Download Board update: Rural health strategy

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Report to:
Southern DHB Board
Date of Meeting
3 October 2013
The issues considered in this paper are:
An update for the Board on establishing a programme to deliver a rural health
Specific implications for consideration (financial/workforce/risk/legal etc):
Document previously
submitted to:
Approved by Chief
Executive Officer:
Date: 01/10/13
Prepared by:
Presented by:
Dr Pim Allen
Carole Heatly
Chief Executive Officer
Date: 18.09.2013
1. That the Board note the progress.
Executive Summary
A programme has been initiated as of September 2013 to develop and consult on a rural
health strategy for the Southern DHB to support action planning for continuing clinical
and financial sustainability for the widely dispersed communities of Southland and
Otago. As part of this, the respective contributions of the rural hospital network will be
reviewed and refreshed.
Key to prudent use of public resources for this varied range of individual communities is
a contemporary and detailed understanding of the present population and its current and
projected health needs.
This is timely as the results of the recent census begin to
become available.
The DHB has encountered a degree of misunderstanding in several constituencies in the
past so although relationships have improved significantly in recent months, there are
seen to be significant benefits from an independent analysis of the data.
This is
important because:
There is limited evidence-based scrutiny and documentation of the health needs
of the rural population giving a poor basis for planning and action to meet
community health needs
Sustainability and future-proofing of local health services will require different
models of care and therefore alternative resource allocation arrangements;
changes of this kind are often contentious and a solid health needs analytical
foundation is essential groundwork for informed discussion. Awareness of, and
sensitivity to, over-provision is as important as under-provision for DHB planning
Future changes are likely to require new ways of working, including greater use of
technologies that improve patient access and outcomes and service performance
as well as enabling healthcare personnel to best contribute individual skills and
Accordingly, the DHB has commissioned an independent expert group 1 to undertake a
contemporary health needs analysis (HNA) as the basis for developing the rural health
Health Partners Consulting Group is led by Stephen McKernan, QSO, who will also be
leading this project in collaboration with public medicine specialist Dr Gary Jackson.
Stephen is an extremely experienced executive who has earned a strong international
reputation through operating successfully at the highest levels within the New Zealand
health system. As Director-General of Health for New Zealand, Stephen was the
government’s principal advisor on health and disability matters. He held the key
strategic role in leading the development and the performance of the New Zealand
health system, including responsibility for the allocation and monitoring of the $13 billion
of Vote Health spend.
During this period Stephen represented New Zealand at a number of international fora
including the Executive Board and Program Budget Committee of the World Health
Organisation. He has also represented New Zealand at the annual Commonwealth Fund
Health Partners Consulting
Symposium on Health System Performance, and has been both a chair and moderator at
these prestigious annual events.
Prior to his appointment as Director-General, Stephen was a successful Chief Executive
firstly at Hutt Valley Health and following that at Counties Manukau District Health
Board. His time at Counties Manukau saw him turn a $48 million operating deficit to an
operating surplus inside 2 years. The organisation earned a reputation - and won
numerous national and international awards - for its innovative programs in integrated
and chronic care, prevention and lifestyle change, information technology, and in multiagency work within the health and social sectors.
Dr Gary Jackson has an outstanding reputation for using information to support
evidence-based health care management. Trained in epidemiology, informatics, and
public health, Gary has well developed technical and management expertise to lead the
generation, collection, and analysis of information to support broad system policy,
planning and decision making.
Health Partners Consulting operates across New Zealand and Australia and has
undertaken a number of similar projects in both jurisdictions, resulting in very positive
community reception and providing the commissioning health services with an evidencebased platform for responsible and transparent planning. The project’s fees, while
commercially confidential, have been included in the DHB’s budget.
The resulting written report will give the Board a snapshot of the situation at the time it
is completed, and will also link with past needs assessment work, as well as setting up
the framework for future iterative needs assessment work within the DHB. Importantly,
this will be a collaborative project involving the PHO as well as the DHB’s own analytical
staff to ensure the data extracts set up can be repeated, and templates can be
developed for specific indicators as required.
This will be a useful tool in providing transparency across the Otago and Southland
communities about health needs, and how they inform the clinical service priorities for
the Southern DHB. The HNA report is expected by December, and will be used as the
basis for subsequent work on the rural health strategy, itself informed by the following
More health care will be provided at home, and in community and primary care
Secondary and tertiary services will be provided across DHB boundaries 
Flexible models of care and new technologies will support service delivery in
different environments from those traditionally recognised 
Health professionals will work differently to coordinate a smooth transition for
patients between services and providers 
Clinical networks and multidisciplinary alliances will support the delivery of quality
health services across the health continuum2.
In common with much of the South Island, Southern DHB does not appear likely to
experience overall population gains at the level of the NZ average, so Southern DHB
cannot expect to receive additional demographic funding to help with service
reconfiguration. There are however some traditional population movements within the
district, which if sustained may necessitate service reconfiguration.
The resulting analysis will form the basis of the DHB’s rural health strategy, including
community-tailored action plans that recognise the individual features of the different
communities across the Board and PHO’s span of responsibility.
South Island Regional Health Services Plan 2013-2016 p6
Programme structure and functions
This section describes the structure of the project
Programme Governance Group
Southern rural health
Southern rural action plans by community
Programme support: Q-L Project Manager, Supply Chain Manager, P&F project team
Programme Governance
Key functions of Programme Governance Group include:
Provides leadership for developing regional elective services
Is accountable for the outcomes of the programme
Approves programme changes (if required)
Provides programme oversight and guidance
Provides knowledge and recommendations
Commits DHB resources
Helps identify and remove programme barriers
Identifies risks and issues and assists with mitigation
Membership Programme Governance Group:
The programme governance group comprises:
1. Southern DHB CE (Carole Heatly)
2. Chief Executive, Southern PHO (Ian Macara)
3. Southern DHB Executive Director, Maori Health (Donovan Clarke)
4. Southern DHB Executive Strategy, Integration and Funding (Sharon
5. Southern DHB Executive Director Patient Services (Lexie O’Shea)
6. Southern DHB Executive Director, Nursing and Midwifery (Leanne Samuel)
7. Southern DHB Chief Medical Officer (David Tulloch)
Programme Objectives
Below is the list of key performance indicators for the programme
Programme Outcomes
KPI 1: completed rural health
partnership with the PHO by 21
December 2013
experience and capacity to deliver responsive HNA tool
that will be owned by the DHB and can be updated and
reports customised by the DHB as required
analysed by 1 April 2014
Develop roadshow, using updated results as any further
reletant census details emerge.
KPI 3: in collaboration with
stakeholders develop threeyear rural health strategy
completed by December 2014
Barriers to change and means of addressing these
Complete programme of public rural visits through Otago
and Southland to present findings and listen to
community comments
Detailed explanation of how the strategy links with HNA
Defined metrics for monitoring success in meeting
identified benefits from strategy
Political, community and patient support demonstrated
in sizable measure
Work on the first stage of a comprehensive rural health strategy for Southern DHB is
Pim Allen
Programme Director
18 September 2013