2014/15
REGIONAL SERVICES PLAN
GUIDELINES
(Including Planning Priorities)
Amendments
Date
Page
Description
31 Jan 2014
13
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
28 Feb 2014
7
11 & 12
National Entities: The national entity prioritisation process led by the Health
Sector Forum has been completed. Priorities for IT and workforce as detailed at 6
Dec have been confirmed without change.
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
Page 1 of 24
CONTENTS FOR REGIONAL SERVICES PLAN GUIDANCE TOOLKIT
1. Introduction
2. Regional Services Plan Priorities
2.1. Health Of Older People as a Required Priority
2.2. Major Trauma as a New Priority
2.3. Enablers
2.3.1. Regional and National Information Technology
2.3.2. Regional Workforce
2.3.3. Capital
2.4. Sub-Regional Initiatives
3. Regional Governance and Leadership
3.1. Regional Governance and Decision Making
3.2. Supporting Clinical Networks and Clinical Leadership
4. Strategic Position
5. Line of Sight across RSPs and APs
5.1. The planning process across Regional and Annual Plans
5.2. Linkages with Māori Health Plan
6. National Entities
6.1. Health Quality and Safety Commission
6.2. National Health Committee
Appendix One: 2014/15 Regional Services Plan Priorities
Appendix Two: Line of Sight – worked examples
For further information please contact:
Karina Kwai – Manager, Planning
National Health Board, Ministry of Health.
Contact details:
Mobile
027 229 0902
DDI
04 816 3318
Email
Karina_Kwai@moh.govt.nz
Page 2 of 24
1. Introduction
DHBs are expected to work together at a regional level to make the best use of available
resources, strengthen clinical and financial sustainability and increase access to services.
Improving regional collaboration between District Health Boards (DHBs) has been an evolving
process over time. In the last few years, significant progress has been made in establishing the key
foundations to assist regional working and DHBs are in a good position to continue implementing
their regional and sub-regional priorities.
The purpose of a Regional Services Plan (RSP) is to provide a mechanism for DHBs to document
their regional collaboration efforts and align service and capacity planning in a deliberate way. The
RSPs include national and local regional priorities, and outline how DHBs intend to plan, fund and
implement these services at a regional or sub-regional level. The plans have a specific focus on
reducing service vulnerability, reducing costs and improving the quality of care to patients.
In 2014/15, the visibility of contributions by DHBs to achieve regional service priorities has been
strengthened with a Line of Sight guidance framework. The framework has been introduced to
encourage greater alignment between Annual Plans (AP) and RSPs, and to allow DHBs to
demonstrate how individual DHBs contribute to achieving regional objectives.
2. Regional Services Plan Priorities
The 2014/15 RSP priorities are noted below. These 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.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Elective Services
Cancer Services
Cardiac Services
Mental Health and Addictions
Stroke Services
Health of Older People
Major Trauma
Information Technology
Workforce
DHBs are to include additional priority services which are appropriate for their region.
2.1 Health of Older People as a Required Priority
Improving services for people with dementia is a priority area for DHBs and regions in 2014/15. In
November 2013, the Government launched the "New Zealand Framework for Dementia Care".
Regions are expected to develop and implement components of their dementia care pathways at
the regional level. Regions are to achieve this by working with the sector (e.g. primary health care,
community support groups) and supporting the implementation of DHB dementia care pathways
through shared learning and resources. Regions are expected to develop and commence delivery
of dementia awareness and responsiveness education programmes for primary health care
clinicians to improve the timeliness for dementia diagnosis in 2014/15.
Page 3 of 24
2.2 Major Trauma as a New Priority
There is clear international evidence that regional major trauma systems can reduce the number of
deaths, disability levels, improve patient outcomes and satisfaction levels. In 2010, the National
Health Board (NHB) undertook a service review of major trauma care which highlighted variable
service quality and patient outcomes in New Zealand.
The initial focus for major trauma is to develop and implement regional major trauma systems
nationally. DHBs are expected to produce a three year plan on establishment of the local and
regional major trauma systems and implement a process to collect data for a national minimum
data set to contribute to a National Trauma Registry by 1 July 2015.
2.3 Enablers
The National Health IT Plan and Health Workforce Regional Work Plan outline the strategic focus
for these areas, and include key priorities and programmes which are expected to be implemented
regionally by DHBs. The regional priorities for 2014/15 for Information Technology (IT) and
Workforce are outlined in Appendix One and the requirements for enablers can be incorporated
into specific service priorities where applicable.
Further context on how these enablers link with regional objectives in RSPs is noted below.
2.3.1
Regional and National Information Technology
IT provides the platform to support improved information sharing and integrated healthcare. The
priority national initiatives such as cardiac, cancer and elective services are underpinned by
national information platforms.
Well-designed IT solutions help us work smarter to reduce costs, improve efficiency and give
patients better, safer treatment. The National Health IT Plan Update refines the focus areas, ranks
the priorities, and sets out the key performance indicators and action plan for success. Key risk
mitigations for IT delivery rely on strong regional governance and decision making, security of
systems and moving from tactical to strategic IT delivery.
Regions should include their prioritised three year plan of all local, regional and national IT
initiatives, including the applicable critical priorities listed in Appendix One. The following level of
information should be provided for each initiative:



2.3.2
Description of the initiative
Budget allocation by DHB
Benefits, enablers and actions, milestones and measures
Regional Workforce
More standardised ways of delivering services are needed to meet increased demand for services.
This will release resources for use elsewhere and build a platform to develop a workforce with
more generic skills that is flexible and able to work in integrated service models across hospital
and community settings.
Regionally, DHBs are expected to continue to work with the Regional Training Director and build
on the workforce section of the 2013/14 RSP demonstrating further progress on actions they are
undertaking to meet key milestones. Key milestones for 2014/15 are outlined in Appendix One.
2.3.3
Capital
Regional services planning remains an integral part of capital investment planning. Where it is
appropriate, potential capital impacts should be identified. However, quarterly reporting on capital
Page 4 of 24
will not be required via RSPs. In 2014/15, the NHB will collect the regional capital plans separately.
The NHB considers a separate process will reduce administrative workload for DHBs and focus
DHBs on regional capital planning.
2.4 Sub-Regional Initiatives
Current and emerging sub-regional initiatives where DHBs are working together to provide
improved value to their populations should be identified in the RSP. Measurable and time bound
actions are required to be set out in the AP (Annual Plan Toolkit, Module 2: Delivering on Priorities
and Targets).
3. Regional Governance and Leadership
DHBs are expected to continue to provide effective regional governance, accountability and
decision making. All DHB Chairs and Chief Executives from each region will be required to agree
and sign RSPs on behalf of their individual boards.
3.1 Regional Governance and Decision Making
RSPs should provide information about how implementation will be governed, costed, funded and
managed, including how DHBs will manage performance.
Information may include: roles and responsibilities, an outline of arrangements to provide support
and assistance to other DHBs to meet the regional and/or sub-regional performance expectations,
and how barriers and issues will be resolved.
Some regional (including sub-regional) work programmes may require specific governance and
leadership approaches with tailored membership to appropriately represent the key stakeholders
and to ensure the best outcome is achieved (e.g. involvement and alignment with primary care,
NGOs, patient representative groups).
DHBs may also wish to include other examples of regional collaboration, for example, crossappointed board members and clinicians and regular engagement between DHB boards in the
region.
DHBs are expected to assist their colleagues in finding and implementing solutions to financial or
clinical issues which arise. This may include making staff with expertise available to work with the
National Health Board to resolve the issue. An indication of how the region will arrange this should
be included.
3.2 Supporting Clinical Networks and Clinical Leadership
In the 2013/14 year, both nationally and regionally, clinicians had a positive influence in regional
decision making processes. In 2014/15, it is expected that clinical integration will continue to be
visible in the development of service priorities. RSPs are to adopt a proactive approach to
strengthening clinical integration by developing and supporting clinical networks. In particular, the
RSPs are to:


Identify how the region can work with clinical leaders to make better use of clinical networks
to support improved clinical and financial sustainability of services; and
Identify services within the region that may benefit from the development of a regional
clinical network.
Page 5 of 24
4. Strategic Position
In the development of the strategic section, regions should reflect on progress to date, identifying
and explaining any significant changes from earlier years, and identifying the direction of travel for
2014/15 and future years.
The strategic section of the RSP should also be consistent with national strategic imperatives, as
well as all trends and key outcomes outlined in:


the DHB’s Statement of Intent (SOI) that articulates the ability of each DHB in the region to
deliver improved services into the future; and
the Strategic Intentions section of the DHB’s AP where each DHB examines how health
services can be most effectively and efficiently coordinated and delivered.
5. Line of Sight across RSPs and APs
The focus of 2014/15 is to ensure that there is greater alignment between RSPs and APs. The
RSPs are expected to set out the regional priorities and how DHBs intend to work as a region to
achieve these. The requirements of IT, workforce and capital to implement service priorities are
also expected to be incorporated where applicable.
5.1 The planning process across Regional and Annual Plans
A Line of Sight guidance framework is provided below to improve linkages across RSPs and APs
and to demonstrate how individual DHB actions contribute to achieving regional priorities.
The Line of Sight framework outlines common objectives, actions, milestones, costs and measures
for regional service priorities. It also provides guidance on inputs, resources, roles and
responsibilities. Individual contributions by DHBs to regional priorities will be included in APs.
Worked examples for Electives and Mental Health are attached as Appendix Two.
Table One: Guidance Framework for RSP Priorities
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
Page 6 of 24
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.
5.2 Linkages with Māori Health Plan
Activities to improve Māori Health must be included within each regional service priority area. The
activities are to include performance measures that must be measurable as part of the DHB
accountability framework. Performance expectations for Māori must be set at the same level for the
total population. Intervention mechanisms, actions or plans will include a mixture of universal and
tailored activities.
6. National Entities
Linkages with other work, in particular across the National Health IT Plan, HWNZ, Capital, the
National Health Committee (NHC), and the Health Quality and Safety Commission (HQSC) also
need to be considered.
6.1 Health Quality and Safety Commission
DHBs are required to incorporate Health Quality and Safety Commission programmes into their
regional services plans, as outlined in the Commission’s Statement of Intent 2012-15. In particular,
DHBs are encouraged to demonstrate a commitment to the Open for better care national patient
safety campaign, and ensure that activities support the campaign. Each region is expected to:





involve consumers (patient and family) at every level of activity;
maintain and participate in regional governance approaches that ensure regional and local
leadership of the campaign;
work with the Commission to design the topic-specific approaches to the campaign;
work with the Commission to implement the campaign regionally and locally; and
develop networks to support the campaign and build capability for improvement.
Outside the important work of Open for better care, DHBs should also maintain appropriate
mortality and morbidity review systems including supporting national Mortality Review Committee
processes.
Page 7 of 24
6.2 National Health Committee
RSPs should describe how regions will work with the National Health Committee (NHC) to
establish regional networks for the prioritisation of health interventions. These regional
prioritisation networks are expected to become operational in 2014. Plans should include some
discussion of how prioritisation will be coordinated with the NHC work programme, and how
prioritisation decisions will be implemented by DHBs within the region.
The NHC is an independent statutory committee charge with prioritising new and existing health
technologies and making recommendations to the Minister of Health. Technologies under
consideration by the NHC or a regional prioritisation network may not be implemented, or be
expanded if already in use, by DHBs until the results of assessments are made available for
implementation.
Page 8 of 24
Appendix One: 2014/15 Regional Services Plan Priorities
It is expected DHBs will use the Line of Sight framework to develop and document content for
2014/15 RSP priorities. This section provides more specific information about the requirements
and expectations of the priorities to assist DHBs when completing content for their plans.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Elective Services
Cancer Services
Cardiac Services
Mental Health and Addictions
Stroke Services
Health of Older People
Major Trauma
Information Technology
Workforce
1. ELECTIVES
I
Regional Objectives
 Improve access to elective services;
 Reduce waiting times for elective first specialist assessment (FSA) and treatment; and
 Improve equity of access to services, so patients receive similar access regardless of where
they live.
Key Actions
Identify the actions that the region will undertake to improve access to elective services, reduce
waiting times and improve equity of access. These actions will differ by region but could include:





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.
Measure
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 patient’s will wait more than 4 months for First
Specialist Assessment (FSA) or elective treatment; and
a maximum waiting time of 4 months is maintained from January 2015 onwards (ESPI 2 &
ESPI 5).
Page 9 of 24
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.
2. CANCER SERVICES
I
Regional Objectives
Implementing the priorities of the National Cancer Programme remains the focus for regional
planning. In particular to improve:



access to cancer services;
timeliness of services across the whole cancer pathway; and
the quality of cancer services delivered.
Key Actions
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.
Page 10 of 24
3. CARDIAC SERVICES
I
Regional Objectives
The focus for regions in 2014/15 will be to continue to improve access to cardiac services
including:




improved and timelier access to cardiac services;
patients with a similar level of need receive comparable access to services, regardless of
where they live;
more patients survive acute coronary events, and likelihood of subsequent events are
reduced; and
patients with suspected Acute Coronary Syndrome (ACS) receive seamless, co-ordinated
care across the clinical pathway.
Key Actions


To continue to work with regional cardiac clinical networks and the New Zealand Cardiac
Network to implement actions to improve outcomes for people.
To provide quarterly reporting at regional and DHB level, utilising the ANZACS-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 Pathways1 (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.
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
1
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.
Page 11 of 24



Proportion of patients scored using the national cardiac surgery Clinical Priority Access
Criteria (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.
4. MENTAL HEALTH AND ADDICTIONS
I
Regional Objectives
Our objectives for 2014/15 are to improve:





access to the range of eating disorder services;
adult forensic service capacity and responsiveness through the national forensic network;
youth forensic service capacity and responsiveness;
perinatal and maternal mental health service options as part of a service continuum; and
mental health and addiction service capacity for people with high and complex needs.
Key Actions
Identify and deliver on at least two actions for each of the following that will lead to:


continued regional provision of eating disorder inpatient services (Midland and Northern
regions to implement the recommendations from the service review to ensure sustainable
inpatient and community services);
improved Mental Health and Addiction Service capacity for people with high and complex
needs;
robust regional contribution to the national network of forensic inpatient services

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.
Page 12 of 24


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.
5. STROKE SERVICES
I
Regional Objectives
 To improve stroke prevention, stroke event survival, and reduce subsequent stroke events;
and
 to improve access to organised acute and rehabilitation stroke services.
Key Actions
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.
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:
 percentage of eligible* patients receiving active rehabilitation (as recommended in the Stroke
Guidelines) as part of their acute in-patient event; and
 percentage of eligible* patients following discharge who receive community based stroke
rehabilitation services.
*Defined as those patients referred for rehabilitation by lead physician/neurologist
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.
Page 13 of 24
6. HEALTH OF OLDER PEOPLE
I
Regional Objectives
To ensure people with dementia and their families and whānau are valued partners in an
integrated health and social support system that supports wellbeing and control over their
circumstances. The focus for regions in 2014/15 will be that Regional Dementia Care Pathway
Groups (with involvement from secondary, primary and community care) will:
 develop regional components of the dementia care pathways and share learnings and
resources across the region;
 improve awareness and responsiveness in primary health care, working in partnership with
the dementia sector and primary health care organisations;
 continue to provide support and overview of the development and implementation of DHB
dementia care pathways following the New Zealand Framework for Dementia Care; and
 provide representation at a national level when requested by the Ministry of Health
(approximately twice a year) to provide an overview of DHB development and
implementation of dementia care pathways and share learnings and ideas nationally.
Key Actions
 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.
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.
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).
Page 14 of 24
7. MAJOR TRAUMA
I
Regional Objectives
To ensure more patients survive major trauma and recover with a good quality of life the Major
Trauma National Clinical Network is developing major trauma systems across New Zealand.
Key Actions

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.
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.
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.
Page 15 of 24
INFORMATION TECHNOLOGY
I
Initiative
Description
DHBs/Regions
impacted
Service priorities
enabled by the
initiative
Measures
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
Supports all
service priorities –
the PAS is one of
the backbones of
the hospital
All affected DHBs
will be
implementing a
supported PAS
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
National Patient Flow will create a
new national collection that
provides a view of wait times,
health events and outcomes in a
patient’s journey through secondary
and tertiary care.
All DHBs
Elective Services,
Long term
conditions –
cancer services
All DHBs have
implemented phase
2 of National
Patient Flow
Finance
Procurement
and Supply
Chain
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.
All DHBs – as
per the HBL
implementation
plan
Supports financial
sustainability
As per the HBL
implementation plan
Page 16 of 24
Self-Care Portal
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.
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.
All PHOs
Health of Older
People, Mental
Health and
addictions
75% of PHOs
provide an afterhours summary to
ED
25% of the PHO
eligible population
have accessed a
self-care portal
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.
8. HEALTH WORKFORCE
I
Regional Objectives


Strengthen health workforce capability and capacity through improving recruitment and
retention.
Strengthen and improve regional initiatives that:
o maximise workforce resources, reduce duplication;
o encourage flexibility and integrated team working; and
o use all training settings, including primary and community integration and private
settings.
Key Actions
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:

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 Maori 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 criteria2 for post-entry training in medical disciplines in
the region’s DHBs.
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.
2
Page 17 of 24


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: 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: eye healthcare network, palliative care
network, and cancer network); and
 report on at least two regional training programmes for the unregulated healthcare
workforce, detailing progress. (For example: 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.
Page 18 of 24
Appendix two: Line of Sight – worked examples
Outlined below are worked examples to demonstrate how a regional objective could be integrated with annual planning information requirements for electives
and mental health. The tables demonstrate examples as to how a guidance structure could be developed and to show implementation across a region in a
DHB’s Annual Planning template.
An example of information that could be provided to demonstrate regional implementation in a DHB’s Annual Planning template for electives
Electives
Context
Better Sooner More Convenient Health Services for New Zealanders in relation to electives means improved and more timely access to elective services.
Objectives
A health system that functions well for Electives is one that is:
a) Increasing elective surgery discharges
b) Increasing first specialist assessments
c) Reducing waiting times for people requiring elective services
d) Improving prioritisation and selection of patients
e) Supporting innovation and service delivery
Linkages
f) Link with Outcomes Framework (Module 1 & 2)
g) Links include with National, Regional, Local
Actions to deliver improved performance
Health system success is measured by
Reporting Requirements
Electives funding will be allocated to support increased levels of elective
surgery, specialist assessment, diagnostics, and alternative models of care.
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).
Electives Initiative and Ambulatory
Initiative: Monthly
Health Target: Quarterly
Standardised intervention rates and/or other mechanisms (such as demand
analysis) will be used to assess areas of need for improved equity of access.
Refer to SI4: Elective services standardised intervention rates.
Quarterly: cardiac. Annually: major
joints, cataracts.
Actions that contribute to regional priorities
Health system success is measured by
Reporting requirements
DHB C will support the development of a regional agreed pathway for X
service by (date) by XYZ actions.
Measures agreed within the Regional Services Plan
Quarterly regional report

DHB C will manage a service delivery contract with X DHB to see and
treat X of our domiciled patients
Measures agreed within the Regional Services Plan
Quarterly regional report

Include local component of common measures used monitor its
contribution to the delivery of its regional milestones.
Measures agreed within the Regional Services Plan
Quarterly regional report

Mental Health and Addictions Services Plan
Context:
Rising to the Challenge:
Rising to the Challenge clearly articulates prioritised service developments to 2017. The Plan aims to improve client access and service responsiveness across the spectrum of
health promotion, primary, specialist treatment and support services. Service integration will be strengthened while improving value for money and delivering improved outcomes for
people using mental health and addiction services.
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 the
Mental Health and Addiction Plan Module. Refer to the Alliance Charter for a description of the principle of partnership that must underpin any service development.
Rising to the Challenge overarching objectives

Actively using our resources more effectively

Building infrastructure for integration between primary and specialist services

Cementing and building on gains in resilience and recovery

Delivering Increased access
Actions to deliver improved performance
Health system success is measured by
Health system success is
measured by:
For each of the four key objectives from Rising to the Challenge
identified below, provide at least 2 actions for each area, with targets
and 6 monthly milestones for 2014/15. Expected
1.
Make better use of resources/value for money Expected
2.
3.
Improve integration between primary and specialist services
Expected
Cement and build on gains in resilience and recovery (this
includes developing services for Children of Parents with
Mental illness and Addictions). Expected.
4.
Deliver increased access for all age groups Expected
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:
a. Drivers of Crime
b. Welfare reforms
Expected
Implementation of the New Zealand Suicide Prevention Action Plan
2013-2016. DHBs are expected to provide evidence of how the
following will be met:

train health workers to identify and support individuals with
self-harm injuries or at risk of suicide and refer them to the
Reporting Requirements
Meeting agreed performance measure expectations for:
-
PP6, PP7,PP8 ,PP26 &OS10
-
quarterly reporting on SDP
progress against actions
Performance against agreed
measures.
Progress on specific actions.
All above indicators are
expected
TBC
Submit district suicide prevention
plans for review in the second
quarter reporting. Expected
services they need. Expected
develop and implement a district suicide prevention plan.
Expected

facilitate integrated cross-agency collaboration in respect to
suicide prevention and response to suicide
clusters/contagion. Expected

develop and implement a district suicide postvention plan.
Expected
Mental health and addiction service provision ringfence.

Please 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.
Expected
TBC
TBC
Actions that contribute to regional priorities *
Health system success is measured by
Reporting requirements
DHB C will commit to delivery of the actions agreed in Region A’s
Regional Service Plan.
Measures agreed within the Regional Service Plan
Quarterly regional report