NHB eNewsletter - August 2011

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

• From the Chair: Disability Support Services vision
• From the Director's Desk
• Marion Guy: Support costs for the disability sector must be sustainable
• DHB Success Story: Whanganui DHB Whānau Ora integrated contracting
• DHB Annual Plan and 2012/13 Planning Package
• Shorter stays in ED health target on track
• National Screening Unit promoting Cervical Screening Awareness Month
• Emergency Management Team: Infection Prevention and Control
• Christchurch Quake speeds up home care initiative
• Health Workforce New Zealand update
• National Health IT Board: New ebooklet showcases information sharing successes
• About this Newsletter

From the Chair: Disability Support Services vision

Disability Support Services are moving from traditional models of service delivery to one where disabled people have more choice and control over the support services they receive.

Our vision is that disabled people and their families and whanau can live in their homes and take part in their communities in the same way other New Zealanders do.

This new approach stems from the Government's response to the Select Committee Inquiry into Disability Support and consulting with the disability community through forums and strategic planning groups.

A key driver of the NHB's Disability Support Service's work has been the development of a new model for supporting disabled people which recognises that disabled people and their families are the best people to determine how they want to live and to develop goals that will meet their needs.

This new model will increase consumer choice and offer greater flexibility of service provision by:

• Providing better information and assistance to disabled people and their families by introducing Local Area Coordination (LAC). This will see coordinators work alongside disabled people and support them in determining their goals
• Increasing the availability of Individualised Funding (IF) arrangements which allow people with disabilities to choose how their allocation for home and support care services are used. Currently about 950 disabled people are using IF.  Work is underway to add more support care services that can be purchased this way,
• Making contracted services more flexible 
• Offering the option of supported self-assessment and allocating funding rather than services so disabled people can decide what supports would be most beneficial for them to purchase.

The new model for supporting disabled people is currently being demonstrated in Tauranga and the Western Bay of Plenty. DSS is working closely with the local community and disabled people to make sure it goes well.  Recently local area coordinators were also employed in the area.

New options for people living in residential services are also being explored to ensure that residential services do not place unnecessary restrictions on the disabled person's ability to live a normal life.  One of the alternative options being developed would see the disabled person living in their own home, either alone or with others, and accessing the living supports needed to make this a workable option.

As this new model is implemented we will see real benefits to the community and improvements in the lives of disabled people as they are encouraged and empowered to take more control over their care and support.

Dr Murray Horn, Chair

From the Director's Desk

During the past month two National Health Board led reports have been completed on Southern DHB issues.

The first was the Dunedin Hospital Joint Assessment which was led by National Health Board Service Improvement Manager, Jill Lane, Ministry of Health Chief Nurse, Jane O'Malley, Professor of Emergency Medicine Dr Mike Ardagh and Psychiatrist, Dr Greg Young.

This review focused on systems and processes at Dunedin Hospital, as well as relevant issues within the wider DHB, and resulted in a series of recommendations and a timeline for their implementation.

The Wakatipu Expert Panel also made its recommendations on the best structure for primary and secondary health services for the Wakatipu Basin. The report was finalised following extensive community and stakeholder engagement, during which the panel conducted more than 70 meetings.

It met with a wide range of stakeholders, from local government to health providers and listened carefully to their concerns. It also held a number of community drop in centres and three public meetings.

The panel included GP, Dr Peter Foley, consumer expert, David Russell and emergency physicians, Dr Angela Pitchford and Professor Mike Ardagh.

Its recommendations included the creation of a forum of local health providers to look at further ongoing improvements.

The Queenstown community has reacted positively to the recommendations and the process shows the value of open engagement with key stakeholders and community groups when working through contentious community issues.

These reports can found in the above links and I invite you to have a look at them and their recommendations.

Chai Chuah, National Director

Marion Guy: Support costs for the disability sector must be sustainable

National Health Board (NHB) member Marion Guy says combining disability support services across regions may be a way of making sure the cost for such services is more sustainable.

Mrs Guy is a registered nurse with more than 20 years of experience. She says a series of presentations given recently to NHB board members from the disability sector have been very interesting.

"In July we heard from the New Zealand Disability Support Network, in May it was the New Zealand Home Health Association and in March, Disability Support Services.  As a nurse in a general practice, just knowing what is out there to help people is really valuable. The presentations brought me up to speed with what is available."

She says a lot of money is put into the disability sector by the Ministry of Health.

"We need to realise that supporting and helping people with disabilities can take longer and is more complex than other cases. We need to ensure that this support is cost sustainable.

"Sometimes it doesn't make sense for 20 different DHBs to provide individual services.  We must look at pooling resources to make better use of available money in order to ensure better outcomes, not only for this part of the sector, but for the health sector in general."

Work is being done to improve the flow of information between the sectors. This will help clinicians provide care in a more timely fashion and reduce duplication, she says.

"We have a good health system but we want to make it great. The 'Better, Sooner, More Convenient' approach to health care delivery will assist more people to receive care closer to home. Engaging clinicians in frontline services and decision-making bodies will help to ensure appropriate decisions are made to improve health outcomes."

Marion Guy, NHB Board Member

DHB Success Story: Whanganui DHB Whānau Ora integrated contracting

Whanganui District Health Board's (WDHB) work with Whānau Ora integrated contracting and its Māori health providers have been lauded as outstanding.

Iria Pene, the Ministry of Social Development's Programmes and Integrated Contracts Manager, describes WDHB as a 'stand-out' example of a DHB that understands outcomes-based contracts and, the importance of good relationships with the providers it funds.

Miss Pene said the WDHB was fortunate its population health and inequalities manager Rowena Kui was already experienced in results-based accountability.

"When we started working with Whanganui, Rowena had already begun to consolidate services into chunks where they can be integrated more easily.

"It was clear to me that within the long-standing relationship between WDHB and its Māori health providers, there was a good level of trust. This is absolutely essential. That was the very first thing that impressed me," said Miss Pene.

Mrs Kui said because the DHB had first-hand experience of the benefits of results-based accountability, it had already made a commitment to that style of service funding.

"We've been working towards this for years - one step at a time, building it up, knowing that this is where we want to go. It is exciting," she said.

"Our DHB has made a commitment to outcomes-based contracts for Māori providers and the principals of Whānau Ora. This is about making change happen - getting in there and doing it, looking at what we can change to help our providers become Whānau Ora lead agents.

"When you look at the benefits for whānau in our communities, it's well worth the effort."

Mrs Kui, who is also the WDHB's representative on the local Whānau Ora regional leadership group, acknowledged that moving to integrated contracting requires a shift in thinking.

"But Whānau Ora is much more than just the contract. It's an important mechanism, but it's not the whole thing. You have to look at the way organisations are working and take a broader view.  We want to see the providers enhance the way they work with whānau, so they can become leaders in Whānau Ora.

"Respect and trust between the WDHB and its providers is a key element in the Whānau Ora implementation.

"We have good relationships with the Māori health providers. We sit down and talk with them regularly and we have a forum where we meet to discuss ideas, service planning and advice received. We've been doing this for some time now."

National Health Board (NHB) Regional Relationship Manager Aroha Metcalf, said the initiative, energy and enthusiasm shown by Whanganui DHB in supporting integrated contracting and  Whānau Ora was extremely positive and 'should be considered a model for adoption by other DHBs'.

The NHB is represented on the Ministry of Health-wide Whānau Ora Reference Group, which meets regularly to review Whānau Ora implementation progress, share information and give advice.

In addition, the Public Health Group of the NHB's National Services Purchasing Group has, along with the Ministry of Social Development, been instrumental in helping progress integrated contracts around the country.

DHB Annual Plans and 2012/13 Planning Packages

The 2011/12 DHB Annual Plans review process is now complete, and the Minister of Health has communicated his formal agreement for all Annual Plans to DHBs.  Similarly, the DHB Statements of Intent (SOIs) have all been tabled in Parliament.  These documents can be seen on respective DHBs' websites.

We are currently evaluating the DHB Annual Plan   process and feedback (as indicated in my last update).  This confirms that generally the DHB Annual Plans and incorporated SOIs have shown an improved performance story compared with previous years.  However, there is still plenty of room for improvement, both in the content of the documents and in the review process.  The helpful comments from DHBs and other stakeholders are being considered and will inform the 2012/13 DHB Annual Plan process.

For the 2012/13 process, we are likely to continue with the modular document template developed last year.  In addition, we will again be approaching DHBs for representatives on a sector reference group to work with the NHB to develop planning guidance for the DHB Annual Plans.  The 2011/12 reference group was very committed, their contribution crucial and highly valued.  We hope that many of this original group will again be represented on the 2012/13 sector reference group.

The timeframes will be very tight, however we will try to minimise the effect to ensure the Annual Plan guidelines are distributed to DHBs as early as feasible.  Consultation with The Treasury and the Office of the Auditor General will also take account of the various needs of these stakeholders.

Finally, I'd like to thank everyone including DHBs for their work on planning guidance and the 2011/12 Annual Plans.  Working with DHBs will ensure we end up with better, more relevant and more concise planning documents.

Michael Hundleby, Director Performance, Accountability, Monitoring and Funding.

Shorter stays in ED health target on track

There has been a big improvement in many DHBs in the time patients spend in emergency departments (EDs).

The National Health Board and the Ministry of Health have been working with DHBs to improve performance since the Shorter Stays in Emergency Departments health target was introduced two years ago.

Every year, New Zealanders make about one million visits to an ED, and demand for services has increased rapidly in the last ten years with a growing and ageing population.

The Shorter Stays in ED target is for 95% of patients to be admitted, discharged or transferred within six hours.

Professor Mike Ardagh, an emergency medicine specialist at Christchurch Hospital, is the Ministry's National Clinical Director of Emergency Department Services.

"The role, established when Shorter Stays in EDs became one of the six national health targets, is quite broad. But it boils down to supporting DHBs to provide people who come to ED with the best possible care, in an acceptable time frame."

He says the challenge is to make the patient's journey between teams as seamless as possible.

"Our EDs have staff as good as anywhere in the world, and better than most. Patients receive care from multiple teams, and delays in acute care are mostly to do with the transitions between teams."

Auckland DHB recently achieved the 95% target and its average length of stay has almost halved over two years to 3.6 hours.

Waitemata DHB started on a performance of just 61% but is now close to achieving the 95%.

Despite having to cope with the series of earthquakes, Canterbury DHB has so far achieved the target to date.

The pressure is now on some of the 'mid-sized' DHBs to pick up the pace.

Mike Ardagh says it is very pleasing to see the advances being made in most ED and acute services.

National Screening Unit promoting Cervical Screening Awareness Month

September is Cervical Screening Awareness Month and the NHB's National Screening Unit's (NSU) National Cervical Screening Programme (NCSP) is again using the month as an opportunity to encourage women to have regular cervical smears.

NCSP clinical leader, Dr Hazel Lewis, says the month provides a good 'hook' for raising awareness, and last year's promotion had some impressive results.

"In 2010, health sector promotion of Cervical Screening Awareness Month resulted in over 16,000 new visitors to the NSU website and 500 more calls to the NCSP 0800 number.

"There were also 65 articles about cervical screening published in September as a direct result of the promotions."

This year the NSU has again teamed up with Stayfree and Johnson & Johnson and is offering women the opportunity to win one of 1000 beauty travel packs. People can enter by going to the NCSP website. The purpose of the competition is to steer people to the website and get them to answer a simple question, thereby increasing their awareness of cervical screening.

NSCP television commercials playing in September will be tagged with the Cervical Screening Awareness Month banner. Tagged advertisements will also run on radio, in women's magazines, on-line (including on TradeMe and Facebook), at cinema screenings, as posters in bus stops and malls, in Asian, Pacific and Maori publications, on Health TV, and as sponsorship of the Living Channel's Thursday Ladies' Night.

"We'd really appreciate the help of those in the health sector to promote cervical screening through their networks."

Emergency Management Team: Infection Prevention and Control

Infection Prevention and Control (IPC) is a key focus of the National Health Board's Emergency Management Team (EMT). The EMT funds specialised IPC nurses to educate the health and disability sector with a series of workshops.

The workshops are targeted at educating the primary health, community health and the disability sector on IPC as part protecting patient safety and, especially, as part of emergency response measures  where hygiene is increasingly important.

The funding from the EMT has provided five workshops throughout the country commencing in June and finishing this month.  This is in addition to 17 workshops that were held nationally last year.

Director of Emergency Management, Charles Blanch says, "The infection, prevention and control workshops are in response to increased awareness and concern about pandemics and other emerging infectious diseases (the health sector has recently dealt with the bird and H1N1 (swine) flu pandemics).

"It's impossible to predict the timing or severity of the next pandemic, so it's important for the health sector to be prepared now.  These workshops are now closing any gaps by improving the preparedness of the front-line services," says Charles.

To support the workshops, the Ministry of Health has developed an eLearning tool that can be accessed by the health sector  with a view towards achieving certification in infection, prevention and control measures.

Christchurch Quake Speeds Up Home Care Initiative

The impact of the Christchurch earthquake in February has seen a home support initiative for elderly hospital patients implemented much sooner than planned.

Canterbury District Health Board (CDHB) Service Portfolio Manager Nancy Stewart says the loss of hospital and aged residential care beds meant a new supported discharge service that was already in the pipeline had to get up and running within three weeks.

Ms Stewart says Community Rehabilitation Enablement Support Teams(CREST) was planned following a similar programme,(Supported Transfer and Accelerated Rehabilitation Teams [START]), at Waikato Hospital when the quake struck.

"The impact of the 22 February earthquake meant Christchurch lost over 35 medical beds and 600 residential care beds. With a limit to the number of hospital beds available we had to enhance our home supports (especially for older people discharged from hospital) as quickly as possible. We had to move fast to ensure services in the face of the losses suffered."

Ms Stewart says the programme was in place by 5 April, just three weeks after CDHB's decision to fast-track implementation. "It was a superb team effort."

She says the new programme is already proving very successful, with 230 referrals actioned and positive feedback from service users.

"This new service identifies people in hospital who would benefit from an earlier discharge if they got the right support at home. An integrated team of specialists, such as physios and occupational therapists, along with district nurses and other community health care workers, is put in place before the person even leaves hospital."

Ms Stewart says CREST is a much more integrated response, which involves a thorough assessment of an elderly person's needs, the provision of the right help and equipment as soon as they get home, and constant review.

"This leaves a person much more confident about being able to look after themselves at home, and to be able to enjoy being back at home."

NHB's Deputy National Director, Michael Hundleby, says "We're pleased to see initiatives like CREST helping to reduce pressure on the earthquake affected hospital system.  Initiatives like this are an important part of a strategy in managing demand for hospital beds, especially as CDHB plans its services to meet future demands."

Health Workforce New Zealand update

• New Primary Care Role to be tested

Health Workforce New Zealand (HWNZ) is supporting Waitemata PHO Comprehensive Care to demonstrate the role of the Primary Care Practice Assistant (PCPA). This new primary care role aims to benefit patients by freeing up the time of both GPs and nurses.

PCPA's will undertake a range of tasks to support the primary care team such as assisting with nurse led clinics (immunisation, screening and diabetes), recording clinical measurements, treatment room preparation, and sterilising equipment.  Tasks will be delegated and duties performed under the supervision of a GP or practice nurse.

HWNZ Director, Brenda Wraight, said, "As we make the shift to providing more care outside of hospitals, the practice assistant role has the potential to offer real value to the New Zealand health system. Practice assistants will free up the time of GPs and practice nurses enabling them to see more patients."

Twenty students are currently being recruited for the demonstration including some assistants and receptionists already working in local primary care practices. Training for the role will involve tertiary study and practice-based learning beginning in February 2012.

The demonstration also aims to develop a set of national protocols for practice assistants that can be used throughout New Zealand. The demonstration will run for two years and will be fully evaluated to assess the impact on the health workforce, including assessment of professional time saved and the cost and benefits of introducing the role nationally.

More information about the PCPA demonstration 

• Regulatory Authority Consolidation

Earlier this year we consulted with regulatory authorities (RAs) on a proposal to consolidate their administrative functions, reduce the number of Board members, and establish a common, accessible workforce dataset.

Following further consultation, the RAs have agreed to work together to devise a consolidation model by the end of the year. HWNZ has already received proposals from some RAs, indicating how consolidation could occur.

It is important that the agreed consolidation model results in reduced duplication and increased efficiencies without compromising patient safety, as well as improved data and information across the regulated health workforce.

• GP Training Review

Feedback on the discussion paper 'Workforce Requirements for New Models of Service Delivery: Proposed Changes to the General Practice Education Programme (GPEP)' is now available to view.

An implementation plan is now being developed and discussed between the Royal New Zealand College of General Practitioners, the Medical Council of New Zealand and Health Workforce New Zealand. A GPEP1 intake with an enhanced bursary will begin in February 2012 with the first advanced competency modules in mental health, addictions, and dementia implemented from March 2012.

• Workforce Service Reviews

The workforce service reviews have not only identified recommendations relating to workforce development, but also developments needed in wider service planning and delivery. As a result, we are working with other areas of the National Health Board to develop an integrated work programme that will progress the various recommendations relating to service planning and delivery. HWNZ will progress those recommendations relating to workforce.

The mental health workforce service review has reported to the HWNZ Board and is now available to view on our website. The mother and baby, and rehabilitation reviews will report to the HWNZ Board over the next couple of months.

National Health IT Board: New ebooklet showcases information sharing successes

The National Health IT Board's new ebooklet, 'Towards Better Access to Information about our Health,' has examples from frontline health providers about how eHealth is making a real difference to the sharing of patient information.

Information sharing examples include videoconferencing, electronic referrals, electronic prescribing, on-line guidelines, electronic monitoring of medications, TXT2Remind, emergency department practices, examples of regionalisation and shared clinical work stations.

The programmes the National Health IT Board is delivering are moving towards a future in which each patient's health information is stored electronically. This will support improved information sharing and health care planning across multidisciplinary health teams.  This information will be able to be accessed from any location by anyone caring for a patient, including their GP, hospital doctor, nurse, specialist or pharmacist.

Access to information in a shared care environment will only occur after careful consideration of consumer privacy and other information governance issues.

The ebooklet resource is intended not only for those involved in the collection and sharing of health information, but also for people wanting to learn more about the Health IT Board's programmes, and to hear about consumer experiences.

About this Newsletter

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