NASC – What Is It? | Te Whatu Ora - Te Tai Tokerau

NASC – What Is It?

A Health NZ | Te Whatu Ora service, NASC provides Needs Assessments and Service Co-ordination for people aged 65-plus who are in need of support, as well as for other clients under 65 with long-term chronic health conditions.  

A ‘needs assessment’ identifies what support is required to help someone to be as independent as possible in their home and community.  The ‘service coordination’ sees the NASC team liaise with the client to arrange the appropriate support available; such as personal care, carer support, home help, day care, respite care or residential care.  

Support can be for the long-term or a short-term and can range from formal healthcare and community services – funded and unfunded – through to support provided by family/whānau and friends. Options for support are discussed and agreed by all involved before being put in place. 

Depending on the situation, an in-person assessment will be done either in hospital or in the client’s home, otherwise over the phone if determined that a non-complex assessment is sufficient and an in-home visit is not necessary.  

Following this, the NASC assessor will create a ‘care package’  –  a support plan of services that have been arranged with the client and their family/whānau, as well as who is responsible for providing these services. This also considers any support required by carer/s. The service provider will then contact the client to arrange implementation of the services requested.  Once an assessment is completed, the NASC team can support and review changes in a care package via the phone. Every effort is made to provide clients with services that help meet their needs.  

From the community, first referrals need to be made by a GP or other health professional. Once known to the NASC service, any member of the public can refer themselves or, with their consent, be referred by a family/whānau member or friend. 

All referrals for long-term support are triaged and prioritised based on information provided. If the NASC triage identifies an urgent need, an assessor will contact the client within one or two working days to arrange the initial assessment to identify what support they may require.  If a client’s need becomes urgent while on the waitlist, the assessment can be brought forward.  

NASC also provides Acute Home Support Service (AHSS) primarily for post-acute hospital admissions – patients identified as requiring short-term support while recovering from an acute illness. AHSS also supports clients with palliative conditions.  

In Te Tai Tokerau Northland, NASC Clinical Nurse Manager Jenny MacKay says a recent development for the service is its electronic waitlist, whereas previously a static spreadsheet document was used. 

“The electronic waitlist has made a huge difference. We’re able to look and immediately see a live view of how long a referral has been in the system and what the client’s need is. We’re always monitoring the waitlist to ensure we see people when they need to be seen. In fact, we’re constantly looking for any way we can improve our quality and timeliness of seeing clients,” she said. 

NASC Clinical Needs Assessor Jacqui Westren says a comprehensive assessment tool is used to guide the clinical decisions and criteria for support for clients. 

“The InterRAI tool follows international best practice and is used nationwide, so there is consistency across the assessments done throughout the country. It avoids any subjectivity in an assessment and ensures consistency and quality for clients. It is also measurable which is helpful in terms of service improvement,” she said. 

“Another strength of the model is that we do a case review every weekday, where every patient who is complex has their care package discussed as a team. It’s a very robust process; not just one or two people deciding what it should be. 

“We also work collaboratively with Te Whatu Ora multi-disciplinary teams as well as community health services such as hospice, home support providers, non-government organisations, to help us to have the information we need to make the best decisions possible for the clients’ benefit. 

“In fact, I’d say that NASC is a bit of unsung advocate for putting the client at the centre of everything we do. NASC’s purpose is clear and the team is committed to that mission every day.” 

The NASC team welcomes contact from existing clients and other people who may need support or would like advice, by phone at 09 430 4131 or 0800 88 88 90 or email to


Pictured: some of the NASC Whangārei team.


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