------. ------:-~---. -- - \\l'l'li~) Ill . ■ • • 1-11:AITH ,..j, _ I • _. I
133 Molesworth Strt"l.'t PO Box5013 Wellington 6140 New Zealand T +64 4 496 2000
21 December 2020
By email: Ref: H202007923
Dear
Response to your request for official information
Thank you for your request under the Official Information Act 1982 (the Act) on 27 October 2020 for:
"The number of safe sleep devices (incl. wahakura and pepi-pods) provided through DHBs to members of the public each calendar or financial year (whatever is easiest/available) for 2016-2020, including the most recent available figures for this year The number of a) SUD/ and b) SIDS deaths in each calendar or financial year since 2016-2020, including the most recent available figures for this year How much money has been spent each year on SSDs/ SUD/ prevention of the $5. 1m annual allocation Any reports, aide memoires, documents and/or briefings sent to the Minister of Health around SUD/ and/or Safe sleeping devices in 2018, 2019 or this year"
The National Sudden Unexpected Death in Infancy (SUDI) Prevention Programme (NSPP) officially began on 1 October 2017 with the first nine-months being a set up phase to introduce Safe Sleep Guidelines, local district health board (DHB) plans, regional coordinators, Wahakura Wananga set up and programme implementation across Aotearoa.
Addressing inequities in SUDI is a key focus for the Ministry of Health (the Ministry). Through the NSPP, the Ministry is working with the sector to reduce the overall SUDI rate to 0.1 in every 1,000 live births (an 86 percent reduction overall, and a 94 percent reduction for Maori) by 2025. This goal is being implemented by addressing the key modifiable risk factors for SUDI, such as bed sharing and smoking during pregnancy.
The Ministry is undertaking an evaluation of the SUD! Prevention programme in 2020/21. Work is also underway with the sector to redesign current services that will help reduce SUDI and deliver better integrated services with a greater focus on workforce development, including the number of proficient wahakura weavers.
Documents within the scope of this request have been itemised in Appendix One of this letter, and copies of the documents are enclosed. Table One in Appendix One outtines the grounds under which information is withheld. Where information is withheld, this is noted in the document itself. Please refer to Table One overleaf for information on the number of Safe Sleep Beds (SSBs) distributed, and funding per financial year between 2016 and the 2020/2021 financial year.
T abl e O ne: In f ormaf 10n on SUDI prevenf 10n Year Safe Sleep Beds (SSB) distritruted Funding (GST exclusive)
- 1 July 2016 to 30 N/A $919,682 August 2017
1 October 2017 to N/A $3,849,223 30 June 2018 1 July 2018 to 30 5193 (2219 Wahakura/2261 Pepi $4,237,297 June 2019 Pod/other) 1 July 2019 to 30 8189 (2054 Wahakura/6135 Pepi $4,237,297 June 2020 Pod/other)
1 July 2020 to 30 8447 to be distributed $4,692,297 June 2021
The Ministry is able to provide SUDI and Sudden Infant Death Syndrome (SIDS) number of deaths by calendar year. The most recent year of mortality data currently available is for 2017. There were 23 SIDS deaths recorded in the 2016 calendar year and 28 in the 2017 calendar year. SUDI deaths recorded were 42 for 2016 and 48 for 2017. Please note that these two categories overlap, and a single death may be counted in both. Provisional SUDI rates are provided in the documents identified in Appendix One, however, please note that these figures are provisional and as such are subject to change as Coroners give their findings on specific cases following post-mortem and investigation.
I trust this information fulfils your request. Under section 28(3) of the Act you have the right to ask the Ombudsman to review any decisions made under this request.
Please note that this response, with your personal details removed, may be published on the Ministry website.
Yours sincerely
Deborah Woodley Deputy Director-General Population Health and Prevention
Page2 of 4 Appendix 1: List of documents for release
# Date Title Decision on release 1 2016 Fetal and Infant Deaths Available at: 2016 httgs://www. hea Ith. govt. nz/Qublication/fetal- and-infant-deaths-2016
2 1 March Health Report 20180356: Released with some information withheld 2018 Meeting with Hapai te pursuant to section 9(2)(a) of the Act to protect Hauora the privacy of natural persons
3 2019 National SUDI Prevention Available at: Programme: Needs bt1~s://www.hea1th.govt.nzJQublication/national- Assessment and Care sudi-12revention-12rogramme-needs- Planning Guide assessment-and-care-[llanning-guide
4 2019 National SUDI Prevention Available at: Programme: National Safe htt2s://www.health.govt.nz/Qublication/national- Sleep Device Quality sudi-~revention-12rogramme-national-safe- Specification Guidelines sleeg-device-gualitt-sQecification-guidelines
5 22 July Health Report 20191349: Released with some information withheld 2019 Meeting to discuss pursuant to the following sections of the Act: potential ways to help • Section 9(2)(a) to protect the privacy of increase the provision of natural persons wahakura in Aotearoa • Section 9(2)(f)(iv) to maintain the constitutional conventions for the time being which protect the confidentiality of advice tendered by Ministers of the Crown and officials
6 20 August District Health Board Safe Released with some information withheld 2019 Sleep Device Reporting pursuant to section 9(2)(a) of the Act to protect (Quarter 3) the privacy of natural persons
7 11 February Health Report 202000172: Released with some information withheld 2020 Meeting to discuss the pursuant to section 9(2)(a) of the Act to protect National Sudden the privacy of natural persons Unexplained Death in Infancy Prevention Programme
Page 3 of 4 D .. # D aet T"tlI e ecIs1on on re ease J 8 26 June Weekly Report Item: 1.1 Released with some information withheld 2020 Sudden Unexpected pursuant to section 9(2)(a) of the Act to protect Death in Infancy: quarterly the privacy of natural persons update
9 7 August Health Report 20201370: Released with some information withheld 2020 National Sudden pursuant to section 9(2)(a) of the Act to protect Unexpected Death in the privacy of natural persons Infants (SUDI) Prevention Programme - progress for - Maori - - 10 October Weekly Report Item: Released with some information withheld 2020 Sudden Unexpected pursuant to section 9(2)(a) of the Act to protect Death in Infancy (SUDI): the privacy of natural persons End of Year update (July 2019 to June 2020) Please note 8447 has been incorrectly applied as the final SSB distribution number, when this is the total of all SSBs to be distributed. A total of 8189 SSBs were distributed, a 96% national distribution achievement rate.
Page4 of 4 MINISTRY OF HEALTH
MA!'-I ATti HAUORA Health Report number: 20180356
Security classification: In-Confidence Quill record number: H201800757 ~ ~ ~ File number: AD62- 14-2018 ~ ~ pr.f,on required by: 10am Friday 2 ~1arch Meeting with Hapai te Hauora 1•-vc:. v u ~ - MA~ 2018 To: Hon Jenny Salesa, Associate Minister of Health DUE: ...... Copy to: Hon Dr David Clark, Minister of Health MINISTRY OF HEALTH
Purpose This briefing provides you with information for your meeting with Lance Norman, CEO, Hapai te Hauora (Hapai) on 6 March 2018 from 10.30am to 11.30am, 6-8 Pioneer Street, Henderson, Auckland.
This briefing also provides a letter for you to sign and send to Hapai in advance of your meeting.
Key points • You are meeting with Lance Norman CEO of Hapai to discuss Maori health, health inequities and housing. • Discussion points for this meeting are included in this briefing. • Hapai have written to you advising of a demonstration project in Kelston that will be taking place on World Smokefree Day, 31 May 2018. A draft response is attached for your signature.
Recommendations
The Ministry recommends that you: a) sign and send the attached letter to Hapai te Hauora by 10am Friday 2 March Yes/No b) note the information contained in this briefing
Caroline lora Minister's signature: Group Manager Population Outcomes StrategyReleased and Policy under the OfficialDate: Information Act 1982
Contacts: Caroline Flora , Group Manager, Population Outcomes, Strategy and s 9(2)(a) Policy Anne O'Brien, Manager, Maori Health Policy, Strategy and Policy s 9(2)(a)
Paae 1 of 10 MINISTRY OF HEALTH
MANAT(J HAUORA Health Report number: 20180356 Meeting with Hapai te Hauora 1. You are meeting with Lance Norman, CEO of Hapai, to discuss Maori health, inequities and housing. This meeting will take place at the office of Hapai (6-8 Pioneer Street, Henderson, Auckland) on 6 March 2018 from 10.30am to 11.30am. 2. Hapai is a regional Maori public health provider providing services within Auckland, the wider Auckland region, and nationally. 3. Hapai was established in December 1996 following the signing of a tripartite Memorandum of Understanding between Te R0nanga o Ngati Whatua, Raukura Hauora o Tainui, and Te Whanau o Waipareira. Hapai is owned and governed by these three organisations. 4. Hapai is currently contracted by the Ministry of Health for four national services: • National Tobacco Control Advocacy Service • Minimising Gambling Harm National Coordination Service • Minimising Gambling Harm Public Health Workforce Development Service • National Sudden Unexpected Death in Infants (SUDI) Prevention Coordination Service - most recently awarded contract, further information is provided in the discussion points below. 5. In addition to providing both regional and national services, Hapai has a Research and Evaluation team that specialises in innovative social and health research and evaluation. 6. Additional information on Hapai and the four national service contracts that it holds is attached at Appendix One. 7. Hapai has written to you about a demonstration project that will be taking place in Kelston on World Smokefree Day, 31 May 2018. A draft response has been prepared for your signature and is attached at Appendix Two. 8. Hapai have suggested that your meeting cover the following discussion topics: • Maori health • inequities • housing.
Discussion Points
Maori health and health inequities 9. You may wish to reinforce the government's commitment to achieving equity, including that improving Maori health outcomes remains a priority for the Ministry and the whole of the health sector. 10. There have been gains in achieving equity of health outcomes for Maori in immunisation rates and enrolment in community oral health services. However, there is still significant gaps in health Releasedoutcomes between Maoriunder and other the New ZealandersOfficial in almost Information all significant health Act conditions 1982. 11. He Korowai Oranga, the Ministry's Maori Health Strategy, sits alongside and supports the New Zealand Health Strategy. The strategy is premised on the Crown-Maori Treaty relationship and articulates a vision of pae ora - Healthy Futures, supported by the following elements: wai ora - healthy environments; whanau ora - healthy families; and mauri ora - healthy individuals. 12. Responding to He Korowai Oranga is the responsibility of the whole of the health and disability sector. In so far as health determinants extend beyond the health system, it also has relevance for other sectors, including your portfolio responsibilities as Minister for Building and Construction and Associate Minister for Housing and Urban Development.
Page 2 of 10 MINISTRY OF HEALTH
MANAT0 HAUORA Health Report number: 20180356 14. You may wish to ask Lance Norman about the Hapai Research and Evaluation team's current projects.
Housing 15. Housing is a key determinant of health. Issues such as overcrowding and poor housing quality are linked to ambulatory sensitive hospitalisations (ASH) and rheumatic fever, both conditions where Maori are disproportionately represented. 16. The key issues for Maori housing include that: • Maori make up 36 percent of public housing tenants • Maori make up 30 percent of those receiving accommodation supplement • almost a quarter of Maori live in areas that are most deprived • whanau Maori face health risks as rental accommodation tends to be lower quality than owner-occupied homes • public housing does not exist in some remote and rural locations with high Maori populations. 17. You may wish to highlight the Ministry's involvement in housing, specifically in administering and funding the Healthy Housing initiative (Appendix Three) and engaging with the Ministry of Business, Innovation and Employment on developing the New Zealand Housing Strategy. 18. You may wish to gauge Lance Normans thinking on housing and health, particularly in regards to: • addressing homelessness • relationship to health conditions (ASH and rheumatic fever) and SUDI prevention • the degree to which Hapai might be involved in innovation that supports improvement in housing.
Additional discussion points
Tobacco use 19. There has been a decrease in the number of Maori smokers between 2006 and 2016, from 42 percent to 35 percent respectively. However a disparity still exists with Maori being 2.9 times more likely to be smokers than New Zealand Europeans. 20. You may wish to ask Lance Norman about the progress and challenges Hapai face in achieving the four key objectives of their tobacco control advocacy activities: • reducing smoking initiation • increasing quitting • reducing social, economic and health harms of tobacco • reducing inequalities. 21. ReleasedIt is likely Lance Norman under will wish theto discuss Official Smokefree 2025Information and the Government's Act commitment 1982 to reducing smoking prevalence and tobacco availability to minimal levels. Out of scope
Paae 3 of 10 MINISTRY OF HEALTH
MANAT0 HAUORA Health Report number: 20180356 Out of scope
Sudden Unexpected Death in Infants (SUDI) 25. The number of Maori SUDI deaths has decreased since 2000, however the rate of SUDI deaths for Maori (1.7 per 100,000 live births in 2014) continues to be higher than that for New Zealand European (0.4 per 100,000 live births in 2014). 26. In 2017, the Ministry underwent an open tender process for a National SUDI Prevention Coordination Service. Hapai was awarded this contract in August 2017 due to the strengths exhibited in their application, including: • proven experience coordinating nationwide activities • proven track record with Maori • proved understanding of the connection between the different factors • evidence of strong relationships with DHBs already • providing innovative ideas. 27. You may wish to:
• congratulate Lance Norman on Hapai being awarded the National SUDI contract in August 2017
• ask Lance on the progress to date for the National SUDI Prevention Coordination Service.
END.
Released under the Official Information Act 1982
Page 4 of 10 MINISTRY OF HEALTH
MANATU HAVORA Health Report number: 20180356 Appendix one - Hapai te Hauora
About Hapai te Hauora 1. Hapai are owned and governed by Te R0nanga o Ngati Whatua, Raukura Hauora o Tainui and Te Whanau o Waipareira, who work collectively to address inequities for Maori whanau, hap0 and iwi, specifically across Tamaki Makaurau / Auckland, but also across New Zealand. 2. Current governance board members of Hapai include: • John Marsden, Te Runanga o Ngati Whatua • Glen Wilcox, Te Runanga o Ngati Whatua • John Tamihere, Te Whanau o Waipareira • Evelyn Taumanu, Te Whanau o Waipareira • Mike Paki, Raukura Hauora o Tainui • Vacant position, Raukura Hauora o Tainui 3. The core business of Hapai (as set out in their website) is: • to create opportunities for Maori to influence change through proactive leadership • to empower and support Maori to challenge and develop healthy public policy that reinforces healthy lifestyles and encourages role modelling with integrity • to provide excellence in the implementation of Maori public health • to provide a coordination service to all gambling harm prevention clinical and public health service providers • to provide public health workforce development services to gambling harm prevention all public health service providers.
Ministry contracts with Hapai te Hauora 4. The Ministry currently contracts Hapai to provide health services regionally and nationally. The details of these contracts are provided in the below table: Contract and per annum Comments fundinq (GST exclusive) National Tobacco This service is tasked with the identification, delivery and promotion of Control Advocacy - effective evidence based public health information and advocacy $450,000 interventions, and is focused on improving outcomes for priority populations specifically Maori, Pacific peoples and pregnant women.
Released underThe service the objectives Official include contributing Information to: Act 1982 • Reducing the harm caused by tobacco within New Zealand • Reducing inequity in health outcomes that result from tobacco use, particularly amongst Maori, Pacific peoples and pregnant women (and their children) • Improving public and media knowledge, awareness and support for measures that will contribute toward a Smokefree New Zealand • High level engagement of key leaders and decision makers.
Page 5 of 10 MINISTRY OF HEALTH
MANATli HAUORA Health Report number: 20180356
Hapai have held the National Tobacco Control Advocacy contract since 1 Jul 2016.
Maori Public Health This service is for Maori Public Health Leadership & Maori Health Leadership (Tobacco Promotion to whanau, hap0, iwi and Maori communities in Tamaki Control, Nutrition and Makaurau/ Auckland region specifically in the following areas: Physical Activity, Alcohol and Drug) - $1,049,213 • Infrastructure - Leadership, innovation & whanaungatanga (workforce development) • Tihei Mauri Ora - Reducing tobacco use • Kia Maarie - Reducing alcohol and other drug use • Whai Ora - Improving nutrition and exercise
Hapai is well connected with a broad range of stakeholders and communities across Auckland which helps it to influence and address the factors and settin s that im act Maori health. National SUDI This service supports the establishment, development, implementation and Prevention Coordination monitoring of SUDI prevention programmes delivered through four regional Service - $535,000 coordination services and all 20 District Health Boards DH Out of scope
Out of scope Released under the Official Information Act 1982
Page 6 of 10 MINISTRY OF HEALTH
MANAT(i HAUORA
Out of scope
END.
Released under the Official Information Act 1982
Page 7 of 10 MINISTRY OF HEALTH
MANAT0 HAUORA Health Report number: 201 80356 Appendix two - Draft letter response to Hapai te Hauora
Released under the Official Information Act 1982
Page 8 of 10 2 March 2018
Lance Norman, Chief Executive Officer Adrian Te Patu, General Manager Hapai te Hauora 6-8 Pioneer Street Henderson, Auckland
Tena korua Lance raua ko Adrian
Thank you for your letter dated 14 February 2018 advising me of the demonstration project in Kelston that will be taking place on World Smokefree Day, 31 May 2018.
As you know tobacco is the leading cause of premature death and disease in New Zealand and is the most significant driver of health inequality due to difference in smoking rates between New Zealand European and Maori populations.
I note the efforts of Hapai te Hauora to concentrate on reducing supply in the Kelston community and I am particularly pleased to hear that the young people in this community are the ones driving this initiative.
Due to parliamentary commitments I am unable to attend on World Smokefree Day, but please pass on my thanks and congratulations to the dairy owners and the youth coalition involved with this initiative.
Naku noa na
Hon Jenny Salesa Associate Minister of Health Released under the Official Information Act 1982 Out of scope
Released under the Official Information Act 1982
Page 9 of 10 MINISTRY OF HEALTH
MANAT0 HAUORA Health Report number: 20180356 Appendix four - Healthy Homes Initiative process flow chart
Released under the Official Information Act 1982
Page 10 of 10 MINISTRY OF HEALTH
MANATLI HAUORA Health Report number: 20180356 Appendix four - Healthy Homes Initiative process flow chart
Released under the Official Information Act 1982
Page 10 of 10 Out of scope
1982 Act
Information
Official the
under
Released Document 5
MINISTRY OF HEALTH MANATU H AUORA Meeting
Meeting to discuss potential ways to help increase the provision of wahakura in Aotearoa
Date due to MO: 22 July 2019 Date of meeting: 24 July 2019
Security level: IN CONFIDENCE Health Report number: 20191349
To: Hon Julie Anne Genter, Associate Minister of Health
Contact for telephone discussion
Name Position Telephone
Deborah Woodley Deputy Director-General, Population s 9(2)(a) Health and Prevention
Grant Pollard Group Manager, Population Health and s 9(2)(a) Prevention -
Action for Private Secretaries
N/A Date dispatched to MO:
Released under the Official Information Act 1982
Document 5
MINISTRY OF HEALTH MANATU H AUORA
Meeting to discuss potential ways to help increase the provision of wahakura in Aotearoa
About the meeting
Purpose Deborah Woodley (Deputy Director-General, Population and Prevention Health) and Grant Pollard (Group Manager, Population and Prevention Health) are meeting with you and Marama Davidson to discuss potential ways to help increase the provision of wahakura in Aotearoa. To support your meeting, this briefing provides potential options to further increase the provision of wahakura in Aotearoa. Your office has also asked about national wahakura wānanga being delivered through the National Sudden Unexpected Death in Infacy (SUDI) Prevention Programme (NSPP) and an overview has been provided in Appendix 1. In addition to the above information, an overview of some of the wider SUDI prevention initiatives being delivered through the NSPP are outlined in Appendix 1. Appendix 1 also contains reporting and monitoring information for the NSPP.
Meeting/visit Date: Wednesday 24 July 2019 details Time: 1:00pm to 1:30pm Venue: Your office
Released under the Official Information Act 1982
Health Report: 20191349 2 Document 5
MINISTRY OF HEALTH MANATU H AUORA Background 1. The current SUDI rate in Aotearoa is approximately 0.7 in every 1,000 live births and 1.59 for every 1000 Māori pēpi born. The SUDI risk for Māori has remained consistently higher than for non-Māori with ‘Māori babies nearly seven times more likely to die from SUDI’ (CYMRC Special Report, 2017).
2. Through the National SUDI Prevention Programme (NSPP), the Ministry of Health (the Ministry) is working with the sector to reduce the overall SUDI rate by approximately 86 percent, and by 94 percent for Māori, by 2025 through prioritising funding to address the key modifiable SUDI risk factors (bed sharing and smoking during pregnancy). Ultimately the Ministry is working with the sector to reduce the overall SUDI rate to approximately 0.1 in every 1,000 live births by 2025.
3. Wahakura are acknowledged as a Māori response and partial solution to reducing the high rates of Māori infant death as a result of SUDI (Tipene-Leach et al 2014). While wahakura are a traditional expression of Māori custom, they also provide whānau and health professionals with a practical way of addressing one of the top risk factors associated with SUDI, bed-sharing (Hapai Te Hauora). Potential options to further increase the provision of wahakura in Aotearoa s 9(2)(f)(iv) 4.
s 9(2)(f)(iv) 5.
Released under the Official Information Act 1982
1 https://www.parentclub.scot/baby-box, https://www.health.nsw.gov.au/kidsfamilies/MCFhealth/maternity/Pages/baby-bundle- faq.aspx
Health Report: 20191349 3 Document 5
MINISTRY OF HEALTH MANATU H AUORA s 9(2)(f)(iv) 7.
s 9(2)(f)(iv) 8.
Increasing the provision of wahakura through the NSPP 9. Through the NSPP, the current priority for DHBs is to deliver on Government’s expectation that they will provide a minimum of 8,500 safe sleep devices (SSDs) per annum (which equates to approximately 15 percent of total babies born per annum and is equivalent to the current reported number of mothers who smoke during pregnancy). Funding for the NSPP is approximately $5.1 million per annum.
10. Currently through the Crown Funding Agreement (CFA), DHBs have the flexibility to decide which SSDs best meet their population needs. Through NSPP DHB reporting, the Ministry has noted that DHBs are purchasing and providing pēpi pods as the preferred SSD. In order to continue promoting kaupapa Māori approaches to safe sleeping, one option could include the Ministry stipulating a minimum number of wahakura to be purchased and provided to whānau through the CFA.
s 9(2)(f)(iv) 11.
12. Another potential option could be to fund four Regional Wahakura Advisors (Regional Advisors) in the Northern, Midlands, Central and Southern regions. The Regional Advisors could work collaboratively with DHBs and community kairaranga ‘experts’ to support communities to self- determine and implement community-led initiatives to increase the provision of wahakura. This option is intended to increase Maori inputs into the NSPP delivery system, provide a population health focus via community development, support bilateral DHB / Iwi relations and contributions to the success of the programme and provide a lower cost alternative to the TPK option.
13. Through this initiative, the Regional Advisors could also help strengthen pathway access for Releasedvulnerable māmā, pēpi under and whānau the to services Official that improve Information maternal smoking rates Act and 1982safe sleep practices. Other pathways to services that reduce alcohol and drug use during pregnancy and support increased breastfeeding and immunisation could also be strengthened.
s 9(2)(f)(iv) 14.
Health Report: 20191349 4 Document 5
MINISTRY OF HEALTH MANATU H AUORA Appendix 1: Other initiatives being implemented through the National SUDI Prevention Programme Through the NSPP, the most recent wahakura initiative to be implemented is the Hapai te Hauora- led wahakura wānanga which provides an opportunity to bring kairaranga (weavers) and SUDI prevention advocates together to consider ways to increase the capacity and capability of kairaranga; raise awareness about kaupapa Māori approaches to birthing and child caring practices and for participants to learn to weave. On 10 and 11 July 2019, the first wahakura wānanga was held at Makaurau Marae in Auckland. Eighty registrations were received with 57 people attending on the first day and 45 on the second. Participants included kairaranga, health professionals, DHB staff, kōhanga reo kaiako (teachers), whānau and tamariki. The next wahakura wānanga are to be held in Otaki (October 2019), Rotorua (February 2020) and Christchurch (March 2020).
Some of the other SUDI prevention work that the Ministry and the sector have completed includes:
• Needs Assessment And Care Planning Guide to provide strategies for health professionals who are working with whānau to assess SUDI risk and protective factors from which a care plan can be developed • Safe Sleep Device Quality Guidelines to support health professionals to provide information to whānau about how to use SSDs (including wahakura) safely • Online Training for health professionals which includes seven themed SUDI prevention training modules.
To compliment the work outlined above, a range of other initiatives are underway including:
• development of national culturally responsive guidelines for health professionals who are working directly with māmā and whānau in their whare • delivery of DHB-led regional wahakura wānanga, as a mechanism for bringing whānau together to weave wahakura and to promote a consistent whole-of-whānau education approach to safe sleeping • development of a national SSD procurement guide which will provide a set of principles, protocols and procurement advice for how DHBs purchase and supply SSDs • promoting the sustainability of harakeke through bringing communities together to plant Pā Harakeke to ensure that harakeke can continue to be nurtured and sustained. Safe sleep device reporting The Ministry has received the first DHB quarterly reports about the purchase and distribution of SSDs since the NSPP was established in late 2017. The reports are for quarter 3 (January to March 2019) and positively indicate that nationwide, 4,440 SSDs have been purchased with 2,932 SSDs distributed to whānau.
OfReleased the 4,440 SSDs, the under reports have the shown Officialthat: Information Act 1982
• 272 wahakura were woven through wānanga • 240 wahakura woven through wānanga were distributed to whānau • 1115 pre-made wahakura were purchased • 472 pre-made wahakura were distributed to whānau.
Health Report: 20191349 5 Document 5
MINISTRY OF HEALTH MANATU H AUORA Given there were an estimated 14,580 live births in quarter 3, the Ministry estimates that up to 20 percent of these infants were likely to have received SSDs. The reports provide a positive indication that the NSPP is on track to meet the goal of providing up to 8,500 SSDs per annum which covers approximately 15 percent of annual births. The DHB quarter 4 SSD provision reports (April to June 2019) are due on 20 July 2019 and the Ministry will provide you with a weekly report item following the analysis of the data.
To enable the Ministry to analyse demographic information about whānau who are receiving SSDs through the NSPP, from 2019, DHBs will also submit six monthly NHI level data for each māmā and pēpi who has received a SSD in the prior six months. The NHI level data will form part of the NSPP monitoring framework which will also analyse how other services that address the SUDI risk and protective factors (e.g stop smoking, breastfeeding and immunisation) are performing.
Released under the Official Information Act 1982
Health Report: 20191349 6 Document 6
Template: Minister Clark’s Weekly Report Items
Please submit items for Minister Clark’s Weekly Report to mailbox [email protected] by 12:00pm Wednesday. Items received after this time will not be accepted and will be held until the following week.
Please click the topic that your item sits under
☒ Child Wellbeing ☐ Cancer 1982 ☐ Mental Health and Addiction ☐ Obesity and Diabetes ☐ Strong Public Health System ☐ Oral Health ☐ Primary Health Care ☐ Updating Legislation Act ☐ ☐ Health and Disability System Review Māori and Pacific Peoples’ Health ☐ Workforce ☐ Dementia and Aged Care ☐ Capital Asset Management ☐ Family and Sexual Violence ☐ Data and Digital ☐ Disability Support ☐ Drugs and Devices ☐ Other ☐ Drinking-water Information Why are you submitting this item? ☐ Request from Minister ☐ Request from Minister’s office (Private Sec) ☐ Agreed report back (update) ☒ Noting/new item for Minister Official ☐ Other (please specify)
Who is the responsible GM forthe this item? Name: Grant Pollard
Note: ODG will contact the responsible GM on Thursday mornings, if required, to discuss any feedback. under Will this item appear in another Minister’s report this week?
☒ Minister Genter ☐ Minister Salesa
Released Document 6
1.1 District Health Board Safe Sleep Device reporting (quarter 3)
Action: For noting, no action required.
Item: The estimated 2018/19 provisional Sudden Unexpected Death in Infancy (SUDI) rate was approximately 0.56 per 1,000 live births. This is less than the estimated 2017/18 SUDI rate, where the provisional SUDI rate was 1.01 per 1,000 live births. The National SUDI Prevention Programme (NSPP) is seeking to reduce the SUDI rate to 0.1 per 1,000 live births by 2025. The NSPP prioritises funding for the purchase of safe sleep devices (SSDs) as bed sharing is a key SUDI modifiable risk factor. The Ministry has received the second DHB quarterly reports regarding the1982 distribution of SSDs since the NSPP DHB reporting system was established. The reports are for quarter 4 and indicate that 2261 SSDs have been distributedAct to whānau. Of the 2261 SSDs distributed to whānau, 1582 were pēpi pods, 345 were wahakura woven through wānanga and 297 were wahakura purchased in bulk from suppliers. In addition, 23 baby boxes and 14 ‘other’ SSDs (eg basinettes) were distributed to whānau. The reports also indicate that 684 people have attended wānanga which promote SUDI prevention approaches such as weaving wahakura, safe sleep messaging and supporting hāpu māmā to stop smoking. Given there were an estimated 15,251 live births in quarter 4, we estimate that up to 14.5 percent of these infants were likelyInformation to have received SSDs. In addition to the 2932 SSDs distributed to whānau in the first reporting cycle (quarter 3), the data provides a positive indication that the NSPP is on track to meet the goal of providing up to 8,500 SSDs each year which covers approximately 15 percent of annual births. Official
Deborah Woodley,the Deputy Director-General Population Health and Prevention, s 9(2)(a)
under
Released Document 7
MINISTRY OF HEALTH
MANATU IIAUORA
Meeting to discuss the National Sudden Unexplained Death in Infancy Prevention Programme
Date due to MO: 11 February 2020 Date of meeting: 12 February 2020
Security level: IN CONFIDENCE Health Report number: 202000172
To: Hon Julie Anne Genter, Associate Minister of Health
Cc: Hon Dr David Clark, Minister of Health
Contact for telephone discussion
Name Position Telephone
Grant Pollard Group Manager, Child and Community s 9(2)(a) Health
Justine Mecchia Manager, Well Child Tamariki Ora s 9(2)(a)
Action for Private Secretaries Released under the Official Information Act 1982 N/A . Date dispatched to MO: Document 7
MINISTRY OF HEALTH
MANATU IIAUORA Meeting to discuss the National Sudden Unexplained Death in Infancy Prevention Programme
Purpose Hapai te Hauora have requested a meeting with you to discuss the National Sudden Unexplained Death in Infancy (SUDI) Prevention Programme and wahakura capacity and procurement. Meeting/visit Date: 12 February 2020 details Time: 10.00 to 10.30 am Venue: Your office
Attendees Selah Hart, Chief Executive Hapai te Hauora (Hapai)
Associate Professor Dr. Beverley Lawton (ONZM), University of Otago Women's Health Research Centre and member of the SUDI Prevention Expert Advisory Group
Organisation Hapai is contracted by the Ministry of Health to coordinate a national integrated approach to SUDI prevention in Aotearoa. Their objectives are to improve Maori health SUDI outcomes by working wit h local coordinators and national experts to promote best practice solutions which sit alongside action towards a smokefree New Zealand.
Ministry Justine Mecchia and Kylie Mccosh are available to attend. representatives
Other information
Media N/A
Released under the Official Information Act 1982
Health Report: 20200172 2 Document 7
MINISTRY OF HEALTH MANATU IIAUORA Background and context
1. In 2019 the SUDI rate in Aotearoa was 0.85 per 1,000 live births, an increase of 26 per cent from 2018 which was 0.68 per 1,000 live births. 2. The SUDI risk for Maori is consistently higher than for non-Maori, with Maori babies nearly seven times more likely to die from SUDI (CYMRC Special Report, 2017). 3. Through the National SUDI Prevention Programme (NSPP), the Ministry of Health (the Ministry) is working with the sector to reduce the overall SUDI rate to 0.1 in every 1,000 live births (an 86 per cent reduction overall, and a 94 percent reduction for Maori), by 2025 through prioritising funding to address the key modifiable SUDI risk factors (bed sharing and smoking during pregnancy).
4. Wahakura are acknowledged as a Maori response and one solution to reducing the high rates of Maori infant death as a resu lt of SUDI (Tipene-Leach et al 2014). While wahakura are a traditional expression of Maori custom, they also provide whanau and health professionals with a practical way of addressing bed-sharing which is one of the top risk factors associated with SUDI.
Topics for discussion
National SUDI Prevention Programme
SUD/ rates
5. Over 2013-2017, there was an average of 42 SUDI deaths per annum. In 2019, the number of SUDI deaths was 52, and 18 of those deaths were in Counties Manukau District Health Board (CMDHB) area alone.
6. The rate for non-Maori, non-Pacific infants at 0. 19 has continued to fall closer to the 0.1 target, while the provisional rate for Maori is now 10.9 times higher and for Pacific is 7.9 times higher than the non-Maori, non-Pacific rate. This increased inequity in SUDI rates is disappointing given the concerted effort in recent years to specifically address this.
Funding and Contracting
7. The Ministry is working with Hapai and DHBs to better integrate their activities and enable collaboration and partnership to take effect. Hapai requested a meeting with the Ministry and this meeting is set to take place on Wednesday 12 February 2020 at 11 am.
8. Total Ministry funding for NSPP is $4,692,297 per annum. A breakdown of funding is as Releasedfollows: under the Official Information Act 1982 a. Hapai is funded $395,000 per annum to deliver guidelines and resources, support, coordination and programme monitoring to promote consistency and quality improvement in the implementation of SUDI prevention services. Hapai is on track to achieve their deliverables which include: communications and coordination of information to SUDI prevention stakeholders; providing workforce development training; and support to increase the capacity and capability of wahakura weavers throughout the country.
Health Report: 20200172 3 Document 7
MINISTRY OF HEALTH
MANATU IIAUORA b. Four providers are each funded $125,000 per annum for regional coordination, namely Auckland DHB (Northern), Waikato DHB (Midlands), Tech nical Advisory Service (Central) and Canterbury DHB (South Island). c. DHB s are funded a total of $3,342,297 per annum to provide a range of services to women, babies and their whanau that address key modifiable risks and protective factors in order to reduce the incidence of SUDI. Services include safe sleep device (SSD) provision, increased access and support for women and whanau to quit smoking and other locally led initiatives. d. $455,000 will be used to evaluate the SUDI programme.
Safe Sleep Device reporting
9. The Ministry's expectation is that DHBs will supply a minimum of 8,500 SSDs per annum (which equates to around 15 percent of babies born each year and is equivalent to the current reported number of mothers who smoke during pregnancy). To support this, the DHB must, at a minimum, provide SSDs for the estimated high-risk population in the funding formula. 10. DHBs report the purchase and distribution of SSDs to whanau since 1 July 2019 to 31 December 2019 as follows: • 2322 Pepi Pods • 845 wa hakura 11. All DHBs are either running wananga wahakura or have the intention of doing so. The current data indicates that 1166 people have attended wananga for the same reporting period. 12. Wahakura provision continues to be a challenge with a limited number of proficient weavers around the country.
Next steps
13. The Ministry plans to commence an eva luation of the SUDI Prevention programme in 2020/21. 14. The Ministry is working with Hapai and DHBs to redesign current services that wi ll reduce SUDI and deliver better integrated services with a greater focus on workforce development including the number of proficient wahakura weavers. 15. The Ministry is exploring and developing different and better commissioning and relationship approaches that improve wellbeing and equity outcomes, particularly for Maori and Pacific peoples. Released under the Official Information Act 1982 cJ7c:J~ Deborah Woodley Deputy Director-General Population Health and Prevention
Health Report: 20200172 4 Document 8
1. Core Priorities
Child wellbeing
1.1 Sudden Unexpected Death in Infancy: quarterly update
Action For noting.
Key points This item provides a quarterly update on sudden unexpected death in infancy (SUDI). SUDI rates have fallen for non-Maori non-Pacific but remain high for Māori and Pacific infants Between 2013-2017, there was an average of 42 SUDI deaths per annum. In 2019, the number of SUDI deaths was 52, and 18 of those deaths were in Counties Manukau DHB alone. The current provisional SUDI rate (2019) for non-Māori and non-Pacific infants is 0.19 deaths per 1,000 live births and the rate has continued to decrease. However, the provisional rates for Māori infants is 2.05 deaths per 1,000 live births and for Pacific infants is 1.48 deaths per 1,000 live births. SUDI rates are higher for Maori (10.9 times) and Pasifika infants (7.9 times) than non-Māori, non-Pacific infants. National SUDI Prevention Programme Addressing inequities in SUDI is a key focus for the Ministry. Through the National SUDI Prevention Programme (NSPP), the Ministry is working with the sector to reduce the overall SUDI rate to 0.1 in every 1,000 live births (an 86 per cent reduction overall, and a 94 percent reduction for Māori) by 2025. This ambitious goal is being implemented by addressing the key modifiable SUDI risk factors (such as bed sharing and smoking during pregnancy). Of the approximately 60,000 births per annum, it is estimated 15 percent of pregnant women smoked during pregnancy. Current SUDI prevention activities DHBs are required to deliver 8,500 safe sleep devices to high risk populations each year. As at 30 March 2020, 5,975 safe sleep devices were distributed nationally. The Ministry is currently reviewing SUDI liaison reports from the Coroner’s office to identify opportunities to strengthen our SUDI response. Officials will work in partnership with members of the Child and Youth Mortality Review Committee, Hāpai te Hauora, SUDI expert advisors and sector workforce to develop a plan to address the issues in the short to long term. This includes system improvements to meet the aims of the national programme and to reduce the inequitable SUDI rates for Māori and Pasifika infants. ReleasedThe under Ministry plans the to evaluat Officiale the SUDI pre Informationvention programme during Act 2020-21 1982. Document 8
Next steps The Ministry will continue to provide quarterly updates on the SUDI prevention programme.
Contact Deborah Woodley, Deputy Director-General Population Health and Prevention, -s 9(2)(a)
Released under the Official Information Act 1982 Document 9 MINISTRY or HEALTH
MANATU IIAUOJV. Health Report
National Sudden Unexpected Death in Infants (SUDI) Prevention Programme - progress for Maori health
Date due to MO: 7 August 2020 Action required by: N/A Security level: IN CONFIDENCE Health Report number: 20201370
To: Hon Peeni Henare, Associate Minister of Health (Maori Health)
Contact for telephone discussion
Name Position Telephone
Grant Pollard Group Manager, Child and Community s 9(2)(a) Health, Population Health and Prevention
Justine Mecchia Manager, Well Child Tamariki Ora, Child s 9(2)(a) and Community Health
Action for Private Secretaries
Return the signed report to the Ministry of Health. Date dispatched to MO:
Released under the Official Information Act 1982 Document 9
National Sudden Unexpected Death Infants {SUDI) Prevention Programme progress for Maori health
Purpose of report
This report responds to your request for further information about the National SUDI Prevention Programme (NSPP) and progress for Maori health.
Summary
• Since 2013 SUDI rates have decreased for non-Maori to 0.19 (closer to the target rate of 0.10), but rates have increased for Maori to 2.05 (10.9 times higher than non-Maori) and Pacific to 1.48 (7.9 times higher than non-Maori).
• 8,500 Safe Sleep Devices (pepi pods and/or wahakura) are required to be distributed to whanau annually via District Health Boards (DHBs), alongside existing wrap around support to address the two key modifiable risk factors for SUDI: smoking and bedsharing. • An independent evaluation of the NSPP is planned to take place during 2020/21.
• The Ministry of Health (the Ministry) has committed funding for a further three yea rs to the NSPP to provide certainty for providers working towards equitable outcomes for Maori and Pacific babies.
Recommendations
The Ministry recommends that you:
a. note that national SUDI rates since 2013 have decreased for non-Maori, but have increased for Maori and Pacific babies
b. note that the Ministry plans to conduct an evaluation of the NSPP during 2020/21.
Released under the Official Information Act 1982 Hon Peeni Henare Deputy Director-General Associate Minister of Health Population Health and Prevention Date: Document 9
National SUDI Prevention Programme - progress for Maori health
Background
1. The SUDI risk for Maori is consistently higher than for non-Maori, with Maori babies 10.9 times more likely to die from SUDI (SUDI Provisional Rates, 2019). 2. In 2019 the overall SUDI rate in Aotearoa was 0.85 per 1,000 live births, an increase of 26 per cent from 2018, where the overall rate was 0.68 per 1,000 live births. 3. The National SUDI Prevention Programme (NSPP) officially began on 1 July 2017. Through the NSPP, the Ministry is working with the sector to reduce the overall SUDI rate to 0.1 in every 1,000 live births by 2025. The 0.1 target is based on what can be expected from
looking at other OECD countries that have rates at that level 1• For Aotearoa, this would mean an 86 per cent reduction overall, and a 94 percent reduction for Maori. 4. The Ministry provides funding for the NSPP to address the key modifiable risk factors for SUDI, which are bed sharing and smoking during pregnancy.
5. Wahakura are acknowledged as a Maori response and one solution to reducing the high rates of Maori infant death as a result of SUDI (Tipene-Leach et al 2014). While wahakura are a traditional expression of Maori custom, they also provide whanau and health professionals with a practical way of addressing bed-sharing for mothers who have smoked in pregnancy, as bed-sharing and smoking are the most significant risk factors associated with SUDI.
6. For the past two years, the Ministry of Health has been exploring how to improve smoking cessation outcomes for wahine Maori. This includes a co-design and developmental evaluation process engaging directly with wahine Maori with lived experiences of smoking and liaising with health and quit coaches who are devising new ways or working with wahine.
7. The result of the co-design sessions is outlined in Ka PO te Ruha, ka Hao te Rangatahi - Good practice guidance for stop smoking services. The aim of this guidance is to open up the permission space for stop smoking services to work in more responsive ways with young wahine Maori.
SUDI rates
8. The table below is the estimated provisional SUDI rates per 1,000 births between January 2019 to December 2019; eighteen of those deaths were in Counties Manukau DHB area alone. It should be noted actual rates and therefore ratios between population groups Releasedmay change once under actual SUDI the death numbersOfficial are confirmed. Information Act 1982
1 Taylor BJ, Garstang J, Engelberts A, et al
International comparison of sudden unexpected death in infancy rates using a newly proposed set of cause-of-death codes Archives of Disease in Childhood 2015;100:1018-1023. Document 9
Estimated Births Total Number of Provisional Estimated Provisional SUDI Ethnicity over 12 months SUDI Deaths Rate per 1,000 births Maori 36 17521 2.05 Pacific Peoples 9 6091 1.48 NZ European 6 25112 0.24 Asian 1 10688 0.09 Other 0 1452 0.00 Unknown 0 11 0.00 Total NZ 52 60876 0.85 9. The current rates for non-Maori, non-Pacific infants have continued to fall closer to the 0.1 target , while the current provisional rate for Maori is now 2.05 (10.9 times higher than the non-Maori, non-Pacific rate) and the Pacific rate is 1.48 (7.9 times higher than the non Maori, non-Pacific rate). 10. This preliminary evidence of increased inequity in SUDI rates is very disappointing and upsetting given the concerted effort in recent years to specifically address this. 11 . In response, the Ministry has initiated case reviews of all SUDI that have occurred since 2019 to identify key findings, and once complete, will provide recommendations to support immediate improvements. This will include sharing the findings with Counties Manukau and working with them to formulate and implement a plan of action. 12. The Ministry also plans to evaluate the NSPP over 2020/21 to inform future changes and impro vements needed to the programme to address the continued inequity in SUDI rates for Maori and Pacific pepi and make recommendations to improve the NSPP so whanau receive the support they need.
Equity
13. In Aot earoa, people have differences in health that are not only avoidable but unfair and unjust. Inequities are evident in the rates of SUDI between non-Maori and Maori populations.
14. Factors leading 2 3 to worse SUDI outcomes for Maori and Pacific babies are : a. poverty b. smoking c. bed-sharing
d. alcohol and drug use.
Released under the Official Information Act 1982
2 New Frameworks for Understanding Sudden Unexpected Deaths in Infancy (SUDI) in Socially Vulnerable Families. Journal of Pediatric Nursing Volume 37, November-Dec ember 2017, Pages 35-41 , https:ljdoi.org/10.1016lj.pedn.2017.06.022 3 https://www.nzma.org.nzLjournal-articles/the-combination-o f-bed-sharing-and-maternal-smoking-leads-to-a-greatly-increased- risk-of su d den-unexpected -d eath-i n-i nfanc;y -th e-new-zea I and-sud i-nationwi de-case- control-study
Health Report: HR2020137 0 3 Document 9
Safe Sleep Devices
15. Through the NSPP, the Ministry expectation is that DHBs will collectively distribute a minimum of 8,500 Safe Sleep Devices (SSDs) per annum. This number equates to around 15 percent of babies born nationally each year and is equivalent to the current reported number of mothers who smoke during pregnancy. 16. For the 2019/20 financial year, DHBs have reported the purchase and distribution of 4485 pepi pods and 1490 wahakura (total of 5,975 SSDs) to whanau up to 31 March 2020. 17. Wahakura provision continues to be a challenge with a limited number of proficient weavers around the country.
Funding and Commitments
18. The Ministry has committed to the NSPP for a further three years allowing for the SUDI evalu ation to be completed and recommendations implemented that enable change to improve outcomes for Maori and Pacific pepi.
19. The Ministry funds sixteen stop smoking services, five of whom are DHBs (including CMDHB). All stop smoking services offer multi-sessional behavioural support and a range of medications including nicotine replacement therapy.
20. At the same time, the Ministry is exploring and developing different commissioning approaches that improve wellbeing and equity outcomes, particularly for Maori and Pacific peoples.
Next Steps
21. The Ministry plans to commence an evaluation of the NSPP in 2020/21. 22. The Ministry is reviewing SUDI liai son reports from the Coroner's office to identify opportunities to strengthen the SUDI response. This review will be completed by the end of August 2020. 23. Officia ls are working in partnership with members of the Child and Youth Mortality Review Committee, Hapai te Hauora, SUDI expert advisors and sector workforce to develop a plan to address the issues in the short to long term. This includes system improvements to meet the aims of the NSPP and to reduce SUDI rates for Maori and Pacific whanau.
ENDS. Released under the Official Information Act 1982 Document 10
Delegation 1Child Wellbeing Sudden Unexpected Death in Infancy (SUDI): End of Year update (July 2019 to June 2020)
Action For noting
Key points Provisional SUDI rates have fallen for non-Maori non-Pacific infants but remain high for Māori and Pacific infants
Between 2013-2017, there was an average of 42 provisional SUDI deaths per annum. In 2019, the number of provisional SUDI deaths was 52, and 18 of those deaths were in Counties Manukau DHB area alone. The 2019 current provisional SUDI rate for non-Māori, non-Pacific infants is 0.19 deaths per 1,000 live births and that rate has continued to decrease. However, the provisional rates for Māori infants at 2.05 deaths per 1,000 live births and for Pacific infants at1.48 deaths per 1,000 live births have increased. SUDI rates are now 10.9 times higher for Maori and 7.9 times higher for Pacific infants than non-Māori, non- Pacific infants. National SUDI Prevention Programme
Addressing inequities in SUDI is a key focus for the Ministry. Through the National SUDI Prevention Programme (NSPP), the Ministry is working with the sector to reduce the overall SUDI rate to 0.1 in every 1,000 live births (an 86 per cent reduction overall, and a 94 percent reduction for Māori) by 2025. This ambitious goal is being implemented by addressing the key modifiable risk factors for SUDI, such as bed sharing and smoking during pregnancy. Of the approximately 60,000 births per annum, it is estimated 15 percent of pregnant women smoke during pregnancy. Current SUDI prevention activities
Each year DHBs are required to deliver 8500 safe sleep beds to whānau where their baby is at high risk. In the year ending 30 July 2020, 8447 safe sleep devices were distributed nationally. The Ministry has completed reviewing all 2019 and 2020 SUDI liaison reports from the Coroner’s office and will now work in partnership with members of the Child and Youth Mortality Review Committee, Hāpai te Hauora (National SUDI Prevention Programme Coordinator), SUDI expert advisors and sector workforce to develop a plan to address the issues in the short and long term. This includes system improvements to meet the aims of the NSPP and to reduce the inequitable rates for Māori and Pacific infants. The Ministry also plans to formally evaluate the SUDI prevention programme during 2020-21.
Next Steps The Ministry will continue to provide quarterly updates on the SUDI prevention Releasedprogramme. under the Official Information Act 1982
s 9(2)(a) Contact Deborah Woodley, Deputy Director-General Population Health and Prevention, ■
Ministers -Hon Julie Anne Genter Document 10
Hon Peeni Henare Hon Jenny Salesa
Minister Hipkins meeting agenda item? No
1982 Act
Information
Official the
under
Released