Amendments to the Regional Service Plan Guidelines (note that minor editorial amendments have not been recorded in the following table)
Section / Description2A.1 / -Further clarification has been provided of the expectations for inclusions of at least one specific action that should be delivered in 2018/19.
2A.2 / -This section has been removed.
2A.5.1 / -Priority area: Regional Quality and Safety guidance is updated
4.1 / -This section has been edited to provide further clarification
Table of Contents
Introduction to the Guidelines
Regional Collaboration
Regional Service Plan
Overview of Content Requirements
SECTION ONE: Strategic Position
1.1Linkages
SECTION TWO A: Regional Enablers
2A.1 Equitable Access and Outcomes
2A.1.1Health Equity Tools
2A.3Workforce
2A.3.1Workforce Priorities for 2018/19 RSPs
2A.4Technology and Digital Services
2A.4.1Technology and Digital Services Priorities for 2018/19 RSPs
2A.5Quality
2A.5.1Quality Priorities for 2018/19 RSPs
2A.6Clinical Leadership
2A.6.1Clinical Leadership Priorities for 2018/19 RSPs
2A.7Pathways
2A.7.1Pathways Priorities for 2018/19 RSPs
SECTION TWO B: Regional Priorities
2B.1 Hepatitis C
2B.1.1Regional Objectives
2B.1.2Measures
SECTION THREE: Regional Governance and Leadership
3.1Regional Governance and Decision Making
SECTION FOUR: Line of Sight
4.1The Planning Process across Regional Service Plans and Annual Plans
4.2Guidance Framework for RSP Enablers Priorities
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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 collaboration 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. This year the RSPs are expected to include a particular focus on regional enablers, and this guidance has been structured to reflect this. The RSPs are also expected to retain a focus on those vulnerable services that have been included in the RSP guidance in previous years, through an enablers lens.
The 2018/19 RSPs must also reflect the New Zealand Health Strategy’s direction, and in particular the RSPs should clearly align to the Strategy themes of People powered, Closer to home, Value and high performance, One team, and Smart system. The guidance includes linkages to Strategy themes to assist regions to do this.
The RSPs include national priorities for regional delivery 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.
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 2018/19 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 Section2A.1: Equitable Access and Outcomes.
The Line of Sight framework is again included in Section4 as a general guideline for consideration while developing your plans.
Overview of Content Requirements
SECTION ONE: Strategic Position1.1 Linkages
SECTIONTWOA: Regional Enablers
2A.1 Equitable Access and Outcomes
2A.1.1 Health Equity Tools
2A.2 Section removed
2A.3 Workforce
2A.3.1 Workforce Priorities for 2018/19 RSPs
2A.4 Technology and Digital Services
2A.4.1 Technology and Digital Service Priorities for 2018/19 RSPs
2A.5 Quality
2A.5.1 Quality Priorities for 2018/19 RSPs
2A.6 Clinical Leadership
2A.6.1 Clinical Leadership Priorities for 2018/19 RSPs
2A.7 Pathways
2A.7.1 Pathways Priorities for 2018/19 RSPs
SECTION TWOB: Regional Priorities
2B.1 Hepatitis C
2B.1.1 Regional Objectives
2B.1.2 Measures
SECTIONTHREE: Regional Governance and Leadership
3.1 Regional Governance and Decision Making
SECTIONFOUR: Line of Sight
4.1 The Planning Process Across Regional and Annual Plans
4.2 Guidance Framework for RSP Priorities
SECTION ONE: 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 2018/19 and future years.
Your strategic section should reflect your local and regional Population health approaches and services. Population health approaches and services are essential components of strategies to address determinants of health and achieve better health equity and wellbeing.
Progress to date should be clearly visible and can be demonstrated using both qualitative and quantitative data. Demonstrate how the regional work programme is making a difference for service delivery in the region.
1.1Linkages
The strategic section of the RSP should also be consistent with national strategic imperatives and include appropriate commitments to the refreshedNew Zealand 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.
1
SECTION TWO A:Regional Enablers
This section includes both enablers that have traditionally been included within the RSPs and some newly identified enablers.
2A.1Equitable Access and Outcomes
Strong planning and collaboration is critical to achieving health equity for all New Zealanders. The Ministry expects that achieving health equity is a focus for all DHB and regional activity. Regions are expected to keep identifying inequity in their health needs assessments and to outline actions to improve equitable access and outcomes in their RSPs within each of the regional enablers outlined below.
The specific actions to improve equitable access and outcomes will vary between regions and enabler areas depending on their various needs and can range from collection of ethnicity data to targeting services. Actions can be focused on the short and longer term. However, there should be at least one specific action for delivery in 2018/19, for each of theprioritysubsections inthe Workforce and Pathways enabler’s and, at least one specific action each for theIT and the Leadership enabler group. Each priority subsection within the Quality enabler section will meet the equity action requirement by addressing the Health Quality & Safety Commissions strategic priorities (see section 2A.5). The Ministry will be looking for evidence that the regions have worked through a process of identifying the disparities evident in each enabler area, and outlined relevant activities to reduce these disparities in order to achieve improve equitable access and outcomes for their population.
2A.1.1Health Equity Tools
Actions vary depending on the understanding of the equity issues of the priority area. The following tools, or others at your disposal, can be used to assess and identify regional disparities and outline activities for improving equitable access and outcomes.
- Equity of Health Care for Māori: A Framework.
- Whānau Ora Health Impact Assessment 2007.
- The Health Equity Assessment Tool: A User's Guide 2008.
The Ministry DHB Māori Health Profiles 2015, may also help identify areas of focus for planning to improve equitable access and outcomes.
To facilitate the delivery of high-quality health services that meet the needs of Pacific people,‘Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2014–2018 has been developed. The Ministry publishes six-monthly progress reports on its website.
2A.3Workforce
The workforce section of the RSP must be cognisant of the priorities and/or areas of action outlined in the New Zealand Health Strategy, the need to demonstrate leadership and commitment to supporting the development of the region’s health workforce consistent with the objectives of the Strategy, and the need to strengthen local and regional health workforce to meet future healthcare needs. In particular, regions will support a sustainable and adaptive workforce by putting in place workforce development initiatives to enhance capacity, capability, retention, diversity and succession planning and build workforce flexibility. Regions will take account of the need for equitable access to services in considering workforce distribution in workforce planning. Consideration should be given to making best use of the multidisciplinary team including kaiāwhina.
Regional population health needs and desired health outcomes should inform and direct health workforce planning and development initiatives. For workforce initiatives to sustainably enable the desired health outcomes they must be considered alongside models of care, business models, the financial, legislative and regulatory environment and other enablers (Technology and Digital Services, Quality, Clinical Leadership, and Pathways).
In 2018/19, regions will build upon work from previous RSPs and identify workforce priorities specific to their region. Further, DHBs are expected to work in collaboration with Regional Training Hubs and in conjunction with the Ministry of Health to achieve agreed regionally-based solutions for the following areas: workforce planning, workforce diversity, equitable outcomes, healthy ageing and mental health and addictions.
In summary regional workforce plans should include:
a)the population health need that initiatives are designed to address
b)the desired health outcomes the initiatives will help to address, including equitable outcomes for populations
c)an assessment of how the initiatives align with models of care, business models, the financial, legislative and regulatory environment and other enablers (Technology and Digital Services, Quality, Clinical Leadership, and Pathways)
d)evidence that consideration has been given to making best use of the multidisciplinary team including kaiāwhina.
2A.3.1Workforce Priorities for 2018/19 RSPs
Priority / Health Strategy Linkage / Guidance / MeasuresWorkforce Diversity / One team / Work regionally and in collaboration with DHB Shared Services and the Ministry of Health to:
- identify workforce data and intelligence that is collected across services and DHB areas, understanding workforce 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
- support DHBs with training placements for eligible new health professional graduates within their region’s DHBs (PGY1 and PGY2, CBA nurses, allied health, scientific and technical).
- increase Māori participation and retention in the health workforce and ensure that Māori have equitable access to training opportunities as others
- 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.
Health Literacy / One team / Action:
Promote and co-ordinate action to raise awareness of, and build skills in health literacy practice among the health workforce and across the health system.
Organisations that are responsible for setting professional standards recognise the link between cultural competency and health literacy, and apply this to professional development programmes.
It is accepted that most individuals and whānau will at times have difficulty understanding and applying complex health information, and that the health workforce will work on ways to make it less difficult.
Organisations should approach health literacy in a way that recognises levels of health literacy differ between individuals and can differ for an individual at different times of their life.
It is expected that regional shared service agencies will support DHBs with activities that DHBs have identified from their Health Literacy Review as being beneficial for their own region, and across regions. / Regional progress reporting on the requirements and key actions to be provided via quarterly RSP reports.
Palliative Care / One team / Work regionally and in collaboration with DHB Shared Services and the Ministry of Health to develop a robust workforce plan to ensure regions are able to deliver quality, accessible palliative care across all geographical areas and settings. These plans will outline the need for palliative care across the region and projections of future demand. They will demonstrate how the region will address current and future needs for palliative care.
Areas of focus include:
- understanding of the vision of accessible quality palliative care for all
- examples of initiatives that support implementation of the Palliative Care Action Plan 2017
- workforce resource profiles and distribution that support the needs and vision of the region including:
- appropriate skill mix
- full utilisation of the existing workforce
- optimal use of expertise and skills
- one team approach across organisations, agencies, professions and teams.
Cardiac Services / People powered / Work regionally and in collaboration with the DHB Shared Services and Regional and National Cardiac Networks to:
- clearly identify current demand for cardiac physiology services and the regional ability to meet these demands.
- develop and implement a workforce plan to ensure that training, recruitment, retention and other relevant workforce issues are addressed to sufficiently support all pathways to cardiac services, including to cardiac surgery.
Elective Services / Value and high Performance / Identify the actions that the region will undertake to maximise workforce resources. For example, completing a forecast through to 2019/20 of future workforce requirements, based on service demands and maintaining a local and regional view of specialist workforce capacity and capability.
Development of long-term recruitment plan for vulnerable or hard-to-recruit roles.
Orthopaedics: Complete a regional review of current orthopaedic workforce resources, factoring in subspecialty capability. This should include an evaluation of current workforce, a view on the indicative resourcing levels required to meet acute and planned orthopaedic demand in 2018/19, and a gap analysis on how well resourcing levels can meet 2018/19 anticipated delivery levels. Based on this, develop and implement a regional orthopaedic workforce plan that considers how orthopaedic workforce resources can be best used across the region to maximise deliver for patients, and identifies initiatives to support closing any gaps between demand and capacity, including use of alternative care models and workforce where appropriate. / Regional progress reporting on key actions to be provided via quarterly RSP reports.
Orthopaedics:
Regional review of current orthopaedic workforce (Q1)
Development of regional implementation plan (Q2)
Progress against identified implementation plan milestones (Q4)
Mental Health / One team / Work regionally and in collaboration with DHB Shared Services and the Ministry of Health to implement the actions set out in the Mental Health and Addiction Workforce Action Plan 2016-2020. This work should also ensure organisations across the region are appropriately supported with a particular focus on supporting staff development and leadership. / Regional progress reporting on the requirements and key actions to be provided via quarterly RSP reports.
Addiction Treatment Services / One team / Work regionally to build addiction treatment staff capability to support implementation of the Substance Addiction (Compulsory Assessment and Treatment) Act 2017 (SACAT). / Regional progress reporting on the requirements and key actions to be provided via quarterly RSP reports.
Stroke Services / People powered / Work regionally and in collaboration with the DHB Shared Services and Regional and National Stroke Networks to:
- clearly identify current demand for acute and rehabilitation stroke services in both the hospital setting and in the community, including ambulance and radiology services and the regional ability to meet these demands
- develop and implement a workforce plan to ensure that training, recruitment, retention and other relevant workforce issues are addressed and are ongoing
- seek new and innovative ways of addressing service delivery in environments where health professionals work primarily in isolation or where the workforce is limited in its ability to meet recommended service delivery.
2A.4Technology and Digital Services
Strategic Context for Digital Health
Delivery of ICT enabled change and innovation is critical in supporting the delivery of the New Zealand Health Strategy and the Government ICT Strategy. Technology will support transformational change in the way patients and care teams access health services
New Zealand Digital Health Strategy[1]
The Digital Strategy is a living document that describes a digital eco-system creating conditions that support us to achieve the components of the New Zealand Health strategy.
The following is a schema of the draft Digital Health Strategy components.
Health ICT Investment Portfolio
The Ministry of Health is working with the sector to create an ICT Investment Portfolio to support decision making and to maximise the value of sector ICT investment.