First Nations Health Authority 2014-2015, the Year Ahead
2014-2015 the Year Ahead (1)
Contents 2014-2015, the Year Ahead... 3 Not quite 6 months in the driver s seat... 3 2014-2015 Budget Overview... 5 Budget Highlights... 5 New investments... 5 2014-2015 Strategic Priorities and Investments Overview... 6 1. Transition... 6 2. Governance and Decision-Making... 6 Regional Capacity and working in partnership with the FNHC and FNHDA... 6 3. Heath Services and Improvements... 7 Enhancing services in the regions... 7 Protecting and enhancing community agreements... 7 Health Benefits... 8 Health Services... 8 Program Reviews, Moving to Wellness... 9 Nursing... 9 Capital... 9 ehealth... 10 4. Partnerships... 10 Federal Partnership... 10 Provincial Partnerships... 11 Joint Project Board Ministry of Health... 11 Partnership with Provincial Health Services Authority... 11 Wellness Partnership... 12 Regional Partnerships... 12 Other Provincial Health Organization Partners... 12 5. Leadership, Organizational Development and Planning... 13 Accreditation... 13 Health and Wellness... 13 2014-2015 the Year Ahead (2)
2014-2015, the Year Ahead Not quite 6 months in the driver s seat On October 22, 2013 BC First Nations held a transfer commemoration ceremony to celebrate the transfer of health services from Health Canada to First Nations control. In the way of the Coast Salish, leadership present was invited to witness the event. Corner Posts and Living Markers were stood up. Blessing the work through ceremony took care of our spirits and gave us strength for the work ahead. The FNHA set and met the 4 success factors for transfer including: Pay community, minimize service disruption, pay staff, and improve services where possible. Since October, the organization has been focused on delivering programs and services, maintaining funding relationships and stabilizing operations. These activities include: refining systems, structures, controls and corporate policies and additional administrative functions associated with the transfer. The work to complete the second phase transfer of the federal programs, services and assets is labour intensive, but overall is a small part of the FNHA scope and mandate. Social Determinants of Health Provincial health services integration Future sphere of influence- the factors that determine our health, economics, education, etc. AANDC, MoED, etc FNHA work with Province - access to Services available to 100% of First Nations in BC First Nations community programs and services A core part of the FNHA mandate- Focus on 45% of First Nations in Community + Health Benefits 2014-2015 the Year Ahead (3)
Key Transition Dates 2013 January: Vice-President, Health Benefits and Vice-President, Policy, Planning and Strategic Services join FNHA April: Canada Funding Agreement and Novation Sub-Agreement signed May: Human Resources, Information Sharing, Records Transfer, Accommodations, Capital Planning, and Assets and Software Sub-Agreements signed June: Chief Financial Officer starts, Information Sharing, Health Benefits sub-agreements and Health Benefits Service Agreement signed; Provincial MSP Agreement signed July 2: Phase 1 Transfer Day met Transfer of federal functions including headquarters NIHB Service responsibility August: Vice-President, Corporate Services starts; Service Continuity Agreement signed Successful novation of 209 out of 210 contribution agreements October 1: Phase 2 Transfer Day met Transfer of regional operations, Vice-President, Health Services starts; Canada Consolidated contribution agreement signed October 22-24: Five Regional Directors hired; Gathering Wisdom for a Shared Journey VI This period has also been marked by growth in the regions and the establishment of regional health plans and decision-making processes. We are excited by our immediate opportunity to reset the traditional funder/fundee relationship to one of partnership. Much work remains to transform the former federal health programs and services, to reset our relationship with BC First Nations and to recalibrate our approach to program and service delivery. Working together to pace this change is an exciting prospect. This year the FNHA will begin the incremental change process. Our focus will be on stabilizing the organization, improving customer experience, and making incremental changes where possible. A holistic budget review process based on the following principles resulted in a number of new strategic investments and increases. Principles: - First Nations first: Agreements that provide funding directly to First Nations communities received additional funding - Direct services to community: Increased investment in health programs and services that are community-facing - Needs based programming will be assessed on a case by case basis As a result of this budget review new investments are being made in community contribution agreements, health benefits and many other areas. The First Nations Health Authority is well positioned to deliver on its mandate. Bolstered by strong partnerships with the First Nations Health Council and the First Nations Health Directors Association the work ahead is clear. 2014-2015 the Year Ahead (4)
It has been nearly a decade since our leadership signed the Transformative Change Accord and set in motion the changes we are now privileged to be a part of. As we continue down the path toward transformation we must never forget their vision. 2014-2015 Budget Overview The total FNHA budget is $431 million dollars. Overall a total of 73% of the FNHA budget supports efforts in two areas: direct delivery of the FNHA Health Benefits Program, and direct transfer to First Nations through community contribution agreements. 40% through First Nations contribution agreements 33% for First Nations Health Benefits Program 9% for operations (Accommodations, Vehicles, Personnel etc) 7% for health transformation (ie. Joint Project Board investments, Regional envelopes, Health Actions) 7% for health services (Direct service provision, nursing, environmental health, telehealth etc.) 3% for governance community engagement and regional supports 1% for implementation fund projects Budget Highlights $173 million (40%) through contribution agreements including: o $155 million or (36%) of the overall budget direct to First Nations Communities for community health programs and services (includes $21 million in patient transportation) o $12.5 million to First Nations treatment centres o $ 5.9 million for non-community based contribution agreements (ie. Indian Residential School Survivors Society, Healing our Spirit etc.) $144 million (33%) for the First Nations Health Benefits Program New investments A permanent 29% increase in medical travel meal rates from $31 dollars per day to $40 per day. A 5.5% increase to core community serving programs (non-needs based) programs (ie. Aboriginal head start, Suicide Prevention) $15.2 million dollars in regional envelopes including over $5.5 million dollars in new primary care funding and $5.3 million dollars in Health Actions A $1.6 million dollar investment based on the four wellness streams of Nurturing Spirit, Being Active, Healthy Eating, and Respecting Tobacco to support community, regional and provincial partnerships, events, campaigns and tools and resources. 2014-2015 the Year Ahead (5)
2014-2015 Strategic Priorities and Investments Overview The FNHA s second Interim Health Plan celebrates a new chapter in our story the FNHA in our first full year as a health service delivery organization. This year s plan includes goals and commitments in 5 areas: 1. Transition 2014-2015 will be a year of stabilization for the FNHA. The work to transition from Health Canada systems is ongoing and ensuring that communities experience a consistent level of service through transition is our number one priority. To enable transfer to take place October 1 st service agreements were established with Health Canada to provide for business continuity. For example, Health Canada still runs claims processing for Health Benefits. In this arrangement, the FNHA must navigate a complicated process to get access to program data. Program transformation cannot properly be executed in a scenario where the FNHA do not have appropriate ownership and controls. The FNHA is working to establish our own systems and structures and to end our dependence on Health Canada for certain software and data management services. In total $3.7 million dollars from the implementation fund are ear-marked this year to support migration from Health Canada applications and networks and related activities. FNHA migration off Health Canada s applications and services include Citrix, Novell, Domino, and Proxy Server projects. In the area of health benefits we will establish an operational system to support the medical transportation program, and determine a plan to migrate off of ESC claims processing and implement the Health Benefits Client Registry. In the area of accommodations, the FNHA is revising its corporate accommodations strategy and is seeking where possible to locate FNHA offices in community (on-reserve) in order to keep more money in First Nations hands longer and lessen the cost of accommodations overall to invest more in direct services. Overall, the FNHA is interested in developing long-term, mutually beneficial business relationships with First Nations Land Owners. The FNHA has some flexibility regarding the types of arrangements it will consider. In order to maximize resources flowing to health services, preference will be given to transfer of ownership / joint venture options over facility leasing arrangements. 2. Governance and Decision-Making Regional Capacity and working in partnership with the FNHC and FNHDA The governance partnership among the three families of the FNHC, FNHDA and FNHA is guided by the Relationship Agreement signed in 2012. A joint decision-making body called the Collaboration Committee steers and stewards this relationship. In total, over $12.5 million dollars is earmarked for governance and regional supports this year. These funds support the activities of the First Nations Health Council and First Nations Health Directors Association and regional activities such as caucus meetings. This fund also covers regional staff and community engagement capacity in the regions. 2014-2015 the Year Ahead (6)
The work to establish regional capacity and to align engagement staff and activities in each region is moving forward. Through regional decision-making processes, over nineteen community engagement positions will be posted and filled as employees of the FNHA. This will increase consistency in community engagement efforts regionally and support the development of regional teams. Regional directors will be completing a fair and transparent recruitment process early this fiscal year. To enable a comfortable transition process and to ensure high quality community engagement services through this transition, contribution agreements with host agencies have been extended to July 2014. 3. Heath Services and Improvements Over 73% of the FNHA budget is delivered directly to BC First Nations through contribution agreements and the First Nations Health Benefits Program. A number of health service improvements will be realized to ensure high quality health services to BC First Nation individuals, families and communities with provincial and other partners. Standard to all improvements is the FNHA commitment to increase efficiency in business processes. Enhancing services in the regions To support and enable decision-making at a regional level, the FNHA will deploy the regional envelopes approach as a mechanism to pair investment with planning; providing regions with the ability to make decisions around the investment in their key priority areas identified in their Regional Health and Wellness Plans (RHWPs) and Regional Partnership Accords. Health planning and decision-making are being brought closer to home. RHWPs have been prepared in partnership with leadership and technicians in each region. These plans, once formally approved trigger regional envelopes. The initial overall regional investment is $15.2 million dollars; these funds include $5.3 million dollars for regional Health Actions implementation, $5.5 million for Project Board, $3.2 million for Community Engagement (excluding salaries), and $1.2 million for Governance Engagement. Protecting and enhancing community agreements In 2014/2015 the FNHA and the First Nations Health Directors Association will begin engagement and a review of current community health planning processes, and will work in partnership with BC First Nations to develop new and workable health planning and reporting processes. This year, the FNHA is in a position to ensure that each community Contribution Agreement will enjoy the customary annual increases of 2-3% for certain programs. In addition to the historic increase, the FNHA will also be able to provide additional funding for certain programs to bring the overall increase to 5.5%. Other key programs included in community Contribution Agreements that did not receive the annual increase will be given an additional 5.5% for this upcoming fiscal year. Increases to community contribution agreements will flow through Notice of Budget Adjustment s (NOBA s) this July. The FNHA is committed to getting these funds out early in the year to enable communities to plan for the often busy summer and fall health promotion activities. 2014-2015 the Year Ahead (7)
In total over $173 million (40%) will flow directly through Contribution Agreements. An extra $1.2 million will flow to health plan management, to assist those Nations that want to increase local governance and decision-making over programs and services. Health Benefits The FNHA health benefits program is currently delivered through a combination of buy-back and FNHA administered services. Claims processing for the benefits that have been transferred to the FNHA on July 2 and October 1, 2013 are being delivered through an interim buy-back arrangement with Health Canada for at least two years. The buy-back arrangement ensures continuity of services while the FNHA gets necessary systems and infrastructure in place. The FNHA health benefits team is focussed on improving client relations and service times. Since transfer, service times have improved across all benefit areas (ie dental predeterminations have been reduced from 10 weeks to 2 weeks). Also to support better customer service, Health Benefits has recruited a Benefits Support Representative whose sole purpose is to help clients to access the program. While transformation of this program is not possible until we have full ownership and control, incremental change can be made today. This year, the FNHA will rebase patient travel meal rates from $31 per day to $40 per day. This is an evergreen commitment of $638,000 dollars over the next 9 years of the Canada Funding Agreement for a total of $5.75 million dollars. This investment is made in response to concerns raised by First Nations and to the First Nations Health Directors Association survey recommendations received in November of 2013. The Health Benefits team will be engaging directly with each region to discuss program improvements in 2014-2015. Health Services The FNHA will continue to meet its obligations to communities to ensure minimal disruption of services including programs and services through contribution agreements and in some cases direct services in the areas of Nursing (Home and community care, recruitment and retention), Environmental Public Health Services, Health Surveillance, Health Promotion & Injury and Disease Prevention (Mental wellness, early childhood and maternal health), and Health Protection (immunization, pandemic/emergency preparedness and planning, prevention and treatment of communicable disease). In the area of health services the FNHA is pleased to announce the appointment of Dr. Shannon Waters as the Acting Senior Medical Health Officer for the FNHA. Over the next 18 months Dr. Waters will work closely with Yousuf Ali, VP of Health Services to oversee a restructuring process in the health services department including the establishment of a Chief Nursing Officer. This restructuring will bring a clinical voice to the executive table, and signals a recalibration of the Health Services department overall. 2014-2015 the Year Ahead (8)
The FNHA is also changing the orientation of health services to one that is 100% client focused. In the past program managers had to manage programs and execute contracts and contribution agreements. This often meant that the time of those with clinical expertise was often being consumed in corporate or administrative tasks. This year funding agreement management will move out of health services. This will enable program managers with clinical and service knowledge to focus 100% of efforts community relationships and program delivery. Dedicated Emergency Management capacity will be established within FNHA and will be actively engaged in province-wide tables to protect human health and facilitate community support. Program Reviews, Moving to Wellness This year, the FNHA will complete program reviews in the priority areas of Indian Residential School Program and National Native Alcohol and Drug Abuse Program. Early results of the Indian Residential School program review have revealed service disparities between some regions in the province. Targeted efforts are underway to address these gaps and to bring new services to previously underserved regions. Nursing Nursing is a central activity and function within First Nations health services at the community level and within the structure of the FNHA. The FNHA has committed to undertake a review of the potential contributions nursing can make to the goal of improving, strengthening, diversifying, and transforming services in a manner that supports better access to and more effective supports for nurses in First Nations communities. Looking at new model and the needed supports is also a means to better attract and retain nurses as part of our health teams. Through the partnership with the Province of BC, the FNHA is supporting the successful integration of Nurse Practitioner services into First Nations communities. Through the NP4BC Initiative, 24 of the 82 (29%) Nurse Practitioner positions funded by the Province provide services for First Nations /Aboriginal communities and populations. 15 of these positions are currently filled and additional positions are currently being secured through the most recent proposal call. The FNHA is working closely with the Province of BC and Regional Health Authorities to provide additional supports to ensure the success of these new primary care practitioners for First Nations. Capital First Nations health centres are the heart of the community. This year the FNHA will develop a new approach for capital investments including, health centres, staff accommodations and fleet vehicles. The FNHA adopted the Health Canada Capital Plan as the Interim FNHA Capital Plan in 2013. Currently there are 39 active community capital projects. Major construction projects in the FNHA s 2014/2015 capital plan count for $11.9 million dollars. 2014-2015 the Year Ahead (9)
ehealth The First Nations Telehealth Expansion Project is actively working with 38 First Nations Health Organizations representing 64 First Nation communities. This year $1.9 million will be invested in Telehealth and ehealth initiatives. In the realm of ehealth, BC is leading Panorama implementation in Canada with 5 sites representing 20 communities already using the public health reporting tool and more to come in 2015. 4. Partnerships When the Transformative Change Accord: First Nations Health Plan was signed in 2006 and the Tripartite Health Plan in 2007 there was recognition that improving First Nations health outcomes was not something that we could do on our own. From Joint Project Board to federal RDG relationships, strong partnerships are essential to making the health system effective, safe, and accessible for all of our citizens. Since 2006, the Tripartite Health Actions work has been successful in the building of provincial and regional level partnerships and creating a strong sense of shared responsibility for improved First Nations health outcomes across the health system. Provincial and federal governments and Regional Health Authorities are beginning to view First Nations health as a common lens across their planning and investment decisions, and all report against the various Health Action areas. Strategic Approaches in the Health Actions cluster areas describe broad frameworks of agreement, enabling regional and local-based planning and implementation. Regions are establishing Regional Health and Wellness Plans outlining their priorities in alignment with health actions. The FNHA has redirected internal capacity to support regionally-oriented planning and implementation of health actions. All of this sets the stage for the next phase of health actions implementation, including: Based on the priorities outlined in Regional Health and Wellness Plans, rolling out the majority of health actions funding through regional envelopes. Increasing partnership wellness grants. Working in partnership with First Nations, Regional Health Authorities, and others to undertake regional and local-level planning and project development in primary care, mental wellness, maternal and child health, and other stated priorities of First Nations. Advance region-wide and system-wide improvements through the Tripartite Committee on First Nations Health and Joint Project Board. Establishing a system-wide reciprocal accountability framework to outline every partner s responsibility at all levels of the health system. Federal Partnership BC First Nations have been clear that a strong and ongoing federal partnership is key to our success. Today there remain a number of outstanding transition related issues that the FNHA continues to work 2014-2015 the Year Ahead (10)
through with our federal partners. One is the establishment of joint review processes to ensure that outstanding funding issues with First Nations communities are resolved. First Nations across Canada and the federal government are interested in learning about and sharing the Made in BC First Nations Tripartite Health Process. Last year the Assembly of First Nations commissioned a book detailing the journey to transfer, Our Story is available on the FNHA website. There are also national funding and knowledge transfer processes that the FNHA and BC First Nations can benefit from. FNHA enjoys an ongoing relationship with senior federal counter parts. This year the FNHA will receive the first new funding that will roll out nationally since the signing of the Canada Funding Agreement. New tobacco cessation funding for next year is $570,000. The FNHA will receive $700,000 the following year and another $700,000 the year after that. The FNHA continues with our work in administering the Indian Residential Schools Resolution Health Support program for Canada. This program is part of Canada s legal obligation from the Indian Residential Schools Settlement Agreement signed in 2006. The FNHA has also started a discussion with AANDC to establish a working partnership to address matters such as environment health and data access and sharing. Provincial Partnerships Joint Project Board Ministry of Health In 2014 the FNHA leveraged a $15 million dollar multi-year commitment from BC through an agreement in lieu of MSP premiums. As per the Agreement, the Joint Project Board has a three-year multi-million dollar fund available to initiate primary care projects across the province that will be sustained in future years. Projects funded through this envelope will result in health service improvements and may include such investments as: additional health care providers to previously underserved locations, and the introduction of new, innovative models of health service delivery. Regional Partnership Accord tables will be the forum for identifying projects and recommending to Joint Project Board which projects to fund in their region. Joint Project Board investments in Primary Care projects for regional decision-making will total $5.55 million for 2014-2015. In additional to the regional planning targets, $4 million will invested directly by the Joint Project Board to support flagship innovation projects in each region. Partnership with Provincial Health Services Authority The Provincial Health Services Authority s primary responsibility is to ensure that BC residents, including BC First Nations people, have access to a coordinated network of high-quality specialized health care services. Specialty services are lead through nine specific agencies, BC Cancer Agency, BC Centre for Disease Control (BCCDC), BC Children s Hospital and Sunny Hill Health Centre for Children, BC Women s Hospital and Health Centre, BC Mental Health and Addiction Services, Cardiac Services BC, Perinatal Services BC, BC Renal Agency, and BC Transplant. 2014-2015 the Year Ahead (11)
The FNHA has entered into discussion with the Provincial Health Services Authority to establish an overall partnership to leverage working relationships with specialty agencies to address improved services and programs for First Nations peoples in BC. Initial areas of focus will involve BC Cancer Agency, Cardiac Services BC, and the BCCDC. Wellness Partnership The FNHA is working to establish its role as the health and wellness partner to all BC First Nations individuals, families and communities. As a wellness partner, the FNHA will provide on-demand services, tools, resources and clinical advice. In total the FNHA will invest 1.6 million in wellness related partnerships, campaigns, events, and tools & resources. We recognize that much work will occur in community and be delivered in a manner that builds on the cultural and spiritual strength of First Nations. In 2014/2015 the FNHA will increase direct grants to support community based wellness initiatives based on the five wellness streams of Nurturing Spirit, Being Active, Healthy Eating, Maintaining a Healthy Weight and Respecting Tobacco from $65,000 to $195,000. This includes doubling our investments in the Aboriginal Day of Wellness and offering additional granting opportunities to support wellness. The FNHA will invest $579,000 thousand to develop tools and resources for use by all Nations. The FNHA will also continue to support wellness events aimed at youth and elders. Regional Partnerships Regional Partnership Accords have opened new opportunities for regional-level cooperation and collaboration toward the delivery of health services in a manner that respects the diversity, cultures, languages, and contributions of BC First Nations. To this end, each of the First Nation Regional Caucuses has entered into a Partnership Accord with their respective Regional Health Authority. The FNHA is a partner to Regional Tables and RHAs, and able to operationally and at a service level support the priorities of these regional partnership accords. Deployment of regional envelopes will provide financial support for the implementation of those priorities. Other Provincial Health Organization Partners The FNHA will continue its work to establish partnerships with key organizations that have a significant role to play in the delivery of health services in the province of BC and therefore can be instrumental in supporting provincial health system transformation and improved health services to First Nations peoples in BC. These include regulatory bodies such as the College of Physicians and Surgeons, the College of Dental Surgeons of BC, and the College of Pharmacists. The FNHA is also working with Professional Associations such as the Doctors of BC (formerly the BC Medical Association) and Universities across the province. 2014-2015 the Year Ahead (12)
5. Leadership, Organizational Development and Planning Our goal is to establish the First Nations Health Authority as a model First Nations health organization, and as a partner to BC First Nations community health organizations. Internally we are focused on making the FNHA whole and stable. The expectations of First Nations are high- leadership in BC established Directive 7 -Operational Excellence in 2011. In order to be excellent, we need to be committed to continuous improvement. Accreditation This year the First Nations Health Authority will begin the Accreditation journey. The accreditation process will establish baseline measures in areas such as quality of care, client safety, cultural competence, and customer service. Being able to measure where we started is the first step towards continuous improvement. We look forward to joining the ranks of the 33 First Nations health centres and treatment centres who have achieved accreditation status in BC. We are also excited to invest over $1 million dollars into community s accreditation journeys. Health and Wellness Every staff member at the FNHA will have a personal health and wellness plan this year. The health of our staff members is important to us, this job is too big and there is too much at stake not to put people at the centre of this process. Our family is bigger than the FNHA staff, and the tools and resources developed for staff will be extended to First Nations health centre staff. The FNHA will invest $579,000 in support of health and wellness resources and tools for use by all First Nations. In particular, the FNHA looks to support the work of First Nations Health Directors as health and wellness champions. In an immediate post-transfer environment, over 27% FNHA employees are First Nations. Work is underway to increase this over time. In addition to our own work in areas of recruitment and retention, the FNHA is supporting work with the regional health authorities on their respective Aboriginal recruitment and retention strategies. The FNHA will be preparing a more detailed Summary Service Plan which will outline further organizational objectives and highlights for the coming year, and include a budget breakdown. The 2014-2015 Summary Service Plan will be published May 1 st. 2014-2015 the Year Ahead (13)