South Kaipara Health Needs Assessment

Executive Summary June 2018

Project Purpose The South Kaipara Health Needs Assessment (HNA) was conducted to inform facilities planning for Helensville Health Campus, to achieve a purpose built facility that will meet the health needs of the South Kaipara community. The HNA was carried out by Helensville District Health Trust (HDHT) with support from Waitemata District Health Board (DHB) and ProCare Primary Health Organisation (PHO). The HNA examined (i) South Kaipara population demographics, (ii) community, health provider and stakeholder perspectives on current and future health needs and health services for South Kaipara, (iii) general practice service use and health outcomes, and (iv) secondary care service use. Population Demographics People living in South Kaipara (domiciled population*) may seek general practice services outside of this area (e.g. attend a general practice close to their work or previous residence) and people enrolled with a general practice in South Kaipara (enrolled population) may live outside of South Kaipara and travel to see their General Practitioner (GP). Just over half of people living in South Kaipara were enrolled with one of the four South Kaipara practices and 83.3% of people enrolled in the four South Kaipara practices lived in South Kaipara. The domiciled and enrolled populations of South Kaipara had similar age and ethnicity profiles. However, there were differences in socioeconomic status with the domiciled population being more affluent. *The domiciled population included people who live in Census Area Units that cover a larger geographical area than the defined South Kaipara region to ensure the domiciled population included all five local marae. Domiciled Population There are an estimated 35,790 people living in South Kaipara. Over the next 15 years the population is projected to increase by 40% to 50,350 with the largest percentage increase among adults aged over 65. The domiciled population is largely comprised of New Zealand European and Other (83.4%) and Māori (10.9%) with a smaller percentage of Asian (3.6%) and Pacific (1.8%). The majority of people in South Kaipara (81.2%) live in the least deprived areas compared to 51.5% for Waitemata DHB and 40% nationally. Māori and Pacific living in South Kaipara have a younger population profile and are more likely to live in the most deprived areas compared to New Zealand European and Other. General Practice Enrolled Population There were 20,777 people enrolled in the four South Kaipara practices. The enrolled population is largely comprised of New Zealand European and Other (83.1%) and Māori (11.7%) with a smaller percentage of Asian (2.7%) and Pacific (2.4%). Sixty percent of people enrolled in South Kaipara live in the least deprived areas compared to 44.3% for the total ProCare population and 40% nationally. Māori and Pacific enrolled in South Kaipara have a younger age distribution and are more likely to live in the most deprived areas compared to New Zealand European and Other.

Community, Health Provider and Stakeholder Perspectives Community, health provider and stakeholder perspectives on current and future health needs and health services for South Kaipara were collected using a community and health provider survey, focus groups and key informant interviews. Perspectives were grouped into the following key themes. Positive Feedback on Health Services Many community members felt welcomed and cared for by their local general practice and there was positive feedback from health providers for GP clinics being trialled at a local marae. Laboratory services were seen as easy to use and staff were praised for providing a good service. Helensville Birthing Centre was highly valued by the community and health providers, and local midwives received positive feedback for the care they provide. Health providers and local Māori valued the role Māori providers played in supporting clients and whānau. Health Service Gaps Mental illness and addictions were seen as the most important health issue in South Kaipara. The opportunity to develop more local services was raised, including; addiction services, youth services and talking therapies. There was consistent feedback about the need for these services to be easy to access and navigate. Timely access to GP appointments and continuity of GP care were seen as important issues. The community valued continuity of provider and preferred to see their own doctor. The community felt there were not enough GPs and reported waiting up to 2 weeks to see their GP. Accident and emergency and radiology were reported as the most difficult services to use due to lack of local provision meaning people had to travel to access these services. Hospital outpatient appointments were also seen as difficult to use due to lack of public transport, limited shuttle buses, traffic congestion, parking and fuel costs. Specific Populations Needing Tailored Support Health services for older people were seen as difficult to use and there were concerns older people were not getting the health services they need due to a lack of local services and difficulties with transport. There was a call for more residential facilities, home based services and carer support to keep up with the growing population. There was also a call for more youth appropriate services including mental health, family planning and support for young mothers. Health providers and community members reported Māori living in South Kaipara were not getting the health services they need and highlighted a need for mainstream services to be more culturally accessible, have stronger Māori engagement and have a more holistic approach to whānau health through initiatives such as Whānau Ora. Social Determinants of Health and Healthy Lifestyles Poverty, poor housing and transport were identified as some of the most important health issues for people in South Kaipara. Lack of transport affected a number of different groups including the elderly, youth, low income groups and people living in isolated communities.

Supporting healthy lifestyles was seen as the most important step towards becoming a healthy community; this included healthy food environments, support for physical activity, education on healthy lifestyles and supporting people to manage their long term conditions. New Ways of Working There was a call for better communication and integration across health services and across health and social services to support a more holistic approach to health. A ‘one stop shop’ for health and social services was seen as one way of supporting better integration. Mobile nursing services and clinics in other community settings were seen as a way to improve access to health services particularly for isolated communities, older people and low income groups. Health navigators and a repository with information on local health and social services were suggested to make it easier to navigate services. Technologies such as patient portals, mobile apps and telehealth initiatives were also seen as a way of improving access to health care.

General Practice Service Use and Health Outcomes ProCare PHO data were used to establish general practice service use and health outcomes for the South Kaipara enrolled population with the total ProCare population used as a comparator. General Practice Service Use South Kaipara has 11.0% more GP and 55.6% more practice nurse full time equivalents per patient compared to the total ProCare population. On average, people enrolled in South Kaipara visited their GP less often than people enrolled in ProCare (2.7 times per year for South Kaipara compared to 3.2 times per year for the total ProCare population). Risk Factors Māori and Pacific had the highest smoking rates in South Kaipara. Ninety percent of smokers in South Kaipara received brief advice to stop smoking and 31.7% were offered cessation support in the previous 15 months. Two out of three adults in South Kaipara were overweight or obese with Māori and Pacific being more likely to be obese or severely obese. Adults with increased cardiovascular risk enrolled in South Kaipara were less likely to be prescribed dual therapy (for 5-year cardiovascular disease risk over 20%) or triple therapy (for prior cardiovascular disease) to reduce their cardiovascular risk when compared to the total ProCare population. Preventative Care Eighty three percent of eligible women had a cervical smear in the last 3 years, higher than the 80% national target. However, this target was not being met for Māori and Pacific women. Immunisation rates for children enrolled in South Kaipara were below the national target of 95% (88.3% at 8 months, 88.5% at 2 years). Older adults were also less likely to have had a flu vaccine compared to the total ProCare population.

Mental Health and Long Term Conditions One in seven people in South Kaipara had a history of psychological distress (had a recorded history of psychological distress in the last 10 years). Younger adults and youth had higher rates of psychological distress compared to younger adults and youth for the total ProCare population. There were 692 adults with diabetes enrolled in South Kaipara giving a prevalence of 4.3%. The highest prevalence was among Pacific (9.0%) and Asian (6.7%) ethnicities. People with diabetes in South Kaipara had better outcomes for blood pressure and glycaemic control when compared to the total ProCare population.

Secondary Care Service Use Secondary care service use data for the domiciled South Kaipara population were obtained from national and local databases with the total Waitemata DHB population used as a comparator. Rates of Secondary Care Use South Kaipara had lower rates for outpatient appointments, emergency department attendance and acute admissions when compared to Waitemata DHB. Reasons for lower use of secondary care services could include; better health status, secondary care needs being managed by other services e.g. primary care, or unmet need for secondary care services. Māori in South Kaipara had higher rates of secondary care use compared to Non-Māori which likely reflects higher health care need for this group. However, Māori children had lower rates for outpatient appointments, emergency attendance and acute admissions compared to Non- Māori children in South Kaipara. These lower rates of secondary care use are surprising given the higher burden of disease for Māori children seen regionally and nationally and suggest unmet need for secondary care services among Māori children in South Kaipara. Hospital Outpatient Services The largest volumes of outpatient attendances were for mental health, oncology, orthopaedic surgery, ophthalmology and geriatric services. Rates for mental health outpatients were 18% lower for South Kaipara compared to Waitemata DHB. Rates for individuals attending mental health appointments were 3% lower for South Kaipara compared to Waitemata DHB. This suggests South Kaipara residents’ access mental health outpatient services less than the rest of Waitemata DHB and those who do access services have less frequent contact with the service when compared to Waitemata DHB. Emergency Department Attendances and Acute Admissions There was an average of fifteen attendances per day to emergency departments from people in South Kaipara. The majority of visits were to Waitemata DHB hospitals and were between 8am and 9pm, over half of those who attended where discharged home. There was an average of nine acute hospital admissions per day for people living in South Kaipara with angina and chest pain being the leading cause of acute admission.

Recommendations 1. A comprehensive ‘one stop’ approach for health and social services a. Expand the Alison McKenzie House Project to include a whole of facilities master planning project to review facilities planning for the whole Helensville Health Campus*. b. Expand co-location of community health services at Helensville Health Campus, including hot desks, bookable rooms and flexible workspaces for community services. c. Expand co-location of health and social services in the Helensville Health Campus including social workers and other social agencies e.g. housing and welfare agencies. d. Community engagement and input into the redesign of Helensville Health Campus. *recommendation already enacted December 2017 2. A comprehensive ‘one team’ approach for health and social services a. Explore the feasibility of introducing Health Care Home models of care to general practices in South Kaipara*. b. Better communication and collaboration (according to patient permissions) between health providers enabled by technology e.g. patient portals and shared care views. * This model of care supports improved access to general practice services, management of patient demand, communication and coordination of care, patient self-management and practice efficiency. 3. Increase locally available health services for people in South Kaipara a. Explore the feasibility of additional mental health services including addiction services, youth services and talking therapies. b. Explore the feasibility of additional satellite hospital outpatient clinics held in South Kaipara with a focus on clinics with the highest volume of appointments including mental health, oncology, orthopaedics, ophthalmology and health of older people. c. Explore the feasibility of offering publically funded radiology services e.g. plain X-rays and ultrasound in South Kaipara. d. Explore the feasibility of youth services such as the Youth Hub providing satellite clinics in a youth focused setting in South Kaipara. e. Explore the feasibility of expanding the role of a local general practice to include an urgent care facility to increase local access to afterhours primary care and accident and medical services.

4. Mobile nursing and setting based health services a. Explore the feasibility of mobile nursing services to delivery primary care services in the community for low income groups, isolated communities and older people. b. Explore the feasibility of additional primary care clinics in community settings e.g. schools and marae. c. Ensure any new mobile or setting based services work in collaboration with and complement existing mobile nursing and setting based services.

5. Tailor support for different groups a. Establish community based support groups for older people to promote social connections and health promotion delivered from a community hub e.g. Te Whare Oranga ō Parakai or local marae with support for transport if needed. b. Establish community based support groups for young mothers to promote social connections and parent craft delivered from a community hub e.g. local marae or Helensville Birthing Centre. c. Expand Māori models of care such as Whānau Ora to provide a holistic approach to whānau health and wellbeing that encompasses mental, physical, social, cultural and economic wellbeing.

6. Make it easier to navigate and engage with health and social services a. Additional navigator roles to support people in South Kaipara and their whānau to navigate health and social services. b. A local repository within Healthpoint with up to date information for service providers and community members on local health and social services.

7. Harness technology a. Promote and support the use of patient portals through awareness raising activities and community education groups to support computer literacy. b. Explore the feasibility of using technology for virtual hospital outpatient clinics.

8. Addressing social determinants of health a. Work with organisations and initiatives such as Te Puni Kōkiri, Habitat for Humanity and Kainga Ora to address poor quality housing stock in South Kaipara. b. Work with Auckland Transport to advocate for improvements to public transport and transport infrastructure for South Kaipara.

9. Support healthy lifestyles a. Work with local businesses, community groups and growers to promote healthy food environments and access to affordable healthy food in South Kaipara. b. Locally delivered nutrition and healthy lifestyle classes e.g. healthy eating on a budget, reading food labels and growing vegetables at home. c. Locally delivered fitness classes that are inclusive of all ages and abilities and combined with measures to support nutritional education and social connectedness.

10. Improve long term condition management and preventative care a. Develop systems in general practice (with support from ProCare) to identify patients with long term conditions requiring additional assessment or management for: i. Cardiovascular disease risk assessment ii. Diabetic control with a focus on treatment of microalbuminuria iii. Dual or triple therapy for cardiovascular disease primary and secondary prevention b. Develop systems in general practice (with support from ProCare) to identify patients requiring additional preventive care including: i. Childhood immunisations ii. Influenza vaccination for adults aged over 65 iii. Cervical smears iv. Smoking cessation support c. Explore the feasibility of community water fluoridation for Helensville and Muriwai treatment plants.

11. Investigate and address variations in the use of secondary care services a. To understand reasons for lower rates for use of outpatient appointments, emergency department attendance and acute admissions across all age groups in South Kaipara when compared to Waitemata DHB. b. To understand lower rates of use of outpatients, emergency department attendance and acute admissions for Māori children in South Kaipara compared to Non-Māori children. c. To understand lower attendance and frequency of contact with mental health services for people living in South Kaipara compared to Waitemata DHB.