THE

BIGGER

PICTURE

Fiona Murdoch

Portfolio Manager

Health of Older People &

Disability

Strategy & Funding

Waikato DHB

By the end of the presentation

• Political processes influencing services

for older people – Understanding the national environment

– Understanding the local environment

• Overview of DHB funding – Where does the money come from?

– What do we spend it on for older people?

Understanding and managing performance

Vote Health

• Key drivers

• Population Based Funding Formula 8.7%

• Legislation

– Provider regulation

• Crown Funding Agreement & variations

• Service Coverage Agreement

• Minister’s Letter of Expectations

• Needs Analysis

• District Annual Plans

• Regional Service Plans

Health Service Structure

• District Health Board and Committees

• Midland Healthshare

• Corporate Team

• DHB Divisions – Clinical e.g Provider Arm

– Non-clinical e.g. Strategy and Funding

– People and Performance (HR) / Legal Services / IS etc

• MoH DHB Account Manager

• Ministry of Health - DHB support services – Sector Services (Payment Services)

– Health Policy / HealthCert

– InterRAI Training Programme

– MoH contracts

DHB funding and purchase ‘enablers’

• Budget

• Forecast

• Contracting intent

– Prioritisation

– Investment / Disinvestment

• Purchase documents

– Contracts and Service Level Agreements

– Price Volume Schedule (PVS)

• Tender and procurement processes

• Contribution to Cost Pressure (CCP)

The Funding – Where does it come from?

$1095 Million CFA (PBFF share)

$37 Million Ministry of Health Contracts

$7 Million DSS

$15 Million Screening and Population Health

$11 Million Clinical Training Agency

Where will it all go – 2013/14?

$383 Million

NGO: $480M

$77 Million ARRC

$105 Million Pharmacy [including pharmaceutical cancer treatments]

$97 Million PHO

$21 Million LABs

$29 Million Home Support

$47 Million Mental Health Providers

$104 Million – Other (contracts under $7m)

What about ‘too many older people’

• We have a total DHB population of around 380

thousand

• We have a population that is getting

proportionately older

• We have a Māori population which is growing at

a slightly faster rate than other population

groups and is estimated to be 23.3 per cent by

2026

• We have a population of Pacific people who

make up an estimated 2.5 per cent of our

population

Two dimensions of Population Ageing

• Numerical Ageing

– Absolute increase in numbers of older people

(primarily caused by increased life expectancy)

– 100% guaranteed and NOT the ‘problem’

• Structural ageing

– Increase in proportion of older people (primarily caused by

low/falling birth rates)

– Diminished proportions at younger ages

– Structural crossovers (more older people than children; fewer

labour market entrants than exits)

What does this mean for healthcare for older people with long-term

disability?

• Regional differences will be enormous

– Growth will end in the rural areas

• The working age population will be increasingly competed for

– Skill shortages will rapidly intensify

– Participation rates will increase

– Labour costs will increase

– Unemployment rates will be low

– Unpaid carers will be less available

• Maori will comprise a substantial and steadily growing

proportion of the region’s workforce – Median age 23 years cf. 38 years

Deciding where to spend the money

Needs analysis

Service gaps

Strategic priorities

Required outcomes

MoH directives

Emerging risk

Prioritising Resources

Planning Environment

• Each District Health Board (DHB) has a statutory responsibility to prepare:

– An Annual Plan for approval by the Minister of Health (Section 38 of the New Zealand Public Health and Disability Act 2000) - providing accountability to the Minister of Health.

– A Statement of Intent (Section 139 of the Crown Entities Act 2004) - providing accountability to Parliament, and the public.

• Cabinet decisions require both documents to be brought together into a single DHB Annual Plan with Statement of Intent.

• Each DHB is also required to participate in Regional Planning and deliver against a Regional Service Plan

Annual Plan

What does it do?

• Sets out the DHBs priorities;

• Outlines how we are going to meet the

national targets;

• Outlines what we are spending our

revenue on.

Health of Older People

Key issues for the Waikato DHB in relation to

the older population include:

• The healthcare cost is around five times higher

for those over the age of 65 than for those under

65 years;

• Increasing prevalence of dementia;

• Exponential increase in expenditure on long-term

disability supports (such as home care and aged

residential care);

• Increase in depression and suicide;

• Avoidable Admissions.

Health of Older People funded services

• Age-related residential care

– Including psychogeriatric services

• Community Day Programmes

• Home & Community based Support Services

• Ageing in Place

• Medication Oversight

• Respite / Carer Support

• Accredited Visiting Services

• Post-discharge services

• Nutrition education / promotion programmes

Revenue streams supporting residential care

• Long-term Disability Support services

– ARRC / ARHSS agreements

– Residential Respite Services Agreement

– Long-term Support- Chronic Health Conditions

(LTS-CHC)

– MoH - Young People with a Disability (YPD)

– ACC

– Private contributions

• Short-term ‘personal health’ services

– Transitional Care / PCIP / End-of-Life

Long-term Care

Age-related residential care bed-day prices (GST excl)

• Waikato DHB Hamilton City TLA (2016- 17)

• Rest home $116.98

• Secure Dementia $158.53

• Hospital Level of Care $188.67

• Hospital Specialist Services $210.21

• Psychogeriatric High Dep. $245.05

• Maximum Contribution: $919.59 per week GST incl.

Funding