2019 11 25 Wairarapa Board Meeting PUBLIC - Agenda
Public Board Meeting
Meeting Date: Monday 25th November 2019
Meeting Time: 12:00pm
Venue: Board Room CSSB Building Wairarapa DHB
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Wairarapa District Health Board
Well Wairarapa : Better health for all
Government Priorities 2019/20 “Improving the wellbeing of New Zealanders and their families“
Improving child wellbeing Improving mental wellbeing
Better population health outcomes Improving wellbeing through prevention supported by a strong and equitable public health and disability system
Better population health outcomes Strong fiscal management supported by primary health care
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AGENDA Held on Monday 25th November 2019
Lecture Room, CSSB Building, Wairarapa DHB, Masterton Commencing at 12:00pm – 01:35pm
BOARD PUBLIC SESSION Item Action Lead Minute Allocation PG 1. Procedural Business 1.1. Karakia 5 1.2. Apologies Accept Continuous disclosure Accept 1.3. 6 Interest/Conflict register Confirm 1.4. Minutes October 2019 Meeting Accept Sir P Collins 25 12:00pm 10 1.5. Actions October 2019 15 1.6. Draft 2019 Board Work Plan Accept 16 1.7. Chairperson Report Verbal 1.8. Chief Executive Report Note D Oliff 17 2. . Patient Story Verbal C Stewart 15 12:25pm 3. Decision Approve 3.1 Wairarapa DHB 2019/20 Tobacco Control Plan S Williams 10 12:40pm 21 Decline Community & Public Health Advisory Approve 3.2 S Williams 10 12:50pm 23 Committee (CPHAC) Updates Decline 3DHB Sub Regional Pacific Health & Wellbeing Approve T Suafole 3.3 10 01:00pm 25 Strategic Plan 2020/25 Decline Gush 4. Information 4.1 Financial Report Note S Flavin 5 01:10pm 27 4.2 Hospital and Community Services Report Note K McCann 5 01:15pm 48 4.3 Planning & Performance Report Note S Williams 5 01:20pm 63 Wairarapa DHB Quality, Risk & Innovation 4.4 Note C Stewart 5 01:25pm 67 Quarterly Report 5. Other 5.1 General Business 5 01:30pm 81 5.2 Resolution to Exclude the Public Agree Date of next meeting: Monday 16th December 2019
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Appendices # Item PG 1.1 Karakia 5 1.3 Continuous disclosure Interest/Conflict register 6 1.4 Minutes October 2019 meeting 10 1.5 Actions October 2019 15 1.6 Draft 2019 Board work plan 16 1.7 Chief Executive Report 17 1.7.1 Media of Interest for October 2019 82 1.7.2 Wairarapa DHB Code Red & elective surgery waitlists article 84 3.1 Wairarapa DHB 2019/20 Tobacco Control Plan paper 21 3.1.1 Wairarapa DHB 2019/20 Tobacco Control Plan 85 3.2 Community & Public Health Advisory Committee (CPHAC) Updates 23 3.2.1 Community & Public Health Advisory Committee (CPHAC) Terms of Reference (ToR) 96 DRAFT Public Community & Public Health Advisory Committee (CPHAC) October 2019 3.2.2 98 minutes DRAFT Excluded Community & Public Health Advisory Committee (CPHAC) October 2019 3.2.3 101 minutes 3.3 3DHB Sub Regional Pacific Health & Wellbeing Strategic Plan 2020/25 25 4.1 Finance Report 27 4.2 Hospital & Community Services Report for November 2019 48 4.2.1 Wairarapa DHB Planned Care Performance for September 2019 190 4.3 Planning and Performance Report for November 2019 63 4.4 Wairarapa DHB Quality, Risk & Innovation Quarterly Report 67 4.4.1 Wairarapa DHB HDC report January – June 2019 159 5.2 Resolution to Exclude the Public November 2019 81
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Karakia Tuia ki runga, Tuia ki raro Tuia ki roto, Tuia ki waho Ka rongo te ao, Ka rongo te pō Haumi e, Hui e Taiki e ------Unite above Unite below Unite without Unite within Listen to the night Listen to the world Now we come together As one.
Wairarapa District Hutt Board
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Wairarapa Board INTEREST REGISTER Name Interest Sir Paul Collins ∑ Director of: Active Equity Holdings Limited (Chair) Chair Hurricanes GP Limited Ides Limited Shott Beverages Limited Technical Advisory Services Limited ∑ Director and shareholder of: AEL Managers Limited Beverage Holdings Limited Cohiba Traders Limited Ecopoint Limited Tofino Trustee Limited ∑ Member of shareholders Review Group for New Zealand Health Partnerships Limited Mrs Leanne Southey ∑ Chair, Wairarapa District Health Board, Finance Risk & Audit Committee Deputy Chair ∑ Deputy Chair, Wairarapa District Health Board ∑ Chair of Lands Trust Masterton (15 February 2016) ∑ Director, Southey Sayer Limited ∑ Chartered Accountant to Health Professionals including Selina Sutherland Hospital and Selina Sutherland Trust ∑ Trustee, Wairarapa Community Health Trust ∑ Shareholder of Mangan Graphics Ltd ∑ Member of UCOL Council Dr Nicholas Crozier ∑ Board Member Compass Health Member ∑ Branch Medical Advisor ACC ∑ GP Masterton Medical ∑ Board Member Cancer Society Dr Liz Falkner ∑ Member, Wairarapa District Health Board Member ∑ Member, WRDHB Hospital Advisory Committee (30 March 2016) ∑ Retired General Practitioner with Masterton Medical Limited ∑ Medical Advisor – Post Polio Support Society NZ Inc ∑ Sister in Law works part time at Wairarapa District Health Board (23 February 2016) Ms Jane Hopkirk ∑ Member, Wairarapa District Health Board Member ∑ Member, Wairarapa, Hutt Valley and CCDHB Disability Support Advisory Committees (30 March 2016) ∑ Member, Wairarapa Te Iwi Kainga Committee ∑ Data Analyst, Takiri Mai Te Ata, Kokiri Hauora Mr Ronald Karaitiana ∑ Member, Wairarapa District Health Board Member ∑ Member, Wairarapa Te Iwi Kainga Committee ∑ Member, Wairarapa District Health Board, Finance Risk & Audit Committee ∑ Akura Lands Trust Chairman ∑ Extended family members work in varying roles at DHB ∑ Chair of WrDHB Hospital Advisory Committee ∑ CE Te Hauora Runanga o Wairarapa ∑ RK Consulting Ltd, Business owner ∑ Whanau ora Collective Member Te Hauora and Whaiora via Te Pou Matakana
Updated: 2019-11-14 1
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Name Interest Mr Rick Long ∑ Member, Wairarapa District Health Board Member ∑ Member, Wairarapa District Health Board, Finance Risk & Audit Committee ∑ Chairman of Wairarapa Community Transport Services Inc ∑ Chairman of Tolley Educational Trust ∑ Trustee for Sport and Vintage Aviation Society ∑ Member of Masterton Lands Trust ∑ Director, Longs Properties Limited (1 February 2016) Mr Derek Milne ∑ Member of 3DHB DSAC Member ∑ Brother-in-law is Chairman of Health Care NZ ∑ Daughter works as GP at Masterton Medical Ltd (MML) Ms Fiona Samuel ∑ Member of Wairarapa District Health Board Member ∑ Casual Nurse at Wairarapa Hospital ∑ Duty Nurse Manager at Wairarapa Hospital (on a casual basis) ∑ Contractor Auditor for Central Technical Advisory Services Ltd ∑ Member of Clinical Board at Wairarapa District Health Board ∑ Violence Intervention Programme o Clinical Co-ordinator from 22 August 2017 o Casual from November 2018 ∑ Director in Primary Care Development Ltd ∑ Contractor working with Whaiora Whanui Dr Alan Shirley ∑ Member, Wairarapa District Health Board Member ∑ Member, Wairarapa, Hutt Valley and CCDHB DSAC ∑ Surgeon at Wairarapa Hospital ∑ Wairarapa Community Health Board Member ∑ Wairarapa Community Health Trust Trustee (15 September 2016) Mrs Adrienne Staples ∑ Councillor – Greater Wellington Regional Council Member ∑ Director – Sanctuary Hill Limited ∑ Trustee – Staples Property Trust ∑ Board Member – NZ Geographic Board
Updated: 2019-11-14 2
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Wairarapa DHB Executive Leadership Team Interest Register
Name Interest
Dale Oliff ∑ No interests declared Chief Executive Wairarapa DHB Tofa Suafole Gush ∑ Member of the Te Awakairangi Health Board Director Pacific Health ∑ Member Compass Health Network
∑ Husband is an employee of Hutt Valley DHB
Nigel Fairley ∑ Fellow, NZ College of Clinical Psychologists General Manager, 3DHB Mental ∑ President, Australian and NZ Association of Psychiatry, Health Addictions & Intellectual Disability Service ∑ Psychology and Law ∑ Trustee, Porirua Hospital Museum
∑ Director and Shareholder, Gerney Limited
Jason Kerehi ∑ Negotiator – Rangitane Settlement Negotiations Trust Executive Leader Māori Health ∑ Trustee – Rangitane Tu Mai Ra – Post Settlement Governance Entity
∑ Partner is employed as a school nurse by Compass Health Tracy Voice ∑ Secretary, New Zealand Lavender Growers Association CIO, 3DHB ∑ Board Member, Primary Growth Partnership with PGG Wrightsons/Grassland Seed Technology Innovation
Michele Halford ∑ No interests declared Executive Leader Nursing Nigel Broom ∑ Treasurer, Martinborough School Board of Trustees Executive Leader Planning & Performance Chris Stewart ∑ Member St Matthews Collegiate BOT Executive Leader Quality Risk & Innovation Selena McKay ∑ No interests declared Executive Leader People & Capability Anna Cardno ∑ No interest declared Communications Manager
Wairarapa District Hutt Board Month Year Page 1 of 2
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Name Interest Kieran McCann ∑ Partner works part time as an RN on MSW Executive Leader Operations Liz Stockley ∑ Substantive role – Director Primary Care, Compass Health Director of Primary Care, ∑ CEO, GPNZ Wairarapa Compass Health ∑ National Board Member, Girl Guiding NZ ∑ Director of Strong Point Ltd – Electrical contracting based in Wairarapa (Husband’s business)
Sandra Williams ∑ No interests declared Acting Executive Leader Planning and Performance Susan Flavin ∑ Employed by Hutt Valley DHB Acting Executive Financial Officer Shawn Sturland ∑ Intensive Care Specialist Capital and Coast DHB Chief Medical Officer ∑ My partner, Holly Brindle, is a DNM at Wairarapa Hospital
Wairarapa District Hutt Board Month Year Page 2 of 2
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PUBLIC Minutes: Kadeen Williams , Board Secretary
Held on 21ST October 2019 Lecture Room, CSSB Building, Wairarapa Hospital, Masterton Commencing at 9:30am – 10:53am
Board Meeting Public Board Members Present Leanne Southey Deputy Chair Adrienne Staples Member Nick Crozier Member Liz Falkner Member Rick Long Member Jane Hopkirk Member Ron Karaitiana Member Derek Milne Member Rick Long Member Executive Leadership Team Present Dale Oliff CEO WrDHB Sandra Williams Acting Executive Leader Planning & Funding Michele Halford Director of Nursing Jason Kerehi Executive Leadership Māori Health Anna Cardno Communications Manager Shawn Sturland Chief Medical Officer Kieran McCann Executive Leader Operations Jason Kerehi Executive Leader Māori Health Visitors Jill Stringer New Board Member Eli Times Age Absent Sir Paul Collins Board Chair Alan Shirley Member Fiona Samuels Member 1. Procedural Business
1.2 Apologies As noted above
1.3 Minutes from previous meeting: September 2019
∑ The Board RESOLVED to approve the minutes of the Members’ (Public) meeting held in September 2019 as a true and accurate record of the meeting.
Moved J.Hopkirk Second D.Milne Carried
1.4 Action Items Register
∑ NOTE: Action for patient food by large our food is under direction of dieticians and food has had a lot of effort and will be a constant action
Wairarapa DHB October 2019 Board Meeting Page 1 of 5
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PUBLIC
1.5 Interest/Conflict Register
∑ The Board NOTED that no changes to the interest register were declared in the meeting ∑ The Board CONFIRMED that it was not aware of any matters (including matters reported to, and decisions made, by the Board at this meeting) that require disclosure and that there would be an opportunity to declare any conflicts prior to discussion on each item of the agenda.
Work plan
ACTION: Provide Board with DRAFT 2020 work plan and schedule
1.6 Chairperson reports
∑ Nothing to report
1.7 Chief Executive Reports
The report was taken as READ NOTES this paper and discusses as appropriate The Board: a. NOTED MHAIDs project team held three meetings in Wairarapa to capture input for a co-development for new stricture which is still progressing b. NOTE: Countdown kids Charity Ball was a great event with members of the Executive and other staff attending c. NOTE: Oracle went live 1st October, fundamental new project and congratulations to the project team and staff
2 Decision
2.1 Old Hospital Demolition
The report was taken as READ NOTES this paper and discusses as appropriate The Board: a. NOTED Timelines are relatively fluid as they are based around the contract being awarded by LINZ b. NOTED interest with the RMO accommodation
ACTION: Provide the Board a map of LINZ/WrDHB owned lands
3.Information Financial Report The report was taken as READ NOTES this paper and discusses as appropriate The Board a. NOTED Forecast is conservative to be $100K better for year end b. NOTED Accounts payable/receivable above budget due to ministry/PHARMAC revenue and accruals being higher for funder expenditure
Wairarapa DHB October 2019 Board Meeting Page 2 of 5
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Hospital and Community Services The report was taken as READ NOTES this paper and discusses as appropriate The Board c. NOTED Recruitment is ongoing for multiple roles in the hospital d. NOTED Long term locums for continuity of care for patient e. NOTED Maternity has been significantly busier with a higher rate of C-section, and births f. NOTED Orthopaedics planned procedures are down which is causing pressure for waiting times. There have been a number of changes due to strike actions. Alternative treatment options are being taken into consideration where appropriate care for patients g. NOTED Theatre procedures improvement project happening for best use of time in theatre rooms and staff. The concept of having a “stand-by list” for patients with improved communications h. NOTED intensive physio therapy has been an option raised i. NOTED Focus are moving to Lincoln Road which will addresses the issue with access
ACTION: Provide achievement positions to show progress with the theatre improvement project when provided Māori statistics to be included where appropriate for statistical reporting Planning and Performance Report The report was taken as READ NOTES this paper and discusses as appropriate The Board a. NOTED Annual Plan has been sent to the Ministry b. NOTED Annual Report going through process c. NOTED 2020 Annual Plan is happening d. NOTED Measles are getting on track with more vaccinations coming. Wairarapa has only had one case from January 2019 e. NOTED Local responses need to be with providers (GPS etc.) to make sure that the public have access to MHAIDs services f. NOTED Māori Mental health RFP due to be released February 2020 g. NOTED Aged concern expo in Wairarapa which provided a wider reach than previous years h. NOTED Featherston medical centre will have a medical room available for the WrDHB to i. NOTED Steven Earnshaw will be working with WrDHB on how we can improve our systems and be innovative with how we present ourselves at the Wairarapa “5” DHB Equity Priorities The report was taken as READ NOTES this paper and discusses as appropriate The Board a. NOTED Māori Diabetes Target; working with S.Sturland. M.Halford. PHOs. The group has meet and are working on the management of Diabetes with Māori. Focus is with patients who have not had follow up within 6months and those who have not had an HBC within 1year. WrDHB have data showing that 70 people are in these groups.
Wairarapa DHB October 2019 Board Meeting Page 3 of 5
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PUBLIC Kia Ora Hauroa will have some further details with statistics, Hera Edwards lead this. WrDHB Board would like to work in partnerships with a wider big picture with strategic investments b. NOTED first 1000 days, Milestone was getting the midwifery director, antenatal Māori Class, Taranaki have introduced Kaupapa Māori antenatal classes which we would like to introduce in the Wairarapa c. NOTED Māori Youth Mental Health, we will be developing with a Māori provider to ensure we are able to receive some of the funding. PG88 is suitable but we need to look at how to make it happen locally d. NOTED Respiratory looking at how we can improve the 18/19 actions with increase smokefree homes, data to be correct, housing assessments and what their outcomes are (improvements) e. NOTED Oral Health, Letters have been written requests of assistance. They have indicated we may offer a smaller team/surge as an option. We could progress without the NZ Defence Force but it would be harder. This was also included. Management of resources, equipment and commitment to keeping this going in a long term. We are one of the few DHBs who do not have a DHB oral health based service f. NOTE,
ACTION: M.Halford Discussions with Hauora for opportunity to work collaboratively on Diabetes target D.Oliff Dental Bus updates. Logistics for planning and opportunity to have a Regional Dental Bus Wairarapa DHB Dashboard September The report was taken as READ NOTES this paper and discusses as appropriate The Board a. NOTED MRT Strikes are impacting theatre and surgical plans b. NOTED Are the statistics being discussed with the Executive Team and the CEO does discuss and address key issues
ACTION: D.Oliff Immunisations statistics update from PHO
Resolution to exclude the public moved and done
The Board RESOLVED to AGREE that as provided by Clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons:
SUBJECT REASON REFERENCE Public Excluded Minutes For the reasons set out in the 29th July Board agendas Information contained in the paper may be subject to change as the Section information has not yet been reviewed by the FRAC Chief Executive’s report 9(2)(f)(iv) Paper contains information and advice that is likely to prejudice or Section 9(2)(j) disadvantage negotiations Would restrict the DHB from carrying out commercial activities Seismic Remediation Section 9(2)(i) Paper contains information and advice that is likely to prejudice or Wairarapa DHB Annual Section 9(2)(j) Report 2018/19 – Final disadvantage negotiations Draft (V2) for approval (subject to audit sign off) Protect the privacy of natural persons MHAIDs 3DHB August Section 9(2)(a) Update Commercially sensitive information Update on 2018/19 Section 9(2)(i) Financial Result
Wairarapa DHB October 2019 Board Meeting Page 4 of 5
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PUBLIC Resolution to exclude the public moved and done
The Board RESOLVED to AGREE that as provided by Clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons:
SUBJECT REASON REFERENCE Would be likely to prejudice the supply of similar information, or Interim Audit of Section 9 (ba)(i) Wairarapa DHB for year information from the same source, and it is in the public interest that ended 30th June 2019 such information should continue to be supplied Would be likely to prejudice the supply of similar information, or WrDHB Quality, Risk and Section 9 (ba)(i) Innovation By Exception information from the same source, and it is in the public interest that Report such information should continue to be supplied FRAC minutes September Papers contain information and advice that is likely to prejudice or Section 9(2)(j) disadvantage negotiations and are unsigned Correspondence Commercially sensitive information Section9(2)(i)
Moved L.Southery Second D.Milne Carried Closed 10:53am
CONFIRMED that these minutes constitute a true and accurate record Dated this day of 2019.
Leanne Southey Deputy Chair, Wairarapa District Health Board
Wairarapa DHB October 2019 Board Meeting Page 5 of 5
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PUBLIC WrDHB MEETING ACTION
Wairarapa DHB Public Action Register # Lead Action How Dealt with Completed Date
Provide the Board a map of LINZ/WrDHB owned lands to show clear 1. K.Williams Paper included as information for the Board November 2019 boundaries
Dental Bus updates. Logistics for planning and opportunity to have a Update provided in CE Report for December 2. D.Oliff Regional Dental Bus report
Discussions with Hauora for opportunity to work collaboratively on Collective discussions has occurred to collate 3. M.Halford November 2019 Diabetes target data Update provided in CE Report for December 4. D.Oliff Immunisations statistics update from PHO report
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Wairarapa DHB Work Plan 2019
Regular monthly items: Strategy, Planning and Outcomes updates to include Public Chair report CEO report Resolution to exclude the public ALT update Palliative care update Obesity prevention Public Excluded Chair report CEO report FRAC report back FRAC minutes Primary care update Child & Youth health Smoking cessation
January February March April May June July August September October November December
Wairarapa DHB Board and Draft 2019/20 Final Annual Plan Statuary Annual Plan 2019/20 Committees’ DSAC meeting Final Financial n o
i Report Plan 2019/20 s i c e D
4th QTR DAP People & 5 Priorities DAP Draft Annual Plan Report Capability update update 2020/21
Vision, Values, Health & Safety 1st QTR DAP Draft Financial MHAIDs update Voice update Report report Plan 2020/21 OSH, Incidents, adverse events, HDC, Risk Review 48hour Health & Safety n Screening report MHAIDs Report o i register, Patient Readmission Report s s
u experience c s
i HQSC markers D 3DHB MHA Security ICT Role Strategy “Living with TAS (tent) Life Well” n o
i Iwi Kainga t a
t Planning & Consumer
n Clinical Board Pacifica Health
e Funding Council s e r P s t i s i V
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PUBLIC
BOARD INFORMATION PAPER
Date: November 2019
Author Dale Oliff, Chief Executive Wairarapa District Health Board
Subject Chief Executive Public Report to the Board
RECOMMENDATION It is recommended that the Board: a. NOTES this paper and discusses as appropriate APPENDICIES 1. Media of Interest for October 2019 2. Code Red and Elective Surgery Waitlists
1 PURPOSE
The purpose of this paper is to provide the Board with updates from across the hospital and wider Wairarapa Health Community. It highlights work that is occurring at the DHB.
2 COMMUNICATION
Media October 2019
There have been a number of “Media of Interest” items for the month of October 2019 relating to Wairarapa DHB which we have kept the Board updated with via email; Appendix one illustrates this. During October 2019 we also encountered an article in relation to a Hospital code red and our elective surgery waitlists, as referenced in appendix two.
Local Events
Wairarapa Ambulance Service Popup Wellington Free Ambulance have daily “Pop-Up” sessions running between 23rd October – 15th November 2019 to look at the road map for the future resilience and wellbeing of Wairarapa. The sessions are being held in Masterton to help create a co-designed future for the Wellington Ambulance service.
Wairarapa District Health Board Page 1 of 4
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PUBLIC Ministry of Health Cyber Security Incident On the Saturday 5th October the Ministry of Health held a media advisory session; streamed live regarding the cyber security incident originating from Tū Ora Compass Health PHO.
Arbour House Rest Home and Hospital Closure Arbour House announced its closure. Arbour House contributed to the community with age related care services. There were 19 residents who were all successfully transferred to other facilities in the Wairarapa with one resident moving closer to family near Taranaki. We would like to again acknowledge and thank staff for their work throughout the time of Arbour House.
3 NURSING ACTIVITY
There have been a number of staffing changes for the last reporting period. Palliative Care will have a Clinical Coach begin work in quarter one 2020 with the Aged Care Residential (ARC) and Primary Health Nursing staff. A resignation within the Charge Nurse Management (CNM) Assessment, Treatment and Rehabilitation (AT&R) team have opened up the opportunity to further develop with an internal move to the Planning and Performance Team. Recruitment to replace the CNM AT&R role is underway with a closing date of 25th November 2019 for the advertisement. The AT&R Team are working to address an ongoing increase with medical boarder numbers with resources nurses for speciality subjects and conditions. This is in addition to continued upskilling for staff being addressed within the Care Capacity Demand Management (CCDM) programme to ensure patient care. The Emergency Department (ED) nursing staff initiated an x-ray request project and currently with Radiologists for consultation.
Care Capacity Demand Management
The Care Capacity Demand Management (CCDM) Governance group have set up an inpatient quality group partnering with Quality and a Certified Nurse Educator (CNE). The group are working on several work streams providing alignment support for ward quality improvements. The 2019 roster and Full-time Equivalent (FTE) recommendations for the High Dependency Unit (HDU) and Medical Surgical Ward (MSW) have been completed. CCDM have approved and will develop a business case to go through to the Executive Leadership Team. Variance Response Management are developing an integrated operations centre and a virtual operational management environment.
NETP
Following the 2018 mid0year intake four have been successful; including one for Primary Care. One ARC graduate failed to complete requirements despite being offered additional support. We are awaiting finally results from the University’s for our January 2019 intake, all portfolios have been submitted. New graduates for 2020 have been interviewed and ACE Nursing have been informed of our preferred candidates.
Diabetes Equity Imitative
We have completed data collection and will be formalising this into a work programme while developing the Terms of Reference to support our continued work.
Wairarapa District Health Board Page 2 of 4
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4 NZ MEDICAL COUNCIL ACCREDITATION VISIT
The New Zealand Medical Council (MCNZ) undertook a planned accreditation visit to the Wairarapa DHB on the 17th and 18th October 2019 to review progress from their previous visit in 2016. The purpose of MCNZ visiting is to ensure that Register Medical Officer (RMOs) receive the very best of training and experience as they commence practice in Medicine. Wairarapa DHB is part of the Hutt Valley DHB and Capital Coast training network for RMOS and provides a provincial/rural experience which in invaluable as part of their training experience. Whilst the final report has yet to be received, the audit committee provided verbal feedback on the final day they generally found that there has been good improvement and in several areas, there were commendations as well as further recommendation for areas of improvement for the overall training experience for the RMOs. I would like to acknowledge the following Senior Medical Officers (SMO’s) for their commitment to making Wairarapa such a positive experience for the RMOs, Dr Bob Sahakian, General Surgeon, Dr Tim Matthews, Internal Training Supervisors and Dr Shawn Sturland, Chief Medical Officer. The Wairarapa DHB is waiting and looking forward to the final report being received by the end of the year.
5 THE MINISTRY OF HEALTH FORUM HELD 29TH - 30TH OCTOBER 2019
The theme of the forum was “Delivering equity of health and wellbeing in Aotearoa” A clear focus by the speakers and through presentations at the forum was on both equity and enabling wellbeing and were included and explored in detail. Four workshops also addressed the challenges facing the disability and mental health community through’ person –directed support’ sessions and undertaking a strategic approach to the health workforce. The forum was well attended by health leaders across all of the all sectors and served to reinforce the direction of the Minister and the Ministry of Health to make New Zealand a fairer system for all. The Health and Disability System review was also discussed by Heather Simpson and the expert review panel. Leadership for the development of the system was explored along with a more joined up New Zealand health system and options as to what ideas for improving it were invited. The review is to be presented to the Government in March 2020.
6 TRAUMA NETWORK FOR THE CENTRAL REGION DHB’S
The Central Region (CR) continues to work collaboratively on developing and implementing a contemporary Trauma Network in line with the services that are established throughout the rest of New Zealand. The clinical lead Dr James Moore from Capital Coast DHB along with specialist nursing and medical representatives for the CR. The Wairarapa Chief Executive is the lead for this regional work. This is going to be a focus in 2020 for the region as there are very clear improved long-term clinical outcomes for patient by having a timely and responsive service.
Wairarapa District Health Board Page 3 of 4
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PUBLIC 7 ONGOING CE “MEET AND GREET” IN THE WAIRARAPA DHB REGION.
As part of the ongoing meeting and greeting of staff and services, it has been a privilege to meet nearly all the General Practitioners and their staff, Residential care facilities, Hospice and Community groups witnessing first-hand the wonderful commitment to providing services to our community. I have also attended the three Mayors youth employment awards and celebrations for the trades which was invaluable to feel and see the pride that builds important relationships and serves to strengthen health communities.
8 RESIGNATION AND RETIREMENT OF MR ALAN SHIRLEY, SURGEON
I wish to sincerely acknowledge the work and resignation for retirement of Dr Shirley. Alan has been a long serving surgeon for nearly thirty-six years for Wairarapa hospital. This is exceptional dedication to services in a provincial hospital that does not have the large surgical teams as in secondary /metro hospital where there is often a large team to serve the on call needs. Alan was also served as the Chief Medical Officer during that time. Our very good wishes go with you Alan and to your wife Diana for a long and enjoyable retirement.
Wairarapa District Health Board Page 4 of 4
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PUBLIC
BOARD DECISION PAPER
Date: 11 November 2019
From Sandra Williams, Executive Leader Planning and Performance
Author Lisa Burch, Service Development Manager, Planning and Performance
Endorsed By Dale Oliff, Chief Executive
Subject Wairarapa DHB 2019/20 Tobacco Control Plan
RECOMMENDATION It is recommended the Board:
a. Notes the DHB receives funding from the Ministry of Health for the planning and coordination of activities designed to reduce the uptake of smoking and support current smokers to quit. b. Notes in 2019/20 the DHB intends to consolidate its health promotion activities and provide increased support for Māori, particularly whanau with babies. c. Notes Community Public Health Advisory Committee considered the Tobacco Control Plan at its October meeting and agreed to recommend the Board endorse the plan. d. Agrees to approve the 2019/20 Tobacco Control Plan.
APPENDICIES
1. 2019/20 Wairarapa DHB Tobacco Control Plan
1 PURPOSE
This paper presents the 2019/20 Tobacco Control Plan (TCP) for reducing the incidence and impact of smoking in Wairarapa to the Board for it’s consideration and approval.
2 BACKGROUND
For a number of years the Ministry of Health has provided funding, through an annual side contract, for coordination of tobacco control activities in a DHB area. The Ministry also separately funds national health promotion activities, through the Health Promotion Agency and Hāpai Te Hauora, and quit smoking services (SSS) through the national Quitline, and local quit services. In Wairarapa, this service is provided by Whaiora, who are sub-contracted by the sub-regional provider Tākiri Mai Te Ata.
For several years, the Wairarapa DHB contracted Regional Public Health to provide the coordination service, and funded Tū Ora Compass Health for activities to support the primary care smoking target. In 2018/19, following the re-establishment of the Planning and performance Team, the decision was made to bring the planning and coordination of the plan back in-house. This was in recognition of the need to accelerate our efforts towards the 2025 Smokefree Aotearoa goal, to provide increased management and governance support for local activities, and to better integrate activities across providers.
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PUBLIC 3 2019/20 PLAN
The 2019/20 Plan builds on activities to date, but increases our efforts to coordinate health promotion activity, increase referrals to stop smoking services, and provide better support for Māori smokers and pregnant women. The 2019/20 plan TCP will: 1. Maintain the 90% primary care health target and report quarterly to the Alliance (Tihei) and the Wairarapa District Health Board. 2. Encourage referrals from primary care and promote the SSS to medical practises. In 2018, 53 referrals were received by the SSS from primary care. 3. Continue to offer ABC training to secondary, primary and pharmacies and extend the training to include dentists. Continue to support and incentivise the Pharmacy Project and include dentists on completion of the ABC training. “Vape to Quit” training will also be offered on request. 4. Support other agencies as appropriate. For example supporting smokefree environments through the support of the Fresh Air project for smokefree outdoor dining. 5. Ensure PIKI counsellors are aware of support pathways should the individual they are counselling indicate they wish to stop smoking. 6. Investigate funded visits for initial GP visit for Varenicline Pfizer. Investigate current Varenicline Pfizer usage and identify opportunities for increasing uptake.
4 FEEDBACK FROM CPHAC MEETING
The Committee discussed the plan and agreed to endorse the plan for approval by the Board.
The Committee noted there was a large number of actions and requested the list of actions be prioritised to enable the committee to understand the relative importance of the different actions.
The committee discussed the place of vaping as a support to stop smoking and it was noted the benefits and issues about vaping continue to evolve and noted that it may change over time as more evidence emerges. We will continue to take advice from the Ministry of Health and follow the guidelines suggested.
Wairarapa District Health Board Page 2 of 2
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PUBLIC
BOARD DECISION PAPER
Date: November 2019
Presented By Sandra Williams, Executive Leader Planning and Performance
Endorsed By Dale Oliff, Chief Executive Officer
Community & Public Health Advisory Committee (CPHAC) Terms of Reference and Subject minutes RECOMMENDATION It is recommended that the Board: a. Notes the attached terms of reference reflect the statutory responsibilities of a Community and Public Health Advisory Committee as set out in the New Zealand Health and Disability Act 2000 b. Agrees Community and Public Health Advisory Committee Terms of Reference c. Agrees the membership for the Committee as four board members, 2 Maori representatives, 2 PHO representatives (one being a primary care clinician), a public health clinician, a pacific representative, and a Consumer Council member d. Agrees Diane Sotiri, Wairarapa Consumer Council member, be formally appointed as a member of the Committee APPENDICIES 1. Community and Public Health Advisory Committee (CPHAC) Terms of Reference (ToR) 2. DRAFT Public Community and Public Health Advisory Committee (CPHAC) October 2019 minutes 3. DRAFT Excluded Community and Public Health Advisory Committee (CPHAC) October 2019 minutes
1 PURPOSE
The purpose of this paper is to request the Board consider the recommendations arising from the discussions about the refreshed Terms of Reference and membership at the October 2019 Community and Public Health Advisory Committee (CPHAC). The draft minutes of the meeting on the 24 October are attached as Appendix 2 and 3.
2 TERMS OF REFERENCE APPROVAL
The Community and Public Health Advisory Committee meeting on 24 October 2019 discussed the Terms of Reference and agreed to recommend the Board approve the refreshed TOR in Appendix 1. CPHAC will meet monthly with up to 10 meetings per annum.
3 MEMBERSHIP
CPHAC considered the membership of the committee and agreed to recommend to the Board as below: 3.1 Board Members It is proposed the current number of Board members (4) be retained. The current Board members will see out their current term and new Board members for the new board term will be agreed by the Board as soon as practicable.
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23 2019 11 25 Wairarapa Board Meeting PUBLIC - Decision
PUBLIC 3.2 Other representation With the Board’s commitment to its relationship with Iwi, its commitment to improving equities in health outcomes, integration with primary care, and improving patient experience CPHAC recommended the Board appoint additional members: ∑ Pacific community representative. ∑ Public Health clinician. ∑ Consumer Council Representative. ∑ Two Māori Representatives. ∑ Two Public Health Organisation Representatives (PHO) (clinician and senior manager).
Appointment of Consumer Council Representative As part of the refresh of the CPHAC) the Chief Executive has recommended that a representative from the Consumer Council be included in the membership of CPHAC. At the Consumer Council meeting held on 17 October 2019 it was agreed that Diane Sotiri would be the representative.
Appointment of two Māori Representatives CPHAC recommended that two Māori representatives; one from each iwi to be appointed as members. Having a greater Māori presence on the committee will enable a better informed decision process for the community. We would look to engage our Iwi Kainga group to assist with these appointments in due course.
Appointment of Public Health Organisation Representatives (PHO) Two representatives were recommended: a primary care clinician and a senior manager from the local PHO with a good overview of primary care in the Wairarapa.
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PUBLIC
Date:25 November 2019 BOARD DECISION
Author Tofa Suafole Gush, Director Pacific Health, Candice Apelu Mariner, Integration Lead
Endorsed by Dale Oliff, Chief Executive Officer Fionnagh Dougan, Chief Executive Officer
Subject Draft - Sub Regional Pacific Health and Wellbeing Strategic Plan 2020-2025
RECOMMENDATIONS It is recommended that the Boards: a. Note the contents of the Draft Plan b. Note the extensive community consultation undertaken by the DHB with the support of the Sub-region Pacific Heath Advisory Group c. Endorse the Draft –Sub Regional Pacific Health & Wellbeing Strategic Plan 2020-2025. d. Agree to disseminate the Draft–Sub Regional Pacific Health & Wellbeing Strategic Plan 2020-2025 to stakeholders for their feedback
APPENDICES 1. Draft Sub Regional Pacific Health and Wellbeing Strategic Plan 2020-2025 2. 3DHB Pacific Plan 2019 - Data
1. INTRODUCTION
1.1 Purpose The purpose of this paper is to provide a six monthly Pacific Health update on progress for the 3DHBs and seek the endorsement of all three Boards to the Draft - Sub Regional Pacific Health & Wellbeing Plan 2020- 2025.
1.2 Previous Board Discussions/Decisions The Wairarapa and the joint Capital Coast and Hutt Valley District Health Boards in their respective meetings of February 2019 approved the approach to develop a ‘One Pacific Health and Wellbeing Plan’ for the sub region to guide and inform decision making around Pacific people’s health in all 3 District Health Boards. 2. BACKGROUND The Hutt Valley and Wairarapa DHBs Pacific Plan (Paolo mo Tagata ole Moana) expired in 2018. A performance review on the implementation of the expired strategy was tabled and approved by the Boards in November 2018. The visual presentations made to community and stakeholders were well received. Discussions with Pacific stakeholders also provided us with feedback on what we need to do more to benefit the Pacific people and its communities. The CCDHB Pacific Plan (Toe timata le Unpeg) is due to expire in 2020.
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PUBLIC
The national Pacific strategy ‘Ala Moui’-Pathway to Pacific Health and Wellbeing 2014-2018 sets out the strategic direction and actions for improving health outcomes for Pacific peoples and reducing inequalities. The development of a single plan for all three DHBs has been closely aligned to the national strategy and is consistent with what our local communities needs are, and what has been fed back during the community consultation /fono process. The accompanying Pacific Population Health Profile of the 3DHBs is the first we have done. It collates demographic and health information for this population and was used to inform this current draft 3DHB Pacific Health and Wellbeing Plan. It will also inform future Health Needs Assessment of the Pacific population in our sub region.
2.1 CONSULTATION – THE VOICE OF THE COMMUNITY The development of the Sub Regional Pacific Health & Wellbeing Strategic Plan 2020-2025 is the result of six months’ work including extensive community and stakeholder fono/meetings to ensure the voice of communities have been heard. Feedback identified key opportunities for joint work with PHOs, Pacific providers, Regional Public Health and NGOs.
3. THE PLAN
There are six priorities to action in this Plan. We have intentionally selected this number of priorities from what the community have said during the consultation process as well as what our Pacific data has confirmed are areas of health need. The same priorities are closely aligned to what we are required by the Ministry to report on under the equity indicators. The Plan also adopts the strategic directions as outlined in key strategic documents of our 3DHBs to guide our response to improving the health and wellbeing of the Pacific communities in the sub-region.
4. NEXT STEPS
With the Boards endorsement we will arrange for the draft to be disseminated to the key stakeholders, Pacific Providers & NGOs for their feedback before a formal launch of the document in the community in May, in time for the start of the financial year. 1. consult on the draft with a key group of stakeholders 2. refine the plan based on this feedback 3. seek the 3 Boards’ approval of the final plan 4. formal launch The funding for the implementation of the Plan is expected to be from the DHBs baseline in 2019/20 and out-years with most initiatives building on existing DHB and PHO programmes for improvement of the health of the Pacific population.
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Wairarapa District Health Board Financial Report
October 2019
Dale Oliff Susan Flavin Chief Executive Interim Executive Leader Finance
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1 FINANCIAL PERFORMANCE OVERVIEW
The month of October shows a favourable variance to budget of $435k and $723k year to date.
Month $000s Year to Date Annual Actual Budget Var Actual Budget Var Forecast Budget Var 164 (272) 436 Funder (580) (1,024) 443 (2,714) (2,875) 161 (57) (59) 2 Governance (55) (73) 18 4 (0) 4 (608) (605) (3) Provider (1,331) (1,592) 261 (6,828) (6,666) (161) (501) (936) 435 Net Result (1,966) (2,689) 723 (9,538) (9,541) 3
The key changes in October 2019 include: ∑ IDF changes favourable $292k due to wash-up for 2018/19 financial year, ∑ Recoveries from Selena Sutherland Hospital that are $135k higher in the month than budgeted,
Forecast adjustments for October include: ∑ Increased provision for Holidays Act remediation; annual impact is ($342k) ∑ Re-phasing of Medical outsourced ($123k) as locum costs are expected later in the year. We are forecasting to breakeven.
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Operating Report for the month of October 2019
Month $000s Year to Date Annual Actual Budget Variance Actual Budget Variance Forecast Budget Variance
Revenue 13,568 13,577 (9) Devolved MoH Revenue 54,114 53,999 116 162,149 161,725 423 157 168 (12) Non Devolved MoH Revenue 587 673 (86) 1,884 1,970 (86) 181 196 (16) ACC Revenue 736 785 (49) 2,306 2,355 (49) 468 372 96 Other Revenue 1,930 1,588 342 4,920 4,565 355 235 381 (146) IDF Inflow 1,376 1,524 (147) 4,484 4,572 (87) 94 80 14 Inter DHB Provider Revenue 383 361 22 1,020 999 22 14,703 14,775 (72) Total Revenue 59,127 58,929 197 176,763 176,185 577
Expenditure Employee Expenses 1,047 1,144 97 Medical Employees 4,065 4,427 362 12,822 13,114 292 2,025 2,028 4 Nursing Employees 7,829 7,802 (27) 23,371 23,143 (228) 561 543 (18) Allied Health Employees 2,174 2,100 (74) 6,372 6,272 (101) 86 95 9 Support Employees 362 366 4 1,077 1,077 (0) 724 778 54 Management and Admin Employees 2,825 2,912 87 8,655 8,776 120 4,443 4,588 145 Total Employee Expenses 17,255 17,607 352 52,298 52,381 83
Outsourced Personnel Expenses 425 280 (145) Medical Personnel 1,288 1,120 (168) 3,668 3,361 (307) 6 16 10 Nursing Personnel 69 65 (4) 199 195 (4) 6 10 4 Allied Health Personnel 27 41 15 109 123 15 0 0 0 Support Personnel 1 0 (1) 1 0 (1) 57 68 11 Management and Admin Personnel 273 271 (2) 813 807 (6) 494 374 (120) Total Outsourced Personnel Expenses 1,658 1,498 (160) 4,789 4,485 (304)
294 325 30 Outsourced Other Expenses 1,271 1,298 27 3,873 3,895 22 1,055 1,053 (2) Treatment Related Costs 4,262 4,125 (137) 12,465 12,296 (169) 832 848 16 Non Treatment Related Costs 3,381 3,440 59 9,939 9,949 10 3,242 3,520 278 IDF Outflow 13,903 14,081 177 42,243 42,242 (1) 4,631 4,778 147 Other External Provider Costs 18,605 18,737 131 56,019 55,679 (341) 212 225 14 Interest, Depreciation & Capital Charge 757 833 77 4,675 4,799 125
15,203 15,711 508 Total Expenditure 61,093 61,618 526 186,300 185,726 (574)
(501) (936) 436 Net Result (1,966) (2,689) 723 (9,538) (9,541) 3
Result by Output Class 164 (272) 436 Funder (580) (1,024) 443 (2,714) (2,875) 161 (57) (59) 2 Governance (55) (73) 18 4 (0) 4 (608) (605) (3) Provider (1,331) (1,592) 261 (6,828) (6,666) (161) (501) (936) 435 Net Result (1,966) (2,689) 723 (9,538) (9,541) 3
1.1 Revenue
Revenue is unfavourable against budget by $72k for the month and favourable $197k year to date, this is due to one off donation of $110k and Selena Sutherland hospital revenue $218k, which is a timing variance and increased Ministry revenue. These are offset by ACC revenue ($49k) tracking below budget and reduced IDF inflow ($147k).
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1.2 Workforce expenses Total employee and outsourced workforce expense is $25k favourable to budget for the month and $192k favourable year to date. Adjustment has been made across the board to increase the year to date Holiday leave liability. The variance by employee type is explained by: • Medical workforce costs are ($48k) unfavourable for the month and $194k favourable year to date due to vacancies in Acute services and Mental Health. We are forecasting ($15k) adverse to budget. • Nursing costs are favourable to budget by $14k for the month and adverse ($31k) year to date; ($45k) due to the increase in the Holiday Act Provision. • Allied Health costs are unfavourable ($59k) year to date due to timing and staff mix. • Management and administration costs are $85k favourable year to date due to vacancies mainly in planning & funding and corporate services. Forecast includes a reduction for 1 FTE budgeted as management but paid from nursing.
1.3 Outsourced Other Expenses Outsourced other costs are $27k favourable to budget year to date due to MRI Scans and Outsourced Clinics.
1.4 Treatment related costs Treatment related costs are ($137k) unfavourable year to date due to pharmaceuticals (new high cost drugs) and Instrument costs.
1.5 Non Treatment related costs Non-treatment related costs are $59k favourable to budget year to date mainly due to IT costs where there has been a favourable wash-up of 2018/19 costs from Central TAS and underspend on Kia Ora Hauora Initiatives which is offset in revenue.
1.6 IDF Outflows IDF outflows are $177k favourable to budget year to date, due to an advantageous wash-up from 2018/19 but currently forecast to breakeven.
1.7 Other External Provider costs These are $131k favourable year to date and forecast to be ($341k) unfavourable, but this is offset by additional revenue; see funder section for more detail.
1.8 Interest, Capital Charge & Depreciation The year to date position is favourable against budget by $77k year to date from depreciation phasing.
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2 STATEMENT OF FINANCIAL POSITION
Movement Actual Variance to Previous $000s Budget from 30 Explanation of Variances Between Actual and Budget 31-Oct Budget Year End June
Assets Current Assets Bank 5,068 10 5,058 9 5,059 Cash advance received from MOH Accounts Receivable 5,676 4,289 1,387 6,435 (759) Variance is because of higher accruals for Pharmac rebates and MOH revenue which was not factored into the phasing of the budget. Stock 1,158 1,039 119 1,039 119 Prepayments 306 550 (244) 320 (14) Total Current Assets 12,207 5,888 6,319 7,803 4,404 Fixed Assets Fixed Assets 48,087 43,013 5,074 50,588 (2,502) Variance is because of the revaluation not being reflected in the budgets Work in Progress 6,938 7,169 (231) 6,490 448 Total Fixed Assets 55,024 50,182 4,842 57,078 (2,054) Investments Trust Funds Invested 185 185 0 185 0 Total Investments 185 185 0 185 0
Total Assets 67,417 56,255 11,162 65,067 2,351
Liabilities Current Liabilities Bank 0 292 292 1,799 (1,799) Difference is because of cash advance received this month.
Accounts Payable and Accruals 22,088 9,372 (12,716) 14,212 7,876 Variance is because of $7m cash advance received and higher accruals for Funder expenditure which was not factored into the phasing of the budget. Crown Loans and Other Loans 85 85 0 85 0 Current Employee Provisions 10,890 8,062 (2,828) 10,844 46 Variance because of 2018/19 increase in Holiday Pay provision not being reflected in the budgets. Total Current Liabilities 33,062 17,811 (15,251) 26,939 6,123 Non Current Liabilities Other Loans 25 24 (1) 54 (29) Long Term Employee Provisions 639 639 (0) 639 0 Trust Funds 185 185 (0) 185 0 Total Non Current Liabilities 849 848 (1) 878 (29) Total Liabilities 33,911 18,659 (15,253) 27,817 6,095 Net Assets 33,506 37,596 (4,090) 37,250 (3,744)
Equity Crown Equity 90,573 97,869 (7,296) 90,573 (0) $7m equity funding budgeted for September
Revaluation Reserve 11,234 5,558 5,676 13,012 (1,778) Increase in land and buildings valuation as at 30 June not factored into budget. Opening Retained Earnings (66,335) (63,080) (3,255) (51,937) (14,398) Increase in Holiday Pay Act provision in 2018/19 not included in budgeted opening balance. Net Surplus / (Deficit) (1,966) (2,751) 785 (14,398) 12,432 Total Equity 33,506 37,596 (4,090) 37,250 (3,744)
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3 TREASURY MANAGEMENT
3.1 Cash Flow Statement & Forecast
Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 Actual Actual Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast $'000 $'000 $'000 $'000 $'000 $'000 $'000 $'000 $'000 $'000 Cash flow from operating activities Operating receipts 16,681 17,265 16,323 26,679 16,928 15,820 15,820 15,820 16,195 15,820 Payment to suppliers (12,399) (12,385) (12,418) (13,056) (12,785) (11,823) (11,833) (11,838) (12,088) (11,838) Payments to employees (4,956) (4,305) (3,768) (3,818) (3,939) (5,310) (4,130) (4,620) (4,180) (4,210) Capital charge 0 0 0 0 0 (983) 0 0 0 0 GST (net) (480) (562) (474) (543) (525) 0 (1,000) (500) (500) 0 Net cash flow from operating activities (1,154) 12 (338) 9,263 (321) (2,296) (1,143) (1,138) (573) (228)
Cash flows from investing activities Purhase of property, plant & equipment (240) (240) (198) (255) (442) (183) (125) (528) (327) (459) Net cash flow from investing activities (240) (240) (198) (255) (442) (183) (125) (528) (327) (459)
Cash flows from financing activities Capital contribution from the Crown 0 0 0 0 0 0 0 0 0 0 Repayment of loan (7) (7) (7) (7) (7) (7) (7) (7) (7) (7) Net cash flow from financing activites (7) (7) (7) (7) (7) (7) (7) (7) (7) (7) Net Cash Flows (1,401) (235) (542) 9,001 (769) (2,486) (1,275) (1,673) (907) (694) Opening cash balance (1,799) (3,200) (3,434) (3,976) 5,025 4,256 1,771 495 (1,178) (2,084) Closing cash balance (3,200) (3,434) (3,976) 5,025 4,256 1,771 495 (1,178) (2,084) (2,778) This table indicates the forecast position at the end of each month. This cashflow forecast includes funding in advance received in October of $7m and now assumes the Ministry will provide us with a $13m equity funding in May 2010 at which time the cash advance will be repaid.
3.2 Borrowing Schedule The following table shows the borrowing facilities currently available to the DHB and the amounts drawn against each facility.
Wairarapa DHB Borrowing Schedule as at 31 October 2019
Facility Limit Maturity Date Balance 31-Oct OCR Interest Rate Paid/Payable $000 $000 Working Capital - NZ Health Partnerships Sweep arrangement ( 5,642) 5,025 1.00% 3.82% Average Debit Interest Rate
Selina Sutherland ( 700) ( 109) 7% Fixed Margin plus OCR
Total Borrowing ( 6,255) 4,916 The bank account was overdrawn on 10 days during the month from 21-30 September, and the interest rates ranged between 3.77% and 3.97%.
3.3 Funding and Equity Changes A cash advances was received at the beginning of the month.
Wairarapa DHB Equity / Funding Changes as at 31 October 2019
Amount (excl GST) Expected Date of $000 Received Repayment MOH Income in Advance
- Cash Disbursement Funding $ 7,000 1-Oct-19 May-20
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3.4 Foreign Exchange Transactions The following table shows the transactions involving foreign currencies, and is provided for the purposes of monitoring risk.
Wairarapa DHB Foreign Exchange Transactions as at 31 October 2019
Month Year to Date Foreign Foreign Currency Currency Range of Exchange Total No. of Amount NZD Cost Amount NZD Cost Rates Transactions Currency AUD $0 $11,441 $42,080 $44,438 0.9250 to 0.9556 5 USD $1,097 $1,719 $2,357 $3,670 0.6379 to 0.6458 2 GBP $1,422 $0 $1,422 $2,865 0.4964 1 EUR $0 $0 $0 $0 0 Totals $13,159 $50,973 8
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4 CAPITAL EXPENDITURE The following table shows the capital expenditure for the year to date (note that this table has not been updated for October).
Budgeted Expenditure and Balances Actual Expenditure WIP Balances
Project description WIP Balance Committed Costs Budget for Expected Budgeted Closing Year to Date Year to Date Year to Date Amounts Current WIP Brought Forward from 2018/19 2019/20 Capitalisation Balance Costs Budget Variance Capitalised Balances ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000)
BASELINE CAPEX - WIP - INTANGIBLES Regional and 3DHB Regional - Central TAS - RDHS 4,416 - 324 (1,591) 3,149 101 81 (20) - 4,517 Regional - Central TAS BAU 469 - 192 - 661 41 48 7 - 510 Local - - - - Oracle Project 800 243 - (1,043) - 367 243 (124) - 1,167 Gynae Plus Project 17 - - - 17 - - - (17) - NCAMP - 373 - - - - - Webpas Project 538 - 250 (570) 218 65 63 (2) - 603 Diagnostic Sign-offs (Radiology and Lab) - - 67 - 67 18 18 - - Software Licensing (Citrix, Microsoft) - Growth - - 50 - 12 12 - Software - Cyclical Maintenance & Upgrade - - 25 - 6 6 - Security Improvement Programme - - 25 - 6 6 - Concerto Transition & Enhancements - - 100 - 24 24 - National Screening Solution - - 25 - 6 6 - CostPro Upgrade - - 250 - 63 63 - TOTAL WIP PROJECTS 6,240 616 1,308 (3,204) 4,112 574 570 (4) (17) 6,797
BASELINE CAPEX - NON WIP Buildings - Capex < $100k 187 - - - - Seismic Remediation - Front Canopy 250 29 - (29) - 29 Clinical Equipment - - Capex < $100k 266 64 50 (14) - DDR and Fluoroscopy 900 - - - - Diagnostic Digital Radiology 400 - - - - Lease Switching 200 - - - Other Equipment - Capex < $100k 60 3 60 57 IT - Hardware - IT Server Upgrade 250 - (250) - - - - - 250 - Capex < $100k 150 2 - (2) TOTAL NON-WIP CAPEX 250 2,413 (250) 98 110 12 - 279 TOTAL CAPITAL EXPENDITURE (excl GST) 6,490 616 3,721 (3,454) 4,112 672 680 8 (17) 7,076
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5 FUNDER FINANCIAL RESULT 5.1 Financial Statement of Performance – October 2019 Annual Month $000s Year to Date Actual Budget Variance Actual Budget Variance Forecast Budget Variance
Revenue
12,425 12,425 0 Base Funding 49,700 49,700 0 149,100 149,100 0 1,142 1,151 (9) Other MOH Revenue 4,409 4,293 116 13,032 12,609 423 27 27 (0) Other Revenue 109 109 0 326 326 0 235 381 (146) IDF Inflows 1,376 1,524 (147) 4,484 4,572 (87) 13,829 13,984 (155) Total Revenue 55,594 55,626 (32) 166,943 166,607 336
Expenditure DHB Governance & 188 188 0 Administration 752 752 0 2,255 2,255 0 5,604 5,770 166 DHB Provider Arm 22,914 23,080 166 69,140 69,306 166
External Provider Payments 1,055 1,081 25 Pharmaceuticals 4,192 4,197 6 12,764 12,620 (144) (0) 2 2 Laboratory 4 7 2 20 20 0 993 1,090 97 Capitation 4,144 4,054 (90) 12,160 11,890 (270) 555 591 36 ARC-Rest Home Level 2,227 2,344 118 6,957 6,957 (0) 485 467 (19) ARC-Hospital Level 1,911 1,851 (60) 5,494 5,494 (0) 538 519 (20) Other HoP 2,148 2,146 (2) 6,257 6,185 (72) 265 265 (0) Pay Equity 1,059 1,059 (0) 3,178 3,178 (0) 335 335 (0) Mental Health 1,180 1,344 164 3,873 4,038 164 Palliative Care / Fertility / Comm 18 18 (0) Radiology 85 84 (1) 231 231 0 397 407 11 Other External Provider Payments 1,663 1,635 (28) 5,044 5,025 (19)
3,232 3,524 292 IDF Outflows 13,895 14,095 200 42,284 42,284 (0) 13,665 14,256 591 Total Expenditure 56,174 56,649 475 169,657 169,482 (175) 164 (272) 436 Net Result (580) (1,024) 443 (2,714) (2,875) 161
Overall, the result for Wairarapa DHB Funder for the month of October is $436k favourable and $443k favourable for the year to date. The main reason for the favourable variance in the month and for the year to date is because of the favourable wash-up for IDF Outflows for 2018/19 financial year. We are forecasting a deficit of ($2,714k) which is $161k favourable to the budgeted deficit of ($2,875k). The main reason for the improvement in the net result for 2019/20 is additional funding of $219k for new cancer drugs. The costs for these are included in the IDF Outflows and at this stage we expect the IDF Outflows to be within the 2019/20 budget. Other MOH revenue is ($9k) unfavourable for the month and $116k favourable for the year to date. The month’s result includes a timing variance of ($122k) which is related to System Level Measure Capability funding received in September. This variance is off-set by the favourable variance in PHO Capitation costs. This month’s result also includes two new unbudgeted revenue lines from MOH for new cancer drugs ($73k) and In Between Travel funding for minimum wage increase ($24k). Both of these are off-set by the additional costs. The Other MOH revenue is forecasted to be $423k favourable for the full year and the details are presented in the table below:
Oct-19 MOH Revenue Variance to budget $000s Month $ YTD $ Forecast $ Additional Funding for Combined Pharmaceutical Budget 2019/20 73 73 219 Primary Care initiatives -(Community Service Card holders, Under 14s, VLCA) 15 48 144 Reduce Pressure on Fees Total Annual Funding 0 18 18 In Between Travel wash-up revenue 2016/17 & 2017/18 0 (49) (49) Well Child Tamaraki Ora (WCTO) (3) 2 18 System Level Measure Capability Funding -19/20 (Budget phasing variance) (122) 0 0 In Between Travel minimum wage increase 19/20 24 24 72 System Level Measure Capability Funding 18/19 0 (1) 0 Electives Revenue 18/19 4 4 4 Pay Equity Wash-up revenue 18/19 0 (3) (3) Sub-Total (9) 116 423
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IDF Inflows are ($147k) unfavourable for the year to date. The main reason is due to ($217k) under delivery for inpatient services; which has been clawed back from the DHB Provider Arm. The year to date result also includes $51k favourable IDF Inflows wash-up for 2018/19 financial year. The IDF Inflows revenue is forecasted to be ($87k) unfavourable for the full year. The details are presented in the table below:
Oct-19 IDF Inflows Variance to budget $000s Month $ YTD $ Forecast $ Inpatient IDF Inflows 19/20 (217) (217) (217) Inpatient IDF Inflows 18/19 51 51 51 PHO Capitation / FFS 20 19 79
Sub-Total (146) (147) (87)
Provider Arm payments costs are $166 favourable for the year to date. The reduction in payments for under delivery in inpatients IDF activities for 2019/20 financial year, is partially off-set by the unbudgeted additional payment of $51k for the inpatients IDF activities for 2018/19 financial year. The details as follows:
Oct-19 PROVIDER ARM FUNDING CHANGES Variance to budget Funding Changes
$000 Month YTD Forecast Activity Based Wash-up IDF Wash-ups: - Inpatient IDF Inflows 2018/19 (51) (51) (51) - Inpatient IDF Inflows 2019/20 217 217 217
Total Changes 166 166 166
Pharmaceutical costs are $25k favourable for the month and $6k favourable for the year to date. These are demand driven costs based on the actual claims. The latest Pharmac forecast released in June 19 indicated that the rebates receivable for 2019/20 would be $106k ($35k year to date) higher than the budgeted rebates of $4,015k. The year to date result reflects this change in rebates receivable. In October-19 we have received $72k additional funding for Combined Pharmaceuticals budget ($219k for the full year). This funding is targeted for newly subsidised Pharmaceuticals Cancer Treatment (PCT) drugs for 2019/20 fy. This service is provided by Capital Coast DHB for Wairarapa patients. Therefore the additional costs are included in the IDF Outflows expenditure line. The year to date result also includes ($22k) higher than budgeted payments to National Haemophilia Management Group (NHMG). The costs for this services for 2019/20 are likely to be up to $5.5 million more than anticipated nationally (1.10% or $61k for Wairarapa DHB). The June forecast also indicated that the net full year community pharmacies cost would be ($144k) or (1.14%) higher than the budgeted cost of $12.620k. This is reflected in the October forecast. The following graph compares the current year actual costs (blue bar) to the current year budget and the actuals for the last two previous years. The actual costs in this graph are net of Pharmac rebates and includes GST Credits, Pharmac Discretionary Pharmaceutical Fund (DPF) and Pharmac operating costs.
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The graph below shows the community pharmaceuticals spending over the past 7 years by month and illustrates seasonality. This graph includes only gross drug costs (cash expenditure) and the accruals (excludes rebates and other Pharmac operating costs).
Pharmaceuticals Expenditure by year (Cash expenses plus accruals 1,600 1,500 1,400 1,300 t
s 1,200 o c
l 1,100 a t o
T 1,000 900 800 700 600 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
2019/20 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
Capitation costs are $97k favourable for the month and ($90k) unfavourable for the year to date. The month’s result includes a timing favourable variance of $122k which is related to System Level Measure Capability Funding. This payment was budgeted to pay to Compass Health in October for the first quarter in 19/20; however in September MOH paid this in advance for the quarters starting from Oct & Jan. Of the year to date result, $48k is off-set by the additional MOH revenue received for PHO Capitation services (Care Plus, VLCA, Community Services Card and Under 14s) and $20k off-set by the additional IDF Inflows revenue for the patients who are enrolled with a Wairarapa General Practice but not Wairarapa residents. The balance ($22k) is related to higher than budgeted enrolments. The table below shows the movements in enrolment by quarter for the last five quarters.
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PHO Enrolment Jul-18 Oct-18 Jan-19 Apr-19 Jul-19 Oct-19 Wairarapa Residents 43,657 43,829 43,807 43,731 44,173 44,434 Non-Wairarapa Residents (inflows) 1,080 1,096 1,109 1,563 1,584 1,586 Total Enrolled in Wairarapa PHOs 44,737 44,925 44,916 45,294 45,757 46,020 Wairarapa resident enrolled elsewhere (outflows) 1,537 1,539 1,596 2,021 1,906 1,943 Total Wairarapa Population Enrolled 45,194 45,368 45,403 45,752 46,079 46,377 Change from previous quarter 252 174 35 349 327 298 Change from same time last year 1,121 984 908 810 885 1,009 %Change from same time last year 2.54% 2.22% 2.04% 1.80% 1.96% 2.22%
Net IDF Volumes 457 443 487 458 322 357
Satistics NZ Population estimate 45,880 45,880 45,880 45,880 46,445 46,445 Population Enrolled 98.5% 98.9% 99.0% 99.7% 99.2% 99.9% We are forecasting the Capitation costs to be ($270k) unfavourable to budget of which ($224k) off-set by the additional revenue for PHO capitation services. The balance ($46k) is for the higher than budgeted enrolments. Aged Residential Care costs are $18k favourable for the month and $57k favourable for the year to date ($118k rest home & ($60k) hospital level). These are demand driven services. Aged Residential Care Services costs are favourable mainly due to fewer than expected new entries to ARC and an increase in the proportion of private payers. We expect the Aged Residential Care costs for the full year to be within the budget for 2019/20. The graph below shows the percentage of ARC Residents who are maximum contributors. Maximum contributors are the people who do not meet the Ministry of Social Development’s financial criteria for a DHB subsidy meaning that the DHB pays a lower proportion of the total ARC costs. This reflects a socio- economic impact beyond the influence of the DHB.
The following graph compares the current year ARC actual costs (blue bar) to the current year budget and the actuals for the last three previous years.
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Other HOP costs are ($20k) unfavourable for the month and ($2k) unfavourable for the year to date. The main reason for the unfavourable variance in the month is because of the higher utilisation in Residential Care: Community- Under 65s. This services is for adults (not older people) who have a long term condition (not disability) and need residential care services. The increase in allocation of this service should reduce the costs for Health Recovery and Chronically Medically Ill services in long term. Other services included in this line are community based demand driven services. The year to date variance includes underspend in Respite Care services and Home and Community Support Services. Respite Care services provide support to informal family carers. Most of these clients would otherwise be at risk of needing full time residential care. The table below shows the different types of services that are included in Other HOP expenditure line.
Oct-19 Variance to budget Health of Older People (HOP) Expenditure 2019/20 Forecast Month $ YTD $ $000 Variance $ Home and Community Support Services 3 31 (72) Residential Care: Community -Under 65s (20) (53) 0 Respite Care 4 33 0 Day Programmes (5) (16) 0 Residential Care: Loans Adjustment (1) (4) 0 Carer Support (1) 7 0 Total (20) (2) (72)
Pay Equity costs line shows no variance to budget. The MOH is responsible for providing data on the impact of pay equity costs and this information is only partially available for 19/20 financial year. Therefore the pay equity costs are accrued to budget until the actual costs information is available. Mental Health expenses are $164k favourable for the year. The reason for the favourable variance for the year to date is that the release of the prior year accruals for acute mental health bed usage wash-up with Capital and Coast DHB and Hutt Valley DHB as this is no longer required. Other External Provider Payments are $11k favourable for the month and ($28k) unfavourable for the year to date. The year to date result includes ($58k) for planning costs and largely off-set by a refund received from Hutt Valley DHB for mental health acute beds wash-up payment for 2017/18 financial year and the favourable variance in General Medical Subsidy (GMS). The table below shows the different types of services that are included in Other External Provider Payments expenditure line.
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Oct-19 Service Description Variance to budget Comments $000
Month $ YTD $ Planning Costs 0 (58) Sappere contract -Not budgeted in 19/20 MH Acute beds wash-up 17/18 0 14 Credit note received in 19/20 General Medical Subsidy 13 17 Demand driven services (Prior year claims were less than accrued) Well Child Tamaraki Ora Services 2 (2) Off-set by additional MOH Revenue Advance Care Planning costs 1 4 Paid via IDFs but budgeted in other costs Immunisation services 2 6 Demand driven services Dental services (4) (4) Demand driven services Other (3) (5) Other demand driven services Total 11 (28)
IDF Outflows are $292k favourable for the month and $200k favourable for the year to date. The main reason for the favourable variance in the month and year to date is because the favourable wash-up for IDF Outflows for 2018/19 financial year. The overall IDF Outflows wash-up result for 2018/19 financial year against the provisions was $1,153k favourable. Of which ($847k) was accrued as IDF risks provision for 19/20 financial year based on the information available as at Oct-19 and ($11k) accrued for mental health acute beds wash- up with Hutt Valley DHB. The year to date result also includes ($73k) costs accrued for high costs new PCT drugs (Funded by MOH) and ($16k) for PHO Capitation wash-up for Q1 of 2019/20 fy. The following table shows the components of the IDFs that are reflected in this line.
IDF Wash-ups and Service Changes Oct-19 Variance to Budget $000s Month $ YTD $ Forecast $ IDF Inflows Activity Based Wash-ups - Inpatient IDF Inflows 2018/19 51 51 51 - Inpatient IDF Inflows 2019/20 (217) (217) (217) - PHO Capitation / FFS 20 19 79 Total IDF Inflow Changes (146) (147) (87)
IDF Outflows Activity Based Wash-up - Inpatients (567) (647) (749) -PCTs (273) (273) (273) - Mental Health Acute Beds -Hutt Valley DHB (3) (11) (36) 2018/19 IDF Wash-up 0 - Inpatients ADHB 732 732 732 - Inpatients Other DHBs 266 266 266 - Outpatients / Non- DRG 113 113 113 - AT & R 42 42 42 Other Wash-ups and service changes - PHO Capitation / FFS (17) (16) (80)
IDF Service Changes - CCDHB - Advance Care Planning (1) (4) (13) - ADHB - National Services Q4 2018/19 0 (2) (2) Total IDF Outflow Changes 292 200 0
Year end IDF outflows wash-up provisions were mainly based on MOH IDFs wash-ups forecast files with the adjustment where the internal data from CCDHB & HVDHB were available (inpatients, outpatient and PCT). We expect the IDF Outflows to be within the budget for 2019/20 financial year.
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6 PROVIDER FINANCIAL RESULT
Financial Statement for the month of October 2019 Month $000s Year to Date Annual Actual Budget Variance Actual Budget Variance Budget Revenue Government and Crown Agency 1 1 0 MoH - Devolved Funding (Funds arm) 5 5 0 16 4 4 0 MoH - Personal Health 16 16 0 49 9 8 1 MoH - Public Health 24 31 (7) 94 70 71 (1) MoH - Disability Support Services 279 284 (4) 851 26 38 (12) MoH - Maori Health 83 150 (67) 400 48 48 0 Clinicial Training Revenue 185 192 (7) 577 94 80 14 Revenue From Other DHBs 340 319 22 956 153 169 (16) ACC Revenue 627 676 (49) 2,029 3 3 0 Other Government Revenue 14 14 0 41 409 422 (13) Total Government and Crown Agency 1,574 1,687 (113) 5,012
Non Government Revenue 3 4 (2) Patient Revenue 7 17 (10) 52 462 364 97 Other Income 1,909 1,557 352 4,472 5,604 5,770 (166) DHB Internal Revenue 22,914 23,080 (166) 69,306 6,068 6,139 (71) Total Non Government Revenue 24,830 24,654 176 73,830
6,477 6,561 (84) Total Revenue 26,404 26,342 63 78,842
Expenditure
Employee Expenses 1,047 1,144 97 Medical Employees 4,065 4,427 362 13,114 2,025 2,028 4 Nursing Employees 7,829 7,802 (27) 23,143 561 543 (18) Allied Health Employees 2,174 2,100 (74) 6,272 86 95 9 Support Employees 362 366 4 1,077 676 728 52 Management and Admin Employees 2,652 2,718 66 8,205 4,395 4,538 143 Total Employee Expenses 17,082 17,413 331 51,810
Outsourced Personnel Expenses 425 280 (145) Medical Personnel 1,288 1,120 (168) 3,361 6 16 10 Nursing Personnel 69 65 (4) 195 6 10 4 Allied Health Personnel 27 41 15 123 0 0 0 Support Personnel 1 0 (1) 0 46 57 11 Management and Admin Personnel 226 228 2 676 483 364 (120) Total Outsourced Personnel Expenses 1,610 1,454 (156) 4,355
275 305 30 Outsourced Other Expenses 1,194 1,222 27 3,665 1,054 1,053 (2) Clinical Supplies 4,262 4,125 (137) 12,296 952 983 31 Non Clinical Expenses 3,887 4,025 138 12,301 0 0 (0) Provider Payments 0 0 (0) 0 2 1 (2) Financing Expenses 7 3 (4) 2,005 (77) (77) 0 Internal Allocations (308) (308) 0 (924)
7,085 7,166 81 Total Expenditure 27,735 27,934 199 85,509
(608) (605) (3) Net Surplus / (Deficit) (1,331) (1,592) 261 (6,666)
The Provider Arm shows a net deficit of ($1.33m) for year to date October. This is favourable to budget by $261k.
6.1 Revenue Total revenue for the Provider year to date is $26.4m, which is favourable to budget by $63k. ∑ ACC Revenue is ($49k) unfavourable year to date, despite income of $33k coming from staff claim 16
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reimbursements, which offsets against payroll expenditure. For non-staff related ACC income, there were under recoveries in AT&R ($28k), Imaging ($15k) and Community Nursing ($21k), while Outpatients and MSW both show favourable variances. An increase in the annual targeted revenue of $100k has yet to be achieved, with an adverse impact year to date of ($33k). ∑ Other Income is favourable to budget by $352k year to date because of a donation from Wairarapa Community Health Trust for an Image Intensifier $110k. Also, Selina Sutherland’s activity has resulted in favourable cost recovery income of $218k, due to volume which has associated costs in implants and prostheses and phasing of budget. ∑ MoH revenue for Kia Ora Hauora ($72k) has been transferred to revenue in advance pending the programme structure setup. This is matched by a reduction in cost.
6.2 Expenditure Total Expenditure for the Provider is $27.7m for October year to date; an underspend against budget of $199k. Total personnel expenses (employed and outsourced) were $23k favourable in October, and $174k favourable year to date. An increase in the Holiday Act provision in line with Board recommendation, has added to the YTD position and well as being included in the out months of the forecast across all employment groups. Medical costs (including outsourced) are favourable to budget for year to date of $194k due to vacancies in Acute 1.3FTE, Mental Health 1.4FTE and General Medicine 0.3FTE. The forecast takes into account the timing difference for sabbatical leave. The Psychogeriatric activities budgeted as employee SMO, but has been provided as Outsourced Clinical is now treated as an outsourced locum ($30k) year to date. Nursing (including mental health and midwifery) costs are unfavourable to budget for the year to date by ($31k); FTE are over budget by (4.6) year to date. Registered nurses over budget of (3.9) mainly in Acutes (2.9) FTE due to non-budgeted pm to midnight shift. HCA’s over budget of (3.1) this is mainly due to MSW HCA’s for patient watches. Midwives over budget by 1 FTE. This is offset by senior nurses are favourable 3.6 FTE in the following departments, Mental Health, Periop, Outpatients, and Clinical Nurse specialists. Positive FTE variances in Mental Health and Focus due to changes of staffing mix between nursing allied and management. Allied Health personnel expenses, employed and outsourced, were unfavourable by ($59k) to budget year to date despite FTE favourable by 2.1 year to date. FTE’s favourable in CAMHS, due to timing and staff mix. Other vacancies in Oral Health, Therapies and Imaging, are covered within the service or by casual and outsourced staff. Management & Admin workforce, employed and outsourced year to date were $68k favourable to budget, with vacancies in the executive team have been covered by outsourced. Vacancies in Clinical Services Management, Finance, HR and IT, are currently under recruitment. Other Outsourced Expenses were favourable $27k year to date. Radiology Services are favourable by $18k year to date, covering Radiologist services and MRI’s provided by Hutt Valley DHB. There are underspends in other outsourced services, including gastro services, ENT, Audiology, Halter readings, outsourced surgical procedures, tracking below budget due to timing of services. Clinical Supplies costs were ($137k) unfavourable year to date October. Treatment disposables ($40k) unfavourable, Patient consumables ($52k) which is mainly in Periop and Infusion supplies ($17k, offset by an underspend in Community Nursing supplies $15k Instruments and Equipment are unfavourable by ($41k). The Perioperative Unit was ($29k) unfavourable year to date, following the previous month’s write off of a rental from 2017. The CSSD was ($14k) unfavourable due to service contracts timing. 17
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Implants and Prostheses favourable by $94k, due to the number of elective surgeries cancelled. Patient Appliances $32k favourable year to date. Ostomy supplies in community nursing $22k underspent, due to current demand, but with costs likely to increase due to order placement phasing. Clinical and Client Related costs ($44k) unfavourable year to date due to Air ambulance ($16k) and Outpatients ($23k) budget savings for plastic clinics will not be realised, this has been adjusted in the forecast. Pharmaceutical spend is ($119k) unfavourable largely due to gastro-intestinal pharms and malignant disease pharms.
Non Clinical Expenses were $138k favourable to budget for October year to date. Hotel and laundry expenses were ($26k) unfavourable year to date. Cleaning is ($13k) overspend, mainly due to adhoc cleans and laundry costs were up ($15k) on budget due to demand. Facilities costs ($20k) unfavourable; property compliance and maintenance costs were ($25k) over budget, due to more stringent compliance requirements. Business related travel ($14k) unfavourable, mostly due to timing of travel against evenly allocated budget. ITC expenses are $95k favourable due to Central TAS 18/19 wash-up $57k and budget phasing. Timing of spending on Corporate Training $10k favourable and Kia Ora Hauora extension programme set up due to timing shows an underspend of $67k year to date, offsets by additional funding transferred to revenue in advance. Depreciation $80k favourable year to date this is due to $20k for seismic asset rate recalculation, IT capitalization phasing $40k and Oracle implementation delay $17k.
Employment costs - analysis and trends (excluding outsourced)
Month Wairarapa DHB Year to Date Variance $000s Variance
Actual vs Actual vs October 2019 Actual vs Actual vs Annual Actual Budget Last year Budget Last year Actual Budget Last year Budget Last year Budget
Personnel 1,047 1,144 1,014 97 (33) Medical Employees 4,065 4,427 3,938 362 (127) 13,114 2,025 2,028 1,855 4 (169) Nursing Employees 7,829 7,802 7,257 (27) (572) 23,143 561 543 480 (18) (81) Allied Health Employees 2,174 2,100 1,877 (74) (297) 6,272 86 95 74 9 (12) Support Employees 362 366 296 4 (66) 1,077 724 778 704 54 (20) Management and Admin Employees 2,825 2,912 2,618 87 (207) 8,776 4,443 4,588 4,127 145 (316) Total Employee Expenses 17,255 17,607 15,986 352 (1,269) 52,381
Month Wairarapa DHB Year to Date Variance FTE Variance Actual vs Actual vs Actual vs Actual vs Annual October 2019 Actual Budget Last year Budget Last year Actual Budget Last year Budget Last year Budget FTE 45.5 46.7 45.2 1.2 (0.4) Medical 44.5 46.7 45.9 2.1 1.3 46.7 256.7 250.8 253.1 (5.9) (3.7) Nursing 255.4 250.8 249.5 (4.6) (5.8) 250.8 72.9 75.3 70.9 2.4 (2.0) Allied Health 73.2 75.3 72.3 2.1 (1.0) 75.3 15.3 16.1 14.8 0.8 (0.5) Support 15.3 16.1 14.9 0.8 (0.4) 15.9 108.9 116.3 116.4 7.4 7.5 Management & Administration 107.9 116.3 111.5 8.4 3.6 116.0 499.4 505.2 500.4 5.8 1.0 Total FTE 496.4 505.2 494.2 8.8 (2.2) 504.7 Average $ cost per FTE ($000) 23,001 24,496 22,451 1,496 (550) Medical 91,255 94,814 85,808 3,559 (5,447) 280,883 7,886 8,088 7,330 202 (556) Nursing 30,658 31,110 29,084 452 (1,574) 92,277 7,695 7,209 6,764 (486) (931) Allied Health 29,677 27,873 25,962 (1,804) (3,715) 83,254 5,606 5,870 4,988 264 (618) Support 23,640 22,718 19,788 (923) (3,852) 67,942 6,649 6,693 6,047 45 (602) Management & Administration 26,178 25,038 23,476 (1,140) (2,702) 75,619 8,896 9,082 8,247 185 (650) Cost per FTE all Staff 34,761 34,849 32,348 88 (2,413) 103,783
Medical FTEs is 1.2 favourable MTD to budget due to vacancies in Acutes and Child & Family MHU .
∑ Nursing FTEs is (5.9) adverse MTD; (3.9) FTE MTD being HCA’s mainly MSW for patient watches, RN’s (3.1), 18
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Midwives (1.2) FTE combined with savings in senior nurses 2.5 FTE.
∑ Allied Health FTE is 2.4 favourable due to vacancies mainly in Oral Health and Imaging.
∑ Support Staff is 0.8 FTE favourable to budget mainly in Building & Property and Procurement Services.
∑ Management and Administration Staff is 7.4 FTE favourable to budget due to vacancies in Planning & Funding, HR, Finance, Kia Ora Hauora and CE office, covered by outsourced. and reclassification the supervisor roll in Focus to Nursing 1.0 FTE
FTE Trends (from June 2012)
Actual FTE for Month (not year to date) Jun Jun Jun Jun Jun Jun Jun Jun Jul Aug Sep Oct 12 13 14 15 16 17 18 19 19 19 19 19 Medical 38 39 39 40 42 44 46 43 43 44 45 46
Nursing 198 204 209 226 218 241 243 258 257 254 254 257 l a
u Allied Health 89 69 69 71 71 70 71 72 72 73 74 73 t c
A Support 13 14 14 13 17 16 17 16 16 16 15 15
Mgmt/Admin 108 101 89 90 93 100 109 105 108 107 108 109
l Actual FTE 444 426 421 440 440 471 486 495 495 493 495 499 a t o
T Budget 450 437 428 423 452 453 468 494 505 505 505 505
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Annual Leave Accrual $000s
2020 2019 2018
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
- Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
Annual Leave Accrual in $'000's Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2013 2,745 2,765 2,833 2,720 2,787 2,809 2,642 2,653 2,694 2,660 2,775 2,787 2014 2,838 2,938 2,907 2,863 2,928 2,887 2,773 2,800 2,793 2,891 2,911 3,025 2015 3,045 3,090 3,043 3,030 3,033 3,001 3,050 3,020 2,937 2,984 3,019 3,024 2016 3,105 3,173 3,057 3,024 3,097 3,093 2,950 2,961 2,902 2,929 3,004 3,115 2017 3,152 3,038 3,128 3,101 3,167 2,993 2,853 2,936 2,984 3,047 3,165 3,327 2018 3,213 3,348 3,434 3,454 3,524 3,350 3,294 3,320 3,474 3,535 3,617 3,682 2019 3,541 3,584 3,697 3,755 3,837 3,752 3,521 3,626 3,717 3,820 3,949 3,990 2020 3,925 3,993 4,087 4,114
6.3 Provider Arm Delivery
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This graph shows the value of activity delivered in the provider arm (blue line) compared to the revenue passed through from the funder (blue bar). The yellow bar is other revenue, such as health workforce New Zealand and ACC. The pink bar shows the expenditure. Note that activity for the current month is likely to be understated until coding is completed.
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7 GOVERNANCE
The following table shows the governance position for October 2019. Month $000s Year to Date Annual Actual Budget Variance Actual Budget Variance Forecast Budget Variance Revenue
Government and Crown Agency 188 188 0 MoH - Devolved Funding (Funds arm) 752 752 0 2,255 2,255 0 (0) (0) 0 Revenue From Other DHBs 42 42 0 42 42 0 188 188 0 Total Government and Crown Agency 794 794 0 2,297 2,297 0
Non Government Revenue (0) (0) 0 Other Income (0) (0) 0 (0) (0) 0 (0) (0) 0 Total Non Government Revenue (0) (0) 0 (0) (0) 0
188 188 0 Total Revenue 794 794 0 2,297 2,297 0
Expenditure
Employee Expenses 47 50 3 Management and Admin Employees 173 194 21 550 571 21 47 50 3 Total Employee Expenses 173 194 21 550 571 21
Outsourced Personnel Expenses 11 11 0 Management and Admin Personnel 48 44 (4) 139 131 (9) 11 11 0 Total Outsourced Personnel Expenses 48 44 (4) 139 131 (9)
19 19 (0) Outsourced Other Expenses 77 77 (0) 230 230 (0) 90 90 (0) Non Clinical Expenses 244 245 1 450 442 (9) 77 77 0 Internal Allocations 308 308 0 924 924 0
245 247 2 Total Expenditure 849 867 18 2,294 2,297 4
(57) (59) 2 Net Surplus / (Deficit) (55) (73) 18 4 (0) 4
Governance for year to date is a net surplus of $18k to budget. Revenue for Governance is on budget. Management and Admin employed costs were favourable by $21k due to vacancies arising from adviser positions in Planning and Performance. These positions are currently under recruitment. Outsourced Personnel year to date is ($4k) unfavourable due to increased charges for the Hutt based advisor. Non Clinical costs are within budget.
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PUBLIC
BOARD INFORMATION PAPER
Date: 31 October 2019
Author Kieran McCann, Executive Leader Operations
Endorsed By Dale Oliff, Chief Executive
Subject Hospital & Community Services Report for November 2019
RECOMMENDATION It is recommended that the Board:
a. NOTES the content of this report
APPENDICIES
1. Wairarapa DHB Planned Care Performance for September 2019
1. PROVIDER OVERVIEW
Operationally October has seen the hospital delivering 864 inpatient discharges and 1,513 Emergency Department (ED) attendances. For the first four months, inpatient discharges are 3,357, resulting in 7,856 bed days with an average length of stay of 2.34 days. Whilst broadly comparable to the same period last year, there is a decrease in inpatient discharges of 178 patients but with patients staying slightly longer there is an increase of 243 bed days or 0.19 average days stayed. Maternity has remained busy particularly early in the month with the unit reaching capacity on occasions. Again the flexibility and hard work of the Midwifery team has managed this period well. Strike activity comprised six days of full withdrawal of labour for a 24 hour period and three days of 24hr partial strike action between 30th September 2019 to 4th November 2019. A number of outpatient imaging appointments were reschduled to free up staff capacity to cover the acute workload on strike days, together with Life Preserving Services (LPS) arrangements as agreed over this time. In terms of ongoing local impact, the strike activity has pushed out the wait time for CT referrals that are protocoled to be seen within 10 working days, and has also impacted routine imaging requests that are usually seen within six weeks. Both groups of clients are now waiting longer than these timeframes for their imaging appointments and will be reflected in reporting for November 2019. Both parties (DHBs and APEX) have agreed to formal facilitation to resolve the current impasse. Facilitation is scheduled for late November 2019 and early December 2019 and no further strike activity is anticipated leading up to or during the facilitation period. These delays and impacts are likely to be flow into measures other than those on waiting times for diagnostic services adding additional disruption on planned elective Surgery which is already under strain particularly in Orthopaedic due to Senior Medical Officer (SMO) vacancies coupled with the pressure from acute orthopaedic workload redirects resources away from planned procedures.
Wairarapa District Health Board Page 1 of 15
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PUBLIC 2. STAFFING
2.1. Sick Leave The Wairarapa DHBs sick leave rate sits at 2.6% of worked hours for October 2019. Perioperative has increased this month to 4.1% and averaging 5.9% so far this financial year. Medical Surgical Ward (MSW) however has dropped back to 2.7% close to the DHB target of 2.5%. Maternity has also dropped this month to 2.7% and Radiology is at 2.6%.
Perioperative - Sick Leave as % of Worked Hours Maternity - Sick Leave as % of Worked Hours
Sick as a % of Worked - DHB Wide Sick as a % of Worked - Periop Linear ( Sick as a % of Worked - DHB Wide) Linear (Sick as a % of Worked - Periop) Sick as a % of Worked - DHB Wide Sick as a % o f Worked - Maty Linear ( Sick as a % of Worked - DHB Wide) Linear (Sick as a % of Worked - Maty) 12.0% 9.0%
8.0% 10.0% 7.0%
8.0% 6.0%
5.0% 6.0% 4.0%
4.0% 3.0%
2.0% 2.0% 1.0%
0.0% 0.0% l l t t t t t t t t r r r r r r r r c c c r r r r r r r r c c c v v v y v v v y y y y y y y y y g g g g y y y y e e e n e e e g g g g n n n n n b p b p b p b p n n n n b p b p b p b p l l l l l l c c c c u c c c c u a a a a p p p p p p p p a a a a e e e e e e a a a a o o o u u u u o o o a a a a u u u u e e e e e e e e e e e e e e e e a a a a n n n a a a a n n n u u J J u u u u u u J J J J J J J J J J O O O O O O O O A A A A F A S F A S F A S F A S F S F S F S F S J J J u u u J D J D D J D D D A A A A A A A A u u u N N N N N N M M M M M M M M M M M M M M M M J J J J J J 2016 2017 2018 2019 2016 2017 2018 2019
MSW - Sick Leave as % of Worked Hours Radiology - Sick Leave as % of Worked Hours
Sick as a % of Worked - radiology Sick as a % of Worked - DHB Wide Sick as a % of Worked - DHB Wide Sick as a % of Worked - MSW Linear ( Sick as a % of Worked - DHB Wide) Linear (Sick as a % of Worked - MSW) Linear (Sick as a % of Worked - radiology) Linear ( Sick as a % of Worked - DHB Wide) 10.0% 10.0% 9.0% 9.0% 8.0% 8.0% 7.0% 7.0% 6.0% 6.0% 5.0% 5.0% 4.0% 4.0% 3.0% 3.0% 2.0% 2.0% 1.0% 1.0% 0.0% l t r r r r r r r r t t t c c c v v v y y y y y y y g g g g e e e b p b p b p b p n n n n n 0.0% l l l c c c c u l p p p p a a a a r r r r e e e a a a a t t t t u u u u c c c o o o r r r r e e e e e e e e n n n a a a a v v v e e e y y y y y y y n b p b p b p b p J g g g g u n n n n l l l u u u u c c c c J J J J a a a a J p p p p O O O O e e e a a a a A A A A u u u u o o o a a a a F S F S F S F S e e e e e e e e n n n J D J D D J A A A A J u u u u N N N u u u M M M M J J J J M M M M J O O O O J J J A A A A F S F S F S F S J D J D D J A A A A u u u N N N M M M M M M M M J J J 2016 2017 2018 2019 2016 2017 2018 2019
2.2. Annual Leave
Annual Leave Hours Coded in Payroll (AL & AAL) by employee category Total Annual Leave Hours Coded in Payroll (AL & AAL) 10000 Allied Medical Mgmt & Admin Nursing Support 9000 4000 8000 3500 7000 3000 6000 2500 5000 2000 4000 1500 3000 2000 1000 1000 500 0 0 r r t t r r c v y y g g y y e e r r n n r r t t b p b p v c g g y y e e y y l l b p b p n n c c a a l l p p a a e c c u u o a a a a n n p p e e e e a a e o u u a a n n u u e e e e J J u u O O A A J J F S F S J D J u u O O A A A A F S F S N u u J D J M M A A N M M M M J J M M J J 2018 2019 2018 2019
Annual leave for October levels remains relatively consistent with previous trends during school holidays. 2.3. New recruitment updates Key Staff Monthly Changes ∑ NIL
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PUBLIC Existing recruitment actions Key Staff Existing General Surgeon ∑ Two General Surgeon vacancies at the end of September. 1.95FTE ∑ Two appointments secured one for six months and a further candidate who has formally accepted a role for at least one year with a strong view to a permanent position in the Wairarapa. The appointments are booked to start on 22 February 2020 and the 16 March 2020 respectively. ∑ Active recruitment continues; Reference checks underway for two other strong candidates. ∑ Discussions and contingency arrangements underway with other DHBs for support and future collaboration and support. ∑ Co-ordination and continuity challenges with high dependency on locum use; Preferred candidate for a senior clinical nurse co-ordinator to work with surgeons identified and fixed term position progressing. Orthopaedic Surgeon ∑ Two current vacancies under active recruitment. 2.0 FTE ∑ Offer to locum with experience in Wairarapa and completing a fellowship in the United Kingdom. Position is future planning for succession of retirement. ∑ A further offer has been accepted with the successful candidate now processing immigration and registration requirements. ∑ Two further potential recruits are being pursued for succession planning. ∑ Some short term locum options secured using gap period for NZ graduates prior to fellowship appointments overseas. ∑ Engagement with Capital and Coast DHB (CCDHB) for regional collaboration and support in process. Anaesthetist 1.5 FTE ∑ 1.5 FTE vacancies by the end of 2019 with early notification of changes from current staff. ∑ Active Locum procurement with some long term contracts possible if required to cover any gaps between permanent recruitment. ∑ One role for full year locum accepted due February 2020 and two further long term candidates subject to reference checks. ∑ Interviews booked for two candidates looking permanent roles. ∑ Consideration for retirement succession planning for two full time staff. MOSS AT&R 0.8 FTE ∑ Anticipated vacancy in ATR being considered alongside recruitment Head of Department, Clinical Leadership role considered as alternative for replacing current MOSS role. ∑ Locum cover available for interim during configuration and recruitment. MIT ∑ One vacancy. ∑ Active recruitment with proposal to supplement the service with an Allied Technician for the interim. Charge Midwife ∑ Interviews complete and permanent CMM role under offer. Manager (CMM) 0.8FTE Director of Midwifery ∑ Position successfully appointed. 0.2 FTE Dental Therapist ∑ 1.8FTE Vacancies historically difficult to recruit for. ∑ Active recruitment. ∑ Otago University employer’s forum booked for this month. Speech-language ∑ Vacant since 12/8/19, active recruitment underway. Therapist, Child ∑ Historically difficult to recruit to and extended timeframe likely. Development Service ∑ Plan to use vacancy to support additional psychologist hours in interim 0.2FTE (to reduce psychologist waiting list).
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PUBLIC 3. ACTIVITY AND OPERATIONAL PERFORMANCE
3.1. Acute Services ED Waiting times Wait time performance for the six hour ED target for Quarter one is not achieved at 90.9%. The October 2019 wait time performance is also below the 95% target at 91.9%. As previously reported the non- achievement of the six hour target includes an increase in Triage three as a proportion of presentations having increased by 652 (over 10%) presentations since 2017. This trend has increased into the current financial year with Triage three presentations being 43% of total ED presentations. One of the ED FACEMS has recently reviewed two weeks of breaching patient data to look for opportunities to improve care in the department and address waiting times. We are currently working through these findings but already some aspects of note presented are; ∑ Approximately 62% of breaching patients occur in the evening with the remaining 38% equally spread across morning and afternoon; ∑ Approximately 10% of breaches are likely incorrectly classified due to clerical error in time captures. (This represents 1% of target reporting); and ∑ Nearly a third of all breaches have their ED treatment completed less than 30 minutes beyond the six hour target time. We welcome the engagement of the senior clinicians in the department and look forward to exploring options to help improve our performance.
Month Total Within 6 Result Quarter Total Within 6 Result Presentations hours Presentations hours Jul-18 1,446 1,338 92.5% QRT1 18/19 4,484 4,146 92.5% Aug-18 1,536 1,425 92.8% QRT2 18/19 4,508 4,113 91.2% Sep-18 1,502 1,383 92.1% QRT3 18/19 4,530 4,198 92.7% Oct-18 1,521 1,365 89.7% QRT4 18/19 4,250 3,987 93.8% Nov-18 1,439 1,340 93.1% QRT1 19/20 4,286 3,889 90.7% Dec-18 1,548 1,408 91.0% QRT2 19/20 1,514 1,392 91.9% Jan-19 1,598 1,477 92.4% Feb-19 1,395 1,327 95.1% Mar-19 1,537 1,394 90.7% Apr-19 1,359 1,289 94.8% May-19 1,499 1,391 92.8% Jun-19 1,392 1,307 93.9% Jul-19 1,503 1,370 91.2% Aug-19 1,418 1,300 91.7% Sep-19 1,365 1,219 89.3% Oct-19 1,514 1,392 91.9%
Total ED Presentations 2020 2018 2019 1,800
1,600
1,400
1,200
1,000
800
600
400
200
0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2020 1,513 1,423 1,378 1,513 2018 1,515 1,548 1,463 1,538 1,492 1,680 1,634 1,435 1,502 1,438 1,431 1,452 2019 1,451 1,548 1,509 1,528 1,442 1,559 1,600 1,397 1,542 1,363 1,503 1,394
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PUBLIC ED Attendances By Triage ED Presentations by Referral Source 1 2 3 4 5 800 Ambulance Other GP Self Referral 1,400 700 1,200 600 1,000 500 800 400 600 300 400 200 200 100 0 l l l t t t r r v v c c g g g y y n n p b p b p n n r r u u u c c c 0 a a a a e e u u u o o a a u u e e e e e p p J J J l l l t t r r t c c v v J J y y g g g p b p b p J J n n n n O O O r r S F S F S D D A A A c c c u u u N N a a M A M A e e a a o o u u u e e e e e a a M M p p J J J u u J J J J O O O S F S F S D D A A A N N M A M A M M 2018 2019 2020 2018 2019 2020
3.2. Maternity Services The first part of the year has seen a busy start for maternity with July being one of the busiest birthing months for many years with 53 births. October 2019 has also seen high delivery rates with 47 births recorded on the unit. The C-section rate sits at 21.6% for October 2019 compared with September 2019 peaking at 6.3%, as a result of 19 C-sections for that month.
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PUBLIC
Wairarapa DHB Hospital Births 2019
Breech Delivery and Extraction 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
ALOS & ACWD 3.4. Medical & Rehab General Medical ALOS and ACWD has remained relatively static for the last year. However given the overflow of acute Medical patients into ATR the shorter stay non-rehab patients i.e. medical boarders has seen the average length of stay for ATR reduce in the last four months. The year to date (YTD) to October 2019, 18 non-rehab patients have been admitted to ATR with an ALOS of 5.39 days.
General Medicine ALOS & ACWD July 18 - Oct 19 Avg Length Of Stay Avg CaseWeighted Discharges Inpatient Caseweighted Discharges 2 per. Mov. Avg. (Avg Length Of Stay) 2 per. Mov. Avg. (Avg CaseWeighted Discharges)
5.00 300
4.00 250 200 3.00 150 2.00 100 1.00 50 0.00 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May June Jul Aug Sep Oct
ATR ALOS Jul 18 - Oct 19
Avg Length Of Stay Inpatient Discharges 2 per. Mov. Avg. (Avg Length Of Stay)
25.00 30
20.00 25 20 15.00 15 10.00 10
5.00 5
0.00 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May June Jul Aug Sep Oct
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PUBLIC 3.5. Surgical Orthopaedic average length of stay in the last three months has dropped slightly by 0.29 days this month currently sitting at an average 2.91 days comparable to 2018 2.64 days. This is mostly due to the larger proportion of acute admissions. Early reporting of data for this report means that some of the results may change as coding is completed on patients through the month.
General Surgery ALOS & ACWD July 18 - Oct 19
Avg Length Of Stay Avg CaseWeighted Discharges Inpatient Caseweighted Discharges 2 per. Mov. Avg. (Avg Length Of Stay) 2 per. Mov. Avg. (Avg CaseWeighted Discharges) 6.00 120 5.00 100 4.00 80 3.00 60 2.00 40 1.00 20 0.00 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May June Jul Aug Sep Oct
Orthopaedics ALOS & ACWD July 18 - Oct 19
Avg Length Of Stay Avg CaseWeighted Discharges Inpatient Caseweighted Discharges 2 per. Mov. Avg. (Avg Length Of Stay) 2 per. Mov. Avg. (Avg CaseWeighted Discharges) 4.00 100
80 3.00 60 2.00 40 1.00 20
0.00 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May June Jul Aug Sep Oct
Fiscal Year 2020 Fiscal Month Desc 04 - Oct
MTD MTD Actual MTD Volume YTD Actual YTD Contract YTD Volume Purchase Unit code Contract Volume Variance Volume Volume Variance Volume Caseweight Acute 409.9 418.8 (8.9) 1,770.8 1,675.3 95.5 M00001.a - General Internal Medical Services - acute 211.3 195.5 15.9 830.7 781.8 48.8 M05001.a - Emergency - Inpatient Services acute 35.6 39.7 (4.1) 156.0 158.8 (2.8) M55001.a - Paediatric Medical - Inpatient Services acute 22.1 20.2 2.0 103.2 80.7 22.5 S00001.a - General Surgery - Inpatient Services acute 52.2 55.8 (3.7) 213.0 223.3 (10.3) S30001.a - Gynaecology - Inpatient Services acute 1.8 7.8 (6.1) 11.4 31.3 (19.9) S45001.a - Orthopaedics - Inpatient Services acute 38.6 59.1 (20.5) 200.6 236.3 (35.7) W06003.a - Neonatal - Inpatient Services acute 4.3 7.8 (3.5) 56.3 31.3 25.0 W10001.a - Maternity - Inpatient Services acute 44.1 32.9 11.2 199.6 131.7 67.9
Grand Total 409.9 418.8 (8.9) 1,770.8 1,675.3 95.5
Local Acute CWDs volumes are tracking ahead of contract by 95.5 YTD. (Note this number may continue to change due to coding for the current month not being finalised).
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PUBLIC 3.6. Planned Care (including Electives) NB* Appendix 1 corresponds to the Planned Care performance as reported to the Ministry of Health (MoH) and is aligned to the MoH dashboard for the activity delivered as of September 2019.
Key Performance Area Commentary Planned Care Interventions The MoH has split the 2019/20 planned care initiative into three Delivery (case weights, discharges components (replacing the electives and ambulatory initiatives and minor procedures) of the past) ∑ Inpatient surgical discharge. ∑ minor procedures both inpatients and outpatient. ∑ non-surgical interventions. September 2019 is positive with 117 (113.9%) additional interventions more than planned. Although we are currently sitting positive overall at 113.9% at year-end we need to be at 95% of agreed total expectations by type of Intervention, that is each intervention needs to be looked at separately. This is further broken down by: ∑ Inpatient Surgical discharges sitting adverse at 90.6%, which equates to 60 less discharges than planned. Case weight delivery is also adverse at 90.2% or 85.9 CWDs. ∑ Minor procedures positive at 185.1%, with 177 more interventions delivered than planned. ∑ A break down by main surgical specialities discharges and case weights is below to September 2019: 1. ENT are eight discharges (1.9 CWD’s) ahead; Hutt Valley DHB (Hutt DHB) provide this service for ENT patients. 2. Gynaecology is 15 patients ahead of discharge targets, 9.5 CWD’s ahead. 3. General Surgery is 19 behind of contracted discharge targets which equates to 86.8%. Also 31.1 CWD’s behind contract at 84.7%. 4. Ophthalmology is a deficit of 10.1 CWD. Discharges at 77.3% (20 behind); due to surgeon availability. Complex surgeries are performed at CCDHB with cataracts at Wairarapa. Theatre schedules have been altered to accommodate the shortfall in discharges. 5. Orthopaedics are 48.7 CWD’s under delivered 82%. Similarly, discharges are 42 patients behind. Orthopaedic surgery has been most impacted by strikes. Use of locums has impacted on case selection relating to clinical continuity and procedural familiarisation. We currently have one vacancy in Orthopaedics which is sporadically covered by locums. Locums do not routinely operate on elective patients for the purposes of continuity and surgical approach standardisation and consequently are predominately used for acute theatre. 6. Urology is currently at 97% of overall discharges, which equates to one patient. 7. Minor procedures delivered to September 2019 are 385 on a plan of 208, 185.1%. This is due to 79 more skin lesions than planned, 18 more Gynaecology, 83 more Avastin and eye procedures.
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PUBLIC
Planned Care Interventions Delivery Actions ∑ Implementation of Production Plan monitoring and reporting is completed and now monitored. ∑ Prioritising access to planned services for Wairarapa DHB (WrDHB) domiciled patients. ∑ A Planned and Acute care flow working group comprising of Orthopaedic Clinicians, Nursing, Theatre Staff and Public Health Organisation (PHO) liaison is currently being set up to discuss patient options and management of Orthopaedic referrals. ∑ Theatre utilisation project around Orthopaedics is being undertaken to ensure optimum theatre capacity. Key Performance Area Commentary Elective Service Patient Flow WrDHB performance has been in red for both ESPI two and five Indicators (ESPIs) – breakdown of for the last 23 months. ESPI two and five Non-compliant services for ESPI two September 2019: ∑ Ophthalmology 35 patients. ∑ ENT 14 patients. ∑ Orthopaedics two patients. ∑ External contractors provide ENT and Ophthalmology. Non-compliance services ESPI Five September 2019: ∑ General Surgery seven patients. ∑ Orthopaedics 77 patients. ∑ Urology three patients. ∑ Gynaecology one patient. ∑ Ophthalmology five patients. OPHTHALMOLOGY ∑ Work to validate First Specialist Appointment (FSA) waitlist and re-align our triaging criteria neighbouring DHB’s has been completed. ∑ Additional clinics arranged to bring long wait patients (four months or more) for a FSA. ∑ Extra clinics has resulted in an increase in cataract surgery; resulting in additional theatre requirements. ∑ By the end of October 2019 four patients will be waiting longer than four months for FSA. ∑ We are on track to be compliant by end of 2019. ∑ Ophthalmology nurse specialist running clinics releasing time for the SMO’s. ENT ∑ Realignment with our triaging criteria to Hutt DHB *is completed. New Triage criteria allows more FSA patients to be seen. ∑ ENT service through Hutt DHB, have not been able to provide clinicians clinics. A locum was secured to cover some of the shortage. ∑ Hutt DHB is unable to provide clinics during December 2019 and January 2020 and we are unable to secure a locum in December but have secured a locum in January 2020 to backfill two clinics. ∑ We have committed to the MoH to become compliant by November 2019; on target to meet ∑ Currently exploring the option of nurse led follow up clinics to release further clinical time for clinicians to see more patients at FSA
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Key Performance Area Commentary ORTHO & GEN SURGERY ∑ ESPI five performance is non-compliant and this continues to rise. Anticipate 94 patients will be waiting for surgery by the end of October 2019. ∑ General Surgery have 10 patients waiting longer than four months for treatment reducing to three patients in October 2019. ∑ On-going recruitment for SMO resignations in both services with the need to backfill is a constant concern. ∑ Current General Surgeon locum secured for a month from mid-November cancelled two days prior to starting. This has left a big gap not just in General Surgery but for endoscopy as well. Cover is currently being sort. ∑ It has been agreed not to introduce the New Orthopaedics referral prioritisation tool until after the Orthopaedic patient flow project has been completed. Triaging of referrals has changed in the interim whereby an Orthopaedic clinician from the project team is undertaking triaging to ascertain changes needed. GYNAECOLOGY ∑ Eight patients waiting longer than four months for surgery in August 2019 reducing to one patient in September 2019 and October 2019 Gynaecology to become compliant in November 2019. Diagnostics performance (CT, MRI) CT performance continues to exceed the 95% targets set for the DHB. Currently sitting at 97.1%. Note that MIT strike activity (six days of 24hr full withdrawal of labour over October) will extend CT wait times and achievement against the 95% target. It will also impact general imaging performance and activity due to the time required to plan and prepare for decreased services on the strike days. MRI waiting times and under performance against the 90% waiting time targets. Currently sitting at 66.7%. A further 2.7% improvement on last month to 66.7% against the 85% target as evidence actions indicated below. ACTION ∑ The Radiology Manager at Hutt DHB regarding ongoing performance and capacity. ∑ Appropriate triage is being applied to ensure acute and urgent requests (excluded from MoH reports) are being appropriately prioritised and expedited. ∑ Additional evening and Saturday sessions being used to assistant with increased volumes. ∑ Hutt DHB outsourcing to supplement capacity. ∑ Positive returns on recruitment of MITs and Radiologists. Ophthalmology Waiting times – As referenced above ESPI 2, ESPI 5 and Follow up appointments Cardiac Surgery – Delivery and Cardiac Surgery and management is provided by CCDHB waiting list
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PUBLIC 3.7. FSA/FU Volumes to contract First Assessments shows an over delivery of 347 attendances and under delivery of 78 follow-ups to October 2019 with variations by specialty provided in the table below. Variation is managed through the Electives Process and production planning.
Fiscal Year 2020 Fiscal Month Desc 04 - Oct
MTD MTD Actual MTD Volume YTD Actual YTD Contract YTD Volume Purchase Unit code Contract Volume Variance Volume Volume Variance Volume Outpatients - First Assessments 788 714 74 3,203 2,856 347 D01002 - Dental - 1st attendance 0 9 -9 12 34 -22 M00002 - General Medicine - 1st attendance 82 67 15 305 267 38 M00010 - Virtual FSA - Medical 42 26 16 169 104 65 M10002 - Cardiology - 1st attendance 45 13 32 191 53 138 M20002 - Endocrinology - 1st attendance 10 6 4 29 25 4 M20004 - Diabetes - 1st attendance 1 4 -3 8 14 -6 M25002 - Gastroenterology - 1st attendance 4 9 -5 41 35 6 M55002 - Paediatric Medical Outpatient - 1st attendance 44 44 0 239 177 62 MS01001 - Nurse Led Outpatient Clinics 46 50 -4 220 200 20 MS02002 - Botulinum toxin therapy 1 7 -6 19 28 -9 S00002 - General Surgery - 1st attendance 112 125 -13 507 500 7 S00011 - Virtual FSA - Surgical 65 62 3 266 250 16 S25002 - ENT - 1st attendance 32 37 -5 142 146 -4 S30002 - Gynaecology - 1st attendance 46 66 -20 193 263 -70 S40002 - Ophthalmology - 1st attendance 116 58 58 359 233 126 S45002 - Orthopaedics - 1st attendance 65 58 7 232 230 2 S45004 - Fracture Clinic - 1st attendance 9 7 2 35 28 7 S60002 - Plastics (inc Burns & Maxillofacial) - 1st attend. 53 43 10 151 173 -22 S70002 - Urology - 1st attendance 15 24 -9 85 95 -10
Outpatients - Subsequent Assessments 929 861 68 3,368 3,446 -78 M00003 - General Medicine - Subsequent attendance 91 100 -9 312 400 -88 M10003 - Cardiology - Subsequent attendance 0 0 0 1 1 0 M20003 - Endocrinology - Subsequent attendance 23 7 16 44 27 17 M20005 - Diabetes - Subsequent attendance 12 12 0 49 47 2 M25003 - Gastroenterology - Subsequent attendance 8 47 -39 20 189 -169 M55003 - Paediatric Medical Outpatient - Subsequent attend. 170 133 37 534 534 0 S00003 - General Surgery - Subsequent attendance 114 133 -19 519 533 -14 S25003 - ENT - Susequent attendance 23 45 -22 168 179 -11 S30003 - Gynaecology - Subsequent attendance 60 71 -11 233 285 -52 S40003 - Ophthalmology - Subsequent attendance 260 165 95 809 660 149 S45003 - Orthopaedics - Subsequent attendance 80 72 8 327 289 38 S45005 - Fracture Clinic - Subsequent attendance 27 34 -7 76 138 -62 S60003 - Plastics (inc Burns & Maxillofacial) - Sub attend. 24 19 5 74 74 0 3.8. Elective CWD Volumes to Contract
Fiscal Year 2020 Fiscal Month Desc 04 - Oct
MTD MTD Actual MTD Volume YTD Actual YTD Contract YTD Volume Purchase Unit code Contract Volume Variance Volume Volume Variance Volume Caseweight Elective 105.8 129.3 (23.6) 492.7 517.3 (24.6) S00001.e - General Surgery - Inpatient Services elective 26.9 28.7 (1.8) 118.7 114.8 3.8 S30001.e - Gynaecology - Inpatient Services elective 10.8 14.1 (3.3) 63.9 56.3 7.6 S40001.e - Ophthalmology - Inpatient Services elective 14.4 8.0 6.4 38.7 32.1 6.6 S45001.e - Orthopaedics - Inpatient Services elective 47.0 67.2 (20.2) 234.1 268.8 (34.7) S60001.e - Plastic & Burns - Inpatient Services elective 0.0 3.0 (3.0) 4.2 12.0 (7.8) S70001.e - Urology - Inpatient Services elective 6.8 8.3 (1.5) 33.2 33.3 (0.1) Elective CWDs are behind plan by 24.6 YTD. Variation to contract commentary is referenced in the Planned Services report in the previous section. Note that this number may continue to change due to coding for the current month being finalised.
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PUBLIC 3.9. Theatre Utilisation/ Cancellation Rate There were 28 day of surgery cancellation in October, or 8.0% of total theatre events. ∑ 11 Orthopaedic; ∑ one Endoscopy; ∑ 11 General Surgery; and ∑ five Gynaecology.
The reasons for cancellations were 11 acute substitution, six no beds, four for patient reasons including unfit, DNA and patient cancelled , two not required, one list over run and four were miscellaneous/admin errors. A review of theatre utilisation data has been completed. This has resulted in the system being updated to reflect current resourcing levels across all three theatres. As a result theatre utilisation has shown a slight improvement in what has been previosuly reported. Theatre utilisation for October 2019 was 67% combined, 73% theatre one, 70% theatre two and 58% theatre three. At the same time longer term look at DoS cancellation rates suggest that there has been a marked increase over last two years and this remains a key area of focus for targeting improvement at a planned care systems level.
No. of DOS Theatre Cancellations No. of DOS Cxl as a % of theatre events 40 12.0% 35 10.0% 30 8.0% 25 20 6.0% 15 4.0% 10 2.0% 5 0 0.0%
Theatre Utilisation All theatres Theatre Utilisation - theatre 1
Combined Target TH1 Target
90% 100% 80% 90% 70% 80% 60% 70% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% 8 8 9 8 8 9 8 9 8 9 8 9 8 8 9 8 9 8 9 8 9 8 9 8 8 9 9 8 8 9 8 9 8 9 8 9 8 9 8 9 8 8 9 9 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ------l l l l r r r r r r t t t t r r c v c g g v y y g g n n y y n n n n b p b p n n b p b p u u c c c c u u a a a a p p p p a a e a a o e u u a a o u u u u a a e e e e e e e e u u J J J J J J J J J J J J O O A A O O F S F S A A F S F S D A A D N A A N M M M M M M M M
Theatre Utilisation - theatre 2 Theatre Utilisation - theatre 3
TH2 Target TH3 Target
90% 100% 80% 90% 70% 80% 60% 70% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% 8 8 8 9 8 9 8 9 8 9 8 9 8 9 8 9 8 9 8 9 8 9 8 9 8 9 8 8 8 9 8 9 8 9 8 9 8 9 8 8 9 8 9 9 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ------l l l l r r r r r r r r t t t t c c v v g g g g y y y y n n n n n n n n b p b p b p b p u u u u c c c c a a a a p p p p a a a a e e o o u u u u a a a a e e e e e e e e u u u u J J J J J J J J J J J J O O O O A A A A F S F S F S F S D D A A A A N N M M M M M M M M
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PUBLIC
Key Issues Key actions underway Theatre Utilisation ∑ Following Surgical Services meeting team looking at planned care metrics and avoidable and monitoring. Specific project to target and improve Orthopaedics as unplanned down area of priority underway. Workshop undertaken on Friday 18th October time 2019 with three key aspects of systems improvement. ∑ Community and non-surgical treatment options. ∑ Surgical Candidacy optimisation. ∑ Operating room throughput & Efficiency.
3.10. Community Services District Nursing
Monthly patient volumes for District Nursing have seen high levels of care provided in excess of planned activity and previous year’s volumes. Home help and personal care are tracking below and to plan respectively.
DOM101.pc contacts - Community Services - palliative care services DOM101.ps contacts - Community Services - professional services
This Yr Last Yr Actual Budget / SLA This Yr Last Yr Actual Budget / SLA 4,500 900 4,000 800 3,500 700 3,000 600 2,500 500 400 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 2,000 140 120 1,500 100 80 1,000 60 40 500 20 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
3.11. CDS
The Government’s 2019 budget included additional new funding of $35million across the country ($8.75m per annum) over four years to improve the health and social outcomes of children who are not meeting their developmental milestones and have additional needs.
The Central Region implementation plan has progressed over October 2019, along with confirmation from the Ministry that our Central Region funding allocation has increased from $446,000 to $670,000 for the region for the 2019/20 financial year. WrDHB have put forward a request for $67,500 for this period, including funding for increased Clinical Psychologist hours (fixed term, January – June 2020) and a permanent 0.4FTE increase in occupational therapy resourcing. Pending funding approval we intend having these positions in place and operational by Feb 2020.
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PUBLIC 3.12. Allied Health, Scientific and Technical
As indicated previously strike activity by Medical Imaging Technologists who are APEX members had an impact on usual imaging and wider hospital activity over October. The Imaging team are currently engaged in the procurement process for two new diagnostic radiography suites, one of which will have videofluroscopy function. This has been approved via CAPEX funding, at a cost of $1.2m. It is anticipated a RFP will be out prior to Christmas to progress this. HR activity has been constant over October, including two formal complaints within a technical team and notification from the NZ Health Practitioners’ Disciplinary Tribunal of a charge that will be laid as a result of a notification of concern made under the HPCA Act regarding a previous WrDHB scientific employee. There has also been activity within an allied health team that has required legal engagement. Progressing planning of services within the community integration space is a priority over the coming quarter, as changes to the ACC Non Acute Rehab contract and Ministry expectations re community stroke rehabilitation together with the progression of the Health Care Homes framework in primary care place increasing requirements on community service delivery. We currently have minimal allied health resource based in the community. 3.13. FOCUS
Staffing challenges steadily resolving with return to work trial underway for staff on ACC since July and interviews for two part time vacant positions completed and roles offered with a tentative start date 02/12. The team are settling in well to their new office location with some outstanding long term in relation to file storage awaiting permanent resolution and early issues following move with phone and fax systems resolved.
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PUBLIC 3.14. Diagnostics Commentary on Diagnostics wait time performance is included in the Planned Section of this report in relation to MRI. All other performance metrics and targets met for the month from the Imaging department. As noted Community Referred Radiology volumes exceeded contract for the month and is 330 tests ahead of contract.
CT Wait Times MRI Wait Times Wai Result Target Hutt Result Wai Result Target Hutt Result 120.0% 100.0% 100.0% 95.0%
80.0% 90.0%
85.0% 60.0%
80.0% 40.0%
75.0% 20.0%
70.0% 6 7 8 7 8 9 7 8 9 6 7 8 9 6 7 8 9 7 8 9 0.0% 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ------6 7 8 - - - 7 8 9 7 8 9 6 7 8 9 6 7 8 9 7 8 9 l l l l r r r v v v y y y 1 1 1 1 1 1 1 1 1 1 n n n 1 1 1 1 1 1 1 1 1 1 p p p p u u u u ------a a a - - - - - a a a o o o l l l l a a a e e e e J J J J r r r v v v y y y n n n p p p p J J J u u u u S S S S a a a a a a o o o N N N a a a M M M e e e e J J J J M M M J J J S S S S N N N M M M M M M
Fiscal Year 2020 Fiscal Month Desc 04 - Oct
Values MTD MTD Actual MTD Volume YTD Actual YTD Contract YTD Volume Purchase Unit code Contract Volume Variance Volume Volume Variance Volume CS01001 - Community-referred radiology 1,638.1 1,291.7 346.4 5,845.9 5,166.7 679.2
3.15. Endoscopy Waiting For October 2019, the Urgent and Semi Urgent Colonoscopy targets were achieved at 100% and 93.2% respectively however; Surveillance Colonoscopy at 62.9% was not achieved against a target of 70%. Waiting time performance is heavily impacted by current Surgeon vacancies.
Urgent Colonoscopy Semi-Urgent Colonoscopy
Result Target Result Target
120.0% 120.0%
100.0% 100.0%
80.0% 80.0%
60.0% 60.0%
40.0% 40.0%
20.0% 20.0%
0.0% 0.0% 6 7 8 7 8 9 6 7 8 6 7 9 7 8 9 7 8 9 6 7 8 9 7 8 9 7 8 9 7 8 9 8 6 7 8 9 6 7 8 9 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ------l l l l l l l l r r r r r r v v v v v v y y y y y y p p p n n n p p p p p n n n u u u u u u u u a a a a a a a a a o o o a a a a a a o o o e e e e a a a e e e e J J J J J J J J J J J J J J S S S S S S S S N N N N N N M M M M M M M M M M M M
Surveillance Colonoscopy
Result Target
120.0%
100.0%
80.0%
60.0%
40.0%
20.0%
0.0% 7 8 9 6 7 8 7 8 9 6 7 8 9 6 7 9 7 8 9 8 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ------l l l l r r r v v v y y y n n n p p p p u u u u a a a a a a o o o a a a e e e e J J J J J J J S S S S N N N M M M M M M
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PUBLIC
BOARD INFORMATION PAPER
Date: 11 November 2019
Author Sandra Williams, Acting Executive Leader Planning and Performance
Endorsed By Dale Oliff, Chief Executive
Subject Planning and Performance Report for November 2019
RECOMMENDATION It is recommended that the Board
a. Notes this paper and discusses as appropriate
1 PURPOSE
This paper provides an update to the Board on the work being progressed by Planning & Performance (P&P). The key areas of focus of the P&P work program are: ∑ Accountability documents- Annual Plan , Annual Report, and Ministry of Health quarterly reporting ∑ Improving equity ∑ Improving our commissioning for services, to better meet needs, improve performance, outcomes and value for money.
2 ACCOUNTABILITY
2.1 Annual Report 2018/19
The Ministry of Health has reviewed our Annual Report and on the 8 November 2019 notified us that the report meets statutory requirements. The final version of the 2018/19 Annual Report has been prepared and is available to the Board at the November Board meeting. Key dates for the Board are set out below: Dates Actions 21 November 2019 Hard copies of the signed 18/19 Annual Report and 19/20 Statement of Performance Expectations and Statement of Intent sent to Ministry/Parliament 28 November 2019 Annual Report, Statement of Performance Expectations and Statement of Intent tabled in Parliament 5 December 2019 DHB publishes Annual Report, Statement of Performance Expectations and Statement of Intent
2.2 2019/20 Annual Plan
The final signed version of the 2019/20 Annual Plan incorporating the Statement of Intent 2019/20 to 2022/23 and the 2019/20 Statement of Performance Expectations and System Level Measures Improvement Plan was approved by the Chair and sent to the Ministry of Health in early October. The Ministry has submitted the Annual Plan to the Minister of Health for review and approval and we were notified on the 11 November that the Annual Plan has been approved.
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PUBLIC 2.3 2020/21 Annual Planning Preparation
Work has begun on preparing the next Annual Plan. A timetable has been prepared and distributed.
2.4 Strategic Planning
There are a multitude of documents about the Wairarapa direction, many of them produced some years ago including the last strategic plan. As outlined by the Chief Executive at the September Board meeting, a transformation strategy is needed to guide the development of a clinical services and well-being plan for the Wairarapa, in order to support the DHB into the future. The Pacific Strategic Health Plan refresh and the development of a clear strategy for Maori will also support our new strategic direction for health services. Sapere has been commissioned to support our approach to developing a common sense of purpose and direction for health services in the Wairarapa and enabling us to increase the pace of change. A series of meetings are planned for November and December with primary care and hospital clinicians, senior management, Board members, NGOs, community representatives and other stakeholders.
2.5 Ministry of Health Forum
In late October staff attended the MOH forum bringing people together to reflect on success, address challenges and shape efforts to deliver a strong and fair public health and disability system in New Zealand. Of key note was the strong theme of health inequities. Sessions on equity, wellbeing and person directed support expanded on this theme and a number of speakers addressed the initiatives that they were undertaking to make a difference in health outcomes for people. Heather Simpson talked to the forum attendees about the Health and Disability System Review and what the panel had heard during the engagement process. She and the panel members able to join the forum reflected on a greater role for primary and community care to deliver better outcomes for Maori and address inequity, focus on prevention, better leadership and planning, stronger accountability and better service integration across the system.
3 IMPROVING EQUITY
3.1 Measles
From 1 January to 11 November 2019 there have been 2024 confirmed measles cases across New Zealand. There been a significant number of cases reported in the Auckland area. Some cases are being reported outside of the Auckland area and most are linked to exposure from the Auckland cases. The number of new cases being reported has dropped from previous periods. There has been no change for Wairarapa, with only one case reported since 1 January 2019 and no recent cases confirmed. Ministries’ joint approach set to help prevent measles spreading The Ministry of Health has signed a memorandum of understanding (MoU) with the Ministry of Education, guiding the ministries to work together to help prevent the spread of measles in schools. The MoU will allow the Ministry to use the National Immunisation Register to calculate information about schools' overall vaccination rates – the number and percentage of students in schools fully vaccinated against measles – and share them with local public health officers. This will allow for a greater understanding of schools' overall rates of immunity against measles. The agreement also allows the Ministry to provide information about individual students’ vaccination status to local public health officers if a school or schools are directly affected by the outbreak (for example if a student has contracted measles). This information will only be shared as requested by public health officers and will be used to help reduce the spread of measles in schools. The MoU complies with the Privacy Act 1993 and only applies to the Auckland region, remaining in place until the outbreak is over.
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PUBLIC 3.2 Refugees
New Zealand Red Cross has been announced as the primary settlement provider for former refugees in two new locations – Blenheim and Levin – and will be delivering settlement support in Masterton in partnership with Connected Communities Wairarapa. Red Cross is also the lead provider for employment support in all five new locations, including Timaru and Ashburton.
3.3 Mental Health and Addictions
Primary Mental Health and Addiction Services The Ministry of Health has issued two new requests for proposals (RFP) for the expansion/replication of existing Maori and Pacific primary mental health and addiction services as part of the. Budget 2019 investment in increased access to, and choice of, mental health and addiction services. A local collaborative approach to the RFP is underway. More investment through RFPs has been signalled for 2020 for new services. The MOH has started a collaborative design process with Maori to develop kaupapa Maori community mental health service model.
4 IMPROVING COMMISSIONING OF SERVICES
4.1 Aged Residential Care Capacity
There has been a reduction in the number of Aged Residential Care facility beds (25) with the closure of Arbor House last month. Changes in the number of residential care beds is largely the result of market forces. The DHB is not legally able to manage the number of beds. Changes in residential care during 2019- 20 are expected to result in a gain of 31 beds across Wairarapa, taking the total to 577. Rest Home Hospital Secure Name of Facility Geographic Area Dual Gain/Loss Only Only Dementia Arbor House Sth Wairarapa 0 25 less 0 0 25 less Palliser House Sth Wairarapa 1 more 11 more 0 20 more 32 more Roseneath Carterton 0 5 less 0 5 more 0 Glenwood Masonic Masterton 0 4 more 0 0 4 more Wairarapa Village Masterton 0 20 more 0 0 20 more Gains 1 5 more 25 more GAIN 31
Another potential development over the next 4 – 5 years include a new facility in Greytown of about 60 beds, 20 of which are likely to be for secure dementia care.
4.2 Central Region interRAI infographic – Dementia
The most recent Central Region infographic focuses on dementia. It describes the different impacts of mild and moderate/significant cognitive impairment as measured by the Cognitive Performance Score in interRAI assessments. Not surprisingly, the results show an increasing impact on a person’s daily living when the cognitive impairment is more severe. Because numbers and therefore percentages are so low by DHB (especially Wairarapa) this data has not been derived for a local level. However, logically, one would expect a very similar result to be reflected for the local population.
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PUBLIC
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PUBLIC BOARD INFORMATION PAPER
Date: 12th November 2019
Author Chris Stewart, Executive Leader Quality, Risk and Innovation
Endorsed By Dale Oliff, Chief Executive, Wairarapa District Health Board
Subject Wairarapa DHB Quality, Risk & Innovation Quarterly Report
RECOMMENDATIONS It is recommended that the Board:
a. NOTES reporting is for the months of August, September & October 2019. b. NOTES that there were no Work Safe notifiable events during the reporting period.
APPENDICIES
1. HDC Report Analysis Wairarapa DHB Jan-Jun 2019
1 INTRODUCTION
As a DHB we are working towards meeting our quality goals by working together at all levels of the DHB to achieve patient centred care, openness and transparency, learning from error or harm and ensuring that the contributions of staff for quality improvement and innovation are truly valued. All of our goals are in line with the triple aim outcomes, national and regional priorities as identified by the Health and Disability Services Standards, Health Quality and Safety Commission (HQSC), Regional Services Plan and the Wairarapa DHB Annual Plan. They are outlined in the Quality Improvement and Patient Safety Strategy, which guides our focus and local service quality improvement and work plans.
The Quality Team continues to provide support and leadership to clinical staff and develop and build on the systems, processes and capability required to maximise quality and patient safety. Current work plan activities include but are not limited to: ∑ Quality improvement project around the review and learning from SAC three and four events in SQuARE ∑ Document Control System rebuild and review and update of all policies, procedures and guidelines ∑ Quality SharePoint site development to enable organisation wide access and sharing of Quality Improvement and a central organisation Corrective Action Plan to allow centralised monitoring of and organisational access to recommendations, learnings and corrective actions ∑ 3DHB collaboration and streamlining of SQuARE (reportable event system)
1.1 Highlights
∑ All outstanding corrective actions following surveillance audit signed off by the Ministry of Health (MOH) ∑ Tracer Audit training tested with Clinical Quality Facilitators doing first Tracer Audit across a number of services training – provided onsite by MOH, with the plan to integrate this audit technique into our auditing schedule ∑ Three spaces on CCDHB Improvement Movement 12 week programme secured and filled ∑ Two clinically led Serious Event reviews completed with comprehensive reports and learnings shared
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PUBLIC ∑ Patient Safety Week 3rd to 7th November2019, Anton Blank Webinar on Unconscious Bias well attended and a selection of online learning modules now available for use ∑ Maternity Early Warning score (MEWS) implemented
2 CONSUMER VALUE
Focussing on consumer value encourages us to involve our communities in improving current performance and planning for the future, and to achieve improved health outcomes and equity for our population. The Consumer Council is another way that we ensure our services are patient and family/whānau centred. We receive consumer information through our complaints and compliments feedback and the National Patient Experience Survey.
2.1 National Adult In-Patient Experience Survey
WrDHB is required to and has consistently met the requirements by participating and submitting quarterly national adult patient experience survey (adult inpatient’s over 15 years of ages, excluding mental health patients).
The benefits of using an external specialist provider is the advanced technology available to collect and report results, access to international ‘best-practice’ survey questions that are proven to be relevant and national benchmarking. However participation rates and completion rates remain low at WrDHB and across the country with many DHBs funding separate in-house patient experience surveys.
All DHBs have welcomed the news that a new provider has been found to administer the national survey. Ipsos is a market and social research agency that provides qualitative and quantitative data collection as well as reporting and data analysis services. Ipsos is a leading provider of full-service patient experience research services in Australia; and currently holds contracts to design, collect, report and analyse on public hospital patient experiences across New South Wales and Victoria – covering 50% of the total Australian population. Ipsos has also delivered the UK GP survey since its inception 13 years ago.
Quarter three results show an improved response rate of 26% compared with the previous quarter’s response rate of 19% which we believe was a result of marketing to patients using meal tray flyers.
Quarter four will be the last round contracted by Cemplicity as advised above, we therefore will not employ any additional methods to increase participation as this is very resource intensive. We look forward to new methodologies and reporting that will be provided by Ipsos.
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2.2 Equity results – Inpatient Experience for Maori/Pacifica and Comments
Small cohort NZ European (73), Other European (1), Māori (2), Middle Eastern (1) & Don’t know / Refused to answer (9) makes it difficult to make assumptions and raises the question of how we can get a better representation of Māori patient experience – something national quality leaders have highlighted as a key issue with the new provider.
Filter set one - European & other: Filter set two – Maori
Patient Comments - Communication
I was listened to. When and if help was needed staff were aware of a possible need e.g. shower. Staff always explained what was going to take place first. Staff always explained clearly to my fiancé and kept her informed.
Drs were compassionate, friendly and helpful. As were nurses, cleaning staff etc. Everyone lovely.
Nurse on my last day was too busy with a demanding other patient and did not have time to assist to me.
I was put at ease and spoken to with respect and understanding in a stressful situation.
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PUBLIC I was in the maternity ward and found the midwives were great, but I often received conflicting information and answers to my questions.
Filter set one - European & other: Filter set two – Maori
Patient Comments - Partnership
Good responses from nursing staff to me and family.
When I asked for pain relief it was expedited quickly
Clear explanations were given for all tests that were being done and why.
Between the two doctors that were looking after me I was well served.
I really appreciated the candid, no nonsense, intelligent way my not good situation was explained.
Filter set one - European & other: Filter set two – Maori
Patient Comments - Coordination
As I stated previously my case is complex and the staff understood this and made me understand that it's ok to go there if my pain isn't manageable at home with my treatment plan.
I was on fluids only and even though I requested natural yoghurt rather than sweetened yoghurt on the menu sheet it would come back with a big blue X through it telling me it wasn't on the menu selection etc. Fortunately the person giving out the meals took pity on me and arranged to get it for me. I also found the food very difficult to tolerate and would have benefited from speaking to a dietician. I essentially had 7 days in the hospital and ate virtually nothing. Again although the transit nurse had been booked the previous night I was given about 5 minute’s notice of going to Lower Hutt.
Staff member came round, asked questions about home, she was told situation. All I got offered was shower chair, which I did not need. No other assistance was offered i.e. dressing, showering, brushing hair, even though they were told I was on my own in day.
Doctors/Consultants often seemed in a rush to get on to their next patient. Occasionally they would not turn up at all despite pleas to be seen.
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PUBLIC Nurse’s efficient instruction on how to use Air cast cooler system on leg physiotherapist turned up on time and explained process exercises and use of crutches. Surgeon and Doctors visited and explained what had been done checked knee movements all 3 days.
Filter set one - European & other: Filter set two – Maori
Patient Comments – Physical and Emotional Needs
Two or three nurses totally stood out for their amazing attention, attitude and dedication however, there were also two nurses who were rude and should not be employed. The rest were fine and doing their job in a reasonable manner.
The young doctor who attended me on Friday 9 August needed to understand his use of words needs greater consideration especially in a room with others present. I was very embarrassed to be told the MRI showed “nothing wrong”
Everybody down there did very well which made it easy for myself and everyone else (relaxing) both staff and patients. Very good.
Extra good treatment from all staff but one (nurse) once. All the rest were very very good.
I was given pain relief when I needed it. Staff worked really hard to meet my needs despite how busy the ward was.
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PUBLIC
3 COMPLAINTS AND COMPLIMENTS
A summary of Health and Disability (HDC) Complaints is provided in the Public Excluded Quality, Risk and Innovation Quarterly Report.
3.1 Patient Voice
The words below are extracted from August to October 2019 complaints and compliments, with the more frequently repeated words being largest.
Compliments
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PUBLIC Complaints
4 EFFECTIVENESS
Effectiveness focuses on monitoring and evaluation of patient care and performance in relation to our peers to ensure focused quality improvement. Our data is pulled form SQuARE our electronic reporting system (that we share with CCDHB, and HVDHB) – accurate data relies on timely and accurate reporting and reviews, which can be a challenge. We are currently reviewing the Medication Errors, Patient Falls, Hospital Acquired Pressure Areas data that is also reported within the WrDHB Balanced Scorecard to ensure accuracy and usefulness.
4.1 General Adverse Events
Learning and improving from incidents remains an important safety improvement strategy. Reported incident data is not necessarily an indicator to monitor organisational safety performance. Reporting constitutes one component of a broad range of conversations and activities focused on safety and risk.
The top four events for the hospital are consistently Staff and Others Health & Safety, Patient Falls, Clinical Care and Medication. Staff and Others Health and Safety numbers have been effected by repeating behaviours from individual patients. For further detail refer to Occupational Health and Safety Hazards of significance.
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PUBLIC General Events 1 August to 31 October 2019
General Events YTD 1 November 2018 to 31 October 2019
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PUBLIC General Events Previous YTD 1 November 2017 to 31 October 2018
5 HQSC – QUALITY SAFETY MARKERS (QSMS)
DHBs are expected to collect data to support the QSMs which include both process markers and outcome measures, to monitor the progress of its priority programmes. The HQSC monitors and publishes these on their website. The current programmes include Falls, Hand Hygiene, Patient Deterioration, Pressure Injuries, Opioids, Safe Surgery. WrDHB meets the requirements of collection on a quarterly basis, however the work required to do so is significant due to most data needing to be extracted manually from paper files.
6 OCCUPATIONAL HEALTH & SAFETY
The role of Occupational Health & Safety is to support a progressive and continuous improvement philosophy within the WrDHB by providing health and safety advisory services and facilitating change aimed at improving the work environment to reduce risk.
Initiatives and Improvements ∑ Stage 2 Health and Safety Rep Training held on Wairarapa DHB Hospital Campus ∑ Participation in National Shakeout Exercise including promotion, exercising and provision of home preparedness information in both Te Reo and English made available to staff, visitors and patients at Hospital main entrance foyer display ∑ Review and development of a Lone Worker and Community Worker Safety Procedure commenced with highlighting hazards identified by Contracted Allied Laundry Service in line with over lapping PCBU duties expectation to discharge these duties to the extent we have the ability to influence and control. ∑ Extra security lighting installed outside Emergency Department following the Health and Safety Advisory Committee raising this as a hazard and recommending improvement in this area.
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PUBLIC Positive Performance Indicators ∑ Work Station audits undertaken on request by individual staff reporting discomfort or with new office equipment ∑ Hospital Campus annual Security audit undertaken ∑ New Health & Safety Representatives secured for Procurement, AT&R and Selina Sutherland, ∑ Stage 1 Health and Safety Rep training held ∑ The WrDHB Worker Participation Agreement in place (in-line with the WorkSafe Worker Engagement, Participation, and Representation Good Practice Guidelines) has been reviewed, updated and consulted on by Health and Safety Advisory Committee ∑ Engaging Leaders in Health and Safety training for Managers developed advertised and fully subscribed for session in November 2019. Priorities undertaken in line with health and safety & emergency annual plans ∑ Health and Safety Advisory Committee meeting convened October 2019 and included: ∑ Education update on national workplace health harm statistics ∑ Staff Wellbeing Poster: tips to boost your mood for distribution by Health and Safety Reps to all areas ∑ Formal tri-annual Health and Safety Representative elections held supported with a call for nominations from the Chief Executive ∑ 2019/2020 Health and Safety Annual work plan submitted ratified by HSAC and submitted to ELT for consultation and approval ∑ Emergency Management Meeting: Convened September 2019 ∑ Specialised Training delivered on Health and Safety and Emergency Preparedness ∑ Nurses Core update Health and Safety training delivered on Health and Safety ∑ SQUARE - Staff and Others Health and Safety Events - Reviewed and managed.
7 NOTIFIABLE / MAJOR EVENTS SINCE LAST REPORT
Nil Work Safe notifiable events
7.1 Health and Safety Reportable Events
Health and Safety Events 1 August to 31 October 2019
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PUBLIC Safety Security Events 1 August to 31 October 2019
Health and Safety Events YTD 1 November 2018 to 31 October 2019
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PUBLIC Comparison of previous 12 month period 1 November 2017 to 31 October 2018
Commentary: Much of the increase shown in categories Violence (Physical Assault), Inappropriate Behaviour and Verbal Abuse is the result of a very limited number of patients with extensively long inpatient stays (refer Hazard of Significance below).
7.2 Hazards of Significance (new, emerging or requiring escalation)
Rising concern over complex displaced patients/or of no fixed abode who effectively become stranded within our hospital environment. This has resulted in increased reportable events of violence (physical assault), verbal abuse, vandalism and inappropriate behaviour severely adversely affecting staff, visitors and other patients and their family/whanau and on an increasing basis resulting in harm to staff and absorbing a high level of resource to manage. Strategies for the appropriate placement of such cases needs to be prioritised and set in place to eliminate a reoccurrence in future.
7.3 Static High Risk Hazards update
Moving and Remains a static risk for staff particularly in relation to patient handling. Handling High Heat For staff, patients and contractor health and wellbeing due to increasingly high summer temperatures and ineffective controls to mitigate to an acceptable level in buildings with no air conditioning available. An options paper has been requested by ELT and submitted for review November 2019. Potable Water A meeting is scheduled with Masterton District Council representatives to Storage review viability of portable containerised solution compatibility with existing infrastructure on campus. Insufficient A decontamination guideline is in draft. Additionally a regional approach is Decontamination being taken with DHBs in greater Wellington area meeting together and agreeing to work collaboratively to address common issues faced by all three DHBs around effective PPE, training, facilities and best practice guidance.
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PUBLIC 8 OCCUPATIONAL HEALTH
WrDHB Staff Influenza Vaccination Figures for the last 6 years
NB. Due to a national shortage of flu vaccine in 2019, restrictions on staff vaccination were put in place part way through the campaign. Vaccine was restricted to frontline clinical staff only for a period of time, unfortunately despite the restriction ceasing when more vaccine arrived, despite promotion the group of ‘other employees’ did not return for vaccination, hence a poorer % for ‘Other employees’ in 2019.
Response to Measles Alert In response to the outbreak of measles around the country, including in the Greater Wellington region, staff working in the following areas have had their immune status checked and have been followed up when necessary: Acute Services, Paediatrics, Maternity, Medical Surgical Ward (MSW), Duty Nurse Managers, Duty Nurse Team. We are currently working through the casual Health Care Assistants (HCA) and Registered Nursing (RN) staff list and the Dental Service staff. Compass Health is following up with the Independent Midwives (not employed by WrDHB). All new staff with patient contact routinely have their immune status checked through the Occupational Health pre-employment screening. The Public Health Organisation (PHO) have advised that the restrictions for vaccinating against measles and we are now able to vaccinate those deemed to be at risk. Occupational health will continue to liaise with the PHO team with regards to other staff of lesser risk still requiring immunization.
9 RISK
The moment in time Risk Report is generated from the WrDHB SharePoint Risk Register and presented to FRAC on a bi-monthly basis, which is then shared to Clinical Board and Board via the Quality Public Excluded quarterly report. At any stage a ‘real time’ report is available on SharePoint.
Risk review is a standing item on the ELT agenda with ELT members responsible for reviewing and managing risks at an operational level and providing summaries and updates to ELT.
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PUBLIC 10 CERTIFICATION/CORRECTIVE ACTIONS
We have now received confirmation from MOH that all WrDHB Corrective Actions from February Surveillance have been signed off and we will be heading into June Certification next year with a clean slate.
All Certification and Hospital Corrective Actions are now recorded and managed from the Corrective Action Plan on SharePoint and reporting on corrective actions hereon will be generated from there. A period of testing is underway to fine tune the site before it is socialised and staff are given full access.
11 EMERGENCY PREPAREDNESS
An Emergency Preparedness update will be provided annually or by exception.
12 INFECTION PREVENTION AND CONTROL
Infection Prevention and Control updates are provided bi-annually or by exception to Clinical Board.
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BOARD DECISION PAPER
Date: November 2019
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 For the reasons set out in the public Board agenda Information contained in the paper may be subject to change Section as the information has not yet been reviewed by the FRAC Chief Executive’s report 9(2)(f)(iv) Paper contains information and advice that is likely to Section 9(2)(j) prejudice or disadvantage negotiations Provision of Regional Oral Discussions about creation of/employment into roles where Section 9(2)(a) & Maxillo Facial Services individuals in those roles may be identifiable, and therefore revealing details such as remuneration details Revealing gaps in security, knowledge of which someone Section 9(2)(c) Tū Ora Company Cyber could take advantage of to cause harm Security Breach
Educational and Support Information that may compromise the privacy of staff Section 29(1)(a) for staff at Wairarapa District Health Board Response to Board Commercially sensitive information Section 9(2)(i) questions with communications in Primary Health Care in Wairarapa Wairarapa DHB 2018/19 Info/discussion on restructuring/change processes that may Section 29(1)(a) Final Annual Report enable affected individuals to be identified, therefore revealing details of individuals’ possible redundancies or redeployment MHAIDS Integration project Staff sensitive information ahead of a staff consultation Section 9(2)(a) launch FRAC minutes October Sub Committee Excluded Minutes Section 9(2)(j) 2019 Correspondence Commercially sensitive information Section9(2)(i)
Wairarapa District Health Board Page 1 of 1
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Internal Memorandum
To: Wairarapa Board Members
From: Dale Oliff, Chief Executive Officer
Date: 13th November 2019
Subject: Media of Interest for October 2019
Email sent through to Board members 18th October
Iwi plan $30 million development at site of old Masterton Hospital From NZ Doctor Published 13:00 17/10/2019 Also from NZ Doctor Since the new Wairarapa Hospital opened next door 13 years ago most of the buildings on the grounds have deteriorated, though a few were still occupied by important health organisations. Another measles case reported in Wellington as number of cases continues to grow From Dominion Post Published 12:34 17/10/2019 Another measles case has been confirmed in Wellington. (File photo) ... Another measles case has been confirmed in Wellington, bringing the number of confirmed cases across the region to 32 this year. ... A Regional Public Health ( RPH) spokeswoman said the latest case, within the Capital and Coast District Health Board (CCDHB) area, was confirmed on Wednesday. The curious case of the 15-minute consult: Is the funding tail wagging the dog? From NZ Doctor Published 15:46 17/10/2019 I acknowledge that health care homes and practice portals are moving us in this direction, but it’s not far enough, quickly enough. New elected councillor’still digesting success’ From The Lakes District & Central Otago News Published 07:00 18/10/2019 Central Otago’s two candidates for the Southern District Health Board have missed out on election to the board’s Otago constituency. ... Health Minister David Clark will appoint the new chairman of the board, and may also appoint up to four other board members. District health boards not giving low-paid workers the living wage From Stuff.co.nz Published 05:06 18/10/2019 Almost 800 Canterbury District Health Board staff are paid below the living wage. ... None of New Zealand's district health boards ( DHBs) have become accredited living wage employers, despite the health and disability sector employing more people than any other. ... In the Canterbury DHB area, nearly 800 employees are paid below the current living wage. Opinion Dr David Clark: Rebuilding our hospitals From Magic Talk Published 18:46 17/10/2019
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By Dr David Clark, Minister for Health, Labour MP for Dunedin North. ... If there’s one thing I never tire of hearing as Minister of Health, it’s just how great our nurses and doctors are. ... That’s more than 2,500 additional health workers in our district health boards delivering services and taking care of people when they need it. New Zealand chidren are the second most obese in the OECD From Radio New Zealand Audio Published 17:00 17/10/2019 [00:00:01] ...earlier this week we discussed the possibility of a sugar tax being introduced after Associate Health Minister, Peeni Henare through his support behind the tax...... [00:05:12] ...[ Health Minister], David Clark is not in favour of a sugar tax. Report created by Anna Cardno, Wairarapa DHB. Powered by Fuseworks.
Email sent to Board members 25th October 2019
Staff shortages and rising number of patients leading to activation of 'code red' in hospitals From Stuff.co.nz Published 19:19 24/10/2019 On Wednesday, the Wairarapa District Health Board (DHB) declared a "code red" at its hospital in Masterton for the second time this month. Another measles case confirmed in Wellington but the number's steady at 33 From Dominion Post Published 16:26 24/10/2019 The number of measles cases for Wellington region has reached 34 with another case confirmed on Thursday afternoon. ... Another measles case has been confirmed for the Wellington region. ... Regional Public Health ( RPH), Wellington notified the public on Thursday afternoon, however the case related to a traveller which meant the case numbers for the capital have remained steady at 33. Government to create nationwide agency to regulate drinking water From TVNZ Published 08:16 25/10/2019 A Government inquiry was launched, and Minister of Health David Clark said "this Government has learned the lessons from the Havelock North tragedy and we are working to fix the problems exposed by the resulting inquiry". Report created by Anna Cardno, Wairarapa DHB. Powered by Fuseworks.
Email sent to Board members 28th October 2019
Patients' appointments and surgeries affected by radiographers' strike From Stuff.co.nz Published 17:59 25/10/2019 A Wairarapa DHB spokeswoman said the strike meant it had to reschedule appointments for about 15 to 20 patients. Report created by Anna Cardno, Wairarapa DHB. Powered by Fuseworks.
Surgery cancelled three times From Wairarapa Times-Age Published 09:38 28/10/2019 The Code Red situation which caused the surgery to be cancelled was due to a surge of urgent unplanned cases, at the expense of planned work, Wairarapa DHB spokesperson Anna Cardno said. ... Wairarapa District Health Board said it has detailed plans in place to ensure it can continue to provide the best possible care for the Wairarapa community during the strikes. ... "We have skeleton-staff rosters in place to manage any urgent need during the strikes," chief medical officer, Shawn Sturland said. Report created by Anna Cardno, Wairarapa DHB. Powered by Fuseworks.
83 2019 11 25 Wairarapa Board Meeting PUBLIC - Appendices Advertorial Code Red & elective surgery waitlists
surgery and resident But there is more to surgical on strike, we have to delay rather than later. medical patient cases. delays than just a busy day surgery. We are also looking into Sometimes, as we have at the hospital. Wairarapa And we also have a shortage more efficient regional recently experienced, we see Hospital being under of Senior Medical Officers collaboration. an unexpected increase in pressure is not just down to (SMOs), particularly General Having a well-connected unplanned, urgent trauma an influx of seasonal illness Surgeons and Orthopaedic regional service is very and illness presentations that and acute injury – there is a Surgeons and our Allied important for Wairarapa. tip that balance. bigger picture at play. Health specialties, like We rely on our neighboring When that happens, we have The broader context of Sonographers. tertiary hospitals to provide more patients than we have continuing industrial action, Wairarapa is not alone in its care for our community that beds and staff for. We call this staffing vacancies and specialist clinical staffing we can’t provide locally, and a Code Red. recruitment challenges, issues, there are nationwide ensuring we are doing all we Wairarapa DHB’s Chief To manage, we are forced to and high numbers of low shortages. The strong can to provide a seamless, Medical Officer, Shawn look at finding more beds, acuity patients all adds market competition makes efficient service is critical. Sturland, explains our bringing in more staff and, complexity. recruiting to Wairarapa What can the community do surgery delays. as a last resort, rescheduling At Wairarapa Hospital, we are increasingly difficult. to help? elective surgeries. now exceeding the Ministry Current clinical staffing We know that we have high 25th October 2019 In a Code Red, we can of Health guideline for 4 restraints has resulted in numbers of people being repurpose our small, short months wait for planned a rapid rise in wait lists for treated in our hospital Last week, Wairarapa stay unit beds to use for surgeries. orthopaedic procedures that could be just as easily hospital was in code red for admitted patients, and we When we have to delay especially. This means seen by their GP or medical the second time this year. can bring in extra staff, but surgery, our wait lists grow. waiting patients may practitioner. We don’t like With all its beds full, this is simply not sustainable This causes extra work for experience pain for longer, to turn people away from capacity was stretched long term. We also work staff to reschedule lists, and and have an extended loss of our ED, but when we have beyond what was hard to assess inpatients, causes a lot of disruption for function. people to treat that are low discharging as appropriate our waiting patients. We know that because of the acuity (non-urgent) it takes manageable and some and freeing up beds. It also means the time it will extended wait lists, some time away from those acute elective surgeries (planned When we have a lot of urgent take to ‘operate our way out’ people will be waiting many cases we really do need to surgery by appointment) need, it puts pressure on staff is pushed out, because our months for routine surgery. see. If they then go on to be were cancelled in order to and patients alike. Patient normal, business as usual What are we doing to admitted, they take a bed treat urgent need. safety is first and foremost, demand does not stop in the address these issues? that could otherwise be filled For some patients, it was and all our decisions are meantime to let us catch up. We are putting a lot of effort by higher-need patients. not the first time their made with the patient at the Our waitlists can grow into recruiting. People can help by seeking appointment was put centre. quickly, but they shrink We aim to hire into roles and care where it is best off. Wairarapa DHB Chief Delaying surgical slowly. be at full capacity. We want delivered. If it is URGENT, Medical Officer, Shawn appointments is the last So why do we have long to have sufficient staffing to call 111 or come to ED. If it is Sturland, explains. approach taken – but it is waitlists? allow us to deal with acute not, call Healthline on 0800 Wairarapa Hospital has 74 sometimes unavoidable. Our growing waitlists are not emergent demand (business 611 116, see your doctor or inpatient beds, and planning The considerable just because of Code Red as usual emergency care) as medical professional, or go bed use is a complex inconvenience for someone days. Industrial action also well as manage our planned to Wairarapa After Hours at business. in having their surgery takes its toll. work (elective surgeries). Masterton Medical. We build on a patient delayed is well understood We have had a long spate We are having some recent And of course, be a healthy safety matrix that works – so our patients can be of different workforce success with multiple Kiwi! Do what you can to within our rostered staff assured that, if it happens, strikes lately, which we have interviews, many of them keep yourself well, manage resource to allow for an we have had absolutely to plan theatre lists and from global applicants, and your health and, if you estimated number of urgent unavoidable reason to clinics around. When we are we are optimistic we can notice something amiss, get presentations versus planned reschedule. managing the impact of staff recruit to positions sooner checked out early.
FEELING UNWELL OR INJURED? Family Doctor Where should I be?
y Contact your family doctor y For weekend help – After first – they know you and Wairarapa After Hours Hours the care you need. service is available Service y Call Healthline 0800 611 9am-5pm based at 116 – for free medical Masterton Medical Centre. advice 24 hours a day. You don’t have to be a y Ask a pharmacist – they patient at Masterton Emergency are a good source of Medical to use this. Care information.
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Wairarapa DHB
Tobacco Control Plan 2019/20
Smokefree Aotearoa 2025 In March 2011, the New Zealand Government adopted the Smokefree 2025 goal for New Zealand. This was in response to the recommendations of a landmark Parliamentary inquiry by the Māori Affairs select committee.
The Māori Affairs Committee’s report was clear that the term ‘smokefree’ was intended to communicate an aspirational goal and not a commitment to the banning of smoking altogether by 2025. On that basis, the Government agreed with the goal of reducing smoking prevalence and tobacco availability to minimal levels, thereby making New Zealand essentially a smokefree nation by 2025.
The New Zealand tobacco control sector is committed to the goal of a Smokefree Aotearoa by 2025. Achieving Smokefree Aotearoa by 2025 means that almost no-one (less than 5% of the population) will smoke tobacco. This will be achieved through: ∑ protecting children from exposure to tobacco marketing and promotion, ∑ reducing the supply of and demand for tobacco, and ∑ providing the best possible support for quitting.
Responsibility and accountability for achieving the Smokefree Aotearoa 2025 goal is shared between the New Zealand Government, health services, the tobacco control sector and communities.
The work of the tobacco control sector is focused on three action streams to support a reduction in smoking rates to below 5% (adult daily smoking). These are ∑ cessation, ∑ regulation and legislation, and ∑ public support.
There is a widespread acceptance that if New Zealand is to reach the goal of a Smokefree Aotearoa 2025, efforts across all three areas will need to increase.
Wairarapa DHB Smoking Profile In New Zealand, around 16.3% of adults aged over 15 years smoke daily. Māori and Pacific people are more likely to smoke (38.6% and 25.5% respectively). Māori, Pacific people and pregnant women are priority groups for all tobacco control work, due to the higher prevalence and/or higher impact of smoking in these groups.
Data from the Ministry of Health indicates that in June 2017, 21% of the PHO enrolled population in the Wairarapa were recorded as a current smoker. In 2019 it has slightly decreased to 19.3% but still remains higher than the National average.
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Figure 1: WDHB Enrolled Population Smoking Prevalence
Apr-Jun 2019 Maori Pacific Other Total Number of people recorded as smoking 1951 143 4172 6266 Enrolled population aged 15-74 years 4936 655 26909 32500 % of enrolled population aged 15-74 years who smoke 39.5% 21.8% 15.5% 19.3%
As illustrated in figure 2 below, the initiation of smoking occurs generally between the teenage years and late twenties.
Figure 2: Smoking Prevalence by Age
Figure 3: Smoking Prevalence 2017 - 2019
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Our 2019/20 Priorities The emphasis of the DHB Tobacco Control Plan over the past ten years has been on supporting people to quit through the ABC approach at every opportunity presented in a clinical interaction.
The ABC of smoking cessation is to: ∑ Ask about and document every person's smoking status. ∑ Give Brief advice to encourage every person who smokes to make a quit attempt. ∑ Strongly encourage every person who smokes to use Cessation support (a combination of behavioural support and stop-smoking medicine works best) and refer them to a Stop Smoking Service.
Supported by the implementation of health targets, the Ask & Brief Advice has become well embedded in all three settings (primary, hospital and maternity), and remains the cornerstone of efforts to encourage smokers to quit. However these clinical interactions require constant effort to maintain, and need to be resourced. Although health target performance is not currently a primary planning focus, we intend to retain the previous targets as organisational performance indicators.
The DHB has been less successful in systematically offering and encouraging referrals to cessation services. As evidence suggests that smokers are most likely to be successful in their quit attempts when provided with both pharmacological and behavioural support, the DHB intends to increase our focus on referrals to cessation support (SSS) from both hospital and primary care services in the 2019/20 year, including through adoption of improvement milestones.
The DHB’s Annual Plan reflects the Government’s and DHB’s equity priority, particularly in health outcomes for Māori. We recognise that smoking remains one of the major drivers of poor health outcomes, and that there is significant disparity in Māori and non-Māori smoking rates across all age groups. The DHB has prioritised five Māori equity targets for 2019/20. These are: ∑ The first 1000 Days, ∑ 0 – 4 respiratory, ∑ youth mental health, ∑ diabetes, and ∑ oral health.
Smoking is a factor in each of these priority areas, reinforcing the importance of this Tobacco Control Plan. We intend to more deliberately focus our health promotion and cessation support to Māori, and increase the range of support available to Māori whānau with babies.
Both nationally and locally, the smoking rate is highest in the 20-29 age group. This age group are not high users of health services, and our efforts to date have probably not reached this group very effectively. We have targeted support to hapū māmā, but our own experience and national evidence suggests that the complexity of many young women’s lives, and the challenges they face, mean that stopping smoking is not a high priority for them. During the 2019/20 year we intend to trial new ways of providing antenatal and post- partum support for Māori women with high or complex needs.
Wairarapa DHB has developed this revised Tobacco Control Plan for the 2019/20 year in conjunction with Tākiri Mai Te Ata Whānau Ora Collective and Whaiora Whānui Trust (Regional Smoking Cessation Providers), the Regional Public Health Tobacco Control Team, and Tū Ora Compass Health.
In summary, the headline actions for the 2019/20 Plan include:
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∑ Refocusing existing health promotion and cessation work to prioritise key population groups in particular Māori and Māori households with babies. ∑ Trialling new initiatives, including increasing antenatal and post-partum support for Maori women with high or complex needs. ∑ Strengthening smoking cessation support in primary, secondary, maternity, mental health and community settings. ∑ Continuing to support health care practitioners to provide Smokefree ABC (Ask, Brief Advice, offer Cessation support) ∑ Increasing the number of referrals to the stop smoking services. ∑ Increasing access and reducing inequities to smoking cessation medications in particular Varenicline Pfizer. ∑ Collaborating with key stakeholders (both health and non-health stakeholders) to inform service planning and implementation.
The following sections of this plan summarise our progress to date and key activities for the 2019/20 year.
Secondary Care Smokefree Support Services The Wairarapa DHB have successfully reached “The Better Help for Smokers to Quit” health target and is no longer required to report quarterly to the Ministry of Health. The DHB intends to: 1. Retain the previous target “95% of hospitalised smokers will be provided with advice and help to quit” as an organisational performance indicator. 2. Increase the focus on referrals to cessation support from the hospital in the 19/20. In 2018 5.5% of hospital patients were referred to the SSS. A target of 20% of hospital patients will be referred to the SSS has been set for 2019. 3. Continue to provide weekly updates of the target to the managers of the inpatient wards 4. Continue to give updates of smokefree initiatives to the hospital clinicians 5. Continue to support the Stop Smoking Service in the hospital. 6. Implement a Pepē Ora Navigator /coach to provide wrap around support for high-needs hapū māmā and their whānau (including delivery of smoking cessation) 7. Ensure that any new kaupapa Māori ante-natal service (e.g. Hapū Wānanga) incorporates smokefree messages and support.
Primary Care Smokefree Support Services Primary care clinicians can play a key role in initiating smoking cessation – hence the emphasis over a number of years on the ABC approach as a routine part of a primary care consultation.
Primary care clinicians, along with those in other community and hospital settings, are supported in the ABC approach through the pathway promulgated on the 3D HealthPathways website.
In order to support primary care to reach and maintain the health target, the DHB has funded Tū Ora Compass Health, over a number of years, to support the education of general practice providers in the ABC approach to smoking cessation. Providing smoking brief advice is considered to be a core primary care function. Tū Ora Compass Health has successfully implemented systems that support general practise teams to focus on patients that smoke, and to maintain the 90% target.
In recent years Tū Ora Compass Health and Wairarapa DHB have provided ABC training for Pharmacists and Pharmacy Technicians, and a number of Pharmacy Assistants.
The training informs pharmacy staff of the need for increased health and behavioural support of smokers, through referrals to the Regional Stop Smoking Services. Incentivised funding is provided to pharmacies that make referrals and promotion of the service was rolled out in November 2018 – February 2019.
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The 2019/20 year will explore opportunities to extend the incentivised programme to include Varenicline Pfizer prescriptions. Dentists will also be invited to join the incentivised programme and ABC training will be offered to all dentists in 2019/20.
Primary care has also played a key role in health promotion efforts, including supporting the RSSS branding and promotion, and contributing to a raft of public awareness and support projects, including:
∑ Pharmacy project ∑ Fresh Air project ∑ Vape to Quit training ∑ World Smokefree day
We consider there is benefit in combining tobacco health promotion with the PHO’s wider health promotion plan.
The 2019/20 Tobacco Control Plan will – 1. Maintain the 90% primary care health target and report quarterly to the Alliance (Tihei Wairarapa) and the Wairarapa District Health Board. 2. Encourage referrals from primary care and promote the SSS to medical practices. In 2018, 53 referrals were received by the SSS from primary care. 3. Continue to offer ABC training to secondary, primary and pharmacies and extend the training to include dentists. Continue to support and incentivise the Pharmacy Project and include dentists on completion of the ABC training. “Vape to Quit” training will also be offered on request. 4. Support other agencies as appropriate. For example supporting smokefree environments through the support of the Fresh Air project for smokefree outdoor dining. 5. Ensure PIKI counsellors are aware of support pathways should the individual they are counselling indicate they wish to stop smoking. 6. Investigate funded visits for initial GP visit for Varenicline Pfizer. Investigate current Varenicline Pfizer usage and identify opportunities for increasing uptake.
Pregnant Women and their Whānau
The number of smokers and prevalence rate has steadily increased from 2015 although the 2019 rate indicates that it may be on the decline. This has been a disappointing result, with a number factors perhaps influencing the increase in the prevalence rate and a decrease in engagement onto the current hapū māmā programme.
∑ In 2015 the Wairarapa had a dedicated smokefree quit coach for the hapū māmā programme (then called Growing Love) who worked closely with the LMCs, the ante-natal programme for our less equitable whānau and the Wairarapa Smokefree Network.
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∑ The local Aukati Kai Paipa service was dis-established. A new regional service, Wairarapa, Hutt Valley and Capital and Coast, were combined and called Tākiri Mai te Ata. This impacted on the delivery and control of the programmes and local health promotion. ∑ Limited funding was provided for this programme so the promotion of the programme relied on the LMCs, the Whaiora outreach services and other health professionals to recruit women onto the programme. These referrals have gradually increased over the years. ∑ A part time position, at Whaiora, for a smokefree health promoter is no longer funded. This health promoter actively worked with Māori whānau who smoked to bring them into the service. The smokefree health promoter also worked closely with the Wairarapa Smokefree Network at local events to generate referrals to the service.
The Wairarapa DHB want all children to have a healthy start in life. Babies who are born to smokefree mothers and live in a smoke free home have better outcomes. Maternal smoking is associated with a range of poor outcomes including sudden unexpected death in infancy (SUDI) and low birth weight. One of our key priorities is to reduce the rate of foetal and infant exposure to cigarette smoke. The Wairarapa DHB will do this by: ∑ Improving the reach and increasing referrals to the Hapū Māmā incentivised programme by using the results of a survey of hapū māmā who were referred to the programme to encourage more māmā to give it a go. ∑ Employ a Pepē Ora Navigator/coach to work alongside Wairarapa Maternity, Regional Stop Smoking Service and Breast Feeding Wairarapa and provide additional support to hapū māmā and their whānau to give their pepē the best start to life. ∑ Develop and implement Hapū Wānanga as a core component of the DHBs antenatal programme. ∑ Provide education in Taki Taki Mai, motivational interviewing techniques and key messages for health professionals to better engage with Māori.
Vaping or E-Cigarettes The Ministry of Health considers vaping products have the potential to make a contribution to the Smokefree 2025 goal and could disrupt the significant inequities that are present.
The Ministry of Health encourages smokers who want to use vaping products to quit smoking to seek the support of local stop smoking services. Local stop smoking services provide smokers with the best chance of quitting successfully and must support smokers who want to quit with the help of vaping products. (Ministry of Health September 2018)
The Wairarapa DHB provided “Vape to Quit” training for health professionals and the community in 2018/19. The training was presented by the National Training Service. Fifty nine people attended the training.
The Wairarapa Smokefree Network have informed the Wairarapa community of the new Health Promotion Agency Vape Facts website and they will distribute the new Vaping Facts brochure through their networks when available.
“Vape to Quit” training will be provided again if necessary. The Wairarapa DHB Smokefree Coordinator is available to visit workplaces to discuss vaping and provide updates. Two workplaces requested this in 2018/19.
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Health Promotion Activity The Wairarapa DHB will continue the work started in 2018 to decrease the number of current smokers by addressing the inter-generational smoking prevalence found in whānau. In 2018 a collaborative community project led by the smokefree coordinator and supported by the three councils, Regional Public Health, Tū Ora Compass Health, Regional Stop Smoking Service, Wairarapa Times Age and Aratoi – Museum of Art and History was implemented. The project was called Ka Tipu Nga Mokopuna (I Quit Smoking for My Moko) and the inspiration came from research by the Ministry of Health “Addressing the Challenges of Young Māori Women who Smoke” (November 2018) and the Health Promotion Agency on “Why Wāhine Māori find it hard to quit smoking”. This project focused on nine local wahine tau who quit smoking for their moko. Through their portraits and stories told in the local media and social media and in the community it highlighted the importance of supporting our wāhine hapū to quit smoking. For 2019/20 health promotion efforts will focus on Smokefree Kapa Haka. The Wairarapa has three teams competing in regional and national competitions in 2019/20: Ngā Puawai o Te Kura Kaupapa Māori o Wairarapa, Wairarapa ki Uta Wairarapa ki Tai (combined secondary schools) and Te Rangiura o Wairarapa (seniors). By supporting these teams with sponsorship the Wairarapa DHB and the Stop Smoking Service will be working directly with performers and their tutors to be smokefree and whānau will be committed to the message “leave your tobacco at home” while attending practices and performances. Local smokefree champions with their smokefree messages from the three teams will be celebrated and published throughout the Wairarapa. The Wairarapa Smokefree Network (WSN), which includes representatives from the DHB, Regional Public Health, Whaiora, Cancer Society and Tū Ora Compass Health, will continue to coordinate other health promotion and advocacy activity relating to tobacco use during the year. This will be guided in part by the national promotional activity of the Health Promotion Agency and Hāpai Te Hauora, the national advocacy group. Promotional activity includes: ∑ Social media engagement ∑ Community awareness campaigns ∑ Pepē Ora expo ∑ Smokefree May – World Smokefree Day ∑ Local promotions by the Stop Smoking Service at events ∑ Deep Dive Hui
Collaborative Planning Local stakeholders have identified the 18-29 age group as a priority for future action. During 2019/20 we intend to work together to understand drivers of smoking among young people and investigate options for further targeted interventions
Advocacy Smokefree advocacy activity will continue in 2019/20 in Wairarapa, including: ∑ RPH retail education ∑ Smokefree environments (signage; smokefree public spaces; smokefree outdoor dining) ∑ Collaborative work with the Cancer Society “Fresh Air Project” ∑ Vaping, communications and sharing of Ministry of Health policy and guidelines to the general public, workplaces, schools, health professionals regarding vaping. Training provided for health professionals and community workers as required.
Regulatory A range of activity is planned in 2019/20, including ∑ Enforcement and complaints ∑ Controlled purchase operations ∑ Working on legislative submissions that support tobacco activity
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2019 /20 Action Plan
What Activities Who When
∑ Active monitoring of progress against all targets and 2025 goal. Active DHB Leadership of the ∑ Reviewing and updating the district Tobacco Control Plan. district’s efforts to reduce the harm WrDHB Ongoing caused by tobacco ∑ Advocating for legislative and regulatory change to reduce the uptake of smoking and support smokers to quit.
Achieve the Health Targets WrDHB ∑ 95% of hospitalised smokers will be provided with advice and help to quit.
∑ 90% of PHO enrolled patients who smoke have been offered help to quit by a health care Tū Ora Compass practitioner in the last 15 months. Tobacco Control Targets Ongoing ∑ 90% of women who identify as smokers upon registration with a DHB employed midwife WrDHB Maternity or Lead Maternity Carer are offered brief advice and support to quit smoking.
Tū Ora Compass ∑ Increase referrals from secondary and primary care to the Stop Smoking Service. WrDHB
∑ Design and implement a survey of female smokers who have recently given birth in the Wairarapa to identify opportunities to improve uptake and effectiveness of the Hapū WrDHB Māmā programme.
Hapū Māmā Incentivised Programme ∑ Implement any improvement changes from the survey. WSSS, WrDHB Q1
∑ Design a standard format for data collection of the Hāpu Māmā programme. Whaiora
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What Activities Who When
∑ The Wairarapa DHB will employ a Pepē Ora Navigator /coach, who will work closely with the Maternity Ward to work alongside LMCs and hospital midwives to encourage greater Pepē Ora Navigator WrDHB Q3 engagement of hapū māmā who smoke onto the incentivised quit smoking programme and encourage exclusive breastfeeding up to six months.
∑ The WrDHB will implement a hapū wānanga for Wairarapa hapū māmā. This will Hapū Wānanga WrDHB Q4 involve weaving wahakura and learning the principles of Safe Sleep.
Babies in smokefree household ∑ Continue to provide WCTO with education and training support on the implementation WrDHB system level measure. of the Smokefree SLM data standard. 95% of whānau are asked about Ongoing ∑ Explore the feasibility of increasing referrals from Primary Care to Stop Smoking their smoking status at the first Tū Ora Compass well child core check. Services by using primary care data set to target households with babies.
∑ Continue to support Pēpe Ora’s collaborative work engaging with services and RPH, WrDHB, Tū Ora Pēpe Ora providing resources for organisations that work with mums from ante natal to five Compass, Sport Wairarapa, Ongoing years old. Plunket, Tamariki Ora, LMCs Tū Ora Compass, EL ∑ If possible add SSS as an option for referral alongside the Quitline in practices. Q2 Operations ∑ Implement a process for referring hospitalised smokers to Stop Smoking Services. A WrDHB Q2 target for Hospital Service of 20%.
∑ Investigate presenting the ABC in specialist’s training. WrDHB, Tū Ora Compass Q1 Increase referrals to Whaiora Stop Smoking Service ∑ Identify champion pharmacies and continue to support these pharmacies with training, WrDHB Ongoing resources and media.
∑ Add to the pharmacist referral programme patients who receive a script for Varenicline Pfizer. RPH Q2 ∑ Develop relationships and approaches to facilitate opportunities to promote access to SSS particularly for priority communities such as Masterton East.
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What Activities Who When ∑ Wairarapa DHB will sponsor and support the senior Kapa Haka group, Te Rangiura o Wairarapa to be totally smokefree. The Wairarapa is hosting the lower North Island’s regional Kapa Haka competition at McJorrow Park, February 22 and 23 2020. This will WrDHB, Tū Ora Compass, Health Promotion be the Wairarapa DHB’s main smokefree health promotion for 2019/20 and will require WSSS, RPH collaborative planning and promotion led by the SFC and supported by the Wairarapa Smokefree Network. Other partners include Masterton District Council, the Kapa Haka committee, Wairarapa Times Age and Te Awhina House.
∑ Continue tobacco retailer education programme through newsletters and visits, including plain packaging updates to retailers. Increase compliance and ∑ Plan for, undertake and report on Controlled Purchase Operations. awareness of the Smokefree RPH Ongoing ∑ Respond to possible breaches of the Smokefree Environments Act 1990. Environments Act Health Assessment and surveillance ∑ Maintain an internal database of known tobacco and e-cigarette/vape retailers.
∑ Identify and respond to opportunities for written and oral submissions. RPH
Cancer Society WrDHB ∑ Continue to support the Fresh Air Project led by the Cancer Society. Tū Ora Compass ∑ Provide support for smokefree environments with signage and policy work ∑ Work with Councils and Ministry agencies to strengthen policies and systems to WrDHB RPH increase smokefree environments. Increase public support for Ongoing Smokefree Aotearoa ∑ Build and maintain collaborative relationships with key stakeholders eg Te Iwi Kāinga, RPH, WrDHB, Tū Ora HPA, Hāpai te Hauora. Compass
∑ Participate in regional and national advocacy efforts. RPH, WrDHB
∑ Support, inform and respond to Territorial Authorities (TAs) enquiries to create/promote/implement smokefree and/or vape-free environments. RPH ∑ Workplace settings: Support, inform and respond to tobacco/vaping enquiries from workplaces.
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What Activities Who When Develop and implement a Whaiora, Tū Ora Compass, smokefree communication and ∑ Communication Plan written for collaborative smokefree work. Q2 WrDHB promotion strategy
∑ Continue to promote the ABC on line training to all health professionals. Ongoing
∑ Provide ABC training to Wairarapa dentists and include them in the incentivised Tū Ora Compass WrDHB, Training Q2 &Q4 training RPH
∑ Provide training as required i.e. Vape to Quit Ongoing
Wairarapa DHB Equity Priorities ∑ Ensure that each of the Wairarapa DHB Equity Priorities has initiatives linked to Tū Ora Compass Ongoing Smoking Cessation. WrDHB, kaupapa Māori ∑ First 1,000 days – ensure that the kaupapa Māori ante-natal initiative will include services Q2 & Q4 Smoking Cessation offer and advice to all participants. ∑ 0-4 respiratory – ensure that all whānau that present to ED for 0-4 Māori respiratory Ongoing and that identify as smokers are offered/referred smoking cessation advice ∑ Youth Mental Health –ensure that the kaupapa Māori provider refers all youth smokers to WSSS ∑ Diabetes – ensure that Smoking Cessation is considered in the planning and execution of this equity initiative and where appropriate, referrals are made to WSSS ∑ Oral Health – WSSS will identify a cohort of smokers who require emergency oral health care and ensure they are registered for this initiative. WSSS will also assist in the programme during its delivery to ensure each patient who smokes uses patches and other Smoking Cessation tools.
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Appendix 1
COMMUNITY & PUBLIC HEALTH COMMITTEE of the WAIRARAPA DISTRICT HEALTH BOARD
TERMS OF REFERENCE
October 2019
Purpose The Community and Public Health Committee (CPHAC) is a Wairarapa District Health Board (DHB) committee established under section 34 of the New Zealand Public Health and Disability Act 2000 to provide advice to the Board on enhancing health outcomes for the population and the priorities for the use of health funding. A Community and Public Health Advisory Committee’s advice may not be inconsistent with the New Zealand health strategy. The Committee shall comply with the Board’s Standing Orders for Statutory Committees.
Functions The provisions applying to DHB advisory committees, including the functions, are defined in Schedule 4 of the Act. The functions of the Committee are to give the Board advice on: a) The needs, and any factors that the committee believes may adversely affect the health status of the resident population of the Wairarapa DHB, and b) Priorities for use of the health funding provided to the Wairarapa DHB. The aim of the Committee’s advice must be to ensure that the DHB maximises the overall health gain for the population the committee serves through: a) The service interventions the Wairarapa DHB has provided or funded or could provide or fund for the population of the Wairarapa. b) The policies the Wairarapa DHB has adopted or could adopt for the population of the Wairarapa.
WrDHB CPHAC ToR OCTOBER 2019
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Appendix 1
Objectives The Committee shall: ∑ Monitor the health status and health services needs of the Wairarapa DHB population and provide advice to the Board; ∑ Provide advice to the Board on policies, strategies, and commissioning (planning and funding) to support improved health outcomes in the Wairarapa; ∑ Provide advice to the Board on priorities for health improvement as part of the strategic and annual planning processes to improve health outcomes; ∑ Provide advice to the Board on the optimum arrangements for the most effective and efficient delivery of services in order to meet local, regional and national needs; ∑ Provide advice to the Board on strategies to achieve equity in health status for Maori and other vulnerable population groups; ∑ Provide advice to the Board on strategies to support partnership with social sector and other strategic relationships to foster intersectoral, sub regional, regional and national planning; ∑ Provide advice to the Board on strategies to promote the integration of health services across the health system; ∑ Perform any other function as directed by the Board.
Accountability The Committee is accountable to the Wairarapa District Health Board. The Committee will report to the Wairarapa DHB at each Board meeting.
Members of the Membership of the Committee will be determined by the Board. Committee The Committee can co-opt expert advisors as required.
Quorum A quorum will be half the members if the number of members is even and a majority if the number of members is odd.
Meetings The Committee will meet up to 10 times per annum.
Procedure Schedule 4 of the New Zealand Public Health and Disability Act will apply to the business and procedure of the Committee.
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COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE PUBLIC
MINUTES Held on Tuesday 24 October 2019 Lecture room, CSSB Wairarapa District Health Board 9.00am
COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE PUBLIC SECTION
PRESENT Derek Milne Chair Nick Crozier Member Jane Hopkirk Member
ATTENDANCE Dale Oliff Chief Executive, Wairarapa District Health Board (CE) Sandra Williams Acting Executive Leader Planning & Performance (ELPP) Jason Kerehi Executive Leader, Māori Health (ELMH) Joanne Edwards Service Development Manager, Planning & Performance (P&P) Lisa Burch Service Development Manager, Planning & Performance (P&P) Jen Bergantino Minute taker, Planning & Performance
Diane Sotiri, a representative from the Consumer Council, was in attendance.
1.0 PROCEDURAL BUSINESS
1.1 APOLOGIES Apologies were received from Alan Shirley (Member) and Kristina Perry (Member).
1.2 CONTINUOUS DISCLOSURE
1.3 CONFIRMATION OF MINUTES
RESOLVED MOVED Derek Milne SECONDED Nic Crozier CARRIED
The following correction is to be made to the Minutes as follows:
Item 2.1 Presentation from Wairarapa PHO – The Chair would like to know what is the PHO’s end state vision and milestones for Health Care Homes at the end of 5 years. This is to be reported regularly to CPHAC by way of quarterly reports and against quality indicators.
2.0 DECISION
2.1 COMMUNITY AND PUBLIC HEALTH COMMITTEE REFRESH NOTE that for particular meetings the DHB may co-op different people into the meeting dependent upon the agenda and expertise that is required.
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COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE PUBLIC
NOTE that it would be beneficial to have a PHO representative, whom has an overview of primary care, on the committee as well as a primary care clinician. NOTE that it was suggested that two Māori representatives, one from each iwi, be appointed members of the committee. The Executive Leader Māori Health informed the committee that Iwi Kāinga is in the process of refreshing themselves. Jane Hopkirk advised that with more Māori sitting around the table our decisions would be better informed. AGREED that there should be two Māori representatives for this committee. NOTE that the minutes from the Alliance Leadership team (ALT) meetings are to be presented at this committee. The Chief Executive advised the Committee that the ALT is currently being refreshed and a discussion with the ALT Chair, Bob Francis, has already taken place. NOTE that regular reporting from the PHO, on what they are undertaking and progress, should be reported back through this committee. NOTE that IT and innovation is what the DHB needs to be thinking about for the future. NOTE the terms of reference reflect the statutory responsibilities of a Community and Public Health Advisory Committee as set out in the New Zealand Health and Disability Act 2000. NOTE the proposed meeting schedule of up to 10 meetings per year (monthly except for January and December). NOTE the proposed work programme. AGREED to recommend to the Board its endorsement of the Terms of Reference. AGREED to recommend to the Board additional members for the Committee be appointed.
2.2 WAIRARAPA DHB 2019/20 TOBACCO CONTROL PLAN
Jane Hopkirk declared a conflict of interest. The sub-regional provider Tākiri Mai Te Ata is a whanau ora collective with multiple services. She is currently working in the collective in the whanau ora service and is not part of the Regional Stop Smoking Service.
TAKEN AS READ. NOTE that the DHB receives funding from the Ministry of Health for the planning and coordination of activities designed to reduce the uptake of smoking and support current smokers to quit. NOTE that in 2019/20 the DHB intends to consolidate its health promotion activities and significantly increased support for Māori, particularly whanau with babies. AGREED to endorse to the Wairarapa Board the approval of the 2019/20 Tobacco Control Plan. Jane Hopkirk moved the recommendations.
Jane Hopkirk left the meeting 10.00am NOTE that the use of vaping and other therapies used to help people quit smoking is evolving and over time may change. Wairarapa DHB will ensure it keeps up to date with the recommended therapies and treatments. Action: Executive Leader Planning & Performance is to provide the Committee with a revised prioritised list of actions out of the tobacco control plan.
3.0 INFORMATION
3.1 STRATEGIC DIRECTION FOR THE WAIRARAPA DISTRICT HEALTH BOARD ENDORSED the work underway on the plan to outline the strategic direction for health services in the Wairarapa and the timeframes for delivery with final versions approved in March 2020.
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COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE PUBLIC
3.2 3DHB PACIFIC HEALTH ACTION PLAN UPDATE NOTE the progress made to develop a draft 3DHB Pacific Health Action Plan to guide the work of the Wellington Sub-Region in attaining optimum health outcomes for its Pacific communities. NOTE that the plan will come through the committee for endorsement
3.3 ADMISSIONS OF PEOPLE 65+ TO ED AND READMISSIONS FOR OLDER MAORI NOTE the rate of ED visits for Māori 65+ has been increasing over the past 3 years and is higher than the rate of ED visits for other older people. NOTE that there is no significant difference between the proportion of older Māori who present to ED and are admitted to hospital and the proportion of older others who present to ED. NOTE that all readmissions of Māori 75+ for the year 2017-18 have been reviewed by a senior RN who has concluded that readmission rates for this group does not display cultural inequity.
Action: Provide a copy of the Rapid Readmissions report prepared by Michele Halford, Executive Leader Nursing, to the CPHAC members.
MEETING CLOSED AT: 10.45am
Reopened Public meeting at 10.55am MOVED from Public Excluded meeting - Feedback on Item 2.1 Child and Youth.
NOTE that the DHB is working with Featherston School, Meta Riddiford Kindergarten and Featherston Medical Centre to implement a school based telehealth service for these two schools.
NOTE that planning for the longer term for the Masterton iMOKO schools is underway.
MEETING CLOSED AT: 11.00AM
Date of next meeting: 5 December 2019
CONFIRMED that these minutes constitute a true and accurate record of the proceedings of the meeting.
DATED this day of 2019
DEREK MILNE Chair, Community & Public Health Advisory Committee (CPHAC) Wairarapa District Health Board
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COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE PUBLIC EXCLUDED
MINUTES Held on Thursday 24 October 2019 Lecture room, CSSB Wairarapa District Health Board 10.45am
COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE PUBLIC EXCLUDED SECTION
PRESENT Derek Milne Chair Nick Crozier Member
ATTENDANCE Dale Oliff Chief Executive, Wairarapa District Health Board (CE) Sandra Williams Acting Executive Leader Planning & Performance (ELPP) Jason Kerehi Executive Leader, Maori Health (ELMH) Joanne Edwards Service Development Manager, Planning & Performance (SMPP) Lisa Burch Service Development Manager, Planning & Performance (SMPP) Jen Bergantino Minute taker, Planning & Performance
Diane Sotiri, a representative from the Consumer Council, was in attendance.
1.0 PROCEDURAL BUSINESS
1.1 APOLOGIES Apologies were received from Alan Shirley (Member) and Kristina Perry (Member). Jane Hopkirk was an apology for the Public Excluded meeting.
1.2 CONTINUOUS DISCLOSURE 1.3 MINUTES OF PREVIOUS MEETING
RESOLVED
MOVED Derek Milne SECONDED Nic Crozier CARRIED
MOVE TO PUBLIC MEETING – 10.55am Feedback on Item 2.1 Child and Youth.
MEETING CLOSED AT: 10.55AM
CONFIRMED that these minutes constitute a true and accurate record of the proceedings of the meeting.
DATED this day of 2019
DEREK MILNE Chair, Community & Public Health Advisory Committee (CPHAC) Wairarapa District Health Board
Wairarapa District Health Board FEBRUARY 2019
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DRAFT SUB REGIONAL PACIFIC HEALTH AND WELLBEING STRATEGIC PLAN 2020-2025
Capital & Coast District Health Board Wairarapa District Health Board Hutt Valley District Health Board
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Contents
Acknowledgement ...... 1 Foreword ...... 1 Introduction ...... 2 Our Vision for Pacific in the Sub Region ...... 4 Our Strategic Outcome ...... 4 System Enablers ...... 4 Principles of Pacific Healthcare delivery across the 3DHBs ...... 5 So’oso’o Le Upega Framework for guiding this Plan ...... 6 Our Strategic Priorities and Measuring Progress ...... 7 Priority One: Pacific Child Health & Wellbeing ...... 11 Rationale: ...... 11 What the data tells us: ...... 11 What we are going to do? ...... 14 What is working well: Case Study ...... 15 Priority 2: Pacific Young People ...... 16 Rationale: ...... 16 What the data tells us: ...... 17 What we are going to do? ...... 18 What is Working Well: A Case Study ...... 19 Priority 3: Pacific Adults and Aging Well ...... 20 Rationale: ...... 20 What the data tells us? ...... 20 What we are going to do? ...... 21 What is working well: Case Study ...... 22 Priority 4: Pacific Health Workforce & Pacific Providers/NGOs ...... 23 Rationale...... 23 What the data tells us? ...... 24 What we are going to do? ...... 25 What’s working well: Case Study ...... 26 Priority 5: Culturally Responsive & Integrated Health System ...... 27 Rationale: ...... 27 What we are going to do? ...... 28 What’s working well: Case Study ...... 29 Priority 6: Social Determinants of Health ...... 30 Rationale...... 30 What the data tells us? ...... 31 What we are going to do? ...... 32 What’s working well: Case Study ...... 33 APPENDIX: Pacific Health Data across the Sub-Region ...... 34
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Acknowledgement
We wish to acknowledge the invaluable contributions of all those who provided input to the development of this Pacific Sub-regional Strategic Health and Wellbeing Plan. In particular, our gratitude is extended to the Pacific communities who supported the development of this plan by contributing their voices, stories, ideas and insights as well as our provider community and DHB staff across the entire sub-region. We were delighted at the response we received from communities and the interest there is to improving Pacific health outcomes.
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Foreword
It is our privilege to present the Pacific Sub regional peoples is empowered and enabled Pacific peoples Health and Wellbeing Strategic Plan 2020-2025 for the living longer quality lives, supported by a culturally Capital Coast, Hutt Valley and Wairarapa District Health responsive health system. Boards. This plan represents the blueprint for meeting the changing needs of Pacific individuals, families and There are many health challenges facing our Pacific communities over the next five years. communities. The priorities and strategies identified in this plan represent the key touch points which we This plan outlines the three District Health Boards believe will enable us to leverage improved outcomes as strong commitment to improving the health and efficiently and effectively as possible. These priorities wellbeing of Pacific people. Pacific peoples do not are as follows: always enjoy the same access, service experiences and health and wellbeing outcomes as non-Pacific peoples. This plan recognises that we need a specific and Pacific Child Health and Wellbeing, targeted approach to redressing inequities that exist Pacific Young People, within our health system. We believe that a core role Pacific Adults and Ageing Well, of District Health Boards is to apply the revenue they Pacific Health Workforce & Pacific Providers/NGOs, receive to provide the best health care services that are Culturally Responsive & Integrated Health System, culturally responsive to the needs of our Pacific Social Determinants of Health populations. The above strategies do not cover all possible We acknowledge that a range of factors such as approaches to reducing health inequalities, but rather education, housing, income, employment and social the emphasis is on priorities where there is good reason policies have a significant impact on achieving better to believe action by the DHBs and its partners outside of health outcomes for Pacific peoples. We also recognise health will lead to the attainment of better health and that we are operating in an increasingly complex and wellbeing outcomes for our Pacific people. challenging health environment, with competing financial pressures and health interests, emerging health technologies and pharmaceuticals, shortages of The 3DHBs are committed to implementing this Pacific health workforce, and changing demographics. health and wellbeing strategic plan and we look forward to continuing to work with the Pacific communities, To this end, improving Pacific people’s health is not only partners and stakeholders to achieving equity in access a mandate of the three District Health Boards, but it and, most importantly, equity in health outcomes for should be everyone’s business. Our vision for Pacific Pacific people and communities.
Fionnagh Dougan Dale Oliff
Chief Executive Chief Executive Capital & Coast District Health Board Wairarapa District Health Board Hutt Valley District Health Board
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Introduction
This Pacific Sub Regional Health and Wellbeing Strategic Plan represents the beginning of a new way of approaching service design and delivery for Pacific families and communities and builds on the Unfortunately, Pacific people’s health, as measured by progress of previous plans; most major indicators of health, still remains poorer when compared to non-pacific. Whilst many of the “Paolo mo Tagata o le Moana” HVDHB & WrDHB Pacific barriers Pacific peoples face such as cost, are shared Health Action Plan 2015-2018, with other groups in the Subregion, there are issues that are unique to Pacific peoples. “Toe timata le Upega” CCDHB Pacific Health Action Plan Differences in health outcomes confirm that there are 2017-2021. also issues for specific groups within Pacific communities.3 This plan adopts a human rights based approach to health. There is a growing body of evidence confirming that health services reflect the dominant economic or We are determined to build on the achievements cultural group. Consequently in practice, Pacific particularly focusing on programmes and services that communities do not receive equitable care.1 Varying address health inequity and reduce discrimination. This degrees of social isolation, acculturation, the impact of will be done by advancing strategies that support locally migration, and different views of illness between Pacific developed solutions, cultural and collaborative models communities all impact on the ability to provide services of health care that support individuals and families from that appropriately meet needs.2 As a Sub-region we a holistic perspective and tailored to meet local need are committed to ensuring policies, programmes and across the Sub-region. services provide a level playing field and equal opportunities for best health possible for Pacific people We recognise that many other organisations regardless of age, gender, ability, religious beliefs or outside of the health sector hold the levers to social economic backgrounds. progress health outcomes. Inter-professional and
inter-disciplinary teamwork, partnering across health
service providers and cooperation across sectors, as We acknowledge the gains and milestones reached in well as including the voices of Pacific people, families the last five years, with some improvement in access and communities opens the way for new and and interaction of Pacific people with the health system, collaborative partnerships for shared solutions and partnerships across the health sector, AND innovations innovative planning. delivered in the community by Pacific providers for example Pacific Nurse led services (Vaka Atafaga Nursing service, Pacific Health Service Hutt Valley Primary nurses and Thriving Cores Well Child services, Pacific Navigation Services), Pacific Churches and community leaders to name a few.
1 Southwick, M., Kenealy, T., Ryan, D. (2012). Primary Care for Pacific People: A Pacific and 3 Southwick, M., Kenealy, T., Ryan, D. (2012). Primary Care for Pacific People: A Pacific and Health System Approach. Wellington: Pacific Perspectives. Health System Approach. Wellington: Pacific Perspectives. 2ibid 107 2019 11 25 Wairarapa Board Meeting PUBLIC - Appendices
Key Strategic Directions
This plan applies a Pacific approach and lens to the strategic directions outlined in key strategic documents which guide our response to improving the health and wellbeing of the Pacific communities in the Wellington Sub-Region. These include;
CCDHB Health System Plan 2030, HVDHB Vision For Change 2017-2027, WrDHB Well Wairarapa- Better Health for All vision 2017 Ministry of Health refreshed Pacific Health Plan 2020-2025 Faiva Ora National Pasifika Disability Plan 2014-2016 The Child and Youth Wellbeing Strategy 2019, Department of the Prime Minister PHARMAC Pacific Responsiveness Strategy 2017-2026
5) Inclusiveness – ensuring that Pacific disabled The Key strategic directions include: children, youth and adults and their families are also at the centre of service and programme 1) Equity – advancing decisions, solutions and decision making and are not left behind. innovations that eliminate health inequalities Recognising that those with a disability may for Pacific people. have extra barriers to overcome in accessing health services than most. 2) Collaboration– strengthening partnerships including integrated planning and service 6) Robust Evidence Base- Implementing and delivery with both health and non- health investing in what is already working and partners across different sectors AND Pacific building evidence through research, monitoring communities themselves. and evaluation.
3) Strengthening Accountability and Performance 7) Integrated Planning - Strengthening integrated monitoring across the health system - To hold planning and service delivery and accelerating ourselves liable and answerable to ensuring we the shift of services closer to home. are doing more than enough to achieve equitable health outcomes for Pacific peoples 8) Culturally Responsive Services - Developing and through consistent reporting and measurement Sustaining a culturally safe and competent of progress. health services and work settings including elimination of racism and developing strategies 4) Building the Pacific workforce - strengthening to mitigate negative attitudes and behaviours. Pacific health providers providing sustainable resources for long-term, rather than short-term funding.
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Our Vision for Pacific in the Sub Region
Our Pacific peoples are enabled and empowered to live longer and enjoy meaningful physical, mental, emotional and spiritual wellness supported by a culturally responsive health system.
Our Strategic Outcome
To work in partnership, collaboration and in an integrated way with Pacific communities, Pacific providers, health and multisector partners to deliver culturally responsive, fanau centred, accessible, appropriate, quality and timely health care services that meet the needs of the Pacific peoples.
System Enablers
Partners and Networks Build new and strengthen existing partnerships and networks with multiple organisations, Pacific communities and individuals. Leverage off strengths and skillsets of different organisations. Also look at new partnerships to create a shared sense of ownership and responsibility to deliver the best services for Pacific peoples. Commissioning The way we commission services and invest will be more intentional and targeted. System funding should be aligned, sustainable and equitable to ensure resources are distributed to scaling up and supporting programmes that are already working and meet the needs of the Pacific community. For instance initiatives that are run in the Community by Pacific providers or Faith based Pacific organisations. In addition priority activities are explicitly outlined in contracting work to ensure a strong equity focus for Pacific. Influence & Advocacy Leverage off the influence we have to accelerate and progress change at not only at policy, planning, service and programme levels locally, regionally and nationally. ICT and Knowledge Resource We have access to the technology, evidence based data and resources that can be utilised and shared across to our Primary care and Community based partners to ensure decision making, investments and design processes. DHBs as an employer We have a mandate to create a culturally sensitive work environment that entices and supports employees to feel and be their best. In addition, we can influence creating a work environment that attracts Pacific skilled workforce to want to be a part of.
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Principles of Pacific Healthcare delivery across the 3DHBs
In the development of this plan, it is important to foreground Pacific peoples as diverse with unique The Five key Principles include; values, cultural intelligence, social capital, differing languages and “lived experiences”. The term ‘Pacific Family. Family underpins identity, genealogy, peoples’ is an umbrella term used to describe a population made up of 16 distinct and diverse cultures relationships and a sense of belonging for Pacific people. of peoples from Melanesia, Polynesia and Micronesia. In It lies at the heart of who Pacific people are as every the Wellington sub-region the seven largest ethnic Pacific person belongs to an aiga or kainga. groups are, Samoan, Tongan, Cook Island Maori, Niuean, Fijian, Tokelauan, Tuvaluan (Statistics New Environment. Built and natural environments is Zealand, 2018). important to Pacific people. Their connectedness and By making this the focal point, we commit as District experiences of both plays a huge role in the holistic Health Boards to ensure that Pacific people are actively approach to health and wellbeing. involved in co-designing services and programmes that help address difficulties based on “one size does not fit Spiritual. Churches have historically played a crucial all” due to the growing diversity of Pacific peoples and their ability to access quality and responsive services. role in the lives of Pacific people providing spiritual We are putting a stake in the ground and acknowledging guidance with values such as faith, integrity, truth and that as navigators of this wide ocean that we call the health system, we owe it to our Pacific communities and trust. Churches are still an integral part of Pacific other indigenous ethnicities to reconstruct a system that communities and their everyday lives. they can voyage through without difficulty. We have chosen five key principles or values common Respect. Showing respect when relating to one across Pacific cultures which have been weaved through another is an important aspect of Pacific people right this plan, and will guide our work alongside the input of Pacific communities through community leaders, from an early age. This includes respect towards elders, churches, providers and others. people in positions of authority, each other, women and children.
Culture. Cultural diversity such as the different languages, ethnicity, gender, generational issues, religion, and sexual orientation influences how Pacific people view and respond to health services. This diversity is also evident and seen in individuals and family practices, behaviours, understanding and responsiveness to the world around them.
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So’oso’o Le Upega Framework for guiding this Plan
The plan adopts a well utilised and known Pacific framework to illustrate how the Sub Region is going to work with its partners collectively to achieve better health and wellbeing outcomes for Pacific peoples.. Upega (fishing net) is a Samoan fishing proverb and so’oso’o means connect. So’oso’o le Upega therefore means to connect (so’oso’o) other agencies to health and vice versa so that the Pacific families we serve are being provided the best services that support them addressing issues that have an impact on their health and wellbeing. By being purposeful and intentional in drawing on the knowledge, expertise and understanding of the Pacific communities to partner with the District Health Boards to bring about much needed and sustainable changes across areas of need in the health system.
By utilising this framework, we acknowledge that the cultural wisdom of Pacific peoples still defines and shapes how information is processed, harnessed and acted out. Therefore meaningful and respectful relationships with community are imperative to the design and implementation of this Plan. This ensures that the Pacific communities we serve are not just passive beneficiaries of services but are stewards of their own health care and management.
So’oso’o le Upega Framework
Employment & Income
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Our Strategic Priorities and Measuring Progress
Our six Strategic Priorities as identified and informed by the Pacific communities are
1) Pacific Child Health & Wellbeing 2) Pacific Young People 3) Pacific Adults & Aging Well 4) Pacific Health and Disability Workforce & Pacific Providers 5) Culturally Responsive & Integrated System 6) Social Determinants of Health
These strategic priorities and priority actions, activities and performance indicators with accompanying budgets will be embedded into the Annual Plan and existing performance and accountability mechanisms of each District Health Board. Indeed, accountability and responsibility towards reporting against this strategic Pacific health and wellbeing plan and achieving measurable outcomes for Pacific peoples should be the responsibility of all levels of management.
We know we have been successful when we see improvements in the following areas;
Priority One: Pacific Child Health & Wellbeing
Measures 1. Increased uptake of antenatal and postnatal maternity services that are culturally responsive and wrapped around needs of Pacific mothers and children.
2. A decrease in Ambulatory Sensitive Hospital Admissions (ASH) rates for Pacific children and adults through improved coordination between community, primary care and secondary care providers and other sector partners.
3. Coordinated approach with stronger links across health, education and social service providers to reach greater number of Pacific families through home visiting programmes, culturally appropriate parenting education and support.
4 Increased number of Pacific families accessing warmer drier homes through the Well Homes Healthy Housing initiative 5 Increased number and uptake of Pacific mothers, infants and children with disabilities and their families accessing the right maternity and services and receiving funded disability support services.
6. Support increased uptake of healthy lifestyles programs targeting nutrition, exercise, sleep, smoking and mental for Pacific families in the communities and in schools.
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Priority Two: Pacific Young People
Measure 1. Increased number and uptake of Pacific young people with disabilities and their families accessing the right services and receiving support
2. Support existing and new programmes and initiatives like the Piki free youth Mental Health services, community driven mental health programmes like Taiala mo le Ola Manuia (A Guide to Healthy Living) Mental Health project with Church communities.
3 Encourage and better use of social media to promote health messages and campaigns to reach Pacific young people 4. Establish collaborations with Health & P.E & Science Heads of Departments in Colleges to promote health as a career in schools but also to collaborate on health promotion initiatives driven by Pacific young people
Priority Three: Pacific Adults and Aging Well
Measures 1. Improved access to primary, secondary and tertiary health care closer to home and in the communities 2. Increase in accessibility to medications and faster treatment pathways for Pacific patients
3. Increase uptake of healthy lifestyle programmes and early prevention health promotion programmes 4. Increase and improvement in early screening rates for cancer such as Bowel, Breast and Cervical screening programmes, uptake of diabetes checks and early intervention programs for diabetes, cardiovascular, respiratory, smoking and high blood pressure.
5. Decreased number of prescriptions unfilled due to cost and increased access to Pharmacies and Pharmaceuticals
6. Ensure new funding in early intervention mental health services meets the needs of Pacific people and is appropriate
7 Reduced ASH rates and Pacific people admitted to hospital due to complications from chronic conditions
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Priority Four: Pacific Health Workforce & Pacific Providers/NGOs
Measures 1. Increase in Pacific skilled workforce being interviewed for positions and employed within the District Health Boards in different areas.
2. A review of commissioning and contracting processes within the DHBs is undertaken to ensure Pacific providers are utilized and resourced to support primary and secondary care to reach and serve Pacific peoples.
3. Work with Pacific health workforce community organisations e.g. Tausi Soifua Samoa Nurses Association, Tongan Nurses Association, Tokelau Nurses, Pacific Social Workers Association, Pacific Pharmacy Association, to provide mentoring & scholarship support not only to students undertaking nursing and social work studies. But also work across to mainstream providers to ensure there are pathways in place for mentoring and leadership trainings for the current workforce.
4 Strengthen reporting mechanisms through ensuring the right support with Technology and backroom admin support to our Pacific providers and NGOs as required
Priority Five: Culturally Responsive and Integrated System
Measures 1. Increase in the number of specialist and health care services closer to home and out in the community
2. Strengthen connection and support of Pacific providers to mainstream services for example Health Care Homes and Community Integration projects in primary care. 3. Number of Mandatory Cultural Competency trainings rolled out across Secondary and Primary care services.
4. Scale up support for Integration projects that are working and across the Sub-region 5. Establish a Pacific specific sub regional health pathways for the 3D Health Pathways programme.
Priority Six: Social Determinants of Health
Measures 1. Strengthening partnerships and work in collaboration with housing organisations, Ministry of Social Development, Ministry of Pacific Peoples, Ministry of Education, Pasifika Future, Local councils and other sectors and leverage off programmes such as Pasifika PowerUP Education programmes and Living wage 2. Advocate for free or cheaper visits to general practice and prescriptions for 15-18 year olds, especially for large families with three or more children.
3. Promote the Well Homes service to Pacific families and services, which helps families’ access housing interventions such as insulation, heating, curtain banks, beds, bedding, and carpets.
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Priority One: Pacific Child Health & Wellbeing
Our goal is to give Pacific children and their families the best possible start in life AND ensure they meet key childhood developmental milestones through culturally responsive and safe services and support.
Rationale:
With a fast growing young population, Pacific children, their families and support networks will benefit from early fanau centred health and wellbeing interventions that are culturally sensitive, community determined, partnerships driven and system enabled. The early years, and in particular the first 1,000 days of life is a crucial time and a window of opportunity whereby efforts need to be concentrated to enable the best start to life for our Pacific children.
What the data tells us:
Latest data tell us that children aged under 15 years, make up 33% of the Wairarapa Pacific population, 29% in the Hutt Valley and 27% for Capital & Coast DHB respectively. And that over 60% of the Pacific population in the Wellington Sub-region are now New Zealand born. There have been improvements in health outcomes as evidenced by a decrease in ASH rates for Hutt Pacific and Capital & Coast for Pacific children in the last 5 years. Including increased newborn enrolment with a General Practice and Community Oral health service. Also improvements in immunisation rates, increased percentage receiving WellChild or Tamariki Ora core checks in their first year and B4 School Checks by the time they are four years old.
However, despite improvements in health we are also seeing higher rates of caesarean for Pacific mothers, lower uptake of antenatal or postnatal maternity services, or pregnant Pacific mothers registering and seeing a Lead Maternity carer in their first trimester, increasing complexities due to gestational diabetes and having heavier babies. Pacific children also made up 55% of CCDHB children aged 0-14 years, 33% of the HVDHB and 12% of Wairarapa living in the most deprived areas.
Most of the ASH presentations of Pacific children to hospital were for asthma, dental conditions, gastroenteritis/dehydration, upper respiratory tract infections and cellulitis across the three DHBs.
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There also remains a disparity in the percentage of Pacific children being caries free by the age of five, higher rates of obesity or overweight and Pacific children turning 1 year old were less likely to have had all their scheduled core checks than children of other ethnicities excluding Maori. For Wairarapa Pacific children, 70% had received all their core checks, 57% of Hutt Pacific and 69% of Capital & Coast Pacific.
Efforts should be focussed on the provision of culturally responsive maternal health services that support healthy pregnancies and delivered close to and in people’s homes and in the communities. We want to see easy access and better engagement in reproductive, perinatal, antenatal and postnatal services for Pacific mothers.
In addition, we need to progress health services support and care that focus on good nutrition and physical activity, smoking, positive parenting, immunisation, warm homes, mental health and wellbeing of parents are crucial for healthy physical and social development.
Certainly approaches that focus on the strengths of Pacific families with a spotlight on parents, a mothers overall wellbeing, focus on role of grandparents, strengthening communities and empowering families economically, socially and educationally will provide environments and foundations that bring up strong healthy Pacific children. Research and literature affirms that if we focus our efforts on fanau centred approaches that provide support and work with whole families and what they care about in their homes, our young children benefit.
We want the Wellington sub-region to be one of the best places in New Zealand to raise healthy thriving Pacific children. These actions will focus on supporting timely and quality access to health care and advocating and influencing early childhood development initiatives in other sectors like education and social sectors. We will also be specifically focussed on working collaboratively to improve access and engagement of Pacific families with
Primary Health Organisations (PHOs) & Pacific Providers, Well Child Tamariki Ora (WCTO) Providers, Addressing causes and issues with Ambulatory Sensitive Hospitalisation, Mental health and wellbeing Cross agency collaborations & integrated partnerships to address social determinants of health, Childhood obesity focussed initiatives Good oral health Breastfeeding Rates Smokefree and Warm healthy homes
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What we are going to do? Support and invest in new initiatives and support programmes already working that are fanau centred and targeted at addressing;
• First 1,000 days of life • Healthy relationships, healthy pregnancy, positive parenting, parents and child mental health • Healthy nutrition, sleep and physical activity • Parenting programmes that support mothers and fathers focused on pre- conception, antenatal and postnatal • Safe environments for bringing up Pacific children including warm homes, safe sleeping, reducing smoking and alcohol consumption • Ensuring 100% of Pacific newborn’s in the Wellington sub-region are enrolled with a General Practice, AND Well Child Tamariki Ora service by 3 months of age • Focused on making sure 100% of Pacific infants and pre-school aged children receive oral health checks by 1 years of age. • Improved and timely immunization uptake and rates • Invest in programmes that build capacity and capability of primary and secondary workforce to build relationships with parents and families. • Support investment in services and initiatives that provide home visits to families. • Investigate initiatives and improve access to information and services that address Family violence and work with relevant stakeholders • Strengthened approach to working across agencies to address timely access to maternity services and birthing options • Support Pacific families through a inter-sectoral model for health education in schools and in the communities. • Leverage off Pacific specific Well Child services and build up these providers to reach the most vulnerable families. • Support the Well Homes initiative to ensure Pacific families have access to warm dry homes • Implement strategies to increase rates and duration of breastfeeding • Integration with general practice & Health Care Homes, PHOs and other services with shared plans and ability to cross-refer electronically.
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What is working well: Case Study
Thriving Cores Pacific Well Child Tamariki Ora is the only Pacific run WellChild Tamariki Ora service provided through Pacific Health Service Hutt Valley (PHSHV) in the Wellington Sub-region. PHSHV is a not-for-profit agency based in Naenae in the Hutt Valley. The Thriving Cores service is a mobile service that has successfully worked with over 1,000 Pacific families over the years by conducting Core checks in people’s homes and also running out of hours clinics to suit working mothers and parents.
They have provided social services support and working alongside Lead maternity carers to offer educational support to the families. They have also facilitated a lot of Pacific infants through provision of transportation to get infants and parents to their dental and specialist appointments. This service also helps with Car seat rental discounts, and provision of free Pepi Pods for safe sleeping for babies. They also offer a range of culturally appropriate parenting programmes and support groups. The service is fanau focused, strengths based, relational and the programmes provided are complementary and are designed to improve the outcomes for families/aiga and children.
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Priority 2: Pacific Young People
Pacific young people have timely access to services and programmes that enables them to grow into healthy adults and lead productive lives
Rationale:
Pacific young people growing up in the Wellington sub region are contributing positively to their families and society and are progressing well in many areas. However with the majority now classified as New Zealand born and identifying with more than one ethnicity, our Pacific young people still face issues that previous generations may not have experienced due to exponential social, technological, economic, cultural and educational changes over the years.
What the data tells us:
Various school based health services are provided in low decile colleges, Teen parent units and alternative education centres delivered by Regional Public Health, VIBE, Evolve and some specific DHBs health services across the sub-region. Doctors and Nurses provide students with advice, treatment and referrals to other services on problems including general health, sexual health, and mental health. They also provide routine Health assessments to Year 9 students. Based on the most recent data available for the 2017 calendar year, in Wairarapa 27 Pacific students were seen by School based health services (79% of eligible students) and had on average 2 visits. Hutt Valley School Based health nurses saw 133 Pacific students (28% of eligible students) who had on average 2 visits. 100 Pacific Year 9 students in Hutt Valley received a routine health assessment. Capital & Coast School based health nurses saw 589 Pacific students (94% of eligible students) who had on average almost 2 visits.
Even though we see improvements and the availability of youth centred health services and programmes targeted to our young people in schools, we are seeing a rise in mental health issues, suicide attempts, sexually transmitted infections, smoking, preventable injuries, obesity and family violence. Our young people identified during the consultations the close
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link between mental health issues and the result of identity crises, poverty, lack of cultural sensitive health care models, stigmatisation and discrimination.
Tackling the risk factors associated with these issues alongside sufficient investment to advancing progress made in some areas and investment in new and innovative ways to support our young people to thrive is our goal. Particularly given that across the Sub-Region in the next 10 years most of the Pacific growth will be in the age groups 15-29 years a 8% increase4
We know that youth is a key transitional period in the life of a young person where they make decisions around relationships, career pathways, and responsibilities alongside rapid brain and body transformations. Research and the data tells us that enabling environments that foster healthy behaviours, resilience and confidence of young people puts them in good stead to transition into adulthood. The research and data also tells us that Pacific young people still face obstacles more so than other ethnicities due to socio-economic and educational disadvantage, inter-generational suffering and prejudice to name a few. We heard from our young people that they want to contribute to policies and programs that impact on them given the right support and opportunities to do so. Sport, music and the Arts are some of the areas they identified as having a significant impact in promoting a sense of wellbeing for them.
In light of this, the following actions will be taken to ensure we are supporting Pacific young people to strengthen their resilience, address mental health and wellbeing, establish the right support networks, improve sense of belonging, problem solving skills, strong connection to culture and family.
4 3DHB Pacific Plan Data sets 2019
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What we are going to do?
Support and strengthen initiatives that encourage young Pacific people to adopt healthy lifestyles, make informed choices about sexual health, smoking, and risk taking behaviors
Accelerate strategies and innovations that focus on Pacific young people’s improving access to appropriate and timely primary and secondary mental health services.
Implement programs that prevent and address the problems caused by self- harm and violence
Strengthen partnerships and collaborations with youth specific health, social and educational service providers
Implement initiatives that promote strengthening pride in culture and identity
Interventions and Cultural sensitive models of care are utilised when dealing with mental health, sexual and reproductive health issues of young people
Encouraging parents and families to be positive role models;
Strengthen the participation of Pacific young people in dialogue and decision- making opportunities and activities for monitoring of their health.
Support programs that will focus on sensitizing and training health and disability workforce who with Pacific youth
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What is Working Well: A Case Study Evolve and Vibe Youth Health Services are providing free and confidential health care across the Sub-region including general, sexual and mental health, counselling, social support and youth development activities reaching low decile schools that have high percentage of Pacific students. These services also offer support for young people not in education, employment or undertaking any formal trainings who are between 16 or 17 years old amongst others. Pacific young people interviewed during the consultation phase identified that they were confident in the services provided through these school based clinics. Regional Public Health through their School based health nurses and Social workers in schools are also reaching low deciles primary and intermediate schools and provide onsite health and social support to Pacific families and children.
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Priority 3: Pacific Adults and Aging Well
Pacific adults and elders are actively engaged in their health care, live productive, active, culturally secure and quality long lives.
Rationale:
Healthy Pacific adults and elders contribute positively to their families, churches, work places and society overall. Our Pacific elders play a crucial role as the custodians of traditional wisdom to help sustain cultural traditions, languages and practices, through passing on of knowledge, customs and generational blessings across generations. They are cultural champions that need to be engaged to ensure appropriate cultural approaches to health and wellbeing are utilised.
A social wellbeing survey undertaken by Statistics New Zealand in 2017 highlighted that Pacific adults reported higher levels of wellbeing despite challenging socio-economic situations. The life expectancy of Pacific adults has also increased showing that Pacific adults and elders are living an extra 7-8 years when compared to 20 years ago.
What the data tells us?
Data across the two Primary health organisations and the three DHBs in the Wellington Sub-region show that Pacific people have high rates of healthcare utilisation, accessing their General Practices 3.5 times more than others.
Pacific adults and elders continue to be high users of health services, and are still more likely to suffer and die prematurely from chronic diseases such as diabetes, heart disease, respiratory illnesses, strokes, cancer, obesity and high rates of avoidable ambulatory hospital admissions compared to others. Based on the NZ Health survey standardised rates, 92% of Pacific adults in Capital & Coast are overweight or obese and 89% of Hutt Valley Pacific. This is similar to all Pacific in New Zealand.
Amendable mortality rates for Pacific are also high particularly for people under the age of 75 due to causes that could have been prevented through treatment or better safety precautions. The causes of death include injuries, suicide, cancer and cardiovascular disease. Over the 5 years from 2011-2015, there were 176 deaths in Capital & Coast Pacific people and 71 Pacific Hutt Valley that could have been prevented. The standardised rate of
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amenable mortality is higher for Pacific than non-Maori non Pacific people in Capital & Coast and Hutt Valley. Based on coroner’s information on suspected suicides, over the four years from 2014/15 to 2018/19, 5% of Hutt Valley deaths were Pacific people, 7% of Capital & Coast and none of the deaths in Wairarapa were Pacific people. There is also an increasing trend of individuals suffering from multiple chronic conditions and this impacts on the quality of life of the individual and family due to complications from having more than one long term condition. This is despite improvements in treatments, management and access to clinical care services, wrap around programs and services that support and encourage the adoption of healthy lifestyles and focus on addressing social determinants of health.
Therefore we need to provide holistic and appropriate health promotion, prevention efforts and education to improve health literacy of Pacific adults and elders. We want to make sure that Pacific adults and elders are aging well and accessing the appropriate services including aged care facilities, palliative care services maximise their independence and reducing burden of health problems and disabilities.
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What we are going to do?
Implement early prevention, health education and promotion programmes that draw on Pacific traditional wisdom, languages and cultural strengths to address risk factors and treatment of long term conditions.
Work in partnership with key stakeholders to increase and encourage participation in early screening programs (s cervical, bowel, breast and other cancers) AND cessation support (smoking and drugs).
Continue to support healthy lifestyle programmes focussed on improving accessibility and affordability of nutritious food, sleep and increased physical activities for Pacific adults and elderly.
Continue to complement system-wide health service delivery with targeted activities specifically aimed at chronic disease treatment and prevention
Continue to fund the important ‘Catalyst’ Pacific radio programme and develop comprehensive social media campaigns to promote key messages and health information in the different Pacific languages that will raise awareness and support Pacific people to make the right lifestyle changes
Promote links across mental health and drug and alcohol services and continue to increase community awareness and education about the range of options for dealing with the impact of the use of drugs, alcohol and tobacco.
Implement strategies to promote resilience, empowerment and positive mental health
Strengthen healthy aging initiatives and optimise on opportunities to support Pacific elderly live quality lives in their homes.
Effectively integrate and socialise the idea of Advanced Care Planning with Pacific families and communities.
Continue to identify change levers in programme and service design which will make the greatest impact on a given health condition or issue including cultural competency training for non-Pacific workforce that work with Pacific people.
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What is working well: Case Study
Pacific Nurse Led Services and Navigation services out in the communities are achieving transformational cultural clinical and social outcomes for our Pacific peoples with long term conditions. These mobile nursing and social support services work with General Practices, Specialist services in the Hospitals and sectoral partners to wrap services in a culturally appropriate way around the patient and taking this care directly to their homes.
Examples of these Pacific services the Pacific Health Service Hutt Valley Primary Nursing Service and Vaka Atafaga, alongside Taeaomanino Trust, Vaka Tautua to name a few are reaching and supporting patients to complete and re-engage with their General Practices.
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Priority 4: Pacific Health Workforce & Pacific Providers/NGOs
The Pacific health workforce and Providers have the capabilities, resourcing, aspirations, organisational structures, professional opportunities and potential to lead, support and contribute to achieving positive health and wellbeing outcomes for Pacific people.
Rationale The importance of building and maintaining a qualified Pacific health and disability workforce alongside investment in strengthening Pacific Providers is crucial to closing the gap in addressing the health inequalities that exist for Pacific people. A qualified Pacific health workforce with cultural understanding and who are well versed in the cultural nuances of Pacific people will improve and strengthen our ability to provide culturally responsive health system that benefits the communities we serve to engage them to become good and better stewards of their own health and wellbeing.
We want to ensure our current and future workforce is diverse and have the right skills and qualifications to deliver and provide continued improvement across all parts of the health sector. In addition, funding investments and commissioning of services are directed and help build up Pacific Providers with proven success in providing services that meet the needs of Pacific peoples.
Investing resources and funding into growing the Pacific health and disability workforce & Providers will enable the District Health Boards to close the gap and make a difference in achieving optimum health is achieved for vulnerable groups such as Pacific in the Wellington sub-region.
What the data tells us? The Central Region District Health Boards Pacific Workforce Report as at 30 June 20195 identified that across the Wellington Sub Region, the Pacific workforce was spread across with the highest reported proportion of Pacific peoples in the Care and support occupation group with 20% in CCDHB, 2% in HVDHB and 0% in WrDHB. Followed by those working in Corporate, Admin and other, Nursing and with the lowest proportions in Midwives, Resident and Senior Medical Officers.
Across the Central Region, the proportion of Pacific staff with more than two years of accrued annual leave was typically lower than the proportion of all employees with this level
5 TAS Central Region District Health Boards Dashboard Pacific Workforce Report June 2019,
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of accrued leave, with no Pacific staff in the Midwifery, Resident Medical Officer or Senior Medical Officer Occupation groups reportedly accruing more than two years of annual leave. A cause for concern was the reported number of sick leave hours taken in April-June 2019, as a proportion of total paid hours, was typically higher for Pacific employees than the rate across all DHB employees.
The exceptions are the Midwifery and Resident and Senior Medical Officer Occupation groups, but this may be linked to the low numbers of Pacific employees in these occupation groups.
One of the limitations is that the data sets obtained does not include the Pacific workforce in primary and community health care. The DHBs workforce has also have an aging Pacific Health workforce
Certainly in the Wellington sub-region the forecast for the Pacific population is that there will be persistent inequities, increased demand on health services, increased social isolation with volumes of older people with complex health and social needs.
Hence a strong focus should be on investing now and making it a priority to grow the Pacific health workforce to meet the impact and increase in demand of the changing Pacific demographics and support an aging workforce who are small in numbers and are feeling the weight of supporting older people with long term conditions and other health issues affecting our Pacific populations.
Pacific Providers and NGOs in the community are small, we aim to support them by building their capacity further at all levels to collaborate (especially with other providers) as a key way to improve the range, access and cultural appropriateness of services to Pacific communities.
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What we are going to do? Increasing and attracting our Pacific human capital by targeting students via formal education settings, such as secondary schools to tertiary institutions. This pipeline needs to be socialised as well with the education sector. Explore and invest in cadetship programmes.
Build effective pathways from schools to promote careers in health and focus on students, to transition with ease into higher education and professional institutions.
Influence HR recruitment policies and processes across the 3DHBs to improve Pacific employment opportunities including increasing number of Pacific on shortlisting, interview panels, Steering groups and governance
Focus on overseas/island trained health professionals with overseas training and qualifications and the pathways to get them qualified in the NZ health system
Continue to fund and support improvement of “Pacific by Pacific” Pacific Health Service providers in the community and recognise the crucial part they play within the health system and the achievement of health outcomes.
Retention & Sustaining & Career Development:
Retaining and supporting our current Pacific workforce includes looking at
1. mentoring programmes and support not only for current workforce, but those undertaking studies
2. flexible working arrangements to allow our Pacific workforce to focus on meeting their family/community obligations AND allow for family support
3. encouraging and developing succession plans for retention and professional pathways for Pacific health workforce alongside employment
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What’s working well: Case Study
The recruitment process in the Hutt Valley District Health Board has changed since 2018 to reflect the need to increase the number of Pacific in the nursing workforce by interviewing all Pacific and Maori applicants at the entry point of the process. There is still some fine tuning to this process and small positive changes are happening. But it is a process that needs to be scaled up and embedded across the sub region.
In addition, health specific scholarships through the Aniva Health Scholarships offered through the Ministry of Health as well as HVDHB specific Oral health Scholarships for three students over the last five years provide opportunities to grow our workforce.
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Priority 5: Culturally Responsive & Integrated Health System
A culturally responsive and respectful health care system across the Wellington sub-region secondary/hospital care, specialist services, and aged care that meet the needs of Pacific peoples and are delivered close to home.
Rationale: Culture for Pacific peoples plays a significant role in their decisions on how, where, when and why they should seek and engage with health services, acceptance of treatment protocols, adherence to treatment and follow up of appointments, as well as the ability to trust and be confident in the system.
Therefore, a culturally responsive and integrated system, culturally competent workforce will lead to more effective health service delivery that achieves equitable and better health outcomes for Pacific peoples. It will improve patient experiences and health outcomes.
We know that effective integration of services that wrap around a person’s needs rather than service needs will enhance patient experience, achieve better and seamless care.
By working collectively across all areas clinical and non-clinical within the health system and various settings of care, we are improving the flow of information, continuity of care, and building strong and effective relationships and partnerships which are essential to integrated services and design.
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What we are going to do?
Develop and Implement a Sub-regional Cultural Competency Framework, Checklist and Training Package that nurtures a culturally responsive work environment and improve capacity of the health workforce to deliver culturally sensitive services.
Build accountability and leadership for Pacific health outcomes by embedding accountability at all levels of management within the DHBs and also reporting requirements on health impact of Pacific across services.
Strengthen and support Pacific Health Providers and align their work with General Practices and hospital services in particular with a focus on Health Care Homes and Integrated family health centres in primary care and the community.
Strengthen links across the health system from clinical and nonclinical work streams and focus on better access to coordinated and multidisciplinary care.
Establish a mechanism for collaborative operational planning, strategy development and service design across the 3DHB Pacific directorates
Develop opportunities for regular consultations with Pacific communities to establish and hear views about healthcare delivery
Embed Pacific cultural training as a key component of new employees orientation programme
Explore opportunities for research that promote cultural responsiveness and safety in the workplace.
Continue to support integrated programmes in primary care and hospital/specialist services focussed on early identification, treatment and support for individuals with risk factors such as the Community Integration initiative.
Maintaining trusted relationships within the Pacific community such as Churches and with providers.
Continue to give priority to improving quality of hospital care and specialist services and primary health care systems to ensure they are culturally sensitive and safe for Pacific people.
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What’s working well: Case Study
The Cultural Competency Mandatory Training programme currently being implemented in the Hutt Valley District Health Board and as part of the Cornerstone Accreditation Scheme for General practices through Te Awakairangi Health Network in Primary Care is proving to be a huge success. It has trained over 400 Community Pharmacists, GPs, Radiologists, Theatre staff, Regional Breast and Cervical Screening Services, Community Dental Therapists, Allied Health staff, Practice Managers, Nurses, Strategy and Planning staff, Administrators since it was put in place in 2018. The Training programme is completed and delivered in two phases. 1) Mandatory Training for all Employees E-Learning Module 2) Face to face 2 hour Training
The training was implemented to support and equip non-Pacific colleagues across the hospital and community settings with practical tools, sound knowledge and understanding of Pacific people. Furthermore it was created out of a need to create a “Culturally Responsive” environment within the hospital and general practice settings with a strong equity focus to enhance how people engaged, worked and support both Pacific patients and staff.
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Priority 6: Social Determinants of Health
A health system in the Wellington sub-region that is aligned and better connected to housing, education, employment, social services and other sectors to address environmental, social and economic inequities to achieve better health outcomes for Pacific peoples.
Culturally sensitive models of care are utilised and integrated into health care deliver, education and promotional strategies to enable the best possible mental health and wellbeing for pacific peoples
Rationale The health and wellbeing of our Pacific communities is heavily influenced by the underlying social determinants of health. These include, housing and employment, health behaviours, clinical care and the physical environment. What the data tells us? A higher proportion of Pacific people are living in more deprived areas according to the NZ Deprivation Index. Based on the 2013 Census population, 51% of Capital & Coast Pacific people were living in the most deprived areas, 40% of Hutt Pacific people and 36% of Wairarapa Pacific people.
Research suggests that only about 20 percent of a person’s health is determined by access to health care. The other 80 percent is determined by health behaviours and the social and environmental conditions where they live, work and play.6 The feedback from our Pacific people provided valuable insight on how the social determinants of health were impacting on their health and wellbeing. Most importantly, the feedback highlighted what we need to prioritise to improve the health and wellbeing of our Pacific Peoples across Wellington, the Hutt Valley and Wairarapa. It is well known that income is associated with health and wellbeing. Families on low incomes may struggle to pay all their bills, which can cause stress and tension within a family. The rise in housing costs in recent years, in particular, has put many families under financial strain – with a significant proportion of their income having to be spent on rents or mortgages. This may mean they are unlikely to afford items and activities that can have a positive impact on health and wellbeing. These may include, for example:
healthy foods, like fruits, vegetables and milk team sports and other outdoor activities school outings and events joining and participating in local cultural or religious groups, hobby groups, or clubs appropriate clothing and bedding travel or holidays electricity for heating household items to help keep homes warm and dry, like heaters, curtains, draft stoppers and insulation.
6 https://www.health.govt.nz/publication/health-and-independence-report-2017
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Of course, low income will also impact on a family’s ability to pay for health care, including regular check-ups and care when they are unwell.
Employment helps to raise a family’s income, which can help pay for activities and items that improve health and wellbeing. However, employment can take a parent’s time away from their family – especially if they are having to work more than one job, or work at nights and weekends, to make ends meet. Time away from their family while working can also have a negative impact on wellbeing.
Many Pacific families told us that both employment and income affect their health and wellbeing in different ways. Often, both the mum and dad were working and the family still did not have enough money coming in to meet all their ongoing bills and household costs. Sometimes the mum or dad had more than more job and were working different shifts and at weekends. Young Pacific people would also often be working to help support their family. Some said that they would often settle for less when interviewing for jobs.
We were also told that many Pacific people are not aware of the Government support available. When they do seek support, many felt the process was administratively burdensome, intrusive, and took away their dignity. The process involved too much paperwork and forms, and having to ‘prove’ they had low incomes. We were told that many Pacific people felt judged and humiliated by the process.
Income support was especially needed for Pacific families after a baby is born, for the first 12 months of the infant’s life. During this time finances are particularly stretched because the family will lose the income of one parent. Additional income during this time would also relief financial stress and help the family provide support the baby during this critical period in a baby’s life.
As expected, we were told that low income affects the ability of Pacific people to access health care. They told us that many Pacific people are not having regular check-ups with their general practice due to the health and medical costs.
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What we are going to do?
Support initiatives and innovative programs that promote effective partnerships between local services from different sectors that address the social determinants of health
take action across key social determinants such as health, housing, education and employment;
align program goals across sectors and leverage off existing partnerships, frameworks and programmes that are in place for example working with Pacific Whanau Ora collectives
Strengthen working relationship with the Ministry of Social Development and Work and Income New Zealand to help them promote and inform Pacific people about the support that is available to them and help make their processes for applying for support easier and more user-friendly.
Work with our health providers to ensure that they know what Government supports are available to their clients and can help people apply
Support Pacific people and work alongside them and other agencies to help them apply for the Government support and help that they are entitled to.
Advocate for free or cheaper visits to general practice and prescriptions for 15-18 year olds, especially for large families with three or more children.
Promote the Well Homes service to Pacific families and services, which helps families’ access housing interventions such as insulation, heating, curtain banks, beds, bedding, and carpets.
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What’s working well: Case Study
Pasifika PowerUP is an education programme that aims to actively support Pacific parents, families and communities to champion their children’s learning out in the communities and close to where they live. Delivered through the Ministry of Education, PowerUp stations sessions have been delivered all over New Zealand and have proven to be very successfully in accelerating the learning and achievements of Pacific students. The sessions are delivered in a safe learning environment either through Church partnerships or within school settings, this programme also provides academic support to primary and secondary students using trained Pacific teachers. The Pacific PowerUP Au Lotu model was launched this year as a partnership with Congregational Christian Churches in Wellington. This is a 10 week parent only programme delivered by key churches in specific communities. Au Lotu means the “church” group and is designed to work through the churches influence in Pacific communities. This model harnesses the strength of church pastoral care, inter-faith connections and networks.
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APPENDIX: Pacific Health Data across the Sub-Region
APPENDIX
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3 DHB Pacific Plan 2019 – data
Population An estimated 35,165 Pacific people live in the three DHB area in 2019/20, 22,320 in Capital & Coast, 11,900 in Hutt Valley and 945 in Wairarapa. Hutt Valley DHB has the highest percentage of Pacific people representing 8% of the total DHB population. Pacific people are 7% of the Capital & Coast population and 2% of Wairarapa.
Number of Pacific people in 2019/20 (StatsNZ population estimate 2018)
Number of % of Total DHB Pacific DHB people population Capital and Coast 22,320 7% Hutt Valley 11,900 8% Wairarapa 945 2% Total subregional population 35,165 7%
Age profile of Pacific Pacific are a much younger population than the Total DHB population. In 2019/20 Children aged under 15 years, make up 33% of the Wairarapa Pacific population compared to 19% of the total DHB population. For Hutt Valley, children under 15 years make up 29% of the Pacific population, whereas they make up 20% of to the total population. For Capital & Coast, children under 15 years make up 27% of the Pacific population, whereas they make up 20% of the total population. Whereas, people aged 65 and over made up only 7% of the Pacific population in each DHB which was much lower than proportion in the total population.
Age profile: % breakdown of Pacific population in 2019/20 compared to Total DHB
1
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Pacific population by age group 2019/20 and the percentage of Pacific people in each age group
Although Pacific make up 7-8% of the total population of Hutt Valley and Capital & Coast DHBs, Pacific make up a higher proportion of the DHBs’ children and young people because they are a younger population. Of the children aged under 15, Pacific make up more than 10% of the Hutt Valley and Capital & Coast population. For Wairarapa, Pacific children under 15 make up 3.5% of the population in that age group.
Pacific population as percentage of total DHB population in each age group 2019/20
2
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Future Population growth In the next five years, the Pacific population is expected to grow in all 3 DHBs. Capital & Coast Pacific population is expected to grow by 680 people (3%) by 2024/25, Hutt Valley by 450 people (3.8%) and Wairarapa by 50 people (5%).
Pacific population growth in next 5 years 2024/2025
Growth in % growth 2019/2020 2024/2025 people in in next 5 next 5 years years Capital and Coast 22,320 23,000 680 3.0% Hutt 11,900 12,350 450 3.8% Wairarapa 945 995 50 5.3%
Most of the Capital & Coast growth in the next 15 years will be in the age groups 25-44 and 65+. In the next 5 years, Pacific aged 25-44 are expected to grow by 400 people (6.5%) and Pacific aged 65+ will grow by 180 people (11%).
Most of the Hutt Valley growth in the next 15 years will be in the age groups 15-29, 25-44 and 65+. In the next 5 years, Pacific aged 15-29 are expected to grow by 170 people (8%) and Pacific aged 65+ will grow by 140 people (16%).
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Most of the Wairarapa growth in the next 15 years will be in the age groups 15-29, 25-44 and 65+. In the next 5 years, Pacific aged 15-29 are expected to grow by 25 people (14%) and Pacific aged 65+ will grow by 15people (13%).
Pacific population in 2019/20 aged under 25 (5 year age groups)
Capital and Hutt Wairarapa Coast 00-04 1980 1030 90 05-09 2060 1160 110 10-14 1930 1230 110 15-19 1910 1070 110 20-24 2020 970 75 Total 9900 5460 495
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Population by Deprivation Index 2013 A higher proportion of Pacific people are living in more deprived areas according to the NZ Deprivation Index 2013. The NZ Deprivation Index is based on variables that reflect socioeconomic factors that have significant influence on health such as income, employment, home ownership, and overcrowding.1 Based on the 2013 Census population, 51% of Capital & Coast Pacific people were living in the most deprived areas, 40% of Hutt Pacific people and 36% of Wairarapa Pacific people.
57% of Capital & Coast Pacific adults aged 65 and over were living in the most deprived areas. 47% of Hutt Pacific adults aged 65 and over and 50% of Wairarapa Pacific aged 65 and over were living in the most deprived areas.
Pacific children made up 55% of Capital & Coast children aged 0-14 living in the most deprived areas. Pacific children made up 33% of Hutt children aged 0-14 living in the most deprived areas. Pacific children made up 12% of Wairarapa children aged 0-14 living in the most deprived areas.
1 https://www.otago.ac.nz/wellington/departments/publichealth/research/hirp/otago020194.html https://www.otago.ac.nz/wellington/otago069936.pdf - page 8 - list of variables
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Risk factors Obesity & Physical activity Based on the NZ Health survey standardised rates, 92% of Pacific adults in Capital & Coast are overweight or obese and 89% of Hutt Valley Pacific. This is similar to all Pacific in New Zealand. Around half of Pacific children aged 0-14 years are overweight or obese in Hutt Valley and Capital & Coast, which is less than all Pacific in New Zealand.
Based on the NZ Health survey standardised rates, 67% Hutt Valley Pacific adults are physically active while 10% did little or no physical activity. In Capital & Coast, 55% of Pacific Adults were physically active while 16% did little or no physical activity.
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Health Outcomes: Amenable Mortality Amenable mortality refers to deaths in people under the age of 75 due to causes that could have been prevented through treatment or better safety precautions. The causes of death include injuries, suicide, cancer and cardiovascular disease. Over the 5 years from 2011-2015, there were 176 deaths in Capital & Coast Pacific people and 71 Pacific Hutt Valley that could have been prevented. The standardised rate of amenable mortality is higher for Pacific than non Maori non Pacific people in Capital & Coast and Hutt Valley.
Based on coroner’s information on suspected suicides, over the four years from 2014/15 to 2018/19, 5% of Hutt Valley deaths were Pacific people, 7% of Capital & Coast and none of the deaths in Wairarapa were Pacific people.
Health Outcomes: Hospitalisations Ambulatory Sensitive Hospitalisations (ASH) Ambulatory Sensitive Hospitalisations (ASH) are certain conditions where the hospital admission could have been prevented if the person had received appropriate care earlier in community services. The Ministry uses ASH rates as a measure of how the DHB system as a whole is working for the population in preventive and proactive care. The Ministry reports on the rate of children aged 0- 4 and adults aged 45-64 who have an ASH event at any hospital including those outside the DHB the person lives in. The Ministry does not report rates for Wairarapa as the Pacific population is too small and with a smaller number of events the data could be identifiable.
Hutt Pacific and Capital & Coast ASH rates for Pacific children have decreased in the last 5 years but are still much higher than the National rate for children of Other ethnicities (nonMaori nonPacific). Rates for Hutt Pacific children were 2.2 times higher than the rates for National Non Maori non Pacific children in the year ending March 2019. Rates for Capital & Coast Pacific children were 2.0 times higher than the rates for National Non Maori non Pacific children.
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Most of the ASH events in the 12 months ending March 2109 for Hutt and Capital & Coast Pacific children were for Asthma, Dental conditions, gastroenteritis/dehydration, Upper respiratory tract infections and Cellulitis.
Hutt Pacific and Capital & Coast ASH rates for Pacific Adults aged 45-64 years have been fairly stable in the last 5 years but are much higher than the National rate for Adults of Other ethnicities (nonMaori nonPacific). Rates for Hutt Pacific Adults were almost 3 times higher (2.9) than the rates for National Non Maori non Pacific adults in the year ending March 2019. Rates for Capital & Coast Pacific Adults were 2.6 times higher than the rates for National Non Maori non Pacific adults.
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Most of the ASH events in the 12 months ending March 2109 for Hutt Pacific Adults were for Angina & Chest pain, Cellulitis, Pneumonia, Myocardial Infarction and Chronic Obstructive Pulmonary Disease (COPD). Most ASH events for Capital & Coast Pacific Adults were for Angina & Chest pain, Cellulitis, Pneumonia, Stroke and Gastroenteritis/dehydration.
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All ages and Child & Youth PHO enrolment As at July 2019, Wairarapa has 938 Pacific people enrolled with a PHO 99% of the estimated population, Hutt Valley has 11,573 (98%) and Capital & Coast has 21,536 (97%) enrolled.
Pacific people enrolled with a PHO July 2019
Pacific enrolled % of estimated with any PHO population Wairarapa 938 99% Hutt Valley 11,573 98% Capital & Coast 21,536 97%
Most Wairarapa Pacific people are enrolled with the Compass Wairarapa PHO. 87% of Hutt Pacific are enrolled with Te Awakairangi Health Network while 1,398 (12%) Hutt Pacific people are enrolled with one of the PHOs with a contract with Capital & Coast. Note that Cosine PHO includes the practice Ropata Medical which is located in the Hutt Valley. 98% of Capital & Coast Pacific people are enrolled with Compass Capital & Coast, Ora Toa and Cosine. 263 (1.2%) Capital & Coast Pacific people are enrolled with Te Awakairangi Health Network.
Number of Pacific people enrolled with any PHO July 2019 – by DHB holding DHB contract
DHB of domicile
Capital Capital DHB holding PHO PHO Name Wairarapa Hutt & Total Wairarapa Hutt & contract Coast Coast Capital & Coast Compass Health 6 730 14,430 15,166 0.6% 6% 67% DHB Capital & Coast Ora Toa PHO 91 6,177 6,268 0% 0.8% 29% Cosine PHO 577 452 1,029 0% 5% 2% Capital & Coast DHB Total 6 1,398 21,059 22,463 1% 12% 98% Hutt DHB Te Awakairangi 11 10,075 263 10,349 1% 87% 1.2% Compass Health Wairarapa DHB 915 5 6 926 98% 0.04% 0.03% Wairarapa PHOs in Other DHBs 6 95 208 309 0.6% 0.8% 1.0% Total enrolled with a PHO 938 11,573 21,536 34,047 100% 100% 100%
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All ages and Child & Youth Practice visits Pacific people who were enrolled with Compass Wairarapa PHO saw a GP or Nurse on average 5 times in 2018/19. This excludes visits for immunisation only. For Pacific people enrolled with Te Awakairangi Health Network, they saw a GP or Nurse 3.5 times on average over the year. For Pacific people enrolled with Ora Toa or Compass Wellington, they saw a GP or Nurse 4.5 times on average over the year ending March 2019. Pacific people enrolled with Cosine which include Karori Medical and Ropat Medical practices saw a GP or Nurse on average 3.5 times over the year ending March 2019.
For all PHOs, Pacific aged 65 and over had the most visits on average, followed by people aged 45-64 and children aged under 5. Pacific Adults aged 45-64 in Compass Wairarapa and Te Awakairangi PHOs had slightly more visits on average than other ethnicities including Maori adults.
Pacific children aged under 5 years had slightly more visits in Compass Wairarapa compared to other ethnicities including Maori. But Pacific children aged under 5 years had similar number of visits in Te Awakairangi compared to children of other ethnicities excluding Maori.
Average GP/Nurse visits per person enrolled
Compass Wairarapa 2018/19 Age Group Maori Pacific Other 0-4 4.84 5.14 4.62 5-14 3.44 3.66 3.26 15-24 4.21 3.5 4.22 25-44 4.86 4.7 4.53 45-64 6.75 6.74 5.61 65+ 9.64 8.2 9.34 Total 5.44 5.2 6.26 Te Awakairangi Health 2018/19 Age Group Maori Pacific Other 0-4 3.72 3.61 4.16 5-14 1.93 1.83 2.24 15-24 2.30 1.73 2.52 25-44 3.21 3.11 3.06 45-64 5.39 5.25 4.36 65+ 9.27 7.85 8.10 Total 3.62 3.52 4.23
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Ave visits per Pacific person enrolled 12 months ending Mar 2019 – Capital & Coast PHOs
Age Compass Cosine Ora Toa Group Wellington 0-4 5.1 4.9 5.2 5-14 2.5 2.3 2.7 15-24 2.6 2.3 2.4 25-44 3.8 2.8 4.0 45-64 6.4 4.4 6.2 65+ 10.1 6.4 10.1 Total 4.5 3.5 4.6
Child & Youth After Hours - Hutt Valley birth cohort study Analysis was done on Hutt Valley children born in 2013 and their use of DHB health services in their first four years of life, including 148 Pacific children. It found that Pacific children were using the Lower Hutt After Hours as much as their Hutt GP practice. In their first 12 months of life, 51% of the Pacific cohort had been to both their Hutt GP practice and to Lower Hutt After Hours. 35% of the cohort only went to their Hutt GP Practice. 25 children (17%) had more visits to After Hours than to their GP practice during their first 12 months. While this means that they are receiving good access to Primary Care, they were missing out on continuity of care from their own practice as well as proactive care and preventive care. This also means that children with a high number of visits to After Hours may not be identified by their practice as at risk. There were 4 Pacific children who had 11 or more visits to their GP practice but another 26 Pacific children had 11 or more visits if we include their After Hours visits. 10 children only went to After Hours but may have been enrolled in a practice in another DHB.
Hutt Valley 2013 Birth cohort – Pacific children using Lower Hutt After Hours and Hutt practices in first 12 months of life
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Child & Youth WellChild/Tamariki Ora Checks By receiving all WellChild/Tamariki Ora Checks core contacts in their first year, infants are more likely to have health and developmental issues identified in a timely way. Each child is scheduled to have 5 core checks by the time they turned 1 including their first check at 6 weeks old. During January- June 2018, Pacific children turing 1 year old were less likely to have had all their scheduled core checks than children of Other ethnicities excluding Maori. For Wairarapa Pacific children, 70% had received all their core checks, 57% of Hutt Pacific and 69% of Capital & Coast Pacific.
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Child & Youth School Based Health services DHBs provide School based Health services (SBHS) in low decile colleges, Teen Parent units and Alternative Education centres. Nurses provide students with advice, treatment and referrals to other services on problems including general health, sexual health, and mental health. They also provide routine Health assessments to Year 9 students.
Based on the most recent data available for the 2017 calendar year, in Wairarapa 27 Pacific students were seen by SBHS Nurse (79% of eligible students) and had on average 2 visits. Twelve Pacific Year 9 students in Wairarapa received a routine health assessment. Hutt Valley SBHS nurses saw 133 Pacific students (28% of eligible students) who had on average 2 visits. 100 Pacific Year 9 students in Hutt Valley received a routine health assessment. Capital & Coast SBHS nurses saw 589 Pacific students (94% of eligible students) who had on average almost 2 visits. 121 Pacific Year 9 students in Hutt Valley received a routine health assessment.
Seen in 2017 Calendar year by School Based Health services at Decile 1-3 schools, Teen Parent units and Alternative Education centres
% of Year 9 Ave Students enrolled students % of visits to visits % of eligible seen by students who Pasifika school SBHS per total students SBHS seen by received a roll nurse student visits Nurse SBHS Health seen Nurse assessment
Wairarapa 34 4% 27 79% 59 2.2 4% 12 Hutt Valley 478 20% 133 28% 301 2.3 18% 100 Capital & Coast 626 41% 589 94% 1111 1.9 37% 121
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Prevalence of Mental Health disorder The survey Te Rau Hinengaro (2006), found that 47% of Pacific people had experienced a mental disorder at some stage during their lifetime compared with 39.5% of the overall New Zealand population. Pacific people also had a higher prevalence of any mental disorder in a 12 month period at 24% and 6% of Pacific people experienced a serious disorder.2 But they are less likely to make a mental health visit to a health service, 7.8% of Pacific had a mental health visit compared to 13% of Other ethnicities excluding Maori. Within the 12 months prior to the survey, 5.9% of the Pacific people surveyed had a serious disorder, 11.6% had a moderate disorder and 7.6% had a mild disorder.3 Suicide is also a risk, with 21% of Pacific people aged 16–24 and 20% of Pacific people aged 25–44 reported suicidal ideation over their lifetime. A suicide attempt within their lifetime was reported by 4.8% (almost 1 in 20) of Pacific people.
2 https://www.health.govt.nz/system/files/documents/publications/mental-health-survey-2006-aggregated- prevalence.pdf 3 https://www.health.govt.nz/system/files/documents/publications/mental-health-survey-2006-pacific- people.pdf
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Primary Mental Health Primary Mental Health is provided by PHOs and other community services for people with mild to moderate mental health issues. Capital & Coast services saw 363 Pacific people in the 2018/19, Hutt Valley services saw 304 Pacific people and Wairarapa services saw less than 5 people.
Pacific people seen by Primary Mental Health services in 2018/19 year Capital & Wairarapa Hutt Valley Coast Youth: 12-19 years <5 131 70 Adults: 20+ years 0 173 293 Total <5 304 363 % of total 0.1% 6.6% 7.4% people seen by service % of DHB Pacific population 0.2% 2.6% 1.6%
Specialist Mental Health services Specialist Mental Health services are targeted at people with serious mental health issues. They are provided by DHB and NGO services. Services include acute inpatient services, community services and rehabilitation services for addiction. In Capital & Coast, 811 Pacific people (3.6% of the population) were seen by any specialist mental health and addiction service in the three DHBs in 2018/19. For the Hutt population, 419 Pacific people (3.5%) were seen and 45 Pacific people (4.8%) from the Wairarapa.
Pacific people seen by Specialist DHB & NGO Mental Health services in 3 DHBs 2018/19 Capital & Hutt Wairarapa Coast Valley 0-19 years 266 101 9 20-64 years 526 307 33
65+ years 19 11 3 Total 811 419 45 % of DHB Pacific 3.6% 3.5% 4.8% population
Most of the Pacific people seen in the 3 years 2016/17 to 2018/19 by Specialist Mental Health and Addiction services were Samoan or Cook Island Maori.
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In 2018/19, most Pacific people were new having only been seen in the last 12 months by Specialist Mental Health and Addiction services. Pacific people who were long-term users seen regularly for more than 2 years made up 16% of Pacific service users in Hutt Valley and Capital & Coast, and 22% of Wairarapa Pacific service users.
Only a small number of service users were admitted to an acute Mental Health inpatient ward, 4% of Capital & Coast Pacific service users were admitted in 2018, 6% of Hutt Valley service users and 2% of Wairarapa. Pacific people had a higher rate of admission to an Inpatient ward than people of other ethnicities excluding Maori.
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Long term conditions – Cardiovascular disease For those enrolled with Compass Wairarapa PHO, 24 Pacific people or 3% of enrolled Pacific people had a diagnosed cardiovascular condition which is lower than proportion in the total PHO population with a diagnosed cardiovascular condition. Another 42 Pacific people have been assessed as having a high risk of cardiovascular disease.
For those enrolled with Te Awakairangi Health Network, 420 Pacific people or 4% of enrolled Pacific people had a diagnosed cardiovascular condition. Another 732 Pacific people have been assessed as having a high risk of cardiovascular disease or 7% of the enrolled Pacific population.
People diagnosed with Cardiovascular disease or assessed as high risk as at Sept 2019
Diagnosed % of High risk % of with CVD enrolled of CVD enrolled people people Compass Wairarapa Pacific 24 3% 42 4% Total 2,546 6% 2,324 5% Te Awakairangi Pacific 420 4% 732 7% Total 6,550 5% 6,563 5%
Long term conditions – Diabetes
As at June 2018/19, there were 2,254 Capital & Coast Pacific (10%) diagnosed with diabetes, 1,118 Hutt Pacific (9%) and 59 Wairarapa Pacific people (6%). For more than half of Wairarapa Pacific people with diabetes (58%) their condition was well managed with their HbA1c levels less than 65 mmol. For Capital & Coast Pacific, 49% had results indicating their condition was well managed and 44% of Hutt Pacific.
People with diabetes as at June 2018/19
Well managed condition: % of total enrolled population % HbA1c ≤ 64mmol Pacific
people with Other diabetes Pacific Total Pacific (non Maori non (PHO data) Pacific) Capital & Coast 2,254 10% 4% 49% 67% Hutt Valley 1,118 9% 5% 44% 63% Wairarapa 59 6% 5% 58% 68%
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CONFIDENTIAL
Complaints to HDC involving District Health Boards
Wairarapa DHB
Report and Analysis for period 1 January to 30 June 2019
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Contents
Commissioner’s Foreword ...... i National Data for all District Health Boards ...... 1 1.0 Number of complaints received ...... 1 1.1 Raw number of complaints received ...... 1 1.2 Rate of complaints received ...... 2 2.0 Service types complained about ...... 4 2.1 Service type category ...... 4 3.0 Issues complained about ...... 6 3.1 Primary complaint issues ...... 6 3.2 All complaint issues ...... 9 3.3 Service type and primary issues ...... 11 4.0 Complaints closed ...... 12 4.1 Number of complaints closed ...... 12 4.2 Outcomes of complaints closed ...... 12 4.3 Recommendations made to DHBs following a complaint ...... 13 5.0 Learning from complaints — HDC case reports ...... 15 Data for Wairarapa District Health Board ...... 21 6.0 Complaints received about Wairarapa DHB ...... 21 6.1 Rate of complaints received ...... 21 7.0 Service types complained about at Wairarapa DHB...... 23 7.1 Service type ...... 23 7.2 Facility and service type complained about ...... 23 8.0 Issues complained about for Wairarapa DHB ...... 24 8.1 Primary issues ...... 24 8.2 Service type and primary issues ...... 24 9.0 Closed complaints about Wairarapa DHB ...... 25 9.1 Number of complaints closed ...... 25 9.2 Outcomes of complaints closed ...... 25
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Commissioner’s Foreword
I am pleased to present you with HDC’s second six monthly DHB complaint report for the 2018/2019 year. This report details the trends in complaints received by HDC about DHBs between 1 January and 30 June 2019.
HDC received 427 complaints about DHB services between January and June 2019. This is a small decrease on the average number of 452 complaints. The trends in complaints remain similar to what has been seen in previous six-month periods, with surgery being the most common service type complained about and misdiagnosis being the most common primary issue.
However, I note that there has been a slight increase in the number of complaints received by HDC about mental health services in the 2018/19 year. Complaints about these services increased from 20% of complaints in previous years to 23% in 2018/19. There are a number of factors that could be contributing to this small increase. These include a mental health workforce under significant pressure, and greater public awareness of mental health and addiction issues and service challenges — with significant attention generated by the Government’s Inquiry into Mental Health and Addiction.
There are a number of common issues identified by my Office on assessment of complaints about mental health and addiction services, including:
Inadequate risk assessments. Inadequate discharge planning, including inadequate coordination between inpatient and community teams, inadequate follow-up and failure to adequately include the consumer and their family in discharge planning. Inadequate coordination of care between mental health and physical health services. Inadequate communication with family/whānau, particularly in regards to discharge planning and obtaining information from family in order to adequately complete risk assessments. Issues with management/treatment of co-existing disorders e.g. mental illness and addiction issues. Issues around the treatment of personality disorders and lack of psychologist input. Provision of emergency mental health care, including delays in crisis teams attending, the interface between mental health services and the emergency department and training provided to ED staff in regards to triage and treatment of mental health consumers.
Issues regarding medication management by mental health care services for older persons, including a lack of communication with the consumer’s Enduring Power of Attorney around such management.
A number of these issues reflect a lack of integrated, coordinated care – between community and inpatient teams, between mental health and addiction teams, between mental health and physical health services and between mental health and ED services. New Zealand’s current mental health care model means that transitioning in and out of different mental health and addiction services is part of a consumer’s journey. Additionally, many people with mental illness and/or addiction also have co-existing physical illnesses and multiple conditions, including co-existing substance use and mental health conditions. It is incumbent on mental health services to ensure they have robust systems in place to manage such complexity and ensure continuity of care and timely follow-up between themselves and the other providers involved in a consumer’s journey.
Anthony Hill Health and Disability Commissioner
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National Data for all District Health Boards
1.0 Number of complaints received 1.1 Raw number of complaints received In the period Jan–Jun 2019, HDC received a total of 4271 complaints about care provided by District Health Boards. Numbers of complaints received in previous six-month periods are reported in Table 1.
Table 1. Number of complaints received in the last five years
Jul– Jan– Jul– Jan– Jul– Jan– Jul– Jan– Jul– Average Jan–
Dec Jun Dec Jun Dec Jun Dec Jun Dec of last 4 Jun
14 15 15 16 16 17 17 18 18 6-month 19 periods Number of 368 389 422 383 386 477 439 450 442 452 427 complaints
The total number of complaints received in Jan–Jun 2019 (427) shows a 6% decrease over the average number of complaints received in the previous four periods.
The number of complaints received in Jan–Jun 2019 and previous six-month periods are also displayed below in Figure 1.
Figure 1. Number of complaints received
600
500
400
300
200
100
0 Jul–Dec Jan–Jun Jul–Dec Jan–Jun Jul–Dec Jan–Jun Jul–Dec Jan–Jun Jul–Dec Jan–Jun 14 15 15 16 16 17 17 18 18 19
1 Provisional as of date of extraction (22 August 2019). 1
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1.2 Rate of complaints received When numbers of complaints to HDC are expressed as a rate per 100,000 discharges, comparisons can be made between DHBs and within DHBs over time, enabling any trends to be observed.
Rate of complaints calculations are made using discharge data provided by the Ministry of Health. This data is provisional as at the date of extraction (6 September 2019) and is likely incomplete; it will be updated in the next six-monthly report. It should be noted that this discharge data excludes short- stay emergency department discharges and patients attending outpatient clinics.
Table 2. Rate of complaints received per 100,000 discharges during Jan–Jun 2019
Number of Total number of Rate per complaints discharges 100,000 received discharges
427 485,091 88.02
Table 3 shows the rate of complaints received by HDC per 100,000 discharges, for Jan–Jun 2019 and previous six-month periods.
Table 3. Rate of complaints received in the last five years
Jul– Jan– Jul– Jan– Jul– Jan– Jul– Jan– Jul– Average Jan–
Dec Jun Dec Jun Dec Jun Dec Jun Dec of last 4 Jun
14 15 15 16 16 17 17 18 182 6-month 19 periods Rate per 100,000 76.65 84.60 87.57 81.44 78.79 99.08 88.23 93.80 88.47 92.40 88.02 discharges
The rate of complaints received during Jan–Jun 2019 (88.02) shows a 5% decrease on the average rate of complaints received for the previous four periods, and is very similar to the rate of complaints received in the previous period.
Table 4 shows the number and rate of complaints received by HDC for each DHB.3
2 The rate for Jul–Dec 2018 has been recalculated based on the most recent discharge data. 3 Please note that some complaints will involve more than one DHB, and therefore the total number of complaints received for each DHB will be larger than the number of complaints received about care provided by DHBs.
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Table 4. Number and rate of complaints received for each DHB in Jan–Jun 2019 DHB Number of complaints Number of discharges Rate of complaints to received HDC per 100,000 discharges Auckland 59 61,806 95.46 Bay of Plenty 20 26,136 76.52 Canterbury 40 58,032 68.93 Capital and Coast 45 29,089 154.70 Counties Manukau 39 50,029 77.95 Hawke’s Bay 12 18,111 66.26 Hutt Valley 22 16,448 133.75 Lakes 9 11,512 78.18 MidCentral 23 15,086 152.46 Nelson Marlborough 16 12,514 127.86 Northland 10 20,108 49.73 South Canterbury 6 6,046 99.24 Southern 34 27,173 125.12 Tairāwhiti 3 5,297 56.64 Taranaki 10 13,163 75.97 Waikato 39 48,509 80.40 Wairarapa 4 4,100 97.56 Waitemata 36 52,355 68.76 West Coast 5 3,188 156.84 Whanganui 10 6,389 156.52
Notes on DHB’s number and rate of complaints It should be noted that a DHB’s number and rate of complaints can vary considerably from one six- month period to the next. Therefore, care should be taken before drawing conclusions on the basis of one six-month period. For smaller DHBs, a very small absolute increase or decrease in the number of complaints received can dramatically affect the rate of complaints. Accordingly, much of the value in this data lies in how it changes over time, as such analysis allows trends to emerge that may point to areas that require further attention.
It is also important to note that numbers of complaints received by HDC is not always a good proxy for quality of care provided, and may instead, for example, be an indicator of the effectiveness of a DHB’s complaints system or features of the services provided by a particular DHB. Additionally, complaints received within a single six-month period will sometimes relate to care provided within quite a different time period. From time to time, some DHBs may also be the subject of a number of complaints from a single complainant within one reporting period. This is important context that is taken into account by DHBs when considering their own complaint patterns.
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2.0 Service types complained about 2.1 Service type category Complaints to HDC are shown by service type in Table 5. Please note that some complaints involve more than one DHB and/or more than one hospital; therefore, although there were 427 complaints about DHBs, 452 services were complained about.
Surgical services (31.4%) received the greatest number of complaints in Jan–Jun 2019, with general surgery (8.0%), gynaecology (6.2%) and orthopaedics (5.8%) being the surgical specialties most commonly complained about. This is consistent with what has been seen in previous periods for surgical services, with the exception of gynaecology services which increased from being responsible for 3.2% of DHB services complained about in Jul–Dec 2018 to 6.2% of services in Jan–Jun 2019.
Other commonly complained about services included mental health (21.9%), medicine (17.7%) and emergency department (11.5%) services. This is broadly similar to what has been seen in previous periods.
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Table 5. Service types complained about
Service type Number of complaints Percentage Aged care 2 0.4% Alcohol and drug 4 0.9% Anaesthetics/pain medicine 3 0.7% Dental 7 1.5% Diagnostics 7 1.5% Disability services 4 0.9% District nursing 2 0.4% Emergency department 52 11.5% Intensive care/critical care 3 0.7% Maternity 28 6.2% Medicine 80 17.7% General medicine 15 3.3% Cardiology 16 3.5% Gastroenterology 10 2.2% Geriatric medicine 8 1.8% Haematology 3 0.7% Neurology 8 1.8% Oncology 9 2.0% Palliative care 2 0.4% Renal/nephrology 3 0.7% Respiratory 3 0.7% Other/unspecified 3 0.7% Mental health 99 21.9% Paediatrics (not surgical) 11 2.4% Rehabilitation services 4 0.9% Surgery 142 31.4% Cardiothoracic 7 1.5% General 36 8.0% Gynaecology 28 6.2% Neurosurgery 2 0.4% Ophthalmology 9 2.0% Orthopaedics 26 5.8% Otolaryngology 7 1.5% Paediatric 1 0.2% Plastic and Reconstructive 12 2.7% Urology 11 2.4% Vascular 3 0.7% Other/unknown health service 4 0.9% TOTAL 452
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3.0 Issues complained about 3.1 Primary complaint issues For each complaint received by HDC, one primary complaint issue is identified. The primary issues identified in complaints received in Jan–Jun 2019 are listed in Table 6. It should be noted that the issues included are as articulated by the complainant to HDC. While not all issues raised in complaints are subsequently factually and/or clinically substantiated, those issues provide a valuable insight into the consumer’s experience of the services provided and the issues they care about most.
Table 6. Primary issues complained about
Primary issue in complaints Number of Percentage complaints Access/Funding 78 18.3% Lack of access to services 27 6.3% Lack of access to subsidies/funding 2 0.5% Waiting list/prioritisation issue 49 11.5% Boundary violation 3 0.7% Care/Treatment 210 49.2% Delay in treatment 8 1.9% Inadequate coordination of care/treatment 5 1.2% Inadequate/inappropriate clinical treatment 30 7.0% Inadequate/inappropriate examination/assessment 13 3.0% Inadequate/inappropriate follow-up 8 1.9% Inadequate/inappropriate monitoring 4 0.9% Inadequate/inappropriate non-clinical care 10 2.3% Inadequate/inappropriate testing 1 0.2% Inappropriate/delayed discharge/transfer 11 2.6% Inappropriate withdrawal of treatment 1 0.2% Missed/incorrect/delayed diagnosis 68 15.9% Refusal to assist/attend 3 0.7% Refusal to treat 5 1.2% Rough/painful care or treatment 4 0.9% Unexpected treatment outcome 39 9.1% Communication 37 8.7% Disrespectful manner/attitude 17 4.0% Failure to communicate openly/honestly/effectively with 14 3.3% consumer Failure to communicate openly/honestly/effectively with 6 1.4% family Complaints process 3 0.7% Inadequate response to complaint 3 0.7% Consent/Information 38 8.9% Consent not obtained/adequate 12 2.8% Inadequate information provided regarding condition 3 0.7% Inadequate information provided regarding options 2 0.5% Inadequate information provided regarding results 2 0.5% Inadequate information provided regarding treatment 1 0.2% Incorrect/misleading information provided 1 0.2% Issues with involuntary admission/treatment 17 4.0% Documentation 5 1.2% Delay/failure to disclose documentation 2 0.5%
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Primary issue in complaints Number of Percentage complaints Inadequate/inaccurate documentation 2 0.5% Inappropriate maintenance/disposal of documentation 1 0.2% Facility issues 14 3.3% General safety issue for consumer in facility 7 1.6% Inadequate/inappropriate policies/procedures 4 0.9% Issue with sharing facility with other consumers 1 0.2% Waiting times 2 0.5% Medication 18 4.2% Administration error 2 0.5% Inappropriate administration 1 0.2% Inappropriate prescribing 10 2.3% Refusal to prescribe/dispense/supply 5 1.2% Reports/certificates 6 1.4% Inaccurate report/certificate 6 1.4% Other professional conduct issues 12 2.8% Disrespectful behaviour 5 1.2% Inappropriate collection/use/disclosure of information 5 1.2% Other 2 0.5% Disability-related issues 1 0.2% Other issues 2 0.5% TOTAL 427
The most common primary issue categories were:
Care/treatment (49.2%) Access/funding (18.3%) Consent/information (8.9%) Communication (8.7%)
The most common specific primary issues complained about in complaints about DHBs were:
Missed/incorrect/delayed diagnosis (15.9%) Waiting list/prioritisation issue (11.5%) Unexpected treatment outcome (9.1%) Inadequate/inappropriate treatment (7.0%) Lack of access to services (6.3%)
Table 7 shows a comparison over time for the top five primary issues complained about. These have remained broadly consistent.
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Table 7. Top five primary issues in complaints received over the last four six-month periods
Top five primary issues in all complaints (%) Jul–Dec 17 Jan–Jun 18 Jul–Dec 18 Jan–Jun 19 n=439 n=450 n=442 n=427 Misdiagnosis 12% Misdiagnosis 13% Misdiagnosis 14% Misdiagnosis 16% Unexpected Waiting list/ Lack of access to Waiting list/ 10% treatment 12% 9% 12% prioritisation services prioritisation outcome Unexpected Unexpected Unexpected Waiting list/ treatment 8% 11% treatment 9% treatment 9% prioritisation outcome outcome outcome Inadequate Lack of access to Waiting list/ Inadequate 7% 6% 7% 7% treatment services Prioritisation treatment Lack of access to Inadequate Inadequate Lack of access to 6% 4% 6% 6% services treatment treatment services
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3.2 All complaint issues As well as the primary complaint issue, up to six additional other complaint issues are identified for each complaint received by HDC. Table 8 includes these additional complaint issues, as well as the primary complaint issues, to show all issues identified in complaints received.
Table 8. All issues identified in complaints
All issues in complaints Number of Percentage complaints Access/Funding 108 25.3% Lack of access to services 43 10.1% Lack of access to subsidies/funding 4 0.9% Waiting list/prioritisation issue 63 14.8% Boundary violation 3 0.7% Care/Treatment 330 77.3% Delay in treatment 70 16.4% Delayed/inadequate/inappropriate referral 8 1.9% Inadequate coordination of care/treatment 62 14.5% Inadequate/inappropriate clinical treatment 147 34.4% Inadequate/inappropriate examination/assessment 113 26.5% Inadequate/inappropriate follow-up 52 12.2% Inadequate/inappropriate monitoring 35 8.2% Inadequate/inappropriate non-clinical care 37 8.7% Inadequate/inappropriate testing 60 14.1% Inappropriate admission/failure to admit 7 1.6% Inappropriate/delayed discharge/transfer 43 10.1% Inappropriate withdrawal of treatment 5 1.2% Missed/incorrect/delayed diagnosis 94 22.0% Personal privacy not respected 1 0.2% Refusal to assist/attend 11 2.6% Refusal to treat 8 1.9% Rough/painful care or treatment 25 5.9% Unexpected treatment outcome 63 14.8% Unnecessary treatment/over-servicing 4 0.9% Communication 288 67.4% Disrespectful manner/attitude 67 15.7% Failure to accommodate cultural/language needs 2 0.5% Failure to communicate openly/honestly/effectively with 167 39.1% consumer Failure to communicate openly/honestly/effectively with 89 20.8% family Insensitive/inappropriate comments 8 1.9% Complaints process 45 10.5% Inadequate response to complaint 42 9.8% Retaliation/discrimination as a result of a complaint 3 0.7% Consent/Information 90 21.1% Consent not obtained/adequate 19 4.4% Inadequate information provided regarding adverse event 10 2.3% Inadequate information provided regarding condition 16 3.7% Inadequate information provided regarding options 13 3.0% Inadequate information provided regarding provider 3 0.7%
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All issues in complaints Number of Percentage complaints Inadequate information provided regarding results 10 2.3% Inadequate information provided regarding treatment 17 4.0% Incorrect/misleading information provided 10 2.3% Issues with involuntary admission/treatment 18 4.2% Documentation 22 5.2% Delay/failure to disclose documentation 7 1.6% Delay/failure to transfer documentation 1 0.2% Inadequate/inaccurate documentation 12 2.8% Inappropriate maintenance/disposal of documentation 1 0.2% Intentionally misleading/altered documentation 3 0.7% Facility issues 61 14.3% Accreditation standards/statutory obligations not met 2 0.5% Cleanliness/hygiene issue 4 0.9% Failure to follow policies/procedures 8 1.9% General safety issue for consumer in facility 10 2.3% Inadequate/inappropriate policies/procedures 19 4.4% Issue with sharing facility with other consumers 5 1.2% Issue with quality of aids/equipment 6 1.4% Staffing/rostering/other HR issues 7 1.6% Waiting times 7 1.6% Other 1 0.2% Medication 41 9.6% Administration error 2 0.5% Inappropriate administration 8 1.9% Inappropriate prescribing 25 5.9% Refusal to prescribe/dispense/supply 8 1.9% Reports/certificates 16 3.7% Inaccurate report/certificate 15 3.5% Refusal to complete report/certificate 1 0.2% Teamwork/supervision 7 1.6% Delayed/inadequate/inappropriate handover 4 0.9% Inadequate supervision/oversight 3 0.7% Other professional conduct issues 34 8.0% Disrespectful behaviour 15 3.5% Inappropriate collection/use/disclosure of information 16 3.7% Other 6 1.4% Disability-related issues 2 Other issues 9
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On analysis of all issues identified in complaints about DHBs, the most common complaint issue categories were:
Care/treatment (present for 77.3% of all complaints) Communication (present for 67.4% of all complaints) Access/funding (present for 25.3% of all complaints) Consent/information (present for 21.1% of all complaints).
The most common specific issues were:
Failure to communicate effectively with consumer (39.1%) Inadequate/inappropriate clinical treatment (34.4%) Inadequate/inappropriate examination/assessment (26.5%) Missed/incorrect/delayed diagnosis (22.0%) Failure to communicate effectively with family (20.8%) Delay in treatment (16.4%) Disrespectful manner/attitude (15.7%) Inadequate coordination of care/treatment (14.5%) Unexpected treatment outcome (14.8%) Waiting list/prioritisation issue (14.8%)
These issues are broadly similar to what was seen in the last six-month period. There was a small increase in the proportion of complaints involving a ‘waiting list/prioritisation issue’ from around 10- 11% in previous periods to 15% in Jan–Jun 2019.
3.3 Service type and primary issues Table 9 shows the top three primary issues in complaints concerning the most commonly complained about service types. This is broadly similar to what was seen in the last six-month period.
Table 9. Three most common primary issues in complaints by service type Surgery Mental health Medicine Emergency department n=142 n=99 n=80 n=52 Issues with Unexpected Missed/ Missed/ involuntary treatment 23% 17% incorrect/ 21% incorrect/ 29% admission/ outcome delayed diagnosis delayed diagnosis treatment Waiting list/ Inadequate/ Waiting list/ Lack of access to prioritisation 21% 8% inappropriate 10% prioritisation 12% services issue treatment issue Inadequate/ Missed/ Waiting list/ 15% inappropriate 9% Delay in incorrect/ 8% prioritisation 10% examination/ treatment delayed diagnosis issue assessment
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4.0 Complaints closed 4.1 Number of complaints closed HDC closed 4444 complaints involving DHBs in the period Jan–Jun 2019. Table 10 shows the number of complaints closed in previous six-month periods.
Table 10. Number of complaints about DHBs closed in the last five years
Jul– Jan– Jul– Jan– Jul– Jan– Jul– Jan– Jul– Average Jan–
Dec Jun Dec Jun Dec Jun Dec Jun Dec of last 4 Jun
14 15 15 16 16 17 17 18 18 6-month 19 periods Number of complaints 344 410 365 482 316 465 383 476 449 443 444 closed
4.2 Outcomes of complaints closed Complaints that are within HDC’s jurisdiction are classified into two groups according to the manner of resolution — whether investigation or other resolution. Within each classification, there is a variety of possible outcomes. Notification of investigation generally indicates more serious issues.
In the Jan–Jun 2019 period, 5 DHBs had no investigations closed, 8 DHBs had one investigation closed, 3 DHBs had two investigations closed, 2 DHB had three investigations closed, 1 DHB had four investigations closed and 1 DHB had five investigations closed.
The manner of resolution and outcomes of all complaints about DHBs closed in Jan–Jun 2019 is shown in Table 11.
4 Note that complaints may be received in one six-month period and closed in another six-month period — therefore, the number of complaints received will not correlate with the number of complaints closed.
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Table 11. Outcome for DHBs of complaints closed by complaint type5
Outcome for DHBs Number of complaints closed
Investigation 28 Breach finding — referred to Director of 1 Proceedings Breach finding 18 No breach finding with adverse comment 7 and recommendations No breach finding 2 Other resolution following assessment 414 No further action6 with recommendations 70 or educational comment Referred to District Inspector 13 Referred to other agency 6 Referred to DHB7 105 Referred to the Advocacy Service 77 No further action 137 Withdrawn 6 Outside jurisdiction 2 TOTAL 444
4.3 Recommendations made to DHBs following a complaint Regardless of whether or not a complaint has been investigated, the Commissioner may make recommendations to a DHB. HDC then follows up with the DHB to ensure that these recommendations have been acted upon.
Table 12 shows the recommendations made to DHBs in complaints closed in Jan–Jun 2019. Please note that more than one recommendation may be made in relation to a single complaint.
5 Note that outcomes are displayed in descending order. If there is more than one outcome for a DHB upon resolution of a complaint, then only the outcome that is listed highest in the table is included. 6 The Commissioner has a wide discretion to take no further action on a complaint. For example, the Commissioner may take no further action because careful assessment indicates that a provider’s actions were reasonable in the circumstances, or that the matters that are the subject of the complaint have been, or are being, or will be, appropriately addressed by other means. This may happen, for example, where a DHB has carefully reviewed the case itself and no further value would be added by HDC investigating, or where another agency is reviewing, or has carefully reviewed the matter (for example, the Coroner, the Director-General of Health, or a District Inspector). Assessment of a complaint prior to a decision to take no further action will usually involve obtaining and reviewing a response from the provider, seeking clinical advice, and asking for input/information from the consumer or other people. 7 In line with their responsibilities under the Code, DHBs have developed systems to address complaints in a timely and appropriate way. It is often appropriate for HDC to refer a complaint to the DHB to resolve, with a requirement that the DHB report back to HDC on the outcome of its handling of the complaint.
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Table 12. Recommendations made to DHBs following a complaint Number of Recommendation recommendations made Apology 20 Audit 19 Meeting with consumer 6 Presentation/discussion of complaint 9 with others Provision of evidence of change to 35 HDC Reflection 5 Review/implementation of 34 policies/procedures Training/professional development 26 Total 154
The most common recommendation made to DHBs was that they provide evidence to HDC of the changes they had made in response to the issues raised by the complaint (35 recommendations). Often, when HDC asks for this evidence, it is also recommended that the provider conduct a review of the effectiveness of the changes made. Conducting a review of their policies/procedures or implementing new policies/procedures (34 recommendations) was also often recommended. 26 recommendations were made in relation to staff training – this was most often in regards to clinical issues identified in the case followed by training on documentation requirements.
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5.0 Learning from complaints — HDC case reports Cultural care plan and psychiatric review of at-risk patient (16HDC00195)
Background A Māori woman in her 40s had been a consumer of mental health services since the mid-1990s. She had been diagnosed with bipolar affective disorder. The woman had experienced several mental health admissions, including an admission under the Mental Health (Compulsory Assessment and Treatment) Act 1992 (the MHA).
The woman’s mother contacted the DHB’s mental health emergency team (MHET) about her concerns for her daughter’s mental health, and requested that her daughter be admitted under the MHA. A consultant psychiatrist undertook a psychiatric assessment of the woman, and concluded that hospital admission was not necessary and that she could be managed by the community mental health team. MHET made regular contact with the woman and her mother following this assessment.
The following month, the woman’s mother told MHET that her daughter had hunting knives in her possession, which the mother had confiscated. She also reported that her daughter’s highs and lows were more extreme. A short time later, the woman was taken into Police custody after harming a woman unknown to her.
Findings HDC’s clinical advisors were critical of a number of aspects of the woman’s care, including: The level of engagement with the woman lacked elementary factors of Māori communication and care. Additionally, the advisor noted that the lack of a cultural care plan was a departure from accepted standards of care in the Māori mental health context. No structured plan was put in place to address the difficulty in engaging with the woman. HDC’s clinical advisor noted that the difficulty in obtaining a thorough and complete team review of the woman pointed to a lack of structured ways to deal with complex cases. Reliance was placed on the woman’s mother to monitor and evaluate the woman and initiate the MHA if she felt it necessary, and little support was offered to her. There was a lack of a clear leader in the woman’s care planning. The specialist psychiatrist was especially absent from the planning overview. The woman’s clinical notes had no comprehensive longitudinal view. There was also no acknowledgement of the differences in assessment by different individuals and/or at different visits and no attempt to understand these differences.
The Mental Health Commissioner accepted that this was a complex case with several mitigating factors. Overall, however, he was of the view that the failings exhibited were systems issues for which the DHB was accountable.
The Mental Health Commissioner’s fundamental concern was the lack of an adequate care plan, contributed to by the lack of psychiatric review over a protracted time. HDC’s clinical advisor noted that the care offered “seemed to be of wait and see rather than a careful structured plan that sought to create engagement and the gathering of sufficient information to know the depth and severity of the illness effect”. This was further compounded by the lack of an adequate cultural care plan. The Mental Health Commissioner found that the DHB failed to provide the woman with services with reasonable care and skill, in breach of Right 4(1) of the Code.
The Mental Health Commissioner commented that “this decision highlights the importance of having a broader overall care plan for any consumer, which will require timely psychiatric oversight and should always take account of cultural needs.”
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Criticisms were also made of the psychiatrist for his inadequate documentation, and for failing to discuss the woman’s mental health with her mother at the time of the psychiatric assessment. Recommendations The Mental Health Commissioner recommended that the DHB assess how its cultural and clinical care can be best coordinated and integrated, in collaboration with local Māori communities, and with input from consumer and family/whānau advisors. He also recommended that the DHB provide a further update to HDC in relation to the changes made since this complaint, and in relation to the outstanding recommendations made following the DHB’s Serious Adverse Event Review.
Care of woman in labour with abnormal CTG (17HDC00384)
Background A woman pregnant with her second baby was admitted to a public hospital for a maternal and fetal check as her due date had passed. This included cardiotocography (CTG) monitoring (monitoring of the baby’s heart rate). The woman had delivered her first baby by emergency lower segment Caesarean section owing to a failed forceps delivery. The woman was hoping for a vaginal birth this time.
When the CTG was commenced, the woman’s lead maternity carer (LMC), a registered midwife, noted a variable fetal heart rate (FHR), no accelerations, and three late decelerations. She contacted the obstetrician who failed to recognise non-reassuring features of the CTG. The obstetrician reviewed the woman throughout the day. The obstetrician offered the woman a Caesarean section, which he recommended, or an induction of labour. The obstetrician accepts that he did not advise the woman that, in the circumstances of the abnormal CTG, a Caesarean section was the only appropriate course of action. He stated that he needed to consider the woman’s “very strong preference”.
CTG monitoring continued into the evening, and the obstetrician reviewed the woman one more time. Despite the fetal heart rate showing decelerations, the obstetrician carried out a Cook’s catheter induction of labour. His plan was to stop CTG monitoring to allow the woman to mobilise, and for another CTG to be commenced at 10pm. The obstetrician went home after this, and said he asked to be called back at 10pm. This was not documented and he was not called. At handover, all four hospital-employed midwives working on the shift viewed the CTG and made a decision to discontinue the trace despite ongoing late decelerations. The decision was made because the CTG had not deteriorated and was no different from previous CTGs reviewed by the obstetrician.
In the early hours of the next morning, the core midwife recommenced CTG monitoring and documented that it was non-reassuring. After turning the woman on her left side to try and improve the CTG, the obstetrician was called in to review her. He arrived at 4am, and at 4.40am documented that there had been a prolonged period of reduced variability and that he had ruptured the woman’s membranes and found meconium-stained liquor present. The obstetrician noted his plan to continue the CTG monitoring and to review the trace again in 15 to 30 minutes.
At 5.20am, the obstetrician decided to proceed to an emergency Caesarean section. The baby was delivered at 6.44am in poor condition, with no heartbeat and no respiratory effort, and immediate resuscitation was carried out. Later the baby was diagnosed with multiple co-morbidities and hypoxic ischaemic encephalopathy, and passed away.
Findings The Deputy Commissioner found that the obstetrician failed to provide services to the woman with reasonable care and skill by incorrectly interpreting the CTG when the woman was admitted, not recommending a Caesarean section as the only appropriate course of action and by proceeding with
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the induction of labour in the presence of an abnormal antenatal CTG, in breach of Right 4(1) of the Code
The Deputy Commissioner found the woman’s care by the DHB concerning for a number of reasons. Over an extended period of time, four midwives failed to comply with RANZCOG guidelines, which had been adopted as policy by the DHB, in regards to CTG monitoring. Further, although the DHB advised that it had a CTG interpretation sticker in use, there is no evidence in the clinical notes that this was used by staff. Additionally, at no time during the women’s admission did midwifery staff think critically about the woman’s CTG, challenge the obstetrician’s management plan or advocate for the woman. The DHB should have in place a system that ensures that staff are aware of and comply with its policies and procedures, and a culture that supports staff to voice concerns and ask questions.
The Deputy Commissioner was also critical of the staffing levels in the maternity unit at the time of these events. The obstetrician commented that the unit had a small number of obstetricians that had to provide 24-hour cover without support of middle-grade doctors or shift arrangements. He noted that obstetricians may sometimes be required to work excessive hours without collegial support. It is clear that the obstetrician would have benefited from greater collegial support and less onerous working hours. The DHB’s workload measurement tool also indicated that the afternoon and night shift staff could have benefited from additional midwifery support. Additionally, in the evening, the obstetrician went home to sleep, and therefore, at handover, midwifery access to an obstetrician was limited. The Deputy Commissioner noted that as an employer, the DHB had a responsibility to ensure that obstetric and midwifery staff were supported appropriately to manage their workload.
The Deputy Commissioner concluded that the DHB failed to provide services to the woman with reasonable care and skill in breach of Right 4(1) of the Code.
The Deputy Commissioner commented: “This case highlights the importance of regular fetal surveillance updating for all staff and, in particular, that senior medical officers are encouraged and supported to self-reflect on whether or not they are fully up to date with all aspects of their core competencies.”
Recommendations The Deputy Commissioner recommended that the DHB: Update HDC on the progress made in relation to increasing the number of employed obstetricians based at the hospital from three to four Consider developing local policies around intrapartum fetal surveillance in accordance with RANZCOG guidelines Consider implementing an updated CTG interpretation sticker and providing training on the use of that sticker Consider introducing mandatory fetal surveillance updating for all staff who work in maternity services Use this investigation (anonymously) as a case study to provide training for obstetric and midwifery staff. The training should include discussion on the importance of speaking up when staff are concerned about a clinical situation or plan of care.
Multiple presentations to ED before stroke diagnosis (17HDC00725)
Background A woman was seen by her GP due to worsening neck pain, a pulsing noise in her head, and a persistent headache. Her GP referred her to the Emergency Department (ED) at a public hospital for further investigation. Over the next three days, the woman presented to the ED four times.
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At the first visit, the woman was reviewed and discharged with treatment for an ear infection, neck pain, and a migraine.
The woman developed vertigo and vomiting, and presented to the ED for a second time. She was reviewed and her care was discussed with the ED consultants. She was referred to the Ear, Nose and Throat (ENT) service for investigation, in accordance with protocols for patients who present with vertigo. She was reviewed by two junior ENT doctors and diagnosed with otitis media with labyrinthitis (a viral infection that affects the inner ear) and migraine. No consultant review or CT scan was arranged, and she was discharged home.
At the third visit, an ED doctor discussed a CT scan with the admitting ENT registrar. The woman was referred to the ENT service for investigation, and seen by the ENT doctor who had examined her previously. Again, she was discharged with a diagnosis of vertigo caused by a middle ear infection. No CT scan was performed, and her presentation was not discussed with a consultant.
That evening the woman returned to the ED and was reviewed by a senior medical officer who ordered a CT scan. The scan revealed a vertebral artery dissection and acute and subacute bilateral cerebellar infarcts (two strokes).
Findings The Commissioner accepted his clinical advisor’s advice and was satisfied that, overall, the standard of care provided by the ED was appropriate in the circumstances, noting that the woman’s diagnosis was rare. Nonetheless he was thoughtful that when no firm diagnosis was made over several presentations with concerning symptoms that were not resolving, further critical thinking and diagnostic enquiry was not undertaken more actively.
The Commissioner found that the ENT care provided by the DHB was sub-optimal in several respects, including: The failure to offer the woman a CT scan of her head during her first and second ENT review; The failure by the junior doctor to discuss the woman’s presentation with a consultant; and Inadequate communication which resulted in the ED doctor’s recommendations for a CT scan not being adequately communicated to the ENT registrar.
The Commissioner was concerned that the ENT doctors failed to show critical thinking and make the necessary active diagnostic enquiries, despite the fact the woman was re-presenting with concerning unresolved symptoms. The Commissioner noted that this case demonstrates the significance of the patient’s voice and the importance of listening to the patient’s experience. The woman said that she told a doctor that her symptoms were not consistent with migraines she had experienced previously, and that she felt “unheard and brushed off”. There was an opportunity to incorporate the woman’s concerns into the analysis of her presentation, and he was critical that this did not occur.
Overall, the Commissioner was critical of the care provided by the ENT service at the DHB, and considered that this contributed to the delayed diagnosis of the woman’s condition. In his view, these failings demonstrated a pattern of poor care by the DHB, in breach of Right 4(1) of the Code.
Recommendations The Commissioner recommended that the DHB report back to HDC confirming the procedures in place at the DHB to oversee and support junior registrars who are failing to satisfy the requirements of their clinical placements. He also recommended that the DHB use his report as a basis for training staff in the ED and ENT departments, and audit its compliance with the ENT guidelines to ensure that the escalation process is followed in situations where a consultant review is indicated.
The Commissioner asked the DHB to consider developing ED guidelines for situations when a junior doctor in the ED has a different diagnosis from the referring GP, and guidance for staff for situations
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where a patient with no definitive diagnosis re-presents to ED with concerning symptoms that have not resolved.
Coordination of care for toddler with suspected non-accidental injury (16HDC00134)
Background A sixteen-month-old boy and his mother presented to the ED of a public hospital. The boy had not been weight-bearing on his left leg for approximately 36 hours. He was assessed by a number of ED staff, and an X-ray of his left leg was taken. No fracture was identified on the imaging, and the boy was transferred to the paediatric department, where further assessments were carried out and the X-ray re-reviewed. Again, no fracture was seen, and the boy was discharged home with analgesia and advice to return immediately if he deteriorated. There is no record in the clinical notes that non- accidental injury was considered specifically, but it was noted that the cause of injury was unknown. The paediatric consultant on this shift acknowledged that the clinical documentation for the presentation was incomplete, and attributed this to considerable pressure on the ward, with days being long and busy.
The boy and his mother re-presented to the paediatric department. In the context of a busy clinic, the paediatric consultant on this shift carried out a concise and focused assessment of the boy’s left foot, and an X-ray of the foot was taken. No abnormalities were identified. The boy’s presenting issue was documented as a deep soft tissue injury, and although the paediatric consultant considered inflicted injury, he acknowledged that this was not captured in the documentation. The boy was discharged home for monitoring and follow-up review in the paediatric ward if symptoms persisted.
Two days later the boy and his mother presented to the paediatric ward, and the boy was reviewed by a senior house officer. The paediatric consultant on this shift requested that the boy remain on the ward, and an orthopaedic opinion be sought. An orthopaedic registrar attended and recommended an MRI scan. The paediatric consultant advised that he attended the ward later that day with the intention of carrying out a child protection assessment. However, when he arrived on the ward, he was advised that the boy had gone home. An MRI scan was scheduled.
When the boy presented to the orthopaedic ward to undergo the MRI under general anaesthesia, a pre-anaesthetic checklist noted that he had a broken tooth. A Paediatric Nursing Assessment Form documented faded bruises on his right forehead and cheek, a missing tooth, and two black fingernails on the right hand. According to the nurses who assessed the boy, these findings were passed on to the house officer on duty. Following the MRI, a bone scan was recommended. However, because of the difficulty in arranging this, the boy was transferred to another hospital.
The paediatric team at the second hospital reviewed the boy, and a repeat X-ray of his left leg confirmed a diagnosis of a tibial spiral fracture. Additional injuries were also documented, including two black fingernails, two damaged fingernails, a missing left bottom incisor, bruises around the hips and chest, and a light pink discolouration over the right lower quadrant of the abdomen. Given this, an Unexplained Injury Process was initiated. A Report of Concern was sent to Oranga Tamariki, and a referral made to the Child Protection Team. A skeletal survey was also planned.
The boy was flown back to the first hospital for the skeletal survey and, following this, was discharged. The paediatric consultant on call for this shift advised that the boy was discharged without her knowledge. In addition, although the findings of the skeletal survey were discussed and forwarded on to Oranga Tamariki on the day it was carried out, it was not formally reported on until much later.
The boy sustained further injuries following discharge, and was found deceased.
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Findings The Commissioner noted that the boy’s care demonstrates the challenges clinicians face when diagnosing non-accidental injuries. However, he considered these challenges could have been addressed by more rigorous analysis. The Commissioner commented that “in my view, the system that was meant to wrap around this boy had the information it needed to diagnose his fracture and non-accidental injuries earlier. However, a series of failings in assessment, communication, documentation, and coordination of care, and a failure to adhere to policies and procedures prevented this from occurring.”
The Commissioner found the DHB in breach of Right 4(1) of the Code for failing to provide services to the boy with reasonable care and skill for the following reasons:
The diagnosis of non-accidental injury was not considered adequately across multiple presentations to hospital, resulting in a delayed diagnosis. This was reflected in poor documentation of social history, cause of injury, and family violence screening.
The important policies and procedures around family violence screening and non-accidental injury were not followed by numerous staff. Moreover, the DHB did not have robust systems in place to ensure that the policies could be followed.
The Commissioner found the DHB in breach of Right 4(5) for failing to ensure quality and continuity of services for the following reasons:
The inadequate documentation led to an incomplete clinical picture being passed on from team to team, and this contributed to a delay in the boy’s diagnosis.
The boy’s journey through the Paediatric, Orthopaedic, and Radiology teams was inadequate, and included two inappropriate discharges from hospital and delayed reporting of his skeletal survey.
The Commissioner referred the DHB to the Director of Proceedings who decided to institute a proceeding in the Human Rights Review Tribunal.
Recommendations The Commissioner made a number of recommendations to the DHB, including that it: Advise HDC on the outcome of its review of medical staffing levels and rostering practices in the Paediatric and Radiology departments, and whether any improvements had occurred with respect to this. Carry out an audit on the standard of documentation of 50 child presentations to the hospital — in particular, the completion of family violence screening and social history. Additionally, carry out an audit on the reporting timeframes of paediatric skeletal surveys. Where the results of either of these audits do not reflect 100% compliance, the DHB should consider and advise HDC on what further improvements could be made to ensure compliance. Report back to HDC on the protocol being developed around hi-tech imaging requests for children under the age of 12 years. For the purpose of shared learning, disseminate the anonymised version of this report to clinical teams across all hospitals within the DHB, as well as on a national level at relevant meetings.
The Commissioner also recommended that the DHB continue to follow up with Oranga Tamariki and the New Zealand Police regarding a multi-agency meeting to discuss the findings from the DHB’s serious adverse event report and the Commissioner’s investigation report.
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Data for Wairarapa District Health Board
Please note that data reported captures only those complaints in which the DHB was identified as a provider by the complainant or was subsequently identified by HDC as a party. Where a complaint is made about an individual practitioner at a DHB and the DHB is not identified, the complaint may not be included in these reports.
6.0 Complaints received about Wairarapa DHB In the period Jan–Jun 2019, HDC received a total of 48 complaints about care provided by Wairarapa District Health Board.
6.1 Rate of complaints received Table 13 shows the rate of complaints to HDC per total discharges from Wairarapa DHB (4,100) compared to the rate of complaints per total discharges nationally (485,091).
The number of total discharges excludes short-stay discharges from emergency departments, and patients attending outpatient units and clinics.
Table 13. Number and rate of complaints per total discharges National Wairarapa DHB (All DHBs) Number of Number of Rate per Rate per complaints discharges 100,000 100,000 discharges discharges 4 4100 97.56 88.02
When DHBs are ranked according to their rate of complaints, Wairarapa DHB was DHB 12. Wairarapa DHB was DHB 20 in the previous six month period. As can be seen from the above table, Wairarapa DHB’s complaint rate for Jan–Jun 2019 was higher than that of the national complaint rate for the same period.
Table 14 shows the number and rate of complaints about Wairarapa DHB received by HDC per 100,000 discharges for Jan–Jun 2019 and previous six-month periods.
Table 14. Number and rate of complaints received in last five years
Jan– Jan– Jul– Jan– Jul– Jan– Jul– Jan– Jul– Average Jan– Jun Jun Dec Jun Dec Jun Dec Jun Dec of last 4 Jun 14 15 15 16 16 17 17 18 189 Periods 19 Complaints received 3 7 5 6 5 3 7 14 9 8 4
Rate per 100,000 78.60 194.97 133.05 173.01 123.58 71.07 147.84 320.07 202.93 185.48 97.56 discharges
8 Provisional as of date of extraction (22 August 2019). 9 The rate for Jul–Dec 2018 has been recalculated based on the most recent discharge data.
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The rate for Jan–Jun 2019 (97.56) showed a decrease of 47% over the average rate of complaints received for the previous four periods.
Figure 2 shows the rate of complaints received about Wairarapa DHB for Jan–Jun 2019 and previous six month periods.
Figure 2. Rate of complaints received per 100,000 discharges in last five years
350
300
250
200
150
100
50
0 Jul–Dec Jan–Jun Jul–Dec Jan–Jun Jul–Dec Jan–Jun Jul–Dec Jan–Jun Jul–Dec Jan–Jun 14 15 15 16 16 17 17 18 18 19
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7.0 Service types complained about at Wairarapa DHB 7.1 Service type For the complaints received, the services concerned, and the numbers of complaints about these services, are shown in Table 15.
Table 15. Service types complained about
Service type Number of Percentage complaints Disability services 1 25.0% Medicine – Palliative care 1 25.0% Paediatrics (not surgical) 1 25.0% Surgery – General 1 25.0% TOTAL 4
7.2 Facility and service type complained about All services complained about at Wairarapa DHB in Jan–Jun 2019 were located at Masterton Hospital.
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8.0 Issues complained about for Wairarapa DHB 8.1 Primary issues For each complaint received by HDC, one primary complaint issue is identified. The primary issues identified in complaints received about Wairarapa DHB are listed in Table 16.
Table 16. Primary issues complained about
Primary Issue Number of Percentage complaints Access/funding 1 25.0% Lack of access to subsidies/funding 1 25.0% Care/treatment 2 50.0% Inadequate/inappropriate follow-up 1 25.0% Missed/incorrect/delayed diagnosis 1 25.0% Consent/information 1 25.0% Consent not obtained/adequate 1 25.0% TOTAL 4
8.2 Service type and primary issues The primary issues complained about in relation to each service are set out in Table 17.
Table 17. Primary issues complained about by service type
Service type Number of Primary issues identified in each complaint complaints Disability services 1 Lack of access to subsidies/funding Medicine – Palliative care 1 Inadequate/inappropriate follow-up Paediatrics 1 Consent not obtained/adequate Surgery – General 1 Missed/incorrect/delayed diagnosis
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9.0 Closed complaints about Wairarapa DHB 9.1 Number of complaints closed HDC closed 7 complaints about Wairarapa DHB in Jan–Jun 2019. HDC closed 1 complaint about Wairarapa DHB following investigation in this period.
Table 18 shows the total number of complaints closed and complaints closed following investigation for Jan–Jun 2019 and previous six month periods.
Table 18. Total number of complaints and formal investigations closed in last five years
Wairarapa DHB All DHBs Jul– Jan– Jul– Jan– Jul– Jan– Jul– Jan– Jul– Average of last 4 Jan– Jan– Dec Jun Dec Jun Dec Jun Dec Jun Dec 6-month periods Jun Jun 14 15 15 16 16 17 17 18 18 19 19 Total 3 6 6 10 3 4 3 12 10 7 7 444 complaints closed Investigations 0 1 0 1 0 0 0 1 0 0 1 28 closed
9.2 Outcomes of complaints closed The outcomes of all complaints closed about Wairarapa DHB in Jan–Jun 2019 are shown in Table 19.
Table 19. Outcomes for Wairarapa DHB of complaints closed10
Outcome for Wairarapa DHB Number of complaints Investigation 1 Breach finding 1 Other resolution following assessment 6 No further action with recommendations 2 or educational comment Referred to DHB 2 No further action 2 TOTAL 7
10 Note that outcomes are displayed in descending order. If there is more than one outcome for a DHB upon resolution of a complaint then only the outcome listed highest up in the table is included.
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Wairarapa DHB Planned Care Performance for September 19
5 6 7 8 9 10 11 12 13 14 15 16 Planned volumeActual volume Planned caseweightsActual caseweights Planned Care Interventions ▼ 113.9% Planned Care Interventions / Acute Readmission AR ▼ 10.8% Patient Experience Surveys Period: May 2019
Response 2019 2020 Interventions Caseweights Inpatient Experience Survey questions: (% Yes, completely / Yes, always) Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Plan Actual % Plan Actual % Aug 18 Nov 18 Feb 19 May 19 Planned 237 550 844 1,142 1,449 1,673 1,915 2,143 2,444 2,669 2,976 3,232 Non Surgical PUC with Surgical DRG 17 17 100.0% 36.3 37.9 104.5% Before the operation did staff explain the risks and benefits in a way you could understand? 96.6 85.3 84.8 87.0 Actual 344 653 961 Surgical PUC 619 559 90.3% 837.7 750.2 89.6% Did staff tell you how the operation went in a way you could understand? 89.3 74.3 71.9 82.6 Variance 107 103 117 Inpatient Surgical Discharges 636 576 90.6% 874.0 788.1 90.2% Did hospital staff include your family/whānau or someone close to you in discussions about your care? 65.4 60.8 61.8 64.0 %Achievement 145% 119% 114% Inpatient Minor Procedures 22 31 140.9% Response (% , May 2019) 3,500 Primary Care Patient Experience Survey questions: Outpatient Minor Procedures Hospital 186 354 190.3% < 1 week 1-4 weeks 1-3 months > 3 months 3,000 Outpatient Minor Procedures Community 0 0 #DIV/0! 1. How long did you wait to see the specialist doctor? 40.8 38.3 8.3 12.5 Response 2,500 Minor Procedures 208 385 185.1% (% Yes, always) 2,000 2. When you received care or treatment from specialist doctors, did they do the following: Aug 18 Nov 18 Feb 19 May 19 Non Surgical Interventions 0 0 #DIV/0! a) Ask what is important to you? 46.9 44.4 55.9 52.2 1,500 Total 844 961 113.9% b) Tell you about treatment choices in ways you could understand? 69.8 78.8 74.0 71.4
1,000 c) Involve you in decisions about your care or treatment as much as you wanted to be? 67.4 70.7 70.9 71.4
500 Acute Readmission Measure (0 - Standardized Acute Number of Agreed AR 3. Does your GP/nurse seem informed about the care you get from specialist doctors? 68.9 69.0 67.3 66.0
Access, Quality, Experience 28 days) Readmission Rate Readmissions Target Rate 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Year to Jun 2019 10.8% 820 10.1% For more information regarding the patient experience surveys please contact your DHB’s System Level Measure (SLM) team or visit your DHB’s patient experience survey reporting portals. Non Surgical Intervention Minor Procedures Inpatient Surgical Discharges Planned 2019/20 Year to Jun 2018 11.6% 999
Colume look up MonthLookupESPI colum Look Traffic uplookup Light MonthLookupESPI colum Look Traffic uplookup Light ESPI Results 23 Consecutive Months Red FCT (31 Day) 93.8% ESPI 2 - by Service 3 Non Compliant Services ESPI 5 by Service 5 Non Compliant Services #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! Consecutiv # #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! 2 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! e months 3 month 2019 2019 3 mth 2019 3 mth red ESPI to trend Imp Req Imp Req Feb Mar Apr May Jun Jul Aug Sep Sep 19 Feb Mar Apr May Jun Jul Aug Sep Trend Feb Mar Apr May Jun Jul Aug Sep Trend ESPI 1 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Ophthalmology 58.4% 64.7% 65.0% 58.9% 43.5% 32.7% 20.0% 17.9% 35 ▼ R Orthopaedics 30.7% 28.7% 22.8% 16.6% 19.0% 23.2% 28.1% 36.3% 77 ▲ 0 ▬ 0 Level 0 0 0 0 0 0 0 0 Ear, Nose & Throat 20.1% 28.7% 17.0% 1.1% 0.0% 10.3% 12.6% 12.0% 14 ▲ R Urology 12.5% 13.8% 13.8% 29.6% 12.0% 16.7% 23.8% 25.0% 3 ▲ ESPI 2 29.7% 34.3% 31.3% 24.4% 15.3% 10.5% 5.8% 5.6% Orthopaedics 0.0% 0.0% 1.6% 0.6% 0.0% 0.0% 0.0% 0.9% 2 ▲ Y General Surgery 30.8% 31.0% 28.6% 28.4% 21.7% 25.9% 13.5% 10.6% 7 ▼ 16 ▼ # Level 264 308 246 194 103 87 53 51 Ophthalmology 1.8% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 4.4% 5 ▲ ESPI 3 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Gynaecology 4.8% 4.8% 11.1% 14.9% 25.9% 13.7% 14.9% 2.3% 1 ▼ 0 ▬ 0 Level 0 0 0 0 0 0 0 0 ESPI 5 21.0% 20.5% 18.9% 17.3% 16.1% 15.9% 16.1% 20.2% 23 ▲ # Level 81 80 76 77 77 78 77 93 ESPI 8 100.0% 100.0% 100.0% 100.0% 99.4% 100.0% 100.0% 100.0% 0 ▬ 0
Level 0 0 0 0 1 0 0 0 Access, Timeliness Faster Cancer 2019 3 month Treatment Feb Mar Apr May Jun Jul Aug Sep trend FCT % 93.3% 100.0% 91.7% 94.7% 87.5% 90.5% 83.3% 93.8% ▲ Level 14 20 22 18 21 19 15 15
5 Ophthalmology ESPI 24 Colour5 6 7 8 9 10 11 12 13 14 15 18 18 18 18 18 18 19 19 19 19 19 19 19 105 116 127 18 29 103 114 125 136 147 158 169 Ophthalmology ESPI 5105 Colour116 127 18 29 103 114 125 136 147 158 169 4 80 130 170 210 260 300 340 390 430 480 520 0 Diagnostics Performance CT 97.1% MRI 66.7% Angiography Ophthalmology Waiting Times ESPI 2 17.9% ESPI 5 4.4% FUA (50%) 0.0% Cardiac Surgery Delivery 63.0% Waiting over Timeframe 20 Cardiac Provider: Capital and Coast DHB 2018 2019 2018 2019 2019 2020 Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
CT 96.4% 100.0% 98.8% 98.0% 97.0% 98.9% 97.2% 96.8% 97.9% 96.9% 98.3% 97.1% ESPI 2 31.1% 39.9% 40.6% 55.3% 58.4% 64.7% 65.0% 58.9% 43.5% 32.7% 20.0% 17.9%
28Jul 25Aug 29Sep 27Oct 24Nov 29Dec 26Jan 23Feb 29Mar 31May 28Jun Ophthalmology ESPI 2 % 26Apr MRI 48.9% 62.7% 46.7% 35.3% 53.4% 53.7% 52.4% 55.3% 49.0% 51.7% 64.0% 66.7% OphthalmologyESPI 5 ESPI 5 11.0%% 6.4% 0.0% 1.8% 1.8% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 4.4% 0 Delivery 47.1% 59.7% 63.0% # Overdue Followups 0 0 0 0 0 0 0 0 0 0 0 0 Waiting list 66 63 68 50% Overdue ND ND ND ND 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 Max Waiting 77 77 77 100.0% 0 100% Overdue ND ND ND ND 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% OverTimeframe 21 9 20
80.0% 0 90 120% 70.0% 80 110% 60.0% 60.0% 70 100% 50.0% 60
Timeliness 40.0% 40.0% 50 90% 40 80% 20.0% 30.0% Delivery
Waiting list Waiting 30 70% 20.0% 20 0.0% 10.0% 10 60% Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep 0.0% 0 50% 2018 2019 Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep 28 Jul 25 Aug 29 Sep 27 Oct 24 Nov 29 Dec 26 Jan 23 Feb 29 Mar 26 Apr 31 May 28 Jun 2018 2019 2019 2020 CT MRI Angiography CT and Angiography Indicator (95%) MRI Indicator (90%) ESPI 2 ESPI 5 50% Over Due 100% Over Due Waiting list Outside timeframe Max Waiting Delivery
Report to: Sep 19 Data Extracted on: 04/11/19
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Definitions & Information
Planned Care Interventions Planned Care Interventions / Acute Readmission Patient Experience Surveys
Data Source - Planned Care Interventions Data Source Data Source
This data is sourced from the DHB monthly Planned Care Interventions (PCI) report summary page. This table and This data is sourced from the DHB monthly PCI report and YTD performance against plan for the Planned Care These data are sourced from the Health Quality and Safety Commission’s (the Commission) quarterly national graph shows monthly YTD delivery against the planned YTD delivery. Intervention Groups, YTD Caseweight Summary for Inpatient Surgical Discharges adult inpatient and primary care patient experience surveys. Selected questions from both surveys have been What do the colours mean? What do the colours mean? chosen to recognise the Experience and Equity principles within the Planned Care Programme. A rolling four quarters of data are displayed. The colour code below determines whether the performance meets expectations (green) or does not (red). This is The colour code below determines whether the performance meets expectations (green) or does not (red). This the same as in the Planned Care Interventions reports. is the same as in the Planned Care Interventions reports. For the wait time to see a specialist question, the percent of respondents who selected each response option in Green Greater than or equal to 100% ▬, ▲, Green Greater than or equal to 100% ▬, ▲, the latest quarter is provided. For all other questions, the percentage displayed is the percentage providing the Change from previous month Change from previous month Red Less than 100% or ▼ Red Less than 100% or ▼ most positive response to the question. What other information is available regarding the patient experience surveys? Data Source - Acute Readmissions For more information regarding the patient experience surveys please contact your DHB's System Level This data is sourced from the quarterly Acute Readmission (AR) reporting. The figures are the most recent Measure (SLM) team; visit your DHB's patient experience survey reporting portals; or visit the Commission’s quarter's Standardised Acute Readmission rate and number of Observed Readmissions for the 0-28 days website measure, and the same numbers for the same period 12 months ago. (https://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/patient-experience) What do the colours mean? In the top right hand corner of this box next to the title is the % result for the latest period, the colour code below Access, Quality, Experience determines whether the performance meets expectations (green) or does not (red).
Green Less than or equal to planned AR rate ▬, ▲, Change from previous period's standardised Red Greater than planned AR rate or ▼ rate
ESPI - DHB Level / FCT (31 Day) ESPI 2 - by Service ESPI 5 by Service
Data Source - Elective Services Patient Flow Indicator (ESPIs) Data Source Data Source This data is sourced from the DHB Final ESPI Reports. Also included is the Total number of consecutive months of Red ESPI performance, and a 3 month trend of ESPI performance for each ESPI. This data is sourced from the DHB monthly Final ESPI Reports, including the Improvement Required, and a 3 This data is sourced from the DHB monthly Final ESPI Reports, including the Improvement Required, and a 3 month trend arrow. The ESPI result in this report is for an 8 month period, and only services which are currently month trend arrow. The ESPI result in this report is for an 8 month period, and only services which are currently What do the colours mean in the title bar? non compliant, or have been non compliant at least once in the last 4 months will appear on this report. non compliant, or have been non compliant at least once in the last 4 months will appear on this report. In the top right hand corner of this box next to the title is the period of Red level ESPIs non compliance. Green All ESPI Results at a DHB Level are either Green or Yellow What do the colours mean in the title bar? What do the colours mean in the title bar? Orange The first month of the DHB having a Red ESPI at a DHB Level In the top right hand corner of this box next to the title is the number of non compliant services for ESPI2 for the In the top right hand corner of this box next to the title is the number of non compliant services for ESPI5 for the Red The DHB has had 2 or more consecutive months with a Red ESPI at a DHB Level current month. current month. What do the colours mean in the table? Green All services are compliant Green All services are compliant The colours show whether a DHB is compliant (green) or non compliant (yellow and red) for each ESPI. Orange Equal to or less than 3 services non compliant Orange Equal to or less than 3 services non compliant Data Source - Faster Cancer Treatment (FCT) 31 Day Indicator Red Greater than 3 services are non compliant Red Greater than 3 services are non compliant
This data is sourced from the DHB Faster Cancer Treatment (FCT) Reporting Database. This measure indicates whether 85% of What do the colours mean in the table? What do the colours mean in the table?
patients receive their first cancer treatment (or other management) within 31 days from date of decision-to-treat. Please note that The colours for each cell show whether a DHB is compliant (green) or non compliant (yellow or red) for each The colours for each cell show whether a DHB is compliant (green) or non compliant (yellow or red) for each Access, Timeliness the FCT data may vary from the SS01 Quarterly Reporting measure due to the date of extraction. service. A warning light (box will turn orange) for the 3 Month Trend arrow when a service if the three month service. A warning light (box will turn orange) for the 3 Month Trend arrow when a service if the three month What do the colours mean in the title bar? trend is worsening. trend is worsening. Green DHB met 85% Indicator for the latest month. Red DHB not met 85% Indicator for the latest month. From July 2012 onwards Prior to July 2013 the definition of ESPI 2 is the number of patients waiting From July 2012 onwards Prior to July 2013 the definition of ESPI 5 is the number of patients waiting What do the colours mean in the table? Green = 0% over 6 months for FSA. Between July 2013 and December 2014 the Green = 0 % over 6 months for Treatment. Between July 2013 and December 2014 the definition of ESPI 2 is the number of patients waiting over 5 months for FSA, definition of ESPI 5 is the number of patients waiting over 5 months for Green DHB met 85% Indicator for the month. Red DHB not met 85% Indicator for the month. Yellow > 0% but < 0.4% and from January 2015 the definition of ESPI 2 is the number of patients Yellow > 0% but < 1% Treatment, and from January 2015 ESPI 5 is the number of patients waiting Red > = 0.4% waiting over 4 months for FSA. Red > = 1% over 4 months for Treatment.
Diagnostics Performance Ophthalmology Waiting Times Cardiac Surgery
Data Source Data Source Data Source This data is sourced for FSA and Treatment waiting times from the monthly DHB ESPI reporting, and the follow This data is sourced from the weekly reporting supplied from each of the five DHB cardiac units (Auckland, The data is sourced from the monthly Diagnotics Reporting, the table and graph show the DHB % for a 12 month up information is sourced from the collection used through the Ophthalmology service improvement Waikato, Capital & Coast, Canterbury, and Southern). trend for CT, MRI and Angiography against the respective national indicator percentage expectations. programme. What does the coloured cells mean in the title bar and in the table? What does the coloured traffic light mean? In the top right hand corner of this box next to the title is the regional provider % delivery for the latest week and What does the coloured cells mean in the title bar and in the table? the national number of patients waiting greater than the 90 day expectation for surgery. This is also shown in the In the top right hand corner of this box next to the title is the DHB % result for the latest month for waiting time table below with the % every four weeks, the colour code below determines whether the performance meets In the top right hand corner of this box next to the title is the DHB % result for the latest month for CT, MRI and results for Ophthalmology for ESPI 2, ESPI 5 and % of patients waiting longer than 50% overdue for their follow expectations (green) or does not (red). Angiography. This is also shown in the table below with the % by month for the 12 month period, the colour code up appointment or treatment. This is also shown in the table below with the % for a 12 month period, the colour below determines whether the performance meets expectations (green) or does not (red). This is the same as in code below determines whether the performance meets expectations (green) or does not (red). This is the The graph shows the total waiting list, the number on the waiting list for greater than the expected timeframe, the the Diagnostics reporting. same as in the ESPI reports for ESPI 2 and ESPI 5. maximum acceptable waitlist and the delivery.
CT MRI Angiography ESPI 2 ESPI 5 Follow up (50% and 100%) Timeliness
Greater than or equal Greater than or Greater than or equal Green = 0% Green = 0 % Green = 0 % Green Green Green to 95% equal to 90% to 95% Yellow > 0% but < 0.4% Yellow > 0% but < 1% Red > 0% Red Less than 95% Red Less than 90% Red Less than 95% Red > = 0.4% Red > = 1% NOTES: % delivery Waiting over timeframe The measure is a DHB of service measure, where NA is present this means the DHB is not the provider for Green 100% Green 0 patients NA the service and other DHB provides this service. Red Less than 100% Red Greater than 0 ND This indicates that no data is currently available, as the DHB has been unable to supply this.
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