TARANAKI DISTRICT HEALTH BOARD MONTHLY MEETING AGENDA – OPEN

The business of all TDHB Statutory Committees is included within the TDHB Board agenda

Friday, 27 August 2021 – 10.30am Via Zoom

Item Time Topic 1.0 10.30am Declaration to Open Meeting and Welcome Attendees Chair 2.0 Apologies Chair • Pauline Lockett (Board Member) 3.0 Conflict of Interest Register Chair 4.0 Public Comment Chair 5.0 Chair’s Comment Chair 6.0 Minutes of Previous Meeting – 9 July 2021 Chair Previous minutes to be adopted. Matters Arising 6.1 Action List from Board 7.0 Te Whare Pūnanga Korero Update Chair / Group Chairs / Chief Executive 8.0 MANAGEMENT REPORTS 8.1 10.45am • Chief Executive Chief Executive 8.2 • COVID-19 SITREP Chief Executive 8.3 11.05am • Hospital & Specialist Services Chief Operating Officer 8.4 11.30am • Planning, Funding & Population Health GM, Planning & Funding o Planning & Funding Report o Progress on Annual Plan Activities 2020/21 – Metrics Quarter 4 - Appendix 1 – Annual Plan 2020/21 Performance Metrics - Appendix 2 – Māori Health Priority Indicators 8.5 11.55am • Māori Health and Equity Directorate Chief Māori Health & Equity Officer 8.6 12.10pm • People & Capability (Human Resources) GM, People & Capability 8.7 12.25pm • Financial Reports o Finance & Corporate Services GM, Finance & Corporate - Hospital & Specialist Services Chief Operating Officer o Planning, Funding & Population Health GM, Planning & Funding 9.0 GENERAL BUSINESS 9.1 12.40pm • Taranaki DHB Working Groups – Update Group Chairs / Chief Executive 9.2 12.45pm • Accessibility Action Plan GM, Planning & Funding o Appendix 1 - Accessibility Action Plan (12 months) 2021/22 o Appendix 2 - Accessibility Action Plan on a Page 9.3 • Next Meeting – Friday, 30 September 2021 (Taranaki Base Hospital)

Taranaki DHB – Agenda - OPEN

KARAKIA

Kia Uruuru Mai

Kia uru-uru mai a hau-ora, a hau-kaha, a hau-māia ki runga, ki raro, ki roto, ki waho rire-rire hau, pai marire

Taranaki DHB – Agenda - OPEN

Resolution to Exclude the Public The Taranaki District Health Board resolves in reliance on Schedule 3, of the New Zealand Public Health and Disability Act 2000 and the particular interest(s) protected by clause 32 Schedule 3 of that Act and/or sections 6, 7 and/or 9 of the Official Information Act 1982, would be prejudiced by the holding of the whole or relevant part of the proceedings of the meeting in public, and in particular: 1. To present Taranaki District Health Board – Board minutes pursuant to an earlier resolution publicly excluding the item. 2. To present Chief Executive Reports and attachments; Clinical Governance Support Unit Report; Financial and Internal Audit Reports and Board Priorities in that the public conduct of the meeting would be likely to result in the disclosure of information where the withholding of the information is necessary to: likely to result in the disclosure of information where the withholding of the information is necessary to: (g) Enable the DHB, Board or Board Committee holding the information to carry out, without prejudice or disadvantage, commercial activities. (h) Enable the DHB, Board or Board Committee holding the information to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations).

Taranaki DHB – Agenda - OPEN

MONTHLY DECLARATION OF INTEREST Board / Finance, Audit & Compliance / Hospital Advisory Committee / Community & Public Health Advisory and Disability Support Advisory Committee

Board Meeting – August 2021

Name of Member Interest Being Declared Nature of Interest/Transaction as it relates to Date of Interest Taranaki DHB (include positional or transactional interests, eg funding agreements, proposals and other relationships) Cassandra Crescendi Group Limited Director & Shareholder 19 December 2019 Crowley Grand Debut Limited Director & Shareholder 19 December 2019 (Chair) Maket ū Foods Limited Director 19 December 2019

Ng āti Manawa Developments Incorporated Trustee 19 December 2019 Ng āti Manawa Developments Limited Director 19 December 2019 Ng āti Manawa Gas Limited Director 19 December 2019 New Zealand Transport Agency Deputy Chair 19 December 2019 Ng āti Manawa Tokuwaru Asset Holding Company Director 19 December 2019 Limited Nisa Advisory Board Chair 19 December 2019 Sacred Heart Girls College New Plymouth Alumni Executive Member 19 December 2019 Association Te Arawa Management Limited Commercial Advisory 19 December 2019 The Skills Organisation Independent Director 19 December 2019 Trustee Narsha Nayolet Foundation Trust Trustee 19 December 2019 Western Institute of Technology at Taranaki Director 19 December 2019 Be Pure Health Limited Minority shareholder via nominee company April 2020 Ossis Limited Minority shareholder via nominee company April 2020 Zeffer Brewing Limited Minority shareholder April 2020 Bledisloe Park Board Board Member April 2020 Aratu Forests Limited Director April 2020

Name of Member Interest Being Declared Nature of Interest/Transaction as it relates to Date of Interest Taranaki DHB (include positional or transactional interests, eg funding agreements, proposals and other relationships) Cassandra Relatives Taranaki DHB employee (x5) April 2020 Crowley • Consultant Rural Health – Hawera (Chair) • RMO, TBH cont’d • Duty Nurse Manager – TBH • Public Health Nurse • Booking & OPD Admin/Reception – Hawera K.L.C. Limited Chair November 2020 Lead Chair, DHBs November 2020 Te Matai Water Scheme Limited Director January 2021 Bridget Sullivan Ministry of Business, Innovation and Employment Employee December 2019 (Deputy Chair) Partner is a member of the TOI Foundation and a December 2019 Partner in Young, Carrington & Ussher Lawyers Married to Deputy Chair of TSB Community Trust Sister-in-law Family member employed as senior doctor December 2019 by Taranaki DHB Tiaki te Mauri o Parininihi Trustee August 2021 Pat Bodger Te Whare Punanga Korero (TWPK) – Te Atiawa Te Atiawa representative 19 December 2019 representative Hospice Taranaki Inc. Soc. Board Member 19 December 2019 NPDC Accessibility, Aged and Issues & Working Party Member 19 December 2019 Taranaki Nurses Scholarship Grant Trust Member 19 December 2019

Manukorihi Hap ū Chairperson 19 December 2019

Manukorihi Hap ū Charitable Trust Trustee 19 December 2019

Manukorihi Paa Reserve Trust Trustee 19 December 2019 Te Kowhatu Tu Moana (NPDC Land Act 2018) Trustee 19 December 2019

Name of Member Interest Being Declared Nature of Interest/Transaction as it relates to Date of Interest Taranaki DHB (include positional or transactional interests, eg funding agreements, proposals and other relationships) Pat Bodger cont’d Te Tai Pari Board - Waitara Perpetual Community Fund Trustee 19 December 2019 (NPDC Land Act 2018) Te Hanataua Family Trust Trustee 19 December 2019 Alison Brown NZ Nurses Organisation Honorary Life Membership 19 December 2019 Grey Power Committee Committee Member 19 December 2019 Age Concern Taranaki Board Member 19 December 2019 Daughter is employed as a Registered Nurse by Capital & Coast, Wellington Hospital Mike Davey Taranaki Regional Council Elected councillor – sit on Consents & Regulatory 19 December 2019 and Policy & Planning committees, plus member of Ordinary meeting Taranaki Electricity Trust Deputy Chair 19 December 2019 Taranaki Health Foundation Board Member April 2020 Relative Taranaki DHB employee – Pharmacy 4 June 2020 Technician Te Pahunga Te Whare Punanga K ōrero Trust Chair 19 December 2019 (Marty) Davis Tuituia Trust Trustee 19 December 2019 Taranaki M āori Trust Board Trustee 19 December 2019 Ng āti Ruaiti Nukumaru Marae Trust Trustee 19 December 2019 Wai-o-Turi Marae Trust Trustee 19 December 2019 Meremere Marae Trust Trustee 19 December 2019 Tumararoa Properties Ltd Director 19 December 2019 Mental Health and Addictions Cross Sector Group Co-Chair 19 December 2019 Taranaki DHB Planning & Infrastructure Group Member 2 April 2020 Taumaruroa Co-Chair March 2021

Name of Member Interest Being Declared Nature of Interest/Transaction as it relates to Date of Interest Taranaki DHB (include positional or transactional interests, eg funding agreements, proposals and other relationships) Harry Duynhoven Taranaki Disability Resource Centre Patron 19 December 2019 Community Christmas Dinner Trust Patron 19 December 2019 Habitat Taranaki Board Member 19 December 2019

Member of several community organisations 19 December 2019

Nistelrode Trust – family trust ownership part share in Beneficiary 19 December 2019 house & bach

New Plymouth District Council Councillor 19 December 2019 Consultant – Part-time 19 December 2019 NZ Federation of Motoring Clubs President 19 December 2019 NP Model Aeroplane Club Patron 19 December 2019 Automobile Association Council (Taranaki) Member 19 December 2019 Board, Air Quality Asia (NGO, based in USA Sec retary 19 December 2019 NZCAA Board (NZ Civil Aviation Authority) Member 19 December 2019 David Lean Daughter is a Taranaki DHB employee 19 December 2019 Taranaki Regional Council Deputy Chair 19 December 2019 Rahotu Dairy Ltd Chair 19 December 2019 David Lean & Associates Ltd Chair 19 December 2019 Surf Life Saving New Zealand Life Member 19 December 2019 Cameron Clow Trust Trustee 19 December 2019 Return 2 Earth Ltd Shareholder and Advisor December 2020 Bioplant Manawatu NZ Ltd Shareholder, Company Director and Advisor December 2020 Bioplant Tairawhiti NZ Ltd Shareholder, Company Director and Advisor December 2020 Bioplant Waikato NZ Ltd Shareholder, Company Director and Advisor December 2020 Bioplant Hokitika NZ Ltd Shareholder, Company Director and Advisor December 2020

Name of Member Interest Being Declared Nature of Interest/Transaction as it relates to Date of Interest Taranaki DHB (include positional or transactional interests, eg funding agreements, proposals and other relationships) David Lean cont’d Bioplant Canterbury NZ Ltd Shareholder, Company Director and Advisor December 2020 Westland Industries for Sustainable Environment Charitable Trust – Member and Advisor December 2020 (WISE) Pauline Lockett Trustee P Lockett Family Trust Trustee 19 December 2019 Trustee of Taranaki Work Trust Trustee – no transactions and interest; noted only 19 December 2019 Te Tai Pari Trust – Waitara Perpetual Fund currently Chairperson 19 December 2019 known as ‘The Board’ (appointed June 2019) Ngati Te Whiti Whenua Topu Trust Advisory Trustee and Independent Contractor Te Hapai Hoe Trust Trustee Kevin Nielsen Conductive Education Taranaki Trust Adviser 19 December 2019 NPL Riding for Disabled President 19 December 2019 Hospice Taranaki Inc Lifetime Member Flourish Charitable Trust Committee Member March 2021 Paul Veri ć Kaitake Community Board Board member 19 December 2019 Oakura School Board of Trustees 19 December 2019 BTE Consulting Ltd Director 19 December 2019 PASS Ltd Director 19 December 2019 Wife holds following positions which are connected to 19 December 2019 Taranaki DHB work: • GP at Vivian Medical Centre (partner) • On call doctor for Med SAC

Name of Member Interest Being Declared Nature of Interest/Transaction as it relates to Date of Interest Taranaki DHB (include positional or transactional interests, eg funding agreements, proposals and other relationships) Carla White Health Literacy NZ Ltd Director - Nature of interest, working for health 25 August 2020 sector clients including contracts with: • Ministry of Health Population Health and Prevention - in partnership with Health Navigator NZ to provide Self-Management Support information and advice to primary care • Arthritis NZ - providing oversight for the evaluation of the Managing Gout Project • University of Auckland - Te Pae Herenga research project advisory group member (funded by Health Research Council); reducing antibiotic usage in primary care (research project) • Essence The Health Agency/Johnson& Johnson; Janssen-Cilag Ltd – developing information for mental health treatments • Waitemata DHB – HPV self-test study and Lung Screening Pilot • Te Pou Limited – providing national delivery of health coach training for Integrated Mental Health and Addictions in Primary Care Initiative includes providing training to health coaches from Tui Ora, Ngaruahine Health, Ngati Ruanui Healthcare (also covers Waitara Medical Centre, Parklands, Opunake Coastal Care, Eltham, Avon Medical Stratford) • Writing articles for NZ Medical Journal, NZ Pharmacy and NZ Doctor • ProCare (PHO) Limited health literacy plan implementation • National Hauora Coalition – training Diabetes Coaches

Name of Member Interest Being Declared • Nature of Interest/Transaction as it relates to Date of Interest Taranaki DHB (include positional or transactional interests, eg funding agreements, proposals and other relationships) Carla White cont’d • CARI (Caring for Australians with Renal Impairment) – working group to develop guidelines for working with M āori with chronic kidney disease • PHARMAC – writing and publishing information about gout • Auckland DHB – Cerebral Palsy Register TAS Pharmacy Expert Advisory Group Member – providing advice on the future of 19 December 2019 community pharmacy Ministry of Health Project to improve gout management in primary care March 2021 project

Prime Minister’s Chief Science Advisor’s Reference Infectious diseases and antimicrobial resistance March 2021 Group

Health Quality & Safety Commission Rewrite of health literacy guidance for the health March 2021 workforce Health Research Council Assessment Committee Member March 2021 Rosemary Family trust affiliated to Carefirst Trust Ltd Trustee - pecuniary benefits 19 December 2019 Clements (Chief Executive)

MINUTES – Open – (unconfirmed)

TARANAKI DISTRICT HEALTH BOARD

9 July 2021 11.10am Corporate Meeting Room 1 Taranaki Base Hospital

Present: Cassandra Crowley (Chair), Bridget Sullivan (Deputy Chair), Paul Verić, Alison Brown, Patsy Bodger, Harry Duynhoven, Kevin Nielsen, Carla White, David Lean and Pauline Lockett; via zoom – Te Pahunga (Marty) Davis

Board Observer – Jane Parker-Bishop

In Attendance: Rosemary Clements (Chief Executive), Becky Jenkins (GM Planning, Funding & Population Health), Beth Findlay-Heath (Communications Manager), Channa Perry (Executive Advisor), Lisa Varga (PA to Chief Executive), Megan Tahere (Chief Māori Health & Equity Officer – 11.30am), George Thomas (GM Finance & Corporate – 1.15pm)

1633.0 Karakia and Welcome The Chair welcomed attendees and a group Karakia was performed.

1634.0 Apologies Apologies were received from Mike Davey (Board Member) and Gillian Campbell (Chief Operating Officer.

1635.0 Conflict of Interest The Conflict of Interest register was received with the following to be noted: • Board Member, Patsy Bodger has resigned from her role with Tui Ora in Mokau and is no longer contracted to the DHB.

1636.0 Public Comment The Chair welcomed Lance Girling-Butcher as an attendee from the Positive Aging Trust and invited him to address to the meeting; the following comments were made: • Paid tribute to the Project Lead and the Consumer Engagement Advisor (Clinical Governance Support Unit) in relation to the Consumer Council, great communication lines have been developed. • Member of the Disability Action Group and impressed with the way the group was listened to during the design of the Acute Services Building; they are also being asked for input into the latest build. • Over 60 people attended the National Bowel Screening Programme presentation the Trust hosted recently. • Applauded the staff and facilities in the Emergency Department.

1637.0 Chair’s Comment • The Chair thanked everyone for allowing the meeting start time to be delayed. The national Chairs and Chief Executives were called to a conversation with the Prime Minister and Ministers Chris Hipkins and Andrew Little primarily in relation to the vaccination rollout. The Prime Minister is grateful for the work being done and the focus of the meeting was our readiness to mobilise when the extra vaccine is received. • People are asking about progress in the Transition Unit. The Unit publishes a regular newsletter that Board members are able to sign up to. The work is ongoing. • The Taranaki DHB Chief Executive is the Te Manawa Taki representative for Chief Executives working with the Transition Unit. • A good number of Expressions of Interest were received for both the Māori Health Agency and Health New Zealand boards. Announcements can be expected in September 2021. • RSV is having an impact on hospitals across the country who are already at a high level of acute demand.

1638.0 Minutes of Previous Meeting The minutes of the Taranaki DHB Board meeting held on 3 June 2021 were received and confirmed as a true and accurate record. Adopted.

1638.1 Action List The Action List was noted and an update provided from the Chief Executive: • Due to the Chief Operating Officer being an apology, the latest Ministry of Health Performance Report will be discussed at the August 2021 meeting to enable an in-depth discussion. The Board requested that areas where we are achieving better than our peers be highlighted along with areas where we need to improve. • A “meet and greet” with the Senior Medical Officers will be arranged following the August 2021 meeting. • An update in relation to gender view of our workforce will be presented in August 2021.

1639.0 Te Whare Pūnanga Korero Update A verbal update was provided by Te Pahunga (Marty) Davis: • The Chief Māori Health & Equity Officer and her Executive Assistant were introduced to Te Whare Pūnanga Korero (TWPK) at their June 2021 meeting. A large part of this meeting was spent discussing the health reforms. • Te Tiriti and Māori Health Equity Governance and Leadership Workshops in Rotorua were postponed due to the COVID-19 situation at the time. • A report was received from the Senior Consultant, Māori Health in relation to COVID-19 vaccinations and Project Maunga. • A job description for the Māori Project Manager has been developed and finalised. A memorandum is currently sitting with the Chief Executive relating to procurement for that role. • The kahui tikanga group visited the Mental Health Unit and met with the Mental Health Manager and the Manager – Community Mental Health. A report has been prepared of what was noted and TWPK are happy to share this with the Chief Executive. • There are a number of pieces of work being done in conjunction with Te Manawa Taki.

• On 12 July 2021 TWPK, Tui Ora Ltd and Te Kawau Maro are meeting with iwi chairs to provide an update on the health reforms. • On 14 July 2021 TWPK will be meeting in relation to the Annual Plan. • The Chair commented that Te Manawa Taki wide statutory committees was discussed at the last Board meeting. These would be made up of one representative from the Board and one from TWPK with the purpose being to embed relationships and strengthen iwi boards. Conversation needed about how this will be approached and to seek volunteers.

1640.0 Management Reports

1441.0 Chief Executive The Chief Executive spoke to her report with the following noted: • The Health and Disability Sector Standards audit was completed prior to the last meeting. The written report has been received, very pleased with the findings. There are a few things to be followed up. • Continue to do quite a lot of work in relation to cybersecurity and ensuring we are as safe as possible. Commissioning a national review to look at systems and let us know if there is anything we are missing. • Board to note the achievements leading to the bowel screening launch in August 2021.

1642.0 COVID-19 SITREP • The latest report was received and noted.

1643.0 Hospital & Specialist Services The report of the Chief Operating Officer was presented and discussed, noting the following: • It has been a busy couple of months in the hospital, volumes have remained very high. • Challenge with the planned care. • Credit to staff that cancellations are well thought through before cancelling. • The trend of increased births has continued. • Quite a lot happening in Mental Health as well, over 100% occupancy for most of the month. • The Board queried youth in crisis and the approach that is being taken. Youth contracts in the community have not been as successful as we would like. A project is being developed within Te Manawa Taki in relation to youth mental health, this will be a Māori lead project. The Chair commented that the Chairs have been having conversations with the Ministry of Health following recent media around the release of additional funding. Action: The GM Planning, Funding & Population Health will bring more information to the August 2021 meeting regarding mental health services for youth. It was also suggested that the Clinical Lead, Child & Adolescent Psychiatry be invited to speak at the August 2021 meeting. • The Board queried the Oral Health KPIs and the lack of data in relation to “chair utilisation”. • The Board noted it would be useful to see numbers as well as percentages and a bit more of a written update in relation to what is being done now and the next steps. • The Chair commented that TWPK and iwi chairs need to see this is an area in which we are struggling and failing. Think about how we partner better with Te Kawau Maro partners and how we can change it.

• The Chief Māori Health & Equity Officer commented that enrolments do not necessarily convert into children getting oral health assessments on time, it is multifaceted. Aware of underlying issues in relation to the workforce and also aware of the need to look at a better way to coordinate engagement with whānau. Action: The Director of Allied Health is to be invited to attend along with Oral Health partners to answer some of the Board’s questions.

1644.0 People & Capability (Human Resources) The report of the GM People & Capability was presented and discussed, noting the following: • There has not been a huge shift in this report since the last Board meeting. • Key priorities for the team at the moment are around providing wellbeing support to leadership and nursing. • Looking to increase “my feedback” rates. The priority is to look at corporate areas and those less impacted by winter pressures. • The GM People & Capability is looking forward to working with the Chief Māori Health & Equity Officer and her team around recruitment and advertising to gain more insight into the Māori community. • Seeing better outcomes in relation to unprofessional behaviour. It is notable in HR that people feel safe to say they are having a problem and asking what their options are. • The Board would like to understand the extent to which clinicians are skilled and adept at being empathetic to patients. Keen to understand in the “deep dive” to be presented at the October 2021 meeting, what training staff are receiving in regard to equity and culture from an ethnicity perspective and a socio-economic perspective. Action: A report being developed by the Chief Medical Advisor and GM People & Capability looking at how to deal with clinical equity will be brought to the October 2021 meeting.

1645.0 Planning, Funding & Population Health The following reports prepared by the GM Planning, Funding & Population Health were received and noted: o Planning & Funding Report – July 2021 o Progress on Annual Plan Activities 2020/21 – Quarter 4 - Appendix 1 – Annual Plan 2020/21 Performance Metrics • Currently in the midst of contracting. Annual planning/funding advice and timing has been challenging; working through this with our NGO providers. • Childhood immunisation is showing deterioration across the country, level of concern with a “call to action” piece around translating the action plan into something tangible and catching some children who are delayed with their childhood immunisations. The Board queried the number of children with delayed immunisation; the GM Planning, Funding & Population Health thinks this affects about 100 children. • The new laboratory service has been operational for nearly a year, positive movement in the service. The current location is providing comprehensive laboratory services to the community. • The second tranche of funding for the Te Manawanui practitioners and health coaches in the region will enable us to expand the service further.

• The Board commented that in relation to the Diabetes Kaitautoko, there is awareness of dissatisfaction in the community with GPs and queried if there was a self-referral system to some services. The GM Planning, Funding & Population Health responded that the new rules have not yet been worked through however self-referral might be something to consider for the Mental Health practitioners and/or diabetes.

1646.0 Māori Health & Equity Directorate The report of the Chief Māori Health & Equity Officer was presented noting the following: • Representatives from the Transition Unit were in New Plymouth on 17 June 2021; 33 people in attendance including Māori service providers and iwi representatives. • The GMs Māori are getting regular 30-40 minute hui with the Ministry of Health and Transition Unit for updates. • Taranaki DHB is only meeting one of 13 Māori Health priority measures, this is in relation to workforce.

1647.0 Financial Reports The report of the GM Finance & Corporate was received and discussed with points of interest noted below: • The 2020/21 financial year completed on 30 June 2021, waiting for information from the Ministry of Health. Hopeful at the end to be able to match some of the expenditure that has been in excess of the budget, should receive more clarity next week. • The cashflow struggles experienced over the last few months in relation to Project Maunga Stage 2 have been resolved with the Ministry paying us in advance of the costs being incurred. • The Board queried the 12 FTE short of budgeted figures within Allied Health. Action: Paper to be presented at the September 2021 meeting showing the vacancies within Allied Health over the last 24 months and what they were comprised of.

1648.0 Presentation – Kaitautoko (Mental Health Coaches) Warren Nicholls, Business Manager & Whānau Ora Practitioner – Ngāruahine Iwi Health Services and Hayley Arnet, Kaiwhakahaere Kaupapa – Senior Project Manager (via zoom) presented to the Board. • In 2016 the Pinnacle Midlands Health Network looked at ways to reshape primary mental healthcare. • Funding was made available through an RFP process. • Te Tīriti o Waitangi is the foundation on which the programme works. • Te Manawanui wraps services around any whānau in distress and is largely an adult service however there is an expansion service across Te Kawau Maro which is more fit for purpose for youth. • Need to ensure every practice has the ability to access the service across Taranaki. Phased approach so not all practices have access currently.

The Board noted the presentation and thanked the team.

1649.0 General Business

1650.0 Taranaki DHB Working Groups Update

1650.1 Infrastructure & Planning Working Group • One thing of note that was not included in the written update is the change of personnel – the new Associate Programme Directors (who replace Ian Grant’s role as Programme Director) commenced mid-June 2021 and the transition has gone smoothly. • The Associate Programme Directors will attend the August 2021 meeting for introductions and to provide a project update.

1650.2 Disability Working Group • Thanks were passed to the Director of Allied Health and the Consumer Engagement Advisor for the work involved in developing the Accessibility Action Plan. • Keen to find out what KPIs services are working towards and how Taranaki DHB compares for non-urgent referrals for a child diagnosed with a disability. Discussion amongst the Disability Working Group about what is a disability e.g. fetal alcohol syndrome is not classed as a disability. Action: The Accessibility Action Plan will come to the August 2021 Board meeting for endorsement.

1650.3 Community & Primary Working Group • List of upcoming community meetings provided offering Board members the opportunity to attend.

1651.0 Hospital Campus

1651.1 Roading • The Board queried the roading around the campus and the uptake of the park and ride shuttle by staff. The Chief Executive commented that the shuttle service would undergo a review three months from the start date.

1651.2 Signage • The Board commented that the signage for the “red path” to guide patients from the bottom carpark into the building needed to be made more prominent. The Chief Executive will follow this up.

1652.0 Next Meeting Friday, 27 August 2021 – Taranaki Base Hospital

1653.0 Exclusion of Public The Taranaki District Health Board moved into closed and in reliance on Schedule 3, of the New Zealand Public Health and Disability Act 2000 and the particular interest(s) protected by clause 32 Schedule 3 of that Act and/or sections 6, 7 and/or 9 of the Official Information Act 1982, would be prejudiced by the holding of the whole or relevant part of the proceedings of the meeting in public, and in particular: 1. To present Taranaki District Health Board – Board minutes pursuant to an earlier resolution publicly excluding the item. 2. To present Chief Executive Report/Financial Report and attachments; Internal Audit report in that the public conduct of the meeting would be likely to result in the disclosure of information where the withholding of the information is necessary to: (g) Enable the DHB, Board or Board Committee holding the information to carry out, without prejudice or disadvantage, commercial activities. (h) Enable the DHB, Board or Board Committee holding the information to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations).

TDHB Board Meeting (Open) Task List as at August 2021 Action Date (next Date Raised Action Description Status Assigned Due Date Updates By Whom Completed no 126) 125 July 2021 Accessibility Action Plan for endorsement. WIP GM P&F August 2021 On agenda August 2021 GM P&F 124 July 2021 Report showing vacancies within Allied Health within last WIP COO September COO 24 months. 2021 123 July 2021 Report into training staff receive in regard to clinical WIP CMA October 2021 CMA equity and culture. GM P&C GM P&C 122 July 2021 Director of Allied Health along with Oral Health partners WIP COO September COO to be invited to attend a future meeting to answer some 2021 of the Board’s questions. 121 July 2021 Information on Mental Health services for youth to be WIP GM P&F August 2021 GM P&F provided. 120 July 2021 Clinical Lead, Child & Adolescent Psychiatrist to be WIP PA to CE August 2021 Due to availability, PA to CE invited to the August 2021 meeting. will attend the September 2021 meeting 106 January 2021 Report in May/June 2021 in relation to gender WIP GM P&C July/August August 2021 GM P&C disparities; particularly in senior positions and what are 2021 we doing to encourage women into these roles. 101 January 2021 Next sustainability report to include a summary of the 12 WIP SRO July 2021 To be presented to September SRO actions and timeframes towards zero carbon target. Infrastructure & 2021 Planning Working Group 87 September Planned Care performance report from Ministry of Ongoing COO From October Latest report to be August 2021 COO 2020 Health 2020 presented • To be included in future reports. 82 September Specialist vacancies within Provider Arm WIP COO To be JCC Report Included in GM P&C 2020 • Vacancies in vulnerable services - ENT, Psychiatry provided each regular and Psychology. Report to be provided on month until reporting recruitment progress. vacancies fill 77 August 2020 Financial Results – early (email) advice when financial WIP CE Ongoing Update email sent Business as CE results become available. August 2021 Usual

BOARD REPORT

For: Key questions the Board should consider in reviewing this paper: Approval • Does the report provide a useful update on Discussion local, regional and national matters? • X Noting Are there any areas of the report that you would like further information on?

To TDHB Board • Are there any additional matters that should be included as routine items in future updates? Author Rosemary Clements, Chief Executive

Endorsed by

Date 19 August 2021

Subject Chief Executive’s Report for August 2021

RECOMMENDATION It is recommended that the Board: • Note the update of key local, regional and national matters.

BOARD REPORT

1. PURPOSE

To provide the Board with an update of key local, regional, and national matters. No decision is required.

2. LOCAL MATTERS

Independent Review of Taranaki DHB security capability and capacity

Stoks Limited was recently commissioned to undertake an independent review of Taranaki DHB’s security capability and capacity. The review included an assessment of the DHB’s current security processes and practice against current good practice; a gap analysis indicating strengths and weaknesses in security arrangements; and identification of any security matters that should be considered for continuous improvement. This included a desk top review of relevant documentation, interviews with management and staff, site visit assessments and development of an implementation plan for future security improvements. The review was completed in August and recommended a number of immediate, short term and longer term actions (below) to improve security and safety. The Executive Leadership Team (ELT) will provide oversight of the process to implement these recommendations over the next year.

BOARD REPORT

Whakarongorau Aotearoa NZ Telehealth Services

Taranaki DHB’s Mental Health and Addiction Service’s Assessment and Brief Care (ABC) Team have partnered up with telehealth service Whakarongorau Aotearoa NZ to provide support for people who need rapid access to mental health and addictions support. As well as providing faster telephone responses, this partnership will enable ABC clinicians to spend more time working face to face with people in crisis and with high levels of distress.

Whakarongorau Aotearoa is an experienced provider of many telephone based health services, including the ‘1737 Need to Talk’ mental health support line and already provide the same service to 11 other DHBs. They employ experienced mental health and addiction clinicians who will carry out a brief initial assessment over the phone and either liaise with the ABC team as soon as they are available or redirect the caller to a service more appropriate to their needs.

The service, which was launched at the start of August, will provide much needed capacity to the ABC Team, particularly outside of office hours when the team consists of two clinical staff covering all of Taranaki. The team is often busy, travelling long distances and outside of mobile phone coverage. At times this has meant they have been unable to answer their phone immediately which can be distressing for people seeking help. The new service will ensure all calls from people in Taranaki seeking urgent mental health support are answered in a timely manner, provide faster appropriate responses to people’s needs.

Hepatitis C Awareness Week

In recognition of World Hepatitis Day (28 July) the Taranaki Hep C Action Network ran a number of hepatitis C testing pop-up clinics at Base and Hāwera hospitals, the DHB Alcohol and Drug Unit, New Plymouth’s Needle Exchange and Community Probation Service. More than 90 people were tested with three new positives and two existing cases identified.

It is estimated that there could be up to 1250 people in Taranaki with hepatitis C, but more than half of them are unlikely to know that they are unwell. 537 people in Taranaki have been diagnosed with hepatitis C and the Taranaki Hep C Action Group has spent the last 3 years focusing on ‘finding, testing, treating and curing people’. This includes a number of initiatives including staff education, targeted testing and raising community awareness. New Zealand, along with 194 other countries, have signed up to eradicate hepatitis C by 2030 however one of the biggest challenges to achieving this is the stigma of hepatitis C being associated with drug abuse which prevents people coming forward for testing.

BOARD REPORT

Flu vaccination

Several local flu vax champions have generously shared their names and faces with us to help influence others in the community with a focus on increasing flu vaccination rates for Māori. These champions have appeared on posters around the maunga and on social media. The campaign is a collaboration between the DHB, Ngāti Ruanui Healthcare, Ngaruahine Iwi Health Service, Tui Ora and Pinnacle Midlands Health Network.

We are also encouraging people to register with FluTracking at https://www.flutracking.net/Join . The Flutracking project is an international partnership of health agencies which runs an online survey that asks if you have had fever or cough or other symptoms in the last week. The survey takes just 10-15 seconds to answer and is sent via email each week. The data collected via the Survey is used to help track the spread of influenza-like-illness and COVID-19 in New Zealand and provide early warning of potential outbreaks and monitor trends during pandemics

Project Maunga

Building work around the hospital site continues to progress, including the recent demolition of the Base Hospital main entrance. The front entrance canopy, complete with entrance sign still attached, needed to be taken down. The whole front foyer will be demolished and then rebuilt complete with base isolation and links between the ASB and the New East Wing building. Reconstruction of the Mobility Garden (previously located to the right of the main entrance) is also underway outside the Base Hospital cafeteria. Meanwhile, we have been receiving a lot of positive feedback about the park and ride shuttle service with staff saying the service is easy to use, the drivers are friendly and it’s a great way to get to work.

BOARD REPORT

COVID-19 Update

2.6.1 COVID-19 Response

In response to Alert Level 4 the DHB has activated our Incident Management Team (IMT) and Hospital COVID-19 Response Group to respond to the outbreak situation. There are currently no COVID-19 cases in Taranaki, but we anticipate case numbers to increase throughout New Zealand over the coming days and our mission is to keep Taranaki free from the virus. Meanwhile, there has been a significant increase in the number of people accessing COVID-19 testing centres around Taranaki with over 500 tests completed on the first day of lockdown (18 August). Testing centres are currently operating in New Plymouth, Hāwera, Opunake and Waitara.

Prior to the recent outbreak in Auckland, the DHB and Taranaki Public Health Unit had been working with the Ministry of Health after ESR reported a positive COVID-19 test result from a wastewater sample in New Plymouth on 24 July. Based on previous incidences, it is most likely that the two positive wastewater results were due to recently recovered cases continuing to shed the virus. The COVID-19 IMT was stood up, along with additional COVID-19 testing capacity to support an increase in testing. Between Wednesday 21 July and Tuesday 27 July 1,082 swabs were taken in Taranaki. No positive tests were reported and further wastewater testing showed no further detection of the COVID-19 virus.

2.6.2 COVID-19 Vaccination Programme Update

The COVID-19 Vaccination Programme is progressing well in Taranaki with vaccinations now being opened to those aged 50 and over. In line with Government guidance, the time between doses has now been doubled from three to six weeks. The two main hubs continue to operate in New Plymouth and Hāwera along with outreach clinics being delivered by Tui Ora and Ngati Ruanui. A number of GP practices and community pharmacists are also providing vaccinations. A mass vaccination event held in Stratford on 6-7 August was hugely successful with 2,395 people vaccinated. Feedback has been really positive with those who attended commending the DHB on how well the event was run. Mayor Neil Volzke was first to be vaccinated at the event which attracted people of all ages across the district.

BOARD REPORT

Consultation was recently undertaken with rural communities around Taranaki including Mokau, Whangamomona, Patea, Kaponga and Okato to help inform planning of a rural outreach programme. There was a positive response to this engagement, along with the offer of a number of community halls as venues for vaccination pop-up clinics. The key message from rural communities was that outreach vaccination clinics in rural halls, particularly those in more isolated communities, would be welcomed by rural farm workers who work long hours and who may otherwise not access a vaccination centre. The rural roll out programme will be developed in the next month and shared through rural networks.

In the meantime, the vaccination team has responded to the Level 4 lockdown by ensuring vaccinations can be delivered in a safe way that enables social distancing. In response to the cancellation of the Nursing and Midwifery Strike the opportunity was taken to deliver COVID-19 vaccination to essential health workers and their families on the Taranaki Base and Hawera Hospital sites on 19 August to ensure we lost as little time as possible from our vaccination programme. This was further supported by primary care continuing to deliver vaccinations over the first two days of the lockdown.

NZNO/MERAS Strike

Following the Midwifery Employee Representation and Advisory Service (MERAS) midwives’ strike on 10 August, Taranaki DHB began contingency planning for further strike action by nurses and midwives who are part of the NZNO and MERAS Union on Thursday 19 August. As a result of the Level 4 lockdown, the strike notice was withdrawn by NZNO and MERAS on Wednesday 18 August. Talks are ongoing at this stage.

Community response to Acute Drug Harm incidents in Taranaki

NZ High Alert, the national drug information and alert system, recently issued a warning regarding a particularly dangerous ‘batch’ of synthetic cannabinoids (also known as synthetics or synnies) in the Taranaki region. The High Alert notification, coordinated by NZ Police and Ministry of Health, advised of two acute drug harm incidents, one death and a serious hospitalisation likely linked to the synthetic cannabinoid, 4F-MDMB-BICA. Since then, there has been a second death also thought to be linked to synthetic cannabinoids.

The DHB is working with the Ministry of Health Addictions Group on developing an acute drug harm response which will build on the recently established community drug and alcohol service based in Waitara. One of the options being considered is the delivery of an outreach service to other parts of Taranaki where incidents of synthetic drug related harm have been reported. The New Zealand Drug Foundation has also offered support with developing a comprehensive community response. BOARD REPORT

Bowel Screening Programme - Official Launch

Taranaki’s Bowel Screening Programme is finally underway after it was officially launched by the Minister of Health, Andrew Little, at Base Hospital on Friday 13 August. Taranaki DHB is the 18th DHB to offer free bowel screening as the programme is rolled out around the country. More than 21,000 Taranaki residents aged 60 – 74 will be offered a free screening test starting this month.

An incredible amount of work has gone into the planning and implementation of this programme, and I’d like to thank everyone who has worked over and above to create capacity for the projected increase in demand that bowel screening will bring. Key people involved include Dr Louise Tester (Project Manager), Kareen Mcleod (Bowel Screening Clinical Nurse Specialist), Dr Tom Boswell (Clinical Lead), and Dr Nadja Gottfert - Primary & Secondary Integration Advisor.

Taranaki expects to screen about 6,500 people annually and to find about 26 new early colorectal cancers in the first year of screening. The programme is for people who don’t have symptoms, because bowel cancer is slow growing and can go unnoticed for a long time. Since starting in 2017 more than 396,000 people have participated and more than 1000 have had cancer detected – most unaware they had it.

Health Minister visit to Salvation Army

Health Minister, Hon Andrew Little and Glen Bennett, MP, visited the Taranaki Salvation Army as part of their visit to Taranaki to launch the Bowel Screening programme. They spoke with Peer Recovery Coach, Marino Hiha, to find out more about the transitional support service that was established in September 2020 to provide wrap around support for clients leaving the residential rehabilitation programme. Shane Smith, Service Manager, also talked about the impact that funding increases to residential addiction services as part of Budget 19 has had in increasing volumes of clients through the service. Manu Matthews, AOD counsellor delivering the 4Waitara Acute Drug Harm service, joined the group to share his experience of providing addiction counselling in Waitara. The 4Waitara service, which is funded by the Ministry’s Acute Drug Harm Discretionary Fund, is typically accessed by clients who have not previously engaged in Alcohol & Drug services, over half of whom are Māori.

BOARD REPORT

Taranaki DHB Consumer Council

Work to establish the inaugural Taranaki Consumer Council is progressing well and recruitment for consumer representatives to sit on the council is underway. The Consumer Council will comprise of 16 members and is based on a Te Tiriti partnership model (Te Whare ō Tiriti o Waitangi). The Council will incorporate two whare (Te Whare ō Tangata Whenua and Te Whare ō Tangata Tiriti) each with eight members. Mary Bird (Project Lead Consumer Engagement) and Jake Mills (Consumer Engagement Advisor) have initiated the recruitment of council members, and will now work with the Chief Māori Health and Equity Officer and Te Whare Punanga Korero on the selection process. The selection process has a strong equity focus and will ensure representation by Māori, young people, people with disabilities and rural communities. The Consumer Council will play a key role in ensuring patients have a good experience across all services by seeking feedback on service design and delivery issues.

Taranaki DHB Annual Report

Deloitte were on site for 2 weeks beginning 2 August 2021 carrying out the annual audit relating to our non-financial measures and reporting. Work is still ongoing on the Annual Report 2020/21 and once we have a version available for the Board to review we will advise by email and add it to the Resource Centre on Board Books.

The final date for submission to the Ministry of Health is 8 October 2021.

3. REGIONAL MATTERS

Regional governance arrangements until 30 June 2022

Te Manawa Taki DHB Chairs are currently working on the development of a regional governance model for the next year to support the transition period. A regional subgroup has been established to develop a proposal. The focus of the proposed regional governance structure will support a model that can be used into the future to support regional governance across Te Manawa Taki.

BOARD REPORT

4. NATIONAL MATTERS

Holidays Act

DHBs, like many organisations in New Zealand, have been dealing with the issue of how to identify and rectify Holidays Act non- compliance. Resolving these historic pay issues is a priority for DHBs working alongside unions. The Ministry of Health has appointed KPMG to establish and deliver a National Programme Management function to support the District Health Boards and NZ Blood Service in the successful delivery of the Holidays Act 2003 review, rectification and remediation work currently in progress.

The intent of the review, rectification and remediation activity is to ensure that current and former DHB employees are paid according to the legislation regardless of their employee status, role or working pattern. KPMG will work with the DHBs and key stakeholders at a national level to coordinate the sequencing and timeline of activity across the DHBs and assist with the timely delivery of the various independent Holidays Act Remediation projects that are underway nationally. The DHBs and the NZ Blood Service will remain responsible for the independent calculation and testing of remediation payments as wellas the rectification of underlying payroll systems and processes.

The National Programme Management function has been established and engagement with key stakeholders across MoH, DHBs, HSRA and unions is underway.

DHB Sale and Supply of Alcohol Act 2012 Position Statement

A position statement calling for an urgent review to the Sale and Supply of Alcohol Act 2012 was agreed at the DHB Chief Executive and Chairs’ meeting in August. The position statement paper outlines a number of specific changes and also calls for a number of broader changes to address alcohol related harm and its inequities. The Paper briefly summarises the Act, outlines some of the problems and deficiencies in the current Act, and proposes recommended changes to the Act in order to better address alcohol related harm. This follows on from an earlier paper to DHB Chairs and CEs summarising the gaps and opportunities for DHBs to address alcohol related harm.

The Sale and Supply of Alcohol Act 2012 is widely acknowledged to have failed in its objective to minimise alcohol related harm. In a recent media statement Minister of Justice Kris Faafoi has expressed a willingness to review the Act. It is understood that this is likely to be a mid-range review focusing on amending the current Act rather than a full review of the Act.

The position statement agreed that the top priorities for changes to the Act should be:

• Give effect to Te Tiriti O Waitangi in alcohol legislation BOARD REPORT

• Reduce the harm from high alcohol availability • Reduce the harm from alcohol advertising and sponsorship • Reduce the harm from cheap alcohol The intention is that DHBs collectively adopt the position statement in order to begin advocating for a modification and strengthening of the Act and eventually a full review of the Act. It is crucial to use this opportunity to position alcohol law reform as a key public health issue that offers significant potential to improve Māori health gain and reduce alcohol harm inequities. It is also intended that this position statement is circulated with health leaders and others to build consensus on the scope of the review.

Smokefree Aotearoa 2025 Goal

The DHB Chief Executive and Chairs’ meeting in August considered a decision paper from Nick Chamberlain (Lead CE for Public Health) in response to a draft discussion document released by Government in April 2021 on a national plan for achieving the Smokefree Aotearoa 2025 Goal. The plan recognises the importance of ongoing evidence based interventions to encourage more cigarette smokers to make more quit attempts more often through mass and targeted media campaigns supported by the wider availability of cessation support including the use of reduced harm products. The plan proposes key actions aimed at restricting access to tobacco products, reducing their affordability and enhancing existing initiatives.

The paper called on DHB CE’s to agree the following:

• Full implementation of the Smokefree Aotearoa 2025 Action Plan • Development of an investment plan for stop smoking services • Fully support the MOH in future funding bids for stop smoking services • Review DHB tobacco control expenditure and ensure that this is being optimally used • Review local stop smoking pathways and services locally and support development of local plans to deliver a fourfold increase in the number of smoking quitters • To advocate to Pharmac to reduce the cost of nicotine replacement therapies (NRT) • Mental health and addiction service users being added to priority populations for stop smoking services due to the very high rates of smoking and within this population CE’s agreed to bring the decision paper back to their respective DHB Boards for further discussion before making a decision.

BOARD REPORT

5. EXECUTIVE LEADERSHIP TEAM AND STAFFING MATTERS

Resignation of CIO/Appointment of Interim CIO and Senior Responsible Officer for COVID-19 vaccination

I’d like to take this opportunity to thank and farewell one of our Executive Leadership Team members, Steven Parrish, who held the roles of Chief Information Officer (CIO) and most recently Senior Responsible Officer (SRO) for the COVID-19 Vaccination Programme. Steven is moving back to Australia with his family to work for Dedalus APAC as Principal Senior Medical Expert/Chief Medical Information Officer.

Steven has led our DHB through some extensive technology changes and modernisation, including programmes in clinical business intelligence, cybersecurity, eMeds and Project Maunga. He was also the CIO lead for our Te Manawa Taki region. Steven has been a great asset to our DHB, challenging our thinking and advocating for not only IT solutions which would enhance our way of working, but beyond this how we could work together to improve as an organisation.

I am pleased to advise that Amber Erueti, who has been acting CIO while Steven undertook the SRO role, has agreed to continue as Interim CIO. Meanwhile we welcome back Bevan Clayton-Smith to Taranaki who will take over as SRO for the vaccination programme on 6 September. Bevan has recently been Incident Controller in Waikato DHB leading the COVID-19 and cyber-security responses.

Review of Te Pā Harakeke

A change process has been initiated to review the management and organisational structure of Te Pā Harakeke, Māori Health and Equity Directorate to enhance the contribution of Te Pā Harakeke to leading the development, implementation, and refinement of Tiriti o Waitangi-led (Tiriti-led) and pro-equity approaches across the DHB. Consultation is currently underway with impacted staff and the outcome of this process will be communicated in coming weeks.

New Zealand Medical Council accreditation audit

A number of Taranaki DHB staff participated in the recent New Zealand Medical Council prevocational training accreditation audit for which the DHB received some really good feedback, especially around Resident Medical Officers (RMO) wellbeing support and the DHB providing support and opportunities for professional training and education programmes. A lot of time and hard work went into planning, preparation and participation which was noted by Council members who wanted to pass on their gratitude to everyone involved. BOARD REPORT

The Council has also provided some focus areas for review and improvement, but overall the feedback was very positive and all staff should be proud of how our DHB works together to provide quality services for our patients and wider community while supporting the training and development of our staff entering their professional career pathways. Special thanks are due to Jonathan Albrett (Director of Clinical Training), Taryn Hall (Education Coordinator), Jackie Sewell (RMO Support Unit Manager) and the RMO unit team.

Workplace wellness

High patient load, high acuity and the seasonal demands associated with winter illness have placed significant pressure on our organisation in recent weeks, particularly with the additional challenges caused by RSV and the impact of this on our paediatric ward. Supporting staff to maintain wellness, especially in the face of these recent challenges, is a high priority. One initiative to assist this is through a Wellbeing Dashboard on our intranet. The Dashboard provides wellbeing tips, resources and leadership support and is supported by initiatives across our sites such as ‘Wellbeing Walls’ that provide health information for staff.

This is part of a newly developed DHB Health and Wellbeing Strategy that comprises 5 ways to wellbeing: Personal Health; Better work practices; Korero/Communication; Arahitanga/Leadership; and Tikanga/Culture & Values.

COMMUNICATION & ENGAGEMENT JUNE/JULY RAISE THE Could it be FLAG Sepsis? Trust NZ

If you’ve noticed these symptoms raise your voice and raise the flag - it could be a serious infection. Call 111, tell them what’s happening and ask “Could it be Sepsis?” 20 31 proactive reactive 8 21 media media 7 COVID-19 vaccine projects/campaigns releases releases media interviews newsletters

6 3 6 148 internal Dose chief executive videos radio adverts intranet notices newsletters PROJECTS JUNE/JULY

World Hepatitis Day 2021 How much do you know about hep C?

Scan the QR code below to take the quick quiz and be in to win a gift pack

www.tdhb.org.nz > Services > Hepatitis Winner drawn on Monday 2 August 2021

Celebrating 100 years of oral National Bowel Screening Hep C awareness health for children Programme

THE BEST PROTECTION

FOR YOU, YOUR COLLEAGUES, THE BEST PROTECTION PATIENTS AND WHĀNAU FOR YOU, YOUR COLLEAGUES, PATIENTS AND WHĀNAU “We get vaccinated to lead by example and help keep our people safe”

- Doctors Reagan and Moerangi

“I get vaccinated to protect those I go home to”

Get your free healthcare workforce influenza vaccination this season. See your peer vaccinator or head to a drop-in clinic asap.Get your free healthcare workforce influenza vaccination this season. See your peer vaccinator or head to a drop-in clinic asap. Ngāti Ruanui Healthcare

Ngāti Ruanui Healthcare

COVID-19 vaccine Influenza - staff and public Go Zero Carbon Week SOCIAL MEDIA – BEST PERFORMING FACEBOOK POSTS JUNE/JULY

SOCIAL MEDIA MEASUREMENT

Reach The number of people who had content from or about our page enter their screen.

Reactions Likes, sad, shocked, angry, funny e.g.

Engagements The number of times the post had someone interact with it, such as reacting to the post, posting comments, reacting to comments, sharing the post, etc.

19 August 2021

Current status of COVID-19 outbreak as at 2pm, 19 August There are now 21 positive community cases of COVID-19 recorded so far in New Zealand. Cases in the cluster are linked to a returnee from Sydney who arrived on an MIQ flight on August 7. Nearly 70 locations of interest have been identified so far. Taranaki currently has no COVID-19 cases or locations of interest.

Face coverings now mandatory in most public places Face coverings are now mandatory for all people (employees and customers) at businesses and services operating at Alert Level 4, including hospitals, healthcare facilities, pharmacies, supermarkets and petrol stations. Face coverings remain mandatory: • on public transport and at departure points, e.g., train stations, flights and bus stops • in taxi or ride-share vehicles (drivers and passengers), and • for visitors to healthcare facilities. Current exemptions for face coverings include for people aged under 12 or with illness, conditions or disabilities that make wearing them unsuitable.

Taranaki testing update Around 500 COVID-19 tests were completed in the region yesterday, this includes swabs taken at local testing centres, GP clinics, outreach in our community, and in our hospitals. High volumes of people being tested continues today with 160 swabs taken just at Base Hospital’s testing centre this morning. Further test data will be available tomorrow. Advice remains the same; anyone who has visited one of the locations of interest, or has any cold or flu-like symptoms should get a COVID-19 test. Anyone who is tested is required to isolate until they receive a negative test result. Our testing centres are open throughout the region in New Plymouth, Hāwera, Opunake and Waitara. For more testing information please visit TDHB - COVID-19.

Base and Hāwera hospitals We continue to run emergency services for people who need urgent treatment and care. We are still encouraging people to ‘Save ED for Emergencies’ and seek help for non-urgent issues from their GP, emergency walk-in clinics like Phoenix or Medicross, visit a pharmacy or call Healthline on 0800 611 116. Any visitor to our hospital campus is expected to wear a face covering, including contractors, suppliers or those who are supporting a patient in maternity or the children’s ward. Please help keep everyone in our hospitals and healthcare centres safe by following health hygiene protocols.

Primary and Community Services Primary care and community services have reviewed how they will operate under Alert Level 4 and this is attached to this update as a PDF document. This table provides the latest update on the service continuity arrangements in place across local community and primary service provision in response to the COVID-19 Alert Level 4 rating. Essential services are being maintained but there is change in the way many of the services are being delivered, including a move to telephone and online contact where possible and appropriate. GP and nurse telephone triage, patient portals, repeat prescriptions, email and video consults are already used by many health providers to help patients receive the care they need without having to see their doctor in person. Patients, who need face-to-face appointments with their GP team will still have access to these.

Taranaki’s vaccination hubs re-open on Friday 20 August The main vaccination hubs in New Plymouth and Hāwera are open again tomorrow, Friday 20 August, so please attend as normal if you have a booked appointment. There will be reduced numbers to allow for social distancing, and if your appointment needs to be re- scheduled you will be contacted. Vaccination appointments at GP clinics and pharmacies Vaccination appointments at GP clinics and pharmacies are running as planned, but under Level 4 restrictions. You will be contacted if your appointment time needs to be changed, otherwise please attend as booked. Community Vaccination Clinic - Stratford The clinic in Stratford will be open this Friday and Saturday, but with reduced numbers and under Alert Level 4 restrictions. Some people may have been contacted with a request to change the time of their appointment so we can ensure social distancing is observed. If you’re attending this clinic; • Please do not arrive early – we’ll only be permitting entry to the clinic 10 minutes before your appointment time. If you arrive early, we’ll ask you wait in your car. • Please do not bring children with you. • Those who need assistance to receive their vaccination can bring a single support person. Further assistance will be available from clinic staff. Remember your face covering You MUST wear a face covering and observe all social distancing and hygiene protocols (such as using hand sanitiser) when attending your vaccination appointment. Thank you!

Tangihanga at Alert Level 4 To help prevent the spread of COVID-19, gathering for public funerals and tangihanga is not permitted while New Zealand is at Alert Level 4. Bereaved whānau from all cultures and backgrounds will find this time challenging, particularly those living in Auckland/Tāmaki Makaurau or the Coromandel. This makes it even more important to show each other manaakitanga and aroha. If someone in your whānau or in your bubble passes away, the following steps can help you make the necessary arrangements: • Contact the health provider/doctor of the person who has passed away — ideally this should be done by someone in the same bubble. • Get in touch with a local funeral director who will help you organise next steps. Funeral directors will continue working during Alert Level 4 and will be able to guide you on the best options for your situation, which may include: • livestreaming services on social media, or videoing them for later viewing • holding the funeral or tangi after the Alert Level 4 restrictions ease • holding a memorial service later when restrictions on hui are lifted and it is safe to do so.

- Becky Jenkins, Incident Controller, Incident Management Team

Thursday 19 August 2021

What does Alert Level 4 mean for us? A range of measures have been put in place at level 4 to ensure our safety, including people staying at home (unless they’re essential workers), all schools and businesses closed (except for essential services), limited travel and major reprioritisation of healthcare services. At Alert Level 4, Taranaki DHB is cancelling all hospital appointments, including surgery, but will continue to run urgent and emergency services for those who need our help. Visitors are fully restricted in Level 4 (just one support person for patients on maternity and children’s wards and compassionate exceptions) and main entrance security is back in place at both Base and Hāwera hospitals.

Staffing We’re asking all essential workers to attend work as usual, unless you’ve been to a location of interest or have COVID-19 symptoms. If this is the case, please get tested and isolate at home. Most of you will have had contact with your team leader or line manager advising what is expected, but if you’re still unsure please touch base with them. Non-essential workers are being asked to stay home. This may mean working from home, but all non- clinical staff please confirm with your manager. For some roles we may need to deploy you and this will be a conversation with your manager. We’re currently waiting for national guidance about employment related matters during Alert Level 4 but in the meantime talk with your manager. We are updating employee information after the last COVID-19 Alert Level 4, including vulnerable staff, vaccination, and FIT testing status. If your vaccination status has changed recently please let your manager know. If you have employment related questions please talk with your manager or contact the HR helpdesk on ext 8827 or [email protected]

Face coverings The Government has mandated that all people over the age of 12+ wear a face covering when in public. Staff : Any staff who are unable to work at a 2metre spatial distance while doing their job must wear a mask. Patients : Where able patients should wear masks but we recognise this will need clinical discretion. Visitors : Support people and any visitors must wear a face covering when on-site.

Cafeteria and groups The cafeterias at both Base and Hāwera hospitals will remain open, as well as Espresso Alley, but for takeaway food and beverages only. There is no seating provided so please take your food back to your department. Staff are reminded to keep up their spatial distancing and not congregate in any areas.

Testing advice We encourage anyone in Taranaki with flu like symptoms who has been to a location of interest to get tested. For information on testing centres visit: https://www.tdhb.org.nz/covid19/public.shtml COVID-19 tests are free and results are usually back to you within 2-3 days. Stay at home until you get a negative result and it’s been 24 hours since you’ve had any symptoms.

Wear your staff ID at all times Please remember to wear your official Taranaki DHB identification badge as this is crucial for gaining access to the hospitals (swipe access and identification by security officers). It will also be imperative when out in public to verify you are an essential service worker.

- Gill Campbell, chief operating officer

TDHB Vaccination Programme Status Report

Programme Sponsor Rosemary Clements Programme Status Active

Number #23 Senior Responsible Officer Rachel Court – Acting SRO Date 24 August 2021

Total Vaccinations to date

46,624

Total people Vaccinated (dose 1 + 2)

16,146

TDHB Vaccination Programme Status Report

TDHB Vaccination Programme Status Report

Key Activities last week Planned activities this week Barriers or Blockers Sites Sites • Workforce continues to be a challenge • NP and Hawera hubs continue 7 days a • Continue Work with P&F contracting team to o National delays in police checks week. Doing 120 days in Hawera and contract GP’s and Pharmacies o Doctors APC’s take time after 450 days in NP - reserve capacity for • Onboarding continues contract in place priority groups on top of this Workforce • Significant media interest and OIA’s take us • Tui Ora and Ngati Ruanui continue • Recruitment continues. away from planning and delivery. • Mobile sites continue focusing on • Maori equity leads role interviews planned for next • Team wellbeing with everyone working long disability and new ARC residents week hours. Workforce • SRO starts 6th September, Covid permitting • National booking system – not as flexible • Continued recruitment. Other as needed so many workarounds. Limited o Vaccinators • Looking at possibility of Drive through Vaccination reporting available to select users. o Clerical Clinic • Contracting process for providers – new o HCA’s rules that site cannot be put on system o Logistics Lead unless a contract in place. o Team Administrator Other TDHB Vaccination Programme Status Report • Stratford Rural Vaccination event was Mitigation for Barriers or Blockers successful with 1700 people vaccinated • Recruitment for recruitment resource been following Level 4 restrictions completed • Escalating police checks and APC’s to MoH. • Working with Communications team on key messages and communication plan • Continue to work with MoH on National booking system and enhancements to system and reporting. • Pinnacle taking over the onboarding of GP practices. • Working with P&F to put in place contracts

Positive Items of note • Stratford Rural Vaccination Dose Two planned for 3rd and 4th September • Mass vaccination events planned for Essential workers in New Plymouth Friday 27th and Saturday 28th, Hawera Sunday 29th August

TDHB Vaccination Programme Status Report

Overview of concerns Level 4: Taranaki currently in Level 4 lockdown. Guidance in place re level 4 restrictions. All hubs and providers abide by these. Increase in demand for vaccinations. Building capacity within hubs and partner providers. Working closely with Comms department to ensure community has awareness of clinics, pharmacies and practices that are taking bookings. Should have another 5 onboard this week, with more next week.

Cold Chain accreditation: Achieved. Awaiting monitoring equipment for after hours

Wasted doses/Vials: Minimal wastage currently due to needle/syringe issue being sorted

Adverse events: At the Stratford event we had no severe adverse reactions and have had no anaphylaxis

TDHB Vaccination Programme Status Report

MoH Qlik Dashboards as at 22nd August 2021

TDHB Vaccination Programme Status Report

BOARD REPORT

For: Key questions the Board should consider in reviewing this paper: Approval • What is driving increases in acute demand Discussion across Base Hospital and Hawera Hospital? • X Noting How are the increases in acute impact impacting on our clinical outcomes and financial position?

To TDHB Board • What is the DHB doing to respond to increasing acute demand and the financial impacts of this? Author Gillian Campbell, Chief Operating Officer • What other options do we have for managing Endorsed by Rosemary Clements, Chief Executive acute demand, particularly as move into the winter period? Date 19 August 2021

Subject Hospital & Specialist Services Report for August 2021

RECOMMENDATION It is recommended that the Board: • Note the Hospital & Specialist Services Report.

BOARD REPORT

1. PURPOSE

To provide the Board with an update on Hospital & Specialist Services activity and clinical quality.

2. HOSPITAL ACTIVITY

Overview

Hospital & Specialist Services have continued with the ambitious work programme for 2020/21 focused on enhancing the system and processes to ensure hospital services can be delivered as efficiently as possible with a focus on quality care. The hospital is seeing progress in these projects and is utilising change management systems to ensure changes are evaluated, adapted and reviewed ensuring services, systems and processes are embedded.

Throughout July the hospitals in New Plymouth and Hawera have experienced exceptionally high demand for acute services. Many staff have been working additional shifts to ensure we continue to provide care during this period. While the demand was across the hospital, the impact of respiratory illness in our babies and children resulted in unprecedented levels of demand for the paediatric service.

After commencing planning for the introduction of bowel screening for the population of Taranaki in February 2020, August 2021 has seen this programme commence. This home test will help detect bowel cancer early enabling earlier treatment and improved outcomes. Ongoing promotion of this programme is essential to its success. The hospital has resourced both the increased demand for colonoscopy that will result from this programme, as well as ensuring that we can meet the requirements for all investigations and treatment when positive tests are found.

Planned Care

The priority and biggest challenge for our planned care delivery is to recover our waitlists so patients are given certainty for assessment and treatment within the 4 month timeframe. There remains a high volume of referrals that continue to be received and we are working with referrers to ensure the right patients are being referred. We continue to review our pathways too and a Musculoskeletal pathway re-design has commenced.

Our trajectories for recovery of waitlists are in place, however the high inflows need to be managed in order to ensure these are achieved. We have made gains in line with recovery trajectory plan, however this is being challenged by recent strike planning and the sudden move to level 4 COVID response.

BOARD REPORT

In 2020/21 average monthly caseweight delivery was 434.50.

In July 2021 we locally delivered 260.92 caseweights. This delivery was directly impacted by the acute demand where a large number of procedures were cancelled. For much of July non deferrable planned care was prioritised and completed.

Graph: Planned care monthly delivery Acute Demand

July was an exceptional month for acute demand. Compared to July 2020 there was a 16% increase in presentations to the Base ED. There were 211 additional admissions or a 25% increase (7 additional patients per day). In terms of acuity there was a 22% increase in triage 2 patients presenting to the Base ED. Hawera ED continues to show a decrease (5%) in presentations with the urgent care clinic available at the practice. Last year 27 patients were transferred to Taranaki Base Hospital, this year 44 patients were transferred. The GP practice completed approximately 850 patient contacts in July. Paediatrics had 271 discharges in July this year compared to 120 last year. Additionally, their length of stay increased from 1.3 days to 1.8 days.

We continued to strive for increased planned care delivery in order to manage ongoing demand along with recovery of historical waitlists. This was significantly challenged in July due to the level of acute demand and bed capacity.

The Frailty Project has been very well received with Frailty Pathways in development for ED, perioperative patients, cardiology and the inpatient wards. BOARD REPORT

BOARD REPORT

Child & Maternal Health Services

The number of births in July were lower than the past 12month average with 128 babies in June and 88 babies in July (compared with 155 in May). Enhancements to antenatal pathways, as previously described, continue to be embedded within the maternity and O&G services. A new induction pathway that has been shown to reduce C Section rates when introduced is being developed for Taranaki DHB.

BOARD REPORT

Mental Health Services

Mental Health discharges have decreased from May and are less than for the same period in 2019. Progress is being made with improved discharge planning, ensuring appropriate plans are in place to support patients post-discharge. Occupancy for Te Puna Waiora during July and August to date has regularly exceeded 100%.

There was a spike in seclusion hours for non-Māori in June followed by a spike for Māori in July. Overall the total seclusion hours reduced from June to July. Minimising seclusion time for patients remains a focus for the team.

Community Treatment Orders issued under Section 29 of the Mental Health Act (rate per 100k adult population) have reduced slightly from May, however remain high for both Māori and non-Māori despite concerted efforts to reduce this.

Recent vacancies within the Crisis Assessment Team is placing significant challenges on this acute high demand service. A telephone crisis triage line commenced as of 1 August 2021. This model is be run by Whakarongorau who currently deliver this service to 11 other DHBS. Early indication is that this service is delivering to our population with improved timeliness of calls being responded to and has made a significant impact on the Crisis Assessment Team with improved ability to deliver assessments without phone interruptions.

BOARD REPORT

BOARD REPORT

Community Allied Health Services

Telehealth workshop for stroke rehabilitation clinicians to optimise our stroke ‘Intervention within 7 days of discharge’ has been held. The focus of the workshop was using telehealth as an enabler. Run by health-share’s regional leads for stroke and telehealth this is a first for the Te Manawa Taki region.

3. SAFE STAFFING

The delivery of the CCDM (Care Capacity Demand Management) programme of work has remained a priority. Full evaluation of DHB progress is underway with Taranaki DHB currently completing the national evaluation. FTE calculations for 14 wards have been completed and models of staffing and care are now being implemented.

Close tracking of FTE rostering, vacancy and annual leave management continues as part of the safe staffing programme goals and annual leave is tracking to plan and being well managed by unit managers.

Taranaki DHB Close Care Project was rolled out in August. This is set to improve the way we provide 1:1 care to those who require it during their hospital stay and where possible prevent unnecessary and costly 1:1 close care.

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4. ORAL HEALTH UPDATE

4.1. Equity focussed service improvements:

Due to ongoing vacancies within the Oral health service the following strategies have been put in place:

. Linked with Whanganui to support South Taranaki . Facilitated staff to stay in Mokau whilst Mobile is in this area to increase capacity . Provided late afternoon clinics as a trial – trial finished and evaluation underway . Adjusting recall status to focus on high needs children and Māori . Developed a Trainee proposal to support up to 4 trainees for the next 2 years, then 1 every year thereafter. The training is 3 years in length so we will not see benefit of this until 2025, this is being done in full partnership with Why Ora. . Employed Kaiawhina in South Taranaki and continue to actively recruit in North Taranaki

DNA rate improvements 2020-2021:

• Reduction in DNA rates from 31% to 11% for Māori of all ages – Target is 10%. This equates to 74 DNAs out of 664 appointments. • DNA rate for 0-4 year olds has approximately halved 32% to 15.2% - Target is 10%. This equates to 20 DNAs out of 132 appointments.

BOARD REPORT

5. CLINICAL GOVERNANCE – OVERVIEW 5.1. Overview

Taranaki District Health Board Hospital and Health Service Clinical Governance Scorecard

TDHB Hospital and Specialist Services Month Jul Oct Area Population Maori 19.40% Non Maori 80.60%

2.1 Patient Safety Incidents compared to 100 Discharges Ethnicity Discharges Midnights Total Incidents Non Rate - Non SAC v Discharge Open Incidents by SAC Rating Benchmark Total Incidents Clinical Incidents Rate Total Incidents Maori Rate - Maori Maori Maori Maori 599 1256 3.00 300 Overall Incidents 5.5 - 8 251 8.2%51 8.51% 184 7.6% Non Maori 2435 5284 2.50 SAC 1 < 0.03 00.0% 0 0.0% 0 0.0% Not Identified 12 28 250 Total 3046 6568 2.00 2.1.1.1 SAC 2 < 0.2 1 0.0%0 0.0%1 0.0% 200 SAC 3 < 1.5 5 0.2%2 0.3%1 0.0% 1.50 150 SAC 4 Minor <3.8 82 2.7%17 2.8%62 2.5% 1.00 <3.8 SAC 4 Minimal 76 2.5%13 2.2%56 2.3% 0.50 100 Unconfirmed 872.86% 19 3.2%64 2.6% 0.00 50 Jul Aug Sep Oct NovDec Jan FebMar AprMayJun 0 Closed in % Closed in Clinical Incidents Closure Target Total Closed Closed in Total Closed in Total SAC 1 SAC 2 SAC 3 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Time Time Time - Closed % Closed in Time - Non Closed % Closed in Time SAC 4 Minor SAC 4 Minimal SAC 1 SAC 2 SAC 3 SAC 4 Unconfirmed 2.1.1.2 Maori Maori Time - Maori Maori Non Maori - Non Maori SAC 1 < 70 days 100% 0 39 0% 0 5 0% 0 30 0% SAC 2 < 70 days 95% 1 0 100% 0 0 100% 1 0 100% SAC 3 < 30 days 95% 5 5 100% 2 1 200% 1 2 50% Open Incidents by Ethnicity Closed Clinical Incidents SAC 4 < 30 days 90% 114 64 178% 23 17 135% 78 34 229% 600 150 No. Open Incidents Target 500 Open No. Open Maori No. Open Non Maori 400 100 SAC 1 TBC 8 5 3 300 SAC 2 TBC 14 2 10 50 SAC 3 TBC 30 7 19 200 SAC 4 TBC 207 37 138 100 0 Unconfirmed TBC 243 44 173 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2.2 Consumer Engagement Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Complaints v Compliments Closed in Time - Maori Closed in Time - Non Maori Complaints Acknowledged Open - Maori Open - Non Maori Open - Not Identified Closed in Time - Not Identified Total Closed Complaints Resolved 2.3 Clinical Effectiveness per 1000 Note that medication incidents are not based on 2.3.2 Evidence Based Best Practice Target Incidents Midnights demographics. Falls v 1000 Midnights Total Falls Incidents Medication Incidents v Midnights 2.3.2.1 1 3.50 Medication Incidents 2 20 3.05 6.00 per 1000 0.8 3.00 2.3.3 Standards of Clinical Care Target Incidents 5.00 Midnights 0.6 4.00 2.50 per 1000 Falls per Midnight Benchmark Target Incidents Total Incidents Non Rate - Non 0.4 2.3.3.2 Midnights 3.00 2.00 Total Incidents Maori Rate - Maori Maori Maori 0.2 Falls Incidents 4.92 4.110 0.000 0.00 0 0.00 2.00 1.50 0 Hosp Acquired Pressure Injuries per per 1000 1.00 1.00 Incidents Total Incidents Non Rate - Non Midnight Midnights 2.3.3.3 Benchmark Target Total Incidents Maori Rate - Maori Maori Maori 0.00 0.50 Stage 3 & 4 0.01 0.070 0.000 0.00 0 0.00 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Falls Incidents Falls - Not Identified 0.00 Total Hosp Acquired Pressure Injuries 1.37 2.470 0.000 0.00 0 0.00 Ratio - Maori Ratio - Non Maori Falls Incidents Falls - Non Maori Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2.3.4 Morbidity and Mortality Reviews Target TotalReviewed % Benchmark Target Falls Incidents Falls - Maori Ratio Target Mortality and Morbidity Meetings Completed 2.3.6 Infection Control Target TotalReviewed % # Rate 2.3.6 Infection Control Target Actual Pressure Injury v 1000 Midnights Total Pressure Injury Incidents 2.3.6.1 Healthcare Associated Infections - Staph Aureus Bacteremia 3.00 1 2.3.6.2 Surgical Site Infections 2.50 0.8 2.00 0.6 1.50 Ethnicity Note 0.4 TDHB currently collects patient level data for approximately 91% of incidents. 1.00 0.2 Where the incident is not identified at a specific patient level, the ethnicity is recorded as Not Identified. 0.50 All ethnicity responses of "not stated" are recorded as Not Identified 0.00 0 Non Maori category is all identified ethnicity responses which are not Maori and includes Pacific Island and Asian. Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21

Ratio - Maori Ratio - Non Maori Pressure Injuries Hosp Acquired - Maori Pressure Injuries Hosp Acquired - NonMaori Benchmark Target Pressure Injuries Hosp Acquired - Not Identified Pressure Injuries Stage 3/ 4 BOARD REPORT

5.2. Patient Safety and Quality Improvement There were 251 incidents reported last month up from 220 in June (8.2% of benchmark). Although this rate is outside of the benchmark threshold (5.5-8%), the hospital has experienced unprecedented service demand recently and the increased in incidents is to be expected. We continue to encourage reporting of all incidents and near misses; every event is a learning opportunity for all.

Of the total incidents, 87 (34%) are unconfirmed (awaiting management approval of SAC score).

There were no SAC1 or SAC 2 events occurring during the month. There were six SAC 3 events – updated after the scorecard was produced. Of these events, two related to Māori patients.

Details of the SAC 3 events are as follows:

• Patient developed an unstageable pressure injury; • Admission of a patient to inappropriate clinical setting (after suffering a seizure) and lengthy wait for treatment and no monitoring; • Patient transfer complications due to the bariatric bed not fitting in the lift; • Inappropriate food provided to patient with special dietary requirements; • Paediatric patient care delayed due to patient assessment unit not being adequately prepared and equipment not charged/ available; • Concerns over the lack of pre admission anaesthetic clinics.

SAC 4 (minor) events were up from 64 to 82 this month (2.7% within benchmark); SAC 4 (minimal) also increased from 71 to 76 (2.87% within benchmark).

5.3. Consumer Engagement & Participation

5.3.1. HDC Complaints

There was two new HDC complaints received between 11/07/2021 to 12/08/2021 . Six complaints were closed during the same period. There are number of open HDC complaints which Taranaki DHB has responded which we are now awaiting on an HDC response these are being monitored appropriately.

BOARD REPORT

5.3.2. Taranaki DHB Complaints

There were 29 general complaints received in July 2021. 329 complaints (100%) were acknowledged within five working days and 100% (n=17) of those due for responses were closed within the 20 working day timeframe. The remaining complaints are awaiting responses and are still within the 20 day timeframe.

The most common themes for complaints in July 2021 were: Communication (9), Clinical Treatment (7), and Admissions/Transfer and Discharge procedures (3).

Communication and mixed messages from staff to patients were the most common theme during July, information either not being understood or lack of information about patient’s conditions following appointment or care.

5.3.3. Taranaki DHB Compliments

During July 2021 we received 13 compliments across Hospital & Specialist Services. We have seen all of the service lines receive huge praise in the last few months. For July, Child and Maternal Health have received the most with a total of five.

BOARD REPORT

For: Key questions the Board should consider in reviewing this paper: Approval • Does the report provide useful and relevant Discussion information about the work that is being undertaken? X Noting • Is the focus on innovation and different ways of working something that the Board would like to To TDHB Board see more of in future reports?

Author Becky Jenkins – GM Planning, Funding & Population Health • Is there any further information that you would like to see included in these reports? Endorsed by

Date August 2021

Subject Planning & Funding Report – August 2021

RECOMMENDATION It is recommended that the Board: • Note the update on activities relating the Planning, Funding and Population Health Function

BOARD REPORT

1. PURPOSE

To provide the Board with an update on key activities within Planning, Funding and Population Health and to provide information on areas of innovation and/or different ways of working, or future planned activities that are expected to have a positive and measurable impact on health outcomes.

The “Board Priorities” of Immunisation and Diabetes will be included in this report and will not be reported on separately. Oral Health will be included within the Hospital & Specialist Services report. As a comprehensive update on the South Taranaki Rural Model of Care was provided at the previous Board Meeting there is only a brief update included in this report.

2. NEW MINISTRY OF HEALTH PERFORMANCE INDICATORS

In August 2021, the Ministry of Health in collaboration with the Health Quality & Safety Commission announced a Health System Indicators framework. This framework is designed to give a snapshot of health system performance at a high level and will be publicly accessible via an online dashboard. The set of indicators is listed in the table below. It is expected that quarter 4 2020/21 data will be published in December 2021.

As part of this initiative DHBs are expected to partner with key stakeholders including Māori/Iwi partnership boards and clinicians to develop a set of actions for each indicator. Guidance on the particulars of this are forthcoming, but initial expectations are for actions to be in place for 22/23.

Government priority High -level indicator

Improving child wellbeing Immunisation rates for children at 24 months

Ambulatory sensitive hospitalisations for children (age range 0 — 4)

Improving mental wellbeing Under 25s able to access specialist mental health services within three weeks of referral

Access to primary mental health and addiction services

Improving wellbeing through Ambulatory sensitive hospitalisations for adults (age range 45-64) BOARD REPORT

prevention Participation in the bowel screening programme

Strong and equitable public health Acute hospital bed day rate system Access to planned care

Better primary health care People report they can get primary care when they need it

People report being involved in the decisions about their care and treatment

Financially sustainable health Annual surplus/deficit at financial year end system Variance between planned budget and year end actuals

3. ANNUAL PLAN 2021/22

The DHB has continued to prepare the 2021/22 Annual Plan and this is now at final draft stage.

4. DIABETES

Work continues to progress on the implementation of the Integrated Diabetes Team including work on the operational framework, contracting and recruitment to the new roles. An outline of the model in development across organisations is shown below:

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The two principle functions that underpin the Diabetes Integrated Team are:

1. Comprehensive Clinical & Psychosocial Intervention - Providing clinical

expertise when it is needed to directly manage patients with diabetes with

the aim of transitioning them back to primary care as appropriate.

2. Enhancement & Capability Support - Provide support, education and training for both health professionals and patients, guided by the needs of primary care and Māori providers and secondary care teams, to ensure patients with diabetes receive high quality and consistent clinical care and health information.

5. CHILD HEALTH

BOARD REPORT

5.1 Childhood Immunisation • Taranaki DHB submitted a plan in response to the Deputy Director General of Health’s request to progress action to improve our declining Childhood Immunisation rates, a trend presenting around the country at this time. This plan has received provisional endorsement from the MOH to proceed with implementation planning.

• The plan included: Short-term interventions 1. Primary Care engagement in partnership with the PHO: GP Liaison, Practice List Audit, Patient Access Centre team support, missed appointments support. 2. Engagement of a targeted Immunisation Project Manager and Vaccinator to run short term interventions with the support a Contracted Navigator/Kaiawhina Whānau Support Coordinator. 3. Targeted intervention of Outreach Immunisation Services (OIS) Waitlist including GP Clinic support, Catch-up Clinics. 4. Reframe current Outreach Immunisation Provider service specifications to refocus reporting for outcomes. 5. Strengthening of opportunistic immunisations within the DHB: Hospital admissions, Clinics for B4SC’s, Vision and Hearing, Paediatric appointments. Long-term Interventions 6. Proactive work with GP Practices with high referral rates to OIS. 7. Proactive work with Midwives with delayed referral time to WCTO provider and high rates of children appearing on the GP Unknown and OIS lists. 8. Proactive work with the PHO and whānau of children aged 0-5 who are recorded as GP unknown. 9. PHO led Gen2040 Best Start Kawae Roll Out – Funded Primary Care visits for hapu mama. 10. BPAC system roll-out Taranaki DHB Immunisation team – faster immunisation referrals between Primary Care practices and Immunisation Administration Team. 11. Long term establishment of a Navigator/Kaiawhina Whānau Support Coordinator to the Child Health and Immunisation Programme. 12. Automated referral to preferred GP and WCTO provider completed at birth. 13. Continued support of ante-natal immunisation education and GP enrolment. 14. Continued but enhanced business as usual for Outreach Immunisation Services, Immunisation Administration and Coordination and Immunisation Services delivered in Primary Care settings. 15. Coordinated Communications and campaigns.

• Work to implement the above initiatives has begun and will be measured for progress against targets. • Immunisation rates are below targets of 95% for both Māori and non-Māori across 8, 24 month and 5-year milestones • Inequity exists across all milestones however this is widest at 8 months

BOARD REPORT

5.3 Healthy Active Learning Healthy Active Learning (HAL) is a joint Government initiative between Sport New Zealand and the Ministries of Health and Education to improve wellbeing of tamariki and rangatahi through healthy eating, drinking and quality physical activity. All ECE’s and schools are involved in the provision of, or education about, food and drink in some way. 40% of schools have food and drink policies but most fail to provide clear guidance about providing healthy foods and drinks. Overall, the service seeks to:

HAL Taranaki is being delivered through a network of providers Sport Taranaki will deliver to Taranaki Schools, Tui Ora will continue their delivery to Taranaki Kohanga and ECE and support Taranaki Kura Kaupapa. Nutritional Advice and Support will be through the Heart Foundation and the service will be overseen by the Public Health Unit.

Contracting with our service providers was enacted for 1 July and service implementation is now beginning. Taranaki is the only DHB to have co-designed its HAL service and partnered with our community providers to strengthen Nutrition and Activity Services to our ECE and Schools. The feedback on this innovative approach has been very favorable.

6. HEALTH OF OLDER PEOPLE

6.1 Workforce Shortage in Age Residential Care Facilities The national shortage of nurses is impacting many sectors and this includes the aged care sector. Workforce challenges in relation to Registered Nurses are also being seen in the Taranaki region.

The contract between the DHB & ARC facilities requires an RN on duty at all times for hospital level residents. Until recently, the shortage has had minimal impact on timely discharges from the DHB to aged residential care however, this situation is being carefully monitored.

Nationally there is a workforce team working on a high-level plan around the nursing shortage and MBIE settings from a Government and multi-agency perspective, looking at a long-term solution.

• A national risk assessment tool is being developed by a working group comprised of representatives from DHB’s, NZACA and HealthCert, the tool will be used to assess the risks for each ARC facility • A guiding set of principles being developed nationally

7. CONTRACTING UPDATE BOARD REPORT

The contracting with DHB funded services has largely been completed.

8. CERVICAL SCREENING

On 29 August 2021 we honour the four-year anniversary of Talei Morrison's cervical cancer diagnosis when we as whānau encourage our loved ones to participate in cervical screening.

Talei was the influence behind the Smear Your Mea campaign, which launched after the Rotorua woman was diagnosed with cervical cancer in 2017. Talei found there was no messaging that resonated with her about why cervical screening’s so important.

The Smear Your Mea campaign (a slogan gifted by whānau from Korowai Aroha in Rotorua) is a play on words – Smear is what many still refer to cervical screening as, and Mea means thing in Māori – in this instance the thing we refer to is our whare tangata. Sadly, Talei passed away in 2018 at age 42. In her final months she encouraged wāhine Māori to have regular cervical screening tests so no other wāhine and their whānau would be challenged with and lose a life to cervical cancer.

A number of events are being held in Taranaki and across Aotearoa to mark Smear Your Mea day and to honour Talei's legacy.

9. MENTAL HEALTH

9.1 Youth Mental Health Respite Service A review of the Youth Mental Health & Addiction Crisis and Planned Respite Service was recently undertaken in response to concerns that the current funding model was unsustainable. The service, delivered by Pathways, had been finding it increasingly difficult to staff the overnight respite service particularly at short notice for crisis admissions. Additional investment has been allocated to the service for 21/22 enabling the service to put in place a more sustainable staffing arrangement based on a five-day a week, 24/7 service. This will run initially as a one-year pilot programme, with any BOARD REPORT

continued funding being dependent on the outcomes of a service evaluation later in the year. The service operates from a three-bedroom residential house in New Plymouth with capacity for up to two clients at a time.

With the new stable staffing arrangements being implemented, the opportunity was also taken to review the service model in partnership with the Child & Adolescent Mental Health Service (CAMHS) and the provider (Pathways). This allowed the two teams to consider how they could work together more collaboratively and re-design the service to meet unmet need in the community. The previous access criteria for youth aged 14-18 years will now be expanded. Having a residential facility of this nature will also allow the CAMHS team to avoid unnecessary hospitalisations and facilitate more timely discharges of younger people. The service will also accept perinatal referrals, providing a new residential respite option for mothers with postnatal depression. The service will begin recruitment for new staff in the next few weeks and we anticipate the service being up and running by September 2021.

9.2 Waitara Acute Synthetic Drug Harm Pilot

The Waitara Acute Synthetic Drug Harm Pilot (known as 4Waitara) has been running in the community for approximately 10 months now. It was created when Taranaki DHB applied for and received pilot funds to proactively respond to acute synthetic drug harm in Waitara and establish a community AOD response service that was able to take referrals from key community agencies (Police, Oranga Tamariki, Schools, Primary Care, etc) along with self- referrals and provide immediate treatment and access to rehabilitation (including residential detox/rehab programmes) via a community based AOD clinician. The service is currently supporting 30 patients routinely, coordinates referrals to in-patient programmes and is responding to work supported by the Drug Foundation in response to recent harm experienced in the Waitara Community including deaths attributable to the use of synthetics. A community navigator supports the programme and is working towards building up a long-term multi-agency response to manage synthetic drug harm in the community. An evaluation of the project is underway which will inform the future development of the service.

BOARD REPORT

9.3 Te Manawanui

• Te Manawanui is entering its second Tranche which will increase staffing levels • The service is available at 13 of 32 practices covering 39% of our population • 92% of responding service users rated the service as 7-10 on the helpfulness scale • In the first nine months 520+ patients were seen, with consult volumes doubling in April – an indication of the new model settling in

Our quarterly waananga was held at Whakaahurangi in June. It bought together the team of HIPs and Kaitautoko to share what is working well, challenges and areas of focus for next quarter. The group also had training on Diabetes provided by the Taranaki Diabetes Collaborative (GP, Dietician, Podiatrist, Kaitautoko). To give perspective of scale, the HIP FTE in South Taranaki is Opunake and Ngatiruanui- Patea have up to a one day a week, Avon 2/3 days and Hawera 0.8 FTE. For a three- week period in June just under 100 consults were delivered by the HIPs based in South Taranaki and we are observing that as the practice, health providers, whanau become more aware and comfortable with the service, volumes and reach continues to build.

M e m o ra n d u m OPEN

DATE: August 2021 TO: Taranaki DHB Board FROM: Becky Jenkins – GM Planning, Funding & Population Health COPIES: Rosemary Clements – Chief Executive SUBJECT: PROGRESS ON ANNUAL PLAN ACTIVITIES 2020/21 – METRICS QUARTER 4

1. PURPOSE

This memorandum aims to provide the performance metrics for 30 June 2020/21 based on available data.

2. ANNUAL PLAN 2020/21 – PERFORMANCE METRICS

Please see full report in Appendix 1.

Performance metrics are established in the Annual Planning process. This report relates to the fourth quarter of 2020/21 and gives a summary of the results for all performance indicators at the most recent reporting period.

Ethnicity results are displayed in the right-hand columns of the report where available. This system means that the corresponding indicator is a Māori Health priority for 2020/21. An additional report of measures identified as specific Māori Health priorities is also included in Appendix 2.

3. SUMMARY OF NON-FINANCIAL PERFORMANCE

The following shows a summary of population performance based on the number of indicators. Noting not all indicators are considered equal – the weighting of indicators is not taken into account in these summaries.

Targets met Taranaki DHB achieved 39.8% of indicator targets. This has improved over the quarters.

Improved Performance – Indicators in this category have shown Targets not met but progress towards success - Improving performance improved performance on indicators can often take several years.

Performance Deteriorated – 36.7% of indicators failed to meet Targets not met target and declined during the year.

36.7%

There have been three key drivers for Data Not Available data being unavailable: • National measures being established without process to collect/record/ provide the data. This is the most common issue • Data being delayed at the Ministry of Health • Data for local measures becoming unavailable after the measures are set (measures are set much earlier in the year than data availability is confirmed)

The following shows a summary of performance of indicators as they relate to the Māori population results compared to non-Māori and current equity gaps. It should be noted that equitable or inequitable performance does mean that results were met or not met – there are cases that show equity where targets are not being achieved. 11.8% of measures were deemed not applicable (see below section), these have been excluded from numerators and denominators.

Performance against targets Maori Performance Indicators - Māori Taranaki DHB met targets in 27.5% of indicators. However, ethnicity 27.5% 32.4% data was not available 38.2% of indicators making overall performance difficult e to evaluate.

40.2%

No equity gap No equity gap Indicators in this category have demonstrated that results for Māori are at least equitable to 33.9% non-Māori.

Equity gap <10% Equity gap less than 10% 30.6% of indicators demonstrated an equity gap within 10% between Māori and non-Māori. 30.6%

Equity gap between 10% 14.3% of indicators demonstrated an and 20% equity gap between 10-20% .

Equity gap greater than 20% 22.2% of indicators demonstrated an equity gap of more than 20%.

A large proportion of indicators lack ethnicity data. A project is underway Ethnicity data not available to improve this gap which has already yielded an improvement from 57.9% to 38.2%

Encouraging performance has been observed in the following areas: • Percentage of elective surgical discharges under the Planned Care Initiative • Planned Care Interventions • Ambulatory sensitive avoidable hospital admissions 0-4 years • Children Caries Free at age 5 years • DMFT Score at Year 8 • Percentage of MH&A clients discharged from MH&A adult inpatient services that are followed up within seven days • Percentage of obese children identified in the Before School Check (B4SC) Programme offered a referral to a health professional for clinical assessment and family-based nutrition, activity and lifestyle intervention • Percentage of newborns enrolled with a general practice by six weeks of age • Percentage of newborns enrolled with a general practice by three months of age

Improvement continues to be needed in the following areas: • Focus Area 2: Immunisation coverage for five-year olds • Immunisation coverage for two-year olds • Focus Area 1: Percentage of children are fully immunised at eight months • Percentage of patients referred with a high suspicion of cancer who receive their first cancer treatment within 62 days • Percentage of enrolled pre-school and primary school children overdue for their scheduled dental examination • MRI Scans: Percentage of patients with accepted referrals for MRI scans that receive their scan within six weeks (42 days) • Elective Services Performance Indicator (ESPI) 2: Percentage of patients waiting longer than four months for their First Specialist Assessment (FSA) • Elective Services Performance Indicator (ESPI) 5: Percentage of patients given a commitment to treatment but not treated within four months

4. DENTAL DATA QUALITY Quality of dental data remains an issue due to limitations of the Titanium dental software. While results have been presented, they are dependent on the output quality of the database reports and accuracy cannot be verified.

5. MISSING ETHNICITY DATA UPDATE

In January, it was reported that during Quarter 1, 43 measures were missing data (an additional 12 were deemed not relevant and eight were unavailable for all ethnicities). During Quarter 2, 19 measures were updated to include Māori ethnicity splits – there has been no subsequent improvement during Q3 or Q4. Work continues to enrich these data.

Non-relevant measures The below 12 measures were flagged as not relevant for ethnicity reporting, a brief explanation is provided for each.

Measure Reason for excluding equity Focus Area 1 - (Indicator 1) Improving the quality of data IT Data quality measure within the NHI: New NHI registration in error Focus Area 1 - (Indicator 2) Improving the quality of data IT Data quality measure within the NHI: Recording of non-specific ethnicity Focus Area 1 - (Indicator 3) Improving the quality of data within the NHI: Update of specific ethnicity value in IT Data quality measure existing NHI record with a non-specific value Focus Area 1 - (Indicator 4) Improving the quality of data within the NHI: Validated addresses excluding overseas, IT Data quality measure unknown and dot(.) in line 1 Focus Area 1 - (Indicator 5) Improving the quality of data IT Data quality measure within the NHI: Invalid NHI data updates Foc us Area 2 - (Indicator 1) Improving the quality of data submitted to national collections: NPF collection has IT Data quality measure accurate dates and links to NNPAC, NBRS and NMDS for FSA and planned inpatient procedures Focus Area 2 - (Indicator 2) Improving the quality of data submitted to national collections: National Collections IT Data quality measure completeness Focus Area 2 - (Indicator 3) Improving the quality of data submitted to national collections: Assessment of data IT Data quality measure reported to NMDS % contracts with a Healthy Food and Drink Policy reported Contracting measure with 100% as a proportion of total contracts compliance A separate Māori measure exists Percentage of eligible population have their Before School already in the report parallel to this Checks completed - High needs measure Number of Violence Intervention Programme (VIP) training This is a count of training secessions sessions delivered delivered A comparison with non -Māori cannot Percentage of Māori employed in the health and disability be made as this is a Māori specific workforce at the Taranaki DHB measure

6. MISSING ETHNICITY DATA UPDATE A new report has been included listing all performance measures flagged as a having ‘red’ disparity (>20% vs non-Māori). This report also outlines the number of Māori contributing to this result, as some measures show huge disparity but due to low overall numbers could be down to a few individuals. A ‘desired direction’ is also included with up indicating a higher number being desired and down indicating a lower number being desired.

Becky Jenkins GENERAL MANAGER PLANNING, FUNDING AND POPULATION HEALTH

APPENDIX 1: Quarterly Progress on Annual Plan 2020/21 Performance Indicators/Measures APPENDIX 2: Quarterly Progress on Annual Plan 2020/21 Māori Health Priority Indicators

Taranaki District Health Board - Progress on Annual Plan 2020/21

Quarter Four 2020/21 Not measured against target  Target met  Target not met - deterioration from last reporting period Target Met      (Blank)  Target not met - improvement on last reporting period  New measure or information not yet available Within 10% of Target 10-20% away from Target Number 39 23 16 0 36 0  Target not met - no improvement since last reporting period (Blank) Indicator not measured against a target More than 20% from Target

Percentage 39.8% 23.5% 14.0% 0.0% 36.7% TOTAL POPULATION PERFORMANCE ETHNICITY COMPARISON

Current result Total population Total population Previous result Status Previous result Māori result Non Māori result Disparity Service area Indicator period target result period

Child and Youth Oral Health Children Caries Free at age 5 years Q3 20-21 60% 64.4%  59.1% Q3 19-20 45.8% 69.6% -23.8%

Child and Youth Oral Health DMFT Score at Year 8 Total Q3 20-21 0.61 0.60  0.69 Q3 19-20 0.80 0.54

Child and Youth Oral Health Percentage of Children (0-4 years) enrolled in DHB funded dental service Q3 20-21 95.0% 97.6%  106.6% Q3 19-20 87.0% 103.0% -16.0%

Child and Youth Oral Health Percentage of enrolled pre-school and primary school children overdue for their scheduled dental examination Q3 20-21 10.0% 28.0%  9.3% Q3 19-20 25.0% 29.0% 4.0%

Child and Youth Oral Health Percentage of utilisation of DHB funded dental services by adolescents from school year 9 including 17 years Q4 20-21 85.0% 40.0%  67.0% Q4 19-20 Not Available Not Available Not Available

Increased Immunisation Focus Area 1: Percentage of children are fully immunised at eight months Q4 20-21 95.0% 82.0%  84.5% Q3 20-21 67.0% 87.6% -20.6%

Increased Immunisation Focus Area 2: Immunisation coverage for five year olds Q4 20-21 95.0% 78.37%  84.0% Q3 20-21 74.3% 80.3% -6.1%

Increased Immunisation Focus Area 3: Percentage of eligible girls and boy fully immunised with HPV vaccine Q4 20-21 75.0% 60.9%  59.2% Q4 19-20 56.0% 62.7% -6.8%

Health of Older People Focus Area 4: Percentage of the population (>65 years) who have had the seasonal influenza immunisation Q1 20-21 75.0% 67.2%  57.3% Q1 19-20 51.8% 68.5% -16.7%

Maternal & Child Health Improving breast-feeding rates - 3 Months Q3 20-21 70.0% 60.2%  59.0% Q4 19-20 41.7% 66.3% -24.6%

Integration Percentage of newborns enrolled with a general practice by 6 weeks of age Q4 20-21 55.0% 69.9%  72.1% Q3 20-21 59.2% 74.9% -15.7%

Integration Percentage of newborns enrolled with a general practice by 3 months of age Q4 20-21 85.0% 80.8%  88.5% Q3 20-21 64.5% 86.9% -22.4%

Increased Immunisation Immunisation coverage for two year olds Q4 20-21 95.0% 82.90%  86.49% Q3 20-21 69.5% 88.0% -18.5%

Percentage of obese children identified in the Before School Check (B4SC) Programme offered a referral to a Obesity Q4 20-21 95.0% 95.5% 98.8% Q3 20-21 97.0% 94.1% 2.9% health professional for clinical assessment and family based nutrition, activity and lifestyle intervention 

Mental Health & Addictions Improving the health status of people with severe mental illness through improved access 0-19 years Q4 20-21 3.78% 3.17%  3.11% Q2 20-21 2.96% 3.28% -0.32%

Mental Health & Addictions Improving the health status of people with severe mental illness through improved access 20-64 years Q4 20-21 4.02% 5.07%  5.22% Q2 20-21 7.9% 4.4% 3.5%

Mental Health & Addictions Improving the health status of people with severe mental illness through improved access 65+ years Q4 20-21 3.50% 2.47%  2.51% Q2 20-21 3.40% 2.40% 1.00%

Mental Health & Addictions Percentage of clients discharged from community MH&A services have a transition (discharge) plan Q4 20-21 95.0% 41.7%  42.8% Q3 20-21 Not Available Not Available Not Available

Mental Health & Addictions Percentage of audited files that meet accepted good practice Q4 20-21 95.0% 63.0%  Not Available Q3 20-21 Not Available Not Available Not Available

Mental Health & Addictions Percentage of people referred for non urgent addiction services are seen within 3 weeks 0-19 years Total Q4 20-21 80.0% 90.9%  94.7% Q3 20-21 100.0% 83.3% 16.7%

Mental Health & Addictions Percentage of people referred for non urgent addiction services are seen within 3 weeks 20-64 years Total Q4 20-21 80.0% 73.1%  73.4% Q3 20-21 70.7% 74.5% -3.8%

Mental Health & Addictions Percentage of people referred for non urgent addiction services are seen within 3 weeks 65+ years Total Q4 20-21 80.0% 93.8%  93.3% Q3 20-21 100.00% 92.86% 7.14%

Mental Health & Addictions Percentage of people referred for non urgent mental health services are seen within 3 weeks 0-19 years Total Q4 20-21 80.0% 74.2%  62.4% Q3 20-21 78.18% 72.56% 5.62%

Mental Health & Addictions Percentage of people referred for non urgent mental health services are seen within 3 weeks 20-64 years Total Q4 20-21 80.0% 79.6%  81.7% Q3 20-21 85.9% 77.6% 8.4%

Mental Health & Addictions Percentage of people referred for non urgent mental health services are seen within 3 weeks 65+ years Total Q4 20-21 80.0% 82.9%  79.4% Q3 20-21 83.33% 82.84% 0.49%

Mental Health & Addictions Percentage of people referred for non urgent addiction services are seen within 8 weeks 0-19 years Total Q4 20-21 95.0% 90.9%  94.7% Q3 20-21 100.00% 83.33% 16.67%

Mental Health & Addictions Percentage of people referred for non urgent mental health services are seen within 8 weeks 0-19 years Total Q4 20-21 95.0% 93.8%  83.5% Q3 20-21 93.64% 93.86% -0.23%

Mental Health & Addictions Community Treatment Orders issued under Section 29 of the Mental Health Act (rate per 100,000) Total Q4 20-21 115.2 125  128 Q3 20-21 288 85 -108.8%

Percentage of MH&A clients discharged from MH&A adult inpatient services that are followed up within 7 Mental Health & Addictions Q4 20-21 TBC 75.2% 73.3% Q3 20-21 71.4% 77.4% -5.9% days Total 

Cancer Services/Faster Cancer Percentage of eligible women (50-69 years) have had a breast screen every two years Total Q4 20-21 70.0% 71.6% 70.9% Q2 20-21 59.5% 73.4% -13.8% Treatment 

Cancer Services/Faster Cancer Percentage of eligible women (25-69 years) have a cervical cancer screen every three years Total Q4 20-21 80.0% 76.5% 76.7% Q2 20-21 67.7% 78.2% -10.5% Treatment 

Cancer Services/Faster Cancer Percentage of patients with a confirmed diagnosis of cancer who receive their first cancer treatment with 31 Q4 20-21 85.0% 87.7% 83.2% Q2 20-21 Not Available Not Available Not Available Treatment days 

Secondary Care Ambulatory sensitive avoidable hospital admissions 0-4 years Q4 20-21 5200 4865  4577 Q3 20-21 4715 4939 4.6%

Secondary Care Ambulatory sensitive avoidable hospital admissions 45-64 years Q4 20-21 4990 5124  4933 Q3 20-21 8266 4588 -57.2% Taranaki District Health Board - Progress on Annual Plan 2020/21

Quarter Four 2020/21 Not measured against target  Target met  Target not met - deterioration from last reporting period Target Met      (Blank)  Target not met - improvement on last reporting period  New measure or information not yet available Within 10% of Target 10-20% away from Target Number 39 23 16 0 36 0  Target not met - no improvement since last reporting period (Blank) Indicator not measured against a target More than 20% from Target

Percentage 39.8% 23.5% 14.0% 0.0% 36.7% TOTAL POPULATION PERFORMANCE ETHNICITY COMPARISON

Current result Total population Total population Previous result Status Previous result Māori result Non Māori result Disparity Service area Indicator period target result period

Improved Access to Elective Percentage of elective surgical discharges under the Planned Care Initiative Q4 20-21 100.0% 110.0% 106.3% Q3 20-21 Not Available Not Available Not Available Surgery 

Improved Access to Elective Measure 1 - Planned Care Interventions Q4 20-21 7311 9636 7108 Q3 20-21 953 8683 Surgery 

Improved Access to Elective Measure 2 - ESPIs (Elective Services Performance Indicators) - ESPI 1 Percentage of referrals appropriately Q4 20-21 100.0% 100.0% 95.5% Q3 20-21 Not Available 100.0% Not Available Surgery acknowledged and processed within 15 days 

Improved Access to Elective Measure2 - ESPIs (Elective Services Performance Indicators) - ESPI 2 Percentage of patients waiting longer than Q4 20-21 0.0% 52.1% 48.2% Q3 20-21 Not Available 52.1% Not Available Surgery four months for their First Specialist Assessment (FSA) 

Improved Access to Elective Measure 2 - ESPIs (Elective Services Performance Indicators) - ESPI 3 Percentage of patients waiting without a Q4 20-21 0.0% 0.0% 0.0% Q3 20-21 0.0% 0.1% 0.1% Surgery commitment to treatment whose priorities are higher than the actual treatment threshold (aTT) 

Improved Access to Elective Measure 2 - ESPIs (Elective Services Performance Indicators) - ESPI 5 Percentage of patients given a Q4 20-21 0.0% 30.7% 37.4% Q3 20-21 43.1% 28.7% -14.4% Surgery commitment to treatment but not treated within four months 

Improved Access to Elective Measure 2 - ESPIs (Elective Services Performance Indicators) - ESPI 8 Proportion of patients who were Q4 20-21 100.0% 100.0% 100.0% Q3 20-21 100.0% 100.0% 0.0% Surgery prioritised using approved nationally recognised processes or tools 

Measure 3 - Coronary Angiography Percentage of patients with accepted referrals for elective coronary Improved Access to Diagnostics Q4 20-21 95.0% 100.0% 92.7% Q3 20-21 Not Available Not Available Not Available angiography that receive their procedure within 3 months (90 days) 

Measure3 - CT Scans Percentage of patients with accepted referrals for CT scans that receive their scan within Improved Access to Diagnostics Q4 20-21 95.0% 86.3% 69.2% Q3 20-21 Not Available Not Available Not Available 6 weeks (42 days) 

Measure 3 - MRI Scans: Percentage of patients with accepted referrals for MRI scans that receive their scan Improved Access to Diagnostics Q4 20-21 90.0% 38.7% 38.8% Q3 20-21 Not Available Not Available Not Available within 6 weeks (42 days) 

Improved Access to Elective Measure 4 - Percentage of ophthalmology patients waiting more than 50% longer than the intentded time for Q4 20-21 0.0% 38.4% Not Available Q2 20-21 Not Available Not Available Not Available Surgery their follow-up apointment 

Secondary Care Measure 5 - Acute readmissions to hospital Q3 20-21 9.1% 12.2%  11.8% Q2 20-21 11.7% 12.2% 0.5%

Secondary Care Acute readmissions to hospital 75+ years Q3 20-21 10.9% 12.2%  12.0% Q2 20-21 11.4% 12.2% 0.8%

Strong and equitable public health Did Not Attend Rates (DNA) for First Specialist Assessment (FSA) by Ethnicity (Developmental) Q4 20-21 TBC 6.4% 6.6% Q3 20-21 14.1% 4.6% -9.5% and disability system 

Ethnicity Not Ethnicity Not Improving data quality Focus Area 1 - (Indicator 1) Improving the quality of data within the NHI: New NHI registration in error Q4 20-21 3.0% 2.3% 2.3% Q3 20-21 Not Available  applicable applicable

Ethnicity Not Ethnicity Not Improving data quality Focus Area 1 - (Indicator 2) Improving the quality of data within the NHI: Recording of non-specific ethnicity Q4 20-21 2.0% 0.4% 0.2% Q3 20-21 Not Available  applicable applicable

Focus Area 1 - (Indicator 3) Improving the quality of data within the NHI: Update of specific ethnicity value in Ethnicity Not Ethnicity Not Improving data quality Q4 20-21 2.0% 0.0% 0.0% Q3 20-21 Not Available existing NHI record with a non-specific value  applicable applicable

Focus Area 1 - (Indicator 4) Improving the quality of data within the NHI: Validated addresses excluding Ethnicity Not Ethnicity Not Improving data quality Q4 20-21 85.0% Not Available Not Available Q3 20-21 Not Available overseas,unknown and dot(.) in line 1  applicable applicable

Ethnicity Not Ethnicity Not Improving data quality Focus Area 1 - (Indicator 5) Improving the quality of data within the NHI: Invalid NHI data updates Q4 20-21 TBC Not Available Not Available Q3 20-21 Not Available  applicable applicable

Focus Area 2 - (Indicator 1) Improving the quality of data submitted to national collections: NPF collection has Ethnicity Not Ethnicity Not Improving data quality Q4 20-21 90.0% 90.0% 93.3% Q3 20-21 Not Available accurate dates and links to NNPAC, NBRS and NMDS for FSA and planned inpatient procedures.  applicable applicable

Focus Area 2 - (Indicator 2) Improving the quality of data submitted to national collections: National Ethnicity Not Ethnicity Not Improving data quality Q4 20-21 94.5% 104.2% 99.8% Q3 20-21 Not Available Collections completeness  applicable applicable

Focus Area 2 - (Indicator 3) Improving the quality of data submitted to national collections: Assessment of Ethnicity Not Ethnicity Not Improving data quality Q4 20-21 75.0% 90.4% 90.8% Q3 20-21 Not Available data reported to NMDS  applicable applicable

Shorter stays in Emergency Shorter stays in Emergency Departments - percentage of patients admitted, discharged, or transferred from an Q4 20-21 95.0% 79.9% 81.8% Q3 20-21 84.5% 78.4% 6.0% Departments Emergency Department within six hours 

Cancer Services/Faster Cancer Percentage of patients referred with a high suspicion of cancer who receive their first cancer treatment within Q4 20-21 90.0% 66.7% 70.2% Q3 20-21 Not Available Not Available Not Available Treatment 62 days 

Living well with Diabetes Focus Area 2 - (Diabetes services) Ascertainment of people enrolled in the PHO 15-74 years Q4 20-21 95.0% 73.2%  73.1% Q3 20-21 88.3% 70.6% Not Available

Focus Area 2 - (Diabetes services) The percentage of people enrolled in the PHO, 15-74 years with HbA1c Living well with Diabetes Q4 20-21 60.0% 54.4% 54.6% Q3 20-21 50.6% 55.4% -4.8% <64mmols 

Focus Area 2 - (Diabetes services) The percentage of people enrolled in the PHO, 15-74 years with no HbA1c Living well with Diabetes Q4 20-21 7.0% 10.1% 10.7% Q3 20-21 12.7% 9.4% -3.3% result 

Focus Area 2 - Count of enrolled people aged 15-74 in the PHO who have completed a diabetes annual review Living well with Diabetes Q4 20-21 TBC 67.1% 65.5% Q3 20-21 59.3% 69.2% -9.9% (DAR) in the previous 12 months 

Focus Area 4 - (Acute heart service) Indicator1 Percent of high-risk patients will receive an angiogram within 3 Cardiac Services Q4 20-21 70.0% 55.2% 69.3% Q3 20-21 54.5% 55.4% -0.8% days of admission. (‘Day of Admission’ being ‘Day 0’) 

Focus Area 4 - (Acute heart service) Indicator 2a Percent of patients presenting with Acute Coronary Syndrome Cardiac Services who undergo coronary angiography have completion of ANZACS QI ACS and Cath/PCI registry data collection Q4 20-21 95.0% 39.7%  70.3% Q3 20-21 30.8% 39.2% -8.4% within 30 days

Focus Area 4 - (Acute heart service) Indicator 2b Percent of patients presenting with Acute Coronary Syndrome Cardiac Services who undergo coronary angiography have completion of ANZACS QI ACS and Cath/PCI registry data collection Q4 20-21 99.0% Not Available  Not Available Q3 20-21 Not Available Not Available Not Available within 3 months

Focus Area 4 - (Acute heart service) Indicator 3 Percent of ACS patients who undergo coronary angiogram have Cardiac Services Q4 20-21 85.0% 70.8% 75.5% Q3 20-21 80.0% 69.8% 10.2% pre-discharge assessement with LVEF 

Focus Area 4 - (Acute Heart Service) Indicator 4 Composite Post ACS Secondary Prevention Medication Cardiac Services Q4 20-21 85.0% 86.2% 83.9% Q3 20-21 100.0% 85.2% 14.8% Indicator Total  Taranaki District Health Board - Progress on Annual Plan 2020/21

Quarter Four 2020/21 Not measured against target  Target met  Target not met - deterioration from last reporting period Target Met      (Blank)  Target not met - improvement on last reporting period  New measure or information not yet available Within 10% of Target 10-20% away from Target Number 39 23 16 0 36 0  Target not met - no improvement since last reporting period (Blank) Indicator not measured against a target More than 20% from Target

Percentage 39.8% 23.5% 14.0% 0.0% 36.7% TOTAL POPULATION PERFORMANCE ETHNICITY COMPARISON

Current result Total population Total population Previous result Status Previous result Māori result Non Māori result Disparity Service area Indicator period target result period

Focus Area 4 - (Acute heart service) Indicator 5 Percent of patients who have pacemaker or cardiac Cardiac Services defibrillator implantation/replacement have completion of ANZACS QI device forms within 2 months of Q4 20-21 99.0% Not Available  Not Available Q3 20-21 Not Available Not Available Not Available procedure Total

Focus Area 4 - (Acute heart service) Indicator 6 Percent of patients who have pacemaker or implantable Cardiac Services cardiac defibrillator implantation/replacement have completion of ANZACS QI Device PPM (Indicator 5A) and Q4 20-21 99.0% New Measure  New Measure Q3 20-21 Not Available Not Available Not Available ICD (Indicator 5B) forms within 2 months of the procedure Total

Focus Area 5 - (Stroke services) Indicator 1 ASU: Percent of stroke patients admitted to a stroke unit or Stroke Services organised stroke service with demonstrated stroke pathway within 24 hours of their presentation to hospital Q4 20-21 80.0% Not Available  Not Available Q3 20-21 Not Available Not Available Not Available Total

Focus Area 5 - (Stroke services) Indicator 2 Reperfusion Thrombolysis /Stroke Clot Retrieval: Percent of Stroke Services patients with ischaemic stroke thrombolysed and/or treated with clot retrieval and counted by DHB of Q4 20-21 12.0% Not Available  Not Available Q3 20-21 New Measure New Measure Not Available domicile, (Service provision 24/7) Total

Focus Area 5 - (Stroke services) Indicator 3 In-patient rehabilitation: Percent of stroke patients admitted with Stroke Services acute stroke and transferred to inpatient rehabilitation services, are transferred within seven days of acute Q4 20-21 80.0% Not Available  Not Available Q3 20-21 New Measure New Measure Not Available admission Total

Focus Area 5 - (Stroke Services) Indicator 4 Community rehabilitation: Percent of patients referred for Stroke Services community rehab seen face to face by member of community rehab team RN/PT/OT/SLT/SW/Dr/Pysch within Q4 20-21 60.0% Not Available  Not Available Q3 20-21 Not Available Not Available Not Available 7 calendar days of hospital discharge Total

Diagnostic colonoscopy - Urgent: Percent of people accepted for an urgent diagnostic colonoscopy receive (or Improved Access to Diagnostics Q4 20-21 90.0% 98.8% 109.9% Q3 20-21 16.3% 82.5% -66.3% are waiting for) their procedure in 14 calendar days or less Total 

Diagnostic colonoscopy - Urgent: Percent of people accepted for an urgent diagnostic colonoscopy receive (or Improved Access to Diagnostics Q4 20-21 100.0% 98.6% 100.0% Q3 20-21 Not Available Not Available Not Available are waiting for) their procedure in 30 calendar days or less Total 

Diagnostic colonoscopy - Non-urgent: Percent of people accepted for non-urgent diagnostic colonoscopy Improved Access to Diagnostics Q4 20-21 70.0% 33.3% 23.8% Q3 20-21 3.5% 29.8% -26.4% receive in less than 42 calendar days or less Total 

Diagnostic colonoscopy - Non-urgent: Percent of people accepted for non-urgent diagnostic colonoscopy Improved Access to Diagnostics Q4 20-21 100.0% 77.1% 67.6% Q3 20-21 Not Available Not Available Not Available receive (or are waiting for**) their procedure in 90 calendar days or less 

Diagnostic colonoscopy - Surveillance: 70% of people accepted for surveillance colonoscopy receive in 84 Improved Access to Diagnostics Q4 20-21 70.0% 90.6% 88.0% Q3 20-21 7.7% 82.9% -75.1% calendar days or less 

Diagnostic colonoscopy - Surveillance: 70% of people accepted for surveillance colonoscopy receive (or are Improved Access to Diagnostics Q4 20-21 100.0% 84.5% 95.1% Q3 20-21 Not Available Not Available Not Available waiting for**) their procedure in 120 calendar days or less - Total 

Percent of patients who returned a positive FIT have a first offered diagnostic date within 45 days of their FIT Improved Access to Diagnostics Q4 20-21 95.0% Not Available Not Available Q3 20-21 Not Available Not Available Not Available being recorded 

Primary Care Percentage of population enrolled with a PHO Q4 20-21 95.0% 93.5%  93.8% Q3 20-21 78.8% 97.4% -18.5%

Primary Care Percentage of PHO enrolled patients identified as smokers Q4 20-21 5.0% 15.8%  16.4% Q2 20-21 33.3% 12.6% -20.7%

Percentage of PHO enrolled patients who smoke have been offered help to quit smoking by a health care Tobacco Q4 20-21 90.0% 76.4% 79.7% Q2 20-21 70.5% 79.2% -8.7% practitioner in the last 15 months 

Percentage of pregnant women who identify as smokers upon registration with a DHB-employed midwife or Tobacco Q4 20-21 90.0% 64.7% 53.8% Q3 20-21 64.3% 66.7% -2.4% Lead Maternity Carer are offered brief advice and support to quit smoking 

Obesity The number of referrals to the GRx programme - Adult Q4 20-21 1714 1353  1240 Q4 18-19 351 1002

Obesity The number of referrals to the GRx programme - Children Q4 20-21 60 71  86 Q4 18-19 28 43

Reducing Unintended Teenage Reduce the teen birth rate per 10,000 Q4 20-21 84 96 107 Q4 19-20 178 58 -101.7% Pregnancy 

Reducing Unintended Teenage Reduce the teenage termination of pregnancy rate per 10,000 Q4 20-21 70 22 44 Q4 19-20 37 14 -87.0% Pregnancy 

Obesity % contracts with a Healthy Food and Drink Policy reported as a proportion of total contracts Q2 20-21 100.0% 0.0%  2.4% Q4 18-19 Not Available Not Available Not Available

Cardiovascular Health: 90% of the eligible population will have had their cardiovascular risk assessed in the Cardiovascular Disease Q4 20-21 90.0% 93.9% Not Available Q3 20-21 92.6% 94.1% -1.5% last five years 

Secondary Care Percentage of Emergency Department presentations who are triaged at levels 4 & 5 - Base Q4 20-21 32.2% 29.7%  31.8% Q3 20-21 34.7% 28.4% -6.4%

Secondary Care Percentage of Emergency Department presentations who are triaged at levels 4 & 5 - Hawera Q4 20-21 59.4% 52.5%  60.4% Q3 20-21 53.6% 52.0% -1.6%

Secondary Care Percentage of Emergency Department presentations who are triaged at levels 4 & 5 - Total Q4 20-21 40.5% 36.3%  40.5% Q3 20-21 41.6% 34.6% -7.0%

Maternal & Child Health Percentage of eligible population have their Before School Checks completed - High needs Q4 20-21 67.5% 98.2%  93.1% Q3 20-21 Not Available Not Available Not Available

Maternal & Child Health Percentage of eligible population have their Before School Checks completed Q4 20-21 67.5% 98.2%  83.6% Q3 20-21 100.0% 97.3% 2.7%

Secondary Care Number of Violence Intervention Programme (VIP) training sessions delivered Q4 20-21 3 8  2 Q3 20-21 Not Available Not Available

Secondary Care Ward 2B (paediatric) Violence Intervention Programme routine questioning rates Q4 20-21 85.0% 78.0%  60.0% Q3 20-21 Not Available Not Available Not Available

Secondary Care Ward 15 (maternity) Violence Intervention Programme routine questioning rates Q4 20-21 85.0% 75.0%  70.0% Q3 20-21 Not Available Not Available Not Available

Secondary Care Number of Oranga Tamariki reports of concern Q4 20-21 27 20  26 Q3 20-21 Not Available Not Available

Improving Quality Percentage of inpatients who completed the National Inpatient Patient Experience Survey Q3 20-21 TBC 22.2%  Not Available Q2 20-21 Not Available Not Available Not Available Taranaki District Health Board - Progress on Annual Plan 2020/21

Quarter Four 2020/21 Not measured against target  Target met  Target not met - deterioration from last reporting period Target Met      (Blank)  Target not met - improvement on last reporting period  New measure or information not yet available Within 10% of Target 10-20% away from Target Number 39 23 16 0 36 0  Target not met - no improvement since last reporting period (Blank) Indicator not measured against a target More than 20% from Target

Percentage 39.8% 23.5% 14.0% 0.0% 36.7% TOTAL POPULATION PERFORMANCE ETHNICITY COMPARISON

Current result Total population Total population Previous result Status Previous result Māori result Non Māori result Disparity Service area Indicator period target result period

Disability Support Services % of staff that have completed on-line Disability Responsiveness Training by the end of Q4, 2020/21 Q4 20-21 7.6% 2.7%  2.9% Q4 19-20 Not Available Not Available

Secondary Care Acute hospital bed days per capita Q4 20-21 350 446  391 Q3 20-21 405 461 12.8%

Maternal & Child Health Arranged Caesarean deliveries without catastrophic or severe complication as a % of secondary deliveries Q4 20-21 18.0% 32.2%  29.9% Q4 19-20 26.5% 34.0% 7.5%

Cancer Services/Faster Cancer A reduction in the % of palliative care clients who have had an inappropriate Emergency Department Q4 20-21 0.0% 8.2% 6.7% Q4 19-20 0.0% 8.9% 8.9% Treatment presentation 

Non urgent community laboratory tests are completed and communicated to practitioners within the relevant Improved Access to Diagnostics Q4 20-21 90.0% Not Available 100.0% Q4 18-19 Not Available Not Available Not Available category timeframes for Cat 1, < 24hrs 

Non urgent community laboratory tests are completed and communicated to practitioners within the relevant Improved Access to Diagnostics Q4 20-21 90.0% Not Available 100.0% Q4 18-19 Not Available Not Available Not Available category timeframes for Cat 2, <96 hrs 

Non urgent community laboratory tests are completed and communicated to practitioners within the relevant Improved Access to Diagnostics Q4 20-21 90.0% Not Available 77.0% Q4 18-19 Not Available Not Available Not Available category timeframes for Cat 3, <72 hrs 

Workforce Development Percentage of Māori employed in the health and disability workforce at the Taranaki DHB Q4 20-21 18.0% 9.2%  8.8% Q3 20-21 9.2% Not Available Not Available

Primary Care Patient Experience Survey score - Primary Q4 19-20 36 Not Available  Not Available Q3 19-20 Not Available Not Available Not Available

Secondary Care Patient Experience Survey score - Inpatients Q4 19-20 TBC Not Available  Not Available Q3 19-20 Not Available Not Available Not Available

Amenable Mortality Amenable Mortality Rates Q4 20-21 82 Not Available  91 Q4 18-19 Not Available Not Available Not Available

Reductions in self harm hospitalisations and short stay ED presentations for under 24 year olds (rate per Mental Health & Addictions Q4 20-21 575 746 629 Q3 20-21 810 726 -10.9% 100,000) 

Tobacco Proportion of babies who live in a smoke-free household at six weeks post-natal Q3 20-21 35.0% 50.1%  47.3% Q1 20-21 32.7% 56.9% -24.2%

Maternal & Child Health Did not attend (DNA) rate for outpatient services Q4 20-21 5.0% 6.6%  6.4% Q3 20-21 12.4% 5.1% -7.4% Taranaki District Health Board - Progress on Annual Plan 2020/21 - Māori Health Priorities only Quarter Four 2020/21 Not measured against target  Target met  Target not met - deterioration from last reporting period Target Met  Target not met - improvement on last reporting period  New measure or information not yet available Within 10% of Target (Blank)       Target not met - no improvement since last reporting period (Blank) Indicator not measured against a target 10-20% away from Target Number 0 6 0 1 6 0 More than 20% from Target Percentage 0.0% 46.2% 0.0% 7.7% 46.2% TOTAL POPULATION PERFORMANCE Number of Current result Total population Māori population Māori population Non Māori result Disparity Disparity progress Māori Definition of Māori number Service area Indicator / Activity period target result status

Number of Māori enrolled with PHO until the current quarter with a Primary Care 1. Percentage of population enrolled with a PHO Q4 20-21 95% 78.8% 97.4% -18.5% 20798  rolling 12-month data period (since 1 Jul 2020 until 30 Jun 2021)

Secondary Care 2. Ambulatory sensitive avoidable hospital admissions 0-4 years Q4 20-21 5200 4715 4939  4.6% 124 Number of ambulatory sensitive hospital admissions for Māori for 12 months to March 2021 for specified age group Secondary Care 3. Ambulatory sensitive avoidable hospital admissions 45-64 years Q4 20-21 4990 8266 4588  -57.2% 391

Number of Māori children between 70 and 111 days who are exclusively Maternal & Child Health 4. Improving breast-feeding rates - 3 Months Q3 20-21 70% 41.7% 66.3% -24.6% 65  breast fed at that time. Measure is reported every six-month

Number of Māori women aged 45-69 who have completed breast Cancer Services/Faster Cancer 5. Percentage of eligible women (50-69 years) have had a breast screen every two Q4 20-21 70% 59.5% 73.4% -13.8% 1224 screening in the previous two years (data is two years coverage until Treatment years  March 2021)

Number of Māori women aged 45-69 who have completed cervical cancer Cancer Services/Faster Cancer 6. Percentage of eligible women (25-69 years) have a cervical cancer screen every Q4 20-21 80% 67.7% 78.2% -10.5% 3684 screening in the previous three years (data is three years coverage until Treatment three years  March 2021)

Number of Māori children received all measured immunisations scheduled Increased Immunisation 7. Focus Area 1: Percentage of children are fully immunised at eight months Q4 20-21 95% 67.0% 87.6%  -20.6% 67 between birth and age eight months between 1 April 2021 and 30 June 2021

Number of Māori aged 65 and over enrolled on NIR completed at least one 8. Focus Area 4: Percentage of the population (>65 years) who have had the Health of Older People Q1 20-21 75% 51.8% 68.5% -16.7% 912 influenza vaccine for given vaccination year (1 March 2019 to 30 seasonal influenza immunisation  September 2019 is reported for 2021 Q1)

9. Community Treatment Orders issued under Section 29 of the Mental Health Act Number of Māori under community treatment orders s29 of the Mental Mental Health & Addictions Q4 20-21 115 288 85 -108.8% 73 (rate per 100,000)  Health Act period April 2020 to March 2021 for Q4

Number of Māori pre-school children enrolled in DHB funded oral health Child and Youth Oral Health 10. Percentage of Children (0-4 years) enrolled in DHB funded dental service Q3 20-21 95% 87.0% 103.0% -16.0% 2298  services during 1 Jan - 31 Dec 2019 reported annually in Q3 2021

11. Percentage of Māori employed in the health and disability workforce at the Workforce Development Q4 20-21 0.18 9.2% Not Available Not Available Not Available 211 Number of Māori workforce as of end of Q4 June 2021 Taranaki DHB 

Number of outpatient apointments that were marked Did Not Attend by Maternal & Child Health 12. Did not attend (DNA) rate for outpatient services Q4 20-21 5.0% 12.4% 5.1% -7.4% 591  Māori (Apr-May-Jun 2021)

This is a measure of acute bed days, not people. Bed days can be Secondary Care 13. Acute hospital bed days per capita Q4 20-21 350 404.9 460.5  12.8% significantly skewed by a few people in a small population and the number of people is not readily available in this data set. BOARD REPORT

For: Key questions the Taranaki DHB Board should consider in

reviewing this paper: X Approval • Does the report provide useful and relevant information X Discussion about the work that is being undertaken to address Taranaki DHB Board priorities? X Noting • Is the focus on innovation and different ways of working something that Taranaki DHB Board would like to see more To Taranaki DHB Board of in future reports?

Author Megan Tahere, Tumuaki Matua Hauora Māori – Chief Māori Health and Equity • Is there any further information that you would like to see Officer included in these reports?

CC Rosemary Clements, Chief Executive

Date 27 August 2021

Subject Te Pā Harakeke – Māori Health and Equity Directorate Summary Report for July 2021

RECOMMENDATION It is recommended that Taranaki DHB Board: • Note items 2 to 6.

BOARD REPORT

1. PURPOSE

The purpose of this paper is to provide a summary of kaupapa and kōrero to highlight priority areas for the Taranaki DHB Board attention, comment, and decision making.

2. MINISTRY OF HEALTH (MOH) – WĀNANGA HAUORA - TE TIRITI AND MĀORI HEALTH EQUITY GOVERNANCE AND LEADERSHIP WORKSHOP (NOTE)

The Wānanga Hauora (wānanga) are for District Health Boards (DHBs) and Iwi/Māori Partnership Boards to support and assist DHBs to meet their obligations under te Tiriti o Waitangi and to improve Māori health equity. This series of workshops are the first step in the development of an ongoing programme to support all in how best to govern and lead so we can achieve more equitable outcomes for Māori now, and into the future. Delivering these wānanga is an action in Priority Area Two: Māori Leadership in Whakamaua: Māori Health Action Plan 2020-2025 (Whakamaua). Action 2.3 Design and deliver professional development and training opportunities for Māori DHB board members and members of DHB/Iwi/Māori Partnership Boards.

Members of Taranaki DHB and TWPK Trust were invited to attend Hui Whakaoranga on 27 July 2021 in Rotorua. Four members of the Taranaki DHB Board, two members of Te Whare Pūnanga Kōrero, and myself attended this Wānanga Hauora.

The Powerpoint presentation from Wānanga Hauora can be found in the Resource Centre.

3. DEPARTMENT OF THE PRIME MINISTER AND CABINET – TRANSITION UNIT HUI (NOTE)

Work within the Transition Unit continues, which remains wide in scope and fast paced. The Transition Unit have recently met with Tumu Whakarae and informed leads on their next piece of work regarding further development of Iwi Māori partnership Boards (IMPBs). The Transition Unit plans to hold a combined workshop with current IMPB members on either 26 August or 1 September 2021 in Hamilton. The purpose of the workshop is to define the skill requirements of the new IMPBs, to plan for the establishment of the IMPBs, and to identify what capabilities are needed in support of the new IMPBs.

4. CONSUMER COUNCIL (NOTE)

A Tiriti o Waitangi-led (Tiriti-led) approach to the recruitment of the Taranaki DHB inaugural Consumer Council is being facilitated between the Clinical Governance Support Unit (CGSU) and Te Whare Pūnanga Kōrero. Expressions of Interest have been shared with Te Whare Pūnanga Kōrero and discussion with respective iwi is taking place regarding an agreed approach to progressing the recruitment process. Te Whare Pūnanga Kōrero aim to have further advice for the CGSU on 6 September 2021.

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BOARD REPORT

5. SERVICE AND WORKFORCE DEVELOPMENT (NOTE)

5.1. He Ara Oranga Mental Health and Addictions System Redesign Project

The Strategy and Commissioning Manager Mental Health and Addiction role has been advertised with one candidate progressing to interview which is scheduled to occur on 19 August 2021.

5.2. Pouhāpai – Whānau Engagement and Experience Specialist

The Pouhāpai – Whānau Engagement and Experience Specialist role has been advertised with two candidates progressing to interview which are scheduled to occur on 23 August 2021.

5.3. Pou Whakaturuki – Executive Assistant to the Tumuaki Matua Hauora Māori – Chief Māori Health and Equity Officer

The Pou Whakaturuki – Executive Assistant to the Tumuaki Matua Hauora Māori – Chief Māori Health and Equity Officer has been advertised with one candidate progressing to interview. This person has been advised they are the preferred candidate and contract negotiation is underway.

6. TE PĀ HARAKEKE – MĀORI HEALTH AND EQUITY DIRECTORATE CHANGE PROPOSAL (NOTE)

Te Pā Harakeke, Māori Health and Equity Directorate Proposal for Change documents were disseminated for consultation on 4 August, 10 August, and 19 August 2021. The consultation process has taken a staggered approach due to Industrial Action.

The proposed changes aim to ensure that Te Pā Harakeke is fit for purpose and has the most appropriate workforce to deliver the Ministry of Health Whakamaua: Maori Health Action Plan 2020-2025, Te Manawa Taki Regional Equity Plan 2020-2021 (and pending 2021-2022 plan), and Taranaki District Health Board (Taranaki DHB) Te Kawau Mārō Taranaki Māori Health Strategy Refresh 2020, and achieve the Taranaki DHB Annual Plan 2021/22 (and pending 2022/23 plan).

Strategic alignment of Te Pā Harakeke with national, regional, and local plans, and equitable resourcing of Te Pā Harakeke will facilitate progress towards achievement of the Taranaki DHBs aspiration for increased Māori health workforce, accelerated, accumulative, and radical improvements in Māori health, and vision of Pae Ora for Māori in Taranaki. Critical to the organisations success in achieving these aspirations is provision of authentic support and enablement of the hauora and health aspirations of iwi and Māori in Taranaki, and commencement of a deliberate and intentional shift to transition with the health and disability system transformation (reform).

The proposed change to how Te Pā Harakeke contributes to leading the development, implementation, and refinement of Tiriti-led and pro-equity approaches that will ensure the provision of fit for purpose, high quality, and safe models of care and services, delivery of services that strengthen responsiveness to Māori, and the organisations ability to understand and met the needs of whānau, hapū, iwi, and Taranaki DHB partners and stakeholders.

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BOARD REPORT

Commitment to the Taranaki DHBs obligations under te Tiriti has informed the development of this proposal and will continue to inform its implementation. This direction and the proposal for change was presented to Te Whare Pūnanga Kōrero Trust (TWPK Trust) on 2 August 2021 where it was endorsed to proceed to consultation.

Independent cultural support has been provided as part of the consultation process. Alan Wilcox was appointed by TWPK Trust to discuss this proposal with each team member of Te Pā Harakeke, as well as any other historical issues that may impact them moving forward. The opportunity to access support by way of an individual appointment with Alan has also been made available to all executive leade5rship team members to discuss how they can champion change to accelerate the flourishing of Māori through Tiriti-led and pro-equity approaches in our organisational structure and operations.

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BOARD REPORT

For: Key questions the Board should consider in reviewing this paper: Approval • What are the DHB doing to ensure the Discussion wellbeing of the workforce is supported during these challenging times? X Noting • How is the DHB supporting diversity in the SMO workforce? To TDHB Board

Author Joanie Sims, GM People & Capability

Endorsed by Rosemary Clements, Chief Executive Officer

Date 27 August 2021

Subject People & Capability Report for August 2021

RECOMMENDATION It is recommended that the Board: • Note the update on key achievements and focus areas within People & Capability; including Organisational Development, Employment Relations, Recruitment and Training. No decision is required.

BOARD REPORT

1. PURPOSE

The purpose of this paper is highlight key achievements and focus areas within People and Capability – Organisational Development, Employment Relations, Recruitment and Training.

2. PEOPLE & CAPABILITY STRATEGY

A refreshed People & Capability Strategy (‘Plan-on-a-Page’) with associated programme of work is being developed. The first revision of this strategy occurred prior to the health reforms announcement, since then the leadership team has refocused this strategy to focus on the next 24 months. This strategy will ensure that Taranaki DHB has a clear direction of initiatives which link to culture and also provide a stable platform as the health system transitions to a national system.

3. EMPLOYMENT RELATIONS OVERVIEW

3.1. Bargaining Update

Negotiations are still ongoing for the following MECAs:

• Nursing & Midwifery MECA (NZNO) with TDHB having a representative on the bargaining team; • PSA (Public Service Association) Nursing and PSA Allied MECAs; • Midwifery Employee Representation and Advisory Service Incorporated (MERAS); • Etu – Trades; • Association of Salaried Medical Specialists;

The following have been settled since the last report: • APEX Laboratory MECA; • NZRDA Resident Medical Officers.

BOARD REPORT

4. RECRUITMENT OVERVIEW

Recruitment challenges continue to be experienced both locally and nationally. Work is being conducted at a National level to support challenges experienced with immigration and Covid-19 related challenges.

Senior managers met to discuss our current model for the TDHB Health Education Scholarship Programme with the outcome for HR Recruitment to lead a group to identify options to deliver the programme for the 2022 study year, targeting vulnerable workforces.

Collaborating with multiple DHBs to investigate the feasibility to implement a new e-recruitment system. The first stage has been implemented aligned to the Kiwi Health Jobs website that creates the ability to have a talent pool accessible to participating DHBs.

5. TRAINING OVERVIEW

A total review of the Training & Development function has recently commenced to understand the requirements going forward and ensure it is a fit for purpose programme for the DHB. Alongside this progress continues with the enhancement of the StarGarden training systems by the ICT analysis team to improve reporting on various training activities.

6. ORGANISATIONAL DEVELOPMENT OVERVIEW

6.1. Leadership Development

Leadership Development programmes for the Health sector are being centralised via a full market tender run by MOH. A Steering group has been established to lead this work and the current target date is October.

Internally, we have launch fortnightly ‘Leader Rounds’, which is presentations by leaders for leaders. To date we have had five presentations from both internal and external presentations as well as two questions and answer panels with members from our Executive Leadership team. Our most recent presentation was hosted by ADON – Medical, the topic “Bullshift, Get more honesty and straight talk at work”.

6.2. Engagement Survey

Health Round Table has been endorsed by the Executive Leadership Team as the vendor for our Engagement Survey. A project plan is being established to include detail on the roll-out and associated communication plan. Due the ongoing industrial action we BOARD REPORT anticipate this launching end of September. The survey offered by Health Round Table is a ‘Hospital Culture Assessment’ which aims at providing further insights into the underlining factors impacting organisation culture and goes beyond that provided by a pure engagement survey.

6.3. Unprofessional Behaviour

This programme has now embedded into organisation and incorporated into the ongoing lunchtime Leader training sessions. We have also had great feedback from staff who have attended the information sessions and we will be looking at how this session can be more accessible to frontline staff, including the option of online versions. The People & Capability team will work in partnership with the GM Maori Health & Equity to continually improve this programme so that it meets the needs of all employees.

6.4. Employee Wellbeing

The organisation wellbeing strategy has undergone a review and a wellbeing framework has been developed. The framework has been endorsed by the Executive Leadership team with initial feedback supportive. The intention is that the framework by published on the intranet with an official launch forming the next Wellbeing Wall update in September.

Due to the recent challenges and acuity within the DHB we launched a Wellbeing Huddle project that provide our leaders with tools including how to huddle to support their teams. We also provided daily Wellbeing Tip of the Day to drive conversation, support employees and provoke thought into how our staff are supporting their own wellbeing.

To support our staff following a critical event a working group lead up our Organisation Development – Projects role has drafted an ‘After Critical Event – Staff Wellbeing & Operational Review Framework’. This has been presented to the Hospital Leadership team and feedback was supportive. It is currently in the pilot stages and being implemented on an ad hoc basis as and when required. Training modules have been created and a schedule on how this will be rolled out to our leaders is in progress. It is anticipated that this will be carried out of the coming six weeks. The training will include Psychological First Aid Training for our facilitators and Clinical Nurse Managers.

BOARD REPORT

7. DIVERSITY

Diversity by Position Type Ethnicity Proportions by DHB

10% 11% 15% 19% 29% 43% 49% 57%

90% 89% 85% 81% 71% M 57% 51% 43% F

New hires that identify as Maori Workforce Ethnicity, Maori

Total 10.2% Change + 0.4% Total 9.1% Change +0.3%

Maori Recruitment - Statistics for the quarter 1 March – 31 May 2021: • 133 of 1321 or 10% of all applicants identified as Maori. • 63 of 468 or 13% of all applicants interviewed identified as Maori. • 41 of 269 or 15% of all applicants hired were Maori • 35 of 133 or 31% of all Maori applicants were hired.

31% of applicants hired this quarter identified as Maori this is a 10% improvement from last report and is a credit to the work the Recruitment Team ensuring our workforce represents the community that we provide for.

The People & Capability team are going to work in partnership with the GM Maori Health & Equity and the Senior Consultant Maori Health (Workforce) to implement initiatives from Te Kawau Maro to grow and support Maori Workforce. BOARD REPORT

8. ANNUAL LEAVE

% of employees with annual leave 2x their entitlement Average annual leave balance in days

Total 14.0% Change + 0.4% Total 21.2 Change +0.2

% Employees Taking <=20 Days A/L in Past 12 Months % Employees Taking <=20 days A/L in Last 12 months

91.8% 82.8% 75.4% 77.3% 75.0% 18%

Employees worked > 12mths taking >20 days A/L Employess worked > 12 mths taking <=20 days A/L

82%

Medical Nursing Allied Health Non-Clinical Admin/ Support Management

Recent decreases in annual leave balances can be attributed to increase in annual leave taken over the Christmas/ New Year pe riod. This is a common trend over the summer months especially with our Non-Clinical Support and Admin/Management cohorts. These figures have now plateaued. Work continues to support areas with high leave balances ensuring these balances are trending downwards.

A focus with the allied workforce group will begin to look at ways to ensure annual leave is taken, it is assumed that this current lack of leave is due to high acuity and recruitment challenges BOARD REPORT

9. TRAINING & PERFORMANCE MANAGEMENT

Total instances of training attendance Total instances of e-learning

Total 418 Change - 500 Total 472 Change + 24

The recent increase in training was associated to the large number of in-service sessions The above illustrates the usual trends in e-learning across a 12 month period. The spike was being facilitated by Nurse Educators and MedChart trainers in addition to increased CPR in seen in March which was attributed to approx. 450 courses completion from previous training for vaccinators and general staff. These levels have returned to what is expected months due to reporting error. Our mandatory training has now moved online which will for winter months, with generally less face-to-face training. result in ongoing higher rates of e-learning.

% of employees who are up-to-date on Mandatory Refresher Up-to-date My Feedback Training 18-month period: 63.5% 12-month period: 26.4% Total 76% Change + 1% We have seen a gradual decline in My Feedback rates over the past six - month period, which can be expected due to the demand and acuity experienced across the organisation. However, if we broaden the parameters of this KPI to an 18-month period, our completion rates show a much better picture of 63.5% increase. This shows that for nearly two thirds of our employees they receive a My Feedback conversation within 18 months.

Having reviewed our inclusion criteria at the end of 2020 as well as changing the format of Given our workforce is 24/7 and many employees work less than a full 1.0 the sessions to online we saw an initial increase in completion. The current rate is reflective FTE it is to be expected that the parameters for My Feedback would be of the new ‘norm’ of completion rates. better set at 18 months. This is a more practicable expectation on the workforce dynamics and current challenges.

The Organisational Development team in conjunction with the Training team are developing a talent identification framework th at relates to the training participation of our leaders. It is anticipated that this will see an increase in the participation rate of leaders in both face-to-face training as well as e-learning. BOARD REPORT

10. TURNOVER

12-month Rolling average of Turnover

HWIP Rolling Average of Turn-Over

0.09 0.08 0.07

0.06 0.05 All Staff 0.04

0.03 Maori

0.02 Linear (All 0.01 Staff) 0 1/07/2020 1/10/2020 1/01/2021 1/04/2021 1/07/2021

As at May 2021 the 12 -month rolling average is 7.7% a significant drop from figures of around 8% to 9% over recent years. Work is being completed at a National Level to support areas of the DHB which may have increased uncertainty due to the health reforms.

NB – the definition of turnover is permanent employees, excluding casuals.

BOARD REPORT

11. DIVERSITY IN LEADERSHIP

This paper has a focus on diversity as opposed to focus on Gender. Gender is defined by the World Health Organisation as “the characteristics of women, men, girls and boys that are socially constructed. This includes norms, behaviours and roles associated with being a woman, man, girl or boy, as well as relationships with each other. As a social construct, gender varies from society to society and can change over time”. Whilst we acknowledge that gender inequality and discrimination means that women face greater barriers, our current data collection and therefore the above analysis is related to the sex of our staff members. We are currently doing work in exploring our inclusion and diversity constructs around this and would look to provide a more accurate presentation of this data in the future.

Diversity past 5 year period SMO Cohort Diversity of current Leaders by Position Type Clinical Leaders – Held by Females

Female Male Female Male Total Clinical Director - South Taranaki Rural Health Total Total Nursing 36 2 38 2015 37% 63% Head of Department - Mental Health Services for 2016 41% 59% Admin/Mgmt 44 18 62 Older People Allied Health 19 - 19 2017 39% 61% 2018 37% 63% Medical 4 14 18 Head of Department – Geriatrics 2019 41% 59% Non-health 1 7 8 2020 39% 61% support Head of Department – Clinical Lead Anaesthetics 2021 48% 52% Total 104 41 145

SMO Headcount by Age Bracket SMO Diversity of New Hires

The Talent Identification Programme in development will ensure specific support for females wishing to move towards clinical leadership are supported and have an identified career path

M e m o ra n d u m

DATE: 18 August 2021

TO: TDHB Board

FROM: George Thomas - GM Finance & Corporate services

COPIES: CEO

SUBJECT: REPORT FOR FINANCIAL YEAR ENDED 30 JUNE 2021

RECOMMENDATION : That the Finance and Corporate Services report for the financial period ended 30 June 2021 is noted and received.

1. FINANCIAL SERVICES

1.1 Financial results (provisional): Fiscal year ended 30 June 2021.

($’000) Budget Actual Variance Forecast Prev ious 2020/21 year 2019/20 1. Hospital Services (26,446 ) (33,259 ) (6,813 ) (33,610) (39,413 ) 2. Governance & funding 0 22 22 10 72 3. DHB Funder operations 14,440 17,475 3,035 17,200 14,140

TDHB consolidated result (1 2,006 ) (15,762 ) (3,756 ) (16,400 ) (25,201)

Extraordinary expenses • Covid19 (unfunded) - - - - 1,832 • Holiday Pay provision - 7,000 (7,000) 7,000 2,000

NET SURPLUS/(DEFICIT) (1 2,006 ) (2 2,762 ) (1 0,756 ) (2 3,400) (29,033)

Closing FTE: 30 June 202 1 1635 1678 (43 ) 1675 1599 Average FTE: 20 20/21 1635 1615 20 1551

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1.2 2020/21 – in a nutshell:

The Board closed the fiscal year 2020/21 with a consolidated financial deficit of $ 22.76M, which included extraordinary expenditure of $ 7.00M. The deficit net of extraordinary expenditure was $ 15.76M; the forecast deficit was $ 16.40M. This result:

• failed to achieve the financial plan target (-$3.76M), • achieved the financial forecast result for the period (+ 0.64M), • is an improvement on the previous year financial deficit result (-$9.44M),and • is 3.40% of the consolidated revenue for 2020/21 (2019/20: 6.00%).

A major influence on the financial result for 2020/21 has been the continuing operating deficit carried by the hospital services operations, with a negative shift relative to previous fiscal periods. The DHB Funder achieved its planned surplus for the year and remained the main contributory to a reduced consolidated deficit for the period. The key points:

1. The hospital services operations closed the year with a deficit of $ 33.26M, which was $6.81M at odds with the plan deficit. Consolidated TDHB revenue throughput was $ 463M, up 10% on the previous year (2019/20: $ 420M). Total operating expenditure increased by 7.60% year on year. 2. The DHB Funder operations delivered a surplus of $ 17.48M, doing well in the final stretch to exceed its targeted surplus ($ 14.44M) for the year. The Funder financial result was assisted by a better than budgeted PHARMAC rebate and a positive IDF outflow against plan. 3. The DHB achieved its financial forecast deficit for 2020/21, net of extraordinary expenditure for provision of $ 7M for Holidays Act remediation. 4. ACC revenue in 2020/21 saw a sharp increase on the previous year (+$ 1.67M) and exceeded budget. Miscellaneous income was $ 6.54M – which included donations of $ 2.31M against a budget of $ 1.40M. 5. Personnel costs and outsourced clinical costs were the main outliers in the expenditure lines. The cost overrun in wages (12.36M) is primarily due to more FTEs carried against plan (primarily in nursing), impact of staff staffing (CCDM), specialling and staffing for Covid. The increase in Outsourced services ($ 1.66M) is attributed to use of locums to fill vacancies in Psychiatric and ENT services. Additionally, the need to reduce waiting lists in Radiology and send away Pathology tests contributed to the overrun. 6. The total cost impact of Covid YTD is $10.60M, of which $5.70M relates to 2020/21. All Covid related expenses have been funded to date. 7. Achievement of initiatives & efficiencies was 30% or $1.49M against a target of $5.00M for 2020/21. 8. Overall, general operating overheads and non clinical costs (finance and depreciation) were below plan outlay and tempered the increase in the financial deficit. Internal cost controls and capping of discretionary cost lines delivered positive outcomes, albeit modest, but were eclipsed by other cost movements. 9. The DHB closing FTE count end June was 1678. The average FTE was 1615 against a plan of 1635. This increase was noticeable in the second half of the fiscal year – from February 2020. In particular increases to nursing staff due to CCDM and the use of casuals had a material impact on both FTE numbers and associated costs. 10. Capital expenditure during the year was $ 11.07M (Budget: $ 23.65M). The capital outlay during the year was within the base line depreciation of $ 17.96M. Investment in Project Maunga Stage 2 business cases and preliminary works was $ 19.56M in 2020/21 (cumulative: $ 29.50M). This amount was fully recovered from Stage 2 project funding approved in May 2020. 11. Fundamentally, during 2020/21 the Board’s core liquidity position has been eroded by the cumulative financial deficits, coupled with demands on capital for projects (Stage 2, e-Space, NZHPL programmes). Capital expenditure prioritisation and working capital management remain 2

mechanisms to manage cashflow. The DHB was reimbursed circa $ 30M in May and June 2021, which was incurred by the DHB to support the early development of the Stage 2 building programme, enabling the DHB to repay temporary cash advances taken to support its cashflow. No deficit support was sought in 2020/21 (2019/20: $18M).

These financial results are provisional and subject to audit review and confirmation. This interim result is also subject to movements in revenues and expenditure that are pending finalisation with the Ministry and other District Health Boards. Factors that are likely to impact the final result are:

• Agreement of Inter District Flow (IDF) between TDHB and other DHB’s. The final wash up for the year is expected to be finalised in September. • Reconciliation and agreement with MOH Finance Directorate of funding accruals and inter DHB transactions. • Audit confirmation post review of contractual liabilities and commitments against provisions carried. • Audit opinion and differences in accounting treatment of income and expenditure .

1.3 Outlook for 2021/22:

The core funding for Taranaki DHB received from the MOH for 2021/22 was a significant decrease (-$ 12M) over the previous year. The draft Annual Plan carries a consolidated financial deficit that is materially in excess of the deficit posted in 2020/21 just concluded, besides other risks. Personnel and clinical costs will come under pressure to reduce planned care waitlists, meet MECA commitments for safe staffing (CCDM), whilst new services planned in the community setting will need additional investment. The increasing demand (local and regional) to adopt and sustain new technology (primarily IT based) is testing budgetary outlay and cashflow. Traditional pressure points include acute demand, ED presentations, specialling and delivery of Planned Care targets in the face of increased acute demand and clinical staffing constraints. There are three capital projects underway, its impacts on the operating line (car parking management, additional personnel, security, health and safety to name a few) will add to the mix. Collectively, these will fully absorb the 2021/22 funding increase, leaving an increased financial deficit in its wake.

Forecast: A tough year ahead.

George Thomas GM – Finance & Corporate Services

Encl: Financial statements: FY 30 June 2021 Summary financials + hospital services + DHB Funder activity: July 2021 (FY 2021/22)

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Provider Arm Performance – June 2021

Statement of Financial Performance

Month Month Month Month YTD YTD YTD YTD % Annual Actual Budget Variance Trending Actual Budget Variance Variance Budget Revenue Total (27,961) (19,737) (8,224) (248,295) (236,727) (11,568) 4.9% (236,727) Personnel Costs 21,549 14,583 6,966 193,063 173,703 19,360 11.1% 173,703 Outsourced Services 1,986 783 1,203 16,082 9,392 6,690 71.2% 9,392 Clinical Supplies 3,560 3,472 88 41,469 41,407 62 0.1% 41,407 Infrastructure & Non Clinical Supplies 3,180 2,753 427 37,945 38,676 (732) (1.9%) 38,676 Internal Allocations (1) (0) (0) (5) (5) (0) 1.6% (5) Total Expenses 30,275 21,591 8,684 288,554 263,173 25,380 9.6% 263,173 (Surplus) /Deficit 2,314 1,854 460 40,259 26,446 13,813 52.2% 26,446

Note: Trending has been based on comparing the current month actual to the previous months actual and whether this has improved or worsened.

YTD Comments Status Personnel Above budget at year end, mainly due to additional nursing staff across various clinical areas and management & administration staff. The nursing and management & administration FTE required for COVID in June was approx 30FTE, this was to cover both testing and vaccination. The ongoing impact of the increased FTE, ongoing leave liability (historical) and the MECA accruals have largely driven the year end result. Outsourced Above budget at year end , largely driven by the use of locums (ro ster cover – services psychiatrists) and planned additional activity to reduce waitlists for planned care and radiology. Outsourced lab tests remained above budget, this budget has been adjusted for 2021-22 (original was budget under-estimated due to service change). Ophthalmology remained above budget, this service has been re-negotiated and budget has been updated for 2021-22. Clinical Above budget at year end which was driven by reduced patient travel and supplies pharmaceuticals expenses. However patient consumables and diagnostic supplies remained under pressure throughout the financial year, these are demand driven supplies monitored closely by our units. Infrastructure Below budget at year end which was driven by redu ced staff travel expense and timing of and non- IT expenses (depreciation and software maintenance fees). However the security clinical expense and hotel expenses (laundry, cleaning supplies) remained under pressure supplies throughout the financial year. Internal Tracking to budget. allocations

Statement of Personnel Costs and FTE by Professional Group

June YTD (Average FTE) Personnel Costs $(000) FTE FTE YTD YTD FTE FTE FTE Actual Budget Var. % Var. Var. % Var. Var. % Var. Var. % Var. Actual Budget Actual Budget Actual Budget Trending 1 Medical Staff 6,916 4,773 2,143 44.9% 216.9 216.3 0.6 0.3% 58,871 56,569 2,302 4.1% 209.9 216.3 (6.4) (3.0%) 2 Nursing Staff 8,485 5,409 3,076 56.9% 739.5 704.8 34.7 4.9% 74,941 65,004 9,937 15.3% 717.0 704.8 12.2 1.7% 3 Allied Health Staff 3,005 1,983 1,022 51.5% 278.2 290.1 (11.9) (4.1%) 26,144 23,444 2,701 11.5% 276.0 290.1 (14.1) (4.9%) 4 Support Staff 737 498 239 48.0% 103.5 99.5 4.0 4.0% 7,364 5,917 1,446 24.4% 104.5 99.5 5.0 5.1% 5 Mgmt & Admin Staff 2,406 1,920 486 25.3% 325.4 302.3 23.1 7.6% 25,743 22,769 2,974 13.1% 309.9 302.3 7.6 2.5% Grand Total 21,549 14,583 6,966 47.8% 1,663.5 1,613.0 50.5 3.1% 193,063 173,703 19,360 11.1% 1,617.3 1,613.0 4.3 0.3%

Note: Trending has been based on comparing the current YTD average FTE to the previous months average FTE and whether this has improved or worsened.

YTD Comments Status General Personnel FTE was above budget by 3.1% in June, a slight improvement from May (3.3%). The FTE above budget was mainly driven by nursing and management & administration FTE. Overall the dollars at year end are above budget which has been driven by the increased FTE on an ongoing basis, MECA accruals and leave liability. Medical staff Medical FTE decreased slightly from May to June, however a number of senior medical officer (SMO) vacancies remain, including psychiatry, ENT and radiology. We therefore have continued to engage locums or make additional payments to current staff where appropriate to maintain service delivery, both of which have an impact on our financial position. The medical MECA accrual has also impacted the year end result. Nursing staff Nursing FTE rema in ed significantly above budget in June although decreased slightly from May. The FTE was above budget across multiple areas including registered nurses (RNs) and health care assistants (HCAs). High demand for specials (HCAs) continued across all wards, as well as for RNs (particularly in ED). There was also approx 21FTE of nursing staff required for COVID vaccination and testing in June. The financial position at year end is worse than budget, mainly driven by increased FTE, the Nursing MECA accrual and the ongoing leave liability. Allied Health Allied health FTE remained below budget in June due to a number of vacancies across staff multiple services and in particular community oral health (11.8FTE, 32.2%) and mental health. Every effort is being made to recruit into these roles. While FTE was under budget at year end the dollars were above budget. This has mainly been driven by a number of salary increases earlier in the year which were only partially budgeted for (as increase not known at time of budgeting) and the PSA MECA accrual. Support staff The support services FTE in June was above budget although a slight improvement from May. This is the impact of the ongoing need for additional cleaners and orderlies. The central sterile services department (CSSD) continued to also be above budget as part of a planned piece of work to ‘grow our own’ in CSSD. Management The management & administration FTE in June remained above budget. This is mainly due to & additional COVID FTE, approx 9.4FTE for June and also additional medical typist FTE to Administration ensure timely processing of clinical letters and associated documentation. This FTE staff continues to be monitored by management to ensure all employed FTE is optimised.

Summary Financials for July 2021 (FY: 2020-21)

A: Financial summary:

Consolidated Financial Result as @ 31 July 2021

(amount in $'000) Actual Budget Variance

1. Hospital Services -3415 -2875 -540 2. Governance & Funding admin 45 -2 47 3. DHB Funder 861 310 551

TDHB consolidated -2509 -2567 58 Extraordinary Expenses Covid19 (unfunded) 0 0 0 Holidays Act Remediation provision 167 167 0

NET SURPLUS/(DEFICIT) -2676 -2734 58

Notes:

• Due to increased activity and pressure on resources in June and July due to year end finalisation of accounts + preparation for the external audit + financial returns to the MOH and Treasury + Annual Plan 2021/22, the MOH has waived the submission of the July financial template and reporting requirements. • At the time of writing this report, the Annual Plan 2021-25 remains in draft form and is yet to be approved. The budget applied in the July financial summary is based on the draft financial result submitted in the Annual Plan, which is under discussion.

• The consolidated financial position YTD to July is a deficit of $2.68M which is $0.058M positive to plan. • The hospital provider arm delivered a deficit result of $3.42M in July, which was negative to plan by $0.54M. • The DHB Funder was positive to plan, with a surplus of $0.86M.

The summarised performance and activity reports for the hospital services and the DHB Funder follow. Provider Arm Performance – July 2021

Statement of Financial Performance

Month Month Month Month YTD YTD YTD YTD % Annual Actual Budget Variance Trending Actual Budget Variance Variance Budget Revenue Total (21,325) (21,462) 137 (21,325) (21,462) 137 (0.6%) (257,415) Personnel Costs 16,227 15,931 296 16,227 15,931 296 1.9% 193,469 Outsourced Services 1,514 956 558 1,514 956 558 58.3% 11,473 Clinical Supplies 3,781 3,476 305 3,781 3,476 305 8.8% 41,915 Infrastructure & Non Clinical Supplies 3,386 4,141 (755) 3,386 4,141 (755) (18.2%) 49,936 Internal Allocations (0) - (0) (0) - (0) #DIV/0! 0 Total Expenses 24,907 24,505 403 24,907 24,505 403 1.6% 296,794 (Surplus) /Deficit 3,582 3,043 540 3,582 3,043 540 17.7% 39,379

Note: Trending has been based on comparing the current month actual to the previous months actual and whether this has improved or worsened.

YTD Comments Status Personnel Above budget for July, mainly due to additional nursing staff across various clinical areas and management & administration staff. The nursing and management & administration FTE required for COVID in July was approx. 42.3FTE, this was to cover both testing and vaccination. The ongoing impact of the increased FTE and ongoing leave liability (historical) is impacting the dollar position. Outsourced Above budget for July, mainly been driven by continued locum cover and in particular for services psychiatrists. Also planned additional activity continued across orthopaedics and radiology which has not been included in the budget. Clinical Above budget for July, mainly been driven by the pharmaceutical and patient travel supplies expense. While this remained under budget in the previous financial year this has shifted in July to being above budget. The patient travel expense has increased due to both demand and the increased cost of this expense. Patient consumables and diagnostic supplies also continue to be under pressure as we move into this financial year, these will continue to be monitored closely by our units. Infrastructure Below budget for July due to reduced staff travel expense and timing of IT expenses and non- (depreciation and software maintenance fees). However the hotel expenses (laundry, clinical patient meals etc) and facilities expense (including security) remained under pressure in supplies July. Internal Tracking to budget. allocations

Statement of Personnel Costs and FTE by Professional Group

July YTD (Average FTE) Personnel Costs $(000) FTE FTE YTD YTD FTE FTE FTE Actual Budget Var. % Var. Var. % Var. Var. % Var. Var. % Var. Actual Budget Actual Budget Actual Budget Trending 1 Medical Staff 4,803 5,566 (763) (13.7%) 218.6 223.3 (4.7) (2.1%) 4,803 5,566 (763) (13.7%) 218.6 223.3 (4.7) (2.1%) 2 Nursing Staff 6,284 5,547 737 13.3% 757.1 721.1 36.0 5.0% 6,284 5,547 737 13.3% 757.1 721.1 36.0 5.0% 3 Allied Health Staff 2,166 2,185 (20) (0.9%) 279.5 286.7 (7.2) (2.5%) 2,166 2,185 (20) (0.9%) 279.5 286.7 (7.2) (2.5%) 4 Support Staff 642 553 89 16.2% 103.2 104.2 (1.0) (1.0%) 642 553 89 16.2% 103.2 104.2 (1.0) (1.0%) 5 Mgmt & Admin Staff 2,332 2,080 252 12.1% 334.0 310.3 23.7 7.6% 2,332 2,080 252 12.1% 334.0 310.3 23.7 7.6% Grand Total 16,227 15,931 296 1.9% 1,692.4 1,645.6 46.8 2.8% 16,227 15,931 296 1.9% 1,692.4 1,645.6 46.8 2.8%

Note: Trending has been based on comparing the current YTD average FTE to the previous months average FTE and whether this has improved or worsened.

YTD Comments Status General Personnel FTE was 46.8FTE (2.8%) in July. The FTE above budget was mainly driven by nursing and management & administration FTE. The dollars continue to be a result of the ongoing leave liability and the continued increased FTE. Medical staff Medical FTE increased from June to July, however a number of senior medical officer (SMO) vacancies remain, including psychiatry, ENT, radiology and anaesthetics. Until we are successful with recruitment of these roles we have continued to engage locums or current employees paid additional were appropriate, to ensure no impact to service delivery. Nursing staff Nursing FTE increased from June to July and continues to be significantly over budget. The FTE was above budget across multiple areas including registered nurses (RNs) and health care assistants (HCAs). High demand for specials (HCAs) continued across all wards, as well as for RNs (particularly in ED). The nursing FTE for COVID (community testing & vaccination) for July was approx. 30FTE. Also the care capacity demand management (CCDM) FTE for 2021 has also been rolled out across inpatient areas and recruitment is activity happening in these areas. Allied Health Allied health FTE remained below budget in July due to a number of vacancies across staff multiple services. In particular community oral health (11.6FTE, 31.9%) and anaesthetic technicians (2.6FTE, 9.1%). For the anaesthetic technicians, those sessions not able to be covered by employed staff are outsourced. While there continues to be a number of areas that remain under budget there has also been a number of winter cover FTE rolled out to allied health areas to assist with winter demand. Support staff The support services FTE in July was 1FTE below budget. This is mainly due t o some vacancies across facilities and stores. While overall the FTE was under budget the cleaning and orderly services continue to be under pressure requiring additional FTE. Management The management & administration FTE in July was above budget. This was mainly due to & additional FTE for COVID which was approx. 12.3FTE and additional FTE for medical typists. Administration This FTE continues to be monitored by management to ensure all employed FTE is staff optimised. In some cases the areas will engage outsourced providers continue to be engaged to ensure timely completion of the work.

Taranaki DHB:

DHB Funder financial summary: July 2021(FY: 2021/22)

TARANAKI DISTRICT HEALTH BOARD FISCAL YEAR : 2020-21 CONSOLIDATED FINANCIAL STATEMENT FOR THE FINANCIAL PERIOD ENDED: 30 June 2021 (Amounts in $'000) ……………………….. 2020/21………………………………………………………………………………. Previous Year Movement %

Hospital services Governance Funder FY ended 30 Jun 2021 (actual) (actual) (actual) (actual) (budget) variance (2019-20) 2020 vs '21 REVENUE

* MOH revenue 233,714 2,883 211,579 448,176 435,044 13,1 32 409,731 38,445 9% (% of total revenue) 52.1% 0.6% 47.2% 100%

* Donations 2314 2,314 1,403 911 218 2,096 * Other revenue 12,267 - - 12,267 9,462 2,805 9,975 2,292 23%

TOTAL REVENUE 248,295 2,883 211,579 462,757 445,909 16,84 8 419,924 42,833 10% OPERATING COSTS * Personnel costs 186,063 1,560 - 187,623 175,882 (11,741) 168,217 (19,406) -7% * Outsourced services 16,082 - - 16,082 9,392 (6,690) 14,094 (1,988) 1% * Clinical supplies 39,225 - - 39,225 38,665 (560) 34,931 (4,294) -13% * Infrastructure and establishment costs 17,029 1,301 - 18,330 14,939 (3,391) 20,346 2,016 3% 258,399 2,861 - 261,260 238,878 (22,382) 237,588 (23,672)

SURPLUS/DEFICIT before depr & int (10,104) 22 211,579 201,497 207,031 (5,534) 182,336 66,505

* Depreciation 15,571 - - 15,571 17,966 2,395 16,799 1,228 -5% * Capital charge + interest 7,584 - - 7,584 9,210 1,626 9,699 2,115 -28%

* Payments to : NGO providers - - 194,104 194,104 191,861 (2,243) 181,039 13,065 7% : Hospital provider ------

SURPLUS/(DEFICIT) before extr. items (33,259) 22 17,475 (15,762) (12,006) (3,756) (25,201) 9,439 -37% Holidays Act remediation provision 7,000 - - 7,000 - (7,000) 2,000 (5,000) Covid-19 expenditure (unfunded) ------1,832 1,832

NET SURPLUS/(DEFICIT) (40,259) 22 17,475 (22,762) (12,0 06) (10,756) (29,033) 6,271 -22%

Closing FTE - (paid FTE) 1,661 17 - 1,678 1,635 (43) 1,599 (79) -5%

Closing FTE - DHB Consolidated @ 30 Jun 2020 1582 17 1599 TARANAKI DISTRICT HEALTH BOARD FISCAL YEAR : 2020-21

OPERATING FINANCIAL STATEMENTS FOR THE FINANCIAL PERIOD ENDED : 30 June 2021

(Amounts in $'000) ……………………….. 2020/21……………………………………………………………………………......

Hospital provider Governance TDHB Funder actual budget variance actual budget variance actual budget variance

REVENUE

* MOH revenue 233,714 225,862 7,852 2,883 2,881 2 211,579 206,301 5,278 * Donations 2,314 1,403 911 ------* Other revenue 12,267 9,462 2,805 ------

TOTAL REVENUE 248,295 236,727 11,568 2,883 2,881 2 211,579 206,301 5,278

OPERATING COSTS

* Personnel costs 186,063 173,703 (12,360) 1,560 2,179 619 - - - * Outsourced services 16,082 9,392 (6,690) ------* Clinical supplies 39,225 38,665 (560) ------* Infrastructure and est.costs 17,029 14,237 (2,792) 1,301 702 (599) - - - * Depreciation 15,571 17,966 2,395 ------* Interest & financing costs 7,584 9,210 1,626 ------

TOTAL OPERATING COSTS 281,554 263,173 (18,381) 2,861 2,881 20 - - -

* Payments to : NGO providers ------194,104 191,861 (2,243) : Hospital provider - - - -

OPERATING SURPLUS/(DEFICIT) (33,259) (26,446) (6,813) 22 - 22 17,475 14,440 3,035 Extraordinary Expenditure

Holidays Act remediation provision 7,000 - (7,000) ------Covid-19 expenditure (unfunded) ------NET SURPLUS/(DEFICIT) (40,259) (26,446) (13,813) 22 - 22 17,475 14,440 3,035

Full time employees (closing) 1,661 1,612 (49) 17 23 6 - - - TARANAKI DISTRICT HEALTH BOARD FISCAL YEAR : 2020-21 Previous Year on Statement of Financial Performance : Hospital Provider Year Year (YTD) $'000 YTD Jun '21 YTD Jun '21 YTD Jun '21 (*) MOH Revenue budget = contract with DHB Funder actual budget variance 2019-20 Movement REVENUE

MOH revenue (*) 231,015 223,406 7,609 209,381 21,634

Other MoH funding (HWNZ, new initiatives etc) 2,699 2,456 243 2,597 102 Total MoH Revenue (*) 233,714 225,862 7,852 211,978 21,736 - ACC Revenue 8,033 6,498 1,535 6,359 1,674 Donations 2,314 1,403 911 218 2,096 Other Revenue 4,234 2,964 1,270 3,616 618 14,581 10,865 3,716 10,193 Total Other Revenue F 4,388 - TOTAL REVENUE 248,295 236,727 11,568 F 222,171 26,124 OPERATING EXPENDITURE Personnel costs 186,063 173,703 (12,360) U 166,630 (19,433) Outsourced services - personnel 3,897 2,233 (1,664) U 2,717 (1,180) - clinical services 12,185 7,159 (5,026) U 11,377 (808) Clinical supplies 39,225 38,665 (560) 34,931 (4,294) Infrastructure and establishment costs 17,029 14,237 (2,792) 19,431 2,402

258,399 235,997 (22,402) U 235,086 (23,313) SURPLUS/(DEFICIT) before depreciation and interest (10,104) 730 (10,834) U (12,915) 2,811 Depreciation 15,571 17,966 2,395 16,799 1,228 Capital charge + interest 7,584 9,210 1,626 9,699 2,115 TOTAL EXPENDITURE 281,554 263,173 (18,381) U 261,584 (19,970) NET RESULT before extraordinary expenses (33,259) (26,446)9,320 (6,813) U (39,413) 6,154 Holidays Act remediation provision 7,000 - (7,000) 2,000 (5,000) Covid-19 expenditure (unfunded) - - - 1,832 1,832 NET SURPLUS / (DEFICIT) (40,259) (26,446) (13,813) U (43,245) 2,986

Full time employees (closing) 1,661 1,612 -49 1,582 -79

Closing FTE in HSS operations @ 30 June 2020 1599 TARANAKI DISTRICT HEALTH BOARD FISCAL YEAR : 2020-21 CONSOLIDATED FINANCIAL POSITION AS AT: 30 June 2021

($'000) As at As at Movement 30 Jun'21 31 May'21

CURRENT ASSETS * Bank Account / (OD) (5,363) 16,218 * Short term deposits - - * Debtors (net of provision) 18,501 12,650 * Inventory (net of provision) 4,105 3,995 17,243 32,863 (15,620) CURRENT LIABILITIES * Creditors & other payables 37,556 58,163 * Provisions 43,102 39,955 80,658 98,118 17,460

WORKING CAPITAL (63,415) (65,255) 1,840

NON CURRENT ASSETS * Net Fixed Assets 251,209 231,900 * Long term investments 2,682 3,229 * Trust funds 797 797 254,688 235,926 18,762

NET FUNDS EMPLOYED 191,273 170,671 20,602

NON CURRENT LIABILITIES * Provisions - non current 1,375 1,275 * Term Loans - - * Leases - -

1,375 1,275 100 CROWN EQUITY * Crown Equity 155,982 149,062 * Reserves 132,813 117,337 * Retained earnings (98,897) (97,003) 189,898 169,396 20,502 NET FUNDS EMPLOYED 191,273 170,671 20,602 TARANAKI DISTRICT HEALTH BOARD FISCAL YEAR : 2020-21 CONSOLIDATED STATEMENT OF CASHFLOW : 30 June 2021

($'000)

YTD Jun'21 YTD May'21 Movement

OPERATING ACTIVITIES

* MOH funding 439,614 423,756 * Other revenue 21,512 18,776 total receipts 461,126 442,532 18,594

* Payment of salaries & operating exp. 264,236 234,612 * Payment to providers & DHB's 191,147 178,115 total payments 455,383 412,727 42,656

NET CASHFLOW FROM OPERATIONS 5,743 29,805 (24,062)

INVESTING ACTIVITIES * Sale of fixed assets etc (348) (348)

* Increase / (decrease) in investments 49 104

* Interest (receipts) (35) (25)

* Capital expenditure 31,138 26,634

NET CASHFLOW FROM INVESTING 30,804 26,365 4,439

FINANCING ACTIVITIES

* Equity injections / (repayments) 32,969 25,090

* Pvt.sector borrowings / (interest paid) (32) (32) * Term loans borrowing / (repayments) - - * Other liability/equity movements (959) - NET CASHFLOW FROM FINANCING 31,978 25,058 6,920

Total cash in 493,104 467,590 Total cashout (486,187) (439,092)

NET CASHFLOW 6,917 28,498 (21,581)

Add: Cash (opening) (12,280) (12,280) CASH (CLOSING) (5,363) 16,218 (21,581) TARANAKI DISTRICT HEALTH BOARD CAPITAL EXPENDITURE REPORT FOR THE YEAR ENDED JUNE 2021 For the Period Ended Jun-21

Month Year to Date Year End Actual Budget Variance Actual Budget Variance Actual Budget Variance A Plant & Equipment - Clinical 329,032 416,000 86,968 2,052,254 5,000,000 2,947,746 2,052,254 5,000,000 2,947,746 Plant & Equipment - Other 761,164 41,000 (720,164) 1,114,181 500,000 (614,181) 1,114,181 500,000 (614,181) Information Technology 994,558 584,000 (410,558) 6,129,831 7,000,000 870,169 6,129,831 7,000,000 870,169 Buildings & site redevelopment 363,439 924,000 560,561 1,697,224 11,000,000 9,302,776 1,697,224 11,000,000 9,302,776 Motor Vehicles 0 37,500 37,500 74,891 150,000 75,109 74,891 150,000 75,109

Total 2,448,193 2,002,500 (445,693) 11,068,380 23,650,000 12,581,620 11,068,380 23,650,000 12,581,620

Covid19 External Expenditure 4,004 0 (4,004) 250,129 0 (250,129) 250,129 0 (250,129)

Project Maunga Stage 2 2,870,840 0 (2,870,840) 16,793,561 0 (16,793,561) 16,793,561 0 (16,793,561)

Seismic Concept Design 105,693 0 (105,693) 2,776,213 0 (2,776,213) 2,776,213 0 (2,776,213) B Capital Contingency - 1,000,000 1,000,000

Total 5,428,730 2,002,500 (3,426,230) 30,888,284 23,650,000 (7,238,284) 30,888,284 24,650,000 (6,238,284)

Project Maunga Stage 2 Incl Seismic Prior Financial Years 9,937,441 Project Maunga Stage 2 16,793,561 Seismic Concept Design 2,776,213 Cummulated Spend to Date 29,507,216 TDHB FUNDER : FUNDING DISTRIBUTION : 2020-21

Disability Support Serv. 15% Public Health 1%

Maori Health (direct) 1%

Mental Health 8% Personal Health Mental Health Maori Health (direct) Disability Support Serv. Public Health Personal Health 75% HOSPITAL SERVICES: REVENUE STREAMS : 2020-21 ($'000)

ACC, $8,033 , 3% MOH revenue MOH revenue, ACC $233,714 , 94% Other revenue, $6,548 , 3% Other revenue HOSPITAL SERVICES : EXPENDITURE LINES: 2020-21

Finance costs 3% Depreciation 6% Infrastructure 6%

Personnel + outsourced Clinical supplies + outsourced Clinical supplies + outsourced serv serv Infrastructure 18% Personnel + Depreciation outsourced Finance costs 67% TDHB WAGE COST DISTRIBUTION (FTE + OUTSOURCED) : 2020-21

Planning & Funding Mgt & Adm - clinical 1% 6%

Mgt & Adm - clerical 8% Support 4% Medical 31% Medical Nursing Allied Health Allied Health Support 13% Mgt & Adm - clerical Mgt & Adm - clinical Planning & Funding

Nursing 37%

M e m o ra n d u m

DATE: August 2021

TO: Taranaki DHB Board

FROM: Becky Jenkins – GM Planning, Funding & Population Health

SUBJECT: June 2021 FUNDER FINANCIAL RESULTS

1. OVERVIEW

This report gives an overview of the Taranaki DHB Funder financial performance for twelve months to June 2021. The overall Funder position for the period is a surplus of $17.47m against a budgeted surplus of $14.44m resulting in a positive variance of $3.03m.

Revenue exceeds plan due in the main to additional funding received to support Pharmaceutical and COVID-19 related costs, funding for Mental Health community projects and IBT final funding tranche plus IBT relating to minimum wage.

PHARMAC rebate tracked slightly higher than budget.

Expenditure exceeds plan primarily due to COVID related costs, which includes higher bed occupancy rates in Aged Residential Care and pharmaceutical costs and Mental Health community projects.

Actual Budget Variance Surplus/(Deficit) Surplus/(Deficit) Surplus/(Deficit) Personal Health $13.57 m $14.44 m $(866 )k Mental Health $339 k NIL $339 k Population H ealth $2. 50 m NIL $2. 50m Health Of Older People $537k NIL $537 k Maori Health $521 K NIL $521 k Governance NIL NIL NIL Total $17.47 m $14.44 m $3. 03 m

Becky Jenkins GENERAL MANAGER PLANNING, FUNDING & POPULATION HEALTH

Summary of the Funder financial performance 2020-21

Month Month Month YTD YTD YTD Annual Jun-21 Actual Budget Variance Actual Budget Variance Budget $ $ $ $ $ $ $

Revenue (38,550,897) (35,653,772) (2,897,126) (437,029,734) (427,845,255) (9,184,479) (427,845,255)

NGO Expenditure 13,551,365 16,208,666 (2,657,302) 194,105,275 191,861,700 2,243,575 191,861,700 Provider Arm Expenditure 24,489,836 18,471,389 6,018,445 225,449,711 221,543,554 3,906,158 221,543,554 Total Expenditure 38,041,201 34,680,055 3,361,143 419,554,986 413,405,254 6,149,733 413,405,254

Surplus/(Deficit) 509,696 973,717 (464,017) 17,474,748 14,440,001 3,034,746 14,440,000 Personal Health

Month Month Month YTD YTD YTD Annual Jun-21 Actual Budget Variance Actual Budget Variance Budget $ $ $ $ $ $ $

Revenue (28,793,104) (26,852,094) (1,941,010) (324,972,876) (322,225,130) (2,747,746) (322,225,130)

NGO Expenditure 7,379,688 10,141,597 (2,761,909) 119,040,605 119,056,867 (16,262) 119,056,867 Provider Arm Expenditure 21,719,604 15,735,492 5,984,112 192,358,476 188,728,262 3,630,214 188,728,262 Total Expenditure 29,099,292 25,877,089 3,222,203 311,399,081 307,785,129 3,613,952 307,785,129

Surplus/(Deficit) (306,188) 975,005 (1,281,193) 13,573,795 14,440,001 (866,206) 14,440,000

Commentary on Variances

Revenue The 19-20 IDF actual positive wash up for July Additional CT & MRI scan delivery 2019/20 Capital charge reduced 6% to 5% - offset in Provider expenditure B4schools funding received in April Additional funding for Electives accrued to be passed over The 20-21 IDF positive EOY estimate

Expenditure Lab expenditure - tracking under budget Pharmaceuticals expected to exceed budget Capital charge reduced 6% to 5%, reduce Provider expenditure PCTs currently tracking same as prior year and under budget Wash up of Pharmac rebate for EOY in June Additional Electives accrued offset by funding EOY internal revenue adjustment to support cost pressures

The major services included under NGO expenditure for Personal Health are Community Laboratory, Pharmaceutical costs, Community pharmacy services, Primary Care including PHO capitation, Palliative Care and Inter District Flows Mental Health

Month Month Month YTD YTD YTD Annual Jun-21 Actual Budget Variance Actual Budget Variance Budget $ $ $ $ $ $ $

Revenue (2,506,413) (2,969,030) 462,616 (36,599,277) (35,628,354) (970,923) (35,628,354)

NGO Expenditure 1,204,115 1,164,823 39,292 14,501,514 13,977,873 523,641 13,977,873 Provider Arm Expenditure 1,818,127 1,805,140 12,987 21,758,720 21,650,481 108,239 21,650,481 Total Expenditure 3,022,242 2,969,963 52,279 36,260,234 35,628,354 631,880 35,628,354

Surplus/(Deficit) (515,829) (933) (514,895) 339,043 0 339,043 0

Commentary on Variances

Revenue Additional Integrated PMHAS Additional Early Intervention Additional AOD Community Services EOY carryforward of revenue to 2021/22

Expenditure Additional expenditure offset by additional revenue as above

The major services included under Mental Health are Alcohol and Drug, Child and Adolescent, Maternal, Residential Care, Community Clinical and Non-Clinical and Vocational Mental Health support Population Health

Month Month Month YTD YTD YTD Annual Jun-21 Actual Budget Variance Actual Budget Variance Budget $ $ $ $ $ $ $

Revenue (292,326) (140,677) (151,649) (5,816,824) (1,688,125) (4,128,699) (1,688,125)

NGO Expenditure 137,206 85,654 51,552 2,503,162 1,027,850 1,475,312 1,027,850 Provider Arm Expenditure 74,419 55,051 19,367 810,167 660,275 149,892 660,275 Total Expenditure 211,625 140,705 70,919 3,313,329 1,688,125 1,625,204 1,688,125

Surplus/(Deficit) 80,701 (28) 80,730 2,503,495 0 2,503,495 0

Commentary on Variances

Revenue Funding related to COVID-19

Expenditure Increased COVID-19 related costs offset by additional COVID-19 funding Tobacco under budget Provider Arm increased ISLA primarily related to Immunisation

The major services included under Population Health are Mama Pepe Hauora project, Green Prescriptions and Smokefree Health of Older People

Month Month Month YTD YTD YTD Annual Jun-21 Actual Budget Variance Actual Budget Variance Budget $ $ $ $ $ $ $

Revenue (6,391,093) (5,124,010) (1,267,083) (62,825,229) (61,488,118) (1,337,111) (61,488,118)

NGO Expenditure 4,607,559 4,550,036 57,522 55,382,803 54,600,436 782,367 54,600,436 Provider Arm Expenditure 576,250 574,270 1,979 6,905,494 6,887,682 17,813 6,887,682 Total Expenditure 5,183,809 5,124,306 59,501 62,288,297 61,488,118 800,180 61,488,118

Surplus/(Deficit) 1,207,284 (296) 1,207,582 536,932 0 536,931 0

Commentary on Variances

Revenue No significant variances have been reported for the year to date. Additional IBT revenue offset additional expenditure

Expenditure Expenditure expected to exceed budget Residential care exceed budget as consequence of COVID - less deaths

The major services included under Health of Older People are Needs assessment, Home based support, Aged residential care, Day activity programmes and Respite Care Maori Health

Month Month Month YTD YTD YTD Annual Jun-21 Actual Budget Variance Actual Budget Variance Budget $ $ $ $ $ $ $

Revenue (327,916) (327,916) 0 (3,934,991) (3,934,991) 0 (3,934,991)

NGO Expenditure 222,797 266,556 (43,759) 2,677,191 3,198,674 (521,483) 3,198,674 Provider Arm Expenditure 61,391 61,391 0 736,317 736,317 0 736,317 Total Expenditure 284,188 327,947 (43,759) 3,413,508 3,934,991 (521,483) 3,934,991

Surplus/(Deficit) 43,728 (31) 43,759 521,483 0 521,483 0

Commentary on Variances

Revenue No variances have been reported for the year to date.

Expenditure Expenditure under budget related to Service Development

The major service included under Maori Health is Whanau Ora which includes aspects of the Te Kawau Maro contract Governance

Month Month Month YTD YTD YTD Annual Jun-21 Actual Budget Variance Actual Budget Variance Budget $ $ $ $ $ $ $

Revenue (240,045) (240,045) 0 (2,880,537) (2,880,537) 0 (2,880,537)

Expenditure 240,045 240,045 0 2,880,537 2,880,537 0 2,880,537

Surplus/(Deficit) 0 0 0 0 0 0 0

Commentary on Variances

Revenue No variances have been reported for the year to date.

Expenditure No variances have been reported for the year to date.

The major services included under Governance are Planning and Funding, Communications and DHB board expenses

M e m o ra n d u m

DATE: 19 July 2021

TO: Taranaki DHB Board

FROM: Working Group Chairs

SUBJECT: TARANAKI DHB WORKING GROUPS - UPDATE

INTRODUCTION Please find below an update for each of these groups. This will be provided monthly in conjunction with the Group Chairs. Each month an update as appropriate will be provided on the activities of the various working groups and Chairs of these groups will also be given the opportunity to provide an update.

Infrastructure & Planning Working Group

The Infrastructure & Planning Working Group was scheduled to meet on 19 August 2021 however due to the COVID-19 lockdown, this meeting was cancelled.

Disability Working Group

A verbal update will be provided.

Community & Primary Working Group

A verbal update will be provided.

Upcoming Community Meetings

Meeting Date Meeting Convenor (invites sent to Board members) • 18 August 2021 (cancelled due to the COVID-19 lockdown) South Taranaki Health Forum Councils • 20 October 2021 • 15 December 2021 Taranaki ki te Raki DHB • 29 November 2021

Taranaki ki te Tonga DHB • 10 November 2021

M e m o ra n d u m OPEN

DATE: 18 August 2021

TO: Taranaki DHB Board

FROM: Becky Jenkins on behalf of the Taranaki DHB Disability Working Group

SUBJECT: ACCESSIBILITY ACTION PLAN 2021/22

Recommendations

• To Note Accessibility Action (12 month) Plan

The Accessibility Action (12 month) Plan 2021/22 has been developed in collaboration with multiple partners within the local Disability sector. The Accessibility Action Plan aims to encourage best practice and equity for people who live with some form of health condition or long-term disability. It is focused on enabling a person and whānau centred approach to healthcare services for people with disabilities. The plan is aligned with the national Disability Strategy and key directives such as choice and control and health and wellbeing.

The Taranaki DHB has a commitment to the Ministry of Health to establish and begin implementation of a Disability Action Plan by 1 July 2021.

The final drafts of the “Accessibility Plan on a Page” and the Accessibility Action (12 month) Plan were endorsed by the Disability Working Group at their meeting on 5 July 2021. A copy is attached as Appendix 1

With the health reform changes announced earlier this year, it was agreed that the Accessibility Action Plan would focus on the next 12 months and its priorities would be to: • Empower disabled people and their family/whānau to feel confident about their healthcare choices and how to best access them • Improve the overall quality of the journey and experience inside the health system for disabled people and their family/whānau • Ensure disabled people and their family/whānau feel listened to and clear communication is established • Provide a closed loop feedback system for quality improvements to be made easily.

A six-month report on progress against the plan will be provided to the Disability Working Group in February 2022.

APPENDIX 1: Accessibility Action Plan (12 months) 2021/22 APPENDIX 2: Accessibility Action Plan on a Page

APPENDIX 1

ACCESSIBILITY ACTION (12 MONTH) PLAN What will we focus on Initiative/s (How) Milestones (a step towards the Measures (a target) ELT LEAD initiative, only if over 1 year) Workforce: Work with Human Resources to ensure we are GM People and Review recruitment recruiting with accessibility awareness in mind Capability processes Explore internship opportunities for people with Disabilities COVID-19 All Disabled People, their whānau and caregivers Internal review to ensure PPE Increasing # of people COVID-19 Response are able to access PPE during the COVID-19 distribution is appropriate with disabilities having Group and response access to PPE Senior Responsible Officer COVID-19 Work alongside the COVID-19 response team to Working with the COVID-19 response Vaccine ensure that all people are able to access the team vaccine and access to testing Embed the national Māori Work alongside the Māori Health Directorate to Consult and implement Director of Māori and health strategies within ensure that these strategies are embedded recommendations from consultation Equity the Action Plan Connect with whānau and organisations that work with them with a Whānau Ora approach To provide options for Transition for child and adolescents Child and adolescent services are Transition from Director of Allied services that encourages supported Paediatrics to adult Health people with impairments services is managed with to have choice and Planned processes about the transition a DSS plan control as to how they of patients from child services to adult best manage their own support health needs Planned processes for the first thousand days of a child’s journey Disability Action Group to Disability Action Group Chief Operating support Hospital and Officer Special Services and advise on Disability issues and standards What will we focus on Initiative/s (How) Milestones (a step towards the Measures (a target) ELT LEAD initiative, only if over 1 year) Health care professionals Responsiveness training is supported and is a Attitudes are improved as a result of Increased # of staff GM People and attend Disability Equity priority targeted approach to supporting the attend the Capability Course (formerly needs of disabled people Responsiveness training Responsiveness training) Internal staff training that includes online and is included into modules and one day training professional development External Taranaki Disability Information Centre train nurses in responsiveness, practical day Health care professionals Responsiveness training is supported and is a Attitudes are improved as a result of Increased # of staff GM People and attend Disability Equity priority targeted approach to supporting the attend the Capability Course (formerly needs of disabled people Responsiveness training Responsiveness training) Internal staff training that includes online and is included into modules and one day training professional development External Taranaki Disability Information Centre train nurses in responsiveness, practical day Methods for collating An organisational wide assessment to identify The information is valued and people Chief Information disability data and current state data of the use of (DSS) and how understand the importance of Officer/Clinical disability alerts are in we can use the information for understanding collecting disability statistics and the Governance Unit place trends and where to allocate resource DHB has a clear strategy that aligns with this data

Statistics are collected with national look to understand who has a Disability and what services they access how regularly Internal and external Work with the communications team at Taranaki Engage with external providers to have Increased choice and Communications Information will be DHB to ensure all future communications are information translated control over how people Advisor available and in user available in user-friendly formats e.g. large print, best access information friendly formats easy read, New Zealand sign etc. Adopt a Social Model of Review alongside the Disability Working Group Chief Operating Disability and way in Officer/Director of approach to how people Allied Health view healthcare What will we focus on Initiative/s (How) Milestones (a step towards the Measures (a target) ELT LEAD initiative, only if over 1 year) Adopt Enabling Good Review alongside the Disability Working Group Chief Operating Lives principles and Officer/Director of model, determine Allied Health approach to support these principles Translate Disability Action Work with the Māori Health directorate Work with Te Reo o Taranaki Trust Increase in number of Director Māori Health Plan into Māori language people who have choice and Equity Key information is translated into the Te Reo and control over how Māori they access the information

APPENDIX 2