Annual Report for the year ended 30 June 2003

Annual Report for the year ended 30 June 2003
Director-General’s Report

Date of Publication: October 2003

ISBN 0-478-25824-0 (Book)
ISBN 0-478-25825-9 (Internet)
HP 3705

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I am pleased to present the Annual Report for the year ended 30 June 2003. I continue to be impressed with the efforts and achievements of Ministry staff, District Health Boards (DHBs) and the wider sector. This section of the Annual Report provides me with the opportunity to highlight some of our achievements over the past financial year.

Severe Acute Respiratory Syndrome (SARS)

Normally the Ministry of Health reports against pre-set expectations, but when an unexpected major threat to health occurs it is important that we assess our response. The World Health Organization (WHO) reports that the total cumulative number of cases of SARS from 1 November 2002 to 19 June 2003 is 8465. The areas most affected by SARS were China (including Hong Kong) and Taiwan, accounting for over 90 percent of cases. New Zealand has reported one probable case. Subsequent blood testing was negative.

The New Zealand Government declared SARS a legally notifiable disease under the Health Act 1956 on 1 April 2003. The New Zealand response was initiated utilising the Influenza Pandemic Plan and advice from the Influenza Pandemic Planning Committee, supported at the local level by corresponding action utilising existing regional plans. Advice from the WHO, and from the Ministry of Health’s technical and health professional advisory groups and networks, informed the New Zealand response. The latter include the independent SARS Technical Advisory Group (STAG). The response had several critical components:

information
border control
intersectoral action
symptom and suspect identification
isolation and treatment.

The Ministry of Health provided SARS information through an 0800 number and on its website, which is used by the public, health professionals and other agencies for their policy and programme development. Nurses were stationed at all international airports. Health professionals were provided with an extensive array of guidelines to enable them to identify potential cases, trace contacts, implement infection control procedures, and provide appropriate management. These guidelines were regularly updated to reflect the changing epidemiology of SARS and the increasing knowledge base.

Early self-identification of people with symptoms suggestive of SARS was achieved by providing good information for incoming travellers and good information for settings (eg, polytechnics) that host larger numbers of visitors from affected areas.

The Ministry was supported by other government departments, most notably Department of Prime Minister and Cabinet, Ministry of Foreign Affairs and Trade, Customs and Immigration, and by the Officials Committee for Domestic and External Security process which enabled coordination of the chief executives of the key agencies involved in the challenge of managing New Zealand’s response to this emergency. The Officials Committee for Domestic and External Security also provided a forum where joint actions could be identified and managed.

Disability support services: devolution of services for older people

The Disability Services Directorate of the Ministry of Health is currently preparing for the devolution of contracts and funding of services for people aged 65 and over to DHBs from 1 October 2003. The objective is to encourage better integration of services for older people and for DHBs to develop relationships with community-based support services. DHBs will need to demonstrate that they can meet the needs of older people in their communities and that they have robust reporting and monitoring systems in place.

Preparation for this change has required intensive work to ensure the transition will achieve its aim of improving care for older people.

Population-based funding formula

On 2 December 2002 Cabinet agreed that population-based funding for DHBs will occur from 1 July 2003. The aim of population-based funding is to distribute fairly the available funding between DHBs according to the relative needs of their populations and the cost of health and disability support services to meet those needs. Each DHB’s share of health and disability funding will be determined by its share of the cost-weighted New Zealand population, together with a limited set of adjustments that will redistribute funding between DHBs. Population-based funding covers all personal health, mental health, Ma¯ori health, and other services devolved from the Ministry of Health to the DHBs. Excluded from population-based funding are the national screening programme, national public health services, disability support services, and a small number of national mental health and public health contracts.

Those disability services planned for devolvement in 2003/04 will be funded outside population-based funding, but will be included for 2004/05.

Primary Health Organisations

The Primary Health Care Strategy, launched in early 2001, has provided a clear direction for the future development of the primary health care sector. Key components of the vision include a greater emphasis on population health and the role of the community, health promotion and preventive care. The aims of the strategy are being achieved through the establishment of Primary Health Organisations (PHOs), with services organised around the needs of defined groups of people. The objective is to get in front of ill health and to better manage chronic disease processes, such as diabetes. As at 30 June 34 PHOs have been established covering a population of approximately 1.1 million New Zealanders. On 1 July 2003 a further 13 PHOs will be established, covering an additional population of around 600,000 people.

General practitioners (GPs) and nurses are the backbone of personal and primary health care, and PHO development allows for a diverse range of professionals to take a key role in delivering primary care services. Some services to improve access are led by primary care nurses and community nurses with input from other health providers, and in collaboration with organisations such as schools, marae and community groups. Funding for PHOs to deliver services to improve access constitutes a significant opportunity for PHOs to deliver services in innovative ways to those populations that have been missing out.

Examples of services to improve access being delivered by PHOs include:

schemes to provide transport options to people who have difficulty getting to their PHO’s health services
projects to better manage diabetes and respiratory conditions in the community
outreach screening initiatives
marae- or school-based clinics
home visits for patients who are terminally ill
mobile primary health care clinics
additional Māori primary health care nursing and general practitioner services
cultural competency training for primary health care providers.

It is estimated that the level of savings per person per year for a patient enrolled with an access-funded PHO is:

under six – $0
age 16 to 17 years – $35
age 18 to 64 years – $50
age 65 plus – $85.

This constitutes an average saving of $45.

Interim PHOs have been established in areas where the populations do not demonstrate the same high levels of health need as those targeted through access PHOs. Interim PHOs do not yet receive the same level of funding as access PHOs. The Community Services Card status of patients is used both to determine funding levels and to set patient fees. However, additional funding is available to all PHOs, including interim PHOs, to provide a range of new functions such as health promotion and services to improve access. Over time, as further funding becomes available, the difference between the two funding formulas will diminish and low-cost access will be available to all New Zealanders.

A copy of the Primary Health Care Strategy and other information on the Strategy and PHOs can be downloaded from the Ministry’s website (www.moh.govt.nz/primaryhealthcare).

Meningococcal vaccine

The meningococcal epidemic continued at high levels into its 12th year, with the number of total reported cases now exceeding 5000, including over 200 deaths. Public and media awareness remains heightened, particularly as a result of recent deaths. In 2002/03 there was rapid progress in the planning and operation of the clinical trials of the Chiron produced strain specific group B meningococcal vaccine, MeNZBTM, in preparation for an immunisation campaign targeting all under-20-year-olds.

The phase I clinical trial in healthy adults and phase II clinical trials in 8–12-year-olds and toddlers have been successfully completed. Clinical trials are under way in the older infant age group. Results of the clinical trials continue to be positive. Trials will continue in other age groups over the next 12 months.

Planning for the mass immunisation campaign has intensified over the last 12 months. A close working relationship with Counties Manukau DHB has been formed to assist with planning for the pilot roll-out. National workforce development is also being planned to support the delivery of the vaccine to all under-20-year-olds nationally. A communications strategy has been completed, tenders for an external advertising agency are being prepared, national guidelines for service delivery are being finalised, and engagement with key stakeholders continues. Both hospital-based safety monitoring and GP-based safety monitoring systems have been piloted to support the roll-out of the vaccine.

WAVE implementation

In October 2001 the Ministry published From Strategy to Reality: The WAVE Project. The objective of the WAVE (Working to Add Value through E-information) programme was to produce an information and technology plan for the health and disability sector with the aim of improving health outcomes through the effective use of information, at the least cost. The Ministry has made considerable progress with implementing the recommendations of this report, such as:

the establishment of the New Zealand Health Information Standards Organisation to determine sector information management/information technology standards)
the development of a draft Sector Information Management Standards Plan
commencement of work to improve the National Health Index
the development of a portal to provide DHBs with access information on contracts and agreements and to national information systems
commencement of work with DHBs to develop a sector-wide framework for the management of information.

Further information on these and other initiatives may be found later in this document in the ‘Report Against Outcomes’ and in the section on ‘Ministry of Health Capability and Capacity’.

Information Systems Strategic Plan for the Ministry

Ministry capability and capacity were advanced during the year and an Information Systems Strategic Plan was completed in 2003. The main business themes, which emerged during the preparation of the Plan, were:

flexibility and mobility
better use of tools
tools and capability for information sharing and collaboration
partnership in developing and delivering information systems and solutions
improving how we manage knowledge
helping to improve what we do
improving decision-making and advice through information derived from good data.

Five separate but inter-related work streams supported the Plan:

Web Strategy
National Applications Strategy
Data and Information Strategy
Ministry Systems and Infrastructure Strategy
Service Delivery and Capability Framework.

Deliverables have been identified in each of these work streams and these will be implemented over the next three years.

Outcome framework

The Ministry’s 2002/03 Statement of Intent introduced an outcome framework to help clarify the Ministry’s contribution to the goal of healthy New Zealanders and to guide future activities. The framework was designed to show how the Ministry influences the health and disability support system and how we use this influence. This framework was an important first step to moving from an input/output-based accountability system to one based on measuring ourselves against predetermined outcomes. The framework articulated five objectives for the health and disability sector and six outcomes for the Ministry of Health. These objectives and outcomes were originally intended to have a three- to five-year life span, but over 2002/03 the Ministry more clearly articulated its desired outcomes and a new outcome framework was developed. Information on the new outcome framework may be found in the Ministry’s 2003/04 Statement of Intent.

The 2002/03 outcome framework informed the development of the new outcome and intervention logic framework, and most of the elements of the key outcomes have been included in the new framework, along with performance measures. A report on the Ministry’s progress against the 2002/03 framework may be found in pages 15 to 43 of this report.

The above overview highlights some of the work that contributes to the Ministry’s aim of ensuring that the health and disability support system works for New Zealanders.

Karen O Poutasi (Dr)
Director-General of Health

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