17 October, 2012
Address to the Platforms Charitable Trust Leaders Forum
And thank you for the chance to speak at this Platform leaders’ forum to discuss the Government’s Better Public Services programme and its likely impacts on the mental health and addictions NGO sector.
Better Public Services
The Better Public Services programme supports the delivery of the third priority of the Government’s four priorities for this term:
- responsibly managing the Government’s finances
- building a more competitive and productive economy
- delivering better public services within tight financial constraints
- rebuilding Christchurch.
The public sector represents a quarter of New Zealand’s real economy and so has a big part to play in how our society and economy perform.
New Zealand’s State Services have been performing well in some areas.
However, there are opportunities to be more flexible and innovative and to improve how we deliver services to New Zealanders.
The Government has set 10 challenging results for the public sector to achieve over the next five years.
Ministers and a public sector chief executive have been appointed to lead each result area and they will be accountable for demonstrating real progress against the result it is their duty to attain.
These results require a stretch beyond immediate deliverables and highlight opportunities for new ways of working together to deliver better public services to New Zealanders.
The work underway in these areas is designed to, in time, demonstrate innovation and improvement across a connected, collaborative public sector.
Targets have been published for each result. The results fall into five themes:
- Reducing long-term welfare dependence
- Supporting vulnerable children
- Boosting skills and employment
- Reducing crime
- Improving interaction with government.
This Government is committed to protecting and growing the publicly funded health service.
This year, we are spending $14.1 billion on health – the biggest investment ever.
Health’s budget increase is three times greater than education and five times greater than welfare, both also very important areas for government expenditure.
The major challenge for public health services in New Zealand over the next three to five years will be to focus on what matters most – using health dollars to get better healthcare for patients.
Improvements can be made by community and hospital services working more closely together in their own regions and with their neighbouring district health boards – resulting in a smarter use of our workforce and increasing clinical leadership.
At this point, I would like to acknowledge the work Platform is doing in the area of the Programme for the Integration of Mental Health Data NGO role out and information use.
We currently have 240 NGOs reporting to PRIMHD.
I am aware that in the past Platform has published two reports that contain important information about the NGOs operating in the sector.
First, in 2005, the Landscape Survey provided a snap-shot of the range of services provided by those NGOs.
And that was followed in 2007by the Workforce Survey, which drew responses from 1833 people working in 212 NGOs, and provided data on the workforce employed by NGOs in the sector.
Off the back of those two important reports, I am very pleased that Platform recently published a further report, Towards Integration: Building an integrated primary mental health and addiction service (2012).
This latest report outlines the potential contributions the NGO sector can make in improving primary/secondary integration.
As you will be aware the Ministry of Health is consulting on “Rising to the Challenge”, The Mental Health and Addiction Service Development Plan 2012 to 2017.
I would like to, therefore, take this opportunity to thank Platform for assisting with the consultation process.
I am sure the NGO sector will make a significant contribution to meeting the challenges that will be set out in the service development plan.
We have come a long way from the days of halfway houses and large psychiatric institutions.
In 2010/11 132,800 people accessed mental health and addiction services (3 percent of the population); of these, 12,400 (9 percent) were seen in the NGO sector only, 15,600 (12 percent) were seen by both DHB provider arm and NGO services and 104,800 (79 percent) were seen by DHB provider arm services only.
The NGO sector makes a significant contribution to treatment, support and rehabilitation of mental health addiction clients.
Approximately 25% of the $1.2 billion mental health funding went to NGOs providing direct care.
What you can notice from the figures I have just given you is that against that 25% of the funding that NGOs received, only 21 percent of the service users used wholly NGO or combined public and NGO services.
When I say that the NGO contribution is a significant one, it certainly is.
But is there room for more efficiency?
Is there room for a better return on that investment of funding?
The numbers say, yes there is, and I would want to see the sense of doing ‘more for less’ extend beyond the public sector.
These are tough times, and all sectors need to be fully accountable for their use of public money.
How the Government measures the performance of the health system
In that spirit of accountability, government agencies will be required to collect, use and publish better performance information.
Measuring performance in the public health system is important.
It allows us to assess how effective and efficient a service is and gauge how the needs – indeed, on occasion, if the needs – of consumers are being met.
A good performance measurement system supports the Government's key objective to streamline processes, reduce costs and improve service quality.
The Government currently measures the quality and value of mental health through three key measures:
- health targets
- key performance indicators
- the formal accountability framework the Ministry of Health has with DHBs.
But a fourth and equally important parameter involves outcome measures.
Since 1997, successive governments have fostered the development and use of routine outcome measurements to help the mental health sector provide better services for people experiencing mental illness.
Mental health and addiction outcomes
Measurement of outcomes provides the most meaningful information about the quality of mental health and addiction services.
This is because ultimately, the most important measurement for a consumer is whether or not their quality of life has improved after contact with a health service.
It is pleasing to hear of the push coming from the NGO sector to measure mental health and addiction clients as an outcome measure.
We know that when used effectively, mental health outcomes and information can inform service planning, quality and service delivery improvements.
- supports the delivery of mental health care
- improves services; and
- monitors sector performance and sector progress against strategy objectives.
National information developments such as the National Key Performance Indicator Framework for Mental Health and Addiction Services, and Knowing the People Planning use information to underpin improvements in outcomes for service users.
The national KPI process is a good example of using information to understand service and quality improvements required at local, regional and national levels.
DHBs and NGOs use KPIs to benchmark themselves against one another.
The major goal of this benchmarking is to understand and address changes and variations that could impact on outcomes for consumers.
Knowing the People Planning (KPP) is a practical approach that assists mental health services plan for and meet the needs of long-term service users.
KPP is based on an easy-to-use survey to evaluate the experience of service users.
This allows us to assess how well local mental health systems are working and to identify where improvement is needed.
The Government supports measurement tools like KPP and the KPI process because they enhance the efficiency and effectiveness of services.
The challenge for each organisation here is to respond to the demands for greater accountability while supporting a sustainable process of learning for improvement.
We need to promote and practice a culture of enquiry that is based on individual reflection, collective learning, and joint accountability.
The Ministry is interested in the use of all information for inclusion in the Mental Health and Alcohol and Drug Sector Performance Monitoring and Improvement Report.
This report is produced every six months and is a compilation of performance indicators that provides an overall picture of how the sector is performing.
Measures of mental health outcomes are a key indicator in this report.
The Prime Minister’s Youth Mental Health Project and the Drivers of Crime initiative both impact directly on Alcohol and Drug providers who are required to reduce waiting time to treatment.
Currently 61 percent of 12 to 19 year olds are seen by alcohol and drug NGOs within three weeks; the goal is that 85 percent seen within three weeks and 95%percent within 8 weeks.
Information on mental health and addiction services occurring in primary care represents a significant gap in our understanding across the service continuum.
The Ministry of Health is currently looking at how this information gap can be plugged.
To achieve an integrated and better health system, we need to use all of the information available.
It is time to focus our attention on the continued improvement of services to enhance the health outcomes of our service users.
From my perspective, I would add that a key way we provide better services is by utilising effectively all of the resources available to us – across the government and non-government sectors, and making sure that, to the greatest extent we can, the services that are provided by those best equipped to provide them.