Terms of reference

Agreed by: Minister of Health

Date: 8 August 2011

Date of next review: 1 July 2012

1. ESTABLISHMENT

1.1 The National Advisory Committee on Health and Disability, also known as the National Health Committee (NHC), was established under sections 11 and 13 of the New Zealand Public Health and Disability Act 2000 (the NZPHD Act).

2. BACKGROUND

2.1 In January 2009, the Government established a Ministerial Review Group (MRG) to advise on improving the quality and performance of the publicly funded health service.

2.2 The MRG released its report on 31 July 2009.  The report contained a number of recommendations designed to reduce bureaucracy, to improve frontline services, and to improve value in the public health and disability sector.

2.3 Cabinet has recognised that the assessment of new and existing health technologies needs to be done by a specialist national body that will help to avoid duplication, capitalise on scarce assessment skills and apply a consistent and authoritative standard of assessment across New Zealand.

2.4 Accordingly, Cabinet accepted the MRG’s recommendation that the NHC should be refocused and reconfigured as a vehicle for strengthened prioritisation of new and existing technologies and interventions in the health and disability sector.

3. STATUTORY PURPOSE

3.1 Section 13 of the NZPHD Act specifies the NHC’s purpose as providing advice the Minister of Health on:

1. the kinds, and relative priorities, of public health services, personal health services, and disability support services that should, in the NHC's opinion, be publicly funded; and
2. other matters relating to public health, including –
   1. personal health matters relating to public health; and
   2. regulatory matters relating to public health; and
3. any other matters that the Minister specifies by notice to the NHC.

3.2  Section 6(1) of the NZPHD Act defines terms relevant to section 13 as follows:

public health means the health of all of —

1. the people of New Zealand; or
2. a community or section of such people.

public health services means goods, services, and facilities provided for the purpose of improving, promoting, or protecting public health or preventing population-wide disease, disability, or injury; and includes —

1. regulatory functions relating to health or disability matters; and
2. health protection and health promotion services; and
3. goods, services, and facilities provided for related or incidental functions or purposes.

personal health means the health of an individual.

personal health services means goods, services, and facilities provided to an individual for the purpose of improving or protecting the health of that individual, whether or not they are also provided for another purpose; and includes goods, services, and facilities provided for related or incidental purposes.

disability support services includes goods, services, and facilities —

1. provided to people with disabilities for their care or support or to promote their inclusion and participation in society, and independence; or
2. provided for purposes related or incidental to the care or support of people with disabilities or to the promotion of the inclusion and participation in society, and independence of such people.

4. ROLE, OBJECTIVES AND FUNCTIONS

4.1 The NHC’s primary role is to provide independent and objective advice to the Minister of Health, consistent with its statutory purposes.

4.2 The NHC’s objectives include contributing to improved value for money and fiscal sustainability in the health and disability sector by:

1. providing timely advice and recommendations about relative cost-effectiveness, based on the best available evidence;
2. providing advice and recommendations which influence the behaviour of decision makers including clinicians and other health professionals;
3. providing advice and recommendations which are reflected in resource allocation at national, regional and local levels; and
4. contributing to tangible reductions in the use of ineffective interventions and improved targeting to those most likely to benefit.

4.3 In order to achieve its objectives under 4.2 and to achieve ‘Value for Money’ the NHC will establish nationally consistent processes which have five domains for assessment – clinical, societal, ethical, economic and financial.

4.4 Cabinet has agreed that the NHC’s functions should reflect those set out in the Cabinet paper ‘Improving the Health System: Further Elements Paper Seven: Reconfiguring the National Health Committee to Focus on Value for Money’.

4.5 Accordingly, the NHC will advise the Minister of Health on matters including, but not limited to:

1. the introduction of specific new diagnostic and treatment (non-pharmaceutical) services, or significant expansions of existing services, and the circumstances under which they should be introduced, expanded or decommissioned (e.g. clinical indications, population groups, location);
2. the introduction of medical devices (until such time as PHARMAC assumes responsibility for their assessment) ;
3. when not to introduce particular interventions, or not to expand particular existing services;
4. when to introduce new interventions as pilots so that evidence can be gathered about their effectiveness and cost-effectiveness in the New Zealand context;
5. applications (put forward by District Health Boards (DHBs) or other sector stakeholders) to pilot new technologies or services through the Innovation Fund;
6. appropriate targeting for the use of, or access to, existing interventions (e.g. targeting to appropriate patient groups, or delivery through particular models of care);
7. the removal of lower quality interventions that are not cost-effective or have low cost-effectiveness;
8. ways to reduce the historical rate of growth in the cost and scope of new and existing technologies and services across the public health and disability sector; and
9. providing options for delivering the annual savings target agreed with the Minister. 

5. OPERATING FRAMEWORK

5.1 The NHC needs to build capacity and develop credible, trusted, principle-based processes for assessing the relative effectiveness, cost-effectiveness, and affordability of new and existing services using the principles outlined in paragraph 4.3.

5.2 Under section 11(3)(b) of the NZPHD Act, the NHC is able to regulate its own procedure, subject to written directions from the Minister of Health.  Detailed operating procedures will be developed by the reconfigured NHC during its establishment phase, with final approval by the Minister.

5.3 It is expected that, as it gains experience, the NHC will include review and refinement of these processes within its annual work programme.

5.4 Work programme

5.4.1 The NHC will develop an annual work programme, for final approval by the Minister.  The work programme will be published on the NHC’s website following Ministerial approval.  The initial work programme is expected to include a balance of establishment issues and prioritisation issues.  Annual work programmes will also incorporate relevant financial information about the NHC’s proposed expenditure for the year.

5.5 Scope

5.5.1 The NHC will assess and make recommendations on new, and a selection of existing technologies and interventions and related functions, which will include systems and models of care.

5.6 Assessment criteria

5.6.1 In prioritising services, the NHC will apply criteria (agreed to by the Minister) which place a strong focus on cost-effectiveness and affordability.

5.7 Referral process

5.7.1 In consultation with the National Health Board, the NHC will develop and promote awareness of a referral process to ensure that DHBs refer services and, interventions within the scope of paragraph 4.5 to the NHC, for assessment.
5.7.2 In addition, Ministerial initiatives may also be referred to the NHC for assessment at the discretion of the Minister.

5.8 Innovation Fund

5.8.1 There is an NHC Innovation Fund, established to trial, test, and assess new diagnostic and treatment innovations, and gather evidence to inform the NHC’s cost-effectiveness and prioritisation recommendations.
5.8.2 Detailed processes for disbursements of the fund, including criteria, are to be developed as a matter of urgency by the NHC, in consultation with the Minister.

5.9 Savings target

5.9.1 The NHC is required to provide an annual (notional) savings target, to be agreed with the Minister. The target should comprise the potential savings that could be achieved by the public health and disability sector if the NHC’s recommendations are implemented.

5.10 Engagement and participation

5.10.1 In accordance with section 13(2) of the NZPHD Act, advice given by the NHC to the Minister must be developed after ‘consultation’.  To give effect to this, the NHC will employ transparent processes which will include high levels of engagement with, and participation of, representative clinical and community groups, funders and providers.

5.11 Publication and review

5.11.1 The NHC will publish in an appropriate format its assessments and rationale, including the evidence on which the assessments were made.
5.11.2 Following an assessment’s publication, should any pertinent errors of fact or new information be drawn to the NHC’s attention, the NHC may review, reconsider and adjust the assessment accordingly in light of these.

5.12 Accountability and reporting

5.12.1 The NHC is accountable to the Minister. This includes accountability for:

1. the content and quality of its work programme and advice to the Minister
2. operating within relevant legislative parameters (including the NZPHD Act, the Public Finance Act 1989, the State Sector Act 1988 and the Official Information Act 1982).

5.12.2 Under section 13(3) of the NZPHD Act, the NHC must report to the Minister at least once each year in relation to its statutory purposes.  This will take the form of an ‘annual report’, outlining the NHC’s achievements against its work programme.  The NHC may also choose to report to the Minister on any matter within its purview at any time.
5.12.3 In accordance with section 13(4) of the NZPHD Act, the Minister is required to table these Terms of Reference in the House of Representatives.

5.13 Meeting procedure

5.13.1 The NHC will publish Meeting Procedure Guidelines on its website alongside these Terms of Reference.  The frequency of meetings will be determined by the Chair in accordance with the Guidelines.

6. NHC MEMBERSHIP

6.1 Membership

6.1.1 The NHC will comprise up to a total of ten ordinary members (including the Chair), appointed by the Minister of Health.

6.1.2 Member appointments shall be made for a term of up to three years and members are eligible for reappointment at the completion of their terms.  Reappointment to the NHC is not however automatic; rather, it is made only after a careful consideration of factors such as the NHC’s current and future work programme, and the mix of skills and experience on the NHC at that time.

6.1.3 The Minister will appoint one of the ordinary members of the NHC as Chair, for the duration of their current term as a member or a lesser term.  If there is no Chair, the Minister may appoint an Acting Chair for an interim period.  If the Chair is not present or is interested in a matter before the NHC, an Acting Chair may be appointed by the Chair for a temporary period.

6.1.4 Within the NHC’s establishment, the Minister may choose to delegate to the NHC the power to appoint one further member, who shall be a member of the board of the Pharmaceutical Management Agency (PHARMAC).  The Chair of the NHC shall consult with the Minister prior to the NHC exercising this power.  The provisions of these Terms of Reference which apply to ordinary members also apply with all necessary modifications to this co opted member.

6.2 Composition

6.2.1 In order for the NHC to provide high-quality advice, its membership will need a diverse range of skills and experience.  These include:

1. an ability to provide facilitative leadership to the New Zealand health and disability sector based on an understanding of its clinical, structural and financial systems and resources
2. an understanding, and the skills and experience to ensure, that better national stewardship of the investment in health technology and services will lead to enhanced service delivery for all New Zealanders within the resources available
3. knowledge, skills and practice in delivery of health and disability services in both public and private settings, including the planning, funding, management and delivery and evaluation of safe, effective and efficient services
4. a strong grasp of business and economic concepts, including prioritisation and rationalisation principles, and relevant international approaches
5. an ability to weigh up competing options and priorities, apply constructive and knowledgeable judgement, contribute to NHC discussions, and commit to evidence-based decision-making
6. an ability to think ahead, to take a strategic approach, and to understand how today’s decisions will help address future demands on the health and disability sector
7. highly developed communication skills and a commitment to working as a team
8. understanding and valuing the perspective of patients, families and communities on the health and disability system
9. knowledge of how health and disability services are currently structured and delivered in New Zealand, and the role of the NHC’s decisions in this
10. an appreciation of New Zealand’s multi-cultural society, including Maori and Pacific perspectives
11. knowledge of contemporary social, moral and ethical issues in the health and disability sector and the ability to examine issues with a view to reducing inequalities in New Zealand communities
12. governance experience and a knowledge of ‘good practice’ governance principles
13. a commitment to critical self-appraisal, evaluation and improvement of the NHC’s work, as it grows in experience and expertise.

6.3 Resignation and removal

6.3.1 A member may resign from office at any time by written notice to the Minister (with a copy to the Chair) signed by the member. The resignation is effective on receipt by the Minister of the notice or at any later time specified in the notice.

6.3.2 The Minister may, at any time and entirely at his or her discretion, remove a member from that office.  The removal must be made by written notice to the member (with a copy to the Chair), stating the date on which the removal takes effect.  The Minister shall have the discretion to consult with the Chair before removing a member from office.

6.3.3 The Minister may also, at any time and entirely at his or her discretion, remove the Chair from that office.  The removal must be made by written notice to the Chair, stating the date on which the removal takes effect.  The Chair will remain a member of the NHC unless also removed from that office.

6.4 Duties and responsibilities of members

6.4.1 All members (including the Chair) are responsible for:

1. acting with honesty and integrity
2. acting in good faith and not at expense of the NHC’s interests (recognising that members are appointed to advance the health and disability sector as a whole, and not the interests of other groups with which they may be affiliated)
3. acting with reasonable care, diligence, and skill
4. respecting requirements around confidentiality, outlined at paragraph 12.1
5. participating actively in meetings and other relevant NHC events
6. communicating and engaging with other members in a constructive manner
7. supporting the Chair
8. preparing in advance for meetings and other duties
9. demonstrating their commitment to the committee by attending all NHC and advisory committee meetings (where relevant)
10. complying with these Terms of Reference, any associated committee policies and any relevant legislative requirements
11. being informed about the NHC and its operating environment
12. ensuring that any potential conflicts of interest they have are disclosed or that subsequently arise are managed in accordance with the process set out at paragraph 10
13. being committed to the NHC’s continual improvement through participating in self-assessment processes
14. undertaking ongoing professional development and education (where relevant).

6.4.2 The Chair is responsible for, among other things:

1. providing effective leadership and direction to the NHC
2. providing the necessary guidance and support to members to ensure that they contribute effectively to the NHC’s business
3. ensuring a process is in place to undertake a regular (preferably annual) performance review of the NHC as a whole, as well as of the Chair and members individually
4. maintaining an ongoing review of the NHC’s membership profile and that of its advisory committee(s), with regard to the skills needed for the NHC to carry out its business and around succession to key positions
5. developing and maintaining sound relationships with the Minister and Associate Ministers of Health (as required), Ministers’ Offices, the Ministry of Health, the National Health Board, and other stakeholders.

7. ADVISORY COMMITTEES

7.1 The NHC must establish a public health advisory committee in accordance with section 14 of the NZPHD Act.  With the agreement of the Minister of Health, the NHC may establish and disestablish other advisory committees as required.

7.2 The NHC will set each advisory committee’s Terms of Reference and advisory committee members will be appointed in accordance with those Terms of Reference.

7.3 Once established, the ongoing need for each advisory committee is to be reviewed on an annual basis.  Each advisory committee’s Terms of Reference will also be reviewed annually.

8. EXPERT ADVISORS

8.1 The NHC may draw on external expertise as required and may appoint expert advisors to assist in making deliberations, after first discussing financial implications with the Director-General of Health.  These expert advisors are not NHC members and have no decision-making rights.  Expert advisors are appointed on terms and conditions agreed between the NHC and the expert advisor.

9. FEES AND ALLOWANCES

9.1 Member fees are set by the Minister of Health in accordance with Cabinet Office Circular CO (09) 05, Fees framework for members appointed to bodies in which the Crown has an interest.

9.2 The fair and reasonable costs associated with individual members’ participation at each NHC meeting will also be met.  These costs will include, for example, travel, accommodation, meals, and reasonable preparation time and/or follow-up time associated with attending NHC meetings (and advisory committee meetings, if appropriate).

10. CONFLICTS OF INTEREST

10.1 Any NHC member who has an interest in a transaction of the NHC must, as soon as practicable after the relevant facts have come to the member’s knowledge, disclose the nature of the interest to the NHC.  For the purposes of this requirement, section 6(2) of the NZPHD Act shall be deemed to apply.

10.2 A disclosure may be made during the regular time reserved for consideration of conflicts of interest at each NHC meeting, but may also be at any other point before, during or after a meeting, as required by the nature of the disclosure.  After receiving a disclosure, the NHC will determine whether it believes, in the context, the disclosure is a material conflict of interest.

10.3 Disclosures that are made during a meeting are to be recorded in the minutes of that meeting and entered into a separate Interests Register maintained by the NHC in accordance with its Meeting Procedure Guidelines.  Disclosures that are made outside of a meeting must be recorded in the minutes of the next meeting and also entered into the Interests Register.

10.4 The Interests Register will also contain a standing list of members’ interests (in addition to those specific disclosures of interest made in relation to particular transactions), and members shall update this standing list of interests as and when required.

10.5 All interests, either disclosed in relation to a particular transaction or listed generally in the Interests Register, are to include the nature and extent of the interest and where appropriate, their monetary value.

10.6 A member who makes a disclosure which has been determined to be a material conflict of interest by the NHC, after that disclosure must not:

1. subject to paragraph 10.7, take part in any deliberation, discussion or decision of the NHC relating to the transaction
2. be included in the quorum required for any such deliberation or decision.

10.7 However, a member who makes a disclosure may take part in any deliberation or discussion (but not decision) of the NHC relating to that transaction provided a majority of the other members of the NHC and the Chair wish the member to do so.

10.8 In such a case, the NHC must record in its minutes:

1. the permission and the majority and Chair’s reason for giving it, and
2. what a member said in any deliberation or discussion relating to the transaction concerned.

10.9 Every member must ensure that:

1. the statement completed by the member is incorporated into the conflicts of interest register, and
2. any relevant change in the member’s circumstances affecting a matter disclosed in that statement is also entered into the register as soon as practicable after the change occurs.

11. EXTERNAL COMMUNICATIONS AND PUBLIC STATEMENTS

11.1 The NHC will provide the Minister of Health with sufficient advance notice of any media statements or reports to be published, under the principle of ‘no surprises’.

11.2 Members may only speak with any outside individual or organisation, including their employer or the media, in relation to any matters discussed at or considered by the NHC at its meetings, or any other non-public activity, if they have the prior written agreement of the Chair.

12. CONFIDENTIALITY

12.1 All information supplied to the NHC will be treated on a strictly confidential basis (including information which deals with matters of a commercially sensitive nature) subject to legal requirements (e.g., the Official Information Act 1982).  In order to assist confidentiality requirements, all NHC meetings will be held ‘in committee’.

12.2 NHC members must ensure that any information acquired or created for NHC consideration is only used for performing duties as an NHC member.  Members may not use their knowledge of confidential NHC issues to provide inequitable benefit, gain or advantage to any individual, private or public agency or group.

12.3 For the avoidance of doubt, requirements around confidentiality will apply equally to NHC members, advisory committee members, expert advisors and staff supporting the NHC.

13. LIABILITY

13.1 In accordance with section 90(4) of the NZPHD Act, members are not liable for any act or omission done or omitted in their capacity as a member, if they acted in good faith, and with reasonable care, in pursuance of the functions of the NHC.

14. REVIEW OF NHC PERFORMANCE

14.1 The NHC will continually keep its performance under review, and refine and improve its processes accordingly.  As a part of its annual report, the NHC will assess the extent to which it has been effective in contributing to improved sector performance, value for money and fiscal sustainability.

14.2 Cabinet has decided that an evaluation of the NHC will be conducted by July 2013, looking at progress to date and recommendations for any necessary changes.  This evaluation will be informed by the actions outlined in paragraph 14.1.

15 NHC SUPPORT

15.1 The NHC will be funded and resourced at an appropriate level, to allow it to meet the requirements of its work programme.

15.2 The NHC will be supported in its work by an Executive, to be resourced by the Ministry of Health.  The Executive will be responsible to the NHC and will provide day-to-day management services to the NHC (e.g., analytical, administrative and contract management support).

16 REVIEW OF TERMS OF REFERENCE

16.1 These Terms of Reference may be amended, replaced or revoked by the Minister of Health from time to time.

16.2 The NHC will review the operation of these Terms of Reference by the date listed at the head of the document, and report its findings and any recommendations for change to the Minister.