1. Primary Health Alliance
HCHA presentation
Members meeting, March 2018

2. HCSS Client groups Frail older people
Injured older people
HCSS Client groups
Frail older people
People living with disabilities
People living with chronic conditions
People living with short term injury
People living with long term injury
People dyng
People with mental health and addiction needs

3. Brief facts
Over 100,000 clients, growing (aging, injury, disability)
55 NGOs and private providers including 16 iwi providers
22,000 kaiāwhina, 93% women, 82% Pakeha. 57% over 55, Total govt expenditure HCSS $669m (rising to $750m with pay equity)
Use of service can reduce expenditure on residential and hospital care and result in better general health status.
Multiple funders (20 DHBs, ACC, DSS), inconsistency of funding and service allocation. Very low funding per service unit, no costing framework.

5. www.interRAI.co.nz Older clients
41% older than 85 years, 65% women, 7% Maori, 4% Pacific
58% living with chronic conditions
Almost half are living alone, a third living just with spouse
25% live with diagnosed moderate or severe cognitive impairment
56% at risk of hospital or residential care admission
22% feel lonely
22% of informal carers report severe stress due to caring

6. Service commissioning responses
Health and Disability Strategies Self directed care, consumer choice
Use of Data to drive outcome measures Casemix, targeting, bulk-funding
Reduction of provider numbers Falls prevention
Post acute support Workforce funding and expectations Integration/closer liaison between (pay equity, guaranteed hours, travel) services: nursing, physio, GP Whanāu ora
Rehabilitative, restorative support Medication

7. Community Health Vision
Scope of practice,
Team approach
better trained personnel
career pathways
Provider capacity
Costing models
Health records
interRAI, assessments
Outcome measures
Research, monitoring
Assistive technology
Improved accountability
Inter provider networks
Client group liaison
Shared health goals
National and cross regional health goals all health providers
Systemic issues addressed
Casemix,
Restorative, rehabilitative, client goals
Self-directed options
Equity in supports
Carer support
Clients more in control of health outcomes, have better outcomes,
Providers work closely and with clients to use health $ better
Improved capacity to meet complexity and increasing demand
Data and technology used more effectively to improve decisions, quality & efficiency

8. LiLACS NZ, interRAI, NZ Health Survey
Health conditions of older home support clients
Coronary heart disease (32%), diabetes (32%) and stroke/CVA (18%).
25% of home care clients report 1-2 diseases and 15% report 3-4 diseases.
Incontinence reported by 34.3% of men and 42.6% of women.
43% have untreated tooth decay to three teeth
35% over 75 experience chronic pain.
50% live with arthritis
General improvement in function, living longer, living independently for longer, requiring support for longer
44% aged have fallen at least once in last three months
LiLACS NZ, interRAI, NZ Health Survey