Statement of Intent 2008-11 Operating Intentions: C. Enabling a strong, sustainable health sector for the longer term On this page C1 Strategically developing the health sector workforce C2 Building seamless health information and communication systems C3 Optimising capital infrastructure development Back to Operating Intentions page C1 Strategically developing the health sector workforce What are we seeking to achieve? Workforce issues impact on all of the Minister’s priority areas. The Ministry is leading the sector in the creation of an environment where innovation is able to prosper, resulting in increased recruitment and improved retention of an appropriate health workforce. What will we do to achieve these outcomes? The role of the Ministry in workforce development is to ensure that the policy and regulatory environments support the Government’s strategic objectives, and to provide leadership and support to the sector. The Ministry will in 2008/09 be undertaking a number of linked initiatives that move towards a system-wide infrastructure to support workforce activity at the national, regional and local levels. Increasing the number of workers in the health and disability sector will ensure we can provide future services. Development of the Career Framework (Ministry of Health and DHBNZ Workforce Group 2007). The Career Framework is a medium to long term project to help with the recruitment and retention of the health and disability workforce in New Zealand. The framework for the health sector was launched in October 2007. Work will continue into 2008/09 to develop the framework to include the disability sector. It is intended that the framework will help the disability support workforce and the provision of support services for disabled people by better understanding the current workforce, acknowledging what people currently do, giving workers more status, analysing gaps in the disability workforce, and predicting and planning for the future. Initiate phase two of the Barriers to Workforce Innovation project. The Ministry will this year initiate phase two of the Barriers to Workforce Innovation project. This will involve consulting stakeholders to identify those barriers that are most material and most amenable to central government solutions. The project will have an impact on many health outcomes by enabling service providers to better use workforces to deliver services that meet people’s needs. As 70 percent of health expenditure is on workforce, better, more flexible and more efficient service delivery will mean higher returns. Development of the Maternity Services Strategic Plan. Leadership and support on workforce planning and development will include development of a Maternity Services Strategic Plan to provide better co-ordinated and integrated maternity services. This will support improved health outcomes for women and their children and more streamlined linkages in the continuum of care. The Ministry’s core operating functions also support workforce development. Administration of funding and purchasing of health and disability services is focusing on service development for targeted groups, such as home-based support service workers and needs assessment and service co-ordination, mental health workforce development and clinical training services. Why is this outcome a priority? The health workforce is the sector’s largest resource. It accounts for approximately 70 percent of public health expenditure. The ageing of the population will have a significant impact on the health labour force – not only on demand but also critically on supply. Although New Zealand has always had a significant migrant-derived workforce, the international shortage in skilled health workers is a concern, both currently and over the long term. With fewer workers available, health delivery will need to become less labour intensive through changing work practices, supporting individual care, and the use of technology. We need a different health workforce capable of working in new ways to meet increased demands. How will we demonstrate success? Health is a labour-intensive industry. Achieving the health targets is critically dependent on the quality and distribution of the health workforce, which will be influenced by the Ministry’s key interventions. Table 8 shows how we will measure the Ministry’s contribution to improving the workforce infrastructure. Table 8: Measuring the Ministry’s contribution to improving infrastructure (workforce) Level Indicators/measures Ministry of Health The Ministry, in accordance with agreed measures and standards, will: lead and support workforce planning and development review the Health Practitioners Competence Assurance Act 2003. How will we demonstrate cost-effectiveness The investment in leadership and support on workforce planning and development is designed to support a better strategic alignment of services and increased co-ordination and communication among maternity care services. Taking a joint approach reduces duplication and improves the likelihood of improved efficiencies being achieved. Good workforce planning and an approach that allows for more innovative and flexible deployment of the workforce will result in the more cost-effective delivery of services. Back to top C2 Building seamless health information and communication systems What are we seeking to achieve? Health information is a key input into the provision and administration of effective health services and the development of policies and strategies to improve health outcomes. Improved information systems are integral to supporting this to happen, by: supporting better decision-making and service delivery a more patient-centric approach to health information management providing faster dissemination of best practice through well-developed information systems reducing costs associated with poor decision-making. The vision for the future for ICT in the health system is one of networks, connectivity and sharing of information for community health care. This requires an environment where every health provider is connected through a cohesive sector networking capability. High speed, high capacity broadband is a foundation for this improved connectivity and is fundamental to enabling dependable electronic co-ordination of care between all health care providers and improved efficiency and effectiveness of health care delivery throughout the health system. What will we do to achieve these outcomes? To achieve these improvements in connectivity, the Ministry will work with other government agencies on joint initiatives to drive increased utilisation of existing networks and will support demand aggregation across the state sector to accelerate the deployment of high-speed broadband. The Ministry will support the Digital Strategy’s Common Framework for broadband and build on these principles to establish standards around linking networks and health data transfer. The objective is to establish a national ‘virtual network backbone’ of interlinked networks and link these to local broadband fibre access capability. These local access networks then provide an aggregation point for multiple local health providers to access high speed broadband services. This provides the opportunity to support increased collaboration and the potential for wider access to health applications. The Ministry will develop and promote policies to leverage this improved connectivity and move the focus to patient centric, collaborative clinical sytems. The objectives of these changes will be to enable: improved linkages between primary and secondary care consistent clinical and non-clinical processes supported by availability of consistent data content effective information sharing, cross-referencing and interaction in a standardised and consistent way across different parts of the health system easier implementation of new health initiatives and programmes because they will be built on a foundation of nationally accessible consistent data better value for money through better utilisation of telecommunications investments, shared use of applications and databases and easier integration of diverse applications. The Ministry maintains a large and varied programme of work towards achieving these outcomes. This includes a mixture of ongoing support to the health and disability sector infrastructure, implementation of programmes over a limited time, and advice to the Minister and sector. National Services Development Programme (NSDP) 2008/09 will be the third year of the NSDP’s four-year initiative to deliver improved and sustainable national payment, information and connectivity systems that interact more efficiently in the health and disability sector. The Programme seeks to consolidate, rationalise and optimise a range of core payment, information and connectivity systems. Areas of focus for this year include the following. The Connected Health Programme will continue to address issues within the health and disability sector by delivering a set of national reference standards, linking infrastructure (including a health directory search engine), procurement framework and governance and management structure. The Access and Integration Workstream will deploy the strategic secure portal infrastructure which will support the improved financial reporting project. The Health Statistics and Reporting Workstream will complete the pilot implementation of a new online health information framework that will provide consumers with improved access to health information. The Recipient and Provider Identity Services Workstream will provide a single unique identifier for each recipient, provider, facility, organisation and address, which will be used throughout the health and disability sector. This will contribute to improved electronic information sharing and collaboration. The Health Payments Systems Workstream will deliver improved health-related information and supporting infrastructure, and reduce constraints on information availability and quality. Better quality and more accessible data will help planners and funders to allocate funds to the most valuable areas. Health payments and agreements Payments are made to the sector for a wide variety of claim types and agreements are produced under a national framework, which are used by funders across the sector to contract services. In 2008/09, a National Contact Centre will be provided for the health sector for national health information and payments services. A comprehensive programme of audits and investigations will also be undertaken, to safeguard specified areas of funding to health service providers. Health information policy In 2008/09 the Ministry will provide the Minister with an analysis of the value of a Health Information Act, to provide clarity in the law of the roles, rights and responsibilities of the various parties and stakeholders in health information. Information services to the Ministry and sector New areas of focus for information services to be provided in 2008/09 include: review of the Ministry’s formal statistical publications programme for usefulness and value for money review of the Memorandum of Understanding with DHBs and any necessary improvements to the model used in the sector to govern health information systems will be implemented implementation of a governance framework for the sector-facing Ministry IT to define, capture and measure the value of the electronic services provided to the sector by the Ministry establishment of a Terminology and Classification Centre to co-ordinate the activities neces ary to promote emerging electronic health information, terminologies and standards (eg, input into New Zealand’s adoption of SNOMED CT as the clinical terminology which will enable semantic interoperability in New Zealand) implementation of the plan for NGOs to report to national mental health information system (PRIMHD). All DHB provider arms will be reporting to the national system from end of July 2008, after which the NGO reporting implementation plan will be implemented. Planning for Phase 3 NGO reporting will also be completed, to enable implementation in 2009/10. Why is this outcome a priority? Knowledge underpins improvements in the health system. It is essential that decision-makers (increasingly individuals and community bodies) have access to relevant and timely information to ensure their choices are well informed. Stable, accessible and well developed information systems are a pre requisite for the faster dissemination of best practice information. Improvements in the collection use and management of health information for servicing of Ministers and Ministerial committees is one of the keys to ensuring that the health system is well placed to keep delivering quality services to support the achievement of health outcomes for New Zealanders. In particular the role of information is well recognised as critical to support the management of chronic conditions at affordable levels. How will we demonstrate success? Table 9 shows how we will measure the Ministry’s contribution to improving information systems infrastructure. Table 9: Measuring the Ministry’s contribution to improving infrastructure (information systems) Level Indicators/measures Ministry of Health The Ministry, in accordance with agreed measures and standards, will deliver: National Systems Development Programme information services to the Ministry and sector health information policy health payments and agreements. How will we demonstrate cost-effectiveness? The National Systems Development Programme will demonstrate cost-effectiveness in the following ways: The Connected Health Programme will improve the cost-effectiveness of health care delivery by enabling easier and more efficient information sharing and clinical collaboration. The Access and Integration Workstream will contribute to the Ministry’s cost-effectiveness by improving the effectiveness of infrastructure, applications and processes. It will improve the health sector’s ability to access key national systems, which will result in efficiency and accuracy gains. The sector’s access to information is inefficient and costly. The Health Statistics and Reporting Programme will enhance internal and sector productivity, freeing up resources and enhancing the cost efficiency of information accessed. The Recipient and Provider Identity Services Workstream will return long-term benefits to the sector that arise from staff needing less time to access and use identity data. This workstream will also reduce the risk of an unplanned and lengthy National Health Index systems outage. The Health Payments Systems Workstream investment will deliver substantial cost improvements for the sector and the Ministry by reducing current administration and compliance costs. Revitalised systems will enhance the prevention of fraud and over/under payments. Investment decisions will be presented with a supporting return on investment analysis to ensure public funds are best utilised. Improvements in the national health information collections will enable the Ministry, DHBs and other organisations to undertake more accurate and timely, administration processes. A feasibility study conducted in 2005 found that it was more cost effective for service providers to report one integrated data set than continue to collect and report two. Audit and investigation risk management of payment services will ensure money is used for its intended purpose. Using internationally accepted calculations, the effects of audit and investigation programmes have stopped, deterred and recovered funds at a level greater than the cost of operating the programmes, in every year of operation so far. The ongoing provision of health information for developing policy will identify opportunities to improve the value of health information to support improvements in the provision and administration of health services and the management of the health system. Back to top C3 Optimising capital infrastructure development What are we seeking to achieve? Modern health care systems require capital investment which enables the system to operate safely and effectively and support new models of care. Following a period of under-investment in capital, there has been $2 billion of major capital investment since 1998 to maintain and enhance the capital infrastructure of DHBs. However, the sector faces ongoing capital pressures in the Auckland region in particular. The Ministry needs to ensure cost-effective and safe provision of health and disability services through the alignment of capital investment with national, regional, and local service priorities and new models of care. What will we do to achieve this outcome? To achieve greater cost-effectiveness and safe service provision through capital investment and service planning alignment, the Ministry will further strengthen current prioritisation processes and the link between service planning and capital investment. This will include updating the 2003 Capital Investment Guidelines, including extending the principles of this policy to the Ministry, strengthening the Service Planning and New Health Interventions Assessment framework, supporting improved DHB asset management practices via the National Asset Management Improvement Program, updating the National Capital Plan, supporting development of regional asset management plans, continuing work on the Long Term Systems Framework, and implementing wider government capital management processes. The potential for capital investment policy to improve primary health care services will also be investigated. The Ministry will also continue to collaborate with the Australian states on areas where joint activity is the most cost effective way to fund large and complex on-going activities, for example keeping current the Australasian Health Facility Guidelines. This is undertaken by the Centre for Health Assets Australasia at the University of New South Wales. The Ministry will continue to support the sanitary works subsidy scheme and progress implementation of re-oriented child and adolescent oral health services. Why is this outcome a priority? Demographic growth is increasing beyond the current physical capacity of some health facilities, particularly in the Auckland region. Additionally, changing demographic profiles, for example, ageing populations, and new models of care require the constant reassessment of capital needs and the ability of assets to support modern models of care. For example, development of community oral health services and team-based care mean that larger facilities, new locations and greater mobility are required for our oral health assets. Improved asset management planning and a national asset management plan, informed by a sector-wide view of service priorities, will further improve the ability of the health asset base to support quality and safe services. As well as major building programmes, investing in improving IT infrastructure, data collection capability, and information on current and future asset bases are all necessary to support improved service planning, development of new models of care and sound decision-making. Changes to the Building Act in 2004 have also placed pressure on health’s capital investment. These changes have caused several existing facilities to be classified as non-compliant earthquake-prone buildings resulting in the need to hasten replacement of some buildings if they do not meet current service needs rather than simply upgrading them. How will we demonstrate success? Table 10: Measuring our progress in achieving cost-effective and safe capital investment Level Indicators/measures Health and disability sector Collaborative input via the National Capital Committee (NCC) and national asset management improvement program into strengthening capital investment decision-making that supports with national, regional, and local service needs. Successful development and implementation of approved business cases. Well informed DHB and regional asset management plans. Ministry of Health The following initiatives delivered in accordance with agreed measures and standards: update of the 2003 Assets and capital strategic framework (Capital Investment Guidelines) including extending the principles of this policy to the Ministry of Health joint leadership (with DHBs) of the National Asset Management Improvement Programme Service Planning and New Health Interventions Assessment strengthened development of National Capital Plan capital investment informed by service planning models as developed in the Long-Term Systems Framework and DHB and regional health service plans that are required for major capital approvals development of a Long-Term Capital Profile effective implementation of Treasury's Capital and AssetManagement initiative collaboration with Australian states to keep current the Australasian Health Facility Guidelines facilitated by the University of New South Wales support sanitary works subsidy scheme progress implementation of re-oriented child and adolescent oral health services. How will we demonstrate cost-effectiveness? Demand for capital investment commonly exceeds the resources available and the Ministry has developed a robust prioritisation process to underpin its advice to Ministers. The prioritisation process is led by the National Capital Committee (NCC) and emphasises cost-effectiveness, regional collaboration, enablement of modern models of care and health gain. The NCC comprises DHB and Ministry representatives, with attendance by Crown Health Financing Authority officials. It assesses and prioritises DHB capital investment proposals. The NCC considers DHB capital investment proposals through a three stage business case process consisting of a strategic stage, options analysis stage, and final business case stage. During the process expert advice is provided to DHBs and the Ministry and prior to receipt of a final business case two independent review are undertaken. Through this process affordability (at both the DHB and national capital budget level), regional and national resource implications, and clinical sustainability of proposed capital investments are considered. Health capital investment is also informed by the Crown Financing Health Authority and soon by new wider government capital management processes such as Treasury’s Capital Asset Management framework and the State Services Commission’s Gateway programme. Figure 5: Service and capital planning linkages View this figure at full size and text description. Back to top

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