Whangaroa Health Services Review Preferred Model of Care

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4.2 Preferred pathwayThere was general consensus at the Whangaroa Model of Care Workshop held with key stakeholders on 28February 2013 that the preferred option is to redesign services provided in Whangaroa to a refocused andbetter value model of care, with improved access and population health outcomes, and lower costs – Option3 above. This reflects a growing recognition among key stakeholders that the current service model isfinancially unsustainable for WHST and NDHB, and that there are opportunities to improve access andoutcomes via a refocussed model, which can also contribute to productivity and cost improvements. Option3 is seen as offering gains in all three dimensions of the Triple Aim.Five areas of focus were agreed at the Workshop as important in service redesign:1. Shifting the balance of primary care services to planned and preventive care (particularly in regard tolong-term conditions and child health)2. Strengthening urgent, after-hours and acute care3. Shifting the emphasis of services for older people to ‘ageing-in-place’ (ie, supporting independent livingin the local community for as long as possible)4. Integration of services across professional and organisational boundaries, and in particular in relation tocommunity nursing services5. Strengthening governance, leadership, and management.(A sixth potential area was also discussed – increasing acute capacity in Whangaroa to reduce demand atBay of Islands and Whangarei hospitals. This option is not supported, in light of the analysis summarised inAppendix 1.)These five focus areas are discussed further below, and are interlinked and mutually reinforcing. In keepingwith the NHSP, they also provide the opportunity for a greater emphasis on reducing health inequalitiesbetween Māori and non-Māori in terms of access and health outcomes. It should be noted that the ReviewSteering Group considers these five focus areas and the initiatives for each described below as a ‘completepackage’, rather than a list from which items can be selected for implementation.Key components of the preferred pathway for the better value model of care include: Developing a patient-centred model that proactively addresses the immediate and longer-term healthand support needs of the Whangaroa community Strengthening the role of primary care services as the hub of the patient-centred model in Whangaroa Improving coordination between primary care, community health and home-based support services inWhangaroa by, inter alia:– Developing multidisciplinary teams and care planning– Nurse-led models of care including cost-effective models of mobile nursing– Strengthening and formalising information sharing across providers– Integrating health and support services where this contributes to efficiency and effectiveness,including consideration of shared governance and management options Ensuring administration costs are minimised.13
Figure 4 provides a graphic depiction of the preferred model of care, while Figure 5 shows in stylised formthe funding and resource allocation impacts of the preferred model of care option.Figure 4 - The preferred model of care for WhangaroaHealth literacy & self managementWhānau OralinkagesCommunity & mobile servicesWhangaroaHealth Centre servicesAged residential careservicesAcutehospitalservicesTertiarycarePaihia, KaikoheKerikeri, KaitaiaWhangareiKawakawaKaitaiaWhangareiAuckland5. Shifting the balance to planned and preventive careHealth systems were historically oriented to diagnosis and treatment of acute episodes of illness and injuryas a reactive response to patient needs. However, today increasing emphasis is being placed onanticipating and proactively addressing patient and population health needs, given the increasing demandarising from population ageing, and increased prevalence and complexity of long-term conditions. Thisincludes a focus on prevention of ill-health, early detection of risks and disease, and slowing the progressionof the disease through structured care. Long-term conditions generate much of the burden of disease inNew Zealand, and as a consequence, reduce the quality and quantity of life, while also increasing healthservice demand and expenditure.The NHSP recognises the significant demand and cost pressure that unplanned care (including urgentgeneral practice visits, ED attendances and acute hospitalisations) place on the Northland health system;pressures that are forecast to intensify as a result of population ageing and increasing prevalence of longtermconditions. In light of this, the NHSP has a headline target of reducing unplanned hospital admissionsfor Northlanders by 2,000 annually by 2017.In Whangaroa there is an opportunity to accelerate the shift to planned and structured care. This isimportant given forecast future demand growth (ageing; long-term conditions), and workforce and fundingconstraints. WHST has already started on this journey (through initiatives such as Care Plus, use of thePredict CVD tool, and mobile diabetes nursing), and is delivering good results on national indicators in areassuch as child immunisation, diabetes and CVD. The next stage could be planned and actioned across thelong term-conditions continuum (from health promotion to case management), building on what’s workingnow together with evidence of cost-effective interventions.14
Page 2 and 3: Contents1. Background .............
Page 4 and 5: Figure 2 -TheTriple Aim frameworkFo
Page 6 and 7: 4. Increase sub-specialisation, and
Page 8 and 9: Historically the Whangaroa area was
Page 10 and 11: Table 1 - Funding allocation patter
Page 12 and 13: Table 3 - Option 2 - Maintain the c
Page 16 and 17: Figure 5 - Stylised overview of fun
Page 18 and 19: The overall goals of shifting to pl
Page 20 and 21: 6.4 Primary Options Programme North
Page 22 and 23: In the immediate future, better int
Page 24 and 25: Scope the possibility for WHST to b
Page 26 and 27: 10.2 Information sharing and techno
Page 28 and 29: Table 5 - Implications of the prefe
Page 30 and 31: Appendix 2Significant activities to

Whangaroa Health Services Review Preferred Model of Care

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