2021 04 27 WrDHB Public Board - Agenda

Public Board Meeting

Meeting Date: Tuesday 27th April 2021

Meeting Time: 09:30am

Venue: Wairarapa District Health Board Board Room, Ground Floor, CSSB, Masterton

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AGENDA Held on Monday 27th April 2021

Commencing at 09:30am

BOARD PUBLIC SESSION Item Action Lead Min Allocation 1. Procedural Business 1.1 Karakia 1.2 Apologies

1.3 Health, Safety & Privacy Updates Accept Chair 1.4 Interest/Conflict Register Confirm 10 09:30am 1.5 Previous Minutes 1.6 Chief Executive Report Note D Oliff Jo Christie 2. Patient Story Receive 30 09:40am Clare Matthews 3. Information 3.1 Planning & Performance Report S Williams 5 10:10am Receive 3.2 Hospital & Community Services Report K McCann 5 10:05am 4. Other 4.1 General Business 5 10:10am 4.2 Resolution to Exclude the Public Agree Chair

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Wairarapa District Health Board Disclosure of Interests Register - as at .March 2021 Appointment Health Sector Other Name Date Interests Disclosed Interests Disclosed Board Member Sir Paul Collins December ∑ Director, New Zealand Health Partnerships Limited ∑ Director of: Board Chair 2019 ∑ Trustee of the Malaghan Institute of Medical Research Active Equity Holdings Limited (Chair) ∑ Member to Governance Board for Health Finance, Hurricanes GP Limited Procurement & Information Management System Ides Limited Programme (FPIM) Shott Beverages Limited ∑ Director of Technical Advisory Services Limited (TAS) ∑ Director and shareholder of: AEL Managers Limited Beverage Holdings Limited Cohiba Traders Limited Ecopoint Limited Tofino Trustee Limited Dr Tony Becker December 2019 ∑ Shareholder and Director (Clinical) Masterton Medical ∑ Wife contracts to Wairarapa District Health Board Deputy Chair Limited ∑ Trustee, Hau Kainga ∑ Shareholder and Director Wairarapa Skin Clinic ∑ Sister in law is an Associate Director of Nursing at Surgery Women’s and ∑ Wairarapa GP Trustee Tū Ora Compass Health Children’s Directorate at CCDHB Helen Pocknall December 2019 ∑ Contractor with Ministry of Health ∑ Nil Interests declared Member Ryan Soriano December 2019 ∑ Clinical Services Manager, HealthCare NZ ∑ Member, Board Trustee for Saint Patrick School Board, Masterton Member ∑ Wife Employed as Senior Caregiver at Lansdowne Park Aged Care Facility Joy Cooper December 2019 ∑ Nil Interests declared ∑ Chairperson Wharekaka Trust Board Incorporated Member Jill Stringer December 2019 ∑ Nil Interests declared ∑ Director, Touchwood Services Limited Member ∑ Husband employed by Rigg-Zschokke Ltd ∑ Trustee, Wellington Welfare Guardian Trust Yvette Grace December 2019 ∑ Member, Hutt Valley District Health Board ∑ Husband is a Family Violence Intervention Coordinator at Wairarapa District Member ∑ Member Concurrent FRAC Hutt Valley and Capital and Health Board Coast DHBs ∑ Sister-in-law is a Nurse at Hutt Hospital ∑ Member 3DHB Disabilities Committee for Hutt Valley ∑ Sister-in-law is a Private Physiotherapist in Upper Hutt DHB ∑ Trustee House of Science Wairarapa ∑ Member Wairarapa CPHAC Committee ∑ Trustee Equippers Church and Oasis Trust

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Appointment Health Sector Other Name Date Interests Disclosed Interests Disclosed Board Member Jill Pettis December 2019 ∑ Nil Interests declared ∑ Nil Interests declared Member Leanne Southey December 2019 ∑ Chair, Wairarapa District Health Board, Finance Risk & ∑ Chair of Lands Trust Masterton (15 February 2016) Board Member Audit Committee ∑ Director, Southey Sayer Limited ∑ Chartered Accountant to Health Professionals including ∑ Shareholder of Mangan Graphics Ltd Selina Sutherland Hospital and Selina Sutherland Trust ∑ Trustee, Wairarapa Community Health Trust ∑ Board Member, Wellington Free Ambulance Ronald Karaitiana December 2019 ∑ Member, Wairarapa District Health Board ∑ Akura Lands Trust Chairman Board Member ∑ Member, Wairarapa Te Iwi Kainga Committee ∑ RK Consulting Ltd, Business owner ∑ Member, Wairarapa District Health Board, Finance Risk & Audit Committee ∑ Extended family members work in varying roles at DHB ∑ Chief Executive, Te Hauora Runanga o Wairarapa ∑ Whanau ora Collective Member Te Hauora and Whaiora via Te Pou Matakana ∑ Board Director from Presbytarian Support Central Dr Norman Gray December 2019 ∑ Association of Salaried Medical Specialists (ASMS) Branch ∑ Nil Interests declared Board Member Representative for Wairarapa ∑ Emergency Consultant and Clinical Lead, Wairarapa DHB ∑ Board member MidCentral DHB

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Health Sector Other Name Appointment Interests Disclosed Interests Disclosed Wairarapa DHB Management Dale Oliff July 2019 ∑ Nil to declare ∑ Daughter is an employee of Ministry of Health for planned Chief Executive Care funding

Frank van Ham November 2019 ∑ Nil to declare ∑ Sole Director and shareholder of “Stadtholder Limited’ Executive Leader Finance & Non Clinical Support Services

Kieran McCann March 2018 ∑ Partner works part time as an Registered Nurse at the Wairarapa ∑ Nil to declare DHB Executive Leader Operations

Sandra Williams December 2019 ∑ Nil to declare ∑ Nil to declare Executive Leader Planning & Performance

Nigel Fairley ∑ Fellow, NZ College of Clinical Psychologists ∑ Director and Shareholder, Gerney Limited General Manager, ∑ President, Australian and NZ Association of Psychiatry, Psychology ∑ Trustee, Porirua Hospital Museum Mental Health and Law Addictions & Intellectual Disability Service, 3DHB

Jason Kerehi February 2015 ∑ Partner is employed as a school nurse by Compass Health ∑ Negotiator, Rangitane Settlement Negotiations Trust Executive Leader Māori Health

Tracy Voice May 2019 ∑ Nil to declare ∑ Secretary, New Zealand Lavender Growers Association Chief Digital Officer, 3DHB

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Health Sector Other Name Appointment Interests Disclosed Interests Disclosed Wairarapa DHB Management Phill Halligan September ∑ Wife is an employee of MOH Border Health ∑ Nil to declare 2020 Director of Nursing

Nigel Broom July 2019 ∑ Nil to declare ∑ Treasurer, Martinborough School Board of Trustees Executive Advisor

Keri Titherington July 2020 ∑ Nil to declare ∑ Board Member – Trinity Schools Trust Board Executive Leader People, Capability & Organisational Development

Anna Cardno December 2015 ∑ Nil to declare ∑ Nil to declare Communications Manager

Shawn Sturland July 2019 ∑ Intensive Care Specialist Capital and Coast DHB ∑ Nil to declare ∑ Partner, Holly Brindle, is a DNM at Wairarapa Hospital Chief Medical Officer

Dianne Mazey ∑ Nil to declare ∑ Nil to declare Acting Executive Leader Quality, Risk & Innovation

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Held on Monday 29th March 2021 Wairarapa District Health Board Board Room, Ground Floor, CSSB

Board Meeting Public Board Members Present Sir Paul Collins Board Chair Dr Tony Becker Deputy Chair Ron Karaitiana Member Joy Cooper Member Ryan Soriano Member Jill Stringer Member Yvette Grace Member Jill Pettis Member Helen Pocknall Member Dr Norman Gray Member Guest Clare Matthews Patient Experience Coordinator Amber Cox Nurse Educator/CQF Tracey Kerr Acting Charge Nurse Manager, Periop Te Oranga o Te Iwi Kainga Nil Executive Leadership Team Present Dale Oliff Chief Executive Officer Kieran McCann Executive Leader Operations Sandra Williams Executive Leader Planning & Performance Apologies Leanne Southey Member 1. Karakia – lead by Ron Karaitiana

1.2 Apologies As noted above

1.3 Privacy and Health & Safety Updates

The Board NOTED no updates

1.4 Interest Register

The Board RESOLVED to APPROVE the interest register The Board CONFIRMED current conflicts prior to discussion on each item of the agenda are accurate

1.5 Minutes from previous meeting

The Board RESOLVED to APPROVE the minutes from the previous meeting as a true record of the meeting

Moved H Pocknall Seconded J Cooper Carried

Chief Executive Reports

The report was taken as READ and the Board NOTED the following Notes this paper and discusses as appropriate Notes the general updates from the Chief Executive on various projects through the DHB

2. Patient Story: PERIOP

The Board received a Patient Story presentation from the PeriOp unit and NOTED the following: Notes Board Members were impressed with the change in service delivery which has been an initiative which has provided good outcomes and patient empowerment and works well

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Notes currently the trial has been successful for endoscopy and carpal tunnel; part of the check list is to ensure the patient is comfortable to progress with the new process of walking into the operating theatre 3. Information Planning & Performance Report The report was taken as READ and the Board NOTED the following Notes the 2019/20 Annual Report and Statement of Performance expectations 2020/21 has now been tabled in Parliament Notes the first draft of the 2021/22 Annual Plan went to the Ministry of Health on the 5 March 2021 Notes the work for COVID 19 vaccination planning continue at pace Notes the new youth hub space has been established Notes R.Karaitiana has declared his conflict as the CEO Te Hauora before speaking. The physical location with being close to the centre of town and close to School locations is excellent. The number of referrals has increased due to the location and “Hub” to be more fluid and accessible and “with a warm” handover” Notes CPHAC meeting update Hospital & Community Services Report The report was taken as READ and the Board NOTED the following Notes this paper and discusses as appropriate Notes the performance of Wairarapa District Health Board for Planned Care Activity including ESPI 2 and 5 Notes Latest Surgical Intervention Rate Reports for all DHBs and Wairarapa DHB Performance Notes Month acute surgical activity for February Notes Ongoing work streams across Acute Care flow with MSW Occupancy and continued improvement in LOS performance Notes the CT Target has dropped due to staffing and sickness with the impact of the Acute volumes as well Notes average length of stay has decreased, the Board raised that number is significantly lower than previous years/months. This has been a reflection of the Whakapuāwai project work for a more connected plan for the patient to have an involved plan/better and more timely communication Notes there will be more seasonal information available when the March Report is completed. There is a plan to work through wellness/wellbeing and preventative work for staff sickness/time off work Notes the sustainability and savings is through a number of revenues with Length of Stay, Patient Flow, and Vacancies etc. Further work to be done for the reporting of gains with overall Notes all of staff DHB Services, can be provided (sick/annual/etc.). is provided in the People & Capability Report Notes wellness and “staff burnout” is a real concern and is being addressed and will be provided in the People & Capability Report

4. Other General Business

Nil Resolution to Exclude the Public SUBJECT REASON REFERENCE Public Excluded Minutes Information provided in confidence Section 9(2)(ba) Excluded Chief Executive Report Finance Report Information on change processes that may enable affected Section 9(2)(a) People, Capability and Organisational individuals to be identified Development Report

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Mental Health Addictions and Intellectual Disability Service (MHAIDS) 3DHB Update New Zealand Blood Services Contract Any department or organisation holding the information to carry out, without prejudice or disadvantage, commercial Section 9(2)(i) activities Wairarapa Radiology Services Withholding to enable us to carry on Negotiations without prejudice or disadvantage Section 9 (2) (j) Funder commitments 2021/22 Delegation to sign Crown Funding Would be likely unreasonably to prejudice the commercial Section 9 (2) (b) Agreement (CFA), for Planned Care position of the person who supplied or who is the subject ii Initiative for 2020/21 of the information Moved J Stringer Seconded T Becker Carried

Meeting Closed: 11:22am

CONFIRMED that these minutes constitute a true and accurate record dated March 2021

Sir Paul Collins Chair, Wairarapa District Health Board

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PUBLIC

BOARD INFORMATION PAPER

Date: April 2021

Author Dale Oliff, Chief Executive Wairarapa District Health Board

Subject Chief Executive Public Report to the Board

RECOMMENDATION It is recommended that the Board: a. Notes this paper and discusses as appropriate b. Notes the general updates from the Chief Executive on various projects through the DHB

APPENDICIES 1. Media Coverage

1 PURPOSE

The purpose of this paper is to provide the Board with updates from across the hospital and wider Wairarapa Health Community. It highlights work that is occurring at the Wairarapa District Health Board (WrDHB). STRATEGIC DIRECTION 2020 – 2030 “HAUORA MO TATAOU –WE ARE WAIARAPAPA” The Wairarapa DHB formally launched the Strategic Direction 2020 – 2030 “Hauora Mo Tatou We are Wairarapa” on Monday 12th April 2021. The launch was well-received by the community with representation from local Councils, Health Providers, Iwi Leaders and other Wairarapa leaders and key stakeholders. The strategy provides a roadmap for the DHB and will provide the guidance for the planned actions and focus for investment for the next ten years. The eight areas for action are: ∑ Integrating Health and Social services ∑ Strengthening Primary Health Care ∑ Excellence in Older Persons Services ∑ Improving access to Health and Disability Services ∑ Close connections between Primary and Secondary Care ∑ Fit for purpose Hospital ∑ Building a sustainable workforce ∑ Tamariki- Mokopuna - Our Children and young people are our future It is vital that the DHB and primary health work with the Community, our Iwi partners, other government agencies that provide health and social services if we are to improve the health outcomes for region.

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PUBLIC 2 PLANNING AND IMPLEMENTING THE COVID-19 VACCINATION PROGRAMME

The focus for the WrDHB has been on developing the COIVD-19 Vaccination plan and models of service delivery for the COVID-19 vaccination across the Wairarapa. The Executive Leader for Planning and Performance is the Senior Responsible Officer (SRO) for the programme in the WrDHB supported by the Executive Team Members and a dedicated Project Manager. This is the priority work for all the teams across the WrDHB with a deliberate focus on Māori and Pacific populations. The vaccination programme commenced on the 7th April 2021 and will continue through to December 2021. Our goal is to vaccinate as many of our eligible community as we possibly can. Further information is available on the Ministry of Health website.

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Internal Memorandum

To: Wairarapa Board Members

From: Dale Oliff, Chief Executive Officer

Date: 8th April 2021

Subject: Media of Interest for March 2021

From: Dale Oliff, Chief Executive Officer

Experts baffled by how E.coli can survive in Carterton water network From Dominion Post Published 17:11 07/04/2021 There have been no reports of sickness in Carterton related to the E.coli contamination, according to the Wairarapa District Health Board.

Coronavirus: Ministry of Health releases dashboard tracking New Zealand's vaccine rollout From Newshub Published 15:00 07/04/2021 Also from MSN The DHB breakdown shows that no doses have been administered in Wairarapa or West Coast.

Covid-19: Dispute over vaccine rollout progress From Radio New Zealand Audio Published 07:45 08/04/2021 Also from Radio NZ audio [00:00:43] The head of the Auckland University Immunisation Advisory Centre, Dr Nikki Turner, spoke to Corin Dann.

Auckland District Health Board chair gets vaccination early despite frontline workers still waiting From Newshub Published 20:57 07/04/2021 Also from New Zealand Herald National, 1 News Auckland District Health Board's chair and other board members managed to get early COVID- 19 vaccinations, even though about 50 percent of its frontline staff are yet to get the jab. ... At a meeting last week, some members of the 11-person board decided to lead from the front and get immunised to set an example, even though according to the government vaccine schedule it appears they would not be due their shots for months. ... Well, I suppose when you're the board of a DHB you do get privileged access.

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Covid-19: Chairman defends jabs for Auckland DHB members after criticism From Stuff.co.nz Published 18:54 07/04/2021 Vaccinations are under way for border workers and their families at centres in Auckland. ... Frontline health workers are disappointed after Auckland District Health Board members received Covid-19 vaccines ahead of some healthcare staff. ... Speaking to Stuff, a nurse at Auckland DHB said they were "not surprised" that board members had received their jabs: "Just another nail in the coffin of disrespect towards [staff]," they said.

Covid-19 vaccinations: All New Zealand DHBs now operating vaccine programmes - Bloomfield From Radio New Zealand Published 13:27 07/04/2021 Also from Rotorua Now, Otago Daily Times, Otago Daily Times, SunLive News, MSN Director-General of Health Ashley Bloomfield says all New Zealand's district health boards are now operating vaccination programmes, and vaccine numbers are likely to increase further. ... He says the vaccination numbers dipped over the Easter weekend, and he expects 35,000 people will be vaccinated per week. ... He is one of several politicians with a health-based portfolio who have been invited to get the immunisation early, in an attempt to boost confidence in its safety.

Stocktake 'highlights scale' of New Zealand primary care From General Practice NZ Published 13:09 07/04/2021 ‘Large scale transformation of how people access services, such as the Health Care Home model of care, new integrated primary mental health services and Whakarongorau Aotearoa (formerly Homecare Medical), which provides our national telehealth services, have been initiated and driven by our PHOs and practices.

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PUBLIC

BOARD INFORMATION PAPER

Date: April 2021

Author Sandra Williams, Executive Leader, Planning & Performance

Endorsed By Dale Oliff, Chief Executive Officer

Subject Planning and Performance Report for April 2021 RECOMMENDATION It is recommended that the Board: a. Note the final draft of the 2021/22 Annual Plan is due to the Ministry of Health on the 25 June 2021. b. Note Hauora Mō Tātou was launched on the 12 April 2021. c. Note there is sufficient beds available in the Wairarapa area to accommodate residents moving from Aversham House. d. Note the work for COVID 19 vaccination planning continues at pace with the first Wairarapa based vaccination occurring on the 7 April 2021.

1 PURPOSE

This paper provides an update to the Board on the work being progressed by Planning & Performance.

2 ACCOUNTABILITY

Annual Plan 2021/22 Work is continuing on our Annual Plan and Systems Level Improvement Plan (SLM) for2021/22. The draft Annual Plan was sent to the Ministry of Health (the Ministry) as required on the 5 March. Te Oranga o Te Iwi Kainga (Iwi Kainga) met on the 7 April and indicated they wanted to have more discussion before feeding back to us. We will meet with them in May and incorporate changes in the next version of the plan. The feedback from the Ministry was received on the 9 April 2021. The Ministry has asked for specific sections to be updated and submitted by the 7 May. Feedback from the Ministry on those sections is expected on the 21 May. We expect to receive the funding envelope information post the budget announcements on 20 May. The final draft Annual Plan is due to the Ministry on the 25 June

3 STRATEGIC DIRECTION

Hauora Mō Tātou was launched on the 12 April 2021. The event was well attended and the document well received. The document is now available on our website Strategic Direction 2020 – 2030

4 HEALTH OF OLDER PEOPLE SERVICES

Closure of Aversham House In March we were informed by the owner that they were closing the facility. We are working closely with Aversham House owners, residents and their families to make sure that they are well supported during this challenging time. There is a sufficient number of beds available in Wairarapa, and all affected residents are able to be accommodated. We will be working hard to identify the most suitable care options and solutions that best meet the needs of each of the residents and their families.

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PUBLIC

5 IMMUNISATION PROGRAMME

Childhood Immunisation Childhood immunisation has three key measures - at 8 months, at 2 years and at 5 years. The target is 95% coverage. In Quarter 3 we did not achieve the targets for these three measures although we were above the national average for all three measures. The tables below show the numbers vaccinated out of the total eligible for the quarter. Childhood Immunisation at eight months: Total 89.7%; Māori 88.6%; NZE 90.7%; Pacific 80% and Dep 9-10 69.7%. National average 87.7%. MOH Report Total Māori NZE Pacific Dep 9-10 Immunised/eligible 130/145 39/44 78/86 4/4 23/33

Childhood immunisation at 2 years Total 91.4%; Māori 82.6%; NZE 95%; Pacific 100% and Dep 9-10 91.7%. National average 88.1%.

MOH Report Total Māori NZE Pacific Dep 9-10 Immunised/eligible 128/140 38/46 76/80 7/7 33/36

Childhood immunisation at five years Total 88.7%; Māori 87.3%; NZE 88.9%; Pacific 66.7%; and Dep 9-10 84.8%. National average 85.4%.

MOH Report Total Māori NZE Pacific Dep 9-10 Immunised/eligible 134/151 48/55 72/81 2/3 28/33

Measles, Mumps and Rubella (MMR) The Ministry has informed us the priority for DHBs is the successful rollout of the Covid-19 vaccination programme. The second priority for vaccination is the MMR vaccine for 15-30 year olds who may have missed their second dose in early childhood. The data used by the Ministry, to determine uptake, is sourced from the National Immunisation Register. The Wairarapa statistics are gathered as often as required, by Tu Ora and show that as at the end of March 72% of this cohort had received the MMR vaccine. The MMR campaign end has been pushed out to the end of October 2021, previously it was the end of August 2021. Managing the campaign in the Wairarapa will take a hiatus while the DHB determines how many people within this cohort are actually requiring a second (or first) dose. The PHO will support practices with administrative support to check that all MMR records on paper files have been recorded on the NIR. COVID 19 Vaccination Currently we are vaccinating people in sequencing Group 2. Group 2 are frontline health workers and people living in high risk places. This includes frontline health workers, residents in Aged Residential Care facilities, older Māori and Pacific living with their whanau, and people living in the Counties Manukau area at higher risk. We expect to have all in this group vaccinated by the end of May. Our first vaccinations took place on the 7 April 2021 and at the time of writing this report we are in our third week of vaccination. Last week we vaccinated our first Aged Residential Care Facility. Planning for Group 3 is well underway and we expect to begin this group in June. Group 3 is people at risk of getting very sick from COVID 19 such as people over the age of 65 years, disabled people, pregnant women, people with underlying health conditions, and people in custodial setting.

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PUBLIC

BOARD INFORMATION PAPER

Date: April 2021

Author Kieran McCann, Chief Operating Officer

Endorsed By Dale Oliff, Chief Executive Officer, Wairarapa District Health Board

Subject Hospital & Community Services Report for March 2021

RECOMMENDATION It is recommended that the Board: a. Notes the content of this report b. Notes the performance of Wairarapa District Health Board for Planned Care Activity including ESPI 2 and 5 c. Notes Month acute activity for March d. Notes Staff sickness rates e. Note Updates on Diagnostic waiting times and Child Development Services

APPENDICIES 1. Executive Dashboard March 2021 2. Planned Care Performance February 2021

1. PROVIDER OVERVIEW

The Wairarapa DHB (WrDHB) seen acute presentations for March remain high, with 246 more Emergency Department (ED) presentations than the same period last year and 152 more than last month. General Medicine admissions has seen the quarterly monthly average rise from 180 to 191. In Orthopaedics the average acute admission for the quarter compared to first half of year has risen from 30 to 35 admissions. Subsequently we have seen the greatest number of acute displaced planned care cancellations for the year. The main service affected was orthopaedics. Notwithstanding delivery of planned care volumes and waiting times continues to be broadly met.

As indicated last month the anticipated increase in sick leave and absenteeism for staff has been reflected in the March reporting with sickness in all three areas of provider arm exceeding the target rate of 2.5% sickness. Collectively sickness rates are reported at 3.1%

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PUBLIC 2. PERFORMANCE

Results Improvement focus Financial The month of March returned a negative Savings Targets position of ($358k). The result is predominantly The Provider arm is currently comprised of unachieved monthly savings tracking ($1,004k) YTD inclusive of targets of ($175k) revenue ($102k Nursing) and YTD savings targets of ($755k) ($99k) Clinical Supplies. Monthly saving targets represent a total of ($375k) Operational ED 6 Hr Target Planned Care targets continue to perform well Performance MRI Wait Times with only two patients breaching ESPI2 and two DNA Outpatient rates patients for ESPI 5. Overall the WrDHB is on CWD Targets track to deliver local discharge targets for planned surgery performing at 107.1% but remains behind on CWD targets set by the Ministry of Health (MoH). Currently delivering slightly better than last month at 89.2% of target (127.9 local CWD behind) We are currently liaising closely with IDF providers to forecast their delivery vector and estimate the level of risk posed to reduced access to electives funding as a consequence f under delivering target case weights. The ED 6hr target has improved from last month to 92% but remains below target of 95% and continues to remain a priority area for improvement. Ongoing pressure on the ED target achievement nationally is noted.

3. KEY AREAS OF FOCUS

Focus Action Points Balanced Scorecard ∑ ED redirection to Primary Care continues 6Hr Waits ∑ Inpatient admission flow through SAFER CARE bundle in progress ∑ Trial medical Senior Medical Officer (SMO) roster in development ∑ ED staff configuration modelling in development ∑ Trial Fast Track modelling in ED Endoscopy ∑ Optimising sessions through theatres ∑ Surveillance target are slightly behind but this will correct itself in this next couple of months, while compliance achieved in Urgent, Semi-Urgent Diagnostics MRI ∑ Increased MRI capacity by additional volumes provided by outsourced to Private Provider as below ∑ Of the 100 patients outsourced to a private provider, there are 24 patients still to be scanned Equity - DNA rates ∑ Supported by our Māori Health Team we are continuing to refresh all work currently being done specifically for DNA rates to target/prioritise services or areas of focus. We have arranged Saturday clinics where possible and the DNA rate though marginal are slightly improved for those clinics

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PUBLIC 4. PERFORMANCE

4.1. PLANNED SERVICES

Performance Planned Services FY 19/20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Target ESPI2 1 0 0 0 0 6 21 0 2 0 ESPI5 30 9 0 2 0 5 6 3 2 0 Delivery to Plan - discharges 96.7% 102.1% 103.1% 98.1% 97.8% 94.5% 95.6% 95.1% 98.5% TBA 95% Delivery to Plan - caseweights 96.7% 104.3% 110.2% 100.3% 99.3% 92.6% 94.4% 91.5% 95.2% TBA 95% Average length of Stay - Planned 3.29 2.49 3.69 3.15 3.34 3.06 3.64 3.44 2.92 3.69 3.50 Colonoscopy Wait Time - Urgent 82% 100% 100% 100% 88% 100% 73% 100% 100% 90% Colonoscopy Wait Time - Semi-Urgent 67% 78% 83% 90% 79% 75% 66% 76% 76% 70% Colonoscopy Wait Time - Surveillance 49% 53% 54% 63% 75% 80% 73% 74% 65% 70% MRI Wait Time 57% 55% 46% 40% 72% 53% 44% 41.1% 42% 90% CT Wait Time 97% 97% 96% 96% 98% 85% 81% 83% 91% 95% Theatre Utilisation 68% 76% 82% 77% 79% 79% 79% 77% 75% 76% 85% Day of Surgery Cancellations as a % 6.7% 4.2% 6.1% 4.5% 6.1% 5.1% 7.3% 9.0% 6.2% 8.1% 5.0% Outpatient DNA First Specialist assessments 7.8% 8.6% 6.7% 8.2% 7.7% 8.9% 6.5% 8.1% 8.1% 8.1% 8.0% Outpatient DNA Follow-Up Specialist assessments 5.9% 6.7% 5.6% 6.5% 5.5% 4.2% 5.2% 6.5% 6.4% 5.5% 8.0% Outpatient DNA - Maori 16.0% 18.2% 15.0% 16.1% 16.6% 13.7% 14.2% 17.1% 14.8% 13.4% 8.0% Activity & Commentary / Action Points Operational Performance ESPI 2 & 5 March ( Provisional) * Note final results are 1 month in arrears and are included in appendixes to this report)

ESPI Two – Orange – Partially Compliant P - 2 Orthopaedics patients waiting

ESPI Five – Orange – Partially Compliant P - 1 Ophthalmology and 1 General Surgery patient waiting Diagnostic Wait Colonoscopy Times 100% achieved for Urgent – target 90%. P Colonoscopy & Radiology 76% achieved for Semi Urgent – target 70% P

65% achieved for Surveillance – target 70%. O Note the slight underachievement in surveillance measures. CT/MRI CT – 91.5% not achieved – target 95%. O CT continues to improve from the previous noted performance dip at start of year. Only narrowly missing target for the month. We expect this service to return to compliance in April. MRI – 42.3% not achieved - target 90%. O 100 MRI scans have been referred to a private provider and appointments are being scheduled with 80% completed. The MRI results above do not currently reflect any of these outsourced referrals as performance reporting is provided by the Hutt Valley DHB against referred volumes through contract.

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PUBLIC Activity & Commentary / Action Points Operational Performance Diagnostic Wait The below table shows the current numbers of referrals and completed scans as of Times March. Colonoscopy & Wairarapa DHB Monthly Return, March 2021 Radiology Overall patient event numbers (Community and Outpatient Referrals) - including planned patient events Total number of accepted referrals waiting for scan at end of month 167 (including referrals for scans that are planned patient events) Total number of referrals accepted for scan during calendar month 60 (including referrals for scans that are planned patient events) Total number scanned and reported in month (patient events) (including 72 referrals for scans that are planned patient events) Total number of DNAs in calendar month 2 Total number of referrals not accepted in calendar month 0

Waiting times (Community and Outpatient referrals) - excluding planned patient events Total number of accepted referrals waiting for scan at the end of the 127 month (excluding referrals for scans that are planned patient events) Number of accepted referrals waiting within 6 weeks (42 calendar 69 days) (excluding referrals for scans that are planned patient events) Number of accepted referrals waiting within 21 weeks (147 calendar 122 days) (excluding referrals for scans that are planned patient events)

Monthly activity and demand (Community and Outpatient Referrals) - excluding planned patient events Total number of referrals for scan accepted during the month (excluding 56 referrals for scans that are planned patient events) Total number of accepted referrals scanned and reported in month 67 (patient events) (excluding referrals for scans that are planned patient events) Total number of accepted referrals scanned and reported in month within 13 6 weeks (42 calendar days) (excluding referrals for scans that are planned patient events) Total number of accepted referrals scanned and reported in month within 67 21 weeks (147 calendar days) (excluding referrals for scans that are planned patient events) Waiting time performance against target ( excluding outsourced scans) 42% Additional MRI Requests to outsourced provider 100 Target Completed as of March 2021 80

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PUBLIC Activity & Commentary / Action Points Operational Performance MoH National February February February Diagnostic 2021 2021 2021 Dashboard Wait Urgent Colonoscopy Non urgent Colonoscopy Surveillance Colonoscopy times Feb 2021 Waiting or Total Waiting or Total Waiting or Total % in 14 Days % in 42 Days % in 84 Days Scoped in 14 Waiting and Scoped in 42 Waiting and Scoped in 84 Waiting and or less or less or less Days or less Scoped Days or less Scoped Days or less Scoped Auckland 71 71 100.0% 374 471 79.4% 351 463 75.8% Bay of Plenty 32 40 80.0% 328 915 35.8% 97 573 16.9% Canterbury 44 50 88.0% 324 836 38.8% 1,059 1,505 70.4% Capital & Coast 7 7 100.0% 122 231 52.8% 232 328 70.7% Counties Manukau 51 54 94.4% 556 1,085 51.2% 473 524 90.3% Hawkes Bay 46 48 95.8% 243 393 61.8% 135 239 56.5% Hutt Valley 17 20 85.0% 192 401 47.5% 214 336 63.7% Lakes 19 20 95.0% 136 298 45.6% 56 151 37.1% MidCentral 20 20 100.0% 111 249 44.6% 2 49 4.1% Nelson Marlborough 16 18 88.5% 168 230 73.0% 134 425 31.5% Northland 45 46 97.8% 205 464 44.2% 166 475 34.9% South Canterbury 8 8 100.0% 26 29 89.7% 29 29 100.0% Southern 13 16 81.3% 208 234 88.9% 260 596 43.6% Tairawhiti 3 3 100.0% 71 101 70.3% 10 18 55.6% Taranaki 31 31 100.0% 157 438 35.8% 71 89 79.8% Waikato 65 67 97.0% 431 455 94.7% 271 324 83.6% Wairarapa 4 4 100.0% 35 46 76.1% 143 194 73.7% Waitemata 42 45 93.3% 637 1,832 34.8% 508 1,416 35.9% West Coast 2 2 100.0% 70 70 100.0% 43 52 82.7% Whanganui 9 15 60.0% 61 82 74.4% 86 165 52.1% National Total 545 585 93.2% 4,455 8,860 50.3% 4,340 7,951 54.6% February February February 2021 2021 2021 Coronary Angiography CT Scan MRI Scan Waiting or Waiting or Waiting or Total Catheterised % in 90 Scanned in CT Waiting % in 42 Days Scanned in MRI Waiting % in 42 Days Waiting and in 90 Days or Days or less 42 Days or and Scanned or less 42 Days or and Scanned or less Catheterised less less less Auckland 152 201 75.6% 785 1,093 71.8% 859 1,344 63.9% Bay of Plenty 67 81 82.7% 747 799 93.5% 511 541 94.5% Canterbury 106 118 89.8% 2,303 2,417 95.3% 925 1,376 67.2% Capital & Coast 123 139 88.5% 677 1,187 57.0% 378 899 42.0% Counties Manukau 58 58 100.0% 1,340 1,595 84.0% 787 1,038 75.8% Hawkes Bay 44 45 97.8% 576 737 78.2% 296 555 53.3% Hutt Valley - - - 416 511 81.4% 388 958 40.5% Lakes - - - 233 246 94.7% 204 236 86.4% MidCentral 10 10 100.0% 543 670 81.0% 420 655 64.1% Nelson Marlborough 33 44 75.0% 556 572 97.2% 282 379 74.4% Northland - - - 559 814 68.7% 377 616 61.2% South Canterbury - - - 300 313 95.8% 185 190 97.4% Southern 93 96 96.9% 826 1,330 62.1% 561 1,329 42.2% Tairawhiti - - - 224 232 96.6% 121 134 90.3% Taranaki 58 61 95.1% 35 75 46.7% 376 629 59.8% Waikato 169 205 82.4% 1,154 1,204 95.8% 758 1,309 57.9% Wairarapa - - - 98 118 83.1% 0 0 0%* Waitemata 117 117 100.0% 1,218 1,735 70.2% 1,105 1,715 64.4% West Coast - - - 162 170 95.3% 83 94 88.3% Whanganui - - - 249 302 82.5% 85 196 43.4% 1,030 1,175 87.7% 13,001 16,120 80.7% 8,701 14,193 61.3% NB* MRI Results reported via Hutt DHB

Theatre 76.4% Theatre utilisation, is consistent with previous months with the YTD utilisation at Utilisation and 77.7%. Day of Surgery Cancelations Acute work pressures continue to pose significant challenges for March resulting in the on the day cancellation of 14 planned surgeries which has also contributed to the lower utilisation (remains static at 76.4 %, up slightly from last month). Resourced theatre Utilisation is more likely to sit over 80% as the reported percentages do not take into account when theatres are not staffed (un-resourced capacity). Principles are being set for theatre utilisation when we move into the new CostPro application. Day of Surgery Cancellation has increased by 8.1%. 31 patients cancelled on the day of surgery, an increase this month of2%. This month’s result was predominantly driven by acute displacement (14) patient preparedness (9), and cancellation from patient (3). There was one patient cancelled due to hospital capacity issues.

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PUBLIC Activity & Commentary / Action Points Operational Performance ALOS Monitoring of surgical lists are ongoing with Service improvement reviews underway to continue to improve the rates of Day of Surgery cancellations and late starts. Acute ALOS continues being achieved being below the targeted 3.50 days currently at 3.08 days. Virtual Clinics & Having reported previously the first Quarter 1 results from July to Sept the following use of remote distance and time calculators for appointments made using telehealth the results are technology now presented by month and YTD.

Colonoscopy Wait Time - Urgent Colonoscopy Wait Time - Semi Urgent

Colonoscopy Wait Time - Urgent Colonoscopy Wait Time - Urgent Target Colonoscopy Wait Time - Semi-Urgent Colonoscopy Wait Time - Semi-Urgent - Target 120% 100% 100% 80% 80% 60% 60% 40% 40%

20% 20%

0% 0% 0 0 0 0 9 0 0 1 9 0 0 9 0 0 1 0 0 9 0 0 0 9 0 0 0 1 0 0 1 0 1 9 0 0 0 1 2 2 2 1 2 2 2 2 2 2 2 2 1 2 2 2 2 2 1 2 1 2 2 2 2 2 2 2 1 2 2 2 2 2 1 2 ------l l r r r r t t r r c c t t v v c c y g v v y g b p b n b p b n n n n n u u c c c c a a a a p e e e e p a a a a o o u o o u a a u J e e e u J e e e J J J J J O O J A O O F S F A D D F S F A D D N N A N N M M M M M M

Treatment - ESPI 5 First Specialist Assessment - ESPI 2 ESPI5 total patients waiting > 4 mths ESPI2 total patients waiting > 4 mths 140 70 120 60 100 50 80 40 60 30 40 20 20 10 0 0 9 0 0 9 0 0 0 0 0 0 0 1 0 0 9 0 0 1 9 0 0 1 0 0 0 0 1 0 1 9 0 0 0 1 9 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 2 1 2 1 2 2 2 1 2 2 2 2 1 2 1 2 2 2 ------l l r r r r r r t t t t c c v v c c g v v y g y b p b b p b n n n n n n u u c c c c a a a a p p e e e e a a a a a a o o o o u u u u e e e e e e J J J J J J J J O O O O A A F S F F S F D D D D A A N N N N M M M M M M

Total Theatre Utilisation On the Day Theatre Cancellations

Theatre Utilisation Theatre Utilisation - Target Day of Surgery Cancellations Day of Surgery Cancellations - Target

90% 12.0% 80% 10.0% 70% 60% 8.0% 50% 6.0% 40% 30% 4.0% 20% 2.0% 10% 0% 0.0% 0 0 0 0 9 0 9 0 0 0 9 0 0 0 0 0 1 0 0 1 9 0 0 0 1 9 0 0 1 0 1 9 0 0 0 1 2 2 2 2 2 2 2 2 1 2 2 2 1 2 2 2 2 2 2 2 1 2 2 2 2 2 2 2 1 2 2 1 2 2 1 2 ------l l r r r r t t r r t t c c c c v v v v y g y g b p b b p b n n n n n n u u c c c c a a a a p p e e e e a a a a a a o o o o u u u u e e e e e e J J J J J J J J O O O O A A F S F F S F D D D D A A N N N N M M M M M M

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PUBLIC

CT Wait Time MRI Wait Time

CT Wait Time CT Wait Time - Target MRI Wait Time MRI Wait Time - Target

120% 100%

100% 80% 80% 60% 60% 40% 40%

20% 20%

0% 0% 9 0 0 9 0 0 0 0 0 0 0 0 0 1 9 0 0 0 0 1 0 1 9 0 9 0 0 0 1 0 1 9 0 0 0 1 2 2 2 2 2 2 2 1 2 2 2 1 2 2 2 2 1 2 2 2 2 2 2 1 2 2 2 2 2 2 1 2 2 2 1 2 ------l l r r r r r r t t t t c c c c v v v v g y y g b p b b p b n n n n n n u u c c c c a a a a p p e e e e a a o o o o a a a a u u u u e e e J J e e e J J J J J J O O O O A A F S F F S F D D D D A A N N N N M M M M M M

General Surgery ALOS & ACWD Oct 19 - Mar 21

Avg Length Of Stay Avg CaseWeighted Discharges Inpatient Caseweighted Discharges 2 per. Mov. Avg. (Avg Length Of Stay) 2 per. Mov. Avg. (Avg CaseWeighted Discharges) 3.50 140 3.00 120 2.50 100 2.00 80 1.50 60 1.00 40 0.50 20 0.00 0 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21

Orthopaedics ALOS & ACWD Oct 19 - Mar 21

Avg Length Of Stay Avg CaseWeighted Discharges Inpatient Caseweighted Discharges 2 per. Mov. Avg. (Avg Length Of Stay) 2 per. Mov. Avg. (Avg CaseWeighted Discharges) 4.00 100 3.50 80 3.00 2.50 60 2.00 1.50 40 1.00 20 0.50 0.00 0 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21

4.2. ACUTE SERVICES

Performance Acute Services FY 19/20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Target ED 6 hour wait 92% 92% 92% 94% 90% 92% 92% 91% 91% 91% 95% Average length of Stay - Acute 3.50 3.82 3.30 3.19 3.05 3.15 3.00 2.95 3.07 3.08 3.50 Acute Readmissions 5.3% 4.7% 6.4% 5.7% 5.9% 5.8% 4.9% 5.2% 5.8% TBA 8.0% C-Section Rate 33% 27% 26% 32% 30% 17% 26% 31% 41% 27% 25% C-Section Rate Standard Primiparae rolling 12 mths 21% 19% 19% 20% 18% 17% 18% 17% 16% 16% 20% MSW discharges before 11am 13% 15% 15% 11% 14% 15% 11% 15% 16% TBC MSW Bed Utilisation 94% 96% 92% 92% 89% 85% 86% 89% 92.5% 90.4% 85%

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PUBLIC Activity & Commentary / Action Points Operational Performance ED 6hr wait 1,368 patients passed through the emergency department, excluding those that did not wait and 1,248 of these were seen within 6 hours resulting in a not achieved result of 91.2%. This is an increase on February’s 90.5%

March ED >6hrs 15

10

5

0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3

39 % of those who were treated outside of target waiting times were triage 4 or 5 patients and some 58% were patients who presented to the emergency department after 6:00pm and before 7:00am or on Public holidays or weekends. Performance attainment in acute management and wait times at our front door remains as one of the critical measures of success for our Whakapuāwai Programme. Whakapuāwai work continues to reduce the ALOS this has help improve the patient flow in to the ward. Work with Primary care continues to promote and ensure patients are cared for in the correct environment. We continue to work in partnership and consider any options provided for alternative appropriate access to Primary Care in order to reduce avoidable presentation to ED. Maternity There were 37 births in March (coding still to be finalised) and 65 Maternity ward Services discharges. Total hospital births for 2020 were 461, slightly more than 2019 at 456 births. The standard primiparae C-section rate is at 15.9% for the FY YTD, with 88 primiparae births, 14 by C-section. The YTD track of rolling previous 12 month averages for this target is provided in the refreshed Dashboard. It is of note that expected delivery figures for February is expected to increase when coding is finalised and March are anticipated to be very high.

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PUBLIC ALOS Overall General Medicine Average Length of Stay (ALOS) continues to see improvements and is slightly increased on last month’s 2.70 days to 2.97 days. This is reflective of a couple of complex medical/mental health long stay patients. There has been a month on month improvement on this ALOS since July at which point ALOS was 3.33 days.

General Medicine LOS Profile General Medicine LOS Profile - Current Period 2018 & 2019 Baseline [Nov 2020 - Mar 2021; all wards; discharge = M00] [Nov - Mar baseline ; all wards; discharge = M00] 40% 40% 36%

s s

e 35% e 35% g g r

r 29% a

a 27% 30% 27%

30% h h c c s s i 25% i 25% D D 19% 19%

f f 20% 20% o o

15% n

n 13% o

o 15% 15% i i t t r r 9% o o 10% 10% p p 5% o o r r 5% 5% P P 0% 0% 0 1 2 3 4+ 0 1 2 3 4+ Length of Stay Days Length of Stay Days This Year Previous 2 years LOS Nov 2020 - Mar 2021 Nov- Mar 2018 & 2019 Change 0 9% 5% 4% 1 27% 27% 1% 2 19% 19% 0% 3 15% 13% 2% 4+ 29% 36% -7% MSW shows a Bed utilisation of 90.4% for March which is a decrease on last month’s 92.5% with average LOS across all services showing a decrease from 3.04 days last month to 2.81 days in March.

WrDHB ED 6 Hour Wait WrDHB Total Hospital Births & C-Section Rate ED 6 hour wait ED 6 hour target Births C-Section Rate 98% C-Section Rate Standard Primiparae rolling 12 mths 96% 60 50.0%

94% 50 40.0% 92% 40 30.0% 90% 30 20.0% 88% 20 86% 10 10.0% 84% 0 0.0% 9 0 0 0 0 0 0 1 0 1 0 9 0 0 0 9 0 0 0 0 1 9 0 0 0 1 9 0 9 0 0 1 0 1 9 0 0 2 2 2 2 2 2 2 2 2 2 2 1 2 2 2 1 2 2 1 2 2 2 2 1 2 2 2 2 1 2 1 2 2 2 2 1 2 ------l l r r r r t t r r t t c c v v c c y g v v y g b p b n p b p b n n n n n u u c c c c a a a a p p e e e e a a a a a a o o u o o u u u e e e e e e e J J J J J J J J O O O O A A F S F S F S F D D D D A A N N N N M M M M M M

Wairarapa DHB Hospital Births 2020 - 2021

Spontaneous Vaginal Delivery Instrumental Vaginal Delivery Caesarean Section Delivery

60

50

40

30

20

10

0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2020 2021

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PUBLIC General Medicine ALOS & ACWD Oct 19 - Mar 21 Avg Length Of Stay Avg CaseWeighted Discharges Inpatient Caseweighted Discharges

2 per. Mov. Avg. (Avg Length Of Stay) 2 per. Mov. Avg. (Avg CaseWeighted Discharges) 4.00 300 3.50 250 3.00 200 2.50 2.00 150 1.50 100 1.00 50 0.50 0.00 0 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21

4.3. COMMUNITY & INTEGRATION SERVICES

Activity & Operational Commentary / Action Points Performance Allied Health Allied Health PVS volumes for outpatient and community are ahead of contract volumes for March-21 by 84 contacts with small under delivery in social work, dietetics, and speech therapy. YTD Allied Health PVS volumes are ahead of contract by 543 contacts. 30 patients were discharged from AT&R (Rehab) in March with an average length of stay of 13.30 days and 399 bed nights. The YTD ALOS is currently 13.44 days which is higher than last year’s 12.03 days. Community Nursing The signalled Community Nursing review (due to commence in March 2021) will provide an opportunity to further examine the current demand and supply metrics, alongside models of care to support a well- integrated, sustainable and effective community nursing service to meet current and future community needs. Hospital at Home (H@H) The H@H proof of concept was put into hiatus in mid-March due to very low referral numbers and significant resource / capacity limitations over the past four months. The element that continues at this stage involves Community Nursing and IV therapy to clarify operational processes and clinical governance / duty of care for this component of the H@H model. One of the 21/22 budget bids to support ongoing quality initiatives resulting from the Whakapuāwai work is for the development of an Acute Assessment Unit (AAU). This will provide acute ambulatory care following ED presentation, and if this bid is successful the H@H model will be considered as part of this model. Virtual Front of House Learnings from the Virtual Front of House and care coordination / community integration activity are in the early stages of work through Whakapuāwai. It is being incorporated into the Health Systems Plan. A workshop to explore this in more depth is being planned by Planning & Performance for April / May 2021.

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PUBLIC ATR ALOS Oct 19 - Mar 21

Avg Length Of Stay Inpatient Discharges 2 per. Mov. Avg. (Avg Length Of Stay)

20.00 45 18.00 40 16.00 35 14.00 30 12.00 25 10.00 20 8.00 6.00 15 4.00 10 2.00 5 0.00 0 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21

DOM101.pc contacts - Community Services - palliative care services DOM101.ps contacts - Community Services - professional services

This Yr Last Yr Actual Budget / SLA

900 This Yr Last Yr Actual Budget / SLA 4,000 800 3,500 700 3,000 600 500 2,500 400 2,000 300 1,500 200 1,000

100 500

0 0 Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun

DOM105 Community Services - home help DOM107 Community Services - personal care

This Yr Last Yr Actual Budget / SLA This Yr Last Yr Actual Budget / SLA 160 1,600 140 1,400 120 1,200 100 1,000 80 800 60 600 40 400 20 200 0 0 Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun

5. STAFFING

Staffing FY 19/20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Target Hospital & Community - Sick as a % of worked 2.8% 3.6% 3.4% 4.3% 3.2% 3.4% 3.0% 2.4% 2.4% 3.1% 2.5% Acute Services - Sick as a % of worked 3.4% 5.3% 3.4% 5.2% 3.2% 3.2% 3.8% 2.6% 2.6% 3.7% 2.5% Planned Services - Sick as a % of worked 3.1% 3.1% 3.6% 4.0% 3.3% 5.2% 2.5% 2.8% 3.4% 3.8% 2.5% Community & Integration Services - Sick as a % of worked 2.6% 2.5% 3.3% 3.2% 1.9% 3.2% 2.7% 2.2% 2.4% 2.7% 2.5% All payroll information is as at the 21/03/2021 Acute Services Planned & Support DHB Wide Acute Unit MSW DHB Wide Pharmacy Radiology Outpatients Paediatrics Maternity DNM's Perioperative CSSD SSH Clinical Admin 10.0% 14.0% 12.0% 8.0% 10.0% 6.0% 8.0%

4.0% 6.0% 4.0% 2.0% 2.0% 0.0% 0.0% 9 0 0 9 0 9 0 9 0 0 9 0 0 1 0 0 0 0 9 0 9 0 9 0 0 1 0 1 9 0 0 1 9 0 0 1 9 0 9 0 0 1 2 2 2 1 2 1 2 1 2 2 2 2 2 2 2 2 2 2 1 2 1 2 1 2 2 2 2 2 1 2 2 2 1 2 1 2 1 2 1 2 1 2 ------l l l l r r r r r r t t t t c c v v c c y y v v g g g g p b p b p b p b n n n n n n u u u u c c c c a a a a p p e e e e a a o o a a a a o o u u u u u u e e e e e e e e J J J J J J J J J J O O O O A A S F S F S F S F D D D D A A A A N N N N M M M M M M

Community & Integration Annual Leave and Anticipated annual leave Hours Coded in Payroll - by employee category DHB Wide AT&R Comm Nursing Allied Medical Mgmt & Admin Nursing Support Allied Therapies FOCUS Oral Health 10.0% 4000 3500 8.0% 3000 2500 6.0% 2000 4.0% 1500 1000 2.0% 500 0.0% 0 r r r r v v v y y y y y y p p p n n n n l l l a a a a a a a a a a a 9 0 9 0 0 0 0 9 0 o o o 9 0 0 1 0 1 9 0 9 0 0 1 e e e u u u J J J J S S S 2 J J J 1 2 2 2 1 2 2 2 1 2 2 2 2 2 1 2 1 2 1 2 N N N M M M M M M M ------l l r r r t t c c v v y g g p b p b n n n u u c c a a p e e a a a o o u u u e e e e J J J J J O O A S F S F D D A A 2018 2019 2020 2021 N N M M M

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PUBLIC STAFFING Monthly changes / Commentary Sick Leave The sick leave rate is above target at 3.1% of worked hours for March. Perioperative is 4.8%. MSW has increased from 1.8% in January and 2.0% in February to 4.4% in March. Acute Unit at 2.1% down from 3.3% last month, Paediatrics at 7.9% and Radiology 5.1% from 6.1% last month. Annual Leave The DHB Targets remain under development for monitoring and performance management and we will commence reporting delivery for remaining quarters of the 20/21 year when available. Trend information provided on leave taken does not include 7,243 hours paid and 16 hours unpaid COVID-19 special leave issued over the year (mostly over level 3 and 4 lockdown) that are not represented in the above graphs. Whilst longer term targets are being developed we are already maximising every opportunity to have staff take leave and are now finalising our summer plans to maximise this period to allow our staff time off after an exceptionally disruptive year. Overtime Overtime hours have dropped slightly since last month but remain high against trends. Consequently the higher casual use for March is enabling this reduction. Flexible staffing is currently a significant mechanism to deal with unplanned variation in both patient demand and unplanned staff absence.

Overtime Hours Planned & Support Acute Services Comm & Int Hospital & Community 700 600 500 400 300 200 100 0 … - 9 0 9 0 9 0 0 0 0 1 9 0 0 1 9 0 9 0 0 1 y 1 2 2 2 2 2 1 2 2 2 1 2 1 2 2 2 1 2 1 2 a ------l l r r r t t c c v v g g p b p b n n n u u M c c a a p e e a a o o u u u e e e e J J J J J O O A S F S F D D A A N N M M

Casual Hours Planned & Support Acute Services Comm & Int Hospital & Community 8000 7000 6000 5000 4000 3000 2000 1000 0 9 0 0 9 0 9 0 0 0 0 1 9 0 9 0 9 0 0 1 0 1 2 1 2 2 2 1 2 2 2 2 2 1 2 1 2 2 2 1 2 1 2 ------l l r r r t t c c v v y g g p b p b n n n u u c c a a p e e a a a o o u u u e e e e J J J J J O O A S F S F D D A A N N M M M

Key Changes Staff & Recruitment Orthopaedic There are two permanent surgeons in place and one fixed term locum with an offer of substantive employment made. A fixed term Non training Registrar role is currently before the Medical Council as an interim arrangement to support this service whilst recruitment commences again for a permanent Surgeon role.

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PUBLIC Key Changes Staff & Recruitment General There are two permanent surgeons in place and another for a one year fixed term Surgery contract. Locums available and being used to cover gaps

Allied Health The 0.9FTE Speech-Language Therapist (SLT) vacancy has been offered and verbally accepted, with a start date of January 2021 (the overseas clinician who requested an extended start date, which was agreed given the difficulty recruiting to this role). Two fixed term external contractors are providing paediatric and adult caseload support from early April, with additional clinical support being provided by HVDHB, CCDHB and Mid-Central DHB. This interim arrangement will provide cover for core SLT services through until the end of September, and will be renegotiated prior to this time. 0.25FTE fixed term Physiotherapist commenced 22 March (backfill for the musculoskeletal non operative pilot). Additional fixed term CDS Psychologist hours commenced in March, with four cognitive assessments completed over the month – refer to CDS overview for further details. FOCUS Recruitment to the 1FTE FOCUS Manager role is underway following resignation of the current manager this month. Community Recruitment to the new Nurse with a Special Interest – Diabetes role is underway, Nursing with interviews set for the week of 12 April. This new position has been configured from 0.3FTE budgeted for Diabetes CNS together with vacant District Nurse FTE, and will provide a succession plan for the Diabetes CNS team. AT&R RNs are fully staffed against budgeted FTE, with the outstanding 1.3FTE being recruited to during March. A proposal for the revised leadership model for AT&R will be communicated during April. Oral Health Recruitment continues for the remaining 0.4FTE Oral Health Therapist vacancy. Casual staffing in place in the interim.

6. VOLUMES TO CONTRACT

Variance to contract YTD FY $ Variance Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Target Caseweight to plan - Planned -$ 137,448 -3.2 -14.2 -34.6 -54.8 -91.9 -118.7 -146.8 -115.9 -157.5 0 Caseweight to plan - Acute -$ 1,214,363 39.2 47.6 95.2 152.3 151.1 138.8 162.8 184.8 231.3 0 Outpatients - First Assessments -$ 297,553 -81 -138 -222 -294 -379 -561 -716 -771 -721 0 Outpatients - Subsequent Assessments -$ 142,476 302 478 630 747 1011 989 1012 1033 1348 0 Allied Therapies (Diet, Speech, OT, PT, Social Work) $ 46,287 25 156 307 399 449 523 398 396 543 0 Community-referred radiology $ 104,912 478 911 1515 2146 2837 3346 3705 3953 5044 0 March numbers are included above for high level performance to contract. Please note that this number will continue to change due to coding for the current month not, as yet, being finalised. This is also likely to be more significant given the earlier date this information was extracted to meet reporting timeframe for an earlier Board meeting.

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28 2021 04 27 WrDHB Public Board - Information

PUBLIC 7. WAIRARAPA DHB CHILD DEVELOPMENT SERVICE BOARD UPDATE – MARCH 2021

Child Development Services are non-medical, multidisciplinary Allied Health and Community based services. Whilst a significant component of the service is early intervention for pre-school children who have disabilities or who are not achieving developmental milestones, the service is intended to promote and facilitate each child’s developmental pathway so that their maximal potential is attained throughout their development and growth. Access to the service is for • Children and young people who have been identified as having a physical, sensory or intellectual disability or a combination of these, which is likely to continue for a minimum of six months. • Children who are at risk of developing such a disability or have developmental delay. • Children who have Autism Spectrum Disorder. • Whanau, families, caregivers and advocates associated with the above children. Current wait list: Overall there are approximately 70 children waiting to access the Service in the Wairarapa. In relation to this a small numbers of specific referrals for assessment by Physiotherapy, Visiting Neurodevelopmental Therapy, or Occupational Therapy there is currently little to no substantive wait list for these services. Referrals are seen as soon as families are ready to engage. The bulk of referrals and therefore subsequent workloads sits in two broad areas of service: 1. Multi-Disciplinary Team (MDT) 38 children are currently waiting (for developmental assessment). The oldest referral is from March 2019. The next longest wait is from September 2019. It is of note that length of waiting time to assessment can also be heavily influenced by individual challenges with family/Whānau engagement and therefore not exclusively a capacity issue. The children waiting at the outlying end of our wait list are commonly where these issues are encountered. 2. Cognitive Assessment 25 children are currently waiting (for Psychologist assessment only). The oldest referral is from June 2019, however it is noted that in these longest outlying wait times there are minimum age thresholds prior to assessment and alignment to other service input such as surgery. Team structure & Local Service Developments The Wairarapa Child Development Service is made up of five different professionals with a total of 2.8FTE. We are fortunate to have our CDS team fully staffed and all have a sound depth of clinical experience and neurodevelopmental and paediatric knowledge within the team. While there are challenges within the service managing demand in two key areas, the MDT referral for developmental assessments and the Psychology Cognitive assessments, they are reliant on a psychologists to be the diagnostician; and we have a 0.4 FTE providing this service. Both these assessments modalities take many hours to complete. Engaging Paediatrician participation in collaborative community based work to diagnose children in partnership with the CDS team has a significant potential to support alleviating this issue. A recent proposal to establish a community based Paediatric Clinics collocated with CDS services at Lincoln Road received unanimous support including our Paediatricians, and we were excited at the opportunity to facilitate this approach. However due to other off-site lease priorities the vacant space has been reallocated in order to relocate Public Health from their current location in Russel Street. Whilst other alternatives are likely to be suboptimal in terms of co-ordinating and collocating service, we continue to explore options for having our specialists working closer with teams in the community.

Wairarapa District Health Board Page 14 of 15

29 2021 04 27 WrDHB Public Board - Information

PUBLIC Whilst acknowledging the non-service capacity delays noted previously, lengthy cognitive and MDT assessment wait lists are reflected nationally. All CDS’ are grappling with timely service delivery in this area. Nationwide referral numbers for Autism Spectrum Disorder have increased significantly over the past 10 years and the complexities of the children and families the CDS team are seeing and working with have also increased markedly. This has also been noted nationally. The Wairarapa team works very closely with other child health agencies, particularly CAMHS, FOCUS, paediatric services and MoE, Oranga Tamariki and NGOs (e.g. Autism Wairarapa, CCS Disability Action Support). National CDS Review The MoH are leading work to develop a new Future Operating Model (FOM) / national framework for CDS services. This is a complex piece of work given there are currently 33 contracted providers across the country with disparate consistency of service delivery and reporting (in regards to age and services delivered). One aim of the FOM is for CDS’ to provide a nationally consistent service. As part of this review, $8 million was allocated to CDS’ nationally in the 2019 budget to address wait list issues over the next four years. $2 million was earmarked for innovation funding (regional projects to encourage innovative practice) and the remaining $6 million was allocated across the four regions (Northern, Midlands, Central and Southern). The Central Region received $668,000 to be shared across 6 DHBs and 2 NGOs. It has been confirmed that this additional funding is permanent going forward. The funding within the Central Region was distributed on a PBFF basis and WrDHB received $34,000. The MoH requirement was that this would be used to decrease wait lists. This was the first step increase in funding received by CDS services over the last 10 years+. The WrDHB CDS used the new funding as follows: • 2019/20 – contracted extra Psychologist hours to complete an additional 16 cognitive assessments. • 2020/21 – contracted extra Psychologist to complete 12 additional cognitive assessments (funding carried over from 19/20 plus some from the 2020 budget) It is noted that the 28 additional assessments undertaken would have otherwise been on top of the existing backlog currently being experienced. The team decided the best way to improve the journey for families, streamline and ensure the right children were being seen by the CDS team, was to employ someone in a permanent 0.3FTE referral co- ordinator. This was filled by our Occupational Therapist, who was able to increase her work hours with the team. The role started late October 2020, so has been operating for the past five months. This role screens referrals for MDT assessment to ensure all relevant information is collected as part of referral triage in order to determine that CDS is the required service. If not, the co-ordinator redirects the referral to the appropriate service, this eliminates children waiting for an extended period on a wait list only to find that CDS is not the right service to meet their needs. If OT or other disciplines are indicated prior to MDT assessment the screener identifies and actions this. This maximises clinical intervention opportunities while the child is waiting for MDT assessment, and engages the family with the service. The role is also extended to ensuring all new and relevant up to date information is gathered for those next in line for an assessment, as the original information is often old and potentially out of date. This ensures a more time effective assessment. The CDS Central Region network is strong and WrDHB is well represented on this group by Margie van der Lans, CDS Team Leader, who is the current chair.

Wairarapa District Health Board Page 15 of 15

30 2021 04 27 WrDHB Public Board - Information

Wairarapa DHB: Dashboard Report - March 2021

MOH PERFORMANCE MEASURES

95% of children fully immunised at 8 95% of patients will be admitted, discharged or 90% of patients receive their first cancer 90% of Maternity & PHO identified smokers are offered 95% of identified obese children will be 2020/21 Planned Care - Inpatient Surgical months (quarterly) advice and support to quit (quarterly) transferred from ED within six hours. treatment within 62 days referred for assessment (quarterly) Discharges Primary Care Actual % Maternity Actual % Actual % Target 95% Actual % Target 90% No. of patients submitted Actual % Target 95% Primary & Maternity Target Actual % Target 95% YTD Actual No. YTD Target No. 101% 100% 100% 100% 100% 100% 100% 98.0% 100% 100% 3,000 100% 14 100% 95% 96.0% 12 95% 99% 2,500 80% 95% 93% 93% 90% 94.0% 10 92% 85% 98% 2,000 91% 92.0% 60% 80% 97% 96% 8 90% 89% 89% 90.0% 1,500 6 75% 96% 40% 70% 95% 88.0% 1,000 4 85% 65% 20% 94% 86.0% 500 2 60% 93% 84.0% 0% 0 80% 55% 92%

- 50%

Jul Jul

Jul Jul

Jun

Jan Jan

Jun

Oct Oct Sep Sep

Apr

Dec Dec

Sep Feb Sep Feb

Jan Jan

Dec Dec

Jun

Aug Aug

Oct Oct

Mar Mar

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Sep Dec Sep Dec 2019-20 2020-21 2019-20 2019-20 2019-20 2019-20 2020-21 2020-21 2020-21 2019-20 2020-21 2018-19 2018-19 2019-20 2019-20 2019-20 2019-20 2020-21 2020-21 2018-19 2019-20 2019-20 2019-20 2019-20 2020-21 2020-21

KEY INDICATORS

ED Presentations Ambulatory Sensitive Hospitalisations (ASH) (per 100,000 population) - Caseweight (local delivery) Theatre Utilisation Total Triage (4 & 5) Average Length of Stay (ALOS) 00 - 04 Age Group Acute Actual Planned Actual 1,750 12500 Elective & Arranged Acute Acute Target Planned Target Theatre Utilisation Target Theatre 3 Utilisation 5.00 6,000 100.0% 4.00 1,250 80.0% 7500 4,000 3.00 60.0% 2.00 750 2,000 40.0% 2500 1.00 20.0% Year to Year to Year to Year to Year to - 250 - 0.0%

30/12/16 30/12/17 30/12/18 30/12/19 30/12/20

Jul Jul

Jul Jul

Jan Jan

Oct Oct

Apr

Sep Feb Sep Feb Jul

Jan Jan

Dec Dec

Aug Aug

Jul Jul

Oct Oct

Nov Nov

Apr

Sep Sep Feb Feb

Mar Mar

Dec Dec

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Aug Aug

May

Nov Nov

Oct

Jan Jan

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June

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Sep Feb

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Mar Mar June Wairarapa Other Wairarapa Maori May Wairarapa Total National Total 19-20 20-21 19-20 20-21 20-21 19-20 20-21 NUMBER LONG WAIT PATIENTS ( >4 Months) PROCESS & EFFICIENCY FINANCIAL RESULT

YTD Actual First Specialist Assessment - ESPI 2 Treatment- ESPI 5 vs Variance Surplus/(Deficit) - YTD ($000) Target Mnth YTD Variance Surplus/(Deficit) - MTD ($000) 80 150 Target 1,000 60 1,000 800 100 Elective/Arranged Day Surgery rate 62% 70.5% 63.2%  40 Ward Bed Utilisation - MSW 85% 90.4% 90.1% 500 600 50  20 400 Caesarean Rate (Elective & Acute) 25% 27.0% 28.5%  - - - Acute Readmission Rate 8% 5.8% 5.6%  200 (500) Theatre Sessions Starting on Time 90% 78.4% 78.4%  - Theatre Session Utilisation (Time in Theatre) 85%

Jun-20 76.4% 77.7%

Oct-20 Oct-19

Apr-20

Jun-20

Feb-21 Feb-20 Oct-20

Oct-19 

Dec-20 Dec-19

Apr-20

Feb-20 Feb-21

Aug-20

Dec-19 Dec-20 Aug-20 (1,000) (200)

Cancellation on Day of Surgery 5% 8.1% 6.3% 

Jul

Jul

Jan

Jan

Jun

Jun

Oct

Oct

Apr

Apr

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Sep Feb

Dec

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Mar

Mar May Total patients > 4 mths Total patients > 4 mths Did Not Attend (DNA) Rate - FSA 8.0% 8.1% 7.9%  May Did Not Attend (DNA) Rate - FUP 8.0% 5.5% 5.8%  MTD ($000) Actual vs YTD ($000) DIAGNOSTIC WAIT TIMES Did Not Attend (DNA) Rate - Maori all 8.0% 13.4% 15.5%  Actual vs Budget  = Meets Target  = Exceeds Target  = Does Not Meet Target Actual Budget Variance Actual Budget Variance Budget Diagnostics Target Actual (1,127) (229) (898)  (1,787) (1,760) (27)  Did Not Attend (DNA) Appointments - FSA MRI Wait List seen in 42 days 90.0% 42.3% MSW Ward Bed Utilisation  Result FSA Target FSA PROVIDER MTD ($000) 15.0% Result Target Actual vs PROVIDER YTD ($000) 85.0% 48.8% Actual vs Ultrasound Waitlist seen in 42 days  Actual Budget Variance Budget Actual Budget Variance Budget CT Waitlist seen in 42 days 95.0% 91.5%  10.0% 90% (787) (261) (526)  (2,747) (2,382) (365) Urgent Colonoscopy - Wait or Procedure within 14 Days 90.0% 100.0%   5.0% FUNDER MTD ($000) Actual vs Non-Urgent Colonoscopy - Wait or Procedure within 42 Days 70.0% 75.7%  FUNDER YTD ($000) Actual vs 40% Actual Budget Variance Budget Surveillance Colonoscopy - Wait or Procedure within 84 Days 70.0% 64.6%  0.0% Actual Budget Variance Budget (343) 34 (377)  821 625 196 Urgent Colonoscopy Non-Urgent Colonoscopy  PROVIDER - Variance Surplus/(Deficit) - YTD Result Target 90% Result Target 70% C-Section Rate Acute Readmissions FUNDER - Variance Surplus/(Deficit) - YTD ($000) 100% 100% Result Target Result Target 500 ($000) 50% 10.0% 800 40% 600 30% 50% 50% 5.0% 0 400 20% 200 10% 0% 0% 0% 0 0.0% -500

-200

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31 2021 04 27 WrDHB Public Board - Information

QUALITY MEASURES

Patient Falls SAC 1 - 2 (from July-19) Medication Errors SAC 1 - 3 Compliments Complaints Hospital Acquired Pressure Areas SAC 1 - 3 25 20 8 8 20 6 15 4 4 4 15 10 10 2 0 0 5 5 0

-4 -4 0 0 -2

Jul-18 Jul-19 Jul-20 Jul-17

Jul-18 Jul-19 Jul-20 Jul-17 Jul-18 Jul-19 Jul-20 Jul-17 Jul-18 Jul-19 Jul-20 Jul-17

Jul-17 Jul-18 Jul-19 Jul-20

Nov-16 Nov-17 Nov-20 Nov-18 Nov-19

Mar-17 Mar-18 Mar-19 Mar-20 Mar-21

Nov-16 Nov-17 Nov-18 Nov-19 Nov-20 Nov-17 Nov-18 Nov-20 Nov-18 Nov-19 Nov-20 Nov-16 Nov-17 Nov-16 Nov-19

Mar-17 Mar-18 Mar-19 Mar-20 Mar-17 Mar-18 Mar-19 Mar-20 Mar-21 Mar-17 Mar-18 Mar-20 Mar-21 Mar-21 Mar-19

Nov-16 Nov-19 Nov-20 Nov-17 Nov-18

Mar-17 Mar-18 Mar-19 Mar-21 Mar-20

STAFF INTER DISTRICT FLOWS

YTD FTE Actual Budget Var IDF Outflow - CWD IDF Inflow - CWD Staff Turnover Actual Budget Medical 39.2 49.5 10.2 5,000 Actual Budget Actual % Target 13% 300 Nursing 239.0 255.3 16.3 20% 4,000 3,000 200 Allied 67.1 80.8 13.7 15% 2,000 Support 16.0 15.8 - 0.2 10% 1,000 100 Mgmt/Admin 100.8 112.6 11.7 0 5% 0

Total Jul Jan

462.2 513.9 51.7 Jun

Oct

Apr

Sep Feb

Dec

Aug

Nov

Jul

Mar

May

Jan

Jun

Oct

Apr

Sep Feb

Dec

Aug

Nov Mar 0% May Appraisals Last 14m 35%

Jul-20 NOTES - MARCH 2021

Jan-20 Jan-21

Jun-20

Oct-19 Oct-20

Apr-20

Sep-20 Feb-20 Feb-21

Dec-19 Dec-20

Aug-20

Nov-19 Nov-20

Mar-20 Mar-21 May-20 From July-18 the definitions for Hospital Acquired Pressure Areas and Patient Falls have been % Sick Leave redefined. Faster Cancer and Planned Care are impacted by timing of data submission. Actual Target 2.5% No. of Staff with >24 Months Annual Leave 5% 75 75 74 67 69 67 64 64 4% 62 60 61 62 61 55 56 56 56 57 3%

2%

1%

0%

Jul-20

Jul-20

Jan-20 Jan-21

Jun-20

Jan-21 Oct-19 Oct-20 Jan-20

Apr-20

Jun-20

Feb-20 Sep-20 Feb-21

Oct-19 Oct-20

Dec-19 Dec-20

Apr-20

Aug-20 Feb-20 Sep-20 Feb-21

Nov-19 Nov-20

Dec-19 Dec-20

Aug-20

Mar-21 Mar-20

Nov-19 Nov-20

Mar-21 Mar-20

May-20 May-20

32 2021 04 27 WrDHB Public Board - Information

Wairarapa DHB Planned Care Performance for February 21

5 6 7 8 9 10 11 12 13 14 15 16 Planned volumeActual volume Planned caseweightsActual caseweights PLANNED CARE INTERVENTIONS ▲ 104.4% PLANNED CARE INTERVENTIONS / ACUTE READMISSION AR ▲ 10.9% PATIENT EXPERIENCE SURVEYS PERIOD: November 2019

Response 2020 2021 Interventions Caseweights Inpatient Experience Survey questions: (% Yes, completely / Yes, always) Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Plan Actual % Plan Actual % Feb 19 May 19 Aug 19 Nov 19 Planned 247 568 871 1,176 1,492 1,720 1,971 2,210 2,551 2,793 3,118 3,404 Non Surgical PUC with Surgical DRG 59 57 96.6% 157.5 125.9 79.9% Before the operation did staff explain the risks and benefits in a way you could understand? 84.8 87.0 91.2 92.0 Actual 312 634 922 1,227 1,536 1,821 2,018 2,307 Surgical PUC 1,568 1,545 98.5% 2,115.1 2,037.6 96.3% Did staff tell you how the operation went in a way you could understand? 71.9 82.6 82.9 85.2 Variance 65 66 51 51 44 101 47 97 Inpatient Surgical Discharges 1,627 1,602 98.5% 2,272.6 2,163.5 95.2% Did hospital staff include your family/whānau or someone close to you in discussions about your care? 61.8 64.0 54.9 57.6 %Achievement 126% 112% 106% 104% 103% 106% 102% 104% Inpatient Minor Procedures 162 84 51.9% Response (% , Nov 2019) 4,000 Primary Care Patient Experience Survey questions: Outpatient Minor Procedures Hospital 397 621 156.4% < 1 week 1-4 weeks 1-3 months > 3 months 3,500 Outpatient Minor Procedures Community 0 0 0.0% 1. How long did you wait to see the specialist doctor? 35.4 34.3 14.1 16.2 Response 3,000 Minor Procedures 559 705 126.1% (% Yes, always) 2,500 2. When you received care or treatment from specialist doctors, did they do the following: Feb 19 May 19 Aug 19 Nov 19

2,000 Non Surgical Interventions 24 0 0.0% a) Ask what is important to you? 55.9 52.2 46.6 54.9 1,500 Total 2,210 2,307 104.4% b) Tell you about treatment choices in ways you could understand? 74.0 71.4 60.8 74.2 1,000 c) Involve you in decisions about your care or treatment as much as you wanted to be? 70.9 71.4 59.2 71.4 3. Does your GP/nurse seem informed about the care you get from specialist doctors? 67.3 66.0 69.4 78.0 500 Acute Readmission Measure (0 - Standardized Acute Number of Agreed AR 28 days) Readmission Rate Readmissions Target Rate 0

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Year to Sep 2020 10.9% 822 10.5% For more information regarding the patient experience surveys please contact your DHB’s System Level Measure ACCESS, QUALITY, EXPERIENCE Year to Sep 2019 10.6% 801 (SLM) team or visit your DHB’s patient experience survey reporting portals. Non Surgical Intervention Minor Procedures Inpatient Surgical Discharges Planned

Colume look up 8 9 10 11 12 13 14 15 ESPI colum lookup4 17 20 23 26 29 32 35 38 40 ESPI colum lookup4 17 20 23 26 29 32 35 38

ESPI RESULTS 0 Consecutive Months Red FCT (31 DAY) 90.0% ESPI 2 - BY SERVICE All Services Compliant ESPI 5 - BY SERVICE 5 Non Compliant Services

#REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! Consecutive 0 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! 0 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! months red 3 month 2020 2021 2020 2021 3 mth 2020 2021 3 mth ESPI to Feb trend Imp Req Imp Req Jul Aug Sep Oct Nov Dec Jan Feb 21 Jul Aug Sep Oct Nov Dec Jan Feb Trend Jul Aug Sep Oct Nov Dec Jan Feb Trend ESPI 1 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Plastics 0.0% 0.0% 0.0% 0.0% 0.0% 100.0% 100.0% 100.0% 1 ▬ 0 ▬ 0 Level 0 0 0 0 0 0 0 0 General Surgery 0.0% 0.0% 0.0% 0.0% 0.0% 2.5% 2.2% 3.3% 3 ▲ ESPI 2 0.1% 0.0% 0.0% 0.0% 0.0% 0.5% 1.8% 0.0% Gynaecology 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 2.9% 1 ▲ 0 ▼ 0 Level 1 0 0 0 0 6 21 0 Ophthalmology 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 2.0% 2 ▲ ESPI 3 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Orthopaedics 24.0% 7.9% 0.0% 2.3% 0.0% 2.2% 3.0% 1.3% 1 ▼ 0 ▬ 0 Level 0 0 0 0 0 0 0 0 ESPI 5 9.5% 3.0% 0.0% 0.6% 0.0% 1.5% 1.7% 2.5% 0 ▲ 0 Level 30 9 0 2 0 5 6 8 ESPI 8 100.0% 99.3% 99.2% 100.0% 100.0% 100.0% 100.0% 100.0% 0 ▬ 0 Level 0 1 1 0 0 0 0 0

ACCESS, TIMELINESS Faster Cancer 2020 2021 3 month Treatment Jul Aug Sep Oct Nov Dec Jan Feb trend FCT % 85.7% 100.0% 92.0% 88.2% 96.2% 88.0% 91.7% 90.0% ▲ Level 12 33 23 15 25 22 22 27

5 Ophthalmology ESPI 24 Colour5 6 7 8 9 10 11 12 13 14 15 18 18 18 18 18 18 19 19 19 19 19 19 19 35 46 57 68 79 108 119 1012 1113 1214 1 15 2 16Ophthalmology ESPI 5 Colour 35 46 57 68 79 108 119 1012 1113 1214 151 162 4 90 130 174 229 2613 3117 3522 3926 4331 4835 5239 43 DIAGNOSTICS PERFORMANCE CT 83.1% MRI 0.0% Angiography OPHTHALMOLOGY WAITING TIMES ESPI 2 0.0% ESPI 5 2.0% FUA (50%) 0.0% CARDIAC SURGERY DELIVERY 68.7% WAITING OVER TIMEFRAME 17 Cardiac Provider: Capital and Coast DHB 2020 2021 2020 2021 2020 2021 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

CT 90.9% 73.4% 85.7% 96.4% 97.1% 97.1% 95.5% 96.1% 98.4% 84.7% 80.5% 83.1% ESPI 2 0.0% 19.4% 11.4% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.4% 0.0% 0.0%

23Aug 27Sep 25Oct 29Nov 27Dec 31Jan 28Feb 28Mar 25Apr 30May 27Jun Ophthalmology ESPI 2 % 26Jul MRI 50.4% 34.1% 38.9% 50.7% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% OphthalmologyESPI 5 ESPI 5 %0.0% 5.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 2.0% 0 Delivery 73.5% 76.0% 69.5% 68.8% 67.3% 68.9% 68.6% 68.7% # Overdue Followups 0 200 150 0 0 0 0 0 0 0 0 0 Waiting list 67 52 59 65 67 69 60 55 50% Overdue 0.0% 19.1% 13.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 Max Waiting 76 76 76 76 76 76 76 76 100.0% 0 100% Overdue 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% OverTimeframe 14 7 8 8 7 5 13 17

80.0% 0 80 120% 25.0% 70 60.0% 110% 20.0% 60 100% 50 40.0% 15.0% 90%

TIMELINESS 40 80%

20.0% 10.0% 30 Delivery Waiting list Waiting 20 70% 0.0% 5.0% 10 60% Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb 0.0% 0 50% 2020 2021 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb 26 Jul 23 Aug 27 Sep 25 Oct 29 Nov 27 Dec 31 Jan 28 Feb 28 Mar 25 Apr 30 May 27 Jun 2020 2021 2020 2021 CT MRI Angiography CT and Angiography Indicator (95%) MRI Indicator (90%) ESPI 2 ESPI 5 50% Over Due 100% Over Due Waiting list Outside timeframe Max Waiting Delivery

Report to: Feb 21 Data Extracted on: 05/04/21

33 2021 04 27 WrDHB Public Board - Information

Definitions & Information

PLANNED CARE INTERVENTIONS PLANNED CARE INTERVENTIONS / ACUTE READMISSION PATIENT EXPERIENCE SURVEYS

Data Source - Planned Care Interventions Data Source Data Source

This data is sourced from the DHB monthly Planned Care Interventions (PCI) report summary page. This table and This data is sourced from the DHB monthly PCI report and YTD performance against plan for the Planned Care These data are sourced from the Health Quality and Safety Commission’s (the Commission) quarterly national graph shows monthly YTD delivery against the planned YTD delivery. Intervention Groups, YTD Caseweight Summary for Inpatient Surgical Discharges adult inpatient and primary care patient experience surveys. Selected questions from both surveys have been What do the colours mean? What do the colours mean? chosen to recognise the Experience and Equity principles within the Planned Care Programme. A rolling four quarters of data are displayed. The colour code below determines whether the performance meets expectations (green) or does not (red). This is the The colour code below determines whether the performance meets expectations (green) or does not (red). This same as in the Planned Care Interventions reports. is the same as in the Planned Care Interventions reports. For the wait time to see a specialist question, the percent of respondents who selected each response option in Green Greater than or equal to 100% ▬, ▲, Green Greater than or equal to 100% ▬, ▲, the latest quarter is provided. For all other questions, the percentage displayed is the percentage providing the Change from previous month Change from previous month Red Less than 100% or ▼ Red Less than 100% or ▼ most positive response to the question. What other information is available regarding the patient experience surveys? Data Source - Acute Readmissions For more information regarding the patient experience surveys please contact your DHB's System Level This data is sourced from the quarterly Acute Readmission (AR) reporting. The figures are the most recent Measure (SLM) team; visit your DHB's patient experience survey reporting portals; or visit the Commission’s quarter's Standardised Acute Readmission rate and number of Observed Readmissions for the 0-28 days website measure, and the same numbers for the same period 12 months ago. (https://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/patient-experience) What do the colours mean? In the top right hand corner of this box next to the title is the % result for the latest period, the colour code below determines whether the performance meets expectations (green) or does not (red). Green Less than or equal to planned AR rate ACCESS, QUALITY, EXPERIENCE ▬, ▲, Change from previous period's standardised Red Greater than planned AR rate or ▼ rate

ESPI - DHB LEVEL / FCT (31 DAY) ESPI 2 - BY SERVICE ESPI 5 - BY SERVICE

Data Source - Elective Services Patient Flow Indicator (ESPIs) Data Source Data Source This data is sourced from the DHB Final ESPI Reports. Also included is the Total number of consecutive months of Red ESPI performance, and a 3 month trend of ESPI performance for each ESPI. This data is sourced from the DHB monthly Final ESPI Reports, including the Improvement Required, and a 3 This data is sourced from the DHB monthly Final ESPI Reports, including the Improvement Required, and a 3 month trend arrow. The ESPI result in this report is for an 8 month period, and only services which are currently month trend arrow. The ESPI result in this report is for an 8 month period, and only services which are currently What do the colours mean in the title bar? non compliant, or have been non compliant at least once in the last 4 months will appear on this report. non compliant, or have been non compliant at least once in the last 4 months will appear on this report. In the top right hand corner of this box next to the title is the period of Red level ESPIs non compliance. Green All ESPI Results at a DHB Level are either Green or Yellow What do the colours mean in the title bar? What do the colours mean in the title bar? Orange The first month of the DHB having a Red ESPI at a DHB Level In the top right hand corner of this box next to the title is the number of non compliant services for ESPI2 for the In the top right hand corner of this box next to the title is the number of non compliant services for ESPI5 for the Red The DHB has had 2 or more consecutive months with a Red ESPI at a DHB Level current month. current month. What do the colours mean in the table? Green All services are compliant Green All services are compliant The colours show whether a DHB is compliant (green) or non compliant (yellow and red) for each ESPI. Orange Equal to or less than 3 services non compliant Orange Equal to or less than 3 services non compliant Data Source - Faster Cancer Treatment (FCT) 31 Day Indicator Red Greater than 3 services are non compliant Red Greater than 3 services are non compliant

This data is sourced from the DHB Faster Cancer Treatment (FCT) Reporting Database. This measure indicates whether 85% of What do the colours mean in the table? What do the colours mean in the table? patients receive their first cancer treatment (or other management) within 31 days from date of decision-to-treat. Please note that the The colours for each cell show whether a DHB is compliant (green) or non compliant (yellow or red) for each The colours for each cell show whether a DHB is compliant (green) or non compliant (yellow or red) for each

FCT data may vary from the SS01 Quarterly Reporting measure due to the date of extraction. service. A warning light (box will turn orange) for the 3 Month Trend arrow when a service if the three month service. A warning light (box will turn orange) for the 3 Month Trend arrow when a service if the three month ACCESS, TIMELINESS What do the colours mean in the title bar? trend is worsening. trend is worsening. Green DHB met 85% Indicator for the latest month. Red DHB not met 85% Indicator for the latest month. From July 2012 onwards Prior to July 2013 the definition of ESPI 2 is the number of patients waiting From July 2012 onwards Prior to July 2013 the definition of ESPI 5 is the number of patients waiting What do the colours mean in the table? Green = 0% over 6 months for FSA. Between July 2013 and December 2014 the Green = 0 % over 6 months for Treatment. Between July 2013 and December 2014 the definition of ESPI 2 is the number of patients waiting over 5 months for FSA, definition of ESPI 5 is the number of patients waiting over 5 months for Green DHB met 85% Indicator for the month. Red DHB not met 85% Indicator for the month. Yellow > 0% but < 0.4% and from January 2015 the definition of ESPI 2 is the number of patients Yellow > 0% but < 1% Treatment, and from January 2015 ESPI 5 is the number of patients waiting Red > = 0.4% waiting over 4 months for FSA. Red > = 1% over 4 months for Treatment.

DIAGNOSTICS PERFORMANCE OPHTHALMOLOGY WAITING TIMES CARDIAC SURGERY

Data Source Data Source Data Source This data is sourced for FSA and Treatment waiting times from the monthly DHB ESPI reporting, and the follow This data is sourced from the weekly reporting supplied from each of the five DHB cardiac units (Auckland, The data is sourced from the monthly Diagnotics Reporting, the table and graph show the DHB % for a 12 month trend up information is sourced from the collection used through the Ophthalmology service improvement Waikato, Capital & Coast, Canterbury, and Southern). for CT, MRI and Angiography against the respective national indicator percentage expectations. programme. What does the coloured cells mean in the title bar and in the table? What does the coloured traffic light mean? In the top right hand corner of this box next to the title is the regional provider % delivery for the latest week and What does the coloured cells mean in the title bar and in the table? the national number of patients waiting greater than the 90 day expectation for surgery. This is also shown in the In the top right hand corner of this box next to the title is the DHB % result for the latest month for waiting time table below with the % every four weeks, the colour code below determines whether the performance meets In the top right hand corner of this box next to the title is the DHB % result for the latest month for CT, MRI and results for Ophthalmology for ESPI 2, ESPI 5 and % of patients waiting longer than 50% overdue for their follow expectations (green) or does not (red). Angiography. This is also shown in the table below with the % by month for the 12 month period, the colour code below up appointment or treatment. This is also shown in the table below with the % for a 12 month period, the colour determines whether the performance meets expectations (green) or does not (red). This is the same as in the code below determines whether the performance meets expectations (green) or does not (red). This is the The graph shows the total waiting list, the number on the waiting list for greater than the expected timeframe, the Diagnostics reporting. same as in the ESPI reports for ESPI 2 and ESPI 5. maximum acceptable waitlist and the delivery.

CT MRI Angiography ESPI 2 ESPI 5 Follow up (50% and 100%) TIMELINESS Greater than or equal to Greater than or Greater than or equal to Green = 0% Green = 0 % Green = 0 % Green Green Green 95% equal to 90% 95% Yellow > 0% but < 0.4% Yellow > 0% but < 1% Red > 0% Red Less than 95% Red Less than 90% Red Less than 95% Red > = 0.4% Red > = 1% NOTES: % delivery Waiting over timeframe The measure is a DHB of service measure, where NA is present this means the DHB is not the provider for Green 100% Green 0 patients NA the service and other DHB provides this service. Red Less than 100% Red Greater than 0 ND This indicates that no data is currently available, as the DHB has been unable to supply this.

34 2021 04 27 WrDHB Public Board - Other

BOARD DECISION PAPER

Date: April 2021

Author Sir Paul Collins, Wairarapa District Health Board Chair

Subject Resolution to Exclude the Public RECOMMENDATION It is recommended that the Board a. Agrees that Public be excluded from the following parts of the of the Meeting of the Board in accordance with the NZ Public Health and Disability Act 2000 (“the Act”) where the Board is considering subject matter in the following table. b. Notes The grounds for the resolution is the Board, relying on Clause 32(a) of Schedule 3 of the Act believes the public conduct of the meeting would be likely to result in the disclosure of information for which good reason exists under the Official Information Act 1982 (OIA) to withhold, in particular:

SUBJECT REASON REFERENCE

Public Excluded Minutes Section Information provided in confidence Excluded Chief Executive Report 9(2)(ba) Finance Report Information on change processes that may enable Section People, Capability and Organisational affected individuals to be identified 9(2)(a) Development Report

Enable a Minister of the Crown or any department or 3DHB Unified Communications (Voice) Clause 9,2 organisation holding the information to carry on, Project Implementation Business Case (j) without prejudice or disadvantage, negotiations.

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