Vote Health. APPROPRIATION MINISTER(S): Minister of Health (M36) APPROPRIATION ADMINISTRATOR: Ministry of Health

Vote Health APPROPRIATION MINISTER(S): Minister of Health (M36) APPROPRIATION ADMINISTRATOR: Ministry of Health RESPONSIBLE MINISTER FOR MINISTRY OF HEALTH: Minister of Health THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 1

Overview of the Vote The Minister of Health is responsible for appropriations in the vote for the financial year totalling nearly $15,868 million covering the following. A total of just over $192 million (1.2% of the Vote) relates to the functions of the Ministry of Health for: policy advice; administering the purchase of national health services; monitoring the performance of the funders and providers of health and disability services; developing and administering legislation and regulations related to health service facilities, providers, and public safety; ministerial servicing; payment services; and information services. A total of nearly $14,573 million (91.8% of the Vote) is intended to be spent as follows, almost entirely to fund the purchase of health and disability services: nearly $11,720 million (73.9% of the Vote) to fund health services from district health boards (DHBs) through the DHB appropriations just over $1,158 million (7.3% of the Vote) to purchase national disability support services nearly $861 million (5.4% of the Vote) to purchase national health services and provide clinical training for health professionals just over $427 million (2.7% of the Vote) to purchase public health services just over $172 million (1.1% of the Vote) to purchase primary health care services nearly $147 million (0.9% of the Vote) to purchase national maternity services, just over $59 million (0.4% of the Vote) to fund other health and disability services, and a total of just over $28 million (0.2% of the Vote) is for other expenses to fund provider development, legal expenses, and international health obligations, including World Health Organization (WHO) membership. A total of just over $1,103 million (7.0% of the Vote) is to provide Capital funding and will be spent as follows: $818 million (5.2% of the Vote) is to provide debt or equity for DHBs or health sector Crown agencies to cover new investments or for other purposes agreed by the Crown, including balance sheet restructuring, or to invest in specific health sector assets just over $200 million (1.3% of the Vote) is to provide for the refinancing of capital loans made to DHBs or health sector Crown agencies $55 million (0.3% of the Vote) is a provision for DHBs deficit support just over $15 million (0.1% of the Vote) is to purchase or develop assets for use by the Ministry of Health, and $15 million (0.1% of the Vote) is to provide interest-free loans to assist people in long-term care. Details of these appropriations are set out in Parts 2-4. 2 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6

Details of Appropriations and Capital Injections Annual and Permanent Appropriations Titles and Scopes of Appropriations by Appropriation Type Final ed Actual Departmental Output Expenses Health Sector Information Systems (M36) This appropriation is limited to the provision of information technology services and the publication of data derived from these services to the health and disability system. Managing the Purchase of Services (M36) This appropriation is limited to purchasing services for the public and health and disability sector on behalf of the Crown, for those services where the Ministry has responsibility for the purchasing function (i.e. funding is not devolved to another entity). Payment Services (M36) This appropriation is limited to the administration and audit of contracts and payments on behalf of the Crown and Crown agencies. Regulatory and Enforcement Services (M36) This appropriation is limited to implementing, enforcing and administering health- and disabilityrelated legislation and regulations, and provision of regulatory advice to the sector and to Ministers, and support services for committees established under statute or appointed by the Minister pursuant to legislation. Sector Planning and Performance (M36) This appropriation is limited to advising on and co-ordinating health sector planning and performance improvement; and funding, monitoring, and supporting the governance of, health sector Crown entities, and sector co-ordination. 50,673 49,497 50,201 32,918 32,154 30,807 17,948 17,532 18,171 26,150 25,543 24,027 48,001 46,887 48,038 Total Departmental Output Expenses 175,690 171,613 171,244 Departmental Capital Expenditure Ministry of Health - Capital Expenditure PLA (M36) This appropriation is limited to the purchase or development of assets by and for the use of the Ministry of Health, as authorised by section 24(1) of the Public Finance Act 1989. 18,010 18,010 15,010 Total Departmental Capital Expenditure 18,010 18,010 15,010 Non-Departmental Output Expenses Health and Disability Support Services - Auckland DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Auckland DHB. Health and Disability Support Services - Bay of Plenty DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Bay of Plenty DHB. Health and Disability Support Services - Canterbury DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Canterbury DHB. Health and Disability Support Services - Capital and Coast DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Capital and Coast DHB. Health and Disability Support Services - Counties-Manukau DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Counties-Manukau DHB. 1,092,299 1,092,299 1,115,555 614,392 614,392 633,648 1,277,138 1,277,138 1,281,426 678,807 678,807 689,554 1,246,364 1,246,364 1,268,476 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 3

Titles and Scopes of Appropriations by Appropriation Type Final ed Actual Health and Disability Support Services - Hawkes Bay DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Hawkes Bay DHB. Health and Disability Support Services - Hutt DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Hutt DHB. Health and Disability Support Services - Lakes DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Lakes DHB. Health and Disability Support Services - MidCentral DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from MidCentral DHB. Health and Disability Support Services - Nelson-Marlborough DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Nelson-Marlborough DHB. Health and Disability Support Services - Northland DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Northland DHB. Health and Disability Support Services - South Canterbury DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from South Canterbury DHB. Health and Disability Support Services - Southern DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Southern DHB. Health and Disability Support Services - Tairawhiti DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Tairawhiti DHB. Health and Disability Support Services - Taranaki DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Taranaki DHB. Health and Disability Support Services - Waikato DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Waikato DHB. Health and Disability Support Services - Wairarapa DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Wairarapa DHB. Health and Disability Support Services - Waitemata DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Waitemata DHB. Health and Disability Support Services - West Coast DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from West Coast DHB. Health and Disability Support Services - Whanganui DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Whanganui DHB. 435,492 435,492 457,128 357,834 357,834 363,557 278,253 278,253 283,482 460,022 460,022 465,870 378,204 378,204 393,161 487,869 487,869 509,308 164,569 164,569 167,378 776,461 776,461 789,623 144,333 144,333 146,813 304,189 304,189 317,712 1,002,408 1,002,408 1,040,100 122,511 122,511 127,817 1,311,848 1,311,848 1,342,072 119,605 119,605 121,511 202,295 202,295 205,636 4 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6

Titles and Scopes of Appropriations by Appropriation Type Final ed Actual Non-Departmental Output Expenses - cont d Health Workforce Training and Development (M36) This appropriation is limited to provision of clinical training for doctors, nurses, dentists and other health professionals, and Voluntary Bonding Scheme claims. Monitoring and Protecting Health and Disability Consumer Interests (M36) Provision of services to monitor and protect health consumer interests by the Health and Disability Commissioner, District Mental Health Inspectors and Review Tribunals, and the Mental Health Commission. National Advisory and Support Services (M36) Provision of advisory and support services by independent service providers. National Child Health Services (M36) For the funding and purchase of child health services directly by the Crown. National Contracted Services - Other (M36) This appropriation is limited to the purchase of other services directly by the Crown to support the health and disability services sector, including the national management of pharmaceuticals, and health research. National Disability Support Services (M36) Delivery of disability support services provided through DHBs and third-party service providers. National Elective Services (M36) Funding for the purchase of additional elective surgery services. National Emergency Services (M36) For the funding and purchase of health emergency services directly by the Crown. National Health Information Systems (M36) This appropriation is limited to the provision of information technology services for the New Zealand health and social sectors. National Māori Health Services (M36) For the funding and purchase of Māori health services directly by the Crown. National Maternity Services (M36) For the funding and purchase of maternity services directly by the Crown. National Mental Health Services (M36) For the funding and purchase of mental health services directly by the Crown. National Personal Health Services (M36) This appropriation is limited to personal healthcare and support services purchased directly by the Crown, including mobile surgical services, telephone and online advice services, hospice services, sexual and reproductive health services, and services associated with the implementation of the Oral Health and Cancer Control Strategies. Primary Health Care Strategy (M36) This appropriation is limited to services to implement and deliver the Primary Health Care Strategy. Problem Gambling Services (M36) Funding to support the research and implementation of strategies to prevent and minimise the harm from gambling, and for the provision of treatment services to problem gamblers and assistance to their families and whānau in accordance with the Gambling Act 2003. Public Health Service Purchasing (M36) Public Health Services funded by the Ministry of Health from DHBs and other public health service providers. 177,441 177,441 174,250 27,596 27,596 27,096 260 260 260 85,704 82,704 87,048 25,130 25,130 45,378 1,109,410 1,109,410 1,158,113 290,177 290,177 316,512 96,318 96,318 96,440 14,200 14,200 14,887 7,308 5,308 7,308 144,666 144,666 146,767 46,639 46,639 55,797 95,645 94,645 77,933 155,290 155,290 172,130 19,333 19,333 17,130 401,927 397,927 427,491 Total Non-Departmental Output Expenses 14,151,937 14,141,937 14,544,367 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 5

Titles and Scopes of Appropriations by Appropriation Type Final ed Actual Non-Departmental Other Expenses International Health Organisations (M36) Funding for New Zealand s membership to the World Health Organisation (WHO), and the contribution to specific WHO projects. Legal Expenses (M36) Funding for the defence and settlement of legal claims against the Crown. Provider Development (M36) Funding support and provide assistance for the development of the third party health service workforce, in particular, Māori and Pacific people s providers. 1,530 1,530 2,030 1,028 1,028 1,028 25,623 25,623 25,414 Total Non-Departmental Other Expenses 28,181 28,181 28,472 Non-Departmental Capital Expenditure Deficit Support for DHBs (M36) This appropriation is limited to equity injections to District Health Boards to address deficits. Equity for Capital Projects for DHBs and Health Sector Crown Agencies (M36) Capital contributions to District Health Boards and health sector Crown agencies to cover new investments and reconfiguration of their balance sheets. Health Sector Projects (M36) Capital investment in specific health sector assets. Loans for Capital Projects (M36) Provision of new loans to DHBs and health sector Crown agencies for the purpose of facilities redevelopment and other purposes agreed by the Crown including balance sheet reconfiguration. Refinance of Crown Loans (M36) This appropriation is limited to refinancing existing Crown loans made to DHBs for the purpose of facilities redevelopment and other purposes agreed by the Crown including balance sheet reconfiguration. Refinance of DHB Private Debt (M36) Provision of funding to DHBs to replace their current debts held by private banking institutions as they become due for refinancing. Residential Care Loans - Payments (M36) Funding to provide interest-free loans to people entering into aged residential care facilities. 39,500 39,500 55,000 51,970 44,595 304,000 155,280 119,349 390,000 82,546 55,800 74,000 480,090 476,036 200,100 - - 50,000 15,000 15,000 15,000 Total Non-Departmental Capital Expenditure 824,386 750,280 1,088,100 Multi-Category Expenses and Capital Expenditure Policy Advice and Ministerial Servicing MCA (M36) The overarching purpose of this appropriation is to provide policy advice and other support to Ministers in discharging their policy decision-making and other portfolio responsibilities. 21,188 20,696 21,188 Departmental Output Expenses Ministerial Servicing This category is limited to the provision of services to Ministers to enable them to discharge their portfolio responsibilities other than policy decision-making. Policy Advice This category is limited to the provision of advice (including second opinion advice and contributions to policy advice led by other agencies) to support decision-making by Ministers on government policy matters. 4,747 4,637 4,747 16,441 16,059 16,441 Total Multi-Category Expenses and Capital Expenditure 21,188 20,696 21,188 Total Annual and Permanent Appropriations 15,219,392 15,130,717 15,868,381 6 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6

Capital Injection Authorisations Final ed Actual Ministry of Health - Capital Injection (M36) 1,517 1,517 315 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 7

Supporting Information Part 1 - Vote as a Whole 1.1 - New s Appropriation ed District Health Board (DHB) Additional Funding for Pressures More Elective Surgery, Reducing Pain, and Increasing Prevention Additional 2000 Elective Procedures Bowel Cancer Screening Pilot Extension Palliative Care Community Service Support Roles National Child Health Services - Pressure Improving Hospice Community Palliative Care Services In-Between Travel Disability Support: Community Residential Services - Pressure Various DHBs Non-departmental output expenses National Elective Services Non-departmental output expense National Elective Services Non-departmental output expense Public Health Service Purchasing Non-departmental output expense National Contracted Services - Other Non-departmental output expense National Child Health Services Non-departmental output expense National Contracted Services - Other Non-departmental output expense National Disability Support Services Non-departmental output expense National Disability Support Services Non-departmental output expense - 300,000 300,000 300,000 300,000-11,000 27,000 12,000 - - 12,000 12,000 12,000 12,000-3,400 6,000 3,000 - - 3,100 7,000 7,000 7,000-2,961 2,961 2,961 2,961-13,000 13,000 13,000 13,000-14,000 14,000 14,000 14,000-12,307 12,307 12,307 12,307 Disability Support: High and Complex Services Cost Pressure Disability Support: Other Services and Minimum Wage Increase - Pressure National Disability Support Services Non-departmental output expense National Disability Support Services Non-departmental output expense - 510 510 510 510-1,933 5,683 5,683 5,683 Disability Support: Home and Community Support Services - Pressure Disability Support: Environmental Support Services - Pressure Disability Support Services - Pressures National Disability Support Services Non-departmental output expense National Disability Support Services Non-departmental output expense National Disability Support Services Non-departmental output expenses - 6,090 6,090 6,090 6,090-2,241 2,241 2,241 2,241-9,800 9,800 9,800 9,800 8 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6

Appropriation ed Ambulance Services - Pressure Community Midwives - cost and volume pressures Primary Health Care - Pressure Public Health - Pressure National Emergency Services Non-departmental output expense National Maternity Services Non-departmental output expense Primary Health Care Strategy Non-departmental output expense Public Health Service Purchasing Non-departmental output expense - 3,350 3,350 3,350 3,350-4,882 4,882 4,882 4,882-3,631 3,753 3,779 3,805-2,140 4,218 4,218 4,218 Total operating initiatives - 406,345 434,795 416,821 401,847 Reprioritising DHB Savings Delivered by PHARMAC Social Sector Trials - Extension To June 2016 Various DHBs Non-departmental output expense National Mental Health Services Non-departmental output expense - (9,800) (9,800) (9,800) (9,800) - (2,726) - - - Total reprioritised savings - (12,526) (9,800) (9,800) (9,800) Net total operating and capital - 393,819 424,995 407,021 392,047 The 2015 Health package funded just over $409 million in new operating initiatives across Vote Health and Vote Social Development in. Over the forecast period, total new operating initiatives amount to nearly $1,663 million. The new operating expenditure is summarised below: Vote ed 5 Years New operating initiatives Health - 406,345 434,795 416,821 401,847 1,659,808 Social Sector Trials - Extension To June 2016 Total new initiatives funded Social Development - 2,726 - - - 2,726-409,071 434,795 416,821 401,847 1,662,534 Total reprioritised savings Health - (12,526) (9,800) (9,800) (9,800) (41,926) Total new operating expenditure funded from the operating allowance and Vote Health baselines Health and Social Development - 396,545 424,995 407,021 392,047 1,620,608 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 9

10 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 1.2 - Trends in the Vote Summary of Financial Activity Appropriations 2010/11 2011/12 2012/13 2013/14 Actual Actual Actual Actual ed Actual Departmental Transactions Non- Departmental Transactions Output Expenses 12,768,899 13,233,248 13,568,150 14,002,497 14,327,627 14,313,550 171,244 14,544,367 14,715,611 14,651,980 14,614,111 14,596,637 Benefits or Related Expenses - - - - - - N/A - - - - - Borrowing Expenses - - - - - - - - - - - - Other Expenses 27,924 33,597 26,100 27,873 28,181 28,181-28,472 28,472 28,472 27,347 27,347 Capital Expenditure 361,518 296,900 259,582 336,432 842,396 768,290 15,010 1,088,100 1,103,110 368,206 402,464 319,221 Intelligence and Security Department Expenses and Capital Expenditure Multi-Category Expenses and Capital Expenditure (MCA) Total - - - - - - - N/A - - - - Output Expenses - - 15,750 20,036 21,188 20,696 21,188-21,188 21,188 21,188 21,188 Other Expenses - - - - - - - - - - - - Capital Expenditure - - - - - - N/A - - - - - Total Appropriations 13,158,341 13,563,745 13,869,582 14,386,838 15,219,392 15,130,717 207,442 15,660,939 15,868,381 15,069,846 15,065,110 14,964,393 Crown Revenue and Capital Receipts Tax Revenue - - - - - - N/A - - - - - Non-Tax Revenue 581,335 603,624 625,524 655,187 677,285 677,285 N/A 689,459 689,459 701,599 713,341 725,315 Capital Receipts 23,879 24,112 25,645 375,698 147,499 147,499 N/A 27,499 27,499 27,499 27,499 27,499 Total Crown Revenue and Capital Receipts 605,214 627,736 651,169 1,030,885 824,784 824,784 N/A 716,958 716,958 729,098 740,840 752,814 VOTE HEALTH Note - Where restructuring of the vote has occurred then, to the extent practicable, prior years information has been restated as if the restructuring had occurred before the beginning of the period covered. In this instance Total Appropriations for the ed and Actual year may not equal Total Appropriations in the Details of Appropriations and Capital Injections.

1.3 - Analysis of Significant Trends Total Vote: All Appropriations The graph below shows that Vote Health appropriations will total nearly $15,868 million in. Figure 1 - Trends in total voted and actual expenses (capital and operating) $ millions 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Financial Year 2010/11 2011/12 2012/13 2013/14 Source: Ministry of Health Output Expenses Departmental Output Expenses Voted Actual expenditure The impacts of policy initiatives from earlier s on individual appropriations are detailed in Part 2.1 and Part 4. Figure 2 - Trends in actual and estimated departmental output expenses $ millions 250 200 150 100 50 0 Financial Year 2010/11 2011/12 2012/13 2013/14 Source: Ministry of Health Actual expenditure Actual expenditure THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 11

Non-Departmental Output Expenses The increase in non-departmental output expenses in is due to additional funding provided for new initiatives in 2015 (as shown in Part 1.1 above) and the rephasing of expenditure for various programmes between years. The impacts of policy initiatives from earlier s on individual appropriations are detailed in Part 3.1. Figure 3 - Trends in actual and estimated non-departmental output expenses $ millions 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Financial Year 2010/11 2011/12 2012/13 2013/14 Source: Ministry of Health Other Expenses Actual expenditure actual expenditure Other Expenses comprise approximately 0.2% of the Vote. They provide funding for provider development, to defend the Crown against legal claims, to fund legal settlements, and to contribute to the World Health Organization. The impact of policy initiatives from earlier s on individual appropriations is detailed in Part 3.4. 12 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6

Capital Expenditure Figure 4 - Trends in actual and estimated departmental and non-departmental capital expenditure $ millions 600 500 400 300 200 100 0 Financial Year 2010/11 2011/12 2012/13 2013/14 Source: Ministry of Health Note 1 - This graph excludes capital appropriated specifically for: the roll-over of Crown loans to DHBs, and the refinancing of DHB private debt with Crown loans. Note 2 - In the information Supporting the Estimates of Appropriations prior to 2013 this graph reported the approximate expenditure for the outyears. The timing of the expenditure for capital projects can legitimately differ from the period when it was appropriated, so the graph has been updated to show forecast expenditure. Departmental capital The Ministry expects to meet its departmental capital needs for through its balance sheet. As such, no departmental capital appropriation has been sought. Detail of Vote Health departmental capital appropriations is provided in Part 2.3. Non-departmental capital Actual expenditure Actual expenditure The Ministry expects that the health and disability sector s needs for non-departmental capital in can be met through a combination of DHB baselines and Crown funding already allocated to the Health capital envelope. As such, no non-departmental capital appropriation has been sought. Detail of Vote Health non-departmental capital appropriations is provided in Part 3.5. THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 13

1.4 - Reconciliation of Changes in Appropriation Structure Old Structure New Structure Appropriations in the Structure (Current) Appropriations to which Expenses (or Capital Expenditure) have been Moved from or to Amount Moved Appropriations in the Structure (Restated) Health Services Funding 39,500 Transferred to Deficit Support for DHBs 39,500 Deficit Support for DHBs 39,500 55,000 Note - $39.500 million of the Health Services Funding appropriation was restructured in. Transactions affecting the balance of funding for that year are described in the Supplementary Estimates for. The balance of funding in the Health Services Funding appropriation, which was held as a Vote Health risk pool, has been returned to the Crown as emerging risks in the health sector will now be assessed and funded from the centre on a case-by-case basis. Explanations of the reasons for changing the appropriation structure are noted in the details of each appropriation in Parts 2-4. 14 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6

Part 2 - Details of Departmental Appropriations 2.1 - Departmental Output Expenses Health Sector Information Systems (M36) This appropriation is limited to the provision of information technology services and the publication of data derived from these services to the health and disability system. Expenses and Revenue ed Actual Total Appropriation 50,673 49,497 50,201 Revenue from the Crown 50,673 50,673 50,201 Revenue from Others - - - This appropriation is intended to achieve the following: information technology services and infrastructure are provided to support the operation of New Zealand s health services. Assessment of Performance ed Actual The percentage of time for which key sector- and public-facing systems are available (Note 1) 99% 99.5% 99% The number of active user logins to National Systems (Note 2) 10,000 15,000 10,000 The number of National Collection reports produced annually 10 13 10 The percentage of data submitted by DHBs that is processed within two working days (Note 3) Number of requests, for data and/or analysis, responded to in respect of information held within the national collections datasets (Note 4) 97% 97% 97% 2,400 2,900 2,900 Note 1 - Key sector- and public-facing systems are National Health Index (NHI), National Immunisation Register (NIR), Online Pharmacy, Special Authorities, Oracle Financials, and Web Access. Note 2 - This measures the extent of use of national systems by the Health Sector. An active user is either an individual user or an organisation. Each login by an active user is counted. Note 3 - This percentage relates to the national minimum dataset (hospital events) and the national booking reporting systems (patients waiting for elective surgery) only. Note 4 - The measure illustrates the usage made of the national data collections by external parties. THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 15

End of Year Performance Reporting The Ministry of Health will report performance information for this appropriation in its Annual Report. Current and Past s ed Appropriation established (technical adjustment) 51,099 51,099 51,099 51,099 51,099 Electronic oral health record 530 740 340 340 340 Population Health Data Warehouse 393 491 136 136 136 Whānau Ora IT System - transfer to departmental expenses 390 350 350 - - Managing the Purchase of Services (M36) This appropriation is limited to purchasing services for the public and health and disability sector on behalf of the Crown, for those services where the Ministry has responsibility for the purchasing function (i.e. funding is not devolved to another entity). Expenses and Revenue ed Actual Total Appropriation 32,918 32,154 30,807 Revenue from the Crown 32,918 32,918 30,807 Revenue from Others - - - This appropriation is intended to achieve the following: health and disability services are purchased on behalf of the Crown in line with Government priorities and the Ministry of Health s strategic intentions (as outlined in the Ministry of Health s Statement of Intent). Assessment of Performance ed Actual Total number of contracts held by the Ministry for the purpose of purchasing goods and services on behalf of the Crown (Note 1) The Ministry Procurement Policy is assessed and confirmed to be in line with government standards The ratio of departmental expenditure for the output class against relevant non-departmental expenditure (Note 2) 4,000 4,300 4,300 Achieved Achieved Achieved 1:80 1:80 1:80 16 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6

Assessment of Performance ed Actual Social agencies are required to move contracts with NGOs to the streamlined contract framework as they are renewed. The Ministry will move the following numbers of contracts by 30 June 2016 The percentage of Ministry feedback to Crown Funding Agreement Variation (CFAV) monitoring reports that are supplied to DHBs within agreed timeframes (Note 3) The percentage of complaints received by the National Quality Group, National Services Purchasing, National Health Board, that receive a timely initial response from the Ministry (Note 4) New New 320 90% 100% 90% 95% 100% 95% Note 1 - The following are defined as contracts for the purpose of this measure: any contract which has any dollar value and is managed under the Ministry s Non-Departmental Contract Management System, or payments made under section 88 of the New Zealand Public Health and Disability Act 2000, or payments managed by the Ministry s Client Claims Processing System. The measure does not include Crown Funding Agreements with the DHBs. Crown Funding Agreements were included in the 2011/12 measure. Note 2 - This is an efficiency measure which assesses the ratio between departmental expenditure (DE) and non-departmental expenditure (NDE). Note 3 - The Ministry s feedback is due within 14 business days after receiving CFAV monitoring reports. CFAV monitoring reports are usually due on the 20th day of the month following the end of the quarter. Note 4 - Once a complaint is loaded into the complaints database a letter is sent within five working days, to the complainant acknowledging his/her letter, and advising about the process for dealing with the complaint. End of Year Performance Reporting The Ministry of Health will report performance information for this appropriation in its Annual Report. Current and Past s ed Better Public Services seed funding: social bonds pilots 1,493 360 360 - - Healthy Families NZ 1,000 1,000 1,000 1,000 1,000 National Telehealth Service implementation 1,000 - - - - Problem Gambling 3-Year Service Plan 2013/14 282 304 - - THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 17

Reasons for Change in Appropriation The decrease in this appropriation in of $2.111 million is mainly due to: $1.133 million was due to the funding profile of the initiative: Better Public Services seed funding: social bonds pilots, and $1 million was due to the funding profile of the initiative: National Telehealth Service implementation. Memorandum Account ed Actual Problem Gambling Opening Balance at 1 July (433) (433) (433) Revenue 1,117 1,117 957 Expenses 1,117 1,117 957 Transfers and adjustments - - - Closing balance (433) (433) (433) Payment Services (M36) This appropriation is limited to the administration and audit of contracts and payments on behalf of the Crown and Crown agencies. Expenses and Revenue ed Actual Total Appropriation 17,948 17,532 18,171 Revenue from the Crown 17,326 17,326 17,549 Revenue from Others 622 622 622 This appropriation is intended to achieve the following: timely and appropriate payments are made to eligible parties (including eligible health service providers and consumers) and contracts are audited and processed efficiently and effectively. 18 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6

Assessment of Performance ed Actual The number of claims processed per annum 1.800 million 1.750 million 1.800 million The percentage of claims paid on time (Note 1) 95% 100% 95% The percentage of claims processed accurately (Note 2) 95% 99% 95% The direct cost per claim transaction processed (Note 3) $2.70 $2.60 $2.70 The number of agreements processed per annum 9,400 10,000 9,400 The percentage of all draft agreements prepared for funders within target timeframes (Note 4) 95% 85% 95% The percentage of agreements prepared accurately (Note 5) 95% 93% 95% The cost per agreement processed $155.00 $100.00 $155.00 Number of contact centre calls per annum 580,000 500,000 500,000 The percentage of calls to contact centres answered within service specifications for timeliness (20 seconds currently) The percentage of calls abandoned by callers prior to being answered by the contact centre 80% 70% 80% less than 5% 5% less than 5% The cost per enquiry (Note 6) $4.70 $5.00 $4.70 The percentage of enquiries resolved in under 10 business working days (Note 7) The total dollar value of payments made to those primary health and disability providers who have been subject to audit and compliance activities during the year, expressed as a percentage of the budget for those providers (Note 8) The total number of Ministry prosecuted cases against the percentage of those cases that contain adverse judicial comments (Note 9) 95% 97% 95% 70% 89% 70% less than 10% 0% less than 10% Note 1 - Claims include all transactions where payment is required, including invoices and other support claims. On time means the claim is paid by the invoice due date or within agreed timeframes, where no due date is provided, if full information for payment is available. Note 2 - All claim information is deemed to be processed accurately if payments are made to valid payee, on time, and at the correct rate. Note 3 - Direct cost includes all costs directly attributable to processing claims. These costs mainly relate to staff time. Note 4 - As well as transacting payments, the Ministry facilitates the establishment of agreements between funders and providers. Agreements are contracts administered by Sector Services for the Ministry and DHBs including new contracts and variations to existing contracts. Agreements are drafted based on templates following requests from DHB funders. In general the expected turnaround time for issuing a draft agreement to the Funder is five working days. Note 5 - All information is deemed to be processed accurately if agreements are legally binding and purchase order information is correctly entered. Note 6 - Enquiries received are submissions requiring a response made to the Ministry by telephone, email, fax, or post. THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 19

Note 7 - All enquiries are deemed to be resolved if they are closed to customer satisfaction within ten business days. Note 8 - Total dollar value of payments to primary healthcare and disability providers is approximately $5,900 million. Note 9 - Total number of cases is also recorded for context. Adverse Judicial includes any negative judicial commentary with regard to the evidential basis for bringing the case before the Court and/or whether the matter was sufficiently serious to warrant the intervention of the criminal law. End of Year Performance Reporting The Ministry of Health will report performance information for this appropriation in its Annual Report. Current and Past s ed Free under 13s - Ministry payment system changes - 223 223 223 223 Appropriation established (technical adjustment) 19,898 19,898 19,898 19,898 19,898 Regulatory and Enforcement Services (M36) This appropriation is limited to implementing, enforcing and administering health- and disability-related legislation and regulations, and provision of regulatory advice to the sector and to Ministers, and support services for committees established under statute or appointed by the Minister pursuant to legislation. Expenses and Revenue ed Actual Total Appropriation 26,150 25,543 24,027 Revenue from the Crown 10,852 10,852 10,852 Revenue from Others 15,298 10,701 13,175 This appropriation is intended to achieve the following: health and disability services are regulated so that appropriate standards are followed. 20 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6

Assessment of Performance ed Actual Number of quality audits of providers conducted or assessed (Note 1): Total 627 653 664 Medsafe 37 37 37 HealthCert 330 349 267 Medicines Control 260 267 360 The percentage of medium and high priority quality incident notifications relating to medicines and medical devices that undergo an initial review within 5 working days (Note 2) The percentage of all certificates issued to providers under the Health and Disability Services (Safety) Act 2001 within 20 working days of the receipt of all information and payment of the required fee The percentage of all licences and authorities issued to providers under the Medicines Act 1981 and Misuse of Drugs Act 1975 within target timeframes The percentage of all licences and consents issued to radiation users under the Radiation Protection Act 1965 within 10 working days of the receipt of all information and payment of the required fee The percentage of all New Medicines Applications (for ministerial consent to market) that receive an initial assessment within 200 days The percentage of all Changed Medicines Notifications (for ministerial consent to market) responded to within 45 days All statutory officers appointed by the Ministry meet the criteria set by the Director-General of Health and any statutory prerequisites for appointment All recommendations for appointments meet the requirements of health legislation (Note 3) The number of appointments to statutory committees and regulatory authorities The percentage of recommendations for appointments where recommendations are presented to the Minister prior to expiration of term for the current appointee Average rating for statutory committee satisfaction with secretariat services provided by the Ministry 90% 98% 90% 90% 91% 90% 90% 91% 90% 90% 90% 90% 80% 90% 80% 100% 100% 100% Achieved Achieved Achieved 100% 100% 100% 77 175 107 95% 100% 95% greater than 4 out of 5 4.1 (2013/14 actual) greater than 4 out of 5 Note 1 - The Ministry conducts quality audits of pharmacies and premises regulated under the Medicines Act 1981 and the Misuse of Drugs Act 1975, and reviews surveillance audits performed by Designated Auditing Agencies for providers certified under the Health and Disability Services (Safety) Act 2001. Note 2 - The Ministry of Health responds to incident notifications under the Medicines Act 1981 regarding the quality of medicines, medical devices and advertising. An estimated 1,200 medium and high priority quality incident notifications are received each year. In general they are responded to within five working days. THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 21

Note 3 - The requirements are included in the following legislation: For DHBs and Crown entities: Crown Entities Act 2004 New Zealand Public Health and Disability Act 2000 Health Research Council Act 1990, and Health and Disability Commissioner Act 1994. For regulatory authorities and committees: Health Practitioners Competence Assurance Act 2003 New Zealand Public Health and Disability Act 2000, and Human Assisted Reproductive Technology Act 2004. End of Year Performance Reporting The Ministry of Health will report performance information for this appropriation in its Annual Report. Current and Past s ed Regulation of Psychoactive Substances 2013/14 900 1,260 1,800 1,800 1,800 Reasons for Change in Appropriation The decrease in this appropriation in of $2.123 million is due to a change in the forecast revenue from third parties. The revenue from the Crown remains the same. Memorandum Account ed Actual Office of Radiation Safety Opening Balance at 1 July 702 702 877 Revenue 701 800 926 Expenses 701 625 926 Transfers and Adjustments - - - Closing Balance at 30 June 702 877 877 Medsafe Opening Balance at 1 July 3,059 3,059 2,345 Revenue 8,385 8,385 8,385 Expenses 9,305 9,100 9,305 Transfers and Adjustments - - - Closing Balance at 30 June 2,139 2,344 1,425 22 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6

ed Actual Psychoactive Substances Opening Balance at 1 July (233) (233) (948) Revenue - 10 - Expenses 956 725 800 Transfers and Adjustments - - - Closing Balance at 30 June (1,189) (948) (1,748) Natural Health and Supplementary Products Opening Balance at 1 July - - (270) Revenue - - - Expenses 635 270 800 Transfers and Adjustments - - - Closing Balance at 30 June (635) (270) (1,070) Sector Planning and Performance (M36) This appropriation is limited to advising on and co-ordinating health sector planning and performance improvement; and funding, monitoring, and supporting the governance of, health sector Crown entities, and sector co-ordination. Expenses and Revenue ed Actual Total Appropriation 48,001 46,887 48,038 Revenue from the Crown 47,641 47,641 47,678 Revenue from Others 360 360 360 This appropriation is intended to achieve the following: health sector services are appropriately planned, funded, and monitored; health sector Crown entities, agencies, and companies are appropriately governed; and sector co-ordination is encouraged and assisted. THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 23

Assessment of Performance ed Actual Planning and funding advice for the financial year is provided to Crown entities by 31 December (Note 1) The Ministry provides the Minister with advice on agreement of all DHB annual plans by 30 June (Note 2) The percentage of monitoring feedback reports about performance supplied to DHBs within agreed timeframes (Note 3) The percentage of all letters to DHBs with Health Target performance tables and supporting information, provided to the Minister within 5 working days of the date for publication (Note 4) The percentage of quarterly and monthly monitoring reports about DHBs provided to the Minister within agreed timeframes (Note 5) The percentage of quarterly and monthly monitoring reports about Crown entities (excluding DHBs) provided to the Minister within agreed timeframes (Note 6) Percentage of emergency responses to national emergencies is available within 2 hours (Note 7) The number of people who annually receive two training/exercise sessions on National Health Coordination Centre (NHCC) activation and response Quarterly regional or national health sector emergency planner meetings held in each region (Note 8) The percentage of appointments to DHBs and other health Crown entity boards where advice is presented to the Minister prior to the current appointee s term expiring (Note 9) The number of appointments to DHBs and other health Crown entity boards (for, see Note 10) Achieved Achieved Achieved Achieved Achieved Achieved 90% 99% 90% 100% 100% 100% 100% 65% 100% 100% 100% 100% 100% 100% 100% 30 30 30 Achieved Achieved Achieved 100% 100% 100% 33 30 15 Note 1 - The end of the calendar year marks a significant milestone for this output class. Advice to assist Crown entities in planning for the upcoming financial year needs to be provided well in advance. Note 2 - DHB annual plans (including their funding schedules) include the Annual Plans and advice by year end - the achieved standard will be met if advice has been given to the Minister for all 20 DHBs on or before 30 June. By working closely and collaboratively with DHBs, the Ministry expects to advise the Minister on agreement of all DHB plans by the 30 June. Note 3 - No more than 11 working days after the 20th of the month following the end of each quarter, or as timeframes are specified in the guidance document provided to DHBs at the beginning of each reporting year. Note 4 - The Ministry produces and circulates the tables used to publish health target results once a quarter to DHBs (ie, within five working days - this means that the date on which the letter was sent falls into a range that is five working days before the relevant publication date, to five days after the relevant publication date). This is a significant way in which performance of the sector is communicated to the public. 24 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6

Note 5 - Monitoring reports include: monthly free and frank report to the minister on DHB sector financial performance (due within one month after the month end, except for the December report which is due mid-february because of the Christmas/New Year break), and quarterly DHB performance report: overall report on DHB performance (due within 12 weeks after the quarter end). Note 6 - Monitoring reports include Quarterly Crown entity performance report (due within two months of quarter end). Note 7 - The Ministry maintains capability and capacity to lead and coordinate a national health response to an emergency. Sections 58 and 59 of the Civil Defence Emergency Management Act 2002 require all government departments to prepare plans to continue functioning during and after an emergency. Note 8 - The Ministry maintains emergency management coordination and collaboration within the health sector and across government. Some regions will not have a quarterly meeting if a national meeting is held in that quarter. Note 9 - Unexpected resignation or departure prior to the expiration of the term is not included. Note 10 - Reforecast to 33, as the 117 included three-year DHB appointments. End of Year Performance Reporting The Ministry of Health will report performance information for this appropriation in its Annual Report. Current and Past s ed Cancer: next phase of Faster Cancer Treatment 293 330 330 - Departmental Appropriation Restructure (appropriation established) 2011/12 27,216 27,216 27,216 27,216 27,216 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 25

2.3 - Departmental Capital Expenditure and Capital Injections Ministry of Health - Capital Expenditure PLA (M36) This appropriation is limited to the purchase or development of assets by and for the use of the Ministry of Health, as authorised by section 24(1) of the Public Finance Act 1989. Capital Expenditure ed Actual Forests/Agricultural - - - Land - - - Property, Plant and Equipment 8,719 8,719 7,010 Intangibles 9,291 9,291 8,000 Other - - - Total Appropriation 18,010 18,010 15,010 This appropriation is intended to contribute to the following: the Ministry of Health delivers its core functions and responsibilities (refer to Part 2.1). Expenditure supports the delivery of the department s output performance measures (refer to Part 2.1). End of Year Performance Reporting The Ministry of Health will report performance information for its departmental outputs in its Annual Report. Capital Injections and Movements in Departmental Net Assets Ministry of Health Details of Net Asset Schedule Actual Projected Explanation of Projected Movements in Opening Balance 34,648 36,165 Capital Injections 1,517 315 The funding relates to the Free Primary Care for Under 13s and the Population Health Data Warehouse. Work on the Data Warehouse continues into. Capital Withdrawals - - Surplus to be Retained (Deficit Incurred) - - Other Movements - - Closing Balance 36,165 36,480 26 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6

Part 3 - Details of Non-Departmental Appropriations 3.1 - Non- Departmental Output Expenses Health and Disability Support Services - Auckland DHB (M36) Funding of personal and mental health services including services for the health of older people, provision of hospital and related services and management outputs from Auckland DHB. Expenses ed Actual Total Appropriation 1,092,299 1,092,299 1,115,555 This appropriation is intended to achieve the following: the DHB provides services that align with: Government priorities; the strategic direction set for the health sector by the Ministry of Health; the needs of the district s population; and regional considerations. The performance measures are outlined in the DHB s Statement of Intent. End of Year Performance Reporting The DHB will report performance information for this appropriation in its Annual Report. Current and Past s ed DHB Efficiency Savings - - - (874) (874) District Health Board (DHB) Additional Funding for Pressures - 36,417 36,417 36,417 36,417 Reprioritising DHB Savings Delivered by PHARMAC - (1,217) (1,217) (1,217) (1,217) DHB Demographics 13,199 13,199 13,199 13,199 13,199 Transitional funding for Auckland DHB (one off) 10,000 - - - - Contribution to DHB cost pressures 8,745 8,745 8,745 8,745 8,745 Aged Residential Care - subsidy increase 662 881 881 881 881 DHB Demographics 2013/14 12,068 12,068 12,068 12,068 12,068 Contribution to DHB cost pressures 2013/14 9,368 9,368 9,368 9,368 9,368 THE ESTIMATES OF APPROPRIATIONS - HEALTH SECTOR B.5 Vol.6 27