Health and Disability Sector NGO-Moh Forum

Health and Disability Sector NGO-Ministry of Health Forum

Annual Report from the NGO Working Group

1 July, 2004 to 30 June, 2005

Introduction

The Health and Disability Sector NGO-Ministry of Health (MoH) Forum process, aimed at promoting the relationship between the MoH and NGOs, has now been operating since March 2002. The Working Group, which has responsibility for the “executive” function, was first elected in September of that year. This is the third annual report on the Working Group’s activities and seeks to inform Forum members, the MoH and other stakeholders on the issues the Working Group has addressed during the last 12 months. It should be noted that the reporting period was adjusted during 2005, so that the reporting and funding years were synchronized.

The year covered by this report has witnessed the Working Group members undertaking an increasing number of new activities and involvements while continuing to pursue other tasks commenced in previous periods. Significant in this has been the feedback provided to the MoH from the NGO sector on key areas of concern, such as relationships with the MoH and with PHOs, as well as the financial pressures facing Health and Disability NGOs.

Membership

The Working Group, current at the end of the period (following the election held in October, 2004) was:

Member

The October, 2004 elections for the Working Group, as well as seeing a number of new members welcomed, also marked a change in Chair. Louise Carr, founding Chair, stood down and was replace by Gil Greer. The Working Group expressed their gratitude to Louise for the role she had played as Chair since its establishment in September 2002. The Group especially appreciated Louise’s ability to deal with issues as they emerged and initiate processes to meet these needs. Her resilience and skills in holding the Group together were commented on.

Meetings were held in July and December, 2004 and then January, March and June, 2005. Connected with the July 2004 meeting, the Working Group held a facilitated Strategic Planning day.

Elected Working Group members’ meeting attendance record

(for period December 2004 to June 2005, 4 meetings)

1.  Summary of Activities

Forums

The Working Group convened two national forums during the year-one in September, 2004 and the other in April 2005. The September forum explored the relevance of the 2001 “Statement of Government Intentions for an Improved Community-Government Relationship” and the Treasury’s “Guidelines for Contracting with Non-Government Organisations for Services Sought by the Crown”. Keynote speaker was Tim Barnett,

Parliamentary Private Secretary to the Minister for the Community and Voluntary Sector

There were about 150 registrations for this forum.

In April, 2005 the forum was held for the first time in the South Island. At this Christchurch meeting the theme was “Strengthening the sector from within”- an effort to offer NGOs an opportunity to explore the potential to share expertise and resources. Nearly 140 registrations where received, many being from the South Island who were attending one of these forums for the first time. Keynote addresses where made on behalf of the Hon. Annette King, Minister of Health the Director General of Health and by Brenda Ratcliff, Director of the Office for the Community and Voluntary sector.

Reports/Papers Prepared

Survey of NGO relationships with the MOH

As part of its contractual requirements for building the relationship between health and disability sector NGOs and the MoH, the Working Group undertook a survey in October, 2004, (which replicated much of an earlier NGO-DHB relationship survey, 2003). A draft report on the was finalised in March, 2005

This survey explored NGOs’ perceptions of their relationships with the MoH. The survey findings were one of the reports provided to the Director General of Health (Dr Karen Poutasi) at a meeting in March, 2005. Subsequently, Directorate-specific reports would be sent to each Directorate. An NGO stakeholder version of this report was presented to attendees at the April NGO-MoH Forum held in Christchurch.

The survey questionnaire was sent out to the Working Group’s NGO mailing list database. 70 responses to the survey were received. The response rate was difficult to objectively determine, as the exact number of NGOs in a contractual relationship with the MoH and on the database is unclear at present. The completed responses were evaluated confidentially by a contractor of the NGO Working Group and the survey results produced both quantitative and qualitative data.

Maori and Pacific Island organisations were under-represented in the survey, and disability organisations were over-represented. The respondent organisations held a wide mix of contracts ranging from Ministry of Health contracts only to contracts with the Ministry of Health, DHBs and other Ministries. A small number of respondents receive no Government funding.

In general, the NGOs who responded to this questionnaire viewed their relationship with the Ministry as fair or good, but not excellent. Primarily, they saw room for improvement in communication between NGOs and the Ministry, which would include more feedback about reporting, increased involvement in policy matters as well as the Ministry improving their knowledge of the day-to-day operations of the NGOs.

Funding is a major concern for NGOs including their ability to meet compliance costs and successful workforce development. The desire for longer-term, flexible contracting arrangements was also frequently mentioned in this survey.

The survey reports prepared for the MoH directorates formed the basis for a number of subsequent meetings that the Working Group undertook to address the concerns of the NGO sector (see below).

Relationships between NGOs and PHOs

During the year, the Working Group received information which indicated that NGOs where experiencing difficulties in participating in the Primary Health Care strategy’s PHO development. Early in 2005 a research paper was commissioned and a contractor engaged to undertake some focussed investigation of the concerns amongst NGOs.

This study explored the experiences and identified the key issues of eight NGOs as they sought to develop relationships with primary health organisations (PHOs) and establish their fit within the new primary health care structure. It also drew on statements reflected in the NGO Working Group’s surveys of relationships with DHBs and the Ministry of Health.

Results showed that NGOs were generally supportive of the philosophy behind the Primary Health Care Strategy, particularly as the desire to reduce health inequalities has traditionally been a major driver for NGOs. The main concerns reported by the NGOs interviewed were about:

§  their place in the new environment

§  the limited PHO responsiveness to NGO attempts to form relationships

§  the transaction costs involved in seeking to build relationships

§  the lack of equitable opportunities to tender for new projects

§  the vulnerability of health promotion within the PHO setting

§  Maori provider issues

§  the lack of understanding by DHBs and PHOs, about the skills and services provided by NGOs

§  the apparent intentions of some DHBs intend to contract with PHOs or even a single PHO rather than NGOs, and

§  the possible gradual devolvement of all primary health, and eventually public health funding, to PHOs.

The feedback overall highlighted that, if NGO participation in the new environment was to be effective, there was an urgent need for action by Ministry of Health, DHBs and PHOs to provide clarity and direction in relation to funding for and inclusion of NGOs in the new primary care system. This was not thought possible without encouragement from the Ministry of Health, DHBs, and their own management, and both groups would need contractual frameworks and funding incentives.

The is report was also presented to the Director-General in March and later became the focus of discussions with the Clinical Services and DHB Funding and Performance Directorates.

Financial Pressures Paper

Again, as part of its contractual obligations to the Ministry, the Working Group identified issues affecting NGOs through a number of strategies. Many of the issues related to increasing financial pressures on NGOs, which have implications for their financial viability, the quality of service delivery and the health and wellbeing of the communities they serve.

This paper outlined a number of the issues identified and suggested some possible ways forward. Most pressing of the concerns was the implication of the Nurses’ MECA and the ongoing ability of NGOs to recruit and retain nurses. New or pending legislation changes (ie Health Practitioners Competency Assurance Act, Holidays Act, Charities Commission Act, Review of Financial Reporting Act, etc) brings with them compliance costs which NGOs reported being unable to sustain without impacting on their ability to provide services at existing levels. It was also reported that the cost of participating in health sector developments, such as PHO establishment, policy reviews, or policy consultations, is not activity that is specifically funded. This gives NGOs a dilemma of stretching their limited resources or passing up opportunities to contribute to policy and sector development.

This paper became part of discussions with the DHB Funding and Performance Directorate.

Lobbying/Advocacy

Since clauses in NGO contracts concerning lobbying where questioned in Parliament, the Ministry has been trying to find way resolve the perceived conflict between political neutrality and the right to lobby/advocate.

This resulted in the Ministry commissioning an independent report entitled Contracts with on Government Organisations – Compliance with Public Service Standards. (The Hunn-Brazier Report.), the removal of clauses in 5 Ministry of Health contracts and distribution of a “Draft Instruction for Ministry of Health staff regarding contracting with NGOs”.

A number of government agencies have now become involve in this discussion and the Working Group has contributed by meetings with and suggestions to the Director General of Health. She has consulted with the Auditor General, the State Services Commission (SSC) and Treasury. The Ministry is till adamant that it cannot contract out functions they are not able (in law) to do themselves. NGOs are able to lobby but must use other funds, reasonable surpluses or volunteers for this activity.

It appears that SSC has taken a leading role in this issue now. There still seems to be confusion about what is lobbying and what is advocacy.

The Working Group has met with the State Services Commission as part of consultation and forwarded an NGO combined report to MoH and SSC.

At the April 2005 Forum, Dr Don Matheson (DDG Public Health) reported that the Ministry was still doing further work to “better define the nature of its (MoH’s) “problem” with this issue, ie a better definition of political neutrality and a way to express this in contracts.” He further indicated that the details would be negotiated with NGOs and that the sector should not assume that there is any negative signal from Government to NGOs in this process.

There will no longer be a “Statement” and the MoH is “following a suggestion from the working group, (is) working on including a new standard clause in MoH contracts that, among other things, states clearly that the Ministry, as a public service department, must comply with the convention of a politically neutral public service and other specified public service standards.”

The Working Group has explored alternative solutions to the issue of ensuring political neutrality is not breached. Paramount amongst these are:

§  the proposal for a Code of Ethics\Code of Practice which has mandatory compliance for NGOs contacting with government departments

§  clarification of the differences between lobbying and advocacy

The Working Group is also eager to ensure that government departments do not require NGOs to make changes to their contracts and constitutions regarding lobbying and advocacy activities, until this matter is fully resolved

Working Group Involvements

During this period, the Working Group has received a number of requests to either provide representatives or continue their participation in a number of consultations processes. The members who attend these meetings keep the WG informed on the issues being considered. Current participations include:

§  Primary Health Care Strategy and PHO Development Taskforce

§  Public Health Forum

§  NZHIS Strategy Group

§  ANGOA

§  Community Sector Taskforce–“Entity”

§  Health & Disability Sector Safer Industry Forum.

The requests received are seen as indications of the Working Group and Forum’s increasing credibility with in the Health sector.

Presentations

The Working Group has been invited to make two presentations to MoH staff, speaking about the NGO health sector. These were:

§  MoH Strategic Presentation

§  MOH Analysts Training programme.

Both were key developments the Working Group’s efforts to better inform Ministry staff about the role of NGOs is service delivery and community connectedness and were received well.