E79 Bay of Plenty District Health Board Annual Report 2020 Bay of Plenty District Health Board Annual Report 2020

Presented to the House of Representatives pursuant www.bopdhb.govt.nz to section 150 of the Crown 1 Entities Act 2004 E79 Ministerial Directions BOPDHB complies with the following Ministerial Directions in accordance with the Crown Entities Act (section 151 (f)):

■ The 2011 Eligibility Direction issues under s.32 of the NZ Public Health and Disability Act 2000.

■ The requirement to implement the New Zealand Business Number (NZBN) in key systems by December 2018, issued in May 2016 under s.107 of the Crown Entities Act. Bay of Plenty ■ The direction to support a whole of Government approach issued in April 2014 under s.107 of the Crown Entities District Health Board Act. The three directions cover Procurement, ICT and Property. Procurement and ICT apply to Hutt Valley DHB.

■ The direction on the use of authentication services issued in July 2008, which continues to apply to all Crown agencies apart from those with sizable ICT business transactions and investment specifically listed within the 2014 Annual Report 2020 direction.

■ In addition DHBs were advised in March 2020 by the Minister of Health that he had issued a COVID-19 response direction.

The Bay of Plenty District Health Board Annual Report 2020

Produced in 2020 by the Bay of Plenty District Health Board PO Box 12024, Tauranga 3143 www.bopdhb.govt.nz

Find us Follow Find us Follow on us on on us on

ISSN: 2230-6447 (Print) ISSN: 2230-6455 (Electronic)

Photography by Brian Scantlebury 2 3 CONTENTS

01 Our Vision, Mission & Values Nga Moemoeā, Nga Kaupapa 5 Nga Moemoeā, Nga Kaupapa 6 Our District 7 Bay of Plenty District Health Board's Population 10 02 Our Priorities & Performance Mahi Whakariterite 13 Strategic Intentions/Priorities 14 Board Chair & Chief Executive Officer’s Report 17 Māori Health Gains and Development Year in Review 25 General Manager Corporate Services Report 32 Toi Te Ora Public Health Year In Review 33 Our Planning Priorities 35 03 Statement of Service Quality Pūrongo Ratonga 43 Clinical Director Health Quality & Safety Service Report 44 Quality and Safety Markers 45 Achieving our Vision of Healthy Thriving CommunitiesThrough Quality 46 04 Our Leadership Mana Tangata 53 Introduction and Objectives of the Board 54 Functions of the Board 55 Board Governance 56 Combined Community and Public Health and Disability Services Advisory Committee 59 Bay of Plenty Hospitals’ Advisory Committee 60 Audit, Finance and Risk Management Committee 61 Strategic Health Committee 63 CEO Performance and Remuneration Committee 64 Delegations 64 05 Our People Te Hunga Ora 67 Being a Good Employer 68 Staff Engagement and Partnership 76 Staff Status 2019/2020 78 06 Statement of Performance Pūrongo Mahi 83 Achievement in Health for the Bay of Plenty 85 Statement of Financial Performance by Output Class 89 Output Class Achievement Summary 90 Healthy Individuals – Mauri Ora 93 Healthy Families – Whānau Ora 100 Healthy Environments – Wai Ora 107 Statement of Responsibility for the Year Ended 30 June 2019 117 07 Financial Statements Pūrongo Pūtea 119 Statement of Comprehensive Revenue and Expense for the Year Ended 30 June 2020 120 Statement of Financial Position as at 30 June 2020 121 Statement of Changes in Net Assets/Equity for the Year Ended 30 June 2020 122 Statement of Cash Flows for the Year Ended 30 June 2020 123 Notes to the Financial Statements 124 08 Audit Report Pūrongo Aotake Pūtea 151 01 Our Vision, Mission & Values Nga Moemoeā, Nga Kaupapa

6 7 NGA MOEMOE, NGA KAUPAPA OUR DISTRICT He Pou Oranga Our VISION One of 20 District Health Boards (DHBs) in New Zealand Tā Mātou Moemoea Tangata Whenua Māori Healthy, Thriving Communities – Kia Determinants of Health The Bay of Plenty District The BOPDHB has a purpose Momoho Te Hāpori Oranga Principles Health Board (BOPDHB) of funding and providing Wairuatanga was established under the personal health services, Understanding and engaging in a spiritual New Zealand Health and public health services and existence. Disability Act 2000. This disability support services Our MISSION Rangatiratanga Act sets out the roles and for the Western and Eastern Positive leadership. Tā Mātou Matakite functions of DHBs1. Bay of Plenty. Enabling communities to achieve good Manaakitanga health, independence and access to Show of respect or kindness and support. Waihi Beach quality services. Kotahitanga Katikati Maintaining unity of purpose and direction.

Mount Whangaparaoa Bay Maunganui Ukaipotanga Waihau Bay Place of belonging, purpose and Tauranga Papamoa Beach Whanarua Bay Maketu importance. Pukehina Beach Te Kaha Our VALUES Te Puke Kaitiakitanga Paengaroa Ā Mātou Uara Matata Guardianship and stewardship over people, Whakatāne Our CARE values underpin the way we Edgecumbe land and resource. Ohope work together to provide you with a Awakeri Opōtiki better-connected health system that is Te Teko Whānaungatanga Kawerau patient and whānau centred. Taneatua Being part of and contributing collectively. Pukengatanga Teaching, preserving and creating knowledge.

Murupara CARE Compassion All-one-team Responsive Excellence The CARE values are aligned to our He Pou Oranga Tangata Whenua Māori Determinants of Health Principles.

Compassion All-one-team Responsive Excellence Manaakitanga

8 1. New Zealand Health and Disability Act 2000 9

Uphold Te Tiriti O Waitangi & Our Community Based Acute Care Indigenous Rights Avoidable Hospital Admissions Be A Toi Ora Change Leader Care In The Community Illuminate & Advance Toi Ora System Performance Ambulatory Child Health Elevate Wai Ora & Reduce Acute Mental Health & Addictions Redesign iving C hr om Demand T m , y u th n Evolving Our Culture l it a i e e Whakamana Whanau With Solutions s H

Embedded In Aroha Agile Business Culture & Processes

K a ia g Support Iwi Led Development n Workforce Wellbeing Support Team m o ra m o ri oh o o te hap Develop Our Toi Ora Leaders, Coordinated Transformation Workforce & Providers Leadership Evolution Invest In Toi Ora Innovation ā Financial Sustainability Quality & Safety Improvement

10 11 BOPDHB’S POPULATION

The Bay of Plenty District Health Board (BOPDHB) is one of 20 DHBs in New Zealand, and one of five DHBs that make Ethnic mix 2019/20 up the Midland region. We serve a population of approximately 255,1102 residents (199,751 living in Western Bay Bay of Plenty has a higher proportion of Māori in comparison to the national average, and a lower proportion of Pacific of Plenty, and 55,359 in the Eastern Bay of Plenty), for the major population centres of Tauranga, Katikati, Te Puke, People. Whakatāne, Kawerau and Ōpōtiki. Of this, 31% are under 25 and 25.6% identify as having Māori ethnicity, and like the national population, our population is ageing (currently 20% aged 65 or over, and forecast to reach 23% in 2026). DHB Population Eighteen Iwi are located within our district. 80 77.8% National Population 73.2% The Bay of Plenty is growing at a faster rate than the New Zealand population, as a whole. The forecast for population 70 growth from 2016 to 2026 is 20.5% with the majority of the growth expected to be in the Western Bay of Plenty region (particularly Tauranga city) with the Eastern Bay of Plenty expected to experience a static or declining population. 60 78.3% of our population resides in the Western Bay of Plenty3.

■ The BOP is strongly bicultural with 25% of residents Māori. 50

■ 20% of our residents are 65 or older. This is expected to grow to 25% by 2026. The over 85 age group in particular 40 will grow from 5,580 to 8,280 people. The 2011-2014 New Zealand Health Survey recorded that 19.5% of the Bay of Plenty population are current 30 ■ 24.9% smokers. This is higher than the national average of 17.7%. 20 ■ The rate of obesity in BOP is higher than the NZ average at nearly 32% of all adults. 15.7%

The BOPDHB acknowledges these challenges and are refocusing their approach to achieving health outcomes. This 10 6.5% will become more collaborative with community and agencies outside the health sector, with emphasis on Health in all 1.9% Policies. Over the next thirty years, progressing to determinants of health approach, through a collective effort will be 0 required to improve health of all New Zealanders4. Other Maori Ethnicity Pacific Ethnicity

Population by Age 2019/20 Deprivation 2019/20 Bay of Plenty’s population tends to be older than the national average5. Bay of Plenty has a relatively low proportion of people in the least deprived section of the population while the most deprived sections are over-represented. 20 DHB Population National Population 70000 Other Māori 60000 Pacific 15.1% 15 50000 13.3% 12.8% 13.1%12.8% 12.9% 13.0%12.8% 12.4% 12.0% 12.2% 40000 11.6% 10.9% 10.5% 30000 10 9.0% 20000 7.0% 10000

5 4.1% 0 3.0% Quintile 1 - Quintile 2 Quintile 3 Quintile 4 Quintile 5 - least deprived most deprived

0.8% 0.6% 0 00-09 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

2. MOH projected population for 2019/2020 based on 2018 census data. 3. http://www.bopdhb.govt.nz/your-dhb/about-your-dhb/ 4. Mason Drury November 2015. 12 5. Ministry of Health NZ 13 02 Our Priorities & Performance Mahi Whakariterite

14 15 STRATEGIC INTENTIONS/PRIORITIES

The BOPDHB Annual Report is where we report on our organisational progress as well as performance related to the Te Toi Ahorangi 2030 provides a strategic framework that describes a unified vision, voice and intention to Annual Plan 2019-2020, towards achieving our vision – Kia Momoho te Hapūri Oranga, Healthy Thriving Communities. successfully influence health and wellbeing outcomes for tangata whenua and all people living in Te Moana ā Toi, Te Tiriti o Waitangi is central to our identity and mission, and we acknowledge our partners in that journey, the DHB from preconception throughout the life course. This vision directly aligns with He Korowai Oranga, the Government's Māori Health Rūnanga. national Māori Health Strategy and vision of Pae Ora - healthy, Māori futures.

Over the next ten years, the BOPDHB and the Māori Health Rūnanga (collectively known as Te Kohao o Te Waka o Toi) commit to working together, partnering for outcomes across sectors and ensuring that tangata whenua determinants of wellbeing are addressed and invested here in Te Moana ā Toi.

The Bay of Plenty Strategic Health Services Plan 2017-27 sets the scene for what we need to focus on to support our communities to be healthy and thriving. It guides us to provide health services which better support people to stay well and manage their own health.

Our fresh approach for the Bay of Plenty Health System

ORITY POPULATI PRI ONS

re es ve su e is s n o rm ti c Live well te i d Pa g d g Empower our r n n tn a i e M o ct population to live r l d a s ā h n r h o t a t healthy lives i r i n p i h o s w t C l e a l e p h o I l y n e a g f P t o o n l r m e o

n a m

h t

i c o

e PATIENT AND

n T FAMILY CENTRED CARE – WHĀNAU ORA Stay well V Get well u Develop a smart fully l n integrated system to Evolve models of e e f r excellence across all of i a l provide care close to b f l our hospital services e where people live, learn, o s o work and play y ld a e d r 0 p e 0 o W s 10 p or tie t l kfo cili s e rce Fa ir F

V uln era le ble peop children and young

TE KŌHAO O TE WAKA O TOI

TE RŪNANGA HAUORA MĀORI O TE MOANA Ā TOI | BAY OF PLENTY DISTRICT HEALTH BOARD

BAY OF PLENTY STRATEGIC HEALTH SERVICES PLAN 13 16 17 BOARD CHAIR AND CHIEF EXECUTIVE OFFICER’S REPORT Achieving Health Equity Achieving equity in health and wellness is a focus for BOPDHB. Given our population make up and our obligations E mihi kau ana ēnei ki a koutou, e ngā rau rangatira mā, mai i ngā kurī ā Whārei ki Tihirau, mai i under Te Tiriti o Waitangi, the BOPDHB has further focused this priority to ensure that reducing Māori inequities are at Maketū ki Tongariro. He hokinga mahara ki a rātou i wehe ki te pō i te tau kua hipa, ā ka tangi tonu te the forefront of the work we do. ngākau ki a rātou i hinga i te parekura ki te Puia o Whakaari. E haere atu rā. Kua tau mai au ki raro i te korowai o ngā iwi o te rohe nei, ka nui te mihi atu, tēnā koutou katoa. Equity in health for the BOPDHB and the wider Manawa Taki region is aligned with all Articles and Principles in Te Tiriti o Waitangi, in particular Article III (which has an Equity focus) and the Principle of Equity. It is also aligned with We are pleased to present Bay of Plenty District Health Board’s Annual Report 2020 which describes and reflects on the United Nations Declaration on the Rights of Indigenous Peoples, which affirms the rights of Māori to determine, the activities, performance and achievements according to our national, regional and local priorities for the 2019/20 develop, maintain, access and administer programmes, medicines and practices that support optimal health and year. wellbeing. Finally, it incorporates and enhances the Ministry of Health’s definition. We have faced two significant challenges over the past 12 months with the Whakaari White Island disaster, and our In the Bay of Plenty, this means prioritising service delivery to achieve equity of access, equity of quality, and equity of health system’s response to COVID-19. We are proud of how the Bay of Plenty health system responded to both of outcomes for Māori that reflects aspirations and needs in the context of advancing overall health outcomes. these events, they brought the best out of our people in providing care for our community. Much learning has come from these events and we want to ensure we take the best of this forward as part of our approach to providing care and “Equity is purposeful investment of resources that transforms pathways of disadvantage to advantage: building a stronger health system in the coming years. 1. Supports rectifying differences that are avoidable, unfair and unjust: Te Toi Ahorangi 2030, our health equity strategy for Māori, sets a clear direction for tangata whenua and our DHB to It recognises that avoidable, unfair, and unjust differences in health are unacceptable. achieve Toi Ora, together. The strategy provides both room and support for self-determination in the provision of care 2. Proportionate investment of resources based on rights and needs: by Māori, for Māori. This is important for our DHB as a party to the Treaty of Waitangi, and is essential to our 18 Iwi – It requires that people with different levels of advantage, receive proportionate investment of resources and our Te Tiriti o Waitangi partners, as collectively we work towards strengthening an authentic relationship that supports approaches based on rights and need. tangata whenua to define, decide and determine wellness pathways.

3. Implements Te Tiriti o Waitangi in contemporary ways at system and service levels: Our emergency responses, population growth and increased demand for services have continued to remain key It demands a health and disability system that is committed to implementing Te Tiriti o Waitangi in contemporary pressures throughout this year, and these have required us to innovate and explore new models of care. Integration ways as a catalyst for success; that our system is culturally safe, competent and enabling of wellbeing. and adaption; partnering and collaboration; supporting our people to work at the top of their scope; and removing 4. Success is measured by equity of access, quality and/or outcomes: traditional barriers to change are some of the key approaches we will employ to deliver on our strategic vision We will know we have achieved equity when we see equity of access, quality and outcomes in the region; of Healthy Thriving Communities, now and on into the future. Towards this end, our revised strategic priorities in particularly for Māori and then for all others who are affected unnecessarily by disadvantage.” 2020/2021 are focused on:

Making measurable progress to achieve equity in health and wellness requires innovation and different approaches to ■ System Integration how services are delivered, as evident in both Te Toi Ahorangi and the Strategic Health Services Plan. ■ Evolving How We Work

■ Child Wellbeing

■ Mental Health

Having a strong focus on equity across these priorities areas will be critical as we look to improve the health and wellbeing of tangata whenua and reduce continuing health disparities.

Ultimately our values remain critical to our success, and we will continue to be guided by our CARE values (Compassion, All-one-team, Responsive and Excellence) both within the organisation, and across the wider health network. We have a truly amazing network of healthcare professionals in the Bay of Plenty whose ongoing hard work and commitment to providing the best care they can is one of our greatest assets. With the immense and ongoing challenges of the Whakaari eruption and COVID-19 that our frontline teams have faced in the last year, we want to take this opportunity to acknowledge and sincerely thank you all for the incredible way you’ve worked together, supported each other and navigated the challenges and opportunities which were presented to you.

1.4 Signatories Agreement dated August 2020 for the BOPDHB Annual Plan 2020/21 Between:

Sharon Shea Pete Chandler Interim Chair Chief Executive Officer

The Honourable Chris Hipkins Sharon Shea Simon Everitt Pouroto Ngaropo Minister of Health Interim Chair Interim Chief Executive Chair Te Rūnanga Hauora 18 Date: 15/10/2020 Bay of Plenty District Health Bay of Plenty District Health Māori ō te Moana ā Toi 19 Board Board

A number of sections of this annual plan have been jointly developed between our organisations and the BOPDHB. We are committed to working in partnership with the BOPDHB to ensure achievement of the outcomes described in this plan.

Chad Paraone Greig Dean Janice Kuka Chairperson Chief Executive Officer Chief Executive Officer Eastern Bay Primary Health Alliance Eastern Bay Primary Health Alliance Ngā Mataapuna Oranga

Melanie Tata Luke Bradford Lindsey Webber Co-Chairperson Co-Chairperson Chief Executive Officer Western Bay of Plenty Primary Western Bay of Plenty Primary Western Bay of Plenty PHO Health Organisation Health Organisation

11

COVID-19 and BOPDHB Executive Director Reviews New Zealand saw its first case of COVID-19 on 23rd February 2020. In response to the increasing number of positive Over the last year we continued to aim to be a high performing healthcare system while meeting the needs of our cases, restrictions were progressively put in place to increase personal and public safety across the country. The community, and have undertaken many great initiatives, some of which are highlighted below: whole of the country was placed into level 4 lockdown on 25th March 2020.

BOPDHB stood up the Emergency Operations Centre (EOC) mid-March supported by the response teams of Toi Te Te Toi Ahorangi Ora; Maori Health Gains and Development (MHGD) and Community Health Based Services (CHBS) with the Technical Our Māori Health Strategy, Te Toi Ahorangi 2030, sets a clear direction for tangata whenua and our DHB to achieve Advisory Group (TAG) providing clinical advice. Toi Ora, together. We are proud of this Treaty-led approach to health and it is significant for our DHB and our eighteen Response to COVID-19 aligned to national directives and Ministry of Health’s advice. Measures were put in place to Iwi – our Te Tiriti o Waitangi partners, as we work towards strengthening our relationships. This will support Tangata ensure physical distancing for staff and patients; management of vulnerable staff; non-urgent and non-emergency Whenua to define, decide and determine their own wellness pathways, according to a Māori worldview. A more procedures deferred to provide hospital capacity; appointments managed using telehealth solutions; restrictions comprehensive review is further in the document. placed on hospital visiting and Personal Protective Equipment (PPE) provided to DHB and non DHB health providers. All BOP health provider entities undertook significant activity and planning to ensure readiness for the potential of the Nursing COVID-19 pandemic at the level of “Red Alert – Severe Impact on both the hospitals and our communities”. DHB staff 2019/20 saw the development of the inaugural cross-sector Nursing Strategy 2019 – 2024 for the BOPDHB. This worked with Aged Residential Care and other Residential Care facilities to prepare for potential COVID-19 outbreaks. Nursing Strategy was developed in partnership with nurse leaders, who provide services to the population of the Some non-discretionary surgeries, such as cancers where performed in private facilities. BOPDHB, across hospital and community settings. The strategy outlines nursing’s key priorities and the outcomes Community Based Assessment Centres (CBACs) were set-up across the region in partnership with our community we wish to achieve over the next five years. Each part of the health sector will develop their own short to medium term providers. MHGD partnered with Iwi in the Eastern Bay in providing mobile clinics for our rural communities. More than actions related to the five strategic priorities. 12,800 people presented for assessment and of these 77% were swabbed. Since the first week in June testing and The strategy is underpinned by our obligations under Te Tiriti o Waitangi to achieve Māori health aspirations and equity assessment transferred to General Practice. for Māori.

Among the 47 COVID-19 BOP cases, three individuals in the Bay of Plenty district were hospitalised with the last In alignment with Te Toi Ahorangi we will prioritise the needs and aspirations of our people utilising a Toi Ora wellness positive case notified on 19/04/2020. During April an outbreak occurred in a Tauranga Hospital inpatient ward approach. We want to improve the lives of our most disadvantaged whānau, and shift resources from acute illness resulting in four positive cases. Contact tracing was, and continues to be, a key factor in managing the impact of all centred services towards upstream wellness and prevention built on He Pou Oranga Tangata Whenua. reported cases. Local surveillance testing of asymptomatic individuals occurred in May and all returned negative tests for COVID-19. Within the hospital setting BOPDHB is the leading DHB nationally achieving 96% towards full implementation of the Care Capacity Demand Management (CCDM) programme by June 2021, as required under the terms of the 2018 BOPDHB experienced significant financial coats and lost revenue as a result of the COVID-19 response. These NZNO MECA. included additional costs of; setting up and staffing CBACs; personal protective equipment (PPE); facility changes; staff support and accommodation; IT equipment, and addressing the backlog of cancelled and deferred services. Allied Health The DHB moved into a transition phase towards the end of May, aware of the need to have a high level of agility and There have been some changes in the Allied Health Scientific and Technical (AHST) leadership in 2019, with Martin readiness to quickly respond to a further wave of COVID-19. The activity during this phase is based around four Chadwick taking up a new role as Chief Allied Health Professions Officer in the Ministry of Health. Sarah Mitchell perspectives as shown in the following diagram: was appointed as his successor in March and is further developing the work started by Martin to ensure the AHST workforce is making a significant contribution to driving service improvement and sustainability across community and acute sectors. The breadth and depth of AHST skills and their reach across people’s lives, communities and TOI ORA organisations makes them ideally placed to lead and support services towards a greater focus on prevention and early Te Moana ā Toi | Bay of Plenty District Health Board intervention.

Some exciting initiatives include:

EOC & Demobilisation Innovation & Change ■ the community enablement project which focuses on delivering responsive services closer to peoples home as part Readiness Community & equity based Data reconfigure EOC resources focus to health services of the keeping Me well initiative, Evaluation & update pandemic Progressing positive changes plans ■ the community orthopaedic triage service which focuses on enabling adults with musculoskeletal conditions to Functioning IOC access appropriate triage, assessment and early interventions closer to home, (Integrated Ops Centre) Acute respiratory Illness management ■ the Emergency Department musculoskeletal (MSK) initiative which focuses on first point of contact physiotherapy triage, assessment and intervention for people presenting with MSK conditions, Tika Pono Aroha Wairua ■ the AWESOMM research initiative which focuses on improving the health and wellbeing of older adults,

■ the LifeCurve initiative supporting people to improve their health and well-being utilising technology,

■ the child development innovation project which focuses on creating community connections and responsive Toi te Ora Community Recovery services for children with developmental needs. Surveillance Psychosocial recovery Case Investigation Linking with EMBOP Monitoring (including Civil Defence, Police, Readiness St Johns)

20 21 Information Management Māori Health Rūnanga Chair's Report BOP is the first DHB in Te Manawa Taki delivering the Midland Clinic Portal in 2020. It provides an excellent launch- "In the now is all time. This means that what we do today matters for our tomorrow. pad to improve consistence, efficiency and standardization for digital patient records. By the end of 2020, BOPDHB We must work together to ensure we leave flourishing legacies for our future generations” will complete Microsoft Modern Workplace Programme including the latest Windows 10 along with Office Pro Plus to our workforce. This programme enables us to work in a modern and secure platform and provide us with flexible ways “Te tini o Toi, Te waka o Toi, kia puawai ai te toi ora o ngā iwi katoa” of accessing our information and collaboration. We have also started Digital Health Strategy development. This work will deliver a shared Digital Health Vision/Strategy and a high-level roadmap to demonstrate how the future digital Te Rūnanga Hauora Māori o Te Moana ā Toi aims to restore the balance strategy will enable the BOP Strategic Health Service Plan 2017 – 2027 and Te Toi Ahorangi. of power and reset our relationship with the Bay of Plenty District Health Governance Board. Te Toi Ahorangi strategizes how, we as Iwi, Mental Health and Addictions Services will determine our own health and wellbeing as tangata whenua.

BOPDHB has begun a journey of transformation of it’s mental health and addiction system in response to the Te Rūnanga exists to optimise the total wellbeing of whānau, hapū challenges of He Ara Oranga, the Government’s report into the Inquiry of Mental Health and Addiction, and the marae Iwi and Māori of Te Moana ā Toi. submission of Te Tumu Whakarae (the National DHB GM Māori Strategic Reference Group). Te Toi Ahorangi provides As tangata whenua, we acknowledge that when we are able to our strategic framework and ensures Iwi and kaupapa Māori partners leadership to the transformation. This journey determine, define and decide our own hauora ( health) and toi has included a range of communications, opportunities for feedback, hui and wānanga across the current Mental ora(wellbeing); as well as the direction and shape of our own Health and Addiction sector, inclusive of Secondary Specialist Services, NGOs, Kaupapa and Iwi providers and Lived environments, communities and development - we will flourish we will Experience leaders. Currently this journey has been focused on the establishment of a representative governance achieve Toi Ora. structure to help lead this significant programme of work into the future. For our Kaupapa and Iwi providers this has included considering their position as Tiriti partners (as per the findings of Wai 2575) in leading this mahi for Whānau We acknowledge that we have essential strengths derived from the Māori. Creator, Io Te Waiora, connecting to our environment and our ancestors and in turn, a level of resilience from our experience through the colonisation period, but by the cultural and spiritual values of ngā pou mana o Io, he pou Within this transformation mahi, significant programmes of work are also under way including the sectors response oranga, this foundation has enabled us to shift from disempowerment to empowerment. Te Toi Ahorangi is a model to various Request For Proposals led by the Ministry of Health as part of its Expanding Access and Choice initiative in of practice that reflects the spiritual , ancestral and cultural aspirations of our people as an enabler to reindigenize primary mental health and addiction, and also the rebuild of both Tauranga and Whakatāne’s inpatient facilities. More our people so they will once again flourish from a tangata whenua perspective shifting from Kahupō to Toi Ora. ( significant than the potential for new services and facilities that this funding presents are the changes to models of disconnection to reconnection). In this generation, our whānau, hapū, marae, Iwi and Māori will be valued and our care and new ways of working that are the opportunity these initiatives provide. world view will become the norm which will raise the confidence of our people to realise their ultimate potential, strong Other steps in this work and in the application of initial funding as part of the Wellbeing Budget and Mental Health in their identity and confident in their rights as tangata whenua. ringfence, has been to support the sustainability and parity of funding for existing NGO services. Other tests of change have included working towards an integrated crisis service delivery model across secondary and kaupapa services Our Iwi in the Eastern Bay, investment supporting the establishment of peer-led support groups for those who experience suicide grief/loss, and the establishment of flexible Whānau Ora wraparound respite options in the Eastern BOP. The Our unique composition as a collective of Iwi across thethe Bay of Plenty within the Bay of Plenty District Health intent of our initiatives is to move BOPDHB closer towards Toi Ora, which is consistent with He Ara Oranga regarding Board (BOPDHB) region gives effect to our status as Te Tiriti o Waitangi partners and as mana whenua, mana closer to home, community-based care and early intervention as priorities. This is a return to the knowledge of our Iwi: rangatira,manamoana motuhake and mana tangata of our respective tribal regions. The Māori Health Rūnanga E hoki koe ki ō maunga, ki ō awa, kia pūrea koe e ngā hauora ō Tāwhiritmātea. provides a platform for Ngāi Tai, Ngāi Te Rangi, Ngāti Awa, Ngāti Mākino, Ngāti Manawa, Ngāti Pūkenga, Ngāti Ranginui, Ngāti Rangitihi, Ngāti Tūwharetoa ki Kawerau, Ngāti Whakahemo, Ngāti Whakaue ki Maketū, Ngāti Whare, Facilities and Business Operations Tapuika, Te Whānau ā Apanui, Te Whānau ā Te Ēhutu, Waitaha and Te Whakatōhea to influence the decision-making processes of the BOPDHB Board and ensure meaningful engagement that brings to life the spirit and the essence of Facilities & Business Operations (FBO) is the new name given to the service formed following a joint review of our Treaty relationship in all the decisions that we make for and on behalf of our people. Property Services (PS) and Hospital Support Services (HSS). Over time, Tauranga and Whakatāne Hospitals have grown in size and complexity and the scope of services managed by PS and HSS increased. Our new service is comprised of a dedicated team specialising in facilities management, project management, clinical engineering, security, non-clinical support services and sustainability. The focus of the non-clinical support services is to ensure major contracts, cleaning, food and linen, deliver quality and value for money.

Sustainability The Minister’s Letter of Expectations highlighted the importance of DHBs doing what they can to reduce their carbon Pouroto Ngaropo emissions. This year our Sustainability Coordinator has undertaken the huge task of developing a sustainability Chair I Te Rūnanga Hauora Māori o Te Moana ā Toi strategy.

As well as this, we have recently procured three new Hybrid fleet cars for Community Allied Health, in our journey towards a cleaner greener fleet. We will continue to look at better ways to respond to climate change over the next year to achieve the global goal of carbon neutrality by 2050.

22 23 Our Leadership | Te Tira Hou Normalising He Pou Oranga Tēnei te tira hou, tēnei hara mai nei! Tangata Whenua Determinants of wellbeing

Our executive team continues to maintain a strong and influential partnership with the Board on behalf of the We look to our tūpuna as examples of wellness. Our tūpuna have laid the foundation and the cultural blueprint hence tangata whenua of Te Moana ā Toi. It has been a good strong year transitioning our executive and our secretarial the word ‘mokopuna’ I am the blueprint of my ancestors and this is what it means to be flourishing by being the administration from a stand alone rūnanga position to integration which is reflective of our one team approach blueprint, “kia puāwai ai te Toi Ora”. with the executive leadership and the operational leadership of Māori Health Rūnanga and Maori Health Gains and He Pou Oranga Tangata Whenua (Te Rūnanga Hauora Māori o Te Moana ā Toi, 2007) provides direction on how Development. Our priority is to always ensure our leadership is representing the direction of our terms of reference to implement and normalize tangata whenua values that lead to Toi Ora. Ngā Pou Mana o Io, the foundation and memorandum of understanding to provide guidance and advice at a strategic governance level to the Bay cornerstones of He Pou Oranga Tangata Whenua - Mana Atua (Spiritual wellness), Mana Tūpuna (Ancestral of Plenty District Health Board and the Senior Executive team including our newly appointed Manukura, Marama knowledge and wisdom), Mana Whenua (In the now is all time, past, present and future, land and environment), Tauranga and Māori Health Gains and Development Services throughout the organisation and interaction and Mana Moana (The health of our waterways and oceans) and Mana Tangata (Creating a pathway of empowerment for engagement with our Māori Providers. It is our role and responsibility to maintain representation throughout the all) underpin a tangata whenua worldview that connects to clinical health. Combined, these two dimensions lead us on organisation as the Treaty partner. the pathway to Te Toi Ora.

These foundation cornerstones navigate us towards our ancestral teachings, principles and knowledge systems that are in alignment with our own māramataka, rongoā, kawa, tikanga, reo and mātauranga. He Pou Oranga supports us to lead flourishing lives as, whānau, hapū, marae, Iwi and Māori. By seeing our world through our own eyes, we are able to articulate our optimum spiritual, mental, social, emotional and physical wellbeing and these principle and values can be realised.

When we support our people to exercise their mana, we encourage their mauri to flourish.

Mana Atua Pouroto Ngaropo Punohu McCausland Rutu Maxwell-Swinton Linda Steel Chair Deputy Chair Member Member Our creation from Io Matua Nui and our connection to the spiritual world, influences how we interact with our Atua, Ngāti Awa Waitaha Tapuika Ngai Tai whose spiritual presence is embodied within the natural world. Spiritual Wellness is key in reclaiming our belief that all elements of health must have a holistic approach. The spiritual health provides spiritual wellness from the Creator to our environment, to our ancestors, to us.

Mana Tūpuna Our connection to our ancestors unites us all as tangata whenua through our whakapapa, strengthening our collective Māori Health Rūnanga Membership 2019/20 spirit and guiding our ultimate direction to Toi Ora through the ancient knowledge and wisdom from our past which Iwi Member guides our present, which influences our tomorrow. Ngati Awa Pouroto Ngaropo (Chairman) Mana Whenua Waitahā Punohu McCausland (Deputy Chair) Tapuika Rutu Maxwell-Swinton (Executive Member) Our connection to time, space, location and environment connects us to our tūrangawaewae that affirms our rights to Ngai Tai Linda Steel ( Executive Member) be self-determining over our ancestral lands, waterways and the environment in which our whānau, hapū, marae and Te Whānau ā Apanui - Te Whānau ā Te Ehutu Astrid Tawhai Iwi originate from connecting them to the core of their beginnings. Kia toi ora ai te taiao, ka ora ai te tangata- when the Whakatōhea Dickie Farrar environment is healthy and well, the people are healthy and well. Ngāti Manawa John Porima Ngāti Tūwharetoa ki Kawerau Ngāti Pūkenga Titihuia Pakeho Mana Moana Ngai Te Rangi Kipouaka Pukekura-Marsden Our connectedness to the oceans and beyond awakens the universal sound which ignites the soul and spirit within as Ngāti Ranginui Tamar Courtney an umbilicus cord to the ocean and waterways as is likened to the nurturing and sustaining of a baby as it grows and Ngāti Whakahemo Margaret Hinepo Williams develops in the sacred womb of its mother. It must have water to survive as we too must have water and be connected Ngāti Rangitihi Robin Cheung to the oceans and waterways around us as water flows within us and sustains us. “Ko au te wai, ko te wai ko au”-“ I am the water and the water is me.” It affirms our way-finding legacies and our unique relationship to Tangaroa, including our responsibilities as kaitiaki.

Mana Tangata Our unique identity, qualities, personalities and genetic DNA and attributes as Ira tangata ( human beings) and as Io Whatukura (tāne) and Io Mareikura (wāhine), affirms who we are, why we are here, our contribution to the journey and our purpose and special place within our whānau, hapū, marae Iwi and te ao tūroa ( the world in which we live).

24 25 MĀORI HEALTH GAINS AND DEVELOPMENT YEAR IN REVIEW Ngā Kaupapa Matua Ihoiho The main objectives that the Rūnanga are proud for this financial year, 2019-2020 are the following: Every component of the last 12 months has been about Toi Ora change; preparing our people, developing systems and processes and most importantly transforming ourselves to become Toi Ora champions and change leaders. Part of a) The integration of our administration within the operational arm of Māori Health Gains and Development enabling preparing the change has been to work towards integrating and reviewing our current business as usual activities such a more timely approach in the Rūnanga business and ensuring our resourcing to enable quality performance in all as the Kaupapa Ward, outpatient clinics, community nursing, our Te Pou Kokiri and ongoing review of processes and Rūnanga matters and business and the decisions that are made. systems in planning and funding.

b) The new appointment of the new CEO, the new appointment of the Manukura. Te Toi Ahorangi is providing the catalyst for change in our system, it has sparked the imagination, provided a call to c) The adoption of Te Toi Ahorangi. action and the motivation to move with purpose and act with integrity for Toi Ora. Our rautaki has ignited Māori Health Gains and Development (MHGD) to think ‘big’ for there is no passion to be found playing small and settling for less d) Working in collaboration with the DHB Board. or maintaining the status quo. Our mission; Toi Tu te Kupu, Toi Tu te Mana, Toi Tu te Ora has required courage and e) Working in collaboration with Te Roopu Manawataki. determination from the team over the past year, because at it’s core Te Toi Ahorangi, is all about ‘flourishing’, and there is an absolute commitment to ‘flourishing’ within the whānau of MHGD. f) Responding culturally , spiritually to Whakaari and the spiritul rahui and support from our Iwi to ensure cultural integrity. We realise that authentic partnership requires authentic dialogue and action, our service and the organisation has been very well supported by the Rūnanga and Te Amorangi Kahui Kaumatua. In the past year there has been greater g) Our whānau hapū, Iwi, maae and Māori providers gave full support and responded to COVID-19. integration of Te Reo Māori both in and beyond the Kaupapa Ward, this has begun the redevelopment of our current bilingual signage policy and is contributing to the design of an indigenizing space protocol. Relationships with the Rūnanga, the Te Amorangi Kahui Kaumatua council have ensured tikanga and kawa are central to our authenticity as a service and an organisation.

Marama Tauranga Manukura - Executive Director Toi Ora

26 27 2019 / 2020 Highlights Whare Waka Te Toi Ahorangi was initiated in late 2019 which required a well-considered deployment plan to ensure the vision of Toi Ora is reached. In 2020, the Whare Waka (PMO) was established to undertake three pieces of work: 1. Embed Māori Health Gains & Development (MHGD) restructure 2. Establish a Te Toi Ahorangi Programme Management Office 3. Deploy Te Toi Ahorangi

1. Embed Māori Health Gains and Development restructure Preparing MHGD for readiness for change has been underway through the introduction of several innovations to improve inefficiencies and reduce waste. The MHGD team has been structured with the Manukura, Leadership Team, Operational Team, Clinical Team and Planning and Funding Team. Each group works from one 12-month plan that originates for the Te Toi Ahorangi 12-month plan. Each tier breaks down the 12-month plan to meet the needs and requirements for their specific areas.

Lean thinking has been introduced with 6 Sigma, Hoshin Kanri, Trello boards and Promapping, all tools have already improved systems and processes and reduced waste by $50k.

In addition, six-week Toi Ora series for staff on becoming a Te Ora Change champion have been initiated and are expected to run for 12 months.

2. Establish a Te Toi Ahorangi Programme Management Office The Whare Waka (PMO) was established in early 2020 to manage the suite of programmes in preparation and deployment of Te Toi Ahorangi. The Whare Waka was designed with robust programme methodology including PRiNCE and Agile.

The Project Executive Team consists of: PROGRAMME EXECUTIVE ■ Manukura (Executive Director Māori Health) (Māori Health Gains & Development Manukura, ■ Rūnanga (Chair) Te Runanga Hauora Chair, DHB Executive) ■ BOPDHB (Board member) Te Amorangi Kahui The Ware Waka (PMO) have the following resource: Kaumatua Roopu ■ Ruahine (Tikanga expertise)

■ Programme/Project Manager WHAREWAKA MANAGER ■ Programme Coordinators

■ Decision Support Analyst Expert 3. Deploy Te Toi Ahorangi Advisory PROJECT MANAGERS/TEAM MEMBERS Group The Deployment of Te Toi Ahorangi was initiated in 2019 and has continued to build its structure and rigour. The first phase was preparing for the change, ADVISORY GROUP allowing time to understand and debate the Au Rangi. Through this a review was conducted for the Kaupapa Ward, an outcomes framework was initiated, and the transformational structure was put in place. This has resulted in a very considered approach with the first 12 mth programme plan being approached. MHGD have chosen to consult widely as the programme is being implemented to ensure Te Toi Ahorangi is agile and will sustain the journey.

Over the last 12 months the increased support from departments outside MHGD has been experienced with the example of Toi Te Ora establishing a senior Leadership role of Pou Oranga Ake who will join MHGD. Toi Oranga

28 29 Planning and Funding refocused their efforts on service development, enabling the Toi Oranga and Toi Awhina Our Wayfinding Compass positons to work more collaboratively within communities, alongside Hauora and those whānau with lived experience of the health system.

This has introduced a mahitahi (co-design, co-created) approach with stakeholder. Key areas they contributed to were:

■ Pahi Tahi

■ Development of Position Statements of Te Tiriti for BOPDHB

■ Y2575 support to the DHB

■ Partnering for outcomes

The Clinical Services move with the principles of toi ora change and has seen the following within the past 12 months:

■ Kaupapa Ward Review

■ Increasing Māori workforce across the DHB

■ Increased community visits

■ Increased demand by Māori for Māori service has tripled

■ Integration of Te Reo Māori signage in the Kaupapa Ward

The Quality Experience of patients is fundamental and the focus areas have been:

■ Employing a clinical quality co-ordinator as a pilot based on the principles of Toi Ora.

■ Whānau Navigator position enchanting quality improvement activity in the DHB

■ Working with Health Quality & Safety Commission on: Korero Mai

■ Deteriorating Patient Program is a project to empower whānau to escalate care concerns.

■ Interventions have been informed by Whānau.

■ Restorative Practice is the second project that is underway with HQSC.

Te Ora Pandemic Response Meeting our obligations under Te Tiriti o Waitangi to ensure Iwi, hapū, whānau, and Māori communities and organisations were active partners in preventing and addressing the potential impacts of COVID-19 was a key priority and driver for Maori Health Gains and Development response to COVID-19. The severe impact of the 1918/19 pandemic on Māori and the increased susceptibility of Māori to the 2009 H1N1 Influenza A pandemic (H1N1 pandemic) provides the rationale for setting up a Tikanga designed Coordinated Incident Māori System (C.I.M.S) to strengthening the DHB’s overall Pandemic Response for Māori. Te Toi Ahorangi change principles provided the strategic direction for MHGD response activities:

■ Toi Tu te Kupe: Tino Rangatiratanga for Iwi, Hapu pandemic response, commitment to being an authentic partner, ensuring access to essential information, resourcing and supporting Iwi and Kaupapa Provider initiatives e.g. pahi tahi.

■ Toi Tu te Mana: Address paucity of Māori data intelligence, monitoring and measuring our response benefits for Māori, utilising technology e.g. virtual management of MHGD EOC, looking after our workforce, using He Pou Oranga as a lens.

■ Toi Tu te Ora: Keeping our eyes on the horizon, eventually COVID-19 will end and when it does Māori in the Bay of Plenty must be left in a position to flourish over generations, Māori Health Gains and Development contribution to resilience, recovery and psychosocial coordination, involvement in Toi te Ora second phase planning and response including contact tracing and co-ordination with Pacific community.

30 31 Health Quality Safety Commission (HQSC) Partnership with Māori A mahitahi is a Te Ao Māori approach to co-design and is our preferred approach because at the core it is Te Tiriti o Waitangi based and uses He Pou Oranga Tangata Whenua determinants to keep our designs holistic and whānau Reducing Patient Deterioration centred. He Pou Oranga principles inform and work harmoniously with all the steps of the HQSC co-design element The HQSC’s Patient Deterioration Program aims to reduce the harm of failures to recognise, or respond to, acute model. physical deterioration of adult inpatients. The principles from He Pou Oranga Tangata Whenua and the aspirations of Te Toi Ahorangi that guide our Mahitahi The program involves three key work streams process are:

1. Standardised recognition and response systems i.e. EWS system ■ Te Tiriti o Waitangi – acknowledge the rights of whānau as descendants of Toi to exercise their rangatiratanga and 2. Patient - family and whānau escalation– Kōrero mai our responsibility as the Crown to work in authentic partnership

3. Shared goals of care ■ Rangatiratanga –whānau in phase 2 will be in authentic partnership with the project team; meaning their ideas for Kōrero Mai involved four DHB’s, including the BOPDHB and the commission requested that the Kaupapa Ward be design are valued and listened to and decision making cannot occur without them involved in the national program so that the commission could understand what whānau escalation looked like in a ■ Mana – whānau are experts in their lives and wellbeing. Ensure a balance of power in this process kaupapa model of care context. ■ Whānaungatanga – engage whānau representatives in a way which fosters relationships with the Kaupapa Ward Patients, families and whānau often recognise subtle signs of patient deterioration even when vital signs are normal. and builds trust in the design process and outcomes

Failures to adequately respond to concerns raised by patients, and whānau are commonly highlighted in adverse event ■ Manaakitanga – hosting whānau representatives for phase 2 meetings so that all barriers to participate are reports from the Health and Disability Commissioner associated with clinical deterioration. removed and that they feel safe and welcome. Using this principle privileges Tangata Whenua voice

Understanding what was in place to support escalation of whānau are a critical component of our partnership with ■ Ako –mutually reinforcing learning, distribute the power and control HQSC in the Kaupapa Ward for phase one of Kōrero mai. The principles in He Pou Oranga Tangata Whenua ensure the intervention we design would be utilised by whānau and “Communication failure is the most common theme identified in an analysis of clinical deterioration or the patient, and supports the removal of barriers which shifts the ‘don’t want to be a hoha mindset’. related to serious adverse events”

From a Te Ao Māori perspective, the current dominant biomedical model of deterioration is limited because it does Toi Ora Target Performance not consider all of the domains which constitute wellness for Māori. The maintenance of wellbeing or preventing Measurable improvements in performance for the Māori population we serve continue in Te Toi Ahorangi. The deterioration for Māori needs to take into consideration; mind, body and spirit perspectives, if a patient and or their DHB's ongoing focus on measurable improvements in performance and health outcomes have been demonstrated whānau have access to healers and or Tohunga. In addition two significant and fundamental aspects to the prevention by continued investment in personnel assigned to health target improvement, and the funding of performance of deterioration for Māori is whānau/ whakapapa and whenua considerations. improvement change initiatives. Coupled with reporting accountability to Executive Leadership and the Board, In the first phase of Kōrero Mai, survey’s of staff and patients and observational studies (interactions between staff the DHB's efforts have seen several highlights over the past year and these are discussed in the Statement of and patients) were performed. Performance.

The findings from phase 1 were: 1. Most patients on the Kaupapa Ward (85% of total sample) are aware of escalation protocols. Whānau awareness of the tools for escalation (using the bell or talking with a nurse) was the same for Māori and non-Māori. 2. Out of the total number of patients surveyed: 75% would escalate their concerns if they felt their condition was getting worse. However 25% of those surveyed would not escalate because they did not want to be a ‘hoha’. Escalation behaviour in the Kaupapa Ward is similar to overall patient behaviour in the other DHB’s undertaking this section of the program 3. All whānau we surveyed would escalate their concerns for a whānau member

Whānau recommendations for improving Māori confidence to escalate included:

■ Information sharing – ensuring whānau are fully informed of ward procedures (kawa)

■ Accessibility and responsiveness of staff

■ Process for regular patient and whānau feedback whilst they are on the ward, timely and constant dialogue

■ Whānaungatanga – consistency 24 hours per day as required

■ Addressing the ‘don’t want to be a hoha mindset’, removing those barriers and,

■ Staff demonstration of Tikanga Māori – all staff who are on the ward

BOPDHB Kōrero Mai phase 2 has commenced on August 12th, 2019. Phase 1 data will inform a mahitahi design of a Kaupapa Māori escalation process and tools.

32 33 GENERAL MANAGER CORPORATE SERVICES TOI TE ORA PUBLIC HEALTH YEAR IN REVIEW REPORT Toi Te Ora Public Health (Toi Te Ora) is the Public Health Unit for the Bay of Plenty and Lakes DHBs. The role of Toi Te Our annual report provides us with an opportunity to tell our community and our stakeholders what we have achieved Ora is to deliver services that promote, protect and improve population wellbeing, prevent ill health and minimise the over the last 12 months, and provides more context about the environment in which we have operated. risk of disease through interventions at a population level.

This year we report a deficit of $33.676m on a total revenue of $896.131m. This is a $23.176m unfavourable variance The 2019-2020 year has been an unusually challenging year for Toi Te Ora, with needing to respond to the measles to our annual plan deficit of $10.5m. Included in this variance is recognition of the potential remediation costs to epidemic, the ongoing COVID-19 pandemic, and staff providing support to the response to the Whakaari White comply with the Holiday’s Act 2003 and our response to both COVID-19 pandemic and Whakaari (White Island) Island Eruption. These events have provided the opportunity for staff to utilise emergency management training eruption. and highlighted the importance of strengthening community resilience in the coming year. These events have had a significant impact on the service’s capacity to progress many planned activities. In spite of this, there have been a Our financial position has deteriorated with a significant reduction in our cash closing balance of $2.4m compared great number of successes and achievements this year. with $21.277m for 2018/19. Under the Government instruction DHB’s were asked to pay 95% of domestic invoices within 10 working days. This alongside the deficit result has reduced our cash position. Our employee liabilities have Toi Te Ora launched a new strategic plan in October 2019. Central to the plan is a commitment to achieve health also increased as little to no annual leave entitlements were taken in the last quarter of the financial year due to the equity, particularly for Māori, and to Te Tiriti O Waitangi. We also continue to prioritise our efforts towards tamariki COVID-19 pandemic. and their whānau. Our strategic direction focuses on six areas which reflect current and emerging public health issues: Strengthening Community Resilience, Maternal and Infant Health, Preventing Childhood Infections, Childhood Even though our district continues to experience continued growth in our population, and our demography continues Smokefree, Healthy Housing, and Preventing Childhood Obesity. to age, as a result of the COVID-19 pandemic our treatment and discharge numbers are well below our targets and prior year figures. Toi Te Ora has finalised Te Iti Kahurangi, an internal Māori Health Action Plan, which aims to transform Toi Te Ora towards being a genuine Te Tiriti led service to achieve Māori health equity and Toi Ora. The plan has been endorsed The 2020/21 financial year will see the DHB enter a recovery phase following the COVID-19 lockdown as we by both the Bay of Plenty District Health Board (Bay of Plenty DHB) Manukura (General Manager) for Māori Health endeavour to reduce our waitlist for elective attendances and procedures. This will present financial challenges as we Gains and Development and the Lakes District Health Board General Manager of Māori Health. service the health needs of our community. In response to the efforts of Toi Te Ora, the Mount Maunganui Industrial Air-shed came into effect in November 2019. Toi Te Ora also continues to provide advice for improving air quality to the Bay of Plenty Regional Council and support Revenue ($000s) Expenditure ($000s) healthy policies as part of Regional Air Plan mediation appeals. Toi Te Ora was involved in four appeals, of which three were settled.

344,716 Toi Te Ora has supported the establishment of the 20 Degree Healthy Housing Programme, in collaboration with partners including regional energy trusts, district councils and the Bay of Plenty DHB. This programme was established with funding of $1.5 million from the partners for the three-year period 2020-2022 and has a focus on assisting communities to improve the condition and quality of their housing. 34,444 70,368 36,488 The new Healthy Active Learning service has been established with the appointment of the team, and the development 22,218 of regional partnerships with the Regional Ministry of Education Office, Sport Bay of Plenty and school principals 45,515 20,411 leadership group. Toi Te Ora is also pleased to be working alongside the Ministry of Education to support the 82,462 implementation of the free Lunch in Schools service in our region. 37,897 As a member of the Youth of Kopeopeo initiative based in Whakatāne, Toi Te Ora has collaborated with multiple organisations, including Whakatāne District Council, Kaupapa Māori organisations, and schools, to build community 819,146 312,347 wellbeing and resilience in a high needs community. This initiative involves the use of art, social media, storytelling, rangatahi and tamariki voice, and career guidance and training to empower youth. Youth of Kopeopeo was awarded second place in the 2019 Bay of Plenty DHB Innovation awards.

Crown Appropriation Revenue Clinical expenses Other MOH revenue Community Providers Other Revenue Depreciation, Interest & Capital Charge Services to other DHBS Infrastructure & Non-Clinical Supplies Outsourced Personnel Services from Other DHBS

Owen Wallace General Manager Corporate Services

34 35 OUR PLANNING PRIORITIES

The BOPDHB is guided by strategies that are integral to achieving the national vision that “All New Zealanders live well, stay well, get well, in a system that is people-powered, provides services closer to home, is designed for value and high performance, and works as one team in a smart system”.

Strengthening Community Resilience People- All communities are resilient powered to challenges in their environment. Mā te iwi hei kawe Preventing Childhood Maternal and Infant Health Obesity All wāhine experience good health before, during and after pregnancy so All tamariki have good food, that tamariki have the best start in adequate sleep and opportunities life, and that tamariki are for healthy activity. supported in their early Closer to Te oranga o development. Smart system home - He atamai te All nga tamariki whakaraupapa Ka aro mai ki New Zealanders te kāinga Caring for children's wellbeing live well Preventing Childhood stay well Healthy Housing Infections All tamariki have adequate, All tamariki are immunised get well warm and dry homes. and live in environments that prevent diseases of poverty. Value and high Childhood Smokefree One team performance All tamariki are born into Kotahi te tīma and grow up in a smokefree Te whāinga hua environment. me te tika o ngā mahi

NZ Health Strategy Annual Plan There were six key areas of focus for the BOPDHB for 2019/20, as directed by the Minister of Health Letter of Expectations:

The guidance and subsequent plan was structured to reflect these priorities, which were: - 1. Improving child wellbeing 2. Improving mental wellbeing 3. Improving wellbeing through prevention 4. Better population health outcomes supported by a strong and equitable public health and disability system 5. Better population health outcomes supported by primary health care 6. Strong fiscal management

During the year the Bay of Plenty experienced the Whakaari emergency as well as the COVID-19. BOPDHB spent 2019-2020 in a phase of transition and recovery, therefore some of the 2019-2020 planned activities were delayed. This had some effect of the BOPDHB’s performance.

36 37 Te Manawa Taki Regional Equity Plan over Te Manawa Taki, Regional Equity Plan 2020-2023, is the plan for the five Midland Region District Health Boards, working within a Te Tiriti o Waitangi partnership. This new plan reflects the way we will work together in order to 90% OF THE 428 implement true Te Tiriti o Waitangi based relationships to effect sustainable and positive partnered change over time. people have received CONTRACTS their first cancer BAY OF PLENTY Sustainability at Bay of Plenty District Health Board treatment within 31 days with health care providers DISTRICT HEALTH BOARD for health services to the At Bay of Plenty District Health Board (BOPDHB) we understand that while our work has positive outcomes for our A e Bay of Plenty community people, it consumes resources and impacts the environment, and therefore goals must be set to reduce these impacts year in the lif as much as possible, and to regenerate the environment where we can. 2020 31 BOPDHB views its sustainability principles and organisational purpose and vision holistically. By understanding and applying the concepts of the Kaitiakitanga Framework for Environmental Sustainability, we aim to work with stakeholders to protect our environment, culture, society, and economic stability, to enable our communities to get well, live well, and stay well.

Kaitiakitanga is one of the eight Pou Oranga in He Pou Oranga Tāngata Whenua. This pou is our acknowledgement 2,356 25.7% IDENTIFY AS HAVING MAORI ETHNICITY that we are all custodians of knowledge and practices that enhance our relationships with each other and our Serves a population of CHILDREN environment. received Financial Year 1 July 2019 – 30 June 2020 Carbon Footprint Information 255,110 26% ARE UNDER 20 Before School Checks 21.7% in the East YEARS OF AGE The graphs below illustrate BOPDHB’s audited carbon footprint information for the 2019/2020 Financial Year. 78.3% in the West Carbon Footprint by Emission Type 31% ARE UNDER 25 YEARS OF AGE

Energy (Natural Gas/ Electricity/Stationary Generators 4.23 Transport and Travel 16,536 MILLION 23% Other (Procurement) community pharmacy Planned care interventions prescriptions 2,723 BABIES delivered in 48% birthing facilities

100% 73,669 29% 1,535,544 of pre-schoolers are enrolled on the attendances at Oral health programme the Emergency Departments laboratory tests have been undertaken

community days 19 is the average 89.9% length of acute adult inpatient stay of patients received an MRI scan and report dispatched within 42 days of referral receipt

38 39 Carbon Footprint (~8464 tCO -e) compated with baseline FY18/19 (~9054 tCO -e) BOPDHB Carbon Footp2rint FY19/20 (~8464 tCO2-e) compared with baseline FY18/19 (~90542 tCO2-e) Changes in emissions activity FY19/20 compared with baseline year

Ntrl Activity – Emission Source Global Warming Potential Global Warming Potential Increase (+) / (t CO2e) FY19/20 (t CO2e) FY18/19 Reduction (-) Electricit (Baseline) ir rel - on l Natural Gas 2,948.06 2,881.57 +2.30% el (eicle n ciner) Electricity 1,118.14 1,191.94 -6.20% P�ent el Air Travel - Long Haul 969.92 1,173.9 -17.40% eicl e Fuels (vehicles and machinery) 635.25 674.26 -5.80%

e nr Serice c r Patient Meals 619.61 645.88 -4.10% u

o ir rel - Sort l S

s Medical Gases 599.69 570.69 +5.10% n

o te i s s

i Laundry Services 380.56 379.51 +0.30%

m ir rel - oe�c E

s Air Travel - Short Haul 240.44 436.88 -45.00% a P�ent rner ir G

e Waste 219.94 218.07 +0.90% s

u Prite r e o

h Air Travel - Domestic 177.04 248.86 -28.90% n

e eriernt e r Patient Transfers by Air 124.77 126.87 -1.70% G P�ent rner o Private Car Use 103.84 104.91 -1.00% ccoo�on Refrigerants 75.51 165.34 -54.30% Per e

entl eicle Patient Transfers by Road 68.35 52.52 +30.10%

St�onr ieel (enertor) Accommodation 57.77 74.39 -22.30%

i Paper Use 47.15 51.79 -9.00%

ter Rental Vehicles 43.35 33.37 -29.90% Stationary Diesel (Generators) 21.38 8.67 +146.60% 000 50000 00000 50000 200000 250000 300000 350000 Taxis 10.72 11.9 -9.90% lol rin Poten�al (t 2e) 20 lol rin Poten�al (t 2e) Water 2.23 3.02 -26.10% During the 2019/2020 year, BOPDHB saw an overall carbon footprint reduction of ~7.5% from the baseline year (FY18/19). This reduction is likely attributed to the COVID-19 response and recovery, rather than planned and We hope to see a reduction in GHG emissions attributed to business activities (and not COVID-19 response/recovery considered changes to business practice. For example, many of our administration based staff worked from home alone) over the coming months and years as we work to embed the Kaitiakitanga Framework into our practice, and during the Level 4 response, seeing a 20% reduction in electricity use at Tauranga Hospital for the month of April reach the goals of our Environmental Sustainability Action Plan. 2020. Further, we have seen a significant reduction in travel related greenhouse gas (GHG) emissions. For example, border closures have seen changes to the way that we travel for work, and we have seen a 25% reduction in carbon Sustainability Goals Financial Year 1 July 2019 – 30 June 2020 footprint relating to flights booked through our travel agent over the past year. These travel related reductions are Below are the five goals relating to environmental sustainability we set out to achieve over the 2019 – 2020 financial supporting discussions on changes we might make to the way that we work. year.

Goal 1. To form and establish Sustainability Team. Achieved. GHG Emissions Source % of Total Carbon Footprint (~8464 tCO2e) Environmental Sustainability is led in BOPDHB by the fulltime Sustainable Manager, Vicktoria Blake, who started in Road Patient a newly created role in June 2019. The Sustainability Manager is guided and supported by a Sustainability Steering Transport Meals 2.5 Group made up of executive and senior leadership representing various areas of the organisation. Further to this, two 10% 7% Medical Gases “green teams” are in place. The “Clinical” Green Team focuses on greening clinical practice and has a membership Refrigerants of +/- 40 clinicians from across the DHB. The “Non-Clinical” Green Team focuses on green practices that are not 7% 2.0 0.89% in a clinical setting, and sees a membership of +/- 50 clinical and non-clinical staff. Members of both teams act as Electricity sustainability champions in their various areas of the organisation, often spearheading initiatives and tests of change. 13% 5% 1.5 Waste 2% Laundry Services Accommodation Goal 2. Carry out and complete the audit and baseline creation of the BOPDHB Carbon Footprint utilising Other 3% 0.68% 1.0 CEMARS accreditation for FY1819. Achieved.

Air Travel Paper use The baseline year carbon footprint data was audited in February 2020, and BOPDHB achieved accreditation for Toitu 0.5 0.56% 18% Envirocare’s Carbonreduce programme (ex. Enviromark CEMARS programme) in March. Baseline year results are Natural Gas Stationary Diesel available on the Toitū website https://www.toitu.co.nz/our-members/members/bay-of-plenty-district-health-board. 35% 0.0 (generators) 0.25% Water 0.03% Systems are now in place to record the carbon footprint data throughout the year to allow reporting to align with the BOPDHB Annual Report.

40 41 Goal 3. Create a Sustainability Strategy to guide DHB Culture and Practice. Achieved. Sustainability Goals for Financial Year 1 July 2020 – 30 June 2021 The Kaitiakitanga Framework for Environmental Sustainability was endorsed by the BOPDHB Executive Committee in The following goals have been set for achievement over the coming financial year: February 2020. This framework outlines the environmental sustainability principles to be adopted by BOPDHB, and Goal 1. Paper use and printing activities are reduced by 25% from baseline year (FY18/19) assisted in informing the creation of the first Environmental Sustainability Action Plan, and the 10 priorities that are embedded in this plan (see Sustainability Goals & Significant Activity FY20.21 below). Work is underway to embed Goal 2. A 10% reduction in waste to landfill footprint from baseline year (FY18/19) is achieved this framework into policy and practice. Goal 3. BOPDHB understands the vehicle fleet utilisation baseline

Goal 4. Utilise Carbon Footprint information and Sustainability Strategy to create Emissions Reductions/ Goal 4. A Fleet Transition Plan outlining activities to reduce the carbon footprint of the BOPDHB fleet is in place, Environmental Sustainability Action Plans. Achieved. informed by vehicle utilisation information

As part of the Toitu Carbon reduce accreditation programme, BOPDHB was required to complete an Emissions Goal 5. Energy consumption is reduced by 2% from baseline year (FY18/19) Reduction and Management Plan. This plan forms part of the broader Environmental Sustainability Action Plan as mentioned above, and sees specific goals set relating to GHG emission reduction and data collection.

Goal 5. Scope project for database, dashboards, business intelligence and reporting. Implement and roll out for first evaluation at FY end 2020. In progress.

Various investigations have taken place into what types of tools could be utilised for sustainability reporting. The platforms have now been decided and BOPDHB is working on testing and configuring these platforms to ensure an output of usable and valuable information that can be utilised to inform business decisions. Priorities over the 2021 – 2022 Financial Year Sustainability Goals & Significant Activity FY20.21 identifies the environmental sustainability priorities for the next financial year. Sustainability Goals & Significant Activity FY20/21

LITY ABI ) PR NT ITORING OCU U MON RE CO G & ME C TIN N A OR T EP (R

IP H W S A R S E T D E A E L

N

O I

T

A

G

I

T E

I

N

M

E

R

&

G

N

Y

O

I

T

A

T

P

A

D A

B U I L T E T N R O V P IR S O N N A M R E T N T

FO ER OD WAT

Annual Plan

Annual Report

Significant Activity

42 43 03 Statement of Service Quality Pūrongo Ratonga

44 45 CLINICAL DIRECTOR HEALTH QUALITY & SAFETY QUALITY AND SAFETY MARKERS SERVICE REPORTClinical Director Health Quality & Safety Service Report The Health Quality & Safety Commission (HQSC) is driving improvement in the safety and quality of New Zealand’s healthcare through the national patient safety campaign Open for Better Care. The quality and safety markers (QSMs) The Ministry of Health (MOH) and Health Quality and Safety Commission (HQSC) has clearly signalled its desire for The Ministry of Health (MOH) and Health Quality and Safety Commission (HQSC) has clearly signalled help evaluate the success of the campaign nationally and determine whether the desired changes in practice and stronger clinical governance and improved healthcare quality across DHBs. In Health Quality and Safety Service’s its desire for stronger clinical governance and improved healthcare quality across DHBs. In Health reductions in harm and cost have occurred. Below are our performance results as at 30 June 2020. (HQSS) second year, we have established strong working relationships to cultivate a shared vision for healthcare Quality and Safety Service’s (HQSS) second year, we have established strong working relationships to quality, expanded HQSS’s services and progressed key strategic enablers (e.g. health intelligence, research cultivate a shared vision for healthcare quality, expanded HQSS’s services and progressed key collaborations) essential for effective clinical governance. A strong platform has been established for significant gains strategic enablers (e.g. health intelligence, research collaborations) essential for effective clinical Marker New Q3 Q4 Q1 Q2 in our third year. governance. A strong platform has been established for significant gains in our third year. Definition Zealand July to October to January to April to Key highlights of activities and outputs HQSS has led or supported are: Goal September December March June 2017 2017 2018 2018 ■ Embedding quality andKey clinicalhighlights governance of activities principles and outputs as BAU HQSS across has service led or planning supported are: Falls: Health intelligence systems, processes and people development and strengthening ■  Embedding quality and clinical governance principles as BAU across service planning Percentage of patients 90% 90% 89% 85% 88% ■ The Do You Really See meHealth Or Just intelligence My Disability systems, publication processes featured and by people The Beryl development Institute and strengthening aged 75 and over (Māori and Pacific Islanders 55 ■ Increasing Unconscious The Bias Do organisational You Really See awareness me Or Just via MyPatient Disability Safety publication Week 2019 featured by The Beryl Institute  Increasing Unconscious Bias organisational awareness via Patient Safety Week 2019 and over) that are given a ■ Supporting Pharmacy undertake the Medication Safety Self-Assessment (MSSA) for BOPDHB falls risk assessment.  Supporting Pharmacy undertake the Medication Safety Self-Assessment (MSSA) for BOPDHB ■ BOPDHB’s Patient Safety Measurement and Monitoring Maturity assessment (SaMMM)  BOPDHB’s Patient Safety Measurement and Monitoring Maturity assessment (SaMMM) Falls: ■ Local and international Localpresentations: & international WHO safety presentations: challenge, WHOOpioids safety and Choosingchallenge, Wisely Opioids and Choosing Wisely Percentage of patients assessed as being at risk Not defined 88% 93% 93% 92% ■ Leading Health Systems Leading Network Health (LHSN) Systems membership Network and (LHSN) collaboration membership – only 1and of 3 collaboration DHBs – only 1 of 3 DHBs  Recruitment of senior quality leads and starting the reinvigoration of the Quality service have an individualised ■ Recruitment of senior quality leads and starting the reinvigoration of the Quality service  Journal articles, conference proceedings and research grants care plan which addresses their falls risk. ■ Journal articles, conference COVID19 proceedings Emergency and Responseresearch grants and Recovery across multiple facets ■ COVID-19 Emergency Response and Recovery across multiple facets Hand Hygiene: NA (data Percentage of 80% 80% reported 78% 78% Our work plan for 2020/2021 includes the development of BOPDHB’s quality action plan and scorecard which includes Our work plan for 2020/2021 includes the development of BOPDHB’s quality action plan and opportunities for hand every three priority areas for improvement and monitoring (across effectiveness, equity, safety and person-centeredness scorecard which includes priority areas for improvement and monitoring (across effectiveness, hygiene for health months) domains), HQSS serviceequity, and communications safety and person plans- centerednessand reinvigorated domains), quality managementHQSS service systems and communications and processes. plans and professionals. These are ambitious goalsreinvigorated we have set quality ourselves. management It will be a challenge.systems and However, processes. we believe These that are we ambitious can and mustgoals do we have set Surgical Site this to enable BOPDHBourselves. to fulfil its promiseIt will be to itsa challenge.community However,in achieving we better believe and morethat equitablewe can andhealth must outcomes do this to enable Infections: and person-centred experiences.BOPDHB to fulfil its promise to its community in achieving better and more equitable health Percentage of hip and 100% 97% 98% 99% Data not outcomes and person-centred experiences. knee arthroplasty primary available procedures were given an antibiotic in the right time. Surgical Site Infections: Data not Percentage of hip and 95% 97% 97% 96% available DrDr Jerome Jerome Ng Ng knee arthroplasty primary Clinical Director: Health Quality & Safety Service procedures were given Clinical Director: Health Quality & Safety Service Bay of Plenty District Health Board an antibiotic in the right Bay of Plenty District Health Board dose.

46 47 ACHIEVING OUR VISION OF HEALTHY THRIVING COMMUNITIES THROUGH QUALITY

Equity Rūnanga Hauora Māori and BOPDHB launch tāngata whenua determined health strategy

On Wednesday 9 October, 2019, at Manuka Tūtahi Marae in Whakatāne, the Māori Health Rūnanga of the Bay of Plenty District Health Board (BOPDHB) launched Te Toi Ahorangi 2030 Toi Pictured: BOPDHB’s Whakatāne based Community Adult Ora Strategy. Te Toi Ahorangi affirms Mental Health Team has been working throughout the lockdown supporting clients across the Eastern Bay. the BOPDHB’s Te Tiriti o Waitangi partnership with the 18 Iwi in the Bay of Plenty and aims to transform the health system for Māori and realise Closer to Home their collective aspirations for Toi Ora (wellbeing). Mobile Mental Health support plus community links takes care to The Māori Health Rūnanga is Eastern Bay vulnerable in COVID-19 response made up of of 17 Iwi governance representatives. Toi Ora is a local Eastern Bay mental health nurses and crisis support to those in need. Our team dressed vision, determined by the 18 Iwi in workers, clad in PPE (Personal Protective in PPE would, where appropriate, meet with 2007. This vision directly aligns with Equipment), went mobile delivering mental clients outside the home on their driveway, He Korowai Oranga, the Government’s health medication and support to clients being careful not to break their bubble.” during the COVID-19 response. national Māori Health Strategy and The support of other health services and its vision of Pae Ora - healthy, Māori The Community Adult Mental Health Team organisations made a big difference. futures. initiative was instigated prior to the country “Eastern Bay Primary Health Alliance going into lockdown, in an effort to keep Te Toi Ahorangi will allow the BOPDHB (EBPHA), Te Pou Oranga o Whakatōhea Iwi those with known mental health struggles to demonstrate an authentic Te Tiriti o Social and Health Services, Pou Whakaaro Waitangi partnership that values and well and out of hospital. TE KŌHAO O TE WAKA O TOI and the police have all worked with us,” said invests in tāngata whenua aspirations TE RŪNANGA HAUORA MĀORI O TE MOANA Ā TOI | BAY OF PLENTY DISTRICT HEALTH BOARD “Making sure clients had their medication Jeff. “That has really helped and we’re very to realise Toi Ora. A 10-year strategy, and support during lockdown was really thankful for the support.” it ensures Iwi and the BOPDHB are important,” said Director of Area Mental He said despite the unusual times, being partnering for outcomes across sectors and ensuring tāngata whenua determinants of wellbeing Health Services and Mental Health Nurse proactive and being supported by other are addressed and invested in. Practitioner Jeff Symonds. “With key support agencies meant most clients coped really from Peta Ruha, Toi Oranga Ngakau and Māori Health Rūnanga Chairperson, Pouroto Ngaropo, said: “We stand on the foundation of all of well. those Iwi leaders who have gone before us and their important work, from Ngā Pou Mana o Io to Māori Health Gains and Development we He Pou Oranga Tāngata Whenua, now realised in Te Toi Ahorangi.” used a camper van to take treatments and

48 49 OneTeam Highly effective tool for identifying deteriorating maternity cases rolled out

A highly effective tool for identifying deteriorating maternity cases - the Maternity Early Warning System (MEWS) - was introduced across the BOPDHB in June, 2020. This nationwide maternity vital signs chart supports the recognition and response to Value and High the deteriorating patient who is pregnant (any gestation) and up to six weeks postnatal. Performance "The MEWS has been a highly effective Mahi Boys make historic and beautiful new forest walkway a tool for identifying deteriorating cases on the maternity ward for the last 10 months,” reality said Medical Leader for Obstetrics and The proud culmination of years of hard work Its success is demonstrated by a decrease Gynaecology Dr Michael John. by a very special team is how the opening of in average bed stay, a drop in readmission “It has improved the clarity of a new walkway in the Kaimai Mamaku State rates, and an improvement in participants communication between the ward staff Forest Park was described. general functioning and health. Some and the obstetric team due to the clear people have also now secured themselves The opening of the Pa Kereru Loop direction provided by the escalation part-time employment in the community. Walkway, a 40-minute forest walk in pathway." Whakamarama, in November 2019 marked “Both Paul (Mason) and Pete (Bull) have The tool was originally designed by the the end of a journey for those on the Mahi been tremendous advocates for all the Health Quality and Safety Commission Boys work training programme. It’s a people who have worked on the programme and the escalation pathway was adapted The MEWS will be used instead of the adult programme with a difference, as all the and without their unwavering enthusiasm by each DHB to fit their facilities. All DHBs Early Warning System (EWS). The key participants are clients of the Bay of Plenty and boundless energy the work completed are required to implement this tool. differences allow for the physiological changes District Health Board (BOPDHB) mental may never have happened,” said BOPDHB that occur as part of pregnancy and last from health service. Community Mental Health Service Manager A short eLearning module for all clinical conception through to 42 days post the end of Michael Joyce. staff to complete was made available on Around 15 people work on the programme, Te Whariki a Toi, with the modules tailored pregnancy. Monday to Thursday, from 8am-4pm. “All the mahi programme participants are for nurses, doctors and midwives. The varied work undertaken by members role models to what can be achieved with a of the Mahi Boys programme enables the can do/will do attitude.” development of transferable workplace and social skills. The programme has made a big difference to those involved.

50 51 People Powered Smart Systems Smartphone App will help people age well says Allied Health expert Whakaari/White Work on a handy new smartphone App could help people age well, retaining a more active Island eruption: lifestyle in the process, says an Allied Health expert. extraordinary A trial of the LifeCurve App began in August 2020 in the Bay of Plenty and, if successful, it is care delivered by intended that the App will be pushed out further afield subsequently. Whakatāne Hospital Allied Health Director Dr Sarah Mitchell said the work looked at the sub-optimal life curve staff says Chief (where people endured a long period of decline) and the optimal curve (where people Executive retained more function for longer as they aged). Speaking at the visit of Minister of Health Hon Dr The App takes people through a series of David Clark and Minister of questions based on everyday tasks to assess Police Stuart Nash, just three their functionality. This information is then days after Whakaari-White used to compare the user with others of Island eruption of 9 December, comparable age Bay of Plenty District Health Whakaari Recovery – A gesture of solidarity, support for each other, the “We’re living longer but we don’t want that Board (BOPDHB) Interim community and Whakaari/White Island victims. Whakatāne Hospital staff to translate as just more years of decline,” Chief Executive Simon Everitt share sentiments the morning after the eruption. said Sarah. “Normal ageing starts with the described his pride in those process of not being able to cut your toenails involved in the response. and progresses through a number of stages around 100 people assisting in the trauma “It is with a sense of privilege and pride all the way through to not being able to eat response. This was a truly extraordinary that I have listened to so many stories over independently. example of teamwork. recent days about the amazing response “What we want to do with the App is say from our wider health team to manage 31 “The staff of Whakatāne Hospital did an ‘This is where you are but if you do this, this patients, all at once after the Whakaari/ incredible job as they received the severe and this, you can get better’. It’s simple but White Island eruption,” said Mr Everitt. trauma patients, and swiftly went about effective. It might also then suggest activities their jobs of triaging, calming, consoling, “We had staff from across the health the person might like to pursue to improve or diagnosing, and starting treatment on system who all came together to support maintain their function. It might for example, injuries that before Monday they had the efforts in the Emergency Department suggest a local aqua aerobics class with one possibly not experienced. and Acute Care Unit. We also had two of our partner agencies,” added Sarah. carloads of Tauranga clinicians who drove “To me they all exemplify what it is to be “Because it’s fun and easy for people, using across to support their colleagues. At dedicated, compassionate and skilled real-life examples of everyday tasks, it really one stage it was estimated there were health professionals.” resonates. People love it. At the end of the day what we’re trying to do is to help people live healthier happier lives as they age.”

52 53 04 Our Leadership Mana Tangata

54 55 INTRODUCTION AND OBJECTIVES OF THE BOARD FUNCTIONS OF THE BOARD

The Bay of Plenty District Health Board (BOPDHB) was established pursuant to section 19 of the New Zealand Public For the purpose of pursuing and demonstrating its objectives, the Board has the following functions: Health and Disability Act 2000 (NZPHD). ■ To ensure the provision of services for its resident population and for other people as specified in its Crown funding The BOPDHB is a Crown Entity and subject to the provisions of the Crown Entities Act 2004 (CEA). As an agent of agreement. the Crown, the BOPDHB is committed to fulfilling its role as a Treaty of Waitangi partner and is guided by two key ■ To actively investigate, facilitate, sponsor, and develop co-operative and collaborative arrangements with persons strategic documents that provide the blueprint for how we will best respond to the health needs and aspirations of in the health and disability sector or in any other sector to improve, promote, and protect the health of people, and tangata whenua and our wider population. Te Toi Ahorangi and the Strategic Health Services Plan (SHSP) sit directly to promote the inclusion and participation in society and independence of people with disabilities. alongside each other to guide how the BOPDHB plan, prioritise, fund and deliver services in Te Moana ā Toi (the Bay of Plenty DHB area) as an integrated system across primary, community and secondary care. ■ To issue relevant information to the resident population, persons in the health and disability sector, and persons in any other sector working to improve, promote, and protect the health of people. The objectives of the Board are: ■ To establish and maintain processes to enable Māori to participate in, and contribute to, strategies for Māori health ■ To improve, promote, and protect the health of Bay of Plenty people and communities. improvement. ■ To promote the integration of health services, especially primary and secondary health services. ■ Maintain the partnership relationship between the Board and the Māori Health Rūnanga. ■ To promote effective care or support for those in need of personal health services or disability support services. ■ To continue to foster the development of Māori capacity for participating in the health and disability sector and for ■ To promote the inclusion and participation in society and independence of people with disabilities. providing for the needs of Māori.

■ To reduce health disparities by improving health outcomes and equity for Māori and other population groups. ■ To provide relevant information to Māori for the purposes of fostering Māori participation in Māori health improvement. ■ To reduce, with a view to eliminating, health outcome disparities between various population groups within New Zealand by developing and implementing, in consultation with the groups concerned, services and programmes ■ To regularly investigate, assess, and monitor the health status of its resident population, any factors that the designed to improve health outcomes. BOPDHB believes may adversely affect the health status of that population, and the needs of that population for services. ■ To exhibit a sense of social responsibility by having regard to the interests of the people to whom it provides, or for whom it arranges the provision of services. ■ To promote the reduction of adverse social and environmental effects on the health of people and communities.

■ To foster community participation in health improvement, planning for the provision of services and for significant ■ To monitor the delivery and performance of services by the BOPDHB and by persons engaged by the BOPDHB to changes to the provision of services. provide or arrange for the provision of services.

■ To uphold the ethical and quality standards commonly expected of providers of services and of public sector ■ To participate, where appropriate, in the training of health professionals and other workers in the health and organisations. disability sector.

■ To exhibit a sense of environmental responsibility by having regard to the environmental implications of its ■ To provide information to the Minister for the purposes of policy development, planning and monitoring in relation operations. to the performance of the BOPDHB and to the health and disability support needs of New Zealanders.

■ To be a good employer. ■ To provide, or arrange for the provision of, services on behalf of the Crown or any Crown entity within the meaning of the Public Finance Act 1989. ■ The Board will pursue and demonstrate its objectives in accordance with its Strategic Health Services Plan and Annual Plan and any directions or requirements given to the Board by the Minister of Health (the Minister) under ■ To collaborate with pre-schools and schools within its geographical area on the fostering of health promotion and sections 32 or 33 of the NZPHD Act. on disease prevention programmes.

■ To perform any other functions it is for the time being given by or under any enactment, or authorised to perform by the Minister of Health by written notice to the Board of the BOPDHB after consultation with it.

56 57 BOARD GOVERANCE

Both Board and Committee Members are reimbursed for reasonable expenses including mileage. Structure Further details on Board and Committee fees can be found in Cabinet Office circular CO (12)06 Fees Framework for In accordance with the NZPHD, the Board may consist of seven elected members and up to four members appointed Members Appointed to Bodies in which the Crown has an Interest. by the Minister of Health. Currently the BOPDHB consists of seven elected and four appointed members. Actual fees paid to Board and Committee Members are listed below (dollars): Under the NZPHD the Minister of Health appoints the Board Chair and Deputy Chair from among the elected or appointed members. Sir Michael Cullen was appointed as Board Chair in November 2019 however due to health Name Board AFRM CPHAC BOPHAC SHC Expenses 2018 reasons he stepped down in March 2020 and Sharon Shea became Interim Board Chair Ron Scott became Interim - DSAC Total Deputy Chair. Mark Arundel 22,866 2,250 250 - 313 284 25,963 The NZPHD requires the formation of three statutory committees: Yvonne Boyes** 9,350 - - 500 250 1,164 11,264

■ Community & Public Health Advisory Committee (CPHAC). Bev Edlin*** 22,866 2,750 875 - 250 148 26,889 Geoff Esterman 22,866 2,500 - 875 250 174 26,665 ■ Disability Services Advisory Committee (DSAC). Marion Guy 22,866 1,250 500 250 250 155 25,271 ■ Hospital Advisory Committee - Bay of Plenty Hospital Advisory Committee (BOPHAC). Peter Nicholl** 9,350 750 - - - 1,343 11,443 The Community & Public Health and the Disability Services Advisory Committees, function as a combined Committee Matua Parkinson** 9,350 - - 250 - 79 9,679 within the BOPDHB. Anna Rolleston** 9,350 500 250 - - 298 10,398 In addition to the statutory committees required by the NZPHD Act, the Board maintains two Committees of the Board, Ron Scott 27,135 3,438 500 750 250 341 32,413 a Finance, Audit and Risk Management Committee (FARM) and a Strategic Health Committee (disbanded July 2020) Judy Turner** 9,350 - 500 - 250 597 10,697 and one standing committee, the CEO Performance and Remuneration Committee. These committees meet four times Sally Webb** 19,250 1,250 500 500 250 4,632 26,382 a year, unless their meeting is scheduled in the month of January, in which case they will only meet 2 or 3 times that year, as there are no January meetings. This is rotated every year between the committees. Michael Cullen * 11,601 250 250 - - 909 13,010 Sharon Shea * 21,162 1,000 - 313 - 800 23,275 The Board also has a Memorandum of Understanding with the Māori Health Rūnanga, which establishes a partnership 13,516 - 250 250 - - 14,016 between the Board and the Rūnanga. The Rūnanga advises the Board on Māori health issues, reviews planning Hori Ahomiro * documents and delivery of services to ensure that they reflect an approach that is culturally acceptable to Māori. The Ian Finch * 13,516 1,250 250 - - 269 15,285 Rūnanga also advises the Board on other issues affecting Māori that may arise from time to time. Leonie Simpson * 13,516 - - 250 - 137 13,904 The Board is responsible for the governance of the BOPDHB. The Board employs the Chief Executive who is Arihia Tuoro * 13,516 1,250 313 - - 496 15,575 responsible for the management and operation of the BOPDHB. Total Board 271,426 18,438 4,438 3,938 2,063 11,826 312,129 Members Accountability and Communication Lyall Thurston - - 500 - 260 760 - - 500 - - - 500 The Board acknowledges its responsibility to maintain consistent and open communication with its stakeholders. The Paul Curry Board values the input of the community and interested groups to assist the Board with its goal of building Healthy, Pouroto Ngaropo 1,000 - - - - - 1,000 Thriving Communities. Without the people of our region taking an interest in their individual and community health, Total All Members 272,426 18,438 4,938 4,438 2,063 12,086 314,389 and disability issues, the Board cannot succeed in its goals and responsibilities. * New Board Members as at 9 December 2019 The Board is at all times accountable to its stakeholders, and to ensure accountability is maintained by the Board, it ** Board Members not re-elected or re-appointed as at 9 December 2019 endeavours to be as transparent and open as possible in its decision-making. *** Board Members who participate as reciprocal members for other Midland DHB Committees Transparency is maintained through the conducting of open Board and Statutory Committee meetings and the ready availability of Board papers, minutes and other publications.

Board Elections The Board is elected every three years. Ministerial Appointments occur to coincide with the BOPDHB election process, however if there is a Ministerial vacancy, the Minister may appoint to fill this vacancy at any time. Elections were held in November 2019 and the new Board was formed.

Board and Committee Fees Effective from 17 December 2019 Board Members receive a fee of $23,171 per annum, the Board Chair receives $46,403 per annum and the Deputy Chair receives $28,963 per annum.

Committee Members of the two Statutory Committees (Combined Community & Public Health Advisory and Disability Services Advisory Committee and Bay of Plenty Hospital Advisory Committee) and the Committee of the Board (Audit, Finance & Risk Management Committee) and Strategic Health Committee are paid $250 per meeting. The Chair of the Committee receives $312.50 per meeting.

58 59 COMBINED COMMUNITY AND PUBLIC HEALTH AND DISABILITY SERVICE ADVISORY COMMITEE Attendance The Board meets on a monthly basis and holds extra meetings when required for planning or other specific issues. Functions Examples of these additional meetings are regional workshops and joint planning sessions. Board Member ■ Make recommendations and provide advice to the Board on the health care and disability support needs of the attendance at Board meetings during the year was as follows: population of the district.

■ Make recommendations and provide advice to the Board on any factors that the Committee believes may adversely Meetings affect the health status of the population.

Name Scheduled Attended Comments ■ To advise and recommend to the Board, within funding levels, priorities for disability support services for the population aged over 65 or having like needs, and those whose disability is a result of a medical condition. Mark Arundel 11 9 Yvonne Boyes 5 4 ■ Make recommendations to the Board on the priorities for the allocation of health funding. Bev Edlin 11 11 ■ Provide advice to the Board on the implications for planning and funding of nationwide health strategies. Geoff Esterman 11 11 ■ Provide advice and make recommendations to the Board on strategies to reduce disparities in health status. Marion Guy 11 11 ■ Ensure mechanisms are in place to assess the performance of service providers against accountability documents, Pouroto Ngaropo 11 4 Rūnanga Representative and industry and sector standards. Peter Nicholl 5 4 ■ Monitor the performance of service providers against accountability documents, and industry and sector standards. Matua Parkinson 5 4 ■ To liaise with community groups in relation to the provision of disability support services for the over 65 age group.

Anna Rolleston 5 5 ■ To perform any other function as directed by the Board. Ron Scott 11 11 Interim Deputy Chair Judy Turner 5 3 Membership and Attendance Sally Webb 5 5 Board Chair to 9.12.19 ■ Membership of the Committee shall be determined by the BOPDHB and shall include at least one Māori Michael Cullen 6 2 Board Chair to March 2020 representative. Sharon Shea 6 6 Interim Board Chair from March ■ The appointment of members must comply with the requirements set out in Schedule 4, Clause 6 of the NZPHD. 2020 ■ The BOPDHB will appoint the Chair and Deputy Chair. The appointment of the Chair and Deputy Chair will comply Hori Ahomiro 6 5 with the requirements set out in Schedule 4, Clause 11 of the NZPHD. Ian Finch 6 6 The Committee meets on a quarterly basis and Committee membership and attendance during the year was as follows Leonie Simpson 6 6 Arihia Tuoro 6 6 Meetings Name Scheduled Attended Comments Interests Declared Ron Scott 2 2 No Board Member is a member of the Executive of the BOPDHB. Sally Webb 2 2 The Board maintains an interest register and ensures members are aware of their obligations to declare conflicts of Judy Turner 2 2 interest. The register outlines areas where a Board or Committee Member has an interest that could lead to a potential 3 1 conflict. In addition to the register members declare any specific conflicts at the commencement of each meeting. Mark Arundel Beverley Edlin 3 3 Chair to 9.12.20 The full Board and Committee Member Interests are declared in each meeting agenda which is publically available on the BOPDHB website. Anna Rolleston 2 1 Marion Guy 2 2 Board Members’ Loans Michael Cullen 1 1 There were no loans to Board Members. Hori Ahomiro 1 1 Ian Finch 1 1 Airhia Tuoro 1 1 Chair to 9.12.20 Paul Curry 3 2 Community Representative

60 61 BAY OF PLENTY HOSPITALS' ADVISORY COMMITEE AUDIT, FINANCE AND RISK MANAGEMENT COMMITTEE Functions

■ To monitor the financial and operational performance of the hospitals, Community Health and Disability Services, Functions Public Health and related services of the BOPDHB and to advise the Board of any current or future implications of Audit monitored performances. ■ Liaise with the internal auditor and review internal audit scope, planning and resourcing. ■ Assess and monitor strategic issues relating to the provision of hospital and other services provided by the BOPDHB and give advice and make recommendations to the Board based on the results of the monitoring and ■ Assist the external auditor to identify risks and issues relevant to the external audit planning process. assessment. ■ The Chair of the Committee is to receive draft copies of all internal and external audit reports when these are ■ Monitor the development of systems to manage operational and clinical risk and advise the Board if a significant circulated to management for comment. risk is not being mitigated. ■ The Committee will receive the final reports of the internal and external auditors and review their findings

■ Assess the performance of the hospital and related services of the BOPDHB against the hospital and related ■ Monitor the progress made by management in implementing recommendations arising from audit. services provisions of the Annual Plan, accountability documents, and accepted industry and sector standards. Report any variation from expected standards to the Board and advise the Board of possible corrective measures. Financial planning and reporting ■ Review and advise the Board on its approval of the BOPDHB’s financial statements and disclosures. ■ Monitor campus redevelopment programmes. ■ Review draft Annual Plans and other accountability documents for their financial impact. ■ Approve variations and changes that are within delegated authorities and the scope of the projects. ■ Review and advise the Board regarding finance-related policies and procedures requiring Board approval, ■ To perform any other function as directed by the Board. including delegation policies.

■ Review management accounting and internal financial reporting practices and issues and alert the Board to any Membership and Attendance areas which appear ineffective. ■ Membership of the Committee shall be determined by the BOPDHB and shall include at least one Māori ■ Review capital expenditure and asset management planning and their relationship with service planning. representative. ■ Monitor the financial performance and position of the BOPDHB against budget and forecast. ■ The appointment of members must comply with the requirements set out in Schedule 4, Clause 66 of the NZPHD. Risk management oversight ■ The BOPDHB will appoint the Chair and Deputy Chair. The appointment of the Chair and Deputy Chair will comply with the requirements set out in Schedule 4, Clause 117 of the NZPHD. ■ Ensure that the BOPDHB complies with its obligations under key legislation. ■ Keep other legislative compliance arrangements under review (such as employment legislation).

■ Monitor risk assessment and risk management mechanisms, including internal control.

The Committee meets on a quarterly basis and the Committee membership and attendance during the year was as ■ Receive and investigate disclosures under the BOPDHB’s ‘whistle-blowing’ policy where it is not appropriate for follows: these to be received and investigated by the Chief Executive.

■ Monitor and review policies and procedures to minimise and manage conflicts of interest among BOPDHB Board Meetings members, management and staff. Name Scheduled Attended Comments ■ Monitor and review policies and procedures to minimise and manage risks in the contracting of health services. Yvonne Boyes 2 2 ■ Other monitoring responsibilities as determined by the Board, for example in relation to major contracts or construction projects Geoff Esterman 3 3 Chair Matua Parkinson 2 1 Peter Nicholl 2 0 Membership and Attendance Ron Scott 3 3 The Audit, Finance and Risk Management (AFRM) Committee comprises: Sally Webb 2 2 ■ The BOPDHB Chair Lyall Thurston 3 2 Lakes DHB Representative ■ Chairs of the following committees: - Combined Community and Public Health and Disability Services Advisory Committee. Hori Ahomiro 1 1 - Bay of Plenty Hospitals Advisory Committee. Leonie Simpson 1 1 ■ Other Members as appointed by the Board. Marion Guy 1 1 ■ The Board will endeavour, where appropriate, to include Māori representation on the committee (clause 38(2), Sharon Shea 1 1 Schedule 3, NZPHD Act).

The Committee meets on a monthly basis and as required for particular issues.

6. New Zealand Public Health and Disability Act 2000. 7. New Zealand Public Health and Disability Act 2000. 62 63 STRATEGIC HEALTH COMMITTEE

Committee membership and attendance during the year was as follows: Functions The Strategic Health Committee (SHC) is a combined forum of the Community and Public Health Advisory Committee Meetings / Disability Services Advisory Committee (CPHAC/DSAC) and the Bay of Plenty Hospitals Advisory Committee (BOPHAC). The role of the SHC is to provide strategic advice to the Board in relation to strategic objectives one, two Name Scheduled Attended Comments and three of the Bay of Plenty Strategic Health Services Plan, to explore disruptive initiatives, and to challenge the Mark Arundel 11 11 status quo. Anna Rolleston 6 2 Beverley Edlin 11 11 Membership and Attendance Geoff Esterman 11 10 The Committee meets on a quarterly basis. Sally Webb 6 5 Committee membership and attendance during the year was as follows: Peter Nicholl 6 3 Meetings Ron Scott 11 11 Chair Michael Cullen 5 1 Name Scheduled Attended Comments Sharon Shea 5 4 Mark Arundel 1 1 Chair Ian Finch 5 5 Sally Webb 1 1 Arihia Tuoro 5 5 Ron Scott 1 1 Marion Guy 5 5 Anna Rolleston 1 0 Beverley Edlin 1 1 Geoff Esterman 1 1 Internal Control Judy Turner 1 1 1 1 To fulfil its responsibilities, management maintains adequate accounting records and has developed and continues to Marion Guy maintain a system of internal controls: Yvonne Boyes 1 1

■ The Board acknowledges that it is responsible for the systems of internal financial control. Peter Nicholl 1 0

■ Internal financial controls implemented by management can provide only reasonable and not absolute assurance Matua Parkinson 1 0 against material misstatement or loss. Pouroto Ngaropo 1 0 Rūnanga Representative The Audit, Finance & Risk Management Committee has established certain key procedures, which are designed to provide effective internal financial control. No major breakdowns were identified during the year in the system of internal control.

After reviewing internal financial reports and budgets the Committee Members believe that the BOPDHB will continue to be a going concern in the foreseeable future, subject to ongoing support from the Crown. For this reason they continue to adopt the going concern basis in preparing the financial statements.

64 65 CEO PERFORMANCE AND REMUNERATION COMMITTEE

Functions The BOPDHB employs the Chief Executive Officer in accordance with Schedule 3, clause 44 of the NZPHD.

The CEO Performance and Remuneration Committee performs the duties of the Board in relation to the employment of the Chief Executive Officer.

Membership The Committee meets on an as required basis for particular issues.

Committee Members during the year were:

■ Peter Nicholl (Chair to 9.12.19) ■ Sally Webb (Board Chair) ■ Bev Edlin ■ Anna Rolleston ■ Ron Scott ■ Mark Arundel (Chair – from 9.12.19) ■ Michael Cullen (to March 20) ■ Sharon Shea (Interim Board Chair) ■ Leonie Simpson ■ Arihia Tuoro

DELEGATIONS

The Board has an approved Delegation Policy in accordance with Schedule 39(3) of the NZPHD Act8. The NZPHD Act requires, under S26(3)9 that the board of a DHB must delegate to the chief executive of the DHB, under clause 39 of Schedule 3, the power to make decisions on management matters relating to the DHB, but any such delegation may be made on such terms and conditions as the Board thinks fit.

8. Schedule 3, New Zealand Public Health and Disability Act, 2000. 66 9. Section 26, New Zealand Public Health and Disability Act, 2000. 67 05 Our People Te Hunga Ora

68 69 BEING A GOOD EMPLOYER

The BOPDHB recognises the seven key elements of being a good employer, as identified by the Human Rights Employment Equity Commission10. These elements are derived from fundamental good human resource practices: It is BOPDHB policy to provide equal employment opportunities for all employees and applicants. This ensures: ■ Leadership, Accountability and Culture ■ Recruitment, Selection and Induction ■ employment decisions are made on the grounds of relevant merit, not on the basis of personal characteristics ■ Employee Development, Promotion and Exit ■ Flexibility and Work Design unrelated to ability ■ Remuneration, Recognition and Conditions ■ Harassment and Bullying prevention ■ BOPDHB avoids employment practices that may be inconsistent with or contrary to the provisions of the Human ■ Safe and Healthy Environment Rights Act 1993 and other relevant legislation

BOPDHB has the stated intention of being a good employer consistent with Section 118 in the Crown Entities Act ■ there is no discrimination (as required by human rights legislation) 200411 which cover: ■ all employees have the opportunity to develop to their potential ■ healthy and safe working conditions ■ recognition of the aims and aspirations of Māori in recognition of our commitment to the Treaty of Waitangi. ■ an equal employment opportunities programme The Board has adopted a remuneration policy that reflects the need to set a target range for each individual ■ the impartial selection of suitably qualified persons for appointment employment agreement position, within the limitations of available funding. This gender neutral, fair remuneration ■ recognition within the workplace of the aims, aspirations and cultural differences of Māori, other ethnic or minority policy is part of an overall employment relations strategy that includes defining the role of employees, performance groups, women and persons with disabilities development and appropriate reward mechanisms. Students are casual, therefore not staff. We pay above minimum ■ opportunities for the enhancement of the abilities of individual employees. wage. BOPDHB supports the Government putting into place pay and employment equity response plans, and recognises The BOPDHB’s equal employment opportunities policy is governed by Human Rights12, Health and Safety in the obligations we have to make sure we continue to address and respond to any identified gender inequities as Employment13, and Employment Relations14 legislation. part of good management practice and being a good employer. BOPDHB are proud to report this measure, by key People and Capability (HR) policies and procedures are reviewed biennially in-line with the BOPDHB’s commitment to occupational groupings. good employer practices and the BOPDHB’s values. Current employment policies include: ■ equal employment opportunity ■ occupational health and safety Gender Pay Equity recruitment and selection discipline and dismissal ■ ■ Many female employees in New Zealand work in occupations that are more than 80% female, and these female- ■ protected disclosures (whistle blowing) ■ learning policies dominated occupations tend to be lower paid. Women are under-represented in higher-level jobs15. The gender ■ employee assistance programme ■ performance development pay gap is a high level indicator of the difference between women and men’s earnings, with a number of factors ■ leave (annual, sick, tangihanga/bereavement, leave without pay, long service, jury service) contributing to the gender pay gap. ■ orientation ■ staff presentation Pay and employment equity cannot be achieved for women or men unless the ways gender is affecting employment ■ position descriptions ■ identity card standards are identified and addressed. Government policy and direction encourages employment and workplace relations that demonstrate good faith, natural justice, human rights, sound employer practice and legal compliance. ■ volunteers and work experience ■ shared expectations (Code of Conduct). The majority of our staff are covered by collective employment agreements (93%, 3,529 of our 3,789 staff). This Workforce Development ensures that all employees, regardless of gender or other areas of potential inequity, are remunerated at the same level for equivalent work. BOPDHB has endorsed the Te Tumu Whakarae Position Statement on Increasing Māori Participation in the Workforce, and has endorsed the targets to support the Position Statement being realised. Our Māori workforce has increased to 2019/20 Employees with Collective Employment Agreements 13% of our total workforce.

Workforce development is a key strategic objective in both Te Toi Ahorangi and the Strategic Health Services plan (Strategic Objective 2: Develop a smart, fully integrated system to provide care close to where people live, learn, work and play and 3: Evolve models of excellence across all of our hospital services). Male 616 In 2019/20 year BOPDHB prepared a stocktake of its workforce, and started to explore how to enable the workforce to 17.4% provide care closer to our communities. The BOPDHB continues to focus on lifting Māori participation in our workforce with a particular focus on Māori leadership. We continued the Creating our Culture strategic programme to further embed our CARE values to guide how we work together.

Whakaari impacted the BOPDHB staff in many ways, and we continues psychosocial support and offering wellbeing programmes to support recovery. Female 2914 Towards the end of the financial year, the demands of COVID-19 also impacted our people and we continue to 82.6% offer additional support. It also bought a time of more flexible working arrangements for many staff with technology supporting staff to work remotely. Many found that this offered benefits for both staff and the organisation and continue to work in this way.

10. Human Rights Commission NZ 11. Section 118 Crown Entities Act 2004 12. Human Rights Act 1993 15. Emloyment NZ 13. Health and Safety at Work Act 2015 14. Employment Relations Act 2000 70 71 2019/20 Employees with Individual Employment Agreements 2019/20 Nursing Staff

Male 157 9%

Male 79 30.4% Female 1677 Female 91% 181 69.6%

Allied Health is our next largest group, representing 706 staff (2018/19: 661). This group includes occupational therapists, social workers, physiotherapists, therapy assistants and a range of other clinical positions. 84% of this group are female, and there is a difference noted in average remuneration between male and female staff with males The remaining 260 staff are covered by individual employment agreements (IEA). To ensure that IEA roles are fairly earning 3% more on average. This is due to the nature of the roles filled by male vs female. Females occupy a higher remunerated, BOPDHB has adopted the Strategic Pay SP10 job evaluation methodology. This methodology has portion of lower paid groups such as therapy assistants. All allied health staff are paid agreed MECA rates based on extensive following in the public and private sectors, and provides high quality and robust remuneration data. It suits qualifications and experience. a wide range of roles including executive and professional; technical; administrative or production and environments where points differentials, also known as role sizing, is considered important. This methodology also gives due weight Median Hourly Rate - Allied Health to roles with a requirement for education, experience and strong problem-solving skills, and ensures that each position is objectively remunerated, regardless of gender or other areas of potential inequity. $40.00 Nursing is our largest employment occupational group, representing 1,834 staff (48%) of our work force (2018/19: $35.00 1,709, 48%). 91% of this group are female, and no difference is noted in median remuneration between male and female staff. $30.00 Median Hourly Rate - Nursing $25.00 $20.00 $40.00 $15.00 $35.00 $10.00 $30.00 $5.00 $25.00 $0.00 $20.00 Female Male $15.00 2019/20 Allied Health Staff $10.00

$5.00 Male 110 $0.00 Female Male 16%

Female 596 84%

72 73 Non-clinical and clerical staff are another large group, representing 547 staff. This group includes Security, Stores, Leave Orderlies and Clerical staff, amongst others. 84% of this group are female, and there is a difference noted in average In 2019/20, 95 staff went on paid parental leave (compared to 78 staff in 2018/19). Staff sick leave utilisation has remuneration between male and female staff with females being paid 6% more on average. This is due to more female remained materially stable at 3.3% (2018/19:3.5%) staff occupying clerical roles which are higher paid than support roles. Resignations/Turnover has decreased to 9.2% in 2019/20 (from 10.3% in 2018/19). Median Hourly Rate - Non-Clinical Support and Clerical Services

$30.00 Workforce Development The BOPDHB recognises the need to develop the capacity and capability of its workforce in response to the increased $25.00 population, and evolving models of care. The BOPDHB has endorsed Te Tumu Whakarae Position Statement about increasing Māori Participation in the $20.00 Workforce, and has endorsed the targets to support the Position Statement being realised. Our Māori workforce has increased to 13% of our total workforce. $15.00 Workforce development is a strategic priority and we continue to engage with the Ministry of Health according to the strategic health and disability workforce priorities 2019- 2024. $10.00 Unions $5.00 The New Zealand Nurses Organisation (NZNO) Joint Action Group (JAG) with nursing, Association of Senior Medical $0.00 Staff (ASMS) Joint Consultative Committee with senior doctors, the Public Service Association (PSA) Enterprise Female Male Committee (Mental Health Nursing, Clerical and Allied Health) and the Local Resident Medical Officer (RMO) Engagement Group (LERG), form key partnerships with unions in delivering improved levels of staff engagement, 2019/20 Non-Clinical & Clerical Staff as well as taking a joint action approach to support the delivery of improved health services through strengthening clinical governance and decision making processes.

Male The BOPDHB was the first DHB in New Zealand to appoint a union convener role. This role was dedicated to enhancing 100 the partnership approach with PSA, the BOPDHB was proud to be part of this sector leading initiative. 16% A pan union forum known as the BOPDHB Bipartite Forum enables the gains from the activity of the various union groups to be shared and monitored and the translation of the national Bipartite Action Group initiatives to something beneficial and workable at a local level.

Female Valuing People 447 84% The Staff Service Recognition Programme was introduced in 2007 by the Board and Chief Executive, as a means of recognising and thanking staff for their loyalty and service to the BOPDHB (and its predecessor organisations).

The annual Staff Recognition Celebrations recognise staff with over ten years’ service. The longest serving staff member recognised in the 2019/20 year has served 60 years in Whakatāne, with our longest serving Tauranga staff member recognised for 46 years. Across the Bay of Plenty, our recipients have provided 5,920 years of service to our The three groups reported above represent 81% of our work force. The remaining 19% of staff cannot be compared community. for equity. 12% of the remaining 19% are medical staff on Collectives. Remuneration for this group is determined by The BOPDHB has had no substantiated complaints regarding discrimination with respect to recruitment, selection and seniority of service, the needs of the service in relation to on-call and availability and the associated allowances employment. earned. 7% of the remaining staff are on individual employment agreements. The BOPDHB is open to applications for flexible work and considers them on a case-by-case basis. Feedback from Board and Senior Management both the Pulse Engagement Survey and Exit Survey indicate that staff believe the BOPDHB has flexible work practices in place and that these meet the requirements of employees. Numbers stayed the same for 2019/20 with 58% of the Board Members being female and 17% Māori. 27% of Managers in the top two tiers of the BOPDHB are female (27% in 2018/19) and 18% are Māori (18% in 2018/19). Health and Safety Employment Safe and Healthy Environment Effective workplace health and safety contributes to organisational success and to a safe working environment This year we welcomed 795 new staff (2018/19: 662 new staff), including 639 clinical staff (2018/19: 549 new clinical for all staff, visitors and contractors. It can also influence business risk, higher productivity and lower preventable staff). costs. Poor workplace health and safety conversely can have detrimental impacts on the lives of individuals and their The majority of our staff are covered by collective employment agreements (93%, 3,529 of our 3,789 staff). This families. There are a number of contributory factors including an awareness of organisational culture and embedding ensures that all employees, regardless of gender or other areas of potential inequity, are remunerated at the same the safety culture into the organisation to ensure the safety culture is shared and integrated across all areas. level for equivalent work.

74 75 The changing work environment is also challenging with a need to address any catastrophic events and the changing Performance of the BOPDHB nature of harm. Some of the key impacts for the future include the changing population dynamic, growth in the sector, technological advancement and innovation, the changing nature of work and increasing prevalence of psychological Claims per $1 million of liable earnings harm. Everything that contributes to safe, healthy workplaces – people, organisations and environment are part of the Total cost of work Number of open Year Levy risk group wider health and safety at work framework. related injury claims claims BOPDHB (average of other The Health and Safety Team for the Bay of Plenty District Health Board consists of the Health and Safety Manager, two DHB's) Health and Safety Advisors and nearly 100 Health and Safety Representatives from all the Services. The Health and Safety Representatives consist of staff voted into the role by the relevant service and are given allocated time at work 2016/17 $ 523 489 214 0.61 0.81 to complete tasks to support the safety of the designated areas assigned 2017/18 $ 719 372 194 0.82 0.87

Bay of Plenty District Health Board has systems and processes to identify workplace hazards, minimize the risk and 2018/19 $ 464 549 21 0.80 0.84 reduce the risk of harm or injury to patients, visitors and workers. There is a 24/7 on-line system for incidents and 2019/2020 $704,015.07 45 Not available Not available risk to be documented and reported (Datix) and this is available and accessible to all staff with log in rights. Datix is utilized to assist with identifying deficits, trends and ensuring the business can be proactive in risk management. Employer Assisted Programme We ensure that our people, prospective new employees, other clinical personnel, including locums and health care students are assessed, screened and vaccinated against infectious diseases prior to commencing employment or BOPDHB provide individual psychosocial support to staff, which is able to be accessed 24 hours a day. All staff members clinical placement. All staff are required to complete on-line health and safety training specific to the business before are entitled to 3 free confidential sessions of EAP to assist with work or personal issues. Extra providers were procured to they start employment. There are regular updates on health and safety for staff and a requirement for staff to ensure assist with EAP for Whakaari related experiences for the 19/20 year. BOPDHB spent $94,206.92 on EAP services for 19/20. they are updated on new developments and specific programmes each month. These updates are online, and they are A Staff Health clinic is available for all employees and volunteers onsite to check cholesterol, blood sugars, blood pressure, sent to each staff member individually. body mass index and body fat percentage and visual acuity. Also offered is a discussion on healthy living, diet and lifestyle. We continue to demonstrate our commitment to safety within the workplace for the patients, visitors and employees Cervical screening for female staff can be arranged, as can the recommended hospital funded vaccinations for some by retaining Tertiary status within the ACC Partnership Programme at the annual audit which was last undertaken in employees. The BOPDHB offers a staff influenza vaccination programme that runs during April 1st – 31st August. For July 2019. 2019/20, 73.1% of staff (2,556 staff members) received vaccination (2018/19: 67%, 2,316 staff members).

Health and Safety activities include: The BOPDHB provides two on-site staff funded gym facilities (Staff Wellness Exercise and Training - SWEAT), based on the Tauranga and Whakatāne campus’. SWEAT started as a voluntary staff movement with the simple objective of providing ■ Work and non-work accident rehabilitation of employees in conjunction with Work AON, our third-party provider an affordable health and wellness service, at a convenient location, for all BOPDHB staff and associated organisations staff ■ A range of injury prevention programmes including moving and handling refreshers, fire evacuation practice and to enjoy. workstation assessments Over a decade later, now managed by Wellness Systems Group Limited, the SWEAT membership of more than 800 people ■ On-line Health and Safety, Moving and Handling, Electrical and Fire Safety, Infection control and Hand Hygiene has access to equipment, weekly timetabled group fitness classes (virtual and live instruction), and a variety of annual training modules are available for employees to update their knowledge wellness programmes and services. Health and Safety representatives actively monitor workplaces for hazards and liaise with the Health and Safety ■ As a staff initiative, there is a measured and positive difference in absenteeism, ACC claims (workplace and out of work Advisors to address any concerns injuries) and productivity between the staff who are active members of SWEAT and those who are not members. ■ Encouragement to employees and stakeholder participation in health and safety ensuring there is representation WorkWell is a free, workplace wellbeing initiative developed by our Public Health Service, Toi Te Ora. WorkWell supports from all parties; this includes the Health and Safety Operations group, Health and Safety Advisory Group and Bi- workplaces to work better through setting wellbeing goals with businesses and staff. Partite meetings with Unions Workwell has now been rolled out at a national level and is able to be adapted to suit any work place. For the year end June ■ Employee Assistance Programmes are provided to staff at no cost and there are two providers of this service 2020, Toi Te Ora have 58 workplaces signed up regionally, and nationally, 123 are signed up with Workwell and 6 of those ■ Both Tauranga and Whakatāne Hospitals have a gym and membership is available to all staff at a reduced rate being other DHBs. There is a yearly influenza vaccination programme provided for all staff at no cost ■ There are 9 DHBs in total (including BOPDHB) that are offering WorkWell to workplaces in their regions. Six of these DHBs ■ Ongoing training for Health and Safety Representatives are doing WorkWell themselves (internally).

■ Health and Safety Community site on the intranet for information on all health and safety, occupational health and The BOPDHB is accredited at the highest level, gold. Gold Standard Accreditation was awarded to the BOPDHB in July emergency management programmes. 2016 when we demonstrated having all the successful components of a health and wellbeing programme, and these have This year we have had one catastrophic event with White Island (Whaakari) and the impact on several individuals both become embedded in the BOPDHB work-place. patients and staff was significant. Mobilising our staff to attend to the significant injuries and outcomes took a toll on everyone involved.

COVID-19 also impacted a significant number of staff and services pre and post lockdown.

76 77 STAFF ENGAGEMENT AND PARTNERSHIP

Creating our Culture Finalists: An Alpha Response to the Emergency Department Hayley Cowley, Fiona Burns, Amanda Johnstone, Ellise Robinson, Colleen MacGregor, Whakatāne Hospital Staff Engagement and Culture is priority under Toi Oranga Tikanga of the Bay of Plenty District Health Board. Cardiotocography (CTG): Functional Testing of Ultrasound FHR (Fetal Heart Rate) Transducer The initial work began in 2016 and identified four priorities: Udai Kumar, Clinical Engineering, Whakatāne Hospital 1. To implement the CARE values Rheumatic Fever School Prevention Programme 2. Improve inter-personal and team communications Yvonne Rurehe, Te Ika Whenua Hauora 3. Performance appraisals 4. Address inappropriate and bullying behaviours. Learning Environment A programme addressing these priorities, “Creating our Culture” was launched in November 2016. The Education Team works to embed learning, innovation and information into organisational culture; within the Since then individual pieces of work have been completed as part of the Creating our Culture initiative. These include: framework of BOPDHB CARE values and honouring Te Tiriti o Waitangi. More education is being opened up to our primary and community care colleagues, with closer working relationships being fostered ■ The refreshed CARE values ■ The BUILD model used to call out inappropriate behaviour Te Tiriti o Waitangi ■ The ABC of appreciation model used to promote positive behaviour The BOPDHB is committed to the principles of the Treaty of Waitangi. Employees receive training on bicultural practice ■ The V-BR model, which is a values based recruitment model used for recruiting new staff who live by our CARE in accordance to Te Tiriti O Waitangi commitments. In 2019/20, a total of 652 staff attended these training courses values (2018/19: 822). ■ Speak up Safely initiative, developed to embed a safe environment in which to speak out about unprofessional or unsafe practice or behaviours Attendances are as follows: ■ Treaty of Waitangi half day refresher: 79 Scholarships and Study Funding ■ Treaty of Waitangi full day course: 253 The BOPDHB is committed to supporting staff financially with study undertaken through a tertiary institution such as a ■ Engaging Effectively with Māori: 320 university or polytechnic. In addition, training is provided for managers and staff on the Human Rights Act 1993, health and disability rights, Study funding totalling $49,123 was awarded to BOPDHB employees during the 2019/20 financial year (2018/19: Shared Expectations (State Services Code of Conduct), and the BOPDHB’s employment policies. $42,800). ■ Advanced Study Fund: $25,778 Professional Development ■ Whakatāne Staff Study Fund: $3345 In 2019/20, 1,654 internal training events were offered with 29,921 participants completing training, both face- ■ BOP Learning Scholarships: $20,000 to-face and online. (2018/19:1,774 events and 27,930 participants). This figure includes orientation, clinical, non- clinical, leadership, fire, health and safety, IT training and mental health. BOP Learning Scholarships are available to staff through the generous support of businesses sponsoring the funding of the scholarships. In 2018/19 scholarships totalling $22,000 were sponsored by: Bay of Plenty Medical Research Due to COVID-19, a number of face to face courses were cancelled or replaced with online learning courses. Trust, Holland Beckett Lawyers, Pure Print, and our newest sponsor, Jigsaw Architecture. Learning scholarships were 55% of learning was completed online (compared with 43% in 2018/19) with104 on-line learning courses offered awarded to 12 staff members (compared with 10 awarded in 2018/19). Recipients were from a range of roles and through Te Whāriki ā Toi. services including Allied Health, Radiography, Mental Health and Service Improvement Unit. Three Whakatāne staff members received awards from the Whakatāne Staff Study Fund. Te Whāriki ā Toi also includes the Mahara e-Portfolio platform which enables staff to demonstrate professional competency. In 2019/20, 18 BOPDHB employees were reimbursed a portion of their course fees for tertiary study through the Advanced Study Fund (compared to 14 employees in 2018/19). Applicants received 60% reimbursement towards their Completion of online learning courses increased by 48% with 16,451 courses completed in 2019/20 compared to fees16. 11,120 in 2018/19. Study funding totalling $49,123 was awarded to BOPDHB employees during the 2019/20 financial year (2018/19: Innovation Awards $42,800). The BOPDHB Innovation Awards are held every two years and give BOPDHB employees and contractors an opportunity to showcase innovative initiatives completed in their service within the past two years. There is a focus on initiatives which all connected to one of the DHB or Ministry of health priorities: closer to home; good to great; smart systems. The last awards were held in October 2019. There were 35 entries received from across the DHB and region.

First place: Vaping at Te Whare Maiangiangi Planning & Funding, and Mental Health and Addiction Services, Tauranga Hospital

Second Place: Youth of Kopeopeo Toi Te Ora Public Health

People’s Choice Winner: Complex Decision Pathway Anaesthesia and Surgical Services

16. It was a bit different this year, we gave up to $2000, so for some people they got the whole thing, for others it was a portion. Also less staff applied, so we were able to provide more funding. 78 79 STAFF STATUS 2019/20

Staff Number 3,789 permanent and temporary staff (2018/19: 3,554) BOPDHB Staff by Age Band Average Age Average age is 47.3 years (2018/19: 47.0 Years) 30 2019/2020 Percentage of Staff 2018/19 Percentage of Staff Disability Profile Our proportion of employees who report a disability is 0.1% 26.7% (2018/19: 0.1%) 25 25.2%

Gender Profile Women make up the majority of our workforce with 81.7% female 22.5% 21.5%

compared with 18.3% male (2018/19: Female 81.0%, Male 19.0%) 20 20.1% 18.5% 18.3% 18.0% 15 The BOPDHB recognises and accommodates the workplace needs of staff with stated disabilities. The BOPDHB

currently employs four people who identify with a disability, covering a range of different impairments. 12.5% 12.6% 10 Staff who require suitable parking are provided with the option to access this on campus in close proximity to their

work area. Staff are also encouraged to use the in-house occupational health service as and when they require 2.1% 5 1.9% assistance. 0.1% 0.1% Staff with disabilities that impact on their mobility are identified, and a buddy system is set up to assist them in event 0 of emergency evacuation of buildings. Staff with disabilities provide a valuable insight into the challenges faced <19 Years 20-29Years 30-39 Years 40-49 Years 50-59 Years 60-69 Years > 70 Years by those with disabilities within our communities and are valuable in the development of Disability Planning in the BOPDHB. BOPDHB Staff by Ethnicity 60 2019/20 Percentage of Staff Occupational Group 2019/20 2019/20 2019/20 2018/19 2018/19 2018/19 55.4% 53.1% Full Time Part Time Total Full Time Part Time Total 50 2018/19 Percentage of Staff Admin/Management 364 300 664 368 266 634 40 Allied Health 360 346 706 352 309 661 Medical 317 126 443 289 134 423 30 Non-clinical Support 69 73 142 63 64 127 20 18.1% Nursing 261 1,573 1,834 257 1,452 1,709 17.6% 5.3% 12.8% 12.8% 5.1% 3.7% 0.6% Grand Total 1,371 2,418 3,789 1,329 2,225 3,544 10 0.6% 0.7% 7.7% 6.5% 0 Asian/Indian NZ European NZ Maori European Other Other Paci c Islander Not Stated Termination Payments 2019/20 BOPDHB Staff Status Reason Number Redundancy Gratuity Exgratia Redundancy 1 $27,982.17 2019/20 Full Time 2018/19 Full Time Redundancy 1 $24,158.95 Redundancy 1 $22,500.00 2019/20 Part Time 2018/19 Part Time Gratuity 1 $35,975.80 Gratuity 1 $4,336.96 Gratuity 1 $2,500.00 Gratuity 1 $2,500.00 Gratuity 1 $2,500.00 Gratuity 1 $2,500.00 1,371 1,329 Gratuity 1 $2,500.00 36.2% 37.4% Gratuity 1 $2,500.00 Gratuity 1 $2,500.00 2,418 2,225 Gratuity 1 $2,000.00 63.8% 62.6% Gratuity 1 $2,500.00 Gratuity 1 $2,500.00 Gratuity 1 $2,000.00 Gratuity 1 $2,000.00 Exgratia 1 $3,173.17 Exgratia 1 $2,500.00 Exgratia 1 $2,000.00 Exgratia 1 $1,900.00 Total 21 $74,641.12 $68,812.76 $9,573.17

80 81 Salaries over $100,000 Directors’ and Officers’ Insurance

Year ended 30 June 2020 30 June 2019 Insurance premiums were paid in respect of Board Members’ and certain Officers’ Liability Insurance. The policies do not specify a premium for each individual. Salary Bands Medical & Dental Staff Other Total Total 101,000-110,000 45 100 145 110 The policy provides cover against costs and expenses involved in defending legal actions and any resulting payments 110,000-120,000 31 57 88 69 arising from a liability to people or organisations (other than the BOPDHB) incurred in their position as Board Members or Officers. 120,000-130,000 32 31 63 38 130,000-140,000 23 13 36 16 140,000-150,000 12 10 22 24 Donations 150,000-160,000 12 8 20 24 The BOPDHB made no donations during the year 2019/20 (2018/19: Nil). 160,000-170,000 10 4 14 14 170,000-180,000 11 5 16 10 180,000-190,000 9 3 12 6 190,000-200,000 11 1 12 7 200,000-210,000 14 2 16 12 210,000-220,000 9 0 9 5 220,000-230,000 10 0 10 8 230,000-240,000 10 0 10 11 240,000-250,000 10 1 11 17 250,000-260,000 11 0 11 10 260,000-270,000 8 0 8 7 270,000-280,000 11 0 11 8 280,000-290,000 8 0 8 11 290,000-300,000 13 1 14 8 300,000-310,000 4 0 4 6 310,000-320,000 3 0 3 6 320,000-330,000 2 0 2 4 330,000-340,000 8 0 8 8 340,000-350,000 3 1 4 3 350,000-360,000 1 0 1 5 360,000-370,000 3 1 4 1 370,000-380,000 0 1 1 2 380,000-390,000 2 0 2 0 390,000-400,000 0 0 0 0 400,000-410,000 3 0 3 1 410,000-420,000 0 0 0 3 420,000-430,000 0 0 0 1 430,000-440,000 1 0 1 1 440,000-450,000 1 0 1 0 450,000-460,000 1 0 1 0 470,000-480,000 0 0 0 1 480,000-490,000 0 0 0 0 490,000-500,000 0 0 0 0 500,000-510,000 2 0 2 1 510,000-520,000 0 0 0 0 520,000-530,000 0 0 0 0 530,000-540,000 0 0 0 1 580,000-590,000 1 0 1 1 Total over $100,000 335 239 574 460

82 83 06 Statement of Performance Pūrongo Mahi

84 85 ACHIEVEMENT IN HEALTH FOR THE BAY OF PLENTY

Statement of Performance relating to the Statement of Performance Expectations for The Bay of Plenty District Health Board (BOPDHB) provides health and disability services in the Bay of Plenty in order year ended 30 June 202017 to improve the health outcomes of our 255,110 residents, a quarter of whom identify as being Māori. Our vision of ‘healthy, thriving communities,’ compels us to understand the level of need within our population, how effective our Module Three: Statement of Performance services are in reaching the intended recipients while considering the current and future drivers of service demand. 3.1 Statement of Performance (SP) Increasingly we are called to improve our engagement with other government agencies and local body organisations Output Classes to best deliver services that will achieve the best outcomes for our residents. Recognition of the impact of social Output Class Funding Allocation determinants such as healthy housing solutions, employment, establishing whānau goals and public health initiatives Healthy, Thriving Communities - Kia Momoho Te Hāpori Oranga on the health and wellbeing of whānau and individuals requires the DHB to embrace new ways of working. Healthy Futures - Pae Ora This section provides an overview of the key elements of our outcomes framework, which is designed to align with the 3.2 Healthy Individuals – Mauri Ora strategic direction and statement of intent of the Ministry of Health, and the Midland region, of which we are one of the 3.2.1 Fewer People Smoke five member DHBs. Our strategic direction identifies health outcomes for three population groups. These are: 3.2.2 Reduction in vaccine preventable diseases 1. Healthy Individuals - Mauri Ora: 3.2.3 Improving Healthy Behaviours All people deserve to live healthily and expect a good quality of life. All children deserve the best start in life. 3.2.4 People Can Access their Health Information People should be given the opportunity to die in their place of choice. 3.2.5 Fewer Children and Adolescents have Decayed Missing Filled Teeth 3.2.6 People with a terminal illness or life limiting chronic disease die in their place of choice 2. Healthy Families – Whānau Ora: 3.3 Healthy Families – Whānau Ora Family and whānau should be empowered to live well with long-term conditions. People are entitled to be safe, 3.3.1 Fewer people are admitted to hospital for avoidable conditions well and healthy in their own homes and community-based settings. 3.3.2 Long-term conditions are detected early and managed well 3. Healthy Environments – Wai Ora: 3.3.3 People Maintain Functional Independence All people should live, learn, work and play in an environment that supports and sustains healthy life. Our 3.3.4 Families and whānau are at the centre of their healthcare population should be enabled to self-manage their personal health. People should expect to receive timely, 3.4 Healthy Environments – Wai Ora seamless and appropriate care on their health journey. 3.4.1 Providing Healthier Homes These long-term outcomes will be achieved through the combined efforts of all those people working across the Bay 3.4.2 Connecting with Agencies to Meet Community Needs of Plenty health system, central and local government, other DHBs within and outside of our region, and the wider 3.4.3 Appropriate Access to Services health and social services sector. Progress towards these long-term outcome measures is monitored through the 3.4.4 People receive prompt and appropriate acute and arranged care annual metrics reported in this Statement of Performance. 3.4.5 Services provided or funded by the BOPDHB contribute to the transfer of knowledge and skills to family/ whānau to enable self-management In monitoring our progress towards these measures the DHB compares annual performance against results of previous years as well as targets within our annual plan. While we have not met all targets for our performance measures in many cases a positive trend is evident when compared with baseline indicators from prior years.

The function of the Statement of Performance Expectations is to summarise performance against metrics used by BOPDHB to evaluate and assess the services and products required to deliver the outcomes of the 2019/20 Annual Plan.

The performance measures chosen are not a comprehensive list and do not cover all BOPDHB activity. However, BOPDHB believes the outputs and measures presented do provide a good representation of the full range of services we provide, and highlight our performance in major areas of service activity against local, regional and national priorities. Where possible, past performance information (baseline data) has been supplied to clearly articulate the performance story over time.

This year’s Statement of Performance Expectations provides the reader with a detailed account of performance against five key priority groups outlined in BOPDHB’s Strategic Health Services Plan. Again, these metrics do not tell the full performance story, but provide an overview of the work BOPDHB has underway to address the health needs of our priority populations.

17. This Statement of Performance relates to the Statement of Performance Expectations from the 2019/2020 Annual Plan, therefore numbering reflects the Annual Plan document. 86 87 Output Classifications Preventative Services have the following strategic goals: 1. People are healthier, able to self-manage and live longer Section 149E of the Crown Entities Amendment Act 2013 requires District Health Boards (DHBs) to identify reportable classes of output delivery each year in a Statement of Performance Expectations. Output classes allow DHBs to group 2. People are able to participate more in society and retain their independence for longer services and demonstrate the application of Board and Government service priorities, population health ‘impacts’ of 3. Health inequalities between population groups in our community will reduce by identifying and addressing Population Based Funding (PBF) allocations, and monitoring of investment across the entire health spectrum. For preventable conditions across the population early. each output class there are agreed national output performance measures and targets. Supplementing nationally Preventative Services are represented in our reporting as an outcome target of ‘people take greater responsibility for agreed measures are a number of regional or local measures that report our achievement against strategic or their health’ with three impact goals: operational goals targeted in our Strategic Health Services Plan and Annual Plan. 1. Fewer people smoke. DHBs are required to provide performance measures and a statement of performance each year under one of four 2. Reduction in vaccine preventable diseases. output classes. For 2020 these were: 3. People have healthier diets. 1. Prevention 2. Early Detection and Management 3. Rehabilitation and Support Output Class 2: Early Detection and Management 4. Intensive Assessment and Treatment Services Early Detection and Management Services are delivered by a range of health and allied health professionals in both the community and hospital settings. These services are delivered by private clinicians, not-for-profit agencies Our measures and financial performance against these output classes for the year ended 30 June 2018 are set out in and governmental organisations including general practice, community and whānau-centred groups, pharmacists, the following section of our annual report. laboratories, radiography services and community dentists. How Output Classes work These services are by their nature more general in design, usually accessible from multiple health providers and from a number of different locations within Bay of Plenty DHB.

On a continuum of care these services are preventative and treatment services focus on individuals and smaller family/ Purchase Unit whānau groups. More recently, health professionals have sought to empower individuals to better understand their Budget specific health needs and continue self-management of life-long conditions. Purchase Unit is part of a By detecting health needs and implementing management strategies across the population before acute or chronic classification system Activity disease occurs, these services will assist in achieving the following strategic goals: The budget is created used to consistently 1. People receive timely and appropriate complex care. measure, quantify and based on Volume per PUC. Patients and their 2. Early detection programs with focus in health inequities. value a health and inpatient stays and disability service. Every Early Detection and Management services are represented in our reporting by an outcome target of ‘people stay well outpatient visits are in their homes and communities’ with the following impact goals: Purchase Unit Code(PUC) recorded during the has an Output Class. financial year based on 1. Children and Adolescents have better oral health. PUC and Volume. 2. Treatable conditions are detected early and people are better at managing their long term conditions. 3. Fewer people are admitted to hospital for avoidable conditions.

Output Class 3: Rehabilitation and Support Rehabilitation and Support Services are aimed at supporting people to maximise their independence and increase their ability to live in the community. Access to a range of short or long-term community based services is arranged by Our measures and financial performance against these output classes for the year ended 30 June 2020 are set out in Needs Assessment Service Coordination (NASC) services following a ‘needs assessment’ and service co-ordination the following section of our annual report. process. The range of services includes palliative care services, home-based support services, day programmes, respite and residential care services. Output Class 1: Prevention Ideally these services will provide support for individuals and their carers while being provided predominantly within a community setting or in the patient’s home. Preventative Services are services that protect and promote health for the whole population or identifiable sub- populations. They comprise services designed to enhance the health status of the population as distinct from Rehabilitation and support services assist in achieving the following strategic goals: treatment services which repair/support health and disability impairment. Services such as health promotion ensure 1. People are able to participate more in society and retain their independence for longer. that illness is prevented and unequal outcomes are reduced. Obligatory health protection services that are delivered 2. Restore some or all the patient’s capabilities. by our Toi Te Ora Public Health team protect the public from communicable diseases and population health protection 3. Support people to live independently after an illness or accident. services such as immunisation and screening services provided by staff in our General Practice clinics reduce the risks of poor health in the future. By ensuring the provision of timely and appropriate rehabilitation and support services, individuals can return to the best possible level of participation in society as quickly as possible. These services influence whānau and individual behaviours by targeting population wide physical and social environments to enhance health and wellbeing.

88 89 STATEMENT OF FINANCIAL PERFORMANCE BY OUTPUT CLASS Output Class 4: Intensive Assessment and Treatment Services The following table discloses the actual financial performance by output class against our Annual Plan for the year Intensive Assessment and Treatment Services are delivered by a range of secondary and tertiary providers using ended 30 June 2020. public funds. These services are usually integrated into facilities that enable co-location of clinical expertise and specialised equipment such as a ‘hospital’. These services are generally complex and provided by health care professionals that work closely together. Summary of Revenues and 2019/20 2019/20 2018/19 2018/19 Expenses by Output Class $000s $000 $000s $000s They include: Actual Plan Actual Plan 1. Ambulatory services (including outpatient, district nursing and day services across the range of secondary preventive, diagnostic , therapeutic, and rehabilitative services). Early Detection 2. Inpatient services (acute and elective streams) including diagnostic, therapeutic and rehabilitative services. Total Revenue 244,022 204,700 215,769 204,800 Total Expenditure 253,192 207,200 220,227 207,300 3. Emergency Department services including triage, diagnostic, therapeutic and disposition services. Net Surplus / (Deficit) (9,170) (2,500) (4,458) (2,500) On a continuum of care these services are at the complex end of treatment services and are focused on individuals.

Intensive Assessment and Treatment services will assist in achieving the following strategic objectives: Rehabilitation & Support Total Revenue 157,151 140,700 149,012 125,600 1. People receive timely and appropriate complex care Total Expenditure 163,056 142,300 152,091 127,200 2. People experience an informative and seamless hospital journey. Net Surplus / (Deficit) (5,905) (1,600) (3,079) (1,600) 3. Preventing deterioration/complications.

These objectives will be reached by ensuring access to timely acute and elective services to the Bay of Plenty Prevention population before the burden of disease significantly impacts on individuals and their ability to participate in society. Total Revenue 11,985 16,500 36,931 16,000 Total Expenditure 12,436 16,700 37,694 16,200 Intensive Assessment and Treatment services are represented in our reporting as an outcome target of ‘people receive Net Surplus / (Deficit) (451) (200) (763) (200) timely and appropriate care’ with four impact goals: 1. People are seen promptly for acute and arranged care. Intensive Assessment & Treatment 2. People have appropriate access to elective services. Total Revenue 483,045 513,300 439,019 487,000 3. Improved health status for people with a severe mental illness or addictions. Total Expenditure 501,196 519,500 448,089 493,200 4. People with end-stage conditions are supported. Net Surplus / (Deficit) (18,151) (6,200) (9,070) (6,200)

Totals Total Revenue All output classes 896,203 875,200 840,731 833,400 Total Expenditure All output classes 929,880 885,700 858,100 843,900 Net Surplus / (Deficit) (33,677) (10,500) (17,370) (10,500)

Summary of expenses by output class

Early detection and management Rehabilitation and support Prevention 27% Intensive assessment and treatment services

54%

18%

1%

90 91 OUTPUT CLASS ACHIEVEMENT SUMMARY

Prevention Early Detection and Rehabilitation and Support Intensive Assessment Management and Treatment Services

We treated and discharged We provided 89% of smokers We dispensed over 4.2m 9,488 elective patients Our hospices supported 1,102 in secondary services with pharmaceutical items. against a target of 11,247. patients and their families in smoking cessation advice and the community support.

The percentage of pre-school Of our patients referred for Total ED volumes (across We fully immunised 2,692 aged children enrolled in radiotherapy or chemotherapy Tauranga and Whakatāne) eight month olds against dental services is at 101.6% treatment, 95% were seen were significantly lower during vaccine preventable diseases. (target 95%), 95.6% for Maori. within 62 days of referral March to June2020 due to (target 90%). COVID-19.

We promoted seasonal PHO enrolment rates remains We completed 72,845 influenza immunisation to high in the BOPDHB region community referred radiology ensure 74% of our over 65 than observed for both the total events (measured as relative aged population received population (96%) and for Māori value units). immunisation (target 75%). (90%). A further 1,327 (1,139 Māori) BOPDHB residents are enrolled with Te Kaha practice.

We coordinated 2,476 participants in the Green Prescription (GRx) We undertook 1,535,544 programme. community laboratory tests and completed these within 48 hours 99% of the time (target 90%).

Six out of every ten infants were still receiving some breast milk at six months - this reduces to five out of ten for Māori infants.

92 93 HEALTHY INDIVIDUALS – MAURI ORA

Over the next three years, we will fund services and partner with health providers who will make a positive impact on Our performance against our long-term framework is reported over the following pages. Overall, these outcome the health and wellbeing of our population. Our key outcomes are as follows: measures show the health of our population is improving.

Healthy, Thriving Communities - Kia Momoho Te Hāpori Oranga Outcome Goal Outcome Measure Healthy Futures - Pae Ora All people have healthy lifestyles with a good ■ Fewer people smoke. quality of life ■ Reduction in vaccine preventable diseases. Healthy Individuals - Healthy Families - Healthy Environments - Wai Ora Mauri Ora Whānau Ora Strategic Direction All children have the best start in life ■ Improving healthy behaviours. Bay of Plenty Local Bay of Plenty Local Bay of Plenty Local Outcomes: ■ People can access their health information. Outcomes: Outcomes: 1. All people live, learn, work and ■ Fewer children and adolescents have 1. All people have healthy 1. Family/whānau live well play in an environment that Decayed Missing Filled Teeth. lifestyles with a good quality with longterm conditions. supports and sustains a healthy of life. life. People die in comfort in their place of choice ■ People with terminal illness or life limiting 2. People are safe, well and 2. All children have the best 2. Our population is enabled to self- chronic disease die in their place of choice. start in life. healthy in their own homes manage. 3. People die in comfort in their and communities. 3. All people receive timely, place of choice. seamless and appropriate care. 3.2.1 Fewer People Smoke Population Indicators: Population Indicators: Population Indicators:

Fewer people smoke. Fewer people are admitted Providing healthier homes. Delivering on Priorities The Ministry of Health reports that if no one in New Zealand smoked, the lives of almost 5,000 New Zealanders would to hospital for avoidable Reduction in vaccine Connecting with agencies to meet be saved every year. preventable diseases. conditions. community needs. Improving healthy behaviours. Long-term conditions are Appropriate access to services. The health effects of smoking are devastating: detected early and managed People can access their health well. People receive prompt and 1. Smoking harms nearly every organ and system in the body. information. appropriate acute and arranged care. People maintain functional 2. It’s the cause of 80% of lung cancer cases, and is linked to many other cancers. Fewer children and independence. Services provided or funded by the adolescents have decayed BOPDHB contribute to the transfer 3. It’s a major cause of heart attacks, heart disease, stroke, and respiratory diseases such as emphysema and chronic missing filled teeth. Families and whānau are at of knowledge and skills to family/ the centre of their healthcare. bronchitis. People with a terminal illness whānau to enable self-management. or life limiting chronic disease 4. Smoking can also cause blindness, impotence and infertility. die in their place of choice. Population Measures: Population Measures: Population Measures: 5. Smoking also hurts your children, through the damage done by smoking when pregnant or the effects of second- How much did we do? How much did we do? How much did we do? hand smoke. # referrals of adults to # of whānau ora promotional # homes that are insulated through The ongoing focus of our Primary Health Organisations (PHOs) on ABCs in a primary care setting has enabled steady the Green Prescription activities undertaken. the community-based insulation and programme. % eligible Maori men in the healthy housing programmes. performance. The primary care smoking cessation stipulates that brief advice is offered and support to quit smoking # general practices offering PHO aged 35-44 who have # people supported by specialist given to over 88% of eligible patients who smoke and were seen by a health practitioner in general practices within patient portals. their cardiovascular disease palliative care. the last 15 months. This target has not been met during 2019/20 by a 1% for total population, although it has improved % enrolled patients2 registered risk assessed in the last 5 # registered users of CHIP client to uses general practice years. health information portal. from last year. The high percentage reflect the maturity of cessation programmes delivered and the conversations portals. Statement of Performance Expectations facilitated by all health professionals in general practice. There remains inequity of performance against this metric Population Priorities How well did we do? How well did we do? How well did we do? for Māori, though the gap is less than 2% based on last 3 quarters of 2019/20 data – the total population result was % people received smoking Reduced ASH rates 45 – 64 Number of inpatient surgical 89.1%, while the result for Māori was 88.1%. There is also a clear inequity of smoking prevalence based on the primary cessation advice – hospital years. discharges under elective initiative. care smoking data. While Māori comprise roughly 25% of the population in the BOPDHB region, they make up over and primary care. % population enrolled with a Percentage of patients admitted, % pregnant women who Primary Health Organisation. discharged or transferred from an ED 44% of smokers, based on 2019/20 primary care smoking data. identify as smokers offered % women enrolled in a PHO within six hours. advice. aged 50-69 years who Standardised Intervention Rates meet

People with long term severe mental health and addiction issues % children fully immunised at are enrolled in the Breast national expectations. eight months. Screening Programme with % improvement in access to mental Breastscreen Midland. % population over 65 years health services. Value by Period and Ethnicity who have had the influenza % women enrolled in a PHO Improved management for long term immunisation. aged 25-69 years who have conditions (CVD, Acute heart health, Ethnicity Maori Non-Maori Total % infants fully and exclusively had a cervical sample taken Diabetes and Stroke). 89.94 in the past three years. 90 breastfed at three months. 89.49 89.63 % patients to receive their first cancer 89.31 Vulnerable Older People Vulnerable Children and Young People First 1000 Days Māori Vulnerable Older People Children and Young % children caries free at 5 % of triage level 4 and 5s treatment within 62 days of being 89.10 presenting to the Emergency years of age. referred with a high suspicion of 89 88.73 Department. cancer and a need to be seen within 88.44 two weeks. 87.96 88.07 Is anyone better off? Is anyone better off? Is anyone better off? 88 87.64

Value 87.39 % obese children identified in Maintain current percentage Hospitalisation rates per 100,000 for the B4SC programme will be of population over 65 years acute rheumatic fever. 87 offered a referral to a health who have accessed aged % of long-term condition clients professional. residential care. reporting an improved quality of life. 86.05 % patients receiving specialist Incidence number of acute 86 palliative care die in their place rheumatic fever cases. 2019-09 2019-12 2020-03 2020-06 of choice. Period Infrastructure Workforce, facilities, information, partnerships, contracting, technology 94 95 Expectant mothers who register with Lead Maternity Carers are also offered support to quit if they are smokers. The 3.2.2 Reduction in vaccine preventable diseases health target is 90% of pregnant women who identify as smokers at the time of confirmation of pregnancy in general Immunisation can prevent a number of vaccine preventable diseases. It not only provides individual protection but practice or booking with Lead Maternity Carer (LMC) are offered advice and support to quit. There have been mixed also population-wide protection by reducing the incidence of infectious diseases and preventing spread to vulnerable results against this metric during 2019/20, which is, in large part, due to small numbers in the denominator for this people. Some of these population-wide benefits only arise with high immunisation rates, depending on the metric. The 90% target was not achieved. The principal concern with the maternity smoking measure, is again the infectiousness of the disease and the effectiveness of the vaccine. The immunisation coverage measures have been disparity in smoking prevalence between expectant Māori and non-Māori mothers. Due to COVID-19 there is no data adjusted to reflect a shift in focus to ensuring children have received all the immunisations scheduled for them up to available for Q3 2019/20, although the smoking prevalence is higher for non-Māori mothers, similar to last year. There and including the age measured. In addition the measures include a stronger focus on achieving equitable coverage. remain ongoing concerns with the quality of the maternity smoking data set, as the denominator is only a fraction of what it should be based on annual births within the BOPDHB region. Volumes Volumes Main measures of 2018 2019 2020 2020 2020 Achieved Main measures of Comments 2018 2019 2020 2020 2020 Achieved Comments performance Actual Actual Target Actual National performance Actual Actual Target Actual National Average18 Average Output class: 1 As part of our improvement Smoking cessation advice in primary care Output class: 1 we have a strong focus did not met the 90% target for the total Children are fully Providing smokers who on timely vaccination & population and Māori, while being just immunised at two years access primary care below the target by 1% for Total population Missed babies, however services with smoking of age and five years of and 2% for Māori. acknowledging missed cessation advice and age – CW05. support – PH04. babies can be due to either parental choice to delay, ■ Total 91% 89% 90% 89.1% NA  ■ Two years of age Māori NA NA 95% 80.8%  immunisations given at ■ Two years of age Total 82% 83% 95% 76% ■ Māori 89% 87% 90% 88.1% NA   GP practice but after the Output class: 1 Maternity smoking targets were not milestone age. Transfers achieved for both total and Māori ■ Five years of age Māori NA NA 95% 78.4%  in to BOPDHB already Percentage of populations in 2019/20. pregnant women ■ Five years of age Total NA NA 95% 82%  overdue are included in the who identify as Smoking prevalence for Māori mothers is missed target data, these smokers at the time a significant concern and is one of the key children are on catch-up focus areas in the DHB. of confirmation of programmes including pregnancy in general This measure was not reported for Q3 due outreach so unable to practice or booking to Covid-19. with Lead Maternity complete by milestone Carer are offered age despite strong system advice and support to priority for timely vaccination quit. CW09 to the schedule. Total ■ 92% 93% 90% 85.7% NA  Output class: 1 Process review and ■ Māori 95% 93% 90% 87.0% NA  improvement actions Children are fully have achieved marginal Output class: 1 A series of 4 day Wananga – called immunised at eight ‘Ukaipo’ for hapu mama who smoke have 19 improvement compared Māori babies who NA 35 60% 33.1% 35.7%  been held around the region. Mothers months. live in smokefree with last year along with a register for the upcoming Ukaipo during reduction in missed children households at six their pregnancy and whānau members ■ Total 86% 82% 95% 83.1%  weeks post-natal. from 8% to 6%. Also there are also invited to attend. Ukaipo are ■ Māori 83% 76% 95% 76.8%  held on Marae and attract 5-12 pregnant is a reduction in declines mothers per wananga. 2 wananga had to compare to last year from be postponed due to COVID-19. Mothers 10% to 8%. The disparity in and whānau reduce or quit smoking after attending Ukaipo and are also referred to coverage between Māori and Hapainga (regional stop smoking service) total populations remains to continue their smokefree journey. high as is an area of focus In addition, BOPDHB fund wahakura for further development wananga (safe sleep) where smoking is of innovative approaches identified as a key risk factor for SUDI. engaging with whānau. Women and whānau who attend these marae based wananga are also supported Output class: 1 Total population 65+ towards a smokefree life. influenza immunisation Percentage of the The BOPDHB funds a Hapū Māmā coverage in the BOPDHB population (>65 years) Programme with the Hāpainga Stop region almost reached the Smoking service. This enables a pregnant who have had the target for the 2020 season, mother to receive up to $250 in vouchers seasonal influenza assisted by COVID-19 over a 12 week period. A Quit Buddy can immunisation20. also be identified (preferably the partner) awareness and the who can receive up to $150 vouchers ■ Total 58% 58% 75% 74.2% NA  consistent implementation when succesfully quit. This has now been  of the MOH vaccination extended to cover the First Thousand Days ■ Māori 54% 51% 75% 67.7% NA Initiative and is available to the main carer campaign for vulnerable of the child that may not be the mother. populations.

18. Data for the last 2 quarters on 2019/20 was not available on the time of the Statement of Performance Expectations was published. 19. Immunisation result reported is the annual coverage for 12 months ended 30 June 2020. 20. 2019 actual results usually reflects influenza coverage in the 2019 calendar year. Although, for this year is more relevant show partial results that are compatible with the 96 reporting period because of the impact of COVID-19 in most of the indicators. The 2019-20 influenza immunisation season ends in September 2020, with data not available 97 until October 2020, which is outside of annual reporting timeframes, therefore we normally report previous year data. Eight month immunisation coverage performance explained 3.2.3 Improving Healthy Behaviours Eight month immunisation coverage was one of the targets monitored by the Ministry of Health in 2019/20. This target Breastfeeding helps lay the foundations of a healthy life for a baby and also makes a positive contribution to the stipulates that 95% of children at eight months of age would have received the requisite immunisations as outlined health and wider wellbeing of mothers and whānau/families. Exclusive breastfeeding is recommended by the Ministry within the schedule. Eight month immunisation coverage has been a challenging area for BOPDHB, due to historically of Health until babies are around six months as it provides numerous health benefits for mother and baby. These high rates of declines and opt-off children over 10%. benefits include helping baby develop physically and emotionally, providing protection from infections, reducing the risk of sudden unexpected death in infancy.

Volumes Main measures of Comments performance 2018 2019 2020 2020 Achieved Actual Actual Target Actual Value by Period and Ethnicity Ethnicity Maori Non-Maori Total Output class: 1 Although we did not reach the target for the full period, we reach the target for the first 89.52 Percentage of obese 88.81 seven months of the period. 90 87.93 children identified 87.15 87.47 86.49 86.68 86.41 85.57 85.82 85.89 86.33 85.40 86.05 in the Before We have two main programmes; Active 84.68 85 83.76 84.12 School Check Families and Te Hihiko healthy lifestyles 82.19 82.88 81.35 81.74 81.95 81.43 81.37 80.77 (B4SC) programme programme; COVID 19 has affected the 79.65 80.11 80 78.29 78.82 will be offered a numbers of participants however alternative 77.10 95% 94.4%  Value referral to a health efforts were made through Facebook/ 74.88 74.51 74.78 professional for website information and phone contacts with 75 73.99 73.96 74.24 clinical assessment family to maintain contacts. and family bases 70 nutrition, activity 2019-07 2019-08 2019-09 2019-10 2019-11 2019-12 2020-01 2020-02 2020-03 2020-04 2020-05 2020-06 and lifestyle interventions – Period CW10 Output class: 2 BOPDHB again exceeded the target number The graph above illustrates rolling twelve months DHB immunisation rates for Māori, non-Māori and the total of referrals received. Over the last few years The number of population for the twelve month period from June 2019 to June 2020. Rolling twelve-monthly immunisation shows in over 40% of referrals are for Māori. referrals to adult 2,584 2,932 2,233 2,476  the latest half year an improvement for Māori due to MoH immunisation campaigns. GRx (Green COVID-19 did impact the number of referrals Prescription) received, which explains the reduced volume programmes compared to 2019. However, adaption to a virtual programme delivery continued ■ Māori 1,085 1,313 1,060 momentum for active clients during Levels 3 and 4. ■ Non-Māori 1,499 1,619 1,416

Output class: 2 In order to change breastfeeding at 3 months, we need to address the earlier Percentage of inequities. Our 2 community kaupapa Māori infants receiving breastfeeding support services have seen breast milk at three a steady increase in volumes over the past months21 CW06. year, which will hopefully impact future breastfeeding prevalence. In the past 6 ■ Total 71% 72% 70% 64%  months (Jan-June 2020) the combined two services have supported 556 mama and pepi Māori 57% 62% 70% 51% ■  and their whānau. 82% of non-Māori and 76% of Māori infants are exclusively breastfed at 2 weeks of age (inequity of 6%). 79% of non-Māori and 68% Māori infants and are still exclusively breastfed at discharge from LMC at 4-6 weeks post-natal (inequity of 11%). 70% of non-Māori and 51% of Māori infants continue to be exclusively breastfed at 3 months old (inequity of 19%).

21. This measure is reported on as part of Well Child Tamariki Ora reporting, and monitor in the IDP reporting, only data available from MOH was for March 2020, this was the only data available for period 2019/20 98 99 3.2.4 People Can Access their Health Information Volumes Main measures The use of patient portals within general practice provides a mechanism for greater involvement of patients in their 2018 2019 2020 2020 2020 Achieved Comments of performance Actual Actual Target Actual National personal health management. Portals such as ‘Manage my Health’ enable patients to self-manage by monitoring test Average results, reviewing BMI updates and booking on-line appointments with their GP. Output class: 2 As an unintended consequence the substantive improvements in enrolments Percentage of Volumes has placed additional capacity on an Main measures of enrolled pre- Comments already constrained service. Addressing performance 2018 2019 2020 2020 Achieved school and these capacity challenges should enable Actual Actual Target Actual primary school improvements in this area. Intervention children (0-12) There has been an increase in uptake scheduling and system capacity is Output class: 2 overdue for their 9% 15% 15% 17.8% of patient portals by enrolled patients currently under investigation through The percentage of enrolled  scheduled dental in the BOPDHB region. an analytics project to determine future registered to use general examination – 26 improvements required (system & practice portals.22 CW04 resource) to ensure maximum potential ■ Total 15% 17% <=10% 16.8% NA  to see enrolled children. 3.2.5 Fewer Children and Adolescents have Decayed Missing Filled Teeth ■ Māori 13% 17% 10% 16.4% NA 

Volumes Main measures 2018 2019 2020 2020 2020 Achieved Comments 3.2.6 People with a terminal illness or life limiting chronic disease die in their place of of performance Actual Actual Target Actual National Average choice Output class: 2 Significant disparities remain of concern Palliative care focuses on providing patients with the most appropriate care in end of life stages or advanced state an active evaluation project is underway of terminal illness. Historically palliative medicine has considered patients who access services in our community Percentage of to improve the rate of unseen/over- children who are due children to improve intervention hospices and we have monitored activity accordingly. Palliative medicine utilises a multidisciplinary approach to caries free at age potential for treatments. patient care, relying on input from physicians, pharmacists, nurses, chaplains, social workers, psychologists, and five - CW0123 The Oral health promotion team and the other allied health professionals within secondary services. This multidisciplinary approach allows the palliative care ■ Total 58% 51% 53% 52.3% NA  5 2 1 0 Nutrition and activity programme team to address physical, emotional, spiritual, and social concerns that arise with advanced illness. ■ Māori 29% 34% 53% 34.3% NA  adopted within the BOPDHB region will be a key promotion programmes for improvement in population rates. Volumes Main measures of Comments Output class: 2 Although below target the utilisation is performance 2018 2019 2020 2020 Achieved marginally improved in total and in line Actual Actual Target Actual Percentage with national average results. of adolescent Output class: 3 Although data completeness around utilisation of The number of dentists available for the chosen place of death has improved, data Percentage of New New NA TBD NA DHB funded CDA service remains the similar to last is not reliable yet, only 29% of deaths for patients receiving dental services – year and does not appear to limit service 2019/20 have preferred death site. CW0424 availability for access. specialist palliative care who die in their ■ Total 68% 73% 85% 69.7% 68.5%  The Oral health Promotion Team are chosen place of actively evaluating the transfer of year death 9 adolescents to private dentists to ensure access to service providers is explained and informed. Output class: 2 Improvements were driven by a preschool enrolment initiative, where Percentage of parents of non-enrolled Māori children Children (0-4 were identified and called. years - % year 1) enrolled in DHB System improvement is ongoing and with funded dental internal titanium reporting we expect service – CW04 better monitoring. ■ Total 92% 101% 95% 101.6% NA  ■ Māori25 71% 96% 95% 95.6% NA  ■ Non-Māori 108% 104% 95% 105.9% NA 

22. The Annual Plan patient portal measure is one of the contributory measures for the Patient Experience System Level Measure. On reflection, the target set was extremely ambitious due to the lack of baseline data. 23. Oral health reporting is by calendar year to align with school clinics. Published results are for the 12 month period ending 31 December 2019. Key metrics are caries-free, which measures the number of children who require no dental interventions; and decayed, missing, filled teeth (DMFT) that measures the converse number of teeth that are in a poor state due to decay, extraction or previous dental work. 24. This measure was extracted from MoH report on adolescent utilisation for calendar year 2019. 25. Enrolment of Māori children (0-4) in Oral health services is a priority in the Māori Health Plan with a target of 95% engagement. 26. This measures is calculated for 2019 calendar year. 100 101 HEALTHY FAMILIES – WHĀNAU ORA

Families that are informed of the best ways to maintain their health and well-being will get the most out of life. They Volumes are best placed to manage their own health needs with guidance from the appropriate health professionals along their Main measures of 2018 2019 2020 2020 2020 Achieved Comments journey through life. Lead Maternity Carers, Plunket nurses and Public Health nurses can provide advice until children performance Actual Actual Target Actual National reach school. Kaimanaaki, Whanau Ora navigators and General Practitioners can support families in managing Average respiratory illnesses, skin infections, pneumonia and other avoidable admissions. Nurse specialists can provide Output class: 2, 3 Standardised 45-64 ASH rates support for diabetes patients and individuals with chronic obstructive pulmonary disease (lung disease). Home and Reduced ASH rates in the BOPDHB region are below community support providers assist older people to remain in their homes for longer by delivering functional services 45 – 64 years.27 national averages for total and such as personal care and household management services. other populations but above national rates for Māori. However, These multiple contacts with the health system provide opportunities for whānau to be empowered in managing their ■ Māori 7590 7899 7309 7362 7167  there has been improvement in all groups from 2018 and 2019 health needs. Our objective is to enable people to live well with long term conditions and be safe and healthy in their Total 3731 3859 3691 3859 3905 ■  despite not reaching our target for communities. ■ Other NA 2879 2796 2952 total population and Māori. Output class: 2 The trend of checks completed Outcome goal Outcome measure Percentage of was increasing during the year eligible population until march (COVID), then slightly ■ Fewer people are admitted to hospital for avoidable who have had their increased in June 2020. conditions. Before School Weekly performance monitoring Family/whānau live well with long term conditions Checks (B4SC) to the team allowed them to ■ Long-term conditions are detected early and completed. managed well. check volumes to be allocated ■ Total Population 90% 90% 90% 82% NA  smartly across the year, and enabled the team to front foot the ■ People maintain functional independence. High needs 90% 92% 90% 84% NA People are safe, well and healthy in their own homes ■  volumes challenges encountered and communities ■ Families and whānau are at the centre of their over the summer holiday months healthcare. also. Output class: 1, Data indicates an increase in 2, 3 rheumatic fever cases compared Incidence number to the previous year. 3.3.1 Fewer people are admitted to hospital for avoidable conditions of acute rheumatic There were 14 ARF cases in the fever cases.28 The Ministry of Health defines a group of conditions, such as cellulitis, asthma, angina and chest pain, as avoidable, 2.1 2.5 <1.3 5.5 NA  BOPDHB area from 01/07/2019 to p100,000 based on the premise that early diagnosis and proactive treatment by a health professional in general practice or 30/06/2020. the community could prevent an admission to hospital. These conditions are referred to as Ambulatory Sensitive For the calendar year from 01 Jan Hospitalisation (ASH) conditions and are regularly monitored for the 0-4 and 45-64 age groups. Rates of childhood 2020 to 30 June 2020 there were (0-4) ASH are one of seven System Level Measures and hence are not reported within the Statement of Performance 8 ARF cases, 4 during level 4 lockdown (all from EBOP) and 2 Expectations. during level 3 lockdown (both in Rheumatic fever is a condition that affects patients for their entire life and can lead to heart issues if not properly WBOP). treated. However, rheumatic fever can be prevented by throat swabbing programmes within schools. With the Paediatricians who have reviewed introduction of this school based programme, BOPDHB aims to reduce the incidence of first-reported cases of the cases have attributed the rheumatic fever over time. COVID-19 lock down with limited access to services (including no Health professionals acknowledge that Māori often develop chronic conditions at an earlier age than other sub- access to school and pharmacy populations, and that disparities and inequalities exist when Māori access support and health services. Programmes based throat swabbing services, such as Whanau Ora, Koroua and Kuia, and Kaupapa Māori nursing services exhibit strong cultural values and are and restricted access to general practice) and the increase in delivered by Māori service providers in the community. Culturally responsive services are also necessary within overcrowded housing conditions mainstream hospital and primary care settings to ensure Māori can access appropriate health services and receive as potential explanations for the equitable health outcomes. increased cases over this time. We continue to provide targeted primary and secondary prevention of Rheumatic Fever including; school and pharmacy based throat swabbing services, Healthy Housing Initiative and secondary prophylaxis register and district nursing delivery model. We have expanded our programmes to include early detection of skin issues and infections.

27. Period reported is the 12 months ending 31 June 2020. 28. Bay of Plenty DHB Rheumatic fever rates are for the financial year ending 30 June 2020. Please note that annual trending is not particularly reliable for this metric as the number of cases are small. 102 103 An example of how COVID-19 impacted our performance is in the measure “ Percentage of eligible population who 3.3.2 Long-term conditions are detected early and managed well have had their Before School Checks completed”. The percentage of population enrolled with a Primary Health Organisation (PHO) is an important measure as it indicates the proportion of our residents who have access to primary care and have visited a general practitioner within a three year period. Access to primary care has been shown to have positive benefits in maintaining good health, including early detection of long term conditions and assistance in managing these often life-long conditions.

Volumes Main measures of 2018 2019 2020 2020 2020 Achieved Comments performance Actual Actual Target Actual National Average Output class: 2 BOPDHB achieved both PHO enrolment targets in 2019/20, Percentage of with over 96% of our population population enrolled of 255110 enrolled with a PHO. with a Primary Māori enrolment was over 90% Health Organisation (of 65590). A further 1327 (1139 (PHO)29. Māori) BOPDHB residents are ■ Total 99% 99% 90% 96% 96%  enrolled with Te Kaha practice, which is a BOPDHB primary care ■ Māori 96% 97% 90% 90.8% 88%  facility. We can see the trend on the checks completed until March 2020. During April and May there was almost none increment, then in July we can see a slightly trend up. Output class: 1 This metric was almost achieve for all ethnicities. Only Māori was Percentage of below target by 0.3%. eligible population Volumes who have their Main measures of Comments cardiovascular performance 2018 2019 2020 2020 Achieved Actual Actual Target Actual disease (CVD) check completed Output class: 3 Our Emergency Departments received within the last 5 lower presentations to during the 2019/20 30. Percentage of 51% 48% ≤65% 44% years.  financial year from people seeking medical triage level 4 and assistance, than the previous financial ■ Total 93% 92% 90% 92.3% NA 5 presenting to  year. Therefore, this indicator presents a the Emergency ■ Māori 89% 87.4% 90% 89.7% NA  reduction in presentation volumes of 4%, Department (ED). ■ Non Māori 94% 93.2% 90% 93.1% NA and was primarily driven by low demand in  April and May 2020. Despite of the demand Output class: 1 Data is not available for this in previous months, the ED (triage 4-5) measure for year 2019-20. target was achieved in all months for all Percentage of 75% 73% 90% ethnicities which represents an achievement eligible Māori men for 2019/20 year. in the PHO aged 35-44 years who Output class: 3 While BOPDHB has experienced steady have had their population growth in 2019/20, lower triage cardiovascular risk Number of 18% 15.9% ≤12% 12.8%  4 and 5 ED presentations have produced presentations to ED assessed in the last a lower value for this metric, although we 31 – Triage Level 4 and five years. again missed our target of 12%. 5 as a percentage of the total population. Identifying further opportunities to encourage people to attend primary care in the first instance, will assist with meeting this target.

29. In addition to BOPDHB residents who are enrolled with one of the three local PHOs – Western Bay of Plenty Primary health Organisation, Eastern Bay Primary Health Alliance and Nga Mataapuna Oranga – there are a further 1,327 Te Kaha residents enrolled at Te Kaha practice, which is a BOPDHB run primary health care facility. If these residents are included, then Māori enrolment in primary care increases by 2% to over 92.8% enrolment. 30. Data for the 2019/20 year was available just before publishing but no National Average was available. 31. Data for the 2019/20 year is not available from MoH. 104 105 Volumes Breast and cervical screening coverage for Māori explained Main measures of 2017 2018 2019 2019 2019 Achieved Comments Although BOPDHB did not fully achieve all of both metrics we continued our commitment to improving health equity performance Actual Actual Target Actual National for Māori in the Bay of Plenty. However, a disparity still remains, with 7% disparity for cervical screening (reduced Average by 3% from previous year) and 8.4% disparity for breast screening (0.6% reduction from previous year) in coverage Output class: 1 Cervical screening coverage between Māori and non-Māori women. This disparity highlights the need for cervical screening coverage for Māori to Woman enrolled in a did not reach the target remain a priority in 2019/20, which is why this remains a focussed effort to achieve the aspirations of Te Toi Ahorangi- PHO age 25-69 years for Total and Māori but all who have had a cervical the measures are over the the BOPDHB Māori health strategic plan. National Average. cancer screen sample The improvements in equity for Māori women in breast screening is the product of an integrated service improvement taken in the past three. project between the support to screening services, PHOs, Breast Screen Midland, Bay Radiology and BOPDHB- Total 81% 81% 80% 78.9% 70.9% ■  Planning and Funding. ■ Māori 71% 74% 80% 73.2% 66.8%  ■ Non-Māori 83% 84% 80% 80.4% 71.5%  From the following charts we are able to see a slight trend down in coverage for March period that covers January, February and March 2020. Output class: 1 BOPDHB achieved breast Woman enrolled in a screening targets for total and PHO age 50-69 years non-Māori populations. who are enrolled in a This year has seen continued breast screen program improvements women with breast screen screened with all measures midland. over the national average. ■ Total 71% 73% 70% 73.9% 70.8%  ■ Māori 61% 66% 70% 67.0% 66.8%  ■ Non Māori 74% 75% 70% 75.4% 71.4%  Output class 2 During 2019/20, three equity Focus Area 2 - issues have been identified Diabetes Management and addressed by increased 66% 69% 80% 68.5% NA (HbA1c):  FTE (3.2) in the diabetes Improve or, where high, team. maintain the proportion The PHO (funded by DHB) run of patients with good or diabetes self-management acceptable glycaemic classes on Marae. control (HbA1C indicator) SS13-FA2.

Output class 3 BOPDHB continue to Focus Area 5 - Stroke work towards the targets Services: specifically for thrombolysis 7% 9% 10% 11% NA Percentage of  through increased education. potentially eligible In addition, we have worked stroke patients with Auckland to successfully thrombolysed. SS13- implement the transferral of Ind2 patients to Auckland for clot retrieval. Output class 3 Focus Area 5 - Stroke Services: 74% 73% 80% 82% NA Percentage of stroke  patients admitted to a stroke unit or organised stroke service with demonstrated stroke pathway. SS13-Ind1 Output class 3 Focus Area 5 - Stroke Services: 36% 71% 80% 70% NA Percentage of patients  admitted with acute stroke who are transferred to inpatient rehabilitation services are transferred within 7 days of acute admission. SS13-Ind3

106 107 HEALTHY ENVIRONMENTS – WAI ORA

3.3.3 People Maintain Functional Independence People who live in dry, warm homes are most likely to have the best chance of a healthy life. Families that are able to provide appropriate food and clothing for children will be less likely to need intervention from health professionals for Volumes preventable illnesses. Whānau that are connected within their communities will have support networks to assist them Main measures of Comments in managing adverse health events. performance 2018 2019 2020 2020 Achieved Actual Actual Target Actual Our goal is for families and whanau to have as much information as they need to make good decisions about their Output class 3 The proportion of the 65 plus population environments and personal well-being. When they are required to contact a health professional they have easy receiving home community support services Percentage of 11.86% 9.13% 12.15% 8.31%  access to the expertise required and receive the right health services as soon as possible. the population has been steady but since population is 65+ years that growing in this cohort the percentage remains low. access Home and Outcome goal Outcome measure Community Support Services (HCSS) All people live, learn, work and play in an environment ■ Providing healthier homes. Output class 3 There are a number of initiatives that target that supports and sustains a healthy life. ■ Connecting with agencies to meet community needs. this cohort to stay home for longer, therefore Maintain current 5.7% 3.70% 5.0% 3.4%  the result of a 2% decrease is positive, percentage of ■ Appropriate access to services. population over particularly as the population of this cohort is Our population is enabled to self-manage. ■ People receive prompt and appropriate acute and 65 years who have increasing. arranged care. accessed aged residential care ■ Services provided or funded by the BOPDHB (ARC) All people receive timely, seamless and appropriate contribute to the transfer of knowledge and skills to care. Output class 3 Measure for 2019/20 was calculated based family / whānau to enable self-management. on data from TAS, but it’s not available for Increase in 47% 90% 82% NA  occupancy rate for this year. Total respite contracted beds Residential Respite are 2. This indicator will be reviewed for Bed Days. next year since occupancy rates data is not recorded locally. 3.4.1 Providing Healthier Homes

Volumes Main measures of Comments performance 2019 2020 2020 Achieved 3.3.4 Families and whānau are at the centre of their healthcare Actual Target Actual

The Annual Plan 2019/20 identified families and whānau as key stakeholders in a patient’s health and wellbeing. The Output class 1 There has been 118 insulations (52 ceilings and 66 Whanau Ora target was introduced to reflect this importance. A Whānau Ora pathway is in place with our kaupapa Number of homes 137 60 118  floors) done due to BOPDHB financially assisting with PHO as a clinical care tool that is accessible by all health professionals involved in the care of Māori patients. that are insulated the co-payment required to match the ECCA funding. through the The funding has also been utilised for Ground Vapour community-based Barriers which are a necessary pre-requisite for Volumes Main measures of insulation and underfloor insulation. Comments performance 2018 2019 2020 2020 Achieved healthy housing Actual Actual Target Actual program.

Output class 2 There are 9 BOPDHB contracted Whānau Output class 1 2019 has seen the highest number of referrals to the Ora providers in the BOPDHB region. 11% % of BOPDHB 539 NA TBD 11% Percentage of NA 85% 96.3% HHI since the initiative began in 2015. The increase  are using the Tūāpapa model, the remainder  contracted Whānau eligible referrals in referrals is due to active engagement with NGO’s, (89%) have developed Whānau Ora ora providers to healthy home health and social service providers, community models. All are connected as part of Te Pou that are using initiatives program hui, Iwi partnership and improving paediatric and Matakana’s network, including awareness of the Whānau Ora have an intervention pregnancy referral pathways at the hospital sites. their outcomes research. and/or Tūāpapa plan. assessment tool.

108 109 3.4.2 Connecting with Agencies to Meet Community Needs Volumes Main measures of Comments Volumes performance 2018 2019 2020 2020 Achieved Main measures of Actual Actual Target Actual Comments performance 2019 2020 2020 Achieved Actual Target Actual Output class 3 Achieved

Output class 1 Multi-agency collaboration aims to ensure new and ESPIs (Elective existing communities are planned, designed and Services Number of cross- NA 3 NA Performance developed to help people live well and stay well. 100% 100% 100% 100% collaborative Indicators)  initiatives underway This indicator was modified from last year where we ESPI 1 - timely to improve counted number of multiagency meetings held. integration of health processing of and social services, Specific areas of focus for this collaborative work referrals in 15 especially housing. are: transport; health; education; land use and calendar days or infrastructure planning. less BOPDHB are actively involved in the multi-agency ESPI 2 – Multiple pressures are affecting all services Western BOP homelessness governance committee percentage of and thresholds are adjusted accordingly. 0.1% 5.3% 0% 12.6% and action groups (Kainga Tupu). patients waiting  COVID-19 significantly impacted elective longer than four delivery. months for their 3.4.3 Appropriate Access to Services first specialist assessment The intent is to deliver a public health system that delivers better, sooner, more convenient healthcare for all New Zealanders. This includes access to services when needed, prompt referrals between different facets of the ESPI 3 - patients Achieved waiting without 0% 0% 0% 0% health system and a simplified process for receiving healthcare, that members of the public may understand and  a commitment to comprehend. Outcomes of such a health system are a greater number of residents receiving elective surgeries treatment (for example, joint replacements, cardiology services and eye procedures), efficient services within Emergency ESPI 5 - patients As noted above, COVID-19 has significantly Departments and timely referrals for suspicion of cancer. given a commitment 0.7% 6.3% 0 14.2%  impacted this target, alongside other to treatment but not multiple pressures including: Volumes treated within four • Theatre capacity Main measures of Comments months • Bed capacity performance 2018 2019 2020 2020 Achieved Actual Actual Target Actual • Acute demand • ICU/HDU bed availability Output class 3 BOPDHB did not exceed the 2019/20 Increased outsourcing has assisted. Number of inpatient electives target by 759 discharges. surgical discharges During COVID 19 Alert Level 3 & 4 all ESPI 8 - proportion Not achieved under elective non-urgent elective surgery/procedures of patients treated 99.8% 100% 100% 99.4% initiative (includes were postponed. Non urgent outpatient who were prioritised  all discharges activity was also postponed, with a focus using recognised regardless of on providing telehealth appointments, as tools and processes. whether they are clinically appropriate, reducing the number discharged from Māori outpatient DNA rates are similar than of in person appointments. Output class 3 surgical or medical Did Not Attend previous year. However, Māori DNA remains specialty) The clinical teams across all specialties (DNA) rate for significantly higher than the 5% target and Total 12,112 12,101 10,247 9,488  made a tremendous effort in Alert Level 2 outpatient services. the DNA rate achieved for non-Māori. and then in Alert Level 1 to achieve a 96.3% result. ■ Total 6.3% 5.42% 5% 6.1% 

Output class 3 Standardised intervention rates for coronary ■ Māori 14.6% 13.85% 5% 14.3%  Standardised angiography, cardiac and angioplasty ■ Non Māori 3.9% 3.70% 5% 3.6%  Intervention Rates procedures were below targets and national as per 10,000 of averages. However the figures show the population- SI4 impact of COVID-19. Coronary Targets were achieved for both joint and 31.66 30.3 34.7 27.39 Angiography  cataract procedures. Cardiac 5.20 5.14 6.5 4.51  Angioplasty 11.27 11.20 12.5 11.06  Joint 26.33 28.02 21.0 23.06  Cataract 24.80 29.20 27.0 28.15 

110 111 Volumes Volumes Main measures of Main measures Comments Comments performance 2018 2019 2020 2020 Achieved of performance 2018 2019 2020 2020 Achieved Actual Actual Target Actual Base Base Target Actual Output class 3 These figures only include hospice palliative Output class 2 3,666,354 3,606,864 3,676,982 4,238,026 Community pharmacy prescriptions has 1,490 1,157 769 1,102  increased significantly in 2019/20. Number of clients  care services as this data has not been Number of collected to date by the palliative care team community Given population growth is around 2%, this means supported by that prescription levels per head of population specialist palliative in Tauranga Hospital. pharmacy prescriptions33 have increased more than population growth in care.32 2019/20. The intent is to maintain prescription numbers as Output class 3 The majority of clients supported in much as possible, acknowledging there may be 17% 29% 23% 22.7% Percentage of  specialist palliative care, where a primary changes in line with population growth. diagnosis was recorded, had cancer or end people supported by Output class 3 There has been a number of significant issues stage renal failure as their primary diagnosis specialist palliative Improved over the last 10 months which have impacted on performance of the indicator. care, other than wait times for cancer or end stage diagnostic • Limited access to facility because of acute renal failure. services34 – demand. accepted referrals • Limited access due to implant and pacemaker receive their scan: procedures Both of the above take priority over elective angiography. Coronary 92% 98.6% 95% 68.4%  Angiography • In March April the results were further hit with COVID-19 disruption to elective procedures in all specialties. BOPDHB is planning the commissioning of a second cath lab which will ensure increased capacity, however this is unlikely to be operational before April/May 2021. Diagnostic The urgent target has been achieved for Colonoscopy 2019/2020 through significant focus particularly on administrative processes. Urgent (within 14 82% 90% 90% 94.4%  The non –urgent target was not achieved. days) This, on the whole, is a capacity issue with the Non-urgent 44% 43% 70% 33%  service receiving significantly more referrals (within 42 days) than capacity allows. The service does where possible contract out non-urgents but the market has a limited capacity. In addition, the service continues to utilise locums where available for leave cover and extra lists are provided utilising existing staffing, particular at weekends. Surveillance 39% 56% 70% 32%  The surveillance result is also affected by Colonoscopy capacity as per non-urgent noted above. Computing 98% 97% 95% 92%  The CT target was not achieved by BOPDHB in Tomography (CT) 2019/20. There are four months where target was not achieved: October-November 2019 were not achieved due to strike action undertaken by the MIT workforce and in April-May 2020 due to COVID-19 lockdown and response framework limitations. The lowest figures were in April- May 2020 when staff numbers were limited due to COVID-19 response to social distancing requirements and staffing bubbles. Magnetic BOPDHB almost achieved the MRI target again during 2019/20. The target was not achieved in Resonance 91% 91% 90% 89.9%  Imaging (MRI) April and May 2020 due to COVID-19 lockdown and response framework limitations. Output class 3 Delivery of community radiology services Total number exceeded target in 2019/20. The volume of delivery was comprised of volumes delivered of community 76,941.5 72,770 72,090 72,845  in secondary settings and volumes delivered in referred radiology primary care. Relative Value Units (*RVUs) Output class 2 Community laboratory test volumes decreased Total number in 2019/20, comparing with a steady growth in previous years As test volumes are increasing at a of community 1,524,521 1,565,573 1,450,000 1,535,544  rate exceeding population growth, the implication laboratory tests is that there is also an increase in the number of community lab tests completed per person in the BOPDHB region.

33. This output is measured by the total number of pharmaceutical items dispensed in the community for Bay of Plenty residents. Data is sourced from Central TAS. 32. Our main hospice provider installed a new patient management system (PalCare) that provides greater transparency over patient support and types of activity within palliative care services. The service review will provide a greater understanding of the demand pressures within palliative care. 34. Activity is for all patients who received a diagnostic service in the 12 months ended 30 June 2020. The percentage reflects the proportion of patients who received their service in the specified timeframe. 112 113 Volumes Volumes Main measures of Main measures of Comments Comments performance 2018 2019 2020 2020 Achieved performance 2018 2019 2020 2020 Achieved Base Base Target Actual Base Base Target Actual Output class 2 All non-urgent community lab test Output class 3 This metric is met. Non-urgent community category targets were met during Average length of acute 14-21 14 days 16 days 19 days laboratory tests 2019/20. Category results were adult (18+ years) inpatient days  are completed and broadly similar to those obtained in stay (days) communicated to the previous financial year. Output class 3 This metric has been influenced in practitioners within 77% 67% 90% 64% part by vacancies within the service the relevant category Rates of 7 day follow-up  community teams. A test of change timeframes: in the community post discharge is being developed to look at a Category 1: Within 24 98% 97% 95% 100%  process to enable intensive follow hours up for clients leaving the ward an Category 2: Within 96 100% 100% 100% 100%  therefore free up community case hours managers to follow up all other Category 3: Within 72 100% 100% 100% 100%  discharges. In Whakatane they are hours testing a joint ward and community MDT meeting so that all clients Output class 2 While there were steady numbers that require case management in performance against both routine Percentage of community are allocated prior to discharge and urgent targets, 2019/20 results laboratory tests completed to enhance follow up. A test of were both well in excess of annual within designated change having a social worker plan targets. timeframe from receipt on the ward in Whakatane is also of the specimen at the being implemented to enhance laboratory the transition of clients back to the community. Within 48 hours (routine 99% 99% 90% 99%  test) Within 3 hours (urgent 98% 97% 80% 97%  Average length of acute adult inpatient stay explained test) Average length of stay for acute adult mental health inpatients has remained steady over the last three financial Output class 2 This is a new measure within years, towards the lower end (14 days) of the target range. There are a number of factors impact the length of stay for the Annual Plan and is one of Improvement in the an acute adult inpatient, which is why a target range is identified. 28-day readmission rates are also closely tied to participation domain for BOPDHB’s six System Level Māori and non-Māori Measure milestones. As with average length of stay. within the primary care patient portals, there was no Some of the factors that impact length of stay include: survey. baseline data available prior to setting this target, resulting in ■ ongoing limitations in funded housing/ respite options in the community, which means clients stay longer than an overly ambitious target. While the target was missed there have required for treatment, ■ Māori 7.5 7.3 8 NA  been steady improvements for ■ clients with borderline intellectual disability (not picked up by Support Net) who, due to limitations in independent this metric from 27% in Q1 to 47% living, reside for long periods in the inpatient unit as there are no accommodation options available to discharge ■ Non-Māori 7.6 7.6 8 NA  currently. them. Output class 2 As above. Māori patients completing The introduction of additional resource for follow-up post discharge provides a more comprehensive discharge will provide over 15% of 13.5% 13% 15% NA  process, which means clients can potentially be discharged earlier than if these supports were not in place. responses in the primary care survey Output class 3 There have been significant Volumes changes within the Child and Main measures of Improving mental health 2018 2019 2020 2020 2020 Achieved Comments services using transition Adolescent Service including performance Base Base Target Actual National (discharge) planning high number of vacancies and Average36 for child and youth – turnover of staff. Focused work on MH023635 transitions has been done within Output class 3 Three-week youth (0-19) AOD adult service to test and implement A referral of a young wait times have not been met for Total ■ 87% 80% 95% 74%  and it will then to be adapted for person (0-19 years) the 12 month period from May the Child and Adolescent teams. ■ Māori 82% 75% 95% 79%  is seen by Alcohol 19 – April 20. There has been a The service is entering a service and Other Drug reduction over the past twelve development programme and health professional months. integrating processes with wider within 3 weeks 85% 79% 80% 70.7% 81%  stakeholders so we look to see of referral being This indicator is only based on improvement in this metric over the received. new clients, therefore a new next year. initiative to monitor waiting times for all referrals.

35. Mental Health reports are for 12 months rolling periods and are not currently reported by ethnicity. 36. National Indicators based on values from Mar19 to Mar20.

114 115 Volumes Volumes Main measures of Main measures of 2018 2019 2020 2020 2020 Achieved Comments 2018 2019 2020 2020 2020 Achieved Comments performance Base Base Target Actual National performance Base Base Target Actual National Average Average Output class 2 Meeting 3 week waiting times Output class 2 The ‘Quiktest’ STI self-testing Percentage of in mental health and AOD has An increase in pilot was due to commence in people referred for been challenging in the last 12 chlamydia testing April/May 2020. Unfortunately non-urgent mental months due to the number of coverage for 15-24 this had to be postponed until health or addiction vacancies in the service and years olds October 2020. The pilot has been 5% services are seen turnover rates. One vacancy is TBD is to test the prototype with 100 increase within 3 weeks. currently being advertised in the young people and men who have Mental Health Youth AOD team (SORTED). We sex with men. It will be offered (Provider Arm) % expect this to be filled in the next at a large Alternative Education people seen <3 6 weeks. COVID-19 has definitely provider and through some high weeks impacted in this area. Mental school nurse clinics. 0-19 yrs 80% 77% 80% 71.3% 65%  Health access achievement has 20-64 yrs 80% 85% 80% 85.5% 81%  remained higher than the national Addictions (Provider average. 3.4.4 People receive prompt and appropriate acute and arranged care Arm and NGO) % people seen <3 Access rates have also been Bay of Plenty DHB achieved over 90% of patients with a confirmed diagnosis of cancer received their first treatment weeks higher than the national average within 62 days – which reflects the improvements made under some of the recent initiatives introduced within the in all areas which has further 0-19 yrs 85% 79% 80% 82% cancer space at BOPDHB and the change in methodology for calculating this result. 75.1%  challenged our system. 20-64 yrs 77% 77% 80% 75.4% 79%  Volumes Output class 2 Performance against eight-week Main measures of Comments Percentage of wait time targets has largely been performance 2018 2019 2020 2020 Achieved people referred for maintained for mental health Base Base Target Actual non-urgent mental and addiction service provision. Output class 3 Performance against this target has health or addiction Child and Youth services have improved slightly, particularly in the last services are seen been challenged by vacancies Percentage of 94% 93% 95% 91.2% quarter of the year. Associate Clinical within 8 weeks. and turnover of staff. COVID-19 patients admitted,  Nurse Manager workshop on capacity Mental Health has also impacted on the waiting discharged or and demand management in ED is being (Provider Arm) % times for less urgent work transferred from an coordinated. people seen <8 particularly during Level 3 and ED within six hours weeks. 4 when non-urgent work was – Health Target. at times delayed. We now have 0-19 yrs 96% 96% 95% 93% 85%  Output class 3 BOPDHB have achieved both acute processes in place to try and coronary syndrome services targets in 20-64 yrs 96% 95% 95% 95.2% 93%  Focus area 4 – utilise technology to prevent 2019/20. Reported results are based on the Acute Heart service 91% 93% 70% Addictions (Provider these waits happening again 90.5%  mean of the four quarterly results reported 70% of high risk Arm and NGO) % should we need to re-introduce to the Ministry of Health as part of the IDP patients receive an people seen <8 Level3/4 lockdown. Recruitment reporting process. weeks is also underway for all vacant angiogram within 3 positions. days of admission. 0-19 yrs 97% 90% 95% 88.3% 94%  (‘Day of Admission’ 20-64 yrs 94% 96% 95% 93.8% 92% Performance against eight-week being ‘Day 0’) –  wait time metrics is equivalent or SS13 better than national averages for three of four metrics. Output class 3 Performance against both acute coronary Output class 3 Focus area 4 – syndrome services metrics is similar to Over the 19/20 period, the MH101 what has been achieved in the previous two Māori youth (10-24) youth workforce training initiative Acute heart service 97% 99% 95% 99.73% years. ED hospitalisations has commenced with a view to Over 90% of  per 10,000 improving early identification patients presenting population resulting 43.6% TBD and referral of those at risk of with ACS who from deliberate self self-harm. This will be evaluated undergo coronary harm in the new year with a view angiography to determining whether this have completion approach has been successful. of ANZACS QI ACS and Cath/ Output class 2 As above – this initiative focusses PCI registry data An increase in the on early identification in areas collection within 30 10% number of Māori TBD that most commonly interact with days – SS13 youth seen within increase youth. This is a multiagency focus. Primary Mental Health

116 117 STATEMENT OF RESPONSIBILITY FOR THE YEAR ENDED 30 JUNE 2020 Volumes Main measures of Comments performance 2018 2019 2020 2020 Achieved The Board and Management of the BOPDHB accept responsibility for the preparation of the financial statements and Base Base Target Actual the judgements used in them. Output class 3 BOPDHB achieved the FCT target in The Board and Management of the BOPDHB accepts responsibility for establishing and maintaining a system of all four quarters in 2019/2020, the Part A Faster Cancer internal control designed to provide reasonable assurance as to the integrity and reliability of the financial reporting Treatment – 62-day 95.1% result representing a weighted and non-financial reporting. indicator - proportion average of these quarterly results. BOP was 5th Nationally in Quarter 1 of patients with a In the opinion of the Board and Management of the BOPDHB, the financial statements for the year ended confirmed diagnosis and 4th Nationally in quarters 2-4 30 June 2020 fairly reflect the financial position and operations of the BOPDHB. of cancer who receive across all DHB’s, which is a great their first cancer 94% 92% 90% 95.1%  achievement and recognition of the treatment (or other hard work that is being done. management) within 62 days of decision- to-treat– see Health Target.

Output class 3 BOPDHB achieved the FCT target in Part B Faster Cancer 90% 88% 85% 90.5%  all four quarters in 2019/2020, the Treatment – 31 day 90.5% result representing a weighted indicator Patients average of these quarterly results. receive their first Sharon Shea Pete Chandler Owen Wallace cancer treatment (or Interim Board Chair Chief Executive Officer General Manager other management) Corporate Services within 31 days from date of decision-to- treat.

3.4.5 Services provided or funded by the BOPDHB contribute to the transfer of knowledge and skills to family/whānau to enable self-management

Volumes Main measures of Comments performance 2018 2019 2020 2020 Achieved Actual Actual Target Actual

Output class 2 There are two instances of CHIP in Number of 6,440 3,231 6,500 3,315 NA use within the BOPDHB region: The registered users of secondary care view of CHIP and for the Clinical Health primary care use. Information Portal (CHIP)37

37. Previous years this measure was based on registered users which does not provide system usage, current measure was based on actual users in the last 90 days as at 7th Aug 2020. 118 119 07 Financial Statements Pūrongo Pūtea

120 121

Bay of Plenty District Health Board Bay of Plenty District Health Board Statement of financial position STATEMENT OF COMPREHENSIVEStatement of REVENUEcomprehensive revenue AND and expense STATEMENT OF FINANCIAL POSITION As at 30 June 2020 For the year ended 30 June 2020 EXPENSE FOR THE YEAR ENDED 30 JUNE 2020 AS AT 30 JUNE 2020 Statement of financial position Statement of comprehensive revenue and expense As at 30 June 2020 For the year ended 30 June 2020 Actual Budget Actual Actual Budget Actual 2020 2020 2019 2020 2020 2019 Note $'000 $'000 $'000 Note $'000 $'000 $'000 ASSETS Income Current assets Crown revenue 4 886,587 858,013 831,908 Cash and cash equivalents 10 2,429 7,767 21,277 Finance income 9 654 810 1,229 Trade and other receivables 12 36,059 38,125 31,400 Other revenue 5 8,890 6,866 7,594 Inventories 13 3,133 2,764 3,086 Total income 896,131 865,689 840,731 Total current assets 41,621 48,656 55,763 Less expenditure Non-current assets Employee expenses 7 312,347 294,980 279,019 Investments in associates and joint ventures 16,17 428 367 503 Depreciation and amortisation expense 14,15 21,225 22,144 21,028 Other investments 305 305 304 Outsourced services 37,897 30,482 43,732 Property, plant and equipment 14 304,380 283,615 284,582 Clinical supplies 66,653 70,368 67,379 Intangible assets 15 16,672 15,664 12,034 Other district health boards 82,462 81,037 76,606 Total non-current assets 321,785 299,951 297,423 Non-health board provider payments 344,716 324,222 313,165 Non-clinical expenses 8 45,515 40,441 41,701 Finance costs 9 15,263 15,502 16,322 Total assets 363,406 348,607 353,186 Total operating expenditure 929,793 876,187 858,226 LIABILITIES Share of associates/joint ventures surplus/(deficit) 16,17 (15) - 130 Current liabilities Surplus/(deficit) (33,677) (10,498) (17,365) Trade and other payables 19 53,169 58,501 52,335 Borrowings 20 57 - - Other comprehensive revenue and expense Employee benefits liabilities 18 43,894 38,574 35,594 Provisions 21 12,480 - 4,832 Items that will not be reclassified to surplus/(deficit) Total current liabilities 109,600 97,075 92,761 Gains/(Losses) on property revaluations 26,184 - - Total other comprehensive income 26,184 - - Non-current liabilities Total comprehensive income (7,493) (10,498) (17,365) Borrowings 20 302 - - The above statement of comprehensive revenue and expenses should be read in conjunction with the accompanying notes. Employee benefits liabilities 18 1,682 676 1,110 Total non-current liabilities 1,984 676 1,110

Total liabilities 111,584 97,751 93,871

Net assets 251,822 250,856 259,315

EQUITY Crown equity 223,271 223,270 223,271 Accumulated funds (58,664) (33,445) (24,987) Property revaluation reserve 87,215 61,031 61,031 Total equity 251,822 250,856 259,315

Total equity 251,822 250,856 259,315

The above statement of financial position should be read in conjunction with the accompanying notes.

Sharon Shea Ron Scott

______

-5-

-4-

122 123

Bay of Plenty District Health Board Bay of Plenty District Health Board STATEMENT OF CHANGES IN NETStatement ASSETS/ of changes in net assets/equity STATEMENT OF CASH FLOWS FOR THEStatement YEAR of cash flows For the year ended 30 June 2020 For the year ended 30 June 2020 EQUITY FOR THE YEAR ENDED 30 JUNE 2020 ENDED 30 JUNE 2020

Statement of changes in net assets/equity Statement of cash flows For the year ended 30 June 2020 For the year ended 30 June 2020 Property Actual Budget Actual revaluation Retained 2020 2020 2019 Crown equity reserve earnings Total Note $'000 $'000 $'000 $'000 $'000 $'000 $'000 Cash flows from operating activities Balance as at 1 July 2019 223,271 61,031 (24,987) 259,315 Receipts from Crown and patients 893,737 859,355 836,789 Interest received 774 652 1,380 Comprehensive revenue and expense GST (net) 659 147 (852) Surplus or deficit for the year - - (33,677) (33,677) Payments to suppliers (585,995) (542,088) (531,557) Gain on the revaluation of land and buildings - 26,184 - 26,184 Payments to employees (293,533) (291,190) (275,156) Total comprehensive revenue and expense - 26,184 (33,677) (7,493) Capital charge paid (15,249) (15,477) (16,294) Net cash flow from operating activities 11 393 11,399 14,310 Transactions with owners Contribution from the Crown - - - - Cash flows from investing activities Total transactions with owners - - - - Receipts from sale of property, plant, and equipment 88 24 9 Balance as at 30 June 2020 223,271 87,215 (58,664) 251,822 Acquisition of Investments - - - Purchase of property, plant and equipment (14,251) (16,923) (10,383) Property Purchase of intangible assets (5,040) (5,000) (4,138) revaluation Retained Acquisition of investments - - (491) Crown equity reserve earnings Total Net cash flow from investing activities (19,203) (21,899) (15,003) $'000 $'000 $'000 $'000 Cash flows from financing activities Balance as at 1 July 2018 223,271 61,031 (7,622) 276,680 Repayment of Finance Leases (38) - - Net cash flow from financing activities (38) - - Comprehensive revenue and expense Surplus or deficit for the year - - (17,365) (17,365) Net increase/(decrease) in cash and cash equivalents (18,848) (10,500) (693) Transactions with owners Contribution from the Crown - - - - Cash and cash equivalents at the beginning of the year 10 21,277 18,267 21,970 Total transactions with owners - - - - Cash, cash equivalents, and bank overdrafts at the end of the Balance as at 30 June 2019 223,271 61,031 (24,987) 259,315 year 10 2,429 7,767 21,277

The accompanying notes form part of these financial statements. The above statement of changes in net assets/equity should be read in conjunction with the accompanying notes.

-7-

-6-

124 125 NOTES TO THE FINANCIAL STATEMENTS

1. Statement of Accounting Policies for the Year Ended 30 June 2018 (iii) Letter of comfort The actions outlined above to address the operational viability and cash flow requirements are dependent on Reporting entity a combination of initiatives the Board intends taking over the next twelve months but there is still uncertainty of whether these actions will be successful and therefore the Board has received a letter of comfort from the Bay of Plenty District Health Board (DHB) is a District Health Board established by the New Zealand Public Health and Ministers of Health and Finance which states that deficit support will be provided where necessary to maintain Disability Act 2000. Bay of Plenty DHB is a crown entity in terms of the Crown Entities Act 2004, owned by the Crown, viability. and is domiciled and operates in New Zealand. Bay of Plenty DHB is a reporting entity for the purposes of the New Zealand Public Health and Disability Act 2000 (NZ PHD), the Financial Reporting Act 2013, the Public Finance Act 1989 and the Crown Entities Act 2004 (CEA). 2. Summary of Significant Accounting Policies

Bay of Plenty DHB is a public sector, public benefit entity (PS PBE), as defined under External Reporting Board (XRB) Standard A1. PS PBEs are reporting entities whose primary objective is to provide goods or services for community or 2.1 Basis of preparation social benefit and where any equity has been provided with a view to supporting that primary objective rather than for The financial statements have been prepared on the going concern basis, and the accounting policies have been a financial return to equity holders. applied consistently throughout the year. The financial statements of Bay of Plenty DHB incorporate Bay of Plenty DHB and Bay of Plenty DHB’s interest Statement of compliance in associates and joint ventures. Bay of Plenty DHB is required under the CEA to prepare consolidated financial statements in relation to the economic entity for each financial year. These financial statements, including the comparatives, have been prepared in accordance with the requirements of the New Zealand Public Health and Disability Act 2000 and the Crown Entities Act 2004, which include the Consolidated financial statements for the economic entity have not been prepared due to the small size of the requirement to comply with New Zealand generally accepted accounting practice (NZ GAAP). controlled entities which means that the controlling entity and economic entity amounts are not materially different. The following are the Bay of Plenty DHB controlled entities which have not been consolidated in the financial The financial statements have been prepared in accordance with Public Sector Tier 1 PBE Accounting Standards (PS statements: PBE IPSAS). These standards are based on International Public Sector Accounting Standards (IPSAS).

Tauranga Community Health Trust (Inc.) and Whakatane Community Health Trust (Inc.) are charitable trusts which Measurement base administer donations received which are tagged for specific use within the Bay of Plenty DHB. The Bay of Plenty DHB The financial statements have been prepared on a historical cost basis, except that land and buildings are stated at has no financial interest in either of these trusts. The trusts are controlled by the Bay of Plenty DHB in accordance with their fair value. PS PBE IPSAS 6 as the Bay of Plenty DHB is able to appoint the majority of the Trustees of the Charitable Trusts. The objective for which the Charitable Trusts are established is entirely charitable. Functional and presentation currency Bay of Plenty DHB’s activities involve funding and delivering health and disability services and mental health services The financial statements are presented in New Zealand dollars and all values are rounded to the nearest thousand in a variety of ways to the community. dollars ($'000) unless otherwise stated. The functional currency of the Bay of Plenty DHB is New Zealand dollars.

The financial statements were authorised for issue by Bay of Plenty DHB on 3rd December 2020. Changes in accounting policies Going Concern Assumption There have been no changes in accounting policies during the financial year. The going concern assumption has been adopted in the preparation of these financial statements. The Board has Critical accounting estimates a reasonable expectation that the DHB has adequate resources to continue operations for the foreseeable future based on current trading terms and legislative requirements. The Board has reached this conclusion having regard to The preparation of financial statements requires the use of certain critical accounting estimates. It also requires circumstances which it considers likely to affect the DHB during the period of one year from the date of signing the management to exercise its judgement in the process of applying the Bay of Plenty DHB’s accounting policies. The 2019/20 financial statements, and to circumstances which it knows will occur after that date which could affect the areas involving a higher degree of judgement or complexity, or areas where assumptions and estimates are significant validity of the going concern assumption (as set out in its current Statement of Intent). The key considerations are set to the financial statements, are disclosed in note 3. out below. 2.2 Reclassification of comparative figures (i) Operating and Cash flow forecast Certain comparative figures have been reclassified to be on a consistent basis as the current year figures. The Board has considered the current year’s deficit of $33.7m and the forecasted deficit of $5.4m for next year together with forecast information relating to operational viability and cash flow requirements as well as the significant proposed capital spend in the future period. The Board expects that it will be able to use its working 2.3 Non-derivative financial instruments capital facility and access to additional funding, together with making adjustments to its capital spend to address Non-derivative financial instruments include cash and cash equivalents, receivables (excluding prepayments), the operational viability and cash flow for the coming year whilst still meeting expected patient demand and investment in associates, investment in joint ventures, payables, accruals and borrowings. These are recognised funding the required resources to deliver the relevant clinical services to meet such demand. initially at fair value plus or minus any directly attributable transaction costs.

(ii) Borrowing covenants and forecast borrowing requirements A financial instrument is recognised if the Bay of Plenty DHB becomes a party to the contractual provisions of the The Bay of Plenty DHB is subject to borrowing restrictions as detailed in the Ministry of Health Operations Policy instrument. Financial assets are derecognised if the Bay of Plenty DHB's contractual rights to the cash flows from Framework. The cash flow forecast for the next year prepared by the DHB reflects that equity funding or lease the financial assets expire or if the Bay of Plenty DHB transfers the financial asset to another party without retaining funding, together with the working capital facilities will be required to meet cash requirements. Whilst there is control or substantially all risks and rewards of the asset. Regular way purchases and sales of financial assets are uncertainty regarding the mechanism that will be used to meet such cash requirements, the Board is confident accounted for at trade date, i.e., the date the Bay of Plenty DHB commits itself to purchase or sell the asset. Financial that this can be achieved without breaching covenants or other borrowing restrictions. liabilities are derecognised if the Bay of Plenty DHB's obligations specified in the contract expire or are discharged or cancelled.

126 127 Subsequent to initial recognition, non-derivative financial instruments are recognised as described below: Additions

2.3.1 Financial assets The cost of an item of property, plant, and equipment is recognised as an asset if, and only if, it is probable that future economic benefits or service potential associated with the item will flow to the Cash and cash equivalents, receivables and investments in JV & associates under 2.5, 2.9, 2.10 and 2.4 respectively. Bay of Plenty DHB and the cost of the item can be measured reliably.

2.3.2 Financial liabilities Work in progress is recognised at cost less impairment and is not depreciated. The total cost of a Payables and accruals are described under 2.11 project is transferred to the appropriate class of asset on its completion and then depreciated. In most instances, an item of property, plant, and equipment is initially recognised at its cost. Where 2.4 Cash and cash equivalents an asset is acquired through a non-exchange transaction, it is recognised at its fair value as at the Cash and cash equivalents include cash on hand and deposits held at call with banks with original maturities of three date of acquisition. months or less. Depreciation Bank overdrafts are shown within interest bearing liabilities in current liabilities in the statement of financial position. Bank overdrafts that are repayable on demand and form an integral part of the Bay of Plenty DHB’s cash management Depreciation is provided on a straight-line basis on all property, plant, and equipment other than are included as a component of cash and cash equivalents for the purpose of the statement of cash flows. land, at rates that will write-off the cost (or valuation) of the assets to their estimated residual values over their useful lives. The useful lives and associated depreciation rates of major classes of assets 2.5 Trade and other receivables have been estimated as follows: Class of property, plant and equipment Estimated useful life Short-term debtors and other receivables are recorded at the amount due, less an allowance for expected credit losses. The DHB applies the simplified expected credit loss model of recognising the lifetime expected credit losses Buildings 2 to 92 years for receivables. Leasehold improvements 2 to 50 years Plant, equipment and vehicles 1 to 25 years In measuring expected credit losses, short-term debtors and other receivables have been assessed on a collective basis as they possess shared credit risk characteristics. The residual value and useful life of an asset is reviewed, and adjusted if applicable, at each financial year end. Short-term receivables are written off where there is no reasonable expectation of recovery. Indicators that there is no reasonable expectation of recovery include the debtor being in liquidation. Freehold land and work in progress are not depreciated.

Subsequent costs 2.6 Inventory Costs incurred subsequent to initial acquisition are capitalised only when it is probable that future Inventories acquired through non-exchange transactions are measured at fair value at the date of acquisition. economic benefits or service potential associated with the item will flow to the Bay of Plenty DHB and Inventories held for use in the provision of goods and services on a commercial basis are valued at the lower of cost the cost of the item can be measured reliably. (using the weighted average cost method) and net realisable value. Disposals The amount of any write-down for the loss of service potential or from cost to net realisable value is recognised in the Realised gains and losses on disposal of property, plant and equipment are recognised in the surplus or deficit in the period of the write-down. statement of comprehensive revenue and expense. Any amounts included in property, plant and equipment revaluation reserve in respect of the disposed property, plant and equipment are 2.7 Property, plant and equipment transferred from the property revaluation reserve to accumulated funds. Property, plant, and equipment consist of: (i) Land 2.8 Intangible assets (ii) Buildings Intangible assets are initially recorded at cost. Where acquired in a business combination, the cost is (iii) Plant, equipment and vehicles the fair value at the date of acquisition. The cost of an internally generated intangible asset represents (iv) Leasehold improvements expenditure incurred in the development phase. (v) Work in progress Subsequent to initial recognition, intangible assets with finite useful lives are recorded at cost, Revaluation less any amortisation and impairment losses and are reviewed annually for impairment losses. Land and buildings are revalued by an independent valuer with sufficient regularity to ensure that their carrying Amortisation of intangible assets is provided on a straight-line basis that will write off the cost of amount does not differ materially from fair value and at least every three years. the intangible asset to estimated residual value over their useful lives. Assets with indefinite useful lives are not amortised but are tested, at least annually, for impairment and are carried at cost less Revaluations of land and buildings are accounted for on a class-of-asset basis. accumulated impairment losses. The net revaluation results are credited or debited to other comprehensive revenue and expense and are accumulated Where an intangible asset's recoverable amount is less than its carrying amount, it will be reported at to an asset revaluation reserve in equity for that class of asset. Where this would result in a debit balance in the asset its recoverable amount and an impairment loss will be recognised. Impairment losses resulting from revaluation reserve, this balance is not recognised in other comprehensive income but is recognised in the surplus or impairment are reported in statement of comprehensive revenue and expense. deficit. Any subsequent increase on revaluation that reverses a previous decrease in value recognised in the surplus or deficit will be recognised first in the surplus or deficit up to the amount previously expensed, and then recognised in Realised gains and losses arising from the disposal of intangible assets are recognised in statement other comprehensive revenue and expense. of comprehensive revenue and expense in the year in which the disposal occurs.

128 129 Intangible assets comprise of computer software and others: The surplus or deficits resulting from transactions between the Bay of Plenty DHB and the associate are eliminated to the extent of the Bay of Plenty's interest in the associate or joint venture. Acquired computer software licences are capitalised based on the costs incurred to acquire and bring to use the software. Costs are amortised using the straight line method over their estimated useful lives. 2.10 Joint ventures Costs associated with maintaining computer software programmes are recognised as an expense when incurred. The interest in a joint venture is accounted for in the financial statements using the equity method and is carried at Costs directly associated with the development of identifiable and unique software products are recognised as an cost. Under the equity method, the share of the profits or losses of the joint venture is recognised in the statement asset. of comprehensive revenue and expense, and the share of movements in reserves is recognised in reserves in the Staff training costs are recognised as an expense when incurred. statement of financial position.

Finance Procurement Supply Chain, including Finance Procurement and Information Management 2.11 Trade and other payables (FPIM) Short-term creditors and other payables are recorded at amortised cost. The Finance Procurement Supply Chain (FPSC), which includes the Finance Procurement and Information Management (FPIM), is a national initiative funded by DHB's and facilitated by NZ Health Partnerships Limited 2.12 Employee entitlements (NZHPL) to deliver sector wide benefits. NZHPL holds an intangible asset recognised at the capital cost of development relating to this programme. Bay of Plenty DHB holds an asset at the cost of capital invested by Bay of Short term employee entitlements Plenty DHB in the FPSC programme. This investment represents the right to access the FPSC assets. DHB's have the Employee benefits expected to be settled within 12 months after the end of the period in which the employee renders ability and intention to review the service level agreement indefinitely and the fund established by NZHPL through the the related service are measured based on accrued entitlements at current rates of pay. on-charging of depreciation and amortisation on the assets to the DHB's will be used to, and is sufficient to, main the assets standard of performance or service potential indefinitely. These include salaries and wages accrued up to balance date, annual leave earned to, but not yet taken at balance date, and sick leave. Information technology shared services rights Long term employee entitlements Bay of Plenty District Health Board has provided funding for the development of information technology (IT) shared Employee benefits that are due to be settled beyond 12 months after the end of the year in which the employee services across the DHB sector and the rights to the shared services is recognised as an intangible asset at the cost of renders the related service, such as long service leave and retirement gratuities, have been calculated on an actuarial Bay of Plenty District Health Board share of investment. basis. The calculations are based on:

Amortisation ■ likely future entitlements accruing to staff, based on years of service, years to entitlement, the likelihood that staff The carrying value of an intangible asset with a finite life is amortised on a straight-line basis over its useful life. will reach the point of entitlement, and contractual entitlement information; and Amortisation begins when the asset is available for use and ceases at the date that the asset is derecognised. The ■ the present value of the estimated future cash flows. amortisation charge for each period is recognised in the surplus or deficit. Presentation of employee entitlements The useful lives and associated amortisation rates of major classes of intangible assets have been estimated as Sick leave, annual leave, vested long service leave and non-vested long service leave expected to be settled within 12 follows: months of balance date, are classified as a current liability. All other employee entitlements are classified as a non- Class of intangible asset Estimated useful life current liability.

Software 2 to 3 years (i) Defined contribution schemes Obligations for contributions to KiwiSaver, the Government Superannuation Fund, and the State Sector 2.9 Investments in associates Retirement Savings Scheme are accounted for as defined contribution superannuation schemes and are The Bay of Plenty DHB's associate investments are accounted for using the equity method. recognised as an expense in the surplus or deficit when incurred.

An associate is an entity over which the Bay of Plenty DHB has significant influence, and that is neither a controlled (ii) Wages and salaries, annual leave, sick leave and medical education leave entity nor an interest in a joint venture. Liabilities for wages and salaries, including non-monetary benefits, annual leave and accumulating sick leave Under the equity method, the investment in an associate is initially recognised at cost, and the carrying amount is expected to be settled within 12 months of the reporting date are recognised in other payables in respect of increased or decreased to recognise the Bay of Plenty DHB’s share of surplus or deficit of the investee after the date employees' services up to the reporting date and are measured at the amounts expected to be paid when the of acquisition. The Bay of Plenty DHB’s share of the surplus or deficit of the associate is recognised in the Bay of liabilities are settled. Liabilities for non-accumulating sick leave are recognised when the leave is taken and Plenty DHB’s statement of comprehensive revenue and expenses. Distributions received from an associate reduce the measured at the rates paid or payable. carrying amount of the investment in the Bay of Plenty DHB’s statement of financial position. (iii) Long service leave If the Bay of Plenty DHB’s share of deficits of an associate equals or exceeds its interest in the associate, the Bay The liability for long service leave is recognised in the provision for employee benefits and measured as the of Plenty DHB discontinues recognising its share of further deficits, unless it has incurred legal or constructive present value of expected future payments to be made in respect of services provided by employees up to the obligations or made payments on behalf of the associate. reporting date using the projected unit credit method. Consideration is given to expected future wage and salary levels, experience of employee departures and periods of service. Expected future payments are discounted If the associate subsequently reports surpluses, the Bay of Plenty DHB resumes recognising its share of those using market yields at the reporting date on national government bonds with terms to maturity and currency that surpluses only after its share of the surpluses equals the share of deficits not recognised. match, as closely as possible, the estimated future cash outflows.

130 131 2.13 Provisions Revenue from services is recognised, to the proportion that a transaction is complete, when it is probable that the payment associated with the transaction will flow to Bay of Plenty DHB and that payment can be measured or A provision is recognised for future expenditure of uncertain amount or timing when there is a present obligation estimated reliably, and to the extent that any obligations and all conditions have been satisfied by Bay of Plenty (either legal or constructive) as a result of a past event, it is probable that an outflow of future economic benefits will DHB. be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. (iv) Revenue relating to service contracts Provisions are measured at the present value of the expenditures expected to be required to settle the obligation using a pre-tax discount rate that reflects current market assessments of the time value of money and the risks Bay of Plenty DHB receives revenue for service contracts on an invoice or payment schedule basis. Bay of specific to the obligation. The increase in the provision due to the passage of time is recognised as an interest expense Plenty DHB is required to expend all monies appropriated within certain contracts during the year in which it is and is included in “finance costs”. appropriated. Should this not be done, the contract may require repayment of the money or Bay of Plenty DHB, with the agreement of the Ministry of Health, may be required to expend it on specific services in subsequent 2.14 Equity years. The amount unexpended is recognised as a liability. (v) Financing revenue Equity is measured as the difference between total assets and total liabilities. Equity is disaggregated and classified into the following components: Interest received and receivable on funds invested are calculated using the effective interest rate method and are recognised in the surplus or deficit. ■ Crown equity. ■ Accumulated funds. (vi) Inter District Flow Revenue ■ Property revaluation reserves. Inter-District Flow revenue is received for activity undertaken by Bay of Plenty DHB for patients domiciled in other DHB regions. Receipts are based on an agreed level of production and are subject to wash-up rules if Property revaluation reserves actual volumes are different to agreed volumes. This reserve relates to the revaluation of land and buildings to fair value after initial recognition. 2.18 Leases 2.15 Income tax (i) Finance leases Bay of Plenty DHB is a crown entity under the NZ PHD and is exempt from income tax under section CW38 of the A finance lease is a lease that transfers to the lessee substantially all the risks and rewards incidental to Income Tax Act 2007. ownership of an asset, whether or not title is eventually transferred. 2.16 Goods and services tax At the start of the lease term, finance leases are recognised as assets and liabilities in the statement of financial position at the lower of the fair value of the leased item or the present value of the minimum lease payments. All items in the financial statements are stated exclusive of goods and services tax (GST), except for receivables and payables, which are presented on a GST-inclusive basis. Where GST is not recoverable as input tax, it is recognised as The finance charge is charged to the surplus or deficit over the lease period so as to produce a constant periodic part of the related asset or expense. rate of interest on the remaining balance of the liability.

The net amount of GST recoverable from, or payable to, the Inland Revenue Department (IRD) is included as part of The amount recognised as an asset is depreciated over its useful life. If there is no certainty as to whether the receivables or payables in the statement of financial position. Entity will obtain. The net GST paid to, or received from the IRD, including the GST relating to investing and financing activities, is (ii) Operating leases classified as an operating cash flow in the statement of cash flows. An operating lease is a lease that does not transfer substantially all the risks and rewards incidental to ownership of an asset. 2.17 Revenue Lease payments under an operating lease are recognised as an expense on a straight-line basis over the lease Revenue is measured at fair value. term.

The specific accounting policies for significant revenue items are explained below: Lease incentives received are recognised in the surplus or deficit over the lease term as an integral part of the (i) Crown funding total lease expense. The majority of revenue is provided through an appropriation in association with a Crown Funding Agreement. Revenue is recognised monthly in accordance with the Crown Funding Agreement payment schedule, which 2.19 Financing costs allocates the appropriation equally throughout the year. Financing costs comprise interest paid and payable on borrowings calculated using the effective interest rate method, (ii) ACC contracted revenue are recognised in the surplus or deficit. ACC contract revenue is recognised when eligible services are provided and any contract conditions have been The interest expense component of finance lease payments is recognised in the surplus or deficit using the effective fulfilled. interest rate method.

(iii) Goods sold and services rendered 2.20 Budget figures Revenue from goods sold is recognised when Bay of Plenty DHB has transferred to the buyer the significant The budget figures are made up of Bay of Plenty DHB's Annual Plan which was tabled in Parliament. The budget risks and rewards of ownership of the goods and Bay of Plenty DHB does not retain either continuing managerial figures have been prepared in accordance with NZ GAAP, using accounting policies that are consistent with those involvement to the degree usually associated with ownership nor effective control over the goods sold. adopted by Bay of Plenty DHB in preparing these financial statements.

132 133 2.21 Cost allocation Compliance with Holidays Act 2003 Bay of Plenty DHB has arrived at the net cost of service for each significant activity using the cost allocation system Many public and private sector entities, including the BOPDHB, are continuing to investigate historic underpayment of outlined below. holiday entitlements. For employers such as the BOPDHB that have workforces that include differential occupational Direct costs are charged directly to output classes. Direct costs are those costs directly attributable to an output class. groups with complex entitlements, non-standard hours, allowances and/or overtime, the process of assessing Indirect costs are charged to output classes based on cost drivers and related activity and usage information. Indirect compliance with the Act and determining the underpayment is time consuming and complicated. costs are those costs that cannot be identified in an economically feasible manner with a specific output class. DHBs have decided to take a national approach and have been working with key stakeholders to define a baseline The cost of internal services not directly charged to outputs is allocated as overheads using appropriate cost drivers interpretation document for the health sector. This is substantially agreed, but there are some remaining issues which such as actual usage, staff numbers and floor area. are in the process of being resolved. The intention is that, once the baseline document is agreed, this would be used by each DHB to systematically assess their liability. The BOPDHB has included an estimated liability in note 21.

3. Critical Accounting Estimates and Judgements Other Provision A provision is recognised for future expenditure of uncertain amount or timing when there is a present obligation Critical accounting estimates and assumptions (either legal or constructive) as a result of a past event, it is probable that an outflow of future economic benefits will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. Provisions In preparing these financial statements, estimates and assumptions have been made concerning the future. These are measured at the present value of the expenditures expected to be required to settle the obligation using a pre- estimates and assumptions may differ from the subsequent actual results. Estimates and assumptions are continually tax discount rate that reflects current market assessments of the time value of money and the risks specific to the evaluated and are based on historical experience and other factors, including expectations or future events that obligation. The increase in the provision due to the passage of time is recognised as an interest expense and is are believed to be reasonable under the circumstances. The estimates and assumptions that have a significant risk included in “finance costs”. of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year are discussed below. COVID-19 Pandemic Fair value of land and buildings On 11 March 2020, novel coronavirus (COVID-19) was declared a pandemic by the World Health Organisation (WHO); this was followed by the New Zealand Government implementing a full-lockdown of non-essential services on 25 Land and buildings are carried at fair value as determined by an independent valuer, which is based on market based March 2020. The initial four-week level-four lockdown period was subsequently extended to 27 April 2020. evidence. The fair value of buildings is determined based on optimised depreciated replacement cost where a number of assumptions are applied in determining the fair value of land and buildings. Where a revaluation is not undertaken The BOPDHB’s incident management team began planning the COVID-19 response in January 2020, with the in a financial year, Bay of Plenty DHB undertake an assessment at each financial reporting date to ensure the fair value Emergency Operations Centre (EOC) activated on 16 March 2020. BOPDHB activated measures to ensure the of property, plant and equipment does not materially differ to the carrying values of those assets. safety of patients and staff by minimising avoidable contact and the potential for spread. A number of initiatives were introduced in preparedness for the pandemic, including reducing non-essential surgeries to increase Useful lives of property, plant and equipment hospital capacity, providing alternative methods of patient care (phone and video consultations) and working with stakeholders to ensure access to healthcare services throughout the pandemic. The Bay of Plenty DHB reviews the estimated useful lives of property, plant and equipment at the end of each annual reporting period. In addition to this, every three years the land, buildings and infrastructure are re-valued by an BOPDHB’s response to the COVID pandemic did incur additional expenditure for the DHB including personnel costs, independent valuer, estimating the remaining life of these assets thus setting the appropriate annual depreciation to Personal Protection Equipment (PPE), security costs, cleaning costs and contractual payments to contracted health reflect this. providers. While additional revenue was received form the Ministry of Health to cover some of these costs, the net cost of the COVID response was $7.5m Impairment of intangible assets The Bay of Plenty DHB assesses intangible assets that are not yet available for use and indefinite life intangible assets (FPSC/FPIM) at the end of each annual reporting period. These assets have been tested for impairment by comparing the carrying amount of the intangible assets to its depreciated replacement cost (DRC). The carrying value intangible assets, including any accumulated impairment losses, are disclosed in note 15.

Estimation of Employee Entitlement Accruals The liability relating to back pay and long term employee benefits (long service leave) is based on a number of assumptions in relation to the estimated length of service, the timing of release of the obligation and the rate at which the obligation will be paid to be applied in determining the present value. If any of these factors changed significantly, the actual outcome could be materially different to the estimate provided in the financial statements. The carrying value of the accruals has been disclosed in note 18.

134 135 Bay of Plenty District Health Board Bay of Plenty District Health Board BayNotes of Plenty to the Districtfinancial Health statements Board BayNotes of Plenty to the District financial Health statements Board 30 June 2020 BayNotes of Plenty to the District financial 30Health statements June Board 2020 BayNotes of Plenty to the District financial Health30 statements June Board 2020 (continued) Notes to the financial30 statements (continued)June 2020 Notes to the financial30 statements (continued)June 2020

30 (continued)June 2020 30 (continued)June 2020 (continued) (continued)

4.4 Crown Crown revenue revenue 8.8 Non Non-clinical clinical expenses expenses 8 Non-clinical expenses 4 Crown revenue Actual Actual Actual Actual 4 Crown revenue Actual Actual 8 Non-clinical expenses Actual2020 Actual2019 Actual2020 Actual2019 Actual$'0002020 Actual$'0002019 Actual$'0002020 Actual$'0002019 $'0002019 $'0002020 $'0002019 $'0002020 $'000 $'000 $'000 $'000 Crown appropriation revenue 819,146 770,381 Fees to Deloitte for financial statements audit 175 InterInterCrown-district appropriation patient inflows revenue 819,14620,411 770,38119,575 181 FeesImpairment to Deloitte of receivables for financial statements audit 181243 175250 CrownInterCrown-district nonappropriation appropriation patient inflows revenue revenue 819,14647,03020,411 770,38141,95219,575 ImpairmentOperating lease of receivables expenses 6,614243 2,286250 TotalCrownInter- districtCrown non appropriation patient Revenue inflows revenue 886,58747,03020,411 831,90841,95219,575 Fees to Deloitte for financial statements audit 181 175 OperatingInfrastructure lease servicing expenses costs and other sundry expenses 6,614 37,1312,286 TotalCrown Crown non appropriation Revenue revenue 886,58747,030 831,90841,952 Impairment of receivables 38,178243 250 InfrastructureDirectors' fees servicing costs and other sundry expenses 38,178273 37,131289 TheTotal appropriation Crown Revenue revenue received by the DHB equals the Government’s actual expenses incurred 886,587 in relation to the831,908 Operating lease expenses 6,614 2,286 The appropriation revenue received by the DHB equals the Government’s actual expenses incurred in relation to the Directors'Intangible feesasset impairment 273- 1,542289 appropriation, which is a required disclosure from the Public Finance Act. Performance against this appropriation is Infrastructure servicing costs and other sundry expenses 38,178 37,131 appropriation,The appropriation which revenue is a required received disclosure by the DHB from equals the Public the Government’s Finance Act. Performanceactual expenses against incurred this appropriationin relation to theis IntangibleKoha asset impairment 39- 1,54237 reported in the Statement of Performance. Directors' fees 273 289 reportedappropriation,The appropriation in the whichStatement revenue is a required of received Performance. disclosure by the DHB from equals the Public the Government’s Finance Act. Performanceactual expenses against incurred this appropriationin relation to theis IntangibleKohaLoss/(gain) asset on sale impairment of assets (13)39- 1,542(9)37 reportedappropriation, in the whichStatement is a required of Performance. disclosure from the Public Finance Act. Performance against this appropriation is KohaLoss/(gain)Total other onexpenses sale of assets 45,(13)51539 41,701(9)37 reported in the Statement of Performance. Loss/(gain)Total other onexpenses sale of assets 45,(13)515 41,701(9) 5.5 Other Other revenue revenue Total other expenses 45,515 41,701 5 Other revenue Actual Actual 5 Other revenue Actual Actual 9 Finance income and finance costs Actual2020 Actual2019 9 Finance income and finance costs $'000 $'000 9. Finance income and finance costs Actual Actual Actual$'0002020 Actual$'0002019 9 Finance income and finance costs $'0002019 Actual2020 Actual2019 $'0002020 $'000 $'000 Actual$'0002020 Actual$'0002019 Donations and bequests received 68 200 $'0002020 $'0002019 OtherDonations revenue and bequests received 8,09668 6,774200 Finance income $'000 $'000 RentalOtherDonations revenue income and frombequests investment received properties 8,07269668 6,774620200 FinanceInterest income income 654 1,229 RentalOther revenue income from investment properties 8,88,07269096 7,5946,774620 InterestTotal finance income income 654 1,229 Rental income from investment properties 8,872690 7,594620 Finance income Total finance income 654 1,229 8,890 7,594 Interest income 654 1,229 TotalFinance finance costs income 654 1,229 6.6 Exchange Exchange versus versus non exchange non exchange revenue revenue FinanceInterest expense costs - 11 InterestBank charges expense 14- 1117 6 Exchange versus non exchange revenue Actual Actual Finance costs Actual Actual BankCapital charges charge 15,24914 16,29417 6 Exchange versus non exchange revenue 2020 2019 Interest expense - 11 Actual2020 Actual2019 CapitalTotal finance charge costs 15,24915,263 16,29416,322 $'000 $'000 Bank charges 14 17 Actual$'0002020 Actual$'0002019 CapitalTotalNet finance finance charge costs costs 15,24915,26314,609 16,29416,32215,093 2020 $'0002019 $'000 TotalNet finance finance costs costs 15,26314,609 16,32215,093 $'000 $'000 Exchange revenue 55,836 51,904 NetThe financeBay of Plenty costs DHB pays a six monthly capital charge to the Crown based on the greater of its actual14,609 or budgeted 15,093

NonExchange-exchange revenue revenue 840,29555,836 788,82751,904 Theclosing Bay equity of Plenty balance. DHB Thepays capital a six monthly charge ratecapital for chargethe period to the ended Crown 30 basedJune 2020 on the was greater 6% (2019: of its 6%).actual or budgeted 896,131 840,731 NonExchange-exchange revenue revenue 896,131840,29555,836 840,731788,82751,904 Theclosing Bay equity of Plenty balance. DHB Thepays capital a six monthly charge ratecapital for chargethe period to the ended Crown 30 basedJune 2020 on the was greater 6% (2019: of its 6%).actual or budgeted Non-exchange revenue 896,131840,295 840,731788,827 closing equity balance. The capital charge rate for the period ended 30 June 2020 was 6% (2019: 6%). 896,131 840,731 10 Cash and cash equivalents 10 Cash and cash equivalents 7 Employee benefit costs Actual Actual 7 Employee benefit costs 10 Cash and cash equivalents Actual2020 Actual2019 Actual Actual 7.7 EmployeeEmployee benefit benefit costs costs Actual 10. Cash and cash equivalents Actual$'0002020 Actual$'0002019 Actual2020 Actual2019 $'0002020 $'0002019 Actual$'0002020 Actual$'0002019 $'000 $'000 $'0002020 $'0002019 Cash at bank and in hand 7 6 Salaries and wages $'000284,251 $'000270,987 Salaries and wages 284,251 270,987 CashCall deposits at bank and in hand 2,4227 21,2716 Defined contribution plan employer contributions 8,594 DefinedSalaries contributionand wages plan employer contributions 284,2519,224 270,9878,594 CallTotal deposits cash and cash equivalents 2,4222,429 21,27121,277 Increase/(decrease) in employee entitlements/liabilities 18,872 (562) Cash at bank and in hand 7 6 Increase/(decrease)DefinedSalaries contributionand wages inplan employee employer entitlements/liabilities contributions 284,25118,8729,224 270,9878,594(562) CallTotal deposits cash and cash equivalents 2,4222,429 21,27121,277 TotalDefined personnel contribution costs plan employer contributions 312,347 279,0198,594 TotalIncrease/(decrease) personnel costs in employee entitlements/liabilities 312,34718,8729,224 279,019(562) TotalWorking cash capital and cash facility equivalents 2,429 21,277 TotalIncrease/(decrease) personnel costs in employee entitlements/liabilities 312,34718,872 279,019(562) Working capital facility Total personnel costs 312,347 279,019 Bay of Plenty DHB is a party to the DHB Treasury Services Agreement between New Zealand Health Partnerships Limited

WorkingBay(NZ HPL)of Plenty capital and DHB the facility participating is a party to DHBs.the DHB This Treasury agreement Services enables Agreement NZ HPL betweento sweep New DHB Zealand bank accounts Health Partnershipsand invest surplus Limited Bay(NZfunds HPL)of on Plenty their and DHB behalf.the participating is aThe party DHB to DHBs.theTreasury DHB This TreasuryServices agreement ServicesAgreement enables Agreement provides NZ HPL betweenforto sweepindividual New DHB DHBs Zealand bank to accounts haveHealth a credit Partnershipsand invest facility surplus withLimited NZ (NZfundsHPL, HPL) whichon their and will behalf.the incur participating interestThe DHB at DHBs. Treasuryon-call This interest Services agreement rates Agreement received enables byprovides NZ NZ HPL HPL forto plus sweepindividual an DHBadministrative DHBs bank to accounts have margin. a credit and The invest facility maximum surplus with NZ fundsHPL,credit whichonfacility their will that behalf. incur is available interestThe DHB toat Treasuryanyon-call DHB interest Servicesis the ratesvalue Agreement received of one month’s byprovides NZ HPLplanned for plus individual P anrovider administrative DHBs Arm toCrown have margin. funding,a credit The facilityinclusive maximum with of NZ HPL,creditGST. whichfacility will that incur is available interest toat anyon-call DHB interest is the ratesvalue received of one month’s by NZ HPLplanned plus P anrovider administrative Arm Crown margin. funding, The inclusive maximum of creditGST. facility that is available to any DHB is the value of one month’s planned Provider Arm Crown funding, inclusive of GST. -18- -17- -18- -17- -17- -18- -17-

136 137 Bay of Plenty District Health Board Notes to the financial statements Bay of Plenty District Health Board 30 June 2020 Notes to the financial statements (continued) Bay of Plenty District 30Health June Board 2020 Notes to the financial statements(continued) 30 June 2020 13 Inventories 11. Reconciliation of net surplus/(deficit) to net cash flow from (continued) 13. Inventories Actual Actual 11operating Reconciliation activities of net surplus/(deficit) to net cash flow from operating activities 2020 2019 $'000 11 Reconciliation of net surplus/(deficit) to net cash flow from operating activitiesActual Actual $'000 2020 2019 Actual$'000 Actual$'000 Central stores 2,006 1,791 2020 2019 Pharmaceuticals 975 965 Surplus/(deficit) $'000(33,677 ) $'000(17,365) Other supplies 152 330 Add/(less) non-cash items 3,133 3,086 ShareSurplus/(deficit) of associates/joint ventures surplus (33,67715) (17,365)(130) ShareAdd/(less) of other non investment-cash items surplus 59 (4) Inventories are recognised at their historical cost. Inventories recognised in the profit or loss amounted to $37,894,766, DepreciationShare of associates/joint and amortisation ventures expense surplus 21,22515 21,028(130) (2019: $33,684,220) ImpairmentShare of other on intangiblesinvestment surplus 59- 1,542(4) TotalDepreciation non-cash and items amortisation expense 21,299225 22,43621,028 No inventories are pledged as security for liabilities (2019: nil). However, some inventories are subject to retention of title Impairment on intangibles - 1,542 clauses. Add/(less)Total non- cashitems items classified as investing or financing activities 21,299 22,436 (Gains)/losses on disposal of property, plant, and equipment (88) (9) TotalAdd/(less) items items classified classified as investing as investing or financing or financing activities activities (88) (9) (Gains)/losses on disposal of property, plant, and equipment (88) (9) Add/(less)Total items movements classified as in investingworking capital or financing items activities (88) (9) (Increase)/Decrease in receivables (4,659) (3,341) (Increase)/DecreaseAdd/(less) movements in inventory in working capital items (47) (182) Increase/(Decrease)(Increase)/Decrease in payablesreceivables and employee benefit liabilities (17,5654,659) (3,341)12,771 Net(Increase)/Decrease movement in working in inventory capital items 12,859(47) 9,248(182) NetIncrease/(Decrease) cash inflow/(outflow) in payables from operatingand employee activities benefit liabilities 17,565393 14,31012,771 Net movement in working capital items 12,859 9,248 Net cash inflow/(outflow) from operating activities 393 14,310 12 Trade and other receivables 12.12 Trade Trade and otherand otherreceivables receivables Actual Actual 2020 2019 Actual$'000 Actual$'000 2020 2019 Trade receivables from non-related parties $'0001,344 $'000 691 Expected credit loss (264) (296) AmountsTrade receivables due from fromrelated non parties-related parties 1,344435 921691 CrownExpected and credit Ministry loss of Health receivables 23,956(264) 17,617(296) AccruedAmounts income due from related parties 9,164435 11,300921 PrepaymentsCrown and Ministry of Health receivables 23,9561,424 17,6171,167 TotalAccrued debtors income and other receivables 36,0599,164 31,40011,300 Prepayments 1,424 1,167 ReceivablesTotal debtors from and exchange other receivables transactions 14,38636,059 10,16131,400 Receivables from non-exchange transactions 21,673 21,239 Receivables from exchange transactions 36,05914,386 31,40010,161 Receivables from non-exchange transactions 21,673 21,239 All receivables greater than 30 days in age are considered to be past due. 36,059 31,400

TheAll receivables comparative greater figure thanfor the 30 Pharmacdays in age rebate are consideredhas been reclassified to be past asdue. accrued income to be consistent with the current year at the Ministry of Health’s request. The comparative figure for the Pharmac rebate has been reclassified as accrued income to be consistent with the current Dueyear toat thethe largeMinistry number of Health’s of other request. receivables, the assessment for expected credit losses is performed on a collective basis. These debtors were grouped into commercial, patients and Crown entities. The credit losses were based on an analysis of pastDue collectionto the large history number and of write other-offs. receivables, the assessment for expected credit losses is performed on a collective basis. These debtors were grouped into commercial, patients and Crown entities. The credit losses were based on an analysis of Movementspast collection in thehistory allowance and write for- offs.credit losses are as follows: Movements in the allowance for credit losses are as follows: Actual Actual 2020 2019 Actual$'000 Actual$'000 2020 2019 At 1 July $'000(296) $'000(394) Movement in expected credit losses on recognised receivables 32 98 At 1 July Bay of Plenty(296) District Health(394) Board Movement in expected credit losses on recognised receivables 32 98 -20- -19- Notes to the financial statements 30 June 2020 -19- (continued)

At 30 June (264) (296)

138 139

-19-

Bay of Plenty District Health Board Notes to the financial statements 30 June 2020 (continued)

1414. Property, Property, plant andplant equipment and equipment Restrictions Plant, Bay of Plenty DHB does not have full title to crown land it occupies but transfer is arranged if and when land is sold. Land at Buildings at Leasehold equipment Work in Cost/valuation valuation valuation improvements and vehicles progress Total Some of the land is subject to Waitangi Tribunal claims. Titles to land transferred from the Crown to Bay of Plenty DHB $'000 $'000 $'000 $'000 $'000 $'000 are subject to a memorial in terms of the Treaty of Waitangi Act 1975 (as amended by the Treaty of Waitangi (State Enterprises) Act 1988). The effect on the value of assets resulting from potential claims under the Treaty of Waitangi Balance as at 1 July 2018 14,605 253,887 3,931 73,461 3,796 349,680 Act 1975 cannot be quantified. Additions - 3,793 1,037 5,838 9,563 20,231 Disposals - - - (129) - (129) The disposal of certain properties may also be subject to the provision of section 40 of the Public Works Act 1981. Capitalised - - - - (9,635) (9,635) Transfers - 4 - (5) (223) (224) Balance as at 30 June 2019 14,605 257,684 4,968 79,165 3,501 359,923 Revaluation The most recent valuation of land was performed by an independent registered valuer, Darroch Limited, a member Plant, Land at Buildings at Leasehold equipment Work in of the New Zealand Institute of Valuers. The valuation is effective as at 30 June 2018. The board determines that the valuation valuation improvements and vehicles progress Total carrying value reflects the best estimate value for land as at 30 June 2020. $'000 $'000 $'000 $'000 $'000 $'000 A high level valuation review was prepared by an independent registered valuer Peter Todd of RS Valuations Limited Balance as at 1 July 2019 14,605 257,684 4,968 79,165 3,501 359,923 and a member of the New Zealand Institute of Valuers who issued a findings letter dated 14 May 2020. Buildings Revaluation Surplus - (958) - - - (958) Additions - 6,095 29 5,549 13,501 25,174 were last fully revalued in 2018. Management prepared its own fair value calculations based on the valuer’s letter Disposals - - (59) (5,568) - (5,627) to estimate a fair value for buildings as at 30 June 2020 of $262.8 million. The Board recognised an increase to the Capitalised - - - - (11,673) (11,673) carrying value of buildings as at 30 June 2020 to ensure that the carrying value materially reflected fair value. The fair Transfers ------Balance as at 30 June 2020 14,605 262,821 4,938 79,146 5,329 366,839 value estimate was determined using a number of significant assumptions which included: ■ Estimate of the changes in replacement cost based on building cost inflation according to Department of Statistics Plant, Capital Good Price Index (CPGI) indices. Land at Buildings at Leasehold equipment Work in Accumulated depreciation valuation valuation improvements and vehicles progress Total ■ Straight-line depreciation applied to reflect the consumption of the asset since the last valuation. $'000 $'000 $'000 $'000 $'000 $'000 ■ Considerations of potential impacts from COVID-19 on building costs, demand on contractors and the construction Balance as at 1 July 2018 - - (1,539) (54,387) - (55,926) Depreciation charge - (13,271) (137) (6,146) - (19,554) industry. Disposals - - - 130 - 130 The next valuation is expected to be completed as at 30 June 2021. Transfers - 19 (20) 10 - 9 Balance as at 30 June 2019 - (13,252) (1,696) (60,393) - (75,341) Impairment Plant, Land at Buildings at Leasehold equipment Work in No impairment losses have been recognised by Bay of Plenty DHB during 2020 in relation to property, plant and valuation valuation improvements and vehicles progress Total equipment. $'000 $'000 $'000 $'000 $'000 $'000

Balance as at 1 July 2019 - (13,252) (1,696) (60,393) - (75,341) Depreciation charge - (13,890) (199) (5,756) (28) (19,873) Elimination on revaluation - 27,142 - - - 27,142 Disposals - - 59 5,554 - 5,613 Transfers ------Balance as at 30 June 2020 - - (1,836) (60,595) (28) (62,459)

Net book value As at 30 June 2019 14,605 244,432 3,272 18,772 3,501 284,582 As at 30 June 2020 14,605 262,821 3,102 18,551 5,301 304,380

-21-

140 141 Bay of Plenty District Health Board Bay of Plenty District Health Board Notes to the financial statements Notes to the financial statements 30 June 2020 30 June 2020 (continued) (continued)

1515. Intangible Intangible assets assets 16.16 Investments Investments in associates in associates Computer Others Work in Gross carrying amount software Progress Total (a) General information $'000 $'000 $'000 $'000 Interest held at 2020 2019 Name of entity Principal activities % % Balance date Balance as at 1 July 2018 10,409 2,766 6,510 19,685 Additions 4,736 498 3,271 8,505 Provision of urology Impairment charge - (1,542) - (1,542) Venturo Limited services - 50 30 June Capitalised - - (4,625) (4,625) Transfers - - 224 224 Balance as at 30 June 2019 15,145 1,722 5,380 22,247 The investment with Venturo Limited was exited by Bay of Plenty DHB in July 2019. There was no interest held as at 30 June 2020 Computer Others Work in software Progress Total $'000 $'000 $'000 $'000 (b) Summary of financial information on associate entities (100 per cent)

Balance as at 1 July 2019 15,145 1,722 5,380 22,247 Assets Liabilities Equity Revenue Profit/(loss) Additions 847 - 5,989 6,836 $'000 $'000 $'000 $'000 $'000 Disposals (1,123) - - (1,123) 2020 Capitalised - - (847) (847) Venturo Limited - - - - - Transfers - - - - Balance as at 30 June 2020 14,869 1,722 10,522 27,113 2019 Venturo Limited 1,053 934 119 6,490 350

Computer Others Work in Accumulated amortisation and impairment software Progress Total (c) Share of profit of associate entities $'000 $'000 $'000 $'000 Actual Actual 2020 2019 $'000 $'000 Balance as at 1 July 2018 (9,053) - - (9,053) Amortisation charge for the year (1,474) - - (1,474) Transfers 314 - - 314 Share of profit/(loss) before tax - 62 Balance as at 30 June 2019 (10,213) - - (10,213) Share of profit/(loss) after tax - 62

Computer Others Work in software Progress Total (d) Investment in associate entities $'000 $'000 $'000 $'000 Actual Actual

2020 2019 Balance as at 1 July 2019 (10,213) - - (10,213) $'000 $'000 Amortisation charge for the year (1,230) (122) - (1,352) Disposals 1,124 - - 1,124 Balance as at 30 June 2020 (10,319) (122) - (10,441) Carrying amount at the beginning of the year 60 - Share of total recognised revenue and expenses - 62 Other impairment losses (60) (2) Computer Others Work in Carrying amount at the end of the year - 60 software Progress Total $'000 $'000 $'000 $'000 (e) Share of associates' contingent liabilities and commitments Net book value There are no contingent liabilities and commitments at year end (2019: nil). As at 30 June 2019 4,932 1,722 5,380 12,034 As at 30 June 2020 4,550 1,600 10,522 16,672 The Bay of Plenty DHB is not jointly or severally liable for the contingent liabilities owing at balance date by the associates.

-23- -24-

142 143 Bay of Plenty District Health Board Bay of Plenty District Health Board Notes to the financial statements Notes to the financial statements 30 June 2020 Bay of Plenty District Health30 June Board 2020 (continued) Notes to the financial statements(continued) 30 June 2020 (continued) 17.17 Investments Investments in joint in ventures joint ventures 1818. Employee Employee entitlements entitlements Actual Actual (a) General information 18 Employee entitlements 2020 2019 Interest held at Actual$'000 Actual$'000 2020 2019 2020 2019 Name of entity Principal activities % % Balance date Current portion $'000 $'000 Annual leave 32,362 27,686 Provision of health CurrentLong service portion leave 1,694 1,492 HealthShare Limited contracting services 20 20 30 June AnnualSalary andleave wages accrual 32,3629,838 27,6866,416 LongTotal servicecurrent leave portion 43,8941,694 35,5941,492 Salary and wages accrual 9,838 6,416 (b) Summary of financial information on joint ventures (100 per cent) TotalNon-current current portion portion 43,894 35,594 Long service leave 1,682 1,110 Assets Liabilities Equity Revenue Profit/(loss) Total non-current portion 1,682 1,110 $'000 $'000 $'000 $'000 $'000 Non-current portion LongTotal serviceemployee leave entitlements 45,5761,682 36,7041,110 2020 Total non-current portion 1,682 1,110 HealthShare Limited 37,604 35,459 2,145 18,630 (72) Total employee entitlements 45,576 36,704 19 Trade and other payables 2019 HealthShare Limited 26,525 24,309 2,216 17,390 340 Actual Actual 1919. Trade Trade and otherand otherpayables payables 2020 2019 Actual$'000 Actual$'000 (c) Share of profit of joint ventures 2020 2019 Trade payables $'000 $'0006,197 Actual Actual 4,129 ACC levy payable 350 2020 2019 378 Accrued expenses 37,236 $'000 $'000 Trade payables 37,04,12928 6,197 ACCAmounts levy duepayable to related parties 112378 1,016350

AccruedPAYE payable expenses 37,03,55728 37,2363,258

AmountsIncome received due to related in advance parties 3,995112 1,016970 Share of profit/(loss) before tax (15) 68 PAYEGST payable payable 3,5573,970 3,2583,308 Tax expense - - IncomeTotal creditors received and in advance other payables 53,13,99569 52,335970 Share of profit/(loss) after tax (15) 68 GST payable 3,970 3,308 PayablesTotal creditors from exchange and other transactions payables 45,26453,169 45,41952,335 Payables from non-exchange transactions 7,905 6,916 (d) Investment in joint ventures Payables from exchange transactions 45,26453,169 45,41952,335 Actual Actual Payables from non-exchange transactions 7,905 6,916 2020 2019 53,169 52,335 $'000 $'000 20 Borrowings

All borrowings measured at amortised cost. Carrying amount at the beginning of the year 443 375 20 Borrowings Actual Actual Share of total recognised revenue and expenses (15) 68 All borrowings measured at amortised cost. Carrying amount at the end of the year 428 443 2020 2019 Actual$'000 Actual$'000 2020 2019 (e) Share of joint ventures' contingent liabilities and commitments Current portion $'000 $'000 Finance lease liabilities 57 - There are no contingent liabilities and commitments at year end (2019: nil). CurrentTotal current portion portion 57 - The Bay of Plenty DHB is not jointly or severally liable for the contingent liabilities owing at balance date by the joint Finance lease liabilities 57 - venture. TotalNon-current current portion portion 57 - Finance lease liabilities 302 - NonTotal-current non-current portion portion 302 - Finance lease liabilities 302 - Total nonborrowings-current portion 302359 -

Total borrowings 359 -

-25- -26-

-26-

144 145 Bay of Plenty District Health Board Notes to the financial statements 30 June 2020 (continued)

18 Employee entitlements Actual Actual 2020 2019 $'000 $'000

Current portion Annual leave 32,362 27,686 Long service leave 1,694 1,492 Salary and wages accrual 9,838 6,416 Total current portion 43,894 35,594

Non-current portion Long service leave 1,682 1,110 Total non-current portion 1,682 1,110 Total employee entitlements 45,576 36,704

19 Trade and other payables Actual Actual 2020 2019 $'000 $'000

Trade payables 4,129 6,197 ACC levy payable 378 350 Accrued expenses 37,028 37,236 Amounts due to related parties 112 1,016 PAYE payable 3,557 3,258 Income received in advance 3,995 970 GST payable 3,970 3,308 Bay of Plenty District Health Board Total creditors and other payables 53,169 52,335 Notes to the financial statements 30 June 2020 Payables from exchange transactions 45,264 45,419 Bay of Plenty District Health(continued) Board Payables from non-exchange transactions 7,905 6,916 Notes to the financial statements 53,169 52,335 30 June 2020 (continued) 21 Provisions 2020. Borrowings Borrowings 21. Provisions 21 Provisions All borrowings measured at amortised cost. Movements in provisions are as follows

Actual Actual Other 2020 2019 Movements in provisions are as follows $'000 $'000 provisions Total $'000 $'000 Other Current portion provisions Total Finance lease liabilities 57 - 2019 $'000 $'000 Total current portion 57 - Balance as at 1 July 2018 - - Additional provisions and increases to existing provisions 4,832 4,832 2019 Bay of Plenty District Health Board Balance as at 30 June 2019 4,832 4,832 Balance as at 1 July 2018 - - Non-current portion Notes to the financial statements Finance lease liabilities - Additional provisions and increases to existing provisions 4,832 4,832 302 30 June 2020 Total non-current portion 302 - Balance as at 30 June 2019 4,832 4,832 (continued) Other provisions Total Total borrowings 359 - $'000 $'000 Other Borrowings (continued) provisions Total 2020 Analysis of finance leases $'000 $'000 Current Actual Actual Balance as at 1 July 2019 4,832 4,832 2020 2019 2020 -26- Use of provisions (2,352) (2,352) $'000 $'000 Current Additional provisions and increases to existing provisions 10,000 10,000 Balance as at 1 July 2019 4,832 4,832 Balance as at 30 June 2020 12,480 12,480 Minimum lease payments payable Use of provisions (2,352) (2,352) Not later than one year 57 - Additional provisions and increases to existing provisions 10,000 10,000 Later than one year and not later than five years 227 - Balance22 Operating as at 30 and June capital 2020 commitments 12,480 12,480 Later than five years 75 - Total minimum lease payments 359 - 22.22Capital Operating Operating commitments and capital and capitalcommitments commitments Actual Actual 2020 2019 Future finance charges - - Capital commitments $'000 $'000 Present value of minimum lease payments - - Actual Actual 2020 2019 Present value of minimum lease payments payable $'000 $'000 Not later than one year 57 - Not later than one year - 1,031 Later than one year and not later than five years 227 - Later than one year and not later than five years - - Later than five years 75 - NotLater later than than five one years year - - 1,031- Total present value of minimum lease payments 359 - Later than one year and not later than five years - - 1,031- Later than five years - - Finance leases as lessee - 1,031 Finance leases are for various items of plant and equipment. The net carrying amount of the plant and equipment held Operating leases as lessee under finance leases is $182,121 (2019: nil). The Bay of Plenty DHB leases property, plant, and equipment in the normal course of its business. The future aggregate Operatingminimum lease leases payments as lessee payable under non-cancellable operating leases are as follows: Finance leases can be renewed at the Bay of Plenty DHB's option, with rents set by reference to current market rates for The Bay of Plenty DHB leases property, plant, and equipment in the normal course of its business.Actual The future aggregateActual items of equivalent age and condition. The Bay of Plenty DHB does have the option to purchase the assets at the end of minimum lease payments payable under non-cancellable operating leases are as follows: the lease terms. 2020 2019 Actual$'000 Actual$'000 There are no restrictions placed on the Bay of Plenty DHB by any of the finance leasing arrangements. 2020 2019 $'000 $'000 Not later than one year 2,662 2,706 Later than one year and not later than five years 4,963 6,509 NotLater later than than five one years year 2,6621,435 2,7062,015 LaterTotal thannon -onecancellable year and operating not later than leases five years 4,9639,060 11,2306,509 Later than five years 1,435 2,015 TotalDuring non the- cancellableyear ended 30operating June 2020 leases $3,876,243 of operating leases were recognised as an expense9,060 in the profit or11,230 loss, split between clinical expenses and non-clinical expenses (2019: $3,465,022). During the year ended 30 June 2020 $3,876,243 of operating leases were recognised as an expense in the profit or loss, split between clinical expenses and non-clinical expenses (2019: $3,465,022).

-28-

-28-

146 147

-27-

Bay of Plenty District Health Board Notes to the financial statements 30 June 2020 (continued)

23 Financial instruments (continued) Bay of Plenty District Health Board Notes to the financial statements (b) Liquidity risk (continued) 23. Financial instruments 30 June 2020 Contractual maturity analysis of financial liabilities (continued) ContractualThe table below maturity analyses analysis the Entity'sof financial financial liabilities liabilities into relevant maturity groupings based on the period remaining at balance date until the contractual maturity date. Future interest payments on floating rate debt are based (a) Credit risk The table below analyses the Entity's financial liabilities into relevant maturity groupings based on the period remaining at 23 Financial instruments balanceon the floating date until rate the on contractual the instrument maturity at date. the balance Future interest date. The payments amounts on floatingdisclosed rate are debt the are contractual based on the undiscounted floating In the normal course of business, exposure to credit risk arises from cash and term deposits with banks and NZHPL, ratecash on flows. the instrument at the balance date. The amounts disclosed are the contractual undiscounted cash flows. receivables, and forward foreign exchange contracts in an asset position. For each of these, the maximum credit risk (a) Credit risk Less Between 6 Between Between Over 5 Total Carrying exposure is best represented by the carrying amount in the statement of financial position. than 6 months and 1 and 2 2 and 5 years contractual Amount In the normal course of business, exposure to credit risk arises from cash and term deposits with banks and NZHPL, months 1 year years years cash flows (assets)/ receivables,The Board places and forward its cash foreign and termexchange investments contracts with in an high asset quality position. financial For each institutions of these, via the a maximum national DHB credit shared risk liabilities exposurebanking arrangement,is best represented facilitated by the by carrying NZ Health amount Partnerships in the statement Limited of financial position. $'000 $'000 $'000 $'000 $'000 $'000 $'000 The Board places its cash and term investments with high quality financial institutions via a national DHB shared banking Concentrations of credit risk for receivables are limited due to the large number and variety of customers. The 2020 arrangement, facilitated by NZ Health Partnerships Limited MoH is the largest debtor (approximately 88%). It is assessed as a low-risk and high-quality entity due to being a Payables and accruals 49,500 - - - - 49,500 49,500 Finance leases 28 29 57 170 75 359 359 Concentrationsgovernment-funded of credit purchaser risk for receivables of health areand limited disability due services. to the large No number collateral and or variety other ofcredit customers. enhancements The MoH are is the held largest debtor (approximately 88%). It is assessed as a low-risk and high-quality entity due to being a government-funded Total financial liabilities 49,528 29 57 170 75 49,859 49,859 for financial instruments that give rise to credit risk. purchaser of health and disability services. No collateral or other credit enhancements are held for financial instruments 2019 that give rise to credit risk. Payables and accruals 48,057 - - - - 48,057 48,057 Credit quality of financial assets Credit quality of financial assets The credit quality of financial assets that are neither past due nor impaired can be assessed by reference to Standard Classification and fair values The credit quality of financial assets that are neither past due nor impaired can be assessed by reference to Standard and Poor’sand Poor’s credit credit ratings ratings (if available) (if available) or to historical or to historical information information about counterparty about counterparty default rates. default rates. The classification and fair values together with the carrying amounts shown in the statement of financial position are as follows: TheThe statusstatus of of trade trade receivables receivables at atthe the reporting reporting date date is as is follows: as follows: Financial Financial TheThe tradetrade receivables receivables balance balance is ismade made up up of oftrade trade receivables receivables from from non -non-relatedrelated parties parties and trade and receivablestrade receivables from related from assets at liabilities at parties.related parties. amortised amortised Carrying cost cost amount Fair value 2020 2019 2020 2019 $'000 $'000 $'000 $'000 Gross Gross Receivable Receivable Impairment Impairment 2020 $'000 $'000 $'000 $'000 Cash and cash equivalents 2,429 - 2,429 2,429 Trade and other receivables 34,635 - 34,635 34,635 Not past due 4,965 1,808 - (51) Trade and other payables - (49,500) (49,500) (49,500)

Past due 0-30 days 273 460 - (28) 37,064 (49,500) (12,436) (12,436) 2019 Past due 31-120 days 907 288 - (21) Cash and cash equivalents 21,277 - 21,277 21,277 Past due 121-360 days 1,423 2,022 (264) (196) Trade and other receivables 30,233 - 30,233 30,233 Total 7,568 4,578 (264) (296) Trade and other payables - (48,057) (48,057) (48,057) 51,510 (48,057) 3,453 3,453 Actual Actual 2020 2019 $'000 $'000 (c) Capital management The Bay of Plenty DHB’s capital is its equity, which comprises Crown equity, reserves and retained earnings. Equity is Trade receivables represented by net assets. The Bay of Plenty DHB manages its revenues, expenses, assets, liabilities and general financial Gross trade receivables 7,568 4,578 dealings prudently in compliance with the budgetary processes. Individual impairment (264) (296) (c) Capital management Net total trade receivables 7,304 4,282 The Bay of Plenty DHB’s policy and objectives of managing the equity is to ensure the Bay of Plenty DHB effectively achievesThe Bay ofits Plentygoals and DHB’s objectives, capital whilstis its equity,maintaining which a strongcomprises capital Crown base. equity,The Bay reserves of Plenty and DHB retained policies earnings.in respect Equityof capitalis represented management by net are assets. reviewed The regularly Bay of Plentyby the governingDHB manages Board. its revenues, expenses, assets, liabilities and general (b) Liquidity risk financial dealings prudently in compliance with the budgetary processes. Liquidity risk is the risk that the Bay of Plenty DHB will encounter difficulty raising funds to meet commitments as they fall The Bay of Plenty DHB’s policy and objectives of managing the equity is to ensure the Bay of Plenty DHB effectively due. achieves its goals and objectives, whilst maintaining a strong capital base. The Bay of Plenty DHB policies in respect Liquidity(b) Liquidity risk represents risk the Bay of Plenty DHB’s ability to meet its contractual obligations. The Bay of Plenty DHB of capital management are reviewed regularly by the governing Board. evaluates its liquidity requirements on an ongoing basis. In general, the Bay of Plenty DHB generates sufficient cash flows froLiquiditym its operating risk is the activities risk that to themeet Bay its ofobligations Plenty DHB arising will fromencounter its financial difficulty liabilities raising and funds has a to working meet commitmentscapital facility linesas they in placefall due. to cover potential shortfalls (refer note 10). -30- InLiquidity the previous risk represents year, cash theand Baycash of equivalents Plenty DHB’s were ability classed to meet as cash its contractualand cash equivalents, obligations. and The Trade Bay and of Plentyother DHB receivables classed as loans and receivables evaluates its liquidity requirements on an ongoing basis. In general, the Bay of Plenty DHB generates sufficient cash flows from its operating activities to meet its obligations arising from its financial liabilities and has a working capital facility lines in place to cover potential shortfalls (refer note 10).

In the previous year, cash and cash equivalents were classed as cash and cash equivalents, and Trade and other receivables classed as loans and receivables. -29-

148 149 24. Related party transactions 25. Segment information

Ownership Bay of Plenty District Health Board Description of segments Notes to the financial statements 30 June 2020 The Bay of Plenty DHB is a Crown Entity in terms of the Crown Entities Act 2004, and is owned by the Crown. The Bay of Plenty DHB operates in only one business segment, the funding and provision of health and disability (continued) services, throughout one geographical region (Bay of Plenty). Related party disclosures have not been made for transactions with related parties that are:

■24 within Related a normal party supplier transactions or client/recipient relationship, 26 Contingencies ■Ownership on terms and conditions no more or less favourable than those that are reasonable to expect that the Entity would have adopted in dealing with the party at arm's length in the same circumstances. The Bay of Plenty DHB is a Crown Entity in terms of the Crown Entities Act 2004, and is owned by the Crown. Compliance with the Holidays Act 2003 Further, transactions with other government agencies (for example Government departments and Crown entities) are Related party disclosures have not been made for transactions with related parties that are: not• disclosedwithin as a normalrelated supplier party transactions or client/recipient when theyrelationship are consistent with the normal operating arrangements between A number of New Zealand’s public and private organisations have identified issues with the calculation of leave government• on terms agencies and conditionsand undertaken no more on or the less normal favourable terms than and conditionsthose that are for reasonable such transactions. to expect that the Entity would entitlements under the Holidays Act 2003 (“the Act”). have adopted in dealing with the party at arm's length in the same circumstances Work has been ongoing since 2016 on behalf of 20 District Health Boards (DHBs) and the New Zealand Blood RelatedFurther, transactions party transactions with other government with agencies subsidiaries, (for example associates, Government departments or joint and ventures Crown entities) are not Service (NZBS), with the Council of Trade Unions (CTU), health sector unions and Ministry of Business Innovation disclosed as related party transactions when they are consistent with the normal operating arrangements between and Employment (MBIE) Labour Inspectorate, for an agreed and national approach to identify, rectify and remediate government agencies and undertaken on the normal terms and conditions for such transactions. Bay of Plenty DHB entered into no transactions with related parties on non-commercial terms, and as a result there are any Holidays Act non-compliance by DHBs. DHBs have agreed to a Memorandum of Understanding (MOU), which noRelated amounts party outstanding transactions or duewith at subsidiaries, balance date associates, (2019: nil). or joint ventures contains a method for determination of individual employee earnings, for calculation of liability for any historical non- Bay of Plenty DHB entered into no transactions with related parties on non-commercial terms, and as a result there are no compliance. amounts outstanding or due at balance date (2019: nil). Transactions with key management personnel For employers such as the DHBs that have workforces that include differential occupational groups with complex Transactions with key management personnel entitlements, non-standard hours, allowances and/or overtime, the process of assessing non-compliance with the Key management personnelpersonnel compensation compensation Act and determining any additional payment is time consuming and complicated.

Total remuneration is is included included in in employee employee benefit benefit costs costs (note (note 7). 7). The remediation project associated with the MOU is a significant undertaking and work to assess all non-compliance Actual Actual will continue through the 2019/20 financial year. The review process agreed as part of the MOU will roll-out in 2020 2019 tranches to the DHBs and NZBS, expected to be over 18 months although DHB readiness and availability of resources $'000 $'000 (internal and external to the DHB) may determine when a DHB can commence the process. The final outcome of the remediation project and timeline addressing any non-compliance will not be determined until this work is completed. Board members Full-time equivalent members 11 11 Notwithstanding, as at 30 June 2020, in preparing these financial statements, Bay of Plenty DHB recognises it has Remuneration 273 301 an obligation to address any historical non-compliance under the MOU and has made estimates and assumptions Executive Management Team, including the Chief Executive Full-time equivalent members 6 6 to determine a potential liability based on its own review of payroll processes which identified instances of non- Remuneration 1,749 1,849 compliance with the Act and the requirements of the MOU. BOPDHB has included an estimated liability in note 21 of $12,480,000.

Total full-time equivalent personnel 17 17 This indicative liability amount is the DHB’s best estimate at this stage of the outcome from this project. However, until Total key management personnel compensation 2,022 2,150 the project has progressed further, there remain substantial uncertainties.

All remuneration paid to key management personnel is short term benefits and they did not receive any remuneration or The estimates and assumptions may differ to the subsequent actual results as further work is completed and result in compensation other than in their capacity as key management personnel (2019: nil). further adjustment to the carrying amount of the provision liabilities within the next financial year. The Bay of Plenty DHB did not provide any compensation at non-arm’s length terms to close family members of key management personnel during the year (2019: nil). The Bay of Plenty DHB did not provide any loans to key management personnel or their close family members (2019: nil). 27 Events after the Balance Date

25 Segment information There were no significant events after the balance date.

(a) Description of segments The Bay of Plenty DHB operates in only one business segment, the funding and provision of health and disability services, throughout one geographical region (Bay of Plenty).

150 151 -31-

08 Audit Report Pūrongo Aotake Pūtea

152 153

INDEPENDENT AUDITOR’S REPORT The basis for our opinion is explained below, and we draw attention to other matters. In addition, we outline the responsibilities of the Board and our responsibilities relating to the financial statements and the performance TO THE READERS OF BAY OF PLENTY DISTRICT HEALTH BOARD’S FINANCIAL STATEMENTS AND PERFORMANCE information, we comment on other information, and we explain our independence. INFORMATION FOR THE YEAR ENDED 30 JUNE 2020 Basis for our qualified opinion on the financial statements and unmodified opinion on the performance The Auditor-General is the auditor of Bay of Plenty District Health Board (the Health Board). The Auditor-General has information appointed me, Bruno Dente, using the staff and resources of Deloitte Limited, to carry out the audit of the financial statements and the performance information, including the performance information for appropriations, of the As outlined in note 3 on page 133 and note 26 on page 149, the Health Board has been investigating issues with Health Board on his behalf. the way it calculates holiday pay entitlements under the Holidays Act 2003, as part of a national approach to remediate these issues. We have audited: The provision for employee entitlements includes a provision of $12.48 million for the estimated amounts owed • the financial statements of the Health Board on pages 120 to 149, that comprise the statement of to current and past employees. Due to the complex nature of health sector employment arrangements, the financial position as at 30 June 2020, the statement of comprehensive income, statement of changes in Health Board’s process is ongoing, and there is a high level of uncertainty over the amount of the provision. equity and statement of cash flows for the year ended on that date and the notes to the financial Because of the work that is yet to be completed, we have been unable to obtain sufficient appropriate audit statements that include accounting policies and other explanatory information; and evidence to determine if the amount of the provision is reasonable.

• the performance information of the Health Board on pages 84 to 116. We were also unable to obtain sufficient appropriate audit evidence of the $2.2 million provision as at 30 June 2019. We accordingly expressed a qualified opinion on the financial statements for the year ended 30 June 2019. Qualified opinion on the financial statements We carried out our audit in accordance with the Auditor-General’s Auditing Standards, which incorporate the In our opinion, except for the possible effects of the matter described in the Basis for our qualified opinion Professional and Ethical Standards and the International Standards on Auditing (New Zealand) issued by the New section of our report, the financial statements of the Health Board on pages 120 to 149: Zealand Auditing and Assurance Standards Board. Our responsibilities under those standards are further described in the Responsibilities of the auditor section of our report. • present fairly, in all material respects: We have fulfilled our responsibilities in accordance with the Auditor-General’s Auditing Standards.

o its financial position as at 30 June 2020; and We believe that the audit evidence we have obtained is sufficient and appropriate to provide the basis for our qualified opinion on the financial statements and the basis for our opinion on the performance information. o its financial performance and cash flows for the year then ended; and

• comply with generally accepted accounting practice in New Zealand in accordance with Public Benefit Emphasis of matters Entity reporting standards. Without further modifying our opinion, we draw attention to the following disclosures in the financial Unmodified opinion on the performance information statements.

In our opinion, the performance information of the Health Board on pages 84 to 116: The Health Board is reliant on financial support from the Crown

• presents fairly, in all material respects, the Health Board’s performance for the year ended 30 June 2020, Note 1 on page 124 outlines that Crown support would be required if the Health Board was required to settle the including: estimated historical Holidays Act 2003 liability within the period of one year from approving the financial statements. The Health Board therefore obtained a letter of comfort from the Ministers of Health and Finance, which confirms that the Crown will provide the Health Board with financial support, where necessary, to o for each class of reportable outputs: maintain viability. - its standards of delivery performance achieved as compared with forecasts included in the statement of performance expectations for the financial year; and Impact of Covid-19

- its actual revenue and output expenses as compared with the forecasts included in the Note 3 on page 133 outlines the impact of Covid-19 on the Health Board. statement of performance expectations for the financial year; and Responsibilities of the Board for the financial statements and the performance information

o what has been achieved with the appropriations; and The Board is responsible on behalf of the Health Board for preparing financial statements and performance information that are fairly presented and comply with generally accepted accounting practice in New Zealand. o the actual expenses or capital expenditure incurred compared with the appropriated or forecast expenses or capital expenditure; and The Board is responsible for such internal control as it determines is necessary to enable it to prepare financial • complies with generally accepted accounting practice in New Zealand. statements and performance information that are free from material misstatement, whether due to fraud or error. Our audit of the financial statements and the performance information was completed on 3 December 2020. This is the date at which our opinion is expressed. 154 155

In preparing the financial statements and the performance information, the Board is responsible on behalf of the • We evaluate the overall presentation, structure and content of the financial statements and the Health Board for assessing the Health Board’s ability to continue as a going concern. The Board is also performance information, including the disclosures, and whether the financial statements and the responsible for disclosing, as applicable, matters related to going concern and using the going concern basis of performance information represent the underlying transactions and events in a manner that achieves accounting, unless there is an intention to liquidate the Health Board or there is no realistic alternative but to do fair presentation. so. • We obtain sufficient appropriate audit evidence regarding the financial statements and the performance The Board’s responsibilities arise from the Crown Entities Act 2004, the New Zealand Public Health and Disability information of the entities or business activities within the Health Board to express an opinion on the Act 2000 and the Public Finance Act 1989. consolidated financial statements and the consolidated performance information. We are responsible for the direction, supervision and performance of the of the Health Board audit. We remain solely Responsibilities of the auditor for the audit of the financial statements and the performance information responsible for our audit opinion.

Our objectives are to obtain reasonable assurance about whether the financial statements and the performance We communicate with the Board regarding, among other matters, the planned scope and timing of the audit and information, as a whole, are free from material misstatement, whether due to fraud or error, and to issue an significant audit findings, including any significant deficiencies in internal control that we identify during our auditor’s report that includes our opinion. audit.

Reasonable assurance is a high level of assurance, but is not a guarantee that an audit carried out in accordance Our responsibilities arise from the Public Audit Act 2001. with the Auditor General’s Auditing Standards will always detect a material misstatement when it exists. Misstatements are differences or omissions of amounts or disclosures, and can arise from fraud or error. Other Information Misstatements are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of readers taken on the basis of these financial statements and the performance The Board is responsible for the other information. The other information comprises the information included on information. pages 6 to 81, but does not include the financial statements and the performance information, and our auditor’s report thereon. For the budget information reported in the financial statements and the performance information, our procedures were limited to checking that the information agreed to the Health Board’s statement of Our opinion on the financial statements and the performance information does not cover the other information and performance expectations. we do not express any form of audit opinion or assurance conclusion thereon.

We did not evaluate the security and controls over the electronic publication of the financial statements and the In connection with our audit of the financial statements and the performance information, our responsibility is to performance information. read the other information. In doing so, we consider whether the other information is materially inconsistent with the financial statements and the performance information or our knowledge obtained in the audit, or otherwise As part of an audit in accordance with the Auditor-General’s Auditing Standards, we exercise professional appears to be materially misstated. If, based on our work, we conclude that there is a material misstatement of this judgement and maintain professional scepticism throughout the audit. Also: other information, we are required to report that fact. We have nothing to report in this regard.

• We identify and assess the risks of material misstatement of the financial statements and the Independence performance information, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis We are independent of the Health Board in accordance with the independence requirements of the Auditor- for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for General’s Auditing Standards, which incorporate the independence requirements of Professional and Ethical one resulting from error, as fraud may involve collusion, forgery, intentional omissions, Standard 1: International Code of Ethics for Assurance Practitioners issued by the New Zealand Auditing and misrepresentations, or the override of internal control. Assurance Standards Board.

• We obtain an understanding of internal control relevant to the audit in order to design audit procedures Other than the audit, we have no relationship with, or interests in, the Health Board. that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Health Board’s internal control.

• We evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by the Board. Bruno Dente Deloitte Limited • We evaluate the appropriateness of the reported performance information within the Health Board’s On behalf of the Auditor-General framework for reporting its performance. Hamilton, New Zealand

• We conclude on the appropriateness of the use of the going concern basis of accounting by the Board and, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast a significant doubt on the Health Board’s ability to continue as a going concern. If we conclude that a material uncertainty exists, we are required to draw attention in our auditor’s report to the related disclosures in the financial statements and the performance information or, if such disclosures are inadequate, to modify our opinion. Our conclusions are based on the audit evidence obtained up to the date of our auditor’s report. However, future events or conditions may cause the Health Board to cease to continue as a going concern. 156 157

E79 Bay of Plenty District Health Board Annual Report 2020 Bay of Plenty District Health Board Annual Report 2020

Presented to the House of Representatives pursuant www.bopdhb.govt.nz to section 150 of the Crown Entities Act 2004