Ministry of Health: Monitoring the progress of the Primary Health Care Strategy
In 2001, the Minister of Health launched the Primary Health Care Strategy (the Strategy). Primary health care covers a broad range of out-of-hospital health services supplied by private and public providers. The Strategy was introduced in response to four main concerns about the health of New Zealanders:
- differences in the health of different groups of people (populations);
- high levels of preventable illnesses;
- high levels of hospital admissions; and
- the existence of barriers to accessing primary health care services.
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The following paragraph should read: The Strategy required significant changes to how primary health care was delivered and funded, including the introduction of Primary Health Organisations (PHOs), and significant extra expenditure, increasing from about $226 million in 2002/03 to about $835 million in 2007/08. |
The Strategy required significant changes to how primary health care was delivered and funded, including the introduction of Primary Health Organisations (PHOs), and significant extra expenditure, increasing from about $2.6 million in 2002/03 to about $835 million in 2007/08.
The Ministry of Health (the Ministry) is responsible for carrying out the Strategy, and for monitoring and reporting on its progress.
The scope of our audit
We carried out a performance audit to assess how well the Ministry was monitoring the Strategy's progress against its goals. We focused on how the Ministry was measuring the progress of the Strategy and how it was reporting on the Strategy's performance. We were interested in whether the Ministry was collecting and presenting the right information to allow Parliament and the public to make an informed judgement about progress against the Strategy. We also audited how the Ministry was using the information it collected to maintain progress, and to develop and evolve the Strategy as needed to ensure its success.
We did not audit whether the Strategy's goals were being achieved or if the Strategy was producing value for money. We did not audit funding or financial information.
Our findings
The Ministry was actively collecting a large amount of information on the changes made and the effects of the Strategy's implementation. It had begun to report on performance and other indicators as the data became available. However, we were concerned that there were significant gaps in the Ministry's approach to collecting and reporting information about the Strategy. These needed to be addressed to present a coherent and complete picture of performance.
The Ministry had some concerns about our findings, and whether we had given full consideration to the work that it had been doing to monitor and report on the Strategy. The Ministry emphasised that it took a flexible and permissive approach to how it carried out the Strategy.
We made five recommendations to the Ministry. Its response is detailed below.
The response to our findings and recommendations
Overall, we are pleased with the progress that the Ministry has made towards addressing the issues identified in our report. However, we would like to see more consolidated reporting on the performance of PHOs and for this information to be easier to access.
We recommended that the Ministry review its performance measures to ensure that they are complete and that it can assess progress towards all of the Strategy's goals for its first ten years, to 2011. The Ministry is working to develop an implementation priority plan for the Strategy that will include measures that link to the Strategy. We consider that, if properly developed, this plan would meet the intent of our recommendation.
We also recommended that the Ministry regularly produce consolidated reports about progress toward the Strategy's goals and summarise how the information collected was used to ensure that the Strategy will be successful. We recommended that the Ministry produce and publish the first of these reports by 30 June 2009.
In response, the Ministry has modified how it advises the Minister of Health through his annual monitoring report to Cabinet. This advice will now include a wider range of measures, and recommendations about the public release of the advice. Although it did not meet our recommended 30 June 2009 timeframe, we are pleased that the Ministry is planning to give its Minister a broader report. However, the Ministry will have carried out our recommendations only if it publishes a plain English report that consolidates the information it holds about progress toward the Strategy's goals and summarises how it is using the information to ensure that the Strategy will be successful.
We recommended that the Ministry ensure that performance reports for PHOs that have been in the PHO performance programme for more than 15 months are written and published promptly. In response, District Health Boards New Zealand (DHBNZ) published the first series of performance results in September 2009.
The results document the combined achievements of all of each district health board's PHOs, against a series of indicators, for the six months up to 31 December 2008. These results will be updated regularly and published one month after performance payments have been made to PHOs. The results as at 30 June 2009 were published on the DHBNZ website in March 2010, although they were not easy to find on the website.
PHOs are meant to be accountable to their communities. One of the ways they can do this is by reporting their performance against relevant indicators. The Ministry understands that PHOs are reporting their own performance information publicly. DHBNZ is going to propose to the PHO Performance Programme Governance Group (the Governance Group) how this information can be made more easily and collectively available. DHBNZ has a website where this information will be available, once decisions have been made by the Governance Group on the format of the release of the information.
In March 2010, information on performance, by PHO, was released by the Ministry of Health under the Official Information Act. We understand that the Governance Group will continue to regularly release such information. We welcome this, because we consider that public access to the reports about individual PHOs' performance (for example, through the Ministry's or district health boards' websites and accountability documents) still needs to improve.
We also recommended that the Ministry work with district health boards and PHOs to review, by 30 June 2009, the PHO performance programme so that performance results are published once PHOs are eligible for performance payments. We are not aware that any progress has been made with this.
We note that the PHO environment is currently undergoing changes that may affect how PHO performance is reported. We encourage the Ministry to ensure that, throughout these changes, it continues to report and promote relevant performance measuring and reporting.