2014/15 DHB ANNUAL PLANNING
PRIORITIES
(DHB Annual Plan and Regional Services Plan)
The DHB Planning Priorities are provided to assist District Health Board
(DHB) and Shared Service Agency staff to meet Ministerial expectations.
Amendments
Date
Page
Description
31 Jan 2014
17-18
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
16-17
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
Contents
2014/15 DHB Annual Planning Priorities (Annual Plan and Regional
Services Plan)
Planning Guidelines ..................................................................................................................................... 3
Changes and Updates to the Planning Guidelines ...................................................................................... 3
Planning Priorities ....................................................................................................................................... 4
Better Help for Smokers to Quit˟ ................................................................................................................ 6
More Heart and Diabetes Checks˟ .............................................................................................................. 6
Increased Infant Immunisation˟ .................................................................................................................. 7
Shorter Stays in Emergency Departments˟ ................................................................................................. 7
Improved Access to Elective Surgery˟ ......................................................................................................... 7
Shorter Waits for Cancer Treatment / Faster Cancer Treatment˟ .............................................................. 8
Better Public Services and all of government initiatives (including Social Sector Trials) ............................ 9
Reduced Incidence of Rheumatic Fever˟..................................................................................................... 9
Children’s Action Plan˟ ................................................................................................................................ 9
Whānau Ora˟ ............................................................................................................................................. 10
Prime Minister’s Youth Mental Health Project* ....................................................................................... 10
System Integration .................................................................................................................................... 11
Cardiac Services ......................................................................................................................................... 11
Improved Access to Diagnostics˟............................................................................................................... 11
Primary Care* ............................................................................................................................................ 12
Stroke Services˟ ......................................................................................................................................... 12
Diabetes and Long-term Conditions˟ ........................................................................................................ 12
Maternal and Child Health ........................................................................................................................ 13
Mental Health Service Development Plan˟ ............................................................................................... 13
Health of Older People˟............................................................................................................................. 14
National Entity Priority Initiatives ............................................................................................................. 15
Improving Quality ...................................................................................................................................... 15
Actions to support delivery of regional priorities ..................................................................................... 15
Living within our means ............................................................................................................................ 15
2014/15 Regional Services Plan Priorities and Expectations .................................................................... 16
Electives ..................................................................................................................................................... 16
Cancer Services.......................................................................................................................................... 16
Cardiac Services ......................................................................................................................................... 16
Mental Health and Addictions................................................................................................................... 17
Stroke ........................................................................................................................................................ 17
Health of Older People .............................................................................................................................. 18
Major Trauma ............................................................................................................................................ 18
Workforce, IT and Capital .......................................................................................................................... 19
2
2014/15 DHB Annual Plan and Regional Services Plan
Planning Guidelines
As in previous years, the 2014/15 Planning Guidelines include guidance for Annual Plans (APs),
Regional Services Plans (RSPs), Māori Health Plans (MHPs) and Public Health Unit Annual Plans
(PHUAPs). This year, the following changes take place:

The structure of DHB APs and RSPs has been adjusted to make them shorter, easier to
develop and simpler for DHBs to use

Within 2014/15 Planning Guidelines, the Planning Priorities for DHB APs and RSPs have
been consolidated into a single document to better reflect the interrelationship of these
documents and encourage the integration of services at the regional and DHB levels

the more technical Operational Requirements of the CFA Schedules of the OPF, SCS and
reporting requirements have been separated from 2014/15 Planning Guidelines and are
included for use by planners on the NSFL website

the focus of the RSP guidance for this year is on improving the alignment between APs and
RSPs. In 2014/15 there is an improved guidance structure that aims to establish a clear
line of sight from regional priorities to action by DHBs. DHB contributions to the
implementation of regional objectives are expected to be included in DHB APs.
Changes and Updates to the Planning Guidelines
Following feedback from the sector changes have been made to the working drafts that were
circulated on 6 November. Further detail to the guidance in a number of key areas will be
relayed as soon as it is available:

Primary Care – the Integrated Performance and Incentive Framework is to be
implemented and Service Level Alliance Teams established for distribution of rural primary
care funding; and the development of a primary care youth service

the Children’s Action Plan related to new legislative requirements currently being
considered as part of a Vulnerable Children's Bill

new regional priorities:
o Health of Older People – Is a required priority with the expectation that regions are to
develop and implement components of their dementia care pathways at the regional
level to improve the timeliness for dementia diagnosis
o Major Trauma – The focus for major trauma is to develop and implement regional
major trauma systems nationally. DHBs are expected to establish 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

National Entities Prioritisation Initiatives – A national entity prioritisation process is again
being led by the Health Sector Forum this year and the expectation is to finalise national
entity priorities for inclusion in 2014/15 DHB Annual Plans prior to Christmas. Financial
and non-financial information is required from DHBs covering a period of four years
(current and three outyears). Priorities identified in the Planning Guidelines for the
Information Technology, Workforce and the Health Quality Safety Commission (HQSC) are
subject to confirmation following the conclusion of this process
3

HQSC plans to review the 2012/13 quality accounts and, 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 of future quality
accounts will be aligned with the DHB annual reporting timeframes

The 62-day developmental faster cancer treatment (FCT) indicator will transition into a full
policy priority accountability measure, and will become the next cancer health target
during 2014/15. DHB planning advice signals that further details, including the health
target definition, DHB performance expectations for 2014/15, and the process for
transition, will be provided to DHBs by the end of February 2014.
Planning Priorities
The Planning Priorities for 2014/15 are generally a continuation of those for 2013/14, with the
key exceptions noted above, and the addition of Major Trauma and Health of Older People as
regional service planning priorities. The planning priorities will be confirmed in the Minister’s
Letter of Expectation. DHBs are expected to use their Alliance Leadership Team and any Service
Level Alliance Teams to jointly develop the primary care sections of their 2014/15 Annual Plan
with their primary care partners to strengthen clinical integration.
Health Targets1
Health Targets for 2014/15:
1.
Shorter Stays in Emergency Departments˟2
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 AP priority areas (in addition to the Health Targets) are:
Better Public Services (including Social Sector Trials):

Reducing Rheumatic Fever˟

Children’s Action Plan˟

Whānau Ora˟

Prime Minister’s Youth Mental Health Project*3,4
1
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 they already have 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
2
Better Help for Smokers to Quit Health Targets; as are planning priorities in this table marked with a ˟.
3
* 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).
4
System Integration:












Cardiac Services˟
Improved Access to Diagnostics˟
Primary Care*
Stroke˟
Long Term Conditions˟ and Diabetes˟
Maternal and Child Health˟
the Mental Health Service Development Plan˟
Health of Older People˟
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:
1.
Elective Services
2.
Cancer Services
3.
Cardiac Services (Acute Coronary Syndrome)
4.
Mental Health and Addictions
5.
Stroke Services
6.
Health of Older People
7.
Major Trauma
8.
Information Technology
9.
Workforce
DHBs are expected to include actions/milestones/budget allocation/measures which will
contribute to the achievement of 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 National Health Board (NHB) will collect the regional capital plans separately again in
2014/15. Regional Services Planning remains an integral part of capital investment planning,
but quarterly reporting on capital will not be required via Regional Services Plans. However,
where a regional service priority requires capital (e.g. IT) this should be reported through the
RSP quarterly reporting process.
4 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.
5
2014/15 DHB Annual Plan Priorities and Expectations
Health Targets5
Better Help for Smokers to Quit˟6
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 Smokefree 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 smokefree 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.
o
Actions in your Tobacco Control Plan could include working with your local NGOs and councils to develop local smokefree
initiatives and/or to introduce further smokefree 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
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.
5
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.
˟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
6
included; as are planning priorities in this table marked with a ˟.
6
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 newborn 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
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)
Shorter Stays in Emergency Departments˟

Diagnostic/analysis work to identify the main factors impacting on ED length of stay.
o
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.
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.
7
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.
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 (PP 30) 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 (PP 24) 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.
8
Better Public Services and all of government initiatives (including Social Sector Trials)
Reduced Incidence of Rheumatic Fever˟

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
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
2.6
0.9
1.9
1.8
2.9
0.0
1.9
0.3
2.4
Northland
10
Waitemata
8
Auckland
9
Counties Manukau
42
Northern region
69
Waikato
8
Lakes
5
Bay of Plenty
5
Tairawhiti
3
Taranaki
1
Midland region
21
Hawkes Bay
4
MidCentral
2
Whanganui
1
Capital and Coast
5
Hutt
4
Wairarapa
0
Central region
17
Southern region
3
New Zealand
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
9
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
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*(PP25)
* 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 (PP25):

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:
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.
10
System Integration
Cardiac Services
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.
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

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

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. TBC% 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.
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.
The 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.
11
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 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.
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.
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
12
Measures

Linkage with Ambulatory Sensitive Admissions to Hospital (ASH) rates

Measurement of improved diabetes outcomes using a set of clinical indicators to be developed.
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.
Measures
o At least 80 percent of women register with an LMC by week 12 of their pregnancy.
o 98% of newborns are enrolled with general practice by three months
o systems are in place to ensure enrolment of all newborn babies with WCTO and Community Oral Health Services
o At least 90 percent of children receive a B4 School Check, including at least 90 percent of children living in high deprivation areas.
o
o Improved performance against WCTO Quality Indicators measuring access.
o 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.
o A nationally consistent approach to the screening, diagnosis and management of gestational diabetes
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.
13
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.
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).
14
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.

Identify actions to support the Quality & Safety Markers (QSMs) with a focus on achieving:
o 90 percent of older patients are given a falls risk assessment
o 80 percent compliance with good hand hygiene practice
o all three parts of the surgical safety checklist used 90 percent of the time
o 95 per cent of hip and knee replacement patients receive cephazolin ≥ 2g as surgical prophylaxis
o 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
15
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 (Appendix 1)
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:
o Developing a regional delivery plan that supports achievement of local intervention rates, maximised regional capacity,
optimal use of specialist resources and sub-specialist capability, increased access to less complex surgery and local Health
Target Delivery
o Developing consistent pathway, access criteria, and clinical protocols for individual services
o Establishing and delivering sub-regional agreement to facilitate cross-boundary patient care
o Implementing sub-regional referral management and scheduling systems
o
Delivering actions agreed to in regional Elective 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 Pathways7 (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.
7
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.
16
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 Northern, Midland and Central regions 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.
17
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)
Represented at national meetings as required 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.
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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 (eg. 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 criteria8 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 forecast 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 the 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, 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, cancer network)

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
o
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.
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.
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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
Midland and
Supports all
100% of the applicable population
Clinical Workstation (Orion,
Central
service
have a CDR record available through
Concerto) and Clinical data
regions
priorities –the
a regional view
repository (mixed products).
CWS and CDR
The CWS is a web based system,
are the key
accessed via a single sign-on that
clinical systems
connects multiple clinical
in the hospital
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 The 8 DHBs with legacy PAS need
Northland,
Supports all
All affected DHBs will be
Patient
to progress implementation of a
Auckland,
service
implementing a supported PAS
Administration
supported system that is aligned
Whanganui,
priorities –the
Systems (PAS)
with the regional plan.
MidCentral,
PAS is one of
The PAS supports and manages
Wairarapa,
the backbones
the administrative details of a
Nelson
of the hospital
patients encounter with a hospital Marlborough,
or DHB service. It supports the
Canterbury
management of the hospital
and South
resources used to provide patient
Canterbury
care such as clinical staff, rooms,
DHBs
beds and equipment.
National Patient Flow
National Patient Flow will create a
All DHBs
Elective
All DHBs have implemented phase 2
new national collection that
Services, Long
of National Patient Flow
provides a view of wait times,
term conditions
health events and outcomes in a
– cancer
patient’s journey through
services
secondary and tertiary care.
Finance Procurement
The Finance procurement and
All DHBs – as
Supports
As per the HBL implementation plan
and Supply Chain
Supply Chain programme will
per the HBL
financial
implement a single finance
implementati
sustainability
management information system,
on plan
common catalogue for the
ordering of goods and services,
and centralised procurement and
distribution processes for DHBs.
Self-Care Portal
Portals are an on-line IT tool that
All PHOs
Health of Older
75% of PHOs provide an after-hours
will enable individuals to have
People, Mental
summary to ED
access to their own health
Health and
information.
addictions
25% of the PHO eligible population
It will enable patients to
have accessed a self-care portal
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.
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.
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Appendix 1: 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.
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