CEO UPDATE 25 February 2019 Creating a pathway forward for our health system This week I’d like to share the introductory speech delivered last week by Canterbury DHB Chair Dr John Wood [CNZM, QSO] to the Health Select Committee in Parliament. By way of background, each year DHBs are requested infrastructure deficit facing Canterbury. This process has to provide responses to a number of questions and then helped reset relationships and create a pathway forward. invited to present these and answer further questions A path which has become known colloquially as the “Truth from Health Committee members. and Reconciliation Process”. John provided an overview of where we are at. It’s a I would like to provide context for your discussion today by longish read, but I encourage you to take the time to describing the scale of Canterbury and the contribution it read it, and feel justifiably proud of the part you play in makes to health service delivery for New Zealand. the Canterbury Health System. We are the second largest of the 20 DHBs by geography Chair and members of the Health Select Committee, Kia (if you exclude the sea between here and the Chatham Ora Tatou Katoa. Islands) and by population size, with the obligation Thank you for the invitation to be here today and to present of improving, promoting and protecting the health on behalf of the Canterbury DHB. and independence of our population. We are directly responsible for a population of 567,870 people, 11.5 percent I have here with me, our Chief Executive David Meates, our of the New Zealand population. Chief Medical Officer Dr Sue Nightingale, our Executive Director of Finance and Corporate Services Justine White Our integrated health system employs 10,000 people and our Executive Director of Planning, Funding and across the DHB’s own facilities and a similar number Decision Support Carolyn Gullery. of people are employed through our community-based provider contracts. But we are much more than the South It is a pleasure to be here as a first time Board member and Island’s largest employer. Chair representing an organisation that has provided such strong and innovative leadership during the challenging Canterbury is the second largest tertiary services provider times Canterbury health has faced in recent years. I can say in New Zealand and supports patients from across the that in Canterbury the DHB and its executive leadership is South Island and the lower North Island in a number of universally respected. specialty areas. For example, it is one of only two DHBs able to provide services such as: As a new Chair I have been brought in to work on rebuilding the relationships between the District Health › Specialist paediatric oncology Board and the Ministry of Health and other agencies in › Spinal cord impairment surgery and rehabilitation Wellington by helping create a shared view of the unique and unprecedented challenges that have faced and › Hyperbaric oxygen therapy continue to face the region, including understanding the › Specialist burns treatment. In this issue › Regulars... pg 4-7 › Celebrating Dr Steve Williams | Increase in › One minute with... pg 13 › Tribute to Dr Maureen Swanney: kindness, screening rates for family violence... pg 10 › Notices... pg 14-17 enthusiasm, vision and tireless work... pg 8 › Healthy Commute at Riverside on › University of Otago, Christchurch hangs Wednesday... pg 11 rainbow flag in its foyer... pg 9 › New recliner chairs donated to Ward 12... pg 12 1 25 February 2019 We have one of the largest Neonatal Intensive Care units Canterbury Māori generally have better health than other and rank second in the country for delivery of elective Māori in New Zealand. Life expectancy for Canterbury surgery and first in acute surgical discharges with a Māori is 2.4 years lower than Canterbury non- Māori procedure. We see 15 percent of the country’s cancer compared to a national difference of 6.3 years. This gap is activity, which is partly driven by the South Island having closing with differences decreasing by 46 percent between higher rates of cancer in a number of key areas such as 2005–07 and 2012–14 compared to national progress of 17 bowel cancer. In addition, we are New Zealand’s largest percent. At this rate we could achieve equal life expectancy trauma centre. for Māori and non-Māori in 15 years (compared to 42 years for New Zealand as a whole). We are also responsible for a range of healthcare that covers the whole of the South Island and includes: Māori and Pasifika in Canterbury are also much less likely to end up in hospital acutely unwell than national rates, and › Canterbury Health Laboratories, which acts as the we have demonstrated that we can achieve our childhood reference testing lab for the South Island, and also vaccination rates for all ethnicities. for the World Health Organization for measles-related testing But underlying this are the ongoing consequences of the Canterbury earthquakes. On one hand Canterbury is › Radiation oncology and gynae oncology recovering well, things are happening and opportunities › Mental health services for child and adolescent, mothers abound. We also see the darker side – higher levels of and babies, forensics and eating disorders mental health distress and issues; older populations still › Air retrieval services living in earthquake damaged homes; our own damaged infrastructure which forces us to spend $60 million on › Specialist fertility and cardiothoracic services. various workarounds just to maintain services. On any Our population is growing fast and will reach 578,340 in given day, for example, we are utilising eight operating 2019/20 with an increase of 12.4 percent or 63,000 over theatres in the private sector to meet the surgical demand. the last five years. The popular belief that the Canterbury We are also seeing an ongoing increase in the complexity population has decreased post the earthquakes is a myth. of challenges as all of these factors combine. Following the earthquakes, Statistics NZ projections The Canterbury Health System has worked incredibly hard did not anticipate such rapid increases – the December to make itself better for people: to cut waste out of the 2013 projection for example was nearly 41,000 lower system and improve the patient journey by putting people than eventuated. And the immediate post-earthquake at the centre of everything we do. predictions upon which the business case for our new Despite the unprecedented challenges over the past eight Acute Services Building were based were lower still. years, the Canterbury Health System continues to be Such rapid population growth has put services under highly regarded around the world. It is used as a model by pressure and meant our damaged physical infrastructure the Australian, UK, Irish and some Asian health systems. is inadequate to cope with our actual population and their A number of Canterbury’s innovations are used in other needs. In a recent, very positive development, we have countries as everyone grapples with an ageing population, agreed with the Ministry of Health a process that will see increasing demand and limited resources by re-orienting the completion of two major business cases by June 2019 health systems around primary and community-based care, to address the significant facility constraints. and the engaging of communities and the broader social sector in addressing the issues early, thus reducing the Canterbury has the largest older population in New load on more expensive hospital and institutional care. Zealand in absolute numbers. People over 65 years now comprise 16.1 percent of our population or 93,150 people, Canterbury is focused on enabling our people to live well up 9,500 over the past five years. People over 75 years now and be healthy in their own homes and communities, comprise 6.8 percent of our population or 39,550 people, surrounded by their families, friends and whānau. We up 2,700 over five years. use collaborative models such as the Canterbury Clinical Network Alliance and genuine co-design to achieve real Canterbury’s demographic makeup is changing: Over gains in community health and wellbeing alongside our the past five years our Māori population has become the many partners. second fastest growing Māori population by percentage (16 percent) and by volume (7,360) reflecting a move of Māori As an example, the Government invested $27 million over from other areas to Canterbury. Māori now comprise 9.2 three years in a new service to support children in our percent of our population. primary schools who were suffering from a range of mental health and wellbeing issues. We were privileged to be Although inequities remain between Māori and non- Māori, empowered to roll this service out using our collaborative 2 25 February 2019 approaches. Co-designing a new way of working with all The success so far is a direct response to the power of our partners, particularly education and the NGO sector of collaboration across the health and social sectors, with its development being overseen by the Canterbury between local and central Government agencies, local Clinical Network Alliance. non-government organisations and community providers and the communities we all serve. It is an encouraging We can report that this new service, announced by the demonstration of what is possible when we work all Prime Minister on 22 February last year, was prototyped together for the benefit of our communities. in two school clusters (15 schools) from April to June and progressively rolled out from July. By April this year we will As noted by the Ministry of Health, the issues facing the have rolled out to all 218 Canterbury schools. Canterbury region are complex and substantial.