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 t...
Health and Disability CommissionerPatients’ rights New Zealand’s Code of Consumer’s Rights recognise that patients referre...
What do patients want?   a reasonable level of service.   to know what is available to me   to know when I will receive...
New Zealand Government PolicyFundamental Principles for Access to Publicly     Funded Elective Services (2000)      •Reaso...
Reasonable Level of Service   Significant targeted investment        - specific and more flexible   Overall increase in ...
Reasonable Level of Service   2007/08   118,000 discharges   2008/9    130,000 discharges   2009/10   138,000 discharges
Reasonable Level of Service   Current situation    - steady increase of 3% per year   Unintended consequences    - varia...
ClarityPatients know whether or not and when they will  receive publicly funded elective assessment or  treatment.     •Ac...
Timeliness  Available services are provided within  specified timeframes•Health Targets•Elective Services Performance Indi...
Emergency                        CancerDepartment   Elective Services   Treatment< 6 hours    Increased Numbers   < 4 weeks
Health TargetsCancer    - % of patients beginning radiotherapy within x weeks   2008 - 97% within 8 weeks, 65% within 4 w...
Timeliness - Elective Services    Available elective services are provided within    specified timeframes   Patients are ...
Fairness   Prioritisation for access to treatment is based on    nationally-recognised criteria and processes    (ESPI 8)...
Elective Services Performance Indicators ESPIs                                     Status “Traffic Light”                 ...
Cross DHB Results: All Services31/03/02                                                            As at: 31-Mar-02 Servic...
Within DHB - Surgical Services31/03/02                                             Canterbury DHB - period ending: 31-Mar-...
 Clarity      - targets met Timeliness   - targets met Fairness     - targets met, but ?
New Investment            Prioritisation important“There was no way we could invest in a system  that was clearly not meet...
New Investment   $200 million into elective surgery   Phase 1 (2006) - goal to increase the number    of NZers who get e...
“Prioritisation systems should be fair,systematic, evidence-based and transparent.” Health and Disability Commissioner   2...
Office of the Auditor-General     “Progressin delivering publicly funded     scheduled services to patients” - June 2011 ...
The Media and Politicians
Processes of Public Accountability   Legal System (the Courts)   Human Rights Commission   Health and Disability Commis...
Conclusions and Reflections Explicit patient-oriented goals Simple measures drive performance Complex System Conflicti...
http://www.health.govt.nz search on “elective services”http://www.oag.govt.nz/2011/scheduled-services
Public Accountability Processes New Zealand
Public Accountability Processes New Zealand
Public Accountability Processes New Zealand
Public Accountability Processes New Zealand
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Public Accountability Processes New Zealand

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Public Accountability Processes New Zealand

  1. 1. Taming of the Queue Ottawa March 2012Public Accountability Processes In New Zealand Ray Naden
  2. 2. New Zealand•4.5 Million people•Universal Taxpayer-Funded Healthcare + Private•Strong Social Welfare System
  3. 3. 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.
  4. 4. 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
  5. 5. 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.
  6. 6. New Zealand Government PolicyFundamental Principles for Access to Publicly Funded Elective Services (2000) •Reasonable level of service •Clarity •Timeliness •Fairness
  7. 7. 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
  8. 8. Reasonable Level of Service 2007/08 118,000 discharges 2008/9 130,000 discharges 2009/10 138,000 discharges
  9. 9. 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
  10. 10. 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
  11. 11. Timeliness Available services are provided within specified timeframes•Health Targets•Elective Services Performance Indicators (ESPIs)
  12. 12. Emergency CancerDepartment Elective Services Treatment< 6 hours Increased Numbers < 4 weeks
  13. 13. 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
  14. 14. 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)
  15. 15. 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 (……)
  16. 16. 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
  17. 17. Cross DHB Results: All Services31/03/02 As at: 31-Mar-02 Service: (All)(All) 2 Patients wait 3 Patients above 4 Patients waiting 1 Referrals 5 Patients waiting 6 Patients waiting 7 Percent contract 8 Prioritisation FSA>6m: 31-Mar- FST not offered without plan of acknowledged >6m for treatment >6m for review completion to plan Quality 2002 treatment care Level St Level St Level St Level St Level St Level St Level St Level StDHBAuckland DHB 1416 2% 239 8% 5 1% 535 4% 631 57% 62% 0.825259848 29% 0.293991416Bay of Plenty DHB 3059 23% 100% 115 2% 14 1% 3104 66% 72% 0.962651411 0Canterbury DHB 5793 15% 100% 5397 39% 236 2% 272 69% 70% 0.939146976 0Capital and Coast DHB 3078 7% 100% 1 1% 462 5% 424 53% 71% 0.948867338 0Counties Manukau DHB 6911 23% 100% 100% 100% 100% 75% 1.006197088 0Hawkes Bay DHB 3024 24% 100% 491 8% 1156 #DIV/0! 319 63% 77% 1.023627418 0Hutt DHB 1103 8% 100% 949 31% 571 24% 55 100% 76% 1.011101516 0Lakes DHB 887 10% 100% 879 27% 26 1% 19 43% 80% 1.072435864 0Midcentral DHB 2960 13% 100% 191 3% 390 7% 11 12% 76% 1.019919309 0Nelson Marlborough DHB 2205 12% 489 20% 59 1% 312 7% 518 46% 79% 1.059266961 74% 0.741721854Northland DHB 2179 16% 100% 83 1% 196 4% 1231 62% 65% 0.860363046 0Otago DHB 746 3% 100% 100% 233 4% 316 67% 79% 1.059220772 0South Canterbury DHB 185 2% 100% 100% 302 12% 12 63% 78% 1.036487149 0Southland DHB 688 6% 953 44% 356 10% 71 3% 283 34% 2% 0.024478044 139% 1.394557823Tairawhiti DHB 1052 17% 100% 1001 41% 116 #DIV/0! 2 1% 71% 0.945507252 0Taranaki DHB 351 3% 239 8% 441 10% 147 4% 10 63% 81% 1.074255736 94% 0.944444444Waikato DHB 2144 6% 324 #DIV/0! 233 2% 44 1% 173 4% 73% 0.975429737 11% 0.111773472Wairarapa DHB 1143 23% 100% 5 1% 35 3% 5 1% 77% 1.028351369 0Waitemata DHB 1507 5% 100% 156 2% 709 12% 253 100% 76% 1.009628968 0West Coast DHB 639 13% 13 2% 77 5% 112 8% 33 58% 84% 1.11755474 63% 0.629032258Whanganui DHB 293 3% 100% 118 3% 168 7% 56 82% 71% 0.948587075 0 41363 2257 10557 5835 7727
  18. 18. Within DHB - Surgical Services31/03/02 Canterbury DHB - period ending: 31-Mar-2002Canterbury DHB 7 Percent 2 Patients wait 3 Patients above 4 Patients waiting 5 Patients 1 Referrals 6 Patients waiting contract 8 Prioritisation FSA>6m: 31-Mar- FST not offered without plan of waiting >6m for acknowledged >6m for review completion to Quality 2002 treatment care treatment plan Level St Level St Level St Level St Level St Level St Level St Level StSurgical ServiceCardiothoracic 0% 100% 5 1% 1 1% 100% 263% 3.500307395 0Dental 0 1% 100% 100% 100% 100% 66% 0.874936898 0ENT 394 9% 100% 1046 41% 31 1% 100% 72% 0.960498416 0General Surgery 0% 0% 100% 100% 100% 67% 0.897247318Gynaecology 581 26% 100% 100% ## 100% 66% 0.875316132 0Neurosurgery 13 2% 0% 143 41% 2 1% 100% 72% 0.964850616Ophthalmology 551 13% 100% 628 39% 12 1% 100% 79% 1.049087186 0Orthopaedics 1243 41% 100% 1515 88% 100 6% 100% 61% 0.809931919 0Paediatric Surgery 0 1% 100% 100% 100% 100% #VALUE! 0Plastics 140 5% 100% 598 57% 24 3% 100% 69% 0.919119117 0Urology 288 19% 0% 424 35% 13 1% 100% 69% 0.920284248Vascular 27 3% 0% 0% 0% 0% #VALUE! 3237 0 4359 183 0
  19. 19.  Clarity - targets met Timeliness - targets met Fairness - targets met, but ?
  20. 20. 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
  21. 21. 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.
  22. 22. “Prioritisation systems should be fair,systematic, evidence-based and transparent.” Health and Disability Commissioner 2006
  23. 23. 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
  24. 24. The Media and Politicians
  25. 25. 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
  26. 26. 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
  27. 27. http://www.health.govt.nz search on “elective services”http://www.oag.govt.nz/2011/scheduled-services

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