3.5 Coverage of the forecast SSP – Bay of Plenty DHB

District Health Boards: Learning from 2010-2013 Statements of Intent.
Coverage of the forecast SSP
The coverage of the forecast SSP is the biggest challenge for DHBs. Output classes are the mechanism for grouping outputs of a similar nature. The SOI needs to provide a picture of planned service delivery that is detailed enough to be meaningful to the reader but does not swamp the reader with information.

There are two aspects to coverage: the services and the performance measures.
  • The forecast SSP should give proper coverage of the significant services for which the DHB is responsible.
  • The performance measures should give a rounded and proportionate view of performance. They should include measures relating to the quality of services, as well as quantity, timeliness, and any other types of measure where relevant. The reader should be able to see the level of service provided and how well it is being provided.
Given the volume and complexity of services for which DHBs are accountable, it may be helpful for them to comment specifically on why their selection of services and performance measures appropriately represents their significant services.

Bay of Plenty DHB clearly identifies the services (outputs) under each output class. (As noted earlier, there are new descriptors for the four output classes from 2011/12 – Prevention, Early Detection and Management, Intensive Assessment and Treatment, and Rehabilitation and Support.)

The nature of the outputs identified within each output class suggests that the forecast SSP has a reasonable level of coverage. Table 2 below summarises the outputs.

Table 2: Outputs in each output class

Public Health Services Output Class
Support Services Output Class
Health Promotion and Education Services
Needs Assessment and Support Coordination Services
Environmental Health and Compliance
Palliative Care Services
Population Based Screening Programmes
Home Based Support Services
Immunisation Services
Aged Residential Care Bed Services
Primary and Community Services Output Class
Respite Care Services
Primary Health Care Services (GP services)
Day Services
Oral Health Services
Allied Health Services
Primary and Community Care Programmes
Community Mental Health Services
Pharmacist Services
Addiction Services
Community Referred Test/Diagnostic Services
District Nursing Services
Community Mental Health Services

Hospital Services Output Class

Mental Health Services

Elective Services

Acute Services

Maternity Services

Assessment Treatment and Rehabilitation Services

Allied Health Services

Bay of Plenty DHB specifies considerably more performance measures than other DHBs. The number of measures needed to give a concise and useful summary of the DHB’s performance without "over reporting" is a moot point. Apart from the question of “how many is too many”, examples of performance measures that are not commonly reported by other DHBs in their SOIs are:

  • under Public Health Services: measures on schools participating in a Rheumatic Fever prevention throat swabbing programme, and on environmental health inspections of Early Childhood Centres;
  • under Primary and Community Services: measures on the number of pre-school and primary school children provided with oral health services, the number overdue for their scheduled examination, and completion times for laboratory tests;
  • under Hospital Services: measures on available bed days for mental health patients, and inpatient detox waiting times; and
  • under Support Services: measures on patient satisfaction with Needs Assessment and Support Coordination Services, and the number of respite care days.

Some of these measures are clearly very specific to Bay of Plenty DHB (such as the rheumatic fever measure). The relevance of this measure is clear from the information on the district's health profile – "Maori children and youth in the Bay of Plenty also have substantially worse indicators for …acute rheumatic fever (and chronic rheumatic heart disease) that are amongst the highest in the world".

The volume of measures is, of course, just one aspect of a quality forecast SSP – a DHB should aim to portray performance with as concise a set of measures as it can to give a meaningful picture. Importantly, the measures need to be relevant, both to the DHB’s significant services and to readers, and cover different dimensions of performance – such as timeliness, quantity, and quality.

Bay of Plenty DHB’s forecast SSP shows a lot of potential because the performance measures are supported by a comprehensive outcomes framework (Appendix One to the SOI). The framework presents the following hierarchy of information against each of Bay of Plenty DHB’s nine strategic goals:

  • long-term population health outcomes, and related performance measures;
  • specific services it provides;
  • the impacts its services are designed to have, and related performance measures;
  • the specific outputs it purchases; and
  • a description of how it will know when the outputs are delivered successfully.

It colour-codes the outputs to describe the relevant output class to which they relate. Although the DHB recognises that its framework is still evolving, it is comprehensive and helps the reader to see the "fit" of the outputs and performance measures in the forecast SSP with the bigger picture. It allows the reader to better assess the coverage of the forecast SSP.

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