Closer to home

Ka aro mai ki te kāinga

Good health begins at home and in communities and these are the places most people would choose to receive the care and support they need for their health. We will always need hospitals. But the opportunities are growing for shifting services out of such specialist centres, so that we can prevent and manage health conditions safely and effectively in people’s local communities. One way we can do this is to help people in the health workforce undertake tasks they are skilled (or can be trained) to do that have traditionally been outside their roles.

This theme is where public health, personal health services, other social services and the broader community and business environment intersect. It focuses on prevention and wellbeing, early intervention and rehabilitation for long-term conditions, through evidence-based initiatives aimed broadly at all New Zealanders as well as those designed for people at higher risk. It also recognises the pressing need for us to work together more effectively to support children, families and whānau, particularly those at risk of poor health or social outcomes.

What do we want in five years?

  • People have access to services, information and support as close as possible to home. These services are available when they want them, and access to services is as easy as possible.
  • The balance of services for long-term conditions will have shifted closer to the service user (by growing preventative, self-management, rehabilitation, home, community and primary care services).
  • Services from health promotion and primary care up to tertiary-level services are configured in a way that is more effective, equitable and sustainable. Services are delivered in community settings where possible.
  • Investment approaches will be the norm for agencies across government to improve overall outcomes and to support provision of services for at-risk children and families and other priority populations.

The actions below are intended to be carried out within a five-year timeframe, with the first steps starting in 2016/17 and indicated with an asterisk (*).

Shift services

Action 6

To maximise value for people and achieve the best health outcomes, the Ministry of Health, with input from others in the system, will ensure the right services are delivered at the right location in an equitable and clinically and financially sustainable way.

  1. * The Ministry of Health and DHBs work together to establish service configuration design principles (recognising that some services, such as allied health and primary care, need to be available locally, while other specialist services, such as heart transplants, need only be in one location).
  2. Map and simplify referral pathways.
  3. Collaborate on the approach to implementation and timing.

Action 7

Enable all people working in the health system to add the greatest value by making sure they are providing the right care at the earliest time while fully utilising their health skills and training.

  1. * Work with health professionals to develop a single competency framework, which includes cultural competence, for all prescribers in New Zealand.
  2. * Increase the use of telehealth approaches, including telemedicine and telemonitoring, to provide services to people closer to their home.
  3. * Take advantage of technological advances in order to make services more accessible.

Tackle long-term conditions and obesity

Action 8

Increase the effort on prevention, early intervention, rehabilitation and wellbeing for people with long-term conditions, such as diabetes and cardiovascular disease, by addressing common risk behaviours such as obesity and intervening at key points across the life course.

  1. * Agree the outcomes framework for setting expectations and judging success.
  2. * Reorient planning guidance and performance management to outcomes for long-term conditions. Begin by focusing on one of these conditions; for example, diabetes or mental health conditions or cardiovascular disease.
  3. * Make greater use of new and existing clinical networks across different DHB regions to strengthen collaborative approaches to long-term conditions.
  4. Support the spread of best practice over time, by requiring partnerships between those producing the best and most equitable health outcomes and others.
  5. Over time, progressively target other aspects of preventing and managing long-term conditions – perhaps population segments, or weaker segments of the end-to-end journey; perhaps emerging conditions.
  6. Capture the service user’s care plan in an electronic form for access by all health providers who make up the care team.
  7. * Collaborate with other government agencies to implement an evidence-based programme of vocational rehabilitation to keep people with long-term conditions in employment.
  8. * Implement and monitor a package of initiatives to prevent and manage obesity in children and young people up to 18 years of age. The package should take a life-course and progression of condition approach, and ensure parents have good information and that those with greater need receive greater support. Action will be taken across a range of settings where children learn, live and play, such as schools.

A great start for children, families and whānau

Action 9

Collaborate across government agencies, using social investment approaches, to improve the health outcomes and equity of health and social outcomes for children, young people, families and whānau, particularly those in priority groups or at risk.

  1. * Increase support to pregnant and postnatal women experiencing mental health and alcohol and other drug conditions.
  2. * Promote healthy nutrition and activity for pregnant women and children to reduce the prevalence of childhood and adult obesity.
  3. * Support families, especially those with newborn babies, to have healthy housing (warm, dry and smokefree) and address crowding issues, to reduce transmission of infectious diseases, infant mortality and family stress.
  4. * Enhance collaboration between early childhood services and health services for pre-schoolers, to improve early childhood education attendance and better address unmet health and development needs.
  5. * Lead the Government’s work to improve outcomes for at risk children aged 0–5 years, so they are safe, healthy and learning, they belong and enjoy economic opportunities.
  6. * Support the Ministry of Education’s lead for at-risk 15- to 24-year-olds, which includes working towards improved health outcomes for these young people.
  7. Investigate expanding the Well Child / Tamariki Ora programme to include parenting education, training and support aimed at increasing children’s social, emotional and behavioural competence.
  8. Expand the Healthy Housing programme to target and measure a reduction in avoidable admissions to hospitals in priority groups.
  9. * Connect children and families of offenders to health services.
  10. * Work with the Accident Compensation Corporation (ACC) and other partners to build on a range of programmes that support young people to make healthy relationship choices, with the aim of reducing the incidence of sexual and family violence in the future.
  11. Plan and implement a range of actions to prevent fetal alcohol spectrum disorders and improve the response of the health and social sectors to children and families living with the disorder.

Support for older people with high and complex needs

Action 10

Involve health and other social services in developing shared care for older people with high and complex needs in residential care facilities  or those needing support at home, so that older people and their family and whānau receive integrated support to live well.

  1. Enhance the role of shared-care plans, using lessons learned from the new model of disability support.
  2. Improve connections between primary care and support services delivered in people’s homes and in the community.
  3. Work with the Ministry of Social Development and other social sector agencies to improve health and social outcomes for vulnerable older people and improve support for those who care for them at home.
  4. Review, together with service users, quality dimensions for aged residential care and home support.
  5. ACC, Health Quality and Safety Commission New Zealand (HQSC), DHBs and the Ministry of Health work jointly on injury prevention and rehabilitation to improve the quality of life for older people.

Support for the final stages of life

Action 11

Support clinicians and people in developing advance care plans and advance directives by building existing national and international resources and networks.

Action 12

Review adult palliative care services to ensure all those who would benefit from palliative care at the end of their life are able to access high-quality, culturally appropriate care and have a seamless experience regardless of whether they are at home, in hospital, in a hospice or in an aged residential care facility.

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