annex 6 - the beehive · (f) the nhb contract on behalf of the minister with dhbs for regional and...

Annex 6 Meeting the Challenge:

Report Recommendations

2

Annex 6: RECOMMENDATIONS

Report Recommendations 3

1 Closer to home: new models of care 3

2 Improving patient safety and quality of care 4

3 Identifying the services people need: funding new services 5

4 The right service in the right place: changing service configuration 6

5 The right capacity for the future: making better investments 7

6 Shifting resources to the front-line 7

7 Getting more from our public hospitals: improving hospital productivity 7

8 Further work 8

9 Conclusion 8

Annex 2 Recommendations 9

1 Enhancing Clinical Leadership 9

2 Initiatives to increase elective services and reduce patient waiting times, improve access to timely primary and hospital services and improve productivity and quality of services for patients 10

3 Ways to establish clinical networks and leadership programmes to support these goals 11

4 Establishing and fostering greater clinical leadership in primary care and across primary and hospital care within DHBs – primary and hospital integration 12

5 The acceleration of national quality and safety improvement programmes 12


1 Capital expenditure 14

2 Workforce 14

3 Information technology 15


1 Testing the line-by-line spending review with the Ministry to identify any additional in-depth reviews or longer-term work that will need to be addressed 17

2 Consideration of the Ministry’s role as a manager of a range of national operational functions 17

3 Selectively reviewing the rest-of -sector expenditure, including DHBs, to reduce waste and bureaucracy and improve spending quality and patient service 18

4 Review the reporting and accountability processes between the Ministry, DHBs and PHOs to improve focus and reduce unnecessary bureaucracy 19

5 Selectively review the plethora of existing Ministerial and Ministry committees and functions 20

Contents

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Report Recommendations

1 Closer to home: new models of care

The MRG recommends that the Government:

(a) RequiretheNHB(fornationalservices)andtheDHBs(forregionalandlocalservices)toreportannuallyon

thedevelopmentofclinicalnetworksandassesstheircost-effectivenessinhelpingtodeliverseamlesscare

forpatients,

(b)ClarifythattheroleofPHOsis:todomoretokeeppeoplewell;toreduceavoidablehospitaladmissionsand

unplannedreadmissions;toshareresponsibilityforshiftingservicesfromsecondarytoprimarysettings

whensensible;andtoreduceunnecessaryGPreferrals,

(c) ReducethemanagementfeespaidtoPHOswithanenrolledpopulationoflessthan40,000andusethe

resultingsavingstohelpthesePHOstotransitiontoastrongermanagementconfiguration(e.g.via

amalgamation,confederation,orsomeotherarrangementforsharingmanagerialsupport-seeAnnex4

recommendationsformoredetail),

(d)RequireDHBstoagreeprotocolsandestablishagreements,withcontractualandfinancialincentives,among

community,primary,andsecondaryproviderstodevelopnewmodelsofcarethatarepatient-centric,less

fractured,andmorecost-effective.Thisshouldincludeagreementstoreduceavoidablehospitaladmissions

andunplannedreadmissionstodevelopcost-effectivesubstitutesforsecondarycaretostrengthenincentives

formoreefficientandeffectiveuseofreferredservices.Financialincentivesforrisksharingshouldbe

strengthenedforthosePHOswhoalreadyhavethecapabilitytomanagethefinancialrisksassociatedwith

takinggreaterresponsibilityforthehealthoftheirenrolledpopulations.DHBsshouldalsoberequiredto

reportonthedevelopmentoftheseagreementsandassesstheircost-effectiveness,

(e) TheNHBshouldassumeresponsibilityforthepreparationofnationallyconsistentcontractsthatDHBs,

PHOs,andothersmightchoosetouseforthepurposeofmeetingtherequirementsinrecommendation

(d)above.Thesecontractsshouldincludesomeformofrevenueandcostsharingwhereappropriate,

(f) ReassesstheroleofthePHOPerformanceProgrammeinthelightofthedevelopmentofthesebroader

arrangements,

(g)EnsurethattheNHB,DHBsandPHOsworktogethertodevelopsharedelectronicaccesstoacommon

patientrecordsbasedonadistributedapproach(seeAnnex3)andwithinareasonabletimeframe,and

(h)Withinthreeyears,theGovernmentshouldseekanassessmentofthosePHOsthatarenotsuccessfully

meetingtherequirementsoftheirrolewithaviewtoremovingthem.

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2 Improving patient safety and quality of care

(a) ThequalityprogrammesinitiatedbyQICareusedasafoundationtodevelopthenextphaseofnational

qualityandsafetyprogrammesthataddresspatientsafetyandcontinuousqualityimprovement.Existing

initiativesshouldbecomebusinessasusualforDHBs,whoshouldassumethefundingforthemasthe

existingQICbudgetisworkedthrough,

(b)ThecurrentPHOPerformanceProgrammeshouldbescaledbackforaperiodand

theresultingsavingsusedtohelpacceleratetheintroductionofqualityimprovementforprimarycareusing

theQ14GPasastartingpoint,and

(c) AnindependentnationalqualityagencyisestablishedtoreplaceQICandwithresponsibilityforhelping

providersacrossthewholesectorimprovepatientsafetyandservicequality,withthefollowingrolesand

characteristics:

(i) Theagencyisindependentoftheregulatory,fundingandperformancemonitoringagenciesof

government,reportingdirectlytotheMinisterandwithitsownstaff,

(ii) Theagency’sroleshouldbeto:developamenuof‘certified‘programmesforproviderstochoosefrom;

developsafetyandqualitystandardsandguidelines;benchmarkandgathercomparativedataonwhat

worksandwhy;runworkshopsaimedathelpingcliniciansandmanagerstomakeimprovements;and

publishnationalreportsofqualityindicatorse.g.seriousandsentinelevents,

(iii)Theagencyshouldacttoensuresectorbuy-intoitsprogrammes,recognisingthatprogrammeswillnot

besustainediftheyaremandatedandforcedonthesector,

(iv)AgencyfundingshouldbeamixtureoftopslicedPBFF(recognisingtheproportionoftheagency’stime

devotedtoDHBs),andchargingprivateproviderswhowanttouseitformanagingtheimplementation

ofagency-certifiedprogrammes,and

(v) Atsomepoint,thisagencyshouldbecomemoreindependentofgovernmentandbefundedbya

mixtureoffee-basedqualityprogrammesandfinancialsubscriptionsfrompublicandprivatemember

organisations.

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3 Identifying the services people need: funding new services

The MRG recommends that the SPNIA process be abandoned and replaced with:

(a) AreconfiguredandstrengthenedNHCwiththeroleofevaluatingallnew–andanongoingselectionof

existing–healthanddisabilityservices.Thisroletoinclude:

(i) Assessingtheextenttowhichnewhealthanddisabilityservicesareclinicallysafeandshouldattract

publicfundingbasedontheireffectivenessandcost,

(ii) Determiningtheconditionsunderwhichnewpubliclyfundedservicesshouldbemadeavailable,

includingtheeligiblepatientgroup,restrictionsontheprovider(e.g.tertiaryhospitalsonly)and/orthe

situationsinwhichthenewserviceshouldbeused(e.g.trialonly),

(iii)Selectivelyreviewingfundingforexistinginterventionstoidentifywhichshouldnolongerqualifyfor

publicfundingbasedontheireffectivenessandcost,and

(b)ThatwhenitispossibleforPharmactoassumeresponsibilityforanominalbudgetformedicaldevicesfrom

DHBs,thenPharmacshouldassumethesameresponsibilitiesandapplythesameprocessestothesedevices

asitcurrentlydoesforhospitalpharmaceuticals,

(c) AnewnationalprocurementagencyrecommendedinSection12below‘Shiftingresourcestothefront-line‘

shouldestablishaprocessforgraduallyassumingresponsibilityfromDHBsforthecollectiveprocurementof,

andmanagingthesupplychainfor,medicaldevicesusedinpublichospitalsthatarenotmanagedby

Pharmac,and

(d)ThescopeofMedsafe’sactivitiesbeextendedtocoverregulationofthesafetyofmedicaldevices,in

conjuctionwiththeTherapeuticGoodsAdministrationinAustralia.Giventhescarcityofregulatory

expertise,thiscouldinvolveaprocessforrecognisingtheregulatorydecisionsofsimilarjurisdictionsas

applicableinNewZealand,atleastinthefirstinstance.

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4 The right service in the right place: changing service configuration

The MRG recommends that:

(a) TheMinisterestablishapositivelistofnationalservicesthatwillbeplannedandfundedbytheNHBand

financedbytopslicingthePBFFcurrentlyallocatedtoDHBsforthatpurpose.TheNHBwouldthencontract

withaselectionofDHBstodeliverthesenationalservicesfortheentirecountry,

(b)TheNHBestablishatransparentprocessforadvisingtheMinisteraboutwhichservicescurrentlyplanned,

funded,andprovidedatthenational,regional,andlocallevelsshouldbeorganisedatadifferentlevelinfuture,

(c) DHBsberequiredtoproduceRSPsacrossawiderangeofservices.Theinitialplansshouldfocusonplanning

andfundingforvulnerableservicesaswellasthosewhoselonger-termclinicalandfinancialviabilityclearly

dependsonservicingalarger,regionalpopulation,

(d)DHBsbeaskedtodelegateauthoritytotheirChairsandCEOstomakedecisionsontheirbehalfatthe

regionallevelandwhowillbecometheregionalservice‘sgovernancebodyaccountableforthedevelopment

andimplementationoftheRSP,

(e) InthoserarecaseswhenDHBscannotagreeontheRSP,thesedisputesbeescalatedtotheNHBfor

resolutionandthatitidentifiesthemostclinicallyandfinanciallyviableoptionthatdeliversaqualityservice,

(f) TheNHBcontractonbehalfoftheMinisterwithDHBsforregionalandlocalserviceandplanning,and

delivery,andmonitorDHBperformance,thustakingthisfunctionoutoftheMinistry,

(g)Thatoverthenext12monthstheMinistrybeaskedtoworkthroughthevariouspolicyandmachineryof

governmentissuesassociatedwithdevolvingallofthe$2.5billionofNDEcurrentlymanagedbythe

MinistrytoeithertheNHB(nationallevel)orDHBs(regionalandlocallevel)andadvisetheGovernment

accorgingly(Annex4),and

(h)ThattheMinistryofHealth’srolefocusesincreasinglyonprovidingpolicyadvice,administrationof

regulations,monitoringtheNHB,andservicingtheMinister’soffice.

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5 The right capacity for the future: making better investments


(a) TherolesandfunctionsascribedtotheNHBinthisreportwouldbetransferredtotheCHFA,whowould

operateastheNHB.TheMinisterwillneedtoreconsiderthecurrentmembershipoftheCHFABoardin

ordertoensurethatitisbestplacedtomanageitsnewrolesandfunctions.Aspartofthetransition

arrangements,atemporaryestablishmentboardmightbeappointedtomanagethetransition,and

(b)TheproposedNHBismaderesponsibleforcapacityplanningandfunding,includingworkforce,capital,and

IT.Detailedrecommendationsforaddressingthecapacityplanningissuesdiscussedinthissectionarefound

inAnnex3.

6 Shifting resources to the front-line

The MRG recommends:

(a) ThecreationofaPharmac-likenationalsharedserviceagencywithamandatetomanagetheassessment,

standardisation,management,purchasing,and/orsupplychainmanagementofanyofthecommonback

officefunctionsofDHBsthatarereferredtoitbytheMinisterofHealth(Annex4),and

(b)TheNHBberequiredto:

(i) EstablishaprocessforworkingthroughtheentirerangeofcommonDHBbackofficeservicestoidentifya

listofservicesthatarebestsuppliedbyasinglenationalprovider,startingwithnon-pharmaceuticalhospital

procurement(Annex4),and

(ii) Dependingonhowlongitwilltaketoestablishtheproposednationalsharedserviceagency,manage

theexistingthreesharedservicefunctionsthatweproposebeshiftedoutoftheMinistryandintothe

nationalagency(i.e.Healthpac,AuditandCompliance,HealthSystemReportingInformation).

7 Getting more from our public hospitals: improving hospital productivity


(a) DHBsberequiredtoidentifythetopthreeorfourproductivitymeasureseachyearthataremostimportant

tothemandreportprogressagainsttheimprovementtargetstheyhavesetforthemselves,and

(b)TheNHBshouldensurethat:

(i) Productivitymeasuresshouldbedevelopedforuseatsystemandhospitallevel.Theseshouldbe

developedbyacredible,expert,andindependentsource,and

(ii) Clinicalproductivitymeasuresshouldbedevelopedattheappropriatelevel,withstrongclinicalinput.

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8 Further work

The MRG recommends that the Ministry report on 14.1 and 14.3 and within its first year of operation

the NHB:

(a) Reviewsthearrangementsfortheplanning,funding,andprovisionofnational,regional,andlocal

laboratoryandradiologicaldiagnosticserviceswithaviewtodeterminingtheoptimalplanning,funding,

andserviceconfigurationarrangementsforNewZealand,and

(b)ReportstotheMinisteronhowtobestaddresstheotherissuesraisedforfurtherworkinthissectionof

thereport.

9 Conclusion

The MRG recommends that, within three years, the Government:

(a) Seeksanassessmentoftheextenttowhichthepublichealthanddisabilitysectorislikelytobeableto

continueliftingperformancewithoutrequiringaneverlargershareofGDP,and

(b) IdentifiesthechangesintheNewZealandPublicHealthandDisabilityAct2000,orreplacementlegislation,

requiredtosimultaneouslysecurethesustainabilityandlifttheperformanceofthepublichealthand

disabilitysystemsoitisreadytointroducethesechangesifachangeinthelegislativeframeworkisdeemed

necessaryfollowingtheassessmentin(a)above.

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Annex 2 Recommendations

1 Enhancing Clinical Leadership


(a) TheNHBshoulddevelopaculturalchangeprogrammeaimedatenhancing:

(i) Recognitionofandsupportforhealthcareleaders,includingviaanannualleadershipawardprogramme

celebratingandshowcasingoutstandinghealthcareleadersfromallpartsofthesector,and

(ii)Theabilityofcliniciansandmanagerstoformproductivepartnerships,bothwithinthehospitalsector

andacrosssectors.


(a) DHBsshouldensurethatformalpositiondescriptionsareagreed,includingannualperformance

expectationsandleadershipperformancedevelopmentplansforeachformalclinicalleadershiprole,from

departmentaltoexecutivelevelineveryorganisation,and

(b)DHBsshouldensurethatclinicianstakingonfull-timeleadershiprolesareassuredonappointmentofformal

supportforreturntoclinicalpracticeattheconclusionoftheappointment.


(a) DHBsshouldensurethatformalclinicalleadershiprolesarerecognisedbytheallocationofsessionaltime

duringtheworkingweektofulfilltheirduties.


(a) TheMinistershouldseekadviceonhowbesttoencourageuniversitiesto:

(i) Furtherembedanddeveloptheacademicstatusofthedisciplineofclinicalleadership,supporting

researchinmulti-disciplinarymodelsandfurtherformalisingacademicachievementinthisarea,

includingviatheestablishmentofrelevantChairs,and

(ii) Ensureundergraduatecoursesinallhealthdisciplinestoincludeformalattentiontoleadership

developmentappropriatetoeachyearofthecurriculum,bothintheoryandinpractice.

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(a) DHBsshouldensurethatnewappointmentstoclinicalleadershippositionsreceiveapersonalised

assessmentofleadershipdevelopmentneeds,togetherwithsupportandtrainingtoanticipateand

understandenvironmentalfactorsandtheirconsequencesandtheopportunityformulti-disciplinary

leadershipskillsdevelopmentandmentoring,

(b)DHBsshouldensurethatapackageofresourcesfocusingonleadershipskillsandqualitiesisavailableto

supportcliniciansinleadershippositionsaspartofprofessionaldevelopmentprogrammes,toensureleaders

havethetoolstoworkacrosscontemporaryboundariestocollaboratetoachievethebestoutcomes,

(c) DHBsshouldconsiderincludingaformalrequirementforthreetosixmonthswithinasuitablementoring

partnershipforallnewappointmentstoleadershippositionsandallpromotions.Thementoringpartnership

shouldbedefinedbyformalisedexpectationsofbothpartnersandspecifiedoutcomes,andeducationand

trainingmadeavailabletothosenewtoofferingmentoringsupporttonewleaders,and

(d)DHBsshouldensurethatpotentialfutureleadersshowingearlypromiseareofferedopportunitiestodevelop

theirskillsandcompetenciesthroughinvolvementinperformanceimprovementinitiatives.

2 Initiatives to increase elective services and reduce patient waiting times, improve access

to timely primary and hospital services and improve productivity and quality of services

for patients


(a) PlanningwithinDHBstomeettheGovernment’selectivesurgerytargetsshouldbeledbycliniciansfromboththe

primaryandhospitalsectorsinpartnershipwithmanagerstoensureappropriateallocationofclinicalpriorities

betweenandwithinspecialtiesaswellascapabilitybetweenlocations,andensuresuitableclinicalprovisionisin

place.Intheoccasionalcasewhereagreementcannotbereachedwithinthespecifiedtimeframe,thematterwill

beelevatedtotheNationalhealthBoardfordecision,and

(c) DHBsshouldreviewlocalprimarycareaccesstoappropriatediagnosticstoensureappropriatedirect

accessismadeavailableinaplannedandevaluatedway,ensuringthatallservicedemandsarefairlyand

transparentlyprioritised.


(a) Clinicalleadersshouldbesupportedtotrial,develop,andleadtheimplementationofnewscopes

ofpracticeandsupportingworkforcemodels.

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(a) Anationalcampaign(ledfromthehighestlevel)beundertakenbytheMinistrytoexplainandpromote

agreednationalprioritisationtools.


(a) FurtherworkshouldbeundertakenbytheMinistrytopromoteexamplesofgoodpracticeinsupporting

primarycaretomanageunmetneedsandtoensureimplementationnationally.


(a) TheNHBshouldensurethat:

(i) Productivitymeasuresshouldbedevelopedforuseatsystemandhospitallevel.Theseshouldbedeveloped

byacredible,expert,andindependentsource,and

(ii) Clinicallevelproductivitymeasuresshouldbedevelopedatadepartmentalandclinicianlevelwithstrong

clinicalinput.

3 Ways to establish clinical networks and leadership programmes to support these goals


(a) Irrespectiveoftheirorigin,clinicalnetworksshould:

(i) Havecleartermsofreferenceandreportingarrangements,

(ii) Beledbyclinicianswithappropriatequalificationsandarecordofachievementinmanagement–

appointmentstoleadershippositionsshouldbeforafixedtermandholdersshouldmaintainsome

clinicalrole,

(iii) Normallyincluderepresentativesfromacrossthebreadthofhealthcareandincludeanexpectationof

aholisticapproachtorecommendations,

(iv)Includeregularmeasurementandreportingofoutcomesandoutputsintheirtermsofreferenceaswell

asassessmentforimpactinthelocalenvironment,

(v) Haveaclearplanofhowtheirqualityandprocessoutcomeswillbegiveneffect,

(vi)Expecttodisbandoncetheyhavefulfilledtheirobjectives,and

(b)Dedicatedprojectsupportshouldbeavailableforthosenetworksfulfillingtherequirementsaboveandwith

clearqualityandprocessoutcometargets,and

(c) Clinicalleaders,particularlyofthoseformalnationalnetworksestablishedbytheMinistryorNHBtomeet

programmedtasksanddefinedtimeframes,shouldhavearecognisedallocationoftimefortheroleand

theiremployerreimbursedtoenableback-fillingoftheposition.

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4 Establishing and fostering greater clinical leadership in primary care and across

primary and hospital care within DHBs – primary and hospital integration


(a) PHOsshouldbeassessedfortheirlevelofpreparednessincludinggovernanceandmanagementcapability

andsupportinfrastructure,clinicalengagement,‘community’engagement,andthenoffereddelegated

budgetswithaccountabilityfor,andtakesomefinancialriskaround,deliveringqualityandfinancialoutcomes,

(b)Wherepracticableanddesiredbystakeholders,co-locationofPHOprimarycareservices,hospitaland

relatedNGOservicesshouldbeconsidered.ThismayincludethedevelopmentofIntegratedFamilyHealth

Centres,virtualconnectionsbetweenexistingentitiesorotherconfigurationsinvolvingallcomponentsof

primarycaredelivery,inapatient-centricmanner.Suchconceptswouldconstituteprimarycareclinicsmade

upofGPs,nurses,alliedhealthprofessionalandhospitalspecialists,

(c) DHBswillneedtoensurethatitisclearwhattheirfundingarmsareresponsibleforandwhatresponsibilities

andriskshavebeendelegatedtoPHOsaspartofanydelegatedfundingandrisksharingarrangemente.g.

inordertoavoidoverlaporcompetitionbetweenfunders,and

(d)DHBfundingofPHOsshouldbelessprescriptiveabouttyingfundingtoacertainworkforcemixandinstead

putagreaterfocusontheoutcometheyarelookingforandallowprimaryproviderstochoosethebestmix

oftheskillsofGPs,nurses,andnursepractitionersinmeetingthatoutcome.PHOsshouldmakemoreofthe

opportunitiestheyalreadyhavetoconsiderworkforcemix,newscopesofpracticeandusingspecialistsas

partoftheprimaryhealthcareteam.


(a) AnindependentnationalqualityentityshouldnowbeestablishedtoreplaceQICandwithresponsibilityfor

helpingprovidersacrossthewholesectorimprovepatientsafetyandservicequality.

5 The acceleration of national quality and safety improvement programmes


(a) AnindependentnationalqualityentityshouldnowbeestablishedtoreplaceQICandwithresponsibilityfor

helpingprovidersacrossthewholesectorimprovepatientsafetyandservicequality.

The MRG recommends that the national quality entity should:

(a) Establishformallinkageswithoneormoresimilarinternationalbodies,butmustconcentrateonseeding

andgrowingalocalsafetyandqualityculture,providingstateofthearttools,skillsandsupportand

buildingNewZealandcapability,

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(b)Developthenextphaseofanationalqualityandsafetyprogrammethataddressespatientsafetyand

continuousqualityimprovement,and

(c) ScalebackthecurrentPHOPerformanceProgrammeforaperiodandtheresultingsavingshouldbeusedto

helpacceleratetheintroductionofQI4GP.


(a) BegovernedbyanappointedboardandreporttotheMinister.Clinicalappointmentsonthisboardmustbe

drawnfromthebreadthofhealthcareproviders.


(a) Expecttobecomepartiallyself-fundingbytheendofitsthirdyearofoperationthroughthedevelopmentof

resources,teachingandlearningopportunitiesandothersupportsforworkforcedevelopmentand

education,and

(b)Supportprospectiveresearchandrigorousevaluationtodemonstratethetransferabilityofrealcashsavings

fromimprovedsafetyandquality.

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1 Capital expenditure


(a) TheNCCshouldbereplacedbyasingleInvestmentCommitteeoftheNHB,

(b)TheInvestmentCommitteeshouldbeindependentlychairedanditsmembershipshouldincludeclinicians

andthechairsoftheNHB’sworkforceandITboards,

(c) Thereshouldalong-termcapitalandassetmanagementplanwithanannualcomponentthatoutlinestotal

capitalexpenditureinvestment,andthelevel,nature,andsourceofthefundingrequired,

(d)Theplansin(c)aboveshouldbedrivenbyservicedeliverymodelsofcarewithinlocal,regional,andnational

healthplans,

(e) Theplansin(c)aboveshouldhavestronglinkageswithworkforceandITdevelopmentandinvestmentplans,

(f) Theplansin(c)shouldincludeallproposals(includingallnon-departmentalproposalsbytheMinistry)that

exceedtheexistingcentralapprovalthresholds,withtheNHBreplacingtheMinistryintheapprovalprocess,

and

(g)TheissuesoutlinedinFurtherworkaboveshouldbeexplored.

2 Workforce


(a) TheformationofaNationalHealthWorkforceBoard(NHWB)thatwillreporttotheNHB,

(b)TheNHWBwouldberesponsiblefor:

(i) Theplanning,developmentandimplementationofaNHWB,

(ii) Assessingfutureworkforceneeds,overseeingtheplanningandfundingofpostgraduatetraining(ifthe

recommendationsoftheMinisterialTaskforceontheFundingofHeathWorkforceTrainingareaccepted),

andadvisingtheMinisteronchangesinscopeofpracticeandworkforceinnovations,

(iii)WorkingwithDHBsindevelopinganindustrialrelationsstrategythathelpsfacilitatethechangesinwork

practicestosupportthesector’swiderobjectivesforworkforcedevelopment,and

(c) TheNHWBberepresentedontheNHBSingleInvestmentCommitteetoensurethereisstrongalignmentof

theworkforcewithnon-workforceinvestmentssuchasITandfacilities,and

(d)ThecurrentHWIPbemadeanationalresourceunderthegovernanceoftheNHWBandthattherespective

coveragebequicklyincreasedtoincludethewholehealthsectorworkforceandtodevelopaneffective

modelingcapability.

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3 Information technology


(a) AninterimgovernancegroupbesetupforbothNSDPandKDtoreprioritiseandreducethenumberof

NSDPandKDprojectswithafocuson(a)addressingtherisksinthepaymentssystemand(b)supporting

theimplementationofthedistributedapproachtoasafesharingandtransferofpatientelectronic

informationamongstproviders,

(b)TheRefreshHISNZprojectofKDshouldceaseandtheSafeSharingofHealthInformationCommunityDialogue

andEducationprojectofKDshouldbeslimmeddownandutilisetheexistingHISACconsumerforum,

(c) AllprimarycarerelatedITprojectssuchasGPtoGPNotesTransfer,PHOPerformanceProgramme,Qi4GP,

electronicreferrals,electronicdischarges,electronicmedication,andelectroniclaboratoryshouldbe

integratedandrationalisedunderanewprimarycareinformationsysteminitiative,

(d)TheGrantsSchemeprojectofKDbereviewedtosupportprojectsrelatedtotheprimarycareinformation

systeminitiatives,

(e) ThePHOPerformanceProgrammebescaledbackandsavingsberedirectedtosupportthedevelopmentof

QI4GPaspartofabroaderprimarycareinformationsysteminitiative,

(f) Thattheinteroperableandconnecteddistributedapproachratherthanthesinglesector-wideenterprise

systembeconfirmedasthepreferredapproachforthedevelopmentofasafesharingandtransferof

patientelectronichealthinformationfortheNewZealandhealthsector,

(g)TheHMSCinitiativesbysevenDHBsrevisetheirscopetoconcentrateonreplacingthePASforhospitals.

Thisrevisedscopebeimplementedusingadistributedapproachforthedevelopmentofasafesharingand

transferofpatientelectronichealthinformation,usinginteroperabilitystandardssetbyHISOtoensure

integrationwithprimarycareandotherproviders’systems,

(h)TherolesandfunctionoftheMinistryofHealthIDbereviewedandfocusedsolelytosupporttheITneedsof

theMinistry,

(i) ThenationalpaymentsandcontractsmanagementsystemsprovidedbySectorServices(withabudgetof

272FTEs)shouldbemovedoutofIDtoanationalsharedserviceagency.Whileworkisbeingundertaken

toestablishthelegislationtosetupanationalsharedserviceagency,thisfunctionshouldbetransferredto

asingleNHBsubsidiary,

(j) AllothercurrentresponsibilitiesoftheMinistryIDbetransferredtotheNHB,

(k)ANationalHealthITBoardbesetupwithin,andreportto,theNHBandreplacethecurrentHISAC.This

boardwillprovideastrategicleadershiprolefornationalhealthITstrategyandplanningaswellas

governanceovernationalcollectionsandsystems,

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(l) TheNationalHealthITBoardwill,onbehalfoftheNHB,workwiththesectortodevelopaNationalITPlan

(includinganationalITarchitectureframework)toadvanceHISNZ.Thisplanwillbearollingplanwithlocal,

regional,andnationalviews,andashort,intermediate,andlong-termperspectivethatitisalignedwiththe

NationalHealthWorkforcePlanandNationalHealthCapitalPlan,

(m)TheNationalHealthITBoardwillberepresentedontheNHBsingleInvestmentCommitteeresponsiblefor

planningandfundingITandfacilitiesprogrammes,

(n)TheNationalHealthITBoardwillensurethereisstrongsectorclinicalmanagerandgovernanceleadershipof

ITprojects,and

(o)TheNationalHealthITBoardwillworkcloselywiththeHSMCinitiativeandtheproposedprimarycare

informationsysteminitiativetoadvance:

(i) Theimplementationofasafe,sharedandtransferablepatientelectronichealthrecordforNewZealand

healthsector,usingadistributedapproachbasedoninteroperabilitystandardssetbytheHISO,and

(ii) Theimplementationofaconsumerportal.

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1 Testing the line-by-line spending review with the Ministry to identify any additional

in-depth reviews or longer-term work that will need to be addressed

With respect to NDE managed by the Ministry, in addition to the recommendations in the main paper,

the MRG recommends that:

(a) Allnewexpenditureproposalsshouldbeaccompaniedbyathree-yearforecastofthemostlikelyfullfuture

costoftheproposal,anassessmentoftheproposal’scost-effectiveness,andanindicationofsavingsthat

couldbereleasedfromlowpriorityexpenditureelsewhereinVoteHealthtofundtheproposal,and

(b)TheresultsoftheongoingprogrammethattheDirectorGeneralhasforseekingsavingsinkeyareasinboth

departmentalexpenditureandNDEbesubjecttoindependentexpertreviewforrelativelylargeareasof

expenditureandbecompletedbeforetheassociatedfundingfunctionisshiftedoutoftheMinistry.

2 Consideration of the Ministry’s role as a manager of a range of national operational

functions

With respect to the longer-term management of the $2.5 billion of NDE managed by the Ministry, the

MRG recommends that:

(a) Overthenext12monthstheMinistrybeaskedtoworkthroughthevariouspolicyandmachinery

ofgovernmentissuesassociatedwithdevolvingallofthe$2.5billionofNDEcurrentlymanagedbythe

MinistrytoeithertheNHB(nationallevel)orDHBs(regionalandlocallevel),

(b)ThefundingstreamsthatarerelativelystraightforwardtomoveoutoftheMinistrybeforethe12month

periodshouldbemoved,and

(c) Unlessunanticipatedissuesarise,allofthisfundingandtheassociatedbudgettomanagethatfunding

shouldhavebeenshiftedoutoftheMinistryattheendofthisperiod.


(a) TheHeathpac(SectorServices–InformationDirectorate)bemovedoutoftheMinistrytobecomepartof

theproposednewnationalsharedservicesagency,probablyoperatingasasubsidiarywithitsown

governancestructure.


(a) AuditandCompliancebecomeapartoftheproposedHeathpacsubsidiaryofthenewsharedservices

organisation,withaninternalauditfunctionanddirectaccountabilitytotheboardthatisindependentof

management.

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(a) MedSafemaintainitscurrentstatusuntiltheTherapeuticProductsandMedicinesBillispassedandit

becomespartoftheANZTPA.Inthemeantime,itwouldmakesensetoensurethatlegislationallowed

MedSafetosetfeestoensurecostrecovery.WealsorecommendthattheGovernmentstronglysupports

MedsafemanagingtheNZULMwhenitiscomplete,andconsidersexpandingthescopeofMedSafeto

includetheregulationofmedicaldevices.

The MRG recommends that, with respect to the NRL:

(a) TheNRLremainasanindependentunitwithintheMinistryofHealthinthefirstinstance,

(b)TheMinistryofHealthactstoincreasethecommercialflexibilityoftheNRL,withintheconstraintsof

operatingwithintheMinistry,and

(c) TheMinisterofHealthconsiderstheopportunityprovidedbythenewRadiationSafetyBilltoinvestigatethe

‘onestopshop‘optionforscientificservicesunderpinningthepublichealthservice.


(a) TheMinistryofHealthbeaskedtoconsideriftheNSUshouldremainanationalserviceandbemovedto

theNHB,orifitisbettertodevolveitsfunctionstoDHBstomanageeitherregionallyorlocally.Unless

unanticipatedissuesarise,thisshouldbeconcludedinthe12monthtimeframeformovingNDE.


(a) TherepositoriesanddatabasescurrentlymaintainedbythevariousMinistryDirectoratesbemovedintothe

proposednewnationalsharedserviceagency,probablyoperatingasasubsidiarywithitsowngovernance

structure.

3 Selectively reviewing the rest-of -sector expenditure, including DHBs, to reduce waste and

bureaucracy and improve spending quality and patient service


(a)ThemanagementfeepaidtoPHOswithenrolledpopulationsoflessthan40,000bereducedandsome

oftheresultingsavingsbeusedoverthesubsequentyeartohelpthosePHOsamalgamate,confederate,

orenterintootherarrangementsforsharingmanagementoverheads,

(b)DHBsbeadvisedthatbarrierswhichrestricttheabilityofGPstoleaveorjoinaPHOshouldbeabolished,

and

(c) DHBsbeadvisedthatnewPHOsshouldbepermitted,onconditionthat:

(i)establishmentfundingisnotprovided

(ii)thatitisthepreferenceofhealthcareproviders,and

(iii)soundcorporategovernance,soundclinicalgovernance,andeffectivecommunityparticipationis

demonstrated.

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The MRG recommends:

(a) ThecreationofaPharmac-likenationalsharedserviceagencywithamandatetomanagetheassessment,

standardisation,management,purchasing,and/orsupplychainmanagementofanyofthecommonback

officefunctionsofDHBsthatarereferredtoitbytheMinisterofHealth,

(b)Theoperationalbudgetofthisagencybefundedbytop-slicingtheDHBfundingformula,

(c) ThatthisagencywillactasanagentforDHBsandwillagreewiththemanotional(oractual)budgetforthe

management,purchasing,and/orsupplychainmanagementtasksitundertakesontheirbehalf,

(d)Aslongasabudgetcanbeidentified,thentheboardofthisagencywillmakethefinaldecisiononwhatis

purchasedandtheterms,conditions,andpricesofprocureditemsandthemanagementofsharedservices

(likepayrollandsupplychain),and

(e) ThattheNHBberequiredtoestablishaprocessforworkingthroughtheentirerangeofcommonDHBback

officeservicestoidentifyalistofservicesthatarebestsuppliedbyasinglenationalprovider,startingwith

non-pharmaceuticalhospitalprocurement.

4 Review the reporting and accountability processes between the Ministry, DHBs and PHOs

to improve focus and reduce unnecessary bureaucracy


(a) WithrespecttotheNationalCollectionAnnualMaintenanceProgramme,thereisconsultationbetweenthe

DHB’spatientmanagementsystemvendorsandothersectorstakeholdersearlierintheprocess(October)

ratherthanwaitinguntillateDecember.


(a) DHBsarecleareraboutwhatisneededforpayments(versusmonitoringcontractperformance)andthat

paymentmethodsaresimplifiedinordertoreducethecostandcomplexityofthepaymentssystem.

The MRG recommends that a:

(a) Workingpartyisestablishedwitharangeofsectorrepresentativestodevelopanationalframeworkfor

contracting,reportingandaccountabilitythatstreamlinesprocessesandensuresclear,timelyaccountability

e.g.toaligntheDAPandSOIreporting,toinvestigatehowthecertificationandexceptionbasiscanbeused

morewidely,andtoagreetheprocessforidentifyingkeyIDPreportingrequirements,andtodevelopthe

DAPintoanaction-orientateddocumentthatismorerelevanttoDHBprioritiesandperformance.

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5 Selectively review the plethora of existing Ministerial and Ministry committees and

functions.


(a) Fourcommitteeshavetheirtermsofreferenceandmembershiprefocusedtofulfilthenewmandate

outlinedintheMRGreport,

(b)16committeesbedisbanded,

(c) 16committeesbedisbandedandtheirfunctionstransferredtotheNHB,

(d)Sevencommitteesbemerged,

(e) FivecommitteesbereconfiguredintoExpertPanelsasoutlinedintheFrameworkinSection3,and

(f) 54committeesareretained.Ofthese10areStatutoryCommittees,fourareMinisterialCommittees,and40

areMinistryofHealthCommittees(including10NSUandeightEthicsCommittees).

The MRG recommends the following principles govern all committees, including Statutory, Ministerial

Advisory, Ministry of Health, and NHB:

(a) FormalMinistryofHealthCommittees(Programme/ProjectAdvisorGroups)shouldonlybeestablishedon

approvaloftheSeniorLeadershipTeam,

(b)Programme/ProjectAdvisoryCommitteesmaybeestablishedfortheplanningandinitialimplementationof

aspecificprogramme/project.Howeverwhereongoingadvicefromexpertisenotavailablewithinthe

MinistryofHealthisrequired,existingnetworksshouldbeutlisedfirsttoinformpolicyandprogramme

development,especiallyforcontentiousorcomplexissuesorthosewheresectorsupportisrequired,

(c) AllcommitteesandExpertPanelsshouldhavearobusttermsofreference,aworkplan,andreporting

requirements,

(d)AllcommitteesshouldhaveanindependentlyappointedskilledChair,whoseroleisnottorepresentan

opinionbuttoensurethecommitteefulfilsitsresponsibilities,

(e) AllcommitteesandExpertPanelsshouldconsiderhowtheyincludeconsumervoicesin

theirprocesses,

(f) AllcommitteesandExpertPanelstouseteleconferenceasthepreferredmethodofmeeting

wheneverpossible,

(g)Allcommitteestohaveanindependentreviewoftheirtermsofreference,deliveryagainsttheworkplan,

andmembershiptoensuretheycontinuetoaddvalueand/orbenefittothesector,and

(h)AllMinistryofHealthcommitteestohaveanend-of-lifedate.

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(a) Thestructurebelowisendorsedforthefuture.

PHOs stratified by population size

Statutory Committees

Ministerial Advisory Committees

MoH and NHB Programme/Project Advisory Groups

MoH and NHB Expert Panel

Rationale for existence

Term of office

Established by an Act of Parliament

To provide advice to the Minister of Health on specific issues

The expertise required is not employed within the Ministry of Health; and/or

Existing networks do not have the full required expertise; and/or

There is a requirement for long-term expert advice

When expertise and input is required for a specific topic or piece of work

Drawn from the service panel of experts (see below)

Three years or less Three years or less One year or more Short-term focused work then disbanded; or called together as required to fulfil a specific agenda

Renewal As Minister of Health directs after the three- year review

As Minister of Health directs after the three-year review

As approved by the MoH Senior Leadership Team


(a) TheMinistryofHealthestablishacommontermsofreferencetemplate,and

(b)ThattheMinistryofHealthdevelopasetofguidelinesfortheregulationandmonitoringofcommitteesand

ExpertPanels.


(a) ThattheMinistryofHealthimplementafullcostprocessforeverycommitteeandExpertPanel.

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(a) TheNationalHealthCommitteeberefocusedwithabroadermandatetoadvisetheMinisteronservicesthat

shouldbepublicallyfunded,

(b)ThePublicHealthAdvisoryCommitteeberefocusedwithabroadermandatetoadvisetheMinisteronthe

configurationandprovisionofpublichealthservices,

(c) TheNationalHealthEpidemiologyandQualityAssuranceAdvisoryCommittee,knownastheQuality

ImprovementCommittee(QIC),bereplacedbyanindependentqualityentitywithresponsibilityforhelping

providersacrossthewholesectorimprovepatientsafetyandservicequality,

(d)ThefourMortalityReviewCommitteesaremergedintotwocommittees,

(e) TheDrinkingWaterImplementationAdvisoryCommitteeisnotestablished,

(f) TheHealthInformationStrategyAdvisoryCommitteebedisbandedandbecomespartoftheNHBITcapacity

planningmechanism,and

(g)10StatutoryCommitteesareretained,eachtohaveaprocessestablishedforthree-yearlyreviewoftheir

termsofreferenceandmembershiptoensuretheycontinuetoaddvalueand/orbenefitfortheMinister.


(a) TheCancerControlCouncilofNewZealandberetainedandtherecommendationsofthereviewofthe

termsofreferenceandmembershipareimplemented,

(b)TheSanitaryWorksTechnicalAdvisoryCommitteeberetainedandisrefocusedontheDrinkingWater

AssistanceProgrammeonlyandmeetsonceperannum,

(c) TheHealthofOlderPeopleForumisdisbandedinitscurrentform,and

(d)Thethreeothercommitteesareretained,eachtohaveaprocessestablishedforthree-yearlyreviewoftheir

termsofreferenceandmembershiptoensuretheycontinuetoaddvalueand/orbenefitfortheMinister.

The MRG notes that 12 committees have already been reformulated into Expert Panels and

recommends that:

(a) TheNSUcommittees,includingtheJointMinistriesCommitteeandtheExpertPanels,continue

tobereviewedannuallytoensuretheyareaddingvaluetotheNSUprogrammes.

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(a) TheNationalSystemsDevelopmentProgrammeSectorAdvisoryGroupandtheNationalSystems

DevelopmentProgrammeConnectedHealthCommunitySteeringGrouparedisbanded,and

(b)TheHealthInformationStandardsGovernanceGroupbedisbandedandbecomespartoftheNHBIT

capacityplanningmechanism.


(a) Sixofthecurrentworkforcecommittees’rolesandfunctionsbecomeastandingfeatureofeitherthe

NursingReferenceGrouportheMedicalReferenceGroupinthehealthworkforcecapacityandplanning

capabilityoftheNHB,and

(b)TheSpecificationReviewofMidwiferyFirstYearofPracticeAdvisoryGroupandtheMidwiferyPost

GraduateEducationExpertAdvisoryGroupbedisbandedandtheirfunctionslefttotheMidwifery

RegistrationBoard.


(a) TheoperationalandcommitteefunctionsoftheNationalInfluenzaStrategyGroupbeseparatedandthe

structureandfunctionofthecommitteebereviewedonce2009influenzavaccinationprogrammesare

completed,

(b)AnoverarchingImmunisationTechnicalForumandanImmunisationCoverageForumbeformedto

incorporatethecurrentrolesoftheImmunisationTechnicalWorkingGroup,theMenzBEffectiveness

Group,andtheImmunisationProgrammeAdvisoryCommittee,and

(c) Theneedforonefurthercommittee(theNationalImmunisationRegisterAdvisoryGroup)bereviewedas

partofareviewoftheinternalarrangementsrequiredtomeetresearch,privacy,andethicalneeds.

Oftheremainingsix,theMRGrecommendsthat:

(a) Fivecommittees(theHepatitisCTreatmentAdvisoryGroup,theAIDSMedicalandTechnicalAdvisory

Committee,theAntibioticResistanceAdvisoryCommittee,theNationalCertificationCommitteeforthe

EradicationofPolio,andtheTuberculosisAdvisoryGroup)beretained,and

(b)ThetermsofreferenceandmembershipofthePneumococcalSurveillanceAdvisoryGroupbereviewedwith

aviewtoabroaderroleinvaccinepreventablediseasesurveillance.


(a) ThoserecommendationsfromthereviewoftheEthicsSystempertainingtocommitteestructureandrole

areimplementedinatimelymanner.

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(a) ThethreeCoreCancerControlCommitteesareretainedandreviewedannuallytoensuretheycontinueto

addvaluetotheCancerControlStrategy.


(a) Beforethetwo-yeartermiscompletethePrimaryHealthCareAdvisoryCouncilhasanindependentreview

oftheirtermsofreference,deliveryagainstworkplan,andmembershiptoevaluatethevalueand/orbenefit

tothesectorfromthecommitteestructureandprocess,and

(b)ThefunctionsofthePrimaryHealthCareNursingExpertAdvisoryGroupbeassumedbytheNursing

ReferenceGroupoftheHWTB.


(a) ThethreecommonFinanceRelatedCommitteesaredisbandedandthefunctionsmoveintotheNHBrole,and

(b)TheNationalCapitalCommitteebedisbandedandbecomepartoftheNHBcapitalcapacity

planningmechanism.


(a) TheTeTaumataRoopu–MaoriPublicHealthReferenceGroupberetainedandthatitsmembershipand

termsofreferencebereviewedannuallytoensureitaddsmaximumvalueforpublichealthservices.

Of the other three, the MRG recommends one is retained and that:

(a) TheFoodandBeverageClassificationSystemTechnicalAdvisoryGroupandtheNationalBreastfeeding

CommitteearereconfiguredasExpertPanelsandcalledtogetherasrequiredforspecificissues.


(a) TheMinistryofHealthworkwiththeCancerControlCouncilandtheHealthSponsorshipCounciltoremove

anyduplicationofworkplan,and

(b)TheMinistryofHealthreviewstherequirementfortheTobaccoControlResearchSteeringGrouppriorto

thenextcontractbeinglet.


(a) TheNationalDiabetesRetinalScreeningAdvisoryGroupisdisbanded.


(a) Thethirdiscurrentlyretained.

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(a) TheworkforcedevelopmentcomponentoftheHealthProtectionAdvisoryGroupistransferredtotheNHB

HealthWorkforcecapacityplanningfunctionandthatthecommitteemeetsuptotwiceyearlytofulfilits

assessmentprocess.


(a) TheJointMinistryofHealth/DepartmentofInternalAffairsStakeholderReferenceGrouponPreventingand

MinimisingGamblingHarmbereviewedand/ordisbandedattheendofitsterm.


(a) TheSexualHealthAdvisoryGroupbedisbanded.


(a) BoththeNationwideServiceFrameworkCo-ordinatingGroupandtheHealthImpactAssessmentSupport

UnitReferenceGroupbereformulatedintoExpertPanels,

(b)TheDHBInformationLiaisonGroupbedisbandedandthemonitoringfunctionsbecometheresponsibilityof

theNHB,and

(c) TheNationalServiceandTechnologyReview(NSTR)Committee’srolebecomesafunctionofthe

reformulatedNationalHealthCommittee.

annex 6 - the beehive · (f) the nhb contract on behalf of the minister with dhbs for regional and...

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