Media release from Capital & Coast, Hutt Valley and Wairarapa DHBs

The evolving partnership arrangement between the three District Health Boards in the Wellington region - the 3DHB Programme - is about to move into a new phase.  This document outlines what this next phase of integration will look like for the three DHBs - Wairarapa, Hutt Valley and Capital and Coast.  While the overall direction outlined here is set, much of the detailed implementation will require further design and consultation. 

For the last two years, a group of clinical leaders and managers from the three DHBs, known as the Sub-regional Clinical Leadership Group (Clinical Leadership Group) has been leading the way with a programme of partnership development across the DHBs at a service by service level.  Known as the 3DHB Programme, progress has been very encouraging in specialties such as ENT, Gastroenterology, Child Health and Palliative care.  Exciting progress has also been made in supporting technologies, a very good example of which is the eTree initiative which enables clinicians in any of the three DHBs to view a patient's electronic medical record which is kept in their home DHB. This is also an example of how, to be truly effective, the 3DHB programme needs to extend beyond the clinical level to support and management services such as IT, and HR, in fact, right through to the senior management teams.

The three Boards have concluded that now is the time to accelerate and enhance this partnership process.  As a result they commissioned an analysis by independent consultants which has helped define the corporate and clinical measures required to move the 3DHB Programme forward at pace.

At its simplest the three elected Boards will be retained to represent their communities and ensure local accountability, but the day-to-day operations of the three DHBs will become increasingly joined-up.

The 3DHB Programme can be viewed as a response to the new opportunities which modern health practice has brought, such as new high end technologies in specialist services, progress in health practice and the support technologies which enable more and better treatment for people in the community and in their home.

The next phase of the 3DHB programme is about seizing these opportunities and doing this faster, more effectively and sustainably into the future.  This approach will also help deal with some of the challenges each DHB faces such as an ageing population, increasing demand for services, the recruitment and retention of clinical staff and financial pressures.

Key points of the 3DHB Programme

•    Retention of the three DHB boards with their responsibilities unchanged
•    Greater collaboration between board and statutory committees between the three DHBs
•    Better integration of primary and hospital care across the three DHBs.
•    Integration of the three Planning and Funding services into one service - the Service Integration Development Unit
•    Improving the use of existing hospital facilities in Wairarapa, Hutt, Kenepuru and Wellington
•    Gradual  integration of clinical services across the three DHBs
•    Greater use of a shared services approach for corporate services such as HR and IT, and clinical support services such as laboratory and radiology
•    Amalgamation of the senior management teams of Hutt Valley and Wairarapa DHBs, with a view to gradual integration across all three DHBs as opportunities arise
•    Gradual integration of the management of service delivery between Wairarapa and Hutt Valley DHBs moving to integration of all three in the future
•    Reduction from three to two chief executives with one for Hutt Valley and Wairarapa DHBs

The 3DHB programme is an attempt to achieve the maxim of trying to work smarter rather than harder and in this context "smarter" means more joined up, greater critical mass and increased professional collaboration.  The programme will not result in reduced services to our shared population, but more effective and sustainable delivery. 

Principles of partnership

There are some important principles lying behind the 3DHB Programme:

•    Clinical leadership - improvements are clinically led  with management and organizational design in support
•    Local voice and accountability - the local community voice must continue to be "heard" in each community, and accountability should remain with local boards
•    One-population - considering the 480,000 people of the region as a single population (with many communities) and serving it from the most effective point within the three DHBs
•    Equitable access - common criteria for access to services
•    Shared vision and values
•    Integrated decision -making - decisions are made in the collective interest of the three DHBs
•    Local initiative - Despite a collective approach local initiative will still be strongly encouraged

Benefits of partnership

Three principal benefits are sought:
 
•    Improved quality, safety and experience of care:
Service integration will allow a model of care that is the best a mix of services closer to home, and equitable access to good quality secondary services and to high performing centres of excellence.

•    Better use of resources to meet future demands:
By working together with a shared population base resources can be best used to provide the services required for each DHB's population.

•    Recruiting and retaining top people:
A larger shared population served by better coordinated services will create more opportunities for staff, attracting and retaining well qualified people. It also allows best use of scarce specialist resource.
The 3DHB Programme for 2012-14

The proposed programme for 2012-14 is consistent with the Regional Services Plan, reflects the work of the Clinical Leadership Group and draws heavily on the independent analysis.  This work is currently being translated into the 3 DHB work programme and an implementation plan which will propose five areas as follows:

1.    Streamlined governance and decision-making -  giving greater priority to 3DHB solutions while remaining responsive to local communities:
o    Retain the existing three DHB boards to maintain local accountability and keep close touch with the local community voice
o    Create a single chief executive and executive team across Hutt Valley and Wairarapa DHBs
o    Operate a single 3DHB Community & Public Health Advisory Committee (CPHAC) to oversee a joined up work programme
o    Operate a single Disability Services Advisory Committee (DSAC)
o    Operate a joint Hospital Advisory Committee (HAC) between Wairarapa and Hutt Valley DHBs
o    Introduce a single Service Integration and Development Unit (SIDU)
o    Introduce a 3 DHB chief executive forum which includes attendance of the chair of the Clinical Leadership Group, with executive and programme management support from SIDU.

2.    Strengthened management accountabilities
o    Develop a long-term integrated planning framework across the three DHBs
o    The three DHB board committees to be supported by the Director of SIDU. 
o    Each DHB chief executive will have individual accountabilities for specific workstreams as well as collective accountability for delivery of the overall 3DHB work programme. 
o    These will be linked through the chief executive forum

3.    Removal of structural barriers and disincentives to collaboration
o    Progress towards full amalgamation of the provider arms of all three DHBs
o    Align capital expenditure budgets between the three DHBs

4.    Alignment of services and better use of capacity and resources - as a result of consolidation and streamlining of administrative and support functions
o    Continue to explore alignment of
   Single laboratory service between CCDHB and Hutt Valley DHB
    radiology services across all three DHBs
    Information Technology services
o    Review volumes of elective surgery contracted to the private sector

5.    Consistency in business rules, policies and protocols across the three DHBs
o    Single human resources team
o    Single communications team
o    Common criteria for equitable access to services
o    Common policies and protocols
Further partnership opportunities being considered

In considering these changes account needs to be taken of the large amount already done under the auspices of the Clinical Leadership Group.  Under the oversight of the Group, a number of specialist services have already made significant progress on 3DHB partnerships such as ENT, Gastroenterology, Child Health, and Palliative care.  Progress has also been made in support areas as diverse as payroll, booking systems, human resources and occupational health. 

Consideration is being given to future additional areas of partner activity:
•    Enhancement of elective surgery through creation of dedicated capacity and stronger separation from acute service delivery and early assessment, treatment and transfer of complex acute cases
•    Continued consolidation of tertiary services onto the Wellington Regional Hospital campus
•    Continual exploration of opportunities for single services, such as major elective surgical services
•    Opportunity to develop Kenepuru
•    Continued development of Wairarapa as an integrated primary/secondary/specialist campus in line with the Tihei Wairarapa BSMC business case, and continuing to offer acute assessment and management, and elective procedures.

For further information

You can find more information via your DHB intranet, which will link to the 3DHB pages currently hosted by the Clinical Leadership Group on the Wairarapa DHB web site.
www.wairarapa.dhb.org.nz          home>health services>sub-regional
Please send any feedback or questions to 3DHBquestions@(your DHB address e.g. @huttvalleydhb.org.nz), use the link on the web pages.  The questions and answers log will be updated regularly so we can all learn from them.

Briefing sessions will be arranged as and when required in each DHB over the next six weeks.

The Clinical Leadership Group will continue to meet on the first Thursday of each month.
                     
Virginia Hope                            Bob Francis
Chair - CCDHB and Hutt Valley DHB                Chair - Wairarapa DHB
                                Board Member - CCDHB