District Health Boards

Northland District Health Board

AGENDA

DATE: Monday 25 May 2020

TIME: 11.00 am

VENUE: Zoom Meeting

1 AGENDA

MONDAY 25 MAY 2020 BOARD MEETING – PART I

11.00am Karakia

Apologies

 Does any member have an interest they have not previously disclosed?  Does any member have an interest that may give rise to a conflict of interest with a matter on the agenda?

Attendance Register 7

11.00am 1.0 Board Minutes

1.1 Confirmation of Minutes 29 April 2020 8 1.2 Matters/Actions Arising

11.05am 2.0 Quality & Safety Governance Report 11

11.20am 3.0 Chair’s Report

11.30am 4.0 CEO’s Report 27

11.50am 5.0 Decision Items

5.1 Health & Safety Board Charter 37

11.55am 6.0 System Performance

6.1 Quarterly Health and Safety Report 39 6.2 Finance Report 45 6.3 NDHB Funded Services Dashboard 64

12.15pm 7.0 Information Reports & Updates

7.1 COVID-19 Update 7.2 Mental Health & Addiction Services and Psychosocial Initiatives 68 in Te Tai Tokerau 7.3 Increasing Planned Care 90 7.4 Community Response Framework 97 7.5 Budget 2020 Briefing 100

1.00pm 8.0 Next Meeting Details

The next meeting will be 10.45am on Monday 13 July 2020 at Tangihua Room, Tohora House, Whangarei Hospital.

1.00pm 9.0 Resolution to Exclude the Public 104

2 BOARD MEETING – PART II

PUBLIC EXCLUDED SECTION

1.30pm 10.0 Confirmation of Public Excluded Minutes

10.1 Confirmation of Minutes 29 April 2020 10.2 Matters/Action Arising

11.0 Risk Management/Initiatives

12.0 Decision Items

12.1 Contribution to National Haemophilia Management Group 12.2 healthAlliance C Class Shares 12.3 Aged Residential Care Service Contracts 12.4 Renewal of NGO Contracts 12.5 Te Tumu Waiora – Health Improvement Practitioners Contract Variation 12.6 Ngati Hine Health Trust – Services to Promote Resilience, Recovery and Connectedness 12.7 Health and Safety Governance Maturity and Capability Assessment 12.8 Business Case Whangarei Hospital Power Upgrade Projects

13.0 Information Updates

13.1 Capital Projects Report 13.2 Regional ISSP – Infrastructure as a Service Update 13.3 Equity with Resources Committee Chair’s Report Meeting - 25 May 2020

4.00pm Closure

3 NORTHLAND DHB - BOARD MEMBERS INTERESTS REGISTER

Name Interest Date

ANDERSON  Director/Shareholder - Fluid Chemicals NZ Ltd 29/4/20 Nicole  Director - Northland Inc  Director/Shareholder - Northern Tyre Co Ltd  Director – PHARMAC; Chair Audit & Forecast Committee  Member - NZ Conservation Authority  Trustee - Te Runanga A Iwi O Ngāpuhi  Director/Shareholder - Anderson Trading Co Ltd  Trustee - Matai Aranui Marae  Director/Chair - Manea Footprints of Kupe Ltd  Trustee - Te Au Marie 1769 Sestercenial Trust (Tuia250)  Director – Northland Polytechnic Ltd

Iwi affiliations: Ngāpuhi

BAIN  Councillor - Northland Regional Council 9/12/19 John  Member – St John Chapter  Director - Noble Imports Ltd.  Director -Banjo Trading Co Ltd  Trustee – Northland Road Safety Trust  Justice of the Peace

BURKHARDT  Director/Owner - Replas Ltd 9/12/19 Harry  Chair - Ngāti Kuri Trust Board  President - Packaging Council of New Zealand  Member - Independent Advisory Panel for MPI  Chair - Northland Economic Advisory Committee  Board member - Māori Economic Development Board  Chair - New Zealand Maori Arts and Crafts Institute | Te Puia  Director - Burkhardt Investments Limited  Director - Ngāti Kuri Tourism Limited  Director - Te Manawa o Ngāti Kuri Trustee Limited  Director - Taitokerau Investment Fund General Partner Limited  Director - Burkhardt Ventures Limited  Director - Te Urungi o Ngāti Kuri Limited  Director - Te Paki Limited  Director - Waimarama Orchards Limited  Director - Wharekapua Limited

Hapu/Iwi affiliations: Hapu: Ngāti Waiora, Ngāti Murikahara Iwi: Ngāti Kuri; Whakapapa links to Te Rarawa, Ngāti Kahu

COCURULLO  Councillor (Okara Ward) – Whangarei District Council 28/1/20 Vince  Director/Owner - Cocurullo's Ltd  Director - Cocurullo Investments Ltd  President - Whangarei Club  Councillor - Northland Automotive Association  Member of several Service Clubs within Whangarei

EGGLETON  Employee - Ki A Ora Ngätiwai 28/1/20 Kyle  Member - Northland Faculty Board, Royal New Zealand College of General Practitioners  Member - Medicine Adverse Reactions Committee, MedSafe  Trustee - Auckland Faculty, Royal New Zealand College of General Practitioners, Charitable Research and Education Trust

4 Name Interest Date

 Chairperson - Bream Bay Community Support Trust  Member - Australasian Association of Academic Primary Care Advocacy and Policy Committee  Senior Lecturer University of Auckland

Family members

 Ariel Eggleton – Employee - Ki A Ora Ngätiwai  Marcia Underwood - Employee – Northland DHB

EVANS  CEO – Kaipara Community Health Trust (KCHT) 9/12/19 Debbie  KCHT Community Representative – Kaipara Total Health Care Joint Venture Board  KCHT Representative Kaipara Care Committee  Member - Dargaville Integrated Family Health Centre Committee  Member – Northland Community Foundation Grassroots Funding Allocation Committee  Member – Rural Women  Member Habitat for Humanity Dargaville Sub-committee

Family Members associated with Northland DHB employment/programmes  Bernadette Buisman, Registered Nurse – Renal Unit  George McNally, Lecturer at NorthTec – Nursing Department

JONES  Trustee - Rural Support Northland 9/12/19 Libby  Trustee - Sport Northland  Deputy Chair - Paparoa Medical Society  Member - Rural Health Alliance Aotearoa New Zealand (RHAANZ)  Member – Rural Women NZ  Manager - Jigsaw North Family Services  Trustee – Volunteering Northland

LYNDON  Employee – Te Kaupapa Mahitahi Hauora Te Papa O Te Raki Trust 29/4/20 Mataroria  Lecturer – University of Auckland  Board member – Health Promotion Agency  Member - Advisory Group, Aktive Sport Auckland  Member - Steering Group, Ministry of Health Primary Care Models of Care Research Partnership  Member - Health, Quality & Safety Commission Patient Experience of Care Governance Group  Employee -Tend Healthcare

Iwi affiliations Ngāti Hine, Ngāti Whātua, Ngapuhi

MACAULEY  Chairman – Bay of Islands Arts Festival Trust 9/3/20 Sally  Director/Trustee – Kerikeri International Piano Competition Trust  Director – Kaikohe Education Trust  Director- Kaikohe Community and Youth Centre Trust  Judicial and Ministerial Justice of the Peace – Far North Justice of the Peace Association Inc.  Visiting Justice Northern Regional Corrections Facility  Director - Turner Art Centre, Kerikeri

Family Members

Peter Macauley  Partner Palmer Macauley Lawyers

5 Name Interest Date

 Member of Priority Chapter NZ St John

PETERS  Councillor – Whangarei District Council 28/1/20 Carol  Employee – 155 Community House  Trustee – Channel North  Trustee - Northland Rural Urban Mission (NURM)  Trustee - Food Rescue Northland  Trustee - Creative Northland  Trustee - Climate Change Taitokerau Northland  Trustee - Cnorth

RAE  Trustee - Foundation North 28/1/20 Ngaire  Employee - Te Kaupapa Mahitahi Hauora Te Papa O Te Raki Trust  Board member - Waka Ama New Zealand  Collective member - Tryphina House Whangarei Women’s Refuge  Secretary - STIR (Stop Institutional Racism)  Chair - Healthy Homes Tai Tokerau  Member - Parihaka Waka Ama Club  Convenor - Whangarei Child Poverty Action Group

Family Members Richard Pehi  Housing Coordinator, One Double Five Community House

6 MEMBER ATTENDANCE - Financial Year - 1 JULY 2019 - 30 JUNE 2020

2019 2020 BOARD Jul Aug Sept Oct Nov Dec Jan Feb 9-Mar 23-Mar Apr May June Harry Burkhardt (Chair from 9/12/19)     Nicole Anderson     John Bain         Vince Cucurullo     Kyle Eggleton     Debbie Evans         Libby Jones         Mataroria Lyndon     Sally Macauley (Chair until 8/12/19)         Carol Peters     Ngaire Rae     Craig Brown     Sue Brown (Deputy Chair until 8/12/19)     Denise Jensen     June McCabe     Gary Payinda     Sharon Shea    

MEMBER ATTENDANCE - Calendar Year 1 JANUARY - 31 DECEMBER 2020

2020 BOARD Jan Feb 9-Mar 23-Mar Apr May Jun Jul Aug Sept Oct Nov Dec Harry Burkhardt (Chair)     Nicole Anderson     John Bain     Vince Cucurullo     Kyle Eggleton     Debbie Evans     Libby Jones     Mataroria Lyndon     Sally Macauley     Carol Peters     Ngaire Rae    

No Meeting Held Term Commenced 9/12/19 Term of Office Concluded 8/12/19

Draft Minutes of Meeting Northland District Health Board Zoom Board Meeting

10.30am, Wednesday, 29 April 2020 Waipoua Room, Tohora House, Whangarei Hospital https://northlanddhb.zoom.us/j/95273039788

Present Harry Burkhardt – (Chair) Kyle Eggleton (part) Ngaire Rae (Deputy Chair) Libby Jones (part) Nicole Anderson Sally Macauley Vince Cocurullo Carol Peters Debbie Evans Mataroria Lyndon (part) John Bain

In Attendance Nick Chamberlain, Joyce Donaldson, Mark McGinley (part), Sarah Hoyle, Neil Beney, Jeanette Wedding, Dean Oldham, Julie Shepherd (minutes)

Susan Botting (Advocate) joined at 1.20pm

Karakia was said by Mataroria Lyndon 10.30am

Nicole Anderson noted she is a shareholder in a company which manufacturers hand sanitiser Mataroria Lyndon noted his involvement with a digital health company

1. RESOLUTION TO EXCLUDE THE PUBLIC

IT WAS MOVED THAT the public be excluded from the following part of this meeting, under Schedule 3, Clause 32 of the NZ Public Health & Disability Act 2000 and in accordance with the Official Information Act 1982 as detailed in the table below;

Agenda item and general subject of the Reason Reference matter to be discussed

2.0 2.1 Confirmation of minutes for For reasons previously given meeting held 9 March 2020 - public

excluded session and 23 March 2020

2.2 Matters Arising

Draft Minutes of Meeting, 23 March 2020 | Page 1 of 3

8 3.0 Capital Projects Update Commercial Activities: To enable the Board to 9(2)(i) carry out, without prejudice or disadvantage,

commercial activities

Negotiations. To enable the Board to carry out, without prejudice or disadvantage, negotiations 9 (2)(j) (including commercial and industrial negotiations)

4.0 Draft Whangarei Hospital Programme Commercial Activities: To enable the Board to 9(2)(i) Business Case carry out, without prejudice or disadvantage,

commercial activities

Negotiations. To enable the Board to carry out, without prejudice or disadvantage, negotiations 9 (2)(j) (including commercial and industrial negotiations)

Sally Macauley / John Bain Carried

2. CONFIRMATION OF MINUTES The minutes were approved

3. CAPITAL PROJECTS UPDATE The projects were discussed

4. DRAFT WHANGAREI HOSPITAL PROGRAMME BUSINESS CASE The Business Case was approved 5. RESOLUTION TO READMIT THE PUBLIC The public were readmitted at 1.20pm

6. CONFIRMATION OF OPEN MINUTES

6.1 Confirmation of Minutes 9 March 2020

Page 8 of the Minutes, Chair’s Report last line should read – Where the Chair is unable to attend a meeting the Deputy Chair will attend

IT WAS MOVED THAT the minutes of the meeting held on 9 March 2020 be accepted subject to the above amendment John Bain / Vince Cocurullo Carried 6.2 Matters/ Actions Arising There were no items raised for discussion

7. CHIEF EXECUTIVE’S REPORT AND COVID-19 UPDATE

7.1 COVID-19 presentation from Sarah Hoyle (Incident Manager), Neil Beney (Incident Controller), Jeanette Wedding (General Manager)  Northland has had no confirmed case of COVID-19 for 12 days  4,361 Northlanders have been tested. Our Public Health team have been recognised by the MoH for their work both with testing and tracing  48% of all those swabs have been Māori which is the highest in country and has been recognised by MoH

Zoom Board Meeting Minutes, 29 April 2020 | Page 2 of 3

9  Our teams have completed significant assessments of all aged residential care facilities in Northland and no outbreaks have occurred  Increased Flu vaccinations this year  Initially seven static testing sites throughout Northland, which were extended with nine Māori health providers and mobile outreach providers. In addition to COVID-19 testing, general health wellbeing checks and flu vaccinations are being undertaken in remote areas  Logistics played a superb role sourcing and distributing products  Telehealth and Zoom have been used extensively

8. FINANCE REPORT

The Board noted the financial report for March 2020

Key Issues and Discussion Points

 Report taken as read  YTD $10.8m deficit to the end of March 2020 against a deficit budget of $8.2m  The unfavourable result includes just over $1m of unbudgeted extra-ordinary costs related to the Pandemic and Holidays Act Remediation  The April result will reflect the full extent of the impacts of the Pandemic response and the Level 4 and 3 lockdowns  Funding for the Holidays Act provision will be through an equity injection from the MoH

9. NEXT MEETING DETAILS

The next meeting will be held on 25 May 2020 by Zoom. The Equity with Resources meeting will be held commencing at 9.00am followed by the Board meeting at 11.00am

Closing karakia was said by Harry Burkhardt

The meeting closed at 1.55pm

Zoom Board Meeting Minutes, 29 April 2020 | Page 3 of 3

Quality & Safety Summary Report May 2020

Executive Summary

Prioritisation of the work related to the Covid 19 pandemic has necessitated that this is an abridged report.

Patient story No. 1 Raewyn is a voice I have heard answering the phones for quite a while now. I just want to compliment her for her helpfulness today. Today the sincerity in her voice when I asked her for help was comforting. NZ is in COVID-19 lockdown. I have a son in Whangarei Hospital and I am usually his support network, but I can't be there. So I asked her for some info, now I imagine she would be receiving all sorts of calls. So I appreciate that she took the time to give me the right information and was compassionate about it in doing so. Thank you Raewyn, that was total professionalism but also you just went that extra mile. A quote I was told once was, "A kind gesture can reach a wound that only compassion can heal." Nga mihi nui Raewyn

Quality Report to Board – May 2020

11 Patient Trend Experience

Compliments

Aug 18 = 87 Compliments - Bed days p Chart Sep 18 = 45 0.012

Oct 18 = 53 Nov 18 = 78 0.010 0.01 Dec 18 = 38 UCL Jan 19 = 41 0.008 Bed days

Feb 19 = 53 - CL 0.01 Mar 19 = 40 0.006 Apr 19 = 36 May 19 = 37 0.004 LCL 0.00 Jun 19 = 48 July 19 = 51 0.002 Aug 19 = 50 Compliments Sept 19 = 62 0.000 Oct 19 = 54 Jul-18 Jul-19 Jan-18 Jan-19 Jan-20

Nov 19 = 65 Jun-18 Jun-19 Oct-18 Oct-19 Apr-18 Apr-19 Apr-20 Feb-18 Sep-18 Feb-19 Sep-19 Feb-20 Dec-18 Dec-19 Aug-18 Aug-19 Nov-18 Nov-19 Mar-18 Mar-19 Mar-20 Dec 19 = 60 May-18 May-19 Jan 20 = 56 Feb 20 = 61 Mar 20 = 41 Most compliments now entered into Datix by service/department areas, rather than by PSQID, which Apr 20 =16 may account for the drop in number of compliments

Complaints Complaints - Bed days p Chart Aug 18 = 59 0.012 Sep 18 = 36

Oct 18 = 61 0.010 Nov 18 = 56 UCL 0.009 Dec 18 = 45 0.008

Jan 19 = 39 Bed days

- CL 0.006 Feb 19 = 42 0.006 Mar 19 = 38 Apr 19 = 57 0.004 LCL 0.004 May 19 = 54 Jun 19 = 54

Complaints 0.002 July 19 = 78 Aug 19 = 58 0.000 Sep 19 = 52 Oct 19 = 41 Jul-18 Jul-19 Jan-18 Jan-19 Jan-20 Jun-18 Jun-19 Oct-18 Oct-19 Apr-18 Apr-19 Apr-20 Feb-18 Sep-18 Feb-19 Sep-19 Feb-20 Dec-18 Dec-19 Aug-18 Aug-19 Nov-18 Nov-19 Mar-18 Mar-19 Mar-20 Nov 19 = 42 May-18 May-19 Dec 91 = 42 Jan 20 = 39 February 2020 exceptionally high, includes an increase in car parking complaints relating to reduction Feb 20 = 93 in car parks in main public car park due to the theatre build Mar 20 = 56 Apr 20 = 21

Complaints – Complaints closed within 20 working days (excludes HDC) Final response in 100% 20 working days 80% Target = 80%

2018/2019 60% 1st Qtr = 70% 40% 2nd Qtr = 78% 3rd Qtr = 73% 20% 4th Qtr = 66% 0%

2019/2020 Qtr 1 Qtr 3 Qtr 1 Qtr 3 Qtr 1 Qtr 3 Qtr 1 Qtr 3 Qtr 1 Qtr 3 Qtr 1 Qtr 3 Qtr 1 Qtr 3 Qtr 1 Qtr 3 Qtr 1 Qtr 3 Qtr 1 Qtr3 st 1 Qtr = 73% 2010/2011 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 nd 2 Qtr = 75% rd 3 Qtr = 64%

Page 2 of 16 Quality Report to Board – May 2020

MH Complaints Closure Rate MH Complaints closed within 20 working days 2018/2019 100% 1st Qtr 2018/19 = 85% 2nd Qtr 2018/19 = 50% 80% 3rd Qtr 2018/19 = 63% 60% 4th Qtr 2018/19 = 17% Rest of DHB, 64% 40% 2019/2020 MH&AS, 50% 1st Qtr 2019/20 = 16% 20% nd 2 Qtr 2019/20 = 83% 0% 3rd Qtr 2019/20 = 50% 2nd Qtr 2nd Qtr 2018/19 2019/20 3rd qtr 2019/20 qtr 3rd 1st Qtr 2018/19 Qtr 1st 2019/20 Qtr 1st 4th Qtr 2018/19 Qtr 4th 3rd Qtr 2018/19 Qtr 3rd

HDC Complaints

(Non-NDHB requests also 40 included) 35 Sep 18 = 2 Oct 18 = 0 30 Nov 18 = 0 Dec 18 = 2 25 Jan 19 = 1 20 Feb 19 = 0 Mar 19 = 3 Apr 19 = 3 15 May 19 = 1 Jun 19 = 2 10 Jul 19 = 2 Aug19 = 4 5 Sep 19 = 2 Oct 19 = 3 0 Nov 19 = 1 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Dec 19 = 2 Jan 20 = 0 Complaints Breach findings Non DHB request for info Feb 20 = 2 Mar 20 = 2 Referred back to DHB #REF! For investigation Apr 20 = 0

Adverse Events By date event occurred, Adverse Events-Bed days p Chart not date reported 0.035 Aug 18 = 185 Sep 18 = 174 0.030 Oct 18 = 151 UCL 0.028 Nov 18 = 179 0.025 Dec 18 = 222 CL 0.023 Jan 19 = 156 0.020 Feb 19 = 156 LCL 0.018 Mar 19 = 231 Apr 19 = 175

Bed days 0.015 May 19 = 217 Jun 19 = 205 July 19 = 237 0.010 Aug 19 = 216 Sep 19 = 175 0.005 Oct 19 = 220 Nov 19 = 123 0.000 Dec 19 = 196 Jan 20 = 195 Jul-18 Jul-19 Jan-18 Jan-19 Jan-20 Jun-18 Jun-19 Oct-18 Oct-19 Apr-18 Apr-19 Apr-20 Feb-18 Sep-18 Feb-19 Sep-19 Feb-20 Dec-18 Dec-19 Aug-18 Aug-19 Nov-18 Nov-19 Mar-18 Mar-19 Mar-20 Feb 20 = 255 May-18 May-19 Mar 20 = 195 Apr 20 = 138

Page 3 of 16 Quality Report to Board – May 2020

Medication Events Aug 18 = 34 Medication events reported-Bed days p Chart Sep 18 = 44

Oct 18 = 29 0.008 Nov 18 = 25 0.007 UCL 0.007 Dec 18 = 40 0.006

Jan 19 = 46 Bed days

- Feb 19 = 36 0.005 Mar 19 = 34 CL 0.005 Apr 19 = 31 0.004 May 19 =37 Jun 19 = 42 0.003 LCL 0.002 July19 = 36 0.002 Aug19 = 48 Sep 19 = 37 0.001 Oct 19 = 44 Nov 19 = 45 0.000 Dec 19 = 34 Medication events reported Jul-18 Jul-19 Jan-18 Jan-19 Jan-20 Jun-18 Jun-19 Oct-18 Oct-19 Apr-18 Apr-19 Apr-20 Feb-18 Sep-18 Feb-19 Sep-19 Feb-20 Dec-18 Dec-19 Aug-18 Aug-19 Nov-18 Nov-19

Jan 20 = 26 Mar-18 Mar-19 Mar-20 May-18 May-19 Feb 20 = 30 Mar 20 = 38 Apr 20 = 18

Serious & Sentinel Events (SAC 1 & 2) 7 SAC 1&2 c Chart

6 UCL 5.965 Confirmed by Reportable Events Committee (REC) 5 and reported to HQSC 4 Updated data unavailable for this 3 report HQSCreported to 2 CL 1.867

Car Parking Complaints Car parking c Chart 12

6 UCL 5.795

2 CL 1.786

0 Jul-18 Jul-19 Jan-18 Jan-19 Jan-20 Jun-18 Jun-19 Oct-18 Oct-19 Apr-18 Apr-19 Apr-20 Feb-18 Sep-18 Feb-19 Sep-19 Feb-20 Dec-18 Dec-19 Aug-18 Aug-19 Nov-18 Nov-19 Mar-18 Mar-19 Mar-20 May-18 May-19

Increased complaints in February due to reduction in car park spaces in main public carpark due to theatre build

Page 4 of 16 Quality Report to Board – May 2020

14 All Falls

Falls with Harm

Falls with Harm = any fall requiring treatment, ie from a skin tear to a fractured femur

Pressure Injuries

Page 5 of 16 Quality Report to Board – May 2020

15 Patient Experience Survey August 2016 – March 2020 (9257 patients surveyed )

Q1: When you ask the doctor important questions, do you get answers that you can understand?

% Yes always

Q2: Do you feel the doctors listen to what you have to say?

% Yes always

Q3 : Do you feel the nurses listen to what you have to say?

% Yes always

Page 6 of 16 Quality Report to Board – May 2020

Q4: Have you been given conflicting information by different staff members eg, one staff member tells you one thing and another tells you something different?

% No

Q 5: Do you feel safe in this environment?

% Yes always

Q6: Do you feel you can discuss any anxieties or fears about your condition or treatment with the nurse or doctor of you want to?

% Yes always

Page 7 of 16 Quality Report to Board – May 2020

Q7: If you need help from the staff getting to the toilet or using a bedpan, do you get it in time?

% Yes always / Didn’t need help

Q8 Do you feel staff do everything they can to help control your pain?

% Yes definitely / Had no pain

Q 9 : Do you feel staff treat you with respect and dignity(including respecting your cultural & /or spiritual needs and preferences?

% Yes always

Page 8 of 16 Quality Report to Board – May 2020

18 Q10: Has cultural support been available when you needed it

% Yes always or not required

Q11: Has religious/spiritual support been available when you need it?

% Yes always or not required

Q12: Are you involved as much as you want to be in decisions about your care and treatment?

% Yes always

Page 9 of 16 Quality Report to Board – May 2020

Q13: Have you had a conversation with staff about the estimated date for discharge

% Yes definitely / Too soon

Q14: Are you aware of what's happening in terms of your care and treatment today, or what needs to happen?

% Yes definitely

Q15: Do you know that you need to do or achieve before you can go home? (eg up and walking, able to manage your medications at home, cleared by the physio or OT etc.)

% Yes definitely

Page 10 of 16 Quality Report to Board – May 2020

Q16: Where possible, have your whanau/family or close friends been made to feel welcome and able to give you the support you need?

% Yes always

Q17: How would you rate your overall experience of being here?

Using NPS

Cumulative Ethnicity data 100%

80% 69.5%

60% Average 40% 29.9%

20% 1.5% 0.4% 0.4% 0.2% 0.2% 0.1% 0% NZ Māori Other Cook Island Samoan Tongan Indian Chinese European Māori

Mental Health Real time survey not available this month Page 11 of 16 Quality Report to Board – May 2020

Page 12 of 16 Quality Report to Board – May 2020

Page 13 of 16 Quality Report to Board – May 2020

Project progress Start Finish Comment

SC Quality and Safety Jan-13 On going Nil to report this month Markers, quarterly reporting

Patient Experience On going The national Adult Inpatient Survey is currently under Surveys review. A new provider (IPSOS) has been contracted to provide the survey platform and a co-design process is underway, with DHB and consumer input. A change to the number and type of questions has been suggested and the draft question set is currently being consumer tested, in collaboration with HQSC. The new question set is designed to flow in step with the patient journey. The current lack of platform and change to a new question set means the national reporting milestone measures for the four domains (Communication, Coordination, Partnership, Physical and Emotional Needs) for the SLM and Annual Plan no longer exist. The new national survey is planned to go-live in August 2020. How this change is expected to impact on the in-house survey is yet to be determined.

NZ MEWS Nov-16 On going Consultation has taken place with nursing staff in the hospital and modifications made to the escalation pathway to make it more generic, for hospital-wide use. The obstetrician on the working group is arranging a meeting with relevant medical staff to seek their feedback prior to implementation, initially with Ward 3. Support will be given to ward staff by the Maternity Educator and Quality Midwife.

Choosing wisely – Labs Apr - 19 A project within general surgery to reduce by 20% unnecessary blood tests on patients who have had abdominal surgery.

Datix system Jun - 19 On going A Datix Users group refined the content of pages, in response to end user feedback that the system does not flow and is lengthy to enter events. The updated page went live in February 2020 and has received positive feedback. Exploring possibilities for using the Datix system to provide wider visibility of certification corrective actions and recommendations from serious adverse events, and creation of dashboard for recommendations from serious adverse events.

Resuscitation Jun 19 As part of a high risk corrective action the resuscitation policy and process is under review. Issues identified were : a) The patient client resuscitation treatment decision prescription policy is not legally accurate with regard to decision making, does not meet the intent

Page 14 of 16 Quality Report to Board – May 2020

24 of the Code and is being inconsistently implemented. b) The resuscitation documentation does not include adequate information on discussion occurring or evidence of patient/family involvement. Required changes to review, with patient input, the policy and practice related to “not for resuscitation” and make the necessary changes to align with legislation and current best practice. The plan needs to include policy review, documentation review, education, practice changes and audit. Consultation process is in progress. MOH have downgraded corrective action to Moderate risk.

Transfer of Care Jan 19 Feb 20 A draft report with recommendations is awaiting feedback Summary (medical) from participants. A final report to be presented to the Health Records Leadership Group, as the request to create a medical Transfer of Care summary originated from that group.

Page 15 of 16 Quality Report to Board – May 2020

25 Definitions Patient Experience Survey of patient experiences during their hospital stay, utilising i-Pads. This replaced the previous postal patient satisfaction survey. Sentinel Events Definition from the HQSC website www.hqsc.govt.nz “A serious adverse event is one that leads to significant additional treatment but is not life-threatening, and has not resulted in a major loss of function.

Compliments Collected from paper reporting, telephone calls, emails, link from the website and letters, and are logged into the Integrated Patient Safety System.

Complaints Complaints from all sources (telephone, email, website, letter, paper forms) are collated and logged by PS&QID into the Integrated Patient Safety System, for follow-up and/or investigation by the relevant Service/Department Quality Facilitator.

Complaints Report by service (produced via the Integrated Patient Safety System) of numbers of (resolved within 20 complaints resolved, with feedback to the complainant, within the mandated 20 working working days) days.

Quality Accounts Quality Accounts were introduced into the NHS in 2007, with the aim to demonstrate the importance of quality care as being a core business, by placing the reporting of quality on equal footing with financial reporting. In June 2012 the Health Quality & Safety Commission (HQSC) recommended that each health and disability service provider document and publish a yearly set of Quality Accounts, providing the public with a transparent indication of health and quality outcomes being delivered.

Quality Markers A set of 16 measures across 3 areas – Falls, Healthcare-associated infections and Peri- operative harm.

Severity A numerical score given to an incident, based on the consequence of the outcome of the Assessment Code incident and the likelihood that it will recur. A matrix is used to stratify the actual and/or (SAC) potential risk associated with the incident.

Control chart The Shewhart chart (or control chart) is a statistical tool used to distinguish between description variation in a measure due to common causes and variations due to special cause. These charts include a centre line and an upper and lower limit. See ‘Choosing the • CL = Centre line right chart’ below • UCL = Upper control limit • LCL = Lower control limit The rationale for the use of limits includes: • The limits have a basis in statistical theory. • The limits distinguish between special and common cause variation. • In most cases, use of limits will minimize the total cost due to over-reaction and under-reaction to variation in the process. • The limits protect the morale of workers in the process by defining the magnitude of the variation that has been built into the process. These charts are used to determine if a change is an improvement. Net Promoter Score The NPS takes the percentage of patients who are Promoters and subtracts the percentages who are Detractors. Promoters (score 9-10) are very satisfied, Passives (score 7-8) are satisfied, Detractors (score 0-6) are unhappy patients.

Page 16 of 16 Quality Report to Board – May 2020

Chief Executive Report May 2020

STRATEGIC INITIATIVES

Adult Assessment Unit – Whangarei Hospital

As part of the response to the COVID-19 pandemic the Emergency Department was divided into Red Zones for COVID-19 suspected patients and Green Zones for non-COVID suspected patients. As part of this tactical initiative a 12-bedded Adult Assessment Unit (AAU) was approved by ELT on 21 May 2020 to alleviate bed pressure in the ED Green Zone. This allows for the rapid transfer of patients from ED to a bed where further assessment can occur before a patient is admitted, or where a patient is provided with the appropriate care for up to 48 hours to enable a rapid discharge. Because this is located in our main Outpatients area, it has a big impact on these services although alternatives are being found, partly assisted by the use of Telehealth solutions for many of our interactions with Patients. ELT gave approval for the AAU to be expanded to 22-beds based on a full understanding of any costs. It’s important to note, this is not an overall increase in bed capacity as there are many other bed spaces in the hospital which can’t be fully utilized as we endeavor to keep patients and staff safe. However, it does provide an AAU solution adjacent ED and Radiology which was very difficult to achieve prior to COVID-19. ELT also agreed to allocate resource to develop a comprehensive business case exploring risks, benefits and costs of maintaining the Adult Assessment Unit beyond the COVID-19 response.

Whangarei Community Mental Health and Addictions Building

Strategic Projects will be making a bid for funding through the “shovel ready” projects government funding. The schedule of accommodation is complete, with the architect ready to complete fit-out plans. There is continuing consultation and feedback to staff, and small groups are being set up to deliver the functional briefs for rooms. Cultural and consumer representatives will be on each group. The Strategic Project timetable has the fit-out for the ground and top floor starting in March 2021, and completion in September 2021.

Northland Health Strategy

Key information has been consolidated from all reference documents, providing an easier reference point for reviewers and to ensure alignment.

Information from the stakeholder engagement process will be captured in an Insights document that will inform the Strategy. The Insights document is in development and once completed the draft will be circulated for feedback and review.

We estimate that the impact of COVID-19 response on the strategy delivery is 3-4 weeks, however that could be impacted further by the availability of resources and the delayed release of the Health and Disability Review.

Northland Community (Triage) Hub

The Governance Group Meetings will recommence in May, with a focus on developing governance systems to support interdisciplinary team working, credentialing and patient safety. The completed and revised Business Case now includes significant learnings from the COVID-19 response and its submission to ELT is planned for June 2020.

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The Calderdale Framework (CF)

Five Cohort 1 Facilitators have been credentialed as Calderdale Framework Facilitators. The remaining four Facilitators are either submitting late reports, or have some outstanding work to complete. The COVID-19 response has resulted in a delay for the Expressions of Interest selection process for a second cohort of CF trainees. The implementation of Cohort 1 Facilitator projects has also been delayed. Once the availability of the CF Practitioners has been confirmed, the EOI process will be recommenced for Cohort 2.

Neighbourhood Healthcare Homes (NHH) Programme

It was noted that all NHH practices were better positioned to respond to COVID-19 with components such as Clinical Phone Triage, Virtual Consults and Patient Portal being well established as business as usual, and this enabled continuity of care for patients.

NHH toolkits (Clinical Phone Triage & Video Consults with Zoom) were well utilised by all general practices throughout the response, alongside various other resources available on the NHH website. The Health Care Home (HCH) Collaborative also held four webinars for all NZ general practices which were well received.

Progress has been made with the HCH Collaborative model of care enhancement and equity focus, with the new model of care close to being completed. The process to collate data reports for general practices is still predominantly manual, pending availability of a live data dashboard.

We have been working closely with General Practice and Mahitahi Hauora regarding General Practice financial and clinical sustainability, and as well as General Practice payments, there may be solutions to this in the further expansion of NHH as well as the Health and Disability System Review recommendations.

Whānau Tahi Project and Primary Care Led Multidisciplinary Team Meeting Project

The Whānau Tahi project has now transitioned to BAU with Mahitahi Hauora.

The rate of Shared Care plans being created has slowed from previous months: 105 were created during April, but there were 251 Care Plans updated. In total there are 8189 Shared Care plans created to date and 8514 updated. Reports also indicate that the Whānau Tahi patient summary report was accessed just over 1800 times by secondary services during the month of April.

Transition of MDT work was planned to be completed by 31 March 2020; the final transition meeting has now been rescheduled to May 30 2020.

SYSTEM PERFORMANCE

Financial Results

The April result is a deficit of $3.228m against the approved budget of $1.127m deficit, unfavourable by $2.101m. The year to date result to April is a deficit of $14.046m against the approved budget deficit of $9.341m, unfavourable by $4.705m. The unfavourable result for the month was almost entirely due to incremental cost related to our response to COVID-19. Year to date, we estimate incremental cost to the Northland DHB of $2,325k. Closing cash for April 2020 is $4.2m.

ED Length of Stay

Performance has improved with a result of 92 percent of patients remaining in ED less than 6 hours against a target of 95 percent. Improvement is largely due to a reduction in presentations due to COVID-19.

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28 Planned Care Initiative

As at 31 March and 30 April, we estimate that YTD discharges totalled 9,163 and 9,548 respectively. At present, coding is only 84 percent complete for March and 12 percent for April, therefore these are estimates and as a result this is subject to change. This is the total volume under the Planned Care Initiative and includes inpatient surgical activity as well as minor procedures. This output is 102 percent for March and 95 percent for April of the target volume, which is reflective of the reduced level of throughput during March and April following the COVID-19 response.

The most recent advice from MoH is that funding associated with this initiative will not be impacted by under- delivery against the target. Given our performance in the YTD prior to COVID-19, we were forecasting to meet this target and therefore had not anticipated any challenges with accessing the full quantum of funding. We have noted previously that the funding model remains relatively consistent with Electives Initiative and the Ministry of Health has placed a greater focus on delivering care outside the theatre environment. This also requires a detailed three-year strategic plan that spans significantly wider than the scope of inpatient surgery and minor procedures.

With an expectation of increasing unmet need in the community, there is likely to be greater focus on supporting care outside of the hospital environment. It’s likely because of all the hospital constraints that towards further incentivising this form of delivery of more minor planned care in the community. We have just received a pre-budget announcement of a national one-off boost of $282.5 million (operating and capital) over three years for a planned care (including elective surgery) catch-up campaign following COVID-19. If this is allocated on a PBF basis this would equate to over $13m over three years.

Faster Cancer Treatment

The result for March was 70 percent, which is below target. Additional resources have recently been approved to support the administration, tracking and management of the FCT pathways. This additional support is critical to ensuring a long term sustainable turnaround in performance.

Without this it is reliant on the use of nursing and clinician time, which reduces their capacity for the delivery of patient care. We have discussed previously that patients are not recorded as breaches until they receive their treatment; therefore favourable performance in a single month could still mean patients are in the FCT pathway with a waiting time of greater than 62 days.

The most difficult tumour streams to achieve compliance are Lung, Skin and Breast. Access for Lung diagnostics as part of the FCT pathway have improved recently with the arrival of several new Radiologists with interventional skills. This provides a level of robustness to the service that was not previously available.

Immunisation

COVID-19 has had an impact on the recall system operated by General Practitioners because families have not been able to physically access primary care during the Lockdown.

We have continued to operate the Immunisation Outreach Service over the past months, however COVID-19 has seen many of our families not wanting healthcare in their home.

The National Immunisation Register predictor tool predicts that we will reach 86 percent for Quarter 4. We will need to see how the decreasing Alert Levels of COVID-19 enable opening up more opportunities for vaccinating tamariki.

We will also use the new model we have developed with our Maori providers and their use of mobile testing services to also provide childhood immunisations and other hauora interventions.

The following data is for the period ended March 2020 (Quarter 3). Whilst the target is for coverage at 8 months there are indicators also included for 24 months and 5 years.

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29 Summary of results: coverage at age 8 months – 2019/2020

Target: 95% Total Māori Non- Dep 9-10 Change: Change: Maori total Māori

Q1 2019/20 83% 81% 84% 82% 1% 0

Q2 2019/20 86% 86% 85% 83% 3% 4%

Q3 2019/20 83% 81% 86% 80% 3% 5%

Summary of results: coverage at age 24 months

Target: 95% Total Māori Non Dep 9-10 Change: Change: Maori total Māori

Q1 2019/20 82% 81% 82% 80% 0 5%

Q2 2019/20 83% 81% 83% 80% 1% 0

Q3 2019/20 83% 84% 82% 85% 0 2%

Summary of results: coverage at age 5 years

Target: 95% Total Māori Non Dep 9-10 Change: Change: Maori total Māori

Q1 2019/20 81% 84% 80% 82% 0 4%

Q2 2019/20 79% 77% 81% 77% 1% 1 %

Q3 2019/20 81% 81% 80% 82% 2% 4%

B4 School Checks

The B4 School Check is a free health and development check for 4-year-olds. It aims to identify and address any health, behavioural, social, or developmental concerns which could affect a child’s ability to get the most benefit from school, such as a hearing problem or communication difficulty. It is the 12th core contact of the Well Child Tamariki Ora Schedule of services. The target set is 95 percent at year’s end.

The B4 School Programme commenced in July 2019, and due to initial issues relating to the new terms and conditions of the service agreement there was a delay in its signing off by the providers of three months. This impacted on the commencement and progress of the B4 School Checks and therefore the low completion rates we are experiencing in Northland.

It is also unfortunate that COVID-19 has had a severe impact in providers achieving rates to see an improvement in results. Currently Northland is 758 checks behind target as at 1 March 2020, and we have achieved 40.7%. This is the worst in the country due to the three month lag time as mentioned above and is extremely disappointing. However with Alert Level 2 hopefully upon us we are ramping up strategies to at least improve this indicator over the next two months utilising all providers to support this.

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30 Raising Healthy Kids Target

This target relates to 95 percent of obese children being identified in the B4 School Check programme being offered a referral to a health professional for clinical assessment and family-based nutrition, activity and lifestyle interventions. Northland continues to over-achieve in this target – currently 98 percent.

Hospital Smokefree

Between August 2019 and February 2020, Northland DHB has consistently not achieved the target of 95 percent, with results ranging from 84 to 89 percent.

Further investigation found that there were a number of events that had been coded incorrectly. After being corrected this improved the results. Broader audits will be conducted to identify strategies for improvement and implement solutions as appropriate.

A new referral process from the Emergency Department to Toki Rau Stop Smoking Services (since December 2019) has resulted in increased referrals.

This process allows opportunities for the Hospital Smokefree Facilitator to engage with smokers who may not regularly visit their GP and have health concerns that may prompt stronger motivation to quit smoking.

During the months of January and February 2020 referrals to stop smoking support doubled in comparison to the three months prior, with more than half of the referrals being Māori. Feedback from many of the referrals from the Emergency Department is that they appreciate being contacted as it makes them feel we care about their health and wellbeing, and this appears to make them think more seriously about a quit attempt.

The increase in referrals is hopeful, as people who engage with support are four times more likely to quit smoking for good. However, COVID-19 has impacted referrals to stop smoking support during March and April.

Whaia Te Ora is an innovative new wananga approach to wellbeing in the smokefree area. Referrals have been affected by the recent restructure of Toki Rau Stop Smoking Services, with feedback indicating that rebuilding faith in this service is required to increase referrals. COVID-19 has also impacted on referrals of hapu mama to stop smoking support.

Maternity Smokefree- March Quarterly Report

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31 SERVICE DEVELOPMENT

Diabetes Strategy

Governance Group meetings are planned to recommence in June 2020. We are currently planning for the key stakeholder workshop for input into a Northland Diabetes Strategy.

IT Supported Projects Fast Tracked

Several IT supported projects have been fast tracked to assist in the management of COVID-19. These include initiating some electronic prescribing and creating the capability for geriatricians to hold remote consultations with Aged Residential Care facilities via Zoom as well as all the telehealth activity in Outpatients and Primary Care.

Influenza Vaccine

Māori Health Providers across Northland are doing some remarkable work to deliver flu vaccine to their eligible population. The DHB Immunisation and Public Health Nursing (PHN) teams have made it a priority to support Māori Health Providers, for example working with Te Hau O Ngāpuhi to deliver vaccinations and maintain cold chain to vaccinate their eligible population. Northland DHB is resourcing the cost for registered nurses who work for Māori Health Providers and other organisations to become Authorised Vaccinators. Our PHN’s and Immunisation team have supported one Aged Care Rest home in vaccinating all of their staff and residents, and have provided drive-through vaccinating programmes in Kerikeri and Whangarei. Primary Care has been encouraged to continue delivering the Well Child schedule, albeit many parents may chose not to visit general practices at this time. We may see a further drop in immunisation rates in the next quarter. Our focus is to continue to deliver vaccinations to our eligible population, in particular the Influenza immunisation, and those most vulnerable in high priority areas in regards to the childhood schedule. At 30 April there had been 49,641 Influenza vaccines had been distributed in Northland.

Te Tumu Waiora

Te Tumu Waiora is a highly prescribed model of Primary Mental Health Service delivery within General Practices and NGOs. Contracts have been issued to Mahitahi Hauora and the members of the NGO Collaborative for the Health Improvement Practitioners (HIPs) and Health Coaches. Tranche 1 Funding (including pilot funding) funds 18 Practices in Northland to appoint: - 9.5FTE HIP - 0.3FTE clinical lead - 7FTE Youth Health Coaches plus 0.3FTE clinical lead.

Recruitment is partially delayed by COVID-19. So far 11 practices have been recruited into. Mahitahi Hauora is subcontracting some HIP positions to Kaupapa Māori NGOs.

Youth Primary Mental Health and Addiction Expansion, Replication or New Service

Mental Health & Addiction Services, together with Mahitahi Hauora, completed an RFP for this funding and assisted other Northland NGO providers with their RFPs. Ministry of Health are in the process of setting up interviews with the preferred RFPs from Mahitahi Hauora and Rubicon, and there may be others.

NGO Contracts that expire on 30 June 2020

A simplified and expedited process to roll over contracts expiring on 30 June 2020 for one year has been approved by MoH and NZ Audit. A Board Decision Paper has been prepared and is in the approval process.

Regional Development Fund

Mental Health & Addictions put in an Expression of Interest to Te Ara Mahi to extend the current specialist employment service in Kaipara to up to four new sites this financial year. Focus is on rural areas, with one urban site and will sit under the auspices of the Joint Venture between Northland DHB and NZ Police. The project may not go ahead, with priorities changing due to COVID-19 and the drought, though we believe that

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32 employment support for those with Mental Health & Addiction issues is more relevant than ever.

Advanced Care Planning (ACP) Project

Good progress had been made prior to COVID-19 to obtain ACP’s from all Aged Residential Care facilities across Northland and these have been added as alerts in Concerto, a patient portal. It is planned that ACP work will focus initially on Māori 55+ and non-Māori 65+. A stock-take of the current ACP environment across Northland is in progress. Our next area of focus is Renal and ED.

MSD Funding Last June pilot funding was received from MSD for Hāpai te Hauora (Youth Programme) and Better Communities. The funding for Hāpai te Hauora ends on 30 June 2020 and will not be renewed - there were teething difficulties, with a lack of appropriate referrals from MSD. Those rangatahi that completed the programme were successfully transitioned into work/study/back to MSD for pre-employment programmes. The Better Communities funding was to be allocated to Mahitahi Hauora for a Hauora Academy, but in April MSD decided not to go ahead with the funding.

HIGHLIGHTS Specialist Addiction Treatment Services Funding Allocation The Northern Region proposal for allocation of MoH revenue of $3M per annum has been approved. The proposal is for increases in rates for existing NGO services, including clinical and non-clinical FTE rates and residential bed days. The Northland DHB share is $308K per annum, which will go to four NGO providers. The submissions are in the signing process.

COVID-19 I want to express my heartfelt thanks to everyone who worked incredibly hard to prepare Northland for COVID-19. The health sector and our community and patients are truly fortunate to have such a dedicated workforce. We worked in true partnership across services, hospitals, public health, Māori Health Providers, Iwi, General Practice, government and local government agencies, Pharmacy and aged care. There is a great story to tell about the preparedness of all our hospitals, our testing rates and the number of Māori patients with COVID-19. As of 11 May, 48 percent of our COVID-19 tests have been for Māori, which is higher than non-Maori (47 percent) and just 29 percent of all our cases were of Māori ethnicity (8 of 28). This compares very well with the last pandemic where Māori fared terribly and had many times the death rate. There are many unsung heroes’ including facilities, builders, laundry staff, porters, cleaners, kitchen staff, admin teams and other ancillary staff. They have helped keep us safe wherever they work, and despite everything that was going on, they did it with positivity and grace. I also acknowledge our front line staff, ED and regional accident and medical teams, Wards, Theatre and ICU teams, Midwifery and Maternity teams, Scientific, Technical and Allied health teams, age care and home and community support workers, mental health & addiction services, public health and the Community- Based Testing Teams in fixed and mobile services.

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33 As at 14 May, 2020

COVID-19 cases . No new confirmed or probable cases notified for the past twenty seven days . 28 of the 28 confirmed and probable cases in Northland have now recovered.

COVID-19 testing o Over 8,000 tests done in Northland to date across Primary care, Northland DHB hospitals, CBTCs, mobile testing and Aged Residential Care o 6,404 tests in Northland have been done at the Community Based Testing Centres and mobile testing.

Background

The COVID-19 Pandemic Response has been our key priority since February 2020. Our Incident Management Team was established to implement the local pandemic plan and Public Health initiated strategies regionally and nationally.

All five Hospitals in Northland established Red & Green Zone areas to manage the external patient screening process and internal patient flow. Red Zones for probable and positive COVID-19 patients and Green Zones for all other patients not suspected to have COVID-19.

We quickly realised that people were not coming to our hospitals, in April presentations were down 60 percent. We initiated a public awareness campaign that included newspaper and radio encouraging people to seek medical advice and to come to the hospital if they needed to. We also produced a video with all five hospitals showcasing the red and green zone preparedness’s to help reassure our communities that it was safe to come to hospital if they needed to. The videos reached 54,590 people over a two week period. https://youtu.be/bXk8Y_CzcCY

In late February and early March, seven COVID-19 static Community Based Testing Centres were set up in Rawene, Kaitaia, Kawakawa, Kerikeri, Kaikohe, Whangarei and Dargaville. The Centres were initially established to test symptomatic people. The case definition was amended frequently which broadened the criteria for eligibility for testing for COVID-19 over time. In early April, Te Hau Ora O Ngāpuhi (Kaikohe) and then at Easter Ngāti Hine Health Trust (Kawakawa) took over the testing centres. Northland DHB staff, from its community health services, staffed all the centres and supported the Māori Health Providers with staffing resources. The Centres have been operating seven days a week since soon after they were set up. In addition Northland DHB worked in collaboration with all Māori Health Providers in Northland to add testing for COVID-19 to their existing mobile outreach services. It was important we took the opportunity to ensure high access to COVID-19 testing for Māori across the rohe. Although testing rates for Māori are higher than for non-Māori across all parts of Te Tai Tokerau, there are still some areas where access is harder due to remoteness. Additional concerns were raised by Māori Health Providers, particularly for kaumātua and kuia, who are reluctant to come out of their bubbles and communities because they are worried about putting themselves at risk. Also acknowledging, that even in remote and isolated locations, there is still movement for whānau needing to access essential services, and some visitors are still coming in from other parts of the region and from further afield. It is proposed that the testing will continue at least until the end of June 2020. A communications and engagement strategy for Māori including the launch of daily social media programme The Whaanau Guide to COVID-19, advertising on targeted channels, and the creation of specific resources for Māori. Recent resources include videos featuring Tammy Davis and Pio Terei that explain what to expect and do as we change alert levels and encourage whānau to safely continue to access health services through the pandemic. 13 full-time equivalents Kaimanaaki (community health workers) and one clinical lead were engaged in Northland to support whānau wellbeing during and post the COVID-19 outbreak in partnership with iwi and Māori health providers. This first phase of the Ngā Kaimanaaki service will be followed by a second phase of an iwi-led outreach programme of care and support for Māori whānau and communities across the region. In addition to testing people who meet the COVID-19 case definition, we conducted targeted community testing of people as part of the Ministry of Health’s ongoing surveillance against COVID-19.

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34 On April 23 asymptomatic testing of healthcare and essential workers was initiated. Anyone who wished to be tested would be swabbed, whether they have symptoms or not. Testing people without symptoms helps provide assurance that there are not undetected cases of COVID-19 in the community and that it is safe to move down the alert levels. It is voluntary and was offered to people in the following categories:  essential workers at Māori health providers,  healthcare workers in hospitals, laboratories, CBACs, and elsewhere in the community,  police and ambulance staff, and  staff in aged residential care facilities.

Between 27 April and 10 May 802 symptomatic and 294 asymptomatic healthcare and essential workers were tested in Northland.

New Zealand has avoided the high need for hospital services, particularly ICU care, experienced in many parts of the world. In this context, aged residential care (ARC) facilities have emerged as one of our highest risk areas and a regional work stream was set up to support work that the individual DHBs are doing with ARC providers in their areas.

Virtual and onsite visits were carried out to better understand how our DHBs can increase their support for ARC facilities to prevent COVID-19, and to minimise the impact of an outbreak if it occurs. Resources, training and other expertise and support is being provided as needed. Similar work is underway to develop resources and processes to support residential care providers in the mental health and addiction, and disability sectors.

There has been a significant increase in the number of homebirths in Northland over the last two months. This is reflective of a national trend. Te Puawai Ora, the service that deliver childbirth education classes, came up with an ingenious solution to film a series of short video classes on relevant topics for expectant mums and their whānau. While Level 3 and 2 remain in place, the online classes will continue. There are two cohorts of new graduates participating in 2019/2020 Nurse Entry to Practice (NETP) Programme, whom have only been in practice for seven and two months retrospectively. The majority of new graduates have coped well with the COVID-19 adjustments, up-skilling in certain areas, with increased support from the NETP team. Face to face study days have been replaced with zoom tutorials and resources accessible online during this time.

All student nurses were removed from clinical placements during the lockdown period, which was a concern for transitioning students, however, they have returned or been redeployed back into clinical areas to fulfil their clinical hours. This ensures eligibility for state exam, and minimal disruption to the workforce pipeline and graduate programmes.

Mental Health & Addictions services have a specific psychosocial response to COVID-19. A working group made up of representatives from across the continuum of mental health care has been set-up. The group is focused on strengthening access to mental health and addiction resources for the people of Northland impacted by COVID-19 and identifying where there may be gaps in access to this information. Currently the group is working on developing an online Wellbeing Hub that can be accessed by people in the community and professionals. The plan is that hub will have both online resources and links to other sites as well as provide a directory of services to support mental health and wellbeing for the people of Te Tai Tokerau. There is also a strong focus on welfare with the Caring for our Future work programme initially led by the Civil defence emergency response. Longer term, this will continue to be overseen by the Welfare sub-group and governed by the Social Wellbeing Governance Group The Patient Safety & Quality Directorate, Health Intel Hub, MIS and Population Health are working together extremely effectively to deliver data and information which is supporting our understanding of COVID-19 in Northland, and have provided many new reports for the Ministry of Health. Warren Moetara, the Public Health Unit service manager has been appointed by the Minister of Health to the Contact Tracing Assurance Committee who will be assigned the task of advising to the Ministry any further improvements to the tracing system including advice on any national changes required to strengthen national contact tracing.

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35 Going Forward

We are still in response mode to COVID-19 however now that the hospital is in green due to very low prevalence of COVID-19 we are returning more planned care and outpatient services. The planned care work has an equity focus because of the poorer health outcomes that Māori and Pacifica endure. All four hospitals are having minor facility changes to condense the red and green zones to enable the streaming of any future COVID-19 patients while still maintaining service delivery.

More staff are returning to work under Level 2. Human Resources have provided Managers with resources for returning staff to work ensuring their workspace is the correct physical distance, and that they meet the occupational health requirements. We are continuing to provide symptomatic and asymptomatic swabbing in both fixed and mobile swabbing centres across Northland. We see an increase through employers wanting staff to be swabbed before they return to work, and we are preparing a resource for employers to guide them and their employees through this process. Over the next couple of weeks if we continue to see a low prevalence of COVID-19 we will reduce the Incident Management Team to a light team that maintain a watch on what is happening internationally and nationally with the ability to ramp up again should we need to. We are building a recovery plan that will include community, primary care and the hospitals. We are assessing our capacity to respond if there is a second wave of COVID-19 including staffing, resources and the ongoing plan for the testing. The national contact tracing preparedness plan is in development and we are assessing our community response plan that includes the provision of mobile and static testing centres. A public health campaign is in development with a focus on three key messages – stay home if you are unwell, cough into your elbow, and wash your hands.

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Decision Paper to Board

Health & Safety Board Charter Date 11 May 2020

Prepared by: John Wansbone, GM Planning, Integration, People & Performance. Endorsed by: Nick Chamberlain, Chief Executive

Recommendation That the Board adopts the proposed Health and Safety Board Charter.

Background In 2013 the Institute of Directors published ‘Good Governance Practices Guideline for Managing Health and Safety Risks’. This document provides advice to Board Members and sets out a framework for how Boards can lead, plan, review and improve health and safety, meeting their due diligence obligations. Included in this is the recommendation of a Board Charter that sets out the authority, responsibilities and governance requirements of Board members. In the March meeting the Board requested that a draft Board charter is developed for consideration.

Issues / Risks

None

Funding Source N/A

Board Approval:

Name and Role Signature Date

Board Chair

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Board Charter

Northland District Health Board (NDHB) is committed to providing a healthy and safe place of work for all its employees, clients, visitors and contracts in a manner that aligns the NDHB values.

The Board will ensure the above by:

1. Policy and Planning Ensuring the NDHB:  Has effective health and safety practices and an annual Health and Safety plan  Holds the CEO accountable for the implementation and management of the plan and policies by specifying expectations and feedback requirements.  Tracks the DHB’s health and safety performance via timely reports

2. Delivery  Laying down clear expectations that the NDHB will have a fit for purpose health and safety management system  Exercising due diligence by ensuring that this system is effectively implemented, regularly reviewed and continuously improved  Being sufficiently familiar with best practice health and safety systems to know whether the DHB systems are fit for purpose  Monitor the implementation of the health and safety programme  Seeking independent external advice if needed

3. Monitoring and Review  Ensuring internal and external health and safety system audit reports are submitted to the Board in a timely manner and that any recommendations from these reports are acted on and the Board is notified when they are remedied  Ensure progress reports on the NDHB’s Annual Health and Safety Plan are included in the Quarterly Health and Safety report to the Board

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38 Briefing Paper to Board Quarterly Health and Safety Report (Q3) Jan - March 2020

Date: 11 May 2020

Prepared by: John Wansbone, General Manager, Planning, Integration, People & Performance Endorsed by: Dr Nick Chamberlain, Chief Executive

Recommendation That the Board notes the attached report. ______

Executive Summary  Northland DHB has commenced using Safe365, an online tool that provides organisations the ability to continuously assess, improve and monitor their health, safety and wellbeing capability, culture, performance and engagement. Undertaken as a quarterly self-assessment against 84 workplace health and safety elements, the report and recommended actions will be a helpful tool for the Board to monitor organisation performance and maturity. Included in the assessment is a section on Director Knowledge. Attached as a separate paper is a self- assessment for the Board to discuss and agree on their own level of capability and knowledge.  Statistically the quarter was a satisfactory performance however there were six Lost Time Injuries recorded. The injuries sustained were not significant and range from sprains, finger cuts and slips, trips and falls. There were no similarities or trends in any of the incidents. The Lost Time Injury (LTI) Frequency Rate of 4.5 injuries per one million work hours is low and remains well ahead of other DHB’s.  Employee health, safety and wellbeing has been a significant focus during COVID. No staff were infected or harmed through the course of the response. Early planning considered the needs of a significant and prolonged response and a range of services were rapidly deployed to support employee fatigue and stress, welfare and accommodation concerns, employee assistance programmes and psychosocial support. Fortunately demand for such services never eventuated. It has been noted that utilization of employee assistance programmes across the country has been significantly reduced over the past month.  In March the Board approved a Health & Safety Governance Programme to support their induction and understanding of workplace health and safety management at Northland DHB. Due to the COVID response the schedule of deliverables will be pushed back one month. As agreed in the last meeting a paper is attached outlining a proposed Health & Safety Charter for the Board to adopt.

 Unfortunately due to a reconfiguration within our Datix system this quarter, data is not available to be broken down for non-LTI harm events. This will be amended in the next quarterly report.

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39 1. Health & Safety Management System Maturity and Capability

a. Safe365 Index The Safe365 Index provides an overall score to monitor our health and safety maturity and capability. Assessments will be undertaken each quarter to monitor progress. A baseline assessment was conducted at the start of the year with an overall score of 55%. The index score is determined from the results of a self-assessment of capability across ten different modules.

Note: The ‘Director Knowledge’ element will be updated following input from the Board during the May meeting.

b. Benchmark Against other DHB’s The index score has been benchmarked against 16 other anonymised DHB’s. Northland DHB’s index score of 55% is slightly above the average. As a self-assessment there is likely to be inconsistent interpretation and it is recommended future reporting will focus on quarterly performance improvement rather than DHB benchmarking.

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40 c. Safe365 Recommended Actions The following table outlines actions to assist in strengthening each module.

Briefing Paper to Board – NDHB Quarterly Health and Safety Report Page 3 of 6

41 2. Key Performance Indicators

Quarter FY19/20 FY18/18 Indicator Benchmark Performance Actual Target Actual WorkSafe Notifiable Events 0 0 1 n/a The number of events that have been reported to WorkSafe Near Miss Reporting Not 78 72 *tbc The number of reported near miss events that had the available per quarter per quarter potential to cause injury, illness, or damage Onsite Contractor Notifiable Events 0 n/a n/a *tbc The number of Notifiable Events that have been reported to WorkSafe by onsite contractors Total Adverse Events Not ≤ 130 130 n/a Total number of health and safety adverse events available per quarter per quarter

Serious Harm Injuries (SAC2) 0 0 0 n/a The number of injuries that resulted in serious harm (legal definition) Total Recordable Injuries (SAC2 + SAC3) Not 42 44.25 n/a The total number of reported workplace injuries available (7x LTI target) average per quarter Lost Time Injuries (LTI) 6 ≤ 8 10.25 n/a The number of injuries that required an ordinary working (refer to per quarter per quarter Frequency day off work Rate) LTI Severity Rate 11.9 ≤ 20 24.7 *tbc The average days lost per lost time injury 553 days / 37 LTI’s LTI Frequency Rate 4.5 ≤ 7 7.7 9.2 The rate of lost time injuries per 1,000,000 employee (Medium Size hours DHB Group)

Lost Time Injury Frequency Rate Number of LTI's per 1,000,000 employee hours 14

0 Q4 FY18/19 Q1 FY 19/20 Q2 FY 19/20 Q3 FY 19/20

LTIFR All DHBs Northern DHB's Medium Size DHB's NDHB Target NDHB Rolling Annual LTIFR New Zealand (all sectors) Australia (all sectors) Australia (Healthcare)

Note: Due to the timeframes for submitting national and regional data the DHB benchmark data will lag each quarter.

Briefing Paper to Board – NDHB Quarterly Health and Safety Report Page 4 of 6

42 Lost Time Injuries (LTI) 7

0 Apr May Jun July August Sept Oct Nov Dec Jan Feb March

Lost Time Injuries Rolling Average Target

Summary of Lost Time Injuries 11 January 2020 Transferring patient, sprain shoulder (5 days off work) 16 January 2020 Dismantling frame- injured little finger (4 days off work) 12 February 2020 Leg of chair failed resulting in falling to ground, hurt shoulder and back (4 days off work) 13 February 2020 Picking up something off floor, low back sprain (9 days off work) 4 March 2020 Walking down hall, slipped; sprain hamstring (9 days off work) 18 March 2020 Shoes caught in floor, tripped and fell (2 days off work)

LTI Severity Rate Measuring the severity of of lost time injuries by the average number of days off work per LTI 50

0 Apr May Jun July August Sept Oct Nov Dec Jan Feb March LTI Severity Rate Rolling Average Target

Near Miss Reporting Measuring the number of near miss events against the total number of events reported 140

120

100

0 Apr May Jun July August Sept Oct Nov Dec Jan Feb March

Near Miss Events Total Reported Events

Briefing Paper to Board – NDHB Quarterly Health and Safety Report Page 5 of 6

43 Note: This graph captures all SAC2 and SAC3 harm events along with near miss events where there was a high potential of harm.

*Data reported % by DHB National Average to December 2019

Briefing Paper to Board – NDHB Quarterly Health and Safety Report Page 6 of 6

Briefing Paper to Board Finance Report – April 2020 May 2020

Prepared by: Joyce Donaldson, Acting Chief Financial Officer Endorsed by: Nick Chamberlain, Chief Executive

Recommendation That the Board notes the financial report for April 2020.

Operating Result

Month ($000) YTD ($000)

Actual Budget Variance Actual Budget Variance

DHB Owned Services (3,903) (1,357) (2,546) (17,519) (9,189) (8,330) DHB Funded Services 675 230 445 3,473 (152) 3,625

TOTAL NDHB (3,228) (1,127) (2,101) (14,046) (9,341) (4,705)

Result For The Month

Overview

The consolidated financial result for the month is a deficit of $3,228k against a budgeted deficit of $1,127k, an unfavourable variance of $2,101k. Of this, $2,546k is an unfavourable variance in DHB Owned Services, with DHB Funded Services reporting a favourable variance of $445k. The year to date consolidated financial result is a deficit of $14,046k against a budgeted deficit of $9,341k, an unfavourable variance of $4,705k. Of this, $8,330k is an unfavourable variance in DHB Owned Services, with DHB Funded Services reporting a favourable variance of $3,625k. The consolidated result includes costs incurred for COVID-19 and provided for Holidays Act as shown in the table below:

Month ($000) YTD ($000) Operating Result (1,120) (10,908) Holidays Act Provision (63) (813) COVID-19 (2,045) (2,325) Total NDHB (3,228) (14,046)

For April, acute caseweights were under budget by 543 (29%) for the month and over budget year to date by 1,231 (6.5%). Elective caseweights were under budget by 389 (71%) for the month and under budget year to date by 230 (4%). Overall, year to date inpatient activity is 4% over budget by 1,001 caseweights.

45 COVID-19

Unbudgeted COVID-19 costs incurred year to date were approx. $4,464k comprising $2,139k in DHB Funded Services and $2,325k in DHB Owned Services. Of the year to date DHB Owned Services costs, $1,500k was for salaries and $200k was for clinical supplies including PPE and respiratory equipment. The $2,139k of expenditure in DHB Funded Services relates to the pass through of funding received from the MoH in respect of the Primary Care response.

Revenue

Consolidated revenue was $1,032k favourable to budget in the month and $7,901k favourable year to date. The favourable year to date variance includes DHB Funded services: Health of Older People pay equity and IBT revenue which is offset by additional demand contract expenditure plus MoH funded primary care activity and COVID-19 which is offset by expenditure on Funder Demand contracts. DHB owned services revenue variance includes $925k ACC surgery revenue, $401k sub lease of Manaia House and $173k donations.

Expenditure

The month’s expenditure (excluding capital charge) was unfavourable to budget by $3,131k. Year to date expenditure was unfavourable by $13,546k. DHB Funded Services expenditure (excluding payments to DHB Owned Services) was $572k unfavourable to budget for the month and unfavourable by $1,669k year to date. DHB Owned Services expenditure (excluding capital charge) was $2,558k unfavourable to budget for the month and $11,877k unfavourable year to date. Salary costs were $2,675k unfavourable to budget for the month and $3,998k unfavourable year to date. The year to date variance includes $813k Holidays Act provision. Full Time equivalent numbers increased in the month to backfill staff on COVID-19 related leave such as stand down or isolation. Annual leave taken was less than budget increasing wage costs as a result. Emergency, Radiology and Pathology incurred penal rates; additional sessions; call backs costs in excess of budget mostly due to COVID-19. Overall outsourced services were unfavourable to budget for the month by $332k and overspent year to date by $7,763k. Outsourced salaries are unfavourable in the month by $337k and unfavourable year to date by $4,742k. Outsourced supplies are favourable for the month by $5k and unfavourable year to date by $3,021k. Clinical supplies were favourable to budget in the month by $373k and unfavourable year to date by $449k. The year to date variance includes an unfavourable result for diagnostic supplies and test kits of $403k. Implants and pharmaceuticals are $772k favourable year to date. Infrastructure and non-clinical supplies (excluding capital charge) were favourable to budget in the month by $75k and favourable year to date by $332k.

Financial Results

For the first 10 months of the 2020 financial year, the result is a deficit of $14,046k compared to a budgeted deficit of $9,341k, an unfavourable variance of $4,705k.

Briefing Paper to Board - Finance Report – April 2020| Page 2 of 10

Note: The expenditure and revenue showing in the chart above is categorised more specifically than those categories used on the board financials. This is to provide more detailed visibility on the specific variance contributors.

As previously noted, Outsourced Salaries and outsourced supplies are overspent by $7,763k YTD. The main contributors are medical and radiology services to cover vacancies and leave, pathology services for outsourcing of tests and ED, the district hospitals and shared services.

Cash Flow

Cash flow for the month was a net outflow of funds of $6,724k, compared to a budgeted inflow of $2,333k, unfavourable to budget by $9,057k. Year to date, overall cash is a net inflow of $1,723k compared to a budgeted outflow of $4,906k, favourable to budget by $6,630k. The closing cash balance for the month was $4,211k in funds, favourable to budget by $6,630k.

Financial Position (Balance Sheet)

Cash balances are held in the NZHP banking sweep.

Briefing Paper to Board - Finance Report – April 2020| Page 3 of 10

47 Debt to Debt + Equity ratio is 6.2% compared to the budget of 5.1% and the NDHB adopted maximum of 50% (based on the former CHFA’s benchmark). Interest Cover is (7.1) times compared to the budget of 9.3. Working capital is ($87,194k) compared to a budget of ($78,200k).

Briefing Paper to Board - Finance Report – April 2020| Page 4 of 10

Provider Contract Volumes (Caseweights)

Summary of Volume Variance Analysis

Annual Contract Measure Volume Month Volume YTD Volume

Bud Act Var Var % Bud Act Var Var %

Total Caseweights Acute 22,807 1,901 1,357 (543.1) (28.6%) 19,006 20,236 1,230.5 6.5%

Total Caseweights Elective 6,563 547 158 (389.1) (71.1%) 5,469 5,239 (229.7) (4.2%)

Total 29,370 2,447 1,515 (932.2) (38.1%) 24,475 25,476 1,000.8 4.1%

Staffing Full Time Equivalents

Staffing Full Time Equivalents Accrued Apr-20 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 Mth Var Bud

Medical 343 335 311 321 322 326 335 339 324 339 350 366 388 22 Nursing 1,258 1,246 1,196 1,246 1,230 1,202 1,260 1,271 1,241 1,318 1,238 1,341 1,173 (168) Allied Health 566 578 554 576 566 558 581 568 498 579 592 620 562 (58) Support 101 101 98 98 100 101 105 103 100 106 100 110 103 (7) Mgmt/Admin 453 458 448 464 457 451 468 469 404 471 481 494 454 (41) Total (FTEs) 2,721 2,718 2,607 2,704 2,675 2,638 2,749 2,750 2,567 2,812 2,761 2,931 2,680 (252)

Briefing Paper to Board - Finance Report – April 2020| Page 6 of 10 50

Briefing Paper to Board - Finance Report – April 2020| Page 7 of 10 51

Caseweights, Acute

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Month Budget 1,901 1,901 1,901 1,901 1,901 1,901 1,901 1,901 1,901 1,901 1,901 1,901 Month Actual 2,148 2,214 2,094 2,084 1,910 2,094 2,251 2,121 1,962 1,357 Month Variance 247 314 193 183 10 194 351 220 62 (543) Month Variance % 13% 17% 10% 10% 1% 10% 18% 12% 3% (29)% YTD Budget 1,901 3,801 5,702 7,602 9,503 11,403 13,304 15,205 17,105 19,006 20,906 22,807 YTD Actual 2,148 4,362 6,456 8,540 10,450 12,545 14,796 16,917 18,879 20,236 YTD Variance 247 561 755 938 948 1,141 1,492 1,712 1,774 1,230 YTD Variance % 13% 15% 13% 12% 10% 10% 11% 11% 10% 6%

Briefing Paper to Board - Finance Report – April 2020| Page 8 of 10 52

Caseweights, Elective

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Month Budget 547 547 547 547 547 547 547 547 547 547 547 547 Month Actual 644 652 632 673 590 494 399 546 451 158 Month Variance 97 105 85 126 43 (53) (148) (1) (96) (389) Month Variance % 18% 19% 16% 23% 8% -10% -27% 0% -18% -71% YTD Budget 547 1,094 1,641 2,188 2,735 3,281 3,828 4,375 4,922 5,469 6,014 6,561 YTD Actual 644 1,297 1,929 2,601 3,191 3,686 4,085 4,631 5,082 5,239 YTD Variance 97 203 288 414 457 404 256 255 159 (230) YTD Variance % 18% 19% 18% 19% 17% 12% 7% 6% 3% -4%

Briefing Paper to Board - Finance Report – April 2020| Page 9 of 10 53

Caseweights Acute, Caseweights Electives

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Month Budget 2,447 2,447 2,447 2,447 2,447 2,447 2,447 2,447 2,447 2,447 2,447 2,447 Month Actual 2,792 2,867 2,726 2,757 2,500 2,588 2,651 2,666 2,413 1,515 Month Variance 345 419 278 309 53 141 203 219 (34) (932) Month Variance % 14% 17% 11% 13% 2% 6% 8% 9% -1% -38% YTD Budget 2,447 4,895 7,342 9,790 12,237 14,685 17,132 19,580 22,027 24,475 26,917 29,364 YTD Actual 2,792 5,659 8,385 11,142 13,642 16,230 18,881 21,547 23,960 25,476 YTD Variance 345 764 1,042 1,352 1,404 1,545 1,748 1,967 1,933 1,001 YTD Variance % 14% 16% 14% 14% 11% 11% 10% 10% 9% 4%

Briefing Paper to Board - Finance Report – April 2020| Page 10 of 10 54 Northland District Health Board - REVENUE STATEMENT Page 1 Consolidated For the Month and Year-to-Date: 30-Apr-20

CURRENT MONTH ANNUAL ACTUAL BUDGET VAR VAR ACTUAL BUDGET VAR VAR BUDGET $(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

Operating Income MoH Devolved Funding 58,070 57,142 928 1.6% 576,356 571,422 4,934 0.9% 685,705 MoH Non-Devolved Contracts (provider arm side contracts) 1,378 1,232 146 11.8% 12,358 12,324 34 0.3% 14,789 Other Government (not MoH or other DHBs) 449 533 (84) 15.7% 6,732 5,327 1,405 26.4% 6,393 Non-Government & Crown Agency Sourced 269 337 (68) 20.1% 4,446 3,313 1,133 34.2% 3,988 InterProvider Revenue (Other DHBs) 120 99 20 20.7% 1,011 992 19 1.9% 1,190 Inter-DHB and Internal Revenue 1,022 933 89 9.6% 9,706 9,329 376 4.0% 11,195 Total Operating Income 61,308 60,277 1,032 1.7% 610,608 602,707 7,901 1.3% 723,260

Cost of Services Personnel Costs 26,135 23,460 (2,675) 11.4% 233,972 229,974 (3,998) 1.7% 277,190 Outsourced Services 3,286 2,954 (332) 11.2% 37,494 29,732 (7,763) 26.1% 35,641 Clinical supplies 4,562 4,935 373 7.6% 49,698 49,249 (449) 0.9% 59,284 Infrastructure & Non-clinical supplies 3,524 3,599 75 2.1% 35,760 36,092 332 0.9% 43,302 Funder Demand Contracts 16,667 14,593 (2,073) 14.2% 151,861 148,393 (3,468) 2.3% 178,457 Funder Fixed Contracts 2,391 4,003 1,612 40.3% 38,830 40,031 1,201 3.0% 48,038 Inter District Flows 7,197 7,085 (112) 1.6% 70,252 70,849 597 0.8% 85,019 Total Cost of Services 63,762 60,630 (3,131) 5.2% 617,868 604,321 (13,546) 2.2% 726,930

Operating Surplus /(Deficit) (2,453) (354) (2,100) 593.3% (7,260) (1,614) (5,646) 349.9% (3,670)

Capital Charge 775 773 (2) 0.2% 6,787 7,728 941 12.2% 9,131 Surplus/(Deficit) (3,228) (1,127) (2,101) 186.5% (14,046) (9,341) (4,705) 50.4% (12,801)

55 Northland District Health Board - STATEMENT OF FINANCIAL POSITION Page 2 Consolidated as at: 30-Apr-20

AS AT BUDGET ACTUAL BUDGET VAR VAR 6/30/2019 6/30/2020 ASSETS EMPLOYED $(000) $(000) $(000) % $(000) $(000) Current Assets Inventories 4,290 4,241 49 1.1% 4,241 4,241 Trade and other receivables 23,498 21,191 2,307 10.9% 23,791 21,191 Prepayments 689 364 325 89.3% 364 364 Cash and cash equivalents 4,211 (2,419) 6,630 274.1% 2,488 (14,000) Total Current Assets 32,688 23,377 9,311 39.8% 30,883 11,796

Less Current Liabilities Interest-bearing loans and borrowings 6,373 6,308 (65) 1.0% 6,308 6,326 Trade and other payables 51,455 43,847 (7,608) 17.4% 41,702 39,700 Employee benefits 62,053 51,422 (10,631) 20.7% 57,446 46,994 Total Current Liabilities 119,881 101,577 (18,304) 18.0% 105,456 93,020

Working Capital (87,194) (78,200) (8,994) 11.5% (74,573) (81,224)

Add : Property, plant and equipment 216,618 227,904 (11,286) 5.0% 214,089 232,100 Investments in subsidiaries and associates 21,982 21,763 219 1.0% 21,023 21,763 Trust/Special fund asset 416 426 (10) 2.4% 426 426 239,016 250,093 (11,077) 4.4% 235,538 254,289 Deduct : Interest-bearing loans and borrowings 2,451 1,960 (491) 25.1% 2,787 1,871 Employee benefits 16,480 16,480 0 0.0% 16,480 16,480 Trust/Special fund liability 267 266 (1) 0.5% 266 266 19,199 18,706 (493) 2.6% 19,533 18,617

NET ASSETS 132,624 153,187 (20,563) 13.4% 141,431 154,448 REPRESENTED BY : SHAREHOLDERS FUNDS Crown equity 71,637 85,887 (14,250) 16.6% 65,037 71,605 Equity Injections 5,250 0 5,250 100.0% 6,600 19,000 Retained Earnings (33,164) (26,317) (6,847) 26.0% (8,430) (26,315) Retained Earnings for Year to Date (14,046) (9,341) (4,705) 50.4% (24,734) (12,801) Retained earnings/(losses) (47,210) (35,658) (11,552) 32.4% (33,164) (39,116) Revaluation Reserve 102,568 102,568 0 0.0% 102,568 102,568 Trust/Special funds 378 390 (12) 3.0% 390 390 TOTAL SHAREHOLDERS FUNDS 132,624 153,187 (20,563) 13.4% 141,431 154,448

56 Northland District Health Board - CASH FLOW STATEMENT Page 3 Consolidated For the Month and Year-to-Date ended: 30-Apr-20

CURRENT MONTH YEAR TO DATE ACTUAL BUDGET VAR VAR ACTUAL BUDGET VAR VAR $(000) $(000) $(000) % $(000) $(000) $(000) % Cash flows from operating activities Cash receipts from Ministry of Health and Patients 59,631 60,260 (628) 1.0% 613,630 605,140 8,490 1.4% Cash paid to suppliers (39,726) (38,525) (1,201) 3.1% (364,744) (361,830) (2,914) 0.8% Cash paid to employees (24,026) (21,701) (2,325) 10.7% (231,442) (229,182) (2,260) 1.0% Cash generated from operations (4,120) 34 (4,154) 12218.7% 17,443 14,127 3,316 23.5%

Interest received 25 17 8 48.2% 389 167 222 133.4% Interest paid (40) (39) (1) 3.2% (427) (391) (36) 9.3% Capital charge paid 0 0 0 0.0% (4,146) (4,637) 491 10.6% Net cash flows from operating activities (4,136) 12 (4,148) 35737.3% 13,259 9,267 3,993 43.1%

Cash flows from investing activities Acquisition of property, plant and equipment (2,389) (2,787) 397 14.3% (15,545) (26,888) 11,343 42.2% Increase In investments & Trust Fund Assets (120) (0) (120) 0.0% (970) (740) (230) 0.0% Net cash flows from investing activities (2,509) (2,787) 277 9.9% (16,515) (27,628) 11,113 40.2%

Cash flows from financing activities Proceeds from equity injection 0 5,182 (5,182) 100.0% 5,250 14,282 (9,032) 63.2% Increase/(Repayment) of borrowings (79) (74) (5) 6.9% (271) (827) 556 67.2% Net cash flows from financing activities (79) 5,108 (5,187) 101.5% 4,979 13,455 (8,476) 63.0%

Net increase (decrease) in cash and cash equivalents (6,724) 2,333 (9,057) 388.2% 1,723 (4,906) 6,630 135.1% Opening Cash and cash equivalents 10,935 (4,752) 15,687 330.1% 2,487 2,487 0 0.0% Closing Cash and cash equivalents 4,211 (2,419) 6,630 274.1% 4,211 (2,419) 6,630 274.0%

57 Northland District Health Board - Notes to the Financial Statements as at: 30-Apr-20 Page 4

DEBTORS' AGEING $000's $000's $000's $000's $000's Sundry Overseas Total MOH ACC Debtors Patients Debtors

Current (up to 30 days) 1,459 44 933 1 2,437 30-60 Days 183 0 104 13 300 60-90 Days 29 1 25 20 75 90-120 Days 648 6 126 17 797 Over 120 Days 439 99 109 179 826 Less Provision for Doubtful Debts 0 0 (28) (116) (144) Provisions and Accruals 14,198 274 4,736 0 19,208 Total 16,956 424 6,004 114 23,498

CREDITORS SCHEDULE Current Prior Month Month 30-Jun-19 $000's $000's $000's

Suppliers 43,283 49,977 37,364 healthAlliance loan account 1,326 1,326 1,326 Payroll Accruals 22,848 22,773 19,956 Holiday Pay Accruals 39,205 37,376 37,490 GST 6,846 4,290 3,012 Total 113,508 115,742 99,148

58 Northland District Health Board - Page 5 Consolidated For the Month and Year-to-Date ended:

1 2 3 4 5 6 7 8 9 10 10 INDICATOR Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 BUDGET

1. Debt : Debt plus Equity 6.0% 5.9% 5.9% 5.9% 5.9% 5.8% 5.7% 5.7% 6.2% 6.2% 5.1%

2. Total Debt(Incl. Creditors) : Total Assets 47.0% 47.1% 47.6% 48.4% 48.8% 48.2% 47.5% 48.1% 51.0% 51.2% 44.0%

3. Interest Cover - Rolling 6 months (88.4) (92.5) (69.5) (68.9) (67.6) 4.7 7.5 9.7 (0.9) (7.1) 9.3

4. Quick (Acid Test) Ratio 0.24 0.26 0.27 0.28 0.28 0.28 0.24 0.25 0.29 0.24 0.19

5. Level of Working Capital (75,690) (74,755) (75,231) (76,848) (77,888) (76,167) (77,400) (78,675) (83,197) (87,194) (78,200)

6. Earnings before Interest and Tax - Month Surplus(Deficit) (1,510) (1,299) 35 (1,285) (895) (1,185) (1,152) (738) (2,399) (3,188) (1,088)

7. Return on Funds Employed - (YTD Annual) (12.8)% (11.8)% (7.8)% (9.1)% (9.0)% (9.0)% (8.7)% (8.5)% (10.8)% (12.3)% (6.8)%

8. Fixed Asset Utilisation (Y-T-D Annualised) 311% 310% 311% 311% 311% 311% 312% 311% 308% 307% 317%

9. Net Income (Year-to-Date) (2.6)% (2.4)% (1.6)% (1.7)% (1.7)% (1.7)% (1.8)% (1.7)% (2.0)% (2.3)% (1.5)%

10. Return on Equity (Y-T-D Annualised) (13.5)% (12.4)% (8.2)% (9.1)% (8.9)% (9.1)% (9.3)% (9.1)% (10.6)% (12.7)% (7.3)%

11. Proprietorship Ratio 53.0% 52.9% 52.4% 51.6% 51.2% 51.8% 52.5% 51.9% 49.0% 48.8% 56.0%

Banking Covenants 1. Interest Cover - YTD (88) (93) (69) (69) (68) 5 8 10 (1) (7) 9

2. Net Profit - YTD (1,574) (2,903) (2,898) (4,223) (5,155) (6,377) (7,574) (8,351) (10,818) (14,046) (9,341)

3. Debt : Debt plus Equity 6.0% 5.9% 5.9% 5.9% 5.9% 5.8% 5.7% 5.7% 6.2% 6.2% 5.1%

59 Northland District Health Board - Community Services Page 1 REVENUE STATEMENT For the Month and Year-to-Date ended : 30-Apr-20

CURRENT MONTH YEAR TO DATE ANNUAL ACTUAL BUDGET VAR VAR ACTUAL BUDGET VAR VAR BUDGET $(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

Operating Income

MOH Devolved Funding 58,070 57,142 928 1.6% 576,356 571,421 4,935 0.9% 685,705 Inter-DHB and Internal Revenue 1,022 933 89 9.6% 9,706 9,329 376 4.0% 11,195

Total Operating Income 59,092 58,075 1,017 1.8% 586,061 580,750 5,311 0.9% 696,900

Cost of Services

Funder Demand Contracts 16,667 14,594 (2,072) 14.2% 151,861 148,393 (3,468) 2.3% 178,457 Funder Fixed Contracts 2,391 4,003 1,612 40.3% 38,830 40,031 1,201 3.0% 48,038 Inter District Flows 7,197 7,085 (112) 1.6% 70,252 70,849 597 0.8% 85,019 Provider Contracts 32,163 32,163 (0) 0.0% 321,646 321,629 (17) 0.0% 385,955

Total Cost of Services 58,417 57,845 (572) 1.0% 582,589 580,903 (1,686) 0.3% 697,468

Surplus/(Deficit) 675 230 445 3,473 (152) 3,625 (568)

60 Northland District Health Board - Community Services Page 2 DHB SERVICE FUNDING REPORT For the Month and Year-to-Date ended: 30-Apr-20

CURRENT MONTH YEAR TO DATE ANNUAL ACTUAL BUDGET VAR VAR ACTUAL BUDGET VAR VAR BUDGET $(000) Fixed Sum Contracts Planning, Primary & Population Health 616 1,148 532 46% 10,909 11,478 569 5% 13,773 Mental Health 723 1,469 746 51% 14,604 14,703 99 1% 17,644 Health of Older People and Palliative Care 558 600 42 7% 5,730 5,997 267 4% 7,196 Maori 489 710 221 31% 7,341 7,598 257 3% 9,118 Public Health and Dental 5 76 71 93% 246 255 9 4% 307 Total Fixed Sum Contracts 2,391 4,003 1,612 40% 38,830 40,031 1,201 3% 48,038

Fee for Service Contracts Adol Dental Benefit 6 99 93 94% 749 992 243 24% 1,191 General Medical Subs -1 43 44 102% 224 425 201 47% 510 Health of Older People & Clinical Support 6,094 6,003 (90) 2% 62,175 60,822 (1,355) 2% 73,026 Immunisation 550 346 (204) 59% 976 721 (255) 35% 1,090 Laboratory 611 646 35 5% 6,859 7,107 248 3% 8,536 Mental Health 215 252 36 1% 2,247 2,518 271 11% 3,022 Pandemic 1,392 0 (1,392) 2,139 0 (2,139) 0 Pharmaceuticals 3,513 2,941 (572) 19% 34,072 33,527 (545) 2% 40,275 Primary Health Organisation 4,127 4,112 (15) 0% 40,913 40,766 (147) 0% 48,989 Rural Bonus 160 152 (8) 5% 1,507 1,515 8 1% 1,818 Total Fee for Service 16,667 14,594 (2,073) 14% 151,861 148,393 (3,470) 2% 178,457

Total Cost of Services 19,058 18,597 (461) 2% 190,691 188,424 (2,269) 1% 226,495

61 Northland District Health Board - REVENUE STATEMENT Page 1 Hospital Services & Governance For the Month and Year-to-Date ended : 30-Apr-20

CURRENT MONTH YEAR TO DATE ANNUAL Hospital Services & Governance ACTUAL BUDGET VAR VAR ACTUAL BUDGET VAR VAR BUDGET $(000) $(000) $(000) % $(000) $(000) $(000) % $(000) Operating Income

MOH Non-Devolved Contracts (provider arm side contracts) 1,378 1,232 146 11.8% 12,358 12,324 34 0.3% 14,789 Other Government (not MoH or other DHBs) 449 533 (84) 15.7% 6,732 5,327 1,405 26.4% 6,393 Non-Government & Crown Agency Sourced 269 337 (68) 20.1% 4,446 3,313 1,133 34.2% 3,988 InterProvider Revenue (Other DHBs) 120 99 20 20.7% 1,011 992 19 1.9% 1,190 Internal Revenue (DHB Fund to DHB Provider) 32,163 32,163 0 0.0% 321,646 321,629 17 0.0% 385,955

Total Operating Income 34,379 34,364 15 0.0% 346,192 343,586 2,607 0.8% 412,314

Total Cost of Services 37,507 34,949 (2,558) 7.3% 356,925 345,047 (11,877) 3.4% 415,416

Operating Surplus /(Deficit) (3,128) (584) (2,544) 435.2% (10,732) (1,462) (9,271) 634.2% (3,102)

Capital Charge 775 773 (2) 0.2% 6,787 7,728 941 12.2% 9,131

Surplus/(Deficit) (3,903) (1,357) (2,546) 187.6% (17,519) (9,189) (8,330) 90.7% (12,233)

62 Northland District Health Board - TREASURY REPORT as at: 30-Apr-20

Derivatives Use No derivatives have been, or are being used.

Cost of Funds

Actual Budget Var Var $(000) $(000) $(000) % Interest Expense, YTD 427 391 (36) 9.3%

Foreign Exchange Position and Policy Compliance No Foreign Currency is being held, compliant with policy.

Counterparty Credit Risk Position

Maturity Balance Cash and cash equivalents $(000) NZHP on call 4,211

Total Cash and cash equivalents and Investments (4,211)

Funding Risk/Liquidity Position

Funding risk is minimal as in February 2017, loans from NZ Debt Management Office (Formerly CHFA) were transferred to equity.

Bank Facility/Loan Funding Usage and Maturity

Maturity Balance Loans $(000) Energy, Efficency and Conservation Loan 1 15-Aug-21 211 Energy, Efficency and Conservation Loan 2 15-Feb-22 286 Total Loans 497

Finance Leases Maia Finance - Patient Monitoring 1-Jan-26 2,037 Maia Finance - Manaia House 1-Jan-24 5,735 Stryker - Surgical Equipment 1-Mar-26 555 8,327

Total Loans 8,824

Briefing Paper to Board Northland DHB Funded Services – as at 30 April 2020 May 2020

Prepared by: Joyce Donaldson, Acting Chief Financial Officer Endorsed by: Nick Chamberlain, Chief Executive

Recommendation That the Board notes the update on the Northland DHB funded services.

Annual YTD YTD YTD Actual Expenditure Type Budget Budget Variance Annual KPIs* YTD Activity $000's $000's $000's $000's PHE Capitation Funding 48,989 40,913 40,766 (147) Enrolled Service Users 172,157 1.9%  Community Pharmacy 40,275 34,072 33,527 (545) Drug Costs 40,364,999 9.6%  Community Labs 8,536 6,859 7,107 249 Tests 1,046,445 0.4%  Palliative Care 4,614 3,745 3,845 100 Palliative Care FSA 822 4.3%  Mental Health and Addictions 18,746 16,250 15,621 (628) Residential Bed Days 16,962 0.9%  IDF Expenditure 85,019 70,252 70,849 597 Acute IDFs 2,407 0.2%  Health of Older People 75,608 64,161 62,974 (1,187) ARRC Bed Days 348,340 1.6%  HBSS Hours 595,910 (1.2%)  Other Primary Care Services 16,141 15,501 13,263 (2,238) Items Dispensed 3,022,270 4.6%  Community Oral Health 1,348 871 1,123 252 Maori Health Services 8,518 7,153 7,098 (54) Total 307,794 259,777 256,173 (3,601) KPIs are annualised over the 12 months of available data Maori Health Services reflects contracts managed directly by the directorate

• PHO Capitation Funding – additional expenditure funded by non-devolved MoH revenue • Community Pharmacy – Community pharmacy dispensing increased dramatically in the week leading up to, and during, the level 4 lockdown. This created a significant spike in drug and dispensing costs. The halting of 3 month dispensing will also have an ongoing effect on dispensing fees with many repeats now being dispensed three times as often. The overall pharmaceutical picture (community hospital, and cancer) for NDHB is still tracking under budget • Community Labs – no material variance. Significant savings (relative to trajectory) are expected from July 2020 as a result of the new regional community labs contract. • Mental Health and Addictions - The unfavourable variance of $628k is the cost of pay equity and is totally offset by additional income received from MoH. Rolling 12 months residential bed days are 0.91% lower than prior year due to a portion of Whangarei Level 3 residential beds being converted to community support work hours from 1 July 2018. The beds have been retained by the NGO, now as private tenancies with clients. • IDF Expenditure – the variance represents a favourable wash-up of our 30 June position. • Health of Older People – additional expenditure funded by non-devolved MoH revenue. • Community Oral Health expenditure is lower than budget due to underutilisation of community providers. This is offset to some degree by an increase in the cost of DHB owned services. • Other Primary Health Care Services – includes the Pandemic costs YTD of $2,139k • Maori Health – The unfavourable variance of $54k is a timing issue which will resolve over the next months.

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64 Pay Equity

Pay Equity funding was devolved to DHBs from 1 July 2019. The 2018/19 DHB wash-up process is now complete.

Contract Prices

Mental Health & Addiction Services (MHAS) Contract variations incorporating 2019/20 Pay Equity and Cost Pressure Funding (CPF) have now been prepared by sector services and signed by all Providers. The MoH Pay Equity Implementation Team undertook workforce data collection in early 2020, the purpose of which is to inform 2020/21 contract pricing.

Note the implementation of pay equity has resulted in pricing disparities between providers delivering the same services, primarily due to the bespoke method adopted for calculating the 2018/19 pay equity component of contract prices. As a result of pricing disparities, the national Mental Health and Addictions Partnership Group have identified pricing of Mental Health and Addiction NGO services as a priority area. A Pricing Project Group has been established with representatives from Central TAS, MoH and six DHBs. A preliminary data collection has been conducted and analysis of results is underway.

Health of Older People Eligible Contracts 2019/20 Pay Equity Rates for eligible Health of Older People contracts (Age Related Residential Care (ARRC), Home Care Support Services (HCSS), Respite and Day-care) have been included into contracts, based on a consistent approach nationally.

Acute IDF Admissions

• Maori and Non-Maori IDF admission rates are consistent with Maori and Non-Maori Acute admission rates.

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65 Quality & Safety

Monitoring information is not available for Q2 at this time to relieve the burden placed on providers as a result of the COVID-19 pandemic. The usual summary for Q2 will be provided in the next report.

Northland DHB Age Related Residential Care Facilities Certification Periods

30-Jun-16 Certification Period 11-May-20 (baseline) 48 months 3 9 36 months 16 14 24 months 2 0 12 months 2 1 Total 23 24 One facility was sold and purchased in April 2020. Any facility under new ownership automatically receives one year certification.

Number of ARRC Facilities Where Northland DHB notified by auditors of high risk • There were no high risks identified by auditors during this period.

Northland DHB Mental Health Facilities Certification Periods

Certification Period 30-Jun-17 30-Jun-18 30-Jun-19 48 months NHHT 36 months Odyssey House Emerge Aotearoa Te Roopu 24 months Taurima 12 months Total 3 1

• Odyssey House received 36 months certification from August 2017. Confirmation has been received from MoH that Odyssey will undergo their midpoint unannounced surveillance audit later this year. • Emerge Aotearoa completed their certification audit in August 2016 and received 36 months certification. Emerge underwent a certification audit (in conjunction with their routine audit) from late August to early September 2019. The draft audit report has now been received from HealthCert but is yet to be received by Northland DHB. There is only one low risk query in the report which is being reviewed with Emerge this month. Northland DHB has still not received the final audit. • Ngati Hine services received 36 months certification in June 2017. The organisation is still working through a remedial process (in consultation with DHB services).

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66 Support Hours

A review of Northland mental health supported accommodation was commissioned in late 2017. As a result of this review, it was determined that many of Northland DHB’s contracted NGO Level 3 residential beds would be converted to a model of private tenancies with support hours. Under the proposed model, there would a mixed transition over a two year period from 1 July 2018 whereby: • A proportion of Level 3 beds would be converted to private tenancies, with funding converted to support hours • A proportion of Level 3 beds would be converted to Level 4 beds to meet need • A proportion of Level 3 beds would be retained One Whangarei-based facility successfully transitioned across to a model of private tenancies with support hours from 1 July 2018. Agreement has been reached with a second facility to make no change to the current bed configuration. Discussions regarding the reconfiguration of Level 3 beds are ongoing with remaining NGO providers.

Northland DHB Māori Health Provider Audits

Audit Completed Planned Narrative Type* 2017/18 2018/19 2019/20 Audits Audit findings have identified mainly low risk corrective actions. DHB works with each Routine 2 5 1 1 provider to complete corrective actions within prescribed timeframes Note * Routine Audits are those planned on a regular basis to check how the business is performing and to detect errors for compliance against contracts.

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Briefing Paper to Board

Mental Health and Addiction Services and Psychosocial Wellbeing Initiatives in Te Tai Tokerau Date 11 May 2020

Prepared by: Michelle Ball, Project Manager, Tania Papalii, Suicide Prevention Programme Lead, Alexis Nathan, Project Monitoring Coordinator Endorsed by: Ian McKenzie, General Manager

Recommendation That the Board notes the following information

Background Board members have requested an update in regards to: COVID 19 psychosocial supports, the Primary Mental Health program implementation, suicide rates and mental health crisis response.

Issues / Risks Nil

Mental Health and Addiction Services: COVID 19 initiatives With the onset of COVID 19, Mental Health and Addiction services (MHAS) implemented an immediate IMT Mental Health response. Three core work streams have been formed to address aspects of service delivery and support across the wider mental health and addiction continuum of care. Work streams have addressed resource capability to ensure that essential mental health and addiction services can continue to be provided during COVID 19. A number of these new initiatives will continue as a part of BAU. The work streams have provided leadership and practical support to NGOs to develop pandemic plans, access PPE and additional resources via the DHB, complete environmental audits to ensure residential mental health facilities are safe to delivery services to service users.

Pandemic Plans The sudden onset of COVID19 restrictions left little or no preparation for mental health and addiction NGOs for pandemic planning. To support our providers in strengthening their pandemic plan for COVID 19, pandemic plans were collected from all NGOs at a northern regional level. A mental health and addictions crisis planner was engaged by Northern Regional Alliance (NRA) to review all pandemic plans. NGOs then received their results and a resource tool kit to support the update of their plans. Most were outdated, generic to an environmental disaster and not responsive to the COVID 19 pandemic. Once there is a return to business as usual, the Portfolio Manager will support Northland NGOs with the revision of their pandemic plans.

MHAS Residential Service Assessments Subsequent to loss of life at an Aged Related Care (ARC) facility, a review of all ARC facilities was required by the Ministry of Health. The net was spread to include mental health and addiction residential services too. Following the ARC process, a combination of self-assessment by providers and a virtual assessment will be used. This work will be completed before end of May.

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68 DHB Staff Wellbeing Planning MHAS have provided support and expertise to establish an online Wellbeing Hub on the NDHB intranet site. This site has had over 1,000 hits in the first few weeks’ operation. The internal MHAS staffing needs are reviewed daily with staff redeployed as required to essential services. A significant number of staff have been able to work virtually to provide consultation from home. Crisis Support and Community teams have established work bubbles to ensure that face to face services can continue to be delivered if a member of a smaller bubble becomes infected. Transmissions support to community MHAS has provided a valuable link to the work that is being done by the DHB and ensuring that is appropriate in the community setting.

MHAS Service Delivery During the COVID19 period from 23 March 2020 to 08 May 2020 the Mental Health Crisis team has had 376 client contacts compared to the same period in 2019 which was 303 client contacts, an increase of 24%. New referrals to the crisis service have decreased during the COVID 19 period by 46% (68 from 23 March 20 to 08 May 2020 and 126 in the same period for 2019). The Mental Health Crisis team is expecting to see a rise in new referrals in the coming weeks MHAS continue to work closely with community organisations including local iwi providers MSD, Police, Oranga Tamariki and telehealth services to identify and prioritise high risk and vulnerable service users. With MHAS support MSD have initiated temporary motel accommodation for homeless mental health service users during lockdown. In response to the expectation of increased psychological distress following COVID 19, a work stream focussing on identifying resource gaps in mental health and addiction services and sharing knowledge across the continuum of care has been initiated. The work stream is working to ensure that appropriate resources and health pathways are in place in order to ensure that people are able to access the right level of care when they seek help. A proposal for funding is being developed to initiate a new on-line wellbeing platform for GPs and services across Te Tai Tokerau to guide them to access the most appropriate resource for their patients. The Ministry of Health is due to release a new psychosocial planning document and enhance their website with a range of self-help resources and apps.

Primary Mental Health Programme Implementation The Primary Mental Health Initiative, Te Tumu Waiora continues to be implemented during COVID 19. The 4.8 Health Improvement Practitioner (HIP) FTE and 3.0 Health Coach (HC) FTE based in the eight existing GP practice sites have continued to see patients through a mix of face to face and virtual consultations dependant on how each GP practice was choosing to operate. During the 6 week period from 26 March – 5 May 2020 there were 817 consultations provided to patients. 40.0% of consultations were to patients who identified as Māori. 88% of consultations were provided via phone call, the remainder via face to face and video apps. Half of the presentations were for people aged between 25 – 64 years with a further 35% of session being delivered to people aged over 65 years. HIPs and HCs have also been engaged in other support functions during this time e.g. practice staff psychological support, flu vaccinations and welfare checks on the vulnerable patients within the practice and linking to appropriate welfare resources. Patient feedback has indicated a high level of satisfaction with the virtual service that has been provided during COVID 19 although a preference for face to face consultation also remains high. Recruitment is underway for the remaining FTE for Tranche 1 implementation. Mahitahi Hauora has subcontracted with Te Hiku, Hokianga Health and Ngati Hine for the Health Improvement Practitioners based in hauora in their locality. The local NGO collective are funded to provide Health Coach FTE. It is anticipated that all 18 GP practices will have service delivery underway by 1 July 2020. The Te Tumu Waiora service is anticipated to have a significant impact in the delivery of primary mental health resources to the population of Northland.

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69 Suicide Prevention 1. Covid-19  The media reporting of a (significant) national increase in suicide during Covid-19 is not accurate. There is no significant increases of suspected self-inflicted deaths (SSID) *  There has been no significant increase in SSIDs in Northland during lockdown *  Although Covid-19 may increase some common issues/risks (unemployment, social isolation, lack of face-to-face support, depression etc) that precipitate suicidal behaviour – this trajectory is not inevitable, suicide is NOT inevitable  Clinical Advisory Services Aotearoa (CASA) is now providing brief therapeutic online support for those bereaved by suicide in the context of Covid-19. Very limited referral pathways, currently via NDHB - Suicide Lead and Victim Support for the region of Northland *It is important not to draw conclusions on small numbers of data over short timeframes

2. Suspected Self-Inflicted deaths in Northland 2020 (YTD)

SSID Northland January - April 2020

16 Over the period - 1st January 2020 to the 30th April 2020; 14 there have been 15 suspected 12 self-inflicted deaths (SSIDs) in 10 Northland, 4 of these are under Māori the age of 25 yrs. More 8 significantly, 11 deaths identify `Total 6 as Māori. The five year average U/25 yrs (Jan-Apr 2015-19) of SSIDs in 4 Northland is 11 and 5 deaths 2 identified as Māori 0 2015 2016 2017 2018 2019 2020

Suspected self-inflicted deaths in Tai Tokerau – 30th April 2020

2012 2013 2014 2015 2016 2017 2018 2019 2020 2018/19 (30/4) National Total 35 28 18 27 28 43 37 37 15 685 U 25 yrs 19 7 4 1 5 7 7 5 4 73 Maori 18 10 7 6 9 13 16 13 11 169 Male 23 18 13 19 24 32 26 31 9 498 Female 12 10 5 8 4 11 11 6 6 187 Whangarei 16 12 8 12 10 27 15 20 8 n/a Mid North 7 3 3 3 10 8 7 5 5 n/a Far North 11 9 4 8 5 5 10 6 2 n/a Kaipara 1 4 3 4 3 3 7 6 0 n/a MHAS 11 8 3 14 11 11 5 14 4 unknown

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70 3. Fusion

Te Amorangi (a model of Suicide Prevention whānau that provides leadership and advocacy from a whānau Māori paradigm) was tabled by Fusion and whānui subsequently endorsed at the SWGG hui on Te the 21st October 2019. The Proposal was sent Amorangi to the Suicide Prevention Office - Ministry of agency/services at the behest of Health which was met with interest but no whānau current viable funding. Fusion proposes a ‘scaled down’ version which includes a specialist team that gives voice to whānau and privileges whanaungatanga and all things Māori. See Appendix 1.

The Ministry of Health have funded via NDHB a full-time FTE to the 30th September 2021 to support the Suicide Prevention Lead, particularly with postvention. Māori whānau and communities will continue to be prioritised. This Taituaraa role is being advertised on Friday 8th May 2020.

The Ministry of Social Development have approved ‘access’ to x2 (based in Whangarei and Kaitaia) partial FTE to support the work of Fusion which includes providing WINZ support directly to whānau devastated by suicide; those bereaved by suicide, are suicidal or looking after someone suicidal.

4. Nationally

The Suicide Prevention Lead is well positioned, an active member of;  The Health Quality Commissions (HQSC) Suicide Mortality Review Committee (SuMRC)  Ngā Pou Arawhenua the HQSC Mortality Review’s Māori Caucus  The Postvention Leadership Group, facilitated by the Suicide Prevention Office; representing the Suicide Prevention Co-ordinators with CASA, Mental Health Foundation, Kia Piki te Ora and Victim Support  The Suicide Prevention/Postvention Māori Caucus

This gives national reach across suicide prevention and postvention; providing leadership and equally ensuring Northland is represented well. The recent publication Te Mauri: Rangatahi suicide report 1 features the Fusion story as an exemplar for promising practice

Wellbeing Support Northland Welfare Coordination - Psychosocial support Planning  Northland Civil Defence Emergency Management (CDEM) and IMT work together to provide psychosocial support, through the welfare arms of each group. The CDEM host a weekly meeting welfare community group (WCG). CDEM provides for communities and individuals who request assistance primarily through the welfare 0800 number phone service. The main welfare issues have been finance, accommodation, food, water, animal welfare, and firewood – see diagram below.  CDEM responds directly to requests for household goods and food delivery. For other issues it has a comprehensive list and data base of services in each area that it channels the 0800 calls to. Complex issues are referred to Northland DHB representative direct from the 0800 call centre, and are fed back into the CDEM sitreps.  It is anticipated going forward that the demand for these basic needs will increase as the economic downturn at a community, whanau and individual level continues. In addition, other needs including mental wellbeing, family harm, and unemployment are expected to emerge and increase.

1 https://www.hqsc.govt.nz/our-programmes/mrc/sumrc/publications-and-resources/publication/3949

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Psychological Wellbeing Proposal To support people in our community with psychosocial needs the development of a Te Tai Tokerau Online Wellbeing Hub is proposed. The Hub would be a website that pulls together resources that help with maintenance and improvements in wellbeing. It would provide up to date evidence-based resources specifically aimed at the people in Te Tai Tokerau. MHAS would lead and fund this resource, with initial set up costs of $20,000, then on-going annual costs of $20,000 to maintain the Hub. Although information specific to COVID 19 would be highlighted while the pandemic is in progress, more general wellbeing information will also be included. The wellbeing hub would be an on-going resource available beyond the current situation.

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Appendix 1

Te Amorangi

‘Leadership & Advocacy from a Māori paradigm’

A model of suicide prevention including postvention

Proposal Briefing Paper

Te Amorangi Briefing Paper| 22 November 2019 | Page 1 of 12

Table of contents

1. Mihi …………………...... 3 2. Executive Summary ...... 3 2.1 Introduction ...... 3 2.2 Background ...... 4 3. Suicide …………………...... 4 3.1 Suicide rates globally ...... 4 3.2 Suicide rates nationally ...... 5 3.3 Northland DHB regional suspected suicides ...... 5 3.4 Drivers behind suicide ...... 6 3.5 Protective Factors ...... 6 4. Te Amorangi ...... 7 5. Te Reo o te Kainga ...... 8 6. Te Amorangi Proposal : 2019 – 2021 ...... 9 6.1 Service Development Outline ...... 10 6.2 Workforce Development ...... 10 7. Outcome measures ...... 11 8. Financials ...... 11 9. Bibliography ...... 12

Te Amorangi Briefing Paper| 22 November 2019 | Page 2 of 12

74 1. Mihi

Ko te mea tuatahi, ko Io Matua te kore Tuarua, me mihi atu ki te wāhi ngaro. Ratou kua takahi I te huarahi ki Te Reinga, koutou haere Me mihi ka tika ki ngā maunga whakahī, I ngā awawa e rere ana, I ngā Marae puta noa i te whare tapu o Ngā Puhi, otira ki Te Hiku o te Ika E tu, e tu, e tu Nō reira tēna koutou, tēna koutou, tēna tatou katoa

2. Executive Summary

2.1. Introduction

Te Amorangi is the proposed service with an initial Whangarei site followed by expansion across the region of Te Taitokerau ki Muriwhenua1.

Te Amorangi is a specialist team that is a practical piece to suicide prevention with reach across the spectrum of care including strong links to Primary and Secondary Care to meet the needs of the Taitokerau ki Muriwhenua population.

Te Amorangi gives voice to whānau, someone to listen to, and someone to believe in them.

“It seems to me that is how close it needs to be some times, despite our agency, whatever that may be, despite our NGO-ness or agency-ness, if you’re called to be the one who has to be closer than close, then you’ve got to do that”

The 2019/20 Wellbeing budget2 has recognised the need to target funding towards new mental health, wellbeing and addiction initiatives and specifically provides an opportunity to create a system which works better for Māori.

An allocation of $455.1 million dollars has been designated to the development of new front line mental health services.

A Suicide Prevention Office is being established and Suicide Prevention work is to be expanded and improved with $40 million investment over four years. The new national suicide prevention strategy and action plan He Tapu te Oranga o ia tangata - Every Life Matters (Ministry of Health, 2019) has been released and was one of the urgent priorities for Government from the mental health inquiry He Ara Oranga.3

Te Amorangi underpinned by principals from Te Ao Māori seeks to support whānau to unravel and confront suffering, to determine their own wellbeing

Northland DHB is seeking funding………………………………………. $2,999,645

1 Has a population of 179,000 spread over a large area of 13,789 km2; in 2017 was the third fastest growing population in Aotearoa/New Zealand. https://www.stats.govt.nz/search?Search=northland 2The New Zealand budget for the fiscal year 2019-2020, also known as the Wellbeing Budget passed on 30th May 2019 3 He Ara Oranga, the report of the NZ Government Inquiry into Mental Health and Addiction, was published in November 2018 as a result of the Inquiry, which involved widespread public consultation. He Ara Oranga outlines a set of 40 recommendations to transform New Zealand’s approach to mental health and addiction.

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75 2.2 Background

Fusion is a suicide pre/post-vention team in Te Tai Tokerau ki Muriwhenua. The team was formed initially under the Whangarei Interagency Group in March 2012 after several deaths of taitamariki4 by suicide.

The group included Child, Youth and Family (now the Ministry for Children; Oranga Tamariki), the Ministry of Education, the DHBs Child and Adolescent Mental Health Service - Te Roopu Kimiora, and kaupapa Māori providers Ngāti Hine Health Trust and Ki A ora Ngātiwai. (Suicide Mortality Review Committee, 2019).

Fusion continues to work in the post-vention and prevention landscape daily using a disruptive and dynamic model that exposes the failings and highlights what works - giving voice to whānau to allow genuine engagement.

Fusion functions with whānau front and centre of the whānau-process directing flow and seeks to be where it is most useful A kaupapa Māori model grown and developed from the inside out.

Whānau who are already suffering are forced to suffer more, even when we think we are trying to help.

The response to date often requires those that are most in need to be responsible for seeking help from multiple services for their needs. Those experiencing suicide including grief and trauma are often pushed around by systems that just don’t get them or their needs. Supporting those bereaved by suicide with approaches that understand grief by suicide requires a specific and dedicated set of skills to nurture whānau.

Whānau require a service that feels, sounds and looks like them.

Whānau often access specialist services 5 only after a suicide incident or suicide attempt. At this time whānau are entitled to a service with cultural imperatives coupled with clinical insights with whānau led strategies. A service that is available to their needs and culturally grounded and one that supports mental health, suicide and strengthens whānau. Whānau-led strategies are critical to combat intergenerational and historical trauma (Wendy Dallas-Katoa, 2019).

“Kua tawhiti kē to haerenga mai, kia kore e haere tonu; he tino nui rawa o mahi, kia kore e mahi tonu”

You have come too far not to go further; you have done too much not to do more (Ta Himi Henare)

3. Suicide

3.1. Suicide Rates Globally

Close to 800,000 people die by suicide each year, one person every 40 seconds. Suicide occurs across the lifespan and is the second leading cause of death among 15-29 year olds globally. The global suicide age-standardised rate in 2016 was 10.5 per 100,000. (World health Organization, 2019)

Every suicide is a tragedy; behind every number is whānau and friends lamenting

4 Young people 5 Suicide intervention health services

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3.2 Suicide Rates Nationally

In the 2018/19 year the provisional suicide rate is 13.93 per 100,000 people; 685 people died by suicide according to the Chief Coroner. There is an unacceptable increase in young people dying by suicide, particularly in the 15-19 age range and the 20-24 age range. The rates of suicide among Māori increased to 28.23 from the 2017/18 rate of 23.72 per 100,000 increasing the intolerable equity gap.

The Ministry of Health released the Suicide Facts: 2016 data (provisional)6 showing the rate of suicide is highest amongst males and Māori. Our Māori male rate of suicide is 31.7 per 100,000, the highest rate in the ten year period from 2007 and was twice that for non-Māori, for both males and females. The steep rise in deaths by suicide of Māori aged 25 to 44 since 2009 is shameful, a rate that has doubled from 2009 to 2016.

The Unicef7 2017 Annual report ranked New Zealand the highest for youth suicide in the developed world for youth 15-19 years at a rate of 15.6 per 100,000. (UNICEF Office of Research, 2017).

3.3 Northland DHB Regional Suspected Suicides

2012 2013 2014 2015 2016 2017 2018 2019 YTD

TOTAL 35 28 18 27 27 43 37 29 u/25 yrs 19 7 4 1 5 7 7 4

Māori 18 10 7 6 9 13 16 10

Male 23 18 13 19 23 32 26 25 Female 12 10 5 8 4 11 11 4

Whangarei 16 12 8 12 10 27 15 16 Mid North 7 3 3 3 9 8 7 3

Far North 11 9 4 8 5 5 10 4 Kaipara 1 4 3 4 3 3 5 6

MHAS 11 8 3 11 10 10 9 1

Northland DHB collects suspected suicide data via Fusion and the Coronial Sharing Data MOU with CASA (Clinical Advisory Services Aotearoa). On average 26 percent are cases known to Mental Health & Addiction Services (MHAS), 72 percent were male and nearly half were in Whangarei. Ethnicity is not always identified accurately, however on the information available on average 35 percent were Māori which is in line with the population in Northland8.

Northland DHB reported self-harm events9 shows an almost doubling in the under 25 year age group between 2012 to 2018. Nearly all of the change over time is due to the female group, under 25 years. This is a large multiyear growth trend.

6 Ministry of Health 2019, Suicide Facts: 2016 data (provisional) 7 UNICEF is the global authority on children’s rights 8 Māori comprise of 34.9 percent of Northland’s total population 9 NDHB Emergency Department self-harm coded events

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3.4 Drivers Behind Suicide

Harmful experiences can impact people’s mental, physical, social, emotional, economic and spiritual wellbeing. For Māori these are particularly impacted by the on-going effects of historical trauma evolving from colonisation - unjust legislation, theft of land, language and identity, oppression of traditional cultural healing practices and widespread racial discrimination. (Te Pou o te Whakaaro Nui, 2018).

Violence, abuse, conflictual relationships, previous suicide attempts, a family history of suicide and harmful use of alcohol and drugs leave people in distress, spirit broken and can contribute to suicide (World Health Organization, 2014). The impact of entrapment in poverty is a significant contributor to poor mental and physical wellbeing outcomes which inequitably and unfairly impact on Māori (Suicide Mortality Review Committee, 2019). Trauma and disadvantage across the life course is often compounded - Te Amorangi underpinned by principals from Te Ao Māori seeks to support whānau to unravel and confront suffering, to determine their own wellbeing

The relationship between alcohol-related harm and suicide has been established with a growing evidence base. Alcohol can reduce inhibition and acutely is inked to increased likelihood of suicide attempt and fatality (Borges, 2017) . Methamphetamine is associated with a higher risk of suicide and makes up a large contribution to methamphetamine-related deaths (Darke, 2019) .

Te Taitokerau ki Muriwhenua has the highest use of methamphetamine10, availability and meth related harm is a significant concern. An established relationship with Te Ara Oranga11 programme exists via Fusion and will be extended to Te Amorangi to ensure there is synergy between these supports.

3.5 Protective Factors

Suicide is less likely to occur when adversity is low and resilience is high. Protective factors include: educational attainment, financial security, meaningful employment, self-determination, access to Te Ao Māori, relevant services including health and social services, social inclusion, positive relationships and healthy lifestyles. (M.H. Durie, 2017).

Many stakeholders believe that effective, inclusive and culturally appropriate responses and solutions to Māori suicide need to be found. These whānau centric models support the notion that the wellbeing of an individual is inextricably linked with the health and wellbeing of whānau, hapū and iwi (Wendy Dallas-Katoa, 2019)

10 Nationwide wastewater testing carried out by police (between November 2018 – January 2019) 11 Te Ara Oranga – meth harm reduction collaboration

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78 4. Te Amorangi

whānau

whānau whānui

Te Amorangi

agency/services

The key components of Te Amorangi are:

Whānau are held at the centre, they hold the power Whānau whānui are those that are connected to and obligated to whānau Te Amorangi works directly with whānau or via whānau whānui Agency, services are called on by Te Amorangi at the behest of whānau.

The key principals of Te Amorangi are:

whānaungātanga and whakapapa are the basis of all engagement The right people: specialist staff that are culturally responsive and want to contribute positively alongside whānau who are suicidal, caring for someone suicidal or bereaved by suicide Aroha ki te tangata and kanohi kitea Greater access to appropriate support and therapy chosen by whānau Agency accountability with whānau holding the balance of power Greater access to NGO and iwi-based support services Enhanced interface between primary and secondary services.

Te Amorangi is grown through a kaupapa Māori lens, a Māori model of practice to facilitate access and enhance Māori well-being. Te Amorangi vision speaks to leadership and advocacy from a Māori paradigm. Whānau with the greatest needs and aspirations find a void in support most often. Systemic bias that excludes whānau from services or services cannot meet their need, particularly from a Māori centric place.

The WAI 2575 Tribunal Panel clearly implicates a Crown breech of Te Tiriri o Waitangi with respect to persistently poorer health outcomes for Māori. Te Amorangi aims to respond to the current inequity with an inclusive approach that supports whānau and offers a cultural backbone of support.

Tino ra Ngātiratanga of hauora Māori is necessary to purse health equity12

12 WAI 2575 page 160

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79 Te Amorangi will provide whānau support via;

Brief intervention – immediate brief sessions with skilled practitioners to support in the moment and soon after. This includes crisis intervention, supported after hours by the CATT Assessment and Safety planning – comprehensive assessment and expert safety planning that is inclusive of whānau and significant support people Therapy/support – a range of therapies and social supports including kaupapa māori and clinical Grief (by suicide) counselling – experienced support with grief that is grounded in principals of pani13 and includes specific support with grief by suicide Referral – very strong referral pathways through both primary and secondary care.

A significant aspect of ensuring the success of Te Amorangi is having strong networks and positive, collaborative working relationship between the Northland DHB, PHO, Police, Ministry of Education, Ministry for Children; Oranga Tamariki, NGO, iwi social services, health practices, whānau and those with lived experience. Strong relationships were formed by Fusion from the outset with the community through to governance across all sectors.

Partners share information14 to prevent or lessen a serious threat to the life or the wellbeing of an individual. Te Amorangi builds on the work of Fusion and continues to hold whānau at the centre, cloaked by whānau whānui and surrounded by Te Amorangi, agency is on the periphery and at the behest of whānau.

5. Te Reo o te Kainga

“In loving memory of you Son, I still can’t breathe, the ache so strong, it hurts. I feel like I died with you that day Son and I’m just here existing. Feeling a little lost right now and hoping to find my way back. I’ve cried every day since you left and I don’t imagine I’ll be stopping anytime soon. I’m crying right now. Even though physically you are not here son, you have left behind a light so bright, that it will shine for ever. In this year of your passing, I have seen the greatest amount of Love for you my Son. I was told so many things from many people about how you helped them and were there for them in their times of need, even from people who didn’t know you Son. The funny thing is, I was never surprised because I already knew this.

So I ask myself this My Lovely, why did you not ask all those people for help in your time of need??? Some people blame me Son, you know who but I don’t blame myself, I hold my head high because I know I raised a kind, caring, thoughtful, humble young man and everything you were was because of me. I didn’t need hundreds of people to tell me this Son, but I somewhat found comfort in it.

This past weekend was 1 of the hardest, since you left. Celebrating the Life of my 16 year old daughter followed immediately by remembering the Death of my 16 year old Son, Heart- breaking…. My heart is taking longer to accept what my mind already knows. I’ll never get over loosing you my Love, My son, My Firstborn, My Heart. I’m just going to learn how to live without you until I see your beautiful face again Son. No amount of time will ever change that. Rest In Love My Son, Love & Missing You More Than Life itself”

13 Pani the indigenous process of grief 14 Privacy Act 1993 principal 11 Limits on disclosure of personal information

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80 6. Te Amorangi Proposal: 2019 – 2021

Te Amorangi will provide immediate access to effective support15 for whānau who are experiencing suicide; whether they are caring for someone suicidal, they themselves are suicidal or they are bereaved by suicide. The model ensures that the majority of whānau are seen on the same day for brief intervention therapy, risk assessment, and/or safety planning, ongoing therapy/support or referral to primary or secondary services and/or social supports.

Fusion will carry operational oversight with the governance held by the Social Wellbeing Governance Group (SWGG). The Northland DHB Programme Lead – Suicide Prevention with the Fusion Chair will led and operationalise Te Amorangi – an accessible, culturally responsive, trauma informed model of care that holds whānau centrally, shares skills, builds protection and confidence to support whānau towards recovery.

Te Amorangi will partner with agencies including Primary, Secondary care, NGOs and kaupapa Māori services for a collaborative response where appropriate. There will be a ‘tight-loose’ relationship with MHAS, giving access to the Brief Intervention role within CATT16 to support Te Amorangi afterhours and access to a psychiatrist.

“I’m drawing on the fact that she’s Māori and I’m Māori and I’m speaking to her with all the grace that that gives her; that she is entitled to”

6.1 Service Development Outline:

Timeline Kaiarahi Psychology Counsellin MHA Youth Social NDHB Brief NDHB WINZ (FTE) /Psychiatry g (FTE) Clinician Specialist Worker Intervention Triage kaitautoko (FTE) (FTE) (FTE) (FTE) (FTE) (FTE) (FTE)

Year 2.5 *1.0 *1.0 2.0 1.0 1.0 0.5 0.5 0.5 One 2019 - 2020 Year 5 *1.5 *2 4.0 2.0 2.0 1.0 1.0 1.0 Two 2020 - 2021 *equivalent in hours

Kaiārahi/kaitautoko Kaiārahi may be unregistered or registered, have empathy to hear the whānau journey which is important to their identity and recovery process. Kaiārahi are central to connect with whānau and understand their needs (inclusive of collaboration, choice, trustworthiness and empowerment) they will work closely with the Mental Health clinicians, Social & Addiction workers to respond to what is has been identified as being important to by whānau for whānau.

Mental Health Nurse (Triage) A role to enable whānau on their chosen pathway through Te Amorangi or support whānau through other primary or secondary pathways.

Social Worker Experienced with established networks, including a 0.5 fte seconded role from WINZ to support with social supports and benefits.

15 Cultural imperatives coupled with clinical insights 16 CATT - Community Assessment and Treatment Team

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81 Mental Health & addictions clinician Capacity and capability of engaging with whānau, who are often traumatised. This will be a dually competent (clinically & culturally equipped), skill mixed, hold attitude and experience that enhance and support kaiārahi/kaitautoko in working with whānau - taitamariki to kaumātua.

Youth Specialist This role will have equal status to any other role and provide leadership and advice from the perspective of a young person to whānau and the Te Amorangi team.

Clinical Psychologist/Psychiatrist Support to whānau for brief and ongoing therapy as whānau choose.

Counselling Skills in a range of supportive therapies and experience in grief, family therapy, healthy relationships, trauma.

Brief Intervention Northland DHB Role Strong link to the current Northland DHB Brief Intervention Role that sits within Crisis assessment and treatment teams, to ensure after hours follow-up and support to caseloads through clear safety plans. This role will also bring a synergy through to urgent psychiatry when required.

Triage Northland DHB Role Strong link to the current Northland DHB Triage role to ensure swift and appropriate pathways through secondary care. This role will provide triage skill development across Te Amorangi.

Ministry of Social Development Support Role A seconded position to support whānau, particularly with benefits and social supports so whānau can determine how to strengthen their fabric and will select the threads that will bind and connect their whānau.

6.2 Workforce Development Workforce development is a significant component to Te Amorangi. This specialist team will continually upskill to ensure the most current research and practices are shared throughout the team and sourced if not held within the team. Staff will be specifically selected for a particular set of skills, firstly a cultural rigour and a preference to working with suicide.

Staff will hold skills in a range of therapies that will be agreed with whānau rather than enforced. Kaupapa Māori practices will be considered and where whānau chose form part of the journey to wellness.

Nau te rourou nāku te rourou ka ora te iwi

Training Mana Akiaki – Suicide Awareness Sad Blokes – Tap, think, point – examples (not Le Va - Annette Barry Taylor Lena Gray limited to) Beautrais whānau, whānau whānui Te Amorangi Agency

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82 7. Outcome Measures

The pilot service reporting will include some mainstream markers but more usefully incorporate Māori models of practice such as Te Hiringa Tamariki17 to more appropriately measures against our own standards:

Atua – a scale to measure engagement and belief in concepts of spirituality Pākanga – a scale to measure positive relationships Te Ao - a scale to measure personal resources Ihi – a scale to measure a sense of purpose Number of clients seen Number of sessions/ client Referral from, reason for referral and outcome of referral Age, Ethnicity

Year 1 - Develop Baseline Data e.g.

Self-harm presentation to ED Pre/post support self-harm Intervention.

Year 2 Outcomes Framework Established

Reports are provided bi-monthly.

8. Financials

Expected that contract starts 1 January 2020, in Whangarei then expands in July 2020

2019 2020 2020 2021 Te Amorangi $ FTE FTE 6 months FTE Full Year

Kaiārahi 92,000 2.50 115,000 5.00 460,000

Psychiatrist 280,000 0.25 35,000 0.50 140,000

Psychologist 130,360 0.75 48,885 1.00 130,360

Counsellor 130,360 1.00 65,180 2.00 260,720

Registered Nurse 130,360 2.00 130,360 4.00 521,440

Youth Specialist 130,360 1.00 65,180 2.00 260,720

Social Worker 130,360 1.00 65,180 2.00 260,720

Brief Intervention 130,360 0.50 32,590 1.00 130,360

NDHB Triage 130,360 0.50 32,590 1.00 130,360

Kaitautoko 92,000 0.50 23,000 1.00 92,000

Total 10 612,965 19.50 2,386,680

17 Unicef NZ Te Hiringa Tamariki (2019)

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83 9. Bibliography

Borges, G. e. (2017). A meta-analysis of acute alcohol use and the risk of suicide attempt. Psychol Med, 949-957.

Darke, K. D. (2019). Completed Suicide Among Methamphetamine Users: A National Study. The American Association of Suicidology, 328-337.

Government Inquiry into Mental Health and Addiction. (2018). He Ara Oranga. Wellington: Crown.

L. Pihama, F. C. (2002). Creating Methodological Sapce: A Literature Review of Kauapa Māori Research. Canadian Journal of Native Education, 30-43.

M.H. Durie, K. R.-T. (2017). Tūramarama ki te ora: National Māori strategy for addressing suicide 2017-2020. Rotorua: Te Rūnganga o Ngāti Pikiao Trust.

Ministry of Health. (2019). Every Life Matters - He Tapu te Oranga o ia tangata: Suicide prevention Strategy 2019-2029 and Suicide Prevention Action Plan 2019-2024 for Aotearoa New Zealand. Wellington: Ministry of Health.

Suicide Mortality Review Committee. (n.d.). Retrieved 07 30, 2019, from Health Quality and Safety Commission: https://www.hqsc.govt.nz/our-programmes/mrc/sumrc/news-and- events/news/3448

Suicide Mortality Review Committee. (2019). Overview of suicide postvention. Wellington: Health Quality & Safety.

Te Pou o te Whakaaro Nui. (2018). Trauma-Informed Care: Literature Scan. Auckland: Te Pou o te Whakaaro Nui.

UNICEF Office of Research. (2017). Building the Future: Children and the Sustainable Developement Goals in Rich Countries. Florence: UNICEF Office of Research.

Wendy Dallas-Katoa, G. V. (2019). Summary findings of an exploratory data gathering excercise on Māori suicide in Te Waipounamu. Journel of Indigenous Wellbeing Te Mauri - Pimatisiwin, 49-60.

World Health Organization. (2014). Preventing suicide A global imperative.

World health Organization. (2019). Retrieved 08 05, 2019, from World Health Organization (WHO): https://www.who.int/

Te Amorangi Briefing Paper| 22 November 2019 | Page 12 of 12

Caring for Communities – Regional Operating Model

1. Overview

1.1 Purpose of this document

This document outlines the approach for transitioning the Welfare Pillar (which encompasses the national social sector aspect of the All of Government (AOG) response to COVID-19) to a more sustainable ‘Caring for Communities’ operating model. CDEM groups have been leading the welfare response and there is now a need to transition that leadership into a new national and regional model.

1.2 Background and national context

The Ministry of Health-led response to the COVID-19 pandemic is unique both in its scale and impacts on communities across New Zealand. The Welfare Pillar was established to deliver on the NZ Influenza Pandemic Plan (NZIPAP) arrangements used as the guiding framework for the AOG COVID-19 response.

The National Emergency Management Agency (NEMA) is the responsible agency for the Welfare Pillar under the direction of the Director CDEM, and the AOG National Controller in the National Crisis Management Centre (NCMC).

As the pandemic has evolved, it has become clear that the welfare response to support New Zealand’s communities requires a unique and prolonged approach. The social and economic impacts on New Zealanders will be far-reaching and continue a long time after the state of national emergency is no longer in force, and the COVID-19 Alert Levels have de-escalated.

This transition drives a reframe of the Welfare Pillar from an immediate response model toward a longer-term focus on New Zealand’s communities, particularly those most at risk. For this reason, the ‘Welfare Pillar’ has been renamed as the “Caring for Communities workstream”, and ‘at-risk communities’ will be referred to as “priority communities”.

An operating model needs to be in place which is positioned to, at its ultimate outcome, transition from CDEM Groups to an expanded social sector services framework with clear roles and responsibilities, resources, relationships, systems, processes and intelligence/reporting. The recalibrated Caring for Communities workstream is intended to achieve this.

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85 1.3 Caring for Communities workstream objective

The overarching objective of the Caring for Communities workstream is to ensure all those individuals, whānau and communities at greater risk of experiencing adverse health, social or economic outcomes as a result of COVID-19 and associated restrictions have information and support to provide for their immediate and continued wellbeing.

Social Wellbeing Governance Group (SWGG) / Iwi / Council joined up response

Caring for Communities - Regional operating model

Background

 National governance group – membership: MSD (Chair), Te Arawhiti, Kainga ora, Te Puni Kōkiri, Oranga Tamariki, NZ Police. Ministry for Pacific Peoples  Caring for Communities recalibrates the welfare pillar AOG response to COVID-19  Its purpose: o Set the mission and priorities for agencies working with priority communities o Manage risk and take advantage of opportunity o Establish operating model and ways of working to meet the needs of priority communities while COVID-19 restrictions continue o Facilitates the move to social recovery  It sets out an approach for an operating model for transitioning from the immediate emergency response, through to recovery, which includes CDEM’s transition out of the response  This recalibration does not restrict CDEM groups from being innovative or ensuring their responses are tailored to community needs.  At this point it does not show how it operates in recovery phase or for how long it is to operate for. We understand this is being considered by the national governance group. So, some of what’s in the approach may change.  The information to date does not address any financial or other resourcing in any detail.

Regional governance

At the SWGG meeting on 5/5/2020 it was agreed that SWGG will act as the governance group at a regional level for the Caring for Communities in Taitokerau.

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Priority groups and communities framework/ Networks of Networks

A framework for priority groups and priority communities has been set nationally and a lead agency has been identified. This structure forms what is called the Network of Networks. There is also reference to a regional network of networks advisory group to cover the identified priority groups and communities.

It was proposed at the last SWGG meeting that this would likely be best served through the current welfare sub-group of the SWGG (the Services for Whānau cluster), but required further information before making that decision.

At the Welfare Subgroup meeting on 11/05/2020, the feedback was that the way the subgroup were operating will meet (and in fact had wider coverage) the requirements of the priority groups and community framework and the role of the network of networks advisory group.

Priority groups and communities framework

A review of the alignment with the way the Welfare Sub Group is currently operating with the Caring for Communities priority groups and communities framework is shown against the current operating model.

The red text indicates where Welfare Subgroup current operating model and the lead differs from that identified nationally. The blue text indicates agreement or amendments from the SWGG group on 12 May 2020.

Note the appendix which provides guidance on identifying Network Owners/Leads taken from the Memo from NEMA to CDEM groups dated 17/4/2020

1. Coordinated response for Māori whānau across all of the priority areas. TKOT/TPK (newly proposed- reordered)

2. People at higher risk of contracting COVID-19  Elderly – NDHB/MSD (not separated as below) o Maori aged 50+ - National lead - TPK o Pacific aged 50+ - National lead - MPP o People aged 70+ - National Lead - MSD  Disabled persons – NDHB National Lead - MOH  People living with chronic and/or underlying conditions – NDHB National Lead - MOH  Accommodation - Homeless and/or displaced people MHUD/ MSD & TKOT – National Lead - MHUD

3. People requiring continuity of service  Psychosocial services - Mental health and addiction issues - NDHB National Lead - MOH  Financial support - Newly unemployed – MSD National Lead - MSD  Gang families –not been considered a separate priority group. National Lead - MSD  Children and youth in need of care and protection – OT National Lead - OT

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87  People affected by family and/or sexual violence – Police /OT National Lead – Joint Venture  Suicide Prevention-NDHB /Police  Education- MoE /NorthTec

4. People who are vulnerable due to living in rural and/or physically remote communities – Councils /Police National Lead - MPI  Water security (quality of potable and availability in drought) and wastewater  Accessible services (newly proposed) o Travel mobility o Information poverty/ connectivity  Energy security  Kai security

5. People who are vulnerable due to language, or culture – CDEM until the Multicultural Advisory Group is established.  Migrants / Immigrant communities Recent migrants, Ethnic people Refugees - National Lead – Office of Ethnic Communities (DIA)  Visitors Foreigners stuck in NZ, Unlawful migrants - National Lead - Immigration NZ (MBIE)  New Zealander who are trapped offshore – not addressed regionally. National Lead - MFAT

Other matters to be worked through as more detail on this transition phase is provided:  How will the national reporting be undertaken? This is currently through CDEM but will transition to SWGG.  There is reference in the memo to service commissioning. We will need to look at what that means at a regional level.  What resourcing will support the transition to recovery and beyond.

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88 Health Sector Staff Workforce Communications SWGG MULTI-AGENCY Welfare RESPONSE to COVID-19

Primary Services Hospital services Screening / testing Māori Health

Sustain Maintain

Health / COVID-19 Recovery

Protecting Transformation Essential services Economic Recovery Border control

Community Protecting order People vulnerable (on land & Water quality communities Safety – prevention sea) of transmission Iwi Water supply and access

Water Drought

Water infrastructure

Demand management

Welfare

Services for Essential goods Essential whanau and services Council Services Family harm / Financial support violence Water & wastewater Roading Migrants Children Support essential service providers Cemetery

Accommodation Elderly Animal Public Toilets Management

People with Psychological Access essential Consenting disabilities services services CDEM Co- Suicide prevention ordination Refuse and Public transport sanitation Caring for Communities | Page 5 of 5 Immigrant Visitors Communications communities Education

Briefing Paper to Board

Northland DHB Covid19 Recovery of Activity Date

Prepared by: Rhys Manukau (Northland DHB - IMT Intelligence) Endorsed by: Nick Chamberlain, Chief Executive

Recommendation That the Board notes the content of the Ministry of Health’s (MOH) COVID19 Recovery Dashboard dated 3 May 2020 contains large portions of incomplete information for a variety of reasons.

That the Board notes that Northland DHB will work with MOH to close gaps in information in the COVID19 Recovery Dashboard however some gaps will be unavoidable and dependant on timing of distribution.

That the Board notes the content of this paper as a summary of service delivery to date throughout the Covid19 response.

Background Supported by national guidance, community and iwi support and a strong public health response, we have managed to limit the direct impact of Covid19 throughout Te Tai Tokerau. These efforts resulted in reduced volumes of service delivery from health providers. Below provides some insights into that service delivery during the Covid19 response to date.

Acute Care Emergency Departments Presentations to our Emergency Departments (ED) dropped to between 50-60% of last year’s volumes early on in the Covid19 response. After one week of being in National Alert Level 4, a steady climb towards usual volumes is evident. This could be due to national efforts to encourage the public to not hesitate to seek emergency medical care during the National Alert Level 4 period.

Source: EDaaG Whiteboard data, Northland DHB

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90 Inpatients Inpatient discharges during April were 60% of last year volumes for the same month.

Source: Inpatient Discharges by Specialty ,Northland DHB Reporting Services

Three of the discharges during March and April 2020 were Confirmed or Probable cases of Covid19. Not all discharges have been clinically coded with diagnosis information however as this becomes available we will be able to ascertain which cohorts of patients may have been impacted the most. The Surgical (45% of normal volumes) and Paediatric (39% of normal volumes) services saw the biggest reductions in inpatient discharges as per the below chart.

Source: Inpatient Discharges by Specialty ,Northland DHB Reporting Services Despite the significant reduction in surgical discharges, many were as a result of reduced Planned Care surgical procedures. There were 208 acute surgical procedures during April representing 79% of the previous 12 month average volumes for acute surgeries.

Planned Care Referrals from Primary Care Referrals from General Practice (GP) for First Specialist Appointments (FSA) during April were 39% of the volumes from the same month last year. Referrals for FSAs for Māori have reduced at a proportionate level to all referrals at 42% compared with the same period last year. We are unsure at this stage whether this correlates with the presentations to primary care practices.

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Source: E-Referral Detail,Northland DHB Reporting Services

From a secondary care perspective it could be assumed that the unmet need is represented by the approximate 60% reduction in referrals and is in the vicinity of 2000 to 2200 referrals (including 500-600 for Māori) for specialist appointments. At a acceptance rate of 66%, Northland DHB should consider the impact of 1300-1500 FSAs. It is unclear at this stage how this volume will flow through from primary care in the coming months especially if capacity to see patients is no greater than prior to Covid19 response. If this is the case, we may not necessarily see these volumes made up for over the coming months but rather unmet need will be determined by both primary and secondary care prioritisation of demand.

MOH’s COVID19 Recovery Dashboard shows disproportionate volumes of referrals have been returned to primary care as “Service Not Required” during March and April. While this is accurate, rather than being a whole of system response to control demand for FSAs, the increases can be directly related to the Orthopaedic and the Ear, Nose and Throat (ENT) services as shown below.

Source: E-Referral Detail,Northland DHB Reporting Services

Orthopaedics sent 258 of 480 referrals and ENT sent 64 of 284 referrals back to GPs during March and April 2020. These services have each implemented temporary measures to manage demand. For Orthopaedics, there is currently 4.9 months forward load (wailtlist divided by avg. monthly delivery) for FSAs. ENT is currently operating with a significantly reduced specialist capacity however this is expected to increase over the next month. The FSA acceptance within each of these two services has aligned with the MoH requirements for managing flow to capacity to treat. ENTs FSA waiting list had improved over the previous 12 months, however this had laregly been achieved through additional duties (down to two consultants) or locum usage and is not sustainable. Orthopaedics has had deteriorating waiting times for almost 18 months with the waiting list growing from 780 to 1,349. In 12 of the last 18 months the waiting list has increased. Output throughout this period has remained stable. Without increasing thresholds we will not regain ESPI compliance. Delivery of Outpatient Clinics 1211 FSAs were delivered in April at 52% of the previous 12 month average. Given that the reduced delivery of FSAs was above the reduced volumes of referrals coming in, we should not expect an immediate increase in FSA waitlists. There will be variation among specialties and optimal recovery planning will need to consider the unique characteristics of their services.

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92 4017 Follow Up appointments during April were 62% of the previous 12 month average. Understandably, follow ups had less reduction due to the nature of the contact and higher probability that the appointment could be delivered over the phone or via telehealth. From an equity perspective, the overall clinic appointments delivered was proportional however there was a slight variation between Non-Māori and Māori for each of the above clinic appointment types.

Source: Northland DHB Data Warehouse There is variation amongst specialties as to clinic appointment delivery. Either through acuity and/or innovation, some specialties managed to deliver as many appointments during April as they would have in the previous 12 months;  777 Oncology appointments at 105% of previous 12 month average.  655 General Surgery appointments at 101% of previous 12 month average. Unprecedented levels of clinic appointments have been delivered by Telehealth making up 47% of April clinic delivery. This enabled us to deliver 2,483 appointments where patients were prevented from travelling to Whangārei Hospital to attend. Without this uptake in Telehealth by both clinicians and communities, these appointments may not have otherwise have taken place.

Source: Northland DHB Data Warehouse

Theatre Procedures Planned Care surgery volumes were down to 27% (29% fo Māori) of previous 12 month average with 252 procedures taking place.

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93 Source: Northland DHB Data Warehouse This is a reduction in delivery of 600-700 procedures in April as well as approximately 200 procedures from late March. As with clinic appointments, there will be variation by service and services have already commenced work streams to enable increased delivery and optimal prioritisation.

Summary Service delivery could be best summarised by the below:

 Acute Demand: 50%-80% of usual service delivery. Awaiting clinical coding of discharges to identify patient cohorts and determine if we need to do anything differently to support heavily impacted groups.

 Referrals for FSAs: Reduction of 2000-2200 referrals from April. Unknown at this stage as to if or how these will flow through over the coming months.

 Clinic Appointments: Consider the potential demand for 1300-1500 FSAs as a result of reduced referrals mentioned above. Plan to deliver 2400 Follow Ups to make up for April reductions.

 Surgical Procedures: Plan to deliver 800-900 Planned Care surgical procedures to make up for April reductions.

 Equity: At a high level, Māori appear to have been effected proportionately however further investigation into specialties could identify areas of concern and/or opportunity to pursue equitable outcomes.

This summary is up to end of April and we expect that there has been reduced service delivery during May. Work will continue to understand and monitor the impact of service delivery under Covid19 response so as to most equitably and effectively plan recovery.

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94 All District Health Boards

COVID 19 National Hospital Response Framework – The Process

• This Hospital Response Framework is designed to provide escalation levels to support facilities and hospitals to appropriately and safely operate at each agreed Alert Level. • The Framework provides high level, nationally consistent guidance to support your facility’s own emergency response procedures that will need to be deployed at each Alert Level. • The alert levels in this Framework are different to the Government’s National COVID-19 Alert Levels, which note that hospitals will operate in line with the National Hospital Response Framework. • Hospitals are expected to operate in line with their current Alert Levels and have systems and processes proactively in place to identify and respond to any changes in levels (up or down) so that changes are made in a well-managed and planned manner with staff and resources prepared and trained beforehand. • It is expected that alert levels may change rapidly, and decisions are made locally at a hospital or facility to move status up or down. • The Framework aims to ensure that patients remain at the centre of care by making proportionate responses to escalations and de- escalations in the COVID-19 pandemic. • This plan should identify Māori and other vulnerable populations and ensure health disparities do not increase as a result of the response to the COVID-19 pandemic. DHBs must maintain rigorous oversight of waiting lists, including a comprehensive plan setting out the manner by which the risk of patients deteriorating while waiting for assessment and treatment will be identified and managed. • Te Tiriti o Waitangi and Equity are at the centre of each level of the Framework. Critically, DHB escalation and de-escalation will be taken in a way that actively protects the health and wellbeing of Māori and other vulnerable population groups. This includes active surveillance and monitoring of health outcomes, for Māori and other vulnerable groups, to ensure a proportionate and coordinated response to health need for COVID-19 and non-COVID patients. • DHBs should share their planning for management of Alert Levels with primary care and other providers. • Daily EEC meetings should be the mechanism whereby Alert Levels are confirmed, and actions initiated in daily reporting. • It is possible for different hospital facilities and/or departments within a DHB to be at different Alert Levels at any given time. • The overall DHB Alert Level should be reported each day to the National Health Coordination Centre (NHCC) so that a national view of escalation can be compiled. This will be via the NHCC DHB SitRep. • A hospital should determine its Alert Level and readiness and reconfirm daily with senior clinicians, senior managers and other relevant senior personnel as part of the local response plan. This decision should be clearly documented and evidenced. • These criteria may evolve over time and be revised by the National Hospital Response Group, then reissued as appropriate.

Version 2.0, released 21 April 2020

95 All District Health Boards COVID-19 National Hospital Response Framework

Trigger Status: No COVID-19 positive patients in your facility; Any cases in your community are managed and under control; managing service delivery as usual with only staffing and facility impact being for training & readiness purposes

• Screen for COVID-19 symptoms & travel history for any new Emergency Department attendances, pre-op sessions, planned admission, or clinic attendance • Plan for triage physically outside the Emergency Department (or outside the hospital building) • Plan to have a separated stream for COVID-19 suspected cases and non COVID-19 cases in Emergency Department COVID-19 Hospital • Undertake regular training and exercises for management of a COVID-19 suspected case in the Emergency Department, Wards, Theatres, ICU/HDU • Maintain PPE training for COVID-19 care in the Emergency Department, wards, theatres, ICU/HDU, outpatients, other relevant settings Readiness • Plan for isolation of a single case & multiple cases/ cohorting • Plan for Early Supported Discharge, aggressive discharge and step-down arrangements, including with other partners as appropriate (e.g. private, aged residential care, community providers) • Plan for separate streams for staffing, cleaning, supplies management and catering GREEN ALERT • Plan for management of referrals, and increased workload on booking and call centre teams • Plan to have a COVID-19 capable theatre for acute surgery for a known or suspected positive patient • Plan and prepare a dedicated COVID-19 ward • Engage with alternative providers (such as private) to confirm arrangements for their assistance during higher escalation levels, and to fast-track urgent, lower complexity care procedures such as cataracts, endoscopy etc. • Arrange for outpatient activity to move to telehealth and phone screening for virtual assessment, and MDTs to videoconference wherever possible • Planned Care surgery, acute surgery, urgent elective and non-deferrable surgery to operate as usual, National Services to operate as usual, NTA to operate as usual • Review patients on the waiting list (surgery, day case, other interventions) and group patients by urgency level • Prioritise Planned Care surgery and other interventions by focusing on those with the most urgent need, and where ICU/HDU is required

Trigger Status (individual or cumulative): One or more COVID-19 positive patients in your facility; cases in your community are being managed; isolation capacity & ICU capacity manageable; some staff absence and some staff redeployment to support response and manage key gaps

COVID-19 Hospital • Continue screening for COVID-19 symptoms and travel history as per Green Alert • Activate plans as described in Hospital Green Alert, as appropriate Initial Impact • Activate Emergency Department triaging in a physically separate setting • Activate streaming of suspected COVID-19 or COVID -19 positive and non-positive patients as planned across Emergency Department, Wards, Theatres, ICU/HDU, and have dedicated COVID-19 capable theatre available • Activate Early Supported Discharge, aggressive discharge and step-down arrangements, including with other partners as appropriate (e.g. private, aged residential care, community providers) • Engage across other DHBs to appropriately discharge out of area patients back to domicile hospital or other setting (to be considered in conjunction with current Hospital Alert Level at other DHBs) YELLOW ALERT • Acute surgery, urgent elective, and non-deferrable surgery to operate as usual, with consideration given to repatriation processes if patient is non-domicile • Start to move pre-op assessments and outpatient appointments to be undertaken virtually, or in an off-site setting as necessary • Plan to defer non-urgent pre-assessments and non-urgent clinic patients if necessary, ensuring clinical and equity risk is managed • Activate any outsourcing arrangements reached, and engage on options for supporting ‘cold trauma’ cases and less-complex urgent cancer surgery • Planned Care surgery and other interventions to be prioritised based on urgency, and where ICU/HDU is not required, delivery should continue as much as possible • Redeployment of staff as needed/available to ensure perioperative workforces are in place to run theatre, including anaesthesia, anaesthetic technicians, nursing. Scale back delivery of non-urgent Planned Care as needed.

Trigger Status (individual or cumulative): Multiple COVID-19 positive patients in your facility; community transmission is not well controlled; isolation capacity and ICU capacity impacted; significant staff absence, extensive staff redeployment, gaps not being covered

• Continue screening for COVID-19 symptoms and travel history as per Green Alert COVID-19 Hospital • Activate plans as described in Hospital Green and Yellow Alert levels • Work with palliative care and other providers to agree alternative end of life services for non-COVID patients. Moderate Impact • Provide Emergency Department services with prioritisation on high acuity medical and trauma care. Provide advice in non-contact settings where possible. • Fully activate any agreements reached with private (or other) providers • Acute surgery to operate as usual, with priority on trauma cases, as staffing and facilities allow ORANGE ALERT • Prioritise urgent non-deferrable Planned Care cases not requiring ICU/HDU care • Review and manage all non-urgent high risk Planned Care surgery requiring HDU/ICU, adjusting the prioritisation threshold for surgery with Senior Clinician for non-deferrable cases • Increase ICU/HDU capacity as needed, retaining cohorting of suspected COVID-19 and COVID-19 positive and non-positive patients, including moving non-COVID-19 ICU/HDU to theatre complex • Implement acute ambulatory assessments or virtual/telehealth assessments for urgent, non-deferrable cases as staffing allows • Manage outpatient referrals to ensure clinical and equity risk is understood and managed

Trigger Status (individual or cumulative): Multiple COVID-19 positive patients in your facility; community transmission uncontrolled; isolation and ICU at capacity; all available staff redeployed to critical care COVID-19 Hospital • Emergency Department services limited to high acuity medical and trauma care • Activate plans as described in Hospital Green, Yellow and Orange Alert levels Severe Impact • Work with palliative care and other providers to agree alternative end of life services for non-COVID-19 patients. • Continue acute surgery as staffing and capacity allows, prioritising non-deferrable, life-saving surgery • Cancel all non-acute surgery RED ALERT • Activate additional streaming, including non-COVID-19 ICU/HDU to theatre complex, or private provider if agreement reached • As a last resort, move ventilated COVID-19 patients to repurposed ICU/HDU theatre complex for overflow; aim is to not impact on ability to meet non-deferrable, life-saving acute surgery • Continue with acute ambulatory assessments or virtual/telehealth assessments for urgent, non-deferrable cases only, as staffing allows • Only accept urgent outpatient referrals, but ensure clinical risk is understood and managed •

Version 2.0, released 21 April 2020

96 22 April 2020

Primary Care, Pharmacy & CBACs All Community Residential, NASC, HCSS Other community providers including NGOs, Māori and Pacific providers, district & DSS nursing, community midwifery and allied health

Managing service delivery as usual with only staffing and facility impact being for training & Managing service delivery as usual with only staffing and facility impact being Managing service delivery as usual with only COVID-19 readiness purposes for training & readiness purposes staffing and facility impact being for training &

Community • Screen for COVID-19 symptoms & travel history for all attendances to primary care and community • Screen for COVID-19 symptoms & travel history for all attendances to readiness purposes facilities community facilities • Screen for COVID-19 symptoms & travel Readiness • Plan for triage including physical separation • Identify vulnerable patients who may need additional social supports, care history for all attendances to community • Plan to separately stream COVID-19 suspected cases and non COVID-19 cases planning, pre-emptive care and assign specific resource to work with these facilities GREEN ALERT • Practice PPE availability and use for COVID-19 care in appropriate areas groups • Identify vulnerable patients who may need • Undertake training and practice runs for management of a COVID-19 suspected case • Plan to have a separated stream for COVID-19 suspected cases and non additional care planning COVID-19 cases to manage isolation as required • Practice PPE use for COVID-19 care in the Trigger Status summary: No • Ensure shared medical record, secure provider communication, telehealth, virtual consultation and • Practice PPE use for COVID-19 care in the relevant settings COVID-19 positive patients in electronic prescribing options available that consider the needs of the community served. relevant settings your hospital; no cases in your • Ensure local clinical guidance is available e.g. HealthPathways, connected to local processes and • Plan for virtual and non-contact medical and specialist care. • Plan how care may be delivered in non-

community; managing service directories • Identify non-essential (non-urgent) services that can be deferred with no contact ways or be de deemed non-essential delivery as usual with only • Plan for management of calls, phone triaging, remote and virtual consults and virtual MDTS for the risk to patients. • Plan how to deliver essential care and support

staffing and facility impact being majority population, including provision for vulnerable populations with limited phone and • Develop clear COVID-19 visitor policies. to clients including where contact is required for training & readiness internet access. • Implement alert level admission and discharge plans with your DHB. • Plan for whānau/community centred

purposes • Plan for community based assessment and testing clinics and mobile assessment teams and • Plan with additional support staff to confirm arrangements for their responses for priority populations to ensure welfare response teams for all of the levels below including immediate response to any possible or assistance during higher escalation levels access to necessary care and to support

actual outbreak in any community • Create psychosocial messaging, appropriate to all clients. equity. • Plan with additional support staff to confirm • Plan for whānau/community centred responses for priority populations to ensure access to NASC/HCSS/DSS necessary care and equity • Screen for COVID-19 symptoms in all patients where care is provided arrangements for their assistance during • Plan to defer non-essential (non-urgent) services, noting vulnerable populations may still need to • Maintain accurate lists of all vulnerable clients. higher escalation levels receive care • Plan how to manage home and community support services and disability • Create psychosocial messaging, appropriate to • Plan and prepare a dedicated COVID-19 area and staff, including dedicated Māori, Pacific and support services to minimise unnecessary contact and prioritise those with the clients including for their personal support Disability health workers highest need network. • Plan with additional support staff to confirm arrangements for their assistance during higher • Plan to how to support COVID-19 suspected cases and non COVID-19 cases escalation levels in home care settings including streaming of workforce • Identify vulnerable patients who may need additional social supports, care planning, pre-emptive • Practice PPE use for COVID-19 care in the relevant settings care • Create psychosocial messaging, appropriate to the clients including for • Resource kit developed for supporting people with own wellbeing and welfare need their personal support network.

Presence of a COVID-19 probably or small outbreak: May be some staff absence and redeployment to Presence of a COVID-19 probably or small outbreak: May be some staff Presence of a COVID-19 probably or small COVID-19 support response absence and redeployment to support response outbreak: May be some staff absence and Community • Continue screening for COVID-19 symptoms and travel history as per Green Alert • Continue screening for COVID-19 symptoms and travel history as per Green redeployment to support response • Activate Plans as required at Community Yellow Alert Alert • Continue screening for COVID-19 symptoms Mild Impact • Move to delivery of care by virtual or non-contact means wherever possible whilst ensuring access • Refer all patients and staff who exhibit symptoms for assessment and and travel history as per Green Alert for priority and vulnerable populations. testing. • Refer all patients and staff who exhibit YELLOW ALERT • Primary care providing initial assessments of patients with COVID-like symptoms • Activate plans as required at Community Yellow Alert symptoms for assessment and testing. • Activate PPE Plans • Activate appropriate PPE Plans • Activate plans as required at Community • Activate streaming of suspected COVID-19 positive and non-positive patients to separate areas Trigger Status summary: Cases • Managing patients in their place of residence and activate isolation plans Yellow Alert quarantined in your community, • Activate plans for management of calls, phone triaging, remote and virtual consults and virtual where required. • Activate virtual and non-contact delivery contact tracing active; one or MDTS for the majority population, including provision for vulnerable populations with limited • Activate Plan for virtual and non-contact medical and specialist care. where possible. more COVID-19 positive phone and internet access • Activate visitor policies (1 adult visitor per day by appointment) • Activate whānau/community centred patients in your hospital, there • Activate plans for community-based testing clinic(s), by referral only and close to any known • Activates admission and discharge pathways developed with your DHB. responses for priority populations to ensure may be some staff absence and possible outbreaks and mobile assessment teams. I access to necessary care and to support some staff redeployment to • Activate plan for whānau/community centred responses for priority populations to ensure access to NASC/HCSS/DSS equity. necessary care and equity support response • Screen for COVID-19 symptoms in all patients where care is provided • Cease non-essential service delivery. • Activate specific plans for Advanced Care; Palliative Care; Age Residential Care and Mental Health • Refer all patients and staff who exhibit symptoms for assessment and • Virtual midwifery appointments encouraged and Addiction support provided by primary care. testing. where appropriate. • Plan for extended acute demand service available to manage people including extended large-scale • Needs assessment and service coordination prioritised to patients with • Activate appropriate PPE Plans illness and palliative care to all community facilities. highest need • Implement the referral/delivery process for • Plan for all hospital activity that needs to continue to transfer to community options where able, • Implement the referral process developed for non-health related welfare non-health related welfare concerns • Identify and support high risk patients, those awaiting elective services which are postponed and concerns • Implement relationships with Civil Defence those with chronic conditions • Deploy resource kit to support people with own wellbeing and welfare need welfare responses to support welfare need. • Continue with influenza vaccinations and primary care administered childhood immunisations, • Deploy resource kit to support people with prioritising vulnerable populations own wellbeing and welfare need • Implement the referral process developed for non-health related welfare concerns • Deploy resource kit to support people with own wellbeing and welfare need

97 22 April 2020

Other community providers Primary Care, Pharmacy & CBACs All Community Residential, NASC, HCSS including NGOs, Māori and Pacific providers, district

& DSS nursing, community midwifery and allied health

Urgent care facilities and primary care capacity severely affected, significant staff absence, extensive Significant staff absence, extensive staff redeployment Significant staff absence, extensive staff COVID-19 staff redeployment redeployment • Continue screening for COVID-19 symptoms and travel history as per Green Community • Continue screening for COVID-19 symptoms and travel history as per Green Alert Alert • Continue screening for COVID-19 symptoms • Activate additional plans as required at Community Orange Alert • Refer all patients and staff who exhibit symptoms for assessment and and travel history as per Green Alert Moderate • Delivery of care by virtual or non-contact means wherever possible. testing. • Refer all patients and staff who exhibit • Patients with COVID-like symptoms referred to Community Based Assessment Units • Stream for COVID-19 suspected cases and non COVID-19 cases to manage symptoms for assessment and testing. Impact • Expand Community Based Assessment Clinics in multiple locations with good access for priority isolation as required • Activate plans as required at Community populations, mobile teams for immobile or isolated patients and outreach to vulnerable and priority • Workforce Backup Plans in Place with your DHB Orange Alert levels populations ensuring proximity to any known possible outbreaks and mobile assessment teams. • Activate plans as required at Community Orange Alert • Support prioritised for vulnerable or high ORANGE ALERT • Expand whānau/community centred responses for priority populations to ensure access to • Activate appropriate PPE Plans risk patients necessary care and equity • Maintain virtual medical care with Primary Care Trigger Status summary: • Activate virtual and non-contact delivery • • Activate Orange Alert Level visitor policies Community Move to even greater delivery of care by virtual or non-contact means wherever possible whilst where possible. ensuring access for priority and vulnerable populations. • Activate Orange Alert Level admission and discharge pathways developed • Activate whānau/community centred transmission/multiple clusters in your community; one or • Expand specific plans for Advanced Care; Palliative Care; Age Residential Care and Mental Health with your DHB. responses for priority populations to ensure more COVID-19 positive and Addiction support provided by primary care including postponing non-essential care and pre- • Providers continue to accept admissions from DHBs and NASCs within access to necessary care and to support patients in your hospital; emptive care is in place for end of life patients. agreed care levels including early discharge. equity.

significant staff absence, • Activate the plan for extended acute demand service available to manage people including NASC/HCSS/DSS • High risk groups continue to receive face to extensive staff redeployment extended large-scale illness and palliative care to all community facilities. • Activate appropriate PPE Plans face midwifery appointments • Activate the plan for all hospital activity that transfers to community options. • Essential home and community support care in place, • Cease non-essential service delivery.

• Identify and support high risk patients, those awaiting elective services which are postponed and o Shower, bathing and basin washing; oral hygiene - two weekly • Activate appropriate PPE Plans those with chronic conditions o Toileting; Sponge & bed positioning; • Implement the referral/delivery process for • Pharmacies activate tele advice for medicine management and non-contact delivery mechanisms for o Medicine administration; Meals on wheels non-health related welfare concerns

patients • Cease non-essential home and community supports, • Implement relationships with Civil Defence • Continue with influenza vaccinations and primary care administered childhood immunisations, • Workforce Backup Plans in Place with your DHB welfare responses to support welfare need. prioritising vulnerable populations • Safety Check - Phone/ video OR family, friend, • Deploy resource kit to support people with

• Implement pro-active support for non-health related welfare concerns • Implement pro-active support for non-health related welfare concerns own wellbeing and welfare need • Deploy resource kit to support people with own wellbeing and welfare need • Deploy resource kit to support people with own wellbeing and welfare need

•

Urgent care facilities and primary care at capacity, all available staff redeployed to non-deferrable All available staff redeployed to non-deferrable care All available staff redeployed to non-deferrable COVID-19 care • Activate plans as described in Community Red Alert level care Community • Activate additional plans as required at Community Red Alert • Continue screening for COVID-19 symptoms and travel history • Continue screening for COVID-19 symptoms • Streaming of suspected COVID-19 and non COVID-19 positive patients, either within or between • Refer all patients and staff who exhibit symptoms for assessment and and travel history as per Green Alert

Severe Impact facilities as agreed via local incident control testing. • Refer all patients and staff who exhibit • All patients with COVID-like symptoms referred to CBACs with assessment, testing, mobile medical • Workforce Backup Plans in Place with your DHB symptoms for assessment and testing. teams and welfare responses located across districts with a focus on priority communities; • Activate appropriate PPE Plans • Activate plans as required at Community

RED ALERT • Expand whānau/community centred responses for priority populations ensure access to necessary • Stream for COVID-19 suspected cases and non COVID-19 cases to manage Red Alert levels care and equity isolation – this may be across facilities • Support prioritised for vulnerable or high Trigger Status summary: • All clinical services triaged and limited to urgent non-deferrable care including acute, palliative • Maintain virtual medical care with Primary Care risk patients Community • Non-essential delivery of care ceased. • Activate Red Alert Level visitor policies transmission/widespread • Virtual and non-contact delivery where • Provide medical support to Palliative Care; Age Residential Care and Mental Health and Addiction outbreaks in your community; • Activate Red Alert Level admission and discharge pathways developed with possible. support and pre-emptive care is in place for end of life patients. your DHB including alternative admission pathways. • High risk groups continue to receive face to COVID-19 positive patients in your hospital, urgent care • Activate the plan for extended acute demand service available to manage people including • Implement palliative care support where appropriate and necessary. face midwifery appointments facilities and primary care at extended large-scale illness and palliative care to all community facilities. NASC/HCSS/DSS • Whānau/community centred responses for capacity, all available staff • Activate the plan for all hospital activity that transfers to community options. • Activate appropriate PPE Plans priority populations to ensure access to redeployed to non-deferrable • Identify and support high risk patients, those awaiting elective services which are postponed and • Essential home and community support care in place, necessary care and to support equity. care those with chronic conditions o Shower, bathing and basin washing; oral hygiene - two weekly • Cease non-essential service delivery. • Pharmacies provide only tele advice for medicine management and non-contact delivery o Toileting; Sponge & bed positioning; • Activate appropriate PPE Plans mechanisms for patients o Medicine administration; Meals on wheels • Implement the referral/delivery process for • Implement pro-active support for non-health related welfare concerns • Cease non-essential home and community supports, non-health related welfare concerns • Deploy resource kit to support people with own wellbeing and welfare need • Workforce Backup Plans in Place with your DHB • Implement relationships with Civil Defence • Provider and team wellbeing support systems are proactive • Safety Check - Phone/ video OR family, friend, welfare responses to support welfare need. • Implement pro-active support for non-health related welfare concerns • Deploy resource kit to support people with • Deploy resource kit to support people with own wellbeing and welfare need own wellbeing and welfare need.

98 22 April 2020

This framework has been developed as a guide for the community health system when moving between different health sector alert levels. Not all information will be relevant to your workplace.

The alert system used for this framework is not the same as the Government alert system. This alert system considers the state in which the local health system is in- this will vary region by region.

This means that some activities will continue, reduce or cease depending on the state of your local health system, or it may depend on the needs of your practice population or community, including equity considerations. Providers know their population best and will need to provide some services throughout all alert levels. This is particularly relevant for vulnerable communities and rural practices and providers. communities

Essential services such as primary care childhood immunisation, contraception, and access to mental health services should always be available, irrespective of the alert level.

Briefing Paper to Board

Budget Announcement 2020 May 2020

Prepared by: Joyce Donaldson, Acting Chief Financial Officer Endorsed by: Nick Chamberlain, Chief Executive

Recommendation That the Board notes the below briefing.

Wellbeing Budget 2020: Rebuilding Together On 14 May 2020 the Minister of Finance, the Hon Grant Robertson delivered the Governments ‘Wellbeing Budget 2020: Rebuilding Together’.

The Government announced that they have reoriented the Budget 2020 package to focus on maintaining critical support for existing public services and supporting key infrastructure investments. Some previously announced new initiatives under priority spending areas previously announced have been placed on hold to focus on response, recovery and rebuild from Covid-19.

With the outbreak of Covid-19, New Zealand now faces a 1-in-100 year health and economic challenge. The pandemic continues to evolve, and it has already caused enormous social and economic disruption.

Budget 2020 provides almost $5.6 billion for the health sector, so it can respond to the pandemic while maintaining the sustainable delivery of existing services. This investment includes $3.9 billion of operating funding for the 20 District Health Boards. This represents the largest ever annual investment in our DHBs.

Budget 2020 also invests in $1.6 billion in both government and non-government social services which will support New Zealanders education, employment and housing outcomes. This includes providing $183 million for family violence services. This is the largest funding boost for these service providers in over a decade.

The budget builds on the assumption that running operating deficits and allowing net core debt to increase is a necessary and responsible move as we fight the virus, reduce the impact on businesses and works and position NZ for recovery. The Government maintains that New Zealand’s strong financial position going into the Covid-19 pandemic means they are well placed to make investments to cushion the blow on the economy and wellbeing of New Zealanders.

Budget 2020 Highlights

 $50 billion to establish the Covid-19 Response and Recovery Fund  $3.9 billion to ensure all DHBs continue to meet the needs of their populations  $1.1 billion capital invested in improving transport across New Zealand, including replacing  ageing ferries and locomotives  $414.2 million for the early learning sector, including funding subsidies, pay increases for  educators, additional support for home-based educators and investment in play centre  sustainability  $246.1 million investment in community services, including a significant funding boost  for family violence service providers  $193.5 million to support farmers through the eradication of Mycoplasma Bovis  $47.8 million to replace ageing communications capabilities for Police, Fire and Ambulance to support healthier, safer and more connected communities

100 Funding for Health

Budget 2020 includes $5.6 billion of operating revenue and $755 million of total capital. Key initiatives include:  DHB additional support: $3.9 billion operating funding across 20 DHBs to continue providing essential health services for New Zealand’s growing and changing population  Increased capital investment for DHBs: $750 million. This builds on the capital investment over the previous budgets $750 million through Budget 2018 and $1.7 billion through Budget 2019, plus $1.4 billion announced for the redevelopment of the Dunedin Hospital.  Maintaining and increasing the Combined Pharmaceutical Budget: $160 million operating funding. This extends to agreed 2020/21 level into the future and provides funding to increase the publically funded medicines available  Supporting Disabled New Zealanders to Live Good Lives: $832.5 million operating funding. This provides security of funding for people with long-term physical, intellectual and sensory impairment and is a direct response to increased demand  Continuing Funding for Maternity Services and enabling the implementation of the Maternity Action Plan: $177 million operating funding. This addresses cost and volume pressures for primary community maternity services and sets aside funding to begin the implementation of the plan to contribute to improved health outcomes for whanau, better equity of access to responsive services and a stabilised system wide maternity workforce

Health will also continue to receive investment through the Covid-19 Response and Recovery Fund (CRRF)

Vote Health 2020

The detail of the funding available for Health is in the Vote Health appropriation. This increases to $20.269 billion in 2021-21, up from $19.704 billion in 19/20, an increase of $565 million.

Further detail on the new funding is included in Appendix 1.

The Governments Response to Covid-19

On 17 March 2020 a $12.1 billion package to support New Zealanders was announced, including:  A $2.8 billion income support package to support our most vulnerable, including a permanent $25 per week benefit increase and a doubling of the Winter Energy Payment for 2020  A $500 million boost for health services  The Business Finance Guarantee Scheme which provides short-term credit for small and medium- sized businesses. Up to $500,000 per loan is available for businesses with a turnover up to $80 million per annum. It is expected that the scheme will offer up to $6.25 billion in loans to NZ businesses  The Small Business Cash Flow Scheme which provides low cost loans for small businesses. Up to $10,000 is available plus an additional $1,800 per equivalent full time employee. Loans are interest free if paid back within a year, with an interest rate of 3% applying for a maximum term of five years and no repayments in the first two years. The Budget establishes a $50 billion Covid-19 Response and Recovery Fund (CRRF). As at 14 May 2020 $13.9 billion of this has been committed including:  $6.9 billion to extend the Wage Subsidy Scheme beyond 17 March  A Business Tax Relief Package of $1.7 billion  $186 million across education to support distance learning A further $15.9 billion was announced by the Minister of Finance during his Budget speech including:  $4 billion Business Support package to keep people in work and position businesses for recovery and growth  $3.2 billion targeted extension of the Wage Subsidy Scheme, for eight weeks where businesses have suffered at 50% reduction in turnover  $150 million short term temporary loan scheme to incentivise business to continue research and development programmes  $216 million boost to New Zealand trade and enterprise to expand the scope and intensity of support provided to exporting firms  $10 million to support small businesses to improve their e-commerce service offerings

Briefing Paper to Board - Budget Announcement 2020| Page 2 of 4

101

Other Funding increases for key Initiatives and which support health outcomes  Family Violence services increase in funding of $193m  Keeping community-based services open for disabled people increase in funding of $43.3m  Improving access to support services in regional New Zealand increased funding of $19.8m  Increased funding for education of $375.1m  Increased funding for learning support of $79.7m  Investment in school properties of $119.5m operational funding and $115.4m capital  Early Learning Education Package increase in funding of $291.6m

Funding for Northland DHB 2020-21

The Vote Health estimation for Northland DHB is an increase in funding of $56,446 million, up from $645,368 million to $701,814 million in 2020-21.

The details of this will be included in our Funding Envelope package which we expect to receive from the Ministry of Health this week. We will be able to provide a further update to the Board at the Board meeting.

Briefing Paper to Board - Budget Announcement 2020| Page 3 of 4

102

103 9.0 RESOLUTION TO EXCLUDE THE PUBLIC

Recommendation:

“That the public be excluded from the following part of this meeting, under Schedule 3, Clause 32 of the NZ Public Health & Disability Act 2000 and in accordance with the Official Information Act 1982 as detailed in the table below;”

Agenda item and general subject of the matter to Reason Reference be discussed

10.0 Confirmation of Public Excluded Minutes For reasons previously given

10.1 Confirmation of Minutes 29 April 2020 10.2 Matters/Action Arising 11.0 Risk Management/Initiatives Commercial Activities: To enable the Board to 9(2)(i) carry out, without prejudice or disadvantage, commercial activities

Negotiations. To enable the Board to carry out, without prejudice or disadvantage, 9 (2)(j) negotiations (including commercial and industrial negotiations)

12.0 Decision Items Commercial Activities: To enable the Board to 9(2)(i) carry out, without prejudice or disadvantage, 12.1 Contribution to National Haemophilia commercial activities Management Group 12.2 healthAlliance C Class Shares Negotiations. To enable the Board to carry 9(2)(j) 12.3 Aged Residential Care Service out, without prejudice or disadvantage, Contracts negotiations (including commercial and 12.4 Renewal of NGO Contracts industrial negotiations) 12.5 Te Tumu Waiora – Health Improvement Practitioners Contract Variation 12.6 Ngati Hine Health Trust – Services to Promote Resilience, Recovery and Connectedness 12.7 Health and Safety Governance Maturity and Capability Assessment 12.8 Business Case Whangarei Hospital Power Upgrade Projects

13.0 Information Updates Commercial Activities: To enable the Board to 9(2)(i) carry out, without prejudice or disadvantage, 13.1 Capital Projects Report commercial activities 13.2 Regional ISSP – Infrastructure as a Service Update Negotiations. To enable the Board to carry 9(2)(j)

13.3 Equity with Resources Committee out, without prejudice or disadvantage, Chair’s Report Meeting - 25 May 2020 negotiations (including commercial and industrial negotiations)

104 FOR BOARD MEETING – 25 May 2020

INCOMING BOARD CORRESPONDENCE

From Description Date of Correspondence Date Received

Richard Van Alphen – Concern over 5G telecommunication technology 8.8.20 8.8.20 Far North Organic Growers and Producers Inc Soc Hon Dr David Clark COVID-19 ministerial direction 17.3.20 18.3.20

SUBMISSION TO SELECT COMMITTEE

From Description Date of Correspondence

Ngā Tai Ora Submission on Smokefree Environments and 1.4.20 Regulated Products (Vaping) Amendment Bill

105 NORTHLAND DISTRICT HEALTH BOARD

GLOSSARY OF ACRONYMS January 2020

Acronym Meaning

A&D Alcohol and Drug A&E Accident and Emergency Department A&M Accident & Medical Centre AAU Acute Assessment Unit (part of child health services) ACMO Associate CMO ACP Advanced Care Planning A&C Audit & Compliance ACA Access Criteria for First Assessment ACC Accident Compensation Corporation ADON Assistant Director of Nursing ADHD Attention Deficit and Hyperactivity Disorder ALOS Average Length Of Stay AMI Acute Myocardial Infarction AOD Alcohol and Other Drugs AoG All of Government AP Annual Plan AR Active Review ARRC Age Related Residential Care ARC Aged Residential Care ASH Rates Ambulatory Sensitive Hospitalisation Rates ASMS Association of Salaried Medical Specialists BAU Business As Usual BOI Bay of Islands BSC Balanced Scorecard BSI Blood Stream Infections CABG Coronary Artery Bypass Graft CAPD Chronic Ambulatory Peritoneal Dialysis CATT Crisis Assessment Treatment Team CBA Cost Benefit Analysis CCP Contribution to Cost Pressures CCU Coronary Care Unit CEA Collective Employment Agreement CEO Chief Executive Officer CFA Crown Funding Agreement CGB Clinical Governance Board CHC Child Health Centre CHS Community Health Services CIPP Community Injury Prevention Programme CMO Chief Medical Officer CME Continuing Medical Education COPD Chronic Obstructive Pulmonary Disease CPAC Clinical Priority Assessment Criteria CPSOG Clinical Pharmacy Services Operational Group CPHAC Community and Public Health Advisory Committee CPR Cardio pulmonary resuscitation CSC Community Services Card CSU Central Sterilising Unit CT Computerised Tomography CVD Cardiovascular Disease

106 Acronym Meaning

CWD Caseweighted Discharge DAO Duly Authorised Officer DHB District Health Board DHBSS District Health Board Shared Services DIAS Disability Information Advisory Service DiSAC Disability Support Advisory Committee DN District Nurse DNA Did not attend DONM Director of Nursing and Midwifery DRG Diagnostic Related Group DSAC Doctors for Sexual Abuse Care DSS Disability Support Services EAP Employee Assistance Programme ECG Electrocardiogram ED Emergency Department EENT Eyes, Ears, Nose and Throat EEO Equal Employment Opportunity ELT Executive Leadership Team ENT Ear Nose and Throat EOI Expressions of Interest ERA Employment Relations Act ESS Elective Services Statistics ESPI Elective Services Performance Indicators; includes how well DHBs are managing waiting times for patients, and whether they are following processes that support good patient communication and prioritisation. FAQ Frequently Asked Questions FBT Fringe Benefit Tax FFT Future Funding Track FRAC Finance, Risk and Assurance Committee FRS Financial Reporting Standard FSA First Specialist Assessment FST Financial Sustainable Threshold FTE Full time equivalent GETS Government Electronic Tender Service GDB General Dental Benefit GM General Manager GMS General Medical Services Benefit GSE Government Special Education hA healthAlliance HAC Hospital Advisory Committee HBSS Home Based Support Services HDC Health and Disability Commissioner HRT Health Round Table HHC Home Health Care HIN Health Information Network HNA Health Needs Analysis HOD Head of Department HOP Health of Older People HPO Health Protection Officer HPV Human Papillomavirus HQSC Health Quality & Safety Commission HWNZ Health Workforce New Zealand IANZ International Accreditation New Zealand IAT Income and Asset Testing ICU Intensive Care Unit ICT Intensive Care Team (Mental Health)

107 Acronym Meaning

IDF Inter District Flows IEA Individual Employment Agreement IFHC Integrated Family Health Centre IIA Income in Advance InterRAI International Research and Assessment Instruments IR Industrial Relations IS Information Systems / Information Services ISSP Information Systems Strategic Planning IT Information Technology JV Joint Venture KPI Key Performance Indicator LMC Lead Maternity Carer LOS Length of stay LTC Long Term Conditions MDO Maori Development Organisations MECA Multi Employer Collective Agreement MERAS Midwifery Employee Representation & Advisory Services MF (score) Missing Filled (score) (dental services) MHGC Maori Health Gains Council MHIPU Mental Health Inpatient Unit MI Myocardial infarction MIF Monitoring and Intervention Framework MMR Measles-mumps-rubella MoH Ministry of Health MOH Medical Officer of Health MOSS Medical Officer Special Scale MOU Memorandum of Understanding MPDS Maori Provider Development Scheme MRI Magnetic Resonance Imaging MRT Medical Radiation Technologist MSD Ministry of Social Development MVS Meningococcal Vaccine Strategy NCIC National Capital Investment Committee NASC Needs Assessment and Service Co-ordination NDHB Northland District Health Board NEST Northland Emergency Services Trust NGO Non-Government Organisation NHB National Health Board NHH Neighbourhood Healthcare Homes NHI National Health Index NHSP Northland Health Services Plan NHSS National Health Supply Service NIF Northland Intersectoral Forum NIR National Immunisation Register NRA Northern Region Alliance (formerly NDSA Northern DHB Support Agency) NRHP Northern Region Health Plan NRTH Northern Regional Training Hub NTA National Travel Assistance NZBS New Zealand Blood Service NZCOM New Zealand College of Midwives NZHS New Zealand Health Strategy NZHPL New Zealand Health Partnerships Ltd NZMC New Zealand Medical Council NZNO New Zealand Nurses’ Organisation O&G Obstetrics and Gynaecology

108 Acronym Meaning

OIA Official Information Act OMG Operational Management Group OP Outpatient ORL Otorhinolaryngology (=ENT) OSH Occupational Safety and Health OT Occupational Therapy (sometimes also Operating Theatre) PACU Post Anaesthetic Care Unit PBFF Population Based Funding Formula PCO Primary Care Organisation PDRP Professional Development Recognition Programme PGY Post Graduate Year PHO Primary Health Organisation PHN Public Health Nurse PHU Public Health Unit PIPP Planning, Integration, People and Performance PN Practice Nurse POPN Primary Options Programme Northland PQ Parliamentary Questions PSA Public Service Association PSAAP PHO Service Agreement Amendment Protocol PS&QID Patient Safety & Quality Improvement Directorate PUC Purchase Unit Cost RBA Results Based Accountability RDA Resident Doctors’ Association RFF Regional Funding Forum RFP Request for Proposal RG Referral Guidelines RICF Reducing Inequalities Contingency Funding RMO Resident Medical Officer RWL Residual Waiting List SAT Self Assessment Tool SAU Surgical Admission Unit SBL Surgical Booking List SCBU Special Care Baby Unit SCOPE Service Coordination – Primary Care Navigation for Older People in their Environment SDS School Dental Service SHO Senior House Officer SIA Service to Improve Access SLT Speech Language Therapy SMO Senior Medical Officer SOI Statement of Intent SPNIA Service Planning and New Intervention Assessment SSSG Shared Support Services Group STAH Scientific Technical & Allied Health STV Single Transferable Voting SUDI Sudden Unexplained Death in Infancy TAS Technical Advisory Services TLA Territorial Local Authorities TOR Terms of Reference TOW Treaty of Waitangi TPK Te Puni Kokiri TPOT The Productive Operating Theatre TROTR Te Runanga O Te Rarawa VCLA Very Low Cost Access WERO Whanau End smoking Regional whanau Ora Challenge

109 Acronym Meaning

WHO World Health Organisation WIIE Whanau Integration Innovation & Engagement Fund WOC Whanau Ora Collective YTD Year-to-date

Any additions/amendments, please contact Julie Shepherd, [email protected], Extn 60308, 021 945 647

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