Indicator 37: National health plan

The Ministry of Health’s planning documents discuss older people’s health needs and are reported on in annual documents and reports:^[1]

Statement of Intent 2012/13 to 2014/15
Improving the health of older people is one of the Ministry’s five priorities.^[2] The statement identifies vulnerable groups for particular attention and sets out the main areas of focus.

Minister of Health’s Letter of Expectations for district health boards for 2012/13^[3]
The letter stressed faster improvement on integrating primary care services with other parts of the health services to better manage long-term conditions and patients, including an ageing population. DHBs are expected to develop integrated services for older people to support them living at home, particularly after an admission to hospital. The Ministry and DHBs are to work together to fulfill the Government’s commitments on dedicated stroke units and dementia.

2012/13 Annual Plan Guidance^[4]
The measure for improving community support to preserve the independence of older people is that 95%+ of people receiving long-term home-support services have had a Comprehensive Clinical Assessment and a care plan completed in the previous 10 months.

DHBs are also expected to:

• implement Comprehensive Clinical Assessment for home-based services and residential care;
• agree quality measures for the health of older people and benchmark between DHBs;
• prepare a dementia care pathway; and
• proactively use DHB specialists (geriatricians and gerontology nurses) to advise and train health professionals in primary care and aged residential care.

PIF review of the Ministry of Health

The Ministry of Health was formally reviewed in March 2012 and the resulting report was published in December 2012.^[5] The Ministry was rated as "needing development" for its performance in improving the health and independence of older people.^[6] The report is known as a "PIF" (performance improvement framework).

The reviewers said that this should be a critical area for the Ministry’s medium- and long-term planning. They said that:

• The Ministry did not have its own strategic direction document, policy intervention framework, or work plan for this area.
• The 2002 Health of Older People Strategy was out of date.
• From 2008, the Ministry had based its work on the National Party’s document, Choice not chance of Older New Zealanders. The Ministry’s website on this topic was last meaningfully updated in 2008.
• There had been low ownership of this priority throughout the Ministry and little clinical or external stakeholder input into mapping the way forward.
• The Ministry’s current statement of intent identified the impact of an ageing population as one of four priority areas. The intermediate outcome was that older people can live at home. However, there appeared to be critical gaps in relevant metrics and targets.
• The new integration framework was considered to be a step in the right direction.^[7]

Since the review was completed, the Ministry has added new people to its leadership team, improved its policy capability, and prepared an integrated organisational development focus through to 2015.^[8]

Falls

One of the aims of The New Zealand Health Strategy is to reduce the incidence and impact of falls.^[9] In its 2011 annual report, the Ministry reported the percentage of admissions due to falls as a proportion of all hospital admissions for people aged 65+ and 85+ from 2005/06 to 2010/11.^[10]

The rate was relatively stable for people aged 65+ (at 2.4% to 2.6%) but had increased for people aged 85+ from 7.7% in 2005/6 to 8.5% in 2010/11. The mortality rate from falls was not reported.

Data given to us for Madrid indicator 26 shows that the death rate from falls per 100,000 population increased from 37 in 2000 to 53 in 2009.^[11]

The Ministry of Health and DHBs use planning documents to prepare and implement annual work plans. The plans are aimed at improving the quality and quantity of health services. The progress made during the financial year is reported in the relevant annual reports.

Ministry of Health