Planning and Funding

Every year, the Wairarapa DHB gets a sum of money from the Ministry of Health. We also get some direction about what it should be spent on, but under the DHB structure, the 'who gets how much' is now in local hands. The team charged with providing all the information on which funding decisions are made is the Planning and Funding (P&F) team. The DHB has a vision of "Well Wairarapa—Better Health for All", and Planning and Funding are part of turning that vision into a reality.

Each year, the DHB spends around $104 million on health in the Wairarapa

How does it work?

Firstly, we need good information about what's really happening in the Wairarapa in terms of health. When the DHB came into existence, we did the first ever health needs analysis for the region, and from that we identified the areas needing the most attention. We do a similar exercise every 2-3 years, to refine the current health priorities for the Wairarapa.

Once the DHB identifies the health priorities for the region, the P&F team gets on with prioritizing and allocating funds accordingly. They are also responsible for selecting the providers of the services needed, setting up service agreements to make sure they deliver what is required, and monitoring the contracts to check on this. This includes the service level agreements within 'the provider arm' of the DHB—otherwise known as Wairarapa Hospital and community servces. Remember, though, the hospital is only one of the many contracts managed by Planning and Funding.

Many decisions are made within the guidelines set by the Ministry, through their national strategies and priorities. P&F must also make sure we have good service coverage, that quality and safety requirements are met, that the contracts include any national service specifications, and possibly also national prices.

So what do we decide locally?

We can decide the service mix and volumes—how much, where, and for whom. We are also able to work out strategies that include all our local links, so we get better integration that better fits our local needs, and gives the best value for money on the local scene.

So how do P&F actually decide how to cut the pie?

Decisions are based on what the local population actually needs, the capacity to provide the services needed, whether a proposal fits with the District Health Board's priorities and guidelines, what the flow-on effects and linkages might be, and the service cost/price.

How can we tell if any difference is being made?

Each Health Needs Analysis shows if there are any changes in the population health statistics. On top of that, we look at many measurement indicators, like intervention rates (eg: how many people had flu vaccinations, how many caesareans we do), avoidable admissions, waiting times, consumer satisfaction and complaints, inequalities and outcomes achieved.

The nitty gritty

P&F uses Service Level Agreements to specify what is to be provided, how much/many and for whom, performance standards and quality, price, performance measures and targets, and provisions for adjustments for over or under performance.

Why do we measure and report performance?

P&F has to check that the expected services are being delivered and find out the reasons for any variances. Then they find out how actual service delivery in the Wairarapa compares nationally and decide if the level of funding is appropriate, or if any changes need to be made to a contract. There are lots of reasons why a contract might be changed. There might be changes in demand, changes in ability to deliver a service or changes in efficiency, inappropriate targets set, or a change in behavior by another provider.

The Planning and Funding Team

	Liz Barnes—Performance Analyst I first joined the health sector and Wairarapa Health in 1994 at Mental Health Services and went on to work for both MOH and MidCentral DHB. I have been in my current role since December 2005. As Performance Analyst I pull together data supplied from many different sources to identify issues, and measure the DHB's achievements in the context of our obligations to the Ministry of Health and the Wairarapa community. In my 'other life' I am a partner in The Alpaca Place, Wairarapa's largest dedicated alpaca stud farm, where we farm an expanding herd of 40+ alpacas.
	Jen Bergantino—Administration Officer I joined the team as the Administration Officer in November 2006. I work with Joy Cooper as her personal assistant and I assist the team with administrative tasks when required. I'm also involved in setting up administration systems and procedures for the Planning and Funding Unit.
	Nigel Broom—Business Manager My role is Business Manager, providing portfolio managers with financial and analytical advice, and processing day-to-day transactions once funding contracts are in place. Liz, Darryl and I make up the analysis team within P&F. I am Portfolio Manager for Pharmaceuticals, Lab Services and the Service Level Agreement between the Funder and Provider arms. These agreements determine the services that the Funder Arm 'purchases' from the hospital. Before this role, I was the Accounting Manager in the DHB's Finance Department for nearly five years. It's great to now see another side of the DHB's operations. I am originally from Christchurch but moved to Martinborough in 2001.
	Lisa Burch—Portfolio Manager I am the Portfolio Manager for Primary Care, Child Health, Public Health and Maori Health (in conjunction with the Director of Maori Health and the relevant portfolio managers). I am also responsible for the coordination of cancer control and palliative care. During the last 3 years I developed cancer control and palliative care plans and a DHB-wide child health strategy. This will complement the Youth Health Strategy that is currently being implemented. These strategies, along with the District Strategic and Annual Plans will guide the service planning and contracting with the PHO, Maori health providers, public and community health services and hospital services, to provide a continuum of care, integrated services and improved health outcomes.
	Simon Everitt—Acting General Manager  My key responsibilities include management of the total funding budget—ensuring we allocate government funding to meet the Government's and local requirements in ways that are affordable. P&F also provides advice to the Board on the prioritisation and funding decisions it has to make. Other work includes the DHB's Strategic and Annual Plans, Funding Agreement with the Minister of Health, community consultation and communication, and measuring and reporting on performance against plans.
	Joanne Edwards—Portfolio Manager My portfolio includes health of older people, disability, support services, community services and long term health conditions. I work with Wairarapa providers and the community to identify health needs and service gaps. The DHB strategic health goals are then achieved through planning, contract management and project work. Recent projects include the establishment of a new service which enables people who wish to live at home to be supported by a flexible service which is focused on the person's goals. Other ongoing work includes assuring quality in home based and residential care services, and a focus on enabling people with long term conditions to access appropriate support services. The development of a single point of entry to all support services (for disability and health reasons) is underway this year.
	Sue McAuley—HEHA Project Co-ordinator Healthy Eating Healthy Action (HEHA)—Oranga Kai Oranga Pumau—is the Government's umbrella strategy to address obesity, improve nutrition and increase physical exercise. My role is to co-ordinate the planning, preparation and implementation of a HEHA plan for the Wairarapa. Many people have already contributed with exciting and challenging initiatives and it will be my job to make these happen.
	Marie McKay—Portfolio Manager I have really enjoyed being Portfolio Manager for youth, oral health and mental health and addiction for four and a half years. I've been involved in some really exciting projects including the reconfiguration of Mental Health and Addiction Services and the development of the DHB's Youth Health Strategy which led to the opening of health services in two secondary schools in 2007. Oral health has been an exciting area too—a new model of Community Oral Health care is currently being  implemented. There are plans for extending the secondary school services, developing programmes for youth with addiction related issues.  Watch this space!
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