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2015/16 Planning Priorities for Annual Plans and Regional Service Plans This document contains detailed guidance on the expectations for each planning priority. The DHB Planning Priorities are provided to assist district health board (DHB) and Shared Service Agency staff to meet Ministerial expectations. Amendments to the Planning Priorities Document Page Description 5-6 Hepatitis C as a new Planning Initiative - Guidance is provided to the regions on regional hepatitis c service delivery in 2015/16. 6 Clinical Leadership as an Emerging Priority - DHBs are asked to include clear information in their plans on activities they are undertaking to foster clinical leadership. 27-28 Cardiac Services - Standardised intervention rates are provided in the measures sections. 30 Health of Older People Removal of an AP measure (Evidence of DHB using interRAI measures to progress and compare performance with other DHBs). March 2015 Table of Contents Planning Guidelines ...................................................................................................................................................................... 3 Overview of Planning Priorities ................................................................................................................................................... 3 Interpreting the Guidance .................................................................................................................................................................... 5 Emerging Priorities ............................................................................................................................................................................... 6 New Priorities for 2015/16 ................................................................................................................................................................... 6 Structure of the Templates .................................................................................................................................................................. 8 2015/16 Planning Priorities for APs Only ................................................................................................................................. 10 Increased Immunisation .................................................................................................................................................................... 10 Reduced Incidence of Rheumatic Fever ......................................................................................................................................... 10 Children’s Action Plan ........................................................................................................................................................................ 11 Whānau Ora ........................................................................................................................................................................................ 11 Prime Minister’s Youth Mental Health Project ................................................................................................................................ 12 Social Sector Trials ............................................................................................................................................................................ 13 Healthy Families NZ ........................................................................................................................................................................... 13 More Heart and Diabetes Checks .................................................................................................................................................... 14 Diabetes Care Improvement Packages........................................................................................................................................... 14 Long-term Conditions......................................................................................................................................................................... 15 Shorter Stays in Emergency Departments ..................................................................................................................................... 15 Better Help for Smokers to Quit ....................................................................................................................................................... 16 Improved Access to Diagnostics ...................................................................................................................................................... 17 Cancer Services / Faster Cancer Treatment .................................................................................................................................. 18 System Integration ............................................................................................................................................................................. 19 Primary Care ....................................................................................................................................................................................... 20 Maternal and Child Health ................................................................................................................................................................. 20 Spinal Cord Impairment Action Plan ................................................................................................................................................ 21 National Entity Priority Initiatives ...................................................................................................................................................... 21 Improving Quality................................................................................................................................................................................ 21 Actions to Support Delivery of Regional Priorities ......................................................................................................................... 21 Living Within our Means .................................................................................................................................................................... 22 2015/16 Planning Priorities Included in Both RSPs and APs ............................................................................................... 23 Electives (RSPs) & Improved Access to Elective Surgery (APs) ................................................................................................ 24 Stroke (RSPs) & Stroke Services (APs) .......................................................................................................................................... 25 Cardiac Services (RSPs & APs)....................................................................................................................................................... 27 Health of Older People (RSPs & APs)............................................................................................................................................. 29 Mental Health and Addictions (RSPs) & Rising to the Challenge (APs)..................................................................................... 30 2015/16 Planning Priorities for RSPs Only .............................................................................................................................. 32 Major Trauma ...................................................................................................................................................................................... 32 Workforce ............................................................................................................................................................................................ 32 Information Technology (IT) .............................................................................................................................................................. 35 Appendix One – Detail of Changes to the Tobacco Target ................................................................................................... 37 2 Planning Guidelines As in previous years, the 2015/16 Planning Guidelines include guidance for Annual Plans (APs), Regional Services Plans (RSPs), Māori Health Plans (MHPs) and Public Health Unit Annual Plans (PHUAPs). This year, guidelines were also published for Regional Capital Plans (RCPs). The planning priorities guidance for DHB APs and RSPs was not included in the general guidance for these two plans, but is being presented in this document only in order to encourage greater alignment between the two documents, and to encourage the integration of services at the regional and DHB levels. For further information regarding the AP and RSP guidelines or this planning priorities guidance please contact: Stasha Mason National Health Board Ministry of Health Wellington 6145 [email protected] (04) 496 2265. Overview of Planning Priorities The planning priorities for 2015/16 are generally a continuation of those for 2014/15. In line with the Minister’s requirement for increased fostering of clinical leadership in 2015/16, it is expected that DHBs keep in mind how clinical leadership can be used to support delivery of the planning priorities when developing their plans. DHBs are also expected to provide evidence that the Alliance Leadership Team jointly developed and agreed those sections of the plan with a primary care or integration focus. This includes the following sections of the plan: Shorter Stays in Emergency Departments Increased Immunisation Better Help for Smokers to Quit More Heart and Diabetes Checks Children’s Action Plan Prime Minister’s Youth Mental Health Project Social Sector Trials Diabetes Care Improvement Packages Long-term Conditions Stroke Cardiac Services (primary care aspects) System Integration (including IPIF) Primary Care Rising to the Challenge Maternal and Child Health. Annual Plan Priorities Health Targets Shorter Stays in Emergency Departments Improved Access to Elective Surgery Faster Cancer Treatment Increased Immunisation Better Help for Smokers to Quit More Heart and Diabetes Checks 3 Government Priorities Better Public Services (including Social Sector Trials): Reducing Rheumatic Fever Children’s Action Plan Whānau Ora Prime Minister’s Youth Mental Health Project1 Social Sector Trials System Integration: Diabetes Care Improvement Packages Long Term Conditions Stroke Cardiac Services Improved Access to Diagnostics System Integration Primary Care Health of Older People Rising to the Challenge Maternal and Child Health Cancer Services Healthy Families NZ Spinal Cord Impairment Action Plan Other National Entity Priority Initiatives Improving Quality Actions to Support Delivery of Regional Priorities Living Within Our Means Regional Service Plan Priorities Elective Services Cardiac Services Mental Health and Addictions Stroke Services Health of Older People Major Trauma Information Technology Workforce DHBs are expected to include actions/milestones/budget allocation/measures that will contribute to the achievement of regional objectives in their APs. Cancer Services is not included as a planning priority for RSPs in 2015/16. However, guidance was given in the RSP guidelines to include actions to support cancer services in the network section of the RSPs. 1 Where Social Sector Trials are operating locally, DHBs are expected to work with local Trial Leads for the actions identified to improve the responsiveness of primary care to youth, increase school-based health services and improve access to mental health and youth AOD services. 4 Interpreting the Guidance For all priority areas (eg, Improved Access to Diagnostics), and sub-area of focus within the priority area (eg, Colonoscopy/Endoscopy) in the guidance tables below, each DHB must: briefly describe its key objectives/key planning approaches to deliver on the area of focus provide specific and tangible actions to improve performance in the area of focus, some of which must be delivered in the 2015/16 year provide specific and measureable deliverables (measures and outputs with quantifiable performance expectations). It is expected baselines will be included for all measures. Some performance measures will be specified as expected by the Ministry where nationally consistent monitoring and reporting is required provide milestones/dates of delivery (aligned with quarterly reporting timeframes) for all deliverables present an intervention logic linking the DHB’s planning approach, actions and deliverables, within the priority area to high-level outcomes. New Planning Initiative (for RSPs) Hepatitis C (South Island and Northern regions) In 2015/16 the Ministry will be working with these regions to develop regional hepatitis c services. It is expected that South Island and Northern regions make a commitment in their Regional Service Plans to work with the Ministry on the development of this service in 2015/16. The RSP should also include a commitment to developing a plan for implementation of the service. The implementation plan the region develops will focus on how it will deliver identification and treatment services for people at risk of or with hep C. At a minimum this will include: recruitment (or identification) of a hep C clinical specialist (nurse) to provide oversight of the services, support to other clinicians and undertake clinical care as indicated consideration of how DHBs will provide Fibroscanning as part of triage for their region adopting/adjusting pilot clinical pathway for hep C to suit their region’s needs. It is expected that the services will commence by 1 April 2016. The Ministry is currently contacting key stakeholders to begin discussions regarding staff training, continuing awareness and community liaison, and further advice will be provided as soon as possible. Hepatitis C (Midland and Central regions) In 2015/16 the Ministry will be working with these regions to deliver a hepatitis c service to ensure continuity of care for those patients currently in the pilots sites (Bay of Plenty, Capital & Coast and Hutt Valley DHBs). It is expected that Midland and Central regions make a commitment in their Regional Service Plans to work with the Ministry to transition these pilots to a regional service. The RSP should also include a commitment to developing a plan for transitioning the service. It is expected that the current hepatitis C clinical services delivered in the three pilot DHBs will be delivered from 1 July 2015, and then rolled-out to the rest of the region by 1 April 2016. The transition plan should focus on continuity of services for those DHBs that are currently pilot sites. The transition plan should include: consideration of options to transition current hep C clinical staff to provide oversight of the services, support other clinicians and undertake clinical care to a regional service consideration of how to provide Fibro scanning as part of diagnosis and triage for the pilot sites and then out to a regional service adopting/adjusting pilot clinical pathway for hep C to suit their region’s needs. 5 It is expected that the regional delivery of the service in the pilot sites will begin from 1 July 2015 and will be rolled out to the rest of the region by 1 April 2016. The Ministry is currently contacting key stakeholders to begin discussions regarding staff training, continuing awareness and community liaison, and further advice will be provided as soon as possible. Emerging Priorities Obesity The Minister’s Letter of Expectations to DHB Chairs mentioned that the Ministry is currently doing a stocktake of what works to reduce obesity, and asked all DHBs to consider what they can do to help reduce the incidence of obesity. Therefore, DHB’s annual plans for 2015/16 should outline: the three activities/initiatives/programmes/actions the DHB is undertaking in 2015/16 that it considers will have the most significant impact on reducing the incidence of obesity how, if at all, the effectiveness of these activities/initiatives etc are being measured. Clinical Leadership The Minister's Letter of Expectations to DHB Chairs in December 29015 noted that DHBs are ‘expected to include clear detail in their annual plans for 2015/16 that shows how they will foster clinical leadership’. The Ministry will be performing a stocktake of the information that DHBs include in their plans to provide advice to the Minister and the sector about DHBs’ clinical leadership activities. Therefore, DHBs are strongly encouraged to ensure annual plans for 2015/16 clearly outline what clinical leadership currently looks like within the DHB and any new activities the DHB plans to undertake to strengthen clinical leadership in 2015/16. New Priorities for 2015/16 Social Sector Trials In August 2014 Ministers agreed in principle to the first six Social Sector Trials (in Waitomo, Kawerau, South Waikato, Taumarunui, Horowhenua and Gore) becoming permanent, and the second group of 10 Trials being extended for two years, from 1 July 2015. Transition planning for the first six Trials needs to be approved by Cabinet's Social Policy Committee, now due for February, and funding for all 16 Trials has to go through Budget 2015, to complete the process. The Trials, with the exception of Porirua and Rotorua, are focused on improving outcomes for young people, specifically by lowering youth crime, alcohol and drug consumption and truancy, and by increasing engagement with education and employment. Porirua is focused on lowering ED attendances and avoidable admissions, and Rotorua on wider educational outcomes. This leads them to address a wide range of causal factors resulting in these outcomes. The six Trials have become imbedded in their towns and the Ministers are looking for much greater emphasis on the Trial lead as the director of collective action, and for agencies to focus more on strengthening Trials' ability to influence funding and planning and design and delivery of services relevant to their outcomes. Trial Leads will be expected to establish three-year action plans and social development, health, education, police and justice are expected to enable this. The 10 extended Trials (Kaikohe, Ranui, Waikato, Rotorua, Whakatane, Gisborne, South Taranaki, Wairarapa, Porirua, South Dunedin) will be establishing two-year action plans. The Minister of Health’s letter of expectation to DHB Chairs notes the Government priority to reduce the number of children living in material hardship and includes Social Sector Trials as one of those cross-agency initiatives that he expects DHBs to work with in order to deliver outcomes for children across a wide range of dimensions – health, education, social and justice. The Trials offer DHBs the opportunity for a locally6 integrated approach with other agencies to address issues with the most vulnerable populations in specific communities. System Integration (includes Shifting Services into the Community and IPIF) The Minister’s letter of expectations includes expectations for DHBs to shift services into the community. DHBs will need to commit to shifting specific services into the community in 2015/16 (eg mental health diagnostic services, minor surgeries, diabetes management and/or other appropriate services). The Integrated Performance and Incentive Framework (IPIF) is being developed with DHBs, primary health organisations (PHOs), general practices and patients as a core mechanism to lift performance, improve clinical integration and improve quality in the primary health care sector over the next three to five years. Local Alliances across key providers and DHBs underpin the IPIF, so the maturity of these local relationships is crucial to effective implementation of the framework. DHBs are expected to develop work plans with their alliance partners. The sector will be required to progressively implement identified system performance measures from 2015/16. The System Performance Measures for 2015/16 are: Capacity and Capability Healthy Start Healthy Ageing Patient Experience. Healthy Families NZ Healthy Families NZ is a new initiative that aims to improve people’s health where they live, learn, work and play in order to prevent chronic disease. Encouraging families to live healthy lives (by making good food choices, being physically active, sustaining a healthy weight, being smokefree and drinking alcohol only in moderation) is part of the Government’s approach to promoting good health. The most visible aspect of Healthy Families NZ is the establishment of 10 Healthy Families communities across New Zealand. At each location, a locally-based lead provider is responsible for bringing together a partnership of key organisations in the community, and establishing a dedicated health promotion workforce in each community selected to participate in the initiative. The health promotion workforce will work across schools, early childhood education centres, workplaces, and other community settings, such as sports clubs. All DHB Board Chairs were sent a letter in April 2014 from the previous Minister of Health, Hon Tony Ryall, asking DHBs for ongoing support of the initiative. DHBs are expected to support the local initiative in their community if there is a Healthy Families NZ community within their district. Therefore, Healthy Families NZ is included as a new planning priority for 2015/16. Spinal Cord Impairment Action Plan The Spinal Cord Impairment (SCI) Action Plan was developed in consultation with DHBs and aims to deliver better services in a timely manner across the SCI continuum (acute care through to living in the community) for people of all ages with acquired or congenital SCI causing significant impairment. The Action Plan is designed to enable people with a SCI and their families/whanau to achieve better outcomes and support them to remain well and live as independently as possible in their community. All DHB Chairs were sent a letter in June 2014 from the previous Ministers of Health, Hon Tony Ryall, and ACC, Hon Judith Collins, asking for support of the implementation of the Action Plan. Therefore, the Spinal Cord Impairment Action Plan has been included as a new planning priority for 2015/16 7 Structure of the Templates The detailed guidance in the templates covers all Government planning priorities. The priorities have been clustered within the templates to ensure the best alignment between APs and RSPs. However, DHBs should note that the priorities for APs do fall into three broad categories that may represent a better ordering of priorities in the APs. To better reflect the Government’s Better Public Service targets and requirement for increased system integration, DHBs could group the priorities in the following way. Better Public Services Objectives: A system that provides Better Public Services is one that has: decreasing incidence of rheumatic fever more responsive mental health services for youth fully immunised children early identification and support for vulnerable children. System Integration Objectives: A health system that is well integrated provides a sustainable system where people receive services from the right person, at the right time and in the right place. The Government’s health policy, ‘Better, Sooner, More Convenient’, sets out the vision for an integrated health system with patients at the centre, where care is delivered closer to home by trusted, motivated health professionals working together in an effective and efficient manner. Other Objectives: To deliver on all Government planning priorities. All parts of the system are to jointly develop and implement services in high priority areas. Increased Immunisation Health Target Reducing Rheumatic Fever Children’s Action Plan More Heart and Diabetes Checks Health Target Diabetes Care Improvement Packages Long Term Conditions Whānau Ora Prime Minister’s Youth Mental Health Project Social Sector Trials Stroke Cardiac Services National Entity Priority Initiatives (including Health Benefits Limited) Improving Quality Actions to Support Delivery of Regional Priorities Living Within Our Means Shorter Stays in Emergency Department Health Target Better Help for Smokers to Quit Health Target Improved Access to Elective Surgery Health target Improved Access to Diagnostic Cancer Services/Faster Cancer Treatment System Integration Primary Care Health of Older People Rising to the Challenge Maternal and Child Health Healthy Families NZ Spinal Cord Impairment Action plan DHBs should situate their actions, milestones and measures to meet the objectives of an initiative in the Better Public Services and System Integration sections in the context of the integration story. 8 The Integration Story Demands on health services are increasing within a tight financial environment. An ageing population, longterm conditions and the needs of vulnerable populations are placing greater pressures on the health system. These pressures mean we need to explore new and different models of care and increase our focus on how to bend the acute demand curve including early intervention and integrated services focused on the patient and provided closer to home. Integrating health services to ensure a more co-ordinated and closer to home service provides an opportunity to develop a more efficient and sustainable health system. Integrating services through the use of alliancing principles will also support the implementation of the Government’s Better Public Service targets. This involves: effective use of data to inform new models of care that eases the pressure on hospitals joint development of the new models of care improving quality through efficiency and effectiveness ensuring sufficient change management capability to undertake this development, and its implementation effective clinical leadership. System Integration Context DHBs are expected to use the Alliance Leadership Team (ALT) and any Service Level Alliance Teams to jointly develop the 2015/16 Annual Plan with their primary care partners to strengthen clinical integration. DHBs are expected to outline how they will achieve increased primary/secondary integration during 2015/16, describing quarterly milestones to measure progress. As ALTs mature DHBs will be expected to incorporate a broader range of service development involving the appropriate stakeholders within the ALTs. In the 2015/16 year DHBs are expected to develop an alliancing arrangement that follows the principles of partnership and joint service development and implementation with appropriate stakeholders for More Heart and Diabetes Checks, Long-term Conditions, Diabetes Care Improvement Packages, pre-hospital activity to meet the Shorter Stays in Emergency Department Health Target – Primary Care component, Better Help for Smokers to Quit – Primary Care component, Whānau Ora services, Rising to the Challenge, Health of Older People and Maternal and Child Health. Refer to the Alliance Charter for a description of the principle of partnership that must underpin any service development. 9 2015/16 Planning Priorities for APs Only Increased Immunisation Actions to support maintaining infant immunisation rates (six weeks, three months and five months immunisation events) at 95 percent until 2017: o maintain an immunisation alliance steering group that includes all the relevant stakeholders for the DHB’s immunisation services including the Public Health Unit; that identifies service delivery gaps, participates in regional and national forums and takes the lead on monitoring and evaluating immunisation coverage at DHB, PHO and practice level o identify immunisation status of children presenting at hospital and refer for immunisation if not up to date o in collaboration with NGOs and government agencies, describe how the DHB is working across agencies to increase immunisation coverage. Actions to support increasing children’s immunisation rates (for two years and five years) to 95 percent: o include, monitor and increase the four-year-old milestone as part of the immunisation alliance steering group outputs. Actions to support increasing HPV (12-year-old) immunisation rates to support the cancer strategy goal of reducing the incidence of cancer through primary prevention: o use on-line learning tool to promote knowledge benefits of the programme. Measures Increasing immunisation rates – narrative report on DHB and interagency activities to promote immunisation week (expected early 2016). 95% of eight-month-olds and two-year-olds are fully immunised. 90% of four-year-olds are fully immunised by age 5 by June 2016. Reduced Incidence of Rheumatic Fever Meet 2015/16 targets for first episode rheumatic fever hospitalisations. Review and update DHB Rheumatic Fever Prevention Plans. Undertake a root cause analysis of every rheumatic fever case and identify systems failures. Measures Meeting the set targets for first episode rheumatic fever hospitalisations for 2015/16. Delivery of updated rheumatic fever prevention plans to the Ministry in Q1 reporting. Guidance will be provided by the Ministry by May 2015 on areas which updated plans should focus on. Provide a report on the lessons learned and actions taken following the root cause analysis to the Ministry each quarter. A reporting template will be provided by the Ministry. The 2015/16 targets for each DHB are included in the following table. DHB Northland Waitemata Auckland Counties Manukau Northern region Waikato Lakes Bay of Plenty Tairawhiti Taranaki Midland region Hawke’s Bay MidCentral Whanganui Capital and Coast Hutt Wairarapa Central region Southern region New Zealand 2015/16 Target: 55% reduction from baseline level (2009/10– 2011/12) Rate Numbers 4.7 8 1.0 6 1.4 7 5.9 32 3.0 52 1.6 6 3.5 4 1.7 4 4.2 2 0.4 0 1.8 16 1.9 3 1.0 2 1.4 1 1.3 4 2.2 3 0.0 0 1.5 13 0.2 2 1.8 83 10 Children’s Action Plan The Vulnerable Children Act (VCA): as outlined in the workforce section of the AP Guidelines document, DHBs need to ensure they are meeting the requirements of the VCA. Please provide a link (ie, reference page numbers) in the CAP section of your plan to the detailed actions the DHB is taking to meet the requirements of the ACT. Reducing the number of assaults on children DHBs to maintain and evaluate VIP programmes DHBs to maintain their National Child Protection Alerts System and align with other child protection information systems DHBs to describe actions to reduce deaths from assault neglect or maltreatment of children aged 0-14 years DHBs to describe actions to reduce hospitalisations for injuries arising from the assault, neglect or maltreatment of children aged 0-14 years. DHBs support implementation of regional Children’s Teams DHBs to participate in regional Children’s Team governance (DHB and non-DHB employed health professionals) DHBs to collaborate with other agencies to plan, test and monitor assessment processes to support early response systems, assessment processes and service co-ordination for vulnerable children DHBs to develop effective referral pathways to/from Children’s Teams and primary and secondary health services. DHB service planning and development activities work to provide an effective continuum of services across primary and referred health services to meet the needs of: pregnant women with complex needs vulnerable children and their families children in state care children with mental health and behavioural problems mental health and addiction service users in their role as parents. Measures Please provide a link (ie, reference page numbers) in the CAP measures section of your plan to the detailed actions the DHB is taking to meet the VCA requirements under the workforce section of your plan. DHB reports exceptions and remedial actions to audit scores less than 80/100 for each of the child and partner abuse components of their VIP programme. DHB monitors implementation of NCPAS and other child protection information systems by 30 June 2016. DHB reports actions to reduce deaths and hospitalisations due to assault, neglect or maltreatment of children 0-14. DHBs support establishment of Children’s Teams. DHB has internal governance/engagement arrangements and with primary and community partners to provide services for: o vulnerable children and their families/whānau o pregnant women with complex needs o children referred to Gateway. DHB supports implementation of Rising to the Challenge (eg, COPMIA), and Healthy Beginnings: Developing perinatal and Infant Mental Health Services in NZ. Whānau Ora DHBs have a role in continuing their support to Whānau Ora providers and collectives and where appropriate collaborating with Commissioning Agencies to benefit the health of whānau. As DHBs hold the key relationships with health providers, they are best placed to use the opportunity presented by the Whānau Ora provider collectives’ programmes and the NGO Commissioning Agencies to improve service delivery and build mature providers, while building a whānau-centred approach in their districts. The DHB actions/activities that demonstrate this include: strengthening the relationship that the DHB has with its local Whānau Ora provider collectives. This could include: o outlining how the DHB will involve Whānau Ora providers and collectives in strategic planning, how the DHB is supporting outcome focused, whānau-centred service delivery through its contracts with local Whānau Ora providers and collectives, how the DHB is working with Whānau Ora providers and collectives to maximise their capacity and capability to improve whānau health outcomes identifying opportunities to collaborate with Whānau Ora Commissioning Agencies. This could include: o involving local commissioning agencies in planning, working on joint projects/commissioning together, building strong relationships with the Commissiong Agencies for the benefit of families/whānau participating in processes led by the Ministry to obtain a broader health sector view on Whānau Ora implementation, including support to providers using the Whānau Ora Information System. Measures The outcome of the Whānau Ora approach in health will be improved health outcomes for whānau through quality services that are integrated (across social sectors and within health), responsive and patient/whānau centred. Refer S15: Delivery of Whānau ora. 11 Prime Minister’s Youth Mental Health Project Where Social Sector Trials (SST) are operating locally, DHBs are expected to work with local Trial Leads for the actions identified to improve the responsiveness of primary care to youth, increase school-based health services and improve access to mental health and youth AOD services. Initiative 1: School Based Health Services (SBHS) – PP25 Please summarise the actions that you will undertake in 2015/16 to: Implement SBHS in all decile one to three secondary schools (including composite schools), teen parent units and alternative education facilities. The service provided is as per the tier three service specification "Additional school based health services" COCH0031, and reported to the Ministry using the template provided for PP25. Implement Youth Health Care in Secondary Schools: A framework for continuous quality improvement in each school (or group of schools) with SBHS. Initiative 3: Youth Primary Mental Health – PP25 (link to PP26) Please identify actions that you will undertake in 2015/16 to improve and strengthen youth primary mental health (12-19 year olds with mild to moderate mental health and/or addiction issues) to achieve the following outcomes: early identification of mental health and/or addiction issues better access to timely and appropriate treatment and follow up equitable access for Maori, Pacific and low decile youth populations. Initiative 5: Improve the responsiveness of primary care to youth – PP25 In 2013/14 DHBs developed a stocktake and gaps analysis of primary care services for young people (for the 12-19 year age group at a minimum) and identified actions to improve integrated service provision for implementation from 2014/15. During 2014/15 local alliances are establishing youth specific Service Level Alliance Teams (SLATs), or an equivalent group. Youth SLATs (or equivalent) shall have a mandate to make recommendations to the Alliance Leadership Team on local youth health needs and agreed changes to service provision, while providing oversight on the implementation of actions to improve youth health across the system. The youth SLATs should include membership from youth specific health services and SST where they exist, and other relevant stakeholders. Please describe actions that you will undertake in 2015/16 to ensure the high performance of the youth SLAT(s) (or equivalent) in your local alliancing arrangements. Please summarise the actions the youth SLAT(s) will undertake in 2015/16 to improve the health of the DHB’s youth population (for the 12-19 year age group at a minimum) by addressing identified gaps in responsiveness, access, service provision, clinical and financial sustainability for primary and community services for the young people, as per your SLAT(s) work programme. Initiative 6: Review and improve the follow-up care for those discharged from CAMHS and Youth AOD services – PP8 Improve follow-up in primary care of youth aged 12-19 years discharged from secondary mental health and addiction services by providing follow-up care plans to primary care providers. The follow-up care plans should be provided with the expectation that they are activated by the primary care provider within three weeks of discharge. Initiative 7: Improve access to CAMHS and Youth AOD services through wait times targets and integrated case management – PP7 Implement actions to meet the waiting time targets that by 2015 will enable: 80 percent of youth to access services within three weeks; 95 percent to access services within eight weeks. Explanatory note: Social Sector Trials have been established in 16 locations around New Zealand to test what happens when community leads are given the mandate to co-ordinate social development, health, education, police and justice activities at a local level in order to achieve improved social outcomes. Fourteen of the 16 Trials have specific outcomes around 12 to 16-year-olds to improve engagement with education and work, and decreased consumption of alcohol and drugs. The Project initiatives should be co-ordinated with Social Sector Trials where they exist. Measures PP7. PP8. PP25 PP26. 12 Social Sector Trials The Social Sector Trials are designed to improve social outcomes in their communities by bringing together government and nongovernment agencies to address the causes of social issues within those communities. They are a mechanism social sector agencies can use to better determine at a local level how existing and new programmes are impacting on social outcomes and how they might be adjusted to improve effectiveness. As of 1 July 2015, the Trials in Waitomo, Kawerau, South Waikato, Horowhenua and Gore will become permanent. The other 11 Trials are to be extended until 30 June 2017 and reviewed for permanence prior to that date. These Trials are in Kaikohe, Ranui (in West Auckland), Waikato District, Rotorua, Whakatane, Taumarunui, Gisborne, South Taranaki, Wairarapa, Porirua and South Dunedin. Those Trials becoming permanent will need to produce three-year action plans and the others will produce two-year action plans for their extensions. In order to develop their potential to improve social sector effectiveness and efficiency across agencies, improving their ability to influence agency decision-making at a regional and local level is a priority. Please identify: work with SSTs on the Prime Minister's Youth Mental Health Project on improving access of primary care to youth, school-based health services, improved access to mental health and youth AOD services inclusion of SSTs in youth service level alliances and how it enables greater SST input into decision-making on services and delivery related to their outcomes through youth alliances and other means, how decision-making will move closer to the community, including identifying any services which could be devolved to Trials control; management of contract delivery; Trials relationship management and/or monitoring; or any other mechanism by which the SST and the DHB are working together to improve community outcomes. how your DHB will seek from Trial leads a community-level perspective on service gaps, service type and skill sets needed, and a perspective on the capability and capacity of local providers to deliver those services how your DHB includes Trial leads independent advice of provider and service performance, involvement in quality assurance processes and monitoring. how your DHB will include Leads in processes to review and design services, determine existing and future providers of the services how your DHB is aligning its work programmes in the key areas outlined with Trial Action Plans and how outcomes are to be measured and reported. Measures A Quarter 4 confirmation and exception report against the actions identified in the plan. Healthy Families NZ Healthy Families New Zealand is a new initiative that aims to improve people’s health where they live, learn, work and play in order to prevent chronic disease. The ten Healthy Families NZ communities and lead providers are: Far North District - Te Runanga o Te Rarawa Waitakere Ward - Sport Waitakere Manukau Ward - Tāmaki Healthy Families Alliance (Auckland Council in partnership with Alliance Health Plus and Ngā Mana Whenua o Tāmaki Makaurau) Manurewa-Papakura Ward -Tāmaki Healthy Families Alliance (Auckland Council, Alliance Health Plus and Ngā Mana Whenua o Tāmaki Makaurau) Rotorua District - Te Arawa Whānau Ora in joint partnership with Kowhai Health Associates Whanganui District - Te Oranganui Lower Hutt City - Hutt City Council Spreydon-Heathcote Ward - Pacific Trust Canterbury Invercargill City - Sport Southland East Cape (lead provider TBC). Those DHBs that have a Healthy Families NZ community in their area need to explain how they are supporting and participating in the initiative. Examples of support and participation could include: being part of the governance arrangements for the initiative in your area, generating awareness of the initiative in the DHB, aligning existing DHB-led health promotion activities with the aims of the initiative, and taking part in the Prevention Partnership. Measures A Quarter 4 confirmation and exception report against the examples of participation identified. 13 More Heart and Diabetes Checks Note: some changes to this target may occur. Public reporting of the More Heart and Diabetes Checks Health Target data will continue in its current form. In agreement with primary care, identify actions that will improve performance on More heart and diabetes checks provided in primary care including actions in the following areas. Use of Budget 2013 funding to support primary care to deliver services that support achievement of the health target. Ensure the expertise, training and tools needed are available to successfully complete the CVD risk assessment and management to meet clinical guidelines. IT systems that have patient prompts, decision support and audit tools exist, are used and fully report performance. Data collection protocol and capacity to capture patient risk levels based on their cardiovascular disease risk assessment result. Quality improvement plans in place for managing people at risk. Measures Health Target – More Heart and Diabetes Checks: 90 per cent of the eligible adult population will have had their cardiovascular disease (CVD) risk assessed in the last five years. Quarterly reporting on performance against the target and progress on specific actions. Diabetes Care Improvement Packages Goal: People living with diabetes are regarded as leading partners in their own care within systems that ensure they can manage their own condition effectively with appropriate support. APs will demonstrate the following. Prevention People with diabetes have access to healthy lifestyle support. Services in primary care to detect and prevent or delay the onset of diabetes-related complications. Identification Proactive recall for retinal screening, foot checks, renal function tests to ensure the early identification of diabetes related complications. Management Implementation of the 20 Quality Standards for Diabetes Care, using the Quality Standards for Diabetes Care Toolkit 2014. Provision of services for people with Type 1 diabetes, especially youth. Provision of specialist support in primary care. Provision of self-management support and education for people with Diabetes. Enablers Consumer co-design in services. Commitment to data match practice management system diabetes registers against the Virtual Diabetes Register in 100% of practices. Use of the Diabetes Atlas of Variation to identify possible gaps in service delivery. Enablers include ongoing workforce development in primary care, and clinical governance with a named clinical lead. IT capability is to be maintained and improved including provision of audit tools and/or a dashboard reporting system. Measures Reduction in proportion of patients with Hba1c above 64, 80 and 100 mmol/mol (DHBs who cannot report ranges should work towards this as a quality improvement measure). 14 Long-term Conditions Goal: New Zealanders with Long-term Conditions (LTCs) live longer, healthier and more independent lives, with the assistance of an integrated health system. APs will demonstrate the following. Prevention Clearly outline networks between general practice and community organisations to maximise physical activity, nutrition, quit smoking and reduction in alcohol use. Identification of risk Have systems in place for risk stratification of the population to identify people with LTCs. Show evidence of proactive recall and management of at-risk populations. Management Show development and/or implementation of new models of care to support people with LTCs. Provision of multi-disciplinary teams including allied health and kaiawhina supporting service delivery in primary care. Provision of self-management support and education for people with LTCs. Enablers Work with the Ministry of Health to establish a baseline for the number of people enrolled in a LTC programme. Demonstrate clinical governance for LTC services that is supported via Alliancing. Have IT systems to support risk stratification, case management, shared care and or clinical information sharing (focus on collaboration enablers). Show evidence of staff training and education around goal setting, motivational interviewing and shared decision-making concepts. Enablers include ongoing workforce development in primary care, and clinical governance with a named clinical lead. IT capability is to be maintained and improved including provision of audit tools and/or a dashboard reporting system. Measures ASH rates (the Ministry receives ASH rates through separate reporting, and we will not require additional reporting of this). Shorter Stays in Emergency Departments DHBs should describe: a structure and plan for achieving and maintaining the shorter stays in the ED health target, including defining membership and roles of governance and project groups, methodology for process improvement, diagnostic/analysis work to identify priority areas for improving ED length of stay, and an overview of improvements being undertaken or planned continued implementation of the ED Quality Framework, including: o continued measurement of mandatory measures, including prioritised service improvement activity in response to this measurement o continued and expanded measurement of the non-mandatory measures, according to the perceived needs of the DHB, and including prioritised service improvement activity in response to this measurement. Measures 95 percent of patients will be admitted, discharged, or transferred from an Emergency Department within six hours. 15 Better Help for Smokers to Quit Note: a detailed explanation of the changes to the Target indicators is attached as Appendix 1. Each DHB must include a commitment to achieving the Government’s Smokefree 2025 goal in its ‘Introduction and Strategic Intentions’ module. Each DHB must also include the additional actions it will take in 2015/16 to ensure that: 95 percent of hospital patients who smoke and are seen by a health practitioner in a public hospital are offered brief advice and support to quit smoking 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months 90 percent of pregnant women who identify as smokers upon registration with a DHB-employed midwife or Lead Maternity Carer are offered brief advice and support to quit smoking every patient’s smoking information (including A, B and C) is documented accurately within the patient care record. For the hospital target, the DHB’s actions should reflect the Ministry’s expectation that this target become increasingly selfsustaining. The public reporting of the hospital target will continue in 2015/16 but the hospital target will become a DHB monitoring indicator in 2016/17. As a DHB monitoring indicator the hospital target will not be publicly reported from 1 July 2016. More comprehensive actions will be expected from those DHBs that haven’t achieved the target, or that have been below 95 percent in 2014/15. Actions in this section could include: systematising weekly feedback to ward managers so that they can follow up with individual staff, training nurse educators to deliver smoking cessation training to new and existing staff, identifying smokefree champions on each of the wards, and refining mechanisms for making an offer of cessation support and referring patients to stop-smoking services. The DHB could also consider putting some quality assurance mechanisms in place to support this target and a definitive timeline for when they might expect to meet the target. For the primary care target, the DHB’s actions should reflect the changes to the Target. There should be a clear link between the DHB’s actions and reaching (or maintaining) 90 percent. The DHB’s actions should build on those actions identified in the DHB’s 2014/15 Annual Plan, and should clearly address any remaining gaps or barriers. Please note that in 2013/14, DHBs were asked to shift the majority of their tobacco health target resource to support the primary care health target. This expectation continued in 2014/15 and in 2015/16 all DHBs should ensure that the majority of health target resources are invested in primary care. Examples of actions in this section could include: providing weekly feedback to each practice on their health target performance, introducing new IT support tools, ensuring that the health target is built into each practice’s key performance indicators, and identifying a smokefree champion within each practice. For the maternity target, the Ministry will start online reporting of the maternity target from 2015/16. The maternity target will replace the hospital target in newspaper publishing of results from 2016/17. The DHB’s actions should reflect the changes to the Target. The Ministry expects to see actions on how the DHB will support midwives (both independent and DHB-employed) to provide every pregnant woman with advice and support to quit smoking as early in pregnancy as possible. As this is a relatively new area of activity for midwives, the DHB’s actions should address each of the core behaviour change tenets, namely leadership, training, systems support, and regular monitoring and feedback. Examples of actions in this section could include: • providing all midwives with smoking cessation training that is specific to pregnant women, and building relationships between midwives and local stop-smoking services. Measures 95 percent of patients who smoke and are seen by a health practitioner in public hospitals will be offered brief advice and support to quit smoking. 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 90 percent of pregnant women who identify as smokers upon registration with a DHB-employed midwife or Lead Maternity Carer are offered advice and support to quit smoking. By 2025, less than 5 percent of the DHB’s population will be a current smoker. 16 Improved Access to Diagnostics Achieve identified waiting time targets by more efficient use of existing resources; making improvements to referral management and patient pathways; and investing in workforce and capacity as required. Participate in activity relating to development and implementation of the National Patient Flow (NPF) system, including adapting data collection and submission to allow reporting to the NPF as required. Work with regional and national clinical groups to contribute to development of improvement programmes. Radiology Identify actions to support improvements in radiology services. This should include a summary of deliverables under your National Radiology Service Improvement Initiative, along with other local activity planned to support improved access, quality of care, patient flow management, or that maximise available capacity and resources. Colonoscopy/Endoscopy Identify actions to improve waiting times and quality of colonoscopy / endoscopy services. Actions are expected to include: o using the Global Rating Scale as part of the National Endoscopy Quality Improvement programme (NEQIP) o identifying and implementing improvements to colonoscopy services: - use of the National Referral Criteria for Direct Access Outpatient Colonoscopy - regional collaboration to improve access and timeliness to colonoscopy procedures - single waiting lists - standardised triage processes for surgical and medical colonoscopy referrals. Waitemata DHB with Auckland regional DHB partners Support on-going activities associated with bowel screening pilot. Measures Agreed National Patient Flow system changes are implemented. Representation, attendance and participation in national and regional clinical group activities. Refer PP29: Improving waiting times for diagnostic services. Coronary angiography – 95% of accepted referrals for elective coronary angiography will receive their procedure within 3 months (90 days). CT and MRI – 95% of accepted referrals for CT scans, and 85% of accepted referrals for MRI scans will receive their scan within six weeks (42 days) Diagnostic colonoscopy o 75% of people accepted for an urgent diagnostic colonoscopy will receive their procedure within two weeks (14 calendar days, inclusive), 100% within 30 days o 65% of people accepted for a non-urgent diagnostic colonoscopy will receive their procedure within six weeks (42 days), 100% within 120 days Surveillance colonoscopy – 65% of people waiting for a surveillance or follow-up colonoscopy will wait no longer than 12 weeks (84 days) beyond the planned date, 100% within 120 days Above indicators are expected for all DHBs for CT, MRI and colonoscopy. For coronary angiography, indicators are expected where those services are locally provided. 17 Cancer Services / Faster Cancer Treatment Identify actions to ensure at least 85 percent of patients receive their first treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks by July 2016. Actions could include: o ensuring sustainable implementation of round one service improvement fund initiatives and planning for round two service improvement fund initiatives o improving the quality of data and data collection* o implementing tumour standard review findings from 2013/14 and 2014/15. Identify actions to improve the timeliness and quality of the cancer patient pathway from the time patients are referred into the DHB through treatment to follow-up/palliative care. Actions are expected to include: o application of the Equity of Health Care for Māori: A framework resource o identifying actions to maintain timeliness of access to radiotherapy and chemotherapy o improving the functionality and coverage of multidisciplinary meetings (MDMs) across the region by implementing the regionally agreed MDM priorities (measured by the MDM policy priority) o supporting a regional approach to reviewing services against at least two national tumour standards (different tumour types to the reviews undertaken in 2013/14 and 2014/15) o identifying actions to ensure the timeliness of access to adjuvant treatments (this may become a policy priority). Support implementation of Budget 2014 initiatives. Actions are expected to include: o identifying and progressing priorities that will support the implementation of the Cancer Health Information Strategy (to be released in February 2015) o a commitment to implementing supportive care services for cancer patients within the DHB and region (draft service specifications and role descriptions to be provided by May 2015). For Waitemata and Auckland regional DHBs; support on-going activities associated with round two of the bowel screening pilot. Implement guidance** on the use of active surveillance treatment for prostate cancer care by June 2016. *this may include implementation of the high suspicion of cancer definitions that are being developed by January 2015 and tumour specific core datasets that are being developed by May 2015 as part of phase two of the tumour standards work programme. Drafts of the tumour specific core datasets will be ready for consultation in February 2015. **guidance on the use of active surveillance for men with low grade prostate cancer is being developed and drafts will be ready for consultation in February 2015. Further information about active surveillance and the guidance will be provided to DHBs and clinicians providing prostate cancer care. Please note planning guidance on endoscopy/colonoscopy is provided in the Improved Access to Diagnostics section. Measures Improved performance against the Faster cancer treatment health target – 85 percent of patients receive their first treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks by July 2016. Improvements in the number of records being submitted and the number of records being declined for the policy priority (PP30) faster cancer treatment indicators. Improved or maintained performance against the policy priority (PP30) faster cancer treatment indicators (TBC): o Shorter waits for cancer treatment (the previous health target) – all patients, ready-for-treatment, wait less than four weeks for radiotherapy or chemotherapy o 31 day indicator – proportion of patients with a confirmed diagnosis of cancer who receive their first cancer treatment (or other management). Monitor through policy priority (PP24) improving waiting times – cancer multidisciplinary meetings improvements to the coverage and functionality of multidisciplinary meetings. Monitor through service improvement fund contract reporting. Appropriate clinicians such as urologists and radiation oncologists receive the guidance on the use of active surveillance treatment for prostate cancer. Care pathways and MDM proformas are updated to include the guidance on the use of active surveillance treatment for prostate cancer. 18 System Integration DHBs are expected to continue to improve the integration of services in their district in order to ensure patients receive more effective and co-ordinated services closer to home. DHBs are expected to outline how they will achieve this with specific activities describing quarterly milestones to measure progress including the following: evidence of substantive shift over time of services closer to home including specific services and a detailed investment plan that shows a shift in revenue – this is a Letter of Expectations requirement implementation of the newly released National Access Criteria for Community Referred Diagnostics and provide a detailed investment plan for this implementation an acute demand plan that is integrated across primary and urgent care development of clinical pathways that include primary care direct and easy access to specialist nurse and/or doctor advice for three high demand services. Note: If a DHB currently has an appropriately detailed Alliance Plan that covers the above requirements, this can be submitted for review rather than additional narrative in the annual plan (cross-reference to the Alliance Plan would be required in the annual plan). Note that the review of the Alliance Plan would not constitute approval of the Alliance Plan, but would only look to ensure the requirements for the annual plan had been met. Integrated Performance and Incentive Framework DHBs are expected to outline how they will achieve the System Level Measures with specific activities describing quarterly milestones to measure progress including the following: work with primary care to implement the Health Quality and Safety Commission Patient Experience Survey when it is developed your process to select appropriate Contributory Measures specific actions to meet the following System Level Measures: o Early registration with an LMC within the first 12 weeks of pregnancy (target TBC) o Early enrolment with a PHO within 4 weeks of birth (target TBC) o 95% of newborns receive all scheduled immunisations by 8 months of age o 95% of children have received all scheduled immunisations by 2 years of age o There will be no increase in the number of people aged 65 years or older dispensed TBC or more discrete medications o More Heart and Diabetes Health Target o Better Help for Smokers to Quit Health Target. Note: If a DHB currently has an appropriately detailed Alliance Plan that covers the above requirements, this can be submitted for review rather than additional narrative in the annual plan (cross-reference to the Alliance Plan would be required in the annual plan). Note that the review of the Alliance Plan would not constitute approval of the Alliance Plan, but would only look to ensure the requirements for the annual plan had been met. Measures System Integration Achievement of agreed quarterly milestones. Integrated Performance and Incentive Framework Achievement of agreed quarterly milestones Maintain zero growth in the number of people aged 65 years or older dispensed 11 or more discrete medications SI – Capacity and Capability SI6 SI7 SI8 SI9. 19 Primary Care DHBs are expected to continue to improve the integration of services in their district, ensuring patients receive more services closer to home. DHBs are expected to outline how they will achieve this with specific activities describing quarterly milestones to measure progress including the following. Evidence the annual plan was jointly developed and agreed by the Alliance Leadership Team. Continue to implement free general practice visits, and prescription co-payments for children under 13 years of age (this includes daytime and after-hours). Continue to support a Rural Service Level Alliance Team and develop and implement a plan for distribution of the Rural Primary Care Funding according to the agreed processes in the PHO Services Agreement. Implement the National Enrolment Service. Sustainable rural primary health care services. Measures PP22. Access to free visits and prescriptions for Under 13s. Maternal and Child Health The DHB is required to work with the wider sector including Primary Care providers, Lead Maternity Carers (LMCs), Well Child/Tamariki Ora (WCTO) providers, Community Oral Health Services (COHS) and with local communities to achieve national maternal and child health service access expectations. The DHB must describe the actions is will take in 2015/16 to: increase the number of women who receive continuity of primary maternity care during their pregnancy (access to either a community or DHB LMC) increase the number of women who register with an LMC in their first trimester with a focus on Māori and Pacific women living in areas of high deprivation increase the number of Māori, Pacific, teen and other higher need pregnant women who attend DHB funded pregnancy and parenting education implement all recommendations of the Gestational Diabetes Mellitus National Clinical Guideline (published December 2014) ensure all newborn babies are enrolled with a PHO and registered with a GP, WCTO provider and COHS maintain B4 School Check coverage including among children living in areas of high deprivation. Local priority setting for maternity and child health outcomes and quality improvement should demonstrate local needs analysis, including local performance against the New Zealand Maternity Standards, the New Zealand Maternity Clinical Indicators, the WCTO Quality Improvement Framework and Quality Indicators, B4SC monitoring as well as consumer feedback and consultation. The DHB, in partnership with its maternity and child health sector, must: identify the key maternal, infant and child health outcomes it seeks to achieve by 30 June 2016 and describe the actions it will undertake to achieve these. identify the key maternal, infant and child health quality improvements it seeks to achieve by 30 June 2016 and describe the actions it will undertake to achieve these. Measures 95% of pregnant women receive continuity of primary maternity care through a community or DHB LMC. 80% of women who register with an LMC do so in their first trimester. 30% of Māori, Pacific and teen pregnant women complete DHB funded pregnancy and parenting education. 98% of newborns are enrolled with a PHO, general practice, WCTO provider and COHS by three months. 90% of four-year-olds receive a B4 School Check, including 90% of Māori and Pacific children and children living in areas of high deprivation. DHB to define their own maternal and child health outcome measures and targets for 2015/16. DHB to define their own maternal and child health quality measures and targets for 2015/16. 20 Spinal Cord Impairment Action Plan Counties Manukau and Canterbury DHBs to describe the actions they will take in 2015/16 to establish acute supra regional spinal services and early rehabilitation pathways, which are equivalent, of a high standard and accessible, as outlined in the New Zealand Spinal Cord Impairment Action Plan 2014-2019. Auckland DHB to describe the actions it will take in 2015/16 to establish clinical leadership for children’s acute spinal services and work towards establishment of a national paediatric rehabilitation service, as outlined in the New Zealand Spinal Cord Impairment Action Plan 2014-2019. All other DHBs to describe the actions they will take in 2015/16 to implement agreed nationally directed destination and referral processes for acute spinal cord injuries and work with supra regional spinal services (Counties Manukau DHB and Canterbury DHB) and Auckland DHB for children’s spinal services to implement the New Zealand Spinal Cord Impairment Action Plan 2014-2019. Measures A confirmation and exception report in the second quarter of 2015/16 on progress made against actions in the Spinal Cord Impairment Action Plan in 2014/15 and to date in 2015/16. A confirmation and exception report in the fourth quarter of 2015/16 on actions identified in the DHB’s 2015/16 Annual Plan. National Entity Priority Initiatives The Health Sector Forum (HSF) is again leading a process to prioritise the initiatives of the national health entities for the 2015/16 financial year (including National Health IT Board, Health Quality & Safety Commission, National Health Committee, Pharmac, Health Workforce New Zealand, Health Promotion Agency and Health Shared Services Programmes). Details of the indicative list of national entity priority initiatives are included as supplementary planning information on the Nationwide Service Framework Library website. Please note that the prioritised list is still in the process of being agreed with the HSF and the Minister. Improving Quality HQSC priorities for 2015/16. State the Quality & Safety Marker (QSM) and identify specific improvement actions in the following areas: o Falls: 90 percent of older patients are given a falls risk assessment o Falls: 98 percent of older patients assessed as at risk of falling receive an individualised care plan addressing these risks o Hand hygiene: 80 percent compliance with good hand hygiene practice o Perioperative: the current QSM (all three parts of the WHO surgical safety checklist used in 90 percent of operations) will be retired at the end of 2014/15. A new measure aimed at ensuring that the checklist is used in at least 90 percent of operations, but measuring the use of the checklist as a teamwork and communication tool, will be developed during 2015/16, with public reporting from 1 July 2016. For 2015/16 DHBs should identify specific actions to: refocus the use of the checklist as a teamwork and communication tool (rather than an audit tool) and introduce briefing and debriefing for each theatre list o SSI: 95 percent of hip and knee replacement patients receive cefazolin ≥ 2g as surgical prophylaxis o SSI: 100 percent of hip and knee replacement patients have recommended skin antisepsis in surgery using alcohol/chlorhexidine or alcohol/povidone iodine o SSI: 100 percent of hip and knee replacement patients receive prophylactic antibiotics 0-60 minutes before incision o Medication Safety: implementation of the electronic medicine reconciliation platform. Identify actions to meet the guidance for the national inpatient experience survey as part of DHB systems for capturing consumer feedback. This should occur at least quarterly. Identify actions to publish annual quality accounts in accordance with HQSC guidance, incorporating consultation with your local community and consumers. Identify actions to undertake local and support national mortality and morbidity review. Measures Performance updates published by HQSC and included in DHB local quality accounts. Quarterly Reporting on patient experience as set out in performance measure DV3 ‘Improving patient experience’. Actions to Support Delivery of Regional Priorities Local DHBs are to include actions/milestones/budget allocation/measures in their APs that will contribute to Regional Priorities where these are not also DHB Annual Plan priorities, including: Major Trauma Workforce IT. 21 Living Within our Means Keeping to budget is important as it allows investment into new and more health initiatives. Therefore, DHBs are expected to continue to manage their finances prudently, and must ensure that all financial plans for 2015/16 and out years are aligned with previously agreed results. Operate within agreed financial plans (and fund capital investment from internal sources). Fully provide for the National Entity Priority Initiatives. Proactively manage cost growth (including personnel) and improve use of workforce. Provide information on the production plans and explain major variations in the yearly variations in the production schedule. Demonstrate appropriate clinical and executive leadership. Actions could include: continue the implementation of Shared Services actions aligned with Health Benefits Limited (HBL) work programmes as agreed increase theatre utilisation identify and note any regional or sub-regional activity that collectively improves financial performance increase in service outputs delivered within a primary care and/or community setting, relative to hospital delivery, and reduction in demand for acute hospital services. Measures System Integration 3: Ensuring delivery of Service Coverage. Ownership OS3: Inpatient Length of Stay. Ownership OS8: Reducing Acute Readmissions to Hospital. Output 1: Output Delivery Against Plan. 22 2015/16 Planning Priorities Included in Both RSPs and APs In order to encourage greater alignment between the APs and RSPs, those planning priorities that cross both plans are set out below with the expectations for regional planning presented first and followed by the expectations for annual planning. This style of presentation is intended to more clearly demonstrate how the AP objectives for each planning priority feed into the RSP objectives and vice versa. It is expected that DHBs and shared service agencies will also use the Line of Sight guidance framework to identify appropriate DHB level actions to support regional activity. Some priorities, such as Mental Health, do not have the same objectives at the regional and district level. Where this is the case, DHBs and shared service agencies are still expected to use the Line of Sight guidance framework to identify appropriate DHB activities to support regional activity. 23 Electives (RSPs) & Improved Access to Elective Surgery (APs) RSP Expectations – Electives Regional Objectives Improve access to elective services. Maintain reduced waiting times for elective first specialist assessment (FSA) and treatment. Improve equity of access to services, so patients receive similar access regardless of where they live. Key Actions Identify the actions that the region will undertake to improve access to elective services, reduce waiting times and improve equity of access. These actions will differ by region but could include: o developing a regional delivery plan that supports achievement of local intervention rates, maximised regional capacity, optimal use of specialist resources and sub-specialist capability, increased access to less complex surgery and local Health Target Delivery o developing consistent pathway, access criteria, and clinical protocols for individual services o establishing and delivering sub-regional agreement to facilitate cross-boundary patient care o implementing sub-regional referral management and scheduling systems o sustaining progress achieved through previously funded Elective Services Productivity and Workforce Programme (ESPWP) contracts. Information Technology • Identify the actions that the region will undertake to support improved information management. For example, establishing a regional oversight role to ensure any actions required to contribute to or implement the National Patient Flow collection are regionalised where possible. Workforce Identify the actions that the region will undertake to maximise workforce resources. For example, completing a forecast through to 2018/19 of future workforce requirements, developed based on service demands and maintaining a local and regional view of specialist workforce capacity and capability. RSP Measures – Electives For the 2015/16 year it is expected that: your region’s Electives Health Target will be met patients wait no longer than 4 months for First Specialist Assessment (FSA) or elective treatment (ESPI 2 & ESPI 5). AP Expectations – Improved Access to Elective Surgery Delivery against your agreed volume schedule (to be provided with funding advice), including elective surgical discharges, to deliver the Electives Health Target. Electives funding will be allocated to support increased levels of elective surgery, specialist assessment, diagnostics, and alternative models of care. Standardised intervention rates and/or other mechanisms (such as demand analysis) will be used to assess areas of need for improved equity of access. Patient flow management will continue to be improved to maintain reduced waiting times for electives, with patients waiting no longer than four months for first specialist assessment or treatment. Identify actions to support improvements in electives access, quality of care, patient flow management, or that maximise available capacity and resources. Example areas could be: o improving scheduling, patient pathways, use of alternative providers, management of follow-ups, referral management (and relationships with primary care), internal policies and processes, patient focussed booking, preadmission redesign, The Productive Operating Theatre, enhanced recovery or rapid improvement, direct access to diagnostic or treatment. Patients will be prioritised for treatment using national, or nationally recognised, tools, and treatment will be in accordance with assigned priority and waiting time. Participate in activity relating to development and implementation of the National Patient Flow system, including amending data submission as required. Regional Alignment: DHBs to include actions/milestones/budget allocation/measures to deliver on Electives as a regional priority in their APs. AP Measures – Improved Access to Elective Surgery Delivery against agreed volume schedule, including a minimum of xx elective surgical discharges in 2015/16 towards the Electives Health Target (will be provided in electives funding advice). Refer to SI4: Elective services standardised intervention rates. Elective Services Patient Flow Indicators expectations are met, and patients wait no longer than four months for first specialist assessment and treatment, and all patients are prioritised using the most recent national tool available. Refer to Ownership Dimension performance measures for Inpatient Length of Stay (OS3). Include measures for any local projects/actions identified. Increased uptake of latest national CPAC tools to improve consistency in prioritisation decisions. Patient level data is being reported into the National Patient Flow collection, in line with specified requirements. 24 Stroke (RSPs) & Stroke Services (APs) RSP Expectations – Stroke Regional Objectives To improve stroke prevention, stroke event survival, and reduce subsequent stroke events. To improve access to organised acute and rehabilitation stroke services. Key Actions Develop and deliver a regional plan for stroke services supporting the continued implementation of the New Zealand Clinical Guidelines for Stroke Management 2010 (the Stroke Guidelines). This will include key actions to support the following. Organisation of stroke services All stroke patients admitted and treated in a stroke unit or care in the setting of an organised stroke unit with an interdisciplinary stroke team (see PP20 for definitions of a stroke unit and organised stroke services). Thrombolysis All eligible stroke patients have access to thrombolysis (see PP20 for definition of an eligible patient). Rehabilitation All eligible stroke patients receive appropriate rehabilitation services (as defined by the National Stroke Network), supported by an interdisciplinary stroke team. All eligible stroke patients have equitable access to community stroke services, regardless of age, ethnicity or geographic domicile. Education, training and audit All members of the interdisciplinary stroke team participate in ongoing education, training and audit programmes according to the Stroke Guidelines. Workforce A regional workforce plan that supports the delivery and achievement of sustained, consistent and safe thrombolysis, and comprehensive evidence based interdisciplinary acute and rehabilitation stroke care provision. Identified actions that the region will take to develop and implement an ongoing education programme that supports a sustainable and high quality clinical workforce. Information Technology • Identified actions that the region will take to support improved information management, eg, establishing a regional oversight role. RSP Measures – Stroke Use the two DHB annual plan measures to identify gaps and opportunities for development of regional models of care: 6 percent of potentially eligible stroke patients thrombolysed 80 percent of stroke patients admitted to a stroke unit or organised stroke service with demonstrated stroke pathway. 25 AP Expectations – Stroke Services DHBs are to continue to provide an organised stroke service for their population as recommended in the NZ Clinical Guidelines for Stroke Management 2010 (the Stroke Guidelines). This will include: people with stroke admitted to hospital and treated in a stroke unit or care in the setting of an organised stroke service under the care of an interdisciplinary stroke team (see PP20 for definitions of a stroke unit and organised stroke services) all eligible patients have access to thrombolysis (see PP20 for definition of an eligible patient) all stroke patients receive early active rehabilitation by an interdisciplinary stroke team all people with stroke have equitable access to community stroke services, regardless of age or where they live all members of the interdisciplinary stroke team participate in ongoing education and training according to the Stroke Guidelines develop stroke thrombolysis quality assurance procedures, including processes for staff training and audit o examples include: workforce training to support thrombolysis, care pathways developed for thrombolysis, thrombolysis register; workforce allocation to support all DHBs in region having access to thrombolysis, for those DHBs not able to provide thrombolysis transport options to regional provider in place provide care management plans/services for people who have had a stroke, thrombolysis, transient ischaemic attack; rehabilitation – supported by an adequately staffed stroke interdisciplinary service that regularly accesses ongoing education and training. For those hospitals or DHBs not able to provide this level of stoke care, explore accessing support from DHB or regional partners provide lead clinicians designated to stroke (see PP20 for recommended members of an acute stroke team) support and participate in national and regional clinical stroke networks to implement actions to improve stroke services. Collect data to establish a baseline for ongoing reporting of the following: o proportion of patients admitted with acute stroke who are transferred to in-patient rehabilitation service, and the proportion of these transferred within 10 days of acute stroke admission* o proportion of patients admitted with acute stroke referred to community rehabilitation, and the proportion of these undergoing face-to-face community assessment within five days of discharge from hospital. *the collection of baseline data will help assist, support and clarify data definitions, to test the proposed 2016/17 delivery of 60 percent. Regional Alignment: DHBs to include actions/milestones/budget allocation/measures to deliver on Stroke Services as a regional priority in their APs. AP Measures – Stroke Services 6 percent of potentially eligible stroke patients thrombolysed. 80 percent of stroke patients admitted to a stroke unit or organised stroke service with demonstrated stroke pathway. 26 Cardiac Services (RSPs & APs) RSP Expectations – Cardiac Services Regional Objectives The focus for regions in 2015/16 will be to continue to improve access to cardiac services including: improved and timelier access to cardiac services patients with a similar level of need receive comparable access to services, regardless of where they live more patients survive acute coronary events, and likelihood of subsequent events are reduced patients with suspected Acute Coronary Syndrome (ACS) receive seamless, co-ordinated care across the clinical pathway patients with heart failure are optimally managed at admission, reducing the need for further readmission the introduction of Accelerated Chest Pain Pathways (ACPPs) in Emergency Departments, which began in 2014/15. Key Actions To continue to work with regional cardiac clinical networks and the New Zealand Cardiac Network to implement actions to improve outcomes for people. To provide quarterly reporting at regional and DHB level utilising the ANZACS-QI and Cardiac Surgery registers. Secondary Services Develop and deliver a regional (or sub-regional in South Island) plan for cardiac services, ensuring appropriate access to cardiac surgery, percutaneous revascularisation and coronary angiography. All cardiac surgery patients are prioritised, and treated in accordance with assigned priority and urgency timeframes. Sustain performance against cardiac surgery waiting list management expectations. Accelerated Chest Pain Pathways Continue the introduction of Accelerated Chest Pain Pathways (ACPPs) in Emergency Departments, which began in 2014/15. Acute Coronary Syndrome Implement regionally agreed protocols, processes and systems to ensure prompt local risk stratification and management of suspected ACS patients. Implement systems for prompt transfer of high-risk patients to tertiary centres for the appropriate interventions. Heart Failure • Implement locally, regionally and nationally agreed protocols, guidance, processes and systems to ensure optimal management of patients with heart failure. RSP Measures – Cardiac Services Secondary Services Standardised intervention rates: o Cardiac surgery: a target intervention rate of 6.5 per 10,000 of population will be achieved. DHBs with rates of 6.5 per 10,000 or above in previous years will be required to maintain this rate. o Percutaneous revascularisation: a target rate of at least 12.5 per 10,000 of population will be achieved. o Coronary angiography: a target rate of at least 34.7 per 10,000 of population will be achieved. Proportion of patients scored using the national cardiac surgery Clinical Priority Access (CPAC) tool, and proportion of patients treated within assigned urgency timeframe. The waiting list for cardiac surgery remains between 5% and 7.5% of planned annual cardiac throughput, and does not exceed 10% of annual throughput. Patients wait no longer than four months for a cardiology first specialist assessment, or for cardiac surgery. Accelerated Chest Pain Pathways Report quarterly on regional activity that supports Accelerated Chest Pain Pathway development implementation and quality improvement. Acute Coronary Syndrome Each region will have established measures of ACS risk stratification and timeliness for patients to receive appropriate intervention. 70% of patients will receive an angiogram within 3 days of admission. (‘Day of Admission’ being ‘Day 0’). Over 95% of patients presenting with ACS who undergo coronary angiography have completion of ANZACS-QI ACS and Cath/PCI registry data collection within 30 days. Over 95% of patients undergoing cardiac surgery will have completion of Cardiac Surgery registry data collection within 30 days of discharge. 27 AP Expectations – Cardiac Services Secondary Services Deliver a minimum target intervention rate for cardiac surgery, set in conjunction with the National Cardiac Surgery Clinical Network, to improve equity of access. Ensure appropriate access to cardiac diagnostics to facilitate appropriate treatment referrals, including angiography, echocardiograms, exercise tolerance tests etc. Manage waiting times for cardiac services, so that patients wait no longer than four months for first specialist assessment or treatment. Undertake initiatives locally to ensure population access to cardiac services is not significantly below the agreed rates. This includes cardiac surgery, percutaneous revascularisation and coronary angiography. Sustain performance against cardiac surgery waiting list management expectations (for the five cardiac surgery providers only). Ensure consistency of clinical prioritisation for cardiac surgery patients, by using the national cardiac CPAC tool, and treating patients in accordance with assigned priority and urgency timeframe (for the five cardiac surgery providers only). Accelerated Chest Pain Pathways Continue the introduction of Accelerated Chest Pain Pathways2 (ACPPs) in Emergency Departments which began in 2014/15. Acute Coronary Syndrome Contribute data to the Cardiac ANZACS-QI and Cardiac Surgical registers to enable reporting measures of ACS risk stratification and time to appropriate intervention. Develop processes, protocols and systems to enable local risk stratification and transfer of appropriate ACS patients. Work with the regional, and where appropriate, the national cardiac networks to improve outcomes for ACS patients. Heart Failure Work with the regional, and where appropriate, the national cardiac networks to improve outcomes for patients with heart failure. AP Measures – Cardiac Services Secondary Services Agreement to and provision of a minimum of TBC total cardiac surgery discharges for your local population in 2015/16 (will be provided in electives funding advice). Refer PP29: Improved access to diagnostics. TBC% of people will receive elective coronary angiograms within 90 days. Expected for DHBs who provide angiography services only. Elective Services Patient Flow Indicators: patients wait no longer than four months for first specialist assessment and treatment. Refer SI4: Standardised Intervention Rates o Cardiac surgery: a target intervention rate of 6.5 per 10,000 of population will be achieved. DHBs with rates of 6.5 per 10,000 or above in previous years will be required to maintain this rate. o Percutaneous revascularisation: a target rate of at least 12.5 per 10,000 of population will be achieved. o Coronary angiography: a target rate of at least 34.7 per 10,000 of population will be achieved. The waiting list for cardiac surgery remains between 5 and 7.5 percent of annual cardiac throughput, and does not exceed 10 percent of annual throughput. Expected for the five cardiac surgery providers only. Cardiac surgery patients are operated on within nationally agreed urgency timeframes. Expected for the five cardiac surgery providers only. Acute Coronary Syndrome 70% of patients will receive an angiogram within 3 days of admission. (‘Day of Admission’ being ‘Day 0’), reported by ethnicity. Over 95% of patients presenting with ACS who undergo coronary angiography have completion of ANZACS-QI ACS and Cath/PCI registry data collection within 30 days. Over 95% of patients undergoing cardiac surgery at the five regional cardiac surgery centres will have completion of Cardiac Surgery registry data collection within 30 days of discharge. 2 Accelerated Chest Pain Pathways (ACPPs) are patient assessment pathways that speed up the diagnostic process for patients with chest pain, without compromising patient safety. ACPPs have significant potential as diagnostic tools to improve patient outcomes and save time and resources in Emergency Departments. 28 Health of Older People (RSPs & APs) RSP Expectations – Health of Older People Regional Objectives To ensure people with dementia and their families and whānau are valued partners in an integrated health and social support system that supports wellbeing and control over their circumstances. Regional focus in 2015/16 is to understand national variances across dementia pathways and to share any national learnings and/or resources to develop and implement components of dementia care pathways at the regional level. Regional Dementia Care Pathway Groups, in collaboration with primary, secondary, and the community will: identify and develop components of the dementia care pathways that are best achieved at a regional level, sharing learnings and resources to enable regional implementation. For example: o x components of dementia care pathways that are best achieved at a regional level are identified by 30 September 2015; y components of dementia care pathways are developed at a regional level by June 2016 show delivery of dementia awareness and responsiveness education programmes for primary health care clinicians to improve awareness and responsiveness in primary health care (working in partnership with the dementia sector and primary health organisations). For example: o x number of primary care clinicians have attended dementia awareness and responsiveness programmes (number reported each quarter) provide on-going support and overview of the development and implementation of DHB dementia care pathways following the New Zealand Framework for Dementia Care. RSP Measures – Health of Older People Report quarterly on regional activity that supports DHB dementia care pathway development and implementation including pathway components developed and implemented. Report six monthly showing the development and commencement of dementia awareness and responsiveness education programmes in Primary Health Care (as set out in the CFA variations). AP Expectations – Health of Older People Dementia Care Pathways (PP23) Continued development of dementia care pathways is proactive and co-ordinated, building on previous work to develop further components of the dementia pathway. Home and Community Support Services for Older People (PP23) Confirm the funding resultant of the in-between travel settlement is transferred from the DHBs to the contracted home and community based support service providers, to the qualifying employees for qualified travel time and qualified travel costs. Use of interRAI measures to progress and compare performance with other DHBs. InterRAI (Comprehensive Clinical Assessment in residential care and in home settings) (PP23) The number and percentage of older people who have received long-term support services (home or residential) in the last three months who have had an interRAI homecare or a contact assessment and completed care plan. The percentage of older people in aged residential care by facility who have a second InterRAI LTCF assessment completed 230 days after admission. Older people referred for an interRAI assessment to access publicly funded care services will undergo the assessment and have a service allocated/declined in a timely manner. HOP specialists (PP23) Ensure DHB specialist Health of Older People Services (geriatricians, gerontology nurse specialists) to advise and train health professionals in primary care and aged residential care to ensure quality outcomes for older people. Fracture Liaison Service (PP23) Monitoring and measuring the number of people who are seen by the service and the treatment that they receive (ie, osteoporosis treatment, referral to fall prevention programmes, referral for interRAI assessment). Regional Alignment: DHBs to include actions/milestones/budget allocation/measures to deliver on HOP as a regional priority in their APs 29 AP Measures – Health of Older People Dementia Care Pathways Provide specific detail of improvements to support and services available following a dementia diagnosis (eg, education, increase funding, information, on-going support). Home and Community Support Services for Older People Confirmation of transfer of funding from in-between travel settlement. InterRAI (Comprehensive Clinical Assessment in residential care and in home settings) Evidence of the number of older people who received long-term support services for home and community supports. Percentage of older people in aged residential care by facility who have a second interRAI LTCF assessment completed 230 days after admission. Show time taken from referral from any source to complete (not triage) an interRAI assessment (ie, Contact, MDS-HC, LTFC assessment). HOP specialists The DHB provides data to evidence type of specialist support, number of hours or consultations that specialist HOP services consult with health professionals in primary care and aged residential care. Fracture Liaison Service Show that the DHB has established a Fracture Liaison Service (FLS) and is monitoring its operation, in particular report the number of people who are seen by the service and the treatment they receive (ie, osteoporosis treatment, referral to fall prevention programme, referral for interRAI assessment). Mental Health and Addictions (RSPs) & Rising to the Challenge (APs) As the objectives are different in this section for RSPs and APs regional alignment is: DHBs to include actions/milestones/budget allocation/measures to deliver on Mental Health as a regional priority in their APs. As priorities are different across the regions, the Ministry expects DHBs to identify their own appropriate actions to support regional activities, and acknowledges that DHB responses will be varied. RSP Expectations – Mental Health and Addictions Regional objectives Our objectives for 2015/16 are to improve: access to the range of eating disorder services adult forensic service capacity and responsiveness through the national forensic network youth forensic service capacity and responsiveness perinatal and maternal mental health acute service options as part of a service continuum mental health and addiction service capacity for people with high and complex needs. Key Actions Identify and deliver on at least two actions for each of the following that will lead to: continued regional provision of eating disorder inpatient services (Midland and Northern regions to implement the recommendations from the service review to ensure sustainable inpatient and community services) improved Mental Health and Addiction Service capacity for people with high and complex needs robust regional contribution to the national network of forensic inpatient services development and implementation of actions for a Community Youth Forensic Service Plan with the agreed number of additional FTEs. In the North Island (Northern, Midland and Central Regions) develop the continuum of perinatal and infant mental health services by implementing contracted acute services as part of this continuum. Identify and deliver on the actions needed to achieve the following: for the Northern Region: oversight of the implementation of the Northern Region Perinatal and Infant Mental Health Model of Care Guideline establishment of a regional clinical network with close links to clinical networks being established in the other North Island regions co-ordinated and consistent approach to service delivery across the relevant region and the North Island regional co-ordination and access to the perinatal and infant mental health acute services as part of the wider continuum increased access to perinatal and infant mental health services evaluation of the individual services within the continuum and the continuum as a whole co-ordinated, safe and timely after-hours response. 30 RSP Measures – Mental Health and Addictions • A reduction in waiting lists and times for people in prisons requiring assessment in forensic services. For example: a reduction in waiting lists from x to y with targets set for each quarter. Increased access to community youth forensic services through the development of sustainable youth forensic services. Measure and report improved youth forensic access rates overall including increases in all three settings (court liaison, CYF youth justice residences and community). Increased access in the North Island to perinatal and maternal mental health services. For example: x being current numbers to be increased to y with progress measured each quarter. AP Expectations – Rising to the Challenge 2012-2017 For each of the four key objectives from Rising to the Challenge (1) make better use of resources/value for money; 2) improve integration between primary and specialist services; 3) Cement and build on gains in resilience and recovery (including developing services for children of parents with mental illness and addictions); and 4) deliver increased access for all age groups: provide prioritised actions for each area, with deliverables and 6 monthly milestones for 2015/16 that will ensure that the entire still to be completed/outstanding actions will be met by the end of the 2016/17 year please provide the number of actions that will be outstanding at the end of 2015/16 please describe what processes will be used to ensure NGO, PHO and the justice sector are involved in actions that could impact on them or that you will fund them for and for which they will be responsible for delivering please ensure plans include how employment rates and physical health needs of people with low prevalence disorders will be addressed the Ministry will release implementation guidance for COPMIA service provision in March 2015. Therefore, please acknowledge that you will work with the Ministry to implement the stages of the COMPIA guidance. This will likely require that some implementation actions are included in the final draft of the 2015/16 annual plan (but these are not expected for the initial draft APs) in the context of Rising to the Challenge and the Māori Health Plan measure of reducing the rate of Māori under compulsory treatment orders please outline any plans to review Kaupapa Māori mental health services. please outline the strategic approach to ensuring NGO services form part of the mental health and addiction service continuum and outline what processes are in place to ensure NGO sustainability. Implementation of the New Zealand Suicide Prevention Strategy 2006-2026 and the New Zealand Suicide Prevention Action Plan 2013-2016. DHBs are expected to provide evidence of: workforce development training to identify and support individuals with self-harm injuries or at risk of suicide and refer them to the services they need cross reference to the development and agreement of district suicide prevention and postvention plans (as the suicide prevention and postvention plans will still be at draft stage by the time the final APs are submitted, DHBs are expected to commit to delivering on their suicide prevention and postvention plans in their final AP) cross-agency facilitation in respect to suicide prevention and response to suicide clusters and contagion. DHBs are expected to continue to improve the integration of services in their district, ensuring patients receive more services closer to home - this is a 'Letter of Expectation requirement'. DHBs are expected to outline how they will achieve this by describing the current state and planned shift of services, including milestones, which will provide evidence of a shift over time of mental health and addiction services closer to home - within the ring fence expectations. Note: a shift over time of mental health and addiction services should be reflected in the investment plan developed for the System Integration requirements. AP Measures – Rising to the Challenge 2012-2017 PP26. PP7. PP8. PP25. 31 2015/16 Planning Priorities for RSPs Only Major Trauma Regional Objectives To implement a formal regional trauma system to ensure more patients survive major trauma and recover with a good quality of life. Key Actions Update the three-year action plan to confirm actions that the region will undertake to ensure more patients survive major trauma and recover with a good quality of life. These actions should include progressing the development and implementation of local and regional major trauma systems to achieve: o functional regional networks with established relationships between local, regional and national networks o continued clinical lead and co-ordinator roles in each DHB o achievement of quality improvement markers as defined by the National Major Trauma Clinical Network o development and implementation of regionally consistent clinical trauma management guidelines and process of care protocols o implementation of Regional Destination Policies in collaboration with DHBs, Ambulance and Air Transport providers o development and implementation of inter-hospital transfer protocols. Information Technology All regions and DHBs will have data systems capable of recording the fields in the NZMTDS to be able to report that data to the national New Zealand Major Trauma Minimum Dataset (NZMTMD). Regions will identify the actions that they will undertake to support improved information collection and data quality for the NZMTMD. For example, establishing a regional oversight role to ensure any actions required to contribute to NZMTMD collection are implemented. Workforce All regions and DHBs will develop a training plan to ensure relevant clinical staff are appropriately trained in trauma care. Regions and DHBs are encouraged to explore opportunities for additional experience to be provided to trauma care providers at centres with more exposure to major trauma management. Measures Quarterly reporting on the NZMTMD on all mandatory fields from 1 July 2015. Lead trauma clinical leads and co-ordinators in each DHB. Baseline reporting against defined process and outcome markers. Report quarterly against the regional workplan. Report quarterly on guideline and protocol development. Workforce Workforce priorities for 2015/16 are subject to confirmation following the conclusion of the Health Sector Forum led prioritisation process. To enable and sustain our health and disability workforce, Health Workforce New Zealand (HWNZ) will work collaboratively with DHBs to: actively address and progress a coordinated approach to future 'new models of care' thinking, planning and development clearly define and contribute to national workforce priorities that lead to, and/or support, interventions at a regional level provide leadership and commitment that supports the regional training hub to deliver solutions that deal with regional challenges actively address national/inter-regional/intra-regional co-ordinated approaches that support individual DHBs’ workforce needs, now and for the future. To achieve this, DHBs are expected to work in close collaboration with the Regional Workforce Development Director and the regional hub to: improve recruitment, retention and distribution of the health and disability workforce deliver on health and disability workforce priorities through increased collaboration, inter-sectoral partnerships and regional approaches that improve productivity and economies of scale align workforce development to meet service demand maximise the value derived from workforce resources and reduce duplication strengthen health workforce intelligence to provide high-quality support and advice. Measures Regional and local DHB level progress reporting on the above requirements and key actions to be provided via quarterly RSP reports. The template below should assist the Region to complete their Regional Workforce Plan as part of the Regional Service Plan 2015/16 and ensure each objective is adequately met. 32 Whilst the use of the template is optional, all priority area and outlined initiatives need to be reflected. Priority area Initiatives Actively support and contribute to the initiatives listed below and any further initiatives the Region is undertaking Medical Workforce The HWNZ Medical Workforce Programme Nursing Workforce The HWNZ Nursing Workforce Programme creating new palliative care specialist nurses and educators expanding the role of nurse practitioners and clinical nurse specialists specialist nurses to perform colonoscopies increasing the number of sonographers increasing the number of medical physicists providing midwifery services in hard to staff areas Allied Health Workforce Midwifery Workforce Care and support (Kaiawhina) Workforce Leadership and Management Maori health workforce Pacific health workforce Aged Care Cancer Care Disability Support services Mental Health Primary Care/community settings Rural health Vulnerable communities and child health programmes Elective services Cardiac services Stroke services Major trauma Information Technology Use all training settings, including Outcomes What will be achieved? Regional actions What are your (up to 4) key actions to achieve the outcomes? Milestones 2015/16 (Q1 to 4) Actions broken down by quarter to allow reporting and monitoring Milestones 2016/17/18 Provide high-level details for out years (if appropriate) more detail will need to be provided in future plans) increasing capability and capacity increasing participation of Maori and Pacific providing access to primary care/community settings for prevocational trainees supporting implementation of the Children’s Action Plan 33 primary/communi ty integration and private settings Build on the 2014/15 RSP demonstrating further progress on actions to meet milestones Career guidance/ planning ensuring all HWNZ funded trainees have access to career guidance and a career plan aligned to individual aspirations and future health workforce needs Support the development of clinical networks Additional areas will be identified as HWNZ’s strategic direction progresses and Ministry, Government priorities change. These will be added after consultation and agreement with the region’s DHBs. Measures Regional progress reporting on the above initiatives, outcomes sought, actions and milestones to be provided via quarterly RSP reports. 34 Information Technology (IT) IT priorities for 2015/16 are subject to confirmation following the conclusion of the Health Sector Forum led prioritisation process. The critical IT priorities for 2015/16 are largely a continuation of the previous years. This is reflective of the size and complexity of some initiatives that are being implemented in a phased approach. In the 2015/16 RSPs regions must include: their prioritised three-year plan of all local, regional and national IT initiatives, including the applicable critical IT priorities outlined below. The following level of information should be provided for each initiative (a, b and c are mandatory): a. name of the initiative b. budget allocation by DHB (capex and opex) c. the key deliverable that will be achieved in the 2015/16 year d. benefits, dependencies and milestones (where available). strategies the region has put in place to address the following IT delivery challenges: a. regional governance, leadership and decision making b. regional funding and approval model(s) c. regional capacity and capability. Initiative Description DHBs/Regions involved Applicable HISO standards Measures eMedicines Reconciliation (eMR) with eDischarge Summary Implementation of electronic reconciliation of medicines on admission and discharge from hospital. All DHBs except Northland, Waitemata, Counties Manukau, Taranaki, Canterbury and South Canterbury, which will have eMR in place by June 2015. HISO 10041.1 Clinical Document Architecture Templates for Medications, Allergies and Adverse Reactions. Eleven DHBs will have implemented eMR and the national clinical standard for eDischarges: Draft standard HISO 10011.4 eDischarge Messaging Standard describes the transport of the discharge summary. Midland and Central regions. HISO 10040 Health Information Exchange Architecture describes standard clinical data repository and record locator service interfaces. Two DHBs from the Midland and Central regions will have implemented a regional CWS and CDR. Regional Clinical Workstation (CWS) and Clinical Data Repository (CDR) Replacement of legacy Patient Administration Systems (PAS) Implementation of a regional Clinical Workstation (Orion, Concerto) and Clinical data repository (mixed products). The CWS is a web based system, accessed via a single sign-on that connects multiple clinical applications and data sources to provide clinicians with secure access to patient data. A CDR is a database of patient identifiable clinical information, such as medications, laboratory results, radiology reports, care plans, patient letters and discharge summaries. The 8 DHBs with legacy PAS need to progress implementation of a supported system that is aligned with the regional plan. South Island and Northern Region already have a regional CWS and CDR. Northland, Auckland, Whanganui, MidCentral, Wairarapa, Nelson Marlborough, Canterbury and South Auckland Bay of Plenty Lakes Tairawhiti Whanganui Hawke’s Bay MidCentral Wairarapa Hutt Valley Capital & Coast West Coast HISO 10004 New Zealand Pathology Observation Code Set (NZPOCS) describes the required code set for lab results. HISO 10046 Consumer Health Identity Standard describes the required patient identity and demographic information, Three DHBs will have implemented a supported PAS: Northland Canterbury (at Burwood) 35 Canterbury DHBs. The PAS supports and manages the administrative details of a patient’s encounter with a hospital or DHB service. It supports the management of the hospital resources used to provide patient care, such as clinical staff, rooms, beds and equipment. conforming to the NHI. Nelson Marlborough HISO 10005/6 Health Provider Index standards define the required health provider organisation, facility, health professional and health worker identity and demographic information. Six DHBs will be implementing a supported PAS: Auckland Whanganui MidCentral Wairarapa South Canterbury Canterbury (other sites) National Patient Flow National Patient Flow will create a new national collection that provides a view of wait times, health events and outcomes in a patient’s journey through secondary and tertiary care. All DHBs SNOMED Clinical Terms for clinical impression codes and clinical pathway codes. All DHBs have implemented phase 2 of National Patient Flow and are ready to collect phase 3 data. Patient and Provider Portals Portals are an on-line IT tool that will enable individuals to have access to their own health information. All PHOs Government Web Accessibility Standard 75% of PHOs/practices provide a summary of patient information to ED and after-hours practices It will enable patients to communicate with their primary health practitioners and add information to their health record. 75% of the PHO eligible population have a patient portal available 25% of the PHO eligible population have registered for a patient portal Each of the General Practice Patient Management System (PMS) vendors are developing portals, and Orion Health is developing a portal in conjunction with Canterbury DHB eSCRV project. National Infrastructure Platform programme The National Infrastructure Platform (NIP) proposal is to have all DHBs use Government Common Capability supplier, IBM as the provider for Infrastructure as a Service. All DHBs – as per the HBL transition plan NIP Reference Architecture As per the HBL transition plan The proposal, which is primarily related to backoffice IT infrastructure, would modernise and consolidate today's 40 DHB Data Centres into two worldclass Data Centres Please note that DHBs are to support the implementation of the Cancer Health Information Strategy (to be released in February 2015), please refer to the Cancer Services/Faster Cancer Treatment section for further guidance. 36 Appendix One – Detail of Changes to the Tobacco Target For the primary care component of the Target, please note that in 2015/16 two technical changes will apply. Removing the ‘seen by a health practitioner’ wording from the target definition. This change takes away the need for an ‘adjuster’ in calculating the denominator of the target’s indicator. Removing the adjuster will improve the accuracy of the target as the target result will be based on actual numbers rather than estimates. Importantly, this change will better support all enrolled patients who smoke, regardless of whether they are seen by their health practitioner. This means that PHOs could reach enrolled smokers via a range of activities such as health promotion and public health activities. Changing the numerator to cover 15 months, rather than 12 months. This change gives the practice/PHO 12 months to offer smokers help to quit, and then a three-month follow-up period to contact those smokers who did not go to see their health practice. From 1 July 2015/16, the Target will read ‘90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months.’ For the maternity component of the Target, the Ministry will start online reporting from 2015/16. The maternity target will replace the hospital target in the newspaper publishing of results from 2016/17. From Q1 2015/16 the Ministry expects all DHBs to provide health target data based on the activities of the DHB-employed midwives (template provided below). The DHB data will be added to the existing maternity health target data sources to establish a national maternity health target result. To help improve the accuracy of the maternity target result, two changes will apply to the maternity target from Q1 2015/16. Removing the inclusion of women who confirm their pregnancy in general practice. This change will improve the accuracy of the target as it will remove the potential for double counting women in both general practice and upon registration with a midwife. Including women who confirm their pregnancy with a DHB-employed midwife. This change will ensure all DHB-appointed midwives are encouraged and supported to provide ABC to all pregnant smokers. Following the changes the Target will read ‘90 percent of pregnant women who identify as smokers upon registration with a DHB-employed midwife or Lead Maternity Carer are offered brief advice and support to quit smoking.’ Please complete this table based on the data provided by the DHB employed midwives Number of DHB employed midwives Number of Smokers Brief advice given Offered cessation support Referred to cessation support Smokers' gestation (weeks) % offered brief advice % offered advice and support to quit % accepted cessation support Smoking prevalence 37 Please complete this table based on DHBs activities including those by the independent and DHB-employed midwives 2015/16 Better help for smokers to quit quarterly reporting template - Maternity DHB: please select from the drop down box Reporting Quarter: please select from the drop down box Name and contact details of person completing the report Please answer ALL of the questions below What has your DHB done this quarter to support capture and accuracy of data? What are the barriers to reducing smoking in pregnancy in your DHB? What has your DHB done this quarter to increase the number of pregnant women being offered advice and support to quit smoking by their midwife (independent and DHB-employed), as early in pregnancy as possible? What activities has your DHB got planned for next quarter to increase the number of pregnant women being offered advice and support to quit smoking by their midwife (independent and DHB-emplyed), as early in pregnancy as possible? Target: 90 percent of pregnant women who identify as smokers upon registration with a DHBemployed midwife or Lead Maternity Carer are offered brief advice and support to quit smoking. Please note anything else you would like the Ministry to be aware of. 38
