THAMES ;PREA I I ALTH-S ARD
A PROPOSAL TO THE MINISTER OF HEALTH THE HON. DR. MICHAEL. BASSETT
VOL. A Al FINANCE A2 PERSONNEL A3 NURSING WORKFORCE A4 REPORT OF_MS N. CLARKE A5 C.V.- OF CHAIRMAN, MR N. CLARKE
1 AM ES HOSPITAL BOARD LETTER TO MINISTER OF HEALTH
FROM CHAIRMAN THAMES HOSPITAL BOARD 4.... ! ..; ..-
- - :: •:- Wsn cUnq
12 February 1987
The Hon. Dr. M. Bassett, Minister of Health, Parliament Buildings, WELLINGTON.
Dear Dr. Bassett,
Herewith the Thames Hospital Board s proposal that requests your approval for the formation of the Thames Area Health District and Board.
My Board has chosen to proceed differently to Northland, Nelson and Wanganui. Rather than form a Steering Committee we chose to use Thames Hospital Board staff to plan the proposed Area Health Board, and to then issue a "Public Discussion Document". The contents of this document were then widely circulated amongst health professionals, the private and voluntary sectors and amongst community groups likely to be interested. Advertisements in newspapers, articles in local newspapers and on the several radio stations serving the district were used to further increase coverage.
Meetings were held throughout the district with health professionals and a series of public meetings were scheduled in all major communities of the district. Public meetings were chaired by Mr. N. Clarke a prominent resident and his report to you is attached.
Submissions were called from the public to the "Discussion Document" and these are included in Appendix C. The Thames Hospital Board received 25 in total.
The major modifications to the circulated discussion document are - 1. Maori Health The Thames Area Health Board will form a Maori Health Committee. This committee will have similar status to other committees of the Board - (namely Executive, Finance, Planning and Community Health), and it will have a membership drawn from the Board itself and from nominees of the Hauraki District Maori Council.
2. Community Committees The membership of various community committees has been modified to allow for the inclusion of nominees of local authorities (rather than necessarily councillors per se).
3. The Accident Compensation Commission The ACC will be invited to provide input into all management units of the Board, however we see a prominent role for the Commission especially the Health Promotion Unit.
Cont d... -2-
4. The Thames Hospital Board has no objection to the inclusion of Kaiaua in the Thames Area Health Board District as requested by that community. If the Minister so desires a formal approach could be made to the residents of Kaiaua and the Auckland Hospital Board for the inclusion of Kaiaua in this district.
The Thames Hospital Board, sir, has pleasure in submitting this proposal to you and looks forward to your reply.
Yours sincerely,
Aa-"-et^ J.P. Farrow, CHAIRMAN. LEVIER TO MINISTER OF HEALTH
FROM MR. N. CLARKE, OBE, JP
CHAIRMAN PUBLIC MEETINGS The Honourable Minister of Health, Parliament Buildings, Private Bag, WELLINGTON.
Dear Sir,
AN AREA HEALTH BOARD FOR THAMES The Thames Hospital Board asked me if I would assume the position of Chairman for the organised series of public meetings to discuss the proposed "Thames Area Health Board". In so doing the Hospital Board stated a Chairman was required who was: independant from the Hospital Board and the health profession in general who would be accepted and considered impartial by all communities and their leaders who displayed no overt political persuasions who had experience chairing large meetings I was pleased to accept the Thames Hospital Board s invitation.
The duties of Chairman were perceived by myself and the Thames Hospital Board as: to conduct advertised public meetings to ensure these meetings provided an opportunity for: The Thames Hospital Board to describe in detail the implications of the Area Health Board Act 1983, and the proposed "Thames Area Health Board". The public to clarify matters relating to the Act and the proposal. The public an opportunity to express its opinion.
As an independant resident I was requested by the Thames Hospital Board if possible to access the reaction (largely as expressed at the public meetings) of the residents of this district to the proposed "Thames Area Health Board", and to convey my assessment to the Minister of Health. At all public meetings at least one resolution arose spontaneously from the floor. In carrying out the task I have given consideration to the following:
the extensve advertising campaign by the Thames Hospital Board (via the "Public Discussion Document", leaflets, press, radio, posters, word of mouth).
the excellent attendance at public meetings (eight meetings held throughout the region).
the discussion at public meetings
the resolutions passed at public meetings (all meetings proposed a resolution in support of the proposed Thames Area Health Board, and all resolutions except that of Thames were passed unanimously. A resolution was passed in Thames with no dissent, however two residents recorded their abstentation). the press coverage
the reaction of local civic leaders
verbal communications to me personally
a review of the submissions received by the Thames Hospital Board
It is my opinion that:
the public of this district have been informed in some detail as to the implications of the Thames Hospital Board requesting the Minister to consider the establishment of the "Thames Area Health Board".
the public have been adequately consulted on this matter.
the residents of the Thames Hospital Board District support the Board in making this proposal to the Minister of Health and wish the Minister to consider it favourably.
the residents of Kaiaua desire to be included in the Thames Area Health Board District.
the proposal is supported by residents with the assumption that adequate funds are made available and continue to be provided to the Thames Area Health Board in order for it to perform its duties as set down in the Area Health Board Act 1983, and the attached Thames Hospital Board Document "The Thames Area Health Board, A Proposal to the Minister of Health". I therefore commend, Sir, on the weight of evidence presented and the overwhelming public opinion expressed that you give favourable consideration to the Thames Hospital Boards proposal that the "Thames Area Health Board" be formed.
Yokerei N.J. Clarke, CHAIRMAN OF PUBLIC MEETINGS. RECOMMENDATIONS
It is recommended by the Thames Hospital Board: -
I. That an Area Health District be established on the 1st October 1987 based on the boundaries of the Thames Hospital District and named the I hames Area Health District.
H. That an Area Health Board named the Thames Area Health Board be constituted on the 1st October, 1987, with it headquarters in Thames. ifi. That the Thames Area Health Board make a formal approach to the residents of Kaiaua and to the Auckland Hospital Board with the intention of including Kaiaua in the Thames Area Health Board (Ref 2.13.2).
IV. That, in so forming the Thames Area Health Board, the Thames Hospital Board and the Hamilton District Office of the Department of Health ensure that a "new health service" is provided for the region. (3.1 & 3.7.6).
V. That the objectives of the Thames Area Health Board be as stated in Section 9 of the Area Health Board Act 1983 (3.2).
VI. That the Thames Area Health Board be encouraged to allocate sufficient staff and resources to its Health Promotion, Community Service and Hospital Management Units so that health promotion, health protection and caring health service are provided (3.3.13).
VII. That the relationships between the private health sector and the Thames Area Health Board be further enhanced and developed (3.3.13).
Yffi. That Thames Area Health Board should ensure that not only is the independence and antonomy of voluntary organisations retained, but that their relationship with the Area Health Board is developed especially through participation in Service Development Groups and Community Committees (3.5).
IX. That the Thames Area Health Board consist of 12 members elected on the same ward basis as the Thames Hospital Board and that a further 3 members be appointed to the Board by the Minister.
X. That the Thames Area Health Board establish the following Committees - Executive Committee, Finance Committee, Planning Committeeand
Community Health Committee, and Maori Health Committee (3.9 & 5.0).
XI. That and Executive Staff Unit be established comprising a Chief Executive,
Chief Medical Officer and Chief Nurse (3.10.1, 3.10.2).
XII. That three Management Units be formed - viz. "Community Services", "Health Promotions" and "Hospital Management" (3.1 0.3).
Xffl. That the Thames Area Health Board establish (initially 9) Community Committees and a sufficient number of Service Development Groups. (3.6).
XIV. That Community Committees be formed with functions and in communities as specified by the Area Health Board (6.5, 6.8). That Members be appointed to the Community Committee by the Board from the membership of the Area Health Board itself, from nominees of local authorities and. from nominees of the community represented (6.8). That each Community Committee be convened by a Area Health Board member and that it elect a Chairman from amongst its members (6.9).
XV. That members of Service Development Groups be appointed by the Area Health Board (4.7).
XVI. That all three management units of the Area Health Board appoint staff to "Community Liaison Posts" (5.3, 5.10).
XVII. That staff in service of the Thames Hospital Board and the appropriate proportion of staff in the Hamilton District Office of the Department of Health at the time of establishment be employed by the Thames Area Health Board.
XVIII. That transfer of staff to the Area Health Board from the Thames Hospital Board and the District Office of the Department of Health be in accordance with Section 47 of the Health Service Personnel Act (8.5).
XIX. That Job Descriptions of Area Health Board Executive Officers be agreed upon jointly with the Health Service Personnel Commision as soon as possible after formation and appointments to these posts be made promptly. (8.8).
XX. That the financial grant presently allocated to the Thames Hospital Board and the appropriate proportion of that allocated to the Hamilton District Office be allocated to the Thames Area Health Board.
XXI. That a supplementary grant be provided to cover one-off establishment costs (7.2).
XXII. That the Department of Health continue to provide finance for all services currently supplied by the Hamilton District Office of Department of Health to the residents of the Thames Hospital District. (7.4).
XXIII. That the Thames Area Health Board assume responsibility for the payment of accounts and salaries of the Thames Hospital Board and those appropriate of the Health Department Office Department of Health and School Dental Service from the date of establishment. (6.6).
XXIV. That all land and assets of the Thames Hospital Board and those of the Health Department Office of Department of Health - the Area Health District be transferred to the Thames Area Health Board (6.5).
XXV. That the following establishment, there be a transition period for the transfer of functions, duties and powers to the Area Health Board (3.8). CONTENTS Page
1-5 1. Introduction
2. The Area 8 2.1 General 8 2.2 Geography 8 2.3 Access 9 - 10 2.4 Orientation 10 - 12 2.5 Employment 12 2.6 Population Centre 12 2.7 Commerce 12 - 13 2.8 Towns 13 2.9 Population 14 2.10 Population Growth 14 2.11 Elderly Population 14 2.12 Maori Population 15 2.13 Demography 16 2.14 Boundaries
3. The Area Health Board 22 3.1 General 22 - 24 3.2 Objectives and Functions 24 - 27 3.3 Relationship with Department of Health District Office 27 - 29 3.4 Relationship with the Private Sector 30 3.5 Relationship with the Voluntary Sector 30 - 31 3.6 Planning & th-ordination with the Community 31 - 33 3.7 Constitution of the Board 33 - 34 3.8 Transition Period 34 - 35 3.9 Board Organisation 37 - 40 3.10 Management Structure
47 - 50 4. Service Development
51 5. Maori Health
52 - 55 6. Community Committees
57 - 58 7. Finance
58- 61 8. Personnel CONTENTS
Page Figs. 1 6 Boundaries 2 7 The Area 3 9 Community of Interest 4 11 Visitor Destinations/Peak Numbers 5 17 Population Density 6 18 Percentage Maori Population 7 19 Growth Percent 1981 - 2001 8 20 Index of Aging: Year 2001 9 21 Synthesis : Communities
Organogram 1 36 Board Organisation 2 38 Management Structure 3 41 Community Services Unit 4 42 Health Promotions Unit 5 43 Hospitals Management Unit
Table 1 44 Senior Medical Staff 2 45 Senior Administration Staff 3 46 Senior Nursing Staff 4 56 Community Committees
Appendices Al Finance A2 Personnel A3 Nursing Workforce A4 Report of Mr. N. Clarke A5 C.V. of Chairman, Mr. N. Clarke
B "Public Discussion Document"
Cl "Public Discussion Document"Cjrculatjon List C2 Programme of Meetings - I Health Professionals II Public Meetings C3 Minutes of Meetings with Health Professionals C4 The Hamilton District Office of Department of Health, services to Thames.
Cont d... CONTENTS
Appendices (Cont d)
C5 Advertising Details C6 Press Clippings C7 Minutes of Public Meetings C8 Submissions -1-
1. INTRODUCTION
1.1. The Thames Hospital Board has for several years viewed with interest developments nationally with respect to the establishment of Area Health Boards. In principle the concept has appeared as an attractive progression for this Board in its endeavour to continue to provide health services of a high standard to the residents of the Coromandel Peninsula, the Waihi district, northern Waikato and the Hauraki Plains.
1.2. This Board has followed with interest the pilot schemes both for Wellington and Northland, and it has reviewed the documents coming from these areas.
1.3. The Chairman and other Board Members have attended meetings, seminars etc (such as the Hospital Boards Association meeting in Whangarei in 1984) in order to gather information that may be applicable to this area.
1.4. The Hospital Board s executive staff have corresponded with colleagues in the Department of Health and with counterparts in other hospital boards (some progressing towards Area Health Board formation, others not) in order to gain a greater insight.
1.5. These efforts culminated in a letter dated 15th July 1985 from the Chairman of Thames Hospital Board to the Director-General of Health inquiring about the criteria governing the formation of area health boards.
1.6. The Director-General s reply provided a framework for future consultation, investigation and planning; and -T it is largely within this framework that this proposal is made to the Minister of Health. -2-
1.7. The Thames Hospital Board has had discussions from time to time with neighbouring hospital boards - Waikato (on 8 February 1986), Tauranga (on 22 May 1986) and Auckland (Chairman to Chairman in August 1986). An exploratory meeting with the Department of Health district office executive staff was held in October 1985 in Thames, and a rather more "concrete" meeting between a delegation from the Board and the staff took place in Hamilton on 18 August 1986. A further meeting with Department of Health representatives was held in Hamilton on 13 November 1986.
1.8. The Chairman, Board Members and hospital executive staff attended Waikato University Seminars to explore Area Health Boards in Hamilton and Rotorua in June 1986, August 1986 and November 1986.
1.9. Throughout the period the concept of Area Health Boards and how such might improve the health services of this area were discussed on many occasions by the Board and its executive staff.
1.10. The above educative and exploratory stages culminated in the Thames Hospital Board resolving on 25 July 1986 "THAT the Executive Staff be directed to prepare a submission to the Minister of Health that an Area Health Board be formed within essentially the existing boundaries of the Thames Hospital Board as soon as practical".
1.11. In recognition of Section 5(3) of the Area Health Board Act 1983 that the Minister is required to satisfy himself "THAT there has been adequate consultation, planning, and preparation for the establishment of an Area Health Board in the proposed area health district", it was felt that the first priority of the Hospital Board was to inform and discuss with its staff and health professionals _3. in a frank and uninhibited manner in broad terms all aspects of Area Health Board formation. Thus, an extensive series of private meetings between Board staff and health workers was organised - this included well attended meetings in Coromandel, Whitianga, Waihi, Paeroa, Ngatea, Whangamata, Thames and 4 meetings at Thames Hospital. These meetings provided not only an opportunity to educate those attending in features of an Area Health Board, but also provided, through lively dialogue, feedback an indication as to likely public reaction to the concept.
1.12. Next this proposal was drafted in detail, submitted to the Thames Hospital Board for approval in principle; made available to staff, health professionals, voluntary and private organisations as a "draft discussion document"; and then as a "Public Discussion Document" to the public for consideration.
1.13. This "Public Discussion Document" was circulated widely within the Hospital Board District and also to potentially interested parties outside the region; and submissions were requested. Please see Appendix Cl Public Discussion Document Circulation. The submissions received are also included in Appendix C8.
1.14. The community was further informed through widespread press publicity (both paid advertising and journalistic copy) in all regional newspapers and on the several radio stations serving the area. Every household will have received extensive information via "free" newspapers at least once and most households three times. Please see Appendix C5, C6 for details.
1.15. A series of public meetings to inform the Public and to assess its opinion of the proposal were organised in eight major localities during early December (for details -4- of attendance, minutes etc please see Appendix C7 ). These well attended meetings were all chaired by Mr. Neil Clarke, OBE, JP a prominent resident of Paeroa and of the region.(C.V. Appendix A5). Mr. Clarke who has no association with the Thames Hospital Board or health service and is not directly involved in local government affairs, was well respected in all locations as an independent chairman and his report is attached as Appendix A4.
1.16. In 1986 the Thames Hospital Board established a Community Mental Health Programme and Shadow Service Development Groups for the health of the Elderly, for Domiciliary Care and for Child Health. These are examples of Thames Hospital Board s desire to move as quickly as possible to embrace the concepts exemplified in the Area Health Board Act.
1.17 Indeed the motivation of the Thames Hospital Board to proceed in this direction are:
(a) to investigate changing the emphasis from curative medicine to disease prevention, health promotion, and health education.
(b) to provide the individual diverse and often isolated communities of the area with a greater input into and influence over health decisions affecting their area.
(c) to provide a Service Development Group approach (involving the public, private and voluntary sectors) in the planning of health services.
(d) to investigate and endeavour to maintain a balance between the demand for sophisticated curative services and the cost of providing these services. I
1.18. Having due regard to all submissions received (both -: written and verbally from Public Meetings) the Thames Hospital Board .now respectfully submits this proposal for recommending the establishment of the Thames Area Health Board to the Minister of Health for his consideration MJNWMESOM
f ice f ice
C)
THE AREA
Fig.2
1 A AN
COROMANDEL
WHITIANGA JIp.41 AA APt A APt A Auckland AA TAIRUA Bospital A PAUANUI WP8od I #^A AAA A THAMES AA A&
4 WHANGAMATA t AA A • NGATEA AA d PAEROA Waikato A^ Hospital Board __lIIP\\ ,WAI HI I
TE AROHA A , Taurang Hospita Board -8-
2. THE AREA
2.1. General There are geographic and demographic factors that make the Thames Hospital Board area unique. This uniqueness does not mean that the area is self sufficient in commerce, health services etc, it is too small for this. The area looks to adjacent regions for aspects of educational, commercial, health services etc, but there is no single orientation.
2.2. Geography The area comprises - the Coromandel Peninsula with coastal beach resorts and bar-harbours in the east, coastal communities and harbours in the west, and the rugged Coromandel range traversing the length of the peninsula. In the south are the fertile Hauraki Plains which are bounded on the east by the Coromandel and Kaimai Ranges, on the west by the Hapuakohe range, while further to the north is the firth of Thames, separated from the southern Auckland suburbs by the Hunua ranges.
2.3. Access 2.3.1 The access to the eastern seaboard of the peninsula is from the west by six routes through the Coromandel range and one in the south between the Coromandel and Kaimai ranges.
2.3.2 The principle access route, the most recently developed, commences six kilometres south of Thames and services the east coast communities from Whiritoa in the south to Whitianga in the north. The other five access routes to the east coast arise from the western side of the peninsula north of Thames.
2.3.3 The most southern route is from Paeroa, 32 kilometres south of Thames, and is also the northern access route to the Bay of Plenty. -9.- COMMUNITY OF INTEREST Fig.3
3, L1 WHIT IANGA
1111w ) PAUANU:TAIRIUA THAMES
OOOOW WHANGMMATAI IEA \ \• 4- PAEROA To HamiltonThames To Auckland ------4 r .4 To Tauranga _10-
2.1 Orientation The physical features, more than any other, produce the communities of interest in the region - all look towards Thames - but in the south east there is some orientation for shopping/commerce and other purposes to Tauranga. (See Fig.3).
2.5. Employment. Changing patterns of employment have the ability to increase the population of the Boards district -
2.5.1 Farming is the main occupation of the Hauraki Plains and adjacent hill country. Many farms, especially in the south east are changing to horticulture with a resulting increase in population density.
2.5.2 The forestry industry is well established and as more forests mature the milling and associated timber product industries are expected to increase in size and manpower.
2.5.3 Mining Activities are projected for three separate sites. At least two of these are major and both are expected to proceed within the next year or so. The manpower requirements are small, but significant in the areas in which they are sited, and will remain for some years.
2.5.4 Tourism provides a larger ever changing population which at certain times makes substantial and irregular demands on health services. Fig.4. gives some indication of peak populations. (up to a 10 fold increase in population in some centres).
2.5.5 Retirement immigration is the most significant feature affecting population growth. The influx of people from
Fig.4 V?LJI IJt.T1NAT1ON5 I PEAK NUMBERS
North of Colville Wai ka w 10,000 6, Walkawau 4,000
Kennedy Bay : a Q 500 Whan5oua Kuao 600 300 Coroffnd&
0 J_J WhQ Ianoaa Cooks Beach
Hahel
1:rnwi&TrIrI_
Tairua 6,000 0 Thames Coast Pauanui 10.000 2.500
) Ohul /
Onemana 33.000
hk Wh.ngam ta
- SOURCE : Holder 1983 WaP Beach 10,000 Courtesy TCDC Planning Department
• -S - )
\ -12- other districts for permanent retirement shows no sign of abating. These new residents, because of their age will shortly make extensive demands on the health services of the district. These people are residing in widely scattered coastal communities and will require careful co-ordination of their health services.
2.6 Population Centre. There is no single predominant population centre but the area consists of numerous small, isolated, parochial communities, many of which are growing significantly.
2.7. Commerce Thames is undoubtedly the centre of commerce, business and health for the area. Being central It is Ideally placed to serve the area. Some government departments are further considering consolidating their interest in this region here. The base hospital for the community is In Thames.
LI Tow= The major urban towns, their populations and orientations are:- (I) (Ii)
Thsmas population 1986: 6448 (estimated year 2001: 5628), is the centre of commerce for the region, servicing both rural, farming, and recreational areas. Several major Industries (car assembly, foundry), and a few light industries. The hospital Is one of the two major employers of labour In the town.
Coromandel population 948 (estimated 2001: 1294) - fishing, recreation, farming, forestry.
40 $taUstles pow by Thsaus Co aidil, OIihiiecici Coimty, Ws Md 1 Puffs Coimty. as Yssr tool estimates bessd cc 1101 Comm Ioiece - DsmraQh1c Profiles; Dsmc P,o.ct1ces —_ Dsçsrta.st of 1tststi, awtdaw_ 1110 -13-
Whitianga, population 2479 (estimated 2001: 4804) - holiday, retirement, fishing, farming, horticulture, forestry.
Tairua population 1101 (estimated 2001:2366) - or - recreation, retirement.
Pauanui population 558 (estimated 2001:1696) - or recreation, holiday, retirement.
Whangamata, population 2395 (estimated 2001:3552) - holiday, retirement, forestry, horticulture.
Waihi population 3679 (estimated 2001:4100) - rural and horticultural services, light industry, mining, service centre for nearby holiday and retirement areas.
Waihi Beach population 1671 (estimated 2001:1880) - holiday, retirement, recreation.
Paeroa population 3661 (estimated 2001:3700) - rural service town.
Ngatea, population 800 (estimated 2001 approx. 1000) - rural service town, dormitary town for Thames
2.9 Population Of the total present population of 39737 in the Thames Hospital Board District 59.7% live in townships, the remainder is spread in the extensive rural areas in communities dedicated to as diverse activities as farming, horticulture, marine farming, tourism, retirement settlements, forestry, mining, maraes, "community life". -14-
2.10 Population Growth Assuming medium fertility and medium migration the Thames Hospital District population is expected to be 46,000 in 2001 and 48000 in 2006. Previous census results have been consistent with "high fertility and high migration assumptions" and certainly migration to the District is anticipated to continue at high levels. If the "higher assumptions" are used anticipated Board populations will be 50,000 and 53,000 in 2001 and 2006 respectively.
2.11 Elderly population 2.11.1 The numbers of people in the Thames Hospital Board district over the age of 65 years has risen and this trend is expected to continue. In 1976 the 65+ population was 4070 (or 12.1% of the total population); in 1981 it was 4674 (13.2%); in 1986 it is predicted to have been 5700 (14.6%); in 2001 it is predicted to be 7600 (16.5%) and 2006 to be 8000 (16.7%)
2.11.2 Consideration of the 75+ years population the following trend is revealed. In 1976 this population was 1286 (or 3.8% of the total population); in 1981 it was 1533 (4.3%) in 1986, it is predicted to have been 2100 (5.4%); in 2001 it is predicted to be 3500 (7.6%); and in 2006 to be 3700 (7.7%).
2.11.3 This increase in numbers of elderly residents in this area is recognised by the Thames Hospital Board and the service implications of this must be duly considered
2.12 Maori Population The total Maori population of the Thames Hospital Board District recorded at the 1981 census was 4515. This represents 12.7% of the total Board population. -15-
2.13.Demography No single demographic factor exists common to both Thames and any one of its neighbouring districts - however similarities in certain aspects exist with certain neighbours.
2.13.1 Fig.5 shows the region with a mixture of all three categories of population density. The Thames area, with little high density population, can be compared with Tauranga which has a mixture but with a large high density component; and with neighbouring Waikato which is predominantly high density.
2.13.2 Fig. 6 clearly shows the contrast between the Maori population of Thames and both Waikato and Tauranga. The Thames area having a lower percentage Maori population.
2.13.3 Fig. 7 shows the Thames area with a similar projected growth rate (1981 - 2001) to the Waikato, but less than that of the Tauranga region. If the region was depicted in more detail, the eastern seaboard of the- Coromandel Peninsula would be shown to have a similar rate to Tauranga i.e. it is growing at a faster rate than the rest of the Thames area.
2.13.4 Fig. 8 (Index of aging : year 2001) aligns the Thames region with that of Tauranga, clearly much "older" communities than the Waikato.
2.13.5 When an attempt is made to synthesise all of the above factors it can be shown that demographically the Thames area does not uniformly match its neighbours - the eastern portion most closely aligns with the Tauranga community, the western with Waikato (Fig. 9) -- -16- 2.14 Boundaries 2.14.1 The present boundaries of the Thames Hospital Board district do not conform with those of the Thames Valley United Council which includes Morrinsville and Te Aroha; but it is felt that these two communities do not share a common interest with Thames and they do not presently look towards Thames as a centre of commerce or health. The Thames Hospital Board district does coincide with the boundaries of the five local authorities of the region viz. Thames Coromandel District Council, Ohinemuri County Council, Paeroa Borough, Waihi Borough, Hauraki Plains County Council.
2.14.2 There has been verbal representation from the public, their general practitioners, and ambulance services (the latter two based on the Hauraki Plains) asking that the Board s area be extended slightly into that of the Auckland and Waikato Hospital Boards.(west and north) to include Maramarua and Kaiaua. This representation has been further formalised by the people of Kaiaua with a written submission. The Thames Hospital Board has no objection to the inclusion of Kaiaua in the Thames Area Health Board District, but it acknowledges that to do so would be to cross existing local government boundaries. -17-
POPULATION DENSITY
I I FIG. 5.
- -
Density
IIJJJIJB High Low l7:Very low - uninhabited
REFERENCE FIG. 5-9
"Demographic Communities of South Auckland - Bay of Plenty Janet Sceats & Ian Pool Hamilton 1986 -18-
PERCENTAGE MAORI POPULATION
FIG. 6.
iI!ç- L) - •-. -k.- --
2UJJ1IIJ TO ecL 7 % Maori Local Govt. Areas LOW MODERATE umHIGH -19-
GROWTH PERCENT 1981 - 2001
FIG. 7.
MuM
( I
-H
-I
tJ r_ :i, I
= I H R
. •.•••• :••
Growth % 1981-2001 Locat Govt Areas [:•. :• <20 -T- 2029 Ii!1t 30+ -20-
INDEX OF AGING : YEAR 2001
FIG. 8.
0
Thames Cor
A l R ape IN -Al I L14IIIA cTongnro Index of Aging (P65#/Po/4) % Locat Govt Areas Y] 5 -45-5Lf 55+ - 21 -
SYNTHESIS : COMMUNITIES
FIG. 9.
x Taupo town similar community to Bay of Plenty
1) v -i Old, retirement; rapid growth, low % Maori, urban growth important High density, medium growth, but (2)E-i young and medium % Maori ,' urban growth important (3)V/A High density, medium growth, but mature and with high % Maori • Low density, high proportion Maori, [ow growth, young -22-
3.THE THAMES AREA HEALTH BOARD
3.1 Throughout all the stages of development of this proposal, including all communications with staff and the public, the Thames Hospital Board has insisted that an Area Health Board is a different body entirely to either a hospital board or a district office of the Department of Health. This proposal must not be viewed as a parochial attempt to maintain the status quo; but as an enthusiastic attempt to provide a "new" health service for the region. It must be seen by those inside and outside "the organisation" that the Thames Area Health Board will be an entirely new organisation
3.2 Objectives and Functions
3.2.1 The objectives of the Thames Area Health Board will be as stated in the Area Health Board Act 1983. The Thames Hospital Board sees the emphasis placed on health promotion, health education and disease prevention, together with community involvement in delivery and planning of health services as most desirable.
Section 9 of the Act states:
"Primary Objectives of Boards - The primary objectives of an area health board in its district shall be as follows: (a) To promote, protect, and conserve the public health, and to provide health services. (b) To provide for the effective co-operation of the planning, the provision and evaluation of health services between the public, private, and voluntary sector. (c) To establish and maintain an appropriate balance in the provision and use of resources for health protection, health promotion, health education, and treatment service." -23-
3.2.2 The Thames Hospital Board, and in general the community it represents, are in agreement with the functions, duties and powers of the Area Health Board as set out in Section 10 of the Act. Private Health Services are represented in the area by general practice, some specialist services, paramedical, "fringe" medical, and increasingly importantly by those in the field of care of the elderly. A catalyst to further consultation and co-operation with the private health agencies will be welcomed by all. Voluntary health agencies are strongly represented in the region and a relationship with an Area Health Board will benefit the health community.
Section 10 of the Act states: "(1) The functions of an area health board shall be as follows:
(a) Generally to promote and protect the health of the residents of its district, and, towards that end, to consult and co-operate with individuals and organisations (including voluntary agencies, private agencies, departments of state, and territorial authorities) concerned with the promotion and maintenance of health: (b) To investigate and assess health needs in its district (c) To plan future development of health services in its district, and, towards that end,(i) To consult, as appropriate, with any regional or united council in the district; and (ii) To support, encourage, and facilitate the organisation of community involvement in the planning of such services. (d) To set objectives and determine priorities within the scope of its functions, duties, and powers. -24-
(e) Such of the functions of the Minister and the Department as may from time to time be delegated to the board in accordance with section 36 of the Act. (f) As and to the extent that the Minister from time to time directs pursuant to his functions under this Act (i) To provide and at all times maintain health services; and (ii) To provide relief in accordance with this Act; and (iii) To provide, services for Government departments, hospital boards, and other area health boards. (g) To manage all institutions and health services for the time being vested in or controlled by it. (h) At the discretion of the board but subject to section 84 of this Act, to grant financial or other assistance to any individual or organisation involved within its district in (i) Setting up programmes for health services and maintaining health services or (ii) Training volunteers engaged in any such programmes or services. (i) To make available to the public reports, information, and advice concerning the public health and the health services available within its district.
(2) An area health board shall have such other functions duties, and powers as are conferred or imposed on it by this or any other Act."
3.3 Relationship with the Department of Health District Office
3.3.1 Presently the Department of Health supervise their activities in the Thames Hospital Board District from their Hamilton district office. The District Office is cognisant of the fact that the Department of Health has an obligation to provide these services to the region with or without the -25-
formation of an area health board. Their staff have indicated that they are prepared to work within the framework of an Area Health Board.
3.3.2 The Department of Health do have officers (and an office) based in the Thames Hospital Board area, but the area is currently administered from Hamilton.With the formation of an Area Health Board the area will benefit considerably from the governing authority being based within the region and being answerable to the region.
3.3.3 The proportion of the district office staff and basic grant presently allocated to service the Thames Hospital Board district will be incorporated by the Thames Area Health Board. Most administrative aspects (such as transfer of staff to the new employer, financial changes, etc) of the transition could be undertaken by existing Thames Hospital Board from District Office and Hospital Board to Area Health Board status staff. Due recognition will be given to personnel matters and to the continuation of services currently administered from the district office. The experience gained in the formation of other Area Health Boards will be heeded.
3.3.4 It is noted that the functions of the pharmaceutical pricing department and the payments of benefits will remain centrally with the Health Department.
3.3.5 The smallness of the region is recognised and accepted. As a consequence essential functions in an Area Health Board do not require to be fulfilled by the appointment of whole time officers - for example Medical Officer of Health, and Principal Dental Officer. The Thames Area Health Board intends to enter into an agreement with a neighbouring authority (for the time being the District Office of the Department of Health) to employ these key personnel on a contractual (part time) basis. -26-
3.3.6 For example, it is estimated on a population basis that the Thames Area Health Board should employ its Medical Officer of Health only on a part time (3/10) basis, i.e. for 3 half days each week. He/she may well have other duties within the Thames Area Health Board, or alternatively with another authority.
3.3.7 The Principal Dental Officer should be a specialist in community dentistry, and, as is the case now, the Board does not envisage a suitably qualified person to be available locally. Therefore, as with the Medical Officer of Health, the Board intends contracting with a neighbouring authority (initially the Department of Health District Office in Hamilton) for the services of a Principal Dental Officer (based on present responsibilities, population etc, this is expected to be on a 1.5/10ths basis).
3.3.8 Currently a group of 12 school dental nurses are supervised by, and relate to, the Department of Health s district office in Hamilton. It would be seen (after due consideration of personnel and other administrative matters discussed in the Appendix Al, A2) that they be employed by the Thames Area Health Board.
3.3.9 Presently the Department of Health has various staff totalling the equivalent of one full time health protection officer dedicated to this area and there is a good working relationship with the territorial local authorities in their respective fields. These relationships are expected to improve further when staff employed in this field have their headquarters in and work from within this district.
3.3.10 There presently exists good co-operation and some overlap between Public Health Nurses and Hospital Board staff. There are 5.5 Public Health Nurses working in the area with their principal and supervisory staff based in Hamilton. See Appendix A3 for details. -27-
3.3.11 The Thames Hospital Board employs 8.35F.T.E. District Nurses, an increase in this number is expected with population increases.
3.3.12 There are 7 practice nurses employed by the Thames Hospital Board in its health centres in Ngatea and Thames.
3.3.13 It is proposed that the Thames Area Health Board employ a Principal Community Nurse and sufficient registered nurses in the Health Promotion and Community Services Units to provide a Comprehensive Nursing Service able to carry out the health promotion, protection and caring aspects of the service as the Area Health Board directs (See Appendix A 3).
3.4 Relationship with the Private Sector
3.4.1 The private health sector in the area is represented by practitioners (in family medicine, dentistry, optometry physiotherapy, pharmacy, and "alternative medicine"), by specialists in consultative practice, by agencies with homes for the frail ambulant, and by pathological laboratories with collection centres. There are no private surgical, medical or geriatric hospitals in the area.
3.4.2. The Thames Hospital Board has built and owns Health Centres in Ngatea and Thames; 3 general practitioners in Ngatea and 4 in Thames provide services along with specialists, dentists, paramedics, district nurses, public health nurses and voluntary groups from these centres. 3.4.3 Thames (with its base hospital, and larger population) contains the majority of medical practitioners, the others are scattered in groups of 1 to 4 members throughout the district. There is no local branch of the New Zealand Medical -28- Association and no real unifying local body for medical practitioners (the closest approximation could be the Thames Hospital Post-Graduate Medical Society). Consequently representative submissions have not been possible from the medical profession.
3.4.4 Even so, the opinions of medical practitioners in the area have been canvassed and the Board has received a variety of responses. Most have been enthusiastic about the broad principles of the Area Health Board concept, and have definitely been keen to see the preservation of local control over treatment services (especially for the peripheral hospitals and the base hospital in Thames). The Thames Hospital Board has shown that it can maintain a full range of normal base hospital services but reservations have been expressed as to the size of the Area Health Board (and therefore the range of super-specialties that can be provided).Thames Hospital Board enjoys an excellent relationship with neighbouring Hospital Boards for the provision of certain specialised services - these relationships would continue as an Area Health Board.
3.4.5 Private medical practitioners from smaller towns welcome the opportunity (through community committees and service development groups) to influence more than at present the range of services provided by the Hospital/Area Health Board for their patients. Although some reservations were expressed by the private medical practitioners at the involvement on time-consuming committees - universally throughout the area the concept of greater private-public health dialogue planning and co-operation was enthusiastically welcomed.
3.4.6 A special relationship already exists between the community, private practitioners and the Thames Hospital Board in the fields of mental health, substance abuse and -29-
obstetric services, and it is felt that the formation of a Thames Area Health Board offers an opportunity to develop these and other fields further and a unique model for New Zealand health services could well be created by so doing.
3.4.7 The Thames Hospital Board has clearly informed all that the formation of an Area Health Board will not lead to local control of funds presently administered by the Department of Health for pharmaceutical or general medical benefits. There has never been any suggestion that the Thames Area Health Board would provide general practitioner services (unless requested to do so in an emergency) nor was it the intention of the Board that the function of an Area Health Board was the first step towards complete nationalisation of the health services. Never-the-less it is fair to state that representation was made by individual practitioners for the Area Health Board to be involved directly in primary health care provision, and for private practitioners to play a greater part in hospital treatment services.
3.4.8 The calibre and motivation of members of health committees and service development groups was of concern to some private practitioners, who were worried about the development of an inappropriate balance between treatment and preventative services - some fearing a down-grading of existing treatment services, others welcoming quality productive preventive programmes.
3.4.9 There is presently a good working relationship between the Thames Hospital Board and the Accident Compensation Commission (the A.C.C. District Office is in Tauranga). Both the corporation and the Thames Hospital Board welcome the formation of an Area Health Board as an opportunity to develop this relationship further, especially in such fields as accident prevention. -30-
3.5. Relationship with Voluntary Sector
3.5.1 As in many other communities in New Zealand the voluntary health sector is active in the Thames Hospital Board district. There is no inter-organisational co-ordination at present with the possible exception of child health co-ordinated by a Department of Health Medical Officer (who also is a part time Thames Hospital Board Paediatrician).
3.5.2 The voluntary sector includes the larger national health related agencies (e.g. Plunket, IHC), support groups (.e.g. Counterstroke etc), locally orientated groups (.e.g. charitable trusts to establish "Rest Homes"), non medical agencies who increasingly adopt medical projects (e.g. Lions, Rotary) through to a large army of individual volunteers (working in Day Care, Red Cross, Meals on Wheels, etc) requiring co-ordination. The Thames Area Health Board would ensure that these organisations retained their independance and autonomy, but would see their input into Service Development Groups as important for the planning, provision and evaluation of health services.
3.6 Planning and Co-ordination with the Community
3.6.1 Clearly within the spirit of the Area Health Boards Act 1983 is a committment to health service planning and it is intended that the community and the consumer be an integral part of this. To quote:- Section 9(b) "To provide for the effective co-ordination of the planning, provision, and evaluation of health services between the public, private, and voluntary sectors": and Section 10(c) "To plan future development of health services in its district, and towards that end, -31- i) To consult, as appropriate, with any regional or united council in the district; and (ii) To support, encourage, and facilitate the organisation of community involvement in the planning of such services. The Thames Area Health Board will enter into this spirit."
3.6.2 Mechanisms for public involvement in this process will be available apart from the triennial elections, viz. community committees, the Maori health advisory groups and service development groups.(See Sections 4 & 5 & 6).
3.6.3 Aplanning committee of the Area Health Board will be established (see Paragraph 3.9). It will be serviced by executive staff, and it will take over functions previously performed by the Thames Hospital Board together with planning components of health promotion and community_ health.
3.6.4 It is intended that, service development groups will channel all their activities through the Executive Staff Unit for comment, advice, etc; and the Executive Staff Unit will submit all service development group reports to the Board.
3.6.5 The Maori health advisory groups will be accountable to the Maori Health Comrhittee of the Area Health Board and thence to the Board.
3.6.6 Community committees will have a direct channel to the Board, via its Community Health and Planning Committees.
3.7 Constitution of the Board
3.7.1 Section 8(1) of the Area Health Boards Act 1983 stipulates "Every area health board shall consist of ' -32- (a) Up to 14 members, being one or more elected representatives of each of the constituent districts within the area health district; and
(b) Such number (if any) of members appointed by the Governor-General on the recommendation of the Minister, not exceeding 1 for every 4 elected members, as may be agreed between the elected members and the Minister under Section 18 of this Act".
3.7.2 Presently there are 12 members elected to the Thames Hospital Board and it is recommended that this number be elected to the Area Health Board.
3.7.3 Representation of the Thames Hospital Board is on a ward basis and this basis was reviewed by the Board in 1986. This representation should be retained, viz. (a)Mercury Bay, Whitianga, Whenuakite Coromandel and Colville Areas 2 members (b) Tairua, Whangamata, Puriri and Hastings area 2 members (c) Thames Urban 2 members (d) Waihi Borough 1 member (e) Ohinemuri County - 2 members (f) Paeroa Borough 1 member (g) Hauraki Plains County 2 members
3.7.4 It is the intention of the Thames Hospital Board (if it is to become the Thames Area Health Board) to recommend to the Minister of Health the appointment of not exceeding three further members to the Area Health Board as prescribed in Section 18 of the Act. The appointed members will hold office until expiration of the term of office of the elected members, and it is intended that persons be recommended -33-
to represent social and cultural aspects of the Board s work or under represented geographic locations, and not necessarily for their specific professional skills.
3.7.5 It is anticipated that the Thames Area Health Board will be established within two years of the triennial elections dated 11 October 1986. Therefore it is anticipated that members elected to the Thames Hospital Board on 11 October 1986 will be deemed to have been elected to the Thames • Area Health Board as stipulated in Section 14 of the Act." However, should this not be the case, and the operative date should be "within" the period of 12 months preceding the date of the next triennial general election of members • of territorial authorities a date shall be specified by the Governor-General for the first election of members to the Thames Area Health Board.
3.7.6 Having due regard to the above, the Board again must emphasise that the formation of the Thames Area Health Board should not be just a new name for the Thames Hospital Board, but an entirely new concept and entity.
3.7.7 The Chairman of the Thames Area Health Board shall be elected from within the elected Board Members at the first meeting of the Board as provided for in Section 23 of the Area Health Boards Act."
3.8 Transition Period
3.8.1 In common with other recently established Area Health Boards it is recommended that following the establishment of the Thames Area Health Board there be a transitional
LI -34-
period for the transfer of the functions, duties, and powers of an Area Health Board during which time all aspects of the organisations involved in the merger will be transferred to the new Area Health Board.
3.8.2 This transitional period would allow for the appointment of the Board s executive team and the implementation of the management structure. At the same time the accounting systems must be standardised and resources transferred from the two parent organisations to the new organisation. This will require transfer of trust documents and deeds for land and buildings and gazetting of the transfers of the District Office to the Area Health Board.
3.9 Board Organisation
3.9.1 It is proposed that the Area Health Board establish the following committees: (Org.1) (i) An Executive Committee (ii) A Finance Committee (iii)A Planning Committee (iv) A Community Health Committee (v) A Maori Health Committee
P1 Board executive officers will advise to each committee
3.9.2 These Committees of the Board will make recommendations to the Board and will have such duties and power as the Board may delegate under Section 28 of •.•._•__•. the Act.
3.9.3 The Area Health Board itself will be advised by the Executive Staff Unit. The Medical Officer of Health will attend meetings of the Board (under some circumstances he may also be a member of the Executive Staff Unit). -35-
3.9.4 Advisors to the above committees will be:-
(i) Executive Committee - the Board s Executive Staff uW
(ii) Finance Committee - The Executive Staff Unit plus the Finance Executive.
(iii) Planning Committee - The Executive Staff Unit plus the Planning Officer, plus other staff co-opted as appropriate.
(iv) Community Health Committee - the Directorate of the Health Promotions Unit and the Executive Staff Unit.
(v)Maori Health Committee. -Maori health advisory groups (such as representatives of the Hauraki District .Maori Council other organisations or individuals with an interest in Maori health) and Community Liaison Officer. 3.9.5 The place of ccommunity committees service development groups and Maori advisory , groups is as have a communication/liaison link with the Area Health Board. Community committees will have an accountability directly through the Board s Planning and Community Health Committees to the Area Health Board. Service Development Groups will be accountable to the Board through the Executive Staff Unit whose responsibility will be to analyse and collate their recommendations and to advise the Board. Maori advisory groups will be accountable to the Maori Health Committee of the Board and hence directly to the Board.
11
AREA HEALTH RIi1At1J]
I I I I I COMMUNITY BOARD MAORI PLANNING I FINANCE HEALTh EXECUTIVE HEALTH COMMITTEE COMMITTEE I COMMITTEE COMMITTEE I 1 I COMMITTEE I I I I I I I $ I I
I I A I I S I I I $ I I I I I I I fMAOR I\ I I I •HEALTH /COMMUNITY I / ADVISORY MITTEES I I S.D.6. s I GROUPS I I I•I ala .a a a a a a - A
L- - _ ------AFF _ - J II T
BOARD ORGANISATION ABILITY COMMUNICATION LIAISON -37-
3.10 Management Structure
3.10.1 The Thames Area Health Board will initially adopt a triumvirate Executive Staff Unit comprising of a Chief Executive, a Chief Medical Officer and a Chief Nurse. This unit will advise the Board and administer those public sector services under the Board s control. The relationship between this unit and the rest of the Board s management staff is illustrated - Org.2.
3.10.2 The three members of the Executive Staff Unit will be accountable directly to the Board for the implementation of its policies. Each member shall be individually responsible U for services under his/her control, and decision making will be by concensus when recommendations are made to the Board or when more than one service is affected.
3.10.3 Three further management units, responsible to the Executive Staff Unit will be formed - viz, the Community Services Unit, the Health Promotions Unit and the Hospital Management Unit.
3.10.4 The Executive Staff Unit and the Management Units will additionally be able to call on the services of a Finance Unit and Planning Unit who will have Board wide responsibilities.
3.10.5 The community services------unit will be responsibble for management of all non-hospL(largely treatment orientated) services - including nursing, paramedical, (physiotherapy, occupational therapy, speech, etc), social workers, all domiciliary services to the elderly, mental health, substance abuse, ambulance services. The executive staff of this unit will be a Medical Director, Nursing Director, a Principal --=.,------.------.-.-.--- Nurse and an Administrative Di rector. Their relationship to subordinate staff is illustrated in Org. 3. COMMUNITY SERVICES HEALTH PROMOTION UNIT UNIT
0
Non Hospital Treatment EXECUTIVE STAFF UNIT Public Health Promotion Services - Chief Executive Unit - Chief Medical Officer - Chief Nurse \ I PLANNING UNIT I FINANCE UNIT 00
SERVICE
HOSPITALS MANAGEMENT UNIT.
Base Centre and Peripheral Hospitals
MANAGEMENT STRUCTURE. -39-
3.10.6 The Health Promotions Unit will be, as its name WA suggests, involved in Public Health, preventative medicine and will be charged with ensuring the "good health" of the community - functions previously undertaken by the District Office of the Health Department. It will also assume a major role in community liaison. It is envisaged that the Accident Corporation Commission will provide input to the operation of this unit. Org. 4. illustrates the units staffing structure - it will be headed by the Medical Officer of Health and an Administrative Director.
3.10.7 The Hospitals Management Unit will control all the hospitals in the Boards area, and as such will be the second "treatment orientated" arm of the Board s services. Its management structure is illustrated in Org. 5. and it will be seen that the unit is also to be lead by a Medical Director, Nursing Director,and a Administration Director.
3.10.8 Dental Health is under the auspices of the Health Promotions Unit. The Principal Dental Officer will be responsible through the Medical Officer of Health and this unit to the Board.His service will be contracted from a neighbouring Board (or District Office) and he will be expected to be present in the Thames District on a 1.5/10ths basis.
$ -40-
3.10.9 The Executive Staff Unit will be primarily involved in policy making and Board-wide planning; management units for planning policies and the day-to--day running of their services.
3.10.10 It is important that the Board s principal executive officers have broad experience and skills which not only embrace the treatment services, but also those of community health. To this end the combination of certain positions necessitated by the size of the Board could well be advantageous - for example the Chief Medical Officer if appropriately qualified could simultaneously hold the position of Medical Officer of Health (the Medical Officer of Health component required being approximately 3 tenths on a population basis). Likewise the position of Medical Director (Community Services) could be combined with that of Medical Director (Hospitals). See Table 1.
3.10.11 Similarly senior administrative staff positions are likely to be combined with officers having roles to play in more than one unit - See Table 2.
3.10.12 The Chief Nurse will clearly assume responsibilities in both Hospitals and Community Services - Table 3.
3.10.13 The job descriptions of principal officers should clearly reflect the combined responsibilities in the fields of health promotion, hospital and community services and will be submitted to Hospital Health Service Personnel Commission for advice and ratification.
3.10.14 It would be anticipated that the offices of all principal staff will be situated under the one roof in Thames, thus facilitating the provision of services in keeping with the spirit of the Area Health Board Act.
EXECUTIVE STAFF UNIT II
COMMUNITY SERVICES UNIT II
DIRECTORATE
MEDICAL DIRECTOR NURSING DIRECTOR INISTRATIVE DIRECTOR (Community Services) (Community S.rvices) munity Services)
Pmdi1 ServIces nirLtstrat1cn/Iagiant Soc Cty Ind
Sezrk,es to Rli1y J SLWXy Mental Health 8exvis bW Substanos Abuse Cmmtty waison
Civil AWanco Plai lxsg
COMMUNITY SERVICES-UNIT EXECUTIVE STAFF UNIT
HEALTH PROMOTIONS UNIT
DIRECTORATE
?AL OW cr I&Th ADMINISTRATION DIRECTOR (Health Promotions)
Public Health Inspectorate flIfli8traticn
Nursing Services Camuiity LtMa
Dental Health
mily Health!
HEALTH PROMOTIONS UNIT EXECUTIVE STAFF UNIT
N
HOSPITALS MANAGEMENT UNIT
DIRECTORATE
TIVE DIRECTOR
Heads of Clinical Principal Departments Works & Develciient Officer
- TheI Hospital tnanent Off low Meal OfficersJ... Coratnde]. SLçply Officer J cy Bay Watcy Bay Ccmmity Lia.iacnl
WaiM Waihi
Posros
HO$PITAL8 MANAGNENT UNIT -44- TABLE 1
SENIOR MEDICAL STAFF
Chief Medical Officer
Medical Director (Hospitals)
Medical Director (Community Services)
Medical Officer of Health (part time employee or sharing another post e.g. Chief Medical Officer)
An individual staff member could occupy more than one post. -45- TABLE 2
SENIOR ADMINISTRATION STAFF
Chief Executive
Finance Executive
Senior Administration Officer (Community)
Duties include + Administrative Director (Community Services)
+ Administrative Director (Health Promotion)
• Works/Development Officer • A.C.C. Liaison
Senior Admin. Officer (Management)
Duties include + Administrative Director (Hospitals)
+ Administration/Management - (Health Promotions)
+ Administration/Management - (Community Services)
Planning Officer
Duties include + Community Liaison Officer
Supply Officer
Duties include • Supply Manager (Hospitals)
• Supply Manager (Community Services) + Supply Manager (Health Promotion)
• An individual staff member could occupy more than one post. -46- TABLE 3
SENIOR NURSING STAFF
Chief Nurse
Nursing Director (Hospitals)
Nursing Director (Community Services)
Principal Nurses - Thames Hospital - Coromandel Hospital - Mercury Bay Continuing Care Unit - Waihi Hospital - Paeroa Hospital
• An individual staff member could occupy more than one post. -47-
4. SERVICE DEVELOPMENT
4.1 It is accepted that service development planning is a vital component of any organisation involved in health care in New Zealand, especially considering the fiscal limitations of today and the future. The Area Health Board Act certainly broadens this sphere to include not only the public sector, but also the private and voluntary sectors; and it also provides the health professional and consumer with greater input. This involvement will come from participation in Service Development Groups who will include amongst their members representatives of the aforementioned sectors and groups.
4.2. Service Development Groups are advisory groups to the Area Health Board and will submit proposals to it concerning public sector services, after consideration has been given to the needs of the service in the entire area of the board.
4.3 Section 3.2.44 of the report of the Wellington Health Services Advisory Committee, July 1981 captures the concept.
"3.2.44. Bringing together the public private and the voluntary sectors for planning on service lines will:-
- enable a comprehensive overview of the health services in the region;
- provide a forum for a consideration of the plans and aspirations of the private and voluntary sectors, and the means by which consumers views can be given recognition; -48-
- establish a process for arriving at planning proposals agreed upon by all sectors;
- provide a mechanism for the consideration of health problems related to the service under study by the formation of working parties of the Service Development Group; and the co-ordination of the phases or levels of the health service concerned;
- provide a mechanism for identifying the needs of the region and the formulation of options for the setting of policies and priorities by the board, based on local conditions; and a base for the regional planning process."
4.4 Thames Hospital Board, has, prior to the submission of this proposal appointed shadow service development groups to examine care of the elderly, child health and domiciliary service.
4.5 It is proposed that the Thames Area Health Board have the range of service development groups established in Section 29 of the Act.
4.6. To quote Section 29(2) "Without limiting the generality of subsection (1) of this section, every board shall appoint sufficient service development groups to deal adequately with the following: (a) Medicine (other than paediatric, geriatric, or psychiatric medicine (b) Surgery (c) Child Health d) Health of the elderly (e) Mental Health (f) Dental Health (g) Health protection (h) Health promotion (i) Primary health care" -49-
4.7 Members of service development groups will be appointed by the Board in accordance with Section 29 of the Act for public, private and voluntary sectors and they will be mostly persons with an active professional (or voluntary) involvement in the particular service. The Board will also ensure consumer representation, a balance between rural and urban representatives and representation for important social and ethnic groups on service development groups. Elected Board Members will be eligible for appointment to service development groups.
4.8 The size of service development groups has not been prescribed, but it is anticipated groups will contain no more than 12 persons.
4.9 A convenor shall be appointed by the Board for each service development group and a Chairman for each group will then be appointed by the group.
4.10 Section 30 of the Act sets the minimum standards for communication to the Area Health Board. To quote:- "Every committee of the Board, and every service development group shall (a) Report to the Board on any matter referred to it by the Board:
(b) Submit to the Board an annual report covering its activities for the preceding year:
(c) On the expiry of its appointment, submit a report to the Board on whether or not it should be reappointed and, if it considers that it should be so reappointed, what its aims and objectives should be:" -50-
4.11 Reports of Service Development Groups (both annual and otherwise) are to be referred to the Executive Staff Unit for comment, prior to tabling at a meeting of the Board. Day to day management matters will be handled through the Executive Staff Unit of the Board.
4.12 It is recommended that the Area Health Board provide adequate services to Service Development Groups and it is anticipated that these be provided largely through the Planning Unit and the Executive Staff Unit. - 51 -
5. MAORI HEALTH
5.1 The Thames Hospital Board considers that Maori Health issues should be given prominence by the Thames Area Health Board this consideration being strengthened by statements made at public meetings and upon receipt of written submissions to the "Public Discussion Document".(Appendix C8).
5.2 The total Maori population of the Thames Hospital Board area in 1981 was 4515 representing 12.7% of the total population.
5.3 The Area Health Board will have as one of its 5 Board Committees a Maori Health Committee. This committee will comprise appropriate members of the Board and members nominated by the Hauraki District Maori Council.
5.4 The Maori Health Committee will be accessible by individuals and organisations wishing to be heard on Maori Health matters.
5.5 The Maori Health Committee will provide advice on Maori health matters to other components of the Area Health Board, viz, service development groups, community committees and management units. -52-
6. COMMUNITY COMMITTEES
6.1 An essence of the concept of Area Health Boards is one of communication with, and accountability to, the consumer and to the community that the Board serves. To this end the role of community committees is vital, and they therefore feature prominently in both the structure of the Thames Area Health Board, and in the management format of the Board ("Communnity Liaison" is a post in all three management units). This should allow good communication from the community to the Board and ensure good communication of matters vital to that community from within the Board s management organisation.
6.2 Professional bodies (e.g. N.Z. Medical Association, N.Z. Nurses Association, School Dental Nurses Assoc. etc) will also communicate to the Board through "Community Liaison" posts.
6.3. Although all three management units (viz. Health Promotion, Community Services, Hospital Management) will have "Community Liaison" posts; the most prominent (responsible for co-ordination of all community liaison posts) will be that of the Health Promotions Unit.
6.4 As an indication of the prominence that Community Committees deserve, it is proposed that they report directly to the Area Health Board through its Community Health and Planning Committees. Simultaneously copies of reports should be furnished (for comment) to the Board s Executive Staff Unit via "Community Liaison" posts.
6.51t is envisaged that Community Committees will have the following functions in respect of their relevant area:- -53-
advise the Area Health Board on health needs promote health promote voluntary organisations gather local information to assist the Board provide liaison between community groups in the health field and the Board assist Service Development Groups
Community Committees will be appointed by the Area Health Board as outlined in Section 31 of the Act from amongst those nominated by particular communities and those offering themselves for appointment.
6.6 As Community Committees will play a prominent role in the planning of the board s health services, much consideration has been given to their membership. In consultation, the public and health professions have sought an assurance that membership will be democratically representative and that "appropriate" "interested" and "well motivated" members of the public are appointed. It is therefore proposed that Community Committees are formed based on territorial local body electoral regions (as in fact the Thames Area Health Board will be), and further that these committees are composed of more than a minority number of members representing those elected to office at the triennial local body elections (i.e. Community/Borough/County Councils (or their nominees) and• Area Health Board Members). Further members of -54-
Community Committees will be a designated number of consumers and representatives of the voluntary, private and public health sectors. Other residents of communities may attend and speak at Community Committee meetings at the discretion of the concerned committee - but will not have voting rights.
6.7 The aforementioned composition of Community Committees was discussed at all public meetings and two principles were developed (i) - that of not overtaxing elected councillors etc already under pressure, and (ii) that membership should be democratically elected. Several mayors were concerned by councillor workload, and hence the suggestion of "council nominated" community committee members has been included in this document. The public of Waihi requested that community committee numbers be elected by the people of Waihi (as opposed to being nominated and appointed by the Board) at the triennial local body elections.
6.8 The proposed Community Committees and their membership are listed in Table 4.
6.9 Each committee will be convened by a relevant Health Board member and will elect a Chairman from amongst its members.
6.10 Communication with the Area Health Board will be as outlined above directly via the Boards committees, and also through the Executive Staff Unit via "Community Liaison" posts. Liaison with service development groups will be through the Planning Unit and Executive Staff Unit. -55-
6.11 The Area Health Board will not provide secretarial services to the Community Committees, however a small budget to cover stationery, postage and some other incidental expenses will be provided.
TABLE 4 -56- COMMUNITY COMMITTEES
Councillor or Nominee of Prea Health Community Total Community Local Board Represent- Members Authority Members atives Thames/Hastings 3 2 5 10 (Thames Coast) (2/1)
Whangamata 2 1 3 6
Pauanui/Tairua 2 1 3 6
Whitianga 2 1 3 6
Coromandel 2 1 3 6
Waihi Borough 2 1 3 6
Ohinemuri County 2 1 3 6
Paeroa Borough 2 1 3 6
Hauraki Plains County 2 1 3 6 -57-
7. FINANCE
7.1 The funding allocation for the Thames Area Health Board will be a combination of that presently received by the Thames Hospital Board and the appropriate proportion of that received by the Hamilton District Office of the Department of Health. A detailed report on this funding prepared jointly by the Chief Executive of the Thames Hospital Board and the Chief Executive Officer of Hamilton District Office of the Department of Health is included as Appendix Al.
7.2 A supplementary grant will be requested to cover the one-off cost of establishing the Thames Area Health Board - for example legal costs incurred in changing Title Deed etc, new accommodation provided to house previous Department of Health functions.
7.3 The resources, both "national" and "local" in the fields of health promotion and health protection available presently in the Department of Healths Hamilton District Office must not be lost. It is anticipated that the Thames Area Health Board will continue to have access to these resources. Unless such services continue to be supplied "free of charge" to the district; a seeding grant to establish and maintain these facilities in Thames will be requested.
7.4 It is assumed that the Department of Health will continue to provide finance for all services currently being provided by the District Office.
7.5 Concern was expressed on several occasions by the public regarding the likelihood of Thames Hospital Board receiving sufficient funds to allow the Thames Area Health Board to meet its objectives as specified in Section 9 of the Area Health Board Act 1983 - considering particularly -58-
the relationship between health promotion, health education and the provision of treatment services. The Thames Hospital Board has indicated that it has every confidence that the Minister of Health will ensure the appropriate funding.
7.6 All land and assets owned by the Thames Hospital Board, and those in the Boards area owned by the District Office of the Department of Health will be transferred to the Thames Area Health Board.
7.7 The Thames Area Health Board will assume responsibility for payment of accounts and salaries of the Thames Hospital Board Staff, appropriate District Office of Department of Health Staff in the Board s service and the staff of the School Dental Service in the Board s service at the time of its establishment. -59-
8. PERSONNEL
8.1 The formation of the Thames Area Health Board within the existing boundaries of the Thames Hospital Board will bring together approximately 400 staff for the Thames Hospital Board and approximately 25 staff currently employed by the Hamilton district office of the Department. of Health.
8.2 Most of the Department of Health staff (public health nurses, dental nurses etc) are currently resident in the Thames Area Health Board area and their duties will not change markedly - these could be referred to as the "old" positions.
8.3 There will be "new" appointments made to the Area Health Board (some whole-time, others part-time) and both the Hamilton District Office staff and the Thames Hospital Board staff may wish to make application. Applications will be considered and appointments made in accordance with the Health Services Personnel Act. These positions will be considered as "newly created positions" and existing staff will not simply make an "internal transfer" to one of these posts, but must make formal application should they wish to be considered for appointment.
8.4 With regard to transfer of staff, Section 47 of the Health Service Personnel Act stipulates: "47(1) - On the date of transfer, every person employed by the initiating Hospital Board or by the Crown in the affected area shall cease to be employed by the Board or the Crown, as the case may be and shall become an employee of the Area Health Board. -60-
47(2) Every person who, on the date of transfer, becomes an employee of the Area Health Board by virtue of sub-section (1) of the section shall, as from that date have the same functions, duties and powers as he had immediately before that date unless and until the Area Health Board otherwise determines".
8.5 Section 48 of this Act details the rights etc of employees transferred from District Offices. These employees have the right to apply in writing within 12 months after the date of transfer to resume employment with the public service.
8.6 The Health Service Personnel Act protects the employment and conditions of employees at time of transfer; employees will continue under the same conditions and salary until a new determination is issued by the Health Service Personnel Commission. To quote this act: 1149 - Every transferred employee-
(a) Whose conditions of employment immediately before the date of transfer were prescribed by:
(i) A determination issued under the State Services Conditions of Employment Act 1977; or (ii) An award or collective agreement issued under the Industrial Relations Act 1973; or (iii) An apprenticeship order made under the Apprentices Act 1948; and -61-
(b) Whose position in the employment of the Area Health Board on the date of transfer is the same in terms of responsibility and function as that which he occupied immediately before that date, shall continue to be employed on the same conditions until a new determination affecting his conditions of employment is issued by the Commission pursuant to the State Services Conditions of Employment Act 1977."
8.7 The provisions of the Health Service Personnel Act will be complied with by the Thames Area Health Board. No doubt there will be changes to job descriptions, duties, etc of employees and the Board will undertake adequate consultation with employees before such changes are made.
8.8 Job descriptions of the Area Health Board Executive Officers should be agreed upon as soon as possible after formation jointly with the Health Service Personnel Commission. Appointments to these posts will be made in accordance with Section 20 of the Health Service Personnel Act. The appointments of the executive management team should be made as quickly as possible and lines of communication maintained in order to avoid uncertainty amongst staff. APPENDIX Al
REPORT ON FUNDING
THAMES AREA HEALTH BOARD
It is difficult to be specific as to the exact funds that would be available to the Thames Area Health Board. This is because many functions of the Hamilton Office of the Department of Health are shared with other Hospital districts and it is accepted that the information made available to us by the Department s Executive staff in Hamilton is at best an approximation.
There may be items provided to the Hamilton District Office at no change, (and hence overlooked) if so this should continue.
In this statement are expressed costs in percentage terms or fractions.
The costs in dollars will change as salaries increase and this should be addressed at the time of the creation of the Area Health Board. Accounting Services Some accounting services are provided by Treasury for both of these organisations and this will be an extra cost to the Board.
Computer/Payroll Processing Costs These are processed externally by the Government and it is assumed that such computer/payroll processing would fall back on the Area Health Board. This cost needs to be assessed and provision made for these extra costs.
District Office Imprest Account An imprest account is currently held by the District Office which is not shown as a proposed payment during the year. It is proposed to operate an imprest account of this nature and a one-off payment will be required to set it up.
Transfer and Removal Expenses It appears that some transfer and removal expenses are paid by the Head Office of the Department and are not charged to the individual organisation this includes dental nurses on initial appointment. This should be subject to either The Department of Health should either continue to meet this cost or a lump sum grant to the Area Health Board.
Dental Clinic Staff The Hamilton Office of the Department of Health provide the following staff to the Thames area.
Principal Dental Officer 156 of 1.0 F.T.E. Supervising Dental Nurse 10% of 1.0 F.T.E. Dental Nurses 12 F.T.E.
Relieving Expenses for Dental Nurses Expenses are paid to dental nurses who operate outside of their own base (i.e. sub bases and other clinics). These are not shown in the Al-i expenditure listed in this report and will need further consideration. Dental Nurses Expenses Other expenditure for dental nurses is paid by the Education Board and a clear statement on these costs will be needed to assess the amount the Area Health Board would claim.
Dental Clime Costs Dental nurses salaries and payments for clinic costs have been estimated and shown in the costs for the local office but we are unable at this stage to ascertain the cost of the related on-going expenses for repairs and maintenance on dental equipment. It is believed that such costs could be extremely high and this will require addressing by the Department of Health. At the present time dental nurses salaries are paid by the Hamilton Office.
Dental Clinic Buildings These are provided and maintained by the Education Board. If there is any change in this policy the Area Health Board would need to be recompensed accordingly.
Mobile X-Ray Use is made of the Mobile X-Ray Unit in Thames on occasions and it should be provided at no cost to the Area Health Board as before, or a grant made to the Area Health Board in the ratio of 40/305 to cover the cost of contracting the service.
We understand that the approximate cost of this service for the Thames District is $8500.
Effects of Government Policy Some policy decisions may effect the funding of an Area Health Board, i.e. the providing of Impedence Audiometers to Public Health Nurses. Extra funding must be provided for such policy changes. Building Maintenance The Department of Health have residences in Coromandel, Thames and Waihi for Public Health Nurses and share accommodation at Whitianga, Paeroa, Waihi and the Thames Health Centre. As some of these premises are in need of major maintenance the Area Health Board will need to establish a cost for continued maintenance for the replacement of these buildings.
Funding for Pilot Schemes The Area Health Board Act Section lOh refers to the granting of assistance to individuals or organisations for
(i) Setting up programmes for Health Services
(ii) Training volunteers engaged in such services
Some provision will therefore be required in the funding for the setting up of pilot schemes. Al-2
Legal Fees incurred in Prosecutions Expenses incurred in taking legal action against those persons prosecuted for violating Health regulations can be considerable. It is considered these costs should be met by a special grant as they can vary greatly from year to year.
Accommodation The question of funding of accommodation for the central offices of an Area Health Board requires further clarification. There should be provision of capital finance for an ultimate building at a later stage. Additional offices will need to be provided the Area Health Board is required to cater for the extra staff in Thames. Discussion will need to take place on additional space for Area Health Board Personnel acquired from the Department of Health.
Salary Rates It is as yet still unclear if staff salary rates would be adjusted in the future up to State rates. If this does occur a stabilisation payment would be required to fund this. It is also considered that an Area Health Board should be funded for "Salary Creep" which amounts to a considerable sum. (This occurs when an employee moves through an automatic scale in an award or determination).
Freezer space rental The renting of freezer space to hold contaminated food seized by health inspectors and needs further quantification but this is likely to be a rare occurence...
Public Health Nursing The following staff services the Board area.
Principal Public Health Nurse 10% of 1.0 FTE
Supervising Public Health Nurse 50% of 1.0 FTE
Public Health Nurses 5.5 FTE
Occupational Health (PAP Scheme) 0.5FTE
The Area Health Board will maintain this service and discussion will need to take place on the pay scale and any future salary increase for these staff.
Family Health The Department employs a staff member to provide vision and hearing testing on a 3/10ths basis in this area. Funding will be required for this person. Equipment is costly. The Board would expect to obtain a grant for this or contract this service to the Department of Health - Hamilton.
Medicine Control The department state it is difficult to assertain the exact amount of time spent on such items as medicine control, visits to pharmacies and general practitioners. It has been estimated that 12 days per annum is spent in this work. This will need to be funded and the Area Health Board will contract this duty with the Department of Health in Hamilton. (funding to the Area Health Board would be on a population ratio 40/305) Al-3
Environmental Health The Health Protection duties are carried out by three officers of the Department of Health. These consist of:
Medical Officer of Health 3/10 Principal Health Protection Officer 40/305 x 2.0 Health Protection Officer 6/10
The Board should be funded to this extent for these services and would contract to the Department of Health for such Health functions.
Medical Staffing A total of 8/10ths services are presently provided to the Thames area from Hamilton, shared between the Medical Officer and a Community Paediatricain.
Discussion with the Department of Health will need to be held as the Board would need to be funded for this service. Some of the duties such as Medical Officer of Health would have to be contracted in the interim.
Motor Vehicles Extra vehicles will be required for staff in "new" positions by the Area Health Board for those staff employed who do not have a vehicle provided or who will be employed by the Area Health Board and will not have a vehicle provided by the Department of Health.
These are mainly in the supervising role or medical staff who have an inspection function in their duties. The number and type of vehicle will form part of later discussion.
Additional Staff The Area Health Board may need to increase some areas of staff these would be in the salaries and wages section and Board Office in dealing with the extra workload created by this change. An additional typist may have to be employed as the staff now employed would need assistance to cope with the typing involved in this change. APPENDIX 2
PERSONNEL
The aim of the Board and the Health Service Personnel Commission has been to do all that can be done to make the transition from Hospital to Area Health Board a smooth one for the people concerned.
For the majority of hospital board staff the formation of the Area Health Board will not involve any change in their job or conditions of employment. Existing awards or determinations will continue to apply until new documents are issued.
The Health Service Personnel Commission is by statute the employing authority. Area health boards are the employers of staff.
Transfer and Status of Staff
On a given date hospital board staff and Department of Health staff will transfer to a new employer - the Thames Area Health Board. Both staff groups are then employees within the Health Service. All staff will continue to undertake the same responsibilities and exercise the same authorities, unless and until the Area Health Board otherwise determines.
Conditions of Employment
All transferred employees from either a hospital board or a public health office whose positions on the date of transfer are the same in terms of responsibilities and functions as those occupied before the transfer, will continue to be employed on the same salaries and conditions until new employment instruments have been issued.
Staff appointed subsequent to formation of the Area Health Board
New staff appointed subsequent to the formation of the Area Health Board but prior to issuing of new determinations will be employed on the same salary scale and conditions of employment as other staff in their occupation at the same place of work.
Preservation of existing rights
The Health Service Personnel Act 1983 (Sections 51 - 58) contains specific provisions relating to employees who transfer from the Department of Health and from hospital boards to area health boards. Superannuation
The superannuation scheme for employees of an area health board is the Government Superannuation Fund. This will be available to all new employees of the area health board who are employed under Health Service determinations. However the existing superannuation rights of employees transferred from hospital boards, who are members of the National Provident Fund schemes, are protected. Retirement Provisions
The Public Service and the Health Service at present have their own packages of retirement provisions. The Health Service Personnel Commission is charged with the task of developing a uniform Health Service retirement scheme. APPENDIX A3 NURSING WORKFORCE The region covered by the proposed Area Health Board is served by District Nurses (employed by the Thames Hospital Board), Public Health Nurses (employed by the District Office of the Department of Health in Hamilton), and Practice Nurses employed at 2 Health Centres owned by the Thames Hospital Board, as well as Practice Nurses employed by General Practitioners. There presently exists good co-operation between the staff employed in the hospitals throughout the Thames Hospital Board and those working in the community. In Thames and Mercury Bay, Public Health Nurses and District Nurses share facilities, and in Paeroa the Public Health nurse works from a clinic in the hospital grounds. This co-operation can only be enhanced by the formation of an Area Health Board.
PUBLIC HEALTH NURSING SERVICE There are 5 Public Health Nursing positions in the territory covered by the proposed Area Health Board and a half time position in the Priority Approved Programme situated at Thames. The staff are directly responsible to the Supervising Public Health Nurse and through her to the Principal Public Health Nurse to the Medical Officer of Health in Hamilton. The rural nature of the region with its scattered population requires flexibility in planning to provide the optimum service to families and communities.
Thames Area: (Ruamahunga Bay, Thames, Omahu Road, Pipiroa, Miranda). A 5 day area with infant, toddler and Pre-school children and school work important. 1 Public Health Nurse works in this area, and 0.5F.T.E. Nurse works in the Occupational Health field with 37+ firms to visit (P.A.P.)
Paeroa Area: Omahu, Paeroa, Ngatea, Pipiroa, Torehape, Tirohia, Rotokohu). A 5 day area requiring much travelling with some emphasis on occupational health as well as the family and school work.
Waihi Area: (Maratoto, Waitawheta, Waihi, Bowentown, Waihi Beach, Waimana). A 5 day area, work with the unemployed, some occupational health, schools and families characterise the work here.
Whangamata Area:Waimana, Whangamata, Pauanui, Look Out Hill, Table Mountain, Maratoto). 0.6 F.T.E. nurse works in this area. Family health workload growing rapidly. Whitiaja Area: (Look Out Hill, Summit Tapu Hill, Whitianga, Kuaotunu, Matarangi Beach, Summit 309). A 5 day area. Family health, infant care, school and some occupational health work.
Coromandel Area: (Ruamahanga Bay, Summit Tapu Hill, 309, Motutere, Whangapoua, Coromandel, Port Charles, Port Jackson). A 7 day area taking in domiciliary nursing, infant welfare, (contracted from Plunket Society) as well as Health Promotion. In 1987 to become a 5 day area with domiciliary nursing to be taken over by District Nursing Service.
Total staff 4.6 Public Health Nurses 0.5 Occupational Health Nurses 5.1 F.T.E. with supervision from the Hamilton District Health Office. A3 -1
In the interim, supervision for the Public Health Nursing Service should be contracted from the District Office in Hamilton. When the Community Health Service has had the opportunity to plan for the future, a position combining the supervision of Public Health Nursing Staff community liaison and a position in the Ho pita1, i.e. Assistant Principal Nurse, could well be a suitable option.
DISTRICT NURSING SERVICE Services are provided on a Monday - Friday basis (except in emergency or terminal care situations) throughout the Hospital Board area with the exception of Coromandel where services are provided by the Public Health Nurse. The area is mainly rural, and time is required to reach patients. District Nurses liaise with Public Health Nurses, Social Workers, Occupational Therapists, Home Aids, G.P. s, Practice Nurses, Hospital Staff Volunteers, including the providers of meals-on-wheels. With so many elderly people being maintained in their homes, an extended service will be required in the foreseeable future. a) Thames District: Wilsons Bay, Omahu, Turua, Kaihere, Miranda) 2 F.T.E. nurses and a student nurse plus the Principal District Nurse cover this area. Some weekend work is required in this area which has the largest population centre. An average of 110 patients per month required 8880 visits during 1986. b) Paeroa District: (Omahu, Paeroa, Mackaytown, Netherton, Mangaiti) 1.4 F.T.E. nurses work here. From April 1987 a student nurse will gain clinical experience in this district. An average of 60 patients per month required 4249 visits during 1986. c) Waihi District: (Mackaytown, Waihi, Waihi Beach, County Boundary to start of Athenree Gorge) 1.5 F.T.E. nurses work in this area. An elderly population requires assistance from all available services. An average of 52 patients per month required 3677 visits during 1986.
d) Ngatea District: (Pipiroa, Miranda, Ngatea, Hauraki Plains, Kaihere, Patetonga). This covers a large geographical area and is serviced by a District Nurse/Practice Nurse from the Hauraki Plains Health Centre. When the workload is very heavy, Paeroa and Thames nurses assist. An average of 47 patients per month required 2423 visits during 1986.
e) Tairua District: (Lookout Hill, Tairua, Pauanui, Hikuai) 0.4 F.T.E. nurse covers this area. The permanent older population is growing steadily in what was a mainly holiday area. An average of 33 patients per month required 1400 visits during 1986. f) Whangamata District: Hikuai, Opoutere, Onemana, Whangamata, Whiritoa) 0.8 F.T.E. nurse covers this area with great difficulty. It is the fastest growing area on the Eastern Coast, and there are no hospital facilities or backup services easily accessed. Further assistance will have to be made available here during 1987. An average of 59 patients per month required 2986 visits during 1986. A3-2 g) Whitianga District: (Lookout Hill, Coroglen, Whenuakite, Cooks Beach, Hahei, Hot Water Beach, Whitianga, Kuaotunu) 0.85F.T.E. nurses cover this area share accommodation at Mercury Bay Hospital. An average of 51 patients per month required 2117 visits during 1986. h) Coromandel District: The most difficult area geographically, stretching from Wilsons Bay to Port Jackson to Whangapoua. This is serviced by a Public Health Nurse who has a 7 day a week area. Plans are being formulated whereby the area will become a 5 day area, and District Nursing Services will then have to be provided separately. An average of 42 patients per month were cared for by the Public Health Nurse.
Total Staff 1.0 Principal District Nurse 7.35 District Nurses 8.35 District Nurses with holiday relief extra
The Future of the Community Health Services under the proposed Area Health Board
Improvement in health care only come about by individuals taking responsibility for their own health. Priority must therefore be given to the promotion of health. This must clearly be done in the communities where people live and work. The East Coast region is growing rapidly and in the reasonably short term future, a full time position for a Public Health Nurse will be a necessity at Whangamata.
Occupational Health will also require more emphasis and the creation of a full time position to cover both Thames and Paeroa will rationalise the work for the staff working in these areas.
The elderly population in this area is increasing (1981 census 13.2% were 65+ - assuming medium fertility and medium migration, by 2001 15.5%). To maintain the elderly in the community, an increase in the District Nursing Service will be vital, in the first instance at Whangamata and Coromandel. The Area Health Board s priorities will determine when the funding for this increase will be available. A Monday-Friday office hours service will not be sufficient. Extension of services to weekends and evenings must be worked towards. APPENDIX A4
REPORT OF MR. NEIL CLARKE, OBE, J.P.
Public Meeting Chairman
(Refer Appendix AS for Curriculum Vitae) A4-1 The Honourable Minister of Health,, Parliament Buildings, Private Bag, WELLINGTON.
Dear Sir,
AN AREA HEALTH BOARD FOR THAMES
The Thames Hospital Board asked me if I would assume the position of Chairman for the organised series of public meetings to discuss the proposed "Thames Area Health Board". In so doing the Hospital Board stated a Chairman was required who was:
independant from the Hospital Board and the health profession in general
who would be accepted and considered impartial by all communities and their leaders
who displayed no overt political persuasions
who had experience chairing large meetings
I was pleased to accept the Thames Hospital Board s invitation.
The. duties of Chairman were perceived by myself and the Thames Hospital Board as: to conduct advertised public meetings
to ensure these meetings provided an opportunity for:
The Thames Hospital Board to describe in detail the implications of the Area Health Board Act 1983, and the proposed "Thames Area Health Board".
The public to clarify matters relating to the Act and the proposal.
- The public an opportunity to express its opinion.
As an independant resident 1 was requested by the Thames Hospital Board if possible to access the reaction (largely as expressed at the public meetings) of the residents of this district to the proposed "Thames Area Health Board", and to convey my assessment to the Minister of Health. At all public meetings at least one resolution arose spontaneously from the floor.
0 A4-2
In carrying out the task I have given consideration to the following:
the extensive advertising campaign by the Thames Hospital Board (via the "Public Discussion Document", leaflets, press, radio, posters, word of mouth).
the excellent attendance at public meetings (eight meetings held throughout the region).
the discussion at public meetings
the resolutions passed at public meetings (all meetings proposed a resolution in support of the proposed Thames Area Health Board, and all resolutions except that of Thames were passed unanimously. A resolution was passed in Thames with no dissent, however two residents recorded their abstentation). the press coverage
the reaction of local civic leaders
verbal communications to me personally
a review of the submissions received by the Thames Hospital Board
It. is my opinion that:
the public of this district have been informed in some detail as to the implications of the Thames Hospital Board requesting the Minister to consider the establishment of the "Thames Area Health Board".
the public have been adequately consulted on this matter.
the residents of the Thames Hospital Board District support the Board in making this proposal to the Minister of Health and wish the Minister to consider it favourably.
the residents of Kaiaua desire to be included in the Thames Area Health Board District.
the proposal is supported by residents with the assumption that adequate funds are made available and continue to be provided to the Thames Area Health Board in order for it to perform its duties as set down in the Area Health Board Act 1983, and the attached Thames Hospital Board Document "The Thames Area Health Board, A Proposal to the Minister of Health". A4-3
I therefore commend, Sir, on the weight of evidence presented and the overwhelming public opinion expressed that you give favourable consideration to the Thames Hospital Boards proposal that the "Thames Area Health Board" be formed.
YoLincereerelr,
N.J. Clarke, CHAIRMAN OF PUBLIC MEETINGS. APPENDIX A5
C.V. OF CHAIRMAN, MR. N. CLARKE APPENDIX A5
CHAIRMAN
Mr. Neil Clarke
OBE, J.P.
Prominent citizen of Paeroa. Managing Director of the Provincial Transport Group of Companies which has activities in the Thames Valley, Auckland and Tauranga. Director of the Trustee Bank Waikato Immediate Past-President of the N.Z. Association of Trustee Banks. Chairman of Paeroa Industries Committee Member of the Advisory Board to the Catholic Bishop of the Diocese of Hamilton Councillor of the N.Z. Road Transport Association Chairman of the Heavy Vehicle Research Association Past-member of the Transport Advisory Council