2014/15 ANNUAL PLANGuidelines

(Including Planning Priorities)

WITH STATEMENT OF INTENT and STATEMENT OF PERFORMANCE EXPECTATIONS

Amendments

Date Page Description

31 Jan 2014

28 Feb 2014

37

36-37

Stroke: In response to feedback from DHBs we have made the following changes to RSP priorities:

definition of ‘eligible’ added to measures removal of requirement ‘within 3 hours from onset’ from key actions

Cardiac:

Further guidance is provided on the implementation of Accelerated Chest Pain Pathways (ACPPs) in Emergency Departments

Recognising the need to gain national consensus, the deadline for definition of ‘high risk’ within Acute Coronary Syndrome (ACS) measures has been removed

28 February 2014

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This document is for District Health Board (DHB) staff to use as appropriate to assist in the development of their 2014/15 Annual Plan including Statement of Intent (Annual Plan) and Statement of Performance Expectations.

The Annual Plan Guidelines (including Planning Priorities) are a reference document to enable DHBs to meet their minimum legislative and Ministerial obligations when drafting their Annual Plan. Note that included in these Guidelines there are references to additional guidance, and resources which will be useful when developing Annual Plans.

The District Health Board Annual Plan with Statement of Intent

Each District Health Board (DHB) has a statutory responsibility to prepare:• an Annual Plan for approval by the Minister of Health (Section 38 of the New Zealand Public Health

and Disability Act 2000) - providing accountability to the Minister of Health• a Statement of Intent ( Section 139 of the Crown Entities Act 2004 , as amended by the Section 49 of

the Crown Entities Amendment Act 2013) - providing accountability to Parliament and the public at least triennially1

• a Statement of Performance Expectations (New CE Act s149C) – providing financial accountability to Parliament and the public annually

In 2010 Cabinet determined that the above documents would be brought together into a single DHB Annual Plan with Statement of Intent, to be known as the ‘Annual Plan’ (AP). This will continue for 2014/15. The AP must incorporate national and regional (including sub regional) service planning, as well as balance the medium term accountability requirements inherent in a Statement of Intent (SOI) with annual requirements.

Annual Plan Structure

A modular approach has been adapted to the DHB Annual Plan, as in previous years, to achieve a single document that meets the requirements of both Acts, as well as Cabinet requirements and the needs of key stakeholders. The modules allow various sections of the document to be highlighted for different purposes and audiences. The modular structure also makes it possible to extract modules as appropriate and only table in Parliament those most relevant to the purposes of an SOI.

There is no major departure from the structure of previous guidance, and the modular approach of guidance for DHBs Annual Plans/SOIs is being retained for 2014/15. As for previous years this enables the relevant sections to be extracted for different purposes such as tabling the SOI in Parliament. (There may be some change for 2015/16). Please note that the order and shape of some modules has been adjusted to reflect the amended requirements of the New CE Act 2013. For example, what were modules One and Two have been combined into a single module, which is the guidance for the SOI. The Government priorities become module Two.

The slightly revised structure of the AP continues to allow the themes of the DHBs overall performance story through the whole document – helping cascade the conversation on each theme to a greater level of detail with each module – from high level strategic outcomes down to service delivery and financial detail. So while a theme may be repeated, it is expected the information will differ as the reader progresses further through the document to learn more about the topic with increasing detail.

The legislation that sets out the requirements for SOIs has been reviewed. Amendments to the Crown Entities Act 2004 can be found in CE Amendment Act 2013.

Key changes to SOI resulting from the CE Amendment Act 2013:

extension of reporting timeframe of SOI to four years minimum (forthcoming year and at least the following three financial years) (New CE Act s139 (2) as amended/inserted by S49 CE Amendment Act 2013)

an SOI to be produced at least once in every three-year period (New CE Act s139 (3))

a Crown Entity’s responsible Minister may require the crown entity to provide a new SOI at any time (New CE Act s139A (1))

1 Please note: ‘New CE Act’ refers to the ‘CE Act as amended/inserted by CE Amendment Act 2013’ in this document. The CE Amendment Act is due to be enacted on 1 July 2014.

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SOIs to contain only high-level strategic information as relates to four year reporting timeframe, rather than as it relates to annual reporting requirements, which will be provided separately in a statement of performance expectations (New CE Act s141 & s149E).

The Statement of Performance Expectations (SPE), (the old Statement of Forecast Service Performance), is separate from the SOI and is made up of the annual information that used to be in the SOI. It is produced and tabled each year and subject to the same process timeframe as the SOI (New CE Act s149B – s149M). The SPE includes the Financial Performance.

During the year that the SOI is tabled the SPE can be consolidated with the SOI.

In 2011 DHBs were required to develop a Workforce Plan to support achievement of annual, regional and relevant national service plans. As with last year, the production of individual DHB Workforce Strategies is not a requirement for 2014/15 as DHBs will instead be required to develop their Workforce Strategies further in their 2014/15 Regional Services Plans (RSPs).

DHBs should find the State Services Commission’s - Preparing a Statement of Intent – Guidance and requirements for Crown Entities a useful resource while bearing in mind that the AP has considerations beyond solely an SOI2.

For further information regarding these guidelines please contact:

Jacob White National Health BoardMinistry of HealthWellington 6145 annual_plan@moh.govt.nz, (04) 496 2000

2 The SSC guidance document is for the use of DHBs and is to be updated to address changes arising from the CE Amendment Act 2013 shortly. Any DHB subsidiaries required to produce an SOI should do so with regard to the above SSC guidance and that within the Crown Entities Act 2004 and Crown Entities Amendment Act 2013.

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MODULE 1: INTRODUCTION and STRATEGIC INTENTIONS (included in SOI extract)

1.1 EXECUTIVE SUMMARY CEO foreword, executive summary and signatory page

1.2 CONTEXT Background and operating environment Nature and scope of functions / intended operations

1.3 STRATEGIC INTENTIONS – strategic objectives DHB vision Strategic outcomes in national, regional and local context Key risks and opportunities

MODULE 2: DELIVERING ON PRIORITIES & TARGETS (NOT included in SOI extract)

2.1 PRIORITIES & TARGETS – actions to achieve our outcomes Implementing Government priorities Better, Sooner, More Convenient system DHB regional, sub regional and local actions to deliver on RSPs DHB local priorities

MODULE 3: STATEMENT OF PERFORMANCE EXPECTATIONS (Can be consolidated with the SOI extract)

3.1 STATEMENT OF PERFORMANCE EXPECTATIONS – outputs from activities Statement of Performance Expectations (SPE) Output classes Measures of DHB performance by Output Class:

Prevention Services Early Detection and Management Intensive Assessment and Treatment Rehabilitation and Support

MODULE 4: FINANCIAL PERFORMANCE (included with SPE)

4.1 FINANCIAL PERFORMANCE Statement of Performance Expectations (for current and three following financial years) Any other measures and standards necessary to assess DHB performance Any significant assumptions Any additional information to reflect the operations and position of the DHB

MODULE 5: STEWARDSHIP (included in SOI extract)

5.1 STEWARDSHIP – managing our business for efficient operation Managing our business Building capability Strengthening our workforce Organisational health Reporting and consultation

MODULE 6: SERVICE CONFIGURATION (NOT included in SOI extract)

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6.1 SERVICE COVERAGE AND SERVICE CHANGE Service coverage Service change Service issues

MODULE 7: PERFORMANCE MEASURES (NOT included in SOI extract)

7.1 MONITORING FRAMEWORK PERFORMANCE MEASURES Dimensions of DHB Performance Measures (non-financial performance targets)

MODULE 8: APPENDICES (NOT to be included in final documents)

8.1 MODULE THREE CONTENT REQUIREMENT (NOT included in final – reference only)

8.2 GLOSSARY OF TERMS (DHB Option)

8.3 ANNUAL PLAN REVIEW: FINANCIAL STATEMENTS 2014/15 (and supporting templates)

8.4 OUTPUT CLASS RECOMMENDATIONS (NOT included in final – reference only) Prevention Services Early Detection and Management Intensive Assessment and Treatment Rehabilitation and Support

8.5 ANNUAL PLAN CONTENT REQUIREMENTS (NOT included in final – reference only) Crown Entities Act 2004 (CE ACT), as amended by CE Amendment Act 2013 New Zealand Public Health and Disability Amendment Act 2010 (NZPHD Act) Recommendations from Cabinet Social Policy Committee (CSPC)

8.6 STRENGTHENING OUR WORKFORCE – DIMENSIONS OF THE WORKFORCE PLAN (NOT included in final – reference only)

8.7 LINE OF SIGHT GUIDANCE FRAMEWORK (NOT included in final – reference only)

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MODULE 1: INTRODUCTION and STRATEGIC INTENTIONS

DHBs are strongly encouraged by the Minister of Health and the Ministry of Health to keep this section brief and to minimise use of diagrams, pictures and / or white space where possible. DHBs may wish to reference more detailed information contained on their websites if appropriate rather than replicate it here.

FOREWORD/EXECUTIVE SUMMARY

This section will contain: CE foreword, executive summary and signatory page.

1.2 CONTEXT

1.2.1 Background information and operating environment

Briefly comment on the background of your District Health Boards (DHB), and consider including: overarching system context that influences the DHB e.g. RSP objectives, the Ministry of Health’s

Statement of Intent, and the Treaty of Waitangi health profile of the district linked to the key issues identified in the DHB’s Health Needs Assessment Government focus on Better Sooner More Convenient Services (BSMC) for all New Zealanders.

The DHB, to explain its operating environment, is encouraged to provide a very brief description of the structure and funding of wider health structures including the hospital and primary/community organisations. The DHB may note any: key internal/external operating environment factors that affect performance key areas of risk and opportunity coverage or location.

1.2.2 Nature and scope of functions / intended operations (New CE s141(2)(a) ):

Explain the nature and scope of the entity’s functions and intended operations, performed by the DHB in the following roles: Planner (in partnership with appropriate stakeholders) Provider Funder (including managing budget within funding allocation/specific financial constraints) Owner of Crown assets.

1.3 STRATEGIC INTENTIONS – strategic objectives ( New CE Act s141(1))

WHAT outcomes we want to achieve through a whole of system approachKeep this section high level and be sure to demonstrate how the DHB is giving effect to the New Zealand Public Health and Disability Act (NZPHD Act s38(2)(a&b)). The AP must reflect the overall direction of the New Zealand Health Strategy and New Zealand Disability Strategy (NZPHD Act s38(2)(d)).

High level strategic objectives that the entity intends to achieve or contribute to (strategic intentions must be identified here (New CE Act s141(1)(a)). Links between high level strategic intentions and DHB performance on an annual basis will be outlined in the SPE ( New CE Act s149(b-g)) .

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System integrationWhile taking a whole of system approach is not new to the health sector it is expected that a growing commitment will be applied to achieving more effective system integration in partnership with primary care and other appropriate stakeholders; and this will be demonstrated in the strategic direction and planned activities of DHBs. This includes the DHB’s work to provide Better Public Services (including Social Sector Trials) in:

Prime Minister’s Youth Mental Health Project Children’s Action Plan Increased Immunisation Health Target Reducing Rates of Rheumatic Fever

DHBs are expected to demonstrate how they will use clinical leadership to drive system integration and Better Public Services.

DHBs are expected to use their Alliance Leadership Team and any Service Level Alliance Teams to jointly develop 2014/15 DHB Annual Plans for:

Primary Care (including Rural Health) Prime Minister’s Youth Mental Health Services – Youth Health

While in 2014/15 there is no requirement that NGOs are formal members of your ALT, the principle of partnership must underpin any service development including:

the Shorter Stays in Emergency Departments Health Target – Primary Care the Improved Access to Elective Surgery Health Target Shorter Waits for Cancer Treatment Faster Cancer Treatment Increased Immunisation Health Target the Better Help for Smokers to Quit Health Target – Primary Care More Heart and Diabetes Checks Health Target Reducing Rheumatic Fever Prime Minister’s Youth Mental Health Project Children’s Action Plan Whānau Ora Long Term Conditions Diabetes Care Stroke Acute Coronary Syndrome Improved Access to Diagnostics Cardiac Services – Network Agreed Health of Older People the Mental Health Service Development Plan Maternal and Child Health

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Intervention logic flowIntervention logic is central to this module as the links between outcomes in this section and subsequent sections of the AP illustrate the performance story (CSPC 8A rec: 21.3): specific actions/activities the DHB will undertake to deliver on these outcomes should be described in

Module 2

how the outcomes identified here flow into detailed impacts and outputs in the SPE in Module 3 should be clear

how DHB activity to build organisational capability in Module 5 will enable delivery on these outcomes should also be clear

Consider some form of reference to link sections, e.g., numbering outcomes and referencing numbers in Statement of Performance Expectations where relevant.

This section must be consistent with and reflect the RSP and any national plans. (CSPC 8A rec: 16).

DHB vision

Outline the vision for the DHB population and service provision.

Strategic outcomes in national, regional and local context (New CE Act s141 , NZPHD Act s38 (2)(a))Outline the specific strategic outcomes or objectives for the DHB. These should be considered in the context of developing service planning to ensure the AP addresses:

i. local, regional, and national needs for health services, including Better Public Services; andii. how health services driven by clinical leadership can be properly integrated to meet those needs; andiii. the optimum arrangement for the most effective and efficient delivery of health services.

The DHB’s vision should include an outline of how the DHB will support clinically led service planning in partnership with primary care and other appropriate stakeholders to achieve its high level objectives and Better, Sooner, More Convenient (BSMC) service. It should focus on service sustainability, service quality and safety, integrated models of care where appropriate, and best use of resources. It could also describe key DHB issues that will be addressed by the intended focus areas of service planning for each stakeholder.

Module 2 should identify a number of key principles fundamental for robust planning to achieve BSMC services through a systems integration approach. It is expected these will be visible in this part to explain the DHB’s strategic planning where appropriate.

* Consider a structure that flows from national to regional (including sub-regional) and local/community levels while linking to strategic objectives outlined in Module 1. Specific actions should be described in subsequent Modules.

The following requirements must be covered in this section:

Appropriate reference to the Māori Health Plan (CSPC 8A rec: 21.5).

*ensure related Performance Measures in the Māori Health Plan are consistent with those in the AP

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MODULE 2: DELIVERING ON PRIORITIES & TARGETS (NOT included in SOI extract)

HOW we are delivering on Module 1.3 Strategic ObjectivesThis section should include commentary on key DHB activities, actions and outputs to deliver on each of the priorities outlined in the Minister’s Letter of Expectations (CSPC 8A rec: 21.4).

Any significant new expenditure should be signalled where applicable.

2.1 PRIORITIES AND TARGETS

Implementing Government Priorities (CSPC 8A rec: 21.4).The Ministry of Health and DHBs are charged with giving effect to the overarching goal for the health sector of BSMC health services for all New Zealanders, including Better Public Services.. Key principles that are foundational to planning in order to achieve BSMC services are: using an alliancing approach to service planning in which Alliance Leadership Teams involving the

appropriate primary/secondary clinicians and primary/secondary managers jointly agree service priorities along with appropriate funding levels. Refer to the new PHO Services Agreement and Alliance Agreement which took effect 1 July 2013.

using a whole of system view to determine the most efficient model of service delivery. Ensuring service planning is not done in silos, including using alliancing principles to jointly plan and agree service models with appropriate stakeholders for other services (e.g. community clinicians and NGOs)3

providing a model of care that incorporates a range of ‘hospital’ services to be delivered within community/primary care settings

active engagement of ‘front-line’ clinical leaders/champions in health services delivery planning across the sector at both local and regional levels

integrating/coordinating clinical services to provide greater accessibility and seamless delivery strengthening clinical and financial sustainability making better use of available resources ensuring total population measures and targets are applied to all ethnic groups and that all targets and

measures replicated in any other plans (e.g., Māori Health Plans) are consistent with those in APs and RSPs.

Four important policy drivers have been identified through which the health sector may best utilise resources to achieve BSMC services:

Better Public Services (including Social Sector Trails): DHBs must work more effectively with other parts of the social sector. The Government’s Better Public Services targets and the Social Sector Trials will help drive this integrated approach that puts the patient and user at the centre of service delivery. DHBs are expected to work closely with other sectors such as education and housing specifically to improve the child immunisation rate, reduce the rate of rheumatic fever, deliver the Prime Minister’s Youth Mental Health Project and the Children’s Action Plan.

Regional collaboration: means DHBs working together more effectively, whether regionally or sub-regionally.

Integrated care: includes both clinical and service integration to bring organisations and clinical professionals together, in order to improve outcomes for patients and service users through the delivery of integrated care. Integration is a key component of placing patients at the centre of the system, increasing the focus on prevention, avoidance of unplanned acute care and redesigning services closer to home.

Value for Money: is the assessment of benefits (better health outcomes) relative to cost, in determining whether specific current or future investments/expenditures are the best use of available resource.

The AP should reflect how these approaches link in with the DHB’s overall performance story and identify the outcomes that will be achieved through them. DHBs must show in their AP the specific tangible and measurable actions they will undertake to deliver on identified service priorities and targets listed below in relation to the above policy drivers. The activities identified must include a range of actions that are expected to be completed within 2014/15.

3 Refer to the Alliance Leadership Charter for a description of alliancing principles. While in 2014/15 there is no requirement that NGOs are formal members of your ALT, the principle of partnership must underpin any service development.

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HOW we are delivering on Module 1.3 Strategic ObjectivesThis section should include commentary on key DHB activities, actions and outputs to deliver on each of the priorities outlined in the Minister’s Letter of Expectations (CSPC 8A rec: 21.4).

Any significant new expenditure should be signalled where applicable.

Government priorities are presented in the Ministers Letter of Expectations and in individual letters to DHB Chairs from the Minister. Priorities for 2013/14 are yet to be formally confirmed. Currently the potential areas of priority focus are:

2.1.1 HEALTH TARGETS4

The six Health Targets for 2014/15 are:

1. Shorter Stays in Emergency Departments˟5 2. Improved Access to Elective Surgery˟ 3. Shorter Waits for Cancer Treatment˟ / transitioning to Faster Cancer Treatment 4. Increased Immunisation˟ 5. Better Help for Smokers to Quit˟6. More Heart and Diabetes Checks˟.

2.1.2 GOVERNMENT PRIORITIES

The 2014/15 Annual Plan Priority areas (in addition to the Health Targets) are:

Better Public Services (including Social Sector Trials):

Reducing Rheumatic Fever˟ Prime Minister’s Youth Mental Health Project*6,7

Children’s Action Plan˟ Whānau Ora˟

System Integration:

Diabetes˟ and Long Term Conditions˟

Stroke˟ Acute Coronary Syndrome˟ Improved Access to Diagnostics˟ Faster Cancer Treatment˟ Cardiac – Secondary Services (network agreed)˟ Primary Care* Health of Older People˟

4 If your DHB has consistently met a Health Target, for example, Shorter Stays in Emergency Departments, then you are not required to provide a detailed plan for 2014/15. DHBs do, however, need to commit to continue to meet the target and to the actions the DHB already has in place. 5 ˟ Refer to the Alliance Leadership Charter for a description of alliancing principles. While in 2014/15 there is no requirement that NGOs are formal members of your ALT, the principle of partnership must underpin any service development. This includes the primary care component of the Shorter Stays in Emergency Departments and Better Help for Smokers to Quit Health Targets.

Priorities with a ˟ in the list of priorities are included. 6 * DHBs are expected to use their Alliance Leadership Team and any Service Level Alliance Teams to jointly develop 2014/15 DHB Annual Plans for the Youth Services component of the Prime Minister’s Youth Mental Health Project and Primary Care (including

Rural Health). These are indicated by a *in the list of priorities.7 Where Social Sector Trials are operating locally, DHBs are expected to work with local Trial Leads for the actions identified to improve the responsiveness of primary care to youth, increase school-based health services and improve access to mental health and youth AOD services.

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the Mental Health Service Development Plan˟ Maternal and Child Health˟

National Entity Priority Initiatives

Improving Quality

Actions to Support Delivery of Regional Priorities

Living Within Our Means

Regional Service Plan Priorities

Regional Planning Priorities for 2014/15 include: Elective Services Cancer Services Cardiac Services (Acute Coronary Syndrome) Mental Health and Addictions Stroke Services Health of Older People Major Trauma Information Technology Workforce

DHBs are expected to include actions/milestones/budget allocations/measures to deliver of on regional objectives in their Annual Plans. This will include, as appropriate, actions to deliver on Major Trauma as a regional priority for 2014/15.

Appendix 8.1 provides a guide to content for each Government priority and Health Target. Aspects within these tables that are mandatory are indicated as such. While the table structure itself is not mandatory this is a useful model to follow to meet the expectations of this module.

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For each priority area (e.g. Wrap-around Services for Older People), and sub-area of focus within the priority area (e.g. Improving Dementia Pathways) in the guidance templates in appendix 8.1, each DHB must:

briefly describe its key objectives/key planning approaches to deliver on the area of focus provide specific and tangible actions to improve performance in the area of focus, some of which must

be delivered in the 2014/15 year. provide specific and measureable deliverables (measures and outputs with quantifiable performance

expectations). It is expected baselines will be included for all measures. Some performance measures will be specified as expected by the Ministry where nationally consistent monitoring and reporting is required.

provide milestones/dates of delivery (aligned with quarterly reporting timeframes) for all deliverables present an intervention logic linking the DHB’s planning approach, actions and deliverables, within the

priority area to high level outcomes.

Primary care agreement to the specific activities in each area is to take the form of a signed letter of support from primary care, with their support reflected in APs. For the templates provided at Appendix 8, evidence must be provided that the identified section has been developed and agreed with primary care partners: Regional, sub regional and local actions sponsored/led by the DHB to deliver on RSPs (CSPC 8A rec: 16 & 22.8).

The DHB is expected to identify in their AP the specific activities it will undertake at a local level to deliver on their RSP implementation plan commitments in the 2014/15 year.

DHB local priorities (NZPHD Act s38 2(a))

Outline specific activities the DHB will undertake to achieve its identified local strategic outcomes and priorities and where these align with Government priority areas and targets.

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3.1 STATEMENT OF PERFORMANCE EXPECTATIONS

Statement of Performance Expectations (SPE) (New CE Act 2013 s149 (B-G ))

To ensure that the SPE meaningfully supports the key strategic outcomes and priorities of the DHB’s planned activities (as outlined in Modules 1,2 and 3) and performance, clear intervention logic is expected to explain the link between the selected outputs and how they will contribute to impacts, and priorities (CSPC 8A rec: 21.1 & 21.3). *Refer to definitions provided in the glossary (Appendix 8.2) to ensure consistency of terms.

The SPE is to provide specific measures/targets for the coming year, with comparative prior year and current year forecast (at a minimun). We encourage DHBs to provide both historic and future trends in your SOI and SPE so far as it is meaningful and practical to do so.

Output classes (New CE Act s149E ):

Four Output Classes are to be used by all DHBs to reflect the nature of services provided. The Output Class categories are:

Prevention Services Early Detection and Management Intensive Assessment and Treatment Rehabilitation and Support

There is a close correlation between these descriptions and the logic applied when mapping Purchase Unit Codes (PUCs) to each output class last year.

For this module the DHB is required to describe services it plans, funds, provides, and promotes within each Output Class. Include at least total expected revenue and proposed expenses for each Output Class (New CE Act s149E).

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MODULE 3: STATEMENT OF PERFORMANCE EXPECTATIONS

4.1 FINANCIAL PERFORMANCE

(New CE Act s149 (1)(a-g) ), (CSPC 8A rec: 21.7)

Each statement of performance expectations must, in relation to a Crown entity and a financial year:

contain forecast financial statements that comply with section 149G. (New CE Act 2013 s149E(1)(d) )

and also for each reportable class of outputs:

identify the expected revenue and proposed expenses for the class of outputs. (New CE Act 2013 s149E(2)(b))

Forecast financial Statements ( New CE Act 2013 s149G(1)

Each statement of performance expectations, in relation to a Crown entity and a financial year, must contain forecast financial statements for the financial year, prepared in accordance with generally accepted accounting practice. The forecast financial statements must include:

a statement of all significant assumptions underlying the forecast financial statements (New CE Act 2013 s149G(2)(a))

any additional information and explanations to fairly reflect the forecast financial operations and financial position of the DHB (New CE Act 2013 s149G(2)(b) )

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All sections within this module are mandatory ( New CE Act 2013 s149C) and relate to a reporting timeframe of five years minimum (prior year audited actual, current year forecast and three years’ plan. (New CE Act 2013 s149G(2)(b))

Note: Financial templates submitted to the NHB in support of financial statements must be completed in accordance with the 'Requirements and Guidelines for using Financial Templates' which are issued to DHBs in conjunction with the blank templates.

*A checklist for financial templates is included in Appendix 8.3 for reference.

MODULE 4: FINANCIAL PERFORMANCE

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5.1 STEWARDSHIP

Managing our business (CSPC 8A rec: 21.2)

This section should reflect the scale and scope of your services and show the extent of resources required to provide these services, covering physical, human and intellectual aspects. Consider comment on: organisational performance management funding and financial management (key high level figures/assumptions) alignment of the DHB’s agreed share of HBL costs and benefits with HBL’s work programmes risk management performance (availability/utilisation/functionality/ condition) and management of assets quality assurance and improvement.

Building capability ( New CE Act s141(2)(c))

Outline the capabilities the DHB will need over the next three to five years and measures being taken in the short term to work towards developing these. Reference any sub-plans the DHB uses to support improvements in capability (this should be useful for future business planning and for auditing purposes).

Link to national or regional plans where relevant, including comment on: information communications technology (e.g. payroll system information) clinical technology/communication (e.g. patient specific information) quality assurance and improvement, including:

o how increased integration will improve qualityo the Health Quality and Safety Commissions Quality Markers and Quality Accounts, ando as it is developed, the Patient Experience Indicator.

capital and infrastructure development (three year forecasts and proposed funding, capital pressures, mitigation)

innovation and initiatives to achieve sustainability and a wider roll out of successful innovations. up-skilling the organisation to deliver improvement initiatives co-operative developments (working with other organisations, e.g. education and training providers)

Workforce

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MANAGING business to ensure we can deliver modules 1 & 2

This is the detail of how high level DHB strategic planning translates into action in an organisational sense within the DHB.

It should show the DHB’s stewardship, (as owner, provider and funder) of its assets, workforce, IT/IS, and other infrastructure needed to build organisational capability to deliver planned services s141(2)(c)) (CSPC 8A rec: 21.2)

Explain how the entity intends to manage its functions and operations to meet its strategic intentions ( New CE Act s141(2)(b)) DHB to progress towards achieving these.

*DHBs may wish to consider incorporating a range of performance measures within in this module as suggested in the Treasury guidance (refer link page 3).

MODULE 5: STEWARDSHIP

Managing our workforce within fiscal restraints (CAB Min (11) 24/5A)

To meet the Government Expectations for Pay and Employment Conditions in the State Sector this module must include comments on: how the DHB will ensure bargaining will deliver organisational and sector performance improvement,

foster continuous improvement and productivity enhancement, support effective employee engagement and achieve results as identified in the DHB’s budget plan

how the identified business imperatives (such as improved performance and demonstrable recruitment and retention difficulties) will be met

how the pay structures and other conditions for employees are necessary to support the DHB business and workforce objectives

Strengthening our workforce

The DHB will work with their Regional Training Hub Director to develop and deliver a workforce plan as part of the 2014/15 Regional Service Plan. The workforce plan will outline regional actions and key milestones. Further advice is contained in the 2014/15 Regional Service Plans’ Guidance.

There will be particular workforce issues which are local and need to be reflected in the DHB’s Annual Plan (AP) in relation to the following:

a. Cultureb. Capabilityc. Capacityd. Change Leadership (guidance on each area is included in Appendix 8.6):

The DHB to demonstrate in its 2014/15 AP actions it will undertake and key milestones: To support the training and development of at least x diabetes nurse prescribers during 2013/14 and

2014/15 To implement and evaluate the General Practice Education Programme (GPEP) 2 registrars training

alongside doctors registered in another vocational scope during 2014/15 To increase the number of trainee sonographers from x to y to meet current and expected future

demands To provide robust career advice, guidance and support to all HWNZ funded trainees enabling their

career development To meet the 70/20/10 funding criteria8 for post-entry training in medical disciplines.

Further areas of focus will be identified as HWNZ’s strategic direction progresses and Ministry, Government priorities change. These will be added after consultation and agreement with DHBs.

Safe and Competent Workforce The Vulnerable Children Bill, which is due to attain Royal assent in June 2014 contains some workforce requirements relating to: Child Protection Policies Children’s Worker safety checks.

8 The funding model is part of the DHB’s new medical training agreement with HWNZ, effective from 1 January 2014 and was provided to the DHBs on 24 September 2013. This new agreement is for a three-year term and it is anticipated that the funding model will be adjusted annually, after consultation and agreement with DHBs.

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Child Protection Policies (Part 1 Subpart 2 sections 17, 19, 20)The Vulnerable Children Bill sets out various organisational requirements of DHBs relating to obligations to adopt and report on a child protection policy.

DHB’s need to detail implementation of child protection policies as indicated in section 17 of the Vulnerable Children Bill (below).

Section 17 of the Vulnerable Children’s Bill requires DHB boards to adopt and report on a child protection policy. Every board of a DHB must:a) adopt, as soon as is practicable, a child protection policyb) report in its annual report (under the New CE Act 2004 s150) on whether, or on the extent to which, its

operations have implemented the policyc) ensure that a copy of the policy is made available on an Internet site maintained by or on behalf of the

boardd) ensure that every contract, or funding arrangement, that after that commencement the board enters

into with an independent person requires the person as soon as practicable to adopt a child protection policy

e) review the policy within 3 years.

Children’s Worker Safety Checking (Part 1 Subpart 3 sections 25 – 38)

The Vulnerable Children’s Bill is introducing worker safety checks to reduce the risk of harm to children by requiring people employed or engaged in work that involves regular or overnight contact with children to be safety checked. Section 38 requires the provision of information to the Director-General of Health, as the Chief Executive of a key organisation, regarding the safety checking of children’s workers employed or engaged by the organisation.

DHB’s must include in the Annual Plan: details of the DHB’s plans for recruiting workers in the children’s workforce including safety checking as

specified in Part 1, Subpart 3 (s25-38) of the Vulnerable Children Bill. The Bill is expected to receive Royal assent in June 2014 after which the initial safety checking plan will be immediately applicable

details for the implementation of worker safety checks for new employees in the core children’s workforce from 1 July 2014 and for existing employees in the core children’s workforce from 3 years after the date the provision comes into force (s25 – 26)

details of plans to reassess workers on a 3 yearly basis (s27).

Every safety check must include: confirmation of identity of the person (prescribed by regulations) consideration of specific information prescribed by regulations made under section 32 a risk assessment carried out as prescribed by regulations made under section 32 that assesses the risk

the person would pose to the safety of children if employed or engaged as a children’s worker.

Recruitment policies must also describe the DHB process for ensuring no person convicted of one of the specified offences is employed or remains in the employment of the DHB unless the person holds an exemption under section 34.

Organisational health (New CE Act s141(2)(c) )

This notes your DHB’s Equal Employment Opportunities policy and may comment on governance, leadership and management aspects as well as general human resources.

The following information must be included to satisfy legislation (New CE Act s141(2)(d,e&f) ):

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explain how the entity proposes to assess its performance any plans to enter into a body co-operative agreement or arrangement, or to acquire shares or

interests in any body corporate, trusts, joint venture partnerships and/or other association of persons, to settle or appoint a trustee of a trust, and any processes to be followed and requirements to consult with the Minister.

set out and explain any other matters that are reasonably necessary to achieve an understanding of the entity's strategic intentions and capability: or that the entity is required to include in its statement of intent under this Act or another Act.

*It is suggested DHBs include an express empowering provision for service agreements in the AP to avoid any doubt in relation to Section 25(2) of the New Zealand Public Health and Disability Act 2000. DHBs are encouraged to seek independent legal advice on appropriate wording with regards to this.

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6.1 SERVICE COVERAGE AND SERVICE CHANGE

Service coverage

DHBs should show that any significant changes to service coverage and delivery continue to support the needs of their populations effectively.

Describe all service coverage exceptions that have been approved for the 2014/15 year. Provide a high level note explaining why these exceptions have been required and the process followed for approval.

Service change

DHBs are to describe all service changes which have been approved for implementation in the 2014/15 year. For each change, provide a high level explanation that gives confidence the changes will deliver benefits. It is suggested the DHB consider: whether the change is directly linked to delivery within a lower future funding path if the change is associated with regional clinical services planning outlining the process followed for approval of the service change.

Service coverage exceptions and service changes must be formally approved before they are included in Annual Plans. As in previous years DHBs are expected to provide early signals of proposed service changes to the NHB. These are required by 14 February 2014.

Service issues

It is suggested the DHB includes any emerging or current service issues it considers relevant (where a formal exception is not being sought).

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MODULE 6: SERVICE CONFIGURATION (NOT included in SOI extract)

7.1 MONITORING FRAMEWORK PERFORMANCE MEASURES* The performance measures table/template is mandatory. Note: the full detail of the monitoring framework for 2014/15 forms a separate component part of the planning package.

Dimensions of DHB Performance Measures (Non-financial) The AP must contain the key actions and outputs the DHB will deliver to meet performance targets for the measures within the performance monitoring framework (CSPC 8A rec: 21.1 & 21.6).

Include the full set of performance measures in the following template and ensure accuracy across any other use of this information in the narrative of the document (e.g. Health Target figures shown here match those used in Module 2) and other plans i.e. the Māori Health Plan.*Consider including a reference back to where these may have been included/expanded on in the Statement of Performance Expectations, Health Targets or Government, regional and local priorities sections.

2014/15 Performance Measures

The current monitoring framework aims to provide the Minister with a rounded view of performance using a range of performance markers.

Four dimensions are identified that reflect DHBs functions as owners, funders and providers of health and disability services. The four identified dimensions of DHB performance cover: achieving Government’s priority goals/objectives and targets or ‘Policy priorities’ meeting service coverage requirements and Supporting sector inter-connectedness or ‘System

Integration’ providing quality services efficiently or ‘Ownership’ purchasing the right mix and level of services within acceptable financial performance or ‘Outputs’.

It is intended that the structure of the framework and associated reports assists stakeholders to ‘see at a glance’ how well DHBs are performing across the breadth of their activity, including in relation to legislative requirements, but with the balance of measures focused on government priorities. Each target and performance measure has a nomenclature to assist with classification as follows:

Code DimensionPP Policy PrioritiesSI System IntegrationOP OutputsOS OwnershipDV Developmental – Establishment of baseline (no target/performance expectation is set)

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MODULE 7: PERFORMANCE MEASURES (NOT included in SOI extract)

8.1 Module 2 Content Requirements

This section identifies the mandatory requirements for each priority area within Module 2.

The example templates also contain a range of suggested actions and measures for these priorities which, while not mandatory, provide a strong signal on additional content that it is expected DHBs will consider including in their AP.

HEALTH TARGETS9

The six Health Targets for 2014/15 are:

1. Shorter Stays in Emergency Departments˟10 2. Improved Access to Elective Surgery˟

3. Shorter Waits for Cancer Treatment / transitioning to Faster Cancer Treatment˟

4. Increased Immunisation˟

5. Better Help for Smokers to Quit˟6. More Heart and Diabetes Checks˟.

GOVERNMENT PRIORITIES

The 2014/15 Annual Plan Priority areas (in addition to the Health Targets) are:

Better Public Services (including Social Sector Trials): Reducing Rheumatic Fever˟ Prime Minister’s Youth Mental Health Project*11, 12

Children’s Action Plan˟

Whānau Ora˟

System Integration: Diabetes˟ and Long Term Conditions˟ Stroke˟

9 If your DHB has consistently met a Health Target, for example, Shorter Stays in Emergency Departments, then you are not required to provide a detailed plan for 2014/15. DHBs do, however, need to commit to continue to meet the target and to the actions the DHB already has in place. 10 ˟ Refer to the Alliance Leadership Charter for a description of alliancing principles. While in 2014/15 there is no requirement that NGOs are formal members of your ALT, the principle of partnership must underpin any service development. This includes the primary care component of the Shorter Stays in Emergency Departments and Better Help for Smokers to Quit Health Targets; as are

areas in this list marked with a ˟. 11 * DHBs are expected to use their Alliance Leadership Team and any Service Level Alliance Teams to jointly develop 2014/15 DHB Annual Plans for the Youth Services component of the Prime Minister’s Youth Mental Health Project and Primary Care (including

Rural Health). Marked with a *in the above list.12 Where Social Sector Trials are operating locally, DHBs are expected to work with local Trial Leads for the actions identified to improve the responsiveness of primary care to youth, increase school-based health services and improve access to mental health and youth AOD services.

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MODULE 8: APPENDICES (NOT included – for reference in developing documents only)

Acute Coronary Syndrome˟ Improved Access to Diagnostics˟ Cardiac – Secondary Services (network agreed) ˟ Faster Cancer Treatment Primary Care* Health of Older People˟ the Mental Health Service Development Plan˟ Maternal and Child Health˟

National Entity Priority Initiatives

Improving Quality

Actions to Support Delivery of Regional Priorities

Living Within Our Means

Regional Services Plan Priorities

Regional Planning Priorities for 2014/15 include:

Elective Services Cancer Services Cardiac Services (Acute Coronary Syndrome) Mental Health and Addictions Stroke Services Health of Older People Major Trauma Information Technology Workforce

DHBs are expected to include actions/milestones/budget allocation/measures to deliver of on regional objectives in their Annual Plans. This will include, as appropriate, actions to deliver on Major Trauma as a regional priority for 2014/15.

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2014/15 DHB Planning Priorities

Structure of the templates – the integration storyDemands on health services are increasing within a tight financial environment. An ageing population, long term conditions and the needs of vulnerable populations are placing greater pressures on the health system. These pressures mean we need to explore new and different models of care and increase our focus on how to bend the acute demand curve including early intervention and integrated services focused on the patient and provided closer to home. Integrating health services to ensure a more coordinated and closer to home service provides an opportunity to develop a more efficient and sustainable health system. Integrating services through the use of alliancing principles will also support the implementation of the Government’s Better Public Service targets.

This involves:o effective use of data to inform new models of care that eases the pressure on hospitalso joint development of the new models of careo improving quality through efficiency and effectivenesso ensuring sufficient change management capability to undertake this development, and its implementation ando effective clinical leadership.

Guidance in these templates covers all the Government’s priorities. The priorities have been clustered within the templates to reflect the Government’s Better Public Service targets and requirement for increased system integration. The sections with their component parts are:

Better Public Services (including Social Sector Trials): System Integration: Increased Immunisation Health Target More Heart and Diabetes Checks Health Target

Diabetes & Long Term Conditions Stroke Acute Coronary Syndrome

reducing rheumatic fever Shorter Stays in Emergency Departments Health Target

Prime Minister’s Youth Mental Health Project Better Help for Smokers to Quit Health Target

Children’s Action Plan Improved Access to Elective Surgery Health Target Diagnostic Waiting Times Cardiac Services

Whānau Ora Shorter Waits For Cancer Treatment / Faster Cancer Treatment Health Target

Primary Care Health of Older People the Mental Health Service Development Plan* Maternal and Child Health

National Entity Priority Initiatives

Improving Quality

Actions to Support Delivery of Regional Priorities

Living Within Our Means

Regional PrioritiesRegional Planning Priorities for 2014/15 include: Elective Services Cancer Services Cardiac Services (Acute Coronary Syndrome) Mental Health and Addictions Stroke Services Health of Older People Major Trauma Information Technology WorkforceDHBs are expected to include actions/milestones/budget allocation/measures to deliver of on regional objectives in their Annual Plans. This will include, as appropriate, actions to deliver on Major Trauma as a regional priority for 2014/15. The Line of Sight Guidance Framework is attached as Appendix 8.7.

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2014/15 DHB Annual Plan Priorities and Expectations

Better Public Services and all of government initiatives (including Social Sector Trials)

Context

DHBs are to situate their actions, milestones and measures to meet the objectives of an initiative in this section in the context of the integration story.

Objectives

A system that provides Better Public Services is one that has:Decreasing incidence of rheumatic feverMore responsive mental health services for youth13

Fully immunised childrenEarly identification and support for vulnerable children.

Linkages – for templates in this section

1. Ministry’s Output Plan2. Ministry’s Statement of Intent3. Outcomes Framework (Module 1 and 2)4. Maternal and Child Health Template5. Mental Health and Addiction Service Development Plan14

6. Whānau Ora Template7. Living Within Our Means Template

2014/15 DHB Annual Plan Priorities and Expectations

Reduced Incidence of Rheumatic Fever˟15 Meet 2014/15 targets for acute rheumatic fever initial hospitalisations Deliver actions specified in DHB Rheumatic Fever Prevention Plans Undertake a root cause analysis of every rheumatic fever case and identify systems failuresMeasures Meeting the set targets for acute rheumatic fever initial hospitalisations for 2014/15 Delivery of the actions specified in the rheumatic fever prevention plans Provide data from the root cause analysis as requested by the Ministry. A reporting template will be provided by the Ministry Provide a report on the lessons learned and actions taken following the root cause analysis to the Ministry each quarter. A

reporting template will be provided by the Ministry

The 2014/15 targets for each DHB are included in the following table.

DHB 2014/15Target:40% reduction from baseline levelRate Numbers

Northland 6.3 10Waitemata 1.4 8Auckland 1.9 9Counties Manukau 7.9 42Northern region 4.0 69Waikato 2.1 8Lakes 4.7 5Bay of Plenty 2.3 5Tairawhiti 5.6 3Taranaki 0.5 1Midland region 2.5 21Hawkes Bay 2.6 4MidCentral 0.9 2

13 These actions also support delivery of social sector trials14 These actions also support delivery of social sector trials15 ˟While in 2014/15 there is no requirement that NGOs are formal members of your DHB Alliance Leadership Teams, the principle of partnership must underpin any service development. The Alliance Leadership Charter refers. The Primary Care components of both the Better Help for Smokers

to Quit and Shorter Stays in Emergency Departments Health Targets are included; as are planning priorities in this table marked with a ˟.

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Whanganui 1.9 1Capital and Coast 1.8 5Hutt 2.9 4Wairarapa 0.0 0Central region 1.9 17Southern region 0.3 3New Zealand 2.4 109

Children’s Action Plan˟ Reducing the number of assaults on children:

o DHBs to develop and evaluate VIP programmeso DHBs to describe actions taken to plan, implement and/or maintain their National Child Protection Alerts Systemo DHBs to confirm provision of Ministry-accredited training for health professionals to recognise signs of abuse and

maltreatment in designated services

Implement the Children’s Action Plan:

Describe DHB actions to support establishment of Children’s Teams includingo participation in regional Children’s Team governance and leadership involvement by DHB and non-DHB employed health

professionals,o collaboration with other agencies to plan, test and monitor assessment processes to support early response systems,

assessment processes and delivery of coordinated services for vulnerable childreno work to develop effective referral pathways to/from Children’s Teams and primary and secondary health serviceso enabling health professionals to attend necessary training to support Children’s Teams.

Describe DHB service planning and development activity to provide an effective continuum of services across primary and referred health services to meet the needs of:o pregnant women with complex needso vulnerable children and their familieso children in state careo children with mental health and behavioural problemso mental health and addiction service users in their role as parents

Measures

All DHBs achieve audit scores of 70/100 for each of the child and partner abuse components of their VIP programmes. All DHBs implement NCPAS by 30 June 2015 DHBs support establishment of multi-disciplinary Children’s Teams DHB has internal governance/engagement arrangements within the DHB and with primary and community partners to provide

services for:o Vulnerable children and their families/whānauo Pregnant women with complex needso Children referred to Gateway

DHBs support the implementation of Rising to the Challenge (e.g. COPMIA), and Healthy Beginnings: Developing perinatal and Infant Mental Health Services in NZ

Increased Infant Immunisation˟ Actions to support increasing infant immunisation rates (six weeks, three months and five months immunisation events) from 90 per

cent of eight-month-olds to 95 percent by December 2014:o maintain an immunisation alliance steering group that includes all the relevant stakeholders for the DHB’s immunisation

services including the Public Health Unit; and that participates in regional and national forumso work with primary care partners to monitor and increase new born enrolment rates to 100%o monitor and evaluate immunisation coverage at DHB, PHO and practice level, manage identified service delivery gapso identify immunisation status of children presenting at hospital and refer for immunisation if not up to dateo in collaboration with primary care stakeholders develop systems for seamless handover of mother and child as they move

from: maternity care services to general practice and WCTO serviceso in collaboration with NGOs and government agencies, describe how the DHB is working across agencies to increase

immunisation coverage

MeasuresIncrease infant immunisation rates increasing infant immunisation rates (six weeks, three months and five months immunisation events) from 90 per cent to 95 percent by December 2014a) 98% of newborns are enrolled with general practice by three monthsb) Narrative report on DHB and interagency activities to promote immunisation weekc) 85% of 6 week immunisations are completed (measured through the completed events report at 8 weeks)

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Whānau Ora˟ DHBs to provide actions that show support for implementation of the national Te Puni Kōkiri led Whānau Ora initiative that is

supported by the Ministry of Health. This includes DHBs supporting the transformation of Whānau Ora provider collectives towards becoming mature providers through:o Building capacity and capability: build on the investment TPK has made to strengthen both the capacity and capability of the

provider collectives across the governance, management and service delivery levelso Being outcomes focused: continue implementation and refinement of integrated contracting processes, focused on outcomes;

and to work with the Ministry to support GP providers, who are part of Whānau Ora provider collectives, to use their practice management systems to report on Whānau outcomes

o Implementing programmes of action: support the provider collectives in the planned activities for implementation in 2014/15; and substantive engagement with provider collectives

o Supporting strategic change: strategic planning with the DHB includes participation of the Whānau Ora provider collectives; building and maintaining relationships with agencies implementing Whānau Ora; and support for Whānau Ora across all levels of the DHB, including at Board and Planning and Funding level

o Minister Turia announced changes on the future direction of Whānau Ora in July. A key feature of the announcement is the establishment of three NGO Commissioning Agencies. It is not yet clear what the commissioning agencies will look like and what will be required of DHBs. Te Puni Kōkiri aim to complete the procurement process and be in a position to announce the selected agencies by the end of this year. We will update you as soon as more information becomes available.

Measures The outcome of the Whānau Ora approach in health will be improved health outcomes for whānau through quality services that are

integrated (across social sectors and within health), responsive and patient/whānau centredRefer S15: Delivery of Whānau ora

Prime Minister’s Youth Mental Health Project*

* DHBs are expected to use their Alliance Leadership Team and any Service Level Alliance Teams to jointly develop 2014/15 DHB Annual Plans for the Youth Services component of the Prime Minister’s Youth Mental Health Project; and Primary Care (including Rural Health).

These are marked with a * in this table.

Where Social Sector Trials are operating locally, DHBs are expected to work with local Trial Leads for the actions identified to improve the responsiveness of primary care to youth, increase school-based health services and improve access to mental health and youth AOD services.

Expand the use of HEEADSSS Wellness Checks in schools and primary settings:o HEEADSSS is a wellness check that is part of school-based health services.o Work in this area is yet to be confirmed

Improve the responsiveness of primary care to youth: DHBs to establish a youth-specific Service Level Alliance Team (for 12 – 19 year olds), including YOSS where they exist, and other

stakeholders such as school based health services to determine local needs and agree service provision and funding. Examples of appropriate activity include: development of youth wellness hubs/networks extend school based health services to provide HEEADSSS assessments to high-risk students in Decile 4 -5 secondary schools workforce development for GPs, nurses and general practice receptionists to improve competency in working with youth in

primary care set up a youth specific service as part of the primary care network, specifically targeting young people who do not attend

school.Review and improve the follow-up care for those discharged from CAMHS and Youth AOD services:

o Improve follow-up in primary care of youth aged 12-19 years discharged from secondary mental health and addiction services by providing follow-up care plans to primary care providers. The follow-up care plans should be provided with the expectation that they are activated by the primary care provider within three weeks of discharge.

o Ensure services are culturally-competent and provided to meet the health needs of Māori and Pacific populations.

Improve access to CAMHS and Youth AOD services through wait times targets and integrated case management:o implement agreed action to meet the waiting time targets that by 2015 will enable: 80 percent of youth to access services

within three weeks; 95 percent to access services within eight weeks.Explanatory note:

o Social Sector Trials have been established in 16 locations around New Zealand to test what happens when community leads are given the mandate to co-ordinate social development, health, education, police and justice activities at a local level in order to achieve improved social outcomes. Fourteen of the 16 Trials have specific outcomes around 12 to 16-year-olds to improve engagement with education and work, and decreased consumption of alcohol and drugs. The Project initiatives should be co-ordinated with Social Sector Trials where they exist.

Measures Primary care services are more responsive to the specific needs of young people Improved youth access to appropriate services Improved integration of services for youth Improved sustainability of youth-specific services, such as YOSS The percentage of care plans will increase Delivery against target.

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System Integration

Context

DHBs should situate its actions, milestones and measures to meet the objectives of an initiative in the third section in the context of the integration story.

All parts of the system are to jointly develop and implement services in high priority areas.

A new PHO Services Agreement, Alliance Agreement along with an Alliance Charter took effect 1 July 2013. DHBs are expected to use their Alliance Leadership Team (ALT) and any Service Level Alliance Teams to jointly develop the 2014/15 Annual Plan with their primary care partners to strengthen clinical integration. DHBs are expected to outline how they will achieve increased primary/secondary integration (including the development of Service Level Alliance Teams for Rural Primary Care and Youth Services) during 2014/15 describing quarterly milestones to measure progress.

As ALTs mature DHBs will be expected to incorporate a broader range of service development involving the appropriate stakeholders within the ALTs. In the 2014/15 year DHBs are expected to develop an alliancing arrangement that follows the principles of partnership and joint service development and implementation with appropriate stakeholders for More Heart and Diabetes Checks, long term conditions, Diabetes Care Improvement Packages, pre-hospital activity to meet the Shorter Stays in Emergency Department Health Target – Primary Care component, Better Help for Smokers to Quit – Primary Care component, Whānau Ora services, Mental Health and Addiction Plan, Health of Older People and Maternal and Child Health. Refer to the Alliance Charter for a description of the principle of partnership that must underpin any service development.

Objectives

A health system that is well integrated provides a sustainable system where people receive services from the right person, at the right time and in the right place. The Government’s health policy, Better, Sooner, More Convenient, set out the vision for an integrated health system with patients at the centre, where care is delivered closer to home by trusted, motivated health professionals working together in an effective, efficient manner.

Linkages – for all templates in this section

Ministry’s Output Plan Ministry’s Statement of Intent Outcomes Framework (Module 1 and 2) Youth Mental Health Template Diagnostic Services Template Elective Services Health Target Whānau Ora Template Living Within Our Means Template

More Heart and Diabetes Checks˟

Use Budget 2013 funding to support primary care to deliver on the health target and ensure its sustainability Ensure the expertise, training and tools needed are available to successfully complete the CVD risk assessment and management to

meet clinical guidelines IT systems that have patient prompts, decision support and audit tools exist, are used and fully report performance.

Measures

Health Target – More Heart and Diabetes Checks 90 per cent of the eligible adult population will have had their cardiovascular disease (CVD) risk assessed in the last five years.

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Diabetes and Long-term Conditions˟

DHBs, in collaboration with PHOs, primary and secondary care providers, and where feasible local consumers of care, will identify actions to improve performance of in the Diabetes Care Improvement Packages (DCIPs) and long term conditions services that are driving demand in the district including actions in the following areas:

Key Actions:

DHBs to continue to progress the Diabetes Care Improvement Plans (DCIPs) developed in 2013/14 Diabetes is the condition of focus and ensuring DCIPs are delivering the expected outcomes is the primary focus for DHBs. Successful

models developed for DCIP can then be utilised for other services.

Actions to include:

Prevention of diabetes and other LTCs through improved services to promote healthy lifestyles, including nutrition and physical activity advice

Identification of populations at risk of diabetes or LTCs using risk stratification. Risk stratification is the systematic categorisation of patients at risk of, or with, any long term conditions, in order to provide appropriate management.

DHB examples include:o Risk stratification is being implemented in all DHBs for the Acute Coronary Syndrome (ACS) programme using tools such as the

Global Registry of Acute Coronary Events (GRACE). The tools for long term conditions and chronic care are more gradually being implemented at different rates across the country.

o Counties Manukau DHB’s At Risk Individuals programme aims to reduce unplanned hospitalisations using the risk stratification algorithm, Patients at Risk of Re-hospitalisation (PARR).

o Auckland DHB developed an avoidable admissions plan for high risk individuals using the Predictive Risk Management (PRM) algorithm which identifies individuals at high risk of admission to hospital.

o West Coast DHB has augmented their long term conditions management with risk stratification also using the PRM algorithm. This matches the people identified through new risk profiles with existing LTCM enrolees and incorporates into LTCM with new/existing tools and structure.

o Canterbury DHB is trialling three algorithms for risk of readmission within 12 months, risk of ED attendance within 6 months, and risk of index admission within 12 months. This is based on work done in Scotland, which used pharmacy data as one of the best predictors, although the DHB does not currently have access to the Pharmacy NHI level data.

Management of people with diabetes or LTCs will be person/whānau centred. Develop clinical pathways to ensure appropriate and consistent access to all services and support. Self-management and other care plans will be developed in conjunction with people and their whānau/family

Enablers include ongoing workforce development in primary care, and clinical governance with a named clinical lead. IT capability is to be maintained and improved including provision of audit tools and/or a dashboard reporting system.

Measures Linkage with Ambulatory Sensitive Admissions to Hospital (ASH) rates Measurement of improved diabetes outcomes using a set of clinical indicators to be developed.

Stroke Services˟DHBs to: develop stroke thrombolysis quality assurance procedures, including processes for staff training and audit

o Examples include: workforce training to support thrombolysis, care pathways developed for thrombolysis, workforce allocation to support all DHBs in region having access to thrombolysis, for those DHBs not able to provide thrombolysis transport options to regional provider in place

provide dedicated stroke units or areas for management of people with stroke, thrombolysis, and transient ischaemic attack services supported by ongoing education and training for interdisciplinary teams

support national and regional clinical stroke networks to implement actions to improve stroke services.

Regional Alignment: DHBs to include actions/milestones/budget allocation/measures to deliver on Stroke Services as a regional priority in their APs.

Measures 6 percent of potentially eligible stroke patients thrombolysed 80 percent of stroke patients admitted to a stroke unit or organised stroke service with demonstrated stroke pathway.

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Acute Coronary Syndrome˟ Implement the Cardiac ANZACS-QI and Cardiac Surgical registers to enable reporting measures of ACS risk stratification and time to

appropriate intervention Develop processes, protocols and systems to enable local risk stratification and transfer of appropriate high risk ACS patients Work with the regional, and where appropriate, the national cardiac networks to improve outcomes for high risk ACS patients. A national definition for the counting of high risk will be made available as soon as it is agreed (intended before July 2014)Regional Alignment: DHBs are expected to include actions/milestones/budget allocation/measures to deliver on Acute Coronary Syndrome as a regional priority in APs.

Measures

70% of high-risk patients will receive an angiogram within 3 days of admission. (‘Day of Admission’ being ‘Day 0’) Over 95% of patients presenting with ACS who undergo coronary angiography have completion of ANZACS-QI ACS and Cath/PCI

registry data collection within 30 days.

Shorter Stays in Emergency Departments˟

Diagnostic/analysis work to identify the main factors impacting on ED length of stay. Further detail will be provided upon completion of the ED Quality Framework including information about increased reporting

requirements.

Measures95 percent of patients will be admitted, discharged, or transferred from an Emergency Department within six hours.

Better Help for Smokers to Quit˟

Each DHB must provide clear actions on how it will ensure that: all patients (who smoke and are seen by a health practitioner in primary, secondary and maternity care settings) are asked about

their smoking status, given brief advice to stop smoking, and are offered/given effective smoking cessation support (ie, ABC), as part of their routine clinical care; and

each patient’s ABC information is documented accurately within their patient record.

Each DHB must also provide evidence that it has a current Tobacco Control Plan in place, and that the plan outlines what work will be done, outside of the health target, to reduce the prevalence of smoking in the lead up to a Smoke free Aotearoa by 2025.

Identify concrete actions on how your DHB will ensure that the Better help for smokers to quit health target is embedded in hospitals’ routine care pathways. More robust actions will be expected from those DHBs that have not achieved the 95 percent target yet or have been swinging below 95 percent in 2013/14o Examples of actions in this section could include providing weekly reports to ward managers on their health target performance,

and/or ensuring that 100 percent of staff have completed some form of ABC training Outline what money or FTE your DHB will commit to improving the primary care component of the Better help for smokers to quit

health target in 2014/15; and what actions will be taken, by the DHB and PHOs, to reach the 90 percent target by 30 June 2015. In 2013/14, all DHBs were asked to transition more resource into primary care and develop a brief action plan. The actions in this section should also reflect those discussions and should align with some of the More Heart and Diabetes Checks health target worko Examples of actions in this section could include providing weekly feedback to each practice on their health target performance,

ensuring that the health target is built into each practice’s own key performance indicators, identifying a smoke free champion within each practice, and/or ensuring that 100 percent of practice staff have and know how to use audit and prompting tools

Although the maternity component of the Better help for smokers to quit health target is not being publicly reported on at present, the Ministry still expects to see what actions the DHB will take in 2014/15 to support midwives and general practices to provide pregnant women with advice and support to quit smokingo Examples of actions in this section could include providing 100 percent of midwives and general practitioners with ABC training

that is specific to pregnant women, and/or building relationships between midwives and local cessation services through monthly or bi-monthly meetings

Provide evidence that your DHB has a current Tobacco Control Plan in place for its area, and that the plan outlines what work will be done, outside of the health target, to reduce the prevalence of smoking in the lead up to 2025

Actions in your Tobacco Control Plan could include working with your local NGOs and councils to develop local smoke free initiatives and/or to introduce further smoke free areas.

Measures 95 percent of patients who smoke and are seen by a health practitioner in public hospitals will be offered brief advice and support to

quit smoking 90 percent of patients who smoke and are seen by a health practitioner in primary care will be offered brief advice and support to

quit smoking 90 percent of pregnant women (who identify as smokers at confirmation of pregnancy in general practice or booking with a Lead

Maternity Carer) will be offered advice and support to quit smoking By 2025, less than 5 percent of the DHB’s population will be a current smoker.

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Improved Access to Elective Surgery˟

Delivery against your agreed volume schedule (to be provided with funding advice), including elective surgical discharges, to deliver the Electives Health Target

Electives funding will be allocated to support increased levels of elective surgery, specialist assessment, diagnostics, and alternative models of care.

Standardised intervention rates and/or other mechanisms (such as demand analysis) will be used to assess areas of need for improved equity of access.

Patient flow management will be improved to achieve further reductions in waiting times for electives. No patient will wait longer than five months during 2014, and waiting times are reduced to a maximum of four months by the end of December 2014.

Identify actions to support improvements in electives access, quality of care, patient flow management, or that maximise available capacity and resources. Example areas could be improving scheduling, patient pathways, use of alternative providers, management of follow-ups, referral management (and relationships with primary care), internal policies and processes, patient focussed booking, preadmission redesign, The Productive Operating Theatre, enhanced recovery or rapid improvement, direct access to diagnostic or treatment. This should include activity planned as part of Elective Services Productivity and Workforce Programme (ESPWP) projects, where relevant

Patients will be prioritised for treatment using national, or nationally recognised, tools, and treatment will be in accordance with assigned priority and waiting time

Participate in activity relating to development and implementation of the National Patient Flow system, including amending data submission for FSA referrals as required.

Regional Alignment: DHBs to include actions/milestones/budget allocation/measures to deliver on Electives as a regional priority in their APs.

Measures Delivery against agreed volume schedule, including a minimum of xx elective surgical discharges in 2014/15 towards the Electives

Health Target (will be provided in electives funding advice) Refer to SI4: Elective services standardised intervention rates Elective Services Patient Flow Indicators expectations are met, and all patients wait four months or less for first specialist assessment

and treatment from January 2015 Refer to Ownership Dimension performance measures for Inpatient Length of Stay (OS3). Include measures for any local projects/actions identified Increased uptake of latest national CPAC tools to improve consistency in prioritisation decisions Patient level data for referrals for FSA are reporting into new collection.

Improved Access to Diagnostics˟Improving diagnostic waiting times has been identified a policy priority area for 2014/15. As a consequence, diagnostic waiting time indicators are shifting from a developmental status to full DHB accountability measures in 2014/15. This means formal performance targets will be set against the indicators for 2014/15.

Expectations are that DHBs: Achieve identified waiting time targets by more efficient use of existing resources; making improvements to referral management

and patient pathways; and investing in workforce and capacity as required Participate in activity relating to development and implementation of the National Patient Flow (NPF) system, including adapting data

collection and submission to allow reporting to the NPF as required Work with regional and national clinical groups to contribute to development of improvement programmes.

MeasuresRefer PP29: Improving waiting times for diagnostic services: Note: Indicators have not yet been updated for 2014/15. They will be confirmed following December 2013 results, and notified in early 2014 Coronary angiography – X% of accepted referrals for elective coronary angiography will receive their procedure within 3 months (90

days). CT and MRI – X% of accepted referrals for CT scans, and X% of accepted referrals for MRI scans will receive their scan within six weeks

(42 days) Diagnostic colonoscopy – X% of people accepted for an urgent diagnostic colonoscopy will receive their procedure within two weeks

(14 days); and X% of people accepted for a diagnostic colonoscopy will receive their procedure within six weeks (42 days) Surveillance colonoscopy – X% of people waiting for a surveillance or follow-up colonoscopy will wait no longer than 12 weeks (84

days) beyond the planned dateAbove indicators are expected for all DHBs for CT, MRI and colonoscopy. For coronary angiography, indicators are expected where those services are locally provided. Representation, attendance and participation in national and regional clinical group activities. Agreed system changes are implemented.

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Cardiac Services

Secondary Services˟ Deliver a minimum target intervention rate for cardiac surgery, set in conjunction with the National Cardiac Surgery Clinical Network,

to improve equity of access Ensure appropriate access to cardiac diagnostics to facilitate appropriate treatment referrals, including angiography,

echocardiograms, exercise tolerance tests etc. Manage waiting times for cardiac services, so that no patient waits longer than five months for first specialist assessment or

treatment during 2014, and reduce waiting times to a maximum of four months by the end of December 2014 Undertake initiatives locally to ensure population access to cardiac services is not significantly below the agreed rates. This includes

cardiac surgery, percutaneous revascularisation and coronary angiography Sustain performance against cardiac surgery waiting list management expectations (for the five cardiac surgery providers only) Ensure consistency of clinical prioritisation for cardiac surgery patients, by using the national cardiac CPAC tool, and treating patients

in accordance with assigned priority and urgency timeframe (for the five cardiac surgery providers only)

Measures Agreement to and provision of a minimum of XX total cardiac surgery discharges for your local population in 2014/15 (will be

provided in electives funding advice) Refer PP29: Improved access to diagnostics. To be confirmed % of people will receive elective coronary angiograms within 90 days.

Expected for DHBs who provide angiography services only Elective Services Patient Flow Indicators: all patients wait five months or less for first specialist assessment and treatment during

2014, and less than four months during 2015 Refer SI4: Standardised Intervention Rates

o Cardiac surgery: 6.5 per 10,000 of populationo Percutaneous revascularisation: 12.5 per 10,000 of populationo Coronary angiography: 34.7 per 10,000 of population

The waiting list for cardiac surgery remains between 5 and 7.5 percent of annual cardiac throughput, and does not exceed 10 percent of annual throughput. Expected for the five cardiac surgery providers only

Cardiac surgery patients are operated on within nationally agreed urgency timeframes. Expected for the five cardiac surgery providers only.

Shorter Waits for Cancer Treatment / Faster Cancer Treatment˟ Identify actions to maintain timeliness of access to radiotherapy and chemotherapy Actions to sustain performance could include:

Cancer centre DHBs:o using the recommendations from the National Radiation Oncology Plan to invest in workforce and/or invest in capacityo more efficient use of existing resourceso supporting workforce training, in particular medical physicistso implementing the priority areas identified in National Medical Oncology Models of Care Implementation Plan 2014/15Non cancer centre DHBs:o monitor provider DHBs

Identify actions to improve timeliness and quality of the cancer patient pathway from the time patients are referred into the DHB through treatment to follow-up / palliative care

Actions are expected to include:o identifying and implementing improvements to the quality of faster cancer treatment indicator data including ensuring that

reporting meets the data quality expectations as agreed in the DHB’s 2013/14 ‘Support for improving the faster cancer treatment indicator reporting’ contract

o making the faster cancer treatment data collection systems /processes part of business as usualo improving the functionality and coverage of multidisciplinary meetings (MDMs) across the region by implementing the

regionally agreed MDM prioritieso undertaking a review of three tumour standards (different tumour types to the review undertaken in 2013/14)o supporting cancer nurse coordinators

Identify actions to improve waiting times and quality of endoscopy / colonoscopy servicesActions are expected to include:o implementing the Endoscopy Quality Improvement (EQI) programmeo identifying and implementing improvements to colonoscopy services

Waitemata DHB with Auckland regional DHB partners: support on-going activities associated with bowel screening pilot.Regional Alignment: DHBs are expected to include actions/milestones/budget allocation/measures to deliver on Cancer as a regional priority in their APs.

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MeasuresPerformance maintained against the Shorter waits for cancer treatment health target (radiotherapy and chemotherapy) – all patients, ready-for-treatment, wait less than four weeks for radiotherapy or chemotherapy,Improvements in the performance against the policy priority (PP30) faster cancer treatment indicators: 62 day indicator - proportion of patients referred urgently with a high suspicion of cancer who receive their first cancer treatment (or

other management) within 62 days 14 day indicator - proportion of patients referred urgently with a high suspicion of cancer who have their first specialist assessment

within 14 days 31 day indicator - proportion of patients with a confirmed diagnosis of cancer who receive their first cancer treatment (or other

management)

Monitor through policy priority (PP24) improving waiting times – cancer multidisciplinary meetings improvements to the coverage and functionality of multidisciplinary meetings.Monitor through six-monthly crown funding agreement variation – appoint cancer nurse coordinators reporting.Monitor through policy priority (PP29) waiting times for diagnostic and surveillance /follow-up colonoscopy. Diagnostic colonoscopy: TBC percent people accepted for an urgent diagnostic colonoscopy will receive their procedure within two

weeks (14 days); and TBC percent of people accepted for a diagnostic colonoscopy will receive their procedure within six weeks (42 days)

Surveillance/Follow-up colonoscopy: TBC percent of people waiting for a surveillance or follow-up colonoscopy will wait no longer than 12 weeks (84 days) beyond the planned date.

Primary Care*DHBs are expected to continue to improve the integration of services in their district, ensuring patients receive more services closer to home. DHBs are expected to outline how they will achieve this with specific activities describing quarterly milestones to measure progress including: Evidence the annual plan was jointly developed and agreed by the Alliance Leadership Team Increasing the number of services shifted into the community Increasing the volume of direct referrals from primary care for flat X-rays and ultrasounds Broadening the scope of POAC available to primary care (for those DHBs who do not already offer the level and breadth of services

described in the 2013/14 Guidance) Embedding the referral pathways for primary care direct access to two elective surgery procedure lists Improving and embedding the pathways for primary care access to specialist nurse and/or doctor advice for three high-demand

services The work streams (Service Level Alliance Teams), e.g. acute demand, long term conditions, health of older people, agreed by the ALT

including use of the Flexible Funding Pool and an appropriate transition plan for work agreed out of scope Implementation of the Integrated Performance and Incentive Framework (IPIF) once developed. Content to be advised. Establish a Rural Service Level Alliance Team and develop and implement a plan for distribution of the Rural Primary Care Funding

according to the agreed processes in the PHO Services Agreement by the end of Quarter One In addition, DHBs are expected to use their Alliance Leadership Team and any Service Level Alliance Teams to jointly develop 2014/15

DHB Annual Plans for the following in 2014/15:o Primary Care (including Rural Health) , ando Prime Minister’s Youth Mental Health Project – Youth Services.

Measures Improvement in the acute demand curve for the district Improved performance of the district-wide system. Further specifics will be provided when the Framework is completed Sustainable rural primary health care services.

Health of Older People˟Rapid response and discharge management services (wrap around services) (PP23) Implement the findings of your review of your DHB’s rapid response and discharge management services; ; and the lessons to be

learned from CREST (in Canterbury) and START (in Waikato)Home and Community Support Services for Older People (PP23) Use of Budget 2013 funding for home and community support services Use of quality measures for Home and Community Support Services identified by the DHB HOP Steering GroupDementia Care Pathways (PP23) Continued development and implementation of dementia care pathwaysFracture Liaison Service (PP23) Full operation of a fracture liaison serviceComprehensive Clinical Assessment is residential care (interRAI) (PP23) Facilities trained or engaged in training in the use of interRAI DHBs supporting the uptake of interRAI trainingHOP specialists (PP23) Proactive use of DHB specialist Health of Older People Services (geriatricians, gerontology nurse specialists) to advise and train health

professionals in primary care and aged residential careRegional Alignment: DHBs to include actions/milestones/budget allocation/measures to deliver on HOP as a regional priority in their APs.

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Measures Evidence of implementation of findings from review of rapid response and discharge management services/teams Evidence of continued price or volume increases based on receipt of Budget 2013 funding Evidence of DHB using interRAI quality measures to progress and compare performance with other DHBs Evidence of continued development and implementation of a dementia care pathway (- in line with the New Zealand Framework for

Dementia Care) All aged residential facilities in DHB area using, or training their nurses to use, the interRAI LTCF assessment tool. Evidence of how the DHB has supported the uptake of interRAI training Evidence that the DHB has established a Fracture Liaison Service (FLS) and is monitoring its operation, in particular from the number

of people identified as having fragility fractures and the proportion who avoid a secondary fracture The DHB has increased the number of hours that specialist HOP services consult with health professionals in primary care and aged

residential care (‘maintain’ rather than increase if already at an optimal level) or used another relevant measure to show an increase or maintenance at optimal level (eg using FTEs rather than hours).

Mental Health Service Development Plan˟For each of the four key objectives from Rising to the Challenge (1) make better use of resources/value for money; 2) improve integration between primary and specialist services; 3) Cement and build on gains in resilience and recovery (including developing services for children of parents with mental illness and addictions); and 4) deliver increased access for all age groups Provide at least 2 actions for each area, with targets and 6 monthly milestones for 2014/15 Deliver and report on required actions with targets and 6 monthly milestones for 2014/15 which will either increase access or improve

outcomes for each of the following Government work programmes:o Drivers of Crimeo Welfare reforms

Implementation of the New Zealand Suicide Prevention Strategy 2006-2016 and the New Zealand Suicide Prevention Action Plan 2013-2016. DHBs are expected to provide evidence of how the following will be met:o train health workers to identify and support individuals with self-harm injuries or at risk of suicide and refer them to the services

they needo develop and implement district suicide prevention and postvention planso facilitate integrated cross-agency collaboration in respect to suicide prevention and response to suicide clusters/contagion

Mental health and addiction service provision ringfenceo Explain how the mental health and addiction ringfence is assured in the planning process. The ringfence calculation will include

demographic and cost pressure increases, supplemented by expenditure under- spends to bring forward growth so that the long term growth path can be maintained. Also show the connection between maximising ringfence funding and addressing service gaps.

Regional Alignment: DHBs to include actions/milestones/budget allocation/measures to deliver on Mental Health as a regional priority in their APs.

Measures PP6, PP7,PP8 ,PP26 &OS10 Submit district suicide prevention and postvention plans for review in the second quarter reporting.Maternal and Child Health˟ Actions to improve the access that pregnant women, babies, children and families have to services that maintain good health and

independence:o Timely registration with an LMC: Describe actions to increase the number of women who register with an LMC by week 12 of

their pregnancy, for example raising awareness through social media campaigns or improving referral pathways by working with primary care or pharmacies

o Newborn enrolment: Describe actions to ensure all newborn babies are enrolled with a PHO and registered with a GP, Well Child Tamariki Ora (WCTO) provider and Community Oral Health Services

o B4 School Check: Describe actions to increase B4 School Check coverage to 90 percent of the eligible population, for example holding evening/weekend clinics, increased promotion or working with ECE providers to identify and invite children who have not had a B4 School Check

o Oral Health: Commit to actions to improve referrals to, and enrolment in, oral health services for children 0-18 years of ageo WCTO Quality Improvement Framework: Implement between one and three quality improvement activities (not covered in the

above guidance) from the WCTO Quality Improvement Framework relating to improved access Pregnant women, babies, children and families have improved health outcomes:

o WCTO Quality Improvement Framework: Implement between one and three quality improvement activities (not covered by the above guidance) from the WCTO Quality Improvement Framework relating to improved outcomes

Services for pregnant women, babies, children and families are of high quality and are nationally consistent:o Maternity Quality & Safety: Continue to implement Maternity Quality and Safety Programme, identify local quality improvement

priorities that include addressing National Maternity Monitoring Group priorities, DHBs who are outliers in the NZ Maternity Clinical Indicators put programmes in place to reduce unnecessary variation in clinical practice

o Gestational Diabetes: Implement the national guideline for the screening, diagnosis and management of gestational diabetes (expected to be released in early 2014)

o WCTO Quality Improvement Framework: Implement between one and three quality improvement activities (not covered by the above guidance) from the WCTO Quality Improvement Framework relating to improved quality.

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Measures

At least 80 percent of women register with an LMC by week 12 of their pregnancy. 98% of newborns are enrolled with general practice by three months systems are in place to ensure enrolment of all newborn babies with WCTO and Community Oral Health Services At least 90 percent of children receive a B4 School Check, including at least 90 percent of children living in high deprivation areas

Improved performance against WCTO Quality Indicators measuring access Improved quality and safety of maternity services including improved access, outcomes and consumer satisfaction as measured by

national and DHB data analysis and surveys, reduced variation in performance against the NZ Maternity Clinical Indicators A nationally consistent approach to the screening, diagnosis and management of gestational diabetes

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National Entity Priority Initiatives

A national entity prioritisation process was led by the Health Sector Forum this year. National entity priorities for inclusion in 2014/15 DHB Annual Plans have now been finalised. A template was shared with DHB CFOs and GMs F&P on Thursday 20 February. Both financial and non-financial information is required from DHBs to cover a period of four years (current and three outyears).

Improving Quality

HQSC priorities for 2014/15 are subject to confirmation following the conclusion of the Health Sector Forum led prioritisation process.

Identify actions to support the Quality & Safety Markers (QSMs) with a focus on achieving:o 90 percent of older patients are given a falls risk assessmento 80 percent compliance with good hand hygiene practiceo all three parts of the surgical safety checklist used 90 percent of the timeo 95 per cent of hip and knee replacement patients receive cephazolin ≥ 2g as surgical prophylaxiso 100 per cent of hip and knee replacement patients have appropriate skin preparation Identify actions to support projects that make a difference to improving the quality of care, reducing patient harm and contribute to

the national patient safety campaign ‘Open for better care’ Identify actions to support improved patient experience through increased patient involvement in decision making (at all levels), and

the introduction of national survey questions as part of DHB systems for capturing consumer feedback Identify actions to support continued implementation of quality accounts The HQSC plans to review the 2012/13 quality accounts. As a result of the review it is anticipated that some areas where greater

standardisation is needed will be identified for the next set (2013/14) of accounts. Any mandatory areas identified will be updated in DHB accountability documents once they are confirmed. The production future quality accounts will be aligned with the DHB annual reporting timeframes.

Measures Performance updates published by HQSC and included in DHB local quality accounts Quarterly Reporting on patient experience as set out in performance measure DV3 ‘Improving patient experience’

Actions to Support Delivery of Regional Priorities

Local DHBs are to include actions/milestones/budget allocation/measures in their APs that will contribute to Regional Priorities where these are not also DHB Annual Plan priorities, including: Major Trauma Workforce IT

Living within our means

Operate w/in agreed financial plans (and fund capital investment from internal sources) Appropriate clinical and executive leadershipActions could include: Continue the implementation of Shared Services actions aligned with Health Benefits Limited (HBL) work programmes as agreed Increase theatre utilisation Proactive management of employment cost growth and improved use of workforce Reconfigure current service delivery models Increase in service outputs delivered within a primary care and/or community setting, relative to hospital delivery, and reduction in

demand for acute hospital services Service coverage exceptions and service changes must be formally approved before they are included in Annual Plans. As in previous

years DHBs are expected to provide early signals of proposed service changes to the NHB, these are required by 14 February 2014.Measures System Integration 3: Ensuring delivery of Service Coverage Ownership OS3: Inpatient Length of Stay Ownership OS8: Reducing Acute Readmissions to Hospital Output 1: Output Delivery Against Plan.

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2014/15 Regional Services Plan Priorities and Expectations

The 2014/15 RSP priorities are mostly a continuation from 2013/14 with the exceptions of Health of Older People (which is now a required priority) and Major Trauma as a new priority. DHBs are to include additional priority services which are appropriate for their region. To improve the visibility of contributions by DHBs to achieve regional service priorities a Line of Sight guidance framework has been developed. Attached as Appendix 8.7.

Electives Identify the actions that the region will undertake to improve access to elective services, reduce waiting times and improve equity of

access. These actions will differ by region but could include: developing a regional delivery plan that supports achievement of local intervention rates, maximised regional capacity,

optimal use of specialist resources and sub-specialist capability, increased access to less complex surgery and local Health Target Delivery

developing consistent pathway, access criteria, and clinical protocols for individual services establishing and delivering sub-regional agreement to facilitate cross-boundary patient care implementing sub-regional referral management and scheduling systems delivering actions agreed to in regional Elective Services Productivity and Workforce Programme (ESPWP) contracts.

Information TechnologyIdentify the actions that the region will undertake to support improved information management. For example, establishing a regional oversight role to ensure any actions required to contribute to or implement the National Patient Flow collection are regionalised where possible.

WorkforceIdentify the actions that the region will undertake to maximise workforce resources. For example, completing a forecast through to 2017/18 of future workforce requirements, developed based on service demands and maintaining a local and regional view of specialist workforce capacity and capability.

MeasuresFor the 2014/15 year it is expected that: your region’s Electives Health Target will be met by the end of December 2014, zero patients will wait more than 4 months for FSA or elective treatment a maximum waiting time of 4 months is maintained from January 2015 onwards (ESPI 2 and ESPI 5).

Cancer Services Identify the actions your region will undertake to improve access, timeliness and the quality of cancer services. For example: Improve the functionality and coverage of multidisciplinary meetings (MDMs) by implementing the regionally agreed MDM priorities;

and Implement actions that support the region to deliver on the priorities for cancer as outlined in the DHB annual plan guidance, e.g.

regional radiation oncology and medical oncology services.MeasuresFor each quarter of the 2014/15 year it is expected that:

The cancer treatment health target will be met; Improvement in performance against the policy priority (PP30) faster cancer treatment indicators is evidenced; Progress against specific agreed actions to support the regional objectives is demonstrated; and Improvement in coverage and functionality of MDMs as reported against the policy priority (PP24) improving waiting times – cancer

multidisciplinary meetings, is demonstrated.Cardiac Services To continue to work with regional cardiac clinical networks and the New Zealand Cardiac Network to implement actions to improve

outcomes for people To provide quarterly reporting at regional and DHB level utilising the ANZACS-Q1 and Cardiac Surgery registers

Secondary Services Develop and deliver a regional (or sub-regional in South Island) plan for cardiac services, ensuring appropriate access to cardiac

surgery, percutaneous revascularisation and coronary angiography. All cardiac surgery patients are prioritised, and treated in accordance with assigned priority and urgency timeframes. Sustain performance against cardiac surgery waiting list management expectations.

Acute Coronary Syndrome The phased introduction of Accelerated Chest Pain Pathways16 (ACPPs) in Emergency Departments will begin in 2014/15. A working

group linked to the New Zealand Cardiac Network and Emergency Department Clinical Groups has commenced preliminary work on ACPPs. Support will be provided to DHBs to develop, implement and measure ACPPs.

Implement regionally agreed protocols, processes and systems to ensure prompt local risk stratification and management of suspected ACS patients

Implement systems for prompt transfer of high risk patients to tertiary centres for the appropriate interventions.

16 Accelerated Chest Pain Pathways (ACPPs) are patient assessment pathways that speed up the diagnostic process for patients with chest pain, without compromising patient safety. ACPPs have significant potential as diagnostic tools to improve patient outcomes and save time and resources in Emergency Departments.

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Measures

Secondary Services

Standardised intervention rates:o Cardiac surgery: 6.5 per 10,000 of populationo Percutaneous revascularisation: 12.5 per 10,000 of populationo Coronary angiography: 34.7 per 10,000 of population

Proportion of patients scored using the national cardiac surgery Clinical Priority Access (CPAC) tool, and proportion of patients treated within assigned urgency timeframe.

The waiting list for cardiac surgery remains between 5% and 7.5% of planned annual cardiac throughput, and does not exceed 10% of annual throughput.

No patient waits longer than five months for cardiac surgery during 2014, and waiting times are reduced to a maximum of four months by the end of December 2014.

Acute Coronary Syndrome

Report quarterly on regional activity that supports Accelerated Chest Pain Pathway development and implementation Each region will have established measures of ACS risk stratification and timeliness for patients to receive appropriate intervention. 70% of high-risk patients will receive an angiogram within 3 days of admission. (‘Day of Admission’ being ‘Day 0’) Over 95% of patients presenting with ACS who undergo coronary angiography have completion of ANZACS-QI ACS and Cath/PCI

registry data collection within 30 days

Please note: A national definition for the counting of high risk will be made available as soon as it is agreed.

Mental Health and Addictions

Identify and deliver on at least two actions for each of the following that will lead to:

continued regional provision of eating disorder inpatient services (Midland and Northern regions to implement the recommendations from the service review to ensure sustainable inpatient and community services);

improved Mental Health and Addiction Service capacity for people with high and complex needs; robust regional contribution to the national network of forensic inpatient services; and Develop and implement actions for a Community Youth Forensic Service Plan with the agreed number of additional FTEs.

In the North Island, the regions Northern, Midland and Central develop and implement the appropriate options to establish a perinatal and maternal mental health service as part of a continuum of care.

Measures

A reduction in waiting lists and times for people in prisons requiring assessment in forensic services. For example: a reduction in waiting lists from x to y with targets set for each quarter.

Increased access to community youth forensic services through the development of sustainable youth forensic services and availability of liaison officers in court. For example: the number of liaison officers in court will increase from x to y with progress tracked each quarter.

Increased access in the North Island to perinatal and maternal mental health services. For example: x being current numbers to be increased to y with progress measured each quarter.

Stroke

Continue to implement NZ Clinical Guidelines for Stroke Management 2010 (the Stroke Guidelines). This will include:

People with stroke admitted to hospital and treated in a stroke unit with an interdisciplinary stroke team. Smaller DHBs, as defined in the Stroke Guidelines, are expected to develop models of stroke care that adhere as closely as possible to the criteria for stroke unit care.

All eligible patients, as specified in the clinical definition previously supplied to DHBs, have access to thrombolysis All stroke patients receive early active rehabilitation by a multidisciplinary stroke team All people with stroke have equitable access to community stroke services, regardless of where they live. All members of the multidisciplinary stroke team participate in ongoing education and training according to the Stroke Guidelines.

Workforce

Identify actions that the region will take to develop and implement an ongoing education programme that supports a sustainable and quality clinical workforce.

Information Technology

Identify actions that the region will take to support improved information management, e.g. establishing a regional oversight role.

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Measures

Provision of quarterly reports that provide progress on:

6% of potentially eligible stroke patients thrombolysed 80% of stroke patients admitted to a stroke unit, or for smaller DHBs, stroke patients admitted to an organised stroke service with a

demonstrated stroke pathwayand:

% of eligible*patients receiving active rehabilitation (as recommended in the Stroke Guidelines) as part of their acute in-patient event % of eligible* patients following discharge who receive community based stroke rehabilitation services

*Defined as those patients referred for rehabilitation by lead physician/neurologistHealth of Older People

Regions identify and develop components of dementia care pathways that are best achieved at a regional level. For example, X components of dementia care pathways that are best achieved at a regional level are identified by 30 September 2014. Y components of dementia care pathways are developed at a regional level by 31 March 2015

Regions develop and commence delivery of dementia awareness and responsiveness education programmes for primary health care clinicians. For example, Z number of primary care clinicians have attended dementia awareness and responsiveness programmes (number reported each quarter)

Regions provide representation at national dementia meetings organised by the Ministry of Health.

Workforce

Regions develop dementia awareness and responsiveness education programmes that educate primary health care clinicians on:

the importance of an early diagnosis of dementia diagnosing dementia (e.g. diagnostic tools, use of CT scanning); diagnosing delirium; and managing dementia (including optimal use of acetylcholinesterase inhibitors and training on the use of the local dementia care

pathway).

Measures

Report quarterly on regional activity that supports DHB dementia care pathway development and implementation Report six monthly on the development and commencement of dementia awareness and responsiveness education programmes in

Primary Health Care (as set out in the CFA variations) X regional representatives attended national meetings organised by the Ministry of Health

Major Trauma Regions develop and implement a three year regional action plan that in year 1 supports the collection and reporting of a nationally

consistent major trauma data set for each DHB in the region. Progress in years 2 and 3 focuses on the implementation of local and regional major trauma systems

Establish a process so that each DHB in a region collects and reports the data required to implement a national major trauma register by 1 July 2015. This will involve aligning local trauma definitions with those used in the New Zealand Major Trauma Minimum Dataset (NZMTMD)

Regions identify a designated clinical lead and co-ordinator at each DHB to provide a focus for major trauma care delivery and quality initiatives in 2014/15

Information Technology All regions and DHBs will establish data systems capable of recording the fields in the NZMTDS to be able to report that data to the

national major trauma registry.Measures Where DHBs already have capacity to report on the NZMTMD, quarterly reporting on the NZMTMD on at least 50% of the fields will

commence on 1 July 2014 Where regions and DHBs are building capacity, it is expected that processes for measuring and commencing reporting on the full

NZMTMD will be established by 1 July 2015 All DHBs, will have commenced reporting on the full NZMTMD by 1 July 2015

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Workforce, IT and Capital

Workforce

Workforce priorities for 2014/15 are subject to confirmation following the conclusion of the Health Sector Forum led prioritisation process

DHBs to work with their Regional Training Hub Director to develop and deliver a workforce plan as part of the 2014/15 Regional Service Plan (RSP). The workforce plan will include actions and key milestones. DHBs: to implement workforce initiatives that will:

o deliver on regional service priorities, as identified in the 2014/15 RSP and local workforce priorities as identified in the DHBs’ annual plans

o increase participation of Māori and Pacific from x to y FTEs in the workforce (e.g. scholarship programmes, supporting high school based programmes)

o reduce number of non-vocational registrars in PGY 3 and above from x to yo increase the number of New Zealand trained SMOs from x to yo provide x number of nursing graduates, registered and enrolled nurses, with a one year internship using innovative

strategies without increasing expenditureo meet the 70/20/10 funding criteria17 for post-entry training in medical disciplines in the region’s DHBs

to achieve the workforce mix and distribution required for the future. The workforce plan will use baseline workforce data collated over the last five years, service demand forecasts and will take account of workforce requirements in hard-to-staff clinical specialties and geographical high need areas

to implement systems to provide all HWNZ funded trainees with career advice, pastoral care and a career plan that aligns individual career aspirations with regional and national identified future health workforce needs.

Build on the workforce section of the 2013/14 RSP and detail progress with actions and key milestones to: standardise at least four PGY1 and 2 programmes (in addition to the eight already standardised during 2012/13 and 2013/14), roll

programmes out to other professional groups as appropriate, and optimise implementation across regions implement at least two new roles/innovative ways of working, assist deployment of these across the region and share successes.

(For example: include registered nurse first surgical assistant, credentialing for primary care nurses in mental health and addictions, physician assistant, and simulation based training for multi-disciplinary teams)

report on at least two clinical networks, detailing progress on network development and multi-disciplinary approaches. ( For example: include eye healthcare network, palliative care network, and cancer network)

report on at least two regional training programmes for the unregulated healthcare workforce, detailing progress. ( For example include training for clinical exercise physiologist and allied health assistant).

MeasuresRegional and local DHB level progress reporting on the above requirements and key actions to be provided via quarterly RSP reports

Information Technology (IT) IT priorities for 2014/15 are subject to confirmation following the conclusion of the Health Sector Forum led prioritisation processThe critical IT priorities for 2014/15 are largely a continuation of the previous years. This is reflective of the size and complexity of some initiatives that are being implemented in a phased approach.

17 The funding model is part of the DHB’s new medical training agreement with HWNZ, effective from 1 January 2014 and was provided to the DHBs on 24 September 2013. This new agreement is for a three-year term and it is anticipated that the funding model will be adjusted annually, after consultation and agreement with DHBs.

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eMedicines Reconciliation (eMR) with eDischarge Summary

Implementation of electronic reconciliation of medicines on admission and discharge from hospital.

All DHBs Health of Older People and Long term conditions (Cancer, Cardiac and Stroke)

All DHBs have implemented eMR and the national clinical standard for eDischarges

Regional Clinical Workstation (CWS) and Clinical Data Repository (CDR)

Implementation of a regional Clinical Workstation (Orion, Concerto) and Clinical data repository (mixed products).The CWS is a web based system, accessed via a single sign-on that connects multiple clinical applications and data sources to provide clinicians with secure access to patient data.A CDR is a database of patient identifiable clinical information such as medications, laboratory results, radiology reports, care plans, patient letters and discharge summaries.

Midland and Central regions

Supports all service priorities –the CWS and CDR are the key clinical systems in the hospital

100% of the applicable population have a CDR record available through a regional view

Replacement of legacy Patient Administration Systems (PAS)

The 8 DHBs with legacy PAS need to progress implementation of a supported system that is aligned with the regional plan.The PAS supports and manages the administrative details of a patients encounter with a hospital or DHB service. It supports the management of the hospital resources used to provide patient care such as clinical staff, rooms, beds and equipment.

Northland, Auckland, Whanganui, MidCentral, Wairarapa, Nelson Marlborough, Canterbury and South Canterbury DHBs

Supports all service priorities –the PAS is one of the backbones of the hospital

All affected DHBs will be implementing a supported PAS

National Patient Flow National Patient Flow will create a new national collection that provides a view of wait times, health events and outcomes in a patient’s journey through secondary and tertiary care.

All DHBs Elective Services, Long term conditions – cancer services

All DHBs have implemented phase 2 of National Patient Flow

Finance Procurement and Supply Chain

The Finance procurement and Supply Chain programme will implement a single finance management information system, common catalogue for the ordering of goods and services, and centralised procurement and distribution processes for DHBs.

All DHBs – as per the HBL implementation plan

Supports financial sustainability

As per the HBL implementation plan

Self-Care Portal Portals are an on-line IT tool that will enable individuals to have access to their own health information.It will enable patients to communicate with their primary health practitioners and add information to their health record.Each of the General Practice Patient Management System (PMS) vendors are developing portals, and Orion Health is developing a portal in conjunction with Canterbury DHB eSCRV project.

All PHOs Health of Older People, Mental Health and addictions

75% of PHOs provide an after-hours summary to ED

25% of the PHO eligible population have accessed a self-care portal

Capital – In 2013/15 the National Health Board (NHB) will collect the regional capital plans separately. Regional Services Planning remains an integral part of capital investment planning, but quarterly reporting on capital will not be required via Regional Service Plans. The NHB considers a separate process would reduce administrative workload for DHBs and focus DHBs on regional capital planning.

Measures

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Regional and local DHB level progress reporting to be provided via quarterly regional services plan reports.

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8.2 GLOSSARY OF TERMS

Term MeaningActivity What an agency does to convert inputs to Outputs.

Capability What an organisation needs (in terms of access to people, resources, systems, structures, culture and relationships), to efficiently deliver the outputs required to achieve the Government's goals.

Crown agent A Crown entity that must give effect to government policy when directed by the responsible Minister. One of the three types of statutory entities (see also Crown entity; autonomous Crown entity and independent Crown entity)

Crown entity A generic term for a diverse range of entities within one of the five categories referred to in New CE Act 2004 s7, namely: statutory entities, Crown entity companies, Crown entity subsidiaries, school boards of trustees, and tertiary education institutions.

Crown entity subsidiary A crown company is a company that is incorporated under the Companies Act 1993 that are controlled by Crown entities and that are: (a) a subsidiary of another Crown entity under sections 5 to 8 of the Companies Act 1993; or (b) a multi-parent subsidiary of 2 or more Crown entities New CE Act 2013 s7 1(c)

Cost containment Reducing costs or cost growth in general, whether through improved efficiency, or other means such as contract negotiation/consolidation, changes to budget management, changes in structure etc.

Efficiency Reducing the cost of inputs relative to the value of outputs.

Effectiveness The extent to which objectives are being achieved. Effectiveness is determined by the relationship between an organisation and its external environment. Effectiveness indicators relate outputs to impacts and to outcomes. They can measure the steps along the way to achieving an overall objective or an outcome and test whether outputs have the characteristics required for achieving a desired objective or government outcome.

Impact Means the contribution made to an outcome by a specified set of goods and services (outputs), or actions, or both (Public Finance Act 1989, s2 ). It normally describes results that are directly attributable to the activity of an agency. For example, the change in the life expectancy of infants at birth and age one as a direct result of the increased uptake of immunisations.

Impact measures Impact measures are attributed to agency (DHBs) outputs in a credible way. Impact measures represent near-term results expected from the goods and services you deliver; can often be measured soon after delivery, promoting timely decisions; and may reveal specific ways in which managers can remedy performance shortfalls.(http://www.ssc.govt.nz/upload/downloadable_files/performance-measurement.pdf page 13)

Input The resources such as labour, materials, money, people, information technology used by departments to produce outputs, that will achieve the Government's stated outcomes.

Intervention An action or activity intended to enhance outcomes or otherwise benefit an agency or group.

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Intervention logic model A framework for describing the relationships between resources, activities and results. It provides a common approach for integrating planning, implementation, evaluation and reporting. Intervention logic also focuses on being accountable for what matters – impacts and outcomes

(Refer State Services Commission ‘Performance Measurement – Advice and examples on how to develop effective frameworks’

Intermediate outcome See Outcome

‘Living within our means’ Providing the expected level of outputs within a break even budget or National Health Board (NHB) agreed deficit step toward break even by a specific time.

Management systems The supporting systems and policies used by the DHB in conducting its business.

Multi-parent subsidiary A company (incorporated under the Act) is a multi-parent subsidiary if, under sections 5 to 8 of the Companies Act 1993,—

(a) the company is not a subsidiary of any one Crown entity; but (b) if 2 or more Crown entities were treated as 1 entity (a

combined entity), with their rights, entitlements, and interests in relation to the company taken together, the company would be a subsidiary of the combined entity (New CE Act s7(1 – 2)

Measure A measure identifies the focus for measurement: it specifies what is to be measured

Objectives The use of this term recognises that not all outputs and activities are intended to achieve “outputs”. For example, increasing the take-up of programmes; improving the retention of key staff; improving performance; improving Governance etc. are ‘internal to the organisation and enable the achievement of ‘outputs’.

Outcome Outcomes are the impacts on or the consequences for, the community of the outputs or activities of government. In common usage, however, the term 'outcomes' is often used more generally to mean results, regardless of whether they are produced by government action or other means. An intermediate outcome is expected to lead to an end outcome, but, in itself, is not the desired result. An end outcome is the final result desired from delivering outputs. An output may have more than one end outcome; or several outputs may contribute to a single end outcome.

A state or condition of society, the economy or the environment and includes a change in that state or condition. (Public Finance Act 1989).

Output agreement Output agreement/output plan - See Purchase Agreement

An output agreement is to assist a Minister and a Crown entity (DHB) to clarify, align, and manage their respective expectations and responsibilities in relation to the funding and production of certain outputs, including the particular standards, terms, and conditions under which the Crown entity will deliver and be paid for the specified outputs. Responsible Minister may set standards, terms, and conditions in respect of certain classes of outputs (New Crown Entities Act 2004 s170).

Output classes An aggregation of outputs, or groups of similar outputs. (Public Finance Act 1989.) Outputs can be grouped if they are of a similar nature. The output

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classes selected in your non-financial measures must also be reflected in your financial measures.

Outputs Final goods and services, that is, they are supplied to someone outside a Crown Entity. They should not be confused with goods and services produced entirely for consumption within the DHB group (New Crown Entities Act 2004 s136(1)(a – c))

Ownership The Crown's core interests as 'owner' can be thought of as:

Strategy - the Crown's interest is that each state sector organisation contributes to the public policy objectives recognised by the Crown.

Capability - the Crown's interest is that each state sector organisation has, or is able to access, the appropriate combination of resources, systems and structures necessary to deliver the organisation's outputs to customer specified levels of performance on an ongoing basis into the future;

Performance - the Crown's interest is that each organisation is delivering products and services (outputs) that achieve the intended results (outcomes), and that in doing so, each organisation complies with its legislative mandate and obligations, including those arising from the Crown's obligations under the Treaty of Waitangi, and operates fairly, ethically and responsively.

Performance measures Selected measures must align with the DHBs Regional Service Plan and Annual Plan. Four or five key outcomes with associated outputs for non-financial forecast service performance are considered adequate. Appropriate measures should be selected and should consider quality, quantity, effectiveness and timeliness. These measures should cover three years beginning with targets for the first financial year (2014/15) and show intended results for the three subsequent financial years.

Priorities Statements of medium term policy priorities.

Productivity Increasing outputs relative to inputs (i.e.: either more outputs produced with the same inputs, or the same output produced using fewer inputs)

Purchase agreement A purchase agreement is a documented arrangement between a Minister and a department, or other organisation, for the supply of outputs.

Regionalintegration

Regional integration refers to DHBs across geographical ‘regions’ for the purposes of planning and delivering services (clinical and non-clinical) together. Four regions exist. Northern: Northland DHB, Auckland DHB, Waitemata DHB and Counties

Manukau DHB Midland: Bay of Plenty DHB, Lakes DHB, Tairawhiti DHB, Taranaki DHB

and Waikato DHB Central: Capital and Coast DHB, Hawkes Bay DHB, Hutt Valley DHB,

MidCentral DHB, Waitemata DHB and Whanganui DHB Southern: Canterbury DHB, Nelson Marlborough DHB, South Canterbury

DHB, Southern DHB and West Coast DHBA region for some clinical networks may vary slightly to the four regional groupings described above. For example Central Cancer Network contains seven DHBs, with Taranaki DHB in addition to the Central Region DHBs.

Results Sometimes used as a synonym for 'Outcomes'; sometimes to denote the degree to which an organisation successfully delivers its outputs; and sometimes with both meanings at once.

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Standards of Service Measures

Measures of the quality of service to clients which focus on aspects such as client satisfaction with the way they are treated; comparison of current standards of service with past standards; and appropriateness of the standard of service to client needs.

Statement of Performance Expectations (SPE)

Government departments and Crown entities are required to include audited statements of objectives and statements of performance expectations with their financial statements. These statements report whether the organisation has met its service objectives for the year.

Strategy See Ownership

Sub regional collaboration Sub regional collaboration refers to DHBs working together in a smaller grouping to the regional grouping, typically in groupings of two or three DHBs and may be formalised with an agreement. For example a Memorandum of Understanding. Examples of sub regional collaboration include DHBs in the Auckland Metropolitan area, MidCentral and Whanganui DHBs (CentralAlliance), Capital and Coast, Hutt Valley and Wairarapa DHBs and Canterbury and West Coast DHBs.

Targets Targets are agreed levels of performance to be achieved within a specified period of time. Targets are usually specified in terms of the actual quantitative results to be achieved or in terms of productivity, service volume, service-quality levels or cost effectiveness gains. Agencies are expected to assess progress and manage performance against targets. A target can also be in the form of a standard or a benchmark.

Values The collectively shared principles that guide judgment about what is good and proper. The standards of integrity and conduct expected of public sector officials in concrete situations are often derived from a nation's core values which, in turn, tend to be drawn from social norms, democratic principles and professional ethos.

Value for money The assessment of benefits relative to cost, in determining whether specific current or future investments/expenditures are the best use of available resource.

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8.3 ANNUAL PLAN REVIEW: FINANCIAL STATEMENTS 2014/15 (and supporting templates)

* Financial checklist to help DHBs ensure they have provided all the required information.

1. Financial Statements

Requirements Interpretation

1 Does the AP contain a complete set of consolidated financial statements that comply with applicable legislation, GAAP and Crown accounting policies?

AP financial statements prepared under GAAP are forecast financial statements required to cover five years: prior year audited actual, current year forecast and three years’ plan.

As a minimum, AP financial statements must include: a full set of consolidated financial statements including:

financial performance showing1 Revenue as MOH Sourced, Other Government sourced, and

other, and Inter-DHB and Internal Revenue.2 Expenses as the major services of Personal, Mental,

Disability Support, Public and Māori plus Personnel costs, Outsourced services costs, Clinical supplies costs, and Infrastructure, Non Clinical supplies and Other costs.

financial position showing Current and Non-current Assets, Current and Non-current Liabilities and Equity

cash flows detailing Cash in and Cash out for Operating, Investing and Financing Activities

movements in equity showing Opening Balance, Net results, Revaluation of Fixed Assets, Equity Injections/ Repayments, and Other (New CE Act 2004 s149G(1))

Summary statements of financial performance for each arm (Provider, Funder and Governance) showing;1 Revenue from Ministry of Health, other Government, Non-

Government and Other, and Inter-DHB and Internal Revenue.

2 Provider arm expenses – split by Personnel, Outsourced services, Clinical supplies, and Infrastructure and Non Clinical supplies and Other.

3 Funder arm expenses – split by major service areas, eg, Personal, Mental, Disability support, Maori, Public and Other.

4 Governance arm expenses split by Personnel, Outsourced services, Clinical Supplies, and Infrastructure and Non Clinical supplies and Other

2 Does the AP explain the nature, reasons for, and effects on the AP financial statements of any significant change in accounting policies?

Statement of accounting policies (New CE Act 2004 s149G(1)). Accounting policies applied in the AP financial statements should be consistent with prior years unless a change of policy has been noted.

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3 Does the AP contain a statement of all significant assumptions underlying the financial statements?

The AP must include a statement of all significant assumptions underlying the financial statements (New CE Act 2004 s149G(2))

4 Do the financial statements align with the text of the document?

The financial statements and any related narrative information should be consistent with any general or narrative information presented with them.

5 Has the DHB supplied complete AP financial templates that agree to the AP financial statements?

AP templates for 2014/15 are:

1. AP Financial Template

2. Mental Health Financial Plan Template

3. Revenue Reconciliation

4. Production Plan

Financial information in the Mental Health financial plan template, revenue reconciliation and Production Plan must agree back to the AP Financial Template

6 Does the DHB include mention of any subsidiaries in which it has an interest?

If a DHB subsidiary is a single-parent subsidiary then it is not required to produce a separate SOI/SPE if it is covered in the parent DHB’s SOI/SPE (New CE Act 2004 s156(A)(1)). If a DHB’s subsidiary is a multi-parent subsidiary then it is not required to prepare a SOI/SPE (New CE Act 2004 s157A(2)). A multi-parent subsidiary may, however be directed to prepare an SOI/SPE by the Minister of Finance (New CE Act 2004 s157A(3)). These may include the condition that the SOI of one of the parents must cover the multi-parent subsidiary.

2. Planned Net Results

Requirements Assumptions1 a) Are the DHB’s planned net

results acceptable?

b) Are the DHB’s planned productivity improvement initiatives appropriate and achievable?

The Ministry will assess this section against the following criteria:

Do the planned net results meet the Minister of Health’s expectations for the four plan years of the AP?18

If there is a planned deficit caused by Mental Health deficits, is there a genuine DHB surplus available to carry forward to cover the deficit?

If there is a planned deficit (other than for Mental Health), is there a genuine DHB surplus available to carry forward to cover the deficit?

If the DHB plans consolidated deficit(s), is there appropriate approval to submit an AP including deficit(s)?

Does the AP include sound realistic and quantifiable action plans or efficiency projects to address planned deficits or to ensure breakeven is achieved?19

Significant savings anticipated from action plans of efficiency projects should be explained and justified in the AP, or in a confidential document sent separately to the Ministry]

18 The Minister’s expectations for net results will either be expressly stated in correspondence to the DHB or be the approved net results in the previous year’s AP for the second and third plan years.19 Sound action plans and efficiency projects means plans and projects that have quantifiable savings or cost reductions, are time-bound and can be realistically achieved.

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3. Revenue Assumptions

Requirements Assumptions

1 Does total devolved revenue (including Inter-District Flows) agree with the latest Funding Envelope? If not, are variances appropriate and explained?

All devolved revenue received from the Ministry that is disclosed in the AP will be confirmed against what has been advised in the latest Funding Envelope. Variances from the latest Funding Envelope should be explained in the Revenue Reconciliation20

2 Does revenue for non-devolved service contracts materially agree with what has been advised by the Ministry?

All non-devolved revenue sourced from the Ministry will be confirmed directly with the responsible Ministry directorates.

3 Out-year revenue assumptions consistent with Ministry advice?

Indicative out-year revenue increases are advised in the latest Funding Envelope.

4. Cost and Volume Assumptions

Requirements Interpretation

1 Are the assumptions for personnel costs, outsourced services costs and Full Time Equivalent (FTE) movements appropriate and 1adequately explained?

Assessment of whether cost assumptions are ‘appropriate’ and ‘adequately explained’ will be based on whether cost changes are consistent with:

1. financial information disclosed in the AP and AP financial templates

2. estimated revenue growth advised in the latest Funding Envelope

3. the percentage ranges estimated in CPI and salary indices4. changes in volumes, practices, service delivery, etc.

Significant variation from the latest Funding Envelope or indices should be explained and justified in the AP, or in a confidential document sent separately to the Ministry. Expenditure planned for out years should reflect a realistic assessment of requirements to support the projected revenue stream in those years. It should not be derived simply by applying the same preliminary increase as for revenues to each expenditure line.

2 Are planned interest, depreciation, capital charge costs and assumptions appropriate and adequately explained?

3 Are all other cost assumptions (eg, clinical supplies costs) appropriate and adequately explained?

4 Is the productivity gain and associated risk inherent in the plan clearly explained?

5. Fixed Assets

1 Does the AP include a statement about:a) when assets were last

revaluedb) in which year the next

revaluation will take place as required by relevant accounting standards.

No interpretation required.

2 Does the AP include, (if known), the asset impacts and additional costs resulting from re-evaluation?

No interpretation required.

3 Does the DHB note its strategy No interpretation required.

20 Funding Envelope’ refers to the most recent Funding Envelope advice letter for 2013/14, sent to DHBs by the Ministry.

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for actively disposing of assets which are surplus to requirements?

4 Does the AP include a statement about the procedure for disposing of any land transferred to, or vested in the DHB under the Health Sector (Transfers) Act 1993?

Section 42(2) of the NZPHD Act requires the inclusion a statement about a DHB’s procedure for disposing of land transferred to or vested to it under the Health Sector (Transfers) Act 1993, irrespective of whether land disposals are planned

6. Capital Expenditure

Requirements Interpretation

1 Is the capital expenditure section of the AP consistent with the DHB’s asset management plan and the relevant Regional Services Plan?

No Interpretation required

2 Does the capital expenditure section of the AP narrative reflect major capital projects, clearly distinguishing between approved and unapproved projects and whether they are baseline or strategic?

An ‘approved’ capital project means that the DHB has a letter from the Minister of Health approving that capital project.

3 Are sources of planned capital financing for both baseline and strategic capital expenditure clearly identified?

Sources of planned financing may include:

1. DHB contribution2. New Crown debt (approved/unapproved)3. Crown equity (approved/unapproved)4. Finance leases5. Community donations/funding.

4 Is capital expenditure and financing correctly reflected in all sections of the AP financial template including the cash flow statement

The AP financial template should reflect only approved capital expenditure (even if included in baseline capital expenditure) and financing. The only exception is for the capital plan worksheet which should also include unapproved capital projects and anticipated sources of funding.

7. Debt and Equity

Requirement Interpretation

1 Does the AP include a schedule of key lenders, borrowing arrangements (including rates and limits) that distinguish between new and existing borrowing facilities?

The schedule of key lenders should cover working capital, short-term and long-term borrowing and finance leases.

2 Does the AP show the related banking covenants, and is the DHB planning to meet them?

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8.4 OUTPUT CLASS RECOMMENDATIONS

Output Class definitions

It is expected that all DHBs will use the following output class definitions:

Prevention

Preventative services are publicly funded services that protect and promote health in the whole population or identifiable sub-populations comprising services designed to enhance the health status of the population as distinct from treatment services which repair/support health and disability dysfunction.

Preventative services address individual behaviours by targeting population wide physical and social environments to influence health and wellbeing.

Preventative services include health promotion to ensure that illness is prevented and unequal outcomes are reduced; statutorily mandated health protection services to protect the public from toxic environmental risk and communicable diseases; and, population health protection services such as immunisation and screening services.

On a continuum of care these services are public wide preventative services.

Early Detection and Management

Early detection and management services are delivered by a range of health and allied health professionals in various private, not-for-profit and government service settings. Include general practice, community and Māori health services, Pharmacist services, Community Pharmaceuticals (the Schedule) and child and adolescent oral health and dental services.

These services are by their nature more generalist, usually accessible from multiple health providers and from a number of different locations within the DHB.

On a continuum of care these services are preventative and treatment services focused on individuals and smaller groups of individuals.

Intensive Assessment and Treatment Services

Intensive assessment and treatment services are delivered by a range of secondary, tertiary and quaternary providers using public funds. These services are usually integrated into facilities that enable co-location of clinical expertise and specialized equipment such as a ‘hospital’. These services are generally complex and provided by health care professionals that work closely together.

They include: - Ambulatory services (including outpatient, district nursing and day services) across the range of

secondary preventive, diagnostic, therapeutic, and rehabilitative services - Inpatient services (acute and elective streams) including diagnostic, therapeutic and

rehabilitative services - Emergency Department services including triage, diagnostic, therapeutic and disposition

services On a continuum of care these services are at the complex end of treatment services and focussed

on individuals.

Rehabilitation and Support

Rehabilitation and support services are delivered following a ‘needs assessment’ process and coordination input by NASC Services for a range of services including palliative care services, home-based support services and residential care services.

On a continuum of care these services will provide support for individuals.

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Recommended outputs that may be useful for describing bundles of service within each output class are included in the table below:

PREVENTION

Health Promotion and EducationStatutory RegulationPopulation Based ScreeningImmunisationWell Child Services

EARLY DETECTION & MANAGEMENT

Primary Health CareOral HealthPrimary Community Care ProgrammesPharmacistCommunity Referred Testing & DiagnosticsMental Health

INTENSIVE ASSESSMENT & TREATMENT

Mental HealthElective (Inpatient/Outpatient)Acute (Emergency Department/Inpatient/Outpatient)MaternityAssessment Treatment & Rehabilitation

REHABILITATION & SUPPORT

Needs Assessment & Service CoordinationPalliative CareRehabilitationAge Related Residential Care BedsHome Based SupportLife Long DisabilityRespite CareDay Services

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8.5 CROWN ENTITIES’ ACCOUNTABILITY REQUIREMENTS

New Crown Entities Act 2004 (CE Act) as amended by the Crown Entities Amendment Act 2013

s139 Obligation to prepare statement of intent

“(1) A Crown entity must provide to its responsible Minister a statement of intent for the Crown entity that complies with this section and section 141.“(2) A statement of intent must relate to the forthcoming financial year and at least the following 3 financial years.“(3) The Crown entity must provide a statement of intent at least once in every 3-year period.“(4) This section applies unless the Crown entity is exempted from the requirements of this section by or under this or another Act.

s139A Minister may require Crown entity to prepare new statement of intent at any time “(1) A Crown entity's responsible Minister may, if the Minister considers it

necessary or desirable, require the Crown entity to provide a new statement of intent at any time.“(2) A statement of intent provided under this section must comply with sections 139 and 141.“(3) Despite section 139(2), the Minister may require the new statement of intent to relate to the remainder of the current financial year in addition to the forthcoming financial year and at least the following 3 financial years.

139B Minister may grant extension of time for, or waive, requirement to provide statement of intent

“(1) If a Crown entity is likely to have a significant change in the nature or scope of its functions, the responsible Minister may grant the Crown entity an extension, of up to 1 year, of the period specified in section 139(3).“(2) However, the responsible Minister must not grant an extension unless he or she is satisfied that the extension will enable the entity to improve the quality of the statement of intent that it provides.“(3) If a Crown entity is likely to be disestablished or, in the case of a Crown entity company, removed from the register under the Companies Act 1993, the responsible Minister may grant the entity a waiver of the requirements in section 139.“(4) If the responsible Minister grants an extension or a waiver under this section,—

“(a) the responsible Minister must, as soon as practicable after granting the extension or waiver, notify the Crown entity of the extension or waiver and the Minister's reasons for granting it; and

“(b) the Crown entity must, as soon as practicable after receiving notice under paragraph (a), publish notice of the extension or waiver, and the Minister's reasons for granting it, on an Internet site maintained by or on behalf of the Crown entity; and

“(c) the Crown entity must include, in the next annual report that it provides to its responsible Minister for presentation to the House of Representatives under section 150, a statement of the exemption or waiver and the Minister's reasons for granting it.”

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s141 Content of statement of intent(1) A statement of intent must, for the period to which it relates, set out the strategic objectives that the entity intends to achieve or contribute to (strategic intentions).(2) A statement of intent must also, for the period to which it relates,—(a) explain the nature and scope of the entity's functions and intended operations:(b) explain how the entity intends to manage its functions and operations to meet its strategic intentions:(c) explain how the entity proposes to manage its organisational health and capability:(d) explain how the entity proposes to assess its performance:(e) identify any process to be followed for the purpose of section 100:(f) set out and explain any other matters—(i) that are reasonably necessary to achieve an understanding of the entity's strategic intentions and capability:(ii) that the entity is required to include in its statement of intent under this Act or another Act.(3) A statement of intent—(a) must be in writing, be dated, and be signed on behalf of the board by 2 members or, in the case of a corporation sole, by the sole member; and(b) is a final statement of intent when it has been signed in accordance with paragraph (a).

s149C Obligation to prepare statement of performance expectations(1) Before the start of each financial year, a Crown entity must prepare a statement of performance expectations for that financial year that complies with section 149E.(2) However, if the Crown entity does not propose to supply any reportable classes of outputs in that financial year, the entity's statement of performance expectations—(a) must comply with section 149E(1)(b) to (d) and (3); but(b) need not comply with section 149E(1)(a) or (2).

New Zealand Public Health and Disability Act 2000 (NZPHD Act)

s38 Planning framework and requirements(1) The Minister —(a) must direct every DHB to prepare a plan for each financial year beginning on or after 1 July 2011;

and(b) may direct a DHB to prepare or contribute to 1 or more other plans.(2) Every plan—(a) must address—

(i) local, regional, and national needs for health services; and(ii) how health services can be properly co-ordinated to meet those needs; and(iii) the optimum arrangement for the most effective and efficient delivery of health services; and

(b) must demonstrate how a DHB that is a party to the plan is to give effect to the purposes of this Act; and

(c) must demonstrate how a DHB that is a party to the plan is to operate in a financially responsible manner; and

(d) must reflect the overall direction set out in, and not be inconsistent with, the New Zealand health strategy and the New Zealand disability strategy.

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New Zealand Public health and Disability (Planning) Regulations 2011

s8 Content of DHB annual planA DHB annual plan must include the following:

(a) a statement outlining how the DHB's performance as a funder and as a provider of services is to be demonstrated:

(b) an outline of the DHB's stewardship, as owner, of its assets, workforce, information technology and information services, and other infrastructure needed to deliver its services. [The Minister expects clear planning, monitoring and reporting of the DHB’s separate roles as funder and provider of services and owner of Crown assets];

(c) a strong explanation of the link between—(i) funding, key actions, and outputs; and(ii) expected impacts and outcomes:

(d) key actions and outputs, linked to funding, that the DHB will deliver in order to meet Government priorities and health targets, including the DHB's performance targets for all measures within the performance monitoring framework:

(e) a statement of service coverage requirements, service change requirements, emerging policy or sector issues, and any relevant Māori health or other sub-plan requirements:

(f) detailed outputs for which the DHB will be held to account, both as a funder of services for its

population and as a provider of services:

(g) detailed financial budgets:

(h) a statement of the actions the DHB will lead, or will deliver (as the case may be), to support delivery of any—

(i) regional service plans in which the DHB is to participate, including (without limitation) the implementation element of the plan (as reviewed annually under regulation 7(3)); and(ii) relevant national service plans.

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8.6 Strengthening Our Workforce – Dimensions of the Workforce Plan

Strengthening our workforce

How will we match our workforce to our local, regional and national strategies to achieve our desired future state?

Information and Analysis

- What information/data do we need to inform our workforce decisions? What information do we have on how productive we are and whether we are improving?

- Where will our people supply come from? What is the lead-in time to produce the skills we need?- What external information do we need, and do we have it? (E.g. labour market dynamics; supply and demand factors. What are our forecast wage

cost pressures?

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Culture

- What people and organisational behaviours do we need to deliver high quality services for our community?

- Does our current culture foster the environment and level of workforce engagement needed to achieve our goals?

- What culture do we want for the future? What is our strategy to achieve the culture we need? What is our approach to equality and diversity?

- How will we maintain/develop the staff engagement we need? - How will organisational change impact on organisational culture?

How will this impact be managed?

Change Leadership

- What is our change strategy? What organisational development strategies do we have in place?

- What resources will be needed to ensure the success of our change programme?

- What is our strategy to engage our staff and encourage their input around change? How will we engage unions with the organisation’s direction? What’s our strategy for stakeholder communication around the change required?

- How does this impact our funding track?

Capacity (numbers)

- What is the core workforce required to deliver our current business? How will we meet our ongoing capacity requirements (employ/contract in/outsource)?

- How many people, and which occupational categories and mix (more of /less of) will we need in the future? How do we know this is affordable? What does the transition pathway look like?

- How will we source, attract, engage and/or grow the people we need? Are there skills that are in short supply?

- How will we keep the people we need?- How does our approach to capacity impact our funding track?- Does our workforce reflect the community it serves?

Capability- What workforce capability do we have/need to meet our current

requirements (e.g. occupational groups/competencies and mix of skills)?

- What workforce capability do we need to achieve our organisational goals?

- How will we achieve the capability we need (develop recruit/ outsource/contract in)?

- What is our strategy for new roles and workforce innovation?- How will we grow our leadership capability? Do we need to

develop our capability for leading change? - How does our approach to capability impact our funding track?

8.7 LINE OF SIGHT GUIDANCE FRAMEWORK

Line of sight across Regional and Annual Plans

RSP - Common Priorities and Objectives

Priorities and objectives that DHBs within a region want to achieve.

RSP - Key Actions, Milestones and Measures

Key actions to set out what the region will do to achieve its objectives (and where appropriate significant individual DHB contributions are identified)

Key milestones required to reach regional objective Measures the region will use to assess actions agreed to achieve milestones, including setting of

baselines

RSP - Inputs / Resources

The nature of inputs may vary and could include: Costs to implement actions in order to achieve priority People / teams / and/or new roles required to progress actions

RSP - Responsibilities

Accountable roles Organisations and/or networks required to implement priority e.g. PHOs

RSP – Requirements of Enablers to Achieve Regional Priorities

Workforce, IT and capital requirements to deliver on regional services priorities should be explicitly identified where relevant to achieving a regional objective

AP – Individual DHB’s Contribution to Regional Priorities

The AP in Module 2 sets out the DHB’s individual actions to deliver against regional priorities and targets. This should include:

Key individual DHB actions to deliver on regional milestones and priorities (links to regional actions) Measures to demonstrate progress on regional milestones and priorities Budget allocation by DHB

To streamline reporting, the local actions of DHBs to deliver on regional objectives are reported quarterly within a consolidated regional report by Shared Services Agencies on behalf of DHBs. This is intended to streamline reporting as individual DHBs will not be required to report local actions to support regional priorities through their local DHB quarterly reports.

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