Realignment Guiding Coalition
Date:
Thursday 26 June 2015
Time:
9.00am – 3.00pm
Topic:
Summary of the Guiding Coalition meeting
Location:
Faculty of Medical and Health University of Auckland Sciences,
Function Room 220, Glen Innes, Auckland
Attendees:
Associate Professor Marewa Glover, Ben Youdan, Dr Lance O’Sullivan,
Dwayne Tamatea, Fay Selby-Law, Jo Houston, Lance Norman1, Louisa Ryan,
Marewa Glover, Margie Apa, Maxine Shortland, Nigel Chee, Papatuanuku
Nahi, Professor Ashley Bloomfield (VC)2, Professor Chris Bullen, Stephanie
Erick, Teresea Olsen and Tracey Wright-Tawha, Te Miha Ua-Cookson
(Chair), Manaia King, Dr Hayden McRobbie, Emma Solomon, Hingatu
Thompson, Jillian Bartlam, Leigh Sturgiss (VC)3, Neville Johnson, Sharlaine
Chee-Keil and Everdina Fuli (Secretariat).
Apologies:
DrJohn
JohnMcMenamin,
McMenamin,Keriana
KerianaBrooking
Brooking(MoH),
(MoH),Kim
KimTito,
Tito,Professor
ProfessorJanet
Janet Hoek and Professor
Dr
Hoek and Professor Richard Edwards.
Purpose:
For the Guiding Coalition and Ministry of Health to identify common themes from
the engagement process; identify purchasing principles; and clarify next steps.
1. Welcome and introduction
Chair Te Mihi Ua-Cookson opened welcomed Guiding Coalition (GC) members to meeting with
a whakatau (welcome) and outlined the agenda for the day. He then handed it to Mr Manaia
King who then briefly summarised developments since the last meeting held in May of the
Guiding Coalition and set the context for the day.
1
Mr Lance Norman, Ms Stephanie Eric and Dr Lance O’Sullivan arrived during or, after session 1.
Attendance to meeting via video conferencing at 1.00 – 3.00pm.
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Ibid.
2
2. Session 1: Outcomes of the engagement process
Ms Sharlaine Chee, Project Lead for the Realignment project led the discussion for this section
of the agenda. Ms Chee acknowledged the sector’s input and participation during the
engagement process over a 6 week period. She then outlined the objective of the meeting was
to give a brief outline of process to date and then to open the floor allowing for open debate and
dialogue across the GC and the MOH officials to meet the outcome of developing a set of key
principles to underpin the procurement requirements.
Ms Chee outlined that a series of thirteen engagement workshops were held nationally between
May to June 2015. A structured and designed format was facilitated by the Ministry project
team which formed the methodology for the collation of sector information. The engagement
workshops were as follows:
Engagement workshops
TeTairawhiti (Gisborne)
Rotorua
Hastings
Porirua
Palmerston North
Kerikeri
Auckland Maori*
Auckland Smokefree Working Coalition*
Auckland University of Auckland
Auckland Pacific*
Dunedin
Christchurch
Nelson
19 May 2015
21 May 2015
22 May 2015
26 May 2015
27 May 2015
4 June 2015
5 June 2015
8 June 2015
9 June 2015
11 June 2015
15 June 2015
16 June 2015
19 June 2015
Asterixed* locations highlight those groups who requested for a separate engagement
workshop.
Engagement participants
Approximately three hundred participants attended the workshops from current to potential
service providers as well as sector stakeholders. Participants comprised of Maori providers,
Aukati Kaipaipa, Pacific providers, Asian providers, mental health, maternity, PHOs, DHBs,
NGOs, pharmacy and cross sector representatives. Summaries of ten workshops have been
posted onto the Ministry of Health website and next week the remaining three will be posted. In
addition, an online survey gathering further data from the market is in process and this will close
at 4pm 29 June 2015. No further comment will be accepted post this deadline.
Data
GC members were emailed the raw data (written as received and with no analysis) from the
thirteen workshops and as the email specified is only for the GC’s consideration. The data was
categorised into four areas identified with the Guiding Coalition from the May meeting and these
were (in no order of priority): (1) model of care, (2) funding, (3) health promotion, advocacy and
leadership and (4) Maori and Pacific Provider development.
2
From the data the areas highlighted in blue from each of the thirteen engagement workshops
show the feedback of participants who considered themselves experts or, knowledgeable in one
of the areas identified from 1-4 shown above.
To date the feedback from the engagement process has been wide and varied. First and
foremost the majority of the workshops but not all, wanted to discuss burning issues in
particular, how the Ministry of Health (MoH) will address issues for Maori and Pacific peoples?
Importantly, participants wanted to ensure the MoH was not about making “providers” happy but
importantly, “end users” were the focus of decisions made.
Some of the feedback is outside the scope of the terms of reference for the Realignment project
and from a glance there is a significant amount of consistency in the feedback and variation
seems specific because of regional differences.
Guiding Coalition’s advice: data analysis
From the raw data submitted, GC members advised that it will be helpful for the Ministry of
Health to:








Examine the statements written in the raw form and identify the underpinning value of each.
That is for example, one statement states “the end of Aukati Kapaipa” but underpinning that
value is the fear of losing their jobs.
Address the burning issues identified in the engagement process back to the sector.
Develop a framework into sub-categories from the data given as there is a significant
amount.
A strategic discussion to identify key themes for purchasing.
Examine the ‘stresses’ in people’s lives in: social, education, and health. Services will
require to be authentic.
Keep options such as individual, group and face to face engagement and use good
technology in the new world. This is validated in the data.
Re-think what is required to quit as a group, this is essential to the new world and group
quitting is evident in the data.
Examine that what strongly emerges in the data as a requirement for the new world.
Conversations with Consumers
The MoH gave an overview of the consumer group interviews undertaken nationally in: Te
Tairawhiti; Northland; West Auckland; Bay of Plenty; and Christchurch. This work supplements
the data from the engagement process. The interviews gave insight to the consumer lens and
participants discussed: (1) what prompted them to smoke? (2) What key issues did they faced
and (3) what support do they need to quit? Key findings from the interviews were: stress is a big
factor on consumers quitting and staying quit; when consuming alcohol consumer’s smoke
more; group treatment is a preferred approach of support network to quit; and health focussed
incentives i.e. getting fit and healthy eating and help to remain staying quit.
Sessions 2: Purchasing principles – procurement process and funding model
Ms Chee introduced Mr Neville Johnson, Manager of Procurement for the Ministry of Health to
the GC and highlighted his role in managing the conflicts of interests from the project outset of
all those involved in the Realignment project through to the procurement stage of the ROI and
RFP. Mr Johnson discussed and led this section of the agenda.
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Procurement
The MoH purchases outcomes. In brief, Mr Johnson explained that when procuring an outcome
it is about, ‘What is best for the individual?’ and, ‘What is best for government in purchasing that
service?’ Further, there are different levels and layers in procuring an outcome for the MoH.
This means asking procurement questions like, ‘are we triaging and purchasing the right people
and in the right places? Procurement is about demonstrating sophistication around the efficacy
of a service and it requires a paradigm shift in thinking from funding a provider to the MoH
purchasing services from a provider. All procurement models reflect outcomes.
Funding Models
Examples of funding models were: (1) FTE; (2) population based funding on need; (3) bulk
funding and (4) fee for service. The MoH asked GC members to think about the outcomes they
would like to achieve? GC members then asked the MoH about monitoring. Mr Johnson
responded by informing members that there are multiple ways of monitoring with qualitative
reportage on a quarterly basis, as an example.
Guiding Coalition’s Input
a) Key purchasing principles
GC members highlighted that a discussion on financial scoping could not be undertaken until
they fundamentally considered ‘key principles’ that would determine their approach in
purchasing. That is, identifying key principles at a higher level which will determine an approach
in purchasing services. Given that, purchasing requires a focus on the ‘needs of the consumer’.
There was a general agreement that the current funding model is not working. However, GC
members highlighted that the world of the smoker is complex and therefore any purchasing
principles require understanding the complexities of that world.
A draft framework was recommended by Associate Professor Marewa Glover of the GC which
began discussions in identifying values/key principles and purchasing. The framework is as
follows in Table 1. However, this further led the GC to discuss in detail their shared thinking and
commonality regarding key values, assumptions and outcomes for the procurement process for
new services. These are highlighted in Table 2.
Table 1: Draft framework
Outcomes
(the plan)
Purchasing
Providers
Place
(context)
People
Values/principles
Rationale
Process
(tikanga)
Practice
Perfecting
The morning session was summarised and key points taken from the GC and MoH discussion
regarding the engagement process, raw data, advice given by the GC in further analysing the
data, the procurement process and funding models including key principles in purchasing
services were highlighted. This approach would require a fundamental shift in paradigm from
4
funding to purchasing services. After lunch it was agreed that discussions are kept at a high
level for the remainder of the meeting.
Table 2: Guiding Coalition’s assumptions, values and outcomes
The assumptions, principles and outcomes identified were based on need, prevalence,
geographical spread, co-morbidities and uniqueness i.e. Christchurch’s earthquakes.
Assumptions
Values/principles
Outcomes
Tele-health is available
Consumer-centric
Funding will not increase and
funding will get tighter
Estimated dollar amount is
allocated for HP, Advocacy
and Treatment.
Tax policy
Every health professional is
smoke free
Every smoker wants to quit
Equity
Better integration connectedness
Funding model needs to
change
Localisation
i
Accessible
Culturally appropriate
Quality (evidence –
informed/effective and efficient)
Integrity
Outcomes focussed
Good capacity and capability
Information
Maori and Pacific
development
Note: The focus must be on Maori and Pacific populations who smoke.
b) Purchasing methodology





Ability to have multiple methods for purchasing services by region and integration.
No further FTE funding models.
Budget holdings will be different.
Services will show how they are connected to each other.
Services reflect strong components of assessment, planning, settings based, approaches
have ability to scale up:
- Routine recruitment that is systematic and reliable.
- Reliability of getting people into services.
- Monitoring of reliable data.
- Focus on Hapu Mama
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d) Funding formula and allocation model
Treaty of Waitangi, equity, and high need and prevalence will premise the funding formula
and allocation model for Maori and Pacific.
 Considerations:
- Impact of funding decisions on the regions. What will it be?
- Transparency in funding.
- Discern about funder flexibility.
- Commit DHBs to use their resource in leveraging their existing services.
 Services will show how they are connected to each other.
 Services reflect strong components of assessment, planning, settings based,
approaches have ability to scale up:
- Routine recruitment that is systematic and reliable.
- Reliability of getting people into services.
- Flexibility.
- Allowing for innovation.
- Use of good technology.
Recommendation: For change management, incrementally change services.
Session 3: Purchasing principles for Health Promotion, Advocacy and Leadership and
Co-ordination
There is urgent advice needed in this area and this is validated in feedback from the data from
the engagement workshops.
The GC agreed the key value for this area is led by tobacco control and it is focussed on
building independence. Note: the MoH does not purchase direct lobbying against the
Government.
 Key principles
-
National consistency and local action.
Advocating for smokers.
National voice and meaningful connect to the local level.
Evidence informed innovation.
Leadership.
 Advocacy requires: Changing policy (National level) and advocating for smokers at a
local level.
-
Requires social change to benefit local providers and local advocacy.
National voice and meaningful connect to the local level.
 Purchasing
-
Expertise in disability and mental health.
Co-ordinated approach.
Better co-ordination.
Communication and messaging is clear and concise.
Access and engaging i.e. Hapu Mama.
Integrated at a local level.
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-
Protecting the independence and advocacy of community development.
Maori development is in the new world.
Close
Mr King then thanked members of the GC as well as MoH officials and ended the meeting with
a karakia.
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