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

• From the Chair
• From the Directors Desk
• The New Zealand Public Health and Disability Amendment Act 2010
• The Move to Regional Planning
• Input Required on Planning Package 2011/12 Documents
• Clinical ED Role all About Making it Better for Patients
• National Health Board to Assist Service for Rare Skin Disorder
• Health Workforce Update
• IT Health Board Update
• About this Newsletter

From the Chair

Welcome to the first issue of the National Health Board's electronic newsletter.

Real progress is being made by the health and disability sector on a number of fronts and I would like to highlight some of these successes.

This year District Health Boards (DHBs) are aiming to have 140,000 elective surgical discharges, up from 117,900 in 2007/08, 87% of DHBs are meeting the emergency department shorter stays wait times health target  and the number of doctors and nurses in public hospitals is increasing.

Ministry of Health establishment positions have decreased and are continuing to do so, and the growth of administration and management numbers in DHBs has been halted.  

We are starting to see a sustained improvement in clinical and financial performance, part of which is due to an increase in productivity and a greater emphasis on moving resources from the back office to the front line.

I expect this progress will accelerate as we move towards greater collaboration by DHBs, and start to see the impact of the groups created in response to the Ministerial Review Group (MRG) recommendations.

Much of the National Health Board's (NHB) focus in the past year has been on the changes necessary to create a more unified health and disability sector, with much more focus on regional collaboration and on the alignment between service planning and the various aspects of capacity planning (workforce, IT and facilities investment).

The MRG looked at the many challenges facing the public health and disability sector and made recommendations about how to ensure New Zealanders could continue to have affordable access to a strong public health and disability system.

The recommendations of the MRG report focused on two areas:

• Encouraging changes in culture and processes, for example, promoting greater clinical leadership and engagement in decision-making and improving the integration of primary and hospital-based care, and
• Changes in structure aimed at: reducing waste and bureaucracy, improving safety and quality, and enhancing clinical and financial viability

The NHB was formed 12 months ago with strong sector membership  and terms of reference and agreed on a charter to guide its decision making. The Chairs of the Health Workforce New Zealand (HWNZ), National Health IT Board (NHITB) and Capital Investment Committee (CIC) groups are members of NHB and these groups are serviced out of the NHB Business Unit to ensure our efforts are closely coordinated

Key highlights from the HWNZ and NHITB boards are outlined later in this newsletter.

The CIC, has been formed as a sub committee of the NHB to develop a new centrally-led process for the national prioritisation and allocation of health capital funding. The CIC's Capital Investment Guidelines will be available soon. They herald a more transparent process that will take a long-term, service driven view that places far more emphasis on national and regional priorities.

We have also been involved in the creation of Health Benefits Ltd (HBL) and the Health Quality and Safety Commission (HQSC). HBL has the task of saving up to $700m over five years from non clinical support functions so savings can be transferred to further strengthen frontline care. HQSC aims to accelerate safety and quality improvements that will benefit patients as well as reduce cost.

It is important that the sector plans, funds and delivers services at the right level, whether that be national, regional or district.

The passing of the New Zealand Public Health and Disability Amendment Act 2010 will better enable the sector to accomplish this and the NHB has completed a draft Planning, Funding and Accountability Framework for DHBs to help implement the new environment. This framework is now being communicated to DHBs ahead of the annual planning package.

To tie together this work over the 20 year term, we are in the final stages of putting together a draft Long Term Health Sector Plan. This plan will set the future direction for public health services focusing on new models of care and allowing a greater emphasis on self care and primary care.  DHBs will have the opportunity to contribute to this plan in the New Year.

In addition, we have identified vulnerable services to become national services or national service improvement programmes and have begun working on their implementation.

We are also supporting clinical networks and are about to give feedback to DHBs on their inaugural Regional Service Plans.

We are starting to make real progress and should be increasingly confident that we can work together to meet significant increases in forecast demand, to continue to improve health outcomes and to reduce disparities of access - all within an overall growth in health expenditure that is more in line with what the economy can sustain.

Dr Murray Horn, Chair

From the Director's Desk

This newsletter will become a regular part of the National Health Board's effort to engage with the sector about what it is doing and why.

While we will continue to focus on face-to-face meetings with sector and consumer groups, we also need to communicate our messages more broadly.

We have launched our website www.nationalhealthboard.govt.nz and have a fledgling presence on Facebook and Twitter.

Over the coming months a great deal of the foundational work we have been involved in will begin to see results as we move towards the implementation of the New Zealand Public Health and Disability Amendment Act 2010 and focus on regional planning by DHBs, sector input into the Long Term Health Sector Plan and implementing new National Services.

I am committed to increasing our engagement and communication over the next year and to ensuring it becomes an even stronger focus for us. I look forward to talking to many of you during this time.

If you would like to ask questions, raise issues or make comments to us then please feel free to e-mail me at enquiries@nationalhealthboard.govt.nz attn; Chai Chuah or to engage with us on our new Facebook site.

Chai Chuah, National Director

The New Zealand Public Health and Disability Amendment Act 2010

The Government has passed the New Zealand Public Health and Disability Amendment Bill to help meet the many challenges faced by the public health and disability system.

The Act provides the statutory framework for the National Health Board and DHBs to establish a more deliberate approach to deciding which services should be planned, funded and provided at the national, regional and local levels and put a much stronger emphasis on DHB collaboration to plan health services regionally.

Chai Chuah says the changes in the Act and its regulations are designed to support better planning across the sector.

"The Act requires DHBs to work together in the planning and coordination of resources, so these resources are used in the most effective way."

The Act at a glance:

The New Zealand Public Health and Disability Amendment Act 2010:

• Includes a duty to work together for the most effective and efficient delivery of health services in the objectives and functions of DHBs
• Amends planning requirements for DHBs to include a planning and accountability framework to support more collaborative planning
• Enables the appointment of elected DHB members to the boards of other DHBs, to enhance collaboration
• Includes provisions to support shared administrative, support, and procurement services, including additional powers such as ministerial direction to require greater system collaboration
• Amends the regulation-making powers relating to arbitration and mediation
• Establishes a new Crown agent, the Health Quality and Safety Commission, to promote improved quality in the sector

The Move to Regional Planning

The National Health Board (NHB) is supporting District Health Boards (DHBs) to put in place regional plans. These plans will be at the heart of increased collaboration by DHBs.

These plans will outline where each DHB region aims to be in five to 10 years and will include current and future population characteristics, models of care, and the optimum configuration of services. Strategic planning will now occur at the regional, rather than district level.

Each plan will be signed by the contributing DHBs and all plans are subject to the Minister of Health's agreement, to ensure clear accountability for delivery.

An annual plan will still need to be produced at the district level and will need to incorporate a DHB's responsibilities at the regional level and the services it is delivering at the district level.

To help reduce the reporting burden on DHBs, it is proposed that the annual plan integrate its statement of intent and the annual plan into a single plan.

The NHB will prepare resources, such as planning templates and guidelines, to assist DHBs with planning and make the process easier.

Regional meetings have begun between NHB staff and DHBs to provide high level feedback on draft regional plans. These will be followed up with more detailed written feedback with the plans to be finalised by early March.

Further detail about the NHB's initial view of the planning, funding and accountability framework is in the document Health Sector Framework: An outline of the intention of legislative and regulatory changes.

Input Required on Planning Package 2011/12 Documents

The National Health Board is working with District Health Boards (DHBs) to get input and advice on the components of the which includes the Annual Plan, Operational Policy Framework and Service Coverage Schedule.

Once comments are received, an External Reference Group and the National Health Board (NHB) will work to incorporate feedback into the draft Planning Package, with the Ministry of Health's Executive Leadership Team scheduled to consider the Planning Package on Monday 15 November.

During this process, the NHB is attending regional planning workshops being hosted by DHB Planning and Funding Managers.

The NHB will consider the entire Planning Package at their board meeting scheduled for Thursday 25 November, with a national planning workshop scheduled for Thursday 2 December.

Release of the full Planning Package is scheduled for Friday 3 December.

Clinical ED Role all About Making it Better for Patients

The emergency department shorter stays target is an important indicator of the health of a hospital.

The National Health Board (NHB) monitors health targets and works with Ministry of Health target champions and District Health Boards (DHBs) on improving performance.

Professor Mike Ardagh says his role as the Ministry's Clinical Leader Emergency Department Services is all about improving acute care so emergency department patients have as little discomfort and inconvenience as possible.

"The role, established when shorter stays in Emergency Departments (EDs) become one of the six health targets, is quite broad. But it boils down to providing people who come to ED, with the best possible care, in an acceptable timeframe."

Professor Ardagh, who is based at Christchurch Hospital*, says emergency departments have excellent individual clinicians and teams of clinicians and are well supported by top-notch non-clinical staff - "as good as anywhere in the world, and better than most".

However, he says the challenge is ensuring the patient journey between teams is as seamless as possible.

"Patients receive care from multiple teams, and deficiencies in acute care are mostly to do with the transitions between these teams. Patients sometimes wait during these transitions and this leads to 'back ups' particularly in the emergency department, meaning it takes longer for patients to receive the care they need.

"We know this is bad for patients' experience and outcomes."

He says a number of contributing factors are unearthed if the delays are examined.

"These include duplication, communication problems, outdated systems, wide variation in care, insufficient capacity, and bottlenecks in patient flow - slowing the whole patient journey.

"The first challenge is to examine the patient journey from a perspective which reveals these problems across the whole continuum, and then to have a commitment to resolve them in order of importance, without being constrained by traditional practices or professional or speciality boundaries."

Professor Ardagh says it is pleasing to see the advances being made in some emergency department services, and in acute services in general.

"In some DHBs the best pathways for care of patients are being negotiated among clinicians.

"Of course, this is for the benefit of our patients, but governance of the whole patient journey by the clinicians the patient sees along that journey, inevitably will make for a more satisfying day at work."

He believes clinical leadership is vital to achieve the necessary improvements to acute care.

"Clinical leadership enhances the understanding of acute care, and improves engagement with both clinical and non-clinical staff in DHBs.

"Within DHBs, we need to continue to see leadership by clinicians, and collaboration among them, and this needs to be well supported by a management structure which gets things done."

Health target: Improving access to emergency departments

• The Government's aim is for 95 percent of patients to be admitted, discharged, or transferred from an emergency department within six hours
• Each year nearly one million New Zealanders visit emergency departments
• Emergency Departments are on the frontline of healthcare and it is important they operate well so New Zealanders get the care they need without long waits
• In the 2009/10 year, 87 percent of DHBs achieved the target
• The target is important as it is an indicator of the efficiency of the entire hospital, and the flow of acute (urgent) patients through the hospital, and home again
• The target requires the whole hospital system to be working well, not just emergency departments.
• Although the target measures time spent in the emergency department, it tells a wider story of performance because emergency department stays are influenced by the availability of community care and by the ability of the rest of the hospital to receive patients who have finished their emergency department care

*Mike Ardagh is Professor of Emergency Medicine at the University of Otago, and Specialist in Emergency Medicine at Christchurch Hospital.

National Health Board to Assist Service for Rare Skin Disorder

The Government recently announced it is to fund specialist nurses to support the treatment of the debilitating skin condition, Epidermolysis Bullosa (EB).

The National Health Board (NHB) has arranged for three specialist EB nurses to be employed through Capital and Coast DHB and located at Auckland, Wellington and Christchurch. They will provide clinical advice when a new baby is born with EB, manage ongoing care and support local medical professionals.

EB is a rare genetic skin disease in which blistering and shearing is caused by even the gentlest friction such as touch, clothes rubbing, sucking and even swallowing food. Severe EB requires special protective dressings and hours of wound care and bandaging every day using techniques and products that avoid any friction on the skin.

It is a debilitating condition which can have an enormous impact on sufferers and their families. Many people with EB live very restrictive lives because their skin is so fragile it can blister or break down at the slightest touch.

For eight years the agency supporting New Zealand's 120 EB sufferers, the Dystrophic Epidermolysis Bullosa Research Association (DEBRA) New Zealand, has funded two part-time EB specialist nursing positions. However, following a decline in fund-raising income this essential service was in danger.

"I am pleased that the National Health Board has been able to take a role in ensuring the future of this important service," NHB member and Paediatrician, Dr Jeff Brown said.

"EB is very rare and many doctors and nurses have no experience with the condition. These specialist nurses will ensure expert guidance for families, and their health professionals, on how to look after a baby with such fragile skin," he said.

Health Workforce Update

Health Workforce New Zealand has developed a number of new work programmes designed to improve recruitment and retention and ensure we have a sustainable health workforce to meet future needs.

Among new initiatives is the introduction of the Advanced Trainee Scheme (ATS) which provides medical registrars with a scholarship to cover the cost of a period of advanced study overseas.  In return, the doctor will be bonded to work in the specialty in New Zealand on completion of their training. The first group of trainees has been selected and the scheme has already attracted widespread interest.

In future trainees in all professional groups who are funded by Health Workforce New Zealand (HWNZ) will be expected to have a personal career plan.  The initiative will be phased in from 2011 and will ensure that trainees can identify a realistic career pathway and be offered the necessary training and advice, while employers will have more systematic information to help with workforce planning.  

A national mentoring scheme will also be rolled out which is currently being scoped with the pharmacy profession.

The review of GP training, which HWNZ is undertaking with the Royal New Zealand College of General Practitioners (RNZGP) and the Medical Council of New Zealand (MCNZ), is progressing well. The review aims to develop a model of training that will result in general practitioners who are skilled to work in a range of settings and ensure general practice is a more attractive choice for new medical graduates.

A series of workforce service reviews are underway across a range of specialties to develop a '2020 vision' of what New Zealand's future health workforce should look like. The reviews will outline future scenarios, based on patient need, demographic and technological changes and emerging models of care, and the first outputs are expected by the end of the year.

Work on the establishment of a national health leadership institute is continuing and discussions with prospective partners and programme providers are underway. The aim is for the institute to be in place by the end of the year.

A number of workforce innovations projects have made significant progress in 2010. Appointments have been made at Counties Manukau DHB to demonstrate the role of the physician assistant and the first nurse surgical assistants are undergoing training in a number of centres. Demonstration sites are being selected for extension of prescribing powers for diabetes nurse specialists and 15 sites have been chosen to allow community pharmacist prescribing of anticoagulant therapy.

Professor Des Gorman, Executive Chair

IT Health Board Update

The National Health IT Board's vision is to ensure that New Zealanders have a core set of personal health information available electronically to them and their treatment providers, regardless of the setting, by the end of 2014.

The publication of the National Health IT Plan provides much needed direction for the sector in the development of IT capability to support improved health outcomes and productivity enhancements across the sector. It is a plan that calls for District Health Boards (DHBs) to increase their IT expenditure from 2% to 4% – a big ask but improved efficiency and health outcomes are the long-term goals.

The Plan has been developed with strong clinical engagement and leadership, with valuable contributions from the National Clinical Information Leadership Group, and from consumers, who were engaged through a series of community workshops run through July and August.

The Plan sets out two phases of work to achieve the eHealth Vision. Phase 1 is aimed at consolidating systems and building the foundations for Phase 2, the development of the Shared Care Model. By 2014, implementation of the Shared Care Model will enable health providers to share electronic health records and contribute trusted information to personal health records held by patients.

The regional DHB groups have developed their regional IT plans to align with the National Health IT Plan. At national and regional levels key initiatives are being executed to bring the plans alive across the sector.

The NHB is delivering two priority foundational projects: Connected Health and Health Identity. The Connected Health Programme is supporting a 'network of private networks', and giving health providers a choice of certified telecommunication products to connect to the secure Connected Health Network. The Network interconnections are currently being tested and are on target to go live in December. The Health Identity Initiative will provide an authoritative, reliable source of national health identifiers for both patients and healthcare professionals, and it is progressing through the business case sign-off process with the Minister and Cabinet.

The Safe Medication Management Programme and the National Health IT Board are running another important national initiative: Community ePrescribing. The vendor, SIMPL, has recently been selected using an independent evaluation process. The ePrescribing broker service solution being developed will be trialled in three different locations over the next eight months, before being rolled out nationally.

In Auckland, Health Alliance, as the lead agency, has established a pilot project to trial approaches to shared care in the area of long-term conditions. The programme has recently selected HSAGlobal as the vendor partner to provide the application system to support the Shared Care Planning trial. The aim is to have the trial underway by the end of February next year.

The national project to develop a shared care maternity record had its first governance meeting in Christchurch (chaired by David Meates, CEO of Canterbury DHB). The project involves collaboration between Canterbury DHB, the College of GPs, College of Midwives, College of Obstetricians and Gynaecologists, and the Ministry of Health Child, Youth and Maternity Team. The goal is that by June 2012, there will be shared care records for all New Zealand newborn babies, and their mothers.

Through all our efforts, the IT Health Board is promoting an environment of collaboration and coordinated investment, with committed support from our vendor partners to deliver the outcomes that we all desire – the right information available for patients and clinicians in the right care setting.

Dr Murray Milner, Chair

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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