2018 05 03 Hutt Valley Board Public - Cover Page
Public Board meeting
Meeting: Thursday, 3 May 2018
Start time: 12.30 pm
Venue: Boardroom, Pilmuir House Hutt Valley DHB Lower Hutt
1 2018 05 03 Hutt Valley Board Public - Hutt Valley DHB Values, Strategic Priorities, Strategic Objectives and Minister's Expectations
Hutt Valley District Health Board
Whanau Ora ki te Awakairangi Healthy People, Health Families, Healthy Communities
Our Values Always caring – respectful, kind and helpful Can-do – positive, learning and growing and appreciative In Partnership – welcoming, listens, communicates and involves Being our Best – innovating, professional and safe.
Hutt Valley DHB Strategic Priorities Improving health of our population and reducing inequalities Improving the patient journey Best value for money and living within our means Building a thriving organisation
Central Region Strategic Objectives 2017/18 Cancer Services Major Trauma Cardiac Services Mental Health and Addictions Elective Services Health Quality & Safety Healthy Aging Stroke Services Hepatitis C Palliative Care/End of Life Care ICT Regional workforce Sudden Unexpected Death in Infancy Prevention Programme
Minister’s Expectations 2017/18 Refreshed NZ Health Strategy Living within our Means Working across Government National Health Targets
2 2018 05 03 Hutt Valley Board Public - AGENDA
AGENDA Held on Thursday, 3 May 2018 Boardroom, Pilmuir House, Hutt Hospital Commencing at 12.30 pm BOARD PUBLIC SESSION
Item Action Presenter Min Time Pg 1. PROCEDURAL BUSINESS 40 12.30 pm 1.1 Karakia 1.2 Apologies ACCEPT A Blair 1.3 Continuous Disclosure A Blair 5 - Interest Register ACCEPT - Conflict of Interest CONFIRM 1.4 Minutes of previous meeting 29 March 2018 ACCEPT A Blair 9 1.5 Matters arising from previous meeting NOTE D Oliff 15 1.6 2018 Board work plan NOTE D Oliff 16 1.7 Chair’s Report VERBAL A Blair 1.8 Chief Executive’s report, including: NOTE D Oliff 18 ∑ February 2018 financials ∑ Clinical Council update ∑ MHAIDS 3DHB update ∑ Health & Safety update 2. PATIENT STORY 2.1 Patient experience story NOTE A O’Callaghan 10 1.10 pm 3. FOR DECISION 3.1 Te Atiawanuitonu partnership agreement APPROVE K Dougall 5 1.20 pm 29 4. FOR DISCUSSION 4.1 Hospital & Health Services report NOTE P Voon 15 1.25 pm 30 4.2 Quality and Safety report NOTE A O’Callaghan 10 1.40 pm 43 4.3 Strategy, Planning and Outcomes update, including: NOTE H Carbonatto 10 1.50 pm 56 ∑ Clinical Service Plan update ∑ Wellness Strategy update ∑ Winter 2018 planning update ∑ Health Care Home update ∑ Inquiry into Mental Health and Addictions ∑ Rheumatic Fever 4.4 Capital Investment process NOTE H Carbonatto 10 2.00 pm 67 5. FOR INFORMATION 5.1 Disability update NOTE P Boyles 15 2.10 pm 72 5.2 Population Health update NOTE P Voon 5 2.25 pm 77 6. COMMITTEE REPORTING 6.1 3DHB DSAC minutes 19 March 2018 RECEIVE A Blair 5 2.30 pm 94 7. OTHER 7.1 General Business 5 2.35 pm 7.2 Resolution to Exclude the Public AGREE A Blair 5 2.40 pm 99 DATE OF NEXT MEETING 31 May 2018
Hutt Valley District Health Board Page 1 April 2018
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APPENDICES 1.7 Chair’s report 1.7.1 DHB sector financial performance report January 2018 100 1.7.2 DHB sector financial performance report February 2018 107 1.8 Chief Executive’s report 1.8.1 February 2018 finance report 114 1.8.2 HuttInc February 2018 newsletter 137 3.1 Te Atiawanuitonu partnership agreement 3.1.1 Te Atiawanuitonu partnership agreement 151 5.1 Disability update 5.1.1 Auckland Disability Law Easy read leaflet - Supported decision-making 155 5.1.2 Examples of Concerto alerts 175 5.2 Population Health update 5.2.1 Regional Child Oral Health Service 2017 vvaluation of late night appointment trial 181 5.2.2 Te Ra o Te Raukura report 184 5.2.3 Creekfest report 186
Hutt Valley District Health Board Page 2 April 2018
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Hutt Valley Board INTEREST REGISTER
Name Interest Graeme Andrew Blair ∑ Chair, Capital & Coast DHB Chair ∑ Chair, Hutt Valley District Health Board ∑ Chair, Hutt Valley District Health Board Hospital Advisory Committee ∑ Member, Hutt Valley District Health Board Finance, Risk and Audit Committee ∑ Member, 3DHB combined Disability Support Advisory Committee ∑ Member, Hutt Valley District Health Board Community and Public Health Advisory Committee ∑ Owner and Director of Andrew Blair Consulting ∑ Advisor to the Board, Forte Health Ltd Christchurch ∑ Former member of the Hawke’s Bay DHB (2013-2016) ∑ Former Chair, Cancer Control (2014-2015) ∑ Former CEO, Acurity Health Group Limited Wayne Guppy ∑ Upper Hutt City Council Mayor Deputy Chair ∑ Deputy Chair, Hutt Valley District Health Board ∑ Deputy Chair, Hutt Valley District Health Board Finance, Risk and Audit Committee ∑ Member, Hutt Valley District Health Board Hospital Advisory Committee ∑ Wife employed by various community pharmacies in the Hutt Valley ∑ Trustee - Orongomai Marae ∑ Director MedicAlert ∑ Chair – Wellington Regional Mayoral Forum ∑ Chair – Wellington Regional Strategy Committee Lisa Bridson ∑ Member, Hutt Valley District Health Board Member ∑ Member, Hutt Valley District Health Board Hospital Advisory Committee ∑ Member, 3DHB combined Disability Support Advisory Committee ∑ Member, Hutt Valley District Health Board Community and Public Health Advisory Committee ∑ Hutt City Councillor ∑ Chair, Kete Foodshare Ken Laban ∑ Member, Hutt Valley District Health Board Member ∑ Member, Hutt Valley District Health Board Finance, Risk and Audit Committee ∑ Member, Hutt Valley District Health Board Hospital Advisory Committee ∑ Trustee, Hutt Mana Charitable Trust ∑ Member, Ulalei Wellington ∑ Chairman, Hutt Valley Sports Awards ∑ Member, Greater Wellington Regional Council ∑ Commentator, Sky Television ∑ Broadcaster, Numerous Radio Stations ∑ Member, Christmas in the Hutt Committee ∑ Trustee, Te Awakairangi Trust ∑ Member, Computers in Homes David Ogden ∑ Member, Hutt Valley District Health Board Member ∑ Member, Hutt Valley District Health Board Finance, Risk and Audit Committee ∑ Member, Hutt Valley District Health Board Hospital Advisory Committee ∑ Regional Councillor ∑ Principal, Oak Chartered Accountants Limited ∑ Accountant, affiliated, with Simple Accounting Services Limited, which has various clients involved in the Health Sector ∑ Daughter is a Doctor in Clinical Psychology and working within a District Health Board outside of the Central Region
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∑ Former Mayor and Councillor, Hutt City Council. John Terris ∑ Member, Hutt Valley District Health Board Member ∑ Member, Hutt Valley District Health Board Hospital Advisory Committee ∑ Member, 3DHB combined Disability Support Advisory Committee ∑ Member, Hutt Valley District Health Board Community and Public Health Advisory Committee Prue Lamason ∑ Member, Hutt Valley District Health Board Member ∑ Member, Hutt Valley District Health Board Hospital Advisory Committee ∑ Member, 3DHB combined Disability Support Advisory Committee ∑ Member, Hutt Valley District Health Board Community and Public Health Advisory Committee ∑ Deputy Chair, Hutt Mana Charitable Trust ∑ Deputy Chair, Britannia House – residence for the Elderly ∑ Councillor, Greater Wellington Regional Council ∑ Deputy Chair, Greater Wellington Regional Council Holdings Company ∑ Trustee, She Trust ∑ Daughter is a Lead Maternity Carer in the Hutt Yvette Grace ∑ Member, Hutt Valley District Health Board Member ∑ Member, Hutt Valley District Health Board Hospital Advisory Committee ∑ Deputy Chair, 3DHB combined Disability Support Advisory Committee ∑ Chair, Hutt Valley District Health Board Community and Public Health Advisory Committee ∑ Trustee, Rangitane Tu Mai Ra Treaty Settlement Trust ∑ Husband, Family Violence Intervention Coordinator Wairarapa DHB ∑ Husband, Community member of Tihei Wairarapa Alliance Leadership Team ∑ Sister in law, Nurse at Hutt Hospital ∑ Sister in Law, Private Physiotherapist in Upper Hutt Tim Ngan Kee ∑ Member, Hutt Valley District Health Board Member ∑ Member, Hutt Valley District Health Board Finance, Risk and Audit Committee ∑ Member, Hutt Valley District Health Board Hospital Advisory Committee ∑ Member, Hutt Valley District Health Board Community and Public Health Advisory Committee ∑ General Practitioner, Churton Park Medical Care ∑ Partner, Churton Park Medical Care Kim von Lanthen ∑ Member, Hutt Valley District Health Board ∑ One third shareholding Kim von Lanthen and Associates Ltd ∑ One half shareholding Commodity Markets (NZ) Ltd ∑ Thirteen percent share Toitu Te Waonui Operations Ltd
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Hutt Valley DHB Executive Leadership Team Interest Register
Name Interest
Dale Oliff ∑ Chair, National COO meeting Acting Chief Executive Officer ∑ Member of Employment Relations Steering Group ∑ Medical Council, RMO Community placement member Nigel Fairley ∑ Fellow, NZ College of Clinical Psychologists General Manager, 3DHB Mental ∑ President, Australian and NZ Association of Psychiatry, Health Addictions & Intellectual Psychology and Law Disability Service ∑ Trustee, Porirua Hospital Museum ∑ Director and Shareholder, Gerney Limited Peng Voon ∑ No interests declared Acting Chief Operating Officer Tofa Suafole Gush ∑ Member of the Te Awakairangi Health Board Director Pacific Peoples Health ∑ Pacific Member, Board of Compass Health ∑ Husband is an employee of Hutt Valley DHB Dr Sisira Jayathissa ∑ Member of the Medicine Adverse Reaction Committee Chief Medical Officer MedSafe (MOH) ∑ Member Standing committee on Clinical trials (HRC) ∑ Member Editorial Advisory Board NZ formulary ∑ Member Internal medicine Society of Australia and NZ ∑ Member Australian and NZ society of geriatrics ∑ Writer NZ internal Medicine Research Review ∑ Clinical Senior Lecturer and Module convenor Clinical Skills module (HUTT campus), University of Otago Judith Parkinson ∑ Director of Allied Laundry General Manager, Finance and Corporate Services Amber O’Callaghan ∑ Member, Tissue Bank Governance Committee – GMRI General Manager Quality Service, ∑ Expert Advisor - HQSC National Adverse Event Learning Improvement and Innovation Programme Bridget Allan ∑ Chief Executive, Te Awakairangi Health Network (PHO) Chief Executive, Te Awakairangi ∑ Board member of Vibe Health Network (PHO) ∑ Healthy Families Lower Hutt Leadership Group member Chris Wilson ∑ No interests declared Interim Communications Manager Shayne Hunter ∑ Owner/Director Genesis Consulting Group – a boutique 3DHB Chief Information Officer consulting practice ∑ Director Patients First – a not-for-profit charitable company,
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jointly owned by GPNZ and RNZCGP, with the purpose to provide and facilitate information technology solutions Claire Tahu ∑ Chair of Dieticians New Zealand Director Allied Health, Scientific and Technical Helene Carbonatto ∑ No interests declared General Manager Strategy Planning & Outcomes Fiona Allen ∑ No interests declared. General Manager Human Resources & Organisational Development Kerry Dougall ∑ Board Chair, Kokiri Marae Māori Women’s Refuge Director of Māori Health ∑ Board member, Ta Kirimai te Ata Whanau Collective Chris Kerr ∑ Member of Nurse Executives New Zealand (NENZ) Director of Nursing ∑ Family member is a senior registered nurse in SCBU. ∑ Relative is HVDHB Bowel Screening Programme Manager
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BOARD PUBLIC MINUTES Held on Thursday, 29 March 2018 Boardroom, Pilmuir House, Hutt Hospital, Lower Hutt Commencing at 12.30 pm
BOARD PUBLIC SECTION
PRESENT Andrew Blair Chair Wayne Guppy Deputy Chair Kim von Lanthen Member Tim Ngan Kee Member Lisa Bridson Member Ken Laban Member David Ogden Member John Terris Member Prue Lamason Member
APOLOGIES Yvette Grace Member
IN ATTENDANCE Dale Oliff Acting Chief Executive Kristine McGregor Board Secretary Judith Parkinson General Manager, Finance and Corporate Services Kerry Dougall Director of Maori Health 12.30 – 1.30 pm Chris Kerr Director of Nursing Tofa Suafole-Gush Director of Pacific People’s Health Nigel Fairley General Manager 3DHB Mental Health, Addictions and Intellectual Disabilities Shayne Hunter 3DHB Chief Information Officer 2.30 – 2.45 pm
GUESTS Dr Ashley Bloomfield Interim Chief Executive, Capital & Coast DHB Alison Hobcraft Member of the public Nanai Muaau Executive Director, Pacific Health Services Hutt Valley 1.05 – 1.30 pm Mona Hawkins Clinical Nurse Leader, Pacific Health Services Hutt Valley 1.05 – 1.30 pm Macala Samuels Primary Nurse, Pacific Health Services Hutt Valley 1.05 – 1.30 pm Lynda Ryan Team Leader – programmes, Te Awakairangi Health Network 1.05 – 1.30 pm Otila Tefono, Team Leader – Pacific People’s Health, Hutt Valley DHB 1.05 – 1.30 pm Candice Apelu-Mariner Integration Leader – Pacific People’s Health, Hutt Valley DHB 1.05 – 1.30 pm
Hutt Valley District Health Board Page 1 MARCH 2018
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BOARD PUBLIC 1. PROCEDURAL BUSINESS
1.2 APOLOGIES The Board NOTED apologies from Ms Y Grace
1.3 CONTINUOUS DISCLOSURE 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 required disclosure.
1.3.1 INTEREST REGISTER The Board REQUESTED the following changes be made to the updated Interest Register: ∑ Correction to Mr D Ogden’s interest – his daughter is a doctor working in a DHB outside of the Central Region
1.3.2 CONFLICT OF INTEREST 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.
1.4 CONFIRMATION OF MINUTES The Board RESOLVED to approve the minutes of the Members’ (Public) meeting held on 22 February 2018 as a true and accurate record of the meeting.
MOVED: W Guppy SECONDED: T Ngan Kee CARRIED
1.5 MATTERS ARISING The Board RECEIVED the matters arising from the previous meeting.
1.6 BOARD WORK PLAN The Board noted the 2018 workplan.
1.7 CHAIR’S REPORT The Board Chair provided a verbal report to the Board, noting the correspondence he has received, the meetings he had attended since the last Board meeting, the upcoming meetings he will be attending and any media queries he had received.
Correspondence 28 February 2018 Letter from NZNO regarding Employment Relations Education Leave that is to be allocated to nurses at HVDHB who are members of the NZNO 20 March 2018 Letter from the Minister of Health regarding the Board’s letter of 18 January regarding sugar-sweetened beverages
Meetings 1. 8 March 2018 Combined National Chairs’ and CEs’ meeting National Chairs’ meeting 2. 21 March 2018 Audit NZ update for Crown Entities
The Board NOTED the contents of the verbal report.
Hutt Valley District Health Board Page 2 MARCH 2018
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BOARD PUBLIC 1.8 CHIEF EXECUTIVE’S REPORT The report was taken as READ.
Action: The Board requested that management provide an update on the work the DHB is undertaking to reduce rheumatic fever rates and the efficacy of this work
The Board: a) NOTED that Hutt Valley DHB received an “achieved” or “satisfactory” rating against 55 percent of the performance measures monitored by the Ministry of Health for quarter two 2017/18; once “partially achieved” measures are added, this rises to 96 percent (55/57 measures); b) NOTED that for February 2018, Hutt Valley DHB achieved 91 percent against the Shorter Stays in ED health target; c) NOTED that Hutt Valley DHB’s year-to-date performance against the Faster Cancer Treatment health target is 90.8 percent; d) NOTED that Hutt Valley DHB’s performance against the Improved Access to Elective Surgery health target was 114.2 percent for February 2018, well ahead of the target; e) NOTED that Hutt Valley DHB’s year-to-date performance against the Improved Access to Elective Surgery health target is 114.2 percent; f) NOTED that interviews for the Establishment Chair of the Consumer Council are planned to be held in March 2018; g) NOTED the January 2018 DHB financial performance showed a favourable variance of $1,194K for the month and ($852K) year to date.
2. PATIENT STORY 2.1 PATIENT EXPERIENCE STORY Mrs Tofa Suafole-Gush introduced the patient story, which was about the integration work that has been happening between the Pacific People’s Health Unit, Naenae Medical Centre and Pacific Health Services Hutt Valley. This included a short video that provided an overview of some work the team has done with a blind patient.
The Board Chair thanked Tofa for bringing the story to the Board meeting.
3. DISCUSSION ITEMS 3.1 HEALTH AND SAFETY REPORT The paper was taken as READ.
The Board: a) NOTED that in February there were no notifiable events; b) NOTED that there were 80 reported events with health and safety implications reported during February 2018, compared with 89 for the October and November 2017 period; c) NOTED that there were eight new workplace injury claims received by Hutt Valley DHB during February; d) NOTED the Employee Assistance Programme (EAP) usage statistics show a peak in usage during February 2018; e) NOTED the establishment of a ‘steering committee’ for Worker Engagement Participation and Representation (WEPR); f) NOTED an overview of the operations of the WHS Team including Occupational Health Services.
Hutt Valley District Health Board Page 3 MARCH 2018
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BOARD PUBLIC 3.2 MENTAL HEALTH, ADDICTIONS & INTELLECTUAL DISABILITY SERVICE 3DHB UPDATE The paper was taken as READ.
The Board: a) NOTED Te Haika and the Crisis Resolution Service have launched a 24 hour Electronic Whiteboard; b) NOTED that training is underway for the New Digital Client Records and Client Pathway for the Mental Health, Addictions and Intellectual Disability (MHAID) Services 3DHB; c) NOTED that since July 2015, seclusion rates have decreased across mental health services at Hutt Valley and Capital & Coast DHBs; d) NOTESD 25 New Entry to Specialist Practice Programme (NESP) nurses began in the MHAID Service 3DHB at the beginning of February; e) NOTED following the review of the Infant, Child, Adolescent and Family Service (ICAFS) last year, an implementation project underway that will: i. Implement changes to the ICAFS team structure; ii. Scope and implement service improvements to enhance efficiency, responsiveness and flexibility; iii. Scope relocation of the service. f) NOTED a six bed new youth respite services for Hutt Valley and Capital & Coast DHBs service, located in either Petone or Johnsonville, is currently being tendered for. Once the preferred provider has been selected, services are expected to commence from July 2018; g) NOTED that the new Substance Addiction (Compulsory Assessment & Treatment Act) 2017 (SACAT) began in February and all legislatively required staff and duly authorised officers have been appointed into the required roles.
3.3 HUTT VALLEY DHB INFORMATION, COMMUNICATION AND TECHNOLOGY QUARTERLY UPDATE The paper was taken as READ.
The Board: a) NOTED that the availability of key (Category one) ICT systems over the quarterly reporting period measured 99.4 percent against a target of 99.90 percent. All planned data backups completed successfully during the reporting period. There were no successful attempts to impact systems or expose data by virus and other electronic attacks or misuse by staff during the reporting period. b) NOTED that ICT and the Communications team have established a Cyber Safety Awareness team. The ICT Cyber Incident Response Team are now trained on security incident management and are working with Emergency Management on an operational procedures; c) NOTED that resources for ICT security are not sufficient to meet the demands for security management. This presents a risk to the DHB and resourcing will need to be factored into the 2018/19 budgets; d) NOTED since reporting to the Board in December, good progress towards improving the resilience of the DHB’s ICT infrastructure has been made; e) NOTED ICT has been actively engaged in DHB annual planning to determine the ICT priorities and budgets for 2018/19, and development of the draft Annual Plan; f) NOTED the Chief Information Officer (CIO) 3DHB attended an invite only, two-day briefing at Microsoft’s Executive Briefing Centre in Seattle, USA to: i. gain insights about emerging technologies and trends to assist with planning for future DHB ICT strategies; ii. determine how 3DHBs can establish a strategic partnership to maximise the value that can be obtained from spend on Microsoft’s products and services.
Hutt Valley District Health Board Page 4 MARCH 2018
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BOARD PUBLIC g) NOTED Mike Rillstone of Rillstone Wells has completed a planned, independent review of the Regional Health Informatics Programme (RHIP). Stakeholder confidence in the programme delivery has improved and the roll-out progress remains “on track”; h) NOTED the next stage of the National Electronic Health Record Platform business case is still awaiting Minister and cabinet feedback; i) NOTED that the Minister of Health has advised NZ Health Partnerships (NZHP) that the National Oracle System (NOS) programme cannot secure funding from DHBs or contractually commit to Oracle licensing and build activities until the Minister of Health approves this; j) NOTED the Ministry of Health (the Ministry) has engaged Deloitte to undertake an independent review of the NOS Programme. Deloitte is expected to provide its report to the Ministry in April 2018;
4. DISCUSSION ITEMS 4.1 DRAFT HUTT VALLEY DHB COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEE MINUTES 2 MARCH 2018 AND REPORT BACK The Board RECEIVED the Hutt Valley DHB CPHAC minutes of the meeting held on 2 March 2018.
5. OTHER 5.1 GENERAL BUSINESS No items of general business were raised
Hutt Valley District Health Board Page 5 MARCH 2018
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BOARD PUBLIC 5.2 RESOLUTIONS TO EXCLUDE THE PUBLIC 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 For the reasons set out in the 22 February 2018 Board Public Excluded Minutes agendas Public Excluded Matters Arising from previous Public Excluded For the reasons set out in the 22 February 2018 agendas meeting Information contained in the paper may be subject to change as the information has not yet been reviewed by Section 9(2)(f)(iv) Chief Executive’s report the FRAC Section 9(2)(j) Paper contains information and advice that is likely to prejudice or disadvantage negotiations Papers contain information and advice that is likely to 9(2)(j) Sub-Committee draft minutes prejudice or disadvantage negotiations
Chair’s report Papers contain information and advice that is likely to Section 9(2)(i)(j) prejudice or disadvantage commercial activities and/or Plastics Surgery Overview disadvantage negotiations.
Emergency Department Overview
Regional Child Oral Health Service: Digital Radiography Project Planning Phase Register of Board Chair Executed documents February 2018
MOVED: P Lamason SECONDED: A Blair CARRIED
The meeting closed at 1.45 pm
5. DATE OF NEXT MEETING The next meeting will be held on Thursday, 3 May 2018, in the Boardroom, Pilmuir House, Hutt Valley DHB, commencing at 12.30 pm.
CONFIRMED that these minutes constitute a true and correct record of the proceedings of the meeting.
DATED this day of 2018
ANDREW BLAIR CHAIR HUTT VALLEY DISTRICT HEALTH BOARD
Hutt Valley District Health Board Page 6 MARCH 2018
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BOARD PUBLIC
MATTERS ARISING FROM PREVIOUS MEETINGS Original Meeting Ref Topic Action Resp How Dealt with Delivery date Completed Date Date 29 March 2018 The Board requested that management provide GM Strategy, Information included in Chief Executive’s an update on the work the DHB is undertaking to B2018-1 Planning and Strategy Planning and April Board meeting 3 May 2018 report reduce rheumatic fever rates and the efficacy of outcomes Outcomes report this work 22 February 2018 GM Finance and The Board requested management provide a Maori Health Corporate Services Investigation undertaken and B2018-6 paper to the Board regarding the rolling June 2018 update (via the Property advice provided to the Board installation of bilingual signage at the DHB Committee) Chief Executive’s The Board requested standardized terms be used B2018-1 Chief Executive Standard terms used Ongoing report across Board papers 23 November 2017 Clinical Service Plan The Board requested a communications plan be To be considered as part of – update of key B2017-28 developed to ensure the DHB is proactively Chief Executive June options and next steps June 2018 findings and keeping the public up-to-date paper progress The Board will review opportunities for Discussion held at March B2017-26 Chair’s report Board Chair 29 March 2018 cross-boundary collaboration in March 2018. Board meeting
Hutt Valley District Health Board April 2018
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Hutt Valley DHB Board work plan 2018
Regular monthly items: Strategy, Planning and Outcomes updates to include: Public Chair’s report CEO’s report Resolution to exclude the public ∑ ALT update ∑ Palliative Care update ∑ Obesity prevention Public Excluded Chair’s report CEO’s report FRAC report back FRAC minutes ∑ Primary Care update ∑ Child & Youth health ∑ Smoking cessation services
January February March April May June July August September October November December Regional Child Oral Health Service Final 2018/19 Final 2018/19 2019 Board Dates Audit NZ Audit 2018/19 Draft HVDHB 2017/18 Digital Radiography Operating and Operating and and work planning 2018 Annual Plan Draft Annual report Commented [KM[1]: Project Planning Capital budgets Capital budgets programme Approved by the Board in February 2018 Phase Commented [KM[2]: Shifted to align with FRAC work plan and Plan to address Replacement data when funding envelope will be received Internal audit plan MHAIDS integration $3M deficit by June back-up system Draft 2018/19 RSP 2018/19 final proposal 2018 business case Commented [KM[3]: Deferred until June 2018 as has not yet Fleet Car Lease Implementation been approved/endorsed by ELT or the Clinical Council
n Upgrade to Citrix Clinical Services TAS Annual Report
o Replacement and Insurance renewal costs for Digital i platform Plan and AGM s i Renewal Radiography project c
e Business Process D Automation MHAIDS integration 2018/19 Funder NZHP accountability Youth Health Solutions – Phase 1 – recommendation Commitments documents Services Commented [krm014]: Digitising patient post consultation Rescheduled from June 2018 records Replacement data Health and Safety back-up system Strategy business case Provision of orthotics at HVDHB Hospital & Health 3DHB MHAIDS Hospital & Health 3DHB MHAIDS Hospital & Health 3DHB MHAIDS Hospital & Health 3DHB MHAIDS Hospital & Health 3DHB MHAIDS Hospital & Health Services report update Services report update Services report update Services report update Services report update Services report
p Quality & safety Health and Safety Quality & safety Health and Safety Quality & safety Health and Safety Quality & safety Health and Safety Quality & safety Health and Safety Quality & safety
o Strategy, Planning Strategy, Planning Strategy, Planning Strategy, Planning Strategy, Planning Strategy, Planning
h Quarter 2 and Outcomes and Outcomes and Outcomes and Outcomes and Outcomes and Outcomes
s performance report update update update update update update n k o
i Prevention/ r s Māori Health Māori Health Quarter 3 Māori Health Quarter 4 Māori Health Quarter 1 s Community u
o update update performance report update performance report update performance report c
s wellness plan i D
w Health & Safety Capital Investment Equity Indicators Equity Indicators plan process report & review report & review g Role of the national
n executive and how i national work n programmes are
n allocated to CEs
a External Audit l 3DHB ICT update 3DHB ICT update 3DHB ICT update 3DHB ICT update 3DHB ICT update report P
Population health Population health Population health l update update update n a o
i Disability update Disability update t u a Pacific Health Pacific Health Pacific Health m n r update update update Commented [krm015]: Update given to the Board via the o
f patient story presentation in March 2018. A further update
n 3DHB DSAC minutes 3DHB DSAC minutes 3DHB DSAC minutes n I CPHAC minutes CPHAC minutes CPHAC minutes CPHAC minutes scheduled for July A
Draft findings –
d 2018 surveillance
r audit a a t Megan Main & Chair, Sub-regional Chair, Sub-regional Chair, Sub-regional n n Claire Austin, e o o s
i Peter Anderson - Disability Advisory Te Atiawa – Pacific Health Pacific Health t
e General Manager, r B NZHP Group Advisory Group Advisory Group P
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Health Workforce Chair, Sub-regional NZ Disability Advisory Group Regional Dental s Regional Public t i Regional Screening Service – Nae Nae, s Waiwhetu Marae Health Medical i Service Wainuiomata and V Officers of Health Trentham hubs
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PUBLIC
BOARD DISCUSSION PAPER
Date: 3 May 2018
Author Dale Oliff, Acting Chief Executive
Reviewed/approved by The Executive Leadership Team (reviewing on 2 May 2018)
Subject Chief Executive’s report April 2018
RECOMMENDATIONS It is recommended that the Board: a) NOTES that planning and work to upgrade the DHB’s maternity and birthing areas is progressing. The high level concept design of the primary birthing area being developed, and the Consumer Group is working with Bunnings on the design of the Whānau room; b) NOTES that there were no notifiable incidents reported in February and March 2018; c) NOTES that the DHB’s 2018 influenza campaign has commenced. During the first day and a half of the campaign, 20 percent (500 staff) were vaccinated; d) NOTES the update from the Clinical Council, including the Council’s endorsement for the first phase of the Citrix upgrade; e) NOTES primary care’s involvement in health promotion events held in the Hutt Valley during February (the Te Rā o Te Raukura festival) and March 2018 (Tumeke Taita 2018). These events were both well- attended; f) NOTES the retirement of three long-serving Domestic services staff in March, with a combined length of service of members of 80 years; g) NOTES the February 2018 DHB financial performance showed an unfavourable variance of ($465K) for the month and ($1,497K) year to date.
APPENDICES 1. February 2018 finance report 2. Hutt Inc February 2018 newsletter
Shorter, Safer, Smoother Care Effective Commissioning
Hutt Valley DHB Strategy Care Closer to Home Living Well links
Smart Infrastructure
1. UPDATE – UPGRADE OF MATERNITY AND BIRTHING AREAS
Over the last month, the project to upgrade the DHB’s maternity and birthing facilities has focused on progressing the primary birthing and the Whānau room upgrades.
Hutt Valley District Health Board Page 1 April 2018
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The high level concept design for the primary birthing room has been developed and a high level cost estimate is being calculated. Management are looking to confirm the essential and desirable work as well as funding options (including use of Trust funds);
Bunnings have offered to paint the Whānau room (including paint and labour). The design of the room (including stencilled pictures on the wall) is currently being worked through by Bunnings with the Consumer Group. New curtains new furniture will also be installed, and management are exploring upgrading the Kitchen Unit.
2. HEALTH & SAFETY UPDATE Section 1.3.1 “Our DHB’s Vision, Mission, Values and Strategic Goals” – Hutt Valley DHB 2016/17 annual plan pg. 9
2.1 Notifiable Events –March 2018 A notifiable event, as defined in the Health and Safety at Work Act 2015, is when any of the following occurs as a result of work: ∑ A death; ∑ A notifiable illness or injury; ∑ A notifiable incident.
During March 2018, there were no notifiable incidents.
2.2 Reported Health and Safety incidents per directorate – March 2018
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PUBLIC
During March 2018, there were 103 reported health and safety events. This is an increase of 23 (29 percent) compared to February 2018. Some of this increase may be attributable to more categories of incident being included in the report.
2.3 2018 Influenza “campaign” The 2018 “campaign” started on Monday, 16 April. As in previous years, it is being led by the DHB’s Senior Occupational Health Nurse in collaboration with and assisted by nursing colleagues within the hospital. The following vaccination sessions have been planned: ∑ 16 – 20 April Drop-in clinics in the Clinical Training Unit ∑ 23 – 27 April Roving vaccinators will be available to vaccinate staff throughout the DHB ∑ Various dates between 24 April and 17 May Drop-in Clinics at OHSS (Occupational Health & Safety Services Clinic).
Early uptake of the flu vaccination has been higher this year (compared to previous years) with 20 percent (500 staff) being vaccinated during the first day and a half of the campaign.
3. CLINICAL COUNCIL UPDATE
The Clinical Council met on 5 April 2018. The matters discussed are outlined below:
3.1 Pager replacement project Peter Hicks, Clinical Leader ICU, Capital & Coast DHB provided an update on the pager upgrade process undertaken at Capital & Coast DHB to replace 660 pagers with mobile phones. Peter outlined the analysis, implementation, benefits and issues and whether Hutt Valley DHB would look at a similar changeover. Following a robust discussion amongst Council members as to whether this would be the avenue Hutt Valley DHB should undertake, it was recommended:
Hutt Valley District Health Board Page 3 April 2018
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∑ An evaluation of the Capital & Coast DHB upgrade from pager to mobile be undertaken and presented to Council before any investment is made; ∑ Moving in the direction of an application for smartphones rather than the purchase of new phones for all staff; ∑ Investigate the solutions undertaken by Canterbury DHB and Auckland DHB.
3.2 Citrix update – phase one Following endorsement from ELT, Shayne Hunter, Chief Information Officer, 3DHB presented the decision paper for Phase one of the Citrix Platform upgrade to the Clinical Council for its approval. The Council members endorsed the paper noting the end of life in June 2018; the execution for Phase one and the current risk. Issues raised by Council and addressed by Shayne included: ∑ will this address speeds remotely (currently slower than when first introduced); ∑ the effects on Primary Care for access; ∑ will this investment impact on any other long term IT solutions currently being sought.
3.3 Regional Clinical Portal Transition – Concerto Data Replication Implementation Business Case Shayne Hunter also presented Regional Clinical Portal Transition – Concerto data replication the business case to the Clinical Council for approval. The Council approved this paper progressing to ELT for endorsement.
3.4 Hutt Valley DHB draft capital plan 2018/19 Judith Parkinson, General Manager – Finance and Corporate Services provided the draft Hutt Valley DHB capital plan 2018/19 to Council. The Council noted the plan and the process to date and will provide feedback to Judith for further clarification. Discussion points raised centred on how the prioritisation was undertaken and whether review (ideally in smaller portions) would be of more benefit than the total plan in one meeting.
4. MHAIDS UPDATE
4.1 Infant, Child, Adolescent and Family Mental Health Services (ICAFS) review The progress on implementing the recommendations from the ICAFS external review continues to be steady with the new service going live on 30 April 2018.
This project will run through until June 2018. The Steering Group will provide strategic direction and guidance around the planning and resourcing of the project, and will monitor results. The group will meet monthly for the duration of the project.
The external review returned 19 recommendations (and various sub-recommendations), intended to reduce waiting times and strengthen the service through improving efficiency and effectiveness. The steering group are consulting with staff, unions and other key stakeholders, to make sure that processes in place to ensure a smooth transition.
Following consultation with staff, unions and other key stakeholders on the review, a document was released that outlined the new team structure to be established within ICAFS. The ‘Infant and Child’ and ‘Youth’ Teams and Team Leader roles have been disestablished, and two new teams established, organised by their role in supporting families at different stages, rather than by age. The Mental Health, Addictions and Intellectual Disability Service 3DHB (MHAIDS) Kaumatua Kaunihera and local Mana Whenua were consulted on new team names:
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∑ The Tautāwhi team “We respond, embrace and support “ The Tautāwhi team will now provide all of the initial assessments (including new referrals and consult liaison to the hospital).
∑ The Kaiārahi team “We guide, provide and mentor” The Kaiarahi team will look after children and young people requiring further assessment and assistance.
5. PRIMARY CARE UPDATE
5.1 Accreditation Te Awakairangi Health Network (TeAHN) supports practices to achieve and/or maintain accreditation against the Royal NZ College of General Practitioners (RNZCGP) Foundation and Cornerstone standards. TeAHN offers in-practice support (using the expertise of the Clinical Quality manager) and regular trainings opportunities for practice staff. The most recent training covered the Treaty of Waitangi and its relevance to primary health care. Future training sessions are planned to cover Reportable Events, Quality Improvement, Infection Control, Pacific Health, Health Literacy and further Treaty training.
5.2 Emergency management TeAHN assisted general practices across the Hutt Valley to form Local Emergency Groups (LEGs) some years ago, to bringing practices together in geographic locations to update their emergency preparedness. TeAHN held an emergency management training for all the LEGs in February 2018, including a presentation on tsunami preparedness and an overview from Wellington Regional Emergency Management Office (WREMO) on their work. Practices found this very useful, with many commenting on their greater understanding of the topics covered.
5.3 Influenza plan 2018 TeAHN is working closely with the Winter Surge Planning group established by Hutt Valley DHB. The planned approach for TeAHN for the influenza season follows a timeline framework – Plan (February), Prepare (March), Promote (April), Protect (May – October). Practices have been provided with patient lists of at risk patients that should be engaged for their influenza vaccination. Practices and partners including Kokiri Marae Health and Social Services and the Pacific Health Service have each been provided with Influenza packs that include promotional material, hand sanitiser, face masks, WellHomes information and the ‘Flu Kit resources.
5.4 Mental Health TeAHN is continuing to support the DHB in their work on mental health integration and service development opportunities eg, the ICAFS steering group overseeing the implementation of service changes, support to develop a Hutt mental health network, and Te Whare Ahuru patient journey workshops. Other networking opportunities have been with the Mental Health Nurse Practitioner at Compass Health, VIBE and PACT youth mental health team leaders and working with the 3D Youth Mental Health Pathway development group.
5.5 Health promotion TeAHN’s health promotion team supports the wider Hutt Valley community with a range of community events and promotions. During the 2017/18 summer, TeAHN supported the Hauora presence at Te Rā o Te Raukura festival. The Hauora tent had nine health check stations, with a registration table at the beginning and a prize and evaluation table at the end. Hutt Valley District Health Board Page 5 April 2018
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There were several events in March. Tumeke Taita 2018 was a success with lots of whānau attending. TeAHN’s theme was “clean skin”, and many whanau-centred packs (containing a flannel, soap, plasters and key messages) were given out. Multi-fest 2018 was organised by Team Naenae and the Hutt Multicultural Council, with a multicultural concert event held in the community hall. TeAHN’s theme was “looking after yourself”, with opportunities for people to measure their weight and height. The Lions Family Fun at Avalon Park had a diabetes awareness theme. The Lions committed all proceeds from the Lions train and Mini Golf to supporting diabetes prevention, and have identified Te Awakairangi Health Network as the organisation they would like to give this to.
5.5.1 Rata Street School Community Champion Following the Lions diabetes awareness event, TeAHN talked with Whaea Silvia Morgan, the kaiako from Rata Street School (a Turning the Tide school). The team supported her and Principal David Appleyard to present the “Go the H2O - Water Only” message to a school assembly in both Te Reo Maori and English. TeAHN gifted the school several reusable drink bottles, posters and take-home sheets to support the session.
Principal David Appleyard and Kaiako Silvia Morgan, Rata Street School, with “Go the H2O resources
6. FINANCIAL OVERVIEW – FEBRUARY 2018 Section 2 “Delivering on Priorities and Targets – Living Within our Means” – Hutt Valley DHB 2017/18 annual plan p. 23
The draft February 2018 financial report is attached as appendix one. The month of February showed an unfavourable variance to budget of ($645K) and ($1,497K) year to date (YTD).
Key results YTD were: ∑ Funder favourable by $3,325K; ∑ Governance favourable by $57K;
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∑ Provider unfavourable by ($4,880K). ∑ The draft full year forecast is a deficit of ($5,619K) against a budget deficit of ($2,103K).
Material YTD variances: ∑ Revenue favourable $5,400K: - Devolved Ministry of Health Revenue favourable $5,263K due to unbudgeted Pay Equity funding of $3,4805K that is passed onto External Providers, Capitation Funding of $189K that is passed onto PHOs, addition In-between Travel funding of $273K, additional capital charge funding of $160K, and the move of Disability Support Services (DSS) funding of $1,169K; - Non-devolved revenue was unfavourable by ($1,038K) including the DSS change, Bowel Screening $245K, and Regional Public Health $85K; - ACC Revenue was $235K favourable, but slowing; - Other revenue was $845K favourable, including a PHARMAC rebate of $1,076K and donations of $199K, offset by unfavourable results in Cafeteria, Interest and Patient Revenue income; - IDF Inflows were ($389K) unfavourable, with pay equity of $1,945K offset by unfavourable ($1,947K) inpatients and ($633K) MHAIDS; - Inter DHB Revenue was $484K favourable, predominantly related in Wairarapa and Capital & Coast DHBs. ∑ Personnel and outsourced Personnel unfavourable ($1,626K): - Medical personnel was ($1,533K) unfavourable: Outsourced medical ($1,645K) YTD offset by $115K favourable internal staff. The main areas of overspend were: outsourced Senior Medical Officer (SMO) ($1,329K) – general surgery ($236K), Women’s Health ($411K), Anaesthesia ($239K), Children’s Health ($177K) and MHAIDS ($166K). Outsourced Resident Medical Officers was adverse by ($320K) mainly in Emergency and Maternal. Internal medical costs included favourable internal SMO costs of $647K including MHAIDs $197K, Anaesthesia $184K, Maternal $140K, and Plastics $112K. These were offset by unfavourable RMO ($541K) with $277K in overtime. The main overspends were in General Surgery, ICU/Anaesthetics, Plastics, Children’s, Maternal and MHAIDs. - Nursing was unfavourable ($1,569K). Vacancies in Senior and Registered Nurses were covered using Bureau nurses, mainly in General Medical, Plastics and ED. Outsourced nursing was a reflection of MHAIDS staffing from Capital & Coast DHB, offset by savings from internal vacancies. Health Care Assistants were overspent both in internal staff and external staff required mainly in the General Medicine and OPRS for minders, Orthopaedics, Plastics and Community Nursing; - Allied Health favourable $1,274K, relating to vacancies in Physiotherapist, Dental Therapist and Psychologist; - Annual leave liability cost increased $435K since February 2017, and there are approximately 36,566 outstanding leave days; - The sickness level for the month was 2.2 percent; this is higher than last month, but slightly lower than this time last year. ∑ Outsourced other expenses were unfavourable ($1,938K) with overspends in clinical services of ($1,230K), mainly: outsourced Surgical patients in Orthopaedics ($381K), and Maternal ($162K) to meet waiting times, Radiology Outsourced ($527K) and Breast surgery ($156K) to manage volumes and vacancies, and the IT ($546K) savings target; ∑ Treatment related costs unfavourable by ($2,522K); Pharmaceuticals ($944K), Leased Radiology equipment ($271K), and Treatment Disposables ($1,001K);
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∑ Non-treatment related costs were favourable by $1,262K; ICT licences $372K, consultants $754K (Innovation Funding, project manager costs are within personnel); ∑ IDF outflows were unfavourable by ($255K), this includes and prior year wash up of ($209K); ∑ Other external provider costs were ($1,499K) unfavourable, mainly related to pay Equity payments to providers, funded via additional revenue.
Hospital activity in February was higher than budgeted, with a high rate of discharges in Medical. ED volumes were down, with admissions the same as the same period last year. The average length of stay was above budget and higher than last year. Surgical case-weighted discharges were down for February, but slightly higher than February 2017.
The cash position averaged $22.6M during February and $20.03M during January and was $3.1M at the end of February.
7. COMMUNICATIONS HIGHLIGHTS – MARCH – APRIL 2018
The table below provides a brief summary of communications activity in March and April 2018. Subject Activity Communications continues to support the rolling out of the DHB’s Strategic vision, HVDHB strategy following the production of the print version of the strategy and an accompanying video and animation.
Media Reactive media has slowed down over the past few weeks. We have had the media at the hospital to cover the donation of an artwork to our OPRS team. Communications provided support to a number of projects across the DHB. At the Supporting moment, due to staffing constraints, we are not in a position to offer our usual level of support to hospital wide projects. Following the resignation of the Acting projects Communications Manager and the 0.5 Communications Advisor, we are working on a reactive basis, while compiling a handover document and work plan. An updated version of the Intranet was be rolled out following the Internet Intranet Explorer 11 upgrade. Communications continues to work with service areas to increase the quality of content on their pages.
Health The March edition of Health Highlights focused on Healthy eating and reminded members of the public that they can attend the public section of board meetings. Highlights Our April edition will focus on Advanced Care Planning
Internal Various internal communications were prepared to keep staff updated. The intranet is regularly updated with interesting and relevant content, including communications project updates and introducing new staff.
8. RECENT MEDIA STORIES AND INTERNAL COMMUNICATIONS
8.1 Hutt Inc news Hutt INC is the Alliance Leadership Team in the Hutt Valley. Catch up on all of the latest Hutt Inc news – their February 2018 update is attached as appendix two.
8.2 Appointment announcement Natalie Richardson would like to welcome Emily Marsh as the new Clinical Nurse Manager, Medical Assessment and Planning Unit (MAPU).
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Emily is currently one of the ACNM on the Medical Ward and will commence her new role on 30 April 2018. On behalf of the staff in MAPU, Natalie would like to acknowledge the support and work that Vera Sullivan has done as Interim Clinical Nurse Manager, MAPU. We would like to wish Emily all the very best in her new role.
8.3 Older Person’s Rehabilitation Service (OPRS) “always caring” As part of OPRS' programme of celebrating our new values, they hosted an afternoon tea on 15 March to recognise our value of "always caring" with a special donation from the community.
As part of OPRS’s programme of celebrating our new values, they had an afternoon tea themed “always caring” with treats with green icing to go along with the theme. The Hutt Calligraphy Association also donated a beautiful artwork to the OPRS lounge, depicting clouds with “silver linings”, special thoughts and inspirations for patients to enjoy and ponder. The art work was part of the association’s 25th anniversary.
8.4 Domestic Services staff retire after combined 80 years of service Happy retirement to three of our long-serving Domestic Services staff.
The Domestic Services staff and others took time out of their busy days to say farewell to Annie Whatarau, Beverly Fitzwater and Pani Whatarau who retired on 15 March after a combined service of over 80 years.
Best wishes to you all and thank you all once again for the many years of loyal services you have provided the DHB.
8.5 Rebirth of Sustainability Movement A group of interested HVDHB staff have re-created the sustainability movement. The first meeting was held in February 2018 with the aim of creating sustainability as a social movement within the organisation.
A few projects have already been undertaken including the provision of fillable water bottles to new house surgeons who started a few weeks ago. A water fountain to fill water bottles will be installed in the cafeteria in the near future. All new resident medical staff who will start in the middle of the year, will also be provided with re-usable water bottles, this great initiative has been sponsored by Regional Public Health. We thank them for their support and hope the use of plastic water bottles will reduce over time.
In the near future the Hutt Valley DHB will also be ceasing the purchase of polystyrene cups, which are not biodegradable. These will be replaced by paper cups which are a much more environmentally friendly option.
The group will work with local Councils and other interested groups to network and improve sustainability and be a good co-operate citizen within the Hutt Valley region.
Dr Dominic Monaghan, Emergency Department Specialist has been appointed as Chair of the group and they will meet monthly to look at new initiatives and Hutt Valley District Health Board Page 9 April 2018
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to work through implementation. Dr Sisira Jayathissa, Chief Medical Officer will sponsor the group and would like to invite champions from each area, both clinical and non-clinical.
8.6 Dignity trolley, a final act of kindness A heartfelt initiative by two of our wonderful staff members will make a huge difference to the families of patients who have passed away.
The final moments of a loved one's life for a family can be devastating. Not only would they have had to come to grips with medical jargon and a strange, clinical environment, they are emotionally spent.
The introduction of the “Dignity Trolley” on the medical ward is hoped to offer some support and practical kindness for these families. Laden with beautiful china, tea, coffee and a few special treats, it is hoped the trolley will offer some sustenance and encouragement to weary family members.
The trolley was designed and created by Liz McCloat and Liz Sellers (Medical Ward).
"The concept derived from a conversation between us that there was a need for a more personal approach to families and next of kin when their loved one passed away," explains Liz.
"Through the kindness of our DHB colleagues and the wider community we were over whelmed with the generosity and aroha of exquisite items for the trolley. The trolley will be available for use during the End of Life journey. We have the ability to individualise the trolley to the wide range of items to suit the needs of the family and next of kin."
The trolley will be used for family members when they have been with their loved ones who are in the final stages of life. Liz sourced beautiful ceramic hearts, which will be placed on the door handle of the room the patient is in with their family and the trolley will be made available once the patient has passed away.
The trolley was recently used and the family were very appreciative of the effort and kindness shown.
8.7 Easter Bunny comes early to the Children’s Ward Sacred Heart College students brought smiles to the faces of children at Hutt Hospital on 27 March 2018 when they delivered Easter eggs with their furry friend.
Hospital Play Specialist Tania Pitama said there were so many Easter eggs that staff from the Children's Ward were able to share them across other wards too.
Nurse Sophie worked her magic with some face paint so staff could get their 'bunnies on' and deliver in costume to ED, Children's Outpatients, the Special Care Baby Unit (SCBU), Maternity and OPRS.
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Thank you Sacred Heart College for your wonderful donation.
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BOARD DECISION PAPER
Date: 3 May 2018
Author Kristine McGregor, Executive Assistant to the Chief Executive and Board Secretary
Dale Oliff, Acting Chief Executive Endorsed by Kerry Dougall, Director of Māori Health
Reviewed/approved by The Executive Leadership Team (reviewing on 2 May 2018)
Subject Te Atiawanuitonu partnership agreement
RECOMMENDATION It is recommended that the Board: a) NOTES that management have been working with Te Runanganui o te Atiawa to draft the partnership agreement between Te Atiawanuitonu tribal groups and Hutt Valley DHB; b) ENDORSES the draft terms of reference for Te Atiawanuitonu; c) NOTES that should the partnership agreement be endorsed by the Board, it will be signed by the Tribal Council’s elders and the Chair at the Board meeting being held at Waiwhetu marae on 31 May 2018.
APPENDICES 1. Draft Te Atiawanuitonu partnership agreement
1. PURPOSE
The purpose of this paper is to seek the Board’s endorsement of the partnership agreement between Hutt Valley DHB and Te Atiawanuitonu tribal groups.
2. TE ATIAWANUITONU
Over the last nine months, management have been working with Te Runanganui o te Atiawa to draft and agree the partnership agreement between the DHB and Te Atiawanuitonu tribal groups (Te Runanganui o Te Atiawa, Wellington Tenths Trust, Taranaki Whanaui Ki te Upoko o te Ika). The draft partnership agreement is attached as appendix one.
3. NEXT STEPS
Should the Board endorse the partnership agreement, it will be signed at the Board’s forthcoming meeting at Waiwhetu marae on Thursday, 31 May 2018.
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BOARD DISCUSSION PAPER
Date: 3 May 2018
Author Peng Voon, Acting Chief Operating Officer
Endorsed by Dale Oliff, Acting Chief Executive
Reviewed/approved by The Executive Leadership Team (reviewing on 2 May 2018)
Subject Hospital and Health Services report
RECOMMENDATIONS It is recommended that the Board: a) NOTES that during the August to December 2017 period, approximately 5,800 Bowel Screening FIT kits were issued, with 2,300 returned. This is in line with management’s expectations; b) NOTES the appointment of Chris Mallon to the role of Chair, Midwifery Council by the Minister of Health; c) NOTES that during March 2018, 12 beds were temporarily closed. Service Group Managers, Service Managers and Duty Nurse Managers are monitoring bed requirements on a daily basis. To date, bed requirements have not been effected by the bed closures; d) NOTES that a number of projects are underway across the DHB, including: i. WorkWell; ii. Community Integration (Community Health); iii. Flu vaccinations; iv. Paediatrics; v. Ophthalmology. e) NOTES that Hutt Valley DHB achieved 91 percent against the Shorter Stays in ED target during March 2018. This is a slight improvement on the March 2017 result; f) NOTES that for February 2018, Hutt Valley DHB achieved 100 percent against the Faster Cancer Treatment target, with 12 patients receiving treatment within the 62 day timeframe; g) NOTES that Hutt Valley DHB’s performance against the Improved Access to Elective Surgery health target was 111.4 percent for March 2018, well ahead of the target; h) NOTES that contingency planning is underway to mitigate the risks of potential industrial action by nurses. This includes working with the clinical leads and staff on criteria for Life Preserving Services (LPS).
Adaptable Workforce Living Well
Hutt Valley DHB Strategy Shorter, Safer, Smoother Care Care Closer to Home links Smart Infrastructure
Effective Commissioning
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1. PURPOSE
This report provides the Board with an update on hospital services and progress on the key hospital and system target measures.
Included in the report is the progress on service delivery to patients and key DHB projects and initiatives.
2. HIGHLIGHTS
2.1 Generous Donation helps Vulnerable Patients A donation from a Lower Hutt family of $10,000 will help the Hutt Hospital Dental Unit to provide the safest experience for vulnerable patients, many of whom have disability issues.
The Juno family recently donated a new Welch Allyn vital signs monitor that monitors patients while they are undergoing treatment under sedation. Rachel Juno (aged 27) has first-hand experience of dental procedures where the monitor may be used, having been a patient at the Hutt Valley DHB Dental Unit for 15 years.
“We are really grateful to the hospital to have this facility to come to,” says Mum, Belinda. “We wanted to give something back to the Back row (from left): Dental Assistant Sue Roughton, SMO Dental Unit as the service has been really Dental Geoff Hunt, Belinda Juno; Seated: Rachel Juno with good.” the new monitor.
Senior Medical Officer (SMO) at Hutt Hospital’s Dental Unit Geoff Hunt, said the monitoring unit allows dental clinicians to treat more patients who are unable to cope with treatment in a more conventional manner.
“Already, there has been a reduction in the number of patients we have referred to theatre for dental procedures under general anaesthetic,” he says. “This equipment also ensures that we can continue to comply with regulations that are designed with the health and safety of patients in mind.”
Recent changes to procedural sedation regulations from the Dental Council of New Zealand require patients’ vital signs to be continuously monitored, from the time of drug administration until the patient is discharged in a fit condition.
“Thanks to the Juno family’s generosity, we can take pride in knowing that we are meeting this requirement and offer a valuable service to those most in need,” says Geoff.
2.2 Speech Language Therapist earns Master of Science Degree in Speech Sciences Congratulations to Louise McHutchinson, Speech Language Therapist, on earning her Master of Science Degree in Speech Services from Auckland University. Her dissertation was based on her collaborative work developing a multidisciplinary guidelines for risk feeding.
With support and mentorship from Dr Sisira Jayathissa, Dr Anna Miles, and Dr David Spriggs, Louise conducted interviews with staff, patients, and whānau, as well as a retrospective audit exploring feeding decisions for patients with severe oropharyngeal dysphagia (difficulty or abnormality swallowing).
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Through this study, she identified the need for the development of a guideline to help clinicians, patients, and their family members to navigate the complex decision-making process around the management of eating and drinking in the presence of chronic dysphagia.
2.3 Bowel Screening Since the roll out of the Bowel Screening Programme in July last year, eligible residents have been screened and when necessary, accessed preventative treatment for bowel cancer.
The National Bowel Screening Programme is a free programme to detect bowel cancer at an early stage. It is being offered to those residents who are eligible for publically funded healthcare residents (and who are aged between 60 and 74).
The Hutt Valley DHB programme has embedded well. For the August to December 2017 period, approximately 5,800 Bowel Screening FIT Kits were issued, with 2,300 returned. There have been 121 Positive FIT results with 76 of those patients receiving a colonoscopy at the DHB. Of these patients, 68 had some form of biopsy taken, including polypectomies, thereby reducing the potential for getting cancer at a later stage, and five have had a cancer diagnosis. Of the five, three patients have proceeded to other treatments including surgery. A portion of the remaining patients will still be part way through their pathway with colonoscopies still to occur, having chosen to go private or opt off the programme.
Hutt Valley DHB is receiving positive feedback from patients, including comments on the efficient and friendly service of the team. One of the DHB’s participants emailed to say:
“I am very pleased to have taken part in the National Bowel Screening Programme and would encourage others to do the same.”
2.4 New friends at the Tree Hutt The ‘creatures’ of the Tree Hutt at Hutt Hospital have a whole new host of friends, thanks to the Free Masons, Wellington District.
The TLC (teddies for loving care) project, sponsored by the Free Masons means that any child who comes through the emergency department at Hutt Hospital will have a cuddly friend by their side while they are here and of course, can take their new teddy home with them once they are better.
“This is an on-going project. So far 2.5 million teddies have been given to children in the UK and we are thrilled to be able to trial the programme here in New Zealand,” said Tony Mansfield of the Free Masons.
In addition to calming children down whilst they are in the emergency department, the teddies have also been designed as a diagnostic aid, allowing doctors to show where on teddy the child’s injuries/ illness might be.
Hutt Valley DHB acting Chief Executive Dale Oliff thanked the Free Masons for their help in making the experience of the emergency department a little less traumatic for children.
“We are absolutely delighted with the supportive work you do. We see a moment of magic when there is a positive interface between the parent, Nico Beddis, 4, was thrilled child and clinician. This initiative will really have a wonderful impact for to make a new friend. the children we look after and we really appreciate you being part of that,” she said.
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2.5 Congratulations Chris Mallon The DHB is delighted to be advised of the appointment of Chris Mallon (Service Manager, Women’s and Children’s Health and Director of Midwifery for Hutt and Wairarapa) to the role of Chair, Midwifery Council by the Minister of Health.
2.12 Senior Medical Officer Appointments ∑ Sotiata Leilua, Orthopaedic Surgeon, March 2018; ∑ Jessica Allen, Paediatric SMO, February 2018.
3. INITIAVITES FOR THE COMING MONTHS
3.1 WorkWell WorkWell is a free workplace wellbeing programme that supports workplaces to ‘work better through wellbeing’.
The programme provides a framework that supports workplaces to develop and implement a wellbeing programme that creates a happier, healthier and more productive workplace for their employees that follows a step-by-step process in order to continually improve employee wellbeing. The WorkWell approach is evidence-based and is strongly modelled on the World Health Organization's Healthy Workplaces model. Management will be looking at a range of areas including physical activity, mental wellbeing and healthy eating.
“A healthy workplace is one in which workers and managers collaborate to use a continual improvement process to protect and promote health, safety and wellbeing of all workers and the sustainability of the workplace” World Health Organization, 2010.
WorkWell has a multi-level approach, prompting workplaces to consider employee wellbeing across three levels: ∑ Organisational - ensuring that the workplace's policies, procedures, formal and informal rules support and encourage employee wellbeing; ∑ Environmental - addressing factors in the physical work environment that could either hinder or facilitate employee wellbeing; ∑ Individual - providing opportunities that support and encourage employees to increase their knowledge, behaviours and beliefs or attitudes around wellbeing.
Hutt Valley DHB are dedicated to improving the wellbeing of all of its employees and have signed up to the WorkWell Programme.
3.2 Bed Management During the months of March and April (coinciding with Easter, Anzac Day and the school holidays) there are a number of medical staff taking some well-deserved leave. The DHB have reviewed the use of beds over this period in the last three years and there is the opportunity to temporarily reduce the number of beds for a six to eight week period.
From Monday, 5 March the Medical ward reduced its beds by four. From the 12 March, a further four beds were closed in the Plastics Ward and four on the fourth floor (the Gynaecology and General Surgery, and Hutt Valley District Health Board Page 4 April 2018
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Orthopaedics wards). Service Group Managers, Service Managers and Duty Nurse Managers continue to monitor bed requirements on a daily basis. They have been more visible during this time in order to address any issues that may arise.
In March there was a decrease of 11 percent in overall admissions compared to previous years, with 6.3 percent of the reduction via the Emergency Department. To date, the bed requirements have not been affected by the bed closures.
3.3 Community Integration project Proposed models of practice changes have been endorsed by the Executive Leadership Team, the Alliance Leadership Team, and the Clinical Council with planning underway to implement a number of recommendations. This is a two to five year transformational piece of work with the first priorities being: ∑ A review of current service provision to identify where capacity can be released to work differently and be able to have a responsive same day service; ∑ Investigation and development of a “one point of entry” for referrals for existing DHB community services; ∑ Creation of a single community health service (the DHB currently has five); ∑ Progress the implementation of skill sharing framworks to support transdiciplinary working; ∑ Confirmation and creation of virtual locality teams that are targetted at areas of need; ∑ Expansion of specialist support to practices; ∑ Support of the above with technology enablers.
3.4 Free Flu Vaccination As part of the winter plan, there is an organisation-wide approach to encourage staff to take up the free flu vaccination. The flu vaccination clinics started in mid-April. The national target is 80 percent and the organisation will also be encouraging staff family members to be vaccinated.
3.5 Paediatrics Project During February and March, the Strategy, Planning and Outcomes group and Surgical Women’s and Children’s Health directorate commenced the development of the Paediatrics Service Improvement project. The project plan was endorsed by Child Health Network during March 2018. The focus of the project is reviewing existing service delivery model for specialist paediatric services with a view to looking at options for releasing capacity and /or transitioning services to more integrated and community based models in the future.
Alongside this work, the Paediatric Acute Flow project is progressing well with the focus on winter planning preparedness and improving the flow of children from both direct GP referral and ED into the Paediatrics ward and the Child Assessment Unit.
3.6 Ophthalmology Hutt Valley DHB has commenced a project to review the ophthalmology service model for its population and develop a recommended option. Up until February 2016, ophthalmology services were provided by Capital & Coast DHB at Wellington Regional Hospital. After this time, Capital & Coast DHB surgeons supported the delivery of approximately half of our population’s procedures at Hutt Hospital with the remainder still going to Wellington.
In recent times, a range of issues have materialised with this model, the most significant one being the loss of surgical FTE being provided due to the parental leave of one of the visiting surgeons resulting in the DHB having a growing wait list and having to outsource assessments and surgery to private
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providers. Management believes it is timely to investigate the range of service delivery options that could be possible and develop a preferred option for consideration by the Board.
4. HEALTH TARGETS
4.1 Shorter Stays in Emergency Department (ED) During March 2018, Hutt Valley DHB achieved 91 percent against the Shorter Stay in ED target. This is a slight improvement on the March 2017 result. Compared to March 2017, there was little change to the number of patients who presented to ED in March, however there was a drop of 6.3 percent of those patients who required admission.
Presentations to ED: July-March 2016/17 and 2017/18 2016/2017 2017/2018 Difference % Difference Triage 1 145 185 40 28% Triage 2 4716 4782 66 1% Triage 3 13600 13215 -385 -3% Triage 4 12103 11733 -370 -3% Triage 5 2552 3522 970 38% Total 33116 33437 321 1%
The table above compares the presentations to ED for 2017/18 to the same period last year. The date shows that there has been some increase in triage five (low acuity) presentations, but there has only been a 1 percent overall increase in presentations. The department has started a service improvement project that focuses on the positive side of the target and what the target means to the staff and patients (rather than focussing on speed of throughput).
The paragraph below outlines the work the DHB has planned for quarter three to improve the DHB’s Shorter Stays in ED result: ∑ Triage project: A new electronic triage tool will be trialled. It is hoped this will provide consistent triage outcomes that will have a positive impact on patient flow and patient safety; ∑ Triage nurse side-by-side project: This will trial having two triage nurses sitting out front and should enable patients to be triaged more promptly. ∑ Reconfiguration of the sub-acute area of ED: to accommodate more patients who are ambulatory, avoid putting or keeping patients supine and ensure examination rooms are always available; ∑ A review of demand and rostering– especially in the evenings and overnight to ensure that staffing levels match demand.
4.2 Faster Cancer Treatment For February 2018, Hutt Valley DHB achieved 100 percent against the Faster Cancer Treatment target, with 12 patients receiving treatment within the 62 day timeframe. The DHB’s quarterly performance against the target (that incorporates performance for the previous six months) continues to be above 90 percent.
Implementation of sustainable improvements for lung and skin cancer continue to be a focus. Management are awaiting the outcome of current discussions on progressing work on improving sub-regional breast cancer services (alongside Capital & Coast and Wairarapa DHBs).
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FinYear FinYear Total 62 Day Patient Clinical Capacity 62 Day 62 Day Target Result Target Incl Quarter Patients Breach Breach Breach Patients* Target Met (%) Breachs 2017/2018 Quarter 1 38 1 2 3 35 32 91.4% 84.21% Quarter 2 39 0 1 4 38 34 89.5% 87.18% Quarter 3 35 0 3 2 32 29 90.6% 82.86% 2017/2018 Total 112 1 6 9 105 95 90.5% 84.82% 2016/2017 Quarter 1 45 4 2 5 39 34 87.2% 75.56% Quarter 2 47 1 5 11 41 30 73.2% 63.83% Quarter 3 52 1 2 10 49 39 79.6% 75.00% Quarter 4 40 1 1 3 38 35 92.1% 87.50% 2016/2017 Total 184 7 10 29 167 138 82.6% 75.00% 2015/2016 Quarter 1 46 2 10 5 34 29 85.3% 63.04% Quarter 2 43 0 3 6 40 34 85.0% 79.07% Quarter 3 56 2 3 5 51 46 90.2% 82.14% Quarter 4 48 1 9 9 38 29 76.3% 60.42% 2015/2016 Total 193 5 25 25 163 138 84.7% 71.50%
4.3 Improved Access to Elective Surgery For the 2017/18 year to March, Hutt Valley DHB’s performance against the Improved Access to Elective Surgery target is 111.4 percent. This is made up of 120.7 percent delivered at Hutt Hospital and 93.7 percent delivered at Capital & Coast DHB. The majority of the over-delivery is in arranged admissions (admitted under seven days from decision to treat).
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YTD YTD YTD YTD Full Year Discharges Discharges Discharges Discharges Discharges Row Labels BUDGET VARIANCE PREYEAR BUDGET Hutt Surgical Purchase Unit - Elective MS02016 Skin Lesion 325 349 -24 362 466 S60001 Plastics/Max/Burns Inpatient 517 468 49 473 625 S25001 Ear, Nose and Throat Inpatient 331 330 1 277 440 S45001 Orthopaedics Inpatient 483 427 56 422 570 S00001 Surgical Inpatient 578 548 30 665 731 S40001 Ophthalmology Inpatient 337 232 105 309 310 S30001 Gynaecology Inpatient 437 446 -9 487 595 Surgical Purchase Unit - Elective Total 3008 2799 209 2995 3737 Surgical Purchase Unit - Arranged 618 199 419 283 276 Surgical DRG from a Non Surgical PUC - Elective 7 14 -7 12 19 Surgical DRG from a Non Surgical PUC - Arranged 7 3 4 6 4 IDF Total 3640 3015 625 3296 4036 OFL Surgical Purchase Unit - Elective S60001 Plastics/Max/Burns Inpatient 0 1 -1 1 2 S25001 Ear, Nose and Throat Inpatient 57 76 -19 66 102 S45001 Orthopaedics Inpatient 46 55 -9 52 74 S70001 Urology Inpatient 281 250 31 256 334 S75001 Vascular Surgery Inpatient 122 86 36 92 115 S00001 Surgical Inpatient 69 120 -51 70 160 S35001 Neurosurgery Inpatient 49 50 -1 43 67 S40001 Ophthalmology Inpatient 313 392 -79 315 523 S55001 Paediatric Surgery Inpatient 119 142 -23 141 189 S15001 Cardiothoracic Inpatient 47 48 -1 51 64 S30001 Gynaecology Inpatient 43 74 -31 40 99 Surgical Purchase Unit - Elective Total 1146 1295 -149 1127 1729 Surgical Purchase Unit - Arranged 213 167 46 226 231 Surgical DRG from a Non Surgical PUC - Elective 74 84 -10 67 112 Surgical DRG from a Non Surgical PUC - Arranged 46 33 13 59 45 IDF Total 1479 1579 -100 1479 2117 Grand Total 5119 4594 525 4775 6153
4.3.1 ESPI2 and ESPI5 compliance Jan Feb March April ESPI 2 - FSAs ESPI 5 - surgery
The services that were non-compliant for ESPI2 were ENT, general surgery and ophthalmology. Service that were non-compliant for ESPI5 were orthopaedics and ophthalmology. Hutt was given dispensation from Ministry of Health for being non-compliant for ESPI2 and a plan is in place to address access issues.
4.4 Hospital Average Length of Stay (ALOS) The ALOS for March (excluding ED patients) was 2.52 days. For the 2017/18 year to date, 339 less patients have been admitted compared to the same period last year. This was across all three types of admissions – acute, arranged and electives.
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Admit Grp Data 2015/2016 2016/2017 2017/2018 Acute Discharges 1257 1252 1132 Avg Caseweights 0.91 0.96 0.99 Avg LOS 3.20 3.35 3.71 Day Case (%) 28% 20% 19% Arranged Discharges 569 798 678 Avg Caseweights 0.75 0.73 0.69 Avg LOS 3.26 2.76 2.95 Day Case (%) 31% 44% 44% Elective Discharges 1069 1044 945 Avg Caseweights 0.76 0.83 0.83 Avg LOS 0.70 0.87 0.79 Day Case (%) 77% 74% 75% Total Discharges 2895 3094 2755 Total Avg Caseweights 0.82 0.86 0.86 Total Avg LOS 2.29 2.36 2.52 Total Day Case (%) 47% 45% 44% Note: ∑ The increase in the caseweights in acutes is a reflection of the complexities of admissions. This has driven the increase in length of stay in acute admissions; ∑ There were little change in electives.
Key initiatives to reduce ALOS include: ∑ Health pathways being developed so that GPs know to call physicians before referring; ∑ Development of acute clinics and seeing patients in urgent clinics rather than in ED; ∑ Analysis of frequent admissions to the hospital. This analysis is now complete and showed lack of coordinated system to manage the more complex patient such as those with chronic obstructive pulmonary disorder (COPD). Moving forward, actions will include working closely with PHOs, After Hours and respiratory nurses to support the patient and their families; ∑ Working with ICT on the development of an electronic whiteboard so that staff in the wards are aware of the ‘waste’ or delays in discharge from the hospital. This is part of the Red2Green initiative.
5. KEY RISKS
5.1 Community Health Services Workload over winter It is likely the demand for community health services will be higher over the winter months. The team are looking at entry and exit criteria and how to work with referrers to reduce the number of referrals that only need one visit (26 percent of all personal care referrals). Other initiatives include recruiting to budgeted FTE levels, and working with primary care on education opportunities.
5.2 Potential Industrial Action by Nurses Contingency planning is underway to mitigate the risks of potential industrial action by nurses. This includes working with the clinical leads and staff on criteria for Life Preserving Services (LPS), rosters as well as primary, ambulance and private services to mitigate the impact.
6. PROFESSIONAL LEADERS REPORTS
6.1 Dr Sisira Jayathissa, Chief Medical Officer (CMO) 6.1.1 Emergency Department Accreditation and After Hours Medical Service
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A meeting has been held recently between DHB staff, After Hours Medical staff and key stakeholders to discuss surges in patients presenting to ED after 10.00 pm (when the Afterhours Medical Centre closes). These surges have the potential to create extra pressure in ED (when the number of doctors in ED reduces to two). During the meeting, an action plan was developed that will mitigate the pressure.
6.1.2 Choosing Wisely Two major Choosing Wisely initiatives begun last month. All new patients attending medical outpatient clinics will be sent four ‘choose wisely’ questions prior to their appointment that they can ask the Doctor during a consultation. These questions were developed by the Council of Medical Colleges. Management hope this will empower patients to ask questions and to discuss what matters to them during a consultation.
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6.2 Claire Tahu, Director Allied Health, Scientific and Technical (DAHST) 6.2.1 Education Review Office (ERO) Review for Hospital Play Service The Ministry of Education (MoE) have recently visited the the Hospital to undertake an ERO (Education Review Office) review of the Hospital Play specialist service on the Children’s Ward. As the DHB is a licenced play service it is required to complete an ERO review as determined by the
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MoE. The report is due in a few weeks and will enable management to begin to review the service in light of any recommendations.
6.2.2 Allied Health Career Framework Work has begun with the Anaesthetic Technicians and a draft concept of what their framework will look like has been developed. Due to the direct link of this work to the multi-employer collective agreement (MECA) and the ongoing bargaining of the PSA Allied, Public Health and Technical MECA this work will remain in draft until the parameters of the new MECA are known.
Initial awareness raising for all Sterile Service staff has been completed and they are currently establishing a working group to begin developing their draft framework.
Phase two of an allied health career framework is to complete a service needs analysis for the service or profession. The following five therapy professions are now at a point to begin stakeholder engagement: ∑ Physiotherapy; ∑ Occupational Therapy; ∑ Social Work; ∑ Speech Language Therapy; ∑ Dietitians.
The engagement work will take the form of surveys to various staff groups and individual interviews with key stakeholders in order to gain an overall picture of the stakeholder needs from these professions.
6.2.3 Therapy Assistant Development Project A core competencies document has now been developed for this group. This document has gained feedback through consultation from the assistant workforce and therapy staff. The next part of this project is the development of a generic role description for all therapy assistants including agreement on title and baseline qualification.
6.2.4 Medical Services Improvement Project Allied Health, Scientific and Technical are now part of this project and represented on the steering group. An initial awareness session for the Red2Green project has been completed with the Professional Leaders and Team Coordinators for the five therapy professions. The next phase is to provide input into the proposed whiteboard changes and review the analysis of the initial pilot of the system.
6.2.5 Supervision in Scientific and Technical Professions A needs analysis has begun to determine the requirements of supervision in the scientific and technical professions. There is currently no training of clear standards required for these professions so the aim will be to develop appropriate training and resources to support these professions. The project is beginning with radiology staff and once completed will be made available to all scientific and technical professions across the sub-region.
6.2.6 Celebrations/highlights ∑ The DHB have successfully recruited a Radiology Manager who has started in her role in early April. In addition the vacancies within MRI will be filled by the end of April and those in general x-ray;
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∑ The DHB have successfully had two key roles within the DHB re-scoped under the career framework to be expert clinicians. These are the national paediatric Rheumatology Physiotherapist and the regional cleft Speech Language Therapist; ∑ The National Allied Health, Scientific and Technical conference will be run in Wellington in early May. Presentations from three Hutt Clinicians have been accepted for the programme.
6.3 Chris Kerr, Director of Nursing (DoN) 6.3.1 Congratulations to the staff of the Older Persons Rehabilitation Service (OPRS) Management are pleased to acknowledge the staff of OPRS who achieved a ‘Continuous Improvement’ (CI) rating following the recent Surveillance Audit of our DHB against the NZ Health & Disability Service Standards. Receiving a continuous improvement rating is very hard to achieve and that sustainable improvement must be evident.
The criteria OPRS met to achieve this ‘CI’ rating is: “The use of enablers shall be voluntary and the least restrictive option to meet the needs of the consumer with the intention of promoting or maintaining consumer independence and safety”.
Feedback from the Auditors was that the achievement is for the programme of activity and distraction that has been implemented in the OPRS East wing with use of equipment and staff trained to divert, engage, distract and de-escalate behaviours for challenging patients in this area. This has resulted in a more settled environment and fewer episodes of aggressive behaviour. The programme has been formally reviewed with positive outcomes, including greater participation and socialisation, and is now business as usual activity for patients in OPRS.
6.3.2 Nursing at its Best’ Project – Key achievements of the first three months work The ‘Nursing at Its Best’ project, developed to look at ways to support the nursing resource across the hospital, has been in place for three months. The achievements over this period include: ∑ Development of Patient Observation Policy, flowchart and request form to support and guide nursing staff with the level of observation required for patients who need close observation; ∑ Development of a pamphlet for patients and their families to describe patient observation within a hospital environment; ∑ Development of standard job descriptions and interview templates in line with values based recruitment and processes implemented to support filling nursing vacancies with the right skill mix; ∑ Development of a Relocation Policy, a values based booklet and decision support tool to guide the staff when relocated to help in another area of the hospital; ∑ Development of annual leave tool kit to support Clinical Nurse Managers. The kit includes annual leave process flow chart, annual leave planning, updated annual leave form and annual leave plan and letter templates for managers to be able to have a discussion and follow up letter for nursing staff who have high leave balances; ∑ Development of a survey for staff and volunteers to measure understanding of volunteers within the organisation; ∑ Two students from Upper Hutt College are interested in a nursing career through the gateway programme and contracts are being set up. ∑ During a team planning day in March, it was agreed to continue to develop the ‘Nursing at its Best’ concept and adopt it as the name of the Hutt Valley DHB Nursing Strategy and Action Plan so that staff can continue to build on the great work already started, continuing to involve and engage with the Clinical Nurse Managers and the whole of the nursing workforce.
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BOARD DISCUSSION PAPER
Date: 4 April 2018
Author Amber O’Callaghan, General Manager, Quality, Service Improvement & Innovation
Endorsed by Dale Oliff, Chief Executive (Acting)
Reviewed/approved by The Executive Leadership Team (reviewed on 11 April 2018)
Subject Hutt Valley DHB Quality and Safety update
RECOMMENDATIONS It is recommended that the Board: a) NOTES that the Consumer Council Establishment Chair interviews are being scheduled for the second week of May 2018; b) NOTES the work of the Hutt Valley DHB Quality and Patient Safety Committee (QPSC) that last month received reports from the Infection Prevention and Control Committee (IPCC), and the Violence Intervention Programme (VIP). The IPCC were commended for the work that they continue to do and are noted to be a high functioning committee. The VIP group were supported by feedback to help address the challenges faced in implementing the programme at Hutt Valley DHB; a presentation to the ELT to ensure leadership and accountability for the programme is planned for May 2018; c) NOTES the addition of an Improvement Advisor to the Quality, Service Improvement and Innovation team who brings experience in process improvement (including Lean and Six Sigma), Project management and engineering. His skills are being put to good use coaching others in improvement methodology, and he is supporting quality projects and initiatives across Hutt Valley DHB; d) NOTES the draft Certification HealthCERT Service Provider Audit Report was received following the Surveillance Audit that took place from 6 to 8 March 2018; work has begun on developing an action plan to address identified areas for improvement; e) NOTES the latest data included in the Hutt Valley DHB Quality and Patient Safety dashboard for March 2018 that is generally in line with previous months. Special cause variation was noted for the number of complaints open and not responded to within 20 working days. The number outside the 20 day timeframe has been increasing over the last several months, and has coincided with a change in process, where services are responding to some complaints without the involvement of the QSI&I team. QSI&I will work with the services to identify any areas of the process that will contribute to more timely responses; f) NOTES that the number of reported events in the Staffing category demonstrates special cause variation with fewer staffing events being reported. This lower number may therefore be a positive outcome reflecting improved levels of staffing, although other factors may also be contributing, such as requests for staff to cover roster gaps that are not due sickness, and to provide close care. It is also possible that staff reporting behavior has changed. The QPSC will consider this category of events at the next meeting. The Director of Nursing will lead the committee’s discussions, and consider what actions, if any, need to be taken; g) NOTES the work building the DHB’s Quality Improvement capability and capacity in Quality Improvement and Patient Safety for 2017 – 2019. Different training options are being offered to staff at different levels, and both e-learning and face to face options are available;
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h) NOTES that the March 2018 Quality Walk-Round was held in the Plastics and Burns ward where the ELT were impressed with the welcoming and engaging feeling, and enthusiastic and engaging staff who “go that step further.”
Effective Commissioning Adaptable Workforce Hutt Valley DHB Strategy links Shorter, Safer, Smoother Care Living Well
1. PURPOSE
The purpose of this report is to provide the Board with an update on key Service Quality and Safety activities at Hutt Valley DHB.
2. CONSUMER ENGAGEMENT AND PARTICIPATION
Consumer participation and effectiveness is about patients and their families/whānau making decisions about their own care and taking part in the design, delivery and evaluation of the services they use.
The DHB receives consumer feedback through its complaints and compliments processes, DHB-specific patient satisfaction surveys and consumer group forums. This information is analysed and directly informs continuous quality improvements.
2.1 Consumer Council establishment – update Work is progressing to ensure that management has the Hutt Valley Health System Consumer Council embedded by early 2018.
Management are interviewing for the Establishment Chair first, before progressing the process for interviewing for Council members. The dates for the interviews are being finalised, and are expected to have been completed by the second week of May 2018. A preferred applicant for Establishment Chair will be recommended to the Board by the Chief Executive, prior to making an appointment. Once the Establishment Chair has been appointed, management will then look at the process for appointment of Consumer Council members.
The skill set being sought for in the Establishment Chair includes: ∑ Chairing groups with different backgrounds, abilities and gathering the multiple voices; ∑ Handling busy agendas and prioritising to what is important; ∑ Assimilating an understanding of sometimes complex systems and the role needed to be played in them; ∑ Dealing at multiple levels in large organisations; their degree of comfort in working with governance; ∑ Handling ambiguity; ∑ What drives them personally; their values.
3. A COMMITMENT TO WORKING ON QUALITY AND SAFETY
A Hutt Valley DHB value is being our best: one of the ways staff model this is by looking for and acting on opportunities for improvement and innovation. Staff aim to make sure that improvements made are sustainable by making process and system-level improvements. Hutt Valley DHB is building its capability to use the Institute for Healthcare Improvement (IHI) – Model for Improvement as our key improvement methodology.
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3.1 Hutt Valley DHB Quality & Patient Safety Committee update The Quality and Patient Safety Committee (QPSC) is the key committee for enabling clinical governance; ensuring the organisation has appropriate systems and process for patient safety, and learning from events. The committee meets monthly; as part of the agenda the committee reviews the quality and patient safety dashboard. The dashboard includes key patient safety metrics such as events and patient feedback, new and reviewed serious and sentinel events, and receives updates from sub-committees.
In March 2018, the QPSC met and received reports from the Infection Prevention and Control Committee (IPCC) and an update from the Violence Intervention Committee.
The Chair of the IPCC, Dr Matt Kelly, presented on behalf of that committee. The QPSC noted the IPCC to be a high functioning committee with a clear terms of reference, workplan and annual report based on the Health and Disability Sector Standards. The auditors who conducted the recent DAA Group surveillance audit followed eight patients to assess IPC standard, and were impressed with the performance across the system. Dr Kelly noted that the team has worked hard over several years to achieve this. The IPCC was requested to include an update on the Anti-Microbial Stewardship Programme in the next report, in six months’ time.
Lynn O’Toole and Claire Southward gave a brief update on Violence Intervention Programme and received feedback on how to address the challenges facing the programme, including attendance at training, engaging clinical champions, and increasing rates of screening for intimate partner violence. Amber O’Callaghan, Chair of QPSC will join Lynn in presenting the work and its challenges to ELT to develop a way forward.
The QPSC completed its routine work in reviewing the QPS Dashboard (noting no special cause variation in the February data), noting preliminary reports for adverse events in two services, and confirming the review of one patient who suffered a fall with harm while an inpatient.
3.2 Quality Improvement Programmes and Projects The Quality, Service Improvement and Innovation (QSI&I) team supports quality projects and initiatives across Hutt Valley DHB. The team has recently welcomed a new team member: Vivian Martin, Improvement Advisor. Vivian has experience in process improvement (including Lean and Six Sigma), Project management and engineering. He has previously worked in a range of non-health industries including telecommunications and IT both in New Zealand and internationally. It’s great to have these skills and a set of fresh eyes in the team; he continues be oriented to the organisation and has joined the project team working on the Shorter Stays in ED health target, and is coaching others in improvement.
3.3 Certification Surveillance Audit – update Certification is the auditing of inpatient services provided by Hutt Valley DHB to ensure it complies with the Health and Disability Sector Standards. Hutt Valley DHB has a service agreement with the Designated Auditing Agency (DAA) Group to provide certification services as our audit agency.
Hutt Valley DHB underwent an on-site Surveillance Audit for Certification from 6 to 8 March 2018. A copy of the Draft HealthCERT Service Provider Audit Report has been received; work has begun on developing an action plan to address areas identified for improvement.
3.4 Quality and Patient Safety Dashboard –March 2018 The Hutt Valley DHB Quality and Patient Safety ‘dashboard’ is under development. The dashboard provides reporting at an organisational level on a small set of quality and patient safety indicators that are internationally recognised in a range of aspects of quality. The data in the dashboard is viewable in one place and includes trends over time presented, where appropriate, in Statistical Process Control (SPC) charts. The SPC charts show an Upper Control Limit (UCL) a Mean and a Lower Control Limit (LCL).
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Presenting the data in this way enables staff and management to identify common cause variation (those causes inherent in the system over time that affect everyone working in the system and affect all outcomes of the system), and special cause variation (those causes not part of the system all the time or that do not affect everyone but arise because of specific circumstances).
The Hutt Valley DHB Quality and Patient Safety Dashboard Indicators include: ∑ the number of reported events; ∑ reportable events by service; ∑ reportable events by category; ∑ feedback data – number of complaints; ∑ themes of complaints; ∑ complaints received by service; ∑ open complaints by service; ∑ patient falls events reported; ∑ medication error events reported; ∑ skin/tissue events reported; ∑ safe staffing events reported.
The data included in the dashboard is drawn from Hutt Valley DHB’s Safety, Quality and Reportable Events (SQuARE) database, on the first available working day of the month.
The QSI&I team is working with the Health intelligence & Decision Support team, and Lightfoot on a piece of work that will enable SQuARE data to be pulled into the Lightfoot information, this will enable management to be able to build a ‘live’ Quality and Patient Safety dashboard. This is based on the “Signal for Noise” programme, where control charts are used to identify special cause variation in the DHB’s data. Bringing this into this system will also mean that staff will be able to easily identify and adjust for seasonal variation. A live dashboard will mean that managers closer to care will be able to see, in real time, what is happing in their areas of accountability. This will also free up capacity within the QSI&I team to be able to help teams understand the data and provide improvement support.
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Reportable Events
Commentary Suggested Action The number of Reportable Events received this month is consistent Continue monitoring. with what would be expected through normal common cause variation.
Commentary Suggested Action Of the events reported in March 2018, 40 percent (n=107) of the total Continue monitoring. number reported originate from Medical Services. This is a similar pattern to previous months. The top five departments were Medical Ward (n=51), Emergency Department (n=24), MAPU (n=20), Te Whare Ahuru (n=13), CATT (n=12).
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Commentary Suggested Action For the events reported in March 2018, 20 percent (n=53) of all events Continue monitoring. occurred in Staff and Other Health and Safety, 14 percent (n=39) occurred Drilled down into data for in Clinical Care/Service/Coordination, Safety and Security, 13 percent the majority groups is in (n=34) occurred in Medication, and 13 percent (n=34) occurred in patient progress. falls – these account for 59 percent of all reportable events logged.
Reportable Events Key Clinical Indicators
Commentary Suggested Action The number of patient fall events logged on SQuARE during March 2018 is Continued monitoring by consistent with what would be expected through normal common cause the Falls Prevention variation. Committee with active No special cause variance/trend identified. implementation of falls Noted that the target for patient falls in hospital is that no falls should prevention strategies. occur.
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Commentary Suggested Action The number of medication events logged on SQuARE for March 2018 is Continue monitoring consistent with what would be expected through normal common cause and analysis by the variation. Medication Group. No special cause variance/trend identified. Noted that the target for medication errors in hospital is that none should occur.
Commentary Suggested Action The number of skin/tissue events logged on SQuARE for March 2018 is Continue monitoring consistent with what would be expected through normal common cause and analysis by the variation. Pressure Injury Group. No special cause variance/trend identified. Noted that the target for hospital acquired skin tissue events (pressure area events) is that none should occur.
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Commentary Suggested Action The number of reported events in the Staffing category demonstrates special Continue cause variation, with fewer staffing events being reported. A staffing event form monitoring and is completed when a staff member reports an incident that is related to safe drilling down to staffing, skill mix, availability or co-ordination. ward/department This lower number may therefore be a positive outcome reflecting improved level. levels of staffing, although other factors may also be contributing – this prompted a closer review of the events data. In summary: The Emergency Department and After Hours Management are the departments who most frequently report staffing events with 177 events and 107 events reported respectively for the time period March 2016 and March 2018. All other wards, including delivery suite have reported between eight and 30 events over the same timeframe. Note that one event form (particularly from After Hours) may report a variable amount of staffing shortage eg, one Registered Nurse short, or shortages across the organisation. Events are most commonly about nursing staff, with very few events regarding other staff. The reduction in events forms has been apparent in all services, and all severity levels. The 2016 Winter months had large numbers of reports (up to 20 per month in ED and After Hours), in the 2017 Winter numbers were far fewer with departments peaking at eleven per month. There have been a number of changes that may be impacting the number of staffing events reported. Certainly, nursing staff have been recruited up to base requirements in recent months after considerable effort. However, other changes have also occurred in the requests for staff to cover roster gaps that are not due sickness, and to provide close care. It is also possible that staff reporting behavior has changed; while there may still be staffing shortages, staff may not be reporting. A field in the event form is completed (usually by the Charge Nurse Manager) to close the event with the title ‘Action taken to prevent recurrence.’ Several of these responses use similar terms: ‘unlikely to be prevented in the short term,’ ‘CCDM FTE Calculation,’ ‘risk mitigation only.’ These responses may be deterring future reporting. The QPSC will consider this category of events at their next meeting. The Director of Nursing will lead the committee’s discussion, and consider what actions, if any, need to be taken
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Feedback
Commentary Suggested Action The number of complaints logged on SQuARE for March 2018 (n=29) is Continue monitoring. consistent with what would be expected through normal common cause variation. No special cause variance/trend identified. Overall trend indicates a rise in complaints for 2017 compared with the partial data available for 2016.
Commentary Suggested Action Complaints received (including HDC complaints) for March 2018 Services continue to respond to (n=29) remains consistent with previous months with regard to and learn from complaints. the main spread across Service Groups. Surgical, Women’s and Organisation-wide work on Children’s attracting most complaints (n=12). ‘Shaping our values’ has commenced. Continue monitoring and drilling down to ward/department level.
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Commentary Suggested Action 51 percent of the identified themes from complaints received in Continue monitoring and March 2018 were in the area of the standard of clinical care; 30 percent drilling down to involved Communication. These two categories account for 81 percent of ward/department level. the themes identified in complaints received.
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Commentary Suggested Action Of the open complaints (not including HDC) 34 percent (n=10) are in the Continue monitoring– Surgical, Women's and Children's Service Group and 32 percent (n=9) in services are actively Medical and Acute Care. 44% (n=13) are outside the 20 working day working to respond to response KPI. complaints within the A greater proportion of complaints not responded to within 20 days has expected timeframe. been increasing, the QSI&I team has more closely reviewed the complaints that are outside of the timeframe. One has subsequently been closed. The remaining 12 are spread across the services – five in Medical and Acute, three are in Surgical, Women’s and Children’s, two for Strategy Planning and Outcomes (related to contracted providers) and two for MHAIDs. A small number of these complaints are complex, requiring input from several clinicians and other staff, meetings with the patient and their family – which can take longer than 20 working days to complete; the complainants are kept informed of delays. This increase has coincided with a change in process, where services are responding to some complaints without the involvement of the QSI&I team. QSI&I will work with the services to identify any areas of the process that will contribute to more timely responses.
4. AN ENGAGED, EFFECTIVE WORKFORCE
As part of being a thriving organisation, we want to be: the organisation of choice for people to work in; a place where patients are at the centre of what we do; a place where staff feel valued, have development opportunities, are involved in improving the way we do things; and have a safe and supportive workplace. An engaged and effective workforce focuses on how we are growing staff members to ensure that the people who use Hutt Valley DHB services are getting the best care and the DHB is facilitating the best value health care for our population.
4.1 Growing our people: Quality Improvement Capability and Capacity Plan update The QSI&I team has developed and leads the implementation of the plan to build capability and capacity in Quality Improvement and Patient Safety for 2017 – 2019. The plan is based on models from the Institute
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for Healthcare Improvement (IHI) and the Health Quality and Safety Commission’s (HQSC) Framework ‘From Knowledge to Action’. Different training options are being offered to staff at different levels, and both e-learning and face to face options are available. This plan was able to be progressed in part due to funding from the 2017/18 Innovation Fund.
Training Method Delivered by All health workforce ∑ Improvement Clinics being developed Clinical Leader QSI&I, and tested by QSII – first sessions to Improvement Advisor be delivered in April and Quality Advisors ∑ Improving Together, open access e- Online option learning from HQSC. Being promoted to staff currently Those involved in ∑ Fundamentals of Improvement: three Ko Awatea staff delivering improvement day face to face course, 1 – 3 May. 20 coming to HVDHB projects applicants for course, projects to be (funded by confirmed. Innovation Fund) ∑ Second cohort of Fundamentals course to be delivered in August 2018. ∑ IHI Open School: 13 online modules to Online Option be completed over 12 month period. 12 Staff currently enrolled, available to 50 further staff until 2019. Quality and Safety ∑ Applications received, three staff to Ko Awatea at Experts attend Improvement Advisor Counties Manukau Training. Seven month course, three DHB (two places block courses. funded by Innovation Fund, one through HQSC Scholarship)
4.2 Quality and Safety Walk-Rounds Quality and Safety Walk Rounds (walk-round) involve members of the Executive Leadership Team (ELT) visiting an area in the DHB to meet with patients and staff. The aims include: ∑ demonstrating leadership’s commitment to quality and safety for patients, staff and the public; ∑ increasing staff engagement; ∑ and strengthening commitment and accountability for quality and safety.
Through structured and informal discussions issues can be raised, good practices identified, and actions agreed to improve quality and safety. The walk-rounds have been held on a monthly basis since June 2016.
During the March walkround the ELT visited the Plastics and Burns ward. The ward is very clean, light and airy and there is a very welcoming and engaging feeling when first entering the ward’s reception area. Staff were observed to have a lovely warm, enthusiastic and engaging manner and a feeling that staff “go that step further.” The ELT felt that this gives reassurance to patients and their families about the care they would receive on the ward. The patients spoken to also reflected the very positive and welcoming environment, and that they felt very well cared for and looked after.
“I receive quality care every time I come in; I am very grateful for the service I receive.”
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“If I was the Chief Executive I would not change a thing! They are doing what I would do if I was in charge.” “It is really quiet at night and I can sleep. There is always a smile from staff and I feel well informed.”
It was obvious to the ELT that staff are living the DHB values and are very patient centric.
The ward is very well organised, there is a high level of cleanliness and despite the constant challenge for space, the ward is uncluttered. There is a lot of good information available to both patients and staff with everything having a place (and in its place). It was very pleasing to see that a high standard has been maintained since the ELT’s last visit to the ward nearly a year and a half ago.
Staff feel well supported and note that there is a really good relationship amongst staff and fantastic leadership which is reflected by the low turnover of staff.
“The CNM and the ACNM are happy to put their uniforms on and take a patient load, this is great team work.” “This ward is very well organised, it is a nice environment and everyone is really supportive.” “I want to make patients’ days better, it is very satisfying.” “I am really proud to work here and it makes my heart sing when patients walk out the door.” “The toilet seat was broken and it was immediately attended to, with a BEIMS request and a note to say that toilet was going to be repaired and when.”
Members of the ELT and staff from left to right: Tofa Sufafole-Gush (Director Pacific People’s Health), Claire Tahu (Director Allied Health Technical and Scientific), Dale Oliff (Acting Chief Executive), Judith Parkinson (General Manager Finance and Corporate Services), Amber O’Callaghan (General Manager Quality, Service Improvement and Innovation), Linda Roeters (Nurse Educator), Angela Gillman (Clinical Nurse Manager), Carolyn Braddock (Service Manager)
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BOARD DISCUSSION PAPER
Date: 3 May 2018
Author Helene Carbonatto, General Manager – Strategy, Planning and Outcomes
Endorsed by Dale Oliff, Acting Chief Executive
Reviewed/approved by The Executive Leadership team (reviewing on 2 May 2018)
Subject Update from Strategy, Planning and Outcomes
RECOMMENDATIONS It is recommended that the Board: a) NOTES the development of the Clinical Services Plan is on track to be completed in June 2018; b) NOTES the development of the Wellness Strategy continues to progress well, and the draft Wellness Strategy discussion document has been circulated amongst the DHB’s key stakeholders; c) NOTES the procurement process for youth mental health respite services is close to completion, with a letter of offer being issued to the preferred supplier (Emerge Aotearoa);
d) NOTES that procurement for Regional Alcohol and Other Drug Acute Residential Treatment is nearing completion. The proposals were evaluated 9 – 19 April 2018; e) NOTES work underway to implement an integrated winter plan across the health system in 2018; f) NOTES two primary care practices (Ropata Medical Centre and Hutt City Health Centre) are on track to go live as Health Care Homes in July 2018; g) NOTES the work that is currently underway locally and sub-regionally to plan for the Inquiry into Mental Health and Addictions visit in May 2018; h) NOTES that DHBs have embarked on a national review of the Aged Residential Care (ARC) funding model. The review will include: examining the strengths and weaknesses of the existing ARC funding model, and finding a preferred funding model that will drive and incentivise the right models of care and outcomes; i) NOTES the update on rheumatic fever as requested by the Board at its March 2018 Board meeting.
Effective Commissioning Adaptable Workforce
Hutt Valley DHB Shorter, Safer, Smoother Care Living Well Strategy links
Care Closer to Home
1. PURPOSE
The purpose of this paper is to provide an update to the Board on the work being progressed within the Strategy, Planning and Outcomes group (SPO).
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2. STRATEGIC WORK PROGRAMME
2.1 Clinical Services Plan The Clinical Services Plan (the Plan) is due for completion in June 2018. There remains only one final meeting on the 1 May 2018 that brings together the over 100 people who have participated in the more than 40 meetings and workshops that have been held as part of developing this Plan. The final meeting will bring together all the key findings and directions, and confirm the proposed options in the final draft.
The Plan will not address the specific services that may form part of a wider network of services across the sub-region; rather, it will identify the possible configurations across the sub-region, and propose to establish governance and institutional arrangements across both Boards to develop and finalise those options.
2.2 Wellness Strategy The Wellbeing Strategy aims to provide a strategic framework for how the DHB invests in wellbeing promotion and engages with other stakeholders in this space. The development of the Wellbeing Strategy has progressed well and in accordance with the project plan.
The draft strategy discussion document has been circulated amongst key stakeholders: government agencies (Housing New Zealand, the Ministry of Education, the Ministry of Social Development, ACC, Corrections, and Police), local government, iwi and community providers. The project lead has met with key representatives from these agencies to explain the background to the Strategy and seek stakeholder input. These meetings have provided an opportunity to develop the DHB’s relationships with these key stakeholders. Input from the wider sector has been collated and reviewed by the project group.
The next steps are drafting the Strategy and submitting for review by the project group.
2.3 Te Whare Ahuru reconfiguration The two phase programme of work to better understand the current and future inpatient mental health needs of the Hutt Valley district and develop options for the reconfiguration of Te Whare Ahuru (TWA) continues to progress well. During phase one, a series of workshops with stakeholders, consumers and staff have been held culminating in a Patient Journey Workshop on 28 March 2018. The information from these workshops, an in-depth data analysis and a literature review are now being combined to develop a model of care that will inform the unit’s redesign in phase two. The final report for phase one is due in late May 2018.
2.4 Youth Mental Health Respite services The procurement of much-needed youth mental health respite services for Capital & Coast and Hutt Valley DHBs is almost finalised, with Hutt Valley DHB leading the procurement. Following completion of an open procurement process via the Government Electronic Tenders Service (GETS), a Letter of Offer has now been issued to Emerge Aotearoa Limited (Emerge).
Currently staff from Hutt Valley DHB, the Mental Health Addictions and Intellectual Disability Service (MHAIDS) 3DHB, and Emerge are in a co-design process to ensure the most effective service possible is implemented. It is now intended for this service to be in place by 1 August 2018; this will largely be dependent on Emerge being able to secure an appropriate residential property in a central location.
2.5 Infant, Child, Adolescent and Family Service (ICAFS) review Implementation of the decisions relating to the review of ICAFS are now well advanced. Wait times have continued to improve and as at 19 March 2018, the wait time for first appointments was under five days, with urgent appointments being managed within 24 hours.
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There has been very positive feedback on the six month pilot to manage referrals to ICAFS through Te Haika and an evaluation is planned for May 2018 to determine if the pilot should be extended.
Implementation of a new team structure has started with all staff now having been confirmed into one of the two new teams. Recruitment is still being completed for the two Team Leader positions that remains a key risk. Management anticipates having the new structure in place by the start of April.
2.6 Regional Alcohol and Other Drug Acute Residential Treatment (AODART) procurement The procurement process for the provision of regional AODART services, led by Capital & Coast DHB is well advanced with the Request for Proposals (RFP) having closed on GETS on 28 March 2018. Evaluation of proposals will begin the week of the 9 April, and conclude on the 18 April. Exit meetings with affected current providers (Nova Trust, Salvation Army and Odyssey Auckland) have been completed. The new services are anticipated to be in place by 1 November 2018 and any required transition planning of clients in contracted services expiring 31 Oct 2018 will require coordination during the establishment phase of the new service arrangements.
2.7 Integrated Initiatives 2018 to battle Influenza Season The 2017/18 Northern Hemisphere influenza season has been marked by high influenza activity. The USA and UK have had a particularly severe season when compared with recent seasons (see figure on the following page for USA).
There has been no single influenza type driving the influenza activity in the Northern Hemisphere. In the USA, influenza A has been the main type of influenza detected, with the major strain being influenza A (H3N2) (the ‘Aussie flu’). In contrast, influenza B has been the major circulating type in Europe and UK.
Hutt Valley DHB is actively preparing for a likely significant influenza season. Vaccination remains the key strategy to reduce the burden of influenza-related disease. This year, the vaccine contains four influenza
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strains: two influenza A and two influenza B. This year’s vaccine has an additional influenza B strain when compared with last year and a new influenza A (H3N2) strain that is better matched to the circulating ‘Aussie flu’.
The DHB has developed a winter plan across the system to ensure that demand is proactively managed over the likely busy winter flu season. An operational committee from across primary and community care through to hospital meets weekly to oversee the plan. Core to the Plan is immunising staff, keeping both unwell patients and visitors from the hospital site where possible, establishing isolation bays across the hospital, the roll out flu immunisation in primary care, proactive management of respiratory patients in primary care, and implementation of good infection control policies in clinical areas. Work is also underway more broadly with aged care and other health providers to ensure they also have wellbeing plans in place to immunise staff.
A number of other acute demand initiatives are also underway with the aim to address and manage the increased demand experienced on health services, especially over the winter period.
2.7.1 Acute Paediatric Model Project The focus for 2018 is on improving the model and flow for children once they attend ED. This includes establishing clear pathways and for children to be treated and discharged home from ED, have access to additional paediatric support or transition to the inpatient ward. The focus for 2019 will be establishing community access to acute specialist paediatric assessment clinics.
2.7.2 GP acute availability Ensuring same day acute appointment availability in Hutt Valley General Practices. This includes providing support to practices with the reception and triage process for booking same day appointments and the ability to monitor metrics in the practice.
2.7.3 Active follow up for people with frequent admissions Identifying and targeting proactive follow-up prior to winter in primary care for a cohort of people with frequent admissions in 2017 and at risk of further hospitalisation over the 2018 winter period (focuses on Ambulatory Sensitive Hospitalisation (ASH) related admissions for respiratory and other Long Term Conditions (LTCs). This has also been aligned with the cohort identified through the primary care LTC risk stratification tool and implementing follow up early alongside flu vaccination work in primary care.
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2.7.4 Winter communications Implementing consistent winter messaging to the Hutt Valley community focusing on wellness over the winter period and accessing health care at the right time in the right place. This will utilise many of the resources and messaging developed last year and will include a broader reach and targeting to primary care, early childhood settings, schools, workplaces, sports groups, Regional Public Health and on-going social media mechanisms. Some messaging will focus on childhood illness due to the on-going pressure on primary care/ED and on injuries in the 14 – 29 year old group due to the increase in triage five (low acuity) ED attendances.
2.7.5 ED messaging Implement and embed consistent messaging to community members attending ED who could be managed in the community and providing education to clinically appropriate triage four and five on where best to access care next time they are unwell. This includes implementing further refinements to the communications mechanisms within ED and broader promotion with ED staff to ensure consistent educational messages are distributed from the ED team.
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3. INTEGRATION WORK PROGRAMME
3.1 Health Care Home The Health Care Home (HCH) programme is progressing well, with the five tranche one HCH practices1 undertaking training in preparation for the development of their HCH implementation plans.
Ropata Medical Centre and Hutt City Health Centre are on track to ‘go live’ as a Health Care Homes in July 2018. These practices are currently implementing the minimum requirements and are developing practice implementation plans that will be submitted to the steering group for approval in May 2018. Once the minimum requirements have been met and the practice implementation plan has been approved, practices will be eligible to receive additional ‘go live’ funding from the DHB.
The HCH peer review training programme has started. The first session on 21 March covered GP Triage, and had a very good turnout. The HCH Clinical Lead, Dr Kirsty Lennon, led this session, with a presentation from Feilding Health Centre (as this Health Centre has approximately 12 GPs completing triage every day). The HCH business analyst also provided background about the tools available for analysing the practice’s acute demand profile that assists in setting up GP triage. This acute demand profiling is now available to practices.
The next peer review session was organised for 10 April, and was on business modelling. It provided hands-on support for each HCH practice to quantify the financial impacts of changing models of care, including forecasting future workforce requirements, demand, revenue and expenses to provide assurance to business owners. After this session, there will be on-going mentoring with HCH business modelling.
The service specifications for practices to ‘go live’ and receive DHB funding has been completed and a monitoring framework with an equity focus has been approved by the steering group. A framework to support the implementation of the three local requirements including equity, consumer co-design and community integration has been developed and will be submitted to steering group for approval in April 2018. An EOI process will begin in late 2018 to identify the year two practices for a rolling implementation.
3.2 Community Integration Project Following the endorsement of the community integration model of care, various workstreams will need to be established to support the phase one projects have been prioritised and include: ∑ Completing Service Delivery Reviews to free up capacity within services; ∑ Developing a Central referral point initially focusing on existing DHB community services; ∑ Develop a single community health service with trans-disciplinary working; ∑ Confirm and implement virtual locality teams targeted to areas of greatest need. This includes: • Reconfiguring the DHB community health workforce (Community nursing, allied health and assistant workforce) into localities and begin piloting integrated care with general practice teams; • Implementing specialist support to general practices and align these with locality areas. ∑ Develop an acute responsive community service to support hospital avoidance and early supported discharge (intermediate care).
There are a range of initiatives already underway through the integration work programme that need to continue in phase one and include:
1 Ropata Medical Centre, Hutt City Health Centre (go live from July 2018); Silverstream Medical Centre (go live from October 2018); Naenae Medical Centre and Waiwhetu (go live from January 2019)
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∑ Continue the acute triage, assessment and management in the home setting and transport by ambulance services for chronic obstructive pulmonary disorder (COPD) patients and expand to other people with LTCs; ∑ Continue and expand direct access to senior medical officer (SMO) advice across specialist services and investigate acute assessment clinics across essential specialist services; ∑ Continue to progress and expand the Palliative Care and advanced care planning (ACP) work programmes to improve access to end of life care.
An implementation plan is currently being developed for the various projects above. The Acute Demand Network will continue to provide oversight of the work programme with an aim to implement new ways of working with general practices (targeted to Health Care Home and non-Health Care Home practices with the greatest need) by January 2019.
3.3 Sub-regional enablers – Health Pathways and Information Management The Health Pathways work programme involves developing Clinical Pathways to provide electronic best practice for primary care. The Health Pathways Steering Group provides oversight to this programme that continues to progress well with over 400 pathways now localised across the sub-region and ongoing improvements in utilisation of this resource in primary care. An external provider has also been selected to complete an evaluation of the Health Pathways programme and outcomes.
3.4 Hutt INC and Clinical Networks Planning is underway to establish a Mental Health Network. Membership is currently being confirmed and the first meeting will be held in May 2018. The Programme Manager for this Network is also working closely with the Capital & Coast DHB network that was recently established to align the work programmes where appropriate. A key component in establishing such a network is understanding the mental health needs of the population, and as a first step a large analytical programme of work is underway.
The first Older Persons Forum is being planned for June 2018 and will provide an opportunity for stakeholders across the Hutt Valley to share the large amount of work taking place to advance the Healthy Ageing Strategy.
4. SPO OPERATIONAL PROGRAMME
4.1 Inquiry into Mental Health and Addition All DHBs received an invitation in early March 2018 to engage with the Inquiry into Mental Health and Addiction recently set up by the new Government. The Inquiry is hoping to visit all DHBs for two days, and meet with as a broad range of local stakeholders to understand the mental health barriers and challenges facing New Zealand. Hutt Valley DHB will be involved sub-regionally when the committee meets with Capital & Coast DHB, with half a day dedicated to meeting with the executive on the key issues regarding mental health across the sub-region. Management will continue to work with the Inquiry to find an appropriate date and time to visit the local community.
4.2 Falls Management Programme Hutt Valley DHB has been successful in securing a contract with ACC ($250,990 per annum for three years beginning on 1 December 2017) to support the implementation of the 3DHB falls prevention and management model. The 3DHB falls management model was developed throughout 2016 and 2017 by a working group through the local Alliance Leadership Teams. This model aims to reduce the incidence and impact of falls and fractures in older people and takes a whole of system approach including the following key components: ∑ Falls risk screening, assessment, triage and management of frail elderly and to manage and treat patients with low impact fragility fractures (delivered by local PHOs and general practices);
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∑ Primary care based fracture liaison and prevention pathways to identify and treat those at risk of osteoporosis (delivered by Compass Health/the primary care alliance trust (PCAT) as a 3DHB function); ∑ In home strength and balance programmes (delivered by local DHB community health teams). ∑ Group based community and balance programmes (delivered by local providers and coordinated by Sports Wellington through a separate contract with ACC as a 3DHB function).
Service specifications have been completed and contracts will be in place in May 2018 to support the implementation of the model. A sub-regional steering group has been established to provide oversight to the model and had their first meeting in March 2018. A 3DHB Programme Manager is currently being appointed to support the roll out and monitoring of the programme. The 3DHBs and ACC will collaboratively review the impact of the programme to understand the implications for on-going investment beyond the three year contract.
4.3 Sudden Unexpected Death in Infancy (SUDI) The DHB has recently contracted with Kokiri and the Runanga to provide safe sleep devices to 400 at risk whānau of SUDI across the district. Both providers have undertaken to locally weave as many of the wahakura as possible rather than purchase the plastic pods. Kokiri marae have also been contracted to provide a safe sleep coordination service, working with midwives, GPs and other key stakeholders to support safe sleep education across the Hutt Valley. This initiative is part of funding provided in Budget 2017 for a national SUDI approach.
4.4. Improving performance of Māori Health services For several months, SPO staff have been actively engaging with Māori health providers to strengthen relationships at the same time managing proposed contractual changes to align with Hutt Valley DHB Strategy. Changes include: ∑ Delivery of high intensity and focused work for whanau with high complex health and social needs. Using a whānau ora / holistic approach, highly trained navigators will be helping whānau to address not only their health needs but to address the social determinants of health; ∑ Using cloud based technology to capture data and reporting mechanisms; ∑ Using Results Based Accountability framework to measure outcomes.
4.5 Tobacco Control Tobacco control funding has been made available to primary care and Regional Public Health (RPH) with a specific focus on helping the system perform against the governments quit target.
Recent work in this area includes the DHB Communications Team and members of VIBE meeting to discuss youth appropriate communication strategies. This work is continuing. During February and March two training days were held for Lead Maternity Carers by the DHB’s Smoke Free Coordinator. Management are awaiting the final evaluation of this training.
Most recent data from Takiri Mai Te Ata Regional Stop Smoking Service for quarter two (October – December 2017) shows the total number of referrals was 766 (65 percent from Secondary Services, 13 percent from Primary Care). Of the total referrals, 29 people enrolled on the programme. The co-validated quit rate2 at four weeks for those on the programme was 20 (69 percent).
The Hapu Mama programme is now running at Kokiri Marae. The Hapu Mama programme is a new incentivised programme that encourages women and their partners to give up smoking.
2 Definition of a 4-week quitter is no smoking (not even a single puff) in the last 2-week at 4-week follow-up Hutt Valley District Health Board Page 8 April 2018
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4.6 Childhood Immunisations 4.6.1 School Based Immunisations The 2017 School Based Immunisation Programme is complete. There has been extensive collaboration with the DHB’s partners in education and primary care to promote and plan for the year’s programme. This included resourcing, referral pathways, communications and public awareness activities. The Public Health team have been proactive in disseminating appropriate information as required.
4.7 Youth Health Services review The review of youth health services scheduled in the annual plan for quarter three 2017/18 is underway. The scope of the review will cover primary care, sexual health and mental health services for young people in the Hutt Valley.
Management are currently seeking participants for the steering group to oversee the review. The steering group is collectively responsible for: ∑ Providing advice and direction to the working group. This includes identifying and understanding key issues relevant to youth health. ∑ Supporting the review process and helping support any improvement work that is identified as a result of the review.
The review will consist of a series of meetings between April and August 2018, with a final paper going to the Board for consideration in September 2018.
4.8 Advancing the pharmacy action plan (including a new contract for pharmacist services) DHBs are currently consulting widely on a proposal to deliver on the Pharmacy Action Plan that is a plan developed in 2016 with the vision of having pharmacist services integrated, delivered in more innovative ways, and across a broad range of settings. There is a strong focus on equity in health incomes, and having pharmacists practice at the top of their scope.
A key part of the consultation is on a new contract for pharmacist services. It is proposed that the new contract will be evergreen and allow for nationally consistent pharmacist services, while enabling some local commissioning within a national framework. It also explicitly recognises the cognitive (advice and counselling) component of pharmacist services and paves the way for pharmacists to be paid for those services, whether or not a medication is dispensed. At present payment is tied to the supply of medication. This represents a significant change in the structure of the contract, although services and payment will initially continue unchanged. Further change will largely occur through a consultative process provided in the contract.
Pharmacies do have the option of continuing on the current contract for up to 1 year but won’t be able to take up any new services unless they move to the new contract.
The consultation period was from 5 March until 10 April and Hutt Valley and Capital & Coast DHBs worked collaboratively to allow pharmacists and other interested people in the region to have a choice of meeting time and location. Management have met locally with Hutt Valley pharmacists and other key stakeholders (primary care and consumers were present at the consultation meeting), and have also had individual meetings with those pharmacists who requested it. There is some confusion as to what the contract means for community pharmacists long term, and there are continued discussions both locally and nationally to understand the issues being raised in these forums. The consultation process and timeline to a new contract being in force from 1 July 2018 will be tight but management have been advised it is achievable.
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4.9 Rheumatic Fever The Hutt Valley is one of ten regions in New Zealand with a high incidence of rheumatic fever. Providing access to rapid sore throat management is one initiative aimed at improving the management of sore throats in high-risk children by preventing the transmission of Group A streptococcal throat infections.
Sore throat assessment and treatment is provided by GPs/Nurses and pharmacists for patients that meet the clinical criteria. The free service is available to people at high risk of developing rheumatic fever. This High Risk Group are: ∑ Maori and pacific children, youth and young adults, aged four to 19 years who normally live in the Hutt Valley and are enrolled in a general practice in the Hutt Valley; ∑ Anyone else aged four to 19 years with a family history of rheumatic fever who is living in the Hutt Valley; ∑ Low socioeconomic areas of the Hutt Valley or are living in crowded circumstances.
At present there are eight general practices and 16 pharmacies actively engaged with the Rapid Response programme. All patients presenting to a Sore Throat Rapid Response clinic are assessed and treated, as appropriate on the day that they present. Pharmacists and GPs emphasis the importance of completing the whole course of antibiotics.
It is worth noting that only about 50% percent of incidence of rheumatic fever have a preceding sore throat.
Raising awareness of the programme is ongoing through relationships with community providers, Te Awakairangi Health Network and the DHB. Resource material has been developed in conjunction with support from community providers that promote sore throat awareness and rheumatic fever. The resources will be distributed through a number of channels including, social media pages, Websites of community providers, monthly advertorial in local newspapers, radio segments on Maori and Pacific radio stations.
There continues to be strong links between the Rheumatic Fever programme and Well Homes programme at RPH with a combined Well Homes and Rheumatic Fever Governance Group meeting quarterly.
Ministry of Health of recently provided the first episode rheumatic fever hospitalisation data for the 2017 calendar year. Overall, the 2017 hospitalisation data for Hutt Valley DHB showed eight hospitalisations (a rate of 5.5 per 100,000) for first episode rheumatic fever - this is an increase of four cases from the 2016 calendar year. The DHB continues to work with its partners, RPH and primary care along with other government agencies to ensure that there is consistent messaging across all areas of Rheumatic Fever prevention with the aim of increasing the number of sore throat checks and reducing rheumatic fever hospitalisations.
5. NATIONAL DEVELOPMENTS
5.1 Aged Residential Care (ARC) review As part of the national agreement with Aged Residential Care (ARC) facilities, DHBs have embarked on a national review of the ARC funding model. The scope of the review includes examining the strengths and weaknesses of the existing ARC funding model, and working through a preferred funding model that will drive and incentivise the right models of care and outcomes. Some of the key issues already identified in the process are: ∑ There is a lack of sensitivity to clients’ needs in the funding model of ARC; ∑ There is a lack of alignment between government policies that relate to ARC;
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∑ Variation in models of care and assessment for older people result in national inconsistencies in ARC outcomes and cost; ∑ Current resourcing is unlikely to provide for future demand in ARC.
The review is narrow in the sense that it is solely focussed around ARC rather than models of care to support older persons, but it will consider if there are any policy settings in the way to maximise our expenditure in this area. The review is due for completion December 2018.
5.2 Pay Equity for Mental health services Work is nearly complete on the implications of moving pay equity settlement to all mental health services in 2018. An announcement on this is due shortly, with implementation planned for October 2018.
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BOARD DISCUSSION PAPER
Date: 3 May 2018
Author Helene Carbonatto, General Manager – Strategy, Planning and Outcomes
Endorsed by Dale Oliff, Acting Chief Executive
Reviewed/approved by The Executive Leadership Team (reviewing on 2 May 2018)
Subject Capital Investment process
RECOMMENDATIONS It is recommended that the Board: a) NOTES the Capital Investment Committee (CIC) provides advice to the Ministers of Health and Finance on the prioritisation and allocation of funding for capital investment and health infrastructure; b) NOTES DHBs are required to follow the Treasury Better Business Case process for all investments requiring CIC approval. This includes four stages: i. Strategic Assessment; ii. Indicative Business Case iii. Detailed Business Case; iv. Implementation Business Case. c) NOTES that DHB’s Clinical Services Plan will support some of the detailed planning required in both the Strategic Assessment and the Indicative Business Case process, but does not yet have a Master Site Plan; d) NOTES the conservative timeframe of four years for new capital in a simple local reconfiguration of services.
Hutt Valley DHB Strategy links Effective Commissioning
1. PURPOSE
The purpose of this paper is to describe to the Board the capital investment process for new facilities.
2. CAPITAL PROCESS IN NEW ZEALAND
The Capital Investment Committee (CIC) is a committee that provides advice to the Ministers of Health and Finance on the prioritisation and allocation of funding for capital investment and health infrastructure. The Health Capital Budget covers both new debt and equity, and the health sector’s capital requirements must be funded from the Health Capital Budget. DHBs are not permitted to access private sector debt to support cashflow (beyond the accepted overdraft for working capital). The Operational Policy Framework (OPF) makes it clear that private debt is for working capital purposes only or where the Minister of Finance has approved a private facility.
The current CIC process applies to capital investment proposals in the public health sector that meet any one of the following criteria:
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i. All investment in fixed assets that require Crown equity; ii. Investment in projects or programmes where one or more of the following applies: a) capital expenditure of $10M; b) capital expenditure of $10M calculated as the capitalized value of future revenues if financed from those revenues (such as a finance lease); c) 20 percent of total assets on the DHB balance sheet. iii. Strategic investments by DHBs that may substantially affect DHB performance; iv. Investments identified as high risk in DHB annual plans (using the State Services Gateway Risk Profile Assessment).
All proposals falling under criteria i – iv require the agreement of the Ministers of Health and Finance.
2.1 Better Business Case Process DHBs are required to follow the Treasury Better Business Case process for all investments requiring CIC approval. Figure one below shows the four stages, their deliverables and the approval decisions at each stage. As can be seen, there are at least four key steps and decision points to get capital approval from Government, with more and more detailed planning and costings as the DHB moves through the process.
Figure one: Better Business Case process and Approval stages
•Intervention Logic Map Strategic Assessment •Problem (Approved by CIC) •Benefits •Strategic Response
•Make the Case for change Indicative Business Case •Long list of options/short list of options (Cabinet Decision) •Alternative procurement considered •Range of costs estimate
•Determine potential value for money Detailed Business Case •Prepare for the potential deal (Cabinet decision) •Ascertain affordability and funding •Plan for successful delivery
•Procure the value for money options Implementation Business Case •contract the arrangements (Decision - joint Ministers) •ensure successful delivery
Each of the above steps take approximately 12 months (except the Strategic Assessment that should take about six months) – assuming the process is strictly adhered to and the business cases are approved the first time around. Therefore it would take between three and four years simply to get the range of approvals required, alongside the detailed planning, to start any capital project. Due to the changes to the Ministry of Health’s (the Ministry’s) leadership, it is unclear yet how it will drive these capital processes, but a DHB-led process supported by the Ministry and Treasury would seem to be the most efficient way of managing such a process.
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2.2 Hutt Valley DHB’s capital redevelopment process 2.2.1 Clinical Services Plan Developing a business case for capital requires comprehensive planning. It is not about resolving current issues (ie, reactive planning), but understanding the long term future needs of the population and clinical needs, and considering the range of options that can deliver on improved models of care, how care is delivered and where.
With respect to Hutt Valley DHB, the development of its Clinical Services Plan provides an excellent understanding of current and future needs, provides a clear direction for addressing those needs through service configurations, additional investment, strategic enablers such as IT and workforce and models of care. As a result, the DHB’s Clinical Services Plan will support some of the detailed planning required in both the Strategic Assessment and the Indicative Business Case process.
However, the Clinical Services Plan (CSP) will not resolve the broader sub-regional options, as the planning was based on the Hutt Valley population only. A subsequent piece of work that will be required following the Clinical Services Plan is joint planning with Capital & Coast DHB to better understand the options for delivery across the network of hospitals currently in place, and how management might configure the Hutt hospital facility to address service delivery within a sub-regional context. This could stretch anywhere from configuring a current service provided at Hutt to be led from Capital & Coast DHB through to Hutt hospital, Wellington hospital and Keneperu operating as a network of hospitals for the sub-regional population. In such a scenario, there is the opportunity to deliver different components of services across different sites eg, more complex surgery at Wellington and ambulatory/outpatient/day surgery at Hutt and Keneperu. These options have not been explored to date, as it will require entering into a joint clinical planning process with Capital & Coast DHB that has not, as yet, commenced. It will be recommended as part of the next steps of the CSP – alongside other important mechanisms that would support sub-regional planning such as addressing how funding and staffing would operate in a network of hospitals.
2.2.2 Master Site Plan A Master Site Plan provides a full analysis of the current state, adequacy and appropriateness of the existing facilities and plant to accommodate current and future developments. Such a Plan would: ∑ Identify site conditions requiring corrective actions; ∑ Determine land use possibilities; ∑ Understand service routes, Utilities such as water, electricity, air conditioning, medical gases; ∑ Document and evaluate appropriateness of current space allocations; ∑ Understand current functional analysis of the site and each department; ∑ Determinate adequacy of facilities in each department; ∑ Understand the services that are interdependent; ∑ Adequacy of space and accommodation; ∑ Physical condition and potential for expansion and conversion. Hutt Valley DHB does not have a Master Site Plan, and as such, understanding current and future needs is limited from a capital perspective. A Master Site Plan supports the first stage of an Indicative Business Case.
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2.2.3 Timeframe for addressing facilities Figure two summarizes the steps and likely timeframes for addressing facility issues at Hutt Valley DHB. As can be seen, it is at least a four year timeframe before the go-ahead of an agreed configuration of hospital services to address facilities in the Hutt would occur. The four year timeframe is conservative, and assumes management can progress sub-regional planning in a satisfactory way and the business cases being accepted by the CIC in a timely fashion.
Furthermore, if the sub-regional hospital configurations options were significantly different to what they are today, both DHBs would need to go through the CIC process together as there would be significant interdependencies between the DHBs (ie, if some services were to shift to Capital & Coast DHB, Capital & Coast DHB would need to expand its facilities as they are currently at full capacity across many services – in particular ICU and surgical services). If this was the case, the business case process would be significantly more complex and take much longer.
Figure 2: Timeframe and Process for new capital in a simple local reconfiguration of services June 2018 Hutt Valley DHB Clinical Services Plan
Hutt Valley DHB Master Site Plan
Sub-regional facilities plan with Capital & Coast DHB
Strategic Assessment
Indicative Business Case
Detailed Business Case
Detailed Implementation Case
Facility Build COMMENCES
3. SUMMARY
In summary, with the development of Hutt Valley DHB’s Clinical Services Plan, the DHB will understand current and future clinical needs and demand, and will identify some key options for how management can address these burgeoning needs. It will identify the models of care and investments the DHB will need to address locally to improve health outcomes for its population. This work is critical to both steps in the CIC process (the Strategic Assessment and Indicative Business Case).
What remains outstanding ahead of moving through the business case process for capital investment is 1) a Master Site Plan, and 2) a sub-regional plan with Capital & Coast DHB that provides options for the configuration of hospital facilities across the network (if this was something both Boards wanted to consider). If that were the case, the development of a Master Site Plan and the Sub-regional Clinical Services Planning process could occur simultaneously as management develop a Strategic Assessment and
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Indicative Business Case for the CIC process. Depending on the size of the change in hospital facilities proposed through a sub-regional planning process, the timeframe for development and implementation would take at least four years, and longer if the proposed change was more complex.
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BOARD DISCUSSION PAPER
Date: 3 May 2018
Author Dr Pauline Boyles, Director, Disability Strategy and Performance, Capital & Coast DHB
Endorsed by Rachel Haggarty, Director Strategy Innovation and Performance, Capital & Coast DHB Helene Carbonatto, General Manager – Strategy, Planning and Outcomes Sir Bob Francis, Chair – Sub-regional Disability Advisory Group
Reviewed/approved The Executive Leadership team (reviewed on 11 April 2018) by
Subject Disability update
RECOMMENDATIONS It is recommended that the Board: a) NOTES the update on the electronic health passport; b) NOTES the research and proposed resource development on Informed Consent for people with learning disabilities; c) NOTES the progress on the New Zealand Sign Language (NZSL) plan; d) NOTES the strategic issues identified by the Capital & Coast and Hutt Valley DHBs (joint needs assessment services (NASC) and clinicians Interim Clinical Governance Group (ICG). e) NOTES a new approach to improving care of Māori and Pacific Disabled People sub-regionally; f) NOTES the planning for the fourth sub-regional Disability Forum to be held October 2018; g) NOTES the sharing of expertise with other New Zealand DHBs; h) NOTES progress on improving clinical care for disabled people at Hutt Valley DHB with particular reference to: i. The increased use of quality disability alerts by staff in partnership with patients; ii. The Children’s ward and Coronary Care Unit’s engagement on system development for consistent use of tools; iii. Increased use of help desk as a mechanism for improvement of information for patients and the patient journey; iv. Increase in numbers of staff engaging in education face to face and eLearning; v. Consideration of improved coordination by clinical staff of patients who present with the highest and most complex needs within acute services. APPENDICES 1. Auckland Disability Law Easy read leaflet - Supported Decision-making 2. Examples of Concerto alerts
Smart Infrastructure Adaptable Workforce
Hutt Valley DHB Shorter, Safer, Smoother Care Living Well Strategy links
Care Closer to Home
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The report provides Board members with updates on: ∑ progress against the Disability Strategy 2017 – 2022; ∑ key sub-regional areas of work to meet the goals on the 2017/18 Annual Plan; ∑ improvement in clinical disability responsiveness at Hutt Valley DHB.
2. UPDATE OF PROGRESS AGAINST THE 3DHB DISABILITY STRATEGY 2017 – 2022
The following is a brief update of progress against the 2017 – 2022 3DHB Disability Strategy including performance against the sub regional commitments within the 2017/18 Annual Plan. This will be followed in section three on local Hutt Valley progress.
2.1 Electronic Health passport development In October and November 2017 extensive co-design work was carried out with Price Waterhouse Coopers, the Ministry of Health (the Ministry), clinicians and consumers of services. A prototype was presented for development. The 3DHBs, along with the Sub-regional Disability Advisory Group are committed to proceeding and some prioritisation for funding has been undertaken within the ICT service. While the project will proceed in partnership with the Health and Disability Commissioner, the team is engaging with the Acting Director-General of Health and the Ministry’s ICT team to ensure anything developed can be scaled up and in the longer term is owned by the Ministry. This will ensure electronic application updates are monitored and system integration over the years is assured.
2.2 Informed Consent and People with Learning Disabilities A draft report on scoping policy guidance and resources required for disabled people, families, clinicians and people with learning disabilities (formerly referred to as “intellectual disability”)1 across the sub region on informed consent is near completion. There is much community interest in this policy. Clinician feedback on the current informed consent policy across the sub-region identified by the Quality teams is that it is long, not well used or user friendly to clinicians. It currently aligns with the Protection of Personal and Property Rights Act but does not ensure or facilitate the progressive rights-based approach of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). 2
The UNCRPD requires supported decision-making with safeguards. This means that regardless of level of impairment or understanding, at least a “best guess” of the disabled person’s will and preferences are respected and enacted within similar reasonable safeguarding parameters to non-disabled people. It does not allow substitute decision-making, decisions made with best interest intent, or presence or not of conflict of interest by the substitute decision maker.
Extensive consultation in NZ and internationally has led to adaptable resources, such as representation agreements. Such representatives would be people who know the person with a learning disability well, usually family. However where there is no appropriate family member the ideal person would be of the same gender, generation, ethnicity, and where possible have similar experience of disability. It is expected they have understood a person’s choices and preferences and can represent them within a mutually agreed process for communicating decisions.
The cutting edge of progress would be a representation agreement expressed through video via a health passport held on a computer application or similar device. This includes information introducing the person,
1 “People First NZ., the national advocacy movement for people who experience a range of intellectual impairments have asked that all documents refer to learning disability rather than ID. The latter is still used for diagnostics to establish levels of impairment usually at an early age) 2 Hutt Valley and Wairarapa have also expressed concern about informed consent and any tools developed will be shared including the proactive use of the supported decision-making document (appendix one) Hutt Valley, Wairarapa and Capital & Coast District Health Boards Page 2 April 2018
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PUBLIC others close to them, their consenting information and a suggested process accessible to, but not amendable by, the health system.
Auckland Disability Law, the Human Rights Commission, the Office of Disability Issues, and People First NZ have developed a nationally available plain language resource for supported decision making (see appendix one). All resources will be shared sub-regionally and distributed to all community members and groups with an interest in developing the tools for their own use.
2.3 Progress on the New Zealand Sign Language (NZSL) plan The NZSL in health program of work is led by the ‘NZSL in Health Task Force’. This group is made up of eight members of the local deaf community including an NZSL interpreter, a parent of a Deaf child and representation from Deaf Aoteaora of New Zealand, as well as the NZ Video Interpreting Service (NZVIS). This group meets quarterly, advises on the work program and is involved in or running a number of projects that received external funding from the NZSL Board. The next meeting will involve setting the work program for the coming year based on the five year programme of work. There are two specific strategic project areas within the Disability Strategy this work plan is linked to. The approach and philosophy embeds commitment to people led co design and partnerships for collaboration.
Thanks to grants received from the NZSL Board, two short videos have been produced: ∑ one for the deaf community about useful information to know when coming to hospital; ∑ one for DHB staff about working with deaf people.
These videos highlight the importance of access to full information and communication including the ease and availability of the video interpreting service currently available in New Zealand. To improve access to interpreters, five iPads have been costed to cover key departments across all hospital locations sub-regionally that will allow access to an interpreter online from 8.00 am – 8.00 pm.
Two more applications to the NZSL Board have been made: i. for the development of health information videos into NZSL; ii. to support and provide access for deaf people who struggle with mental health difficulties and isolation.
2.4 Strategic issues arising: Interim Clinical Governance Group (Capital & Coast and Hutt Valley DHBs) The Interim Clinical Governance Group was established in January 2017 to address the needs of people using and often stuck in acute services. Since 2015, an increasing number of people in this category have come to the attention of clinicians and funders. The main referrals are people who are “hard to place” and/or discharge from acute services and/or for whom the appropriate funding stream is difficult to identify. The panel is chaired by the Hutt Valley or Capital & Coast DHB Chief Medical Officers and the Director of Disability Strategy and Performance. It has been largely successful in helping staff and people using services achieve a resolution in a shorter time period.
There are some themes emerging that require a more strategic approach. One example in related to the issues with people who are homeless and disabled and/or experiencing some other long term physical or mental health condition. While solutions have been found, there is often difficulty in achieving a physically accessible or a generally safe and dry home. It is intended to work with both the Ministry of Social Development and the Ministry of Health to design short, medium and long-term solutions. A second example is that concerning bariatric clients and their access to any kind of health care. The most significant issue is that of appropriately scaled equipment. In the past, Enable3 has been reluctant to provide
3 Enable Palmerston North provide equipment for a large percentage of the population in New Zealand and are funded by the MOH. Hutt Valley, Wairarapa and Capital & Coast District Health Boards Page 3 April 2018
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PUBLIC equipment due to cost, but increasingly as people become more disabled, it is provided once a funding stream has been identified.
Clinicians are querying whether access to bariatric surgery is adequate in New Zealand and whether the increasing number of people in the “at risk” category might require some national discussion. People who are obese are considered at risk of discrimination in all aspects of society including health services. Some data analysis is planned as well as a meeting with the funding-holder within the Ministry regarding this issue. Clinicians have requested that the whole picture is addressed, including surgery, equipment and wrap-around intensive support to prevent disabling obesity.
2.5 Sub-regional Disability Strategy forum and links to Māori and Pacific disabled people The main piece of work for the Sub-regional Disability Advisory Group (SRDAG) in the next financial year is planning of the fourth Sub-regional Disability forum. The Disability Strategy was formally launched on 9 March 2017 and while implementation is still in an early phase, the group is keen to be report back to the sector. In this section the steps are identified.
A commitment has been made within each local Annual Plan to a bi-annual forum led by the 3DHB in partnership with local communities and the wider government sector. This ensures accountability for the time invested by the wider sector in planning to improve cross system and health services for people experiencing disability. The next forum is planned for October 2018.
In order to strengthen cultural responsiveness to Māori and Pacific peoples with disability, a preparatory project was established in December 2017 to review an approach to improved integration of Kaupapa Māori and Pacifica models within the strategic framework. A core leadership group was established and met a number of times.
On the advice of Maori and Pacific leaders, two steps have been identified as required: i. the establishment of two separate groups for Māori and Pacific in order to advise and embed some initial thinking into the October forum; ii. to make recommendations for future strategic collaboration with and on behalf of Māori and Pacific People with Disabilities.
Iris Pahau has agreed to lead this on behalf of Māori sub-regionally. The Pacific group is in the process of being established.
2.6 National Collaboration on Strategy Within the last two months, the Disability Strategy Team have been approached by other DHBs (including Auckland and Southern) to ask for advice on education, disability strategy, and development of embedded systems of consumer engagement including consumer council.
Permission has been given for the innovative eLearning tool to be used as an example within the Auckland DHBs in the first instance. Consideration for national consistency is now critical to ensure rigour and avoidance of confusion in the way disability responsiveness is addressed nationally.
Based on feedback, the Sub-regional Disability Strategy is nationally considered to be “gold standard” for strategy development. While support and advice is freely given, the principle of people-led strategic development is critical. To this end, each DHB and community partnership will own their own and invest in its success. Response to former government Ministerial priorities has been a lever for increased engagement on and investment in disability responsiveness. The Donald Beasley Institute Dunedin has been commissioned to lead strategy for Southern.
3. HUTT VALLEY LOCAL PROGRESS
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PUBLIC Work to improve disability responsiveness at the front line of Hutt Valley DHB is increasingly reaching a high standard. The placement of a help desk/office for the disability educator has led to significant public and staff engagement on the practical tools offered to support improved clinical care. The educator is supported three days a week by an expert parent who operates on a voluntary basis and is also involved in education initiatives.
The combination of visibility of staff, practical tools and ongoing multiple levels of education has led to a growing improvement in overall disability responsiveness. When things go wrong, both staff and consumers are now more easily able to find the right person or system to change the experience. The following section outlines some of the progress made in the last three months.
3.1 Staff/Clinical success stories Education both within hospital services and the community is now stepping up as the range of video montages developed with and by staff and consumers are made available.
eLearning numbers are increasing as staff engage with the interactive learning media to gain basic knowledge and understand best practice approaches.
As the number of patients with the most complex needs increases, senior clinical staff are working on system solutions to ensure a more streamlined and safe approach to clinical care. This will involve a dedicated key worker model which will work closely with the disability educators and the disability strategy team. Such a model may also be of value at the other DHBs so an early evaluation will yield critical information.
3.1.1 The Medical ward (Ward five) The Medical ward has the most significant and frequent interactions with people who experience barriers linked to their long term health or disability issue. There is a group of people whose complex needs can be challenging for staff when admitted with acute medical needs. The range includes people with serious ongoing long term health conditions, people disabled from birth or a young age, older people who have acquired disability in later life, and those with significant injury-related disability. All staff of the medical ward have partnered in the development of systems that incorporate tools such as the health passport and the disability alert (appendix two) that supports the early identification of solutions to care. Feedback from staff and patients moving from the medical ward to other departments suggests that the patients’ needs and suggested solutions are now being taken seriously and contributing to a much safer patient journey. The staff of ward five are congratulated for their efforts.
3.1.2 Children’s ward and the Coronary Care Unit The Children’s ward and Coronary Care Unit are also congratulated on entering partnership with patients and families on creative solutions presented within the disability alerts and health passports.
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BOARD INFORMATION PAPER
Date: 3 May 2018
Authors Nicky Smith - Service Manager, Wellington Regional Dental Service Lindsay Wilde – Service Manager, Regional Screening Services Peter Gush – Service Manager, Regional Public Health
Endorsed By Peng Voon– Acting Chief Operating Officer Dale Oliff – Acting Chief Executive
Reviewed/approved by The Executive Leadership team (reviewed on 11 April 2018)
Subject Population Health update
RECOMMENDATIONS It is recommended that the Board: a) NOTES the initiatives to increase accessibility to the Wellington Regional Dental Service including the 2018 holiday programme and the later evening appointments; b) NOTES the Wellington Regional Dental Service’s initiatives in collaboration with internal and external stakeholders to engage with pre-school aged children through Well Child Tamariki Ora training, increased Kohanga Reo programme, and targeting of pre-school children by Hub Administration Officers; c) NOTES the Wellington Regional Dental Service’s new initiatives to engage with vulnerable tamariki in the Hutt Valley area, in collaboration with the Māori Women’s Refuge Resource Centre; d) NOTES that Regional Public Health (RPH) made an oral submission to the Hutt City Council supporting the Local Alcohol Policy amendment; e) NOTES that in March 2018, RPH held a ‘Healthier Food and Drink Environments’ workshop for Councils in the Central Region. They are working alongside them to improve healthy food environments f) NOTES that the Regional Breast Screening Service exceeded the breast screening target for all women for quarter two 2017/18; g) NOTES that the Regional Screening Service has made significant gains in improving the breast screening rate for Māori and Pacific women since 2015, with both groups falling just short of the 70 percent target (69.7 and 69.2 percent respectively); h) NOTES the range of strategies the Regional Screening Service is using to improve cervical screening rates for Māori, Pacific and Asian women, including: ∑ phoning overdue women on behalf of General Practice (day/evening), ∑ booking clinic appointments; ∑ arranging transport and support; ∑ making referrals for women to support to services; ∑ and informing women of priority Saturday Smear Clinics. i) NOTES the Regional Screening Service held a joint breast and cervical screening day in late 2017 for staff. This was well attended and will be repeated in future.
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APPENDICES 1. Late Night Trial Evaluation 2. Te Ra o Raukura Report 3. Creekfest Report
Shorter, Safer, Smoother Care Adaptable Workforce
Hutt Valley DHB Strategy Care Closer to Home Living Well links
Effective Commissioning
1. PURPOSE
This report updates the Boards on the work of the sub-region’s Population Health services (Wellington Regional Dental Service, Regional Screening and Regional Public Health) activities to date.
2. WELLINGTON REGIONAL DENTAL SERVICE
2.1 Background Hutt Valley DHB is the current Ministry of Health contract holder for the Regional Dental Service that currently encompasses thirteen dental hubs and eleven mobile vans covering Wellington (including Kapiti-Mana) and the Hutt Valley.
2.2 Update of key work from the last three months and planning for 2018 2.2.1 2018 Holiday programme The Wellington Regional Dental Service (WRDS) has arranged for the four main councils in the region to fund and install the electrical requirements that allow a mobile dental van to see children at a nominated venue during the 2018 school holidays. The venues include: ∑ Te Rauparaha Arena, Porirua; ∑ Frank Kitts Park, Wellington; ∑ Town Hall, Upper Hutt ∑ Walter Nash Stadium, Lower Hutt.
A full programme is in place to ensure maximum usage and opportunities for each of the venues, with support from the Early Intervention Prevention (EIP) team.
In addition, Ora Toa (Cannons Creek) will also be supported with a mobile clinic for the second week of the April school holidays, in coordination with their Tamariki Ora holiday programme.
Extensive publicity will be repeated to ensure maximum exposure for all the holiday programmes with the use of Hutt Valley and Capital & Coast DHBs’ Facebook pages, the relevant City Council communications and in Ora Toa’s instance, the use of the public health organisation’s (PHO’s) media.
A health promotion initiative is also planned with the Hutt Valley Māori Women’s Refuge Resource Centre Tamariki Ora Holiday programme. The EIP Team will be providing an
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information and tutorial session for all tamariki who attend the April school holiday programme at the centre and will provide dental care resources to the children.
2.2.2 February 2018 Creekfest summary The WRDS attended Creekfest in February 2018. Creekfest is an annual event that the Service attends in order to provide health promotion, dental advice, and knee-to-knee checks for pre-school aged children.
The event this year was very well attended and saw an influx of children and parents who were all impressed with the range that the Service was offering at this event. Children were offered a new toothbrush and toothpaste free of charge from the Service and various resources to ensure regular oral hygiene eg, tooth brushing reward charts. The opportunity was also taken to provide preventative treatments with fluoride varnish on a number of children, update contact information and appropriately refer children to secondary services when required (see table below).
Total number of children seen (for dental needs) 12 No. new enrolments (NE) into service 5 No. of contacts updated 13 Previous FTA 1 No. of fluoride applications 9 No. of follow up treatment plans 4 No. Māori & Pacific seen 8 Pre-schoolers seen 9 First exams 7
The event was well publicized on the Service’s Facebook page. It is intended that the Service will continue to attend Creekfest and utilize the skills and resources currently in place to ensure community engagement with the population of Porirua and surrounding areas.
Pictured: Members of the EIP and Dental Therapist team (Jacky Dhlamini, Jenny Liu, Batool Ghashi and Ashna Singh)
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2.2.3 Collaboration 2.2.3.1 Regional Public Health (RPH) – Water in Schools Initiative The WRDS EIP team is actively continuing its partnership with Regional Public Health (RPH) on the Water in Schools Initiative in 2018. At every school visited by a mobile dental van in the Hutt Valley in 2018, the school principal will receive the actual data from the visit of how many children were seen and the percentage of decay detected in the children examined. Accompanying this data will be the contact details and information on the Water in Schools Initiative. In addition, RPH will also be sent the individual schools’ data that will then allow RPH a ‘step in’ and continue discussions with the school.
2.2.3.2 Plunket Well Child Provider– Water Only in Early Childhood Centres (ECC) The WRDS is currently in discussion with Plunket on the feasibility of supporting Well Child Tamariki Ora Providers to support Early Childhood Centres (ECC) and Kohanga Reo to adopt a water-only policy. Decayed missing and filled teeth (DMFT) data obtained from knee- to- knee checks at identified ECCs can be utilised in a similar manner to that of the water-in-schools collaboration with RPH. It is anitipated that this will be implemented late 2018/ early 2019.
2.2.4 Increasing scope of Kohanga Reo and Kindergarten Visits Planning has been completed by the WRDS EIP team to increase the scope of Kohanga Reo and Kindergarten visits in 2018 that provides knee-to-knee checks (dental examinations) for pre-school children. An extra six Kohanga Reo have been contacted and engaged in this programme, bringing the total to 62 centres that will be visited in 2018 . These checks are carried out by a WRDS Qualified Dental Therapist or Dentist. Below are photographs taken at recent knee-to-knee visits to demonstrate the technique of examining pre-school aged children in Early Childhood Centres throughout the region.
Den
2.2.5 Lift the Lip Training A refresher training programme for 2018 is currently being developed by WRDS for all Well Child Tamariki Ora providers in the region to ensure that all staff are confident and competent to undertake a “Lift the Lip” assessment on all 0 – 2 year old children and appropriately refer into the Service.
2.2.6 Update on Trials to Support Service Delivery 2.2.6.1 Increasing Flexibility of Service The Naenae Dental Hub trialled late evening appointments during terms three and four in 2017. The trial was evaluated (appendix two) and assessed to provide increased flexibility of Service to children. This project will now be progressed in consultation with the Service and PSA Union with the aim of implementing in a number of hubs from term three 2018 onwards.
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2.2.6.2 Supporting Consumer Input in WRDS The WRDS has extended the trial of electronic consumer feedback throughout the Service, with all accompanying adults of children who attend the hubs being asked to complete a two minute online survey. This trial was commenced on 28 August 2017 and to date, 209 parents/ guardians have taken the opportunity to provide feedback on the Service. This has allowed WRDS to get a fuller appreciation of what is important to its consumers and also act promptly on issues that complaints may arise from. The WRDS has taken the decision to source a more permanent solution and are currently exploring consumer applications and IPads to ensure that the WRDS remains connected to the population its serves.
2.2.6.3 Arrears and Inaccessibility of Service – Hub Administration Officers The WRDS continues to see a reduction of arrears through the appointment of three hub administration support officers in July 2017. Arrears are on target and are currently at 18 months at end of March 2018 (pre-July 2017, this was 32 months). The focus for 2018 is on pre-school aged children and reduction of waitlists for first examinations. The overwhelming effectiveness of these roles has been ascertained and all three roles have been approved as permanent with effect from 1 July 2018.
2.2.6.4 Working with Primary Health Organisations Support Services to increase accessibility for Pacific Children The WRDS is currently in discussion with the Pacific Navigation team based in Compass Health on potential solutions on how better to support the WRDS’s enrolled children to attend treatment appointments at dental hubs. It is planned that Brandon Dental Hub will be utilised to trial collaborative working with Compass Health on supporting this group of children and their fanau during 2018.
2.2.7 Capital & Coast and Hutt Valley DHB Board visits to WRDS hubs Following on from the successful Hub visits undertaken by Dr Ashley Bloomfield, Dale Oliff and Chris Lowry, the invitation to visit the dental hubs has been extended to Capital & Coast and Hutt Valley DHB Boards.
The Capital & Coast DHB Board visited Selby House on 28 March, with a visit to the Brandon hub to be arranged. The Hutt Valley DHB Board is scheduled to visit the dental hubs in Naenae, Wainuiomata and Trentham on 30 August 2018.
2.2.8 Hutt Hospital Foundation Trust The WRDS has been recently successful in gaining the support of the Hutt Hospital Foundation Trust in providing funding for new treatment gowns (designed in collaboration with Tree Hutt Inc) and health promotion resources for the Hub waiting rooms. These initiatives are still in the development stage.
2.2.9 Service Balanced Scorecard – February 2018 The high percentage of x-rays associated with an examination appointment for children aged between five and thirteen years is still within expected parameters. This may reflect the risk status of children being seen within the Service.
The number of exams completed in February 2018 was 14 percent less than the target. This reduction was anticipated with nine new therapists requiring more time to complete examinations and the time availability of experienced clinicians to mentor them. This anticipated short fall was also observed for preschool child examinations.
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Consistent with 2017, there was a marked difference between the attendance at a booked hub appointment of Māori and Pacific children when compared with non-Māori and Non-Pacific children. Already established (eg, preschool knee-to-knee) and new initiatives (eg, school holiday mobile programme) will be utilised throughout 2018 to allow more options for these children and their families to engage with the Service.
3. REGIONAL PUBLIC HEALTH (RPH)
3.1 Health Promotion in Action – Te Ra o Te Raukura and Creekfest In February 2018, two major community festivals were held that RPH supported both financially (sponsorship) and with staff on the ground on the day seeking to engage with the communities regarding a variety of our services, as well as connecting with other health providers.
Reports on both of these events are attached as appendices two and three.
Highlights from these events include: ∑ Referrals to our Well Homes service (as well as giving away door snakes and promotional cards); ∑ Ear checks for children (the Porirua-based mobile Ear Van was at both events); ∑ Promoting messages regarding smokefree, water only and healthy ‘kai’; ∑ Helping the community to be prepared in the event of an emergency.
3.2 Research on the impact of repeat vaccination on response to influenza virus infection (SHIVERS II) RPH has been invited by the Institute of Environmental Science and Research (ESR) to collaborate on an important research project looking at the effect of repeat influenza vaccination on how a person’s immune system responds to influenza infection. Dr Annette Nesdale is the lead Medical Officer of Health for this work. The study will recruit approximately 2,500 people through Compass PHO GPs and will occur across the 2018 winter influenza season. Participants will have blood tests at the beginning and end of the project and if they develop influenza like illness (ILI).
This research follows on from the successful Southern Hemisphere Influenza and Vaccine Effectiveness, Research and Surveillance project (SHIVERS) that occurred in Auckland from 2012 – 2014. This project is led and funded by the National Institute for Allergy and Infectious Disease (NIAID) and St. Jude Children’s Hospital USA that is a recognised centre of excellence for influenza research and surveillance.
3.3 Hutt City Council (HCC) 3.3.1 Local Alcohol Policy (LAP) Amendment The HCC adopted its draft LAP Amendment in its entirety in August 2017 that became the Provisional Amendment to Hutt City Council Local Alcohol Policy. RPH is supportive of the changes in the Provisional Amendment and jointly with Police, made an oral submission to the Council on the Amendment. The Health Promotion Agency (HPA), Alcohol Health Watch, and Te Awakairangi Health Network (TeAHN) also delivered supporting submissions. A key aspect of the Amendment was agreement to cap off-licences in six locations: Naenae, Stokes Valley, Taita, Avalon, Hutt Central, and Wainuiomata.
The Provisional Amendment was publically advertised and, as prescribed by the legal process, is open to appeal by parties who had submitted earlier on the draft. The Provisional LAP Amendment was opposed by two parties who have not been publically named. The process is on hold until the case can be heard by the Alcohol Regulatory and Licensing Authority. To date, management are not aware that a hearing date has been set.
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3.3.2 Central business district (CBD) Spatial Plan, District Plan Change 43 RPH was invited to attend a stakeholder workshop of the HCC’s strategy and planning division. The focus was to learn about the CBD Spatial Plan and contribute to the vision for the CBD. This work is being implemented by design consultants and is the new iteration of the Making Places 2030 framework developed through citizen consultation in 2009.
The objective of the workshop was to explore every opportunity to ensure that the CBD offers an exceptional quality of life within a sustainable context, and to achieve strategic outcomes for the city in terms of economic growth and high-quality urban living, resilient infrastructure, environmental sustainability, and well-being. RPH and other health and social sector representatives offered the perspective of well-being and sustainability with examples of having green spaces, walking and cycle tracks, services for families and opportunities for diversity and community to co-exist with business priorities.
3.3.3 Healthier Food and Drink Environments On 14 March 2018, RPH held a workshop focusing on healthier food and drink environments. The workshop was aimed at city councils to provide insights and tips on how to change the food and drink environments they manage. All councils from the Central Region were invited and the workshop was attended by representatives from Upper Hutt, Porirua, Kapiti, Palmerston North and Napier City Councils along with Local Government New Zealand, Victoria University, Healthy Families Lower Hutt and the Ministry of Health.
Guest speakers included Jacqui Yip, Public Health Dietitian, Auckland Regional Public Health; Ben Maw, Council Lead Food Systems, Healthy Families Manukau; and Pete Caccioppoli, Senior Activation Advisor, Auckland Council. They shared Auckland City Council’s journey to healthier food and drink environments. The question and discussion time was productive with workshop participants openly discussing their experiences within their respective communities, what had worked for other organisations and how this could be applied in their work.
Key learnings from the day were to “just start” and the importance of the wider team in the council supporting the work. The workshop provided participants with baseline guidelines from which to start making changes and a support network of people to draw from. Attendees found the workshop networking opportunities useful as they learnt more about what is happening in the food and drink environment space. RPH will continue to work with local councils to assist them to improve food environments.
3.4 Drinking Water – Collaborative Committee The Havelock North Drinking Water Inquiry identified early on that a lack of collaboration between various agencies contributed to the drinking water contamination event in Havelock North. Subsequent to that, the Ministry of Health (the Ministry) has asked Public Health Units to work with drinking water agencies across their regions to establish effective collaboration. The Greater Wellington Regional Council, RPH and Wellington Water have jointly sponsored workshops aimed at establishing a region-wide drinking water collaborative group that is attended by all nine councils in the Wellington sub-region. The workshops, held in November and December 2017, focused on identifying the issues, risks and opportunities, the drivers for change and what success would look like, and setting out a draft stakeholder engagement model.
A draft terms of reference and initial draft work plan was an outcome of the workshops. This is a significant step forward to ensuring a collaborative approach to issues in relation to the source of drinking water and water treatment and reticulation across the Wellington/Wairarapa region.
The Hutt Valley (including Wainuiomata) obtains its water supply from the Wainuiomata, Orongorongo and Hutt Rivers, the Te Marua storage lakes, and the Waiwhetu aquifer. Drinking water sourced from
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rivers and the Te Marua storage lakes is treated through filters and is disinfected with chlorine. Drinking water sourced from the Waiwhetu aquifer was supplied to consumers with no treatment because the Waterloo and Gear Island bores held “secure” status in terms of the Drinking Water Standards of New Zealand. When a number of samples detected e-coli at the Waterloo drinking water bores, an investigation into the source of the contamination was inconclusive but pointed to the November 2016 Kaikoura earthquake causing a change in the aquifer. In December 2017, Wellington Water introduced UV and chlorine treatment at the Waterloo pumping station and is planning to do the same at Gear Island that is only used intermittently. All reticulated drinking water in Wainuiomata and the Hutt Valley is fluoridated. The public bores at Petone and the Dowse are treated only with UV and are not fluoridated. All these responses are in line with the Ministry’s guidelines that have been prompted by The Havelock North Inquiry.
3.5 Smokefree Aotearoa 2025 RPH has recently completed training for most of the registered pharmacists in the Hutt Valley and the DHB has incentivised them to refer clients to Tākiri Mai Te Ata, the Regional Stop Smoking Service. RPH has also provided brief training to over 30 lead maternity carers and midwives during March to encourage more referrals to both Tākiri Mai Te Ata and the local Hapū Mama programme. It is hope that some good quality referrals will result from this training.
3.6 Public Health Nurse (PHN) Referral Summary 1 October 2017- 31 March 2018 and top ten Conditions
PHNs provide personal health support to children attending primary and intermediate schools in the Hutt Valley DHB area. The service is focused on deciles one – three schools with at least one visit per week, and then one visit per fortnight to decile four – six schools if required. A response service is delivered to decile seven – ten schools when a need arises.
The complexity of problems for children that PHNs are encountering is increasing and multiple conditions are frequent with behavioural, developmental, social concerns, and child protection all featuring in the top ten conditions for the Hutt Valley children RPH works with.
Condition Ranking Number of children Behavioural 1 117 Vision 2 98 Hearing Concerns 3 93 Developmental 4 85 Social Concern 5 51 Minor skin infections 6 46 Dental 7 38 Absenteeism 8 36 Eczema 9 31 Child Protection 10 30
The PHN’s work closely with the school social workers and are able to ensure the children are receiving appropriate medical assessments which is vital for children that might otherwise appear to be behavioural, developmental or social concerns. Some of these children require specialist referrals for clinical review of the developmental or behavioural condition.
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Activity Totals New Referrals In 436 New Referrals In - # of Conditions 679 New Entrant Assessment Decile 33 Nursing Consultation 800 Phone Triage/Assessment 106 Health Education 1 Home Visit 69 Internal & External Agency 564 School Liaison 586 Transport & Advocacy 16 Referral Out 48 Referrals Closed 409
3.7 Human Papilloma Virus (HPV) vaccination (Gardasil) The HPV/Gardasil vaccination for boys was introduced across the country from January 2017. The Ministry predicted that 30 – 50 percent of boys would take up the opportunity for the vaccination. The number of students that have consented and have been vaccinated is significantly larger than the Ministry predicted, with the boys’ vaccination rate at 77 percent. Planning has been flexible enough to manage the higher than expected numbers, with additional staff required to meet the demand.
The table below shows the Hutt Valley DHB data for HPV until the end of December 2017.
HVDHB Target Eligible Roll to Date Māori Pacific
Cohort 1851 417 166
Dose 1 75% 75.5 percent 79 percent 85.5 percent
Dose 2 (on-going) 70% 72.3 percent 69 percent 73.5 percent
Consent forms returned 1821 406 157 to date (98.3%) (97%) (94.5%) Consent from cohort to 1402 336 142 date (75.7%) (80.5%) (85.5%) Decline 423 70 15 (22.6%) (16.5%) (9%) Non-return 24 1 9
3.7.1 Gender Breakdown There was concern over a vaccine shortage for November 2017, but close liaison with the Ministry and Pharmac allowed the completion of the programme. Pharmac indicated the reason for the shortage of vaccine included the impact of the unexpected higher uptake of vaccine by boys.
Boys are still leading the way for consenting to be immunised with HPV as the table below shows.
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Boys HVDHB Eligible 1039 Consented 796 Overall % 76.6%
Girls HVDHB Eligible 812 Consented 609 Overall % 75%
4. REGIONAL SCREENING (BREAST AND CERVICAL)
4.1 Breast Screening quarter two – October - December 2017 Breast Screen Central (BSC), covering Hutt, Capital & Coast and Wairarapa DHBs exceeded the 70 percent screening target for all women overall during quarter two 2017/18. The Service is also showing consistent incremental gains in reaching the 70 percent screening target for Māori and Pacific women (see table one). The Service continues to focus its recruitment and retention work on these priority women to ensure the gap continues to decrease.
BSC is continuing Saturday priority clinics at Hutt base and Kenepuru for both breast and cervical priority women as these are significant in allowing some women to access screening. A combined breast and cervical staff screening day at the DHB was also held as there are a number of under-screened and unscreened priority staff. This was very well attended.
BSC’s ‘did not attend’ (DNA) management project is working well with priority women; this attempts to prevent a women from becoming a DNA. When priority woman has not confirmed her appointment and administration staff have exhausted their contacts – these women are handed over to recruitment and retention to further investigate through community contacts.
BSC is slightly behind budgeted volumes year to date due to mammographer vacancies but plans have been put in place to reach the target by year end (see table two).
Over the last year, a number of workshops have taken place with the providers of national breast screening services. As a result, agreement has been reached both on the principles for a new funding model and options for funding models that the National Screening Unit is now developing. These are as follows: ∑ Variation to the fixed and variable components of the contract; ∑ Application of a population based funding formula; ∑ Differential payment for Māori and Pacific women, recognising the overall cost of screening for these women is sometimes higher; ∑ Tagged proportion of funding dependent on achievement of pre-agreed targets relating to equity and re-screening.
The funding options are due to be presented and discussed with all the lead providers in early in 2018. At the workshops, management have advised the National Screening Unit that any significant changes to the funding model may affect current outcomes if the overall funding package for each provider is decreased.
The age extension plan is awaiting an Impact Analysis to be completed for Associate Minister Genter and in the meantime the eligibility criteria for BreastScreen Aotearoa remains 45 to 69.
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4.1.1 DHB coverage by ethnicity in the two years ending 31 December 2017 Figure one: BSA coverage (%) of Māori women aged 50 – 69 years in the two years ending 31 December 2017 by DHB
Figure two: BSA coverage (%) of Pacific women aged 50 – 69 years in the two years ending 31 December 2017 by DHB
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Figure three: Overall BSA coverage (%) of women aged 50 – 69 years in the two years ending 31 December 2017 by DHB
4.1.2 DHB coverage comparison trends by ethnicity Table one: BSA coverage (%) of women aged 50 – 69 years in the two years ending 31 December for 2015, 2016, 2017, by ethnicity and DHB
Note that: Wahine Māori Coverage for Wairarapa DHB has reached 70.7% in December 2017,compared to 69.8% from the previous year Wahine Māori coverage for Hutt Valley is very close at 69.7%, up from 67.2% the previous year.
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Table two: BSA actual volumes year to date against budget BUDGETED - Breast Screening Volumes 2017-18 Year number of w orking days 21 23 21 21 22 14 17 19 21 19 23 20 240 2017-18 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Total Budget 2,489 2,726 2,489 2,489 2,607 1,658 2,015 2,252 2,489 2,252 2,724 2,370 28,560 Actual 2,209 2,242 2,373 3,050 3,179 1,509 1,630 2,103 YTD Actual 2,209 4,451 6,824 9,874 13,053 14,562 16,192 18,295 YTD Budget 2,489 5,215 7,704 10,193 12,800 14,458 16,473 18,725 21,214 23,466 26,190 28,560 28,560
4.2 National Cervical Screening Programme (NCSP) data The Cervical screening graphs (table three) show that the Service achieved the overall 80 percent target for European/other women for Capital & Coast and Wairarapa DHBs, but did not achieve it for Hutt Valley DHB. Coverage of Māori women across all of the 3DHBs is well behind target. Pacific coverage for Wairarapa DHB has been reached for each of the last three years but not for Capital & Coast or Hutt Valley DHB. Hutt Valley is approaching the target for Asian women but Capital & Coast and Wairarapa are behind.
To improve these results, the Service is continuing to work with the PHOs and GP practices to identify, recruit and screen hard to reach NCSP priority women. Targeted data matching with high-needs practices using PHO/Data Matching Reports to assist follow-up of all overdue women who have High Grade, Low Grade results or are Māori, Pacific or Asian women, phoning overdue women on behalf of the Practice (day/evening), booking clinic appointments, arranging transport and support, referral to support to services, and re-engagement to priority Saturday Smear Clinics are a key contributor to increasing coverage and reducing inequalities for cervical screening.
The Service’s combined breast and cervical staff screening day at Hutt Valley DHB was particularly well attended by cervical screening women and will repeat this annually.
The after-hours smear clinic (started in July 2017) with Te Runanganui o te Atiawa o te Upoko o te Ika a Maui based at Waiwhetu and extended to Orongomai Marae Health Services in Upper Hutt this year is proving to be very successful with good uptake from unscreened and under-screened priority women.
Recently the National Cervical Screening Programme Support to Services Providers was given access to the NCSP Register for screening histories. This will be particularly useful for after hour’s clinics and to answer queries from women preventing delays to screening.
The 2018 plans for the National Cervical Screening Programme (NCSP) to move to HPV screening from cytology is on track as the plans to move the screening age from 20 – 25 years.
January to March 2018 has seen increased engagement in education and health promotion events within the community to raise the key messages of the National Cervical Screening Programme under the new Time to Screen branding.
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4.2.1 DHB coverage comparison trends by ethnicity Table three: NCSP coverage (%) of women aged 25–69 years in the three years ending 31 December, 2015, 2016, 2017, by ethnicity and DHB
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4.2.2 DHB coverage by ethnicity in the three years ending 31 December 2017 Figure four: NCSP coverage (%) of Māori women aged 25–69 years in the three years ending 31 December 2017 by DHB
Figure five: NCSP coverage (%) of Pacific women aged 25 – 69 years in the three years ending 31 December 2017 by DHB
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Figure six: NCSP coverage (%) of Asian women aged 25 – 69 years in the three years ending 31 December 2017 by DHB
Figure seven: Overall NCSP coverage (%) of women aged 25 – 69 years in the three years ending 31 December 2017 by DHB
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Table four: NCSP number of screens and coverage (%) in women aged 25–69 years in the three years ending 31 December 2017 by District Health Board
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3DHB DSAC Meeting Minutes
DATE: 19 March 2018 TIME: 10am – 12.30pm
VENUE: Level 11, Board Room, Grace Neill Block, Wellington Regional Hospital
PRESENT: Dame Fran Wilde (Chair), Eileen Brown, Sue Driver, Sue Kedgley, Prue Lamason, Kim Smith, Bob Francis, Dr Tristram Ingham, Jane Hopkirk, John Terris, Derek Milne
APOLOGIES: Andrew Blair, Lisa Bridson, Alan Shirley, Yvette Grace, ‘Ana Coffey, Tino Pereira, Jane Hopkirk and Kim Smith
IN ATTENDANCE: Ashley Bloomfield, Adri Isbister, Dale Oliff, Rachel Haggerty, Helene Carbonatto, Nigel Broom,
PUBLIC One member of public present. Mental Health and Addiction: Joint work Programme Update PRESENTERS Arawhetu Gray, Director, Mental Health and Addiction, Capital and Coast DHB (CCDHB)
Report on UK Research Trip: Citizen Led Social Care and NHS Transformation Pauline Boyles, Director, Disability Strategy and Performance (CCDHB)
Update on Implementation of Disability Strategy Pauline Boyles, Director, Disability Strategy and Performance (CCDHB)
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Agenda Item Discussion Action Required And by Whom
1 PROCEDURAL BUSINESS
1.1 KARAKIA Dr Tristram Ingham led Karakia. Committee Chair, Dame Fran Wilde, welcomed members and DHB staff
1.2 APOLOGIES Received from Andrew Blair, Lisa Bridson, Alan Shirley, Yvette Grace, ‘Ana Coffey, Tino Pereira, Jane Hopkirk and Kim Smith
1.3 INTEREST REGISTER The Committee notes conflicts from Tristram and Eileen. Tristram and Eileen will provide their updated information to Catherine.
1.4 Confirmation of previous Otherwise, minutes were accepted as true and correct. minutes Fran notes that the minutes need to record the times of people leaving the meeting (attending in person or video).
1.5 Matters arising No matters arising
1.6 Terms of Reference The three Chief Executives (CEs) have agreed to the Terms of Reference (TOR) Rachel to amend the Quorum and the TOR have had legal review. as follows: Tristram requested an amendment to the definition of a Quorum to reflect at A quorum of is a majority of least one co-opted member from each of the advisory groups or their Committee members, and nominated alternate. must include at least one member from each Board and Moved Tristram Ingham seconded by Sue Driver at least one co-opted member from each of the Sub-Regional Disability Advisory Group (SRDAG), Sub-Regional Pacific
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Fran noted that if there is an important decision to be made, the CEs would Advisory Group (SRPAG)and have consulted the advisory groups for their views. The Committee noted Maori Partnership Board(s) that DSAC is an advisory committee and not a decision-making committee. (MPB) or their nominated alternates. Fran suggested to add another bullet point under Objectives and Accountabilities, “inform and engage with each advisory group on all issues” Rachel to add an additional bullet point under Objectives The Committee endorsed the Terms of Reference with the recommended and Accountabilities, as a amendments. fifth row from the bottom: Ensure that this Committee is appropriately engaged with, and informed by, the other advisory groups of each DHB.
2 PRESENTATION
2.1 Approach to DSAC Prior to presentation, Derek noted that he would also like the minutes to The CEs have been advised. Fran Wilde show that it is important that the CEs use their best judgement in Rachel Haggerty determining how and when the three Boards of Capital & Coast, Hutt Valley Helene Carbonatto and Wairarapa are bought together to work together on key strategic issues. Nigel Broom Note the importance of focusing on mental health and addictions. The Committee noted the discussion paper.
2.2 Mental Health and Arawhetu and team presented covers the work programme that covers the The executive to report on Addiction: Joint work key priorities that ensure the improvement of mental health and wellbeing highlights on Mental Health & Programme Update outcomes across the 3DHBs. Addictions Integration in the Arawhetu Gray, Director, next meeting. Fran asked Nigel where we are doing well for MHAIDS Integration and areas Mental Health and where we need to focus on. The executive to provide an Addiction, Capital and Coast overall picture of the tertiary, DHB (CCDHB) Eileen asked to be provided with a staff engagement process that is with the secondary and primary mental Nigel Fairley, workforce representatives. health services in the next Waiatamai Tamehana, meeting.
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Sandra Murray, Fran asked to share the Consumer Leadership presentation with the 3DHB Rod Bartling Consumer Advisory Groups and Citizens Health Council (CHC) and obtain their Nigel Broom, feedback on how it fits with CHCs framework and what are their Marion Thomas recommendations. Adri dropped off from VC at Fran said with less than a month to the Mental Health inquiry, there is approx. 11.20am insufficient time to arrange for a discussion meeting between DHBs to align messages. Fran noted that the Inquiry will not be combative in nature, so there is no need for messaging to employees. Fran also noted that until a combined 3DHBs response becomes a formal submission, there is no need to go to governance level for endorsement. The Committee noted the presentation.
3 DECISION
3.1 Report on UK Research Trip: Pauline reported on her recent study trip to the UK to examine the value of The Executive to develop Citizen Led Social Care and citizen led initiatives to strengthen health and social wellbeing and also to proposals to identify how each NHS Transformation seek endorsement on further development work on Community Circles. DHB can implement the Pauline Boyles, Director, approach. There was support for the concept of Community Circles. Fran noted the Disability Strategy and proposal should be further developed to identify how each DHB can Performance (CCDHB) implement the approach. Derek noted that programmes such as Healthcare Homes are being funded by the 3DHBs and we should investigate how they can be connected up with Community Circles and who will take the lead. Member from the public left Tristram offered endorsement but cautions on resourcing challenges and the meeting at approx. leadership hazards. 11.55am Eileen recognised the work done by Pauline and her team and she thanked them. The Committee noted the paper and presentation.
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4.0 DISCUSSION
4.1 Update on Implementation Pauline gave an update on the progress against the Disability Strategy to of Disability Strategy meet the goals of 2017/18 Annual Plan. Pauline Boyles, Director, Derek and Fran noted that informed consent is undergoing further revision Disability Strategy and and welcome the suggested rewording that the research is noted with a focus Performance (CCDHB) on developing resources and investments. The Committee noted the paper with the amendment. Moved Prue Lamason seconded by Derek Milne
General Business Fran requested a DSAC report to the Board with the minutes. Fran noted the TOR will be reported with changes. The Executive will report on the Mental Health Integration Project and the Mental Health Inquiry. Tristram closed the meeting.
Next meeting is 18 June 2018 at Hutt Valley DHB.
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BOARD DECISION PAPER
Date: 3 May 2018
Author Andrew Blair, Board Chair
Subject Resolution to Exclude the Public
RECOMMENDATIONS It is recommended that the Board: a) AGREES that the 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 that 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), in particular:
SUBJECT REASON REFERENCE Public Excluded Minutes For the reasons set out in the 29 March 2018 Board agendas Public Excluded Matters Arising from For the reasons set out in the 29 March 2018 agendas previous Public Excluded meeting Information contained in the paper may be subject to change as the information has not yet been reviewed by the FRAC Section 9(2)(f)(iv) Chief Executive’s report Paper contains information and advice that is likely to prejudice Section 9(2)(j) or disadvantage negotiations Papers contain information and advice that is likely to prejudice 9(2)(j) Sub-committee draft minutes or disadvantage negotiations Non-Government Organisation Papers contain information and advice that is likely to prejudice Section 9(2)(i)(j) funding commitments 2018/19 or disadvantage commercial activities and/or disadvantage negotiations. Upgrade to the Hutt Valley DHB Citrix platform – phase 1 Certification Surveillance Audit Update Register of Board Chair Executed documents March 2018 Serious and Sentinel Events report Papers contain information that is likely to prejudice the privacy Section 9(2)(a) of natural persons, including that of deceased natural persons.
* Official Information Act 1982.
Hutt Valley District Health Board Page 1 April 2018
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Finance Report
February 2018
Strategic enabler; Effective Commissioning
Dale Oliff Judith Parkinson Acting Chief Executive General Manager Finance & Corporate Services
HVDHB Monthly Operating Report Page 1 March 2018
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FINANCIAL PERFORMANCE OVERVIEW The month of February had a total unfavourable variance to budget of ($645k) and ($1,497k) year to date. Key results YTD were: ∑ Funder favourable by $3,325 , Governance favourable by $57k, Provider unfavourable by ($4,880K) ∑ The draft full year forecast is a deficit of ($5,619k) against a Budget deficit of ($2,103k). Material variances year to date
Total Revenue favourable $5,400k: Devolved MoH Revenue favourable $5,263k due to unbudgeted Pay Equity funding of $3,480k passed onto External Providers, Capitation Funding $189k passed onto PHO, additional In-between Travel funding of $273k, additional capital charge funding $160k and the move of Disability Support Services (DSS) funding of $1,169k. Non-Devolved MoH Revenue is unfavourable by ($1,038k) including the DSS change, Bowel screening $245k, and Regional Public Health $85k, ACC Revenue is $235k favourable, but slowing; Other Revenue is $845k favourable, includes Pharmac Rebate of $1,076k and Donations of $199k, offset by unfavourable results in Cafeteria, Interest and Patient Revenue income. IDF Inflows are ($389k) unfavourable, with pay equity of $1,945k offset by unfavourable ($1,947k) In-Patients and ($633k) MHAIDS. Inter DHB Revenue is $484k favourable, predominantly related to Wairarapa and Capital Coast DHB’s.
Personnel and outsourced Personnel unfavourable ($2,147): Medical unfavourable ($1,533k); Outsourced medical is ($1,648k) adverse YTD offset by $115k favourable internal staff. Main areas of overspend are; Outsourced SMO ($1,329k) with General Surgery ($239k), Women’s Health ($411k), Anaesthesia ($239k) Children’s Health ($177k) and MHAIDS ($166k). RMO Outsourced is adverse ($320k) mainly in Emergency and Maternal. Internal medical costs include favourable internal SMO costs of $647k including MHAIDS $197k, Anaesthesia $184k, Maternal $120k and Plastics $112k offset by unfavourable RMO ($541k) with $277k in overtime. Main RMO overspends are in General Surgery, ICU/ Anaesthesia, Plastics, Children’s, Maternal and MHAIDS. Nursing unfavourable ($1,569k); Vacancies in Senior and Registered Nurses are covered using Bureau nursing, mainly in General Medical, Plastics and ED. Outsourced nursing is a reflection of MHAIDS staffing from CCDHB, offset by internal vacancies. Health care Assistants are overspent both in internal staff and external staff required mainly in General Medical and OPRS for minders, Orthopaedics, Plastics and Community Nursing. Allied Health favourable $1,274k; relating to vacancies in Physiotherapist, Dental Therapist and Psychologist. Annual leave Liability cost has increased $435k since February 2017, and there are approx. 36,566 outstanding leave days. Sickness level for the month is 2.2%; this is higher than last month but slightly lower than this time last year.
Outsourced other expenses unfavourable ($1,938k) with overspends in clinical services of ($1,230k), mainly outsourced Surgical and Orthopaedics ($381k) and Maternal ($162k) to meet waiting times, Radiology Outsourced ($527k) and Breast surgery ($156k) to manage volumes and vacancies and IT ($546k) savings target. Treatment related Costs unfavourable ($2,522k); Pharmaceuticals ($944k), Leased Radiology equipment ($271k) and Treatment Disposables ($1,001k) Non Treatment Related Costs favourable $1,262k; IT licences $372k, consultants $754k (Innovation Funding, project manager costs are within personnel). IDF Outflow unfavourable ($225k); this includes and prior year wash up of ($209k). Other External Provider Costs ($1,499k) unfavourable; mainly related to pay Equity payments to providers, funded via additional revenue.
Hospital activity; Throughput in February was higher than budgeted, with a high rate of discharges in Medical. ED volumes were down, but admissions were the same as this time last year. Average Length of stay (ALOS) was above budget and higher than last year. Surgical CWD is down for February, but slightly higher than last February. Cash position averaged $22.6m for February and $20.03m during January and was $3.1m at the end of February.
HVDHB Monthly Operating Report Page 2 March 2018
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The following table provides a summary of the financial performance of the DHB for February 2018 Hutt Valley DHB Operating Report for the month of Month February 2018 Year to Date Annual Actual Budget Variance Last Year Variance $000s Actual Budget Variance Last Year Variance Forecast Budget Variance Last Year Variance
Revenue 33,440 33,128 313 32,869 572 Devolved MoH Revenue 273,370 268,107 5,263 262,532 10,837 410,503 403,016 7,487 391,614 18,889 1,420 1,626 (205) 1,347 73 Non Devolved MoH Revenue 12,251 13,289 (1,038) 13,648 (1,396) 18,586 20,116 (1,530) 20,458 (1,872) 390 484 (94) 384 6 ACC Revenue 4,104 3,869 235 3,348 757 6,359 5,803 555 5,542 817 630 557 73 437 194 Other Revenue 5,206 4,361 845 4,261 945 7,806 6,557 1,248 8,169 (364) 8,115 8,480 (365) 7,340 775 IDF Inflow 67,460 67,849 (389) 63,037 4,423 101,602 101,770 (168) 95,382 6,220 413 307 106 323 90 Inter DHB Provider Revenue 2,938 2,454 484 3,054 (115) 4,381 3,681 700 5,380 (999) 44,408 44,581 (173) 42,699 1,710 Total Revenue 365,329 359,929 5,400 349,880 15,450 549,237 540,945 8,293 526,546 22,691 1
Expenditure
Employee Expenses 3,849 3,852 4 3,917 68 Medical Employees 34,532 34,647 115 33,255 (1,277) 51,249 51,675 426 50,949 (300) 4,864 4,623 (241) 4,954 90 Nursing Employees 41,680 40,859 (821) 40,473 (1,207) 61,821 60,633 (1,188) 61,429 (392) 2,180 2,215 35 2,089 (91) Allied Health Employees 17,838 19,244 1,406 17,924 86 27,428 28,942 1,514 27,527 99 556 547 (9) 531 (26) Support Employees 4,648 4,662 13 4,482 (167) 6,956 6,993 37 6,851 (105) 1,987 1,920 (67) 1,726 (261) Management and Admin Employees 16,887 16,910 22 13,967 (2,920) 25,381 25,338 (43) 22,194 (3,187) 13,436 13,157 (279) 13,217 (219) Total Employee Expenses 115,586 116,321 735 110,101 (5,484) 172,835 173,581 747 168,950 (3,884) 2
Outsourced Personnel Expenses 304 198 (106) 145 (159) Medical Personnel 3,230 1,582 (1,648) 2,366 (864) 4,170 2,376 (1,794) 4,154 (16) 116 59 (57) 71 (45) Nursing Personnel 1,219 471 (748) 786 (433) 1,684 707 (978) 1,246 (438) 28 19 (9) 117 89 Allied Health Personnel 286 154 (132) 295 8 418 232 (187) 557 139 15 10 (5) 14 (1) Support Personnel 104 81 (23) 121 17 144 121 (23) 176 32 96 30 (66) 162 66 Management and Admin Personnel 567 236 (331) 1,010 443 691 354 (337) 1,438 746 558 316 (242) 509 (49) Total Outsourced Personnel Expenses 5,406 2,524 (2,882) 4,577 (829) 7,108 3,789 (3,319) 7,571 463 2
702 558 (144) 631 (71) Outsourced Other Expenses 6,485 4,547 (1,938) 6,098 (386) 9,192 6,828 (2,365) 8,169 (1,023) 3 2,071 1,935 (136) 1,938 (134) Treatment Related Costs 18,320 15,798 (2,522) 16,986 (1,334) 28,299 24,546 (3,753) 26,578 (1,721) 4 1,216 1,563 347 1,191 (25) Non Treatment Related Costs 11,228 12,489 1,262 10,894 (333) 16,891 18,626 1,734 16,942 51 5 7,321 7,601 280 7,719 398 IDF Outflow 61,344 61,118 (225) 58,866 (2,478) 93,168 91,935 (1,233) 89,238 (3,930) 6 16,219 15,886 (333) 15,034 (1,185) Other External Provider Costs 135,303 133,804 (1,499) 128,137 (7,166) 203,571 199,926 (3,644) 191,450 (12,121) 7 1,949 1,983 35 1,723 (226) Interest, Depreciation & Capital Charge 15,644 15,816 172 15,383 (261) 23,792 23,816 24 21,446 (2,345)
43,472 43,000 (472) 41,962 (1,510) Total Expenditure 369,314 362,417 (6,897) 351,042 (18,272) 554,856 543,048 (11,808) 530,345 (24,510)
936 1,581 (645) 737 200 Net Result (3,984) (2,488) (1,497) (1,162) (2,822) (5,619) (2,103) (3,516) (3,799) (1,819)
Result by Output Class 602 539 63 1,625 (1,023) Funder 3,283 (42) 3,325 2,366 917 3,608 1,056 2,552 3,078 530 14 23 (9) (95) 109 Governance 144 86 57 (245) 389 194 120 74 146 48 320 1,020 (700) (793) 1,113 Provider (7,412) (2,532) (4,880) (3,283) (4,129) (9,422) (3,280) (6,142) (7,024) (2,398) 936 1,581 (646) 737 199 Net Result (3,985) (2,488) (1,498) (1,162) (2,823) (5,619) (2,103) (3,516) (3,799) (1,820)
HVDHB Monthly Operating Report Page 3 March 2018
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February month results had an unfavourable variance to budget of ($645k)
The main variances to budget for the month are detailed below:
1. Revenue: Total revenue is unfavourable ($173k) for the month. Devolved MoH revenue is $313k favourable for February related to an adjustment to recognised Pay Equity revenue, and the line move of DSS funding. Non Devolved revenue is ($205k) unfavourable, ($150k) related to the transfer of DSS funding to Devolved, and ($86k) to Health Workforce Training revenue. ACC Revenue is ($94k) unfavourable this month, unfavourable across most areas, with OPRS being unfavourable ($46k) for the month. IDF inflows are unfavourable ($365k) for the month and include a favourable $244k from CCDHB for Pay Equity relating to the HSS contract. Inter DHB Provider Revenue is $106k favourable for the month, mainly relating to revenue from CCDHB.
2. Total Personnel including outsourced is unfavourable by ($521k) for February. ∑ Medical personnel incl. outsourced are unfavourable ($102k) for the month. Outsourced costs are ($106k) unfavourable for month Maternity Care ($47k), General Surgery ($29k) and Anaesthesia ($36k). Medical Staff internal is favourable for the month $4k. ∑ Nursing incl outsourced ($298k) unfavourable for the month. Total Outsourced nursing personnel is unfavourable ($57k), mainly in MHAIDs and General medical - Senior Nurses favourable by $37k, and Registered Nurses favourable by $31k, offset by Bureau Nurses unfavourable ($138k) covering RN vacancies and sick leave mainly in Plastics, ED, Maternity, GSG, OPRS and General Medical. Internal HCA unfavourable ($129k). Main pressure points continue to be HCA being used as minders primarily in General medical, but also in Plastics, Orthopaedics, OPRS, and additional costs in District Nursing to cover increased volumes. The total beddays for the month was 4% higher than budget and 8% higher than the same month last year. ∑ Allied Health incl. outsourced favourable $26k for the month due to continued vacancies. ∑ Support incl. outsourced unfavourable by ($14k) for the month. ∑ Management & Admin incl. outsourced is unfavourable ($133k) for the month with vacancy savings not being fully realised.
3. Outsourced other unfavourable ($144k) for the month, with Clinical Outsourced ($97k) driven mainly by radiology and outsourced other ($46k) driven by ICT and outsourced HR. 4. Treatment related costs are unfavourable by ($136k) for the month. Main drivers Treatment Disposables ($26k) – mainly blood (intragam), and Pharmaceuticals (MABS) ($155k), offset by favourable $28k in Instruments and Equipment. 5. Non Treatment Related costs are favourable $347k. Facility costs are $97k favourable due to timing, Consultants underspend of $96k relates to the Innovation Fund timing, ICT software $68k and Hotel services costs (Food) $20k. 6. IDF Outflows are $280k favourable for the month. 7. Other External Provider costs unfavourable ($333k) for the month. Pay Equity costs are now reported separate from Arc and Other Hop, the movement affecting the month result. Capitation unfavourable ($235k), but offset by additional revenue, and Pharmaceuticals unfavourable ($148k), offset by underspend in Mental Health and other external.
HVDHB Monthly Operating Report Page 4 March 2018
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Funder Financial Statement of Performance
This month’s result for the funder is $63k favourable and $3,325k favourable year to date. The main contributing factors year to date are: ∑ Other MOH Revenue $5,263k favourable related to; Pay Equity $3,480k passed onto External Providers predominantly in; Other HOP, In between Travel Funding (including prior year wash-up) $307k, PHO Capitation $189k and Capital charge $160k and the reporting adjustment for DSS revenue. ∑ Governance and Administration is over budget by ($338k) due to revenue transfers to cover additional costs for Healthcare Home, Clinical Services Plan and Hutt Valley strategy rollout. ∑ Provider Arm payments are $364k favourable for the year to date due to under performance in IDF inflow of $1,164k, offset by an adjustment to Disability Support services funding construct (formally direct to provider, now via Funder) . ∑ Capitation expenses are adverse by ($569k) for which additional revenue of $189k has been reported.
HVDHB Monthly Operating Report Page 5 March 2018
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∑ Aged residential care costs are favourable by $1,476k; rest home & hospital level combined. Pay equity is now reported separately, however, previous estimated underlying underspend was slightly more favourable than now recognised. ∑ Other HOP costs are ($912k) unfavourable; the movement this month related to the separation of pay Equity costs from the base Other HOP costs . This includes unbudgeted costs of $220k for to In-Between Travel, high needs infants in the community and $493k for Access Home Health contract. ∑ Mental Health costs are under budget by $1,275k; of which $339k relates to wash-ups and $260k to regional contracts (offset by an equivalent reduction in revenue). ∑ Palliative Care, Fertility and Community Radiology costs are over budget ($203k) due to timing. ∑ Other external provider costs are favourable by $1,490k for the year to date. This is mostly due to an overstated expenditure accrual of $484k made in June which has been reversed, expenditure through SPO $297k (expenditure in the governance line), and budget for cost in Palliative Care and contracts which start later in the year IDF Financial Summary IDF Wash-ups and Service Changes Feb 2018 IDF Wash-ups and Service Changes Feb 2018 Variance to budget Variance to budget IDF Inflows ($000s) IDF Outflows $000s Month YTD Forecast Month YTD Forecast Regional Mental health (Central Health) (32) (260) (390) CAP - Disability related AP obligations (4) (29) (44) CAP - Pay equity 244 1,945 2,933 Auckland Congenital Cardiac Surgery - (30) (30) CAP - Access Contract 54 326 543 Clinical Genetics - (19) (19) CAP - Individual patient MH 7 56 56 CAP - Wellington Free Ambulance (7) (7) (36) WRP - Green Prescription (5) (11) (11) CAP - Assignment MH contracts - - - CAP - Assignment MH contracts - - - Heart Lung transplant - - (44) Other Regional MH contract changes - - 6 Hyperbaric Chamber - - (85) Adjustment for timing variance - - (4) Adjustment for timing variance - - (171) Wash-ups Wash-ups - - - Current Year Mental Health (49) (339) (339) PHO Capitation & FFS Wash-ups (37) (106) (106) Current Year Inpatients (567) (1,947) (2,775) PCT Wash-up (50) (439) (659) PHO Capitation & FFS Wash-ups (9) (24) (24) Current Year Inpatients 438 367 (248) Refund Regional MH Manager (8) (66) (100) Prior Year Wash-ups - 209 209 Prior Year Wash-ups - (66) (66) Rounding - - (1) - - - Total IDF Inflow changes (365) (385) (168) Total IDF Outflow changes (340) (54) (1,233) Budgeted variance (0) 4 - Budgeted variance 60 (171) - IDF Inflow variance (365) (389) (168) IDF Outflow variance (280) (225) (1,233)
IDF inflows are unfavourable (365k) for the month and ($389k) YTD. Provider arm service delivery worsened during the month by a further ($567k), but this is offset by revenue from CCDHB for Pay Equity costs in the Access Home health contract IDF Outflows IDF Outflows are unfavourable ($225k) year to date; and we are forecasting a year end overspend of ($1,233k) which will be offset by a wash-up provision of $1,280k.
HVDHB Monthly Operating Report Page 6 March 2018
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Pharmaceutical Costs Community Pharmaceuticals accruals are calculated on a consistent methodology which takes into account the seasonality of the expenditure, and timing delays between the month of service and the month of payment. In the 2016/17 financial year, on average, 30.8% of the costs were paid in the month of service, 65.2% in the month following, and the remaining 3.0% spread across the following months.
The graph above shows the expenditure on community pharmaceutical costs including the actuals for 2014/15 to 2017/18 together with the budget for 2017/18. The budget for 2017/18 has been phased based on trends of expenditure in previous years. The net amount reported as pharmaceutical costs in the accounts includes community pharmaceutical costs, Pharmac rebates, payments for National Haemophilia services and any transactions relating to the Discretionary Pharmaceutical Fund (DPF).
HVDHB Monthly Operating Report Page 7 March 2018
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Aged Residential Care The following table shows the expenditure for aged residential care.
HVDHB Monthly Operating Report Page 8 March 2018
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Personnel
Month FTE Report Year To Date Annual Actual Budget Variance Last Year Variance Feb-18 Actual Budget Variance Last Year Variance Budget Last Year FTE 267 247 (20) 253 (14) Medical 256 247 (10) 253 (3) 247 253 766 736 (30) 749 (17) Nursing 759 737 (22) 745 (14) 737 749 383 400 17 387 4 Allied Health 371 401 30 382 11 401 382 135 138 3 130 (5) Support 133 138 5 130 (2) 138 131 347 355 8 315 (32) Management & Administration 341 354 12 306 (35) 354 314 1,898 1,876 (22) 1,834 (64) Total FTE 1,860 1,876 17 1,817 (43) 1,876 1,829 $ per FTE ($000) 14,423 15,580 1,157 15,495 1,071 Medical 134,786 140,541 5,754 131,441 (3,345) 207,681 204,079 6,349 6,283 (66) 6,611 261 Nursing 54,922 55,413 491 54,309 (613) 83,901 80,935 5,692 5,532 (160) 5,398 (294) Allied Health 48,118 47,994 (125) 46,954 (1,165) 68,425 75,832 4,111 3,967 (144) 4,085 (26) Support 35,081 33,806 (1,275) 34,371 (709) 50,444 53,345 5,726 5,411 (315) 5,474 (251) Management & Administration 49,485 47,814 (1,671) 45,571 (3,913) 71,684 80,723 7,078 7,013 (65) 7,205 127 Average Cost per FTE all Staff 62,157 61,992 (165) 60,600 (1,558) 92,110 94,905
FTE Commentary ∑ Medical (20) FTE over budget for the month; SMOs under by 0.17FTE’s. 1.62 SMO FTE are cost recovered from other DHBs. RMOs & House Surgeons over by (15.6) FTEs, General Medical (3.77) FTEs, Anaesthesia/ICU (1.06) FTE, General Surgery (0.93) FTE, Plastics (2.01) FTE, Orthopaedics (1.03) FTE, CCU (1) FTE, ED (1.31) FTE and OPRS (1) FTE, Children’s (1.05) FTE and Maternal (1.45) FTE. Of the 20 FTE over 5.7FTE relate to SMO overtime, 3.93 to RMO overtime and 1.38 to House Officer overtime. RMO Schedule 10 rosters have now been implemented for the following services; Surgery, Medical ward, Cardiology, Paediatrics, O & G, Plastics and Orthopaedic.
∑ Nursing over by (30) FTEs for the month. Senior Nurses under budget by 7.66FTE, Registered and enrolled nurses under by 2.95 FTE and this was offset by Internal Bureau Nurse FTEs (15.73) in; Maternity, General Medical, GSG and Emergency. Health Care Assistants are (20.72) FTEs over during the month mainly in General Medical, but also in Orthopaedic, Plastics, OPRS, District Nursing and TWA for minders.
∑ Allied FTEs are under by 17 FTEs for the month due in the main to; Child Dental Therapist and Assistants under 1.72 FTE, Mental Health Social workers and Psychologist 5.33FTE, MRT’s 4.24FTE and Therapists 1.29, Vision / Hearing testers 5.4.
∑ Support FTEs are under budget by 3 FTEs mainly in cleaning.
∑ Management & Admin are under 8 FTEs mainly Clinical Admin FTE.
HVDHB Monthly Operating Report Page 9 March 2018
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FTE Trend
Jun 12 Jun 13 Jun 14 Jun 15 Jun 16 Jul 16 Feb 17 Mar 17 Apr 17 May 17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Medical 238 224 228 257 257 250 253 249 249 254 263 248 253 252 248 250 269 262 267
l Nursing 707 690 733 744 744 750 749 760 752 757 759 762 769 767 759 746 748 754 766 a u
t Allied Health 437 428 435 385 385 388 387 381 377 382 385 375 373 373 372 367 360 362 383 c A Non Health Support 145 133 135 129 129 131 130 134 135 131 131 129 130 130 133 134 132 135 135 Managemt/Admin 342 272 305 302 302 301 315 328 327 330 330 334 341 343 337 338 348 343 347 l
a Actual FTE 1,869 1,748 1,836 1,817 1,817 1,820 1,834 1,851 1,840 1,853 1,869 1,848 1,865 1,865 1,850 1,836 1,857 1,857 1,898 t o
T Budget 1,862 1,824 1,785 1,835 1,835 1,865 1,864 1,864 1,862 1,862 1,862 1,873 1,875 1,877 1,876 1,876 1,879 1,878 1,876
2,000 1,800 1,600 1,400 1,200 1,000 800 600 400 200 - Jun 12 Jun 13 Jun 14 Jun 15 Jun 16 Jul 16 Feb 17 Mar 17 Apr 17 May 17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18
Medical Nursing Allied Health Non Health Support Managemt/Admin Budget
HVDHB Monthly Operating Report Page 10 March 2018
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Annual Leave
The following graphs show the historical trends in annual leave for the last two years.
Category Total staff with Annual leave days Less Greater % of staff Total Leave than 20 20-30 30-40 than 40 >40 Total Staff Less LSL $ Medical - Senior 76 29 19 35 22% 159 4,506,626 Medical - Junior 106 22 14 9 6% 151 1,288,357 Nursing 543 176 86 75 9% 880 6,777,993 Allied Health 362 70 15 14 3% 461 1,674,746 Support 70 34 16 15 11% 135 750,418 Mgmt/Admin 297 60 20 10 3% 387 1,373,731 Total* 1,454 391 170 158 7% 2,173 16,371,870
HVDHB Monthly Operating Report Page 11 March 2018
124 2018 05 03 Hutt Valley Board Public - APPENDICES
Sick Leave
The following graph shows the historical trends in sick leave for the last two years.
Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Medical 1.2% 1.1% 1.3% 1.7% 3.0% 1.7% 1.7% 1.7% 1.0% 1.4% 2.0% 1.1% 1.6% Nursing 3.0% 3.5% 3.7% 3.8% 3.6% 4.8% 4.6% 4.0% 3.8% 3.1% 2.7% 2.0% 2.3% Allied Health 2.4% 3.1% 3.5% 3.1% 4.0% 4.6% 4.1% 3.9% 3.0% 3.1% 3.3% 1.4% 2.2% Support 2.3% 2.9% 2.7% 3.5% 5.2% 3.4% 4.1% 3.4% 3.5% 3.3% 2.4% 2.0% 1.7% Admin 1.8% 2.2% 2.4% 2.9% 4.0% 4.4% 3.6% 2.9% 2.2% 2.4% 2.5% 1.5% 2.5% Total 2.4% 2.7% 3.0% 3.3% 3.8% 4.2% 3.8% 3.4% 2.9% 2.8% 2.7% 1.6% 2.2%
HVDHB Monthly Operating Report Page 12 March 2018
125 2018 05 03 Hutt Valley Board Public - APPENDICES
IDF Analysis Month Inter District Flows (IDF) - $000s Year to Date Annual Actual Budget Variance Last Year Variance YTD Feb-18 Actual Budget Variance Last Year Variance Budget Last Year IDF Inflows 871 997 (126) 846 25 Acute 7,735 7,974 (239) 7,216 519 10,367 10,693 597 976 (379) 723 (126) Elective 6,104 7,811 (1,708) 6,336 (232) 11,249 9,595 2,991 2,991 0 2,903 89 Laboratory 23,932 23,932 0 23,263 668 34,833 34,874 (62) 0 (62) (62) Prior year wash-up (62) 0 (62) (62) 0 0 3,718 3,516 202 2,868 850 Other Services 29,752 28,131 1,620 26,222 3,529 45,322 40,219 8,115 8,480 (365) 7,340 775 Total IDF inflows 67,460 67,849 (389) 63,037 4,423 101,770 95,382 IDF Outflows 1,936 2,524 588 2,824 888 Acute 19,553 19,923 370 19,043 (510) 25,119 29,167 1,080 1,183 103 1,084 4 Elective 9,425 9,422 (3) 8,864 (561) 13,709 13,610 1,794 1,794 0 1,820 26 Outpatient 14,352 14,352 0 14,557 205 21,835 22,053 270 270 0 325 55 Pharmaceutical Cancer Treatment 2,159 2,159 0 2,597 438 2,364 3,301 106 0 (106) (106) Prior year wash-up 106 0 (106) (106) 0 0 2,135 1,830 (305) 1,667 (468) Other Services 15,750 15,263 (486) 13,806 (1,944) 28,907 21,108 7,321 7,601 280 7,719 398 Total IDF Outflows 61,344 61,118 (225) 58,866 (2,478) 91,935 89,238 107 107 Funder IDF provision 853 853 1,280 1,280 7,321 7,708 387 7,719 398 Total IDF Net of provision 61,344 61,972 628 58,866 (2,478) 93,215 90,518
Note: Timing differences when reporting on IDFs will have a bearing on year to date figures reported above Note: Other Services Inflow includes: Outpatients, Mental Health, PHO, Older people services (incl ARC) and NGO (e.g. Fertility). Other Services Outflow is the same with the addition of laboratory
IDF inflow (revenue): Inpatient inflows are under budget YTD by ($389k), lower acute and elective inflows are offset by higher inflows in other services. Elective Plastic surgery, and General surgery were under budget this month, and Rheumatology electives reduced because cases are now counted as acutes.
IDF Outflow (expense): Analysis is based on 8 months data from CCDHB and 7 from others: YTD there has been under provision in Acutes but Electives are close to budget. Note there was a large psychogeriatric discharge in July with 398 days stay ($292k). There are several cases due for discharge in March and April that are likely to be high caseweights totalling about $248k. There is also a sick child still in Starship.
HVDHB Monthly Operating Report Page 13 March 2018
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The graphs below show actual IDF CWD flows by month
Acute IDF Outflow CWD Elective IDF Outflow CWD 700 350 600 300 500 250 400 200 300 150 200 100 100 50 0 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
2017/2018 2016/2017 2015/2016 2017/18 Budget 2017/2018 2016/2017 2015/2016 2017/18 Budget
Acute IDF Inflow CWD Elective IDF Inflow CWD 300 250
250 200 200 150 150 100 100
50 50
0 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
2017/2018 2016/2017 2015/2016 2017/18 Budget 2017/2018 2016/2017 2015/2016 2017/18 Budget
HVDHB Monthly Operating Report Page 14 March 2018
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Hospital throughput Month Hutt Valley DHB Year to Date Annual Variance Variance Hospital Throughput Variance Variance Actual vs Actual vs Actual vs Actual vs Annual YTD Feb-18 Actual Budget Budget Last year Last year Actual Budget Budget Last year Last year Budget Last year Discharges 1,044 1,138 94 1,033 (11) Surgical 9,001 8,683 (318) 8,242 (759) 13,463 12,797 1,566 1,450 (116) 1,441 (125) Medical 13,778 12,456 (1,322) 12,741 (1,037) 18,942 19,506 428 401 (27) 396 (32) Other 3,716 3,591 (125) 3,669 (47) 5,356 5,474 3,038 2,989 (49) 2,870 (168) Total 26,495 24,730 (1,765) 24,652 (1,843) 37,762 37,777 CWD 1,024 1,080 57 990 (33) Surgical 8,884 8,855 (29) 8,412 (472) 13,463 12,852 882 870 (12) 825 (58) Medical 8,290 7,974 (317) 7,874 (417) 11,967 11,991 391 322 (68) 314 (77) Other 3,224 3,284 60 3,064 (160) 4,867 4,698 2,297 2,273 (24) 2,129 (168) Total 20,398 20,112 (286) 19,350 (1,048) 30,296 29,540
Other 3,675 3,812 137 3,686 11 Total ED Attendances 32,167 31,913 (254) 31,429 (738) 47,902 47,491 835 913 78 834 (1) ED Admissions 7,635 7,977 342 7,793 158 11,967 11,847 740 800 60 714 (26) Theatre Visits 6,188 6,419 231 6,071 (117) 9,784 9,271 93 158 65 143 50 Non- theatre Proc 1,019 1,240 221 1,175 156 1,989 1,891 6,749 6,485 (264) 6,227 (521) Bed Days 58,094 56,228 (1,866) 56,046 (2,048) 85,512 85,515 4.93 4.29 (0.65) 4.09 (0.85) ALOS Inpatient 4.41 4.29 (0.12) 4.27 (0.14) 4.29 4.29 2.29 2.20 (0.09) 2.00 (0.29) ALOS Total 2.14 2.20 0.05 2.20 0.05 2.20 2.20 7.85% 7.36% -0.49% 6.35% -1.50% Acute Readmission 7.55% 7.36% -0.19% 7% -0.30% 7.31% 7.36% Note: Other inpatient includes mental health and maternity. Activity in this report includes ACC, overseas cases and privately funded cases.
Discharges from the hospital were higher than budget this month and higher than February last year for medical but lower for surgical. Cases for elective surgery were similar in most specialties than February last year but caseweights were lower.
ED volumes for the month were lower than budget and February last year. A similar proportion of patients were admitted compared to last year. Theatre visits were lower than budget this month but higher than last year. Non-Theatre procedures are lower than budget for the month and lower YTD. Bed days were higher in the month and are over YTD. ALOS was higher than expected and higher than February last year overall and for inpatients. The acute readmission rate has increased but the last ministry report shows our rate is below the national average.
HVDHB Monthly Operating Report Page 15 March 2018
128 2018 05 03 Hutt Valley Board Public - APPENDICES
Hutt Hospital Inpatients CWD per Clinical FTE 4000 2.20 2.00 3500 1.80 3000 1.60 2500 1.40 1.20 2000 1.00 1500 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
1000 2017/18 2015/16 2016/17
500 0 CWD per Total FTE 5 6 7 8 5 6 7 4 5 6 7 5 6 7 4 5 6 7 4 5 6 7 4 5 5 6 6 7 7 8 4 5 6 7 5 6 7 5 6 7 4 5 6 7 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 1 1 ------l l l l r r r t t t t r r r c c c c v v v v y y y g g g g p b p b p b p b n n n n n n n 1.60 c c c c u u u u a a a p p p e e e e a a a u u u u o o o o e e e e e e e e a a a a u u u J J J J J J J J J J J O O O O A A A S F S F S F S F D D D D A A A A N N N N M M M M M M 1.50 Total Discharges Total CWD 1.40 1.30 1.20 Emergency Dept Attendances 1.10 5000 1.00 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
4500 2017/18 2015/16 2016/17
4000 Primary Care Contacts 100,000 3500 80,000 60,000 3000 40,000 20,000 - r r r r r r r c c c c c c c p p p p p p p 2500 n n n n n n n a a a a a a a e e e e e e e e e e e e e e u u u u u u u J J J J J J J S S S S S S S D D D D D D D M M M M M M M ------l l l l l l l r r r r r r r t t t t t t t n n n n n n n p p p p p p p u u u u u u u c c c c c c c J J J J J J J a a a a a a a A A A A A A A O O O O O O O 2000 J J J J J J J 5 6 7 5 6 7 8 4 5 6 7 5 6 7 4 5 6 7 4 5 5 6 6 7 7 8 4 5 6 7 5 5 6 7 4 5 6 7 5 6 7 4 6 7 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 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 1 1 ------l l l l t r r r t t t r r r c c c c v v v v y y y g g g g p b p b p b p b n n n n n n n c c c c u u u u a a a p p p e e e e a a a u u u u o o o o e e e e e e e e a a a a u u u J J J J J J J J J J J O O O O A A A S F S F S F S F D D D D
A A A A Doctor Nurse N N N N M M M M M M
HVDHB Monthly Operating Report Page 16 March 2018
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Caseweighted Activity The table below provides detail on the hospital throughput for acute and elective inpatient services. This is only for CWD DHB purchased lines and is a subset of the data in the hospital throughput table. It excludes ACC, items purchased as procedures, ATR and mental health. It is the data we provide to the Ministry of Health for the MIF meeting.
Month Variance DHB funded Caseweights YTD Variance Actual Actual Actual Actual vs vs Last vs vs Last Actual Budget Last Yr Budget Yr YTD Feb-18 Actual Budget Last Yr Budget Yr 965 1,010 913 46 (52) Surgical 8,296 8,559 7,993 263 (304) 32 36 37 4 5 Ear, Nose and Throat - Inpatient Services (DRGs) 268 307 235 39 (33) 234 230 168 (4) (65) General Surgery - Inpatient Services (DRGs) 2,063 1,983 1,916 (81) (147) 54 73 80 19 26 Gynaecology - Inpatient Services (DRGs) 547 638 536 91 (11) 19 21 12 1 (8) Inpatient Dental treatment 151 177 143 26 (8) 25 17 16 (9) (9) Ophthalmology - Inpatient Services (DRGs) 151 144 149 (7) (2) 286 265 264 (21) (22) Orthopaedics - Inpatient Services (DRGs) 2,383 2,290 2,196 (93) (187) 315 369 337 54 22 Plastic & Burns - Inpatient Services (DRGs) 2,734 3,021 2,817 287 84 715 675 625 (40) (90) Medical 6,633 5,827 6,065 (806) (568) 55 70 64 15 8 Cardiology - Inpatient Services (DRGs) 598 610 624 11 26 125 95 95 (29) (29) Emergency Medical Services - Inpatient Services (DRGs) 1,064 822 790 (242) (274) 40 6 6 (34) (34) Gastroenterology - Inpatient Services (DRGs) 90 48 57 (42) (33) 390 393 361 3 (28) General Internal Medical Services - Inpatient Services (DRGs) 3,831 3,406 3,636 (425) (196) 74 85 79 11 5 General Paediatric Services - Inpatient Services (DRGs) 755 734 759 (21) 4 31 26 19 (5) (12) Rheumatology (incl Immunology) - Inpatient Services (DRGs) 294 208 200 (86) (94) 223 214 218 (9) (5) Other 2,052 1,847 2,015 (205) (36) 174 158 144 (16) (29) Maternity inpatient (DRGs) 1,479 1,364 1,433 (116) (46) 49 56 73 7 24 Specialist neonates 573 483 582 (90) 9 1,902 1,899 1,755 (3) (147) Total 16,981 16,233 16,073 (748) (908)
Surgical services have had less CWD than budget this month, but more than last year. Plastics has had less CWD than budget this month as February has been another quieter month but the service has been catching up on volumes after filling vacancies. Year to date General Surgery and Orthopaedics have more than expected CWD and this has partially offset the lower CWD from Plastics. The medical specialities had more activity than budgeted this month and also year to date due to the winter season being worse than last year. Scopes appear in the CWD until coded which makes Gastroenterology look high; these are funded outside of CWD. Maternity services and Neonates are over budget YTD and maternity is higher than last year.
HVDHB Monthly Operating Report Page 17 March 2018
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Statement of Financial Position as at 28th February 2018 $000s Actual Budget Variance Jun 17 Variance Explanation of Variances Between Actual and Budget
Assets Current Assets Bank 3,110 7,462 (4,352) 7,144 (4,033) Average bank balance in Feb-18 was $22.1m, closing NZHP $3.1m Bank - Non DHB Funds * 7,716 5,311 2,406 6,093 1,623 Accounts Receivable 17,868 16,556 1,312 17,018 850 Inclusive of accrued debtors Stock 1,454 1,489 (35) 1,443 11 Prepayments 1,818 1,953 (135) 2,481 (663) Total Current Assets 31,967 32,770 (803) 34,180 (2,213) Fixed Assets Fixed Assets 188,359 190,652 (2,293) 194,932 (6,574) Work in Progress 18,887 15,774 3,113 16,302 2,585 WIP Balance investigated each month, Fully operational assets capitalised following month. Total Fixed Assets 207,246 206,426 820 211,234 (3,988) Investments Investments in Associates 850 850 0 550 300 Trust Funds Invested 1,342 1,373 (30) 1,368 (25) Restricted trusts in high interest savings account Total Investments 2,192 2,223 (30) 1,918 275 Total Assets 241,405 241,418 (13) 247,331 (5,926) Liabilities Current Liabilities Accounts Payable and Accruals 33,888 39,074 5,186 39,164 5,276 Crown Loans and Other Loans 172 165 (7) 471 299 Current Employee Provisions 22,234 21,328 (905) 21,899 (335) Total Current Liabilities 57,957 62,257 4,300 61,534 3,577 Non Current Liabilities Other Loans 730 479 (251) 663 (67) Finance leases Long Term Employee Provisions 7,181 7,634 453 7,181 0 Non DHB Liabilities 7,725 5,311 (2,414) 6,128 (1,597) These are held in NZHP account, term deposits and separate bank accounts Trust Funds 1,340 1,671 330 1,368 28 Total Non Current Liabilities 16,976 15,095 (1,882) 15,340 (1,636) Total Liabilities 74,933 77,352 2,419 76,874 1,941 Net Assets 166,472 164,067 2,405 170,457 (3,985)
Equity Crown Equity 124,538 124,537 1 124,538 0 Revaluation Reserve 95,352 91,341 4,011 95,352 0 Opening Retained Earnings (49,432) (49,323) (109) (45,633) (3,799) Net Surplus / (Deficit) (3,985) (2,488) (1,498) (3,799) (186) Total Equity 166,472 164,067 2,405 170,457 (3,985)
HVDHB Monthly Operating Report Page 18 March 2018
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Statement of Cash Flow – February 2018 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun $000s Actual Actual Actual Actual Actual Actual Actual Actual Forecast Forecast Forecast Forecast Operating Activities Government & Crown Agency Revenue 37,429 35,695 35,974 34,748 35,448 35,421 35,142 36,239 37,084 35,462 35,602 35,720 Receipts from Other DHBs (Including IDF) 6,989 10,990 6,711 11,827 8,415 9,217 8,677 8,070 9,016 8,856 8,856 8,856 Receipts from Other Government Sources 551 681 553 712 661 518 487 438 661 661 661 661 Other Revenue 540 (922) 440 (930) 509 3,425 (1,554) 985 388 354 385 901 Total Receipts 45,509 46,444 43,678 46,357 45,033 48,581 42,751 45,732 47,149 45,333 45,503 46,138
Payments for Personnel (13,251) (16,574) (15,152) (13,791) (16,295) (13,980) (17,188) (15,397) (14,740) (14,375) (15,467) (14,370) Payments for Supplies (Excluding Capital Expenditure) (4,626) (5,180) (5,303) (1,951) (5,915) (6,047) (1,636) (4,749) (4,551) (4,572) (4,586) (5,086) Capital Charge Paid 0 0 0 0 0 (5,101) 0 0 (0) (0) (0) (5,069) GST Movement 786 (553) 83 146 (290) 2,080 (1,720) 167 0 0 0 0 Payments to Other DHBs (Including IDF) (7,603) (7,924) (7,574) (7,661) (7,759) (8,293) (7,208) (7,321) (8,331) (7,715) (7,715) (8,064) Payments to Providers (16,732) (18,230) (17,216) (20,469) (16,400) (17,858) (17,638) (15,966) (19,175) (16,304) (16,580) (16,430) Total Payments (41,427) (48,461) (45,162) (43,726) (46,658) (49,199) (45,390) (43,266) (46,796) (42,966) (44,348) (49,019) Net Cashflow from Operating Activities 4,082 (2,016) (1,485) 2,631 (1,626) (618) (2,639) 2,466 353 2,368 1,156 (2,881)
Investing Activities Interest Receipts 44 47 42 40 41 45 37 37 46 46 46 46 Capital Expenditure (1,070) (765) (388) (706) (783) (211) (684) (251) (798) (865) (679) (967) Increase in Investments and Restricted & Trust Funds Assets (254) (194) 13 168 (41) 177 (169) 25 0 0 0 0 Net Cashflow from Investing Activities (1,280) (912) (333) (498) (782) 11 (817) (189) (753) (819) (633) (921)
Financing Activities Interest Paid on Finance Leases (5) (5) (5) (5) (5) (5) (3) (5) (6) (5) (5) (5) Other Equity Movement 0 0 0 0 0 0 0 0 0 0 0 (207) Net Cashflow from Financing Activities (5) (5) (5) (5) (5) (5) (3) (5) (6) (5) (5) (212)
Total Cash In 45,553 46,491 43,720 46,397 45,074 48,626 42,787 45,769 47,195 45,379 45,549 46,184 Total Cash Out (42,756) (49,425) (45,542) (44,269) (47,486) (49,238) (46,247) (43,497) (47,600) (43,836) (45,031) (50,198) Net Cashflow Opening Cash 7,145 9,943 7,009 5,186 7,315 4,902 4,290 831 3,103 2,698 4,241 4,759 Net Cash Movements 2,797 (2,934) (1,823) 2,128 (2,413) (612) (3,459) 2,272 (405) 1,544 518 (4,014) Closing Cash 9,943 7,009 5,186 7,315 4,902 4,290 831 3,103 2,698 4,241 4,759 745
Non DHB Funds - NHMG Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Opening Balance 6,091 6,765 7,506 7,929 7,449 7,752 7,740 9,693 7,725 7,725 7,725 7,725 Net Movement 673 741 423 (480) 303 (11) 1,952 (1,968) 0 0 0 0 Closing Balance 6,765 7,506 7,929 7,449 7,752 7,740 9,693 7,725 7,725 7,725 7,725 7,725
HVDHB Monthly Operating Report Page 19 March 2018
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Weekly Cash Flow – Actual up to 28th February 2018
Note – the overdraft facility shown in red at $18 million
HVDHB Monthly Operating Report Page 20 March 2018
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Capital Expenditure – Actual to 28th February 2018 Budget* Actual Variance Unfinished Current year Total Capital Unfinished Current Total Estimated Estimated Total Total Projects / 2017-18 Budget Projects / year spend Spend to Costs to Costs Post Forecasted Forecasted Project description Prior Year Prior Year Date June 2018 June 2018 Project Costs Project Costs vs Budgets Actual Spend at Budget Completion ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000) Baseline Buildings and Plant 3,035 2,495 5,530 547 675 1,222 3,752 555 5,529 (0) Clinical Equipment 1,801 2,000 3,801 788 1,381 2,169 1,153 479 3,802 (0) Office Equipment - 100 100 - - - 100 - 100 - Information Technology (Hardware) 1,857 1,100 2,957 908 824 1,732 1,225 - 2,957 0 Intangible Assets (Software) 1,101 2,325 3,426 684 281 964 2,392 70 3,426 (0) Baseline Total 7,794 8,020 15,814 2,927 3,161 6,087 8,622 1,104 15,814 0
Strategic Mobility - 250 250 - - - 250 - 250 - RHIP - Regional RIS Migration - 400 400 - - - 195 205 400 - RHIP - Regional Clinical Portal (CTAS) 500 500 1,000 - - - 595 405 1,000 - e-Medicines Management - 350 350 - - - 350 - 350 - Electronic Nursing Observation - 300 300 - - - 80 220 300 - Mental Health Shared Electronic Record - 250 250 - - - 250 - 250 - Shared Cared - Record and Planning - 100 100 - - - 100 - 100 - National Oracle Solution 909 165 1,074 748 146 894 180 - 1,074 (0) Kitchen Relocation (incl fitout & equipment) - 1,500 1,500 - - - - 1,500 1,500 - Digitial Mamography 841 - 841 186 450 636 205 - 841 (0) E-Pharmacy 750 - 750 387 99 486 264 - 750 0 VOIP Upgrade 146 - 146 124 - 124 21 - 145 0 PACS Version Upgrade 200 - 200 3 111 114 86 - 200 (0) Integration into Clinical Record ------Strategic Total 3,346 3,815 7,161 1,448 806 2,254 2,576 2,330 7,160 (0)
Total Capital (excluding Trust Funds) 11,140 11,835 22,975 4,375 3,967 8,341 11,198 3,434 22,974 (0)
Donated from Trust Funds IT - Trust ------Building Services - Trust - - - - 20 20 - - 20 (20) Clinical - Trust - - - - 51 51 - - 51 (51) Total Donated from Trust Funds - - - - 71 71 - - 71 (71) ------Total Capital 11,140 11,835 22,975 4,375 4,038 8,412 11,198 3,434 23,045 (71)
HVDHB Monthly Operating Report Page 21 March 2018
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Summary of Leases – as at 28th February 2018 Monthly Annual Total Lease Original Cost Amount Amount Cost Start Date End Date Lease type Rental Property Leases Occupants Wainuiomata Health Centre District Nurses - 1,149 13,787 1/11/2014 30/06/2018 Operating Public Trust House (Lower Hutt) Community Mental Health - 22,853 274,239 1/09/2017 1/09/2020 Operating CREDS - Johnsonville Eating Disorders - 5,370 64,435 1/01/2015 30/06/2018 Operating RPH - Porirua Public Health RPH School Health - Promotional Health - 9,088 109,055 1/03/2013 15/03/2021 Operating Criterion Lane Upper Hutt Lagans Pharmacy - Physiotherapy - 2,166 25,992 5/01/2017 31/12/2018 Operating CBD Towers Upper Hutt Community Mental Health - 9,524 114,287 1/02/2015 30/01/2021 Operating Upper Hutt Health Centre District Nurses - 671 8,056 24/01/2015 1/02/2022 Operating - 50,821 609,851
Car Park Leases CBD Towers Upper Hutt - 542 6,500 1/02/2015 30/01/2021 Operating St Peters (SPO) - 270 3,240 Ongoing Ongoing Operating - 812 9,740
Motor Vehicle Leases Motor Vehicle Lease plus Management Fees (122 Vehicles) 2,250,539 39,635 475,615 Ongoing Ongoing Operating 2,250,539 39,635 475,615
Equipment Leases Supplier MRI ingenia 1.5T 1,737,941 38,934 467,203 2,336,013 29/06/2016 26/09/2019 Operating Theatre Equipment (FAR0135107) All Leasing 710,858 21,009 252,103 756,309 1/04/2017 1/01/2020 Finance Theatre Equipment (FAR0135105) All Leasing 330,881 6,039 72,468 217,403 1/07/2017 1/04/2020 Finance Anaesthetic Machines 1,092,000 22,237 266,839 1,334,194 1/06/2014 31/05/2019 Finance Stryker Tools 603,401 9,024 108,292 758,044 1/09/2016 31/08/2023 Operating 3 x Ultrasounds (Equigroup) GE Healthcare Limited 433,500 7,315 87,782 438,908 28/06/2017 28/06/2022 Operating 1 x Ultrasound (Equigroup) Philips NZ Commercial Ltd 88,825 1,761 21,129 105,647 28/08/2017 28/07/2022 Operating CT Scanner (Equigroup) Toshiba Medical Systems 1,356,434 25,076 300,911 1,504,555 28/05/2017 28/05/2022 Operating Fluoroscopy Equipment (BAN0132109) All Leasing 32,927 3,658.58 32,927 32,927 1/10/2017 1/04/2018 Operating 6,386,768 131,394 1,609,653 7,484,000
Total Leases 8,637,307 222,661 2,704,859
HVDHB Monthly Operating Report Page 22 March 2018
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Treasury as at 28th February 2018
1) Short term funds / investment ($000) 4) Debtors ($000) 1-30 31-60 61-90 91-120 121-180 181+ NZHP banking activities for the month Current month Last month Top 10 Debtors Outstanding Current Days Days Days Days Days Days ($000) ($000) Capital & Coast District Health Board $2,869 $637 $160 $157 $105 $35 $171 $1,603 Average balance for the month $22,571 $20,032 Ministry of Health $2,360 $2,172 $2 $32 $0 ($0) ($26) $181 Lowest balance for the month ($269) $438 Wairarapa District Health Board $730 $218 $179 $3 $130 $0 $183 $17 Accident Compensation Corporation $486 $493 ($59) $18 $2 $3 $6 $22 Average interest rate 1.90% 2.16% Health Workforce NZ Limited $116 $116 $0 $0 $0 $0 $0 $0 Auckland District Health Board $101 $131 ($28) $0 $0 ($1) $0 $0 Net interest earned for the month $37 $37 Ministry for Vulnerable Children, Oranga $55 $0 $0 $41 $0 $0 $13 $0 Non Resident Debtor $35 $0 $0 $0 $0 $0 $0 $35 Non Resident Debtor $33 ($0) $0 $13 $2 $3 $15 $0 2) Hedges Midcentral District Health Board $24 $24 $0 $0 $0 $0 $0 $0 No hedging contracts have been entered into for the year to date. Total Top 10 Debtors $6,808 $3,791 $254 $264 $238 $40 $362 $1,859
3) Foreign exchange transactions for the month ($)
No. of transactions involving foreign currency 5 Total value of transactions $20,146 NZD Largest transaction $16,674 NZD
No. of Equivalent transactions NZD
AUD 4 $18,677 USD 1 $1,469 Total 5 $20,146
HVDHB Monthly Operating Report Page 23 March 2018
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Hutt INC February 2018 - Update
Kia ora, talofa lava, malo e lelei and welcome to the Hutt INC update that has exciting news about the future direction for community integration in the Hutt Valley and excellent progress underway in respiratory and Health Care Home.
At our February meeting we endorsed:
Community Integration Programme The community integration model was presented and endorsed during our meeting and will now form a substantial work programme for the next three to five years to fully implement. This compliments the Health Care Home work stream and will improve how our secondary, primary and community services work together as one team to provide more coordinated and people centred care in the community. Thank you to the working group members and our acute demand network who have been involved in developing this model of care. Keep an eye out for a weekly forum coming your way soon and in the meantime check out the presentation below for more information.
CI summary model of care Feb 2018 FINAL.pdf
We also had presentations and updates on:
Respiratory patient journey work programme Great progress is being made to improve care for respiratory patients in the Hutt Valley with many phase one recommendations now complete. The group is currently focused on expanding and embedding specialist support for primary care and implementing acute care plans and access to ambulance services in the community for people with COPD.
Health Care Home roll out The Health Care Home model works to improve how primary care delivers patient centred acute and proactive care to the community. Change management is well underway with the first five Hutt Valley practices and we are on track for the first Health Care Home practices to ‘go live’ from July 2018.
Community nursing improvements Excellent work has been led by the community nursing team to understand how they currently provide services and to identify areas for improvement that will be implemented over the next 12 months.
We hope everyone had a lovely break and look forward to an exciting year of integration in 2018!
If you would like more information or would like to join the integration movement please contact: [email protected]
Remember to check in for our next update in April 2018
137 2018 05 03 Hutt Valley Board Public - APPENDICES COMMUNITY INTEGRATION PROJECT
Future Model of care 2018
138 2018 05 03 Hutt Valley Board Public - APPENDICES
Model of care – future direction
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Overarching Principle
Services are people centred and are focused on addressing inequity Community
Primary Healthcare is delivered based on need with a clear care Targe ted understanding of roles and responsibilities in care and servic Spes trust between services & clinicians eci ali st
A culture that supports people centred care
Services work to reduce health disparities and provide culturally appropriate care
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Key Components
Services are accessible, responsive and flexible and provide care to addresses people’s real need Review service delivery models
Central Referral Point for community services (also known as single point of entry)
Developing a broader community health service with trans- disciplinary working
Flexibility in where, when and how we provide services
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Key Components
Integrated and more joined up care across services so hospital, primary care and community services function as ‘one team’ Building and supporting ‘Health Care Homes’ in general practice
Virtual locality teams are formed across primary, secondary and community services and work together as ‘one team’ to coordinate care for people • Community based health workforce integrates with general practice teams • Specialist services provide support to general practice teams and other community services • Health services actively engage and work with wider sector services
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Key Components
Enhanced proactive care to support people to stay well People can access early education, intervention and support to empower self management in the community
Shared care for patients with complex health and social care needs
Access to wrap around support and coordination services for those with the most complex needs
Access to reablement and rehabilitation in the community setting
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Key Components
Improved acute care and access to services in the community to support return to function/wellness Early detection of deterioration in the community
Acute triage, management in the home setting and transport by ambulance services
Access to extended acute care delivered by primary care
Responsive access to specialist advice and assessment
Access to responsive community services to support hospital avoidance and early supported discharge (intermediate care)
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Key Components
Workforce development enabler Trans-disciplinary working Upskilling and top of scope working e.g. developing assistant workforce Cultural competency and diversity Develop and support community roles Impact and utilisation of technology
Technology enabler Shared care planning tools Electronic patient information (notes, medications and diagnostics) Two way electronic communication Infrastructure for mobile and virtual working Virtual monitoring tools and applications Real time data and information to support services
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Phase 1 implementation (12-18months)
• Service Delivery Reviews: • Continue general medicine improvement programme and community nursing improvement work • Begin service delivery reviews of community allied health services in the next 6 months with dedicated project resource.
• Central referral point: • Investigate and develop a central referral point initially focusing on existing DHB community services. • • Single community health service with trans-disciplinary working: • HR service change process for DHB community services (community nursing, allied health and assistant workforce) to form a single community health service with specialist sub-streams. • Implement skill sharing framework with appropriate clinical governance and training to support transdisciplinary working across professional groups.
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Phase 1 implementation (12-18months)
• Virtual locality teams: • Confirm the proposed virtual localities areas for the Hutt Valley that are targeted to areas of greatest need.
• Reconfigure DHB community based health workforce (Community nursing, allied health and assistant workforce) into localities and begin piloting integrated care with general practice teams.
• Continue specialist support to general practice (e.g. diabetes and respiratory) & expand to other specialist services (e.g. general medicine and geriatrics) and align these with locality areas.
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Phase 1 implementation (12-18months)
• Access to acute responsive community services to support hospital avoidance and early supported discharge (intermediate care) • Plan and develop the service and model alongside the components above. This will include: • The provision of responsive same day acute input from nursing, allied health and assistant workforce in the community setting. • Access to medical oversight and support from primary care with clear triage, pathways and access to specialist advice or assessment if required. • Streamline access to short term packages of care with a reablement approach (utilising family and community supports, Home and Community Support Services and the Community Health Service assistant workforce).
• Acute triage, assessment and management in the home setting and transport by ambulance services • Continue COPD ambulance pilot and expand to other COPD and LTC patients in the Hutt Valley.
• Responsive access to specialist advice and assessment • Continue provide standardised direct access to SMO advice (e.g. geriatrics) across specialist services and expand to other specialist services (e.g. general medicine). • Investigate acute assessment clinics across essential specialist services as part of service planning work.
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Phase 1 implementation (12-18months)
• Early education, intervention and support • Progress and expand the Palliative Care and ACP work programmes to improve access to end of life care.
• Workforce Development and Technology enablers • Establish a workforce development programme to support the implementation of the phased work programme and link to the broader organisational work required in this area. • Prioritise and dedicate local IT resource and project support the implementation of the work programme in the Hutt Valley noting linkages with the existing information management alliance work programme.
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Next steps
• Endorsed by ALT Feb 2018 and wider communications • Acute Demand Network oversight to phased implementation of 3-5 year work programme • Work with staff and community to implement phase 1 in the first instance
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Te Atiawa Iwi Partnership Board Agreement for the Hutt Valley District Health Board
1. PARTNERSHIP AGREEMENT
This agreement establishes the formal Relationship and Partnership between: Te Atiawanuitonu tribal groups (Represented by Te Runanganui o Te Atiawa, Wellington Tenths Trust, Taranaki Whanaui Ki te Upoko o te Ika (PNBST)) and The Hutt Valley District Health Board
2. PURPOSE
This agreement is to establish a forum to enable Te Atiawa people and Maori to participate in, contribute to, influence and advise on the health strategies and plans developed by Hutt Valley District Health Board to achieve equity and health improvement for Te Atiawa and all Maori.
3. PERIOD COVERED
This agreement will be from 31 May 2018 and will continue indefinitely or until terminated by mutual consent.
4. OBJECTIVES OF THE PARTNERHSIP
The objectives of the Partnership are to: 1. Provide input into setting the Hutt Valley District Health Board strategic directions for Te Atiawa Iwi and Maori health, 2. Advocate on achieving health equity and improvement in the health of Te Atiawa Iwi and Maori, 3. Support Te Atiawa Iwi and Maori leadership in Hutt Valley District Health Board, 4. support Hutt Valley District Health organizational accountability and transparency, 5. Bring depth and breadth of understanding of Te Atiawa Iwi and Maori concerns, 6. Contribute diverse Te Atiawa Iwi and Maori views to assist wise decision making, 7. Support the Hutt Valley District Health Board to manage Te Atiawa Iwi and Maori relationships, as required, 8. Participate in discussions and decisions on Achieving Maori health equity across the system, and nominate Te Atiawa Iwi representatives to Hutt Valley District Health Board’s committees, and other committees/groups, as required.
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5. RESPONSIBILITIES OF THE PARTIES
The parties to this agreement accept the following principles as the basis of the partnership:
Principles of partnership: ∑ Whakautu – Respect; ∑ Whakamarama – Understanding; ∑ Whakapono – Trust; ∑ Ngaakau Taputahi – Integrity; ∑ Ngaakau Pono – Good Faith; ∑ Pononga – Honesty.
6. STRUCTURE
That; Partnership will consist of the whole partnership group. That; Te Atiawanuitonu will nominate a member of the group to be the Chair. The Chair will be elected annually by the Partnership Board.
7. MEMBERSHIP
That; Te Atiawanuitonu shall comprise up to six representatives – two from each of the three lwi entities: Te Runanganui o Te Atiawa, Wellington Tenths and Taranaki Whanui ki te Upoko o te Ika (PNBST) and two members from the Hutt Valley District Health Board.
8. ADMINISTRATION
The Partnership Board will meet once every two months but not more than eight times per annum except with the consent of the parties. Outside of these meetings the Partnership Board and Members will communicate by email.
Secretariat support will be resourced by the DHB and managed through the Director Maori Health. A draft agenda for meetings will be sent out a week in advance and each partner should let the Chair know whether they have additional items. Draft minutes of the meetings will be sent out five working days after the meeting by the secretariat.
9. DECISION MAKING
The Partnership Board will have decision-making capacity; where possible the Partnership Board will try to achieve a consensus. If the Partnership Board does need to vote on any issue the decision will he carried by a majority vote.
10. RESOLVING PROBLEMS
In the event that a dispute or difference arises, the Partnership Board will in the first instance make every endeavor to settle the dispute between themselves.
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If, the dispute or difference is not settled by mutual agreement the Partnership Board will refer the matter for mediation by an independent mediator like the Arbitrators and Mediators Institute of New Zealand.
If mediation is unsuccessful the matter will be resolved in accordance with the Health Sector Mediation and Arbitration Rules 1993.
11. REMUNERATION
The Partnership Board members will receive a fee of $250.00 per meeting per person. A fee of $312.50 will be paid to the Chair and $280.00 for the Deputy Chair. In addition, payment of actual and reasonable travel expenses incurred by members of the Partnership Board for attending meetings will be met.
12. CONFLICTS OF INTEREST
Members of the Partnership Board who become aware of a conflict of interest should disclose the nature and extent of the interest to other members of the Partnership Board. They should then withdraw, abstain or otherwise conduct themselves in a way that ensures that the matter being considered by the Iwi Partnership Board is unbiased.
13. SIGNED ON BEHALF OF:
Te Runanganui o Te Atiawa
Represented by: Name ______
Signature: ______
Date: ______
Te Runanganui o Te Atiawa
Represented by: Name ______
Signature: ______
Date: ______
Wellington Tenths Trust
Represented by: Name ______
Signature: ______
Date: ______
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Wellington Tenths Trust
Represented by: Name ______
Signature: ______
Date: ______
Taranaki Whanui ki te Upoko o te Ika (PNBST)
Represented by: Name ______
Signature: ______
Date: ______
Taranaki Whanui ki te Upoko o te Ika (PNBST)
Represented by: Name ______
Signature: ______
Date: ______
Hutt Valley District Health Board
Represented by: Name ______
Signature: ______
Date: ______
Hutt Valley District Health Board
Represented by: Name ______
Signature: ______
Date: ______
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Supported Decision Making
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What is Supported Decision Making?
Everyone has the right to make their own decisions.
Sometimes you might need support to make your decisions.
Supported decision making means that people assist you to make your own decisions.
This way you have control and choice over your life.
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Why is Supported Decision Making important?
Supported decision making is a human right.
This means that everyone has this right.
You should have the same control over your life as other people have over their own lives.
Supported decision making is a right in the United Nations Convention on the Rights of Persons with Disabilities.
The United Nations Convention on the Rights of Persons with Disabilities is an agreement. 2
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It is also called the Disability Convention.
This agreement say what countries have to do to make sure that disabled people have the same rights as everybody else.
The Disability Convention says that:
∑ everyone has the right to make decisions about their own lives
∑ everyone should have the support they need to make decisions.
Supported decision making is a way to make sure disabled people have equal rights with other people.
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Communication support
It is important you are given the support you need when you communicate.
Communicate means how you tell other people what you think or feel.
Everyone communicates in different ways.
Some people: ∑ use body language ∑ use sign language ∑ speak ∑ use communication tools, like computers.
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Kinds of support
There are lots of different kinds of support that you can use to assist you to make decisions.
You can choose which kinds of support are right for you.
1 kind of support you can choose is:
Having a team of people who know you well that can assist you.
Teams like this are sometimes called:
∑ circles of support
∑ support networks
∑ effective communication partners.
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Another kind of support you can choose is:
Having the time you need to: ∑ talk about the different choices
∑ make your own decision.
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Another kind of support you can choose is:
Using a communication tool.
These are sometimes called augmentative or alternative communicators.
Sometimes they are called AAC.
Augmentative or alternative communicators are tools which assist people to communicate. These can include: ∑ electronic speech devices like tablets
∑ electronic speech Apps
∑ talking mats
∑ other visual aids.
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Another kind of support you can choose is:
Having information in easy to use formats.
This can include: ∑ Easy Read
∑ braille
∑ large print
∑ sign language.
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Getting the right support
Most people have whānau / family or support people who know what they usually want and need.
You can choose who the best people to support you are.
You might choose to have more than one support person.
When someone is supporting you to make a decision it is important that they know some things about you:
∑ they need to know what is important to you
∑ they need to know what kinds of decisions and choices you usually make.
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What if people do not listen to you?
Sometimes people might think that you cannot make decisions for yourself.
This might be:
∑ your whānau / family
∑ your support staff.
Some people might need to change their thinking about whether you can make your own decisions.
You might need to speak up for yourself and show people that you can make your own decisions.
You have the right to make your own decisions about your life.
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An example of Supported Decision Making
Here is a story about someone using supported decision making.
We changed the names of the people in the story to protect their privacy.
Jake and his mum Mary went to a dentist appointment at the hospital.
When the dentist looked at Jake’s teeth she decided that Jake needed surgery on his teeth.
The dentist wanted Mary to sign a form for Jake to have surgery.
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She said that the form had to be signed that day so they could book the surgery.
Mary said that Jake needed to make his own decision.
Jake needed time to make a decision.
Mary said that she and Jake could talk while the dentist met with other patients.
This would give Jake some time to make his decision.
The dentist said this was okay.
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Jake and Mary talked about the form.
They also talked about the surgery.
Mary asked Jake if he wanted to talk to his stepbrother Rob about it.
Jake said he did.
Mary rang Rob on her mobile phone. Jake and Rob talked about what would happen if Jake had the surgery.
They also talked about what would happen if Jake did not have the surgery.
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Rob reminded Jake of the last time he had surgery on his teeth.
After talking to Rob Jake said “I say yes.”
After this Mary and Jake went back to talk to the dentist.
Mary said that Jake was ready to sign the form.
The dentist checked with Jake that he wanted the surgery.
Jake said “I say yes”
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This story shows that Mary was not allowed to make a decision about surgery for Jake.
This is because the law says that Jake should make his own decision.
The dentist could have let Mary and Jake take the form away.
This would have meant Jake and Mary would have had lots of time to talk about the decision.
But the dentist did let Mary and Jake have some time to talk.
The dentist also checked that Jake had made his own decision.
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This meant that Jake was able to make a supported decision.
Mary supported Jake to make his own decision.
This is how she supported him:
∑ Mary supported Jake with his communication.
Mary was able to talk to Jake about the surgery in a way that Jake could understand.
Mary also talked about what signing the form meant.
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∑ Mary supported Jake to talk to another person in his support network.
∑ Jake was supported to understand what the surgery meant.
Rob reminded Jake of a surgery he had had before.
This helped Jake to understand what this surgery would be like.
Jake was able to make his own decision about surgery.
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ADL would like to thank our Conversation Partners:
For more information see our website: www.aucklanddisabilitylaw.org.nz
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This information has been translated into Easy Read by People First New Zealand Inc. Ngā Tāngata Tuatahi
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Child
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Adult
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Older Person
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Appendix 1: Regional Child Oral Health Service 2017 Evaluation of Late Night Appointment Trial
1.0 BACKGROUND
Over 73,000 children are currently enrolled with the Regional Bee Healthy Dental Service and the Service offers dental examinations and treatment appointments to children aged between two to 13. The Service has 13 community based dental hubs in the region and 11 mobile dental vans. Examinations, radiography, preventative treatment and clinical treatments can be provided at the Community Dental Hubs, with examinations, x-rays and preventative treatments only being provided on the mobile dental vans at schools, through term time. Community Dental Hub and mobile van appointment times run from 08.10hrs to 15.40hrs and are available throughout the year (with the exception being the Christmas and New Year Period during which the Service closes down). Increasing accessibility of the Service has been highlighted as a focus for parents/ caregivers, with timing of appointments during the working day being verbally cited by parents as a reason for not attending daytime appointments. The PDSA tool (Plan, Do, Study Act) was utilized to ensure that the trial was productive and effective.
2.0 PLAN
In order to increase flexibility of appointments for children and their respective parents/ caregivers, the Regional Bee Healthy Dental Service trialed later evening appointments for children for 15 weeks from 30 August 2017 to 13 December 2017 at Naenae Dental Hub (NHC). NHC has 5 chairs available and is staffed by 5.8 FTE Dental Therapists, 6.0 FTE Dental Assistants and a 0.8 FTE Hub Administration Support Officer. Pre-trial all staff were surveyed on their support of this trial, with the addition of the Public Service Association (PSA) being involved in planning.
2.1 Objective The underlying objectives for this trial were ∑ To provide access for parents of school aged children who prefer appointments outside of usual clinic working hours, ∑ To provide flexibility of working hours for staff and ∑ To potentially increase parental satisfaction with the service regarding timing of appointments
2.2 Predictions It was predicted that this trial would enable better appointment utilization (appointments booked and attended), with a potential reduction in DNAs (did not attend). There was also the expectation that this trial would run aligned to consumer feedback survey in which parents were asked specifically about their satisfaction with of later evening appointments.
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2.3 Process for appointments The Service acknowledged that later evening appointments would not be suitable for all children so guidelines were put in place to enable the administration team to effectively utilize the later appointment times. These guidelines included: ∑ No children under the age of 8 were offered later appointments as younger children were considered to be less able to tolerate the later hours; ∑ No ROP (relief of pain)/assessments; ∑ No treatments past 18.30hrs, only exams; ∑ Good level of communication with 0800 administration team on process; ∑ Parents only offered later appointments if: ∑ They say can only attend later than 3pm ∑ Specifically required late appointment ∑ Families have DDI for Naenae Dental Hub; ∑ Term time only (school holidays excluded due to potential for children and families being out of area).
2.4 Security/ general considerations As this trial extended the working hours of the Hub into the evening, it was vital to consider the security and support of the staff involved. The following measures were taken to ensure a safe working environment: ∑ Outdoor lights installation at Naenae hub; ∑ Drive-bys with security firm and monitoring; ∑ Hub reception cover with Hub Administration Officer; ∑ Building services informed for alarm queries; ∑ Cleaning services informed for later cleaning times; ∑ Hard charting if IT failure; ∑ Roster for clinical support by dentists/team leaders if required; ∑ All calls come through SM for triage for trial period; ∑ Sick cover – potentially difficult to manage, text message parent to alert (hub admin role).
2.5 Plan for collection of data – who, what, when where It was confirmed that to fully measure the effectiveness of this trial the following evaluation tools would be utilized: ∑ Audit calls through to SM– time, frequency, nature of call, action required; ∑ Survey staff that worked – how well it worked; ∑ Customer feedback – late night appointments through survey ; ∑ Mean percentage utilisation of time period when compared with same numbers of hours during day for assessing DNAs.
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3.0 PILOT DATA
During the period 30 August to 13 December 2017, 15 late night clinics were held between 15:30 and 19:30 hrs. Two chairs were staffed by a Dental Therapist and Assistant, and the Hub Administration Support officer worked on reception. A total of 138 appointments were offered, and 111 attended. Table 1 contains the total appointments booked during the entire initiative when compared with a four hour time period for the same number of Dental Therapy teams from usual business hours Categories 11.30am - 3.30pm Total Number Categories After 3.30 - 7.30pm Total Number Total patients appointments 128 Total patients appointments 138 booked booked School-aged 89 School-aged 126 0-4yrs 39 0-4yrs 12 Maori 25 Maori 22 Pacific 22 Pacific 15 Other 81 Other 101
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Appendix 2 – Te Ra o Te Raukura Report
Background Te Rā o Te Raukura is an annual whānau oriented community festival. ‘Arohanui ki te Tangata’ is the guiding statement expressing sentiments of sharing, love, respect and togetherness towards our fellow neighbour. There is a focus on whānau, culture, entertainment, health, education and youth, all centred around the characteristic day long stage schedule of renowned local acts and national artists coordinated by iwi radio station Atiawa Toa FM.
Te Rā attracts a range of ethnicities and ages from across the Wellington region, and also a far. The majority of festival goers are Māori, young, and are residents of Lower Hutt.
Te Rā is an alcohol, smoke and sugar free drinks festival. This has been enhanced with a focus in 2016 on promoting ‘Wai Māori’ (water only) which continues today.
History Te Rā was established 22 years ago and has grown into the premier Māori festival for the wider Wellington region attracting up to 20,000 people to Te Whiti Park, Waiwhetū, Lower Hutt. The name of this event, Te Rā o Te Raukura, is significant to the people of Waiwhetū and the tangata whenua in the Wellington region. The 'Raukura' was used as a symbol of peace, love and harmony by the prophet Te Whiti-o-Rongomai at Parihaka. He and fellow prophet, Tohu Kākahi, led their people to passive resistance and patient obedience as an armed constabulary invaded the peaceful village of Parihaka on 5 November 1881. Te Rā commemorates this day and celebrates unity in Lower Hutt and the wider Wellington region.
2018 This year Te Ra o Te Raukura was held on Saturday 3 February with the focus on kapa haka performances from local groups as well as the family oriented event offering a range of fun activities, food, arts and crafts and health, education and youth services.
Qualifiers from this competition advanced to the National Te Matatini Festival to be hosted in Wellington in February 2018. The qualifying groups were Ngā Taonga Mai Tawhiti, Tū Te Maungaroa and Nga Uri Taniwha.
Regional Public Health RPH has had a presence at Te Rā for the last 14 years and has used this to connect with our communities, provide important population health messaging and seek feedback on what the community needs. It is important for us to be present at this event because it is attended by our priority populations; Māori, Pacific and children. It gives RPH the ability to connect with community
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and community access to health services and community focused health professionals in their neighbourhood.
RPH has been a member of the Executive Organising Committee since our involvement began and was represented by Twiggy Welsh and Kiri Waldegrave. Twiggy was also an integral member of the Hāuora Tent organising committee which is one of the most visited areas of Te Rā by festival goers if they are not watching acts on stage or looking for something delicious to eat.
This year RPH provided water bottles and paper cups to support the Te Rā ‘Wai Māori’ (water only) kaupapa. Festival goers were encouraged to bring their own water bottle to fill as well.
In addition to supporting a healthier environment for festival goers, RPH provided advice and information about sexual health, immunisation (HPV) . The following areas were of particular interest to Te Rā festival goers:
Well Homes Shirley Pierce, Agnes Ta’anoa, Latisha Coffey and Vanessa Cameron provided advice on checking your home is warm, safe and dry and set up free visits with whanau who required it.
The top three tips they shared were: 1. Open your windows for at least a few minutes each day. 2. Stop cold air getting into your home by stopping draughts around doors and windows (use a door snake, or rolled up towel). 3. Use white vinegar to remove mould.
Ear Van The highly valued RPH Ear van provided free drop in ear examinations for tamariki. Our Speciality Ear Nurse, Helen Ryan, provided 17 tamariki with an ear exam, with several referrals generated. Unfortunately, the RPH Ear Van was only available for part of the day however last year RPH provided 76 exams and at Creekfest this year the Ear Van provided 113 exams.
Emergency Preparedness Helen van Mil and Tina Hong (Health Protection Officers) attended Te Rā and highlighted emergency preparedness in the home. The display and messaging specifically promoted the: ∑ importance of storing water for an emergency, ∑ how to make water safe to drink, ∑ how to make a simple toilet and ∑ knowing when it is safe to swim.
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Appendix 3 - Creekfest Report
Creekfest is an annual event held in February/March at Cannons Creek Park in Porirua East. Creekfest is the result of a combined effort by the Porirua Health Links Trust and the Porirua community. Creekfest started in 2003 in the Cannons Creek car park but due to its growth over the years, it is now held at Cannons Creek Park. The Porirua Whānau Centre is now responsible for organising Creekfest. Regional Public Health has been involved with Creekfest since its inception.
Porirua East has a population of 12,0421 (23.2% of Porirua City 51,717) where the majority of the population is made up of Pacific (51.2%) and Maori (22.7%). Our contributions to the festival allow us to be visible in the community and with relevant stakeholders in Porirua. We are also able to promote key messages that are relevant to Pacific and Maori communities throughout the day.
RPH’s Porirua Community Liaison, Anita Taggart, was part of the organising committee for Creekfest. Planning for this event starts in December and requires full on commitment until the day of the event. As part of her role, Anita was responsible for organising workshops for all food stall holders. RPH sponsors a Health Kai Award ($200/$100/$100/$50/$50 Pak’n’Save vouchers) to encourage and motivate stall holders to be more mindful of how to be creative and health conscientious when considering what to sell on the day. Others attendees at the workshop are Porirua Volunteer Fire Service (to talk about fire safety), Porirua City Council Environmental Health Officer (to talk about healthy food preparation practices) and Compass Health Community Dietitian to talk about the Creekfest Food and Beverage guidelines and recommendations.
RPH teams involved with Creekfest 2018 included: ∑ School Health: Claudia Schotz and Erika Ware (Ear Van) with support from Chris Cambpell and Lisa van Zeyl (PH Nurses) ∑ Healthy Environments and Disease Control: Marie Gibson and Nicola Esson (Health Protection Officers) with a focus on safe water and Emergency Preparedness ∑ Well Homes: Vanessa Cameron, Agnes Ta’anoa, Caroline, Tui ∑ Tobacco, Alcohol, Drugs Team: Andrea Boston (PH Advisor) providing information around drugs (with a focus on synthetic cannabis) ∑ Twiggy Welsh (PH Advisor) – supporting and promoting every team present RPH also invited the team from Wesley Community Action, (who we are in partnership with for the Fruit & Vege Co-ops) and they were able to promote their community gardens. Weather conditions later on in the day saw the Dental team from Bee Healthy set themselves up in our tent (after theirs nearly blew away) allowing them to continue doing dental checks.
1 Data source 2013 census, includes CAU Porirua Central, Porirua East, Ranui Heights, Cannons Creek North, Cannons Creek South, Cannons Creek East
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∑ The Ear van saw 113 children during the day with 17 referral’s; one of the busiest and most successful (in terms of referrals) Creekfest for the team so far. ∑ The Well Homes team collected 24 referrals for visits to homes, and gave away 300 door snakes and information cards to whanau. This type of networking is a great way for these teams to get out amongst the people and be available to answer any probing questions from whānau. ∑ The Tobacco, Alcohol, Drug team had created ‘flashcards’ with information about synthetic cannabis on them. These were used as a means to generate conversations with not only community but also providers around the issues that synthetic cannabis is creating in Porirua. RPH did receive requests from providers to come and speak to their teams about these psychoactive substances and provide up to date information for their workers. ∑ A mother was referred to us by the Whānau Centre, as she had concerns for her child’s eczema. The PH Nurse was able to look at the child, have a chat with the mum, and RPH were able to provide some skin care products for the child. There were other issues that arose out of this situation and the PH Nurse followed up on these on the Monday.
Other providers/organisations also came over to see what services RPH had to offer and this often led to ‘business card swapping’. Health and Social services were keen for us to come and talk to their teams about Emergency Preparedness, the Well Homes programme as well as a presentation we gave before Christmas on Psychoactive Substances.
Staff present were able to have an in-depth conversation with Ashley Bloomfield, Taima Fagaloa and Eileen Brown (CCDHB Board Member), about the teams representing RPH at Creekfest and the services that we provide to this community. Ashley mentioned that that was the first time he had been to Creekfest.
Pictured: Dr Ashley Bloomfield meeting Anita Taggart (RPH’s Porirua Community Liaison) while Andrea Boston (Public Health Advisor) talked to members of the community about synthetic cannabis. RPH invited the community to make suggestions on how RPH could help the community deal with drugs.
RPH’s representation at Creekfest is crucial. This is a community that we work with intensely so it is important that we are visible in a number of ways. Developing relationships with children and/or whānau is something that is established during the usual working day, however, these types of events allow us to build on those connections. Often this is an opportunity for parents to connect with nurses that have worked with and supported their children in schools.
Creekfest is a Sugar Sweetened Beverage free event, so it is made very clear to all food stall holders that only Diet and Zero drinks are to be sold. A water tank is available on the day, so everyone has access to free water. This is promoted, alongside suggestions of water bottles as free giveaways, so that people can fill them up.
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On the day of the event a dietitian (with the support of RPH) goes around the stores to see who is making a positive effort to make the food on sale healthy and affordable and this person makes recommendations on who should receive the vouchers.
These prizes were kept to community fundraising groups, rather than commercial food vendors.
Health Kai Awards were awarded as follows:
First Prize Taste of Fiji who provided curries with rice; there were fish, chicken and a vegetarian option. They also included a range of vegetables in their meals.
Second Prizes (two) Junior Youth Empowerment programme who provided a range of curries including butter chicken; mushroom, spinach and chicken; chicken; and chop suey. They also provided brown bread and fresh fruit with each meal.
Tuhoe Hangi who provided a hangi filled with various vegetables and meats. The fat had been drained from the hangi to make it a healthy option.
Third Prize Rere Family who supplied chop suey served with rice and also steak and chicken wraps as a healthy option. It was visible that they were using a lot of vegetables in their wraps. The wraps were also seen as a great success as they were a healthy, easy to eat option (nice alternative from a sausage in bread).
H & M Whānau Fundraiser Provided hangi cooked in a healthier way. Fat had been removed from pork and chicken prior to cooking. It also contained a range of vegetables. They also provided sandwiches and chop suey.
RPH has previously supported the Whānau Centre with conducting surveys on the day and then collating and analyzing the data. This year RPH provided the surveys, but the Whānau Centre will be analysing them, due to shortage of RPH resources.
Creekfest is also a Smokefree event; RPH’s Community Liaison ensures that this ‘kaupapa’ is adhered to by working closely with Takiri Mai Te Ata Regional Stop Smoking service and making sure that they are present on the day. Recycling of rubbish is also becoming a priority for Council and RPH’s Community Liaison co-ordinated this with Porirua City Council to ensure that it continued.
Creekfest really showcased how RPH teams can work closely together and support each other’s specialised areas, to display how a holistic approach can work. Whānau that visited one team, were then able to go from table to table and reap the rewards of what each team had to offer. Many children and whānau left the RPH tent feeling well supported from the service.
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