Nelson Bays Primary Distribution
Board Members: . John Hunter (Chair) Health Trust . Philip Chapman . Pat Curry . Sarah Green . Olivia Hall . Stuart Hebberd . Helen Kingston . Lisa Lawrence AGENDA . Sue Stubbs
Management: . Angela Francis, CE . Emily-Rose, EA/Board Secretary
Public: Board . Hard copies (3) . Open Agenda Distribution List (e) . www.nbph.org.nz Open
Contact Details Board Secretary: Emily-Rose Richards Date: 7 July 2016 Tel: 03 543 7850 Time: 2.00pm
Next Meeting Date: Place: Meeting Room 2 4 August 2016 Nelson Bays Primary Health 281 Queen Street Richmond Nelson Bays Primary Health
Board Meeting 2.00pm Thursday 7 July 2016 Open
Agenda
Page
1.0 Welcome/Karakia – John Hunter
2.0 Apologies: Helen Kingston, Pat Curry
3.0 Register of Interests
3.1 Amendment to the Register of Interests 4 For review
3.2 Declaration of Conflicts in Relation to Today’s Business
4.0 Confirmation of Agenda For review
5.0 Minutes of 2 June 2016
5.1 Confirmation of Minutes 6 For approval
5.2 Matters Arising (and not for discussion in 5.3)
5.3 Discussion of Action Points 9 For review
6.0 Environmental Scan Discussion
7.0 Reports
7.1 Chief Executive’s Report – Open Section 10 For information
7.2 GM Health Services’ Operational Report 36 For information
7.3 Health and Safety Report 39 For information
7.4 ToSHA Update 42 For information
7.5 Committee Meetings Update 48 For information
7.6 Telemedicine/Telehealth 52 For information
8.0 Board Work Programme 58 For information
9.0 Presentations
9.1 Male’s access to service and the health disparities For information between males and females – Philip Chapman 9.2 Integrated Performance and Incentive Framework – For information Angela Francis
10.0 General Business Discussion
Next Meeting: Thursday 4 August 2016 Register of Interests – Board | as at 3 June 2016
Possible Future Name Existing – Health Interest Relates To Existing – Other (Role) Conflicts Chair PHO Alliance Executive PHO Christchurch Polytechnic of Technology None notified John Hunter – (Director since April 2011) PHO Alliance Member Powerhouse Ventures Ltd – Director Hydro Works Limited – Director
Helen Kingston Abbeyfield Golden Bay Inc Medical Adviser Incorporated Society providing accommodation None declared Non- and Committee Member for elderly Governmental Provider Lisa Lawrence Member of the Order of St John Motueka Family Service Centre None notified Motueka Family Service Centre Have a provider contract with NBPH (Kaiwhakahaere) Motueka Family Service Centre Location of a lactation clinic trial for Motueka area Motueka Health Alliance Primary Health Services in Motueka PHARMAC Community Advisory Committee Member Olivia Hall None declared Nelson Bays Heritage Trust (Chair) None notified Te Runanga o Ngati Rārua (Chair) Whakatu Boxing Trust NMIT Employee Pat Curry Fundraising role Nelson Hospice None declared None notified Board of Trustees Abbeyfield Nelson Inc. Director Accuro Private Health Insurance Philip Chapman Employed by Nelson Public Health Men’s health; positive fathering research; improve Whakatu Boxing Trust Potential Manager – Men’s Centre (Male Room) access to family health services for fathers, men Community Committee Member “Men’s Shed” & boys; Initiative National Chairman of Male Survivors Of The Male Room receives money from the NBPH Funding Sexual Abuse A.N.Z Primary Mental Health Initiative. Sarah Green Tasman Medical Centre Employee None declared None notified Nursing leadership Nursing Clinical Governance Committee Member Stuart Hebberd MIC Provider Contract None declared None notified Prices Pharmacy 2011 Ltd DHB Contract Prices Pharmacy Blenheim DHB Contract Nelson Care Chemist DHB Contract Sue Stubbs Tima Health General practice owner with PHO contract None declared None notified Nelson Bays General Practice Limited Shareholder ACC Nelson Branch Medical Advisor
4 Possible Future Name Existing – Health Interest Relates To Existing – Other (Role) Conflicts CE Institute of Directors, NZ Member None declared None notified Angela Francis Australasian College of Health Service Associate Fellow Management Medical & Injury Centre Director Health Systems Solutions Director Immunisation Governance Group Chair
5 Nelson Bays Primary Health Trust Board Meeting
Minutes of meeting held at 2.15pm on Thursday 2 June 2016 at Nelson Bays Primary Health, 281 Queen Street, Richmond
Open
PRESENT: John Hunter (Chair), Helen Kingston, Lisa Lawrence, Philip Chapman, Sarah Green, Stuart Hebberd, Sue Stubbs
IN ATTENDANCE: Angela Francis, Chief Executive; Emily-Rose Richards, Board Secretary; Linzi Birmingham, GM Golden Bay Community Health; Ward Steet, GM Health Services.
Public: (1) Charles Tyrrell, Chairman of Age Concern
1.0 Welcome/Karakia – Stuart Hebberd
2.0 Apologies: Olivia Hall, Pat Curry
3.0 Register of Interests
3.1 Amendment to the Register of Interests
There were none.
3.2 Declaration of Conflicts in Relation to Today’s Business
There were none.
4.0 Confirmation of Agenda
The agenda was confirmed.
5.0 Confirmation of Minutes of 5 May 2016
The minutes of 5 May 2016 were confirmed as a true and accurate record. Chapman/Green
5.1 Matters Arising
There were none.
5.2 Action Points
6 TO BE CONFIRMED Some matters for consideration this month had been dealt with, formed part of today’s agenda or were discussed as follows:
A32 Identifying whether unclaimed funds can be reallocated. Completed.
A38 Telemedicine being provided in remote communities. Carry forward.
A40 The Clinical Governance Committee to make the register a template relevant for GPs. Completed.
A41 System Levels Measures Framework expectations of NBPH. The expectations required from NBPH are yet to be released by the Ministry of Health. In progress.
A42 Good news stories to be sent to Samantha Gee. Completed.
A44 The Golden Bay Community Health workplace risk assessments, plans to eliminate risk, ongoing monitoring audits and trend reporting to be reported on going forward. Completed.
6.0 Environmental Scan
Ms Francis noted there have been three confirmed cases of Measles in the Nelson Tasman region. Management have taken a targeted approach and asked the General Practices to inform their decliners who have not been immunised on the outbreak, with a view to getting their babies immunised. A media release has been sent from NBPH promoting immunisation.
Ms Lawrence attended the post-budget breakfast for the Child Poverty Action Group at NMDHB. The meeting was well attended by NGO’s across the sector. The 2016/17 budget lacks focus on the healthy housing initiative which impacts on health.
Mr Chapman noted the family violence funding is continuing into the 2016/17 financial year.
Mr Chapman noted the suicides report has been released. The report indicates the three top groups of suicides coming from working age males, young Maori and mental health consumers. Mr Chapman will present the gender break-down figures in his presentation at the July Board meeting.
Mr Hunter noted the health sector is evolving quickly with the new 26 System Level Measures being introduced by the Ministry of Health. The funding issues arising will be presented to the Board. The Ministry of Health are allowing an adjustment period for the District Health Boards and Primary Health Organisations to adjust to the new measures.
7.0 Policy Register
It was noted the Board had previously asked for a schedule of NBPH’s policies.
The following amendments were asked to be made: • Remuneration for Board and Advisory Groups Policy – Change to Remuneration and Governance Committee as the reviewer • Treaty of Waitangi Policy – Include Governance and Remuneration Committee as a reviewer
The Board approved the policy registers with the two amendments made.
7 TO BE CONFIRMED 8.0 Reports For Noting
8.1 Chief Executive’s Report – Open Section
Report taken as read.
8.2 General Manager Health Services Operational Report – Open
It was noted 35% of the consumers using the NBPH Mental Health Programmes are males.
There was a discussion held on the spirometers distributed to GP’s. The implementation of the respiratory service allows GPs to deliver spirometry which improves patient access. The GP’s are able to charge for use the spirometers through the options for care or co-pay initiatives. Mr Hunter asked for Management to acknowledge NMDHB for agreeing to the spirometers proposal. A45
8.3 Health and Safety Update Report
Ms Francis noted NBPH have taken the lead on Health and Safety for the building occupants at 281 Queen Street. However, the Building Management Group ensure Health and Safety is being implemented for all occupants in the building.
Mr Hunter asked if there is a consistent definition on what are near-misses and harm. Ms Francis noted the Health and Safety Committee are looking into the definitions to ensure there is consistent reporting across the organisation.
8.4 ToSHA Update
The ToSHA Dashboard was received.
Mr Hunter asked what participation does NBPH have on ToSHA working groups. Ms Francis noted where appropriate NBPH staff are involved in some of the working groups and provide input and time as appropriate.
8.5 Committee Meetings Update
The Te Tumu Whakaora minutes of 19 May 2016 were noted.
Mr Chapman mentioned that at the last Te Tumu Whakaora meeting, there was a large number of staff in attendance in comparison to members. Ms Lawrence stated some staff only attend meetings for their presentation and there are three new members which are being appointed.
8.0 Board Work Programme
Noted.
9.0 General Business
There was none.
The meeting closed at 2.51pm
Next Meeting: Thursday 7 July 2016
8 TO BE CONFIRMED OPEN Action List v 24 June 2016
Meeting Action Action Bring up Who Status date number Apr 16 A35 Management to report on IT at the June meeting in two Jun 16 IT Refer to reports; detailed and summary. Jul 16 Manager closed agenda item 3.4
A38 There was a discussion held on Telemedicine being May 16 Dr Stubbs Refer to provided in remote communities. The process would Jul 16 agenda item include triaging patients at an early stage when an 7.6 appointment is made and offering Telemedicine consults. Dr Stubbs to research further and come back to the Board.
A39 Management confirmed to the Board NBPH are compliant Jul 16 Kaiatawhai In progress with the obligations to the Treaty of Waitangi. Aug 16 Service Management to come back to the Board with the Treaty of Manager Waitangi policy and how NBPH responds as an organisation. The Kaiatawhai Service Manager will review the policy. The draft policy will be presented to the Board in August.
May 16 A41 The System Level Measures framework will come back to Jun 16 CE Refer to the Board with the expectations required from NBPH. Jul 16 agenda item 9.2 The expectations required from NBPH are yet to be released by the Ministry of Health.
A43 It was noted there is a systemic problem for males Jun 16 Mr Refer to accessing health services which is not fixing itself. It was Jul 16 Chapman agenda item asked for Mr Chapman do a 20 minute presentation on 9.1 male’s access to service and the health disparities between males and females in the open section of the July Board meeting.
Jun 16 A45 Mr Hunter asked for Management to acknowledge Jul 16 GMHS Completed NMDHB for agreeing to the spirometers proposal.
9 To Nelson Bays Primary Health Board From Angela Francis, Chief Executive Meeting date 7 July 2016 Subject Chief Executive’s Report – Open Section
For approval For action For information √
1. PURPOSE
To provide the Board with an update of the organisation’s progress against strategy, risk and budget. Where appropriate, fuller details are provided in the Closed Section.
2. OVERVIEW
Business as usual continues: • Risk identification and mitigation – Refer Closed Section – Risk Register for further detail • Staffing levels – Nelson Bays Primary Health (NBPH) staffing levels remain constant. Refer Closed Section for attrition rates. The focus on reducing excess leave liability continues • Financial forecast – NBPH continues to track against budget, with a small surplus forecasted year- end. Refer financial paper in the Closed Section for further details • Progress against strategy continues with: o Scheduled papers aligned to the Board’s work plan are included within Board packs
3. MEDIA AND GOOD NEWS STORIES
3.1 Nelson Bays Primary Health Media Releases
For the month of June, NBPH sent through four media releases to the Nelson Mail and local community newspapers. The media releases submitted were: • Toddler Better Health Programme • Measles Outbreak in Nelson Tasman Region • Patient Portals • Community Falls Prevention
Refer to Appendix 1 for the NBPH media releases. From the four media releases submitted, one was published, as follows:
Toddler Better Health Programme An article in the Nelson Mail provided coverage on the Toddler Better Health Programme which is an evidence based healthy lifestyle programme for families with children aged between two to four years to address and prevent childhood obesity. It focuses on changing habits or behaviours, physical activity and healthy eating.
The article resulted in Radio New Zealand, Rhema Media, and TVNZ contacting Nelson Bays Primary Health requesting interviews with Tonia Talbot, Dietician and facilitator of the Toddler Better Health Programme. Tonia held interviews with Nerida Ashcroft from Rhema Media, Simone Beksinska from Radio New Zealand and Shalleen Hern from TVNZ, who visited the Toddler Better Health Programme on
10 Tuesday 22 June. Refer to Appendix 2 for the Toddler Better Health Programme article in the Nelson Mail. A link to a Stuff article, Radio New Zealand interview and the TVNZ video clip follows: http://www.stuff.co.nz/national/health/80813677/obese-toddlers-referred-for-help-in-new-health- drive.html http://www.radionz.co.nz/national/programmes/afternoons/audio/201804025/tubby-toddlers https://www.tvnz.co.nz/one-news/new-zealand/health-programme-kiwi-toddlers-aims-combat- childhood-obesity
3.2 Nelson Bays Primary Health Media Coverage
The other media coverage NBPH was involved in for the month of June follows.
Loss of Pharmacy Facilitator Roles An article in the Nelson Mail provided coverage on the Nelson and Marlborough Primary Health Organisations losing their community-based pharmacy facilitators, as a part of the Nelson Marlborough District Health Board (NMDHB) management restructure. Campbell Live also featured the Pharmacy changes on Radio New Zealand. Refer to Appendix 3 for the Loss of Pharmacy Facilitator Roles article in the Nelson Mail. A link to a Stuff article and the Campbell Live audio from Radio New Zealand follows: http://www.stuff.co.nz/nelson-mail/news/80415983/disappointment-in-nelson-marlborough-over- the-loss-of-pharmacy-facilitator-roles http://www.radionz.co.nz/national/programmes/checkpoint/audio/201804488/health-board- warning-over-pharmacy-charges
Teen Health Fest An article in the Nelson Mail provided coverage on Teen Fest which held during the week of 30 May. A team from NBPH, NMDHB and the INP Medical Clinic have been visiting schools in the region to encourage students to talk about their health. Refer to Appendix 4 for the Teen Fest article in the Nelson Mail. A link to a Stuff article follows: http://www.stuff.co.nz/nelson-mail/news/80625518/young-people-in-nelson-empowered-to-seek- health-advice-as-part-of-teen-health-fest
Dawn for Diabetes An article in the winter issue of the National Diabetes Magazine, showcased the World Health Day on Diabetes. NBPH staff took part in the day and walked to the Centre of New Zealand dressed up as Superhero’s, resulting in a winning image published in the magazine. Refer to Appendix 5 for the Dawn for Diabetes article in the National Diabetes Magazine.
3.3 Golden Bay Community Health (GBCH) Media Coverage
Support Group Helps Carers of the Frail Elderly An article in the Golden Bay Weekly provided coverage on the support group for locals who care for the frail elderly. The Support group is run by Margaret Fricker and is held monthly at Golden Bay Community Health. Refer to Appendix 6 for the Support Group Helps Carers of the Frail Elderly article in the Golden Bay Weekly.
New Golden Bay Leaders Share Vision An article in the Nelson Mail showcased the five new leaders in Golden Bay sharing a vision. Linzi Birmingham, General Manager Golden Bay Community Health is included in the article. Refer to Appendix 7 for the New Golden Bay Leaders Share Vision article in the Nelson Mail. A link to a Stuff article follows: http://www.stuff.co.nz/nelson-mail/80378132/five-new-golden-bay-leaders-share-a-vision-for-change
11 4. CORPORATE SERVICES UPDATE
4.1 Information Systems
NBPH Website Development Phase one of the NBPH Website went live in April 2016, in-line with the implementation project plan. Positive feedback has been received from a variety of users of the new website. An internal governance group has been established to support the ongoing refinement and further development of the website functionality and content. The enhancement and refinement suggestions received are being reviewed by the governance group, prioritised and actioned.
Phase two of the NBPH website development is scheduled to go live on 30 September 2016. The objectives of the second phase include the addition of the GBCH sub-site and tools to increase communication efficiency with identified user groups. A detailed project plan is in place to support the delivery of this second development phase.
IT Infrastructure Review An internal review of NBPHs infrastructure has been completed as scheduled. The Disaster Recovery testing has also been completed. The actions have been identified and prioritised for implementation that will continue to strengthen NBPH’s ICT structure and disaster resilience.
4.2 Human Resources
The Collective Bargaining for the General Practitioners’ Collective Employment Agreement at GBCH has been initiated. The negotiations commenced on 27 June 2016.
5. LOCAL PLATFORM
5.1 Victory Community Centre
A meeting was facilitated by the Chief Executive of NBPH with Victory Community Health and local GP’s, to explore pathways to increase access to GP services. The meeting was a success and a following meeting has been scheduled for Monday 4 July. An email was received from the Victory Community Centre, thanking NBPH and the local GPs for attending the meeting. Refer to Appendix 8 for the thank you email received from Victory Community Centre.
5.2 Community Meetings
In its attempt to broaden out the PHO’s approach to community health, and facilitate alignment to shared service provision, a number of meetings have been scheduled with the following community meetings, attended in June: • Motueka Community and Whanau Meeting – Wednesday 1 June 2016 • Nelson Asthma Society Annual General Meeting – Wednesday 8 June 2016 • Red Cross Refugee Intake Welcome Meeting – Friday 17 June 2016
5.3 NMDHB Mental Health Restructure
NMDHB Mental Health Services will form a new directorate combined with Disability Support Services (DSS) under a new General Manager (GM) position. The GM DSS and GM Mental Health positions have been disestablished and the new GM position will be advertised shortly.
12 6. NATIONAL PLATFORM
For updates on the PHO Alliance and PSAAP, refer to item 3.6 in the Closed Section. For an update on the System Level Measures Framework, refer to item 9.2.
6.1 Pharmacy Guild of New Zealand
Notification has been received of the newly appointed Chief Executive, Andrew Gaudin, for the Pharmacy Guild of New Zealand. Refer to Appendix 9 for the letter received from the Pharmacy Guild announcing the new Chief Executive.
6.2 PATHS Contract with Ministry Social Development (MSD)
The MSD has notified NBPH that the PATHS programme is being ceased across New Zealand. While the contract ends 30 June 2016, NBPH have negotiated an additional two months funding to meet contract requirements.
7. MAORI HEALTH
7.1 Te Tiriti o Waitangi Policy
The revised Te Tiriti o Waitangi policy has been endorsed by Te Tumu Whakaora to go to the Board for approval. The Te Tiriti o Waitangi procedure is under review and is due for presentation to Te Tumu Whakaora on 18 August 2016. The Te Tiriti o Waitangi policy will come to the August Board meeting for approval, along with the procedure.
7.2 Treaty of Waitangi Training
The Treaty of Waitangi Training day was held on Wednesday 29 June at NBPH. There were 22 staff from NBPH who attended the training.
7.3 NMDHB GM Māori Health and Whanau Ora
The GM Māori Health and Whānau Ora at NMDHB has resigned. The Poroporoaki (farewell) was attended by the Chief Executive of NBPH, which was held at the Whakatū Marae on Thursday 9 June.
8. INTEGRATED PERFORMANCE AND INCENTIVE FRAMEWORK (IPIF) RESULTS
The Minister of Health has released the health target results for the third quarter of 2015/16. Nationally, NBPH ranked first equal for cervical screening and third place for smoking brief advice.
The health targets are represented in the below table:
Highest NBPH Lowest National rank % % rank % target % More heart and diabetes checks 93 90 81 90 Better help for smokers to quit 95 93 67 90 Increased immunisation (8 month olds) 99 89 88 95 Increased immunisation (2 year olds) 98 91 84 95 Cervical screening coverage 87 87 69 80
13 Refer to Appendix 10 for the IPIF Measures Results Table for quarter three of 2015/16.
The Minister of Health was pleased to see coverage for Māori in immunisation was equal to the highest coverage previously reported. Refer to Appendix 11 for the correspondence received from the Minister of Health regarding the health target results for quarter three of 2015/16.
9. CORRESPONDENCE
Community Respiratory Service At the Board Meeting on 2 June 2016, Management were requested to acknowledge NMDHB for agreeing to the spirometers proposal. Refer to Appendix 12 for the letter to NMDHB regarding the Community Respiratory Service.
10. RECOMMENDATION
It is recommended that: • The Board receives the report.
Appendices: 1. NBPH Media Releases 2. Toddler Better Health Programme article in the Nelson Mail 3. Loss of Pharmacy Facilitator Roles article in the Nelson Mail 4. Teen Fest article in the Nelson Mail 5. Dawn for Diabetes article in the National Diabetes Magazine 6. Support Group Helps Carers of the Frail Elderly article in the Golden Bay Weekly 7. New Golden Bay Leaders Share Vision article in the Nelson Mail 8. Thank you email received from Victory Community Centre 9. Letter received from the Pharmacy Guild announcing the new Chief Executive 10. IPIF Measures Results Table for quarter three 2015/16 11. Correspondence received from the Minister of Health regarding the health target results for quarter three of 2015/16 12. Letter to NMDHB regarding the Community Respiratory Service
14 APPENDIX 1 Media Release - Toddler Better Health 24 May 2016
Obesity screening to pick up 1000 South Island kids
It is estimated that more than 1000 south island pre-schoolers classified as being ‘too big’ will be offered help to manage their weight in a new government health target, which takes effect from July 1 2016.
Under the new health target, children will be identified at a Be 4 School Check (B4SC) and the nurse doing the check will be responsible for discussing the results and implications with the parent and referring on to the family doctor.
“The doctor is best placed to assess the situation and work out what treatments could help,” says Angela Francis CE for Nelson Bays Primary Health. “One option that may be considered is a prevention programme such as Toddler Better Health being run by Nelson Bays Primary Health”, says Angela.
The Toddler Better Health (TBH) is an evidence based healthy lifestyle programme for families with children aged between 2-4 years to address and prevent childhood obesity. TBH focuses on changing habits or behaviours, physical activity and healthy eating.
“During the programme, there are food discussions that focus on meal planning, label reading and serve sizes. There is also snack time that allows the toddlers (and the families) to try new vegetables and fruits with the aim to encourage healthy eating habits”, says Tonia Talbot Community Dietitian at Nelson Bays Primary Health who facilitates the programme.
Results from the Toddler Better Health programme that finished recently in Richmond showed 60% of parents said their children were spending more time being physically active, and 60% of parents have seen a reduction in the time their children were spending on screens (TV, computer etc). The results also showed 80% of parents said that their children were eating more vegetables on a daily basis.
Jenny Dravitzki, of Sport Tasman throws a ball to Quayde McIntyre, 4, at the Toddler Better Health Programme at the Richmond Town Hall.
15 APPENDIX 1
“The programme has had a real flow on effect to my extended family. My mother sent the children money instead of chocolate for Easter this year and my sister and brother in law don’t offer fizzy drinks when we come to visit now” said one of the parents on the programme.
“Having a health target is a great way to address a health issue, but it only has a health benefit if a programme such as Toddler Better Health is available to support families. Our children are our future, so through this programme Nelson Bays Primary Health can focus on prevention and giving parents the knowledge and strategies to give their children the best start," says Angela Francis.
ENDS
Contact: Tonia Talbot, Primary Care Dietitian Nelson Bays Primary Health Phone: 543 7814 Email: [email protected]
Media Release - Measles Outbreak 30 May 2016
Measles Outbreak in the Nelson region is a serious concern
Measles can affect both children and adults, but it is also easily preventable. It only take 2 doses of the measles vaccine to protect yourself, your family and your community.
“Please protect your family and help prevent further cases in our region”, says Nelson Bays Primary Health Chief Executive. Angela Francis. “Vaccination is the key to stopping measles outbreaks occurring. Vaccination with the two doses of the MMR ( measles, mumps, rubella) vaccine is free and available from your GP. Check with your GP or practice nurse if you are not sure if you, or your child, has had two doses and if need be go in to the surgery to get the vaccination.”
Measles is highly contagious, it affects both children and adults and spreads easily from person to person through the air, via breathing, coughing and sneezing.
In the current nationwide outbreak centred in the Waikato there have been 51 cases so far and 9 people have been admitted to hospital. People with measles are infectious 5 days before and until 5 days after the rash appears. Measles can also lead to other complications, including:
• ear infections (which can cause permanent hearing loss) • diarrhoea • pneumonia • seizures • swelling of the brain – this is rare, but can cause permanent brain damage or death.
Measles during pregnancy increases the risk of miscarriage, premature labor and low birth-weight babies.
ENDS
Contact: Vicky Bryant Phone: 021 277 2180 Email: [email protected]
16 APPENDIX 1 Media Release - Patient Portals 30 May 2016
Health Minister Jonathan Coleman is encouraging people to use a new online map to see whether their family doctor (general practice) offers a patient portal.
Jonathan says a growing number of general practices are introducing patient portals which are secure online sites and the health equivalent to online banking.
“Portals enable patients to book appointments, order repeat prescriptions and view lab test results online”, says Yvonne Youngman, Primary Health Manager for Nelson Bays Primary Health.
“You can have secure conversations with your doctor via email, and in some cases, patients can also view their notes online”, says Yvonne. “Portals are convenient, secure and real time savers” she says.
“A new interactive map launched on www.patientportals.co.nz makes it easy for patients to check which general practices are offering portals.
More than 330 general practices are now offering patient portals, with nearly 136,000 New Zealanders have registered to use one.
The new map on the patient portal website allows you to search by either typing in the name of your general practice, or zoom into your region to see which practices have portals.
You can also access the patient portal website via http://nbph.org.nz/general-practices
ENDS
Contact: Yvonne Youngman Phone: 543 7852 Email: [email protected]
17 APPENDIX 1 Media Release – Community Falls Prevention 16 June 2016 Leaves are falling but older adults aren’t in Nelson Bays
The leaves are falling but luckily the same can't be said for our older adult population thanks to a falls prevention programme run by Nelson Bays Primary Health.
Upright & Able is a community falls prevention programme designed to reduce injuries from falls, in particular fractures or broken bones. It is for people over the age of 65 years who have had a fall.
In New Zealand 18,500 people are hospitalised after a fall each year. When older adults fall, not only do they suffer terrible (sometimes fatal) injuries, a fall can lead to loss of independence and increased the likelihood of more falls.
During the past 3-years that ACC has been funding Upright & Able, 1149 older adults were referred to the programme and as a result of attending: • 99% have more awareness of what can causes them to fall and how they can avoid falling. • Six months after attending Upright & Able; 23% had suffered a further fall. • Of those who fell, only 10% received an injury and only 1% fractured a bone.
In 2014 research undertaken by ACC showed delivery of Upright & Able covered all relevant topics in an easy to understand way and that participants were motivated to make changes.
“I have been doing my exercises every day and already I find it easier to stand up when I am getting out of a chair”, says one female participant from Nelson. “I’ve also thrown out some old shoes and put a mat in the shower”, she says.
Angela Francis, CE for Nelson Bays Primary Health states “The falls prevention model has been a very effective intervention, resulting in a significant reduction of fractures from falls in our older adult population”.
If you are over 65 years and can answer yes to any of the questions below…you may be at risk of falling. 1. Have you had a slip, trip or fall in the past 12 months? 2. Do you have a fear of losing your balance? 3. Are you on 4 or more medications?
“Slip, trips and falls can happen to us all. Many think it won’t happen to them, or that falls are not important. Some think, falling is a natural part of ageing and there is nothing you can do. The good news is, most falls are preventable.” says Cherie Thomas, Coordinator of Upright & Able.
ENDS
Contact: Glenis Bell, Health Promotion Manager, Nelson Bays Primary Health Phone: 543 7827 Email: [email protected]
18 APPENDIX 2
19 APPENDIX 3
20 Appendix 4
21 22 APPENDIX 5
23 APPENDIX 6
24 1ne NciSen Mail J7 Ho� J).01b APPENDIX 7 New Golden Bay leaders sharevision NINA HINDMARSH you're ill is to travel over that hill," she We want to tryand said. They are currently revising models of Five change-making professionals all keeppeople out of care, including the aged care centre, new to Golden Bay this year and each hospital We,re quite They were looking into developing a day heading some of the community's most care for people with dementia important centres, trusts and schools, pleased to have not Tony Keatley moved up to Golden Bay shared their trials, tribulations and from Christchurch with his wife earlier visions forchange at a community meet had anyone admitted this year where he ran a forensicmental ing on Tuesday. to the mental unit in health unit. Katrina Hutton, the new head of He had been managing mental health Golden Bay High School, is a mother of Nelsonfor three services for more than 10 years, nine children and first-time principal. specialising in emergency mental health Originally from England, Hutton months and two prior to that. taught maths before taking on the role as weeks. "A really special thing about this deputy principal at a variety of high place is you have a mental health service Tony Keatley schools and colleges around the country Commwtitymental health services which is run by a ch aritable trust which fortwelve years. manager is pretty unique in this country. I think "Its one of the biggest jobs you could there'sjust one other." ever imagine," she said. By the year 2030 the government aims Last year alone New Zealand lost over to implement similar charitable trust 50 principals. services for mental health, alcohol and "I think that spells out just how diffi drug services everywhere. cult of ajob it is." conversations with confidence." "We're actually at the front-line, and Hutton said her goals for the school She said education should become thats really exciting for a guy like me." this year were to strengthen multi more "learner-centric" to enable Community mental health services culturalism; analyse test and exam data students to be change-makers, rather was striving toward more biculturalism, and revise the way the school tested than being put in a box and told to con greater family involvement, and to students; and to develop leadership form. improve the capacity to provide acute among students. "I like kids that challenge, and r like care of people experiencing acute issues. "One of the biggest focuses for me last kids who challenge me and the system. "We want lo try and keep people out of term was putting myself on a platform in But also that we give them a set of really hospital. We're quite pleased to have not front of the kids at the assembly, rather good values as framework." had anyone admitted to the mental unit than being on the stage. I wanted to have The key values were integrity, adapta in Nelson for three months and two a whanau-feel and that there wasn't a dis bility, open to learning, respect and weeks." tance between me and the students." empathy. Shelly Harvill is fro)11 the Unites The new head of Takaka Primary Linzi Birmingham, the new manager States but moved to New Zealand from School, Jenny Bennet, said coming back of Golden Bay Community Integrated Canada earlier this year on a one-year to the Nelson area with her children and Health Centre, trained as a nurse. sabbatical to head Te Whare Mahana husband was like coming home. Originally from England, she has been Trust in Takaka, a residential program Bennet grew up in Nelson where she working in New Zealand for 15 years. for people suffering serious mental started adulthood as a young single "I don't know if I was delusional or health issues. parent. had this illusion that a small community A psychologist by profession, She then completed her teaching health centre was going to be a walk in Harvi.ll's work has mainly focused'on degree by correspondence and in the face the park when I have been managing people with serious mental illness and of being told she wasn't going to succeed, such big DHB. centres. How wrong was personality disorders. she did. I?" "We're also looking at developing She taught overseas and around New She said the centre was extraordi services more effectively in dealing with Zealand before moving to Golden Bay narily complex because it offered so people with trauma." late last year. many services w1der one roof. She said they would like to work with "I believe our children can know what "I know there's been some difficult patients' families more. they need at five years old. I believe at journeys over the past few years and "It's one thing to have the healing five years old they can know what their we've quite thankfully put that to rest." experience in Golden Bay but then you next steps are. I believe that because at Birmingham said she would like to have to go back. my last school on the East Coast where I see a "one stop shop" offered to patients "It's really important that we work on was the principal, my 5-year-olds were · in the community. that transition with families and going leading their student-led learning "The last thing you want to do when back."
25 he new faces leading Golden Bay sit with the community behind them. From front left Tony Keatley, Shelley Harvill, Jenny Bennet, Katrina utton and Linzl Birmingham. PHOTO NINA HINDMARSH/FAIRFAX NZ
. .. '·)
26 APPENDIX 8
From: Angela Francis To: Emily-Rose Richards Subject: FW: Meeting thanks - Date: Thursday, 26 May 2016 4:52:57 p.m.
-----Original Message----- From: John Moore [mailto:[email protected]] Sent: Tuesday, 24 May 2016 9:23 a.m. To: Angela Francis
Dear Angela, On behalf of the Victory Community Centre I wish to thank you for initiating the meeting last night. It was successful on many levels, not least the chance to sit down with our local GPs. We look forward to progress with all our issues. Can you please forward out thanks to them? At a personal level it was a delight to meet them! Thanks again, John Moore, Independent chair, VCC.
27 APPENDIX 9
Jenny Black Nelson Marlborough District Health Board Private Bag 18 Braemar Campus, Waimea Rd Nelson 7042 [email protected]
25 May 2016
Dear Jenny,
On behalf of the Pharmacy Guild Board I am pleased to announce that we have recruited Andrew Gaudin as the Guild’s new Chief Executive. Andrew will be starting with the Guild on 4 July 2016.
We are looking forward to working with Andrew and believe he brings a vast range of knowledge and experience to the table and is very well equipped to lead the Guild in supporting our members, advocating for community pharmacy, and working with the broader health sector.
Andrew has significant health sector experience, having spent more than 20 years in a variety of leadership and advisory roles at the Crown Company Monitoring and Advisory Unit, Ministry of Health, District Health Boards and healthAlliance. This includes five years as a Strategic Advisor in the Director General of Health’s office.
Andrew brings considerable knowledge and experience of the current Community Pharmacy Services Agreement, as he was closely involved in establishing this agreement in 2012. He was also involved in the policy decision to expand the provision of the Community Pharmacy Anticoagulation Management Service pilot across the community pharmacy sector.
I am delighted the Guild has secured a Chief Executive of such high calibre. The Board and headquarters team look forward to working with Andrew to continue to support members and add value to their businesses.
Between 30 May and 3 July 2016, Linda Caddick, our Professional Services and Support Manager will be our interim Chief Executive.
If you have any questions please feel free to contact me directly or via Emma, the Guild’s Office Manager, on [email protected].
Yours sincerely,
Ken Orr President Pharmacy Guild of New Zealand
28 APPENDIX 10 How is My PHO performing? for the 5 transitional IPIF measures 2015/16 QUARTER THREE (JANUARY TO MARCH) RESULTS
More Heart Better Help for Increased Increased Cervical and Diabetes Smokers to Quit Immunisation Immunisation Screening Quarter three Quarter three Quarter three Quarter three Quarter three performance Checks 90% performance (Primary Care) 90% performance (eight-month-olds) 95% performance (two-year-olds) 95% performance Coverage 80%
Alliance Health Plus Trust 92% 86% 95% 95% 74% Auckland PHO Limited 92% 92% 95% 92% 83% Central Primary Health Organisation 90% 88% 95% 95% 80% Christchurch PHO Limited 86% 69% 98% 97% 78% Compass Health – Capital and Coast 91% 83% 95% 95% 82% Compass Health – Wairarapa 91% 86% 97% 96% 80% Cosine Primary Care Network Trust 90% 87% 99% 98% 85% East Health Trust 91% 84% 97% 96% 82% Eastern Bay Primary Health Alliance 89% 79% 91% 86% 75% Hauraki PHO 91% 90% 93% 92% 77% Health Hawke’s Bay Limited 90% 78% 97% 94% 81% Kimi Hauora Wairau (Marlborough PHO Trust) 93% 78% 96% 94% 81% Manaia Health PHO Limited 92% 95% 92% 92% 79% Midlands Health Network - Lakes 92% 88% 98% 87% 83% Midlands Health Network – Tairawhiti 92% 93% 92% 94% 81% Midlands Health Network – Taranaki 92% 86% 94% 92% 87% Midlands Health Network – Waikato 92% 87% 94% 91% 82% National Hauora Coalition 91% 80% 96% 96% 75% Nelson Bays Primary Health 90% 93% 89% 91% 87% Nga Mataapuna Oranga Limited 81% 89% 97% 97% 76% Ngati Porou Hauora Charitable Trust 93% 91% 90% 88% 74% Ora Toa PHO Limited 88% 82% 93% 91% 74% Pegasus Health (Charitable) Limited 85% 88% 97% 95% 80% Procare Networks Limited 92% 90% 94% 94% 81% Rotorua Area Primary Health Services Limited 86% 67% 94% 96% 77% Rural Canterbury PHO 92% 79% 97% 95% 83% South Canterbury Primary & Community 91% 86% 92% 94% 82% Te Awakairangi Health Network 89% 79% 94% 95% 78% Te Tai Tokerau PHO Ltd 90% 81% 93% 91% 76% Total Healthcare Charitable Trust 91% 89% 95% 97% 69% Waitemata PHO Limited 91% 89% 94% 91% 82% Well Health Trust 93% 82% 91% 94% 73% WellSouth Primary Health Network 88% 90% 95% 94% 82% West Coast PHO 90% 82% 88% 84% 83% Western Bay of Plenty PHO Limited 89% 78% 92% 92% 84% Whanganui Regional PHO 92% 86% 95% 93% 80%
All PHOs 90% 86% 95% 94% 81%
More information on the Integrated Performance and Incentive Programme can be found on www.health.govt.nz/IPIF
29 APPENDIX 11
30 31 32 33 34 APPENDIX 12
35 To Nelson Bays Primary Health Board From Ward Steet, GM Health Services Endorsed by Angela Francis, Chief Executive Meeting date 7 July 2016 Subject General Manager Health Services’ Operational Report
For approval For action For information √
1. SERVICE OVERVIEW
The Health Services division continues to operate in a small surplus position Year To Date (YTD) against budget. The results for the third quarter Incentive Programme Performance Framework (IPIF), confirmed Nelson Bays Primary Health (NBPH) met three of the five IPIF targets, missing both the 8- month and the 24-month immunisation targets. Current Month To Date (MTD) data indicates NBPH are on track to achieve two out of the five indicators for the fourth quarter. The Cardiovascular Risk Assessment is tracking at 89% (target 90%), with one practice in particular significantly underperforming. Attempts are being made to assist the practice to achieve compliance. The Nelson Tasman catchment immunisation decliner rate remains the key issue regarding non-compliance with the two immunisation targets.
The NBPH subcontract template has been revised to ensure it aligns with the PHO Services Agreement minimum requirements. Subcontracts are currently being prepared and will be issued shortly.
There has been a focus on reducing excess leave liability. The Health Services division has only three staff with leave liability in excess of one year’s entitlement. Action plans have been written detailing how the liability will be reduced and has been requested from the relevant Managers.
2. PHARMACY
Nelson Marlborough District Health Board (NMDHB) Pharmacy Restructure The new NMDHB Pharmacy Services Manager appointment is yet to be announced. As soon as the appointment is made, a meeting will be arranged to meet with the new manager to discuss the future of Pharmacy services in the region and highlight the importance of the community-based pharmacy facilitator roles.
Golden Bay Pharmacy Service Consultation documents for the Golden Bay Pharmacy service have been released by NMDHB. The consultation period ends 29 July 2016. NBPH has requested a meeting with NMDHB to discuss the proposal and information will be presented to the Clinical Governance Committee meeting on 21 July 2016.
3. MENTAL HEALTH
Funding for Primary Mental Health Initiative (PMHI) The PMHI funding is yet to be confirmed by NMDHB. NBPH continues to lobby for additional funding in this area, particularly for mild to moderate mental health, as this area has high demand and has an
36 identified gap in service delivery with demand significantly exceeding supply. Youth mental health is another area in need of additional funding.
Gateway It has been confirmed that the Ministry of Social Development (MSD) will continue to fund the Gateway program for at least another year. However, NBPH are yet to receive confirmation of the exact funding that will be received. The existing delivery model will be retained with two services across the Nelson Marlborough region delivered by Kimi Hauora Wairau (KHW) and NBPH respectively. A meeting is scheduled with NMDHB on 28 June 2016, where the exact model and funding is likely to be finalised.
PATHS The MSD has notified NBPH that the PATHS programme is being ceased across the nation. While the contract ends 30 June 2016, NBPH have negotiated an additional two months funding so that the staff member can be provided with the required notice period of the position ending.
Strengthening Families The MSD has confirmed funding for the Strengthening Families programme for an additional year. However, NBPH are yet to receive confirmation of the exact funding that will be received. The program is running in a small deficit currently and will need reviewed if additional funding is not received for 2016/17.
Youth Mental Health Teen Fest was successfully delivered across the Nelson Tasman region. This programme has been embraced by the schools and youth alike and has proven to be a very successful mechanism to engage with the client cohort. Teen Fest is included as part of the NMDHB Annual Plan for 2016/17 and NBPH is lobbying for dedicated resource to be allocated to the co-ordination function for this valuable initiative.
NMDHB Mental Health Restructure Within the restructure, NMDHB Mental Health Services will form a new directorate combined with Disability Support Services (DSS) under a new General Manager (GM) position. The GM DSS and GM Mental Health positions have been disestablished and the new GM position will be advertised shortly. There has been some concern raised about the combining of these two services as they each have distinctly different interfaces and needs.
4. HEALTH PROMOTION
Falls Prevention The ToSHA vote on the ACC funded fracture liaison and home-based community falls prevention programme business case resulted in NMDHB becoming the lead agency for the programme. NBPH is in negotiation with NMDHB to secure funding to provide the co-ordination and Single Point of Entry (SPOE) functions for the programme, a function NBPH have been leading for the last four years. An Expression of Interest (EoI) for the community-based strength and balance component is due for release at any time. NBPH will be submitting an application to deliver this service.
Green Prescription The National Green Prescription survey results were pleasing with NBPH clients expressing improved satisfaction with the service consecutively for the last two years. NBPH is one of the only services across New Zealand that is successfully meeting the target. Demand for the service continues to grow which is putting pressure on an already stretched resource. The introduction of gestational diabetes to the eligible population is being questioned by NBPH due to the inherent medical instability of this cohort of client and the associated risk.
37 5. PRIMARY HEALTH
Respiratory Service Meetings have commenced between the Asthma Society and NBPH to plan the development and implementation of the new Pulmonary Rehabilitation service. The key objective is to build capacity and capability within the Asthma Society to manage the programme into the future. Plans to increase the spirometry service capability across the region have also progressed. Correspondence has been sent to NMDHB acknowledging and thanking them for their contribution towards the purchase of new spirometry equipment for the General Practices (GP’s).
After Hours Telephone Nurse Triage The NMDHB and NBPH are meeting with Home Medical Ltd on 28 June 2016 to negotiate the new terms for the after-hours telephone nurse triage service. The current contract terms are not sustainable moving forward as they would result in the service costs far exceeding the available funding.
Smoking Cessation and ABC Smoking NBPH ordinarily performs very well in the National rankings for this IPIF measure, with the majority of GP’s easily exceeding the national target of providing brief advice to 90% smokers. One GP in particular is having problems complying with the requirement and it is impacting greatly on our performance as a collective and has potential to impact funding received from the Ministry of Health, due to the decrease in performance.
Education NBPH remains committed to the provision of Continuing Nursing Education (CNE) and Continuing Medical Education (CME) for the GP’s. The Education Committee is currently preparing the education calendar for CNE for 2016/17, based on the feedback received over the last year and a survey of the Practice Nurses. NBPH is also investigating the suitability of the Pegasus Small Group Education model for the delivery of CME across the region.
6. SPECIALIST SERVICES
Infectious Diseases The service continues to be exceptionally responsive with very low waiting periods.
Community Rheumatology Service Negotiations with NMDHB were successful in securing some additional funding for this programme in 2016/17. The programme has run at a loss over 2015/16, however by re-engineering the service across the broader region, the service will be more efficient and more responsive in 2016/17. The waiting periods have steadily reduced over the last year and this trend will continue as the new model of care is implemented.
7. RECOMMENDATION
It is recommended that: • The Board receives the report.
38 To Nelson Bays Primary Health Board From Naomi Johnson, Lead Health and Safety Representative Endorsed by Angela Francis, Chief Executive Meeting date 7 July 2016 Subject Health and Safety Report
For approval For action For information √
1. OVERVIEW AND UPDATE
The following provides a high level update on Health and Safety for Nelson Bays Primary Health (NBPH). The report covers both the Richmond and Golden Bay sites.
2. TRAINING STATUS
There were 13 clinical and administration staff from 281 Queen Street, that attended the de-escalation training, provided by Karen Winton. Karen received positive feedback regarding the training and staff felt more confident about using de-escalation techniques, if required.
In May, the Area Wardens from 281 Queen Street received their annual training on the emergency evacuation procedures, which was provided by Opus International Consultants Ltd. The training was well received and all instructions have also been communicated with the facility staff, as Health and Safety is everyone’s responsibility.
3 HEALTH AND SAFETY AT WORK ACT 2015
Work is ongoing to ensure that policies and procedures are consistent with the new legislation.
4. INCIDENT AND HAZARD REPORTING
For the month of May, there were zero hazard identification and risk forms submitted by 281 Queen Street staff to the Management Operations Group. The work is ongoing to complete the implementation of risk management strategies, for the hazards previously identified.
The majority of the Health and Safety hazards and incidents below, were reported by Golden Bay Community Health (GBCH) staff. This is to be expected due to the nature of the services delivered to a high needs population in Golden Bay. There were zero serious harm events reported this month.
39 Table 2. Near Miss and Incident Records:
This Month: Total for May 2016 May GBCH Richmond Near-Miss: no harm 2 1 3 Actual: no harm 23 0 23 Actual: injury 5 1 6 Serious Harm 0 0 0 Total 30 2 32
Incident Reporting Trends: April to May 2016 25 23 21 20
15
10 9
6 5 5 2 1 1 1 0 0 0 0 0 0 0 0 Near miss: Near Actual, no Actual, no Actual, injury: Actual, injury: Serious Harm: Serious Harm: GBCH miss:NBPH harm: GBCH harm: NBPH GBCH NBPH GBCH NBPH
April May
5. OTHER HEALTH & SAFETY MATTERS
Stress in the Workplace
It is difficult to identify stress in the workplace, as stress can be mediated by both workplace and personal factors. To guide the organisation in this, the usage of the Employee Assistant Programme (EAP) services over the last three months, has been reviewed. The EAP is a confidential service and the matters raised are not necessarily stress related. The statistics on the usage of this service are shown below. This is based on the number of calls.
Richmond Golden Bay Total March 2016 0 6 6 April 2016 0 2 2 May 2016 0 2 2
40 Fleet Vehicle Safety
A new risk-mitigation process is being implemented regarding the fleet vehicle safety checks at 281 Queen Street. The new process includes: • Full service check every two months via Bowater Toyota, in addition to the annual service and Warrant of Fitness checks • A clipboard has been placed in each fleet v ehicle, including the driver safety checklist/information, vehicle damage report forms and vehicle accident reference sheets and report forms.
5. RECOMMENDATION
It is recommended that: • The Board receives the report.
41 To Nelson Bays Primary Health Board From Angela Francis, Chief Executive Meeting date 7 July 2016 Subject ToSHA Update
For approval For action For information √
1. BACKGROUND
Attached for the Board’s information is ToSHA Dashboard as presented at the ToSHA meeting on 30 June 2016. Refer to Appendix 1 for the ToSHA Dashboard.
The ToSHA meeting was held at Nelson Bays Primary Health on 30 June 2016. The next ToSHA meeting is scheduled for 28 July 2016.
2. RECOMMENDATION
It is recommended that: • The Board receives the report.
Appendix: 1. ToSHA Dashboard
42 APPENDIX 1
ToSHA at a Glance As at: May 2016
Acute Demand Management In progress
Medicines Management In progress
Primary Care Strategy On track
CVD/Diabetes On track
Rural Services In progress
Access to Diagnostics In progress
Health of Older People On track
Promoting Health In progress
Key
Currently being established
Progressing, but slower than expected
Delivering or expected to deliver on time
Needs ToSHA review. Exception report included
Exceeding expectations
43 ToSHA Dashboard Activity As at: May 2016 Acute Demand Management In progress Achievements Planned Activities Spirometry service incorporated in to PHO Further investigate possible additional services ❶ Option for Care contracts ❶ including alignment of specialist respiratory care services with primary care Community Response Advisory Group Continued refinement of the overarching Community ❷ meeting held and further work completed on ❷ Response framework understanding the patient population ❸ ❸
Medicines Management In progress Achievements Planned Activities ❶ No update to report ❶ ❷
CVD/Diabetes On track Achievements Planned Activities Principles document drafted to align the Update health pathways to reflect recent changes ❶ three self management services across ❶ TPO, KHW and NBPH Meeting between primary care and Diabetes Progress further heart function nurse training in ❷ Nurse Specialists to progress DNS activity ❷ primary care in primary care Pathways updated for self management, Continue to identify gaps delivering to the diabetes ❸ with other areas of change to be updated ❸ standards of care and ensure services realigned to fill over coming months those gaps
44 2 Rural Services In progress Achievements Planned Activities Location planning at Golden Bay has Document Golden Bay locality plan and explore ❶ started with a site visit by the Laboratory ❶ financial considerations. Manager. ❷ ❷ Undertake locality planning at other rural areas. ❸ ❸ Progress further integration of community nursing with practices.
Access to Diagnostics In progress Achievements Planned Activities ❶ Progression of Wairau X-ray process ❶ Review Nelson X-ray Voucher access criteria ❷ Definition of System Integration Plan ❷ Development of Wairau X-ray model milestones ❸ Sucessful completion of National Radiology ❸ Service Improvement Project
Promoting Health In progress
Achievements Planned Activities
❶ Opportunity to develop multi-agency AHRS ❶ PHS to meet with key staff in DHB to recruit the has been thoroughly tested. Steering Group members. ❷ Process to develop health-sector AHRS re- ❷ PHS to meet with the other health organisations to commenced. recruit the Steering Group members. ❸ ❸ PHS to meet with Communications staff to discuss internal communications.
Health of Older People On track Achievements Planned Activities ❶ HOP and Stroke Annual Plans approved ❶ Completion of Business Case HOP restructure ❷ Support Works re-homed into Richmond ❷ Complete contract for In House Falls Prevention Hub Programme partnered with PHO and ACC. ❸ Large Rest Home investigation completed ❸ Further explore HOP integration with NMDHB Rapid Nelson response model
Primary Care Strategy On track Achievements Planned Activities ❶ Draft completed ❶ Plan and progress community engagement ❷ Draft reviewed ❷ Finalise strategy post community engagement ❸ Started community engagement planning ❸ Refine action plan with new GM Strategy, Primary & Community
45 3 ToSHA Reporting Calendar 28-Jan-15 17-Mar-16 12-May-16 30-Jun-15 28-Jul-15 8-Sep-16 20-Oct-15 24-Nov-16 Dec-16
Health of Older People
Acute Demand Management
Child & Maternal Health Integration Pilot
Medicines Management
Primary Care Strategy
CVD/Diabetes
Rural Services
Access to Diagnostics
Being Healthy
Key Progress Report Annual review
46 Chair Alliance Support
Access to Diagnostics Dr Graham Loveridge Tom Wheatley
Acute Demand Management Dr Andrew Morgan Rebecca Mason
Being Healthy tbc Claire McKenzie
Child & Maternal Health Integration Pilot Annette Milligan Jane Kinsey
Health of Older People tbc Gabrielle Stent
CVD/Diabetes Pauline Tout Andrew Goodger
Medicines Management Maria Alexander Glenis McAlpine
Primary Care Strategy tbc Belinda Wheatley
Rural Services Dr Buzz Burell Andrew Goodger
KEY TO DASHBOARD SYMBOLS In development Workstream/SLAT is in planning stages In progress Workstream/SLAT is progressing, but pace is slower than expected On track Workstream/SLAT is delivering, or expected to deliver on time Exceeding expectations Workstream/SLAT is deliver more than expected, or ahead of delivery schedule Critical Workstream/SLAT is not progressing to plan and requires ToSHA intervention
Additional note Workstream has not met since last report
47 To Nelson Bays Primary Health Board From Emily-Rose Richards, Executive Assistant/Board Secretary Endorsed by Angela Francis, Chief Executive Meeting date 7 July 2016 Subject Committee Meetings Update
For approval For action For information √
1. BACKGROUND
This report presents to the Board the unconfirmed minutes of the: • Te Tumu Whakaora meeting held on 16 June 2016
Refer to Appendix 1 for the Te Tumu Whakaora Minutes – 16 June 2016.
2. RECOMMENDATION
It is recommended that: • The Board receives the report.
Appendix: 1. Te Tumu Whakaora Minutes – 16 June 2016
48 APPENDIX 1
Nelson Bays Primary Health Trust
Te Tumu Whakaora Committee Meeting
Minutes of meeting held at 3.30pm on Thursday 16 June 2016 at Nelson Bays Primary Health, 281 Queen Street, Richmond
PRESENT: Lisa Lawrence (Chair); Chris Knight; Kim Ngawhika; Myra Dick; Ra Hippolite.
IN ATTENDANCE: Angela Francis, Chief Executive; Emily-Rose Richards, Executive Assistant/Board Secretary; Luke Katu, Kaitakawaenga; Ward Steet, General Manager Health Services.
1.0 Mihi/Welcome Karakia – Luke Katu
2.0 Apologies: Hemaima Hughes, John Hughes, Neil Whittaker, Harvey Ruru.
3.0 Register of Interests
3.1 Amendment to the Register of Interests
Remove for Myra Dick: Member of Waka Ora – Whānau Ora Project Governance Group for Te Waipounamu
Kim Ngawhika’s information received.
3.2 Declaration of Conflicts in Relation to Today’s Business
There were none.
4.0 Confirmation of Minutes of 19 May 2016
The minutes of 19 May 2016 were confirmed as a true and accurate record. Lawrence/Hippolite
4.1 Matters Arising
4.1.1 There was none.
4.2 Action Points
Some matters for consideration this month had been dealt with, formed part of today’s agenda or were discussed as follows:
4.2.3. There was no decision made at the last Iwi Health Board hui. Carry forward.
4.2.4. Lisa will discuss with Anne. In progress.
A2. Kim Ngawhika has been appointed a member of Te Tumu Whakaora. Chris Hill and Kuia Geiger will be appointed as members before the next hui, once police vetting checks 49 TO BE CONFIRMED have been received. Chrissy Randall declined the invitation to be a member due to other commitments. Completed.
A3. Completed.
A8. Refer to agenda item 6.1. Completed.
A9. Completed.
A10. Carry forward.
A11. Completed.
A12. Completed.
5.0 Updates
5.1 NBPH Board Update – Lisa Lawrence
A verbal update was provided.
The Board hui on 2 June focused on the end of the financial year and ensuring NBPH are on track financially and statistically.
There will be an overall review of the Board Subcommittees to ensure they are cohesive in their respective workflows.
5.2 Top of the South Health Alliance (ToSHA)
Dashboard taken as read.
The Primary and Community Strategy is now complete and the action plan is being developed. A Roadshow will be conducted within the next quarter to showcase the Primary and Community Strategy and action plan to the community and staff.
5.3 Clinical Governance Committee
Minutes of 19 May 2016 noted.
The Clinical Governance Committee are currently considering their Terms of Reference, with the renewed Terms of Reference being approved at the 21 July hui. A recommendation from Te Tumu Whakaora has been submitted requesting for two Māori memberships to be included on the Clinical Governance Committee. This has the support of the Chair of the Clinical Governance Committee and will be considered against the overall Board discussion on the direction of Subcommittees.
6.0 Strategic Items
6.1 Te Tiriti o Waitangi Policy
It was noted the updated Te Tiriti o Waitangi policy relates to partnership, participation and protection. The policy covers the broader perspective of health to ensure the organisation has appropriate relationships with the Māori communities.
The Te Tiriti o Waitangi policy is reflected in the Māori statement in subcontracts, Māori Health Strategy, Quarterly Reporting Templates and the NBPH Operational Plan to ensure there is consistency across the organisation. It was asked for there to be a consistent use of macrons throughout the policy document. 50 TO BE CONFIRMED It was noted Myra does not have the level of confidence to endorse the policy without seeing the procedure, to ensure the policy will be implemented. The Te Tiriti o Waitangi procedure will come to the August Te Tumu Whakaora hui for information. A13
Te Tumu Whakaora approved the policy subject to the review of the procedure to be received. One member voted against the motion.
7.0 Operational Items
7.1 Māori Mortality Rates
It was noted the Management Operations Group received a presentation on the Māori population in the Nelson Tasman region which saw the Māori population numbers decrease in the age groups 45 to 64 and 65+ when compared to non-Māori. The Management Operations Group felt it was appropriate to send the statistics to Te Tumu Whakaora to inform them of the Māori mortality rates.
It was decided for the Māori mortality rates to be provided to all presenters at Te Tumu Whakaora as a guideline on the context required in presentations.
8.0 Presentation
8.1 Podiatry – Luke Katu
The Podiatry service is subcontracted to Justin Powell, Mapua Podiatry.
It was noted the DNA rates at Mapua Podiatry are low. Luke has asked Justin to report on specific Māori data, with 13% of the patients using the Podiatry service being Māori.
Luke was asked to provide feedback to Justin Powell on behalf of Tumu Whakaora on the exceptional job he is doing, the benefits for Whānau from him being on the Marae and the flexibility to working with everyone. It is a valuable service being provided. A14
Podiatry Service Presentation - 16 June 2016.pptx
9.0 General Business
9.1 There was none.
10.0 Correspondence
There was none.
The hui closed at 4.40pm.
Next Hui: Thursday 21 July 2016
Meeting Dates 2016 21/07/16 18/08/16 15/09/16 20/10/16 17/11/16
51 TO BE CONFIRMED To Nelson Bays Primary Health Board From Dr Sue Stubbs Meeting date 7 July 2016 Subject Telemedicine/Telehealth
For approval For action For information √
1. PURPOSE
To provide a brief overview of Telemedicine and it’s possible relevance to Nelson Bays Primary Health (NBPH) and Golden Bay Community Health (GBCH).
2. SUMMARY
Telemedicine is the use of information and communication technologies to deliver health care when patients and care providers are not in the same physical location.
Health carerelated education, research and evaluation can also take place using Telehealth.
Telehealth has many benefits including: • People can be seen by their health professional and care team without having to leave the area in which they live • People can better monitor and manage their health • Lower health care costs overall • More flexibility for the health workforce.
Telemedicine is becoming an increasingly common part of medical practice. If we fail to take advantage of new technology then we risk failing to meet patient expectations and some of our patients, particularly isolated patients and those with mobility issues, may continue to struggle to access the care that they need.
NBPH is already providing or supporting Telehealth in a number of ways: • Videoconferencing for meetings and education • Storing and forwarding images from general practitioners to the Minor Skin Lesion Service • Encouraging and supporting the use of patient portals in General Practices.
There remains further opportunities for NBPH to encourage and support telehealth in primary care. Researching business models for teleconsulting in primary care, already occurring in other parts of NZ, could assist practices to introduce teleconsulting here as part of the extended general practice model. Refer to Appendix 1 for the overview report on Telemedicine/Telehealth by Dr Sue Stubbs.
3. RECOMMENDATION
It is recommended that: • The Board receives the report.
Appendix: 1. Overview report of Telemedicine/Telehealth by Dr Sue Stubbs 52 APPENDIX 1
Defining Telemedicine and Telehealth
In much of the healthcare industry, the terms “telehealth” and “telemedicine” are often used interchangeably. However, if you want to get technical, telemedicine is really a subset of telehealth. Whereas telehealth is a broad term that includes all health services provided using telecommunications technology, telemedicine refers specifically to clinical services.
Here are a couple quick examples:
Telehealth: ● A public health app that alerts the public of a disease outbreak ● A videoconferencing platform for medical education
Telemedicine: ● A mobile app that lets clinicians treat their patients remotely via videochat ● A software solution that lets primary care providers send patient photos of a rash or mole to a dermatologist at another location for quick diagnosis
As the field of telehealth continues to expand and change, these terms are likely to change and encompass even more health services.
There are three main categories of telemedicine:
Remote patient monitoring (telemonitoring) allows patients with chronic diseases to be monitored in their homes through the use of devices that collect data about blood sugar levels, blood pressure or other vital signs. The data can be reviewed instantly by remote caregivers.
Store and forward technology stores clinical data, as well as Xrays and other images, and forwards the data to other locations for evaluation.
Interactive telemedicine (teleconsulting) allows clinicians and patients to communicate in real time. Such sessions can be conducted in the patient's home or in a nearby medical facility.
This topic of telemedicine arose for the NBPH Board in the context of telemedicine being provided in remote communities such as Golden Bay.
Golden Bay has primary care services but people need to travel for secondary care services to the Nelson/Richmond area NBPH or to Nelson Public Hospital or to private specialists.
In addition, clinicians often feel isolated from training and continuing education options available in more populated areas.
53 Resources for Considering Telehealth/Telemedicine
The National Health IT Board aims to:
● provide leadership across the New Zealand health and disability sector for IT investments that offer patient safety and value for money ● build relationships while progressing critical foundation investments to support an improved health information model, and support future healthcare delivery models ● set a direction for the appropriate and effective use of personal health information.
Their website has much information and many examples of telehealth being used in NZ though much would appear to be in pilot projects and still in development phases.
Of particular relevance to NBPH would be the West Coast Telemedicine Model. The West Coast has a chronic doctor shortage and part of addressing that solution has been with telemedicine.
“Telemedicine equipment is being used across the West Coast and enabling patients to link up with GPs, hospital specialists and others – who may be hundreds of kilometres away.
Modern highdefinition video links – have been deployed in eight towns up and down the Coast – from Karamea in the north to Haast in the south.
Those towns have medical centres staffed round the clock by rural nurse specialists who provide most of the care. A GP is only on site one day a week.
In the past if a patient needed to see the GP they often faced a sixday wait or a long drive to one of the provincial centres. Patients in those towns are able to book a video link – with a GP or specialist in Greymouth or Westport. ‘The nurse stays with them during that hookup to carry out any measurements that may be required, to support the patient and to begin planning followup care.Using these video units – known as ‘telemedicine’ – includes a second handheld video camera, so the doctor can see things like skin lesions or rashes in extreme closeup.
‘We don’t talk about primary health and secondary health on the Coast – we just talk about health,’ Jenny Robertson says.(manager of Buller health in Westport). “
54 Waikato DHB launches first NZ virtual health service.
“Virtual DHB lets patients talk to their hospital doctor over their smartphone from home instead of travelling to an outpatient appointment.
Waikato DHB is gradually signing up doctors from all its services across its five hospital sites and is talking to GPs and other community organisations about opportunities this service can offer their patients too.”
“If your doctor is registered on the system and they deem it appropriate for your particular treatment, it means you can choose to have a video conference call or text chat with the doctor via the app from your home or work rather than travelling to the hospital.”
Patients will also be able to use the app to book an appointment with their specialist, share a medical photo with them, send a direct message to their doctor like a text, and view their health record on the app. A multidisciplinary team of professionals who are caring for the patient will all have access to the shared care plan and can discuss the patient’s care with each other.
Patients can access health information, tips and the latest research to help them manage their own health effectively.”
What isnt so clear in the information on line, is how these models are funded and what safeguards and strategies are in place for patient privacy and safety.
The Medical Council of NZ has produced a Statement on Telehealth, and stresses in that statement that treatment via telemedicine should meet the same standards of care provided in a face to face consultation.
The NZ Telehealth Forum has a Guideline for Establishing and Maintaining Sustainable Telemedicine Services in New Zealand. This is a very detailed document and does outline the complexities and extensive requirments for providing a telemedicine service. It would appear to have been written mainly for full consultations between patients and clinicians, especially between patients and secondary care services.
55 It seems likely that telemedicine will eventually proceed from the electronic referral system :
Figure 1. eReferral pathways
Telehealth and NBPH
Having viewed these various documents and models, my thoughts would be that NBPH concentrate on continuing to assist patients and practices with patient portals, and with the telemonitoring and storeandforward technologies, as these technologies are both requirements for good teleconsulting.
“However, it is believed that no physical examination is necessary in a third of general practice consultations, suggesting the potential and appropriateness for teleconsultation. And video consulting is associated with advantages, including to enable fair and equitable access to care, which may apply particularly to rural, Māori and Pacific patients.”
Teleconsulting will flow on from the telemonitoring and store and forward technologies, and patients are increasingly knowledgable about and requesting patient portals.
NBPH could also look at developing teleconsulting between Golden Bay and NBPH services of rheumatology and infectious diseases, as those specialties reside within NBPH. It is likely that patients would generally require a face to face visit for their first specialist assessement, but teleconsulting could be very useful for follow up appointments.
56 At the present time, I can see that there are major benefits for secondary care to embrace teleconsulting as the patient does not pay for secondary care consultations. And the patient benefits from ease of access and less travel.
Primary care has a different system and has to consider different financial and business models. The current general practice system would need some assistance in developing a process that was reasonable and sustainable financially. NBPH could investigate how funding of teleconsultations in primary care is funded elsewhere and what systems are available for patient payments for telehealth.
Telehealth technologies could also be very useful for Golden Bay for peer review and CME once the technologies are reliable and high quality.
Telehealth comes under the “Smart System” Signpost for the NZ Health Strategy and also “Strategic Outcome 5: Technology” in the Primary and Community strategy.
Dr Sue Stubbs
June 2016.
http://www.telehealth.co.nz/images/telehealth/guidance/150303_Telemedicine_Guideline_for_NZ TRC.pdf https://www.mcnz.org.nz/assets/NewsandPublications/Statementontelehealthv3.pdf http://evisit.com/whatistelemedicine/ http://healthitboard.health.govt.nz/whowework/newzealandtelehealthforum/telehealthreso urcesandcasestudies http://healthitboard.health.govt.nz/healthitgroups/newzealandtelehealthforum/telehealthresou rcesandcasestudies/westcoastcase http://www.waikatodhb.health.nz/forpatientsandvisitors/virtualdhb/ https://www.nzma.org.nz/journal/readthejournal/allissues/20102019/2014/vol127no.1398/62 24
57 Board Work Programme v 22 May 2016
2015 2016 Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Oct Nov Dec BOARD Meetings Richmond 5 4 3 7 5 2 7 4 1 6 27 Golden Bay 3 7 Strategic Planning Day 6 NBPH and KHW Board Meeting – Havelock 20 Events Board dinner 4 Agenda items Board appointment process (A6) x Delegations policy (A9) x Appointment of Deputy Chair x Subcommittee appointments review x Approve audited financial statements x Approve 2016/17 Budget x Other Review annual formal appointments of Board x members to AFRIC and Gov and Rem Send Fit and Proper declarations to Trustees for x completion COMMITTEES Remuneration and Governance Meetings 19 18 18 26 19 17 Chief Executive performance Staff/Providers/Stakeholders Survey – carry out x appraisal Staff/Providers/Stakeholders Survey – review x Chief Executive performance appraisal meeting x Other Completed Fit and Proper declarations – review x Audit and Financial Risk Meetings 19 1 Agenda items Review and recommend the budget x Consider 2015-16 audited financial statements x
Te Tumu Whakaora Meetings - 17 18 17 21 19 16 21 18 15 20 17 15
Clinical Governance Council Meetings 19 17 18 17 21 19 16 21 18 15 20 17 15
AGM Meeting x Agenda items Adopt Annual Report x Appoint Auditors 2016/17 x
58 2015 2016 Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Oct Nov Dec OTHER Strategy and Budget Cycle Strategic Planning Day 6 Strategic Plan Annual Plan Audit 25 - 5 Budget process x x x Consider 2016/17 Budget x Kimi Hauora Wairau Board meetings Blenheim - 17 30 - 11 29 - 10 - 2 14 AGM Blenheim 21 Public Holidays Nelson Anniversary Day 1 Waitangi Day (observed) 8 Good Friday 25 Easter Monday 28 Anzac Day (observed) 25 Queen’s Birthday 6 Labour Day 24
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