Policy, Information and Commissioning GroupDepartment of Health and Human Services

Tasmanian Health

Organisations

David Nicholson and Alex Tay Department of Health and Human

Services

Background: National Health Reform

National Health Reform is underpinned by the:

• National Health Reform Agreement (NHRA)Signed in August 2011

• National Partnership Agreement on Improving Public Hospital Services (NPA IPHS)Also signed in August 2011

NHRA - outlines the governance and operational arrangements of the

new system

NPA IPHS - designed to drive improved service delivery across

Emergency departments, Elective surgery and Sub acute care

National Health Reform Key Stakeholders

• Many stakeholders – existing, new and reformed• Some relationships are clearly defined the remainder

continue to be discussed (state-wide services, support services, medicare locals)• Implementation of the reforms needs to be well considered and reflective of local needs

• Strong consultation on outstanding elements will occur

• The focus of this discussion is the implementation of Local Hospital Networks in Tasmania

Hospitals under the NHRA

• Under the NHRA, management of public hospitals will change to ensure:

• A nationally consistent model – Local Hospital Networks

• Independent governance• Local decision making – Governing Councils• Transparency – Funding and Performance

• All LHNs are to be fully operational by 1 July 2012

In Tasmania

• LHNs will be called Tasmanian Health Organisations (THOs)

• Three THOs will be formed as statutory bodies, independent from DHHS

• THOs will have the same boundaries as existing Area Health Services

• Each THO will have a Governing Council (board)

Purpose of THOs

• The primary purpose of a THO is to:

– Provide relief to sick and injured citizens, through the provision of care and treatment.

– To promote, protect and maintain the health of the Tasmanian community.

Impact on patients

• THOs will help to improve patient care through:– greater autonomy to ensure care delivery

meets patient expectations and needs– improved engagement with local clinicians– improved community engagement– higher performance standards– unprecedented levels of transparency

• The government will clearly state its expectations of THOs and service arrangements will be formally agreed with clear funding attached.

Impact on staff

• Steps have been taken to minimise disruptions to staff

• THO staff will remain under the State’s industrial relations system and the State Service Act 2000

• The establishment of THOs will not affect current employee entitlements for staff eg: leave entitlements, superannuation arrangements and salary packaging

• Existing AHS employees will transition across to the corresponding THO

Impact on staff continued• New staff will have the same entitlements as

existing staff

• THO CEOs will have the delegated authority for the day-to-day management of THO employees

• Enterprise bargaining agreements will continue to be negotiated centrally with the respective industrial bodies, to ensure consistency of application across all services and all regions of the State

Secretary

Central Agency

CEO

AHS

CEO

AHS

CEO

AHS

Secretary

CEOCEO

CEO

DHHS

Minister

Current Governance Structure

Future Governance Structure

Future role of DHHS and THOs

• DHHS -System manager acting on Ministers’ behalf (requirement

of NHRA)-Purchaser of services-System-wide policy (high level) and planning-Performance monitor and manager-A “Business Services Network” will provide support

services to both the THOs and the Department.• THOs

-Service providers (without bureaucratic interference)-Collaborate with Medicare Local at the local level to close

gaps-Local service planning-Strengthening local voice in health care delivery

Establishes functions

and powers of THOs

Allows for appointmen

t of Governing

Council members

Sets out corporate

governance requirement

s

Establishes contractual

and performanc

e arrangemen

ts

Establishes functions

and powers of

Governing Councils

Operating Environment

Chair

CEO

THO

LEGISLATION: Underpins new structure

Chair

CEO

THO

Chair

CEO

THO

Governing Council

Governing Council

Governing Council

• Focus on maintaining and improving patient care

• Provides flexibility

• Allows for transition arrangements to ensure orderly change

• Builds strong accountability

• Minimises disruption to employees and the community

• Maintains staff entitlements

• Based on a proven model (GBE)

Benefits of proposed legislation

Performance of THOs

• THOs will have autonomy over the day to day management of their hospitals and services

• The Ministerial Charter and the Service Agreement will be the main instruments for Government Direction. Expectations will be clear and will be matched with funding

• The Minister remains ultimately accountable for the State’s public health system

• If there are performance issues, the Minister will have tools available to protect the interests of patients as well as the broader community (eg emergency preparedness requirements)

Additional features - TCC

• The Legislation will also establish a strong advisory body to be known as the Tasmanian Clinical Council (TCC). The TCC will be a ‘lead clinician group’

• At a broad level, the TCC will:• be a multi disciplinary, skills based group with

strong regional representation• provide independent clinical advice on health

priorities in Tasmania• provide advice to all levels of the system• receive funding to support its aims

Where to from here?

• The draft THO legislation is now available for public comment

• Public comments will be accepted up until Tuesday 6 September 2011

• Comments can be emailed to health.reform@dhhs.tas.gov.au or alternatively posted to GPO Box 125, Hobart TAS 7001

• Comments do not need to be written as formal submissions to be considered by the Health Reform Implementation Team

• A copy of the draft Legislation can be found on the health reform website www.dhhs.tas.gov.au/healthreform

• Fact sheets have been developed to assist understanding• Ongoing consultation will continue until legislation is

introduced to Parliament later this year

QUESTIONS