Oral Health Target: Adolescent Use of Free Dental Services Improving
Community-based oral health services open year round and equipped with modern facilities have helped Invercargill reach more Maori and Pacific children, the two groups most likely to have poorer oral health.
Around 7200 schoolchildren from 18 schools are estimated to be using free dental services in clinics in the Invercargill suburbs of Fernworth and Waihopai. In addition, the Invercargill-based Waihopai clinic is working to increase the number of adolescents using the free dental service, from 460 at present to over 1200 next year.
“These clinics work well because of their central location and modern facilities,” explained Lynley Irvine, Oral Health Services Manager at Southland DHB.
Linked to an 0800 number and aggressively promoted in schools, school newsletters and student diaries, the services have been getting favourable feedback from regular patient satisfaction surveys, Ms Irvine said.
“The success of the Invercargill clinics mirrors the commitment of district health boards to improve access to oral health services,” said Dr Robin Whyman, the Ministry of Health’s Chief Advisor on Oral Health.
"The monitoring of the health targets allows us to find those DHBs that are doing well and then tell their stories to other DHBs so that we can collectively learn from each other and continue to make progress in these critical areas of health," he added.
As part of the first quarterly report on the health targets, Dr Whyman said the number of adolescents using publicly funded oral health services rose to 58.3 per cent in 2006, from 54 per cent the previous year.
Use of oral health services increased in 16 DHBs, mostly in the North Island where levels of use have traditionally been lower.
South Canterbury DHB achieved the national target of having 85 per cent of adolescents using the free dental services. Three other DHBs – Otago, Wairarapa, MidCentral – had more than 75 per cent of their 13- to 17-year-old kids using the services.
“The figures are encouraging. But we need to sustain these efforts to further improve access to appropriate dental services in all regions, and to raise awareness about the availability of these services,” Dr Whyman said.
Launched in July, the 10 health targets represent priority areas for health improvement. These targets include improving immunisation coverage, reducing cancer waiting times, improving nutrition, increasing physical activity activity and reducing obesity, and reducing the percentage of the health budget spent on the Ministry of Health.
The first quarterly report showed that most DHBs have made progress towards health targets. The figures in two areas -- elective services and diabetes -- require some explanation. Two-thirds of DHBs effectively manage the patients referred for elective assessment or treatment. However, two-thirds were also unable to deliver an agreed increase in the level of elective service patient discharges. Reasons for the slow progress in this area are variability in first quarter volume delivery, delays in DHB reporting and capacity constraints.
"Although the electives target poses a challenge for some DHBs, we are confident the target will be met for the full year," Elective Services Manager Karen Orsborn said.
In diabetes, phasing of updated contracts, which include more frequent reporting requirements, means the level of information will improve over time. A complete analysis of performance on achieving these targets will be made when a full year's results have been collected.
To read the first quarterly report on the health targets, click on the link below:
http://www.moh.govt.nz/moh.nsf/indexmh/healthtargets-targets-q1reportsupportinginfo
Additional Questions & Answers:
How have DHBs progressed in relation to the improving elective services target?
There are two parts to the improving elective services health target: DHBs have to show their management of patient flow complies with the Elective Services Patient Flow Indicators (ESPIs). They also have to deliver an agreed increase in the level of elective service patient discharges.
For patients referred for elective (non-urgent) assessment or treatment, there are a number of decision points about priority and access to treatment. The indicators (ESPIs) monitor how effectively DHBs manage the patients referred for elective assessment or treatment. DHBs have made significant progress in improving the way they manage their elective systems. The first quarter results reflect this improvement, with two-thirds of DHBs receiving achieved or outstanding ratings for the ESPI part of the health target.
DHBs have recently agreed to set a base (minimum) number of elective services to be delivered each year. Under this health target, DHBs have agreed to provide an additional (extra) level of elective service discharges for their populations each year. These services may be delivered by a patient's own hospital, while some specialty services such as cardiac surgery may be delivered by another hospital outside the patient’s DHB region. Progress in this area has been slow, with the amount of elective services delivered lower than the amount planned for the first quarter. Two-thirds of DHBs failed to deliver on their planned target volumes due to a number of factors. These include variability in first quarter volume delivery, delays in DHB completion of reporting and capacity constraints.
2. The Ministry continues to work with the sector to support DHBs’ ability to deliver elective services.
Why are there no data from a number of DHBs on the number of people with diabetes accessing diabetes services?
Phasing of updated contracts, which include more frequent reporting requirements, means the level of information will improve over time. A complete analysis of performance on achieving the improving diabetes services target will be made when a full year's results have been collected.
3. What happens if DHBs fail to meet the targets?
Each health target has a reporting and measurement system specific to that particular target area and work programme. Targets were agreed between each individual DHB and Ministry of Health Chief Advisors. When the Ministry negotiated the targets, it took into account what would be a realistic stretch for each DHB, given that DHB’s current and predicted future performance.
The setting of targets was a negotiated process, with DHBs opting for more substantial stretches of performance in areas where they were confident of good gains. For this reason, we can expect increased effort in areas where DHBs can afford to exert more effort without compromising service quality.
The health targets are part of the Ministry’s wider performance management, audit and benchmarking programme. DHBs are reporting regularly to the Ministry as part of standard reporting requirements. Where performance concerns are identified, the Ministry will increase both its monitoring and support for the DHB concerned. However, continued poor performance may result in a formal change in status applied through the Monitoring and Intervention Framework (MIF).
The MIF Framework is used to evaluate DHB performance as a whole and has five levels of monitoring:
Standard Monitoring
Performance Watch
Intensive Monitoring
Intermediate Governance Action
Direct Governance Action
The MIF provides for increasingly intensive levels of monitoring and, where necessary, intervention to ensure that issues relating to poor performance are addressed. At the most serious end of this spectrum, the Minister will consider the make-up of DHBs that fail to perform satisfactorily. The framework is designed to ensure that monitoring is undertaken in a consistent and transparent manner.
The Ministry has appointed target champions to work with their colleagues in the sector to support progress. The Ministry is looking closely at each health target area to understand performance trends and factors related to success. The champions have each developed an action plan identifying the key areas of focus that will support improved performance within each target area. They have also begun to work with DHBs and health providers to facilitate useful links and use existing networks to share successful innovations that are working in local areas. This work will continue to develop as the current financial year progresses