E90 Annual Report Quality and Performance Account 2019/20 Feature photos: Special thanks to our little superstars from Wakari Hospital Early Childhood Centre – Te Ariki, Avaley, Maia and Beau E90 Annual Report Quality and Performance Account 2019/20 This Southern District Health Board Annual Report 2019/20 is presented to the House of Representatives pursuant to section 150(3) of the Crown Entities Act 2004. 2 | Southern District Health Board Annual Report 2019/20 Contents Foreword from the Chair & Chief Executive .......................4 Statement of Responsibility ................................................4 Our world in 2019/20 .........................................................6 Key highlights .....................................................................7 Our Purpose, Governance and Partnership with Iwi ..........8 Our Pathway .....................................................................10 IMPROVING HEALTH OUTCOMES FOR OUR POPULATION Statement of Service Performance ...................................13 Outcome One: People are healthier and take greater responsibility for their own health ........................15 Outcome Two: People stay well in their own homes and communities ...........................................19 Outcome Three: People with complex illness have improved health outcomes ..............................................24 Outputs – Short-term performance measures .................28 Output Class: Prevention .................................................30 Output Class: Early detection and management .............33 Output Class: Intensive assessment and management ....37 Output Class: Rehabilitation and support .......................42 IMPROVING PATIENT EXPERIENCES AND QUALITY OF CARE Creating an Environment for Good Health ......................48 Primary and Community Care ..........................................50 Clinical service redesign ..................................................54 Quality Account ................................................................59 ENABLING SUCCESS: ORGANISATIONAL RESILIENCE AND SUSTAINABILITY Enabling our people .........................................................64 Good Employer Obligations Report ................................66 Systems for success ..........................................................69 Facilities for the Future .....................................................70 Asset Performance Indicators ...........................................72 FINANCIAL STATEMENTS Statement of Comprehensive Revenue and Expense ......76 Statement of Changes in Equity .......................................76 Statement of Financial Position ........................................77 Statement of Cash Flows ..................................................78 Notes to the Financial Statements ...................................80 Information on Ministerial Directions .............................107 Independent Auditor’s Report ........................................108 Southern District Health Board Annual Report 2019/20 | 3 Foreword from the Chair & Chief Executive Dr David Perez Chris Fleming Acting Board Chair Chief Executive Officer We will not be alone in reflecting on 2019/20 as a year Other areas are stubbornly static, including lengthy of two halves. waiting times in the Emergency Department. This The first half of the reporting period, when we were remained the case, even as presentations plummeted industriously engaged on numerous worthy projects during the lockdown period, and reinforces the need and initiatives and life was normal, seems to belong to for more systemic changes in our management of the annals of history. patients awaiting specialist review and admission. We also remain concerned about persistent issues with From January our world progressively, and then colonoscopy referrals. suddenly, changed and every activity and decision since then has been made in the context, or shadow, We continue to see inequities between our Māori of the COVID-19 pandemic. and non-Māori populations, in areas from oral health to long-term conditions management, which are So this reflection on the past year contains unacceptable. achievements, challenges and some important lessons. Addressing these areas requires a comprehensive These include appreciating that annual plans are approach that touches upon all aspects of the executed at the mercy of greater forces. And that, Southern Health system. in the face of a near and present danger, requiring rapid systems and services to be overhauled almost In transitioning to the new governance for the Southern overnight, we have the skills, relationships and DHB, we acknowledge the important efforts of the capacity to respond. Commissioner team in developing the strategic framework to ensure a strong pathway forward for We’re willing to chalk it up to coincidence that the first Southern DHB, to continue to serve the health needs half of this reporting year was also the period where of the community into the future. The board has also the DHB was governed by a Commissioner team, with welcomed new perspectives around the table, and will the new board elected in October and taking office in continue to shape the future of the Southern Health December. system, with a strong focus on equity, sustainability, Suffice it to say it was a tumultuous induction for risk identification and improved primary-secondary the new team, but also an opportunity to see the integration. dedication and expertise of the Southern health system in action. The following goals have provided the basis for reporting the Southern DHB’s journey in recent years, So reflecting on 2019/20 needs to begin with the and in 2019/20 we continued to make progress in events of its last quarter, as the Southern district these areas. became the hardest hit area by the presence of COVID-19, with two significant clusters in our district, • Creating an environment for good health – building 216 people being infected with the virus, of whom two an environment and society that supports health died. We want to acknowledge those affected by this and well-being disease, and the tremendous efforts of health care staff, • Primary and Community Care Strategy and Action and the wider community, in stamping the virus out. Plan – creating a health system that is more equitable, coordinated, accessible and delivered The impact of the virus is reflected throughout the closer to home where possible reporting against our measures for 2019/20, as core services were disrupted, and business as usual was • Valuing Patients’ Time – focusing on patient flow put on hold. Nevertheless, we do have important through our hospital system to remove steps that achievements to report, and areas that remain critical add time with no value to our patients focuses for the future. • Enabling our people – so that people have the skills, support and systems to deliver the care our We are continuing to see improvements in people communities have asked for being supported in their own homes, as our Primary and Community Care Strategy and a range of • Systems for success – building systems that make it initiatives including the ‘Home Team’ and the Older easy for people to manage care, and work together Persons Assessment and Liaison unit (OPAL) at safely Dunedin take increasing effect. • Facilities for the future – including ongoing planning for the new Dunedin Hospital, redevelopment Significant progress was also made in reducing waiting work at Lakes District Hospital, and progressing times for first specialist appointments and elective Community Health Hubs to accommodate and surgery, following intensive focus in this area. The adapt to new models of care. achievements are not entirely reflected in the results, as more than 900 surgeries and 16,000 outpatient visits Significant progress has been made against this were displaced during the COVID-19 lockdown period. strategic programme of work, and achievements are highlighted in the pages ahead. Special mention 4 | Southern District Health Board Annual Report 2019/20 should be made of the work toward Detailed Business signalled, and our priorities as a Southern health Case for the new Dunedin Hospital, behind which sits system, is affirming. a mountain of planning and reflection on new ways We have also been reminded of the strengths of delivering a health system for the entire Southern of a strong culture, and professionals working district into the future. collaboratively, creatively and to the top of their We were excited to formally open the new emergency scope. Investment in leadership, building and looking department at Lakes District hospital, and pleased to ahead to workforce requirements of the future make good progress in engaging with the community therefore remain a priority. regarding the needs for primary maternity facilities in And of course, we must retain our capacity to respond the Central Otago/ Wanaka area. to any future waves of COVID-19, as this newcomer to The digital requirements of the future of the Southern our global neighbourhood looks set to be with us for health system have been increasingly mapped, and some time to come. indeed received a significant boost during the COVID-19 More than ever, the experiences of the past year lockdown period, demanding greater use of technology endorse what we already well understand – that to meet the health care needs of the community. no part of the health system works in isolation. The Indeed, looking ahead, we have a precious health