NHB eNewsletter - May 2012
"Better, sooner and more convenient care from a unified and sustainable public health system."
- From the HWNZ Chair
- From the National Director
- From the Board: Primary Care
- Planning & Analysis: Clinical Genetics
- Electives: Seminars launching the 'Improving Patient Flow Toolkit'
- National Services Purchasing: Sleepovers update
- Emergency Management: Health sector readiness
- Health Workforce New Zealand: Regional training hubs
- National Health IT Board: GP2GP gains momentum
- About this Newsletter
Professor Des Gorman is the Executive Chair of the Health Workforce New Zealand (HWNZ) Board and a Board Member of the National Health Board (NHB). Here Professor Gorman discusses how HWNZ has unified and simplified the processes through which we plan, train and fund health workforce development in New Zealand to ensure a sustainable and fit-for-purpose health workforce, which will benefit staff, patients and the public.
Health Workforce New Zealand (HWNZ) was established by the Minister of Health in 2009 to simplify the planning and funding of the healthcare workforce and to ensure that the workforce was both sustainable and fit for purpose. The HWNZ Board is supported by a business unit established within the Ministry of Health.
Working together the Boards of the NHB, HWNZ, National Health IT Board and the Capital Investment Committee, underpin a level of coordination in health care governance not seen previously.
Prior to the advent of HWNZ, health workforce planning and funding processes in New Zealand were arcane, iterative and historical, and essentially reactive. HWNZ has since created very clear prioritisation criteria, which are used in all HWNZ activities and are aligned with both the Government's intentions and with those of the other key Ministry of Health groups under the NHB. The criteria are based on a number of health domains which can be found on our website.
"Our approach to workforce planning, including supporting clinician-led workforce service forecasts, is world leading."
Through HWNZ, the system for planning and funding of the New Zealand health workforce has been greatly simplified. At the outset, there were more than 500 agencies involved in health workforce development roles in an uncoordinated manner.
Our work programme includes the proposal for an amalgamation of support functions for the regulatory authorities (RAs) to extend the focus of the RAs from 'patient safety' alone to 'patient safety, workforce intelligence gathering and workforce husbandry'. A reform of this nature in Australia has proven highly successful.
Our approach to workforce planning, including supporting clinician-led workforce service forecasts, is world leading. The methodology has been peer-reviewed and published in international literature and is based on planning under conditions of inherent uncertainty. Core principles for such plans have been adopted and planning is required to address a cohort of iterative possible future service forecasts that are generated by inter-professional groups of clinician champions. The latter use a representative collection of 'patient journeys' to develop and test these scenarios. There is also a deliberate inclusion of private health sector 'needs' in these scenarios.
Funding of training by HWNZ has been rendered accountable and, where possible, contestable. Funds are made available to employers on the basis of coherent health district, regional and national healthcare workforce plans.
Because it is difficult for individual DHBs to adequately support health workforce development, four regional training hubs have been established. These hubs will be required to:
Develop regional health workforce plans;
Support and standardise post-graduate training programmes;
Ensure career planning and guidance is in place for all staff in receipt of HWNZ funding; and
Introduce and implement innovative new clinical placements.
In future they will also manage internships in medicine, nursing, midwifery and psychology, and administer and manage a range of HWNZ programmes including advancing the Voluntary Bonding Scheme, and the Advanced Trainee Fellowship Scheme.
Each hub will appoint a Regional Programme Director of Training by 1 July 2012 who will be responsible for the overall management of a range of programmes and initiatives across the hub.
Although the New Zealand health system currently has low vacancy rates and the number of doctors and nurses leaving permanently appears to be at an all-time low, a number of long-term strategies have nevertheless been put in place and are working. These include:
- The Voluntary Bonding Scheme and the Advanced Trainee Fellowship;
- Engagement of clinicians in governance roles;
- Discretionary HWNZ funding in regard to 'critical' training schemes;
- HWNZ supported extensions of the roles of nurses, pharmacists and other allied health professionals, and the development of novel health workers; and
- A complete revision of the general medical practitioner training scheme and career progression.
A series of international collaborations has also been established (Australia, UK, Canada and the US) to boost the analytical and support capacity of HWNZ.
The HWNZ Board considers that key infrastructure is now in place and that those barriers to obtaining the outcomes that are necessary if the future health care needs of New Zealanders are being addressed.
Prof Des Gorman, Executive Chair HWNZ
Regional Integration is one of the key health sector priorities for 2012/13. The National Health Board led Regional Service Plans (RSPs) clearly demonstrate the areas where District Health Boards (DHBs) are regionally working together and illustrate the deliverables addressing the priority areas and common issues facing DHBs.
We are placing a strong focus on ensuring the actions identified by DHB regions in RSPs (such as improved access to services and the resulting improved health outcomes) will provide tangible benefits to patients. Importantly, DHBs need to ensure that their deliverables are specific with clear measures and timeframes.
It's worth iterating the areas of priority focus for all four regions are the three mandated regional clinical services including:
- Cancer services
- Cardiac services, and
- Stroke services.
All four DHB regions are also required to focus on specific workforce initiatives, the on-going implementation of regional information systems (IS), capital investment priorities, and working with Health Benefits Ltd on back office functions and initiatives.
In addition to the above priorities, RSPs need to identify regional priorities, reflecting local needs and circumstances that each DHB region will progress.
The four regions are working together on Electives and Health of Older People as additional priorities. Examples of where DHBs are also successfully working together as regions include:
- Mental Health - Northern, Midland and South Island regions
- Radiology - Northern, Midland and Central regions
- Child Health- Northern and South Island regions
Where regions are working on the same priority areas then the sharing of intended actions occurs to limit duplication of effort.
"We are placing a strong focus on ensuring the actions identified by DHB regions in RSPs will provide tangible benefits to patients."
We received the draft 2012/13 RSPs from each of the four DHB regions on 12 March. The Ministry has completed its review of the draft RSPs and feedback has been provided to each region. Each DHB region is in the process of revising and strengthening their RSP and final draft RSPs are due to be received on 18 May. The Ministry then undertakes a final review of RSPs before they go to the Minister of Health for final decisions.
It's good to see that as a sector we are working together regionally towards delivering the above priority areas. Through regional integration we are overcoming some of the issues facing DHBs in providing better health services and outcomes for New Zealanders.
Chai Chuah, National Director
The Minister's recent Letter of Expectation to District Health Boards (DHBs) places a strong emphasis on delivering integrated services wrapped around patients, with a clear emphasis on primary care.
The National Health Board also expects DHBs to include primary care networks in their planning discussions and processes as they develop their 2012/13 Annual Plans, and feedback to date suggests this been variable.
Primary care networks play a critical role in supporting the Government to achieve its priorities, through effective partnership with DHBs. A well supported and organised primary care sector that is well linked with DHBs and hospital services can assist to:
- Reduce acute demand
- Contain cost growth, particularly in referred services
- Deliver seamless and efficient patient pathways from general practice to hospitals and back to general practice, and
- Provide the platform for more patient services to be provided closer to home.
New Zealand primary care networks are founded on stable and sustained trusting partnerships between clinicians and skilled network managers. Over the past two decades, they have spawned significant innovation, information technology development and quality initiatives across the general practice and primary care sector. A number also have significant experience in managing referred services budgets, and reinvesting savings into health services.
While the historical context is not always well understood by more recent recruits to the health sector, the capability of New Zealand's primary care networks receives ongoing positive international exposure, particularly from Australia, the United States and the United Kingdom.
"Primary care networks play a critical role in supporting the Government to achieve its priorities, through effective partnership with DHBs."
Successful primary care networks deliver services that are patient centred, clinically led, management supported, and community engaged. We are recognised as an international leader in this development.
We will gain most for New Zealanders when DHBs across the country have achieved supportive and respectful working partnerships with their local networks, who bring with them the trust and experience of local primary care clinicians, and the significant wisdom and knowledge of highly specialised primary care managers.
I would be delighted to receive enquiries from anyone who wants to better understand the primary care networks, and their pivotal role in delivering on the government's 'Better, Sooner, More Convenient' policy.
Dr Bev O'Keefe, NHB Board Member
District Health Boards (DHBs) and the National Health Board (NHB) have been working together to establish Genetic Health Service New Zealand (GHSNZ) as a national service, following approval by the Minister of Health.
The service will be officially launched in May with an expectation of increased activity and enhancements in quality, safety and service access for people nationwide.
Genetic Health Service NZ provides genetic diagnostic and genetic counselling services, operating fourteen clinics throughout the country. They also provide assistance in managing genetic conditions, expert advice on genetic diseases and education on genetics.
GSHZ provides the following services:
- Diagnostic assessment of genetic disorders and information about genetic diagnoses
- Diagnostic, pre-conceptional, pre-natal or pre-symptomatic tests for genetic conditions
- Assistance in the clinical management of genetic diseases and identification of preventable complications by early and accurate diagnosis and surveillance
- Genetic counselling and management advice for the extended family of affected individuals
- Telephone enquiry service for doctors, midwives and other health professionals concerning genetic diseases
- Genetics education for professional and lay groups
"Our focus is on improving access to genetic clinics and genetic testing."
Two DHBs (Auckland and Capital & Coast) are partnering in the provision of GSHNZ's service, delivered from three main hubs (Auckland, Wellington and Christchurch) known as Northern, Central and South Island. There will also be an extensive outreach clinic programme provided to all DHBs.
Genetic services are advancing with new technologies and interventions and this service will be better placed to respond to the requirements, particularly of patients and their families, whānau and health professionals who rely on genetic health expertise.
Acting GHSNZ National Director, Dr Joanne Dixon says "we're delighted to be working as a single integrated team. Our focus is on improving access to genetic clinics and genetic testing, as well as ensuring the service has a sustainable foundation to build on for meeting the future needs of patients, families and whānau in NZ. We are very pleased the NHB and DHBs have agreed to support us as a new national service."
To support the launch of the new service, GHSNZ have developed a new logo and website. The website has a wide range of valuable information for patients, families and health professionals.
The National Health Board (NHB) Electives team has held the first of three seminars to launch the 'Improving Patient Flow Toolkit'. The Toolkit is designed to support Clinicians and District Health Boards (DHBs) to reduce waiting times and improve access and quality of elective care by providing 10 evidence based service improvement strategies.
The seminar recently held in Dunedin attracted a wide range of hospital specialists from various elective services, clinical champions and others who wanted to support elective service improvement in their locality.
Simon Duff, Team Leader, Service Improvement Team for Elective Services says that, "early feedback from participants at the seminar has been positive. Most found the seminar to be informative and valued the opportunity to learn about how other DHBs are being innovative in their approach to addressing the challenges of improving access, quality of care and waiting times."
"DHBs are being innovative in their approach to addressing the challenges of improving access, quality of care and waiting times."
The next seminars to be held in Auckland and Wellington consist of six presentations by clinical leaders and DHB staff that have been successful in adopting improvements and will share their experience with the health sector.
As part of the seminars, interactive workshops will be held where participants can learn from clinical leaders and others who have implemented the changes and learnt valuable lessons.
The Ministry continues to make good progress on establishing settlements with employers and their staff under the provisions of the Sleepover Wage (Settlement) Act 2011.
Since the Act was implemented in October 2011, the Ministry has been working with employers who provide sleepover services to disability communities across New Zealand to help them reach agreement and progress towards settlement. As a result of this work, four employers have now progressed towards final settlement.
The Ministry of Health is using the Act as the basis for settlements for providers who deliver sleepovers. Once an employer, their employees, and the Crown have signed a settlement, an Order in Council is made. The Order applies the Act to that employer and their employees. The settlements and implementation of the Act is ensuring that some of the most vulnerable disabled people will continue to receive quality care in the community. The Order is followed by a contract variation with the Ministry and/or DHB to enable the transfer of funds to the relevant provider for the transitional payments for sleepovers.
"The settlements and implementation of the Act is ensuring that some of the most vulnerable disabled people will continue to receive quality care in the community."
Under the Act, employees stand to gain access to back wages that the employer may not have otherwise been able to fund. From 1 April 2012 the minimum wage for sleepover provider staff increased from $13 per hour to $13.50. The Ministry will reimburse the providers for the change in the minimum wage from 1 Apr 2012 based on the provisions in the agreed settlement template.
Payment of the minimum wage for sleepovers is being introduced progressively. Crown funding since 1 July 2011 helps providers meet costs based on 50 per cent of the minimum wage. That increases to 75 per cent on 1 July 2012 and to 100 per cent on 1 July 2013.
As set out in legislation the Ministry will be reinforcing that claims that missed the 2 September 2011 cut-off date are ineligible for back-dated payments. The Crown has agreed to meet at least half the minimum wage cost for back-dated claims. So far the Crown's contribution has been approximately $22.5m for back-dated payment claims.
For further information on the sleepovers settlement process, the Ministry of Health is producing a monthly update on the Ministry website and more information is also available from the New Zealand Disability Support Network.
New Zealand Shakeout is a nationwide exercise taking place on 26 September 2012. It provides a great opportunity for health and disability organisations and individuals to get better prepared for major earthquakes.
Charles Blanch, the Director for Emergency Management says "It's great to see that already 14 health and disability providers have signed up to the exercise and we hope to see this number grow."
Talking about preparedness with colleagues is a great way of sharing ideas and turning the intention to prepare into action.
It's important to seriously consider what your requirements are to care for staff and plan on how your organisation continues to function after an emergency event. The Ministry of Health has designed a multi-month staff awareness programme to ensure staff is informed.
The staff awareness programme includes the following themes that can be adapted to an organisation's needs:
"Already 14 health and disability providers have signed up to the exercise and we hope to see this number grow."
Keep in Contact. Encourage staff to have a household emergency plan and to know how to get in contact with work and family. We recommend carrying your family's phone numbers in your wallet so you can contact them if you lose your phone.
Have a Get Home Kit. Compare and share ideas for Get Home or Getaway kits; The Ministry encourages staff to have warm clothing, walking shoes and medication at work to enable them to get home safely. Also discuss alternative transport options and timeframes for getting home.
Spot the Hazard. Make staff aware of potential hazards in their workspace, and how to report a hazard or accident. Encourage them to take responsibility for their own health and safety.
Find the Emergency Gear. Ensure your staff knows where the emergency equipment (such as Civil Defence cabinets, first aid kits) is located and what they contain. They should know where their closest fire extinguisher and defibrillator are, and where the emergency water supplies are stored.
Know the Drill. Discuss with your staff what to do for different emergencies, walk down their main and alternate fire escapes and know who their fire wardens are. Business (or service) continuity plans should be examined, reviewed and staff know what they would do in the minutes, hours and days after an emergency at work.
New Zealand ShakeOut is planned for 9.26am on Wednesday 26 September 2012 and is a good opportunity and time to practice "Drop, Cover and Hold" with one million other New Zealanders. Resources and more information about New Zealand ShakeOut, for individuals, families and organisations is available at www.getthru.govt.nz
To ensure ShakeOut has a national response and involvement you can see who has signed up here.
Health Workforce New Zealand (HWNZ) collaborated with District Health Boards (DHBs), education providers and professional associations to establish four regional training hubs (hubs) which became operational on 1 January 2012.
The four Regional Training Hubs are designed to support more effective and integrated health professional training, each cover a population of approximately one million people. They aim to work collaboratively across each region to oversee the planning and delivery of clinical training, ensuring it meets the needs of trainees and local communities and is aligned with regional service planning.
As of 1 April 2012 the hubs are required to ensure that all trainees in receipt of HWNZ funding have a personal career plan. Systematic career planning is designed to ensure that training has a clear purpose and will benefit the trainee through discussion and support for career development. It also means employers will be able to plan their workforce more effectively in line with service needs.
Local governance arrangements for the hubs are integrated into regional decision-making systems with performance measured via the National Health Board's quarterly framework. The hubs started reporting via this framework in July 2011.
During March 2012, HWNZ held a meeting with the hubs' clinical leaders, project leaders and other key DHB personnel to seek their input into immediate, medium and long term priorities. The meeting provided an opportunity to share good practice, offer support, and develop collaborative working relationships and networks.
"Employers will be able to plan their workforce more effectively in line with service needs."
The Medical Council of New Zealand and the Royal New Zealand College of General Practitioners also attended the meeting, providing an opportunity to share information on the review of prevocational medical training and changes to general practice training.
In addition to regional standardisation of a number of PGY1and PGY2 programmes, the hubs discussed working collaboratively to standardise a number of programmes nationally over the coming year as well as sharing information about innovative clinical placements.
The hubs will have an increasing role in administering and managing a range of HWNZ programmes, including career planning, the Voluntary Bonding Scheme, and the Advanced Trainee Fellowship Scheme.
Regional Programme Directors of Training will be appointed by the hubs by 1 July 2012 to provide guidance and on-going support for their regions.
HWNZ will continue to act as a resource and work closely with the hubs to ensure that their activities are aligned to regional service plans and decisions on workforce are informed by local, regional and national service needs.
The four hubs cover the four DHB regions:
- Northern - Waitemata, Auckland, Counties Manukau and Northland
- Midland - Waikato, Taranaki, Lakes, Bay of Plenty, Tairawhiti
- Central - Whanganui, Hawke's Bay, MidCentral, Wairarapa, Capital & Coast, Hutt Valley
- South Island - Southern, Canterbury, South Canterbury, West Coast and Nelson Marlborough.
Regional Training Hub contacts:
- Northern - Crisna Taljaard, CrisnaV@arrmos.co.nz
- Midland - Angela Norman, Angela.Norman@healthshare.co.nz
- Central - Bridgette Connor, Bridgette_Connor@centraltas.co.nz
- South Island - Kathryn Goodyear, Kathryn.Goodyear@cdhb.govt.nz
The roll out of General Practice to General Practice (GP2GP) continues and is gaining momentum.
GP2GP is an electronic system that enables a person's medical records to be transferred from one general practice system to another. This means when a person changes GP, their records can be transferred at the touch of a button. Previously, records would have been printed out or photocopied, then mailed to the new practice where they would be re-entered into the practice management system.
GP2GP has the potential to improve patient safety because GPs will have quicker access to information about a person's current medications, drug interactions, and past medical history. Data will be directly populated into the practice management system, rather than being entered manually, so transcription errors and omissions will be reduced. Practices will spend less time processing incoming paper-based patient records, and patients won't need to repeat their medical history when changing GP.
"GPs will have quicker access to information about a person's current medications, drug interactions, and past medical history."
While GP2GP has been used in some practices for a while, others have not had the functionality to be able to use it. Now functionality has been extended to include all practice management systems, and rollout of the system to all general practices in New Zealand is in progress.
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