2017/18 Regional Planning Workshop Thursday 24 November 2016

Agenda Overview Time Item Presenter 9.30 ­– 9.35 Arrival and Welcome Grant Pollard 9.35 – 9.50 Regional Service Planning in the Future 9.50 – 10.15 Equity in Regional Service Planning Hingatu Thompson 10.15 -10.35 Health Workforce Margareth Attwood 10.35 – 10.50 Opportunity for attendees to discuss amongst themselves and ask questions 10.50 – 11.10 Morning Tea 11.10 – 11.25 Information Technology/Digital Health Eileen Duddy 11.25 – 11.40 Healthy Ageing Karina Kwai 11.40 – 11.55 Hepatitis C Karen Evison 11.55 – 12.15 12.15 – 12.20 Final Comments 12.20 – 1.00 Lunch

Regional Service Planning in the Future Grant Pollard, Group Manager, Operational Excellence

Hingatu Thompson, Manager, Māori Health Service Improvement Equity 2017-18 Hingatu Thompson, Manager, Māori Health Service Improvement

Māori and non-Maori are not receiving equivalent benefit from our health services. There has been a growing realisation in the health sector over recent years that Maori and non-Maori people are not receiving equivalent benefit from our health services. While some changes have been made, our services remain essentially monocultural and often fail to respond to the needs of Maori people. Some of the trends shown in this report are a matter of grave concern. Asthma deaths have increased significantly and deaths from stroke and heart disease among adult Maori remain 3-4 times as frequent as those for non-Maori people. Risk factors for these conditions, including obesity and smoking, remain much higher for some Maori groups.

Māori and Pacific peoples still have lower life expectancy Māori and Pacific peoples still have lower life expectancy. Source: Complete New Zealand Period Life Tables – time series summaries: Life expectancy by age and sex, 1950–52 to 2012–14 from Statistics New Zealand.

Equity and He Korowai Oranga, 2014

Health Workforce RSP Planning Priorities Margareth Attwood, Manager, Policy Advice and Regulation

The workforce guidance maps back to our strategic themes and priorities Strategic priorities Workforce enabler Cross-cutting workforce enabler Improve health outcomes for population groups with a focus on: Māori, older people and children Work 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 work force working In health of older people outside the DHB provider arm by 30 June. Identify the workforces working with clients requiring palliative care services and their family/ whanau/ 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 planning Work regionally and in collaboration with DHB shared services and the Ministry of Health, continue to: Identify workforce and data 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 workforce planning Workforce diversity Work regionally to: Build cultural competent across the workforce Increase participation of Maori 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 Maori health workforce that matches the proportion of the Maori 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. People Powered Closer to Home Improve access to, and the efficacy of health services for New Zealanders with a focus on: Disability support services Mental health and addictions Primary Care Bowel cancer Work regionally to: Implement the actions set out in the Mental Health and Addiction Workforce Plan 2016-2020 One Team Improving outcomes for New Zealanders with long-term conditions with a focus on: Obesity Diabetes Supported by the cross-cutting enablers such as IT, Workforce and Capital Value and High Performance Improving our understanding of system performance: DHB cost pressures DHB capital Electronic Health Record Technology and models of care prioritisation Supported by the cross-cutting enablers such as IT, Workforce and Capital Standing up our investment approach Implementation of a health investment work programme starting with our priorities Investigate need, benefit, costs/savings and suitability of workforce investments. Smart System Delivering Ministry on the Move N/A

Data and intelligence to inform planning Themes: Closer to home, One team, Smart system Work 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.

Diversity 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: 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.

Health of Older People and Palliative Care Themes: One Team, Closer to home Health of Older People Strategy Work 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 Care 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 Themes: One Team Work regionally to implement the actions set out in the Mental Health and Addiction Workforce Action Plan 2016-2020. Measures (across the proposed workforce planning priorities) 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.

Information Technology/Digital Health Eileen Duddy, Senior Advisor, Investment and Planning, Technology and Digital Services

Digital Health 2020 Overview Digital Health 2020 has been developed in response to the New Zealand Health Strategy, to progress the core digital technology opportunities presented in the strategy. It delivers on the focus areas that together will drive towards a uniform information platform and a consistent data approach across the sector. a single longitudinal view of health information accessible to consumers, carers and decision-makers Architecture and Standards Information Governance Common ICT Capabilities Single Electronic Health Record Access to health data to support government, health organisations and individuals to make evidence based decisions aligned to the Government’s social investment approach Health and Wellness Dataset Preventative Health IT Capability Information and enabling ICT capability to support improving the targeting of screening, immunisation and other public health initiatives Digital Hospital lift the digital capability within hospitals and the integration with the wider sector Regional IT Foundations eHealth foundations supporting regional access to health information, delivery of the Single EHR and lifting digital capability within hospitals Architecture and standards aligning delivery of the Digital Health 2020 projects towards a future state vision Health Information Governance Framework supporting data sharing, privacy, security, information management Core ICT infrastructure and ICT enablers common to Digital Health 2020 focus areas MOH led projects 17/09/2018 DHB led projects MOH led

Digital Health 2020 Approach Summary Single Electronic Health Record (EHR) Project led by MOH to deliver NZ wide capability – strategic assessment completed. Health and Wellness Dataset Information governance, data sharing principles and processes, and data standards aligned to the government’s social investment approach. Applied to all new solutions (eg. Single EHR) and existing systems aligned over time, delivered through multiple aligned projects led by MOH. Preventative Health IT Capability Business, data and technology architecture to support health screening solutions. Delivered incrementally through multiple aligned projects (eg. BCSP, CCSP) led by MOH. Digital Hospital Use EMRAM assessment to target gaps in hospital digital maturity. Lift digital maturity, with regionally agreed solutions aligned to national standards. DHB/region led delivery. Regional IT foundations Regional governance and supporting capabilities to align core DHB systems to deliver regional access to clinical information and support the Single EHR and Digital Hospital delivery. Delivered through multiple regional or DHB-led projects.

Health ICT Investment Portfolio ICT 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. 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 prioritised four year plan of all local, regional and national IT initiatives with the following level of information provided for each initiative.

Draft 17/18 Planning Guidance – 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. DHBs to accelerate maturity through regional and sub- regional activities where possible. Recommended DHB-specific investments.

Draft 17/18 Planning Guidance – Digital Health 2020 Investment focus Approach Description of 17/18 activity DHBs involved Measures 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. 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. Bowel screening rollout. Cervical screening project to support HPV testing. Bowel screening rollout Refer to DHB Annual Planning guidance

Draft 17/18 Planning Guidance – Digital Health 2020 Investment focus Approach Description of 17/18 activity DHBs involved Measures Regional IT Foundations DHBs accountable for delivery. Regional governance, leadership and decision making. DHBs must demonstrate how they are regionally aligned and where they are leveraging digital hospital investments. All DHBs 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

Draft 17/18 Planning Guidance – 0ther Priorities Investment focus Approach Description of 17/18 activity DHBs involved in 2017/18 Measures Maternity Nationally led programme with local DHB Implementation tbc All DHBs  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 4.1 Regional Cancer Networks National Immunisation Register (NIR) replacement Nationally led programme to replacement the current NIR register All DHBs

Draft 17/18 Planning Guidance – Digital Hospital DHB 2017/18 Activity (Planning Priority) Value and high performance   Smart System Other Activity A Regional alignment DHBs to demonstrate how they are regionally aligned and where they are leveraging digital hospital investments. Digital Hospital Leverage implementation of Order Entry & Nursing Documentation via healthAlliance. Starting work on eOrders for Radiology and ePA rollout. B Continue the rollout EMRAM Stage 3 & 4 capabilities throughout the hospital Continue the work with Ministry of Health and HIMSS Analytics on Stage six, closed looped medication. C Replacement of the legacy PAS

Karina Kwai, Manager, Health of Older People Healthy Ageing Karina Kwai, Manager, Health of Older People

Health of Older People Community support for older people Rapid response and discharge management services (wrap around services) Comprehensive Clinical Assessment in residential care (interRAI) Dementia care pathways (activity at both DHB and regional levels) Develop and implement dementia care pathways (DHBs) Provide support and overview of the development and implementation of DHB dementia care pathways regionally (regions) Develop regional components of the dementia care pathways and share learnings and resources across the region (regions) Improve awareness and responsiveness in primary health care, working with the dementia sector and primary health care organisations (regions) Health of Older People specialists  Fracture liaison service

Karen Evison, Manager, CVD Diabetes Long Term Conditions Hepatitis C Karen Evison, Manager, CVD Diabetes Long Term Conditions

Major advances in treatment & delivery of hep C Over the past year there have been major advances in the treatment and delivery of hepatitis C services in New Zealand. Implementation began on a revised approach to service delivery moving to regionally led services with resources directed towards detection, management and treatment of hepatitis C in at risk populations. New funded direct acting antiviral medications became available from July 2016 and increased the urgency of implementation of the reconfigured hepatitis C services. In 2015/16, DHB regions were funded to set up cross-sector working groups to plan and develop clinical care pathways, identify clinical and diagnostic capacity and capability requirements and develop an implementation plan for integrated service delivery across primary and secondary care.

DHB regions providing integrated services Regional realignment and enhancement of hepatitis C care has been co-designed with the sector with strong clinical input at both secondary, primary level and across disciplines such as Needle Exchange Services. Following the planning and establishment phase, DHB regions have now been funded from 2016-2018 to implement the integrated hepatitis C assessment and treatment services. Specifically, the funding is being used to provide integrated, accessible, and sustainable identification assessment and treatment services. These services aim to increase diagnosis rates, provide better individualised care, improve patient-related outcomes, and reduce liver-related and extra hepatic morbidity and mortality.

Funding of new hepatitis C treatments In July 2016, PHARMAC announced funding of direct acting antiviral therapy for hepatitis C. Access to these direct acting antivirals provides for the first time a treatment that offers a 95% cure for approximately 57% of the hepatitis C population (i.e. only those with genotype 1). From 1 October 2016, fully funded antiviral treatment was made accessible to all relevant prescribers, including general practitioners. This allows the majority of patients with hepatitis C to be managed in the community, which over time would reduce the need for secondary healthcare and reduce the number of people with hepatitis C who would develop cirrhosis and liver cancer.

Supporting people with hepatitis C The Ministry supports treating people with hepatitis C as part of core business for general practitioners and primary care providers. With the new treatments and the reconfigured service delivery approaches underway over the past year, the sector has a real opportunity to treat and cure more people with hepatitis C and in future work towards eradication of this disease. It is important for all DHBs to support implementation of the hepatitis C clinical pathway and primary care prescribing where appropriate.

Regional service planning focus The regional service planning focus for 2017/18 is to continue to implement a single clinical pathway for hepatitis C assessment and treatment across the sector. The Hepatitis C Implementation Advisory Group has developed a series of regional and national hepatitis C measures to monitor service progress. Quarter two 2016/17 will be the first time DHBs provide data for these new measures. The following tables outline the data requested from DHB regions and the national data the Ministry will provide in 2016/17 and 2017/18.

Regional Service Planning Measures – Hepatitis C DHB regions report six monthly at the end of Q2 and the end of Q4 on the following regional measures: Measures Data collection process Number of people diagnosed with hepatitis C per annum by genotype. DHB regions to obtain data (by age bands) from 5 reference labs on the total number of people with a positive hepatitis C virus PCR test and report to the Ministry of Health via six monthly Regional Service Plan reports.   Number of hepatitis C virus patients who have had a Liver Elastography Scan in the last year (a) new patients (b) follow up. DHB regions to establish a data collection process to obtain regular data (by age and ethnicity) from the delivery of Liver Elastography Scans in primary and secondary care and report to the Ministry of Health via six monthly Regional Service Plan reports. Note all Liver Elastography Scans are to be counted irrespective of the device used.

Regional Service Planning Measures – Hepatitis C Data will be collected on the four national measures below and provided to DHB regions in Q2 and Q4: Measures Data collection process 3. Number of people receiving PHARMAC funded antiviral treatment per annum by medication type. Ministry of Health to obtain data (by age, ethnicity and medication type) from PHARMAC and provide this to DHB regions via annual reporting in the Regional Service Plans. 4. Incidence of hepatitis C virus related hepatocellular carcinoma (HCC).   Number of liver transplants for people with hepatitis C performed each year. 6. Percentage of patients with hepatitis C virus caused HCC who have new hepatitis C diagnosis at time of HCC cancer diagnosis. Ministry of Health to obtain data (by age and ethnicity) from the Liver Transplant Unit HCC national data collection and provide this to regional DHB regions via annual reporting in the Regional Service Plans.

Grant Pollard, Group Manager, Operational Excellence Final Comments Grant Pollard, Group Manager, Operational Excellence