Hon Andrew LittleMinister of Health
The Government’s reform of the health system took a big step forward today with the unveiling of the system that will be used to hold it accountable and ensure it
delivers more equitable healthcare for all New Zealanders.
Health Minister Andrew Little has already announced the 20 district health boards will be disestablished and replaced
with a new national system with a a greater focus on primary healthcare, bring an end to the postcode lottery system of
health services, and cutting bureaucracy so healthcare workers can focus on patients.
Today, Andrew Little launched the Health System Indicators framework that complement the reforms.
“The indicators are a new way of thinking. They are not about incentivising with funding or pointing the finger if
targets are not met – they are neither a carrot nor a stick,” Andrew Little said.
“They are a measure of how well our health system is functioning across the country, and an opportunity to then create
local solutions to address local health needs.
“This framework will help the sector focus on the areas that most need to improve – especially for Māori and Pacific
peoples.
“The indicators are based on the Government’s six priorities for health – improving child wellbeing, improving mental
wellbeing, improving wellbeing through preventative measures, creating a strong and equitable public health system,
better primary healthcare and a financially sustainable health system.
“Twelve indicators have been developed and progress in meeting them will be publicly reported on every three months.
“When the indicators show there is a problem, health services will work with local communities to come up with effective
ways to fix it.”
The indicators replace the outdated and ineffective National Health Targets regime.
“The targets have been in place since 2007 and there’s plenty of evidence – from New Zealand and other countries – that
they don’t work,” Andrew Little said.
“They are arbitrary and don’t reflect the real priorities of the health system.
“Even worse, they led to what can only be described as perverse outcomes, with district health boards seeking to meet,
such as doing lots of small procedures instead fewer major ones so they could claim more people were being treated.”BackgroundWhat are the indicators within the Health System Indicators framework?Government priorityIndicatorDescriptionImproving child wellbeingImmunisation rates for children at 24 monthsPercentage of children who have all their age-appropriate scheduled vaccinations by the time they are two years oldAmbulatory sensitive hospitalisations for children (age range 04)Rate of hospital admissions for children under five for an illness that might have been prevented or better managed in
the communityImproving mental wellbeingUnder 25s able to access specialist mental health services within three weeks of referralPercentage of child and youth accessing mental health services within three weeks of referralAccess to primary mental health and addiction servicesMeasurement criteria under developmentImproving wellbeing through preventionAmbulatory sensitive hospitalisations for adults (age range 4564)Rate of hospital admissions for people aged 4564 for an illness that might have been prevented or better managed in the
communityStrong and equitable public health systemAcute hospital bed day rateNumber of days spent in hospital for unplanned care including emergenciesAccess to planned carePeople who had surgery or care that was planned in advance, as a percentage of the agreed number of events in the
delivery planBetter primary health carePeople report they can get primary care when they need itPercentage of people who say they receive care from a GP or nurse when they need itPeople report being involved in the decisions about their care and treatmentPercentage of people who say they feel involved in their own care and treatment with their GP or nurseFinancially sustainable health systemAnnual surplus/deficit at financial year endNet surplus/deficit as a percentage of total revenueVariance between planned budget and year end actualsBudget vs actuals variance as a percentage of budgetHow does the Health System Indicators framework work?
The Health System Indicators framework is a new way of measuring how well the health system is working for people in New
Zealand and identifying where we need to do better to meet the needs of Māori and Pacific peoples.
The new framework includes 12 high-level indicators that have been carefully selected to ensure the health system
focuses on the right areas to achieve Pae Ora – healthy futures – for all New Zealanders.
The new framework recognises that local problems require local solutions. This means the actions developed to improve
performance on each of the high-level indicators will vary across the country to reflect the unique challenges and needs
of each community and any barriers preventing equitable access to services. The emphasis is on continuous improvement at
a local level rather than focusing attention on achieving nationally set performance targets.What is happening to the national health targets?
While results for the national health targets will no longer be published as a set of metrics, DHBs will continue to
report to the Ministry on their performance for the targets, as part of their regular quarterly reporting processes.How will the framework be further developed in 2021/22?
The Ministry and HQSC will work with the Transition Unit and sector stakeholders during 2021/22 to further develop the
framework and ensure it complements overarching monitoring and accountability arrangements for the health and disability
system going forward.
This will include finalising the measurement criteria for the two remaining initial indicators and could potentially
also include developing further indicators, for example in relation to mental health, youth health, access to health
services, equity of access/outcomes and infant health. It will be important to ensure any additional indicators are
aligned with the roles and accountabilities of sector participants.When will the local actions be put in place?
DHBs and local providers will be supported during 2021/22 to partner with their stakeholders including Māori/Iwi
partnership boards and clinicians to develop a set of local actions for each high-level indicator that will contribute
to national improvement. It is anticipated that all local actions will be in place by 1 July 2022.How will the new framework improve equity for Māori and Pacific peoples?
Data for all the high-level indicators (except financial performance) will be available by ethnicity, both nationally
and (in due course) at a local level. This will help us identify where we need to do better, especially for Māori and
Pacific peoples.
The local actions to improve national performance will be developed in partnership with local communities and
stakeholders to ensure they are fit for purpose and will be delivered in a way that works for Māori and Pacific
communities.