Becoming a National Service or National Service Improvement Programme
A framework has been developed for assessing new applications for National Service status, either as a National Service or National Service Improvement Programme.
The framework provides clarity on the criteria, and ensures a transparent decision making process is in place.
The principles underpinning National Service designation are described below.
The principles that differentiate a potential National Service from regional or tertiary services are the following.
- The service is provided by a highly skilled team and/or specialist equipment that can only be provided cost effectively in one or, at most, two DHB providers, either through a supra-regional or quaternary model.
- The service users (patients) are highly complex, and costs of providing treatment are high, with a national approach required to maintain clinical quality, and prevent inappropriate or unmanaged proliferation.
- Demand is limited, or episodic, requiring fixed infrastructure costs to ensure available capacity.
- The number of specialists providing the service is small and considered vulnerable, with a national approach required for clinical effectiveness and sustainability.
- Funding should be managed centrally through either top slice or programme funding to provide stable, protected, funding with risk shared across all DHBs.
Funding for National Services is generally allocated by DHBs so that a designated national provider is funded to deliver services for all eligible New Zealanders, on behalf of other DHBs. The funding may be to deliver patient care or to deliver co-ordination services.
National Service Improvement Programmes
In some cases a service may not meet the National Service principles, but can demonstrate that patient access and outcomes will be substantially improved through a centrally co-ordinated approach to support regional service models. In these cases an application can be submitted for consideration of National Service Improvement Programme status.
Service Improvement programmes may receive central funding for implementation of the Service Model but are not supported by sustainable funding. Principles for a Service Improvement Programme are the following.
- The Service is provided to highly complex, high-cost patients.
- The Service requires a collaborative and integrated approach across DHBs and/or specialties.
Some services that are applying for National Service status may, instead, be accepted for developing as a National Service Improvement Programme.
Funding for National Service Improvement Programme implementation is likely to be for a clinical leader and project manager to lead the implementation, but would not cover costs such as infrastructure, IT or clinical staff to deliver the service. Funding would be time limited, for the duration of the Service Improvement Programme implementation.
In achieving National Service or National Service Improvement Programme status, the service must be set up to ensure that it, and wider health services, achieve, a range of outcomes, including consistency with the five themes of the New Zealand Health Strategy.
The services will need to demonstrate ability to meet the following objectives.
- People powered – services will be patient-centred, with culturally appropriate care providing health gains
- Closer to home – services will be integrated, collaborative and provide equitable access to high quality care
- Value and high performance – services will be evidence-based, cost effective, financially and clinically sustainable with reduced clinical variation
- One team – services will be integrated across a range of clinical support systems, reducing unnecessary proliferation or duplication
- Smart system – services will use available technology to support patient care and outcomes.
Governance and decision making
The National Services Governance Group provides cross sector advice, oversight and leadership for National Services to ensure they are supported to deliver patient focused, high quality and accessible services that are clinically and financially sustainable.
Endorsing to proceed to design - The Governance Group will be asked to consider applications and determine whether they should be endorsed to progress to design and/or development of a service model. Where appropriate, the Group may be supported by a broader evaluation panel.
Evaluators will be selected based on subject matter expertise in relation to one or more areas of the evaluation, eg, funding, cultural appropriateness, clinical expertise, impartiality and availability. Evaluators will be required to complete a conflict of interest declaration.
Endorsing the draft service model to proceed to consultation - Services that are approved to proceed to design as either a National Service or a National Service Improvement Programme will then have a project initiated to design and develop a service model, with project governance established.
At the conclusion of the design phase, the Governance Group would then be tasked with determining whether to endorse the draft model to proceed to sector stakeholder consultation. This would normally be targeted consultation, involving those potentially affected by the proposed model.
Endorsing the draft service model - Following consultation, support for the service model would be sought from key sector stakeholders, specifically DHB funders, and where appropriate, operations managers and lead clinicians.
Endorsing the model for implementation - The final process of endorsement would be through the Director of Service Commissioning and DHB Chief Executives, and the Director General of Health, prior to final approval being sought from the Minister of Health.