assist one another, and take a whole-of-system approach
to planning and decision making based on what is best
for the patient and health system.
Alliance goals variously include shifting services from
hospitals to primary care or creating new arrangements
combining elements of both service domains to, for exam-
ple, reduce avoidable hospitalisation or improve chronic
condition management. The key, as noted, is to focus on
and work towards what makes best sense in the context of
integration to the players in the local health system.
All DHBs now have an alliance leadership team (ALT),
membership of which is determined by the DHB and PHO
and evolves as an ALT sees fit. Members are likely to include
doctors, nurses, allied health professionals, others from hos-
pital and primary care settings, and those with resources,
such as the chief executives of the DHB and respective
PHOs and consumer representatives. Each member signs
a charter spelling out the rules of engagement and focus
of the ALT, which then sets local priorities and plans how
these will be met.
There is flexibility for how an alliance goes about its ac-
tivities. Many ALTs are focused on developing service-level
alliance teams (SLATs). These are work streams that include,
again, a combination of clinical leaders and management.
The Southern Health Alliance Leadership Team, of which I
am Independent Chair, has chosen initially to create SLATs
for acute service demand management; outpatient services;
diagnostics; rural health; community and hospital pharma-
ceuticals; frail older people; and respiratory conditions. To
illustrate how a SLAT functions, initial respiratory SLAT
work involved a workshop including hospital emergency
department and respiratory physicians, GPs, nurses and
ambulance services. Resulting actions include identifying
frequently hospitalised patients, providing nurse-led care
plans for them and ensuring that the patient’s GP and,
where necessary, hospital services are involved in this, and
developing primary care-based options for ambulance ser-
vices. Development of web-based clinical pathways aimed at
integration, involving health professionals from the primary
and hospital sectors, is also governed by the ALT.
In the Canterbury region, where alliance development is
more established, dozens of people from different parts of
the health system are involved. With care design decided
on advice of a SLAT, it is then up to the ALT and its member
organisations to pool or shift resources to support new con-
figurations. This process is being propelled by new flexible
funding arrangements, whereby the PHO can use existing
ring-fenced allocations in new ways as decided by the ALT.
The DHB is expected to contribute to this pool which will
grow with time, along with the level of joint risk sharing,
as an alliance work program advances.
How alliance performance will be measured is an impor-
tant question that the government is tackling. An impending