Consultation working draft
2016/17
Regional Service Plan Guidelines
Summary of changes to the Regional Service Plan Guidelines
Section / Description1 / -Stronger focus on demonstrating that regional planning is making a difference.
2A / -Background and themes of the health strategy
2.3.1 / -Updated expectations for health IT programme
2.3.2 / -Updated expectations for regional workforce
2.3.3 / -Capital planning reporting requirement cancelled, move to Treasury led process
3 / -Minor updates of expectations for governance arrangements
4.1 / -Updated requirements regional cancer networks
5 / -Stronger focus of health equity on actions for 2016/17
6 / -Clarified inclusion of local actions to deliver on regional priorities
-Addition of outcomes to line of sight
7 / -Updated national entities requirements
October 2015
Table of Contents
MODULE 1:STRATEGIC POSITION
1.1Linkages
MODULE 2:RSP priorities
2A: Implementation of the New Zealand Health Strategy
2.1Context
2.2Themes from the Health Strategy
2.2.1People Powered
2.2.2Care Closer to Home
2.2.3High Value and Performance
2.2.4One Team
2.2.5Smart System
2B: REGIONAL PRIORITIES
2.3Enablers
2.3.1Health IT Programme
2.3.2Regional workforce
2.3.3Capital
2.4Sub-regional Initiatives
MODULE 3:REGIONAL GOVERNANCE and LEADERSHIP
3.1Regional Governance and Decision Making
MODULE 4:NETWORKS
4.1Regional Cancer Networks
4.1.1Key actions
4.2Supporting Clinical Networks and Clinical Leadership
MODULE 5:HEALTH EQUITY
5.1Health Equity Tools
MODULE 6:LINE OF SIGHT
MODULE 7:NATIONAL ENTITIES
7.1Linkages
7.1.1Health Quality and Safety Commission
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 working 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 regional government priorities 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, including the roadmap, has recently been released for consultation. The consultation will further clarify the roadmap actions the sector is expected to implement in 2016/17. Module 2A shows the immediate planning impacts for 2016/17 and this module will be updated following the consultation.
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 section 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 the past plans. The Line of Sight framework is included in section 6.1 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 Goh
National Health Board
Ministry of Health
(04) 816 2214.
Overview of Content Requirements
1: STRATEGIC POSITION1.1 Linkages
2A: Health Strategy
2.1 Context
2.2 Themes from the Health Strategy
2B: RSP PRIORITIES
2.1 Priorities
2.2 Enablers
- Health IT programme
- Regional workforce
- Capital
3: REGIONAL GOVERNANCE and LEADERSHIP
3.1 Regional Governance and Decision Making
4: NETWORKS
4.1 Regional Cancer Networks
- Key actions
5: HEALTH EQUITY
5.1 Health Equity Tools
6: LINE OF SIGHT
6.1 The Planning Process Across Regional and Annual Plans
7: NATIONAL ENTITIES
7.1 Linkages
- Health Quality and Safety Commission
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 the enablers the progress can either be described for enablers as a whole or as part of the individual priority sections (Module 2).
1.1Linkages
The strategic section of the RSP should also be consistent with national strategic imperatives (refer to Module 2A for the 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.
MODULE 2:RSP priorities
2A: Implementation of the New Zealand Health Strategy
2.1Context
As you are aware, the refresh of the New Zealand Health Strategy is currently under way. The updated Strategy is intended to 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 DHBs to have a clear roadmap for future planning as well.
The 2016/17 RSPs must reflect the overall direction of the draft updated New Zealand Health Strategy (section 38(2)(d) of the NZPHD Act) and should commit to delivering appropriate actions from the Strategy Roadmap.
It is not expected that the regions will fully embed the refreshed New Zealand Health Strategy into the strategic position of their RSPs for 2016/17 (given the timelines for completion of the Strategy), but rather will include appropriate commitments and actions in this separate module.
Further advice will be provided once the consultation is complete to confirm the immediate planning expectations arising from the Strategy for 2016/17.
2.2Themes from the Health Strategy
The current strategic themes of the consultation draft of the Strategy are outlined below. While these themes are not finalised it is worth noting that DHBS and regions will need to be focussed on the critical areas to drive change that come out of the refresh of the Strategy.
Once the Strategy is finalised, it is expected that DHBs and regions will need to identify specific, tangible, measurable and time bound actions to deliver the relevant Roadmap Actions. Confirmation/guidance about appropriate actions to deliver on the Roadmap Actions will be provided once the consultation on the Strategy is complete.
There are some existing annual planning priorities that may impact 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 will be expected to provide a table in this Module showing where the detailed actions can be found elsewhere in their Plan.
2.2.1People 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.
2.2.2Care Closer to Home
- Providing health services closer to home.
- More integrated health services, including better connected with wider public services.
- An investment early in life.
- A focus on the management of chronic and long-term conditions.
2.2.3High 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.
2.2.4One 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.
2.2.5Smart System
- The increased use of analytics and systems to improve management reporting 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.
2B: REGIONAL 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 section 4: Networks.
- Elective Services
- Cardiac Services
- Mental Health and Addictions
- Stroke Services
- Health of Older People
- Major Trauma
- Hepatitis C
Enablers
- Information Technology
- Workforce.
2.3Enablers
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.
2.3.1Health IT Programme
Health IT plays an increasingly significant role in today’s environment by enabling the delivery of quality, timely and cost-effective health care. Strong governance and decision making are essential to 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 a new level of digital capability in hospitals.
The Health IT Programme 2015-2020 will set the direction of IT investment in regional EMRs and a national longitudinal electronic health record (EHR) over the next five years. The programme will include investment in a national preventative health IT platform to support screening and immunisation. The programme will also establish the data resources to support health and social sector investment.
The 2016/17 critical priorities continue regional and national programmes of the previous year. Regional clinical workstation, clinical data repository and patient administration systems provide the foundations to support the integrated EMR environment that regions must build towards. EMRs will conform to a nationally agreed blueprint for digital hospitals, ensuring that each hospital will eventually be operating under the same model and implementing conformant software from their chosen vendor.
EMR models are widely understood with the HIMSS Analytics EMR Adoption Model (EMRAM). EMR adoption will be benchmarked in June 2016 to show how each region is progressing.
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):
- name of the initiative and budget allocation by DHB (WOLC)
- the key deliverable that will be achieved in the 2016/17 year
- benefits, dependencies and milestones (where available)
- strategies the region has put in place to address the following IT delivery challenges:
- regional governance, leadership and decision making, with clear escalation pathways
- regional funding and approval model(s)
- regional capacity and capability
- roadmap for development of an EMR environment.
2.3.2Regional workforce
To enable a consistent approach to workforce planning, the national DHB General Managers Human Resources (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
Additionally, in order to enable a consistent approach to leadership, the 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).
Health Workforce New Zealand’s vision is for a ‘health care workforce that is sustainable, flexible and fit for purpose’. Health Workforce New Zealand will continue to work with DHBs through the Regional Workforce Development Directors to:
- facilitate regionally based solutions to address national workforce priorities, enabling:
- implementation of community based attachments for prevocational trainees
- increasing participation of Māori and Pacific in the health workforce
- implementation of the Children’s Action Plan
- recruitment of new palliative care specialist nurses and educators
- support for the role of nurse practitioners, clinical nurse specialists and nurses performing endoscopies
- support for the training of sonographers and medical physicists
- identify and progress a regionally co-ordinated approach to 'new models of care', planning and development
- demonstrate leadership and commitment that supports the development of the region’s health workforce
- strengthen local and regional health workforce intelligence
- build on the 2015/16 RSPs, demonstrating further progress on actions to meet milestones.
2.3.3Capital
Regional 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 2015/16, the Treasury Investment and Asset Performance (IMAP) system comes into effect. All DHBs will be required to provide Long Term Investment Plans to the NHB. 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.
2.4Sub-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 2: Delivering on Priorities and Targets).
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.
3.1Regional 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 cooperate and assist their colleagues in finding and implementing solutions to financial or clinical issues that arise. An indication of how the region will cooperate and resolve issues arrange this 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, 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).
MODULE 4:NETWORKS
4.1Regional 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 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: