Vote Health - Health Sector - Estimates 2021/22

Vote Health#

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Overview of the Vote#

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Vote Health ('the Vote'), $24,398 million in 2021/22, is a significant public investment in the wellbeing of New Zealanders and their families. The Vote directly supports the day-to-day operation of strong and equitable public health and disability services delivered by a skilled workforce in our communities, hospitals and other care settings.

The Vote plays a key role in supporting population health across peoples' lives, including improving health equity for Maori and other groups, and helps facilitate the delivery of key system priorities including child wellbeing, mental wellbeing, wellbeing through prevention, and primary health care.

The Vote has increased significantly since 2019/20 as the government has responded to the COVID-19 pandemic. Additional funding in Vote Health for the COVID-19 public health response over these three years has totalled $4,780 million enabling the government to pursue an elimination strategy for COVID-19, to establish a portfolio of vaccines, and to deliver a COVID-19 Immunisation programme.

The Government is also providing core initial funding in 2021/22 to implement a new health system operating model associated with Health and Disability System Reform, including funding to support the early establishment of entities at national and subnational levels (Health New Zealand, a Maori Health Authority, iwi/Maori partnership boards). The Government is also making targeted investments to strengthen capabilities in these new entities, including commissioning, cultural capability, Maori service design, and data and digital expertise.

The Minister of Health (M36) is responsible for the appropriations in the Vote with the exception of the multi-category appropriation 'National Response to COVID-19 Across the Health Sector' ($894 million) which is the responsibility of the Minister for COVID-19 Response (M103).

The Vote for 2021/22 comprises the following:

• $16,188 million (66.4% of the Vote) is provided to the 20 district health boards (DHBs) for services to meet the needs of each district's population, taking into account regional considerations, government priorities, and the strategic direction set for the health sector. Among the many services provided or funded by DHBs are hospital care; most aged care, mental health, and primary care services; the combined pharmaceuticals budget; and some public health services
• $5,764 million (23.6% of the Vote) funds health and disability services, funded at a national level, and managed by the Ministry of Health, consisting of:
  • National Disability Support Services ($1,830 million or 7.5% of the Vote)
  • COVID-19 Public Health Response ($851 million or 3.5% of the Vote)
  • Purchasing Potential and Proven COVID-19 Vaccines and Other Therapeutics ($508 million or 2.1% of the Vote)
  • Implementing the COVID-19 Immunisation Programme ($183 million or 0.7% of the Vote)
  • National Planned Care Services ($560 million or 2.3% of the Vote)
  • Public Health Service Purchasing ($507 million or 2.1% of the Vote)
  • Primary Health Care Strategy ($403 million or 1.7% of the Vote)
  • National Maternity Services ($254 million or 1.0% of the Vote)
  • National Mental Health Services ($243 million or 1.0% of the Vote)
  • National Emergency Services ($181 million or 0.7% of the Vote)
  • National Child Health Services ($116 million or 0.5% of the Vote)
  • National Personal Health Services ($74 million or 0.3% of the Vote)
  • Other national services ($54 million or 0.2% of the Vote)
• $766 million (3.1% of the Vote) for the support, oversight, governance, and development of the health and disability sectors, consisting of: 
  • Ministry of Health operating costs ($446 million or 1.8% of the Vote), made up of:
    • Core operating costs ($334 million or 1.3% of the Vote)
    • COVID-19 related response costs ($67 million or 0.3% of the Vote)
    • Health and Disability System Reform ($45 million or 0.2% of the Vote)
  • Health Workforce Training and Development ($234 million or 1.0% of the Vote)
  • Monitoring and Protecting Health and Disability Consumer Interest ($36 million or 0.1% of the Vote)
  • Health and Disability Reform initiatives including funding to prototype Locality Health and Wellbeing Networks and an initial commissioning budget for a Māori Health Authority to invest in hauora Māori ($27 million or 0.1% of the Vote)
  • Other services ($23 million or 0.1% of the Vote)
• $49 million (or 0.2% of the Vote) for other expenses including $40 million for Provider Development
• $1,631 million (6.7% of the Vote) for capital investment, consisting of:
  • sector capital investment ($1,548 million or 6.3% of the Vote)
  • Equity Support for DHB deficits ($39 million or 0.2% of the Vote)
  • Residential Care Loans ($20 million or 0.1% of the Vote)
  • Ministry of Health capital expenditure ($24 million or 0.1% of the Vote).

The Minister of Health is also responsible for a capital injection to the Ministry of Health of $10 million.

Details of these appropriations are set out in Parts 2-4.

Details of Appropriations and Capital Injections#

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Annual Appropriations and Forecast Permanent Appropriations#

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Multi-Year Appropriations#

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Total Annual Appropriations and Forecast Permanent Appropriations and Multi-Year Appropriations#

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Capital Injection Authorisations#

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Supporting Information#

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Part 1 - Vote as a Whole#

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1.1 - New Policy Initiatives#

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1.2 - Trends in the Vote#

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Summary of Financial Activity

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 Budgeted and Estimated Actual year may not equal Total Annual Appropriations and Forecast Permanent Appropriations and Multi-Year Appropriations in the Details of Appropriations and Capital Injections.

Adjustments to the Summary of Financial Activity Table Due to Vote Restructuring

There have been no restructuring adjustments to prior year information in the Summary of Financial Activity table.

1.3 - Analysis of Significant Trends#

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Total Vote: All Appropriations

Vote Health has grown from actual expenditure in 2016/17 of $18,395 million to budgeted expenditure in 2021/22 of $24,398 million, an increase of $6,003 million over five years. This has mainly been driven by changes to:

• Output Expenses, which were $15,249 million in 2016/17 and are budgeted at $22,718 million in 2021/22 - an increase of $7,469 million, and
• Capital Expenditure, which was $3,044 million in 2016/17 and is budgeted at $1,631 million in 2021/22 - a decrease of $1,413 million. The actual expenditure in 2016/17 on capital projects was $376 million compared to budgeted expenditure in 2021/22 of $1,572 million.

Additional capital expenditure of $2,619 million was provided in 2016/17 to refinance existing debt on capital projects and to replace DHB debt with equity. This resulted in a significant increase in capital expenditure appropriated in that year. See Summary of Financial Activity table in Part 1.2.

Output Expenses

The growth in the Vote's Output Expenses mainly reflects:

Annual funding increases provided to DHBs to address demographic and cost pressures. Their appropriations for 2021/22 are budgeted at $16,188 million, an increase of $3,994 million over the actual expenditure in 2016/17. In addition to this expenditure, DHBs are typically contracted by the Ministry of Health for additional national services. In some cases, this funding is being devolved to DHBs, making them directly responsible for services previously administered nationally.

Increases in funding for national services administered by the Ministry of Health, such as disability support services and various public and personal health services have also contributed to the growth in the Vote's Output Expenses. The 2021/22 appropriations for these national services are budgeted for $5,764 million which is $3,126 million greater than the actual expenditure in 2016/17. Responding to the COVID-19 pandemic has contributed to this significant increase in funding and is budgeted at $1,542 million across multiple appropriations for 2021/22.

The other main drivers of the increase are the Crown's ongoing investment in:

• disability support services, which has increased by $642 million since 2016/17
• Ministry of Health funded primary health care services, which has increased by $218 million since 2016/17
• Ministry of Health funded planned care services, which has increased by $209 million since 2016/17
• Ministry of Health funded mental health services, which has increased by $178 million since 2016/17, and
• Ministry of Health funded public health services purchasing, which has increased by $121 million since 2016/17.

Funding for the support, oversight, governance, and development of the health and disability sectors has also grown. Actual expenditure of $417 million in 2016/17 has increased to budgeted expenditure in 2021/22 of $766 million. The increase is mainly in core funding to the Ministry, for oversight and management of the health sector, and additional funding provided for the COVID-19 response, and for Health and Disability Sector Reform.

Other Expenses

Vote Health also provides funding for Other Expenses, such as grants to support the development of service providers in the health and disability sector, and to fund international health organisations. It also funds the defence and settlement of legal claims. Actual expenditure in 2016/17 of $102 million is budgeted to reduce to $49 million in 2021/22. This reduction in Other Expenses is due to a cost of $76 million incurred in 2016/17 for one off expenses associated with the early repayment at fair value of District Health Board Loans.

Capital Expenditure

The Crown continues to provide funding for sector infrastructure. Appropriations for 2021/22 are $1,548 million, compared to actual expenditure of $366 million in 2016/17. As in previous years, this includes funding for multi-year projects and provision for some future expenses or risks.

There is $83 million of other capital expenditure appropriated for 2021/22. This comprises equity injections to district health boards to address working capital requirements, residential care loans, and authority for the Ministry of Health to purchase or develop assets for its use.

Crown Revenue and Capital Receipts

Vote Health receives Crown Revenue from ACC for the purchase of public health acute and other services from DHBs, and capital charge revenue from Crown Entities in the health sector. The ACC revenue has increased from $492 million in 2016/17 to forecast revenue of $657 million in 2021/22.

The capital charge revenue has grown from $184 million in 2016/17 to forecast revenue of $375 million in 2021/22. This has been impacted by changes in the capital charge rate and the replacement of DHBs' Crown loans with equity in 2016/17, the latter which is subject to capital charge.

Vote Health receives Capital Receipts in the form of repayments from residential care loans and equity repayments from DHBs. The residential care loan repayments are forecast at $20 million per annum.

Part 2 - Details of Departmental Appropriations#

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2.1 - Departmental Output Expenses#

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Health Sector Information Systems (M36) (A21)

Scope of Appropriation

Expenses and Revenue

What is Intended to be Achieved with this Appropriation

This appropriation is intended to provide information technology services and infrastructure to support the operation of New Zealand's health services.

How Performance will be Assessed and End of Year Reporting Requirements

Note 1 - Key sector- and public-facing systems are National Health Index, National Immunisation Register, Online Pharmacy, Special Authorities, Oracle Financials, and Web Access.

End of Year Performance Reporting

The Ministry of Health will report performance information for this appropriation in its Annual Report.

Current and Past Policy Initiatives

Managing the Purchase of Services (M36) (A21)

Scope of Appropriation

Expenses and Revenue

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve the administration of health and disability services, 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 Strategic Intentions).

How Performance will be Assessed and End of Year Reporting Requirements

Note 1 - When a monitoring report is received at the Ministry, it is logged into an electronic system. This generates an automated letter to say it has been received. The 'formal response' is the next contact the Ministry has with the provider when necessary. The formal response could be a phone call, email, formal letter or an actual visit.

End of Year Performance Reporting

The Ministry of Health will report performance information for this appropriation in its Annual Report.

Current and Past Policy Initiatives

Payment Services (M36) (A21)

Scope of Appropriation

Expenses and Revenue

What is Intended to be Achieved with this Appropriation

This appropriation is intended to provide for timely and appropriate payments to be made to eligible parties (including eligible health service providers and consumers) and contracts to be audited and processed efficiently and effectively.

How Performance will be Assessed and End of Year Reporting Requirements

Note 1 - All information is deemed to be processed accurately if agreements are legally binding and purchase order information is correctly entered.

End of Year Performance Reporting

The Ministry of Health will report performance information for this appropriation in its Annual Report.

Current and Past Policy Initiatives

Policy Advice and Related Services (M36) (A21)

Scope of Appropriation

Expenses and Revenue

What is Intended to be Achieved with this Appropriation

This appropriation is intended to ensure that Ministers are supported and advised so they can discharge their portfolio responsibilities.

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

The Ministry of Health will report performance information for this appropriation in its Annual Report.

Current and Past Policy Initiatives

Regulatory and Enforcement Services (M36) (A21)

Scope of Appropriation

Expenses and Revenue

What is Intended to be Achieved with this Appropriation

This appropriation is intended to ensure that health and disability services are regulated so that appropriate standards are followed.

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

The Ministry of Health will report performance information for this appropriation in its Annual Report.

Current and Past Policy Initiatives

Conditions on Use of Appropriation

Memorandum Account

Sector Planning and Performance (M36) (A21)

Scope of Appropriation

Expenses and Revenue

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve: 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.

How Performance will be Assessed and End of Year Reporting Requirements

Note 1 - Unexpected resignation or departure prior to the expiration of the term is not included.

Note 2 - Capability and capacity to respond means the Ministry has the necessary systems, procedures, facilities and staffing in place to initiate and manage at the national level the health response to a national emergency or emerging health threat.

End of Year Performance Reporting

The Ministry of Health will report performance information for this appropriation in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation decreases by $9.508 million to $72.290 million due to:

• $10.500 million for a transfer from 2019/20 to 2020/21 for the Budget 2019 initiative Improving the Financial Sustainability and Performance of District Health Boards, reflecting phasing of the work programme
• $1.915 million for a transfer to the Monitoring and Protecting Health and Disability Consumer Interests appropriation in 2021/22 to realign the funding for the Establishment of the Mental Health and Wellbeing Commission
• $1.454 million in 2020/21 only for the Budget 2020 initiative Transforming the Cross-Government Disability Support System
• $1.064 million for a transfer to the Provider Development appropriation in 2021/22 for the Budget 2019 initiative Increasing Investment in Pacific Innovation Fund
• $1 million for a transfer from 2019/20 to 2020/21 for the Budget 2019 initiative Infrastructure Support for District Health Boards' Capital Projects
• $750,000 for a transfer from 2019/20 to 2020/21 for the implementation of the National Asset Management Plan
• $600,000 for a transfer from 2019/20 to 2020/21 for the establishment of the Mental Health and Wellbeing Commission, and
• $350,000 for a transfer from 2019/20 to 2020/21 to support the implementation of the New Zealand Cancer Action Plan.

This decrease was partly offset by:

• $4.500 million in 2020/21 only for a fiscally neutral transfer to the Health Services Funding appropriation to realign the cost allocation of the Budget 2019 initiative Improving the Financial Sustainability and Performance of District Health Boards
• $2.500 million transfer from the Health Services Funding appropriation to support delivery of the DHB sustainability work programme
• $1 million increase in the Budget 2019 initiative Infrastructure Support for District Health Boards' Capital Projects, and
• $125,000 increase for a transfer from Public Health Service Purchasing appropriation for Geospatial Research.

2.3 - Departmental Capital Expenditure and Capital Injections#

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Ministry of Health - Capital Expenditure PLA (M36) (A21)

Scope of Appropriation

Capital Expenditure

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve the renewal, upgrade, or redesign of assets to support the delivery of the Ministry of Health's core functions and responsibilities (refer to Part 2.1).

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

The Ministry of Health will report performance information for this appropriation in its Annual Report.

Reasons for Change in Appropriation

This appropriation increases by $7.484 million to $23.402 million due to:

• $5.100 million for a transfer from 2020/21 to 2021/22 for the Budget 2020 initiative National Storage Facilities - Replacement and Relocation, and
• $4.459 million for a Departmental Capital reforecast due to Budget 2021 changes.

This increase was partly offset by:

• $1.172 million reduction for the National Immunisation Solution, and
• $903,000 for a technical capital forecast adjustment.

Capital Injections and Movements in Departmental Net Assets

Ministry of Health

Part 3 - Details of Non-Departmental Appropriations#

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3.1 - Non-Departmental Output Expenses#

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Health and Disability Support Services - Auckland DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Each DHB has a statutory responsibility to prepare:

• an Annual Plan for approval by the Minister of Health (Section 38 of the New Zealand Public Health and Disability Act 2000) - providing accountability to the Minister of Health
• a Statement of Performance Expectations (Section 149C of the Crown Entities Act 2004 as amended by the Crown Entities Amendment Act 2013) - providing financial accountability to Parliament and the public annually
• a Statement of Intent (Section 139 of the Crown Entities Act) - providing accountability to Parliament and the public at least triennially.

These documents are brought together into a single DHB Annual Plan with the Statement of Intent and Statement of Performance Expectations, and is known as the 'Annual Plan'.

The Statement of Performance Expectations provides specific measures/targets for the coming year, with comparative prior year and current year forecast (at a minimum).

Four Output Classes are used by all DHBs to reflect the nature of services provided:

• Prevention
• Early Detection and Management
• Intensive Assessment and Treatment, and
• Rehabilitation and Support.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $78.064 million to $1,568.189 million mainly due to:

• $65.133 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $6.799 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $3.479 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $3.424 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $2.054 million of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $1.027 million increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19
• $967,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency, and
• $797,000 for a technical adjustment relating to Loan Hedge Contracts Funding.

This increase is partly offset by:

• $3.804 million in 2020/21 only for Investment to Increase Access to Medicines
• $951,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19
• $519,000 reduction for a transfer of the Organ Donation Funding to the New Zealand Blood Service, and
• $365,000 in 2020/21 only for a fiscally neutral transfer from other DHBs to take account of movements in population-based funding to reflect the latest population projections.

Conditions on Use of Appropriation

Health and Disability Support Services - Bay of Plenty DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $65.729 million to $922.346 million mainly due to:

• $55.514 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $5.505 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $2.407 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $2.394 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $1.437 million of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $719,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19
• $323,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency, and
• $166,000 in 2020/21 only for a fiscally neutral transfer to other DHBs to take account of movements in population-based funding to reflect the latest population projections.

This increase is partly offset by:

• $2.244 million in 2020/21 only for Investment to Increase Access to Medicines, and
• $561,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19.

Conditions on Use of Appropriation

Health and Disability Support Services - Canterbury DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $61.246 million to $1,719.485 million mainly due to:

• $42.476 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $10.367 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $6.917 million increase for capital charge on infrastructure projects
• $4.285 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $4.227 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $2.570 million of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $1.285 million increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19, and
• $940,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency.

This increase is partly offset by:

• $6.500 million for a transfer from 2019/20 to 2020/21 for Canterbury Earthquakes Programme of Work
• $4.336 million in 2020/21 only for Investment to Increase Access to Medicines
• $1.084 million for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19, and
• $30,000 in 2020/21 only for a fiscally neutral transfer from other DHBs to take account of movements in population-based funding to reflect the latest population projections.

Conditions on Use of Appropriation

Health and Disability Support Services - Capital and Coast DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $37.971 million to $914.098 million mainly due to:

• $29.612 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $4.057 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $2.242 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $2.237 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $1.346 million of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $673,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19, and
• $604,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency.

This increase is partly offset by:

• $2.280 million in 2020/21 only for Investment to Increase Access to Medicines
• $570,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19, and
• $8,000 in 2020/21 only for a fiscally neutral transfer from other DHBs to take account of movements in population-based funding to reflect the latest population projections.

Conditions on Use of Appropriation

Health and Disability Support Services - Counties-Manukau DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $116.272 million to $1,766.037 million mainly due to:

• $102.162 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $6.256 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $4.455 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $4.370 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $2.622 million of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $1.311 million increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19
• $564,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency, and
• $3,000 in 2020/21 only for a fiscally neutral transfer to other DHBs to take account of movements in population-based funding to reflect the latest population projections.

This increase is partly offset by:

• $4.400 million in 2020/21 only for Investment to Increase Access to Medicines, and
• $1.100 million for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19.

Conditions on Use of Appropriation

Health and Disability Support Services - Hawkes Bay DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $40.126 million to $628.229 million mainly due to:

• $33.498 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $3.505 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $1.598 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $1.590 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $958,000 of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $480,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19
• $335,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency, and
• $70,000 in 2020/21 only for a fiscally neutral transfer to other DHBs to take account of movements in population-based funding to reflect the latest population projections.

This increase is partly offset by:

• $1.536 million in 2020/21 only for Investment to Increase Access to Medicines, and
• $384,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19.

Conditions on Use of Appropriation

Health and Disability Support Services - Hutt DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $20.180 million to $478.085 million mainly due to:

• $15.638 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $2.302 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $1.206 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $1.203 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $724,000 of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $362,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19
• $198,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency, and
• $23,000 in 2020/21 only for a fiscally neutral transfer to other DHBs to take account of movements in population-based funding to reflect the latest population projections.

This increase is partly offset by:

• $1.188 million in 2020/21 only for Investment to Increase Access to Medicines, and
• $297,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19.

Conditions on Use of Appropriation

Health and Disability Support Services - Lakes DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $29.102 million to $411.895 million mainly due to:

• $24.727 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $2.247 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $1.056 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $1.050 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $634,000 of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $317,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19
• $244,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency, and
• $47,000 in 2020/21 only for a fiscally neutral transfer to other DHBs to take account of movements in population-based funding to reflect the latest population projections.

This increase is partly offset by:

• $1 million in 2020/21 only for Investment to Increase Access to Medicines, and
• $250,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19.

Conditions on Use of Appropriation

Health and Disability Support Services - MidCentral DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $24.934 million to $630.882 million mainly due to:

• $17.815 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $3.976 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $1.629 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $1.608 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $977,000 of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $489,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19
• $391,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency, and
• $38,000 in 2020/21 only for a fiscally neutral transfer to other DHBs to take account of movements in population-based funding to reflect the latest population projections.

This increase is partly offset by:

• $1.600 million in 2020/21 only for Investment to Increase Access to Medicines, and
• $401,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19.

Conditions on Use of Appropriation

Health and Disability Support Services - Nelson-Marlborough DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $31.849 million to $550.718 million mainly due to:

• $25.393 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $3.813 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $1.392 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $1.386 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $832,000 of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $416,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19
• $244,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency, and
• $42,000 in 2020/21 only for a fiscally neutral transfer to other DHBs to take account of movements in population-based funding to reflect the latest population projections.

This increase is partly offset by:

• $1.360 million in 2020/21 only for Investment to Increase Access to Medicines, and
• $339,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19.

Conditions on Use of Appropriation

Health and Disability Support Services - Northland DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $54.315 million to $761.244 million mainly due to:

• $45.975 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $3.537 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $1.959 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $1.957 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $1.176 million of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $966,000 for the State Sector Decarbonisation Fund
• $587,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19
• $338,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency, and
• $127,000 in 2020/21 only for a fiscally neutral transfer to other DHBs to take account of movements in population-based funding to reflect the latest population projections.

This increase is partly offset by:

• $1.856 million in 2020/21 only for Investment to Increase Access to Medicines, and
• $464,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19.

Conditions on Use of Appropriation

Health and Disability Support Services - South Canterbury DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $7.449 million to $214.737 million mainly due to:

• $5.118 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $1.398 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $553,000 uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $540,000 for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $332,000 of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $166,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19, and
• $87,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency.

This increase is partly offset by:

• $560,000 in 2020/21 only for Investment to Increase Access to Medicines
• $140,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19, and
• $54,000 in 2020/21 only for a fiscally neutral transfer from other DHBs to take account of movements in population-based funding to reflect the latest population projections.

Conditions on Use of Appropriation

Health and Disability Support Services - Southern DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $50.653 million to $1,085.842 million mainly due to:

• $38.676 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $6.743 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $2.742 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $2.729 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $1.645 million of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $823,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19
• $535,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency, and
• $70,000 in 2020/21 only for a fiscally neutral transfer to other DHBs to take account of movements in population-based funding to reflect the latest population projections.

This increase is partly offset by:

• $2.700 million in 2020/21 only for Investment to Increase Access to Medicines, and
• $675,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19.

Conditions on Use of Appropriation

Health and Disability Support Services - Tairawhiti DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $11.591 million to $202.827 million mainly due to:

• $9.772 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $861,000 increase from devolving pay equity funding to DHBs and Disability Support Services
• $522,000 for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $521,000 uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $313,000 of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $156,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19, and
• $101,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency.

This increase is partly offset by:

• $508,000 in 2020/21 only for Investment to Increase Access to Medicines
• $127,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19, and
• $37,000 in 2020/21 only for a fiscally neutral transfer from other DHBs to take account of movements in population-based funding to reflect the latest population projections.

Conditions on Use of Appropriation

Health and Disability Support Services - Taranaki DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $14.258 million to $415.394 million mainly due to:

• $9.824 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $2.445 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $1.060 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $1.045 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $636,000 of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $318,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19
• $210,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency, and
• $17,000 in 2020/21 only for a fiscally neutral transfer to other DHBs to take account of movements in population-based funding to reflect the latest population projections.

This increase is partly offset by:

• $1.044 million in 2020/21 only for Investment to Increase Access to Medicines, and
• $261,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19.

Conditions on Use of Appropriation

Health and Disability Support Services - Waikato DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $71.203 million to $1,476.179 million mainly due to:

• $57.052 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $6.849 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $3.682 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $3.665 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $2.209 million of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $1.105 million increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19
• $851,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency, and
• $115,000 in 2020/21 only for a fiscally neutral transfer to other DHBs to take account of movements in population-based funding to reflect the latest population projections.

This increase is partly offset by:

• $3.592 million in 2020/21 only for Investment to Increase Access to Medicines, and
• $898,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19.

Conditions on Use of Appropriation

Health and Disability Support Services - Wairarapa DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $11.473 million to $179.158 million mainly due to:

• $9.639 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $1.021 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $458,000 uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $454,000 for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $275,000 of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $137,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19, and
• $64,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency.

This increase is partly offset by:

• $440,000 in 2020/21 only for Investment to Increase Access to Medicines
• $110,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19, and
• $28,000 in 2020/21 only for a fiscally neutral transfer from other DHBs to take account of movements in population-based funding to reflect the latest population projections.

Conditions on Use of Appropriation

Health and Disability Support Services - Waitemata DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $89.060 million to $1,823.567 million mainly due to:

• $73.356 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $8.102 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $4.421 million for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $4.398 million uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $2.638 million of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $1.319 million increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19, and
• $573,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency.

This increase is partly offset by:

• $4.556 million in 2020/21 only for Investment to Increase Access to Medicines
• $1.139 million for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19, and
• $132,000 in 2020/21 only for a fiscally neutral transfer from other DHBs to take account of movements in population-based funding to reflect the latest population projections.

Conditions on Use of Appropriation

Health and Disability Support Services - West Coast DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $7.714 million to $162.770 million mainly due to:

• $3.620 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $2.604 million increase for capital charge on infrastructure projects
• $860,000 increase from devolving pay equity funding to DHBs and Disability Support Services
• $355,000 uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $349,000 for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $213,000 of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $106,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19, and
• $87,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency.

This increase is partly offset by:

• $344,000 in 2020/21 only for Investment to Increase Access to Medicines
• $86,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19, and
• $59,000 in 2020/21 only for a fiscally neutral transfer from other DHBs to take account of movements in population-based funding to reflect the latest population projections.

Conditions on Use of Appropriation

Health and Disability Support Services - Whanganui DHB (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve services provided by the DHB 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.

How Performance will be Assessed and End of Year Reporting Requirements

Please refer to the performance reporting information as shown in "Health and Disability Support Services - Auckland DHB" on pages 40 to 41.

End of Year Performance Reporting

The DHB will report performance information in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $13.071 million to $276.623 million mainly due to:

• $10 million for the Budget 2021 initiative Supporting District Health Boards - Cost and Volume Pressures
• $1.791 million increase from devolving pay equity funding to DHBs and Disability Support Services
• $682,000 uplift for the Budget 2020 initiative Maintaining and Increasing the Combined Pharmaceutical Budget
• $670,000 for the Budget 2021 initiative Increase in the Combined Pharmaceutical Budget
• $409,000 of forecast savings in 2020/21 returned to the Crown from the COVID-19 initiative Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices
• $204,000 increase for the Combined Pharmaceutical Budget - Continuity of Supply of Medicines and Medical Devices in response to global supply issues due to COVID-19, and
• $131,000 increase for the DHB Clerical and Administration Pay Equity Claim: Drawdown from Tagged Contingency.

This increase is partly offset by:

• $652,000 in 2020/21 only for Investment to Increase Access to Medicines
• $163,000 for a transfer from 2019/20 to 2020/21 for the initiative Increase in Combined Pharmaceutical Budget due to increased costs of drugs due to COVID-19, and
• $5,000 in 2020/21 only for a fiscally neutral transfer from other DHBs to take account of movements in population-based funding to reflect the latest population projections.

Conditions on Use of Appropriation

Health Sector Projects Operating Expenses (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to enable the planning for major capital projects for DHBs.

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

Performance information for this appropriation will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation decreases by $5.402 million to $2 million due to:

• $2 million in 2020/21 only to support the oxygen supply and manage the related environmental issues for COVID-19 patients
• $1.432 million to reflect costs associated with the remediation of water pressure valve failure insurance claims at the Christchurch Hospital (Waipapa)
• $1.308 million to reflect costs associated with the remediation of roof damage insurance claims at the Grey Base Hospital
• $392,000 in 2020/21 from a one-off fiscally neutral adjustment to reflect the costs associated with the additional rental revenue received from the existing leases on the New Dunedin Hospital site, and
• $270,000 in 2020/21 only to reflect phasing of ongoing projects.

Health Services Funding (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve long-term financial sustainability in the financial performance of District Health Boards.

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

The performance measures for this appropriation will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Service Providers

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation decreases by $3.619 million to $21.181 million due to:

• $11.500 million transfer from 2019/20 to 2020/21 for the Budget 2019 initiative Improving the Financial Sustainability and Performance of District Health Boards
• $4.500 million in 2020/21 only for a fiscally neutral adjustment from the Sector Planning and Performance appropriation to realign the cost allocation of the Budget 2019 initiative Improving the Financial Sustainability and Performance of District Health Boards, and
• $2.500 million transfer to the Sector Planning and Performance appropriation to support delivery of the DHB sustainability work programme.

This decrease is partly offset by:

• $8 million transfer in 2020/21 only for a fiscally neutral transfer to Vote Prime Minister and Cabinet to fund work associated with the Health and Disability System Review Transition Unit, and
• $6.881 million payment in 2020/21 only for Expediting District Health Boards Holidays Act Remediation.

Health Workforce Training and Development (M36) (A21)

Scope of Appropriation

Expenses

Components of the Appropriation

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve the following: the New Zealand health sector is supported to develop a sustainable, flexible, and fit-for-purpose workforce through the funding of clinical training and other initiatives.

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

Performance information will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Service Providers

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $23.044 million to $234.121 million due to:

• $9 million for the net impact of a funding transfer from 2020/21 to 2021/22 to continue the work on the re-scoped health workforce leadership development programme reflecting phasing of the work programme
• $8 million for the net impact of a funding transfer from 2020/21 to 2021/22 to continue the workforce development for the Budget 2019 initiative Expanding Access and Choice of Primary Mental Health and Addiction Support, reflecting phasing of the work programme
• $8 million for the net impact of a funding transfer from 2020/21 to 2021/22 for the General Practitioners (GPs) Education Programme, reflecting phasing of the work programme
• $4.144 million uplift for the Budget 2019 initiative Expanding Access and Choice of Primary Mental Health and Addiction Support
• $4 million for the net impact of a funding transfer from 2020/21 to 2021/22, to align the funding with the commitments for the Budget 2019 initiative Nursing Workforce Accord - Providing Additional Places for Nurse Entry to Practice
• $1.300 million of forecast savings in 2020/21 returned to the Crown largely driven by lower than forecast demand for services, and
• $850,000 for the Budget 2021 initiative Public Health Units - Providing Sustainable Funding.

This increase was partly offset by:

• $5 million carried forward from 2019/20 to 2020/21 for the health workforce leadership development programme
• $4 million carried forward from 2019/20 to 2020/21 for the Budget 2019 initiative Expanding Access and Choice of Primary Mental Health and Addiction Support
• $1.750 million for a transfer from 2019/20 to 2020/21 for Providing Additional Places for Nurse Entry to Practice due to the lower than forecast number of nurse graduates, and
• $1.500 million for a transfer from 2019/20 to 2020/21 for the funding of additional rural and regional GPs and other rural health workforce initiatives.

Monitoring and Protecting Health and Disability Consumer Interests (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to protect the rights of people using health and disability services. This includes addressing the concerns of whanau and investigating alleged breaches of patients' rights.

How Performance will be Assessed and End of Year Reporting Requirements

Health and Disability Commissioner

The performance measures are those contained in the Crown entity's Statement of Performance Expectations.

Health Quality and Safety Commission

The performance measures are those contained in the Crown entity's Statement of Performance Expectations.

Mental Health and Wellbeing Commission

The performance measures are those contained in the Crown entity's Statement of Performance Expectations.

End of Year Performance Reporting

Performance information will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations; Crown entity performance information will be reported in their respective Annual Reports.

Service Providers

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $4.825 million to $36.172 million due to:

• $2.900 million for the Budget 2021 initiative Health and Disability Commissioner - Sustainability and Expansion of Scope Due to New Legislation
• $1.915 million for a fiscally neutral transfer from the Sector Planning and Performance appropriation to realign the funding in 2021/22 and outyears for the establishment of the Mental Health and Wellbeing Commission
• $1.400 million for the Budget 2021 initiative Health Quality and Safety Commission - Additional Resourcing, and
• $650,000 for the Budget 2021 initiative Establishing an Aged Care Commissioner.

This increase was partly offset by:

• $1.040 million reduction for the initiative Establishing and Operating the Mental Health and Wellbeing Commission, and
• $1 million in 2020/21 only for the Health and Disability Commissioner for the anticipated increase in complaints as a result of COVID-19.

National Child Health Services (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to provide services that support the development of New Zealand children and establish a foundation for those children to live longer, healthier, and more independent lives.

How Performance will be Assessed and End of Year Reporting Requirements

Note 1 - Enrolling with a WCTO provider at birth or as soon as possible thereafter allows sufficient time for WCTO providers to deliver the first core contact on time at around 6 weeks and therefore meet the quality indicator of delivering the full entitlement to children in the first year of life (if core 1 is missed, they are unable to meet the full entitlement measure).

End of Year Performance Reporting

Performance information will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Service Providers

Current and Past Policy Initiatives

Conditions on Use of Appropriation

National Disability Support Services (M36) (A21)

Scope of Appropriation

Expenses

Components of the Appropriation

What is Intended to be Achieved with this Appropriation

This appropriation is intended to provide support for disabled people and their families/whanau to enable them to live good lives.

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

Performance information will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Service Providers

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $170.545 million to $1,829.569 million mainly due to:

• $99.800 million for the Budget 2021 initiative Disability Support Services - Cost and Volume Pressures
• $41.746 million uplift in 2021/22 from devolving pay equity funding to DHBs and Disability Support Services
• $23.067 million for the Budget 2021 initiative Implementing the In-Between Travel Settlement
• $16.700 million of forecast savings in 2020/21 returned to the Crown largely due to a lower than forecast level of claims for Maintaining Essential Disability and Home and Community Aged Care Support Services through the initial Alert Levels 3 and 4
• $14 million of forecast savings in 2020/21 returned to the Crown largely driven by lower than forecast demand for services
• $7.080 million for the Budget 2021 initiative Cochlear implants - Increasing Availability, and
• $4.484 million for the Budget 2021 initiative Transforming the Cross-Government Disability Support System.

This increase was partly offset by:

• $17.379 million carried forward from 2019/20 to 2020/21 for Maintaining Essential Disability and Home and Community Aged Care Support Services
• $7.825 million carried forward from 2019/20 to 2020/21 for the initiative Removing Exclusions on Eligibility for Family Funded Carer
• $4.800 million in 2020/21 only for the Budget 2020 initiative Transforming the Cross-Government Disability Support System
• $4 million reduction for the Budget 2018 initiative Disability Support Services - Additional Support, and
• $1.828 million in 2020/21 only for a fiscally neutral transfer from Ministry of Social Development to the MidCentral Prototype (Mana Whaikaha).

Conditions on Use of Appropriation

National Emergency Services (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to provide emergency services to assist people who require urgent acute health care (for example, air and road ambulances) are provided in a timely fashion.

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

Performance information will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Service Providers

Current and Past Policy Initiatives

National Management of Pharmaceuticals (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to provide for the operating costs of PHARMAC to deliver health-related services that align with Government priorities or the strategic direction for health services (see the Ministry of Health's Statement of Strategic Intentions) but are out of scope for other national services appropriations in Vote Health.

How Performance will be Assessed and End of Year Reporting Requirements

The performance measures are those contained in PHARMAC's statement of performance expectations.

End of Year Performance Reporting

Performance information for this appropriation will be reported by PHARMAC in its Annual Report.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation decreases by $5 million to $25.262 million due to:

• $10 million in 2020/21 only to ensure the continuity of supply of medical devices in response to global supply issues caused by COVID-19.

This decrease was partly offset by:

• $5 million of forecast savings in 2020/21 returned to the Crown due to additional funding for the supply of medical devices no longer being required.

Conditions on Use of Appropriation

National Maori Health Services (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to provide support and encouragement for (i) health services provided by Maori, and (ii) for health services for Maori.

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

Performance information will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Service Providers

Reasons for Change in Appropriation

This appropriation decreases by $4.167 million to $8.828 million due to:

• $5.400 million in 2020/21 only for a fiscally neutral transfer from the Public Health Service Purchasing appropriation to support the Maori Influenza Vaccine Programme
• $4.347 million carried forward from 2019/20 to 2020/21 for the development of the Maori Health Action Plan, and
• $420,000 carried forward from 2019/20 to 2020/21 for the delivery of the Maori Response Package reflecting the phasing of the programme.

This decrease was partly offset by:

• $6 million for the net impact of a funding transfer from 2020/21 to 2021/22 to align the funding with the delivery timeframes of the national Maori health services programme.

National Maternity Services (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to ensure that women are supported with antenatal care, care during labour and birth, and postnatal care, so that the health of both mothers and babies is promoted.

How Performance will be Assessed and End of Year Reporting Requirements

Note 1 - Lead Maternity Carers (LMCs) deliver quality maternity services in compliance with the Section 88 Primary Maternity Services Notice 2007 which excludes DHB primary maternity services.

End of Year Performance Reporting

Performance information will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Service Providers

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $22.706 million to $254.578 million due to:

• $19.200 million of forecast savings in 2020/21 returned to the Crown largely driven by lower than forecast demand for services
• $8.056 million for the Budget 2021 initiative Continuing Section 88 Primary Maternity Funding to Enable Ongoing Access to Free Maternity Services, and
• $280,000 uplift for the Maternity Action Plan - Drawdown from Tagged Contingency Funding.

This increase is partly offset by:

• $3 million for the reduction in the Budget 2020 initiative Continuing Section 88 Primary Maternity Funding to Enable Ongoing Access to Free Maternity Services for New Zealand Women, and
• $1.830 million carried forward from 2019/20 to 2020/21 for the initiative Funding for Community Midwives in Response to COVID-19, reflecting the phasing of the programme.

Conditions on Use of Appropriation

National Mental Health Services (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to ensure that people are supported with mental health issues, including addiction, and work is undertaken to respond to suicidal behaviour and reduce its impact on communities.

How Performance will be Assessed and End of Year Reporting Requirements

Note 1 - The Ministry funds three Mother/Baby unit beds for use during the year.

End of Year Performance Reporting

Performance information will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Service Providers

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increased by $41.505 million to $243.170 million mainly due to:

• $31.969 million uplift for the Budget 2019 initiative Expanding Access and Choice of Primary Mental Health and Addiction Support
• $17.698 million for the net impact of a funding transfer from 2020/21 to 2021/22 for the Budget 2019 initiative Expanding Access and Choice of Primary Mental Health and Addiction Support - Service Delivery, reflecting the phasing of the programme
• $11.620 million for the Budget 2021 initiative Continuing Mana Ake - Stronger for Tomorrow to make mental health support available to all primary and intermediate school age students in Canterbury and Kaikoura in 2021/22 and to fund the co-design of mental wellbeing supports in primary and intermediate schools (utilising the learnings from Canterbury and Kaikoura) in five new areas, including Northland, Counties Manukau, Lakes, Bay of Plenty and West Coast
• $10 million of forecast savings in 2020/21 returned to the Crown to contribute towards the funding required in 2021/22 for the Budget 2021 initiative Continuing Mana Ake - Stronger for Tomorrow
• $6.047 million for the net impact of a funding transfer from 2020/21 to 2021/22 to continue the growth of integrated services for the initiative Expanding Access and Choice of Primary Mental Health and Addiction Support - Enablers
• $4 million of forecast savings in 2020/21 returned to the Crown largely driven by lower than forecast demand for services
• $3 million uplift for the initiative Increasing Wellbeing and Mental Health Support to Learners and Education Workforce
• $2.561 million uplift for the Waikato Alcohol and Other Drug Treatment Court: Drawdown of Tagged Contingency
• $1.510 million uplift for the Budget 2019 initiative Forensic Mental Health Services for Young People
• $1 million uplift for the Budget 2019 initiative Enhancing Primary Addiction Response, and
• $980,000 uplift for the Budget 2019 initiative Forensic Mental Health Services for Adults.

This increase was partly offset by:

• $14.448 million for transfers from 2019/20 to 2020/21 for the Budget 2019 initiative Expanding Access and Choice of Primary Mental Health and Addiction Support, reflecting the phasing of the programme
• $10 million in 2020/21 only for Improving Mental Health Services for Children in Canterbury and Kaikoura
• $9.049 million for a transfer from 2019/20 to 2020/21 to boost the psychosocial response and recovery plan to mitigate the immediate and longer-term impacts of COVID-19
• $4 million in 2020/21 for the Budget 2018 initiative Integrated Therapies Pilot for 18-25 Year Olds
• $3.822 million for a transfer from 2019/20 to 2020/21 for Synthetic Drugs Response - priority areas, reflecting the phasing of the programme
• $3.500 million carried forward from 2019/20 to 2020/21 for the Budget 2019 initiative Expanding Telehealth and Digital Supports for Mental Wellbeing, reflecting the phasing of the programme
• $2 million for a transfer from 2019/20 to 2020/21 for the Budget 2019 initiative Enhancing Specialist Alcohol and Other Drug Services, reflecting the phasing of the programme
• $1.671 million increase in a fiscally neutral transfer to departmental funding to reflect the revised balance of central versus regional/sector responsibility for the Mental Health and Addiction programme, and
• $1 million for a transfer from 2019/20 to 2020/21 for the Budget 2019 initiative Promoting Wellbeing in Primary and Intermediate Schools, reflecting the phasing of the programme.

Conditions on Use of Appropriation

National Personal Health Services (M36) (A21)

Scope of Appropriation

Expenses

Components of the Appropriation

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve the following: people are supported with the identification, management, and treatment of personal health conditions (for example, treatment for cancer, and hospice services).

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

Performance information will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Service Providers

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation decreases by $19.735 million to $73.601 million mainly due to:

• $14.600 million in 2020/21 only for Increased Volumes for the National Telehealth Service in response to COVID-19
• $6 million in 2020/21 only for Funding the Health System Response to COVID-19
• $3.970 million in 2020/21 only for New Zealand Blood Service: Impacts of COVID-19
• $3.342 million carried forward from 2019/20 to 2020/21 for the National Telehealth service
• $2 million carried forward from 2019/20 to 2020/21 for the support for aged residential care providers to maintain their facilities free of COVID-19
• $1.800 million carried forward from 2019/20 to 2020/21 to progress the work on the development of Long-Term Conditions approach reflecting the phasing of the programme, and
• $1.400 million carried forward from 2019/20 to 2020/21 for the implementation of the Gout and Hepatitis C Action Plans, reflecting the phasing of the programme.

This decrease was partly offset by:

• $6.200 million of forecast savings in 2020/21 returned to the Crown largely driven by lower than forecast demand for services
• $6.100 million for the Budget 2021 initiative Assisted Dying Services / End of Life Choice Act 2019 Implementation, and
• $1 million uplift in 2021/22 for a fiscally neutral transfer from the Primary Health Care Strategy appropriation to meet the ongoing costs of the InterRAI Programme that provides a suite of clinical assessment instruments to trained nurses and registered health care workers to assess an older person's care needs.

Conditions on Use of Appropriation

National Planned Care Services (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to improve access to planned care interventions by funding more procedures and improvements to how elective procedures are provided or supported.

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

Performance information will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Service Providers

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $45.220 million to $559.960 million due to:

• $48.620 million for the Budget 2021 Planned Care initiative - Cost Pressure
• $33.500 million for the net impact of a funding transfer from 2020/21 to 2021/22 for the initiative Planned Care - COVID-19 Backlog, and
• $3.100 million of forecast savings in 2020/21 returned to the Crown largely driven by lower than forecast demand for services.

This increase is partly offset by:

• $23.300 million carried forward from 2019/20 to 2020/21 to enable the DHBs to catch up on the under-delivery of the planned care interventions
• $15 million reduction in 2021/22 for the initiative Planned Care - COVID-19 Backlog, and
• $1.700 million carried forward from 2019/20 to 2020/21 for the initiative Radiology Service Improvement and Organ Donation Link Staff.

Primary Health Care Strategy (M36) (A21)

Scope of Appropriation

Expenses

Components of the Appropriation

What is Intended to be Achieved with this Appropriation

This appropriation is intended to provide accessible primary care services to New Zealand communities, enabling people to live healthier, more independent lives.

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

Performance information will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Service Providers

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation increases by $51.152 million to $403.395 million due to:

• $48.735 million uplift for the Budget 2020 initiative A Free Consultation, Including Eye Check, for SuperGold Card Holders
• $46.652 million for the Budget 2021 initiative Primary Care - Cost and Volume Pressures
• $14 million of forecast savings in 2020/21 returned to the Crown from COVID-19 initiative Maintaining the Financial Viability of Critical Community Pharmacy Services as the number of applications against the fund was less than forecast
• $6.300 million of forecast savings in 2020/21 returned to the Crown largely driven by lower than forecast demand for services
• $3.200 million in 2020/21 for a fiscally neutral transfer to the National Emergency Services appropriation to meet the air ambulance service cost pressures, and
• $900,000 for the net impact of a fiscally neutral transfer to the Managing the Purchase of Services appropriation for the delivery of A Free Consultation, Including Eye Check, for SuperGold Card Holders initiative.

This increase is partly offset by:

• $49.635 million for the net impact of reprioritising funding from the Budget 2020 initiative A Free Consultation, Including Eye Check, for SuperGold Card Holders
• $18 million carried forward from 2019/20 to 2020/21 for the initiative Maintaining the Financial Viability of Critical Community Pharmacy Services, and
• $1 million uplift in 2021/22 for a fiscally neutral transfer to the National Personal Health Services appropriation to meet the ongoing costs of the InterRAI Programme that provides a suite of clinical assessment instruments to trained nurses and registered health care workers to assess an older person's care needs.

Problem Gambling Services (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to provide services to reduce the harm caused by problem gambling.

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

Performance information will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Service Providers

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation decreased by $3.017 million to $19.595 million due to $3.503 million carried forward from 2019/20 to 2020/21 to continue work on the problem gambling services plan, partly offset by $486,000 uplift for initiative Strategy to Prevent and Minimise Gambling Harm.

Public Health Service Purchasing (M36) (A21)

Scope of Appropriation

Expenses

Components of the Appropriation

What is Intended to be Achieved with this Appropriation

This appropriation is intended to support communities with the identification, management, and treatment of public health issues. This includes, for example, health promotion, screening for cancer and other conditions, investigating environmental or border health issues, and identifying and managing communicable diseases.

How Performance will be Assessed and End of Year Reporting Requirements

Note 1 - Capability and capacity in DHBs: Each DHB develops, maintains and exercises a DHB Health Emergency Plan (HEP) (which meets the DHBs responsibilities under the Civil Defence Emergency Management Act 2002 and the National Health Emergency Plan 2015) and has sufficient numbers of staff trained to support an emergency response.

Note 2 - Capability and capacity in road ambulance services: Service providers maintain emergency plans (that are integrated with other health agency plans) to enable coordinated health care delivery during an emergency, maintenance of emergency equipment, participation in exercises and to ensure they have sufficient numbers of staff trained to support an emergency response.

End of Year Performance Reporting

Performance information will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Service Providers

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation decreases by $585.755 million to $507.220 million mainly due to:

• $298 million in 2020/21 only to fund costs related to the delivery of quarantine and managed isolation arrangements for arrivals to New Zealand
• $235.780 million carried forward from 2019/20 to 2020/21 for Additional Personal Protective Equipment (PPE) in Response to COVID-19 reflecting timing of expenditure
• $235.769 million in 2020/21 to support the on-going health system response to COVID-19 including community-based testing, laboratory services, PPE and supplies, additional MIQ costs and the Northern Region response to COVID-19
• $129.060 million reduction in funding for the initiative COVID-19 Surveillance Plan and Testing Strategy
• $50 million in 2020/21 only to ensure the provision of PPE
• $37.195 million carried forward from 2019/20 to 2020/21 for purchasing additional ventilated and non-ventilated ICU capacity
• $26.551 million carried forward from 2019/20 to 2020/21 for the initiative Boosting Public Health capacity, including helping to support contact tracing efforts
• $20 million in 2020/21 only for the establishment of managed isolation facilities for all cases and close contacts in the Community under Alert Levels 2 and 1
• $19.500 million in 2020/21 only to ensure Pacific Providers and DHBs across Auckland have the capability to continue delivering the vastly expanded critical Pacific health and Disability services in response to the COVID-19 resurgence
• $18.100 million in 2020/21 only for Measles Outbreak Response and Strengthening the Immunisation System
• $13.964 million carried forward from 2019/20 to 2020/21 for the Contact Tracing Action Plan
• $12.800 million in 2020/21 only to deliver and maintain the operational response through the National Close Contact Service and Technology to support the management of COVID-19
• $11.683 million carried forward from 2019/20 to 2020/21 for the initiative Strengthening Workforce Capability across DHB Provided Services
• $11.186 million carried forward from 2019/20 to 2020/21 for National Bowel Screening Programme
• $8.564 million carried forward from 2019/20 to 2020/21 to boost the Healthline COVID-19 response
• $5.368 million carried forward from 2019/20 to 2020/21 for Public Health COVID-19 campaign across New Zealand including vulnerable groups via all media channels
• $4.431 million carried forward from 2019/20 to 2020/21 for the initiative Increasing Institute of Environmental Science and Research (ESR) and other laboratory COVID-19 testing capacity
• $3.500 million in 2020/21 only for the Public Health Units to continue providing critical population and public health services in 2020/21, including continuing to support the COVID-19 response, and
• $2.300 million carried forward from 2019/20 to 2020/21 for Water Fluoridation Subsidies Scheme.

This decrease was partly offset by:

• $274.202 million for the net impact of a fiscally neutral transfer to move the existing funding for the health system response to COVID-19 to the National Response to COVID-19 Across the Health Sector MCA from January 2021
• $132 million in 2020/21 for the transfer of MIQ funding from Vote Health to Vote Building and Construction to reflect the transfer of MIQ responsibilities to Ministry of Business, Innovation and Employment
• $50.024 million for a fiscally neutral transfer in 2020/21 only to the National Response to COVID-19 Across the Health Sector MCA to continue supporting the COVID-19 health system response, mainly in community testing and laboratory services
• $15.262 million for the net impact of a funding transfer from 2020/21 to 2021/22 for National Measles Campaign and Strengthening the Immunisation System, reflecting the phasing of the programme
• $10.600 million for the net impact of a funding transfer from 2020/21 to 2021/22 for the implementation of the Water Fluoridation scheme, reflecting the phasing of the programme
• $9.465 million for the Budget 2021 initiative Public Health Units - Providing Sustainable Funding
• $8.700 million for the net impact of a funding transfer from 2020/21 to 2021/22 for National Bowel Screening Programme
• $7.055 million for the Budget 2021 initiative National Cervical Screening Programme Sustainability
• $7.045 million for the Budget 2021 initiative National Immunisation Programme - Providing Sustainable Funding
• $6.633 million in 2020/21 only for a fiscally neutral transfer to the Health Capital Envelope 2020-2025 MYA appropriation to recognise the purchases of ventilators as capital expenditure
• $5.500 million for the Budget 2021 initiative Accelerating Progress Towards Smokefree 2025
• $5.400 million in 2020/21 only for a fiscally neutral transfer to the National Maori Health Services appropriation for the Maori Influenza Vaccine Programme
• $4.843 million for the Budget 2021 initiative National Breast Screening Programme - Price, Volume and COVID-19 Catch Up Pressures
• $4.550 million for the net impact of a funding transfer from 2020/21 to 2021/22 for Fetal Alcohol Spectrum Disorder (FASD) Programme - Proceeds of Crime initiatives, reflecting the phasing of the programme
• $4 million for the net impact of a funding transfer from 2020/21 to 2021/22 for the Budget 2020 initiative Specialist Responses to Strangulation - Addressing Family Violence, reflecting the phasing of the programme
• $3.360 million for the Budget 2021 initiative National Bowel Screening Programme Implementation Phase 4, and
• $2.930 million for the Budget 2021 initiative Expanding the Reach and Impact of the Healthy Homes.

3.4 - Non-Departmental Other Expenses#

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International Health Organisations (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to ensure that New Zealand maintains its membership in the World Health Organization (WHO) and contributes to specific WHO projects.

How Performance will be Assessed and End of Year Reporting Requirements

An exemption was granted under s15D(2)(b)(iii) of the PFA as the amount of the appropriation is less than $5 million.

Service Providers

Legal Expenses (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to enable action to be taken regarding legal claims related to Vote Health, and these are funded and appropriate settlements are made, as appropriate.

How Performance will be Assessed and End of Year Reporting Requirements

An exemption was granted under s15D(2)(b)(ii) of the PFA as performance information is not likely to be informative in the light of the nature of the transaction or causal event giving rise to the expenses.

Reasons for Change in Appropriation

This appropriation increases by $3.856 million to $6.778 million due to the net impact of funding transfers for the Litigation Settlement Fund - Funded Family Care, reflecting the timing of negotiation and settlement of the individual cases.

Provider Development (M36) (A21)

Scope of Appropriation

Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to provide for third party health services, particularly those providing predominantly for Maori and Pacific peoples, to be supported to become more effective, efficient, and sustainable.

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

Performance information will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Service Providers

Current and Past Policy Initiatives

3.5 - Non-Departmental Capital Expenditure#

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Equity Support for DHB deficits (M36) (A21)

Scope of Appropriation

Capital Expenditure

What is Intended to be Achieved with this Appropriation

This appropriation is intended to achieve the following: DHBs are supported to maintain their working capital.

How Performance will be Assessed and End of Year Reporting Requirements

An exemption was granted under s15D(2)(b)(ii) of the PFA as the end-of-year performance information for the appropriation is not likely to be informative in the light of the nature of the transaction or causal event giving rise to the capital expenditure because the funding is, in essence, a contingency.

Note that DHBs will report performance information in their Annual Reports.

Current and Past Policy Initiatives

Reasons for Change in Appropriation

This appropriation decreases by $275.789 million to $39.211 million due to additional equity support to District Health Boards in 2020/21.

Conditions on Use of Appropriation

All expenditure from this appropriation requires the joint agreement of the Minister of Health and the Minister of Finance.

Health Capital Envelope 2020-2025 (M36) (A21)

Scope of Appropriation and Expenses

What is Intended to be Achieved with this Appropriation

This appropriation is intended to provide for capital projects delivered on behalf of the Crown, supporting heath sector organisations to deliver health services for New Zealanders.

How Performance will be Assessed and End of Year Reporting Requirements

End of Year Performance Reporting

Performance information for this appropriation will be reported in the Minister's Vote Health Report in Relation to Selected Non-Departmental Appropriations.

Current and Past Policy Initiatives

Conditions on Use of Appropriation

All expenditure from this appropriation requires the joint agreement of the Minister of Health and the Minister of Finance.

Residential Care Loans - Payments (M36) (A21)

Scope of Appropriation

Capital Expenditure

What is Intended to be Achieved with this Appropriation

This appropriation is intended to ensure that New Zealanders who are entering residential care facilities receive an appropriate level of financial assistance so they can afford that care.

How Performance will be Assessed and End of Year Reporting Requirements

An exemption was granted under s15D(2)(b)(ii) of the PFA as the performance information for the appropriation or category is not likely to be informative in the light of the nature of the transaction or causal event giving rise to the expenses.