2014/15 ANNUAL PLAN
Guidelines
(Including Planning Priorities)
WITH STATEMENT OF INTENT and STATEMENT OF
PERFORMANCE EXPECTATIONS
This document is for District Health Board (DHB) staff to use as appropriate to
assist in the development of their 2014/15 Annual Plan including Statement of
Intent (Annual Plan) and Statement of Performance Expectations.
The Annual Plan Guidelines (including Planning Priorities) are a reference
document to enable DHBs to meet their minimum legislative and Ministerial
obligations when drafting their Annual Plan. Note that included in these
Guidelines there are references to additional guidance, and resources which will
be useful when developing Annual Plans.
Amendments
Date
Page
31 Jan 2014
37
28 Feb 2014
36-37
Description
Stroke: In response to feedback from DHBs we have made the following changes to RSP
priorities:

definition of ‘eligible’ added to measures

removal of requirement ‘within 3 hours from onset’ from key actions
Cardiac:


Further guidance is provided on the implementation of Accelerated Chest Pain
Pathways (ACPPs) in Emergency Departments
Recognising the need to gain national consensus, the deadline for definition of
‘high risk’ within Acute Coronary Syndrome (ACS) measures has been removed
28 February 2014
1
The District Health Board Annual Plan with Statement of Intent
Each District Health Board (DHB) has a statutory responsibility to prepare:
•
an Annual Plan for approval by the Minister of Health (Section 38 of the New Zealand Public Health
and Disability Act 2000) - providing accountability to the Minister of Health
•
a Statement of Intent (Section 139 of the Crown Entities Act 2004, as amended by the Section 49 of
the Crown Entities Amendment Act 2013) - providing accountability to Parliament and the public at
least triennially1
•
a Statement of Performance Expectations (New CE Act s149C) – providing financial accountability to
Parliament and the public annually
In 2010 Cabinet determined that the above documents would be brought together into a single DHB
Annual Plan with Statement of Intent, to be known as the ‘Annual Plan’ (AP). This will continue for 2014/15.
The AP must incorporate national and regional (including sub regional) service planning, as well as balance
the medium term accountability requirements inherent in a Statement of Intent (SOI) with annual
requirements.
Annual Plan Structure
A modular approach has been adapted to the DHB Annual Plan, as in previous years, to achieve a single
document that meets the requirements of both Acts, as well as Cabinet requirements and the needs of key
stakeholders. The modules allow various sections of the document to be highlighted for different purposes
and audiences. The modular structure also makes it possible to extract modules as appropriate and only
table in Parliament those most relevant to the purposes of an SOI.
There is no major departure from the structure of previous guidance, and the modular approach of
guidance for DHBs Annual Plans/SOIs is being retained for 2014/15. As for previous years this enables the
relevant sections to be extracted for different purposes such as tabling the SOI in Parliament. (There may
be some change for 2015/16). Please note that the order and shape of some modules has been adjusted to
reflect the amended requirements of the New CE Act 2013. For example, what were modules One and Two
have been combined into a single module, which is the guidance for the SOI. The Government priorities
become module Two.
The slightly revised structure of the AP continues to allow the themes of the DHBs overall performance
story through the whole document – helping cascade the conversation on each theme to a greater level of
detail with each module – from high level strategic outcomes down to service delivery and financial detail.
So while a theme may be repeated, it is expected the information will differ as the reader progresses
further through the document to learn more about the topic with increasing detail.
The legislation that sets out the requirements for SOIs has been reviewed. Amendments to the Crown
Entities Act 2004 can be found in CE Amendment Act 2013.
Key changes to SOI resulting from the CE Amendment Act 2013:

extension of reporting timeframe of SOI to four years minimum (forthcoming year and at least the
following three financial years) (New CE Act s139 (2) as amended/inserted by S49 CE Amendment Act
2013)

an SOI to be produced at least once in every three-year period (New CE Act s139 (3))

a Crown Entity’s responsible Minister may require the crown entity to provide a new SOI at any time
(New CE Act s139A (1))
1
Please note: ‘New CE Act’ refers to the ‘CE Act as amended/inserted by CE Amendment Act 2013’ in this document. The CE
Amendment Act is due to be enacted on 1 July 2014.
2

SOIs to contain only high-level strategic information as relates to four year reporting timeframe,
rather than as it relates to annual reporting requirements, which will be provided separately in a
statement of performance expectations (New CE Act s141 & s149E).

The Statement of Performance Expectations (SPE), (the old Statement of Forecast Service
Performance), is separate from the SOI and is made up of the annual information that used to be in
the SOI. It is produced and tabled each year and subject to the same process timeframe as the SOI
(New CE Act s149B – s149M). The SPE includes the Financial Performance.

During the year that the SOI is tabled the SPE can be consolidated with the SOI.
In 2011 DHBs were required to develop a Workforce Plan to support achievement of annual, regional and
relevant national service plans. As with last year, the production of individual DHB Workforce Strategies
is not a requirement for 2014/15 as DHBs will instead be required to develop their Workforce Strategies
further in their 2014/15 Regional Services Plans (RSPs).
DHBs should find the State Services Commission’s - Preparing a Statement of Intent – Guidance and
requirements for Crown Entities a useful resource while bearing in mind that the AP has considerations
beyond solely an SOI2.
For further information regarding these guidelines please contact:
Jacob White
National Health Board
Ministry of Health
Wellington 6145 annual_plan@moh.govt.nz, (04) 496 2000
2
The SSC guidance document is for the use of DHBs and is to be updated to address changes arising from the CE Amendment Act
2013 shortly. Any DHB subsidiaries required to produce an SOI should do so with regard to the above SSC guidance and that within
the Crown Entities Act 2004 and Crown Entities Amendment Act 2013.
3
MODULE 1: INTRODUCTION and STRATEGIC INTENTIONS (included in SOI extract)
1.1 EXECUTIVE SUMMARY
 CEO foreword, executive summary and signatory page
1.2 CONTEXT
 Background and operating environment
 Nature and scope of functions / intended operations
1.3 STRATEGIC INTENTIONS – strategic objectives
 DHB vision
 Strategic outcomes in national, regional and local context
 Key risks and opportunities
MODULE 2: DELIVERING ON PRIORITIES & TARGETS (NOT included in SOI extract)
2.1 PRIORITIES & TARGETS – actions to achieve our outcomes
 Implementing Government priorities
 Better, Sooner, More Convenient system
 DHB regional, sub regional and local actions to deliver on RSPs
 DHB local priorities
MODULE 3: STATEMENT OF PERFORMANCE EXPECTATIONS (Can be consolidated with the SOI extract)
3.1 STATEMENT OF PERFORMANCE EXPECTATIONS – outputs from activities
 Statement of Performance Expectations (SPE)
 Output classes
 Measures of DHB performance by Output Class:
 Prevention Services
 Early Detection and Management
 Intensive Assessment and Treatment
 Rehabilitation and Support
MODULE 4: FINANCIAL PERFORMANCE (included with SPE)
4.1 FINANCIAL PERFORMANCE
 Statement of Performance Expectations (for current and three following financial years)
 Any other measures and standards necessary to assess DHB performance
 Any significant assumptions
 Any additional information to reflect the operations and position of the DHB
MODULE 5: STEWARDSHIP (included in SOI extract)
5.1 STEWARDSHIP – managing our business for efficient operation
 Managing our business
 Building capability
 Strengthening our workforce
 Organisational health
 Reporting and consultation
4
MODULE 6: SERVICE CONFIGURATION (NOT included in SOI extract)
6.1 SERVICE COVERAGE AND SERVICE CHANGE
 Service coverage
 Service change
 Service issues
MODULE 7: PERFORMANCE MEASURES (NOT included in SOI extract)
7.1 MONITORING FRAMEWORK PERFORMANCE MEASURES
 Dimensions of DHB Performance Measures (non-financial performance targets)
MODULE 8: APPENDICES (NOT to be included in final documents)
8.1 MODULE THREE CONTENT REQUIREMENT (NOT included in final – reference only)
8.2 GLOSSARY OF TERMS (DHB Option)
8.3 ANNUAL PLAN REVIEW: FINANCIAL STATEMENTS 2014/15 (and supporting templates)
8.4 OUTPUT CLASS RECOMMENDATIONS (NOT included in final – reference only)
 Prevention Services
 Early Detection and Management
 Intensive Assessment and Treatment
 Rehabilitation and Support
8.5 ANNUAL PLAN CONTENT REQUIREMENTS (NOT included in final – reference only)
 Crown Entities Act 2004 (CE ACT), as amended by CE Amendment Act 2013
 New Zealand Public Health and Disability Amendment Act 2010 (NZPHD Act)
 Recommendations from Cabinet Social Policy Committee (CSPC)
8.6 STRENGTHENING OUR WORKFORCE – DIMENSIONS OF THE WORKFORCE PLAN (NOT included in final –
reference only)
8.7 LINE OF SIGHT GUIDANCE FRAMEWORK (NOT included in final – reference only)
5
MODULE 1: INTRODUCTION and STRATEGIC INTENTIONS
DHBs are strongly encouraged by the Minister of Health and the Ministry of Health to keep this section brief
and to minimise use of diagrams, pictures and / or white space where possible. DHBs may wish to reference
more detailed information contained on their websites if appropriate rather than replicate it here.
FOREWORD/EXECUTIVE SUMMARY
This section will contain: CE foreword, executive summary and signatory page.
1.2
CONTEXT
1.2.1 Background information and operating environment
Briefly comment on the background of your District Health Boards (DHB), and consider including:
 overarching system context that influences the DHB e.g. RSP objectives, the Ministry of Health’s
Statement of Intent, and the Treaty of Waitangi
 health profile of the district linked to the key issues identified in the DHB’s Health Needs Assessment
 Government focus on Better Sooner More Convenient Services (BSMC) for all New Zealanders.
The DHB, to explain its operating environment, is encouraged to provide a very brief description of the
structure and funding of wider health structures including the hospital and primary/community
organisations. The DHB may note any:
 key internal/external operating environment factors that affect performance
 key areas of risk and opportunity
 coverage or location.
1.2.2 Nature and scope of functions / intended operations (New CE s141(2)(a)):
Explain the nature and scope of the entity’s functions and intended operations, performed by the DHB in
the following roles:
 Planner (in partnership with appropriate stakeholders)
 Provider
 Funder (including managing budget within funding allocation/specific financial constraints)
 Owner of Crown assets.
1.3
STRATEGIC INTENTIONS – strategic objectives (New CE Act s141(1))
WHAT outcomes we want to achieve through a whole of system approach
Keep this section high level and be sure to demonstrate how the DHB is giving effect to the New Zealand
Public Health and Disability Act (NZPHD Act s38(2)(a&b)). The AP must reflect the overall direction of the
New Zealand Health Strategy and New Zealand Disability Strategy (NZPHD Act s38(2)(d)).
High level strategic objectives that the entity intends to achieve or contribute to (strategic intentions must
be identified here (New CE Act s141(1)(a)). Links between high level strategic intentions and DHB
performance on an annual basis will be outlined in the SPE (New CE Act s149(b-g)).
6
System integration
While taking a whole of system approach is not new to the health sector it is expected that a growing
commitment will be applied to achieving more effective system integration in partnership with primary
care and other appropriate stakeholders; and this will be demonstrated in the strategic direction and
planned activities of DHBs. This includes the DHB’s work to provide Better Public Services (including Social
Sector Trials) in:




Prime Minister’s Youth Mental Health Project
Children’s Action Plan
Increased Immunisation Health Target
Reducing Rates of Rheumatic Fever
DHBs are expected to demonstrate how they will use clinical leadership to drive system integration and
Better Public Services.
DHBs are expected to use their Alliance Leadership Team and any Service Level Alliance Teams to jointly
develop 2014/15 DHB Annual Plans for:
 Primary Care (including Rural Health)
 Prime Minister’s Youth Mental Health Services – Youth Health
While in 2014/15 there is no requirement that NGOs are formal members of your ALT, the principle of
partnership must underpin any service development including:
 the Shorter Stays in Emergency Departments Health Target – Primary Care
 the Improved Access to Elective Surgery Health Target
 Shorter Waits for Cancer Treatment
 Faster Cancer Treatment
 Increased Immunisation Health Target
 the Better Help for Smokers to Quit Health Target – Primary Care
 More Heart and Diabetes Checks Health Target
 Reducing Rheumatic Fever
 Prime Minister’s Youth Mental Health Project
 Children’s Action Plan
 Whānau Ora
 Long Term Conditions
 Diabetes Care
 Stroke
 Acute Coronary Syndrome
 Improved Access to Diagnostics
 Cardiac Services – Network Agreed
 Health of Older People
 the Mental Health Service Development Plan
 Maternal and Child Health
7
Intervention logic flow
Intervention logic is central to this module as the links between outcomes in this section and subsequent
sections of the AP illustrate the performance story (CSPC 8A rec: 21.3):

specific actions/activities the DHB will undertake to deliver on these outcomes should be described in
Module 2

how the outcomes identified here flow into detailed impacts and outputs in the SPE in Module 3 should
be clear

how DHB activity to build organisational capability in Module 5 will enable delivery on these outcomes
should also be clear
Consider some form of reference to link sections, e.g., numbering outcomes and referencing numbers in
Statement of Performance Expectations where relevant.
This section must be consistent with and reflect the RSP and any national plans. (CSPC 8A rec: 16).
DHB vision
Outline the vision for the DHB population and service provision.
Strategic outcomes in national, regional and local context (New CE Act s141, NZPHD Act s38
(2)(a))
Outline the specific strategic outcomes or objectives for the DHB. These should be considered
in the context of developing service planning to ensure the AP addresses:
i.
ii.
iii.
local, regional, and national needs for health services, including Better Public Services; and
how health services driven by clinical leadership can be properly integrated to meet those needs; and
the optimum arrangement for the most effective and efficient delivery of health services.
The DHB’s vision should include an outline of how the DHB will support clinically led service planning in
partnership with primary care and other appropriate stakeholders to achieve its high level objectives and
Better, Sooner, More Convenient (BSMC) service. It should focus on service sustainability, service quality
and safety, integrated models of care where appropriate, and best use of resources. It could also describe
key DHB issues that will be addressed by the intended focus areas of service planning for each stakeholder.
Module 2 should identify a number of key principles fundamental for robust planning to achieve BSMC
services through a systems integration approach. It is expected these will be visible in this part to explain
the DHB’s strategic planning where appropriate.
* Consider a structure that flows from national to regional (including sub-regional) and local/community
levels while linking to strategic objectives outlined in Module 1. Specific actions should be described in
subsequent Modules.
The following requirements must be covered in this section:

Appropriate reference to the Māori Health Plan (CSPC 8A rec: 21.5).
*ensure related Performance Measures in the Māori Health Plan are consistent with those in the AP
8
MODULE 2: DELIVERING ON PRIORITIES & TARGETS (NOT included in SOI extract)
HOW we are delivering on Module 1.3 Strategic Objectives
This section should include commentary on key DHB activities, actions and outputs to deliver on each of the
priorities outlined in the Minister’s Letter of Expectations (CSPC 8A rec: 21.4).
Any significant new expenditure should be signalled where applicable.
It is expected that “strong intervention logic across funding, key actions and outputs, expected impacts and
outcomes” is apparent throughout the document (CSPC 8A rec: 21.3).
*Refer Appendix 8.1 for a guide to content for each Government priority and Health Target. Actions within
these tables are mandatory. While the table structure itself is not mandatory this is a useful model to follow to
meet the expectations of this module.
2.1
PRIORITIES AND TARGETS
Implementing Government Priorities (CSPC 8A rec: 21.4).
The Ministry of Health and DHBs are charged with giving effect to the overarching goal for the health sector
of BSMC health services for all New Zealanders, including Better Public Services.. Key principles that are
foundational to planning in order to achieve BSMC services are:
 using an alliancing approach to service planning in which Alliance Leadership Teams involving the
appropriate primary/secondary clinicians and primary/secondary managers jointly agree service
priorities along with appropriate funding levels. Refer to the new PHO Services Agreement and Alliance
Agreement which took effect 1 July 2013.
 using a whole of system view to determine the most efficient model of service delivery. Ensuring service
planning is not done in silos, including using alliancing principles to jointly plan and agree service models
with appropriate stakeholders for other services (e.g. community clinicians and NGOs)3
 providing a model of care that incorporates a range of ‘hospital’ services to be delivered within
community/primary care settings
 active engagement of ‘front-line’ clinical leaders/champions in health services delivery planning across
the sector at both local and regional levels
 integrating/coordinating clinical services to provide greater accessibility and seamless delivery
 strengthening clinical and financial sustainability
 making better use of available resources
 ensuring total population measures and targets are applied to all ethnic groups and that all targets and
measures replicated in any other plans (e.g., Māori Health Plans) are consistent with those in APs and
RSPs.
Four important policy drivers have been identified through which the health sector may best utilise
resources to achieve BSMC services:
 Better Public Services (including Social Sector Trails): DHBs must work more effectively with other parts
of the social sector. The Government’s Better Public Services targets and the Social Sector Trials will
help drive this integrated approach that puts the patient and user at the centre of service delivery.
DHBs are expected to work closely with other sectors such as education and housing specifically to
improve the child immunisation rate, reduce the rate of rheumatic fever, deliver the Prime Minister’s
Youth Mental Health Project and the Children’s Action Plan.
 Regional collaboration: means DHBs working together more effectively, whether regionally or subregionally.
3
Refer to the Alliance Leadership Charter for a description of alliancing principles. While in 2014/15 there is no requirement that
NGOs are formal members of your ALT, the principle of partnership must underpin any service development.
9
 Integrated care: includes both clinical and service integration to bring organisations and clinical
professionals together, in order to improve outcomes for patients and service users through the delivery
of integrated care. Integration is a key component of placing patients at the centre of the system,
increasing the focus on prevention, avoidance of unplanned acute care and redesigning services closer
to home.
 Value for Money: is the assessment of benefits (better health outcomes) relative to cost, in determining
whether specific current or future investments/expenditures are the best use of available resource.
The AP should reflect how these approaches link in with the DHB’s overall performance story and identify
the outcomes that will be achieved through them. DHBs must show in their AP the specific tangible and
measurable actions they will undertake to deliver on identified service priorities and targets listed below in
relation to the above policy drivers. The activities identified must include a range of actions that are
expected to be completed within 2014/15.
Government priorities are presented in the Ministers Letter of Expectations and in individual letters to DHB
Chairs from the Minister. Priorities for 2013/14 are yet to be formally confirmed. Currently the potential
areas of priority focus are:
2.1.1 HEALTH TARGETS4
The six Health Targets for 2014/15 are:
1.
Shorter Stays in Emergency Departments˟5
2.
Improved Access to Elective Surgery˟
3.
Shorter Waits for Cancer Treatment˟ / transitioning to Faster Cancer Treatment
4.
Increased Immunisation˟
5.
Better Help for Smokers to Quit˟
6.
More Heart and Diabetes Checks˟.
2.1.2 GOVERNMENT PRIORITIES
The 2014/15 Annual Plan Priority areas (in addition to the Health Targets) are:
Better Public Services (including Social Sector Trials):
 Reducing Rheumatic Fever˟
 Prime Minister’s Youth Mental Health Project*6,7
 Children’s Action Plan˟
 Whānau Ora˟
4
If your DHB has consistently met a Health Target, for example, Shorter Stays in Emergency Departments, then you are not
required to provide a detailed plan for 2014/15. DHBs do, however, need to commit to continue to meet the target and to the
actions the DHB already has in place.
˟ Refer to the Alliance Leadership Charter for a description of alliancing principles. While in 2014/15 there is no requirement that
NGOs are formal members of your ALT, the principle of partnership must underpin any service development. This includes the
primary care component of the Shorter Stays in Emergency Departments and Better Help for Smokers to Quit Health Targets.
5
Priorities with a ˟ in the list of priorities are included.
* DHBs are expected to use their Alliance Leadership Team and any Service Level Alliance Teams to jointly develop 2014/15 DHB
Annual Plans for the Youth Services component of the Prime Minister’s Youth Mental Health Project and Primary Care (including
6
Rural Health). These are indicated by a *in the list of priorities.
7 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.
10
System Integration:
 Diabetes˟ and Long Term Conditions˟
 Stroke˟
 Acute Coronary Syndrome˟
 Improved Access to Diagnostics˟
 Faster Cancer Treatment˟
 Cardiac – Secondary Services (network agreed)˟
 Primary Care*
 Health of Older People˟
 the Mental Health Service Development Plan˟
 Maternal and Child Health˟
National Entity Priority Initiatives
Improving Quality
Actions to Support Delivery of Regional Priorities
Living Within Our Means
Regional Service Plan Priorities
Regional Planning Priorities for 2014/15 include:
 Elective Services
 Cancer Services
 Cardiac Services (Acute Coronary Syndrome)
 Mental Health and Addictions
 Stroke Services
 Health of Older People
 Major Trauma
 Information Technology
 Workforce
DHBs are expected to include actions/milestones/budget allocations/measures to deliver of on regional
objectives in their Annual Plans. This will include, as appropriate, actions to deliver on Major Trauma as a
regional priority for 2014/15.
Appendix 8.1 provides a guide to content for each Government priority and Health Target. Aspects within
these tables that are mandatory are indicated as such. While the table structure itself is not mandatory this
is a useful model to follow to meet the expectations of this module.
11
For each priority area (e.g. Wrap-around Services for Older People), and sub-area of focus within the
priority area (e.g. Improving Dementia Pathways) in the guidance templates in appendix 8.1, 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 2014/15 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.
Primary care agreement to the specific activities in each area is to take the form of a signed letter of
support from primary care, with their support reflected in APs. For the templates provided at Appendix 8,
evidence must be provided that the identified section has been developed and agreed with primary care
partners: Regional, sub regional and local actions sponsored/led by the DHB to deliver on RSPs (CSPC 8A
rec: 16 & 22.8).
The DHB is expected to identify in their AP the specific activities it will undertake at a local level to deliver
on their RSP implementation plan commitments in the 2014/15 year.
DHB local priorities (NZPHD Act s38 2(a))
Outline specific activities the DHB will undertake to achieve its identified local strategic outcomes and
priorities and where these align with Government priority areas and targets.
12
MODULE 3: STATEMENT OF PERFORMANCE EXPECTATIONS
3.1
STATEMENT OF PERFORMANCE EXPECTATIONS
Statement of Performance Expectations (SPE) (New CE Act 2013 s149 (B-G))
To ensure that the SPE meaningfully supports the key strategic outcomes and priorities of the DHB’s
planned activities (as outlined in Modules 1,2 and 3) and performance, clear intervention logic is expected
to explain the link between the selected outputs and how they will contribute to impacts, and priorities
(CSPC 8A rec: 21.1 & 21.3). *Refer to definitions provided in the glossary (Appendix 8.2) to ensure
consistency of terms.
The SPE is to provide specific measures/targets for the coming year, with comparative prior year and
current year forecast (at a minimun). We encourage DHBs to provide both historic and future trends in your
SOI and SPE so far as it is meaningful and practical to do so.
Output classes (New CE Act s149E):
Four Output Classes are to be used by all DHBs to reflect the nature of services provided. The Output Class
categories are:


Prevention Services
Intensive Assessment and Treatment


Early Detection and Management
Rehabilitation and Support
There is a close correlation between these descriptions and the logic applied when mapping Purchase Unit
Codes (PUCs) to each output class last year.
For this module the DHB is required to describe services it plans, funds, provides, and promotes within each
Output Class. Include at least total expected revenue and proposed expenses for each Output Class (New
CE Act s149E).
13
MODULE 4: FINANCIAL PERFORMANCE
All sections within this module are mandatory (New CE Act 2013 s149C) and relate to a reporting
timeframe of five years minimum (prior year audited actual, current year forecast and three years’ plan.
(New CE Act 2013 s149G(2)(b))
Note: Financial templates submitted to the NHB in support of financial statements must be completed in
accordance with the 'Requirements and Guidelines for using Financial Templates' which are issued to
DHBs in conjunction with the blank templates.
*A checklist for financial templates is included in Appendix 8.3 for reference.
4.1
FINANCIAL PERFORMANCE
(New CE Act s149 (1)(a-g)), (CSPC 8A rec: 21.7)
Each statement of performance expectations must, in relation to a Crown entity and a financial year:
 contain forecast financial statements that comply with section 149G. (New CE Act 2013 s149E(1)(d))
and also for each reportable class of outputs:
 identify the expected revenue and proposed expenses for the class of outputs. (New CE Act 2013
s149E(2)(b))
Forecast financial Statements (New CE Act 2013 s149G(1)
Each statement of performance expectations, in relation to a Crown entity and a financial year, must
contain forecast financial statements for the financial year, prepared in accordance with generally accepted
accounting practice. The forecast financial statements must include:
 a statement of all significant assumptions underlying the forecast financial statements (New CE Act
2013 s149G(2)(a))
 any additional information and explanations to fairly reflect the forecast financial operations and
financial position of the DHB (New CE Act 2013 s149G(2)(b))
14
MODULE 5: STEWARDSHIP
.
MANAGING business to ensure we can deliver modules 1 & 2
This is the detail of how high level DHB strategic planning translates into action in an organisational sense
within the DHB.
It should show the DHB’s stewardship, (as owner, provider and funder) of its assets, workforce, IT/IS, and
other infrastructure needed to build organisational capability to deliver planned services (New CE Act
s141(2)(c)) (CSPC 8A rec: 21.2)
Explain how the entity intends to manage its functions and operations to meet its strategic intentions (
New CE Act s141(2)(b)). Intervention logic should reflect how organisational management enables the DHB
to progress towards achieving these. (CSPC 8A rec: 21.3)
*DHBs may wish to consider incorporating a range of performance measures within in this module as
suggested in the Treasury guidance (refer link page 3).
5.1
STEWARDSHIP
Managing our business (CSPC 8A rec: 21.2)
This section should reflect the scale and scope of your services and show the extent of resources required
to provide these services, covering physical, human and intellectual aspects. Consider comment on:
 organisational performance management
 funding and financial management (key high level figures/assumptions)
 alignment of the DHB’s agreed share of HBL costs and benefits with HBL’s work programmes
 risk management
 performance (availability/utilisation/functionality/ condition) and management of assets
 quality assurance and improvement.
Building capability (New CE Act s141(2)(c))
Outline the capabilities the DHB will need over the next three to five years and measures being taken in the
short term to work towards developing these. Reference any sub-plans the DHB uses to support
improvements in capability (this should be useful for future business planning and for auditing purposes).
Link to national or regional plans where relevant, including comment on:
 information communications technology (e.g. payroll system information)
 clinical technology/communication (e.g. patient specific information)
 quality assurance and improvement, including:
o how increased integration will improve quality
o the Health Quality and Safety Commissions Quality Markers and Quality Accounts, and
o as it is developed, the Patient Experience Indicator.
 capital and infrastructure development (three year forecasts and proposed funding, capital pressures,
mitigation)
 innovation and initiatives to achieve sustainability and a wider roll out of successful innovations.
 up-skilling the organisation to deliver improvement initiatives
 co-operative developments (working with other organisations, e.g. education and training providers)
15
Workforce
Managing our workforce within fiscal restraints (CAB Min (11) 24/5A)
To meet the Government Expectations for Pay and Employment Conditions in the State Sector this module
must include comments on:
 how the DHB will ensure bargaining will deliver organisational and sector performance improvement,
foster continuous improvement and productivity enhancement, support effective employee
engagement and achieve results as identified in the DHB’s budget plan
 how the identified business imperatives (such as improved performance and demonstrable recruitment
and retention difficulties) will be met
 how the pay structures and other conditions for employees are necessary to support the DHB business
and workforce objectives
Strengthening our workforce
The DHB will work with their Regional Training Hub Director to develop and deliver a workforce plan as part
of the 2014/15 Regional Service Plan. The workforce plan will outline regional actions and key milestones.
Further advice is contained in the 2014/15 Regional Service Plans’ Guidance.
There will be particular workforce issues which are local and need to be reflected in the DHB’s Annual Plan
(AP) in relation to the following:
a. Culture
b. Capability
c. Capacity
d. Change Leadership (guidance on each area is included in Appendix 8.6):
The DHB to demonstrate in its 2014/15 AP actions it will undertake and key milestones:





To support the training and development of at least x diabetes nurse prescribers during 2013/14 and
2014/15
To implement and evaluate the General Practice Education Programme (GPEP) 2 registrars training
alongside doctors registered in another vocational scope during 2014/15
To increase the number of trainee sonographers from x to y to meet current and expected future
demands
To provide robust career advice, guidance and support to all HWNZ funded trainees enabling their
career development
To meet the 70/20/10 funding criteria8 for post-entry training in medical disciplines.
Further areas of focus will be identified as HWNZ’s strategic direction progresses and Ministry, Government
priorities change. These will be added after consultation and agreement with DHBs.
Safe and Competent Workforce
The Vulnerable Children Bill, which is due to attain Royal assent in June 2014 contains some workforce
requirements relating to:
 Child Protection Policies
 Children’s Worker safety checks.
8
The funding model is part of the DHB’s new medical training agreement with HWNZ, effective from 1 January 2014 and was
provided to the DHBs on 24 September 2013. This new agreement is for a three-year term and it is anticipated that the funding
model will be adjusted annually, after consultation and agreement with DHBs.
16
Child Protection Policies (Part 1 Subpart 2 sections 17, 19, 20)
The Vulnerable Children Bill sets out various organisational requirements of DHBs relating to obligations to
adopt and report on a child protection policy.
DHB’s need to detail implementation of child protection policies as indicated in section 17 of the
Vulnerable Children Bill (below).
Section 17 of the Vulnerable Children’s Bill requires DHB boards to adopt and report on a child protection
policy. Every board of a DHB must:
a) adopt, as soon as is practicable, a child protection policy
b) report in its annual report (under the New CE Act 2004 s150) on whether, or on the extent to which, its
operations have implemented the policy
c) ensure that a copy of the policy is made available on an Internet site maintained by or on behalf of the
board
d) ensure that every contract, or funding arrangement, that after that commencement the board enters
into with an independent person requires the person as soon as practicable to adopt a child protection
policy
e) review the policy within 3 years.
Children’s Worker Safety Checking (Part 1 Subpart 3 sections 25 – 38)
The Vulnerable Children’s Bill is introducing worker safety checks to reduce the risk of harm to children by
requiring people employed or engaged in work that involves regular or overnight contact with children to
be safety checked. Section 38 requires the provision of information to the Director-General of Health, as
the Chief Executive of a key organisation, regarding the safety checking of children’s workers employed or
engaged by the organisation.
DHB’s must include in the Annual Plan:
 details of the DHB’s plans for recruiting workers in the children’s workforce including safety checking as
specified in Part 1, Subpart 3 (s25-38) of the Vulnerable Children Bill. The Bill is expected to receive
Royal assent in June 2014 after which the initial safety checking plan will be immediately applicable
 details for the implementation of worker safety checks for new employees in the core children’s
workforce from 1 July 2014 and for existing employees in the core children’s workforce from 3 years
after the date the provision comes into force (s25 – 26)
 details of plans to reassess workers on a 3 yearly basis (s27).
Every safety check must include:
 confirmation of identity of the person (prescribed by regulations)
 consideration of specific information prescribed by regulations made under section 32
 a risk assessment carried out as prescribed by regulations made under section 32 that assesses the risk
the person would pose to the safety of children if employed or engaged as a children’s worker.
Recruitment policies must also describe the DHB process for ensuring no person convicted of one of the
specified offences is employed or remains in the employment of the DHB unless the person holds an
exemption under section 34.
Organisational health (New CE Act s141(2)(c))
This notes your DHB’s Equal Employment Opportunities policy and may comment on governance,
leadership and management aspects as well as general human resources.
The following information must be included to satisfy legislation
(New CE Act s141(2)(d,e&f)):
17

explain how the entity proposes to assess its performance

any plans to enter into a body co-operative agreement or arrangement, or to acquire shares or
interests in any body corporate, trusts, joint venture partnerships and/or other association of
persons, to settle or appoint a trustee of a trust, and any processes to be followed and requirements
to consult with the Minister.

set out and explain any other matters that are reasonably necessary to achieve an understanding of
the entity's strategic intentions and capability: or that the entity is required to include in its
statement of intent under this Act or another Act.
*It is suggested DHBs include an express empowering provision for service agreements in the AP to avoid
any doubt in relation to Section 25(2) of the New Zealand Public Health and Disability Act 2000. DHBs are
encouraged to seek independent legal advice on appropriate wording with regards to this.
18
MODULE 6: SERVICE CONFIGURATION (NOT included in SOI extract)
6.1
SERVICE COVERAGE AND SERVICE CHANGE
Service coverage
DHBs should show that any significant changes to service coverage and delivery continue to support the
needs of their populations effectively.
Describe all service coverage exceptions that have been approved for the 2014/15 year. Provide a high level
note explaining why these exceptions have been required and the process followed for approval.
Service change
DHBs are to describe all service changes which have been approved for implementation in the 2014/15
year. For each change, provide a high level explanation that gives confidence the changes will deliver
benefits. It is suggested the DHB consider:

whether the change is directly linked to delivery within a lower future funding path

if the change is associated with regional clinical services planning

outlining the process followed for approval of the service change.
Service coverage exceptions and service changes must be formally approved before they are included in
Annual Plans. As in previous years DHBs are expected to provide early signals of proposed service changes
to the NHB. These are required by 14 February 2014.
Service issues
It is suggested the DHB includes any emerging or current service issues it considers relevant (where a
formal exception is not being sought).
19
MODULE 7: PERFORMANCE MEASURES (NOT included in SOI extract)
7.1
MONITORING FRAMEWORK PERFORMANCE MEASURES
* The performance measures table/template is mandatory. Note: the full detail of the monitoring
framework for 2014/15 forms a separate component part of the planning package.
Dimensions of DHB Performance Measures (Non-financial)
The AP must contain the key actions and outputs the DHB will deliver to meet performance targets for the
measures within the performance monitoring framework (CSPC 8A rec: 21.1 & 21.6).
Include the full set of performance measures in the following template and ensure accuracy across any
other use of this information in the narrative of the document (e.g. Health Target figures shown here match
those used in Module 2) and other plans i.e. the Māori Health Plan.
*Consider including a reference back to where these may have been included/expanded on in the Statement
of Performance Expectations, Health Targets or Government, regional and local priorities sections.
2014/15 Performance Measures
The current monitoring framework aims to provide the Minister with a rounded view of performance using
a range of performance markers.
Four dimensions are identified that reflect DHBs functions as owners, funders and providers of health and
disability services. The four identified dimensions of DHB performance cover:

achieving Government’s priority goals/objectives and targets or ‘Policy priorities’

meeting service coverage requirements and Supporting sector inter-connectedness or ‘System
Integration’

providing quality services efficiently or ‘Ownership’

purchasing the right mix and level of services within acceptable financial performance or ‘Outputs’.
It is intended that the structure of the framework and associated reports assists stakeholders to ‘see at a
glance’ how well DHBs are performing across the breadth of their activity, including in relation to legislative
requirements, but with the balance of measures focused on government priorities. Each target and
performance measure has a nomenclature to assist with classification as follows:
Code
PP
SI
OP
OS
DV
Dimension
Policy Priorities
System Integration
Outputs
Ownership
Developmental – Establishment of baseline (no target/performance expectation is set)
20
MODULE 8: APPENDICES (NOT included – for reference in developing documents only)
8.1
Module 2 Content Requirements
This section identifies the mandatory requirements for each priority area within Module 2.
The example templates also contain a range of suggested actions and measures for these priorities which,
while not mandatory, provide a strong signal on additional content that it is expected DHBs will consider
including in their AP.
HEALTH TARGETS9
The six Health Targets for 2014/15 are:
1.
Shorter Stays in Emergency Departments˟10
2.
Improved Access to Elective Surgery˟
3.
Shorter Waits for Cancer Treatment / transitioning to Faster Cancer Treatment˟
4.
Increased Immunisation˟
5.
Better Help for Smokers to Quit˟
6.
More Heart and Diabetes Checks˟.
GOVERNMENT PRIORITIES
The 2014/15 Annual Plan Priority areas (in addition to the Health Targets) are:
Better Public Services (including Social Sector Trials):
 Reducing Rheumatic Fever˟
 Prime Minister’s Youth Mental Health Project*11, 12
 Children’s Action Plan˟

Whānau Ora˟
System Integration:
 Diabetes˟ and Long Term Conditions˟
 Stroke˟
9
If your DHB has consistently met a Health Target, for example, Shorter Stays in Emergency Departments, then you are not
required to provide a detailed plan for 2014/15. DHBs do, however, need to commit to continue to meet the target and to the
actions the DHB already has in place.
˟ Refer to the Alliance Leadership Charter for a description of alliancing principles. While in 2014/15 there is no requirement that
NGOs are formal members of your ALT, the principle of partnership must underpin any service development. This includes the
primary care component of the Shorter Stays in Emergency Departments and Better Help for Smokers to Quit Health Targets; as are
10
areas in this list marked with a ˟.
* DHBs are expected to use their Alliance Leadership Team and any Service Level Alliance Teams to jointly develop 2014/15 DHB
Annual Plans for the Youth Services component of the Prime Minister’s Youth Mental Health Project and Primary Care (including
11
Rural Health). Marked with a *in the above list.
12
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.
21








Acute Coronary Syndrome˟
Improved Access to Diagnostics˟
Cardiac – Secondary Services (network agreed) ˟
Faster Cancer Treatment
Primary Care*
Health of Older People˟
the Mental Health Service Development Plan˟
Maternal and Child Health˟
National Entity Priority Initiatives
Improving Quality
Actions to Support Delivery of Regional Priorities
Living Within Our Means
Regional Services Plan Priorities
Regional Planning Priorities for 2014/15 include:









Elective Services
Cancer Services
Cardiac Services (Acute Coronary Syndrome)
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 to deliver of on regional
objectives in their Annual Plans. This will include, as appropriate, actions to deliver on Major Trauma as a
regional priority for 2014/15.
22
2014/15 DHB Planning Priorities
Structure of the templates – the integration story
Demands on health services are increasing within a tight financial environment. An ageing population, long term
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 coordinated 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:
o effective use of data to inform new models of care that eases the pressure on hospitals
o joint development of the new models of care
o improving quality through efficiency and effectiveness
o ensuring sufficient change management capability to undertake this development, and its implementation and
o effective clinical leadership.
Guidance in these templates covers all the Government’s priorities. The priorities have been clustered within the
templates to reflect the Government’s Better Public Service targets and requirement for increased system
integration. The sections with their component parts are:
Better Public Services (including Social Sector Trials):
System Integration:

Increased Immunisation Health Target

More Heart and Diabetes Checks Health Target
 Diabetes & Long Term Conditions
 Stroke
 Acute Coronary Syndrome

reducing rheumatic fever


Prime Minister’s Youth Mental Health Project

Shorter Stays in Emergency Departments Health
Target
Better Help for Smokers to Quit Health Target

Children’s Action Plan

Improved Access to Elective Surgery Health Target
 Diagnostic Waiting Times
 Cardiac Services

Whānau Ora

Shorter Waits For Cancer Treatment / Faster Cancer
Treatment Health Target




Primary Care
Health of Older People
the Mental Health Service Development Plan*
Maternal and Child Health
National Entity Priority Initiatives
Improving Quality
Actions to Support Delivery of Regional Priorities
Living Within Our Means
Regional Priorities
Regional Planning Priorities for 2014/15 include:

Elective Services

Cancer Services

Cardiac Services (Acute Coronary Syndrome)

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 to deliver of on regional objectives in their
Annual Plans. This will include, as appropriate, actions to deliver on Major Trauma as a regional priority for 2014/15. The
Line of Sight Guidance Framework is attached as Appendix 8.7.
23
2014/15 DHB Annual Plan Priorities and Expectations
Better Public Services and all of government initiatives (including Social Sector Trials)
Context
DHBs are to situate their actions, milestones and measures to meet the objectives of an initiative in this section in the
context of the integration story.
Objectives
A system that provides Better Public Services is one that has:

Decreasing incidence of rheumatic fever

More responsive mental health services for youth13

Fully immunised children

Early identification and support for vulnerable children.
Linkages – for templates in this section
1.
2.
3.
4.
5.
6.
Ministry’s Output Plan
Ministry’s Statement of Intent
Outcomes Framework (Module 1 and 2)
Maternal and Child Health Template
Mental Health and Addiction Service Development Plan 14
Whānau Ora Template
Living Within Our Means Template
7.
2014/15 DHB Annual Plan Priorities and Expectations
Reduced Incidence of Rheumatic Fever˟15

Meet 2014/15 targets for acute rheumatic fever initial hospitalisations

Deliver actions specified in 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 acute rheumatic fever initial hospitalisations for 2014/15

Delivery of the actions specified in the rheumatic fever prevention plans

Provide data from the root cause analysis as requested by the Ministry. A reporting template will be provided by the Ministry

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 2014/15 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
13
14
15
2014/15
Target:
40% reduction from baseline level
Rate
Numbers
6.3
1.4
1.9
7.9
4.0
2.1
4.7
2.3
5.6
0.5
2.5
10
8
9
42
69
8
5
5
3
1
21
These actions also support delivery of social sector trials
These actions also support delivery of social sector trials
˟
While in 2014/15 there is no requirement that NGOs are formal members of your DHB Alliance Leadership Teams, the principle of partnership
must underpin any service development. The Alliance Leadership Charter refers. The Primary Care components of both the Better Help for Smokers
˟
to Quit and Shorter Stays in Emergency Departments Health Targets are included; as are planning priorities in this table marked with a .
24
Hawkes Bay
MidCentral
Whanganui
Capital and Coast
Hutt
Wairarapa
Central region
Southern region
New Zealand
2.6
0.9
1.9
1.8
2.9
0.0
1.9
0.3
2.4
4
2
1
5
4
0
17
3
109
Children’s Action Plan˟

Reducing the number of assaults on children:
o
DHBs to develop and evaluate VIP programmes
o
DHBs to describe actions taken to plan, implement and/or maintain their National Child Protection Alerts System
o
DHBs to confirm provision of Ministry-accredited training for health professionals to recognise signs of abuse and
maltreatment in designated services

Implement the Children’s Action Plan:
Describe DHB actions to support establishment of Children’s Teams including
o
participation in regional Children’s Team governance and leadership involvement by DHB and non-DHB employed health
professionals,
o
collaboration with other agencies to plan, test and monitor assessment processes to support early response systems,
assessment processes and delivery of coordinated services for vulnerable children
o
work to develop effective referral pathways to/from Children’s Teams and primary and secondary health services
o
enabling health professionals to attend necessary training to support Children’s Teams.
Describe DHB service planning and development activity to provide an effective continuum of services across primary and referred
health services to meet the needs of:
o
pregnant women with complex needs
o
vulnerable children and their families
o
children in state care
o
children with mental health and behavioural problems
o
mental health and addiction service users in their role as parents
Measures






All DHBs achieve audit scores of 70/100 for each of the child and partner abuse components of their VIP programmes.
All DHBs implement NCPAS by 30 June 2015
DHBs support establishment of multi-disciplinary Children’s Teams
DHB has internal governance/engagement arrangements within the DHB 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
DHBs support the implementation of Rising to the Challenge (e.g. COPMIA), and
Healthy Beginnings: Developing perinatal and Infant Mental Health Services in NZ
Increased Infant Immunisation˟

Actions to support increasing infant immunisation rates (six weeks, three months and five months immunisation events) from 90 per
cent of eight-month-olds to 95 percent by December 2014:
o
maintain an immunisation alliance steering group that includes all the relevant stakeholders for the DHB’s immunisation
services including the Public Health Unit; and that participates in regional and national forums
o
work with primary care partners to monitor and increase new born enrolment rates to 100%
o
monitor and evaluate immunisation coverage at DHB, PHO and practice level, manage identified service delivery gaps
o
identify immunisation status of children presenting at hospital and refer for immunisation if not up to date
o
in collaboration with primary care stakeholders develop systems for seamless handover of mother and child as they move
from: maternity care services to general practice and WCTO services
o
in collaboration with NGOs and government agencies, describe how the DHB is working across agencies to increase
immunisation coverage
Measures
Increase infant immunisation rates increasing infant immunisation rates (six weeks, three months and five months immunisation events)
from 90 per cent to 95 percent by December 2014
a) 98% of newborns are enrolled with general practice by three months
b) Narrative report on DHB and interagency activities to promote immunisation week
c) 85% of 6 week immunisations are completed (measured through the completed events report at 8 weeks)
25
Whānau Ora˟

DHBs to provide actions that show support for implementation of the national Te Puni Kōkiri led Whānau Ora initiative that is
supported by the Ministry of Health. This includes DHBs supporting the transformation of Whānau Ora provider collectives towards
becoming mature providers through:
o
Building capacity and capability: build on the investment TPK has made to strengthen both the capacity and capability of the
provider collectives across the governance, management and service delivery levels
o
Being outcomes focused: continue implementation and refinement of integrated contracting processes, focused on
outcomes; and to work with the Ministry to support GP providers, who are part of Whānau Ora provider collectives, to use
their practice management systems to report on Whānau outcomes
o
Implementing programmes of action: support the provider collectives in the planned activities for implementation in 2014/15;
and substantive engagement with provider collectives
o
Supporting strategic change: strategic planning with the DHB includes participation of the Whānau Ora provider collectives;
building and maintaining relationships with agencies implementing Whānau Ora; and support for Whānau Ora across all levels
of the DHB, including at Board and Planning and Funding level
o
Minister Turia announced changes on the future direction of Whānau Ora in July. A key feature of the announcement is the
establishment of three NGO Commissioning Agencies. It is not yet clear what the commissioning agencies will look like and
what will be required of DHBs. Te Puni Kōkiri aim to complete the procurement process and be in a position to announce the
selected agencies by the end of this year. We will update you as soon as more information becomes available.
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
Prime Minister’s Youth Mental Health Project*
* DHBs are expected to use their Alliance Leadership Team and any Service Level Alliance Teams to jointly develop 2014/15 DHB Annual
Plans for the Youth Services component of the Prime Minister’s Youth Mental Health Project; and Primary Care (including Rural Health).
These are marked with a * in this table.
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.
Expand the use of HEEADSSS Wellness Checks in schools and primary settings:
o
HEEADSSS is a wellness check that is part of school-based health services.
o
Work in this area is yet to be confirmed
Improve the responsiveness of primary care to youth:

DHBs to establish a youth-specific Service Level Alliance Team (for 12 – 19 year olds), including YOSS where they exist, and other
stakeholders such as school based health services to determine local needs and agree service provision and funding. Examples of
appropriate activity include:

development of youth wellness hubs/networks

extend school based health services to provide HEEADSSS assessments to high-risk students in Decile 4 -5 secondary schools

workforce development for GPs, nurses and general practice receptionists to improve competency in working with youth in
primary care

set up a youth specific service as part of the primary care network, specifically targeting young people who do not attend
school.
Review and improve the follow-up care for those discharged from CAMHS and Youth AOD services:
o
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.
o
Ensure services are culturally-competent and provided to meet the health needs of Māori and Pacific populations.
Improve access to CAMHS and Youth AOD services through wait times targets and integrated case management:
o
implement agreed action 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:
o
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

Primary care services are more responsive to the specific needs of young people

Improved youth access to appropriate services

Improved integration of services for youth

Improved sustainability of youth-specific services, such as YOSS

The percentage of care plans will increase

Delivery against target.
26
System Integration
Context
DHBs should situate its actions, milestones and measures to meet the objectives of an initiative in the third section in the context of the
integration story.
All parts of the system are to jointly develop and implement services in high priority areas.
A new PHO Services Agreement, Alliance Agreement along with an Alliance Charter took effect 1 July 2013. DHBs are expected to use
their Alliance Leadership Team (ALT) and any Service Level Alliance Teams to jointly develop the 2014/15 Annual Plan with their primary
care partners to strengthen clinical integration. DHBs are expected to outline how they will achieve increased primary/secondary
integration (including the development of Service Level Alliance Teams for Rural Primary Care and Youth Services) during 2014/15
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 2014/15 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, Mental Health and
Addiction Plan, 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.
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, set 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, efficient manner.
Linkages – for all templates in this section

Ministry’s Output Plan





Ministry’s Statement of Intent
Outcomes Framework (Module 1 and 2)
Youth Mental Health Template
Diagnostic Services Template
Elective Services Health Target


Whānau Ora Template
Living Within Our Means Template
More Heart and Diabetes Checks˟

Use Budget 2013 funding to support primary care to deliver on the health target and ensure its sustainability

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.
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.
27
Diabetes and Long-term Conditions˟
DHBs, in collaboration with PHOs, primary and secondary care providers, and where feasible local consumers of care, will identify actions
to improve performance of in the Diabetes Care Improvement Packages (DCIPs) and long term conditions services that are driving demand
in the district including actions in the following areas:
Key Actions:

DHBs to continue to progress the Diabetes Care Improvement Plans (DCIPs) developed in 2013/14

Diabetes is the condition of focus and ensuring DCIPs are delivering the expected outcomes is the primary focus for DHBs. Successful
models developed for DCIP can then be utilised for other services.
Actions to include:

Prevention of diabetes and other LTCs through improved services to promote healthy lifestyles, including nutrition and physical
activity advice

Identification of populations at risk of diabetes or LTCs using risk stratification. Risk stratification is the systematic categorisation of
patients at risk of, or with, any long term conditions, in order to provide appropriate management.

DHB examples include:
o
Risk stratification is being implemented in all DHBs for the Acute Coronary Syndrome (ACS) programme using tools such as the
Global Registry of Acute Coronary Events (GRACE). The tools for long term conditions and chronic care are more gradually being
implemented at different rates across the country.
o
Counties Manukau DHB’s At Risk Individuals programme aims to reduce unplanned hospitalisations using the risk stratification
algorithm, Patients at Risk of Re-hospitalisation (PARR).
o
Auckland DHB developed an avoidable admissions plan for high risk individuals using the Predictive Risk Management (PRM)
algorithm which identifies individuals at high risk of admission to hospital.
o
West Coast DHB has augmented their long term conditions management with risk stratification also using the PRM algorithm.
This matches the people identified through new risk profiles with existing LTCM enrolees and incorporates into LTCM with
new/existing tools and structure.
o
Canterbury DHB is trialling three algorithms for risk of readmission within 12 months, risk of ED attendance within 6 months,
and risk of index admission within 12 months. This is based on work done in Scotland, which used pharmacy data as one of the
best predictors, although the DHB does not currently have access to the Pharmacy NHI level data.
Management of people with diabetes or LTCs will be person/whānau centred. Develop clinical pathways to ensure appropriate and
consistent access to all services and support. Self-management and other care plans will be developed in conjunction with people
and their whānau/family


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


Linkage with Ambulatory Sensitive Admissions to Hospital (ASH) rates
Measurement of improved diabetes outcomes using a set of clinical indicators to be developed.
Stroke Services˟
DHBs to:

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, 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 dedicated stroke units or areas for management of people with stroke, thrombolysis, and transient ischaemic attack services
supported by ongoing education and training for interdisciplinary teams

support national and regional clinical stroke networks to implement actions to improve stroke services.
Regional Alignment: DHBs to include actions/milestones/budget allocation/measures to deliver on Stroke Services as a regional priority in
their APs.
Measures

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.
28
Acute Coronary Syndrome˟




Implement 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 high risk ACS patients
Work with the regional, and where appropriate, the national cardiac networks to improve outcomes for high risk ACS patients.
A national definition for the counting of high risk will be made available as soon as it is agreed (intended before July 2014)
Regional Alignment: DHBs are expected to include actions/milestones/budget allocation/measures to deliver on Acute Coronary
Syndrome as a regional priority in APs.
Measures


70% of high-risk 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.
Shorter Stays in Emergency Departments˟


Diagnostic/analysis work to identify the main factors impacting on ED length of stay.
Further detail will be provided upon completion of the ED Quality Framework including information about increased reporting
requirements.
Measures
95 percent of patients will be admitted, discharged, or transferred from an Emergency Department within six hours.
Better Help for Smokers to Quit˟
Each DHB must provide clear actions on how it will ensure that:

all patients (who smoke and are seen by a health practitioner in primary, secondary and maternity care settings) are asked about
their smoking status, given brief advice to stop smoking, and are offered/given effective smoking cessation support (ie, ABC), as part
of their routine clinical care; and

each patient’s ABC information is documented accurately within their patient record.
Each DHB must also provide evidence that it has a current Tobacco Control Plan in place, and that the plan outlines what work will be
done, outside of the health target, to reduce the prevalence of smoking in the lead up to a Smoke free Aotearoa by 2025.




Identify concrete actions on how your DHB will ensure that the Better help for smokers to quit health target is embedded in hospitals’
routine care pathways. More robust actions will be expected from those DHBs that have not achieved the 95 percent target yet or
have been swinging below 95 percent in 2013/14
o
Examples of actions in this section could include providing weekly reports to ward managers on their health target performance,
and/or ensuring that 100 percent of staff have completed some form of ABC training
Outline what money or FTE your DHB will commit to improving the primary care component of the Better help for smokers to quit
health target in 2014/15; and what actions will be taken, by the DHB and PHOs, to reach the 90 percent target by 30 June 2015. In
2013/14, all DHBs were asked to transition more resource into primary care and develop a brief action plan. The actions in this
section should also reflect those discussions and should align with some of the More Heart and Diabetes Checks health target work
o
Examples of actions in this section could include providing weekly feedback to each practice on their health target performance,
ensuring that the health target is built into each practice’s own key performance indicators, identifying a smoke free champion
within each practice, and/or ensuring that 100 percent of practice staff have and know how to use audit and prompting tools
Although the maternity component of the Better help for smokers to quit health target is not being publicly reported on at present,
the Ministry still expects to see what actions the DHB will take in 2014/15 to support midwives and general practices to provide
pregnant women with advice and support to quit smoking
o
Examples of actions in this section could include providing 100 percent of midwives and general practitioners with ABC training
that is specific to pregnant women, and/or building relationships between midwives and local cessation services through
monthly or bi-monthly meetings
Provide evidence that your DHB has a current Tobacco Control Plan in place for its area, and that the plan outlines what work will be
done, outside of the health target, to reduce the prevalence of smoking in the lead up to 2025
Actions in your Tobacco Control Plan could include working with your local NGOs and councils to develop local smoke free
initiatives and/or to introduce further smoke free areas.
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 patients who smoke and are seen by a health practitioner in primary care will be offered brief advice and support to
quit smoking
 90 percent of pregnant women (who identify as smokers at confirmation of pregnancy in general practice or booking with a Lead
Maternity Carer) will be offered advice and support to quit smoking
 By 2025, less than 5 percent of the DHB’s population will be a current smoker.
29
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 be improved to achieve further reductions in waiting times for electives. No patient will wait longer
than five months during 2014, and waiting times are reduced to a maximum of four months by the end of December 2014.

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 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. This should include activity planned as part of Elective Services Productivity and Workforce Programme (ESPWP) projects,
where relevant

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 for FSA referrals as required.
Regional Alignment: DHBs to include actions/milestones/budget allocation/measures to deliver on Electives as a regional priority in their
APs.
Measures







Delivery against agreed volume schedule, including a minimum of xx elective surgical discharges in 2014/15 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 all patients wait four months or less for first specialist assessment
and treatment from January 2015
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 for referrals for FSA are reporting into new collection.
Improved Access to Diagnostics˟
Improving diagnostic waiting times has been identified a policy priority area for 2014/15. As a consequence, diagnostic waiting time
indicators are shifting from a developmental status to full DHB accountability measures in 2014/15. This means formal performance
targets will be set against the indicators for 2014/15.
Expectations are that DHBs:



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.
Measures
Refer PP29: Improving waiting times for diagnostic services: Note: Indicators have not yet been updated for 2014/15. They will be
confirmed following December 2013 results, and notified in early 2014




Coronary angiography – X% of accepted referrals for elective coronary angiography will receive their procedure within 3 months (90
days).
CT and MRI – X% of accepted referrals for CT scans, and X% of accepted referrals for MRI scans will receive their scan within six weeks
(42 days)
Diagnostic colonoscopy – X% of people accepted for an urgent diagnostic colonoscopy will receive their procedure within two weeks
(14 days); and X% of people accepted for a diagnostic colonoscopy will receive their procedure within six weeks (42 days)
Surveillance colonoscopy – X% of people waiting for a surveillance or follow-up colonoscopy will wait no longer than 12 weeks (84
days) beyond the planned date
Above indicators are expected for all DHBs for CT, MRI and colonoscopy. For coronary angiography, indicators are expected where those
services are locally provided.


Representation, attendance and participation in national and regional clinical group activities.
Agreed system changes are implemented.
30
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 no patient waits longer than five months for first specialist assessment or
treatment during 2014, and reduce waiting times to a maximum of four months by the end of December 2014
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)
Measures

Agreement to and provision of a minimum of XX total cardiac surgery discharges for your local population in 2014/15 (will be
provided in electives funding advice)

Refer PP29: Improved access to diagnostics. To be confirmed % of people will receive elective coronary angiograms within 90 days.
Expected for DHBs who provide angiography services only

Elective Services Patient Flow Indicators: all patients wait five months or less for first specialist assessment and treatment during
2014, and less than four months during 2015

Refer SI4: Standardised Intervention Rates
o Cardiac surgery: 6.5 per 10,000 of population
o Percutaneous revascularisation: 12.5 per 10,000 of population
o Coronary angiography: 34.7 per 10,000 of population

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.
Shorter Waits for Cancer Treatment / Faster Cancer Treatment˟





Identify actions to maintain timeliness of access to radiotherapy and chemotherapy
Actions to sustain performance could include:
Cancer centre DHBs:
o
using the recommendations from the National Radiation Oncology Plan to invest in workforce and/or invest in capacity
o
more efficient use of existing resources
o
supporting workforce training, in particular medical physicists
o
implementing the priority areas identified in National Medical Oncology Models of Care Implementation Plan 2014/15
Non cancer centre DHBs:
o
monitor provider DHBs
Identify actions to improve 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
identifying and implementing improvements to the quality of faster cancer treatment indicator data including ensuring that
reporting meets the data quality expectations as agreed in the DHB’s 2013/14 ‘Support for improving the faster cancer
treatment indicator reporting’ contract
o
making the faster cancer treatment data collection systems /processes part of business as usual
o
improving the functionality and coverage of multidisciplinary meetings (MDMs) across the region by implementing the
regionally agreed MDM priorities
o
undertaking a review of three tumour standards (different tumour types to the review undertaken in 2013/14)
o
supporting cancer nurse coordinators
Identify actions to improve waiting times and quality of endoscopy / colonoscopy services
Actions are expected to include:
o
implementing the Endoscopy Quality Improvement (EQI) programme
o
identifying and implementing improvements to colonoscopy services
Waitemata DHB with Auckland regional DHB partners:

support on-going activities associated with bowel screening pilot.
Regional Alignment: DHBs are expected to include actions/milestones/budget allocation/measures to deliver on Cancer as a regional
priority in their APs.
31
Measures
Performance maintained against the Shorter waits for cancer treatment health target (radiotherapy and chemotherapy) – all patients,
ready-for-treatment, wait less than four weeks for radiotherapy or chemotherapy,
Improvements in the performance against the policy priority (PP30) faster cancer treatment indicators:



62 day indicator - proportion of patients referred urgently with a high suspicion of cancer who receive their first cancer treatment (or
other management) within 62 days
14 day indicator - proportion of patients referred urgently with a high suspicion of cancer who have their first specialist assessment
within 14 days
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 six-monthly crown funding agreement variation – appoint cancer nurse coordinators reporting.
Monitor through policy priority (PP29) waiting times for diagnostic and surveillance /follow-up colonoscopy.


Diagnostic colonoscopy: TBC percent people accepted for an urgent diagnostic colonoscopy will receive their procedure within two
weeks (14 days); and TBC percent of people accepted for a diagnostic colonoscopy will receive their procedure within six weeks (42
days)
Surveillance/Follow-up colonoscopy: TBC percent of people waiting for a surveillance or follow-up colonoscopy will wait no longer
than 12 weeks (84 days) beyond the planned date.
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:










Evidence the annual plan was jointly developed and agreed by the Alliance Leadership Team
Increasing the number of services shifted into the community
Increasing the volume of direct referrals from primary care for flat X-rays and ultrasounds
Broadening the scope of POAC available to primary care (for those DHBs who do not already offer the level and breadth of services
described in the 2013/14 Guidance)
Embedding the referral pathways for primary care direct access to two elective surgery procedure lists
Improving and embedding the pathways for primary care access to specialist nurse and/or doctor advice for three high-demand
services
The work streams (Service Level Alliance Teams), e.g. acute demand, long term conditions, health of older people, agreed by the ALT
including use of the Flexible Funding Pool and an appropriate transition plan for work agreed out of scope
Implementation of the Integrated Performance and Incentive Framework (IPIF) once developed. Content to be advised.
Establish 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 by the end of Quarter One
In addition, DHBs are expected to use their Alliance Leadership Team and any Service Level Alliance Teams to jointly develop 2014/15
DHB Annual Plans for the following in 2014/15:
o Primary Care (including Rural Health) , and
o Prime Minister’s Youth Mental Health Project – Youth Services.
Measures

Improvement in the acute demand curve for the district

Improved performance of the district-wide system. Further specifics will be provided when the Framework is completed

Sustainable rural primary health care services.
Health of Older People˟
Rapid response and discharge management services (wrap around services) (PP23)

Implement the findings of your review of your DHB’s rapid response and discharge management services; ; and the lessons to be
learned from CREST (in Canterbury) and START (in Waikato)
Home and Community Support Services for Older People (PP23)

Use of Budget 2013 funding for home and community support services

Use of quality measures for Home and Community Support Services identified by the DHB HOP Steering Group
Dementia Care Pathways (PP23)

Continued development and implementation of dementia care pathways
Fracture Liaison Service (PP23)

Full operation of a fracture liaison service
Comprehensive Clinical Assessment is residential care (interRAI) (PP23)

Facilities trained or engaged in training in the use of interRAI

DHBs supporting the uptake of interRAI training
HOP specialists (PP23)

Proactive use of DHB specialist Health of Older People Services (geriatricians, gerontology nurse specialists) to advise and train health
professionals in primary care and aged residential care
Regional Alignment: DHBs to include actions/milestones/budget allocation/measures to deliver on HOP as a regional priority in their APs.
32
Measures

Evidence of implementation of findings from review of rapid response and discharge management services/teams

Evidence of continued price or volume increases based on receipt of Budget 2013 funding

Evidence of DHB using interRAI quality measures to progress and compare performance with other DHBs

Evidence of continued development and implementation of a dementia care pathway (- in line with the New Zealand Framework for
Dementia Care)

All aged residential facilities in DHB area using, or training their nurses to use, the interRAI LTCF assessment tool.

Evidence of how the DHB has supported the uptake of interRAI training

Evidence that the DHB has established a Fracture Liaison Service (FLS) and is monitoring its operation, in particular from the number
of people identified as having fragility fractures and the proportion who avoid a secondary fracture

The DHB has increased the number of hours that specialist HOP services consult with health professionals in primary care and aged
residential care (‘maintain’ rather than increase if already at an optimal level) or used another relevant measure to show an increase
or maintenance at optimal level (eg using FTEs rather than hours).
Mental Health Service Development Plan˟
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 at least 2 actions for each area, with targets and 6 monthly milestones for 2014/15

Deliver and report on required actions with targets and 6 monthly milestones for 2014/15 which will either increase access or improve
outcomes for each of the following Government work programmes:
o Drivers of Crime
o Welfare reforms

Implementation of the New Zealand Suicide Prevention Strategy 2006-2016 and the New Zealand Suicide Prevention Action Plan
2013-2016. DHBs are expected to provide evidence of how the following will be met:
o train health workers to identify and support individuals with self-harm injuries or at risk of suicide and refer them to the services
they need
o develop and implement district suicide prevention and postvention plans
o facilitate integrated cross-agency collaboration in respect to suicide prevention and response to suicide clusters/contagion

Mental health and addiction service provision ringfence
o Explain how the mental health and addiction ringfence is assured in the planning process. The ringfence calculation will include
demographic and cost pressure increases, supplemented by expenditure under- spends to bring forward growth so that the long
term growth path can be maintained. Also show the connection between maximising ringfence funding and addressing service
gaps.
Regional Alignment: DHBs to include actions/milestones/budget allocation/measures to deliver on Mental Health as a regional priority in
their APs.
Measures

PP6, PP7,PP8 ,PP26 &OS10

Submit district suicide prevention and postvention plans for review in the second quarter reporting.
Maternal and Child Health˟

Actions to improve the access that pregnant women, babies, children and families have to services that maintain good health and
independence:
o Timely registration with an LMC: Describe actions to increase the number of women who register with an LMC by week 12 of
their pregnancy, for example raising awareness through social media campaigns or improving referral pathways by working with
primary care or pharmacies
o Newborn enrolment: Describe actions to ensure all newborn babies are enrolled with a PHO and registered with a GP, Well Child
Tamariki Ora (WCTO) provider and Community Oral Health Services
o B4 School Check: Describe actions to increase B4 School Check coverage to 90 percent of the eligible population, for example
holding evening/weekend clinics, increased promotion or working with ECE providers to identify and invite children who have not
had a B4 School Check
o Oral Health: Commit to actions to improve referrals to, and enrolment in, oral health services for children 0-18 years of age
o WCTO Quality Improvement Framework: Implement between one and three quality improvement activities (not covered in the
above guidance) from the WCTO Quality Improvement Framework relating to improved access

Pregnant women, babies, children and families have improved health outcomes:
o WCTO Quality Improvement Framework: Implement between one and three quality improvement activities (not covered by the
above guidance) from the WCTO Quality Improvement Framework relating to improved outcomes

Services for pregnant women, babies, children and families are of high quality and are nationally consistent:
o Maternity Quality & Safety: Continue to implement Maternity Quality and Safety Programme, identify local quality improvement
priorities that include addressing National Maternity Monitoring Group priorities, DHBs who are outliers in the NZ Maternity
Clinical Indicators put programmes in place to reduce unnecessary variation in clinical practice
o Gestational Diabetes: Implement the national guideline for the screening, diagnosis and management of gestational diabetes
(expected to be released in early 2014)
o WCTO Quality Improvement Framework: Implement between one and three quality improvement activities (not covered by the
above guidance) from the WCTO Quality Improvement Framework relating to improved quality.
33
Measures


At least 80 percent of women register with an LMC by week 12 of their pregnancy.
98% of newborns are enrolled with general practice by three months


systems are in place to ensure enrolment of all newborn babies with WCTO and Community Oral Health Services
At least 90 percent of children receive a B4 School Check, including at least 90 percent of children living in high deprivation areas


Improved performance against WCTO Quality Indicators measuring access
Improved quality and safety of maternity services including improved access, outcomes and consumer satisfaction as measured by
national and DHB data analysis and surveys, reduced variation in performance against the NZ Maternity Clinical Indicators
A nationally consistent approach to the screening, diagnosis and management of gestational diabetes

34
National Entity Priority Initiatives

A national entity prioritisation process was led by the Health Sector Forum this year. National entity priorities for inclusion in 2014/15
DHB Annual Plans have now been finalised. A template was shared with DHB CFOs and GMs F&P on Thursday 20 February. Both
financial and non-financial information is required from DHBs to cover a period of four years (current and three outyears).
Improving Quality
HQSC priorities for 2014/15 are subject to confirmation following the conclusion of the Health Sector Forum led prioritisation process.

o
o
o
o
o

Identify actions to support the Quality & Safety Markers (QSMs) with a focus on achieving:
90 percent of older patients are given a falls risk assessment
80 percent compliance with good hand hygiene practice
all three parts of the surgical safety checklist used 90 percent of the time
95 per cent of hip and knee replacement patients receive cephazolin ≥ 2g as surgical prophylaxis
100 per cent of hip and knee replacement patients have appropriate skin preparation
Identify actions to support projects that make a difference to improving the quality of care, reducing patient harm and contribute to
the national patient safety campaign ‘Open for better care’

Identify actions to support improved patient experience through increased patient involvement in decision making (at all levels), and
the introduction of national survey questions as part of DHB systems for capturing consumer feedback

Identify actions to support continued implementation of quality accounts

The HQSC plans to review the 2012/13 quality accounts. As a result of the review it is anticipated that some areas where greater
standardisation is needed will be identified for the next set (2013/14) of accounts. Any mandatory areas identified will be updated in
DHB accountability documents once they are confirmed. The production future quality accounts will be aligned with the DHB annual
reporting timeframes.
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
Living within our means

Operate w/in agreed financial plans (and fund capital investment from internal sources)

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

Proactive management of employment cost growth and improved use of workforce

Reconfigure current service delivery models

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

Service coverage exceptions and service changes must be formally approved before they are included in Annual Plans. As in previous
years DHBs are expected to provide early signals of proposed service changes to the NHB, these are required by 14 February 2014.
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.
35
2014/15 Regional Services Plan Priorities and Expectations
The 2014/15 RSP priorities are mostly a continuation from 2013/14 with the exceptions of Health of Older People (which is now a required priority) and
Major Trauma as a new priority. DHBs are to include additional priority services which are appropriate for their region. To improve the visibility of
contributions by DHBs to achieve regional service priorities a Line of Sight guidance framework has been developed. Attached as Appendix 8.7.
Electives

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:

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

developing consistent pathway, access criteria, and clinical protocols for individual services

establishing and delivering sub-regional agreement to facilitate cross-boundary patient care

implementing sub-regional referral management and scheduling systems

delivering actions agreed to in regional 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
2017/18 of future workforce requirements, developed based on service demands and maintaining a local and regional view of specialist
workforce capacity and capability.
Measures
For the 2014/15 year it is expected that:

your region’s Electives Health Target will be met

by the end of December 2014, zero patients will wait more than 4 months for FSA or elective treatment

a maximum waiting time of 4 months is maintained from January 2015 onwards (ESPI 2 and ESPI 5).
Cancer Services


Identify the actions your region will undertake to improve access, timeliness and the quality of cancer services. For example:
Improve the functionality and coverage of multidisciplinary meetings (MDMs) by implementing the regionally agreed MDM priorities;
and

Implement actions that support the region to deliver on the priorities for cancer as outlined in the DHB annual plan guidance, e.g.
regional radiation oncology and medical oncology services.
Measures
For each quarter of the 2014/15 year it is expected that:




The cancer treatment health target will be met;
Improvement in performance against the policy priority (PP30) faster cancer treatment indicators is evidenced;
Progress against specific agreed actions to support the regional objectives is demonstrated; and
Improvement in coverage and functionality of MDMs as reported against the policy priority (PP24) improving waiting times – cancer
multidisciplinary meetings, is demonstrated.
Cardiac Services
 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-Q1 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.
Acute Coronary Syndrome
 The phased introduction of Accelerated Chest Pain Pathways16 (ACPPs) in Emergency Departments will begin in 2014/15. A working
group linked to the New Zealand Cardiac Network and Emergency Department Clinical Groups has commenced preliminary work on
ACPPs. Support will be provided to DHBs to develop, implement and measure ACPPs.
 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.
16
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.
36
Measures
Secondary Services




Standardised intervention rates:
o
Cardiac surgery: 6.5 per 10,000 of population
o
Percutaneous revascularisation: 12.5 per 10,000 of population
o
Coronary angiography: 34.7 per 10,000 of population
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.
No patient waits longer than five months for cardiac surgery during 2014, and waiting times are reduced to a maximum of four
months by the end of December 2014.
Acute Coronary Syndrome




Report quarterly on regional activity that supports Accelerated Chest Pain Pathway development and implementation
Each region will have established measures of ACS risk stratification and timeliness for patients to receive appropriate intervention.
70% of high-risk 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
Please note: A national definition for the counting of high risk will be made available as soon as it is agreed.
Mental Health and Addictions
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; and
Develop and implement actions for a Community Youth Forensic Service Plan with the agreed number of additional FTEs.
In the North Island, the regions Northern, Midland and Central develop and implement the appropriate options to establish a perinatal
and maternal mental health service as part of a continuum of care.
Measures



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 and
availability of liaison officers in court. For example: the number of liaison officers in court will increase from x to y with progress
tracked each quarter.
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.
Stroke
Continue to implement 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 with an interdisciplinary stroke team. Smaller DHBs, as defined in
the Stroke Guidelines, are expected to develop models of stroke care that adhere as closely as possible to the criteria for stroke unit
care.
All eligible patients, as specified in the clinical definition previously supplied to DHBs, have access to thrombolysis
All stroke patients receive early active rehabilitation by a multidisciplinary stroke team
All people with stroke have equitable access to community stroke services, regardless of where they live.
All members of the multidisciplinary stroke team participate in ongoing education and training according to the Stroke Guidelines.
Workforce
Identify actions that the region will take to develop and implement an ongoing education programme that supports a sustainable and
quality clinical workforce.
Information Technology
Identify actions that the region will take to support improved information management, e.g. establishing a regional oversight role.
37
Measures
Provision of quarterly reports that provide progress on:


6% of potentially eligible stroke patients thrombolysed
80% of stroke patients admitted to a stroke unit, or for smaller DHBs, stroke patients admitted to an organised stroke service with a
demonstrated stroke pathway
and:


% of eligible*patients receiving active rehabilitation (as recommended in the Stroke Guidelines) as part of their acute in-patient event
% of eligible* patients following discharge who receive community based stroke rehabilitation services
*Defined as those patients referred for rehabilitation by lead physician/neurologist
Health of Older People



Regions identify and develop components of dementia care pathways that are best achieved at a regional level. For example, X
components of dementia care pathways that are best achieved at a regional level are identified by 30 September 2014. Y
components of dementia care pathways are developed at a regional level by 31 March 2015
Regions develop and commence delivery of dementia awareness and responsiveness education programmes for primary health care
clinicians. For example, Z number of primary care clinicians have attended dementia awareness and responsiveness programmes
(number reported each quarter)
Regions provide representation at national dementia meetings organised by the Ministry of Health.
Workforce
Regions develop dementia awareness and responsiveness education programmes that educate primary health care clinicians on:




the importance of an early diagnosis of dementia
diagnosing dementia (e.g. diagnostic tools, use of CT scanning);
diagnosing delirium; and
managing dementia (including optimal use of acetylcholinesterase inhibitors and training on the use of the local dementia care
pathway).
Measures



Report quarterly on regional activity that supports DHB dementia care pathway development and implementation
Report six monthly on the development and commencement of dementia awareness and responsiveness education programmes in
Primary Health Care (as set out in the CFA variations)
X regional representatives attended national meetings organised by the Ministry of Health
Major Trauma

Regions develop and implement a three year regional action plan that in year 1 supports the collection and reporting of a nationally
consistent major trauma data set for each DHB in the region. Progress in years 2 and 3 focuses on the implementation of local and
regional major trauma systems

Establish a process so that each DHB in a region collects and reports the data required to implement a national major trauma
register by 1 July 2015. This will involve aligning local trauma definitions with those used in the New Zealand Major Trauma
Minimum Dataset (NZMTMD)

Regions identify a designated clinical lead and co-ordinator at each DHB to provide a focus for major trauma care delivery and
quality initiatives in 2014/15
Information Technology

All regions and DHBs will establish data systems capable of recording the fields in the NZMTDS to be able to report that data to the
national major trauma registry.
Measures

Where DHBs already have capacity to report on the NZMTMD, quarterly reporting on the NZMTMD on at least 50% of the fields will
commence on 1 July 2014

Where regions and DHBs are building capacity, it is expected that processes for measuring and commencing reporting on the full
NZMTMD will be established by 1 July 2015

All DHBs, will have commenced reporting on the full NZMTMD by 1 July 2015
38
Workforce, IT and Capital
Workforce

Workforce priorities for 2014/15 are subject to confirmation following the conclusion of the Health Sector Forum led prioritisation
process
DHBs to work with their Regional Training Hub Director to develop and deliver a workforce plan as part of the 2014/15 Regional Service
Plan (RSP). The workforce plan will include actions and key milestones. DHBs:

to implement workforce initiatives that will:
o
deliver on regional service priorities, as identified in the 2014/15 RSP and local workforce priorities as identified in the
DHBs’ annual plans
o
increase participation of Māori and Pacific from x to y FTEs in the workforce (e.g. scholarship programmes, supporting
high school based programmes)
o
reduce number of non-vocational registrars in PGY 3 and above from x to y
o
increase the number of New Zealand trained SMOs from x to y
o
provide x number of nursing graduates, registered and enrolled nurses, with a one year internship using innovative
strategies without increasing expenditure
o
meet the 70/20/10 funding criteria17 for post-entry training in medical disciplines in the region’s DHBs

to achieve the workforce mix and distribution required for the future. The workforce plan will use baseline workforce data collated
over the last five years, service demand forecasts and will take account of workforce requirements in hard-to-staff clinical
specialties and geographical high need areas

to implement systems to provide all HWNZ funded trainees with career advice, pastoral care and a career plan that aligns individual
career aspirations with regional and national identified future health workforce needs.
Build on the workforce section of the 2013/14 RSP and detail progress with actions and key milestones to:

standardise at least four PGY1 and 2 programmes (in addition to the eight already standardised during 2012/13 and 2013/14), roll
programmes out to other professional groups as appropriate, and optimise implementation across regions

implement at least two new roles/innovative ways of working, assist deployment of these across the region and share successes.
(For example: include registered nurse first surgical assistant, credentialing for primary care nurses in mental health and addictions,
physician assistant, and simulation based training for multi-disciplinary teams)

report on at least two clinical networks, detailing progress on network development and multi-disciplinary approaches. (For
example: include eye healthcare network, palliative care network, and cancer network)

report on at least two regional training programmes for the unregulated healthcare workforce, detailing progress. (For example
include training for clinical exercise physiologist and allied health assistant).
Measures
Regional and local DHB level progress reporting on the above requirements and key actions to be provided via quarterly RSP reports
Information Technology (IT)

IT priorities for 2014/15 are subject to confirmation following the conclusion of the Health Sector Forum led prioritisation process
The critical IT priorities for 2014/15 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.
17
The funding model is part of the DHB’s new medical training agreement with HWNZ, effective from 1 January 2014 and was
provided to the DHBs on 24 September 2013. This new agreement is for a three-year term and it is anticipated that the funding
model will be adjusted annually, after consultation and agreement with DHBs.
39
eMedicines
Reconciliation (eMR)
with eDischarge
Summary
Implementation of electronic
reconciliation of medicines on
admission and discharge from
hospital.
All DHBs
Health of Older
People and Long
term conditions
(Cancer, Cardiac
and Stroke)
All DHBs have implemented eMR
and the national clinical standard
for eDischarges
Regional Clinical
Workstation (CWS) and
Clinical Data
Repository (CDR)
Implementation of a regional
Clinical Workstation (Orion,
Concerto) and Clinical data
repository (mixed products).
Midland and
Central
regions
Supports all
service priorities
–the CWS and
CDR are the key
clinical systems
in the hospital
100% of the applicable
population have a CDR record
available through a regional view
Northland,
Auckland,
Whanganui,
MidCentral,
Wairarapa,
Nelson
Marlborough,
Canterbury
and South
Canterbury
DHBs
All DHBs
Supports all
service priorities
–the PAS is one
of the
backbones of
the hospital
All affected DHBs will be
implementing a supported PAS
Elective Services,
Long term
conditions –
cancer services
All DHBs have implemented
phase 2 of National Patient Flow
All DHBs – as
per the HBL
implementatio
n plan
Supports
financial
sustainability
As per the HBL implementation
plan
All PHOs
Health of Older
People, Mental
Health and
addictions
75% of PHOs provide an afterhours summary to ED
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.
Replacement of legacy
Patient Administration
Systems (PAS)
The 8 DHBs with legacy PAS need to
progress implementation of a
supported system that is aligned
with the regional plan.
The PAS supports and manages the
administrative details of a patients
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.
National Patient Flow
Finance Procurement
and Supply Chain
Self-Care Portal
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.
The Finance procurement and
Supply Chain programme will
implement a single finance
management information system,
common catalogue for the ordering
of goods and services, and
centralised procurement and
distribution processes for DHBs.
Portals are an on-line IT tool that
will enable individuals to have
access to their own health
information.
It will enable patients to
communicate with their primary
health practitioners and add
information to their health record.
25% of the PHO eligible
population have accessed a selfcare 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.
Capital – In 2013/15 the National Health Board (NHB) will collect the regional capital plans separately. Regional Services Planning remains
an integral part of capital investment planning, but quarterly reporting on capital will not be required via Regional Service Plans. The NHB
considers a separate process would reduce administrative workload for DHBs and focus DHBs on regional capital planning.
Measures

Regional and local DHB level progress reporting to be provided via quarterly regional services plan reports.
40
8.2
GLOSSARY OF TERMS
Term
Meaning
Activity
What an agency does to convert inputs to Outputs.
Capability
What an organisation needs (in terms of access to people, resources, systems,
structures, culture and relationships), to efficiently deliver the outputs
required to achieve the Government's goals.
Crown agent
A Crown entity that must give effect to government policy when directed by
the responsible Minister. One of the three types of statutory entities (see also
Crown entity; autonomous Crown entity and independent Crown entity)
Crown entity
A generic term for a diverse range of entities within one of the five categories
referred to in New CE Act 2004 s7, namely: statutory entities, Crown entity
companies, Crown entity subsidiaries, school boards of trustees, and tertiary
education institutions.
Crown entity subsidiary
A crown company is a company that is incorporated under the Companies Act
1993 that are controlled by Crown entities and that are: (a) a subsidiary of
another Crown entity under sections 5 to 8 of the Companies Act 1993; or (b)
a multi-parent subsidiary of 2 or more Crown entities New CE Act 2013 s7 1(c)
Cost containment
Reducing costs or cost growth in general, whether through improved
efficiency, or other means such as contract negotiation/consolidation,
changes to budget management, changes in structure etc.
Efficiency
Reducing the cost of inputs relative to the value of outputs.
Effectiveness
The extent to which objectives are being achieved. Effectiveness is
determined by the relationship between an organisation and its external
environment. Effectiveness indicators relate outputs to impacts and to
outcomes. They can measure the steps along the way to achieving an overall
objective or an outcome and test whether outputs have the characteristics
required for achieving a desired objective or government outcome.
Impact
Means the contribution made to an outcome by a specified set of goods and
services (outputs), or actions, or both (Public Finance Act 1989, s2). It
normally describes results that are directly attributable to the activity of an
agency. For example, the change in the life expectancy of infants at birth and
age one as a direct result of the increased uptake of immunisations.
Impact measures
Impact measures are attributed to agency (DHBs) outputs in a credible way.
Impact measures represent near-term results expected from the goods and
services you deliver; can often be measured soon after delivery, promoting
timely decisions; and may reveal specific ways in which managers can remedy
performance shortfalls.
(http://www.ssc.govt.nz/upload/downloadable_files/performancemeasurement.pdf page 13)
Input
The resources such as labour, materials, money, people, information
technology used by departments to produce outputs, that will achieve the
Government's stated outcomes.
Intervention
An action or activity intended to enhance outcomes or otherwise benefit an
agency or group.
41
Intervention logic model
A framework for describing the relationships between resources, activities
and results. It provides a common approach for integrating planning,
implementation, evaluation and reporting. Intervention logic also focuses on
being accountable for what matters – impacts and outcomes
(Refer State Services Commission ‘Performance Measurement – Advice and
examples on how to develop effective frameworks’
Intermediate outcome
See Outcome
‘Living within our means’
Providing the expected level of outputs within a break even budget or
National Health Board (NHB) agreed deficit step toward break even by a
specific time.
Management systems
The supporting systems and policies used by the DHB in conducting its
business.
Multi-parent subsidiary
A company (incorporated under the Act) is a multi-parent subsidiary if,
under sections 5 to 8 of the Companies Act 1993,—
 (a) the company is not a subsidiary of any one Crown entity; but
 (b) if 2 or more Crown entities were treated as 1 entity (a
combined entity), with their rights, entitlements, and interests
in relation to the company taken together, the company would
be a subsidiary of the combined entity (New CE Act s7(1 – 2)
A measure identifies the focus for measurement: it specifies what is to be
measured
Measure
Objectives
The use of this term recognises that not all outputs and activities are intended
to achieve “outputs”. For example, increasing the take-up of programmes;
improving the retention of key staff; improving performance; improving
Governance etc. are ‘internal to the organisation and enable the achievement
of ‘outputs’.
Outcome
Outcomes are the impacts on or the consequences for, the community of the
outputs or activities of government. In common usage, however, the term
'outcomes' is often used more generally to mean results, regardless of
whether they are produced by government action or other means. An
intermediate outcome is expected to lead to an end outcome, but, in itself, is
not the desired result. An end outcome is the final result desired from
delivering outputs. An output may have more than one end outcome; or
several outputs may contribute to a single end outcome.
A state or condition of society, the economy or the environment and includes
a change in that state or condition. (Public Finance Act 1989).
Output agreement
Output classes
Output agreement/output plan - See Purchase Agreement
An output agreement is to assist a Minister and a Crown entity (DHB) to
clarify, align, and manage their respective expectations and responsibilities in
relation to the funding and production of certain outputs, including the
particular standards, terms, and conditions under which the Crown entity will
deliver and be paid for the specified outputs. Responsible Minister may set
standards, terms, and conditions in respect of certain classes of outputs (New
Crown Entities Act 2004 s170).
An aggregation of outputs, or groups of similar outputs. (Public Finance Act
1989.) Outputs can be grouped if they are of a similar nature. The output
42
classes selected in your non-financial measures must also be reflected in your
financial measures.
Outputs
Final goods and services, that is, they are supplied to someone outside a
Crown Entity. They should not be confused with goods and services produced
entirely for consumption within the DHB group (New Crown Entities Act 2004
s136(1)(a – c))
Ownership
The Crown's core interests as 'owner' can be thought of as:
Strategy - the Crown's interest is that each state sector organisation
contributes to the public policy objectives recognised by the Crown.
Capability - the Crown's interest is that each state sector organisation has, or
is able to access, the appropriate combination of resources, systems and
structures necessary to deliver the organisation's outputs to customer
specified levels of performance on an ongoing basis into the future;
Performance - the Crown's interest is that each organisation is delivering
products and services (outputs) that achieve the intended results (outcomes),
and that in doing so, each organisation complies with its legislative mandate
and obligations, including those arising from the Crown's obligations under
the Treaty of Waitangi, and operates fairly, ethically and responsively.
Performance measures
Selected measures must align with the DHBs Regional Service Plan and Annual
Plan. Four or five key outcomes with associated outputs for non-financial
forecast service performance are considered adequate.
Appropriate
measures should be selected and should consider quality, quantity,
effectiveness and timeliness. These measures should cover three years
beginning with targets for the first financial year (2014/15) and show
intended results for the three subsequent financial years.
Priorities
Statements of medium term policy priorities.
Productivity
Increasing outputs relative to inputs (i.e.: either more outputs produced with
the same inputs, or the same output produced using fewer inputs)
Purchase agreement
A purchase agreement is a documented arrangement between a Minister and
a department, or other organisation, for the supply of outputs.
Regional
integration
Regional integration refers to DHBs across geographical ‘regions’ for the
purposes of planning and delivering services (clinical and non-clinical)
together. Four regions exist.
 Northern: Northland DHB, Auckland DHB, Waitemata DHB and Counties
Manukau DHB
 Midland:
Bay of Plenty DHB, Lakes DHB, Tairawhiti DHB, Taranaki DHB
and Waikato DHB
 Central:
Capital and Coast DHB, Hawkes Bay DHB, Hutt Valley DHB,
MidCentral DHB, Waitemata DHB and Whanganui DHB
 Southern: Canterbury DHB, Nelson Marlborough DHB, South Canterbury
DHB, Southern DHB and West Coast DHB
A region for some clinical networks may vary slightly to the four regional
groupings described above. For example Central Cancer Network contains
seven DHBs, with Taranaki DHB in addition to the Central Region DHBs.
Results
Sometimes used as a synonym for 'Outcomes'; sometimes to denote the
degree to which an organisation successfully delivers its outputs; and
sometimes with both meanings at once.
43
Standards of Service
Measures
Measures of the quality of service to clients which focus on aspects such as
client satisfaction with the way they are treated; comparison of current
standards of service with past standards; and appropriateness of the standard
of service to client needs.
Statement of Performance
Expectations (SPE)
Government departments and Crown entities are required to include audited
statements of objectives and statements of performance expectations with
their financial statements. These statements report whether the organisation
has met its service objectives for the year.
Strategy
See Ownership
Sub regional collaboration
Sub regional collaboration refers to DHBs working together in a smaller
grouping to the regional grouping, typically in groupings of two or three DHBs
and may be formalised with an agreement. For example a Memorandum of
Understanding. Examples of sub regional collaboration include DHBs in the
Auckland Metropolitan area, MidCentral and Whanganui DHBs
(CentralAlliance), Capital and Coast, Hutt Valley and Wairarapa DHBs and
Canterbury and West Coast DHBs.
Targets
Targets are agreed levels of performance to be achieved within a specified
period of time. Targets are usually specified in terms of the actual
quantitative results to be achieved or in terms of productivity, service volume,
service-quality levels or cost effectiveness gains. Agencies are expected to
assess progress and manage performance against targets. A target can also be
in the form of a standard or a benchmark.
Values
The collectively shared principles that guide judgment about what is good and
proper. The standards of integrity and conduct expected of public sector
officials in concrete situations are often derived from a nation's core values
which, in turn, tend to be drawn from social norms, democratic principles and
professional ethos.
Value for money
The assessment of benefits relative to cost, in determining whether specific
current or future investments/expenditures are the best use of available
resource.
44
8.3
ANNUAL PLAN REVIEW: FINANCIAL STATEMENTS 2014/15 (and supporting templates)
* Financial checklist to help DHBs ensure they have provided all the required information.
1. Financial Statements
Requirements
Interpretation
1 Does the AP contain a complete
set of consolidated financial
statements that comply with
applicable legislation, GAAP and
Crown accounting policies?
AP financial statements prepared under GAAP are forecast financial
statements required to cover five years: prior year audited actual,
current year forecast and three years’ plan.
As a minimum, AP financial statements must include:
 a full set of consolidated financial statements including:
 financial performance showing
1 Revenue as MOH Sourced, Other Government sourced, and
other, and Inter-DHB and Internal Revenue.
2 Expenses as the major services of Personal, Mental,
Disability Support, Public and Māori plus Personnel costs,
Outsourced services costs, Clinical supplies costs, and
Infrastructure, Non Clinical supplies and Other costs.
 financial position showing Current and Non-current Assets,
Current and Non-current Liabilities and Equity
 cash flows detailing Cash in and Cash out for Operating,
Investing and Financing Activities
 movements in equity showing Opening Balance, Net results,
Revaluation of Fixed Assets, Equity Injections/ Repayments,
and Other (New CE Act 2004 s149G(1))

Summary statements of financial performance for each arm
(Provider, Funder and Governance) showing;
1
Revenue from Ministry of Health, other Government, NonGovernment and Other, and Inter-DHB and Internal
Revenue.
2
Provider arm expenses – split by Personnel, Outsourced
services, Clinical supplies, and Infrastructure and Non
Clinical supplies and Other.
3
Funder arm expenses – split by major service areas, eg,
Personal, Mental, Disability support, Maori, Public and
Other.
4
Governance arm expenses split by Personnel, Outsourced
services, Clinical Supplies, and Infrastructure and Non
Clinical supplies and Other
2 Does the AP explain the nature, Statement of accounting policies (New CE Act 2004 s149G(1)).
reasons for, and effects on the Accounting policies applied in the AP financial statements should be
AP financial statements of any consistent with prior years unless a change of policy has been noted.
significant change in accounting
policies?
45
3 Does the AP contain a The AP must include a statement of all significant assumptions
statement of all significant underlying the financial statements (New CE Act 2004 s149G(2))
assumptions underlying the
financial statements?
4 Do the financial statements The financial statements and any related narrative information should
align with the text of the be consistent with any general or narrative information presented with
document?
them.
5 Has the DHB supplied complete AP templates for 2014/15 are:
AP financial templates that
1. AP Financial Template
agree to the AP financial
2. Mental Health Financial Plan Template
statements?
3.
Revenue Reconciliation
4.
Production Plan
Financial information in the Mental Health financial plan template,
revenue reconciliation and Production Plan must agree back to the AP
Financial Template
6 Does the DHB include mention
of any subsidiaries in which it
has an interest?
If a DHB subsidiary is a single-parent subsidiary then it is not required
to produce a separate SOI/SPE if it is covered in the parent DHB’s
SOI/SPE (New CE Act 2004 s156(A)(1)). If a DHB’s subsidiary is a multiparent subsidiary then it is not required to prepare a SOI/SPE (New CE
Act 2004 s157A(2)). A multi-parent subsidiary may, however be
directed to prepare an SOI/SPE by the Minister of Finance (New CE Act
2004 s157A(3)). These may include the condition that the SOI of one of
the parents must cover the multi-parent subsidiary.
2. Planned Net Results
Requirements
Assumptions
1 a) Are the DHB’s planned net 
results acceptable?
The Ministry will assess this section against the following criteria:

b) Are the DHB’s planned
productivity improvement
initiatives appropriate and
achievable?





Do the planned net results meet the Minister of Health’s
expectations for the four plan years of the AP?18
If there is a planned deficit caused by Mental Health deficits, is
there a genuine DHB surplus available to carry forward to
cover the deficit?
If there is a planned deficit (other than for Mental Health), is
there a genuine DHB surplus available to carry forward to
cover the deficit?
If the DHB plans consolidated deficit(s), is there appropriate
approval to submit an AP including deficit(s)?
Does the AP include sound realistic and quantifiable action
plans or efficiency projects to address planned deficits or to
ensure breakeven is achieved?19
Significant savings anticipated from action plans of efficiency
projects should be explained and justified in the AP, or in a
confidential document sent separately to the Ministry]
18
The Minister’s expectations for net results will either be expressly stated in correspondence to the DHB or be the approved net
results in the previous year’s AP for the second and third plan years.
19 Sound action plans and efficiency projects means plans and projects that have quantifiable savings or cost reductions, are timebound and can be realistically achieved.
46
3. Revenue Assumptions
Requirements
Assumptions
1 Does total devolved revenue
(including Inter-District Flows)
agree with the latest Funding
Envelope? If not, are variances
appropriate and explained?
All devolved revenue received from the Ministry that is disclosed in the
AP will be confirmed against what has been advised in the latest
Funding Envelope. Variances from the latest Funding Envelope should
be explained in the Revenue Reconciliation20
2 Does revenue for non-devolved All non-devolved revenue sourced from the Ministry will be confirmed
service contracts materially directly with the responsible Ministry directorates.
agree with what has been
advised by the Ministry?
3 Out-year revenue assumptions Indicative out-year revenue increases are advised in the latest Funding
consistent with Ministry advice? Envelope.
4. Cost and Volume Assumptions
Requirements
Interpretation
1 Are the assumptions for
personnel costs, outsourced
services costs and Full Time
Equivalent (FTE) movements
appropriate and 1adequately
explained?
Assessment of whether cost assumptions are ‘appropriate’ and
‘adequately explained’ will be based on whether cost changes are
consistent with:
1.
2.
financial information disclosed in the AP and AP financial
templates
estimated revenue growth advised in the latest Funding
Envelope
the percentage ranges estimated in CPI and salary indices
changes in volumes, practices, service delivery, etc.
2 Are
planned
interest,
depreciation, capital charge 3.
costs
and
assumptions 4.
appropriate and adequately
Significant variation from the latest Funding Envelope or indices should
explained?
be explained and justified in the AP, or in a confidential document sent
3 Are all other cost assumptions separately to the Ministry. Expenditure planned for out years should
(eg, clinical supplies costs) reflect a realistic assessment of requirements to support the projected
appropriate and adequately revenue stream in those years. It should not be derived simply by
explained?
applying the same preliminary increase as for revenues to each
expenditure line.
4 Is the productivity gain and
associated risk inherent in the
plan clearly explained?
5. Fixed Assets
1 Does the AP include a
No interpretation required.
statement about:
a) when assets were last
revalued
b) in which year the next
revaluation will take place as
required
by
relevant
accounting standards.
2 Does the AP include, (if known), No interpretation required.
the
asset
impacts
and
additional costs resulting from
re-evaluation?
20
Funding Envelope’ refers to the most recent Funding Envelope advice letter for 2013/14, sent to DHBs by the Ministry.
47
3 Does the DHB note its strategy No interpretation required.
for actively disposing of assets
which
are
surplus
to
requirements?
4 Does the AP include a
statement about the procedure
for disposing of any land
transferred to, or vested in the
DHB under the Health Sector
(Transfers) Act 1993?
Section 42(2) of the NZPHD Act requires the inclusion a statement
about a DHB’s procedure for disposing of land transferred to or vested
to it under the Health Sector (Transfers) Act 1993, irrespective of
whether land disposals are planned
6. Capital Expenditure
Requirements
Interpretation
1 Is the capital expenditure No Interpretation required
section of the AP consistent
with
the
DHB’s
asset
management plan and the
relevant Regional Services Plan?
2 Does the capital expenditure An ‘approved’ capital project means that the DHB has a letter from the
section of the AP narrative Minister of Health approving that capital project.
reflect major capital projects,
clearly distinguishing between
approved and unapproved
projects and whether they are
baseline or strategic?
3 Are sources of planned capital Sources of planned financing may include:
financing for both baseline and 1. DHB contribution
strategic capital expenditure
2. New Crown debt (approved/unapproved)
clearly identified?
3. Crown equity (approved/unapproved)
4. Finance leases
5. Community donations/funding.
4 Is capital expenditure and
financing correctly reflected in
all sections of the AP financial
template including the cash
flow statement
The AP financial template should reflect only approved capital
expenditure (even if included in baseline capital expenditure) and
financing. The only exception is for the capital plan worksheet which
should also include unapproved capital projects and anticipated
sources of funding.
7. Debt and Equity
Requirement
Interpretation
1 Does the AP include a schedule
of key lenders, borrowing
arrangements (including rates
and limits) that distinguish
between new and existing
borrowing facilities?
The schedule of key lenders should cover working capital, short-term
and long-term borrowing and finance leases.
2 Does the AP show the related
banking covenants, and is the
DHB planning to meet them?
48
8.4
OUTPUT CLASS RECOMMENDATIONS
Output Class definitions
It is expected that all DHBs will use the following output class definitions:
Prevention




Preventative services are publicly funded services that protect and promote health in the whole
population or identifiable sub-populations comprising services designed to enhance the health
status of the population as distinct from treatment services which repair/support health and
disability dysfunction.
Preventative services address individual behaviours by targeting population wide physical and
social environments to influence health and wellbeing.
Preventative services include health promotion to ensure that illness is prevented and unequal
outcomes are reduced; statutorily mandated health protection services to protect the public from
toxic environmental risk and communicable diseases; and, population health protection services
such as immunisation and screening services.
On a continuum of care these services are public wide preventative services.
Early Detection and Management



Early detection and management services are delivered by a range of health and allied health
professionals in various private, not-for-profit and government service settings. Include general
practice, community and Māori health services, Pharmacist services, Community Pharmaceuticals
(the Schedule) and child and adolescent oral health and dental services.
These services are by their nature more generalist, usually accessible from multiple health
providers and from a number of different locations within the DHB.
On a continuum of care these services are preventative and treatment services focused on
individuals and smaller groups of individuals.
Intensive Assessment and Treatment Services



Intensive assessment and treatment services are delivered by a range of secondary, tertiary and
quaternary providers using public funds. These services are usually integrated into facilities that
enable co-location of clinical expertise and specialized equipment such as a ‘hospital’. These
services are generally complex and provided by health care professionals that work closely
together.
They include:
- Ambulatory services (including outpatient, district nursing and day services) across the range
of secondary preventive, diagnostic, therapeutic, and rehabilitative services
- Inpatient services (acute and elective streams) including diagnostic, therapeutic and
rehabilitative services
- Emergency Department services including triage, diagnostic, therapeutic and disposition
services
On a continuum of care these services are at the complex end of treatment services and focussed
on individuals.
Rehabilitation and Support


Rehabilitation and support services are delivered following a ‘needs assessment’ process and
coordination input by NASC Services for a range of services including palliative care services,
home-based support services and residential care services.
On a continuum of care these services will provide support for individuals.
49
Recommended outputs that may be useful for describing bundles of service within each output class are
included in the table below:
PREVENTION
Health Promotion and Education
Statutory Regulation
Population Based Screening
Immunisation
Well Child Services
EARLY DETECTION & MANAGEMENT
Primary Health Care
Oral Health
Primary Community Care Programmes
Pharmacist
Community Referred Testing & Diagnostics
Mental Health
INTENSIVE ASSESSMENT & TREATMENT
Mental Health
Elective (Inpatient/Outpatient)
Acute (Emergency Department/Inpatient/Outpatient)
Maternity
Assessment Treatment & Rehabilitation
REHABILITATION & SUPPORT
Needs Assessment & Service Coordination
Palliative Care
Rehabilitation
Age Related Residential Care Beds
Home Based Support
Life Long Disability
Respite Care
Day Services
50
8.5
CROWN ENTITIES’ ACCOUNTABILITY REQUIREMENTS
New Crown Entities Act 2004 (CE Act) as amended by the Crown Entities Amendment Act 2013

s139 Obligation to prepare statement of intent

“(1) A Crown entity must provide to its responsible Minister a statement of
intent for the Crown entity that complies with this section and section 141.
“(2) A statement of intent must relate to the forthcoming financial year and at
least the following 3 financial years.
“(3) The Crown entity must provide a statement of intent at least once in every
3-year period.
“(4) This section applies unless the Crown entity is exempted from the
requirements of this section by or under this or another Act.

s139A Minister may require Crown entity to prepare new statement of intent at any time
 “(1) A Crown entity's responsible Minister may, if the Minister considers it
necessary or desirable, require the Crown entity to provide a new statement of
intent at any time.
“(2) A statement of intent provided under this section must comply with
sections 139 and 141.
“(3) Despite section 139(2), the Minister may require the new statement of
intent to relate to the remainder of the current financial year in addition to the
forthcoming financial year and at least the following 3 financial years.

139B Minister may grant extension of time for, or waive, requirement to provide statement
of intent
 “(1) If a Crown entity is likely to have a significant change in the nature or scope
of its functions, the responsible Minister may grant the Crown entity an
extension, of up to 1 year, of the period specified in section 139(3).
“(2) However, the responsible Minister must not grant an extension unless he or
she is satisfied that the extension will enable the entity to improve the quality of
the statement of intent that it provides.
“(3) If a Crown entity is likely to be disestablished or, in the case of a Crown
entity company, removed from the register under the Companies Act 1993, the
responsible Minister may grant the entity a waiver of the requirements in
section 139.
“(4) If the responsible Minister grants an extension or a waiver under this
section,—
 “(a) the responsible Minister must, as soon as practicable after granting
the extension or waiver, notify the Crown entity of the extension or
waiver and the Minister's reasons for granting it; and
 “(b) the Crown entity must, as soon as practicable after receiving notice
under paragraph (a), publish notice of the extension or waiver, and the
Minister's reasons for granting it, on an Internet site maintained by or
on behalf of the Crown entity; and
 “(c) the Crown entity must include, in the next annual report that it
provides to its responsible Minister for presentation to the House of
Representatives under section 150, a statement of the exemption or
waiver and the Minister's reasons for granting it.”
51
s141
Content of statement of intent
(1) A statement of intent must, for the period to which it relates, set out the strategic
objectives that the entity intends to achieve or contribute to (strategic intentions).
(2) A statement of intent must also, for the period to which it relates,—
(a) explain the nature and scope of the entity's functions and intended operations:
(b) explain how the entity intends to manage its functions and operations to meet its
strategic intentions:
(c) explain how the entity proposes to manage its organisational health and capability:
(d) explain how the entity proposes to assess its performance:
(e) identify any process to be followed for the purpose of section 100:
(f) set out and explain any other matters—
(i) that are reasonably necessary to achieve an understanding of the entity's strategic
intentions and capability:
(ii) that the entity is required to include in its statement of intent under this Act or another
Act.
(3) A statement of intent—
(a) must be in writing, be dated, and be signed on behalf of the board by 2 members or, in
the case of a corporation sole, by the sole member; and
(b) is a final statement of intent when it has been signed in accordance with paragraph (a).
s149C Obligation to prepare statement of performance expectations
(1) Before the start of each financial year, a Crown entity must prepare a statement of
performance expectations for that financial year that complies with section 149E.
(2) However, if the Crown entity does not propose to supply any reportable classes of outputs in
that financial year, the entity's statement of performance expectations—
(a) must comply with section 149E(1)(b) to (d) and (3); but
(b) need not comply with section 149E(1)(a) or (2).
New Zealand Public Health and Disability Act 2000 (NZPHD Act)
s38
(1)
(a)
(b)
(2)
(a)
(b)
(c)
(d)
Planning framework and requirements
The Minister —
must direct every DHB to prepare a plan for each financial year beginning on or after 1 July 2011;
and
may direct a DHB to prepare or contribute to 1 or more other plans.
Every plan—
must address—
(i) local, regional, and national needs for health services; and
(ii) how health services can be properly co-ordinated to meet those needs; and
(iii) the optimum arrangement for the most effective and efficient delivery of health services; and
must demonstrate how a DHB that is a party to the plan is to give effect to the purposes of this
Act; and
must demonstrate how a DHB that is a party to the plan is to operate in a financially responsible
manner; and
must reflect the overall direction set out in, and not be inconsistent with, the New Zealand health
strategy and the New Zealand disability strategy.
52
New Zealand Public health and Disability (Planning) Regulations 2011
s8
(a)
Content of DHB annual plan
A DHB annual plan must include the following:
a statement outlining how the DHB's performance as a funder and as a provider of services is to be
demonstrated:
(b)
an outline of the DHB's stewardship, as owner, of its assets, workforce, information technology
and information services, and other infrastructure needed to deliver its services. [The Minister
expects clear planning, monitoring and reporting of the DHB’s separate roles as funder and
provider of services and owner of Crown assets];
(c)
a strong explanation of the link between—
(i) funding, key actions, and outputs; and
(ii) expected impacts and outcomes:
key actions and outputs, linked to funding, that the DHB will deliver in order to meet Government
priorities and health targets, including the DHB's performance targets for all measures within the
performance monitoring framework:
(d)
(e)
a statement of service coverage requirements, service change requirements, emerging policy or
sector issues, and any relevant Māori health or other sub-plan requirements:
(f)
detailed outputs for which the DHB will be held to account, both as a funder of services for its
population and as a provider of services:
(g)
detailed financial budgets:
(h)
a statement of the actions the DHB will lead, or will deliver (as the case may be), to support
delivery of any—
(i) regional service plans in which the DHB is to participate, including (without
limitation) the implementation element of the plan (as reviewed annually under
regulation 7(3)); and
(ii) relevant national service plans.
53
8.6
Strengthening Our Workforce – Dimensions of the Workforce Plan
Strengthening our workforce
How will we match our workforce to our local, regional and national strategies to achieve our desired future state?
Information and Analysis
-
-
What information/data do we need to inform our workforce decisions? What information do we have on how productive we are and whether we
are improving?
Where will our people supply come from? What is the lead-in time to produce the skills we need?
What external information do we need, and do we have it? (E.g. labour market dynamics; supply and demand factors. What are our forecast wage
cost pressures?
Culture
- What people and organisational behaviours do we need to deliver
high quality services for our community?
- Does our current culture foster the environment and level of
workforce engagement needed to achieve our goals?
- What culture do we want for the future? What is our strategy to
achieve the culture we need? What is our approach to equality and
diversity?
- How will we maintain/develop the staff engagement we need?
- How will organisational change impact on organisational culture?
How will this impact be managed?
Change Leadership
-
What is our change strategy? What organisational development
strategies do we have in place?
-
What resources will be needed to ensure the success of our change
programme?
-
What is our strategy to engage our staff and encourage their input
around change? How will we engage unions with the organisation’s
direction? What’s our strategy for stakeholder communication around
the change required?
How does this impact our funding track?
-
Capacity (numbers)
Capability
-
-
What workforce capability do we have/need to meet our current
requirements (e.g. occupational groups/competencies and mix of
skills)?
What workforce capability do we need to achieve our
organisational goals?
How will we achieve the capability we need (develop recruit/
outsource/contract in)?
What is our strategy for new roles and workforce innovation?
How will we grow our leadership capability? Do we need to
develop our capability for leading change?
How does our approach to capability impact our funding track?
-
-
-
What is the core workforce required to deliver our current business?
How will we meet our ongoing capacity requirements
(employ/contract in/outsource)?
How many people, and which occupational categories and mix (more
of /less of) will we need in the future? How do we know this is
affordable? What does the transition pathway look like?
How will we source, attract, engage and/or grow the people we need?
Are there skills that are in short supply?
How will we keep the people we need?
How does our approach to capacity impact our funding track?
Does our workforce reflect the community it serves?
54
8.7
LINE OF SIGHT GUIDANCE FRAMEWORK
Line of sight across Regional and Annual Plans
RSP - Common Priorities and Objectives
Priorities and objectives that DHBs within a region want to achieve.
RSP - Key Actions, Milestones and Measures



Key actions to set out what the region will do to achieve its objectives (and where appropriate
significant individual DHB contributions are identified)
Key milestones required to reach regional objective
Measures the region will use to assess actions agreed to achieve milestones, including setting of
baselines
RSP - Inputs / Resources
The nature of inputs may vary and could include:
 Costs to implement actions in order to achieve priority
 People / teams / and/or new roles required to progress actions
RSP - Responsibilities


Accountable roles
Organisations and/or networks required to implement priority e.g. PHOs
RSP – Requirements of Enablers to Achieve Regional Priorities

Workforce, IT and capital requirements to deliver on regional services priorities should be explicitly
identified where relevant to achieving a regional objective
AP – Individual DHB’s Contribution to Regional Priorities
The AP in Module 2 sets out the DHB’s individual actions to deliver against regional priorities and targets.
This should include:



Key individual DHB actions to deliver on regional milestones and priorities (links to regional actions)
Measures to demonstrate progress on regional milestones and priorities
Budget allocation by DHB
To streamline reporting, the local actions of DHBs to deliver on regional objectives are reported quarterly
within a consolidated regional report by Shared Services Agencies on behalf of DHBs. This is intended to
streamline reporting as individual DHBs will not be required to report local actions to support regional
priorities through their local DHB quarterly reports.
55