NSTR

Service Planning and New Health Intervention Assessment (SPNIA)

What is SPNIA?

The Service Planning and New Health Intervention Assessment (SPNIA) Framework is a joint institutional framework between District Health Boards (DHBs) and the Ministry of Health to assist DHBs and the Ministry to make health service changes that require a collective decision. It was developed by a joint Ministry of Health, District Health Board (DHB), and DHBNZ working group in and was published in February 2006.

Areas covered

The Framework covers service change at regional and national collaborative decision-making in two related areas:

new health interventions (including a new method of delivering an existing treatment)
service reconfiguration (including the introduction of a new service, cessation of a service, service expansion, quality change or change of providers).

It also seeks to ensure that individual DHBs are not inappropriately compromised by the decisions of other DHBs.

The Framework also provides:

horizon scanning for new interventions, service changes and potential disinvestments (see the Scanning the Horizon newsletter)
a clear format for writing a
- proposal for change
- or a full business case
(see Guidance for information on the format for these documents)
a process for developing and consulting on a case for change
assistance with the analytical support and access to evidence required to develop a credible case for change
clear decision-making steps and responsibilities and assessment criteria
an annual decision cycle linked to the district annual plan round that enables proposals to be prioritised and funding sources identified.

See SPNIA process and Evaluation criteria for more related information.

Referrals

Matters relating to service changes or new health interventions can be referred to the framework through a number of different routes:

the DHB initiating the change (the most common situation)
a DHB (potentially) affected by a service change or new health intervention
a Regional Capital Committee
the National Capital Committee
the DDG-CEO Group
the national CEO group
the Ministry of Health
the Minister of Health
a regional forum or NSTR may choose to initiate consideration of a matter (including a retrospective review of the impacts of a previous service decision).

Referrals to NSTR from DHBs or a regional capital committee must first secure the support of the relevant regional forum.

A Primary Health Organisation, non-governmental organisation, professional agency or other recognised health organisation may bring issues that (potentially) affect more than one DHB to the attention of a DHB. The framework is all-inclusive and, if appropriate, the relevant DHB will refer the issues to the SPNIA framework. A sponsoring DHB is always required – other health organisations cannot access the framework directly.

Mandatory referral

The DHB CEO Group or Ministry of Health’s Executive Leadership Team (ELT), or the Minister, may specifically request NSTR or a regional forum to consider, and make a recommendation, regarding a matter. This means that the Minister have the authority to declare a matter as having regional or national impacts and require a regional or national process. This includes health service changes proposed by the Ministry of Health.

Jurisdiction of the collaborative framework is triggered and is mandatory if a capital investment business case:

has potential health service implications for other DHBs and requires consideration by the National Capital Committee (ie, new lending or equity is required, or it involves capital expenditure over $10 million); such cases must go to the relevant regional forum, which should then report their view to NSTR each February
does not require National Capital Committee consideration, but involves capital expenditure over $1 million and has potential regional service implications; such cases must go to the relevant regional forum.

Groups involved

The Framework draws on existing groups and structures and, where required, identifies new responsibilities, clearer steps, linkages and extra assistance. For example, the Framework creates a clearer role for regional forums, provides assessment and analytical support to the Deputy Director-General and Chief Executive Officer (DDG-CEO) Group via the National Service and Technology Review Subcommittee (NSTR), and improves analytical support and co-ordination of sector proposals via the SPNIA analytical and process support.

See Who's involved? for more related information.

Framework document

More detailed information on the Framework is provided below in Word and PDF format (please note that the document requires updating in some sections):

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Page last updated: 4 November 2008