Counties Manukau Health (CMH) is responsible for commissioning health and care services for the whole population of 500,000 people living in South Auckland, New Zealand, and providing hospital and specialist services in the area. CMH works with a range of local and national partners to integrate services and improve the health of the population living in Counties Manukau.
Locality-based integrated health and care networks
As with many other integrated care systems, CMH has worked with local providers to develop locality-based integrated health and care teams aligned with networks of general practices and working in partnership with hospital services. Capitated budgets are allocated to primary care organisations to deliver care in their localities, and alliance agreements are used to share responsibility between locality partners and CMH.
Services are tailored to the needs of different population groups within each locality, based on population risk stratification, ranging from primary prevention services and lifestyle support through to active case management for patients with complex health and social care needs, with the emphasis on supporting people to manage their own health. Each locality is served by a wider social care network to provide help and support to families with complex needs whose living environments are impacting their health.
While these locality networks are relatively embryonic, early indicators reported by CMH show improving trends in a number of areas. For example, immunisation, cardiovascular risk assessment and smoking cessation support rates have all increased from around 65 per cent to more than 90 per cent in the past two years, while acute hospital and care home utilisation rates are now below demographic growth rates.
Healthy Housing Programme
Alongside these locality networks, CMH also runs a number of other well established programmes with local partners designed to improve population health. One example is its Healthy Housing Programme – a joint initiative between CMH, neighbouring district health boards and Housing New Zealand, the government owned social housing provider – which ran from 2001 to 2013. The programme was open to all people living in rented Housing New Zealand accommodation, and focused on:
- improving access to health and care services
- reducing the risk of housing-related health issues
- identifying social and welfare issues and providing a link to relevant agencies.
After a joint visit and assessment from local health and housing teams, typical interventions included educating families about their health and health risks, referrals to health and social care services, installing insulation to make houses warmer and dryer, modifying houses to meet health and disability needs, and transferring families to alternative houses in cases of overcrowding. These interventions were tailored to the needs of different families and population groups – particularly the Māori and Pacific Island groups, which are disproportionately affected by poor housing conditions. The programme took a locality-by-locality approach to ensure that every eligible household was reached systematically and to reduce the potential for stigmatisation of families involved in the programme.
The programme had a clear impact on the health of families involved. An evaluation involving 9,736 residents in 3,410 homes found that the programme was associated with reductions in acute hospital admissions of 11 per cent (among 0- to 4-year-olds) and 32 per cent (among 5- to 34-year-olds), while housing-related hospital admissions fell by 12 per cent and 27 per cent respectively for these age groups. Qualitative evaluation found strong links between the programme and tenants’ self-reported household wellbeing.
Further work to improve population health
Other interventions run by CMH and its partners include the Providing Access to Health Solutions programme, which supports people in receipt of jobseeker support and other benefits to access appropriate health and vocational services to help them return to employment, and Smokefree 2025, which involves action across multiple sectors to meet the national policy goal of being a smoke-free nation by 2025.