1

MidCentral District Health Board Health & Disability Advisory Committee

Venue: Boardroom, Gate 2 Heretaunga Street, Palmerston North

When: Tuesday 4 February 2020, 9.00am

A consumer story workshop for members will be held at the conclusion of Part 2 of the meeting at 11.50am followed by an Annual Planning workshop from 1.00 – 2.30pm after lunch.

Attendees: Brendan Duffy (Board Chair), Oriana Paewai, Norman Gray, Materoa Mar, Karen Naylor, John Waldon, Muriel Hancock, Jenny Warren, Lew Findlay, Vaughan Dennison, Heather Browning. Kathryn Cook - Chief Executive, Tracee Te Huia – General Manager, Maori Health, Gabrielle Scott – Executive Director Allied Health, Judith Catherwood – General Manager, Quality & Innovation, Craig Johnston – General Manager, Strategy, Planning & Performance, Committee Secretary.

In Attendance: Item 2.1 Lyn Horgan, Sarah Fenwick, Dr Jeff Brown, Cushla Lucas, Dr Claire Hardie, Debbie Davies, Scott Ambridge, Dr Vanessa Caldwell, Andrew Nwosu, Dr Syed Zaman – Operations & Clinical Executives Item 2.2. Scott Ambridge, Operations Executive Item 3.4 Celina Eves, Executive Director Nursing & Midwifery Item 4.1 Angela Rainham, Locality & Population Health Manager Strategy, Planning & Performance

AGENDA – Part 1

1. KARAKIA 09.00

2. ADMINISTRATIVE MATTERS PAGES

2.1 Apologies – Karen Naylor, Member 2.2 Late Items 2.3 Conflicts and / or Register or Interests Update 3-4 2.4 Minutes of the Previous Meeting 5-10 2.5 Schedule of Matters Arising 11

3. PERFORMANCE REPORTING 09.15

3.1 Cluster Update for November and December 2019 12-46 3.2 Enable New Zealand Report to 31 December 2019 47-51

REFRESHMENT BREAK 10.40 2

3. PERFORMANCE REPORTING CONTINUED

3.3 Pae Ora Paiaka Whaiora Progress Update 52-62 3.4 Clinical and Professional Report: Nursing and Midwifery 63-75 3.5 Manawatū District Health and Wellbeing Plan Update 76-91

4. INFORMATION PAPERS PAGES 11.35 Information papers for the Committee to note

4.1 Committee’s Work Programme 2019/20 92-95 4.2 2020/21 Annual Plan Approach and Priorities 96-104

5. LATE ITEMS

6. DATE OF NEXT MEETING

17 March 2020, Boardroom MidCentral District Health Board, Gate 2 Heretaunga Street, Palmerston North.

7. EXCLUSION OF PUBLIC

Recommendation: that the public be excluded from this meeting in accordance with the Official Information Act 1992, section 9 for the following items for the reasons stated:

Item Reason Ref “In committee” minutes of For the reasons set out in the order paper the Health & Disability of 26.11.19 meeting held with the public Committee meeting present

KARAKIA

He Karakia Timata

Kia hora te marino Kia whakapapa pounamu te moana Hei huarahi ma tatou I te rangi nei Aroha atu, aroha mai Tatou I a tatou I nga wa katoa Hui e taiki e

May peace be widespread May the sea be smooth like greenstone A pathway for us all this day Give love, receive love Let us show respect for each other 3 Board Members Register of Interests: Summary, January 2020 (Full Register of Interests available on Governance SharedNet Site) Name Date Nature of Interest / Company/Organisation Browning, Heather 4.11.19 Director - HB Partners Limited Member - MidCentral Governance Group Mana Whaikaha Board Member and Chair, HR Committee - Workbridge Duffy, Brendan 3.8.17 Chair & Commissioner - Local Government Commission Trustee - Electra Trust Member - Environmental Legal Assistance Fund, Ministry for the Environment Chairperson - Business Kapiti Horowhenua Inc (BKH) 8.9.19 Member - Representation Commission

Dennison, To be advised. Vaughan Findlay, Lew 1.11.19 President, Manawatu Branch and Director Central District - Grey Power Councillor - Palmerston North City Council Treasurer - Abbeyfield Gray, Norman 10.12.19 Employee - Wairarapa DHB Branch Representative - Association of Salaried Medical Specialists Hancock, Muriel 4.11.19 Sister is casual employee (Registered Nurse, ICU) - MidCentral DHB Volunteer, MidCentral DHB Medical Museum

Mar, Materoa 16.12.19 Te Tihi o Ruahine Whanaui Ora Alliance EMERGE Aotearoa Matanga Mauri Ora Etipu Rea Science Challenge Naylor, Karen 6.12.10 Employee - MidCentral DHB Member & Workplace Delegate - NZ Nurses’ Organisation 9.10.16 Councillor - Palmerston North City Council Paewai, Oriana 1.5.10 CEO - Rangitane o Tamaki nui a Rua Member - Te Runanga o Raukawa Governance Group Chair - Manawhenua Hauora Member - Child Health Tamariki Ora District Group

13.6.17 Co-ordinating Chair - Te Whiti ki te Uru Trustee - Tararua Hauora Services Charitable Trust Member Alliance Leadership Team (Central PHO Board) - Central Primary Health Organisation Member Clinical Governance Group - Feilding Health Care Member Nga Manu Taiko, a standing committee of the Council - Manawatu District Council

Member Governance Board - Te Ohu Auahi Mutunga (TOAM)

Member - Before School Checks (B4SC) Collective

Committee Member - Nga Kaitiaki o Ngati Kauwhata Inc

Member - Te Tihi o Ruahine Whanau Ora Alliance

30.8.18 Board Member - Cancer Society Manawatu Waldon, John 22.11.18 Co-director and co-owner - Churchyard Physiotherapy Ltd Co-director and researcher - 2 Tama Limited Manawatu District President – Cancer Society Executive Committee Central Districts (rep for Manawatu, 1 of 2) - Cancer Society Member Clinical Board - MidCentral DHB

Warren, Jenny 6.11.19 Team Leader Bumps to Babies - Barnardos New Zealand Consumer Representatives National Executive Committee - National On Track Network Pregnancy & Parenting Education Contractor - Palmerston North Parents’ Centre

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Committee Members Hartevelt, Tony 14.8.16 Independent Director - Otaki Family Medicine Ltd 14.8.16 Elder son is Director, Global Oncology Policy based at Head Office, USA - Merck Sharpe & Dohme (Merck) (NZ operations for Global Pharmaceutical Company) 14.8.16 Younger son is news director for Stuff.co.nz - Fairfax Media 7.10.19 Independent Chair, PSAAP’s Primary Care Caucus - Primary Health Organisational Service Agreement Amendment Protocol (PSAAP)

Management Cook, Kathryn 1.7.16 Director - Central Region’s Technical Advisory Services Ambridge, Scott 20.8.10 Nil Anjaria, Keyur 17.7.17 Wife is a user of the Needs Assessment & Service Co-ordination Service - MidCentral DHB Brown, Jeff Caldwell, 7.5.18 Nil Vanessa Catherwood, 1.5.18 Nil Judith Davies, Deborah 18.5.18 Member, Alliance Leadership Team -Central PHO Daughter is an employee and works within hospital services - MidCentral DHB

Eves, Celina 14.5.18 Owner personal consulting company, UK - Celina Eves Limited Trustee midwifery charity in UK - Iolanthe Midwifery Trust Fenwick, Sarah 13.8.18 Nil Hansen, Chiquita 9.2.16 Employed by MDHB and seconded to Central PHO 8/10ths - MidCentral DHB CEO - Central PHO Hardie, Claire 13.8.18 Member -Royal Australian & NZ College of Radiologists 13.8.18 Trustee - Palmerston North Hospital Regional Cancer Treatment Trust Inc 13.8.18 Member, Medical Advisory Committee - NZ Breast Cancer Foundation Horgan, Lyn 1.5.17 Sister is Coroner based in Wellington - Coronial Services 18.5.18 Member, Alliance Leadership Team - Central PHO Lucas, Cushla 1.5.18 Nil Johnston, Craig 19.2.16 Member, Alliance Leadership Team - Central PHO 19.4.16 Son is an employee and works within hospital services - MidCentral DHB Miller, Steve 18.4.17 Director. Farming business - Puriri Trust & Puriri Farm Partnerships 26.2.19 Board Member, Member, Conporto Health Board Patient’s First trading arm - Patients First 6.3.19 Member, Alliance Leadership Team, Member, Information Governance Group - Central PHO 1.10.19 Chair - National DHB Digital Investment Board

Nwosu, Andrew 10.8.18 Director UK health consulting company - AB Therapy Services Sapsford, David 18.5.18 Nil Scott, Gabrielle 19.8.16 Son is a casual employee and works within various hospital services - MidCentral DHB Te Huia, Tracee 19.11.19 Nil Wanden, Neil Feb 19 Nil Zaman, Syed 1.5.18 Nil Matthews, Jill 1.3.16 Nil Amoore, Anne 23.8.04 Nil Russell, Greig 3.10.16 Minority shareholder - City Doctors Member, Education Committee - NZ Medical Council Bradnock, Barb 26.8.10 Nil Ayres, Vivienne 26.8.10 Nil Ratana, Darryl 29.5.19 Nil Tanner, Steve 16.2.16 Nil Brogden, Greg 16.2.16 Nil Howe, Jonathon 1.8.19 Nil 5

MIDCENTRAL DISTRICT HEALTH BOARD

Minutes of the Health & Disability Advisory Committee meeting held on 26 November 2019 at 9.00am at MidCentral District Heath Board, Board Room, Gate 2, Heretaunga Street, Palmerston North

PART 1

PRESENT

Karen Naylor (Chair) Dot McKinnon Ann Chapman Michael Feyen Barbara Cameron Oriana Paewai Barbara Robson John Waldon Brendan Duffy Vicki Beagley Diane Anderson

IN ATTENDANCE

Kathryn Cook, Chief Executive Andrew Nwosu, Operations Executive, Healthy Ageing & Rehabilitation Celina Eves, ED, Nursing & Midwifery Claire Hardie, Clinical Executive, Cancer Screening Treatment & Support Cushla Lucas, Operations Executive, Cancer Screening, Treatment & Support David Sapsford, CE Acute & Elective Specialist Services Debbie Davies, OE, Primary, Public, Community Health Gabrielle Scott, ED, Allied Health Jeff Brown, Acting Chief Medical Officer/Clinical Executive, Women, Children & Youth Judith Catherwood, General Manager, Quality & Innovation Lyn Horgan, Operations Executive, Acute and Elective Services Sarah Fenwick, Operations Executive, Women, Children & Youth Scott Ambridge, Acting Operations Executive, Mental Health & Addictions Syed Zaman, Clinical Executive, Healthy Ageing & Rehabilitation Tracee Te Huia, GM, Maori Health Carolyn Donaldson, Committee Secretary Allison Russell, Planning & Integration Lead, Primary Public & Community Health (part meeting) Angela Rainham, Locality & Population Manager (part meeting) Barbara Ruby, Planning & Integration Lead, Acute & Elective Services (part meeting) Denise Mallon, Planning & Integration Lead, Cancer Screening, Treatment & Support (part meeting) Vivienne Ayres, Manager DHB Planning & Accountability (part meeting) Communications (1)

Public: 5 Media: 1

Unconfirmed minutes

6

1. ADMINISTRATIVE MATTERS

The Chair made special mention to each retiring member, acknowledging and sincerely thanking them for the contribution over many years. She also passed on appreciation from Dr Manoharan to retiring members. Other members joined in acknowledging the contribution from retiring members and staff, and wishing them well. The Board Chair advised this was her last meeting as she was stepping down from the role.

The Chair acknowledged the attendance of Mr & Mrs Hume and the contribution they had made to the mental health service.

1.1 Apologies

Apologies were received from Members Adrian Broad and Nadarajah Manoharan.

1.2 Late Items

There were no late items.

1.3 Conflicts and/or Register of Interests Update

Barbara Cameron advised she was no longer a member of the Manawatu District Council.

1.4 Minutes of the Previous Meeting

It was resolved:

that the minutes of the previous meeting be approved as a true and correct record. (Moved Karen Naylor; seconded Brendan Duffy)

1.5 Matters Arising from the Minutes

John Waldon noted his name had been spelt wrong in paragraph 3.1, 5th paragraph.

2. HEALTH AND DISABILITY STRATEGIC PLANNING a. Tararua Health and Wellbeing Plan

The Locality and Population Health Manager spoke to this report touching on the various highlights set out in the report. In addition she advised arrangements had been made for the first annual public forum to be held in conjunction with the Age on the Go Expo, planned for 26 March 2020.

There was discussion on the use of methamphetamine and other drugs and gangs in the region. Members were advised of a group in the Tararua district (Anti P Lab Group) who were really passionate and active about the matter. The Locality Manager advised that Oranga Tamariki and the District Council were to have further discussions around this issue following it being raised at a Health & Wellbeing Committee meeting. The establishment of a training hub was another initiative for supporting young people.

Other issues discussed included the difficulty of transport given the issues with the Manawatu gorge, reduced road access due to building the wind farms and rising fuel costs; whether mental health teams were providing services in the more southern parts

Unconfirmed minutes

7 of the region now they had relocated; whether the patient portals were being used to their full extent and the effectiveness of the online directories in terms of knowing which services were the correct ones in the particular circumstances.

It was resolved that the Committee

note the progress that has been made in relation to the Tararua Health and Wellbeing Plan. b. Status Update Report – Implementation of the 2019/20 Regional Services Plan

The Manager DHB Planning and Accountability spoke to this report, noting that the regional cancer plans were likely to be changed due to the impact of the national cancer action plan. There was concern around the ophthalmology services at Whanganui due to the reduced medical ophthalmology input there. Members were advised MDHB was well placed due to the IANZ accreditation. Having the interventional radiology would enable the organisation to recruit more senior medical staff.

It was resolved that the Committee

note the update on progress with implementing the 2019/20 Regional Services Plan.

3. SERVICE CLUSTER REPORTS a. Enable New Zealand Report to 31 August 2019

The Acting Operations Director, Mental Health & Addictions (former General Manager, Enable NZ) spoke to this report because the Acting General Manager Enable New Zealand was unavailable. It was noted Te Tihi would be facilitating progress following the formation of the Collective Impact Group.

It was resolved that the Committee

notes the enable New Zealand report to 31 October 2019. b. Cluster update for September/October 2019

The presentation from Uru Whakamauora Healthy Ageing and Rehabilitation was taken at this stage. The Operations Executive and Clinical Executive, Uru Whakamauora Healthy Ageing and Rehabilitation and four staff spoke to the presentation.

The presentation covered progress and challenges for the Cluster including an increasing aged population and care resources required. A review of the recently commissioned OPAL unit focussed on 2-week milestones and future direction.

Discussion following the presentation covered the organisation’s current move to recruiting and retaining a more solid nursing workforce rather than using short term overseas nurses, the need to be careful when families say there is really good family support, as such statements could mask inequity problems for Maori, and caring for the carer.

Unconfirmed minutes

8

Following the presentation and discussion, the individual Cluster reports were considered. It was noted there would be further information provided in relation to referrals declined in future reporting. An explanation on what minimising the requirement for a patient to come to an appointment was given.

It was noted the Mental Health single stage business case should be presented to the Committee and Board in the first quarter of next year.

It was resolved that the Committee:

note the progress made by the Services for September and October 2019 note the workforce challenges across Te Uru Arotau, Te Uru Pā Harakeke and Te Uru Rauhī note the progress towards achieving ESPI targets note a number of requests for proposals have been issued by the Ministry for Primary Mental Health, Māori and Pasifika services. c. Pae Ora Paiaka Whaiora Māori Progress Update

The General Manager, Māori Health spoke to this report. This was her second week with the organisation, and she noted a few things she had seen in that time, eg the genuine effort being made particularly by the Cluster leads, to make a difference in terms of inequity. She was looking forward to perhaps consolidating and streamlining some of that work. The General Manager, Māori Health would change the Maori Health report to bring it more in line with the other Cluster reports, eg a dashboard, KPIs and accountability reporting. Other areas mentioned were ED inpatient analysis/afterhours care and reintegrating back into primary care and locality work, drugs alcohol and addiction work and staffing matters and what is required moving forward. A suggestion was made to General Manager, Māori Health that she might consider looking at the Whanganui DHB pro equity report particularly relating to the workforce, as there were some good models there.

It was resolved that the Committee:

notes the Pae Ora Paiaka Whaiora progress update.

4. QUALITY IMPROVEMENT a. Clinical Governance & Quality Improvement update

The Manager Quality Improvement and Assurance and Consumer Experience Manager spoke to this report, noting that the Quality Account had been published on the same day as the national and local Adverse Events annual reports. It was noted that the current set of inpatient experience questions were being revamped. The domains should remain unchanged. It was also noted that the survey only covered inpatients, and that there would be consistency between the inpatient and primary care surveys. As a result of this work, there would not be any inpatient surveys undertaken in the first quarter of 2020.

The issue of credentialing recommendations was raised. The Acting Chief Medical Officer advised an improved process was in place to ensure the recommendations were addressed in a timely way. He advised the Clinical Board had been looking at having a three tier approach where each recommendation was identified as being at a medical lead/line manager or cluster or executive leadership team level to address. Using that

Unconfirmed minutes

9 method it would be possible to have owners of the actions and reporting back on progress.

The General Manager Quality & Innovation advised the clinical governance dashboard, previously approved by HDCA, was being developed. Feedback on that was welcomed. It was also noted that the Quality Account would be published quarterly in future.

Management were cautioned in respect to the time taken to close complaints, as in major events the patient/family may not have had time to understand all the issues in ten days. In some events it had taken months before the patient/family was able to talk about the event.

The diversity of work covered by this group was raised as it covered many different areas, eg workforce, customer liaison, patient incidents, clinical issues. The CEO clarified explaining there was a connection between staff and consumer/client/patient experience and bringing them closer together.

It was resolved:

that the content of the Clinical Governance and Quality Improvement report be noted, and progress in delivering improvements in Clinical Governance and Quality Improvement be endorsed. b. Adverse Events (Incidents) Policy

It was suggested that consumer participation could be extended to include involving them in the action plan and advice on when it was completed. Management clarified that the organisation collaborated with patients/whanau in adverse events, and that event reports were shared with the family.

It was resolved that:

the changes to the Adverse Events (Incident) Policy be endorsed.

5. POLICY & GOVERNANCE a. Committee’s Work Programme, 2019/20

The General Manager Quality and Innovation presented this report. The report was taken as read.

It was resolved:

that the update on the 2019/20 work programme be noted.

6. LATE ITEMS

There were no late items.

Unconfirmed minutes

10

7. DATE OF NEXT MEETING

4 February 2020.

8. EXCLUSION OF PUBLIC

It was resolved:

that the public be excluded from this meeting in accordance with the Official Information Act 1992, section 9 for the following items for the reasons stated:

Item Reason Reference “In committee” minutes of the Health & For the reasons set out in the Disability Committee meeting order paper of 15.10.19 meeting held with the public present Potential and Actual Serious adverse To protect personal privacy 9(2)(a) Events for August 2019 to October 2019 Health & Disability Commissioner To protect personal privacy 9(2)(a) Complaints for August 2019 to October 2019

Confirmed this 4th day of February 2020.

………………………………. Chairperson

Unconfirmed minutes

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Health & Disability Advisory Committee  Schedule of Matters Arising, 2019/20 as at 29 January 2020

Matter Raised Scheduled Responsibility Form Status Update re Treaty of Waitangi Policy review process Bd July 19 6-weekly T Te Huia Inc in HP report Ongoing Consumer feedback re Choices, particularly intensive Oct 19 Apr 20 GMENZ Inc in ENZ report Scheduled wrap-around services Mental Health Single Stage Business Case Nov 19 Apr 20 S Ambridge/V Report Scheduled Caldwell

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For:

Decision X Endorsement Noting

To Health and Disability Advisory Committee

Author Cluster Leadership Group

Endorsed by Kathryn Cook, Chief Executive

Date 22 January 2020

Subject Cluster Update for November and December 2019

RECOMMENDATION It is recommended that the Committee: • endorse the progress made by the Services for November & December 2019 • note the conclusion date of Te Uru Whakamauora intermediate care bed initiative with Ranfurly Residential Care Centre is on 31 January 2020. • endorse the progress towards achieving Planned Care • note the workforce challenges within Te Uru Pā Harakeke

Strategic Alignment This report aligns to MidCentral DHB’s Strategy and the implementation of its Annual and Operational Plans, Locality Health and Wellbeing Plans and Cluster Health and Wellbeing Plans.

1. PURPOSE

The purpose of this report is provide the Health and Disability Advisory Committee with a summary of the performance against plans, budget and targets and to advise any current and emerging matters in:

• Te Uru Whakamauora - Healthy Ageing and Rehabilitation • Te Uru Arotau - Acute and Elective Specialist Services • Te Uru Kiriora - Primary Public and Community • Te Uru Rauhi - Mental Health and Addictions • Te Uru Pā Harakeke - Healthy Women Children and Youth • Te Uru Mātai Matengau - Cancer Screening, Treatment and Support

Each areas report is appended.

As agreed in the Board's reporting framework at each Committee meeting a cluster will provide an in depth presentation. On this occasion, Enable New Zealand will provide the presentation. 13

A SUMMARY OF THE SIX HEALTH AND DISABILITY SERVICE CLUSTERS

Te Uru Arotau – Acute and Elective Specialist Te Uru Kiriora – Primary, Public and Services Community Health

Te Uru Arotau is responsible for the planning, Te Uru Kiriora is responsible for the funding and provision of secondary care planning, funding and provision of: (hospital level) services: • Primary and community based services • Medical services and subspecialties via a range of contracted partners’ Public • Surgical services and subspecialties health services spanning health • Anaesthetics and Intensive Care Unit • Medical/Surgical inpatient wards promotion, protection, regulation, and • Medical Imaging and Hospital Pharmacy clinical care delivery • Emergency services • Specialist sexual health services • Child and adolescent dental services for 0-18 year olds across the district • Community based nursing services including District Nursing and Primary Health Care nursing in partnership with Primary Care and the Central Primary Health Organisation

Te Uru Pā Harakeke – Healthy Women Te Uru Rauhī – Mental Health and Children and Youth Addictions

Te Uru Pā Harakeke is responsible for the Te Uru Rauhī is responsible for the planning, funding, commissioning and provision planning, funding and provision of: of: • General adult mental health in • Primary and secondary maternity care, community (moderate to severe and secondary obstetrics and gynaecology services, including antenatal day unit, inclusive of co-existing problems) inpatients, outpatient clinics, community • Primary Mental Health & Addictions midwifery services and lactation services; • Mental Health Acute Inpatient services • Family centred inpatient, outpatient and • Eating disorders community care for neonates (including • Maternal Mental Health neonatal intensive care), children (including • Community Rehabilitation high dependency care) and young people - up • Child Adolescent and Family to their 16th birthday as inpatients and until • Alcohol & other Drug Specialist Services end of school for ongoing ambulatory care. • Maori Mental Health • The commissioning of appropriate services to • Older Adult Mental Health Services help improve the local population’s health needs with a particular focus on the first 1000 (Community and Inpatient) days and youth oriented care. • 24 hour Mental Health Acute Care Team

Te Uru Mātai Matengau – Cancer Screening, Te Uru Whakamauora – Healthy Ageing Treatment & Support and Rehabilitation

Te Uru Mātai Matengau is responsible for the Te Uru Whakamauora is responsible for the planning, funding and provision of: planning, funding and provision of specialist • Prevention and early detection (screening) services for people over the age of 65 programmes years (55 years for Maori) and those • Cancer diagnostic and treatment services between the ages of 16-64 with a physical • Cancer support services disability, with a focus on assessment, • Palliative care services • Non-malignant haematology services treatment and rehabilitation. Services are • Regional services for treatment and screening structured into: • ElderHealth • Rehabilitation • Therapy Services • Supportlinks

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SERVICE: Te Uru Whakamauora Healthy Ageing and Rehabilitation

FOR PERIOD: November & December 2019

PREPARED BY: Andrew Nwosu, Operations Executive Syed Zaman, Clinical Executive Rehabilitation Pauline Holland, Planning & Integration Lead

1. PERFORMANCE OVERVIEW

Te Uru Whakamauora is generally on track with all initiatives under the Annual, Operational and Performance Improvement Plan. There are no emerging risks or areas of concern. Items of note are discussed under Significant Matters.

Rating Initiative & Trend A Increase uptake of integrated falls and fracture liaison service G ↑ A Improve consistency, quality and efficiency of Home and Community Support G ↑ A Improve process for the management of PPPR applications G ↑ A Increase support for older people managing their long term conditions G ● P Implementation of “Red to Green” on wards G ↑ P Develop Complex patient pathway Plans for improved Discharge Planning G ● P Implement an Intermediate Care Bed Pilot to improve Flow G ↑ P Develop Escalation Plans to manage surge G P Timely transfers of care: Improving Acute to Rehab pathways G ↑ O Improve patient flow throughout the hospital, reducing barriers and delays G ↑ O Improve models of care for the older person with frailty G ↑ O Refine models of care for Older Persons (acute) Assessment and Liaison G ↑ O Support regional improvements for people and whānau living with dementia G ● O Enhance orthogeriatric and general surgical models of care G ↑ O Promote wellness and age friendly environments for older people G ● O Develop a more responsive and effective rehabilitation model G ↑

Rating & Trend Legend G On track, A Behind plan – R Behind plan – D Not completed as progressing as remedial action plan major risks and planned. planned. in place. exception report required. ↑ Improved from ↓ Regressed from last ● No change from last report. report. last report. Plan Legend A Annual Plan P Performance O Operational Plan Improvement Plan

COPY TO: Healthy Ageing and Rehabilitation MidCentral DHB Heretaunga Street PO Box 2056 Palmerston North 4440 Phone: +64 (6) 350 8372

15 1.1 Performance Indicators – December 2019

Description Month Month Month YTD YTD YTD Variance KPI Trend Actual Target Variance Actual Target (13 month)

CP21 - Acute readmissions within 28 days 0.0% 7.5% (7.5%) 1.9% 7.5% (5.6%) CP25r - Occurrence Rate of Medication Incidents 1.0 3.5 (2.5) 3.3 3.5 (0.2) CP26r - Occurrence Rate of Patient Falls 3.8 5.0 (1.2) 6.4 5.0 1.4 CP28p - Hospital acquired UTI rate (%) (provisional) 0.00% 0.50% (0.50%) 1.53% 0.50% 1.03% CP30p - Inpatients developing Pressure Ulcers (%) 0.19% 0.50% (0.31%) 0.29% 0.50% (0.22%) CP41 - Complaints responded to within 15 days (%) 0.0% 95.0% (95.0%) 100.0% 95.0% 5.0%

Internal Process and Operations Description Month Month Month YTD YTD YTD Variance KPI Trend Actual Target Variance Actual Target (13 month) IP07 - Bed Day Usage (by Health Specialty) 59.3% 85.0% (25.7%) 66.1% 85.0% (18.9%) IP18 - Outpatient appointment DNAs 3.9% 6.0% (2.1%) 4.4% 6.0% (1.6%) IP22 - Hospitalised smokers provided with help to quit 100.0% 95.0% 5.0% 96.8% 95.0% 1.8% IP28 - One to One Hours 529 0 529 4,384 0 4,384 Organisational Health and Learning Description Month Month Month YTD YTD YTD Variance KPI Trend Actual Target Variance Actual Target (13 month) OH01 - Staff Stability 100.0% 99.0% 1.0% 96.8% 99.0% (2.2%) OH02 - Staff Turnover 2.59% 1.00% 1.59% 3.61% 1.00% 2.61% OH03 - Sick Leave Rate 2.71% 3.20% (0.49%) 4.80% 3.20% 1.60% Legend Achieved Partial Achievement Not Achieved

Te Uru Whakamauora continues to focus on improved compliance and monitoring of key performance indicators. Work continues with the business intelligence teams to ensure the underlying data powering the dashboard is accurate and reflective of activity especially in relation to key metrics such as complaints and bed day usage.

Staff turnover for December exceeded targets, however variables such as staff retirement and changes in circumstance were significant contibutors to staff attrition.

16 2. SIGNIFICANT MATTERS

2.1 OPAL Inpatient Unit

The OPAL (Older People’s Acute Assessment and Liaison) unit continues to deliver positive patient outcomes with improved discharge rates, reduced Length of Stay (LOS), direct admissions and reduced waiting times. An evaluation of the service outputs and impact on other areas is being undertaken to mitigate any unexpected consequences.

2.2 STAR 2

The Red to Green initiative continues to produce positive patient and system outcomes, identifying and minimising potential delays and wasted days where possible.

The partnership between the Te Uru Arotau and Te Uru Whakamauora in relation to the management of uncomplicated hip fractures continues to produce positive outcomes and has been extended until 5 March 2020. It will now include patients who reside in Horowhenua. From an equity standpoint the service will be conducting an audit to ensure that the increased throughput of orthopaedic patients is not disadvantaging other patient groups. Plans for further discussions with the Acute and Elective Specialist Services are intended to better provision the pre operative element of the patient journey.

2.4 Community Rehabilitation

Te Uru Whakamauora has approved a Pilot with Lavender Blue, supporting the delivery of MidCentral DHB’s Accident Compensation Compensation funded In Home Strength and Balance Programme (IHSB). Support staff will receive education so they can support IHSB programme with selected clients in their home. It is due to commence March 2020.

2.5 Creating Hospital Capacity

Te Uru Whakamauora’s draft OPAL Community Service business case that looks to implement a locality based and partnership focussed approach to the management of fraility was agreed in principle by the Organisational Leadership Team in December. Further financial modelling is currently taking place and the proposal will be re- presented in February.

It is expected that with the arrival of two new geriatricians in New Year, Te Uru Whakamauora will implement a 8.00am-4.00pm Monday to Friday interface geriatrics service in the Emergency Department to support elderly patients to be seen at presentation.

The Development of Guidelines and Resources related to Protection of Personal and Property Right, Enduring Power of Attorney, Welfare Guardian and Property Management, Administration and Personal Order Applications concluded in December, 2019. The service is currently working with the communications team to ensure appropriate dissemination to MidCentral DHB Staff, Iwi and Community Partners.

17

2.6 Health Recovery Beds

Te Uru Whakamauora’s intermediate care bed initiative with Ranfurly Residential Care Centre is due to end on 31 January 2020 following an analysis of cost-benefits. One months’ notice of conclusion has been given, a review of outcomes and learnings will take place and be disseminated in due course.

2.7 Improving Health of People with Complex Presentations

Te Uru Whakamauora continues to demonstrate its commitment to reducing health inequities and has commenced the development of a cross cluster complex patient pathway, bringing together stakeholders across the health and care continuum. Initial focus will be around reducing readmissions, timelier and safer discharge and the management of patients with complex social and behavioural issues.

2.8 Non Acute Rehabilitation

Progress continues to be made around meeting the specifications required to deliver community based Non Acute Rehabilitation (NAR). A meeting was held in November 2019 with Home and Community Support Services providers to review options to support community rehabilitation for NAR patients.

A follow on from these discussions has been a trial with one of the facilities, Ranfurly Residential Care, of an education program to prevent, as well as minimise, the likelihood of patients deconditioning during their stay.

2.9 Improving Rehabilitation Services in the MidCentral District

Following on from the outputs of the cross sector Rehabilitation Hui on 13 November, 2019 workstreams are being set up to create a roadmap for rehabilitation services that straddle the health and care continuum and reflect the needs of served communities.

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SERVICE: Te Uru Arotau Acute & Elective Specialist Services

FOR PERIOD: November & December 2019

PREPARED BY: Lyn Horgan, Operations Executive Dr David Sapsford, Clinical Executive Barbara Ruby, Planning & Integration Lead

1. PERFORMANCE OVERVIEW

Te Uru Arotau is generally on track with all initiatives under the Annual, Operational and Performance Improvement Plans. There is one emerging risk, which is SMO vacancies, discussed under Emerging/Current Risks. Items of note are discussed under Significant Matters.

Rating & Initiative Trend Improve delivery of planned care interventions to meet prioritised population A health needs and timely access – utilising outsourcing and outplacing options to G ● maximise capacity for planned surgical interventions. Reduce variation and improve access to cardiac care services – access to G ● A echocardiography and local interventional cardiology service. Improve planned care services across the system through an agreed system G ↑ A wide three year improvement plan for planned care. A Sustain achievement of the minimum requirements for colonoscopy wait times. G ↑ Zero patients waiting longer than four months for a first specialist assessment – A ↑ A streamline referral management and triaging processes. Develop and pilot a community-based model of care for musculoskeletal G ● O services. O Refurbish current building footprint to enable extra theatre capacity. G ↑ Partner with Pae Ora and Healthy Women Children and Youth to pilot an O engagement conduit for proactive engagement with Māori Whānau to support G ↑ attendances for planned assessment. Minimise avoidable repeat hospital admissions for people with COPD through G ● O triaged follow up and intervention. Establish Clinical Pharmacist support service to patients presenting to ED who O have long term health condition where medicines management may have, or G ↑ did, contribute to hospital presentation. Improve patient flow throughout the hospital, reducing barriers and delays to A ↑ O assessment, treatment and discharge through Timely Care programme. P Planned Care Improvement, ESPI 5 compliance. R ↑ P Outpatient ESPI 2 compliance. A ↑ P Takatu, Emergency Department Performance. R ● P Medimorph (General Medicine). A ● P Surgical Acute Care Improvement. A ●

COPY TO: Te Uru Arotau Acute & Elective Specialist Services MidCentral DHB Heretaunga Street PO Box 2056 Palmerston North 4440 Phone: +64 (6) 350 8825

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Quality and Reducing Variation Uru Arotau Quality Improvement Plan. G ● Pharmacy Improvement Programme. G ●

Rating & Trend Legend G On track, A Behind plan – R Behind plan – D Not completed progressing as remedial action plan major risks and as planned. planned. in place. exception report required. ↑ Improved from ↓ Regressed from last ● No change from last report. report. last report. Plan Legend A Annual Plan P Performance O Operational Plan Improvement Plan

1.1 Performance Indicators – December 2019

Non-financial KPI results are PROVISIONAL* Acute and Elective Specialties Cluster Scorecard

For the period ending December 2019. Cluster: C20 - A cute & Elective Specialists; Service: (A ll); RC: (A ll).

Customer Patient

Description Previous Month Month Month YTD YTD YTD Variance KPI Trend Month Actual Target Variance Actual Target (13 month) CP21 - Acute 9.8% 6.9% 7.5% (0.6%) 10.6% 7.5% 3.1% readmissions within 28 CP25r - Occurrence 1.6 4.0 3.5 0.5 3.0 3.5 (0.5) Rate of Medication CP26r - Occurrence 3.5 3.2 5.0 (1.8) 3.6 5.0 (1.4) Rate of Patient Falls CP28p - Hospital 0.00% 0.00% 0.50% (0.50%) 0.21% 0.50% (0.29%) acquired UTI rate (%) CP30p - Inpatients 0.19% 0.22% 0.50% (0.28%) 0.21% 0.50% (0.29%) developing Pressure CP41 - Complaints 95.2% 100.0% 95.0% 5.0% 99.4% 95.0% 4.4% responded to within 15 Internal Process and Operations

Description Previous Month Month Month YTD YTD YTD Variance KPI Trend Month Actual Target Variance Actual Target (13 month) IP00a - ED 3,754 3,951 0 3,951 23,739 0 23,739 Presentations Hospital- IP00d - ED 3,615 3,828 0 3,828 22,745 0 22,745 Presentations (by IP00ma - ED 652 708 0 708 4,232 0 4,232 Presentations, Maori (by IP00nm - ED 2,963 3,120 0 3,120 18,513 0 18,513 Presentations, Non- IP00-04 - ED 205 213 0 213 1,429 0 1,429 Presentations 0-4 years IP00-16 - ED 319 337 0 337 1,935 0 1,935 Presentations 5-16 IP00-64 - ED 2,022 2,148 0 2,148 12,553 0 12,553 Presentations 17-64 IP00-65 - ED 995 1,069 0 1,069 6,290 0 6,290 Presentations 65+ years IP02 - ED stays less 75.7% 71.3% 95.0% (23.7%) 73.2% 95.0% (21.8%) than 6 hours IP03a - Average LoS: 4.7 4.4 4.0 0.4 4.5 4.0 0.5 Acute Inpatient IP03e - Average LoS: 3.2 3.4 4.0 (0.6) 2.9 4.0 (1.1) Elective Inpatient IP07 - Bed Day Usage 123.9% 117.0% 85.0% 32.0% 125.7% 85.0% 40.7% (by Health Specialty) IP18 - Outpatient 6.0% 6.5% 6.0% 0.5% 6.5% 6.0% 0.5% appointment DNAs IP18ma - Outpatient 12.7% 14.8% 6.0% 8.8% 12.5% 6.0% 6.5% appointment DNAs, IP18nm - Outpatient 4.4% 4.9% 6.0% (1.1%) 5.2% 6.0% (0.8%) appointment DNAs, Non- IP28 - One to One 2,508 2,016 0 2,016 14,562 0 14,562 Hours Organisational Health and Learning

Description Previous Month Month Month YTD YTD YTD Variance KPI Trend Month Actual Target Variance Actual Target (13 month) OH01 - Staff Stability 99.0% 99.7% 99.0% 0.7% 98.5% 99.0% (0.5%)

OH02 - Staff Turnover 1.63% 1.30% 1.00% 0.30% 1.32% 1.00% 0.32%

OH03 - Sick Leave Rate 3.17% 2.08% 3.20% (1.12%) 3.84% 3.20% 0.64%

Legend * Non-financial KPI results for Dec- Achieved 2017 to date are subject to data-quality and completeness checks relating to Partial Achievement the WebPAS transition. Not Achieved 20

Work continues to improve compliance and enhance monitoring, including:

• A higher occurrence rate of medication incidents in December can be attributed to some missed doses and prescribing errors which correlate to the new intake of house officers. The Pharmacy department has undertaken additional education sessions which have been well received. There have been no serious medication related incidents. • Reviewing the acute readmission metrics. • Continuing the patient flow programme which in turn will improve the Shorter Stays in Emergency Department (SSIED) result. • A focused programme for outpatient services (commenced in January 2019) which includes improving Did Not Attend (DNA) rates. • Action plans are in place for all areas to increase the giving of brief advice to smokers. • Leave plans in place for all staff with leave in excess of two years.

2. SIGNIFICANT MATTERS

2.1 Planned Care

Michelle Arrowsmith, Deputy Director-General DHB Performance Support & Infrastructure, accompanied by two team members, visited the District Health Board (DHB) on Wednesday, 15 January 2020. The Ministry of Health (MoH) was briefed on the DHB’s medium-term SPIRE (Surgical Procedural Interventional Recovery Expansion) proposal. This programme of work will deliver two additional theatres, additional perioperative and procedure rooms and a cardiac catheterisation laboratory. We are seeking Government funding support from the recently announced $300m DHB infrastructure funding. We are also seeking support to establish additional Emergency Department (ED) and assessment capacity.

Planned Care Performance

MidCentral DHB (MDHB) is delivering to our internal budgeted planned care Case Weighted Discharges (CWDs).

• Planned Care Strategies

Ongoing strategies to achieve Planned Care targets include:

• Outsourcing procedures to CREST • Additional outpatient clinics being held where appropriate • Ensuring patients have access to clinical assessment/advice if required and are kept well informed of any delays.

• Three Year Planned Care Improvement Plan

As part of the new MoH Planned Care Strategy, it is a requirement for all DHBs to formulate a three year improvement plan for planned care. The draft plan continues to evolve following on the Planned Care Hui and further internal engagement.

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Te Uru Arotau has commissioned a contract with TBI Health to deliver a community based early intervention musculoskeletal programme for a cohort of non-Accident Compensation Corporation (ACC) patients with lower back pain. The programme will include an assessment and rehabilitation programme and includes, as appropriate, education, exercise classes and physiotherapy. Eligible patients can be referred to TBI Health directly from their primary care practitioner commencing in January 2020.

The purpose of this service is to:

• provide an early access community based service to support MDHB patients with ongoing lower back pain. • provide an effective assessment and triaging service to identify patients requiring specialist support or multi-disciplinary rehabilitation. • provide functional rehabilitation and self-management education to improve quality of life and independence for MDHB patients. • reduce disparities in health status within the community.

Te Uru Arotau, Te Uru Pā Harakeke and Pae Ora Paiaka Whaiora have partnered for the introduction of a Whānau Equity Facilitator role. This role will support a direct focus on Māori Equity and system engagement to support attendances for planned assessments.

• ESPI 2 and 5 Performance

Steady progress is being made in recovering Elective Services Patient Flow Indicator (ESPI) 2 and 5 performances.

Work continues on being ESPI 2 compliant. ESPI 5 compliance was required by 30 November 2019 (except for Orthopaedics for which compliance was required by 31 December) and this was not achieved. Orthopaedics and General Surgery were not expected to achieve target and a revised recovery plan for these is with the MoH. MDHB have received verbal approval and are awaiting this in writing.

• Referrals Accepted or Declined by Specialty

At the Health and Disability Advisory Committee (HDAC) meeting on 15 October 2019 members requested a breakdown of the number of referrals received, numbers accepted and numbers declined by specialty. There are a number of categories for which a referral is declined including available capacity, insufficient information on referral, not eligible or advice is provided to referrer negating the need for an appointment. The majority of declined referrals are attributed to capacity. This information can be seen in Appendix 1.

2.2 Shorter Stays in the ED (SSIED) and Patient Flow

The organisational SSIED result for November 2019 was 78 percent and December 2019 was 74 percent.

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Major programmes continue, focused on improving the flow of patients throughout the hospital and into the community and a number of new strategies are being applied to support improved performance:

• Takatū – Emergency Department (ED) Performance. • Medimorph and Frailty – Acute Medicine Performance. • Surgical Acute Care – Acute Surgical Performance. • Rationalising Acute Demand – Avoidable Presentations. • Escalation Planning. • Improving staff and patient safety. • ED surge capacity.

Current initiatives to improve patient flow include; opening all available inpatient beds, focusing on proactively identifying two patients before 10 a.m. who can be appropriately discharged from the medical wards, revised home-based warding following the opening of the Older Person’s Assessment Liaison (OPAL) Unit and utilisation of the patient journey boards. There has been a reduction in the number of patients waiting overnight in the ED for an inpatient bed.

Primary Options for Acute Care (POAC) ED redirections began 27 May 2019. There have been 1,008 patients that have presented at ED appropriate for POAC ED redirection. Of these, 83 patients declined the service for various reasons and 925 patients accepted the service.

As the acute demand and number of presentations to the ED have increased over the previous 12 months, there has been a rising trend in the number and therefore percentage of people who did not wait to be seen. This is outlined in the table below with both November and December data.

Did Not Wait Number of Percentage Month/Year (DNW) Presentations (DNW) 01/01/2019 370 3,961 9% 01/02/2019 378 3,628 10% 01/03/2019 407 4,104 10% 01/04/2019 406 3,847 11% 01/05/2019 354 3,945 9% 01/06/2019 392 4,002 10% 01/07/2019 334 4,065 8% 01/08/2019 411 4,142 9% 01/09/2019 440 3,929 11% 01/10/2019 359 3,891 9% 01/11/2019 361 3,773 10% 01/12/2019 459 3,946 12%

As work continues to improve the flow through to inpatient wards, this will free the capacity of the ED to be better able to see patients that are waiting to be seen and we would expect to see a reduction in the patients who did not wait to be seen.

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Prescribing Pharmacist

Prescribing pharmacists work within a clinical team and may prescribe most medicines. MDHB’s Chief Pharmacist undertook the prescribing pharmacist post- graduate certificate in 2019, passed and is now registered as a pharmacist prescriber with the scope of practice of emergency medicine.

The prescribing pharmacist works approximately 12 hours a week in the ED and prescribes medicines to patients presenting with musculoskeletal injuries and assists with prescribing this group of patients’ usual medicines should they be admitted to hospital.

2.3 Diagnostic Wait Times

December results are below, with angiography services achieving target.

Modality Target Sep 19 Oct 19 Nov 19 Dec 19 CT 95% within 6 weeks 96% 96% 84% 77.5% MRI 90% within 6 weeks 87% 77% 74% 79% Angiography >95% within 3 months 100% 100% 100% 100% (elective)

Computed Tomography (CT) performance reduced in December despite there being the highest number of CT examinations ever completed (1,327). There were 227 examinations more in December 2019 compared with December 2018. The February result is expected to improve.

The Magnetic Resonance Imaging (MRI) result improved slightly following the MRI quenching and the MIT industrial action. Additional staff commence at the end of January; the target is expected to improve from then. The MRI is currently working more than eight hours each day.

An increase in acute cases for both modalities is being experienced with MRI having to postpone sessions of routine appointments booked in January to accommodate the acute referrals.

2.4 Cardiac Care Services

Computed Tomography Cardiac Angiography (CTCA) – Sub-Regional Joint Initiative

CTCA takes x-ray pictures of cross-sections of the heart (like slices of bread) very quickly. These images are re-assembled by the computer to produce a detailed picture of the heart.

The investigation of cardiac ischaemia is becoming more dependent on CTCA.

Currently MDHB does not have the software to perform CTCA on site. The purchase of the second CT machine will include CTCA functionality. In the meantime, the MDHB Cardiology service in partnership with Whanganui DHB (WDHB) is establishing a sub-regional CTCA service. WDHB has CTCA software on their machine and a medical imaging technician able to perform the study. This will be supervised by an MDHB Cardiologist trained in CTCA who will also triage the 24

patients eligible for this test and report the studies. Patients from both DHBs will be able to receive this study at Wanganui Hospital supported by the MDHB cardiac diagnostic nursing staff. This is a cost neutral initiative. Two additional SMOs will train in CTCA in 2020. It is expected that this service will commence in the next few months.

3. EMERGING/CURRENT RISKS

Anaesthetics with three Senior Medical Officer (SMO) vacancies and Orthopaedics continue to be areas of concern for Te Uru Arotau. Two Orthopaedic Surgeons have required long periods of leave unexpectedly with one continuing on leave for the foreseeable future. A further Orthopaedic Surgeon also retired in September.

Unfortunately, this will continue to impact on internal capacity and outsourcing arrangements as staff work across both providers. Recruitment for both locum and permanent Orthopaedic Surgeons has been under way for some time. One locum surgeon has commenced in December 2019 for six months and we have one offer out to an Orthopaedic Surgeon.

Nationally recruitment is a challenge. Ongoing work continues to ensure a full staffing complement.

Risk 805 – Follow-up process and procedures

A request for explanation of this risk (to be made to the HDAC) was made at the Finance, Risk and Audit Committee (FRAC) meeting on 19 November 2019.

When MDHB moved to WebPAS, a number of patients who had been seen at an outpatient clinic were inadvertently transferred as patients awaiting a first specialist assessment, i.e. an open referral. This was identified at the time.

The Regional Health Informatics Programme (RHIP) Remediation Team enacted a system change, amending the status of these patients to requiring a “follow-up”. However, some of these patients do not require a follow-up appointment and should have been “closed”. One of the other mitigating factors is a lack of clear outcome from clinics leading to staff entering data without an outcome, i.e. follow up required or discharged back to General Practitioner (GP), and not closing the referral. The focus for the remediation team is on new referrals in the first instance.

A “follow-ups” project has been established and forms part of the Performance Improvement Plan (PIP) to enable focus and resources to be dedicated to remediating this matter.

It is expected to take 16 weeks to work through all the open referrals involved.

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APPENDIX 1

Table 1: Referrals Accepted and Declined

Specialty November 2019 December 2019

Total Accepted Declined Percentage Total Accepted Declined Percentage Received Below Declined Received Below Declined Threshold/ Threshold/ Capacity Capacity Cardiology 104 67 16 15% 79 36 22 28% Dental 91 41 0 0% 97 56 0 0% Diabetes 12 12 0 0% 4 4 0 0% Ear Nose Throat 290 288 0 0% 248 246 0 0% Endocrinology 6 6 0 0% 4 4 0 0% Gastroenterology 83 82 0 0% 95 94 0 0% General Medicine 79 79 0 0% 69 69 0 0% General Surgery 366 316 0 0% 244 215 0 0% Gynaecology 144 135 0 0% 98 75 0 0% Haematology 49 49 0 0% 42 42 0 0% Maxillo-Facial 11 10 0 0% 8 8 0 0% Dermatology 51 40 0 0% 50 42 0 0% Infectious Diseases 7 7 0 0% 5 5 0 0% Neurology 59 58 0 0% 52 50 1 2% Ophthalmology 202 175 11 5% 219 196 9 4% Orthopaedics 300 298 0 0% 298 296 0 0% Paediatric Medicine 101 100 0 0% 64 62 0 0% Respiratory 55 51 0 0% 48 46 0 0% Urology 172 131 39 23% 84 45 37 44% Rheumatology 14 0 0 0% 13 7 0 0% Total 2,196 1,940 66 3% 1,821 1,598 69 4%

NB: The process to review and triage referrals is a continous one across rolling months. For example; a referral may be received at the end of one month and is processed early in the following month.

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CLUSTER: Te Uru Kiriora Primary, Public and Community Health

FOR PERIOD: November and December 2019

PREPARED BY: Deborah Davies - Operations Executive, Alison Russell - Planning and Integration Lead

1. PERFORMANCE OVERVIEW

Te Uru Kiriora is generally on track with all initiatives under the Annual, Operational and Performance Improvement Plans. An emerging risk is the novel Coronavirus. Items of note are discussed under Emerging/Current Risks. Items of note are discussed under Significant Matters.

Plan Initiative Rating & Trend Better Population Health Outcomes Supported by Primary Health Care A Increase enrolment numbers across the MidCentral District with a focus on Māori G ● O Drive effective integrated Locality based care delivery through locality team G ● prototype development and workforce planning P Pharmacy Improvement Programme G ● P Improve management of Long Term Conditions with a focus on Chronic Pain, G ● Diabetes and Respiratory Care Improving Child Wellbeing Improve access to youth friendly and appropriate primary health care services to G ● A improve health outcomes O Achieve equity in immunisation coverage rates across priority groups of infants A ● and children Improving Wellbeing Through Prevention A Increase Cervical Screening coverage rates for Māori, Asian and Pacific women to A ● achieve and sustain equity A Reduce the prevalence of smoking, particularly for Māori and increase uptake of A ● smoking cessation support services A Promote and enable wellbeing in communities through health policy initiatives G ● Better Population Health Outcomes Supported by a Strong and Equitable Public Health and Disability Strategy P Strengthen community based Acute and Urgent Demand model of care and G ● delivery O Improve patient health care outcomes and experience in primary care and G ● community settings through scaling of Health Care Home A Strengthen delivery of Whānau Ora “closer to home” increasing number of whānau G ● who benefit from collective impact participation

Rating & Trend Legend G On track, A Behind plan – R Behind plan – D Not completed progressing as remedial action plan major risks and as planned. planned. in place. exception report required. ↑ Improved from ↓ Regressed from last ● No change from last report. report. last report. Plan Legend A Annual Plan P Performance O Operational Plan Improvement Plan COPY TO: Te Uru Kiriora Primary, Public and Community Health MidCentral DHB Heretaunga Street PO Box 2056 Palmerston North 4440 Phone: +64 (6) 350 8074

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1.1 Performance Indicators

THINK Hauora enrolment for Māori are slowly increasing and a focus is on utilising all potential initiatives to connect. An example is the notification of unenrolled people attending Emergency Department (ED), with consent, to the THINK Hauora for follow up to facilitate enrolment.

The focus remains on recalling all under five year olds that have not completed scheduled vaccinations (which includes Measles, Mumps, Rubella (MMR)), and THINK Hauora are working closely with General Practice (GP)Teams.

To further improve cervical screening the review of the current range of providers and access is a key focus alongside communication with Māori wāhine and increasing access to free cervical smears.

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Child and Adolescent Oral Health arrears are 4.7 percent adverse, and remain a key focus area particularly adolescent Māori. Māori 0-4 year old arrears remain below the target of 10 percent. (See 2.1 for an update on the service dashboard and reconfiguration progress).

Leave plans are in place for all staff with leave in excess of two years, and are monitored monthly. There has been a significant reduction in sick leave over the reporting period. Challenges remain in planned sick leave.

2. SIGNIFICANT MATTERS

2.1 Child Adolescent Oral Health

The majority of the Service Dashboard is in place (as reported in the scorecard), with the implementation of the revised geographical teams set to commence with term one delivery. Following a leadership restructure, recruitment for a Manager of Dental Services is underway, with the service looking to commence the year with potentially one full time position vacant in dental therapists. A full revision of service orientation has been completed, and a ‘pulse check’ providing a sense of the staff culture is being undertaken to be reported to the Committee next meeting.

2.2 Acute Demand and LTC

Over 1000 patients have been redirected from ED to Primary Options for Acute Care (POAC) providers in the past seven months. A current focus is on improved information for consumers presenting to ED regarding their options for their current and subsequent requirements for acute care.

Improving the management and community based support of people presenting with acute Chronic Obstructive Pulmonary Disease to the ED is to commence February in two phases. Phase One is proactive transfer to primary health care team providers (where appropriate) of people presenting to ED with pre-arranged GP Team follow up (including aligned Long Term Conditions nursing input) within 2- 3 days. The aim is to ensure the patient is actively managing with appropriate supports in place. Under the POAC model this is at no cost to the patient.

Phase Two will support inpatients discharged to community utilising the same POAC model to ensure the timely follow-up and wrap around of appropriate services. The management pathway to support this has been co-designed with stakeholders with a focus on transition of care and the consumer experience. A key aim is to utilise the POAC model to increase home based management of these people supported by the GP Team.

Continuing to increase community communication and engagement is concurrently being advanced with joint MDHB and THINK Hauora working group. Key elements will be agreed to commence with pre winter messaging in March.

2.3 Pharmacy Improvement Programme

The Pharmacy Improvement Programme has completed its first year and is tracking well. There have been periods of reduced capacity with vacancies with active recruitment underway. 29

This quarter the Primary Care Support Pharmacists team provided Medicines Management Services to 263 patients. This brought the calendar year total to 1509 patients (Table 1).

Table 1 Total number of Patients Quarter Jan - March April - June July - Sept Oct- Dec Year total Number of Patients 411 419 416 263 1509

To ensure there is access for our communities, patients are able to self-refer and request to see the practice pharmacist. The source of patient referrals have always been significantly diversified, this quarter has seen a continued focus on high-risk polypharmacy patients.

Reducing medication related harm focussed on avoidable Adverse Drug Events (ADEs) originating in primary care continues in collaboration with primary health care teams.

In this quarter, 50 patients were identified as having an ADE. This is comparable to last quarter. Working in collaboration with the primary healthcare teams, they were jointly able to resolve the ADE and help prevent and manage further occurrences in the future.

Table 4 Trend of Adverse Drug Events Quarter Jan - March April - June July – Sept Oct-Dec Year total Number of Patients 90 72 49 50 261 Presenting with Preventable ADEs

2.4 Move to 200 Broadway

On Friday 13 December 2019 staff from Te Tihi, THINK Hauora, the Diabetes Lifestyle Trust and MDHB’s Public Health and Community Child Health Teams moved into the new premises at 200 Broadway.

The move represents the coming together of some of key community based providers. It offers the opportunity to further strengthen relationships between the various organisations, whose focus is working in and with our communities.

The building project was undertaken by the Vining Group, who refurbished the back section of the old Returned Servicemans Association (RSA) premises, adding a new area to accommodate the combined workforce of almost 200 staff.

The Whakatūwheratanga (Dawn Ceremony), held on Monday 2 December 2019 was well attended, with staff and invited guests attending the blessing, and having a look around the new building.

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2.5 Measles

From 1 January 2019 to 15 January 2020 there have been 2,191 confirmed cases of measles notified across New Zealand (as at 1500hrs 15 January 2020) based on ESR reporting. The past two weeks has seen six cases confirmed nationally. This is much lower than was the case in the last report. Most people who have caught measles have been unvaccinated or with uncertain vaccination status.

There have been ten people confirmed with measles in the MidCentral District Health Board (MDHB) district since the beginning of the 2019.

Additional stocks of vaccine have arrived in New Zealand with a further 70,000 doses scheduled to arrive in January.

The Ministry of Health has amended the ordering system so that individual providers are once again able to order MMR vaccine directly from the supplier, along with their other schedule vaccines.

2.6 Manawatu River Leaders forum

The Manawatū River Leaders' Forum has welcomed the MDHB as a new member at their December meeting. MDHB’s General Manager Māori, Medical Officer of Health and Public Health Manager attended the meeting. Tracee noted that the Accord's vision, "if the water is healthy, the land and the people are nourished", aligns well with the MDHB vision and mission. It will be advantageous for the MDHB to partner with the Accord in addressing the issues of the awa.

3. EMERGING/CURRENT RISKS

Cluster of Pneumonia in Wuhan City, China

An outbreak of pneumonia of unknown aetiology in Wuhan City, China was initially reported to World Health Organisation (WHO) on 31 December 2019. Most patients had links to the Huanan South China Seafood Market.

At time of writing this update there have been 2011 confirmed cases, including forty two cases beyond China. The majority having reported travel to Wuhan. 31

Person-to-person spread is now considered to be occurring, however, the mode and readiness of transmission, clinical spectrum of disease, true geographic extent of human infection, and source, are yet to be confirmed.

The Ministry of Health (MoH) Public Health Team has established an Incident Management Team to respond to this event. MDHB has a combined response planned for any suspect case that is identified in the area. Primary Care has confirmed sites for seeing suspect cases, and key public health actions to include isolation of the suspect case, identification and quarantine of appropriate contacts are business as usual. The MoH will act as the key point of contact for general media enquiries and the DHB will respond to specific local enquiries.

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SERVICE: Te Uru Rauhī Mental Health & Addictions Service

FOR PERIOD: November & December 2019

PREPARED BY: Scott Ambridge, Operations Executive Dr Vanessa Caldwell, Clinical Executive Richard Hodgson, Planning & Integration Lead

1. PERFORMANCE OVERVIEW

Te Uru Rauhi is on track with all initiatives under the Annual, Operational and Performance Improvement Plans. There is one emerging risk, which is workforce related, discussed under Emerging/Current Risks. Items of note are discussed under Significant Matters.

Rating & Initiative Trend Inquiry into mental health & addiction – He Ara Oranga (also read in conjunction with sections below) A Work with the Service Alliance Group to implement a district wide plan that supports increased access and capacity to adopt early intervention models of G ● care and recovery. A Work with the PHO, NGOs, Iwi and Kaupapa Māori services on establishing a range of low threshold community based services that support resilience, G  connection and wellbeing. A Partner with the public health service and the sector to expand capability and capacity in suicide prevention and develop high profile campaigns focused on G ● prevention. A Develop the acute model of care and progress initiatives to address the critical gaps for those experiencing psychiatric distress (ie home based treatment G ● teams, multi-function planned respite). Population Mental health A Develop Iwi and community partnerships that support a purposeful focus on addressing the inequities for Maori and prioritise investment towards improving G  Maori outcomes. A Work in partnership with the community to develop and pilot community-based G ● services that expand access in the Horowhenua and Tararua areas. A Work with the PHO to improve the overall physical health outcomes for people G ● with mental health and addictions conditions. A Develop initiatives to increase the diversity of the workforce and work in G ● partnership with Pae Ora to improve the cultural competency. Mental Health & Addictions improvement activities A Drive whole of system improvement across the six domains of quality and G ● against the HSQC quality improvement programmes (incl. zero seclusion). A Commence transitioning to a person centred model of practice and explore ways to use data and technology to increase workforce effectiveness and G ● mobility. A Complete business case to Government to secure funding for progressing G ● redevelopment of acute mental health inpatient (Ward 21) facility.

COPY TO: Te Uru Rauhī Mental Health & Addictions MidCentral DHB Heretaunga Street PO Box 2056 Palmerston North 4440 Phone: +64 (6) 350 8358

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Maternal Mental Health / Addictions A Improve equity of access and reduce waiting times for young people and G ● pregnant Māori women and their whanau.

Rating & Trend Legend G On track, A Behind plan – R Behind plan – D Not completed progressing as remedial action plan major risks and as planned. planned. in place. exception report required.  Improved from  Regressed from last ● No change from last report. report. last report. Plan Legend A Annual Plan P Performance O Operational Plan Improvement Plan

1.2 Performance Indicators – December 2019

vs. Last KPI #Description Target Jan‐19 Feb‐19 Mar‐19 Apr‐19 May‐19 Jun‐19 Jul‐19 Aug‐19 Sep‐19 Oct‐19 Nov‐19 Dec‐19 Month 28 day acute inpatient readmission KPI 2 0‐10% 25% 19% 18% 20% 16% 13% 25% 20% 15% 22% 21% ↓ rate Average length of acute inpatient KPI 8 14‐21 days 10.2 10.4 8.4 8.3 8.9 13.1 11.4 15.6 8.1 10.5 11.1 8.9 ↓ stay (days) Pre‐admission community care KPI 18 (Seen in 7 days before ward 75‐100% 45% 57% 54% 56% 60% 32% 51% 45% 35% 48% 42% 56% ↑ admission) Post‐discharge community care KPI 19 (Seen in 7 days following ward 90‐100% 68% 66% 64% 67% 59% 46% 65% 51% 50% 57% 63% 47% ↓ discharge) Percentage of contact time with KPI 33 80‐90% 89% 87% 87% 87% 89% 89% 86% 86% 85% 86% 85% 86% ↑ client participation Community service‐user‐related KPI 34 35‐40% 18% 18% 18% 18% 20% 18% 22% 20% 19% 20% 19% 16% ↓ time % Current clients in a service for more than 91 days after first seen 0% 25% ↑ with no diagnosis % HoNOS/CA/65+ within previous 3 months ‐ Community Teams 80% 60.7% 61.5% 68.1% 63.5% 66.5% 66.0% 67.7% 70.4% 70.4% 71.6% 71.6% 74.1% ↑ (excl. A&OD) % HoNOS/CA/65+ within previous 3 months ‐ Inpatient Teams (Ward 80% 83.1% 84.7% 87.7% 93.4% 94.9% 93.8% 95.4% 96.1% 97.6% 98.5% 98.3% 97.6% ↓ 21 and STAR 1) Seclusion ‐ Ward 21 0 12 10 3 5 9 17 6 5 20 12 3 5 ↑ Acute Care Team Police referrals PP26 Face‐to‐Face Contact within 3 68% 51% 54% 74% 67% 57% 46% 64% 67% 64% 75% 64% ↓ hours

LEGEND Meets Ministry of Health Target Does not meet Ministry of Health Target Ministry of Health Alert or Significantly below target

KPI2: Readmissions within 28 days, remains a key improvement area for our teams. The efforts over the Christmas period to work more closely with the NGOs is currently being evaluated and it is anticipated that some of the activities undertaken during this time has contributed to improved outcomes and connections being made for people being discharged from the ward. A review of the data relating to KP19: Seen within Seven days of discharge; does show that the numbers being discharged to the teams are low enough (often only two or three people) that if a team misses seeing only one discharged client within the seven day time frame, it can be enough to miss compliance and if enough teams miss compliance, the overall score is significantly adversely affected. The most common reason for not being able to see a client within the seven day period is that the client has rescheduled the appointment.

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It is pleasing to see the positive result for complaints due to a concerted effort by the team to be more responsive to feedback from our customers. All managers are working on plans for their staff with leave in excess of two years.

2. SIGNIFICANT MATTERS

2.1 Request for Proposals (RFP) – Ministry of Health

Access and Choice Primary Mental Health & Addictions Services

On 3 December we received notification by the Ministry that our proposal was shortlisted for implementation in the first tranche (January through June 2020) of this RFP. The Ministry was very impressed with the strength of our response and in particular the collaboration demonstrated between the DHB, THINK Hauora and Te Tihi o Rauhine Alliance.

On the 19 December we met with the Ministry to discuss details regarding our proposal. The Ministry advised that as the tender had been oversubscribed, the funding allocation had been based on the MH Population based funding formula. As such, we have been approved for 1/3 of the proposed funding to a total of $1.9m which has been prescribed for 7.1FTE Health Improvement Practitioners and 10.7FTE Support workers/wellbeing coaches. The Ministry did indicate that there will be further funding increases in the out years without a need to re-tender.

We are pleased that we have the opportunity to increase the capacity of workforce in the primary care setting however did express our disappointment to the Ministry given this allocation will be insufficient to create a critical mass to enable the transition of our model of care to be largely focused in the community and in early intervention by itself. We will of course, continue to work with our key partners to achieve this.

Subject to confirmation of some details we hope to receive contract by the end of January.

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Expansion and/or Replication of Existing Māori and Pacific Primary Mental Health and Addiction Services

Te Tihi o Ruahine Alliance led the response in conjunction with the DHB that was submitted on the 26 November. We have since been told that this tender is over- subscribed and we should expect a response from the Ministry in January.

A decision was made not to submit a response for the specific Pasifika RFP as we did not meet the tender criteria. We do expect further RFPs focused on youth in February.

2.2 Older Adult Model of Care

The official project kick off meeting to identify the best practice model of care for Older Adult psychogeriatric care in this region was held in December. Annette Carse the Current Clinical Manager for Star 1 and OACMH will be the Project lead. A project scope has been agreed and work has commenced on researching what current models exist both in New Zealand and internationally.

Regular updates will be provided to this committee.

2.3 Acute Alternatives

Services which provide 24 hour supported living environments in the community to facilitate both planned and unplanned respite are needed in priority locations (Horowhenua and Tararua). Ideally these are services operated by peers, kaupapa Māori and those focused on young people to have real alternatives to manage their wellness in the community, get back on track quickly and prevent unnecessary ward admission (through lack of other options). They will be supported as required by secondary teams for specialist clinical review.

We are currently working with Housing New Zealand to investigate options in the Horowhenua area that will support a multi-function, planned and unplanned respite service including providing support for those discharged from inpatient care as a “step down” to support supported re-integration for those who may need extra time.

We have also initiated an informal initiative with an Aged Care facility to provide support for people who may be ready for discharge from the ward and could benefit from a little extra time to ensure better integration back into the community. Overall the initiative was successful with the majority of people transitioning quickly through the facility. This initiative has concluded and will now review evaluations to decide whether formal arrangements will be put in place.

2.4 Inpatient facility redevelopment

As previously reported, workshops and consultations have been held over his past year to engage stakeholders in the design of a new inpatient facility. Aligned to this, work on a new model of care, work with Unison, Iwi and Kaupapa Māori provider’s network, and leadership workshop sessions have contributed to this development. We have been keeping relevant government departments updated with our progress and we were delighted that during their visit in November, the 36

Prime Minister, Jacinda Ardern and the Health Minister, Dr David Clark announced the $30m funding package for the inpatient redevelopment.

The single stage business case is due to be presented to HDAC and the Board in the first quarter of 2020.

2.5 Demand

The graph below shows the number of people presenting by day to the Emergency Department who are seen by the Acute Care team.

Presentations to ED by Day 40 35 30 25 20 15 10 5 0 Mon Tues Wed Thurs Fri Sat Sun

July October November

50 percent of the presentations are seen between 4pm and 11pm at night and 20 percent seen between 2am and 5am in the morning. It is also important to note ACT is a mobile team that attends assessment at people homes and at police cells sometimes is very difficult and challenging situations. Over a five-month period (July to November) the ACT team saw 423 people, 82 percent of those within six hours.

Other acute alternatives remain limited in the community and access to appropriate housing options for people remains the biggest problem, particularly those who might require a more personalised response.

2.6 Financial Sustainability

Financial sustainability remains a significant challenge for Te Uru Rauhī which are predominately being driven by staffing costs. Whilst these cost pressures remain any opportunities to reinvest in the new model of care will remain extremely challenging. Request for Proposals from the Ministry will provide new opportunities to invest, however these do little to change the current pressures on secondary services in the short to medium term.

Work is continuing on a number of initiatives aimed at stabilising the current situation.

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3. EMERGING/CURRENT RISKS

3.1 Workforce

While the majority of teams are near fully recruited we are focused on Registered Nurse (RN) vacancies in Ward 21 and Senior Medical roles. It is anticipated that a fully staffed ward will reduce security costs.

A number of strategies are being pursued on an ongoing basis in regards to recruitment for SMOs and in particular, our Medical Lead role. A microsite to promote our area and SMO vacancies went live in December as a landing point to direct people to our information. This will also allow us to engage google analytics to highlight this site when people access information about relevant targeted conferences as a ‘google ad’. Joint advertising in relevant professional journals will also be investigated. We have engaged a recruitment specialist to support our efforts.

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CLUSTER: Te Uru Pā Harakeke Healthy Women Children and Youth

FOR PERIOD: November & December 2019

PREPARED BY: Sarah Fenwick, Operations Executive Dr Jeff Brown, Clinical Executive Barb Bradnock, Planning & Integration Lead

1. PERFORMANCE OVERVIEW

Te Uru Pā Harakake is on track with the majority of initiatives under the Annual, Operational and Performance Improvement Plans. There are two risks, which are Workforce and Midwifery. These are discussed under Emerging/Current Risks. Items of note are discussed under Significant Matters.

Initiative Rating & Trend A Increase number of Māori women registered with a Lead Maternity Carer within G ● the first trimester of pregnancy A Reduce equity gap between Māori and non-Māori babies who are exclusively or G ● fully breastfeeding A Reduce rate of Māori sudden unexpected death in infancy G ● A Promote the “5 things to do in the first 10 weeks of pregnancy” initiative G ● A Increase support to first time parents requiring education, advice and guidance G ● as they transition to parenthood following the birth of their baby A Deliver district wide breast feeding strategic plan A  A Identification of infants with an unhealthy weight enabling access to appropriate G ● interventions through referrals A Increase engagement with family harm training G ● A Cross cluster development of Child Health Nurse Practitioners G ● A Support Housing NZ client families to access and engage with health and social G ● services through one point of contact A Support a sustainable midwifery workforce G ● A Develop the nurse practitioner workforce G ● A Strengthen the P2A transition programme - complete evaluation of programme G ● A Improve understanding around service options for transgender young people G ● A Scope opportunities to develop a connected early intervention approach for G ● learning and behaviour with Ministry of Education and CAFMHS A Implement findings of Massey research into childhood obesity engagement G ● O Develop strong relationships with Iwi across the district G ● O In partnership with Pae Ora new names are gifted to the cluster G ● O Develop a cross cluster collaborative approach with Te Uru Arotau and Paiaka G ● Whaiora to better support whanau who do not engage with services O Identify and evaluate opportunities for RNs to increase scope in Gynaecology G ● O Increase clinical procedures in the outpatient setting G ● O Investigate POAC opportunities to provide care closer to home G ● O Improve experience for women experiencing miscarriage A  O Increase access to SUDI prevention activities, education and parenting support to G ● rangatahi and their whānau O Cross cluster collaboration with Te Uru Rauhī to improve maternal mental health G 

COPY TO: Uru Pā Harakeke Healthy Women Children and Youth MidCentral DHB Heretaunga Street PO Box 2056 Palmerston North 4440 Phone: +64 350 8928

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O Increase the number of midwifery students on clinical placement and quality of G ● the practicum experience O Sustain appointment of midwives to established positions employed by DHB A  O Increase participation in formal training in leadership positions G ● P Planned Care ESPI 2 compliance A  P Planned Care ESPI 5 compliance A  P Reduce shorter stays in the Emergency Department A 

Rating & Trend Legend G On track, A Behind plan - R Behind plan D Not N Action not progressing as remedial action - major completed commenced planned plan in place risks and as yet exception planned report required  Improved from  Regressed from ● No change last report. last report. from last report. Plan Legend A Annual Plan P Performance O Operational Improvement Plan Plan

1.1 Performance Indicators – December 2019

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Work is continuing to create a dashboard that meets clinical governance and operational reporting requirements. Exception reporting is noted as follows:

 Acute readmissions within 28 days for November and December have all been reviewed and were appropriately readmitted  Emergency Department (ED) stays less than six hours compliance deteriorated in December 2019. Each breach is investigated and some adjustments have been made to correct the data as required.  Slow progress continues to be made with annual leave balances over two years with leave plans in place for staff with the high balances, actual number reduced by three this month  Outpatient Did Not Attends (DNAs) have breached, however have improved from the previous month by 1.9 percent to 7.2 percent. This has been supported by the introduction of a text messaging service in Colposcopy and Gynaecology Continence services which has reduced DNAs significantly, by 20 percent of baseline for Colposcopy and by 50 percent of baseline for Continence.

2. SIGNIFICANT MATTERS

2.1 Breast Feeding Strategic Plan

MidCentral District Health Board (MDHB) Breast Feeding Strategic Plan has been delayed due to the plethera of feedback received regarding the draft plan and the need to incorporate this into the document. Positive feedback regarding the draft plan was received from the Breast Feeding Hopsital Initaitve audit team. The final document will be signed off by governance at the next meeting.

2.2 Women Experiencing Miscarriage

MDHB are at the early stages of work to improve services for women experiencing miscarriage or early foetal demise. Work with the gynaecology team has commenced regarding appropriate clinical pathways and positive progress is being made to ensure women have the best experience at this difficult time.

2.3 Planned Care ESPI 2

Gynaecology is compliant with achieving FSA (ESPI 2) target. Close monitoring is in place to ensure on-going compliance. Paediatrics was noncompliant at end of December 2019 due to a 4 FTE gap in their Resident Medical Staff roster, necessitating the cancelling of outpatient work. The staff shortage continues until the end of February. Locum cover is being sourced where possible, alongside the use of Nurse Practitioner clinics to help recover the position as soon as possible.

2.4 Planned Care ESPI 5

The Gynaecology team has continued to utilise additional available theatre sessions. Long-wait patients are being compromised by the significant number of elective caesarean sections bookings. A number of urgent patients have been referred for surgery this month that have also displaced the long-wait patients for routine surgeries. CREST had been engaged to perform 15 Gynaecology surgeries to ensure compliance by the end of November, but have not delivered this number 41

to date due to availability of staff. As of the end of December 2019 twelve patients are waiting longer than four months for their surgery.

2.5 Shorter Stays in ED (SSIED)

ED stays less than six hours compliance deteriorated in December 2019. Each breach is investigated by the Charge Nurses and some adjustments have been made to correct the data as required. The team are working to ensure transfers to the Department are undertaken as soon as possible.

2.6 Te Papaioea Primary Birthing Unit

In December MDHB jointly announced an agreement with the Wright Foundation for MidCentral DHB to take over the operational management of Te Papaioea Primary Birthing Unit. Staff on both sites have been informed and reassured that MidCentral are fully committed to primary birthing. The model of care will be co- designed in preparation for a 1 April 2020 start.

2.7 BFHI Accreditation

The Baby Friendly reaccreditation audit occurred on 28 November 2019 with a positive outcome and only two remedial actions required for reaccreditation, which must be completed within six months. These are:

 a plan to provide appropriate on-going education for staff  monthly audits of partially fed babies for the next three months.

2.8 Child Development Service

The Budget 2019 announced additional funding to Child Development Service (CDS) to improve the health and social outcomes of children who are not meeting their developmental milestones and have additional needs. Additional funding has been allocated by the Ministry of Health to increase access to CDS and ensure the appropriate mix of allied health staff are available to meet service demand.

Budget 2019 funding is being administered through Shared Support Agencies who are acting as fund holders and will administer funds in accordance with approved implementation plans submitted to and approved by the Ministry of Health each financial year. Central TAS will manage the Central region funding allocation.

Following a transparent RFP process MDHB was successful in their proposal to improve point of entry co-ordination and integration of early intervention services for children aged zero to eight years. The funding will flow in January 2020 and, pending sign off of the contract, project management and experienced resource has been secured.

This is an exciting piece of work that will scope, design and develop systems and pathways to coordinate the receipt of all referrals received into Early Intervention Providers across the DHB and Ministry of Education in order to improve timely access and reduce multiplicity of referrals and services. Underpinning the work will be the Enabling Good Lives (EGL) principles and the Good Start in Life practice guidance. It is anticipated that some of the funding allocation will be utilised to reduce the Psychology wait list and options are being explored. 42

3. EMERGING/CURRENT RISKS

3.1 Workforce

Previous HDAC reports have highlighted gaps in the Paediatric RMO roster from December 2019. Whilst the Medical Administration Unit has worked hard to try and secure locums for as many shifts as possible significant gaps remain. Work has been undertaken with the SMO workforce to prioritise safe cover for all services during this period and to ensure their health and wellbeing is maintained. The workforce position is impacting on the ESPI performance for the department.

3.2 Midwifery

In August 2019 a Midwifery Trendcare report highlighted 792 shifts over the previous financial year with insufficient care hours. This led to discussion with the Chief Executive regarding clinical risk within the service and an additional six Full Time Equivalent (FTE) midwifery posts (in excess of budget) was agreed to. Four new graduate midwives have been recruited to commence January 2020, however despite local, national and international recruitment efforts MDHB has not been able to recruit sufficient midwives to begin appointing to this additional FTE, with the four additional staff filling existing vacancies. Risk controls, mitigations and actions are in place (discussed in previous Health and Disability Advisory Committee (HDAC) meetings) to ensure safe service delivery. An on call arrangement was trialled with staff, however this has not been successful due to lack of interest from midwives due to risk of fatigue and burn out.

Acuity within the service remains high, deeming it necessary to consider short term measures to ensure clinical safety within the service. It is proposed that the additional six midwifery FTE be utilised in an alternate way for the next 12 months. This would entail recruiting additional Registered Nurses (RNs), Health Care Assistants (HCAs) and extending clerical hours for a 12 month period. Specific tasks within appropriate scope of practice would be allocated to RNs and HCAs. This will free up time to ensure midwives can be prioritised to care for antenatal, labour, birth and immediate postnatal (first two hours after birth) care for women. Engagement with the unions regarding these proposals is underway.

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CLUSTER: Te Uru Mātai Matengau Cancer Screening, Treatment and Support

FOR PERIOD: November & December 2019

PREPARED BY: Cushla Lucas, Operations Executive Dr Claire Hardie, Clinical Executive Denise Mallon, Planning & Integration Lead

1. PERFORMANCE OVERVIEW

Te Uru Mātai Matengau is generally on track with all initiatives under the Annual, Operational and Performance Improvement Plans. There are no emerging risks or areas of concern. Items of note are discussed under Significant Matters.

Rating & Initiative Trend A Work with Ministry of Health to implement the Cancer Action Plan G ● A Work with Central Cancer Network to implement Regional Services Plan G ● A Implement the pro-equity plan for Breast and Bowel Screening G ● A Implement Bowel Screening / Bowel Cancer Improvement Programme G ● A Minimise breaches of the 62 day FCT waiting times G ● A Increase support for women to live well beyond breast cancer G ● A Replace linacs, including implementation of regional outreach programme G ● P Improve stewardship of blood and blood products G ● O Meet 14 day wait time for Category B radiation treatment G ● O Develop and implement a cancer prevention strategy G ● O Implement a tumour stream framework G ● O Develop a strategic plan for the Regional Cancer Treatment Service G ● O Implement an Advisory Oncology in Primary Care service G ● O Agree and implement a supportive care work programme G ● O Implement systems to capture patient reported outcome measures G ● O Launch Cancer Society volunteer programme G ●

Rating & Trend Legend G On track, A Behind plan – R Behind plan – D Not completed as progressing as remedial action plan major risks and planned. planned. in place. exception report required.  Improved from  Regressed from last ● No change from last report. report. last report. Plan Legend A Annual Plan P Performance O Operational Plan Improvement Plan

COPY TO: Te Uru Mātai Matengau Cancer Screening, Treatment and Support MidCentral DHB Heretaunga Street PO Box 2056 Palmerston North 4440 Phone: +64 (6) 3569169

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1.1 Performance Indicators – December 2019

Twenty eight patients attended the Emergency Department (ED) in December, of which fifteen exceeded the six hour wait time; all breeches occurred during times where the Inpatient Unit was at capacity and/or managing high volumes of arranged admissions. Work is continuing on redirecting acutely unwell patients directly to the service rather than the ED.

Acute length of stay is above target, the cases in question have been reviewed and there was no significant or action noted for the month.

Staff turnover was marginally above target due to two staff retirements, but below target year to date.

Sick leave has been reviewed; higher rates than expected are due to a small number of staff experiencing major illness/injury.

Slow progress is being made with annual leave in excess of two years, while the number of staff is not decreasing there has been a reduction in hours owing (now 1,246 from 1,327 in November), with further improvements expected as leave is taken over the Holiday Season.

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2. SIGNIFICANT MATTERS

2.1 Cancer Action Plan

In December 2019 the National Cancer Control Agency was launched. The Agency is situated within the Ministry of Health but operates autonomously with its own Chief Executive, reporting report directly to the Minister of Health. The Agency will have a strong focus on eliminating inequitable outcomes from cancer. The four Regional Cancer Networks will be consumed within the Agency; however a regional presence will be maintained. The structure of the Agency is yet to be released.

2.2 National Bowel Screening

Invitations sent Kits returned Positive results 2,272 785 44

Bowel Screening is proceeding as planned. Thirty five per cent of the invited population has returned a kit to the National Centre, of which 44 out of 785 individuals have tested positive.

Health promotion activity continues, with the team attending a number of community events scheduled over the summer. Other promotions include further posters to be circulated, displays at local library, pod casts, large bill boards and developing relationships with local champions to add depth to the current strategy.

While the coverage is low it remains early days. Whanganui coverage is slightly ahead of MDHB at 39 per cent reflecting their roll out the month earlier. Also of note (as at 10 January 2020) 28 positive tests had been identified locally which increased to 44 the following week.

2.3 Linear Accelerator Replacements – Palmerston North

The installation and commissioning of the new linacs has begun. The first outgoing linac treated its last patient on 10 January 2020. This machine had been operational since 2003 and delivered 130,000 doses of radiation in its lifetime. It was craned out the bunker on the 18 January 2020.

The first new machine arrives on the 8th February. After which an extensive technical and clinical commissioning programme will be undertaken led by the Medical Physics team, and will conclude by the end of May 2020.

The staff has volunteered to work extended hours (7 a.m. to 8.p.m) during this time to ensure all patients are treated on the three remaining linacs. The welfare of the team, as well as the patients, is critical and close monitoring is in place to ensure staff wellbeing. The staffing plan during this period has been agreed with the relevant unions as part of the project preparation

The regional project, focusing on the new outreach sites in Hastings and New Plymouth, has also commenced with a startup meting to occur in early February. This work will continued over the next 36 months, with the expectation that the Hastings site will be opened within the next 12 months.

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2.4 Blood Stewardship (Performance Improvement Plan)

The aim of this work is to ensure the optimal stewardship of blood and blood products, with a particular focus on patient safety.

In the first half of 2020 MDHB will launch a hospital wide safety initiative that has been successfully used in other DHBs to reduce labelling errors and the number of re-tests re-sampling. The campaign focusses on correct patient identification and transcription of this information to samples and request forms.

Ongoing audit continues including monitoring of wastage, appropriate ordering and use, optimal haemoglobin management and refinement of pre-transfusion sampling and testing processes. Year to date blood expenditure is $98k favourable.

2.5 Category B Radiation Treatment

All patients ready for treatment continue to start within 14 days, although there are challenges managing Statutory Holidays which shorten turnaround times. New systems are being trialled to accommodate this, but remain work in progress.

2.6 Tumour Stream Framework Development

Five of the nine Tumour Streams have been established with Quality Improvement Plans in place for each group. A notable achievement has been the in-house development of electronic referral templates for Multi-Disciplinary Meetings (MDM).

MDMs are a core part of treatment planning for all cancer patients and involve a structured discussion between the treating specialists, including pathology and radiology, to formulate the best set of treatment options for each individual’s condition and prognosis.

The previous paper based referral system has been transformed into a web based form, accessible online across the region. This process makes the MDM more efficient administratively and has improved data collection. The need for transcription services is eliminated and the MDM outcome report is available on Clinical Portal almost immediately after the meeting. The MDM data is available for clinicians on a QLIK dashboard, which will be a significant addition to supporting clinical audit and service planning.

Key performance indicators and significant outcomes from the overarching clinical governance programme, representing all tumour streams, will be noted in future reports. The remaining four tumour streams will be rolled out later this year.

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For:

Decision X Endorsement Noting

To Health and Disability Advisory Committee

Author Greg Brogden, Acting General Manager, Enable New Zealand

Endorsed by Kathryn Cook, Chief Executive

Date 21 January 2020

Subject Enable New Zealand Report to 31 December 2019

RECOMMENDATION It is recommended that the Committee:  endorses the Enable New Zealand Report to 31 December 2019.

Strategic Alignment This report is aligned with the District Health Board’s (DHB’s) strategy, specifically to achieve equity of outcomes, and sets out performance results for Enable New Zealand. It also identifies activity that will further develop Enable New Zealand’s capability and capacity across a number of the DHB’s enablers.

The report also aligns to all three of the Strategic Goals embedded in Enable New Zealand’s Operational Plan.

COPY TO Enable New Zealand MidCentral DHB 585 Main Street PO Box 4547 Manawatu Mail Centre Palmerston North 4442

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1. PURPOSE

The purpose of this report is to set out Enable New Zealand’s performance against its Operational Plan and advice of any current and emerging matters.

2. SERVICE OVERVIEW

Enable New Zealand is a semi-autonomous business unit of MidCentral District Health Board.

It provides local, regional and national disability support services to over 75,000 disabled people and whānau across New Zealand through a range of contracts managed on behalf of the Ministry of Health (MoH), Accident Compensation Corporation (ACC) and District Health Boards (DHBs).

3. AIM AND PRIORITIES

The aim of Enable New Zealand is encapsulated within its shared purpose:

“To support disabled people and whānau to live everyday lives in their communities”

This statement embodies why Enable New Zealand exists and guides the decisions it makes and the priorities it sets.

4. PERFORMANCE OVERVIEW

Rating & Initiative Trend Strengthen and enhance existing services to provide a quality customer experience O Actively seek feedback, measure, monitor and interpret our performance G ● O Deliver responsive and accessible customer services across all areas of the G ● organisation aligned to the customer’s requirements O Partner with key stakeholders to deliver long term sustainable outcomes for G ● the customer Employ efficient delivery practices and maintain a culture of effectiveness and responsiveness in all areas of work O Develop a quality driven practice model to drive service excellence G ● O Our infrastructure is healthy and our technology drives enhanced performance A ● in the delivery of services to our customers O We nuture a positive and diverse workforce culture and a healthy workplace G ● that reflects our values and respects the dignity and privacy of all stakeholders O We cultivate competency and capability in our workforce that is flexible and responsive to the current and future needs of the business and service G ● requirements We aggressively pursue opportunities to grow and develop sustainable services O Meet a broader range of customer needs to remain competitive in the changing G ● market O Increase the total number of customers that purchase services directly from G ● Enable New Zealand O Increase the number of primary customer contracts G ● O Grow diversified revenue streams G ● O Ownership and Governance G ●

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Rating & Trend Legend G On track, A Behind plan – R Behind plan – D Not completed progressing as remedial action plan major risks and as planned. planned. in place. exception report required.  Improved from  Regressed from last ● No change from last report. report. last report. Plan Legend A Annual Plan P Performance O Operational Plan Improvement Plan

4.1 Performance Indicators

Regional

Mana Whaikaha Regional Launch of Total number Total Results Prototype to 30 November Launch of December November 2019 2019 Prototype to 31 2019 December 2019

Total Disabled People active 2186 40 2210 30 in the database People who have had a 686 100 782 135 financial outcome People allocated to a MoH 862 56 870 19 connector (and are still allocated to a MoH Connector) People allocated to their own 103 15 111 10 / Independent Connector People in queue (awaiting 274 52 289 26 allocation to a connector) Total, completed, allocated to 1,239 123 1,270 55 connector or in queue

National

KPI/Measure Target Achieved Percentage of Band 1 Equipment delivered within 5 working days. 90% 85%

Percentage of Complex Housing Modifications completed within 120 60% 79% working days (MoH). Percentage of Equipment provided to Service Users supplied from 35% 29% refurbished stock (MoH). Grabrails Installation Non-Urgent (ACC) 95% 90% Enablement Programme –Exiting RTL platform 100% 100%

The table below sets out the number of customers accessing Enable New Zealand’s contracted services, for the financial year to date at 31 December 2019.

Client volumes by Service MDHB Region All Service Regions Housing Service 101 1,080 Equipment Service 1,731 20,880 Hearing Aids Service 606 12,876 Spectacles Service 850 12,701

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December results for the MidCentral region continued to see Complex Housing requests average between 13-18 requests per month. Due to the roll out of the new Equipment app at the end of October we saw a spike in requests of 336 for the month of November as Occupational Therapists were asked hold requests until the new system became live. December showed the numbers return to normal with 273 requests received. Hearing requests for December were also up by 44 percent. At this point in time it is unclear if this is a trend or one off incident due to Audiologists proactively sending requests through before the commencement of the holiday period.

5. SIGNIFICANT MATTERS

5.1 Mana Whaikaha Prototype

The MoH has invited organisations to register attendance at Notice of Information sessions being held in February. Mana Whaikaha and Enable New Zealand representatives have registered to attend the presentations.

The aim is to identify what alternative models might be available to deliver a transformed disability support system in the MidCentral DHB region including whether any other organisation could deliver the key components of a transformed system and/or whether there are other ways of delivering the key components of a transformed system i.e. what other operating models could look like.

The sessions will provide organisations with the background and current operating model of Mana Whaikaha; the key components of a transformed system; the outcomes that Mana Whaikaha want to achieve through a future operating model; “Try, learn and adjust” report recommendations and the next steps to the information gathering process.

Enable New Zealand’s two year contract with the MoH ends on 30 June 2020 and the future of the prototype beyond this date is uncertain.

5.2 Enablement Programme

The Enablement Programme, approved by the Board in November 2018, outlines a five to seven year programme of work that will transform Enable New Zealand into a highly-personalised customer-led organisation.

It built on work undertaken over the previous four years identifying a powerful case for change based on four key areas of customer experience, workforce, processes and technology.

Stage one of the technology plan has been completed moving services off Round Trip Logistics (RTL) successfully before the RTL agreement expired. Ongoing work will continue to enhance the portal for both customers and internal users.

The Enablement Programme Leads and Senior Management Team will now focus on implementing a Contact Centre management system and retiring the end of life Enterprise resource planning (JD Edwards) technology system.

Progress on the Programme will continue to be monitored by Finance Risk and Audit Committee, via the Enablement Programme Steering Group. 51

Enable New Zealand’s planned timing for the Enablement Programme slipped slightly. Completion of the RTL was finished in December 2019. Historical data has been retrieved from RTL but is yet to be transferred across into a new system. Enable New Zealand maintains read only access of the old system until 28 February 2020.

5.3 Contract Matters

Enable New Zealand has been advised by the MoH that the Equipment and Modification Service contract, due to expire 31 March 2020, will be rolled over for another 2-3 years. This is a significant contract for the organisation.

5.4. Community Initiatives

Enable New Zealand continues to develop initiatives to engage and support the disability community. A new pilot programme sees one of our professional advisors based in our EASIE Living Centre where they advise customers on different solutions that enhance and facilitate independent living, as well as running workshops for health professionals and the public.

Our Firstport website has collected and shared stories from the disability community for its “In My Own Words” series this year. Videos of these stories have reached more than 88,000 people across social media. We will shortly be launching the “Accessible Day Out” library.

Mana Whaikaha, has held numerous events around the region as well as co-hosting an International Day of Persons with a disabilities event in Palmerston North, and sponsoring three young people to attend the inaugural I.Lead conference in Wellington.

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For:

Decision X Endorsement Noting

To Health and Disability Advisory Committee

Authors Wayne Blissett, Operations Executive – Pae Ora Paiaka Whaiora Hauora Māori Directorate Tracee Te Huia, GM Māori Health

Endorsed by Kathryn Cook, Chief Executive

Date 27 January 2020

Subject Pae Ora Paiaka Whaiora Progress Update

RECOMMENDATION It is recommended that the Committee:  endorses the Pae Ora Paiaka Whaiora progress report

Strategic Alignment This report aligns to the DHB’s Maori Health Strategic Framework Ka Ao Ka Awatea and the Manawhenua Hauora Boards Annual Plan for 2019/2020.

COPY TO Pae Ora – Paiaka Whaiora MidCentral DHB Heretaunga Street PO Box 2056, Palmerston North Phone: +64 (6) 350 8913

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1. OVERVIEW

MANAWHENUA HAUORA BOARD WORK PROGRAMME 2019/2020 RATING (Appendix 1) THOUGHT LEADERSHIP MW 1. To provide clear and cohesive governance leadership for Māori health across the A  AP DHB region MW 2. To provide direction, investment priorities and focus areas to MDHB on Māori G  AP health needs and priorities to support equity of outcomes for Maori MW 3. To provide strategic advice on the priorities and focus areas to MDHB across all G ● AP strategic planning processes MONITORING AND REPORTING MW 4. To provide a clear direction and purposeful strategies for Māori health gains G ● AP across the district MW 5. To monitor Māori health gains in the district through impacts of MDHB's health A ● AP service delivery and investment STEWARDSHIP MW 6. Provide expert advice, direction and counsel on important issues that impact on G  AP Māori at a governance level

Rating & Trend Legend G On track, A Behind plan – R Behind plan – D Not completed as progressing as remedial action plan major risks and planned. planned. in place. exception report required.  Improved from  Regressed from last ● No change from last report. report. last report. Plan Legend AP Annual Plan P Performance O Operational Plan MW Manawhenua Improvement Plan Hauora

1.1 Thought Leadership

Paiaka Whaiora Hauora Māori Cluster

As the organisational cluster development has progressed over the last quarter it’s been made clear that the Māori Health structure within the District Health Board (DHB) should be neither a cluster or an enabler. While it has the functions of both roles, it shouldn’t be confused with one or the other. Therefore, going forward Pae Ora will be known as a Directorate. We are now able to finalise our Directorate plan in February 2020 for the Māori Alliance Group to endorse. The team has been working with the six clusters to ensure they have key set Māori health priorities as per the planning process. The Māori Alliance Group representatives that sit across the other cluster alliance groups are integral in the development of this plan. We expect the finalised wellbeing plan to be with Health and Disability Advisory Committee (HDAC) in March.

Commissioning for Māori Health Services

Pae Ora Directorate is now responsible for the commissioning and management of Kaupapa Māori Health Services across the MidCentral District. This shift is a strong approach to assisting to reduce health inequity for Māori. Evidence suggests that by Māori for Māori service delivery and commissioning increases access and reduces the numbers of people who don’t attend clinics. We are working through the capacity and capability issues for the change. The recruitment for a Tumu Rautaki – Strategy Integration Lead is underway. Once appointed the role will partner with the Clusters ensuring pertinent services are contracted for. 54

Applications closed on the 19 January with shortlisting now completed. The panel expect to appoint to the role in early February.

Relevant Māori Health Priorities

Our mission is simple: Māori in the MidCentral region have the best health status in Aotearoa. To guide MidCentral DHB to achieving the mission we are aligning our efforts to the Māori Health Strategic Framework; Ka Ao Ka Awatea 2017 - 2022, our Kaimahi Ora Whānau Ora - Māori Workforce Strategy and Implementation Plan 2017 - 2022, and the Manawhenua Hauora Boards work programme. We are currently engaging all Iwi to ascertain their planning priorities and where these have not been established, we are providing capacity for Iwi to do so. This will further inform DHBs planning into the future. Iwi engaged so far have supported this direction of travel. These are Rangitāne ki Tamaki Nui a Rua, Muaūpoko, Kahungunu ki Tamaki Nui a Rua and Ngāti Raukawa ki te Tonga.

As we move into Annual Planning for 2020/21 the organisation has agreed we will continue to develop one plan ensuring we can lift out the Maori component of the plan for the purposes of meeting the Ministry of Health’s expectations. For this Annual Plan we will ensure we include the Maori health priorities listed in Ka Ao Ka Awatea which are, Whānau free of violence, Women’s health, Mental Health and Addictions, Older People, Child Health particularly 0-4 year olds, Workforce Development and Investment and Development into Iwi and Māori providers. Planning will be a key focus for the next six weeks. (Appendix 2)

2. MONITORING AND REPORTING

Equity and its Application into DHB

A draft Terms of Reference has been agreed between the Internal Auditor Service and DHB for the internal audit on equity across the system. This is an internal deep dive on where we are situated with our response to the issue of Māori health inequity. It’s a brave approach for the organisation and one the executive team is not taking lightly. Once we have the results of the audit we will bring the recommendations to HDAC and the Board for endorsement before implementation.

Equity Monitored Across the System

A Māori Health Dashboard for monitoring inequity is being developed with the expectation to have a draft completed for the March HDAC meeting for endorsement. Once we agree the measures for monitoring these will become the new structure for reporting Māori health at the governance level of DHB. We will partner with PHO and Manawhenua Hauora Board to ensure we are well aligned with their identified priorities so that there is buy-in to the finalised dashboard. This will be reported through to the HDAC, Manawhenua Hauora Board and DHB Board six monthly.

Equity of Funding for Māori Providers

The Manawhenua Hauora Board has a work programme (which forms the template for this reporting) that priorities the increase in Māori funding for services from 17/18 forward. Analysis is being completed to assist the commissioners to understand the current baseline. Once complete an agreement will need to be reached with the commissioners about how increase is achieved over time. 55

Moreover, work is being undertaken to ensure Māori health provider contracts are conducive to population needs. Planning Services and Integration and Pae Ora are in early discussions on how the DHB move to outcomes contracting and how we become early adopters to the findings of WAI 2575 – the Hauora Claim.

3. STEWARDSHIP

Māori Workforce Development

Kia Ora Hauora is a national Māori Workforce Development programme designed to increase the number of Māori into the Health workforce. This is a Ministry funded programme designed to support DHBs and other sectors in employing more Māori into the health sector. Currently there are 3,354 people engaged in the programme with 532 people registered from within the Central Region. There are 97 people registered from within the MidCentral DHB district with Universal College of Learning (UCOL) being the top tertiary institution of enrolment for Kia Ora Hauora students. It’s particularly exciting to see that 31 students are enrolled into a midwifery course in Central Region, as we have just one Māori midwife in MDHB.

Pae Ora has worked in partnership with Kia Ora Hauora to sponsor two Summer internships. Xavier Bowe and Davis Ferguson commenced in the DHB on the 8 January 2020 and is with us for six weeks being exposed to all aspects of health from a Māori context. This builds on the internships we hosted in 2019 as part of the Kia Ora Hauora programme.

In line with the national Chief Executive Key Performance Indicators for Māori Workforce Development, the Māori Health Service is working with Human Resources to identify the statistics for the Māori workforce and where they are employed. This coupled with the report on Māori utilisation of services in DHB, will help us to identify where the gaps are and will support us to grow the workforce in the right places. Of the total DHB workforce 9 percent or 261 staff identify as Māori with Acute and Elective and Mental Health and Addiction clusters employing 45 percent of these. We are currently seeking information from UCOL and Massey on the numbers of Māori within the three year nursing programme to ascertain the pipeline of potential staff recruits over the next three years. Next month we will be reaching out to the Kia Ora Hauora students who whakapapa to the iwi of this district to build relationships with the intent to employ them once qualified.

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Kaimahi Māori by Cluster/Enabler 70 65 60 52 50 40 30 22 21 20 17 15 15 20 14 11 10 4 3 11 0

Strategic Advice within DHB

Manawhenua Hauora members are cascaded into committees and alliance groups of clusters to ensure strong advice and support is provided to cluster development, strategic planning and commissioning of services. While this development is in its infancy there is a willingness to get it right for Maori across the services. The Maori Alliance Group has been established to ensure consistency and clarity across all strategic imperatives. Ensuring a Treaty partnership is enacted is key for the DHB and this is one initiative to support strong partnership.

DHBs Tiriti o Waitangi Policy Update

The MDHB Te Tiriti o Waitangi Policy is due for review. The Ministry of Health is currently updating their policy position on the Treaty of Waitangi opting to use the Articles of Te Tiriti and moving away from the Principles approach of previous years. Therefore, MDHB is working with the Ministry of Health to align our policy position.

The above information outlines the priority work currently being undertaken by Pae Ora Paiaka Whaiora.

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Appendix One:

MANAWHENUA HAUORA & MIDCENTRAL DISTRICT HEALTH BOARD: 2019/2020 WORK PROGRAMME

Manawhenua Hauora and MidCentral DHB: 2019/20 Shared Work Programme

Objective Focus Area Measures Responsibility

MidCentral DHB Manawhenua Hauora

To provide clear and Identification of local Paiaka Whaiora – Hauora Māori Cluster is established in Incorporate local Consider and Endorse all cohesive governance Māori health synchronicity with other Clusters Māori health priorities MDHB Cluster and leadership for Māori priorities to direct into AP, budget Enabler 5 year Plans THOUGHT All Kaupapa Māori contracts sit with Paiaka Whaiora by health across the DHB investment and focus planning and portfolio prior to MDHB Board June 19 region from the DHB work‐plans as advised Approval Relevant Māori health priorities are identified across all by Manawhenua Support the Clusters and Enablers as part of the 5 year planning Hauora Establishment of Paiaka process. Agree a framework for Whaiora in accordance service specification with the review and recommendations redevelopment in of provided by LEADERSHIP Iwi/Maori provider Manawhenua Hauora in contracts by June 30 September 2018 2019.

To provide direction, Equity assessment How equity is being applied in MCDHB is reported Provide Cluster and Provide advice on Equity investment priorities and quarterly to Manawhenua Hauora Enabler specific needs from Māori Cluster and Enabler focus areas to MDHB on measures of success in perspectives, identifying Plan Reporting Māori health needs and addressing Māori key issues for priorities to support Equity results in respect of Māori Health, including Health Equity actions consideration in equity of outcomes for trends and emerging trends, reported to Manawhenua as identified in the 5 determining local Māori Maori Hauora and MidCentral DHB’s Board six monthly Year Plan health priorities and strategies in context Equity of funding for Māori Providers is addressed with the Locality Plans moving from the 17/18 baseline of 1% of total revenue to 3% by 19/20

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Actively support the development of the Paiaka Whaiora Alliance Group

To provide strategic Strategic Imperatives Strategic imperatives will deliver on Manawhenua Consistently obtain Work in partnership with advice on the priorities Hauora aspirations Manawhenua Hauora the MDHB Board to Cluster development and focus areas to MDHB input across strategic ensure the Treaty across all strategic Community imperative Partnership is enacted at planning processes. integration and development. Governance level to cohesion provide clear leadership Ensure the monitoring and direction for the and reporting of organisation to give progress against the effect to the Treaty of strategic imperatives Waitangi is provided to Manawhenua Hauora. REPORTING MONITORING To provide a clear Development of a Monitoring and reporting against Ka Ao Ka Awatea, Quarterly reporting Monitor and review direction and purposeful Māori health strategy clearly identifies the performance of Clusters and against Ka Ao Ka performance as strategies for Māori Enablers in meeting the health and wellbeing Awatea is provided to governance Iwi partner

health gains across the aspirations of the Māori communities across the Manawhenua Hauora district district. from Clusters Position Statement of Whānau Ora is adopted to Clusters and Enablers provide a clear governance expectation of MDHB’s identify key actions commitment and delivery methodology for health’s quarterly that can contribution to Whānau Ora across the District address the health

inequities currently

experienced by Māori AND across the district Receive quarterly report from MCDHB as

to how whanau ora is being implemented by the DHB. 59

To monitor Māori health Equity and Health Monitor trends in Māori Health via the Locality Plans Provide quarterly As above gains in the district Needs Assessment (as above) and health equity tools report as to how through impacts of (as above) Locality Plans are All Clusters and Enablers to report against their MDHB's health service addressing Maori identified equity actions quarterly to Manawhenua delivery and investment Health Hauora

Local, regional and Quarterly review of results against local, regional and Provide quarterly Provide direction and national priority national Māori Health measures reported to reports advice on reports measures (as Manawhenua Hauora and MidCentral DHB's Board (NB: Accurate and Manawhenua Hauora attached) this includes Whānau Ora.) meaningful data will monitor Whānau Ora Manawhenua Hauora will monitor implementation of profiles are provided position paper and assist Māori workforce development against the MDHB as part of the to hold the organisation Kaimahi Ora Whānau Ora – Workforce Development reporting process to to account. Strategy and Implementation Plan 2017 ‐ 2022 Manawhenua Hauora Monitor investment in Iwi/Māori providers workforce development and Whānau Ora

Annual Report of results against Ka Ao Ka Awatea is Provide annual Provide advice on report reported to Manawhenua Hauora and MidCentral reporting of and assist to identify DHB’s Board as part of MDHBs Annual Report performance against priorities for the Ka Ao Ka Awatea following year

Support and monitor the Regional Māori Health Provide quarterly Provide advice on Priorities identified via Te Whiti Ki Te Uru and reports reports Board’s Annual Forum, i.e.:  Use of the national Māori indicator report to drive improvements in the health outcomes of Māori in our region.

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STEWARDSHIP Provide expert advice, Major service Any potential Major service change proposals are Provide report on any Provide critique, direction and counsel on changes actively considered by Manawhenua Hauora during the potential or major direction and important issues that design phase to ensure any likely impact on Māori service proposals prior considerations on any

impact on Māori at a Health and Equity Issues considered at the earliest to a final position major proposal for governance level possible point change with a specific focus on health gains for

Māori and any potential impacts

Significant service Manawhenua Hauora views are sought regarding the All significant Provide direction. plans, e.g. site Long Term Investment Plan being developed for investment plans are Advice, guidance and

redevelopment and MidCentral DHB as a Treaty Partner, submitted to critique across all central Alliance Manawhenua Hauora aspects of design, for consideration at development and

the earliest possible implementation of the time Long Term Investment Plan.

Manawhenua Hauora views sought on the Central Develop Strategic Plan Provide advice and Alliance Strategy being developed by MidCentral and for Central Alliance direction on Central Whanganui DHBs that actively considers Alliance Strategic Plan in both Iwi Relationship partnership with Hauora Boards perspectives as A Iwi. part of the Alliance

Supporting Arrangements

To support this work programme, the following hui arrangements have been put in place:  Two Board to Board hui between Manawhenua Hauora and MDHB's boards per annum  Six‐monthly review meetings between Manawhenua Hauora's Chair & Deputy Chair and MDHB's Chair and CEO  Six‐weekly meetings of Manawhenua Hauora, with MDHB management in attendance  Participation (through Chair) in Te Whiti Ki te Uru – the Central Region's Māori Relationship Forum  Participation (through Chair and Deputy Chair) in annual planning workshops and other appropriate workshops, forums as necessary  Ongoing engagement and consultation by Manawhenua Hauora with the Governors of the 4 Iwi Boards regarding Māori Health priorities and outcomes

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Appendix Two:

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For:

Decision X Endorsement Noting

To Health and Disability Advisory Group

Author Celina Eves, Executive Director of Nursing & Midwifery Yvonne Stillwell, Associate Director of Nursing, Educational and Professional Practice Paula Spargo, Midwifery Director

Endorsed by Kathryn Cook, Chief Executive

Date 21 January 2020

Subject Clinical and Professional Report: Nursing and Midwifery

RECOMMENDATION It is recommended that the Committee:  endorse the progress Nursing and Midwifery has made in the 2019/2021 work plan initiatives

Strategic Alignment

This paper supports the MidCentral District Health Boards (MDHBs) strategic imperatives:

 Achieve quality and excellence by design  Partner with people and Whānau to support health and wellbeing  Connect and transform primary, community and specialist care  Achieve equity of outcomes across the communities

COPY TO: Nursing & Midwifery MidCentral DHB Heretaunga Street PO Box 2056 Palmerston North 4440 Phone +64 (6) 365 9140

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1. PURPOSE

This report is to inform the Committee of the Nursing and Midwifery workforce initiatives in the draft Nursing and Midwifery Workforce Plan (2020-2023), due to be finalised in February 2020. It is for the Committee’s information. No decision is required.

2. SUMMARY

Our ability to meet immediate and growing demand and to continue to transform our health system relies heavily on having the right people, with the right skills, in the right place. The generalist nature of the nursing workforce will continue to be a core strength, as it enables the flexible deployment of nurses within and across care settings. However, our nursing population is ageing, particularly in specialities such as sexual health, midwifery, district nursing and public health, with concern over the availability of this workforce to meet predicted increases in demand by the year 2035.

In addition, the prediction of increasing medical workforce pressures will require advanced nursing practice roles, programmes and funding streams to ensure the stability of the wider health workforce.

Changing workforce patterns, the expectations of newly registered health professionals, new technology and changing community expectations also put pressure on traditional service delivery models.

Average Age in Nursing and Midwifery March – September 2019 October 2018 – March 2019 Nursing 45.2 years of age 45.4 years of age Midwifery 49.8 years of age 49.1 years of age

Nationally the midwifery workforce is greatly under pressure. There is a recognised lack of midwives, problems with understaffed maternity units struggling to meet demand for midwifery services, as well as difficulty retaining and recruiting midwives.

In addition, the maternity population has increased in complexity over the last decade. Most women give birth at a secondary or tertiary facility (approximately 86 percent), whilst 10 percent will birth in a primary facility and four percent choose to homebirth.

The draft Nursing and Midwifery Workforce Plan (2020-2023) identifies four strategic priorities that will help us address these emerging issues:

 A workforce that is the right size and skill mix  A workforce that is competent and capable  A workforce that is focused on people and improved outcomes  A workforce that is integrated and connected across the continuum

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3. NURSING AND MIDWIFERY WORKFORCE

Nurses and midwives at MidCentral District Health Board (MDHB) strive to provide exceptional patient care in an environment that continues to challenge. An aging population and workforce, increasing complexity of individual health needs and recruitment challenges continue to put pressure on our ability to meet safe staffing expectations.

One response to these challenges is the Nursing Council of New Zealand (NCNZ) Expanded Practice Guidelines for Registered Nurses (RNs). This means RNs who have developed their expertise may expand their practice beyond the established contemporary or ‘traditional’ scope of practice to include new technology and management of health consumers with long term conditions including prescribing and other activities previously considered the scope of other health professionals.

3.1 Care Capacity Demand Management (CCDM)

The CCDM programme is a set of tools and processes developed by the Safe Staffing Healthy Workplaces Unit in partnership with the 20 DHBs and health unions. The programme focuses on achieving quality patient care, in quality work environments, with the best use of health resources.

The Government's Nursing and Midwifery Accords, signed with the New Zealand Nursing Organisation, Midwifery Employee Representation and Advisory Services and DHBs in 2018 and 2019, puts safe staffing levels as a top priority for nurses, midwives and DHBs.

MDHB has overall achieved 60 percent implementation so far, making excellent progress over the last 18 months with an action plan for final implementation by June 2021. Our Variance Response Management protocols are being developed, led by four working groups:

1. The Essential Care and Reallocation of Staff Working Group 2. The Variance Indicator Score Working Group 3. Integrated Operations Centre working group 4. Escalation Pathway Working Group

3.2 TrendCare

Fundamental to the success of the CCDM programme is each DHB having access to a validated patient acuity tool. MDHB uses the TrendCare platform as our acuity repository. The validated acuity data provides the basis for the calculation of nursing full-time equivalents (FTEs), recommended skill mix, forecasting, planning and funding.

The Improvement Plan for the Validated Acuity Tool (2017) contains 12 outcomes. As of December 2019, MDHB had met 96 percent of these outcomes with a plan established to achieve the remainder.

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3.3 Staffing October 2018 – September 2019

Contracted FTE March – September 2019 October 2018 – March 2019 Nursing 873.3 852.3 Midwifery 24.67 33.84

Sick Leave Hours March – September 2019 October 2018 – March 2019 Nursing 5.4 % 3.9 % Midwifery 6.3 % 5.3 %

Annual Leave over 2 years March – September 2019 October 2018 - March 2019 Nursing & Midwifery 14.0 % 12.9 %

Due to national and local midwifery shortages, nursing now makes up 33 percent of the Midwifery and Nursing workforce with Uru Pā Harakeke maternity services, with a mix of permanent and temporary nursing contracts.

3.4 Turnover July – Dec 2019

Turnover of Staff March – September 2019 October 2018 – March 2019 Nursing 9.4 % 8.4 % Midwifery 5.9 % 3.85 %

3.5 Recruitment

Our aim is that our workforce will be the right size and skill mix, reflective of our community demographics, sustainable, highly qualified, appropriately credentialed and responsive to the changing needs of our communities.

Developed in partnership with Human Resources and Paiaka Whaiora Hauora Māori, the Nursing and Midwifery Recruitment and Retention Plan (2019 – 2021) outlines the initiatives MDHB is undertaking, linked to the Nursing and Midwifery Accords, MDHBs People Strategy and our Kaimahi Ora, Whānau Ora Māori Health Workforce Development Strategy and Implementation Plan (2017 – 2022).

These initiatives include the Career Force Gateway Programme, nurse and midwifery entry to practice programme recruitment, career expos, ongoing recruitment campaigns (local/national/international), reinstatement of the Voluntary Bonding Scheme for employed midwives, promoting the Year of the Nurse and Midwife (2020) and return to nursing programmes.

3.5.1 Career Force Gateway Programme

In our district we have 27 secondary schools with 11,397 students. In partnership with Allied Health, we are participating in this programme that will see thirteen Year 12 and Year 13 high school students come on site to observe/assist as appropriate in areas that they are interested pursuing a career in, including 67

nursing and midwifery, allied health, administration, domestic services and business support. The students will complete unit standards towards their National Certificate of Educational Achievement qualification during the 10-12 weeks at the DHB. The programme will align with the Kia Ora Hauora Programme also offered by MDHB.

3.6 Undergraduate and Postgraduate Training

3.6.1 Undergraduate Nursing Students

We have two large tertiary providers in our district that offer undergraduate and postgraduate nursing programmes. There are three intakes per annum in the Bachelor of Nursing (BN) programmes of up to 150 students with an attrition rate of approximately eight percent. We provide placements for 50 weeks of the year, in a 24/7 model, to Massey and Universal College of Learning (UCOL).

3.6.2 Undergraduate Midwifery Students

There are no local tertiary providers for midwifery in MDHB. Currently Otago Polytechnic provides a satellite midwifery student support hub to the Manawatu/ Whanganui areas. There is one intake per annum. In 2015-2017 the annual enrolments for Otago Midwifery were approximately 150 students across New Zealand (averaging 12 students in year one for Palmerston North/Whanganui).

From 2008-2016 the Otago Polytechnic Midwifery course had a 21 percent completion rate across all its five satellite centres. In 2020 Victoria University (Wellington) commences its Midwifery Undergraduate program with 40 places per annum. MDHB midwifery will offer places for first, second and third year students.

In 2020, in partnership with Paiaka Whaiora Hauora Māori, we will work with our tertiary providers to ensure Māori students have priority access to our clinical placements and the support of MDHBs Nurse Entry to Practice Programme (NETP) and Nurse Entry to Specialist Practice (NESP: Mental Health) Programme.

3.6.3 NETP Programme

The NETP programme is accredited by the NCNZ and meets the national NETP Programme specifications. The programme is delivered through practice experience, self-directed learning, e-learning and classroom based study days. The Programme is completed over a period of 10 – 12 months and results in the achievement of a competent Professional Development and Recognition Programme (PDRP) Portfolio.

Health Workforce New Zealand (HWNZ) provides $374,400 over an 18-month period to support the newly registered nurses in their first year of practice in the NETP programme, which includes hospital and community settings. MidCentral also supports CREST and the New Zealand Defence Force new graduate nurses in the programme. From January 2018 and December 2019 we recruited 101 new graduate nurses to MidCentral.

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3.6.4 NESP Programme (Mental Health)

The Mental Health Nursing and its Future discussion document (2006, Ministry of Health) recommended all nurses entering the mental health field undertake a Post Graduate Certificate in Nursing.

This 40-week Programme is funded by Te Pou o te Whakaaro Nui (Te Pou), the national centre of evidence based workforce development for the mental health, addiction and disability sectors in New Zealand. Each year up to 140 places are funded nationally.

While MDHB is funded for five placements per annum, over the last three years we have enrolled 35 RNs new to mental health into the NESP programme. Of these, 15 have been funded by Te Pou and the rest through the Nursing External Education and Development (NEED) Committee, HWNZ post-graduate nursing funding and the Palmerston North Medical Trust.

3.6.5 Midwifery First Year of Practice Programme (MYFP)

All new graduate midwives must complete the New Zealand MYFP. The New Zealand College of Midwives is contracted by HWNZ to provide the programme nationally in accordance with the Programme Specification. We have successfully recruited four new graduate midwives who will start their first year of practice with us in February 2020.

3.6.6 Postgraduate Education

HWNZ post-graduate nursing funding supports nurses across the district to gain qualifications that meet Nursing Council of New Zealand specifications.

Allocation of HWNZ funding of $542,904 needs to meet our strategic nursing workforce priorities. In 2020 we received 112 applications, all of which were funded as follows:

Funding Type Designation Number Amount Contract value $542,904 Uru Arotau RN 57 $234,040 Uru Pā-Harakeke RN 4 $13,530 Uru Mātai Matengau RN 6 $24,433 Uru Kiriora RN 28 $119,344 Uru Rauhī RN 11 $28,096 Uru Whakamauora RN 6 $24,435 Provisional allocation 112 $492,739 9% Deduction For Admin costs $48,861 Final Allocation $443,878 Under Spend $50,165

The New Zealand College of Midwives provides postgraduate funding for midwives in New Zealand.

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4. NURSING AND MIDWIFERY SHARED GOVERNANCE MODEL

The Nursing and Midwifery Council was established in 2019, with the overarching purpose to assure the highest possible standards of nursing and midwifery care are maintained across all areas of MDHB and aligned with the delivery of the strategic objectives. This is the most senior nursing and midwifery decision making body in the DHB. The Council structure is depicted in the model below:

4.1 Professional Standards and Behaviour

A number of tools and processes are available to monitor the performance of clinical staff from peer review, clinical audits, supervision, credentialing, appraisals and PDRP. The refresh of the clinical governance framework will further refine how the quality of care is monitored.

The Professional Presentation/Behaviour and Dress Standards (MDHB-2862) Policy has been implemented that sets the standard and expectation of professional dress, presentation and behaviour for the organisation.

5. WORKFORCE DEVELOPMENT: ADVANCING PRACTICE

Extended and Advanced Practice Roles

The Nursing and Midwifery Service supports staff to advance their nursing and midwifery practice.

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5.1 Professional Development

To support the organisational development plan to deliver “Happy, Healthy and High-performing” staff, MDHB has various approval committees to manage staff training applications and funding.

The Nursing External Education Development (NEED) and Midwifery External Education Development (MEED) committees have oversight of professional development funds for nurses and midwives. In this current financial year, NEED has funding of $156,000 for allocation and MEED has $16,000. Approximately $20,000 contestable funding is also available from the Palmerston North Hospital Medical Trust for nursing and midwifery education purposes, including annual research prizes. Other smaller trust funds are also available, on a case by case basis. Nursing and midwifery share a NEED and MEED policy and procedure to ensure transparency and equity of available funding.

In the 2018-2019 financial year, the NEED and MEED Committees allocated funds as follows:

Funding Designation Number Amount Committee NEED RN/Enrolled Nurse (EN) 44 $41,333 Senior Nurses 31 $51,163 All Nurses: Mandatory 30 $23,614 External Training Overseas Conference 10 $30,428 TOTAL 115 $146,538

MEED RM 10 $2,055

No applications were declined. Overseas conferences in Australia included Quality and Safety in Healthcare, Delirium Clinical and Research update, Transplant Nurses National Conference and Sleep Association conference.

Other courses and conferences attended include National pre-admission conference, Sexual Health Congress, New Zealand Triage Course, Trauma Meeting and TOPIC Course, Advanced Care Planning, Health Informatics New Zealand Conference and eHealth Workshop and the Perioperative Nurses Conference.

5.2 Career Framework

Once qualified, nurses are required to maintain their competence and must complete a minimum of 60 hours professional development every three years including short courses and seminars, conferences, continuing professional development offered online and/or post-graduate (level eight) studies.

MDHB provides a career framework for nurses to guide them in their career development and aspirations, as well as providing a means to recognise their level of expertise and additional roles available in the workplace. 71

Figure 1: Primary health nursing career pathway

5.3 Credentialed Activities

Credentialing is required when RNs expand their practice and expertise beyond their traditional scope of practice. In April 2016 a Credentialing Framework for RNs was established with the following outcomes:

Nurse Led Intravitreal Injection Service

The focus of this work stream is to further develop the nurse led service that has shown promising results to date by increasing the number of credentialed RNs. The driver for this development at MDHB is the rapidly increasing demand for intravitreal injections of anti-vascular endothelial growth factor to treat neovascular age-related macular degeneration.

The number of injections delivered has increased significantly since the development of this RN led service. Prior to the nurse injection service 519 injections were delivered in 2015. By 2018 with the addition of nurse injectors but no additional medical staff, 1,459 injections were delivered and the wait time has decreased.

Nurse Led Macular Review Clinic

The focus of this work stream is to ensure that a robust clinical review process is in place to complement gains made in the nurse led intravitreal injection service. The clinical workload associated with the frequent follow-up required for people with macular degeneration is substantial.

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As more new patients are diagnosed and the population continues to age, the patient population will continue to increase. It is thus vital that clinical services continue to adapt so that they can provide a fast and efficient service.

Cataract Service: Nurse Led Biometry

The focus of this work stream is to look at the future of service provision for people with cataracts, with nurses contributing to better patient flow. When patients agree to have cataract surgery it is important that they are fully assessed to determine their fitness for surgery. Essential components of the assessment include obtaining consent and performing biometry - the process by which the power of an intraocular lens implant is calculated prior to cataract surgery. Nurse led biometry has been shown to improve the quality and efficiency of the patient's 'journey'.

Peripherally Inserted Central Catheter (PICC) Insertion Service

PICC insertion is a procedure that is traditionally undertaken by medical staff, so a registered nurse performing the same procedure needs to be credentialed to do the activity with the same level of knowledge and skill as their medical colleagues.

The MDHB credentialing programme enables suitably trained registered nurses to perform ultrasound-guided PICC insertions and electrocardiograph - visual positioning system rhythm.

Since starting in July 2018, 156 nurse-led PICCs have been inserted by four nurses, including the Clinical Nurse Specialist (CNS) IV therapy, two RNs in Transitory Care Unit and the Nurse Educator Ward 23/Oncology.

Seventy–five percent of PICCs were inserted within 48 hours or less of the referral being made.

5.4 Registered Nurse Prescribing

There are four levels of prescribing authority for registered nurses in New Zealand and each has its own educational requirements:

Registered Nurse Prescribing in Community Health

We are leading a pilot of this with our community partners in 2020, including Tamariki Ora Nurses, District Nursing, Public Health and Integrated Family Health Centres. Nurses prescribing in community health will be prescribing for normally healthy people using decision support tools, current best practice information and with the support of colleagues.

They will be responsible for asking for help when they need it and referring patients who have health problems beyond their abilities.

Registered Nurse prescribing in Diabetes Health

Nurses prescribing in diabetes health are designated prescribers with a condition in their scope of practice.

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The condition states “may only prescribe in diabetes health under supervision of a medical practitioner”.

They may also prescribe in diabetes health from the medicines list for registered nurses practising in primary health and specialty teams (2016). There are 303 nurses in New Zealand, with five of these in the MidCentral district.

Registered Nurse Prescribing in Primary Health and Specialty Teams

Nurses are designated prescribers and can prescribe from a schedule of common medicines for common and long-term conditions. Ten nurses in the district have this qualification.

CNSs will be required to engage in this pathway, and each is in the process of developing a plan for achieving prescribing.

Nurse Practitioners (NPs) are authorised to prescribe any prescription medicine, and there are 36 NPs in the district across primary and secondary services.

5.5 Nurse Practitioners

NPs are endorsed by NCNZ. This endorsement requires a Master in Clinical Nursing and evidence of significant clinical supervision demonstrating generalist expert knowledge within a specialty.

There are 422 registered NPs in New Zealand, with 36 of these in the MidCentral District.

There are a further eight Nurse Practitioner Candidates (NPCs) on the pathway to NP. MDHBs NPs and NPCs are working in Te Uru Arotau (Acute and Elective Specialist Services), Te Uru Matāi Matengau (Cancer Treatment, Screening and Support), Te Uru Pā Harakeke (Healthy Women, Children and Youth), Te Uru Kiriora (Primary, Public and Community Health), Te Uru Rauhī (Mental Health and Addictions) and Te Uru Whakamauora (Healthy Aging and Rehabilitation). There is a nationally recognised need to increase.

5.6 Leadership Development

5.6.1 Transformational Leadership Programme (TLP)

Leadership development is well recognised as an essential component of safe and effective care, improved staff satisfaction, succession planning and staff retention.

The TLP, established in 2009, blends theory and experiential learning so that staff are equipped with the knowledge and skills to apply models and frameworks in their workplace at the end of the programme.

As of December 2019, 500 participants have completed the programme. A further two programmes are planned for 2020.

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5.6.2 Leading and Empowered Organisation (LEO)

The LEO programme is used worldwide and is a mixture of evidence-based input, practical exercises, storytelling and reflection, most of which are discipline specific.

It is an intense three day programme with a one-day follow-up about two to three months after completion of the course for reflections and presentation of a clinical improvement project.

Over 40,000 nurses and midwives have completed the course worldwide. In our district, the programme commenced in January 2019 and 140 nurses and midwives completed this as of December 2019. A further four programmes are planned for 2020.

5.6.3 He Pōkai Koko

He Pōkai Koko Leadership Programme offer a unique experience that will develop a cohort of future nursing leaders in Aotearoa New Zealand.

The MDHB cohort will come together for a one-day orientation in January 2020 and then engage in leadership workshops throughout the year, drawing on the expertise of the programme facilitator, the wisdom and knowledge of their peers, mentorship and monthly meetings with a coach.

The programme will emphasize inquiry, continuous learning and the importance of evidence-based leadership. Eight MDHB nurses are participating in this inaugural programme.

5.7 Reward and Recognition Programmes

Recognising and rewarding employees for their contribution to quality patient care and peer relationships is integral to any retention programme, affirming that staff that are making a positive difference.

5.7.1 DAISY Awards 2020

The DAISY Foundation works to recognise and celebrate the exemplary work of nurses and midwives, with recipients recognized in a public ceremony within their workplace and provided with a certificate, a DAISY award pin and a hand-carved stone sculpture from Zimbabwe entitled “A Healer’s Touch.” This will commence in February 2020.

6. MODELS OF CARE INITIATIVES

6.1 Nursing Professional Practice Model

We are developing a Professional Practice Model, following consultation with nursing on how we should practice, collaborate, communicate and develop professionally to ensure the provision of the highest quality care for people, whānau and our communities.

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Whānau centred partnership is the centre of the model, with the aim of ensuring Māori ownership and management of their own health conditions and the delivery of services, in a way that empowers whānau with the necessary knowledge and skills to be able to do that.

It will be enabled by the implementation of Ngā Pou o Te Oranga: Fundamentals of Health, which are embedded in Te Whare Tapa Whā. This will be socialised in 2020, supported by cultural competence training and support.

6.2 Midwifery: A Partnership Model

The word midwife means ‘with woman’ and is reflective of the midwife’s role in accompanying the woman on her journey through pregnancy and childbirth into motherhood. The midwife has a responsibility to share all the available information with the woman and to respect her values and beliefs and also acknowledges the woman’s autonomy in her own life and respects the decisions she makes for her childbearing experience

Midwives work in partnership with the woman and her family/whānau, providing or supporting continuity of midwifery care throughout the woman’s maternity experience. This partnership is based on a relationship of trust, shared decision making and responsibility, negotiation and shared understanding.

6.3 MDHB Bicultural Model of Care: Kaitiaki Pae Ora

Working in partnership with Paiaka Whaiora Hauora Māori, nursing and midwifery are integrating the Bicultural Model of Care into all job description key performance indicators and activities.

The Bicultural Model of Care has been specifically designed for use in the New Zealand context. It has been developed by integrating Pae Ora (Healthy Futures) and Te Whare Tapa Whā concepts. Culturally responsive practice integrates the above elements to reinforce and further strengthen the strategic direction for Māori health and the advancement of healthcare for all New Zealanders.

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For:

Decision X Endorsement Noting

To Health and Disability Advisory Committee

Author Angela Rainham, Locality and Population Health Manager

Endorsed by Craig Johnston, General Manager, Strategy, Planning & Performance

Date 17 January 2020

Subject Manawatū District Health and Wellbeing Plan Update

RECOMMENDATION It is recommended that the Committee:

 endorse the progress that has been made in relation to the Manawatū Health and Wellbeing Plan.

Strategic Alignment This report is aligned to achievement of the District Health Board’s (DHB’s) strategy and four strategic imperatives.

COPY TO: Strategy, Planning & Performance MidCentral DHB Heretaunga Street PO Box 2056 Palmerston North 4440 Phone +64 (6) 350 8928

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1. PURPOSE

The purpose of this report is to update Committee members on progress with MidCentral DHB’s locality approach in the Manawatū District. It is for noting. No decision is required.

2. BACKGROUND

Health and Wellbeing Plans have been developed for five different localities (Territorial Local Authority areas) across the MidCentral district. The Plans aim to make a positive contribution to the health outcomes of the locality and will be used to make changes necessary to continuously improve our health system, as part of the wider heath sector and social services network. The Plans place residents and their families/whānau at the centre of planning decisions and design to best meet the needs of the community.

Plans for Horowhenua, Manawatū, Ōtaki, Tararua, and Palmerston North City have been completed and presented back to their communities. A copy of these plans can be found at: http://www.midcentraldhb.govt.nz/Planning/localPlan/Pages/LocalityPlanning.aspx

Each Plan identifies priority areas in relation to the health and wellbeing of the community, as identified by the community. The top four community priority areas identified for Manawatū were:

Access to Healthcare Easy access to Healthcare when people need it

Mental Health and Addiction Improved Mental Health and Addiction support in communities

Healthy Living A well community where everyone is supported to have quality living and healthy and active lives

Better Communication and Connection A district that has quality communications and connections between health services, people, whānau and communities

3. PLAN OF ACTION PROGRESS

The graphs on the following page summarise pictorially the progress of action points in each priority area. Generally there has been good progress, with many actions completed or progressing well. Some of the actions will be ongoing, so will never be ‘completed’.

The detailed dashboard report for the Plan of Action is attached as Appendix 1.

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Access to Mental Health and Healthy Living Communication and Healthcare Addictions Connections 16 Actions 10 Actions 13 Actions 14 Actions

3.1 Additional Actions Since the Plan was Developed

Since this plan was developed, five additional actions have been added - four relating to Access to Healthcare and one relating to Healthy Living. These appear at the end of the detailed report in Appendix 1.

4. HIGHLIGHTS IN IMPROVING ACCESS TO HEALTHCARE

4.1 Improving Access to Primary Care

Feilding Health Care (FHC) has implemented new systems which are proving successful in reducing barriers to accessing primary care. These include:

 Providing the option of video consults – saving people travel time  General Practitioner (GP) phone triaging – 60 percent of GP triaging calls are resolved over the phone which helps reduce the waiting time for face to face appointments  An online tool (patient portal) which enables patients to book appointments, send secure messages to FHC staff, order repeat prescription requests and see test results – 40 percent of FHC patients have registered with the patient portal with an average of 100 registrations per month in 2019  Establishing after school children’s clinics and winter ills and chills clinics.

4.2 Feilding Health Care Equity Focus Work

FHC has had a strong equity focus in 2019. Work in this area has included:

 Reducing debt as a barrier – the Integrated Family Health Centre changed digital messaging and ways of communicating and helped people to work out plans to reduce their debt  Focusing on increasing cardiovascular risk assessments for 33- 44 year old Māori men - this resulted in an increase from approx 60 percent to 90 percent and the rate now sits at approximately 85 percent.  Focusing on improving screening rates to reduce differences between Māori and non-Māori - this has been successful with rates now being similar between Māori and non-Māori for cervical screening, breast screening and immunisation.

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5. HIGHLIGHTS IN MENTAL HEALTH AND ADDICTIONS

5.1 Te Ara Rau Based at Feilding Health Care

Te Ara Rau aims to improve mental health and wellbeing through having a mental health team based at Feilding Health Care. The programme was implemented in Feilding in October 2018 and saw 422 referrals received during its first six months. This equated to a 354 percent increase in utilisation of Mental Health support in the Feilding community.

5.2 Support for Local Youth and Rural Communities

The Public Health team continue to provide support to different communities in the Manawatū District in the area of Mental Health. Examples of this include:

 Working with the Manawatū Youth Ambassadors on a Preventing Youth Suicide Event  Supporting rural communities through events such as the ‘5 Ways to Wellbeing’ presentation delivered in Apiti in June  Planning to deliver an anxiety and depression workshop for teachers in Feilding in 2020.

6. HIGHLIGHTS IN HEALTHY LIVING

6.1 Supporting Adults to Make Good Lifestyle Choices

MidCentral DHB contract Sport Manawatū to deliver Green Prescription programmes for adults in the Manawatū District. This programme supports people to make healthy lifestyle choices, particularly in relation to physical activity and nutrition. Twenty nine people graduated from the Feilding Green Prescription programmes in 2019. One programme participant said:

“My confidence in managing my health conditions has increased due to the support and information I received while on the Green Prescription programme.”

The Green Prescription programme also organised a ‘Workplace Wellness Challenge’ at Manawatū District Council in April 2019. Ten teams registered for the challenge (approx. 30 participants). A variety of activity opportunities were offered and information/education sessions were provided, including: heart health, diabetes, eating well, and engagement with your general practice team.

6.2 Collaborative Approach to New Active Teens Programme

The DHB also fund Sport Manawatū to run Active Teens programmes. A new Active Teens programme was co-designed with Feilding High School and ran in the second half of 2019.

The purpose of this programme was to engage students in different types of physical activity they aren’t normally exposed to at school in the hope they would find one they liked and would want to continue to engage in. This resulted in the programme consisting of activities such as ultimate frisbee, multisport, boxing and turbo touch; sports they wouldn’t normally get to play within the school setting. There were also general physical activities and a nutrition session for the students. 80

7. HIGHLIGHTS IN BETTER COMMUNICATION AND CONNECTION

7.1 Manawatū Health and Wellbeing Group

The development of a Health and Wellbeing Group in Manawatū was a key outcome of the Locality Planning process. We are already seeing the benefits of bringing representatives from health, local iwi, local council, Ministry of Social Development, Non-Goverment Organisations and the community around one table - with resulting collaboration on local issues. The group has been in place since June 2019 and has evolved over the first six months with a representative from the Education sector being the latest addition to the group. The group is also looking at adding an additional iwi representative, alongside Dennis Emery from Ngāti Kauwhata), and will approach the Ngā Manu Tāiko forum to suggest a representative of other iwi in the area.

This group is chaired by local Councillor Alison Short and meetings are held quarterly with a key theme for each meeting.

The DHB is represented on this group by a member of the Te Uru Kiriora Primary, Public and Community Health) leadership team and the Locality and Population Health Manager.

7.2 Improving Communication

The first Annual Locality Forum, held at St John Hall in Feilding on Tuesday 7 May, was an opportunity to get further feedback from the community and to give an update to community members on progress in each of the community priority areas within the Manawatū Health and Wellbeing Plan. The Forum was attended by 26 local people.

Regular communications from the DHB are also being sent out to a database of community groups and providers on a quarterly basis. These are done in an email newsletter format.

8. FEEDBACK FROM ANNUAL FORUM

There were a lot of individual comments made, however the common themes were:

 increasing cost of living and growing poverty  the ageing population and potential social isolation  a shortage of housing  timely access to local health services  lack of transport – affecting ability to access services and also social isolation

We need to acknowledge that, whilst this feedback was gathered from people who are very passionate about the health and wellbeing of their community, it was only a small group and is not representative of all of the population groups within the Manawatū District. 81

9. FEEDBACK FROM OTHER ENGAGEMENT

The feedback below was gathered during the 2019 year and disseminated to the Organisational Leadership Team at the DHB to ensure they are aware of issues for different population groups in the Manawatū District.

Further engagement will take place this year with iwi representatives and other population groups within the Manawatū community. The information will again be shared with members of the Organisational Leadership Team to ensure they are aware of current health and wellbeing issues in the Manawatū District and can use that information to inform their planning going forward.

9.1 Manawatū Youth Ambassadors

Prior to the Annual Locality Forum in May, the Locality Manager attended a Manawatū Youth Ambassador meeting to get their perspectives on the key issues affecting the health and wellbeing of young people and their whānau in Manawatū District.

The youth highlighted the key issues as:

 not knowing where to go for help  too much use of electronics – limits physical activity and socialising  expense of sports fees and gyms/fitness facilities  being afraid or too shy to ask family or friends for help  people under stress and pressure – caused by school, jobs, friends  affordability of healthcare  dentist is expensive for over 18s.

9.2 Ngā Kaitiaki o Ngāti Kauwhata

At Health and Wellbeing Group meetings during the year key issues raised for Ngāti Kauwhata iwi members were:

 For the 5,000 Māori in Feilding poverty is a huge issue  The main issues affecting access to health services for iwi members are transport and fees  Housing is also an issue - iwi are working on a healthy homes project in Feilding.

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Appendix 1 Priority Area Progress Action Points in Tararua Plan Impact seen Comments re progress General Comments Access To People being able to get help when Healthcare they need it Started People (particularly in rural communities) FHC are in final stages of will be able to connect more with health implementing as business as services through improved technology (eg usual. 50 Video consults now virtual consults). completed. Patients can book VC using patient portal. All GPs will be delivering Video Consultations by March 2020.

Complete People in need will be able to get 60 percent of GP FHC is implementing as part 8,000 episodes of GP appointments easier through new triaging calls are of Health Care Home. FHC triage completed between systems, which include GP triaging. resolved over phone has achieved certification in October 2017 and – reduces waiting April - is first MidCentral October2019. times for practice to achieve appointments. certification. Progressing well General Practices will increase the In 2019 FHC GPs sent 15,389 Since 2016 there have number of patient consultations over the online messages and been: 7,180 appointments phone or online, which will save people received 14,047. Nurses sent made online, 175000 time and travel costs. a further 515 messages. This patient logins and 27250 service allows people to secure messages sent to communicate with their GP FHC staff from patients. team without needing a face to face or phone appointment. Complete Communities will be able to use an online 7611 FHC patients Feilding Healthcare Numbers growing all the tool to get repeat prescriptions, make registered on implementing as part of time. 11,558 prescriptions appointments and receive test results Manage My Health. Health Care Home have been requested through a patient portal online since 2016. Progressing well People with complex conditions will have Almost 1000 Care Plans in a care coordinator to help build a trusted place for people with complex relationship and have continuity of care. conditions. All patients with Care plans have care coordinator. GPs also offer continuity of care – patients see their own GP unless they are unavailable.

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Started People will have more choice by 2018 Flu Campaign promoted Series of articles outlining increasing awareness of what different pharmacy flu shots. In 2019 the roles and abilities of health professionals can do and which Consumer Council and Think primary clinicians is under service to choose when. Eg your Hauora Clinical Board have development. pharmacist may be able to give your flu formed a small working group shot. to begin scoping this.

Started People will be more aware of how to THINK Hauora are continuing access the right health service to get the to work on campaigns with help they need. The “Right Choice” input from Consumer Council campaign will help this. and DHB staff. Improving people’s access to hospital and specialist care Behind/challenges People’s circumstances (such as locality There have been issues All booking staff have and family/ whānau responsibilities) will identified regarding the been reminded to ensure be taken into consideration by more integration of the electronic they are not giving early flexible hospital booking systems. system and solutions are morning or late afternoon being sought. appointments to people from Tararua or other outer areas. Started People will be provided with options of a This is happening in some consult over the phone or online, where areas and the DHB is appropriate, for follow-up specialist working hard to ensure appointments. This will be piloted in some we have the technology to hospital specialist areas first. roll it our further.

Complete People attending Palmerston North Feedback received Reception complete. Hospital’s Emergency Department will find about the new a more welcoming environment as the improvements has reception and waiting areas are improved. been positive. Complete Patients will have improved privacy in This has been achieved with redeveloped Emergency Department the introduction of designated triage rooms. triage areas for ambulance patients and those who self present to the waiting area, enabling private consultation without the risk of breaching confidentiality. 84

Health working together as one team

Started People will be better supported by health Feilding Health Care have Part of the new digital providers who can access the notes they shared electronic health health strategy need via improved IT systems. records so essential information is available to hospital staff when their patients attend. Yet to start Locality based teams will be put in place There are already small to help address the unique needs of the locality teams in place. community. The goal is to further develop these based on local needs. Complete A DHB digital strategy is being developed The Digital Health to identify priority areas for improvement, Strategy has been ensuring people and whānau have a more developed connected health journey by services working together as one team. Progressing well People feel better informed about their Feilding Health Care have a Part of the new digital health by making it easier for them to good uptake of the patient health strategy access to their health information through portal which gives people improved technology. access to lab results. Started There will be more opportunities to Consumer Council members Manawatū Health and provide feedback, which will be used to are part of Service Cluster Wellbeing Group also constantly improve health services. The Alliancing Groups. Also a provides a good forum for Consumer Council will be involved in the database of consumers who getting feedback from a design of this. are keen to be part of future locality perspective. service development programmes has been developed. Mental Health and People are able to get help when they Addiction need it 85

Started People will receive help and support Six month data post Te Ara Rau are based in FHC Community mental health within their General Practice Team in a implementation of for people with mild to team operate from FHC to timely manner. Mental Health teams will Te Ara Rau at FHC moderate mental health support people who have be based on site with GPs and Nurse showed 422 conditions. Telephone support had secondary service Practitioners to offer free accessible help referrals were service is also ongoing. mental health for people with mental health issues. received during intervention, including October 2018 - addiction support. New March 2019 = 354% roles likely to bring 2FTE increase in Primary Mental Health utilisation of Mental support workers to FHC Health support in early 2020. the Feilding Community. Yet to start Better support for communities locally by This is planned for 2020 having a Suicide Prevention Local Response team in place in the district in 2019. This will involve local agencies working collectively as one team. Yet to start Mental Health and Addiction Services will be more visible in our community as the DHB develop a relevant and modern communications strategy.

Progressing well Promote an online directory of Mental Health Point is the online Health and Addiction Services, linking directory being promoted by services and people to what is available in Mental Health Services. the community and how to access them. Started People will be more easily able to find Public Health is working with information on alcohol and drugs through other agencies to distribute a more coordinated and modern approach information re Fetal Alcohol to how information is distributed. syndrome. Social media channels are used in particular for getting the message out to young woman who may be drinking and not knowing they are pregnant. Progressing well People will be able to see how all services ‘Unison’ is the service work and where they should seek help mapping document. It has and support through the promotion of a been promoted widely. service mapping document. 86

Support for our Youth

Started The Mates and Dates programmes will be Public Health are working with available and promoted to local secondary WellStop and Youthline to schools, helping our youth build healthy promote the Mates and Dates relationships. programme. Progressing well Manawatū Youth Ambassadors are Public Health has worked with focusing on increasing awareness of Youth Ambassadors on services available locally for youth. Preventing Youth Suicide Guidance is provided to support them with Event. their project where needed. Started Health will work with other agencies in A subcommittee of 'Unison' is linking our vulnerable youth to working on this - includes employment opportunities and work DHB, MSD, Chamber of experience. Commerce. Rural Mental Health Started People who visit rural communities in their Public Health have been A presentation on 5 Ways jobs will receive training and support to working in conjunction with to Wellbeing was help them recognising the signs of Rural Support Trust on this. delivered to approx 12 depression and help isolated and members of the Apiti vulnerable people to seek help when network in June. needed. Health will work in partnership with Rural Services to achieve this. Healthy Living Quality living for older adults

Started People working with older adults in the Manchester House delivered community will be kept up-to-date with the a Super Seniors Expo on 1st different types of support, service and November 2019. DHB staff community activities available for older offered support with planning adults through an annual workshop. They and also promoted the event. will then be able to link the people they are working with to relevant things in the community. Progressing well Older adults will be assisted to maintain After a poor start a big their strength and balance and remain increase was seen and now independent through in home strength there is a waitlist. Now and balance exercise support starting in working on a joint programme the Manawatū District in 2018. with Lavender Blue where they take over the second 12 weeks of the programme. 87

Progressing well Community groups will be better Progressing well as reported supported to provide strength and balance by Sport Manawatū classes for older people.

Progressing well Support older adults to easily access their THINK Hauora report this test results, book appointments online and work is progressing well, see their health information through the however there will be a patient portal by running two free change of software rolled out workshops in 2018 on how to use the which will supersede the portal. current software. Wider determinants of health

Yet to start A training programme for screening Training is yet to happen in patients for family violence will be offered Feilding to all GP practices who will support people to talk about and seek help for family violence. Started People will be more aware of the financial In conjunction with MSD, support that is available to them and how information sessions for to access it, through workshops run in community groups and partnership with other organisations in individuals were offered in Manawatū. May/June 2019. Complete Identify and increase support for adult Adult literacy programmes literacy programmes, including computer available through Literacy literacy skills within the Manawatū. Aotearoa who also offer computer skills and driver licence training as well as help with developing Curriculum Vitaes. Started The DHB will advocate, where The Health and Wellbeing appropriate, for positive changes in areas Group provides a forum to do outside of health which have a this. fundamental impact on people's health and wellbeing within the Manawatū district.

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Complete The DHB will advocate for change in the Submission to National National Travel Assistance Policy to help Travel Assistance Review make the process for registering and asked for a simplified claiming travel expenses easier. system. The review has recently been released and recommendations have been made to improve the scheme and make it more accessible. Started Actively lead connecting community The DHB led the development groups and services; as collectively they of a Health and Wellbeing can have a greater impact on the Group in partnership with wellbeing of community members. MDC. There is representation from a variety of sectors with education recently being added. Link local people to local activities Started Support people to eat well, be active and In first 6 months of 2019 A "Workplace Wellness lead a healthy lifestyle through increased Feilding classes were Challenge" was also run promotion of the Green Prescription attended by 25 people and 51 at MDC with approx 30 programme in the Manawatū. others were supported via participants. phone. Complete Encourage more kids to ride bikes, by Put into 2019 annual plan advocating to Council for a bike in schools submission. programme and encourage schools to adopt it.

Started Promote the “Health Promoting School” Offered to all schools programmes where schools partner with annually. A workshop is being their community to make positive steps to offered on how to recognise improve the health and wellbeing of and assist with students students. coping with anxiety and depression. Communications Improving Communications and Connections 89

Started Community members and the Consumer The Acute and Elective The Consumer Council Council will be involved in the redesign of cluster will work with are working on a number correspondence so communications are Consumer Council members of projects to improve clear and friendly. on this. communications.

Started People will receive more relevant The new external MidCentral The Consumer Council information when attending a hospital DHB website will have this are working on a number appointment, including parking and shuttle kind of information easily of projects to improve services. accessible. communications. Started People will be able to access the new PN The app has been promoted Hospital Navigation App through through social media and the increased promotion of the App; helping latest newsletter out to people to navigate their way around the communities. hospital.

Started To ensure our communities are receiving A Communications Strategy clear and people-friendly messaging, the was completed in 2018. DHB will continue to find new and innovative ways to communicate. People are aware of their choices and what's available Started Share local success stories, promoting The annual forum and the programmes and initiatives that are quarterly communications are working well in the Manawatū District. ways this is being done.

Started Identify opportunities to work with other THINK Hauora is health agencies to increase awareness of developing a plan of how what’s available in the community. to engage with people and whānau to ensure they know how to access the services they need. Started People will be more up-to date with what’s Press releases about matters Information has been happening in the Manawatū community by of interest to the community distributed about the ensuring communication is distributed are ongoing. formation of the Health through: local newspapers, social media and Wellbeing Group channels, community committees and through all channels. other key groups.

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Started It will be easier for people to choose a Two clusters have signed up HealthPoint has much service appropriate to their needs through to Health Point. The info but the DHB are not a website which offers reliable information development a new fully subscribed to it yet. on local and district health services. MidCentral DHB external website, which will be much easier for people to navigate and find the information they need, is also underway. It is planned to have easy access to HealthPoint information through the new website. Progressing well Communication will be sent out on a more Quarterly newsletters are regular basis, with opportunities for being sent out. people to provide suggestions and feedback. Increasing engagement and visibility Yet to start When designing a new health service in Manawatu District has Other consumer the Manawatū District, people, representation on the representatives are also families/whānau will be placed at the Consumer Council through on project teams and centre of planning decisions and design to Hilary Humphrey. Cluster Alliancing Groups. best meet the needs of the community. Progressing well Continue to engage and seek feedback The first forum was held in from Manawatū District residents about May - it was reasonably well strengths, challenges and areas of attended and good feedback priority, with an annual forum. was gathered. Started Feedback from the Manawatū community Locality information is locality project will be used to help shape being used in current and support DHB’s planning and future planning for clusters. services.

Progressing well Develop a health and wellbeing group for The group has been the Manawatū District, or connect to an developed and is functioning existing group, where we all work together well. on a common agenda to tackle the bigger issues. Started Health will be aware of key issues for the Being part of the Manawatū Manawatū by having a greater presence Health and Wellbeing Group at key meetings. is keeping DHB representatives abreast of 91

issues in the Manawatū District.

Additional Actions since the plan was developed Access To People are able to get help when they Healthcare need it Started Children aged Under 14 will be able to Started Dec18 access GP services at no cost (previously Under 13). Started Finance is less likely to be a barrier to THG practices have opted Started Dec18 access for Community Service Card into this scheme. Dr Short's holders who can now visit a General Surgery has not Practice team member for $18.50 Improving people’s access to hospital and specialist care Started Young people with long term conditions 19 Manawatū District young will be better prepared to move to adult people and their whānau health services through a Transition benefitted from this Programme being implemented. programme in 2019. General feedback indicated they are very pleased with the transition process. Started A review of outpatient gynaecology Work has commenced on services will be undertaken to make these this. services more person centred. Healthy Living Quality Living for Older Adults Started An OPAL unit will be opened within The unit has been officially A phased implementation Palmerston North Hospital - providing opened on 11 November is being implemented with specialist multidisciplinary geriatric care full implementation for frail patients with acute illness. expected in March 2020.

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For:

Decision X Endorsement Noting

To Health & Disability Advisory Committee

Author Judith Catherwood, General Manager, Quality & Innovation

Endorsed by Kathryn Cook, Chief Executive

Date 23 January 2020

Subject Committee’s Work Programme, 2019/20

RECOMMENDATION It is recommended that the Committee:  endorses the update on the 2019/20 work programme.

Strategic Alignment This report is aligned to the DHB’s Strategy and key enabler, “Stewardship”. It discusses an aspect of effective governance.

Quality and Innovation COPY TO: MidCentral DHB Heretaunga Street PO Box 2056 Palmerston North 4440 Phone +64 (6) 350 8030

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1. PURPOSE

This report updates the Committee on the 2019/20 work programme.

The report is for the Committee’s consideration and no decision is required.

2. BACKGROUND

The Board has established the 2019/20 governance reporting framework to ensure the Board and its Committees will receive appropriate information at the right time to enable members to carry out their duties.

Work programmes for all Committees, including the Health & Disability Advisory Committee (HDAC), have been developed from the framework and approved by the Board.

3. 2019/20 WORK PROGRAMME

3.1 General

A copy of the Committee’s work programme for 2019/20 is attached. It focuses on the planning, delivery, quality and performance of health and disability services across the district and continuum of care.

A schedule of matters arising from committee meetings is maintained for the Committee and this is reported separately.

3.2 Progress

Reporting is occurring in line with the work programme. Pae Ora Paiaka Whaiora Health and Wellbeing Plan is in progress and currently being consulted on with key stakeholders. It will be presented at the next meeting.

This meeting, a presentation will be provided by Enable New Zealand.

The work programme is currently under review, under the overall leadership of the Board Chair, and further work to update this is anticipated.

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Health & Disability Advisory Committee | 2019-20 Work Programme Report Fqncy Aug Sep Oct Nov Feb Mar Apr Jun Jul Resp Strategy/Planning Health Needs Assessment & Equity Snapshot Triennial GMSPP &  to consider the health needs assessment of the district and sub-region Nov 21 GMP&P Ka Ao Ka Awatea – Maori Health Strategic Framework Triennial GMM  on a three-yearly basis, review/refresh the strategy to ensure it remains relevant and Oct 20 reflects the DHB’s Strategy Disability Roadmap One-off X GMENZ  to determine a disability strategy and roadmap for the district, and thereafter how it has (Aug 19) EDAH been advanced, changes, and priorities/investments for the future (3-5 years). then triennial Locality Health & Wellbeing Plans Triennial OEs & CEs  to determine how the locality plans have been advanced, what’s changed & priority Apr 21 initiatives/investments for the future (3-5 years), and to receive community feedback Cluster Health & Wellbeing Plans Triennial X X X OEs & CEs  to determine each cluster’s planned outcomes, priorities & targets for the next three (Pae Ora) years, and the roadmap for achieving these, including required investment & resources Quality Improvement Clinical governance & quality improvement framework – progress & trends Qtrly X X X X GMQ&I  to monitor the quality and safety of health care services in the district, including trends, performance against dashboard and markers, and confirm the adequacy of the programme planned or established to advance or address issues.  to monitor serious and sentinel events, and HDC complaints Clinical Professions Annual X X X EDAH, CMO  to monitor the quality and standard of care and processes from a professional perspective AH N&M Med & EDN&M  to monitor the implementation of workforce strategies from a professional perspective, and the health of the professional workforce group across the district Consumer Stories 3/year X X X GMQ&I  to hear direct from consumers of health and disability services about their experience Wkshop Quality account Annual X GMQ&I  to determine the Quality Account for the financial year Research Annual X CMO  to receive details of research activity underway within MidCentral DHB Performance Cluster Reports & Health & Wellbeing Plans 6-wkly X X X X X X X X X OE & CEs  to monitor each Cluster’s performance, including the implementation of their Health & 6-mthly MHA HWCY CSTS HAR ENZ AESS PW MHA PPCH Wellbeing Plans, including progress against key targets, initiatives and outcomes. deep PPCH  to monitor current and emerging matters, including quality & safety, opportunities and dive challenges, and the adequacy of any mitigations Locality Health & Wellbeing Plans Annual Otaki Horo Tara Man PN OE & CEs &  to determine how the locality plans have been advanced, what has changed, and priority GMSPP initiatives/investments for the future (3-5 years), and to receive community feedback Ward 21 Business Case One-off X OEMH&A  to determine the most appropriate means of ensuring an effective mental health inpatient GMF&CS facility is provided. 2018/19 Regional Service plan (implementation) One-off X GMSPP

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Health & Disability Advisory Committee | 2019-20 Work Programme Report Fqncy Aug Sep Oct Nov Feb Mar Apr Jun Jul Resp

 to monitor the implementation of the Plan and achievement of stated outcomes. (NB: detailed report to be provided from Governance SharedNet site.) 1/4 to 6/12 Nov18 2019/20 Regional Service plan (implementation) Quarterly X X X GMSPP  to monitor the implementation of the Plan and achievement of stated outcomes. Equity Ka Ao Ka Awatea – Maori Health Strategic Framework Annual X GM  to monitor progress being made in achieving the Framework, including the appropriateness of initiatives and investment planned/established. Equity Targets – Progress 6-mthly X X GM  to monitor progress being made in achieving the national Maori health targets, including the appropriateness of initiatives planned/established Disability Disability Strategy Annual X GMENZ  to monitor progress in implementing the Disability Strategy, including opportunities and EDAH challenges, and confirming the priorities and initiatives/investment for years ahead Governance Policies Triennial  to determine governance and significant quality & improvement policies  Serious & Sentinel Event Reporting Policy X GMQ&I

Key: AESS Acute & Elective Specialist Services EDN&M Executive Director, Nursing & Midwifery GMQ&I General Manager, Quality & Innovation CE Clinical Executive EHR Elder Health & Rehabilitation GMSPP General Manager, Strategy, Planning & Performance CEO Chief Executive Officer GMENZ General Manager, Enable New Zealand MHA Mental Health & Addictions CMO Chief Medical Officer GMF&CS General Manager, Finance & Corporate Services OE Operations Executive CPHO Central Primary Health Organisation GMM General Manager, Māori PPCH Primary Public & Community Health CSTS Cancer Screening, Treatment & Support GMP&C General Manager, People & Culture W&CS Women and Children’s Health EDAH Executive Director, Allied Health

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For:

Decision X Endorsement Noting

To Health and Disability Advisory Committee

Author Bronwyn White, – Strategy and Planning Advisor

Endorsed by Craig Johnston, General Manager – Strategy, Planning and Performance

Date 21 January 2020

Subject 2020/21 Annual Plan Approach and Priorities

RECOMMENDATION It is recommended that the Committee:  endorse the 2020/21 Annual Plan Approach and Priorities

Strategic Alignment This report concerns the operational and annual planning approach and priorities for 2020/21. It is aligned to our Strategy and the DHB’s governance and accountability responsibilities.

Strategy, Planning & Performance COPY TO: MidCentral DHB Heretaunga Street PO Box 2056 Palmerston North 4440 Phone +64 (6) 350 8928

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1. PURPOSE

This report provides background material for the planning workshop to be held after the Health and Disability Advisory Committee meeting. The purpose of the workshop is to provide an opportunity for the Committee to have input to the priorities and directions for the 2020/21 Operational and Annual Plan.

2. BACKGROUND

MidCentral DHB’s Planning and the Integrated Service Model The yearly operational planning and budgeting process is a key part of MidCentral’s strategy framework, with particular relevance to the implementation of the District Health Board (DHB) strategic direction. The DHB has a strong concept of how its strategy and plans are linked, as is demonstrated in the following graphic.

Planning and the Integration Service Model

The roles of the strategy and plans are as follows:

MDHB Strategy (10 years): The MidCentral Strategy has a ten-year outlook and it drives shared direction and aspirations for health and disability services across the district. Now three years in, a Strategy refresh is currently underway.

Cluster and Enabler Plans (three to five years): These plans have a three to five-year outlook; they drive decision processes which are designed to identify the key priorities of the Cluster or Enabler to best achieve our strategy. 98

Operational Business Plan, including budgets (one year): The Operational Business Plan is a are one-year plan focusing on intended action in the year to come and are driven by the Cluster and Enabler plans.

Statement of Intent (SOI): DHBs are required to publish an SOI triennially. The SOI sets out the Board’s strategic intentions, the nature and scope of the District Health Board’s functions and operations and how these will be managed. MidCentral’s SOI was last refreshed and published in 2019, as required by the Minister of Health.

Annual Plan: The Annual Plan is a key element of the DHB’s accountability to the Minister of Health. The Annual Plan is a concise document that outlines how the DHB will achieve the Government priorities and targets. The table of contents, format and timelines for the Annual Plan are determined by the Ministry of Health and are in accordance with the New Zealand Health and Disability (Planning) Regulations 2011.

The Annual Plan also contains:  The Statement of Performance Expectations (SPE) that provides financial and non-financial expectations for the planning year, with four-year outlook, and demonstrates accountability to Parliament and the public annually (Section 149C of the Crown Entities Act 2004)  The System Level Measures (SLM) Improvement Plan is based on the national SLM Framework for continuous quality improvement and requires collaboration across the health system and across government agencies. It is completed as part of the annual planning process, geared to the six system-wide measures and contributory performance measures.

3. PLANNING PRIORITIES

The purpose of the workshop with the Committee is to consider the priorities for the 2020/21 year. As always, the first thing to consider is our people, our whānau, our communities and their needs.

The official demographic data from the 2018 Census has not yet been provided by the Ministry, however we know our population is growing and aging. In particular, Manawatū and Horowhenua have been growing at a faster pace than other localities. Demographic change is driving increased need for health services.

The profile of our communities is well understood and has been detailed in our locality Health and Wellbeing Plans. There is unequal distribution of resources and health need across our district. In particular, Ōtaki, Horowhenua and Tararua are areas of high need.

There are enduring inequities for Māori and Pacific people. This includes inequities in access, experience and health outcomes. There is also significant amenable mortality and morbidity in our district, generally requiring primary and community level activity.

It is also pertinent to consider changing Government priorities, particularly the emphasis on working across Government and including wellbeing, particularly with 99

respect to children and mental health. Within the health and disability sector, we anticipate more emphasis on regional and national health system planning.

DHB performance will continue to have increased focus of attention in 2020/21. The Minister has been clear with Board Chairs and Chief Executives about the need to address financial and service performance. The Ministry is developing a formalised DHB performance monitoring system using a balanced scorecard approach.

There are two main influences on the DHB’s 2020/21 planning priorities. These are:

1. The Government’s priorities, and 2. Priorities identified through the Cluster, Enabler and Localities Health and Wellbeing plans.

3.1 The Government’s Priorities

Each year, DHB’s receive a letter from the Minister setting out the Government’s expectations and priorities. This is referred to as the “Letter of Expectations”; it has not yet been received for 2020/21. Based on the Ministry planning guidance which was received in December 2019, the Minister’s priorities are expected to be similar to 2019/20 but have explicit expectations around health equity and wellbeing for Māori throughout (see summary in Appendix 1). Some of the key changes from 2019/20 identified from the planning guidance are as follows:

 Giving practical effect to He Korowai Oranga Māori Health Action Plan (new) . accelerating the spread and delivery of Kaupapa Māori services . shifting cultural and social norms . reducing health inequities – the burden of disease for Māori . strengthening system setting

 New section on Improving Sustainability . out year planning processes . savings plans . sector partnerships to sustain system improvements

 For the first time, the Public Health Unit (PHU) Plan is to be integrated into the DHB Annual Plan demonstrating collaboration and integration with PHUs and DHBs (primary, community, other sectors and Iwi). The Annual Plan is to include the five public health core functions (health promotion, health protection, health assessment and surveillance, public health capacity development, and preventive interventions).

All Ministry guidelines have to be met. Our approach is that the Cluster Health and Wellbeing Plans are key drivers of the draft 2020/21 operational plans, together with recent health and population health need updates. Cluster Leads have identified activities from their draft 2020/21 Operational Plans that align to the Minister’s priorities, as at 18 December 2019, for inclusion in the Annual Plan.

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3.2 Priorities Identified Through MidCentral’s Strategy

3.2.1 MidCentral DHB Planning Priorities

Throughout the Integrated Service model planning activities, from the 10 year Strategic planning, and through the Cluster, Enabler and Locality Health and Wellbeing three to five year planning, a number key themes stand out. These are:

 Commitment to Te Tiriti O Waitangi  Working towards equity and reducing inequities  Providing quality and excellent care  Partnering with people and whānau in planning, designing and delivering care  Developing the workforce and our culture  Strengthening care in the community

Priority Programmes

The Organisational Leadership Team (OLT) discussed the priority programmes for 2020/21 based around the four themes from the Locality planning engagement. These are programmes that need to be done (The Vital Few). OLT see that Clusters continue to implement their Health and Wellbeing plans, and that the Priority Programmes are applied to the DHB as a whole. See below for the resulting list. i Access to Health Care

 Improve access to first contact health care services through General Practice teams  Establish locality-based, trans-disciplinary teams across the district, based around Integrated Family Health Centres to support whānau to meet their health and wellbeing needs  Digital business  Coordinated ‘Personalised’ care for people with high and complex needs, including primary, specialist and community services  Improve access to timely, responsive, quality specialist and hospital services by addressing patient flow, planned care programme, revised models of care in key specialties and workforce ii Building Healthy Whānau, Communicating and Connecting

 Work with schools to improve health and wellbeing of children and communities  Communicate with the community about health services, with particular reference to new models of care, and use of acute and urgent services, what to expect from general practice  Intersectoral work in localities, for example, with Councils, Housing organisations, Police, Justice and Corrections  Co design ‘my health myself’ programme with a Kaupapa Māori approach iii Mental Health and Addictions

 Implement new Primary Mental Health initiatives and leverage off the anticipated new funding  Develop an Older Adult Mental Health Model of Care to support our older population  Ward 21 re-build 101

iv Infrastructure Developments

 Implement the next horizon of the Digital Strategy  Progressively invest in the facilities MidCentral DHB needs to meet the needs of its community  Continue implementation of the Workforce strategy  Further develop data/analytics, including performance measurement v Overarching Priorities

 Taking concrete steps to improve equity of access, equity of outcome, equity of experience, with a particular emphasis on health and wellbeing gains for Māori  Improving our financial sustainability – sticking to our commitments

4. ANNUAL PLAN APPROACH FOR 2020/21

The first tranche of planning guidance was received from the Ministry in late December 2019. We are awaiting the Minister’s Letter of Expectations and funding envelope. The key timelines have been set (see Appendix 2) and the first draft of the Annual Plan and budget, are due with the Ministry by 2 March.

The Ministry will progressively release planning guidance throughout the planning period. This includes updates to the Service Coverage Schedule and the Operational Policy Framework, which underpin the activities of all DHBs. There will also be changes to the Non-Financial Monitoring and Performance Measures Framework which set out DHBs’ performance expectations and reporting obligations and are aligned to the Government’s annual planning priorities.

Planning Assumptions were approved by Finance, Risk and Audit Committee (FRAC) and the Board in late 2019. These include an anticipated bottom-line result as per the Statement of Intent – ie, a deficit of $5.504 million for 2020/21. However it should be noted that this deficit was not endorsed by the Minister when the 2019/20 Annual Plan was signed.

A planning steering group is being established and budgeting is underway. Regular planning updates will be provided to the Board and the Board Committees.

5. NEXT STEPS

Following the input from the Committee, management will work on the preparation of the first draft of the Annual Plan.

The first draft of the Annual Plan is expected to be tabled at the February FRAC meeting and the March Board meeting, prior to submission to the Ministry.

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APPENDIX 1. Summary of the Government’s planning priorities from the from the Ministry of Health’s Annual Planning Guidance as at 18 December 2019  Specific section on giving practical effect to He Korowai Oranga o engagement and obligations as a Treaty partner (similar to 2019/20) o Māori Health Action Plan (new) – further guidance when interim plan is released and when final plan is completed . accelerating the spread and delivery of Kaupapa Māori services . shifting cultural and social norms . reducing health inequities – the burden of disease for Māori . strengthening system setting  Specific (new) section on Improving Sustainability – o out year planning processes – financial and workforce focus areas o savings plans – in year and out year gains, including workforce planning, models of care o sector partnerships to sustain system improvements (that also support Māori health outcomes)

 Improving child wellbeing (maternal, child and youth) (similar to 2019/20) – Child and Youth Wellbeing Strategy o maternity and midwifery workforce o maternity and early years (some different areas of focus – strong prevention and early intervention focus) o immunisation o school based health services o family violence and sexual violence

 Improving mental wellbeing (similar to 2019/20, but different emphases) o Mental Health and Addiction system transformation o Mental Health and addictions improvement activities o Addiction o Maternal Mental Health

 Improving wellbeing through prevention (note below re inclusion of PHU core functions, new for DHB’s Annual Plan) o Environmental sustainability o Antimicrobial resistance o Drinking water o Environmental and border health o Healthy food and drink o Smokefree 2025 o Breast screening o Cervical screening o Reducing alcohol related harm (PHU, new) o Sexual health (PHU, new) o Communicable diseases (PHU, new) o Cross sectoral collaboration including health in all schools (PHU, new)

 Population health outcomes – strong and equitable public health and disability system

o Whānau Ora (slightly different emphasis) o Pacific Health Action Plan (commitment, once agreed) 103

o Care Capacity and Demand Management (CCDM) o Disability Action Plan (new – commitment to develop plan) o Disability o Planned care o Acute demand o Rural health o Healthy ageing o Improving quality o System level measures o NZ Cancer Action Plan 2019-2029 (new, includes 3-year plan to develop) o Bowel screening and colonoscopy waiting times o Workforce (modified, more) o Data and digital (similar, bit more) o Implementing the NZ Health Research Strategy (new) o Delivery of RSP

 Population health outcomes – primary health care o Primary health care integration o Pharmacy o Long term conditions, including diabetes

Public Health Unit Annual Plan  The Public Health Unit Plan is expected to be integrated into the DHB’s Annual Plan, demonstrating collaboration and integration with PHUs and DHBs (primary, community, other sectors and Iwi). The Annual Plan is to include the 5 public health core functions (health promotion, health protection, health assessment and surveillance, public health capacity development, and preventive interventions).

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APPENDIX 2. Annual Planning Timelines as Advised by the Ministry (December 2019)

Requirements item MoH Timeline Date received Initial Guidance issued Dec 2019/Jan2020 18 Dec. 2019 Minister's Letter of Expectations Approx Jan Population demographics issued Approx. late Jan Non Financial Monitoring Framework and Approx. late Jan Performance measures -consultation draft issued Indicative Funding guidance issued Approx. Feb Strategic conversation with DHBs From February DHBs advise of service change proposals tbc Submit first draft of Annual Plan, Statement 2 March of Performance Expectations, financial templates, Regional Service Plans to MoH Feedback to DHBs on first draft Plans and 9 April release of guidance for any additional confirmed Government priorities Budget 2020 Late May (tbc) Final draft SOI/SPE signed by the Board to Before 30 June be made publically available on the DHB website Final draft SLM plan submitted to Ministry By 30 June Ministry approval of SLM plan 31July Any outstanding 2020/21 SPEs tabled with December 2019/20 Annual Reports

Glossary of Terms

ACC Accident Compensation Corporation The New Zealand Crown entity responsible for administering the country's no fault accidental injury compensation scheme. ADON Associate Director of Nursing Anti- VEGF Anti-Vascular Endothelial Growth Factor AP Annual Plan The organisation's plan for the year. BN Bachelor of Nursing CAG Cluster Alliance Group A group or 10-12 members from across the health and wider sector supporting the Cluster Leadership Team to identify population health needs, planning, commissioning and evaluating services and developing models of care. Members include consumer and Māori representatives.

CCDM Care Capacity Demand Management A programme that helps the organisation better match the capacity to care with patient demand. CLAB Central Line Associated Bacteraemia CNS Clinical Nurse Specialist COPD Chronic Obstructive Pulmonary Disease A common lung disease which makes breathing difficult. There are two main forms, Chronic bronchitis - a long term cough with mucus. Emphysema - which involves damage to the lungs over time. CT Computed Tomography A CT scan combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images of the bones, blood vessels and soft tissues inside your body.

CTCA Computed Tomography Coronary Angiography A CT scan that looks at the arteries that supply blood to the heart. Can be used to diagnose the cuase of chest pain or other symptons. CWDs Cost Weighted Discharges Case weights measure the relative complexity of the treatment given to each patient. For example, a cataract operation will receive a case weight of approximately 0.5, while a hip replacement will receive 4 case weights. This difference reflects the resources needed for each operation, in terms of theatre time, number of days in hospital, etc. DHB District Health Board DIVA Difficult Intravenous Access DNA Did Not Attend DNW Did Not Wait ED Emergency Department EDG-VPSR Electrocadiograph – Visual Positioning System Rhythm EN Enrolled Nurse ENT Ear Nose and Throat ESPI Elective Services Patient Flow Indicator Performance measures that provide information on how well the District Health Board is managing key steps in the electives patient journey. FHC Feilding Health Care FRAC Finance Risk and Audit Committee FTE Full Time Equivalent The hours worked by one employee on a full-time basis. GP General Practitioner HDAC Health & Disability Advisory Committee HQSC Health Quality & Safety Commission HWNZ Health Workforce New Zealand ICU Intensive Care Unit IDF Inter District Flow The default way that funding follows a patient around the health system irrespective of where the are treated. IFHC Integrated Family Health Centre General practice teams with the patient at the centre, providing quality health care when, where and how patients need it. IOC Integrated Operations Centre IOL Intraocular Lens IT Information Technology / Digital Services KPI Key Performance Indicator A measurable value that demonstrates how effectively an objective is being achieved. LEO Leading an Empowered Organisation MDHB MidCentral District Health Board MEED Midwifery External Education and Development Committee MERA Midwifery Employee Representation and Advisory Service MIT Medical Imaging Technologist A radiographer who works with technology to produce X-rays, CT scans, MRI scans and other medical images. MoH Ministry of Health MRI Magnetic Resonance Imaging A medical imaging technique used in radiology to form pictures of the anatomy using strong magnetic fields and radio waves. MSD Ministry of Social Development MYFP Midwifery First Year of Practice Programme NAMD Neovascular Age-Related Macular Degeneration NCEA National Certificate of Educational Achievement NCNZ Nursing Council of New Zealand NEED Nursing External Education and Development Committee NESP Nurse Entry to Specialty Practice Programme (Mental Health) NETP Nurse Entry to Practice Programme NGO Non Government Organisation NP Nurse Practitioner NPC Nurse Practitioner Candidate NPTP Nurse Practitioner Training Programme NZ New Zealand NZCOM New Zealand College of Midwives NZCPHCN New Zealand College of Primary Health Care Nurses NZNO New Zealand Nurses Organisation OLT Organisational Leadership Team OLT comprises all General Managers, Chief Medical Officer, Executive Directors - Nursing & Midwifer and Allied Health, General Manager of Enable NZ, all Operations Executives and Clinical Executives. OPAL Older Peoples Acute Assessment and Liaison Unit PDRP Professional Development and Recognition Programme PHU Public Health Unit PICC Peripherally Inserted Central Catheter PIP Performance Improvement Plan This plan is designed to support the OLT in the prioritisation and optimisation of system wide efforts to achieve our vision. The plan was presented to the MoH as part of MDHBs 2019/20 strategic discussion. POAC Primary Options for Acute Care PPA Promoting Professional Accountability RHIP Regional Health Infometrics Programme Provides a centralised platform to improve access to patient data in the Central Region. RM Registered Midwife RN Registered Nurse RSP Regional Service Plan RTL Round Trip Logistics A technology platform. SLM System Level Measures SMO Senior Medical Officer SOI Statement of Intent SPE Statement of Performance Expectations SPIRE Surgical Procedural Interventional Recovery Expansion A project to establish additional procedural, interventional and surgical resources within MDHB. SSHW Safe Staffing, Healthy Workplaces SSIED Shorter Stays in Emergency Department SUG Space Utilisation Group TLP Transformational Leadership Programme UCOL Universal College of Learning VRM Variance Response Management WDHB Whanganui District Health Board WHEI Whole Hospital Escalation Indicators YTD Year To Date