Operational Policy Framework
2016/17
December 2015 (updated March 2017)
This Operational Policy Framework (OPF) is incorporated as part of the Crown Funding Agreement under section 10 of the New Zealand Public Health and Disability Act 2000.
The OPF is released subject to endorsement by the Minister of Health in accordance with Crown Funding Agreement requirements.
The OPF is also subject to ongoing updates.
Published in December 2015
by the Ministry of Health
PO Box 5013, Wellington 6145, New Zealand
This document is available at www.nsfl.health.govt.nz
Contents
1 Purpose and overview of the Operational Policy Framework 1
1.1 Scope of this document 1
1.2 Structure of the OPF 2
2 DHB governance 3
2.1 Purpose of the chapter 3
2.2 Legislative compliance 3
2.3 New Zealand health and disability strategies 3
2.4 Conflicts of interest 4
2.5 Board self-assessment 6
2.6 Political neutrality 7
3 Planning and accountability 8
3.1 Purpose of the chapter 8
3.2 Crown Funding Agreement 9
3.3 DHB accountability and planning documents 9
3.4 The Annual Report 9
3.5 Key financial information 10
3.6 National services planning and implementation 11
3.7 Emergency planning and management 11
3.8 The DHB Health Emergency Plan 13
3.9 Reducing health disparities and achieving health equity 15
3.10 Improving the health of Māori 16
3.11 Improving the health of other population groups including Pacific peoples and ethnic peoples 16
3.12 Acceptability of services 16
3.13 Prioritising health needs and services 17
3.14 Implementation of evidence-based guidelines 17
3.15 Research ethics and governance 17
3.16 Service information for consumers 18
3.17 The Pharmaceutical Schedule 18
3.18 Selection of service providers 19
3.19 Provider selection protocols 20
3.20 The Nationwide Service Framework 22
3.21 Contracting for services 25
4 Service change 28
4.1 Purpose of the chapter 28
4.2 Key service change processes 29
4.3 Why good management of service change and consultation matters 29
4.4 DHB service change protocols and requirements 29
4.5 Service change process 30
4.6 Significant service change and consultation 32
4.7 Funding implications of significant service change 32
4.8 The facilitation role of the Regional Relationship Manager 32
4.9 DHBs as providers of last resort 34
4.10 National Health Committee (NHC) 34
5 Service planning and policy 36
5.1 Purpose of the chapter 36
5.2 Primary health care 36
5.3 Cervical screening 38
5.4 Tobacco control 39
5.5 Health of older people 40
5.6 Family care policy 40
5.7 Disability and long-term support services 40
5.8 Long-term support – chronic health conditions 42
5.9 Vulnerable Children – Children’s Action Plan 42
5.10 Management of elective services 42
6 Improving Māori health 46
6.1 Purpose of the chapter 46
6.2 Māori health planning 46
6.3 Working with Māori 47
6.4 Engagement with and participation of Māori 48
6.5 Other means of providing for the needs of Māori 48
7 Inter-district flows 50
7.1 Purpose of the chapter 50
7.2 Principles guiding the IDF rules 50
7.3 Residence criteria for the purposes of the IDF rules 51
7.4 General IDF referral and management principles 52
7.5 Referral and management of IDFs for inpatient elective services 52
7.6 Referral and management of IDFs for acute/ arranged services 53
7.7 Referral and management of national services 53
7.8 Referral and management of IDFs for aged residential care services 54
7.9 Referral and management of IDFs for other services 54
7.10 Setting and management of IDF volumes 54
7.11 Special arrangements for residential mental health services 54
7.12 Travel, accommodation and inter-hospital transfers 55
7.13 Management of exceptional situations 55
7.14 Payments and ‘wash-ups’ 55
7.15 IDF supplementary payments 56
7.16 Privacy of patient information 57
7.17 Explanation of terms used in this chapter 57
8 Dispute resolution 59
8.1 Purpose of the chapter 59
8.2 Legislative provisions for resolving planning disputes 59
8.3 The national dispute resolution process 60
8.4 Mediation stages and deadlines 60
8.5 Arbitration stages and deadlines 60
8.6 Submitting notification of a dispute 60
8.7 Information requirements 61
8.8 Expectations of DHBs and other publicly owned health and disability organisations engaged in disputes 61
9 Quality 62
9.1 Purpose of the chapter 62
9.2 Provider quality specifications 62
9.3 Quality improvement 63
9.4 Improving the quality of services 63
9.5 Provider quality plans 64
9.6 Consumer rights 64
9.7 Capturing consumer experience 65
9.8 Infection control 65
9.9 Clinical effectiveness 65
9.10 Mortality review 66
9.11 Complaints procedures 66
9.12 Effectiveness of services 66
9.13 Service delivery 66
9.14 Prevention of abuse and neglect 68
9.15 Facilities 69
9.16 Death 69
10 Workforce 70
10.1 Purpose of the chapter 70
10.2 DHBs as good employers 71
10.3 Registration and continuing education of DHB employees 71
10.4 Health Workforce New Zealand 72
10.5 Planning requirements 72
10.6 Vulnerable Children Act – safe and competent workforce 72
10.7 Employment relations and management of bargaining 73
10.8 Pay and employment equity 74
10.9 Protected disclosures 74
11 Information technology 75
11.1 Purpose of the chapter 75
11.2 eHealth systems development strategy 75
11.3 IT change processes in the National Collections 76
11.4 IT change processes in the National Systems 77
12 Financial and capital operations 78
12.1 Purpose of the chapter 78
12.2 Legislative compliance 79
12.3 Statements of Intent 80
12.4 Statement of Performance Expectations and forecast financial statements 80
12.5 Financial statements 80
12.6 Accounting policies 81
12.7 Good financial management 81
12.8 Internal financial controls 81
12.9 Information available on procurement policies and practices 81
12.10 Bank accounts 82
12.11 Financial risk management 83
12.12 Derivative transactions 84
12.13 Insurance 85
12.14 Working capital management 85
12.15 Deficit support 86
12.16 Non-working capital financing 87
12.17 Finance leases 87
12.18 Withholding of money from DHBs 88
12.19 Retention of surpluses by DHBs 89
12.20 Capital charges 89
12.21 Mental health 90
12.22 Guarantees and indemnities 92
12.23 Cooperative agreements and arrangements 93
12.24 Acquisition of securities, shares and other interests 93
12.25 DHB subsidiaries 94
12.26 Full-time equivalent definition 95
12.27 Asset valuation 95
12.28 Asset management planning 95
12.29 Investment Management and Asset Performance 95
12.30 Business cases 96
12.31 Dealings with land 97
12.32 Contribution to financial cost associated with membership of the Australasian Health Infrastructure Alliance 97
13 Monitoring and reporting 98
13.1 Purpose of the chapter 98
13.2 DHB annual reporting process 99
13.3 DHB quarterly reports (non-financial) 99
13.4 DHB risk management 99
13.5 DHB monthly financial reports 100
13.6 Monitoring and intervention framework 100
13.7 Information for the Minister 102
13.8 Ministry–DHB relationship protocol 103
13.9 The provision of quality information 105
13.10 Quality, standards and completeness 105
13.11 National Health Index 105
13.12 Audit of data collection and reporting 106
13.13 Privacy and security 106
13.14 Ethnicity reporting 106
13.15 National Collections 107
13.16 Health Practitioner Index 109
13.17 Medical Warning System 109
13.18 National Minimum Data Set (NMDS) 109
13.19 National Booking Reporting System 110
13.20 National Patient Flow 110
13.21 Programme for the Integration of Mental Health Data 110
13.22 National Immunisation Register 111
13.23 B4 School Check Information System 111
13.24 National Non-admitted Patient Collection 112
13.25 Accident Compensation Corporation 112
13.26 Ministry reports to DHBs 112
Appendix 1: Abbreviations and definitions 113
Appendix 2: Amendments to the 2015/16 Operational Policy Framework for 2016/17 116
References 122
List of Tables
Table 4.1: Overview of the service change process 39
Table 4.2: Decision tool for triggering service change protocols 40
Table 4.3: Information guideline for early discussion of a proposed service change 42
Table 13.1: The Ministry and ministerial levels of the MIF 122
Table 13.2: Ministry MIF levels 123
Table 13.3: Minister of Health MIF levels 123
Table 13.4: The Ministry–DHB relationship protocol 125
List of Figures
Figure 4.1: Process flow chart for DHB service change proposals 41
Operational Policy Framework 2016/17 89
1 Purpose and overview of the Operational Policy Framework
The Operational Policy Framework (OPF) is a set of business rules, policy and guideline principles that outline the operating functions of district health boards (DHBs). Clause A.3.2 of the Crown Funding Agreement (CFA) is signed by the Minister of Health (the Minister) and each DHB confers DHB agreement to the OPF. All parties must adhere to the requirements set out in the OPF.
A summary of the relevant mandatory statutes, policies and rules is provided at the beginning of each section.
1.1 Scope of this document
1.1.1 DHBs are required to adhere to:
· legislation
· ministerial directions
· Government policy (Cabinet decisions and published policy statements), in which case the Minister or Director-General of Health (Director-General) is exercising a statutory power
· the Crown Funding Agreement (CFA)
· rules set out by the Cabinet Social Policy and Health Committee (SPH) (00) 160 (2 November 2000) report
· the updated New Zealand Health Strategy
· the New Zealand Disability Strategy (Minister for Disability Issues 2001)
· He Korowai Oranga: Māori Health Strategy (Minister of Health and Associate Minister of Health 2002).
1.1.2 A DHB or the Ministry of Health (the Ministry) may request a DHB-specific variation to a part or parts of the OPF. The National Health Board (NHB)[1] will consider such a request as part of the relevant Annual Plan and CFA variation processes. Any variation or exemption will be recorded in the DHB’s CFA.
1.1.3 The issue and dispute management provisions set out in the CFA with each DHB apply to this document. The provisions set out the formal pathway for dealing with issues arising in relation to this document.
1.1.4 Although every care has been taken to identify the main statutory requirements of DHBs in this document, the OPF does not cover DHB statutory obligations exhaustively. DHBs should be aware that all relevant statutory obligations apply regardless of whether this document refers to them. Each DHB should obtain legal advice regarding any statutory compliance to which it is subject.
1.1.5 In addition to the OPF, each DHB is further obliged by its CFA to comply with the Service Coverage Schedule (SCS). The SCS sets out, on a national basis, the minimum services in terms of range, level of access and standards that DHBs must ensure are provided to their populations.
1.2 Structure of the OPF
1.2.1 Each chapter contains:
· the purpose of the chapter
· a summary of mandatory requirements
· relevant legislation, guidelines and policy principles
· context
· any other relevant information.
1.2.2 This document makes no distinction between ongoing, longer-term requirements and short-term, or transitory, requirements. Timeframes relating to particular requirements are clearly indicated in the text.
1.2.3 Some terms have been defined only where a specific or expanded meaning applies to the term in the context of a particular description, chapter or appendix. Some chapters include a glossary of terms specific to their content. For more commonly used terms and abbreviations relevant to the overall document, see Appendix 1.
1.2.4 Appendix 2 summarises amendments to the previous year’s OPF.
2 DHB governance
2.1 Purpose of the chapter
This chapter sets out various general organisational requirements of DHBs relating to legislative compliance, conflicts of interest, the process of self-evaluation by Board members, and political neutrality.
Summary of mandatory requirements
Each DHB must:
· meet legislative requirements (Section 2.2)
· apply an open approach to disclosing interests and an active approach to managing conflicts of interest as they arise as set out in the New Zealand Public Health and Disability Act 2000 (NZPHD Act) and CAB (00) M32/2A (2) (Section 2.3)
· conduct Board member self-evaluation as part of Board business (Section 2.4)
· maintain neutrality and be able to serve successive governments that may be drawn from different political parties (Section 2.5).
2.2 Legislative compliance
2.2.1 In carrying out its objectives and functions, each DHB should act in a lawful manner and in compliance with all relevant legislation (ie, Acts, regulations and legislative instruments). DHBs should seek legal advice regarding their statutory obligations and how to comply with them. DHBs are established under the NZPHD Act. As Crown entities, they also fall within the scope of the Crown Entities Act 2004 (CE Act).
DHBs also should be aware of other legislation and any legislative amendments that may impact their operations.
2.3 New Zealand health and disability strategies
(See s 8(1) s 8(2) and s 38(2)(d) of the NZPHD Act.)
2.3.1 The New Zealand Health Strategy sets the platform for the Government’s action on health. It identifies the Government’s priority areas and aims to ensure that health services are directed at those areas that will ensure the highest benefits for our population, focusing in particular on tackling inequalities of health.
2.3.2 The New Zealand Disability Strategy provides a framework to guide the direction of planning to improve disability support services and change New Zealand from a disabling to an inclusive society.
Incorporation of strategies into DHB plans
2.3.3 Every DHB plan must reflect the overall direction set out in, and must not be inconsistent with, the New Zealand Health Strategy and the New Zealand Disability Strategy.
New Zealand Disability Strategy
2.3.4 DHBs should illustrate that they have:
a. a plan for advancing the objectives of the New Zealand Disability Strategy that addresses the health needs of people with disabilities[2] of all ages, including the disability support needs of the groups for whom DHBs have funding and planning responsibilities.[3] This plan will require DHBs to incorporate the needs of people with disabilities in their population health needs assessment so that comprehensive information on the health and support needs of people with disabilities in their districts is available
b. an accessibility plan that addresses physical and non-physical access for people with disabilities; for example, all facilities should be accessible and all information should be available in appropriate, accessible formats. Staff should also have an understanding of different disabilities and can tailor their communication and interactions appropriately. This plan should include an outline of how DHBs are responding to the New Zealand Sign Language Act 2006; for example, by having a written New Zealand Sign Language policy that considers other forms of communication with Deaf people to remove barriers to accessing information and services.