E.17

Office of the

Health and Disability

Commissioner

Te Toihau Hauora, Hauātanga

Statement of Intent

2017‒2021

NEW ZEALAND GOVERNMENT OPEN ACCESS AND LICENSING FRAMEWORK – VERSION 2 – DECEMBER 2014

Published by the Health and Disability Commissioner

PO Box 1791, Auckland 1140

Crown copyright ©. This copyright work is licensed under the Creative Commons Attribution 4.0 International licence. In essence, you are free to copy, distribute and adapt the work, as long as you attribute the work to the New Zealand Government and abide by the other licence terms. To view a copy of this licence, visit

http://creativecommons.org/licenses/by/4.0/. Please note that neither the New Zealand Government emblem nor the New Zealand Government logo may be used in any way which infringes any provision of the Flags, Emblems, and Names Protection Act 1981 or would infringe such provision if the relevant use occurred within New Zealand. Attribution to the New Zealand Government should be in written form and not by reproduction of any emblem or the New Zealand Government logo.

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Table of contents

Our Statement of Intent......................................................................................................................... 2

1.0 Executive summary ....................................................................................................................... 3

2.0 Our organisation ........................................................................................................................... 4

Background ................................................................................................................................... 4

The Health and Disability Commissioner Act 1994 ...................................................................... 4

The Code ....................................................................................................................................... 4

Our purpose, role, and functions ................................................................................................. 5

Our operating principles ............................................................................................................... 6

Our funding ................................................................................................................................... 6

3.0 Our objectives and approach ....................................................................................................... 7

Our vision for the sector ............................................................................................................... 7

Our strategic intent — outcomes, objectives, and activities ....................................................... 8

The difference we make ............................................................................................................... 9

Our strategic objectives ................................................................................................................ 9

Alignment with Government objectives .................................................................................... 10

Resolving complaints effectively and in a timely way ................................................................ 13

Working with providers to improve complaints processes ........................................................ 14

Influencing change and improvement at different levels .......................................................... 14

The tools we use to deliver on our objectives............................................................................ 17

4.0 Assessing our performance ........................................................................................................ 22

5.0 Organisational health and capability .......................................................................................... 23

Leadership .................................................................................................................................. 23

People capabilities and capacity................................................................................................. 23

Environmental sustainability ...................................................................................................... 25

Financial sustainability ................................................................................................................ 25

Technology.................................................................................................................................. 25

Physical assets ............................................................................................................................ 25

Continuous improvement ........................................................................................................... 26

Acquisition of shares or interests in companies, trusts, and partnerships ................................ 26

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Our Statement of Intent

This Statement of Intent (SOI) describes our organisation, our work, our working environment, what we intend to achieve in the medium term, and how we will achieve it. The associated Statement of Performance Expectations (SPE) contains the annual financial and non-financial measures by which the Office of the Health and Disability Commissioner will be assessed.

This SOI and its accompanying SPE have been prepared in accordance with, and are submitted in compliance with, the Crown Entities Act 2004.

Anthony Hill

Health and Disability Commissioner

29 June 2017

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1.0 Executive summary

The purpose and overriding strategic intention of the Health and Disability Commissioner (HDC) is to promote and protect the rights of consumers as set out in the Code of Health and Disability Services Consumers’ Rights (the Code). HDC promotes changes to improve the quality of health and disability services, and a system that puts the consumer at the centre.

A consumer-centred system is characterised by transparency, by engagement, by seamless service, and by a culture that is consumer centred in its focus and operation. When consumer rights are promoted and protected, we create an environment in which the activities and attitudes of both individual and group providers, and the culture of their workplaces, is encouraged — and required — to become more consumer centred. This change occurs through local change, through wider sector change, and through influencing the ideology of providers.

HDC has four strategic objectives to influence change:

1. to protect the rights of health consumers and disability services consumers under the Health and Disability Commissioner Act and Code

2. to improve quality within the health and disability sectors

3. to hold providers to account appropriately

4. to promote, by education and publicity, respect for and observance of the rights of health and disability services consumers

These four objectives are interdependent, working together to promote and protect consumer rights more effectively.

HDC’s strategic priorities for 2017‒2021 are to:

resolve complaints in a fair, timely and effective way while dealing with the constantly increasing volume and complexity of complaints

work with District Health Boards (DHBs), health providers, and disability services providers to improve their complaints processes so that complaints are resolved at the lowest possible appropriate level

monitor mental health and addiction services and advocate improvements to those services

continue to work with providers, the Health Quality & Safety Commission (HQSC) and other key stakeholders to effect recommended changes from complaint learnings

operate a financially sustainable organisation with an appropriate resource level to manage volume and complexity

strive for continuous improvement in the way we operate

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2.0 Our organisation

Background

Judge Silvia Cartwright’s landmark report on the cervical cancer inquiry changed the landscape of the consumer–provider relationship in New Zealand. As a result, HDC was established as an Independent Crown Entity by the Health and Disability Commissioner Act 1994 (the Act).

In New Zealand the ACC scheme takes away the right to sue a health provider for causing a treatment injury (except for exemplary damages in limited circumstances). In this legal environment the HDC provides the only practicable independent legislative means by which a consumer can request the actions of a health provider to be reviewed and for the provider to be held to account.

The Health and Disability Commissioner Act 1994

In addition to establishing HDC, the Act also creates two positions to act independently of the Commissioner:

A Director of Advocacy responsible for entering into and administering advocacy services agreements and monitoring the operation of advocacy services

A Director of Proceedings, responsible for taking civil proceedings in the Human Rights Review Tribunal (HRRT) and disciplinary proceedings in the Health Practitioners Disciplinary Tribunal (HPDT), where a significant breach of the Code has been found

The HDC complaints resolution service was put in place in 1996. The Act was amended in 2003, giving the Commissioner a wider range of options for resolving complaints. As of 1 July 2012, some of the functions of the former Mental Health Commission were transferred to HDC. Accordingly, the Act was amended to give HDC responsibility for monitoring and systemic advocacy in relation to mental health and addiction services.

The Code

The Code of Health and Disability Services Consumers’ Rights (the Code) applies to all health and disability service providers.

The ten rights under the Code are described in the diagram. It was the first legislated code in the world, giving consumers’ rights the force of law. Code rights can be upheld via the complaints process, and by proceedings taken by the Director of Proceedings before the two Tribunals. The Human Rights Review Tribunal may declare that conduct breached the Code and grant various remedies, including damages.

1. Respect

2. Fair Treatment

3. Dignity & Independence

4. Appropriate Standard of

Care

5. Effective Communication

6. Full Information

7. Informed Choice & Consent

8. Support

9. Teaching & Research

10. Right to Complain

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Our purpose, role, and functions

HDC’s purpose is to promote and protect the rights of health and disability services consumers.

HDC plays an important role in New Zealand’s health and disability system as an independent “consumer watchdog”, providing health and disability services consumers with a voice, resolving complaints, and holding providers to account for improving their practices at an individual and system-wide level. The Commissioner is independent of providers, of consumers, and of government policy, allowing him to be an effective watchdog in relation to consumers’ rights.

To perform this role, we carry out six core functions, described in more detail in the section on our objectives and approach:

1. Complaints resolution. Complaints resolution remains the central function for HDC and provides the platform for achieving our strategic objectives. HDC focuses on the fair and early resolution of complaints. Options for achieving resolution include referring the matter for advocacy support, referring the matter to the provider for resolution between provider and consumer, seeking expert advice, or referring to an appropriate regulatory body for further action or formal investigation. The Commissioner can also undertake investigations on his own initiative, without the receipt of a complaint.

2. Advocacy. HDC’s Director of Advocacy currently contracts with the National Advocacy Trust to provide the independent Nationwide Health and Disability Advocacy Service (Advocacy Service). Advocacy is a highly successful mechanism for ensuring the fair, simple, speedy and efficient resolution of complaints. The Advocacy Service plays a crucial role in managing complaints that are suitable for resolution between the parties, with advocates located in community-based offices assisting consumers to work with providers to achieve resolution. Advocates also offer community-based education and training about consumer rights and provider duties to both consumers and providers of health and disability services.

3. Proceedings. Sometimes there are cases in which formal proceedings against a provider are necessary to promote and protect consumer rights. The Director of Proceedings, appointed under the Act, exercises independent statutory functions. Where the Commissioner has found a serious breach of a consumer’s rights, the Commissioner may refer the provider to the Director of Proceedings. The Director then reviews the Commissioner’s investigation file and makes an independent decision on whether to take proceedings.

4. Monitoring and advocacy. We have a statutory role to monitor and advocate for improvements to mental health and addiction services. This role is delegated to the Mental Health Commissioner. Service monitoring is based on analysing themes and trends from HDC complaints and assessing service performance information, and through sector engagement. Our advocacy work is informed by the results of that monitoring.

5. Education. We deliver a variety of education and training initiatives aimed at improving providers’ and professionals’ knowledge of their responsibilities, and consumers’ knowledge of their rights. Education initiatives are delivered to groups at national and community levels, and directly to consumers and providers (through response to individual enquiries). Promoting learning from complaint trends is also an important facet of our education function, and to this end we produce complaint trend reports in order to ensure that these learnings are reported back to the sector and to the general public in a way that supports quality improvement. Our education work is informed by the other activities, which may identify the need for education

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on specific consumer rights, and is also an outcome of those activities, particularly in relation to the specific providers engaged in those other processes.

6. Disability. The Deputy Health and Disability Commissioner (Disability) has a particular focus on promoting awareness, respect for and observance of the rights of disability consumers. This role is also responsible for HDC’s contribution toward the implementation of the New Zealand Disability Strategy 2016-2026 and the United Nations Convention on the Rights of Persons with Disabilities.

The Commissioner’s jurisdiction is confined to quality of care; it does not extend to funding issues or service entitlement.

Our operating principles

HDC’s operating principles or values guide our approach and the way we respond to all of those with whom we interact, both internally and externally. HDC’s values are:

Our funding

HDC is funded under the Monitoring and Protecting Health and Disability Consumer Interests Appropriation. This appropriation is intended to achieve the following: the rights of people using health and disability services are protected. This includes addressing the concerns of whānau and appropriately investigating alleged breaches of consumers’ rights.

Fair

Responsive

Professional

Empathetic

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3.0 Our objectives and approach

Our vision for the sector

We work towards our vision of a consumer-centred health and disability system.

In this system, consumers are fully engaged in their own care, families are listened to, providers work effectively and respectfully together at all levels, information is freely shared, and services are provided seamlessly within and between services. In a consumer-centred system the Code is upheld.

The principles that sit at the heart of the Code are also those that define the international safety and quality agenda. Everything we do supports the journey toward that consumer-centred system.

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Our strategic intent — outcomes, objectives, and activities

The following diagram shows how our activities link to our strategic objectives and, ultimately, our vision for the sector.

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The difference we make

Through complaints resolution, quality improvement, and provider accountability, HDC minimises the harm and maximises the well-being that consumers experience in their dealings with, and use of, health and disability services.

By learning, addressing unacceptable behaviour, and avoiding repetition of errors, the system improves experiences and outcomes for consumers, reduces preventable harm and reduces system costs.

Our strategic objectives

HDC has four strategic objectives, which operate together to improve experiences and outcomes for consumers. These objectives work for individual consumers in response to a problem, and by improving the system so that it works more effectively the next time. The objectives are:

Protection of the rights of health consumers and disability support consumers — The fair, effective and timely resolution of complaints is an essential protection in a country where medico-legal litigation is largely unavailable to consumers. It is also a means of ensuring provider accountability through the Commissioner’s findings of non-compliance, and to quality improvement through recommendations and educative comments that typically accompany such findings.

Quality improvement — systems, organisations, and individuals learn from complaints, prosecutions and other interventions, and improve their practices. The objective of quality improvement has self-evident intrinsic value, but also plays a part in effective complaints resolution, as the express motivation of many complainants is to see change occur so that what happened to them does not happen to others. Quality is improved by using the learning from complaints to promote best practice and consumer-centred care. Providers are also held to account for their own quality improvement through HDC’s monitoring and audit of the recommendations made.

Provider accountability — systems, organisations, and individuals are held to account. Provider accountability is also important in the context of New Zealand’s no-fault treatment injury regime. The mere existence of accountability mechanisms is an important driver for change and thus quality improvement, both at an individual and systemic level. In addition, in some cases, it is only through appropriate accountability that true resolution can occur.

Promotion, by education and publicity, and respect for and observance of the Code rights — consumers and providers understand their rights and responsibilities under the Code. For the system to operate in a consumer-centred way, the participants in that system — consumers and providers — need to understand what their rights and responsibilities are, particularly in relation to the Code. Awareness of rights enables consumers to advocate for themselves and seek support when they need it; awareness of responsibilities means that providers will be more proactive in designing and delivering a consumer-centred experience.

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Alignment with Government objectives

HDC’s strategic objectives and activities align with, and contribute to, the Government’s goals for the health and disability systems.

The Act establishes HDC as an independent Crown entity. In determining HDC's strategic objectives, the Commissioner has regard to section 7 of the Act that requires him to take into account the New Zealand health strategy and the New Zealand disability strategy, so far as those strategies are applicable.

A refreshed New Zealand Health Strategy was released in April 2016. This Strategy sets out the direction and focus of efforts over the next ten years to ensure effective and sustainable health care for New Zealanders. The Strategy sets out five interconnected themes to focus effort on priority areas of work. The themes are reflected in a broad statement about the Strategy’s vision for a “fit for the future” system:

“All New Zealanders live well, stay well, get well in a system that is people-powered, provides services closer to home, is designed for value and high performance, and works as one team in a smart system.”

The work of HDC contributes to the themes of the Health Strategy in the following ways:

Health Strategy theme

HDC contribution

People-Powered This theme supports a health system that is genuinely centred around those it aims to serve — the consumers. This means ensuring that health consumers:

are well informed (“health smart”);

are empowered to make effective choices about the care or support they receive;

have their needs and preferences understood by service designers and providers, and are appropriately involved in service design; and

are easily able to navigate the health system, informed by effective communication.

These goals are consistent with the Code and the work of HDC. HDC supports a people-powered system by:

resolving complaints about healthcare providers and disability services providers;

promoting, by education and publicity, respect for and observance of the rights of health consumers and disability services consumers, and awareness of the means by which those rights may be enforced;

investigating any action that is, or appears to the Commissioner to be, in breach of the Code;

making recommendations to any appropriate person or authority in relation to the means by which complaints involving alleged breaches might be resolved and further breaches avoided;

making public statements and publishing reports in relation to any matter affecting the rights of health consumers and/or disability services consumers, including statements and reports that promote an

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understanding of, and compliance with, the Code or the provisions of the Act

monitoring mental health and addiction services and advocating improvements to those services;

advising the Minister on any matter relating to the rights of health consumers and/or disability services consumers;

reporting to the Minister from time to time on the need for, or desirability of, legislative, administrative, or other action to give protection or better protection to the rights of health consumers and/or disability services consumers;

making suggestions to any person in relation to any matter that concerns the need for, or the desirability of, action by that person in the interests of the rights of health consumers and/or disability services consumers;

receiving and inviting representations from members of the public and from any other body, organisation, or agency on matters relating to the rights of health consumers and/or disability services consumers; and

administering and promoting advocacy services that advocate for health consumers and disability services consumers.

Value and high performance

This theme supports a health system that is underpinned by a culture and practice of delivering value and high performance.

HDC’s work on complaints, investigations and proceedings supports this theme by revealing the underlying causes of the problems, holding providers to account, and identifying how providers can learn and improve their performance.

One team This theme supports an integrated health system, operating seamlessly from the consumer’s perspective.

HDC’s work on complaints and investigations identifies gaps and makes recommendations based upon its findings about how parts of the system can work better together, to produce better outcomes.

Closer to home This theme supports care closer to where people live, work, learn and play.

Through the Director of Advocacy, HDC contracts community-based advocacy work delivered by the Advocacy Service around New Zealand, which provides consumers with access to support closer to where they are based.

Smart system This theme supports a learning system underpinned by evidence and technology.

HDC contributes through analysis and reporting on complaint trend data and systemic monitoring, a core purpose of which is to contribute to systemic learning and improvement.

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The New Zealand Disability Strategy 2016-2026

A new New Zealand Disability Strategy was launched in November 2016. One of the aims of the new strategy is to move beyond conceptual objectives, and have measurable targets and concrete goals which could be reported in the next ten years. There are eight outcomes which are all interconnected. These outcomes are education, employment and economic security, health and wellbeing, rights protection and justice, accessibility, attitudes, choice and control, and leadership. The Strategy is written from the perspective of people with disabilities with the eight outcomes outlining an aspirational description of what things should look like for disabled people in ten years’ time.

For Outcome 3: Health and Wellbeing it is “We have the highest attainable standards of health and wellbeing”.

This Plan contains specific actions which government departments need to achieve in order to adhere to the strategy. In relation to health and wellbeing and the work of HDC as the independent consumer watchdog of health care providers and disability services providers, the focus is:

· Access to mainstream health services is barrier-free and inclusive.

· Services that are specific to disabled people, including mental health and aged care services, are high quality, available and accessible.

· All health and well-being professionals treat disabled people with dignity and respect.

· Decision making on issues regarding the health and well-being of disabled people is informed by robust data and evidence.

The Disability Action Plan will be determined in 2017 with the implementation of this new strategy.

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Resolving complaints effectively and in a timely way

As shown in the graph below, complaints to HDC continue to increase. At 30 June 2016 the growth in complaints received over the preceding five years was 39% (an average increase of 6.9% per annum). In response to this growing demand, HDC increased its annual output by 48% in the five years to 30 June 2016. This growth in complaints to HDC continues despite the efforts made by providers to resolve complaints directly.

HDC anticipates a range between 5% to 10% ongoing growth per year.

HDC continues to prioritise its work and to increase productivity to ensure that we maintain, and where possible improve on, our current levels of timeliness to ensure the “speedy and efficient” resolution of complaints.

As one option for addressing the increase in complaints received, HDC is working with providers to strengthen their own complaints management processes so that issues may be resolved directly between provider and consumer in appropriate cases.

HDC’s statutory functions include to promote, by education and publicity, respect for and observance of the rights of health consumers and disability services consumers — in particular, to promote awareness among health consumers, disability services consumers, healthcare providers, and disability services providers, of the rights of consumers and the means by which those rights may be enforced. Promoting awareness of consumer rights is likely to result in an increase in the number of complaints.

HDC will:

continue to receive, assess, investigate and resolve complaints

continue to further improve its timeliness in the resolution of complex complaints

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ensure quality and fairness in complaints assessment processes and resulting decisions, notwithstanding increasing volumes

continue to train staff, review processes, and encourage innovation so that our processes are as streamlined and efficient as possible

Working with providers to improve complaints processes

Wherever possible, complaints should be resolved at the lowest appropriate level to ensure early resolution. In many cases, complaints can be best addressed by service providers. This ensures best use of resources as well as enabling consumers to provide direct feedback to providers.

HDC refers a number of complaints back to providers for resolution each year to encourage such action. These are complaints that could have been resolved directly between the consumer and provider without the need for HDC involvement.

HDC works with DHBs and other health and disability services providers to improve their complaints processes. This includes the following:

providing guidance on complaints processes, including through complaint management workshops

where appropriate, monitoring DHBs’ complaints resolution processes to ensure that consumer rights are protected

providing six-monthly DHB complaint trend reports, which include reference to any complaints about DHB complaints management processes.

Influencing change and improvement at different levels

We influence change locally, at sector level, and through influencing the ideology of providers.

Local change

Local change (both at individual provider and system levels) occurs in relation to the majority of complaints that come to HDC. This may be either in response to direct recommendations made by HDC, or by providers taking their own proactive steps in response to the issues raised.

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Sector change

The learnings from HDC decisions are widely disseminated across the health and disability sectors, thus encouraging providers to make changes to their own systems and practices. In some cases, HDC makes direct recommendations to the wider sector, even to those not involved in the case concerned. HDC also disseminates learnings and makes recommendations based on the analysis of complaint data.

Influencing ideology

In some cases, the questions the sector is grappling with are complex, and the thinking is still developing. HDC engages with the sector on these difficult questions and influences the ideology, bearing in mind our vision of having consumers at the centre of services. In this way, HDC aims to be a thought leader, influencing the development of policy and practice within the sector.

Example

A case where a disability services provider and two disability support workers were found to have breached the Code in relation to the care of a profoundly disabled teenage boy in respite care.

The boy was left alone in the bath and, tragically, he was found submerged in the bath not breathing. The boy was vulnerable with high needs and, given his severe impairments, he was fully dependent on his carers and should not have been left alone in the bath. While there were policies in place at the home, HDC was critical that a culture had developed whereby support workers of all levels would leave children alone in the bath. Several recommendations were made, including that the provider commission an independent review of the changes made as a result of the complaint, and of the personal plans and risk management plans for each resident.

Examples

Recently published reports include:

Delayed diagnosis of cancer in primary care: an analysis of all complaints received over a ten-year period in which primary care management had been found to contribute to delayed diagnosis of cancer. HDC made a number of recommendations based on this analysis, with a view to improving quality of care.

Residential aged care report: an analysis of the issues complained about regarding residential aged care facilities. This report brought together the recommendations made by HDC in this area, with a view to improving quality of care.

Doctor complaints report: an analysis of trends concerning doctors complained about over a seven-year period. The report is designed to encourage doctors to consider their own service provision in relation to commonly complained about issues, and to contribute to the literature about which providers are at greater risk of complaint.

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Working closely with HQSC and other key stakeholders to effect change from complaint learnings

HDC already consults and cooperates with a number of other agencies with responsibilities for quality and safety, including: the Ministry of Health, the Health Quality and Safety Commission (HQSC), health and disability services providers, professional bodies, the office of the Privacy Commissioner (OPC), the Director of Mental Health, the Office for Disability Issues (ODI), the Office of the Chief Coroner, the Human Rights Commission (HRC), and the Accident Compensation Corporation (ACC). Our stakeholder relationships are represented in the diagram below.

Example

The Commissioner continues to focus on culture, as it goes to the very core of the quality of care provided. In the margins where things do not go well, culture often plays a role, such as in a case involving a two-year-old girl who presented for a second time at the emergency department of a public hospital. The girl’s symptoms included a worsening cough, runny nose, fever, increased heart rate, and wheezing when she exhaled. The Commissioner was critical of the standard of care provided by the DHB, the consultant, and the house office during that presentation. One of the key issues was that staff members felt unable to, or failed to, raise questions or concerns, despite remaining concerned about the child’s condition. The DHB failed to encourage a culture where staff felt comfortable doing that, and lacked a multidisciplinary approach to the child’s care.

HDC

Consumers & consumer organisation

s HDC

Consumer Advisory

Group

Professional Colleges &

Registration Bodies

Director of Mental Health

Prison Inspectors

Other Commission

s

e.g., HRC, OPC

Health Quality &

Safety Commission

Office of the Ombudsmen

Office of the Chief

Coroner

Media

Providers — Individuals & Groups

Family/

whānau

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As appropriate, HDC shares the learnings from the complaints we resolve and recommendations we make.

We relate closely with the HQSC at a Board level, and refer to the HQSC for its attention specific matters of concern identified by the Commissioner. In addition, matters are also referred on a case-by-case basis following assessment and/or investigation by HDC. We also support the development of systems that reduce variation and improve consumer safety.

With a view to educating healthcare professionals about the Code, HDC provides case studies and disseminates learning throughout the sector. HDC also provides disability responsiveness training to the staff of disability services providers. HDC and the Advocacy Service provide education for Cornerstone Accreditation for primary health organisations (PHOs) and contribute to the continuing professional development programmes of various health professions.

HDC will continue to:

work alongside other agencies, including HQSC, to identify areas for joint work

share with relevant stakeholders the learnings from complaints data

contribute to professional education, accreditation, and credentialing programmes.

A key advisory group to HDC is the Consumer Advisory Group, which is made up of disability, health, Pacific, and iwi consumer advisors. The group meets twice a year to provide input to HDC, including advice on promotional and educational initiatives.

HDC will continue to seek input from a Consumer Advisory Group.

HDC is a member of a network of Australasian Healthcare Complaints Commissioners. This allows HDC to establish best practice in complaints management, and to discuss safety and quality issues of common interest.

The tools we use to deliver on our objectives

The way we approach each of our core functions is described below.

Complaints resolution

In 2015/16, HDC received over 1,950 complaints. In 2016/17, we expect to receive over 2,000 complaints, demonstrating significant continued growth in the volume of complaints.

The Act allows a range of resolution options, and we assess each complaint and resolve it in the most appropriate way in the interests of the consumer and the system that serves him or her.

Every complaint is an opportunity for learning and service improvement. We continually engage with the sector to communicate those learnings.

We make recommendations in the great majority of investigations and assessments. Recommendations are designed to improve the practice of an individual provider, the systems being used by providers, and the culture within which providers work, and to strengthen delivery to ensure that repeat performances of errors are minimised. Our recommendations are extremely successful in this regard, with the vast majority being complied with, providing confidence that lessons are learnt, behaviour changed, and systems improved.

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Advocacy

Independent health and disability advocates are located throughout New Zealand in community-based offices. They receive over 10,000 enquiries a year, assist consumers to resolve over 3,000 complaints, and deliver more than 1,600 education sessions on the Code to consumers and providers.

Advocates assist consumers to identify what is needed to achieve resolution, and then support them in their chosen actions. Advocates consistently assist consumers to reach resolution in over 90% of the complaints made to the Advocacy Service. The advocacy process can be very effective for teaching self-advocacy skills to consumers, so that they become more confident in handling any future concerns, and also in providing direct and valuable feedback to providers. Advocates are often able to assist consumers to rebuild relationships, which is particularly important if the consumer and provider need to have ongoing contact.

In addition to complaints resolution, advocates work to establish and maintain contact with vulnerable consumers in the community. This is achieved by networking activities, such as visiting rest homes and residential disability facilities to make sure the residents and whānau members acting on their behalf have easy access to an advocate.

Proceedings

The Director of Proceedings, appointed under the Act, exercises independent statutory functions. Where the Commissioner has found a serious breach of a consumer’s rights, the Commissioner may refer the provider to the Director of Proceedings. The Director then reviews the Commissioner’s investigation file and makes an independent decision regarding whether or not to proceed.

The Director can lay a disciplinary charge before the Health Practitioners Disciplinary Tribunal (HPDT),1 issue proceedings before the Human Rights Review Tribunal (HRRT), or both. The Director can also issue proceedings or provide representation in other forums (other tribunals, courts, or inquiries).

Charges against registered health practitioners are heard before the HPDT. If the provider is not a registered health practitioner,2 the Director may file proceedings with the HRRT. The Tribunal may hear claims against bodies such as rest homes and district health boards, or against a registered health professional, regardless of whether disciplinary proceedings are also brought. Unlike the HPDT, the HRRT has the power to order the provider to pay compensation to a consumer. However, the Accident Compensation legislation limits the circumstances in which compensatory damages are available.

The purpose of laying a charge in the HPDT is to ensure that standards for the profession are maintained, that the individual practitioner is held to account for his or her actions, and that the public is protected. Proceedings in the HRRT are used to obtain remedies for the consumer, and to set standards for providers, particularly non-registered providers. Therefore, the work of the Director of Proceedings is important in helping to set professional standards for both registered and non-registered providers. When a case is successful, often the decision sends a strong message to

1 Registered health practitioners include medical practitioners, nurses, midwives, dentists, psychologists, chiropractors,

and pharmacists. 2 Non-registered practitioners include providers such as counsellors, massage therapists, caregivers, rehabilitation

workers, and acupuncturists.

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health and disability services providers. It also helps maintain public confidence in the quality and safety of services. The Director’s role is key in ensuring that providers are held to account where appropriate.

Mental Health and Addictions — monitoring and advocacy

HDC has a statutory function to monitor and advocate for improvements to mental health and addiction services. The Mental Health Commissioner, under delegation from the Commissioner, is responsible for the performance of this function.

The foundation for HDC’s monitoring and advocacy function is in our complaints resolution work. That work, alongside sector engagement and monitoring sector performance information, provides insights into consumer and family/whānau experiences and enables HDC to identify wider mental health and addiction system and service issues that need to be addressed. Our independence and the powers of the Commissioner to investigate, report, and suggest actions, puts us in a unique position to influence service improvement as a result of what we have learnt from the complaints we consider and the patterns and trends we identify.

We monitor services to determine the extent to which they are meeting the needs of consumers and their family/whānau. We do this through:

Learning from complaints: Our complaints resolution work includes engagement with individual consumers/tangata whaiora and their family/whānau, and DHB and NGO providers, and identifying themes and trends in our complaints work.

Sector engagement: Engagement with a wide range of stakeholders, including:

o national consumer and family/whānau representatives o the Ministry of Health o DHBs and NGO providers o statutory agents such as the Director of Mental Health, the Ombudsman, the Human Rights

Commission, and the Health Quality and Safety Commission

Assessing service performance information: Scanning and analysing mental health and addiction service performance information and data to build on what we learn from the complaints we consider, and engagement with stakeholders, allows us to develop a holistic picture of mental health and addiction services. We have also worked with the sector to develop and introduce a consumer experience survey tool — Real Time Feedback — for use in services to capture timely and meaningful consumer and family/ whānau feedback to inform quality improvement.

We advocate for improvements by reporting on findings and key issues, preparing submissions on major legislative or policy initiatives, and providing recommendations and educational comments to providers and others when considering complaints about services.

We may also provide Ministers and other key stakeholders, such as government agencies, funders, planners and providers, with advice and recommendations on improving services.

Education

Through education, HDC is committed to ongoing systemic improvements in safety and quality in the health and disability sector. HDC delivers education sessions to both provider and consumer groups, which aim to give providers a clear understanding of their responsibilities, so that they

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comply willingly with the requirements of the Health and Disability Commissioner Act 1994 and ensure that consumers know and are able to exercise their rights under the Act. HDC delivers these education and training sessions to national service organisations and group providers, professional bodies, and consumer-based organisations. Community-based independent health and disability advocates, contracted by the Director of Advocacy, on the other hand, provide more community-level education. Thus the work of the Advocacy Service greatly complements HDC’s educational initiatives.

As part of HDC’s focus on empowering providers to deal with complaints better themselves, so that complaints are resolved at the lowest appropriate level, HDC produces six-monthly DHB complaint trend reports and runs complaints management workshops for DHBs and other group providers. These interactive workshops aim to increase: the proportion of complaints effectively resolved by the provider; complainant satisfaction with the provider’s response to complaints; and learning from complaints in order to improve service quality.

HDC conducts regular review of the Act and the Code and recommends changes where appropriate. HDC also responds to many enquiries from consumers, providers, and other agencies about the Act, the Code, and consumer rights under the Code. Chiefly through making submissions, HDC advises on the need for, or desirability of, legislative, administrative, or other action to give protection or better protection to the rights of health consumers or disability services consumers or both.

HDC’s educational initiatives are shown in the following diagram:

Educational Initiatives

Presentations

To provider and consumer

groups about HDC's role, the

Act and the Code

Resources

For awareness raising & general

information

Complaint trend reports

Provide an analysis of complaint

trends about a variety of

providers and issues

Articles

On topical issues in a wide range of health and

disability publications

Opinions

To assist in improving

accountability and service

delivery

Complaints management

guides and workshops

To assist providers to

improve their complaint processes

Submissions

Advise on the need for, or

desirability of, action to give protection to the rights of consumers

Enquiries

Respond to enquiries from

consumers, providers and other agencies about the Act

and Code

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Disability educational initiatives

The Deputy Health and Disability Commissioner (Disability) has a particular focus on promoting awareness, respect for, and observance of, the rights of disability services consumers. The Deputy Commissioner, Disability is also responsible for HDC’s work on the New Zealand Disability Strategy and the United Nations Convention on the Rights of Persons with Disabilities.

Work in the above areas includes:

increasing consumer awareness of their rights under the Code

making our complaints management processes more accessible

encouraging disabled people, their families and support staff to complain

making our educational resources more accessible

facilitating and encouraging disability support providers to improve their complaints management processes

disability responsiveness training provided to HDC staff

increasing disability sector knowledge and experience capability within HDC’s staff.

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4.0 Assessing our performance

HDC will assess its impact through the key measures described below. Other measures are set out in detail in HDC’s Statement of Performance Expectations.

Impact How we will measure performance

Protection of the rights of health consumers and disability services consumers

The fair, effective and timely resolution of complaints is a critical lever to ensure protection of the rights of health and disability services consumers. Accordingly, measuring our performance in relation to complaints resolution is particularly important. We want to make sure our complaints resolution and advocacy processes are responsive to consumers and effective at achieving satisfactory resolution. The key measures we use to assess our impact in this area are:

Timeliness of the process. We close a targeted number of complaints each year and measure the age of open complaints using our internal administrative systems.

Participants’ experience of the advocacy process. We survey the experience of participants (complainants and providers) and use the insights gained to continuously improve our approach.

Quality improvement

Our work aims to improve quality of services at a local and sector level. The primary means through which we influence this is by investigating complaints, understanding the causes, and making recommendations, which are disseminated through our reports and our educational initiatives. To understand the extent to which our recommendations have led to positive change, we monitor compliance with our recommendations through an audit process. This enables us to understand the extent to which our recommendations have been adopted into practice.

Holding providers to account

Holding providers to account is both a lever for change and improvement, as well as an important step in the healing process for complainants. While the fact of taking action (e.g., through investigations and proceedings) holds providers to account by definition, we seek to ensure that we take proceedings in circumstances that are well judged, and that the processes we initiate lead to a result that holds providers to account in fact. We measure the extent to which:

professional misconduct was found in disciplinary proceedings taken

a breach of the Code was found in Human Rights Review Tribunal Proceedings

an award was made when damages were sought

Promotion, by education and publicity, respect for and observance of the Code rights

Our educational initiatives and our interaction with consumers and providers (as part of monitoring, advocacy, and complaints handling) aim to build this awareness. The key measures include:

provision of, and satisfaction with, education sessions provided by HDC

provision of, and satisfaction with, education session provided by the Advocacy Service

provision of, and satisfaction with, consumer seminars held by HDC

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5.0 Organisational health and capability

Leadership

The Commissioner leads the organisation with the Executive Leadership Team of three Deputy Commissioners (one of whom is the Mental Health Commissioner), the Director of Proceedings, an Investigation Manager, a Chief Legal Advisor, a Corporate Services Manager and an Associate Commissioner. These positions are shown in the diagram below.

The Executive Leadership Team is responsible for monitoring organisational health and performance. This includes ensuring that HDC:

has the right people capabilities and capacity to perform its functions effectively and efficiently, that any current or forecast gaps are addressed promptly, and that appropriate plans are in place to develop the capabilities of teams and individuals

reviews progress against its priorities and makes adjustments as required

is managing its delivery within budget and to time, and more generally is managing its finances and assets effectively

has systems, practices and processes in place to enable effective and efficient delivery

is managing its risks appropriately.

People capabilities and capacity

Our people are our greatest resource. The majority of HDC’s staff possess professional qualifications and predominantly come from health, disability or legal backgrounds. Together they bring to the organisation a wide range of skills in management, training, investigation, litigation, clinical practice, research and development, information technology, and financial management. This unique combination of skills and qualifications enables us to perform our core functions.

To further complement staff skills, HDC uses a number of expert advisors, consultants, and contractors for specific specialist advice and/or projects.

Health and Disability Commissioner

Anthony Hill

Deputy Commissioner,

Complaints Resolution

Meenal Duggal

Mental Health Commissioner

Kevin Allan

Director of Proceedings

Nicola Wills

Acting Investigation

Manager

Corporate Services Manager

Jason Zhang

Chief Legal Advisor

Jane King

Deputy Commissioner,

Disability

Rose Wall

Associate Commissioner

Cordelia Thomas

Executive Assistant

Sue O'Connor

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We also actively use HDC’s consumer advisory group to inform our work. This group provides input from the perspective of the consumer.

We continue to improve our systems and implement policies that guide and enable staff to do their jobs well.

To support a culture of high achievement and learning and a commitment to excellent service, we adhere to the State Services Code of Conduct within HDC and remain committed to our obligations of being a good employer. Members of the Executive Leadership Team will continue to promote whole system improvements within HDC in order to achieve its quality aims.

To ensure that we attract and retain quality people, HDC will continue to promote equal employment opportunities and endorse the seven key elements of a “good employer” as follows:

1. Leadership, accountability, and culture:

Provide inclusive leadership, systematic accountability, and a healthy culture

2. Recruitment, selection, and induction:

Identify and eliminate barriers to equal employment opportunities

Attract and appoint the best people, who have the appropriate skills, values, and attributes to meet HDC’s needs, objectives, and strategic direction, in a manner that provides equal employment opportunity to Māori, women, ethnic or minority groups, and people with impairments

3. Employee development, promotion, and exit:

Provide opportunities for learning, growth and development

Provide opportunities to be innovative and productive through challenging tasks and projects

4. Flexibility and work design:

Provide flexibility in work design, hours, and working arrangements

5. Remuneration, recognition, and conditions:

Provide fair remuneration, recognition, and good working conditions

Provide good communication to staff with regular staff forums and our internal newsletter

Organise functions to celebrate national days, for example, New Zealand Sign Language Week

6. Harassment and bullying prevention:

Apply bullying and harassment prevention strategies

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7. Safe and healthy environment:

Invite employee participation in reducing occupational health and safety concerns

Provide sponsorship for health and wellness activities

Provide an Employee Assistance Programme — incident and confidential counselling

Environmental sustainability

HDC works to reduce its impact on the environment and to save money. HDC has a recycling programme, endeavours to buy locally, keeps a close eye on travel, encourages staff use of public transport where appropriate, and purchases environmentally friendly products and services where possible.

Financial sustainability

HDC, with ongoing prudent financial management, strives to operate sustainably and resource at an appropriate level to manage volume and complexity.

Funding additional resources to meet the increasing demand for HDC’s services continues to be challenging in the context of a fiscally constrained environment. The number and nature of complaints drives expenditure across three key areas of the organisation, being staff, facilities (IT and property) and expert advisors. In response to these pressures, HDC will:

ensure that complaints are resolved at the lowest appropriate level

focus on efficiency and value for money

review processes to ensure they are consistent with the principles of natural justice, the right to be heard, and the complexity of issues upon which we are required to adjudicate.

Technology

Our information systems (information technology, document management, and website) must link to everything we do in order to maximise the accessibility of data and our ability to share information. Mining our own complaints data provides the statistical and evidential information required to both support improvements in our own complaints handling processes and provide insight into areas of potential risk and areas for improvement in health and disability services.

Key technology solutions are reviewed regularly and data is backed up frequently, and the IT disaster recovery plan is tested annually.

We have a rolling programme of work to review and enhance systems to meet the organisation’s requirements and enhance staff productivity.

HDC has a secure and reliable internal IT platform. Security of IT systems and data is paramount, and HDC proactively manages its IT security arrangements, using specialised support as required.

Physical assets

HDC continues to manage its assets cost effectively, and aims to maximise the useful life of its assets. Our governance policies and practices are strong. Our office spaces are well equipped, and office

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equipment is well maintained. The office space is used effectively, and teamwork is encouraged through the use of office layout.

Continuous improvement

HDC’s internal continuous improvement programme focuses on identifying and implementing initiatives to further improve HDC’s performance. HDC will continue to explore the use of technology to streamline the complaints management process and enhance the effectiveness of personnel and the efficiency of systems and processes.

Acquisition of shares or interests in companies, trusts, and partnerships

HDC does not hold any shares or interests in companies, trusts or partnerships, and does not intend to enter into any arrangement during the period of this document.