2019 10 21 Wairarapa Board Meeting PUBLIC - Agenda
Public Board Meeting
Meeting Date: Monday 21st October 2019
Meeting Time: 09:30am
Venue: Board Room CSSB Building Wairarapa DHB
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Wairarapa District Health Board
Well Wairarapa : Better health for all
Government Priorities 2019/20 “Improving the wellbeing of New Zealanders and their families“
Improving child wellbeing Improving mental wellbeing
Better population health outcomes Improving wellbeing through prevention supported by a strong and equitable public health and disability system
Better population health outcomes Strong fiscal management supported by primary health care
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AGENDA Held on Monday 21st October 2019
Lecture Room, CSSB Building, Wairarapa DHB, Masterton Commencing at 09:30am –11:05am
BOARD PUBLIC SESSION Item Action Lead Minute Allocation PG 1. Procedural Business 1.1. Karakia 5 1.2. Apologies Accept Continuous disclosure Accept 1.3. 6 Interest/Conflict register Confirm Minutes 23rd September 2019 L Southey 25 09:30am 1.4. Accept 10 meeting 1.5. Draft 2019 Board work plan Accept 15 1.6. Chairperson report Verbal 1.7. Chief Executive report Note D Oliff 16 2. Discussion 2.1. Old Hospital Demolition Note D Oliff 5 09:55am 18 3. Information 3.1. Financial Report Note S Flavin 10 10:00am 21 Hospital and Community Services 3.2. Note K McCann 10 10:10am 41 Report 3.3. Planning & Performance Report Note S Williams 10 10:20am 57 3.4. “5” DHB Equity Priorities Verbal Executives 25 10:30am 62 Wairarapa DHB Dashboard September 3.5. Receive 63 2019 4. Other 4.1. General business 5 10:55am 65 4.2. Resolution to exclude the public Agree L Southey Date of next meeting: Monday 25th November 2019
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Appendices # Item PG 1.1 Karakia 5 1.3 Continuous disclosure Interest/Conflict register 6 1.4 Minutes 23rd September 2019 meeting 10 1.5 Draft 2019 Board work plan 15 1.7 Chief Executive Report 16 2.1 Old Hospital Demolition 18 2.1.1 Masterton Site Plan – Fences 66 2.1.2 WrDHB Fencing Encroachment 67 3.1 Financial Report 21 3.2 Hospital and Community Services Report 41 3.2.1 Wairarapa DHB Planned Care Performance for August 2019 68 3.2.2 Graph Surveillance colonoscopy to Sept 2019 70 3.3 Planning & Performance October Report 57 3.3.1 Ministry of Health Planned care Strategic approach 2019 to 2024 71 3.4 “5” DHB Equity Priorities 62 3.4.1 Adult Māori Oral Health Project 91 3.4.1a Letter to Hon Ron Mark, Minister of New Zealand Defence Force 92 3.4.1b Letter to Air Marshal Kevin Short, Chief of Defence Force New Zealand 94 3.4.1c Letter to Riana Clarke, National Clinical Director Oral Health, Ministry of Health 96 3.5 Wairarapa DHB Dashboard September 2019 63 4.2 Resolution to exclude the public 65
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Karakia Tuia ki runga, Tuia ki raro Tuia ki roto, Tuia ki waho Ka rongo te ao, Ka rongo te pō Haumi e, Hui e Taiki e ------Unite above Unite below Unite without Unite within Listen to the night Listen to the world Now we come together As one.
Wairarapa District Hutt Board
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Wairarapa DHB Executive Leadership Team Interest Register
Name Interest
Dale Oliff ∑ No interests declared Chief Executive Wairarapa DHB Tofa Suafole Gush ∑ Member of the Te Awakairangi Health Board Director Pacific Health ∑ Member Compass Health Network
∑ Husband is an employee of Hutt Valley DHB
Nigel Fairley ∑ Fellow, NZ College of Clinical Psychologists General Manager, 3DHB Mental ∑ President, Australian and NZ Association of Psychiatry, Health Addictions & Intellectual Disability Service ∑ Psychology and Law ∑ Trustee, Porirua Hospital Museum
∑ Director and Shareholder, Gerney Limited
Jason Kerehi ∑ Negotiator – Rangitane Settlement Negotiations Trust Executive Leader Māori Health ∑ Trustee – Rangitane Tu Mai Ra – Post Settlement Governance Entity
∑ Partner is employed as a school nurse by Compass Health Tracy Voice ∑ Secretary, New Zealand Lavender Growers Association CIO, 3DHB ∑ Board Member, Primary Growth Partnership with PGG Wrightsons/Grassland Seed Technology Innovation
Michele Halford ∑ No interests declared Executive Leader Nursing Nigel Broom ∑ Treasurer, Martinborough School Board of Trustees Executive Leader Planning & Performance Chris Stewart ∑ Member St Matthews Collegiate BOT Executive Leader Quality Risk & Innovation Selena McKay ∑ No interests declared Executive Leader People & Capability Anna Cardno ∑ No interest declared Communications Manager
Wairarapa District Hutt Board Month Year Page 1 of 2
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Name Interest Kieran McCann ∑ Partner works part time as an RN on MSW Executive Leader Operations Liz Stockley ∑ Substantive role – Director Primary Care, Compass Health Director of Primary Care, ∑ CEO, GPNZ Wairarapa Compass Health ∑ National Board Member, Girl Guiding NZ ∑ Director of Strong Point Ltd – Electrical contracting based in Wairarapa (Husband’s business)
Sandra Williams ∑ No interests declared Acting Executive Leader Planning and Performance Susan Flavin ∑ Employed by Hutt Valley DHB Acting Executive Financial Officer Shawn Sturland ∑ Intensive Care Specialist Capital and Coast DHB Chief Medical Officer ∑ My partner, Holly Brindle, is a DNM at Wairarapa Hospital
Wairarapa District Hutt Board Month Year Page 2 of 2
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Wairarapa Board INTEREST REGISTER Name Interest Sir Paul Collins ∑ Director of: Active Equity Holdings Limited (Chair) Chair Hurricanes GP Limited Ides Limited Shott Beverages Limited Technical Advisory Services Limited ∑ Director and shareholder of: AEL Managers Limited Beverage Holdings Limited Cohiba Traders Limited Ecopoint Limited Tofino Trustee Limited ∑ Member of shareholders Review Group for New Zealand Health Partnerships Limited Mrs Leanne Southey ∑ Chair, Wairarapa District Health Board, Finance Risk & Audit Committee Deputy Chair ∑ Deputy Chair, Wairarapa District Health Board ∑ Chair of Lands Trust Masterton (15 February 2016) ∑ Director, Southey Sayer Limited ∑ Chartered Accountant to Health Professionals including Selina Sutherland Hospital and Selina Sutherland Trust ∑ Trustee, Wairarapa Community Health Trust ∑ Shareholder of Mangan Graphics Ltd ∑ Member of UCOL Council Dr Nicholas Crozier ∑ Board Member Compass Health Member ∑ Branch Medical Advisor ACC ∑ GP Masterton Medical ∑ Board Member Cancer Society Dr Liz Falkner ∑ Member, Wairarapa District Health Board Member ∑ Member, WRDHB Hospital Advisory Committee (30 March 2016) ∑ Retired General Practitioner with Masterton Medical Limited ∑ Medical Advisor – Post Polio Support Society NZ Inc ∑ Sister in Law works part time at Wairarapa District Health Board (23 February 2016) Ms Jane Hopkirk ∑ Member, Wairarapa District Health Board Member ∑ Member, Wairarapa, Hutt Valley and CCDHB Disability Support Advisory Committees (30 March 2016) ∑ Member, Wairarapa Te Iwi Kainga Committee ∑ Data Analyst, Takiri Mai Te Ata, Kokiri Hauora Mr Ronald Karaitiana ∑ Member, Wairarapa District Health Board Member ∑ Member, Wairarapa Te Iwi Kainga Committee ∑ Member, Wairarapa District Health Board, Finance Risk & Audit Committee ∑ Akura Lands Trust Chairman ∑ Extended family members work in varying roles at DHB ∑ Chair of WrDHB Hospital Advisory Committee ∑ CE Te Hauora Runanga o Wairarapa ∑ RK Consulting Ltd, Business owner ∑ Whanau ora Collective Member Te Hauora and Whaiora via Te Pou Matakana
Updated: 2019-10-10 1
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Name Interest Mr Rick Long ∑ Member, Wairarapa District Health Board Member ∑ Member, Wairarapa District Health Board, Finance Risk & Audit Committee ∑ Chairman of Wairarapa Community Transport Services Inc ∑ Chairman of Tolley Educational Trust ∑ Trustee for Sport and Vintage Aviation Society ∑ Member of Masterton Lands Trust ∑ Director, Longs Properties Limited (1 February 2016) Mr Derek Milne ∑ Member of 3DHB DSAC Member ∑ Brother-in-law is Chairman of Health Care NZ ∑ Daughter works as GP at Masterton Medical Ltd (MML) Ms Fiona Samuel ∑ Member of Wairarapa District Health Board Member ∑ Casual Nurse at Wairarapa Hospital ∑ Duty Nurse Manager at Wairarapa Hospital (on a casual basis) ∑ Contractor Auditor for Central Technical Advisory Services Ltd ∑ Member of Clinical Board at Wairarapa District Health Board ∑ Violence Intervention Programme o Clinical Co-ordinator from 22 August 2017 o Casual from November 2018 ∑ Director in Primary Care Development Ltd ∑ Contractor working with Whaiora Whanui Dr Alan Shirley ∑ Member, Wairarapa District Health Board Member ∑ Member, Wairarapa, Hutt Valley and CCDHB DSAC ∑ Surgeon at Wairarapa Hospital ∑ Wairarapa Community Health Board Member ∑ Wairarapa Community Health Trust Trustee (15 September 2016) Mrs Adrienne Staples ∑ Councillor – Greater Wellington Regional Council Member ∑ Director – Sanctuary Hill Limited ∑ Trustee – Staples Property Trust ∑ Board Member – NZ Geographic Board
Updated: 2019-10-10 2
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PUBLIC Minutes: Kadeen Williams , Board Secretary
Held on 23rd September 2019 Lecture Room, CSSB Building, Wairarapa Hospital, Masterton Commencing at 9:30am – 11:42am
Board Meeting Public Board Members Present Sir Paul Collins Board Chair Leanne Southey Deputy Chair Adrienne Staples Member Nick Crozier Member Liz Falkner Member Rick Long Member Jane Hopkirk Member Ron Karaitiana Member Derek Milne Member Alan Shirley Member (Teleconference) Rick Long Member Executive Leadership Team Present Dale Oliff CEO WrDHB Chris Stewart Executive Leader Quality, Risk & Innovation Debbie Oldham Financial Accounting Manager Sandra Williams Acting Executive Leader Planning & Funding Michele Halford Director of Nursing Jason Kerehi Executive Leadership Maori Health Liz Stockley Director Compass Health Anna Cardno Communications Manager Selena McKay Executive Leader People and Capability Shawn Sturland Chief Medical Officer Kieran McCann Executive Leader Operations Visitors Trish Wilkinson Manaaki Health Wairarapa Apologies Fiona Samuels Member 1. Procedural Business
1.2 Apologies As noted above
1.3 Minutes from previous meeting: August 2019
∑ The Board RESOLVED to approve the minutes of the Members’ (Public) meeting held in August 2019 as a true and accurate record of the meeting.
Moved R Long Second R Karaitiana Carried
1.4 Action Items Register
∑ NOTE: Action for patient food by large our food is under direction of dieticians and food has had a lot of effort and will be a constant action
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1.5 Interest/Conflict Register
∑ The Board NOTED that no changes to the interest register were declared in the meeting ∑ The Board CONFIRMED that it was not aware of any matters (including matters reported to, and decisions made, by the Board at this meeting) that require disclosure and that there would be an opportunity to declare any conflicts prior to discussion on each item of the agenda.
1.6 Chairperson reports
∑ No update to report
1.7 Chief Executive Reports
The report was taken as READ NOTES this paper and discussed as appropriate The Board: a. NOTED Senior Leadership Group initial meeting went well with good engagement and feedback from attendees; b. NOTED that the DHBs working on a strategic direction for 2020/21 and will work with CPHAC before presenting to the Board; c. NOTED that the DHB attended the Wairarapa Launch of PIKI (youth Mental Health services) 23rd August 2019. Services are provided via phone, online and opportunity to meet face to face with providers in Masterton, Featherston and Greytown.
ACTION: Follow up with the Lisa Burch report on youth services for Wairarapa (due December 2019) to be presented through CPHAC before the Board
2 Decision
2.1 Wairarapa DHB Board and Statutory Committee’s
The report was taken as READ NOTES this paper and discussed as appropriate The Board: a. APPROVED CPHAC to meet monthly; b. APPROVED HAC to remain part of the Main Board meeting; c. APPROVED Patient stories to be included in the Board; d. APPROVED Board provide and attend opportunities for areas of interest to be visited for casual lunch with staff and receive updates on patient safety and quality improvements activities.
ACTION: Board visits to be scheduled through the work plan for on coming Board
Moved A Staples Second J Hopkirk Carried
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2.2 DSAC Meeting Report September 2019
The report was taken as READ NOTES this paper and discussed as appropriate The Board a. APPROVED endorsement of a five year commitment to progressing the use of the Accessibility Charter across the three DHBs leveraging existing resources only in the 2019/20 financial year; b. APPROVED approach to outcome measurement using population indicators for the Living Life Well – Mental Health and Addictions Strategy; c. APPROVED approach to service performance measurement and dashboards related to the Living Life Well- Mental Health and Addictions Strategy d. NOTED the suicide prevention awareness role (0.5 FTE) has been appointed to and would like to acknowledge A.Cardno’s work in the community for their work in the community
Moved J Hopkirk Second R Karaitiana Carried
3.Discussion Hospital and Community Services Report The report was taken as READ NOTES this paper and discussed as appropriate The Board a. NOTED code red during August with a number of short peaks and troughs; b. NOTED We are working with staff to ensure best continuity of care for patients when possible during use of short term locum support; c. NOTED Theatre utilisation is a priority; d. ACKNOWLEDGE Services of the surgeons and operations teams
ACTION: Screening programme update at next Board meeting People and Capability Report The report was taken as READ NOTES this paper and discussed as appropriate a. NOTE MECCA activity with new agreements; b. NOTE On going strike activity with APEX Medical Imaging Technologists, APEX Psychologists, APEX Sonographers (Auckland) and APEX Medical Laboratory Workers; c. NOTE Pay equity for nurses, administration and SMO’s will be happening early 2020; d. NOTE Staff turnover is affected by retirement and personal movements. There are future proofing and succession planning strategies in place to try and mitigate Financial Report The report was taken as READ NOTES this paper and discussed as appropriate a. NOTE Favourable budget with savings under employment and unfavourable costs relate to Pharmaceuticals, and patient transport costs (including air)
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PUBLIC Planning & Performance Report The report was taken as READ NOTES this paper and discusses as appropriate a. NOTE Draft Annual Plan with the Ministry for approval; b. NOTE The Ministry will continue to work alongside the Expert Advisory Group and engage with Māori and the health and disability sector to develop the Action Plan, before Cabinet consideration and release in November 2019; c. NOTE Youth health services gaps analysis for future services; d. NOTE Implementation of a more comprehensive child health coordination service for Child Health; e. NOTE Meseals is a National concern (only one case in Wairarapa). MoH has a national action plan to support an outbreak if required. There is a concern with the vaccination of our Pacific Island population. CMO Introduction Dr Shawn Sturland provided a verbal update to the Board regarding work experience for the Chief Medical Officer role and responsibilities. He also informed the Board of the changes and updates he is working on to improve the functionality. The Board a. NOTED Key areas of work are succession planning, retention planning, the FTE will have clinical leadership and hospital and community responsibilities will be key to assisting with getting strategic and service development in place for future proofing the hospital; I. Looking at what services we need to be delivering and working to fit the community; II. Revitalisation of the Clinical Board, which will also report through to the Board and vis versa. This will allow solutions and options to be shared; III. One outcome would be that Wairarapa is a good example of services, etc. as an exemplary for the country. There is a real opportunity to become an innovative hospital; b. NOTED The new responsibilities will become part of the role/job not an extra. This will include supporting them as management and staff in their roles; c. NOTED There is great support and interest with new roles with over 50% subscription for the new roles. Review 48hour Readmission The report was taken as READ NOTES this paper and discussed as appropriate a. NOTED Readmissions rates for WrDHB are not high and services are working well individually however further work can be done for the initial discharge to mitigate readmission; b. NOTED will be presented to the Clinical Board; c. NOTED Ownership of readmissions should be with the services; d. SUPPORTS the approach recommended by the Director of Nursing.
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Resolution to exclude the public moved and done
The Board RESOLVED to AGREE that as provided by Clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons:
SUBJECT REASON REFERENCE Public Excluded Minutes For the reasons set out in the 29th July Board agendas Information contained in the paper may be subject to change as the information has not yet been reviewed by the FRAC Section9(2)(f)(iv) Chief Executive’s report Paper contains information and advice that is likely to prejudice or Section 9(2)(j) disadvantage negotiations Voice, Values and Vision Would restrict the DHB from carrying out commercial activities Section 9(2)(i) Report Voice, Values and Vision Would restrict the DHB from carrying out commercial activities Section 9(2)(i) work programme Shareholders Review Commercially sensitive information Section 9(2)(i) Group Resolution Spotless Food & Catering Paper contain information and advice that is likely to prejudice or Section 9(2)(i) contract right of renewal disadvantage commercial activities and/or disadvantage negotiations 2019
Renewal of 3DHB To protect the ability of agencies to negotiate effectively Section 9(2)(i) Laboratory contract with Wellington Southern Community Laboratories
Replacement of Commercially sensitive information Section 9(2)(i) Computer Radiology , general x-ray and fluoroscopy machines Wairarapa Annual Report Information contained in the paper may be subject to change as the Section 2018/19 information has not yet been reviewed by the FRAC 9(2)(f)(iv) Paper contains information and advice that is likely to prejudice or Section 9(2)(j) disadvantage negotiations Wairarapa Annual Plan Information contained in the paper may be subject to change as the Section 2019/20 information has not yet been reviewed by the FRAC 9(2)(f)(iv) Paper contains information and advice that is likely to prejudice or Section 9(2)(j) disadvantage negotiations Moved D Milne Second R Long Carried Closed 11:42am
CONFIRMED that these minutes constitute a true and accurate record Dated this day of 2019.
Sir Paul Collins Chair, Wairarapa District Health Board
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Wairarapa DHB Work Plan 2019
Regular monthly items: Strategy, Planning and Outcomes updates to include Public Chair report CEO report Resolution to exclude the public ALT update Palliative care update Obesity prevention Public Excluded Chair report CEO report FRAC report back FRAC minutes Primary care update Child & Youth health Smoking cessation
January February March April May June July August September October November December
Wairarapa DHB Board and Draft 2019/20 Final Annual Plan Statuary Annual Plan 2019/20 Committees’ DSAC meeting Final Financial n o
i Report Plan 2019/20 s i c e D
Palliative care 4th QTR DAP People & 5 Priorities DAP Draft Annual Plan implementation Report Capability update update 2020/21 paper Vision, Values, Health & Safety 1st QTR DAP Draft Financial MHAIDs update Voice update Report report Plan 2020/21 OSH, Incidents, adverse events, HDC, Risk Review 48hour Health & Safety n Screening report MHAIDs Report o i register, Patient Readmission Report s s
u experience c s
i HQSC markers D 3DHB MHA Strategy “Living Life Well” Regional Māori Health Report (MoH) n o
i Iwi Kainga t a
t Planning & Consumer
n Clinical Board Clinical Board
e Funding Council s e
r Pacifica Health P s t i s i V
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BOARD INFORMATION PAPER
Date: October 2019
Author Dale Oliff, Chief Executive Wairarapa District Health Board
Subject Chief Executive Public Report to the Board
RECOMMENDATION It is recommended that the Board:
a. NOTES this paper and discusses as appropriate
1 PURPOSE
The purpose of this paper is to provide the Board with updates from across the hospital and wider Wairarapa Health Community. It highlights work that is occurring at the DHB.
2 MENTAL HEALTH ADDICTIONS AND INTELLECTUAL ABILITIES (MHAIDS)
Phase two of the development of the MHAID’s management structure for the three DHB with Capital Coast as the lead has continued with three staff meetings held here at Wairarapa and one expressly to catch the input and voice of the local Senior Medical Officers ( MO). Further consultation is required for the Emergency SMO team as mental health patients often present to ED initially and need to be seamlessly connected to MHAIDs.
3 DIABILITY ADVISOR
An appointment has been made to the Disability Advisor role. The successful candidate is Vicki Smith. Vicki comes from the education sector and lives locally in the Wairarapa though most of her career was based in the United States as a caseworker for disabled children and adults within a variety of settings. Vicki is spending this week with her colleagues at Capital Coast DHB and Hutt Valley DHB.
4 EQUITY INITIATIVE – DIABETES
The working group consisting of Shawn Sturland, Annie Lincoln, Tony Becker, Lisa Burch (P&P) and Sue Baines (PHO) have already begun working on this initiative. We have identified 70 patients whom meet the criteria. Patients of Māori ethnicity with a diagnosis of diabetes, no consultation within last six months or have had no HbA1C in the last 12 months.
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5 NURSING ACTIVITY
5.1 Care Capacity Demand Management Implementation of the Care Capacity Demand Management (CCDM) programme is tracking well against the agreed roadmap for Wairarapa DHB (WrDHB). Midwifery and Allied Health have recently joined the programme and planning is underway to incorporate them into the implementation process. Information Technology (IT) infrastructure was with specific IT resource being allocated to targeted projects in support of both TrendCare and CCDM. The TrendCare upgrade is now scheduled for 1 June 2020 to allow for appropriate planning for the roll-out. 5.2 NETP Interviews for new graduate positions in 2020 are taking place at present. Our current contract with Health Workforce New Zealand (HWNZ) is for nine placements: seven in the Provider Arm and two external. As conveyed in a previous paper, the Ministry’s commitment to the accord intention to support full employment of nursing graduates means that WrDHB will receive funding to employ a clinical coach to support the Nurse Entry to Practice (NETP) Programme
6 COUNTDOWN KIDS CHARITY BALL
A number of Wairarapa District Health staff including myself will be taking time to attend the Countdown Kids Charity Ball this Saturday 12th October 2019. This will be the second annual charity ball and we look forwards to both the event and a good future relationship with our local Masterton Countdown. Masterton Countdown have made donations through a variety of fundraising methods and the monies have been used towards a neonatal incubator and flooring which has improved our maternity services for our community. They really have gone above and beyond to support us.
7 ORACLE PROJECT
The Wairarapa Oracle Implementation Project is live. The teams have been working hard to organise the roll out of the new system and processes while continuing to ensure business as usual has continued. I would like to thank you for you and the staff for their patience. The stores and imprest teams are successfully replenishing stock. We are still working through some questions but the project go live has been relatively straight forward.
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BOARD INFORMATION PAPER
Date: 8th October 2019
Author Dale Oliff, Chief Executive Officer
Subject Demolition of Decommissioned Old Wairarapa Hospital Buildings
RECOMMENDATION It is recommended that the Board:
a. NOTES this paper and discusses as appropriate
APPENDICES:
1. Masterton Site Plan – Fences
2. Fencing encroachment
1. PURPOSE
The purpose of this report is to inform the Wairarapa DHB Board of the demolition and remediation plan, outline the planned phases and approximate time lines to complete the demolition of the decommissioned old hospital buildings and the impact that it may have on existing services, public and staff.
2. BACKGROUND
The former Masterton hospital was decommissioned in April 2006 when the hospital services shifted in to the new facility. Although no patient services were provided out of the facilities, a number of plant and Information systems continued to connect from the old building to various sites around the DHB campus. The buildings and land were transferred back to the building owners, Land Information New Zealand (LINZ) in December 2012 and they have been responsible for the integrity of the facility since. Ongoing risks from unauthorised entry have been an issue over the past year resulting in incidences with local police, fire and building damages. The LINZ team have working closely with the WrDHB teams and have measures in place to increase the vigilance with security and fire surveillance measures. The demolition of the facilities is a significant undertaking and is rated as “tier one” by LINZ due the size and cost of the contract. The time lines are still quite fluid at this point and will be dependent contactors and associated work plans.
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PUBLIC 3. THE PLANNED DEMOLIOTION PROCESS
The demolition process will happen in five distinct phases.
3.1 Phase 1: Separation of Services
Existing services such as electricity and information services are currently linked through the old building will need to need to be decoupled and re-routed to ensure continuous operation to existing services. As part of the decoupling process an incident team will be established to ensure the smooth transition.
3.2 Phase 2: Securing and gaining access to the site
Fencing and hoarding will be going up around the perimeter of the old buildings in the next few weeks to minimise the risks of the demolition and ensure public and staff safety. The fencing will be a mixture of deer fencing type and hording depending on the activities and security. This is further outlined in appendix one. A new road will be formed, coming in off Colombo Street to assist with the larger vehicles gaining access to the site and ensure minimal traffic disruption during the project. It is also during this phase that the specialist teams will be involved in removing any asbestos from the site.
3.3 Phase 3: Soft strip of buildings
All the internal linings will be removed back to the concrete core and foundations of all the buildings.
3.4 Phase 4: Demolition Issues: RMO and Mental Health WrDHB and Masterton Medical Centre
Demolition works will be kept within legal noise and dust limitations but there will be disruptions to day to day surrounding buildings and staff during this period. Masterton Medical Limited (MML) will be relocating some of their services to the other side of their existing facility. MML and LINZ are working together on their mitigation planning during this time. The Resident Medical Officer (RMO) accommodation will be directly impacted specifically in relation to doctor’s who are undertaking the night shift and will be sleeping during the hours of demolition. This has been included on the Risk Register for the Hospital’s planning and mitigation planning. Mental health Services will also be impacted in terms of continuing to run services with all the demolition activity close by decommission.
3.5 Phase 5: Remediation of the site
The site is required to be put back to its natural condition. Detailed assessments of the soils will be undertaken and decontaminated as appropriate. The underground tunnels etc. will also be neutralised.
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PUBLIC 4. PROGRESS TO DATE
LINZ have advised that they have released a Request for Tenders to bid for the contract process of the demolition and remediation of the old hospital site and expect to award this contract by end of November 2019. The work is planned to commence in early 2020 following a successful tender being awarded. A steering group and framework has been established to work with LINZ to progress the work and have already started having regular meetings. Anna Cardno, Communications Manager will be directly liaising with the Masterton Medical Centre and LINZ on all communication for the patients, the public, the staff and the organisation. Kadeen Williams is the Liaison and contact person between WrDHB and LINZ and is providing administration support to the steering group.
5. RECOMMENDATION
It is recommended that the Board notes this paper as read.
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Wairarapa District Health Board Financial Report
September 2019
Dale Oliff Susan Flavin Chief Executive Interim Executive Leader Finance
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1 FINANCIAL PERFORMANCE OVERVIEW
The month of September reports a favourable variance to budget of $121k and $286k year to date.
Month $000s Year to Date Annual Actual Budget Variance Actual Budget Variance Forecast Budget Variance (95) (141) (47) Funder (745) (752) (7) (2,758) (2,875) (117) (13) 1 14 Governance 2 (14) (16) 1 (0) (1) (105) (192) (88) Provider (724) (987) (263) (6,685) (6,666) 19 (212) (333) (121) Net Result (1,467) (1,753) (286) (9,441) (9,541) (100)
The key changes in September 2019 include: ∑ A donation from Wairarapa Community Health trust for the Image Intensifier favourable of $165k, ∑ Recoveries from Selena Sutherland Hospital that are $50k higher in the month than budgeted, ∑ Lower Clinical Supplies for the month $100k, which may be partially due to non-reporting during the Oracle system implementation, ∑ External provider payments costs unfavourable by ($91k), offset by revenue. Following further work, we have increased the provision for Holidays Act remediation from $342k for the year to $684k; the impact of this for the first three months is ($86k). Other forecast adjustments for September include: ∑ Focus office relocation and increased rental costs of ($60k), ∑ Additional maintenance compliance costs of ($45k), and ∑ Re-phasing of Medical outsourced ($123k) as locum costs are expected later in the year. The budget also provided for $70k reduction in consumables from adjustments in Plastic surgery clinics. This has not been implemented, so forecast expenditure has been increased by a further ($52k).
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Operating Report for the month of September 2019
Month $000s Year to Date Annual
Actual Budget Variance Actual Budget Variance Forecast Budget Variance Revenue
13,580 13,441 139 Devolved MoH Revenue 40,546 40,421 125 162,060 161,725 335
135 168 (33) Non Devolved MoH 431 505 (74) 1,896 1,970 (74)
116 196 (81) ACC Revenue 556 589 (33) 2,322 2,355 (33)
683 471 212 Other Revenue 1,462 1,215 247 4,826 4,565 262
381 381 (0) IDF Inflow 1,141 1,143 (2) 4,570 4,572 (2)
88 80 9 Inter DHB Provider 289 281 7 1,006 999 7
14,983 14,737 246 Total Revenue 44,424 44,155 269 176,680 176,185 494
Expenditure Employee Expenses
1,007 1,045 38 Medical Employees 3,018 3,283 265 12,850 13,114 265
1,933 1,853 (80) Nursing Employees 5,804 5,774 (31) 23,292 23,143 (149)
521 496 (25) Allied Health Employees 1,612 1,557 (56) 6,327 6,272 (56)
79 86 7 Support Employees 276 271 (5) 1,082 1,077 (5)
694 711 17 Management and Admin 2,101 2,133 33 8,664 8,776 111
4,235 4,191 (43) Total Employee Expenses 12,812 13,018 206 52,215 52,381 166
Outsourced Personnel Expenses
352 280 (72) Medical Personnel 864 840 (23) 3,507 3,361 (146) 32 16 (15) Nursing Personnel 63 49 (14) 209 195 (14) 9 10 2 Allied Health Personnel 20 31 11 113 123 11 0 0 0 Support Personnel 1 0 (1) 1 0 (1)
79 68 (11) Management and Admin 216 204 (13) 824 807 (17) Total Outsourced 471 374 (97) Personnel Expenses 1,164 1,123 (41) 4,653 4,485 (168)
Outsourced Other 321 325 4 Expenses 977 974 (3) 3,903 3,895 (8)
912 1,012 100 Treatment Related Costs 3,208 3,073 (135) 12,494 12,296 (198)
959 920 (39) Non Treatment Related 2,549 2,592 43 10,036 9,949 (87)
3,524 3,520 (4) IDF Outflow 10,661 10,560 (101) 42,250 42,242 (9)
4,598 4,511 (87) Other External Provider 13,974 13,959 (15) 55,886 55,679 (207)
176 216 41 Interest, Dep&Cap Charge 547 608 61 4,684 4,799 115
15,195 15,070 (125) Total Expenditure 45,891 45,907 16 186,121 185,726 (395)
(212) (333) 121 Net Result (1,467) (1,753) 286 (9,441) (9,541) 100
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1.1 Revenue
Revenue is favourable against budget by $246k for the month and $269k year to date, this is due to one off donation of $165k, Selena Sutherland hospital revenue $50k, which is a timing variance and increased Ministry revenue. ACC revenue is tracking below budget.
Workforce expenses Total employee and outsourced workforce expense is ($140k) unfavourable to budget for the month and $165k favourable year to date. Adjustment has been made across the board to increase the year to date Holiday leave liability. The variance by employee type is explained by: • Medical workforce costs are ($34k) unfavourable for the month and $242k year to date due to vacancies in Acute services, General Medicine, and Mental Health. • Nursing costs are unfavourable to budget by ($95k) for the month and ($31k) year to date, ($45k) is due to the increase in the Holiday Act Provision and the remainder to additional FTE for the month in Acutes, MSW, Perioperative and Palliative Care. We are forecasting nursing cost to continue the unfavourable trend due to 1 FTE budgeted as management and paid from nursing and an allowance for training costs higher than budget. • Allied Health costs are unfavourable ($45k) year to date due to timing and staff mix. • Management and administration costs are $20k favourable year to date due to vacancies mainly in planning & funding and corporate services. Forecast includes a reduction for 1 FTE budgeted as management but paid from nursing.
1.2 Outsourced Other Expenses Outsourced other costs are ($3k) unfavourable to budget year to date.
1.3 Treatment related costs Treatment related costs are ($135k) unfavourable year to date due mainly to pharmaceuticals and treatment disposable costs.
1.4 Non Treatment related costs Non-treatment related costs are $43k favourable to budget year to date mainly due to IT costs where there has been a favourable wash-up of 2018/19 costs from Central TAS.
1.5 IDF Outflows IDF outflows are ($101k) unfavourable to budget year to date but currently forecast to breakeven.
1.6 Other External Provider costs These are ($15k) unfavourable and forecast to be (4207k) unfavourable, but this is offset by additional revenue; see funder section for more detail.
1.7 Interest, Capital Charge & Depreciation The year to date position is favourable against budget by $61k year to date from depreciation.
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2 STATEMENT OF FINANCIAL POSITION
Movement Actual Variance to Previous $000s Budget from 30 Explanation of Variances Between Actual and Budget 30-Sep Budget Year End June
Assets Current Assets Bank 2 10 (8) 9 (8) Accounts Receivable 7,110 5,290 1,820 6,435 675 Variance is because of higher accruals for Pharmac rebates and MOH revenue which was not factored into the phasing of the budget. Stock 1,113 1,039 74 1,039 74 Prepayments 360 370 (10) 320 40 Total Current Assets 8,585 6,709 1,876 7,803 782 Fixed Assets Fixed Assets 50,130 43,148 6,982 50,588 (458) Variance is because of the revaluation not being reflected in the budgets Work in Progress 7,076 7,060 16 6,490 586 Total Fixed Assets 57,206 50,208 6,998 57,078 128 Investments Trust Funds Invested 185 185 0 185 0 Total Investments 185 185 0 185 0
Total Assets 65,976 57,102 8,874 65,067 910
Liabilities Current Liabilities Bank 3,976 (3,312) (7,288) 1,799 2,178 Difference is due to $7m equity budgeted to be received in September Accounts Payable and Accruals 14,457 12,968 (1,489) 14,212 245 Variance is because of higher accruals for Funder expenditure which was not factored into the phasing of the budget.
Crown Loans and Other Loans 85 85 0 85 0 Current Employee Provisions 10,819 7,982 (2,837) 10,844 (25) Total Current Liabilities 29,337 17,723 (11,615) 26,939 2,399 Non Current Liabilities Other Loans 32 32 0 54 (22) Long Term Employee Provisions 639 639 (0) 639 0 Trust Funds 185 185 (0) 185 0 Total Non Current Liabilities 856 856 (0) 878 (22) Total Liabilities 30,193 18,579 (11,615) 27,817 2,377 Net Assets 35,783 38,523 (2,740) 37,250 (1,467)
Equity Crown Equity 90,573 97,869 (7,296) 90,573 (0) $7m equity funding budgeted for September
Revaluation Reserve 13,012 5,558 7,454 13,012 0 Increase in land and buildings valuation as at 30 June not factored into budget. Opening Retained Earnings (66,335) (63,080) (3,255) (51,937) (14,398) Increase in Holiday Pay Act provision in 2018/19 not included in budget. Net Surplus / (Deficit) (1,467) (1,824) 357 (14,398) 12,931 Total Equity 35,783 38,523 (2,740) 37,250 (1,467)
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3 TREASURY MANAGEMENT
3.1 Cash Flow Statement & Forecast
Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 Actual Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast $'000 $'000 $'000 $'000 $'000 $'000 $'000 $'000 $'000 $'000 Cash flow from operating activities Operating receipts 16,681 17,265 16,323 18,168 27,320 16,195 15,820 15,820 16,195 15,820 Payment to suppliers (12,399) (12,385) (12,418) (12,409) (12,663) (11,823) (11,833) (11,838) (11,988) (11,838) Payments to employees (4,956) (4,305) (3,768) (3,965) (3,940) (5,310) (4,130) (4,620) (4,180) (4,210) Capital charge 0 0 0 0 0 (983) 0 0 0 0 GST (net) (480) (562) (474) (500) (525) 0 (1,000) (500) (500) 0 Net cash flow from operating activities (1,154) 12 (338) 1,294 10,192 (1,921) (1,143) (1,138) (473) (228)
Cash flows from investing activities Purhase of property, plant & equipment (240) (240) (198) (229) (557) (183) (125) (1,908) (327) (459) Net cash flow from investing activities (240) (240) (198) (229) (557) (183) (125) (1,908) (327) (459)
Cash flows from financing activities Capital contribution from the Crown 0 0 0 0 0 0 0 0 0 0 Repayment of loan (7) (7) (7) (7) (7) (7) (7) (7) (7) (7) Net cash flow from financing activites (7) (7) (7) (7) (7) (7) (7) (7) (7) (7) Net Cash Flows (1,401) (235) (542) 1,058 9,628 (2,111) (1,275) (3,053) (807) (694) Opening cash balance (1,799) (3,200) (3,434) (3,976) (2,918) 6,710 4,600 3,324 271 (535) Closing cash balance (3,200) (3,434) (3,976) (2,918) 6,710 4,600 3,324 271 (535) (1,229) This table indicates the forecast position at the end of each month. This cashflow forecast assumes the Ministry will provide us with a $10m cash advance in November which will be repaid when the equity funding is received.
3.2 Borrowing Schedule The following table shows the borrowing facilities currently available to the DHB and the amounts drawn against each facility.
Wairarapa DHB Borrowing Schedule as at 30 September 2019
Facility Limit Maturity Date Balance 30-Sep OCR Interest Rate Paid/Payable $000 $000 Working Capital - NZ Health Partnerships Sweep arrangement ( 5,642) ( 3,976) 1.00% 4.07% Average Debit Interest Rate
Selina Sutherland ( 700) ( 116) 7% Fixed Margin plus OCR
Total Borrowing ( 6,255) ( 4,092) The bank account was overdrawn on 14 days during the month, 1-3 September and then again from the 20- 30 September, and the interest rates ranged between 3.81% and 4.21%. Last month we were overdrawn 13 days and the interest rates varied from 3.91% to 4.41%.
3.3 Funding and Equity Changes There have been no funding or equity changes so far this financial year.
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3.4 Foreign Exchange Transactions The following table shows the transactions involving foreign currencies, and is provided for the purposes of monitoring risk.
Wairarapa DHB Foreign Exchange Transactions as at 30 September 2019
Month Year to Date Foreign Foreign Currency Currency Range of Exchange Total No. of Amount NZD Cost Amount NZD Cost Rates Transactions Currency AUD $10,588 $11,441 $42,080 $44,438 0.9250 to 0.9556 5 USD $0 $0 $1,260 $1,951 0.6458 1 GBP $0 $0 $0 $0 0 EUR $0 $0 $0 $0 0 Totals $11,441 $46,389 6
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4 CAPITAL EXPENDITURE The following table shows the capital expenditure for the year to date.
Budgeted Expenditure and Balances Actual Expenditure WIP Balances
Project description WIP Balance Committed Costs Budget for Expected Budgeted Closing Year to Date Year to Date Year to Date Amounts Current WIP Brought Forward from 2018/19 2019/20 Capitalisation Balance Costs Budget Variance Capitalised Balances ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000)
BASELINE CAPEX - WIP - INTANGIBLES Regional and 3DHB Regional - Central TAS - RDHS 4,416 - 324 (1,591) 3,149 101 81 (20) - 4,517 Regional - Central TAS BAU 469 - 192 - 661 41 48 7 - 510 Local - - - - Oracle Project 800 243 - (1,043) - 367 243 (124) - 1,167 Gynae Plus Project 17 - - - 17 - - - (17) - NCAMP - 373 - - - - - Webpas Project 538 - 250 (570) 218 65 63 (2) - 603 Diagnostic Sign-offs (Radiology and Lab) - - 67 - 67 18 18 - - Software Licensing (Citrix, Microsoft) - Growth - - 50 - 12 12 - Software - Cyclical Maintenance & Upgrade - - 25 - 6 6 - Security Improvement Programme - - 25 - 6 6 - Concerto Transition & Enhancements - - 100 - 24 24 - National Screening Solution - - 25 - 6 6 - CostPro Upgrade - - 250 - 63 63 - TOTAL WIP PROJECTS 6,240 616 1,308 (3,204) 4,112 574 570 (4) (17) 6,797
BASELINE CAPEX - NON WIP Buildings - Capex < $100k 187 - - - - Seismic Remediation - Front Canopy 250 29 - (29) - 29 Clinical Equipment - - Capex < $100k 266 64 50 (14) - DDR and Fluoroscopy 900 - - - - Diagnostic Digital Radiology 400 - - - - Lease Switching 200 - - - Other Equipment - Capex < $100k 60 3 60 57 IT - Hardware - IT Server Upgrade 250 - (250) - - - - - 250 - Capex < $100k 150 2 - (2) TOTAL NON-WIP CAPEX 250 2,413 (250) 98 110 12 - 279 TOTAL CAPITAL EXPENDITURE (excl GST) 6,490 616 3,721 (3,454) 4,112 672 680 8 (17) 7,076
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5 FUNDER FINANCIAL RESULT 5.1 Financial Statement of Performance – September 2019 Month $000s Year to Date Annual Actual Budget Variance Actual Budget Variance Forecast Budget Variance Revenue 12,425 12,425 0 Base Funding 37,275 37,275 0 149,100 149,100 0 1,152 1,014 138 Other MOH Revenue 3,267 3,142 125 12,944 12,609 335 27 27 0 Other Revenue 81 81 0 326 326 0 381 381 (0) IDF Inflows 1,141 1,143 (2) 4,570 4,572 (2) 13,986 13,848 138 Total Revenue 41,765 41,642 123 166,940 166,607 333 Expenditure 188 188 0 DHB Governance & Admin 564 564 0 2,255 2,255 0 5,770 5,770 0 DHB Provider Arm 17,310 17,310 0 69,306 69,306 0 External Provider Payments 985 1,018 33 Pharmaceuticals 3,136 3,116 (20) 12,700 12,620 (80) 2 2 (0) Laboratory 4 5 1 20 20 (0) 1,116 968 (148) Capitation 3,151 2,964 (187) 12,172 11,890 (282) 542 572 30 ARC-Rest Home Level 1,672 1,754 82 6,957 6,957 (0) 470 452 (19) ARC-Hospital Level 1,426 1,385 (42) 5,493 5,494 0 514 495 (19) Other HoP 1,610 1,628 17 6,185 6,185 0 265 265 0 Pay Equity 794 794 0 3,178 3,178 0 308 339 31 Mental Health 845 1,009 164 3,873 4,038 164 Palliative Care / Fertility / 18 18 0 66 66 (1) 231 231 0 Comm Radiology 375 379 4 Other External Provider 1,266 1,228 (38) 5,043 5,025 (18) 3,527 3,524 (4) IDF Outflows 10,663 10,571 (92) 42,284 42,284 (0) 14,080 13,989 (91) Total Expenditure 42,509 42,393 (116) 169,698 169,482 (216) (95) (141) 47 Net Result (745) (752) 7 (2,758) (2,875) 117 Overall, the result for Wairarapa DHB Funder for the month of September is $47k favourable and $7k favourable for the year to date. We are forecasting a deficit of ($2,758k) which is $117k favourable to the budgeted deficit of ($2,875k). The main reason for the improvement in the net result for 2019/20 is the additional funding of $219k for Combined Pharmaceutical Budget. The costs for these are included in the IDF Outflows and at this stage we expect the IDF Outflows to be within the 2019/20 budget. The detailed breakdown of this is shown in the Financial Statement of Performance above. Other MOH revenue is $138k favourable for the month and $125k favourable for the year to date of which $122k is related to System Level Measure Capability Funding. This funding is budgeted to receive in October for the first quarter in 19/20; however in September MOH paid this in advance for the quarters starting from Oct & Jan. This additional revenue is off-set by the adverse variance in PHO Capitation costs. The Other MOH revenue is forecasted to be $335k favourable for the full year and the details are presented in the table below:
Sep-19 MOH Revenue Variance to budget year Month to Forecast $ date $ $000s $ Additional Funding for Combined Pharmaceutical Budget 2019/20 0 0 219 Primary Care initiatives -(CSC Card holders, Under 14s, VLCA) 12 33 132 Reduce Pressure on Fees Total Annual Funding 0 18 18 In Between Travel wash-up revenue 2016/17 & 2017/18 0 (49) (49) Well Child Tamaraki Ora (WCTO) 5 5 18 System Level Measure Capability Funding -19/20 (phasing variance) 122 122 0 System Level Measure Capability Funding 18/19 (1) (1) 0 Pay Equity Wash-up revenue 18/19 0 (3) (3)
Sub-Total 138 125 335
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IDF Inflows are ($2k) unfavourable for the year to date because of the PHO Capitation and Fee For Services (FFS) wash-up for quarter one for 19/20 financial year. Provider Arm payments costs are on budget and there are no funding changes in the month. Pharmaceutical costs are $33k favourable for the month and ($20k) unfavourable for the year to date. These are demand driven costs based on the actual claims. The latest forecast released by Pharmac in June 19 indicated that the rebates receivable for 2019/20 would be $106k ($26k year to date) higher than the budgeted rebates of $4,015k. The September 19 year to date result reflects this change in rebates receivable. The year to date result also includes ($16k) higher than budgeted payments to National Haemophilia Management Group (NHMG). The costs for this services for 2019/20 are likely to be up to $5.5 million more than anticipated nationally (1.10% or $61k for Wairarapa DHB). The June forecast also indicated that the net full year community pharmacies cost would be ($178k) or (1.45%) higher than the budgeted cost of $12.310k; however the September forecast reflects the year to date variance extrapolated to the full year ($80k) as the June Pharmac forecast yet to be updated to correct some errors. The following graph compares the current year actual costs (blue bar) to the current year budget and the actuals for the last two previous years. The actual costs in this graph are net of Pharmac rebates and includes GST Credits, Pharmac Discretionary Pharmaceutical Fund (DPF) and Pharmac operating costs.
The graph below shows the community pharmaceuticals spending over the past 7 years by month and illustrate seasonality. This graphs includes only gross drug costs (cash expenditure) and the accruals (excludes rebates and other Pharmac operating costs).
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Pharmaceuticals Expenditure by year (Cash expenses plus accruals 1,600 1,500 1,400 1,300 1,200 1,100 1,000 900 800 700 600 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
2019/20 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
Capitation costs are ($148k) unfavourable for the month and ($187k) unfavourable for the year to date of which ($122k) is related to System Level Measure Capability payment to Compass Health. This is budgeted to pay out in Oct for the first quarter in 19/20; however in September MOH paid this to Compass in advance for the quarters starting from Oct & Jan. This is off-set by the additional Other MOH revenue. Also ($33k) is off-set by the additional MOH revenue received for PHO Capitation services (Care Plus, VLCA, Community Services Card and Under 14s). The balance $32k is related to higher than budgeted enrolments. The table below shows the movements in enrolment by quarter for the last five quarters.
PHO Enrolment Jul-18 Oct-18 Jan-19 Apr-19 Jul-19 Wairarapa Residents 43,657 43,829 43,807 43,731 44,173 Non-Wairarapa Residents (inflows) 1,080 1,096 1,109 1,563 1,584 Total Enrolled in Wairarapa PHOs 44,737 44,925 44,916 45,294 45,757 Wairarapa resident enrolled elsewhere (outflows) 1,537 1,539 1,596 2,021 1,906 Total Wairarapa Population Enrolled 45,194 45,368 45,403 45,752 46,079 Change from previous quarter 252 174 35 349 327 Change from same time last year 1,121 984 908 810 885 %Change from same time last year 2.54% 2.22% 2.04% 1.80% 1.96%
Net IDF Volumes 457 443 487 458 322
Satistics NZ Population estimate 45,880 45,880 45,880 45,880 46,445 Population Enrolled 98.5% 98.9% 99.0% 99.7% 99.2% We are forecasting the Capitation costs to be ($282k) unfavourable to budget of which ($132k) off-set by the additional Other MOH revenue for PHO capitation services. The balance ($132k) is for the higher than budgeted enrolments. Aged Residential Care costs are $11k favourable for the month and $40k favourable for the year to date ($82k rest home & ($42k) hospital level). These are demand driven services. Aged Residential Care Services costs are favourable mainly due to fewer than expected new entries to ARC and an increase in the proportion of private payers. We expect the Aged Residential Care costs for the full year to be within the budget for 2019/20. The graph below shows the percentage of ARC Residents who are maximum contributors. Maximum contributors are the people who do not meet the Ministry of Social Development’s financial criteria for a DHB subsidy meaning that the DHB pays a lower proportion of the total ARC costs. This reflects a socio- economic impact beyond the influence of the DHB. 12
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The following graph compares the current year ARC actual costs (blue bar) to the current year budget and the actuals for the last three previous years.
Other HOP costs are ($19k) unfavourable for the month and $17k favourable for the year. The main reason for the unfavourable variance in the month is because of an adjustment to transfer out the pay equity costs included in Home and Community Support Services based on the latest information. Pay equity costs related to Home and Community Support Services (HCSS) are transferred from this expenditure line to Pay Equity line. MOH is responsible for providing the actual pay equity costs related to HCSS. Other services included in this line are community based demand driven services. The year to date variance includes overspend in Residential Care: Community- Under 65s. This services is for adults (not older people) who have long term condition (not disability) who needs residential care services. The increase in allocation of this service would expect to reduce the costs for Health Recovery and Chronically Medically Ill services in long term. We will monitor this service closely during this year. Respite Care and Day Programmes services provide support to informal family carers who looks after their family member at home. Most of these clients would otherwise be at risk of needing full time residential care. The table below shows the different types of
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services that are included in Other HOP expenditure line.
Health of Older People (HOP) Expenditure 2019/20 Variance to budget year to date Month $ $000 $ Home and Community Support Services (18) 27 Residential Care: Community -Under 65s (21) (33) Respite Care 17 29 Day Programmes (5) (11) Residential Care: Loans Adjustment (1) (3) Carer Support 9 8 Total (19) 17
Pay Equity costs line shows no variance to budget. The MOH provides data on the impact of pay equity costs and this information is only partially available for 19/20 financial year. Therefore the pay equity costs are accrued to budget until the actual costs information is available. Mental Health expenses are $31k favourable for the month and $164k favourable for the year. The reason for the favourable variance in the month and the year to date is that the release of the prior year accruals for acute mental health bed usage wash-up with Capital and Coast DHB and Hutt Valley DHB as this is no longer required. Other External Provider Payments are $4k favourable for the month and $38k unfavourable for the year to date. The year to date result includes ($58k) for planning costs and largely off-set by a refund received from Hutt Valley DHB for mental health acute beds wash-up payment for 2017/18 financial year. IDF Outflows are ($4k) unfavourable for the month and ($92k) unfavourable for the year to date. The reason for the unfavourable variance is because of ($80K) provision made for inpatient IDF outflows wash-up with Capital & Coast DHB and ($8k) for mental health acute beds wash-up with Hutt Valley DHB. The following table shows the components of the IDFs that are reflected in this line.
IDF Wash-ups and Service Changes Variance to Budget year to Month date $000s $ $ IDF Inflows - PHO Capitation / FFS 0 (2) Total IDF Inflow Changes 0 (2) IDF Outflows - Inpatients 0 (80) - Mental Health Acute Beds -Hutt Valley DHB (3) (8) - PHO Capitation / FFS 0 1 IDF Service Changes - CCDHB - Advance Care Planning (1) (3) - ADHB - National Services Q4 2018/19 0 (2) Total IDF Outflow Changes (4) (92) Please note that the year to date growth in IDF activities reflected in the actuals are lower than previous years mainly because of industrial action.
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6 PROVIDER FINANCIAL RESULT
Financial Statement for the month of September 2019 Month $000s Year to Date Annual Actual Budget Variance Actual Budget Variance Budget Revenue
Government and Crown Agency 3 1 1 MoH - Devolved Funding (Funds arm) 4 4 0 16 4 4 0 MoH - Personal Health 12 12 0 49 5 8 (3) MoH - Public Health 16 24 (8) 94 70 71 (1) MoH - Disability Support Services 209 213 (3) 851 18 38 (20) MoH - Maori Health 57 113 (56) 400 38 48 (10) Clinicial Training Revenue 137 144 (8) 577 88 80 9 Revenue From Other DHBs 246 239 7 956 88 169 (81) ACC Revenue 474 507 (33) 2,029 3 3 0 Other Government Revenue 10 10 0 41 318 422 (104) Total Government and Crown Agency 1,165 1,265 (100) 5,012
Non Government Revenue 2 4 (3) Patient Revenue 5 13 (8) 52 678 463 215 Other Income 1,447 1,192 255 4,472 5,770 5,770 0 DHB Internal Revenue 17,310 17,310 0 69,306 6,450 6,238 212 Total Non Government Revenue 18,762 18,515 246 73,830
6,767 6,660 108 Total Revenue 19,927 19,781 146 78,842
Expenditure
Employee Expenses 1,007 1,045 38 Medical Employees 3,018 3,283 265 13,114 1,933 1,853 (80) Nursing Employees 5,804 5,774 (31) 23,143 521 496 (25) Allied Health Employees 1,612 1,557 (56) 6,272 79 86 7 Support Employees 276 271 (5) 1,077 652 665 13 Management and Admin Employees 1,975 1,990 14 8,205 4,193 4,146 (47) Total Employee Expenses 12,686 12,874 188 51,810
Outsourced Personnel Expenses 352 280 (72) Medical Personnel 864 840 (23) 3,361 32 16 (15) Nursing Personnel 63 49 (14) 195 9 10 2 Allied Health Personnel 20 31 11 123 0 0 0 Support Personnel 1 0 (1) 0 64 57 (7) Management and Admin Personnel 180 171 (9) 676 456 364 (93) Total Outsourced Personnel Expenses 1,127 1,091 (37) 4,355
301 305 4 Outsourced Other Expenses 919 916 (3) 3,665 912 1,012 100 Clinical Supplies 3,208 3,073 (135) 12,296 1,084 1,101 17 Non Clinical Expenses 2,937 3,042 105 12,301 3 1 (2) Financing Expenses 4 2 (2) 2,005 (77) (77) 0 Internal Allocations (231) (231) 0 (924)
6,872 6,852 (20) Total Expenditure 20,651 20,768 116 85,509
(105) (192) 88 Net Surplus / (Deficit) (724) (987) 263 (6,666)
The Provider Arm shows a net deficit of ($724k) for year to date September, which is favourable to budget by $263k.
6.1 Revenue Total revenue for the Provider year to date is $19,927k, which is favourable to budget by $146k. ∑ ACC Revenue is ($33k) unfavourable year to date. Income of $33k coming from staff claim reimbursements, which offsets against payroll expenditure. For non-staff related ACC income, there were under recoveries in AT&R ($11k), MSW ($6k), Imaging ($13k) and Community Nursing ($21k), 15
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while Outpatients remained $10k favourable. An increase in the annual target of $100k has yet to be achieved, with an adverse impact year to date of ($25k). ∑ Other Income is favourable to budget by $247k year to date because of a donation from Wairarapa Community Health Trust for an Image Intensifier $165k. Also, Selina Sutherland’s activity during the month resulted in favourable rental income of $31k and cost recovery income of $52k, due to volume which has associated costs in implants and prostheses. ∑ MoH revenue for Kia Ora Hauora ($56k) has been transferred to revenue in advance pending the programme structure setup. This is matched by a reduction in cost.
6.2 Expenditure Total Expenditure for the Provider is $20,651k for September year to date; an underspend against budget of $116k. Total personnel expenses (employed and outsourced) were ($140k) unfavourable in September, but $151k favourable year to date. An increase in the Holiday Act provision in line with Board recommendation, has added $86k to the September employed labour cost allocated to all employment groups. Medical costs (including outsourced) are favourable to budget for year to date of $242k due to vacancies in Acute 1.4FTE, Mental Health 1.5FTE and General Medicine 0.2FTE. The forecast takes into account the timing difference for sabbatical leave. The CMO/Intensivist was budgeted from July, but only commenced in early August, no costs or recovery were attributable to July. Nursing (including mental health and midwifery) costs are unfavourable to budget for the year to date by ($45k). FTE are over budget by (4.1). This is for Acutes (3.4) FTE due to non-budgeted pm to midnight shift and HCA position, MSW (3.6) HCA’s for patient watches, Periop (1.6) and Palliative Care (1.5). These are offset by positive FTE variances in Mental Health and Focus due to changes of staffing mix between nursing allied and management. Allied Health personnel expenses, employed and outsourced, were unfavourable by ($45k) to budget year to date despite FTE favourable by 0.2. FTE’s favourable in CAMHS 2.7 which due to timing and staff mix. Other vacancies in Oral Health, Therapies and Imaging, are covered within the service or by casual and outsourced staff. Management & Admin workforce, employed and outsourced year to date were $5k favourable to budget, with vacancies in the executive team have been covered by outsourced. Vacancies in Clinical Services Management, Finance, HR and IT, are yet to be recruited. Other Outsourced Expenses were ($3k) unfavourable year to date. Psychogeriatric activities budgeted as employee SMO, but provided as Outsourced Clinical ($20k) unfavourable in this code. There are underspends in other outsourced services, including gastro services, ENT, Halter readings, outsourced surgical procedures, tracking below budget due to timing of services. Clinical Supplies costs were ($135k) unfavourable year to date September. Treatment disposables ($69k) unfavourable, Patient consumables ($46k) which is mainly in Periop and Infusion supplies ($19k) Instruments and Equipment are unfavourable by ($9k). The reduced deficit reflects the write off of a rental from 2017 in .the Perioperative Unit $15k favourable year to date. The CSSD is ($19k) unfavourable due to service contracts timing. Implants and Prostheses favourable by $87k, due to the number of elective surgeries cancelled during September. Patient Appliances $27k favourable year to date. Ostomy supplies in community nursing $21k underspent, due to current demand, but with costs likely to increase due to order placement phasing.
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Clinical and Client Related costs ($35k) unfavourable year to date due to Air ambulance ($18k) and Outpatients ($18k) budget savings for plastic clinics will not be realised, this has been adjusted in the forecast. Pharmaceutical spend is ($118k) unfavourable largely due to gastro-intestinal pharms and malignant disease pharms.
Non Clinical Expenses were $105k favourable to budget for September year to date. Hotel and laundry expenses have additional one off cleans ($5k) Laundry costs were up ($11k) on budget due to demand. Facilities costs ($32k) unfavourable; property compliance and maintenance costs were ($37k) over budget, due to more stringent compliance requirements. ITC expenses are $79k favourable due to Central TAS 18/19 wash-up $57k and budget phasing. Timing of spending on Corporate Training $10k favourable and Kia Ora Hauora extension programme set up due to timing shows an underspend of $57k year to date, offsets by additional funding transferred to revenue in advance. Depreciation $63k favourable year to date this is due to $10k for seismic asset rate recalculation and IT capitalization phasing $53k. Employment costs - analysis and trends (excluding outsourced) Month Wairarapa DHB Year to Date Variance $000s Variance Actual Actual Actual Actual Last vs vs Last September 2019 Last vs vs Last Annual Actual Budget year Budget year Actual Budget year Budget year Budget
Personnel 1,007 1,045 981 38 (26) Medical Employees 3,018 3,283 2,924 265 (94) 13,114 1,933 1,853 1,961 (80) 28 Nursing Employees 5,804 5,774 5,402 (31) (402) 23,143 521 496 431 (25) (90) Allied Health Employees 1,612 1,557 1,397 (56) (215) 6,272 79 86 68 7 (11) Support Employees 276 271 222 (5) (54) 1,077 694 711 620 17 (75) Management and Admin 2,101 2,133 1,914 33 (187) 8,776 4,235 4,191 4,061 (43) (174) Total Employee Expenses 12,812 13,018 11,859 206 (953) 52,381
Month Wairarapa DHB Year to Date Variance FTE Variance Actual Actual Actual Actual Last vs vs Last September 2019 Last vs vs Last Annual Actual Budget year Budget year Actual Budget year Budget year Budget FTE 44.6 46.7 45.5 2.1 0.9 Medical 44.2 46.7 46.1 2.5 1.9 46.7 253.9 250.8 253.4 (3.1) (0.5) Nursing 254.9 250.8 248.3 (4.1) (6.6) 250.8 74.5 75.3 72.3 0.9 (2.2) Allied Health 73.3 75.3 72.7 2.0 (0.6) 75.3 14.7 16.1 15.1 1.4 0.4 Support 15.3 16.1 15.0 0.8 (0.3) 15.9 107.6 116.3 112.2 8.7 4.6 Management & Admin 107.6 116.3 109.9 8.7 2.3 116.0 495.4 505.2 498.5 9.8 3.1 Total FTE 495.4 505.2 492.0 9.8 (3.4) 504.7 Average $ cost per FTE ($000) 22,556 22,382 21,555 (174) (1,001) Medical 68,249 70,317 63,430 2,068 (4,819) 280,883 7,613 7,389 7,740 (225) 126 Nursing 22,770 23,022 21,757 252 (1,013) 92,277 6,999 6,584 5,960 (415) (1,039) Allied Health 21,983 20,663 19,215 (1,319) (2,768) 83,254 5,361 5,362 4,514 1 (848) Support 18,035 16,848 14,790 (1,187) (3,245) 67,942 6,451 6,113 5,523 (338) (928) Management & Admin 19,528 18,345 17,416 (1,183) (2,112) 75,619 8,548 8,296 8,146 (252) (402) Cost per FTE all Staff 25,863 25,768 24,104 (96) (1,759) 103,783
∑ Medical FTEs is 2.1 favourable MTD to budget due to vacancies.
∑ Nursing FTEs is (3.1) adverse MTD; (2.2) FTE MTD being HCA’s mainly MSW for patient watches, RN’s (4.8), Midwives (1.1) FTE combined with savings in senior nurses 4.8 FTE.
∑ Allied Health FTE is 0.9 favourable due to vacancies.
∑ Support Staff is 1.4 FTE favourable to budget.
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∑ Management and Administration Staff is 8.7 FTE favourable to budget due to vacancies.
FTE Trends (from June 2012)
Actual FTE for Month (not year to date)
Jun Jun Jun Jun Jun Jun Jun Jun Jul Aug Sep 12 13 14 15 16 17 18 19 19 19 19 Medical 38 39 39 40 42 44 46 43 43 44 45
l Nursing 198 204 209 226 218 241 243 258 257 254 254 a u
t Allied Health 89 69 69 71 71 70 71 72 72 73 74 c
A Support 13 14 14 13 17 16 17 16 16 16 15 Mgmt/Admin 108 101 89 90 93 100 109 105 108 107 108 l
a Actual FTE 444 426 421 440 440 471 486 495 495 493 495 t o
T Budget 450 437 428 423 452 453 468 494 505 505 505
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Annual Leave Accrual $000s
2020 2019 2018
4,500 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 - Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
Annual Leave Accrual in $'000's Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2013 2,745 2,765 2,833 2,720 2,787 2,809 2,642 2,653 2,694 2,660 2,775 2,787 2014 2,838 2,938 2,907 2,863 2,928 2,887 2,773 2,800 2,793 2,891 2,911 3,025 2015 3,045 3,090 3,043 3,030 3,033 3,001 3,050 3,020 2,937 2,984 3,019 3,024 2016 3,105 3,173 3,057 3,024 3,097 3,093 2,950 2,961 2,902 2,929 3,004 3,115 2017 3,152 3,038 3,128 3,101 3,167 2,993 2,853 2,936 2,984 3,047 3,165 3,327 2018 3,213 3,348 3,434 3,454 3,524 3,350 3,294 3,320 3,474 3,535 3,617 3,682 I’ve 3,541 3,584 3,697 3,755 3,837 3,752 3,521 3,626 3,717 3,820 3,949 3,990 2019 2020 3,925 3,993 4,087
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6.3 Provider Arm Delivery
This graph shows the value of activity delivered in the provider arm (blue line) compared to the revenue passed through from the funder (blue bar). The yellow bar is other revenue, such as health workforce New Zealand and ACC. The pink bar shows the expenditure. Note that activity for the current month is likely to be understated until coding is completed.
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7 GOVERNANCE
The following table shows the governance position for September 2019. Month $000s Year to Date Annual Actu Budge Varia Budg Vari Forec Budg Varia al t nce Actual et ance ast et nce Revenue
Government and Crown Agency MoH - Devolved Funding 188 188 0 (Funds arm) 564 564 0 2,255 2,255 0 (0) (0) 0 Revenue From Other DHBs 42 42 0 42 42 0 188 188 0 Total Government & Crown 606 606 0 2,297 2,297 0
Non Government Revenue (0) (0) 0 Other Income (0) (0) 0 (0) (0) 0 (0) (0) 0 Total Non Government (0) (0) 0 (0) (0) 0
188 188 0 Total Revenue 606 606 0 2,297 2,297 0 Expenditure
Employee Expenses 42 46 4 Management and Admin 125 144 18 553 571 18 42 46 4 Total Employee Expenses 125 144 18 553 571 18
Outsourced Personnel 15 11 (4) Management and Admin 37 33 (4) 139 131 (9) 15 11 (4) Total Outsourced Personnel 37 33 (4) 139 131 (9)
19 19 (0) Outsourced Other Expenses 57 57 (0) 230 230 (0) 48 35 (13) Non Clinical Expenses 154 155 1 450 442 (9) 77 77 0 Internal Allocations 231 231 0 924 924 0 201 187 (14) Total Expenditure 604 620 16 2,296 2,297 1 Governance for September year to date is a net surplus of $16k to budget. Revenue for Governance is on budget. Management and Admin employed costs were favourable by $18k due to vacancies arising from adviser positions in Planning and Performance yet to be appointed. Outsourced Personnel year to date is ($4k) unfavourable due to increased charges for Hutt based advisor. Non Clinical costs are on budget.
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PUBLIC
BOARD INFORMATION PAPER
Date: October 2019
Author Kieran McCann, Executive Leader Operations
Endorsed By Dale Oliff, Chief Executive Officer
Subject Hospital and Community Services Report for September 2019
RECOMMENDATION It is recommended that the Board:
a. NOTES the content of this report
APPENDICES
1. Wairarapa DHB Planned Care Performance for August 2019
1. PROVIDER OVERVIEW
Operationally September 2019 has seen the hospital delivering 816 inpatient discharges and 1,378 Emergency Department attendances. For the first quarter, inpatient discharges are 2,467, resulting in 5,897 bed days with an average length of stay of 2.39 days. Whilst broadly comparable to the same period last year there is a decrease in inpatient discharges of 198 patients but with patients staying slightly longer there is an increase of 389 beds days or 0.32 average days stayed. Maternity has also seen a busy period towards the later part of the month with the unit reaching capacity on several occasions. Over the September period we have had two episodes of labour withdrawal as a result of strike action from Radiology Imaging staff and although the first strike was called off at short notice the deferment of activity that had already occurred was not reversible. The industrial action is scheduled to continue with a possible further 6 episodes of strike action anticipated over the coming month. As this continues there are likely to be impacts on waiting times for diagnostic services. Waiting times and planned elective Surgery are coming under pressure particularly in Orthopaedic as the surgeon vacancy impacts are felt and the pressure from acute orthopaedic workload redirects resources away from planned procedures.
2. STAFFING
2.1.Sick Leave The DHB’s sick leave rate sits at 3.2% of worked hours for September 2019. Perioperative has dropped down this month to 2.7% MSW however continues to be above the DHB level at 4.1%. Maternity also this month is at 6.3% and Radiology is at 5.6%.
Maternity - Sick Leave as % of Worked Hours Radiology - Sick Leave as % of Worked Hours
Sick as a % of Worked - radiology Sick as a % of Worked - DHB Wide Sick as a % of Worked - DHB Wide Sick as a % of Worked - Maty Linear ( Sick as a % of Worked - DHB Wide) Linear (Sick as a % of Worked - Maty) Linear (Sick as a % of Worked - radiology) Linear ( Sick as a % of Worked - DHB Wide) 9.0% 10.0%
8.0% 9.0%
7.0% 8.0%
6.0% 7.0%
5.0% 6.0%
5.0% 4.0%
4.0% 3.0% 3.0% 2.0% 2.0% 1.0% 1.0% 0.0% l r r r r r r r r t t t c c c y v v v y y y y y y g g g g e e e n n n n n b p b p b p b p 0.0% l l l u c c c p p p p a a a a e e e l a a a a o o o u u u u t t t e e e e e e e e r r r r c c c n n n r r r r a a a a J u v v v y y y y e e e y y y b p b p b p b p g g g g n n n n n u u u l l l J J J J J c c c u O O O a a a a p p p p A A A A F S F S F S F S e e e J D J D D J o o o u u u u a a a a u u u e e e e e e e e A A A A a a a a n n n N N N J u M M M M u u u M M M M J J J J J J J J A O A O A O A F S F S F S F S J D J D D J A A A A u u u N N N M M M M M M M M J J J 2016 2017 2018 2019 2016 2017 2018 2019
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PUBLIC 2.2.Annual Leave
Total Annual Leave Hours Coded in Payroll (AL & AAL) Annual Leave Hours Coded in Payroll (AL & AAL) by employee category
10000 Allied Medical Mgmt & Admin Nursing Support 9000 4000 8000 3500 7000 3000 6000 2500 5000 2000 4000 3000 1500 2000 1000 1000 500 0 0 r r r r t c v g g y y e e y y r r r r t n n c v b p b p g g e e y y y y l l n n b p b p c a a l l p p c a a a a e o p p a a u u n n e e e e a a e u u o n n a a e e e e u u J J u u O J J A A F S F S O J J u u D A A A A F S F S J J N D u u A A M M N M M M M M M J J J J 2018 2019 2018 2019 Annual leave for September 2019 levels remains relatively consistent with previous trends with the drop in September being that the pay period ended on the 22/9, so a full month of leave data is not available. 2.3.Key changes Staff and recruitment (New recruitment updates) Key Staff Monthly Changes ∑ NIL 2.4. Existing recruitment actions Key Staff Existing General Surgeon 1.95FTE ∑ Two General Surgeon vacancies at the end of September ∑ Interim locum appointments secured ∑ Active recruitment continues; One unsuccessful interview complete with two more planned ∑ Discussions and contingency arrangements underway with other DHBs for support and future ∑ Co-ordination and continuity challenges with high dependency on locum use; seeking senior clinical nurse co-ordinator to work with surgeons Orthopaedic Surgeon 2.0 ∑ One vacancy with active recruitment FTE ∑ Advanced notice surgeon vacancies for January 2020 ∑ Offer to locum with experience in Wairarapa and completing a fellowship in the United Kingdom. Position is future planning for succession of retirement ∑ One further offer being made subject to immigration and registration requirements Anaesthetist 1.5 FTE ∑ 1.5 FTE vacancies by the end of 2019 with early notification of changes form current staff ∑ Active Locum procurement with some long term contracts possible if required to cover any gaps between permanent recruitment.3 interviews currently booked ∑ Consideration for retirement succession planning for two full time staff MOSS AT&R 0.8 FTE ∑ Anticipated vacancy in ATR being considered alongside recruitment Head of Department, Clinical Leadership role considered as alternative for replacing current MOSS role ∑ Locum cover available for interim during configuration and recruitment MIT ∑ One vacancy ∑ Active recruitment with proposal to supplement the service with an Allied Technician for the interim
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Key Staff Existing Charge Midwife Manager ∑ Interim CMM appointed (CMM) 0.8FTE ∑ Advertising in progress Director of Midwifery 0.2 ∑ Position successfully appointed FTE Dental Therapist ∑ 1.8FTE Vacancies historically difficult to recruit for ∑ Active recruitment ∑ Otago University employers forum booked for October Speech-language ∑ Vacant since 12/8/19, active recruitment underway Therapist, Child ∑ Historically difficult to recruit to and extended timeframe likely Development Service ∑ Plan to use vacancy to support additional psychologist hours in 0.2FTE interim (to reduce psychologist waiting list)
3. ACTIVITY AND OPERATIONAL PERFORMANCE
3.1. Acute Services ED Waiting times Wait time performance for the six-hour ED target was not achieved at 90.9% for quarter 1 with July 91.2%, August 91.8% and September 89.6%. Contributing factors to the non-achievement of the 6-hour target includes a noted increase in Triage 3 as a proportion of presentations whereby Triage 3 has increased by 652 (over 10%) presentations since 2017. This trend has increased into the current financial year with triage 3 presentations being 44% of total ED presentations.
Total ED Presentations 2020 2018 2019 1,800
1,600
1,400
1,200
1,000
800
600
400
200
0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2020 1,513 1,423 1,378 2018 1,515 1,548 1,463 1,538 1,492 1,680 1,634 1,435 1,502 1,438 1,431 1,452 2019 1,451 1,548 1,509 1,528 1,442 1,559 1,600 1,397 1,542 1,363 1,503 1,394
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ED Attendances By Triage ED Presentations by Referral Source 1 2 3 4 5 Ambulance Other GP Self Referral 800 1,400 700 1,200 600 1,000 500 800 400 600 300 400 200 200 100 0 l l l t t r r v v c c b p y y n n g g g p b p n n r r u u u c c a a a a
0 e e u u u o o a a u u e e e e e J J J p p l l l t t r r J J c c J J v v y y g g g O O p b p b p n n n n S F S F S r r D D A A A c c u u u N N M A M A a a a a e e u u u o o e e e e e M M a a u u J J J p p J J J J O O S F S F S D D A A A N N A A M M M M 2018 2019 2020 2018 2019 2020 Maternity Services The first quarter of the year has seen a busy start for maternity with July being one of the busiest birthing months for many years. This has an impact on bed space and acuity but has been well managed overall. No First Quarter Complex Activity 2 premature births < 33 weeks gestation birthed in the unit transferred to NICU immediately 6 in utero transfers to CCDHB 4 preterm labour
3.2. ALOS & ACWD Medical & Rehab General Medical ALOS and ACWD has remained relatively static for the last year. However given the overflow of acute Medical patients into ATR the shorter stay non-rehab patients i.e. medical boarders has seen the average length of stay for ATR reduce in the last 3 months. YTD to Sep-19, 11 non-rehab patients have been admitted to ATR with an ALOS of 3.55 days.
General Medicine ALOS & ACWD Aug 18 - Sep 19 Avg Length Of Stay Avg CaseWeighted Discharges Inpatient Caseweighted Discharges 2 per. Mov. Avg. (Avg Length Of Stay) 2 per. Mov. Avg. (Avg CaseWeighted Discharges)
5.00 300
4.00 250 200 3.00 150 2.00 100 1.00 50 0.00 0 Aug Sep Oct Nov Dec Jan Feb Mar Apr May June Jul Aug Sep
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PUBLIC ATR ALOS Aug 18 - Sep 19
Avg Length Of Stay Inpatient Discharges 2 per. Mov. Avg. (Avg Length Of Stay)
25.00 30
20.00 25 20 15.00 15 10.00 10
5.00 5
0.00 0 Aug Sep Oct Nov Dec Jan Feb Mar Apr May June Jul Aug Sep
3.3.Surgical Orthopaedic average length of stay in the last three months has increased to an average 3.16 days comparable to last year’s 2.65 days due to acute admissions. Long stay patients have affected the General Surgery ALOS at times. It is also noted that the early reporting of data for this report means that some of the results may change as coding is completed on patients through the month.
General Surgery ALOS & ACWD Aug 18 - Sep 19
Avg Length Of Stay Avg CaseWeighted Discharges Inpatient Caseweighted Discharges 2 per. Mov. Avg. (Avg Length Of Stay) 2 per. Mov. Avg. (Avg CaseWeighted Discharges) 6.00 120 5.00 100 4.00 80 3.00 60 2.00 40 1.00 20 0.00 0 Aug Sep Oct Nov Dec Jan Feb Mar Apr May June Jul Aug Sep
Orthopaedics ALOS & ACWD Aug 18 - Sep 19
Avg Length Of Stay Avg CaseWeighted Discharges Inpatient Caseweighted Discharges 2 per. Mov. Avg. (Avg Length Of Stay) 2 per. Mov. Avg. (Avg CaseWeighted Discharges) 4.00 100
80 3.00 60 2.00 40 1.00 20
0.00 0 Aug Sep Oct Nov Dec Jan Feb Mar Apr May June Jul Aug Sep
Key Issues Key actions underway Increased length of ∑ Development of early checklists and engagement for proactive stay and flow blocks identification and management for complex social patients ∑ Weekly monitoring and initiation of long stay patients review ∑ Medical rounding on Gen surgical patients with LOA > seven days
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PUBLIC Fiscal Year 2020 Fiscal Month Desc 03 - Sep
MTD MTD Actual MTD Volume YTD Actual YTD Contract YTD Volume Purchase Unit code Contract Volume Variance Volume Volume Variance Volume Caseweight Acute 443.9 418.8 25.1 1,397.1 1,256.5 140.6 M00001.a - General Internal Medical Services - acute 174.2 195.5 (21.2) 612.9 586.4 26.5 M05001.a - Emergency - Inpatient Services acute 41.6 39.7 1.9 121.5 119.1 2.4 M25001.e - Gastroenterology - Inpatient Services elective 1.2 0.0 1.2 1.2 0.0 1.2 M55001.a - Paediatric Medical - Inpatient Services acute 22.8 20.2 2.7 77.1 60.5 16.6 S00001.a - General Surgery - Inpatient Services acute 65.3 55.8 9.5 178.7 167.5 11.2 S30001.a - Gynaecology - Inpatient Services acute 3.2 7.8 (4.6) 13.5 23.5 (10.0) S45001.a - Orthopaedics - Inpatient Services acute 83.3 59.1 24.3 211.4 177.2 34.2 W06003.a - Neonatal - Inpatient Services acute 12.6 7.8 4.8 49.2 23.5 25.7 W10001.a - Maternity - Inpatient Services acute 39.6 32.9 6.7 131.5 98.8 32.7
Acute CWDs volumes are tracking ahead of contract by 140.6 YTD. (Note that this number may continue to change due to coding for the current month not being finalised). Going forward there is a planned action for our monitoring system to move some of these acute case weights to the elective funding line as per the 19/20 MoHs planned care monitoring framework whereby acute arranged patients are monitored with elective patients. These have previously been monitored with acute patients. 3.4. Planned Care (including Electives) NB* Appendix 1 corresponds to the Planned Care performance as reported to the Ministry of Health (MoH) and is aligned to the MoH dashboard for the activity delivered as of August 2019. Key Performance Area Commentary Planned Care Interventions The MoH has split the 2019/20 planned care initiative into three Delivery (case weights, discharges components (replacing the electives and ambulatory initiatives and minor procedures) of the past) ∑ Inpatient surgical discharge ∑ minor procedures both inpatients and outpatient ∑ non-surgical interventions August 2019 is positive with 91 additional interventions than planned. This is further broken down by: ∑ Inpatient Surgical discharges sitting adverse at 91.8%, which equates to 34 less discharges than planned. Case weight delivery is also adverse at 94.4% or 31.9 CWDs ∑ Minor procedures positive at 192.6%, with 125 more interventions delivered than planned ∑ A break down by main surgical specialities discharges and case weights is below to September 2019: 1. ENT are 8 discharges ahead; Hutt Valley DHB provide this service for ENT patients 2. Gynaecology is 9 patients ahead of discharge targets 3. General Surgery is 9 behind of contracted discharge targets which equates to 90.4%. also 16.7 case weights behind contract at 87.4% 4. Ophthalmology is a deficit of 13.7 CWD. Discharges at 56.1% (25 behind); due to surgeon availability. Complex surgeries are performed at Capital and Coast DHB (CCDHB) with cataracts at Wairarapa. Theatre schedules have been altered to accommodate the shortfall in discharges.
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Key Performance Area Commentary Planned Care Interventions Delivery 5. Orthopaedics are 20.8 CWD under delivered. Similarly, (case weights, discharges and minor discharges are 15 patients behind. Orthopaedic surgery has procedures) been most impacted by strikes. Use of locums has impacted on case selection relating to clinical continuity and procedural familiarisation. We currently have one vacancy in Orthopaedics which is sporadically covered by locums. Most locums are not able to operate on elective patients and are predominately used for acute theatre 6. Urology is currently at 109.1% of overall discharges, which equates to 2 patients Minor procedures delivered to August 2019 are 260 on a plan of 135, 192.6%. This is due to 53 more skin lesions than planned, 18 more Gynaecology, 56 more Avastin and eye procedures Planned Care Interventions Delivery Actions ∑ Improvement programme for planned care flow management and reduce avoidable cancellations and improve utilisation ∑ Implementation of Production Plan monitoring and reporting is completed and now monitored ∑ Restricted access to planned services for Non-Wairarapa DHB domiciled patients ∑ The introduction of the MoH Referral Prioritisation tool has been accepted by the Orthopaedic clinicians and are in the process of confirming resources ∑ A wider meeting comprising of Orthopaedic clinicians, nursing, theatre staff and PHO liaison is currently being set up to discuss patient options and management of Orthopaedic referrals Elective Service Patient Flow DHB performance has been in red for both ESPI two and five Indicators (ESPIs) – breakdown of for the last 22 months ESPI two and five Non-compliant services for ESPI two August 2019: ∑ Ophthalmology 39 patients ∑ ENT 14 patients ∑ External contractors provide these services Non-compliance services ESPI Five August 2019: ∑ General Surgery 10 patients ∑ Orthopaedics 57 patients ∑ Urology 5 patients ∑ Gynaecology 8 patients OPHTHALMOLOGY ∑ Work to validate First Specialist Appointment (FSA) waitlist and re-align our triaging criteria neighbouring DHB’s has been completed ∑ An average of 40 referrals accepted compared to previous 68 ∑ Additional clinics arranged to bring long wait patients (four months or more) for a FSA ∑ Extra clinics has resulted in an increase in cataract surgery; resulting in additional theatre requirements ∑ By the end of September 35 patients will be waiting longer than 4 months for FSA. ∑ We are on track to be compliant by end of 2019 ∑ Ophthalmology nurse specialist running clinics releasing time for the SMO’s
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Key Performance Area Commentary ENT ∑ Realignment with our triaging criteria to Hutt Valley DHB is completed. New Triage criteria allows more FSA patients to be seen ∑ ENT service through Hutt DHB, have not been able to provide clinicians clinics. A locum was secured to cover some of the shortage ∑ We have committed to MoH to become compliant by November 2019; on target to meet ORTHO & GEN SURGERY ∑ ESPI five performance is non-compliant ∑ General Surgery have 10 patients waiting longer than four months for treatment reducing to 6 patients in September ∑ Orthopaedics have 57 patients, which is an increase of 10 patients from last month. We are expecting this to increase to nearly 80 in September ∑ On-going recruitment for SMO resignations in both services with the need to backfill is an constant concern ∑ New Orthopaedics referral prioritisation tool has been agreed ∑ Once capacity for the Orthopaedic CNS has been made patients referred to be contacted by the Orthopaedic CNS ∑ Referral prioritisation based on clinical aspects and Life impact ∑ Details entered into the tool for threshold score of continued Hospital service or GP referral GYNAECOLOGY ∑ Eight patients waiting longer than four months for surgery in August reducing to 1 patient in September. Gynaecology to become compliant in October 2019 Diagnostics performance (CT, MRI) CT performance continues to exceed the 95% targets set for the DHB Note that MIT strike activity (6 days of 24hr full withdrawal of labour over October) will extend CT wait times and achievement against the 95% target. It will also impact general imaging performance and activity due to the time required to plan and prepare for decreased services on the strike days. MRI waiting times and under performance against the 90% waiting time targets Significant improvement of 17% to 64% against the 85% target as evidence actions indicated below ACTION ∑ Radiology Manager at Hutt DHB regarding ongoing performance and capacity ∑ Appropriate triage is being applied to ensure acute and urgent requests (excluded from MoH reports) are being appropriately prioritised and expedited ∑ Additional evening and Saturday sessions being used to assistant with increased volumes ∑ Hutt DHB outsourcing to supplement capacity ∑ Positive returns on recruitment of MITs and Radiologists Ophthalmology Waiting times ESPI As referenced above 2, ESPI 5 & Follow up appointments
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PUBLIC Key Performance Area Commentary Cardiac Surgery – Delivery and Cardiac Surgery and management is provided by CCDHB waiting list 3.5. FSA/FU Volumes to contract First Assessments shows an over delivery of 127 attendances and under delivery of 125 Follow-ups to September 2019 with variations by specialty provided in the table below. Variation is managed through the Electives Process and production planning.
Fiscal Year 2020 Fiscal Month Desc 03 - Sep
MTD MTD Actual MTD Volume YTD Actual YTD Contract YTD Volume Purchase Unit code Contract Volume Variance Volume Volume Variance Volume Outpatients - First Assessments 702 707 -5 2,248 2,121 127 D01002 - Dental - 1st attendance 12 9 3 12 26 -14 M00002 - General Medicine - 1st attendance 62 67 -5 223 200 23 M00010 - Virtual FSA - Medical 53 26 27 127 78 49 M10002 - Cardiology - 1st attendance 47 13 34 146 40 106 M20002 - Endocrinology - 1st attendance 8 6 2 19 19 0 M20004 - Diabetes - 1st attendance 0 4 -4 7 11 -4 M25002 - Gastroenterology - 1st attendance 4 9 -5 37 26 11 M55002 - Paediatric Medical Outpatient - 1st attendance 72 44 28 192 132 60 MS01001 - Nurse Led Outpatient Clinics 54 50 4 171 150 21 S00002 - General Surgery - 1st attendance 124 125 -1 396 375 21 S00011 - Virtual FSA - Surgical 67 62 5 203 187 16 S25002 - ENT - 1st attendance 38 37 1 110 110 0 S30002 - Gynaecology - 1st attendance 0 66 -66 0 197 -197 S40002 - Ophthalmology - 1st attendance 45 58 -13 244 175 69 S45002 - Orthopaedics - 1st attendance 50 58 -8 167 173 -6 S45004 - Fracture Clinic - 1st attendance 6 7 -1 26 21 5 S60002 - Plastics (inc Burns & Maxillofacial) - 1st attend. 32 43 -11 99 130 -31 S70002 - Urology - 1st attendance 28 24 4 69 72 -3
Outpatients - Subsequent Assessments 824 861 -37 2,459 2,584 -125 M00003 - General Medicine - Subsequent attendance 70 100 -30 221 300 -79 M10003 - Cardiology - Subsequent attendance 0 0 0 1 1 0 M20003 - Endocrinology - Subsequent attendance 7 7 0 21 20 1 M20005 - Diabetes - Subsequent attendance 17 12 5 37 36 1 M25003 - Gastroenterology - Subsequent attendance 0 47 -47 12 142 -130 M55003 - Paediatric Medical Outpatient - Subsequent attend. 95 133 -38 360 400 -40 S00003 - General Surgery - Subsequent attendance 164 133 31 405 400 5 S25003 - ENT - Susequent attendance 47 45 2 145 134 11 S30003 - Gynaecology - Subsequent attendance 60 71 -11 198 213 -15 S40003 - Ophthalmology - Subsequent attendance 201 165 36 549 495 54 S45003 - Orthopaedics - Subsequent attendance 78 72 6 246 217 29 S45005 - Fracture Clinic - Subsequent attendance 15 34 -19 49 103 -54 S60003 - Plastics (inc Burns & Maxillofacial) - Sub attend. 17 19 -2 50 56 -6 S70003 - Urology - Subsequent attendance 53 23 30 165 68 97 S30002 - IT are fixing this purchase unit line 3.6. Elective CWD Volumes to Contract
Fiscal Year 2020 Fiscal Month Desc 03 - Sep
MTD MTD Actual MTD Volume YTD Actual YTD Contract YTD Volume Purchase Unit code Contract Volume Variance Volume Volume Variance Volume Caseweight Elective 85.2 129.3 (44.1) 302.7 388.0 (85.3) S00001.e - General Surgery - Inpatient Services elective 19.0 28.7 (9.7) 72.9 86.1 (13.2) S30001.e - Gynaecology - Inpatient Services elective 17.8 14.1 3.7 47.3 42.2 5.1 S40001.e - Ophthalmology - Inpatient Services elective 12.6 8.0 4.6 24.3 24.1 0.2 S45001.e - Orthopaedics - Inpatient Services elective 30.9 67.2 (36.3) 134.3 201.6 (67.3) S60001.e - Plastic & Burns - Inpatient Services elective 0.0 3.0 (3.0) 0.0 9.0 (9.0) S70001.e - Urology - Inpatient Services elective 5.0 8.3 (3.4) 23.9 25.0 (1.1) Elective CWDs are behind plan by 85.3 YTD. Variation to contract commentary is referenced in the Planned Services report in the previous section. Note that this number may continue to change due to coding for the current month being finalised. Also noting that there is an IT fix to move acute case weights to the elective funding line as per the 19/20 MoH’s planned care monitoring framework whereby acute arranged patients are monitored with elective patients.
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PUBLIC 3.7. Theatre Utilisation/ Cancellation Rate There were 21 day of surgery cancellation in September, or 6.1% of total theatre events. ∑ 9 Orthopaedic ∑ 5 Endoscopy ∑ 6 General Surgery ∑ 1 Ophthalmology The reasons for cancellations were 9 acute substitution, 1 no beds, 5 for patient reasons including unfit, and DNA, 3 not required or done acutely and 3 were miscellaneous. A review of theatre utilisation data has been completed. This has resulted in the system being updated to reflect current resourcing levels across all 3 theatres. As a result theatre utilisation has shown a slight improvement in what has been previosuly reported. Theatre utilisation for Sep-19 was 68% combined, 67% theatre 1, 62% theatre 2 and 76% theatre 3. At the same time longer term look at DoS cancellation rates suggest that there has been a marked increase over last 2 years and this will remain key area of focus for targeting improvement.
Theatre Utilisation All theatres Theatre Utilisation - theatre 1
Combined Target TH1 Target
90% 100% 80% 90% 70% 80% 60% 70% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% 8 8 8 9 8 9 8 9 8 8 9 8 9 8 9 8 9 8 9 8 9 8 9 8 9 8 8 9 8 8 9 9 8 9 8 9 8 8 8 8 9 9 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ------l l l l r r r r r r t t r r c c v v g g y y g g y y n n n n n n n n b p b p b p b p u u u u c c a a a a p p p p a a o a a e e u u o a a a a u u u u e e e e e e e e u u J J J J J J J J J J J J O A A O F S F S A A F S F S D A A D A A N N M M M M M M M M
Theatre Utilisation - theatre 3 Theatre Utilisation - theatre 2
TH3 Target TH2 Target
100% 90% 90% 80% 80% 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% 8 8 8 9 8 9 8 9 8 9 8 9 8 9 8 9 8 8 9 8 9 8 9 8 9 8 8 9 8 9 8 8 8 9 9 8 8 9 9 8 8 9 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ------l l l l r r r r r r t r r t c c v v g g g g y y y y n n n n n n n n b p b p b p b p u u c u u c a a a a p p p p a a a a e e o o u u a a u u a a e e e e e e e e u u u u J J J J J J J J J J J J O O A A A A F S F S F S F S D D A A A A N N M M M M M M M M
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Key Issues Key actions underway Theatre Utilisation ∑ Following Surgical Services meeting team looking at planned care metrics and avoidable and monitoring. Specific project to target and improve Orthopaedics as area unplanned down time of priority underway. Workshop planned for Friday 18th October
3.5. Community Services District Nursing Monthly patient volumes for District Nursing have seen high levels of care provided in excess of planned activity and previous year’s volumes. Home help and personal care are conversely below plan and previous year activity for both month and YTD.
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Child Development Services The Government’s 2019 budget included additional new funding of $35million ($8.75m per annum) over four years to improve the health and social outcomes of children who are not meeting their developmental milestones and have additional needs. The Ministry of Health are working with Child Development Service providers to distribute this funding and oversee implementation plans to ensure this funding delivers the intended benefits to children. The new funding is being distributed regionally with the Central Region group being allocated a budget of $446,000 / annum, along with ability to access a $1million Innovative Funding pool. The Central Region CDS leaders worked together over August and September to develop a Central Region Implementation Plan which has gone to the Ministry for approval. Included in the implementation plan were requests for funding to support: ∑ 7.3 additional FTE across the region, with an emphasis on Psychologist FTE ∑ Funding for several regional initiatives that would be established and piloted in the larger DHBs and have potential to roll out locally. This includes a regional feeding service, a regional programme for pre-term infant follow up and a regional approach to point of entry coordination for CDS services A response is expected from the Ministry to the Central Region Implementation Plan during October, with an indication initial funding will be released in November. FOCUS Focus have seen a relatively steady start to the year. There are some staffing challenges with regards long term sickness and a vacancy under recruitment but most significantly will be the planned move of office to the new location in Lincoln Road planned for the end of October. .
3.8. Diagnostics Commentary on Diagnostics wait time performance is included in the Planned Section of this report in relation to MRI. All other performance metrics and targets met for the month from the Imaging department. As noted Community Referred Radiology volumes exceeded contract for the month and is 330 tests ahead of contract.
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PUBLIC CT Wait Times MRI Wait Times Wai Result Target Hutt Result Wai Result Target Hutt Result 120.0% 100.0% 100.0% 95.0%
80.0% 90.0%
85.0% 60.0%
80.0% 40.0%
75.0% 20.0%
70.0% 6 7 8 7 8 9 7 8 9 6 7 8 9 6 7 8 9 7 8 9 0.0% 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ------6 7 8 7 8 9 7 8 9 6 7 8 9 7 8 9 6 7 8 9 l l l l r r r v v v y y y 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 n n n p p p p 1 1 1 u u u u ------a a a a a a o o o l l l l a a a e e e e r r r J J J J v v v y y y p p p p n n n J J J u u u u a a a S S S S a a a o o o N N N a a a e e e e M M M J J J J M M M J J J S S S S N N N M M M M M M
Fiscal Year 2020 Fiscal Month Desc 03 - Sep
MTD MTD Volume YTD Actual YTD Contract YTD Volume Purchase Unit code Contract Variance Volume Volume Variance Volume CS01001 - Community-referred radiology 1,291.7 30.4 4,204.9 3,875.0 329.9
3.9. Endoscopy Waiting For September, the Urgent and Semi Urgent Colonoscopy targets were achieved at 100% and 93% respectively however; Surveillance Colonoscopy at 66% was not achieved against a target of 70%.
Urgent Colonoscopy Semi-Urgent Colonoscopy
Result Target Result Target
120.0% 120.0%
100.0% 100.0%
80.0% 80.0%
60.0% 60.0%
40.0% 40.0%
20.0% 20.0%
0.0% 0.0% 6 7 8 6 7 8 6 7 8 9 7 8 9 7 8 9 6 7 8 9 7 8 9 7 8 9 7 8 9 7 8 9 6 7 8 9 6 7 8 9 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ------l l l l l l l l r r r r r r v v v v v v y y y y y y n n n n n n p p p p p p p p u u u u u u u u a a a a a a a a a a a a o o o o o o a a a e e e e a a a e e e e J J J J J J J J J J J J J J S S S S S S S S N N N N N N M M M M M M M M M M M M
NOTE: Graph was uploaded as 3.2.2 Graph Surveillance Colonoscopy to September 2019
3.10. Bowel Screening Programme Following a request from the Board in September enclosed is an operational update on Bowel Screening activity and performance measures for the service over time.
Indicator Performance Indicator Performance Indicator Performance 200: Participation (%) 200: Participation: 200: Participation: Maori (%) Pacific (%) 72 66 75 206: Spoilt Kits: Delayed 209: Kits Tested 303: Time to Initial in Transit (%) Within an Contact for Pre- Appropriate Assessment (% 1 Timeframe (%) 100 within 15 working 97 days) 303: Time to Initial 303: Time to Initial 306: Time to First Contact for Pre- Contact for Pre- Offered Diagnostic Assessment: Maori (% Assessment: Pacific Assessment (% within 15 working days) 93 (% within 15 working within 45 working 96 days) days) 306: Time to First 306: Time to First 307: Time to Offered Diagnostic Offered Diagnostic Diagnostic Assessment: Maori (% Assessment: Pacific Assessment within 45 working days) 94 (% within 45 working (Colonoscopy Wait 95 days) Time) (% within 45 working days)
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Indicator Performance Indicator Performance Indicator Performance 307: Time to Diagnostic 307: Time to 318: Time to Notify Assessment Diagnostic Colonoscopy (Colonoscopy Wait 94 Assessment Results to BSP 82 Time): Maori (% within (Colonoscopy Wait Register (% within 45 working days) Time): Pacific (% 5 working days) within 45 working days) 326: Time to Notify Histopathology Results to BSP Register (% within 99 15 working days)
Participation is an important measure for determining the acceptability, and reach of a screening programme. The indicator used is the proportion of invited people during a timeframe that were screened.As the bowel screening programme invites participants back every two years, participation counts invitations over a two year period. The invitation period is a rolling 2-year period up to the reporting end date. Wairarapa remains ahead of target against this measure showing solid rates of participation including Maori and Pacific Island groups. In relation to the time to notify colonoscopy results to the BSP Register wairarapa is improving against this target measure of 100% (currently only being achieved by one DHB of all the progrmame areas) Volumes from Wairarapa DHB for people invited between 01/07/2017 and 08/10/2019
Notes Kits Sent 10,715 1.Counts for kits returned, colonoscopies and cancers detected etc. for this cohort will increase as more people return their kits or progress through the assessment process. This is especially so for people who have been invited in the last 3 months. Kits Returned 7,096 2.These figures count people. If a person has had two colonoscopies as part of a single Positive Results 332 episode, they will be counted once only. 3.Virtual CTCs are included in colonoscopy count Colonoscopies 280 4.All age groups are included
Cancers Detected 29 5.These figures include people invited between 01/07/2017 and 08/10/2019
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Diagnostics are a vital step in the pathway to access appropriate treatment. Improving waiting times for diagnostic services lead to better patient outcomes in a range of areas including cancer pathways, Emergency Department waiting times, and access to elective surgery. The targets for this indicator have changed over time. The current targets are included below: ∑ 90% of people accepted for an urgent diagnostic colonoscopy receive (or are waiting for) their procedure in the recommended timeframe of 14 calendar days or fewer, 100% in the maximum timeframe of 30 days or fewer ∑ 70% of people accepted for a non-urgent diagnostic colonoscopy receive (or are waiting for) their procedure in the recommended timeframe of 42 calendar days or fewer, 100% in the maximum timeframe of 90 days or fewer ∑ 70% of people accepted for a surveillance colonoscopy receive (or are waiting for) their procedure in the recommended timeframe of 84 calendar days or fewer of the planned date, 100% in the maximum timeframe of 120 days or fewer
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BOARD INFORMATION PAPER
Date: 9 October 2019
Author Sandra Williams, Acting Executive Leader Planning and Performance
Endorsed by Dale Oliff, Chief Executive
Subject Planning and Performance Report for October 2019
RECOMMENDATION It is recommended that the Board:
a. Notes this paper and discusses as appropriate
APPENDICES
1. Ministry of Health Planned care Strategic approach 2019 to 2024
1 PURPOSE
This paper provides an update to the Board on the work being progressed by Planning & Performance (P&P). The key areas of focus of the P&P work program are: ∑ Accountability documents- Annual Plan, Annual Report, Quarter 4 2018/19 reporting to the Ministry of Health (MOH); ∑ Improving equity; and ∑ Improving our commissioning for services, to better meet needs, improve performance, outcomes and value for money.
2 ACCOUNTABILITY
2.1 2019/20 Annual Plan
The final signed version of the 2019/20 Annual Plan incorporating the Statement of Intent 2019/20 to 2022/23 and the 2019/20 Statement of Performance Expectations and System Level Measures Improvement Plan was approved by the Chair and sent to the Ministry of Health on Friday 4 October 2019. It will be part of the first tranche of DHB Annual Plans going up to the Minister for his review and approval. There were only minor changes to the version approved by the Board at their meeting on 23 September 2019 that were required as part of clearing the MOH final feedback. A copy of the final Plan (subject to Ministerial sign-off) has been uploaded onto the Board Books Resource Centre.
2.2 Annual Report 2018/19
The Draft Annual Report was submitted to the External Auditors on the 27 September 2019. The feedback from the Board meeting and the External Auditors has been incorporated into the next draft. A draft has been submitted to the Ministry of Health. The second draft 2018/19 Annual Report has been prepared for approval by the Board.
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PUBLIC Key dates for the Board are set out below: Dates Actions 21 October 2019 Board meeting Approve final version of the Annual Report 21 November 2019 Hard copies of the signed 2018/19 Annual Report and 2019/20 Statement of Performance Expectations and Statement of Intent sent to Ministry/Parliament 28 November 2019 Annual Report, Statement of Performance Expectations and Statement of Intent tabled in Parliament 5 December 2019 DHB publishes Annual Report, Statement of Performance Expectations and Statement of Intent
2.3 Annual Planning preparation for 2020/21
Work has begun on preparing the next Annual Plan for 2020/21. A timetable has been prepared and and distributed. Work is underway on the financial assumptions to support the 2020/21 budget preparation.
3 IMPROVING EQUITY
3.1 Measles
From 1 January to 8 October 2019 there have been 1720 confirmed measles cases across New Zealand (NZ). There is currently a significant number of cases reported in the Auckland area. Cases are being reported outside of the Auckland area and most are linked to exposure from the Auckland cases. Wairarapa has had one case reported since 1 January 2019 but has had no recent cases confirmed. Nationally another 50,000 vaccines doses were received in September 2019 and are being distributed to priority areas. Another 100,000 doses are expected to arrive in NZ in mid-October 2019 ready for distribution later in October 2019. This new stock will see vaccine allocations increasing for Wairarapa DHB and we expect all four year old and 15 month old children will be able to receive their scheduled vaccinations.
3.2 Mental Health and Addictions
Integrated Primary Mental Health and Addiction Services The Ministry of Health has issued a Request for Proposals (RFP) for an integrated primary mental health and addiction services. Budget 2019 invested in increased access to, and choice of, mental health and addiction services. This RFP is for one element of that investment. The Service will make a range of supports rapidly available to a general practice’s enrolled population to help people manage challenges that adversely affect their wellbeing. These include support for self-management, talking therapies and social and cultural supports. The Ministry of Health is seeking collaborative responses from PHOs, DHBs and NGOs intending to develop and deliver the Services to the enrolled population of selected general practices within a defined geographical area. Funding for the Services will be equitably distributed by the Ministry of Health based on population characteristics. The intent is for a phased scale up of the services over the next two financial years. There are two tranches of funding: one for services commencing between January and June 2020 and one for services commencing between July 2020 and June 2021. There will be a further RFP opportunity in 2020 for those who wish to commence implementation in late 2021. Workforce development for the new roles involved in delivering the Services will be funded by the Ministry and coordinated nationally to align with agreed roll out of the services. Wairarapa DHB is collaborating with Hutt Valley and Capital & Coast DHBs, PHOs and NGOs on the proposal which is due on the 24 October 2019.
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PUBLIC Specialist Alcohol and Other Drug Services The Budget for 2019 provided funding of $10.5m per annum to support specialist alcohol and other drug services nationally. The Ministry has retained $1.5m for its own directly funded services and distributed the balance to District Health Boards. The Central Region has been allocated $2m per annum for the next two years and Wairarapa DHB is collaborating with the other regional DHBs on the regional proposal. There is an expectation that the region will use this funding to support sustainability of providers and as a stepping stone to support the existing system whilst a national model of care for AOD is developed. The regional proposal is due to the Ministry of Health by 31 October 2019.
4 INTERSECTORAL
4.1 Age Concern Expo
The annual Age Concern Expo organised by Wairarapa Age Concern was recently held in Carterton. This expo is part of the DHB contract with Age Concern Wairarapa for Health Education and Promotion for Older People. The event aims to assist health and positive ageing by letting the community know what is available. It presents a range of information and enables contacts between various agencies, older people, their families and the general public. Previously, the expo has been held in Masterton. This year it was held in Carterton to enable easier access across the Wairarapa and it is likely that future venues will alternate. About 250 people attended and there were 43 stalls – 17 of these were directly related to health while others were more community based. A wide range of agencies and topics were represented: St John, Stroke Foundation, Diabetes Wairarapa, Masterton Medical (focusing on falls prevention and Advance Care Planning), Heart Foundation, Audiology services, house & garden agencies, Digital Seniors and Senior Net, residential care providers, FOCUS (including information on supports available), Easi Living (for independence), and Alzheimer’s Wairarapa. Feedback was very positive about how informative the Expo was and a number of people who attended came especially to get the information they required. The total number of visitors to the expo was smaller than previous years but more were from South Wairarapa. Age Concern will also be attending the Featherston Community Event at the end of September.
5 IMPROVING COMMISSIONING OF SERVICES
5.1 Featherston Medical Centre Update
New build and one off costs for Mobile Surgical Bus The construction of a new Featherston Medical Centre has begun at 34 Fox Street. The framing and roof is now up and work has begun on fitting out the interior space. The building has been designed, financed and will be owned by Dr Dias and his wife. It is due to be completed and opened in March 2020. In order that the new site can accommodate the Mobile Surgical Bus that visits Featherston regularly, the DHB has agreed to fund one-off set up costs that include site levelling, electrical and data connections and plumbing (water and drainage). This arrangement, whereby the host DHB pays the set up costs, is common throughout New Zealand with the bus itself being funded by the Ministry of Health.
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PUBLIC DHB Presence in the New Medical Centre The DHB has confirmed its support for the new build and has indicated an interest in leasing space in the new premises. We have committed to renting a permanent consultation room for use by the DHB. There are benefits for being co-located with the practice, not only the convenience for patients and whanau but also the increased quality and efficiency of care, as DHB clinicians can speak directly to the practice GPs, nurses and other staff or visiting clinicians under the same roof. Discussions to date have suggested that space in the new build could be used by the DHB for several purposes including (but not limited to) District Nurses, visiting specialists, allied health clinicians and mental health services. We are now in the process of working out how best this space can be utilised and shared to achieve maximum benefit. This is a great initiative to increase access to services for people in South Wairarapa and will also save time on the road for visiting specialists driving from Wellington who will be able to see their South Wairarapa patients in Featherston.
5.2 Planned Care
In May the Ministry of Health finalised its approach to planned care and during September 2019 ran a series of workshops attended by DHBs, PHOs and other providers. Planned care is a new term and reflects the new direction for publicly funded health care in New Zealand. Planned Care is about providing services based on clinical need and service user preferences to achieve better health outcomes within the resources available. It is intended to consider medical and surgical activity (previously known as electives or arranged services) in a way that is not limited to hospital settings. The intent is that services be delivered in the appropriate setting, by the appropriate person and based on the needs of individuals accessing services. The Planned Care Strategic Approach is attached as Appendix 1. As part of the Annual Plan for 2019/20 Wairarapa DHB has committed to developing a three year plan to improve planned care services. This plan will come to CPHAC in Quarter 3 for consideration. The principles of the Planned Care Approach are: ∑ Equity – You’ll get the healthcare that safely meets your needs, regardless of who you are or where you are; ∑ Access – You can access the care you need in the right place, with the right health provider; ∑ Quality - Services are appropriate, safe, effective, efficient, respectful and support improved health; ∑ Timeliness – You will receive care at the most appropriate time to support improved health and minimise ill-health, discomfort and distress; and ∑ Experience – You and your whanau work in partnership with healthcare providers to make informed choices and get care that responds to your needs, rights and preferences. The strategic priorities are: 1. Understanding health need, both in terms of access to services and health preferences, with a focus on understanding inequities that we can change; 2. Balancing national consistency and local context. Ensuring consistently excellent care, regardless of where you are or where you are treated; 3. Simplifying pathways for service users. Providing a seamless health journey, with a focus on providing person-centred care in the most appropriate setting; 4. Optimising sector capacity and capability. Reducing demand on hospital services and intervening at the most appropriate time; and 5. Fit for the future. Planning and implementing system support for long term funding, performance and improvement.
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PUBLIC 5.3 Pharmacy Services
Community Pharmacy Services All Wairarapa community pharmacies have accepted the variation to their contract that provides funding to recognise pharmacists’ role in providing health advice to members of the public. The payments put greater emphasis on equity factors by having greater weighting for Māori and Pacific and people with a Community Services Card. The emphasis on equity is seen as a significant step forward with more work to be done in the future to more fully align this emphasis with the way services are funded. Pharmaceuticals Funding The Government’s announcement of a NZ cancer strategy was accompanied by the announcement of an additional $60m funding for pharmaceuticals, of which $20m will be available in 2019/20. The additional expenditure impact for Wairarapa DHB is expected to be of the order of $220k in 2019/20.
6 ARBOR HOUSE CLOSURE
Arbor House is a 25 bed Aged Residential Care facility managed by a local community based trust. Arbor House Trust has notified the DHB that it will close on the 20 October 2019. The main service provided by Arbor House is long term age residential care and currently houses 19 long term residents. FOCUS are working closely with residents, their families and the facility to ensure the residents are placed in the most suitable accommodation for their needs. There are sufficient beds in the Wairarapa to accommodate all Arbor House residents.
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BOARD INFORMATION PAPER
Date: October 2019
Author Dale Oliff, Chief Executive Officer
Subject “5” DHB Equity Priorities
RECOMMENDATION It is recommended that the Board:
a. NOTES this paper and discusses as appropriate
b. RECEIVES the verbal update from the Executive Leadership Team as appropriate
APPENDICES:
1. Adult Māori Oral Health Project
1. PURPOSE
The purpose of this report is to provide the Wairarapa DHB Board with a verbal update from the Executive Leadership Team (ELT) in regards to the progress on the Equity Priorities from our 2019/20 Annual Plan.
2. BACKGROUND
Equity in Māori health is an issue and is a priority for the Wairarapa District Health Board. This is an area of much activity and targeted funding, yet we struggle to narrow the gap health outcomes. This year we shall focus on five specific measures. If achieved will, these will demonstrably improve Māori health status. Areas identified to be targeted at this stage are: ∑ First 1,000 days - establishing a kaupapa Māori labour, birth and parenting programme ∑ Improving diabetes management for Māori ∑ Māori youth mental health – establishing a kaupapa Māori youth mental health service ∑ Reducing respiratory conditions for Māori children aged 0-4 ∑ Oral health - targeting adult Māori with dentistry needs, delivered by the NZ Defence Force and local dentists To accelerate progress on the five initiatives, additional investment is planned. Meanwhile activities where improvement has not been achieved will be reduced or stopped.
3. RECOMMENDATION
It is recommended that the Board notes this paper as read and receives the verbal update from the Executive Team.
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Wairarapa DHB: Dashboard Report - September 2019
HEALTH TARGETS
Hospital 87% 89.6% 116.5% 100.0% 91% Primary 92% 100% Maternity 100%
Hospitals Actual % Primary Care Actual % Maternity Actual % Actual % Target 95% YTD Actual No. YTD Target No. Actual % Target 95% 96.0% Actual % Target 90% No. of patients submitted Actual % Target 95% 3,000 100% Hospitals Target Primary & Maternity Target 100% 100% 105% 94.0% 2,500 10 80% 95% 92.0% 2,000 8 90% 100% 60% 1,500 6 80% 90.0% 90% 95% 1,000 40% 4 88.0% 70% 500 20% 2 85% 90% 86.0% 60%
- 0% 0 80%
Jul
Jan Jun
Oct 85%
Apr
Sep Feb
Dec
Aug
Nov
Mar
May
Jul
Jul
Jan
Jun Jul
Oct
Jan
Apr
Sep Feb Jun
Oct
Dec
Apr
Aug
Feb Sep
Jan
Nov
Dec
Jun Mar
Aug 50%
Oct
Nov
Apr
Sep Feb
May
Mar
Dec
Jul
Aug
May
Nov
Mar
May
Jan
Jun
Oct
Apr
Sep Feb
Dec
Aug
Nov
Mar
May
Jul Jul
Oct Apr
Jan Jun
Mar
Aug Sep Nov Dec Aug Sep May KEY INDICATORS
ED Presentations Ambulatory Sensitive Hospitalisations (ASH) (per 100,000 population) - Caseweight Theatre Utilisation Total Triage (4 & 5) Average Length of Stay (ALOS) 00 - 04 Age Group Acute Actual Planned Actual 1,750 12500 Elective & Arranged Acute Acute Target Planned Target Theatre Utilisation Target Theatre 3 Utilisation 5.00 6,000 100% 4.00 1,250 80% 7500 4,000 3.00 60% 2.00 750 2,000 40% 2500 1.00 20% Year to Year to Year to Year to Year to 250 - - 0%
30/06/15 30/06/16 30/06/17 30/06/18 30/06/19
Jul Jul
Jul Jul
Jan
Oct
Apr
Jul
Sep Feb Sep
Jan
Dec
Jul Jul
Aug Aug
Oct
Nov
Apr
Sep Feb Sep
Mar
Dec
Jan
Aug Aug
May
Nov
Jan
Oct
Apr
June Mar
Sep Feb
Oct
Dec
Apr
May
Sep Feb Sep
Aug
Nov Dec
June
Aug Aug
Mar
Nov
Mar
May June
Wairarapa Other Wairarapa Maori May June Wairarapa Total National Total 18-19 19-20 18-19 19-20 19-20 18-19 19-20 NUMBER LONG WAIT PATIENTS ( >4 Months) PROCESS & EFFICIENCY FINANCIAL RESULT
YTD Actual First Specialist Assessment - ESPI 2 Treatment- ESPI 5 vs Variance Surplus/(Deficit) - MTD ($000) Variance Surplus/(Deficit) - YTD ($000) 400 100 Target Mnth YTD Target 400 350 300 Elective/Arranged Day Surgery rate 62% 65.0% 57.8% 300 200 50 300 Ward Bed Utilisation - MSW 85% 95.6% 97.4% 250 100 200 Caesarean Rate (Elective & Acute) 25% 44.4% 34.5% 200 - 100 - Acute Readmission Rate 8% 5.8% 6.3% 150 Theatre Sessions Starting on Time 90% 100.0% 99.8% - 100
Theatre Session Utilisation (Time in Theatre) Jun-19
Jun-18 85%
Oct-18
Apr-18 Apr-19 Jun-18
Jun-19 68.2% 65.8%
Feb-19
Oct-18
Dec-18
Apr-18 Apr-19
Aug-19 Feb-19 Aug-18
Dec-18 Aug-18 Aug-19 (100) 50 Cancellation on Day of Surgery (excludes Endocopy) 5% 4.6% 5.1%
Total patients > 4 mths Total patients > 4 mths Did Not Attend (DNA) Rate - FSA 8.0% 7.1% 6.7% (200) -
Jul Jul
Jan Jan
Jun Jun
Oct Oct Apr
Did Not Attend (DNA) Rate - FUP Apr
Sep Feb
Sep Feb Dec
8.0% Dec Aug
5.6% 6.1% Aug
Nov
Nov
Mar
Mar
May May DIAGNOSTIC WAIT TIMES Did Not Attend (DNA) Rate - Maori all 8.0% 15.1% 14.9% YTD ($000) = Meets Target = Exceeds Target = Does Not Meet Target MTD ($000) Actual vs Actual vs Budget Diagnostics Target Actual Actual Budget Variance Budget Actual Budget Variance Did Not Attend (DNA) Appointments - FSA MRI Wait List seen in 42 days 90.0% 66.7% MSW Ward Bed Utilisation Result FSA Target FSA (212) (333) 121 (1,467) (1,753) 286 10.0% Result Target Ultrasound Waitlist seen in 42 days 85.0% 59.1% CT Waitlist seen in 42 days 95.0% 97.1% PROVIDER MTD ($000) PROVIDER YTD ($000) Actual vs 90% Actual vs 5.0% Budget Urgent Colonoscopy - Wait or Procedure within 14 Days 90.0% 100.0% Actual Budget Variance Budget Actual Budget Variance Non-Urgent Colonoscopy - Wait or Procedure within 42 Days 70.0% 92.9% (105) (192) 88 (724) (987) 263 Surveillance Colonoscopy - Wait or Procedure within 84 Days 70.0% 65.6% 0.0% 40% PROVIDER - Variance Surplus/(Deficit) - MTD ($000) PROVIDER - Variance Surplus/(Deficit) - YTD Urgent Colonoscopy Non-Urgent Colonoscopy ($000) 300 Result Target 90% Result Target 70% C-Section Rate Acute Readmissions 300 100% 100% Result Target Result Target 200 250 50% 10.0% 40% 100 200 50% 50% 30% 150 5.0% - 20% 100 10% (100) 50 0% 0% 0% 0.0%
(200) -
Jul
Jul
Jan
Jun
Oct
Apr
Sep Feb
Jan
Jun Dec
Aug
Oct
Apr
Nov
Sep Feb
Mar
Dec
Aug
May
Nov
Mar May
63 2019 10 21 Wairarapa Board Meeting PUBLIC - Information
QUALITY MEASURES
Patient Falls SAC 1 - 2 (from July-19) Medication Errors SAC 1 - 3 Compliments Complaints Hospital Acquired Pressure Areas 25 20 6 8 8 20 15 4 4 4 15 10 2 10 0 0 0 5 5
-4 -4 0 0 -2
Feb-17 Feb-18 Feb-19
Aug-18 Aug-19 Aug-17
Nov-16 Nov-17 Nov-18
Feb-17 Feb-18 Feb-19 Feb-17 Feb-18 Feb-19 Feb-17 Feb-18 Feb-19
May-17 May-18 May-19
Aug-17 Aug-18 Aug-19 Aug-17 Aug-18 Aug-19 Aug-18 Aug-19 Aug-17
Nov-16 Nov-17 Nov-18 Nov-16 Nov-17 Nov-18 Nov-17 Nov-18 Nov-16
Feb-17 Feb-18 Feb-19
Aug-17 Aug-18 Aug-19
May-17 May-18 May-19 May-17 May-18 May-19 May-17 May-19 May-18
Nov-16 Nov-17 Nov-18
May-17 May-18 May-19
STAFF INTER DISTRICT FLOWS
YTD FTE Actual Budget Var IDF Outflow - CWD IDF Inflow - CWD Staff Turnover Actual Budget Medical 44.2 46.7 2.5 5,000 Actual Budget Actual % Target 13% 400 Nursing 254.9 250.8 - 4.1 20% 4,000 300 3,000 Allied 73.3 75.3 2.0 15% 2,000 200 Support 15.3 16.1 0.8 10% 1,000 100 Mgmt/Admin 107.6 116.3 8.7 0 5% 0
Total 495.4 505.2 9.8
Jul
Jan
Jun
Oct
Apr
Sep Feb
Dec
Aug
Nov Mar 0% May
Appraisals Last 12m 47% Jul-19
Jul-18 NOTES - SEPTEMBER 2019
Jan-19
Jun-18 Jun-19
Oct-18
Apr-18 Apr-19
Sep-18 Feb-19 Sep-19
Dec-18
Aug-18 Aug-19
Nov-18
Mar-19
May-19 May-18 Theatre utilisation data review has been complete resulting in small improvements to what has been % Sick Leave reported previously. Some quarterly measures are not as yet available. From July-18 the definitions Actual Target 2.5% No. of Staff with >24 Months Annual Leave 6% for Hospital Acquired Pressureas Areas and Patient Falls have been redefined. ESPI5, Faster Cancer 67 and Electives are impacted by timing of data submission. 5% 62 63 63 60 61 59 61 61 56 56 56 57 57 4% 55 53 53 55 3% 2% 1%
0%
Jul-18 Jul-19
Jul-18 Jul-19
Jan-19
Jun-18 Jun-19
Jan-19
Oct-18
Apr-18 Apr-19
Jun-18 Jun-19
Sep-18 Sep-19 Feb-19
Oct-18
Dec-18
Apr-18 Apr-19
Feb-19 Aug-18 Aug-19 Sep-18 Sep-19
Nov-18
Dec-18
Aug-18 Aug-19
Mar-19
Nov-18
Mar-19
May-18 May-19
May-18 May-19
64 2019 10 21 Wairarapa Board Meeting PUBLIC - Other
BOARD DECISION PAPER
Date: October 2019
Author Leanne Southey, Wairarapa District Health Deputy Board Chair
Subject Resolution to Exclude the Public RECOMMENDATION It is recommended that the Board a. AGREES that Public be excluded from the following parts of the of the Meeting of the Board in accordance with the NZ Public Health and Disability Act 2000 (“the Act”) where the Board is considering subject matter in the following table. b. NOTES The grounds for the resolution is the Board, relying on Clause 32(a) of Schedule 3 of the Act believes the public conduct of the meeting would be likely to result in the disclosure of information for which good reason exists under the Official Information Act 1982 (OIA) to withhold, in particular:
SUBJECT REASON REFERENCE Public Excluded Minutes For the reasons set out in the 29th July Board agendas Information contained in the paper may be subject to change Section as the information has not yet been reviewed by the FRAC Chief Executive’s report 9(2)(f)(iv) Paper contains information and advice that is likely to Section 9(2)(j) prejudice or disadvantage negotiations Would restrict the DHB from carrying out commercial Seismic Remediation Section 9(2)(i) activities Paper contains information and advice that is likely to Wairarapa DHB Annual Section 9(2)(j) Report 2018/19 – Final prejudice or disadvantage negotiations Draft (V2) for approval (subject to audit sign off) Protect the privacy of natural persons MHAIDs 3DHB August Section 9(2)(a) Update Commercially sensitive information Update on 2018/19 Section 9(2)(i) Financial Result Would be likely to prejudice the supply of similar information, Interim Audit of Wairarapa Section 9 (ba)(i) DHB for year ended 30th or information from the same source, and it is in the public June 2019 interest that such information should continue to be supplied Would be likely to prejudice the supply of similar information, WrDHB Quality, Risk and Section 9 (ba)(i) Innovation By Exception or information from the same source, and it is in the public Report interest that such information should continue to be supplied FRAC minutes September Papers contain information and advice that is likely to Section 9(2)(j) prejudice or disadvantage negotiations and are unsigned Correspondence Commercially sensitive information Section9(2)(i)
Wairarapa District Health Board Page 1 of 1
65 2019 10 21 Wairarapa Board Meeting PUBLIC - Appendices
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67 2019 10 21 Wairarapa Board Meeting PUBLIC - Appendices
Wairarapa DHB Planned Care Performance for August 19
5 6 7 8 9 10 11 12 13 14 15 16 Planned volumeActual volume Planned caseweightsActual caseweights Planned Care Interventions ▼ 116.5% Planned Care Interventions / Acute Readmission AR ▼ TBC Patient Experience Surveys Period: May 2019
Response 2019 2020 Interventions Caseweights Inpatient Experience Survey questions: (% Yes, completely / Yes, always) Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Plan Actual % Plan Actual % Aug 18 Nov 18 Feb 19 May 19 Planned 237 550 844 1,142 1,449 1,673 1,915 2,143 2,444 2,669 2,976 3,232 Non Surgical PUC with Surgical DRG No Plan 11 No Plan No Plan 21.6 No Plan Before the operation did staff explain the risks and benefits in a way you could understand? 96.6 85.3 84.8 87.0 Actual 338 641 Surgical PUC No Plan 370 No Plan No Plan 518.0 No Plan Did staff tell you how the operation went in a way you could understand? 89.3 74.3 71.9 82.6 Variance 101 91 Inpatient Surgical Discharges No Plan 381 No Plan No Plan 539.6 No Plan Did hospital staff include your family/whānau or someone close to you in discussions about your care? 65.4 60.8 61.8 64.0 %Achievement 143% 117%
3,500 Inpatient Minor Procedures No Plan 18 No Plan Response (% , May 2019) Primary Care Patient Experience Survey questions: Outpatient Minor Procedures Hospital No Plan 242 No Plan < 1 week 1-4 weeks 1-3 months > 3 months 3,000 Outpatient Minor Procedures Community No Plan 0 No Plan 1. How long did you wait to see the specialist doctor? 40.8 38.3 8.3 12.5 Response 2,500 Minor Procedures No Plan 260 No Plan (% Yes, always) 2,000 2. When you received care or treatment from specialist doctors, did they do the following: Aug 18 Nov 18 Feb 19 May 19
1,500 Non Surgical Interventions No Plan 0 No Plan a) Ask what is important to you? 46.9 44.4 55.9 52.2 Total No Plan 641 No Plan b) Tell you about treatment choices in ways you could understand? 69.8 78.8 74.0 71.4 1,000 c) Involve you in decisions about your care or treatment as much as you wanted to be? 67.4 70.7 70.9 71.4 500
Acute Readmission Measure (0 - Standardized Acute Number of Agreed AR 3. Does your GP/nurse seem informed about the care you get from specialist doctors? 68.9 69.0 67.3 66.0 Access, Quality, Experience 0 28 days) Readmission Rate Readmissions Target Rate Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Year to Mar 2019 10.2% 819 TBC For more information regarding the patient experience surveys please contact your DHB’s System Level Measure Non Surgical Intervention Minor Procedures Inpatient Surgical Discharges Planned 2019/20 Year to Mar 2018 11.8% 1,035 (SLM) team or visit your DHB’s patient experience survey reporting portals.
Colume look up MonthLookupESPI colum Look Traffic uplookup Light MonthLookupESPI colum Look Traffic uplookup Light ESPI Results 22 Consecutive Months Red FCT (31 Day) 83.3% ESPI 2 - by Service 2 Non Compliant Services ESPI 5 by Service 4 Non Compliant Services #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! Consecutiv # #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! 2 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! e months 3 month 2019 2019 3 mth 2019 3 mth red ESPI to trend Imp Req Imp Req Jan Feb Mar Apr May Jun Jul Aug Aug 19 Jan Feb Mar Apr May Jun Jul Aug Trend Jan Feb Mar Apr May Jun Jul Aug Trend ESPI 1 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Ophthalmology 55.3% 58.4% 64.7% 65.0% 58.9% 43.5% 32.7% 20.0% 39 ▼ R Orthopaedics 16.4% 30.7% 28.7% 22.8% 16.7% 19.1% 23.7% 29.2% 57 ▲ 0 ▬ 0 Imp. Req. 0 0 0 0 0 0 0 0 Ear, Nose & Throat 16.4% 20.1% 28.7% 17.0% 1.1% 0.0% 10.3% 12.6% 14 ▲ R Urology 8.0% 12.5% 13.8% 13.8% 29.6% 12.0% 16.7% 23.8% 5 ▲ ESPI 2 30.0% 29.7% 34.3% 31.3% 24.4% 15.3% 10.5% 5.8% Gynaecology 4.4% 4.8% 4.8% 11.1% 14.9% 25.9% 15.4% 16.7% 8 ▼ 15 ▼ # Imp. Req. 254 264 308 246 194 103 87 53 General Surgery 23.8% 30.8% 31.0% 28.6% 28.7% 21.9% 26.2% 13.9% 10 ▼ ESPI 3 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 ▬ 0 Imp. Req. 0 0 0 0 0 0 0 0 ESPI 5 14.2% 21.0% 20.5% 18.9% 17.3% 16.3% 16.4% 17.1% 22 ▲ # Imp. Req. 53 81 80 76 77 77 79 80 ESPI 8 100.0% 100.0% 100.0% 100.0% 100.0% 99.4% 100.0% 100.0% 0 ▲ 0
Imp. Req. 0 0 0 0 0 1 0 0 Access, Timeliness Faster Cancer 2019 3 month Treatment Jan Feb Mar Apr May Jun Jul Aug trend FCT % 95.2% 93.3% 100.0% 91.7% 94.7% 87.5% 90.5% 83.3% ▼ Imp. Req. 20 14 20 22 18 21 19 15
5 Ophthalmology ESPI 24 Colour5 6 7 8 9 10 11 12 13 14 15 18 18 18 18 18 18 19 19 19 19 19 19 19 95 106 117 128 19 102 113 124 135 146 157 168 Ophthalmology ESPI 595 Colour106 117 128 19 102 113 124 135 146 157 168 4 Jul8 Aug13 Nov17 Jan21 Mar26 May30 340 390 430 480 520 0 Diagnostics Performance CT 98.3% MRI 64.0% Angiography Ophthalmology Waiting Times ESPI 2 20.0% ESPI 5 0.0% FUA (50%) 0.0% Cardiac Surgery Delivery 59.7% Waiting over Timeframe 9 Cardiac Provider: Capital and Coast DHB 2018 2019 2018 2019 2019 2020 Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
CT 97.8% 96.4% 100.0% 98.8% 98.0% 97.0% 98.9% 97.2% 96.8% 97.9% 96.9% 98.3% ESPI 2 43.6% 31.1% 39.9% 40.6% 55.3% 58.4% 64.7% 65.0% 58.9% 43.5% 32.7% 20.0%
28Jul 25Aug 29Sep 27Oct 24Nov 29Dec 26Jan 23Feb 29Mar 31May 28Jun Ophthalmology ESPI 2 % 26Apr MRI 57.5% 48.9% 62.7% 46.7% 35.3% 53.4% 53.7% 52.4% 55.3% 49.0% 51.7% 64.0% OphthalmologyESPI 5 ESPI 5 %4.3% 11.0% 6.4% 0.0% 1.8% 1.8% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 Delivery 47.1% 59.7% # Overdue Followups 0 0 0 0 0 0 0 0 0 0 0 0 Waiting list 66 63 50% Overdue ND ND ND ND ND 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 Max Waiting 77 77 100.0% 0 100% Overdue ND ND ND ND ND 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% OverTimeframe 21 9
80.0% 0 90 70% 70.0% 80 60% 60.0% 60.0% 70 50% 50.0% 60
Timeliness 40.0% 40.0% 50 40% 40 30% 20.0% 30.0% Delivery
Waiting list Waiting 30 20% 20.0% 20 0.0% 10.0% 10 10% Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug 0.0% 0 0% 2018 2019 Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug 28 Jul 25 Aug 29 Sep 27 Oct 24 Nov 29 Dec 26 Jan 23 Feb 29 Mar 26 Apr 31 May 28 Jun 2018 2019 2019 2020 CT MRI Angiography CT and Angiography Indicator (95%) MRI Indicator (90%) ESPI 2 ESPI 5 50% Over Due 100% Over Due Waiting list Outside timeframe Max Waiting Delivery
Report to: Aug 19 No Plan: Is displayed as some DHBs have yet to agree the 2019/20 Planned Care Funding Schedule. Data Extracted on: 07/10/19
68 2019 10 21 Wairarapa Board Meeting PUBLIC - Appendices
Definitions & Information
Planned Care Interventions Planned Care Interventions / Acute Readmission Patient Experience Surveys
Data Source - Planned Care Interventions Data Source Data Source
This data is sourced from the DHB monthly Planned Care Interventions (PCI) report summary page. This table and This data is sourced from the DHB monthly PCI report and YTD performance against plan for the Planned Care These data are sourced from the Health Quality and Safety Commission’s (the Commission) quarterly national graph shows monthly YTD delivery against the planned YTD delivery. Intervention Groups, YTD Caseweight Summary for Inpatient Surgical Discharges adult inpatient and primary care patient experience surveys. Selected questions from both surveys have been What do the colours mean? What do the colours mean? chosen to recognise the Experience and Equity principles within the Planned Care Programme. A rolling four quarters of data are displayed. The colour code below determines whether the performance meets expectations (green) or does not (red). This is The colour code below determines whether the performance meets expectations (green) or does not (red). This the same as in the Planned Care Interventions reports. is the same as in the Planned Care Interventions reports. For the wait time to see a specialist question, the percent of respondents who selected each response option in Green Greater than or equal to 100% ▬, ▲, Green Greater than or equal to 100% ▬, ▲, the latest quarter is provided. For all other questions, the percentage displayed is the percentage providing the Change from previous month Change from previous month Red Less than 100% or ▼ Red Less than 100% or ▼ most positive response to the question. What other information is available regarding the patient experience surveys? Data Source - Acute Readmissions For more information regarding the patient experience surveys please contact your DHB's System Level This data is sourced from the quarterly Acute Readmission (AR) reporting. The figures are the most recent Measure (SLM) team; visit your DHB's patient experience survey reporting portals; or visit the Commission’s quarter's Standardised Acute Readmission rate and number of Observed Readmissions for the 0-28 days website measure, and the same numbers for the same period 12 months ago. (https://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/patient-experience) What do the colours mean? In the top right hand corner of this box next to the title is the % result for the latest period, the colour code below Access, Quality, Experience determines whether the performance meets expectations (green) or does not (red).
Green Less than or equal to planned AR rate ▬, ▲, Change from previous period's standardised Red Greater than planned AR rate or ▼ rate
ESPI - DHB Level / FCT (31 Day) ESPI 2 - by Service ESPI 5 by Service
Data Source - Elective Services Patient Flow Indicator (ESPIs) Data Source Data Source This data is sourced from the DHB Final ESPI Reports. Also included is the Total number of consecutive months of Red ESPI performance, and a 3 month trend of ESPI performance for each ESPI. This data is sourced from the DHB monthly Final ESPI Reports, including the Improvement Required, and a 3 This data is sourced from the DHB monthly Final ESPI Reports, including the Improvement Required, and a 3 month trend arrow. The ESPI result in this report is for an 8 month period, and only services which are currently month trend arrow. The ESPI result in this report is for an 8 month period, and only services which are currently What do the colours mean in the title bar? non compliant, or have been non compliant at least once in the last 4 months will appear on this report. non compliant, or have been non compliant at least once in the last 4 months will appear on this report. In the top right hand corner of this box next to the title is the period of Red level ESPIs non compliance. Green All ESPI Results at a DHB Level are either Green or Yellow What do the colours mean in the title bar? What do the colours mean in the title bar? Orange The first month of the DHB having a Red ESPI at a DHB Level In the top right hand corner of this box next to the title is the number of non compliant services for ESPI2 for the In the top right hand corner of this box next to the title is the number of non compliant services for ESPI5 for the Red The DHB has had 2 or more consecutive months with a Red ESPI at a DHB Level current month. current month. What do the colours mean in the table? Green All services are compliant Green All services are compliant The colours show whether a DHB is compliant (green) or non compliant (yellow and red) for each ESPI. Orange Equal to or less than 3 services non compliant Orange Equal to or less than 3 services non compliant Data Source - Faster Cancer Treatment (FCT) 31 Day Indicator Red Greater than 3 services are non compliant Red Greater than 3 services are non compliant
This data is sourced from the DHB Faster Cancer Treatment (FCT) Reporting Database. This measure indicates whether 85% of What do the colours mean in the table? What do the colours mean in the table?
patients receive their first cancer treatment (or other management) within 31 days from date of decision-to-treat. Please note that The colours for each cell show whether a DHB is compliant (green) or non compliant (yellow or red) for each The colours for each cell show whether a DHB is compliant (green) or non compliant (yellow or red) for each Access, Timeliness the FCT data may vary from the SS01 Quarterly Reporting measure due to the date of extraction. service. A warning light (box will turn orange) for the 3 Month Trend arrow when a service if the three month service. A warning light (box will turn orange) for the 3 Month Trend arrow when a service if the three month What do the colours mean in the title bar? trend is worsening. trend is worsening. Green DHB met 85% Indicator for the latest month. Red DHB not met 85% Indicator for the latest month. From July 2012 onwards Prior to July 2013 the definition of ESPI 2 is the number of patients waiting From July 2012 onwards Prior to July 2013 the definition of ESPI 5 is the number of patients waiting What do the colours mean in the table? Green = 0% over 6 months for FSA. Between July 2013 and December 2014 the Green = 0 % over 6 months for Treatment. Between July 2013 and December 2014 the definition of ESPI 2 is the number of patients waiting over 5 months for FSA, definition of ESPI 5 is the number of patients waiting over 5 months for Green DHB met 85% Indicator for the month. Red DHB not met 85% Indicator for the month. Yellow > 0% but < 0.4% and from January 2015 the definition of ESPI 2 is the number of patients Yellow > 0% but < 1% Treatment, and from January 2015 ESPI 5 is the number of patients waiting Red > = 0.4% waiting over 4 months for FSA. Red > = 1% over 4 months for Treatment.
Diagnostics Performance Ophthalmology Waiting Times Cardiac Surgery
Data Source Data Source Data Source This data is sourced for FSA and Treatment waiting times from the monthly DHB ESPI reporting, and the follow This data is sourced from the weekly reporting supplied from each of the five DHB cardiac units (Auckland, The data is sourced from the monthly Diagnotics Reporting, the table and graph show the DHB % for a 12 month up information is sourced from the collection used through the Ophthalmology service improvement Waikato, Capital & Coast, Canterbury, and Southern). trend for CT, MRI and Angiography against the respective national indicator percentage expectations. programme. What does the coloured cells mean in the title bar and in the table? What does the coloured traffic light mean? In the top right hand corner of this box next to the title is the regional provider % delivery for the latest week and What does the coloured cells mean in the title bar and in the table? the national number of patients waiting greater than the 90 day expectation for surgery. This is also shown in the In the top right hand corner of this box next to the title is the DHB % result for the latest month for waiting time table below with the % every four weeks, the colour code below determines whether the performance meets In the top right hand corner of this box next to the title is the DHB % result for the latest month for CT, MRI and results for Ophthalmology for ESPI 2, ESPI 5 and % of patients waiting longer than 50% overdue for their follow expectations (green) or does not (red). Angiography. This is also shown in the table below with the % by month for the 12 month period, the colour code up appointment or treatment. This is also shown in the table below with the % for a 12 month period, the colour below determines whether the performance meets expectations (green) or does not (red). This is the same as in code below determines whether the performance meets expectations (green) or does not (red). This is the The graph shows the total waiting list, the number on the waiting list for greater than the expected timeframe, the the Diagnostics reporting. same as in the ESPI reports for ESPI 2 and ESPI 5. maximum acceptable waitlist and the delivery.
CT MRI Angiography ESPI 2 ESPI 5 Follow up (50% and 100%) Timeliness
Greater than or equal Greater than or Greater than or equal Green = 0% Green = 0 % Green = 0 % Green Green Green to 95% equal to 90% to 95% Yellow > 0% but < 0.4% Yellow > 0% but < 1% Red > 0% Red Less than 95% Red Less than 90% Red Less than 95% Red > = 0.4% Red > = 1% NOTES: % delivery Waiting over timeframe The measure is a DHB of service measure, where NA is present this means the DHB is not the provider for Green 100% Green 0 patients NA the service and other DHB provides this service. Red Less than 100% Red Greater than 0 ND This indicates that no data is currently available, as the DHB has been unable to supply this.
69 2019 10 21 Wairarapa Board Meeting PUBLIC - Appendices
Surveillance Colonoscopy
Result Target
120.0%
100.0%
80.0%
60.0%
40.0%
20.0%
0.0% 9 8 7 6 9 9 9 9 8 8 8 8 8 7 7 7 7 7 6 6 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ------l l l l r r r y v y v y v p n p n p n p u u u u a a a a a a o o o a a a e e e e J J J J J J J S S S S N N N M M M M M M
70 2019 10 21 Wairarapa Board Meeting PUBLIC - Appendices
Planned Care Strategic Approach 2019 – 2024
Document Name: Planned Care Strategic Approach 2019 – 2024 Version: FINAL Date: May 2019 Author: Electives and National Services Team, Ministry of Health
71 2019 10 21 Wairarapa Board Meeting PUBLIC - Appendices
Minister’s Foreword
New Zealanders generally enjoy good health and experience a high performing health system. We have comprehensive, publicly funded access to a large range of quality health services. However, worldwide the demand for health services is increasing as populations grow and age. Advances in digital technologies are rapidly evolving and driving innovations across the health sector. People expect to be more informed and involved in their own care while having timely access to contemporary models of care.
There are also some examples of variation in access to services and health outcomes that should be addressed. For example, we know that Māori and Pacific people have poorer health outcomes for many conditions and on average live shorter lives than other New Zealanders.
Now more than ever it is critical we focus on improving health outcomes for all New Zealanders and support people to remain well. Maintaining the status quo will not achieve this. We need to provide healthcare services which are high quality and responsive to the community’s needs. While continuing to invest in hospital care is important, this cannot be done separate to, or even at the expense of, earlier interventions. This approach does not provide the best experience for people and it is not fiscally sustainable. The term Planned Care is new, and reflects a new direction for publicly-funded healthcare in New Zealand. Planned Care is about providing services based on clinical need and service user preferences to achieve better health outcomes, within the publicly-funded resources available. The intent of Planned Care is to consider medical and surgical activity, traditionally known as Elective or Arranged services, in a way that is not limited to hospital settings or groups of health professionals. Rather than supporting just hospital-based care, Planned Care refers to care provided in the most appropriate setting, by the most appropriate person, based on the needs of individuals accessing services. The way healthcare is arranged and delivered is important to people and influences health outcomes. Implementation of Planned Care provides a platform for improving the way healthcare resources are designed for and used by people. It will enhance the way the multidisciplinary care team works to improve care and health outcomes. I am pleased to endorse this Planned Care Strategic Approach, which represents an important change for our public health and hospital system. The Strategic Approach demonstrates a shift in thinking away from the notion that Planned Care is primarily the role of hospitals. It recognises that truly addressing inequities in access to services and outcomes will require service users’ needs and preferences to be at the centre of the care pathway. There needs to be commitment across every area and level of the sector to better understand the causes of inequities. Once identified, actions need to be prioritised to address these.
Realising the vision for Planned Care will require commitment and collaboration from general practice and other primary care providers, Primary Health Organisations, District Health Boards (DHBs), the Ministry of Health and the people who use health services.
I look forward to our health services embracing the principles of this new approach. By working together we can take the next step forward in improving the equity, access, quality, timeliness and experience of our Planned Care services.
2
72 2019 10 21 Wairarapa Board Meeting PUBLIC - Appendices
Contents
Minister’s Foreword ...... 2 Why do we need a new approach? ...... 4 What is Planned Care? ...... 6 Strategic Vision, Priorities and Principles ...... 7 Planned Care Principles ...... 9 Planned Care Strategic Framework ...... 10 Strategic Priority 1: Understanding Planned Care need ...... 11 Strategic Priority 2: Balancing national consistency and local needs ...... 13 Strategic Priority 3: Simplifying pathways for service users ...... 14 Strategic Priority 4: Optimising sector capability and capacity ...... 16 Strategic Priority 5: Fit for the future ...... 18 Related strategies and work areas ...... 20
3
73 2019 10 21 Wairarapa Board Meeting PUBLIC - Appendices
Why do we need a new approach? Since the introduction of the Reduced Waiting Times Strategy in 2000, we have seen services perform in line with the Strategy’s principles of clarity, timeliness and fairness. After many years of consistent focus and investment, there have been significant increases in the number of first specialist assessments and procedures delivered as well as reductions in waiting times. This has been enabled by hospitals’ use of prioritisation and urgency tools so that people who have the greatest clinical needs and potential to benefit get their care first. The challenges facing us have evolved and changed since the Reduced Waiting Times Strategy was introduced. An ageing, more co-morbid population, increasing public expectations and funding/ capacity constraints are some of the drivers placing increased pressure on Planned Care services. It’s time to build on the improvements delivered in the past decades and mature our view of Planned Care. This means reassessing what we mean and expect when it comes to fairness, equity, and timelines, and broadening our focus to include service quality and service users’ experience. Some of the key challenges and opportunities facing us in 2019 include: Understanding and responding to service users’ needs The Office of the Auditor-General has published reviews of the progress made against the Reduced Waiting Times Strategy in 2011 and 2013. The reviews acknowledged significant improvements in many areas but also identified the need to better understand who is not able to access care.
After a period of increasing delivery, we need to broaden our focus to identify and address inequities by understanding which services are, and are not, being provided to people who need them.
Outcomes and experience for service users In our current policy environment, there is assurance about some aspects of peoples’ care but not others. There is good intelligence on how many services are delivered, but a less comprehensive view of service outcomes and service users experience along the way. Providers have a strong recent record of service delivery, but it is important to also consider what these services mean in terms of health outcomes, including how Planned Care allows people to return to work, whānau and community roles. Just as importantly, we need to understand service users’ experience of the quality of their care, including, for example, how healthcare providers have met the Code of Health and Disability Services Consumers’ Rights. Continuing to grow service delivery We cannot expect the rate of growth seen in the past decade to continue without making deliberate changes to the way we plan and use our resources. Using our finite resources to deliver the right mix of services is an evolving challenge. Health services face significant population growth, ageing and increasingly comorbid populations that are driving increased demand for both acute and planned services. Access to specialist interventions is important, as is access to diagnostics, follow-ups and integration to primary care. We know that the day-to-day pressures on DHBs to balance resources across their hospitals and clinics is increasing as facilities, equipment, funding and availability of workforce can all constrain service provision. It is critical we improve our planning and preparation for future demand and broaden our focus to include new ways of delivering services and supporting people to remain well. Maintaining a focus only on hospital delivered care is unlikely to achieve this.
New delivery models
The traditional approach to delivering Planned Care will not be the way that many people access care in the future. The management of long term conditions recognises that when people are 4
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informed, empowered and supported, they can undertake greater levels of self-management and potentially reduce the number of hospital attendances. The way in which specialist advice is provided is also changing. Options are being provided to enable general practice to access the advice they need without requiring the service user to attend a specialist appointment at the hospital. Within hospital services, new workforce models are developing that recognise expanded roles for nursing and allied health professionals to meet the needs of service users and contribute as part of the multi-disciplinary team.
In recent years, there has been a trend towards establishing sub-specialist service models, and recruiting sub-specialist workforce. While this is appropriate in certain areas, in others this has meant that generalist capability is being diminished, with less specialists available to provide flexible support to people across a range of the most common conditions and procedures that New Zealanders need. There is absolutely a role for sub-specialist care, but we need to be thoughtful about where, and by whom, these services are provided. Careful workforce planning is needed to make sure that training and recruitment activities are aligned to best meet the needs of our population, we need to think flexibility for what our population needs now but also what it might need in 10-20 years.
Planned Care services need to foster and develop service models that optimise the capability and capacity of the health workforce to respond to the rapidly increasing demand for services.
Flexible and sustainable systems and processes
Factors such as technology and service user preferences often change faster than funding and planning frameworks. Truly addressing inequities in health outcomes will require more flexibility and innovation than the current frameworks allow. We need to re-assess our planning, funding and performance frameworks to best support improvement and change. This means that we need to work toward providing services that better meet the needs and preferences of service users, rather than having systems of care built around particular funding streams or the availability of health professionals.
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What is Planned Care?
Planned Care encompasses medical and surgical activity traditionally known as Elective or Arranged services that are delivered by hospitals. It also includes a range of treatments that are funded by DHBs, but are delivered in primary or community settings1.
Planned Care generally begins from the point a person is referred from their primary care provider or another health professional for specialised care. Planned Care considers more than just hospital-based care and admissions, and covers all appointments and support that people need during their healthcare journeys.
Planned Care is about understanding a person’s situation and informing them about the options available so they can make informed decisions about the most appropriate care for their needs, provided by the health professional best suited to care for them.
Planned Care is not intended to replace the existing terms and concepts such as ‘acute’, ‘arranged’ and ‘elective’ admissions. These concepts will continue to exist. The intention of Planned Care is to take more deliberate steps toward considering these concepts collectively and in the context of quality of services, service users’ experience and equitable health outcomes.
Close links to primary care is important to Planned Care, as there is an opportunity to use community based facilities and the multi-disciplinary care team more effectively to support delivery of less complex procedures traditionally provided in a hospital setting.
Ultimately, Planned Care seeks to ensure people can access quality care appropriate to their needs and preferences provided in a timely and respectful way.
Planned Care is about providing a pathway of care based on the service user’s clinical needs to achieve better health outcomes, within the publicly-funded resources available. Delivering Planned Care will require close partnerships between the Ministry of Health, DHBs, Primary Health Organisations, general practice and other primary care providers, individuals and whānau, to adopt innovative and evidence-based approaches.
1 A defined set of these interventions can be found on the Planned Care section of the Ministry of Health website. 6
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Strategic Vision, Priorities and Principles
The purpose of this document is to articulate a whole of sector approach to deliver more sustainable Planned Care that focuses on a person’s needs and improves outcomes for them, their whānau and communities.
This is intended to be a leadership document, outlining at a high level what we are aiming to achieve for the population of New Zealand and the principles that will support this direction. Making steps towards the vision will be iterative and evolving. It will require open engagement between all parts of the system to understand how we might all contribute to creating change, developing and embedding service improvement initiatives, and creating an environment where changes in service delivery can be achieved. It is anticipated that implementation plans will be developed collaboratively and led between key partners in the system.
This approach focuses on strategies that are specific to Planned Care. This approach sits within a wider framework of health system improvement, noting that there are a number of other system initiatives that support overall health system performance, and which will impact on Planned Care. This includes Health Workforce, system capacity (including capital build programmes), health funding, and acute demand management. Vision
New Zealanders experience timely, appropriate access to quality Planned Care which achieves equitable health outcomes.
Principles:
Equity – You’ll get the healthcare that safely meets your needs, regardless of who you are or where you are. Access – You can access the care you need in the right place, with the right health provider. Quality - Services are appropriate, safe, effective, efficient, respectful and support improved health. Timeliness – You will receive care at the most appropriate time to support improved health and minimise ill-health, discomfort and distress. Experience – You and your whanau work in partnership with healthcare providers to make informed choices and get care that responds to your needs, rights and preferences.
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Strategic Priorities:
1. Understanding health need. Understand health need, both in terms of access to services and health preferences, with a focus on understanding inequities that we can change. 2. Balancing national consistency and local context. Ensuring consistently excellent care, regardless of where you are or where you are treated. 3. Simplifying pathways for service users. Providing a seamless health journey, with a focus on providing person-centred care in the most appropriate setting. 4. Optimising sector capacity and capability. Optimising capacity, reducing demand on hospital services and intervening at the most appropriate time. 5. Fit for the future. Planning and implementing system support for long term funding, performance and improvement.
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Planned Care Principles
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Planned Care Strategic Framework
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Strategic Priority 1: Understanding Planned Care need
Despite significant increases in the number of surgeries performed each year, we know that there are not enough resources to meet everybody’s needs right away. In addition to the need to deliver more Planned Care, the same physical capacity and workforce also has to deliver acute services.
New Zealand has unique and robust clinical prioritisation tools that guide the fair use of available resources, based on each individual’s clinical need and potential to benefit. On a larger scale, we also have a wealth of information to inform planning and funding of health services. Standardised Intervention Rates, acute attendances and admissions, waiting list and prioritisation data help us to understand which populations and services are needed based on existing activity within hospital services.
Future focus
To enable accurate planning and scheduling of Planned Care, providers first need to develop a detailed understanding and forecast of the likely acute demand for services. Robust production planning methodologies have been developed for the health system, but there is a need for more widespread adoption of these processes.
While we have good data and intelligence regarding who is treated in our public health system, there is significant opportunity for us to learn more about the people who are not able to access care, and the reasons for this.
Health inequities are recognised as remediable, unjustified inequalities. They are unjustified, as there is no reason that can explain why the inequity is necessary or unavoidable, and they are remedial, in that they are able to be improved. By this definition, it should be of the highest priority to actively identify and address health inequities. Within Planned care, inequities can be caused by differential access to health services or differences in the quality of care received.
Access to consistent and reliable data that provides an understanding of who is and isn’t accessing Planned Care will enable DHBs to identify mismatches between service availability and need, which will help them to target investment where it is most needed. On a regional and national level, use of high quality data will enable health planners and funders to identify inequities in access across a range of variables such as geography, ethnicity, socio-economic deprivation and gender to inform areas for targeted improvement.
Healthcare providers cannot respond to their population’s health needs, without also understanding the reality of their lifestyles and backgrounds. Addressing inequities in health outcomes will require a commitment to understanding factors that create inequitable or unfavourable experiences and outcomes. Additionally, a commitment will be required to respond to and remedy those factors so that the needs and rights of service users are met. In the future, the health system needs to give more thought as to why people may not access care. These may include practical constraints such as the affordability of care, access to transport and health literacy. Other reasons could include cultural considerations such as language barriers or belief systems different to the traditional medical model. Ultimately, all New Zealanders should have
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equitable access to Planned Care, regardless of who they are, where they are, who they are seen by or where they are seen.
Priority actions for health sector organisations
1.1 Establish nationally consistent approaches to better understand the needs of communities for Planned Care services. 1.2 Plan and deliver Planned Care services that acknowledge population growth, ageing, levels of health need and changes in models of care or models of service. 1.3 Identify health inequities and develop solutions to address these.
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Strategic Priority 2: Balancing national consistency and local needs
We know there are unique challenges for some populations to access the care or information they need based on where they live, their ethnicity, age, gender or other factors.
We are working proactively to ensure all service users receive a consistent level and quality of Planned Care. For example, DHBs set and monitor the level of access to surgeries offered to their populations. In relation to quality and outcomes, there are a number of clinical networks and registries that provide leadership to support safe, effective care nationally.
We also have organisations such as the Health and Disability Commissioner and the Health Quality and Safety Commission that play an important role in promoting and protecting service users’ rights, experience and safety.
Future focus
All people have the same rights. They should expect fair and equitable access to care, and the opportunity to make informed decisions about their care.
Ultimately, people with similar health needs should experience similar health outcomes. To achieve this might require tailored approaches, providing fair but different treatment of individuals.
While treating people close to home is an important goal, the future focus will be on the right professionals, treating people at the right time, in the right place according to service users’ needs and health preferences. This is because it is not sustainable or clinically appropriate to offer all services locally at all DHBs. However, pathways to care should be easily understood and consistent for all. Regional centres should work closely with smaller providers and rural facilities to support service users in a region, not just their local area.
With increasing need and pressure on our services, a clear evidence base is required for the decisions we make. People should expect to be informed about and make decisions about their care which is delivered consistently and respectfully, with unwarranted variation minimised. This means, that all people with similar needs, regardless of their treating clinician or hospital, should expect similar outcomes. However, models of care should enable appropriate local adaptation that acknowledges the differences in resources and the mix of workforce available in different areas.
We need to use technology optimally to drive consistent access and outcomes. Administrative systems, decision making tools and telemedicine all have the potential to improve care and outcomes nationally.
Priority actions for health sector organisations
2.1 Find the most appropriate balance between offering local access to new models of care, while ensuring person-centred, safe, effective, efficient and sustainable service models.
2.2 Develop nationally consistent measures to provide a more comprehensive view of the quality of Planned Care.
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Strategic Priority 3: Simplifying pathways for service users
Since the introduction of the Reduced Waiting Times Strategy in 2000, there has been an ongoing focus across the sector on ensuring clarity for service users throughout their care journey.
For example, our focus on waiting times stems from a commitment to ensure people have clear expectations around how long they should expect to wait to receive care once their referral is accepted.
There are already many examples of person-centred care and service development. The consideration of the impact on peoples’ lives when prioritising resources, such as person-led booking processes, health literacy resources and applications such as patient portals, are all great examples of how we plan services around peoples’ needs, rights and preferences.
However, the reality is that not all services offer service users reasonable choice and navigating our public health system is a challenge for many people. This is especially true for those with complex health conditions and co-morbidities who require multiple health professionals to be involved in their care.
Over time, funding and performance mechanisms can create unintended barriers or siloes that further complicate peoples’ journeys. The increasing specialisation of our health workforce makes it difficult for some health professionals to link their advice with the advice of others. Despite thousands of dedicated, expert professionals across the sector working to improve care, navigating the care continuum can be a confusing and isolating experience for many people.
Future focus
Service users, primary care providers, hospitals and funders are all partners in delivering improved health outcomes. We need to take every opportunity to engage with individuals and whānau to provide them with information to support deliberate, informed choices about every aspect of care. People bring critical knowledge, skills and experience to their care that needs to be central to the decisions they make and the plans they agree to. All providers and funders should embody the sentiment ‘nothing about me, without me’.
People should be treated with respect, and their dignity and independence maintained in all circumstances. They have the right to be fully informed by health professionals so they clearly understand their condition and the options available to them.
People must be in a position to make informed decisions, to contribute to their care plan and to understand what their health outcomes might be following care. This will require all health providers, individuals and whānau to ensure they’re communicating in a shared language, using meaningful vocabulary.
A stronger focus is needed on coordinating the multidisciplinary care team to enable people to be empowered to be partners in their care journey and better navigate the health system.
From the time someone is referred to secondary care for an appointment, through tests, surgery and follow ups, service users and health providers alike need to have a clear, shared view of the health journey. Understanding a journey is easier when it is as simple as possible, therefore, we should look for opportunities to streamline care by avoiding unnecessary tests and appointments and combining appointment visits wherever possible. 14
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The health needs of individuals, whānau and communities can be complex and multi-faceted. Services provided by health professionals can only be effective if people have access to the day-to- day supports needed to maintain good health such as healthy diets, warm, safe housing and affordable healthcare. We need health providers to collaborate with people and organisations in the community to ensure people are holistically supported to achieve better health outcomes.
Priority actions for health sector organisations
3.1 More consistently apply person-centred care, from the beginning to the end of a health journey.
3.2 Work with individuals, whānau, other agencies and community organisations to ensure people have the support and resources required to reach their health goals.
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Strategic Priority 4: Optimising sector capability and capacity
Across the sector, there is a wealth of expertise and data that supports health providers to predict and monitor service delivery. We know that more people are being treated than ever before, and that waiting times have improved significantly in the past decade. However, continuing to increase delivery and implement improvements is becoming increasingly challenging, as providers juggle capital, workforce, funding and other constraints alongside the growing health need.
The public health sector is already progressing innovative work to support the shift of care into more appropriate, less intensive settings. Every day, DHBs work hard to allocate resources and manage clinical risk across all groups of service users including specialist outpatient appointments, diagnostics, surgeries, follow ups, and acute and emergency work.
Future focus
There will be a need for ongoing investment in new physical hospital capacity, but Planned Care focuses on the need to find flexible, innovative ways to overcome capacity constraints. For example, some DHBs struggle to recruit and retain the full range of specialists their population needs. In an environment of increasing sub-specialisation, we need to ensure our workforce is operating effectively to make best use of all their skills and expertise. There is a need to consider the level of generalist capability and how best to match the capacity of our services with demand. We also need to encourage and enable referral pathways that recognise the skills of a multi-disciplinary team, so that the most appropriate health professionals see people the first time round to eliminate unnecessary appointments and wasting service users and clinician time.
For service users, navigating Planned Care can be confusing, time consuming and uncomfortable. Wherever possible, we should be working with people to ensure all appointments, tests and procedures are clinically necessary and agreed to.
We need to foster a culture of improvement, where information and technology are used to enable health professionals to work in new ways and use their full range of skills, and where planners and funders can invest in models of care that have benefits over the longer term.
Planned Care will support a system-wide and person-centred view of value and efficiency, including consideration of enabling services such as diagnostics. Across the sector, our service planning will acknowledge the competing demands for capacity across acute and Planned Care and resources will be allocated to effectively support flow through the system.
While the public system is significant and self-sufficient, the role of other funders and providers such as ACC and private hospitals impact service delivery, affordability and sustainability. Future planning needs to deliberately and proactively work with these stakeholders.
Priority actions for health sector organisations
4.1 Design and deliver care in the setting that provides safe, best value, person-centred care.
4.2 Work with relevant colleges and other organisations to optimise how we plan system capacity and how we train and use of our health workforce.
4.3 Ensure the appropriateness of services and reduce unwarranted variation in care. 16
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4.4 More deliberately and consistently spread health improvements and cost effective innovations across health organisations.
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Strategic Priority 5: Fit for the future
Healthcare organisations such as hospitals are large, complex organisations. As such, it can take time to shift focus and direction in response to external changes.
Our budgets, funding cycles and performance measures can sometimes be a barrier to reforming the way care is delivered. Detailed information on the availability of long term funding arrangements is rarely possible for government funded organisations. Faced with a high demand for current services, and without certainty of future budget allocations, it is challenging for healthcare organisations to invest in models of care that only provide benefits over the longer term.
Future focus
Planned Care is intended to support New Zealanders to access multi-disciplinary care via contemporary service models that span primary, community and hospital settings. People are supported with prevention and early intervention to stay well and reduce the need for hospital level services; surgery is not always the best option or only option. As a sector, we will continue to focus on preventive, whole sector solutions that transcend primary care settings and DHBs.
To deliver on this vision will require commitment and support to conduct longer-term planning and to have the flexibility to make investment decisions in the short term that will enable savings over time. In addition, funding and planning frameworks need to be sufficiently flexible to allow resources to be allocated and activity delivered in the most appropriate setting, in a way that promotes good flow and optimises health outcomes for service users.
There will be changes in how people access Planned Care, enabled by better use of technology and a move towards a ‘one system’ approach. People will be less likely to attend face to face appointments in hospitals as their relevant health information and updates to their plan of care are made more widely available across their clinical team. The divisions between primary, community and secondary care providers are already reducing and the move towards a more coordinated, interdependent system will continue.
We also need to partner with service users when designing and delivering our health services to ensure their needs, preferences and rights are met. This includes effective communication, providing information to support people to make informed decisions about their care, have clear expectations about their health outcomes and agreement of the time and supports required during their recovery. The focus on reducing health inequities must remain a priority for the system. There is likely to be an expansion in partnerships with community organisations and other agencies to address inequities in the determinants of health, as well as reducing variation in access to, and the quality of, healthcare. Over time, as models of care evolve, we will need to reassess what ‘good’ performance looks like, in terms of service delivery. Our view of performance needs to expand to consider delivery across healthcare settings. While measuring throughput and activity will always be important, we need to move toward developing performance frameworks that focus on a more comprehensive understanding of the quality of services and peoples’ health outcomes.
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Priority actions for health sector organisations
5.1 Health organisations and service users work in partnership to assess the performance of this strategic approach.
5.2 The Ministry will use these insights to evolve the Performance and Funding framework as part of the annual planning processes.
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Related strategies and work areas
’Ala Mo’ui: Pathways to Pacific Health and Wellbeing 2014–2018 https://www.health.govt.nz/publication/ala-moui-pathways-pacific-health-and-wellbeing-2014-2018
Equity of Health Care for Māori: A framework https://www.health.govt.nz/publication/equity-health-care-maori-framework
Health Ageing Strategy https://www.health.govt.nz/publication/healthy-ageing-strategy
He Korowai Oranga https://www.health.govt.nz/system/files/documents/publications/mhs-maori.pdf
New Zealand Health Strategy https://www.health.govt.nz/publication/new-zealand-health-strategy-2016
Primary Health Care Strategy https://www.health.govt.nz/publication/primary-health-care-strategy
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PUBLIC
BOARD INFORMATION PAPER
Date: October 2019
Presented By Jason Kerehi, Executive Leader Māori Health
Endorsed By Dale Oliff, Chief Executive Officer
Subject Equity Project – Adult Māori Oral Health Project RECOMMENDATION It is recommended that the Board: a. Notes this paper and discusses as appropriate APPENDICIES: 1. Letter to Hon Ron Mark, Minister of New Zealand Defence Force 2. Letter to Air Marshal Kevin Short, Chief of Defence Force New Zealand 3. Letter to Riana Clarke, National Clinical Director Oral Health, Ministry of Health
1 PROJECT BRIEF
Tō Waha is the name of a project delivered by Hawkes Bay District Health Board (HBDHB) and the New Zealand Defence Force (NZDF) as a deployment training exercise in March 2019. The Defence Force set up their dental resource (six chairs) in Hawkes Bay for a ten day period. The HBDHB included two chairs manned and volunteered by 20 Hawkes Bay Dentists, oral hygienists and dental assistants (and their own army of volunteers). Over the ten days they serviced the community working between 08:00am to 05:00pm each day. Tō Waha provided 702 appointments, 1297 dental treatments which is an equivalent to $475,000 of services to the Hawkes Bay community. The project had a huge positive impact on the community.
2 PROJECT UPDATE
The Wairarapa Adult Māori Oral Health project is being driven by Te Iwi Kainga. Kim Smith and I met with Lt Col. Lyndie Foster-Page – Chief Dental Officer, NZDF to discuss Wairarapa DHB’s interest in working together on a similar exercise. Lyndie advised that the next location is likely to be Northland which has been tagged as a priority area by the Ministry of Health (MoH). We have been advised to write to Air Marshal Kevin Short, Chief of Defence Force New Zealand and Riana Clark, National Clinical Director Oral Health, Ministry of Health to signal our interest. A further suggestion was to keep our options open for potentially hosting a smaller exercise for the Wairarapa. The Defence Force may be open to testing their surge capacity in a smaller region like Wairarapa. Other DHB’s will be lining up for similar opportunities. As we understand it, there have been no other DHB’s approac MoH or NZDF to date. We have also written to our resident Member of Parliament and Minister of Defence – Hon Ron Mark for a letter of support. All three letters have been co-signed by the Chairs of Wairarapa District Health Board and Te Oranga o Te Iwi Kainga and have been sent and are included as appendicies with this paper.
Wairarapa District Health Board Page 1 of 1
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Wairarapa Hospital
PO Box 96 Masterton New Zealand
Phone (06) 946 9800 Fax (06) 946 9801 www.wairarapa.dhb.org.nz
Monday 1st October 2019
Hon Ron Mark Minister of New Zealand Defence Force New Zealand Parliament Private Bag Wellington, New Zealand
Email: [email protected]
Tēnā koe e te rangatira,
REQUEST FOR ARMED FORCES DENTAL SERVICES TO SUPPORT A HEALTH EQUITY INITIATIVE IN THE WAIRARAPA
The Wairarapa District Health Board is wanting to register its’ interest with the New Zealand Defence Force requesting support from its Dental Services to assist the Wairarapa DHB with achieving better health equity outcomes for our adult Māori population.
We have been inspired by the Defence Force recent partnership with Hawkes Bay District Health Board and community to provide emergency dental services for over 700 adult Māori and Pasifika people. We would like to emulate that achievement in the Wairarapa.
Our District Health Board, in partnership with our Iwi Relationship Board, Te Oranga o Te Iwi Kainga, have made a commitment towards improving and assisting our adult Māori Oral Health as one of our top five equity priorities for this current financial year. We see a collaboration with the Defence Force as pivotal to provide immediate dental care for many Wairarapa whānau. Assistance to provide this service will provide us with a better understanding of our adult Māori populations dental issues for an ongoing programme to continue this work.
Well Wairarapa – better health for all Wairarapa ora – hauora pai mo te katoa
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Minister, we are seeking a letter of support from yourself to the Chief of Defence and to our own Chief Dental Officer within the Ministry of Health to support our approach. We see this as a fantastic opportunity to create our own partnership with the Defence Force and our local community. We acknowledge both your leadership role for the New Zealand Defence Forces and the high regard with which you are held within the Wairarapa Community.
Thank you for taking the time to consider this request.
Naku noa nā
Sir Paul Collins Kim Smith Chairperson, Wairarapa District Health Board Chairperson, Te Oranga o Te Iwi Kainga
CC: Riana Clarke, National Clinical Director Oral Health Air Marshal Kevin Short, Chief of Defence Force
Well Wairarapa – better health for all Wairarapa ora – hauora pai mo te katoa
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Wairarapa Hospital
PO Box 96 Masterton New Zealand
Phone (06) 946 9800 Fax (06) 946 9801 www.wairarapa.dhb.org.nz
Monday 1st October 2019
Air Marshal Kevin Short Chief of Defence Force New Zealand New Zealand Defence Force Private Bag 39997 Wellington, 6045 New Zealand
Tēnā koe e te rangatira,
REQUEST FOR ARMED FORCES DENTAL SERVICES TO SUPPORT A HEALTH EQUITY INITIATIVE IN THE WAIRARAPA
The Wairarapa District Health Board would like to register its’ interest with the New Zealand Defence Force requesting support from its Dental Services to assist us with achieving better health equity outcomes for our population, most of whom are Māori. We have been inspired by the Defence Force recent partnership with Hawkes Bay District Health Board and community to provide emergency dental services for over 700 adult Māori and Pasifika people. We would like to emulate that achievement in the Wairarapa. Our District Health Board, in partnership with our Iwi Relationship Board, Te Oranga o Te Iwi Kainga, has made a solid commitment towards achieving that goal by including adult Māori Oral Health as one of our top five equity priorities for this current financial year. We see a collaboration with the defence force as helping to provide immediate dental care for many Wairarapa whānau. This project will help better understand dental issues for our adult Māori population and enable us to implement an ongoing programme to continue this work. We would like to start a conversation with the New Zealand Defence Force for future scheduling and to understand what that might look like in the Wairarapa. We understand that the Defence Force has aspirations to test its surge capacity for any emergency. Wairarapa offers a semi- remote and rural based community in close proximity to Wellington and Manawatū for such analysis.
Well Wairarapa – better health for all Wairarapa ora – hauora pai mo te katoa
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We intend to also write to our Ministry of Health Chief Dental Officer seeking their support as well as the Minister of New Zealand Defence Force. Thank you for taking the time to consider this request.
Naku noa nā
Sir Paul Collins Kim Smith Chairperson, Wairarapa District Health Board Chairperson, Te Oranga o Te Iwi Kainga
CC: Hon Ron Mark, Minister of New Zealand Defence Force Riana Clarke, National Clinical Director Oral Health
Well Wairarapa – better health for all Wairarapa ora – hauora pai mo te katoa
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Wairarapa Hospital
PO Box 96 Masterton New Zealand
Phone (06) 946 9800 Fax (06) 946 9801 www.wairarapa.dhb.org.nz
Monday 1st October 2019
Riana Clarke National Clinical Director Oral Health Ministry of Health PO Box 5013 Wellington, 6140 New Zealand
Email: [email protected]
Tēnā koe Riana,
REQUEST FOR ARMED FORCES DENTAL SERVICES TO SUPPORT A HEALTH EQUITY INITIATIVE IN THE WAIRARAPA
The Wairarapa District Health Board would like to register its’ interest with the New Zealand Defence Force and the Ministry of Health to request support from its Dental Services to assist with achieving better health equity outcomes for our Wairarapa population, most of whom who are Māori. We have been inspired by the recent partnership between Hawkes Bay District Health Board, the Hawkes Bay Community and the Defence Force to provide emergency dental services for their adult Māori and Pasifika population. We would like to emulate that achievement here in the Wairarapa.
Our District Health Board, in partnership with our Iwi Relationship Board, Iwi Kainga, have made a commitment towards achieving that goal by including adult Māori Oral Health as one of our top five equity priorities for this current financial year. We see a collaboration with the defence force as helping to provide immediate dental care for many Wairarapa whānau. This project will help us to better understand dental issues for our adult Māori population and enable us to put in place an ongoing programme to continue this work.
Well Wairarapa – better health for all Wairarapa ora – hauora pai mo te katoa
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We are seeking Ministry’s support as we engage with the New Zealand Defence Force. We understand that the Defence Force has aspirations too such as wanting to test its surge capacity for any emergency. Wairarapa offers a semi-remote and rural based community in close proximity to Wellington and Manawatū. We would welcome any opportunity to discuss this initiative further. Thank you for taking the time to consider this request.
Naku noa nā
Sir Paul Collins Kim Smith Chairperson, Wairarapa District Health Board Chairperson, Te Oranga o Te Iwi Kainga
CC: Hon Ron Mark, Minister of New Zealand Defence Force Air Marshal Kevin Short, Chief of Defence Force
Well Wairarapa – better health for all Wairarapa ora – hauora pai mo te katoa
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