Part 6: Our recent and ongoing work in the health sector

Health sector: Results of the 2011/12 audits.

In this Part, we provide summaries of our recent reports and describe our ongoing and future work in the health sector.

Recent reports

Effectiveness of arrangements to check the standard of rest home services: Follow-up report

The Effectiveness of arrangements to check the standard of rest home services: Follow-up report was completed in September 2012. Our earlier report in 2009 found that the certification process for rest homes did not provide adequate assurance that they had met the criteria in the Health and Disability Services Standards. We made nine recommendations in our 2009 report.

In our 2012 follow-up report, we found that all the recommendations had been met through initiatives introduced by the Ministry to strengthen the certification process, including introduction of the integrated audit approach, higher quality audits, and more frequent audits of high-risk rest homes. We also identified further improvements that could be made, such as using clinical and audit information together to continuously improve the quality of care provided. As a result of our report, the nationwide introduction of a technological system to improve information about quality of care (interRAI) has been accelerated, and additional training on audit methodology (the tracer technique) has been arranged for rest home auditors.

District health boards: Quality annual reports

In June 2012, we published a paper discussing characteristics of DHBs' annual reports that we consider are good for accountability. We assessed the 2010/11 annual reports of DHBs and highlighted areas of good reporting and where further improvements were needed.

This paper is intended to help DHBs to improve the quality of their reporting of non-financial performance information. The paper complements our February 2011 publication, District health boards: Learning from 2010–2013 Statements of Intent.

Fraud survey results for district health boards

New Zealand generally has a "clean" image when it comes to fraud. We consistently rank well in surveys that measure public trust in government and the effectiveness of systems and processes that deal with fraud and corruption.

In 2011, we surveyed almost 2000 people working in the public sector, including DHBs. In April 2012, we published our fraud survey results for DHBs,14 which included confirmation that most DHBs had a fraud policy and a culture that encouraged staff to raise concerns about fraud.

However, we cannot afford to be complacent if we are to prevent fraud. It is important that the right systems are in place and that information about fraud incidents is shared internally and externally.

Ongoing work

Scheduled services

We published our report Progress in delivering publicly funded scheduled services to patients in June 2011. Since then, we have met with the Ministry regularly and received reports on its progress in implementing our recommendations.

We consider that significant improvements have been achieved. A greater proportion of patients now receive their first specialist assessment within six months and treatment within six months.15 There has also been significant improvement in ensuring that patients needing cardiac surgery are treated in priority order and within the relevant period. At the same time, DHBs have treated more patients. Data has started to be collected about waiting times for some diagnostic tests and DHBs are to progressively work towards providing access to these tests within specific time frames.

We are continuing to meet with the Ministry to follow progress and will report more fully on this in 2014.

Our future needs work programme

As part of our work programme for 2012/13, we are carrying out several projects that focus on services and resources that are important to our health needs now and in the future.

DHB regional service planning and capital investment

We are currently carrying out a performance audit to establish whether capital investment planning aligns with DHB regional services planning and is guided by high-quality information about future needs. Because of the breadth of coverage of the regional services planning, we will focus on the interaction between regional services planning and cancer services. We will also concentrate on two of the four regions (Northern and South Island), because these regions have the greatest need for new capital investment. We intend to present our report to Parliament by the end of 2013.

Child obesity

Good child health is important for children and families now, and also for continued good health and active contribution to society into adulthood. Almost 30% of New Zealand children between five and 17 years old are classed as obese or overweight. This increases the risks of children developing diseases such as diabetes, heart disease, and asthma as they grow older.

We are examining the approaches that the Ministry, the Ministry of Education, and Sport New Zealand are taking to combat child obesity, and whether these approaches are informed by the end user. We intend to report on this work later this year.

We are considering whether we will do further work to examine the effectiveness of service delivery in combating child obesity. For example, we could take a closer look at the "delivery chain" and test the systems, processes, and relationships from government agencies through to the end users.

Ageing population

The proportion of older people in our population is growing at a faster rate than ever before, resulting in a major shift in our population structure. The number of New Zealanders aged 65 and over will exceed one million by the late 2020s.

We are carrying out a performance audit to examine whether a cross-section of public entities, including the Ministry, are effectively preparing and planning for the projected growth and composition of older people.

The Madrid International Plan of Action on Ageing (2002) set out to address the opportunities and challenges of ageing in the 21st century. A minimum list of 50 indicators was prepared to track progress in implementing the Madrid plan.

We are examining the use and usefulness of these indicators, including whether information is available on each of the 50 indicators, what the available information tells us about the status of older people, and how it is used to make improvements or projections.

We will publish our report in the latter part of 2013. Until then, we will progressively release the interim results for each indicator on our website ( We hope that the final report will provide assurance and stimulate discussion about the public sector's preparations during the last 20-30 years to deal with an ageing population.

Social media and technology-enabled service delivery

We are examining the use of social media by public entities to help deliver services. We are particularly interested in innovative social media practice, barriers to using social media, and common learning that can be shared throughout the public sector. We are selecting several case studies, which might include cases from the health sector – for example, the Ministry's breastfeeding community of practice and Waikato DHB's use of social media to promote discussion of vaccination during a measles outbreak.

The Ministry example demonstrates a cost-effective community of practice for hard-to-reach groups such as Māori and Pacifica. Waikato DHB illustrates a quick and targeted use of social media to prevent a wider outbreak of measles among schoolchildren.

We are using social media as one way to communicate our findings, and we aim to publish our findings by the end of June.

Future work

In 2013/14, we will focus our work on service delivery. Areas of focus are likely to include case management, contracting for outcomes, and delivering services in a digital environment. We are still deciding the work programme and which entities and sectors, including health entities, we will focus on. Our annual plan for 2013/14 will set out this work programme.

Reducing health disparities for Māori

In 2010/11, we reviewed DHBs' 2010/11 annual reports to assess their reporting on reducing health disparities for Māori. We reported our findings in our Health sector: Results of the 2010/11 audits report. We found that the combination of lack of information in the annual reports on Māori health needs and on targets to reduce disparities made it hard to gauge DHBs' progress.

In 2011/12, the Ministry introduced a new structure for DHB Māori health plans. The plans provide a summary of a DHB's Māori population and their health needs. The plan then documents and details the interventions and actions the DHB plans to carry out to address health issues to achieve indicator targets set nationally, regionally, and at district level.

We intend to carry out follow-up work to assess DHBs' progress in their reporting for 2012/13.

14: See the fraud reports on our website,

15: Since we published our report, DHBs have been required to work towards ensuring that all patients get their scheduled treatment within four months. They have two or three years to achieve this.

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