2015/16

Annual PlanGuidelines

WITH STATEMENT OF INTENT AND STATEMENT OF PERFORMANCE EXPECTATIONS

Amendments to the Annual Plan Guidelines

Page / Description
7 /
  • Strategic Intentions – System Integration
-A list has been included of those sections of the plan that are expected to be developed and agreed with ALTs.

February 2015

Table of Contents

Introduction to the Guidelines

District Health Board Annual Plans

Annual Plan Structure

Overview of the Modules

MODULE 1:INTRODUCTION and STRATEGIC INTENTIONS

1.1Foreword, Executive Summary and Signatory Page

1.2Context

1.3Strategic Intentions

MODULE 2:DELIVERING ON PRIORITIES AND TARGETS

2.1Priorities and Targets

MODULE 3:STATEMENT OF PERFORMANCE EXPECTATIONS

3.1Statement of Performance Expectations (SPE)

MODULE 4:FINANCIAL PERFORMANCE

4.1Financial Performance

MODULE 5:STEWARDSHIP

5.1Managing our Business

5.2Building Capability

5.3Workforce

5.4Organisational Health

MODULE 6:SERVICE CONFIGURATION

6.1Service Coverage

6.2Service Change

MODULE 7:PERFORMANCE MEASURES

7.1Monitoring Framework Performance Measures

MODULE 8:APPENDICES

8.1Glossary of Terms

8.2Annual Plan Review: Financial Statements 2015/16 (and supporting templates)

8.3Output Class Recommendations

8.4Crown Entities’ Accountability Requirements

8.5Line of Sight Guidance Framework

Introduction to the Guidelines

District Health Board Annual Plans

Each DHB has a statutory responsibility to prepare:

•an Annual Plan for approval by the Minister of Health (Section 38 of the New Zealand Public Health and Disability Act 2000[1])– providing accountability to the Minister of Health

•a Statement of Performance Expectations (Section 149C of the Crown Entities Act 2004 as amended by the Crown Entities Amendment Act 2013[2]) – providing financial accountability to Parliament and the public annually

•a Statement of Intent (Section 139 of the CE Act) – providing accountability to Parliament and the public at least triennially.

In 2010 Cabinet determined that the above documents could be brought together into a single DHB Annual Plan with Statement of Intent (SOI)and Statement of Performance Expectations (SPE), to be known as the ‘Annual Plan’ (AP). The SOI needs to be prepared and tabled in Parliament every three years. However, the Minister of Health has requested that DHBs prepare new SOIs in 2015/16 (section 139A(1) of the CE Act).

Annual Plan Structure

As in previous years, a modular approach has been adapted to the DHB APsto achieve a single document that meets the requirements of both Acts, as well as Cabinet requirements and the needs of key stakeholders. The modules allow various sections of the document to be highlighted for different purposes and audiences. The modular structure also makes it possible to extract modules as appropriate for tabling in Parliament. For the 2015/16 APs, the SOIs and SPEs need to be tabled. The modules that can be extracted for tabling the SOI are modules 1 and 5, and for tabling the SPE are modules 3 and 4. The process and timeframe for tabling the SOI and SPE is outlined in the CE Act.

There is no major departure from the structure of previous guidance and the order and shape of the modules is the same as last year. The structure used last year for the APs has been retained in order to allow the themes of the DHBs overall performance story through the whole document – helping cascade the conversation on each theme to a greater level of detail with each module – from high-level strategic outcomes down to service delivery and financial detail. So while a theme may be reiterated, it is expected the information will differ as the reader progresses further through the document to learn more about the topic with increasing detail.

As with last year, the production of individual DHB Workforce Strategies will not be a requirement for 2015/16, as DHBs will instead be required to develop their Workforce Strategies further in their 2015/16 Regional Service Plans (RSPs).

For further information regarding these guidelines please contact:

Stasha Mason

National Health Board

Ministry of Health

Wellington 6145

(04) 496 2265.

Overview of the Modules

MODULE 1: INTRODUCTION and STRATEGIC INTENTIONS (for tabling in SOI extract)
1.1 Foreword, Executive Summary and Signatory Page
1.2 Context
  • Background information and operating environment
  • Nature and scope of functions / intended operations
1.3 Strategic Intentions
  • DHB vision
  • Strategic outcomes in national, regional and local context

MODULE 2: DELIVERING ON PRIORITIES AND TARGETS
2.1 Priorities and Targets
  • Implementing Government priorities
  • Regional, sub-regional and local actions sponsored/led by the DHB to deliver on RSPs
  • DHB local priorities

MODULE 3: STATEMENT OF PERFORMANCE EXPECTATIONS (for tablingin SPE extract)
3.1 Statement of Performance Expectations (SPE)
  • Output classes:
  • Prevention
  • Early Detection and Management
  • Intensive Assessment and Treatment
  • Rehabilitation and Support

MODULE 4: FINANCIAL PERFORMANCE (for tabling in SPE extract)
4.1 Financial Performance
  • Forecast financial statements

MODULE 5: STEWARDSHIP(for tabling in SOI extract)
5.1 Managing our Business
5.2 Building Capability
5.3 Workforce
  • Managing our workforce within fiscal restraints
  • Strengthening our workforce
  • Safe and competent workforce
5.4 Organisational Health
MODULE 6: SERVICE CONFIGURATION
6.1 Service Coverage
  • Service Issues
6.2 Service Change
MODULE 7: PERFORMANCE MEASURES
7.1 Monitoring Framework Performance Measures
  • Dimensions of DHB Performance Measures (non-financial)
  • 2015/16 Performance Measures

MODULE 8: APPENDICES
(NOT to be included in final plans – for reference in developing documents only)
8.1 Glossary of Terms
(OPTIONALinclusion in final plans for DHBs)
8.2 Annual Plan Review: Financial Statements 2015/16 (and supporting templates)
8.3 Output Class Recommendations
(NOT included in final plans – reference only)
8.4 Crown Entities Accountability Requirements
(NOT included in final plans – reference only)
  • Crown Entities Act 2004 as amended by the Crown Entities Amendment Act 2013
  • New Zealand Public Health and Disability Amendment Act 2010
  • New Zealand Public Health and Disability (Planning) Regulations 2011
8.5 Line of Sight Guidance Framework
(NOT included in final plans – reference only)

MODULE 1:INTRODUCTION and STRATEGIC INTENTIONS

(for tabling in SOI extract)

DHBs are strongly encouraged by the Minister of Health and the Ministry of Health to keep this section brief and to minimise use of diagrams, pictures and/or white space where possible. DHBs may wish to reference more detailed information contained on their websites if appropriate, rather than replicate it here.

1.1Foreword, Executive Summary and Signatory Page

1.2Context

1.2.1Background information and operating environment

Briefly comment on the background of your DHB, and consider including:

  • overarching system context that influences the DHB eg,RSP objectives, the Ministry of Health’s Statement of Intent, and the Treaty of Waitangi(note: if you are referring to the Ministry of Health’s Statement of Intent or outcomes framework, please ensure that you are referring to/usingthe most up-to-date version. The outcomes framework can be found on page 20 of the 2014-2018 Statement of Intent – associated definitions can be found on pages 23-30)
  • health profile of the district linked to the key issues identified in the DHB’s Health Needs Assessment, this should also include a focus on key drivers of morbidity, in particular obesity
  • Government focus on Better Sooner More Convenient (BSMC) services for all New Zealanders.

The DHB, to explain its operating environment, is encouraged to provide a very brief description of the structure and funding of wider health structures, including the hospital and primary/community organisations. The DHB may note any:

  • key internal/external operating environment factors that affect performance
  • key areas of risk and opportunity
  • coverage or location.

1.2.2Nature and scope of functions / intended operations

Explain the nature and scope of the entity’s functions and intended operations, performed by the DHB in the following roles.

  • Planner (in partnership with appropriate stakeholders).
  • Provider.
  • Funder (including managing budget within funding allocation/specific financial constraints).
  • Owner of Crown assets.

1.3Strategic Intentions

WHAT outcomes we want to achieve through a whole-of-system approach
Keep this section high level and be sure to demonstrate how the DHB is giving effect to the NZPHD Act (section 38(2)(a&b) of the NZPHD Act). The AP must reflect the overall direction of the New Zealand Health Strategy and New Zealand Disability Strategy (section 38(2)(d) of the NZPHD Act).
It should also identify high-level strategic objectives that the entity intends to achieve or contribute to (strategic intentions should be identified here). Links between high-level strategic intentions and DHB performance on an annual basis will be outlined in the SPE (section 149B-G of the CE Act).
System integration
While taking a whole-of-system approach is not new to the health sector, it is expected that a growing commitment will be applied to achieving more effective system integration in partnership with primary care and other appropriate stakeholders, and this will be demonstrated in the strategic direction and planned activities of DHBs. This includes the DHB’s work to provide Better Public Services (including Social Sector Trials) in:
  • Reducing Rheumatic Fever
  • Children’s Action Plan
  • Whānau Ora
  • Prime Minister’s Youth Mental Health Project.
DHBs are expected to demonstrate how they will use clinical leadership to drive system integration and Better Public Services.
DHBs are also expected to provide evidence that the Alliance Leadership Team jointly developed and agreed those sections of the plan with a primary care or integration focus. This includes the following sections of the plan:
  • Shorter Stays in Emergency Departments
  • Increased Immunisation
  • Better Help for Smokers to Quit
  • More Heart and Diabetes Checks
  • Children’s Action Plan
  • Prime Minister’s Youth Mental Health Project
  • Social Sector Trials
  • Diabetes Care Improvement Packages
  • Long-term Conditions
  • Stroke
  • Cardiac Services (primary care aspects)
  • System Integration (including IPIF)
  • Primary Care
  • Rising to the Challenge
  • Maternal and Child Health.
While in 2015/16 there is no requirement that NGOs are formal members of the ALT, the principle of partnership must underpin any service development for all of the planning priorities.
Intervention logic flow
Intervention logic is central to this module as the links between outcomes in this section and subsequent sections of the AP illustrate the performance story(recommendations from Cabinet Social Policy Committee (CSPC) 8A rec: 22.3).
  • Specific actions/activities the DHB will undertake to deliver on these outcomes should be described in Module 2.
  • How the outcomes identified here flow into detailed impacts and outputs in the SPE in Module 3 should be clear.
  • How DHB activity to build organisational capability in Module 5 will enable delivery on these outcomes should also be clear.
Consider some form of reference to link sections (eg. numbering outcomes and referencing numbers in SPE where relevant).
This section must be consistent with and reflect the RSP and any national plans (CSPC 8A rec: 16).

1.3.1DHB vision

Outline the overall vision for the DHB population and service provision.

1.3.2Strategic outcomes in national, regional and local context

(section 38(2)(d) of the NZPHD Act)

Outline the specific strategic outcomes or objectives for the DHB. These should be considered in the context of developing service planning to ensure the AP addresses:

  1. local, regional, and national needs for health services, including Better Public Services
  2. how health services driven by clinical leadership can be properly integrated to meet those needs
  3. the optimum arrangement for the most effective and efficient delivery of health services.

This section should include an outline of how the DHB will support clinically-led service planning in partnership with primary care and other appropriate stakeholders to achieve its high-level objectives and BSMC service.

The Minister’s 2015/16 letter of expectations for DHBs and their subsidiary entities was sent to DHB Chairs before Christmas. The letter had a particular focus on clinical leadership, asking that all DHBs consider how they can better foster clinical leadership in 2015/16. Therefore, when preparing their APs, DHBs should consider how they can further embed clinical leadership into every aspect of the organisation, and include clear detail showing how clinical leadership will be fostered.

This section should focus on service sustainability, service quality and safety, integrated models of care where appropriate, and best use of resources. It could also describe key DHB issues that will be addressed by the intended focus areas of service planning for each stakeholder.

Module 2 should identify a number of key principles fundamental for robust planning to achieve BSMC services through a system integration approach. It is expected these will be visible in this part to explain the DHB’s strategic planning where appropriate.

Consider a structure that flows from national to regional (including sub-regional) and local/community levels while linking to strategic objectives outlined in Module 1. Specific actions should be described in subsequent Modules.

The following requirements must be covered in this section:

Appropriate reference to the Māori Health Plan (CSPC 8A rec: 22.5).
Ensure related Performance Measures in the Māori Health Planare consistent with those in the AP.

MODULE 2:DELIVERING ON PRIORITIES AND TARGETS

HOW we are delivering on Module 1.3: Strategic Intentions
This section should include commentary on key DHB activities, actions and outputs to deliver on each of the priorities outlined in the Minister’s Letter of Expectations (CSPC 8A rec: 22.4).
Any significant new expenditure should be signalled where applicable.
It is expected that ‘strong intervention logic across funding, key actions and outputs, expected impacts and outcomes’ is apparent throughout the document (CSPC 8A rec: 22.3).
A guide to content for each Government priority and Health Target is provided in the planning priorities document, along with details for the RSP priorities.

2.1Priorities and Targets

2.1.1Implementing Government priorities

(CSPC 8A rec: 22.4)

The Ministry of Health and DHBs are charged with giving effect to the overarching goal for the health sector of BSMChealth services for all New Zealanders, including Better Public Services. Key principles that are foundational to planning in order to achieve BSMC services are:

  • using an alliancing approach to service planning in which ALTs involving the appropriate primary/secondary clinicians and primary/secondary managers jointly agree service priorities along with appropriate funding levels. Refer to the PHO Services Agreement and Alliance Agreement that took effect on 1 July 2013
  • using a whole-of-system view to determine the most efficient model of service delivery. Ensuring service planning is not done in silos, including using alliancing principles to jointly plan and agree service models with appropriate stakeholders for other services (eg, community clinicians and NGOs)[3]
  • providing a model of care that incorporates a range of ‘hospital’ services to be delivered within community/primary care settings
  • active engagement of ‘front-line’ clinical leaders/champions in health services delivery planning across the sector at both local and regional levels
  • integrating/co-ordinating clinical services to provide greater accessibility and seamless delivery
  • strengthening clinical and financial sustainability
  • making better use of available resources
  • ensuring total population measures and targets are applied to all ethnic groups and that all targets and measures replicated in any other plans (eg, Māori Health Plans) are consistent with those in APs and RSPs.

Four important policy drivers have been identified through which the health sector may best utilise resources to achieve BSMC services.

  • Better Public Services (including Social Sector Trials): DHBs must work more effectively with other parts of the social sector. The Government’s Better Public Services targets and the Social Sector Trials will help drive this integrated approach that puts the patient and user at the centre of service delivery. DHBs are expected to work closely with other sectors such as education and housing specifically.
  • Regional collaboration: means DHBs working together more effectively, whether regionally or sub-regionally.
  • Integrated care:includes both clinical and service integration to bring organisations and clinical professionals together, to improve outcomes for patients and service users through the delivery of integrated care. Integration is a key component of placing patients at the centre of the system, increasing the focus on prevention, avoidance of unplanned acute care and redesigning services closer to home.
  • Value for Money: is the assessment of benefits (better health outcomes) relative to cost, in determining whether specific current or future investments/expenditures are the best use of available resource.

The AP should reflect how these approaches link in with the DHB’s overall performance story and identify the outcomes that will be achieved through them. DHBs must show in their APs the specific tangible and measurable actions they will undertake to deliver on identified service priorities and targets in relation to the above policy drivers. The activities identified must include a range of actions that are expected to be completed within 2015/16.

Government priorities are presented in the Minister’s Letter of Expectations and in individual letters to DHB Chairs from the Minister. The planning priorities for DHB 2015/16 APs are:

Health Targets

  • Shorter Stays in Emergency Departments
  • Improved Access to Elective Surgery
  • Faster Cancer Treatment
  • Increased Immunisation
  • Better Help for Smokers to Quit
  • More Heart and Diabetes Checks

Government Priorities

Better Public Services (including Social Sector Trials):

  • Reducing Rheumatic Fever
  • Children’s Action Plan
  • Whānau Ora
  • Prime Minister’s Youth Mental Health Project
  • Social Sector Trials

System Integration:

  • Diabetes Care Improvement Packages
  • Long Term Conditions
  • Stroke
  • Cardiac Services
  • Improved Access to Diagnostics
  • System Integration Primary Care
  • Health of Older People
  • Rising to the Challenge
  • Maternal and Child Health
  • Cancer Services
  • Healthy Families NZ
  • Spinal Cord Impairment Action Plan

Other

  • National Entity Priority Initiatives
  • Improving Quality
  • Actions to Support Delivery of Regional Priorities
  • Living Within Our Means

DHBs are expected to include actions/milestones/budget allocations/measures to deliver on regional objectives in their APs. See Appendix 8.5 for the ‘Line of Sight guidance’ framework. To expand further on this framework, the Ministry has released 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.