E.17. Office of the Health and Disability Commissioner. Te Toihau Hauora, Hauātanga

E.17 Office of the Health and Disability Commissioner Te Toihau Hauora, Hauātanga Statement of Performance Expectations 2018/2019

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Table of contents Our Statement of Performance Expectations... 2 1.1 Alignment with New Zealand Health Strategy... 4 2.1 Complaints resolution... 6 2.2 Advocacy... 7 2.3 Proceedings... 7 2.4 Education... 8 2.5 Disability... 9 2.6 Mental health and addiction services monitoring and advocacy... 9 3.1 Statement of Forecast Service Performance... 11 Output Class 1 Complaints Resolution... 12 Output Class 2 Advocacy... 14 Output Class 3 Proceedings... 17 Output Class 4 Education... 18 Output Class 5 Disability... 21 Output Class 6 Mental Health and Addiction Services Monitoring and Advocacy... 22 3.2 Reporting... 25 3.3 Prospective Financial Statements 2018/19... 26 1

Our Statement of Performance Expectations In signing this statement, I acknowledge that I am responsible for the information contained in the Statement of Performance Expectations (SPE) for the Health and Disability Commissioner. This SPE contains the annual financial and non-financial measures by which the Office of the Health and Disability Commissioner (HDC) will be assessed. This SPE has been prepared in accordance with, and is submitted in compliance with, the Crown Entities Act 2004. Anthony Hill Health and Disability Commissioner 29 June 2018 2

1.0 Statement of Performance Expectations The Health and Disability Commissioner (HDC) was established as an independent Crown Entity by the Health and Disability Commissioner Act 1994 (the Act). The purpose and overriding strategic intention of HDC is to promote and protect the rights of consumers as set out in the Code of Health and Disability Services Consumers Rights (the Code). This SPE outlines what HDC will achieve in 2018/19, how it will be assessed, and associated revenues and expenses by reportable output class. This Statement of Performance Expectations has been prepared taking into account the Minister s Letter of Expectations for the 2018/19 financial year. Broader Government priorities are: an increased priority for primary care mental health public delivery of health services a strong focus on improving equity of outcomes. Specific priorities for the Health and Disability Commissioner to focus on in 2018/19 are: supporting the mental health and addictions functions, and the role of the Mental Health Commissioner, as part of HDC, so that the Mental Health Commissioner s roles in advocacy, collaboration, and communication are strengthened supporting the Ministerial Advisory Group for Health in any reasonable way that it may require assistance in pursuing options for better health outcomes for New Zealanders improving services and responsiveness of health providers by coordinating across the health systems where complaints identify immediate flaws supporting the improvement of the timeliness and of health organisations responses to complaints and sharing best practice advice on the handling of complaints in the first instance ensuring that equity of access and service are provided by health services ensuring that the contribution of each organisation reflects safe practice by continuing to work with the Health Quality & Safety Commission. 3

1.1 Alignment with New Zealand Health Strategy A refreshed New Zealand Health Strategy was released in April 2016 with a clear strategic direction for delivery of health services, to ensure that all New Zealanders live well, stay well, and get well. Five strategy themes are reflected throughout HDC s work programme in the following ways. Health Strategy theme People-Powered HDC contribution This theme supports a health system that is genuinely centred around those whom it aims to serve the consumers. This means ensuring that health consumers: are well informed ( health smart ); are empowered to make effective choices about the care or support they receive; have their needs and preferences understood by service designers and providers, and are appropriately involved in service design; and are easily able to navigate the health system, informed by effective communication. These goals are consistent with the Code and the work of HDC. HDC supports a people-powered system by: resolving complaints about healthcare providers and disability services providers; promoting, by education and publicity, respect for and observance of the rights of health consumers and disability services consumers, and awareness of the means by which those rights may be enforced; investigating any action that is, or appears to the Commissioner to be, in breach of the Code; making recommendations to any appropriate person or authority in relation to the means by which complaints involving alleged breaches may be resolved and further breaches avoided; making public statements and publishing reports in relation to any matter affecting the rights of health consumers and/or disability services consumers, including statements and reports that promote an understanding of, and compliance with, the Code or the provisions of the Act; monitoring mental health and addiction services and advocating improvements to those services; advising the Minister on any matter relating to the rights of health consumers and/or disability services consumers, and reporting to the Minister from time to time on the need for, or desirability of, legislative, administrative, or other action to give protection or better protection to the rights of health consumers and/or disability services consumers; making suggestions to any person in relation to any matter that concerns the need for, or the desirability of, action by that person in 4

Value and high performance the interests of the rights of health consumers and/or disability services consumers; receiving and inviting representations from members of the public and from any other body, organisation, or agency on matters relating to the rights of health consumers and/or disability services consumers; and administering and promoting advocacy services that advocate for health consumers and disability services consumers. This theme supports a health system that is underpinned by a culture and practice of delivering value and high performance. HDC s work on complaints, investigations, and proceedings supports this theme by revealing the underlying causes of the problems, holding providers to account, and identifying how providers can learn and improve their performance. One team This theme supports an integrated health system, operating seamlessly from the consumer s perspective. HDC s work on complaints and investigations identifies gaps and makes recommendations based upon its findings about how parts of the system can work better together, to produce better outcomes. Closer to home This theme supports care closer to where people live, work, learn, and play. The Director of Advocacy at HDC contracts with the independent National Advocacy Trust to provide a community-based advocacy service around New Zealand (the Nationwide Health and Disability Advocacy Service), which provides consumers with access to support closer to where they are based. Smart system This theme supports a learning system underpinned by evidence and technology. HDC contributes through analysis and reporting on complaint trend data and systemic monitoring, a core purpose of which is to contribute to systemic learning and improvement. 5

2.0 HDC s Output Classes HDC has four strategic objectives: 1. to protect the rights of health consumers and disability services consumers under the Health and Disability Commissioner Act and Code 2. to improve quality within the health and disability sectors 3. to hold providers to account appropriately 4. to promote, through education and publicity, respect for and observance of the rights of health and disability services consumers HDC s strategic priorities for 2017 2021 are to: resolve complaints in a fair, timely, and effective way while dealing with the constantly increasing volume and complexity of complaints work with District Health Boards (DHBs), health providers, and disability services providers to improve their complaints processes so that complaints are resolved at the lowest possible appropriate level monitor mental health and addiction services and advocate improvements to those services continue to work with providers, the Health Quality & Safety Commission (HQSC), and other key stakeholders to effect recommended changes from complaint learnings operate a financially sustainable organisation with an appropriate resource level to manage volume and complexity strive for continuous improvement in the way we operate. In 2018/19 this includes an ongoing complaints process improvement programme as well as more strategic analysis to look at a full range of options to address the ongoing growth in number and complexity of complaints. HDC achieves its strategic objectives through six principal output classes. These are: Complaints resolution Advocacy Proceedings Education Disability Mental health and addictions monitoring and advocacy 2.1 Complaints resolution HDC anticipates receiving 2,500 complaints by the end of the 2017/18 year (2016/17: 2,221 and 2015/16: 1,958). The number of complaints continues to increase each year. The Act allows a range of resolution options, and we assess each complaint and resolve it in the most appropriate way in the interests of the consumer and the system that serves him or her. This 6

can include referring the matter to the Nationwide Health and Disability Advocacy Service for advocacy support, referring the matter to the provider for resolution between the provider and consumer, seeking expert advice, formal investigation, or referring to an appropriate regulatory body for further action. Formal investigation may lead to an opinion that the consumer s rights have been breached. In a small proportion of cases, a breach finding may also be referred to the Director of Proceedings to decide whether any disciplinary or other proceedings action should be taken. Every complaint is an opportunity for learning and service improvement. We continually engage with the sector to communicate those learnings. We make recommendations in the great majority of investigations and assessments. Recommendations are designed to improve the practice of an individual provider, the systems being used by providers, and the culture providers work within, and strengthen delivery to ensure that repeat performances of errors are minimised. Our recommendations are extremely successful in this regard, with the vast majority being complied with, providing confidence that lessons are learnt, behaviours are changed, and systems are improved. 2.2 Advocacy HDC s Director of Advocacy currently contracts with the National Advocacy Trust to provide the independent Nationwide Health and Disability Advocacy Service (the Advocacy Service). The Advocacy Service operates out of community-based offices throughout New Zealand. The Advocacy Service expects to receive approximately 3,000 complaints, deliver over 1,600 education sessions promoting Code Rights, carry out 4,000 networking visits, and respond to an estimated 10,000 enquiries during the year. HDC s focus is on effective, local, and early resolution of complaints, and the Advocacy Service is critical in ensuring success in that space. The consumer is at the centre of the advocacy process, with advocates supporting and guiding consumers to clarify the issues and the outcomes they are seeking. The Advocacy Service achieves excellent outcomes. Approximately 90% of complaints managed by the Advocacy Service are resolved or withdrawn, and 88% of consumers and 86% of providers were either satisfied or very satisfied with the Advocacy Service complaints process last year. Providing free education sessions about consumer rights and provider duties to both consumers and providers of health and disability services is another key part of an advocate s role. These well-received sessions are in high demand. In addition, advocates network extensively in their local communities to ensure that consumers and providers are aware of the Advocacy Service and the Code, with the emphasis on reaching vulnerable consumers and the family/whānau members who support them. 2.3 Proceedings The Director of Proceedings, appointed under the Act, exercises independent statutory functions. Where the Commissioner has found a breach of a consumer s rights, the 7

Commissioner may refer the provider to the Director of Proceedings. The Director then makes an independent decision regarding whether or not to initiate legal proceedings. The Director can lay a disciplinary charge before the Health Practitioners Disciplinary Tribunal (HPDT), 1 issue proceedings before the Human Rights Review Tribunal (HRRT), or both. The Director can also issue proceedings or provide representation in other forums (other tribunals, courts, or inquiries). Charges against registered health practitioners are heard before the HPDT. If the provider is not a registered health practitioner, 2 the Director may file proceedings with the HRRT. The HRRT may hear claims against bodies such as rest homes and DHBs, or against a registered health professional, regardless of whether disciplinary proceedings are also brought. Unlike the HPDT, the HRRT has the power to order the provider to pay compensation to a consumer. However, the Accident Compensation Act limits the circumstances in which compensatory damages are available. The purpose of laying a charge in the HPDT is to ensure that standards for the profession are maintained, that the individual practitioner is held accountable for his or her actions, and that the public is protected. Proceedings in the HRRT are used to obtain remedies for the consumer and to set standards for providers, particularly non-registered providers. Therefore, the work of the Director of Proceedings is important in helping to set professional standards for both registered and non-registered providers. When a case is brought successfully, the decision often sends a strong message to health and disability services providers. It also helps to maintain public confidence in the quality and safety of services. The Director s role is key in ensuring that providers are held to account where appropriate. 2.4 Education Through education, HDC is committed to ongoing systemic improvements in safety and quality in the health and disability sector. HDC delivers education sessions to both provider and consumer groups. The sessions aim to give providers a clear understanding of their responsibilities, so that they comply willingly with the requirements of the Health and Disability Commissioner Act 1994, and to ensure that consumers know and are able to exercise their rights under the Act. HDC delivers education and training sessions to national service organisations and group providers, professional bodies, and consumer-based organisations. The Advocacy Service, on the other hand, provides more community-level education. Thus the work of the Advocacy Service complements HDC s educational initiatives. To support providers to manage and resolve complaints at the lowest appropriate level, HDC runs complaints management workshops for DHBs and other group providers. These interactive workshops aim to increase: the proportion of complaints resolved effectively by the provider; complainant satisfaction with the provider s response to complaints; and learning from 1 Registered health practitioners include medical practitioners, nurses, midwives, dentists, psychologists, chiropractors, and pharmacists. 2 Non-registered practitioners include providers such as counsellors, massage therapists, caregivers, rehabilitation workers, and acupuncturists. 8

complaints in order to improve service quality. HDC also produces six-monthly DHB complaint trend reports to assist DHBs to identify complaint patterns and emerging issues. HDC conducts regular reviews of the Act and the Code and recommends changes where appropriate. HDC also responds to many enquiries from consumers, providers, and other agencies about the Act, the Code, and consumer rights under the Code. Chiefly through making submissions, HDC advises on the need for, or desirability of, legislative, administrative, or other action to give protection or better protection to the rights of health services consumers or disability services consumers or both. 2.5 Disability The Deputy Health and Disability Commissioner, Disability has a particular focus on promoting awareness of, respect for, and observance of, the rights of disability services consumers. This role is also responsible for HDC s contribution toward the implementation of the New Zealand Disability Strategy 2016 2026 and the United Nations Convention on the Rights of Persons with Disabilities. Work in the above areas includes: increasing consumers awareness of their rights under the Code; making HDC s complaints management processes accessible; encouraging disabled people and their families and support staff to complain; making HDC s educational resources accessible; facilitating and encouraging disability services providers to improve their complaints management processes; providing disability responsiveness training to HDC staff; and increasing disability sector knowledge and experience capability within HDC s staff. 2.6 Mental health and addiction services monitoring and advocacy HDC monitors and advocates for improvements to mental health and addiction services. The Mental Health Commissioner, under delegation from the Commissioner, is responsible for the performance of this function. Monitoring: HDC monitors services by analysing issues and trends identified by HDC complaints and the independent Advocacy Service contracted by HDC. HDC also engages with key stakeholders and monitors sector performance information in order to keep informed about service developments. HDC led the development of the Real Time Feedback system in collaboration with the sector to monitor consumer experience of services. Data from this tool provides timely information on consumer experience to inform quality improvement initiatives as well as contribute to HDC s national monitoring role. Advocacy: HDC advocates for service improvements by making recommendations for improvements arising out of HDC s complaints resolution processes and our specific monitoring role in relation to mental health and addiction services. Recommendations are made to provider organisations such as primary care entities and non-government organisations (NGOs), 9

as well as individual providers. HDC also makes recommendations or suggestions to other organisations in response to issues we identify when considering complaints, for example, recommendations to professional colleges in relation to their practice standards. HDC also makes recommendations to the Minister of Health or other relevant individuals or organisations on issues arising from our wider monitoring and advocacy role. The Mental Health Monitoring and Advocacy function will be strengthened by developing the Real Time Feedback consumer experience tool. Further development is subject to decisions arising from the findings of the Inquiry into Mental Health and Addiction, which reports on 31 October 2018. 10

3.0 Annual Information 3.1 Statement of Forecast Service Performance The services provided under the Health and Disability Commissioner Act are complaints resolution, advocacy, proceedings, education, disability, and monitoring and advocacy (mental health and addictions), which we undertake through six output classes. The output classes are discussed in detail in Section 1 above, and this section sets out HDC s financial and non-financial targets for 2018/19. SPE Budget Forecast 2018/19 2017/18 $000s $000s Complaints resolution Revenue 6,952 7,040 Expenditure 7,158 7,037 Net surplus/(deficit) (206) 3 Advocacy Revenue 3,940 4,043 Expenditure 4,058 4,042 Net surplus/(deficit) (118) 1 Proceedings Revenue 640 462 Expenditure 659 462 Net surplus/(deficit) (19) 0 Education Revenue 362 401 Expenditure 372 401 Net surplus/(deficit) (10) 0 Disability Revenue 586 606 Expenditure 603 606 Net surplus/(deficit) (17) 0 Monitoring and advocacy Revenue 670 654 Expenditure 691 654 Net surplus/(deficit) (21) 0 Totals Revenue 13,150 13,206 Expenditure 13,541 13,202 Net surplus/(deficit) (391) 4 Note: All figures are GST exclusive & each output class has been costed to include a percentage of HDC's overhead costs. 11

Output Class 1 Complaints Resolution Output 1.1 Complaints Management Performance Measures Efficiently and appropriately resolve complaints (which contributes to achievement of Strategic Objectives 1 and 3 see Section 2). SPE 2018/19 Target 2017/18 Comparatives 2016/17 Actual Assume 2,750 2,950 complaints will be received. Close an estimated 2,350 2,420 complaints. The above figure includes an estimated 120 investigations. Assume 2,150 complaints will be received. Close an estimated 2,150 complaints. The above figure includes an estimated 100 investigations. 2,211 complaints were received during the year. 2,015 complaints were closed during the year; this includes undertaking and closing 80 investigations. Manage complaints so that: No more than 18 20% of open complaints are 6 12 months old. No more than 16 18% of open complaints are 12 24 months old. No more than 2 3% of open complaints are over 24 months old. Manage complaints so that: No more than 17% of open complaints are 6 12 months old. No more than 15% of open complaints are 12 24 months old. No more than 1% of open complaints are over 24 months old. Total open files at year end was 626. Age of open complaints at 30 June 2017: 6 12 months old, 121 out of 626 19% 12 24 months old, 70 out of 626 11% Over 24 months old, 29 out of 626 4% 12

Output 1.2 Quality Improvement Performance Measures Use HDC complaints management processes to facilitate quality improvement (which contributes to achievement of Strategic Objective 2). SPE 2018/19 Target 2017/18 Comparatives 2016/17 Actual Make recommendations and educational comments to providers to improve quality of services, and monitor compliance with the implementation of recommendations and encourage better management of complaints by providers: Providers make quality improvements as a result of HDC recommendations and/or educational comments. Audit a sample of providers to verify their compliance with HDC quality improvement recommendations: 97% compliance. Make recommendations and educational comments to providers to improve quality of services, and monitor compliance with the implementation of recommendations and encourage better management of complaints by providers: Providers make quality improvements as a result of HDC recommendations and/or educational comments. Audit a sample of providers to verify their compliance with HDC quality improvement recommendations: 97% compliance. Between 1 July 2016 and 30 June 2017, 228 complaints with quality improvement recommendations were due by 164 providers, and 227 (99.6%) were complied with. There was only one provider who did not comply with HDC s recommendations. Referral to the provider s funder is being considered. HDC will continue to monitor and follow up the providers who received HDC s recommendations to ensure their compliance. 99.6% compliance 13

Output Class 2 Advocacy Advocacy Output 2.1 Complaints Management Performance Measures Efficiently and appropriately resolve complaints (which contributes to achievement of Strategic Objective 1). SPE 2018/19 Target 2017/18 Comparatives 2016/17 Actual Assume 2,800 3,300 complaints will be received. Close an estimated 2,800 3,300 complaints. Assume 2,800 3,300 complaints will be received. Close an estimated 2,800 3,300 complaints. 2,823 new complaints were received by the Advocacy Service in the year ended 30 June 2017. During the year ended 30 June 2017, 2,739 complaints were closed. Manage complaints so that: Manage complaints so that: Complaints were managed so that: 80% are closed within 3 months. 85% are closed within 3 months. 82% were closed within 3 months. 95% are closed within 6 months. 95% are closed within 6 months. 98% were closed within 6 months. 100% are closed within 9 months. 100% are closed within 9 months. 100% were closed within 9 months. Consumers and providers are satisfied with Advocacy s complaints management processes (which contributes to achievement of Strategic Objective 1). Undertake consumer satisfaction surveys, with 80% of respondents satisfied with Advocacy s complaints management processes. Undertake a yearly consumer satisfaction survey, with 80% of respondents satisfied with Advocacy s complaints management processes. 88% of consumers and 86% of providers who responded to satisfaction surveys were satisfied or very satisfied with the Advocacy Service s complaints management processes. Undertake provider satisfaction surveys, with 80% of respondents satisfied with Advocacy s complaints management processes. Undertake a yearly provider satisfaction survey, with 80% of respondents satisfied with Advocacy s complaints management processes. 14

Advocacy Output 2.2 Access to Advocacy Performance Measures Network to promote awareness of the Code and access to the Advocacy Service in local communities (which contributes to achievement of Strategic Objectives 1 and 4). SPE 2018/19 Target 2017/18 Comparatives 2016/17 Actual Advocates carry out 3,000 scheduled visits or meetings with community groups and provider organisations for the purpose of providing information about the Code, HDC, and the Advocacy Service. 3 Such visits/meetings to include aged care facilities and residential disability services, with the emphasis on reaching vulnerable consumers and the family/whānau members who support them. Advocates visit 75% of certified aged care facilities at least once, with multiple visits to facilities as required. Advocates visit 75% of certified residential disability services at least once, with multiple visits to facilities as required. Certified aged care facilities Advocates visited 100% (660) of certified aged care facilities at least once in the year ended 30 June 2017. Advocates visited 62% (412) of aged care facilities more than once in the year ended 30 June 2017. Certified residential disability services Advocates visited 100% (930) of certified residential disability services at least once in the year ended 30 June 2017. Advocates visited 62% (577) of certified residential disability services more than once in the year ended 30 June 2017. 3 A more prioritised approach is being adopted to residential home visits and networking. 15

Advocacy Output 2.3 Education Performance Measures Promote awareness, respect for, and observance of, the rights of consumers and how they may be enforced (which contributes to achievement of Strategic Objective 4). SPE 2018/19 Target 2017/18 Comparatives 2016/17 Actual Advocates provide an estimated 1,600 education sessions. Consumers and providers are satisfied with the education sessions. Seek evaluations on sessions, with 80% of respondents satisfied. Advocates provide an estimated 1,600 education sessions. Consumers and providers are satisfied with the education sessions. Seek evaluations on sessions, with 80% of respondents satisfied. A total of 1,635 education sessions were provided. 87% of consumers and providers who responded to a survey were satisfied with the Advocacy Service education session they attended. 16

Output Class 3 Proceedings Output 3.1 Proceedings Performance Measures Professional misconduct is found in disciplinary proceedings (which contributes to achievement of Strategic Objective 3). SPE 2018/19 Target 2017/18 Comparatives 2016/17 Actual Professional misconduct is found in 75% of disciplinary proceedings. Professional misconduct is found in 75% of disciplinary proceedings. Professional misconduct was found in 100% (3 of 3) of HPDT proceedings during the year ended 30 June 2017. Breach of the Code is found in HRRT proceedings (which contributes to achievement of Strategic Objective 3). A breach of the Code is found in 75% of HRRT proceedings. A breach of the Code is found in 75% of HRRT proceedings. A breach of the Code was found in 100% (3 of 3) of HRRT proceedings during the year ended 30 June 2017. An award is made where damages are sought (which contributes to achievement of Strategic Objective 3). An award of damages is made in 75% of cases where damages are sought. An award of damages is made in 75% of cases where damages are sought. Resolution by negotiated agreement was achieved in 100% (2 of 2) of proceedings. Where a restorative approach is adopted, agreement is reached between the relevant parties (which contributes to achievement of Strategic Objective 3). An agreed outcome is reached in 75% of cases in which a restorative approach is adopted. An agreed outcome is reached in 75% of cases in which a restorative approach is adopted. An agreed outcome was reached in 100% (2 of 2) of cases where a restorative approach was adopted. 17

Output Class 4 Education Education Output 4.1 Information and Education for Providers Performance Measures Monitor DHB complaints and provide complaint information to DHBs (which contributes to achievement of Strategic Objectives 2 and 4). SPE 2018/19 Target 2017/18 Comparatives 2016/17 Actual Produce six-monthly DHB complaint trend reports and provide to all DHBs. 80% of DHBs who respond to an annual feedback form find complaint trend reports useful for improving services. Produce six-monthly DHB complaint trend reports and provide to all DHBs. 80% of DHBs who respond to an annual feedback form find complaint trend reports useful for improving services. Two six-monthly DHB complaint trend reports for each DHB were produced and provided to all DHBs. 100% (20/20) of the DHBs who responded to an annual feedback form rated the complaint trend reports as useful for improving services. Assist DHBs to improve their complaints systems (which contributes to achievement of Strategic Objective 2). Provide two complaints resolution workshops for DHBs. Seek evaluations on the workshops, with 80% of respondents satisfied with the session. Provide two complaints resolution workshops for DHBs. Seek evaluations on the workshops, with 80% of respondents satisfied with the session. Two complaints resolution workshops for DHBs were held. 100% and 93% of respondents reported that they were satisfied or very satisfied with each session respectively. Assist non-dhb group providers to improve their complaints systems (which contributes to achievement of Strategic Objective 2). Provide two complaints resolution workshops for non-dhb group providers. Seek evaluations on workshops, with 80% of respondents satisfied with the session. Provide two complaints resolution workshops for non-dhb group providers. Seek evaluations on workshops, with 80% of respondents satisfied with the session. Three complaints resolution workshops for primary care providers were held. 100% of respondents reported that they were satisfied with each session. 18

Education Output 4.1 Information and Education for Providers Performance Measures Promote awareness, respect for, and observance of, the rights of consumers and how they may be enforced (which contributes to achievement of Strategic Objective 4). SPE 2018/19 Target 2017/18 Comparatives 2016/17 Actual Provide 30 educational presentations. Consumers and health and disability services providers are satisfied with the educational presentations. Seek evaluations on presentations, with 80% of respondents satisfied with the presentation. Provide 30 educational presentations. Consumers and health and disability services providers are satisfied with the educational presentations. Seek evaluations on presentations, with 80% of respondents satisfied with the presentation. 36 educational presentations were made. 97% of respondents who provided feedback (33 of 34) reported that they were satisfied with the presentations. Make public statements and publish reports in relation to matters affecting the rights of consumers: Produce and publish on the HDC website key Commissioner decision reports and related articles. Report on total number. Make public statements and publish reports in relation to matters affecting the rights of consumers: Produce and publish on the HDC website key Commissioner decision reports and related articles. Report on total number. 55 decisions were published at www.hdc.org.nz. 19

Education Output 4.2 Other Education Performance Measures HDC engages in sector education through making submissions on relevant policies, standards, professional codes, and legislation (which contributes to achievement of Strategic Objective 4). SPE 2018/19 Target 2017/18 Comparatives 2016/17 Actual HDC makes at least 10 submissions. HDC makes at least 10 submissions. 13 submissions were made. HDC responds formally to queries from consumers, providers, and other agencies about the Act, the Code, and consumer rights under the Code (which contributes to achievement of Strategic Objective 4). At least 40 formal responses to enquiries provided. At least 40 formal responses to enquiries provided. 44 formal responses to enquiries were provided. 20

Output Class 5 Disability Disability Output 5.1 Disability Education Performance Measures Promote awareness of, respect for, and observance of, the rights of disability services consumers (which contributes to achievement of Strategic Objective 4). SPE 2018/19 Target 2017/18 Comparatives 2016/17 Actual Publish on the HDC website (and make accessible to people who use accessible software ) educational resources for disability services consumers and disability services providers. Publish on the HDC website (and make accessible to people who use accessible software ) educational resources for disability services consumers and disability services providers. In the year ended 30 June 2017, HDC produced two new educational resources: An Easy Read Complaints Assessment process booklet targeting people with a learning disability. An Easy Read Code of Rights poster. Both resources were published on HDC s website and are accessible to people using accessible software. At least two new educational resources will be available in plain English. At least two new educational resources will be available in plain English. Two new educational resources were made available in plain English: An Easy Read Complaints Assessment process booklet. An Easy Read Code of Rights poster. 21

Output Class 6 Mental Health and Addiction Services Monitoring and Advocacy Mental Health and Addiction Services Output 6.1 Monitoring and Advocacy Performance Measures Monitoring Monitor mental health and addiction services to identify potential improvements to services (which contributes to achievement of Strategic Objective 2). SPE 2018/19 Target 2017/18 Comparatives 2016/17 Actual Monitor and analyse issues and trends identified by HDC complaints and the Advocacy Service. Maintain engagement with key sector stakeholders and monitor sector performance information to keep informed about service issues and trends. Monitor and analyse issues and trends identified by HDC complaints and the Advocacy Service. Maintain engagement with key sector stakeholders and monitor sector performance information to keep informed about service issues and trends. HDC completed four quarterly analysis reports for Mental Health and Addiction complaints. These reports are used to inform HDC s advocacy role in relation to mental health and addiction services. HDC participated in 93 mental health and addiction sector stakeholder meetings in 2016/17, held three sector workshops to develop the monitoring and advocacy function, and sought feedback from stakeholders on a draft monitoring framework. Determine HDC s future role in relation to the Real Time Feedback system. HDC entered preliminary negotiations with a third party to undertake championing, management, and analysis of RTF data. Provide briefings to the Minister as required. Provide briefings to the Minister as required. The Mental Health Commissioner briefed the Minister of Health on 22

Mental Health and Addiction Services Output 6.1 Monitoring and Advocacy Performance Measures Advocacy Advocate for improvements to mental health and addiction services (which contributes to achievement of Strategic Objective 2). SPE 2018/19 Target 2017/18 Comparatives 2016/17 Actual Make recommendations and educational comments to providers (and other organisations or individuals) when resolving complaints, to improve the quality of mental health and addiction services and complaints resolution processes. Make recommendations and educational comments to providers (and other organisations or individuals) when resolving complaints to improve the quality of mental health and addiction services and complaints resolution processes. findings of HDC s monitoring role, development of the role, and the introduction of a public report in early 2018. Service improvement recommendations were made in relation to 24 complaints related to mental health and addiction services. Monitor compliance with the implementation of recommendations: 97% compliance Provide briefings or make recommendations or suggestions to any person or organisation in relation to issues or trends identified in HDC s monitoring of mental health and addiction services. Monitor compliance with the implementation of recommendations: 97% compliance Provide briefings or make recommendations or suggestions to any person or organisation in relation to issues or trends identified in HDC s monitoring of mental health and addiction services. HDC monitors providers compliance with recommendations by seeking evidence of changes made. In 2016/17, providers were fully compliant with 100% of recommendations made to them by HDC in response to complaints about mental health services. The Mental Health Commissioner briefed the Minister and the Director-General of Health regarding expectations for service development following the expiration of Rising to the 23

Mental Health and Addiction Services Output 6.1 Monitoring and Advocacy Performance Measures SPE 2018/19 Target 2017/18 Comparatives 2016/17 Actual Challenge and findings of the monitoring role to date. HDC also made submissions in relation to Ministry of Health consultations on the discussion document The Mental Health Act and Human Rights and A Strategy to Prevent Suicide in New Zealand: Draft for public consultation and provided feedback on the revised Royal Australian and New Zealand College of Psychiatrists Code of Ethics. 24

3.2 Reporting HDC will provide quarterly reports to the Minister of Health that cover: progress on our operations, including commentary on any significant variations from objectives and measures in our Statement of Performance Expectations relevant to the quarter an update on key operations, identifying any emerging risks and how these are being managed, and providing a commentary on any significant variation from the objectives and measures in the Commissioner s Statement of Performance Expectations current financial reports in the same format as the agreed Forecast Financial Statements prepared to align with generally accepted accounting practices. Reports will be provided to the Minister by the following dates unless otherwise agreed: Report Period covering Due Date Quarter 1 1 July 2018 30 September 2018 31 October 2018 Quarter 2 1 October 2018 31 December 2018 31 January 2019 Quarter 3 1 January 2019 31 March 2019 30 April 2019 Quarter 4 1 April 2019 30 June 2019 31 July 2019 Annual 1 July 2018 30 June 2019 31 October 2019 25

3.3 Prospective Financial Statements 2018/19 3.3.1 Key Assumptions for Proposed Budget 2018/19 HDC was advised by the Ministry of Health in April 2018 that there will be no additional baseline revenue allocated to HDC for 2018/19. The Ministry proposes that further review and discussion around the HDC s financial position be undertaken midway through the financial year. HDC s proposed budget is based on the organisation being resourced to close approximately 2,350 2,420 complaints annually, including 120 investigations, while continuing to provide the same range of services. This is 9 13% higher than the 2017/18 year SPE target. HDC will also continue to work with the Ministry and the sector to improve complaints handling capabilities of health and disability services providers. The proposed budget reflects a deficit of $391k for 2018/19. The deficit will reduce HDC s equity to $916k. This deficit represents the extent that HDC considers financially prudent to use existing equity to cover the costs of unfunded resources in response to increasing complaint volumes. HDC continues to operate at high degrees of efficiency an independent review by PwC concluded in December 2015 that it could identify no further additional opportunities for cost saving and reduction over and above the strategies adopted by HDC in managing its cost profile. HDC has continued to improve and adapt its systems and processes for managing complaints HDC absorbed 13% growth in 2017/18 and produced over planned output 2,150 planned, 2,300 closed. HDC is planning for further growth in complaints received and closed in 2018/19. CAPITAL EXPENDITURE INTENTIONS Enquiries & Complaints Database System (ECDS) HDC continues to seek opportunities to improve the efficiency and management reporting capability by investing in its core Enquiries & Complaints Database System. Such investment will be funded from HDC s existing reserves. 26

3.3.2 PROSPECTIVE STATEMENT OF COMPREHENSIVE REVENUE AND EXPENSE FOR THE YEAR ENDING 30 JUNE 2019 Full Year Full Year Full Year SPE Budget Forecast Actual 2018/19 2017/18 2016/17 $000s $000s $000s Revenue Funding from the Crown 12,870 12,870 12,070 Interest revenue 50 58 54 Publications revenue 70 70 72 Other revenue 160 208 198 Total revenue 13,150 13,206 12,394 Expenditure Advocacy services 3,485 3,488 3,535 Audit fees 45 45 44 Personnel costs 7,440 7,153 6,422 Travel & accommodation 198 185 152 Depreciation & amortisation 122 128 183 Occupancy 573 560 534 Communications 184 162 158 Operating costs 1,494 1,481 1,482 Total expenditure 13,541 13,202 12,510 Net surplus/(deficit) (391) 4 (116) Total comprehensive revenue and expense (391) 4 (116) 27

3.3.3 PROSPECTIVE STATEMENT OF FINANCIAL POSITION FOR THE YEAR ENDING 30 JUNE 2019 Proposed Full Year Full Year SPE Budget Forecast Actual 2018/19 2017/18 2016/17 $000s $000s $000s Equity Accumulated surplus 128 519 515 Contributed capital 788 788 788 Total equity 916 1,307 1,303 Assets Current assets Bank account 576 768 734 Short-term deposits 700 1,000 1,000 Prepayments 100 100 84 Inventories 20 20 20 Receivables 30 30 96 Total current assets 1,426 1,918 1,934 Non-current assets Property, plant & equipment 151 120 138 Intangible assets 137 145 111 Total non-current assets 288 265 249 Total assets 1,714 2,183 2,183 Liabilities Current liabilities Employee entitlement 450 415 361 Payables 328 420 457 Total current liabilities 778 835 819 Non-current liabilities Payables 20 41 61 Total non-current liabilities 20 41 61 Total liabilities 798 876 880 Net assets 916 1,307 1,303 28

3.3.4 PROSPECTIVE STATEMENT OF CASH FLOWS FOR THE YEAR ENDING 30 JUNE 2019 Proposed Full Year Full Year SPE Budget Forecast Actual 2018/19 2017/18 2016/17 $000s $000s $000s Cash flow from operating activities Receipts from the Crown 12,870 12,870 12,070 Interest received 50 57 55 Publications and other revenue 70 60 83 Payments to suppliers (5,906) (5,662) (5,780) Payments to employees (7,440) (7,153) (6,403) Net cash flow from operating activities (356) 172 25 Cash flow from investing activities Cash was provided from: Receipts from sale of property, plant and equipment - - - Purchase of fixed assets (91) (64) (53) Purchase of intangibles (45) (74) (97) Net cash flow from investing activities (136) (138) (150) Cash flow from financing activities Receipts from capital contribution - - - Net cash flow from financing activities - - - Net (decrease)/increase in cash and cash equivalents (492) 34 (125) Cash and cash equivalents at the beginning of the year 1,768 1,734 1,859 Cash and cash equivalents at the end of the year 1,276 1,768 1,734 Cash balances in the Statement of Financial Position Bank account 576 768 734 Short-term deposits 700 1,000 1,000 Total cash and cash equivalents 1,276 1,768 1,734 29

3.3.5 PROSPECTIVE STATEMENT OF CHANGES IN EQUITY FOR THE YEAR ENDING 30 JUNE 2019 Proposed Full Year Full Year SPE Budget Forecast Actual 2018/19 2017/18 2016/17 $000s $000s $000s Balance at 1 July 1,307 1,303 1,419 Total comprehensive revenue and expense for the year (391) 4 (116) Capital contribution - - - Balance at 30 June 916 1,307 1,303 30

3.3.6 Statement of Accounting Policies REPORTING ENTITY The Health and Disability Commissioner has designated itself as a public benefit entity (PBE) for financial reporting purposes. BASIS OF PREPARATION The prospective financial statements have been prepared on a going concern basis, and the accounting policies have been applied consistently throughout the period. STATEMENT OF COMPLIANCE The prospective financial statements of the Health and Disability Commissioner have been prepared in accordance with the requirements of the Crown Entities Act 2004, which includes the requirements to comply with New Zealand generally accepted accounting practice (NZ GAAP). The prospective financial statements have been prepared in accordance with Tier 2 PBE accounting standards and disclosure concessions have been applied. HDC can report in accordance with Tier 2 PBE Standards as HDC does not have public accountability and HDC s annual expenses are under $30 million. These prospective financial statements comply with PBE accounting standards. Actual financial results achieved for the period covered are likely to vary from the information presented and the variations may be material. PRESENTATION CURRENCY AND ROUNDING The prospective financial statements are presented in New Zealand dollars and all values are rounded to the nearest dollar ($). SIGNIFICANT ACCOUNTING POLICIES Revenue The specific accounting policies for significant revenue items are explained below: Funding from the Crown (Non-exchange revenue) The Health and Disability Commissioner is primarily funded from the Crown. This funding is restricted in its use for the purpose of the Health and Disability Commissioner meeting the objectives specified in its founding legislation and the scope of the relevant appropriations of the funder. The Health and Disability Commissioner considers that there are no conditions attached to the funding and it is recognised as revenue at the point of entitlement. The fair value of revenue from the Crown has been determined to be equivalent to the amounts due in the funding arrangements. Interest revenue Interest revenue is recognised using the effective interest method. 31

Sale of publications Sales of publications are recognised when the product is sold to the customer. IT cost contribution IT cost contribution is recognised when services are provided to the National Advocacy Trust by HDC based on mutual agreement. Sundry revenue Services provided to third parties on commercial terms are exchange transactions. Revenue from these services is recognised in proportion to the stage of completion at balance date. Foreign currency transactions Foreign currency transactions (including those for which forward foreign exchange contracts are held) are translated into NZ$ (the functional currency) using the spot exchange rates at the dates of the transactions. Foreign exchange gains and losses resulting from the settlement of such transactions and from the translation at year end exchange rates of monetary assets and liabilities denominated in foreign currencies are recognised in the surplus or deficit. Expenditure Expenses are recognised when goods or services have been delivered, or when there is a present obligation that is expected to result in an outflow of economic benefits. Leases Operating leases An operating lease is a lease that does not transfer substantially all the risks and rewards incidental to ownership of an asset to the lessee. Lease payments under an operating lease are recognised as an expense on a straight-line basis over the lease term. Lease incentives received are recognised in the surplus or deficit as a reduction of rental expense over the lease term. Cash and cash equivalents Cash and cash equivalents includes cash on hand, deposits held on call with banks, and other short-term highly liquid investments with original maturities of three months or less. Receivables Short-term receivables are recorded at their face value, less any provision for impairment. A receivable is considered impaired when there is evidence that the Health and Disability Commissioner will not be able to collect the amount due. The amount of the impairment is the difference between the carrying amount of the receivable and the present value of the amounts expected to be collected. Investments Bank term deposits Investments in bank term deposits are initially measured at the amount invested. After initial recognition, investments in bank deposits are measured at amortised cost using the effective interest method, less any provision for impairment. 32