2017/18 Regional Service Plan Guidelines Amendments to the Regional Service Plan Guidelines (note that minor editorial amendments have not been recorded in the following table) Page Description 12 - Further clarification has been provided of the expectations for inclusions in the plans on the National Sudden Unexpected Death in Infancy Prevention Programme. May 2017 This document is for shared service agency and DHB staff to use when developing their 2017/18 Regional Service Plans. The Regional Service Plan Guidelines is a reference document to enable shared service agencies and DHBs to
Transcript
2017/18Regional Service Plan Guidelines
Amendments to the Regional Service Plan Guidelines (note that minor editorial amendments have not been recorded in the following table)
Page Description
12 - Further clarification has been provided of the expectations for inclusions in the plans on the National Sudden Unexpected Death in Infancy Prevention Programme.
May 2017
This document is for shared service agency and DHB staff to use when developing their 2017/18 Regional Service Plans.
The Regional Service Plan Guidelines is a reference document to enable shared service agencies and DHBs to meet their minimum legislative obligations when drafting their Regional Service Plans.
Table of Contents
Introduction to the Guidelines...............................................................................................................................3Regional Collaboration.........................................................................................................................................................3Regional Service Plan...........................................................................................................................................................3
Overview of Content Requirements.......................................................................................................................4
2.1 Enablers......................................................................................................................................................62.1.1 Information Technology..........................................................................................................................................6
Information Technology Guidance...................................................................................................................................82.1.2 Regional Workforce..............................................................................................................................................102.1.3 Capital...................................................................................................................................................................12
2.3 RSP Priorities.............................................................................................................................................122.3.1 Emerging Priority – Sudden Unexpected Death in Infancy Prevention Programme................................................122.3.2 Electives..................................................................................................................................................................132.3.3 Cardiac Services.......................................................................................................................................................132.3.4 Mental Health and Addictions.................................................................................................................................142.3.5 Stroke......................................................................................................................................................................142.3.6 Healthy Ageing........................................................................................................................................................152.3.7 Major Trauma.........................................................................................................................................................152.3.8 Hepatitis C...............................................................................................................................................................15
2.4 Regional Cancer Networks........................................................................................................................162.4.1 Key actions............................................................................................................................................................16
MODULE 3: REGIONAL GOVERNANCE AND LEADERSHIP................................................................18
3.1 Regional Governance and Decision Making..............................................................................................18
MODULE 4: CLINICAL LEADERSHIP AND CLINICAL NETWORKS.......................................................19
4.1 Supporting Clinical Leadership and Clinical Networks..............................................................................19
MODULE 5: HEALTH EQUITY..........................................................................................................20
5.1 Health Equity Tools...................................................................................................................................20
MODULE 6: LINE OF SIGHT............................................................................................................21
6.1 The Planning Process across Regional Service Plans and Annual Plans.....................................................21
6.2 Guidance Framework for RSP Priorities....................................................................................................21
MODULE 7: NATIONAL ENTITIES....................................................................................................23
7.1 Linkages....................................................................................................................................................237.1.1 Health Quality and Safety Commission.................................................................................................................23
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Introduction to the Guidelines
Regional CollaborationDistrict health boards (DHBs) are expected to work together at a regional level to make the best use of available resources, strengthen clinical and financial sustainability and increase access to services. Improving regional collaboration between DHBs has been an evolving process over time. In the last few years, significant progress has been made in establishing the key foundations to assist regional collaboration and DHBs are in a good position to continue implementing their regional and sub-regional priorities.
Regional Service PlanThe purpose of a regional service plan (RSP) is to provide a mechanism for DHBs to document their regional collaboration efforts and align service and capacity planning in a deliberate way. The RSPs include national priorities for regional delivery and locally agreed regional priorities, and outline how DHBs intend to plan, fund and implement these services at a regional or sub-regional level. The plans have a specific focus on reducing service vulnerability, reducing costs and improving the quality of care to patients.
High-quality health care results from the simultaneous implementation of three quality dimensions: improved quality, safety and experience of care, improved health and equity for all populations, and best value for public health system resources. High-quality health and disability services respond to the needs and aspirations of diverse population groups, and the health system must work to eliminate barriers to accessing high-quality health care. Therefore, the 2017/18 RSP guidance again includes a focus on health equity, which is a cross-cutting dimension of quality. Further detail on expectations is set out in Module 5: Health Equity.
In 2017/18 the regions are expected to strengthen their focus on the regional enablers, and the guidance has been updated to reflect this. The 2017/18 RSPs must reflect the New Zealand Health Strategy’s direction, and in particular the RSPs should clearly align to the Strategy themes of People powered, Closer to home, Value and high performance, One team, and Smart system.
The Line of Sight framework is again included in Module 6 as a general guideline for consideration while developing your plans.
For further information regarding these guidelines please contact:Michelle GohService CommissioningMinistry of [email protected](04) 816 2214.
Information Technology Guidance2.1.2 Regional Workforce2.1.3 Capital
2.2 Sub-regional Initiatives 2.3 RSP Priorities
2.3.1 Emerging Priority2.4 Regional Cancer Networks
2.4.1 Key actions
MODULE 3: REGIONAL GOVERNANCE AND LEADERSHIP
3.1 Regional Governance and Decision Making
MODULE 4: CLINICAL LEADERSHIP AND CLINICAL NETWORKS
4.1 Supporting Clinical Leadership and Clinical Networks
MODULE 5: HEALTH EQUITY
5.1 Health Equity Tools
MODULE 6: LINE OF SIGHT
6.1 The Planning Process Across Regional and Annual Plans6.2 Guidance Framework for RSP Priorities
MODULE 7: NATIONAL ENTITIES7.1 Linkages
7.1.1 Health Quality and Safety Commission
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MODULE 1: STRATEGIC POSITION
In the development of the strategic section, regions should reflect on progress to date; identifying and explaining any significant changes from earlier years, and identifying the direction of travel for 2017/18 and future years.
Progress to date has to be made more visible and can be done through both qualitative and quantitative data. Demonstrate how the regional work programme is making a difference for service delivery in the region. For enablers (Information Technology and Workforce) progress can either be described as a whole or as part of the individual priority sections (Module 2).
1.1 Linkages
The strategic section of the RSP should also be consistent with national strategic imperatives and include appropriate commitments to the refreshed New Zealand Health Strategy, as well as all trends and key outcomes outlined in:
DHBs’ Statements of Intent (SOIs) that articulate the ability of each DHB in the region to deliver improved services into the future
the Strategic Intentions section of DHBs’ APs.
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MODULE 2: REGIONAL PRIORITIES
2.1 Enablers
The Government ICT Strategy and Health Workforce Regional Work Plan outline the strategic focus for these areas, and include key priorities and programmes that are expected to be implemented regionally by DHBs. The regional priorities for 2017/18 for IT and Workforce are outlined below. The requirements for enablers can be incorporated into specific service priorities where applicable. Further context on how these enablers link with regional objectives in RSPs is also noted below.
2.1.1 Information Technology
Strategic Context for Digital HealthDelivery of ICT enabled change and innovation is critical in supporting the delivery of the New Zealand Health Strategy and the Government ICT Strategy.
New Zealand Health Strategy1
The New Zealand Health Strategy has set a goal of a people-powered, smart health system by 2025.
The opportunity to utilise new health and digital technologies will be one of the ways to make progress towards this outcome. Health ICT plays a significant role in today’s health environment by enabling the delivery of high quality, timely and cost effective health care.
Government ICT Strategy2
The Government ICT Strategy has five focus areas to support the public sector to benefit from ICT enabled opportunities.
Digital Health 2020Digital Health 2020 has been established to progress the core digital technologies presented in the New Zealand Health Strategy. It guides the strategic digital investments that are expected to occur across the health and disability sector in the next five years, 2016–2020. It will also align sector investment with value delivery and encourage health organisations to invest with greater clarity and confidence.
Five core components and three enabling functions that make up the programme are shown below:
eHealth priorities for regional service planningA number of business priorities require eHealth capabilities that need to be delivered in parallel with Digital Health 2020. The priorities to deliver these capabilities for 2017/18 are itemised below.
Health ICT Investment PortfolioICT investments need to be directed to where the needs are greatest and follow a health investment approach with a long-term mindset. The Ministry of Health will be working with the sector to provide policies, guidelines and processes in 2017/18 that will form the basis for the new ICT Portfolio Framework.
As part of this, the Ministry of Heath will maintain the health ICT portfolio of investments to support decision making to maximise the network value of sector ICT investment and deliver strategic goals.
To support this, the 2017/18 RSPs should include the following.1. The prioritised four year plan of all local, regional and national IT initiatives with the following level of
information provided for each initiative.a. Name of the initiative and budget allocation by DHB (WOLC).b. The key deliverable(s) that will be achieved in the 2017/18 year.c. Benefits, dependencies and milestones (where available).
2. How the region will address the following IT delivery challenges.a. Regional governance, leadership and decision making, with clear escalation pathways.b. Regional funding and approval model(s).c. Regional capacity and capability.
Health Information Standards and Architecture3
The Ministry of Health will define and support the development and adoption of fit-for-purpose health information standards and architecture that support the effective and accelerated implementation of eHealth aligned to strategic goals. All investments should demonstrate how they use HISO Standards.
The Ministry of Health expects to strengthen the focus on architecture and standards to support Digital Health 2020 and work with the sector and vendor community towards compliance.
Digital Innovation FrameworkThe Digital Advisory Board will provide strategic leadership on digital and information related technologies and work with the sector on creating an environment that supports and encourages innovation.
The Ministry of Health will support the Digital Advisory Board in providing policy, process and guidance to support and accelerate digital innovation. Sector engagement with the Digital Advisory Board will continue as work develops on the framework.
Information Technology GuidanceInformation Technology (IT)In the 2017/18 Regional Service Plans the following should be included.3. The prioritised four year plan of all local, regional and national IT initiatives with the following level of information provided for each
initiative.a. Name of the initiative and budget allocation by DHB (WOLC).b. The key deliverable(s) that will be achieved in the 2017/18 year.c. Benefits, dependencies and milestones (where available).
4. How the region will address the following IT delivery challenges.a. Regional governance, leadership and decision making, with clear escalation pathways.b. Regional funding and approval model(s).c. Regional capacity and capability.
Digital Health 2020
Investment focus Approach Description of 17/18 activity DHBs involved Measures
Single Electronic Health Record
National programme led by Ministry of Health.
Development of Detailed Business Case.
All DHBs DHB engagement in business case development process.
Digital Hospital DHBs accountable for delivery.
Use EMRAM assessment to target gaps in hospital digital maturity with regionally aligned solutions.
DHBs should recognise the need for enabling infrastructure to support delivery of digital hospital capability.
All DHBs DHBs to accelerate maturity through regional and sub-regional activities where possible.
Refer to the Annual Planning Priorities Guidance for recommended DHB investments.
Health and Wellness Dataset
Ministry of Health led initiatives aligned to the Government’s social investment approach.
Establish information governance based on the draft health information governance framework.
Analysis of current state of Ministry held datasets to identify improvements.
Consider analytics use of health data in all ICT investments.
All DHBs DHB engagement in information governance framework development.
Preventative Health IT Capability
Ministry developed framework of business, data and technology architecture to guide and target investment in health screening solutions to drive consistency and maximise reuse.
DHB and sector engagement to inform planning.
Bowel screening rollout.
Cervical screening project to support HPV testing.
All DHBs DHB engagement in framework development.
Bowel screening rollout (Refer to the Annual Planning Priorities Guidance).
Regional IT DHBs accountable for Regional governance, leadership and All DHBs DHBs must demonstrate how
they are regionally aligned and where they are leveraging digital hospital investments. Specific capability measures are: 95 percent of GP referrals
are sent electronically all DHB discharges are sent
electronically 95 percent of population
have an integrated patient-centric clinical record available through a regional view.
Other eHealth Business Priorities
Investment focus Approach Description of 17/18 activity
DHBs involved in
17/18Measures
Maternity Nationally led programme with local DHB implementation -starting with five early adopter DHBs and MMPO.
The national solution for Maternity Care will be ready for adoption by the second adopter DHBs who wish to implement.
All DHBs either implemented or planning.
(Current early adopters - Counties Manukau, MidCentral, Tairawhiti, Whanganui, and South Canterbury).
DHBs who wish to implement the maternity solution should engage with the National programme.
Nationally consistent Electronic Oral Health Record (EOHR)
National programme led by Ministry of Health with DHB governance and co-design.
Investment approval and implementation planning for preferred software solution.
All DHBs - community and hospital based oral health services.
DHB engagement in investment case development and implementation planning.
Cancer Information Strategy
Deliver nationally consistent systems across DHBs to deliver cancer services and support better treatment.
Refer to Section 2.4 Regional Cancer Networks.
National Immunisation Register (NIR) replacement
Nationally led programme to replacement the current NIR register.
Investment approval and implementation planning for preferred software solution.
All DHBs DHB engagement in investment case development and implementation planning.
NOTE: DHBs should be aware of activity across their PHOs and community providers, such as National Enrolment Service (NES), NZePS and Whānau Ora. No plans are expected from DHBs on these.
2.1.2 Regional Workforce
The workforce section of the RSP must be cognisant of the priorities and/or areas of action outlined in the New Zealand Health Strategy, the need to demonstrate leadership and commitment to supporting the development of the region’s health workforce consistent with the objectives of the Strategy, and the need to strengthen local and regional health workforce to meet future healthcare needs. In particular, regions will support a sustainable and adaptive workforce by putting in place workforce development initiatives to enhance capacity, diversity and
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succession planning and build workforce flexibility. Consideration should be given to making best use of the multidisciplinary team including kaiāwhina.
Regional population health needs and desired health outcomes should inform and direct health workforce planning and development initiatives. For workforce initiatives to sustainably enable the desired health outcomes they must be considered alongside models of care, business models, the financial, legislative and regulatory environment and other enablers (IT and capital).
In 2017/18, regions will build upon work from previous RSPs and identify workforce priorities specific to their region. Further, DHBs are expected to work in collaboration with Regional Training Hubs and in conjunction with the Ministry of Health to achieve agreed regionally-based solutions for the following areas: workforce planning, workforce diversity, healthy ageing and mental health and addictions.
In summary regional workforce plans should include:a) the population health need initiatives are designed to addressb) the desired health outcomes the initiatives will help to addressc) an assessment of how the initiatives align with models of care, business models, the financial, legislative and
regulatory environment and other enablers (IT and capital)d) evidence that consideration has been given to making best use of the multidisciplinary team including
kaiāwhina.
Workforce PlanningHealth Strategy Themes: Closer to home, One team, Smart system.
Work regionally and in collaboration with DHB Shared Services and the Ministry of Health to: identify workforce data and intelligence that is collected across services and DHB areas, understanding work force trends to inform
workforce planning understand the workforce data and intelligence requirements that best supports regions and DHB areas in order to undertake
evidence based work force planning ensure each region is aware of the number of eligible new health professional graduates for their regions DHBs (PGY1 and PGY2,
nurses, allied health, scientific and technical) and plans for where they will be based. This may include: a stock take of workforce data and intelligence information that is collected, including understanding any gaps and the type of
information that the Ministry, regions and DHBs need to inform work force planning identifying and prioritising vulnerable workforces in workforce plans providing workforce data and intelligence that supports regions and DHBs to undertake evidence based workforce planning.
Workforce DiversityHealth Strategy Themes: People-powered, One team.
Work regionally and in collaboration with DHB Shared Services and the Ministry of Health to: build cultural competence across the whole workforce increase participation of Māori and Pacific in the health workforce form alliances with educational institutes (including secondary and tertiary) and local iwi to identify and implement best practices to
achieve the Māori health workforce that matches the proportion of Māori in the population ensure all DHB employed workforce data on ethnicity is updated and collected in accordance with Ministry guidelines on ethnicity for
95-100 percent of the workforce by 30 June 2018.This should include: analysing workforce data and intelligence to understand workforce diversity and mapping this to population demographics within
regions developing workforce plans that include education and training needs incorporating guidance and actions set out in sections 6.3, 6.4, 6.5 and 10.3.2 of the Operational Policy Framework.
In addition to the planning priorities outlined above, regions are expected to align workforce actions with the RSP and AP priorities of Healthy Ageing and Mental Health and Addictions. Regional Training Hubs will be required to work with DHBs in order to implement actions arising from the publication of key documents listed below.
Healthy Ageing (Workforce as an Enabler)Health Strategy Themes: Closer to home, One team.
Healthy Ageing StrategyWork regionally and in collaboration with DHB Shared Services and the Ministry of Health to: identify the workforces working with older people and their family/whānau/informal carers develop a workforce plan to ensure that those working with older people have the training and support they require to deliver high-
quality, person-centred care develop a sustainable mechanism for collecting a minimum workforce data set on the health workforce working in health of older
people outside the DHB provider arm by 30 June 2018.
Palliative Care (Review of Adult Palliative Care Services in New Zealand)Work regionally to: identify the workforces working with clients requiring palliative care services and their family/whānau/informal carers develop a workforce plan to ensure that those working with clients requiring palliative care services have the training and support
they require to deliver high-quality, person-centred care.
Healthy Ageing and Palliative Care workforce plans should: include strategies to support specialist work forces to deliver education and training sessions for non-specialist workforces identify and prioritise vulnerable workforces in workforce plans prioritise allied health, kaiāwhina and carer and support worker workforces refer to and incorporate guidance and actions outlined in the Healthy Ageing Strategy (once released) and the Review of Adult
Palliative Care Services in New Zealand.
Mental Health and Addictions (Workforce as an Enabler)Health Strategy Themes: One team.
Work regionally and in collaboration with DHB Shared Services and the Ministry of Health to implement the actions set out in the Mental Health and Addiction Workforce Action Plan 2016-2020.
Measures Regional progress reporting on the above requirements and key actions to be provided via quarterly RSP reports. A sustainable mechanism for collecting a minimum workforce data set on the health workforce working in health of older people
working outside the DHB provider arm is established by 30 June 2018 (specific to Healthy Ageing Strategy). 95-100 percent of DHB employees have their ethnicity status collected in a manner consistent with Ministry guidelines by 30 June
2018 (specific to workforce diversity).
2.1.3 Capital
Regional service planning remains an integral part of capital investment planning. Where it is appropriate, potential capital impacts should be identified. However, quarterly reporting on capital will not be required via RSPs. In 2017/18, the Treasury Investment and Asset Performance (IMAP) system comes into effect. All DHBs will be required to provide Long Term Investment Plans (LTIPs) to the Ministry. Investment intensive DHBs will also be required to submit their LTIPs to the Treasury, in accordance with the IMAP process. LTIPs will replace the previous requirement for a Regional Capital Plan.
2.2 Sub-regional Initiatives
Current and emerging sub-regional initiatives where DHBs are working together to provide improved value to their populations should be identified in the RSPs, including measurable and time-bound actions.
2.3 RSP Priorities
The 2017/18 RSP priorities are noted below. These are all a continuation from 2016/17. Note, necessary actions to support cancer services at a regional level are outlined in section 2.4 Regional Cancer Networks.
Electives Cardiac Services Mental Health and Addictions Stroke Healthy Ageing Major Trauma Hepatitis C
2.3.1 Emerging Priority – Sudden Unexpected Death in Infancy Prevention Programme
The Ministry has developed a new National SUDI Prevention Programme to be implemented from 1 July 2017 via a new schedule to the Crown Funding Agreement, which may require some commitment in RSPs. Further information and guidance will be advised as soon as possible.
The Ministry has developed a new National Sudden Unexpected Death in Infancy (SUDI) Prevention Programme (NSPP) to be implemented from 1 July 2017. The new NSPP will continue to build on the Ministry's campaign to 'make every sleep a safe sleep' for babies with the aim of working with the wider Government sector to reduce the toll from SUDI. The NSPP includes a national SUDI Prevention Coordination Service and Regional SUDI Prevention Programmes delivered by DHBs and coordinated regionally. Each DHB will have a CFA variation that will agree how they support delivery of the Regional component of the NSPP and will detail reporting requirements.
The national SUDI Prevention Coordination Service will be responsible for providing oversight, monitoring, support, and resources to the Regional SUDI Prevention Coordinators and DHBs to establish and implement their Regional SUDI Prevention programmes.
Once the Regional SUDI Prevention Coordinators are in place, each region will be expected to develop a Regional SUDI Prevention Plan by the end of quarter one 2017/18. Additional guidance and templates outlining what these plans are to include will be provided by the national SUDI Prevention Coordination Service once it is in place (expected from 1 July 2017).
Please include a commitment within your RSP to provide a Regional SUDI Prevention Plan to the Ministry by the end of quarter one 2017/18.
2.3.2 ElectivesRegional Objectives• Improve access to elective services.• Maintain reduced waiting times for elective first specialist assessments (FSAs) and treatment.• Improve equity of access to services, so patients receive similar access regardless of where they live.
• 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:o 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
o developing consistent pathway, access criteria, and clinical protocols for individual serviceso establishing and delivering sub-regional agreement to facilitate cross-boundary patient care o implementing sub-regional referral management and scheduling systemso sustaining progress achieved through previously funded Elective Services Productivity and Workforce Programme (ESPWP)
contracts.Information Technology• Identify 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.
Workforce• Identify the actions that the region will undertake to maximise workforce resources. For example, completing a forecast through to
2018/19 of future workforce requirements, developed based on service demands and maintaining a local and regional view of specialist workforce capacity and capability.
MeasuresFor the 2017/18 year it is expected that:• your region’s Electives Health Target will be met• patients wait no longer than four months for FSA or elective treatment (Elective Services Patient Flow Indicator (ESPI) 2 and ESPI 5).
While individual DHBs are accountable for ESPI performance; regional service activity should support improved access, equity and timeliness. Therefore, ESPIs are one measure of how regional progress is being achieved.
2.3.3 Cardiac Services
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Regional ObjectivesThe focus for regions in 2017/18will be to continue to improve access to cardiac services including:• improved and timelier access to cardiac services• patients with a similar level of need receive comparable access to services, regardless of where they live• more patients survive acute coronary events, and likelihood of subsequent events are reduced• patients with suspected Acute Coronary Syndrome (ACS) receive seamless, co-ordinated care across the clinical pathway• patients with heart failure are optimally managed at admission, reducing the need for further readmission• reviewing and auditing Accelerated Chest Pain Pathways (ACPPs) in Emergency Departments.
• Continue to work with regional cardiac clinical networks and the New Zealand Cardiac Network to implement actions to improve outcomes for people.
• Provide quarterly reporting at regional and DHB level utilising the ANZACS-QI 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.ACPPs• Review and audit ACPPs in Emergency Departments.ACS• 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.Heart Failure• Implement locally, regionally and nationally agreed protocols, guidance, processes and systems to ensure optimal management of
patients with heart failure.
Measures Cardiology Services• Acute- 70% of Acute Coronary Syndrome patients will receive an angiogram within 3 days of admission• Acute - 95% of the ANZACSQI data on ACS patients who have an angiogram will be entered within 30 days• Elective - Patients to wait no longer than 4 months for a Cardiology FSA• Elective + Acute -SIR coronary angiography of at least 34.7 per 10,000 population• Elective + Acute - SIR percutaneous revascularisation of at least 12.5 per 10,000 population
Cardiac-Thoracic Services• Elective - 95% of DENDRITE data on patients who have cardiac surgery will be entered within 30 days of discharge• Elective - Patients to wait no longer than 4 months for a Cardio-thoracic FSA• Elective - Report the proportion of patients scored using the national cardiac surgery Clinical Priority Access tool (CPAC)• Elective - Report the proportion of cardio-thoracic patients treated within assigned CPAC urgency timeframes• Elective - The cardio-thoracic waitlist must remain between 5 and 7.5% of planned annual throughput, and must not exceed 10% of
annual throughput• Elective + Acute - SIR of 6.5 per 10,000 population
2.3.4 Mental Health and AddictionsRegional Objectives Our objectives for 2017/18 are to:• improve access to the range of eating disorder services• develop perinatal and maternal mental health acute service options as part of a service continuum (Midland and Northern)• develop addiction service capacity and capability for implementing the Substance Abuse Compulsory Assessment and Treatment
(SACAT) Bill• develop clinical workstations (Southern and Midland)• improve the physical health of people with low prevalence disorders.
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 addiction service capacity and capability for implementation of substance abuse legislation• develop a plan to improve physical health outcomes of people with low prevalence disorders• the successful implementation of modern clinical workstations (Southern and Midland regions).
For the North Island (Northern, Midland and Central Regions) perinatal and infant mental health services, actions that will facilitate:• regional co-ordination and oversight of service delivery and models of care that support integrated responses to acute care
including consult/liaison• access to a broader range of options for mothers who are acutely unwell• specialist acute response that facilitates timely and integrated care
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• establishment of clinical networks to support, connect and grow the expertise of the workforce • monitoring and evaluation of the individual services within the continuum and the continuum as a whole.
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. Measure
and report improved youth forensic access rates overall including increases in all three settings (court liaison, Child Youth and Family youth justice residences, and community).
• Increased access in the North Island to perinatal and maternal mental health services, increased number of contacts in the community, decreased wait-time (time from referral to first contact), decreased adult admissions. For example: x being current numbers to be increased to y with progress measured each quarter.
• Report progress on developing a plan to improve the physical health of people with low prevalence disorders.
2.3.5 StrokeRegional Objectives• To improve primary and secondary stroke prevention and reduce stroke related disability and mortality. • To improve access to quality assured organised acute, rehabilitation, and community stroke services.• To ensure all stroke patients have access to high-quality stroke services regardless of age, gender, ethnicity or geographic domicile.
Develop and deliver a regional plan for stroke services supporting the continued implementation of best practice stroke care, ensuring equitable access is provided to all New Zealanders. This should be consistent with the New Zealand Clinical Guidelines for Stroke Management 2010 (the Stroke Guidelines) and include advice provided by the national and regional stroke networks. This will include the following.Organisation of stroke services• People with stroke admitted to hospital are treated in a stroke unit and/or in the setting of an organised stroke service (see PP20 for
definitions of a stroke unit and organised stroke services).Thrombolysis• All people with stroke have access to a quality assured thrombolysis service 24/7 (eg, this will include the development of regional
plans to provide remote support via telestroke). Rehabilitation• All eligible people with stroke receive early active rehabilitation services (as defined by the National Stroke Network), supported by
an interdisciplinary stroke team.• All eligible people with stroke have equitable access to community stroke services.Education, training and audit• All members of the interdisciplinary stroke team participate in ongoing education, training and quality assurance and service
improvement programmes according to the Stroke Guidelines, and as recommended by the national and regional stroke networks.Workforce• A regional workforce plan that supports the delivery and achievement of sustained, consistent and safe thrombolysis, and
comprehensive evidence-based interdisciplinary acute and rehabilitation stroke care provision.• Identified actions that the region will take to develop and implement an ongoing education programme that supports a sustainable
and high-quality clinical workforce.Information Technology• Identified actions that the region will take to support improved information management, eg, establishing a regional oversight role.
MeasuresUse the three measures below to identify gaps and opportunities for development of regional models of care.• 8 percent or more of potentially eligible stroke patients thrombolysed 24/7 (see PP20 for definition of ‘eligible’)• 80 percent of stroke patients admitted to a stroke unit or organised stroke service (see PP20 for definitions).• 80 percent of patients admitted with acute stroke who are transferred to inpatient rehabilitation services are transferred within 7
days of acute admission (also report percent of acute stroke patients transferred to inpatient rehab).
Note: when reporting by DHB against above indicators include numerators and denominators in brackets after percent.
2.3.6 Healthy AgeingDemonstrate regional support in the 2017/18 year for DHB delivery of actions identified in the Healthy Ageing Strategy 2016, in particular: strengthening the implementation of the New Zealand Dementia Framework, and the actions specified in Improving the Lives of
People with Dementia (Ministry of Health 2014) using inteRAI assessment data to identify quality indicators and service development opportunities including with health providers.
Measures• See PP23 for measure information at both a local and regional level.
2.3.7 Major Trauma Regional ObjectivesTo implement a regional major trauma system that will result in a reduction of preventable levels of mortality, complications and lifelong disability of clients who have sustained a major trauma (as defined by the National Trauma Network4).
• Report the elements of the National Major Trauma Minimum Dataset for major trauma patients to the New Zealand Major Trauma Registry
• Provide clinical leadership to achieve a contemporary trauma system, including:o Agreed regional clinical guidelines and inter-hospital transfer processes to manage major trauma patients within the region
o Regional Destination Policies for major trauma patients (in collaboration with DHBs, ambulance providers and National Major Trauma Clinical Network).
Measures• Quarterly regional reporting of the NZ Major Trauma Minimum Dataset for major trauma patients to the National Major Trauma
Registry no more than 30 days after patient discharge.• Develop and implement a 6-monthly (minimum) regional process to analyse and interpret regional major trauma data with
mechanisms for quality improvement • Develop and implement a 6-monthly (minimum) regional review process of the alignment of actual service delivery for major
ReportingReport in the second and fourth quarters of 2017/18 on the above measures.
2.3.8 Hepatitis CRegional Objectives• To implement a single clinical pathway for hepatitis C care across all regions in order to provide consistent services, which maximise
the wellbeing of all New Zealanders living with hepatitis C.• To implement integrated hepatitis C assessment and treatment services across community, primary and secondary care services in
the region.
Actions to support the implementation of integrated hepatitis C assessment and treatment services include:• raising community and GP awareness and education of the hepatitis C virus (HCV) and the risk factors for infection• providing targeted testing of individuals at risk for HCV exposure• raising patient and GP awareness of long term consequences of HCV and the benefits of treatment, including lifestyle management
and antiviral therapy• providing community based access to HCV testing and care that will include Liver Elastography Scans 5 services to all regions as a
means for assessment of disease severity and as a triage tool for referral to secondary care and prioritisation for antiviral therapy• establishing systems to report on the delivery of Liver Elastography Scans in primary and secondary care settings• providing community based ongoing education and support (including referral to needle exchange services, community alcohol and
drug services, GP primary care services or social service agencies)• providing long term monitoring (life-long in people with cirrhosis and until cured in people without cirrhosis)• providing good information sharing with relevant health professionals• working collaboratively with primary and secondary care to improve access to treatment.
Note: the Hepatitis C Implementation Advisory Group has updated the Guidance to support the development of regional services to deliver identification and treatment for people at risk of or with Hepatitis C, providing more information on the clinical pathway, minimum requirements, minimum standards and data collection. This document isavailable on the Nationwide Service Framework Library website at the link below.https://nsfl.health.govt.nz/dhb-planning-package/guidance-support-development-regional-Starthepatitis-c-services
Measures• Quarterly narrative report on progress of the key actions.• Report six monthly broken down by quarters on the following measures:
Measures Data and Source1. Number of people diagnosed with hepatitis C per
annum (by age bands and genotype).Total number of people with a positive HCV PCR test in the DHB region (data from five reference labs provided to regional DHBs).
2. Number of HCV patients who have had a Liver Elastography Scan in the last year
(a) new patients (b) follow up (c) (by age and ethnicity).
Total number of hepatitis C Liver Elastography Scans performed annually (data from the delivery of Liver Elastography Scans in primary and secondary care).
Note: all Liver Elastography Scans are to be counted regardless of the
4 Major Trauma patients are defined as ISS>12 using AIS 2008.5 Liver Elastography Scans include mobile and fixed Fibroscan machines and Shear Wave machines being used in radiology departments.
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device used3. Number of people receiving PHARMAC funded
antiviral treatment per annum (by age and ethnicity).
Total number of people prescribed antiviral treatment who have hepatitis C (data from PHARMAC provided to regional DHBs).Ministry of Health to obtain data(by age, ethnicity and medication type) and provide this to DHB regions via annual reporting in the Regional Service Plans.
2.4 Regional Cancer Networks
Cancer networks bring together stakeholders from across the region who are working across the cancer pathway including DHBs, NGOs, GPs and PHOs, cancer service providers, cancer service consumers and their family or whānau, hospices, and research organisations. Cancer networks work across boundaries to improve the outcomes for patients by:
reducing the incidence and impact of cancer increasing equitable access to cancer service and equitable outcomes with respect to cancer treatment and
cancer outcomes.
Implementing the priorities of the New Zealand Cancer Plan: Better, faster cancer care 2015–2018 is the priority for regional planning for cancer services to improve:
equity of access to cancer services timeliness of services across the whole cancer pathway the quality of cancer services delivered.
2.4.1 Key actions
Regional Cancer Networks should identify how they will support coordination and integration of services across their region to improve access, timeliness and quality of cancer services.At a minimum this will include how your region will:
implement the priorities of the New Zealand Cancer Plan 2015-2018 achieve the Faster cancer treatment health target improve equity of access to cancer services support DHBs to deliver on the actions for cancer outlined in their Annual Plans.
DHBs are expected to continue to provide effective regional governance, accountability and decision making. DHB Chairs and Chief Executives from each region will be required to agree and sign RSPs on behalf of their individual boards.
3.1 Regional Governance and Decision Making
RSPs should provide information about how the DHBs in the region are collaborating and how implementation of the plans will be governed, costed, funded and managed, including how DHBs will manage performance and disputes.
DHBs are expected to co-operate and assist their colleagues in finding and implementing solutions to financial or clinical issues that arise. An indication of how the region will co-operate and resolve issues should be incorporated in the RSP and may include roles and responsibilities, an outline of arrangements to provide support and assistance to other DHBs to meet the regional and/or sub-regional performance expectations, and how barriers and issues will be resolved. Some regional (including sub-regional) work programmes may require specific governance and leadership approaches with tailored membership to appropriately represent the key stakeholders and to ensure the best outcome is achieved (eg, involvement and alignment with primary care, NGOs, and patient representative groups).
DHBs may also wish to include other examples of regional collaboration, for example, cross-appointed board members and clinicians and regular engagement between DHB boards in the region.
Regions are expected to provide costing information as per the regulations (sections 5 and 6 of the New Zealand Public Health and Disability (Planning) Regulations 2011).
MODULE 4: CLINICAL LEADERSHIP AND CLINICAL NETWORKS
4.1 Supporting Clinical Leadership and Clinical Networks
In 2017/18, it is expected that clinical integration will continue to be visible in the development of service priorities. Regions should ensure that they are considering appropriate use and growth of clinical leaders in line with the New Zealand Health Strategy’s focus on developing leadership, talent and workforce skills throughout the system under the One team theme. Additionally, RSPs are to adopt a proactive approach to strengthening clinical integration by developing and supporting clinical networks. In particular, the RSPs are to identify:
how clinical leaders have been involved in the development of the RSP how the region is planning to work with clinical leaders to make better use of clinical networks to support
improved clinical and financial sustainability of services services within the region that may benefit from the development of a regional clinical network and how
outcomes from the network will be measured.
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MODULE 5: HEALTH EQUITY
The World Health Organization defines equity as the absence of avoidable or remediable differences among populations or groups defined socially, economically, demographically or geographically. Equity is not a single component, but rather a cross-cutting dimension across all elements of quality. Focus is on reducing gaps in health outcomes between different groups based on ethnicity, deprivation, age, gender, disability and location (for example).
Strong planning and collaboration is critical to achieving health equity for all New Zealanders. The Ministry expects that achieving health equity is a focus for all DHB and regional activity. Regions are expected to keep identifying inequity in their health needs assessments and to outline in their RSPs activities in each of the regional priority areas aimed to improve health equity.
The specific actions aiming to improve equity will vary between regions and priority areas depending on their various needs and can range from enabling collection of ethnicity data to targeting services. Actions can be focused on the short and longer term. However, at least one specific action for each priority should be delivered in 2017/18. The Ministry will be looking for evidence that the regions have worked through a process of identifying the disparities evident in each priority area, and outlined relevant activities to reduce these disparities in order to achieve health equity for their population.
Regions aren’t expected to include specific equity actions for the priority areas listed as enablers.
5.1 Health Equity Tools
Actions vary depending on the understanding of the equity issues of the priority area. The following tools, or others at your disposal, can be used to assess and identify regional disparities and outline activities for achieving health equity.
Equity of Health Care for Māori: A Framework (this was recently released in July 2014). Whānau Ora Health Impact Assessment 2007. The Health Equity Assessment Tool: A User's Guide 2008.
The Ministry has recently released DHB M ā ori Health Profiles 2015 , which can help identify areas of focus for planning to improve equity.
To facilitate the delivery of high-quality health services that meet the needs of Pacific people, ‘Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2014–2018 has been developed. The Ministry publishes six-monthly progress reports on its website.
For 2017/18 focus remains on ensuring there is greater alignment between RSPs and APs. The RSPs are expected to set out the regional priorities and how DHBs intend to work as a region to achieve these. The requirements of IT, workforce and capital to implement service priorities are also expected to be incorporated where applicable.
6.1 The Planning Process across Regional Service Plans and Annual Plans
The Line of Sight guidance framework is provided below for general use. It aims to improve linkages across RSPs and APs and to demonstrate how individual DHB actions contribute to achieving regional priorities.
To expand further on this framework, a combined priorities document that clearly articulates what is required in both the RSPs and the APs for those planning priorities that cross both plans has been released.
DHBs are required to provide a statement of the local actions they will undertake to support the delivery of regional service plans. DHBs and regions can agree to only include the local actions in either one of the plans if they include a cross reference in the other plan.
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.
6.2 Guidance Framework for RSP Priorities
Line of sight across Government, Regional and Annual Plan outcomes and objectives
Health system outcomes
• New Zealanders live longer, healthier, more independent lives.• The health system is cost effective and supports a productive economy.
Ministry of Health high-level outcomes
• New Zealanders are healthier and more independent.• High-quality health and disability services are delivered in a timely and accessible manner.• The future sustainability of the health and disability system is assured.
Regional outcomes
• Outcomes that DHBs within a region want to achieve by working together regionally.
DHB outcomes
• Outcomes that the DHB wants to achieve.
RSP - Common Priorities and Objectives
• Priorities and objectives that DHBs within a region have set to achieve their regional outcomes.
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 effect of actions agreed to achieve milestones, including setting of baselines.
RSP - Inputs / Resources
• The nature of inputs may vary and could include: o costs to implement actions in order to achieve priority o people / teams / and/or new roles required to progress actions.
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 planning priorities document sets out the priority areas that are to be covered in the annual plans. The DHB annual plan should also include any significant individual DHB contributions to deliver against regional priorities and targets.
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MODULE 7: NATIONAL ENTITIES
7.1 Linkages
Linkages with other work, in particular across the National Health IT Plan, Health Workforce New Zealand, Capital, and the Health Quality and Safety Commission need to be considered.
7.1.1 Health Quality and Safety CommissionDHBS are required to incorporate Health Quality and Safety Commission programmes into their RSPs, as outlined in the Commission’s Statement of Intent 2014-18. In particular, DHBs are encouraged to demonstrate a structure and planned actions to support and maintain regional patient safety and quality improvement governance and working arrangements. Each region is expected to meet the following criterion:
RSP Criterion 2017/18 Example of an RSP meeting the criterionIdentify actions and demonstrate leadership for regional patient safety and quality improvement
Demonstrate, including planned actions and quarterly milestones, how you will:
maintain and participate in multi-disciplinary regional governance structures that focus on patient safety and quality improvement, and involve consumers (patients and family)
work regionally to implement the Health Quality & Safety Commission’s deteriorating patient programme in your DHBs.
