Action 10 Align funding better across the system with a rolling programme focused on getting the best value from health investment (including incentives where relevant to support Strategy direction). We strongly support (a) improving access to health services for those most in need through financial support eg very low cost access. However we would like to draw attention to the inequitable outcomes that can arise from well-intentioned initiatives. Eg $90 million allocated over three years to support access to GPs for under 13 year olds has according to many of our primary health care nurses improved access to the “white worried well”, but not to much more vulnerable group. Moreover not all GPs provide free access, and there are not enough GPs to provide the service in some areas. It is important that the right services are funded, in this case improving access to nurse-led clinics in community settings, pharmacies, schools, and after hour’s services outcomes would have delivered better fairer results for a fraction of the cost. b. with regard capital expenditure we note that HBL arose from a similar centralised government approach and the results were disappointing and divisive to say the least. The new “DHB owned” Health Partnership Limited should be encouraged to develop the expertise indicated and be able to call on government advice rather than have it imposed. Note comments above re commissioning d. We support aligned IT funding Action 11 Develop and use a health investment approach with DHBs. This could be used to target high-need priority populations to improve overall health outcomes, while developing and spreading better practices. This will increase knowledge about population segmentation, drive collaboration, build skills in developing investment cases in the system, improve visibility of value for money, and build on the New Zealand Productivity Commission’s recommendations around a learning system. As above re investment approach and trials. Action 12 Continuously improve system quality and safety We support these actions. Note the recent Adverse Events Report from the Health Quality and Safety Commission, which notes nurses keep patients safe in care. 4. One Team Nurses strongly object to being called “actors in the system”. The 5 year aim appears to be aimed at improved systems but delivering what, in terms of workforce, ‘new’ models of care? How does the Strategy take into account the IT changes that could happen ahead and the consequent staffing/role change implications that will ensue?
GPs) interface with the DHB services? Does it speak to the many and varied public and private funding streams that currently exist providing very different 'incentivisations' for the owners, including government appointed (mainly) Boards/Chairs? Action 16 Put in place a system leadership and talent management programme and workforce development initiatives to enhance capacity, capability, diversity and succession planning and build workforce flexibility. We support actions to develop leadership and suggest that this will be dependent on establishing supported career pathways and aligning education and employment opportunities. b. We welcome this action developing skills and capability in the NGO primary and volunteer sector. We like to see at least equal investment in the clinical workforce. d. We strongly support the work of the HQSC. e. We welcome an action supporting the and support workforce – we assume this refers to the Kaiāwhina Action Plan jointly developed by HWNZ and Careerforce? f This action only needs to say the Ministry will identify and use workforce data to inform workforce planning and development. Action 17 To create a ‘one-team’ approach for health in New Zealand, the Ministry of Health will facilitate whole-of-system forums annually (in advance of DHB planning), to discuss government priorities, share international and New Zealand best practices and build leadership. Forums will inform advice to the Minister of Health on system priorities on an annual basis and contribute to a culture of trust and partnership. 5. Smart system As indicated – we support the health benefits that come from robust integrated IT systems, accessible shared records, strengthening national analytical capability etc. However, the Strategy to recognise the downside of IT eg inherent inequity and also its role in promoting ill health eg encouraging sedentary lifestyles and increasing exposure to unhealthy activities such as sexual violence from internet dating, bullying, addiction etc. It also fails to identify the potential of IT to strengthen regional development. . Action 18. Increase New Zealand’s national data quality and analytical capability to improve transparency across the health system. Action 19 The Ministry of Health will establish a national electronic health record that is accessed through certified systems including: patient portals, health provider portals, and mobile applications.