Ministry of Health Annual Review 2015/16 Responses to Supplementary Questions

Transcription

1 Ministry of Health Annual Review 2015/16 Responses to Supplementary Questions 176. What are the key risks to DHBs operating within their available resources and achieving financial sustainability? There are a number of well-known global and local challenges to DHBs operating within their available resources, including: the increasing prevalence of long term conditions such as diabetes and cardiovascular disease the increasing and aging population labour cost inflation given that the majority of health expenditure is on the health workforce the technological challenges of maintaining clinical and management systems while investing in new systems to improve the efficiency and effectiveness of health care and assessing the impact of emergent technologies What steps is the Ministry taking to mitigate these risks and support DHBs to achieve financial sustainability? The Ministry released a refreshed NZ Health Strategy and Roadmap of Actions in April 2016, which outlines the Ministry's approach to dealing with these challenges. Through the annual Budget process all DHBs receive an increase in their baseline funding for new initiatives and to help them meet cost pressures In addition, the Ministry supports DHBs through a range of interventions. The Ministry works with DHBs to create accountability documents that outline what DHBs will deliver and help improve their performance. The Ministry also monitors progress throughout the year against targets (both service and financial) and works with DHBs to address issues that may be affecting their performance. The Ministry provides support for sector employment relations negotiations and pays particular attention to monitoring the Government s six national health targets.

2 178. The Committee notes that the health target Improved access to elective surgery has been consistently exceed by a significant amount since its inception in 2007/08 and the actual increase for 2015/16 is more than 20,000 higher than the target of an average 4000 per annum increase. Is consideration being given to change this target, given that it appears to be set well below the capability of DHBs to deliver? The "Improved access to elective surgery" health target is reviewed annually to ensure relevance in the current environment. For example, the definition was revised following sector wide consultation commencing in 2015/16, to better recognise new models of care, and to support Faster Cancer Treatment priorities, and align closer to other OECD countries through the inclusion of arranged surgery, and surgery undertaken through medical services. DHBs seek to be efficient, and maximise available capacity and resources through different models of care. This includes shifting surgical activity from an inpatient to an outpatient or community setting. Activities such as this will have a long term impact on the "Improved access to elective surgery" health target results. Continuing the current policy is considered appropriate given the increases in delivery that have been achieved each year, to meet ongoing demographic changes and to ensure the sector maintains its focus on the growth of core elective surgical activity Will any monitoring of heart and diabetes checks be carried out now that it is no longer one of the health targets, and if so, how will this be done? While the More heart and diabetes checks (Checks) ceased being one of the six national health targets on 30 June 2016, the work programme that supported it continued. Reporting of the Checks (available on the Ministry of Health website) continues as part of Ministry monitoring processes and the work programme continues to build on the health target investment. In 2016/17 the target transitioned to a DHB accountability measure and a contributory measure for (amenable mortality and acute hospital bed days) System Level Measures framework. PHOs will also continue to report Cardio Vascular Disease (CVD) risk assessments and diabetes checks on all eligible enrollees quarterly Please provide an update on any milestones that have been achieved from the Health Strategy Roadmap of Actions. The New Zealand Health Strategy Roadmap of Actions released in April 2016 outlines 27 actions to be delivered over a five-year timeframe. The Health Strategy and its associated Roadmap set the overall direction for the Ministry of Health and the health sector. Accordingly, over the past nine months the Strategy and Roadmap have been embedded in Ministry of Health and District Health Board annual planning, and provide the foundation for the Vote Health Four Year Plan and Ministry work programme, budgeting processes and target operating model. The Ministry of Health is approaching the implementation of Roadmap actions through six strategic priorities:

3 Improve health outcomes for population groups with a focus on Māori, older people and children, for example release and implementation of the Healthy Ageing Strategy and cross-agency work on improving access to services for 0-5 year olds (Actions 1-6, 8-11, 24) Improve access to, and the efficacy of health services for New Zealanders with a focus on disability support services, mental health and addictions, primary care and bowel screening, for example work on improving the services available for people with moderate mental health needs (Actions 1-8, 10, 12, 14, 19, 24) Improve outcomes for New Zealanders with long term conditions with a focus on obesity and diabetes (Actions 1-4, 6, 8, 10, 24) Improve our understanding of system performance including improved models for forecasting DHB cost pressures, approaches to DHB capital, implementation of electronic health records and an updated approach to the prioritisation of new technologies and models of care (Actions 1-3, 6, 13-17, 19-21, 23, 25-27) Stand up our investment approach, for example work with the Social Investment Unit (SIU) on interventions for mental health (Actions 2-6, 9, 18, 25) Deliver the Ministry on the Move transformation programme for the Ministry of Health. Transformation process for Human Resource, Office of the Director General - Phase One, Finance, Strategy and Policy and Service Commissioning functions are complete. (Actions 2, 3, 6, 7, 16, 17, 20-22, 25). Particular Roadmap actions milestones and progress highlights include: Action 12 (Review of adult palliative care services) has been completed. Action 1 (Inform people about public and personal health services): Growth of the national telehealth service has delivered over half a million contacts. The service s smart and innovative use of technology enables a people-powered system where people can get the help and information they need in a way that is convenient and closer to home. Action 8 (Increased effort on long-term conditions): Improvements are already being achieved against the new health target for raising healthy kids, with good progress on the Childhood Obesity Plan including the following successes over the past six months: industry pledges to change food formulation, advertising and labelling; growth in the extent of the Health Star Rating labelling system, which now covers 2,000 products; an Advertising Standards Authority review of advertising standards for children recommending stricter guidelines that preclude any advertising of Occasional Food and Drinks to children; and the DHB decision to no longer sell sugar-sweetened drinks, while public health units assist schools to move to water and plain milk only. These preventive initiatives focus on care closer to home, but do so through empowering consumers and working as a broad cross-sectoral team. Actions 14 (health outcomes framework) and 15 (performance management approach to reporting): DHBs have been reporting their performance against System- Level Measures as part of accountability arrangements for the 2016/2017 year. These are outcome-based measures, supported by joint plans developed by DHBs in conjunction with local partner organisations, and submitted to the Ministry for approval in October. This initiative helps move accountability to a more flexible and outcomescentred model that has been supported by the sector. It strengthens the themes of

4 value and high performance and one team, while pursuing outcomes consistent with the themes of people-power and care closer to home. Action 22 (whole of system forum): This action is well underway, with the 2016 Health Symposium to be held on 21 and 22 February 2017, and annually thereafter. Action 23 (leadership and talent management programme): Work is being progressed with SSC around leadership within DHB s. Action 24 (workforce development initiatives): Parliament recently passed the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill. This replaces references to medical practitioner with health practitioner in eight different Acts, enabling a wider range of health practitioners to undertake functions previously restricted to medical practitioners, such as issuing sickness certificates and taking blood specimens from road users. In addition, regulations came into effect in September allowing qualified registered nurses to prescribe specified commonly used medicines, including some used to treat long-term conditions. These improvements to workforce flexibility will help provide care closer to home as part of one team, while providing better value.

5 181. How is the Ministry working with DHBs to manage the risks associated with the current round of Multi Category Employment Agreements negotiations? The Ministry works closely with the DHB Employment Relation Strategy Group (ERSG) to manage the risks associated with collective bargaining. ERSG is the DHB governance group for employment relations across all DHBs. It meets regularly and comprises representatives from the DHB Chairs and Chief Executives and from the GM Human Resources and Chief Operating Officers national groups. In consultation with the Ministry, ERSG has developed employment relations settings to govern the employment relations work programme for all twenty DHBs. These settings include the Government Expectations for Pay and Employment Conditions in the State Sector and agreed financial, strategic and operational parameters for collective bargaining. All bargaining strategies must be consistent with the employment relations settings. The Ministry provides advice to ERSG on Government direction, funding, central agency expectations (SSC, Treasury, DPMC), and the Ministry approach to various bargaining strategies. The DHBs consult with the Director-General of Health on each bargaining strategy and provide regular updates on the progress of all collective bargaining as part of meeting their obligations under Schedule 3 of the NZ Public Health & Disability Act The Ministry advises the Minister of Health on the direction of DHBs including progress with current bargaining and any risks associated with bargaining, including industrial action The Committee notes the preliminary findings of the Royal College of General Practitioners (the RCGP) annual Workforce Survey that 44% of GPs plan to retire in the next 10 years: What is being done to determine how many experienced general practitioners are needed to give effect to the New Zealand Health Strategy, and to ensure that this number is achieved? The Ministry has developed a robust forecasting model based on age-specific entry and exit rates and aging of the workforce. Given the number of GPs entering and leaving general practice the model forecasts the number of vocational trained GPs per 100,000 population will increase from 62 in 2016 to 68 in 2026 This is because the number of GPs being trained per annum has increased from 83 in 2007 to 182 in 2017.

6 183. What are the main actions being taken, or are proposed, to address the economic barriers in access to health care noted by the Health Quality and Safety Commission in its November 2015 report A window on the quality of New Zealand s health care? The Very Low Cost Access funding scheme provides low cost access to over 700,000 high needs people in New Zealand. The Ministry continues to monitor access to, and more importantly outcomes for, high needs people as part of the Government s focus on the most vulnerable families. The Ministry continues to invest in the community health sector to minimise co-payment growth and maintain access to Very Low Cost Access. In addition, per capita access to publicly funded home and community support services for the elderly and disabled has increased over the last four years. The successful Social Sector Trials are now business as usual in DHBs and the Ministry is working closely with its agency colleagues to identify and work with the most vulnerable children and their families through the establishment of the Ministry for Vulnerable Children. Further ways to support the most vulnerable New Zealanders are part of the Ministry s ongoing work programme. In 2015 the government introduced the Zero Fees for under-13s scheme which provides zero-fee visits for children under 13; this includes no longer paying the $5 prescription charge on standard prescriptions. Over 99 percent of general practices have opted into the scheme. Under-13s have access to zero-fee after-hours care and prescription medicines in every region. The scheme is intended to improve access to primary health care services for primary and intermediate school-aged children and is benefitting over 750,000 children The Committee notes the Ministry s report that there have been reductions in ethnic health disparities, but that they remain significant for Maori and Pacific populations. What are the main actions being taken or proposed to further reduce the identified disparities? The vision for the health sector is that all New Zealanders live well, stay well, and get well. There are a number of system settings in place that focus on improving outcomes and achieving equity for all New Zealanders. The legislation The health system is guided by the New Zealand Public Health and Disability Act 2000 (the Act). The Act s objectives include improving, promoting, and protecting the health of all New Zealanders, and reducing health disparities by improving the health outcomes of Māori and other population groups. Strategic direction The New Zealand Health Strategy (the Strategy), which was updated in 2016, gives further strategic direction, and identifies specific areas for action, for achieving better long-term results for all New Zealanders. The Strategy also sets the framework for the health system to provide timely and equitable access for all New Zealanders to a comprehensive range of health and disability services to improve the health status of those currently disadvantaged.

7 The Ministry of Health has a range of other population and health strategies that provide more specific directions for particular population groups or health conditions. He Korowai Oranga: The Māori Health Strategy 2014 guides the health and disability sector to provide high-quality and effective services to achieve the best health outcomes for Māori. He Korowai Oranga supports the health system to work towards achieving health equity for Māori by developing good-quality ethnicity data to measure and report on Māori health status, building the evidence base for Māori health, and partnering across government, to tackle the complex and long-term conditions some Māori families face. Ala Mo'ui: Pathways to Pacific Health and Wellbeing sets the strategic direction to address the health needs of Pacific peoples. Ala Mo ui is a guidance tool for planning and prioritising actions and developing new and innovative methods of delivering high-quality health services for Pacific peoples. The Ministry uses Ala Mo ui to monitor and evaluate how the health and disability sector performs against 21 performance measures in order to improve Pacific health outcomes in New Zealand. District Health Boards The Ministry allocates more than three-quarters of Vote Health to DHBs (approximately $12 billion), who use this funding to plan, purchase and provide health services for their regional population. DHBs are expected to outline actions in their DHB Annual Plans to achieve health equity for all of their populations groups based on the characteristics of the current and future population of the district, including; demography, socioeconomic determinants, health status and demand for health services within their district. Specific actions to achieve health equity will vary by DHB and by area of health focus. The Ministry has also been working with the sector to design a suite of System Level Measures that provide a system-wide view of performance that prioritises the reduction of health inequalities. DHBs and PHOs, as part of district alliances, are expected to collaborate across all parts of the health system to analyse, understand and reduce inequalities for Māori and Pacific groups with significant health disparities. Māori and Pacific health providers Investing in the development of Māori and Pacific health providers is also a key part of what makes the New Zealand health system more responsive to Māori and Pacific populations. Māori and Pacific health providers are inherently people-centred and geared to provide effective and accessible care that is responsive to the needs of their communities. The Māori Provider Development Scheme and the Pacific Provider Development Fund provide funding to increase the capacity and capability of Māori and Pacific providers to deliver effective health and disability services for Māori and Pacific peoples. While the government and DHBs put in place service and contract requirements for these providers, Māori and Pacific owners and governors set the overall direction and shape of these organisations. Investment approach The Ministry is continuing its application of a social investment approach to health investment. This approach can target populations to improve overall health outcomes and improve equity, while developing and spreading better practices. This will increase knowledge about

8 population segmentation, drive collaboration, and improve and make equitable the health and social outcomes for all New Zealanders. An example of investing in Māori and Pacific health and wellbeing early in life is the expansion the Healthy Homes Initiative for Vulnerable Children funded in Budget This initiative aims to reduce the number of newborn babies and children living in cold, damp and crowded homes and thereby reduce exposure to preventable illness including the rates and severity of respiratory conditions and other preventable conditions What is the level of engagement from DHBs in delivering Whānau Ora, and what steps is the Ministry taking to ensure this is at the appropriate level? Since 2012, there have been requirements on DHBs to show, through the annual planning package, how they are supporting the Te Puni Kōkiri-led Whānau Ora investment. The specific requirements have changed annually, and for the current year (2016/17), DHBs are required to demonstrate how they will contribute to achieving Whānau Ora across the whole of the health system focusing on progress in five key areas - mental health, asthma, oral health, obesity and tobacco to achieve accelerated progress towards health equity for Māori; and where appropriate collaborating with Whānau Ora nongovernment organisation (NGO) Commissioning Agencies to benefit the health of whānau. The Ministry reviews each DHB s commitment to actions and activities that have a proven impact on this measure at the beginning of the annual plan cycle. At the end of the year, this is demonstrated through improved performance for the five health indicators. DHBs must meet the indicator targets: Mental health - reduced rate of Māori committed to compulsory treatment relative to non-māori Asthma - reduced asthma and wheeze admission rates for Māori children (ASH 0-4 years) Oral health - Increase in the number of children who are caries free at age 5 Obesity - By December 2017, 95 percent of obese Māori children identified in the Before School Check (B4SC) programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions Tobacco - 95% of all pregnant Māori women smoke free at two weeks post-natal for each of the five priority health areas, as well as outlining the improvements their work has made to their Māori and Pacific population. The Ministry ensures that the DHBs provide actions and activities that support working in a whānau-centred way, reflect known health issues for Māori and Pacific families, and provide a mix of interventions and changes to baselines for priorities that can be achieved within four years, that are respective of their population and their performance. In addition, DHBs are required to report on how they have engaged with their relevant Whānau Ora NGO Commissioning Agency, progress made on joint collaborations or investment, how well this has been achieved and the impact of their effort for whānau.

9 186. The Committee notes that the Ministry has implemented the Whānau Ora information system Mahere, and that a number of provider collectives have been trained and are using the system. How much has been spent to date on developing and implementing the Whānau ora information system Mahere? Please provide a further update on progress with rolling out Mahere to provider collectives. How many provider collectives does the Ministry expect to add to Mahere by June 2017? A total of $4,765,767 has been spent since July Since Mahere went live, the focus of rollout has been: - Supporting the first wave of providers to implement the system - Identifying and training a second wave of providers - Testing different ways to support providers to use Mahere to best effect (e.g. by looking at training and implementation approaches) - Identifying any areas for system enhancement or improvement in line with user feedback. 24 providers are using the system as of December 2016 and a further 8 have completed training in preparation for the roll out. The eight providers that have received training in the system will complete their roll out by June Please provide the Committee with an update on progress with the Acute Services Building re-build at Christchurch Hospital, and the Grey Base Hospital project in Greymouth, including original and current estimates of completion dates and costs. The Acute Services Building at Christchurch Hospital is progressing in accordance with the approved construction programme. The completion date for the Acute Services Building at Christchurch Hospital is end of August The cost is within current Budget at $445 million. Grey Hospital is progressing in accordance with the approved construction programme and is scheduled to be completed in the second quarter of The cost is within the current Budget of $78 million Does the Ministry anticipate any cost increases for these projects, and if so what are they and in what areas? These are complex capital projects working in difficult market conditions and there are a number of financial risks associated with this. The Partnership Groups supported by the Ministry of Health have processes in place to identify and manage risks.

10 189. As the lead agency, how is the Ministry ensuring that the clinical and operational requirements of Southern DHB are adequately incorporated into the indicative business case currently being developed? Southern DHB is actively engaged with the project for the redevelopment of Dunedin hospital and through this engagement the Ministry expects that their clinical and operational requirements will be adequately incorporated into the indicative business case. At the governance level of the project Southern DHB is represented on the Southern Hospital Partnership Group. At the management level Southern DHB is on the steering group and control group for the project. At the working level the health planners and business case writers are working with DHB staff on all user groups Please provide the Committee with: an update on progress with developing the Programme Business Case for the National Bowel Screening Programme; the Ministry s assessment of the risks to developing the IT Platform, and to delivering the programme by the end of In August 2016 Cabinet approved the Programme Business Case and Tranche 1 Business Case for the National Bowel Screening Programme. This business case sets out the justification, proposed approach, timing and cost of procuring a national bowel screening programme and also sets out the local context, proposed approach, timing and costs for the first implementation phase of the national bowel screening programme. You can find a copy of the business case here: Following approval of the Programme Business Case the programme is now in the implementation planning phase. This detailed planning ensures the health sector has adequate time to implement a safe bowel screening programme. Hutt Valley and Wairarapa DHBs are on track to commence bowel screening in July The Ministry remains confident in its ability to implement a phased roll-out of bowel screening across the remaining 17 DHBs over the next 3 years. The timeframe to achieve full implementation will be confirmed as part of robust implementation planning. The team are completing a due diligence process for the national IT solution for bowel screening. The Treasury and GCIO are supportive of this approach and its potential impact on programme timing.

11 191. The Committee notes the significant organisational change the Ministry is going through with the Ministry on the Move programme, and is conscious of the risks that such change can pose to staff engagement and morale. How will the Ministry evaluate the Ministry on the Move programme s success in positioning the Ministry to drive implementation of the NZ Health Strategy, and improve engagement with the sector? Please provide the summary results of the latest staff engagement survey, and how these compare with the previous survey. The Ministry has conducted post-implementation reviews regarding initial Ministry on the Move changes; we are currently awaiting results. The latest staff engagement survey was conducted in 2015 and showed a continued increase in engagement from Ministry of Health employees. Using Gallup, the Overall Grandmean score improved from 3.8 in 2013 to 3.86 in A similar increase was seen in the Engagement Ratio (% Engaged to % Disengaged) which increased from 2.75:1 in 2013 to 3.45:1 in Overall Satisfaction also increased from 3.47 in 2013 to 3.6 in We have seen a consistent increase in engagement since The Committee notes the Ministry s assessment of the National Infrastructure Platform (NIP) as Amber/Red in the July Major Projects Performance Information Release, and the delays that the programme has experienced. What progress has been made in delivering the National Infrastructure Platform (NIP) to DHBs, and what actions has the Ministry taken to support New Zealand Health Partnerships to successfully deliver this programme What, in the Ministry s view, are the implications for the sector of the delays in launching the NIP, particularly regarding risks to information accessibility and security, and costs? A new programme structure has been developed which involves multi-vendor provision of services and a flexible Infrastructure as a Service (IaaS) take-up timeline. Delivery confidence is now assessed as Amber. Any risks have been mitigated. NZ Health Partnerships and DHBs have worked together to ensure that all current IT infrastructure needs are met and there are no impacts on day to day operations, information accessibility or security. The delays have not increased costs for DHBs Please provide the dates that the Treasury approved the renegotiated lease agreement. The Treasury does not approve lease agreements. Approval sits with Ministers. The Ministry submitted to joint Ministers of Health and Finance in July 2016 and the Minister of Health approved the proposal on 25 July, and the Minister of Finance provided his approval subsequent to advice provided by the Treasury in August 2016.

12 194. How much of the $39.3 million funding for the bowel screening programme will be spent on IT? A final decision on IT expenditure is yet to be made. The $39.3 million funding provides partial funding for the National Bowel Screening Programme. The remaining funding is subject to future Budget decisions What has been provided for ensuring that children with autism are diagnosed, what are the future projections and how many children are diagnosed experiencing the disorder? The 2016 New Zealand Autism Spectrum Disorder (ASD) Guidelines have been developed and maintained jointly with the Ministry of Education. The ASD Guidelines are a foundation resource for practitioners, people with ASD and their families/whanau and support people. They provide clear guidance for practitioners responsible for the diagnosis and support of autistic people. The ASD Guidelines recommend early diagnosis. Clinical teams in Paediatrics, Child and Adolescent Mental Health or Child Development Services are responsible for ASD diagnosis and referral for intervention and support. A Developmental Coordination function is in place in each DHB area to support families who have children with suspected ASD pre and post diagnosis. The exact number of children diagnosed with ASD in New Zealand is not available as there has not been any research conducted on the prevalence or incidence. The ASD Guidelines use research from the UK to produce an assumed prevalence of ASD in New Zealand of per 10,000 children. Boys are diagnosed more frequently than girls at the ratio of 4:1. In April 2014 Disability Support Services clarified the eligibility of people with ASD only (and no other eligible disability). Since then the numbers of autistic children receiving funded supports has risen. However, this total does not represent all children diagnosed with ASD in New Zealand as children do not always require funded disability supports. International research suggest that the incidence of ASD may be rising. However, it is not clear whether this is due to better identification and diagnosis, or changes to diagnostic systems resulting in higher rates of diagnosis. The ASD Guidelines recommend treating the prevalence rates as a conservative estimate.

13 196. For youth mental health services, please provide figures on what the waiting period is between the first initial visit and the next visit, and how many people are waiting. Data from DHB Mental Health services for 0 to 19 year olds wait times for the year Jul 2015-Jun 2016 shows : For 1st activity, there are 14,681 (91%) youth clients were seen within 8 weeks. For 2nd activity, there are 9,479 (74%) youth clients were seen within 8 weeks. There were in total 16,165 individuals who received a first activity and 12,776 individuals who received a second activity It is not possible to determine how many are currently waiting for their second activity from the national data set Please provide information on the Ministry s plans and actions on macular degeneration. Within the wider ophthalmology service, in December 2016, $2 million was been made available to DHBs to develop and implement service improvement plans. Responses from DHBs are due with the Ministry of Health in early February It is likely that DHB plans will include improvements to processes that will benefit macular degeneration patients. In terms of elective service delivery of intra-ocular injections have increased by 30% between 2014/15 and 2015/16. The Ministry of Health has contracted an external provider to undertake a suite of assessments on age related macular degeneration (AMD) care in New Zealand in order to inform the model of care for AMD, and the management of the loss of visual acuity due to AMD. The key objectives of undertaking a suite of assessments for AMD are: Prevention, early detection and risk stratification; Low vision rehabilitation; and Intravitreal anti-vegf treatment. In order to deliver some material improvements to patient outcomes within the existing resources, these assessments will focus on what the overall model of care for AMD should look like in New Zealand, the population that would be served, and where investment is required. The reports are due to be completed in mid 2017.

14 198. Please provide information on the Ministry s work for those suffering from trigeminal neuralgia. Trigeminal neuralgia is a condition where the treatment pathway is determined by clinicians based on an individual assessment of the patient's condition and needs. Treatment is generally medication and is managed through a medical service such as neurology or pain services. In other instances, care may be led through otorhinolaryngology (ORL), oral surgery or neurosurgery services. The standard of care arises from clinicians' professional associations or regulatory bodies and is credentialed by DHBs. The Ministry does not have a dedicated work programme relating to trigeminal neuralgia. Access to care is supported through ongoing annual investment in health services, with DHBs being responsible for determining the level of resources allocated to each specialty, based on their local population needs. Care is expected to be provided in line with wider government policy where relevant - for example, in line with emergency department or elective waiting time expectations and would include supporting people with trigeminal neuralgia to understand and manage their condition Please provide the Ministry s costs and methodology for primary health care funding. Each year an independent consultancy firm uses an agreed methodology (published on the Central TAS which is based on Statistics New Zealand indices to calculate the general practice cost pressures and the reasonable patient fee increase. The combination of both the additional revenue from government funding and patient fees compensates general practice for cost pressures (as per the agreed methodology). Overall primary care funding has increased by around $230 million or about 34 percent over the last eight years under this government from $667.2 million in 2008/09 to an estimated $892.7 million in 2016/17.

15 200. Please provide copies of the following documents: Evaluation of the Youth Mental Health Project (summative evaluation findings) Prime Minister s Youth Mental Health Project (summative evaluation report findings) Disability Information and Advisory Services and Needs Assessment and Service Coordination Review The Sapere report on a national bowel screening programme mentioned on page 8 of the pre-hearing responses. i. The Youth Mental Health Project evaluation reports requested by the Health Select Committee can be found here: There are three reports on the superu website. The reports are titled : Youth Mental Health Project - Summative evaluation report 2016 Youth Mental Health Project - Localities and national perspectives evaluation 2016 Youth Mental Health Project - Cost-benefit analysis 2016 ii. iii. As above NASC review iv. Sapere Report DIAS and NASC Review FIN The Sapere report Final Evaluation Report of the Bowel Screening Pilot will be published the week of 30 January 2017 and available on