NHB eNewsletter - April 2011

"Better, sooner and more convenient care from a unified and sustainable public health system."

• From the Chair
• From the Director's Desk
• The role of primary health in 'better, sooner, more convenient' care
• Integrated Family Health Centres improve patients' access to primary care
• Health of Older People initiatives underway
• Success Story: Whanau Hauora cervical screening promotion a success
• Nine million to support increased elective services
• New Zealand Disability Strategy - ten years on
• Long Term Health Sector Plan update
• Regional Service Plan update
• Health Workforce New Zealand update
• IT Health Board: Launch of Auckland Shared Care Plan
• About this Newsletter

From the Chair

New Zealanders expect to get quality health and disability services when they need them, so we need to improve sector performance from the resources made available.

Improved performance is starting to show through in the priority areas identified by the Government: the six health targets.

This focus on specific Health Targets is clearly paying off. New and ongoing initiatives are making a positive difference to the performance of District Health Boards (DHBs) and the services they provide.  This in turn translates to better, sooner, more convenient health care.

In 2010 nationally:

• 400 more patients a week got elective surgery which represents a 19% increase from 2008
• 100% of patients received cancer radiation treatment within 6 weeks,  this includes waiting times being decreased from 8 to 6 weeks and an increase in number of people receiving treatment within the recommended timeframe. In 2008 97% of patients received treatment within 8 weeks
• 88% of patients in Emergency Departments were seen and either admitted, discharged or transferred within the target time of 6 hours
• Immunisation rates in children increased by around 15% when compared to 2007, reaching record levels. Of particular note, increases for Maori (19%) and Pacific (17%) children exceeded the average
• There has been a 300% increase in the use of nicotine replacement therapies when compared with 2007
• More DHBs have achieved their targets for ensuring eligible people get their free annual diabetic check
• Cardiovascular disease risk assessments increased to 73% of eligible population, which means more people are having risk assessments

Over recent weeks the National Health Board (NHB) and Ministry of Health have published a number of ebooklets which focus on how progress towards Health Targets benefits New Zealanders.

Health Targets are an important barometer of the progress being made within the health system, progress that improves access to health care and the quality of life for those who need it most.

Health Targets provide a clear and specific focus for action, and transparency around those targets helps to make DHBs more accountable to their populations for the services they provide.

Some DHBs are performing more strongly than others in reaching these Health Targets. While the NHB and the Ministry are tasked with supporting DHBs to improve, performance improvement is everyone's job. Better performing DHBs should be working with their neighbours to help them to reach their Health Targets.

Clinicians also have a key role to play.  It is very encouraging to see the way clinicians around the country are working together to improve the care provided to New Zealanders in our key Health Target areas.  There are many examples where the sharing of clinical best practice is helping DHBs to improve services.

The process of changing the way we work to improve quality and efficiency, challenges the ingenuity and creativity of DHB clinicians and managers. This ongoing challenge is made more urgent by the current fiscal environment.

If we are to improve the performance of the health sector as a whole then we need to build on this collaboration, increase our regional focus on delivering services, and accelerate the sharing of best practice across the whole health system.

Dr Murray Horn, Chair

From the Director's Desk

With winter approaching the health and disability sector is preparing for an expected increased demand for health services in Canterbury.

There are additional challenges arising from February's earthquake this winter for the Canterbury community.

Damage to housing, sewerage and water will be keenly felt and is likely to see Canterbury health and disability staff and facilities stretched to capacity.

This situation will be exacerbated by damage to public and private health and disability facilities throughout Christchurch including rest homes, GP practices and Christchurch Hospital.

Planning is currently taking place to manage this influx which is likely to impact widely on the sector from community, primary and secondary care services to mental health, disability and older persons' health.

It is important to remember that all those working in the health and disability sector, whether in paid employment or volunteer roles, have been greatly affected by the earthquake and are under the same stress and pressures as the rest of the community.

The health and disability sector in Canterbury is continuing to do an outstanding job in very challenging circumstances.

There has been a tremendous response to the earthquake from the entire sector nationally and as we approach winter I look forward to this support throughout the months ahead.

During this time I will ensure that I keep you updated about the situation in Canterbury and look forward to your continuing support.

Chai Chuah, National Director

The role of primary health in 'better, sooner, more convenient' care

National Health Board member Dr Bev O'Keefe is now based in Wellington, but spent 30 years as a partner in a three-doctor general practice in Rotorua.

Following three years as deputy chair of the Independent Practitioners Association Council of New Zealand(IPAC) she became Chair in 2006. Since February 2009 she has held additional executive roles, and has continued as Chair since IPAC joined with the General Practice Nursing Alliance and rebranded in February 2010 to become General Practice NZ. Here she discusses the role of primary health in 'better, sooner, more convenient' care.

'Better, sooner, more convenient' care is about the health sector operating as a single system delivering services closer to home, and centred on the needs of the patient. The role of the National Health Board is to remove as many barriers as possible to help clinicians and health care sector management work together to embrace these changes.

Barriers may be at many levels - at the DHB level, or with health professionals uncertain about change, or related to the way services are currently funded and contracted.

Patients need to be cared for in hospitals only for conditions that cannot be managed outside hospital, which means we need to have a non hospital-based sector able to offer a wider range of services.

Some things currently being done in hospital can be done very well in community settings, and some things that, historically, have been done by a GP, may well be better done by a practice nurse or another member of the health care team.

However, the reality is we are faced with a workforce that's under significant pressure, and we're going to have to look at smarter ways of working to ensure the right people are doing the right job in the right place.

We know that people within the health sector, and particularly within the non hospital-based sector, have huge capacity for innovation, and that there are some fabulous projects, programmes and models in place in many areas around the country.

One of the things we want to do is facilitate a process where these good ideas can be shared across the wider health sector. This may require new ways of relating to one another within the health sector. Change is happening, but we cannot reform relationships overnight.

I'm pleased to say that more conversations are already occurring between professional groups, such as GPs, pharmacists, hospital doctors, and midwives.

One of my priorities is to look at what the Board is able to do to break down barriers so that these conversations can translate into more co-ordinated services for the benefit of patients.

These are small beginnings, but this is all about reforming, reframing, and building new relationships. And it's really exciting when you're committed and you open doors to discover that the people on the other side are really keen to talk to you.

Dr Bev O'Keefe, NHB Board member

Integrated Family Health Centres improve patients' access to primary care

Three new Integrated Family Health Centres (IFHCs) and a Patient Access Centre (PAC) in Hamilton are providing patients with flexible ways to access their health care team, and ensuring those teams have the time and resources to provide appropriate care.

The NorthCare IFHCs were officially opened this month by the Minister of Health Hon Tony Ryall, who congratulated the clinicians at the three centres and the operator, Midlands Health Network, saying it put them 'at the forefront of transformational changes happening in primary health care'.

IFHCs bring together a variety of health professionals, diagnostic and other services in larger community health facilities to deliver more flexible and sustainable primary health care.

The three NorthCare IFHCs are part of the Midlands Health Network, a team of more than 100 general practices delivering health care to nearly 500,000 people in the East Coast, Coromandel, Waikato, Taupo, King Country and Taranaki.

The development of the three IFHCs was one of nine business cases selected to receive funding to implement 'Better, Sooner, More Convenient primary care'.  Successful applicants had to match the funding.

Midlands Health Network CEO John Macaskill-Smith says more IFHCs are planned, with the aim of creating more accessible and sustainable primary health services, and reducing demand on hospitals.

"We'll be able to better manage demand and reduce the number of patients who develop long-term chronic illnesses by improving the way their conditions are managed and, when it's appropriate, using phone and email as an alternative to face-to-face consultations."

All incoming phone calls for NorthCare's 16,500 patients are now managed by an off-site patient access centre. "This is staffed by a St John trained health care team which provides a single point of contact for patients to get in touch with an expanded general practice team," he says.

They establish what the call is about and may give immediate assistance, book the patient in for a face-to-face consultation with the most appropriate member of the health care team, or perhaps arrange for the GP to call the patient at an agreed time.

Mr Macaskill-Smith says sometimes a patient's issue can be resolved immediately at no cost to them by having a quick phone conversation with their doctor, who will have access to the patient's notes and a script of their conversation with the patient access centre. Patients can also contact their primary health team directly by phone or email.

"We've developed IT platforms so that all health providers involved in the patient's care can access their information, and patients can access their own health information online 24/7 via the www.itsmyhealth.co.nz website.

"Patients can update things like their blood pressure, height and weight, and even take these readings themselves at specially designed self-service kiosks," says Mr Macaskill-Smith.

When it's appropriate, lab tests can be organised before a face-to-face consultation, so that when the patient comes in, the doctor already has the results to help with the diagnosis and treatment plan.

"We want to make better use of patients' time so they don't have to come in as often, and make better use of the resources within the practice" says Mr Macaskill-Smith.

NorthCare's Clinical Director, Dr John Morgan has been involved with the move to IFHCs from the beginning and thinks the model is 'fabulous'.

He says giving patients access to their health information is a huge change.

"It gets away from the old paternalistic system and encourages responsibility around the accuracy and usefulness of the information, because if a patient can't understand something, they'll be phoning or emailing me about it.

"Our new model respect patients' time," says Dr Morgan. "They'll only have a face-to-face visit if it's appropriate, and there'll be preparation for it on their behalf beforehand so they get better value out of it.  We're culling the things that can be done remotely, which enables us to spend more time with the patients who really need face-to-face care, and that means I can do a better job."

For more information go to https://provider.midlandshn.health.nz/clinical//pmwiki.php

Health of Older People initiatives underway

A number of initiatives are underway to address the projected increase in demand for health and support services from New Zealand's aging population.

In January, the Minister of Health, Hon Tony Ryall, sent a 'Letter of Expectations' to all District Health Board (DHB) Chairs outlining the key areas they were expected to focus on during 2011/12 to meet the impact of our aging population on health and support services. These included:

• improving older people's underlying health and wellbeing - particularly in the areas of mental health, dementia and preventing disease and injury
• building better systems - including using standardised monitoring and audit tools to improve quality across home-care and aged residential care 
• providing new and expanded services - concentrating on dementia, and primary and community care improvements to avoid hospital admissions
• supporting family/whanau - in particular, provision of and access to respite care, day programmes and social support
• engaging in next steps to work on the recommendations of the 2010 aged residential care review.

While the country's population as a whole is expected to grow by around 20 percent to five million by 2026, it's estimated the population aged 65 and over will increase by 84 percent. As a result of this aged population growth, Treasury estimates that by 2051 expenditure on older people will consume more than 60 percent of the total health budget.

Arawhetu Gray, Acting Manager, Populations Policy Group, says a lot of work is underway to look at how integrated programmes (that provide a range of care, from independent living to full residential care for older people) can be funded and delivered.

The integrated programmes focus on "workforce development, including, clinical and residential care. Home-based support workforces are also being looked at, along with the need for more flexible approaches to how the additional funding provided for respite care can be used to support carers" says Arawhetu.

A recent development already improving the care of older people's health is the increasing use of InterRAI, a clinical personal assessment tool for aged residential care facilities, which is internationally recognised and comprehensive.

InterRAI software takes into account all of an older person's medical and social conditions to guide aged care assessors to develop comprehensive clinical assessments for individuals.

Success Story: Whanau Hauora cervical screening promotion a success

The National Kapa Haka Competition, Te Matatini o te Ra, might seem an unlikely place to promote cervical screening but in many ways it turned out to be the ideal venue - beautiful waiata and a "back to nature" setting.

The promotion was part of a PHARMAC-sponsored health village, or Whanau Hauora, housed in a huge marquee on the competition site.

Cervical Screening Health Promoter, Aroha Te Hau, was part of the team from Tairawhiti District Health Board who, along with other health providers, was invited by PHARMAC to use the Gisborne event as an opportunity to promote their individual services. Also on offer were diabetes and heart checks, smoking cessation and nutritional advice 

'It really worked,' says Aroha. 'Wahine were very interested and responsive. Many came in to check their smear status on the National Cervical Screening Programme Register, which created a lot of interest and engagement.'

As well as the Wahine Ora section, offering smears and diabetes checks, there was a Tane Ora service where men could get heart checks and Plunket offered child health and parenting advice.

'The vibe was all about action. Everywhere you looked people were having checks for this and that and talking about health.'

Aroha says care was taken to make the Wahine Ora section a visually appealing, private space where women felt safe and comfortable.

'The area was beautifully laid out with solid partitions and pongas, and very caring women meeting and greeting them.' 

Over the four days, 155 women visited the screening area, checked their smear histories and other relevant information and 20 had a smear taken. Aroha believes this was a great result but she thinks more smears could have been done. 

'It was a learning experience. We had two nurses available to take smears but they were also doing diabetes checks and heart checks in the men's health section so weren't always available when the women were.'  In future, Aroha says they'd have dedicated smear takers because the interest was certainly there. Her advice for others wanting to capitalise on a cultural or recreational gathering to promote cervical screening?   'Go for it. It's all about taking the service to the people and it really works.'

For more information about cervical screening and other programmes managed by the National Health Board's National Screening Unit.

Nine million to support increased elective services

Nearly $9 million is to be given to 13 District Health Boards over 2010-12 to fund 30 projects supporting increased elective surgery.

Across all the projects, Key Performance Indicators (KPIs) have been agreed with the NHB and put in place by the DHBs involved to help maintain a focus on long-term, sustainable improvements in elective surgical productivity.

The KPIs will contribute significantly to District Health Boards' (DHBs) efforts to reach the Government's target of an increase by an average 4000 discharges per year, compared to the previous average increase of 1400 per year.

The approved projects cover a range of initiatives such as operational and management efficiencies, redesigning patient pathways and revising peri-operative techniques. The flow-on benefits for patients will include improved and more patient-responsive planning and progress along the patient pathway, fewer cancellations, and smoother discharges after treatment.

The projects were selected by an Evaluation Panel that included clinical leaders in the health sector and was endorsed by the Programme's sector-led Steering Group.

Funding has been granted to eight DHBs to implement The Productive Operating Theatre (TPOT) programme. This programme focuses on optimising the management and infrastructure processes fundamental to the running of each operating theatre. The programme will enable fewer surgical cancellations and greater cost efficiencies.  Six DHBs have already started the TPOT programme, and the remaining two will start within the next few months.

Clare Perry, Manager, Elective Services says that, "A number of themes emerged out of the process which showed DHBs are considering and adopting international best practice when this is appropriate.  Clinicians and health board managers are taking the initiative to implement ways to enhance patient experience and overall elective surgical productivity."

Ten DHBs will undertake a redesign of their pre-admission procedures, focussing on care and discharge planning, more efficient use of specialist clinical anaesthetist time, and greater patient engagement in the process.  These redesigned pre-admission processes may focus upon one or a selection of services, but the commitment is to roll them out across many of the DHB's elective services.

Waitemata and Counties Manukau DHBs are working together in the development of Enhanced Recovery After Surgery pilots. Up-skilled nursing staff will support patients through treatment with a focus upon post-operative planning and care. This focus will enable an easier discharge for the patient, while maintaining patient safety standards.

New Zealand Disability Strategy - ten years on

After ten years since the New Zealand Disability Strategy (NZDS) was launched it retains its drive and uniqueness.

Disabled people say that the vision and its supporting objectives of having an everyday life remain as vital to them today as in 2001.

The key to the Strategy's popularity was its early development through partnership between the Ministry of Health and disability sector organisations.  Its vision is for disabled people themselves to say they live highly valued lives and fully participate in society.

"The NZDS sets out a number of key objectives critical to attaining an inclusive society", says Anne O'Connell, Group Manager Disability Support Services Group. "These include supporting families and whanau, promoting the participation of Maori and Pacific disabled people, and providing flexibility, choice and high quality support options."

The success of NZDS was recognised internationally in 2005 when New Zealand was elected to chair the United Nations Convention on the Rights of People with Disabilities. Together with the 2007 UN Convention, the NZDS provides a strong guiding framework focused on removing barriers to disabled people living everyday lives.

"The last ten years has seen the closure of the last large scale institution housing disabled people in NZ, increased cross-government collaboration and increased participation of disabled people in the planning and delivery of support services", says Anne O'Connell.

"But there's still a long way to go to achieve the objectives of the NZDS and a fully inclusive society."

The Disability Support Services Group within the National Health Board is tasked with the planning and delivery of Ministry of Health funded disability support services.

Long Term Health Sector Plan update

The National Health Board (NHB) is continuing to develop the Long Term Health Sector Plan (LTHSP).

The LTHSP will outline the future direction for public health services, focusing on service planning and new models of care in line with international trends.

It will provide high-level direction over the next 20 years and describe the challenges the sector faces and options for models of care that offer solutions and implications for the way services are configured in the future.

The next draft of the LTHSP is well underway and has been supported and guided by recent discussions with some invited sector clinical representatives and attendance at some sector meetings during March. 

National Health Board (NHB) Acting Director Planning and Analysis, Michael Johnson, says, "The feedback received from these discussions provided very useful input to our next draft, building on the input that we received from sector representatives at the end of last year".

"One of the positive aspects that I have taken from these discussions is the strong support for this work.  We are keen to engage and talk with as many sector groups as possible over the coming weeks.  So if this is of interest to you then please let us know. 

"The intention is that the LTHSP should guide, not determine, future decisions across all levels of the health system regarding service configuration and investment to proactively consider future challenges and ensure timely responses," Michael says.

The LTHSP draft document will be considered by the NHB at its next meeting at the end of this month, and also again at the end of the May.  The aim is to present a final document for the Minister of Health's consideration by the end of June 2011.

"I see this as being an ongoing programme of work across the health sector.  One thing we know is inevitable and that is change, and the LTHSP will need to be refined and further developed over coming months and years to respond to the changes that will take place across the health sector" says Michael.

Regional Service Plan update

The National Health Board (NHB) has now received draft Regional Service Plans (RSPs) from three of the four District Health Board (DHB) regions. 

NHB Acting Director Planning and Analysis, Michael Johnson, says "We have received draft RSPs from the Northern, Midland and Central regions.  The DHBs across these regions have worked collaboratively over the last few months to put together these plans and should be congratulated on their work to date". 

Michael adds that "the process has seen DHBs creating draft plans with actions leading to positive, practical and progressive change in the health sector.  The focus over the next few weeks is to review the draft plans, provide feedback to DHB regions and then to continue working collaboratively with DHBs to ensure that progress is made on the actions that they have identified in their plans".

The South Island region will be submitting its RSP to the NHB in early/mid May.  The South Island RSP will focus its attention on actions across the region to assist and support Canterbury recovery following the recent earthquake. 

The Minister of Health will approve all RSPs in June.

Health Workforce New Zealand update

On Thursday 7 April, at Auckland District Health Board, the Minister of Health launched the four demonstration sites for the diabetes nurse prescribing project.

For the first time suitably qualified nurses, other than Nurse Practitioners, are able to prescribe medication for their patients.

It is expected this role will result in greater continuity and less complexity of care for patients, as well as reducing pressure on health practitioners. It will also assist patients by reducing the need for a second appointment for routine prescriptions.

The four demonstration sites are Hawke's Bay, Mid Central Health, Hutt Valley and Auckland DHBs. More information about the project is available on the Health Workforce New Zealand (WHNZ) website

The first tranche of workforce service reviews - in eye health, palliative care, aged care and anaesthesia, have reported their findings and recommendations to the HWNZ Board.

The reviews, being overseen by HWNZ and driven and managed by clinicians across the country, have the potential to deliver some of the most significant shifts in how health services are delivered for decades.

Members of the review teams have demonstrated exceptional leadership, commitment and trust, fostering new and collaborative thinking about more effective delivery of patient-centred service.

The ideas and recommendations emerging from the reviews will influence HWNZ's investment strategy, leading on to longer term changes in workforce training, development and skill mix.  Their insights also provide an opportunity to shape NHB service planning. More information about the workforce service reviews is available on our website.

20 DHB General Manager Human Resources group. The portal is designed to complement and support local/regional DHB recruitment processes, being a "front door" to all public health sector vacancies.

We will be working with DHBs on building the national health job portal over the coming months including promoting health workforce development activity and jobs in rural or hard to staff areas. You can visit the website here.

IT Health Board: Launch of Auckland Shared Care Plan

The Minister of Health, Hon Tony Ryall recently attended the proof of concept launch for a National Shared Care Plan Pilot for Long Term Conditions.

General Practitioner Dr Neil Hefford from Grey Lynn Family Medical Practice is running the concept in partnership with the National Health IT Board and the Northern Region (Auckland, Counties, Waitemata and Northland) DHBs.

Dr Hefford was able to enrol his first patient in the share care system in February directly from his Practice Management System. Dr Rob Doughty, of the Auckland DHB Heart Failure service, was able to access the patient's record, schedule an appointment for him, review his medications and notify his GP, Dr Hefford, all through the shared care plan system. In addition to supporting a multidisciplinary approach, the shared care plan was developed with the patient and includes self management activities he will undertake to manage his condition.

Dr Janine Bycroft, co-clinical champion for the pilot with Dr Doughty, recognised the importance of this initiative in coordinating the delivery of healthcare services and has arranged for the project to be presented at the Australasian Long-Term Health Conditions Conference in Auckland this month.

The goal is for shared care plans to be accessible by the patient online and shared with the wider team (across both primary and secondary care) to strengthen decision making. A common record and plan enable integrated multidisciplinary care teams to coordinate care across boundaries with the patient as a central member of the team.

The Auckland proof of concept is expected to continue for 2-4 months while three other pilots are established in other DHB areas.  These pilots will expand the use of shared care plans to over 1,000 patients. They will also provide further learning and refinement to ensure future regional rollouts meet sector needs and to improve clinician understanding of shared care planning.

National Health IT Board Director, Graeme Osborne, describes the proof of concept as "the very first step towards a shared care record which is fundamental to the eHealth vision - to have core personal health information available electronically to patients and their healthcare providers regardless of where services are provided."

About this Newsletter

This newsletter is published by the National Health Board. To join or unsubscribe from the mailing list please email enquiries@nationalhealthboard.govt.nz

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