Organisation briefing to the Minister of Health

Transcription

1 Organisation briefing to the Minister of Health New Zealand Health and Disability Sector: The Organisations 20 December 2004

2 Published in December 2004 by the Ministry of Health PO Box 5013, Wellington, New Zealand ISBN (Internet) This document is available on the Ministry of Health s website:

3 Glossary ACART AHMAC AHMC ALAC BSA CARM CFA CID CSD CTA CYMRC DHB/s DHB FP DAP DG DDG DHBNZ DSD DSP EpiQual ET FCTC FSANZ Advisory Committee on Assisted Reproductive Technologies Australian Health Ministers Advisory Council Australian Health Ministers Conference Alcohol Advisory Council of New Zealand BreastScreen Aotearoa (MoH) Centre for Adverse Reactions Monitoring Crown Funding Agreement Corporate and Information Directorate (MoH) Clinical Services Directorate (MoH) Clinical Training Agency (MoH) Child and Youth Mortality Review Committee District Health Board/s District Health Board Funding and Performance Directorate (MoH) District Annual Plan Director-General of Health (MoH) Deputy Director-General (MoH) District Health Boards New Zealand Disability Services Directorate (MoH) District Strategic Plans National Health Epidemiology and Quality Assurance Advisory Committee Executive Team (MoH) Framework Convention on Tobacco Control Food Standards Australia New Zealand HART Act Human Assisted Reproductive Technology Act 2004 HDECs HealthPAC Regional Health and Disability Ethics Committees Health Payments, Agreements and Compliance (MoH) HPCA Health Practitioners Competence Assurance Act 2003 HPDT HRC HSC HWAC IMMP MAAC Health Practitioners Disciplinary Tribunal Health Research Council of New Zealand Health Sponsorship Council Health Workforce Advisory Committee Intensive Medicines Monitoring Programme Medicines Assessment Advisory Committee New Zealand Health and Disability Sector: The Organisations iii

4 MACCAH MAF MARC MCC Medsafe MFAT Ministerial Advisory Committee on Complementary and Alternative Health Ministry of Agriculture and Forestry Medicines Adverse Reactions Committee Medicines Classification Committee New Zealand Medicines and Medical Devices Safety Authority (MoH) Ministry of Foreign Affairs and Trade MH(CAT) Act 1992 Mental Health (Compulsory Assessment and Treatment) Act 1992 MLAC MRC MSD NCSP NCSR NDSA NEAC NECART NGOs NHC NPAC NRL NSU NZBS NZCR NZDS NZFSA NZHS NZHIS OCC ODI OPC OPF PHAC PHARMAC PHCS PHD PHO Medical Licensing Advisory Committee Medicines Review Committee Ministry of Social Development National Cervical Screening Programme (MoH) National Cancer Screening Register (MoH) Northern DHB Support Agency Limited National Ethics Advisory Committee National Ethics Committee on Assisted Reproductive Technologies Non-governmental Organisations National Health Committee New Prescribers Advisory Committee National Radiation Laboratory (MoH) National Screening Unit (MoH) New Zealand Blood Service Mortality Cancer Registry New Zealand Disability Strategy New Zealand Food Safety Authority New Zealand Health Strategy New Zealand Health Information Service Office of the Commissioner for Children Office for Disability Issues Office of the Privacy Commissioner Operating Policy Framework Public Health Advisory Committee (subcommittee of the National Health Committee) Pharmaceutical Management Agency Primary Health Care Strategy Public Health Directorate (MoH) Primary Health Organisation New Zealand Health and Disability Sector: The Organisations iv

5 PTAC Pharmacology and Therapeutics Advisory Committee RANZCP Royal Australian and New Zealand College of Psychiatrists RHMU Residual Health Management Unit RPA Radiation Protection Act 1965 RPAC Radiation Protection Advisory Council SCS Service Coverage Schedule SISSAL South Island Shared Services Agency Limited SPD Sector Policy Directorate (MoH) TAS Central Region Technical Advisory Services Limited The Act The New Zealand Public Health and Disability Act 2000 The Code Code of Health and Disability Services Consumers Rights The Commission The Mental Health Commission The Commissioner The Health and Disability Commissioner The Group The National Kaitiaki Group The Minister The Minister of Health The Ministry The Ministry of Health (MoH) The Office The Office of the Health and Disability Commissioner The Sector The New Zealand health and disability sector WHA World Health Assembly WHO World Health Organization New Zealand Health and Disability Sector: The Organisations v

6 Contents Glossary iii Introduction 9 The controlling legislation and associated organisations 9 Agencies outside the sector 9 The sector is more than formal organisations 10 The Ministry has multiple roles 10 The Role of the Minister of Health 11 Your responsibility for core strategy documents 11 Powers and responsibilities in relation to DHBs 11 Appointments to DHB boards 11 Ministerial committees 12 Professional and regulatory bodies 13 The Role of DHBs 15 DHBs legal status 15 DHB objectives and responsibilities 15 DHBs, Mäori and the Treaty of Waitangi 15 DHBs and PHOs 16 DHB accountability mechanisms 16 DHB owned organisations 18 The Role of the Ministry of Health 21 Providing policy advice 21 Acting as agent 21 Monitoring the performance of DHBs 21 Planning and funding selected services 21 Legislation and regulations 22 Nationwide planning and maintenance of service frameworks 22 Providing health information and processing payments 22 Facilitating collaboration and co-ordination 22 Other Organisations Provided for in the Act 23 New Zealand Health and Disability Sector: The Organisations vi

7 New Zealand Blood Service: Te Kura Koiora 23 PHARMAC 23 Residual Health Management Unit 23 Ministerial Committees under the New Zealand Public Health and Disability Act Cancer Control Council (under establishment) 25 Child and Youth Mortality Review Committee 25 Health and Disability Ethics Committees 25 Health Workforce Advisory Committee: Kömiti Taunaki Kaimahi Hauora 26 National Health Epidemiology and Quality Assurance Advisory Committee 26 National Ethics Advisory Committee 27 National Ethics Committee on Assisted Human Reproduction 27 National Health Committee: Hunga Kaititiro i te Hauora o te Tangata 27 Perinatal and Maternal Mortality Review Committee (under establishment) 28 Ministerial Committees under the Medicines Act Medicines Adverse Reactions Committee 29 Medicines Assessment Advisory Committee 29 Medicines Classification Committee 30 Medicines Review Committee 30 New Prescribers Advisory Committee 30 Other Groups and Committees 31 National Kaitiaki Group 31 Other Crown Entities in the Health and Disability Support Sector 32 Alcohol Advisory Council of New Zealand: Te Kaunihera Whakatupato Waipiro o Aotearoa 32 Health Research Council of New Zealand: Te Kaunihera Rungahau Hauora o Aotearoa 32 Health Sponsorship Council: Te Röpu Whakatairanga Hauora 32 Mental Health Commission 33 Food-related Agencies 34 Food Standards Australia New Zealand: Te Mana Kounga Kai Ahitereiria me Aotearoa 34 New Zealand Food Safety Authority: Te Pou Oranga Kai o Aotearoa 34 New Zealand Health and Disability Sector: The Organisations vii

8 Office for Disability Issues: Te Tari mö ngä Take Hauätanga 35 The Ministry of Health: Manatü Hauora 36 Business units of the Ministry of Health 36 Statutory positions within the Ministry of Health 39 The Directorates 40 The executive team 42 Chief advisors 44 Agencies Protecting Patient and Consumer Rights 49 Office of the Health and Disability Commissioner: Te Toihau Hauora, Hauätanga 49 Health and disability consumer advocacy services: Ngä Kaitautoko 49 Office of the Ombudsmen: Nga Kaitiaki Mana Tangata 50 Office of the Privacy Commissioner: Te Mana Matapono Matatou 50 Office of the Human Rights Commission: Te Kahü Tika Tangata 50 Office of the Commissioner for Children: Te Tari o te Kaikomihana mö ngä Tamariki 50 Families Commission Kömihana ä-whänau 51 The Provider and Consumer Community 52 International Aspects of the Sector 54 International contacts 54 International conventions 55 New Zealand Health and Disability Sector: The Organisations viii

9 Introduction This document provides a description of many of the organisations in the New Zealand health and disability sector (the sector) and your statutory duties as Minister of Health in respect of these organisations. The discussion also describes the international agreements and international contacts that impact on the structure and operation of the sector and your responsibilities as Minister. 1 The controlling legislation and associated organisations The organisational features of the sector are dominated by the provisions of the New Zealand Public Health and Disability Act 2000 (the Act) and the Health Act The Act outlines your duties as Minister and the role and functions of District Health Boards (DHBs) and the Ministry of Health (the Ministry). The Act also establishes or otherwise provides for the existence of the National Health Committee, New Zealand Blood Service, Pharmaceutical Management Agency, Residual Health Management Unit, and various ministerial committees. Other Crown entities in the sector, such as the Alcohol Advisory Council of New Zealand, Health Research Council, Health Sponsorship Council, and Mental Health Commission, have their own specialist legislation. Agencies outside the sector Several organisations under the jurisdiction of your ministerial colleagues are also germane to your role as Minister of Health. In particular you will need to understand the interactions between the Ministry of Health and the Accident Compensation Corporation, Specialist Education Services, the Department of Child, Youth and Family Services, the Work and Income service delivery arm of the Ministry of Social Development, and the Office for Disability Issues within the same Ministry. You also need to be aware of the biosecurity functions of the Ministry of Agriculture and Forestry and the Ministry for the Environment. 1 Information about the organisations that make up the sector is also available in The Health Sector: The New Zealand Directory, published by Health Sector Publications, and The Health and Disability Sector in New Zealand: A Directory, published by the Ministry of Health. The first of these titles includes extensive information about consumer, provider and health professional groups, while the Ministry s publication focuses on the formal institutions in the sector. Both publications are updated on a regular basis. New Zealand Health and Disability Sector: The Organisations ix

10 The sector is more than formal organisations This document concentrates on the statutory institutional arrangements governing the operation of the sector. However, these arrangements and the organisations they give rise to are only a part of the sector. As Minister of Health you also need to be mindful of the wide range of advocacy and consumer groups, and healthcare provider and health professional groups, in the sector. The nature of your and the Ministry s relationship with these groups, especially those groups representing providers and health professionals, is central to the effective operation of the sector. You also need to remain mindful of the importance of the work of non-governmental and voluntary groups. The Ministry has multiple roles The complexity of the sector is reflected in the complexity of the role and the scale of the expenditure administered by the Ministry of Health. In 2004/05 the Ministry will administer close to $10 billion in expenditure, be responsible for enforcing over 110 pieces of specialist legislation and regulations, and administer important subsidy payments to primary care providers and health consumers. The Ministry will also have a strategic role in working with the sector and ministers to develop and implement policy to improve the health of all New Zealanders. New Zealand Health and Disability Sector: The Organisations 10

11 The Role of the Minister of Health Your general duty as Minister is to be responsible to Parliament for the exercise of the functions, duties and powers given to you in legislation. Your more specific duties include providing strategic oversight to the sector, powers with respect to DHBs, and making appointments to ministerial committees and professional and regulatory boards. These three tasks are described in greater detail in the following paragraphs. Your responsibility for core strategy documents The Minister of Health, in conjunction with the Minister for Disability Issues, is responsible for strategies that provide a framework for the sector and for reporting on the implementation of these documents to Parliament. The first editions of these documents, the New Zealand Health Strategy (NZHS) and the New Zealand Disability Strategy (NZDS), were published in December 2000 and April 2001 respectively. These documents have already been developed and there is no statutory requirement to review them. If you do decide to review them, the Act requires you to consult with appropriate organisations and individuals. The Act also requires you to oversee the development of a strategy for nationally consistent standards and quality assurance programmes for health services and consumer safety. In September 2003, the Minister of Health released Improving Quality (IQ): A Systems Approach for the New Zealand Health and Disability Sector, as required under the Act, and launched IQ Action Plan: Supporting the improving quality approach. Powers and responsibilities in relation to DHBs You have a number of powers and responsibilities with respect to DHBs. In particular, your consent is required for DHBs district strategic plans and you have to agree to DHBs district annual plans before they can proceed. You are also responsible for reviewing DHBs performance against the objectives agreed with the Government. The Act provides you with reserve powers to direct DHBs to give effect to government policy, to provide or arrange for the provision of certain services, to appoint Crown monitors to sit on DHB boards, and to dismiss DHB boards. These reserve powers are intended for use in exceptional circumstances only. At a more general level you have the power to make the expectations and requirements of the Government clear through reiterating the policies in the NZHS, and promulgating planning expectations and funding agreements. Appointments to DHB boards A maximum of 11 members sit on each DHB board, seven of whom are elected by the community every three years, with the remainder appointed by you in your role as Minister of Health. You are also responsible for appointing the chair and deputy chair of each board. Chairs and deputy chairs can be either elected or appointed members. The chairs, deputy chairs and chief executives of each DHB are listed in Table 3 on page 9. When you make appointments to DHB boards, section 29(4) of the Act requires you to endeavour to ensure that Mäori membership of the board is proportional to the number of New Zealand Health and Disability Sector: The Organisations 11

12 Mäori in the DHB's resident population and, in any event, there are at least two Mäori members on the board. Each member serves for a maximum of three years initially, although appointed members can be appointed for shorter periods. An elected member can stand for re-election. Appointed members can also be reappointed but are not allowed to serve for more than nine consecutive years. The Act also requires DHBs to appoint at least three advisory committees: a Community and Public Health Advisory Committee, a Disability Support Advisory Committee and a Hospital Advisory Committee. DHBs can also form their own committees (eg, Audit Risk and Finance Committees). The members of these committees are appointed by DHB boards and can be board members or members of the public. Members of the public are usually appointed following consideration of publicly invited nominations. Ministerial committees The Act requires you to establish a number of ministerial committees (described as compulsory committees in the following discussion), and also gives you the power to establish other ministerial committees for any purpose relating to the Act (described as discretionary committees in the following discussion). You are also responsible for making appointments to professional and regulatory bodies. Ministerial committees undertake an important role in the policy and decision making process. They provide you with independent, expert advice, a forum for representatives of the sector to have a role in decision-making, and create pre-conditions for balanced decision-making. The statutory bases for the major ministerial committees in the health and disability portfolio are outlined in Table 1. Table 1 also shows that ministerial committees can be divided into advisory committees and deliberative/technical committees. Advisory committees provide you with advice on a particular issue specified in a terms of reference. Deliberative/technical committees focus on reviewing individual cases and applications. Table 1: The major ministerial committees in the health and disability portfolio Type of committee Advisory committees Name Cancer Control Council Statutory basis Discretionary committee to be established in 2005 under section 11 NZPHDA Health Workforce Advisory Committee (HWAC) Discretionary committee under section 15 NZPHDA 1 Ministerial Committee on Assisted Reproductive Technologies (MCART) National Ethics Advisory Committee (NEAC) Compulsory committee to be established in 2005 under section 31 Human Assisted Reproductive Technology Act 2004 Compulsory committee under section 16 NZPHDA New Zealand Health and Disability Sector: The Organisations 12

13 Technical deliberative committees National Health Committee (NHC) Public Health Advisory Committee (PHAC) National Health Epidemiology and Quality Assurance Advisory Committee (EpiQual) Child and Youth Mortality Review Committee (CYMRC) Health and Disability Ethics Committees Medicines Adverse Reactions Committee (MARC) Medicines Assessment Advisory Committee (MAAC) Medicines Classification Committee (MCC) Medicines Review Committee (MRC) National Ethics Committee on Assisted Human Reproduction (NECAHR) National Kaitiaki Group New Prescribers Advisory Committee (NPAC) Perinatal and Maternal Mortality Review Committee Discretionary committee under section 13 NZPHDA The NHC must establish PHAC under section 14 NZPHDA Compulsory committee under section 17 NZPHDA Discretionary committee under section 18 NZPHDA Discretionary committees established under section 11 NZPHDA Discretionary committee under section 8 Medicines Act 1981 Discretionary committee under section 8 Medicines Act 1981 Compulsory committee under section 9 Medicines Act 1981 Compulsory committee under section 10 Medicines Act 1981 Discretionary committee under section 11 NZPHDA to be reconstituted as compulsory committee under section 26 Human Assisted Reproductive Technology Act 2004 Discretionary committee under section 74 Health Act 1956 Discretionary committee under section 8 Medicines Act 1981 Discretionary committee under section 11 NZPHDA 1 New Zealand Public Health and Disability Act Professional and regulatory bodies You are responsible for making appointments to 15 professional and regulatory bodies that are established under the Health Practitioners Competence Assurance Act You are also responsible for a single shared disciplinary tribunal for all boards (the Health Practitioners Disciplinary Tribunal), standardising the size of the membership of boards at up to 14 members, and having all memberships filled by ministerial appointment subject to special provisions for elections in some cases. New Zealand Health and Disability Sector: The Organisations 13

14 Table 2: Professional and regulatory boards Organisation Chiropractic Board Dental Council of New Zealand Dietitians Board Number of ministerial appointments All 7 members All 14 members All 7 members Health Practitioners Disciplinary Tribunal All 106 members, 1 Chair and 3 Deputy Chairs Medical Council of New Zealand Medical Laboratory Science Board Medical Radiation Technologists Board Midwifery Council Nursing Council of New Zealand Occupational Therapy Board Optometrists and Dispensing Opticians Board Osteopathic Council Pharmacy Council Physiotherapy Board Podiatrists Board Psychologists Board All 10 members All 8 members All 10 members All 8 members All 10 members All 7 members All 10 members All 8 members All 8 members All 8 members All 7 members All 10 members New Zealand Health and Disability Sector: The Organisations 14

15 The Role of DHBs DHBs are the main mechanism for funding and providing publicly-funded health and disability services for the population of a specific geographical area. Close to 75 percent of Vote: Health spending flows through DHBs. There are 21 DHBs, with marked differences in area and population, as shown in Figure 1 and Table 4 on page 10. DHBs have been established with the objective of, inter alia, improving and promoting the health of people and communities, and promoting the integration of health services, especially the integration of primary and secondary services. DHBs legal status DHBs are Crown entities, established under the Act and subject to the core public sector accountability statutes, including the recently enacted Crown Entities Act 2004, the Public Finance Act 1989, the Official Information Act 1982 and the Ombudsmen Act DHB board members are also required to exercise their powers in accordance with any code of conduct that applies to Crown entities (no code exists at this time). DHBs are legally responsible to you as Minister of Health, although the Ministry acts as your agent in managing the formal relationship through the chair of the board of each DHB. DHB objectives and responsibilities DHBs are required to undertake their functions according to a set of population health objectives set out in sections 22 and 23 of the Act. These objectives centre on the requirement to work to protect and improve the health of their communities and to foster the independence of people with disabilities. This is to be done by promoting the integration of health services, ensuring the provision of effective health and disability support services, and reducing disparities. DHBs are also required to promote social responsibility, community participation in decision-making, transparent decision-making, prudent management of Crown-owned assets, and to act in a co-operative manner. In particular, they are expected to co-operate with adjoining boards to deliver services, such as specialist services that draw patients from a larger area than is covered by a single DHB. DHBs, Mäori and the Treaty of Waitangi The role of DHBs in respect of the Crown s obligations under the Treaty of Waitangi has been set by Parliament in the Act. The starting point is section 4, which refers to the mechanisms to enable Mäori to contribute to decision-making on, and to participate in, the delivery of health and disability support services contained in Part 3 of the Act. Part 3 of the Act is also linked to the objective of reducing health disparities by improving health outcomes for Mäori (section 22(1)(e)). There are a number of mechanisms for achieving this objective. For example, the section 29(4) requirement that the Minister endeavour to ensure Mäori representation on each DHB board, and sections which require DHBs to provide for Mäori representation on DHB advisory committees. Clause 5 of Schedule 3 also requires DHB board members not familiar with, amongst other topics, Mäori health issues, Treaty issues, and the Mäori groups and organisations in the district of the DHB concerned, to be trained in these areas. Further opportunities for participation by Mäori are provided for in section 23(1) and the requirements to: New Zealand Health and Disability Sector: The Organisations 15

16 establish and maintain processes to enable Mäori to participate in, and contribute to, strategies for Mäori health improvement continue to foster the development of Mäori capacity for participating in the health and disability sector and for providing for the needs of Mäori provide relevant information to Mäori for the above two requirements. There is also an obligation in section 38(6) of the Act for DHBs to ensure their district strategic plans reflect the overall direction established in the NZHS and the NZDS. The NZHS states that acknowledging the special relationship between Mäori and the Crown is a principle that should be reflected across the health sector. The draft version of He Korowai Oranga: Mäori Health Strategy takes this principle to the next stage and provides more detail on how it is to be implemented. The strategy is underpinned by the three principles of the Treaty partnership, participation and protection and is given effect by Whakatätaka: Mäori Health Action Plan The NZDS also reiterates these three principles. DHBs are also expected to show how they intend to put these principles into effect. DHBs and PHOs Primary Health Organisations (PHOs) are funded by District Health Boards for the provision of a set of essential primary health care services to those people who are enrolled with the PHO. Each PHO has a contract with its DHB to provide these services, called the Transitional Primary Health Organisation Agreement, which is currently at version 16.1 with three variations. The DHB is responsible for monitoring whether its PHO(s) is delivering services according to the agreement. PHOs can take a variety of legals forms such as a non-profit company, an incorporated society or a trust. DHB accountability mechanisms The Act requires DHBs to have a set of formal accountability documents, including annual financial statements, annual reports and: the Crown Funding Agreement (CFA), specified in section 10 of the Act a district strategic plan (DSP), specified in section 38 of the Act a district annual plan (DAP), specified in section 39 of the Act a statement of intent, specified in section 42 of the Act. The CFA is the formal accountability agreement between you and each DHB. It includes performance expectations for DHBs in exchange for your formal agreement to defined levels of funding. The CFA also formally obliges DHBs to comply with an Operating Policy Framework (OPF) and Service Coverage Schedule (SCS). The OPF provides detail on how the Ministry expects key aspects of DHBs functions, such as finance monitoring and relations with Mäori, to be carried out in practice. The SCS describes the nationwide minimum service coverage of health and disability support services the Government expects will be made available through Vote: Health. DSPs spell out DHBs medium- to long-term goals for the health of their populations. DAPs spell out DHBs short-term objectives, including the range of services they will provide for their populations. New Zealand Health and Disability Sector: The Organisations 16

17 In addition to formal accountability documents, the Ministry maintains close contact with DHBs through Account Manager relationships, quarterly DHB chairs conferences and regular Deputy Directors-General/DHB Chief Executive meetings. Table 3: DHB chairs, deputy chairs and chief executives, at 17 December 2004 DHB Chair (elected or appointed) Deputy chair (elected or appointed) Chief executive Northland Lynette Stewart (appointed) Stan Semenoff (elected) Karyn McPeake Waitemata Kay McKelvie (appointed) Ross Keenan (appointed) Dwayne Crombie Auckland Wayne Brown (appointed) Ross Keenan (appointed) Garry Smith Counties Manukau Pat Snedden (appointed) Ross Keenan (appointed) Stephen McKernan Waikato Michael Ludbrook (appointed) Sally Christie (elected) Jan White Lakes Stewart Edward (appointed) Joan Williamson-Orr (elected) Cathy Cooney Bay of Plenty Mary Hackett (elected) Graeme Horsley (appointed) Ron Dunham Tairawhiti Ingrid Collins (elected) Pene Brown (elected) Jim Green Taranaki Hayden Wano (appointed) Peter Catt (elected) Tony Foulkes Hawke s Bay Kevin Atkinson (appointed) David Marshall (elected) Chris Clarke Whanganui Patrick O Connor (appointed) Ormond Stock (elected) Memo Musa MidCentral Ian Wilson (appointed) Ann Chapman (elected) Murray Georgel Hutt Valley Peter Glensor (elected) Sharron Cole (appointed) Chai Chuah Capital and Coast Bob Henare (appointed) Judith Aitken (elected) Margot Mains Wairarapa Doug Matheson (appointed) Janine Vollebregt (elected) David Meates Nelson Marlborough Alex Grooby (appointed) Liz Richards (elected) John Peters West Coast Gregor Coster (appointed) Christine Robertson (appointed) John Luhrs Canterbury Syd Bradley (appointed) Olive Webb (elected) Jean O Callaghan South Canterbury Joe Butterfield (appointed) Neil Anderson (elected) Craig Climo New Zealand Health and Disability Sector: The Organisations 17

18 DHB Chair (elected or appointed) Deputy chair (elected or appointed) Chief executive Otago Richard Thomson (elected) Louise Rosson (elected) Brian Rousseau Southland Dennis Cairns (appointed) Neville Cook (elected) Gershu Paul Table 4: DHB populations 2004 (2004 Statistics NZ estimates based on 2001 Census) Figure 1: DHB boundaries DHB Population 1 Northland 148,000 Waitemata 488,000 Auckland 427,000 Counties Manukau 427,000 Waikato 337,000 Lakes 102,000 Bay of Plenty 197,000 Tairawhiti 45,000 Taranaki 107,000 Hawke s Bay 150,000 Whanganui 65,000 MidCentral 165,000 Hutt Valley 138,000 Capital and Coast 268,000 Wairarapa 39,000 Nelson Marlborough 133,000 West Coast 31,000 Canterbury 461,000 South Canterbury 54,000 Otago 180,000 Southland 108,000 Southland West Coast Otago Northland Waitemata Counties Manukau Taranaki Whanganui Capital and Coast Hutt Nelson-Marlborough Canterbury South Canterbury Waikato Kilometers Auckland Lakes Bay of Plenty MidCentral June 2002 Public Health Intelligence Public Health Directorate Hawke's Bay Tairawhiti Note: The Chathams are part of the Hawke's Wairarapa Bay DHB Notes 1 Totals have been rounded to the nearest The total estimated population was 4,067, Further DHB population data is available in: R King, C Skelly, B Borman, Atlas of New Zealand s District Health Boards, Occasional Bulletin Number 13, Public Health Intelligence Unit, Ministry of Health, DHB owned organisations DHBs own a range of organisations, including DHB controlled companies, companies controlled in conjunction with other Crown entities, companies in which DHBs have a minority interest, trusts and incorporated societies, and unincorporated joint ventures and New Zealand Health and Disability Sector: The Organisations 18

19 partnerships. DHB-owned public health units and shared support services are discussed below. Public health units Public health services are centrally funded by the Ministry but are delivered by 12 DHBowned public health units and various non-governmental organisations (NGOs). DHBbased services and NGOs each deliver approximately half of such services. Public health units focus on core public health services as specified in The Public Health Services Handbook, including environmental health, communicable disease control, tobacco control and health promotion programmes. Many of these services include a regulatory component performed by statutory officers appointed under a variety of legislation, though principally under the Health Act These statutory officers are employed by DHBs but are personally accountable to, and subject to, direction from the Director-General of Health. Statutory officers also work closely with the Ministry s Public Health Directorate in respect of funding, co-ordination of services and ongoing support. The organisational arrangements for delivering DHB-based public health services are summarised in Table 5. Table 5: DHB public health units, at 17 December 2004 Public health unit Public Health Unit Northland DHB Auckland Public Health Public Health Unit Waikato DHB Toi Te Ora Public Health Unit Public Health Unit of Tairawhiti DHB Public Health Unit of Taranaki DHB Public Health Unit of Hawke s Bay DHB Public Health Services MidCentral DHB Regional Public Health Service Public Health Unit of Nelson Marlborough DHB Crown Public Health 2 Public Health South Otago DHB Delivering services to Northland DHB Waitemata, Auckland and Counties Manukau DHBs Waikato DHB Bay of Plenty and Lakes DHBs Tairawhiti DHB Taranaki DHB Hawke s Bay DHB MidCentral and Whanganui DHBs Wairarapa, 1 Capital and Coast, and Hutt DHBs Nelson Marlborough DHB Canterbury, South Canterbury and West Coast DHBs Otago and Southland DHBs Notes: 1 The Regional Public Health Service delivers some of its programmes through a subcontract with Wairarapa DHB s Choice Health provider arm. 2 Crown Public Health is owned by Canterbury, South Canterbury and West Coast DHBs but is moving to sole ownership by Canterbury DHB. Canterbury DHB will assume responsibility for providing public health services to all three boards. New Zealand Health and Disability Sector: The Organisations 19

20 Shared services agencies DHBs have also pooled resources to obtain common support services through jointly owned companies, including those shown below. Table 6: Shared services agencies, at 17 December 2004 Shared support agency Northern Clinical Training Network Ltd Northern DHB Support Agency Ltd (NDSA) 1 HealthAlliance Ltd Healthshare Ltd Allied Laundry Services Ltd Central Region Technical Advisory Services Ltd (TAS) HIQ Ltd (HealthIntelligence) South Island Shared Services Agency Ltd (SISSAL) Owned by Northland, Waitemata, Auckland, Counties Manukau and Waikato DHBs; University of Auckland Waitemata, Auckland and Counties Manukau DHBs Waitemata and Counties Manukau DHBs Waikato, Bay of Plenty, Lakes, Tairawhiti and Taranaki DHBs Taranaki, Hawke s Bay, Whanganui and MidCentral DHBs Hawke s Bay, Whanganui, MidCentral, Wairarapa, Capital and Coast and Hutt DHBs Taranaki and Capital and Coast DHBs All South Island DHBs 1 NDSA also provides services to Northland DHB. District Health Boards New Zealand DHBs have formed a national umbrella organisation called District Health Boards New Zealand Incorporated, known as DHBNZ. DHBNZ s role is to co-ordinate joint DHB initiatives and to communicate with the Government and the Ministry over matters that affect all DHBs. There is no statutory relationship between the Crown and DHBNZ. DHBNZ is also designed to provide a forum for DHBs to develop a considered strategic view on key policy and operational issues, and to provide DHBs with a shared capacity to: develop national service frameworks for pricing, contracting, service development and specifications facilitate the sharing of project resources identify and promote best practice provide applied analysis to inform strategies for workforce planning and development, and employee relations and agreements co-ordinate DHB operational activity related to planning and funding national services. New Zealand Health and Disability Sector: The Organisations 20

21 The Role of the Ministry of Health The Ministry s roles can be summarised as: providing policy advice on improving health outcomes, reducing inequalities and increasing participation acting as the Minister s agent monitoring the performance of DHBs and other Crown entities in the sector planning and funding public health, disability support services and other services that are retained centrally implementing, administering and enforcing relevant legislation and regulations nationwide planning and maintenance of service frameworks providing health information and processing payments facilitating collaboration and co-ordination within and across sectors. Providing policy advice The Ministry is Ministers and the Government s primary advisor on health policy and disability support services. Acting as agent The Ministry acts as your and Associate Ministers agent in a number of ways. For example, the Ministry acts as your agent in managing the formal relationship with DHBs and is an intermediary between yourself and representatives of the sector. The Ministry also provides you and Associate Ministers with a range of ministerial support services. These services enable you to respond to the large volume of correspondence, parliamentary questions and other enquiries. Monitoring the performance of DHBs The Ministry monitors the performance of DHBs and other Crown entities in the sector against the objectives agreed with the Government. The Ministry also monitors the performance of the sector in an international context, with a focus on international benchmarks. Planning and funding selected services The Ministry is responsible for planning and funding public health and disability support services, and nationwide funding agreements for selected personal and family health services. New Zealand Health and Disability Sector: The Organisations 21

22 Legislation and regulations The Ministry administers and enforces over 110 statutes and regulations, primarily to protect patient safety and public health. The Ministry also works with other agencies to safeguard public safety with respect to environmental and public health issues such as biosecurity. Nationwide planning and maintenance of service frameworks The Ministry plans and maintains nationwide frameworks and specifications for services. This includes an overview of nationwide planning for capital development. Providing health information and processing payments The Ministry has governance over health information systems and standards across the sector. It is also responsible for ensuring health and disability information is accessible for providers and consumers wherever appropriate and practical. The Ministry s responsibility for processing payments is summarised in the paragraphs about HealthPAC under the section describing the operational arms of the Ministry of Health later in this document. Facilitating collaboration and co-ordination The Ministry is also involved in establishing and promoting links within the sector, providing strategic direction and leadership to the sector, and promoting links with other sectors that influence health status and independence. New Zealand Health and Disability Sector: The Organisations 22

23 Other Organisations Provided for in the Act In addition to DHBs and the Ministry, the Act also provides for the existence of the New Zealand Blood Service, PHARMAC and the Residual Health Management Unit. These organisations are described in more detail in the following paragraphs. New Zealand Blood Service: Te Kura Koiora The New Zealand Blood Service (NZBS) was established as a company in 1998 and is now a statutory corporation under the Act. NZBS initially had responsibility for establishing an integrated national blood transfusion service, which it now has in place. NZBS continues to be responsible for managing the donation, collection, processing and supply of blood products and related services. NZBS s core activity is the safe, timely, high-quality and efficient provision of blood services. Section 65 of the Act also provides you with the power to give NZBS directions relating to government policy. NZBS is governed by a board that can have up to seven members, including the chair, all of whom are appointed by the Minister. There are currently five members on the board. The chair is Dr John Carter. PHARMAC PHARMAC, the Pharmaceutical Management Agency, was established in 1993 and is now a Crown entity under the Act and is directly accountable to you as Minister of Health. PHARMAC s overall objective is to secure the best health outcomes that are reasonably achievable from pharmaceutical treatment within the funding provided. Section 65 of the Act also provides you the power to give PHARMAC directions relating to government policy. PHARMAC manages the Pharmaceutical Schedule (the Schedule), which lists around 3000 prescription medicines and related products subsidised by the Government. Since September 2001 PHARMAC has also been responsible for managing the purchasing of all pharmaceuticals used by, or on behalf of, DHBs, including some hospital drugs. Pharmaceutical suppliers may apply to PHARMAC to have a medicine listed on the Schedule once the product has been registered. The PHARMAC board makes decisions on listing, subsidy levels, and prescribing guidelines and conditions with input from independent medical experts on the Pharmacology and Therapeutics Advisory Committee (PTAC). The PHARMAC board can have up to six members, including the chair, all of whom are appointed by the Minister of Health. There is currently a full complement of members. The chair is Richard Waddell. Residual Health Management Unit The Residual Health Management Unit (RHMU) was established in 1993 to assume responsibility for area health board assets and liabilities that were not otherwise vested with Crown health enterprises, regional health authorities or the Ministry of Health. RHMU New Zealand Health and Disability Sector: The Organisations 23

24 was subsequently continued under section 57 of the Act. Section 65 of the Act also provides you with the power to give RHMU directions relating to government policy. RHMU has three main functions: managing residual assets and liabilities advising DHBs that wish to sell surplus property lending funds to DHBs via RHMU s Crown Financing Agency division. RHMU holds any assets, other than DHB indebtedness, until they are transferred to an approved third party, mature, disposed of by RHMU, or no longer subject to a restriction or encumbrance. This includes residual property leases. RHMU must maximise the value and minimise the cost to the Crown of assets prior to disposal. RHMU is also responsible for assisting DHBs to dispose of surplus property by either buying surplus property from DHBs for the purpose of selling on the open market, or by providing expert consultancy advice to DHBs who wish to sell or manage residual assets until disposal. RHMU s Crown Financing Agency division was established in 2000 following the previous government s decision that DHBs should not borrow from the private sector except for working capital facilities. The Crown Financing Agency provides DHBs with a range of term loan facilities broadly similar to a commercial lending organisation. The Crown Financing Agency has to approve a DHB s business case before funds are provided. The Crown Financing Agency also sets the terms and conditions of the loans and ensures repayment and compliance with the loan conditions. The RHMU board can have up to five members, all of whom are appointed by the Minister. There are currently four members including the chair, Ross Tanner. New Zealand Health and Disability Sector: The Organisations 24

25 Ministerial Committees under the New Zealand Public Health and Disability Act 2000 Cancer Control Council (under establishment) The Minister of Health has approved the establishment of the Cancer Control Council under Section 11 of the New Zealand Public Health and Disability Act 2000 to provide an independent, sustainable focus for cancer control. The Ministry of Health is currently seeking nominations to the Council which will be established no later than 30 June The Council s key objective is to lead the sector to successfully implement the New Zealand Cancer Control Strategy (NZCCS), of which the key purposes are to: reduce the incidence and impact of cancer reduce inequalities with respect to cancer. The Council may also advise on any other matters that the Minister specifies by notice to the Council. The Council is to be established by and will be accountable to the Minister of Health. It shall comprise a maximum of up to eight persons, including the Chair and Deputy Chair. The Minister will appoint all members. Child and Youth Mortality Review Committee Section 18 of the Act provides for the establishment of mortality review committees that review and report to the Minister on specified classes or types of death. The Child and Youth Mortality Review Committee (CYMRC) is the first such committee established under these provisions. CYMRC is responsible for reviewing the deaths of children and young people aged between 28 days and 24 years with a view to reducing the number of preventable deaths of people in these age groups. CYMRC s first task was to develop processes that securely gather electronic information from a range of agencies in to a central database. This central data will assist in reviewing of deaths by collating standard information to support the reviewing of deaths. The central database allows for local input of information. The data gathering processes have been developed with the central database funded via a contract with Otago University. The CYMRC s work plan will now focus on refining the review processes. CYMRC has 10 members, all of whom are appointed by the Minister. The terms of appointment of several members recently ended. The Ministry has run a nominations and appointments process leading to the appointments being agreed by Appointments and Honours Committee on 8 December The letters of appointment have been prepared for signing. Professor Barry Taylor has been reappointed as chair for a further two years. Health and Disability Ethics Committees Health and disability ethics committees (HDECs) undertake ethical reviews of proposed health research in their region of authority. There are currently 7 HDECs: the Multi-region Ethics Committee, 2 Northern Regional Ethics Committees (based in Auckland and Hamilton), the Central Regional Ethics Committee, 2 Upper South Regional Ethics New Zealand Health and Disability Sector: The Organisations 25

26 Committees (both based in Christchurch), and the Lower South Regional Ethics Committee. These committees were established under section 11 of the NZPHDA in December The primary role of HDECs is to safeguard the rights, health and wellbeing of consumers and research participants and, in particular, those persons with diminished autonomy. Each HDEC has 12 members including the Chair, all of who are appointed by the Minister. HDECs were first established in the wake of the 1987 Inquiry into the Treatment of Cervical Cancer and Other Related Matters at National Women s Hospital (the Cartwright Inquiry), and the 1988 Report on the Cervical Cancer Inquiry. Until November 2004 there were 15 regional ethics committees in New Zealand. Following advice from the National Ethics Advisory Committee and further advice from the Ministry of Health, the Minister of Health decided: that the Multi-region Ethics Committee be established as the primary review body for all multi-centre and national research studies that the number of regional health and disability ethics committees be reduced, with 15 committees being disestablished and 6 new committees, covering larger geographical areas, being established under section 11 of the NZPHDA. Health Workforce Advisory Committee: Kömiti Taunaki Kaimahi Hauora The Health Workforce Advisory Committee (HWAC) was established in May 2001 as an independent advisory committee under section 15 of the Act and reports directly to the Minister of Health. HWAC has a small secretariat accommodated in the Ministry of Health. HWAC s role is to advise the Minister about health workforce issues that the Minister specifies by notice to the Committee. HWAC's recommendations, published in 2003, focused on the workforce implications of implementing the Primary Health Care Strategy, health workforce education, building Mäori health and Pacific health workforce capacity, promoting a healthy workplace environment, research and evaluation, and the development of the health and support workforce to meet the needs of disabled people. HWAC has eleven members including the chair, all of whom are appointed by the Minister. The incoming chair is Hon Stanley Rodger. The Mäori Health and Disability Workforce Sub-Committee, which includes 4 members co-opted by HWAC, is chaired by Professor Colin Mantell. HWAC also has a Medical Reference Group, chaired by Dr George Salmond, which includes 7 members co-opted by HWAC. National Health Epidemiology and Quality Assurance Advisory Committee The National Health Epidemiology and Quality Assurance Advisory Committee, known as EpiQual, is a compulsory ministerial advisory committee under section 17 of the Act. EpiQual first met in March New Zealand Health and Disability Sector: The Organisations 26

27 EpiQual will be responsible for providing the Minister with advice on any matter of health epidemiology and quality assurance but must specifically examine perinatal, child and adolescent morbidity and mortality. Their work programme is being finalised. National Ethics Advisory Committee The National Advisory Committee on Health and Disability Support Services Ethics (known as the National Ethics Advisory Committee, or NEAC) was established in December 2001 as a compulsory ministerial advisory committee under section 16 of the Act. NEAC met for the first time in April 2002 and has a small secretariat accommodated within the Ministry. NEAC is responsible for providing you with advice on ethical issues of national significance in respect to any health and disability matters, including research and health services. NEAC is also required to determine nationally consistent ethical standards across the health and disability sector. NEAC has 12 members including the chair, all of whom are appointed by the Minister. The chair of NEAC is Dr Andrew Moore. National Ethics Committee on Assisted Human Reproduction The National Ethics Committee on Assisted Human Reproduction (NECAHR) is responsible for reviewing assisted human reproduction proposals, including health research and innovative treatment proposals. It has a duty to determine whether such proposals are ethical and to determine if the rights of people, and the ethical perspectives of Mäori and other cultural and ethnic groups, will be taken into account. NECAHR also has a general duty to advise you on ethical issues relating to assisted human reproduction. You can also direct NECAHR to consider any other matters relating to assisted human reproduction as you determine. NECAHR has 10 members including the chair, all of whom are appointed by the Minister. The chair of NECAHR is Professor Sylvia Rumball. NECAHR will be disestablished in 2005, and reconstituted into two bodies an ethics committee and a Ministerial Committee - under the Human Assisted Reproductive Technology Act National Health Committee: Hunga Kaititiro i te Hauora o te Tangata The National Health Committee (NHC) was first established in 1991 and was reestablished as a discretionary ministerial advisory committee under section 13 of the Act. NHC is responsible for providing you with advice on the kinds and relative priorities of the public health, personal health and disability support services it believes should be publicly funded. It may also advise you on other public health matters. NHC has a secretariat accommodated within the Ministry of Health. NHC also has a Public Health Advisory Subcommittee (PHAC) to advise you about the promotion and management of public health. PHAC was established in July 2001 to meet the requirement for this subcommittee in section 14 of the Act. New Zealand Health and Disability Sector: The Organisations 27