Whangaroa Health Services Review Preferred Model of Care

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Scope the possibility for WHST to become an operational coordinator of home and community supportservice delivery for older people in Whangaroa, to support alignment with clinical servicesExplore opportunities to increase community voluntary services as per the NHSPAlign any proposed changes to the Whangaroa model of care for older people with other changesoccurring in NDHB’s Specialist Services for Health of Older People including workforce.9. Leadership, governance and managementA key theme of stakeholder engagement, including discussion at the Whangaroa Model of Care Workshop,has been the desire to strengthen leadership, governance and management in Whangaroa health services.Given its relative size and scale in the local Whangaroa health system and its community representativestructure, the role of WHST has received particular attention.Indeed, stakeholders believe that WHST must exercise strategic leadership in the community, as one of thefew local organisations that can make resource allocation decisions. In particular, the Trust has theopportunity to lead the local Whangaroa health system, in identifying community needs and either allocatingits own resources or promoting action from others. However, there is a perception amongst somestakeholders that the Trust has not grasped this opportunity, and has lost the confidence of some of itscommunity.The goal for strengthening leadership and governance is for WHST to function as the leader of the localhealth system, within the wider Whangaroa community development strategy.Key actions to deliver on this leadership potential include: Revisit the Trust’s strategic plan to ensure alignment with funder priorities, and description of a pathwayfor a model of care for the Whangaroa community that delivers improved access and outcomes withinavailable resources Connect this strategic plan more strongly with an action plan, and annual business plans Develop an orientation programme for new Trustees that provides for capability development,particularly in regard to financial management Where necessary, supplement the skills of elected trustees with co-opted members at Trust Board orCommittee level (eg, external financial and clinical governance expertise) Review reporting processes and content to the Trust Board, particularly in regard to financial and clinicaltargets and performance Strengthen the Trust Board’s linkages with senior clinical staff as a means of ensuring alignment ofstrategic and performance expectations, and reducing risk Develop new community communication strategies to build health literacy, promote good health, andincrease engagement with the Trust and its business.A revised strategic plan would build on the work undertaken within this Review by: Outlining a shared vision and mission for the organisation, cognisant of its community partners Developing and aligning medium to long-term strategic priorities (national, NDHB, TTTPHO, TROW,WHST) Identifying short-term actions including capacity (eg, workforce, facilities, IT) and financial ’enablers’, thatsupport the identified medium to long-term priorities Assigning management and clinical accountabilities for delivery of priorities and actions23
Implementing key performance measures at organisational, management, clinical, and service deliverylevels that enable the WHST Board and its committees to monitor achievement of priority actions.Revision of the strategic plan (and associated action plan) should be informed by input from WHST staff,from funders, and from partner organisations. A development process that also engages the Whangaroacommunity would address a number of the issues discussed above.There are stakeholder perceptions that management and administration infrastructure and costs at WHSTappear to be higher than would be reasonably expected of an organisation of its size, particularly given thatthe Trust has ceased to be a PHO (with those functions having been subsumed by TTTPHO).Administration costs have been increasing at a considerable rate at the Trust (131% over the past five years,or 18% a year), although they represent a small share of total expenses. The level of management costsand associated cost growth is less clear. An indication of estimated management costs for primary carelevel services is provided by management fees paid to PHOs by the Government, which for populationsunder 40,000 is $15.60 per person enrolled for each person up to 20,000. If this is applied to the Whangaroaregistered patient population, the implied management fee is $55,000.Given concerns raised by some stakeholders and the potential for more funding to be directed to frontlinecare, more detailed analysis of Trust administration, management, and other overhead costs relative torevenue could be commissioned by the Board, including benchmarking with like organisations.10. Enabling actionsAction in a number of important ‘enabler’ areas will support a refocussed model of care for the Whangaroacommunity including: Workforce capacity and capability Information sharing and technology Clinical and management networks Partnerships and community development Patient support to overcome access barriers.10.1 Workforce capacity and capabilityIt is vital that Whangaroa makes the best use of the available health and support workforce. This requiresinnovations aligned with moving towards coordinated and/or integrated multidisciplinary ways of working, inaccord with the direction of the NHSP.Assuming adoption of the preferred model of care described above, key actions related to workforce include: Ensuring the primary health care workforce (GPs, nurses, and allied health professionals) are workingeffectively together, developing their skills, working at the full scopes of their practice, and utilisingsupport roles effectively Establishing additional health care assistant and other support worker roles where these are costeffective Strengthening the primary health care multidisciplinary team, particularly in regard to the roles of clinicaland community pharmacy, community nursing, and home-based support services Developing the health of older people workforce to support ageing-in-place, including linkages withclinical services and support for voluntary services Strengthening the Māori health and support workforce.24
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
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Page 12 and 13: Table 3 - Option 2 - Maintain the c
Page 14 and 15: 4.2 Preferred pathwayThere was gene
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
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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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