The Ministry of Health and Standards New Zealand worked together with the sector to review standards related to health and disability services.
On this page:
- About the review
- Engagement approach
- Engagement with people and whānau using services
- Modular certification frameworks
- How to stay informed
The following four standards were reviewed and combined into the one, updated Ngā paerewa Health and disability services standard (NZS 8134:2021)(Ngā paerewa).
- Health and Disability Services Standards (NZS 8134:2008)
- Fertility Services Standard (NZS8181:2007)
- Home and Community Sector Standards (NZS 8158:2012)
- Interim Standards for Abortion Services in New Zealand.
The Ministry of Health (the Ministry) partnered with Standards New Zealand, a business unit within the Ministry of Business, Innovation and Employment to review these four standards. This approach allowed the Ministry to undertake the most extensive consultation with the health and disability sector in the standards’ history, with over 300 stakeholders and organisations having direct involvement in updating the standard.
These four standards impacted a large part of the health and disability sector. For this reason, this review was supported by a strong governance framework.
An Operative Alliance provided operational advice and guidance to Phase 2 and Phase 3 of this review. Members included health and disability provider associations, district health boards, Standards New Zealand and people who use these services. For more information about this group and their work, refer to their Terms of Reference and meeting minutes.
Te Apārangi: Māori Partnership Alliance was formed as one of the steps taken to ensure Māori participation and decision-making spanned across all four phases of the standard review work programme (see section on Rangatiratanga). Te Apārangi worked in partnership alongside HealthCERT to review the four standards, using Te Tiriti as their framework. Te Apārangi held ultimate decision-making rights on all Māori content within Ngā paerewa. Te Apārangi continues to provide advice to HealthCERT and to Regulatory Assurance.
Working Group Principles
The Ministry worked with the Operative Alliance, the Governance Group, the Ministry’s Māori Health directorate and key health and disability sector partners to develop the following principles to support the review process.
- Achieving Māori health equity
- Accessible health and disability services
- Partners with choice and control
- Best practice through collaboration
- Standards that increase positive life outcomes
These principles informed discussions and debate when changes to the standards were considered and used to reach consensus aligned to the principles. For more information, including the statement of intent behind each principle and accompanying considerations, please refer to the Review principles.
This review had four key phases.
- Phase 1: Initial sector consultation
- Phase 2: Scoping workshops
- Phase 3: Working groups
- Phase 4: Standard New Zealand
The feedback from this phase reported the need to update the four standards to reflect current practice and to meet changing models of health care. Phase 1 is complete.
Scoping workshops were held throughout New Zealand Aotearoa to determine the breadth of change required to the four standards. The workshops were organised around the service types the Ministry regulates as defined by the Act: hospital, rest home, residential disability services, and mental health services. A workshop was also held for home and community support services. Phase 2 is now complete.
Feedback from the scoping workshops signalled support for a modular standard. For more information on what this means, refer to the Modular Certification frameworks section of this page. Te Tiriti o Waitangi (Te Tiriti) was identified as an important framework to underpin the development of the standard. Attendees supported maintaining the NZS 8134:2008 1.1.4: Recognition of Māori Values and Beliefs. Attendees supported Te Tiriti principles and Māori health being woven throughout criteria and guidance. There is interest across all service types to incorporate quality improvement aspects of service delivery into the standards. Attendees also strongly supported having the Standards written from the perspective of the people and whānau using services.
A mapping exercise of the standards was undertaken determine the exact, partial and no matches across the Standards.
The Operative Alliance met to discuss the output of Phase 2: Scoping workshops and agreed on the following structure and process for the Phase 3: Working groups. The working group phase was broken down into two stages.
Stage 1: Overarching Standards working groups
From September to November 2019, five working groups were established to draft the overarching criteria which would apply to all health and disability services. These working groups met over three days and covered the following topics:
- Ō tātou motika | Our tights (formerly Consumer Rights)
- Hunga mahi me te hangahanga Workforce and structure (formerly Organisational Management)
- Ngā huarahi ki te oranga | Pathways to wellbeing (formerly Continuum of Care)
- Te are ki te tangata me te taiao haumaru | Patient-centred and safe environment and infection prevention and anti-microbial stewardship (formerly Safe environment and Infection Prevention & Control)
- Here taratahi | Seclusion and restraint (formerly Restraint Minimisation and Safe Practice and Seclusion)
Te Apārangi used the experiences of Māori using health and disability services to update the standard and increase visibility of Te Tiriti throughout. Reported Māori consumer experiences of health systems and programs and the Equity of Health Care for Māori: A framework are two of the main sources with other kaupapa Māori research findings about Māori consumers being incorporated.
In moving to the working group phase of the review, the Ministry proposed the development of ‘I know what it means for me’ statements. These statements represent the partnerships that exist across health and disability services. This concept was tested and agreed by Stage 1 working group participants. Participants recommended that people who have received services develop the People Statements and an additional working group session was hosted by the Ministry following this guidance. Participants also recommended Te Apārangi develop te Tiriti o Waitangi (Te Tiriti) statements. The Ministry managed the service provider statements.
Disabled people kānohi-ki-te-kānohi
In November 2019, the Ministry partnered with the Disabled Persons Assembly and People First New Zealand Inc Nga Tangata Tuatahi to host a focus group with people and whānau using residential disability services.
Support people were asked to remain outside the room for the duration of the workshop. This ensured a safe space for the disabled people who attended to tell their story and provide honest feedback. Participants provided examples on what was going well currently within their homes and what they would like to see improved. Comments were anonymised and incorporated into the sector guidance for residential disability services.
People with experience of residential mental health and/or addiction services kānohi-ki-te-kānohi
In November 2019, the Ministry partnered with Te Hā Oranga, a Ngāti Whātua organisation, to host a dedicated kānohi-ki-te-kānohi with people who had recently used residential addiction and/or mental health services. All attendees identified as Māori.
Ministry staff were formally welcomed to Te Hā Oranga. The focus group opened with whakawhanaungatanga and was followed by a discussion of people’s experience in residential services. Opportunities and areas for improvement were identified by the group who also were positive on the parts of service delivery which met their expectations as a service user. Comments were anonymised and incorporated into the sector guidance for residential mental health and addiction services.
From December 2019 to February 2020, six working groups were established to develop guidance on how the standards may be applied in different care settings. In some instances, these groups were responsible for writing modules (of criteria) for specialty groups, for example fertility services. The Sector Guidance working groups ran over two days and covered the following services:
- Fertility Services
- Residential Disability Support Services
- Home and Community Support Services
- Age-Related Residential Care Services
- Residential Alcohol and Other Drugs and Residential Mental Health Services
- Primary Birthing Centres, Hospices and Overnight Hospital Inpatient Services (public and private).
Summary of engagement and feedback of Stage 1 and Stage 2
Over the five-month period, the Ministry hosted 28 all-day working group meetings, involving 145 people across 119 different organisations. Of those involved, 24% were people and whānau who use services or with lived experience; 24% were Māori and/or Māori providers; and 8% were disabled people. Of the health and disability service providers who were involved, nearly 36% were Māori providers (as defined by the Māori Health Directorate within the Ministry of Health).
Participants in the working groups were asked to participate in an evaluation of the working groups. Of those who responded:
- 88% confirmed the working group achieved its intention to update the standards with a diverse range of people across the health and disability sector.
- 94% confirmed that their views were respected and heard.
- 100% confirmed that in addition to providing feedback to the Ministry, they got value out of attending the working groups.
One attendee reported that what they enjoyed most was: ‘The collaboration within a diverse group, the ability to be listened to, heard and aspects of my experience incorporated into the future healthcare standard.’
Phase 3 is now complete.
On 23 March 2020, the Abortion Legislation Act 2020 was passed and responsibility for abortion services changed from the Ministry of Justice to the Ministry of Health. For more information view Abortion legislation: information for health practitioners.
Following this, an additional working group was held with abortion services experts and stakeholders from across the sector to develop sector guidance specific to abortion services. The group reviewed the services aspects of the Interim Standards for Abortion Services in New Zealand (the Interim Abortion Standards). A separate workstream was developed to consider the clinical content of the Interim Abortion Standards in conjunction with the relevant colleges.
Due to the limitations of the COVID-19 alert levels, the group met over six morning Zoom sessions. Their work was incorporated into the document reviewed by the P8134 Standard Development Committee overseen by Standard New Zealand, in alignment with the overall project timeline.
Following the extensive sector consultation, the draft amended standard document was provided to Standards New Zealand (Standards NZ). Standards NZ is responsible for administering the Standards and Accreditation Act 2015, which requires the establishment of a Standard Development Committee, a period of public consultation, and approval of the final Standards by their Independent Statutory Standard Approval Board (the SNZ Board).
The SNZ Board appointed the following members to the P8134 Health and Disability Services Standards Development Committee (the Committee):
- Kerri Butler (Chair) Te Rau Ora – Te Kete Pounamu
- Adam Bouman Kāhui Tū Kaha
- Bronwyn Haines Disabled People’s Organisation Coalition – Disabled Persons Assembly (resigned on 7 September 2020 as no longer able to represent nominating organisation)
- Carmel Conaghan Home & Community Health Association
- Caroline Tilah Health Quality & Safety Commission
- Cathy Cummings (Acting Chair) DAA Group
- Cheryl Benn New Zealand College of Midwives
- Dean Rangihuna Lived Experience, Canterbury District Health Board
- Jane Barnett New Zealand Nurses Organisation – Infection Prevention and Control College; Private Surgical Hospital Association
- Jeanette MacKenzie Fertility Plus, Auckland District Health Board
- Jessica Buddendijk Care Association New Zealand
- Kerry Dougall Te Tumu Whakarae – Māori General Managers, District Health Boards (resigned on 20 July 2020 as no longer able to represent nominating organisation)
- Lizelouize Perkins Ministry of Health
- Martine Abel-Williamson Disabled People’s Organisation Coalition – Association of Blind Citizens of New Zealand
- Peter Godden-Steele Hospice New Zealand
- Rhonda Sherriff New Zealand Aged Care Association
- Riana Manuel (Acting Chair) Te Korowai Hauora o Hauraki
- Sera Tapu-Ta’ala Pacific Peoples Disability
- Sharon Kletchko Quality and Risk Managers, Lakes District Health Board
- Sonya Iszard Accident Compensation Corporation
- Tania Thomas Te Roopu Taurima
- Teresa Wall Ora Toa PHO/Iwi (resigned on 25 August 2020 as no longer able to represent nominating organisation)
- Toni Tinirau He Waka Tapu
- Trish Davis Te Ao Mārama Group, Māori Disability advisory group (resigned on 28 September 2020 as no longer able to represent nominating organisation).
The Committee received the draft amended standard document and was provided the opportunity to make further amendments or finalise the draft standard for public consultation. The draft standard was made available for public consultation for a period of ten and a half weeks.
Over 100 individuals and organisations participated in the public consultation, with over 1400 pieces of feedback addressed and moderated by the Committee.
The NZS 8134:2021 Ngā paerewa Health and disability services standard NZS 8134:2021 was approved by the SNZ Board on 4 May 2021.
Phase 4 is now complete.
People and whānau, and in particular disabled people, using health and disability services have been a part of every step of engagement. Seats were reserved specifically for lived experience advisors within each layer of governance. Lived experience and consumer advisors were present at each scoping workshop and working groups, with two seats reserved for consumer advisors at a minimum.
The process of the review has been iterative, with feedback from participants being incorporated into later stages of the review. In recognition of the findings of the He Ara Oranga : Report of the Government Inquiry into Mental Health and Addiction, the Ministry recommended the SNZ Board to appoint a mental health lived experience advisor as chair of the P8134 Committee, which they did. Of the 24 members appointed to the P8134 Committee, 25% were Lived Experience or Consumer Experts.
Rangatiratanga, as defined in He Korowai Oranga, recognises that Māori are both a legitimate and an essential part of decision-making in the health and disability sector. The following steps have been taken to ensure Māori participation in decision-making for this review:
- The Governance Group includes the Deputy Director-General, Māori Health Directorate. External members include a Māori Consumer Advisor and the Chair of Te Apārangi.
- The Operative Alliance had four Māori representatives, including two Te Apārangi representative.
- Participation in both Stage 2: Scoping workshops and Stage 3: Working groups prioritized Māori organisations and participant attendance.
- There were at least two Māori representatives on each Stage 3: Working group.
- Te Apārangi was established and their terms of reference extended to include implementation.
- Te Apārangi rewrote NZS 8134:2008 1.1.4: Recognition of Māori Values and Beliefs and replaced with NZS 8134:2021 1.1: Pae ora Healthy futures
- The working groups requested Te Apārangi: Māori Partnership Alliance to develop the Māori content of Ngā paerewa.
- Te Apārangi held ultimate decision-making over all Māori content in Ngā paerewa
- The project team worked with Standards NZ to assess how Māori will participate in their decision-making processes. This could include increasing the use of Māori health and disability expertise, for example, having up to 50% of the P8134 Committee membership. The result of this work was that 33% of the nominated P8134 Committee were Māori.
- The P8134 Committee was chaired by Māori. Where the Chair was unable to attend the hui, Māori members were prioritised for the Acting-Chair role.
- Māori providers, Māori working in mainstream providers (DHBs and NGOs), Māori consumers including tāngata whaikaha, tāngata whaiora, and Māori auditors were represented on the P8134 Committee.
- Te Apārangi held a seat on Standards NZ P8134.
- Thirty-four Te Tiriti o Waitangi statements were drafted by Te Apārangi and approved by the P8134 Committee for inclusion in Ngā Paerewa
- Thirty-four Te Tiriti-related criteria were authored by Te Aparangi and approved by the P8134 Committee for inclusion in Ngā Paerewa
Health regulators responsible for developing and/or reviewing standards are trending towards a modular approach to certification frameworks. The Ministry considers a modular approach as being the development of overarching criteria that apply to all service types – for example, Consumer Rights, then modules (of criteria) for specialty groups – for example, Fertility services.
To inform the standards review, an international scan of certification frameworks for health and disability services was conducted. This scan focused on fourteen regulatory agencies within seven countries: England, Scotland, Northern Ireland, Wales, Ireland and Australia. These countries were selected as they share a similar regulatory strategy whereby an external assessor assesses the quality of care via minimum acceptable standards, regular inspections (sometimes unannounced) and sanctions for non-compliance.
There are two main categories of certification frameworks. In the first category, different standards are created for each health and disability service type. This is done in Northern Ireland and Australia. In the second category, high-level, outcome-based standards are developed which apply to all health and disability service types. These are then supported by service specific guidance. This is done in England, Scotland and Wales. These frameworks are modular, with only requirements relevant to the service being used in audits. Countries who have shifted to this model have found it provides flexibility for changing models of care, while ensuring the spirit of care remains focused on the people and whānau using health and disability services.
As part of this review, the Ministry asked the sector whether or not adopting a similar model in Aotearoa New Zealand would serve people and whānau using health and disability services. As noted above, scoping workshop attendees signalled support for a modular framework, supported by service specific sector guidance.