Information about what the long-term conditions (LTC) programme aims to achieve.
LTC work programme
The Ministry Long-Term Conditions Programme provides support to the Ministry, Health Sector and NGOs by:
1. Providing leadership
Enables knowledge sharing for LTC management across all DHBs:
- workshops showcasing LTC best practice. Read more about the Shifting care closer to home conference - Health Navigator website.
- clinical director role for Long-Term Conditions team.
Facilitates guidance development supporting best practice across DHBs:
- patient co-design establishment and use of patient panel
- chronic kidney disease management, diabetes quality standards and toolkit
- health app quality assessment framework. Read more about the health applications assessment guidance.
Enables sharing across LTC work programmes in Ministry.
2. Evaluating progress
- Sets expectations for LTC management within DHB annual plans and reviews quarterly LTC management progress across DHB annual plans:
- developing relationships with DHBs around LTC.
- Evaluates new initiatives aimed at LTC management improvement.
3. Supporting innovation and service improvement
- Supports development of information and resources, where necessary, to fill gaps in LTC management:
- self management guidance (publication).
- Supports testing and service development knowledge sharing for implementing new LTC models of care and clinical pathways:
- self-management support in primary care project.
4. Providing tailored support where required
- Change management support:
- development of Diabetes Care Improvement Plans.
5. Programme measurement/assessment
- Programme measurement and assessment can be reviewed and measured against:
- the internationally recognised ‘characteristics of a high-performing chronic care system framework’ by Chris Ham
- Ministry of Health LTC outcomes framework