2016/17Regional 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

5 - ‘Strategic Position’ – clarification included about expectations for commitment to the draft updated New Zealand Health Strategy.

6 - ‘Implementation of the New Zealand Health Strategy’ – clarification of expectations for 2016/17 Plans.

February 2016

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

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

MODULE 2A: IMPLEMENTATION OF THE NEW ZEALAND HEALTH STRATEGY..................................6

2A.1 Context.................................................................................................................................................6

2A.2 Themes from the Health Strategy.........................................................................................................62A.2.1 People Powered...........................................................................................................................................62A.2.2 Care Closer to Home....................................................................................................................................62A.2.3 High Value and Performance.......................................................................................................................62A.2.4 One Team....................................................................................................................................................72A.2.5 Smart System...............................................................................................................................................7

MODULE 2B: REGIONAL PRIORITIES.............................................................................................8

2B.1 Overview of RSP Priorities....................................................................................................................8

2B.2 Enablers................................................................................................................................................82B.2.1 Health IT Programme...................................................................................................................................82B.2.2 Regional Workforce.....................................................................................................................................92B.2.3 Capital..........................................................................................................................................................9

2B.3 Sub-regional Initiatives.......................................................................................................................10

MODULE 3: REGIONAL GOVERNANCE AND LEADERSHIP...........................................................11

3.1 Regional Governance and Decision Making........................................................................................11

MODULE 4: NETWORKS............................................................................................................12

4.1 Regional Cancer Networks..................................................................................................................124.1.1 Key actions.....................................................................................................................................................12

4.2 Supporting Clinical Networks and Clinical Leadership........................................................................12

MODULE 5: HEALTH EQUITY.....................................................................................................13

5.1 Health Equity Tools.............................................................................................................................13

MODULE 6: LINE OF SIGHT.......................................................................................................14

6.1 The Planning Process across Regional Service Plans and Annual Plans...............................................14

6.2 Guidance Framework for RSP Priorities..............................................................................................14

MODULE 7: NATIONAL ENTITIES...............................................................................................16

7.1 Linkages..............................................................................................................................................167.1.1 Health Quality and Safety Commission..........................................................................................................16

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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.

The draft updated New Zealand Health Strategy and Roadmap of Actions has recently been consulted on. Module 2A has been inserted into this document so that RSPs can clearly show the planning impacts of the update to the Health Strategy for 2016/17.

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 2016/17 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 2016/17 there is a focus on demonstrating the achievements of regional services planning. There is also a continued focus on improving alignment between the DHB Annual Plans (APs) and the RSPs. The visibility of contributions by DHBs to achieve regional service priorities will be further strengthened by expanding on the Line of Sight framework provided for past plans. The Line of Sight framework is included in Module 6 as a general guideline. A combined priorities document has also been released that clearly articulates what is required in both the RSPs and the APs for those planning priorities that cross both 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 2A: IMPLEMENTATION OF THE NEW ZEALAND HEALTH STRATEGY

2A.1 Context2A.2 Themes from the Health Strategy

2A.2.1 People Powered2A.2.2 Care Closer to Home2A.2.3 High Value and Performance2A.2.4 One Team2A.2.5 Smart System

MODULE 2B: RSP PRIORITIES

2B.1 Overview of Regional Priorities2B.2 Enablers

2B.2.1 Health IT Programme2B.2.2 Regional Workforce2B.2.3 Capital

2B.3 Sub-regional Initiatives

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 ENTITIES

7.1 Linkages7.1.1 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 2016/17 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(refer to Module 2A about Implementation of the New Zealand Health Strategy), as well as all trends and key outcomes outlined in:

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

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

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MODULE 2A: IMPLEMENTATION OF THE NEW ZEALAND HEALTH STRATEGY

2A.1 Context

The New Zealand Health Strategy is currently being updated. The updated Strategy will provide DHBs and the wider sector with a clear strategic direction and road map for delivery of more integrated health services to New Zealanders into the future. The Strategy has a ten-year horizon so will impact not just immediate planning and service provision but will enable and require DHBs to have a clear roadmap for future planning as well.

The 2016/17 RSPs must reflect the draft refreshed New Zealand Health Strategy’s direction and should commit to delivering appropriate actions in line with the Strategy Roadmap.

It is not expected that the regions will fully embed the refreshed New Zealand Health Strategy into the performance story of their RSPs for 2016/17 (given the timelines for completion of the Strategy), but rather will include appropriate commitments and actions in this module to ensure that implementation of the Strategy can begin in 2016/17.

Further advice will be provided in February 2016, once analysis of the draft Strategy consultation has been undertaken, in order to confirm the expectations for 2016/17. It is important that the RSPs focus on implementation in 2016/17 as the consultation has revealed general support for the Strategy’s five themes with particular focus on actions and implementation, including ensuring existing activity fits within the Strategy’s framework.

Refer to the Annual Plan Guidelines for guidance on how regions can demonstrate their actions to deliver on the draft Strategy within DHB Annual Plans.

Once the Strategy is finalised, it is expected that DHBs and regions will identify specific, tangible, measurable and time bound actions to deliver the relevant Roadmap Actions. Further guidance about appropriate actions to deliver on the Roadmap Actions will be provided once consultation on the Strategy is complete.

There are some existing planning priorities that may be impacted as a result of the Strategy Roadmap actions, once these are confirmed. In order to reduce duplication, if the Health Strategy actions for 2016/17 cross over with DHB and/or regional activities identified under existing priority areas, DHBs and regions will be expected to provide a table in this Module showing where the detailed actions can be found elsewhere in their plan.[2A.2] Themes from the Health Strategy

The consultation draft Strategy’s strategic themes are outlined below. DHBs and regions will need to be focussed on the critical areas to drive change that come out of the refresh of the Strategy.

2A.2.1 People Powered Developing understanding of users of health services. Partnering with them to design services. Encouraging and empowering people to be more involved in their health. Supporting people’s navigation of the health system.

2A.2.2 Care Closer to Home Providing health services closer to home. More integrated health services, including better connection with wider public services. An investment early in life.

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A focus on the prevention and management of chronic and long-term conditions.

2A.2.3 High Value and Performance The transparent use of information. An outcome-based approach. Strong performance measurement and a culture of improvement. An integrated operating model providing clarity of roles. The use of investment approaches to address complex health and social issues.

2A.2.4 One Team Operating as a team in a high-trust system. The best and flexible use of our health and disability workforce. Leadership and management training. Strengthening the role for people, families and whānau and communities to support health. More collaboration with researchers.

2A.2.5 Smart System The increased use of analytics and systems to improve management reporting, planning and service

delivery and clinical audit. The availability – at the point of care – of reliable and accurate information including on-line electronic

health records. The health system as a learning system, that continuously monitors and evaluates what it is doing, and

shares it.

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MODULE 2B: REGIONAL PRIORITIES

2B.1 Overview of RSP Priorities

The 2016/17 RSP priorities are noted below. These are mostly a continuation from 2015/16, with the exception of Hepatitis C. 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

Detailed guidance on what RSPs need to address for each priority area is included in the separate Planning Priorities guidance document.

2B.2 Enablers

The National Health IT Plan 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 2016/17 for IT and Workforce are outlined in the combined priorities document. 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 noted below.

2B.2.1 Health IT ProgrammeHealth IT plays an increasingly significant role in today’s environment by enabling the delivery of high quality, timely and cost-effective health care. Strong governance, leadership, and decision making are essential for the delivery of IT investments aligned to national and regional strategic plans. Clinical and consumer engagement are critical for the acceptance and full utilisation of health information systems. The sector needs well-designed and integrated systems that support clinical workflow with efficient clinical documentation, clinical decision support and care co-ordination tools.

The last five years have focussed on the establishment of regional information platforms. Regions now need to build on these platforms to create an electronic medical record (EMR) that supports uniform, standards-based information capability across the sector.

The Health IT Programme 2015-2020 requires DHBs to complete the critical priority regional investments. In addition, the programme prioritises IT investment in four new areas:

1. a single longitudinal electronic health record (EHR) over the next five years2. ‘hospital EMRs’ based on a digital hospital blueprint3. a national health prevention IT platform to support screening and immunisation4. data to support health and social investments.

The initiatives above will be commissioned over the next twelve months. The critical priorities continue to be regional and national programmes carrying over from 2015/16. Regional clinical workstation, clinical data repository and patient administration systems provide the foundations to support the integrated EMR

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environment that regions must build towards. EMRs will conform to a nationally agreed blueprint for digital hospitals.

The HIMSS Analytics EMR Adoption Model (EMRAM) will be used to benchmark EMR solutions from June 2016.

In the 2016/17 RSPs regions must include:

their prioritised three-year plan of all local, regional and national IT initiatives, including the applicable critical IT priorities that are outlined in the separate planning priorities document. The following level of information should be provided for each initiative (a and b are mandatory):a. name of the initiative and budget allocation by DHB (WOLC)b. the key deliverables that will be achieved in the 2016/17 yearc. benefits, dependencies and milestones (where available)

strategies the region has put in place to 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 capabilityd. roadmap for development of a hospital EMR environment.

2B.2.2 Regional WorkforceThe workforce section of the RSP must be cognisant of the priorities and/or areas of action outlined in the finalised New Zealand Health Strategy, the need to demonstrate leadership and commitment to supporting the development of the region’s health workforce consistent with the objectives of the finalised Strategy, and the need to strengthen local and regional health workforce to meet future healthcare needs.

DHBs are expected to work in collaboration with Regional Directors - Workforce and in conjunction with Health Workforce New Zealand to achieve agreed regionally-based solutions for:

implementation of community based attachments for prevocational trainees increased participation of Māori and Pacific in the health workforce building on the 2015/16 RSP, demonstrating further progress on actions to meet milestones development of vulnerable workforces introduction of 'new models of care' planning and development establishment of specialist roles, such as palliative care specialists nurses and educators, nurse

practitioners, clinical nurse specialists, nurses performing endoscopies, and medical physicists.

To enable a consistent approach to:

leadership, the national DHB General Managers Human Resources (GMsHR) group, DHB Shared Services and Health Workforce New Zealand developed a national leadership domains Framework, which was approved by DHB Chief Executives in October 2015. DHBs are encouraged to use the Framework to ensure that their local DHB as well as regional leadership capability frameworks and leadership development activities, fit with and complement the national leadership domains Framework (link to domains will be added in the next version of the guidance)

workforce planning, the national GMsHR group and Health Workforce New Zealand have collaborated in the development of a Workforce Intelligence and Planning Framework. The Framework aims to assist DHBs when undertaking workforce planning at the individual DHB, regional and national level for the immediate planning horizons – up to three years. DHBs and regions are encouraged to use the Framework, which can be accessed at the following link: Workforce Intelligence and Planning Framework.

2B.2.3 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 2016/17, the Treasury Investment and Asset Performance (IMAP) system comes into effect. All DHBs

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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.

2B.3 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. Measurable and time-bound actions are required to be set out in the AP (Annual Plan Toolkit, Module 2B: Delivering on Priorities and Targets).

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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 Identify the actions your region will undertake to improve access, timeliness and the quality of cancer services. At a minimum, this will include how your region will:

improve the quality of cancer services by supporting the identification of at least three actions the region will undertake to improve equity at a system and/or organisational level (refer to the Equity of Health Care for Māori: A framework resource )

co-ordinate a review of services against two national tumour standards and identify key activities to address issues identified as a result of completed national tumour standard reviews

improve the functionality and coverage of multidisciplinary meetings (MDMs) by implementing the regionally agreed MDM priorities

implement actions that support the region to deliver on the priorities for cancer as outlined for DHB APs in the combined planning priorities document

where appropriate, identify workforce and IT programmes of work that support the actions the region is undertaking to improve cancer services (as aligned with the New Zealand Cancer Health Information Strategy).

4.2 Supporting Clinical Networks and Clinical Leadership

In 2016/17, 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 2016/17. 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 2016/17 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).

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Key milestones required to reach regional objective. Measures the region will use to assess effect of actions agreed to achieve milestones, including setting

of baselines.

RSP - Inputs / Resources

The nature of inputs may vary and could include: 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 both regional and annual plans. The DHB Annual plan should also include (or reference) DHB’s individual actions to deliver against regional priorities and targets. This includes: key individual DHB actions to deliver on regional milestones and priorities (links to regional actions) measures to demonstrate progress on regional milestones and priorities where appropriate, budget allocation by DHB.

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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:

involve consumers (patient and family) maintain and participate in regional governance approaches that ensure regional and local leadership of

the campaign, and patient safety and quality improvements more generally develop and maintain regional leadership and networks to support quality and safety, and build

capability for improvement.

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