessed and introduced in New Zealand. TheCommittee will identify how the processes forassessing new technologies can be improved topromote the wider issue of effective technologies –

whether new or old – by discovering their realbenefits and costs and so defining the indicationsfor their proper use.

Other new Committee work continues the focus onreducing health inequalities. In its 1998 report onhealth determinants, the Committee recommendedthat the potential impact of social and economicpolicies on the health of the population should beassessed as part of the policy development process.One way of doing this is through a process of healthimpact assessment (HIA).

HIA is any combination of procedures, methods andtools by which a proposed policy or programme maybe judged as to its potential effects(s), direct orindirect, on the health of a population and thedistribution of those effects within the population.The Committee has been following internationaldevelopments in health impact assessment for thelast two years and has gradually built its knowledgein this area.

HIA at central government level is more likely to beintroduced successfully if it has ‘buy in’ and supportfrom a broad range of Ministers and governmentagencies. The Committee is currently investigatinghow to achieve this support, including where HIAcould best fit within the policy development anddecision-making process at central government leveland whether an HIA tool should be developed aspart of a broader impact assessment tool takingaccount of, for instance, social inequalities orquality-of-life impact assessment.

In addition to the HIA work, the Committee iscarrying out a review of key health sectorinterventions that are likely to make the biggestcontribution to reducing health inequalities. We seethis work as a corollary to our advice to the Ministerof Health on improving health inequalities fordisadvantaged New Zealanders through investingin primary health care. The Committee wants toidentify not just the interventions but also theapproaches that will ensure better access, deliveryand uptake of primary care for Mäori as well asPacific people and disadvantaged groups.

In the area of disability support services, our keyfocus is a project evaluating the quality and mix ofservices for people with intellectual disabilitiesliving in the community. This project aims to provideadvice to the Minister of Health and the Ministerfor Disability Issues on which services should beavailable in the community and publicly-funded forpeople with disabilities.

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Fairness is an important principle in the area ofhealth and health care where it is usually referredto as equity. There is no unified view on what is fairin the provision of health care or in the range ofactivities to improve health outcomes. Yet the words‘fairness’ and ‘equity’ are often used as if they aresimple notions, not open to interpretation ordifferences of opinion.

So just what does the NHC mean by equity in health?It is important first to distinguish between equityand equality. The two have different meanings butare often used interchangeably. “Equality” and itscompanion, “inequality” are descriptive terms usedto compare individuals or groups. On the otherhand, equity is about fairness and justice and in thecontext of health has ethical dimensions, whichrelate to the good of the individual and thecommunity as a whole. Equal access to a servicemay in fact be inequitable if it means that peoplewith lesser need receive a service ahead of thosewith greater need just because, for example, theylive in different regions.

Equity has been a key theme in the work of theNational Health Committee since it was establishedin 1992. One of the first pieces of work undertakenby the Committee was a “stocktake” of existinghealth services. This revealed considerable variationin access to services around the country, inparticular, wide variations in the rates of electivesurgical procedures such as cataract operations andhip replacements. As a result of these findings andthe large number of submissions it received, theCommittee felt that it was important to focus oninequities in the health system as well as efforts toimprove its effectiveness, efficiency andacceptability.

Since 1992 the Committee has paid particularattention to the question of fairness in relation toaccess to health services, use of health careresources for individuals and in the opportunitiessociety creates for people to enjoy good health.

Fair accessThere are two important dimensions to fairness ofaccess to health care. The first relates to the notionthat similar people should have similar access toservices, (i.e. equal access for equal need), so-called‘horizontal equity’. It is this notion that underliesconcern about the regional variations in access toelective services that the Committee found in itsearly work. For example, if everybody who had the

same need of a cataract operation received theoperation within a similar timeframe, no matterwhere they lived, we could be confident that therewas horizontal equity – at least with respect tocataract operations.

Of course, there are different perspectives on howwe should define “need” itself. The work of theNational Health Committee and the Health FundingAuthority (HFA) defines need as an ability to benefit.

A second dimension of fairness in access to thehealth system proposes that, as people havediffering health needs, they should have differentaccess to services depending on their level of need,(i.e. unequal access for unequal need), so-called‘vertical equity’. Vertical equity is an importantprinciple in publicly-funded health care. It providesthe rationale for spending more money on peoplewho have chronic illness, to help improve theirquality of life, than on people who are well, or fordevoting more money to prevention initiatives forgroups that have high levels of risk factors such assmoking and poor nutrition. Much of theCommittee’s work has endorsed this principle bysuggesting that we should direct resources to reachdisadvantaged or underserved groups in order toreduce health inequalities.

Fair decisionsSeveral pieces of Committee work have improvedthe fairness of decision-making in the health sector.For example, booking systems and clinical priorityaccess criteria (CPAC) were proposed to replaceunfair and misleading waiting lists and are now anaccepted part of the health system. The Committeehas led the sector in the introduction of evidence-based guidelines, which assist professionals andconsumers to reach shared decisions about besttreatment options. By including information aboutcost-effectiveness they assist practitioners to weighup their responsibilities of fidelity towardsindividual patients with stewardship of resourcesfor the wider community.

Fair opportunityOver the last three years, the Committee has had awork programme on the broader social, cultural andeconomic determinants of health. A key element ofthis work has been a consideration of healthinequalities, in particular potentially avoidablehealth inequalities. In New Zealand, as in otherdeveloped countries, there are persistent

Committee Comment: Good Health on Fair Terms

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inequalities in health that relate to thesocioeconomic position of individuals and groups.The Committee found that overall trends in manysocioeconomic factors in New Zealand over the1980s and 1990s were likely to increase healthinequalities. These factors include income, incomeinequality, housing and employment.

Thus, in addition to a desire to see fairer decision-making in the health sector, the Committee alsocontends that we should be concerned to providefair opportunities for people to enjoy health. Thisrequires a focus on factors outside the health sector.These factors, together with fair opportunity forhealth, can be seen also as part of the wider ideal offair opportunity, which is consistent with thewidespread New Zealand belief that everyoneshould get a “fair go” in life.

Good health on fair termsNot only is fairness a complex concept but itsapplication to the many different levels and systemswithin health care is even more so. Since tensionbetween the good of the community and theexpectations of the individuals is inevitable, theremust be robust consultative processes in place toensure fairness of decision-making – in terms of bothprocesses and outcomes – according to currentsocietal values.

In the future, the Committee has a responsibility toexamine the work of the District Health Boards(DHB) and to help ensure that the potential forachieving greater fairness in the delivery of healthservices and in health outcomes is achieved.Genuine community participation in decision-making, without capture by any particular sector orgroup, will be key to ensuring that fairness in thehealth sector reflects the values of society as awhole.

The Committee’s recent report on primary healthcare is to be followed by work on assessment of newtechnologies, quality measures, care for people withdisabilities and the health impact assessment ofnon-health sector policies. The Committee will takea close interest in the evolution of the internalprioritisation process developed by the HFA in whichequity was identified as a key principle. TheCommittee’s new role of establishing a public healthadvisory committee will strengthen its ability toinfluence factors within and beyond the healthsector that help create opportunities for goodhealth. We believe that this work will continue theCommittee’s record of providing advice thatpromotes improved health for all New Zealanderson fair terms.

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Over the past few years, several themes haveemerged in the Committee’s work programme. Thework completed and ongoing during 2000 reflectsthese themes.

First, priority setting remains a central theme,reflecting the Committee’s key mandate when it wasestablished. Following on from work on bookingsystems and best practice guidelines, theCommittee independently assessed the HealthFunding Authority’s work on prioritisation. A newpiece of work on assessing new health technologieswill commence in 2001, picking up on previousCommittee recommendations in this area.

A second theme over the past three years has beenhealth inequalities. After the Committee’s brief waswidened in 1996 to include public health, theCommittee focused on the broad social, cultural andeconomic determinants of health. Following the

publication of its 1998 report, further work emergedon immunisation for underserved anddisadvantaged groups and reducing inequalitiesthrough primary health care. The publication of theCommittee’s report on primary health in December2000 continues the theme, as does ongoing workon health impact assessment, health sectorinterventions to reduce inequalities and improvedMäori health outcomes.

Disability support services are a third theme in theCommittee’s work, which continues with a newproject on services to support people withintellectual disabilities living in the community.

Finally, an emerging theme in the Committee’s workis quality. A new project in this area is discussedbelow and the Committee is looking forward tocontributing to a culture of quality improvementwithin the New Zealand health sector.

PART TWO: WORK PROGRAMME

Introduction to work programme

Work completed during 2000

Primary Health CareThe Committee’s advice to the Minister of Healthon primary health care is the culmination of workon two specific issues:

• how primary health care can reduce healthinequalities by reaching individuals and groupsin communities who are disadvantaged andcurrently underserved

• how primary health care can best achieveimprovements in health outcomes forcommunities through population-basedapproaches.

The report Improving Health for New Zealanders byInvesting in Primary Health Care is based on evidenceabout effective primary health care in New Zealandand international literature and the growing numberof successful initiatives occurring around NewZealand. It does not cover every aspect of primaryhealth care and is separate from the Ministry ofHealth’s primary health care strategy. However, manyof the conclusions in the report are consistent withthe primary health care strategy, endorsing theimportance of population-based approaches andthe need to reduce health inequalities.

The Committee recommends significant changes forprimary health care in New Zealand. Effectiveimplementation of its recommendations will requireleadership, clear policy directions and co-operationbetween the Government, District Health Boardsand primary care providers. The Ministry of Health’sproposed primary health care strategy will providedirection, but it needs to be supported by adequateinvestment and workforce development.

What is primary health care?

Primary health care is an approach to health carethat includes a range of services designed to keeppeople well, from promotion of health and screeningfor disease to assessment, diagnosis, treatment andrehabilitation. The services provide first level contactthat is universally accessible by self-referral and havea strong emphasis on working with communities andindividuals to improve their health.

The role of primary health care inreducing health inequalities

A significant proportion of hospitalisations andpremature death in New Zealand can be prevented

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through good PHC. There is international researchshowing that PHC has an independent effect onimproving health status and reducing healthinequalities. In addition, there is sufficient evidenceto show that providing free access to PHC servicesreduces the barrier of cost for low-income familiesand contributes to more timely and equitable accessto both primary and secondary care.

The following prevent PHC from reducing healthinequalities in New Zealand:

• the predominance of fee-for-service (FFS)payment for general practice services

• public funding for PHC not being allocated onthe basis of need

• significant co-payments for many groupsdiscouraging them from accessing PHC

• the provision of ineffective services to somepopulation groups

• effective services not being provided to peoplemost likely to benefit.

Population-based approaches toprimary health care

A population-based approach consists of organisedaction to promote and protect the health ofidentified groups and reduce inequalities betweengroups. Many PHC organisations in New Zealandare already encompassing population-basedapproaches.

The following issues need special consideration tohelp extend the use of population-based approachesin PHC in New Zealand:

• the level and system of public-funding of PHC; arelatively small proportion of PHC in New Zealandis publicly-funded compared with similarcountries, while FFS payments provide limitedincentives for population-based approaches

• an environment and incentives that encourageinterdisciplinary team approaches to be usedmuch more widely.

The current level of public funding of PHC isinsufficient to promote population-basedapproaches and ensure that PHC providers can leadto improvements in population health and thereduction of health inequalities.

Conclusions

Genuine action to address health inequalities needsto take into account broader social, cultural andeconomic factors, which are the principal

determinants of health. Reorienting the NewZealand health system towards a focus on healthpromotion, early intervention and diseaseprevention will require a greater emphasis on PHC.In addition, PHC itself will need to continue to movetowards population-based approaches andaccountability for health outcomes.

Evidence suggests prevention initiatives, earlydetection and improved disease management,which should be the key focus of PHC, are more likelyto benefit those with poorer health. It appears thatgood PHC disproportionately improves the healthof socioeconomically disadvantaged people and willhelp reduce health inequalities in New Zealand.

In order to help to reduce health inequalities, PHCin New Zealand should:

1. adopt a broad approach, working withcommunities and individuals to improve theirhealth

2. address the broader social, cultural andeconomic determinants of health where possible

3. be allocated public funding based on the levelof need of the population served

4. minimise access barriers, in particular cost andcultural barriers

5. ensure effective interventions are delivered topeople most likely to benefit.

The Committee believes that population-basedapproaches in PHC should be fostered, as they willcontribute to improving the health of the wholepopulation and can help to reduce healthinequalities. The Committee has identified five keyactions to strengthen population-based approachesin primary health care:

• A focus by District Health Boards and primaryhealth care providers on population healthoutcomes and mechanisms to ensureaccountability for improving health and reducinghealth inequalities.

• An interdisciplinary approach within a structurethat has a community health focus. This willrequire the development of organisationalcapability, particularly management capability,for delivering population-based health care.

• Funding levels and mechanisms that promotepopulation-based approaches, distribution ofresources according to need and accountabilityfor outcomes.

• A ‘whole sector focus’ on a broad PHC approachwith a shift in focus and authority away fromsecondary care.

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• The collection of sufficiently detailed data onpopulation health needs and systems thatprioritise and monitor population-basedinitiatives for outcomes, equity and quality.

Recommendations

1. The Government should support the orientationof the whole sector towards a broad primary healthcare approach with a focus on health promotion,early intervention and disease prevention.

2. The Government should preferentially invest inprimary health care services with the intention ofmoving to fully funded care over the next five years.

3. Funding of primary health care should be largelythrough capitation in order to support population-based approaches, rapidly address existinginequities in funding and improve accountabilityfor better health outcomes.

4. Primary health care organisations should befunded to deliver essential services to their enrolledpopulation through interdisciplinary teams.

5. Workforce initiatives should be funded andimplemented to train primary health carepractitioners to work in the new environment.

Improving Health for New Zealanders by Investing in PrimaryHealth Care was published in December 2000 and isavailable on the NHC web site http://www.nhc.govt.nz.

Health Care of Older PeopleIn May 2000 the National Health Committeeprovided advice to the Minister of Health on how toensure that the health care of older people isprovided in ways that are effective, appropriate andachieve the most efficient use of public funds. TheCommittee had been working to develop a clear andconsistent view on the strategies needed to addressthe health issues in the care of older people duringthe previous five years.

The Committee’s work in this area was motivatedby its concern that demand for services is increasingdramatically as life expectancy and the proportionof older people in the general population increases.This is occurring in what the Committee consideredto be a ‘policy vacuum’.

There is evidence that the ways in which health anddisability services for older people are currentlyfunded and delivered are not providing value formoney. Failure to integrate funds from the variousring-fenced budgets in Vote: Health has led tofragmentation of service provision and cost-shifting.The NHC is particularly concerned that a reduction

in funding for assessment, treatment andrehabilitation (A,T&R) services has led to anunnecessary increase in spending on long-termresidential care.

The evidence for the Committee’s recommendationscan be found not only in New Zealand andinternational literature and a number of successfulinitiatives occurring around New Zealand but alsoin the nine other reports the Committee hascommissioned and published on aspects of thehealth care of older people since 1995.

The ten reports identify consistent problems withthe funding and delivery of health care service forolder people. The Committee considers that thelikely increased demand for services due to publicexpectation, together with the ageing of thepopulation, will only exacerbate the currentproblems.

The Committee’s overall concerns about the currentprovisions for the health care of older peopleinclude:

• the lack of strategic policy development andplanning

• the poor value for money overall currently gainedfrom publicly-funded services due to the way inwhich some services are funded and organised

• the lack of recognition that strategies for thehealth care and support of older people must bedistinct from generic DSS strategies and takeaccount of the complex and serious health needsspecific to older people

• the separation of Needs Assessment/Service Co-ordination (NA/SC) and service delivery imposedby the introduction of the DSS framework, whichhas led to significant fragmentation of services

• limitations in service choices for older people,including acute medical, specialist A,T&R,primary and home care services and long-termcare, because of reductions in the availability ofproviders and reduced options for care

• limitations to the integration of services imposedby funding ring fences

• the increase in admissions to long-term care,particularly in those regions where assessmentservices have changed

• the 20-year trend of increasing severity andcomplexity of the health needs of older peopleon admission to long-term facility care, whichhas accelerated over the past five years; fundingof these services has not increased to reflect theincreased costs of providing long-term care forthese people

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• funding arrangements that have tended to focuson curative and residential care services ratherthan providing incentives to provide services thatpromote wellness and independence

• inadequate accountability mechanisms forimproving, promoting and maintaining thehealth of older people

• the need to re-prioritise funding for the care ofpeople with dementia to ensure that they andtheir carers are adequately supported to ensurethey remain at home for as long as possible.

The Committee commented that the problemsbesetting the health care of older people are notsudden but nor are they insurmountable. They havebeen building in the health sector for some 25 yearsand, to date, have only been dealt with in apiecemeal way. The Committee strongly advised theMinister of Health to seize the challenge of creatinga coherent policy and service delivery framework foran area of health care that absorbs over a third ofVote: Health.

The Committee considers a high priority to be arecasting of the DSS framework as it applies to thefunding of the health care of older people. Integralto this process should be the evaluation of ways toplan and purchase services that will achieve betterintegration, improve decisions about care and re-focus priorities from institutional care to promotinghealthy and independent living, that is, ‘ageing inplace’.

Crucial to the provision of appropriate services forthe care of older people is recognition of thefundamental differences between generic DSSstrategies and those that are appropriate for healthand disability services for older people specifically.The complexity and changing nature of the age-related health problems and disabilities that olderpeople experience requires a range of health anddisability services to be co-ordinated. Theprominence of medical problems, many of whichhave not previously been identified or adequatelymanaged and which present with apparent disability,provides a challenge for NA/SC that is unique toolder people.

The NHC considers that there are a number ofreasons why disability support services for the careof older people require a specific policy frameworkthat is distinct from that for younger people whohave less complex and more stable physical orperceptual disabilities. The reasons include:

• impending demographic changes

• numerous conditions affecting older people arepreventable and/or remediable

• age-related medical conditions play an importantcausative role in disability for older people

• the health and disability support service needsof older people are complex and are unstableover time

• older people’s health problems require specialistgerontological services for comprehensiveassessment, diagnosis and treatment.

Ill-health and disability develop at an earlier age forMäori than for non-Mäori. The age-standardisedprevalence of disability is 15 percent higher for Mäoriand disability requiring assistance higher still, at 26percent above the non-Mäori rate. The applicationto older Mäori of the Health Funding Authority’sproposed DSS strategy for Mäori, He Ratonga TautokoI Te Hunga Haua, has similar limitations to theapplicability of the generic DSS Framework.

The Committee commissioned a separate paper onhealth and disability services for older Mäori as partof its work stream on improving the health andindependence of Mäori. Submissions on this paperwere sought from a range of Mäori health providersand stakeholders. These submissions are beinganalysed and the results fed to the development ofpolicy on health care for older people within theMinistry of Health.

Recommendations

To ensure that the health care of older people isprovided in ways that are effective, appropriate andachieve the most efficient use of public funds, theCommittee made three recommendations to theMinister of Health:

1. Strategic Policy Development – the Ministry ofHealth should develop strategic policy andplanning by the end of 2000 to meet the healthneeds of older people.

This should take account of changes indemographics and available technology, recognisingthat strategies for the health care and home supportfor older people are distinct from generic DSSstrategies. Special strategies will need to bedeveloped to provide adequate health care for olderMäori.

2. Integrated Assessment Services – the delivery ofthe most appropriate, efficient and effective healthcare services for older people (including acutemedical, specialist multidisciplinary A,T&R,community support of home care services and long-term care) should be organised in ways that willachieve an integrated and coherent continuum ofcare.

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Access to multidisciplinary A,T&R services is crucialto ensuring that services are matched to the healthneeds of older people and delivered in a timely andco-ordinated manner. Health services for olderpeople and their carers should be based on anaccurate and holistic assessment of their health careand support needs.

3. Funding arrangements – future fundingarrangements for health and disability supportservices for older people should encourageintegration between primary, secondary, DSS andpublic health services. Appropriate priority shouldalso be given to funding and implementing servicesthat promote health, independence and support‘ageing in place’.

The funding arrangements for health and disabilitysupport services for older people should:

• reflect as far as possible the needs and

preferences of older people and their carers indecisions about the setting for their health care

• reflect the increasing severity and complexity ofhealth needs for older people in long-term carefacilities

• give appropriate priority to health promotion anddisease prevention services that promote health,independence and support ‘ageing in place’

• permit the shifting of funds from servicesconsidered less cost-effective and/or appropriateto the new services above

• encourage integration of services that respondto the often complex needs of older peopleneeding health care.

Health Care for Older People was published in May 2000and is available on the NHC web site http://www.nhc.govt.nz

Work ongoing during 2000

Maori Health Policy OutcomesOver the last two decades, there has been significantprogress in Mäori health and development. TheNational Health Committee is undertaking a projectthat examines the strategies that have beendeveloped in the health sector over the last 15 yearsto improve Mäori health and reduce disparitiesbetween the health of Mäori and non-Mäori.

The Committee’s objectives for this project are toanswer two questions:

• is there a coherent strategy for improving Mäorihealth outcomes?

• what would need to be done to make an effectivestrategy and what would be the roles of differentagencies?

The Committee considers this work to be timelygiven the further period of major structural changethat New Zealand’s public health service is enteringwith the merging of the HFA and the Ministry ofHealth in January 2001 and the development during2001 of 21 District Health Boards.

The Committee considered it important to reviewand analyse the outcomes of government objectivesand policies that have guided the health sectorduring the major structural changes that have takenplace since the mid-1980s.

Throughout much of this change, Mäori health hasbeen a key focus, whether through structuralchanges that altered the level of Mäori participationin the sector, or attempts to improve Mäori healththrough changes to service provision.

The NHC wants to extract the maximum value fromthe experiences of the last 15 or so years of changeand make its findings available to the sector as itcontinues to be challenged by the urgent need forimproved health outcomes for Mäori.

The project approach is to review and analyse whatthe different agencies are doing, what theirstrategies are, looking particularly at issues suchas:

• ownership of the strategies – who is drivingthem?

• what evidence are they based on?

• how are the strategies expressed in action?

• positive examples provided by agencies ofsuccessful implementation

• experience/analysis of barriers toimplementation of strategies to improve Mäorihealth outcomes.

Consultation has involved the HFA, the Ministry ofHealth, Te Puni Kokiri, the Mäori Health

13

Commission, the Mental Health Commission,Hospital and Health Services (HHSs), privateproviders, Non Government Organisations,academic/research agencies, and other agenciessuch as Treasury, Housing, Labour and Work andIncome.

The Committee’s objective is for its advice to beincluded in the future wording of the CrownStatement of Objectives for Health, to see it in thefunding agreement between the Crown and theDHBs and to see it reflected in the futureperformance monitoring framework that the Ministryof Health uses to evaluate the performance of theDHBs.

Timetable for completion of this project is May 2001.

Contact: Sue Crengle (sue_crengle@moh.govt.nz)

Health and Disability Services forOlder MaoriThis is the final piece of work in the National HealthCommittee’s five-year work programme on thehealth of older people. A report on health anddisability services for of older Mäori wascommissioned from Dr Chris Cunningham of TePumanawa Hauora at Massey University as acompanion document to Health Care for Older Peoplepublished by the Committee in May 1999.

Dr Cunningham’s paper identified several issuessimilar to those raised in the Committee’s reporton Health Care of Older People. These and otherimportant issues included:

• failure to recognise the needs of Mäori in thedevelopment of the 1992 Disability SupportServices Framework and a lack of understandingby central agencies of specific Mäori disabilityneeds

• missed opportunities for initiatives that wouldenable Mäori to benefit from health promotionand disease prevention services

• many older Mäori aged 60 to 65 with significantage-related disabilities are not receivingadequate care and support because the age-65threshold for entitlements excludes many Mäori

who develop age-related disabilities at an earlierage

• many older Mäori are disadvantaged by thepriority given to long-term care, which isinfrequently used by Mäori (many whanauprovide an essential safety net for Mäori withdisability)

• a lack of Mäori-responsive assessment servicesand slow development of Mäori services thatprovide appropriate care to older Mäori

• unclear pathways within the HFA forresponsibility for Mäori DSS

• inadequate consideration of Mäori issues in theHFA Draft Strategic Plan for DSS.

Dr Cunningham’s report was sent out for commentto agencies and providers, both those providing careto the wider population and to Mäori healthproviders whose responsibilities include the care ofolder people. The Committee intends to feed theresults of the submissions analysis to the newlyestablished Health of Older People unit within theMinistry of Health.

Timetable for completion is January 2001.

Contact: Marjan van Waardenberg(marjan_van_waardenberg@moh.govt.nz)

Palliative CareIn 1997, the Committee convened a working partyto consider how access to appropriate palliative carecould be more equitable, and how to addressinconsistency of care.

In 1999, the working party’s advice on Care of Peoplewho are Dying was handed over to a joint Ministry ofHealth/Health Funding Authority project team,established to devise a strategy for publicly-fundedpalliative care.

The Committee has continued to have input intothe development of the palliative care strategy bythe Ministry of Health and Health Funding Authority.A draft strategy was distributed for consultation in2000 and the final strategy will be released inFebruary 2001.

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New work planned for 2000 – 2001

As a starting point, the Committee intends to holda workshop of key stakeholders early in 2001 todiscuss issues surrounding a change to a qualityculture. The outcomes of this workshop couldprovide the foundation for a coherent approach toquality improvement in the health sector, includingagreement by all stakeholders on key dimensionsof quality and areas of accountability and thedevelopment of a “common language” for quality.

Timetable is ongoing with initial advice in June 2001.

Contact: Ashley Bloomfield(ashley_bloomfield@moh.govt.nz)

Advancing Maori Health: Areview of key health sectorinterventions to reduce healthinequalities between Maori andnon-MaoriThe Minister of Health has asked the NationalHealth Committee to advise on how the NewZealand health sector can best reduce inequalitiesin health outcomes between Mäori and non-Mäori.

The Committee’s initial work on this project hasbeen to identify the top diseases and conditions bythe size of the “gap” between Mäori and non-Mäoriin categories of mortality, prevalence and disability-adjusted life years lost4.

The work aimed to identify the most effectiveinterventions to reduce the health gap in the shortterm and also indicate interventions to supportclosing the gap and possible improvements in thedelivery environment.

Dr Nick Wilson, a Wellington public health physician,undertook preliminary work for the Committee toidentify and define the gaps in key disease-specificareas and highlight interventions that have beeneffective in those specific areas. This has involved:

• identifying the evidence for effectiveness andcost-effectiveness

• determining the impact of factors that affectimplementation in practice.

The top four disease gaps were cancer (mainly lung),cardio-vascular disease, diabetes, and injury. Thesediseases/conditions are also strongly representedin the 30 percent of hospitalisations deemed to be

4 Ministry of Health. Our Health Our Future 1999. Ministry ofHealth Wellington 1999. P 35 fig 13

A Coherent Framework forQuality in Health Care ServicesIn July 2000, the Minister of Health asked theCommittee to turn its attention to quality issues.The Committee has examined the wide range ofquality initiatives underway in the sector andconcluded that there is currently no agreed coherentstrategy for quality improvement in New Zealand.There is a clear need for agreement on a commonlanguage and understanding of quality among sectororganisations, health professionals, and consumers.This gap has been identified by a number of otherpeople and organisations.

The Committee is interested in promoting a culturechange within the health sector towards greaterconsideration and valuing of quality. In manyrespects, this is closely related to the Committee’sconsistent push for more explicit and transparentdecision-making throughout the sector inpartnership with communities and consumers. TheCommittee’s work on evidence-based guidelinesexemplifies this push for a culture change amonghealth professionals towards one that valuesevidence for effectiveness, partnership withconsumers, life-long learning, value for money andequity. Many of these principles are equallypertinent to quality and underpin a change towardsa quality culture.

The recent and ongoing quality ‘drive’ in the healthsector has tended to be reactive and focus ondimensions of quality that can be easily targetedusing standards-based tools (e.g. safety/riskmanagement, professional competency, technicalperformance). While standards are important, theytend to relate to just one dimension of quality –safety. There is no explicit quality framework thatincludes other essential dimensions of quality thatalso need attention, such as patient satisfaction.There is a need to investigate the approaches thatservices would find most useful and be likely toadopt for use.

The Committee intends to undertake two pieces ofwork to help facilitate a desirable culture change:

• establishing a systematic approach to improvingquality across the health sector that has buy-infrom key stakeholders

• identifying key initiatives and action required toadvance a culture change within the sector,particularly among professionals, towardsembracing all aspects of quality and itscontinuous improvement.

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preventable by public health interventions oravoidable by management in primary care.5

The Committee recognises that some interventionsare more effective than others and that the sameintervention can be more effective for some peoplethan for others. In these situations, the individual’ssocial and economic circumstances, service deliveryenvironment, and family/whänau and widercommunity involvement and support often make thecrucial difference to whether an intervention is trulyeffective in practice.

The Committee also recognises that whileidentifying the gaps in disease-specific areas isuseful, interventions that focus on one disease arenot appropriate for many disadvantaged groups whomay have multiple conditions and be exposed tomultiple risk factors.

Therefore, the Committee is considering whatapproaches or models of service delivery theGovernment should adopt to reduce healthinequalities. The Committee is interested inidentifying approaches that ensure better access,delivery and uptake of primary care for Mäori andPacific people and other disadvantaged groups. Forexample, a focus on a family group that is likely toshare common risk factors for some diseases wouldenable a preventive component to be applied tohealth care delivery. Life style changes that positivelyaffect health status invariably require family andcommunity support to be effective.

Timetable is ongoing, with initial advice in March2001.

Contact: Marjan van Waardenberg(marjan_van_waardenberg@moh.govt.nz)

Health Impact AssessmentThe Minister of Health has asked the Committee todevelop a framework for assessing proposed non-health sector policies for their impact on health.

The Committee has consistently emphasised theimportant role of broader social, cultural andeconomic determinants of health. In its 1998 reporton The Social, Cultural and Economic Determinants of Healthin New Zealand, the Committee recommended thatthe potential impact of social and economic policieson the health of the population should be assessedas part of the policy development process. TheCommittee has been following internationaldevelopments in health impact assessment for the

last two years and has gradually increased itsknowledge in this area.

In theory, good policy analysis should consider allrelevant beneficial or adverse effects of policyoptions, both direct and indirect. In practice,however, the impact of policies on health are oftennot explicitly or implicitly considered by othersectors when officials are providing advice to non-health Ministers.

HIA at central government level is more likely to beintroduced successfully if it has support from abroad range of Ministers and government agencies,especially key agencies such as the Department ofthe Prime Minister and Cabinet, the State ServicesCommission, the Treasury and the Ministry ofHealth. Initial work will consider ways to achievethis support, including whether an HIA tool shouldbe developed as part of a broader impactassessment tool, such as a social impactassessment, inequalities impact assessment orquality of life impact assessment.

Phase one of the project will consider where HIAcould best fit within the policy development anddecision-making process at central governmentlevel. The Committee is researching the experienceof a range of government agencies that have soughtto integrate particular analytical tools or issues intothe policy process. This is to find out which methodshave been successful or unsuccessful, and why, andwhat the impact has been on the initiating agency.This information will assist the Committee to advisehow HIA can best be integrated into the policydevelopment process and what mechanisms areneeded to ensure it achieves its desired objectives.

In phase one the Committee is also seeking detailedinformation about other countries that haveintegrated HIA into the policy development processor intend to do so. This work will establish whetherany information is available about the impact of HIAat central government level internationally, as wellas provide more detailed information about anymodels for integrating HIA at this level which maybe applicable in New Zealand.

In phase two of the project the Committee will scopethe range of possible models and methodologiesfor HIA that could be used and decide which todevelop in detail. Guidelines for carrying out HIAand mechanisms for implementation areunderdeveloped. The Committee will, therefore,carry out a ‘demonstration project’ to test andfurther develop any proposed models to ensure thatthey are both practical and effective in the policydevelopment context.

5 ibid p. 317.

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It has already been agreed that the HIAdemonstration project will look at the healthimpacts of aspects of specific housing policies.

Timetable for completion of the development workand demonstration project is July 2001. TheCommittee notes that the timeframe may need tobe reconsidered if the outcome of Phase one hassignificant implications for the scope of phase twoand the final report.

Contact: Heather McCauley(heather_mccauley@moh.govt.nz)

New Technology AssessmentNew technologies, or new uses for existingtechnologies, are constantly being introduced intothe health sector and can be a significant driver ofincreasing costs. Some new technologies presentexciting possibilities to improve the outcomes andquality of care. Others have limited evidence tosupport their use and may increase costs whileproviding little if any additional benefit.

The Committee has previously maderecommendations on the introduction of newtechnologies in its third and fifth annual reports.Some progress has been made by the HFA to ensuremore systematic introduction of new technologies.However, many new technologies are introduced andsubsequently publicly funded before being carefullyevaluated for their cost-effectiveness and safety.

Appropriate assessment of new technologies isimportant for several reasons:

• some new technologies may improve healthsystem efficiency

• in New Zealand, as elsewhere, there has been atendency for expensive new technologies to beused haphazardly before they have been shownto be effective and appropriate

• they are one (possibly the biggest) driver ofincreasing costs in health care

• decisions about new spending each year, e.g.from the sustainable funding path, are oftenabout new technologies

• difference in their ‘diffusion’ through the sectorcan quickly lead to geographical ineqities inaccess, a situation that could be exacerbated withthe move to DHBs

• DHBs may not have the capacity or skills toidentify and assess new technologies and itwould be unproductive for DHBs to replicate theprocess for similar technologies.

The National Health Committee is to advise theMinister of Health on how the processes forassessing new technologies can be improved toachieve two goals:

• ensure that new technologies are adequately andsystematically assessed before being introducedwith minimal duplication of the process betweenDHBs

• ensure that regional/local differences in accessto new technologies are minimised.

Pressure to introduce new technologies comes froma number of sources including health professionals,increasing consumer awareness and expectations,the use of new technologies in the privately-fundedsector and commercial interests. These all need tobe understood in order to develop a coherentapproach to the issues.

New technology assessment has acquired a negativeimage in some quarters as being concerned withslowing down the adoption of new technologies andover emphasis on cost-containment. In fact, its aimis to promote the wider issue of effectivetechnologies, whether new or old, by discoveringtheir real benefits and costs and so defining theindications for their proper use.

There are three essential elements of an efficientprocess for new technology assessment. These willform the framework the NHC will use to examinehow new technologies are assessed and diffusedthroughout the health sector. They are:

• identification of new technologies in aprospective manner, i.e. ‘horizon scanning’

• a process for systematically assessing the efficacyand cost-effectiveness, as well as the ethical,economic and social implications of newtechnologies

• processes for ensuring that new technologies arediffused throughout the sector in a systematicand equitable fashion.

Work carried out to date indicates that there isconsiderable potential to improve the processeswhereby new technologies are identified, assessedand introduced in New Zealand. There is goodsupport from other agencies for improving NTAprocesses.

Timetable for completion is June 2001.

Contact: Thaw Naing (thaw_naing@moh.govt.nz)

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Services for People withIntellectual DisabilityThe Committee has identified a project to focus ondisability, specifically services for people withintellectual disabilities.

People with intellectual disabilities and theirfamilies or carers are reliant on services and supportprovided at a community level. This includes allpeople with intellectual disability – those who havebeen deinstitutionalised, those who have never beeninstitutionalised, and those still living in a hospital-like setting. There is some evidence for variations

in access to the services available between differentgeographical regions and different livingarrangements.

The Committee is undertaking a project focusing onthe quality and mix of services for adults withintellectual disabilities who need some dailysupport for their living. This project aims to provideadvice to the Minister of Health and the Ministerfor Disability Issues on which services should beavailable in the community and publicly funded foradults with intellectual disabilities.

Contact: stephnie_roberts@moh.govt.nz

THE NATIONAL HEALTH COMMITTEEThe Committee was established in March 1992 asthe National Advisory Committee on Core HealthServices. In August 1992, the Committee’s brief wasexpanded to include advice on priorities fordisability support services. The Committee wasrenamed the National Advisory Committee on CoreHealth and Disability Support Services and becameknown as the Core Services Committee.

In January 1996 the Committee’s brief was extendedagain to include advice on public health and publichealth matters. The Committee is now named theNational Advisory Committee on Health andDisability and is known as the National HealthCommittee.

The National Health Committee is an independentcommittee appointed by and reporting directly tothe Minister of Health. The Committee isadministratively accountable to the Director-Generalof Health through the Deputy Director-General ofSector Policy. The Committee is accommodatedwithin the Ministry of Health and members of thepermanent staff of the Secretariat are employees ofthe Ministry of Health.

The National Advisory Committee on Health andDisability is now established under Section 11 ofthe Public Health and Disability Act 2000.

Public Health and Disability ActDecember 2000“13 National advisory committee on healthand disability

(1) The Minister may appoint a committeeestablished under section 10, to be known as

the National Advisory Committee on Health andDisability, to advise the Minister on:

(a) the kinds, and relative priorities, of publichealth services, personal health services, anddisability support services that should, in thecommittee’s opinion, be publicly funded: and

(b) other matters relating to public health,including:

(i) personal health matters relating to publichealth;

and

(ii) regulatory matters relating to publichealth;

and

(c) any other matters that the Minister specifiesby notice to the committee.

(2) The advice given by the committee to theMinister under subsection (1) is to be formulatedafter consultation by the committee with anymembers of the public, persons involved in theprovision of services, and other persons that thecommittee considers appropriate.

(3) The committee must, at least once each year,deliver to the Minister a report setting out itsadvice on the matters referred to in subsection(1)(a) and (b).

(4) As soon as practicable after giving a notice undersubsection (1)(c) or receiving a report undersubsection (3), the Minister must present a copyof the notice or report to the House ofRepresentatives.

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14 Public health advisory committee

(1) The national advisory committee on health anddisability must establish a committee called thepublic health advisory committee to provideindependent advice to the Minister and to thenational advisory committee on health anddisability on the following matters:

(a) public health issues, including factorsunderlying the health of people andcommunities:

(b) the promotion of public health:

(c) the monitoring of public health:

(d)any other matters the national advisorycommittee on health and disability specifiesby notice to the committee.

(2) The advice given by the public health advisorycommittee is to be formulated after consultationby the committee with any interestedorganisation or individual that the committeeconsiders appropriate.

(3) The Minister must make publicly available, andpresent to the House of Representatives, a copyof any advice given by the public health advisorycommittee.”

Terms of Reference of theNational Advisory Committee onHealth and DisabilityUnder the previous legislation, that is, for most of2000, the terms of reference of the NationalAdvisory Committee on Health and Disability wereas follows.

Key Tasks

The Committee’s main task, in line with therequirements of Section 6 of Health and DisabilityAct 1993, is to provide an independent assessmentfor the Minister of Health of the quality and mix ofservices that should in the Committee’s opinion bepublicly funded within the context of the NewZealand Health Strategy. In doing so the Committeeshould advise the Minister as to whether the currentand proposed public health, personal health anddisability support services funded by the HealthFunding Authority/Ministry of Health are a fair andwise use of resources.

The Committee’s other task, in line with therequirements of Section 6 of Health and DisabilityAct 1993, is to advise the Minister on measures thatwould deliver the greatest benefit to the health ofthe population, and groups of the population, with

particular regard to groups at risk or disadvantage,having regard to available resources.

Under the Public Health and Disability Act 2000 theterms of reference of the National AdvisoryCommittee on Health and Disability are:

Key Functions

The Committee’s key functions are to:

1. Provide an independent assessment to theMinister of Health on the quality and mix ofservices that should, in the Committee’s opinionbe publicly funded, within the context of the NewZealand Health Strategy.

2. Advise the Minister on measures that woulddeliver the greatest benefit to the health of thepopulation, and groups of the population, withparticular regard to groups at risk ordisadvantage, have regard to available resources.

Membership of the NationalAdvisory Committee on Healthand Disability (National HealthCommittee)Membership of the National Health Committee isbroad-based – members bring extensive sectornetworks and other linkages and perspectives toCommittee deliberations. The Committee meetsmonthly to discuss issues arising from its terms ofreference and review progress of the workprogramme against timetable and reportingrequirements.

Robert Logan Chairman (Acting)Maggie BarryJohn CampbellAlthea Page-CarruthTeuila PercivalLyall ThurstonRay WatsonAlistair Woodward

Mason Durie’s term on the National HealthCommittee ended in June 2000. Mason had been amember of the committee since it was formed inMarch 1992 and Chairman since June 1998. In theeight years he served on the Committee its brief hasbroadened from an initial focus on personal healthto include DSS and later public health and publichealth matters.

This wider brief enhanced the opportunities forMason to contribute to the Committee’s work givenhis longstanding leadership in the public healthfield, in particular with respect to Mäori health.Under his chairmanship the Committee’s work

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programme evolved a strong focus on inequalitiesin health and improving health care services fordisadvantaged groups.

Mason brought great insight to the Committee. Withdignity and wisdom – and a sharp sense of humour– he provided an eloquent voice for Mäori healthon the Committee that was highly respected by theCommittee and the wider health sector.

His lengthy contribution is highly valued and greatlymissed.

Robert Logan has been acting Chairman of theNational Health Committee since Mason Durie’s

term finished in June 2000. Robert joined theCommittee in August 1999.

Besides Mason Durie, the terms of Committeemembers Colin Tukuitonga and Bruce Gollopexpired during 2000. Debbie Chin resigned duringthe year to take up an appointment at the Ministryof Health. Their contribution is acknowledged andappreciated.

New members appointed during 2000 were TeuilaPercival and Ray Watson.

Members of the National Health Committee as atDecember 2000

Robert Logan is a specialistphysician and Director ofMedicine at Hutt ValleyHealth with an extensiveclinical and researchbackground as well asexperience in health servicemanagement and is a Boardmember for Health SouthCanterbury and previouslythe Heart Foundation. His particular interestsinclude the ethics and quality of health care deliveryand the impact of medical uncertainty on clinicalpractice.

Maggie Barry is thepresenter and associateproducer of the televisionseries “Maggie’s GardenShow” and a formerpresenter of news andcurrent affairs programmeson New Zealand televisionand radio. She is currentlya member of the board ofthe Worldwide Fund for Nature. She chaired a reviewof New Zealand Maternity Services and is theconsumer representative on the Palliative CareAdvisory Group. She was awarded the ONZM(Member of the Order of NZ Merit) in 1997.

John Campbell is Dean,Faculty of Medicine andProfessor of GeriatricMedicine, University ofOtago. He is ConsultantPhysician in General andGeriatric Medicine atDunedin Hospital. He hasextensive research andpractical experience ingerontology and has been technical advisor andconsultant to several World Health Organisationmeetings on health services for older people andon health research.

Althea Page-Carruthpresently combines apodiatry practice coveringthe Central Otago districtwith the care of her twosmall children. She hasmanagement experience incommunity services in asemi-rural health district inthe UK and also worked asa consultant and educationalist in the health sector.Since coming to NZ she has been course leader forthe podiatry diploma and degree writer at theCentral Institute of Technology. She is currently atrustee for Central Otago Health Trust.

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Teuila Percival is agraduate of AucklandUniversity, who is apaediatrician atMiddlemore Hospital inSouth Auckland. Herparticular areas of interestare Pacific people’s health,child abuse and youthhealth. She is also currentlyVice President of the Pacifika Medical Associationand Chair of the Board of Directors of South SeasHealth Care, a South Auckland Pacific healthprovider.

Lyall Thurston is theNational President ofNZCCS and Chairman of theMinisterial NationalAdvisory Committee onSpecial Education (NACSE).He has extensive experiencein disability, health,education and communityrepresentation. He was adirector from establishment of the Midland RHA anda director of the Transitional Health Authority. Heis a former trustee of the Bay of Plenty CommunityTrust and a past Ministerial representative on thenational board of Workbridge. He is a member ofthe Teacher Registration Board and a former RotoruaDistrict Councillor. He was appointed a Justice ofthe Peace in 1988. He was awarded a QSO(Companion of the Queen’s Service Order forCommunity Service) in 1998

Ray Watson has been the Chief Executive ofLakeland Health Hospital since 1996. He has widehealth sector experience, qualifying as a registeredpsychiatric and thencomprehensive nurse anddeveloping his careerthrough clinical, advisoryand management positions,primarily in Mental HealthServices. Ray has workedwith the Ministry of Healthdeveloping practiceguidelines in mental health,he is a former member ofthe Mental Health Commission Advisory Board, andcurrently serves on the National Health andDisability Sector Safety Standards ManagementCommittee. He is also a director of the NZ MäoriArts & Crafts Institute and the establishment boardof the Ngai Tahu Health & Social Services initiative;He Oranga Pounamu.

Alistair Woodward isProfessor of Public Healthand Head of Department,Wellington School ofMedicine. He has worked inpublic health and clinicalmedicine in New Zealand,Australia and Britain.Particular interests includeenvironmental health,smoking-related diseases and the effects of factorsoutside the health sector (such as income andemployment) on health.

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Secretariat to the National Health Committee as atDecember 2000

Ashley Bloomfield – Manager

Sue Crengle – Mäori Health Advisor

Meg Mackenzie – Analyst

Heather McCauley – Senior Analyst

Judith Mercer – Committee Secretary (on secondment to Ministry of Health from March 2000)

Stephnie Roberts – Senior Analyst DSS (contract/part-time)

Jody Sayers – Acting Committee Secretary and Executive Assistant

Vivienne Smith – Communications Advisor (contract/part-time)

Marjan van Waardenberg – Analyst

Wendy Edgar resigned as National Health Committee Programme Director in January 2000 to take up aposition as health advisor in the Minister of Health’s office. Wendy had been with the Secretariat to theCommittee since it was formed in 1992 and her extensive contribution is greatly appreciated.

Rob Griffiths, Hazel Lewis, Julia Carr and Richard McLachlan left the National Health Committee Secretariatduring 2000. Their contribution to the NHC’s work programme during their years working for the Committeeis greatly appreciated.

NB: The telephone and fax numbers for the National Health Committee changed in December 2000. Thenew contact numbers are:

Telephone (04) 495 4413

Facsimile (04) 495 4401

PO Box 5013

Wellington

This report and all other National Health Committee publications are available on the Committee’s website: http://www.nhc.govt.nz

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Appendix

Individuals and organisations that have made submissions to the NHC on projects reported on in thisAnnual Report:

IndividualsKaren AdamsDr Jim AitkenJacqueline AllenSimon BakerChristine BallElmar BeekmanK. BoulayMeg ButlerLester CalderJill CalveleyMarianne CameronJ A CavanaghKen ClarkeJoy ComleySheryl CorbettDon CoweyPaul DadsonPeter DidsburyDave DixonDr Raina ElleyHorst & Kate ElsenAudrey FentonRuth GerzonIsla N Sue GreenstreetDr Tiwini HemiGinny HintonJack Jackson

Russell KerseLorraine KnutsenSister Monica LandyAndrew LindsayAnne LingardMerian LitchfieldMike LynchSiloma MasinaDr John MeinMichelle MeyerJoy MillarHelen MoriartyJill MowbrayDr Guy NadenDr Pat NgataLysbeth NoblePatrick O’ConnorChris PerkinsDavid E RichmondRichard SainsburyChris SheltonMary StevensLyn TaylorCorrie Van der HulstIunita VaofusiC Ann Whitaker

OrganisationsCCMAUCentre for Rural HealthChristchurch South Health CentreChild and Family Health ServiceChristchurch School of MedicineCollege of Nurses, Aotearoa (NZ) IncCommissioner for ChildrenCompanion Systems LtdCounties Manukau Health CouncilCrown Health AssociationCrown Public HealthCrown Public Health, ChristchurchDept of Oral Health, Otago UniversityDisability Support LinkDPA Palmerston North & DistrictsEIT Hawkes BayElderCare NZElderhealth-Elderwise

A+ Public HealthAccident Compensation CorporationAge Concern NZ IncAge Concern Wanganui IncAlzheimers Foundation (Auck) IncAlzheimers Society NapierAlzheimers Society NZAotearoa HealthArthritis FoundationAT & R Capital Coast HealthAuckland Disability Providers NetworkAuckland HealthcareAustralasian Faculty of Public Health MedicineBay Home SupportBoehringer IngelheimCanterbury HealthCapital Coast HealthCarenet

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Eru Pomare Research InstituteFamily Planning Association NZFar North Area Health ServicesFranklin Community Care CommitteeGoodfellow Unit, Auckland School of MedicineGrey Power ManawatuHamilton East Medical Centre (Pinnacle)Health and Disability CommissionHealth Care AotearoaHealth Care of the Elderly, Healthlink SouthHealth Issues CommitteeHealth Services for Older People, North ShoreHospitalHealth Star PacificaHealth Waikato LtdHealthcare Aotearoa HCAHealthCare HawkesBayHealthcare Independent HospitalsHealthcare Otago LimitedHealthlink South LtdHFA AucklandHFA Central OfficeHFA Christchurch OfficeHillary CommissionHome Care Services Thuiszorg IncHome Health Care ServicesHome Support mid/far northHutt Union & Community Health ServiceHutt Valley HealthIHC National OfficeIPCSLangimalie ClinicManawatu Age Concern Council (Inc)Mangere Health CentreMangere Health Services TrustMäori Health CommissionMental Health CommissionMental Health Services for Older PeopleAuckland Healthcare Services LtdMESAMid Central HealthMinistry of HealthMinistry of Women’s AffairsMPON Z BranchThe Thoracic Society of Australia and New ZealandNational Council of Women of New ZealandNelson HospitalNelson Independent Nursing Practice LtdNelson Marlborough Health ServicesWairau HospitalNew Traditions, Health WaikatoNewtown Union Health ServiceNga Ngaru Hauora O AotearoaNgai Tahu Development CorporationNgai Tahu, Maori Health Research Unit

Ngati Porou Hauora IncNorthland Health LtdNZ Coalition for Public Health (Inc.)NZ Geriatric SocietyNZ Gerontology AssocNZ Rural GP NetworkNZAONZMANZNOOtara Union Health CentrePacific Health LtdPalmerston North Community Health GroupPapanui Medical CentrePegasus IPAPegasus Medical GroupPharmacy Guild of NZ IncPlanning and Environment Committee, DunedinCity CouncilPlatformPorirua Community Health Group & Porirua HealthPartnershipPorirua Union Health ServicePresbyterian Support (East Coast)Presbyterian Support (Upper South Island)Primary & Community Health Services, PH Unit,Northland HealthProcarePsychiatrist Services for the ElderlyPalm Nth HospitalPublic Health AssociationResidential care NZ IncRNZ Plunket Society IncRNZCGPRodney Health TrustRotorua Community Hospice TrustSeaview HospitalSouth Auckland HealthSouth Auckland Integration pilotsSouth Auckland Primary Care ServicesSouth Seas HealthcareSouthern HealthSpectrum CareStrathallan Rest home (1997) LtdTaupo HospitalTe Hauora O Te Tai TokerauTe Puni KokiriTe Roopu Awhina o Whangarei TrustTe Runanga O Nga Mata WakaTe Tai Tokerau MAPOThe Doctors IPA, Northland HealthThe Elder Care Canterbury ProjectThe Royal Australasian College of PhysiciansThe Thoracic Society of Australia and New Zealand,NZ Branch IncThe TreasuryTimaru Hospital

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Unitec Institute of TechnologyUniversity of AucklandWai-HealthWaitaki District Health ServicesWaitemata HealthWDFFWellington Multiple Sclerosis Society

Wellington School of MedicineWestkidsWhitireia Community PolytechnicWIPA LtdWoman’s Health ActionWork and Income New Zealand