26 April 2017 - CCDHB Board PUBLIC papers - AGENDA

CAPITAL & COAST DISTRICT HEALTH BOARD Public Agenda 26 APRIL 2017

Board room, 11th Floor, Grace Neill Block, Wellington Regional Hospital, 1.00pm

ITEM ACTION PRESENTER MIN TIME PG 1 PROCEDURAL BUSINESS 1.00pm 1.1 Karakia 1.2 Apologies RECORD A Blair 1.3 Continuous disclosure - Interest Register CONFIRM A Blair 3 - Conflicts of Interest ACCEPT A Blair 6 1.4 Confirmation of draft Minutes 22 March APPROVE A Blair 8 2017 1.5 Matters arising NOTE A Blair 1.6 Action list NOTE A Blair 14 1.7 CCDHB Work plan 2017 NOTE A Blair 17 2 PRESENTATIONS 2.1 Healthcare Homes - presentation NOTE S Williams 30 1.15pm 20 2.2 Sub Regional Disability Advisory Group NOTE P Boyles 30 1.45pm 2.2.1 The patient story (Video)

3 DECISION 3.1 The updated Sub Regional Disability Strategy NOTE P Boyles 10 2.15pm 41 2017-2022 3.2 Consumer Engagement and Consumer NOTE P Boyles 10 2.15pm 46 Council 4 FOR DISCUSSION 4.1 Chair’s report (verbal) NOTE A Blair 10 2.25pm 4.2 Chief Executive’s report NOTE D Chin 10 2.35pm 61 4.2.1 Financial summary, February 2017 72 4.3 Health and Safety Report March 2017 NOTE T Davis 10 2.45pm 80 4.4 Hospital Services update and scorecard NOTE C Lowry 10 2.55pm 97 5 INFORMATION 5.1 CPHAC/DSAC update (verbal) NOTE F Wilde 10 3.05pm 5.2 Population Health update NOTE A Gray 5 3.15pm 104 6 OTHER 6 General Business NOTE A Blair 5 3.20pm

7 Resolution to Exclude the Public APPROVE A Blair 5 3.25pm 118 ADJOURN

Capital & Coast District Health Board

1 26 April 2017 - CCDHB Board PUBLIC papers - AGENDA

APPENDICES 3.1 ∑ Sub-Regional Disability Strategy 2017-2022 – Enabling Partnerships: Collaboration for Effective 119 Access to Health Services

4.2 ∑ Health matters newsletter 155

4.4 ∑ Electives recovery plan 171 ∑ Hospital Healthcare Services Scorecard 173

5.1 ∑ 3D CPHAC/DSAC Minutes of Meeting 18 November 2016 176 ∑ 3D CPHAC/DSAC Draft Minutes of Meeting 24 March 2017 181

5.2 ∑ Regional Public Health post. 185

Capital & Coast District Health Board Page 2 of 2

2 26 April 2017 - CCDHB Board PUBLIC papers - Continuous Disclosure

CAPITAL & COAST DISTRICT HEALTH BOARD Interest Register

26 APRIL 2017

Name Interest Mr Andrew Blair ∑ Chair, Southern Partnership Group (appointed jointly by Ministers of Finance Chairperson and Health to provide governance for the redevelopment of Dunedin Hospital) ∑ Member of the Board of Trustees of the Gillies McIndoe Research Institute ∑ Chair, Hutt Valley District Health Board (from 5 December 2016) ∑ Former Member of the Hawkes Bay District Health Board (2013-2016) ∑ Former Chair, Cancer Control (2014-2015) ∑ Former CEO Acurity Health Group Limited ∑ Director, Breastscreen Auckland Limited ∑ Director, St Marks Women’s Health (Remuera) Ltd ∑ Director, Safer Sleep Ltd ∑ Director, Safer Sleep LLC Ltd ∑ Advisor to the Board, Forte Health Limited, Christchurch ∑ Owner and Director of Andrew Blair Consulting Limited, a Company which from time to time provides governance and advisory services to various businesses and organisations, include those in the health sector Dame Fran Wilde ∑ Deputy Chair, Capital & Coast District Health Board Deputy Chairperson ∑ Chair, Remuneration Authority ∑ Deputy Chair NZ Transport Agency ∑ Chair Wellington Lifelines Group ∑ Director Museum of NZ Te Papa Tongarewa ∑ Member Whitireia-Weltec Council ∑ Director Business Mentors NZ Ltd ∑ Director Frequency Projects Ltd ∑ Chief Crown Negotiator Ngati Mutunga and Moriori Treaty of Waitangi Claims ∑ Chair Wellington Culinary Events Trust ∑ Chair National Military Heritage Trust Mr Roger Jarrold ∑ Member, Capital & Coast District Health Board Member ∑ Chair, Capital & Coast DHB FRAC committee ∑ Trustee, Auckland District Health Board Charitable Trust ∑ Employee CFO, Downer New Zealand Ltd ∑ Director, Downer New Zealand Ltd ∑ Director, Works Infrastructure Cortex Resources JV Ltd ∑ Director, Works Infrastructure Harker Underground Construction JV Ltd ∑ Director, Works Finance (NZ) Ltd ∑ Director, DGL Investments Ltd ∑ Director, TSE Wall Arlidge Ltd ∑ Director, Waste Solutions Ltd ∑ Employer (Downer NZ) subcontracts to Spotless ∑ Director, Underground Locators Ltd

Capital & Coast District Health Board 12/4/17

3 26 April 2017 - CCDHB Board PUBLIC papers - Continuous Disclosure

Name Interest ∑ Trustee, Works Superannuation Scheme ∑ Member, Finance and Risk Committee, Health Research Council ∑ Past member, Ministry of Health Audit and Risk Committee (resigned 6 December 2013) ∑ Director, Downer Utilities Alliance New Zealand Ltd ∑ Director, Downer Utilities New Zealand Ltd ∑ Assisting ADHB with a Cost of Service programme ∑ Employer, Downer EDI, is acquiring Hawkins Limited ∑ Employer, Downer is bidding to purchase shares in Spotless Australasia. Mr Darrin Sykes ∑ Member, Capital & Coast District Health Board Member ∑ Deputy Chair, Capital & Coast District Health Board, FRAC committee ∑ Trustee, Wellington Regional; Sports Education Trust (trading as Sports Wellington) ∑ Member, Sport and Recreation New Zealand (trading as Sport NZ) ∑ Chief Executive, Crown Forestry Rental Trust Ms Sue Kedgley ∑ Member, Capital & Coast District Health Board Member ∑ Member, CCDHB HAC committee ∑ Member, Greater Wellington Regional Council ∑ Member, Consumer New Zealand Board ∑ Shareholder in Green Cross Health ∑ Step son works in middle management of Fletcher Steel ∑ Deputy Chair, Consumer New Zealand ∑ Environment spokesperson and Chair of Environment committee, Wellington Regional Council Dr Roger Blakeley ∑ Member of Capital and Coast District Health Board Member ∑ Deputy Chair, Wellington Regional Strategy Committee ∑ Councillor, Greater Wellington Regional Council ∑ Director, Port Investments Ltd ∑ Director, Greater Wellington Rail Ltd ∑ Economic Development and Infrastructure Portfolio Lead, Greater Wellington Regional Council ∑ Member, Harkness Fellowships Trust Board ∑ Independent Consultant ∑ Brother-in-law is a medical doctor (anaesthetist), and niece is a medical doctor, both working in the health sector in Auckland ∑ Son is Deputy Chief Executive (insights and Investment) of Ministry of Social Development, Wellington ∑ Invited to join the Board of the Wesley Community Action Group. Ms Kim Ngarimu ∑ Member of Capital and Coast District Health Board Member ∑ Member, Medical Council of New Zealand (MCNZ) ∑ Member, Māori Heritage Council ∑ Board Member, Te Māngai Pāhō (Māori Broadcasting Agency) ∑ Alternate Crown Trustee, Crown Forestry Rental Trust ∑ Director, Taaua Ltd (Public policy and management consulting company) ∑ Trustee, Judith and Taina Ngarimu Whānau Trust (has shareholdings in various health related companies – share acquisition and sale is independently managed)

Capital & Coast District Health Board

4 26 April 2017 - CCDHB Board PUBLIC papers - Continuous Disclosure

Ms ‘Ana Coffey ∑ Member of Capital & Coast District Health Board Member ∑ Councillor, Porirua City Council ∑ Director, Dunstan Lake District Limited ∑ Trustee, Whitireia Foundation Ms Eileen Brown ∑ Member of Capital & Coast District Health Board Member ∑ Board member (until Feb. 2017), Newtown Union Health Service Board ∑ Employee of New Zealand Council of Trade Unions ∑ Senior Policy Analyst at the Council of Trade Unions (CTU). CTU affiliated members include NZNO, PSA, E tū, ASMS, MERAS and First Union. ∑ God daughter/family friend employed as a solicitor at specialist health law firm, Claro. Dr Kathryn Adams ∑ Member, Capital & Coast District Health Board Member ∑ Fellow, College of Nurses Aotearoa (NZ) ∑ Reviewer, Editorial Board, Nursing Praxis in New Zealand ∑ School Nurse Vaccinator (casual) Regional Public Health, HVDHB ∑ Workplace Health Assessments and seasonal influenza vaccinator, Artemis Health ∑ Secretary, National Party Ohariu Electorate ∑ Director, Agree Holdings Ltd, family owned small engineering business, Tokoroa Ms Sue Driver ∑ Community representative, Australian and NZ College of Anaesthetists Member ∑ Board Member of Kaibosh ∑ Daughter, Policy Advisor, College of Physicians ∑ Former Chair, Robinson Seismic (base isolators, Wgtn Hospital) ∑ Advisor to various NGOs

Capital & Coast District Health Board

5 26 April 2017 - CCDHB Board PUBLIC papers - Continuous Disclosure

CAPITAL & COAST DISTRICT HEALTH BOARD Interest Register

EXECUTIVE LEADERSHIP TEAM 26 APRIL 2017

Debbie Chin ∑ Member, Rotary Chief Executive Officer ∑ Member, HBL FPSC Procurement Steering Group (regional Chief Executive representative) ∑ Member, HBL Shared Services Council (regional Chief Executive representative) ∑ Trustee, Wellington Hospitals Foundation ∑ DHB lead CE for sector performance frameworks Chris Lowry ∑ Trustee on Life Flight Trust Board General Manager Hospital and Healthcare ∑ Services Son works at HVDHB Rachel Haggerty ∑ Chair, Takanini Care Ltd General Manager, Strategy Innovation & ∑ Director, Haggety & Associates Performance

Donna Hickey ∑ Sister is a nurse, working for Plunket General Manager, People and Capability Thomas Davis ∑ None General Manager, Corporate Services Nigel Fairley ∑ President, Australian and NZ Association of Psychiatry, Psychology General Manager of 3DHB Mental Health, and Law Addictions and Intellectual Disability ∑ Trustee, Porirua Hospital Museum Services ∑ Fellow, NZ College of Clinical Psychologists ∑ Director and shareholder, Gerney Limited Mr John Tait ∑ Member Fertility Associates Chief Medical Officer ∑ Member, National Maternity Monitoring Group ∑ Member, ACC taskforce neonatal encephalopathy ∑ Member, Waikato Women’s service taskforce ∑ Board member, Wellington Hospitals Foundation Catherine Epps ∑ Deputy Chair, National DHB Directors Allied Health Executive Director of Allied Health, Technical & ∑ Scientific Expert Advisor (Leadership) to New Zealand Speech-Language Therapists Association ∑ Brother is employed at Waikato and Waitemata DHBs Andrea McCance ∑ Trustee, Mary Potter Hospice Executive Director of Nursing & Midwifery

12/4/17

6 26 April 2017 - CCDHB Board PUBLIC papers - Continuous Disclosure

Tony Hickmott ∑ Director, Allied Laundry (CCDHB representative) Chief Financial Officer ∑ Sister-in-law is medical director for Student Health Services at Victoria University ∑ Niece is employed by Deloitte Auckland as a senior marketing advisor Roger Palairet ∑ Chair and Trustee of Carers NZ (non-profit organisation promoting Chief Legal Counsel the interests of family carers; funders include MoH, MSD and Waitemata DHB) ∑ Practices law as Palairet Law, specialising in public law ∑ Sister-in-law is a paediatric nurse at CCDHB Shayne Hunter ∑ Currently in transition from a role at the Ministry of Health and Chief Information Officer Technology, 3 assisting Rillstone Wells on the RHIP/CRISP review DHB Dr Pauline Boyles ∑ Member on the Ministry of Health National Advisory Group for Director of Disability Strategy and Review of Behaviour Support Services Performance ∑ Past President/ Advisor to Board, Wellington Riding for the Disabled ∑ Managing Director, Dream Achievers Ltd

Arawhetu Grey ∑ Co-chair, Health Quality Safety Commission – Maternal Morbidity Director Māori Health Services/Manager Working Group Planning & Funding Mental Health and Addiction Services ∑ Director, Gray Partners

Taima Fagaloa ∑ Cousin works as a community health worker for Ora Toa Health Director of Pacific Peoples’ Health/Manager ∑ Planning & Funding, Child & Population Director, TCF Consulting Limited Jannel Fisher ∑ Mother-in-law and sister-in-law are a Bureau nurse and Communications Manager Healthcare assistant respectively ∑ Another sister-in-law is a nurse at CCDHB Robyn Fitzgerald ∑ Daughter is a nurse at HVDHB Board Secretary

7 26 April 2017 - CCDHB Board PUBLIC papers - Confirmation of Minutes 22 March 2017

CAPITAL AND COAST DISTRICT HEALTH BOARD DRAFT Minutes of the Board Held on Wednesday 22 March 2017 at 1pm Level 11 Grace Neill Block, Wellington Regional Hospital

PUBLIC SECTION

PRESENT: Mr A Blair (Chair) Dame F Wilde (Deputy Chair) Dr K Adams Dr R Blakeley Ms E Brown (2.12pm arrived) Ms A Coffey Ms S Kedgley (2.40pm arrived) Mr R Jarrold Mr D Sykes Mrs S Driver

IN ATTENDANCE: Mrs D Chin (Chief Executive) Ms C Lowry (General Manager Hospital and Healthcare Services) Ms R Haggerty (Director Strategic Innovation and Performance) Mr T Davis (General Manager Corporate Services) Mr N Fairley (General Manager 3DHB Mental Health, Addictions and Intellectual Disability Services) Ms A McCance (Executive Director of Nursing and Midwifery) Ms J Fisher (Communications Manager) Mrs R Fitzgerald (Board Secretary)

SPEAKERS Mr J Rikihana, Chair, MPB, Item 2.1 Lady T Wall, MPB committee member, Item 2.1 Ms Carey Virtue, Item 2.2 Ms Maureen Cahill, Item 2.2 Mr D Lewis, Item 3.3 Ms C Tilah, Item 3.5

MEMBER OF PUBLIC: Mr D George, Fairfax. ______

1 PROCEDURAL BUSINESS

Item 1.1 PROCEDURAL Karakia was led by Darrin Sykes. Chair, Andrew Blair, welcomed Board members, Executive team members and the member of public.

Item 1.2 APOLOGIES Apologies were RECEIVED from Ms Kim Ngarimu. Notice of late arrival were RECEIVED from Ms Eileen Brown and Ms Sue Kedgley.

1 CCDHB Minutes – 22 March 2017

8 26 April 2017 - CCDHB Board PUBLIC papers - Confirmation of Minutes 22 March 2017

Item 1.3 INTERESTS 1.3.1 REGISTER OF INTERESTS Roger Jarrold registered the following changes: ∑ Employer, Downer, is acquiring Hawkins Ltd – a competitor in the market to Fletchers ∑ Employer, Downer, is bidding to purchase shares in Spotless

Roger Blakeley has been invited to join the Board of the Wesley Community Action Group.

Action: 1. Update interest register.

1.3.2 CONFLICTS RELATED TO ITEMS ON THE AGENDA No other conflicts were foreshadowed in respect of items on the current agenda but there would be an additional opportunity at the beginning of each item for members to declare conflicts of interest.

Item 1.4 MINUTES OF PREVIOUS MEETING 22 February 2017

RESOLVED THAT: The minutes of the CCDHB Board meeting held on 22 February 2017, taken with the public present are confirmed as a true and correct record.

Moved: Fran Wilde Seconded: Roger Blakeley CARRIED

Item 1.5 MATTERS ARISING UPDATE Nil.

Item 1.6 ACTION LIST The reporting timeframes on the other open action items were NOTED.

Item 1.7 CCDHB WORK PLAN 2017 Discussion included: ∑ Business cases will come through from FRAC at the next meeting.

2 DISCUSSION ITEMS

Item 2.1 Māori Partnership Board Mr J Rikihana, Chair, Māori Partnership Board (MPB), and Lady T Wall, MPB committee member, presented to the Board.

Discussion included: ∑ Achieving equity ∑ The composition of the MPB ∑ Review of the Terms of Reference ∑ MPB working with CCDHB o Expectations o Monitoring

2 CCDHB Minutes – 22 March 2017

9 26 April 2017 - CCDHB Board PUBLIC papers - Confirmation of Minutes 22 March 2017

o Reporting o Purchasing/commissioning to achieve Māori outcomes ∑ Patient story.

The Board NOTED: (a) CPHAC committee to look at equity (b) That further work will be undertaken in determining the relevance of the current workforce targets for Māori (c) Commissioning – further work is required on this – SIP are developing an “investment plan” which will take account of the needs of purchasing of services to improve the outcomes of Māori. This plan will be reported back to the Board (d) The Chair of the Māori Partnership Board invited the Board Chair and other board members to attend MPB meetings whenever possible. Similarly the MPB representatives will be invited to future Board meetings.

Item 2.2 Emergency Preparedness Discussion included: ∑ Plans ∑ Training ∑ Equipment/supplies/water/fuels ∑ CBAC – community based teams ∑ Disasters ∑ Board role at recovery phase

Action: 1. Board members to go on walk arounds on Board day and one visit will be to the Emergency Centre.

DISCUSSION

3.1 CHAIR’S REPORT Verbal report included: ∑ Correspondence received from Ministry of Health ∑ Meetings he held with: o Ministry of Health o Maori Partnership Board o Community/stakeholder meetings o National DHB Chair/CEO Meeting ∑ Interview with NZ Doctor ∑ The Chair requested as many board members as possible to attend the planned Regional Health Symposium in Masterton on 30 March.

The report was RECEIVED.

Action: 1. Board Secretary to coordinate travel for Board members to Central Region Boards’ Symposium in Wairarapa

Item 3.2 CHIEF EXECUTIVE’S REPORT Items in the CEO’s report were discussed and further details provided by executive members.

3 CCDHB Minutes – 22 March 2017

10 26 April 2017 - CCDHB Board PUBLIC papers - Confirmation of Minutes 22 March 2017

Discussion included: ∑ Financial status ∑ Health targets ∑ Training with Dominion Post on Privacy issues ∑ Nationwide shortage of midwifery staff ∑ Birthing hubs ∑ Clinical Council ∑ HPL resolution ∑ State Services Commissioner’s guide for the 2017 elections.

The Board: (a) Noted the contents of this report (b) Noted the SSC guide for the 2017 elections (c) Endorsed the Health Partnership special resolution.

Actions: 1. Ensure narrative re volume/caseweights/occupied bed days/discharges are consistent. 2. Finalise date of presentation with Cognitive Institute and invite Board members.

The report was RECEIVED.

Item 3.3 CCDHB HEALTH AND SAFETY REPORT (for the month of February 2017)

The report was taken as read.

The Board: (a) Noted the health and safety report for the month of February 2017 (b) Noted the current health and safety risks (c) Noted the number of staff and ‘Other’ reported incidents.

Action: 1. Management to separate Mental Health volume.

Item 3.4 MENTAL HEALTH REPORT

The report was taken as read.

The Board NOTED the contents of the report.

Item 3.5 QUARTERLY QUALITY REPORT

The report was taken as read.

The Board NOTED the report for the period December 2016 to February 2017.

4 CCDHB Minutes – 22 March 2017

11 26 April 2017 - CCDHB Board PUBLIC papers - Confirmation of Minutes 22 March 2017

Item 3.6 PLANNING AND ACCOUNTABILITY DOCUMENTS

The report was taken as read.

The Board: (a) Note the accountabilities of CCDHB to the Minister of Health and the Ministry of Health described below. (b) Comment on the approach to planning and accountability that is described below and being used to guide the performance of CCDHB. (c) Note the Board has currently involved in approving the Annual Plan, Sustainability Plan, Regional Service Plans, Long Term Investment Plan, System Level Measures Plan, Health System Plan 2030, and Disability Strategy. (d) Note that the development of these plans will be represented in the Board work plan by April 2017 meeting and that all Plans developed in the framework will be approved by the Board.

Action: 1. Schedule half a day workshop for all planning documents in May 2017.

4 INFORMATION PAPERS

Item 4.1 KENEPURU ACCIDENT AND MEDICAL Discussion included: ∑ Difficulty night staffing at night ∑ Widening the discussion to support the needs of the locality, recognising improved access to primary care with the implementation of Healthcare Home ∑ Communication with community.

The Board NOTED and RESOLVED: (a) Endorse the processes underway to deliver a service solution that meets the needs of the population in line with the CCDHB 2030 Health System Plan (b) Endorse the development work underway to support interim solutions to support the Kenepuru Accident and Medical service while the wider system level solutions are developed.

Moved: Fran Wilde Seconded: Roger Blakeley CARRIED

5 GENERAL BUSINESS 1. Meetings at other locations 2. Flu jabs 3. Healthcare Home visits.

Actions: 1. Board Secretary to adjust meeting schedule locations for Rātonga Rua ō Porirua (28 June) and Kenepuru Education Centre (20 September) 2. Board Secretary to confirm date of Board meeting at Kapiti 3. Management to organise flu jabs for Board members at next Board meeting 4. Management to confirm dates for Healthcare Home visits for Board members.

5 CCDHB Minutes – 22 March 2017

12 26 April 2017 - CCDHB Board PUBLIC papers - Confirmation of Minutes 22 March 2017

6 RESOLUTION TO EXCLUDE THE PUBLIC

Item 6.1 RECOMMENDATION

The Board NOTED and RESOLVED to:

(a) AGREE that as provided by Clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons:

SUBJECT REASON REFERENCE For the reasons set out in the respective public excluded Public Excluded Minutes papers Public Excluded Matters Arising from For the reasons set out in respective public excluded previous Public Excluded meeting papers FRAC Report Papers contain information and advice that is likely to 9(2)(f)(i)(j)(k) prejudice or disadvantage commercial activities and/or Chair’s report disadvantage negotiations CEO’s report Strategy business case for new services Annual Planning – Population based funding formula – Sapere * Official Information Act 1982.

Moved: Andrew Blair Seconded: Roger Blakeley CARRIED

The meeting closed at 3.02pm.

6 DATE OF NEXT MEETING

26 April 2017, 11th Floor Boardroom, Grace Neill Block, Wellington Regional Hospital.

CONFIRMED that these minutes constitute a true and correct record of the proceedings of the meeting

DATED this ...... day of...... 2017

Andrew Blair CCDHB BOARD CHAIR

6 CCDHB Minutes – 22 March 2017

13 26 April 2017 - CCDHB Board PUBLIC papers - Action list

Meeting Type: BOARD PUBLIC

SCHEDULE OF ACTION POINTS – APRIL 2017 PUBLIC MEETING

Action Date of Agenda Topic Action Designated How dealt Delivery date No meeting item to with number 28 Oct 2016 2.2 Health and Safety Ratios are to be developed for the key indicators. GM CS Inclusion in When data Report The Health & Safety manager is to benchmark against other report becomes available DHBs and industries. Targets for the total recordable injury rate, serious harm and GM CS Report May 2017 lost time injuries are to be set for the New Year. P0001 22 Mar 2017 Management to separate Mental Health volume Report April 2017 11 Nov 2016 Management to request a one page summary from Report April 2017 contractors to identify ratio per work hours; targets to be met; trends and overall performance. Reporting process to flow through FRAC then onto the Board. Management to describe the work programme with primary Report May 2017 Dir SIP care that includes an acute demand work stream and the health care home programme of work.

14 26 April 2017 - CCDHB Board PUBLIC papers - Action list

CLOSED since last meeting – 22 March 2017

Date of Agenda Topic Action Designated How dealt Delivery date meeting item to with number 14 Oct 2016 4.2 Chief Executive’s report Management to provide timeline for System Level Measures Dir SIP Paper March 2017 Plan. Management to take report to Board workshop to discuss outcomes from engagement with community. Management to confirm Birthing Unit timeline and decisions needed. 22 Mar 2017 1.3 Register of Interests Update interest register. Board Amend April 2017 Secretary 2.2 Emergency Preparedness Board members to go on walk arounds on Board day GM CS Schedule April 2017 3.1 Chair’s report Board Secretary to coordinate travel for Board members to Board Coordinate March 2017 Central Region Boards’ Symposium in Wairarapa Secretary Finalise date of presentation with Cognitive Institute and GM Coordinate March 2017 invite Board members PC/Board Secretary 22 Feb 2017 3.1 Healthcare Home and Primary Management to organise a Health Care Home visit by Board Dir SIP Invitation April 2017 Options for Acute Care members. Management to communicate to community on progress on Paper March 2017 community engagement of Kenepuru and other community initiatives. 25 Jan 2017 3.1 Chair’s Report CEO to ask at the next CEO forum and Chair at the National CEO/Chair March 2017 Chairs’ meetings what other DHBs are doing about fluoridation. Management to report back to the Board on emergency GM HHS Presentation March 2017 preparedness next month. 3.3 Health and Safety Report Revamp the Health & Safety Report to the Board with GM CS New H&S dashboard and less detail, making the detail available in Board Report books. In main report identify exceptions, trends, comparative data, mitigation strategies and process.

15 26 April 2017 - CCDHB Board PUBLIC papers - Action list

Schedule a Board ‘walk-around’ with a health and safety view. Schedule March 2017 ‘Near misses’ reporting will be actively promoted across the Add to March 2017 organisation. Board to be updated as details and results come report to hand. Report to the Board on bullying comments and feedback from GM PC Add to OSH March 2017 EAP. report The committee requested management to progress GM PC Report March 2017 discussions through various avenues on the issue of addressing drugs and alcohol in the workplace and to provide advice to the Board early in 2017. The committee requested management investigate the GM CS Report March 2017 accuracy of the directorate statistics graph as the incident patterns correlate to days off to clarify if this is coincidental or an error. Management were requested to provide an update on the Dir Sip Report March 2017 process of auditing aged residential care health and safety compliance to the new committee in early 2017. 28 Oct 2016 2.2 Include in the next report information on risks that have been GM CS Inclusion in March 2017 increasing in severity from the risk register and what is being report done to manage this. 22 March 3.6 Planning and accountability Schedule half a day Board workshop for all planning documents Dir Sip Coordinate April 2017 2017 documents in May 2017 22 March 5 General Business Board Secretary to adjust meeting schedule locations for Board Coordinate April 2017 2017 Rātonga Rua ō Porirua (28 June) and Kenepuru Education Secretary Centre (20 September) Board Secretary to confirm date of Board meeting at Kapiti Board Coordinate April 2017 Secretary Management to organise flu jabs for Board members at next Ex Dir Coordinate April 2017 Board meeting Nursing and Midwifery Management to confirm dates for Healthcare Home visits for Dir SIP Coordinate April 2017 Board members. 14 Oct 2016 2.1 Māori Partnership Board The Intervention Case Studies be presented to Board. Ex Dir MH Include in March 2017 Update Advisory update to Board

16 26 April 2017 - CCDHB Board PUBLIC papers - CCDHB Work plan 2017

Capital & Coast Health District Health Board Workplan 2017

Regular monthly items: (Public) Chair’s Report; CEO’s Report; Health & Safety Report; Resolution to Exclude (Public Excluded): Chair’s Report; CEO’s Report; FRAC recommendations; FRAC minutes.

January February March April May June July August September October November December 2017 Board Loan rollover Integrated Support Disability Strategy Final Draft Annual 2017/18 Funder Final Operating and NZHP Draft Annual Work services plan (Revised) Plan 2017/18 Commitments Capital Budget Report 2016/17 programme 2017/18 Sustainability Plans 17/20

CPHAC- Insurance renewals Health System Plan Regional Services A Strategic Mental Health Allied Laundry DSAC Plan Assessment of System Plan AGM DECISION membership CCDHB’s Children’s and meeting Health Services and timetable Facilities

Draft Board Communication Plan 2018 Board Schedule and workplan Annual Planning Draft Annual Plan DHB Strategic External Audit Overview Planning – Board ½ day planning workshop

Sustainability Plan Options 16/17 Sustainability Plan Sustainability Plan Sustainability Workforce Options 16/17 Plan

DISCUSSION Quarterly performance report Quality and safety Quality and Quarter 3 Quality and safety Quarter 4 Quality and Quarter 1 safety performance performance safety performance report report report Quality and safety Quality and safety Quality and safety

Porirua and Kapiti Child Health Community update response Population Health Population Health Population Health update update update

Hospital and Health Services 3DHB provider arm Hospital and Health 3DHB provider Hospital and Health 3DHB provider arm Hospital and Health 3DHB provider Hospital and 3DHB provider Hospital and Health update MHAIDS update Services update arm MHAIDS Services update MHAIDS update Services update arm MHAIDS Health Services arm MHAIDS Services update update update update update 3DHB funder arm 3DHB funder arm 3DHB funder MHAIDS update MHAIDS update arm MHAIDS update INFORMATION Primary Care Primary Care Primary Care MHAIDS update MHAIDS update MHAIDS update

3D Mental Health Working Group Report

Health & Safety Health & Safety Health & Safety Health & Safety Health & Safety Health & Safety Health & Safety Health & Safety Health & Health & Safety Safety Community Community Community Community Investment Investment Update Investment Investment Update

V2:24/1/2017

17 26 April 2017 - CCDHB Board PUBLIC papers - CCDHB Work plan 2017

Update Update Legal update Legal update TAS annual plan Legal update Legal update

Integration work Integration work programme programme

3DHB ICT update 3DHB ICT update 3DHB ICT update CPHAC/DSAC CPHAC/DSAC CPHAC/DSAC CPHAC/DSAC CPHAC/DSAC update update – Disability update – Mental update – Primary update – Health of – Public health, Strategy/Equity Health, Addictions care and Specialist Older People/End localities and social investment/equity and Intellectual complex care of Life Disability services/Equity Care/Advanced Care Planning/Equity

Maori Partnership SRDAG SRPHAG TBA(Pharmac) TBA (HWNZ MPB SRDAG SRPHAG Board presentation) SRPHAG

Health and Safety Healthcare Homes TBA (Public Health Wellington Antimicrobial WHF WHF Organisation - Hospital resistance, infectious PHO) Foundation diseases within the PRESENTATION (WHF)update hospital and community Emergency Preparedness Sapere Presentation (David Moore)`

HEALTH AND ICU Manual handling Violent behaviour SAFETY VISITS

11.45am- 12.30pm

V2:24/1/2017

18 26 April 2017 - CCDHB Board PUBLIC papers - PRESENTATIONS

CCDHB Primary Care – from good to great!

Chris Fawcett, Clinical Lead HCH Martin Hefford, Co-sponsor HCH Emma Hickson, HCH Workstream Lead

19 26 April 2017 - CCDHB Board PUBLIC papers - PRESENTATIONS

9 General Practitioners 9 Hospital Specialists (inc 2 Surgeons) 4 Nurse & Allied Health 7 Management (incl CE, Primary & Hospital)

20 26 April 2017 - CCDHB Board PUBLIC papers - PRESENTATIONS

Why Health Care Home?

ED presentations - total & not admitted 250 Increasing patient

200 demand

150

Maori Limited workforce 100 Pacific Other and resources Total 50 Age-standardised Age-standardised rate per 1000 Total Unsustainable 0 workload for 2011/12 2012/13 2013/14 2014/15 2015/16 2011/12 2012/13 2013/14 2014/15 2015/16 Q1 2016/17 Q1 2016/17 ED presentations ED presentations - Not admitted primary care

21 26 April 2017 - CCDHB Board PUBLIC papers - PRESENTATIONS

Key elements of the model

Timely Proactive Routine and Business Unplanned Care for Preventative Efficiency Care High Needs Care

22 26 April 2017 - CCDHB Board PUBLIC papers - PRESENTATIONS

Our CCDHB approach

Part of a wider HCH national programme In partnership with the local hospital – early adopters like Pinnacle PHO have led the way Establishing a national data base to Jointly funded, developed and demonstrate impact governed Linking with the College of General Practice and GPNZ to ensure one message GP practices applied and were selected against set criteria Establishing national HCH standards framework Gathering evidence and learning as we go - setting ourselves targets Supported by the MoH

23 26 April 2017 - CCDHB Board PUBLIC papers - PRESENTATIONS

Waikanae Health Centre Health Care Homes 11,173 Paraparaumu Medical Centre Horatepai 2016/17 – 9 practices 11,173 2,851 2017/18 – 7 practices Raumati Road Surgery 3,383

Total Patient Population = 298,209

Enrolled Population

59,897 ; 20%

Whitby Doctors 6,849

Ora Toa Takapuwahia 3,313 Waitangirua Health Centre 4,807

Ora Toa Mungavin Ora Toa Cannons Creek 238,312 ; 80% 2,451 4,768

PUCHS HCH - Tranche 1 5,965 HCH - Tranche 2 Johnsonville Medical Centre Newlands Medical Centre Non-HCH 12,967 9,229 59,897 ; 20%

Karori Medical Centre 14,397

57,783 ; 19% Newtown Union Medical Centre 6,538 Enrolled Population

1,000 Newtown Medical Centre 10,045 5,000 Ora Toa Poneke 180,529 ; 61% 2,488 10,000 Island Bay Medical Centre 11,173

24 26 April 2017 - CCDHB Board PUBLIC papers - PRESENTATIONS

Waikanae Health Centre 11,173

Paraparaumu Medical Centre Horatepai 11,173 2,851

Raumati Road Surgery 3,383 Enrolled Population by Age Group 100% 90% 80% 70% 60% 50% Non-HCH 40% HCH 30% 20% 10% 46% 33% 38% 39% 42% 45% 0% Whitby Doctors 0-14 15-24 25-44 45-64 65-84 85+ 6,849 Ora Toa Takapuwahia 3,313 Waitangirua Health Centre Enrolled Population by Ethnicity 4,807

100% Ora Toa Mungavin Ora Toa Cannons Creek 2,451 4,768 90% 80% PUCHS 5,965 70% 60%

50% Non-HCH Johnsonville Medical Centre Newlands Medical Centre 12,967 9,229 40% HCH 30% 20% 10% 53% 67% 35% Karori Medical Centre 0% 14,397 Maori Pacific Other Newtown Union Medical Centre 6,538 Enrolled Population

1,000 Newtown Medical Centre 10,045 5,000 Ora Toa Poneke 2,488 10,000 Island Bay Medical Centre 11,173

25 26 April 2017 - CCDHB Board PUBLIC papers - PRESENTATIONS

How does Health Care Home help?

Improves access to general practice for patients

Actively manages care for patients with complex needs in partnership with the hospital

Expands roles within the general practice workforce & services in response to patient need

Future proofing Primary Care – building block for future models of care as part of Vision 2030

26 26 April 2017 - CCDHB Board PUBLIC papers - PRESENTATIONS

• GP clinical phone triage – alternative to a face to face appointment Ways • Patient portal -online access for patients we are improving access to • Extended hours in General Practice – general practices longer opening hours for patients • Virtual consults- an ability to book a telephone consultation with your GP/nurse

27 26 April 2017 - CCDHB Board PUBLIC papers - PRESENTATIONS

GP Triage outcomes

• Over 3000 triaged phone calls in 10 months and growing • 35% patients were handled over the phone and avoided having to come in • Hundreds of hours saved for patients and clinicians • Practices are monitoring phone metric to understand call rates ‡

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Phone triage outcomes from HCH practices

TRA Triage appointment 1865

TRC Triage call 597

TRD Triage diagnostic 28 3% TRA TRC 8% TRF Triage – Future appointment 249 TRD TRF TRX Triage call - Script 136 TRX 20% TRU 61% TRU Triage urgent appointment 29 TRN TRR TRN Triage – Refer to nurse 31 VCT

TRR Triage referral 14

Total 3040

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A big reduction in patients attending their local A&M as a result of GPs Referred to Teammedical introducing triage Number

18

16

14

12

10

8

6

4

2

Median

0 12/03/2014 19/03/2014 26/03/2014 2/04/2014 9/04/2014 16/04/2014 23/04/2014 30/04/2014 7/05/2014 14/05/2014 21/05/2014 28/05/2014 4/06/2014 11/06/2014 18/06/2014 25/06/2014 2/07/2014 9/07/2014 16/07/2014 23/07/2014 30/07/2014 6/08/2014 13/08/2014 20/08/2014 27/08/2014 3/09/2014 1/01/2016 8/01/2016 15/01/2016 22/01/2016 29/01/2016 5/02/2016 12/02/2016 19/02/2016 26/02/2016 4/03/2016 11/03/2016 18/03/2016 25/03/2016 1/04/2016 8/04/2016 15/04/2016 22/04/2016 29/04/2016 6/05/2016 13/05/2016 20/05/2016 29/05/2016 3/06/2016 10/06/2016 17/06/2016 24/06/2016 1/07/2016 8/07/2016

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New ways of interacting with practices

Patient Portal Activations • Patients can email their GPs and 20% nurses directly 18% 16% • Able to book appointments online 14%

12% • View their own results

10% HCH Overall • 8% Read their clinical records Non HCH Overall 6% • Request prescriptions 4% 2% • 100% positive patient feedback 0% 6/09/2016 4/10/2016 1/11/2016 8/11/2016 6/12/2016 3/01/2017 23/08/2016 30/08/2016 13/09/2016 20/09/2016 27/09/2016 11/10/2016 18/10/2016 25/10/2016 15/11/2016 22/11/2016 29/11/2016 13/12/2016 20/12/2016 27/12/2016 10/01/2017

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Extended hours

Weekly extended opening hours for HCH practices

Over 60 hours more of General Practice time each week across 16 practices

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Building Block for Future Models

Integrating District Nurses & Allied Health Teams: aligned new “team members”

3. Establishing practice team 1. Collaborative concept 2. Informal gatherings specific processes model design

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“Firsts” for CCDHB

Mobile device roll-out including DHB app store. Shared Lists for Multidisciplinary Team Meetings Electronic continuous notes ready for roll-out

HCH Pop with Practice ORA Pop service

Pop with DN Services

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Increased services in general practices

Growth in number of conditions that were managed in hospitals, now being managed in general practices ‡ Deep vein thrombosis ‡ Cellulitis ‡ Acute urinary retention ‡ Renal colic

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Consistently high performance

Target: 95% Target: 90%

Smoking Brief Advice 100% 90% 80% 70% 60% 50% HCH Overall 40% Non HCH Overall 30% 20% 10% 0% Jul-16 Jul-15 Jul-14 Jul-13 Jan-16 Jan-15 Jan-14 Jan-13 Oct-16 Oct-15 Oct-14 Oct-13 Apr-16 Apr-15 Apr-14 Apr-13

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Impact on our local hospital

Early data suggests a reduction in both ED attendance and avoidable hospital admission for patients who belong to Health Care Home practices

Ambulatory Sensitive Hospitalisations per 1000 ED Attendances per 1000 Patients Patients 60 40

50 35 30 40 25 30 HCH Overall 20 HCH Overall 20 Non HCH Overall 15 10 Non HCH Overall 10 5 0 0 Jul-13 Jul-14 Jul-15 Jul-16 Jul-13 Jul-14 Jul-15 Jul-16 Jan-13 Jan-14 Jan-15 Jan-16 Oct-13 Oct-14 Oct-15 Oct-16 Apr-13 Apr-14 Apr-15 Apr-16 Jan-14 Jan-15 Jan-16 Oct-13 Oct-14 Oct-15 Oct-16 Apr-14 Apr-15 Apr-16

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Much more to do but looking good so far……

• Aligning to CCDHB Health System Plan • Expand population coverage • Continuing to work jointly on this with our hospital colleagues • Develop the HCH concept further • More options for patients • Evaluating what’s working as we go

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Waikanae Health Centre Health Care Homes 11,173 Paraparaumu Medical Centre Horatepai 2016/17 – 9 practices 11,173 2,851 2017/18 – 7 practices Raumati Road Surgery 3,383

Total Patient Population = 298,209

Enrolled Population

59,897 ; 20%

Whitby Doctors 6,849

Ora Toa Takapuwahia 3,313 Waitangirua Health Centre 4,807

Ora Toa Mungavin Ora Toa Cannons Creek 238,312 ; 80% 2,451 4,768

PUCHS HCH - Tranche 1 5,965 HCH - Tranche 2 Johnsonville Medical Centre Newlands Medical Centre Non-HCH 12,967 9,229 59,897 ; 20%

Karori Medical Centre 14,397

57,783 ; 19% Newtown Union Medical Centre 6,538 Enrolled Population

1,000 Newtown Medical Centre 10,045 5,000 Ora Toa Poneke 180,529 ; 61% 2,488 10,000 Island Bay Medical Centre 11,173

39 26 April 2017 - CCDHB Board PUBLIC papers - DECISION

PUBLIC

BOARD DECISION

Date: 7 April 2017

Dr Pauline Boyles, Director of Disability Strategy and Performance Author

Dr Ashley Bloomfield, CEO Hutt Valley District Health Board Endorsed By Adri Isbister, CEO Wairarapa District Health Board Debbie Chin, CEO Capital and Coast District Health Board

Rachel Haggerty, Executive Director Strategy and Performance Reviewed/ approved by

Subject THE UPDATED SUB-REGIONAL DISABILITY STRATEGY 2017-2022, ENABLING PARTNERSHIPS: COLLABORATION FOR EFFECTIVE ACCESS TO HEALTH SERVICES

RECOMMENDATIONS It is recommended that the Board: a) Note that service planning in the sub-region with regard to disability integration has been driven by the previously endorsed Valued Lives Full Participation 2013–2018 b) Note the national and including international drivers for change, particularly the ‘New Zealand Disability Strategy 2016-2026’ and the ‘United Nations Convention on Rights of Persons with Disabilities’ c) Note that we are learning more about disabled communities as data gathering becomes more intuitive and complex. This drives the shift toward a more enabling health system for disabled people, in order to improve equity of health outcomes d) Note the need for disability literacy in the health workforce, acknowledging that disabled people themselves are best placed to know what they need on a daily basis to achieve positive wellbeing e) Note the significance of embedded co-design and joint ownership of planning with community f) Note that the updated Strategy contains a detailed section 3 on the actions and outcomes that make up the framework. This provides direction for health sector leaders to work alongside disability communities in addressing inequities and ensuring better health outcomes, through to 2022 and beyond g) Note the effort of the Sub-Regional Disability Advisory Group members and the Disability Strategy Team in producing this Strategy h) Approve the draft Sub-Regional Disability Strategy 2017–2022 in its entirety.

APPENDIX

1. Sub-Regional Disability Strategy 2017–2022 – Enabling Partnerships: Collaboration for Effective Access to Health Services.

Capital & Coast and Hutt Valley District Health Board Page 1 [month year]

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1. PURPOSE

This paper presents the updated disability strategy for sub-regional DHBs from 2017 to 2022, and outlines a strategic framework of actions and outcomes over five years and beyond. This paper also describes the national and international drivers on which the strategy is built, and highlights the value of robust, consistent leadership, collaboration and co-design with communities of interest.

2. BACKGROUND

2.1 Previous Board Discussions/Decisions Board meeting Decision CPHAC DSAC MARCH It is recommended that the Committee members note as above points 2017 Endorse The updated draft Sub Regional Disability Strategy 2017-2022 in its entirety CPHAC DSAC July 2016 The plan was endorsed.

Endorsed by Boards Recommend to the Boards that they endorse the outline of the draft sub regionally action plan in Section Three emerging from the forum to include following August 2016 areas for further development: a. The development of a performance monitoring framework during 16/18 with meaningful indicators to measure health equity for people with disabilities b. Support for the development of a high level plan for community and intersectoral engagement across funders of inter-dependent services c. The development of disability literacy as a competency in conjunction with national work force agencies d. Promotion and commitment of integration of disability support needs in all new IT development and gradual integration into current platforms e. Endorse in principle a whole of life approach to improve access to funding pathways for staff and people using services f. An approach to the Ministry of Health at Executive level to discuss the impact of decreased DSS funding, increasing health complexity within the disability population, and the impact of the funding gap on DHBs.

December 2013 1.0 .RECOMMENDATIONS Three DHB Board It is recommended that Board members of Wairarapa Hutt Valley and meeting Capital and Coast District Health Boards

ENDORSE The Draft 3 DHB NZDS Implementation Plan

Capital & Coast and Hutt Valley District Health Board Page 2 April 2017

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2.2 The Need for a Disability Strategy According to the 2013 census, one in four New Zealanders have a disability. Disability can include physical, mental health, intellectual, sensory and other impairments. Disability is created by various barriers that hinder the full and effective participation of people in society on an equal basis with others.1

In 2013, the sub-regional DHBs in partnership with disability communities launched an implementation plan for the New Zealand Disability Strategy and the United Nations Convention on Rights of Persons with Disabilities.2 The key goals were to: ∑ improve the health of disability communities ∑ increase independence, participation and inclusion of disabled people ∑ reduce disparity ∑ ensure better care. The following foundational documents informed the development of the updated Strategy: ∑ United Nations Convention on Rights of Persons with Disabilities (2008) ∑ New Zealand Public Health and Disability Act 2000 ∑ The Treaty of Waitangi ∑ New Zealand Disability Strategy 2001 ∑ New Zealand Disability Action Plan ∑ He Korowai Oranga: Māori Health Strategy ∑ Faiva ora – National Pasifika Disability Plan ∑ Whāia Te Ao Mārama: The Māori Disability Action Plan ∑ Sub-regional Disability Plan 2013-18 (Valued Lives Full Participation). The content has been co-produced by the Disability Strategy and Performance team with an expert group of leaders from the Sub-Regional Disability Advisory Group and other partners. Please refer to the attached Disability Strategy. This will be distributed in published form to each Board member.

3. DISCUSSION

3.1 Health Equity and Disability: The Challenges In the context of health services, those who have a range of clinical and support requirements tend to have the most complex interactions with the health system. The easier it is to navigate vital health services, the more enabling the health system becomes. With this in mind, we are moving to a more positive, proactive approach that will improve health systems and services for all, including those with the highest needs. The approach in this Strategy is consistent with mainstream policy on integration and innovation. This includes the call for services closer to home and a more people powered health service.

A snapshot of the sub-regional disability population is provided as a result of the census data collected in 2013. Measurement of health equity for disabled people is largely excluded from nationwide health needs assessment reports. Lack of coherent data has contributed to this gap as well as the discrete separation of funding and services for health and disability. A main foundation of the 2013-18 plan has been commitment to appropriate and valuable data collection to understand the issues for

1 This is adapted from the definition used in the New Zealand Disability Strategy and the United Nations Convention on Rights of Persons with Disabilities. 2 Valued Lives: Full Participation, Implementation Plan 2013-2018, www.huttvalleydhb.org.nz/about-us/reports-and-publications/other-planning- documents/disability-strategy-implementation-plan-2013-2018.pdf Capital & Coast and Hutt Valley District Health Board Page 3 April 2017

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PUBLIC disabled people in the sub-regional health system. There is now enough data to develop a dashboard of indicators that can also inform the equity reports across the DHBs.

The first section of the Strategy presents the research available on health equity. A number of reports are referenced, including a powerful report by the WHO in 2011 on the health issues for disabled people worldwide. Access to healthcare is the most significant issue, especially in developing countries. In New Zealand there is also well documented evidence of very poor health outcomes for people with learning disabilities.

3.2 Disability Literacy and the Health Workforce The need for workforce development has been identified by all stakeholders. The programme of education for staff in the sub-region aims to ensure staff teams are equipped to understand the disability support needs of the people they serve and the impact on changing health needs. Acknowledging the expertise disabled people have about their own daily needs helps to ensure a commitment to partnership and an involvement of the people using services in developing education tools and training.

3.3 Enabling Partnerships: Collaboration for Effective Access to Health Services The detail of the updated Strategy is presented in section three and defines the high level strategic commitments alongside outcome statements. What a person can expect to see in terms of change is always the beginning point and the measure of success. Section three draws on the World Health Organization integrated care model ‘Creating enabling environments’, the Health System Plan Vision 2030 and addresses the principles of the refreshed NZDS and UNCRPD.

A common theme across the frameworks is that any system and service change to improve responsiveness involves the following: ∑ Proactive initiatives collectively led by staff and the communities. ∑ Intentional integration using available tools to identify areas of need. ∑ Long term commitment to transformation led by communities of interest working with staff. ∑ A shared vision to achieve long term radical system change

While disability initiatives and tools provide opportunities for innovation, real systemic change will happen over a long period of time. Every part of the programme aims to enhance the autonomy and wellbeing of people who experience disability within current and planned health system development. Much of the detail that has been used in this Strategy is a result of direct feedback from consumers and key stakeholders who attended our local and sub-regional forums. The last sub-regional forum was held on 3 June 2016 in Upper Hutt and was an opportunity to refresh reform and update the current strategic plan used by the sub-regional DHBs.

Examples of strategic plans in action:

World Health 3 DHB Disability Organization CCDHB Health System Six Guiding Principles of the Implementation Integrated Care Plan Integration Strategy Plan Model

Creation of enabling environments Strategies that build community Community leadership in resilience. Strengthening health care and system Leadership governance and monitoring. Active commitment to accountability strengthening leadership and A health system fit for all. partnership across the sector.

Capital & Coast and Hutt Valley District Health Board Page 4 April 2017

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PUBLIC Community leadership in Inclusion of disabled people in Empowering and education for health and Inclusion & Support the design of all services and engaging people disability literacy and activities. service co-design. Improving access to information about Improved support for people to Access Coordinating services funded services across make well-informed decisions. age groups.

All people using services Movement toward holistic Reorienting the model have improved health model of wellbeing. Health of care literacy and information, Creation of an enabling and and lead their care. more accessible environment.

The above table identifies examples of how the WHO model and the Sub Regional Disability Strategy focus areas align with the health system planning priorities and expected outcomes of the new strategy. This is important to note as the integration agenda requires explicit linkages within planning processes

A performance monitoring framework has been developed with timeframes and specific actions which are short, medium and long term. Some will take time beyond five years but the principle foundations will exist and be strong within five years. For example, datasets will be so much more robust, and equity can be much more easily addressed. The other important platform is workforce development: local areas will have individual measures of success each year but there will be common tools and approaches.

4. NEXT STEPS

Approval of this strategy will coincide with the completion of timelines and actions. The updated plan is a living document that will be annually reviewed and actions agreed with the community stakeholders, Executive Leadership Teams and Planning and Funding Teams sub-regionally.

An update on performance monitoring will be presented twice per year to CPHAC DSAC along with snapshots of innovation.

An update to Boards with key discussion points and progress will be given twice per year by the Sub- Regional Disability Advisory Group Chair and the Director of Disability Strategy and Performance.

Capital & Coast and Hutt Valley District Health Board Page 5 April 2017

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PUBLIC

BOARD DECISION

Date: 10 April 2017

Author Dr Pauline Boyles, Director of Disability Strategy and Performance

Endorsed by Debbie Chin, Chief Executive Rachel Haggerty Executive Director Service Innovation and Performance Reviewed/approved Taima Fagaloa Director of Pacific Health by Arawhetu Gray Director of Māori Health Chair, Maori Partnership Board Chair, Pacific Advisory Group Chair Sub Regional Disability Advisory Group Subject CONSUMER ENGAGEMENT AND CONSUMER COUNCIL

RECOMMENDATIONS It is recommended that the Board: a) Note current consumer engagement at CCDHB: i. CCDHB has world class engagement especially in the Disability and Pacific communities ii. Learning from existing Consumer Councils - A number of District Health Boards (DHBs) have established Consumer Councils (at least 8 DHBs) that work collaboratively to develop effective consumer partnerships. b) Note proposal for an approach to a meaningful consumer engagement: i. A working group approach can build on current successes and implement a Consumer Council Approach that has the commitment and engagement of Maori, Pacific, Disability, the Mental Health sector and the people served by Capital & Coast DHB. c) Endorse the establishment of a Consumer Council Working Group.

1. EXECUTIVE SUMMARY

1.1 Introduction Working with people who use health and disability services has become recognised nationally and internationally as being critical to successful service improvement and clinical governance. The development of a broad ranging and embedded strategy on consumer engagement began at CCDHB in 2010 and a number of approaches are current while others have been adapted and changed based on subsequent evaluation and learning.

1.2 Consumer Engagement at CCDHB A key principle of the Capital and Coast draft Health System Plan (Vision 2030) is the need to achieve individual and Whanau-led wellbeing and empowered communities by working alongside community leaders within local areas. Ensuring the presence of an active consumer voice is important for the success of the Health System Plan and is especially important for vulnerable population.

Capital & Coast and Hutt Valley District Health Board Page 1 [month year]

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PUBLIC CCDHB currently engages with consumers through various groups within a range of settings at strategic and operational levels (see Appendix 2).

1.3 Consumer Councils A number of District Health Boards (DHBs) have established Consumer Councils (at least 8 DHBs) that work collaboratively to develop effective consumer partnerships. Hawkes Bay DHB, Nelson Marlborough DHB and Northland DHBs are examples of those who have established Consumer Council operating now for a number of years. Lessons from these Consumer Councils are outlined in the paper. Everyone involved in the development of Consumer Councils has made clear the need for local development that meets the needs and unique identity of each District Health Board population and identify that consistent strong linkages are critical to a triple aim approach to health service development. In September 2016 Consumer Council representatives and allies from 10 regions met in Auckland to share experience and set a national collective in motion, supported by the Health Quality and Safety Commission (HQSC). This group has continued to maintain contact and share resources as appropriate.

1.4 Proposal – Meaningful Community Engagement The aim is to develop a process of meaningful consumer engagement supported by decision making at the lowest level possible, which gives a voice to consumers. An embedded model supporting locality development is proposed that will connect consumers from local communities with the wider health system and the CCDHB. This approach will require long term commitment for meaningful engagement to evolve and grow over time. CCDHB has very strong and successful engagement across the Pacific community and in the disability community. This is leading work nationally and it is important that the development of a Consumer Council needs to build on this success. As a first step in the process, it is recommended that we set up a Consumer Council Working Group which will develop an approach to improved strategic involvement of consumers and communities. The Maori Partnership Board, the Pacific Advisory Group and the Sub-Regional Disability Advisory Group have endorsed the establishment working group and will advise on appropriate membership. The following figure shows a framework for development of consumer engagement at CCDHB.

Capital & Coast District Health Board Page 2 [April 2017]

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PUBLIC Framework for Development of Good Practice in Consumer Engagement CCDHB

1. Patient and family, whānau directed International Driver: 2. Being open, honest and accountable • UNCRDP 3. Providing Support • WHO Charter 4. Clinician and Leadership preparation • Human Rights creating more enabling environment Guiding 5. Long-term commitment to partnership Principles 6. Care and System redesign

1. Patients, families/whānau direct their own care planning incorporating their values, preferences and goals in care options. 2. Resourcing and supporting to make the cultural shift to value consumer engagement. People 3. Ladder of engagement towards decision And making at the lowest level possible. Whanau-led 4. Consumer Council established to develop consumer partnership. Actions 5. Community Committees function as part of locality developments embedding community Vision Vision 2030 engagement. 6. Co-design new care and systems with consumers. Health System Plan: Plan: Health System

1. Care decisions are made on consumer preference, medical evidence and clinical judgment. 2. Consumer voice on major strategic decisions. 3. Community committees influence wider health system creating choices. Outcomes 4. Consumer co-lead in multiple, active ways. 5. Inclusion at the highest feasible level of New Zealand Drivers: governance. • Te Tiriti o Waitangi • Health and Disability Act 2000 • Code of Health & Disability Rights • Alma Ata declaration • HQSC Frameworks

Capital & Coast District Health Board Page 3 [April 2017]

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PUBLIC APPENDIX 1

FULL DISCUSSION PAPER ON CONSUMER ENGAGEMENT AND CONSUMER COUNCIL

This paper is an accompaniment to the Board Decision Paper on Consumer Engagement and Consumer Council. It provides additional information and rationale for the proposed approach.

1. PURPOSE ∑ To provide context and background to development of consumer partnerships for service improvement in New Zealand and internationally. ∑ To highlight existing partnerships and their strengths and gaps. ∑ To outline an approach for building and embedding partnerships with individuals, whānau and their communities in the short, medium and long term. ∑ To identify next steps to commence meaningful consumer engagement.

2. BACKGROUND Definition

2.1 Health Quality & Safety Commission defines consumer engagement as: ‘… a process where consumers of health and disability services are encouraged and empowered to actively participate in decisions about the treatment, services and care they need and receive. It is most successful when consumers and clinicians demonstrate mutual respect, active listening and have confidence to participate in full and frank conversation. Systems that support consumer engagement actively seek input from consumers and staff at all levels of an organisation.’ HQSC framework for consumer engagement

2.2 ‘Consumer’ is a term used throughout this paper to mean - individuals, patients, Whānau, families, clients, customers, current and potential users of wider CCDHB health services. However communities have expressed the wish for terms such as “people” and/or “people who use services. Terminology will respect those wishes as far as possible.

2.3 There are multiple ways in which people can be safely involved in a partnership approach to planning and service improvement at all levels. Within a Triple Aim approach good engagement begins at the level of front line patient care (See Figure 2: a quality improvement approach).

Capital & Coast District Health Board Page 4 [April 2017]

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PUBLIC 2.4 Figure 1 below illustrates the types of engagement that are commonly employed and in a range of circumstances as outlined above.

Figure 1: Types of engagement and purpose CCDHB Context

2.5 A key principle of the Capital and Coast draft Health System Plan (Vision 2030) is the need to achieve individual and Whānau-led wellbeing and empowered communities by working alongside community leaders within local areas (locality development). In this way the particular system and service issues for each unique population can be addressed by those with the best knowledge of the wide ranging community impacts. Ensuring the presence of an active consumer voice is important for the success of the Health System Plan and is especially important for vulnerable populations. As new models for delivering care are implemented, a renewed focus on consumer engagement is essential to ensure service integration across the sector, the promotion of equity and organising services to meet the needs of all consumers.

2.6 Effective consumer partnerships will depend on the ways meaningful input, engagement, involvement; co- design and co-production are facilitated.

Introduction

2.7 Working with people who use health and disability services has become recognised nationally and internationally as being critical to successful service improvement and clinical governance. There are examples of consumer partnerships being developed with health services in most countries of the world. While there is great diversity in models of health care with regard to public and private ownership, good practice principles on consumer involvement unite planners internationally.

2.8 The development of a broad ranging and embedded strategy on consumer engagement began at CCDHB in 2010 and a number of approaches are current while others have been adapted and changed based on subsequent evaluation. This paper therefore aims to present first the national and international drivers that are at play in health service development including their importance in development of consumer engagement strategy. Secondly, a summary of successful partnership models occurring at CCDHB will be presented. Finally, a proposal is presented for identifying what may be required to develop improved, embedded and robust collaboration with individuals, their Whānau and communities over the next three years.

Capital & Coast District Health Board Page 5 [April 2017]

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PUBLIC 3. INTERNATIONAL AND NATIONAL DRIVERS

3.1 Good practice in health system development is multi-dimensional and similar approaches are required for development of consumer engagement strategies. Below the range of relevant drivers are explained which are incorporated into a proposal in the last section.

3.2 International Drivers

∑ WHO Person Centred Integrated Care Any new initiative in health care improvement planning links to the WHO model for person-centred Integrated Care (20131) which identifies five key strategies for improving access to health care. These are: - Creating enabling environments - Empowering and engaging people - Improving coordination of services within and across services - Re-orienting the model of care - Improving governance and accountability.

Creating enabling environments depends on a consistent approach that embeds the other four strategies. The approach provides an evaluation framework against which all system change can be measured. A consumer engagement strategy aligned to this framework guides good practice in engagement of consumers and communities in all elements of health service planning and delivery. The principles outlined give rise to actions that enable decision making by individuals and groups easily.2 This involves development of decision making mechanisms that make it easy for people and communities to make decisions about their own wellbeing and that of their Whānau and population at the most local level feasible. Other international drivers include the international conventions on Human Rights including for children and persons with disabilities. A robust strategy incorporates all aspects of the key international conventions to which New Zealand has signed up.

3.3 National Drivers ∑ The New Zealand Public Health and Disability Act (2000) (NZPHAD) NZPHAD recognises and respect the principles of the Treaty of Waitangi with a view to improving health outcomes for Māori. The Act provides mechanisms to enable Māori to contribute to decision- making and participate in the delivery of health and disability support services, which are at the heart of consumer engagement. The act has similarly established mechanisms for other groups facing inequity such as disabled people.

∑ The Treaty of Waitangi The Treaty of Waitangi describes the principles of mana whenua, kaitiakitangi and manaakitanga (participation, partnership and nurturing relationship).3 In the New Zealand health system, Māori Partnership Boards have an equal governance role alongside District Health boards. Governance including clinical governance bodies aim to address the Treaty implications of all decisions made. The process of negotiating partnerships at governance level in this context is constantly reviewed in a dynamic process of examining responsibility and culturally appropriate approaches to health care.

1 http://www.who.int/servicedeliverysafety/areas/people-centred-care/strategies/en/

2 http://inquisition.ca/en/polit/artic/solidarite.htm Subsidiarity defined as appropriate decentralisation. In the wake of Brexit and the issues that arose during the USA election the need for solidarity (appropriate centralisation) and subsidiarity have become more important and the careful balance between these approaches to governance

Capital & Coast District Health Board Page 6 [April 2017]

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PUBLIC While engagement with people using services and their whānau requires a range of different approaches, the Treaty implications of partnership and the role of the Māori Partnership Boards remains of central importance in the development of whole of system consumer engagement strategy.

∑ Equity and Consumer/Community Engagement A similar dynamic review of decision making at a range of levels with the people most impacted by services and service change is required. A consumer engagement strategy at CCDHB will align with the wishes and networks of iwi leaders, Pacific community leaders, disability community leaders and others who champion groups experiencing inequity of access to the heath system. Therefore a process of meaningful partnerships with all groups and their leaders who work to proactively promote equity will be an asset and strengthen health system development in future years.

∑ The Code of Health and Disability Rights The Code of Health and Disability Services Consumers’ Rights states that consumer rights need to be recognised in the following ways: respect, information, choice, equity, dignity, effective communication, support and full involvement.4 This code of rights remains a foundation of the health and disability system and is identified within the proposed framework.

3.4 The three principles: Voice, Choice and Safe Prospect Voice, Choice and Safe Prospect are the three principles that emerged from the submissions to the Royal Commission on Social Policy 1988. (See Appendix B).

In 1988, a paper titled ‘Having a Say in Health’ (J. J. Nuthall, 1988) for Department of Health used the framework to develop recommendations to government. These included multiple mechanims to increase the voice of ordinary New Zealanders in heath planning, practical ways to provide more real choice and thus increase the chances of safe prospect.

The paper takes up the challenges by the Royal Commission and many others to increase people's participation in their own health care with the aim of consumer driven policies and just consumer- responsive service. It noted that ‘somehow the system needs to respond when patients demand their rights. Beyond that, the system needs to respond even when they do not.’

A number of recommendations made in this paper are still revelant for the health and disability sector. The following are of most relevance for Capital and Coast District Health Board as it reviews its current practices in consumer engagement and moves to a more comprehensive approach.

∑ Moving from complaints to partnerships involving mechansims for user information, patient advocacy, clinical audits, complaints procedures, partcipation in decision making, collective responsibility of user representatives.5 ∑ Area based community committees established to develop strong connections with their local health providers for improvements in health services and setting priorities. This does not include involvement in the provision of the services.6

The principles and philosophies of voice, choice and safe prospect are closely aligned with the Capital and Coast Health System Plan (Vision 2030) and therefore incoporated into the proposed framework.

3 Health Quality & Safety Commission. 2015. Engaging with Consumers. Wellington: Health Quality & Safety Commission. URL: http://www.hqsc.govt.nz/assets/Consumer-Engagement/Publications/DHB-guide/engaging-with-consumers-3-Jul-2015.pdf (accessed April 2017) 4 Health and Disability Commissioner. 2009. Code of Health and Disability Services Consumers’ Rights. Wellington: Health and Disability Commissioner. URL: http://www.hdc.org.nz/the-act--code/the-code-of rights (accessed April 2017) 5 Mechanisms for feedback as opposed to just complaints have already provided constructive ways for people to suggest changes as a result of some of their experiences of health care. Staff training is often initiated as a result. A number of consumers are involved in service planning and dedicated user groups. 6 The health system plan seeks to set up strong locality based initiatives and governance groups over a three year period beginning with Porirua. Capital & Coast District Health Board Page 7 [April 2017]

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3.5 Consumer Council Development Nationally In New Zealand, Mental Health and Addiction and Disability Sectors have shown leadership around consumer engagement. In more recent times, a number of District Health Boards (DHBs) have established Consumer Counciles (at least 8 DHBs) to work collaboratively to develop effetcive consumer partnerships. Hawkes Bay DHB, Nelson Malrborough DHB and Northland DHBs are examples of those who have established Consumer Council operating now for a number of years. The lessons from other DHBs show that: ∑ Buy in from Clinical Governance level is important and the link needs to established at the outset ∑ Benefited from having the Council report directly to the Chief Executive ∑ Being brave enough to ‘have a go’ and start the process even if all the key elements are not in place yet as the Council and TOR will evolve over time ∑ Being clear about the responsibility of the Council and considering a mechanism (intranet function like Northland) or person like a Consumer Engagement Manager or team where Consumer Council enquiries are directed to so that Council does not become bombarded with requests for support.

In September 2016 consumer council representatives and allies from 10 regions met in Auckland to share experience and set a national collective in motion, supported by the Health Quality and Safety Commission (HQSC). This group has continued to maintain contact and share resources as appropriate.

The HQSC provides a number of resources including a guide for District Health Boards on engaging with consumers and reference to a growing body of international evidence7 to support the benefits of engaging with consumers. HQSC provides a New Zealand framework (figure in Appendix Two) that encapsulates what it means to be fully engaged with consumers in a holistic, system-wide way that can be used to track consumer engagement.

Everyone involved in the development of Consumer Councils has made clear the need for local development that meets the needs and unique identity of each District Health Board population. However all agree that consistent strong linkages with the local populations are of benefit is critical to a triple aim approach to health service development.

Figure two demonstrates the value of a wide and robust strategy for collaboration with communities in relation to the underpinning triple aim approach to health service planning.

7 For international guidelines and frameworks about consumer engagement go to: http:// www.hqsc.govt.nz/our- programmes/consumerengagement/publications-and-resources/ publication/2163/#international-guidelines Capital & Coast District Health Board Page 8 [April 2017]

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Figure 2: Triple aim and alignment with consumer engagement strategy

4. DISCUSSION

4.1 History of engagement at CCDHB In 2010 two local area groups were set up at Kapiti, Porirua and a third was planned in wellington. The Executive leaders of the local services were involved and worked hard to ensure success of the groups. In spite of initial commitment by community members, the groups dissolved and other ways to engage feedback from people have been put in place. In 2014, a consumer council was planned but a request was made by Executive Team for a more far reaching whole of system approach that would seek to engage community leaders and stakeholders. The development of a more centralised consumer governance group to partner with the District Health Board is still planned based on an evaluation of current processes. A stocktake of current environment is presented below.

4.2 Current Environment: Governance CCDHB currently engages with consumers through various groups within a range of settings at strategic and operational levels.

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Figure 3: current consumer engagement short medium and long term

∑ Māori Partnership Board advises the District Health Board on Treaty obligations and assists with safe and appropriate implementation. (MPB) ∑ The Sub Regional Pacific Strategic Health Group (SPSHG) Memebershp represents Pacfic groups sub regionally and advises on governance, strategic and equity for Pacific peoples. The above groups are not consumer groups but are a critical link to and for Māori and Pacfic people who health and disability services. ∑ Sub Regional Disability Advisory Group (SRDAG) established to provide strategic community input to Boards and sub committees. SRDAG has two places one for a person endorsed by the SPSHG and a joint member of MPB and SRDAG. 4.3 Strategic and Operational Groups

∑ Sub Regional Mental Health Consumer Leadership Group (MHCLG) Establised to provide strategic oversight and “guardianship” of developments within mental health services as there district health boards joined their mental health services. This group works in partrnership with the planning and funding units but is run by people who have a live experience of mental health services. MHCLG has one member who is also a member of SRDAG. ∑ Primary Secondary Clinical Governance – strategic advice from Age Concern representative. ∑ Women’s Health Oversight Group- consumer representatives partner with clinicians. ∑ Capital Support Consumer Group, an active consumer run group advising the needs assessment service (CCDHB) on access to disability support services funding. ∑ Child Development Services (CCDHB) have a regular parent forum (Children with disabilities service).

Other examples of active Consumer engagement on specific projects and initiatives: ∑ A&M and Surgical Services Credentialing Processes ∑ Health Care Home planning ∑ Quality accounts for CCDHB ∑ Te Ara Pai CCDHB mental health services 2012-2015 was co designed with NGOs and comsumers. A cutting edge example of service development that finally came to fruition in 2015.

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PUBLIC 4.4 Good practice example of embedded engagement with consumers: Disability Strategy Disability Strategy over nine years has become embedded within mainstream health services sub regionally and has been developed alongside people with disabilities using health services and their allies. As disability issues have been traditionally less understood and inequity of health outcomes less recognized and/or measured, CCDHB partnered with local communities to develop meaningful planning to improve disability responsiveness.

The strategy and the robust engagement at strategic and planning levels as well as on work streams is well documented in the updated Sub regional disability strategy 2017-22 (April Board).

4.5 Mechanisms for engagement included ∑ Local led forums consumer and sector leaders ∑ Sub regional forums SRDAG led with other government agencies ∑ Linkages to and from members of governance group on service and system issue ∑ Engagement in action research for example child to adult transition local pilots ∑ Engagement on development of support needs information on health system (individual identifies support needs for clinician information) ∑ Health passport research (co design with clinicians) ∑ Development of education tools egg video scenarios and interviews ∑ Development of information with and for people with learning disabilities. ∑ Health literacy in simple formats.

The SRDAG Group members link to all age groups including children to older people, main local areas and give feedback as carers and family members. The success of the strategy is a result of the quality of collaboration with staff, executive and boards. Prior to 2010, disabled people in the local district health board expressed dissatisfaction and a sense of invisibility in decision making and service delivery. This has changed as they now feel respected as partners in decision making and planning in relation to service and system development. They understand the pressures on District Health Boards and in turn support communities with that understanding. Partnership has allowed good faith and transparent approaches to decision making and people more often feel heard with regard to the equity issues they experience.

5. PROPOSAL

5.1 CCDHB APPROACH: A Vision for Meaningful Engagement with Communities The strategy identified here is built on best practice health planning and also uses the WHO framework integrated with New Zealand and local drivers to guide good practice in service and system change alongside empowered and engaged consumers.

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A Framework for Development of Good Practice in Consumer Engagement CCDHB

1. Patient and family, whānau directed International Driver: 2. Being open, honest and accountable • UNCRDP 3. Providing Support • WHO Charter 4. Clinician and Leadership preparation • Human Rights creating more enabling environment Guiding 5. Long-term commitment to partnership Principles 6. Care and System redesign

1. Patients, families/whānau direct their own care planning incorporating their values, preferences and goals in care options. 2. Resourcing and supporting to make the cultural shift to value consumer engagement. People 3. Ladder of engagement towards decision And making at the lowest level possible. Whanau-led 4. Consumer Council established to develop consumer partnership. Actions 5. Community Committees function as part of locality developments embedding community Vision Vision 2030 engagement. 6. Co-design new care and systems with consumers. Health System Plan: Plan: Health System

1. Care decisions are made on consumer preference, medical evidence and clinical judgment. 2. Consumer voice on major strategic decisions. 3. Community committees influence wider health system creating choices. Outcomes 4. Consumer co-lead in multiple, active ways. 5. Inclusion at the highest feasible level of New Zealand Drivers: governance. • Te Tiriti o Waitangi • Health and Disability Act 2000 • Code of Health & Disability Rights • Alma Ata declaration • HQSC Frameworks

Figure 4: Framework for Development of good practice consumer engagement

The aim of CCDHB is to develop a process of meaningful consumer engagement supported by decision making at the lowest level possible. The important long-term issues depend upon community development work.

An embedded model supporting locality development is proposed that will connect consumers from local communities with the wider health system and the CCDHB. This community of localities approach is consistent with Health System Plan developments and the framework proposed by Voice, Choice and Safe prospect. It requires long term commitment for meaningful engagement to evolve over time. The evolution can be supported by a ladder of engagement process.

There are many different ways in which people might participate in health depending on their interest and circumstances. The ‘ladder of engagement and participation’ (based on the work of Sherry Arnstein8) is widely recognised for understanding the varied levels of individual and community involvement. Consumer voice on every step of the ladder is valuable and it becomes more meaningful at the top of the ladder.

8 https://en.wikipedia.org/wiki/Sherry_Arnstein Capital & Coast District Health Board Page 12 [April 2017]

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PUBLIC Partnering with communities and individuals making joint decisions. E.g. PARTNER Community Development Approach

Working with communities and individuals in each aspect of the decision COLLABORATE including the development of alternatives and preferred options. E.g. Service users co-design models of care

Working directly with communities and individuals to ensure that aspirations INVOLVE and concerns are consistently understood and acted on. E.g. Service users participate in policy groups

Obtaining feedback from communities and individuals on analysis or CONSULT decisions. E.g. Panels and Focus Groups

Providing communities and individuals with balanced information to assist INFORM them in understanding issues, options , opportunities and solution. E.g. Websites, newsletters and media releases Figure 5: Ladder of Engagement

The proposed framework will be the guide during the next steps to ensure an appropriate, flexible and robust approach underpins the gradual development of both centralised and decentralised decision making in partnership with communities. We are looking to move from involving and collaborating to partnering with indivduals and communities.

6. NEXT STEPS

6.1 An Approach to Consumer Council Development In order to establish a consumer council that meets the needs of the community and the DHB Board an iterative approach that is managed within a quality improvement process is proposed. This would allow a chair to be appointed to act as a project lead in the group development. This chair would be engaged for a set timeframe and would have project management skills with appropriate experience in community development strategies and approaches.

It is proposed that the project lead in collaboration with senior staff and existing strategic advisory groups would develop a process of establishment of a time-bound working group. The working group membership would act as an interim advisory group to Executive and the Board. The working group would be endorsed by current governance and strategic advisory groups.

6.2 Proposal Step One To establish an interim working group to develop an approach to improved strategic involvement of consumers and communities: ∑ It will collaborate with stakeholders across the system and engage with local communities ∑ It will also work alongside boards to report on development while giving views on the quality of local engagement expected in the development of all new services at CCDHB ∑ The interim group will therefore oversee the development of both a centralised and decentralised consumer engagement strategy ∑ After an agreed period, it will recommend a process for establishment of a whole of system consumer governance structure. This structure will take a long-term approach to connecting local communities and an enabling central advisory structure.

The following is suggested membership of working group: ∑ Māori Partnership Board appointee – this person would have a strong understanding of the Treaty and the role of health services to respect the Treaty obligations to Māori

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PUBLIC ∑ Sub Regional Pacific Strategic Health Group- A person endorsed by and/or a (consumer) member of the group ∑ Sub Regional Disability Advisory Group: Endorsement by SRDAG chair or joint member of both groups (CCDHB residents only) ∑ Mental Health Consumer Leadership Group: as above (CCDHB residents only) ∑ Representatives from other governance groups ∑ Local area delegates from Kapiti, Porirua and Wellington regions ∑ Project team and secretariat.

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APPENDIX B

THREE (ROYAL COMMISSION EXTRACT)

Having a Say on Health, Voice, Choice and Safe Prospect

The proposals in the paper reflected the following philosophies and principles: ∑ Community based rather than hospital or institution based ∑ primary health care and Alma Ata declaration that health is only achieved 'with the full participation of the people' ∑ the Treaty of Waitangi ∑ the letter and spirit of the Official Information Act ∑ democratic accountability - responsibility to and from elected and appointed members ∑ improve two-way flow of information - from consumers to providers and planners - from providers and planners to consumers ∑ use available resources to best advantages, adaptation of present structures and roles ∑ make systems simpler and easier to use ∑ make it easier to adopt "Healthy Cities" approach, involving citizens in promoting health ∑ follow W.H.O. Ottawa Charter: - (1) Build healthy public policy - (2) Create supportive environments - (3) Strengthen community action - (4) Develop personal skills - (5) Reorient health services.

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BOARD DISCUSSION

Date: 10 April 2017

Author Debbie Chin, Chief Executive Capital & Coast DHB

Subject CHIEF EXECUTIVE’S REPORT

RECOMMENDATION

It is recommended that the Board: a. Note the contents of this report.

APPENDICES

1. Financial Summary 2. Health Matters Newsletter.

1 FINANCIAL UPDATE 1.1 Financial overview The DHB result is favourable to budget by $3.9m for February 2017 and favourable to budget by $528k year to date.

The DHB has an actual surplus of $2.4m for the month and a year to date actual deficit of ($11.3m).

The year to date variance had been impacted by two industrial action periods, increased throughput volumes in the hospital, the November earthquake and copper pipe costs.

Activity movement compared to last year Variances Months % YTD YTD Variances YTD % As reported in MoH MIF report Feb-17 Feb-16 Month change 16/17 15/16 YTD change Discharges 4,799 5,147 348 6.8% 41,046 42,574 1,528 3.6% Caseweights (Excl MH) 5,318 5,258 (60) -1.1% 45,073 45,280 208 0.5% Bed Days (calculated from Hours) 11,978 11,283 (695) -6.2% 99,477 99,098 (379) -0.4% Length of Stay (excluding day patients) 4.05 3.72 (0.33) -8.9% 3.88 3.82 (0.06) -1.6% ED Presentations 4,887 5,071 184 3.6% 41,787 41,288 (499) -1.2% ED Admissions 1,700 1,656 (44) -2.7% 14,616 14,175 (441) -3.1% Theatre Throughput (Hospital) 1,314 1,455 141 9.7% 10,891 11,310 419 3.7%

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February 17 February 17 Month YTD YTD YTD Net Result Actual $ Budget $ Variance $ Actual $ Budget $ Variance $

Total CCDHB 2,402,819 (1,531,308) 3,934,127 (11,301,114) (11,829,504) 528,390

2 SYSTEM LEVEL MEASURE IMPROVEMENT PLAN

Capital & Coast District Health Board continues its commitment to work in partnership to deliver the 2017/18 System Level Improvement Plan with oversight from the Integrated Care Collaborative Alliance Leadership (ICC ALT).

The ALT has endorsed the SLM dashboards which will continue to be utilised for on-going monitoring processes. We have now acquired data from all stakeholders, and will be able to provide a whole of system view to the ICC ALT.

2.1 The following progress is noted at Quarter 3 2.1.1 Ambulatory Sensitive Hospitalisations 0-4year olds CCDHB ASH 0-4 year olds rates for total population and Maori are below the national average. Immunisation rates Maori and Pacific populations are back to being above the national average of 95% and progress continues in the national Health Target “Raising Healthy Children”. Discussions at the ICC ALT and the Child ICC group are looking to focus further work on improvements for children, and are likely to focus on supporting Pacific children. Based on the preventative and proactive on going work in this arena, the CCDHB Alliance expects to achieve the SLM milestone for 2016/17.

2.1.2 Patient Experience of Care The CCDHB system is likely to achieve the target of >7.5 in the 4 patient experience domains in 2016/17. Contributory activities across primary and secondary care continue to progress. There has been about a 20% increase in the patient portal use since last quarter with 31,807 patients are now registered and 24,550 patients activated in CCDHB. Work continues across the CCDHB Alliance to support the uptake of the patient experience survey.

2.1.3 Acute Bed Day Currently sitting at 350 acute bed days, the CCDHB system is tracking well against the current SLM milestone of <400 acute bed days (ABD) per 1000 for 2016/17. The CCDHB Alliance continues to focus on the Health Care Home model of care, increasing Primary Options for Acute Care packages and management of people that are at risk of admission. While there is an awareness that there continues to be a growing complexity of the population that may result in hospital care, continued focus in the above arena continue to increase access to acute demand in primary care and achieve positive results in overall ABDs.

2.1.4 Amenable Mortality The CCDHB system is on track to achieve the amenable mortality SLM milestone of <80 in 2016/17 plan. CCDHB continues to focus on vulnerable populations and specific conditions such as diabetes management with support from the CCDHB Diabetes Clinical Network, and supporting standardised care approaches with a total of 295 local Health Pathways now available to the sector.

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3 COMMUNICATIONS

3.1 Media

3.1.1 Media enquiries and releases There were 66 media enquiries in March. Around 30% related to patient condition updates. Key matters for the other media enquiries were: ∑ Car parking costs for patients ∑ Whitby mental health respite incident ∑ Midwives and postnatal care in our maternity unit ∑ Transition of a mental health clients into the community ∑ Smoke from generators at Wellington Regional Hospital ∑ Kenepuru afterhours clinic.

Four media releases were issued in March: ∑ ‘Stedy’ as she goes ∑ Porirua after-hours GP clinic to remain open ∑ High patient numbers causing longer waits in Wellington ED ∑ Shoe donations kick in for mental health.

3.1.2 Staff media training Our executive leadership team and clinical directors completed external media training. Twenty three staff attended the half-day sessions run by Cabix. Board members had requested this training to help our key spokespeople confidently give media interviews.

3.2 OIA Requests

Requests received in March 27

Requests sent in March 29

3.3 Website The number of visits to the website has been increasing since the new site was launched mid-November 2016. In March, the website was visited 73,097 times by 38,040 people.

The 5 most visited website pages in March were:

Website page Visits

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Homepage 52,363 (38%)

Staff login 38,005 (28%)

Search 4,498 (3%)

Contact us – how to get in touch 2,688 (2%)

Our hospitals & clinics – Wellington Regional Hospital 2,308 (1.7%)

3.4 Social Media The number of people following us on Facebook continues to increase. We have 1,600 followers.

The post which reached the most people in March was about the after-hours clinic remaining open.

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3.5 Internal Communications

3.5.1 Health Matters staff newsletter The latest copy of the Health Matters staff newsletter is attached as Appendix 1. This month we added a regular column from the Board Chair.

The March edition includes articles about: ∑ Staff flu vaccination clinics ∑ Shorter orthopaedic wait times at clinics ∑ iPads for community ORA staff ∑ What’s in the orange emergency cupboards ∑ Additional ACC revenue at Kenepuru Community Hospital.

3.5.2 Internal campaigns The main internal campaigns in March were the staff engagement survey and staff flu vaccination.

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4 CLINICAL 4.1 Cross Public Sector Governance for Wellington Region Members of the Executive Leadership Team at CCDHB participated in a workshop during March with local public sector leaders to reduce the fragmentation of the multiple existing work streams and consider options for more joined up governance of the multiple programmes of work between our agencies. The agencies represented at the workshop were; CCDHB, Police, ACC, Education, MSD, Ministry of Vulnerable Children Oranga Tamariki, and Corrections. The workshop focussed on a defining a purpose, and identifying opportunities for greater collective focus on our (usually shared, and) most vulnerable populations. From a CCDHB perspective, we anticipate being able to work with our public sector partners to increase our collective performance against the better public services targets, and as a vehicle for our social investment work.

4.2 Victoria University http://www.stuff.co.nz/national/education/90474372/Victoria-University-establishes- health-faculty-to-launch-in-2018 During March, Victoria University announced the establishment of a health faculty, with planning for commencement of courses in 2018 and beyond. The Executive Director Allied Health, Scientific and Technical at CCDHB has played a key role on the Steering Group for this work. CCDHB are pleased to support the development or a range of health related qualifications as the new faculty is expected to be a key pipeline for our future workforce, and also offers the potential for joint research projects and shared academic/ clinical roles.

4.3 Choosing Wisely The Choosing Wisely programme at CCDHB continues to gather momentum. During March the first national symposium on Choosing Wisely was held; http://choosingwisely.org.nz/. There was good attendance from a range of clinical leaders at CCDHB and the Executive

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Director Allied Health, Scientific and Technical spoke on how the programme at CCDHB has grown to engage with all healthcare professionals.

4.4 Brain Awareness Week At CCDHB we used Brain awareness week to promote Delirium awareness and to celebrate the effort CCDHB has made in 2016-2017 to improve the knowledge, prevention, detection and treatment of Delirium. There were stalls in both Kenepuru and Wellington Atrium and twice Delirium champions roamed the inpatient wards to capture staff and family members to promote delirium awareness. The delirium champions had quizzes, simulation exercises and videos depicting delirium screening test and testimonials from patients who had experienced delirium. The week highlighted wards who required some further training on delirium detection and prevention, which was scheduled. Staff were reminded of the delirium pathway and resources were distributed to reinforce the training on delirium detection. There is also a workshop planned for clinical managers in Aged Residential Care in the CCDHB area on Delirium and Dementia.

4.5 Advance Care Planning Advance Care Planning (ACP) is promoted throughout New Zealand in April each year with the ‘Conversations that Count’ (CtC) Day. The nominated day this year was 5 April. The National ACP Cooperative in conjunction with the Health & Quality Safety Commission supported this day with coordination of some national promotional activity and supply of

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some resources. Arthur Te Anini, a South Aucklander, was the ‘consumer face’ of ACP. He was involved in promotional events in South Auckland which sought national media coverage. For CCDHB we achieved the following promotional work: - CtC Stands on 5 April at 3 sites – Pataka Art & Museum, Wellington Regional Hospital, Kenepuru hospital – ACP champions spoke to over 160 visitors across the three stands - DHB web & social media coverage including Daily Dose, an intranet article and a Facebook post - distribution of promotional materials to hospice, general practices, PHO offices, outpatient areas - visits to 20 of 60 CCDHB pharmacies to ask for assistance in distributing leaflets, displaying posters and introducing ACP. This was well received by head pharmacists and some spoke at length and asked about ACP. In particular 4 asked for Pacific resources - ACP presentation on 5 April to a retirement village in Whitby (75 in attendance) - ACP afternoon tea at Mary Potter Hospice on 5 April - used the opportunity to educate staff on documentation of ACP. - Community newsletter pieces - Alzheimer’s Wellington, Age Concern Wellington, 50s Forward news & views - Library displays – Porirua & Wellington Central Library.

Also planned: - Health Matters feature (May) - ACP morning tea & presentation planned at SuperU and Office of the Children’s Commission planned for 27/4/17.

4.6 Care Capacity and Demand Management (CCDM) Care Capacity and Demand Management is the national programme that enables District Health Boards to safely and consistently match the demands in its services with the resources required to meet the demands. The aims are threefold; improve the quality of care for patients, the work environment for staff, and the organisational efficiency. During March at CCDHB, the stakeholder interviews for the discovery phase have been completed. The feedback from the interviews was that leaders and others who were interviewed were enthusiastic about the programme of work.

4.7 Registered Nurse Prescribing A CCDHB Framework for Registered nurse (RN) prescribing has been developed to support the introduction of RN prescribing in the DHB. A nurse in Compass PHO has already gone through the process of Nursing Council registration and is close to being able to prescribe to patients. The CCDHB Hospital/Community RN prescribing advisory committee is being formed to develop a consistent process to oversee and support Registered Nurse prescribing in our district.

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5 MENTAL HEALTH

5.1 CAMHS The Ministry of Health has published the latest wait time data for Child and Adolescent MHS; this includes two reports for the periods during 2016, October 2015 and September 2016.

For CCDHB data there has been a very slight drop in performance on the 3 week and 8 week measures in the last 3 months of 2016.

For Hutt there is a flat performance on the 3 week and slightly better on the 8 week.

An independent review of the service has commenced. The review includes the Service Users first presentations to the service, and how long they have to wait and what this may reflect.

The Ministry of Health data is a running average of the past 12 month’s performance (as of the end of the last quarter).

CAMHS are under huge pressure with referral volumes. For example CCDHB referral volume data for the past 2 years there has been a 27% increase.

5.2 Sick Leave and Overtime Sick Leave for March – the sick leave percentage of total hours was 1.5%; Hutt less than 1% and CCDHB 2.9%.

Overtime hours worked for the month as a percentage of total hours was 1.3% Wairarapa, 2.2% Hutt and 2.7% CCDHB.

5.3 Significant KPIs For March the 7 day post discharge Hutt 23/36 DC were seen within 7 days (3 Clients DNA two clients declined any follow-up, 2 left the area). For CCDHB 31/42 clients were seen within 7 days of DC (4 DNA, 2 Declined follow, 1 appointment cancelled by client) 28 day readmissions are for Te Whare Ahuru is 9% and Te Whare O Matairangi 10% - average length of stay for TWA is 8 days and TWOM 18 days.

Considering the total community caseload for the service in Wairarapa 95% of consumers have been seen in the last 90 days, and CCDHB 86% and in Hutt 81%.

5.4 Temporary reduction of Beds in Te Whare O Matairangi Between early April and 8 May 2017 beds have reduced from 29 to 26 in a graduated way. Beds closed one at a time as they became vacant and the emphasis was to close beds in Manaaki (less secure area) in the first instance as alternatives to hospital may be easier to manage for this client group. There is no plan to reduce Tauira beds at this stage, but this may be considered if the need arises.

This decision was not taken lightly as a number of people had raised concerns about the impact this may have on other parts of the service. Our paramount concern is to continue to provide high quality, safe services to our clients and ensuring a safe, positive workplace for

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staff. At stake here is not just how many people we can admit but the level of care that is provided to each client on a sustainable basis. We decided to reduce numbers temporarily so that clinical teams are best supported to provide the service our clients need.

Mental health staffing levels are a nationwide issue. We have recruited seven mental health nurses, as these new staff members come on board the bed numbers will return to normal levels.

5.5 CAMHS Wairarapa The CAMHS Team is presently being relocated to a purpose renovated space, with WINZ and specialist education services. The opening day was to be end of April however due to inclement weather all of the roof/outside work was delayed. Finish date will now be mid May 2017.

6 DISABILITY SUPPORT SERVICES

6.1 UPDATE ON DISABILITY SUPPORT SERVICES FOR PEOPLE UNDER 65 YEARS OF AGE Background Disability support services for people under 65 years of age with a long-term physical, intellectual and/or sensory impairment are funded and managed by the Ministry of Health. Access to these services is mostly managed through one of the 16 needs assessment and service co-ordination services (NASC).

CCDHB through its Capital Support NASC works with disabled people to identify and allocate services funded by the Ministry of Health. There services can include respite services, home help, assistance with personal cares and supported living in individual or group home and modifications to housing and vehicles. Services funded by the Ministry of Health include respite services for carers, home help, provision of equipment (such as wheelchairs) and modifications to housing and vehicles.

Meeting the needs for disabled people There are a group of people with complex health and disability needs. This high needs population are also high users of CCDHB Health and Disability Services. Recently, CCDHB looked at inpatient bed days for the high needs group. The analysis shows that the number of people who do not meet eligibility threshold or whose services have failed are staying for longer periods in acute beds and are difficult to discharge due to lack of appropriate placements.

To improve the care and more timely return to the community, CCDHB is leading a whole of life approach to needs assessment as part of a wide ranging mitigation strategy to address such needs as they arise in a timely way.

There is also evidence that the numbers of people registered with the NASC service has grown steadily annually by 15%.

Service changes announced by IDEA Services, a subsidiary of IHC IDEA Services a subsidiary of IHC has announced an exit from the following: ∑ Facility based respite ∑ Foster care ∑ Shared care

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∑ Home support ∑ Holiday and After School Programmes ∑ Contract Board.

IDEA has chosen to retain its core business provision of residential and day services.

Implications of Service Exit by IDEA The Ministry of Health communications have promised new services to be established during a transition period that is likely to be three to six months. Below we summarise some of the media information regarding the exit.

While these services only represent 5% of IDEA Services business, it is known that 250 people and their families in the CCDHB district will need to transition to a new provider. These smaller services are particularly vital to families raising children on the spectrum 1 and other highly vulnerable families support those with multiple challenging needs. They have been used to prevent an escalation to long term residential care for children, which is also a very limited and expensive resource.

CCDHB Action CCDHB is monitoring the situation closely, asking daily questions of the Ministry of Health and providing reassurance to families via Capital Support Needs Assessment Service2 and the Director of Disability Strategy and Performance.

Extract from media clipping s – Radio NZ Interview re IDEA Services Radio NZ - National, Wellington hosted by Kathryn 07 Apr 2017 Ryan 9:09 AM

Parents of thousands of children with autism are left reeling after the cancellation of programs by IHC subsidiary, IDEA Services. The Disability Services Minister put the blame on IDEA Services, saying it only informed the Ministry of Health last week. Ann Ronberg, mother of an autistic son says she was extremely frustrated with the news as their children are being shortchanged. Ronberg worries that her 15 year old son will head into a youth court or get into trouble with the police. Ronberg thinks the Ministry of Education, Ministry of Justice need to stop paying middle management consultants a lot of money to design new programs. Ronberg says her interaction with grass roots services such as the Capital & Coast District Health Board, have all been really wonderful. Ryan says the Ministry has said they will make sure that they will continue to work with IDEA to make sure the impact is minimised.

1 Autism Spectrum Disorder – people on the spectrum became eligible for Disability Support Services in 2015. Very few services remain in place for this group and those with multiple and challenging needs. 2 Capital Support is contracted from the MOH by CCDHB but has no control over funding decisions made by the MOH

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Capital & Coast DHB

Board Financial Overview

February 2017

Chief Executive Officer Chief Financial Officer Debbie Chin Tony Hickmott

CCDHB Financial Overview Page 1 February 2017

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FINANCIAL PERFORMANCE RESULT AND OVERVIEW

Result for period ended Feb 2017 February 2017 Year to Date 2016/17

Annual Account Type in $000s Actual Budget Variance Actual Budget Variance Budget 1000. Revenue 86,116 85,758 358 689,086 690,411 (1,324) 1,036,819 2000. Personnel 35,761 35,558 (203) 295,299 297,286 1,987 452,215 3000. Outsourced Services 2,575 2,411 (164) 20,939 18,602 (2,336) 28,416 4000. Clinical Supplies 9,494 8,830 (664) 76,842 75,353 (1,489) 113,316 5000. Infrastructure & Non-Clinical 7,878 8,463 585 70,356 69,725 (632) 100,942 6000. Other Providers 28,005 28,214 209 236,951 237,459 508 357,890

Total 2,403 2,283 120 (11,301) (8,015) (3,286) (15,960) Add Revised Additional Budget (3,814) 3,814 (3,814) 3,814 (12,040) Total 2,403 (1,531) 3,934 (11,301) (11,829) 528 (28,000)

The DHB result is favourable to budget by $3.9m for February 2017, and favourable to budget by $528k year to date. The DHB has an actual surplus of $2.4m for the month and a year to date actual deficit of ($11.3m).

The year to date variance had been impacted by two industrial action periods, increased throughput volumes in the hospital, the November earthquake and copper pipe costs. The final Budget for 2016/17 has been revised to a deficit projection of ($28m) for the year.

Revenue year to date is impacted by the deferral of the elective revenue due to lower volumes achieved in Hospital Services. This is offset by additional revenue for ACC related work, research funds, and inter-district revenue flow from other DHBs.

Staff costs have been contained and there are a number of staff vacancies. Medical staff vacancies in critical areas are being backfilled with locums to make sure that the patient journey is not compromised.

Clinical supplies costs have been impacted by higher pharmaceutical volumes and the release of new Pharmac drugs as well as price increases and the mix of other treatment related disposables used. A high priority in the ongoing sustainability plan is consistent reviews of clinical supplies and consumables costs and volumes. The key focus in this area is to identify cost pressures as early as possible and seek to mitigate the financial risk through process and system changes or price and product changes.

CCDHB Financial Overview Page 2 February 2017

72 26 April 2017 - CCDHB Board PUBLIC papers - FOR DISCUSSION

External Providers Review

Month - February 2017 Capital & Coast DHB - Funder Year to Date Variance Ext Provider Payments - $000s Variance

Actual vs Actual vs YTD February 2017 Actual vs Actual vs Actual Budget Last year Budget Last year Actual Budget Last year Budget Last year External Provider Payments: 4,974 4,897 5,370 (77) 396 - Pharmaceuticals 45,728 46,206 44,415 478 (1,313) (58) 28 (7) 86 51 - Laboratory Transition 141 224 826 83 685 4,826 4,747 4,668 (79) (158) - Capitation 39,368 38,649 37,954 (719) (1,414) 1,450 1,328 1,402 (122) (48) - ARC-Rest Home Level 11,881 11,525 11,326 (356) (555) 2,787 3,392 3,381 604 594 - ARC-Hospital Level 27,862 29,433 28,996 1,572 1,134 1,666 1,468 2,160 (198) 494 - Other HoP 14,437 13,794 17,879 (643) 3,442 1,922 1,753 1,105 (169) (816) - Mental Health 14,937 14,324 13,968 (613) (968) 689 689 664 1 (25) - Palliative Care/Fertility/Comm Rad 5,532 5,534 5,331 2 (201) 1,722 2,086 1,874 364 152 - Other 15,811 16,953 15,899 1,142 88 8,027 7,826 6,198 (201) (1,829) - IDF Outflows 61,253 60,816 47,790 (437) (13,463) 28,005 28,214 26,815 209 (1,189) Total Expenditure 236,951 237,459 224,384 509 (12,566)

The external provider payments variance year to date is $509k favourable to budget. The main drivers for these variances are:

∑ Pharmaceuticals $478k favourable variance due to timing of claims. ∑ Capitation costs are ($719k) adverse mainly due to MOH unbudgeted programmes. These are all offset by MoH additional revenue for new contracts. ∑ ARC rest home, hospital services have a total favourable variance of $1,216k. Services are volume driven and subject to a review process. A trend of lower average volumes has been achieved with better NASC management. ∑ HoP (Health of Older People) is ($643k) adverse due to higher claims for In Between Travel (some of which has additional funding) as well as respite service volume increases. ∑ Mental Health expenses are ($613k) unfavourable due to some services under review. ∑ Other expenses are $1,142k favourable mainly due to the release of a favourable IDF wash-up for 2015-16. ∑ IDF outflows for the current year are ($437k) adverse mainly due to sleepover settlement paid to Hutt DHB as well as increased share of 3 DHB contracts for Labs and Home Community Support.

CCDHB Financial Overview Page 3 February 2017

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Employee FTE Financial Reporting to Ministry of Health (MOH Accrued FTE) For financial accounting purposes MOH require an accrued FTE measure (as shown in the table below). This measure includes all hours on an accrual basis including leave accruals, overtime and casual hours. As an FTE measure this is highly volatile for a 24/7 facility due to the divisor being set based on the number of working days in the month. The year to date total is an average for the year. The average dollars per FTE year on year is impacted by MECA increases.

Month - February 2017 Capital & Coast DHB Year to Date Annual Variance MOH Accrued FTE Variance Variance Annual Budget Forecast vs YTD February 2017 Actual vs Actual vs Actual vs Actual vs Year end Average Annual Budget vs Actual Budget Last year Budget Last year Actual Budget Last year Budget Last year forecast FTE Last year Budget Last year FTE 873 865 896 (9) 22 Medical 866 846 852 (21) (15) 863 863 827 0 (36) 2,396 2,348 2,334 (48) (62) Nursing 2,218 2,230 2,164 12 (54) 2,257 2,257 2,099 0 (158) 674 676 682 2 8 Allied Health 696 672 722 (24) 26 688 688 763 0 75 144 144 180 0 36 Support 139 142 180 3 41 142 142 176 0 33 766 909 799 143 33 Management & Administration 831 879 843 48 12 884 884 841 0 (43) 4,853 4,942 4,891 89 37 Total FTE 4,751 4,769 4,761 18 11 4,834 4,834 4,705 0 (128) Average $ per FTE 13,501 13,558 12,619 57 (882) Medical 109,886 114,320 108,999 4,434 (887) 167,853 172,170 171,566 4,316 (603) 6,014 5,991 5,935 (23) (78) Nursing 54,161 53,697 52,323 (464) (1,838) 80,724 80,756 82,309 32 1,553 6,665 6,427 6,263 (238) (402) Allied Health 51,007 51,681 50,316 673 (692) 76,885 77,099 70,765 214 (6,334) 4,079 3,864 3,965 (215) (114) Support 34,965 33,583 31,982 (1,382) (2,983) 49,818 50,737 45,762 919 (4,976) 5,849 5,354 5,776 (494) (73) Management & Administration 47,627 47,046 45,212 (580) (2,414) 67,112 69,127 68,004 2,014 (1,122) 7,368 7,195 7,106 (173) (262) Cost per FTE all Staff 62,157 62,336 60,127 179 (2,030) 92,251 93,556 92,209 1,305 (42)

CCDHB Financial Overview Page 4 February 2017

74 26 April 2017 - CCDHB Board PUBLIC papers - FOR DISCUSSION

CCDHB STATEMENTS OF FINANCIAL POSITION Month : Feb 17 Carital & Coast DHB Variance Balance Sheet At Feb At June Actual vs Actual vs Jan YTD Feb 2017 Actual Budget 2016 2016 Budget 2016 Notes 97 93 88 12,868 4 9 1 Bank 20,638 12,996 26,096 0 7,642 (5,457) 1 Bank NZHP 8,122 7,232 7,237 7,232 890 885 1 Trust funds 37,550 35,310 38,765 44,284 2,240 (1,214) 2 Accounts receivable 8,454 7,345 8,207 7,345 1,109 247 Inventory/Stock 3,964 4,017 5,111 4,017 (53) (1,147) 2 Prepayments 78,825 66,993 85,503 75,746 11,832 (6,678) Total current assets

465,051 491,678 474,839 473,318 (26,627) (9,788) Fixed assets 9,201 8,360 4,862 8,360 841 4,339 Work in Progress - CRISP 14,731 11,987 20,762 18,395 2,743 (6,031) Work in progress 488,983 512,026 500,463 500,074 (23,043) (11,480) 3 Total fixed assets

6,468 6,468 6,468 6,468 0 0 Investments in New Zealand Health Partnership 1,150 1,150 0 1,150 0 1,150 Investment in Allied Laundry 7,618 7,618 6,468 7,618 0 1,150 Total investments 575,425 586,636 592,434 583,437 (11,211) (17,008) Total Assets

0 0 0 0 0 0 1 Bank overdraft HBL 58,741 67,461 61,683 64,504 8,720 2,942 4 Accounts payable, Accruals and provisions 81 62,326 37,081 34,326 62,244 37,000 7 Loans - Current portion 930 1,316 1,316 0 386 385 6 Capital Charge payable 77,984 69,314 69,107 69,314 (8,670) (8,877) 5 Current employee provisions 137,737 200,417 169,187 168,144 62,680 31,450 Total current liabilities

628 277,628 302,954 305,628 277,000 302,326 7 Crown loans 8,223 7,407 7,401 7,407 (816) (822) Restricted special funds 229 229 292 229 0 63 Insurance liability 5,765 5,765 6,236 5,765 0 471 Long-term employee provisions 14,845 291,029 316,883 319,029 276,184 302,037 Total non-current liabilities 152,582 491,446 486,070 487,173 338,864 333,488 Total Liabilities 422,843 95,190 106,364 96,264 327,653 316,479 Net Assets

424,373 424,817 425,976 428,302 (444) (1,603) 7 Crown Equity 0 0 0 (3,484) 0 0 Capital repaid 0 10,000 2,800 0 (10,000) (2,800) Deficit support 339,000 0 0 0 339,000 339,000 Capital Injection 23,596 24,271 23,791 24,271 (675) (195) Reserves (364,126) (363,898) (346,204) (352,825) (228) (17,922) Retained earnings 422,843 95,190 106,364 96,264 327,653 316,480 Total Equity

CCDHB Financial Overview Page 5 February 2017

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Month : Feb 17 Capital & Coast DHB Year to Date Variance Statement of Cashflows Variance Actual vs Actual vs Actual vs Actual vs YTD Feb 2017 Actual Budget Last year Budget Last year Notes Actual Budget Last year Budget Last year Operating Activities 86,114 87,056 87,082 (942) (968) Receipts 722,012 702,902 699,320 19,110 22,692

Payments 34,210 35,728 33,540 1,519 (670) Payments to employees 284,154 287,825 283,356 3,671 (798) 49,559 47,666 46,759 (1,893) (2,800) Payments to suppliers 399,264 392,423 384,445 (6,841) (14,819) 0 0 0 0 0 Capital Charge paid 3,269 4,381 4,138 1,112 869 169 (90) (90) (259) (259) GST (net) 2,054 1,586 350 (468) (1,704) 83,937 83,304 80,209 (633) (3,728) Payments - total 688,741 686,215 672,289 (2,526) (16,452) 2,177 3,752 6,873 (1,575) (4,696) 8 Net cash flow from operating Activities 33,271 16,687 27,031 16,584 6,240

Investing Activities 81 50 111 (31) 30 Receipts - Interest 1,022 525 1,329 (496) 307 0 0 0 0 0 Receipts - Other 0 0 0 0 0 81 50 111 (31) 30 Receipts - total 1,022 525 1,329 (496) 307

Payments 332 0 0 (332) (332) Investment in associates 840 0 1,902 (840) 1,062 1,048 2,500 1,519 1,452 471 Purchase of fixed assets 13,127 20,000 18,049 6,873 4,922 1,380 2,500 1,519 1,120 139 Payments - total 13,967 20,000 19,951 6,033 5,984 (1,299) (2,450) (1,408) 1,089 169 9 Net cash flow from investing Activities (12,945) (19,475) (18,622) 5,537 6,291

Financing Activities 0 10,000 2,800 (10,000) (2,800) Equity - Capital 0 10,000 5,600 (10,000) (5,600) 0 0 0 0 0 Other Equity Movement 0 0 0 0 0 0 (81) (81) (81) (81) Other 0 (243) (243) (243) (243) 0 9,919 2,719 (9,919) (2,719) Receipts - total 0 9,757 5,357 (9,757) (5,357)

Payments 4,792 0 0 (4,792) (4,792) Interest payments 11,568 6,748 7,066 (4,820) (4,502) 4,792 0 0 (4,792) (4,792) Payments - total 11,568 6,748 7,066 (4,820) (4,502) (4,792) 9,919 2,719 (14,711) (7,511) 10 Net cash flow from financing Activities (11,568) 3,009 (1,709) (14,577) (9,859) (3,914) 11,221 8,184 (15,197) (12,038) Net inflow/(outflow) of CCDHB funds 8,757 221 6,700 7,544 2,672

32,771 9,100 25,236 (23,671) (7,535) Opening cash 20,100 20,100 26,720 0 6,620 86,195 97,025 89,912 (10,892) (3,657) Net inflow funds 723,034 713,185 706,006 8,857 17,643 90,109 85,804 81,728 (4,305) (8,382) Net (outflow) funds 714,276 712,964 699,306 (1,313) (14,971) (3,914) 11,221 8,184 (15,197) (12,038) Net inflow/(outflow) of CCDHB funds 8,757 221 6,700 7,544 2,672 28,857 20,321 33,420 8,536 (4,563) Closing cash 28,857 20,321 33,420 8,536 (4,563)

CCDHB Financial Overview Page 6 February 2017

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Notes to the Balance Sheet and Cashflows A) Notes to Balance Sheet: 1. The DHB’s cash balance at the end of February is higher than budget mainly due to less than expected capital spend and other timing differences. All surplus funds are invested by New Zealand Health Partnerships in short term investments; 2. Accounts receivable is slightly higher than budget due to timing differences. Some of the main customers include Ministry of Health $5.7m, Hutt Valley DHB $2.7m, Clinical Training agency $0.8m; 3. Total non-current assets are lower than budget. This mainly due to lower than expected capital spend; 4. Accounts payable, accruals and provisions is lower than the budget mainly due to timing differences. Some of main suppliers include Spotless $1.6m, Healthcare Logistics $1.2m, Central Region Technical Advisory Services $0.6m, various Strategy, Innovation and Performance Directorate (SIPD) related accruals $22.7m; 5. Employee entitlements are significantly higher than budget. This is due to the increase in accrual for unpaid days and annual leave liability; 6. Capital charge payable is lower then budget due to the reduction in the capital charge rate from 8% to 7%; 7. Crown loans and equity are significantly different to budget. This is due to the conversion of all Crown loans to equity in February 2017. The Government has changed its policy on the capital financing of the DHB health sector. DHBs will no longer have access to Crown debt financing for funding of capital investment. Instead the Crowns contribution to DHB capital investment will now be solely funded via Crown equity injections. As a result of the new capital financing policy, in February 2017, CCDHB converted total loans of $339 million into equity. B) Notes to Cash flow statement: 8. The net cash flow from operating activities is lower than budget. This is due to timing differences; 9. The net cash flow from investment activities is less than the budget. This is due to timing differences; 10. The net cash flow from financing activities is significantly lower than the budget. This is mainly due to the non receipt of deficit support of $10m from the Ministry. The Ministry expects to pay the deficit support to CCDHB in April 2017. C) Ratios 1. Current Ratio – This ratio determines the DHB’s ability to pay back its short term liabilities. DHB’s current ratio is 0.57 (2015/16: 0.45);

2. Debt to Equity Ratio - This ratio determines how the DHB has financed the asset base. DHB’s total liability to equity ratio is 26:74 (2015/16: 83:17). For a detailed explanation, refer note 5 on Crown loans and equity under ‘Notes to balance sheet’.

CCDHB Financial Overview Page 7 February 2017

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Cash Forecast We have projected our cash position based on the proposed capital budget and a forecast deficit of $28m for 2016/17. However any deterioration in these forecasts may put the facility limit at risk and we continue to monitor this closely. The projected cash position includes deficit support of $10m which is expected to be received in April 2017. The working capital facility limit is approximately $50m.

CCDHB Financial Overview Page 8 February 2017

78 26 April 2017 - CCDHB Board PUBLIC papers - FOR DISCUSSION

PUBLIC BOARD DISCUSSION Date: 6 April 2017 Author: Dave Lewis, Health & Safety Manager Endorsed By: Thomas Davies, General Manager Corporate Services Subject: CCDHB HEALTH AND SAFETY REPORT (FOR THE MONTH OF MARCH 2017)

RECOMMENDATIONS It is recommended that the Board: a) Note the Health and Safety Report for the month of March 2017 b) Note the current Health and Safety Risks c) Note the number of Staff and Others H&S reported incidents. All information accurate at time of report production – 06/04/2017

APPENDICES 1. Health & Safety Risk Register 2. Health & Safety Incident Statistics 3. Wellness and Injury Management.

EXECUTIVE SUMMARY The report format has been slightly updated for this month and will continue to be developed over the coming months as further data becomes available.

1 RISK REGISTER – Appendix 1. There are currently 11 active health and safety risks identified on the risk register.

2 INCIDENTS – Appendix 2 H&S incident reporting is encouraged from all workers. Each incident reported is required to be investigated by the relevant manager and appropriate actions are put into place to prevent a re-occurrence. As part of the investigation managers are required to state what actions are required to prevent a recurrence and how they intend to implement them.

Higher reporting indicates a stronger health and safety culture and provides a more realistic picture of the exposure to hazards experienced by our workers. It is the actual work injury claims that accurately reflect the level of harm that is occurring.

Full details are provided in the performance summary.

2.2 Performance Summary Definitions ∑ Incidents - Total number of incidents that were reported ∑ Injury Claims - Any injury resulting in an ACC45 claim ∑ Medical Fee Only Claims - Any incident which results in an ACC45 claim for treatment but with no lost time ∑ Lost Time Injury. Any incident which results in an ACC45 lost time injury ∑ Lost Time Injury Frequency Rate - The number of lost-time injuries (per million hours worked) within a given accounting period relative to the total number of hours worked in the same accounting period (number of LTIs x 1,000,000 / number of hours worked for month).

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PUBLIC

Key: In comparrison to previous month - - Increased - Decreased - Maintained

Trend Performance Indicator (Past 12 months) Current Current Month Previous Month Target Status H&S Incidents ∑ Total Number of Reported Incidents^ 162 158 - Number of Reported Incidents - Non MHAIDS 63 59 - Number of Reported Incidents - MHAIDS 99 100 ∑ Number of Notifiable Events 0 0 0 ∑ Number of Incidents involving visitors 0 0 ∑ Number of Incidents involving contractors 0 0 Staff & Others Incident Lag Indicators ∑ Blood or Body Fluid Exposure 16 13 ∑ Slips, Trips, Falls 10 7 ∑ Physical Assault of Workers - Excluding MHAIDS 6 6 ∑ Physical Assault of Workers - MHAIDS 30 19 ∑ Patient Handling 4 2 ∑ Object Handling 7 7 ∑ Hit by or Ran into Object 4 3 Leading Indicators - Meeting Target - Below Target ∑ % of Pre-Employment Health Screening 70% 89% 100% completed prior to start+ Information not available at time of report production ∑ % of H&S Fundamentals Managers completed 76% 70% ∑ % of H&S Incidents investigated within 14 days* 61% 58%

Claims & Injury Statistics Trend – General Trend - MHAIDS HAIDS

current period excluding (Past 12 months) (Past 12 months) M General General MHAIDS –

∑ Number of Injury Claims 12 4 ∑ Number of Medical Fees Only Claims 7 0 ∑ Number of Lost Time Injuries 5 4 ∑ Number of Lost Days 34 59 ∑ Lost Time Injury Frequency Rate 17 28

+Pre-employment health Declarations being returned with less than the required 2 weeks’ notice is the cause of this *A two month lag in reporting is required to allow for accurate reporting

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2.3 Lost Time Injuries (LTI) Current Month Days Category of Incident Directorate Service Lost Physically Assaulted MHAIDS Forensic & Rehabilitation 31 Slip, Trip, Fall MHAIDS Intensive Recovery 2 Physically Assaulted MHAIDS Intellectual Disability 10 Physically Assaulted MHAIDS Intellectual Disability 16 Slip, Trip, Fall Medicine, Cancer & Community Community Health 6 Kenepuru, Kapiti & Physically Assaulted Medicine, Cancer & Community 10 Community Services Patient Handling Surgery, Women & Children’s Child Health Services 7 Slip, Trip, Fall Surgery, Women & Children’s Cardiothoracic 4 Object Handling Surgery, Women & Children’s ICU 7

Previous Month Days Category of Incident Directorate Service Lost Physically Assaulted Medicine, Cancer & Community Emergency Department 7 Physically Assaulted MHAIDS Intellectual Disability 5 Physically Assaulted MHAIDS Inpatient Unit - HVDHB 4 Injured in Restraint MHAIDS Intellectual Disability 3

Past 12 months

2.4 Notifiable Events – No notifiable events were reported in March 2017 There have been 2 Notifiable Events reported in the past 12 months

2.5 Serious Injury Reduction - The Government has set a target of reducing serious injuries and fatalities in the workplace by at least 25% by 2020. As can be seen from 2.3 above, CCDHB has a very low incidence of Notifiable Events which are serious injuries and fatalities.

3 WELLNESS AND INJURY MANAGEMENT – Appendix 3 3.1 EAP – After a slight rise, the number of employees referring to EAP has declined again. Information is now provided in appendix 3 to show the number of referrals by Directorate as well as the reasons stated for referral.

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PUBLIC 100

50

0 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Total number of Clients: New clients: Total number of Sessions:

3.2 Workplace Injury Management - Wellnz - A Government syndicated contract commenced on the 1st January 2017. We should start to see a reduction in the monthly management costs form the end of January 2017 onwards.

Lumbar sprain injuries remain the most frequent type of injury reported with moving and handling being the largest reported causes of claims.

4 EMPLOYEE PARTICIPATION AND ENGAGEMENT

4.1 Health & Safety Representative (HSR) Elections Information was been sent Directorate General Managers and Executive leads to disseminate to managers. The election process commenced in February 2017 and elections took place in March. We are still awaiting returns from a number of areas with details of their new or re-elected Reps. When a full list is obtained appropriate training will be organised.

5 OTHER BUSINESS 5.1 Annual Influenza Campaign The annual vaccination campaign commenced on the 27th March.

We will be holding a series of fixed clinics followed by mobile vaccination clinics throughout all of the DHB sites and community bases. This will be followed by drop-in clinics from the 24th April.

The campaign will be supported by in-house ‘champions’ who will be offering vaccinations within their own areas.

The graphs below show the number of employees vaccinated as at the end of business on the 31st March 2017 and also displays Directorate and employee group totals.

This information is available to all managers via payroll Kiosk and will enable them to monitor their own areas, and to drive the campaign in their areas.

Numbers of employees vaccinated % of employees vaccinated by by worker group Directorate Page 4 of 17

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APPENDIX 1 – HEALTH & SAFETY RISK REGISTER AS AT 31ST MARCH 2017 Post Risk Profile Pre Pre Post Post Risk Risk Risk Risk Mitigation Change in Risk Description Mitigation Mitigation Mitigation Mitigation Mitigation Number Owner Rating Category Residual Reporting Likelihood Consequence Likelihood Consequence Risk rating Period

118 Asbestos Management Clinical Unlikely High 2 H&S Removal of asbestos containing Likely High 2 No change The presence of asbestos Support material (ACM) will only be containing material (ACM ) is undertaken as required. known to be present in buildings constructed prior to 2000 and Asbestos removal or could result in exposure to investigation activities are asbestos fibres during activity currently occurring around where the product is friable or campuses using certified disturbed during maintenance or asbestos management construction activity contractors. Register in place

Trades staff have been provided specific PPE and training when there is a need to manage asbestos QIPS Overfilled Linen Bags DON&M Likely High 2 H&S Allied Laundry have agreed to Unlikely High 3 No change 15/15 Overfilled linen bags and sew the current linen bags to (CSS12 incorrect placement in disposal make them smaller and to 28) rooms could lead to injury for replace older bags with small support staff during manual bags. handling. At current rate, estimated to date to have them all gone and replaced is 01/01/2018 SWC Inadequate Physical Space Delwyn Likely High 2 H&S Feasibility for additional adjacent Unlikely High 3 No change 0210 Genetic Services has had a space being explored. QM SWC Hunter significant service expansion this has now resulted in inadequate physical space and has the potential to adversely impact on future service expansion.

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PUBLIC Post Risk Profile Pre Pre Post Post Risk Risk Risk Risk Mitigation Change in Risk Description Mitigation Mitigation Mitigation Mitigation Mitigation Number Owner Rating Category Residual Reporting Likelihood Consequence Likelihood Consequence Risk rating Period

130 Staff Risk of Exposure to Blood COO Likely High 2 H&S Staff training in required blood, Unlikely High 3 This risk is and Body Fluids monitored on body fluid safety process and Staff caring for patients are at a continual action required if exposed. risk of exposure to blood and basis with any body fluids that has the potential Regular monitoring of BBFE identified to cause them long term harm. reportable events. incidents Hazard Register 7 South/Ward 2 managed as as a residual hazard risk rating of and when a 2. they occur

129 Slips, Trips & Falls COO Likely High 2 H&S Prompt reporting of contributing Unlikely High 3 This risk is Staff through work duties at risk factors for repair, staff monitored on of slips, trips and falls which has awareness and education, a continual the potential for harm. regular monitoring of reportable basis with any events. identified Hazard Register Kenepuru incidents Theatres a residual hazard risk managed as rating of a 2 and when they occur by the relevant manager. Dedicated incident investigation for is available for managers to utilise to aid in their investigations .

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PUBLIC Post Risk Profile Pre Pre Post Post Risk Risk Risk Risk Mitigation Change in Risk Description Mitigation Mitigation Mitigation Mitigation Mitigation Number Owner Rating Category Residual Reporting Likelihood Consequence Likelihood Consequence Risk rating Period 139 Manual Handling – Patient & COO Likely High 2 H&S Manual handling training, regular Unlikely High 3 Discussions are Object (Risks 127 & 128 monitoring of reportable events. still taking place combined) Hazard Register Kenepuru regarding the While moving patients’ and Theatres a residual hazard risk redevelopment equipment staff at risk of a rating of a 2 of the current manual handling injury method of training delivery to meet the requirements of the NZ Moving & Handling Guidelines

155 Management of Aged SIDU Likely High 2 H&S All providers have been Likely Moderate 3 Please see Residential Care Contracts reminded of their responsibilities mitigation The management of contracts under the ACT. Portfolio section for aged residential care need to Managers will meet with all be aligned to the requirements providers over the course of the of the Health and Safety at Work year to ensure that provider Act 2015 Boards have considered their responsibilities and identified their high risks and have mitigations in place. Contract clauses have been reviewed and are considered sufficient to discharge the DHB Boards responsibilities. Audits cover H&S and ARC in particular to ensure policies are followed. Note DAA auditors of ARC facilities are required to meet international standards. The DHB Contractors policy (control of contractors)

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PUBLIC Post Risk Profile Pre Pre Post Post Risk Risk Risk Risk Mitigation Change in Risk Description Mitigation Mitigation Mitigation Mitigation Mitigation Number Owner Rating Category Residual Reporting Likelihood Consequence Likelihood Consequence Risk rating Period has been reviewed and is due to be disseminated for consultation. Contracts for services will be reviewed to ensure are consistent with the policy requirements.

116 Temperature at Ward Block COO Likely High 2 H&S Monitoring the temperature Likely Moderate 3 27/3/17- Kenepuru Hospital routinely. Discussed at Fluctuating environmental MCC temperatures in clinical areas When entering reportable event within the ward block informing staff to record the Governance throughout the year. The actual temperature at the time. No change temperature variance is Encourage staff with regular QM, MCC unpredictable as can change hydration to prevent dehydration dependant on weather when temp exceeds acceptable conditions. levels. This impacts on delivery of patient care, staff and general Portable Dyson fans in place business. combined with other portable fans.

Portable air conditioning units in medication rooms

Open windows within the limits of safety dependant on patients group

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PUBLIC Post Risk Profile Pre Pre Post Post Risk Risk Risk Risk Mitigation Change in Risk Description Mitigation Mitigation Mitigation Mitigation Mitigation Number Owner Rating Category Residual Reporting Likelihood Consequence Likelihood Consequence Risk rating Period

67 Physical Assaults on Staff COO Likely High 2 H&S A gap analysis has been Unlikely High 3 Draft (QIPS19 On-going high rate of physical completed looking at current Management /15) assaults on Emergency GM practice and strategies against of Workplace Department and MHAID DHB MHAID staff by patients. appropriate standards. Violence & The report and Aggression recommendations have been and Lone & reviewed. A time framed action Community plan has been completed and Worker was discussed at the Health & procedures Safety Steering Committee on are out for the 14/06/2016. consultation Mitigations: 1. Policy - Management of healthcare incidents – All events have a reportable event lodged for visibility. 2. Policy – Security & presence of a security orderly 24/7 3. Meeting between Charge Nurse manager and Police Liaison to discuss individual cases/define process. 4. Violence Intervention Programme training for ED staff 5. Monitoring group is well established in MHAID

NB: Purehurehu/Tawhirimatea Hazard Register a residual risk of a 2. ED hazard register residual risk rating to be reduced as MCC risk 68 closed.

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PUBLIC Post Risk Profile Pre Pre Post Post Risk Risk Risk Risk Mitigation Change in Risk Description Mitigation Mitigation Mitigation Mitigation Mitigation Number Owner Rating Category Residual Reporting Likelihood Consequence Likelihood Consequence Risk rating Period 148 Increased Risk to Staff and Staff control and restraint MHAID Likely High 2 H&S Likely Moderate 3 The MHAIDS Patients of Physical Assault training. 3DHB Violence Risk of physical and psychological harm to staff and other patients Use of environmental restraint Monitoring as a result of long stay patient of Committee has Tawhirimatea Rehabilitation Unit Use of seclusion Personal alarms been set up to with persistent assaultive and duress devices Patient support the behaviour associated with a management/treatment plan organisations’ chronic treatment resistive goal to mental health condition. A moderate to long term plan minimise the has been formulated to risk of harm to transition the patient into a staff or others purpose build facility. due to workplace hazards specifically, assault or threatening behaviour (as defined in the 3DHB Management of Workplace Violence Policy). Replacement 162 Ceiling Tiles/Seismic Event Clinical Likely High 2 H&S Initial assessment needs to be Likely High 2 Potential risk of failure undertaken to identify areas soft fibre tiles & /movement of unsecured heavy most at risk from a failure. Heavy will be trialled Support in a small area plaster ceiling during a design plaster ceiling tiles weighing Services before the end level seismic event which may between 11 and 15kg each are of April. The lead to serious harm likely to be the most trial is designed predominant component to determine creating risk and are present in the logistics of

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PUBLIC Post Risk Profile Pre Pre Post Post Risk Risk Risk Risk Mitigation Change in Risk Description Mitigation Mitigation Mitigation Mitigation Mitigation Number Owner Rating Category Residual Reporting Likelihood Consequence Likelihood Consequence Risk rating Period all buildings over 20 years old. replacement.

Areas such as corridors and lift foyers represent higher potential risk due to minimal areas to take cover.

Solutions based on replacement / restraint need to be considered in conjunction with the campus master plan to determine recommended solutions, cost, ability to implement during normal operation and priority.

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APPENDIX 2 – MONTHLY H&S INCIDENT STATISTICS

2.1 Total Reported Incidents

2.2 Reported Physical Assaults and Abusive/Threatening Behaviour Incidents

2.3 Reported Incidents by Directorate

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PUBLIC 2.4 Injury Claims There were 16 incidents which resulted in injury claims this period

6 4 2 0 Clinical & Support Hospital & Medicine, Cancer MHAIDS Surgery, Women & Services Healthcare & Community Children Services

YEARLY STATISTICS (past 12 months)

2.5 Total Reported Incidents

2.6 Reported Incidents by Directorate

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PUBLIC APPENDIX 3 – WELLNESS & INJURY MANAGEMENT

3.1 EAP SERVICES STATISTICS (last 12 months)

3.1.1 Costs – Total = $85,201.34

$15,000.00

$10,000.00

$5,000.00

$0.00

3.1.2 Monthly Referrals to EAP by Directorate

Clinical & Support Not Stated, 7 Services, 5

Corporate Services, 4

Surgery Womens & Medicine, Children, 8 Cancer & Community, 5

SIPU, 1 MHAIDS, 7

3.1.3 Reasons for Referrals (as stated by worker)

Workload, 2 Bullying, 4 Trauma, 1

Safety, 1

Restructuring, 1 Career, 2

Relationship with Discipline, 2 Manager, 3

Environment, 1

Relationship with Harassment, 1 Co-Worker, 3 Performance, 1

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PUBLIC 3.2 Injury Management Costs 3.2.1 Monthly costs (last 12 months)

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Total Case & Claims $9,814.00 $12,471.00 $17,095.00 $22,541.00 $24,386.90 $29,942.55 $26,483.35 $26,478.75 $30,065.60 $27,908.20 $37,079.71 $29,979.35 $294,245.41 Management

Medical Fees $17,124.34 $18,138.57 $22,050.86 $29,087.77 $14,381.36 $62,962.20 $32,905.90 $35,524.90 $29,368.29 $14,309.65 $32,719.80 $56,855.82 $365,429.46

Total $26,938.34 $30,609.57 $39,145.86 $51,628.77 $38,768.26 $92,904.75 $59,389.25 $62,003.65 $59,433.89 $42,217.85 $69,799.51 $86,835.17 $659,674.87 Notes: ∑ Sept-16 - has shown a spike in costs mainly due to $30,514.65 being paid out in surgery fees ∑ Feb-17 - has shown a spike inmedical fees due to $7,759.29 in surgery fees, $2,720 in dental fees and $10,185.32 in specialist consultation fees ∑ Mar-17 -included a fee for surgery of $32,612.08

$70,000.00

$60,000.00

$50,000.00

$40,000.00

$30,000.00

$20,000.00

$10,000.00

$0.00 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

ACCPP Case & Claims Management Medical Fees

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3.2.2 Medical Fees Breakdown by Directorate March 2017

$60,000.00 $49,413.12 $50,000.00 $40,000.00 $30,000.00 $20,000.00 $4,961.04 $10,000.00 $640.14 $752.66 $1,268.12 $0.00 ($179.26) ($10,000.00) CSS CS HHS MCC MHAIDS SWC Note: MCC incurred expenses of $8,036.64 but received a refund of $8,098.32

Past 12 Months

$200,000.00 $169,993.82 $150,000.00

$100,000.00 $75,836.12 $59,521.63 $58,722.28 $50,000.00 $168.67 $1,849.32 $2,282.20 $0.00 CEO CSS CS HHS MCC MHAIDS SWC

Key: CEO = CEO’s Office HSS = Hospital & Healthcare Services MHAIDS = Mental Health, Addictions & Intelectual Disabilities CSS = Clinical & Support Services MCC = Medicine, Cancer & Community SWC = Surgery , Women & Children CS = Corporate Services

3.2.3 Injury Claims by Category (past 12 months)

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3.2.5 Claims Summary by Accident Date

Medical Fees No. of Lost Month No. of Claims Days Lost* Only Claims Time Injuries

Apr-16 21 16 5 47 May-16 30 21 9 162 Jun-16 23 17 6 44 Jul-16 31 18 13 212 Aug-16 25 15 10 134 Sep-16 19 12 7 40 Oct-16 23 14 9 103 Nov-16 18 15 3 134 Dec-16 25 20 5 118 Jan-17 25 18 7 134 Feb-17 29 25 19 19 Mar-17 16 7 9 93 *The number of days lost are attributed to the month in which the lost time injury occurred i.e the 212 days lost in July 16 is the cumulative days lost relating to the 13 LTIs since then, not the days lost in the month.

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BOARD DISCUSSION

Date: 11 April 2017

Author Chris Lowry, General Manager, Hospital and Healthcare Services

Endorsed by Debbie Chin, Chief Executive

Subject HOSPITAL SERVICES MARCH MONTH END REPORT

RECOMMENDATIONS It is recommended that the Board: a) Note the contents of this report b) Note the balanced scorecard.

APPENDICES 1. Electives recovery plan 2. CCDHB monthly balanced scorecard.

1. HEALTH TARGETS

1.1 Acute Flow – Shorter stays in emergency department (SSiED)

Target: 95% of patients will be admitted, discharged, or transferred from the Emergency Department within six hours

1.1.1 Current Performance CCDHB performance against the SSIED target for the month of March 2017 was 91.1%. The result is a reduction on the results for January and February but still shows an improvement.

Numerator: Patients Denominator: Variance Month Percentage with LOS less than Six The total patients from 95% Year within Target Hours seen in the ED Target Jan-2017 4,490 4,854 92.5% (2.5) Feb-2017 4,317 4,666 92.5% (2.5) Mar-2017 4,849 5,322 91.1% (3.9) Total 13,656 14,842 92.0% (3.0)

The result for Quarter 3 is 92% which is an improvement from the 88% achieved in Quarter 2. Summary of Key features for the last month

Admitted patients compliance was 83%. 96% of ED patients were treated and discharged within the 6hr SSiED target.

The total ED volumes and subsequent admissions continue to be contributing factors with ED averaging 179 patients a day for March 2017. This is in an increase on average of 6 patients per day and is the highest ever average recorded in Wellington ED.

Capital & Coast District Health Board Page 1 April 2017

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Bed occupancy also continues to be a contributing factor to SSiED compliance. The occupancy percentage utilisation for March 2017 was 94.4% which is above an optimum occupancy of 90 – 92% %.

CCDHB Occupancy and SSIED Rate 100%

95%

90%

85%

80%

75% Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- 2016 2016 2016 2016 2016 2016 2016 2016 2016 2016 2016 2017 2017 SSIED 91% 90% 92% 92% 88% 85% 84% 86% 86% 89% 90% 93% 93% Occupancy 92% 93% 92% 97% 97% 97% 97% 97% 97% 92% 92% 94% 94%

SSIED Occupancy

Frances Health (FH) has continued to work with a focus on the Emergency Department and General Medicine over March. Acute flow improvement projects are well underway with trials of new models of care in progress.

1.1.2 Emergency department (ED) Two changes have been tested and are now business as usual within the emergency department. These include: ∑ Two cubicle beds swapped for chairs where chairs are now being utilised by patients who are stable and ambulatory and likely to leave the department or be admitted within two hours. This is resulting in an increase in capacity of the department with the triage teams noting swifter transfer of patients from the waiting room ∑ Regular rapid rounds at 11:00, 17:30, 22:00 with a walk round at 14:00. Rounds are led by the Senior Medical Officer’s (SMOs) and driven by the Patient Flow Coordinators. Situational awareness, communication and teaming have improved as a result, at least one patient per round on average has their disposition decision changed and the triage teams felt well supported. Four tests of change have been completed over the past month for the new pod model of care. The new model allows for: ∑ A dedicated acute flow Senior Medical Officer (SMO), with no clinical load freeing up other SMOs to focus on a full clinical role ∑ More senior presence on the floor allowing for more timely assessment and decision making ∑ The green zone and triage areas are feeling more supported

1.1.3 Emergency Department and the Medical Assessment and Planning Unit Interface There are three processes being reviewed to support improvement in the interface between the Emergency Department (ED) and the Medical Assessment and Planning Unit (MAPU). These include: ∑ Patient transfer time from ED to MAPU – the current process of ED referrals to MAPU has been mapped for discussion with the teams and identification of areas for improvement

Capital & Coast District Health Board Page 2 April 2017

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∑ A rapid cycle test of change has been completed for the MAPU to Radiology patient transfer MAPU is now taking responsibility for orderly requests. Communication between SMOs and RNs is being refined to mitigate any delays in transfer ∑ The process to divert patients direct to MAPU is also being explored.

1.1.4 Facilitating ambulatory care in MAPU The aim of this improvement is to safely discharge greater number of patients on the day. This was trialled for 5 days the last week of March. Good feedback has been received from medical and nursing staff and plans are being made for a second trial in April.

1.1.5 Timely Discharge A number of initiatives are in the process of being tested or implemented in the acute medical areas that will assist with improvements in process, more timely discharge and the freeing up of capacity earlier in the day to support patient flow. ∑ A Discharge Nurse model has been developed and is being implemented on the two acute medical wards. This involves one registered nurse being assigned in each pod of the ward to manage all discharges and support improved management of discharges and earlier time of discharge. The model is being documented with the aim of embedding this across both wards and to support rolling this out across the other adult in patient wards. Text messaging is being used to improve communication between SMOs and Charge Nurse Managers about changes to plans/failed discharge. ∑ Prioritising discharges on ward and board rounds - 3 SMOs are currently trialling rounding on patients likely to be discharged earlier in the day. ∑ Capturing accurate estimated date of discharge (EDD). The EDD is currently estimated for each patient however the current process is not as accurate as it needs to be. EDD stickers are also being trialled to support an improved process. Some improvements in the time of discharge are already being seen as demonstrated in the graphs below:

MAPU Timely ED-MAPU Ambulatory Discharge Long Stay 6 East and 5 South Earlier Ward Discharges

57% increase in discharges before 12pm

51% leaving before 12pm

- Acutely admitted Gen Med Patients discharged from 6E & 5S - Trial Period observed: 7-9 March, 14-16 March, 21-24 March (Combined Average)

Page 16 | April 2017 | Prepared by: Francis Health

Capital & Coast District Health Board Page 3 April 2017

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1.2 Elective Services

1.2.1 Elective Discharges Health Target The Electives Discharges target for 2016/17 is 10,713 discharges. As at the end of March 2017, CCDHB is a net 271 discharges behind target. This is an improvement from the 459 discharges unfavourable to the health target that was reported for February.

The breakdown of performance against each component for the year to date and forecast year end result is detailed in the table below:

True Electives (elective surgical discharges Recovery Plan Mar YTD position from a surgical PUC) (YEnd) position Inhouse production -372 -193 Outsourced -80 58 IDF Outflow 11 ^ 4 Electives Total -441 -131 Other Discharges (arranged discharges from a surgical PUC, arranged surgical discharges from a medical PUC etc) CCDHB 170 214 IDF Outflow 0 0 Other Discharges Total 170 214 Health Target plus Additional TOTAL -271 83 Health Target % (against 100% target) 97.47% 101.75%

1.2.2 Recovery Plan The recovery plan has been further reviewed following the March results. Our current year end forecast, based on this plan, is 198 discharges favourable to the 100% target. Although there remains some stretch in the last quarter of the recovery plan we do expect to achieve the electives health target. Detailed recovery plan attached – Appendix 1 In House Production For the month of March we exceeded our inhouse recovery plan target of 690 discharges by 24, achieving 714 local elective discharges. Although all services increased throughput, the recruitment of locums to ENT and General Surgery contributed significantly to the improvement in discharges for the month. We have been unable to recruit locums or permanent SMOs to vacancies prior to this time having experienced significant delays relating to overseas candidates obtaining registration and APCs to work in NZ. Gynaecology also had a very productive month and achieved 118 discharges, and Orthopaedics had a slight increase of 14 discharges from the previous month despite having a vacancy of one of the two backfilling SMO positions. Outsourcing The original plan and budget provided for 974 discharges which have been reforecast to 1022, while staying within the original budget. The additional discharges are required to achieve the required CWDS to ensure we access all available elective services funding as per the Elective Funding Schedule which is incorporated in CCDHB revenue budgets. The risk with this forecast is mostly associated with finding patients who meet outsourcing criteria in terms of low complexity surgery and low comorbidities. To increase the outsource volume we have identified non cataract ophthalmology, general surgery and gynaecology procedures to contract out.

Capital & Coast District Health Board Page 4 April 2017

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1.2.3 Elective Services Performance Indicator (ESPI) compliance September October November December January February March April * ESPI 2 21 23 13 11 15 9 13 9 ESPI 5 3 6 13 15 19 19 5 2

March ESPI 2 (First Specialist Assessment), and ESPI 5 (specialist treatment) results are not yet confirmed by the MoH however our internal reporting identifies that we remain within the threshold for compliance. We are forecasting nine non-compliant ESPI 2 and two patients non-compliant for ESPI 5 at April month end. This will be within accepted tolerance levels.

1.2.4 Cardiothoracic waiting list Currently the cardiac waitlist is sitting at 72, one above the maximum of 71. There have been a number of cancellations as a result of ICU capacity over March. The strategies to minimise this risk have been reviewed and a number of additional actions identified which will be progressed over the next weeks.

1.3 Faster cancer treatment

1.3.1 62 Day Cancer Target: Target 85%

The target is that patients receive their first cancer treatment within 62 days of being referred with a high suspicion of cancer and the triaging clinician believes the patient needs to be seen within two weeks.

The 62-day wait is measured from receipt of the referral to the date of the patient’s first cancer treatment (or other management). The target is that by July 2016, 85 per cent of patients meeting the criteria should commence treatment within 62 days, increasing to 90 per cent by June 2017.

Approximately 25 per cent of newly-diagnosed cancer patients will be covered by the 62-day target. A large proportion of newly-diagnosed cancer patients will continue to access treatment through pathways not covered by the target.

On recent data released by the MoH, CCDHB has achieved 79.9%. This is a slight deterioration from the previous month and is currently being investigated.

1.3.2 31 Day Indicator Patients with a confirmed diagnosis of cancer to receive their first cancer treatment within 31 days. In March 36 patients were included at time of reporting, 34 patients (94%) were within the indicator timeframe

A number of activities are in progress to ensure the target is met. These include:

∑ Raising awareness through ICT solutions including a new multi-disciplinary meeting dashboard developed, an FCT Alert now on the patient management system, an official FCT column added to the waitlist which is prepopulated from request for surgery. This identifies patients with cancer and will expedite surgery ∑ Raising awareness through engaging with whole of DHB and neighbouring DHBs including a review of the governance group, sub-regional Breach/Exclusion, next meeting at HVDHB. Monthly local breach meetings continue.

Capital & Coast District Health Board Page 5 April 2017

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1.4 Shorter wait time for diagnostics

1.4.1 Colonoscopies The service had been achieving the wait time indicators for colonoscopies however the increasing demand on the service had impacted on this. Waiting times have improved over the past two months and targets are now being met except for surveillance colonoscopies. Urgent Colonoscopy

Internal Diagnostic reports for March indicated that 90% of people accepted for an urgent diagnostic colonoscopy received their procedure within two weeks (14 days) against a Target of 85%. Target Met.

Non-Urgent Colonoscopy

Internal Diagnostic reports for March indicated that 99% of people accepted for a non-urgent colonoscopy received their procedure within six weeks (42 days) against a Target of 70%. Target Met.

Surveillance Colonoscopy

Internal Diagnostic reports for March indicated that 46% of people waiting for surveillance waited no longer than twelve weeks (84 days) beyond the planned date against a Target of 70%. Target Not Met.

The service has outsourced 80 cases; 40 have been done to date with a further 40 planned in April.

Additional funding is being made available by the Ministry of Health therefore a further 80 cases will be outsourced to support a reduction in the wait list size and ensure all waiting times continue to be met.

1.4.2 Acute coronary syndrome (ACS) Performance against the key indicators continue to be met.

1.4.3 Radiology CT and MRI Ministry of Health (MoH) Targets

CT performance for March was 78% against a target of 95% - Target not met

MRI performance for March was 48% against a target of 85% - target not met

CT: CT continues to remain short of the MOH target although there has been a slight improvement over the past two months. The CT replacement project is also impacting on performance which will continue over April and May

MRI: Output has increased however there has been no improvement in performance against the MOH indicator. A large increase in demand and staffing challenges continue to impact on the ability to schedule examinations. Outsourcing with the funds budgeted for MRI / MRT’s will continue until successful recruitment.

Capital & Coast District Health Board Page 6 April 2017

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2. STRATEGIC PRIORITIES

2.1 Integrated Operations Centre A number of initiatives are being progressed that support improved management and coordination of on patient areas across the organisation. These include:

∑ Trendcare implementation Trendcare is a validated acuity or work load measurement tool which has been implemented across the inpatient areas of the DHB . The tool allows for the allocation of resources aligned to work load. There has been a lot of focus on this over the past three months to ensure the implementation is sound and the data is now being utilised to inform reallocation of staff and the requirement for casual staff. TrendCare reporting requirements have now been confirmed and will be in place from March. These will be available in the information portal with the ability to filter and drill down on information. An interim TrendCare scorecard report has been developed for reporting to the Executive and allows for organisation wide reporting and monitoring. ∑ Capacity planner The procurement and implementation of a capacity planning tool has been identified as a priority to support the sustainability plan going forward. A business case has been developed and a preferred provider identified. The plan is to purchase the tool once approved and support a rapid implementation to ensure we are able to realise the benefits as soon as possible. The tool supports patient management and forecasting of demand which allows for improved planning and allocation of staffing resource. ∑ Pager Replacement project As reported to the board previously the current paging system will no longer be supported from July 2017. A project team has been established and project brief developed to support the identification and implementation of an interim solution. Development of solutions is well underway for a planned go live from May 30. This will allow for any issues to be resolved through the month of June.

2.2 ICU Expansion

The plans for the extension of the ICU have been finalised with the best option now signed off by the clinical teams. The plans allow for a six bed extension to the unit which includes appropriate administration and support areas for the unit to be incorporated within the current ICU footprint. The plan is consistent with the early thinking for the master site plan and the copper pipe remediation plans. The business case will now be finalised and submitted to the Board for approval in May.

3. FINANCIAL PERFORMANCE

3.1 Heading 2 The financial position for the Hospital and Healthcare Services (HHS) for the month of March was xxx favourable and is now yyyy unfavourable YTD

TBC.

4. ACTIVITY SUMMARY

TBC

Capital & Coast District Health Board Page 7 April 2017

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BOARD INFORMATION

Date: April 2017

Author Tara D’sousa (acting Service Manager) and Kristen Foley (acting Business and Analytical Support Manager), Regional Public Health Nicky Smith, Service Manager, Community Dental Service Lindsay Wilde, Service Manager, Regional Screening

Endorsed by Dale Oliff, Chief Operating Officer Dr Ashley Bloomfield, Chief Executive

Subject POPULATION HEALTH UPDATE

RECOMMENDATION It is recommended that the Board: a) Note the contents of this report, which outlines key recent public health activities from our regional services.

APPENDIX 1. Regional Public Health Post.

1. PURPOSE

This report updates the Board on the Population Health Group (Wellington Regional Dental Service, Regional Screening and Regional Public Health) activities to date.

WELLINGTON REGIONAL DENTAL SERVICE

2. BACKGROUND

HVDHB is the current Ministry of Health contract holder for the Community Dental Service which currently encompasses 13 dental hubs and 11 mobile vans covering Wellington (including Kapiti – Mana) and the Hutt Valley.

3. UPDATE OF LAST TWELVE MONTHS

3.1 Facilities The project build and refurbishment of dental hubs was completed in early 2016 with all hubs fully operational in conjunction with the 11 dental vans from May 2016 onwards.

3.2 Clinical issues and Quality Innovation Clinical issues that are currently impacting on the service are clinical assurance of dental therapist skills, aligned to the New Zealand Dental Council requirements. From July 2017 onwards, all Dental Therapists working clinically in the service will undergo a bi-annual clinical appraisal, in conjunction with their annual operational appraisal.

Capital & Coast District Health Board / Hutt Valley District Health Board Page 1 [April 2017]

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High “did not attend rates” (DNA), particularly for Māori and Pacific children continue to account for the high DNA rates overall. To address this, the Service Manager and Clinical Director have commenced meeting 6 weekly with CCDHB ELT members for Māori and Pacific and the CCDHB portfolio manager to address working differently to tackle the cause of these high DNA rates. In addition, the community dental team will also be working in conjunction with the HVDHB Māori and Pacific Directors to mirror this work moving forward. These collaborations are to ensure line of sight for both CCDHB and HVDHB and encourage working partnerships, for addressing dental needs of children enrolled within these DHBs.

In addition, clinical audits on children who do not attend appointments will be undertaken from May 2017 onwards by the service team leaders; this will ensure that clinical processes in regards to tracking these children are being followed by Dental hub staff.

The Service is trialling an initiative for offering holiday appointments, in conjunction with Ora Toa (Primary Health Organisation) in Cannons Creek Porirua, with the use of a dental van in the second week of Easter school holidays. This initiative is open to all pre- and primary aged school children of Cannons Creek (not solely children enrolled with Ora Toa) and is available through both appointment times and drop-in sessions. This trial will be evaluated on children seen at this venue, who were overdue for a dental examination, with the plan to roll this initiative out wider for the next school holidays to other high quintile areas i.e. Newtown.

The Community Dental Service has also applied for Dental Council accreditation to provide training for the scope of Stainless Steel Crown and pulpotomy (two treatment options that therapists trained prior to 2004 do not have in their scope).Having a service where all therapists are able to offer this treatment where appropriate means the treatment over the service is consistent and well aligned to evidence based best practice. The placement of a stainless steel crown in appropriate cases is a longer lasting option that will over the course of a person’s childhood reduce treatments and re-treatments. Once accredited, the Wellington Regional Dental Service will also be able to offer this as a training resource to other DHB dental services to generate revenue for HVDHB.

3.3 Regional Dental Service Balance Scorecards Below the February 2017 balance scorecards for the service across both HVDHB and CCDHB.

Capital & Coast District Health Board / Hutt Valley District Health Board Page 2 [April 2017]

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As previously highlighted, the DNA rate for Māori and Pacific continue to be an issue in which the service is now considering different strategies to ensure that these children receive the dental care required; ultimately this will have a positive impact on their long term dental outcome. Part of this initiative is expanding the Early Intervention Prevention Team’s scope on working with Kindergartens and Te Kohanga to undertake knee to knee checks; this removes an initial barrier to the service, allows identification and engagement with children at risk of developing caries and ensures that they are followed up in a timely manner by the service.

3.4 Leadership and Staffing A 1.0 FTE Service Manager for Community Dental Services was appointed from 20 February 2017 onwards and is working in close partnership with the Clinical Director, Kathy Fuge; this ensures that operational and clinical issues affecting service provision for the Wellington Regional Dental Service are dealt with in an effective and timely manner.

Capital & Coast District Health Board / Hutt Valley District Health Board Page 3 [April 2017]

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The leadership team are also currently undertaking FTE modelling for the Wellington Regional Dental Service workforce, which will allow more effective use of staff within service provision, ensuring capacity, capability and succession planning are built into the workforce when recruiting.

3.5 Overall Performance Year to Date Despite continued effort of the Wellington Regional Dental team, it is apparent both at strategic and operational level, that the service is not meeting all the dental needs of the children in HVDHB and CCDHB. Areas of concern for the leadership team are children who are overdue (and are considered arrears) and the constant high DNA rates for our Māori and Pacific children.

Focus moving forward will be on evolving the Wellington Regional Dental Service to better meet service demand and ensuring quality improvement of the service provided. Effort will be concentrated on addressing overdue children who are considered in arrears, ensuring that we can provide dental care of a high quality in a timely manner. The Wellington Regional Dental Service will also be focusing on building sustainability into the model of service provision, through innovation, quality improvement, and appropriate evolution of the model of care.

REGIONAL SCREENING (BREAST AND CERVICAL)

4. BACKGROUND

HVDHB operating as BreastScreen Central (BSC) holds a Breast Screen Aotearoa (BSA) contract holder for the Subregional Breast Screening Contract. This contact covers Hutt Valley, Wairarapa and Capital and Coast DHB regions and is one of eight breast screen providers across the country. The contract is worth around $5.550 million per annum, the bulk of which is for the delivery of the mammography services and the rest for regional coordination and some fixed funding.

We have a number of fixed screening sites (Hutt base and Kenepuru Hospital), two subcontracted sites with Pacific Radiology (PRL) at Wakefield Hospital and on Lambton Quay and a mobile screening unit that mainly services outlying areas such as Wairarapa and Kapiti but also supports other areas within the region as required.

HVDHB also has a contract with the National Cervical Screening Programme (NCSP) to provide coordination, registration, invitation, recall, smear taking (capped volumes) and colposcopy (capped volumes related the cervical screening programme).

Regional Screening Services also include the Hutt Symptomatic Breast Clinic and a Wairarapa Symptomatic Breast Clinic (contracted). Women who have a positive result from a screening mammogram are referred to a breast clinic as the final part of the screening process. Women with breast symptoms are also referred directly to this service. The Symptomatic clinics are DHB hospital services and are a separate stream of both activities and funding. The symptomatic services were joined with screening around 10 years ago (they utilise the same process and staffing much of the time) to ensure that women had a seamless journey through their breast cancer pathway. The growth in this service over the last few years has been significant and as such is straining the services resources.

5. UPDATE OF LAST TWELVE MONTHS

A new 1.0 FTE service manager was appointed in November as part of the organisational restructure replacing a 0.5FTE role shared with Community Dental Services. Working in partnership with the clinical director this role will enhance the development and direction of the service.

Capital & Coast District Health Board / Hutt Valley District Health Board Page 4 [April 2017]

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Breast Screen Central has made incremental gains in all geographical areas over the last 12 months. Despite a national trend in declining rescreening rates for Maori and Pacific women, BSC has shown increased rates in this area.

Breast Screen Central results for all women exceed the 70% target. Note, however, that we do not meet these targets for the Pacific and Maori subset populations in all areas. We continue to focus on these priority women to ensure we continue to decrease this gap.

BSC budgeted volumes for 16/17 are 26,961 and we anticipate that we will see around 29,000 by the end of the financial year. These volumes are paid at the agreed national price and are not capped.

The Cervical screening graphs (page 7and 8) show that overall we are just below the 80% target (last NCSP graph) while the ethnicity specific rates are below this again. For cervical screening, the Asian population are proving more difficult to recruit to the programme. This is also a national problem, often due to cultural mores, and one we will be trying to address over the course of this year.

Over the last twelve months the focus for the teams has been on the priority women (harder to reach women and Pacific and Maori). This includes holding priority Saturday Screening sessions for both Cervical and Breast (one stop shop) with the recruitment and retention (aka Health promotion) team and the ISPs (independent service providers and subcontractors) supporting transport and liaison. These days have proved extremely successful and we credit them with the gains we have made.

BSC is currently working with the BSA around the renewal of our contract with them which expires at the end of June 2017; an interim arrangement will be put in place until the new contract is in place in January 2018. As per Government guidelines for the social sector the new contract will be a Results based accountability contract (RBA).

Overall BSA coverage (%) of women aged 50–69 years in the two years ending 31 December 2016 by District Health Board

Good rescreen results as below for all women. The important thing to note that BSC, as opposed to the rest of the country who are noticing an overall decline in Maori and Pacific rescreens, have seen a slow but steady increase in these rates.

Capital & Coast District Health Board / Hutt Valley District Health Board Page 5 [April 2017]

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BSC Total women report to BSA

Indicator/s for 2 year period ending 6 Response Plan Total women 50 month -69 years period screened ending June Dec 2016 Dec 2015 2016 (1.b.3) Routine 73.3% 77.7% 81.1% rescreening within 27 Target: ≥ 75% attend for their first screen months, Initial within the programme are rescreened within 20-27 months

(5.b) Time taken from 82.9% 86.7% 91.3% screening visit to first Target:≥ 90% offered an assessment offer of an assessment appointment within 15 working days (5.c.2) Proportion of 53.8% 67.9% 100.0% women having an open Target: ≥ 90% of women requiring an biopsy procedure within open biopsy should have this within 20 20 working working days of being notified of the need days for this operation (5.d) Time taken from 80.5% 84.7% 87.7% final diagnostic BSC has shown ongoing but percutaneous needle incremental gains in this area. biopsy to reporting assessment results to the women

Capital & Coast District Health Board / Hutt Valley District Health Board Page 6 [April 2017]

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NCSP coverage (%) of Māori women aged 25–69 years in the three years ending 31 December 2016 by District Health Board

NCSP coverage (%) of Pacific women aged 25–69 years in the three years ending 31 December 2016 by District Health Board

Capital & Coast District Health Board / Hutt Valley District Health Board Page 7 [April 2017]

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NCSP coverage (%) of Asian women aged 25–69 years in the three years ending 31 December 2016 by District Health Board

Overall NCSP coverage (%) of women aged 25–69 years in the three years ending 31 December 2016 by District Health Board

Capital & Coast District Health Board / Hutt Valley District Health Board Page 8 [April 2017]

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REGIONAL PUBLIC HEALTH

6. BACKGROUND

Regional Public Health (RPH) is a sub regional service with a range of contracts and funding lines. Our core contract with the Ministry of Health is based on delivering five core public health functions (health promotion, health protection, health assessment and surveillance, public health capacity development and preventive interactions) to the Hutt Valley DHB, Wairarapa DHB and CCDHB. RPH also provides public health services for the Hutt Valley DHB population via non-core contracts. These are summarised in the following diagram.

7. UPDATE OF KEY WORK FROM THE LAST SIX MONTHS

7.1 Allied Health, Scientific and Technical Award The RPH Healthy Communities Team was the successful recipient of the Allied Health, Scientific and Technical award for “Champion for Collaboration”.

The award was to recognise the collaboration between several entities’ that form the Wellington fruit and vegetables co-operative. The co-op includes: Wesley Community Action (lead service), Orongomai Marae and Health Services, and five churches based in Cannons Creek, Naenae, Waiwhetu, Wainuiomata, Miramar and Titahi Bay. Wesley Community Action and RPH provide the on-going infrastructure for the co-operative.

Capital & Coast District Health Board / Hutt Valley District Health Board Page 9 [April 2017]

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The co-op provides between five and six tonnes of vegetables and fruit per week. Each order provides enough fruit and vegetable for a family of four and includes 3-4 varieties of fruit and 3-4 varieties of vegetable. Families pre-order one week in advance and this enables the co-operative to procure in bulk from suppliers; the discount may be up to half that of vegetables and fruit selling in supermarkets, thereby enhancing accessibility to healthy food for low income families

For more information see: http://www.rph.org.nz/content/a58d7c6d-f188-4e74-a25d-b6c8ea647793.html

7.2 Rheumatic Fever & Respiratory Illness - Housing | Well Homes Well Homes links whānau to appropriate services such as insulation, heating, curtain banks, beds, bedding, carpets, rugs, financial assistance and social housing providers. Simple cost-effective solutions are part of the plan e.g. whānau get white vinegar and a cloth to help with cleaning mould. The Well Homes service is a partnership between Regional Public Health (RPH), Tu Kotahi Maori Asthma Trust, He Kāinga Oranga (University of Otago School of Medicine), and Sustainability Trust. Well Homes is a pathway for nurses, doctors, social workers and community health workers to refer a family or whanau, who may be experiencing housing problems, for support. The following table summarises the types of activities the service provides.

Capital & Coast District Health Board / Hutt Valley District Health Board Page 10 [April 2017]

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In March an automated referral system was put in place in Hutt Valley DHB and CCDHB paediatric and emergency departments. The following diagram shows the referral pathway for Well Home assessments.

For more information: http://www.rph.org.nz/content/57ba28fd-f5ee-4a39-9887-cf9cd8dbd47e.html

Capital & Coast District Health Board / Hutt Valley District Health Board Page 11 [April 2017]

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7.3 Kaikoura Earthquake and Wellington Region Flooding Events The 7.8 M Kaikoura earthquake on 14 November and subsequent heavy rain and flooding triggered an Incident Management Team (IMT) response for RPH. The focus was both on maintaining business continuity (with temporary closures of Porirua and Thorndon bases and some limited availability of staff) and supporting management of potential public health risks (including drinking water, sewage, recreational water, welfare concerns, hazardous substances, liaison roles and the provision of public health information).

Two RPH health protection officers were based in the Wellington Region Emergency Management Office (WREMO) to provide public health information.

RPH conducted a debriefing of our response on 13 December. The learning from our response has created a work plan and a RPH Emergency Management Working Group has been set up tasked with the job of implementing the plan. RPH is working with the HVDHB Emergency Management Team.

7.4 Wellington and Lower Hutt City Council Environmental Health teams post-earthquake request for help Due to potential earthquake damage at both the Wellington and Hutt City Council buildings the Environmental Health teams could not enter and work from their building/office until cleared by an engineer. As a result RPH took all common enteric case investigation in-house for a period of 2-3 weeks post the earthquake. Our RPH disease control team experienced a high workload during this time investigating common enteric notifications, significant disease outbreak investigations and also a few serious enteric notifications. The team was able to pool the resources of the health protection offices and public health nurses to ensure the work was of a high standard and managed cases within timeframes.

7.5 Immunisation Hutt Valley District Health Board immunisation team have succeeded in being the top of the ‘National Performance Measures’ table for the past two quarters for 8 month immunisation. This target is for over 95% of all babies to have received their 6 week, 3 month and 5 month immunisations on time. This target has been met with the RPH immunisation team coordinating the effort by a concerted effort with the PHO, DHB and outreach services.

The school based vaccination team has started the new 2017 regime for HPV Gardasil vaccination for both boys and girls. This is the first year the vaccine has been available for boys and the Ministry of Health was expecting an uptake of 30-50% of boys. Currently we have an uptake of 73% of all year 8 boys which matches the girls’ uptake and shows an acceptance of the vaccination for boys in the community.

7.6 3DHB Monitoring Tool Development A 3DHB Monitoring Tool for the 3DHB Healthy Food and Beverage Guideline has been developed by RPH. This tool has been sent to all four hospital site food providers in the Wellington Region. The intention is to gather information on how well the 3DHB Healthy Food and Beverage Guidelines have been implemented, the challenges faced and the successes gained. A student dietician will conduct interviews and write a report.

Capital & Coast District Health Board / Hutt Valley District Health Board Page 12 [April 2017]

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7.7 FIZZ Symposium 2016 Dr Osman Mansoor (Public Health Physician and Rocky Ali (Public Health Nurse) from RPH presented at the FIZZ (Fighting Sugar in Soft Drinks) Symposium with a presentation on the “Water- only in Schools” survey results.

Of 201 schools surveyed, 78 mostly primary schools responded. Just over one quarter had water only policies and just over 10% were working on developing a water only policy. Just over 15% did not have a policy but had implemented water only in practice at the school.

The presentation can be viewed on YouTube here: [ https://www.youtube.com/watch?v=djjLv8QRsVk ].

7.8 Automated Smokers Referral System On 9 March Hutt Hospital established an automatic referral system for patients who smoke. This system extracts basic patient information from the electronic discharge summary (EDS) and sends it via a secure email to the Stop Smoking Service, Takiri Mai Te Ata (TMTA). Staff at TMTA are responsible for triaging the clients into: enrolled clients, client who refused the service and on-referred clients.

Previous referral systems, which required the faxing of forms to the Quitline, had shown very little utility. Following the set-up of the automated referral system to TMTA, they received 104 referrals in the first two weeks of activation.

This referral system is a leading edge piece of systems change work. Not only are our patients being referred for cessation help, but a number of them are being on-referred to other services.

7.9 Regional Public Health has recently submitted on the following submissions: Healthy Homes Guarantee Bill No. 2 On 8 February RPH gave an oral submission to the Government Administration Select Committee considering the Healthy Homes Guarantee Bill No. 2. Our submission received a positive response and stimulated questions and comments from the select committee on a number of aspects, particularly around the weakness of current tenancy tribunal processes to require landlords to participate in the tribunal and to remediate properties that are clearly of poor standard. These concerns resonated with the select committee, who raised them as questions for presenters of subsequent submissions at the committee hearing.

Testing and Decontamination of Methamphetamine Contaminated Properties RPH made a submission to NZQA on the draft standards (Standards NZ) on testing and decontamination of methamphetamine contaminated properties. Methamphetamine contamination of properties either occurs from the manufacture of methamphetamine and/or the smoking of methamphetamine. The manufacture of methamphetamine results in very serious contamination, while smoking methamphetamine results in much lower level contamination. Recently we have seen significant confusion over what property owners need to do to decontaminate properties exposed to methamphetamine, with a lot of money being spent, perhaps needlessly, on replacing internal cladding, window coverings and carpets.

We supported the intent of the standard to standardise testing and levels suitable for protecting public health. However we recommended a guide for risk assessment is developed to sit alongside the standard to avoid unintended consequences, such as, unnecessarily extensive remediation being undertaken or increased pressure on housing shortages for our most vulnerable populations.

Capital & Coast District Health Board / Hutt Valley District Health Board Page 13 [April 2017]

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Policy Options for the Regulation of Electronic Cigarettes The Ministry of Health consulted on policy options for the regulation of e-cigarettes, including possible amendments to the Smokefree Environments Act 1990 (SFEA). This consultation aimed to clarify the legal position. Proposed amendments would mean that all e- cigarettes (with and without nicotine) would be available for sale and supply lawfully in New Zealand, but sale of e-cigarettes would be restricted to people 18 years of age and over, advertising of e-cigarettes would be restricted and the use of e- cigarettes would be prohibited in areas defined as smokefree in the SFEA.

Capital & Coast District Health Board / Hutt Valley District Health Board Page 14 [April 2017]

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BOARD DECISION

Date: 10 April 2017

Author Andrew Blair, Capital & Coast District Health Board Chair

Subject RESOLUTION TO EXCLUDE THE PUBLIC

RECOMMENDATION It is recommended that the Board: a) Agree that as provided by Clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons:

SUBJECT REASON REFERENCE For the reasons set out in the respective public excluded Public Excluded Minutes papers Public Excluded Matters Arising from For the reasons set out in respective public excluded papers previous Public Excluded meeting Chair’s report Papers contain information and advice that is likely to 9(2)(i)(j) prejudice or disadvantage commercial activities and/or CEO’s report disadvantage negotiations FRAC report Community Pharmacy Service Agreements 2017-18 Annual Plan: Financial Subject to Ministerial approval 9(2)(f)(v) 9(2)(f)(v) Commitments

* Official Information Act 1982.

Capital & Coast District Health Board

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Sub-Regional Disability Strategy 2017 – 2022 Wairarapa, Hutt Valley and Capital & Coast District Health Boards Enabling Partnerships: Collaboration for effective access to health services

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ENABLING PARTNERSHIPS: COLLABORATION FOR EFFECTIVE ACCESS TO HEALTH SERVICES

International Drivers: UNCRDP

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New Zealand Drivers: • Whaia Te Ao Marama: The Maori Disability Action • Plan for Disability Support Services 2012 to 2017 • He Korowai Oranga: Maori Health Strategy • Faiva Ora – National Pasifika Disability Plan • New Zealand Disability Strategy and Action Plan • Health and Disability Act 2000

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1. Creation of an enabling and more accessible environment 2. Inclusion of disabled people in the design of all services and activities 3. Movement towards a holistic model of wellbeing that improves Guiding health outcomes for disabled people Principles 4. Improved support for people to make well informed decisions 5. Strategies that build community resilience 6. Active commitment to strengthening leadership and partnership across the sector

1. Work alongside government agencies involved in the health and disability workforce and disability communities 2. Develop an approach to engage communities alongside SRDAG and community networks 3. Disability Strategy team leads implementation of good practice models (CoDesign etc) for both hospital and community staff Actions 4. Partner with Maori to collaboratively design and implement initiatives that achieve equity in health 5. Prioritise monitoring of data as measure to show improvement and check quality 6. Model safe CoDesign practices where individuals and whanau are respected for their experience, community linkages and expertise

1. A disability literate health workforce who work to local and national practice standards 2. A seamless, ‘whole of life journey across health systems where individuals and whanau are well informed Outcomes 3. Within 10 years the health work force are able to deal with cross system complexity 4. Disability Communities are health literate. Meaning they are able to: identify individual and whanau support needs, share knowledge and support each other 5. Where Staff use person centred/directed approaches so that individuals and whanau are included in decision making 6. Health equity is achieved through partnerships; which lead to the break down of system barriers and changes, which benefit the whole population

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FORWARD

As the three chief executives of the sub-regional district health boards, we have been involved in and endorsed the development of this updated strategy. The strategy provides both challenges and opportunities. The continuing work with communities on disability strategy and actions is forward thinking, practical and has already made a difference in the health journey and lives of people from all age groups. These developments and our united approach across the sub-region are something to be proud of. This plan continues the journey and aims to improve health outcomes for future generations. Naku noa na

Ashley Bloomfield – CEO Hutt Valley District Health Board

Debbie Chin – CEO Capital & Coast District Health Board

Adri Isbister – CEO Wairarapa District Health

Partners and authors

• Participants in the sub-regional disability forum June 2016

• Participants of local forums 2014−2016

• The Sub-Regional Disability Advisory Group (SRDAG) and their allies

• The three Chief Executives and their teams

• The three district health board members

• The Disability Strategy and Performance team across the sub-region

“The work being undertaken in the Wellington sub-region to improve health ser- vices and health outcomes for people with disabilities, is not only of significance nationally but also of international significance”

Paul Gibson Disability Rights Commissioner 3 June 2016 – Sub-regional disability forum, Silverstream Retreat

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CONTENTS

Purpose and reasoning behind this document 6

Section 1: Background 9

Section 2: Where we are now 14

Section 3: Moving Forward 19

Section 4: Action Table 28

Appendix One: Glossary of Acronyms 35

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The purpose of this document

1 in 4 New Zealanders experiences disability. 2013 census

Disability can include physical, mental health, intellectual, sensory and other impairments. Disability is created by various barriers that hinder the full and effective participation of people in society on an equal basis with others.2 This document provides a clear strategic direction for leaders within the health sector working with disability communities to address inequities across the population and ensure better health outcomes. In the context of health services, those who have a range of clinical and support requirements tend to have the most complex interactions with the health system. The easier it is to navigate vital health services, the more enabling the health system becomes. With this in mind, we are moving to a more positive, proactive approach that will improve health systems and services for all, including those with the highest needs. The approach in this Strategy is consistent with mainstream policy on integration and innovation. This includes the call for services closer to home and a more people powered health service.

The aim of this Strategy is to provide guidance, direction and structure for all stakeholders involved, including DHB Hospital Services, funders, contracted services and their intersectoral partners. Internally, the Strategy and the table of priorities will be complemented by a detailed dashboard of indicators.3 This sits alongside a monitoring framework which will enable tracking and reporting progress against each expected outcome. Each priority area has a significant work plan allocated to key people which will be used by the Disability Strategy Team led by the Director of Disability Strategy and Performance.4 The Strategy reinforces a commitment by the three DHBs to involve and collaborate with disability communities and their allies across the sub-region. The Strategy is a published document, and a more detailed work plan and dashboard is available on request.

2 This is adapted from the definition used in the New Zealand Disability Strategy and the United Nations Convention on the Rights of Persons with Disabilities. 3 Endorsed at the sub-regional intersectoral forum ‘Develop a performance monitoring framework to measure success’ 4 SIDU was disestablished on 9 January 2017 and each of the three DHBS have established their own directorate or unit responsible for planning and funding. The office of the Director of Disability Strategy and Performance is based in the CCDHB Service Innovation and Performance Directorate. The work continues to be developed across all three DHBs.

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The revised Strategy and how it has been developed

The strategic priorities presented in this document are based on stakeholder feedback, most recently from participants of the Sub-regional Disability Forum held on 3 June 2016 at the Silverstream Retreat. The forum was attended by the Minister for Disability issues, the CEOs of Wairarapa, Hutt Valley and Capital & Coast DHBs, and consumers and leaders from across the sector. The content has been developed through a co- design process led by the Disability Strategy and Performance team with an expert group of leaders from SRDAG and other partners. The diagram at the beginning lays out a strategic road map including community identified principles, high level expected outcomes and key major actions proposed. Section one of the Strategy provides a background to the development of strategic priorities. They have been informed by the following foundational documents: • UN Convention on the Rights of Persons with Disabilities (2008) • PHAD 2000 • The Treaty of Waitangi • New Zealand Disability Strategy 2001 • New Zealand Disability Action Plan • He Korowai Oranga: Māori Health Strategy • Faiva Ora: National Pasifika Disability Plan • Whāia Te Ao Mārama: The Māori Disability Action Plan • Sub-Regional Disability Plan 2013−2018 (Valued Lives Full Participation) Section two presents an overview of the outcomes of the current sub-regional plan and programme of work up to December 2016. Section three provides lists of priorities under each focus area and expected outcomes. This section clarifies what change will mean for people and their allies. Section four gives an overview of a strategic framework that will guide the downloadable year-by-year action plan. A link to the table is available (WWW.CCDHB.ORG.NZ) to download from the website. For more discussion of work plans and specific projects, please call 0800 DISABILITY (0800 3472245489). 7

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TERMINOLOGY

For the purposes of this document the term ‘disabled people’ is used most often, reflecting language used in the Government Disability Action Plan (2014−2018). We acknowledge an important partnership with People First whose members prefer ‘people with learning disabilities’ while other groups describe ‘people who experience disability’. 1 Other terms less used here include: ‘differently abled’, ‘people with impairments’, ‘tangata haua’ and ‘people with disabilities’. The terms impairment and disability are dynamic and interchangeable, as a change of environment and circumstance can significantly increase the level of disability. Throughout the document we refer to the Disability Strategy as ‘the Strategy’.

1 This term is sometimes preferred to reflect that the disability is not the impairment itself – it is rather the barriers experienced as a result of the impairment.

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SECTION 1: Background

1.1 Meet the disability population in the Wellington sub-region Disability communities in the greater Wellington region are rich in their diversity and breadth of experience. Factors such as age, gender and ethnicity are critical, but even more importantly a unique individual and group identity has emerged. This has emerged from from promotion of ‘disability pride’ by disability advocates. Disabled people locally, nationally and internationally have fought for recognition of their full potential as citizens and for the rights now enshrined in international legislation. There are many people who have life-long impairments as well as a growing number who acquire disability later in life, often as a result of long-term health conditions.

Census data has provided some information about the Greater Wellington disability population but there is still a lot to learn as data improves. The infographic below shows the population broken down by age. We know that Māori and Pacific disability prevalence rates are higher than the total population, even after adjusting for differences in their respective age profiles. As of 2013, 32 percent of Māori and 26 percent of Pacific peoples have a disability.5 There is overwhelming evidence of the need to improve access to health and disability services for Māori and Pacific people. To make changes over the next five years, we need to know more about the barriers people face.

5 Statistics New Zealand, 2013, New Zealand Disability Survey, http://www.stats.govt.nz/browse_for_stats/health/disabilities/disabilitysurvey_hotp2013.aspx

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‘Persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability.’ United Nations Convention of Rights of Persons with Disabilities

1.2 International drivers New Zealand signed the United Nations Convention on Rights of Persons with Disabilities 6 (CRPD) at the United Nations in 2007, and ratified it in 2008. The purpose of the Convention is to ‘promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity.’ 7

1.3 New Zealand: A unique multicultural nation The New Zealand Public Health and Disability Act 2000 (NZPHD Act) laid out specific expectations for DHBs to follow regarding disability support. This was strengthened by The New Zealand Disability Strategy (NZDS) launched in 2001 and recently updated in 2016. This aims to guide the work of government agencies in addressing disability issues until 2026. The strategy outlines eight outcome areas and the updated sub-regional plan is similarly modelled as a strategy for health services. It has provided guidance to policy makers on eradication of systemic, attitudinal and structural barriers in all aspects of service delivery and legislation. This was clear in its vision for ‘a society that highly values our lives and continually enhances our full participation’. The NZDS8 states that: ‘disability is not something individuals have. What individuals have are impairments. … disability is the process which happens when one group of people create barriers by designing a world only for their way of living, taking no account of the impairments other people have.’

The goals within the NZPHD Act established new expectations for all organisations and professionals operating within the health and disability sector. These expectations include; improved health, independence, participation and inclusion of disabled people. Their aim was to provide guidance to health services to eliminate disparities and provide quality care for all people with disabilities. The Disability Support Advisory Committees (DSACs) within DHBs were established as a result of the Act requiring DHBs to reflect the principles from the NZDS (newly updated 2016) and the UNCRPD in all their health policies. Aotearoa New Zealand follows the Treaty of Waitangi’s three main principles of Partnership, Participation and Protection. In health, the Treaty is used alongside the current New Zealand Public Health and Disability Act 2000 (NZPHD) to ensure equitable health outcomes for Māori.

6 United Nations. United Nations General Assembly A/61/611 Convention on the Rights of Persons with Disabilities Dec 2006, www.un.org/disabilities/default.asp?id=61 (accessed Nov 14, 2016)

7 Office for Disability Issues,United Nations Convention on Rights of Persons with Disabilities, www.odi.govt.nz/united-nations-convention-on-the-rights-of-persons-with-disabilities

8 Dalziel, L. (2001). The New Zealand Disability Strategy: Making a world of difference: Whakanui Oranga. Wellington: Ministry of Health.

9 Office for Disability Issues,New Zealand Disability Strategy 2001, www.odi.govt.nz/nz-disability-strategy/about-the-strategy/new-zealand-disability-strategy-2001

10 Ministry of Health, He Korowai Oranga: Māori Health Strategy, www.health.govt.nz/our-work/populations/maori-health/he-korowai-oranga 10

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1.3.1 He Korowai Oranga: Māori Health Strategy As New Zealand’s Māori Health Strategy, He Korowai Oranga sets the overarching framework that guides the government and the health and disability sector to achieve the best health outcomes for Māori. 10 The incidence of poorer health outcomes for Māori is caused by a variety of social determinants which are reinforced where people also live with long term health conditions or lifelong impairment. The particular access issues for Māori with disabilities are addressed in a dedicated action plan as described below. 1.3.2 Whāia Te Ao Mārama The Māori Disability Action Plan 11 for Disability Support Services was similarly conceived to enable tangata haua (Māori people with disability) to achieve their aspirations and to reduce barriers that may impede them and their whānau. This plan reflects a number of priorities that collectively seek to improve outcomes for Māori by incorporating a range of new and innovative support options, providing greater choice and control, and ensuring that all services are culturally appropriate. The plan also recognises the need to ensure better support for whānau, partnerships with Iwi and Māori communities, and effective monitoring and reporting.

1.3.3 Pacific Nations and Disability The Ministry of Health’s ‘Faiva Ora: National Pasifika Disability Plan’ sets out priorities that guide us when working towards the wellbeing of Pacific peoples with disabilities. The plan clearly includes those who have long-term physical, mental, intellectual or sensory impairments. Interaction with various barriers may hinder the full and effective participation of these people in society on an equal basis with others. We recognise that the term ‘Pacific communities’ includes a number of Pacific Island nations, each with its own language and culture, each of which are to be respected. There are some commonalities across the community in terms of their collective values, gatherings, identities and the role culture, stories and values in their lives. The church features largely as a central meeting place for the community and could provide greater opportunities to connect with people with disabilities. Understanding ‘disability’ within Pacific communities is evolving. The Convention on the Rights of Persons with Disabilities has created a shared understanding that informs our collective conversations. Culturally respectful relationships with Pacific peoples with disabilities are critical to ensure development of culturally accessible health services. 12 ‘People with disabilities have generally poorer health, fewer educational achievements, less economic opportunities and higher rates of poverty due to the lack of services available to them’ World Health Organization 2011

1.4 The health of disabled people The WHO report recommends increasing awareness of disability issues and the inclusion of disability as a component in international and national health policies and programmes. 13 Measurement of health equity for disabled people is largely excluded from nationwide health needs assessment reports. Lack of coherent data has contributed to this gap as well as the discrete separation of funding and services for health and disability.

11 Ministry of Health, Whāia Te Ao Mārama: The Māori Disability Action Plan for Disability Support Services 2012 to 2017, www.health.govt.nz/publication/whaia-te-ao-marama-maori-disability- action-plan-disability-support-services-2012-2017 12 Ministry of Health, Faiva Ora – National Pasifika Disability Plan, www.health.govt.nz/our-work/disability-services/pasifika-disability-support-services/faiva-ora-national-pasifika-disability-plan 13 World Health Organization, World report on disability, www.who.int/disabilities/world_report/2011/en/

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National research into the health of people with learning disabilities 14 identifies the much higher rates of chronic illness and early death for this group of people. In 2013 another research report was commissioned by the Ministry of Health and Te Pou o te Whakaaro Nui to look more widely at access to health services. 15 The report outlines multiple barriers faced by people of all ages and disability categories when accessing primary and secondary care. 16 This has contributed to a call for action on access for people with learning disabilities, with an initial national focus on primary care strategy. 59 percent of people over 65 now identify as having a disability and there is no doubt that health and wellbeing will deteriorate for many with the ageing process. It is likely that fewer people who have lived with lifelong disability are represented in the over 65 age group. Although data is difficult to obtain to back this assertion, research has revealed that life expectancy is often reduced particularly for people with certain conditions. 17 It is notable that in the 2017/18 annual planning guidelines the Minister has included Disability Support as a planning priority and is asking for reporting from all DHBs on disability training for staff and use of a range of tools to improve access to health services for disabled people. This is warmly welcomed by disability community leaders as a milestone in the journey for health equity.

1.5 Disability literacy and the health workforce Over the past 25 years disabled people have advocated for a change in the way disability is defined. Over the same period de-institutionalisation 18 has occurred nationally and internationally so people formerly locked away have become present and visible in the community. Both policy and philosophy have led to a shift away from what is known as a ‘medical model of disability’ where the focus is on individual deficiencies, or what is ‘wrong’ with the person. The more inclusive social model of disability makes a distinction between impairments (which people have) and disability (which lies in their experience of barriers to participation). This change in perspective has led to a reduction in what disabled people describe as disability literacy particularly within the health workforce. Patient centred and person directed care terminology 19 is now embraced as significant across mainstream health services and is providing a means of greater understanding of the health experience of people with disabilities. ‘Patient centred care’ takes place when the person’s preferences, needs and values are taken into account. In turn, the patient-centred care puts the individual in control of their own care, driving the decision-making process. Both concepts are relevant as they will apply to different individuals. These approaches benefit all people who have multiple interactions with health services and will improve the experience of those with long term health conditions, as well as people of all ages with life long impairments. The success of the Health System Plan (Vision 2030) which has been proposed by the sub-regional DHBs depends on a shift from service-centric planning to an approach that is led and directed by people in their communities. 20 This Strategy is consistent with that vision and direction, and provides initial steps to its achievement for disabled people. In line with the social model of disability, there is a continued push for policies which remove barriers for people with disabilities and enable them to participate in all areas of society.

14 Ministry of Health, Living a good life, 2001, and Health indicators of people with intellectual disabilities, 2011. 15 Te Pou o te Whakaaro Nui, Improving access to primary care for disabled people, www.tepou.co.nz/library/tepou/improving-access-to-primary-care-for-disabled-people 16 The research provides a thorough literature review and is timely in the focus for the wider population on better sooner more convenient and integrated primary and secondary care. The work on improving access to primary care has been facilitated in the Wellington sub-region as part of reporting against key focus areas of the disability plan (2013−2018). Practices with poorer populations are now making good progress on consideration of disability and have embraced the need for staff training in improved disability literacy and the need for tools such as disability alerts 17 People with intellectual disabilities are 4.5 times more likely to die prematurely than their peer group (Ministry of Health. 2011. Health Indicators for New Zealanders with Intellectual Disability.). Those who do survive age prematurely and are experiencing access issues to Age Residential Care. ARC providers understand the clinical needs but the behaviours caused often by trauma due to change of environment cause problems for staff. Workforce development is being implemented for affected providers. Other degenerative disabilities lead to premature death at a much younger age. Huntingdon’s Disease, Muscular Dystrophy and Motor Neurone Disease are examples of such conditions but there are many more. 18 In the Wellington sub-region between 1992 and 1997 Porirua Hospital moved hundreds of people with intellectual disabilities and mental illness into the community. Kimberley Hospital in Levin was closed later. 19 It is acknowledged that within health services people still identify as patients and are referred to as patients. A discussion and emphasis on approaches to how people are supported in health is seen as more critical than an attempt at this stage to change language comprehensively. 20 Vision 2030, December 2016 Health System Planning

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2 WHERE WE ARE NOW

2.1 Planning health services within the Wellington sub-region In 2013, an implementation plan for Wairarapa, Hutt Valley and Capital & Coast DHBs (sub-regional DHBS) was created. It aimed to identify and address specific inequities within health services for each of the local communities and to reflect the principles of the NZDS and the more recent UNCRPD. The 2013 plan was developed and led by the Service Integration and Development Unit with combined board sub-committees and the newly established Sub-Regional Disability Advisory Group (SRDAG). A mandate and overwhelming support for the work was given at the first sub-regional forum in 2013 at Orongomai Marae. It was attended by disabled people, family members as well as health and disability professionals from each locality within the sub-region. The three DHBs in the Wellington Region have shown leadership in their joint endorsement and ongoing support for the establishment of SRDAG. The commitment to a joint approach for disability remains and a small team led by the Director of Disability Strategy and Performance provides leadership and support for the three DHBs. Additional sub-regional and local forums were held from 2013 to 2016 to monitor and update key priorities for each population. The results of a comprehensive process of co-design, collaboration and community engagement have informed this document and the updated planned priorities.

2.2 What we have achieved The timeline above shows the long road we are all still on towards equitable health outcomes for people with disabilities. Along the way there have been many achievements thanks to the commitment from the three DHBs. The diagram below outlines in more detail some of the work undertaken to date and the influences of the updated Strategy. A number of committed leaders have successfully demonstrated system and service changes over the last few years. Successive Chief Executives locally and sub-regionally have made a commitment to leadership on disability. A Senior Disability Advisor role established in 2009 at CCDHB became sub-regional in 2013. Leadership demonstrated by the Chief Executives has made the work of the sub-regional DHBs nationally significant. Other DHBs are learning from the implementation of the plan that transformation occurs through initiatives that are innovative, community-driven and personcentred. Well-planned integration within business as usual practices has embedded these learnings. Changes across the sub-region have been gradual, but staff and communities across all localities have embraced the changes. The relationships between service users and DHBs have been improved by increased visibility, transparency of communication (including collaboration and planning with communities of interest) and obvious willingness by DHBs to recognise the real issues faced by people with disabilities.

21 CPHAC/DSAC community and Public Health advisory committee and Disability Support Advisory Committees joined to support the work of the three DHB unit SIDU 22 The Office of the Director of Disability Strategy and Performance has oversight of disability programmes across the sub-region and sits within the new CCDHB strategy innovation and performance directorate. 14

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Mainstream health services provide the best base for improved practice and are funded for the whole population. However, health services must work in a sustainable manner to meet the challenges that exist. These strategies and principles also reflect current health thinking with the added innovation of disability communities who are best placed to lead and drive their own health care.

Child-Adult Transition

Improving INCLUSION Staff Experience & SUPPORT Responsiveness

Disabiltiy Primary SRDAG Clause Health

CREATING AN Access NZSL ACCESS Forums LEADERSHIP NASC Review Audit ENABLING Review ENVIROMENT

Quality Disability Improvement Health Action Group Passport

Disability Improved Alerts HEALTH Education

Data Capture

2.3 Valued Lives, Full Participation: Disability Plan 2013−2018 In partnership with disability communities, the sub-regional DHBs launched in 2013 an implementation plan for the New Zealand Disability Strategy and the United Nations Convention on Rights of Persons with Disabilities. 23 Key goals are as follows • improve the health of disability communities • increase independence, participation and inclusion of disabled people • reduce disparity • ensure better care Below is a brief summary of what was achieved in relation to the Plan’s four focus areas and what it meant for all involved.

23 Valued Lives: Full Participation, Implementation Plan 2013−2018, www.huttvalleydhb.org.nz/about-us/reports-and-publications/other-planning-documents/disability-strategy-implementation-plan-2013-2018.pdf 15

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FOCUS AREAS THE STRATEGIC GOAL HOW WE ACHIEVED THIS WHAT THIS MEANT FOR US

SRDAG demonstrate the critical importance of leadership Sub-Regional Disability Advisory Group (SRDAG) was The three DHBs will engage with disability communities by disabled people and show the diverse talents of developed and now govern, implement and champion our and consumers disabled people irrespective of impairment type. SRDAG work programme in the community. is a clear example of successful co-design.

ONE – LEADERSHIP: We will be an employer of choice for disabled people and All three DHBs have demonstrated openness to Wairarapa, Hutt Valley and Capital & Coast DHBs will their families employment of disabled people and implemented a range We are starting to change the culture around employment provide or share leadership with disability communities of trainee schemes. In order to support disabled people of people with disabilities; this will ultimately grow into a in the workforce we have adapted the Equal Employment and others to develop strategies to meet and adapt to more diverse workforce. current and new expectations. Opportunity Form to ensure the DHB meet the support needs of employees with disabilities. Ensure leadership of and engagement with Māori and Pacific peoples with disabilities We held a Hui 2010 and Fono in 2012 to meet and engage The commitment to reducing barriers for Pacific peoples with consumers. The Māori and Pacific expertise on SRDAG with a disability has been proven as it is now included as a has led better understanding of barriers faced by Māori top priority in the CCDHB Pacific Plan. Māori with disability and Pacific peoples with disabilities. are represented at and listened to at a senior level.

Young people, their whānau, primary care and hospital Disabled children will be supported to live and grow as A project focusing on the needs of children and whānau in services are working together to co-design better systems they choose transition from child service to adult services. TWO – INCLUSION AND SUPPORT: and tools. Our district will better include and promote the full When the DHB acts as a funder, any contract provided The Disability Clause creates a mandate for providers participation of disabled people, and services will ensure Where we have a role as funder or provider, working-age now includes a disability clause so providers report on to rethink what access means. Community services and the best support for disabled people and their families disabled people are supported to live as they choose what they are doing to improve access for people with a other providers are starting to become more accessible to range of impairments in their services. disability communities.

People with experience of mental illness recover and live A disability perspective has been integrated into mental The inclusion of a disability perspective to discussions has well health services and consumer groups. started to address access issues and promotes co-design.

As well as publishing research, we have created a five year We conducted comprehensive research with New Zealand work plan targeting isolated deaf people, New Zealand Sign Language users leading to an improvement on current Sign Language users and staff to improve access to health interpreter policy and the creation of staff education plans. THREE – ACCESS: Information and communication meet everyone’s needs services. Disabled people will have more independent access to As part of a full communication plan, the internet and Information has become more readily available and intranet pages have been updated. Video resource has services to meet their health and support needs accessible. been created with captions.

Access audits across Hut and Wairarapa DHBs facilitated We continually work to improve physical access and Physical environment and signage meet everyone’s needs training and some simple changes to improve access in implement audit results. each locality.

The expertise and needs of people and their whānau are Health Passport launched sub-regionally. recognised and respected.

Disability Alert implemented. This has led to a programme In a national first, data is available to monitor how people which gathers data to help to plan services. It also puts use the health system. This helps improve the patient FOUR – HEALTH: the patient’s preferences in the hospital computer system journey and ensure their needs are met safely and where needs are identified. without delay. Health Disparities will be reduced by Primary Health Care and better integration across services We now have access to tools such as eLearning and providing best care and improving, keep disabled people healthier and address their needs Health professionals and consumers are more confident video resources which were made alongside people using protecting and promoting the health of disabled people earlier in discussing experiences. This allows us to make more services. Such education is now mandatory for all staff in targeted education plans. direct contact with patients.

A network of champions who work across community and A network of expert champions was established by hospital services have often provided quick and timely CCDHB Disability Action Group to advise both staff and information to enable people and their families to take service use. control of their health journey.

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FOCUS AREAS THE STRATEGIC GOAL HOW WE ACHIEVED THIS WHAT THIS MEANT FOR US

SRDAG demonstrate the critical importance of leadership Sub-Regional Disability Advisory Group (SRDAG) was The three DHBs will engage with disability communities by disabled people and show the diverse talents of developed and now govern, implement and champion our and consumers disabled people irrespective of impairment type. SRDAG work programme in the community. is a clear example of successful co-design.

ONE – LEADERSHIP: We will be an employer of choice for disabled people and All three DHBs have demonstrated openness to Wairarapa, Hutt Valley and Capital & Coast DHBs will their families employment of disabled people and implemented a range We are starting to change the culture around employment provide or share leadership with disability communities of trainee schemes. In order to support disabled people of people with disabilities; this will ultimately grow into a in the workforce we have adapted the Equal Employment and others to develop strategies to meet and adapt to more diverse workforce. current and new expectations. Opportunity Form to ensure the DHB meet the support needs of employees with disabilities. Ensure leadership of and engagement with Māori and Pacific peoples with disabilities We held a Hui 2010 and Fono in 2012 to meet and engage The commitment to reducing barriers for Pacific peoples with consumers. The Māori and Pacific expertise on SRDAG with a disability has been proven as it is now included as a has led better understanding of barriers faced by Māori top priority in the CCDHB Pacific Plan. Māori with disability and Pacific peoples with disabilities. are represented at and listened to at a senior level.

Young people, their whānau, primary care and hospital Disabled children will be supported to live and grow as A project focusing on the needs of children and whānau in services are working together to co-design better systems they choose transition from child service to adult services. TWO – INCLUSION AND SUPPORT: and tools. Our district will better include and promote the full When the DHB acts as a funder, any contract provided The Disability Clause creates a mandate for providers participation of disabled people, and services will ensure Where we have a role as funder or provider, working-age now includes a disability clause so providers report on to rethink what access means. Community services and the best support for disabled people and their families disabled people are supported to live as they choose what they are doing to improve access for people with a other providers are starting to become more accessible to range of impairments in their services. disability communities.

People with experience of mental illness recover and live A disability perspective has been integrated into mental The inclusion of a disability perspective to discussions has well health services and consumer groups. started to address access issues and promotes co-design.

As well as publishing research, we have created a five year We conducted comprehensive research with New Zealand work plan targeting isolated deaf people, New Zealand Sign Language users leading to an improvement on current Sign Language users and staff to improve access to health interpreter policy and the creation of staff education plans. THREE – ACCESS: Information and communication meet everyone’s needs services. Disabled people will have more independent access to As part of a full communication plan, the internet and Information has become more readily available and intranet pages have been updated. Video resource has services to meet their health and support needs accessible. been created with captions.

Access audits across Hut and Wairarapa DHBs facilitated We continually work to improve physical access and Physical environment and signage meet everyone’s needs training and some simple changes to improve access in implement audit results. each locality.

The expertise and needs of people and their whānau are Health Passport launched sub-regionally. recognised and respected.

Disability Alert implemented. This has led to a programme In a national first, data is available to monitor how people which gathers data to help to plan services. It also puts use the health system. This helps improve the patient FOUR – HEALTH: the patient’s preferences in the hospital computer system journey and ensure their needs are met safely and where needs are identified. without delay. Health Disparities will be reduced by Primary Health Care and better integration across services We now have access to tools such as eLearning and providing best care and improving, keep disabled people healthier and address their needs Health professionals and consumers are more confident video resources which were made alongside people using protecting and promoting the health of disabled people earlier in discussing experiences. This allows us to make more services. Such education is now mandatory for all staff in targeted education plans. direct contact with patients.

A network of champions who work across community and A network of expert champions was established by hospital services have often provided quick and timely CCDHB Disability Action Group to advise both staff and information to enable people and their families to take service use. control of their health journey.

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Disability Responsiveness 2011 – 2016 The Road so Far:

2016: 2015: pathway egional Forum eLearning eLearning at CCDHB R IntersectoralSub is mandatory first non disease Transition becomes Transition 2015: Chlild to Adult Complete citizenship for all responsiveness to Deaf Hired CCDHB leads the country at 2015: NZSL in Health Review. 2015: Educator 2014-16: Locality Forums Locality 2013) 2011: DR Policy created CCDHB 2014: Sub Disability (StatsNZ, Disability (StatsNZ, site 1 in 4 people have a Regional Forum Regional Launched 3DHB 2012: DR goes 2011: Health Passport 2011: Health Passport Transition demonstration Transition 2013: CCDHB Child – Adult 2011: DAG established 2013: 3DHB combined Alert Champions network 2013: CPHAC DSAC 2013: CPHAC 2013: Disability Advisor role created 2010: Senior Disability endorsed 2013: Sub 2013: DR policy Regional Forum Regional 2007: UNCRCP

launched Established 2013: SRDAG Implementation Plan 2013: 2013-18 Disability Strategy participation and access to services Unequal citizenship, Unequal citizenship, 2001: NZ Disability 18

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3 MOVING FORWARD

3.1 How to read this section This section gives the detail of the Disability Strategy 2017−2022, Enabling Partnerships: collaboration for effective health services. There are four levels of detail in the Strategy: 1. The guiding principles 2. The four focus areas 3. The strategic framework under each focus area 4. What achievement will mean for people (predicted outcomes)

INCLUSION & SUPPORT

Guilding principles OUTCOMES

LEADERSHIP ACCESS STRATEGIES ACTIONS

HEALTH

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3.2 Creation of enabling environments This Strategy draws on the World Health Organization Integrated care model ‘Enabling Environments’, the health system plan Vision 2030 and addresses the principles of the refreshed NZDS and UNCRPD. A common theme across the frameworks is that any system and service change to improve responsiveness involves the following: • Proactive initiatives collectively led by staff and the communities. • Intentional integration using available tools to identify areas of need. • Long term commitment to transformation led by communities of interest working with staff. A shared vision to achieve long term radical system change. While disability initiatives and tools provide opportunities for innovation the journey to real whole of system change will happen over a long period of time. Every part of the programme aims to enhance the autonomy and wellbeing of people who experience disability within current and planned health system development. To reflect the above, much of the detail that has been used in this plan is a result of direct feedback from consumers and key stakeholders that attended our local and sub-regional forums. The last sub-regional forum was held on 3 June 2016 in Upper Hutt and was an opportunity to refresh, reform and update the current strategic plan used by the sub-regional DHBs.

World Health 3DHB Disability CCDHB Health System Organisation Integrated 6 Guiding Principles Implementation Plan Plan Integration Care Model

Creation of enabling environments

Strategies that build Community leadership community resilience. Strengthening in health care and Active commitment LEADERSHIP governance and system monitoring. to strengthening accountability A health system fit for leadership and all. partnership across the sector.

Community leadership Inclusion of disabled Empowering and in education for health people in the design ACCESS engaging people and disability literacy of all services and and service co-design. activities.

Improving access to Improved support for information about INCLUSION + SUPPORT Coordinating services people to make well- funded services across informed decisions. age groups.

Movement toward All people using holistic model of services have improved wellbeing. HEALTH Reorienting the model health literacy and of care Creation of an enabling information, and lead and more accessible their care. environment.

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3.2.1 The Guiding Principles From the workshops at the 2016 Forum, there were several issues which seemed prevalent across each group discussion. To ensure there is a continued focus on these issues, we have created guiding principles. These six principles hold the voices, the values and the aspirations of the disability communities within the Greater Wellington region: 1. Creation of an enabling and more accessible environment 2. Inclusion of disabled people in the design of all services and activities 3. Movement towards a holistic model of wellbeing that improves health outcomes for disabled people 4. Improved support for people to make well informed decisions 5. Strategies that build community resilience 6. Active commitment to strengthening leadership and partnership across the sector

3.2.2 The Focus Areas Historically, the Disability Responsiveness programme has always followed the four key focus areas identified by the disability communities: Leadership, Inclusion & Support, Health, and Access. The Sub-Regional Group chose to retain the four areas but asked that leadership should become number one. These continue to act as the foundations of the work carried out by the newly named Disability Strategy Team and are colour-coded in unison with the World Health Organization Integrated Model of Care diagram.

FOCUS AREAS

LEADERSHIP

The sub-regional DHBs, in partnership with disabled people, their families, whänau and communities; plus, other relevant stakeholders, will provide leadership to achieve equity in health and wellbeing on an equal basis to others.

INCLUSION & SUPPORT

The sub-regional DHBs will improve and promote the full inclusion of disabled people and will ensure the best service for disabled people and their families is available on an equitable basis.

ACCESS

Services are more accessible and meet the health, well-being and social needs of disabled people, their families and whänau.

HEALTH

Heath disparities will be reduced and equity will be promoted, in order to improve and promote the health of disabled people.

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3.2.3 The Strategies Using the guiding principles, the strategies for improvement across 2017 to 2022 are listed in the tables in section four. The strategies form the framework for the Disability Strategy work programme including annual plans and targets. Under each strategy is a description of the action that will be taken to achieve this.

3.2.4 How we will implement the strategies While the strategies are high level, below each title in the table is a list of ways we propose to implement the strategy. Further still, the downloadable action framework shows the actions we will take to achieve our overarching focus area.

3.2.5 The Outcomes For each of the strategies and actions, we are trying to achieve an outcome. The desired outcome is shown in the Action Framework alongside the year we aim to do this.

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HIGH LEVEL SUMMARY OF THE STRATEGIES AND AIMS:

FOCUS AREA ONE: LEADERSHIP The sub-regional DHBs, in partnership with disabled people, their families, whānau and communities; plus, other relevant stakeholders, will provide leadership to achieve equity in health and wellbeing on an equal basis to others.

This will be achieved through actions linked to the following priorities: 1. Encourage intersectoral leadership on disability issues across key government organisations including Community and Public Health Services to partner work with local communities 2. Practice positive partnerships to enhance collaboration and co-design 3. Uphold the key principles of the Treaty of Waitangi 4. Ensure better accountability by creating a monitoring framework 5. Lead a disability responsiveness education programme throughout the 3 DHBs

This will mean: 1. Intersectoral leadership that has begun ensures that the commonalities and a shared social investment approach lead to improved access to health and social services and therefore improved health outcomes. 2. People and their families are respected as experts in their own health care and proactively engaged at different levels in advising and co-design of new and existing health services and systems 3. Whāia Te Ao Mārama guiding principles embedded in all actions lead to improved engagement with Māori with Disabilities 4. Accountability for improvement of practice is measurable and leads to initiatives reduced admissions to hospital, shorter stays where admission is necessary and by increased quality feedback from people using community and hospital services 5. Consumer led education targeted to for clinical and non-clinical staff contributes to greater understanding by staff leading to improved patient experience and a seamless patient journey

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FOCUS AREA TWO: INCLUSION & SUPPORT The sub-regional DHBs will improve and promote the full inclusion of disabled people and will ensure the best service for disabled people and their families is available on an equitable basis.

This will be achieved through actions linked to the following priorities (see appendix for more detail): 1. Improve access to funding, information, services and support 2. Ensure IT platforms accommodate disability responsiveness tools 3. Improve transition for children and young people from child to adult services within the healthcare system 4. Ensure health professionals are flexible and responsive to person specific needs 5. Encourage better use of technology 6. Improve accountability and integration across the planning and funding arms of the DHBs 7. Ensure people are supported in decision-making 8. Promote a whole of life approach to needs assessment and service coordination

This will mean: 1. The guide to funded services means people will understand what they can access and where. This enables people and their families to be more in control of their support 2. Technology used across health and disability services enables health practitioners to understand the various components and inputs to the overall support of people and their families 3. The electronic pathway and tool kit co-designed with families enable them to access community health and disability services with general practice as allies 4. Tools such as the disability alerts, the health passport and shared care planning enable staff to facilitate a seamless journey through health services, including funded health and disability services 5. Its tools give people options on ensuring critical information about individuals can be shared. An electronic version of the health passport enables disabled people who prefer to use their devices enables to share support information in real time 6. A disability clause obligates providers to develop plans and improve access on a developmental basis each year. This improves access to general health and community services. 7. Staff understand supported decision-making enabling people to better participate in decision- making about their health care 8. A whole of life approach across needs assessment services reduces fragmentation and enables more timely access to the appropriate support pathways irrespective of age group and condition

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FOCUS AREA THREE: ACCESS Services are more accessible and meet the health, wellbeing and social needs of disabled people, their families and whānau.

This will be achieved through actions linked to the following priorities (see appendix for more detail): 1. Create an enabling environment where the person is at the centre 24 2. Promote community resilience across the sub-region 3. Ensure that physical access remains a priority for the 3 DHBs 4. Improve access to New Zealand Sign Language interpreters and quality of care for the deaf community

This will mean: 1. Information available in plain language documents and in accessible formats across the 3 DHBs electronically and in hard copy puts the person in charge of their journey through the health system 2. Collaboration with councils, other government bodies and community members working across localities provides safety and better emergency preparedness as well improved connection with neighbours and other natural supports 3. As buildings are developed, input from access experts ensures that future health care is fit for all groups irrespective of impairment. 4. Each year deaf people using general and mental health services have a safer journey through the health system, have improved health literacy and a large proportion of staff understand the cultural needs of deaf people

24 Based on World Health Organization model of service integration

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FOCUS AREA FOUR: HEALTH Health Disparities will be reduced and equity will be promoted, in order to improve and promote the health of disabled people.

This will be achieved through actions linked to the following priorities (see appendix for more detail): 1. Shift to person/whānau-directed care model is promoted by the Executive leadership teams 2. Support Primary Health Organisations (PHOs) 25 to improve access to services by utilising education information from and by empowered consumers 3. Support initiatives that improves access to rehabilitation by providing advice and expertise available to the Disability Strategy Team and the responsible leads across the three DHBs 4. Disability Responsiveness Education and training will be mandatory for all DHB staff involved in patient care and other front line DHB disability services

This will mean: 1. A disability lens consistently applied in new models of care mean disabled people are able to access quality health care in community and hospital irrespective of multiple specialists and conditions 2. Alliance Leadership Teams and PHOs lead the way in improving disability responsiveness in general practice settings by integrating a professional and consumer disability lens in education 3. Rehabilitation services improve with disability community input and good practice models are shared across health ACC and MOH 4. Staff at pre-registration and post-registration are competent in disability literacy and adapt care to meet the needs of any person irrespective of impairments or health

25 PHOs are the management bodies that oversee general practice services. There are three in Wellington one in Wairarapa and one in Hutt Valley.

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4 ACTION TABLE

Using the guiding principles, the strategies for improvement across 2017 to 2022 are listed in the tables below. These strategies create the framework of the Disability Directorate work programme as well as annual plans and targets. The tables below show the strategies we will be implementing and how we will do this. Further to this document, a downloadable action plan with timelines and monitoring framework is available from our website https://www.ccdhb.org.nz/your-health/support-services/disability-responsiveness/ The Framework shows specific actions against each of the points below. Targets are set each year by each DHB and the achievement of many are long term while others are clearly identified as short and will aim to be completed between 2017−2019. Other goals are set by 2022. The table shows both actions planned to meet these goals as well as a description of our current progress. The table below should provide you with a solid grasp of our intended plans, but should you want more information, please refer to the Action Framework.

The Action Framework shows: • The Overarching Aim: What we want to do • The Expected Outcome: What we expect to see if we achieve this • The Strategy: How we expect to achieve this • The Action Plan: How we put this strategy into action and achieve our aim • The Progress: Have these actions been started? Have they been completed? • The Project Status: An overview of where we currently stand with these actions • Date of Completion: The year we should expect to see this implemented. 2017−2022

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Focus Area 1: Leadership The sub-regional DHBs, in partnership with disabled people, their families, whanau and communities; plus other relevant stakeholders, will provide leadership to achieve equity in health and wellbeing on an equal basis to others.

SRDAG continues to govern the programme of activities, lead engagement 1.1.1 1.1 Encourage and maintain community partnerships across the region intersectoral leadership on 1.1.2 Annual local forums led and supported by local communities disability issues across key government 1.1.3 Biennial sub-regional forums led and supported by local communities organizations including community The Disability Strategy Team works with the Chief Executives and DHB and Public Health 1.1.4 Planning and Funding Directorates to take an investment approach and build Services to partner capacity within the integration programme to respond to disability strategies work with local Research and innovation is proactively planned and monitored by the communities 1.1.5 Disability Directorate in partnership with the three DHBs

Promote best practice in co-design with expertise of communities facilitated by 1.2.1 the SRDAG model

Provide Disability expertise to the Mental Health Integrated Strategic 1.2.3 1.2 Practice positive Leadership Group and the mental health consumer leadership group partnerships to enhance collaboration 1.2.3 Create a shared understanding of accessibility and joint responsibility and co-design 1.2.3 for addressing social determinants by working with the Councils and local communities

1.2.4 Review the use and content of the Health Passport in partnership with 1.2.4 the Health and Disability Commissioner, clinicians and consumers

1.3.1 Uphold Whāia Te Ao Mārama Principles by engaging Māori disabled people

1.3 Uphold the key Ensure relevant and informative disability related information is available to 1.3.2 principles of the community and health leaders through the Māori Health services Treaty of Waitangi Work to influence the Whāia Te Ao Mārama strategy within disability 1.3.3 responsiveness for Māori disabled individuals, whānau and key stakeholders

1.4 Utilise the skills The DAG leads a proactive plan of work to contribute to quality and clinical and resource of the 1.4.1 Disability Action service improvement for people who experience disability Group and refresh the Champions network to ensure efficient The DAG and Champion Network are interlinked and share both skill and 1.4.2 action resource with the Disability Directorate within the DHBs

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Review the current monitoring framework and continue to build a dashboard 1.5.1 of meaningful indicators 1.5 Ensure better Increase the employment of people who experience disability within the accountability 1.5.2 3 DHBS by educating staff, leaders and Human Resources on how best to by creating support them

a monitoring 1.5.3 Continue to promote work placements in disability fields where appropriate framework DHB Executive Teams to evaluate and improve the effectiveness of services 1.5.4 for Mäori people with disabilities.

Ensure all learning and development programmes sub-regionally gradually 1.6.1 incorporate a rights based approach which is comprehensive and encompasses disability responsiveness

Engage with pre-registration students on placement within health services to 1.6.2 provide disability responsiveness training

Promote core competencies, principles and values within all training 1.6 Lead a disability 1.6.3 programmes to create a culture change more suited to a holistic model of responsiveness wellbeing education Advance disability literacy at all levels and promote disability literacy as a 1.6.4 programme mandatory competency in undergraduate education throughout the Continue to develop, upgrade and review tools that provide a focus for staff 3 DHBs 1.6.5 and people using services to practically understand the diversity of need across the disability population

Work in partnership with Māori Health and community leaders to develop a 1.6.6 strategy to reach out to the Māori disability communities

Uphold the key principles of Faiva Ora and engage with Pacific Health and 1.6.7 community leaders to reach out to the Pacific disability community

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Focus Area 2: Inclusion and support The sub-regional DHBs will improve and promote the full inclusion of disabled people and will ensure the best service for disabled people and their families is available on an equitable basis.

Create a simple guide to Disability Support funding and funding mechanisms 2.1 Improve access to 2.1.1 which is accessible to all and offers a reference point which is regularly funding, information, updated Work towards an improved system of data sharing which enables a person to services and support 2.1.2 own and control their health and support needs information

Disability Alert project is fully operational and the quality of information is 2.2 Ensure IT platforms 2.2.1 accommodate monitored disability Investigate opportunities for disability support or access information to be 2.2.2 responsiveness tools accommodated on other IT systems used by the patient

Complete the development of an electronic pathway to guide and support 2.3.1 healthcare professionals when working with children, young people and families are transitioning between services

Families, children and young people continue to provide information to guide 2.3 Improve transition 2.3.2 for children and projects around transition as part of a co-design method young people from Create a resource kit in partnership with families and health professionals that 2.3.3 child to adult can be used during transition to ensure continuity of care services within the Create a policy on transition with clinical staff to enable safer and more healthcare system 2.3.4 timely transition for young people requiring a number of health and disability supports

The youth leaders of the SRDAG work with youth networks to encourage and 2.3.5 promote a proactive approach to supported decision making

2.4.1 Encourage co-design process to model of care and service models that takes 2.4 Ensure health a holistic approach to service development and delivery professionals 2.4.2 Promote the updated guidelines/algorithm for staff to ensure the service and are flexible and placement needs of people who do not meet required criteria for services or responsive to a funding are addressed in a timely way persons specific 2.4.3 Initiate a clinical governance group with clinicians and NASCs to ensure needs people with the most diverse needs are prioritised and placed in the most appropriate setting

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2.5.1 Scope the use of the technology that is currently being used by disability communities and consider the interface of those being developed for health services 2.5 Encourage better 2.5.2 Support a more coherent approach to data sharing in relation to disability use of technology identification across PHOS sub-regionally

2.5.3 Continue to innovate in healthcare education and promote existing tools such as video resource and the CAT pathway (references 1 - 6.5 and 2 - 3.1)

2.6.1 The disability clause ensures mandatory reporting from all providers across all 2.6 Improve three DHBs outlining how they have implemented the NZ Disability Strategy accountability and 2.6.2 The existing Disability responsiveness policy at CCDHB is promoted and integration across the localised to Hutt Valley and Wairarapa DHBs planning and funding arms of the DHBs 2.6.3 Work with quality and strategy and innovation units to incrementally include a disability lens on all new and reviewed DHB plans and policies

2.7.1 The disability strategy team become familiar with ‘Supported Decision Making’ practice and tools and share knowledge across the DHBs as part of wider education 2.7 Ensure people 2.7.2 Documents are provided in plain language and in accessible formats to ensure are supported in the person is fully informed when making decisions (reference 3 - 1.1) decision-making 2.7.3 Clinicians and service providers are supported to use the information provided within a persons health passport and disability alert

2.7.4 Collaborate with the advanced care planning project which aims to encourage all people to plan for the future

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Focus Area 3: Access Services are more accessible and meet the health, well-being and social needs of disabled people, their families and whanau.

Information is available in plain language documents and in accessible formats 3.1.1 3.1 Create an enabling across the 3 DHBs environment 3.2.1 Improve access to information via internet and intranet

3.2.1 Provide education and resources to regional councils

Support and promote leadership by disabled people in partnership with local 3.2.2 3.2 Promote Community entities to contribute to health system planning and other sector development Resilience across the Promote better engagement and collaboration with leaders from disability 3.2.3 sub-region communities

3.2.4 Inform communities by creating resources and tools that can be shared easily

Access is monitored across the three DHBs and periodic access audits are 3.3 Ensure that physical 3.3.1 access remains a used to provide feedback priority for the 3.3.2 Promote the benefits of improving access to services sub-regional DHBs

3.4 Improve access 3.4.1 Develop and implement a 3DHB NZSL policy to New Zealand Create a framework for education for staff and improve responsiveness to 3.4.2 Sign Language deaf patients interpreters and 3.4.3 Improve access to NZSL interpreters and improve the booking processes quality of care for deaf community 3.4.4 Utilise technology to improve access to healthcare services

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Focus Area 4: Health Heath disparities will be reduced and equity will be promoted, in order to improve and promote the health of disabled people.

Define and promote the concept of a person/whānau-directed care model and 4.1 Shift to person/ 4.1.1 whānau-directed care empowered self-care Work with leaders across the sector to implement better systems for a single model is promoted 4.1.2 by the Executive coordinated plan for each person *long term goal leadership teams 4.1.3 A regional approach is used to improve services and support options

Create a tangible action plan to work with all levels within a Primary Health 4.2 Support PHOs to 4.2.1 improve access Organisation; from senior leaders to clinical staff to administration staff. Ensure there is active engagement and disability perspectives provided on the to services by 4.2.2 utilizing education Healthcare Home project information from and by empowered 4.2.3 Actively engage with primary care services to promote the use of DR tools consumers

4.3 Support initiatives that improves access to rehabilitation by Seek to influence to development of age and life stage appropriate 4.3.1 providing advice and rehabilitation services are available to all and ensure smooth transition points expertise available to the Disability Directorate

4.4 Disability Create annual communication plans targeted to all levels of health care 4.4.1 professionals and actively engage with staff members to provide tailored Responsiveness information and education Education and Hold events across the 3 DHBs every year to celebrate International Day of training will be 4.4.2 Persons with Disabilities, in the form of Disability Responsiveness Week mandatory for all DHB staff involved in patient care and Work closely with Pacific Health Unit and whānau care to ensure staff are 4.4.3 other frontline DHB provided with efficient training disability services

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APPENDIX ONE:- GLOSSARY OF ACRONYMS

CCDHB Capital & Coast District Health Board Community and Public Health Advisory Committee Disability Services Advisory CPHAC DSAC Committee DAG Disability Action Group DHB District Health Board ELT Executive Leadership Team (Hutt Valley & Wairarapa DHB’s) HOP Health of Older People HOP Health of Older People HVDHB Hutt Valley District Health Board LTS-CHC Long Term Support – Chronic Health Conditions MoH Ministry of Health Needs Assessment and Service Coordination # Capital Support – CCDHB (under 65yrs) # Care Coordination Centre – CCDHB & HVDHB (over 65yrs) NASCs # Focus Trust – Mental Health (under & over 65yrs) # Hutt Valley Life Unlimited – HVDHB (under 65yrs) # Te Haika – Mental Health NASC - CCDHB NGO Non-Governmental Agency NZDS New Zealand Disability Strategy (2001) NZSL New Zealand Sign Language PH&DA Public Health & Disability Act (2000) PHO Primary Health Organisations PHOAG Primary Health Organisation Advisory Group SRDAG Sub Regional Disability Advisory Group SIDU Service Integration and Development Unit TOR Terms of Reference UN Convention United Nations Convention UNCRPD United Nations Convention on the Rights of Persons with Disabilities Capital & Coast District Health Board, Hutt Valley District Health Board and 3DHB’s Wairarapa District Health Board 35

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Capital & Coast DHB staff news

ISSUE 24 • MARCH 2017 HealthMatters

The secret garden: Helping patients work towards a more independant life Read Health Matters on the staff intranet Staff engagement survey: Have you completed your survey yet?

WIN MOVIE STAFF FLU STAYING SANE TICKETS: VACCINES: IN WINTER: Read Health Matters Free vaccinations Treating patients in a and be in to win pg 5 for staff pg 3 timely fashion pg 7

154 26 April 2017 - CCDHB Board PUBLIC papers - APPENDICES Compliments Kenepuru ward 7 When I reflect on the treatment I received on Ward 7, these are the words that immediately come to mind: caring, understanding, attentive and competent. Thank you from the bottom of my heart for the amazing treatment I received at Kenepuru Community Hospital. From the CE Short Stay Unit What can I say other than your staff on short stay are amazing. The care I received was tops. I have had more than one visit to Wellington Regional Hospital in the last year and I remain in awe of your staff. A member of our executive management team recently said that sorting out our Therapies finances was a bit like climbing Mt Everest. Fantastic friendly service for my hand therapy. I have been going to I thought this was a great analogy. hand therapy for approximately eleven months and always had great You can’t get straight to the top – you help and advice. Great work. Thank you so much. have to start at base camp and work your way up. Reaching the four camps Capital support are big achievements in themselves. And I found a certain staff member I met to be extremely helpful and sometimes you have to go down the informative. I had given up on the system and she has restored my mountain to regain your strength before faith in accessing services for my son that are relevant and sustainable. heading back up again. This is exactly what After her visit I felt that there was hope that my son would get the we’ve been doing. additional help that he needs to live an independent and fulfilled life. For us base camp was the $68 million deficit we had in 2008/09. We nearly Delivery/Maternity made it made it to the top a couple of I just wanted to let you know how impressed I was with the level of years ago achieving a $4 million deficit. care I received while having my baby. I had some complications during Unfortunately the past few years our my labour but staff were amazing and looked after me and my baby deficit has crept back up. in a great manner. Being on the ward afterwards was also good. All midwives were lovely and there whenever I needed them. What great We are currently $3 million behind this staff. year’s budget. It may sound like a lot, but when you break it down it’s every staff member saving $5 a day for the next three Cardiology months. I would like to express my deep appreciation to the whole team for their extraction of fluid around my heart. I now feel like a new person. Work continues on initiatives across the During my entire week-long stay at the hospital, I received the very organisation, but how can you personally best of care from everyone who attended me. I have nothing but the help the organisation achieve its budget? highest of praise for the Wellington Cardiology Group. We often read It doesn’t have to be big changes – it in the newspapers of people complaining of one thing or another and I could be lots of little ones. I’m avoiding feel it’s about time the hospital received due credit. printing large reports, turning my light and computer off when I leave my office. Ward 7 South My mum died in January. I’d like to extend my very best wishes to all We’re still above base camp which is staff who attended her in her last few days. She was admitted with a something we should be proud of, but we stroke and we couldn’t have asked for better care or consideration. have a way to go to reach the summit. Everyone was marvellous and our family are happy in the knowledge Working together will help us get there. that her last few days were as comfortable as could be. Thank you very much, we are all so grateful.

Debbie Chin, Chief Executive COVER PHOTO: Staff at the Kenepuru Community Hospital garden.

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155 26 April 2017 - CCDHB Board PUBLIC papers - APPENDICES staff influenza vaccination clinics - 2017 Protect yourself and those around you this winter by getting vaccinated against the current circulating strains of influenza. Put a time in your diary to get your free vaccination.

VACCINATION CLINICS MOBILE VACCINATION CLINICS

Monday 27 March - Wellington Regional Hospital Monday 10 april - Wellington Regional Hospital 8.30am - 3.30pm: Whānau Care meeting room, Cultural 9am - 10.30am: Blood & Cancer, interview room 2, level 3 Care Centre, level 2 11.30am - 1pm: Theatre seminar room, level 3 2.15pm - 3.45pm: Ward 5 North meeting room TueSday 28 March - Wellington Regional Hospital 8.30am - 3.30pm: Whānau Care meeting room, Cultural TUESDAY 11 APRIL - Wellington Regional Hospital & Care Centre, level 2 ewart building 8.45am - 10am: Ward 1 & 2 - Tamariki room outside ward 1 WedneSday 29 March - Wellington Regional 11am – 12.30pm: Ward 7 North meeting room Hospital 2pm - 3.30pm: Gym 2, Ewart Community Health building 8.30am - 3.30pm: Whānau Care meeting room, Cultural Care Centre, level 2 WEDNESDAY 12 APRIL - Kenepuru community hospital 9am - 10.30am: Te Whare Marie ThurSday 30 March - Kenepuru community 2pm - 3.30pm: Community Health Service, level 1, ORA Hospital Community Health building 8.30am -3.30pm: Education Centre seminar room 1 THURSDAY 13 APRIL - Hania & Tory Streets Friday 31 March - Kenepuru community hospital 8.30am - 10am: CAFS Hania Street - room 15 8.30am - 3.30pm: Education Centre seminar room 1 11am - 12pm: CMHT, Tory Street

Monday 3 april - Wellington Regional Hospital TueSday 18 april - Wellington Regional Hospital & 8.30am - 3.30pm: Whānau Care meeting room, Cultural Kenepuru community hospital Care Centre, level 2 9am – 11am: CMHT South / Addiction Service administration building, Mein St, ground floor, nurses TueSday 4 april - Wellington Regional Hospital clinic room/middle treatment room, Wellington Regional 8.30am - 3.30pm: Whānau Care meeting room, Cultural Hospital Care Centre, level 2 1.30pm - 3.30pm: Ward 6, Kenepuru Community Hospital

WedneSday 5 april - Wellington Regional Hospital WEDNESDAY 19 APRIL - Wellington Regional Hospital 8.30am - 3.30pm: Whānau Care meeting room, Cultural 10am – 11.30am: Ward 4 North meeting room Care Centre, level 2, Wellington Regional Hospital 2pm – 3.30pm: Ward 5 North meeting room

ThurSday 7 april - Kenepuru community hospital THURSDAY 20 APRIL - porirua 8.30am - 3.30pm: Education Centre seminar room 1 10.30am – 12-30pm: CAMHS/CMHT Level 3 BNZ Tower 2pm - 3.30pm: Tane Mahuta (Tangaroa GP clinic) Friday 7 april - Kenepuru community hospital 8.30am - 3.30pm: Education Centre seminar room 1 FRIDAY 21 APRIL - Kenepuru community hospital 9am – 12pm: ground floor education centre, seminar room 2

DROP-IN FLU VACCINATION CLINICS FOR STAFF From 24 April, at the Health and Safety Service, level 10, Clinical Services Block, Wellington Regional Hospital. See the staff intranet for details or visit fightflu.co.nz

Comms: 00377-1703 - March 2017v3

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BY T NED HE T IN RIP RP LE E A D I The orthopaedic review team N M U

Caption

SHORTER, SAFER shorter orthopaedic HEALTH JOURNEYS wait times at clinics Our orthopaedic outpatient clinic raised the patient satisfaction by 10%, and decreased wait times by 4 minutes. at Wellington Regional Hospital has “We have divided the clinic space in half, so one half is made changes which have allowed dedicated fracture clinics, while the other is dedicated for orthopaedics. This has reduced unnecessary movement them to deal with more patients at a for patients,” says Chris Hoffman, orthopaedic consultant. faster pace. “We have also reduced the nurses workloads. Redundant The team wanted to build on the efficiencies they had procedures have been removed from the their roles, gained over the past few years and conducted a review. and we have increased the communication that happens between them, other departments, and also patients.” The review identified 29 different actions that could be undertaken to improve services. The biggest of which was Our orthopaedic clinics are anticipating a significant changes to the layout and sizes of the clinics. increase in the volume of patients in the future and we want to ensure we are ready to manage that. “In the past, we’ve had patients complain about the wait times for the clinics,” says Julia Catsburg, orthopaedic The next phase of this review is due to happen in the service manager for surgery, women & children’s. coming months where they intend to roll out the changes to Kenepuru Community Hospital. By changing the way the space was utilised, changing the RMO and SMO interactions with each other and their patients, and changing the size of the clinics, they have

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BY T NED HE T IN RIP RP LE E A D I N M U

IPads for community

SHORTER, SAFER ORA staff HEALTH JOURNEYS

ur district nurses and Staff are actively using these iPads as Ocommunity older adult, key tools in multidisciplinary team rehabilitation and allied meetings. health services (ORA) “The on-hand and up to team now use iPads date information that the when working in the iPads give mean that the community. client, their family and A special app has all the staff involved been installed on can be fully informed 52 iPads which of the most recent gives staff details that may secure access impact in their to the DHB care,” says Mirjam systems and Han, community internet while occupational they are out and therapist. about. “The cameras on the “The vast iPads allow us to take majority of our photos of a client or role is spending their home environment time with patients in without breaching privacy their own environment as they are uploaded to the - from people’s homes Fiona Gamble with her iPad in the car DHB systems and attached to and workplaces to community patient files.” settings,” says Fiona Gamble, This technology goes hand in hand with community physiotherapist. creating a digital shared record of all patient files, “We used to have to go back to the office to type up notes which the DHB is moving towards. or fill out equipment request forms, now we can do it “This technology ensures mobility and secure access to the between appointments or even during them. right information, at the right time and in right setting. It is “It also gives us the opportunity to show clients pictures of critical to the development of new and innovative models equipment or feedback on aspects of rehabilitation, such of care” says Shayne Hunter, 3DHB chief information as gait retraining.” officer. As well as the benefits for patient care, it has also allowed This is part of the Health Care Homes initiative - a joint for improved links with their colleagues on the inpatient primary and DHB initiative that is improving the services wards and in the primary health care setting. delivered in the community.

Congratulations to this months winner, Carrie Philliskirk, Team Leader, Simulation & Skills Centre. Read the latest edition, answer three questions correctly and go into the draw to win 2 Embassy theatre tickets donated by the Hospi Foundation. Read This months questions are: 1. Name one item in the orange emergency cabinet? 2. How many iPads are the community ORA team and community nurses using? 3. How much extra ACC revenue is the DHB receiving? & Win! We’ll announce the winner each month in Health Matters. Email your answers to us at: [email protected] with the subject line “Health Matters Competition” before Monday, 18 April 2017.

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Did you know CCDHB View from inpatients now have the board free Wifi? room he new board has been in place for over Tthree month’s now. For the majority of our members, this is the first time they have been on a DHB board. As you will all know, health is complex – health acronyms alone are like learning a new language. Our first few months have been focused on understanding the opportunities and challenges for the DHB. We want to be well informed about what has happened in the past so we can Keeping make the best decisions for the future. We have been visiting different services – patients talking to staff and hearing what it is like on the front line. We have also been meeting with our key partners, such as GPs, PHOs, connected Maori Partnership Board, Sub Regional Pacific ith the new patient WiFi network up and running, Strategic Health Group, and the Ministry of all of our inpatients have the ability to log in for Health. W unlimited free wifi. On behalf of the board, I’d like to thank “All inpatients need to do is turn on WiFi on their everyone who has taken time out of their busy device, choose the ‘DHBPatientWifi’ network, and day to show us around, and talk to us. put in their National Health Index (NHI) number,” says These conversations have been Shayne Hunter, chief information officer. incredibly valuable, and “Patients don’t have to worry about logging out either.” something we plan to continue to do. WiFi – or wireless connectivity – allows laptops, tablets and mobile phones to connect to the internet without a physical connection. Andrew Blair The free WiFi is available to inpatients at Kenepuru Board Chair Community Hospital and Kapiti Health Centre as well as Wellington Regional Hospital. “One NHI can be used to log two devices into the WiFi simultaneously. This allows inpatients to use two devices, or an inpatient and visitor to use the WiFi at the same time,” says Shayne. Information about how inpatients can connect to the network is on the intranet and our external website. Brochures have also been distributed to the wards. ICT is now exploring options and way of making WiFi free for outpatients. Outpatients can continue to purchase tokens from the Hospital Gift Shop at a reduced price.

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improving acute flow

Staying sane in winter

Winter is coming, and is often a 3. refining the way our acute assessment units work to get people home, to the comfort of their own bed, if time when our services are under that is appropriate. This will also need us to focus on the assessment and support we can provide to people increased pressure. This impacts our in their homes soon afterwards patients – some time causing delays 4. improving the way our nursing, allied health staff in their care. and doctors work together to enable people to be discharged earlier in the day after a stay in hospital. We don’t want to see our patients waiting unnecessarily. This would mean our patients spend less time waiting While sick patients wait in the emergency department in traffic to get home (especially if they live on the (ED), they’re at risk of infecting others. If they become Kapiti Coast or outside our district). inpatients for too long, they run the risk of getting many of the complications that come with being in hospital, such According to Chris Lowry, general manager hospital and as suffering from falls or delirium. healthcare services, there are two key causes for delays in treating each patient in a timely manner. If we can treat patients in a more timely fashion, it’s better for them, and makes it easier for us to care for “The first of the challenges is the ability to prioritise the increased numbers we will start to see in the winter their work given the competing priorities. The other is months. insufficient capacity at peak times that result in patients ‘queuing’ for care. “We’re working hard with our clinical teams, and have also engaged consultants Francis Health to bring some “Some of our early work is showing promise. It is ideas and extra support to this work” says John Tait, chief encouraging to see some areas treating patients in a more medical officer. timely way, and lightening their own load at the same time. There is work being undertaken in four main areas: “And if winter goes the same way as summer and vanishes 1. the ED team are trialling new models of care to enable without a trace, it will be worth it for the changes we can them to see and treat patients sooner make for our current patients. 2. Francis Health are working with different departments “Reducing delays improves the experience for patients to find ways staff can get to ED within 60 minutes of and their families. It’s how I would want my family referral cared for.”

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160 26 April 2017 - CCDHB Board PUBLIC papers - APPENDICES Thanks Special thanks and recognition to the following staff

5 Years • Nanette Schleich,s enior medical • Itufa Fruean, health care associate physicist • Lorraine Tetley, social worker • Kimberley Sutherland, clinical • Stephanie Thompson, psychologist physiotherapist • Andrew Clark, medical records • Erin Jourdain, optometrist clerk • Lorna Bingham, nurse practitioner • Vishaya Williams, health care diabetes Staff Profile assistant • Victoria Lobb, registered nurse • Sailosa Kabiriera, registered nurse 15 Years • John Espina, registered nurse • Megan Owens, social worker • Dawn Bailey, registered nurse • Fali Langdana, senior medical Jo McMullan • Dianna Mackley, health service officer Clinical midwifery manager, assistant • Glenda Fallen, administration ward 4 north • Antony Cairns, registered nurse coordinator • Kay Allen, registered nurse • Andrea Wineera, registered nurse • Elaine Van Ooyen, registered • Paula Tarrant, social worker nurse • Andrew Kennedy-Smith, urologist What’s your role at CCDHB? • Anne Fisher, registered GP liaison • John Baker, security orderly nurse • Annette Garrod, registered nurse I am the newly appointed clinical midwifery • Pania Tuiloma, registered nurse • Ngaere Gaudin, registered nurse manager of ward 4 north maternity which • Marion Weir, registered nurse encompasses antenatal and postnatal inpatients. • Ketna Parekh, physician 20 Years • Angela Gibson, dietitian • Carol Johnson, oncologist We also work closely with the delivery suite and • Carina Allen, activities support • Paula Carryer, ultrasonographer the rest of the women’s health service. worker • Susan McGeady, elective service • Jason Parker, support worker manager Until taking this new role, I spent about nine years • Miriam St George, ward • Julie Beattie, administrator as charge midwife manager of Hutt maternity. administrator • Suzanne Barber, therapy assistant • Sandra Garrett, ward • Nicola Wesney, registered nurse What’s an average day like? administrator • Sheryl Sparkes, registered nurse • Robert Weinkove, consultant I have been walking to work which is a huge luxury haematologist 25+ Years compared to the commute to the Hutt. It gives me • Mack Elesoni, orderly • Anna Caballero Newby, registered • Dennis Klue, team leader time to mentally prepare for the day. nurse • Lynda Simeona, registered nurse • Nicola Bryant, registered nurse At the moment I am trying to remember • Janet Barry-Martin, registered • David Malupo, pharmacy nurse everyone’s name and the layout of the unit…I have assistant • David Ryan, registered nurse no sense of direction! I rely on the assistant charge • Lynette Soames, administration • Sharon Smith, clinical coordinator assistant midwife manager to give me the “state of the • Shelley James, charge midwife • Glenys Duncan, registered nurse nation” regarding admissions, discharges, staffing manager • Liam Nattrass,application • Duncan McPhail, senior and to have sussed out any issues on the unit. developer anaesthetic technician • Esme Mckay, registered nurse Once I know that the staff and women are • John Tait, chief medical officer • Rose Sales Corpuz, registered • Raymond McEnhill, team leader happy I can box on with admin such as invoices, nurse • Ann Weston, medical records timesheets, and ordering supplies. I liaise closely • Verna Lawrence, administration clerk coordinator with Shelley James, charge midwife manager in • Pia Raudkivi, specialist • Jody Peipi, health care assistant delivery, to ensure flow across the unit. She has • Adrian Gillies, security orderly • Eugene Kennelly, registered nurse coordinator been invaluable orientating me to this new role. • Linda Chee, medical records clerk • Rae Elliott, registered nurse • Veronica Mansfield, registered Another key task is being involved in • Jane Symonds, registered nurse nurse • Paul Magson, supervising plumber multidisciplinary meetings and work streams • Anthony Ryan, registered nurse • Margaret Hogg, registered nurse relating to quality and safety. 10 Years • Andrew Logan, ophthalmologist • Christina Etimani, mental health • Anne Stewart, quality I also need to remain current clinically to maintain support worker improvement advisor my annual practise certificate and this entails • Gaylene Oyston, staff med • Rosaline Ahmed, health care working across the midwifery scope of practice. radiation technologist assistant • Aileen Anderson, radiographic • Jennifer Irving, registered nurse What’s the most satisfying part assistant • Shanta Kumar, clinical typist • Suzanne Craig, secretary • Catherine Wood, clinical nurse of your job? specialist • Alexis Maxwell, registered nurse Being part of a team providing excellent care for • Pamela Bumalay, registered nurse • Christine Marshall,learning and • Rebecca Oliver, registered nurse development manager women and whanau of our community.

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A day in the life: the imprest team

Have you ever wondered how your The team aim for same day clinical stock is always replaced, even delivery. though you don’t request new stock? “If we find out an item is below Every week day, members of the imprest team move the minimum between different wards and departments and count the level, we try to stock levels they find. have the stock The team, made up 12 staff, help to maintain stock levels replenished across the DHB. that day” says Each department have minimum levels of stock that Michelle. should be available to them. The imprest team conducts “We also replenish the stock in the district nurse mini stocktakes daily to try and make sure that the levels bags for the community with each bag containing of clinical items do not run out. approximately 137 items. The items in these bags range “Our approach requires stock taking high use areas daily, from wound care packs and scissors to dressings and like the emergency department, ICU, NICU and theatres. saline. Where other areas with less turn over, like outpatient “We go through the entire hospital every week almost areas, are usually checked two or three times a week,” top to bottom. Our job is to try to make sure you are all says Michelle Tapa, purchasing and imprest supervisor. equipped to do your roles. Every clinical item is barcoded and is scannable so the “Have a chat to one of us if you think there are issues we team is able to quickly and efficiently count stock levels. can help with.”

CCDHB Health Matters March 2017 l 9

162 26 April 2017 - CCDHB Board PUBLIC papers - APPENDICES Your Emergency Toolboxes You may not know it, but your work area The cabinet contents will help to keep you safe and the is home to a smorgasbord of supplies to clean-up of minor damage, flooding, leaks, etc. “The items are things we might not already have. For help you get through an emergency. example, they don’t contain emergency water because Located across the DHB, orange emergency cabinets can that’s something we already have stored elsewhere.” assist with all kinds of emergencies – from electricity There are 70 orange cabinets across our DHB, each one outages, to major disasters. costing around $2800. “The cabinets’ supplies will help people remain where The key is on the cupboard, and can be accessed by they are if they decide it’s safe to do so,” said emergency breaking the glass or plastic covering. management coordinator Maureen Cahill. The contents are listed at the back of the earthquake “Unless there’s a clear and urgent need to evacuate, response plan found in the emergency management we’re unlikely to be able to leave for quite some time procedures folder – which each service, ward and unit after a major disaster. have– and on CapitalDocs. Working as a team, following the yellow emergency If you remove anything, please return it or let emergency management procedures folder, and using the cabinets management know it needs replacing. and other items in your area is how you and your team will get through.”

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finances Making our data collection more accurate e have saved over $1 million thanks to work our data collection more accurate” says John Lowe, Wfrom our ACC and eligibility team and the acting team leader of ACC and eligibility team. teams at Kenepuru Community Hospital. “The assistant charge nurse managers along with the In 2015, it was discovered that due to collection ACC coordinator meet each week to discuss concerns issues, we were potentially losing money through and issues with data collection and patients.” care that we could have billed to ACC. Between July-December 2016, through the non-acute We have around 20 contracts with ACC where we rehab contract, which deals with complex needs provide healthealth care patients, the teams have now been able to invoice assistant services, and ACC an extra $1 million dollars compared to previous D BY THE NE TRI they pay us for our years. This is expected to rise to $1.8 million by the IN PL P E work. end of the current financial year. ER A D IM N “Since we “That’s $1.8 million worth of care that we as a DHB U discovered the would have paid for. Now we get that money back loss of potential through ACC,” says John. revenue, both the “This is a great example of a service that is working ACC and eligibility hard to correctly identify the correct revenue stream team and the for the treatment they provide which helps their team in Kenepuru service, the DHB and ultimately their patients.” BEST VALUE have worked very FOR MONEY hard at making

sustainability saving the world one light switch at a time e can all be making our DHB more energy Other times we have to reconsider some of our Wefficient. Our hospitals use the same electricity beliefs. Contrary to what many of us believe, our as 5,500 homes to provide lighting, cooling, heating, computer monitors continue to draw power when air pressure and ventilation to our buildings. We they are off, turning the also have to power clinical equipment, computers, power socket off helps screens and appliances. saving energy. Research from the European Environment Agency While being energy tells us that between 5-10% of energy reduction can efficient is a big challenge, be achieved by changing the way we do things. we can all make our “We have to make it common practice to turn lights contribution. If we reduce and equipment off when we can safely do so,” says our power consumption Valentino Luna Hernandez, sustainability manager. 0.1%, that would be enough power used by “We want to show our patients and community that five households. we are being good stewards of their health as well as our environment.” There are basic steps such as turning lights, computer and monitors off when we leave the office. If 10% of the total number of our computers are left on overnight, it can cost us over $30,000 a year.

CCDHB Health Matters March 2017 l 11

164 26 April 2017 - CCDHB Board PUBLIC papers - APPENDICES The sTaff engagemenT survey is now open!

The survey

link has been CCDHB emailed to all ONLINE STAFF ENGAGEMENT staff. Check SURVEY ✔ your CCDHB ✔ email and fill it out today. The online survey is open until Monday 10 April.

Check out the intranet for more information.

165 COMMS 00347-1701 - March 2017 26 April 2017 - CCDHB Board PUBLIC papers - APPENDICES

research saving babies from RSV bronchiolitis e will soon be trialling a vaccine against a The first trial will consist of vaccinating willing Wpotentially deadly respiratory disease. pregnant mothers who are expected to give birth Historically, RSV bronchiolitis causes hundreds of during the winter months when the infection rates hospital admissions of babies per year across New are at their worst. Zealand. The intention is that maternal antibodies will be As a result of new research soon to be undertaken at transferred to the baby and give the baby the ability CCDHB and around the world, this infection could be to fight possible RSV infection after birth, even if born a thing of the past. premature. “We currently have no treatment or prevention The second trial involves giving artificial anti- for bronchiolitis but are intending to conduct two RSV antibody to preterm infants directly, prior to vaccine trials in the coming months,” says Thorsten discharge form the neonatal unit. Stanley, consultant paediatrician CCDHB and senior The trials will follow the babies for 6-12 months and lecturer University of Otago Wellington. collect samples from their blood and mucus to see “If successful, the RSV vaccine could stop around 100 if they still get infected or if they have protective babies coming into Wellington Regional Hospital each antibodies. year. It could also prevent four or five deaths a year that happen across the country from this disease. “While the severe form of the disease is more common in premature babies and ones from lower socioeconomic group families, admission numbers are at present increasing each year.” hr update when did you last go on holiday? e have been looking at statistics around leave. your manager, or they can be put in the payroll WThere are a number of staff with high leave kiosk. HR staff will be working with your managers to balances and some who have not taken leave for over ensure leave plans are in place. a year. We also want everyone to take a break, if they can, In DHBs there is often a focus on the cost of annual before winter sets in. leave, but the high leave balances and the lack of You may like to think regular breaks for some staff are of real concern to about ANZAC day and me and the rest of the executive leadership team Easter that are coming from a wellbeing perspective. up and are close We work in a very busy place. We know some staff together this year. have real difficulty being able to schedule long breaks School holidays but we need to ensure that you get regular rest and are also in April. relaxation. If you can, We are going to make a concerted effort to try to get this could some of the higher leave balances down and ensure be a good you all have leave plans. opportunity Leave plans indicate what leave you plan to take in to take some a year – they can be agreed in a conversation and time off. documented in a way that works best for you and

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166 26 April 2017 - CCDHB Board PUBLIC papers - APPENDICES PH O merger to maximise front-line health services

Well Health Trust provides care to ED BY THE T NN RI Compass Health and Well Health PI PL R E E A D I 3,500 patients via its three member N M U

Primary Health Organisations are practices (Porirua Union Community Health Service, Newtown Union merging. Health Service and Evolve Youth “This merger combines the strengths of both organisations Service). Compass Health provides SHORTER, SAFER and will maximise frontline health resource and services primary health care services to HEALTH JOURNEYS which will benefit over 300,000 Wellington and Porirua around 290,000 people across the people” says Martin Hefford, chief executive, Compass Wellington, Porirua, Wairarapa, and Kapiti areas via 60 Health. general practices. Working together will ensure as much resource as possible The merger is set to take effect on 1 July 2017. goes into health centres, so they are sustainable and can Until the merger happens, services provided by Compass continue to offer the very best primary care for our many Health, Well Health and their respective general practice high needs patients. teams will continue as usual. “Although Compass is a much larger PHO, we have lots to learn from the WellHealth practices about supporting high needs populations,” says Martin. hospi update Jumbo tennis It was great to see staff from the paediatric department and other areas of the hospital compete at Wellington Rotary’s Jumbo tennis Tournament. This tournament was a half day event which raised funds for Wellington Regional Children’s Hospital. Special mention goes to Dr Michelle and Charlotte who were the highest achieving female team of the tournament. New website for Wellington Hospitals Foundation Wellington Hospitals Foundation has recently launched their new website. Have a look at whf.org.nz. You can also keep up to date with Wellington Hospitals Foundations work by following us on facebook.com/wellingtonhospitalsfoundation or on Instagram at wellingtonhospitalsfoundation. Little lives, big journeys The Foundation is now raising $240,000 to buy a second Neonatal Mobile Transport Unit for NICU as well as $161,000 for endoscopes for paediatric theatres. And a wonderful Foundation supporter is providing $114,000 for the new children’s waiting area in ED. New Hospital Gift Shop manager Introducing Keith Pearce, our new Gift Shop Manager. You are likely to see his smiley face next time you are purchasing from the Hospital Gift Shop. Welcome to the team Keith.

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Elizabeth Forward and Michaela Shannon with a mural created by members of the community

BY T NED HE T IN RIP RP LE E A D I N M U

delirium garden SHORTER, SAFER Tucked around a corner at Kenepuru different senses,” says Elizabeth HEALTH JOURNEYS Forward, associate charge nurse. Community Hospital is a garden “The bright flowers and art for the eyes and the sensations where patients can work towards a of touching and smelling different plants. There is even the more independent life. opportunity for taste as there are strawberries growing.” The plants and art work have been donated by Situated behind the Accident & Medical clinic, and next ‘Independent Living’ and other community groups. to the gym, the garden is open to all patients and their families. If you are interested in donating plants, or “We need our patients to have some form of normalcy furniture or outdoor in their lives while they are inpatients,” says Mikaela garden art please Shannon, nurse manager, Kenepuru inpatient service. contact Mikaela “Being an inpatient in hospital can be isolating. Being Shannon. inside for days or weeks can lead to patients not seeing the day and night cycles. It can also lead to delirium in some patients – where they are confused and have reduced awareness of their environment. “When a patient has delirium we tell them they are constricted to a ward or room, they can get very upset. “The garden gives us the option to give these patients more freedom. They can leave the ward and still be in a safe place.” It’s an interactive space that allows patients to move around (either assisted or unassisted) and explore an outside space. “It’s part of our diversional therapy. The different plants and artworks in the garden are designed to engage

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168 26 April 2017 - CCDHB Board PUBLIC papers - APPENDICES NEWSinBRIEF

Good use for Cough reflex Smokefree spare shoes research providers A kind donation of 60 pairs of shoes Congratulations to Dr Molly Kallesen, In 2016, the Ministry of Health made by the Wellington Shoe Clinic has team leader of speech-language changes to national stop smoking given a welcome bolster to a youth therapy, who has been awarded service providers. We now have mental health initiative. her PhD from the University of three providers offering stop smoking The shoes have been gratefully Canterbury. This is a remarkable services in our region: received by staff who run weekly effort. Molly is now one of the few • Quitline offers phone, email and sports sessions for people aged 13 to speech-language therapists in New text support 25 experiencing psychosis. Zealand with a PhD. • The Regional Stop Smoking Service, is a new face-to-face and 24 hour The sport sessions support recovery For five years she has researched - cough reflex following orotracheal phone service, offering a six week through physical well-being and stop smoking program confidence building. intubation: presence and recovery of the cough reflex after extubation and • Hapu Ora is a face-to-face service validity of cough reflex testing. for pregnant women or women who have children up to age five.

Ward 5 north New CT Community lounge space scanner Creekfest Cancer inpatients can now relax Wellington Regional Hospital has On one of the wettest and coldest in a welcoming and homely space, a new CT scanner and is currently days so far this year, staff and health following the opening of Wellington waiting for second scanner to replace providers went to Creekfest in Regional Hospital’s professionally- its older model. Porirua. designed and internationally-inspired The Toshiba Aquilion ONE / GENESIS This is an event that matters to patient lounge. Edition scanner is the first of its kind the community, and our support Opened in February, the new to be installed in New Zealand. of it is key to being relevant to the environment has seating that is more communities that we serve. The advanced technology allows comfortable, creates some private doctors to see internal organs in A highlight of the occasion was space within the room, and has places 3D and is part of a $3.4 million Debbie Chin, chief executive and where patients can read a newspaper, investment to replace ageing Arawhetu Gray, director of Māori work on a computer, make a snack technology. health services meeting Stan Walker, and watch TV. who was one of the key performers.

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Appendix 1 - Electives Recovery Plan

Elective Surgery volumes The forecast summary for elective surgical procedures forecast to be completed by year is outlined in Table 1 below. This is broken down into more detail in Tables 2, 3 and 4. Total Volumes Our current year end forecast, based on this plan and other arranged admissions that contribute to the electives target is 198 discharges favourable to the 100% target. Although there remains some stretch in the last quarter of the recovery plan we do expect to achieve the electives health target.

Table 1 Forecast Summary - FYR Inhouse Outsourcing IDF Outflow Forecast TOTAL Plan Forecast Var Plan Forecast Var Plan Actual + Var Plan Forecast Var Budget Purchase unit description to YE General Surgery 1,532 1,444 (88) 15 29 14 59 32 (27) 1,606 1,505 (101) Bariatrics 20 17 (3) ------20 17 (3) Skin lesion - 101 101 - - - 443 535 92 443 636 193 Anaesthesiology &Pain Mgmnt ------Cardiothoracic 110 65 (45) 41 23 (18) - 1 1 151 89 (62) Ear, Nose and Throat 851 804 (47) 78 90 12 34 21 (13) 963 915 (48) Gynaecology 1,144 1,176 32 - 20 20 82 69 (13) 1,226 1,265 39 Neurosurgery 123 85 (38) - - - 6 4 (2) 129 89 (40) Ophthalmology 1,052 1,015 (37) 332 381 49 2 17 15 1,386 1,413 27 Orthopaedics 1,235 1,277 42 430 387 (43) 33 27 (6) 1,698 1,691 (7) Paediatric Surgical 340 279 (61) - - - 5 7 2 345 286 (59) Plastic & Burns ------772 726 (46) 772 726 (46) Urology 512 450 (62) 78 102 24 3 4 1 593 556 (37) Vascular 217 230 13 ------217 230 13 - - - - TOTAL 7,136 6,943 (193) 974 1,032 58 1,439 1,443 4 9,549 9,418 (131)

Table 2 CCDHB Prod Plan Mar YTD April May June Total General Surgery 1,039 115 145 145 1,444 Bariatrics 12 1 2 2 17 Skin lesion 84 3 7 7 101 Anaesthesiology &Pain Mgmnt - - - - Cardiothoracic 49 4 6 6 65 Ear, Nose and Throat 539 80 96 89 804 Gynaecology 883 84 109 100 1,176 Neurosurgery 67 4 7 7 85 Ophthalmology 733 85 92 105 1,015 Orthopaedics 920 91 136 130 1,277 Paediatric Surgical 213 18 24 24 279 Plastic & Burns ----- Urology 328 34 44 44 450 Vascular 150 26 26 28 230 Monthly Phased Targets 5,017 545 694 687 6,943

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Table 3 Outsourcing CCDHB Prod Plan Mar YTD April May June Total General Surgery 11 6 6 6 29 Bariatrics ---- Skin lesion ----- Anaesthesiology &Pain Mgmnt - - - - Cardiothoracic 20 1 1 1 23 Ear, Nose and Throat 45 15 15 15 90 Gynaecology - 3 8 9 20 Neurosurgery ----- Ophthalmology 242 59 40 40 381 Orthopaedics 252 45 45 45 387 Paediatric Surgical ----- Plastic & Burns ----- Urology 63 13 13 13 102 Vascular ----- Monthly Phased Targets 633 142 128 129 1,032 Monthly Phased Targets 89 90 82 974

Table 4 IDF Outflow CCDHB Prod Plan Mar YTD April May June Total General Surgery 24 2 3 3 32 Bariatrics ---- Skin lesion 405 40 45 45 535 Anaesthesiology &Pain Mgmnt - - - - Cardiothoracic 1 - - - 1 Ear, Nose and Throat 12 3 3 3 21 Gynaecology 53 4 6 6 69 Neurosurgery 3 1 - - 4 Ophthalmology 12 1 2 2 17 Orthopaedics 19 3 3 2 27 Paediatric Surgical 7 - - - 7 Plastic & Burns 551 55 60 60 726 Urology 3 1 - - 4 Vascular ----- Monthly Phased Targets 1,090 110 122 121 1,443

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CCDHB Monthly Balanced Scorecard Mar 2017 KEY PERFORMANCE INDICATORS 2016/2017 CCDHB CCDHB Mar-17 QTR Mar-17 YTD PATIENT EXPERIENCE PROCESS & EFFICIENCY Trend Target Actual Target MOH QTR 3 Trend Jan Target Month Target YTD Shorter Stays in Emergency Departments ↗ 95% 91% 95% 92% Acute Inpatient Length of Stay ↔ 3.66 4.10 3.66 4.02 Improved Access to Elective Surgery ↗ 100% 116% 100% 97% Elective Inpatient Length of Stay (Surgical) ↗ 4.00 3.20 4.00 3.21 Better Help for Smokers to Quit ↔ 95% 91% 95% 90% Elective/Arranged Day Surgery Rate ↘ 58% 50% 58% 52% Target Month Target YTD Elective/Arranged Day of Surgery Admission ↘ 75% 75% 75% 75% Number of Patient Deaths ↔ 40 443 Ward Bed Utilisation - Daily (Incl Weekends) ↗ 90% 94% 90% 94% Severity 1 & 2 (Confirmed) ↔ 3 50 Ward Bed Utilisation - Weekdays Only ↗ 90% 94% 90% 95% All Reported Events ↔ 755 6699 Resourced Theatre Sessions Utilised 85% N/A 85% N/A Hospital Acquired Pressure Areas ↗ 0 16 93 Theatre Session utilisation (Time in Theatre) ↔ 85% 76% 85% 76% The source data has changed (DSU does not support the old data source); Patient Falls Causing Harm (per 1000 bed days) ↔ 0 67 (0.3) 0.0 608 (0.5) Theatre Sessions Starting on Time ↔ 52% 54% In investigating further, I believe Ankh may have used the Theatre Utilisation reports Medication Errors (per 1000 bed days) ↘ 0 62 (0.4) 0.0 571 (0.6) Acute Patients impacting on Elective Sessions ↔ 9 70 which can be found on the DSU Portal in the Theatre Folder. I have never used these reports but can see that these were built in 2012, based on even older specifications for Complaints (per 1000 bed days) ↗ 0 96 (3.9) 0.0 640 (2.9) Cancelled on Day of Surgery - Patient ↗ 20 178 Theatre sessions times/ exclusions etc and the criteria for the reports does differ from Compliments (per 1000 bed days) 0 85 (4.1) 0.0 774 (4.3) Cancelled on Day of surgery - Hospital 5.0% 60 430 ↔ ↗ our current Theatre measures Report criteria which was intensely developed with Cancelled on Day of Surgery - Percentage ↔ 7.4% 5.0% 8.0% Outpatient DNA (FSA & Followup) - DNA Rate ↔ 6.0% 7.0% 6.3% 6.5% WAITLISTS Waitlist Patients (ESPI5 & ESPI2) Outpatient DNA (FSA & Followup) - Maori ↔ 6.0% 14.2% 6.0% 14.9% Target Month Booked Unbooked Outpatient DNA (FSA & Followup) - Pacific ↘ 6.0% 14.1% 6.0% 15.9% Waiting >120 days for Treatment (ESPI5) ↔ 0 13 0 0 Waiting >120 days for Outpatient FSA (ESPI2) ↘ 0 5 0 0 Mar-17 YTD VALUE FOR MONEY Target Month Target YTD HEALTHY WORKPLACE Mar-17 YTD Total Caseweight ↗ 5,987 6,127 51,008 51,406 Target Month Target YTD Local Acute Caseweights ↗ 2,720 2,776 23,860 24,742 Staff Turnover % (Headcount) excluding RMOs ↘ 15.6% 8.4% 15.6% 15.2% Local Elective Caseweights ↗ 1,195 1,190 9,545 8,489 Sickness Absence - % Paid Hours Worked ↗ 2.3% 3.8% 2.3% 3.1% IDF Acute Caseweights ↔ 1,327 1,302 11,442 11,932 Number of Staff having >200 Hrs A/L ↔ 0 1,607 1,611 IDF Elective Caseweights ↗ 745 859 6,161 6,242 Physical Assaults ↗ 0 36 227 Outpatient FSA Volumes ↗ 4,053 4,173 33,170 32,920 First appt Blood and Body Fluid Exposure ↗ 0 16 121 Outpatient FU Volumes ↗ 10,002 11,252 82,129 86,821 follow up Slips, trips and falls ↗ 0 10 77 Hospital FTEs (contracted) ↔ 4,275 0 4,262 Hospital Operating Costs ($'000) ↘ 54,392 59,873 453,986 516,652 Hospital Personnel inc outsourced ($'000) ↘ 35,081 38,334 293,196 330,427

MOH Targets Key Issue MOH Targets MOH Performance Measure Alert MOH Performance Measure Good News

ExclL Rmo Staff Turnover % (Headcount) rotation

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Hospital costs are Draft only

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The source data has changed (DSU does not support the old data source); In investigating further, I believe Ankh may have used the Theatre Utilisation reports which can be found on the DSU Portal in the Theatre Folder. I have never used these reports but can see that these were built in 2012, based on even older specifications for Theatre sessions times/ exclusions etc and the criteria for the reports does differ from our current Theatre measures Report criteria which was intensely developed with specific business guidelines/rules.

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WAIRARAPA, HUTT VALLEY AND CAPITAL & COAST DISTRICT HEALTH BOARDS COMMUNITY PUBLIC HEALTH ADVISORY AND DISABILITY SUPPORT ADVISORY COMMITTEES DRAFT MINUTES 9.10am Friday, 18 November 2016 Board Room, Pilmuir House, Hutt Valley District Health Board

PRESENT: IN ATTENDANCE: Committee Management & Externals Nick Leggett (Chair) Sandra Williams (Acting Director, SIDU) Dr Virginia Hope (Deputy Chair) Dr Pauline Boyles (Senior Disability Advisor, SIDU) Katy Austin (Member) Andrea Bright (Minute Secretary) Wayne Guppy (Member) Dr Ashley Bloomfield (CEO, Hutt Valley DHB) Dr Tristram Ingham (Member) Sandra Greig (Member) Via Video Conference: Margaret Faulkner (Member) Adri Isbister (CEO, Wairarapa DHB) Jane Hopkirk (Member) Nigel Broom (Wairarapa DHB – in attendance) Dr Derek Milne (Member) Alan Shirley (Member) Leanne Southey (Member) APOLOGIES: Presenters Debbie Chin (CEO, Capital & Coast DHB) Item 2.1 Helene Ritchie (Member) SIDU – Mental Health & Addictions Alison Masters, Arawhetu Grey, Waiatamai Tamehana Palliative Care Biddy Harford (Te Omanga Hospice) & Dr Robyn McArthur (GP) IN ATTENDANCE: NOT PRESENT: Fa’amatuainu Tino Pereira (Member) Chris Laidlaw (Member) Helen Kjestrup (Member)

1.0 PROCEDURAL BUSINESS Committee member Dr Tristram Ingham opened the meeting up with a Karakia. 1.1 APOLOGIES Apologies from Helen Ritchie and Debbie Chin were RECEIVED. Moved: Nick Leggett Seconded: Virginia Hope CARRIED

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1.2 CONFLICTS OF INTEREST: No changes. 1.3 CONFIRMATION OF MINUTES: With the changes made below, the Committees APPROVED the minutes as read. Item 2.1 – Section 4 – Title B be stated as an action point. Moved: Nick Leggett Seconded: Virginia Hope CARRIED 1.4 MATTERS ARISING AND SCHEDULE OF ACTION POINTS: 1.4.1 Matters arising: Nil

1.4.2 Schedule of action points: Action point 4.0 : (Meeting 17 July 2015) “The committee requested that more focus is required on Aged Care… “ The Committee was advised that this would be picked up as part of the work programme linked into this action point HOP (Health of Older People) paper on the agenda today. Action point 1.3: (Meeting 20 November 2015) “2. Development of a Maori paper or similar to the Pacific Paper”… The Committee was advised that the Maori Health Plan paper would be deferred until 2017, and it was noted that Kuini Puketapu had left the HVDHB and Arawhetu Grey was introduced as the new Director of Maori Health for CCDHB. 2.0 DISCUSSION PAPERS 2.1 MENTAL HEALTH AND ADDICTION PLANNING The Committees ENDORSED the approach outlined to achieve the finalisation of a strategic action plan and high level business care for mental health and addiction services across the Wairarapa, Hutt Valley and Capital & Coast District Health Boards: NEXT STEPS The co-design groups will, over the next twelve months: ∑ Continue development of the strategic framework. ∑ Continue the development of the model of care for all services. ∑ Continue ongoing consultation on the co-design of the approach and action plan. ∑ Develop a business case, including cost benefit analysis. ∑ Continue ongoing work on the development of a Strategic Action Plan 2017-2030. ∑ Design an implementation/transition plan. All aspects of this project will come back to CPHAC/DSAC during 2017. The Chair thanked and commended the presenters and their Groups for their work on looking to taking a new approach. The Committees RECOMMENDED the presentation be included in the briefing for the incoming new Boards. Moved: Virginia Hope Seconded: Margaret Faulkner CARRIED

2.2 3DHB PALLIATIVE CARE STRATEGY The Committees: 1. NOTED the sub-regional Palliative Care Strategy which has been developed with the oversight of the Lower North Island Palliative Care Managed Clinical Network. 2. NOTED wide engagement has been used in the development of the Strategy and has included clinicians (across hospital, hospice and primary care settings) and service providers representing the wider health Wairarapa, Hutt Valley and Capital & Coast District Health Boards DRAFT NOVEMBER 2016

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and social sector, including aged residential care facilities and NGO providers as well as consumers and caregivers. 3. NOTED the 6 goals in the strategy: (1) Patients and their whānau have early discussions as end of life approaches to ensure they make early informed choices about the what, where and how of care and support they receive (Self- management). (2) Patients and their whānau receive coordinated assessment, care planning and review throughout their illness (Planning). (3) Patients and their whānau experience equitable and seamless care through coordinated service provision (Integration). (4) Patients and their whānau experience high quality services in different settings (Quality). (5) Care in the last days of life is comprehensive, with good symptom control, is in the most appropriate setting in the company of whānau and/or friends (Last days of life). (6) Whanau experience high quality care after death (After death support). 4. NOTED that the implementation of the Strategy is not expected to cost the DHBs more. Rather, it is expected that implementation of the strategy will be achieved through reprioritization of the current funding in these services. 5. NOTED that the recommendations to implement identification and anticipatory care planning for patients with palliative care needs in primary care have just been launched in HVDHB and CCDHB, and additional post death support and the Voices survey are soon to be introduced across the sub-region. These are funded via the new Hospice Initiatives Funding which includes one-off funding ($225k) as well as ongoing funding ($700k per annum across the sub region) for new community focused palliative care services in the sub-region announced in the Budget 2015. 6. NOTED that the actions to develop a sub-regional workforce plan and to develop a training/professional development programme are now underway as Palliative Care Managed Clinical Network projects and funded ($60k) within the pool of funds from the HWNZ contract. 7. NOTED that the funding the sub region had to support the Network is ending in March 2017 and that it is proposed that the local Alliance Leadership Teams will take responsibility for implementing further actions of the Strategy. The Committee RECOMMENDED Wairarapa, Hutt Valley and Capital & Coast DHB Boards endorse the sub regional palliative care strategy. Moved: Wayne Guppy Seconded: Virginia Hope CARRIED

2.3 DISABILITY IMPLEMENTATION PLAN SIX YEAR MILESTONES The Committee NOTED the contents of the report which was taken as read and NOTED: ∑ Six year milestones for improving disability responsiveness in the sub region. ∑ The role of innovation and leadership at all levels that has achieved improved disability responsiveness. ∑ The role of policy embedded in practice and plans for future localised policy at Hutt and Wairarapa DHBs. ∑ Leadership on the health passport by Hutt Valley and Capital and Coast DHBs in 2011 was an important milestone. ∑ Sub regional governance and system change contributed to progress since 2013. ∑ The intentional use of co design for creation of enabling environment (based on World Health Organisation Integrated Care model) 2013-16. ∑ Summary of sub regional progress 2015/16. ∑ Wairarapa DHB highlights: - Work on an interim disability is planned within computer systems in Wairarapa DHB; - Projects for improving staff responsiveness within current clinical practices; and - Education initiatives are stepped up to involve all staff.

∑ Hutt Valley DHB Highlights:

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- Primary Care disability responsiveness training is developed and run with SRDAG members and staff of the DHB and PHO; - Medical ward Disability Support Needs trial leads to significant numbers of alerts being recorded with needs identified; - Access to information is improved by the health passport help desk; and - Final co design Hui for the child to adult transition pathway within primary care.

∑ CCDHB Highlights: - A quality improvement Project to upgrade quality of original disability alerts is developed; - Emergency Department engages in training for improving disability responsiveness - Clinical training at CCDHB is stepped up; - Disability Support Needs indicators are included in the SIDU Equity Report for the first time; - Chair of Sub Regional Disability Advisory Group steps down; - Members lead on an updated action plan 2016-21; - United Nations International Day of Persons with Disabilities December 3rd and plans for disability responsiveness week in the sub region; and - Gratitude expressed to outgoing board members for long term commitment particularly CCDHB Dr Judith Aitken for courageous leadership on disability for many years and to Dr Virginia Hope.

Moved: Nick Leggett Seconded: Sandra Greig CARRIED 2.4 ANNUAL PLANNING PROCESS FOR 2017/2018

The Committees NOTED the planning approach and timetable for 2017/2018 and that: a) No SOI (Statement of Intent) was required for 2017/18. b) The Annual Plan was to be shorter (30 pages) meaning the planning process will be tighter and more robust. c) No separate Maori Health Plan was required. The content of the Maori Health Plan should be integrated into the Annual Plan. d) Maori Partnership Boards should be engaged in the development of the Annul Plan. e) The planning guidelines are still under development, with the final guidance available in December.

The Committees NOTED the new Board will need the opportunity to consider the new process. Moved: Virginia Hope Seconded: Sandra Greig CARRIED

2.5 EQUITY MONITORING INDICATORS The Committees NOTED the most recent performance against the equity monitoring indicators and the actions currently planned or underway. The Committee RECOMMENDED each Board/ CPHAC DSAC to consider in the Annual Planning process how equity improvements could be better represented in the Annual Plan and whether a strategy to improve equity should be developed to cover a longer term outcomes view and to inform future Annual Plans. The Committees NOTED the contents of the report which was taken as read. Moved: Nick Leggett Seconded: Virginia Hope CARRIED

2.6 QUALITY ASSURANCE AND OBLIGATIONS – HEALTH OF OLDER PEOPLE

The Committees NOTED the contents of the report which was taken as read and NOTED: 1. All Residential Care providers must be certified by the Ministry of health before the DHB can contract with them. 2. All DHB service contracts include requirements for meeting quality and legislative obligations. Wairarapa, Hutt Valley and Capital & Coast District Health Boards DRAFT NOVEMBER 2016

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3. DHBs monitor the compliance and quality of residential services in partnership with the Ministry of Health. The Ministry through HealthCERT are responsible for the administration of the Health and Disability Services (Safety) Act 2001. 4. Advice received by Buddle Findlay regarding DHBs’ obligations under the Health and Safety at Work Act (2016) indicated that these are addressed through the DHB’s “normal contract management and performance of their other statutory obligations.” 5. Buddle Findlay have also noted that essentially the same obligations which apply to ARC services also apply to HCSS and all other providers contracted by the DHB.

Moved: Nick Leggett Seconded: Sandra Greig CARRIED

2.7 DIRECTOR, SIDU REPORT

The Committees NOTED the contents of the report which was taken as read.

Moved: Sandra Greig Seconded: Wayne Guppy CARRIED

3.0 GENERAL BUSINESS

There was no general business.

4.0 RESOLUTION TO EXCLUDE THE PUBLIC

It is recommended that the Community & Public Health and Disability Advisory Services Committees: (a) Agree that as provided by Clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons:

Subject Reason Reference* Public Excluded Minutes 15 July For the reasons set out in the respective public excluded 2016 papers

* Official Information Act 1982. Moved: Nick Leggett Seconded: Virginia Hope CARRIED The meeting concluded at 11.35am.

CONFIRMED that these minutes constitute a true and correct record of the proceedings of the meeting.

DATED this day of 2016

Nick Leggett CHAIR

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WAIRARAPA, HUTT VALLEY AND CAPITAL & COAST DISTRICT HEALTH BOARDS COMMUNITY PUBLIC HEALTH ADVISORY AND DISABILITY SUPPORT ADVISORY COMMITTEES DRAFT MINUTES 10am Friday, 24 March 2017 Board Room, Pilmuir House, Hutt Valley District Health Board

PRESENT: IN ATTENDANCE: Committee Management & Externals Fran Wilde(Chair) Dr Ashley Bloomfield (CEO, Hutt Valley DHB) Alan Shirley (Member) Adri Isbister (CEO, Wairarapa DHB) Eileen Brown (Member) Rachel Haggerty (Executive Director Strategy Derek Milne (Member) Innovation and Performance, CCDHB) Lisa Bridson (Member) Dr Pauline Boyles (Senior Disability Advisor, SIDU) John Terris (Member) Nigel Broom (Executive Leader, Planning & Performance, Wairarapa DHB)) Sue Kedgley (Member) Helene Carbonatto (General Manager Strategy, Planning & Outcomes, Hutt Valley DHB)

Lisa Congdon (Minute Secretary)

APOLOGIES: Presenters Yvette Grace (Member) Item 2.1 Jane Hopkirk (Member) Presentation of the NZ Disability Strategy) Kim Smith (Member) Bob Francis (Chair, Sub Regional Disability Advisory Prue Lamson (Member) Group) Debbie Chin (CEO, Capital & Coast DHB) Pauline Boyles Bryony Murray Rachel Nobel Joanne Whitco

IN ATTENDANCE: NOT PRESENT:

1.1 PROCEDURAL BUSINESS Chair Fran Wilde opened the meeting. 1.2 APOLOGIES Apologies from Yvette Grace, Jane Hopkirk, Kim Smith, Prue Lamson and Debbie Chin were RECEIVED.

Wairarapa, Hutt Valley and Capital & Coast District Health Boards DRAFT NOVEMBER 2016

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1.3 CONFLICTS OF INTEREST Conflicts are as noted in the conflicts section in the papers to each Board. These will be collated into one document to be included in papers to this Committee 1.4 CONFIRMATION OF PREVIOUS MINUTES The Committees APPROVED the minutes of 8 November 2016 as read. Moved: Derek Brown Seconded: Alan Shirley CARRIED 1.5 MATTERS ARISING Matters arising: Nil 1.6 MATTERS ARISING AND SCHEDULE OF ACTION POINTS Action Points that have been completed will be removed from the Schedule of Action Points going forward. 1.6.1 Schedule of action points: Action point 4.0 : (Meeting 17 July 2015) “The committee requested that more focus is required on Aged Care… “ This action has been completed and will be removed from the schedule of action points Action point 1.3: (Meeting 20 November 2015) “2. Development of a Maori paper or similar to the Pacific Paper…” The Committee was advised that this will be discussed at today’s meeting Action point 2.3: (Meeting 20 May 2016) “Requested management to bring back to the Committee in the next Equity Report… “ The Committee was advised that this will be discussed at today’s meeting Action point 2.5: Meeting 20 May 2016) “Report back on the DHBs role in working with homeless …” The Committee was advised that this is on the work plan and will be discussed at a future Committee meeting Action point 2.2 (Meeting 16 September 2016) “ Sub Regional Disability Plan implementation update…” This action has been completed and will be removed from the schedule of action points Action point 2.3 (Meeting 16 September 2016) “Child Health & Youth Update…” This action has been completed and will be removed from the schedule of action points Action point 2.4 (Meeting 16 September 2016) “Regional Public Health Update…” The Committee was advised that this is on the work plan and will be discussed at a future Committee meeting Action point 2.5 (Meeting 16 September 2016) “Update on Progress against the regional suicide prevention plan and Porirua Social Sector Trial…” This action has been completed and will be removed from the schedule of action points.

1.7 APPOINTMENT OF REPRESENTATIVES Question was raised prior to the meeting if the Chair needed to be formally appointed. Advice was taken and it was confirmed that the appointment of the Chair was confirmed by the Capital & Coast, Hutt Valley and Wairarapa Boards. However it was noted that a Deputy Chair needed to be appointed. Chair advised that Yvette Grace was considered for this and the Chair will discuss this with her. The Deputy Chair will be formally appointed at the next meeting. Chair moved that the committee endorse the resolution to appoint representatives from the Subregional Disability Advisory Group, Subregional Pacific Strategic Health Advisory Group and the Maori Partnership Board to the Committee. Moved: Fran Wilde Seconded: Eileen Brown CARRIED

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2.0 DISCUSSION PAPERS 2.1 PROPOSED APPROACH TO CPHAC DSAC The Committees ENDORSED the appointment of the Chairs of the Sub Regional Disability Advisory Group, the Subregional Pacific Strategic Health Advisory Group and an appropriate representative from the Maori Partnership Board to the Committee. The Committee AGREED the Terms of Reference pending a wording change on page two to read “to provide advice to each Board on strategies to achieve equity by focusing on relieving barriers to good health and quality of life amongst the population…” Some Committee members who have a particular interest in Health of Older People, currently scheduled for the July meeting that they are unable to attend, asked if the schedule could be changed to ensure their attendance. Health of Older People will now be discussed at the September meeting. Question was raised on how the Committee will ensure that issues that arise outside of a Committee meeting will have the opportunity to be addressed. The Chair advised that Committee members are welcome to advise both the Chair and Rachel Haggerty if there are any issues that they would like discussed and these will be added to the agenda as part of General Business. The Committee advised that they would like more detail in the Work Programme to include what each topic will cover. Rachel Haggerty will provide a one pager to the Committee providing more detail on each topic and what it will be likely to cover. The Committee AGREED to add to the Terms of Reference that part of the Committee’s mandate is to look for opportunities for collaboration between the three DHBs. Moved: Sue Kedgley Seconded: Lisa Bridson CARRIED

The Chair thanked and commended the presenters and their Groups for their work on looking to taking a new approach. 3.1 SUB REGIONAL DISABILITY STRATEGY 2017 Presentation on the New Zealand Disability Strategy was given by Pauline Boyles (Senior Disability Advisor, SIP), Bob Francis (Chair, Sub Regional Disability Advisory Group), Rachel Nobel (Sub Regional Disability Advisory Group Member), Joanne Witco (New Zealand Sign Language and Health Project), Bryony Murray (Programme Co-ordinator) on the New Zealand Disability Strategy. A copy of the presentation is attached to these minutes. The Chair thanked and commended the Sub-Regional Disability Advisory Group Members and Disability Strategy Team for their presentation and advised that the Committee was looking forward to working with the team in the future.

3.2 SUB REGIONAL DISABILITY STRATEGY 2017 The Committee AGREED to add the additional recommendation that each DHB will provide a 6 monthly monitoring update to the committee to inform progress and then ENDORSE all recommendations. The Committee also AGREED to have a section in General Business to discuss progress on the NZ Sign Language in Health Project. The Committee thanked and commended all involved with the work that they have done on the Disability Strategy. Moved: Lisa Bridson Seconded: Derek Milne CARRIED

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3.3 EQUITY MONITORING INDICATORS

The Committee AGREED to add the additional recommendation that Equity Monitoring will become a standing item on the Committee Meeting Agenda.

The Committee NOTED all recommendations.

The Committee was advised that the Maori Health Plan requirement with the Ministry of Health has been removed with the expectation that equity will be built into annual plans.

The proposed approach is that we look at developing reporting that is broader and more sophisticated and is an approach that is relative to our communities but also collaborative across the three DHBs on specific approaches.

Concern was raised that in embedding equity in business as usual that focus not be lost on having specific targets but also make sure the targets are the right targets.

Concern raised around Aged Care monitoring and the suggestion was raised for a workshop to be held to address issues and consider options.

Questions raised around measures of deprivation and what the definition of Deprivation is. This will be provided to the Committee. Moved: Fran Wilde Seconded: Derek Milne CARRIED

4.0 GENERAL BUSINESS

A question was raised regarding Refugee Health. Where does this sit and should it be a specific focus in our workplan or would it be covered under one of the already noted work plan areas. It was advised that this would span a number of topics, including Public Health and Equity.

The meeting concluded at 12.16 pm.

CONFIRMED that these minutes constitute a true and correct record of the proceedings of the meeting.

DATED this day of 2016

Fran Wilde CHAIR

Wairarapa, Hutt Valley and Capital & Coast District Health Boards DRAFT NOVEMBER 2016

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Regional Public Health Better Health For The Greater Wellington Region PUBLIC HEALTH POST Public Health for Primary Care in Wellington, Wairarapa and the Hutt Valley

AlsoAlso availableavailable onlineonline at www.rph.org.nz Issue 28 - February 2017

WELLINGTON REGION TUBERCULOSIS DISEASE RATES LOW IN 2015-2016 Dr Jonathan Kennedy, Medical Officer, Regional Public Health; Dr Dilip Das, Medical Officer, Regional Public Health

The Regional Public Health communicable disease team followed up a welcome low number of cases of tuberculosis disease in 2015 and 2016, with the annual rate approximately half that in 2014 (1). Rates in 2007 and 2009 were also low, though not as low as in 2015 or 2016. Looking back over the last 20 years, annual case notifications have fluctuated. However there appears to have been a substantial sustained reduction in rates from 2005 onwards. Figure 1. Tuberculosis disease notification rates in the Wellington Region and New Zealand, 1997 – The relatively low rates of 2016(1, 3) cases in Wellington in 2015 and 2016 were not matched nationally, with the rate for the whole of New Zealand similar to recent years. However, a similar national reduction from the mid-2000s appears to be sustained. It may be relevant that New Zealand immigration procedures for tuberculosis screening were tightened in 2004(2). The recent low rates in the Wellington region may represent normal variation, but have nevertheless been appreciated by the public health teams responsible for monitoring treatment adherence and Figure 2. Tuberculosis disease notifications in the Wellington Region and New Zealand, 1997 – 2016(1) investigating contacts.

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Wellington, Wairarapa and the Hutt Valley cases: 1/1/2015 – 31/12/2016 (n=54)

Most tuberculosis disease Regional Public Health tuberculosis disease new cases, 1/1/2015 to 31/12/2016, by ethnicity and cases occur in people who prioritised ethnicity were born outside of New Zealand, and especially from high-incidence countries. Of the 54 cases in Wellington, Wairarapa and the Hutt Valley from 1/1/2015 to 31/12/2016, 42 were recorded as having been born outside of New Zealand, with Indian and Filipino ethnicities predominating.

Figure 3. Tuberculosis disease notifications in the Wellington Region, 1/1/2015 – 30/11/2016, by ethnicity and prioritized ethnicity (n=54)(1)

Regional Public Health tuberculosis disease new cases, 1/1/2015 to 31/12/2016, by gender

Figure 4. Tuberculosis disease notifications in the Wellington Region, 1/1/2015 – 31/12/2016, by gender (n=54)(1)

Regional Public Health tuberculosis disease new cases, 1/1/2015 to 31/12/2016, by age group

Figure 5. Tuberculosis disease notifications in the Wellington Region, 1/1/2015 – 31/12/2016, by age group (n=54)(1)

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Cases were evenly spread by gender. There was a majority from the 25-44 age group. Cases were resident across the region with some concentration in Wellington and to a lesser extent in the Hutt Valley and in Northern suburbs.

Two of the 54 cases died with tuberculosis recorded as the primary cause of death, while 26 cases required hospitalisation. No cases of highly resistant (MDR, pre-XDR or XDR) tuberculosis were notified during this time period. Nineteen of the 54 cases were reported to have previously received a BCG vaccination (28 unknown, seven reported no previous BCG vaccine).

Occupations recorded for the 54 cases illustrate the wide variety of people affected by tuberculosis disease. Figure 6. Tuberculosis disease notifications in the Wellington Region, 1/1/2015 – 31/12/2016(1)

Figure 7. Tuberculosis disease notifications in the Wellington Region, 1/1/2015 – 31/12/2016, by occupation (n=54)(1)

References 1. ESR. Episurv database of notifiable conditions. 2017 [cited 13/2/2017]. 2. Dalziel L. New migrant health and disability screening rules. 28/1/2004 ed. Wellington: New Zealand Government; 2004. 3. Population estimates and projections [Internet]. 2016 [cited 6/12/2016]. Available from: http://www.stats.govt.nz/browse_for_ stats/population/estimates_and_projections.aspx

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WHAT ARE YOU REPORTING? THREE MONTHS OF NOTIFIABLE CASES IN THE HUTT VALLEY, WAIRARAPA, WELLINGTON Dr Jonathan Kennedy, Medical Officer, Regional Public Health

Table 1. Notifiable cases by DHB in the Hutt Valley, Wairarapa and Wellington 1/10/2016 – 31/12/2016. Number of confirmed cases (with additional ‘probable’ cases in brackets) Notifiable Condition Capital and Hutt Valley Coast Wairarapa Totals Campylobacteriosis 85 148 36 269 Notes (1,2) Cryptosporidiosis 3 14 6 23 • Campylobacteriosis accounted for 269 of the 459 confirmed Dengue fever 1 1 2 case notifications during the three Gastroenteritis 1(6) 2(15) 1(2) 4(23) months. In most cases no source was confirmed. Identified risk factors Giardiasis 6 23 1 30 included contact with family pets or Hepatitis A 2 2 farm animals, drinking potentially contaminated water, and contact with Hepatitis B 1 1 2 other cases during outbreaks. Hepatitis C 3 3 • Zika and dengue fever cases had all Invasive pneumococcal disease 2 6 1 9 travelled overseas to countries with known outbreaks. One of the dengue Legionellosis 2 1(1) 3(1) fever cases had an unusually long Listeriosis 1 1 apparent incubation period and this is Meningococcal disease 2 1 3 being further investigated. • Tuberculosis cases predominantly Mumps 2 2 reported potential exposure in Pertussis 1(1) 29(15) 30(16) high-risk countries including India, Salmonellosis 4 17 4 25 Vietnam, Myanmar and Somalia. Non-pulmonary tuberculosis cases Shigellosis 2(1) 3 5(1) included two reported to have ocular Tuberculosis 2 5(2) 0(1) 7(3) tuberculosis and one with peritoneal tuberculosis. VTEC/STEC infection 1 1 • Meningococcal disease affected a 16 Yersiniosis 14 24 38 year old male, a 61 year old female, Zika virus 0(1) 0(1) and a 92 year old female in whom meningococcal infection was found to Totals 127(8) 280(34) 52(3) 459(45) be causing an eye infection.

• Hepatitis A cases included some caused by the same strain as recent outbreaks in the Wellington region. One 25 year old woman acquired her hepatitis A infection while travelling in India. Four family members and four flatmates were subsequently vaccinated by public health nurses, including by cooperation with the New Plymouth public health unit. A 59 year old male plumber acquired hepatitis A, with consumption of frozen blueberries identified as a risk factor. The Ministry of Primary Industries continues to recommend that frozen berries can be made safe by cooking before consumption https://www.mpi.govt.nz/food-safety/food-safety-for-consumers/is-it-safe-to-eat/frozen-imported-berries/ (3) and more information can be found via the Ministry of Health at http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/ hepatitis/frozen-berries-and-hepatitis (4). • Legionellosis cases reported potential overseas and local exposures. One 54 year old male with probable soil exposure to legionella longbeachae while gardening in New Zealand became seriously unwell and required admission to the intensive care unit. • In addition to the two confirmed mumps cases in December 2016, eight measles and one mumps notifications were de-notified during the three months, after initial investigations suggested they did not meet case criteria. • Five cases of yersiniosis were notified in November, aged from three years to 78 years. Investigations identified potential risk factors including pork products, bean sprouts, and raw juice from a local market. • Notified outbreaks included gastroenteritis and influenza outbreaks in schools, rest homes and early childhood centres. One wedding party with probable norovirus reported 23 out of 35 respondents unwell, and 12 out of 50 attendees at a local camp developed gastrointestinal symptoms in a mixed cryptosporidiosis and giardia outbreak.

Sources 1. Regional Public Health. Notifiable condition surveillance records. 2016. 2. ESR. Episurv database of notifiable conditions. 2016 [cited 6/12/16]. 3. Ministry of Primary Industries. Frozen imported berries 2017 [updated 31/1/20173/2/2017]. Available from: https://www.mpi.govt.nz/food safety/ food-safety-for-consumers/is-it-safe-to-eat/frozen-imported-berries/ 4. Ministry of Health. Frozen berries and hepatitis A 2016 [updated 30/9/20163/2/2017]. Available from: http://www.health.govt.nz/your-health/ conditions-and-treatments/diseases-and-illnesses/hepatitis/frozen-berries-and-hepatitis

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Figure 1. Notifiable cases in the Hutt Valley, Wairarapa and Wellington 1/10/2016 – 31/12/2016, tabulated by territorial authority 26 April 2017 - CCDHB Board PUBLIC papers - APPENDICES

HEALTH (PROTECTION) AMENDMENT ACT 2016 (HPAA) IN FORCE

On 4 January 2017, the Health (Protection) Amendment For laboratory confirmed disease the clinician is still Act 2016 (HPAA) came into force. Two key changes for required to provide details for public health follow-up. For primary care are: (1) all health practitioners, not just sexually transmitted infections, the diagnosing clinician will medical practitioners, are now required to report to the be asked to complete an on-line questionnaire once the Medical Officer of Health when they have ‘reasonable system is operational, expected in April 2017. Regional suspicion’ that their patient is suffering from a notifiable Public Health is currently updating its disease notification disease; and (2) three sexually transmitted infections manual to reflect the legislative changes. If you have any (syphilis, gonorrhoea, HIV) are now notifiable, but without suggestions on how to improve notification processes, personally identifying information. please contact Oz Mansoor at [email protected] or (04) 587 2632 (Monday to Wednesdays).

BCG VACCINE AVAILABILITY Bacillus Calmette-Guérin (BCG) vaccination was unavailable In the meantime, please continue to undertake the for much of 2016 due to interruption of regular supply of following: the vaccine to New Zealand. The Ministry of Health has • Assess for tuberculosis (TB) exposure risk in neonates advised that this is due to international production issues; and young children; the BCG eligibility criteria in the BCG vaccination has been curtailed throughout New Immunisation Handbook 2014 may be used for this Zealand. purpose. The situation is unchanged. In its last update, the New • Flag increased risk in medical records and advise Zealand vaccine supplier (Seqirus New Zealand) has stated parents or caregivers to seek medical attention if TB that it has been unable to secure alternative supplies signs or symptoms develop. of BCG vaccine for New Zealand. However, Seqirus has • Continue to refer children for BCG vaccination. indicated that a potential manufacturer is restarting However, advise parents that these children will not be production in early 2017, and Seqirus hope to have vaccine booked for BCG vaccination until supply recommences. available before the end of September 2017. A further update on the supply situation is expected in May. If you have any BCG queries, please contact Melanie Kennedy, BCG Vaccination Nurse, 04 570 9002.

DISEASE NOTIFICATION – HOW YOUR GENERAL PRACTICE CAN HELP In 2013 Regional Public Health launched the Public Health Disease Notification Manual to assist in the disease notification process. Updates for this manual are located at http://www.rph.org.nz To enable our staff to promptly initiate disease follow up we need your help in the following ways: 1. Inform your patient of the illness they have been diagnosed with or exposed to and that public health staff may be in contact. 2. Notify Regional Public Health of the disease within a timely fashion (after the case has been informed) - by phone for urgent notifications (as soon as you are aware), or by faxing a case report form for non-urgent (within one working day). You can find a list of urgent vs. non-urgent notifications on the Regional Public Health website under Health Professionals > Notifiable Diseases. 3. Complete all sections of the form, especially: • work/school/early childhood centre information • name of parent or guardian for a child under 16 years old. The 3D HealthPathways includes a pathway on reporting notifiable diseases: http://3d.healthpathways.org.nz

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PUBLIC HEALTH AND THE PROSTITUTION REFORM ACT Dr Peter Murray, Public Health Registrar; Dr Annette Nesdale, Medical Officer of Health; Dr Craig Thornley, Medical Officer of Health

In 2015, Regional Public Health undertook a project to In addition, there does not appear to have been any significant raise awareness among commercial sex premises operators change in the number of sex workers in New Zealand.(5, 7) of their safer sex obligations under the Prostitution Reform PRA and Public Health Act (PRA). As part of this project, assessments were made of commercial sex premises in the greater Wellington In addition to decriminalizing sex work in NZ, the PRA region, to determine whether reasonable steps were being also incorporates a number of public health measures and taken to promote safer sex practices. In general, most imparts special powers to the Medical Officer of Health premises had systems and processes in place to meet their (MOoH). PRA obligations, and recommendations were made for When considering the former, the PRA makes unsafe remediation where basic steps did not appear to be present. sex work practices an offence. For the purposes of the This article overviews the background to the PRA and the legislation, safe commercial sex practices require the use public health role under that legislation. of an appropriate barrier or sheath for all penetrative sex Background (including oral sex) or other activity that carries a risk of acquiring or transmitting sexually transmitted infections. Sex workers are a marginalized societal group.(1)(2) As a The obligation to ensure these safe sex practices are used result of this and the inherent hazards of the occupation, is placed upon sex workers, clients and the operators of sex workers have unique health needs and issues (Table business of prostitution. From the perspective of a business 1).(1) Many of the issues described in Table 1 are relevant operator, this obligation specifically includes provision of in New Zealand. information and displaying health information. Table 1. Health issues facing sex workers globally.(1) Sexually transmitted infections Example of the Ministry of Health poster HIV Hepatitis A, B and C Unmet contraceptive need and reproductive care Substance abuse issues

Physical and sexual violence Mental health disorders

New Zealand’s response The PRA also empowers the MOoH to appoint inspectors Laws concerning sex work and sex workers have been who may enter premises to assess whether the safe sex identified as a key driver of sex worker marginalization.(2) work practices obligations in the PRA are being upheld. Part Contrary to popular understanding, there is no evidence that of this assessment can involve meeting and interviewing making sex work illegal reduces sex work.(2) Furthermore, with the business operator, sex workers or clients. Health alternative models, such as the ‘Swedish Model’ that promotion visits of brothels in the greater Wellington region criminalises the purchasing of sex work (i.e. penalising the were undertaken in late 2015 to assess current standards clients), may also be counterproductive.(2-4) and compliance with the PRA; this work was carried out in New Zealand (NZ) has adopted a novel approach – consultation with the New Zealand Prostitutes’ Collective decriminalization of prostitution. The Prostitution Reform (NZPC). Act 2003 (PRA) radically changed the legal status of sex Finally, given their powers under the PRA, the local MOoH work and sex workers in NZ. The aim of the legislation is to can be contacted for advice if a sex work/client presents to promote the welfare and human rights of sex workers, better your practice with concerns about unsafe commercial sex protect public health and prohibit the use in prostitution of practices. people aged under the age of 18. Research has identified a number of benefits from the implementation of the Act, particularly improvements in safeguarding sex workers’ legal and employment rights.(5, 6)

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Support services for sex workers • A guide to Occupational Health and Safety in the New Zealand Sex Industry: The NZPC is a key organization that provides support http://www.business.govt.nz/worksafe/information- services for sex workers. The NZPC has branches across guidance/all-guidance-items/sex-industry-a-guide-to- New Zealand, including Wellington. The organisation offers occupational-health-and-safety-in-the-new-zealand a range of services for female, male, and transgender sex workers. These services include: References • A drop-in center. 1. Rekart ML. Caring for sex workers. BMJ. 2015;351. • Condoms and water based lubricants. 2. Strathdee SA, Crago A-L, Butler J, Bekker L-G, Beyrer C. Dispelling myths about sex workers and HIV. The Lancet. • Health information. 2015;385(9962):4-7. • Free and anonymous sexual health clinic 3. Danna D. Client-only criminalization in the city of Stockholm: • Wellington clinic times are Tuesday 15:00-18:00 A local research on the application of the “Swedish Model” and Wednesdays from 16:00 to 21:00. of prostitution policy. Sexuality Research and Social Policy. • Legal advice. 2012;9(1):80-93. • Support for individuals seeking to enter or exit the sex 4. Levy J, Jakobsson P. Sweden’s abolitionist discourse and law: industry. Effects on the dynamics of Swedish sex work and on the lives of Sweden’s sex workers. Criminology and Criminal Justice. The contact details for the Wellington branch are: 2014;14(5):593-607. Phone: 04 382 8791 5. Fitzharris P, Hannan C, Baker D, Soeberg M, Piper S, Ritchie Email: [email protected] K. Report of the prostitution law review committee on the Address: 204 Willis Street, Wellington operation of the prostitution reform act 2003. Government of New Zealand, Wellington. 2008. Further information 6. Abel GM. A decade of decriminalization: Sex work ‘down Further information on sex work in New Zealand and the under’but not underground. Criminology and Criminal Justice. PRA can be found at: 2014;14(5):580-92. • New Zealand Prostitutes Collective website: 7. ABEL GM, FITZGERALD LJ, BRUNTON C. The Impact of Decriminalisation on the Number of Sex Workers in New http://www.nzpc.org.nz/ Zealand. Journal of Social Policy. 2009;38(03):515-31.

PUBLIC HEALTH ALERTS

Regional Public Health communicates public health alerts Please contact Regional Public Health on (04) 570 9002 if to primary care practices by fax and by email. These you have not been receiving alerts, or to check and confirm communications often contain information that needs to that we have your correct details. be urgently taken on board by general practitioners and If you are not yet receiving alerts by email, and would like primary care nurses. to, then you can provide your email address via phoning the number above.

Ordering pamphlets and posters: To order any Ministry of Health resources, please contact the Health Information Centre on (04) 570 9691 or email laurina.francis@huttvalleydhb. org.nz

For enquiries regarding the Public Health Post, please contact Dr Jonathan Kennedy, medical officer, Regional Public Health, by email jonathan.kennedy@ huttvalleydhb.org.nz or by phone (04) 570 9002. Alternatively contact one of the regional medical officers of health: Dr Jill McKenzie, Dr Craig Thornley, Dr Produced by: Regional Public Health Private Bag 31-907, Lower Hutt 5040 Annette Nesdale and Dr Stephen Palmer. Ph: (04) 570 9002, Fax: (04) 570 9211

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