NORTHLAND DISTRICT HEALTH BOARD EQUITY IN HOSPITALS
COMMITTEE MEETING
AGENDA
Monday 13 July 2020, 9.00 AM
VENUE Tangihua Room, Tohora House Whangarei Hospital
NORTHLAND DHB EQUITY IN HOSPITALS COMMITTEE AGENDA |
1 AGENDA
MONDAY 13 JULY 2020
EQUITY IN HOSPITALS COMMITTEE
9.00am Karakia
Apologies Register of Interests 3 Does any member have an interest they have not previously disclosed? Does any member have an interest that may give rise to a conflict of interest with a matter on the agenda?
Attendance Register 5
9.00am 1.0 Committee Minutes
1.1 Confirmation of Minutes 18 November 2019 6 1.2 Matters/Actions Arising 9
9.10 am 2.0 Chair’s Report 9.15 am 3.0 Committee Terms of Reference and Work Plan 14
9.20am 4.0 System Performance
4.1 Operational Report 17 4.2 Reporting Metrics 76
10.00am 5.0 Information Reports & Updates
5.1 Presentation; COVID-19 Update – Planned Care (Elective prioritisation) 5.2 National Asset Management Programme 78
10.30am 5.0 Next Meeting Details
The next meeting will be 9.00am on Monday 24 August 2020 at Tangihua Room, Tohora House, Whangarei Hospital.
NORTHLAND DHB EQUITY IN HOSPITALS COMMITTEE AGENDA
2 EQUITY IN HOSPITALS COMMITTEE - INTERESTS REGISTER
Name Nature of Interest Date Updated
Mataroria Employee – Te Kaupapa Mahitahi Hauora Te Papa O Te Raki 29/4/20 LYNDON Trust Lecturer – University of Auckland Chair Board member – Health Promotion Agency Member - Advisory Group, Aktive Sport Auckland Member - Steering Group, Ministry of Health Primary Care Models of Care Research Partnership Member - Health, Quality & Safety Commission Patient Experience of Care Governance Group Employee -Tend Healthcare
Iwi affiliations Ngāti Hine, Ngāti Whātua, Ngapuhi
John Councillor - Northland Regional Council 29/6/20 BAIN Director - Noble Imports Ltd. Director -Banjo Trading Co Ltd Trustee – Northland Road Safety Trust Justice of the Peace
Harry Director/Owner - Replas Ltd 9/12/19 BURKHARDT Chair - Ngāti Kuri Trust Board President - Packaging Council of New Zealand Member - Independent Advisory Panel for MPI Chair - Northland Economic Advisory Committee Board member - Māori Economic Development Board Chair - New Zealand Maori Arts and Crafts Institute | Te Puia Director - Burkhardt Investments Limited Director - Ngāti Kuri Tourism Limited Director - Te Manawa o Ngāti Kuri Trustee Limited Director - Taitokerau Investment Fund General Partner Limited Director - Burkhardt Ventures Limited Director - Te Urungi o Ngāti Kuri Limited Director - Te Paki Limited Director - Waimarama Orchards Limited Director - Wharekapua Limited
Hapu/Iwi affiliations: Hapu: Ngāti Waiora, Ngāti Murikahara Iwi: Ngāti Kuri; Whakapapa links to Te Rarawa, Ngāti Kahu
Vince Councillor (Okara Ward) – Whangarei District Council 28/1/20 COCURULLO Director/Owner - Cocurullo's Ltd Director - Cocurullo Investments Ltd President - Whangarei Club Councillor - Northland Automotive Association Member of several Service Clubs within Whangarei
Kyle Employee - Ki A Ora Ngätiwai 23/6/20 EGGLETON Member - Northland Faculty Board, Royal New Zealand College of General Practitioners Member - Medicine Adverse Reactions Committee, MedSafe Trustee - Auckland Faculty, Royal New Zealand College of General Practitioners, Charitable Research and Education Trust Chairperson - Bream Bay Community Support Trust Member - Australasian Association of Academic Primary Care
3 Name Nature of Interest Date Updated
Advocacy and Policy Committee Senior Lecturer University of Auckland
Family members
Marcia Underwood - Employee – Northland DHB
Debbie CEO – Kaipara Community Health Trust (KCHT) 27/5/20 EVANS KCHT Representative – Kaipara Total Health Care Joint Venture Board KCHT Representative Kaipara Care Committee KCHT Representative - Dargaville Integrated Family Health Centre Committee Member – Northland Community Foundation Grassroots Funding Allocation Committee
Family Members associated with Northland DHB employment/programmes Bernadette Buisman, Registered Nurse – Renal Unit George McNally, Lecturer at NorthTec – Nursing Department
Libby Deputy Chair – Northland Rural Support Trust 15/6/20 JONES Deputy Chair - Sport Northland Deputy Chair - Paparoa Medical Society Member - Rural Health Alliance Aotearoa New Zealand (RHAANZ) Member – Rural Women NZ Manager - Jigsaw North Family Services Trustee – Volunteering Northland
Sally Chairman – Bay of Islands Arts Festival Trust 9/3/20 MACAULEY Director/Trustee – Kerikeri International Piano Competition Trust Director – Kaikohe Education Trust Director- Kaikohe Community and Youth Centre Trust Judicial and Ministerial Justice of the Peace – Far North Justice of the Peace Association Inc. Visiting Justice Northern Regional Corrections Facility Director - Turner Art Centre, Kerikeri
Family Members
Peter Macauley Partner Palmer Macauley Lawyers Member of Priority Chapter NZ St John
Carol Councillor – Whangarei District Council 28/1/20 PETERS Employee – 155 Community House Trustee – Channel North Trustee - Northland Rural Urban Mission (NURM) Trustee - Food Rescue Northland Trustee - Creative Northland Trustee - Climate Change Taitokerau Northland Trustee - Cnorth
4 MEMBER ATTENDANCE - Financial Year - 1 JULY 2019 - 30 JUNE 2020
2019 2020 Equity in Hospital (HAC) Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May June Mataroria Lyndon (Chair from 9/3/20) John Bain (Chair until 8/12/19) Harry Burkhardt Vince Cocurullo Kyle Eggleton Debbie Evans Libby Jones Sally Macauley Carol Peters Sue Brown Denise Jensen Gary Payinda
MEMBER ATTENDANCE - Calendar Year 1 JANUARY - 31 DECEMBER 2020
2020 Equity in Hospital (HAC) Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Mataroria Lyndon (Chair from 9/3/20) John Bain (Chair until 8/12/19) Harry Burkhardt Vince Cocurullo Kyle Eggleton Debbie Evans Libby Jones Sally Macauley Carol Peters
No Meeting Held Term Commenced 9/3/20 Term of Office Concluded 8/12/19
5 Northland District Health Board HOSPITAL ADVISORY COMMITTEE (HAC) Monday 18 November 2019, 9.00 - 10.30 Whangārei Hospital
DRAFT MINUTES
Present John Bain (Chair) Gary Payinda Debbie Evans Libby Jones Sally Macauley Sue Brown Denise Jensen
In Attendance Paul Welford Pip Zammit Ian McKenzie Kathryn Leydon Mike Roberts Nick Chamberlain Liz Inch Sarah Fox (minutes)
Craig Brown - Board Member Vince Cocurullo - Incoming Board Member for 2019 - 2022
1.0 General Business
1.1 Presentation
Catherine Parker, Workforce Development & Wellbeing Manager gave a presentation on the Northland DHB Wellbeing Programme.
Northland was in the process of becoming the first New Zealand DHB to join the Australasian ‘Mayo Wellbeing Index’, facilitated by Health Roundtable, which would enable staff to monitor and benchmark their wellbeing and provides access to resources and support.
Paul Welford, Chief Operating Officer (COO), agreed to report back on how seriously operational managers took the topic.
2.0 Committee Minutes
2.1 Confirmation of Minutes 26 August 2019 It was moved that the minutes of the meeting held on 26 August 2019 be approved. MOVED Sally McCauley SECONDED Denise Jensen CARRIED
2.2 Matters/Actions Arising
2.2.1 Report on formal implementation of domestic violence leave provisions The Domestic Violence Leave policy had been developed and would be implemented following final approval by the Operational Management Group on 20 December.
2.2.2 Report on compliance with mandatory training targets Statistics had not been compiled comprehensively to-date in the way that had been requested. A review was being undertaken on which courses were required to be mandatory including comparing the number Northland categorises as mandatory compared to other DHBs. Reporting would commence once that exercise had been completed.
2.2.3 Dispensing full courses of medications on discharge It was confirmed that this had been implemented across the hospital, including in ED and child health, for at-risk patients.
Hospital Advisory Committee Draft Minutes 18 November 2019 1 / 4
6 2.2.4 Name of Dargaville out-of-hours service The service had been referred to as an ‘ED’ although it did not perform this function. A more appropriate name was yet to be decided.
3.0 Chair’s Report The Chair had no report for this meeting.
4.0 System Performance
4.1 Operational Report The COO highlighted the following points from the operational report: Implementation of phase one of the Managerial Structure Review had commenced, including the redistribution of services across directorates reporting to the COO. The ongoing problem of ED being delayed in admitting patients to wards was noted for discussion at the Board meeting. Work had been continuing to find opportunities to improve contracting, for example a significant saving had been achieved by outsourcing of anatomical pathology. Various ACC initiatives were also being investigated, including increasing revenue from surgery, treatment injuries and MRI. A business case was being developed to move rehabilitation to rural hospitals. Many wards had noted a lull in activity with beds being available and had been able to stand staff down. Union actions had been continuing with some withdrawal of services. Ian McKenzie, GM Mental health & Addiction Services, gave an overview of the work of Mental Health and Addiction Services in relation to the recent national Mental Health review. The outcome of the Mental Health review had seen a shift in emphasis from focussing on specialist services to providing increased primary care mental health support in the community. Northland DHB had been running a successful pilot for improved community mental health for some time and the Ministry of Health Integrated Primary Mental Health and Addiction Services request for proposal (RFP) response had been developed in conjunction with Mahitahi Hauora. The outcome of the RFP had not yet been determined. The review had identified the need for health improvement practitioners and health coaches who would be embedded in practices. The Northland bid had included nearly 80 new FTE and training the workforce was noted as being a key priority to roll out the service across all practices. Another RFP was being developed for youth services and Northland had been trialling working with a Health Improvement Practitioner based in schools. There was discussion on the difficulty faced by DHBs across the country in filling vacancies in mental health services. There was discussion on the following points: Child Development Services Visiting Neurodevelopmental Therapy (VNT) waiting lists were being addressed through national funding via the Northern Regional Alliance. It was suggested that places on Northland DHB Learning and Development courses be offered to other organisations at the appropriate cost. This was already taking place to some extent but opportunities for expansion to other agencies would be investigated. There was a report of a perceived disparity between transport provided for Renal patients compared to others, eg Oncology patients. It was noted that support was available through National Travel Assistance (NTA) if the eligibility criteria were met. The criteria for accessing NTA would be reported to the next meeting. The possible reasons for and measures to address the continued increase in leave balances were discussed. A report including leave hours per head and buy-back options would be included in the papers for the next meeting.
Hospital Advisory Committee Draft Minutes 18 November 2019 2 / 4
7 The DHB was in negotiation with Ngati Hine to offer dental services in Kaikohe and Kawakawa in a public/private partnership. A report on progress would be provided to the next meeting. The high level of approved overtime for the Payroll team was noted as a consequence of the work required for the Holidays Act remediation project.
5.0 Next Meeting Details Monday 9 March 2020, 9.00am, Tangihua Meeting Room, Tohora House, Whangārei Hospital
There being no further business, the meeting closed at 10.25 am.
______CHAIR DATE
Hospital Advisory Committee Draft Minutes 18 November 2019 3 / 4
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Actions Arising from the Minutes of the Northland District Health Board Hospital Advisory Committee Meeting 18 November 2019
ACTION BY WHEN COMMENTS 1. Report on how operational COO August managers treat wellbeing. 2020 2. Report on compliance with GM PIPP July 2020 Paper attached mandatory training targets.
3. Investigate possibility of offering GM PIPP July 2020 Paper attached places on Learning and Development courses to other agencies for appropriate cost. As long as the patient meets 4. Report criteria for National COO July 2020 the eligibility criteria they can Travel Assistance. receive assistance. The visits must be to a specialist (ie not to a GP).
Checklist
1. Do you travel more than: 80 km one way per visit (for a child)? 350 km one way per visit (for an adult)? 2. Do you visit a specialist 22 or more times in 2 months? 3. Do you visit a specialist six or more in six months and travel more than: 25km one way per visit (for a child) 50 km one way per visit (for an adult) 4. Are you a Community Services Card Holder and travel more than: 25km one way per visit (for a child) 80km one way per visit (for an adult)
5. Report on leave balances GM PIPP July 2020 Paper attached including leave hours per head and buy-back options.
6. Report on provision of dental Director July 2020 Discussions with Ngati Hine services in Kaikohe and Allied Health Health Trust are ongoing. A Kawakawa. further update will be given at the meeting.
Hospital Advisory Committee Draft Minutes 18 November 2019 4 / 4
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Briefing Paper to Equity in Hospitals Committee
Mandatory Course Compliance rates Date 02 July 2020
Prepared by: Anne Stevens, Team Leader, Workforce development and Wellbeing Endorsed by: John Wansbone, General Manager Planning, Integration, People and Performance
Recommendation That the Equity in Hospitals Committee notes this paper as an information update.
Background This paper is provided as an update following a request from the previous HAC meeting in November 2019. Workforce Development and Wellbeing provide professional development through workshops as well as online through the LEARN platform. The Treaty of Waitangi (now Honouring the Treaty) is regularly attended by other agencies such as Sport Northland, North Haven Hospice and Parkinson’s NZ. The Disability Responsiveness course figures are currently low as this was a new course replacing the previous Disability Awareness course. The Organisation Orientation that was held every month to welcome new staff was replaced during COVID lockdown with a contemporary interactive online offering called ‘Getting Started Northland DHB’. New staff were emailed a link to the online orientation in the week prior to their start date. This also linked through to online inductions for Nursing and Midwifery, Health Care Assistants and Allied Health. This Initiative proved very popular and we have continued this through July and August.
Workforce Basic Life Fire Safety Disability Engaging with Organisation Privacy Honouring the Treaty Category Support Training Responsiveness Maori Orientation
Yearly - Every 2 Once Once Once Every 5 years Once clinical years
Allied Health (671) 95.53 % 94.93 % 37.11 % 80.63 % 73.32 % 66.02 % 92.25 %
Manage/Admin (612) 72.71 % 79.08 % 21.24 % 53.10 % 66.50 % 49.84 % 78.10 %
Medical (342) 50.88 % 48.25 % 14.62 % 38.89 % 45.61 % 33.04 % 32.46 %
Nursing (1709) 93.74 % 91.57 % 37.68 % 80.22 % 61.26 % 62.84 % 91.81 %
Support (104) 59.62 % 66.35 % 17.31 % 40.38 % 62.50 % 21.15 % 78.85 % AVERAGE 74.50% 76.04% 25.59% 58.64% 61.84% 46.58% 74.69%
Briefing Paper to Equity in Hospitals Committee | Mandatory Course Compliance rates | Page 1 of 1
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Briefing Paper to Equity in Hospitals Committee
Leave Balances and Buy Back Date 01 July 2020
Prepared by: Sharlane Dent, Payroll Manager Endorsed by: John Wansbone, GM Planning, Integration, People & Performance
Recommendation That the Equity in Hospitals Committee notes the update provided following an action from the November 2019 meeting.
Background
At the last HAC meeting a report was requested showing leave balances and information on buy back options available to staff. The table attached shows the percentage of employees with an annual leave balance in excess of 2 years worth of entitlement. It is pleasing to note that Northland DHB is tracking the lowest in this graph with only 3.2%.
Cashing up of Annual Holidays Northland DHB promotes the opportunity for staff to cash up annual leave, particularly where balances are high. Employees who wish to cash up leave are required to request in writing a maximum of 1 week of their statutory annual holiday entitlement is paid out in each 12 month period under ( section28A(2)(b)) of the Holidays Act 2003. Where the DHB agrees to the request to pay out the 4th week of annual holidays the payment is made in accordance with section 21(2)and 28B(1)(a)) of the Holidays Act and excluded from the gross earning calculation. Any additional holiday entitlement requested to be paid out greater than the Act, for example the fifth week of annual holidays if paid out is included in gross earnings.
Briefing Paper to Equity in Hospitals Committee - Leave Balances and Buy Back | Page 1 of 3
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Briefing Paper to Equity in Hospitals Committee - Leave Balances and Buy Back | Page 2 of 3
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Briefing Paper to Equity in Hospitals Committee - Leave Balances and Buy Back | Page 3 of 3
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Briefing Paper to Equity in Hospitals Committee
Committee Terms of Reference
30 June 2020
Prepared by: Dr Nick Chamberlain, Chief Executive
Recommendation That the Committee notes the amended Committee terms of reference and the inclusion of a Health Equity definition.
Background The Board’s committees are currently considering their terms of reference to ensure that they are fit for purpose. The Equity in Hospitals Committee TOR have been amended to include a definition of health equity that has been proposed following discussion amongst Board members.
Briefing Paper to Board - Committee Terms of Reference | Page 1 of 1
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TERMS OF REFERENCE
EQUITY IN HOSPITALS ADVISORY COMMITTEE
1. Establishment
The Committee is established by the board (the Board) of Northland District Health Board (NDHB) under section 36 of the New Zealand Public Health and Disability Act 2000 (the Act). The Board may amend the terms of reference for the Committee from time to time.
2. Functions of Committee
The functions of the Committee are to :
(a) Monitor the operational performance of the hospitals and related services of Northland DHB (b) Assess strategic issues relating to the provision of hospital and related services by or through Northland DHB. Give the Board advice and recommendations on that monitoring and that assessment
Definition of Health Equity
Health equity is the principle underlying a commitment to reduce and, ultimately, eliminate disparities in health and in its determinants, including social determinants.
Health disparities and inequalities are potentially avoidable differences in health between groups of people who are more and less advantaged socially. These differences systematically place socially disadvantaged groups at further disadvantage in Health. Pursuing health equity means pursuing the elimination of such health disparities and inequalities. Equity in resources, therefore, is ensuring resources are allocated and processes are designed in ways that address and eliminate health disparities and inequalities.
3. Membership
Membership of the Committee shall be determined by the Board
Appointment of members must comply with the requirements set out in Clause 6 Schedule 4 of the Act
The Board will appoint the Chair of the Committee
4. Responsibilities
To carry out its functions, the Committee will monitor and advise the Board on the:
(a) Provision of hospital and related services by or through NDHB including key operational and clinical quality issues
(b) Overall activity levels and performance of hospital and related services when assessed against Northland DHB’s annual plan and relevant legislation
Equity in Hospitals Advisory Committee Terms of Reference | Page 1 of 2
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(c) Management by the hospital and related services of the delivery of Northland DHB’s health services delivery programme and other hospital facilities projects
(d) Provision of hospital and related services through other entities in which Northland DHB has an ownership or other interest
5. Relationship with Board and Management (a) The Committee is established by and accountable to the Board. The Committee’s role is advisory only, and unless specifically delegated by the Board from time to time in accordance with clause 39(4) of Schedule 3 of the Act, no decision-making powers are delegated to the Committee.
(b) The Committee shall receive all material and information for its review or consideration through the Chief Executive Officer.
(c) The Committee shall provide advice and make recommendations to the Board only, and is not authorised to give any directions or issue any instructions to NDHB officers or employees unless specifically requested in writing by the Board.
(d) The Committee is to be cognisant of the work being undertaken by other committees to ensure a cohesive approach to health and disability planning and delivery.
6. Meeting Procedure (a) The Committee will meet regularly as determined by the Board. Meetings shall be conducted in accordance with: i) The requirements of the Act ii) The Board’s Standing Orders
(b) The Committee may invite any Northland DHB officers and employees to attend as required.
Approved January 2020
Equity in Hospitals Advisory Committee Terms of Reference | Page 2 of 2
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Report to the Equity in Hospital Committee Northland District Health Board
Reporting Month: May 2020
For the meeting of 13 July 2020
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Contents
Executive Summary ...... 3
Surgical ...... 4
Outpatients/Cancer and Blood Services ...... 6
Radiology ...... 7
Pathology Services ...... 8
Older People and Clinical Support ...... 9
Medical ...... 11
Renal ...... 13
Emergency ...... 15
Mental Health...... 17
Rural Hospitals ...... 22
Paediatric ...... 24
Maternal ...... 27
School-based, Community and Oral Health ...... 30
Human Resources and Corporate Support ...... 33
I&CS: Commercial Services ...... 45
I&CS: Facilities ...... 48
I&CS: Patient Transport & Accommodation ...... 50
Scorecard Definitions ...... 52
EHC May report for July 2020 meeting Page 2 of 59
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Executive Summary
1. Overview Since the last report there has been significant disruption to our services as a result of the COVID-19 pandemic. During the response period, each of the four hospitals was re-organised so that there were separate pathways for both COVID and non-COVID patients. Screening facilities were established at each hospital and out-patient and elective services were stopped.
In the event we had very few COVID patients through the hospitals and there was no transmission of the disease within our facilities. The net result of this service reduction has been a back log of surgery and outpatient appointments. A regional process is underway to ensure that inequity for Māori is not further increased as we returned to business as usual.
2. Commentaries Safety and There are 15 goals in this document that are reported by ethnicity. 33% of these targets are met Quality or exceeded by Māori and 40% are met or exceeded by Non-Māori.
Since the last report performance against targets for surgical activity and cancer is down as result Health Targets of the COVID-19 pandemic. There have been improvements against targets for ED, baby friendly hospitals and maintenance of our over performance on quit smoking.
Service There has been a general deterioration in activity volumes including first specialist appointments, Delivery electives and out-patient generally due to the COVID-19 response .
Due to the COVID-19 response there was some restriction on service delivery by the DHB Population immunisation outreach services. All vaccinations were available at drive-through clinics. The Health Status overall impact of the COVID-19 response on population health is likely to have been material but has not been quantified as yet.
During the COVID-19 response a significant number of non-essential and vulnerable staff worked Workforce successfully from home. There has been in a reduction in the uptake of annual leave during the same period due to the demands of the response.
Information to assist with understanding the scorecards:
The scorecards provide a high level status of performance. The indicators are summarised where appropriate for the organisation and service specific indicators are presented within separate service area sections of the report. Indicators are usually updated monthly or as soon as information becomes available.
Performance Colours
Green indicates achieved
Orange indicates behind target but expect to recover by EOFY
Red indicates behind target and expect to remain this way
Grey indicates no data available
Please refer to Scorecard Definitions for threshold tolerances
EHC May report for July 2020 meeting Page 3 of 59
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Surgical
1. Overview Elective volumes have been significantly impacted due to the response required regarding COVID. We did however also note a reduced level of acute presentations during the early stages of lockdown. While activity has now largely returned to pre-COVID levels, this will not be adequate to address the backlog.
2. Scorecard IP Events Coded For Period – 82%
Surgical Scorecard - Whangārei Hospital
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Reducing Acute Readmissions to 5.0 % 7.0 % 8.0 % 6.5 % 5.0 % 7.1 %
Hospital Elective Day of Surgery Admission 90 % 93 % 88 % 94 % 90 % 95 %
Safety and rate - DOSA Quality Hospital Acquired Pressure Injuries 0 0 0 0 0 11
Falls with major harm within facility 0 2 0 2 0 5
Health Improved Access to Elective Surgery 559 134 425 5 7,539
Targets – (All NDHB)
Inpatient Average Length of Stay 3.9 3.6 2.9 4.0 3.9 3.8
(ALOS) Acute (excludes Day Cases) Inpatient Average Length of Stay 3.1 2.6 2.1 2.7 3.1 2.7
(ALOS) Elective (excludes Day Cases) Inpatient Discharges (excludes Day 534 177 357 6,805 Cases) Elective Caseweights to contract 494 367 5,431 5,016
Acute Caseweights to contract 612 577 6,728 6,639
Service Patients on the Surgical Booking List 1.00 % 59.08
Delivery given a commitment to treatment but % not treated within four months Theatre cancellations by Hospital 2.0 % 1.3 % 2.0 % 4.0 %
% Overdue Surveillance colonoscopy 70 % 66 % 70 % 82 %
within twelve weeks % Urgent Colonoscopy within two 90 % 100 % 90 % 87 %
weeks % Non-Urgent Patients Receiving a 70 % 31 % 70 % 40 %
Colonoscopy within 42 days Number of elective operation short 0 0 0 60
notice cancellations - acute overload
Population Ambulatory sensitive (avoidable) 0 0 0 87 Health hospital admissions by weighted
Status value.
FTE employed to budget 456.9 440.7 456.9 441.5
Workforce Percentage Sick Leave Taken 3.00 % 1.83 % 3.00 % 2.52 %
EHC May report for July 2020 meeting Page 4 of 59
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Total Employees in Excess of 240 0 151
hours Accrued Leave Percentage Annual Leave Taken 11.0 % 5.6 % 11.0 % 9.6 %
Staff Turnover 0 56
Overtime Hours 421 5,925
Commentaries for Scorecard We have successfully run a trial programme to reduce the number of falls within the Surgical Safety and wards. The programme was named “Call, Don’t Fall”. Final analysis is being conducted and Quality findings will be presented to the Quality Directorate
As noted above the surgical output volumes have been materially impacted from March through to Health Targets May. We expect full activity to have resumed during June however this presents challenges in managing the backlog that has grown over that period.
Service Endoscopy services, including colonoscopy was also adversely impacted by COVID and now face Delivery the same challenges as surgery in managing its backlog.
Annual leave taken is very low compared with expected levels. This is largely due to an inability to Workforce travel and the uncertainty which COVID has brought. It also adversely affects the financial performance.
3. Strategic Initiatives / Health Services Planning NDHB is currently undertaking a programme of work targeted at reducing inequity. The focus is primarily on two areas, prioritisation and support services. Both the colonoscopy and breast services have identified to be part of the trial. Surgical Services is working with the Māori Directorate regarding this trial programme.
4. Emergent Issues and Initiatives Identified Bringing services back to 100% of normal capacity has proved challenging given the range of constraints post the intense COVID response. A range of factors included, converting facilities back to their ordinary use while retaining an ability to revert to “response” mode, bringing back to site those staff stood down for occupational health reasons. Increased waiting times have been the result.
EHC May report for July 2020 meeting Page 5 of 59
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Outpatients/Cancer and Blood Services
1. Overview First Specialist Appointment waiting times have materially increased as a result of restrictions to activity during the COVID response. There were a number of patients that continued to receive their appointments or treatment within the hospital, however this was based on the national response framework.
2. Scorecard
Outpatients/Cancer and Blood Services Scorecard - Whangārei Hospital
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Faster Cancer Treatments 90 %
Health Targets Provisional percentage of patients 90 % 53 % 69 % 72 % 90 % 71 %
referred with high suspicion of cancer
commencing treatment within 62 days
Service Patients waiting longer than four 0.40 % 47.53
Delivery months for their FSA %
FTE employed to budget 138.5 135.3 138.5 137.5
Percentage Sick Leave Taken 3.00 % 2.13 % 3.00 % 3.15 %
Total Employees in Excess of 240 0 22
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 3.2 % 11.0 % 8.1 %
Staff Turnover 0 11
Overtime Hours 53 809
Commentaries for Scorecard Health Faster Cancer Treatment results continue to be a problem, however additional resources have Targets recently been appointed to manage patients and revise existing pathways.
Service As noted above First Specialist Appointment volumes have been materially impacted and as a Delivery result a large percentage are overdue.
As with other areas, annual leave has been artificially depressed which has had an adverse effect Workforce on financial performance. Further this will present challenges as staff become fatigued and request leave in high volumes.
3. Strategic Initiatives / Health Services Planning Nothing of note to report this month.
4. Emergent Issues and Initiatives Identified Nothing of note to report this month.
EHC May report for July 2020 meeting Page 6 of 59
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Radiology
1. Overview Like all elective services CT and MRI waiting times have deteriorated in recent months. There is however a plan to largely recover these through “insourcing” which is taking advantage of low annual leave.
2. Scorecard
Radiology Scorecard - Whangārei Hospital
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Improving waiting times for diagnostic 95 % 61 % 95 % 71 %
services - CT % receiving CT scans Service within 6 weeks Delivery Improving waiting times for diagnostic 90 % 44 % 90 % 60 %
services - MRI % receiving MRI scans
within 6 weeks
FTE employed to budget 78.6 81.4 78.6 76.8
Percentage Sick Leave Taken 3.00 % 1.60 % 3.00 % 2.99 %
Total Employees in Excess of 240 0 28
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 2.5 % 11.0 % 9.2 %
Staff Turnover 0 4
Overtime Hours 68 720
Commentaries for Scorecard Service See comments in summary. Delivery
Radiologist FTE are now largely recruited to following approximately 18 months of significant Workforce vacancies. This will ultimately have a favourabe financial impact with a reduced level of outsourcing.
3. Strategic Initiatives / Health Services Planning The Radiology Service has bid for a share of MoH funding targeted at reducing radiology waiting lists post COVID. We have yet to receive advice as to whether we will receive the full quantum of that request.
4. Emergent Issues and Initiatives Identified Nothing of note to report this month.
EHC May report for July 2020 meeting Page 7 of 59
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Pathology Services
1. Overview There was a material reduction in the volumes process by the laboratories through the early stages of the lockdown. This was expected given the reduction in elective services over that period.
2. Scorecard
Pathology Services Scorecard
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Service Laboratory Test Orders 109,213 1,241,267
Delivery
FTE employed to budget 94.2 89.0 94.2 91.5
Percentage Sick Leave Taken 3.00 % 1.44 % 3.00 % 3.38 %
Total Employees in Excess of 240 0 39
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 4.3 % 11.0 % 8.5 %
Staff Turnover 0 8
Overtime Hours 684 5,986
Commentaries for Scorecard Service Volumes in recent months have reduced which is to be expected. Delivery
A high number of employees were unable to work during the COVID response and as a result the Workforce reduction in volumes had less impact.
3. Strategic Initiatives / Health Services Planning Nothing of note to report this month.
4. Emergent Issues and Initiatives Identified Nothing of note to report this month.
EHC May report for July 2020 meeting Page 8 of 59
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Older People and Clinical Support
1. Overview Service disrupted by COVID-19 pandemic
2. Scorecard
Older People and Clinical Support Scorecard
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Falls with major harm within facility 0 0 0 0 0 0
Safety and Quality Hospital Acquired Pressure Injuries 0 0 0 0 0 4
Assessment and Rehabilitation Bed 672 687 6,715 7,448
Days Inpatient Contacts 2,700 2,528 26,995 30,381
Outpatient Contacts 881 457 8,810 7,812
Service Community Contacts 2,490 2,458 24,900 25,384
Delivery Retinal Screens 178 1,119 3,275
Breast Screens 915 642 9,150 9,302
Inpatient Discharges (excludes Day
Cases)
FTE employed to budget 214.7 211.9 214.7 205.9
Percentage Sick Leave Taken 3.00 % 1.36 % 3.00 % 2.94 %
Total Employees in Excess of 240 0 37
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 4.7 % 11.0 % 8.5 %
Staff Turnover 0 9
Overtime Hours 451 3,044
Commentaries for Scorecard Safety and Positive result for the month with no recorded falls and pressure injuries. Quality
Service Low service delivery across all areas except A&R bed days due to COVID pandemic. Delivery
Decrease in annual leave due to extra staffing personnel's required for COVID pandemic, Higher Workforce overtime due to watches.
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3. Strategic Initiatives / Health Services Planning Deliverable / Action Planned Outcome Status
Central Community Hub Initial information collection phase underway New
ACE Project team exploring opportunities for trialling new method of care. On Track New clinical lead will be leading with service manager.
4. Emergent Issues and Initiatives Identified Nothing of note to report this month.
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Medical
1. Overview Service disrupted by COVID-19 pandemic.
2. Scorecard IP Events Coded For Period – 82%
Medical Scorecard - Whangārei Hospital
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Reducing Acute Readmissions to 10 % 14 % 14 % 13 % 10 % 14 %
Hospital Safety and Hospital Acquired Pressure Injuries 0 0 0 0 0 17 Quality
Falls with major harm within facility 0 0 0 0 0 2
Inpatient Bed Days 1,527 364 1,163 21,166
Inpatient Average Length of Stay 4.1 3.3 3.2 3.3 4.1 4.1
Service (ALOS) Acute (excludes Day Cases) Delivery Acute Caseweights to contract 532 467 5,854 5,885
Inpatient Discharges (excludes Day 474 122 352 5,493
Cases)
Population Ambulatory sensitive (avoidable) 0 0 0 186 Health hospital admissions by weighted
Status value.
FTE employed to budget 194.5 201.5 194.5 194.3
Percentage Sick Leave Taken 3.00 % 2.36 % 3.00 % 3.14 %
Total Employees in Excess of 240 0 58
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 7.2 % 11.0 % 9.3 %
Staff Turnover 0 16
Overtime Hours 543 5,045
Commentaries for Scorecard
Safety and No pressure injuries or falls recorded during the month at the time of writing this report. Quality
Service Service delivery disrupted by COVID pandemic Delivery
Population As there were no ASH admission data available at the time of writing this report, no comment has Health Status been provided.
Decrease in annual leave as extra resources required for the pandemic and YTD below target. Workforce Increase in sick leave due to change in season and extra precautions taken as part of COVID.
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3. Strategic Initiatives / Health Services Planning Deliverable / Action Planned Outcome Status
Cath Lab Approved by MoH. Preliminary planning complete and now finalising On Track design.
4. Emergent Issues and Initiatives Identified Overall bed numbers reduced due to changes for COVID.
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Renal
1. Overview Service disrupted by COVID-19 pandemic.
2. Scorecard IP Events Coded For Period –82%
Renal Scorecard - Whangārei Hospital
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Reducing Acute Readmissions to 15 % 17 %
Hospital Safety and Hospital Acquired Pressure Injuries 0 0 0 0 0 1 Quality
Falls with major harm within facility 0 0 0 0 0 0
Inpatient Bed Days 100 184 145 39 1,100 1,692
Inpatient Average Length of Stay 5.0 8.9 11.9 3.9 5.0 6.7
Service (ALOS) Acute (excludes Day Cases) Delivery Acute Caseweights to contract 33 37 360 471
Inpatient Discharges (excludes Day 24 16 8 316
Cases)
Population Ambulatory sensitive (avoidable) 0 0 0 14 Health hospital admissions by weighted
Status value.
FTE employed to budget 73.8 75.0 73.8 71.3
Percentage Sick Leave Taken 3.00 % 2.41 % 3.00 % 3.04 %
Total Employees in Excess of 240 0 35
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 7.6 % 11.0 % 10.7 %
Staff Turnover 0 3
Overtime Hours 50 493
Commentaries for Scorecard Safety and Positive outcome for the month with no major falls or pressure injuries Quality
Service A significant increase to inpatient bed days continue during May and YTD averages Delivery
Population At the time of writing, no ASH admissions were recorded. Health Status
An increase to sick leave due to the change in season and staff required to take extra precautions Workforce around COVID pandemic. FTE employed to budget has increased due to extra nursing personnel's required for COVID screening. Overall YTD under budget.
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3. Strategic Initiatives / Health Services Planning Deliverable / Action Planned Outcome Status
Moving to Home Management Project is in process On Track
4. Emergent Issues and Initiatives Identified Nothing of note to report this month.
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Emergency
1. Overview Service disrupted by COVID-19 pandemic.
2. Scorecard IP Events Coded For Period –85%
Emergency Scorecard
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Safety and Patients waiting in ED longer than 24 0 55 13 42 0 93
Quality hours
Health Shorter Stays in Emergency 95 % 92 % 92 % 91 % 95 % 84 %
Targets Departments (All NDHB)
Percentage proportion of Triage 75 % 69 % 69 % 69 % 75 % 44 %
patients seen within the recommended time for their category Inpatient Discharges (excludes Day 21 10 11 362 Service Cases) Delivery Level 4 attendances to Contract – 1,234 16,652 Discharges Level 4 attendances to Contract – 1,422 17,330
Admissions (includes ED 3 Hour)
FTE employed to budget 97.9 118.5 97.9 101.4
Percentage Sick Leave Taken 3.00 % 2.33 % 3.00 % 2.68 %
Total Employees in Excess of 240 0 57
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 5.0 % 11.0 % 9.0 %
Staff Turnover 0 15
Overtime Hours 382 1,358
Commentaries for Scorecard Safety and During the COVID crisis, ED undertook all screening before patients being admitted to hospital to Quality avoid virus transmission.
Shorter stays remains in line with YTD averages despite high patient volume Health Targets
Service Patient numbers down due to COVID. Delivery
Staff annual leave reduced during May due to leave being deferred as extra resources needed to Workforce help cover vacancies and COVID pandemic. Year to date is still below target.
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3. Strategic Initiatives / Health Services Planning Deliverable / Action Planned Outcome Status
EDaaG Ongoing enhancements On Track
4. Emergent Issues and Initiatives Identified The temporary Adult Assessment Unit was successful in reducing congestion in ED.
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Mental Health
1. Overview The Mental Health & Addictions service is $1m favourable to budget year to date in May 2020, with major financial risk continuing to be medical locum costs from covering vacancies.
Occupancy in Tumanako IPU was 87.5% excluding patients on leave and 93.8% including patients on leave; the three sub-acute units had occupancy of 80.5% in May.
The Integrated Primary Mental health Te Tumu Waiora Service funding has been confirmed for Tranche 1 (1 March – 30 June 2020) establishment phase. HIP (Health Improvement Practitioners) and HC (Health Coaches) FTE have been employed to 12 of the 18 practices allocated for Tranche 1 implementation. Virtualization of service delivery has been implemented during COVID19. Recruitment is underway for the 6 remaining practices
Department of Corrections has funded a Peer Worker to work alongside the current services provided by MoH to offenders prior and post release from the Northland Correctional Facility.
2. Scorecard IP Events Coded For Period –100%
Mental Health Scorecard
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Reducing Acute Readmissions to 13 % 18 % 27 % 5 % 13 % 17 %
Safety and Hospital Quality Falls with major harm within facility 0 0 0 0 0 0
Inpatient Bed Days – Tumanako IPU 659 686 442 244 7,140 7,438
Detox Bed Days - Dargaville 132 100 34 66 1,386 1,655
Service Sub Acute Bed Days (Kaitaia, 474 494 369 125 5,141 5,215
Delivery Kaikohe, Whangārei) Inpatient Average Length of Stay 24 14 14 12 24 15
(ALOS) (excludes Day Cases) Inpatient Discharges (excludes Day 72 49 23 694
Cases)
FTE employed to budget 380.9 351.0 380.9 351.4
Percentage Sick Leave Taken 3.00 % 2.43 % 3.00 % 3.62 %
Total Employees in Excess of 240 0 70
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 3.8 % 11.0 % 8.6 %
Staff Turnover 0 42
Overtime Hours 835 11,567
Commentaries for Scorecard 14 patients were readmitted in May, and 127 YTD. The May readmissions included: *Five readmissions to Tumanako IPU Safety and *Six internal transfers to/from Mental Health Sub-acute Unit Quality *Three readmission/transfer to ED or a Medical/Surgical Ward
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Occupancy at Tumanako IPU for May was 87.5% excluding patients on leave or 93.8 % including patients on leave. Year to date occupancy to May was 89.0% excluding patients on leave or 95.3% including patients on leave. Recommended occupancy guidelines for acute mental health units to ensure access and safe practice are between 85 – 90% and our IPU is above this including patients on leave.
Mental Health Inpatient Unit Utilization and Bed Days Note current year occupancy rates are based on 29 beds. Tumanako IPU was a 25 bed unit up to February 18, transitioning up to 29 beds at one bed per month from March 18 to June 18. Prior to discharge patients commonly go on leave to home with family on a trial basis, or go into community respite or sub-acute beds. Social issues such as housing and family support (versus clinical) are often a significant factor in admissions and completing effective discharge from the inpatient unit.
Mental Health Inpatient Unit Utilisation and Bed Days 2019-20 120.0% 10,000 9,000 100.0%
8,000
7,000 80.0% 6,000 Service 60.0% 5,000 Delivery 4,000 40.0%
MonthOccupancy 3,000 YTD YTD VolumeBed Days 2,000 20.0% 1,000 0.0% - Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
Last Year Occupancy This Year Occupancy Last YTD Bed Days This YTD Bed Days
Mental Health Inpatient Unit Discharges and length of Stay There were 48 admissions and 51 discharges in May, with an average length of stay of 15.07 days in Tumanako IPU (16.22 days YTD). Average length of stay in the Service Delivery Table above is 14 days for the month, which is the combined average length of stay of the inpatient unit, sub-acute units and detox unit.
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Mental Health Inpatient Unit Discharges and Length of Stay 2019-20 70 100.00 90.00 60
80.00
50 70.00 60.00 40 50.00 30 40.00
20 30.00
Number of Discharges of Number Average Average Lengthof Stay 20.00 10 10.00 - - Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
Last Year Discharges This Year Discharges Last Year ALOS This Year ALOS
Sub-acute Discharges and Length of Stay The three sub-acute units, (Whangārei He Manu Pae, Kaitaia Te Kohanga and Kaikohe Tu Kaha), had overall occupancy of 80.5% and an average length of stay of 12.28 days for May. The average length of stay by unit was Far North Kaitaia – 13.47 days; Mid North Kaikohe – 14.29 days, and Whangārei – 10.04 days. There were 45 discharges for the three sub-acute units in May.
Mental Health Whg, Mid and Far North Sub Acute Units Discharges and Length of Stay 2019-20 50 100.00 45 90.00
40 80.00
35 70.00 30 60.00 25 50.00 20 40.00
15 30.00
Number of Discharges of Number Average Average Lengthof Stay 10 20.00 5 10.00 - - Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
Last Year Discharges This Year Discharges Last Year ALOS This Year ALOS
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Community Mental Health The community mental health teams had 9,625 client contacts in May and a further 2,301 care coordination contacts (with persons or agencies other than the client or whanau, such as WINZ). The average number of client contacts in the previous 10 months between July 19 and April 20 was 8,211 client contacts per month and 2,110 care coordination contacts, so we have seen an average increase of 15% in client contacts and a 9% average increase in care coordination contacts
Community Mental Health Client Contacts 2019-20 12,000 120,000
10,000 100,000
8,000 80,000
6,000 60,000 YTD YTD Contacts
MonthContacts 4,000 40,000
2,000 20,000
- - Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
Last Year Contacts This Year Contacts Last YTD Contacts This YTD Contacts
Mental Health & Addiction Services Total Clients Seen YTD 2019-20 9,000 8,000 7,000
6,000 5,000 4,000 OpenCases 3,000 2,000 1,000 - Qtr 1 Qtr 2 Qtr 3 Qtr 4
Clients Qtr End Last Year Clients Qtr End This Year Total Clients Last Year Total Clients This Year
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For May, Mental Health was 30.0 FTE under budget, of which 23.4 FTE for registered nurses which includes Overtime and Callback and part time/part time no fixed hours staff working more than contracted hours.
Workforce The service's recruitment efforts to fill new and existing vacant roles continue.
The service had 287 ACC hours for May attributable to four staff members, all of which was non work related.
3. Strategic Initiatives / Health Services Planning Deliverable / Action Planned Outcome Status
Model of Care MHAS service plan outlining model of care implementation for 20/21 is On Track Implementation finalised
Primary Mental Health Funding confirmed for Tranche 1 (1 March – 30 June 2021) On Track establishment. HIP and HC FTE have been employed to 12 of the 18 practices allocated for Tranche 1 implementation. Virtualization of service delivery has been implemented during COVID 19. Recruitment is underway for the 6 remaining practices Wellbeing Budget - Funding for all of New Zealand known, but funding at DHB level and who On Track additional funding for funding will go to not known. Four RFPs have now issued, and closed, the Mental Health & first being Te Tumu Waiora above. The other three RFP decisions have Addictions been delayed due to COVID 19.
4. Emergent Issues and Initiatives Identified MoH have provided an expedited process to renew NGO provider contracts that expire on 30 June 2020, with renewal for one year with no changes in terms and conditions. The Board approved the renewal of these contracts at its May meeting.
5. Other Highlights Department of Corrections has funded a Peer Worker to work alongside the current services provided by MoH to offenders prior and post release from the Northland Correctional Facility.
Interim funding from MoH has been received for a Suicide Postvention Worker through to 30 September 2021, while a review of community based suicide prevention and postvention services is undertaken over the coming year by the Suicide Prevention Office.
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Rural Hospitals
1. Overview The rural hospitals are slowly returning to normal following the COVID-19 response. While presentations, discharges and bed days were down between 20-30% from average during the two months of lockdown, the teams at each rural hospital worked extremely hard to implement the changes required in each department as part of our response.
2. Scorecard IP Events Coded For Period – 0%
Rural Hospitals Scorecard
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Reducing Acute Readmissions to 10 % 11 % 8 % 12 % 10 % 9 % Hospital Safety and Falls with major harm within facility 0 0 0 0 0 1
Quality Hospital Acquired Pressure Injuries 0 0 0 0 0 10
Inpatient Average Length of Stay 3.0 2.9 2.7 3.0 3.0 2.9
(ALOS) (excludes Day Cases) Inpatient Discharges (excludes Day 289 102 187 3,760 Cases) Acute Caseweights to contract 289 293 3,180 3,608
Elective Caseweights to contract 41 20 451 424
Percentage Attendance rate for all 95 % 91 % 95 % 89 %
OP Appointments in District Hospitals Service Percentage Attendance rate for all 95 % 95 % 95 % 93 % Delivery OP Appointments in Whangārei Hospital Percentage Outpatient Bay of Islands 22 % 28 % 22 % 27 %
Domicile Attendances in BOI (Quarterly) Percentage Outpatient Dargaville 18 % 13 % 18 % 11 %
Domicile Attendances in DRG (Quarterly) Percentage Outpatient Kaitaia 55 % 44 % 55 % 55 %
domicile attendances in KTA
(Quarterly)
Population Ambulatory sensitive (avoidable) 0 0 0 174 Health hospital admissions by weighted
Status value.
FTE employed to budget 231.4 237.4 231.4 232.4
Percentage Sick Leave Taken 3.00 % 2.27 % 3.00 % 2.96 %
Total Employees in Excess of 240 0 85
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 4.1 % 11.0 % 9.0 %
Staff Turnover 0 31
Overtime Hours 335 4,406
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Commentaries for Scorecard Safety and Hospital acquired pressures injuries are up YTD on those reported at the same time last year but Quality remain low over the past few months.
Monthly reported discharges and bed-days across April and May were down 25% relative to the average volumes in the YTD prior to lockdown.
250 Monthly Discharge Count - General Wards Only 200
150 Bay of Islands General 100 Dargaville General
50 Kaitaia General
0
Service
Delivery A&M presentations in Bay of Islands and Kaitaia Hospitals were down 23% on the same comparative basis. A&M Presentations - All Episodes 800 600 400 200
0
Jul-18 Jul-19
Jan-19 Jan-20
Jun-19
Oct-18 Oct-19
Apr-19 Apr-20
Sep-18 Feb-19 Sep-19 Feb-20
Dec-18 Dec-19
Aug-18 Aug-19
Nov-19 Nov-18
Mar-19 Mar-20
May-19 May-20
Kaitaia Bay of Islands
Population Nothing of note this month. Health Status
Workforce Attracting medical staff to work at Dargaville Hospital remains a challenge.
3. Strategic Initiatives / Health Services Planning Planning for BOI second phase of redevelopment is on hold pending further clarification re capital from the Ministry.
4. Emergent Issues and Initiatives Identified Medical workforce in the rural hospitals continues to be a challenge but there have been recent appointments that will see 20/21 better placed in terms of recruitment.
5. Other Highlights All rural hospitals worked well in getting their environments ready and prepared for any COVID-19 cases and staff should be complimented on their commitment towards this.
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Paediatric
1. Overview May has been a month of planning for a recovery post COVID level 4. Acute patient volumes remain lower than expected for this time of year. Outpatient and community volumes have remained the same. New ways of connecting with children requiring outpatient and community appointments were utilised during lockdown e.g. telehealth, consults via zoom and phone/email conversations. Managing in this way enabled the waitlists and urgent referrals to be managed and children still seen and offered plans of care (even if in the interim while waiting for face to face assessment). The Child Health teams have excelled in adapting to new ways of working and adjusting back into the workplace post COVID lockdown.
2. Scorecard IP Events Coded For Period – 89%
Paediatric Scorecard - Whangārei Hospital
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Reducing Acute Readmissions to 5 % 2 % 0 % 4 % 5 % 9 %
Safety and Hospital Quality Falls with major harm within facility 0 0 0 0 0 0
Inpatients with LOS > 21 days 2 1 1 12 Inpatient Average Length of Stay 3.8 4.2 3.3 2.7 (ALOS) Acute (excludes Day Cases) Acute Caseweights to contract 161 125 1,767 1,914
Service Number of Discharges from Ward 2 125 2,291 Delivery Number of Discharges from SCBU 34 335 Bed Utilisation for Ward 2 50.4 82.4 Inpatient Discharges (excludes Day 62 34 28 1,396 Cases)
Bed Utilisation for SCBU 85.1 103.8
Population Ambulatory sensitive (avoidable) 0 0 0 110 Health hospital admissions by weighted
Status value.
FTE employed to budget 113.1 115.0 113.1 114.7
Percentage Sick Leave Taken 3.00 % 1.84 % 3.00 % 3.38 %
Total Employees in Excess of 240 0 25
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 7.0 % 11.0 % 10.3 %
Staff Turnover 0 13
Overtime Hours 150 1,839
Commentaries for Scorecard Safety and Nothing of note to report this month. Quality
Service WARD 2: Delivery Acute patient volume has been lower than expected for this time of year. Concern remains around
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managing patients who require isolation. This is due to the lack of single rooms available. Ward staff will rely on rapid testing in ED before coming to the Ward to help with appropriate bed allocation for children requiring isolation.
The Ward managed a larger than usual number of children requiring 1:1 care. This was mainly due to children with eating disorders and other mental health issues.
SCBU: SCBU have had a manageable volume of acute admissions. Utilisation was 86%. This has meant workloads have been managed without the need for extra registered nurses and additional hours.
CHILD DEVELOPMENT SERVICES (CDS): The National Child Development Services budget increase has continued to be a focus. COVID has had an impact on our ability to achieve our targets as planned. We have recommended to the Northern Regional Alliance (NRA) to have unspent funding transferred to our 20/21 budget. COVID, business as usual work, CDS budget increase, Innovation funding and Improvement champion work has resulted in high management/team leader workloads. Waiting times continue to be an issue however with the CDS increase in funding this is being addressed. The service is confident in reaching the target set for Dec 2020.
COMMUNITY NURSING TEAM (including outpatients): The Paediatric Community Nursing Specialist team embraced telehealth during the COVID lock down period to support children and their families and to mitigate risk.
We continue to progress outpatient clinics which are back to business as usual. We are still limiting capacity of face to face appointments to ensure social distancing. Patients and their families are being screened for COVID prior to clinic appointment attendance. There is on-going work to support the uptake of telehealth due to successes noted during the COVID level 4 and 3 periods.
The service is working on addressing the recommendations of the Child Health Centre Outpatient review: *Review of appointment letters- printed envelope with Child Health logo costed and to discuss with management team. *Review of the end of day (EOD) clinic process- the form has been altered to reflect preference for telehealth as a follow-up option. *Review of the referral process for children discharged from Ward 2 with a request for outpatient follow-up. Internal RMS Lite referrals will support this process and a registrar acute clinic is being established. *Utilisation of DNA prediction data and other strategies available to reduce the likelihood of these occurring. Focus of work in 2020. *An initial clean-up of unscheduled follow-up (FU) appointments on WebPAS. The next area of focus will be Kaitaia. *Individual paediatrician appointments will be scheduled to discuss ideas/suggestion regarding changes to the model of care delivery in the outpatient setting. *Consideration to be given to compiling a dashboard for outpatient review around FSAs, follow- ups and cancelled clinics.
Population Respiratory ASH project work –There are no readmissions within 28 days noted for this month for Health Status children
There were 1,949 hours of annual leave taken in May, up by 791 hours on the previous month. Sick leave was up by 221 hours with a total of 512 hours taken. There were 91 hours of training Workforce leave taken which was up by 5 hours on the previous month. There are 44 staff with more than 200 hours of annual leave owing to them and 26 of these staff have more than 240 hours owing. Leave plans have been submitted for these staff.
3. Strategic Initiatives / Health Services Planning We have successfully transitioned a registered nurse from a Nursing Specialist role into a Nurse Practitioner role. This commenced in March 2020. The main areas of focus within this role will be clinical management/leadership for children with allergies, requiring de-sensitisation (venom, drug or food challenges), and engagement with primary health care.
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We have appointed a new Clinical Nurse Manager into Ward 2/SCBU. The successful applicant has a strong focus on reducing inequities and extensive knowledge on the factors influencing inequities.
We have recruited into Allied Health roles to support the expansion of Child Disability Services.
4. Emergent Issues and Initiatives Identified The SMO workforce is understaffed due to an unfilled vacancy (no suitable applicants) and short notice, unexpected leave. This is impacting on ability to take leave and manage acute plus outpatient work.
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Maternal
1. Overview Services have returned to normal and quality processes have been recommenced following Covid-19. The required changes made during COVID did not result in any known adverse outcomes, yet gave some insight into variations in the way some services could be delivered, particularly antenatal clinics.
The Maternity Clinical Governance committee has made a commitment to place equity as a key focus into the future. Working with Te Poutokamanawa, it is intended to first approach equity by firstly working within the governance committee members themselves, then the staff. Meanwhile, efforts are being made to alleviate access barriers for some women.
The Growth Assessment Programme has been formally introduced. It is hoped this will have some impact on the perinatal mortality rate, for which Te Taitokerau is an outlier in NZ.
2. Scorecard IP Events Coded For Period – 88%
Maternal Scorecard - Whangārei Hospital
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Safety and Reducing Acute Readmissions to 5 % 4 % 6 % 3 % 5 % 5 %
Quality Hospital
Health Better help for smokers to quit – 95 % 100 % 100 % 100 % 95 % 88 %
Targets Pregnant Women
Inpatient Average Length of Stay 5.0 7.5 2.5 3.2 (ALOS) Acute (excludes Day Cases) Acute Caseweights to contract 133 151 1,467 1,762
Number of Births in Whangārei 143 1,604 Service Hospital Delivery Number of Discharges from Post 261 2,985 Natal Ward (Ward 11) % Exclusive Breastfeeding Rates at 90 % 82 % 90 % 92 %
Hospital Discharge Inpatient Discharges (excludes Day 245 115 130 2,730
Cases)
FTE employed to budget 59.0 57.6 59.0 58.6
Percentage Sick Leave Taken 3.00 % 3.63 % 3.00 % 3.49 %
Total Employees in Excess of 240 0 22
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 9.0 % 11.0 % 11.7 %
Staff Turnover 0 6
Overtime Hours 62 604
Commentaries for Scorecard Quality and safety activities are now underway again. Clinical governance and M&M meetings have taken place with the support of Zoom. Education sessions throughout the region have Safety and recommenced for midwives recertification requirements and guidelines are being updated. Quality The clinical governance committee is fully supportive of a priority focus on equity, as presented by the Director of Midwifery. This development of our service will be undertaken in conjunction with and guidance from Te Poutokamanawa, firstly commencing within the committee, then with
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region-wide maternity staff. Several key quality projects are in progress. This includes planning for multi-disciplinary practical education days to be held at all rural hospitals as well as in Te Kotuku. The sessions at rural hospitals will include participation by hospital doctors and nurses who are sometimes called upon to support emergency care led by midwives in these settings, as well as ambulance officers. These training days will be delivered jointly by midwives and obstetricians. Planning is also taking place to establish a region-wide process to provide prophylactic administration of Anti-D to all Rh negative pregnant women in Te Taitokerau. This is a recommendation of the Perinatal and Maternal Mortality Review Committee. In rolling this out, the maternity service is adamant that women in rural isolated areas must have the same ability receive this prophylaxis as those women living in central Whangārei. As one way of addressing access issues, collaboration has been established with the renal transport service. This is with a view to running a small pilot whereby the renal drivers, during their downtime during the day, could be available to transport those pregnant women with no available transport, to necessary scan and antenatal appointments. DHB payment for scans for those women enduring financial hardship continues. Six midwives in the Mid-North have made submissions on behalf of eight women and a total of $345.00 (GST incl) has been paid to the private provider of ultrasound services since November 2019. Formal introduction of the Growth Assessment Programme (GAP) took place in Te Taitokerau on 1 June 2020. The aim of this programme, for which the DHB has a contract, is to assist in the diagnosis and subsequent planning of care for small for gestational age babies who are at increased risk of mortality. It is hoped that this programme may be one contributor towards the reduction of our perinatal death rate. It is however dependent on ultrasound capacity and accessibility throughout the region.
Smoking: All smokefree activities were minimised during COVID and planning is underway for future wananga. Health Baby Friendly Hospital Initiative: Targets Dargaville and Bay of Islands hospitals have both fulfilled requirements following a Baby Friendly Hospital Initiative (BFHI) audit in 2019. This means that all DHB facilities have now met the criteria to be recognised as ‘Baby Friendly’ i.e. quality breastfeeding advice and support is provided to women using the services.
There were 143 births in Te Kotuku in May. 76 percent of women in the region had a normal birth while 23 percent of all women in Te Taitokerau had a caesarean section. There were several days of very high acuity in the month. These days were exacerbated by booked inductions of labour which currently take place on Monday to Friday only. Increasing complexity arising from co-morbidities is one factor in leading to an increase in the number of inductions of labour and it is becoming clear that this intervention needs to be spread across the seven days of the week.
The maternity team worked well together, both region-wide and in Te Kotuku ; employed and self- employed, in preparing for COVID 19 and coping with the associated additional demands. There was a definite increase in the number of homebirths and also women who discharged home early following birth. The Lead Maternity Carer (LMC) workforce in the community are acknowledged for the additional work required of them as a result of these ways women and whanau elected to Service cope.
Delivery A maternity COVID team was established early and comprised the Clinical Director, Acting Director of Midwifery & Service Manager, senior midwives in Te Kotuku, Bay of Islands and Kaitaia Hospitals and a LMC representative. Daily Zoom meetings were held initially and these proved to be an efficient way to share information, answer concerns and decide on an agreed way forward in response to sometimes conflicting information between key sources such as the Ministry of Health, professional organisations, regulatory authorities and the DHB.
Significant changes were made to the specialist antenatal clinics held in Te Kotuku and the rural hospitals. Written referrals were triaged and follow up telephone calls between LMC midwives and obstetricians took place rather than face to face appointments during alert level 4. Only urgent scans took place. No adverse outcomes can be attributed to these measures however services were steadily increased back to normal as the alert levels decreased.
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A survey will be distributed to all women who had their babies since the end of March in order to ascertain the impact of COVID on their childbirth experience.
Te Puawai Ora (TPO): Lactation Consultant (LC) clinics have resumed in Whangārei, Bay of Islands and Dargaville. During alert level 4 all clinics were cancelled and emergency consults took place via zoom. There is increasing demand for LC services in the Far North due to the resignation of the breastfeeding support kaiawhina at Te Hiku and the shortage of midwives working in the community at present. This has seen two whanau travelling from Kaitaia to Whangārei for urgent input from a lactation consultant.
Antenatal classes have resumed again at full capacity, however 2 metre social distancing is applied. A recorded version of antenatal education was made during alert level 4 and this was a popular alternative for those people affected by cancelled classes.
Unfortunately, teen antenatal classes will not be going ahead this term as there was only one interested couple.
The caseload of the DHB community midwifery service of last resort has suitably decreased, in light of an increased number of LMC midwives working in the Whangārei community. There is anecdotal evidence that the birth rate will increase in December and January following the NZ alert level 4 lockdown.
While Te Kotuku enjoys a full complement of staff, three part-time midwives are also covering some shifts in Kaitaia due to an acute community midwifery shortage in the Far North.
While the appointment of a new consultant has been made, she has been unable to commence her work in Northland as she is currently stranded in England. This situation also applies to a senior midwife who has been on leave in England. Workforce
There were 1,294 hours of annual leave taken in May, up by 388 hours on the previous month. Sick leave was up by 397 hours with a total of 521 hours taken. There were 43 hours of training leave taken which was up by 18 hours on the previous month. There are 32 staff with more than 200 hours of annual leave owing to them and 26 of these staff have more than 240 hours owing. Leave plans have been submitted for these staff.
3. Strategic Initiatives / Health Services Planning Midwifery Education / Auckland University of Technology: A portacom which has been used as a classroom for midwifery students for several years has been taken over by medical services post COVID. All students are currently on clinical placement but will be back in class at the beginning of the second semester in July, by which time a solution will be needed. AUT acknowledge that the provision of a learning space by the DHB was established on an informal handshake arrangement twenty years ago however, as these students are our future workforce and the programme has been highly successful in contributing to our workforce over the years, every effort is being made to find a replacement space.
4. Emergent Issues and Initiatives Identified Nothing of note to report this month.
5. Other Highlights Appointment of Sue Bree as Service Manager – Maternity/Director of Midwifery in June 2020.
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School-based, Community and Oral Health
1. Overview The Oral Health service has provided limited services during the COVID19 pandemic. Attendances across the service are lower than normal due to reduced clinics and treatment limitations. The Oral Health team, were redeployed to work in different services within the hospital and at the community based swabbing clinics with great success. Team members worked from home where possible.
Within the period of COVID all staff within School Based & Community Clinical Services were focused on COVID response and management. Contract tracing continued as per usual business for the Public Health Nursing team. Most other services were redeployed to support the COVID response, inclusive of manning the community testing stations. Acute rosters were maintained and the sexual health staff had phone consultations available.
2. Scorecard
School based, Community and Oral Health Scorecard
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Mobile Ear Clinic Contacts (one 62 2,554 month retrospective) Public Health Nurse Contacts 142 2,360 Sexual Health Contacts 187 2,890 Service Number of Oral Health treatment 578 249 329 26,533 Delivery visits 0 - 12 year olds Number of Oral Health treatment 55 38 17 4,340 visits 13 - 17 year olds Number of Oral Health treatment 219 123 96 2,266
visits for low-income adults
Number of Reports of Concern to 39 471 Child Youth and Family Number of Family Violence Positive 34 462 Disclosures Population Newborn Hearing Screening Rates (3 85 % 96% 85 % Health
Months Retrospective) Status Number of children treated for dental 6 2 4 312 conditions under GA Number of presentations to ED due to 14 9 5 542
dental conditions
FTE employed to budget 188.6 183.0 188.6 178.9
Percentage Sick Leave Taken 3.00 % 0.99 % 3.00 % 2.94 %
Total Employees in Excess of 240 0 22
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 1.6 % 11.0 % 8.5 %
Staff Turnover 0 16
Overtime Hours -285 439
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Commentaries for Scorecard There were limited oral health services provided during all levels because of the pandemic, Northland District Health Board and Dental Council guidelines.
Public Health Nurses: The Public Health Nursing team has been focused on the COVID response and management with both contact tracing, management of cases and community testing. Consent forms for both HPV and MMR vaccinations have been sent out to all schools, for distribution to parents and caregivers. The addition of vaccinating for MMR was done with dose 1 of the HPV programme last Service year post measles outbreak and will continue now with dose 2 of HPV and Boostrix. The public Delivery health nursing team were able to complete what is called dose 1 of the HPV vaccinating programme pre-COVID and are currently in schools to complete dose 2. The B4 school programme was required to be on hold during COVID, this is currently back to business as usual, along with a catch up plan for additional clinics.
The Kaiawhina team were essential in supporting the testing centres, supporting families at this time and supporting other providers with their COVID testing. In addition to this, the Kaiawhina teams were heavily supporting the Flu Vaccine Campaign that ran alongside COVID.
Immunisation: During the COVID period of Alerts 4 – 2 there were some intermittent restrictions on service delivery specific to the DHB Immunisation Outreach service. Immunisation Outreach services found over this time many families and whanau did not want services in their homes and did not want to leave their homes to access immunisation. Immunisation drive-through clinics were established and families were able to remain in their cars when receiving vaccinations. All vaccinations (Flu, well child schedule MMR and Vaccines for Pregnant women) were available at the drive-throughs. GPs also offered drive through vaccination clinics, anecdotally we have found this to be something families wanted and found easier than waiting in clinics.
Planning is in progress for a Ministry of Health MMR Catch Up Programme to be delivered for a Population yearlong period in Northland, with focus being on the 15-29yr population. Health Status Northland DHB will apply lessons learnt from the 2017/18 MMR catch-up campaign undertaken post the Measles Outbreak. Northland currently has place actions to support opportunities for vaccination along with increasing awareness of vaccine and vaccine safety. In order to provide further opportunity for access to and information for vaccination, Northland DHB will continue to partner and support Maori Providers across Northland to provide vaccination across all ages along with MMR for those 15 – 29yr. As part of the COVID response, Maori Health Providers led mobile outreach services including to those isolated communities to provide testing, flu vaccination, welfare support and other health checks. Providers have commenced outreach/community based vaccination programmes in isolated communities alongside COVID 19 testing. The work being carried out by the Māori Health providers and others over the past month has proved successful for engaging more Māori.
There are Oral Health Therapist vacancies in the mid and far north areas, positions are advertised. Otago and Auckland University students will come to Northland for clinical placement in July and September. Workforce There were 530 hours of annual leave taken in May. There are currently 21 staff with more than 200 hours annual leave and 22 staff with more than 240 hours. Leave plans will be discussed with these staff members. There were 326 hours of sick leave taken in May - a decrease of 267 hours from April.
3. Strategic Initiatives / Health Services Planning A national working group has been formed to look at how to manage arrears in regards oral health. Virtual appointments have been looked into for under 2 year olds to have a dental consult via tele-health. Tele-health appointments were made during pandemic - both public and private patients to lessen face to face contact.
Regular contact with the Oral health teams via “Zoom”, kept the team updated with the many changes and also checked on their well- being.
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4. Emergent Issues and Initiatives Identified Nothing of note to report this month.
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Human Resources and Corporate Support
1. Overview May was a continuation of April with the hive of activity supporting IMT and COVID work streams.
Overtime in Payroll was at an all-time high due to (a) staff working offsite and the impact of paper timesheets on the team and (b) the sudden implementation of E-timesheets ahead of schedule to enable COVID reporting around staff availability and COVID stand down.
Recruitment continued offsite with the teams including the processing of COVID Expression of Interest received from the public and other health providers such as Kensington Hospital.
Human Resources and Occupational Health and Safety focussed on supporting staff and managers during COVID with a multitude of literature, FAQs etc made available on the intranet for staff.
The Workforce Development and Wellbeing team was deployed to establish Welfare Centres across the campuses, implement a 0800 number, provision of additional EAP sessions, accommodation, developing the online orientation course, developing a manager's guide to support staff and other initiatives as required by IMT Welfare. The Library was designated as the Welfare Centre for Whangārei and was supported by the Library Manager.
A few of our staff members in Customer Services and Admissions were stood down due to compromised immunity. The service therefore ran two rosters in order to balance capacity versus workload. The objective was to spread the load as the future regarding the impact / spread of COVID was unknown as well as to decrease stress and support the team's wellbeing during an uncertain period.
2. Scorecard
Human Resources and Corporate Support Scorecard
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
FTE employed to budget 52.2 57.0 52.2 56.6
Percentage Sick Leave Taken 3.00 % 0.76 % 3.00 % 1.85 %
Total Employees in Excess of 240 0 17
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 5.6 % 11.0 % 8.1 %
Staff Turnover 0 17
Overtime Hours 149 1,244
Commentaries for Scorecard HR and Corporate Support Services completed May 2020 with a YTD underspend of $105,987.
The roles below are current vacancies within the following services: - Library - Library assistant 0.65FTE.
The area of underspend relates to supplies $320k (further impacted by inactivity due to COVID) and an overspend in salaries of $226k due to the approved but unfunded roles within the services. Workforce This includes the overspend of $24k attached to the outsourced HR-ER Consultant and the additional lieu adjustment of leave due to COVID.
There were 641.93 hours of annual leave taken. Currently there are 18 staff, with a leave balance of over 240 hours. This equates to a total of 1,238.37 hours above the benchmark of 240 hours. There was 94.50 sick leave hours in May. There was approved overtime of 149 hours in Payroll, this was due to additional processing required as a result of COVID and e-Timesheets.
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3. Strategic Initiatives / Health Services Planning No actions or deliverables have been set for this service.
4. Emergent Issues and Initiatives Identified Nothing of note to report this month.
5. Other Highlights From an organisational perspective, the following workforce indicators summarise the employee activity with regards to FTE and hours for May 2020.
Actual Budget Difference FTE – Month (Paid) 2,705 2,646 -59 FTE – Month (Accrued FTE) 2,931 2,646 -285 FTE – YTD (May 2019- May 2020) (Average) 2,627 2,646 19 Previous Month Current Month % of Total Hours Hours (April 2020) Hours (May 2020) (May 2020) Actual Hours – Productive1 424,340 536,461 89.4% Actual Hours - Annual leave 27,643 30,055 5.0% Actual Hours - Sick leave 10,341 12,683 2.1% Actual Hours – Training 1,507 2,271 0.40% Actual Hours - Other Leave 24,890 18,555 3.1% Actual Hours – Overtime 4,731 5,452 0.9% Actual cost – locums 503,479 478,734
Staffing Analysis Annual and Sick leave decreased in May against trend. This was due to COVID-19 and the lockdown imposed seeing numerous staff at home either working from home, in isolation or on standby.
1 Productive Hours – Ordinary Hours exclusive of Overtime and Call back
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Leave Balance Accrued > 240 hours
Total Leave Hours Accrued > 240 hours
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Staff turnover percentage
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The quarterly HWIP graphs for quarter ending March 2020.
NDHB Activity Summary for Quarter ending March 2020
Lost time Injury Rates
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Accrued Annual Leave % – NDHB benchmarked against other DHBs
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Average Leave Balances
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Māori Ethnicity %
Pacific Ethnicity %
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Overtime %
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Recruitment Time to Hire
Sick Leave %
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Turnover Voluntary Resignations %
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I&CS: Commercial Services
1. Overview Stable performance was maintained across Commercial Services during May while supporting a return to business as usual activity levels post-lockdown.
2. Scorecard
I&CS: Commercial Services Scorecard - Whangārei Hospital
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Food Complaints received 0 3 0 5
Cleaning Audits – results All 99 % 95 % 99 % 82 %
Safety and hospitals Quality Cleaning Complaints received 0 2 0 5
Laundry and Porter Staff Injuries 0 1 0 3
Number of Doctors Meals 2,104 14,897 (Whangārei Hospital) Medical Waste Volumes - Kilograms 6,900 10,070 75,900 85,855
(Kgs) Locally sourced produce 14% 19% Number of Patient Meals (All Sites) 27,000 22,954 297,000 283,101
Number of isolation cleans (excludes 54 594 Service laundry) Delivery Number of Meals on Wheels (All 290 631 3,190 6,609
Sites) Spotless Patient Satisfaction Survey 90 % 93 % 90 % 79 %
– All Hospital Patient Meals Spotless Patient Satisfaction Survey 90 % 93 % 90 % 83 %
– All Hospital Cleaning Laundry Washes (Wet Kg’s) - 82,000 74,710 902,000 969,840
Kilograms (Kgs)
FTE employed to budget 32.2 32.2 32.2 33.2
Percentage Sick Leave Taken 3.00 % 4.75 % 3.00 % 4.04 %
Total Employees in Excess of 240 0 9
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 6.6 % 11.0 % 9.4 %
Staff Turnover 0 1
Overtime Hours 212 1,646
Commentaries for Scorecard Emphasis is placed on refreshing all staff around the importance of early reporting of any potential risks or health and safety concerns or issues. Safety and Quality
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Capital planning in progress to support the following health and safety initiatives: Laundry ventilation and air-conditioning Secure fencing around laundry chemicals Strengthen loading dock floor Demarcation of lower ground floor unloading area Power tugs for the Porter service Mail cart
Focus is continuing with bringing the total staff numbers down for those who have excess annual Service leave hours. Delivery Push to have all staff current in compulsory L&D Training Moodles.
Locally sourced produce goal of 20% for May was not achieved. No data is available for March and April due to COVID – 19 . Eggs are purchased nationally now by supplier rather than by region at this point in time.
EOI for Laundry chemical supply has been issued. Currently evaluating supplier respondents. This will ensure we refresh supply opportunities and efficiencies within processing and supply of hospital linen. % of Locally Sourced Fresh Produce
29% 30% 27% 26% 25% 25% 24% 25% 23%
19% Workforce 20% 18% 18% 18% 16% 15% 14% 14% 14% 13% 15% 12% 12% 12% 11% 11%
10%
5%
0%
2018 2019 2020
3. Strategic Initiatives / Health Services Planning The National Laundry work group initiative will meet in June to report on progress of standardisation of hospital linen products and industry experience knowledge sharing.
Three-year plan is under development with a particular focus on planning for impact of the large capital projects, CMH, CCL & Theatres.
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4. Emergent Issues and Initiatives Identified Maintaining Commercial Services Risk Register. Quarterly updates occur.
Working with Health Source to analyse the current supply chain (from Southend Ave to the end user) for efficiency opportunities.
Spotless is leading the till swipecard project. This will improve accountability of doctors’ meals and enable better data collection.
5. Other Highlights Vibe Café Comments: staff feedback The new coffee machine makes coffee that taste like Bovril & milo in it – it is disgusting Current coffee is really awful. Like the old coffee, please change back. Fantastic staff & always friendly More vegan hot food please It would be nice if your cottage pie wasn’t overly seasoned with what taste like Moroccan flavours better if it tasted more like a cottage pie Previous coffee was fantastic, new coffee is really bad!!!! Please bring back the other one New coffee machine is not ok at all, please bring back the previous one The new coffee is absolutely undrinkable – bring back the previous coffee
These comments refer to the new coffee machine installed for free vend staff tea and coffee – the strength/taste profile has been tweaked three times to a more palatable taste
Food trolleys and potwash have been ordered and are in transit.
Refresh of food and cleaning recharge rates will take effect for FY2021. This will pass on recent contract increases to user services.
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I&CS: Facilities
1. Overview To provide a safe, clean, productive and well-maintained physical environment for the four Northland DHB hospitals, associated clinics and leased buildings.
2. Scorecard
I&CS: Facilities Scorecard - Whangārei Hospital
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Safety and Estate Services Staff Injuries 0 1 0 7
Quality
BEIMS – Requests Completed 90 % Not 90 % Not
available available Energy Consumption – All 900,000 838,905 9,900,000 8,013,435
Hospitals - Kilowatt (kWh) Natural Gas – Whangārei 570,000 551,836 6,270,000 6,305,307
Hospital - Gigajoules (GJ) Service Fuel Usage – All Vehicles (petrol 40,000 33,931 440,000 307,851 Delivery and diesel) - Litres (Ltrs) Completed Programmed 450 627 4,950 5,646
Maintenance Jobs for Clinical Engineering Outstanding Programmed 0 229 0 1,957
Maintenance Jobs for Clinical
Engineering
FTE employed to budget 46.0 45.7 46.0 43.4
Percentage Sick Leave Taken 3.00 % 6.51 % 3.00 % 3.86 %
Total Employees in Excess of 0 16
Workforce 240 hours Accrued Leave Percentage Annual Leave Taken 11.0 % 7.0 % 11.0 % 8.1 %
Staff Turnover 0 2
Overtime Hours 57 1,126
Commentaries for Scorecard One injury this month – fingers cut by grinder. Safety and Introduced online booking and remote induction process. Quality External H&S provider now available to support project team.
Facilities Management team still 70% COVID related work but returning to BAU.
Power and gas consumption at expected levels.
Vehicle fuels costs well below normal due to lockdown. Service Delivery Clinical Engineering continue to make progress into outstanding maintenance checks.
Security had 19 Code Oranges during May-20: Ward 3 = 1 Ward 16 = 2
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Ward 14 = 6 ED = 5 Carpark 16 = 1 Tumanako = 4
585 Interaction were recorded with staff, visitors and patients 690 other interactions with staff, patients and visitors.
Clinical engineering has a fix termed vacancy to cover parental leave.
Workforce Facilities management has a fix termed vacancy to cover parental leave.
New FTE tradesman employed in Dargaville.
3. Strategic Initiatives / Health Services Planning Work continues on development of a new parking strategy addressing patient, visitor and staff parking requirements. Options covering car-pooling, incentives to bike or use public transport, remote park and ride, shuttle services and building more parking areas are all being explored.
Work has commenced on sourcing a centralised fleet management and GPS solution for the DHB cars.
HealthSource has been tasked with initiating and procuring a panel of contractors able to be used on Northland DHB projects and day to day maintenance.
New online ID Card request process is being developed that will allow new and existing staff to upload photo and details to have new ID cards produced.
The security review is progressing well. The current security contract is to be extended to allow time to develop planning from the security review recommendations.
4. Emergent Issues and Initiatives Identified Three-year planning underway- Focus on an increase in planned maintenance activity.
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I&CS: Patient Transport & Accommodation
1. Overview Renal Transport and NTA continue to provide a high level of service through a period of change. Ambulance services are being actively managed to support improved communications and service delivery.
2. Scorecard
I&CS: Patient Transport & Accommodation Scorecard -
Measure Goal Month Month Month YTD YTD All Maori Non Goal
Maori
Safety and Patient Transport Staff Injuries 0 0 0 3
Quality
Number of Fixed Wing Flights 4 6 44 39
Number of Helicopter Flights 39 34 0 456
Number of patient transfers using 336 251 0 3,318
St John road Ambulance in and outside Northland (excluding private, hospice and ACC transfers) Average transport cost (excl GST) 1,497 1,958 17,962 19,474
per renal transport patient Service Delivery Total Cost (excl GST) of fixed 21,250 29,715 233,750 191,912
wing flights Total Cost (excl GST) of 125,000 150,876 1,375,000 2,431,050
Helicopter flights Total Cost (excl GST) of road 100,000 95,826 1,100,000 983,004
ambulance patient transfers Total cost of Renal transport 149,685 199,755 1,796,222 1,986,356
service (excl GST) Total cost of National Travel 205,000 220,417 2,255,000 2,422,285
Assistance to eligible NDHB
patients (excl GST)
FTE employed to budget 25.1 24.8 25.1 24.0
Percentage Sick Leave Taken 3.00 % 1.82 % 3.00 % 2.20 %
Total Employees in Excess of 240 0 6
Workforce hours Accrued Leave Percentage Annual Leave Taken 11.0 % 8.9 % 11.0 % 7.3 %
Staff Turnover 0 4
Overtime Hours 0 6
Commentaries for Scorecard New phone hardware for Renal Transport has been rolled out which enables a range of safety and efficiency improvements: Daily vehicle safety checks are now completed online and automatically sent to the Safety and Coordinator for review and action Quality Move to an online rostering tool which will streamline development of rosters, and improve notification of any changes. It is also compatible with Northland DHB electronic time-sheeting.
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Improved email communications with drivers who have previously had limited access to emails due to being on the road for a large part of their day.
Improved collaboration between St John and hospital sites to operationalise lessons learnt from incidents.
St John installing shields in vehicles between driver and rear cabin as a COVID infection management initiative.
Working with NEST to refine current protocols to better manage the increase in construction activity underway at Whangārei Hospital.
Investigating alternative transport options in Kaitaia as a contingency as it has traditionally been difficult to resource consistently in-house. St John (Patient Transfer Services) has now staffed all additional shifts. Service delivery has been more consistent with the additional resourcing in place however Kaitaia still remains the most challenging to consistently resource. Working actively with St John on solutions. Service Delivery St John is reverting to basic AED which is not suitable for cardiac transfers. Purchase of 2 x Lifepak 20e’s for Whangārei have been approved and a further 3 units have been requested for the rural hospitals.
New wheelchair vans have arrived. This provides for improved health and safety and a significant increase in patient comfort.
As of April 20 , all Renal drivers have now been paid out the back-pay from October 19.
The impact of COVID related leave is being felt in higher leave balances. We are actively working with staff to take this leave or buy out at their discretion. The Auckland Shuttle drivers also have high leave balances due to historical lack of cover options for this service. With the amalgamation Workforce with Renal Transport, there are now more options available to cover Auckland Shuttle drivers for leave. Longer term we will be seeking to train up another existing driver to supplement this further.
Noticeable improvement in morale in the Coordinator team after a focus on professional development and progression planning.
3. Strategic Initiatives / Health Services Planning Paramedic contract approved. Future opportunity to bring this function in-house by bolstering the ICU team staffing to better support the flight team function. To review leading into contract expiry in 2022.
Leading the setup of a national MoH lead coordination meeting for all DHBs. Seeking to collaborate and share with other DHBs to enable process improvements.
4. Emergent Issues and Initiatives Identified Reviewing options to improve resilience in the Coordinator team particularly as we head into the winter months. This may include training a head driver and/or training a temp into the more complex role. Difficulties particularly with covering across 6 days a week.
Auckland site visit provided useful insights into the quality and suitability of rooms, particularly from a patient perspective. Also highlighted the cost differentials between facilities and the opportunity to negotiate improved rates.
Scoping rostering options to manage SECA requirements around consecutive days off.
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Scorecard Definitions Measure Notes IP Events Coded for period Coding data is used to generate many of the indicators, - 68% including complications of care, Falls, Better help for smokers to Quit. While the denominator includes all events, only those coded as having one of the indicators will be included in the result. The coding pie should be used to understand how close the results are to being finalized. Results are being updated as new information becomes available. Service and Hospital The service is defined in two ways. Patient events whether they are Inpatient, Outpatient or Community events, belong to a Health Service such as Medical, Surgical, Paediatric etc. In this way any indicators that are patient related are grouped. Note that some services report specifically for a hospital. In this way you will find Surgical Discharges for Whangārei hospital reported in the Surgical Service and Surgical discharges for Kaitaia reported under the District hospitals service. Where the indicators are non-patient related, (for example indicators in the financial sustainability area), indicators are reported under the service that manages that area. In this way costs relating to ICU are reported under Medical for example Overview even though the Health Service of patients in ICU may be various. Timeliness of information The latest data available is reported. This means that some data may change after the report is released. Some results are updated daily and others may be quarterly. Performance Indicators Most measures have standard threshold tolerances for measuring performance and these are displayed below. Where tolerances differ from the standard, the light green and orange variances are displayed with the Measure description. Green always means achieved and red is always outside the orange indicator tolerance. Standard threshold tolerances Green indicates achieved or better than target
Light Green indicates within 2% variance from target Orange indicates between 2% and 10% variance from target Red means outside the orange indicator
tolerance
Cleaning Audits – results All hospitals NDHB complete monthly cleaning audits with spotless services. This shows the result of those audits Cleaning Complaints received Number of complaints received from patients for cleaning through the NDHB Safety & Quality complaints process Elective Day of Surgery Admission rate - Admissions where Surgery occurs on the day of DOSA admission are counted here. This excludes Day cases Safety and and counts Elective cases only Quality Estate Services Staff Injuries Number of staff injuries for NDHB estate services Falls with major harm within facility Falls are added to Datix there is major injury involved. The date of the fall and the 'Service Area' occurrence location code are used to determine if the fall Threshold Tolerance happened within the DHB facility. This count should be similar to the 'with injury' figures in the Incident Within 1.0% of target
Reporting system. Recent month figures may be Between 1.0% and 2.0% of target under-reported if coding is not complete.
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Food Complaints received Number of complaints received from patients for food through the NDHB Safety & Quality complaints process Hospital Acquired Pressure Injuries Pressure Injuries are counted using inpatient coding and the Health Round Table rules. Effective July 2013, hospital acquired pressure injuries are based on the Threshold Tolerance Condition Onset Flag. We exclude any patient whose primary diagnosis is a pressure injury and anyone that Within 1.0% of target
is a day case. Recent month figures may be under- Between 1.0% and 2.0% of target reported if coding is not complete
Laundry and Porter Staff Injuries Number of staff injuries for the NDHB Laundry and porter services Patients waiting in ED longer than 24 hours
Threshold Tolerance Within 1.0% of target
Between 1.0% and 2.0% of target
Reducing Acute Readmissions to A readmission is counted when any admission (the Hospital original admission) results in a subsequent acute admission to the same hospital within 28 days. This follows Health Round Table rules and counts readmissions regardless of relation to the original admission. The Original admission is only flagged for inclusion once 28 days have passed and the %
reflects that.
Improved Access to Elective Surgery – NDHB is required to deliver a certain number of (All NDHB) elective discharges. This includes all admitted patients including day cases for our population. The cases can be delivered in any hospital e.g. Auckland. Provisional percentage of patients Health Targets referred with high suspicion of cancer commencing treatment within 62 days Shorter Stays in Emergency Departments 95 percent of patients admitted, discharged, or (All NDHB) transferred from Whangārei or Kaitaia Emergency
Departments, do so within six hours.
% Exclusive Breastfeeding Rates at The breastfeeding counts exclude the following Hospital Discharge records: % Non-Urgent Patients Receiving a P2 Non Urgent Colonoscopies are required to be seen Colonoscopy within 42 days within 42 days of referral. % Overdue Surveillance colonoscopy Surveillance Colonoscopies are for patients at within twelve weeks increased risk of colorectal cancer. This may be due to a family history or patients who need to be monitored on a regular basis due to previous colorectal cancer or Service polyps found. They are required to have a Delivery colonoscopy which is determined by the NZGG (New Zealand Guidelines Group) guidelines for surveillance colonoscopies – in either a 1, 3 or 5 year time frame. % Urgent Colonoscopy within two weeks P1 Urgent Colonoscopies are required to be seen within 14 days of referral. Threshold Tolerance Within 5.0% of target
Between 5.0% and 10.0% of target
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Acute Caseweights to contract Caseweights can be used to measure the volume of actual activity against plan. A certain number of Elective Caseweights are planned to be delivered each year. Performance is managed to avoid under and over delivery. Acute Caseweights are managed in conjunction with population health needs and initiatives such as ‘better, sooner, more convenient”. Assessment and Rehabilitation Bed Days Counts total number of days in a hospital bed. Bed Utilisation for SCBU Bed Utilisation is based on the number of patients in a bed divided by the number of beds available. Bed Utilisation for Ward 2 Bed Utilisation is based on the number of patients in a bed divided by the number of beds available. BEIMS – Requests Completed Number of Building maintenance and new work requests completed by estate services in the month for all hospitals. Breast Screens Community Contacts Completed Programmed Maintenance Number of completed programmed maintenance jobs Jobs for Clinical Engineering on clinical equipment completed by clinical engineering Detox Bed Days - Dargaville Beds dedicated to the Detox service for Drug and Alcohol addiction. Drinking Water Activities Number of Drinking Water Activities Early Childcare Centres Information about Early Childcare Centres Elective Caseweights to contract Caseweights can be used to measure the volume of actual activity against plan. A certain number of Elective Caseweights are planned to be delivered each year. Performance is managed to avoid both under and over delivery. Elective Caseweights are managed in conjunction with waiting times and demand. Energy Consumption – All Hospitals - The energy consumption for all hospitals. Kilowatts Kilowatt (kWh) Environmental Health Activities Information about Environmental Health Activities Fuel Usage – All Vehicles (petrol and The total fuel (petrol and diesel) consumed for all diesel) - Litres (Ltrs) hospitals. Litres Improving waiting times for diagnostic Improving waiting times for diagnostic services – MRI services - CT % receiving CT scans and CT 85% of accepted referrals for CT scans, and within 6 weeks 75% of accepted referrals for MRI scans will receive their scan within than 6 weeks (42 days) Improving waiting times for diagnostic Improving waiting times for diagnostic services – MRI services - MRI % receiving MRI scans and CT 85% of accepted referrals for CT scans, and within 6 weeks 75% of accepted referrals for MRI scans will receive their scan within than 6 weeks (42 days) Inpatient Average Length of Stay (ALOS) The length of time between all admits and discharges (excludes Day Cases) averaged over all inpatient stays. The time is included in the calculation, to include part days. Inpatient Average Length of Stay (ALOS) The length of time between all admits and discharges Acute (excludes Day Cases) averaged over all acute inpatient stays. The time is included in the calculation, to include part days. Inpatient Average Length of Stay (ALOS) The length of time between all admits and discharges Elective (excludes Day Cases) averaged over all elective inpatient stays. The time is included in the calculation, to include part days. Inpatient Bed Days Counts total number of days in a hospital bed for all patients. Will give a similar result to total length of stay, but does not count part days.
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Inpatient Bed Days – Tumanako IPU Inpatient Contacts Inpatients with LOS > 21 days The number of patients who had a length of stay > 21 days. 21 days is considered by the Health Round table to be an indicator for stranded patients, i.e. those patients that stay in hospital longer than they need to. Laboratory Test Orders Laundry Issued Out - Kilograms (Kgs) Total dry kilograms of Laundry issued out in the month Laundry Re Washes - % of Total Laundry % of total laundry washes that had to be rewashed Washes due to not being clean enough. Laundry Washes (Wet Kgs) - Kilograms Total wet kilograms of Laundry washed in the month (Kgs) Level 4 attendances to Contract – Annual plans provide for a certain number of Admissions (includes ED 3 Hour) Emergency department attendances to occur. Whangārei Emergency department is a Level 4 Emergency department and Bay of Islands is level 2 and Kaitaia is level 3 Level 4 attendances to Contract – Annual plans provide for a certain number of Discharges Emergency department attendances to occur. Whangārei Emergency department is a Level 4 Emergency department and Bay of Islands is level 2 and Kaitaia is level 3 Medical Waste Volumes - Kilograms (Kgs) The kilograms of medical waste for all hospitals Mobile Ear Clinic Contacts (one month Number of individual children receiving assessment retrospective) and treatment at the 3 MEC Natural Gas – Whangārei Hospital - The natural gas consumption for all hospitals. Gigajoules (GJ) Gigajoules Number of Meals on Wheels (All Sites) Number of meals on wheels provided for all hospitals by Spotless services Number of Births in Whangārei Hospital Total number of births at Whangārei Hospital, includes caesarean and vaginal births. Number of Discharges from Post Natal Count of total number of patients discharged from Ward (Ward 11) hospital in a period. Does not count admissions still in hospital. Number of Discharges from SCBU Count of total number of patients discharged from hospital in a period. Does not count admissions still in hospital. Number of Discharges from Ward 2 Count of total number of patients discharged from hospital in a period. Does not count admissions still in hospital. Number of elective operation short notice cancellations - acute overload
Threshold Tolerance Within 3.0% of target
Between 3.0% and 5.0% of target
Number of Fixed Wing Flights in Number of Fixed Wing Flights in Northland (excluding Northland (excluding ACC) ACC)
Threshold Tolerance Within 3.0% of target
Between 3.0% and 5.0% of target
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Number of Fixed Wing Flights outside Number of Fixed Wing Flights outside Northland Northland (excluding ACC) (excluding ACC)
Threshold Tolerance Within 3.0% of target
Between 3.0% and 5.0% of target
Number of Helicopter Flights in Northland Number of Helicopter Flights in Northland (excluding (excluding ACC) ACC)
Threshold Tolerance Within 5.0% of target
Between 5.0% and 10.0% of target
Number of Helicopter Flights Outside Number of Helicopter Flights Outside Northland Northland (excluding ACC) (excluding ACC)
Threshold Tolerance Within 3.0% of target
Between 3.0% and 5.0% of target
Number of Oral Health treatment visits 0 - 12 year olds Number of Oral Health treatment visits 13 - 17 year olds Number of Oral Health treatment visits for low-income adults Number of Patient Meals (All Sites) Number of patient meals provided for all hospitals by Spotless services Number of patient transfers using St Number of patient transfers using St John road John road Ambulance in Northland Ambulance in Northland (excluding private, hospice (excluding private, hospice and ACC and ACC transfers) transfers)
Threshold Tolerance Within 5.0% of target
Between 5.0% and 10.0% of target
Number of patient transfers using St Number of patient transfers using St John road John road Ambulance outside Northland Ambulance outside Northland (excluding private, (excluding private, hospice and ACC hospice and ACC transfers) transfers)
Threshold Tolerance Within 3.0% of target
Between 3.0% and 5.0% of target
Number of renal patients transported by Number of renal patients transported by NDHB NDHB
Threshold Tolerance Within 5.0% of target
Between 5.0% and 10.0% of target
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Outpatient Contacts Outstanding Programmed Maintenance Number of outstanding programmed maintenance jobs Jobs for Clinical Engineering on clinical equipment completed by clinical engineering. Patients on the Surgical Booking List Those patients that have been on the Surgical waiting given a commitment to treatment but not list for more than 4 months. treated within four months Patients waiting longer than four months Those patients waiting for a First Specialist for their FSA appointment that have been waiting longer than 4 months. Percentage Attendance rate for all OP Appointments in District Hospitals Percentage Attendance rate for all OP Appointments in Whangārei Hospital Percentage Outpatient Bay of Islands Of all of the attendances of the people who live in the Domicile Attendances in BOI (Quarterly) Bay of Islands hospital area, how many attendances were carried out in the Bay of Islands hospital area. Percentage Outpatient Dargaville Of all of the attendances of the people who live in the Domicile Attendances in DRG (Quarterly) Dargaville hospital area, how many attendances were carried out in the Dargaville hospital area. Percentage Outpatient Kaitaia domicile Of all of the attendances of the people who live in the attendances in KTA (Quarterly) Kaitaia hospital area, how many attendances were carried out in the Kaitaia hospital area. Percentage proportion of Triage patients seen within the recommended time for their category Port Health Information about Port Health Prevention of Alcohol Related Harm Information about Prevention of Alcohol Related Harm Public Health Nurse Contacts Number of 0-18 year olds and their whanau who receive an assessment, treatment, education, communicable disease follow-up or clinic visit from a PHN. Retinal Screens Sexual Health Contacts Number of clients who attend sexual health clinics for assessment, education or treatment Spotless Patient Satisfaction Survey – All Spotless services complete random patient feedback Hospital Cleaning surveys every month at each hospital for cleaning. This shows the result of those surveys Spotless Patient Satisfaction Survey – All Spotless services complete random patient feedback Hospital Patient Meals surveys every month at each hospital for meals. This shows the result of those surveys Sub Acute Bed Days (Kaitaia, Kaikohe, Comprehensive goal-oriented inpatient care designed Whangārei) for a patient who has had an acute illness. It is rendered either immediately after or instead of acute care hospitalization, to treat specific active or complex mental health conditions in the context of the person's underlying long-term condition. Theatre cancellations by Hospital Counts planned theatre procedures cancelled by the hospital. Reasons for cancellation include; Patient unfit; Equipment failure; lack of time etc. Tobacco Control Information about Tobacco Control
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Total Cost (excl GST) of fixed wing flights Total Cost (excl GST) of fixed wing flights
Threshold Tolerance Within 5.0% of target
Between 5.0% and 10.0% of target
Total Cost (excl GST) of Helicopter flights Total Cost (excl GST) of Helicopter flights
Threshold Tolerance Within 5.0% of target
Between 5.0% and 10.0% of target
Total Cost (excl GST) of road ambulance Total Cost (excl GST) of road ambulance patient patient transfers transfers
Threshold Tolerance Within 5.0% of target
Between 5.0% and 10.0% of target
Total cost of National Travel Assistance Total cost of National Travel Assistance to eligible
to eligible NDHB patients (excl GST) NDHB patients (excl GST)
Threshold Tolerance Within 5.0% of target
Between 5.0% and 10.0% of target
Total cost of Renal transport service (excl Total cost of Renal transport service (excl GST) GST)
Threshold Tolerance Within 5.0% of target
Between 5.0% and 10.0% of target
Total KM’s travelled by renal transport Total KM’s travelled by renal transport drivers drivers
Threshold Tolerance Within 5.0% of target
Between 5.0% and 10.0% of target
Ambulatory sensitive (avoidable) hospital Counts those admissions that may be able to be better admissions by weighted value. treated in the community. Patients who need services that can be provided in community settings receive them there rather than at hospitals. Population Newborn Hearing Screening Rates (3 Percentage of all new born babies who receive their Health Status Months Retrospective) new born hearing screen within 3 months of birth. Includes total eligible population not just consented population Number of children treated for dental conditions under GA
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Number of Family Violence Positive Number of people who disclose to staff following Disclosures routine screening that they have suffered family violence in its many forms Number of presentations to ED due to dental conditions Number of Reports of Concern to Child Number of reports of concern from NDHB staff to Child Youth and Family Youth and Family e.g. concern of physical, sexual,
emotional abuse, neglect, family violence.
YTD Variance to net Result ($000) % variance of Actual Net Result (Revenue less Expenditure) to Plan YTD variance to Net Result – Patient YTD variance to Net Result – Patient Transport Transport Positive /(Adverse) Positive /(Adverse)
Threshold Tolerance Within 5.0% of target
Financial Sustainability Between 5.0% and 10.0% of target
YTD Variance to Savings plan ($000) This is the total savings determined for each service, by financial year, and incurred YTD against annual budget. Total savings will vary for each service. The target objective is for each service to align its actual costs to the savings objective on a monthly basis concluding with the achievement of the total savings
plan at financial year end.
FTE employed to budget Measures the number of staff by converting the paid ordinary hours of full time, part-time and casual staff into FTEs. The conversion is assumed on the standard paid ordinary hours of 40hours per week for all groups. All ordinary hours worked over 40 i.e. overtime, call hours and extra paid hours are excluded. The maximum worked FTE for an employee is 1 FTE. All annual, sick and other paid leave types are included, with the exception of annual leave paid out on termination. Percentage Annual Leave Taken Annual Leave taken as a percentage of Total Hours. This is calculated using the following formula: annual Engaged leave hours * 100 / base hours. The benchmark for Workforce this across all services is between 11%, anything under should be flagged as amber or red depending on the variance Percentage Sick Leave Taken Sick Leave taken as a percentage of Total Hours. This is calculated using the following formula: sick leave hours * 100 / base hours. The benchmark for this across all services is between 0% to 3%, anything over the 3% should be flagged as red Total Employees in Excess of 240 hours This is the total headcount of employees that have Accrued Leave accrued leave > 240 hours. Any service operating with zero or minimal headcount over 240 hours is in the clear. We will need to determine the levels of
clearance for this.
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Briefing Paper to Equity in Hospitals Committee
Reporting Metrics to Equity in Hospitals Committee
30 June 2020
Prepared by: Neil Beney, GM Directorate of Medical & Elder Services
Endorsed by: Dr Nick Chamberlain, Chief Executive
Recommendation That the Committee notes the attached information.
Background The attached information has been collated for the purpose of prompting discussion on potential reports to The Equity in Hospitals Committee.
Briefing Paper to Board - Reporting Metrics to Equity in Hospitals Committee | Page 1 of 1
76 PUCDescription Maori NonMaori Grand Total% Maori ATR Inpatient 19 104 123 15% % Maori - Shown for Purchase Units with 100 or more admissions Rheumatology - Subsequent Attendance 49 250 299 16% Nurse Led Outpatient Clinics - Rheumatology 36 164 200 18% Renal Medicine - Incentre dialysis ATR Outpatient – Clinics 34 153 187 18% Automated Peritoneal Dialysis (APD) Service Coordination 65+ 372 1673 2045 18% Renal Medicine - Recurrent home based Haemodialysi General Medicine - Subsequent Attendance 90 402 492 18% Kaitaia ED - Discharged Community Services - stomal service 1346 5552 6898 20% Renal - Acute (DRGs) Pre-renal Replacement Therapy Programme Needs Assessment 173 681 854 20% Bay of Islands ED - Discharged Cardiac Education and Management 107 394 501 21% Renal Medicine - Subsequent Attendance Gastroenterology - Subsequent Attendance 94 335 429 22% Kaitaia ED - Admitted + 3 Hour Admission Community Services - continence service 4304 15108 19412 22% Renal Medicine - Recurrent home based CAPD Rheumatology - 1st Attendance 44 149 193 23% Diabetes Education and Management Respiratory - Subsequent Attendance 84 281 365 23% Social Work Physiotherapy 841 2613 3454 24% Obstructive sleep apnoea long term supply & suppor Dietetics 110 341 451 24% Sleep apnoea - assessment Gastroenterology - 1st Attendance 39 120 159 25% Diabetes - Fundus Screening Respiratory Education and Management 64 187 251 25% Bay of Islands ED - Admitted + 3 Hour Admission Nurse Led Outpatient Clinics - Cardiology 83 217 300 28% Podiatry Medical Non Contact FSA - Any health specialty 270 690 960 28% Nurse Led Outpatient Clinics - Renal Whangarei ED - Discharged Occupational Therapy 330 840 1170 28% Diabetes - 1st Attendance Cardiology - 1st attendance 239 605 844 28% Emergency Medical - Acute (DRGs) Medical Non Contact Follow Up - Any health spec 204 484 688 30% Diabetes - Subsequent Attendance Respiratory - 1st Attendance 54 127 181 30% Whangarei ED - Admitted + 3 Hour Admission Cardiology - Subsequent Attendance 283 653 936 30% General Medicine - 1st attendance General Medical - Acute (DRGs) 1609 3694 5303 30% ATR Outpatient – domiciliary assessments & educati Speech Therapy 107 241 348 31% Speech Therapy ATR Outpatient – domiciliary assessments & education 259 569 828 31% General Medical - Acute (DRGs) General Medicine - 1st attendance 168 369 537 31% Cardiology - Subsequent Attendance Whangarei ED - Admitted + 3 Hour Admission 2554 5479 8033 32% Respiratory - 1st Attendance Diabetes - Subsequent Attendance 91 179 270 34% Medical Non Contact Follow Up - Any health spec Emergency Medical - Acute (DRGs) 1123 2108 3231 35% Cardiology - 1st attendance Occupational Therapy Diabetes - 1st Attendance 47 84 131 36% Medical Non Contact FSA - Any health specialty Whangarei ED - Discharged 3122 5017 8139 38% Nurse Led Outpatient Clinics - Cardiology Nurse Led Outpatient Clinics - Renal 163 256 419 39% Respiratory Education and Management Podiatry 162 250 412 39% Gastroenterology - 1st Attendance Bay of Islands ED - Admitted + 3 Hour Admission 490 716 1206 41% Dietetics Diabetes - Fundus Screening 589 851 1440 41% Physiotherapy Sleep apnoea - assessment 44 61 105 42% Respiratory - Subsequent Attendance Obstructive sleep apnoea long term supply & support 255 345 600 43% Rheumatology - 1st Attendance Social Work 137 167 304 45% Community Services - continence service Diabetes Education and Management 2932 3423 6355 46% Gastroenterology - Subsequent Attendance Renal Medicine - Recurrent home based CAPD 969 1104 2073 47% Cardiac Education and Management Kaitaia ED - Admitted + 3 Hour Admission 464 517 981 47% Needs Assessment Community Services - stomal service Renal Medicine - Subsequent Attendance 401 446 847 47% General Medicine - Subsequent Attendance Bay of Islands ED - Discharged 865 875 1740 50% Service Coordination 65+ Pre-renal Replacement Therapy Programme 288 244 532 54% ATR Outpatient – Clinics Renal - Acute (DRGs) 92 75 167 55% Nurse Led Outpatient Clinics - Rheumatology Kaitaia ED - Discharged 807 601 1408 57% Rheumatology - Subsequent Attendance Renal Medicine - Recurrent home based Haemodialysis 755 396 1151 66% ATR Inpatient Automated Peritoneal Dialysis (APD) 3455 1466 4921 70% 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 Renal Medicine - Incentre dialysis 6825 2058 8883 77%
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Briefing Paper to Equity in Hospitals Committee
National Asset Management Programme June 2020
Recommendation
That the Equity in Hospitals Committee: Note this summary of the attached National Asset Management Programme current-state assessment. Note that this initiative is generally positive for Northland DHB and that it will inform the development of our asset management plan.
Report Summary
On 10 June 2020, the Ministry of Health published a current-state assessment of the health asset portfolio as part of the National Asset Management Programme (NAMP). The Ministry’s intention is that this assessment will inform a full National Asset Management Plan that sets out different investment scenarios, which they aim to complete by 2022. The aim of the programme is to “inform the capital investment plans to enable effective service delivery and improve health outcomes” (p16). This includes: providing information to support planning and decision-making about capital allocations by DHBs, the Ministry of Health, CIC, Treasury and other stakeholders supporting DHBs to improve their asset management supporting the development of plans and guidelines for asset assessment, facility standards, models of care and other factors.
The report is an initial assessment of the current state of DHB-owned health assets, which the Ministry intends to develop further over time. It includes an assessment of the condition of DHB buildings and infrastructure, their fitness for purpose and the suitability of core IT applications. Clinical equipment will be included in future NAMP reports but is not covered in this report. The condition assessment covers over 1000 DHB buildings and includes independent expert assessments of 166 buildings at main hospital campuses and DHB self-assessments of the remaining buildings. To date, the clinical fitness for purpose assessment has only covered a sample of spaces within these buildings. For example, Northland’s assessment only included five areas at Whangarei Hospital (ED, ICU, theatres, paediatrics and AT&R). In IT, the assessment included Northland DHB’s financial management, patient management and clinical support systems. The condition survey found the buildings were in average to good condition, though the methodology involved taking mean scores across different building components and some of the average buildings had very poor components. The clinical fitness for purpose assessment found that most spaces were too small compared with Australasian Health Facility Guidelines and not fit for purpose, particularly spaces in older hospital buildings. The report concludes that asset management is a weakness for the health sector as a whole. It notes that there seems to be a lot of deferred maintenance for health assets, as expenditure is often prioritised for operational rather than capital requirements. Three buildings at Whangarei Hospital were among the 24 buildings assessed as being in poor condition: the surgical wing, the child health building by Tohora House and Te Roopu Kimiora. The overall average condition scores for Whangarei Hospital buildings and infrastructure were generally good. In terms of the clinical fitness for purpose scores, ICU and inpatients were found to be poor and ED and theatres were average. In IT, our financial management system scored poorly while the patient administration and clinical support systems scored well.
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78 Implication for Northland DHB
Overall, the NAMP initiative is positive for Northland DHB and the management of our assets. It will provide greater transparency and an evidence base for future health capital envelope funding allocations. In the current environment where allocation decisions are made annually, the uncertainty about future funding creates significant difficulties in planning for how we will manage our assets, particularly at Whangarei Hospital. For example, the uncertainty about whether and when the Whangarei Hospital redevelopment will proceed has forced us to use previous Crown funding allocations to address urgent issues in facilities that are likely to be decommissioned or replaced as part of the redevelopment. If ministers approve the Whangarei Hospital redevelopment, the $10m theatre extension currently in construction would be in use for less than seven years before a new, modern operating theatre suite is available in the proposed acute services building. Greater certainty about future funding would have enabled us to make better value for money decisions by providing a better understanding of the benefits we get from any investments. The NAMP is also welcome in that it will provide guidance for the development of our asset management plan, particularly the level of service measures. The Ministry’s Health Infrastructure Unit is likely to have greater focus on this as part of the NAMP work and it is an important part of the investor confidence rating assessment, which we may be asked to resume as part of the Whangarei Hospital redevelopment. Infrastructure and Commercial Services is currently updating the asset management plan and we expect to begin to circulate it for review and approval by September. While we have previously produced asset management plans, the current version of the document dates from 2016 and have not been proactive with asset management planning. We have generally adopted a run to failure policy and the updated plan will seek to amend our practices and get agreement on the associated funding implications. Some aspects of the NAMP assessment do not fully reflect the condition and fitness for purpose issues with Northland DHB’s property and we consider the condition of Whangarei Hospital is worse than indicated in the report. We provided feedback on the draft report, but few of the changes were incorporated into the final version. For example, the theatres at Whangarei Hospital score well from a facility size perspective because they are recorded as being 117 percent of the Australasian Health Facility Guidelines (AHFG) overall, but the internal space is poorly configured and the theatre suites and central sterilising unit are below AHFG. In addition the report did not take into account the surgical wing’s passive fire and seismic resilience issues. However, the NAMP assessment provides a good starting point for discussing these issues with the Ministry in the context of any future business cases.
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79 NORTHLAND DISTRICT HEALTH BOARD
GLOSSARY OF ACRONYMS January 2020
Acronym Meaning
A&D Alcohol and Drug A&E Accident and Emergency Department A&M Accident & Medical Centre AAU Acute Assessment Unit (part of child health services) ACMO Associate CMO ACP Advanced Care Planning A&C Audit & Compliance ACA Access Criteria for First Assessment ACC Accident Compensation Corporation ADON Assistant Director of Nursing ADHD Attention Deficit and Hyperactivity Disorder ALOS Average Length Of Stay AMI Acute Myocardial Infarction AOD Alcohol and Other Drugs AoG All of Government AP Annual Plan AR Active Review ARRC Age Related Residential Care ARC Aged Residential Care ASH Rates Ambulatory Sensitive Hospitalisation Rates ASMS Association of Salaried Medical Specialists BAU Business As Usual BOI Bay of Islands BSC Balanced Scorecard BSI Blood Stream Infections CABG Coronary Artery Bypass Graft CAPD Chronic Ambulatory Peritoneal Dialysis CATT Crisis Assessment Treatment Team CBA Cost Benefit Analysis CCP Contribution to Cost Pressures CCU Coronary Care Unit CEA Collective Employment Agreement CEO Chief Executive Officer CFA Crown Funding Agreement CGB Clinical Governance Board CHC Child Health Centre CHS Community Health Services CIPP Community Injury Prevention Programme CMO Chief Medical Officer CME Continuing Medical Education COPD Chronic Obstructive Pulmonary Disease CPAC Clinical Priority Assessment Criteria CPSOG Clinical Pharmacy Services Operational Group CPHAC Community and Public Health Advisory Committee CPR Cardio pulmonary resuscitation CSC Community Services Card CSU Central Sterilising Unit CT Computerised Tomography CVD Cardiovascular Disease
80 Acronym Meaning
CWD Caseweighted Discharge DAO Duly Authorised Officer DHB District Health Board DHBSS District Health Board Shared Services DIAS Disability Information Advisory Service DiSAC Disability Support Advisory Committee DN District Nurse DNA Did not attend DONM Director of Nursing and Midwifery DRG Diagnostic Related Group DSAC Doctors for Sexual Abuse Care DSS Disability Support Services EAP Employee Assistance Programme ECG Electrocardiogram ED Emergency Department EENT Eyes, Ears, Nose and Throat EEO Equal Employment Opportunity ELT Executive Leadership Team ENT Ear Nose and Throat EOI Expressions of Interest ERA Employment Relations Act ESS Elective Services Statistics ESPI Elective Services Performance Indicators; includes how well DHBs are managing waiting times for patients, and whether they are following processes that support good patient communication and prioritisation. FAQ Frequently Asked Questions FBT Fringe Benefit Tax FFT Future Funding Track FRAC Finance, Risk and Assurance Committee FRS Financial Reporting Standard FSA First Specialist Assessment FST Financial Sustainable Threshold FTE Full time equivalent GETS Government Electronic Tender Service GDB General Dental Benefit GM General Manager GMS General Medical Services Benefit GSE Government Special Education hA healthAlliance HAC Hospital Advisory Committee HBSS Home Based Support Services HDC Health and Disability Commissioner HRT Health Round Table HHC Home Health Care HIN Health Information Network HNA Health Needs Analysis HOD Head of Department HOP Health of Older People HPO Health Protection Officer HPV Human Papillomavirus HQSC Health Quality & Safety Commission HWNZ Health Workforce New Zealand IANZ International Accreditation New Zealand IAT Income and Asset Testing ICU Intensive Care Unit ICT Intensive Care Team (Mental Health)
81 Acronym Meaning
IDF Inter District Flows IEA Individual Employment Agreement IFHC Integrated Family Health Centre IIA Income in Advance InterRAI International Research and Assessment Instruments IR Industrial Relations IS Information Systems / Information Services ISSP Information Systems Strategic Planning IT Information Technology JV Joint Venture KPI Key Performance Indicator LMC Lead Maternity Carer LOS Length of stay LTC Long Term Conditions MDO Maori Development Organisations MECA Multi Employer Collective Agreement MERAS Midwifery Employee Representation & Advisory Services MF (score) Missing Filled (score) (dental services) MHGC Maori Health Gains Council MHIPU Mental Health Inpatient Unit MI Myocardial infarction MIF Monitoring and Intervention Framework MMR Measles-mumps-rubella MoH Ministry of Health MOH Medical Officer of Health MOSS Medical Officer Special Scale MOU Memorandum of Understanding MPDS Maori Provider Development Scheme MRI Magnetic Resonance Imaging MRT Medical Radiation Technologist MSD Ministry of Social Development MVS Meningococcal Vaccine Strategy NCIC National Capital Investment Committee NASC Needs Assessment and Service Co-ordination NDHB Northland District Health Board NEST Northland Emergency Services Trust NGO Non-Government Organisation NHB National Health Board NHH Neighbourhood Healthcare Homes NHI National Health Index NHSP Northland Health Services Plan NHSS National Health Supply Service NIF Northland Intersectoral Forum NIR National Immunisation Register NRA Northern Region Alliance (formerly NDSA Northern DHB Support Agency) NRHP Northern Region Health Plan NRTH Northern Regional Training Hub NTA National Travel Assistance NZBS New Zealand Blood Service NZCOM New Zealand College of Midwives NZHS New Zealand Health Strategy NZHPL New Zealand Health Partnerships Ltd NZMC New Zealand Medical Council NZNO New Zealand Nurses’ Organisation O&G Obstetrics and Gynaecology
82 Acronym Meaning
OIA Official Information Act OMG Operational Management Group OP Outpatient ORL Otorhinolaryngology (=ENT) OSH Occupational Safety and Health OT Occupational Therapy (sometimes also Operating Theatre) PACU Post Anaesthetic Care Unit PBFF Population Based Funding Formula PCO Primary Care Organisation PDRP Professional Development Recognition Programme PGY Post Graduate Year PHO Primary Health Organisation PHN Public Health Nurse PHU Public Health Unit PIPP Planning, Integration, People and Performance PN Practice Nurse POPN Primary Options Programme Northland PQ Parliamentary Questions PSA Public Service Association PSAAP PHO Service Agreement Amendment Protocol PS&QID Patient Safety & Quality Improvement Directorate PUC Purchase Unit Cost RBA Results Based Accountability RDA Resident Doctors’ Association RFF Regional Funding Forum RFP Request for Proposal RG Referral Guidelines RICF Reducing Inequalities Contingency Funding RMO Resident Medical Officer RWL Residual Waiting List SAT Self Assessment Tool SAU Surgical Admission Unit SBL Surgical Booking List SCBU Special Care Baby Unit SCOPE Service Coordination – Primary Care Navigation for Older People in their Environment SDS School Dental Service SHO Senior House Officer SIA Service to Improve Access SLT Speech Language Therapy SMO Senior Medical Officer SOI Statement of Intent SPNIA Service Planning and New Intervention Assessment SSSG Shared Support Services Group STAH Scientific Technical & Allied Health STV Single Transferable Voting SUDI Sudden Unexplained Death in Infancy TAS Technical Advisory Services TLA Territorial Local Authorities TOR Terms of Reference TOW Treaty of Waitangi TPK Te Puni Kokiri TPOT The Productive Operating Theatre TROTR Te Runanga O Te Rarawa VCLA Very Low Cost Access WERO Whanau End smoking Regional whanau Ora Challenge
83 Acronym Meaning
WHO World Health Organisation WIIE Whanau Integration Innovation & Engagement Fund WOC Whanau Ora Collective YTD Year-to-date
Any additions/amendments, please contact Julie Shepherd, [email protected], Extn 60308, 021 945 647
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