Notice to the Health Funding Authority of the Crown's Statement of Objectives for Health and Disability Services for 2000/01 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 Objectives This Crown's Statement of Objectives is based on the Government's Medium-Term Strategy for Health and Disability Support Services. Under the Medium-Term Strategy, the overarching health and disability policy objective is to ensure real gains in the health status of New Zealanders so all can enjoy the benefits of good health and maximise their potential to live a full life. The 12 goals set under the Medium-Term Strategy are designed to: build stability, certainty and public confidence in the country's health and disability system so that all New Zealanders feel secure about their health services implement policies that address long-standing health outcome disparities so that all New Zealanders have an equitable health status significantly increase the level of early intervention, integration of primary/community and secondary services, health promotion and population health improvements generally, and the involvement of local communities in developing their own solutions to their health issues improve the operation and management of the health system so as to maximise the contribution health services make to health outcomes for all New Zealanders. Goal 1: Public certainty about access, quality, and security of services Give the public confidence that the level, mix, quality and structures of health and disability support services, including rural services, is secure and appropriate to both present and future. In particular: a) further develop the service coverage schedule so that individuals and communities can improve their understanding of what they can expect from the publicly-funded health and disability services system. b) give full and proper effect to the Hospital Services Plan. Under the Hospital Services Plan, the Government has committed itself to maintaining broadly the current configuration of services for 3 years. Any service modifications should be appropriately worked through with the communities concerned and should go through appropriate officials' processes. c) in both urban and rural New Zealand, ensure as reasonable a spread of services as practicable, with an emphasis on improving health outcomes. That is, locate service delivery points in a way that will facilitate access to those services, according to reasonable and practicable criteria. While the nature of highly specialised tertiary services may result in delivery at a limited number of points, for secondary (and especially lower-level secondary services) and community services, the spread will lead to improved access and better outcomes. d) develop workable funding policies that ensure the ongoing provision of primary and secondary services in rural New Zealand (including incentives, community nursing, nurse-led practices and other types of schemes to support rural service delivery). e) fund cost-effective modern technology to support improved quality in health service delivery where appropriate, including appropriate support for the development of such initiatives as Healthline and telemedicine. f) develop long-term certainty around continuity of service delivery throughout New Zealand, especially primary medical and nurse-led initiatives, by funding services that fit a long-term service-delivery plan. g) having ensured that a consistent HFA policy on the rural and tertiary adjuster framework (consistent with the Medium- Term Strategy) was established and communicated to HHSs in time for operation in the 2000/01 year, work to refine this policy as necessary. h) resolve the remaining issues on the cost of capital in the pricing of services. i) where appropriate, and with the agreement of patients, make use of surplus capacity in publicly-owned services by transferring services from facilities that are unable to provide the service in the meantime to facilities with surplus capacity. j) where appropriate, and with the agreement of patients, use the funding policies developed under (i) to assist in maintaining viability (critical mass of those facilities) of rural health services. k) participate fully with other government agencies, the health sector and the general public in work on the policy reviews announced by the Government, especially the primary care strategy, the primary services compliance cost reduction test panel and the dental/oral health strategy. l) continue working with the Ministry of Health to develop, and to the extent practicable determine, a consistent approach to palliative care services. m) support effective workforce development policies and mechanisms, developed under the leadership of the Ministry of Health, and designed to ensure continuity of service delivery and, where appropriate, service enhancements throughout New Zealand. n) it is expected that the Health and Disability (Safety) Bill will be fully enacted early next year. Once fully enacted, the HFA should fund those services that are covered by the new legislation, only from providers that are certified under the processes established by the new law. o) generally ensure that all contracted services are focused on achieving the Government's Medium-Term Strategy goals and that all contracts are performed effectively and efficiently. Goal 2: Timely, equitable and nationally consistent access to elective services Improve access to a nationally consistent level of publicly funded elective surgery services. This includes more timely access to first assessments and services, and ensuring that elective services are prioritised on a fair, transparent and consistent basis nationwide. In particular: a) ensure that the booking system, which is to be fully implemented by 30 June 2000, operates smoothly and that any ongoing modifications necessary to improve the system are implemented. b) couple implementation of the booking system with continuous evaluation of its operation to ensure clinical `buy-in' and achievement of the overall objective of ensuring that elective services are prioritised on a fair, transparent and consistent basis nationwide. Goal 3: Acknowledging the special relationship between Mori and the Crown Acknowledge the special relationship between Mori and the Crown in the health sector to ensure that publicly funded health and disability support services are responsive to Mori and continue to enable greater Mori participation at all levels of the health and disability sector. In particular: a) recognise the desire of Mori to take increased responsibility for their own health care by supporting existing and new Mori health and social service providers. b) ensure that mainstream services are responsive to the needs of all Mori, whether Iwi or non-Iwi based. c) participate fully with other government agencies in implementing the Government's objective of strengthening co- ordination of Mori social services and improving health outcomes for Mori. d) continue to implement the general policy directions for Mori health in Whaia te ora mo te iwi (1992). Goal 4: Decreased long-standing disparities in health status Make marked progress in decreasing the long-standing disparities in health and disability status, in particular for the needs of Mori and the needs of Pacific peoples, so that these groups can enjoy the same level of health status as other New Zealanders. In particular: a) implement service delivery plans designed to reduce disparities in health and disability status for those groups experiencing historically poorer outcomes than the population in general, including Mori, Pacific people and families of all ethnic groups experiencing multiple social and economic disadvantage. b) explicitly consider and address the impact of health disparities in all documents which plan future developments in health services funding. c) funding policies should ensure the ongoing strength of current Mori and Pacific providers of services, as well as providers of services to families of all ethnic groups experiencing multiple social and economic disadvantage, and also progress new developments in these areas. d) develop additional gender and ethnic-group specific approaches that support improved health outcomes for groups experiencing historic disparities, including anti-smoking, healthier lifestyles and community development programmes. Goal 5: Improved mental health Improve services to decrease the prevalence of mental illness and mental health problems, and reduce the impact of mental disorders on consumers, their families, caregivers and the general community. In particular: a) increase access to specialist mental health services for the three percent of the population with the greatest needs, including Mori, Pacific people, children and young people and those with the highest support needs. b) in making funding decisions, focus on improving the appropriateness, safety, quality and effectiveness of services. c) support the effective development of the mental health workforce, in co-operation with the Ministry of Health and other agencies, to meet the workforce needs of New Zealand throughout the continuing implementation of the National Mental Health Strategy. Goal 6: Improved child health Implement the Government's Child Health Strategy and improve the health status of children at high risk of poor health. In particular: a) improve children's access to health services through: ensuring that all children are enrolled with a primary care/well child provider encouraging and supporting the co-ordination of well child providers at a local level. b) develop in association with groups in the community (including national groups where appropriate) programmes to address child health issues. c) reduce the rates of significant illnesses and injury, especially in populations of children at high risk of poor health, by: implementing, in co-operation with other agencies, funding and other policies to significantly increase immunisation coverage rates, with the aim of eliminating epidemics of vaccine-preventable diseases reducing repeat hospital admissions for respiratory disease in Mori children and in Pacific children reducing rheumatic fever incidence and prevalence in Mori children and in Pacific children reducing meningococcal disease incidence in Mori children and in Pacific children reducing the rate of sudden infant death syndrome in Mori infants reducing the rate of hearing loss at 5 years amongst Mori children reducing intentional and unintentional injury rates for all children. Goal 7: Improved disability support services Improve disability support services, with the aim of maximising the ability of people with disabilities and their caregivers to enjoy a full and independent life. In particular: a) work to ensure that the HFA's prioritisation framework equitably allocates disability support services resources throughout New Zealand and appropriately targets resources to address disparities. b) contribute to the Ministry of Health's development of a new strategic framework for the provision of well integrated and co-ordinated services for people with disabilities, within disability support services and across other government agencies. Goal 8: Greater emphasis on population health approaches Improve population health approaches to improve the overall health outcomes for all New Zealanders, especially those who traditionally have less healthy outcomes. This includes making further progress on immunisation rates, healthier lifestyles, less smoking, better diets, and screening and health promotion programmes. In particular: a) prioritise to shift, over time, funding from programmes that treat illness to programmes that promote and deliver improved health status in the community generally and adopt, as a priority, early interventions designed to lower the level of secondary and tertiary interventions required for individuals. b) develop, in association with the Ministry of Health, consumer groups and others, strategies to address major long-term health issues, including: coronary heart disease stroke cardio-pulmonary disease cancer, including lung and colorectal cancer dementia asthma arthritis diabetes parkinsons and the risk and protective factors for: obesity motor vehicle crashes injuries gender specific health issues healthy lifestyles. c) develop and implement funding plans as resources allow which give effect to the key priorities and desired outcomes set out in existing Government strategies for health improvement: Whaia te ora mo te iwi New Zealand Youth Suicide Prevention Strategy (including both In Our Hands and Kia Piki te Ora o te Taitamariki) National Drug Policy Strategies for the Control and Prevention of Diabetes in New Zealand Breast Cancer Control Strategy Child Health Strategy Sexual and Reproductive Health Strategy Moving Forward, the national mental health strategy Maternity Services Strategy as well as those strategies currently under development: Oral Health Strategy Pacific Health Strategy. d) ensure that all services, regardless of the ring fence NDOC through which they are purchased (personal health, mental health services or public health services), contribute towards improving population health goals and objectives. Goal 9: Well co-ordinated, integrated services that contribute to better health and disability outcomes Develop initiatives that integrate the work of providers of primary and secondary health services so as to maximise the overall health outcomes for people and their communities. In particular: a) expand significantly the use of innovative contracting focused on improving outcomes for individual patients and for the population health by bringing various parts of the sector together, especially the primary and the secondary sectors. b) encourage, through appropriate funding incentives, the involvement of local communities in developing their own solutions to their health issues, by welcoming new ideas that improve health outcomes in an area and/or lead to better and more effective use of health resources. c) support pilot initiatives designed to better integrate primary and secondary health services. d) specifically demonstrate, in your regular reports to the Ministry of Health, the initiatives that are being funded to give effect to this goal. Goal 10: Intersectoral collaboration between agencies and providers to achieve social policy objectives Promote and support collaborative intersectoral initiatives to improve the delivery of health and other social services that recognise the person as a whole. In particular: a) continue to work with other Government agencies to implement the Strengthening Families strategy aimed at breaking the cycle of disadvantage. These programmes are to focus on local specific long-term initiatives that address the needs of children and families with high support needs. b) work with the Ministry of Health, and other Government agencies as appropriate, to contribute to the development and implementation of other intersectoral initiatives. Goal 11: Improved capability and adaptability of the health and disability sector Improve the long-term performance of the health system by enhancing adaptability and the use of information, and ensuring greater coherence between health service purchasing and public hospital ownership strategies. In particular: a) move to longer-term contracts with HHSs and other providers to ensure their ability to plan for the delivery of the services they are contracted to provide. b) move to contracts that provide incentives to improve efficiency in health service delivery, including price/minimum- volume contracting, that commits a provider to a certain minimum, but allows the provider to increase the volume of services they deliver, within the funding they have, where the provider is capable of doing so. c) move to resolve any outstanding issues in contracts with the HHSs that relate to the process of new hospital developments, for example the major developments for Auckland Healthcare (Auckland) and Capital Coast Health (Wellington). d) continue to pilot, trial, develop and/or advance new ways of delivering services, for example, mobile surgery and medical clinics, mobile dentistry clinics and similar initiatives. e) work to improve relationships with health and disability providers and health professionals with the aim of having relationships based on trust and co-operation. f) contribute, as appropriate with other agencies, to the development and, when approved, the implementation of strategies designed to improve the effectiveness and efficiency of the health and disability support system. g) freely share information with providers and other agencies to support planning, funding, monitoring and evaluation of health services. h) contract to allow for flexibility and innovation in the way services are provided. i) significantly improve sector information, including data which provides accurate and timely information on HFA-funded health and disability support service delivery in a cost-effective way in order to: monitor trends in service provision and demand, unmet need and disparities as they affect Mori Pacific peoples and other groups project future trends feed into both strategic and operational planning for future service delivery. Goal 12: Sustainability of the publicly funded health system Fund and develop health services on a sustainable basis, lower compliance and administration costs, and continue to improve management of demand-driven expenditure. In particular: a) give effect to the workforce development objectives outlined elsewhere in this Crown's Statement of Objectives, including the proposed review of the general workforce and clinical training system to be conducted in 2000/01 by the Ministry of Health. b) allocate specific funding to develop the capability to robustly evaluate implemented policy (operational research) to determine whether the expected outcomes have eventuated. c) recognise the importance to all providers of reducing the costs of complying with requirements imposed by the HFA, and contribute to the development of, and fully implement, compliance cost reduction initiatives approved by the Minster of Health. Dated at Wellington this 30th day of September 1999. WYATT CREECH, Minister of Health.