PHARMAC 2020/21 Quarter 3 Performance Report

Summary

PHARMAC is now nine months through the first year of delivery of our new four-year strategic direction and, despite the challenge of an ambitious work programme, we are doing well achieving our goals. Three of the six strategic priority areas are on track at this time, with no priority rated red. Most initiatives are on track with some delayed for a variety of reasons, but we are confident that many will be achieved by the end of quarter four.

We achieved some significant milestones over the third quarter. These included:

Priority: Enhance Key Functions

  • During the quarter we completed our initiative to plan and scope the programme of work to improve planning and implementation practices for our commercial activities. With a Lead in place for this workstream we have also been able to bring forward delivery of Category Planning and held a pilot workshop in March.

Priority: Equitable Access and Use

  • Developed a draft equity assessment tool and commenced testing with a small group of clinical advisors.

Priority: Medical Devices

  • Over the quarter we made significant progress towards our SPE target to have at least $400 million of DHB spend under national contract. We are confident this will be achieved in quarter four.
  • The first DHB Strategic Medical Devices Advisory Group was held. 

Priority: Data and Analytics 

  • A first medicine has been chosen for analysis, internal governance at the operational and strategic levels have been confirmed, and a key external resource has been secured to progress this work.

Priority: Relationships and Partnerships

  • Over the last quarter we received the final report from the stakeholder engagement survey.

Priority: Te Whaioranga

  • Progress continued in developing a Te Tiriti o Waitangi organisational policy.

Priority: People & Capability

  • Finalised the refresh of our organisational values. 

Over the next quarter we are looking forward to:

  • Establishing the Māori Advisory Rōpū.
  • Developing an action plan to address gout medicine access inequities. This will include engagement with others already doing national level work in gout management such as Health Navigator, Health Literacy NZ, Counties Manukau DHB, Gout Action Aotearoa and Ministry of Health.
  • Engaging with DHBs on our proposed approach to capital equipment as part of our medical devices work.
  • Progressing the Health Outcomes work, which is expected to result in the first report on a pilot chemical, selecting the next chemical for analysis, and developing a revised approach to continuing this work based on learnings from the initial piece of work.
  • Working with external PR agencies to support us with consumer targeted campaigns, such as diabetes treatments and brand changes.
  • Embedding new organisational values following significant work over the last six months.
  • Assessing PTAC members’ equity capability in relation to Māori and other priority populations. Testing the tool with a small group and implementing with the whole
    committee.

Strategic Priority: Enhance key functions (EKF)

We continuously improve the way we work to deliver maximum value to New Zealanders

Status: Amber

This Strategic Priority has shifted from Green during quarter two to Amber in quarter three because the planned activities will be partially achieved for the year. We consider most of the initiatives in the programme can likely be achieved with a concerted effort over quarter four, though we will not be able to complete the work for Public Preferences and Changes to Dispensing Arrangements. This has been somewhat outside of PHARMAC’s control.

The plan to progress a Public Preferences survey will be pushed out to the second half of 2021/22 as it was not felt appropriate to undertake this at the same time as the external review is underway. Proposed changes to dispensing arrangements have been reliant on health sector engagement, which has not been possible due to sector focus being on COVID-19.

During the quarter we completed our initiative to plan and scope the programme of work to improve planning and implementation practices for our commercial activities. With a Lead in place for this workstream we have also been able to bring forward delivery of Category Planning and held a pilot workshop in March. The team have also collected data for the EKF Statement of Intent performance measures. These are attached as Appendix Two.

One of the focus areas in EKF over the final quarter will be to develop a package of work for the Responsible Use workstream. A framework has been agreed internally that categorises our work into activity to Prevent, Detect and Respond to under, over, or misuse of medicines and medical devices. Work is now underway to populate a longer-term work programme.

Strategic priority: Equitable access and use

We enable equitable access to medicines and related products by influencing availability, accessibility, acceptability, and appropriateness

Status: Amber

Overall, this programme is on track, however some initiatives are experiencing slippage in timeframes due to delayed engagement from our stakeholders and competing demands for key internal resources. We expect the overall rating to remain Amber for this programme until we have completed work to develop a channel for disseminating baseline measures. We are working towards making this happen in quarter four.

Over the quarter we completed the data insight reports for access to gout preventive medicines by Māori and Pacific peoples. We have completed an analysis of cardiovascular medicines and are on track to complete data insights on, asthma and chronic obstructive pulmonary disease (COPD) and diabetes by the end of the year.

Over the coming quarter the focus for the programme will be:

  • Develop an action plan to address gout medicine access inequities. This will include engagement with others already doing national level work in gout management such as Health Navigator, Health Literacy NZ, Counties Manukau DHB, Gout Action Aotearoa and Ministry of Health
  • Implement the equity capability needs assessment tool with clinical advisors.
  • Complete engagement with health providers who participated in the Whakakotahi projects and external dissemination of findings.
  • Engaging with the Responsible Use Advisory Group about how the gout insights can be used in our contract with Matui to influence primary care.
  • Completing the final parts of the first baseline report on medicines access equity for priority conditions and developing the online portal for their dissemination.

Strategic priority: Medical devices

We drive better value and more consistent access to hospital medical devices

Status: Green

Work on developing our operational approach to the different aspects of investment management has progressed but has taken longer than anticipated. New issues and complexities have cropped up but are being worked through. In addition, pressure on subject matter expert time due to core business priorities has also slowed progress. As a result, external engagement has been delayed, which was also a pragmatic response to the lack of availability of DHB staff following the sector distraction caused by COVID-19.

Despite the delay in external engagement, all initiatives are rated Green and on track for revised timeframes.

Over the quarter we made significant progress towards our SPE target to have at least $400 million of DHB spend under national contract; we are confident this will be achieved in quarter four. The first DHB Strategic Medical Devices Advisory Group face to face meeting was held. This group has been formed to ensure PHARMAC and DHB leadership are aligned in addressing the transitional and long-term issues associated with the PHARMAC medical device programme. The Chair of the DHB Chief Operating Officers Group has offered to facilitate using the national Chief Operating Officers Group to identify subject matter experts for our external engagement activities.

The focus for this Strategic Priority over the next quarter is to recruit a dedicated project manager. This will provide the project with a greater level of planning and confidence on delivery. For our focused engagement activity, we plan to:

  • Share our proposed approach to capital clinical equipment.
  • Prepare for sharing our proposed approaches to health technology assessment and expert advice for devices.

Strategic priority: Data and analytics

We measure health outcomes and make evidence-informed decisions, using and making available data and insights from a wide range of sources

Status: Amber

The outcomes project has made good progress this quarter: an internal reference group has reviewed options to progress, a governance group has selected the first medicine to progress for outcome analysis, and a consultant has been selected to develop the first analysis as a pilot. Staff consider the likelihood is high of delivering this first review by the end of the financial year. This initiative is nevertheless rated amber as momentum was lost during the latter part of 2020 as a range of options for progressing this work were considered.

With regard to other projects:

  • External resource is being used to support and expand the implementation of our visual analytics work as well as introduce new datasets that can be analysed using this platform.
  • The forecast refresh is now in phase three and continues to make good progress.
  • Staff continue to engage with NZ Health Partnerships (NZHP) staff on the National Health Sector Catalogue. NZHP is managing this project, which is making good progress. PHARMAC involvement with the Implementation Steering Committee has been positive, and the NZHP team is now collaborating with PHARMAC staff on the end-to-end sector process for introducing a new medical device all the way to a purchased product arriving at a DHB.

Four out of five initiatives have been rated on track for this programme; the status of the health outcomes project, which is rated amber, is described above.

Over the final quarter our focus will be:

  • Progressing the Health Outcomes work, which is expected to result in the first report on a pilot chemical, selecting the next chemical for analysis, and developing a revised approach to continuing this work based on learnings from the initial piece of work. 
  • Progressing Phase three enhancements of the forecast rebuild (focus is on the rebate area).
  • Completion of data gathering for performance measures for the 2020/21 Annual Report.

Strategic priority: Public Understanding, Trust and Confidence

We listen to the views of New Zealanders and we communicate clearly and
simply

Status: Green

This programme is progressing well and during this year we have redesigned our website, implemented new guidelines for translating publications and developed a social media strategy. It is encouraging to see that we are receiving an increase in ‘clicks’ through to the website and social media posts. All remaining initiatives completed are on track. 

Over the last quarter consultation on PTAC and CAC Terms of Reference closed on 19 March with 25 responses received.

Highlights from the last quarter include:

  • Staff attending the Writing for Audience training.  Plain Language workshops for staff whose documents had been reviewed in the audit by Write Group.
  • Continuing to deliver against our Social Media Strategy. We achieved our target of 15 posts for March and are seeing an increase in ‘clicks’ from our social media posts.

Over the final quarter the team will be focused on:

  • Continuing to enhance website content. The next phase of work is enhancements to the online schedule.
  • Finalising the organisational writing guide.
  • Generating social media content and taking a planned approach, with a monthly social media calendar. Mythbusting posts proved to be too controversial for our current social media audience, so the team is exploring other ways of boosting proactive content. 
  • Working with external PR agencies to support us with consumer targeted campaigns, such as diabetes treatments and brand changes. 

Strategic priority: Relationships and Partnerships

We create strong and enduring partnerships across the health system and beyond 

Status: Green

This programme is progressing well with all initiatives on track.

To date we have completed a key milestone within initiative 6.1 – to undertake stakeholder mapping. The next milestone due to commence in quarter four is to start to develop an engagement strategy which we will progress through 2021/22. Due to lower than hoped uptake of the stakeholder engagement survey we want to ensure this is not the only source of data used to inform the strategy. This may mean a delay if additional engagement is required first.

Over the last quarter we received the final report from the stakeholder engagement survey. PHARMAC staff have helped to identify key issues for us to explore further as part of future interviews. We are currently engaging with key stakeholders to test the results we have found. 

Looking forward we will be focused on:

  • Understanding and developing relationship management models.
  • Create Action Plans for increasing engagement with prioritised stakeholder groups.

Te Whaioranga

We understand and support whānau Māori to achieve best health and wellbeing through access to, and optimal use of, medicines and medical devices; and we uphold Te Tiriti o Waitangi

Status: Amber

Despite significant progress in a number of areas, this programme is rated Amber because we will not fully achieve some of the ambitious goals we set ourselves in Te Whaioranga for this year.

Key progress this quarter includes ensuring te ao Māori input into the new PHARMAC values, completion of the Tiriti o Waitangi review of PHARMAC’s key policies and processes, and good progress on developing an organisational Tiriti o Waitangi policy. These last two have had the effect of increasing awareness of Te Tiriti across the organisation, which is a platform for later capability building work, and other deliverables. A Te Whaioranga update was provided to the Board at their March meeting.

The activities we are unlikely to complete relate to developing Te Tiriti accountabilities for staff and capability building – though work is underway to shape our approach to this. This work has been impacted by significant Māori capacity and capability gaps in PHARMAC, and we are now addressing some of these through recruiting some key staff roles.

Over the next quarter we look forward to establishing the external Māori Advisory Rōpū and moving forward with establishing standards to measure Te Tiriti compliance and developing Te Tiriti accountabilities at Board and senior leadership levels. We will also be continuing work on the Tiriti o Waitangi policy.

We will update the Board on the Māori Advisory Rōpū their May meeting.

SOI and SPE measures 

Status: Green

Of the measures we have data available for, currently we are performing well across our suite of external performance measures (refer to Appendix Two).

External measures on track: 15 (up from 14 last quarter)
External measures rated Amber: 3
Watching brief: 1

Three measures have been rated Amber:

  • 7.1 – Proportion of Māori staff.
  • 13.1 – Actual expenditure variance to budget.
  • 19.3 – Media monitoring score. 

We are keeping a watching brief on the following measure:

  • 12.2 – Number of safety incidents and near misses.