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Third Quarterly Report DHB Crown Funding Agreement

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Third Quarterly Report DHB Crown Funding Agreement Powered By Docstoc
					                                                              Ref. No.: 20071059


EXECUTIVE SUMMARY

DHBs reported on 21 Indicators of DHB Performance (IDP) in quarter three 2006/07.
The DHBs’ performances were varied for this quarter. Only one (Oral Health) IDP
had all 21 DHBs receiving the highest rating.

DHBs were also required to provide additional reports against the Crown Funding
Agreements (CFA) or associated variations, if appropriate. In the third quarter
2006/07, there were 21 additional reporting requirements. However, not all these
reporting requirements were common to all DHBs.

The Ministry assessed each deliverable and provided feedback to each DHB. This
included, where appropriate, a commendation, or a request for further information
where a report was deemed unsatisfactory. This report was produced after DHBs
had fulfilled the additional reporting requirements.




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                                      REPORT

BACKGROUND INFORMATION

1    Quarterly reports are required, as agreed between the Minister and DHBs, in
     DHBs’ respective CFAs.

2    The Operational Policy Framework (OPF) requires DHBs to report on IDP
     targets/deliverables, and other formal reporting requirements. This report
     covers quarter three 2006/07. The Ministry assesses each deliverable, and
     provides feedback to each DHB.           This includes, where appropriate, a
     commendation, or a request for further information where a report is not
     deemed satisfactory. Where a DHB’s report demonstrates performance issues
     or risks, a resolution plan is required, along with confirmation that the DHB
     intends to implement that plan.

3    All DHBs are rated for each of their IDP reports as follows:
     •    Achieved (A)
     •    Partially achieved (P)
     •    Not achieved (N)
     •    Nil report (R)
     •    Not applicable (.).

4    An Achieved rating is not gained by the simple provision of a report for an IDP.
     DHBs must demonstrate, for each IDP, that progress is being made and/or
     targets achieved. This wording was included to take account of an IDP where a
     target/outcome is required to have been met by, say, the end of a fiscal year,
     and some reporting (quarterly / half-yearly) is required to determine progress in
     meeting the target/outcome.

5    The CFA, including associated variations, also requires additional reporting by
     DHBs, for which comment is provided in Appendix B. The above rating system
     does not apply to these particular reports, as they tend to be either
     confirmatory, or they advise of the state of progress of a particular service or
     project.

QUARTER THREE 2006/07 IDPS

6    The following pages illustrate:
     •    page 4—overview of quarter three 2006/07 individual DHBs’ IDP
          performances
     •    page 5—bar chart to graphically illustrate page 5 data
     •    paras 7 to 46 describe sector results for each IDP, and comment on the
          ratings—Appendix A provides descriptions of each IDP.

1.




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                            INDICATORS OF DHB PERFORMANCE ACHIEVEMENT STATUS AS AT 31 MARCH 2007

                  A=Achieved                P=Partially achieved                             N=Not achieved                                                                  R=Nil report                                                                                    =Not applicable




                                                                                                                                                                                                                Nelson Marlborough
                                                                                                                                             Counties Manukau




                                                                                                                                                                                                                                                         South Canterbury
                                                                                                                           Capital & Coast
District Health




                                                                                              Bay of Plenty




                                                                                                                                                                Hawkes Bay




                                                                                                                                                                                                                                                                                                                                                  West Coast

                                                                                                                                                                                                                                                                                                                                                               Whanganui
                                                                                                              Canterbury




                                                                                                                                                                             Hutt Valley



                                                                                                                                                                                                   MidCentral




                                                                                                                                                                                                                                                                                                                                      Waitemata
                                                                                                                                                                                                                                                                            Southland




                                                                                                                                                                                                                                                                                                                          Wairarapa
                                                                                                                                                                                                                                     Northland




                                                                                                                                                                                                                                                                                        Tairawhiti
                                                                                  Auckland




                                                                                                                                                                                                                                                                                                     Taranaki

                                                                                                                                                                                                                                                                                                                Waikato
Boards




                                                                                                                                                                                                                                                 Otago
                                                                                                                                                                                           Lakes
POP-01 Diabetes follow-up                                                         A           P               P            A                 P                  A            A             P       P            P                    P           A       P                  P           P            A          P         A           P           P            A
POP-01 Diabetes management                                                        P           P               A            A                 A                  P            P             P       A            A                    A           P       P                  P           P            A          P         P           P           A            A
POP-01 Diabetic retinopathy screening                                             P           A               P            P                 A                  P            A             A       A            P                    P           A       P                  P           P            P          P         P           A           P            P
POP-01.2.3 Obesity                                                                A           A               A            A                 A                  A            A             P       A            P                    A           A       A                  A           A            A          A         A           A           A            A
POP-01.2.3 Smoking                                                                P           P               P            P                 P                  P            A             P       P            P                    N           P       P                  P           P            P          P         P           P           N            P
POP-02 Cardiac rehabilitation programme                                           A           A               R            A                 P                  A            A             A       A            P                    P           A       A                  A           A            A          P         A           P           A            R
POP-02.3 CVD                                                                      A           A               P            P                 A                  A            P             P       P            P                    A           N       A                  N           P            A          N         A           A           A            N
POP-02.3 CVD follow-up                                                            A           A               N            A                 A                  A            P             P       P            R                    P           P       P                  N           P            A          P         A           A           A            N
POP-03 Organised stroke services                                                  P           P               R            P                 A                  P            P             P       N            P                    A           P       P                  P           A            A          P         P           P           N            P
POP-05 Oral health—percentage of children caries free at age five years 06-07     A           P               A            A                 A                  A            A             A       A            A                    A           A       A                  A           A            A          A         A           A           A            A
POP-06 Oral health—mean DMFT score at year eight                                  A           A               A            A                 A                  A            A             A       A            A                    A           A       A                  A           A            A          A         A           A           A            A
POP-08 (a) Improving the health status of people with severe mental illness
                                                                                  P           A               A            P                 A                  A            A             A       A            P                    A           A       A                  A           A            A          A         A           A           P            P
(total)
POP-12 Progress towards the national target of 95% of two year olds fully         A           A               A            A                 A                  A            A             A       A            P                    A           A       A                  A           A            A          A         A           P           A            R
immunised
POP-14 Radiation oncology and chemotherapy treatment waiting times                A           A               A            A                 P                  P            A             A       P            P                    A           A       A                  A           P            P          A         A           P           A            P
QUA-01 (a) Quality systems                                                        A           A               A            A                 A                  A            A             A       A            A                    P           A       A                  A           A            A          P         A           A           A            R
RIH-01 Progress towards further incorporating health inequalities concepts and
                                                                                  A           A               A            A                 A                  A            A             A       A            P                    R           A       A                  A           A            A          A         A           A           A            A
actions to overall policy, planning, funding and service provision
RIS-01 Service coverage                                                           A           A               A            A                 A                  A            A             A       A            A                    R           A       A                  A           A            A          A         A           A           A            A
SER-01 Accessible and appropriate services in Primary Health Organisations        A           P               A            A                 A                  A            A             A       A            A                    A           A       A                  P           P            A          A         A           A           A            A
SER-02 Care Plus enrolled population                                              A                           A            P                 A                  P            P             P       P            P                    P           P       P                  P           P            P          P         A           P           A            A
SER-04 Low or reduced cost access to first level primary care services            A           A               A            A                 A                  A            A             A       A            P                    A           A       A                  A           A            A          A         A           A           A            A
SER-05 The proportion of laboratory test and pharmaceutical transactions with a
                                                                                  A           A               P            P                 A                  A            A             P       A            A                    A           P       A                  P           A            A          P         A           A           A            A
valid NHI
2.

3.

4.


                                                                                                                                                                                                                                                                                                                                                               4
    5.
                                                                        Number of IDPs




                                                    0
                                                        1
                                                        2
                                                            3
                                                            4
                                                                5
                                                                6
                                                                    7
                                                                        8
                                                                        9
                                                                             10
                                                                             11
                                                                                  12
                                                                                  13
                                                                                         14
                                                                                              15
                                                                                              16
                                                                                                   17
                                                                                                   18
                                                                                                        19
                                                                                                        20
                                       Auckland                                                              21


                                   Bay of Plenty


                                     Canterbury


                                  Capital & Coast


                               Counties Manukau


                                    Hawkes Bay




         Achieved
                                      Hutt Valley


                                          Lakes


                                      MidCentral




         Partially achieved
                              Nelson Marlborough


                                       Northland


                                          Otago

         Not achieved
                                South Canterbury
         Nil report



                                      Southland


                                       Tairawhiti
                                                                                                                  Quarter 3 2006/07 DHB IDP Performances




                                        Taranaki
         Not applicable




                                        Waikato


                                      Wairarapa


                                      Waitemata


                                     West Coast


                                     Whanganui
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6.   POP-01 Diabetes follow-up

7    Ratings:
     •    Achieved—eight DHBs
     •    Partially achieved—13 DHBs.

8    There was no common reason for these 13 DHBs receiving P ratings—
     with DHBs not providing further details and timeframes of sufficient
     quality for the Ministry to alter provisional ratings

7.   POP-01 Diabetes management

9    Ratings:
     •    Achieved—nine DHBs
     •    Partially achieved—12 DHBs.

10   Again, there was no common reason for 12 DHBs to receive a P rating—
     reasons ranged from software problems, gaps between targets and
     actuals, and insufficient progress.

8.   POP-01 Diabetic retinopathy screening

11   Ratings:
     •    Achieved—seven DHBs
     •    Partially achieved—14 DHBs.

12   A number of DHBs were either very close to receiving an A, or had made
     good progress, while others had further work to undertake to improve
     their targets.

9.   POP-01.2.3 Obesity

13   Ratings:
     •    Achieved—19 DHBs
     •    Partially achieved—two DHBs.

14   Both Lakes and Nelson Marlborough DHBs had good results but did not
     receive an A because neither DHB detailed how it is supporting health
     promotion schools to be established.

10. POP-01.2.3 Smoking

15   Ratings:
     •    Achieved—one DHB
     •    Partially achieved—18 DHBs
     •    Not achieved—two DHBs.

16   Hutt Valley was the only DHB with an effective agreement with its PHO
     (public health organisation) to capture smoking status data. Apart from


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     Northland and West Coast DHBs, the other DHBs appear to be
     instituting timeframes and measurable outcomes to this process to
     enable monitoring over time.

11. POP-02 Cardiac Rehabilitation Programme

17   Ratings:
     •    Achieved—14 DHBs
     •    Partially achieved—five DHBs
     •    Nil report—two DHBs (Canterbury and Whanganui).

18   There were varying reasons for the five DHBs that received a P rating,
     including the building of capability, review of performance before making
     changes, and progress towards the capture of more robust data.

12. POP-02.3 CVD (cardiovascular disease)

19   Ratings:
     •    Achieved—10 DHBs
     •    Partially achieved—seven DHBS
     •    Not achieved—four DHBs.

20   While some of the non-Achieved ratings were for insufficient details
     being provided, the main reason related to preparedness and not actual
     data collection, i.e. whether providers had the beginnings of capability to
     measure and record this data.

13. POP-02.3 CVD follow-up

21   Ratings:
     •    Achieved—nine DHBs
     •    Partially achieved—eight DHBs
     •    Not achieved—three DHBs
     •    Nil report—one DHB (Nelson Marlborough).

22   The main Ministry feedback to the non-Achieved DHBs was that it would
     be good to see some level of commitment to this fundamental activity of
     risk assessment and follow-up—well supported by best practice
     evidence, and frequent discussions at every level of government, DHB,
     and PHO.

14. POP-03 Organised stroke services

23   Ratings:
     •    Achieved—four DHBs
     •    Partially achieved—14 DHBs
     •    Not achieved—two DHBs
     •    Nil report—one DHB (Canterbury).


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24    In providing feedback to the DHBs, the Ministry has noted the progress
      that the 16 P and N rated DHBs have made towards the establishment
      of an organised stroke service.

15. POP-05 Oral health - Percentage of children caries-free at age five years
    06-07

25    Ratings:
      •    Achieved—20 DHBs
      •    Partially achieved—one DHB (Bay of Plenty).

26    Bay of Plenty is developing oral health business cases—however, the
      Ministry has informed the DHB that it should have a plan within existing
      services to manage these changing oral health results where the
      percentage caries-free of fluoridated children has declined notably
      against 2005 results.

16. POP-06 Oral health - Mean DMFT score at year eight

27    Ratings:
      •    Achieved—21 DHBs.

17. POP08 (a) Improving the health status of people with severe mental
    illness (total)

28    Ratings:
      •    Achieved—16 DHBs
      •    Partially achieved—five DHBs.

29    Reasons for the five DHBs only receiving a P rating included the setting
      of targets on an annual basis, rather than a monthly basis, insufficient
      data being received, and MHINC (Mental Health Information National
      Collection) data not being up-to-date.

18.     POP-12 Progress towards the national target of 95% of two year olds
fully immunised

30    Ratings:
      •    Achieved—18 DHBs
      •    Partially Achieved—two DHBs
      •    Nil report—one DHB (Whanganui).

31    The two P rated DHBs (Nelson Marlborough and Waitemata) were
      asked to provide comments on the strategies implemented during the
      quarter to improve immunisation coverage, and neither DHB responded
      to these requests. The Ministry will continue to follow-up with these
      DHBs in quarter four.

19.    POP-14 Radiation oncology and chemotherapy treatment waiting times



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32    Ratings:
      •    Achieved—13 DHBs
      •    Partially achieved—eight DHBs.

33    The common reason for the eight P ratings was that those DHBs had
      some patients waiting for longer than 12 weeks.

20.    QUA-01 (a) Quality systems

34    Ratings:
      •    Achieved—18 DHBs
      •    Partially achieved—two DHBs
      •    Nil report—one DHB (Whanganui).

35    Neither of the two partially achieved rating DHBs—Northland and
      Waikato—had completed the Ministry’s template with their initiatives
      aligned with the 10 Improving Quality Goals and effectiveness reported.

21.    RIS-01 Service coverage

36    Ratings:
      •    Achieved—20 DHBs
      •    Nil report—one DHB (Northland).

22.   SER-01 Accessible and appropriate services in Primary Health
Organisations

37    Ratings:
      •    Achieved—18 DHBs
      •    Partially achieved—three DHBs.

38    The three P ranked DHBs—Bay of Plenty, Southland, and Tairawhiti—all
      did not meet the national target. However, Bay of Plenty and Southland
      DHBs provided information on how they are working towards meeting
      the national target.

23.    SER-02 Care Plus enrolled population

39    Ratings:
      •    Achieved—six DHBs
      •    Partially achieved—14 DHBs
      •    Not applicable—one DHB (Bay of Plenty).

40    The partially achieved DHBs are working towards the national goal of
      enrolling 70% of their eligible Care Plus populations by July 2007. The
      achieved DHBs have already had the Care Plus enrolment rates in their
      region’s PHOs exceed 70%.




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41    Bay of Plenty DHB is the only DHB that had no Care Plus enrolments at
      the time of this quarterly review. The DHB has been reminded that, at
      the next July quarterly review, continued Care Plus funding will become
      dependent on the rate of enrolment. The DHB is working with, and
      encouraging, its PHOs to enter the Care Plus programme.

24.    SER-04 Low or reduced cost access to first level primary care services

42    Ratings:
      •    Achieved—20 DHBs
      •    Partially achieved—one DHB (Nelson Marlborough).

43    Nelson Marlborough received a partial rating as it had not demonstrated
      that 100% of increased payments are translating to low or reduced cost
      access for eligible patients, or detailed what processes the DHB has in
      place to address unjust fee increases.

25.   SER-05 The proportion of laboratory test and pharmaceutical
transactions with a valid NHI

44    Ratings:
      •    Achieved—15 DHBs
      •    Partially achieved—six DHBs.

45    Laboratories missing the target was the reason for four of the six DHBs
      receiving partially achieved ratings—Canterbury, Capital & Coast, Lakes,
      and Waikato.

46    Otago and Southland DHBs had data integrity problems, and discovered
      that laboratory reporting was submitted for Otago DHB, along with
      Southland DHB results. Otago and Southland DHBs are working with
      Southern Community Laboratories and HealthPAC to resolve this
      situation—which should be resolved in time for quarter four 2006/07
      reporting.

COMMENT

47    The financial result for the DHB sector, for the nine months ending 31
      March 2007, resulted in a combined unaudited surplus of $19.6M
      reported by DHBs, compared with the planned deficit of $40.2M, which is
      a favourable variance of $59.8M. Appendix C details the financials for
      the period under review.

48    A total of over 450k medical and surgical CWDs (case-weighted
      discharge) were reported as delivered in the nine months to the end of
      March 2007. This is just under 75.1% of the total national CWD plan.
      The sector is on track for a slight over-delivery of the total national
      plan—it is forecast that the medical component will be slightly over-
      delivered, with a corresponding under-delivery in the surgical
      component. Despite the under-delivery, elective CWDs are slightly


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     greater than at the corresponding period last year, and that this trend
     should continue till the end of the year.

IMPLICATIONS FOR REDUCING INEQUALITIES

49   District Strategic Plans (DSP) and District Annual Plans (DAP) are public
     accountability documents, in which DHBs agree, with the Minister, on
     how they will contribute to the New Zealand Health Strategy (2000) and
     the New Zealand Disability Strategy (2001). Within this framework, one
     goal is to reduce inequalities. Meeting the expectations arising from
     these documents via the CFA and IDPs is a tangible indication that
     DHBs have processes in place that will contribute to reducing
     inequalities.




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APPENDIX A
26.

INDICATORS OF          DISTRICT      HEALTH      BOARD       PERFORMANCE
DESCRIPTIONS
27.

28.   POP-01, POP-02, POP-03

Annually in the third quarter—DHBs identified as partially meeting or not
meeting expectations for any component indicator in the third quarter to
provide full reporting in the fourth quarter for that component(s).

29. POP-01 Diabetes follow-up

Good performance on identifying and registering people with diabetes
enhances the ability to target services towards those at most need. This
indicator measures the effectiveness of the healthcare system in identifying
the population with diabetes.

30. POP-01 Diabetes management

31.    The Diabetes Guideline states that target HbA1c levels should be
preferably less than seven. Diabetes is the most common cause of avoidable
loss of vision of people of working age in developed countries. It is reliably
detected by screening, and there are effective treatments to the individual. It
is expected that DHBs will meet the specific targets for this indicator, as
agreed in the 2006/07 DAP. Where the target has not been met, the DHB is
expected to provide commentary and a resolution plan on what it is doing to
address this performance issue.

32. POP-01 Diabetic retinopathy screening

33.   Diabetes is the most common cause of avoidable loss of vision of
people of working age in developed countries. It is reliably detected by
screening, and there are effective treatments.

34. POP-01.2.3 Obesity

35.    Modification of lifestyle factors, such as obesity and exercise, are
crucial components to the prevention of diabetes. People with a body mass
index (BMI) >25 (especially those with BMI >30) can decrease the risk of
diabetes with graduated lifestyle change.

36. POP-01.2.3 Smoking

37.    Modification of lifestyle factors such as smoking, exercise, and obesity
are crucial components to the prevention of CVD.

38. POP-02 Cardiac rehabilitation programme




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There is strong NZ and overseas evidence that patients with coronary heart
disease should be referred to a cardiac rehabilitation programme, except for
individual cases excluded on clinical grounds. Special consideration to cardiac
rehabilitation programmes for appropriateness and acceptability to Māori and
Pacific peoples, who are at high risk, is important. Rehabilitation, post a
cardiac event, is very important to the ongoing minimisation of risk for the
individual.
39.   This indicator attempts to ensure that the services that are provided to
these people are co-ordinated across all providers, so as to ensure the
greatest possible gains for the individual and reduce their risk or follow-on
CVD events.

40. POP-02.3 CVD

41.    CVD is the leading cause of death and morbidity in New Zealand.
Early detection of those at risk and early intervention through primary care are
two of the key approaches to controlling CVD.

42. POP-02.3 CVD follow-up

43.  Treatment of people, with a five-year cardiovascular risk greater than
15% with intensive lifestyle advice and statin therapy, is cost-effective
compared to other community drug therapies that are funded in New Zealand.

44. POP-03 Organised stroke services

45.    There is overwhelming evidence that the most important intervention
that can improve outcomes for all people with stroke is the provision of
organised stroke services. Organised stroke services cover from the acute
stroke event to the eventual discharge from rehabilitation services.

46.   Oral Health Indicators

These indicators provide information that allows DHBs and the Ministry to
evaluate how health promotion programmes, and services such as Well Child
and the School Dental Service (SDS), are influencing the oral health status of
children. The data, itemised by ethnicity and fluoridation status, will enable
DHBs to identify and target the pockets of disadvantage in their districts
where children’s oral health status is poorest. It will also provide DHBs with
information to support the fluoridation of water supplies, which will be
important when dealing with local Council authorities.

POP-05 Oral health—percentage of children caries free at age five years
06-07 (Annually in quarter three for the period 1 January to 31 December
2006)

This indicator provides information on the total number of caries free children
at the first examination after the child has turned five years, but before their
sixth birthday, examined by the DHB SDS.




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POP-06 Oral health—mean DMFT score at year eight (annually in quarter
three for the period 1 January to 31 December 2006)

The total number of permanent teeth of Year eight children, Decayed, Missing
(due to caries), or Filled at the commencement of dental care, at the last
dental examination, before the child leaves the DHB SDS.

47.  POP-08 (a) Improving the health status of people with severe
mental illness (total) (quarterly)

48.    This measure targets improved sufficient access to services that will
lead to improvements in quality of outcomes, and measures the average
number of people domiciled in the DHB region, seen per year, rolling every
three months being reported for three categories—child and youth, adults,
and older people.

49.    POP-12 Progress towards the national target of 95% of two year
olds fully immunised (quarterly)

50.    The aim of this quantitative indicator is for each DHB to identify a four
to six percent improvement in overall immunisation coverage, if its current
annual immunisation coverage is less than 90 percent. For other indicators,
expected targets will be identified from the baseline National Immunisation
Register (NIR) data in the first six months of operation. These indicators will
be negotiated by each DHB depending on when the NIR is implemented and
fully operational in its district for the DHB birth cohort, as there will be an
expectation of increase in the coverage targets over time.

POP-14 Radiation oncology and chemotherapy treatment waiting times
(Part 1 monthly, and Part 2 quarterly

Part 1: Monthly templates that measure the interval between the patient's
referral from a medical practitioner to the oncology department, and the
beginning of radiation/chemotherapy treatment, are supplied on time and
complete from each DHB (or from cancer centre for contributing DHBs as
agreed, including provision of information by DHB of domicile).
Part 2: Each of the six cancer centre DHBs (Auckland, Waikato, MidCentral,
Capital & Coast, Canterbury, and Otago) provide a report updating on
progress towards ensuring all patients receive oncology megavoltage
radiation treatment and chemotherapy treatment according to nationally
agreed standards. This report is to be agreed with all the peripheral DHBs
whose populations have used the service during the quarter.

QUA-01 (a) Quality systems (Annual in the third quarter)

To maximise the quality of services, including cultural appropriateness,
provided and funded by DHBs through effective monitoring and audit and the
promotion of an organisational culture, which is supportive of quality initiatives
and enables a systems approach to quality improvement.




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RIH-01 Progress towards further incorporating health inequalities
concepts and actions to overall policy, planning, funding and service
provision (Measure 1: quarter one, and Measure 2: quarter three)

DHBs are required to report on:
Measure1: key areas of inequalities that are identified within its Health Needs
Assessment
Measure 2: actions/steps taken to address the identified inequalities using an
appropriate equity tool.
51.   RIS-01 Service coverage (quarterly)

This indicator is included to support the active management of service
coverage issues—service coverage gaps affecting a DHB’s population should
be acknowledged in its DAP. Supporting material for each service coverage
gap should include either a workout plan for managing resolution of the gap
identified within the period of the DAP, or background material supporting an
exception to service coverage for the period of the DAP. Where the gap is to
be managed within the period of the DAP, DHBs will be required to report on
progress towards resolution through the service coverage measure in the
Indicators of DHB Performance.

52.  SER-01 Accessible and appropriate services in Primary Health
Organisations (quarterly)

53.    This indicator looks at the utilisation of first level primary health
services through GP consultations in PHOs by high needs populations
compared with rates for the rest of the population. The information for this
indicator forms part of the PHO monitoring framework.

54.   SER-02 Care Plus enrolled population (quarterly)

55.     Care Plus has been designed to give PHOs extra funding to provide
additional services to improve care for individuals with known high health
needs. Implementing Care Plus will involve a PHO developing a focus on
evidence-based practice and quality improvement, better involvement of
patients in its care, multi-disciplinary approaches, and improved care co-
ordination. These are the sorts of capabilities and shifts in service delivery,
which PHOs need to achieve to realise significant health improvements and
significant reductions in health inequalities for their enrolled populations.

56.   SER-04 Low or reduced cost access to first level primary care
services (quarterly)

The policy around the rollout of increased funding associated with the Primary
Health Care Strategy is that the increased subsidy should largely benefit the
patient by way of low and reduced cost general practice fees. This indicator
measures the number of PHO practices that demonstrate that all increased
subsidies translate into low or reduced cost access for eligible patients.




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57.   SER-05 The proportion of laboratory test and pharmaceutical
transactions with a valid NHI (quarterly)

58.    Having valid NHIs (National Health Index) on pharmaceutical and
laboratory test transactions will enable tracking of expenditure and usage by
DHBs’ resident populations. This allows for more accurate analysis of
expenditure against population-based budgets. This indicator also supports
two of the PHO Performance Management financial indicators.




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APPENDIX B
59.

60. ADDITIONAL REPORTING REQUIREMENTS AND REPORTING
REQUIRED BY CROWN FUNDING AGREEMENT VARIATIONS

61.    Child & Family Health

62.    Well Child

Any DHBs, who have yet to confirm that all their Well Child Tamariki Ora
providers are delivering according to the new service specification, to report
on progress made against the plan submitted in quarter one.

Good reports or updates from all 21 DHBs.

Colposcopy

63.    Colposcopy

Confirm that, during the quarter, colposcopy services were provided in
accordance with funder requirements.

Reports received from all 21 DHBs.

Data / NZHIS / National Collections

64.    National Collections

Confirm that data sent to the New Zealand Health Information Service
(NZHIS) for the National Collections during the period were supplied as
specified in the Operating Policy Framework.

Reports sent in by all DHBs. A number of DHBs have MHINC data issues—
NZHIS is working with these DHBs to try to resolve any problems.

Disability Support

65.  Budget 2005 Home Based                   Disability    Support     Services
improvements for the workforce

Auckland, Bay of Plenty, Canterbury, Capital & Coast, Counties Manukau,
Hawkes Bay, MidCentral, Nelson Marlborough, and Waitemata DHBs to
report.

All required DHBs provided good reports.

Disability support services

All DHBs will provide the following written reports to the Ministry as part of the
Quarterly Reporting Template:




                                                                               17
                                                            Ref. No.: 20071059


•    confirmation that the DHB participates in an agreed regional/national
     Aged Residential Care contract management process
•    progress against Health of Older People establishment plan.

All DHBs provided good reports, apart from the Auckland and Nelson
Marlborough DHBs’ reports that were incomplete, and Northland DHB, which
did not provide a report.

Implementation of the New Zealand Disability Strategy

DHBs to report the percentage of staff, both funder and provider arm, who
identify as having a disability.

Eleven DHBs are still in the process of gathering this information.

Immunisation

Outreach Immunisation Services

All DHBs (apart from Canterbury) to provide quarterly reports on ongoing
service delivery of the Outreach Immunisation Services.

All required DHBs provided good feedback.

Maori Health

Mobile Disease State Nursing / Diabetes Service Funding

Capital & Coast to report on whether it has maintained Mobile Disease State
Nursing / Diabetes Services, and also provide a qualitative commentary on
the impact of the Services on Disease and Diabetes outcomes for Maori in the
DHB’s region.

Capital & Coast DHB provided a good, comprehensive report.

Whanau-Ora Services

Canterbury to report on whether it has maintained Whanau-Ora Services, and
also provide a qualitative commentary report on the impact of this service on
Whanau Ora within the DHB region.

Canterbury DHB provided a good report.

Mental Health

Funding for Additional Forensic Services for 2004/05 and outyear
baseline funding

Waikato to provide a report.

A good response received from Waikato DHB.




                                                                             18
                                                            Ref. No.: 20071059


Funding for Additional Regional Alcohol and other Drug Services (ex
Hanmer Devolution)

Nelson Marlborough, South Canterbury, and West Coast to report.

Due to the fact this funding is being applied, there is no longer a need for this
reporting requirement to be separately reported against by either South
Canterbury or West Coast DHBs.

Mental Health Volume Reporting

Each DHB must monitor and evaluate the delivery of Personal Health
Services and Mental Health Services, as set out in its DAP, in accordance
with the requirements of the NZPHD Act.

Good responses from all DHBs, apart from Tairawhiti and Waikato, both of
which were required to provide further information.

Primary Mental Health Initiatives and Innovations Funding

All DHBs, apart from Nelson Marlborough, South Canterbury, Southland, and
Waikato to report.

Very good reports from some DHBs, although further information is required
of other DHBs.

National Health Emergency

Funding for the Provision of Personal Protective Equipment (PPE) in the
event of a National Health Emergency

All DHBs, apart from Waikato, will report quarterly on the total volume of
agreed base and national reserve PPE and critical clinical supplies held by
the DHB.

Good responses received from all DHBs.

Oral Health

Oral Health Regional Co-ordination Services

Hutt Valley, Otago, Taranaki, and Waitemata to report.

Good report from Waitemata DHB. The other three DHBs had difficulties with
delays receiving the necessary HealthPAC data extract for this report.

Price Volume Schedules

Personal Health Volume Reporting

For personal health services, DHBs are required to advise if there has been
any under- or over-delivery in excess of five percent by service.



                                                                              19
                                                           Ref. No.: 20071059


Most DHBs are now providing reports that meet the reporting requirement,
although a few DHBs are still having difficulty meeting the requirement.

Overall, projecting from data reported to the end of March 2007, the sector is
on track to fully delivering the total national CWD (case-weighted discharge)
contract. It is probable that the surgical component will be under-delivered,
possibly by up to 3 - 4%, and there is likely to be a corresponding slight over-
delivery in the medical component. Both elective and acute surgery appeared
to be significantly impacted by the laboratory workers' strike in December
2006.

Primary Health Organisations

District After Hours Planning and Funding Strategic Plan

Generally, good plans—although some DHBs are still awaiting feedback from
the Ministry, or have had time extensions granted before they are required to
provide a plan.

PHO Primary Health Care services funding all DHBs

DHBs to report on:

•    notified fee increases that, pursuant to Schedule F4A of the Standard
     PHO Agreement, have been referred to a regional fee review committee,
     and the outcome of the regional fee review committee process
•    the coverage of, and public access to, local information on the fees PHO
     practices are charging patients.

Good performances from all DHBs.

Quality Systems

Quality

Good feedback from all DHBs.

Reducing Inequalities

Reducing Inequalities Contingency Funding

Seventeen DHBs (apart from Capital & Coast, South Canterbury, West Coast,
and Whanganui) to briefly describe, in relation to each service agreement, the
services and/or resources planned or introduced during the quarter, the
progress/impact of the services and/or resources already introduced, and any
issues or concerns that are affecting the progress/impact of the services
and/or resources.

Good reports from all DHBs.




                                                                             20
                                              Ref. No.: 20071059


Rural Health

Rural Workforce Recruitment and Retention

Written report required from Hawke’s Bay.

Report provided on time by Hawke’s Bay DHB.




                                                             21
                                                            Ref. No.: 20071059


APPENDIX C
66.

67.       2006/07 THIRD QUARTER FINANCIALS

68.

1     DHBs’ success in delivering services, and their success in managing the
      resources in their care, is monitored through regular financial reporting.
      A monthly reporting and assessment cycle measures actual results
      against approved DAPs. DHBs are also required to present to
      Parliament audited Annual Reports incorporating both Financial
      Statements and Statements of Service Performance.

2     The financial data in this Quarterly Report reflects the regular unaudited
      monthly reports from DHBs.

3     The financial result for the DHB sector for the nine months ending 31
      March 2007 resulted in a combined unaudited surplus of $19.6M
      reported by DHBs, compared with the planned deficit of $40.2M. This
      result demonstrates a favourable variance of $59.8M.

4     A summary of performance for each of the three reporting arms,
      Governance, Funder and Provider, is as follows:

      •     Governance—the sector result for this arm was a deficit of $8.1M,
            which was better than plan by $1.9M. The majority of DHBs
            recorded net results that were close to plan, with the largest
            variances being recorded by Auckland ($1.1M favourable),
            Hawke’s Bay ($1.2M favourable), Waikato ($1.7M favourable), and
            Bay of Plenty ($1.4M unfavourable)
      •     Funder—the sector reported a combined surplus of $96.8M. This
            surplus was $73.1M favourable to the planned surplus of $23.7M.
            The main DHBs contributing to the favourable outcome were
            Auckland ($7.9M), MidCentral ($9.1M), Nelson Marlborough
            ($10.1M), Waikato ($13.6M), and Waitemata ($7.9M)
      •     Provider—DHBs reported a total deficit of $69.1M.            This
            represented an unfavourable variance of $15.1M compared with
            the planned deficit of $54.0M. Twelve DHBs have unfavourable
            variances. The main contributors to the unfavourable variance
            were Capital & Coast ($10.4M), MidCentral ($5.6M), and Waikato
            ($5.7M).




                                                                             22
                                                                                                                                                                                                                                                                                                                      Ref. No.: 20071059


APPENDIX D
69.

2006/07 CASE-WEIGHTED DISCHARGE (CWD) DELIVERY UNTIL END
MARCH 2006

Introduction

1    This report is written using CWD delivery data reported to NZHIS by 28
     May 2007. Apart from Capital & Coast DHB, which is consistently
     under-reporting CWD data, there will be little additional data to come for
     the period under review. The absence of Capital & Coast DHB data
     means that a variable percentage of total national data is missing for the
     March quarter, but not enough to materially alter any conclusions about
     overall national trends.

Total CWD delivery until end March 2007

2    A total of 452,819 medical and surgical CWDs were reported as
     delivered to the end of March 2007. This is just under 75.1% of the total
     national CWD plan. Taking the missing Capital & Coast DHB data into
     account, this indicates it is likely that, as a whole, the sector is on track
     for a slight over-delivery of the total national plan. It is, however, virtually
     certain that the medical component will be over-delivered by several
     percent, with a corresponding under-delivery of the surgical component.

                                                                                                                         All DHBs monthly CWD delivery, June 99 to end March 07
    60,000


                                                 Total

    50,000




    40,000




    30,000




    20,000




    10,000




        0
                                                          May-00




                                                                                                                May-01




                                                                                                                                                                      May-02




                                                                                                                                                                                                                            May-03




                                                                                                                                                                                                                                                                                  May-04




                                                                                                                                                                                                                                                                                                                                        May-05




                                                                                                                                                                                                                                                                                                                                                                                              May-06




                                                                                                                                                                                                                                                                                                                                                                                                                                                    May-07
                                                 Mar-00




                                                                                                       Mar-01




                                                                                                                                                             Mar-02




                                                                                                                                                                                                                   Mar-03




                                                                                                                                                                                                                                                                         Mar-04




                                                                                                                                                                                                                                                                                                                               Mar-05




                                                                                                                                                                                                                                                                                                                                                                                     Mar-06




                                                                                                                                                                                                                                                                                                                                                                                                                                           Mar-07
                               Nov-99




                                                                                     Nov-00




                                                                                                                                           Nov-01




                                                                                                                                                                                                 Nov-02




                                                                                                                                                                                                                                                       Nov-03




                                                                                                                                                                                                                                                                                                             Nov-04




                                                                                                                                                                                                                                                                                                                                                                   Nov-05




                                                                                                                                                                                                                                                                                                                                                                                                                         Nov-06
             Jul-99
                      Sep-99


                                        Jan-00




                                                                   Jul-00
                                                                            Sep-00


                                                                                              Jan-01




                                                                                                                         Jul-01
                                                                                                                                  Sep-01


                                                                                                                                                    Jan-02




                                                                                                                                                                               Jul-02
                                                                                                                                                                                        Sep-02


                                                                                                                                                                                                          Jan-03




                                                                                                                                                                                                                                     Jul-03
                                                                                                                                                                                                                                              Sep-03


                                                                                                                                                                                                                                                                Jan-04




                                                                                                                                                                                                                                                                                           Jul-04
                                                                                                                                                                                                                                                                                                    Sep-04


                                                                                                                                                                                                                                                                                                                      Jan-05




                                                                                                                                                                                                                                                                                                                                                 Jul-05
                                                                                                                                                                                                                                                                                                                                                          Sep-05


                                                                                                                                                                                                                                                                                                                                                                            Jan-06




                                                                                                                                                                                                                                                                                                                                                                                                       Jul-06
                                                                                                                                                                                                                                                                                                                                                                                                                Sep-06


                                                                                                                                                                                                                                                                                                                                                                                                                                  Jan-07




                                                                                                                                                                                                                                                                                                                                                                                                                                                             Jul-07




Medical CWD delivery until end March 2007

3    To the end of March 2007, the sector reported delivery of 218,245
     medical CWDs. Despite the impact of the low December and March



                                                                                                                                                                                                                                                                                                                                                                                                                         23
                                                                                                                                                                                                                                                                                                                                  Ref. No.: 20071059


     delivery (shown below), this is 80% of the total medical plan for the year.
     The highest recorded medical plan delivery to the end of the third
     quarter, during the last seven complete years, is only 77%—so this is a
     strong indication that the total medical plan will be over-delivered by
     several percent at the end of the year.

4    It is, however, possible that the long period of settled fine weather
     experienced during April and May will result in lower than normal
     medical discharges in those months, so the over-delivery of the medical
     plan may not be as great as a straight-line projection indicates.

                                                                                                         All DHBs monthly medical CWD delivery, June 99 to end March 07

    30,000


                                        All medical

    25,000




    20,000




    15,000




    10,000




     5,000




        0
                                                          May-00




                                                                                                                May-01




                                                                                                                                                                      May-02




                                                                                                                                                                                                                            May-03




                                                                                                                                                                                                                                                                                  May-04




                                                                                                                                                                                                                                                                                                                                        May-05




                                                                                                                                                                                                                                                                                                                                                                                              May-06




                                                                                                                                                                                                                                                                                                                                                                                                                                                    May-07
                               Nov-99


                                                 Mar-00




                                                                                     Nov-00


                                                                                                       Mar-01




                                                                                                                                           Nov-01


                                                                                                                                                             Mar-02




                                                                                                                                                                                                 Nov-02


                                                                                                                                                                                                                   Mar-03




                                                                                                                                                                                                                                                       Nov-03


                                                                                                                                                                                                                                                                         Mar-04




                                                                                                                                                                                                                                                                                                             Nov-04


                                                                                                                                                                                                                                                                                                                               Mar-05




                                                                                                                                                                                                                                                                                                                                                                   Nov-05


                                                                                                                                                                                                                                                                                                                                                                                     Mar-06




                                                                                                                                                                                                                                                                                                                                                                                                                         Nov-06


                                                                                                                                                                                                                                                                                                                                                                                                                                           Mar-07
             Jul-99
                      Sep-99


                                        Jan-00




                                                                   Jul-00
                                                                            Sep-00


                                                                                              Jan-01




                                                                                                                         Jul-01
                                                                                                                                  Sep-01


                                                                                                                                                    Jan-02




                                                                                                                                                                               Jul-02
                                                                                                                                                                                        Sep-02


                                                                                                                                                                                                          Jan-03




                                                                                                                                                                                                                                     Jul-03
                                                                                                                                                                                                                                              Sep-03


                                                                                                                                                                                                                                                                Jan-04




                                                                                                                                                                                                                                                                                           Jul-04
                                                                                                                                                                                                                                                                                                    Sep-04


                                                                                                                                                                                                                                                                                                                      Jan-05




                                                                                                                                                                                                                                                                                                                                                 Jul-05
                                                                                                                                                                                                                                                                                                                                                          Sep-05


                                                                                                                                                                                                                                                                                                                                                                            Jan-06




                                                                                                                                                                                                                                                                                                                                                                                                       Jul-06
                                                                                                                                                                                                                                                                                                                                                                                                                Sep-06


                                                                                                                                                                                                                                                                                                                                                                                                                                  Jan-07




                                                                                                                                                                                                                                                                                                                                                                                                                                                             Jul-07
Surgical CWD delivery until end March 2007

5    A total of 234,574 surgical CWDs were reported in the first nine months
     of the year. This represents 71.1% of the total national plan. On
     average, at a national level, 75% of a year’s total surgical CWDs are
     delivered in the first nine months of the year. At this time, it is not
     possible to predict, with accuracy, by what percentage the total national
     plan will be under-delivered over the course of the year, but a 3% - 5%
     deficiency is possible, if not likely.

6    Surgical delivery was affected by the December strike, as shown in the
     chart below, which includes total, acute, and elective delivery curves. As
     might be expected, elective delivery was impacted to a greater extent
     than acute delivery, but both were anomalously low, resulting in the low
     total surgical delivery.

7    As noted in the December quarter report, the low total surgical CWD
     delivery is not uniform across the country.        Auckland, Counties
     Manukau, and Waikato DHBs are normally responsible for about 35% of
     all surgical CWD delivery, and are the principal contributors to the low


                                                                                                                                                                                                                                                                                                                                                                                                                                           24
                                                                                                                                                                                                                                                                                                                               Ref. No.: 20071059


     national delivery. It is not possible to assess Capital & Coast DHB’s
     delivery because of missing data.

8    The strike contributed to the under-delivery, but did not cause it. Both
     Auckland and Counties Manukau DHBs have been consistently under
     the anticipated delivery curve all year so far, and Waikato DHB has been
     under the required delivery rate for the last three months. Most other
     DHBs are either at or near the expected level of delivery for this time of
     year, or at least in a position where full or near full delivery can still be
     achieved.

9    Despite the under-delivery, elective CWDs are reported at just over
     101% of those delivered in the same period last year (101,198 compared
     with 100,007). Capital & Coast DHB’s missing data will increase this
     figure—with all other things being equal, a slightly greater delivery of
     elective CWDs can be expected for 2006/07 compared with 2005/06.


                                                                                                        All DHBs monthly surgical CWD delivery, June 99 to end March 07
    35,000
                                                                                     Sub-total surgical
                                                                                     Surgical acute
    30,000                                                                           Surgical elective




    25,000




    20,000




    15,000




    10,000




     5,000




        0
                                                          May-00




                                                                                                                May-01




                                                                                                                                                                      May-02




                                                                                                                                                                                                                            May-03




                                                                                                                                                                                                                                                                                  May-04




                                                                                                                                                                                                                                                                                                                                        May-05




                                                                                                                                                                                                                                                                                                                                                                                              May-06




                                                                                                                                                                                                                                                                                                                                                                                                                                                    May-07
                                                 Mar-00




                                                                                                       Mar-01




                                                                                                                                                             Mar-02




                                                                                                                                                                                                                   Mar-03




                                                                                                                                                                                                                                                                         Mar-04




                                                                                                                                                                                                                                                                                                                               Mar-05




                                                                                                                                                                                                                                                                                                                                                                                     Mar-06




                                                                                                                                                                                                                                                                                                                                                                                                                                           Mar-07
                               Nov-99




                                                                                     Nov-00




                                                                                                                                           Nov-01




                                                                                                                                                                                                 Nov-02




                                                                                                                                                                                                                                                       Nov-03




                                                                                                                                                                                                                                                                                                             Nov-04




                                                                                                                                                                                                                                                                                                                                                                   Nov-05




                                                                                                                                                                                                                                                                                                                                                                                                                         Nov-06
             Jul-99
                      Sep-99


                                        Jan-00




                                                                   Jul-00
                                                                            Sep-00


                                                                                              Jan-01




                                                                                                                         Jul-01
                                                                                                                                  Sep-01


                                                                                                                                                    Jan-02




                                                                                                                                                                               Jul-02
                                                                                                                                                                                        Sep-02


                                                                                                                                                                                                          Jan-03




                                                                                                                                                                                                                                     Jul-03
                                                                                                                                                                                                                                              Sep-03


                                                                                                                                                                                                                                                                Jan-04




                                                                                                                                                                                                                                                                                           Jul-04
                                                                                                                                                                                                                                                                                                    Sep-04


                                                                                                                                                                                                                                                                                                                      Jan-05




                                                                                                                                                                                                                                                                                                                                                 Jul-05
                                                                                                                                                                                                                                                                                                                                                          Sep-05


                                                                                                                                                                                                                                                                                                                                                                            Jan-06




                                                                                                                                                                                                                                                                                                                                                                                                       Jul-06
                                                                                                                                                                                                                                                                                                                                                                                                                Sep-06


                                                                                                                                                                                                                                                                                                                                                                                                                                  Jan-07




                                                                                                                                                                                                                                                                                                                                                                                                                                      25

				
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