Notice to the Health Funding Authority of the Crown's Objectives for Health and Disability Services for 1999/2000 I, Wyatt Beetham Creech, hereby give the Health Funding Authority notice of the Crown's objectives in relation to the matters described in section 8 of the Health and Disability Services Act 1993. Crown's Statement of Objectives for 1999/00 THE CROWN'S FUNDAMENTAL HEALTH OBJECTIVE Government health and disability policies are aimed at making real gains in the health status of New Zealanders, so all enjoy the benefits of good health and maximise their potential to live a full life. The Crown seeks to build certainty and confidence in the security and stability of the New Zealand health and disability support system amongst all participants. Within that broad effort, we wish to see specific initiatives and actions designed to give equity of health status to all New Zealanders, including initiatives: to enable people to take more responsibility for their own health by making better lifestyle choices to improve the health outcomes of Mori and Pacific communities so that these groups can soon enjoy the same level of health status as other New Zealanders to improve children's health status. The Crown aims to maximise the benefits of early intervention, proper integration of services, health promotion and involvement of communities in developing their own solutions to their health issues. All services should: meet quality requirements be delivered effectively and efficiently maximise the health benefits achieved with the available resources work to achieve low compliance and administration costs. This objective sets out the Government's priorities for all efforts in the health and disability sector, public and private. If they are delivered, the people of New Zealand will be the better for it. For the Health Funding Authority specifically, the Crown's Statement of Objectives sets out priorities it must follow in developing operational policies for the expenditure of the public money with which it is entrusted. Implementing this objective is achieved by the Authority funding the optimum mix of services to give New Zealanders the maximum health outcomes practicable. The Health Funding Authority Board is accountable to the Minister of Health for ensuring that this Crown's Statement of Objectives drives: operational policy decisions made by the Health Funding Authority the contents of the Funding Agreement between the Health Funding Authority and the Minister of Health the thinking of the Health Funding Authority in the preparation of its Statement of Intent and Strategic Business Plan for 1999/2000. Where appropriate, the Health Funding Authority should work with other agencies, including the Ministry of Health, to further develop initiatives and strategies that improve health outcomes for all New Zealanders. Government's Medium-Term Goals The following goals are set out in the Government's Medium Term Strategy. Under each goal, this Crown's Statement of Objectives sets out the specific outcomes Government wishes the Health Funding Authority to focus on during 1999/00. 1. Public certainty about access, quality and security of services 2. Timely, equitable and nationally consistent access to elective services 3. Acknowledging the special relationship between Mori and the Crown 4. Decreased long-standing disparities in health status 5. Improved mental health 6. Improved child health 7. Improved disability support services 8. Greater emphasis on population health approaches 9. Well co-ordinated, integrated services that contribute to better health and disability outcomes 10. Intersectoral collaboration between agencies and providers to achieve social policy objectives 11. Improved capability and adaptability of the health and disability sector 12. Sustainability of the publicly funded health system Goal 1: Public certainty about access, quality and security of services The Crown's objectives for 1999/00 are to: a) retain current levels and configurations of services in Hospital and Health Services In order to give people throughout New Zealand confidence in the continuing provision of their hospital and health services, the Minister of Health, in September 1998, announced the Hospital Services Plan. The Hospital Services Plan commits all Crown agencies, including the Health Funding Authority, to retain the current configurations of services in Hospital and Health Services throughout New Zealand for a period of 3 years. It protects communities from arbitrary and unilateral changes (specifically reductions) in services. Any changes proposed to prices, volumes or other aspects of configurations of health services must be consistent with the Hospital Services Plan. b) give consumers greater certainty and transparency The HFA should develop processes, including public information campaigns, designed to give the public and consumers of health services (patients) a clear statement of the publicly-funded services available to them and the terms under which those services can be accessed by: publishing service coverage information in plain language making sure the public, especially relevant subsets of the population, is aware of policies that will benefit them so that they are fully utilised (e.g., the free doctors visits for under 6-year-olds) working with the Ministry of Health and other agencies as relevant to further develop the framework for a national emergency collaborative network of hospitals as set out in `Roadside to Bedside' continuing work to progressively develop a fair, effective and nationally consistent travel policy designed to make reasonable access fair to all people in New Zealand no matter where they are located. c) provide clarity about funding and service intentions The Health Funding Authority must: share information with providers on the analysis of current and future health needs, prioritisation and pricing methodologies when facilitating service agreements, thus allowing providers to assess medium-term funding intentions and service delivery expectations continue work on developing longer-term funding arrangements designed to enable providing organisations to better plan their service delivery. Goal 2: Timely, equitable and nationally consistent access to elective services The Crown's objectives for 1999/00 are to improve access to elective services by: ensuring that people referred for elective services are prioritised through a clinical assessment process based on their need and ability to benefit from the proposed procedure actively continuing the implementation of nationally consistent booking systems in respect of all publicly-funded elective services actively fostering the development, acceptance and use of clinical priority assessment criteria among health professionals giving emphasis to ensuring that people referred for initial assessment have timely access to that assessment working towards nationally consistent access to elective services so that people in like circumstances anywhere in New Zealand are treated in a like manner. Goal 3: Acknowledging the special relationship between Mori and the Crown The Crown recognises the Treaty of Waitangi as the founding document of New Zealand and acknowledges Mori aspirations to increasingly provide their own health services. The Crown's objectives for 1999/00 are to: ensure services are responsive to the cultural values of Mori continue efforts, where appropriate and after consulting Mori, to encourage greater participation by Mori at all levels of the health sector, including in health service delivery for Mori strengthen links between Mori health and other aspects of Mori development. Goal 4: Decreased long-standing disparities in health status The Crown's objectives for 1999/00 are to: Improve Mori and Pacific health status so that these groups have the opportunity to enjoy the same levels of health status as other New Zealanders by: implementing programmes and services that offer the most potential for health gain for Mori and Pacific peoples ensuring that services are responsive to the cultural values of these communities. Goal 5: Improved mental health The Crown's objective for 1999/00 is to fund and deliver services that will better address the mental health needs of the community, including to: improve access to and co-ordination and effectiveness of services consistent with the strategic directions of the national mental health strategy, ``Moving Forward'' strengthen the mental health workforce both immediately and in the longer term. Goal 6: Improved child health The Crown's objective for 1999/00 is to improve health and disability services for children so that they have the care and protection they need for the best possible start to life, including improving health outcomes for children at risk. In particular, support the implementation of the Child Health Strategy by: improving the coverage of preventive services, especially well child care and immunisation improving access to services for all children as appropriate, with special emphasis on access for tamariki Mori, Pacific children, children from families at risk of poor outcomes and children with high health and disability support needs due to chronic illness, mental illness and disability working as appropriate to involve families as much as is reasonable and appropriate in the decisions as to the services that will be provided to those requiring them. Goal 7: Improved disability support services The Crown's objective for 1999/00 is to improve disability support services by: working towards ensuring national consistency of services that fosters the maximum of independence within a climate that encourages maximum choice for those people assessed as needing disability support services working as appropriate to involve families and other relevant support networks as much as is reasonable and appropriate in the decisions as to the services that will be provided to those people assessed as needing disability support services working with other agencies as appropriate on progressing the implementation of the Autism Services Report. Goal 8: Greater emphasis on population health approaches The Crown's objectives for 1999/00 are to improve public health status by establishing effective population health programmes which encourage early interventions, thus reducing secondary and tertiary interventions and admissions. This will include: appropriate information databases on immunisation designed to ensure maximum take-up, especially of child immunisation programmes that address the status of specific illnesses, including diabetes (``Strategies for the Control of Diabetes in New Zealand'' released by Minister of Health in October 1997) effective programmes that promote healthy behaviours, eg, healthy diets, exercise, less smoking, and less alcohol and drug abuse etc reviewing and evaluating programmes to ensure they are effective in achieving their goals and, where more effective options are identified, shifting to those options continuing to progress the development of the national breast cancer screening programme and the identification and management of Hepatitis B. Goal 9: Well co-ordinated, integrated services that contribute to better health and disability outcomes The Crown's objective for 1999/00 is to organise high quality services around ensuring better health outcomes for people and communities Implement innovative approaches to service funding to achieve better and more co-ordinated health and disability support services designed to achieve better outcomes for defined groups of people, communities and the population generally. This will involve: organising services around people; placing decision making about resources as close as possible to need; local solutions to local problems; and better relationships among and with providers. In particular, the Health Funding Authority should: develop innovative funding arrangements and innovative ways of delivering services continue to identify opportunities for more progress in developing integrated care initiatives both between parts of the primary sector and between the primary and secondary sectors encourage providers to think about and develop integrated care initiatives build on evaluations of existing initiatives to extend the benefits to other parts of New Zealand foster and encourage local communities to develop local solutions to local problems. Goal 10: Intersectoral collaboration between agencies and providers to achieve social policy objectives The Crown's objective for 1999/00 is to develop processes that link activities in the health and disability sector to those in the broader social sector, including supporting the implementation of: the Strengthening Families strategy, including Family Start and other such targeted initiatives the New Zealand Youth Suicide Prevention Strategy the National Drug Policy mental health destigmatisation. Goal 11: Improved capability and adaptability of the health and disability sector The Crown's objectives for 1999/00 are for the Health Funding Authority to: encourage co-operation between providers work with the Ministry of Health, CCMAU and other agencies as appropriate to improve coherence between the funding and ownership functions of the health system work with the Ministry of Health and insurers to effectively implement the Accident Insurance Act. Goal 12: Sustainability of the publicly funded health system The Crown's objectives for 1999/00 are for the Health Funding Authority to: ensure that where services are funded, they are funded on a sustainable long-term basis, that they will adapt to changes in technology and medical service changes over time, and that the sector is well informed as to the goals and strategies of the Health Funding Authority in its service funding strategy implement measures designed to reduce the pressures on demand-driven expenditure, e.g., effective education programmes and better integration of health services work towards improving the quality of health and disability sector information and ensuring that the most effective use is made of information endeavour to address, in a consistent way throughout New Zealand, health need, and relative benefits and cost effectiveness of services improve its capability to better deliver on Government's health goals and aspirations establish a reputation for openness, consistency, reliability and certainty in all its relationships with the health and disability sector and the public generally carry out all contract and funding processes in a timely, effective and cost-efficient manner identify, assess, manage and monitor financial and non-financial risk where appropriate, inform the Ministry and the Government of the risks identified in innovative strategies so consideration can be given as to how such risks may be absorbed or addressed, either by the HFA itself or by Government as a whole continually work to lower to the minimum reasonable level the HFA's administration and consultancy costs and the compliance costs for those who deal with the HFA. Dated at Wellington this 2nd day of June 1999. WYATT CREECH, Minister of Health.