Final decision document on changes to the …€¦ · Web viewFinal decision document on changes to the Ministry’s second-tier structure 1 October 2018 Contents 1Contents2 2Introduction4

Delivering on the Ministry’s Sector Leadership and Stewardship RolesFinal decision document on changes to the Ministry’s second-tier structure

1 October 2018

CONFIDENTIAL: Delivering on the Ministry’s Sector Leadership and Stewardship roles: Final decision document on changes to the Ministry’s second-tier structure 1

1 Contents

1 Contents

2 Introduction2.1 Message from the Director-General

2.2 About this Decision Document

2.3 Design Principles

2.4 Expected Benefits

3 Decisions3.1 Summary of Decisions

3.2 Summary of Changes from Proposal to Final Structure

3.3 Summary of Position Impacts

3.4 Directorate Staff Numbers

3.5 Organisational Chart for New Structure

4 Operating Model4.1 Operating Model

4.1.1 Senior leaders

4.1.2 Across the Ministry

5 Your feedback5.1 Process

5.2 Feedback and Responses

6 Implementation6.1 Recruitment


6.1.1 Selection Process

6.2 Timeline

7 Support


2 Introduction2.1 Message from the Director-General

Kia ora koutou katoa,

This Decision Document summarises the key themes and points raised in the submissions received during the consultation process on our second tier structure, along with final decisions on second-tier positions, the functions that will sit within each new directorate, and changes to the original proposal as a result of some of the feedback.

We need to be well-aligned across the Ministry if we are to provide effective leadership and stewardship of the health system. My expectation is that the Ministry’s Executive Leadership Team (ELT) will work to provide collective leadership to ensure we deliver on the Government’s priorities and deliver better and more equitable health outcomes for New Zealanders. As part of this, all Ministry staff members have a responsibility for improving Māori health and driving increased equity of health outcomes. The changes outlined here are designed to ensure that we can deliver the collective leadership required and support us in our engagement with the health sector and other stakeholders.

The feedback that staff provided has helped shape my final decisions and I want to thank everyone who took the time to engage in the consultation process, especially those of you who prepared submissions. I have read each submission carefully and listened to your comments and suggestions provided through the face-to-face sessions we have run over the past month.

What consistently came through across all submissions and comments was people’s passion and ambition for the Ministry to confidently lead the sector. I want to acknowledge the great level of thinking, positive engagement with the proposed changes and the free and frank approach you took in setting out your feedback.

Many of the submissions were supportive of the proposed changes, and some good ideas were provided on how we can get the most out of the proposed new structure.

There were some questions about the rationale for some of the changes in the proposal document and I have provided clarity about my rationale in the decision


document.

Your submissions also emphasised that the new executive team will need to work cohesively to ensure that directorates and teams are aligned to the new structure and the Ministry’s collective priorities. I agree – how we organise ourselves around our priorities, our governance arrangements and how we work together (including with our sector partners) is important. For this reason, I have also included a description of how I see our new operating model working.

You’ll also see I have decided to delay the establishment of the Auckland Director role. There was a lot of interest in the scope of this role and expectations on how it would operate so that it is ‘cross cutting’ but doesn’t ‘cut across’ the work of the other directorates. I agree that it’s important to get this right and I intend to work with the new ELT and our Auckland stakeholders to develop this role further.

I realise that change is disruptive and I remain committed to ensuring we go through this process quickly and with integrity and transparency. I would like to particularly acknowledge those people who are directly affected by this change. I want to emphasise that I have given serious consideration to my decisions and I’m committed to supporting the organisation as we implement them. Staff members who are substantially affected have been offered a range of services and support to help them through the coming period.

The new structure takes effect from 15 October 2018. I’ll be moving quickly to permanently fill any new roles and vacancies, and in fact recruitment for some second tier roles is already underway. In the meantime, there will be a number of acting arrangements in place. The timeline in the Implementation section outlines the activities and timeframes for the change process.

I appreciate your commitment to getting the job done and continuing to ensure that we work to the best of our abilities throughout this transition period.

You can expect to hear a lot more about these changes as we get the implementation underway.

If you have any questions about the changes described in this document, please discuss these with your manager or the People and Capability team in the first instance.

Ngā mihi,

[insert signature]

Dr Ashley BloomfieldDirector-General of Health



2.2 About this Decision Document This document has been prepared for staff at the Ministry of Health. It follows the proposal I released to staff on 20 August 2018. The decisions outlined in this document have been informed by submissions and feedback received through the consultation period that ended on 7 September 2018.

This document describes the final organisational structure and new second tier positions within the structure. It also:

confirms the design principles and benefits I expect this change to deliver

includes final decisions on the overall structure and second tier positions, and outlines how that differs from the proposal contained in the consultation document

provides a summary of key themes from the submissions and my responses

outlines at a high-level an operating model that is intended to support effective ways of working to deliver on the Government’s priorities and the Ministry work programme

describes the implementation activities and timeframes

outlines where you can go to seek support

includes position descriptions for second tier positions that will be advertised.

If you have any questions about these changes or any aspect of the process, please discuss these with your manager or People and Capability in the first instance.


2.3 Design Principles The decisions in this document were informed by the following key design principles1:

Clear responsibilities: Accountabilities, authorities and duties are clear. Our leaders are visible, both internally and externally. What they lead is clear to our people and the sector.

Functional alignment/collaborative operating model: ‘Like’ functions are grouped together where logical and practical. Capability and capacity are organised in the right way to continue to deliver advice and support collaborative working within the Ministry, and across the sector.

Sector and customer engagement: Roles and structure strengthen our sector and customer focus. Our customers can find the front door of the Ministry. Role titles clearly signpost what leaders are responsible for to the sector and our partners.

Strategic, stewardship focus: The structure allows for executives to focus on their stewardship and futures obligations and avoids tactical crowding out.

Future-proofed: The structure is flexible and agile enough to respond to new priorities and changing demands.

Fiscal responsibility: The structure is financially sustainable and affordable.

The span of control: Responsibilities in terms of management of services, Vote Health spend, and/or key relationships are manageable and allow for the Ministry to be responsive to sector needs.

Structure supports the Director-General role: The ELT leads the Ministry, supporting the Director-General to execute the role’s health system and sector leadership responsibilities.

1 These principles were included in the proposal I released to staff on 20 August 2018 and have informed the decisions contained in this document.


2.4 Expected Benefits

The decisions in this document are designed to ensure the Ministry is best placed to deliver on its core functions, its sector leadership and stewardship roles, and deliver on the Government’s priorities for health care, disability support, health improvement and equity.

The new structure, along with the changes to the way we work, will provide a clearer focus on the key areas that require Ministry leadership and improve the oversight and leadership of Ministry corporate functions.

Both the structure and the ‘operating model’ will help to ensure that the Ministry’s work programme is well led and governed. Leaders at all levels will be expected to act collectively and work constructively and collegially across the organisation and with the wider sector.

Other benefits will include:

strengthening the Ministry’s core governance and performance management mechanisms so that we are clear about how we are delivering the results Government and New Zealanders need and expect

continued focus on strengthening our relationships across the health system and public sector

ensuring as Director-General and Chief Executive, I have clear ‘line of sight’ on the work programme, so I can assure myself and the Minister it is appropriately resourced, risks are managed, and good investment decisions are made to ensure the Government’s priorities are delivered on

building a mutually accountable, collaborative and outcomes-focussed culture by improving our leadership capabilities and decision-making

delivering on our stewardship function – having a future focus and enabling decisions that ensure our health system is fit for purpose and sustainable.


3 Decisions3.1 Summary of DecisionsThe Ministry’s second-tier and associated directorates will be organised along functional lines that are aligned with the work programme and reflect the way the health sector organises itself. Taking into account your feedback, I have made the following decisions regarding the membership of the Ministry’s ELT:

There will continue to be an Office of the Director-General (ODG) led by a Director. The Director will assist me to manage the Ministry’s ‘authorising environment’ and be my point person on a range of matters important in discharging my role. It will also hold accountability for the management of Government Services, Communications and Global Health functions. The ODG will support the work of the ELT and its committees.

There will be a Clinical Cluster led by the Chief Medical Officer, Chief Nursing Officer and a newly-established Chief Allied Health Professions Officer. The Clinical Cluster will be responsible for contributing strategically to understanding how services could be better planned and delivered for the benefit of New Zealanders. This includes identifying and promoting innovations at a national level, providing oversight and direction on clinical and professional issues across the sector, and supporting the response to current and future workforce demand.

I am establishing the role of Deputy Director-General Corporate Services to oversee all our important enabling corporate functions. The Deputy Director-General Corporate Services will have line management responsibilities for the Chief Financial Officer (CFO) and finance staff will be part of this directorate. The CFO will oversee all organisational and sector financial matters and have responsibility for the management of Vote Health, including the Budget process.

I am retaining the role of Deputy Director-General System Strategy and Policy, albeit with a new name, which will have responsibility for the Ministry's core policy function, including providing leadership and guidance on policy development and advice across the organisation.

I am confirming the role of Deputy Director-General Mental Health and Addictions, responsible for overseeing the ‘end-to-end’ activities and functions for mental health and addictions services and leading the response to the Government Inquiry into Mental Health and Addictions.

A Deputy Director-General Māori Health will be appointed with an explicit focus on the Crown’s Treaty obligations to protect and improve Māori health


outcomes, by providing strategic advice and guidance on Māori health improvement in a collaborative and integrated manner across the Ministry and the sector.

There will be a Deputy Director-General Population Health and Prevention, responsible for leading the Ministry’s population health programmes including the National Screening Unit, services and programmes for specific population groups, non-communicable disease prevention and control, emergency management and key public health functions.

I will establish a Deputy Director-General Health System Improvement and Innovation, responsible for ensuring strategic leadership and support for the Ministry and wider health sector to deliver ongoing improvements in service quality and outcomes. This includes leadership of research and evidence, quality assurance and improvement, data analytics and support for innovation in the sector. Both Medsafe and Quality Assurance and Safety will be part of this Directorate.

I am also establishing a Deputy Director-General Disability with responsibility for providing the oversight of ‘end-to-end’ activities and functions for the disability community. This includes purchasing disability support services for people with a long-term physical, intellectual and/or sensory impairment that require ongoing Government support to enhance their health and wellbeing, as well as advising on disability policy and ensuring disabled people receive the health care services they need.

There will be a Deputy Director-General DHB Performance, Support and Infrastructure, with responsibility for ensuring a strong working relationship between the Ministry and DHBs, ensuring strategic leadership and support for DHB planning and funding, ensuring accountability for DHB operational performance, and oversight of DHB infrastructure and capital projects. This role will also oversee electives (planned care) and national services.

The role of Deputy Director-General Data and Digital will be responsible for ensuring that our data collections and digital technology support the health system to deliver better services and health outcomes. The role will retain oversight of current data and digital functions as well as the national collections, while the Ministry ICT function will now be part of the Corporates Services Directorate.

I am establishing a Deputy Director-General Health Workforce responsible for creating and supporting a clear strategy and future pathway for health workforce in New Zealand. This includes workforce policy, planning, commissioning of training, and supporting the development and implementation of innovative workforce initiatives across the sector, including with DHBs. This role will also have oversight of employment and industrial relations matters across the sector and will maintain a close working relationship with the Health Workforce New Zealand Committee.


A Director Auckland Health Services Planning and Support will be established in due course to help the Ministry to address specific challenging issues faced by the Auckland region now and in the future.

Underpinning this structure will be an operating model and governance arrangements that focus on collective accountability and shared decision-making. There is more information later in this document about the operating model.The proposal document highlighted several functions or areas of focus that specific directorates will be responsible for and that currently may not be explicit or have dedicated resources. I have confirmed a number of these in the decision document. They relate to:

Organisational Strategy, Planning and Reporting (Corporate Services directorate): this relates to the Ministry’s overall strategy, annual work plan and Output Plan, and our regular financial and non-financial reporting.

Health Promotion (Population Health and Prevention directorate): health promotion is core to the delivery of effective population health programmes and this needs to be strengthened, including through a closer working relationship with the Health Promotion Agency.

Climate Change and Health (Population Health and Prevention directorate): there is already some work underway on this topic, which is a significant public health issue.

Quality Improvement, Research and Evidence (Health System Improvement and Innovation directorate): as noted above, these areas will be a core focus for this new directorate, including working closely with the Health Quality and Safety Commission (HQSC) and the Health Research Council.

DHB Infrastructure and Capital (DHB Performance, Support and Infrastructure directorate): this is an area that is currently being strengthened and is also the subject of external work with the Treasury to identify options to further strengthen this function in future.

Health Workforce New Zealand secretariat (Health Workforce directorate): this function is listed explicitly to emphasise that the work of this directorate is not just the current HWNZ work programme, and HWNZ will continue to need dedicated secretariat support for its work.


3.2 Summary of Changes from Proposal to Final Structure

The following table outlines the key changes from the proposed structure to the final structure and the rationale for these changes. Some changes to the placement of individual roles have also been made based on feedback provided. These are not itemised in the table below but can be seen in the organisational chart.

Changes from proposal to final decision

Rationale

Director, Office of the Director-General (ODG), will have responsibility for all Communications functions. This means that Digital Communications and Web Services will report to the General Manager Communications within the ODG.

While some respondents suggested Digital Communications and Web Services should be part of Data and Digital Services, I received convincing feedback on the rationale for keeping our strategic communications and our communications channels functions together and reporting to the same General Manager.

Within the Clinical Cluster I have changed the name of the Chief Allied Health, Scientific and Technical Officer to Chief Allied Health Professions Officer. The Office of Chief Nursing Officer, Office of the Chief Medical Officer and all advisors in the Clinical Cluster will become part of a single Office of the ‘Clinical Cluster’.

The name change is to avoid any confusion with the role of Chief Science Advisor. The creation of a single office within the Clinical Cluster is intended to support all three professional leaders and clinicians in the Cluster to operate as a cohesive group.


The Corporate Services directorate remains, however, I have decided that Sector Operations, Ethics Committee Support and Digital Communications and Web Services sit better elsewhere in the new structure. I have included the Chief Information Security Officer, DHB Funding, DHB Monitoring and General Manager Sector Quality and Advice in the Corporate Services Directorate. I have also made it clear that the CFO has responsibility for the Ministry’s finance function and oversight of all matters concerning Vote Health, including the Budget process, with a ‘dotted’ reporting line to me.

Changes were made based on feedback about where functions best sat within the structure to create synergies, including bringing together our finance function.

Policy and Strategy directorate is now System Strategy and Policy.

To reflect the intended focus of this directorate on whole of system settings.

Māori Health and Equity directorate is now just focussed on Māori Health. I have removed equity and our Pacific health functions from the scope of this directorate.

There was considerable feedback on the proposal, as I anticipated. Treaty of Waitangi outlines a set of principles that guide the relationship between the Crown and Māori. In recognition of those principles and the specific obligation to address the needs of Māori, I will create a directorate responsible for providing strategic advice and guidance on Māori health improvement across the Ministry and the sector.

I also want to ensure that we take individual and collective responsibility for achieving equity across the Ministry. I have therefore decided that it will be an integral part of our operating model rather than in the title of a single directorate.


Population and Community Health Improvement directorate has been renamed Population Health and Prevention. This directorate now includes Cancer Services, CVD Diabetes/LTC, Pacific health functions. It will also have responsibility for the climate change and health. This directorate no longer includes Medsafe (including Medicines Control), Primary Care, Healthy Ageing, Community and Ambulance or Maternity Services, which I have confirmed will be part of the Health System Improvement and Innovation directorate.

Changes were made based on feedback about where functions best sat within the structure to manage the span of control (volume and range of functions) and to create synergies.While the focus is on prevention and population health programmes, the Population Health and Prevention directorate will be responsible for the full spectrum of non-communicable disease prevention and control, including health service aspects.

Health Service Improvement and Innovation directorate becomes Health System Improvement and Innovation. Its functions include Ethics Committee Support (which remains aligned with the ethics advisors), Medsafe (including Medicines Control), Primary Care, Healthy Ageing, Community and Ambulance, Maternity Services, Operational Excellence Service Analysis & Modelling. This directorate no longer includes National Collections and Reporting, Emerging Health Technologies, Electives and National Services (Planned Care), Cancer Services, CVD Diabetes/LTC, Project Manager Contract Support, and the Lead Data Steward.

Changes were made based on feedback about where functions best sat within the structure to manage the span of control (volume and range of functions) and to create synergies.

Note not all analytics capability will sit in this directorate, e.g. National Collections and Reporting will be part of the Data and Digital directorate. However, the DDG Health Service Improvement and Innovation will be the functional lead on analytics for the Ministry and responsible for ensuring we have strong, accessible and well-aligned analytics capability.

Disability Support directorate now called Disability directorate and includes the Project Manager Contract Support and team, whose work is focused on disability support.

The change to the title indicates that the directorate has wider scope that just disability support, e.g. access to health services for disabled people, and is based on feedback about where specific roles best sit within


the structure to create synergies.

DHB Performance, Support and Infrastructure directorate no longer includes DHB Monitoring, DHB Funding, the General Manager Sector Quality & Advice, or Operational Excellence Service Analysis and Modelling. The directorate now includes Sector Operations as well as Electives (Planned Care) and National Services.


The finance-related functions have been consolidated in the Corporate Services directorate to facilitate oversight by the CFO.

Sector Operations was originally proposed to be part of the Corporate Services Directorate, however feedback confirmed it is a sector-facing function so it has been included in this directorate.

ICT and Digital Services is now called Data and Digital. This directorate will include National Collections and Reporting, Emerging Health Technologies and the Lead Data Steward, all of which were originally proposed to be part of the Health System Improvement and Innovation directorate.


Addition of HWNZ Secretariat to Health Workforce directorate.

Change made to recognise the distinction between providing administrative and advisory support to the Health Workforce New Zealand Committee and the broader workforce agenda.


3.3 Summary of Position ImpactsThe following table outlines how the proposed structure would impact existing second-tier positions.

Second tier position Proposed changesChief People and Transformation Officer

Position disestablished.

The functions under this role are incorporated into the new positions of Deputy Director-General Corporate Services and Deputy Director-General Health Workforce.

Māori Leadership Position disestablished.

This portfolio is incorporated into the new position of Deputy Director-General Māori Health.

Director, Critical Projects Position disestablished.

This portfolio is included as part of the new position of Deputy Director-General DHB Performance, Support and Infrastructure.

Director, Service Commissioning Position disestablished.

The functions within Service Commissioning are dispersed across a number of other Deputy Director-General positions.

Chief Financial Officer Position disestablished.

The functions are split into the new directorates of Corporate Services and DHB Performance, Support and Infrastructure. A new Chief Financial Officer role has been created at the third tier.

Chief Technology and Digital Services Officer


The functions under this role are incorporated into the new positions of Deputy Director-General Corporate


Second tier position Proposed changesServices and Deputy Director-General Data and Digital.

Director, Protection Regulation & Assurance


The functions within Protection Regulation & Assurance are dispersed across a number of other Deputy Director-General positions.

Chief Strategy and Policy Officer Position reconfirmed.

Minor changes in portfolio distribution and change of position title to Deputy Director-General, System Strategy and Policy.

Executive Director, Office of the Director General

Position reconfirmed.

Minor change in portfolio and change of position title to Director, Office of the Director-General.

Chief Nursing Officer Position reconfirmed.

No substantial change to this role.

Chief Medical Officer Position reconfirmed.

No substantial change to this role.


3.4 Directorate Staff NumbersThe approximate head count for each of the directorates is outlined in the table below based on current positives. This does not include vacancies or contractors. There is variation in the size of the directorates as not all roles have the same span of control and there are some large units, e.g. Sector Services, National Screening Unit, Medsafe, that ‘skew’ the numbers regardless of where they sit in the organisation.

Directorate Approximate number of staff

Office of the Director-General 54Clinical Cluster 11Corporate Services 198System Strategy and Policy 64Mental Health and Addictions 38Māori Health 25Population Health and Prevention 195Health System Improvement and Innovation

178

Disability 66DHB Performance, Support and Infrastructure

184

Data and Digital 126Health Workforce 26Auckland Health Services Planning & Support

0

Total 1165


3.5 Organisational Chart for New Structure



4 Operating ModelMaking changes to our second-tier structure is necessary but not sufficient alone. A parallel and more important step is to define how we work together and set up processes that support this. Most submissions on the proposal addressed the need for a clarity on how we work together so we can deliver on our work programme.

In response to those submissions, which I found to be thoughtful and pragmatic, and with reference to the Ministry’s recent Performance Improvement Framework review findings, some information on what we plan to put in place to support our new structure is provided in the following sections. It represents a starting position, to be developed and refined over time.

4.1 Operating ModelOur operating model is based on the following principles:

• that the right people are at the table at the right time for as long as they are required

• there is a high degree of cooperation between and across teams, and Ministry staff see themselves working for the organisation first and their ‘home’ teams second

• achieving equity is everyone’s responsibility and is to be an explicit consideration at all levels of work programme delivery.

4.1.1 Senior leadersThe basic premise is that ELT and ELT committees will ‘govern’ the Ministry’s work programme and make and implement decision collectively. ELT will have both strategic and operational functions. Four standing ELT committees are proposed that will meet regularly, and there will be ad hoc committees established as needed to undertake specific tasks or consider proposals on a specific issue. The committees will:

• have membership that includes ELT members and other senior organisational leaders whose collective role is to make decisions and ‘govern’ aspects of the work programme; membership will be determined by the Director-General

• provide the forum for more detailed consideration and discussion of issues before reference to ELT


• offer a way for the ELT to share knowledge, maintain quality standards, align different pieces of work and ensure a focus on the priorities

• have a Terms of Reference and a Chair.

The following standing ELT committees are proposed.

• Outcomes and Equity: oversees and considers work on health improvement and achieving equity. This ELT committee ensures that appropriate tools (strategy, policy, approaches, methods, measures and infrastructure) are developed and implemented to advance health outcomes and equity. This includes creating a shared vision and understanding of value, increasing sector capability and capacity to shape health outcomes and achieve equity, and improving collaboration.

• System Enablers: oversees and guides the integrated development of initiatives designed to ensure key enablers (workforce, accountability processes, financial management, infrastructure, data and information) support achievement of the government’s goals of a strong public health care system, and improved and more equitable health outcomes for New Zealanders.

• Commissioning and Funding: sets the parameters for best practice management of Vote Health funding, including considering the way that nationally purchased services are commissioned and funded, oversees Vote Health’s contribution to the Government’s annual Budget process and maintains the high standards for procurement across the Ministry.

• Policy and Legislation: oversees and considers all policy advice to ensure it is high quality and consistent with overall strategy. The ELT committee will build and maintain a high performing policy system within the Ministry that supports and enables good government decision making, including having responsibility for policy quality and capability, regulatory stewardship and oversight of the legislative programme.

In addition to being part of ELT and ELT committees, the second tier and other senior organisational leaders will have responsibility for fostering strategic relationships and leading on key functional areas.

Strategic RelationshipsAs system leaders and stewards we need to maintain an overview of the whole system and ensure that organisations work effectively together to deliver outcomes. We want to collectively deliver a health service that is improving, protecting and promoting the health and wellbeing of all New Zealanders and is working closely across government to deliver on wider government priorities. As


part of this, the Ministry’s senior leaders will have responsibility for building and maintaining strategic relationships with health sector Crown entities, including DHBs, and Central Agencies.

An initial view on those key relationships and the primary relationship holder is provided in the table below. Under this model, the DHB Relationship Managers and Crown Entity Relationship Managers will continue to operate in the same way they do now.

Entity Primary relationship holderState Services Commission Director-GeneralThe Treasury CFODepartment of the Prime Minister and Cabinet

DDG System Strategy and Policy

DHB chief executives DDG DHB Performance, Support and Infrastructure

DHB Chairs and Lead DHB Chief Executive

Director-General

Food Standards Australia New Zealand

DDG Population Health and Prevention

Pharmaceutical Management Company (PHARMAC)

DDG System Strategy and Policy

Health and Disability Commissioner Chief Medical OfficerHealth Promotion Agency DDG Population Health and PreventionHQSC DDG Health System Improvement and

InnovationHealth Research Council of New Zealand

DDG Health System Improvement and Innovation

HWNZ DDG Health WorkforceMental Health Commission (once established)

DDG Mental Health and Addictions

New Zealand Blood Service DDG Population Health and Prevention

Functional LeadsFor a range of important cross Ministry services, oversight of standards, processes and delivery against objectives will be the responsibility of a designated functional lead. Initial functional leads will be:

• Analytics – Deputy Director-General Health System Improvement and Innovation.

• Communications – General Manager Communications.

• Finance – CFO.


• ICT, data and digital – Chief Information Officer (CIO).

• Legal – Chief Legal Advisor.

• Procurement – Deputy Director-General Corporate Services.

• Risk – Deputy Director-General Corporate Services.




4.1.2 Across the MinistryWork that crosses Ministry team or external agency boundaries will be driven by Cross Ministry Teams (CMTs). CMTs will be:

• created to support work where there is a desire to achieve a change in outcomes from the system and/or tasks that cross the boundaries of more than one team

• time-bound and closed when the job is done so that people can move on to support work from their home team and/or their next CMT

• configured so that expertise can be brought to the topic for as long as is required.

Deciding if a CMT needs to be established will be the role of the ELT committees, which will also assign a team leader and determine relative priority of the work.

An important feature of CMTs is their membership. Membership is configured so that the right people with the right skills and expertise are contributing. Membership may be part-time, full-time or even periodic during the life of the CMT. Membership and the time commitment are agreed with the person’s home team manager, or organisation if they are external to the Ministry.

CMT membership or leadership may be part of a staff member’s professional development.

Each CMT will need:

• an ELT sponsor who: is ultimately accountable for achievement of the outcome; negotiates time commitments with home team managers of CMT members; provides home team manager with feedback on the CMT leader’s performance

• a leader who: leads the CMT, is accountable to the ELT sponsor for delivering the whole task; provides regular updates to the ELT sponsor and ELT committee; provides home team managers with feedback on CMT members performance. These people may lead others who are more senior than they are and may not be the functional lead in an area

• team members who: work collaboratively with other CMT members; are accountable to the CMT leader for their contribution; use their skills, expertise and knowledge to bear in finding positive solutions

• home team managers who: support the CMT through the release of individual staff members to participate; integrate feedback from the CMT leader into performance management processes.

The operation of CMTs should, at a minimum, be supported by a high-level project plan, face-to-face discussions for new pieces of work and include regular face-to-face issues meetings. This will help ensure that progress is shared and any risks or


issues identified and managed, different perspectives are captured, and an agreed approach/position is adopted.

Closing a CMT is as important a step as creation of the teams. In closing a CMT, the team should clearly identify where any ongoing responsibilities lie.

At the conclusion of the work, the team will review what worked well, what risks emerged, how they were managed and how the team would change its practices given what it has learnt.

The CMT model is already in operation in some parts of the organisation. Embedding this way of working is important to ensure that we:

• are responsive to changes in priorities/our operating environment

• provide opportunities for career development for everyone

• build our collective knowledge and relationships across directorates and with external agencies.

Responsiveness to MāoriMāori health is a priority for the Government and the Ministry. Improving Māori health outcomes and addressing long standing inequities is a responsibility for everyone, in the Ministry and across sectors. This requires focussed effort and leadership.

We should all have an understanding and awareness of Te Tiriti o Waitangi and the place of tangata whenua as the indigenous people of New Zealand. We must also understand the role of the Ministry and the health and disability sector in addressing health inequities and improving health outcomes for Māori. We will build the internal ability (capability) and knowledge (capacity) in Māori cultural competency, Te Tiriti o Waitangi and He Korowai Oranga Māori Health Strategy. This includes having a strong Māori Health directorate and capable Māori staff members across the organisation.

This will be supported by implementing the Treaty principles across all our work and processes, namely:

• Participation: requires Māori to be involved at all levels of the health and disability sector, including in decision-making, planning, development, delivery, monitoring and evaluation of health and disability services.

• Partnership: involves working together with iwi, hapū, whānau and Māori communities to develop strategies for Māori health gain and appropriate health and disability services.

• Protection: involves the Government working to ensure Māori have at least the same level of health as non-Māori, and safeguarding Māori cultural concepts, values and practices.

In practice, this can be achieved by:


1. Ensuring the aspirations of Māori are reflected in the planning, development and delivery of health and disability services.

2. Ensuring the aspirations of Māori are involved at all stages and all levels in the planning, development and delivery of health and disability services.

3. Building and maintaining partnerships with Māori.4. Building internal capability (ability) and capacity (knowledge) in all staff in

Māori cultural competency, Te Tiriti o Waitangi and He Korowai Oranga Māori Health Strategy.

5. Addressing structural barriers in the Ministry such as institutional racism, bias and decision-making powers.

6. Monitoring the responsiveness to Māori across the Ministry.7. Including key performance indicators for all staff on responsiveness to Māori.8. Working collaboratively with other government agencies to achieve Pae Ora.

Achieving EquityIn 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 may require different approaches and resources to get the same outcomes.

Achieving equity in health outcomes for all New Zealanders, in particular for Māori, Pacific people and low-socioeconomic groups, is a key priority for this Government and forms part of the Ministry’s overall work programme. People in these groups are more likely to die prematurely for avoidable reasons, are more likely to report unmet need for primary care and are more likely to access acute hospital services.

Equity touches the entire health and disability systems, so the Ministry will take a proactive and collaborative approach to creating a shift in the system to ensure equity issues are at the forefront of system design and delivery. Success will be measured by the extent to which the health system delivers the same high-quality health outcomes for all people to reach their full health potential no matter where they live, what they have or who they are.

The initial focus is to:

• socialise our strategic framework for achieving equity and work with others to refine our thinking and definitions

• commission data and analytics to understand the types of equity problems and solutions that can be prioritised and woven into core business, with a focus on our priority programmes of mental health, primary care and child well-being


• engage with internal and external stakeholders including across government to identify and implement opportunities at all levels of the system to address equity challenges

• support the building of capability within the Ministry to address equity in specific work programmes.


5 Your feedback5.1 ProcessThe consultation on the proposed changes started at 2pm on Monday 20 August 2018 and closed at 5pm on Friday 7 September 2018.

You had an opportunity to ask questions at various workshops, email me and provide submissions on the proposal. I also asked for suggestions for how the proposal might be improved.

I provided opportunities to meet with staff members to discuss your feedback and answer questions in person.

Through the process, 108 submissions were received and 73 emails addressed the change. Many of the submissions were group submissions.

A submission from the Public Services Association (PSA) and feedback from Central Agencies were also received and considered. A number of DHB Chief Executives and sector leaders also shared their thoughts with me.

Once again, I want to thank everyone who took the time to engage in the process.

The submissions were high quality and, having read them, I want to acknowledge the level of thinking and engagement from you. This level of engagement is very positive and bodes well for our work together in the future.

As a direct result of these submissions, I decided to make some changes to the original proposals, whilst some aspects of what I proposed remain the same.


5.2 Feedback and ResponsesThe table below contains a summary of the key ideas and suggestions that came through in the feedback and my response to these. All submissions have been reviewed and considered as I formed my final decisions. Many touched on the same issues, or raised similar issues. It was not possible to provide individual responses to every piece of feedback or submission made, but regardless of whether or not a response appears in the decision document please be assured your feedback has been considered.

Feedback Outcome / Response

Overwhelming support for the Clinical Cluster.How will the Clinical Cluster work and how will they be represented at the ELT table?Should it include the Director of Public Health, Oral Health and should there be a Chief Pharmacist Officer?Title suggestion: Chief Allied Health Professions Officer.

It is anticipated that the Clinical Cluster will have a central team to support its work. All three of the key roles in the Cluster will have a place at the ELT table.There is a range of clinical roles across the Ministry, some with specific technical expertise, while others have much broader briefs. I have decided the Oral Health team will stay together to keep the current partnership working as the team is making good progress. Like the Director of Mental Health, I believe the Director of Public Health should be situated in the relevant directorate as a professional leader with specific responsibilities and expertise. The roles in the Clinical Cluster are more generic, with a system-wide focus. At this point, I don’t believe we need a Chief Pharmacist Officer; we currently have a Chief Advisor Pharmacy. I agree with the suggested title change – that has been adopted.



Is the span of control for the Director-General and some Deputy Directors-General too broad?

I consider span of control as being the span of influence and awareness a role has to exercise its responsibilities – and in the context of these decisions, the need for the second-tier and me to deliver the Ministry’s sector leadership and stewardship roles. I have made some amendments to the distribution of functions across the directorates as a result of feedback received, in order to achieve a good balance – to the extent possible.My view is that my span of control is similar regardless of how many direct reports I have, but I am confident that with Deputy Director-Generals responsible for leading logical, right-sized parts of the business, and good functional arrangements in place (operating model, culture, leadership expectations and style), that I will be well supported to be effective in my role.

Aren’t some tier 3 roles are affected through this process as the teams they managed are being allocated to different directorates?

I agree that a small number of tier 3 roles are affected and I have met with those staff members. These positions have been allocated to the directorates where they best ‘fit’ at this point, and will be involved in the interim management arrangements that will be put in place when we stand up the new structure.

A number of new positions were proposed to support the new directorates to work effectively.

Aside from at the second tier, there are no new positions at this point. The new Deputy Directors-General will be responsible for determining their capability and capacity needs to deliver on their allocated areas of responsibility, including any new roles that may be necessary.



Why does Auckland have a separate directorate and how will this work? Could this be part of DHB Performance or a tier 3 role, e.g. as part of the DHB Performance, Support and Infrastructure directorate?

I consider having a dedicated Director for Auckland Health Services Planning and Support is an appropriate organisational response to the challenges ahead for this region.There are significant health infrastructure investment demands in Auckland that need consideration, and regardless of structure, the sector and Government will be expecting Auckland to be a key priority for the Ministry. As you know, Auckland is already large and is growing rapidly, and we need to be responding appropriately to the challenges this brings. The role is also about the wider Auckland health system, not just DHBs.That said, I am aware that getting this role positioned correctly is important, so I have decided not to fill it immediately. This will give me the chance to take advice from the new ELT, so they can help shape the role and how it interacts with the other directorates. I also want to keep talking with key Auckland stakeholders to understand what they see as the key issues and challenges facing Auckland and how the Ministry can best support them to deal with these.In time, there will be a team to support this position and the operating model will shape how it works. It’s important that this role is at the second tier due to the nature and magnitude of the issues it needs to respond to.

It is important that the ODG supports the work across the organisation and is not a ‘filter’ or roadblock.

I agree.



There are currently two teams working on health ageing – can these be brought together to avoid duplication and consolidated capacity and capability?

I have left the two teams separate at this point (in System Strategy and Policy directorate and Health System Improvement and Innovation directorate), however this can be reviewed during the next phase to ensure the working arrangements are optimal.

Why is Equity included in the Māori Health directorate? Isn’t that a shared priority? Why is Pacific Health part of this directorate?

I explained my rationale for this proposal in the initial document, and anticipated discussion and feedback. I did receive considerable feedback and there was a range of views. After careful consideration, and based on the fact equity is an organisation-wide priority and will now be reflected in the operating model, I have decided to establish a Māori Health directorate. I expect the Deputy Director-General to determine the specific capability and roles required in this directorate. Regarding Pacific Health, I received a range of views and the weight of these supported having this function elsewhere in the organisation. I have settled on the Pacific roles and functions sitting in the Population Health and Prevention directorate.

Why has the Communications team been split between two directorates?

I have taken on board the feedback on this and I am happy for the Communications team to remain together in ODG.

Why is policy in its own directorate and where does regulation sit?

One of the Ministry’s core roles is the development of sound and high quality policy advice and this is an area that needs strengthening. Likewise, having a clear strategic capability is important to us delivering on our stewardship function.I have decided on a mixed model where ‘system level’ policy is centralised in a directorate, but some operational policy and regulatory activity is aligned with the functions they relate to. Establishing a community of practice that



supports high-quality policy and regulatory advice across the Ministry will be one of key roles for the Deputy Director-General for System Strategy and Policy.

Why is the CFO not a tier 2 role? I believe the Ministry’s finances and our stewardship of the funds we are responsible for warrants a clear focus and a dedicated role in the CFO. The CFO will be a key member of the Ministry’s executive governance arrangements and have direct access to me. I believe this role warrants a specific focus given the size of Vote Health and the complexity of funding arrangements in the sector. And I believe the responsibilities of the DDG Corporate Services will be significant on their own.

Population, Community and Health Improvement is too large.The use of the word ‘improvement’ in Population and Community Health Improvement and Health Service Improvement and Innovation is confusing.What’s the difference between the Population and Community Health Improvement and the Health Service Improvement and Innovation directorates?

I have given considerable thought to the best balance of roles and functions across the groups. As part of addressing the proposed size of this directorate, I have now included Medsafe in the Health System Improvement and Innovation directorate.Population, Community and Health Improvement is now Population Health and Prevention.The Population Health and Prevention directorate is focussed (although not exclusively) on prevention and early intervention to improve health at a population level. The Health System Improvement and Innovation directorate is focused on providing support for the Ministry and wider health sector to support and deliver ongoing improvements in service planning, quality and outcomes.

Why have the Ethics teams been split into different directorates?

After consideration of the feedback, I have chosen to group the Ethics team together in the Health System Improvement and Innovation directorate.



Why are procurement and commercial functions split between Corporate Services and Health Workforce?

Commercial nous and procurement are important sets of expertise for the entire organisation. In Corporate Services, this function will be responsible for leading and monitoring practice across the Ministry. In Health Workforce the function needs to administer ring-fenced funds that support a range of workforce training initiatives. On balance, I believe it is appropriate to have the workforce-related roles in the Health Workforce directorate.There will also need to be an element of procurement and commercial expertise in almost all directorates. As with the policy function, I expect communities of best practice to be established to support this.

Why is Global Health in ODG? I am keen to raise the visibility of Global Health within the Ministry and have it operate as a strategic function that engages across the organisation. I believe placing it in ODG will help achieve this.As Global Health often involves the Director-General and the Minister, there are also other synergies created with its placement in ODG.

Some current tier 3s will become tier 4s. How will this affect job banding and salaries? How will you retain our valued staff?

It is my intention to minimise changes to tier as this is not the purpose of this change. In the short-term, there will be no change to salaries, job banding or level of seniority for those below second tier. As I noted in the proposal document and in staff discussions, there will be further changes as we ‘shake down’ into the new structure and some of the current tier 3 and tier 4 positions will be different given the changes. That said, the new operating and new governance model will create interesting opportunities, so we can retain valued, and skilled staff.



We suggest bringing together the QAS team, Medsafe and regulation policy into Health Services Improvement and Innovation.

I agree that grouping Quality Assurance & Safety and Medsafe makes sense as they are similar functions that both support health service and practice quality, and so I have brought them together in the Health System Improvement and Innovation directorate.I have not created a regulatory directorate per se and I am intending there to be cross-Ministry engagement through a community of best practice on regulation.

Cancer Services and CVD/Diabetes/LTC could be in the Population, Primary and Community Health directorate.

I agree and have made this change.

We suggest the following roles to be included in the Disability directorate: 3 x Business Support Analysts, Senior Advisor Commercial, Financial Analyst.

I agree. These roles are a better fit in the Disability directorate.

The Chief Information Officer should be part of ICT function in Corporate Services.

The CIO is concerned with ICT and digital enabled transformation across the health system to deliver better services to New Zealanders. Because of this system focus, I have placed the role in the Data and Digital directorate.

To support the new way of working we need to reinstate the business managers across all directorates.

I concur that each directorate will need someone to liaise with central functions such as HR, finance and IT. This can be looked at as we get a feel for how the new structure is working.

We suggest a Māori Mental Health and Addiction function in the Mental Health directorate.

I am not creating additional or new roles below the second tier at this stage.Mental health is a priority for the Ministry and I would expect staff in the Mental Health and Addictions directorate and Māori Health directorate to work closely together on this.

How do we include the voice of older people, rural people and

It is my expectation that all Ministry staff are open to convening new and different



communities as well as women and girls in this new way of working?

ideas and listening to different points of view as we go about our work.

Where is Crown Entity monitoring? Relationship managers for the health Crown entities remain within ODG. However, it is the responsibility of senior leaders and staff from across the business to lead on the strategic thinking and development of these relationships.

Why have you put the Health Survey team together into the Health Service Improvement and Innovation directorate?

I want to bring our research and evidence teams together to strengthen our evidence and analytical capability and capacity while remaining responsive to the wider needs of the Ministry. The Health System Improvement and Innovation directorate will have a focus on evidence, innovation and improvement, supported by quantitative and qualitative analysis to inform our change agenda for the system.

I am aligned to Māori Development however we work strictly with MH & A contracts. Where do we fit in this structure?

You are aligned to the Mental Health and Addictions directorate.

Policy & Strategy - Why change this from Strategy & Policy? The proposed 'Policy and Strategy' directorate will replace the current 'Strategy and Policy' Business Unit. Is the transposition in the title inadvertent or intentional? If intentional, what is the rationale for this?

After considering feedback I have named this directorate System Strategy and Policy.

ICT & Digital Services – suggest Digital Services, Integrated Service Design and Delivery or Digital Transformation. The name ICT & Digital Services doesn’t align with the scope and focus of the directorate. “ICT” as a term tends to refer to operational technology such as networks, servers and desktops and it may also be confused with the Ministry ICT team

This will now be Data and Digital directorate.



in Corporate Services.

What is envisaged by the Organisational Strategy, Planning and Reporting function within the Corporate Services directorate?

This function relates to the Ministry (rather than wider sector) strategy, business planning and reporting. It is a function that needs strengthening so that we are clear about our work programme and resources and reporting regularly against delivery on this.

Should the ELT support and MoH Governance function sit within Corporate Services?

I have considered this suggestion and decided, on balance, that this function will sit in the ODG so that there is consistent and appropriate support for the work of the ELT and ELT committees.

Should the People and Capability role be second tier?

The Ministry’s People and Capability teams will be part of the Corporate Services directorate, and the General Manager will be involved in the relevant ELT governance arrangements.


6 ImplementationIt is my intention to appoint an acting second-tier while I undertake recruitment to new second-tier positions. I expect acting arrangements to be in place from 15 October 2018 for between three and six months.

I will ask acting executive leaders to work with each other, and with their new directorates, to determine how our work will be managed and organised and agree with me the proposed management arrangements. Changes in reporting line and/or directorate will be notified in writing to all staff before 15 October 2018.

The reassignment process will be consistent with State Sector practice and the requirements of the State Sector Act.

A link to all vacancies will be published on MOH@WK after 8 October 2018. If you wish to express an interest in applying for one of these roles, this can be done so by contacting the designated person or agency managing selection for that role directly.

I expect the first ELT committee meetings, as outlined in the operating model, to be up and running in the first week of November.

You will receive regular updates on progress, including recruitment into second tier roles, through my weekly email update.

As second-tier appointments are made, and we settle into the new structure, there will likely need to be some changes to how the directorates are organised internally. It will take several months to identify these and so I have said that these changes won’t take place before February 2019 and, likely not until the end of the first quarter calendar year 2019. You will be consulted with on these changes as necessary and the process will be fair and transparent. Any changes will happen in a coordinated way across the organisation.

6.1 RecruitmentThere are 13 roles where a recruitment process will commence after publication of this decision document. These roles are:

Chief Nursing Officer (existing) Chief Allied Health Professions Officer (new) Director Office of the Director-General (existing)


Deputy Director-General Corporate Services (new) Deputy Director-General System Strategy and Policy (existing) Deputy Director-General Mental Health and Addictions (new, currently

interim) Deputy Director-General Māori Health (new) Deputy Director-General Population Health and Prevention (new) Deputy Director-General Health System Improvement and Innovation (new) Deputy Director-General Disability (new) Deputy Director-General DHB Performance, Support and Infrastructure

(new) Deputy Director-General Data and Digital (new) Deputy Director-General Health Workforce (new).

Position descriptions for these roles are attached in the appendix.

As previously mentioned, the establishment of Director Auckland Health Services Planning and Support is on a slower track. Recruitment will commence once the new ELT and our Auckland stakeholders have had the opportunity to develop this role further.

6.1.1 Selection ProcessIn the first instance, any reconfirmation or reassignment will apply. Following that, I intend for vacant roles to be advertised by either an external recruitment firm or the Ministry’s internal recruitment team.

The positions will be advertised internally on the second tier change page of MOH@WK and externally by a recruitment firm or the Ministry’s recruitment team. All staff are eligible to apply for these roles. The selection process will be based on merit and appointment will be made to the person whose skills and capabilities are best suited to the requirements of the role. Affected staff members will be given preference over external candidates providing they meet the criteria for the role.

The following table outlines the selection criteria for the recruitment of vacant roles:

Selection Criteria WeightingTechnical expertise _ /5Embodying the Ministry behaviours _ /5Previous performance _ /5Leadership capability _ /10Stewardship _ /5Stakeholder engagement (convene & collaborate)

_ /5

TOTAL _/35


There will be panel interviews for all positions consisting of at least one technical expert and one sector leader. There will be specific selection criteria for each role, as per the table above, and further detail is outlined in the position descriptions. We will also be engaging a selection and development firm to assist the recruitment process with candidate profiling and psychometric testing.

I will work with any unsuccessful candidates on a one-to-one basis to provide feedback. If your role is to be disestablished and you are unsuccessful in securing a position in the new structure, I will work with you to identify other redeployment opportunities within the Ministry. An affected employee who is offered and accepts a role within the Ministry, other than a reconfirmation or reassignment, is redeployed. An employee who accepts redeployment has no entitlement to redundancy.

If no suitable redeployment opportunities can be identified, affected people will receive notice of termination of employment due to redundancy and will receive redundancy entitlements in accordance with their terms and conditions of employment.

The Chief Nursing Officer and Chief Allied Health Professions Officer roles are already advertised. Recruitment for remaining positions will begin from 8 October 2018. As already mentioned, the Auckland role will be shaped by ELT and therefore recruitment to this role will be deferred until early 2019. I will be working closely with the recruiters to evaluate the suitability of all applicants against the capability requirements of the positions. So that we can run a high-quality recruitment process, given the number of positions, we expect to recruit in two tranches: Tranche 1: To commence from 8 October 2018. Tranche 2: To commence from 5 November 2018 (approximate date, any adjustments to this will be communicated).

Roles in tranche 1 are: Chief Nursing Officer (underway) Chief Allied Health Professions Officer (underway) Deputy Director-General Corporate Services Deputy Director-General Disability Deputy Director-General DHB Performance, Support and Infrastructure Deputy Director-General Population Health and Prevention Deputy Director-General Health System Improvement and Innovation Deputy Director-General System Strategy and Policy Deputy Director-General Mental Health and Addictions

Roles in tranche 2 are: Deputy Director-General Māori Health


Deputy Director-General Data and Digital Director Office of the Director-General Deputy Director-General Health Workforce

I anticipate permanent positions to be filled through the first quarter of 2019.

Staff will be updated on the details and progress of the recruitment process via my weekly updates and regular updates on MOH@WK.

All staff whose roles are disestablished are invited to comment on this selection process. Please contact Charlie Mather by 5pm Friday 5 October 2018.

6.2 TimelineThe following is a high-level indicative timeline for implementation. More detail about the milestones below will be provided as we work through the implementation plan.

Milestone DateConsultation closed 7 September 2018Chief Nursing Officer role advertised and recruitment commenced

19 September 2018

Chief Allied Health Professions Officer role advertised and recruitment commenced

25 September 2018

HRIS change freeze commences for non-urgent changes 28 September 2018

Final decisions announced 1 October 2018Reconfirmed staff and acting second-tier announced 3 October 2018Recruitment to outstanding positions commences 8 October 2018Staff to be informed about change of reporting line and/or directorate

Before 15 October 2018

New structure stands up 15 October 2018Organisation chart and MyHR changes finalised 23 October 2018New ELT committees up and running 5 November 2018Physical move of teams to new floors in Molesworth St as required

Early December 2018

Any changes required within directorates take place From February 2019

New structure and operating model embedded into the Ministry

From March 2019


7 SupportWhile this change mainly affects second tier roles and leaders in the Ministry, organisational change can have a range of impacts on people and I am committed to supporting you as we implement this change.

We encourage you to seek support at any time you need it.

There are a number of support options available, including talking to your ELT member, your manager and colleagues.

You can also use the Ministry’s Employee Assistance Programme - Vitae.

Employee Assistance Programme (EAP)The Ministry’s support programme provides a confidential, 24/7 service for all staff. This programme is available to you if you would like any help. You can contact our contracted external provider, Vitae, by phoning them on 0508 664 981 or emailing [email protected].

Union supportWhile this proposal did not affect current PSA members, the PSA has submitted on the proposal and has been notified of the final decision.


Documents

Final decision document on changes to the …€¦ · Web viewFinal decision document on changes to the Ministry’s second-tier structure 1 October 2018 Contents 1Contents2 2Introduction4