Turning strategy into action

Making the Strategy happen will require effort from everyone who works in the system and contributes to health in New Zealand.

The diagram below shows the wide range of inter-linked players in New Zealand’s health and disability system. They include many government and Crown agencies, including DHBs, as well as NGOs and private providers such as Māori and Pacific providers and independent general practices. As this strategy makes clear, at the heart of the system are New Zealanders themselves – people who use the health system and their families, whānau and networks of informal carers and supporters.

The performance of the system depends not only on the capability of each individual part but also on the strength of links throughout the system. The Ministry of Health supports these links through its stewardship role.

Overview of the New Zealand health and disability system

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A flowchart showing funding flows, accountability relationships and service provision in the New Zealand health and disability system. It includes New Zealanders, central government, the 20 district health boards, health and disability service providers (including non-DHB and DHB-owned providers), the Ministry of Health, Ministerial advisory committees, ACC, local and regional governent, other government agencies and non-DHB Crown agents.

Funding flows from:

  • New Zealanders to:
    • central government (via tax payments)
    • ACC (via levies)
    • local and regional government (via property rates)
    • health and disability service providers (via out-of-pocket payments and health insurance, and donations and volunteering)
  • central government to:
    • the Ministry of Health (via Vote Health)
    • ACC (via funding for acute accident services delivered by DHBs, and funding for non-earners' account)
    • other government agencies
  • the Ministry of Health to:
    • DHBs
    • non-DHB Crown agents
    • health and disability service providers (via Crown contracted services)
  • ACC to:
    • New Zealanders (via compensation)
    • health and disability service providers (via funding for rehabilitation and treatment services)
  • DHBs to:
    • non-DHB Crown agents (via DHB core funding and additional Ministry contracts)
    • health and disability service providers (via service agreements).

There are accountability relationships between central government and the Ministry of Health, Ministerial advisory committees, other government agencies, ACC, and non-DHB Crown agents.

Services are provided to:

  • New Zealanders by health and disability service providers, other government agencies, local and regional government, and non-DHB Crown agents
  • central government by the Ministry of Health and Ministerial advisory committees
  • DHBs by non-DHB Crown agents.

Roadmap of Actions

In a system with so many players, we need to be clear about what needs to happen and when, and who is responsible. This strategy has a 10-year outlook. But making it happen requires some shorter-term signposts. These are developed in the second part of the Strategy, the Roadmap of Actions.

The roadmap takes the five strategic themes introduced in the Future Direction and lays out concrete action areas to focus on over five years. The diagram below indicates some of the results expected from carrying out the actions.

Possible results from implementing the Roadmap of Actions over time

A graph showing a selection of actions for each of the 5 themes, spread from 'do now' in 2016 to '5-year signposts' in 2020. The theme closest to 2016 is 'smart system', with the example of action 27: processes for identifying, assessing, prioritising and procuring new technologies well understood and functioning smoothly. The next theme 'one team' includes action 23a: system-wide leadership and talent management programme in place; action 23c: governance training programme rolled out; and action 22b: all system participants clear on how to find best practice, with rapid spread of established best practice. Then is the theme 'value and high performance', with examples including action 17b: parternship approach standard for major capital expenditure; action 13: patient and service user experience measures used in performance reporting; actions 14 and 15: outcomes are included as an integral part of commissioning and performance managementment; and action 19b: initiatives to reduce patient harm have been strengthened. Then is the theme 'closer to home', with examples including action 8h: obesity reduction initiative in place; action 9k: plan for early identification of and respond to fetal alcohol spectrum disorders published; action 9d: well-functioning referral pathways between early childhood services and health services for preschoolers; and action 8d: partnerships between DHBs in the management of long-term conditions are commonplace. Lastly is the theme 'people-powered', which includes action 4c: priority groups involved in service design; action 1a-vi-b: 10 DHBs using an integrated health record for pregnant women and children; action 1a-ii-b: information on and support for managing early stage diabetes provided via social media; and action 1a-v: a wide range of national telehealth services is available.
Selected examples only; see the roadmap for the full list of actions. The numbers refer to actions in the 2016 version of the roadmap.

The roadmap will be updated annually, serving as a practical guide for DHBs and other organisations to support them in planning and prioritising work to deliver the Strategy. In all the work that they do, DHBs are expected to reflect the directions of the New Zealand Health Strategy. The roadmap updates will be made with continued collaboration across the health system through a new annual forum.

Tracking progress

In partnership with the health system, and other government agencies, the Ministry of Health will monitor work undertaken on the actions in the roadmap as part of making the Strategy happen.1

A set of measures, including measures of health outcomes and equity of outcomes, will be used to track progress. These will be shared widely to demonstrate and motivate ongoing learning and change. They will also support the Minister’s annual report on the implementation of the Strategy as required by legislation.

1. Action 16 in the New Zealand Health Strategy: Roadmap of Actions 2016 sets out this monitoring role.

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