Taming of the Queue Ottawa March 2012Public Accountability Processes In New Zealand Ray Naden
New Zealand•4.5 Million people•Universal Taxpayer-Funded Healthcare + Private•Strong Social Welfare System
Health Care and the Law in New Zealand No legal right to health care “Human Rights Act” - the right to be free from unlawful discrimination (eg, by age or disability) Human Rights Commission Procedural fairness matters.
Health and Disability CommissionerPatients’ rights New Zealand’s Code of Consumer’s Rights recognise that patients referred for specialist assessment or waiting for surgery are entitled to reasonable care in assessment/treatment reasonable information about their condition, whether and when they will be seen, and options
What do patients want? a reasonable level of service. to know what is available to me to know when I will receive treatment. to be treated fairly.
New Zealand Government PolicyFundamental Principles for Access to Publicly Funded Elective Services (2000) •Reasonable level of service •Clarity •Timeliness •Fairness
Reasonable Level of Service Significant targeted investment - specific and more flexible Overall increase in number of patients treated Substantial increase in - cataract replacement - hip and knee replacement - cardiac surgery - other
Reasonable Level of Service Current situation - steady increase of 3% per year Unintended consequences - variable level of service between services - - ? increased inequity of access - volumes ahead of value
ClarityPatients know whether or not and when they will receive publicly funded elective assessment or treatment. •Acknowledgement of Request (ESPI 1) •Prompt advice on whether they will be seen within 6 months (ESPI 1) •Certainty of the plan of care (ESPI 4) - whether treatment is indicated - whether treatment is available within 6 months •Written Information to Patient and GP
Timeliness Available services are provided within specified timeframes•Health Targets•Elective Services Performance Indicators (ESPIs)
Health TargetsCancer - % of patients beginning radiotherapy within x weeks 2008 - 97% within 8 weeks, 65% within 4 weeks 2010 – 100% within 6 weeks 2012 – 100% within 4 weeks
Timeliness - Elective Services Available elective services are provided within specified timeframes Patients are advised within 10 days of receipt of request for assessment (ESPI 1) Where assessment is available, this is provided within 6 months. (ESPI 2) Where treatment is available, this is provided within 6 months. (ESPI 5)
Fairness Prioritisation for access to treatment is based on nationally-recognised criteria and processes (ESPI 8) Patients whose priority score is above the access threshold are given certainty of treatment. (ESPI 3) Patients are treated in order of priority (……)
Elective Services Performance Indicators ESPIs Status “Traffic Light” standardised resultOutcomes for comparison Measure & prioritising Goal Expected Actual result Trend for the DHB “Traffic Light” this period - Getting worse - Static - Improving
New Investment Prioritisation important“There was no way we could invest in a system that was clearly not meeting the ethical guidelines set by the Medical Council and the Health and Disability Commissioner, let alone basic expectations of fairness.” Hon Pete Hodgson Minister of Health Media Statement 2 October 2006
New Investment $200 million into elective surgery Phase 1 (2006) - goal to increase the number of NZers who get elective surgery by 10,000 per annum. Phase 2 requires acceptable prioritisation and audit process.
“Prioritisation systems should be fair,systematic, evidence-based and transparent.” Health and Disability Commissioner 2006
Office of the Auditor-General “Progressin delivering publicly funded scheduled services to patients” - June 2011 “There is also no certainty that the "right" patients are always seen or treated in the appropriate order.” “I encourage … focus on putting in place systems and tools to make sure that the right patients get access to services at the right time.”http://www.oag.govt.nz/2011/scheduled-services
Processes of Public Accountability Legal System (the Courts) Human Rights Commission Health and Disability Commissioner Ministry of Health Performance Measures - Number of services provided - Elective Service Patient Flow Indicators (ESPIs) - Health Targets Office of Auditor-General Politicians Media
Conclusions and Reflections Explicit patient-oriented goals Simple measures drive performance Complex System Conflicting priorities and pressures Considerable progress…. ? how to continue to improve Valuing the patient as an individual
http://www.health.govt.nz search on “elective services”http://www.oag.govt.nz/2011/scheduled-services