Health and Disability Services Standards and Fertility Services Standard Review

COVID-19 update: The Standards Review Work Programme is on hold to enable stakeholders to focus on the COVID-19 response. The Ministry of Health and Standards New Zealand will reassess and provide an update towards the end of June 2020.

These standards are available from the Standards New Zealand website.

About the review

The Health and Disability Services (Safety) Act 2001 (the Act) requires regular review of the Health and Disability Services Standards and Fertility Services Standard. The last substantive review of the Health and Disability Services Standards was in 2008. The Fertility Services Standard has yet to be reviewed. Sector consultation in 2017 found strong support for review of both standards. The home and community sector has some crossover into these services and therefore the Home and Community Sector Standards NZS 8158:2012 is also being considered as part of this review.

The Ministry of Health (the Ministry) and Standards New Zealand, a directorate within the Ministry of Business, Innovation and Employment, adopted a partnership approach to reviewing the standards. This approach allowed the Ministry to undertake significant sector engagement to determine the changes needed to the standards.

The review provides the sector with the opportunity to ensure the standards are sufficiently flexible to meet changing models of care.

Governance

The Health and Disability Services Standards, the Fertility Services Standard and the Home and Community Sector Standard (the standards) impact a large part of the health and disability sector. For this reason, this review is supported by a strong governance framework. 

Governance Group

A Governance Group has been established. The Governance Group provides high-level, strategic oversight of the review. For more information about this group, including membership and responsibilities, refer to their Terms of Reference.

The Governance Group meet every quarter. Minutes are available following each meeting

Te Apārangi: Māori Partnership Alliance

Te Apārangi: Māori Partnership Alliance has been established. Te Apārangi works in partnership with HealthCERT using Te Tiriti o Waitangi as the framework to provide guidance, direction and recommendations on the Standards Review work programme. Te Apārangi members include health and disability service providers, researchers and sector experts. For more information about this group, including membership and responsibilities, refer to their Terms of Reference.

Operative Alliance

The Operative Alliance (the Alliance) was established to provide operational advice and guidance to Phase 2 and Phase 3 of this review. The Alliance held their final meeting on 3 March 2020. Members included relevant 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

Working Group Principles

The Ministry worked with the Operative Alliance, the Governance Group, the Ministry’s Māori Health team and key health and disability sector partners to develop the following principles to support the review process.

  1. Achieving Māori health equity
  2. Accessible health and disability services
  3. Partners with choice and control
  4. Best practice through collaboration
  5. Standards that increase positive life outcomes

These principles are designed to help inform discussions and debate when considering changes to the standards and reach consensus which align with the principles. For more information, including the statement of intent behind each principle and accompanying considerations, please refer to the Review principles.

Engagement approach

This review is planned over four key phases.

Diagram showing the standards review indicative timeline, starting in December 2018 and finishing December 2020. More detail below.

 

Phase 1: Initial sector consultation
2017–2018

The feedback from this phase reported the need to update the standards to reflect current practice and to meet changing models of health care. Phase 1 is complete.

Phase 2: Scoping workshops
May 2019 – August 2019

Scoping workshops were held throughout New Zealand to determine the breadth of change required to the standards. The workshops were primarily organised around the service types the Ministry regulates as defined by the Act: hospital, rest home, residential disability services, and mental health services (service types). A workshop was also held for home and community support services. Phase 2 is now complete.

Feedback from the scoping workshops signalled support for modular standards. For more information on what this means, please refer to the Modular Certification frameworks section of this page. Te Tiriti o Waitangi was identified as an important framework to underpin the development of the standards. Attendees supported maintaining the Health and Disability Services Standard 1.1.4: Recognition of Māori Values and Beliefs. Attendees supported 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.

Mapping document

A mapping exercise of the three Standards was undertaken to compare the similarities and differences across the standards. This report outlines the exact, partial and no matches across the Standards.

Phase 3: Working groups
August 2019 – March 2020

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 amended  overarching standards which would apply to all health and disability services. These working groups met over three days and covered the following areas:

  1. Our Rights (currently Consumer Rights)
  2. Workforce and Structure (currently Organisational Management)
  3. Pathways to Wellbeing (currently Continuum of Care)
  4. Patient-Centered and Safe Environment and Infection Prevention and Anti-Microbial Stewardship (currently Safe environment and Infection Prevention & Control)
  5. Seclusion and Restraint (currently Restraint Minimisation and Safe Practice and Seclusion)

Te Apārangi used the experiences of Māori people and whānau using health and disability services to amend the new Standards and increase visibility of Te Tiriti throughout the document. 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 considered when relevant. 

People statements

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 co-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

The Ministry hosted a dedicated session with people and whānau using residential disability services. In November, 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 solutions for residential disability services. 

People with experience of residential mental health and/or addiction services kānohi-ki-te-kānohi

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 clear on the parts of service delivery which met their expectations as a service user. Comments were anonymised and incorporated into the sector solutions for residential mental health and addiction services.

Stage 2: Sector Solutions working groups

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 standards) for specialty groups, for example fertility services. The Sector Solutions working groups ran over two days and covered the following services: 

  1. Fertility Services
  2. Residential Disability Support Services
  3. Home and Community Support Services
  4. Age-Related Residential Care Services
  5. Residential Alcohol and Other Drugs and Residential Mental Health Services
  6. Primary Birthing Centres, Hospices and Overnight Hospital Inpatient Services (public and private).

Sector solutions were completed to varying degrees, primarily due to the pace of the two days. There will be opportunity to provide feedback and strengthen sector solutions as part of the public consultation taking place in the next Phase 4: Standards New Zealand. 

While the high-level and overarching nature of the amended standards should ensure the standards remain relevant, the sector solutions will likely require more frequent updating to reflect changing models of care. For this reason, the Ministry is considering retaining the sector solutions so that review and amendment can occur in a more timely manner. This approach is being taken into consideration with details of a formalised process currently under discussion. 

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.

Phase 4: Standards New Zealand
Commenced March 2020

Following the extensive sector consultation, the draft amended standards document has been provided to Standards New Zealand (Standards NZ). Standards NZ has their own legislated process to follow.Phase 4 has been put on hold for two months. The following information outlines the process that will take place once the Standards Review Work Programme has recommenced. 

The Standards NZ Executive Board has established the P8134 Health and Disability Services Standards Development Committee (the P8134 Committee). Membership of the P8134 Committee is comprised of the following organisations. More information will be made available about this Committee following their first meeting at which the Terms of Reference will be confirmed. 

Organisation/Interests

  • Te Kete Pounamu, Te Rau Ora (Chair)
  • ACC
  • Association of Blind Citizens New Zealand, Disabled People's Organisation Coalition
  • Canterbury DHB
  • Care Association New Zealand
  • Disabled Persons Assembly
  • Fertility Plus, Auckland DHB
  • Gender Minorities Aotearoa
  • He Waka Tapu
  • Health Quality & Safety Commission
  • Home & Community Health Association
  • Hospice New Zealand
  • Hutt Valley DHB, Te Tumu Whakarae
  • Independent Pacific Health Consultant
  • Kāhui Tū Kaha
  • Lakes DHB
  • Ministry of Health
  • Ngā Maia (Māori Midwives)
  • New Zealand Aged Care Association
  • New Zealand College of Midwives
  • Ora Toa PHO / Māori Partnership Board
  • New Zealand Nurses Organisation – Infection Prevention & Control College
  • Standards Review Te Apārangi - Te Korowai Hauora o Hauraki
  • Te Ao Marama, Capital & Coast DHB
  • Te Roopu Taurima
  • The DAA Group

The Committee will receive the draft amended standard document and will be provided the opportunity to make further amendments or finalise the draft standard for public consultation. The draft standard will be circulated for public comment for a minimum of eight weeks. Submissions will be reviewed and the draft standard updated by the Committee. The final draft will then be circulated to Committee members to approve the new Standard (at least 80% consensus required for publication). 

The final draft will be submitted to the Standards NZ Board for final approval.  

For more information about the Committee and the work of Standards NZ, please visit standards.govt.nz.

Engagement with people and whānau using services

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. The Ministry continues to build on the consumer engagement by presenting at existing events where able. Let the Ministry know if you have an event you think would be useful for the Ministry to attend to discuss the standards review.

Rangatiratanga

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: Māori Partnership Alliance was established.
  • Te Apārangi developed Standard 1.4 Recognition of Māori values and beliefs.
  • The working groups requested Te Apārangi: Māori Partnership Alliance to develop the Māori content of the draft amended standards.
  • 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 Committee membership.
  • Māori providers, Māori working in mainstream providers (DHBs and NGOs), Māori consumers including tāngata whaikaha, tāngata whaiora, and Māori auditors will be represented in decision-making groups.

Modular certification frameworks

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 standards that apply to all service types – for example, Consumer Rights, then modules (of standards) for specialty groups – for example, Fertility services.

To inform the review of the Standards, 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 standards 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 better serve people and whānau using health and disability services. As noted above, scoping workshop attendees signalled support for modular standards, supported by service specific guidance.

How to stay informed

This page will be updated regularly with information about the review.

If you have additional queries, please contact Jade Cincotta, Project Manager, HealthCERT,  jade.cincotta@health.govt.nz.

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