Localities Information gathering exercise

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Localities Information gathering exercise

Health and Disability Review Transition Unit

Wednesday 7 July 2021, 11:20 AM

8 minutes to Read

The purpose of this information gathering exercise is to understand and catalogue existing Primary Health Organisation (PHO) practice and enablers that could support a population health approach to localities.

The key objectives of this information gathering exercise are to:

understand the PHO’s perspective on the aspirations of communities, iwi and providers
catalogue current practice across PHOs in relation to localities
capture learnings from previous initiatives and current practice.

The Transition Unit will also be capturing information from District Health Boards (DHBs), iwi, Māori providers and other key stakeholder groups.

About the locality approach

The locality approach derives from the contemporary concept of population health management. The Kings Fund defines population health management as:

“An approach aimed at improving the health of an entire population. It is about improving the physical and mental health outcomes and wellbeing of people within and across a defined local, regional or national population, while reducing health inequalities. It includes action to reduce the occurrence of ill health, action to deliver appropriate health and care services and action on the wider determinants of health. It requires working with communities and partner agencies.”

There are four pillars underpinning a population health approach:

the wider socio-economic determinants of health (e.g., housing, employment, inequalities in wealth and power);
health behaviours and lifestyles (e.g., smoking, activity, nutrition, drinking, gambling);
the places and communities we live in (the built and natural environment); and
an integrated health and care delivery system.

Localities can be considered as a community of interest set in a geographic area used for the purposes of localising primary and community-based care. The locality sets catchments for community service design and input, population health needs, and accountability. Localities will be set in ways that make sense for the communities being served, which may mean localities could be aligned with council boundaries, iwi rohe, concentrations of particular population groups, or natural borders.

The locality is intended to drive a focus on equity and priority populations.

The locality approach creates a major opportunity to foster integration of care models and services and to ensure people have greater choice over the services they access. It also offers a platform to implement a population health approach, drive innovation and ensure that services are planned for all local people, delivered seamlessly, and that providers work collectively towards shared objectives.

In the future system operating model, Health NZ (in partnership with the Māori Health Authority) will have lead responsibility for service commissioning and other functions required to operationalise a locality approach, including:

partnering with iwi Māori partnership boards to ensure the voice of Māori whanau are reflected in planning and decision-making;
population health needs assessment and locality planning;
engagement with community, iwi, and cross-sectoral agencies;
service planning and service development;
procurement including provider selection, pricing, and payment; and
developing and implementing a monitoring framework including both provider performance and population health indicators.

It is envisaged that provider networks composed of a consortium of providers will deliver joined up primary and community care services to localities. It is expected that providers in these networks will:

embed and enact Te Tiriti o Waitangi obligations, and ensure the viability and sustainability of kaupapa Māori service options and approaches;
take a strong population health approach, including integration with wider social sector agencies;
work collectively towards shared outcomes and objectives, including a singular focus on achieving equity of outcomes for Māori under Te Tiriti obligations;
be subject to common service requirements, priorities, standards, reporting and monitoring processes.

To provide networks with the necessary support to operationalise the locality approach, a management function could be required to coordinate the integration of primary and community care providers within a provider network.

An indicative view of the key functions required to operationalise the locality approach are outlined below:

Commissioning functions

Network management functions

Locality needs assessments using demographic, health risk, activity, costing and funding data across a population to understand inequities, linked to national health needs assessment processes
Locality planning including engaging with communities to understand priorities, needs and aspirations
Partnering with Iwi Māori Partnership Boards
Integrating with public health services and hospital and specialist services
Working with wider government services to promote population health
Procurement (incl. provider selection, pricing, and payment)
Implementing funding models to incentivise working in provider teams and shared accountability
Performance monitoring (incl. provider network performance and health outcomes indicators)
Provider development
Locality budget management

Enabling network data & digital functions including arranging data sharing, locality performance dashboard, managing use of shared care planning tools and the shared patient portal
Provider coordination including facilitating multidisciplinary working, resolving issues between providers, and keeping providers informed and engaged in the network goals and functions
Quality improvement and clinical governance including facilitating process improvement within the provider network, identifying unwarranted variation, reporting to providers and the commissioning team
Workforce planning and development
Provider development (in some circumstances, particularly with regard to Māori or Pacific focused networks)
Change management and supporting changes to models of care
Delegated funding agent (in some circumstances)

Locality prototypes

Funding will be available in Budget 2021 to enable early investments in developing prototypes for the locality approach. The learnings from these prototypes will inform and support policy development and further roll-out of the locality approach across New Zealand over subsequent years.

In order to inform the development of the prototypes, the Transition Unit is conducting a discovery phase which seeks to capture and understand the breadth of existing commissioning arrangements, provider management arrangements, integrated care models and enablers that have similar features to the future locality approach.

The purpose of this information gathering exercise is aimed solely at gathering information and is not a prototype selection process. The process for selecting prototypes will be undertaken in conjunction with the interim Māori Health Authority and interim Health New Zealand, and leverage existing relationships where possible.

An indicative prototype selection timeframe is provided below:

What information is being sought

Through this information gathering exercise, the Transition Unit seeks to capture and catalogue any current practice that is characteristic of a locality approach. We are keen to capture specific examples of current, planned or previously trialed initiatives that have features which are similar to the future locality approach.

The overall ask

“Please describe current, planned or previously trialed initiatives that have elements that are closely aligned to the locality approach as outlined in this brief.”

Please refer to Attachment 1 for the specific questions we would like to answer through this process.

If your current, planned or previous approach does not include a focus of this sort – that is fine, please do not feel obliged to answer the questions.

If you have taken action using similar approaches as described in this brief, you may have board papers or project briefs, or reports/evaluations that describe the interventions and resultant journey to date. We would appreciate copies of significant documents – and feel free to simply refer to attached documents rather than writing a summary in the response template.

A key objective of this exercise is to capture learnings from current practice and previously trialed initiatives - these initiatives do not have to be successful or fully implemented.

This information gathering exercise is a first step in an iterative discovery process. We are likely to have follow-up discussions with at least some PHOs to further understand the information provided and test our interpretation of responses.

Please aim to send responses back by Friday 16^th July.

Attachment A: Response template

The questions outlined below are intended to provide a semi-structured format for responses based on the areas we are seeking to understand. If you would like to provide additional information that you think might be relevant, please feel free to do so.

These questions have been grouped into the following categories:

Locality planning and needs assessment
Partnership with Māori
Community engagement
Cross-sectoral working
Integrated models of care / provider integration
Alliance arrangements
Pacific providers
Data intelligence & governance

Feel free to skip any questions that are not relevant for you. The purpose of the questions is to understand learnings to inform the successful future development of localities. The information is not sought for evaluative purposes.

Questions

Locality planning and needs assessment

Does your PHO use specified geographic boundaries to analyse, plan and/or coordinate primary and community care services? If so, what criteria or principles were used to set these boundaries? Did you partner with Māori in defining these boundaries? Please describe the process undertaken or attach any relevant documents.

Do you have specific examples of how you have used qualitative and quantitative data to understand the needs of the community and design services to meet their needs? Please provide examples of documents, health needs assessments, locality plans, model of care descriptions, or policies where available.

Partnership with Māori

In what ways does your PHO engage and partner with Māori / iwi? Do you have any documents that describe your approach to partnership?

Do you have examples of how you have worked with Māori health providers to develop services or processes that support connected care across providers within a local setting? Do you have learnings relating to integrating Whānau Ora services with other local health services?

Community engagement

In what ways does your PHO seek consumer / community input on the planning, design, monitoring and evaluation of local primary and community care services? Are there documents which provide more insight into processes relating to community involvement in the planning, design, monitoring and evaluation of services? (If yes, please attach)

Do you systematically collect feedback related to patient-reported outcome measures (PROMs) or patient- reported experience measures (PREMs)? Or do you use other mechanisms to incorporate consumer voice into service provision in local areas?

Cross-sectoral working

Does your PHO partner or collaborate with other agencies including local councils, and social sector agencies or providers in the planning and/or delivery of primary and community care services in specific geographic areas? Are there documents underpinning a collaborative approach you could share? (If yes, please attach)

Integrated models of care / provider integration

Does your PHO have any specific focus on locality-based integration of primary care with community-based services delivered by other providers – for example, to address mental health & addictions, the first 2,000 days, long-term conditions, people with complex conditions, etc.

Can you provide existing reports or evaluations which describe initiatives where your PHO has developed new models of care or integrated services relevant to localities? This could include integration between primary and community care providers, and/or between primary care and hospital and specialist services. What mechanisms have helped drive shared accountability for the outcomes of communities / localities?

Pacific providers

Do you have examples of how you have worked with Pacific health providers to develop services or processes that support connected care across providers within a local setting? If yes, please attach relevant documents.

Data intelligence & governance

What data sharing arrangements are in place, or have been in place between your PHO, your provider network and other providers? Do you have a privacy impact assessment on any data sharing arrangements? (If yes, please supply a copy)

Does your PHO have an indicator set that you use to monitor the performance of your provider network across domains such as access, activity, quality, resourcing and outcomes? If so, do you regularly report this within your organisation, and feedback to your provider network? If yes, please provide a copy of such a report(s) – anonymised as necessary

Please describe any arrangements your PHO has which enable Māori to have sovereignty, governance and management rights over use of their health and other information? How were these arrangements developed (e.g. who agreed to them; who was involved throughout planning, design, and implementation; have there been any learnings from this process)?

Additional information

Please provide any further information relating to locality planning and delivery you think might be relevant - particularly any learnings, reviews or evaluations you would like to share, or advice for shaping of the future locality approach.

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