One of the priority actions in the New Zealand Healthy Ageing Strategy (2016) was to improve models of care for Home and Community Support Services (HCSS) in response to the multiple and growing demands on HCSS.
The National Framework for HCSS provides guidance for district health boards for future commissioning, developing, delivering and evaluating HCSS to improve national consistency and quality of care.
The National Framework for HCSS was developed in collaboration with key stakeholders in the HCSS sector, including older people and their whānau. It includes:
- a vision and principles to guide service design
- core (essential) components of services that could be expected anywhere in the country
- a draft outcomes framework describing the outcomes sought from HCSS at individual, population and system levels.
The National Framework for HCSS covers DHB-funded services for:
- people aged 65 years and over who have an assessed need in response to an interRAI assessment and meet criteria for funding
- people considered to be alike in age and interest – for example, Pacific peoples and Māori, aged over 55 years, and others aged over 60 years, with age-related disabilities
- older people receiving HCSS who require increased support following an acute health episode who have required hospitalisation
- HCSS that may continue concurrently with short-term Accident Compensation Corporation (ACC) services.
Three additional initiatives are linked with developing the National Framework to help achieve consistency in service commissioning, provision and resource allocation.
First, a National Service Specification for HCSS. This service specification will become the nationally mandated specification describing in detail the services and service approaches required of DHBs and providers. This National Service Specification will be implemented by July 2022, in line with DHB service commissioning timetables. This approach aims to achieve the best balance between national consistency and flexibility for DHBs in meeting the needs of their populations.
Second, a nationally consistent case-mix methodology will be developed for all DHBs to use as a way of improving targeting of resources according to need. Some DHBs are already applying case-mix methods to resource allocation or use. However, different versions of the methodology are being used, resulting in some inconsistency in resource allocation and lack of transparency across DHBs. This indicates the need for a single, nationally consistent case-mix method which will also be implemented across all DHBs by July 2022.
Third, a nationally consistent outcomes and measurement framework will be developed for use in HCSS and is expected to be completed by July 2021.