2019/20 Regional Service Plan Guidelines

This document is for shared service agency and DHB staff to use when developing their 2019/20 Regional Service Plans.

The Regional Service Plan Guidelines is a reference document to enable shared service agencies and DHBs to meet their minimum legislative obligations when drafting their Regional Service Plans.

Document last updated: May 2019

Ministry of Health

Amendments to the Regional Service Plan Guidelines (note that minor editorial amendments have not been recorded in the following table)

Date / Section

Description

May page 7 Implementation of the New Zealand Framework for Dementia Care, guidance added

May page 8 Section 2.7 Line of sight updated including figure 1 and 2

May page 10 Section 3.1 Assessment, timeline to submit the final draft RSP updated

Contents

1. Regional collaboration..................................................................................................................4

2. 2019/20 Regional Service Plan......................................................................................................4

2.2 Strategic position........................................................................................................................................5

2.3 Locally determined priorities for the region...............................................................................................5

2.4 National regional requirements..................................................................................................................5

2.5 Regional governance and leadership..........................................................................................................8

2.6 Regional governance and decision making.................................................................................................8

2.7 Line of sight.................................................................................................................................................8

3. Assessment of the RSP and monitoring arrangements.................................................................10

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1. Regional collaboration District health boards (DHBs) work together at a regional level to make the best use of available resources, strengthen clinical and financial sustainability and increase access to services. In past years significant progress has been made in establishing the key foundations to assist regional collaboration and DHBs are in a good position to continue implementing their regional and sub-regional priorities.

The purpose of a regional service 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 an outline of how DHBs intend to plan, fund, and implement these services at a regional or sub-regional level.

The New Zealand Public Health and Disability (Planning) Regulations 2011 require the RSP to contain both a strategic and an implementation element. The implementation element must be reviewed annually and the regional plan updated annually for agreement with the Minister of Health.

2. 2019/20 Regional Service Plan To achieve a comprehensive understanding of health and disability services improvement it is important to consider New Zealanders’ levels of access or engagement with services as well as their outcomes. It is important that our services planning includes focus on moving a higher proportion of people into better engagement with services, and on achieving better outcomes for them from that engagement.

For the 2019/20 RSP the Ministry supports the regions to submit a plan that represents the regions locally determined priorities. The RSPs are expected to set out regional activity and locally identified priorities that will benefit most from a regional approach. In addition the plan is also to include a low-number of national priorities for regional delivery. Section 2.4 refers

The Ministry expects the regional plans to show a strong regional collaboration to support financial sustainability of the DHBs in the region. The RSP should reflect how DHBs intend to work as a region to develop and run efficient service models to achieve effective, efficient and sustainable services.

Please identify in your plans how the regional collaborative work programmes in general and, for each area of focus identified in the implementation section of the plan specifically, are supporting financial, clinical and service sustainability.

A new focus for 2019/20 RSPs is to demonstrate regional commitment to engage in the newly established collective improvement work programme, provide regional insights and lead regionally focused improvement activity resulting from the programme. Regions will be expected to report on the areas selected for regionally-led improvement, the benefits realisation being targeted, agreed in-year milestones and progress against these, in the quarterly reporting to the Ministry.

The regions must ensure that the RSP is in line with the legislative obligations of DHBs as Treaty partners and the DHBs obligation in improving Māori health. In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes. Improving health outcomes for Māori and Pacific peoples and making measurable progress towards achieving equity of health outcomes and reducing the equity gap is expected to underpin regional activity.

For the requirements for DHBs please see 2.1 Health Equity and 2.2 Māori Health in DHB Annual Plans Guidance

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The New Zealand Triple Aim is to support the regional activities and services to be implemented. High-quality health care results from the simultaneous implementation of three quality dimensions: improved quality, safety and experience of care, improved health and equity for all populations, and best value for public health system resources. High-quality health and disability services respond to the needs and aspirations of diverse population groups, and the health system must work to address unmet need and eliminate barriers to accessing high-quality health care.

2.1 Tools to help with improving health outcomes for MāoriThe following tools, or others at your disposal, can be used to assess and identify regional disparities and outline activities for improving equitable access and outcomes.

Equity of Health Care for Māori: A Framework . Whānau Ora Health Impact Assessment 2007. The Health Equity Assessment Tool: A User's Guide 2008.

Implementing the HISO 10001:2017 Ethnicity Data Protocols will enable the ability to monitor/measure equity of Health Care for Mâori.

The Ministry DHB M ā ori Health Profiles 2015 , may also help identify areas of focus for planning to improve equitable access and outcomes.

To facilitate the delivery of high-quality health services that meet the needs of Pacific people, ‘Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2014–2018 has been developed. The Ministry publishes six-monthly progress reports on its website.

2.2 Strategic positionThis section should include a brief explanation of the regional strategic context, including long-term strategic intentions.

Your strategic section should reflect your current and future regional population health approaches, services and operating requirements. Population health approaches and services are essential components of strategies to address determinants of health and achieve better health equity and wellbeing.

2.2.1 LinkagesThe strategic section must also be consistent with national strategic imperatives and include appropriate commitments to the New Zealand disability strategy and the New Zealand health strategy as well as all trends and key outcomes outlined in: DHBs’ Statements of Intent (SOIs) that articulate the ability of each DHB in the region

to deliver improved services into the future the Strategic Intentions section of DHBs’ annual plans.

2.3 Locally determined priorities for the regionThis section will document the locally agreed priorities for delivery in 2019/20. It is expected that this section will include information on how the regions expect to measure and monitor performance and monitor outcomes for the 2019/20 priorities.The plan can be framed according to local need. Please note that if the regional services plans plan is produced as a sub component or an addendum to another plan, the region must agree with the Ministry how the nationally required requirements are reflected.

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2.4 National regional requirementsThe Ministry has the following five national requirements to be included in the RSP.

In addition to these requirements, regions are expected to demonstrate regional commitment to engage in the newly established collective improvement work programme, provide regional insights, lead regionally focused improvement activity resulting from the programme, and report on progress during the year.

2.4.1 Data & Digital - Regional ICT Investment Portfolio Commit to future proofing all ICT investments by implementing standards based

integrated systems consistent with the directions of the Ministry of Health Technical Working Groups.

Commit to considering regional and national implementations where possible and consider All of Government initiatives for Cloud based solutions and “as a Service” offerings as first options.

Submit quarterly reports of the regional ICT Investment Portfolio to Data and Digital to support decision making and to maximise the value of sector ICT investment.

2.4.2 Workforce Specify five workforce actions that the region will work on (at a regional level) in the

2019/20 planning year that will support each DHBs local workforce actions. These actions can be a combination of DHB and regionally focused actions.

Please see the 2019/20 DHB Annual Plan Guidelines for the workforce guidance that is also relevant for the regions.

2.4.3 Hepatitis C Regional objectives:

o To implement integrated hepatitis C assessment and treatment services across community, primary and secondary care services in the region.

o To increase hepatitis C treatment uptake and primary care prescribing.o To diagnose those undiagnosed and lost to follow up.

In your regional service plans provide actions to support the hepatitis C objectives. This includes:

o raising community and general practice team awareness and education of the hepatitis C virus (HCV) and risk factors for infection

o providing targeted testing of individuals at risk for HCV exposureo raising patient and general practice team awareness of long-term consequences

of HCV and the benefits of treatment, including lifestyle management and antiviral therapy

o providing community-based access to HCV testing and care that could include Liver Elastography Scans1 services across the region as a means for assessment of disease severity and as a triage tool for referral to secondary care and prioritisation for antiviral therapy

o providing community-based ongoing education and support (including referral to needle exchange services, community alcohol and drug services, general practice primary care services or social service agencies)

1 Liver Elastography Scans include mobile and fixed Fibroscan machines and Shear Wave machines being used in radiology departments.

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o working collaboratively with primary and secondary care to improve access to treatment

o using lab data to identify people who have been diagnosed with possible and active HCV infection who could benefit from new treatments but may have been lost to follow up

o encouraging the use of hepatitis C champions in general practice teams and PHOs

o regularly reviewing the hepatitis C clinical pathway.

Equity focusFor the hepatitis C work, the equity focus is on the detection, management and treatment of hepatitis C in populations who are at increased risk of infection. This includes: those who have ever injected drugs; ever received a tattoo or body piercing using unsterile equipment; had a blood transfusion before 1992; ever lived or received medical treatment in a high-risk country; ever been in prison or have been born to a mother with hepatitis C.

Refer to the national guidance document on the NSFL for information to support regional implementation.https://nsfl.health.govt.nz/dhb-planning-package/guidance-support-development-regional-hepatitis-c-services

Measureso Quarterly narrative report on progress of the key actions.o Using the template provided by the Ministry, report six monthly at the end of

quarter two and quarter four on the following measure:

Measure Data collection process1. Number of people

diagnosed with hepatitis C

DHB regions to obtain data (by age bands) from 5 reference labs, and in future from community labs who perform antigen tests, on the total number of people with a positive HCV PCR and/or antigen test and report to the Ministry of Health via six monthly RSP reports

2.4.4 Cardiac and Stroke Services Chest pain pathways

o Ensure existing chest pain pathways are audited and reviewed annually, and any refinement (based on new evidence) is incorporated into the pathway where appropriate.

Workforceo Develop plans to address vulnerable cardiac workforces at a regional level, with

an initial focus on cardiac physiologists. ANZACS-QI

o ensure accurate and timely data entry to all core ANZACS-QI modules (ACS, PCI, Devices and Heart Failure), and regularly review outcomes data for these modules.

Stroke datao ensure accurate and timely capture of stroke data, regularly review outcomes

including equity of access. Telestroke

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o develop plans to implement equitable comprehensive telestroke services at a regional level, where these are currently not available.

Stroke rehabilitationo ensure plans to improve stroke rehabilitation services align with the National

Stroke Network guidance (when available), to establish consistent, equity of access and care for community based rehabilitation services.

Preventiono ensure stroke prevention plans/programmes to reduce stroke incidence align with

and support National Stroke Network guidance (when available).

2.4.5 Implementation of the New Zealand Framework for Dementia Care

Carry out a regional stocktake of dementia services and related activity with DHBs in your region to be provided to the Ministry by the end of quarter two (via the S12 measure). Using the stocktake, identify and develop an approach to progress regional priority areas for implementing the New Zealand Dementia Care Framework by the end of quarter four.

2.5 Regional governance and leadershipDHBs are expected to continue to provide effective regional governance, accountability and decision making. DHB Chairs and Chief Executives from each region will be required to agree and sign RSPs on behalf of their individual boards.

2.6[2.5] Regional governance and decision makingRSPs should provide information about how the DHBs in the region are collaborating and how implementation of the plans will be governed, costed, funded and managed, including how DHBs will manage performance and disputes.

DHBs are expected to co-operate and assist their colleagues in finding and implementing solutions to financial or clinical issues that arise. An indication of how the region will co-operate and resolve issues should be incorporated in the RSP and 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 (eg, involvement and alignment with primary care, NGOs, and patient representative groups).

DHBs may also wish to include other examples of regional collaboration, for example, cross-appointed board members and clinicians and regular engagement between DHB boards in the region.

Regions are expected to provide costing information as per the regulations (sections 5 and 6 of the New Zealand Public Health and Disability (Planning) Regulations 2011).

2.7[2.6] Line of sightFor 2019/20 a focus remains on the alignment between RSPs and Annual Plans, DHBs are required to provide, in their annual plan, a statement of the local actions they will undertake to support the delivery of the regional service plans. DHBs and regions can agree to include the local actions in one plan, either the DHB annual plan or in the RSP and include a cross-reference to the actions in the other plan.

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The health and disability system outcomes framework supports a stable system by clearly articulating what outcomes the system intends to achieve for New Zealanders, and the areas of focus through which to obtain those outcomes. Figure 1 shows the elements of health and disability system outcomes framework.

The RSP should show a clear line of sight between your regional deliverables and your regional strategy. The Line of Sight guidance framework in figure 2 is provided for general use. It aims to improve linkages across RSPs and annual plans and to demonstrate how individual DHB actions contribute to achieving regional priorities.

Figure 1 the health and disability system outcomes framework elements

Figure 2: Guidance Framework for RSP Enablers Priorities

Line of sight from the Government priority to RSP and AP actionsGovernment GoalImproving the wellbeing of New Zealanders and their families

Government Priority outcomes Ensure everyone who is able to, is earning, learning, caring or volunteering Support healthier, safer and more connected communities Make New Zealand the best place in the world to be a child

New Zealand Health System Vision Pae Ora Healthy Futures

New Zealand Health and Disability System Outcomes We live longer in good health We have improves quality of life We have health equity for Maori and other groups

Government Planning Priorities

Improving child wellbeing Improving mental wellbeing Improving wellbeing through prevention Better population health outcomes supported by strong and equitable public health

and disability system Better population health outcomes supported by primary health care

Regional outcomes

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• Outcomes that DHBs within a region want to achieve by working together regionally.DHB outcomes• Outcomes that the DHB wants to achieve.RSP - Common Priorities and Objectives• Enablers, priorities and objectives that DHBs within a region have set to achieve their

regional outcomes that contribute to the government and system outcomes.RSP - Key Actions, Milestones and Measures• Key actions to set out what the region will do to achieve its objectives (where

appropriate significant individual DHB contributions are identified).• Key milestones required to reach regional objective.• Measures the region will use to assess effect of actions agreed to achieve milestones,

including setting of baselines.RSP - Inputs / Resources• The nature of inputs may vary and could include:

o costs to implement actions o people, teams, and/or new roles required to progress actions.

RSP - Responsibilities

• Accountable roles.• Organisations and/or networks required to implement actions eg, PHOs.

AP – Individual DHB’s Contribution to Regional Enablers and Priorities

• DHB annual plan should also include any significant individual DHB contributions to deliver against national regional planning priorities identified in this guidance and targets.

Related regional structures and processes outside RSP

• Capital plans, clinical networks, national service plans

3. Assessment of the RSP and monitoring arrangements

3.1 AssessmentPlease submit the first draft 2019/20 RSP as a word document to the Ministry on or before 5 April 2019. The final draft plan is due to be submitted one month following the update to the RSP Guideline.

The plan will be assessed to ensure that the minimum legislative requirements are met, including the legislative obligations of improving Māori and Pacific Health.

Plans will be assessed on whether the regional collaborative work programmes in general and, the activities for each area of focus identified in the implementation section of the plan specifically, include a clear and robust rationale explaining how the activity is supporting financial, clinical and service sustainability.

The regional activity planned in response to the low-level national guidance will also be assessed.

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There will be no Ministry assessment of regional activities planned for the locally determined priorities however the plan will be shared with the Ministry teams for comment should the teams wish to do so.

When the Plan is ready it will be sent for Ministerial agreement.

3.2 MonitoringThe 2019/20 regional activity planned in response to the national guidance will be monitored through the quarterly reporting process.

This reporting is expected to include areas selected for regionally-led improvement from the collective improvement work programme, the benefits realisation being targeted, agreed in-year milestones and progress against these milestones.

To ensure visibility and confidence on the progress of the 2019/20 locally determined priorities, please provide the Ministry with a copy of any quarterly progress reports that are provided to local governance structures.

Copies of the reports can be sent to annualplan@moh.govt.nz

Any established reporting mechanisms in place for national programmes and clinical networks are unchanged such as timely reporting of data to the NZ Major Trauma Registry.

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