Consultation Working Draft

2017/18Regional Service Plan Guidelines

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

Page Description

3 - Introduction – Regional Service Plan section updated

- Module 2A: Implementation of the New Zealand Health Strategy section removed as incorporation and alignment of Regional Service Planning with the Health Strategy should occur throughout the entire Plan

6-11 - 2.2 Enablers section – IT, Workforce, Sub-regional initiatives sections updated

11-16 - RSP Priorities guidance is now included in this guidelines document rather than in the Planning Priorities document.

18 - 4.1.1 Key Actions for regional cancer networks updated

22 - 7.1.1 Health Quality and Safety Commission statement updated with new expectations

November 2016

Table of ContentsMODULE 1: STRATEGIC POSITION..............................................................................................5

1.1 Linkages................................................................................................................................................5

MODULE 2: REGIONAL PRIORITIES.............................................................................................6

2.1 Enablers................................................................................................................................................62.1.1 Digital Health 2020...........................................................................................................................................6eHealth priorities for regional service planning............................................................................................................6Health ICT Investment Portfolio....................................................................................................................................6Health Information Standards and Architecture...........................................................................................................7Digital innovation framework........................................................................................................................................7Information Technology (IT)..........................................................................................................................................72.1.2 Regional Workforce..........................................................................................................................................92.1.3 Capital............................................................................................................................................................11

2.2 Sub-regional Initiatives.......................................................................................................................11

2.3 RSP Priorities.......................................................................................................................................11Electives......................................................................................................................................................................11Stroke..........................................................................................................................................................................12Cardiac Services..........................................................................................................................................................13Healthy Ageing............................................................................................................................................................14Mental Health and Addictions.....................................................................................................................................14Hepatitis C...................................................................................................................................................................15Major Trauma.............................................................................................................................................................15

MODULE 3: REGIONAL GOVERNANCE AND LEADERSHIP..........................................................17

3.1 Regional Governance and Decision Making........................................................................................17

MODULE 4: NETWORKS...........................................................................................................18

4.1 Regional Cancer Networks..................................................................................................................184.1.1 Key actions.....................................................................................................................................................18

4.2 Supporting Clinical Networks and Clinical Leadership........................................................................18

MODULE 5: HEALTH EQUITY....................................................................................................19

5.1 Health Equity Tools.............................................................................................................................19

MODULE 6: LINE OF SIGHT.......................................................................................................20

6.1 The Planning Process across Regional Service Plans and Annual Plans...............................................20

6.2 Guidance Framework for RSP Priorities..............................................................................................20

MODULE 7: NATIONAL ENTITIES..............................................................................................22

7.1 Linkages..............................................................................................................................................227.1.1 Health Quality and Safety Commission..........................................................................................................22

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Introduction to the Guidelines

Regional Collaboration

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

Regional Service Plan

The purpose of a Regional Service Plan (RSP) is to provide a mechanism for DHBs to document their regional collaboration efforts and align service and capacity planning in a deliberate way. The RSPs include national priorities for regional delivery and locally agreed regional priorities, and outline how DHBs intend to plan, fund and implement these services at a regional or sub-regional level. The plans have a specific focus on reducing service vulnerability, reducing costs and improving the quality of care to patients.

High-quality health care results from the simultaneous implementation of three quality dimensions: improved quality, safety and experience of care, improved health and equity for all populations and best value for public health system resources. High-quality health and disability services respond to the needs and aspirations of diverse population groups, and the health system must work to eliminate barriers to accessing high-quality health care. Therefore, the 2017/18 RSP guidance again includes a focus on health equity, which is a cross-cutting dimension of quality. Further detail on expectations is set out in Module 5: Health Equity.

In 2017/18 the regions are expected to strengthen their focus on the regional enablers, and the guidance has been updated to reflect this. The 2017/18 RSPs must reflect the New Zealand Health Strategy’s direction, in particular the RSPs should clearly align to the Strategy themes of: People powered, Closer to home, Value and high performance, One team, and Smart system.

The Line of Sight framework is again included in Module 6 as a general guideline for consideration while developing your plans.

For further information regarding these guidelines please contact:Michelle GohMinistry of Healthmichelle_goh@moh.govt.nz(04) 816 2214. 

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Overview of Content Requirements

MODULE 1: STRATEGIC POSITION

1.1 Linkages

MODULE 2: RSP PRIORITIES

2.1 Enablers 2.2.1 Digital Health 20202.2.2 Regional Workforce2.2.3 Capital

2.2 Sub-regional Initiatives 2.3 Regional Priorities

MODULE 3: REGIONAL GOVERNANCE AND LEADERSHIP

3.1 Regional Governance and Decision Making

MODULE 4: NETWORKS

4.1 Regional Cancer Networks4.1.1 Key actions

4.2 Supporting Clinical Networks and Clinical Leadership

MODULE 5: HEALTH EQUITY

5.1 Health Equity Tools

MODULE 6: LINE OF SIGHT

6.1 The Planning Process Across Regional and Annual Plans6.2 Guidance Framework for RSP Priorities

MODULE 7: NATIONAL ENTITIES7.1 Linkages

7.1.1 Health Quality and Safety Commission

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MODULE 1: STRATEGIC POSITION

In the development of the strategic section, regions should reflect on progress to date, identifying and explaining any significant changes from earlier years, and identifying the direction of travel for 2017/18 and future years.

Progress to date has to be made more visible and can be done through both qualitative and quantitative data. Demonstrate how the regional work programme is making a difference for service delivery in the region. For enablers (Information Technology and Workforce) progress can either be described as a whole or as part of the individual priority sections (Module 2B).

1.1 Linkages

The strategic section of the RSP should also be consistent with national strategic imperatives and include appropriate commitments to the draft updated New Zealand Health Strategy, as well as all trends and key outcomes outlined in:

DHBs’ Statements of Intent (SOIs) that articulate the ability of each DHB in the region to deliver improved services into the future

the Strategic Intentions section of DHBs’ APs, where each DHB examines how health services can be most effectively and efficiently co-ordinated and delivered.

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MODULE 2: REGIONAL PRIORITIES

2.1 Enablers

The government ICT Strategy and Health Workforce Regional Work Plan outline the strategic focus for these areas, and include key priorities and programmes that are expected to be implemented regionally by DHBs. The regional priorities for 2017/18 for IT and Workforce are outlined below. The requirements for enablers can be incorporated into specific service priorities where applicable. Further context on how these enablers link with regional objectives in RSPs is also noted below.

2.1.1 Digital Health 2020Digital Health 2020 has been established to progress the core digital technologies presented in the New Zealand Health Strategy. It guides the strategic digital investments that are expected to occur across the health and disability sector in the next five years, 2016–2020.It will also align sector investment with value delivery and encourage health organisations to invest with greater clarity and confidence. Five core components and three enabling functions that make up the programme are shown below:

eHealth priorities for regional service planningA number of business priorities require eHealth capabilities that need to be delivered in parallel with Digital Health 2020. The priorities to deliver these capabilities for 2017/18 are itemised below.

Health ICT Investment PortfolioICT investments need to be directed to where the needs are greatest and follow a health investment approach with a long term mindset. The Ministry of Health will be working with the sector to provide policies, guidelines and processes in 2017/18 that will form the basis for the new ICT Portfolio Framework.

As part of this, the Ministry of Heath will maintain the health ICT portfolio of investments to support decision making to maximise the network value of sector ICT investment and deliver strategic goals.

To support this, the 2017/18 Regional Service Plans should include the following:

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1. the prioritised four year plan of all local, regional and national IT initiatives with the following level of information provided for each initiative:

a. Name of the initiative and budget allocation by DHB (WOLC)b. The key deliverable(s) that will be achieved in the 2017/18 yearc. Benefits, dependencies and milestones (where available)

2. How the region will address the following IT delivery challenges:

a. regional governance, leadership and decision making, with clear escalation pathwaysb. regional funding and approval model(s)c. regional capacity and capability

Health Information Standards and Architecture1

The Ministry of Health will define and support the development and adoption of fit-for-purpose health information standards and architecture that support the effective and accelerated implementation of eHealth aligned to strategic goals. All investments should demonstrate how they use HISO Standards.

The Ministry of Health expects to strengthen the focus on architecture and standards to support Digital Health 2020 and work with the sector and vendor community towards compliance.

Digital innovation frameworkThe Digital Advisory Board will provide strategic leadership on digital and information related technologies and work with the sector on creating an environment that supports and encourages innovation.

The Ministry of Health will support the Digital Advisory Board in providing policy, process and guidance to support and accelerate digital innovation. Sector engagement with the Digital Advisory Board will continue as work develops on the framework.

Information Technology (IT)The 2017/18 critical IT priorities continue regional and national programmes of the previous year. In the 2017/18 Regional Service Plans the following should be included:

3. the prioritised four year plan of all local, regional and national IT initiatives with the following level of information provided for each initiative:

a. Name of the initiative and budget allocation by DHB (WOLC)b. The key deliverable(s) that will be achieved in the 2017/18 yearc. Benefits, dependencies and milestones (where available)

4. How the region will address the following IT delivery challenges:a. regional governance, leadership and decision making, with clear escalation pathwaysb. regional funding and approval model(s)c. regional capacity and capability

Digital Health 2020

Investment focus Approach Description of 17/18 activity DHBs

involved Measures

Single Electronic Health Record

National programme led by Ministry of Health Development of Detailed Business

Case

All DHBs DHB engagement in business case development process

Digital Hospital

DHBs accountable for delivery.

Use EMRAM assessment to target gaps in hospital digital maturity with regionally aligned solutions. DHBs should recognise the need for enabling infrastructure to support delivery of digital hospital capability.

All DHBs DHBs to accelerate maturity through regional and sub-regional activities where possible. Refer to Appendix one for recommended DHB investments. These priorities will also be reflected in the DHB annual planning Guidance.

1 http://healthitboard.health.govt.nz/health-it-groups/health-information-standards-organisation-hiso

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Health and Wellness Dataset

Ministry of Health led initiatives aligned to the government’s social investment approach.

Establish information governance based on the draft health information governance framework.Analysis of current state of Ministry held datasets to identify improvements.Consider analytics use of health data in all ICT investments

All DHBs DHB engagement in information governance framework development.

Preventative Health IT Capability

Ministry developed framework of business, data and technology architecture to guide and target investment in health screening solutions to drive consistency and maximise reuse.

DHB and sector engagement to inform planning.Bowel screening rollout. Cervical screening project to support HPV testing.

All DHBs DHB engagement in framework development.Bowel screening rollout (refer XXX)

Regional IT Foundations

DHBs accountable for delivery.

Regional governance, leadership and decision making Regionally agreed ICT capability for:

• eReferrals• eDischarges• Hospital patient

administration• Access to integrated

clinical records (primary and secondary services)

• Hospital Pharmacy• Hospital Radiology

All DHBs DHBs must demonstrate how they are regionally aligned and where they are leveraging digital hospital investments.Specific capability measures are:

• 95% of GP referrals are sent electronically

• All DHB discharges are sent electronically

• 95% of population have an integrated patient-centric clinical record available through a regional view

Digital Health work programme

Investment focus Approach Description of 17/18 activity DHBs

involved Measures

Preventative Health IT Capability

Ministry developed framework of business, data and technology architecture to guide and target investment in health screening solutions to drive consistency and maximise reuse

DHB and sector engagement to inform planning.

Preventative Health IT Capability

Ministry developed framework of business, data and technology architecture to guide and target investment in health screening solutions to drive consistency and maximise reuse.

Regional IT Foundations

DHBs accountable for delivery

Regional governance, leadership and decision making Regionally agreed ICT capability for:

• eReferrals• eDischarges• Hospital patient

administration• Access to integrated

clinical records (primary and secondary services)

• Hospital Pharmacy• Hospital Radiology

All DHBs DHBs must demonstrate how they are regionally aligned and where they are leveraging digital hospital investments.Specific capability measures are:• 95% of GP referrals are

sent electronically• All DHB discharges are

sent electronically• 95% of population have

an integrated patient-centric clinical record available through a regional view

Please note that DHBs are to support the implementation of the Cancer Health Information Strategy (please refer to the Cancer guidance on page 13).

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Other eHealth Business Priorities

Investment focus Approach Description of 17/18 activity DHBs

involved Measures

Maternity Nationally led programme with local DHB Implementation

See Section XXTbc

Nationally consistent Electronic Oral Health Record (EOHR)

National programme led by Ministry of Health with DHB governance and co-design

Investment approval and implementation planning for preferred software solution

All DHBs - community and hospital based oral health services

DHB engagement in investment case development and implementation planning

Cancer Information Strategy

Deliver nationally consistent systems across DHBs to deliver cancer services and support better treatment

See Section XX Tbc

National Enrolment Service

Nationally led programme to provide a ‘single source of truth’ for all national enrolment and identity data

Tbc

National Immunisation Register (NIR) replacement

Nationally led programme to replacement the current NIR register

Investment approval and implementation planning for preferred software solution

All DHBs DHB engagement in investment case development and implementation planning

2.1.2 Regional Workforce

In 2017/18, regions will build upon work from previous RSPs and ensure that they include actions focussed on workforce planning and diversity as outlined below.

Workforce planningNZHS Themes: Closer to home, One team, Smart systemWork regionally, and in collaboration with DHB Shared Services and the Ministry of Health, continue to: Identify workforce data and intelligence that is collected across services and DHB areas, understanding

work force trends to inform workforce planning. Understand the workforce data and intelligence requirements that best supports regions and DHB areas

in order to undertake evidence based work force planning. This may include: A stock take of workforce data and intelligence information that is collected, including understanding any

gaps and the type of information that the Ministry, regions and DHBs need to inform work force planning. Providing work force data and intelligence that supports regions and DHBs to undertake evidence based

workforce planning.

Workforce diversityNZHS Themes: People-powered, One team Work regionally to: Build cultural competence across the whole workforce. Increase participation of Māori and Pacific in the health workforce. Form alliances with educational institutes (including secondary and tertiary) and local iwi to identify and

implement best practices to achieve the Māori health workforce that matches the proportion of Māori in the population.

Ensure all DHB employed workforce data on ethnicity is updated and collected in accordance with MoH guidelines on ethnicity for 95-100% of the workforce by 30 June 2018.

This should include:

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Analysing work force data and intelligence to understand workforce diversity and map this to population demographics within regions.

Developing workforce plans that include education and training needs. Incorporating guidance and actions set out in sections 6.3, 6.4, 6.5 and 10.3.2 of the OPF. In addition to the planning priorities outlined above, regions are expected to align workforce actions with the following RSP and AP priorities: Health Ageing and Mental Health and Addictions. Regions will be required to work with DHBs in order to implement actions arising from the publication of key documents listed below.

Healthy Ageing (Workforce as an enabler)NZHS Themes: One Team, Closer to homeHealthy Ageing StrategyWork regionally to: Identify the workforces working with older people and their family/whānau/informal carers. Develop a workforce plan to ensure that those working with older people have the training and support

they require to deliver high-quality, person-centred care. Develop a sustainable mechanism for collecting a minimum workforce data set on the health workforce

working in health of older people outside the DHB provider arm by 30 June 2018.

Palliative CareWork regionally to: Identify the work forces working with clients requiring palliative care services and their

family/whānau/informal carers. Develop a workforce plan to ensure that those working with clients requiring palliative care services have

the training and support they require to deliver high-quality, person-centred care. Workforce plans should: Include strategies to support specialist work forces to deliver education and training sessions for non-

specialist work forces. Prioritise allied health, kaiāwhina and carer and support worker workforces. Refer to and incorporate guidance and actions outlined in the Health of Older People Strategy and the

Review of Adult Palliative Care Services in New Zealand.

Mental Health and Addictions (Workforce as an enabler)NZHS Themes: One Team Work regionally to implement the actions set out in the Mental Health and Addiction Workforce Action

Plan 2016-2020.Measures Regional progress reporting on the above requirements and key actions to be provided via quarterly RSP

reports. A sustainable mechanism for collecting a minimum workforce data set on the health workforce working in

health of older people working outside the DHB provider arm is established by 30 June 2018. 95-100% of DHB employees have their ethnicity status collected in a manner consistent with MoH

guidelines by 30 June 2018.

2.1.3 CapitalRegional service planning remains an integral part of capital investment planning. Where it is appropriate, potential capital impacts should be identified. However, quarterly reporting on capital will not be required via RSPs. In 2017/18, the Treasury Investment and Asset Performance (IMAP) system comes into effect. All DHBs will be required to provide Long Term Investment Plans (LTIPs) to the Ministry. Investment intensive DHBs will also be required to submit their LTIPs to Treasury, in accordance with the IMAP process. LTIPs will replace the previous requirement for a Regional Capital Plan.

2.2 Sub-regional Initiatives

Current and emerging sub-regional initiatives where DHBs are working together to provide improved value to their populations should be identified in the RSPs, including measurable and time-bound actions.

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2.3 RSP Priorities

The 2017/18 RSP priorities are noted below. These are all a continuation from 2016/17. Note, necessary actions to support cancer services at a regional level are outlined in Module 4: Networks.

Elective Services Cardiac Services Mental Health and Addictions Stroke Services Health of Older People Major Trauma Hepatitis CEnablers Information Technology Workforce

ElectivesRegional Objectives• Improve access to elective services.• Maintain reduced waiting times for elective first specialist assessments (FSAs) and treatment.• Improve equity of access to services, so patients receive similar access regardless of where they live.

• Identify the actions that the region will undertake to improve access to elective services, reduce waiting times and improve equity of access. These actions will differ by region but could include:o developing a regional delivery plan that supports achievement of local intervention rates, maximised regional capacity,

optimal use of specialist resources and sub-specialist capability, increased access to less complex surgery and local Health Target Delivery

o developing consistent pathway, access criteria, and clinical protocols for individual serviceso establishing and delivering sub-regional agreement to facilitate cross-boundary patient care o implementing sub-regional referral management and scheduling systemso sustaining progress achieved through previously funded Elective Services Productivity and Workforce Programme

(ESPWP) contracts.Information Technology• Identify the actions that the region will undertake to support improved information management. For example, establishing

a regional oversight role to ensure any actions required to contribute to or implement the National Patient Flow collection are regionalised where possible.

Workforce• Identify the actions that the region will undertake to maximise workforce resources. For example, completing a forecast

through to 2018/19 of future workforce requirements, developed based on service demands and maintaining a local and regional view of specialist workforce capacity and capability.

MeasuresFor the 2017/18 year it is expected that:• your region’s Electives Health Target will be met• patients wait no longer than four months for FSA or elective treatment (Elective Services Patient Flow Indicator (ESPI) 2 and

ESPI 5). While individual DHBs are accountable for ESPI performance; regional service activity should support improved access, equity and timeliness. Therefore, ESPIs are one measure of how regional progress is being achieved.

StrokeRegional Objectives• To improve primary and secondary stroke prevention and reduce stroke related disability and mortality. • To improve access to quality assured organised acute, rehabilitation, and community stroke services.• To ensure all stroke patients have access to high-quality stroke services regardless of age, gender, ethnicity or geographic

domicile.

Develop and deliver a regional plan for stroke services supporting the continued implementation of best practice stroke care, ensuring equitable access is provided to all New Zealanders. This should be consistent with the New Zealand Clinical Guidelines for Stroke Management 2010 (the Stroke Guidelines) and include advice provided by the national and regional stroke networks. This will include the following.Organisation of stroke services• People with stroke admitted to hospital are treated in a stroke unit and/or in the setting of an organised stroke service (see

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PP20 for definitions of a stroke unit and organised stroke services).Thrombolysis• All people with stroke have access to a quality assured thrombolysis service 24/7 (eg, this will include the development of

regional plans to provide remote support via telestroke). Rehabilitation• All eligible people with stroke receive early active rehabilitation services (as defined by the National Stroke Network),

supported by an interdisciplinary stroke team.• All eligible people with stroke have equitable access to community stroke services.Education, training and audit• All members of the interdisciplinary stroke team participate in ongoing education, training and quality assurance and service

improvement programmes according to the Stroke Guidelines, and as recommended by the national and regional stroke networks.

Workforce• A regional workforce plan that supports the delivery and achievement of sustained, consistent and safe thrombolysis, and

comprehensive evidence-based interdisciplinary acute and rehabilitation stroke care provision.• Identified actions that the region will take to develop and implement an ongoing education programme that supports a

sustainable and high-quality clinical workforce.Information Technology• Identified actions that the region will take to support improved information management, eg, establishing a regional

oversight role.

MeasuresUse the three DHB annual plan measures to identify gaps and opportunities for development of regional models of care.• 6 percent or more of potentially eligible stroke patients thrombolysed 24/7 (see PP20 for definition of ‘eligible’)• 80 percent of stroke patients admitted to a stroke unit or organised stroke service (see PP20 for definitions).• 80 percent of patients admitted with acute stroke who are transferred to inpatient rehabilitation services are transferred

within 7 days of acute admission (also report percent of acute stroke patients transferred to inpatient rehab).

Note: when reporting against above indicators include numerators and denominators in brackets after percent.

Cardiac Services Regional ObjectivesThe focus for regions in 2015/16 will be to continue to improve access to cardiac services including:• improved and timelier access to cardiac services• patients with a similar level of need receive comparable access to services, regardless of where they live• more patients survive acute coronary events, and likelihood of subsequent events are reduced• patients with suspected Acute Coronary Syndrome (ACS) receive seamless, co-ordinated care across the clinical pathway• patients with heart failure are optimally managed at admission, reducing the need for further readmission• reviewing and auditing Accelerated Chest Pain Pathways (ACPPs) in Emergency Departments.

• Continue to work with regional cardiac clinical networks and the New Zealand Cardiac Network to implement actions to improve outcomes for people.

• Provide quarterly reporting at regional and DHB level utilising the ANZACS-QI and Cardiac Surgery registers.Secondary Services• Develop and deliver a regional (or sub-regional in South Island) plan for cardiac services, ensuring appropriate access to

cardiac surgery, percutaneous revascularisation and coronary angiography.• All cardiac surgery patients are prioritised, and treated in accordance with assigned priority and urgency timeframes.• Sustain performance against cardiac surgery waiting list management expectations.ACPPs• Review and audit ACPPs in Emergency Departments.ACS• Implement regionally agreed protocols, processes and systems to ensure prompt local risk stratification and management of

suspected ACS patients.• Implement systems for prompt transfer of high-risk patients to tertiary centres for the appropriate interventions.Heart Failure• Implement locally, regionally and nationally agreed protocols, guidance, processes and systems to ensure optimal

management of patients with heart failure.

MeasuresSecondary Services• Standardised intervention rates.

o Cardiac surgery: a target intervention rate of 6.5 per 10,000 of population will be achieved. DHBs with rates of TBC per 10,000 or above in previous years will be required to maintain this rate.

o Percutaneous revascularisation: a target rate of at least 12.5 per 10,000 of population will be achieved. o Coronary angiography: a target rate of at least 34.7 per 10,000 of population will be achieved.

• Proportion of patients scored using the national cardiac surgery Clinical Priority Access (CPAC) tool, and proportion of patients

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treated within assigned urgency timeframe.• The waiting list for cardiac surgery remains between 5 and 7.5 percent of planned annual cardiac throughput, and does not

exceed 10 percent of annual throughput. • Patients wait no longer than four months for a cardiology first specialist assessment, or for cardiac surgery.ACPPs• Report quarterly on regional activity that supports ACPP quality improvement.ACS• Each region will have established measures of ACS risk stratification and timeliness for patients to receive appropriate

intervention.• 70 percent of patients will receive an angiogram within 3 days of admission (‘Day of Admission’ being ‘Day 0’) reported by

ethnicity.• Over 95 percent of patients presenting with ACS who undergo coronary angiography have completion of ANZACS-QI ACS and

Cath/PCI registry data collection within 30 days.• Over 95 percent of patients undergoing cardiac surgery will have completion of Cardiac Surgery registry data collection within

30 days of discharge.

Healthy AgeingStrengthening Dementia Pathways To ensure people with dementia and their families and whānau are valued partners in an integrated health and social support system that supports wellbeing and control over their circumstances. The regional focus in 2017/18 is to further understand national and local variances across dementia pathways and to facilitate a co-operative national approach to strengthening dementia pathways and approaches for people with dementia and their carers. National learnings and/or resources will continue to be available to assist DHB regions to develop and implement components of dementia care pathways. Regional Dementia Care Pathway Groups, in collaboration with primary, secondary, and the community will:• identify dementia education and support programmes in operation to support family/whanau carers (eg, Living Well with

Dementia) and people living with dementia, and work with DHBs to improve the quality and consistency of programmes delivered (ie, reduce regional variability)

• deliver (and report volumes of) dementia awareness and responsiveness education programmes for primary health care clinicians to improve awareness and responsiveness in primary health care (working in partnership with the dementia sector and primary health organisations)

• provide DHBs with on-going support and overview so that DHBs identify and strengthen components of dementia care pathways within the parameters of the New Zealand Framework for Dementia Care.

interRAI Regional ObjectivesThe goal of interRAI is to promote evidence-based clinical practice and policy decisions via the collection and interpretation of high-quality data about the characteristics and outcomes of persons served across a variety of health and social services settings. The regional focus for 2017/18 is to improve the (proactive) use of InterRAI data across the continuum (ie, community services through primary and secondary care) to identify equity, population and service trends, and improve outcomes for older people. DHB regions will proactively monitor and share population and service trend data across the continuum (ie, community services through primary and secondary care), and influence service improvements.

MeasuresStrengthening Dementia Pathways • Complete an analysis of the current state of educational programmes and support groups to support family/whanau careers

in operation in the region.• Regional activity that supports DHBs to build a regional response to reduce variability of education and support programmes

available to support family/whanau carers and people living with dementia.interRAI • Proactively monitor and share interRAI population and service data across the continuum (ie, with workers who offer

community services, primary and secondary care clinicians – quarterly) and influence service improvements.

Mental Health and AddictionsRegional Objectives Our objectives for 2017/18 are to improve:• access to the range of eating disorder services• youth forensic service capacity and responsiveness• perinatal and maternal mental health acute service options as part of a service continuum• mental health and addiction service capacity and capability for people with high and complex needs• the physical health of people with low prevalence disorders.

Identify and deliver on at least two actions for each of the following that will lead to:• continued regional provision of eating disorder inpatient services (Midland and Northern regions to implement the

recommendations from the service review to ensure sustainable inpatient and community services)• improved Mental Health and Addiction Service capacity and capability for people with high and complex needs• implementation of actions for a Community Youth Forensic Service Plan

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• develop a plan to improve physical health outcomes of people with low prevalence disorders.

For the North Island (Northern, Midland and Central Regions) perinatal and infant mental health services, actions that will facilitate:• regional co-ordination and oversight of service delivery and models of care that support integrated responses to acute care

including consult/liaison• access to a broader range of options for mothers who are acutely unwell• specialist acute response that facilitates timely and integrated care• establishment of clinical networks to support, connect and grow the expertise of the workforce • monitoring and evaluation of the individual services within the continuum and the continuum as a whole.

Measures• A reduction in waiting lists and times for people in prisons requiring assessment in forensic services. For example: a reduction

in waiting lists from x to y with targets set for each quarter.• Increased access to community youth forensic services through the development of sustainable youth forensic services.

Measure and report improved youth forensic access rates overall including increases in all three settings (court liaison, Child Youth and Family youth justice residences and community).

• Increased access in the North Island to perinatal and maternal mental health services, increased number of contacts in the community, decreased wait-time (time from referral to first contact), decreased adult admissions. For example: x being current numbers to be increased to y with progress measured each quarter.

• Actions that have been undertaken to improve the capability and capacity of services to provide for high and complex needs.• Report progress on developing a plan to improve the physical health of people with low prevalence disorders.

Hepatitis CRegional Objectives• To implement a single clinical pathway for hepatitis C care across all regions in order to provide consistent services, which

maximise the wellbeing of all New Zealanders living with hepatitis C.• To implement integrated hepatitis C assessment and treatment services across community, primary and secondary care

services in the region.

Actions to support the implementation of integrated hepatitis C assessment and treatment services include:• raising community and GP awareness and education of the hepatitis C virus (HCV) and the risk factors for infection• providing targeted testing of individuals at risk for HCV exposure• raising patient and GP awareness of long term consequences of HCV and the benefits of treatment, including lifestyle

management and antiviral therapy• providing community based access to HCV testing and care that will include Fibroscan services to all regions as a means for

assessment of disease severity and as a triage tool for referral to secondary care and prioritisation for antiviral therapy• establishing systems to report on the delivery of Fibroscans in primary and secondary care settings• providing community based ongoing education and support (including referral to needle exchange services, community

alcohol and drug services, GP primary care services or social service agencies)• providing long term monitoring (life-long in people with cirrhosis and until cured in people without cirrhosis)• providing good information sharing with relevant health professionals• working collaboratively with primary and secondary care to improve access to treatment.

Note: a document is being developed by the Hepatitis C Implementation Advisory Group that will include for more information on the clinical pathway, minimum requirements, minimum standards and data collection (Guidance to support the development of regional services to deliver identification and treatment for people at risk of or with Hepatitis C). This document will be available on the Nationwide Service Framework Library website once it is finalised.

Measures• Quarterly narrative report on progress of the key actions.• Report six monthly broken down by quarters on the following measures:

Measures Data and Source• Number of people diagnosed with hepatitis C per

annum (by age).Total number of people with a positive HCV PCR test in the DHB region (data from five reference labs provided to regional DHBs).

• Number of HCV patients who have had a Fibroscan in the last year (a) new patients (b) follow up (by age and ethnicity).

Total number of hepatitis C Fibroscans performed annually (data from the delivery of Fibroscans in primary and secondary care).

• Number of people receiving PHARMAC funded antiviral treatment per annum (by age and ethnicity).

Total number of people prescribed antiviral treatment who have hepatitis C (data from PHARMAC provided to regional DHBs).

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Major Trauma Regional ObjectivesTo implement a regional major trauma system that will result in a reduction of preventable levels of mortality, complications and lifelong disability of clients who have sustained a major trauma (as defined by the National Trauma Network2).

• Report the elements of the National Major Trauma Minimum Dataset for major trauma patients to the New Zealand Major Trauma Registry

• Provide clinical leadership to achieve a contemporary trauma system, including:o Agreed regional clinical guidelines and inter-hospital transfer processes to manage major trauma patients

within the regiono Regional Destination Policies for major trauma patients (in collaboration with DHBs, ambulance providers and

National Major Trauma Clinical Network) – TBC.

Measures• Quarterly regional reporting of the NZ Major Trauma Minimum Dataset for major trauma patients to the National Major

Trauma Registry no more than 30 days after patient discharge.• Develop and implement a 6-monthly (minimum) regional process to analyse and interpret regional major trauma data with

mechanisms for quality improvement • Develop and implement a 6-monthly (minimum) regional review process of the alignment of actual service delivery for major

trauma patients with:o regional pre-hospital destination policy – TBC.o regional clinical guidelines and processes.

ReportingReport in the second and fourth quarters of 2017/18 on the above measures.

2 Major Trauma patients are defined as ISS>12 using AIS 2008.

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MODULE 3: REGIONAL GOVERNANCE AND LEADERSHIP

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

3.1 Regional Governance and Decision Making

RSPs should provide information about how the DHBs in the region are collaborating and how implementation of the plans will be governed, costed, funded and managed, including how DHBs will manage performance and disputes.

DHBs are expected to co-operate and assist their colleagues in finding and implementing solutions to financial or clinical issues that arise. An indication of how the region will co-operate and resolve issues should be incorporated in the RSP and may include roles and responsibilities, an outline of arrangements to provide support and assistance to other DHBs to meet the regional and/or sub-regional performance expectations, and how barriers and issues will be resolved. Some regional (including sub-regional) work programmes may require specific governance and leadership approaches with tailored membership to appropriately represent the key stakeholders and to ensure the best outcome is achieved (eg, involvement and alignment with primary care, NGOs, and patient representative groups).

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

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

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MODULE 4: NETWORKS

4.1 Regional Cancer Networks

Cancer networks bring together stakeholders from across the region who are working across the cancer pathway including DHBs, NGOs, GPs and PHOs, cancer service providers, cancer service consumers and their family or whānau, hospices, and research organisations. Cancer networks work across boundaries to improve the outcomes for patients by:

reducing the incidence and impact of cancer increasing equitable access to cancer service and equitable outcomes with respect to cancer treatment

and cancer outcomes.

Implementing the priorities of the New Zealand Cancer Plan: Better, faster cancer care 2015–2018 is the priority for regional planning for cancer services to improve:

equity of access to cancer services timeliness of services across the whole cancer pathway the quality of cancer services delivered.

4.1.1 Key actions

Regional Cancer Networks should identify how they will support coordination and integration of services across their region to improve access, timeliness and quality of cancer services.At a minimum this will include how your region will:

implement the priorities of the New Zealand Cancer Plan 2015-2018 achieve the Faster cancer treatment health target improve equity of access to cancer services support DHBs to deliver on the actions for cancer outlined in their Annual Plans.

4.2 Supporting Clinical Networks and Clinical Leadership

In 2017/18, it is expected that clinical integration will continue to be visible in the development of service priorities. RSPs are to adopt a proactive approach to strengthening clinical integration by developing and supporting clinical networks. In particular, the RSPs are to:

identify how the region is planning to work with clinical leaders to make better use of clinical networks to support improved clinical and financial sustainability of services

identify services within the region that may benefit from the development of a regional clinical network.

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MODULE 5: HEALTH EQUITY

The World Health Organization defines equity as the absence of avoidable or remediable differences among populations or groups defined socially, economically, demographically or geographically. Equity is not a single component, but rather a cross-cutting dimension across all elements of quality. Focus is on reducing gaps in health outcomes between different groups based on ethnicity, deprivation, age, gender, disability and location (for example).

Strong planning and collaboration is critical to achieving health equity for all New Zealanders. The Ministry expects that achieving health equity is a focus for all DHB and regional activity. Regions are expected to keep identifying inequity in their health needs assessments and to outline in their RSPs activities in each of the regional priority areas aimed to improve health equity.

The specific actions aiming to improve equity will vary between regions and priority areas depending on their various needs and can range from enabling collection of ethnicity data to targeting services. Actions can be focused on the short and longer term. However, at least one specific action for each priority should be delivered in 2017/18. The Ministry will be looking for evidence that the regions have worked through a process of identifying the disparities evident in each priority area, and outlined relevant activities to reduce these disparities in order to achieve health equity for their population.

Regions aren’t expected to include specific equity actions for the priority areas listed as enablers.

5.1 Health Equity Tools

Actions vary depending on the understanding of the equity issues of the priority area. The following tools, or others at your disposal, can be used to assess and identify regional disparities and outline activities for achieving health equity.

Equity of Health Care for Māori: A Framework (this was recently released in July 2014). Whānau Ora Health Impact Assessment 2007. The Health Equity Assessment Tool: A User's Guide 2008.

The Ministry has recently released DHB M ā ori Health Profiles 2015 , which can help identify areas of focus for planning to improve equity.

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

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MODULE 6: LINE OF SIGHT

For 2017/18 focus remains on ensuring there is greater alignment between RSPs and APs. The RSPs are expected to set out the regional priorities and how DHBs intend to work as a region to achieve these. The requirements of IT, workforce and capital to implement service priorities are also expected to be incorporated where applicable.

6.1 The Planning Process across Regional Service Plans and Annual Plans

The Line of Sight guidance framework is provided below for general use. It aims to improve linkages across RSPs and APs and to demonstrate how individual DHB actions contribute to achieving regional priorities.

To expand further on this framework, a combined priorities document that clearly articulates what is required in both the RSPs and the APs for those planning priorities that cross both plans has been released.

DHBs are required to provide a statement of the local actions they will undertake to support the delivery of regional service plans. DHBs and regions can agree to only include the local actions in either one of the plans if they include a cross reference in the other plan.

To streamline reporting, the local actions of DHBs to deliver on regional objectives are reported quarterly within a consolidated regional report by Shared Services Agencies on behalf of DHBs. This is intended to streamline reporting as individual DHBs will not be required to report local actions to support regional priorities through their local DHB quarterly reports.

6.2 Guidance Framework for RSP Priorities

Line of sight across Government, Regional and Annual Plan outcomes and objectives

Health system outcomes

New Zealanders live longer, healthier, more independent livesThe health system is cost effective and supports a productive economy.

Ministry of Health high-level outcomes

New Zealanders are healthier and more independentHigh-quality health and disability services are delivered in a timely and accessible mannerThe future sustainability of the health and disability system is assured.

Regional outcomes

Outcomes that DHBs within a region want to achieve by working together regionally.

DHB outcomes

Outcomes that the DHB wants to achieve.

RSP - Common Priorities and Objectives

Priorities and objectives that DHBs within a region have set to achieve their regional outcomes.

RSP - Key Actions, Milestones and Measures

Key actions to set out what the region will do to achieve its objectives (and where appropriate significant individual DHB contributions are identified).

Key milestones required to reach regional objective.

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Measures the region will use to assess effect of actions agreed to achieve milestones, including setting of baselines.

RSP - Inputs / Resources

The nature of inputs may vary and could include: costs to implement actions in order to achieve priority people / teams / and/or new roles required to progress actions.

RSP - Responsibilities

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

RSP – Requirements of Enablers to Achieve Regional Priorities

Workforce, IT and capital requirements to deliver on regional services priorities should be explicitly identified where relevant to achieving a regional objective.

AP – Individual DHB’s Contribution to Regional Priorities

The planning priorities document sets out the priority areas that are to be covered in the annual plans. The DHB annual plan should also include any significant individual DHB contributions to deliver against regional priorities and targets.

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MODULE 7: NATIONAL ENTITIES

7.1 Linkages

Linkages with other work, in particular across the National Health IT Plan, Health Workforce New Zealand, Capital, and the Health Quality and Safety Commission need to be considered.

7.1.1 Health Quality and Safety CommissionDHBS are required to incorporate Health Quality and Safety Commission programmes into their RSPs, as outlined in the Commission’s Statement of Intent 2014-18. In particular, DHBs are encouraged to demonstrate a structure and planned actions to support and maintain regional patient safety and quality improvement governance and working arrangements. Each region is expected to meet the following criterion:

RSP Criterion 2017/18 Example of an RSP meeting the criterionIdentify actions and demonstrate leadership for regional patient safety and quality improvement

Demonstrate, including planned actions and quarterly milestones, how you will:

maintain and participate in multi-disciplinary regional governance structures that focus on patient safety and quality improvement, and involve consumers (patients and family)

work regionally to implement the Health Quality & Safety Commission’s deteriorating patient programme in your DHBs.

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