Primary Health Alliance HCHA presentation Members meeting, March 2018

HCSS Client groups Frail older people Injured older people HCSS Client groups Frail older people People living with disabilities People living with chronic conditions People living with short term injury People living with long term injury People dyng People with mental health and addiction needs

Brief facts Over 100,000 clients, growing (aging, injury, disability) 55 NGOs and private providers including 16 iwi providers 22,000 kaiāwhina, 93% women, 82% Pakeha. 57% over 55, Total govt expenditure HCSS $669m (rising to $750m with pay equity) Use of service can reduce expenditure on residential and hospital care and result in better general health status. Multiple funders (20 DHBs, ACC, DSS), inconsistency of funding and service allocation. Very low funding per service unit, no costing framework.

www.interRAI.co.nz Older clients 41% older than 85 years, 65% women, 7% Maori, 4% Pacific 58% living with chronic conditions Almost half are living alone, a third living just with spouse 25% live with diagnosed moderate or severe cognitive impairment 56% at risk of hospital or residential care admission 22% feel lonely 22% of informal carers report severe stress due to caring www.interRAI.co.nz

Service commissioning responses Health and Disability Strategies Self directed care, consumer choice Use of Data to drive outcome measures Casemix, targeting, bulk-funding Reduction of provider numbers Falls prevention Post acute support Workforce funding and expectations Integration/closer liaison between (pay equity, guaranteed hours, travel) services: nursing, physio, GP Whanāu ora Rehabilitative, restorative support Medication

Community Health Vision Scope of practice, Team approach better trained personnel career pathways Provider capacity Costing models Health records interRAI, assessments Outcome measures Research, monitoring Assistive technology Improved accountability Inter provider networks Client group liaison Shared health goals National and cross regional health goals all health providers Systemic issues addressed Casemix, Restorative, rehabilitative, client goals Self-directed options Equity in supports Carer support Clients more in control of health outcomes, have better outcomes, Providers work closely and with clients to use health $ better Improved capacity to meet complexity and increasing demand Data and technology used more effectively to improve decisions, quality & efficiency

LiLACS NZ, interRAI, NZ Health Survey Health conditions of older home support clients Coronary heart disease (32%), diabetes (32%) and stroke/CVA (18%). 25% of home care clients report 1-2 diseases and 15% report 3-4 diseases. Incontinence reported by 34.3% of men and 42.6% of women. 43% have untreated tooth decay to three teeth 35% over 75 experience chronic pain. 50% live with arthritis General improvement in function, living longer, living independently for longer, requiring support for longer 44% aged 85-94 have fallen at least once in last three months LiLACS NZ, interRAI, NZ Health Survey

www.hcha.org.nz