Statement of Intent 2008-11 Strategic Direction On this page Introduction Taking primary and preventive care to the next level Strengthening health services we can trust Enabling a strong, sustainable health sector for the longer term Summary of key priorities Introduction The health and disability sector is a large and complex one. It directly employs 130,000 people and consumes 20 cents of every tax dollar raised. It touches every New Zealander every day, whether it is in the quality of the water we drink, the health information messages we see, as one of the 17.3 million annual visits to a GP or one of the 681,102 annual hospital discharges. There have been a number of significant differences in organisational design over the years. The current structure was established by the New Zealand Public Health and Disability Act 2000 (NZPHD Act). This Act replaced the previous market based system, which tried to apply notions of competition, with a system of 21 semi-autonomous DHBs. These organisations are responsible both for assessing the health and disability support service needs of their populations and also providing services to meet that need. Within the legislative framework set by the NZPHD Act, the strategic direction of the sector has been set within two overarching strategic documents, the New Zealand Health Strategy and the New Zealand Disability Strategy. These two strategies have been supported by other more targeted strategies that provide guidance and advice in areas such as Maori health, Pacific health and primary health care. The system is operating well and is demonstrating significant improvements in health and wellbeing. Some achievements include: around 4 million New Zealanders enrolled in PHOs lower doctors’ fees growth in elective services while maintaining relatively short waits improved public attitudes towards those with mental illness improvement in some significant indicators of health status a significant fall in smoking rates high patient satisfaction levels. The Ministry has a well established framework that links key attributes of a fair and functional system with key outcomes for all New Zealanders. This framework is shown in the figure below: Figure 1: Ministry of Health outcomes framework View this figure at full size and text description. Back to top Taking primary and preventive care to the next level Primary care and prevention services are key to addressing the burden of long term conditions. We have created an environment of low fees, greater investment in health promotion and services that increase access in the primary health care and community setting. This is a strong platform for us to be able to get momentum on visible improvements in the health outcomes that can be influenced by community and primary care based services. We need to build on the platform established by the Government’s primary and preventive health care strategies. Long-term conditions continue to be the most signifi cant contributor to early death and premature disability among our populations, and our most vulnerable communities bear a greater burden of early onset and faster disease progression than other New Zealanders. A determined focus on disease management for key disease groups is at the heart of the public health strategy. Better access to screening and development checks, diagnosis and supporting the continuum of care for long term conditions is a priority. So too is a broad view of the underlying social determinants of health; like housing, sanitation, nutrition and lifestyle issues that impact inexorably on the need for primary and secondary layer interventions. The disparities in health outcomes between European, Maori, Pacific peoples and other migrant New Zealanders have diminished but remain unacceptably high. Our children and young people, and older people are among the most vulnerable members of our society. We will also increase our focus on the health of children and young people, because many of these conditions can be influenced earlier in life. Better addressing the health needs of those with the most capacity to benefit, lifts overall health outcomes and reflects New Zealanders’ aspirations to live in a fair and decent society. Back to top Strengthening health services we can trust New Zealanders expect that the very significant investment they make in health care will be well stewarded. They expect safe, high-quality services will be there for them when they and their families and whanau need them. To deliver on these expectations the Minister will hold the Ministry as his agent accountable, as appropriate, for the performance, effectiveness and efficiency of the health system. The statutory accountabilities of DHBs and other health sector entities under relevant legislation will remain. Value for money must continue to be ensured through the annual planning and performance management cycle of DHBs, through which some 75 percent of public health investment is currently channelled. Ministry-led performance monitoring can be supplemented where necessary and appropriate through Ministerial and Board level support. Quality and safety are crucial to ensuring the public has trust and confidence in the system. Patient safety in New Zealand compares well with wealthier counties from the OECD. It is the job of the Ministry and DHBs to further build on these gains. The sector is getting better at measuring quality and benchmarking against proven standards to reduce inappropriate variation, but there is room for further improvement. The role of the Quality Improvement Committee will be enhanced over the coming year. The Ministry has an important role in supporting implementation of its national improvement programme. This includes safe medication management, management of health care incidents, infection prevention and control, optimising the patient’s journey, and the introduction of a national mortality review system. Each project will be led by a DHB and will report regularly to the Quality Improvement Committee. Closer relationships across the sector are needed to ensure organisations share information and develop innovative solutions at district, regional and national levels. Partnership arrangements such as joint purchasing and regional clinical networks will enable our system to be more cohesive and efficient. The Minister expects to see better operational effectiveness through increased clinician input and closer relationships between clinicians and management, primary and secondary services, and between DHBs and the Ministry. This will reduce barriers and ensure the system is working effectively. While the fundamental design of the DHB system therefore remains sound, there is potential to achieve more and to improve some key processes. We still see significant variation in the performance of the sector and there is potential to further strengthen collaboration through regional shared services and stronger central leadership on strategic nationwide priorities. A key challenge is therefore to make consistent national gains within our semi-devolved health and disability system. We also need to ensure that any changes are not unduly disruptive, and add to rather than detract from the effectiveness of the system while maintaining an appropriate focus on value for money and the delivery of measurable outputs according to target, including elective services. Back to top Enabling a strong, sustainable health sector for the longer term Closer relationships also enable the spread of innovative ideas and practices, which is vital to performance improvement being achieved. Access to information, resources, tools and systems helps provide the sector with the capability needed to capitalise on the innovations. The Ministry has strengthened its focus on sharing innovations and information across the sector. A directorate was established during last year’s organisational restructure that is dedicated to working proactively with the sector to share innovations and support implementation. A feature of the work programme this year will be to establish a Health Initiatives Clearing House to promote innovations within the sector. To achieve this over the longer term, a clear focus on the key long-term enablers will be further developed. Considerable investment has already been made into building a strong and sustainable health sector workforce, but despite these gains there are still areas of need as the balance between workforce supply and demand shifts over time. The clinical workforce must be empowered to contribute their best to system improvement. Long-term productivity and quality gains also depend crucially on improved flows of clinical and operational information between providers. Relevant clinical information should follow the patient wherever possible to facilitate seamless interaction along the patient care journey. DHBs must be networked with high speed connectivity and interoperability to enable the sharing of data and the benefits of telemedicine. Achieving these gains will require a long-term and centrally co-ordinated approach to investment in information and communications systems. Back to top Summary of key priorities Accordingly during the coming year the Minister’s priorities are grouped in three key focus areas. A: Taking public and primary health care to the next level: getting ahead of the chronic disease burden (by investing in wellness and its determinants) driving forward the Primary Health Care Strategy investing in the early years and youth potential caring for older New Zealanders. B: Strengthening health services we can trust: achieving value for money actioning the agenda for quality strengthening regional and national collaboration among DHBs. C: Enabling a strong, sustainable health sector for the longer term: strategically developing the health sector workforce building seamless health information and communication systems optimising capital infrastructure development. Using these three areas to drive further health and independence gains has implications for the roles of Ministry, DHBs and the Minister. For the Ministry: the adoption of a stronger leadership role within the sector and clear accountability for system-wide outcomes an enhanced strategic and analytical capability a model of accountability that enables it to leverage improvements in DHB performance within a devolved model. For DHBs: increased collaborative activity with the Ministry, other DHBs and PHOs, including with shared services and clinical networks at regional level and participation in key initiatives co-ordinated nationally a focus upon working for both their local populations and for the population of the country as a whole. For Health Ministers and the Ministry working together: a team-based approach with Associate Ministers of Health actively liaising with groups of DHBs and overseeing the implementation of key health strategies the Minister overseeing the overall integration of the health strategic framework laid out in this SOI, and leading some cross-cutting projects in areas such as workforce, IT, productivity and funding. Back to top

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