Welcome to the NGO Working Group Ministry of Health Forum

1. Welcome to the NGO Working Group Ministry of Health Forum NGO Challenges and Opportunities for Changing Times 19 October 2009

2. Challenges and Opportunities for Changing Times NGO Working Group Report and Update The New Government Horn report NGO / Govt relationship What�s facing NGOs in 2009/2010

3. Challenges and Opportunities for Changing Times Identified NGO issues (2007 survey NGO Working Group) Funding Increased levels of communication Greater understanding of and respect for NGOs Contractual issues � feedback on accountability reporting; auditing Greater involvement in policy development and service planning In 2007 we asked you what you saw as the issues for NGOs over the next five years. You identified these issues which we see as those which you have mandated us to work on. One of the issues not identified but which has had an impact on our work has been change, challenge and opportunity at the Ministry of Health. The first of these was the restructure. The most recent the Ministerial Review Group. In 2007 we asked you what you saw as the issues for NGOs over the next five years. You identified these issues which we see as those which you have mandated us to work on. One of the issues not identified but which has had an impact on our work has been change, challenge and opportunity at the Ministry of Health. The first of these was the restructure. The most recent the Ministerial Review Group.

4. NGO Working Group Represent these sector concerns to decision makers Examples Ministerial Review Group (Horn Report) submissions (See paper) Duplication of auditing/compliance burden Primary Health Care Advisory Group Health Workforce Development Significant achievements this year: Website relaunch Sector Scoping StrudySignificant achievements this year: Website relaunch Sector Scoping Strudy

5. Challenges and Opportunities for Changing Times The New Government MoH Statement of Intent 2009 -2012 �Better. Sooner. More convenient� Challenges Challenges

6. ChallengesMoH Statement of Intent 2009 -2012 Very Ministry/DHB/PHO and GP oriented Community services are typically described in terms of community based health professionals. Include NGOs? Accountability for results/outcomes � Measures to demonstrate success are typically very clinically oriented. NGOs - mentioned twice Modern health and disability systems are large and complex, and touch the lives of all members of the population to some degree at some time in their lives. To make such a large system work effectively while retaining the essential focus on care, we rely entirely on the people who work in the system. That is why I would like to open this Statement of Intent by recognising the passion and hard work of all those who work in the health and disability sector, whether they are in hospitals and community-based services, in non-government organisations, or in the Ministry This Statement of Intent outlines how the Ministry will work with all in the sector to improve health services and health outcomes for New Zealanders. (DG Introduction) � We want to ensure that DHBs forge a new partnership with health professionals and harness clinicians� expertise to improve service quality, planning and co-ordination. We also want to encourage DHBs to plan services more collaboratively with private providers � including hospitals, GP clinics, Ma�ori and Pacific health providers, and other NGOs . (Page 19) � NGOs - mentioned twice Modern health and disability systems are large and complex, and touch the lives of all members of the population to some degree at some time in their lives. To make such a large system work effectively while retaining the essential focus on care, we rely entirely on the people who work in the system. That is why I would like to open this Statement of Intent by recognising the passion and hard work of all those who work in the health and disability sector, whether they are in hospitals and community-based services, in non-government organisations, or in the Ministry This Statement of Intent outlines how the Ministry will work with all in the sector to improve health services and health outcomes for New Zealanders. (DG Introduction) � We want to ensure that DHBs forge a new partnership with health professionals and harness clinicians� expertise to improve service quality, planning and co-ordination. We also want to encourage DHBs to plan services more collaboratively with private providers � including hospitals, GP clinics, Ma�ori and Pacific health providers, and other NGOs . (Page 19) �

7. OpportunitiesMoH Statement of Intent 2009 -2012 Primary initiatives Increase the influence of frontline staff Reduce waiting times for elective surgery Reduce waiting times in emergency departments Devolve more services to primary and community settings Challenges Challenges

8. OpportunitiesMoH Statement of Intent 2009 -2012 Six health targets Four clinical (emergency departments; elective surgery; cancer treatments; increased immunization) better help for smokers to quit better diabetes and cardiovascular services offer opportunities for NGOs but the measures are primarily clinical and PHO based. Challenges Challenges

9. OpportunitiesMoH Statement of Intent 2009 -2012 Medium Term Outcomes Framework Workforce supply meets service demand Systems and services are more patient-centred More services delivered locally in the community and in primary care Faster access to high quality hospital services Challenges Challenges

10. OpportunitiesMoH Statement of Intent 2009 -2012 Medium Term Outcomes Framework Every dollar is spent in the best way to improve health outcomes Whanau Ora: Maori families are supported to achieve their maximum health and wellbeing Leadership and planning are clear, effective and co-ordinated

11. Challenges and Opportunities for Changing Times Ministerial Review Group (Horn report) Moving resources to the frontline Summary of NGO WG activity Submission to the Ministerial Review Group (MRG) Paper for today�s workshop Workshop later today Supplements and extends Statement of Intent Our submission argued strongly that NGO�s were a key resource on the frontline � used figures from the Scoping Study. WE believe there is evidence in the Horn report that we were heard. WE even get our own section under �Further work required� NGOs play a significant role and have a long history of providing front-line care, especially in disability support, addiction, and mental health. Traditionally NGOs are not-for-profit and independent of government, albeit often receiving government funding. They benefit from volunteer contributions and so often provide more service for limited funding.36 They are typically relatively flexible and innovative in meeting consumer needs, in part because they are less limited by the constraints of public ownership and funding. NGOs have an important role to play in the development of new models of care that seek to move care �closer to home�, so it is important that they be well integrated into the wider health and disability sector. 112 The dilemma for NGOs is to keep the balance between the innovation, flexibility, volunteerism, and private financial support against the constraints that inevitably come from contracting with public agencies to deliver publicly-funded services. This tension could be eased by streamlining many of the standard contracting, auditing, and compliance processes so they better reflect the situation of different NGOs, reduce the frustrations that undermine their ability to focus on performance, and allow more discretion in their ability to tailor their services to meet the individual needs of their clients. Given the diversity of NGOs, however, this is not something that we have been able to address adequately in the time available. Supplements and extends Statement of Intent Our submission argued strongly that NGO�s were a key resource on the frontline � used figures from the Scoping Study. WE believe there is evidence in the Horn report that we were heard. WE even get our own section under �Further work required� NGOs play a significant role and have a long history of providing front-line care, especially in disability support, addiction, and mental health. Traditionally NGOs are not-for-profit and independent of government, albeit often receiving government funding. They benefit from volunteer contributions and so often provide more service for limited funding.36 They are typically relatively flexible and innovative in meeting consumer needs, in part because they are less limited by the constraints of public ownership and funding. NGOs have an important role to play in the development of new models of care that seek to move care �closer to home�, so it is important that they be well integrated into the wider health and disability sector. 112 The dilemma for NGOs is to keep the balance between the innovation, flexibility, volunteerism, and private financial support against the constraints that inevitably come from contracting with public agencies to deliver publicly-funded services. This tension could be eased by streamlining many of the standard contracting, auditing, and compliance processes so they better reflect the situation of different NGOs, reduce the frustrations that undermine their ability to focus on performance, and allow more discretion in their ability to tailor their services to meet the individual needs of their clients. Given the diversity of NGOs, however, this is not something that we have been able to address adequately in the time available.

12. Challenges and Opportunities Horn report Defining and Shaping new models of care Focus on defining and measuring client outcomes Serious potential to substantially improve funding arrangements Challenges � potential changes in funding partners There is the opportunity to BOTH improve accountability and funding arrangements AND to improve service by having less rigid �funding buckets� and focus funding on patient outcomes. The challenge is to agree on outcomes and the measurement of them. However, even if the Government, the NHB and DHBs are enthusiastic about this, it is not going to be easy to realise this potential. The new funders are going to need a lot of help to get this right and it is going to require innovative thinking by both funders and providers. NGOs need to give serious consideration to how best to position themselves to help funders work these difficult questions through. There is the opportunity Challenges � potential changes in funding partners There is the opportunity to BOTH improve accountability and funding arrangements AND to improve service by having less rigid �funding buckets� and focus funding on patient outcomes. The challenge is to agree on outcomes and the measurement of them. However, even if the Government, the NHB and DHBs are enthusiastic about this, it is not going to be easy to realise this potential. The new funders are going to need a lot of help to get this right and it is going to require innovative thinking by both funders and providers. NGOs need to give serious consideration to how best to position themselves to help funders work these difficult questions through. There is the opportunity

13. Challenges and Opportunities for Changing Times NGO / Govt relationship Brief history Forum next month Workshop later today The Statement of Government Intentions in (2001) was an expression of the previous Government�s commitment to �strong and respectful relationships between government and community, voluntary and iwi/Maori organisations�. This formed the basis for the Framework for Relations between the Ministry of Health and Health/Disability Non-Government Organisations in (2002) which was a statement of the commitment of the Ministry of Health and health/disability non-government organisations to put the Government's vision into practice.The Framework was endorsed at the first forum held by the Ministry of Health and the NGOs, in March 2002, and the NGO Working Group was elected to progress issues of common concern. New government � new framework Forum next month � oversubscribed but we will get the opportunity as a sector to contribute todayThe Statement of Government Intentions in (2001) was an expression of the previous Government�s commitment to �strong and respectful relationships between government and community, voluntary and iwi/Maori organisations�.

14. Challenges for Changing Times What�s facing NGOs in 2009/2010 �Important issues facing NGOs in the next 5 years (2007 - 2011) Funding/sustainability Workforce issues Impact of policies Increase in service demand Changes to service delivery to meet changing community needs Increased compliance demands and costs involved Reducing numbers of volunteers

15. Changing Times Population trends � ageing; growing; increasing ethnic diversity; urban/rural split Living longer with increased morbidity � long term conditions and their impact on services, service delivery, workforce and models of care Inequalities � by region, ethnicity; service type

16. Changing Times Workforce � demographics; fit for purpose; inequities based on location DHBs � variabilities, inconsistencies; provider arm preferences Information Technology New technologies, treatments and drugs Funding constraints Consumer empowerment and agency

17. Credit Crisis and Recession Funding availability � grants, donations and contract revenue Impact on volunteers � more and less Increase in demand for service delivery Opportunities for change, review our effectiveness, challenges of possible duplication and new ways of working Funding mechanisms Pressures from funders to amalgamate, collaborate � Radio NZ Insight programme. EoIFunding mechanisms Pressures from funders to amalgamate, collaborate � Radio NZ Insight programme. EoI

18. Workshop: CORE Services on the Frontline Challenges Opportunities Risks Efficiencies