Health Targets – making a difference

The first annual National Health Targets report shows that action to date has made a significant impact on peoples' health and challenges the health sector to continue improving services.

Health Minister David Cunliffe says the National Health Targets Programme shows that good progress has been made against key health strategies and priority areas such as primary care and tackling the burden of chronic disease.

"The Health Targets were introduced last year in areas where we need the greatest traction to achieve our goals. Diseases such as diabetes, heart disease and cancer account for more than 80 percent of preventable deaths and 70 percent of health funding.

"The progress in the target areas shows the work of DHBs is making a real difference to the health of New Zealanders."

Highlights of the report include:

4900 more two-year-olds were immunised, with coverage for all two-year-olds enrolled in the National Immunisation Register (NIR) at a national high of 76% - an increase of 9% in the past year.
There has been an 8.7% increase in the number of elective discharges with almost 12,000 more electives completed in the past year.
Cancer waiting times now see 97% of patients starting radiation treatment within eight weeks, and 65% of these within six weeks.
There has been a 16% increase in up-to-date relapse prevention plans for mental health services consumers.
There were 1120 fewer avoidable hospital admissions (ASH), an important marker of improved access and quality of primary health care.
An additional 1800 adolescents accessed dental services.
There are now almost 36,000 Year 10 students who have never smoked. 75% of homes where children and smokers live are now smoke free.
There have been 5% more free annual diabetes checks.
New Zealanders are eating more fruit and vegetables.

"DHBs should be commended for their efforts in the ten target areas. Although there is always room for further gains, the results released today show a continued overall improvement in health outcomes for New Zealanders."

To view the Health Target results in detail see www.moh.govt.nz/healthtargets

Questions and Answers

What are Health Targets?

Health Targets are a set of measures to focus resources on specific areas and improve performance. They provide a focus for action and can be measured as to the impact they are making in improving health for all New Zealanders.

Health Targets do not replace other health priorities; however they do challenge the health sector to continue improving delivery of health services.

There are currently 10 Health Targets that were introduced in August 2007.

It should be noted that seven Health Targets are directly influenced by the DHBs and three targets (improving nutrition and exercise, lowering tobacco use and reducing Ministry of Health expenditure) are only measured at a national level.

How do they fit with other health priorities?

The Health Targets are essential performance indicators for the key health strategies and priority policies.

The strategies include the Primary Health Care Strategy, the Oral Health Action Plan, the Cancer Control Plan, Healthy Eating and Health Action, Elective Services, and several others.

That's why these targets are so important - when we make progress in these areas, we make a direct and measurable improvement in people's health.

Why were these 10 Health Targets selected?

The 10 Health Targets were introduced in August 2007 to stretch and challenge the health sector to produce measurable gains through steady and repeated improvements across a number of areas:

Getting ahead of the chronic disease burden
Child and youth services
Primary health care
Health of older people
Elective service
Infrastructure
Value for money

Were all the Health Targets achieved?

The 10 Health Targets set were specifically designed to challenge the health sector to lift its performance in key areas and this has happened.

The sector has made good progress with gains in all areas towards improving health outcomes and increasing public confidence in the health system. Results from this first year were an important part in setting DHB performance goals for 2008/09, and the consensus has been to aim even higher. The targets themselves are also being reviewed to ensure they remain dynamic and relevant.

The Health Targets allow DHBs to benchmark themselves against each other, share best practice, learn from their colleagues and be more innovative in delivering their services. This is reflected in the 2007/08 Health Target results.

What are the targets and results?

Health Target Goal Indicator

1. Improving immunisation coverage	95% of two-year-olds are fully immunised by 2012	An additional 4900 two-year-olds immunised in 2007/08 - bringing total coverage to 39,973 or 76%. This is an increase of 9% since the NIR has been used as a measure.
2. Improving oral health	85% of adolescents reached by oral health services	An additional 1800 adolescents accessed dental services in 2007 than the previous year - 167,567 young people or 59% of eligible adolescents. The 2007/08 national target has been substantially met.
3. Improving elective services	DHBs deliver an agreed increase in the level of elective discharges All DHBs maintain compliance with Elective Services Patient Flow Indicators (ESPI)	An 11,864 increase in the number of elective discharges - an 8.7% increase over the previous year. Thirteen DHBs were ESPI compliant for every month of the year, and six DHBs were compliant for at least nine months of the year.
4. Reducing cancer waiting times	100% of patients wait less than 8 weeks from referral to treatment	In the month of June 2007, 539 people or 97% of all patients started radiation treatment within eight weeks - 65% of them within four weeks.
5. Reducing ambulatory sensitive (avoidable) hospital admissions	Lower overall avoidable admissions and reduce variation amongst DHBs and population groups	1120 fewer admissions for 2007/08. This target area has 147 sub-targets, with 14 DHBs achieving 100% of individual sub-targets.
6. Improving diabetes services	More people with diabetes well managed and reduced variation amongst DHBs and population groups	4066 or 5% more free annual diabetes checks than the 2007 calendar year - a total of 91,242 free annual diabetes checks.
7. Improving mental health services	Care for long-term mental health clients is well managed	1574 more clients have up-to-date relapse prevention plans or a 16% increase since first quarter 2007/08 when this started to be measured. This is a total of 7476 people or 76% of all clients have up-to-date relapse prevention plans.
8. Improving nutrition Increasing physical activity Reducing obesity	More people at recommended levels of healthy eating and physical exercises	65% exclusive and fully breastfed at six weeks, 54% at three months, and 26% at six months. Two out of every three adults ate three or more servings of vegetables each day. Two out of every three adults ate two or more servings of fruit each day.
9. Reducing the harm caused by tobacco	Reduce the number of young, new smokers and children exposed to tobacco smoke	Target met and exceeded in quarter three. 35,350 students or 57% of all Year 10 students are ‘never smokers' - an increase of more than 2100 young people who did not start smoking. 75% of homes inhabited both by children and smokers are smokefree.
10. Reducing the % of the health budget spent on the Ministry of Health	Increase the proportion of health budget spent on health care - reduce the Ministry's expenditure to 1.65% by 2009/10	On track to meet 2009/10 target - the spend in 2007/08 was $210 million or 1.95% - the same as the year before when adjusted for unplanned increases.

Who is responsible for ensuring the Health Targets are achieved?

The Ministry of Health and District Health Boards have joint responsibility and work together to achieve the targets and the processes to support them.

DHBs have negotiated local targets taking into consideration the health needs of their communities. Collectively these targets contribute to a national improvement in each area.

In addition, the Ministry of Health has appointed ‘Target Champions' who work with and provide support to the health sector.

Who are the Health Target Champions?

1. Improving Immunisation Coverage
Dr Pat Tuohy, Chief Advisor, Child and Youth Health

2. Improving Oral Health
Dr Robin Whyman, Chief Advisor, Oral Health

3. Improving Elective Services
Karen Orsborn, Manager, Elective Services

4. Reducing Cancer Waiting Times
Dr John Childs, Chief Advisor, Cancer Control

5. Reducing Ambulatory Sensitive (Avoidable) Hospital Admissions
Dr Jim Primrose, Chief Advisor, General Practice

6. Improving Diabetes Services
Dr Sandy Dawson, Chief Clinical Advisor

7. Improving Mental Health Services
Dr David Chaplow, Director of Mental Health

8. Improving Nutrition, Increasing Physical Activity and Reducing Obesity to be appointed

9. Reducing the Harm Caused by Tobacco
Dr Ashley Bloomfield, Chief Advisor, Public Health

10. Reducing the percentage of the Health Budget Spent on the Ministry of Health
Stephen McKernan, Director-General of Health

What happens now?

Results from this first year were an important part in setting DHB performance goals for 2008/09 and the consensus has been to aim even higher. The targets themselves are also being reviewed to ensure they remain dynamic and relevant.

For 2008/09 it has already been agreed by the Ministry and the DHBs that the current set of Health Targets will be retained. In addition DHBs, as part of their own DHB District Annual Plan, have already agreed their local targets for the year.

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Health Targets – making a difference