Ministerial Review Group Report Recommendations
Meeting the Challenge: - Enhancing Sustainability and
the Patient and Consumer Experience within the Current Legislative
Framework for Health and Disability Services in New
Zealand
We are generally supportive of the aims of this report, and of
the recommendations it makes, although in respect of many of them,
our support is conditional on the detail which has yet to be
determined.
We believe that the report identifies many inefficiencies in the
current health system, and the recommendations, at face value,
identify options for improving the system.
We note that although the report does not recommend disbanding
DHBs, or reducing their number, it does specifically comment "we
have been struck by the lack of support for maintaining 21 separate
DHBs". The NZMA has adopted a position that there are too many DHBs
and we continue to advocate for consolidation into a much smaller
number of larger and more capable DHBs. We think that to achieve
the full benefits from implementing the recommendations in this
report, it will be necessary for substantial consolidation to
occur.
We strongly support the report's thrust towards greater national
coordination of services, a concept that the NZMA has been
advocating for years. In this context, we support the principle of
the National Health Board (NHB) and the National Shared Services
Agency (NSSA), although we have reservations about the ability to
make savings in resources and personnel given the continuing
existence of the 21 DHBs. We also question the balance of
directional 'power' between the MOH and a new NHB, and as we state
later, see no value in persisting with DHBNZ.
Further we see significant tension in superimposing a regional
structure and tasks over the existing DHB structure, particularly
without additional resources.
While we are pleased to see the recognition the report gives to
matters of workforce we are deeply concerned about the proposal to
move all matters of workforce (seemingly including policy) out of
the Ministry of Health and into the NHB with the creation of a
National Health Workforce Board (NHWB). We are concerned
that
a) by shifting workforce policy development into the NHB
there is significant potential for policy to be too heavily
influenced by the day to day operational needs of the DHBs, thus
losing focus on the bigger picture and the needs of our workforce
10 or 20 years in the future, and
b) Health workforce planning is much bigger than any focus
that current DHBs (as principally service deliverers) seem capable
of applying themselves to.
Also in respect of workforce, we note the concern expressed about
New Zealand's extremely heavy reliance on International Medical
Graduates. This is an issue which has concerned the NZMA for many
years, and we have applauded recent moves to reduce this
reliance.
One matter not covered in the report which we believe does need
consideration is the future status of DHBNZ and the various roles
it undertakes on behalf of the DHBs. It would seem to us that
with the proposed creation of the NHB, that this body would become
superfluous. The NZMA would be concerned if the DHBs considered
that there was a need for a DHBNZ-like organisation to continue. We
are also disappointed that the report does not explicitly recognise
the positive place of clinical research and its key role in quality
and safety.
Our comments in regard to each of the specific recommendations
made in the report are set out below:
1 Closer to home: new models of care
The MRG recommends that the Government:
(a) Require the NHB (for national services) and the DHBs (for
regional and local services) to report annually on the development
of clinical networks and assess their cost-effectiveness in helping
to deliver seamless care for patients,
We agree.
(b) Clarify that the role of PHOs is: to do more to keep people
well; to reduce avoidable hospital admissions and unplanned
readmissions; to share responsibility for shifting services from
secondary to primary settings when sensible; and to reduce
unnecessary GP referrals,
This alters and widens the role of PHOs and is consistent with
the government's intention to strengthen the capacity of PHOs. We
support the principle, but it will be necessary to ensure funding
and resources are available to support these changed
requirements.
(c) Reduce the management fees paid to PHOs with an enrolled
population of less than 40,000 and use the resulting savings to
help these PHOs to transition to a stronger management
configuration (e.g. via amalgamation, confederation, or some other
arrangement for sharing managerial support.
This is also consistent with the government's intention to
strengthen the capacity of PHOs, and the NZMA supports the intent
of the proposal. However, care must be taken in implementation to
ensure that existing successful and capable smaller PHOs are given
the opportunity and support to continue functioning, albeit with
enhanced management arrangements.
(d) Require DHBs to agree protocols and establish agreements,
with contractual and financial incentives, among community,
primary, and secondary providers to develop new models of care that
are patient-centric, less fractured, and more cost-effective. This
should include agreements to reduce avoidable hospital admissions
and unplanned readmissions to develop cost-effective substitutes
for secondary care to strengthen incentives for more efficient and
effective use of referred services. Financial incentives for risk
sharing should be strengthened for those PHOs who already have the
capability to manage the financial risks associated with taking
greater responsibility for the health of their enrolled
populations. DHBs should also be required to report on the
development of these agreements and assess their
cost-effectiveness,
This expands on the earlier proposals, and makes sense. However,
specific provision needs to be made for the involvement of
practices and their representative organisations in these
processes, not just DHBs and PHOs as is currently the case.
(e) The NHB should assume responsibility for the preparation of
nationally consistent contracts that DHBs, PHOs, and others might
choose to use for the purpose of meeting the requirements in
recommendation (d) above. These contracts should include some form
of revenue and cost sharing where appropriate,
We agree in principle but note that the contracting processes
need to be structured effectively, unlike the current
unsatisfactory PSAAP arrangement. In particular they must
include contractual arrangements between PHOs and general
practices.
(f) Reassess the role of the PHO Performance Programme in the
light of the development of these broader arrangements,
We agree that the PHO Performance Programme (PPP) needs to be
re-assessed, and it is very important that general practice,
through its national representative organisations, is part of the
reassessment process and the development of new arrangements.
Consideration must also be given to the fact that the current
programme does have some positive impact on the quality of service
delivery, and provides a limited income stream for practices.
Simply cancelling the current programme without a replacement in
place may potentially have an adverse impact on services and
practice incomes. Like many other quality measure areas, we
would support a health outcome based performance review system,
rather than the current "tick box" quality measures.
(g) Ensure that the NHB, DHBs and PHOs work together to develop
shared electronic access to common patient records based on a
distributed approach (see Annex 3) and within a reasonable
timeframe, and
We agree, with the proviso that general practice, through
relevant national professional organisations, must also be
involved.
(h) Within three years, the Government should seek an assessment
of those PHOs that are not successfully meeting the requirements of
their role with a view to removing them.
We agree that an assessment needs to be made but we do not
believe that the process should take three years, particularly
where it becomes apparent that some PHOs have not attempted to meet
their requirements, perhaps because they are unable to do so.
2 Improving patient safety and quality of
care
(a) The quality programmes initiated by QIC are used as a
foundation to develop the next phase of national quality and safety
programmes that address patient safety and continuous quality
improvement. Existing initiatives should become business as usual
for DHBs, who should assume the funding for them as the existing
QIC budget is worked through,
We agree.
(b) The current PHO Performance Programme should be scaled back
for a period and the resulting savings used to help accelerate the
introduction of quality improvement for primary care using the
Q14GP as a starting point, and
See earlier comments.
(c) An independent national quality agency is established to
replace QIC and with responsibility for helping providers across
the whole sector improve patient safety and service quality, with
the following roles and characteristics:
(i) The agency is independent of the regulatory, funding and
performance monitoring agencies of government, reporting directly
to the Minister and with its own staff,
(ii) The agency's role should be to: develop a menu of
'certified' programmes for providers to choose from; develop safety
and quality standards and guidelines; benchmark and gather
comparative data on what works and why; run workshops aimed at
helping clinicians and managers to make improvements; and publish
national reports of quality indicators e.g. serious and sentinel
events,
(iii) The agency should act to ensure sector buy-in to its
programmes, recognising that programmes will not be sustained if
they are mandated and forced on the sector,
(iv) Agency funding should be a mixture of top sliced PBFF
(recognising the proportion of the agency's time devoted to DHBs),
and charging private providers who want to use it for managing the
implementation of agency-certified programmes, and
(v) At some point, this agency should become more independent of
government and be funded by a mixture of fee-based quality
programmes and financial subscriptions from public and private
member organisations.
2(c) (i) - (v) We agree with the idea in principle but would
need to see further detail. We believe that such an entity must
operate subject to clinical governance and clinical engagement
principles.
3 Identifying the services people need: funding new
services
The MRG recommends that the SPNIA process be abandoned and replaced
with:
(a) A reconfigured and strengthened NHC with the role of
evaluating all new - and an ongoing selection of existing - health
and disability services. This role to include:
(i) Assessing the extent to which new health and disability
services are clinically safe and should attract public funding
based on their effectiveness and cost,
(ii) Determining the conditions under which new publicly funded
services should be made available, including the eligible patient
group, restrictions on the provider (e.g. tertiary hospitals only)
and/or the situations in which the new service should be used (e.g.
trial only),
(iii) Selectively reviewing funding for existing interventions
to identify which should no longer qualify for public funding based
on their effectiveness and cost, and
3 (a) (i) - (iii) We agree with the principle but need to see
more detail.
(b) That when it is possible for Pharmac to assume
responsibility for a nominal budget for medical devices from DHBs,
then Pharmac should assume the same responsibilities and apply the
same processes to these devices as it currently does for hospital
pharmaceuticals,
While we fully support the idea of centralising arrangements for
purchasing of medical devices, we have some reservations about it
being undertaken by Pharmac. Many in the health sector do not
regard Pharmac in a totally positive light, and the factors
involved in managing the purchase of medical devices may be
significantly different from those involved in the purchase of
pharmaceuticals. Any such central purchasing process must be more
transparent in its processes than Pharmac has historically been. In
the interests of consistency it must also be more mindful of the
commercial risks to NZ of ostracizing certain suppliers. It must
also work with private purchasers within New Zealand, as many new
devices may well be of such expense that initially they would
benefit from a shared introduction to New Zealand.
(c) A new national procurement agency recommended in Section 12
below 'Shifting resources to the front-line' should establish a
process for gradually assuming responsibility from DHBs for the
collective procurement of, and managing the supply chain for,
medical devices used in public hospitals that are not managed by
Pharmac, and
We agree.
(d) The scope of Medsafe's activities be extended to cover
regulation of the safety of medical devices, in conjunction with
the Therapeutic Goods Administration in Australia. Given the
scarcity of regulatory expertise, this could involve a process for
recognising the regulatory decisions of similar jurisdictions as
applicable in New Zealand, at least in the first instance.
We agree.
4 The right service in the right place: changing service
configuration
The MRG recommends that:
(a) The Minister establish a positive list of national services
that will be planned and funded by the NHB and financed by top
slicing the PBFF currently allocated to DHBs for that purpose. The
NHB would then contract with a selection of DHBs to deliver these
national services for the entire country,
We agree.
(b) The NHB establish a transparent process for advising the
Minister about which services currently planned, funded, and
provided at the national, regional, and local levels should be
organised at a different level in future,
We query whether the NHB should be the appropriate body for
this. The NHB may be too close to its next tier DHBs to be
able to provide true independent and unbiased advice to The
Minister. We believe that the Ministry of Health should remain the
principal body responsible for advising the Minister on these and
other broader policy matters.
(c) DHBs be required to produce RSPs across a wide range of
services. The initial plans should focus on planning and funding
for vulnerable services as well as those whose longer-term clinical
and financial viability clearly depends on servicing a larger,
regional population,
We agree in principle but advise that we have concerns (noted
above) about superimposing a regional structure on the DHBs,
particularly without resources. Given current government policy to
retain 21 DHBs, however, we accept that this may be a necessary
step. The NZMA continues to advocate for substantial consolidation
of DHBs.
(d) DHBs be asked to delegate authority to their Chairs and CEOs
to make decisions on their behalf at the regional level and who
will become the regional service's governance body accountable for
the development and implementation of the RSP,
We agree.
(e) In those rare cases when DHBs cannot agree on the RSP, these
disputes be escalated to the NHB for resolution and that it
identifies the most clinically and financially viable option that
delivers a quality service,
We agree.
(f) The NHB contract on behalf of the Minister with DHBs for
regional and local service and planning, and delivery, and monitor
DHB performance, thus taking this function out of the Ministry,
We agree.
(g) That over the next 12 months the Ministry be asked to work
through the various policy and machinery of government issues
associated with devolving all of the $2.5 billion of NDE currently
managed by the Ministry to either the NHB (national level) or DHBs
(regional and local level) and advise the Government accordingly
(Annex 4), and
We agree.
(h) That the Ministry of Health's role focuses increasingly on
providing policy advice, administration of regulations, monitoring
the NHB, and servicing the Minister's office.
We agree.
5 The right capacity for the future: making better
investments
The MRG recommends that:
(a) The roles and functions ascribed to the NHB in this report
would be transferred to the CHFA, who would operate as the NHB. The
Minister will need to reconsider the current membership of the CHFA
Board in order to ensure that it is best placed to manage its new
roles and functions. As part of the transition arrangements, a
temporary establishment board might be appointed to manage the
transition, and
No comment.
(b) The proposed NHB is made responsible for capacity planning
and funding, including workforce, capital, and IT.
As noted above, while we support both the recognition of
workforce as a major issue, and the consolidation/coordination of
work in this field, we have serious reservations about workforce
policy being contained solely within the NHB. We believe that it is
essential that at least the policy component of workforce effort be
retained in the Ministry, to ensure that the "bums on seats"
approach to workforce taken by DHBs does not dominate. . DHBs may
be too focussed on short term balance sheets to be able to fully
plan long term for the greater good.
6 Shifting resources to the front-line
The MRG recommends:
(a) The creation of a Pharmac-like national shared service
agency with a mandate to manage the assessment, standardisation,
management, purchasing, and/or supply chain management of any of
the common back office functions of DHBs that are referred to it by
the Minister of Health (Annex 4), and
While we strongly support the concept of a NSSA we have
considerable reservation about the proposal that it be
"Pharmac-like". As discussed earlier, there is less than universal
support for Pharmac within the sector.
(b) The NHB be required to:
(i) Establish a process for working through the entire range of
common DHB back office services to identify a list of services that
are best supplied by a single national provider, starting with
non-pharmaceutical hospital procurement (Annex 4), and
(ii) Depending on how long it will take to establish the
proposed national shared service agency, manage the existing three
shared service functions that we propose be shifted out of the
Ministry and into the national agency (i.e. Healthpac, Audit and
Compliance, Health System Reporting Information).
6(b) (i) and (ii). We agree.
7 Getting more from our public hospitals: improving
hospital productivity
The MRG recommends that:
(a) DHBs be required to identify the top three or four
productivity measures each year that are most important to them and
report progress against the improvement targets they have set for
themselves, and
We agree.
(b) The NHB should ensure that:
(i) Productivity measures should be developed for use at system and
hospital level. These should be developed by a credible, expert,
and independent source, and
(ii) Clinical productivity measures should be developed at the
appropriate level, with strong clinical input.
7 (b) (i) and (ii). We agree. But these must be real measures of
health outcome, and not just populist to placate the voter.
8 Further work
The MRG recommends that the Ministry report on 14.1 and 14.3 and
within its first year of operation the NHB:
(a) Reviews the arrangements for the planning, funding, and
provision of national, regional, and local laboratory and
radiological diagnostic services with a view to determining the
optimal planning, funding, and service configuration arrangements
for New Zealand, and
(b) Reports to the Minister on how to best address the other
issues raised for further work in this section of the report.
8 (a) and (b). We strongly support more nationally
consistent planning of services. The NZMA has advocated for this
approach for many years. However this work must not be left to the
NHB alone. There is a requirement for high level policy guidance on
these services which must come from the Ministry.
9 Conclusion
The MRG recommends that, within three years, the
Government:
(a) Seeks an assessment of the extent to which the public health
and disability sector is likely to be able to continue lifting
performance without requiring an ever larger share of GDP, and
(b) Identifies the changes in the New Zealand Public Health and
Disability Act 2000, or replacement legislation, required to
simultaneously secure the sustainability and lift the performance
of the public health and disability system so it is ready to
introduce these changes if a change in the legislative framework is
deemed necessary following the assessment in (a) above.
9 (a) and (b). We agree.
Annex 1 Current and Proposed Structures
As noted above, while we strongly support the move to
rationalise services and see merit in the creation of the NHB and
NSSA we are not certain that the creation of these entities and the
restructuring of the MOH will achieve the expected savings while
the system continues to carry the overheads of 21 DHBs.
We were surprised that discussion on structures did not mention
DHBNZ, the roles that it has undertaken, and its future role if
any. We have always been critical of the existence and roles of
DHBNZ in its non-statutory capacity, and we would be disappointed
if the DHBs were to continue to see the need for DHBNZ or a similar
body to be super-imposed over other structures.
Annex 2 Terms of Reference: Clinical Leadership and
Quality
1 Enhancing Clinical Leadership
The MRG recommends that:
(a) The NHB should develop a cultural change programme aimed at
enhancing:
(i) Recognition of and support for health care leaders, including
via an annual leadership award programme celebrating and showcasing
outstanding health care leaders from all parts of the sector,
and
(ii) The ability of clinicians and managers to form productive
partnerships, both within the hospital sector and across
sectors.
1 (a) (i) and (2). We agree.
The MRG recommends that:
(a) DHBs should ensure that formal position descriptions are
agreed, including annual performance expectations and leadership
performance development plans for each formal clinical leadership
role, from departmental to executive level in every organisation,
and
We agree.
(b) DHBs should ensure that clinicians taking on full-time
leadership roles are assured on appointment of formal support for
return to clinical practice at the conclusion of the
appointment.
We agree.
The MRG recommends that:
(a) DHBs should ensure that formal clinical leadership roles are
recognised by the allocation of sessional time during the working
week to fulfil their duties.
We agree.
The MRG recommends that:
(a) The Minister should seek advice on how best to
encourage universities to:
(i) Further embed and develop the academic status of the discipline
of clinical leadership, supporting research in multi-disciplinary
models and further formalising academic achievement in this area,
including via the establishment of relevant Chairs, and
(ii) Ensure undergraduate courses in all health disciplines
include formal attention to leadership development appropriate to
each year of the curriculum, both in theory and in practice.
(a) (i) and (ii). We agree.
The MRG recommends that:
(a) DHBs should ensure that new appointments to clinical leadership
positions receive a personalised assessment of leadership
development needs, together with support and training to anticipate
and understand environmental factors and their consequences and the
opportunity for multi-disciplinary leadership skills development
and mentoring,
We agree.
(b) DHBs should ensure that a package of resources focusing on
leadership skills and qualities is available to support clinicians
in leadership positions as part of professional development
programmes, to ensure leaders have the tools to work across
contemporary boundaries to collaborate to achieve the best
outcomes,
We agree.
(c) DHBs should consider including a formal requirement for
three to six months within a suitable mentoring partnership for all
new appointments to leadership positions and all promotions. The
mentoring partnership should be defined by formalised expectations
of both partners and specified outcomes, and education and training
made available to those new to offering mentoring support to new
leaders, and
We agree.
(d) DHBs should ensure that potential future leaders showing
early promise are offered opportunities to develop their skills and
competencies through involvement in performance improvement
initiatives.
We agree.
2 Initiatives to increase elective services and reduce
patient waiting times, improve access to timely primary and
hospital services and improve productivity and quality of services
for patients
The MRG recommends that:
(a) Planning within DHBs to meet the Government's elective
surgery targets should be led by clinicians from both the primary
and hospital sectors in partnership with managers to ensure
appropriate allocation of clinical priorities between and within
specialties as well as capability between locations, and ensure
suitable clinical provision is in place. In the occasional case
where agreement cannot be reached within the specified timeframe,
the matter will be elevated to the National health Board for
decision, and
We agree. It is essential that primary care clinicians and their
representative organisations be involved in this planning.
(c)(sic) DHBs should review local primary care access to
appropriate diagnostics to ensure appropriate direct access is made
available in a planned and evaluated way, ensuring that all service
demands are fairly and transparently prioritised.
We believe that in the interests of national consistency,
including access to services, this must be carried out in
accordance with nationally established guidelines.
The MRG recommends that:
(a) Clinical leaders should be supported to trial, develop, and
lead the implementation of new scopes of practice and supporting
workforce models.
We agree. Clinical research to support these activities must be
funded and supported.
The MRG recommends that:
(a) A national campaign (led from the highest level) be
undertaken by the Ministry to explain and promote agreed national
prioritisation tools.
We agree.
The MRG recommends that:
(a) Further work should be undertaken by the Ministry to promote
examples of good practice in supporting primary care to manage
unmet needs and to ensure implementation nationally.
We agree. There is untapped potential within primary care to
meet unmet need, provided that appropriate resources are made
available.
The MRG recommends that:
(a) The NHB should ensure that:
(i) Productivity measures should be developed for use at system and
hospital level. These should be developed by a credible, expert,
and independent source, and
(ii) Clinical level productivity measures should be developed at
a departmental and clinician level with strong clinical input.
(a) (i) and (ii). We agree. However, it is critical that
national professional bodies are involved, and that appropriate
recognition is made of the major workforce pressures extant in most
workplace situations.
3 Ways to establish clinical networks and leadership
programmes to support these goals
The MRG recommends that:
(a) Irrespective of their origin, clinical networks
should:
(i) Have clear terms of reference and reporting arrangements,
(ii) Be led by clinicians with appropriate qualifications and a
record of achievement in management - appointments to leadership
positions should be for a fixed term and holders should maintain
some clinical role,
(iii) Normally include representatives from across the breadth
of health care and include an expectation of a holistic approach to
recommendations,
(iv) Include regular measurement and reporting of outcomes and
outputs in their terms of reference as well as assessment for
impact in the local environment,
(v) Have a clear plan of how their quality and process outcomes
will be given effect,
(vi) Expect to disband once they have fulfilled their
objectives, and
3 (a) (i) - (v). We agree.
(b) Dedicated project support should be available for those
networks fulfilling the requirements above and with clear quality
and process outcome targets, and
We agree.
(c) Clinical leaders, particularly of those formal national
networks established by the Ministry or NHB to meet programmed
tasks and defined timeframes, should have a recognised allocation
of time for the role and their employer reimbursed to enable
back-filling of the position.
We agree. In addition, as recognised elsewhere in this report,
provision must be made for clinicians from the private sector
involved in this work to be fully compensated for their time. To
date, the lack of adequate compensation has been a major barrier in
respect of clinician involvement in policy development and
implementation.
4 Establishing and fostering greater clinical leadership in
primary care and across primary and hospital care within DHBs -
primary and hospital integration
The MRG recommends that:
(a) PHOs should be assessed for their level of
preparedness including governance and management capability and
support infrastructure, clinical engagement, 'community'
engagement, and then offered delegated budgets with accountability
for, and take some financial risk around, delivering quality and
financial outcomes,
The NZMA has long been concerned about the numbers and highly
variable capacity of PHOs, and the "lasse-faire" policies which
have allowed their proliferation. We fully support the review of
PHOs in this regard, and are comfortable with the principle of PHOs
accepting greater accountability along with fiscal risk, but our
final support will depend on the detail, and the implications for
practices.
(b) Where practicable and desired by stakeholders, co-location
of PHO primary care services, hospital and related NGO services
should be considered. This may include the development of
Integrated Family Health Centres, virtual connections between
existing entities or other configurations involving all components
of primary care delivery, in a patient-centric manner. Such
concepts would constitute primary care clinics made up of GPs,
nurses, allied health professional and hospital specialists,
The NZMA supports the principle of Integrated Family Health
Centres (IFHCs), under conditions in which the interests of
communities, patients and providers are protected. It is essential
that the needs of stakeholders (including general practices) are
taken into account, and that these proposals are not driven by a
"top-down" approach. The NZMA has a well-developed formal position
on IFHCs.
(c) DHBs will need to ensure that it is clear what their funding
arms are responsible for and what responsibilities and risks have
been delegated to PHOs as part of any delegated funding and risk
sharing arrangement e.g. in order to avoid overlap or competition
between funders, and
We agree.
(d) DHB funding of PHOs should be less prescriptive about tying
funding to a certain workforce mix and instead put a greater focus
on the outcome they are looking for and allow primary providers to
choose the best mix of the skills of GPs, nurses, and nurse
practitioners in meeting that outcome. PHOs should make more of the
opportunities they already have to consider workforce mix, new
scopes of practice and using specialists as part of the primary
health care team.
While the NZMA acknowledges and strongly supports the role of
the multi-disciplinary primary healthcare team, and the need for
flexibility in workforce arrangements, we are strongly opposed to
allowing PHOs an unfettered ability to choose the best mix of
skills of "GPs, nurses and nurse practitioners". Many PHOs will
lack the capacity to make evidence-based decisions in this complex
field, and perverse incentives exist for decisions that may not be
in the long-term interests of patients. On the ground, these
decisions need to be made within practices, in accordance with
national professional policies and guidelines, which in turn must
be consistent with the Health Practitioners Competency Assurance
Act 2003 (HPCA Act).
5 The acceleration of national quality and safety
improvement programmes
The MRG recommends that:
(a) An independent national quality entity should now be
established to replace QIC and with responsibility for helping
providers across the whole sector improve patient safety and
service quality.
While we support this concept we note that this is likely to
result in increased bureaucracy.
The MRG recommends that the national quality entity
should:
(a) Establish formal linkages with one or more similar
international bodies, but must concentrate on seeding and growing a
local safety and quality culture, providing state of the art tools,
skills and support and building New Zealand capability,
We agree.
(b) Develop the next phase of a national quality and safety
programme that addresses patient safety and continuous quality
improvement, and
We agree.
(c) Scale back the current PHO Performance Programme for a
period and the resulting saving should be used to help accelerate
the introduction of QI4GP.
We agree, subject to the caveats stated earlier.
The MRG recommends that the national quality entity
should:
(a) Be governed by an appointed board and report to the
Minister. Clinical appointments on this board must be drawn from
the breadth of health care providers.
We agree.
The MRG recommends that the national quality entity
should:
(a) Expect to become partially self-funding by the end of its
third year of operation through the development of resources,
teaching and learning opportunities and other supports for
workforce development and education, and
We have doubts about whether this could ever be fully achieved.
Such an approach may carry the risk of causing the agency to lessen
its focus on improvement of health care systems.
(b) Support prospective research and rigorous evaluation to
demonstrate the transferability of real cash savings from improved
safety and quality.
We agree.
Annex 3 Terms of Reference: Infrastructure, Capacity and
Planning
While this document covers a range of issues our focus has
been on the issue of workforce.
Firstly, the document states (para 2.1) that there has been no
significant reform in respect of workforce. We have a different
view. After a hiatus of many years, some key policy decisions
have recently been taken. These include the increased
workforce policy capacity within the Ministry, the planned
increases in medical student numbers, the creation of the voluntary
bonding scheme and the decision to make student loans interest free
for the period the graduate remains working in New Zealand.
We also believe that significant progress has been made through the
work of the RMO and SMO Commissions and the Medical Training Board.
While the above may not represent "reform" they certainly represent
progress.
Secondly we are cautious about the assertion on page 9 regarding
the need to develop new roles. This follows a theme covered in some
other recent reports. While role delegation (as opposed to role
substitution) may be a part of the solution to workforce shortages
there will be a continuing need for more doctors and nurses on the
frontline. We do however support the expansion of nursing and
allied health professional roles within the team environment if it
has the involvement of doctors, nurses and allied health staff and
their national professional bodies in determining the need for and
type of job redesign, and in the establishment of appropriate
clinical guidelines.
In regard to new roles the NZMA has recently considered the
issues around the possible introduction of a medical assistant role
as created in the United States (and referred to there as a
Physician Assistant). The following extract is taken from the
NZMA's position statement on New Roles and Role Substitution:
"In preparing this statement we have based our view of the
medical assistant on that of the physician assistant in the USA.
Thus when we are discussing the new role of medical assistant we
are thinking in terms of a healthcare professional licensed to
practice medicine under the supervision of a registered medical
practitioner. It is not envisaged that this role is based
around administrative support for the medical practitioner. It is a
dependent role and works within a team environment. As to
training while this is something still to be determined, our
initial thoughts are again around the USA model. Under that
model:
The training of a physician assistant typically consists of 25
months studying an intensive core curriculum, emphasizing a primary
care, generalist approach. Most entrants have a first degree prior
to entering training, and in many cases have clinical experience of
some sort as well. On graduation from accredited training, PAs must
pass a national certifying examination of the National Commission
of Certification of Physician Assistants. Subsequently, they are
required to complete 100 hours of continuing medical education
every two years and to pass a generalist medical recertification
examination every six years, regardless of their clinical
specialty.
NZMA believes that provided the appropriate regulatory
framework is created, and the new vocation is appropriately
supervised by a registered medical practitioner, the medical
assistant could add value to the medical practice team. We
see the following as being key principles, which should govern this
role:
• The role needs to be developed with the best interests of
patient care and safety in mind;
• The delegated care model as practiced in the USA is the
appropriate model for New Zealand to look to in developing this
role;
• Subject to standing orders and appropriate supervision,
medical assistants should be able to prescribe;
• Medical assistants must work within the medical practice
team rather than in competition with it;
• The role needs to be defined and aligned with education,
training, competency and registration requirements;
• In supporting medical assistants the government will need to
set up a formal regulatory body to set standards and oversee
initial and continued registration with reference to both
competence and fitness to practise;
• A medical assistant's continuing registration should be
dependent on their ongoing professional development.
In creating any such role we believe that the Medical Training
Board must be a key stakeholder.
As with the USA we believe medical assistants could play a role in
both primary care practice and in hospitals.
Caveats
Having said the above NZMA notes the following by way of
caveat:
In developing the role steps must be taken to ensure that medical
trainees are not disadvantaged in terms of training (either in
terms of both getting such training, as well as continuing to
perform all necessary tasks in terms of that training). In
our view while medical assistants could play a part of the
interdisciplinary team, any benefit they can offer our medical
service would be grossly cancelled out if as a result New Zealand
trained fewer doctors, or doctors left the country because they
could no longer get the training or experience they needed.
Nomenclature
NZMA believes the new role should be called "medical assistant" so
that the public are not misled into believing the person they are
seeing is a fully qualified doctor.
Next Steps
If the government were to decide to proceed with
developing this role it is the NZMA's view that the development
should be done through a steering group comprised of
representatives from all the relevant medical schools and colleges,
as well as the NZMA."
The report goes on at page 10 to refer to the development of
workforce innovations such as the creation of physician assistants
in surgical and anaesthesia roles, nurse endoscopists, advanced
roles for hospital and community pharmacists and nurse
practitioners in diabetes care. While there may be a case for
the creation for some new roles we think it is vital decisions are
based on sound evidence and that any changes are made within the
statutory regulatory framework. If new roles are created, they must
function within the context of the healthcare team, rather than in
independent or autonomous roles.
Turning to the specific recommendations:
1 Capital expenditure
The MRG recommends that:
(a) The NCC should be replaced by a single Investment Committee
of the NHB,
No comment.
(b) The Investment Committee should be independently chaired and
its membership should include clinicians and the chairs of the
NHB's workforce and IT boards,
No comment.
(c) There should a long-term capital and asset management plan
with an annual component that outlines total capital expenditure
investment, and the level, nature, and source of the funding
required,
No comment.
(d) The plans in (c) above should be driven by service delivery
models of care within local, regional, and national health
plans,
No comment.
(e) The plans in (c) above should have strong linkages with
workforce and IT development and investment plans,
No comment.
(f) The plans in (c) should include all proposals (including all
non-departmental proposals by the Ministry) that exceed the
existing central approval thresholds, with the NHB replacing the
Ministry in the approval process, and
No comment.
(g) The issues outlined in Further work above should be
explored.
No comment.
2 Workforce
The MRG recommends that:
(a) The formation of a National Health Workforce Board (NHWB)
that will report to the NHB,
We note the creation of the NHWB, and assume that it will be
based on the recently announced CTA Board. As a
multidisciplinary body, the support of the proposed medical
reference group (and other reference groups) will be critical to
retaining the necessary focus on specific professions.
In respect of the NHB taking the lead role in workforce issues,
as stated earlier we have major reservations. It is essential that
policy aspects of workforce planning and development are retained
within the Ministry if the "bums on seats" approach of the DHBs is
not to dominate.
(b) The NHWB would be responsible for:
(i) The planning, development and implementation of a NHWB,
(ii) Assessing future workforce needs, overseeing the planning
and funding of postgraduate training (if the recommendations of the
Ministerial Taskforce on the Funding of Heath Workforce Training
are accepted), and advising the Minister on changes in scope of
practice and workforce innovations,
(iii) Working with DHBs in developing an industrial relations
strategy that helps facilitate the changes in work practices to
support the sector's wider objectives for workforce development,
and
2 (b) (i) - (iii). We strongly support the need for a national
workforce plan and the co-ordination of training. However, we
are extremely concerned about the suggestion that the Minister
should be advised on changes to scopes of practice as this is in
our view solely a matter for the Responsible Authorities under the
HPCA Act 2003. Regarding para 2 (b) (iii), we see this as
another reason why high level health workforce capacity should
remain within the MOH. In our view the development of an
industrial relations strategy needs to be entirely separate from
workforce policy development.
(c) The NHWB be represented on the NHB Single Investment
Committee to ensure there is strong alignment of the workforce with
non-workforce investments such as IT and facilities, and
We agree.
(d) The current HWIP be made a national resource under the
governance of the NHWB and that the respective coverage be quickly
increased to include the whole health sector workforce and to
develop an effective modelling capability.
We agree.
3 Information technology
The MRG recommends that:
(a) An interim governance group be set up for both NSDP and KD
to reprioritise and reduce the number of NSDP and KD projects with
a focus on (a) addressing the risks in the payments system and (b)
supporting the implementation of the distributed approach to a safe
sharing and transfer of patient electronic information amongst
providers,
We agree.
(b) The Refresh HISNZ project of KD should cease and the Safe
Sharing of Health Information Community Dialogue and Education
project of KD should be slimmed down and utilise the existing HISAC
consumer forum,
No comment.
(c) All primary care related IT projects such as GP to GP Notes
Transfer, PHO Performance Programme, Qi4GP, electronic referrals,
electronic discharges, electronic medication, and electronic
laboratory should be integrated and rationalised under a new
primary care information system initiative,
We strongly support this recommendation.
(d) The Grants Scheme project of KD be reviewed to support
projects related to the primary care information system
initiatives,
No comment.
(e) The PHO Performance Programme be scaled back and savings be
redirected to support the development of QI4GP as part of a broader
primary care information system initiative,
We support this recommendation subject to the caveats stated
earlier.
(f) That the interoperable and connected distributed approach
rather than the single sector-wide enterprise system be confirmed
as the preferred approach for the development of a safe sharing and
transfer of patient electronic health information for the New
Zealand health sector,
We agree.
(g) The HMSC initiatives by seven DHBs revise their scope to
concentrate on replacing the PAS for hospitals. This revised scope
be implemented using a distributed approach for the development of
a safe sharing and transfer of patient electronic health
information, using interoperability standards set by HISO to ensure
integration with primary care and other providers' systems,
While we agree with the principle we remain concerned that only
7 DHBs are currently active in this project. This is in conflict
with the approach to national coordination of key projects stressed
throughout this report.
(h) The roles and function of the Ministry of Health ID be
reviewed and focused solely to support the IT needs of the
Ministry,
We agree.
(i) The national payments and contracts management systems
provided by Sector Services (with a budget of 272 FTEs) should be
moved out of ID to a national shared service agency. While work is
being undertaken to establish the legislation to set up a national
shared service agency, this function should be transferred to a
single NHB subsidiary,
We agree.
(j) All other current responsibilities of the Ministry ID be
transferred to the NHB, (k) A National Health IT Board be set up
within, and report to, the NHB and replace the current HISAC. This
board will provide a strategic leadership role for national health
IT strategy and planning as well as governance over national
collections and systems,
We agree.
(l) The National Health IT Board will, on behalf of the NHB,
work with the sector to develop a National IT Plan (including a
national IT architecture framework) to advance HISNZ. This plan
will be a rolling plan with local, regional, and national views,
and a short, intermediate, and long-term perspective that it is
aligned with the National Health Workforce Plan and National Health
Capital Plan,
No comment.
(m) The National Health IT Board will be represented on the NHB
single Investment Committee responsible for planning and funding IT
and facilities programmes,
No comment.
(n) The National Health IT Board will ensure there is strong
sector clinical manager and governance leadership of IT projects,
and
We agree.
(o) The National Health IT Board will work closely with the HSMC
initiative and the proposed primary care information system
initiative to advance:
(i) The implementation of a safe, shared and transferable
patient electronic health record for New Zealand health sector,
using a distributed approach based on interoperability standards
set by the HISO, and
(ii) The implementation of a consumer portal.
(o) (i) and (ii). We agree and indeed strongly support (i)
above.
Annex 4 Terms of Reference: Value for Money
We have few comments in regard to this document as we have
little or no knowledge of many of the committees referred to.
However, we support the general thrust of the report which
indicates that there are a number of unnecessary or unproductive
committees. However we do have specific comments on the PHCAC (see
below).
1 Testing the line-by-line spending review with the Ministry to
identify any additional in-depth reviews or longer-term work that
will need to be addressed
With respect to NDE managed by the Ministry, in addition to the
recommendations in the main paper, the MRG recommends that:
(a) All new expenditure proposals should be accompanied by a
three-year forecast of the most likely full future cost of the
proposal, an assessment of the proposal's cost-effectiveness, and
an indication of savings that could be released from low priority
expenditure elsewhere in Vote Health to fund the proposal, and
No comment.
(b) The results of the ongoing programme that the Director
General has for seeking savings in key areas in both departmental
expenditure and NDE be subject to independent expert review for
relatively large areas of expenditure and be completed before the
associated funding function is shifted out of the Ministry.
No comment.
2 Consideration of the Ministry's role as a manager of a range
of national operational functions
With respect to the longer-term management of the $2.5 billion of
NDE managed by the Ministry, the MRG recommends that:
(a) Over the next 12 months the Ministry be asked to work
through the various policy and machinery of government issues
associated with devolving all of the $2.5 billion of NDE currently
managed by the Ministry to either the NHB (national level) or DHBs
(regional and local level),
We agree.
(b) The funding streams that are relatively straightforward to
move out of the Ministry before the 12 month period should be
moved, and
No comment.
(c) Unless unanticipated issues arise, all of this funding and
the associated budget to manage that funding should have been
shifted out of the Ministry at the end of this period.
No comment.
The MRG recommends that:
(a) The Heathpac (Sector Services - Information Directorate) be
moved out of the Ministry to become part of the proposed new
national shared services agency, probably operating as a subsidiary
with its own governance structure.
We agree.
The MRG recommends that:
(a) Audit and Compliance become a part of the proposed
Heathpac subsidiary of the new shared services organisation, with
an internal audit function and direct accountability to the board
that is independent of management.
We agree.
The MRG recommends that:
(a) MedSafe maintain its current status until the
Therapeutic Products and Medicines Bill is passed and it becomes
part of the ANZTPA. In the meantime, it would make sense to ensure
that legislation allowed MedSafe to set fees to ensure cost
recovery. We also recommend that the Government strongly supports
Medsafe managing the NZULM when it is complete, and considers
expanding the scope of MedSafe to include the regulation of medical
devices.
We agree.
The MRG recommends that, with respect to the NRL:
(a) The NRL remain as an independent unit within the Ministry of
Health in the first instance,
No comment.
(b) The Ministry of Health acts to increase the commercial
flexibility of the NRL, within the constraints of operating within
the Ministry, and
No comment.
(c) The Minister of Health considers the opportunity provided by
the new Radiation Safety Bill to investigate the 'one stop shop'
option for scientific services underpinning the public health
service.
No comment.
The MRG recommends that:
(a) The Ministry of Health be asked to consider if the NSU should
remain a national service and be moved to the NHB, or if it is
better to devolve its functions to DHBs to manage either regionally
or locally. Unless unanticipated issues arise, this should be
concluded in the 12 month timeframe for moving NDE.
No comment at this stage.
The MRG recommends that:
(a) The repositories and databases currently maintained by the
various Ministry Directorates be moved into the proposed new
national shared service agency, probably operating as a subsidiary
with its own governance structure.
No comment at this stage.
3 Selectively reviewing the rest-of-sector expenditure,
including DHBs, to reduce waste and bureaucracy and improve
spending quality and patient service
The MRG recommends that:
(a) The management fee paid to PHOs with enrolled
populations of less than 40,000 be reduced and some of the
resulting savings be used over the subsequent year to help those
PHOs amalgamate, confederate, or enter into other arrangements for
sharing management overheads,
We support the principle but believe that provision must be made
for small successful PHOs to continue.
(b) DHBs be advised that barriers which restrict the ability of
GPs to leave or join a PHO should be abolished, and
We strongly agree.
(c) DHBs be advised that new PHOs should be permitted, on
condition that: (i) establishment funding is not provided (ii) that
it is the preference of health care providers, and (iii) sound
corporate governance, sound clinical governance, and effective
community participation is demonstrated.
We agree.
The MRG recommends:
(a) The creation of a Pharmac-like national shared service agency
with a mandate to manage the assessment, standardisation,
management, purchasing, and/or supply chain management of any of
the common back office functions of DHBs that are referred to it by
the Minister of Health,
We support the idea of a NSSA but have concerns about it being
"Pharmac-like" in nature.
(b) The operational budget of this agency be funded by
top-slicing the DHB funding formula,
We agree.
(c) That this agency will act as an agent for DHBs and will
agree with them a notional (or actual) budget for the management,
purchasing, and/or supply chain management tasks it undertakes on
their behalf,
We agree.
(d) As long as a budget can be identified, then the board of
this agency will make the final decision on what is purchased and
the terms, conditions, and prices of procured items and the
management of shared services (like payroll and supply chain),
and
We agree.
(e) That the NHB be required to establish a process for working
through the entire range of common DHB back office services to
identify a list of services that are best supplied by a single
national provider, starting with non-pharmaceutical hospital
procurement.
We agree.
4 Review the reporting and accountability processes between the
Ministry, DHBs and PHOs to improve focus and reduce unnecessary
bureaucracy
The MRG recommends that:
(a) With respect to the National Collection Annual
Maintenance Programme, there is consultation between the DHB's
patient management system vendors and other sector stakeholders
earlier in the process (October) rather than waiting until late
December.
We agree.
The MRG recommends that:
(a) DHBs are clearer about what is needed for payments
(versus monitoring contract performance) and that payment methods
are simplified in order to reduce the cost and complexity of the
payments system.
We agree.
The MRG recommends that a:
(a) Working party is established with a range of sector
representatives to develop a national framework for contracting,
reporting and accountability that streamlines processes and ensures
clear, timely accountability e.g. to align the DAP and SOI
reporting, to investigate how the certification and exception basis
can be used more widely, and to agree the process for identifying
key IDP reporting requirements, and to develop the DAP into an
action-orientated document that is more relevant to DHB priorities
and performance.
We agree.
5 Selectively review the plethora of existing Ministerial and
Ministry committees and functions.
The MRG recommends that:
(a) Four committees have their terms of reference and membership
refocused to fulfil the new mandate outlined in the MRG report,
(b) 16 committees be disbanded,
(c) 16 committees be disbanded and their functions transferred
to the NHB,
(d) Seven committees be merged,
(e) Five committees be reconfigured into Expert Panels as
outlined in the Framework in Section 3, and
(f) 54 committees are retained. Of these 10 are Statutory
Committees, four are Ministerial Committees, and 40 are Ministry of
Health Committees (including 10 NSU and eight Ethics Committees).
The MRG recommends the following principles govern all committees,
including Statutory, Ministerial Advisory, Ministry of Health, and
NHB:
(a) - (f) While we support the reduction in the number of
committees we have insufficient detail to be able to comment
further on each of these.
(a) Formal Ministry of Health Committees ( Programme/Project
Advisor Groups) should only be established on approval of the
Senior Leadership Team,
We agree.
(b) Programme/Project Advisory Committees may be established for
the planning and initial implementation of a specific
programme/project. However where ongoing advice from expertise not
available within the Ministry of Health is required, existing
networks should be utilised first to inform policy and programme
development, especially for contentious or complex issues or those
where sector support is required,
We agree.
(c) All committees and Expert Panels should have a robust terms
of reference, a work plan, and reporting requirements,
We agree.
(d) All committees should have an independently appointed
skilled Chair, whose role is not to represent an opinion but to
ensure the committee fulfils its responsibilities,
We agree.
(e) All committees and Expert Panels should consider how they
include consumer voices in their processes,
We agree.
(f) All committees and Expert Panels to use teleconference as
the preferred method of meeting whenever possible,
We agree.
(g) All committees to have an independent review of their terms
of reference, delivery against the work plan, and membership to
ensure they continue to add value and/or benefit to the sector,
and
We agree.
(h) All Ministry of Health committees to have an end-of-life
date.
We agree.
The MRG recommends that:
(a) The structure below is endorsed for the future.
PHOs stratified by MoH and NHB
We are not sure that this table provides for the complete range
of committees required in all circumstances. Specifically we
believe that some committees with representation from sector groups
may be appropriate for expanded governance and/or consultation
purposes i.e. obtaining the mandated perspectives of key
stakeholder groups. Further discussion on these issues is
required.
The MRG recommends that:
(a) The Ministry of Health establish a common terms of
reference template, and
We agree.
(b) That the Ministry of Health develop a set of guidelines for
the regulation and monitoring of committees and Expert Panels.
We agree.
The MRG recommends that:
(a) That the Ministry of Health implement a full cost
process for every committee and Expert Panel.
We agree.
The MRG recommends that:
(a) The National Health Committee be refocused with a
broader mandate to advise the Minister on services that should be
publicly funded,
We agree.
(b) The Public Health Advisory Committee be refocused with a
broader mandate to advise the Minister on the configuration and
provision of public health services,
We agree.
(c) The National Health Epidemiology and Quality Assurance
Advisory Committee, known as the Quality Improvement Committee
(QIC), be replaced by an independent quality entity with
responsibility for helping providers across the whole sector
improve patient safety and service quality,
We agree.
(d) The four Mortality Review Committees are merged into two
committees,
We would need more detail before we could support this
proposal.
(e) The Drinking Water Implementation Advisory Committee is not
established,
No comment.
(f) The Health Information Strategy Advisory Committee be
disbanded and becomes part of the NHB IT capacity planning
mechanism, and
No comment.
(g) 10 Statutory Committees are retained, each to have a process
established for three-yearly review of their terms of reference and
membership to ensure they continue to add value and/or benefit for
the Minister.
No comment.
The MRG recommends that:
(a) The Cancer Control Council of New Zealand be retained and the
recommendations of the review of the terms of reference and
membership are implemented,
No comment.
(b) The Sanitary Works Technical Advisory Committee be retained
and is refocused on the Drinking Water Assistance Programme only
and meets once per annum,
No comment.
(c) The Health of Older People Forum is disbanded in its current
form, and
No comment.
(d) The three other committees are retained, each to have a
process established for three-yearly review of their terms of
reference and membership to ensure they continue to add value
and/or benefit for the Minister.
No comment.
The MRG notes that 12 committees have already been
reformulated into Expert Panels and recommends that:
(a) The NSU committees, including the Joint Ministries
Committee and the Expert Panels, continue to be reviewed annually
to ensure they are adding value to the NSU programmes.
No comment.
The MRG recommends that:
(a) The National Systems Development Programme Sector Advisory
Group and the National Systems Development Programme Connected
Health Community Steering Group are disbanded, and
No comment.
(b) The Health Information Standards Governance Group be
disbanded and becomes part of the NHB IT capacity planning
mechanism.
No comment.
The MRG recommends that:
(a) Six of the current workforce committees' roles and functions
become a standing feature of either the Nursing Reference Group or
the Medical Reference Group in the health workforce capacity and
planning capability of the NHB, and
No comment.
(b) The Specification Review of Midwifery First Year of Practice
Advisory Group and the Midwifery Post Graduate Education Expert
Advisory Group be disbanded and their functions left to the
Midwifery Registration Board.
No comment.
The MRG recommends that:
(a) The operational and committee functions of the National
Influenza Strategy Group be separated and the structure and
function of the committee be reviewed once 2009 influenza
vaccination programmes are completed,
No comment.
(b) An overarching Immunisation Technical Forum and an
Immunisation Coverage Forum be formed to incorporate the current
roles of the Immunisation Technical Working Group, the MenzB
Effectiveness Group, and the Immunisation Programme Advisory
Committee, and
No comment.
(c) The need for one further committee (the National
Immunisation Register Advisory Group) be reviewed as part of a
review of the internal arrangements required to meet research,
privacy, and ethical needs.
No comment.
Of the remaining six, the MRG recommends
that:
(a) Five committees (the Hepatitis C Treatment Advisory Group, the
AIDS Medical and Technical Advisory Committee, the Antibiotic
Resistance Advisory Committee, the National Certification Committee
for the Eradication of Polio, and the Tuberculosis Advisory Group)
be retained, and (b) The terms of reference and membership of the
Pneumococcal Surveillance Advisory Group be reviewed with a view to
a broader role in vaccine preventable disease surveillance.
No comment.
The MRG recommends that:
(a) Those recommendations from the review of the Ethics System
pertaining to committee structure and role are implemented in a
timely manner.
No comment.
The MRG recommends that:
(a) The three Core Cancer Control Committees are retained
and reviewed annually to ensure they continue to add value to the
Cancer Control Strategy.
No comment.
The MRG recommends that:
(a) Before the two-year term is complete the Primary
Health Care Advisory Council has an independent review of their
terms of reference, delivery against work plan, and membership to
evaluate the value and/or benefit to the sector from the committee
structure and process, and
We do not support the continuation of PHCAC. We have not been
comfortable with its terms of reference. It is not fully
representative of national stakeholder groups, and while the
discussion can be useful for the Ministry and DHB representatives
present to hear various perspectives, we do not believe it is
capable of providing coherent consensus advice to the Ministry.
(b) The functions of the Primary Health Care Nursing Expert
Advisory Group be assumed by the Nursing Reference Group of the
HWTB.
No comment.
The MRG recommends that:
(a) The three common Finance Related Committees are
disbanded and the functions move into the NHB role, and
No comment.
(b) The National Capital Committee be disbanded and become part
of the NHB capital capacity planning mechanism.
No comment.
The MRG recommends that:
(a) The Te Taumata Roopu - Maori Public Health Reference
Group be retained and that its membership and terms of reference be
reviewed annually to ensure it adds maximum value for public health
services.
No comment.
Of the other three, the MRG recommends one is retained
and that:
(a) The Food and Beverage Classification System Technical
Advisory Group and the National Breastfeeding Committee are
reconfigured as Expert Panels and called together as required for
specific issues.
No comment.
The MRG recommends that:
(a) The Ministry of Health work with the Cancer Control
Council and the Health Sponsorship Council to remove any
duplication of work plan, and
No comment.
(b) The Ministry of Health reviews the requirement for the
Tobacco Control Research Steering Group prior to the next contract
being let.
No comment.
The MRG recommends that:
(a) The National Diabetes Retinal Screening Advisory Group
is disbanded.
No comment.
The MRG recommends that:
(a) The third is currently retained.
No comment.
The MRG recommends that:
(a) The workforce development component of the Health Protection
Advisory Group is transferred to the NHB Health Workforce capacity
planning function and that the committee meets up to twice yearly
to fulfil its assessment process.
No comment.
The MRG recommends that:
(a) The Joint Ministry of Health/Department of Internal Affairs
Stakeholder Reference Group on Preventing and Minimising Gambling
Harm be reviewed and/or disbanded at the end of its term.
No comment.
The MRG recommends that:
(a) The Sexual Health Advisory Group be disbanded.
No comment
The MRG recommends that:
(a) Both the Nationwide Service Framework Co-ordinating
Group and the Health Impact Assessment Support Unit Reference Group
be reformulated into Expert Panels,
No comment.
(b) The DHB Information Liaison Group be disbanded and the
monitoring functions become the responsibility of the NHB, and
No comment.
(c) The National Service and Technology Review (NSTR)
Committee's role becomes a function of the reformulated National
Health Committee.
No comment.
Annex 5 Commentary on Enhancing Clinical
Leadership
We strongly support the many initiatives suggested in this document
and share the report's concern over the absence of collegial
linkage between primary and secondary care. The NZMA has been
increasingly concerned about this disconnection, and is currently
working to address this issue and has undertaken practical steps in
a number of areas to foster closer collegial relationships between
primary and secondary care doctors.