AGENDA - Ministry of Health NZ€¦ · 8. PRESENTATION 2:00pm Rachel Haggerty– Health Needs...

Wairarapa District Health Board August 2016

AGENDAHeld on Tuesday 23 August 2016Lecture Room, CSSB Building, Wairarapa DHB, MastertonCommencing at 11:00 am

BOARD PUBLIC SESSION

1. PROCEDURAL BUSINESS 20

1.1 Karakia R Karaitiana

1.2 Apologies ACCEPT D Milne

1.3 Continuous DisclosureInterest Register/Conflict of Interest

ACCEPT / CONFIRM D Milne

1.4 Minutes of previous meeting ADOPT D Milne

1.5 Matters Arising from Previous Meeting D Milne

1.6 Action Items Register D Milne2. REPORTS 11:20

2.1 Chair Report VERBAL D Milne 5

2.2 Inwards/Outwards Correspondence NOTE D Milne 10

2.3 C E Report NOTE A Isbister 10

2.3.1 OIA / Media Report

2.3.2 Seismic Letter of Assurance

2.3.3 Seismic Report

2.4 Iwi Kainga Report NOTE K Smith 15

3. HEALTH & SAFETY 12:15

3.1 Health and Safety Plan 2016/17 25

3.2 Health & Safety Minutes 3 August 2016

4. DECISION PAPERS

4.1 CPHAC/DSAC Recommendations AGREE S Williams 5 12:40

4.2 WDHB Position on donated funds AGREE J Stringer 5 12:45

LUNCH – half hour break 12:50

5. DISCUSSION PAPERS

5.1 Orthopaedic Transfers from FSA to waitlist NOTE T Gibson 5 1:20

5.2 Home and Community Support Services NOTE S Wiliams 5 1:25

6. INFORMATION PAPERS

6.1 Primary Care and Tihei Wairarapa Alliance NOTE J Thorpe 10 1:30

6.2 Director Maori Health Services Report NOTE J Kerehi 10 1:40

6.2.1 Maori Health Plan

6.2.2 Tū Kaha 2016

Wairarapa Board Public 23 August 2016 - PROCEDURAL BUSINESS

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6.3 Proposed approach to 16/17 Annual Planning NOTE S Williams 10 1:50

7. MEETING REPORTS AND MINUTES 2:00

7.1 Verbal Report from HAC NOTE J Vollebregt

7.2 ALT Draft Minutes 9 August 2016 NOTE J Thorpe

7.3 CPHAC/DSAC Draft Minutes 15 July 2015 NOTE S Williams

8. PRESENTATION 2:00pm

Rachel Haggerty – Health Needs Analysis Presentation (60 minutes).

9. RESOLUTION TO EXCLUDE THE PUBLIC

Meeting to Close 3:00pm. Proceed to Public Excluded session


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WAIRARAPA DISTRICT HEALTH BOARD

Wairarapa Board INTEREST REGISTERLAST AMENDED: FEBRUARY 2016

Name InterestMr Derek MilneChair

∑ Chair, Wairarapa District Health Board∑ Deputy Chair, Capital & Coast District Health Board∑ Deputy Chair, Wairarapa, Hutt Valley and CCDHB Hospital Advisory Committees∑ Member, Hutt Valley and CCDHB Finance Risk & Audit Committees∑ Ex Officio Member, WDHB Finance Risk & Audit Committee (30 March 2016)∑ Ex Officio Member, WDHB Hospital Advisory Committee (30 March 2016)∑ Member, WDHB CPHAC/DSAC (30 March 2016)∑ Brother-in-law is on the Board of Healthcare Ltd

Mrs Leanne SoutheyDeputy Chair

∑ Chair, Wairarapa District Health Board, Finance Risk & Audit Committee∑ Deputy Chair, Wairarapa District Health Board∑ Chair of Lands Trust Masterton (15 February 2016)∑ Member, Wairarapa, Hutt Valley and CCDHB, Community Public Health Advisory

Committees & Disability Support Advisory Committees∑ Director, Southey Sayer Limited

∑ Chartered Accountant to Health Professionals including Selina Sutherland Hospital and Selina Sutherland Trust

∑ Trustee, Wairarapa Community Health Trust

∑ Sister-in-Law is employed by WDHB

∑ Shareholder of Mangan Graphics Ltd

∑ Member of UCOL Council

Ms Liz FalknerMember

∑ Member, Wairarapa District Health Board∑ Member, WDHB Hospital Advisory Committee (30 March 2016)∑ Retired General Practitioner with Masterton Medical Limited∑ Medical Advisor – Post Polio Support Society NZ Inc∑ Sister in Law works part time at Wairarapa District Health Board (23 February 2016)

Dr Rob Irwin Member

∑ Member, Wairarapa District Health Board∑ Member, WDHB Hospital Advisory Committee (30 March 2016)∑ Trustee Wairarapa Community Health Trust∑ Member, South Masterton Rotary∑ Chair, Wairarapa Trails Trust (30 March 2016)

Ms Helen KjestrupMember

∑ Member, Wairarapa District Health Board∑ Member, WDHB Finance Risk and Audit Committee (30 March 2016)∑ Works for Central TAS as an Auditor∑ Shareholder, Property Investment Company – Kjestrup Properties∑ Assessor for Royal College of GPs for Cornerstones Programme

Mr Rick Long Member

∑ Member, Wairarapa District Health Board

∑ Member, Wairarapa District Health Board, Finance Risk & Audit Committee

∑ Chairman of Wairarapa Community Transport Services Inc

∑ Chairman of Tolley Educational Trust

∑ Trustee for Sport and Vintage Aviation Society

∑ Biomedical Services New Zealand Limited


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∑ Member of Masterton Lands Trust

∑ Director, Longs Properties Limited (1 February 2016)

Mr Alan ShirleyMember

∑ Member, Wairarapa District Health Board∑ Member, Wairarapa, Hutt Valley and CCDHB Hospital Advisory Committees∑ Surgeon at Wairarapa Hospital∑ Technical Advisory for Ministry of Health∑ Wairarapa Community Health Board Member∑ Technical Expert Advisor∑ Subregional Endoscopy Steering Group∑ Member, Wairarapa, Hutt Valley and CCDHB, Community Public Health Advisory

Committees & Disability Support Advisory Committees (30 March 2016)

Ms Fiona SamuelMember

∑ Member, Wairarapa District Health Board∑ Member, Wairarapa, Hutt Valley and CCDHB Hospital Advisory Committees∑ Member, WDHB Hospital Advisory Committee (30 March 2016)∑ Casual Nurse, at Wairarapa Hospital∑ Duty Nurse Manager, at Wairarapa Hospital∑ Contractor Auditor for TAS∑ Member of Clinical Board Wairarapa District Health Board

Ms Janine VollebregtMember

∑ Member, Wairarapa District Health Board∑ Chair, WDHB Hospital Advisory Committee (30 March 2016)∑ DHB Nurse Educator for the UCOL Undergraduate Maori Students. This 0.4 FTE position is

effective from 30 April 2008 to 30 June 2010.

∑ Community Health Clinic establishment∑ Sister in Law works part time at Wairarapa District Health Board (23 February 2016)

Mr Ronald KaraitianaMember

∑ Member, Wairarapa District Health Board∑ Member, Wairarapa Te Iwi Kainga Committee∑ Member, Wairarapa District Health Board, Finance Risk & Audit Committee∑ ACC Manager in Claims Management∑ Wife Kylie Smith is currently the DHB liaison from Child Youth & Family∑ Maori relationships with staff vary from a number of cousins working at DHB∑ Occasionally plays in a band (potential no risk to the board)∑ Trust Chairman Akura Lands Trust

Ms Jane HopkirkMember

∑ Member, Wairarapa District Health Board∑ Member, Wairarapa, Hutt Valley and CCDHB, Community Public Health Advisory Committees

& Disability Support Advisory Committees (30 March 2016)∑ Member, Wairarapa Te Iwi Kainga Committee∑ Kaiarahi, Takiri Mai Te Ata, Kokiri Hauora∑ Member, Occupational Therapy Board of New Zealand (23 February 2016)


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Wairarapa District Health Board Page 1 Page | 1

Minutes: Anna Cardno, Board Secretary

Held on Tuesday 21 June 2016Lecture Room, CSSB Building, Wairarapa Hospital, Masterton

Commencing at 10:45am

BOARD PUBLIC SECTION

Meeting was preceded by a presentation from Midwives team at 10:15am.

PRESENT

Derek Milne Board ChairLeanne Southey Deputy ChairRick Long MemberRob Irwin MemberAlan Shirley MemberFiona Samuel MemberJane Hopkirk MemberRon Karaitiana MemberLiz Falkner Member

IN ATTENDANCEAdri Isbister Chief Executive (CE)Anna Cardno Board SecretaryTom Gibson Chief Medical Officer (CMO)Nigel Fairley 3DHB MHAID DirectorSandra Williams Acting GM, SIDU (GM SIDU)Jason Kerehi Director, Maori Health Services (DMHS)Catherine Sheridan Senior Finance Manager (SFM)Tofa Suafole Gush Director, Pacific People’s Health (DPPH)

PUBLIC IN ATTENDANCECaleb Harris Dom Post

APOLOGIESJanine Vollebregt MemberHelen Kjestrup MemberJill Stringer Interim Director, Wairarapa Hospital ServicesJustine Thorpe General Manager, Compass Health (GM CH)

1.0 PROCEDURAL

1.1 KARAKIAMeeting opened at 10:45am with a karakia by Ron Karaitiana.

1.2 APOLOGIESAs above.


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1.3 CONTINUOUS DISCLOSURE1.3.1 INTEREST REGISTERThe Board confirmed that it was not aware of any other matters (including matters reported to/decisions made by the Board at this meeting) which would require disclosure.

1.4 MINUTES OF THE PREVIOUS MEETINGApproved

The Board resolved to approve the minutes of the Public meeting held on 24 May 2016 as a true and accurate record of the meeting, pending removal of reference to WBS in Health & Safety training and note No extra funding rather than “unfunded” with regard Primary and Community Health Integration.

MOVED: Fiona Samuel SECONDED: Jane HopkirkCARRIED

1.5 MATTERS ARISINGNo matters arising.

1.6 ACTION ITEMS REGISTERNoted.

2.0 REPORTS

2.1 CHAIR REPORT In Public Excluded.

2.2 INWARDS / OUTWARDS CORRESPONDENCECorrespondence was received

MOVED: Fiona Samuel SECONDED: Jane HopkirkCARRIED

2.3 CHIEF EXECUTIVES REPORT

The Board:

1. Received the report.

2. Noted with respect of the change process, the good staff involvement, constructive feedback and useful suggestions from staff.

3. Noted that the Bowel Screening Programme, scheduled to start 1 July 2016, represented a greatopportunity for Wairarapa and thanked Alan Shirley for early support of the project.

4. Received advice from Tofa Suafole Gush of the recent awards presentation at Parliament. Two Wairarapa volunteers were amongst recipients, Tuifao Lologa and Bridget McLaren, both nominated


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for the Minister of Health Volunteer Awards. Tui for the Pacific Category and Bridget for the Disability Category.

With regards the Subregional Disability Forum, the Board Noted:

1 the advice from Alan Shirley that each service must understand the issues faced by people with disabilities and to accommodate them; and

2 comment from Jane Hopkirk concerning the navigation challenges through primary and secondary care health services for people with multiple issues.

2.4 FINANCE REPORTING

The Board:

Received the Financial Report and noted:

1. The May result is pleasing with a continuing favourable trend, reflecting good work across the WDHBand resulting in a forecast year end of $1.5M deficit – favourable against budget by $400,000; and

2. The result has been helped by considerable donations and by a special dividend paid by BioMed of $80,000; and

3. There are permanent staff vacancies in Nursing staff and Allied for which there is an ongoing recruitment process; and

4. Where vacancies are reported there may be Locums/Casuals filling gaps (reported elsewhere in financials); and

5. There is no compromise on staffing on the ground. (Workforce strategy is in place with Allied): and

6. There has been closer control of Inter District Flows; and

7. The change management process will create more vacancies; and

8. There has been an average of 21 patient movements every 24 hours during May in MSW – a considerable workload; and

9. Helen Pocknall and Michele Halford are working closely with teams to ensure that the Trendcare data is correct; and

10. The excellent work being achieved throughout the WDHB.

11. Resolved that the Board Chair would acknowledge staff for the good work being reported.

12. Received clarification from the SFO of the reduction in Maori Health funding reported and queried in last months financials (variance March – April) and noted that it reflected a Board decision made prior to the 2016 financial year in March 2015, and that the financial report against the budgeted figure does not reflect the signed contract.


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2.5 IWI KAINGA REPORT

The Board:

1. Noted that Yvette Grace has resigned as Chair; and

2. Resolved that the Board Chair write to thank Yvette for her contribution and value to the Board; and

3. Noted that the Maori Health Plan is a shared plan that dovetails into/is an essential part of the Annual Plan, the overall strategy of which was discussed at the combined Board/Iwi KaingaStrategic Planning Day; and

4. Noted that plans ought to include appropriate measurement and accountability, and full engagement is required for successful implementation. The Director, Maori Health role to evolve to ensure full engagement with Iwi Kainga, and liaison with the Clinical Board/other groups to consider access issues etc. for Maori.

5. Noted events ahead for Maori:∑ Carvings coming back to Wairarapa – to be presented to WDHB∑ Whiti ki te Uru – (Regional Maori Relationship Board Chairs) is being hosted by Wairarapa

District Health Board on Wednesday 3rd August 2016∑ Tu Kaha – Board members are invited to attend the Central Region’s bi-annual Maori

Health Symposium, being hosted by HVDHB and CCDHB at Silverstream Retreat 21-23 September 2016

∑ Board Orientation – Oct/Nov 2016

3.0 HEALTH & SAFETY

3.1 Di Mazey presented to the Board. The presentation will be included in Sundry Boardbooks.

The Board:

Noted that

1. Health and Safety legislation captures everyone at the DHB, including guests, patients, staff and visitors; and

2. Ron Karaitiana recorded his confidence in the emphasis WDHB is placing on Health and Safety; and

3. Health and Safety includes bullying, and involves HR; and

4. Managing challenging behaviours training is being offered; and

5. Square system can provide improved reporting – yet to determine scope of its ability to report; and

6. H & S reports go to FRAC and to the Board, and

7. The Board has a specific interest in Health & Safety and requests to be kept continually abreast of issues/information as it arises.


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3.2 Advisory Committee Executive SummaryNoted.

3.3 Health and Safety Policy Statement – RatifiedNoted.

4.0 DECISION PAPERS

4.1 CPHAC/DSAC Recommendations

The Board:

Approved the recommendations as discussed and endorsed at the May 2016 CPAHC DSAC committee meeting.

MOVED: Fiona Samuel SECONDED: Rob IrwinCARRIED

The Board:

1. Noted the focus on communicating with the deaf community – WDHB staff had been engaged with the sign language presentation; and

2. Requested that Board members be invited to similar presentations in future; and

3. Noted that an interpretive service is available at WDHB, which includes access to Skype, triaging services and interpreters; and

4. Asked why breastfeeding rates were an equity indicator; and

5. Noted the explanation that breastfeeding for Maori is not traditionally accepted, so a behavioural change is involved; and

6. Noted that completeness of data may also be an issue if the breastfeeding data is coming from Plunket and not taking into account Whanau Ora statistics.

4.2 WDHB Position on Donated Funds

The Board:

1. Noted a Conflict of interest for Rick Long and Leanne Southey; and

2. Noted the CE’s comment that donors could get a tax advantage if they put their donation through a Charitable Trust; and

3. Requested a clearer explanation and more context about the proposal; and

4. Noted the need for a MOU; and


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5. Requested that an amended paper be presented at the July meeting.

5.0 DISCUSSION PAPERS

5.1 Orthopaedic Prioritisation tool

The Board:

1. Received the report and the CMOs explanation about the tool; and

2. Noted in response to a question by Jane Hopkirk as to what right a patient has to appeal their assessment; that:

3. The tool is useful to gauge need, but is specifically a MoH driven administrative tool for score setting, which is influenced by DHBs ability to provide orthopaedic services; and

4. It cannot determine how many patients may be left longer than desirable, that then leaves the patient deconditioned with a longer recovery and increased cost to patient.

5. Requested that, with an orthopaedic staffing issue looming, a full report is presented to HAC thatincludes numbers (Hips and Knees) with scoring benchmarks compared to other DHBs, and contingency planning should the staffing issue be unable to be quickly resolved.

6.0 INFORMATION PAPERS

6.1 Dementia Care – response to queries

The Board received the report, and applauded the thorough content provided.

6.2 Director, Maori Health Services report

The Board received the report.

The Board noted that:

1. Some patients are not receiving reminder letters until after their appointment, possibly due to slow postal service, and as a result there is a need to consider a process change; and

2. The back up system is to call the patient but this is not in place as a standard procedure, andthe ICT upgrade will have the potential to implement a text to remind system; and

3. The CE and DMHS are aware of the issue and will be taking practical steps to address the gaps in the system; and

4. Some good work is being done in the Maori health arena, as illustrated by the indicators; and

5. The carvings ceremony will be significant and well planned, and the Board will be kept informed.


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7.0 MEETING REPORTS & MINUTES

7.1 Verbal report from HAC

The Board noted that:

1. Before the Board discusses future health delivery systems it needs to see what the likely demand for health services will be. The demand needs to be segmented by age and location and by socioeconomic group as much as is possible; and

2. Health Needs Assessment 2020 – 2030 is a critical piece of work.

The Board agreed that:

3 A verbal report from a HAC meeting immediately preceding the Board meeting is not requiredunless the Chair wishes to raise matters of immediate importance; and

4 Draft minutes from such HAC meetings will go to the next Board meeting; and

5 Any immediate issues from HAC can be raised in General Business, in the Public Excluded meeting of the Board.

7.2 ALT Draft MinutesNoted that point 11 of the Minutes (Access to Concerto) is now incorrect in light of developments since.

8.0 RESOLUTION TO EXCLUDE THE PUBLICThe Board AGREED that Public be excluded from the following parts of the of the Meeting of the Board in accordance with the NZ Public Health and Disability Act 2000 (“the Act”) where the Board is considering subject matter in the following table. The grounds for the resolution is the Board, relying on Clause 32(a) of Schedule 3 of the Act believes the public conduct of the meeting would be likely to result in the disclosure of information for which good reason exists under the Official Information Act 1982 (OIA), in particular:

SUBJECT REASON REFERENCE

Public Excluded Minutes For the reasons set out in the 16 June 2015 Board Agendas

Financial matters; Change proposals; Annual Planning; HDC process reporting, Suicide prevention

Papers contain information and advice that is likely to prejudice or disadvantage commercial activities and/or disadvantage negotiations.

Section 9(2)(i)(j)*

*Official Information Act

MOVED: Derek Milne SECONDED: Leanne SoutheyCARRIED


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MEETING ADJOURNED: 2:30pm

DATE OF NEXT MEETING: 19 July 2016

CONFIRMED that these minutes constitute a true and accurate record.Dated this day of 2016

Derek MilneChair, Wairarapa District Health Board


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WAIRARAPA DISTRICT HEALTH BOARD PUBLIC BOARD MEETING : ACTION ITEMS

Wairarapa District Health Board JUNE 2016 Page 1

JUNE 2016 – ALLOCATED TASKSPUBLIC MEETING

Chair Board to acknowledge staff for the excellent work reflected in the DashboardRecognise Yvette for her contribution to Iwi Kainga and value to the Board

ACTION ITEMS

Action Responsible

Meeting date

How Dealt with

Delivery date

Date Completed

4/16.2 Dementia Care Questions raised by Fiona Samuel to be answered in a report for the June 2016 meeting

Sandra Williams

19/4/16 Report 21/6/16 June 2016

5/16.3 Financial Information Systems

Programme of Action Report required to map planning process over next 24 months

Kate Sheridan

24/5/16 Report to FRAC

June June 2016

5/16.4 National Scoring Tool -Orthopaedics

Board requests a full report on the scoring system Tom Gibson

24/5/16 Report June June 2016

5/16.5 Quals presentation

Board requests a presentation on Quals Tom Gibson

24/5/16 Discussion paper

June June 2016

5/16.6 Supporting Whaiora

Board noted funding cuts in Maori Health will affect Whaiora – how can the Maori Provider best be supported locally?

DMHS 24/5/16 Report June June 2016

Red Text

Carried over Requested Quarterly Future Completed


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WAIRARAPA DISTRICT HEALTH BOARD PUBLIC BOARD MEETING : ACTION ITEMS

Wairarapa District Health Board JUNE 2016 Page 2

12/15.7 Progress on HCSS tender

Any lessons from CC and Hutt DHBs from Home and Community Support Services joint tender process

Sandra Williams

18/8/15 Report Defer until July

5/16.1 Prescription errors (60%)

Decision Paper Item 4.1 Minutes 19/4/16 page 4 noted 60% errors in prescriptions presenting at Pharmacy. Board requests further explanation

Justine Thorpe

24/5/16 Report Defer until July

5/16.2 Concerto –patient safety and informedconsent

The Board seeks full assurance that patient safety and informed consent is properly addressed before access to Concerto is widened

3D ICT 24/5/16 Report Defer until July

5/16.7 Fluoride – local data / science

Localised information on fluoride with statistical relevance is to be provided by RPH for Board

RPH 24/5/16 Report When it is to hand

6/16.1 Donated funds IDWHS to represent the paper Donated Funds with detail as requested at June meeting

IDWHS 21/6/16 Report July

6/16.2 Orthopaedic report

Full report requested on numbers (hips and knees) and scoring benchmarks against other DHBs

CMO 21/6/16 Report July

QUARTERLY REPORTS REQUIRED/

Nursing & Midwifery Report Quarterly Report to the Board Helen Pocknall

Report August

Human Resources Quarterly Annual Leave Management Report including advice on any pay out period policies and management of staff well-being.

Donna Hickey / Gretchen Dean

Report August

Pacific Community Health Report

Quarterly Report to the Board Tofa Suafole Gush

Report October


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Chairman’s Report for August 2016 Public Board Meeting

24 June: Attended the 3D FRAC and Wairarapa FRAC meetings

30 June: By telephone interview gave (positive) feedback on interactions with NZ Health Partnerships.

4 July: CCDHB Board meeting.

13 July: Chair/CE meeting.

14 July: DHB Chairs strategy meeting.

15 July: CPHAC/DSAC meeting.

27 July: Teleconference between CE, CMO, myself and Health and Safety Commission staff about focus for Governing for Quality Workshop that we have asked for.

3August: Regional Chairs and CE meeting hosted at Wairarapa. Included a meeting with Te Whiti ki Te Uru. The whole of Board performance questionnaire created with Institute of Directors was tabled and is the subject of a separate e-mail to you all.

11 August: With CE and Cathrine met with Ministry Officials for the regular Monitoring meeting.

12 August: CCDHB board meeting.

Wairarapa Board Public 23 August 2016 - REPORTS

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BOARD DISCUSSION PAPER

Date: August 2016

Author Adri Isbister, Chief Executive

Subject CHIEF EXECUTIVE’S REPORT TO THE BOARD

RECOMMENDATION It is recommended that the Board:

NOTES this paper and discusses as appropriate

1. Executive Summary

Change Process We are now coming to the final stages of the change process. On the whole it has been a very positive process and we have received a huge amount of feedback. The final decision document was released on the 18th August. In the meantime we have been busy preparing the job descriptions and recruitment process.

Bowel Screening ProgrammeWe have formed a steering group to oversee the programme of work made up of clinical and programme leads, Maori representative, primary care and will be Chaired by the two CE’s of Wairarapa and Hut DHB’s. The group will be accountable to provide governance to all aspects of the screening programme, provide leadership and advice, actively support strategies for service delivery, provide governance level collaboration between the MoH and the DHB’s, and address and resolve any issues.

Kahungunu WairarapaWe are on track to have a celebration to return the Maori carvings to the hospital. Director of Maori services and I met with Kahungunu Wairarapa to discuss their strategic plan and how their objectives coincide with the objectives we have in the annual and Maori Health plan.

Draft Annual PlanThe plan is still at the MoH and we have inserted the Budget. Need wait for further information regarding holiday pay liability or not. More information in Finance.

MIFDerek, Catherine and I attended the regular MIF meeting with the MoH. We discussed budget expectations and FY 2016/17 will continue in a tight deficit forecast position. The DHB will be requesting deficit support to cover the additional cost of the webPas and NOS infrastructure implementation.

CPHAC/DSACWe attended the 3DHB CPHAC/DSAC meeting (papers in diligent board books) with several interesting discussions. FYI the following is the WHO definition of disability under the Disability Discrimination Act (DDA) The DisabilityDiscrimination Act (DDA) defines a disabled person as someone who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities.

We discussed advance care planning (ACP). In Wairarapa we have

We also had a presentation of the health systems planning by Rachel Haggerty. The board will have this presentation at the meeting.


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Regional Chairs and CE’s meeting at Wairarapa DHBWairarapa hosted the regional CE’s, Chairs and the central region Maori representative Te Whiti ki Te Uru. We organised Whaiora and Te Hei Wairarapa to do a presentation on their programmes of work.

Cancer Society CabaretThank you to those Board members who attended this fundraising evening. The Board were thanked and mentioned for the support provided to the Society.

2. Financials The Year End financials have not yet been finalised, as we await audit results. Papers will be provided to the Board as they are to hand.

3. Maori Health Directorate There is a full Maori services Directorate report within the Board papers.

4. Allied Health3 DHB Allied Health Scientific & Technical Awards 2016:Thursday 8 September 2016 Horne Lecture Theatre, Wellington Regional HospitalThese awards are a celebration and acknowledgement of achievements and contribution of Allied Health, Scientific & Technical staff in improving the health and wellbeing for individuals, whānau and the widercommunity. Awards are open to Allied Health, Scientific & Technical staff working across Wairarapa, Hutt Valley, and Capital & Coast DHBs.

5. 3DHB Healthy Food and Beverage GuidelinesPhase 4 which saw the removal of all deep fried food (not an issue for Wairarapa DHB), as well as the removal of diet drinks was implemented in early July.

6. HAC reportA full report on provider activities is within the HAC public report this month. A highlight to this report is the national patient experience survey. Wairarapa DHB scored high in all categories and of note and a credit to the Maori Services Directorate and all staff is “Was cultural support available when you needed it?” Wairarapa scored 100%.

APPENDICES:

1. OIA Report2. Seismic Letter of Assurance3. Seismic Report

Recommendation

That the Board RECEIVES the report.


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Board reports OIAs as at 5 August 2016OIA 16-48

Alex MarettLabour researcher

Under section 12 of the Official Information Act, I request the following information:• What reduction in dollars for inflationary cost pressure and/or percentage decrease did your DHB calculate for your total budget that year when the GST rate was increased from 12.5 percent to 15 percent in 2010/11?Response:1. The Wairarapa DHB did not calculate from the increase in GST rate as all accounting is done on a GST exclusive basis.

Sandra Williams SIDU

Completed 07.07.16

OIA 16-49

Alex Marett Labour researcher

• The total amount of efficiencies your DHB has achieved to date against budget (please also provide budgeted amount) in 2015/16• The amount and description of area that that these efficiencies have been made inResponse:

YTD May 2016 FY 16 Budget Variance

Personnel $000s 240 200 40Outsourced $000s 72 180 -108Clinical Supplies $000s 92 197 -105Infrastructure $000s 4 10 -6Non-clinical $000s 98 213 -115Other $000s 125 616 -491Total 631 1416 -785

Kate S Completed 11.07.16

OIA 16-50

Alex Marett Labour researcher

• What contracts originally held with Māori Health providers, if any, have been transferred/tendered then awarded to non-Māori health providers (PHOs, national organisations etc.) since 2008/09? Broken down by name of contract, date transferred, name of new provider who was awarded the contract.• What were the reasons for the contract to be transferred to a different provider?• How many Māori Health providers are currently providing health services in your DHB, the number and name of contracts they are delivering in your DHB region, and how does this compare to 2010/11?

Sandra W SIDU

In Progress

OIA16-

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B HowseJoyce and Howse Consulting

1. Total annual cost of providing the NASC function in your district in 2014/15, including DHB NASC and Disability NASC.2. The average time from referral to the NASC to commencement of home-based support, for the year 2014/15 and 2015/16 to date.Response:1.

Sandra W Sidu

Completed 14.02.16


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Wairarapa DHB DSS NASC Health of Older People2014/15 $251,741.52 $797,181.48

2. 2014/15 July2015/February 2016

Wairarapa DHB 24 working days 15 working days

The figures provided above are the date of referral to the service allocation start date. The time from the allocation start date to the first support visit is not currently collected.NB. Different data gathering methods are used in each DHB and this data relates to non-urgent assessments. Use of short term services ensures that no client is left with personal care needs which are not being met.

OIA16-

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Pia Lupis Can you please email me all of your locations and beside each location specify:1. the number of full time equivalent employees at each location &;2. the maximum number of patients this location can accommodate.Response:

1. Summary of full time equivalents as at 31 May 2016 (includes all casual employees at all Wairarapa DHB locations):

Category FTEMedical Staff 42.7Nursing Staff 216.6Allied Health Staff 70.7Support Staff 16.1Management/Administration Staff 90.5Total 436.6

2. The maximum number of patients Wairarapa DHB can accommodate (excludes newborns, day procedure chairs, ED trolleys):Ward No. of Beds Acute Assessment Unit 6Assessment & Rehabilitation 15High Dependancy Unit 6Medical and Surgical 38Paediatrics & Multi Service Swing Beds 7

Kate S Completed 12.07.16


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Delivery/Postnatal Unit 6Special Care Baby Unit 2Day Procedure Unit 6Total beds 86

OIA16-

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Cate Broughton Fioarfax Media

1. • Across all hospitals in your DHB how many times and for what length of time has a bariatric bed been hired each year for the last five years.

Over the last 5 years, there has been 1 bariatric bed hire for an estimated rental period of 5-6 weeks.2. For each year in the last five years what was spent on hire costs for bariatric beds?

As per above the cost was approximately $600.3. What percentage increase/decrease in cost has there been for bariatric bed hire

from 2010-11 to 2015-16? If the 2015-16 information is not yet available can you provide the percentage increase between 2010-11 and 2014-15.As per above.

4. Has your DHB purchased bariatric beds in the last 5 years? If so, how many have been purchased each year for the past five years?No bariatric beds purchased in the last 5 years, we have however replaced mattresses.

5. How many wheelchairs, commodes and crutches were purchased for use by obese patients each year for the past five years?Crutches – we have purchased no bariatric crutches in the last 5 years. Standard crutches now have a weight limit of 180kg.

6. For each year in the last five years how much was spent on these purchases?Rental of bariatric equipment is not easily identifiable from our financial system. General Occupational Therapy equipment that is leased or rented is identifiable and the last 5 years of costs are below.

Fiscal Year Cost2011/12 $ 4,750 2012/13 $ 3,000 2013/14 $ 1,144 2014/15 $ 19,149 2015/16 $ 17,009

Kate S Completed12.07.16

OIA16-

54

Alex MarettLabour Researcher

1. In 2016/17, how much are you required to spend on mental health services as per the ringfence policy/amount agreed with the Ministry of Health minus the top slice for regional forensic mental health (if this applies)2. What is the equivalent per capita amount of the figure you supplied in question 13. How much per capita have you been funded for under your PBFF share for mental

SIDU Completed 28.07.16


21

health services for 2016/174. What is the difference in millions, if any, between the amount your DHB needs to spend in 2016/17 for the ringfence/agreed amount with the Ministry for mental health services and the amount you have been provided under your PBFF shareResponse:

1. Table 1: Details of Wairarapa DHB 2016/17 MoH ringfence amountWairarapa DHB 2016/17 $millions

MOH Ringfence $9,397Forensic Topslice $0.00Total WPDHB Ringfence $9,397

2. $ 214.11

3. $259.00 (based on the Wairarapa population projections for 2016/2017)

4. The difference in millions is $1.970 million PDFF funding above the 2016/17 Ringfence.A direct comparison of PBFF mental health funding and the ring-fence funding is not a useful comparison as PBFF funding is based on DHB of Domicile (the number of people in the DHB region) whereas the ring-fence is based on DHB of Service (funding paid to the service provider). Wairarapa DHB pays another $1.8m to other DHBs for services supplied to its population that are not included in its ringfence.

OIA 16-55

James Kelly

Clinic Pathways regarding the treatment of persons diagnosed of HIV positive, relating to the scenarios of: a. Someone recently diagnosed with HIV (a new case), b. Someone knowingly HIV positive (ie A person has just moved from overseas or from a different area) c. Someone becoming HIV positive from birth (ie Mother was HIV positive and child became HIV positive thorough birth) d. A pregnant mother who is HIV positive, e. Any other patient scenarios relating to HIV and diagnosis, and relevant clinical pathwaysResponseBoard can request a copy of the letter

Nigel Raymond

Completed by 3DHB Nigel Raymond

OIA 16-56

Alex MarettLabour researcher

- Please provide a list, if any, of any failure to gain training accreditation in any areas in any of your hospitals/DHB or had accreditation revoked since January 2015, broken down by date and area in which training accreditation has not be granted- Please provide the reasons as to why training accreditation has not been granted or revoked and correspondence from the accrediting organisation that informed the district health board of the training accreditation failure- Please provide dates that your DHB expects to get training accreditation back- Please also include where training accreditation has been provided on an interim basis, the reasons for it being interim and the date that interim accreditation ends- What is the number of vacancies in the unit where training accreditation - has not

Tom Gibson Completed 19.07.16


22

been given/ or provided for the interim/ or been revoked.Response:There have been no failures to gain training accreditation, nor has any accreditation been revoked in the Wairarapa District Health Board since January 2015.

OIA 16-57

R Bollard Parliament Library researcher

. How much has your District Health Board spent on mental health for the last five years, per financial year?2. How much does your DHB anticipate spending in the 2016/17 financial year?3. Are the above figures (from question 1 and 2) the same as the amount of the mental health ring-fence? o If not, what are the ring-fence figures for the last five years, per financial year and the 2016/17 financial year o Why there is a difference?4. How are the above figures (from question 1 and 2) calculated? What general categories of mental health care are included and not included? (For example do theyinclude primary mental health)5. For each financial year, were there any significant changes to mental health service provision? (For example any services that closed, opened, expanded, or reduced)

SIDU In Progress

OIA 16-58

Richard Prosser NZ First

Please would you supply copies of any permissions that the Wairarapa DHB public health Hazardous Substances and New Organisms (HSNO) enforcement officer has issued for aerial 1080 operations, since 2005.Response:We have subsequently become aware of similar requests to the Hutt Valley and Capital and Coast District Health Boards, so have included information for those DHB areas with this reply.Please find enclosed twenty one permissions for the Wairarapa DHB area, fifteen for the Hutt Valley DHB area and three for the Capital and Coast DHB area.

Campbell Public Health

Completed 29.07.16

OIA 16-59

Laura Hopkins NZ First

• The Personnel costs expenditure at Wairarapa Hospital, each financial year since 2007/2008

• The Clinical services expenditure at Wairarapa Hospital, each financial year since 2007/2008

• The Infrastructure and non-clinical expenses expenditure at Wairarapa Hospital, each financial year since 2007/2008

• The Outsourced services expenditure at Wairarapa Hospital, each financial year since 2007/2008

• The Other district health boards expenditure at Wairarapa Hospital, each financial year since 2007/2008

• A list of clinical services that have ceased to be available at Wairarapa Hospital, each financial year since 2007/2008; and the hospital or facility that patients presenting to

Finance/ Hospital Mgrs

Completed 29.07.16


23

Wairarapa Hospital for the identified ceased clinical service are now referred to receive that service

• A list of clinical services that Wairarapa Hospital has reduced its capacity to perform, including data on the previous capacity limit and the new reduced capacity limit, each financial year since 2007/2008

• the number of clinical procedures carried out at Wairarapa Hospital, each financial year since 2007/2008, broken down by procedure

• The number of clinical staff employed at Wairarapa Hospital, broken down by title, each financial year since 2007/2008

• The number of non-clinical staff employed at Wairarapa Hospital, broken down by title, each financial year since 2007/2008

Response:Under Section 18(d) of the Official Information Act 1982, we are refusing this request as the

information is publicly available in the Annual Reports on our website.You have a right to seek a review, under section 28(3) of the Official Information Act, by way

of a complaint to the Ombudsman. OIA16-

60

A MarettLabour Researcher

• What contracts originally held with Pacific Health providers, if any, have been transferred/tendered then awarded to non-Pacific health providers (PHOs, national organisations etc.) since 2008/09? - Broken down by name of contract- Date transferred/lost- Name of new provider who was awarded the contract- Name of provider that previously held the contract.• What were the reasons for the contract to be transferred/awarded to a different provider?• How many Pacific Health providers are currently providing health services in your DHB and how does this compare to 2010/11?- Broken down by name of provider- The number and the description of contracts they are delivering in your DHB region- Please provide the names of providers who held contracts in 2010/11 and the name and number of contracts they were delivering in 2010/11

Sandra Williams SIDU

In Progress

OIA16-

61

R BollardParliament Analyst

1. How is seclusion defined, and what processes are followed to ensure seclusion events are recorded accurately?2. How is the use of Night Safety Orders recorded or otherwise monitored?3. Are practices known as ‘night seclusion’ or ‘night exclusion’ used? If so, how are they defined and monitored?4. What other forms of environmental restraint or de-escalation are used? How are they defined and how do these differ from seclusion? Are the uses of these practices

Nigel In Progress


24

recorded or monitored in any way?OIA16-

62

Omar Hamed APEX

The number of psychologists, audiologists, dental therapists, biomedical engineers in the DHB.Transferred to DHB Shared Services

Gretchen Transferred 18.07.16

OIA16-

63

A Marett Labour Researcher

The CPAC threshold/commitment to treatment threshold (not the average CPAC score) for each of the following surgeries and please do not provide ranges:- Cataract surgery- Hip Joint replacement- Knee Joint replacementFor the end of the month of June 2016.Response: Wairarapa DHB CPAC threshold scores as at 30 June 2016 are:47 Cataract surgery85 Hip Joint replacement85 Knee Joint replacement

Sarah B Completed19.07.16

OIA 16-64

Omar Hamed APEX

DHBs current Health and Safety policies, the minutes and agendas of the last three meetingsResponse:Minutes/agendas and policies attached

AmberDi Mazey

Completed 01.08.16

OIA 16-65

A MarettLabour Researcher

How much has your district health board budgeted for hospital and building maintenance for the following financial years, how much was spent, how much was deferred?Something along the lines of:

Financial year

Amount Budgeted

Amount Spent

Actual assessed maintenance needed in $$$

Amount deferred

2010/112011/122012/132013/142014/152015/16Total

I really want that column in red to show how much was actually assessed as being needed unlike budget and expenditure. But I am not quite sure how dhbs classify/word this.

Kate EB In progress

OIA 16-66

A KingMP

How many qualified sonographers are currently working in the following areas:Obstetrics and gynaecology; and detection of cancer; and vascular abnormalities;and surgical cases; and tendon and muscle injuries

Response:At Wairarapa District Health Board, we have one 0.8FTE permanent qualified sonographer, a

Tina Rirnui Completed 04.08.16


25

0.6FTE regular locum qualified sonographer and a 1.0FTE vacancy (being advertised), along with a 0.8 FTE student sonographer.

OIA 16-67

A MarettLabour researcher

-The number of people waiting for behavioural support services assessment broken down by month for the following years: 2013/14, 2014/15, 2015/16 and the average waiting time for each financial year. What is the average waiting time for a behavioural support services assessment as at June 2016?-The number of people waiting for equipment and modification assessment broken down by month for the following years: 2013/14, 2014/15, 2015/16 and the average waiting time for each financial year. What is the average waiting time for an equipment and modification assessment as at June 2016?

Transfer to MoH

Transferred 28.07.16

OIA 16-68

Simon WallaceNZACA

Since July 1 2015How many LTCF interRAI assessments completed by Age residential providers and submitted to your DHB in support of a change in care level have: been received, been over turned, been redone by DHB assessors?What are the minimum, average and maximum times it has taken in tour DHB to complete a review of providers applications for change in care level since 1 July 2015?How long does it take for payment to be made to the aged residential care home following the NASC or DHBs approval of a change in bed type?Is you DHBS budget for aged residential care set for each care level, ie. Rest homes, hospital and dementia or do you have one global budget for aged residential care?How much has your budget for aged residential care increased for the 2016/17 year over the 2015/16?What budgetary assumptions were made about the increase in residents at each care level for the 2016/17 year over the 2015/16?

JoanneSIDU

In Progress

OIA16-

69

Carrick Graham

In light of legal proceedings brought by Mr Shane Bradbrook – Senior Public Health Advisor at Regional Public Health, I would like to request Wairarapa DHB treat this request as urgent. This request seeks;1. Copies of all communications, including but not limited to emails, letters, copies of text messages, briefings, reports, aide-memoire, or other correspondence sent by, or received from, Mr Shane Bradbrook to:a. Adri Isbister, Chief Executive Officer, Wairarapa DHBb. Tony Hickmott, Executive Director, Corporate Services 3DHB, Wairarapa DHB.Please take this request to cover the period 1 January 2016 through to today’s date – 28 July 2016.2. Copies of all emails sent from or received by Wairarapa DHB from email address [email protected] that include direct or indirect reference to the following names:a. Carrick Graham

Adri/Anna In Progress


26

b. Katherine Richc. Whaleoil and Cameron Slaterd. Dirty Politicse. Prof Boyd Swinburnf. Prof Doug Sellman

OIA16-70

B FraserJan LogieGreen Party

Under the OIA Act can you please provide me with any evaluations undertaken of the domestic violence intervention programme in the last eight years?

Sarah B In Progress


27


28

Wairarapapa DHB Seismic Update August 2016Prepared by: Leon Clews, Operations Manager - Facilities and Engineering / Brian Freeman, Maintenance Manager (Wairarapa)

OtherDHB City/Campus Building name Services in Building Seismic Importance

LevelHas the Building Been Assessed (Yes/No)

If Assessed, Date of Last Assessment (DD/MM/YY)

Assessed NBS (%) Assessment Type (i.e. desktop, IEP, Formal Structural) If other, please specify

Critical Structural Weakness Identified? (yes/no) If yes, specify

Drop Zone Issues Identified? (yes/no) If yes, specify

DHB comment Is Building Occupied? (Yes/No)

If Occupied, Details of Occupation

If Occupied, DHB to detail the Basis of Continued Occupation (include reference to Board decisions, engineering and legal advice as appropriate)

Is a First or Subsequent Assessment Planned?

Date of Next Assessment (DD/MM/YY)

DHB to outline whether future work is planned (Including Details of Interim or Permanent Remediation and/or Indicative Costs if known)

DHB's general comments or issues

Wairarapa Wairarapa Clinical & Support Services Building

IT, Med Library, General Management, Administration

IL2 Yes 1/01/12 65% Formal Structural Assessment/ Detailed Assessment

No No Rapid assessment Level 2 by Aurecon on 20/08/2013

Yes Residential Ref: Spencer Holmes Limited 080562R03.doc February 2011. 22nd December 2011 email correspondence [email protected] "Neither the DHB Admin building nor the Human Resources building pose a significant life risk to the occupants of the building in the event of a moderate to severe earthquake."

No The are no plans to refurbish or strengthen this building at this time. Permanent occupancy. Building needs external weatherproofing remedials including roof replacement. Radiator heating are systems end of life. Will need significant remedials in next 12-24 months to remain useable. Future utilisation needs to be confirmed.

Wairarapa Wairarapa Human Resources Building

Training Rooms, Meeting Rooms IL2 Yes 1/01/12 25% Formal Structural Assessment/ Detailed Assessment

- No Detailed assessment by Charles Consulting

Yes Administrative Ref: Spencer Holmes Limited 080562R03.doc February 2011. Engineer report supports occupancy of building noting "Due to the open nature of the east end of the Human Resources building we would suggest that the occupancy of the east end be limited to 20 in the interim." No full time occupants in the building. Laundry contractor in western end building. Use office space up to 2 hours per day. Remains within parameters set by Spencer Holmes.

Yes 2nd Quarter 16/17 FY

A detailed assessment of the building by structural engineers has been completed and options for strengthening have been provided for further discussion. These can now be considered as part of future capital planning. Building remains in use with restrictions

The DHB has reduced the maximum occupancy levels in the east end training rooms for this building to 20 for intermittant use and there is no permanent occupancy. Office spaces used for approximately 2 hours per day.

Solution to 67% would require new internal building diaphraghms (plywood to specific Walls and Ceilings etc), blocking in of certain windows. steel bracing in two locations and would be extensive. Est build cost $400,000 excl FF&E and any contingencies.

To obtain 100% NBS would require additional plywood to diaphragms, more blockwork and steelwork. Est build cost $500k excluding FF&E and any contingencies.

Additional funds have been provided to Property and Facilities Management in 16/17 to undertake a peer review on the findings and costings.

Wairarapa Wairarapa Pandemic Store (Old Corridor off Doctors)

Store IL2 Yes 30/06/05 45% Initial Evaluation Process (IEP) No Ref: Spencer Holmes Report E080562r01 Earthquake Prone building Assessment.

No Used as storage for pandemic supplies only.

Alternative options for storage are being assessed but no actions are planned at this time.

Intermittent access only., No permanent occupancy

Wairarapa Wairarapa Doctors Accomodation (Ex Old Selina Sutherland / Focus)

Vacant IL2 Yes 26/08/08 7% Initial Evaluation Process (IEP) No Ref: Spencer Holmes Report E080562r01 Earthquake Prone building Assessment.

No No work currently in planning Does not pose a risk to others, however the services which run through the building could be damaged as a result of a moderate to severe earthquake. If this occurs it will stop the services provided in the buildings it is connected to.

Building Details Current Assessment of Seismic Status Occupation Status Future Plans


29

C:\Users\BB2SER~1\AppData\Local\Temp\BCL Technologies\easyPDF 7\@BCL@D80DC05C\@[email protected]

June 2016 to May 2017Health and Safety Plan

Ratified 9th August 2016 by theWDHB Health and Safety Advisory Committee

Wairarapa Board Public 23 August 2016 - HEALTH AND SAFETY

30


IntroductionWairarapa District Health Board recognises health and safety as a core activity within the organisation.

This Health and Safety Plan is fundamental to our long term effectiveness in creating a safe working environment and is an essential part of our accreditation and legal compliance. It details how we intend to deliver high standards of safety management, safety practice and a mechanism for continuous improvement towards safety excellence.

StrategyThe DHB acknowledges there is a need for balance in managing the interfaces between health and safety and other DHB demands to ensure the DHB becomes an increasingly safer and healthier places to work and receive care, however no business objective will take priority over health and safety.

In recognition of our common goal to improve health care quality and safety we actively support and promote a positive safety culture across the DHB. We believe that employee safety plays an integral part in supporting and enabling patient safety. By looking after the well-being of our employees we contribute directly to a safer patient experience.

The DHB will consult with employees and provide opportunities for active participation to ensure they have access to the training knowledge and resources required to maintain and healthy and safe workplace.

Vision“We will all have a safe workplace”

ScopeThis plan applies to all DHB employees, students, volunteers and contractors retained by the DHB and those areas affected by the undertaking of the DHB. The plan does not apply to those areas funded by the DHB which do not employ DHB staff.

Everyone has a role in continuous improvement of health and safety.


31


Health and Safety & Emergency Preparedness Annual PlanAnd Implementation Strategy June 2016 to May 2017

Initiative and Implementation ProcessHow will this be implemented?

Relates to WSMP Element:Relates to tri DHB Strategic

Objective #:

PeopleWho responsible for implementing

BudgetHow much will the

actions cost

Deadlinefor completion

Date completed

Compulsory ANNUAL Initiatives

Annual Event ReviewEvaluate top 3 Occ Health and Safety reported eventsDevise awareness/reduction campaign

2:Planning, Review & evaluation /4:Information/training/Supervision#2: …..steps to prevent Harm

HS&P Co-ord

Within existing allocation for FTE

March 2016

Needlestick flyer Feb + added to training session fromn June 2016

Falls Promotional Displaymain reception, email and In-site article, Promo Display holder poster

4:Information/training/Supervision#2: …..steps to prevent Harm

HS&P Co-ord


1st April 2016

CompleteApril 2016

Workstation Self Assessmentshanded out with Administrators Day celebrations info week prior –Health and Safety prize draw for completed assessment

3:Hazard ID6:Employee Participation#2: …..steps to prevent Harm

HS&P Co-ord


April 24 2016

Complete20 April 2016

World Day for Safety and Health at work Promotion 28th April

Do promotion around 2016 theme: “Workplace Stress: A collective challenge”(In-site article/email all/promo flyer for holders);

3: Hazard ID4:Information/training/Supervision6:Employee Participation#1 Foster H&S Culture

HS&P Co-ord


April 28 2016

Complete 28 April 2016

Health & Safety Rep Transition training 4:Information/training/Supervision#2: …..steps to prevent Harm

HS&P Co-ord

On-line training up to 4 hours paid Rep time

June 30 2016

Commenced May 2016

Request for completion of Work Area Observation Audits 3: Hazard ID 4:Information/training/Supervision#1 Foster H&S Culture#2: …..steps to prevent Harm

HS&P Co-ord


June 2016

May 2016

Call for update of departmental hazard registers with training on new risk rating within the registers

3: Hazard ID 4:Information/training/Supervision#1 Foster H&S Culture#2: …..steps to prevent Harm

HS&P Co-ord


June 2016

Complete August 2016

Generic Hazard registers updated 3: Hazard ID 4:Information/training/Supervision#1 Foster H&S Culture#2: …..steps to prevent Harm

HS&P Co-ord


June 2016

ACC Workplace Safety Management Practices Audit Completion of Template by Executive Leadership Team/ Managers (refer:g\quality\health&safety\audits\templates\master ACC44)

1: Employer commitment Systems#1 Foster H&S Culture#2: …..steps to prevent Harm

HS&P Co-ord


August2016

Complete August 2016

Health and Safety Management Systems Assessment questionnaire handed out to all Reps/ members of Advisory Committee for completion.

2:Planning, Review & evaluation6:Employee Participation#1 Foster H&S Culture#2: …..steps to prevent Harm

HS&P Co-ord


August2016

Sent out 2nd

August


32


2016Dental Therapist Workstation Self Assessment ChecklistFor completion by all Dental Therapists


HS&P Co-ord


August2016

Review proceduresUnder Health and Safety umbrella due for renewal, review against latest legislation, Standards and best practice guidelines.

2: Planning, Review and evaluation3: Information/training/supervision#2: …..steps to prevent Harm

HS&P Co-ord


August 2016

Health & Safety Rep Training 4:Information/training/Supervision#2: …..steps to prevent Harm

HS&P Co-ord

Up to 2 days paid leave for Reps

Sept 2016

EM Get Ready Week.Promotion in line with Civil Defence national campaign

7. Emergency Planning & Readiness #1 Foster H&S Culture#2: …..steps to prevent Harm

HS&P Co-ord


22-26 Sept 2016

ACC Safety WeekPromotion in line with National campaign + additional EM expo held

4. Information/training/Supervision#1 Foster H&S Culture#2: …..steps to prevent Harm

HS&P Co-ord


14-17 Oct 2016

Haz substance registersto be reviewed by reps and managers in conjunction with promo on workers rights for Labour Day.


HS&P Coord

Within Existing allocation for FTE

Labour Day 24/10/16

1. Fire Warden Training session or alternate year quiz & booklet2. Chief Warden Training

4:Information/training/Supervision7. Emergency planning & readiness#2: …..steps to prevent Harm

HS&P Co-ord

$350 + GST per session (organizational training budget)

28 Nov 2016 #2 Complete

23/5/16

Trial Evacs six monthly 7. Emergency planning & readiness#2: …..steps to prevent Harm

HS&P Co-ord

May & Nov

Complete 4/4/16 (oral)

29/4/16 (Main Site)

23/6/16 (Hessey)

Compulsory Initiatives Bi-annual or LongerCIMS TRANING - Offer Bi annuallyFor new Management or refresher as required

7. Emergency planning & readiness#2: …..steps to prevent Harm

HS&P Co-ord/REMA


March 2016

EMERGO EXERCISEBi annual


Oct 2017

WSMP AUDITBi Annual

1: Employer commitment2:Planning, Review & evaluation#1 Foster H&S Culture#2: …..steps to prevent Harm

HS&P Co-ord

Bi-annual audit fee approx $2040

Sept 2016


33


BCP updateTri-annual


TBC TBC Nov 2016

HEP updateTri-annual

Nov 2016

Annual Health and Safety Rep Elections Elections 3 yearly(in line with new 3 DHB policy and new employee participation

agreement)

6: Employee participation#1 Foster H&S Culture#2: …..steps to prevent Harm

HS&P Co-ord

Within existing May 2016 May 2016

Health & Safety Policies and Procedure Review including Worker Participation Agreement

1: Employer commitment#1 Foster H&S Culture#2: …..steps to prevent Harm

HS&P Co-ord

Within existing Sept 2016

HSNO approved handler training5 yearlyLast completed 2011, Next due by November 2016

4:Information/training/Supervision#1 Foster H&S Culture#2: …..steps to prevent Harm

HS&P Co-ord

per person: $80 training session$100 for certificate

Due Nov 2016

Queried CCDHB re training this year?

Additional StrategiesStaff Wellbeing continue to increase options for staff work perks to include health and wellbeing options, such as access to exercise, recreation and items that support relaxation, sleep and stressreduction.

1: Employer commitment#1 Foster H&S Culture#2: …..steps to prevent Harm

HS&P Co-ord

Within existing allocation of FTE

July 2016 Financial wellbeing seminars

Decon - Major Incident Training Scenario – Acute ServicesMajor Incident Scenario – Acute Services - test against their plan oncefinalized.

7. Emergency Planning & Readiness #1 Foster H&S Culture#2: …..steps to prevent Harm

HS&P Co-ord & CNM Acute


July 2016 Plan drafted NSFS input/issues with portable decon being reviewed Sept by NZ FS to be advised

Manager H&S TainingACC WSMP recommendation: Consider developing sometraining for management around how to demonstrate due diligence for health and safety and covering new legislation.

ACC WSMP Recommendation Work with CNS Infection Control to develop recurring training around RTW with managers.

4: Info/Training/ Supervision#1 Foster H&S Culture

HS&P Co-ord

HS&) Coord + Infection Control CNS

$TBC

Within existing budget

October 2016

August 2016

In liaison June 2016 with Peter Hall Gosh re online option

Contractor H&S Performance review

ACC WSMP recommendation

Develop robust procedure for ensuring all contractors have their performance reviewed on an annual basis in line with new legislation. Ensure all contractors,

8. Protection of employees from work by Contractors#2: …..steps to prevent Harm

HS&P Co-ord in conjunction withDirector Clin


Dec 2016 22 June 2016 requested copy of Tinas


34


even ones that are not managed by the facilities area, are part of the contractor management process.

Support services Tina Ririnui

procedure, guideline or performance appraisal documentation that covers this

TBA: To Be Advised TBC: To Be Confirmed


35

C:\Users\BB2SER~1\AppData\Local\Temp\BCL Technologies\easyPDF 7\@BCL@C40D7BB8\@[email protected]

Present: Dianne Mazey, Clare Matthews, Louise Jones, Kerrie French, Tina Te Tau, Megan Futter, Jenny Clarke, Margie Lawton, Pat Collins, Sharon McArthur, Linda Tatton, Tonianne Bainbridge, Jenny Burt

Apologies: Amber O’Callaghan, Sandy Loveday, Jill Stringer, Michele Halford, Julie DennistonCopies to: Chief Executive [26], HR/ Bipartite meeting via Gretchen Dean [1], Lizzie Daniell [28], Tam Wootton [14], Departmental ManagersMinutes of previous meeting accepted as accurate record.

Health and Safety Success Stories

ÿ Letter of thanks received into this committee from MSW for the enormous help in getting the extra lighting installed, it has made an enormous difference

ÿ Additional Spill kit ordered by Kerry for the van that can transport clinical waste bags. ÿ Return to work on-line training package for Managers has been developed and will be rolled out once available on-line.ÿ New Emergency hand held Radios now programmed and installedÿ Local bus company has been contacted Buses and have ceased immediately cutting through the campus at speedÿ Praise from Spotless to the orderlies for the efficient and effect way they handled a recent security event in the Cafe. ÿ On-going Public toilet blockage issues have been resolved: Toilet between MATY and PAEDs constantly blocking due

to hand towels. Problem solved by decision to remove the hand towel option and replace with roller towels.

TOPIC DISCUSSION Actions Responsibility of:

Standing Agenda Items:Reportable Events YTD

Microsoft PowerPoint Macro-Enabled Design Template

Department Agendas

H&S Rep training topic

Annual Plan 2015-2016

SQUARE online stats presented to the group in the form of Pie and Bar Graph. These will be made widely available via the WDHB Health and Safety site.

To be loaded Di Mazey

Reminder to all reps to include H&S as a standing agenda items at all team meetings!

All Reps All Reps

This meetings topics:1. ‘What is Reasonably Practicable’ and what this means under the

new legislation. Full explanation ‘Worksafe’ video presented. 2. `Call it’ - explanation and video around the importance of staff feeling

OK to “Call It” if they feel something isn’t quite right. Reps role is to encourage reporting and support staff to do so.

Reps to encourage reporting

All Reps

Minimal feedback received around the Annual Plan. This is has now been ratified by this group and will be forwarded to ELT.

Document to be forwarded to ELT

Di Mazey

Minutes of Meeting of Health & Safety Advisory Committee3rd August 2016

11.30am


36


Business arising from previous minutes:

DHB Recycling Meeting: Shelli Pillar is holding a meeting on Wednesday 10th August from 1-1.30, 2nd floor meeting room C&SS Building to discuss recycling at the DHB. Anyone with a keen interest in recycling is invited to attend to hear about possible options, and provide views about what is realistic and practical for us to do to improve our recycling rate. All staff are invited to attend. It would be great if we as the H&S committee could support this meeting as it has been on our agenda for some time.

All Reps All Reps

Hazardous Home Visit: This specific case is an on-going issue for District Nursing and is being closely monitored, resolution may be imminent.

Shingles Vaccine: This subsidized vaccine has been advertised and has been taken up by several staff. Any staff interested should talk to Lizzie Daniells in Occupational Health.

Slip -overshoes: Dianne Mazey has been in touch with procurement. There would appear not to be any alternatives available nor has any further issues been reported. As this appears to have been a one off event the Quality Department will monitor for any further events.

Di Mazey

Volunteer’s desk: Request made to Karen Haines to re-site desk to its previous position.

Di Mazey to readdress with Karen Haines.

Di Mazey

Concerns with traffic turning at the top of Blair Street and Te Ore Ore road: Dianne Mazey has raised these concerns with the Council and this has been monitored. Awaiting findings from the council.

Di will keep the group updated.

Di Mazey

Health & Safety Representative identification badges: These have been approved for purchase. Dianne Mazey presented a draft sketch of designand quote for the proposed badge. Suggestion from committee was to include the WDHB logo.

H&S Rep Badge draft.pdf

Logo inclusion to be discussed with manufacturing company

Di Mazey

Infection control: Query over the actual requirement to change curtains in patient areas has been addressed and clarified with Orderlies and Cleaning staff directly by the Infection Prevention Committee.

Radio coverage: The new radios are insitu however there are still issues with coverage on site. A quote has been obtained from Videre has been requested to reposition the aerial.

Di Mazey


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H&S staff perception questionnaire 2015.docx

Spinal board attachment: Not available in the hospital. A reportable event has been submitted. Linda Tatton will look into this. The lack of attachment inSelina Sutherland poses a risk to staff given their low staffing numbers.

Linda Tatton will investigate the Spinal Board attachment for Selina Sutherland.

Linda Tatton

Infectious Isolation: No notification that patients are coming to theatre from isolation. Infection Prevention Control has been consulted and recommend that the ward must notify theatre additionally a SQUARE report must be completed when this is not adhered to, to enable formal follow-up.Our Bi-annual ACC Workplace Safety Management Audit is coming up on the 7th of September and as usual all members of this committee will be asked to be involved in the focus group meeting with the auditor that will be held at 2pm in the CSSB ground floor lecture room for no more than an hour.

All Reps to make themselves available if possible.

Diary invites will also be sent out

All Reps

Di MazeyAnnual Staff Perception Survey: Forms handed out to Reps for completion to collate a snap shot of their perception of current work place health and safety practices etc.

All Reps Di Mazey

New Business Annual Managerial Self-Assessment: This will be sent out in the next few days to Managers and is a comprehensive questionnaire to ensure a robust review of our health and safety systems.

Di Mazey to distributeand collate

Di Mazey

HSAC terms of reference and Policy review: Updated with minor changes. Ratified by this group.

Upload new version to Health and Safety Manual.

Di Mazey

Join action plan for reducing harm in NZ workplaces: The joint action plan for reducing harm in New Zealand is collaboration between Worksafe and ACC with the aim to reduce fatalities and serious accidents by 25% by 2020. Of particular interest is that the health sector has been escalated to be included in the top 5 sectors to be focused on. Although alarming this will allow for funding to directly support programmes that will directly benefit our sector. ACC will lead this piece of work: Overview provided below

Microsoft PowerPoint Template

Policy updates for consultants: Most of the H&S policies are up for review. These will be forwarded to this group for consultation and review.

Di Mazey will facilitate Di Mazey

Fire Trail Evac report: Latest trial held at Hessey House off the main hospital campus (routine 6 monthly trial evac), overall a great response and evacuated without incident. Full report reviewed with committee.


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Presentation to the board – H&S overview:. The Board requested a fully comprehensive overview of Health and Safety at Wairarapa DHB. This was provided by Dianne Mazey and well received. This session will be followed up with an additional training session on the specifics of governance under the new legislation.Stage 1 Rep Training (Face to Face): We have 6 spaces allocated on theNovember 1st and 2nd course at Hutt Valley DHB. Reps are reminded that it is mandatory for stage 1 training to be completed as a bare minimum. This training consistently has very good feedback and remember the cost for this training is met out of the organisational training budget not your departments budget.

All Reps to advise Di Mazey if they want to attend this training immediately to ensure places are secured.

All Reps

General Business

Rep resignation form: an official form has been produced for H&S Reps wishing to resign from their posts in the future.

Will be provided to any Reps resigning in future.

Emergency Instruction sheet: Presented to group. Produced jointly with HVDHB. Easier to refer to than the old flip chart. Copy to be added to the bathroom holders and laminated copy to replace the old flip version. Of note: offsite areas dial111. 777 Calls: Kerrie French raised the issue of no longer being able to dial 777 via new SPARK cell phones (a landline must be used). Are staff widely aware of this?

Follow up with IT suggest notification

Di Mazey

Certified Handler Chem handling training due to expire: CCDHB contacted by Di Mazey who were unaware their training also due to expire. CCDHB will advise when dates available for training and WDHB will join them.

Once date available staff to be contacted to book in to recomplete.

Di Mazey

RMO office and insects: Issue with Cockroaches in RMO office coming in via outside doors into rehab patio. Maintenance to be notified.

Megan Futter to write a request for service.

Megan

Emergency Page: Main receptionist can put out a emergency page but staff phone into telephonist now located in separate room who knows nothing of the page, this slows down the process.

SQUARE report requested and follow-up with Karen

Di Mazey

NEXT MEETING: 5th October 2016, 11.30am, CSSB Lecture Room


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Wairarapa, Hutt Valley and Capital & Coast District Health Boards

DECISION PAPER

Date: 1 August 2016

From Sandra Williams, Acting Director, SIDU

Endorsed By CPHAC DSAC Committee

Subject CPHAC DSAC Recommendations

RECOMMENDATION

It is recommended that the Wairarapa District Health Board: 1. Recommend to the Board that they agree to:

a. The outline of the draft action plan in Section Three emerging from the forum to include the following areas for further development: i. The development of a performance monitoring framework during 16/18 with meaningful

indicators to measure health equity for people with disabilities; ii. Support for the development of a high level plan for community and intersectoral

engagement across funders of inter-dependent services; iii. The development of disability literacy as a competency in conjunction with national

workforce agencies; iv. Promotion and commitment of integration of disability support needs in all new IT

development and gradual integration into current platforms; v. Endorse in principle a whole of life approach to improve access to funding pathways for

staff and people using services; and vi. An approach to the Ministry of Health at Executive level to discuss the impact of

decreased DSS funding, increasing health complexity within the disability population, and the impact of the funding gap on access to services for persons with disabilities.

1 PURPOSE

To seek approval from the Wairarapa District Health Board for the recommendation discussed and endorsed at the July 2016 CPHAC DSAC committee meeting as outlined below.

2 MEETING RECOMMENDATIONS

2.1 Sub Regional Disability Implementation Plan

The Senior Disability Advisor presented a summary of outcomes from the Sub Regional Disability Forum held 3 June 2016.

The Committees:

1. Noted progress on sub regional plan and the local developments: a. The updated disability responsiveness tools b. The agreement on cross sector collaboration of the Child/Adult Transition (CAT) projects. c. Bridget McLaren and her mobility dog Goldie won the national Ministry of Health Youth

Volunteer Award d. The disability responsiveness initiatives being implemented in Hutt ED and Ward 5 e. Capital Support Quality Award winners 2016 CCDHB

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Wairarapa, Hutt Valley and Capital & Coast District Health Boards

f. The updated Generic Orientation for new staff; and g. Friday 3 June 2016, the third Sub Regional Disability Forum took place at Silverstream

Retreat in Upper Hutt.

2. Recommended to the Board that they agree to:

b. The outline of the draft action plan in Section Three emerging from the forum to include the following areas for further development:

vii. The development of a performance monitoring framework during 16/18 with meaningful indicators to measure health equity for people with disabilities;

viii. Support for the development of a high level plan for community and intersectoral engagement across funders of inter-dependent services;

ix. The development of disability literacy as a competency in conjunction with national workforce agencies;

x. Promotion and commitment of integration of disability support needs in all new IT development and gradual integration into current platforms;

xi. Endorse in principle a whole of life approach to improve access to funding pathways for staff and people using services; and

xii. An approach to the Ministry of Health at Executive level to discuss the impact of decreased DSS funding, increasing health complexity within the disability population, and the impact of the funding gap on access to services for persons with disabilities.

3. Noted accolades that have been recognised from the wider sector as well as Paul Gibson the Disability Rights Commissioner to Pauline and the Disability Responsiveness Team for their hard work.

4. Noted the Chair suggested development of some guiding principles to be present in every paper, to guide every decision a Committee member makes in this group.

Moved: Nick Leggett Seconded: Liz Faulkner/Jane Hopkirk CARRIED

2.2 Palliative Care Update – Advanced Care Planning Presentation – Update

Helen Rigby and Emma Hickson presented to the Committee on Palliative Care – Advanced Care Planning.

The Committee noted the content of the report and the presentation.

2.3 Draft Health System Planning Report - Presentation

Rachel Haggerty and Wayne Skipage presented to the Committee on the Draft Health System Planning Report.

The Committee noted the presentation and the next steps as outlined:

Next steps in this process:

a. Complete modelling for patient flows, and investment and disinvestment choices; b. Aligning Maori and Pacific Plans and a stronger focus on equity; c. Completing a draft plan for Executive and Board discussion prior to wider consultation; and d. Engagement and consultation.


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Wairarapa District Health Board

BOARD DECISION PAPER

Date: 7 07 16

Presented By Jill Stringer

Author Jennie Mitchell and Jill Stringer

Endorsed By Kate Sheridan

Subject Wairarapa DHB position statement on Donated Funds

RECOMMENDATION

It is recommended that the Board:

a. Agrees the Board position statement related to donated funds, which endorses philanthropy via the Wairarapa Community Health Trust and accountability for donated funds

b. Endorses management cementing the relationship with the Wairarapa Community Health Trust via an MOU

c. Notes the establishment of a Donated Funds Administration Team to consider future requests for use of Donated Funds

1 PURPOSE

The Board has requested a position statement be developed in relation to donated funds. This statement will be the strategic platform for formalisation of the relationship between the Wairarapa Community Health Trust and the DHB via an MOU.

This paper provides the position statement and outlines the process the DHB is developing to manage donated funds.

2 BACKGROUND

Wairarapa DHB does not actively solicit donations or bequests, though it has done so in the past for specific purposes eg: landscaping the courtyards in the ‘new’ hospital. The DHB does, however, receive unsolicited donations of funds and occasionally bequests.

Many hospitals or DHBs have established charitable foundations or Trusts, as there are significant tax advantages to philanthropists in donating to a registered charity. In the Wairarapa, the Wairarapa Community Health Trust has increasingly taken on this role and it is proposed to formalise this relationship, rather than establish a new Trust.

Over recent years and notably last year, the Wairarapa Community Health Trust (WCHT) has given substantive support for DHB health services. There is scope for working more closely with the Trust to channel incoming philanthropy, given the advantage to donors and the ethical dilemma of whether it is appropriate for the DHB to actively solicit donations. Such a move needs to be underpinned by Board strategy and an operational MOU which is cognisant of the WCHT Trust Deed. Such an MOU would also provide guidance to DHB staff, alongside the Sponsorship, Gifts and Donations policy, regarding accessing financial support for DHB health services.


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DHB support for the WCHT could include information on our website, distribution of WCHT posters or leaflets on DHB sites, and ensuring media awareness of donations to the DHB.

Secondly, the DHB has developed a more consistent approach to how funds donated to the DHB, directly or through the Trust, are managed. It has been of benefit to make the principles of consistency, transparency and accountability more explicit.

3 POSITION STATEMENT

Wairarapa District Health Board position statement regarding donated funds.

Wairarapa DHB will ensure that philanthropy from the community to the DHB is appropriately recognized, receipted and disbursed.

They will work with the Wairarapa Community Health Trust to ensure donors are aware of the advantages of channeling larger donations through this charitable Trust.

All donations made to the DHB will be consistently and transparently managed and in accordance with the wishes of the donors.

4 CURRENT STATUS

Wairarapa DHB is holding Donated Funds totalling $274,331.78 as at 30th June 2016. These are made up of specific donated funds totalling $36,990.45 and General Donated Funds totalling $237,341.33.These funds are held in a separate bank account to that used for day to day DHB income and expenditure.

There are 24 Donated Funds accounts in total of which 17 are specifically ear marked for a service e.g. Palliative Care Fund, Acute Nurses Education Fund. The balances in the Specific funds range from $103.69 to $13,047.47. Most are being used by that service on a regular basis to pay for appropriate items such as Staff training, new equipment etc. The decision on the use of the Donated Funds is made by the relevant Cost centre Manager, and must be signed off by an Executive member in accordance with the Delegations Policy. Specific Donated funds totalled $36,990.45 at 30.6.2016.

The remaining Donated Funds are for general use to benefit Patients and Staff of Wairarapa DHB. These totalled $237,341.33 at 30th June 2016, the majority ($170,748.96) is from a Canadian bequest received in 2009. At the time of this bequest, the Board agreed the Fund would be kept intact and interest used for educational purposes.

In November 2015, the Board agreed to use $10,000 of this Fund as seed funding for the Simon Prior Scholarship to be administered by Masterton Trust Lands Trust.

Most of the Donated funds are on call apart from $150K of the Canadian Donated Fund which was recently moved to a one year Term Deposit to obtain higher interest.

Interest accumulates quarterly to the Donated accounts.

General Donated funds have been used mainly for the purchase of Clinical Capital equipment when this has been needed urgently and there is not sufficient CAPEX budget to cover it. The decision on what Donated Funds will be used for have been made jointly by the Director of Wairarapa Health Services (DWHS) and the Chief Financial Officer (CFO).


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A recent bequest for $70K was used to bring forward the purchase of 5 PACU monitors at a total costof $55K. These were budgeted to be purchased from the 2017 CAPEX budget but with the generous donation of the Cardiac Monitoring System by the Wairarapa Community Health Trust, it was decided to align the PACU monitors with that system as quickly as possible, to improve safety through consistency of equipment and take advantage of servicing contracts. This enabled us to start the 2017 financial year with a bigger contingency budget to cover the cost of essential equipment that breaks down and needs to be replaced urgently.

Recent actions: Management has formalised the DHB’s procedure for receiving Donated Funds and developed a transparent mechanism for access to funds held for General purposes to benefit the patients and staff of Wairarapa DHB.

The Donated Funds Administration Team was established in May 2016. The group has developed draft TOR and principles. It will consider applications for use of the Donated funds and recommend the most appropriate use, for final approval by the CFO.

It is made up as follows: ∑ DWHS (Chair)∑ One Doctor∑ One Nurse∑ One Allied Health professional∑ One Admin Team Member∑ Integration Manager for primary/community perspective∑ HR Manager∑ Financial Accounting Manager to provide information regarding Donated Funds, CAPEX

requests pending and to administer the recommendations of the group.∑ Secretarial support

Requests for use of the General Donated Funds will be made via either the DWHS or the Financial Accounting Manager.

5 WAIRARAPA COMMUNITY HEALTH TRUST

An excellent relationship has been developed between the Wairarapa Community Health Trust and the DHB. The CE or Director Wairarapa Health Services are regularly invited to attend WCHT meetings to discuss areas where the WCHT could best support the health of our population.

In preparation for those meetings the DHB’s CAPEX plan is reviewed, and items of the highest priority that have a good match to the principles of the WCHT’s purpose are presented for their consideration. Items can also include off-plan equipment for which there is an urgent need due to service change or development, unexpected breakdown or new initiative.

In addition, projects which have a direct impact on the health of our community, but which may require support beyond the capacity of the DHB may be presented for consideration.

6 NEXT STEPS

Management will review the success of the DFAT once it has been in place for 12 months.

Management will work with WCHT to develop an MOU, with the Board’s position statement underpinning this.


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BOARD INFORMATION PAPER

Date: 30th June 2016

Author Tom Gibson, Chief Medical Officer

Endorsed By Adri Isbister, CE

Subject Orthopaedic Transfers from First Specialist Appointment (FSA) to Waitlist.

RECOMMENDATION

It is recommended that the Board:NOTES the attached report

APPENDIX:

PURPOSETo provide information as requested by the Board about the numbers of patients seen by orthopaedic surgeons who are subsequently transferred to the waitlist.

REPORTReport to the Wairarapa Board Regarding Orthopaedic Referral Rates from Clinic to Waitlist for Operation.

INTRODUCTION

At the Board meeting in June, a discussion was held regarding the orthopaedic scoring system for access to waiting list. As a result of that discussion information was requested about the number of patients seen in clinic who were placed on the waitlist compared to the numbers who were not.

Within this data, it is pointed out that the number who were not placed on the waitlist consisted of those whose condition may be amenable to surgery but was not of sufficient severity (using the scoring tool), and also those for whom, following clinical assessment, surgery was not an appropriate course of action.

RESULTS

A 6 month review from December to June was conducted by outpatient staff to analyse patients not placed on the waitlist. This information is listed below.

∑ Total number of potential TKJR’s that were declined due to not meeting the score was seven with their scores ranging from 51-79.

∑ Total number of potential THJR’s that were declined due to not meeting the score was zero.

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∑ Total number of potential TKJR’s that went into Active Review was six with their scores ranging from 78-87.

∑ Total number of potential THJR’s that went into Active Review was two with their scores ranging from 83-88.

∑ Total number of TKJR’s that went on to the waiting list for surgery was 19 with their scores ranging from 85-100.

∑ Total number of THJR’s that went on to the waiting list for surgery was 19 with their scores ranging from 85-100.

∑ Total number of revision TKJR’s that went on to the waiting list for surgery was three with their scores ranging from 90-100

∑ Total number of revision THJR’s that went on to the waiting list for surgery was three with their scores ranging from 93-100.

∑ In November 2015 the score to get on the waiting list was raised to 90 due to capacity issues (too many patients on the waiting list) from what is understood. In April 2016 the score was then reduced to 85 (again due to capacity issues, but in reverse order) with Mr Denholm reviewing all patients booking forms that don’t reach the score of 85. If Mr Denholm feels that these patients require surgery, then he gives them a clinical override to 85 to get them on the waiting list. This hopefully will explain to you the reason why some of the Active Review patients have scores higher than 85.

FSA TO WAITLIST CONVERSION

Table 1 shows the percentage of patient transferred from FSA to waitlist since 2012. Table 2 provides the total number of patients transferred to waitlist by month since July 2012.

Table 1 Orthopaedic FSA to Wait ListConversion

All Clinicians2012/13 48%2013/14 48%2014/15 40%2015/16 40%


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Table 2

MonthInpatient Referrals to waitlist

Jul-12 16

Aug-12 37

Sep-12 32

Oct-12 31

Nov-12 53

Dec-12 33

Jan-13 28

Feb-13 28

Mar-13 32

Apr-13 37

May-13 27

Jun-13 55

Jul-13 43

Aug-13 30

Sep-13 24

Oct-13 41

Nov-13 33

Dec-13 25

Jan-14 31

Feb-14 33

Mar-14 25

Apr-14 29

May-14 44

Jun-14 34

Jul-14 33

Aug-14 16

Sep-14 18

Oct-14 25

Nov-14 24

Dec-14 20

Jan-15 32

Feb-15 43

Mar-15 31

Apr-15 43

May-15 45

Jun-15 42

Jul-15 41

Aug-15 40

Sep-15 22

Oct-15 30

Nov-15 26

Dec-15 33

Jan-16 19

Feb-16 11Mar-16 28Apr-16 18


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Fig1

I would like to acknowledge the help provided by the administrative staff in outpatients.

The review of surgical electives has been commenced since the last board meeting. It is apparent that the elective procedures performed at Wairarapa are significantly in excess of the procedures the service is funded for. It has been decided to review elective levels against budget on a regular basis, and this may have an impact on the scoring system cut off value in the future.

Tom Gibson CMO


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Date: 1 August 2016

Author Helene Carbonatto, Group Manager Service Development, SIDU

From Sandra Williams, Acting Director Service Integration and Development Unit

Endorsed By Adri Isbister, Chief Executive Wairarapa DHB

Subject Home and Community Support Services (HCSS) Lessons learnt

RECOMMENDATION

It is recommended that the Board

a. Note the Information paper on lessons learnt from the HVDHB and CCDHB Home and Community Support Services (HCSS) recent tender process.

ADDENDUMS

1 PURPOSE OF THE PAPER

At the June 2016 Board meeting, the Board requested an information paper on the lessons learnt from the recent HCSS tender process in CCDHB and Hutt Valley DHB.

2. BACKGROUND

CCDHB and HVDHB embarked on a joint procurement process in August 2016 for home based support services. HCSS services provide personal care and household management services to people over the age of 65 years and those people with disabilities who fit funding stream criteria.

A tender process for a bulk funded restorative service across the two DHBs was undertaken in October-November 2015, resulting in proposals from six providers both nationally and internationally. As a result of an evaluation process, the two DHBs agreed to enter into an agreement with Access Home health across both DHBs from 1 September 2016.

Savings to both DHBs were realised in the process, as well as an improvement in service (particularly in the Hutt Valley) with a greater restorative approach for supporting clients. Due to the bulk funded nature of the agreement, the cost is also capped over the lifetime of the agreement. Resultant savings in the NASC service are also likely to be realised as the bulk funded arrangement allows the provider (rather than NASC) to develop the care plan for non complex clients.

3. LESSONS LEARNT

Due to the judicial review process which was instigated in CCDHB for the previous HCSS tender in 2011, the 2 DHBs had a lessons learnt framework to ensure this tender process was successful in achieving our outcomes. A range of processes occurred to ensure a successful outcome including:


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∑ A robust process of engagement with consumers, consumer advisory groups and clinicians was undertaken to strengthen the service specifications for these services ahead of the procurement process.

∑ Agreement was sought from these stakeholders as to the final shape of the services procured. Thefinal service, with its focus on a restorative model, is quite different to the model currently provided in the Hutt Valley in that clinical staff (nursing and allied health) are part of the development of the care plan which has a more restorative focus (instead of just providing cares).

∑ All data, volume and financial information spent on services over the last three years were shared as part of the tender document, so that prospective providers could see the size and value of the market

∑ The procurement process requested various market share scenarios from 100, 50% and 33% to allow a comparison of bids and whether a 100% market share would lead to economies of scale that could be returned to the DHB as savings

∑ The procurement document clearly articulated there would be an at risk component to the agreement of 1% - whereby payment of the final 1% would flow to the provider on meeting agreed performance targets.

∑ The tender document was clear that supporting the needs of the support worker workforce was critical, and scoring would consider guaranteed hours, compliance with vulnerable workers legislation and commitment to training of the workforce.

∑ The panel involved in evaluating the proposals included two consumer representatives, a GP, a secondary clinician as well as people with a range of commercial and service expertise. The evaluation of the pricing was undertaken separately by a different panel, with the inclusion of external financial experts.

∑ A probity advisor was involved throughout the process, and their report highlighted a robust procurement process was undertaken.

∑ We established a DHB led Steering Committee for the transition period (May-September 2016) that meets fortnightly to ensure that the implementation of the programme (which is complex and requires 1000s of clients and their records to be transferred to another provider ) as well as the complex tasks of shifting the employment of the support workers to the new provider.

∑ We have developed good relationships with the exiting providers (Enliven, Healthcare New Zealand) to ensure a smooth transition of clients and support workers occurs.

∑ We have continued to hold regular meetings with consumer advocacy groups to ensure they understand what is occurring, can feed questions in, and we can provide reassurance on the process. Regular communication to wider stakeholders has also occurred.

∑ An 0508 line has been set up over the period of transition to enable clients and staff to raise any concerns and have these answered. There have been few calls, and the calls mainly relate to clients wishing to keep their support workers (which in many cases this will occur as the support workers transition to the new provider).

We are pleased to note that implementation is well on track with minimal issues to date.


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Date: 10 August 2016

Author Justine Thorpe, Tihei Wairarapa Programme Director/Compass Health Wairarapa General Manager

Endorsed By Adri Isbister, CEO Wairarapa DHB

Martin Hefford, CEO Compass Health

Bob Francis, Chairperson Tihei Wairarapa Alliance Leadership Team

Subject Primary Care and Tihei Wairarapa Alliance update Quarterly Report

RECOMMENDATION

It is recommended that the Board

a. Note the update from Primary Care and the Tihei Wairarapa Alliance

1 PRIMARY CARE UPDATE

1.1 Primary Care Health Population Health Goals

Better help for smokers

to quit

More heart and diabetes

checks

Increased immunisation

(8 months)

Increased immunisation (24 months)

Cervical screening

Date of data 5/8/16 5/8/16 5/8/16 5/8/16 30/6/16

Maori 75% 84% 95% 95% 73%Pacific 78% 84% 100% 75% 67%High Needs 77% 87% 98% 91% 73%Total 78% 90% 97% 95% 80%

Dashboard Key: Target achieved Within 10% of target

More than 10% required to

achieve target

Better help for smokers to quitAs at 5 August 2016 the percentage of smokers that had received support to quit smoking in the last 12 months was 78%. The goal is to achieve 90% by 30 September 2016 and we are confident that we are on track to achieve this.

Compass Health is now regularly monitoring the quit rate and currently for the Wairarapa this sits at 9.7% which is up .3% from 3 months ago. Our population health goal is to achieve a quit rate of 12%.

More heart and diabetes checksAs at 5 August 2016 the percentage of eligible people that had received a heart check in the Wairarapa is 90% and 87% for the high needs population. The Compass Health Board made a policy decision in April approving the use of incentives to support achievement of these population health goals. The

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plan was to use this incentive programme to target the high needs population however this has not occurred to date due to the need to prioritise cervical screening and getting these processes in place prior to the Mana Wahine Service stopping. We plan to do this later in the year.

Increased immunisationAs at 5 August 2015, 97% of 8 month olds have been fully immunised and 98% of 24 month olds. It is pleasing to see that we have achieved the goal for Maori infants, of note is that the lower pacific rate reflects only one child not being immunised on time.

I am pleased to report that for the quarter ending 30 June 2016 the MoH have given an ‘O’ rating for outstanding achievement as we met the target and achieved 98% for Maori. The SIDU noted that it is rare to receive such a rating from the MoH.

Cervical ScreeningAs at 30 June 2016 cervical screening rates for the Wairarapa are 80% for total population and 73% for high needs. Since this time Compass Health has worked with three practices to implement a voucher incentive programme. For Whaiora this resulted in an increase to 85% achievement of their high needs population. The programme is currently underway at Masterton Medical and Greytown Medical Centres. We have also commenced discussions with the other four practices. Once we have this embedded in the practices we will move the focus to CVDRA for high needs populations focused on Maori 35-45 year olds.

1.2 Primary Care Access

For the quarter four the primary care aged standardised access rate 1.31 for the total population and the annual rate of 5.09 for high needs and 4.61 for non-high needs. This is a total of 214,000 consultations for the financial year. The graphs below show this by ethnicity and high needs highlighting that Maori and Pacific populations have a higher access rate.


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1.3 Population Health

Pacific Church Healthy Lifestyle ProgrammeDr Tony Becker as GP Leader supported by the 2DHB Pacific Health Team recently held a Pacific Men’s health forum. The forum was attended by approximately 40 people and included a range of age groups from youth to elderly.

The session was about health in general but focused in on men. Dr Becker focused on prevention: smoking, exercise, eating and drinking. It also focused on the fact that men do not access services earlier enough and explained that is why often they end up in hospital and the need to ensure they are well to provide for their families.

The underlying message was ‘we don’t want to see you in hospital unwell, we want you to come to your GP before you become unwell’. The forum was well received by the community.

Stanford Self-ManagementFollowing the successful training of 12 more Stanford Self-Management Course Facilitators, the first two programmes led by some of these facilitators have been completed, one in Carterton and one focused on high needs populations run by Whaiora staff who have been trained. We are currently recruiting participants for three more programmes that have been organised to commence in October 2016. Having trained more facilitators has significantly increased our capacity to run more programmes on a regular basis.

Smoke Free Outdoor DiningThe smokefree outdoor dining campaign came to an end with the eight local businesses who participated choosing to keep their outdoor dining areas smokefree. This is a great success and other businesses are now showing interest. The customer survey (703 respondents) has also provided direct feedback from the community that highlights 85% of people supportive of smokefree outdoor dining. This data will be used to support the continued discussions with District Councils on their local smokefree by-laws.

Healthy Skin ProtocolsTraining was held for Medical Practices. 2 day training sessions were facilitated by Tom Gorte of Massey University. Day one an overview (13 attended) with day two allowing completion of the online skin infections training (9 completed). A half day was held for community health workers on which 9 people attended. Five of the seven general practices had representatives at the training.


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1.4 Before School Check (B4SC)

Following the model of care change to transition the B4SC nurse assessment from Plunket to practice nurses 5 practice nurses have now been trained and a further PHO nurse. We now have seven primary care nurses able to undertake these assessments across the Wairarapa with a further two to be trained.

I am pleased to report that for the year ending 30 June 2016 the goal of 95% was achieved for total population and 98% for high needs population.

A meeting with the MoH was held with key stakeholders to discuss the plans to ensure systems and processes are embedded to achieve the ‘raising health kids’ health target (childhood obesity). This was a productive meeting and we are currently working on the development of a consistent family focused approach to this across the Wairarapa.

1.5 District Immunisation Facilitation

A key activity over the past quarter has continued to be the promotion of the influenza vaccine and winter wellness. The immunisation coordinator has presented at a range of Age Concern community meetings across the Wairarapa with the largest one having 60 participants.

In addition, a key focus has been on working with general practices and the community including schools to raise awareness about the measles outbreak in parts of NZ and the need for people who think they have not had the two doses of the MMR vaccine. The national focus is on the 10-29 year old group however in the Wairarapa we have extended this to those born after 1 January 1969 as they are also at risk. This year there has been 99 cases of measles in NZ, fortunately none of these have been in the Wairarapa which has not seen a measles case for over 10 years and we are keen to continue this trend with the extra cautionary measures being put in place.

1.6 Primary Mental Health

The ‘To Be Heard’ service, is a Compass Health service that is integrated into the general practices with most people receiving their initial assessment within their health care home environment. As at 30 June 2016, 1,045 people have been seen by the service, 30% being male and 70% being female.The service sees people of all ages including children and youth. The pacific population is under represented at 1.4% (2% population) and it is good to see that Maori make up for 26% (17% population) of the people seen. Waiting times have decreased from 21 days to 6 days over the 12 month period.

2,082 people were also given alcohol brief advice by their general practice team and this continues to increase.

1.7 Opioid Working Group

The opioid working group, a collaborative group of PHO and DHB staff was established last year as Wairarapa has the one of the highest prescribing rates of strong opioids in the country. In response all Wairarapa practices strengthened or implemented opioid prescribing policies and protocols. The data to date shows that this alongside awareness raising has resulted in a decline in the rate of dispensing over all in 2015. The group has also been looking at the reasons driving this and is planning further education for prescribers. We look forward to receiving the 2016 financial year data in September this year.


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1.8 Medication Return Campaign

From discussions within the opioid working group a desire to run a medication return campaign was raised as this has not been done in the Wairarapa for 10 years. The key theme of the campaign will be ‘Keep your home and family safe’. The campaign will occur during the month of September to align with spring cleaning, and will entail a range of radio and newspaper advertising as well as promotion through the practices, community pharmacy and community providers including mental health, Whaiora, Age Concern and schools. Following the campaign ongoing messaging for the community about medication safety will be developed.

1.9 Bowel Screening Pilot

We are pleased that Wairarapa is part of tranche 1 of the national rollout of the Bowel Screening Programme. How this will work on the ground is still being developed and costed and it has been positive to involve the PHO in the recruitment of the Programme Manager across the two DHBs.

1.10 Practice Management System (PMS) Review

The current PMS Medtech Global that the general practices currently use will not be supported in the future. It has therefore been necessary to undertake a review of future options for a PMS. Compass Health led a review process in collaboration with PHOs across the sub-region and mid-central. The process was extensive and involved a vast amount of input and feedback from general practices. As a result a new vendor has been identified as the preferred provider and we are currently undertaking further due diligence with this provider. All going well we plan to commence transition from 1 January 2017. Of note is that this will be a major project and transition for practices.

1.11 National Enrolment Service (NES)

Compass Health is currently in the process of supporting the general practices to transition to the new National Enrolment Service (NES). This service will enable monthly enrolment processing rather than quarterly which is positive. It is however in its early stages of implementation and has a significant impact on practices as they transition and still work through any ‘bugs’ in the system. Wairarapa has one practice registered for transition in tranche two which is scheduled for implementation on 12 September 2016.


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2 TIHEI WAIRARAPA ALLINACE UPDATE

The Tihei Wairarapa work programme was agreed and aligns with the three key areas of health care homes with the addition of a an enablers focus to support this. Below is a summary of the programme.

Below are key highlights of Tihei Wairarapa activity and future work planned.

2.1 Key Highlights

¸ The primary and community health service integration project is now well underway with regular MDT meetings at all four south practices involving district nurses. We are currently working through the processes for allied health to become members of the MDT. Feedback from the teams is that improved communication has significantly improved their ability to provide more holistic patient centric care.

¸ A soft launch of Health Navigator occurred during June.

¸ All seven general practice annual practice plans are signed off for implementation from 1 July 2016.

¸ Youth Kinex marked the first anniversary of Youth Kinex and celebrated with a shared afternoon tea at the Health Clinic. This coincided with Youth Week which was 21-29 May 2016.

¸ 200 Health Pathways have been localised and developed.

¸ The Maternal Mental Health pathways were launched in May and are available on the 3DHB HealthPathways site.

¸ LMC/General Practice integration as extended with 50% of Wairarapa LMCs now integrated or collocated with Masterton Medical or Carterton Medical.

¸ The Information Management Service Level Alliance agreed to widen access to the Shared Care Record to all hospital clinicians not just ED.

¸ Concerto access for Community Pharmacy and Wellington Free Ambulance was agreed by the Board subject to an agreed set of access/security protocols being finalised.

¸ We have seen a notable increase in the number of people registered to use patient portal in the Wairarapa from 1,402 to 2,084.

¸ The Acute Services Communication Programme was approved by the Alliance Leadership Team and the Acute Care Forum established.


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¸ A range of messaging around winter wellness have been developed and shared across the Wairarapa and we have implemented the traffic light system similar to other areas in NZ to help support people to know where to go when unwell or injured. They key message is for people to call their ‘GP First’.

¸ The ED patient survey was reviewed and changed to include a question to understand if the person tried to make contact with their GP and if not why not.

¸ The first meeting of the Wairarapa Community Radiology Oversight Committee was held in June 2016.

2.2 Key focus areas over the next quarter

∑ Development of a Wairarapa System Level Measures Plan.

∑ Establishment of a Respiratory Focus Group.

∑ Agreement on consistent patient resources and messaging covering respiratory conditions in children.

∑ Development of a draft Obesity Strategic Plan for Wairarapa.

∑ Establishment of an intersectorial provider group focused on reducing obesity in the Wairarapa.

∑ Develop a plan to implement the required infrastructure and service changes to achieve the Raising Healthy Children Health Target.

∑ Inclusion of Allied Health into the phase 1 of the Community and Primary Health Service Integration project at Carterton Medical Centre.

∑ Roll out MangeMyHealth request access and shared care planning to the South Wairarapa General Practices, District Nursing and Allied Health.

∑ Employment of a Locality Development Manager on a fixed term basis to drive the primary and community health service integration work.

∑ Extension of the ED Transfer of Care process to Whaiora.

∑ Attendance at up and coming cluster (school and sports) meetings to discuss acute communications programme and commence development of resources to support schools and sports coaches etc. to refer people to the right service/information the first time.

∑ Commence rollout of Shared Care Record across the hospital.

∑ Implementation of the Community Radiology Access Criteria.

∑ Further discussion on integrated urgent care services.

∑ Sub-regional Palliative Care Strategy.

∑ Advanced Care Planning training held locally in the Wairarapa.


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Hutt Valley and Wairarapa DHBs APRIL 2016

BOARD DISCUSSION PAPER

Date: 4 August 2016

Author Jason Kerehi, Director Māori Health

Endorsed By Adri Isbister, Chief Executive Officer, Wairarapa DHB

Subject Maori Health Directorate Monthly Report

RECOMMENDATION

It is recommended that the Boards:

a) NOTE the report and its recommendations

1. MĀORI HEALTH PLAN 16/17

The Maori Health Plan for 2016/17 has been approved by the Ministry of Health and has now been loaded onto our website.

http://www.wairarapa.dhb.org.nz/your-health/maori-and-pacific-health/waidhb-maori-health-plan-2016-17-final.pdf

2. EXECUTIVE SPONSOR – VIOLENCE INTERVENTION PROGRAMME

The Violence Intervention Programme (VIP) has recently undergone a review and we will see a new configuration of roles here at Wairarapa District Health Board. The service has recently been under the Director of Operations – Surgical Women’s and Child Health but under the new structure will part of the Wairarapa Social Work Team [Allied Health]. I have been appointed as Executive Sponsor for this service and will be reporting on VIP matters to the Board.

The Ministry has recently reviewed the service and has provided new guidelines for the service which we intend to follow here [see Family Violence Assessment and Intervention Guideline – Child abuse and intimate partner violence 2016].

Family violence remains a critical issue here in the Wairarapa and Maori are significantly overrepresented both as victims and as perpetrators. Not only does family violence result in physical and emotional harm but the Ministry’s research shows that it is a contributing factor to obesity, self-harm and other health issues. The research also suggests that a continued focus on family violence will lead to a significant reduction in costs across the health system.

3. EXECUTIVE SPONSOR – PALLIATIVE CARE –END OF LIFE RESPONSE – MSW

Jill Stringer and I met recently with Suzie Adamson from Hospice Trust. Hospice Trust are keen to explore how we could provide a better environment for patients who are nearing their end of life on the hospital site.

Where possible, patients who are dying are supported to do so in their home, but there are some for whom the hospital is their choice or only choice. Given our occupancy rates, it is not possible to designate one let alone two of the eight single rooms in MSW solely for end of life care. However, we


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Hutt Valley and Wairarapa DHBs APRIL 2016

agreed to establish a joint working group to explore short, medium and long term options for creating a more hospice-philosophy centred plan of care, including changes to the inpatient environment

The working group will include Michelle Halford – Director of Nursing, Susan Reeves – CNM Medical Surgical Ward and Wendy Turton – Clinical Lead for Wairarapa Hospice. I will act as Executive Sponsor and report progress of this initiative back up to the Board

4. TU KAHA 2016

Tu Kaha is a bi-annual conference highlighting best practice initiatives across Māori providers and DHB’s. Tu Kaha is a joint collaboration between all six DHB’s in the Central Region. The Board, Te Iwi Kainga and ELT members are encouraged to attend this year’s conference which is being held at Silverstream Retreat from 21-23 September 2016.

You can register online at www.regonline.com/tukaha2016

See flyer attached


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Wairarapa DHBMāori Health Plan2016 / 17


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TABLE OF CONTENTS

TABLE OF CONTENTS..................................................................................................................................2

INTRODUCTION..........................................................................................................................................5

Structure of this plan .............................................................................................................................5

Iwi Kainga Priorities ...............................................................................................................................5

Population priorities ..........................................................................................................................6

Priority disease focus .........................................................................................................................6

Access.................................................................................................................................................6

Quality................................................................................................................................................6

Social Determinants ...........................................................................................................................7

Prevention..........................................................................................................................................7

Abbreviations.............................................................................................................................................8

HEALTH NEEDS ASSESSMENT.....................................................................................................................9

Population..............................................................................................................................................9

Population Growth.................................................................................................................................9

Deprivation ..........................................................................................................................................10

HEALTH SERVICE PROVISIONS .................................................................................................................10

Public Health Services (RPH)................................................................................................................10

Hospital Based Services .......................................................................................................................10

Community Based Services..................................................................................................................11

Primary Health Organisation ...............................................................................................................11

Health Status............................................................................................................................................11

Wairarapa population..........................................................................................................................11

Whānau ora – Healthy families............................................................................................................11

Wai ora – Healthy environments.........................................................................................................11

Education .........................................................................................................................................11

Work.................................................................................................................................................11

Income and standard of living .........................................................................................................12

Housing ............................................................................................................................................12

Area deprivation ..............................................................................................................................12

Mauri ora – Healthy individuals...........................................................................................................12

Pepi, tamariki – Infants and children ...............................................................................................12

Rangatahi – Young adults ....................................................................................................................13


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Pakeke – Adults....................................................................................................................................13

Circulatory system diseases.............................................................................................................13

Diabetes ...........................................................................................................................................13

Cancer ..............................................................................................................................................13

Respiratory disease..........................................................................................................................14

Mental disorders..............................................................................................................................14

Gout .................................................................................................................................................14

All ages .................................................................................................................................................14

Hospitalisations................................................................................................................................14

Mortality ..........................................................................................................................................15

Amenable Mortality .........................................................................................................................15

Injuries .............................................................................................................................................16

ASH: 0–4 and 45–64 years ...............................................................................................................16

Māori children (0-4 years)................................................................................................................16

Māori adults (45-64 years)...............................................................................................................17

NATIONAL INDICATORS ...........................................................................................................................19

Indicator 1: Ethnicity Data Quality.......................................................................................................19

Accuracy of ethnicity reporting in PHO registers.............................................................................19

Indicator 2: Access to Care...................................................................................................................20

Percentage of Māori enrolled in PHOs ............................................................................................20

Ambulatory sensitive hospitalisation rates per 100,000 for the age groups of 0–4 and 45–64 years.................................................................................................................................................20

Indicator 3: Child Health – Tamariki ....................................................................................................22

Breastfeeding...................................................................................................................................22

Indicator 4: Cancer Screening ..............................................................................................................24

Cervical screening: percentage of women (Statistics NZ Census projection adjusted for prevalence of hysterectomies) aged 25–69 years who have had a cervical screening event in the past 36 months. ............................................................................................................................................24

Breast screening: 70 percent of eligible women, aged 50 to 69 will have a BSA mammogram every two years..........................................................................................................................................25

Indicator 5: Smoking ............................................................................................................................26

Smoking cessation: Percentage of pregnant Māori women who are smoke-free at two weeks postnatal. .........................................................................................................................................26

Indicator 6: Immunisation....................................................................................................................26

Percentage of infants fully immunised by eight months of age (ht) ...............................................26


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Seasonal influenza immunisation rates in the eligible population (65 years and over)..................27

Indicator 7: Rheumatic fever ...............................................................................................................28

Number and rate of first episode rheumatic fever hospitalisations for the total population ........28

Indicator 8: Oral health........................................................................................................................29

Percentage of pre-school children enrolled in the community oral health service (preschool enrolments, PP13a)..........................................................................................................................29

Indicator 9: Mental health ...................................................................................................................30

Mental Health (Compulsory Assessment and Treatment) Act 1992: section 29 community treatment order. Reduce the rate of Māori on the mental health Act: section 29 community treatment orders relative to other ethnicities. ...............................................................................30

OTHER KEY INDICATORS ..........................................................................................................................31

Did Not Attend.....................................................................................................................................31

Respiratory...........................................................................................................................................31

Cardiovascular disease.........................................................................................................................31

Percentage of the eligible population who have had their CVD risk assessed within the past five years.................................................................................................................................................31

LOCAL PRIORITIES ....................................................................................................................................32

Population Priorities ............................................................................................................................32

Priority Disease Focus ..........................................................................................................................33

Access...................................................................................................................................................33

Quality..................................................................................................................................................34

Social Determinants.............................................................................................................................34

Prevention............................................................................................................................................35


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INTRODUCTION

The Wairarapa District Health Board is committed to improving Māori health outcomes alongside our iwi partners Rangitāne o Wairarapa and Kahungunu ki Wairarapa. Te Oranga o Te Iwi Kainga (Iwi Kainga) is the Māori Relationship Board appointed by both iwi that engages directly with the DHB Board to ensure that our health initiatives are having the best gain for Māori across the Wairarapa health spectrum.

Wairarapa Māori feature amongst the worst statistically for health outcomes in Aotearoa. This is captured in the Health Needs Assessment for Wairarapa Māori and Te Ara Whakawaiora,which is a tool that tracks the key health indicators for Māori across all 20 DHB’s.

Iwi Kainga has also identified priority areas, again based on the available data but also from what they see in and know about their communities and providers. Iwi have also said that we should focus not just on the diseases but also on the determinants/conditions that lead to the prevalence of disease and inequities e.g. poor housing, lack of employment/suitable income, underachievement in education, and cultural deficiency across the health workforce.

The purpose of this Māori Health Plan is to identify the priority areas for the DHB, Primary Health and NGO’s to focus their efforts to reduce Māori Health inequities. The plan sits alongside the WDHB District Annual Plan with a clear focus on Māori Health actions

This plan is required by the Ministry of Health through the Operational Policy Framework and provides a framework for measuring a range of initiatives aimed at reducing inequalities and improving Māori health gain.

Structure of this planThe 16/17 Māori Health Plan will have a slightly different structure than previous editions. As always we begin with the Health Needs Assessment. The 2013 census data is still our relevant data set. The remainder of the assessment is taking directly from the Wairarapa District Health Board – Māori Health Profile 2015 report.

The next two sections are the National Indicators which are required by the Ministry of Health followed by ‘Other Key Indicators’ which are in addition to the national requirements.

The final section is labelled Local Priorities which traditionally identify what we want to do here in the Wairarapa over and above the national indicator actions. This year we will follow the approach led by Iwi Kainga to focus on addressing the contributing factors to inequities in Māori health. So this section will mirror those priorities and where appropriate, identify actions that meet some of these goals.

Iwi Kainga Priorities

In January 2016 - Iwi Kainga (the Māori Relationship Board to the Wairarapa District Health Board) developed their strategic priorities for Māori Health. This is reflective of how iwi see their communities and the issues that they are dealing with but also recognises the health data for our community. Iwi Kainga has challenged WDHB to address the contributing factors to inequity alongside achieving better health outcomes for Māori.

Iwi Kainga understands that many of these priorities are captured within this Māori Health Plan and the District Annual Plan and they will advocate for those initiatives where appropriate.


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However, there may be areas and initiatives that sit outside the plan where iwi may demand further attention.

The Vision for Iwi Kainga is Wairarapa Mauri Ora – Vibrant, strong and confident whānau.

Population prioritiesThe three key population groups identified by Iwi Kainga were tamariki (children), rangatahi (youth) and tane (men). Wherever an initiative appears in the Māori Health Plan or the District Annual Plan that relates to any of these groups, iwi will take a strong interest and advocate for better health outcomes.

Clearly, tamariki and rangatahi health is critical to iwi as Māori have proportionately greater population growth than non-Māori. The health of Tane has been highlighted because iwi are not seeing as many initiatives to improve health outcomes for our Māori men; therefore Iwi Kainga want to see this emerge as a priority for the District Health Board.

Priority disease focusIwi Kainga identified four priority diseases. These are:

∑ Mental Health and AOD,∑ Smoking,∑ Obesity; and∑ Oral Health

These four areas are captured within the National Indicators for the Māori Health Plan and the Local Priorities and also in the District Annual Plan.

Iwi Kainga has expressed concern with the increasing numbers of whānau presenting with mental illness and addiction issues. Alcohol and drug issues remain prevalent in our communities and the impact on whānau remains a real issue.

Smoking rates amongst our Māori whānau remain high. Recent data suggests that smoking for Māori aged 15-24 in Masterton (particularly the East Side) and Featherston are amongst the highest in the country.

Obesity is seen as an increasing issue amongst our whānau especially in our tamariki. This issue has also been signalled by the Ministry in the New Zealand Health Strategy review 2015.

Finally, oral health is an important issue for iwi/Māori. The DHB has several strategies working with tamariki but Māori oral health issues span across all ages.

AccessIwi Kainga have determined that access issues that need addressing include:

∑ Health Literacy / Cultural Competency / Self Determination,∑ Whānau care outside of our region; and∑ Sooner, Better, More convenient services including opening hours of service.

QualityThe quality of services have direct impact on outcomes for whānau: Iwi Kainga has determined that quality includes:

∑ Workforce Development including mentoring, study time, active recruiting, cultural competent workforce; and

∑ Māori Provider development including equitable funding.


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Social DeterminantsWHO defines the social determinants of health are “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” The unequal distribution of the social determinants of health is an important driver of health inequities. Iwi Kainga seeks to address these determinants particularly:

∑ Affordable, dry and secure housing,∑ Air and water quality; and∑ Regional employment.

PreventionPreventing the onset of the disease needs greater focus with more concerted effort that has direct impact on whānau Māori. The prevention of diseases such as lung cancer, diabetes and oral disease can be addressed by;

∑ Reducing the uptake of smoking,∑ Increasing physical activity and supporting healthy eating; and∑ Good oral health care and fluoridation∑ Child Protection and Family Safety

The local priorities actions will only be constrained by our limited resources both budget wise and people availability.

Jason KerehiDirector Māori HealthWairarapa District Health Board


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Abbreviations3DHB 3 District Health Board HHS Hospital & Health Services

ABC An approach to smoking cessation requiring health staff to: ask, give brief advice, and facilitate cessation support.

HVDHB Hutt Valley District Health Board

ALT Alliance Leadership Team IHD Ischaemic heart disease

AOD Alcohol and Other Drugs IMAC Immunisation Advisory Centre

AP Annual Plan LMC Lead Maternity Carer

ASH Ambulatory sensitive hospitalisation

MHAIDS Mental Health, Addictions and Intellectual Disability Directorate

BFHI Baby friendly hospital initiative MOH Ministry of Health

BSA Breast Screen Aotearoa MMWL Māori Women’s Welfare League

BSC Breast Screen Central NCSP National Cervical Screening Programme

CAMHS Child & Adolescent Mental Health Service

NGO Non-Government Organisation

CCDHB Capital & Coast District Health Board

NIR National Immunisation Register

COPD Chronic obstructive pulmonary disease

NRT Nicotine Replacement Therapy

CPHAC Community & Primary Health Advisory Committee

NSU National Screening Unit

CVD Cardiovascular disease NZQA New Zealand Qualifications Authority

CVDRA Cardiovascular risk assessment OIS Outreach Immunisation Service

DAP District Annual Plan OSA Obstructive Sleep Apnoea

DCIP Diabetes Care Improvement Programme

PHO Primary Health Organisation

DHB District Health Board RFPP Rheumatic Fever Prevention Programme

DIF District Immunisation Facilitator RPH Regional Public Health

dmft diseased, missing, or filled teeth RSS Regional Screening Services

DNA Did Not Attend SIDU Service Integration & Development Unit

DNR Did Not Respond VTC Vaccinator Training Course

ED Emergency Department WCTO Well Child Tamariki Ora

ENT Ear, Nose and Throat WDHBWairDHB


GP General Practice WOHS Wairarapa Oral Health Service


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HEALTH NEEDS ASSESSMENT

This section provides a summarised analysis of population and health condition data. Where possible the data has been aligned to the national Māori Health Plan indicators and areas identified as local priorities.

The following analysis has been sourced from the Draft Sub Regional Health Needs Assessment and the Draft 2015/16 Annual Plan. Data for the Māori Population pyramids has been sourced from Statistics New Zealand.

PopulationWairarapa DHB has a population of 41,109 people. It includes the territorial authorities of Masterton District, Carterton District and South Wairarapa District.

The age distribution in Wairarapa DHB is noted for a smaller population of young working adults compared to the other two DHBs. Around 20% of the population is less than 15 years, and nearly a further 20% are over the age of 65 years.

Eighty-one percent of the Wairarapa DHB is of the Other ethnicity, with a large proportion being aged 50-70 years, reflecting an older population.

Māori make up 16% of the population, and Pacific people and Asian groups make up a very small percentage.

Amongst Māori, a large proportion (35%) is children, and a further 40% are of working age.

The predominant ethnic group as the population ages is the Other ethnic group, with 22% of this population being over 65 years in age.

The largest proportion of Māori live in Masterton District (18%)

Wairarapa population by age and gender, 2013

Population GrowthIn Wairarapa DHB:

The Māori population is expected to increase by about 1.4 % per year. Annual growth rate is highest in the over 65s, and particularly the over 85s although overall numbers remain small.

Wairarapa average annual growth rates by ethnicity, 2013-2033


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The small ‘Pacific’ people population in the Wairarapa is expected to increase about 2.2% per year, but in total is estimated to be only about 1300 people by 2033.

The small ‘Asian’ population in the Wairarapa is expected to grow slightly faster than the Pacific people’spopulation, at about 3% per year. By 2033 it is estimated there will be slightly more Asian than Pacific people in the Wairarapa.

The overall ‘Other’ population is expected to decrease slightly overall (at annual rate of 0.2%) and in all age groups under 65. The population from 65-84 is expected to continue to grow at about 2.5% per year and the very old population by 3.9% per year.

DeprivationThe NZDep2013 index of deprivation reflects eight dimensions of material and social deprivation. These dimensions reflect lacks of income, employment, communication, transport, support, qualifications, owned home and living space.

The most deprived areas are concentrated in central Masterton, and Featherston.

Wairarapa population distribution across deprivation deciles, 2013

HEALTH SERVICE PROVISIONS

Public Health Services (RPH)RPH is a sub-regional public health service, serving the populations of Wairarapa, Hutt Valley, and Capital & Coast DHBs. The services include health prevention, health promotion, preventive interventions, health assessment and surveillance, and public health capacity development. Because many of the strongest influences on health and wellbeing come from outside the health sector, RPH provides services that are coordinated with other sectors such as social, housing, education, and local government sectors, as well as coordinating with other health sector providers.

Hospital Based ServicesWairarapa DHB provides secondary services via its Hospital and Health Services (HHS) provider arm which is located in Masterton.


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Community Based ServicesWairarapa DHB has service agreements with a range of providers for the delivery of primary health services, well child services, oral health services, Māori and Pacific health services; community mental health services, community pharmacy and laboratory services.

Primary Health OrganisationCompass Primary Health Care Network provide PHO services in the Wairarapa district.

Health Status

Wairarapa population• In 2013, 7,010 Māori lived in the Wairarapa District Health Board region, 17% of the

District’s total population. Twenty-nine percent of the District’s children aged 0–14 years and 28% of the District’s youth aged 15–24 years were Māori.

• The Wairarapa Māori population is youthful, but showing signs of ageing. The median age in 2013 was 24 years. The number of Māori aged 65 years and over will increase by 38% between 2013 and 2020.

Whānau ora – Healthy families• Te Kupenga data (NZ Census) is presented for Wairarapa and Hutt DHBs combined. In

2013, most Wairarapa and Hutt Māori adults (80%) reported that their whānau was doing well, but 7% felt their whānau was doing badly. A small proportion (7%) found it hard to access whānau support in times of need, but most found it easy (76%).

• Being involved in Māori culture was important to the majority of Māori adults (76%) and spirituality was important to 66%.

• Practically all Wairarapa and Hutt Māori (98%) had been to a marae at some time. Most (68%) had been to their ancestral marae, with 76% stating they would like to go more often.

• Eleven percent had taken part in traditional healing or massage in the last 12 months.• One in six Wairarapa and Hutt Māori (17%) could have a conversation about a lot of

everyday things in te reo Māori in 2013.

Wai ora – Healthy environments

Education

• In 2013, 96% of Wairarapa Māori children starting school had participated in early childhood education.

• In 2013, 45% of Māori adults aged 18 years and over had at least a Level 2 Certificate, a higher proportion than in 2006 (37%). The proportion of non-Māori with this level of qualification in 2013 was 63%.

Work

• In 2013, 11% of Māori adults aged 15 years and over were unemployed, compared to 6% of non-Māori.

• Most Wairarapa Māori adults (90%) do voluntary work.• In 2013, Māori were 87% more likely than non-Māori to look after a household member

who was disabled or ill, and 44% more likely to care for someone outside of the home, without pay.


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Income and standard of living

• In 2013, just over one in three children and adults in Māori households (defined as households with at least one Māori resident) were in households with low equalisedhousehold incomes (under $15,172), compared to just under one in five children and one in six adults in other households in the Wairarapa District.

• In 2013 16% of Wairarapa and Hutt Māori adults reported putting up with feeling the cold a lot to keep costs down during the previous 12 months, 7% had gone without fresh fruit and vegetables, and 16% had postponed or put off a visit to the doctor.

• In 2013, 9% of residents of Māori households in Wairarapa DHB had no motor vehicle compared to 4% of residents in other households.

• Residents of Wairarapa Māori households were less likely to have access to telecommunications than those living in other households: 32% had no internet, 26% no telephone, 13% no mobile phone, and 3% had no access to any telecommunications.

Housing

• The most common housing problems reported to be a big problem by Wairarapa and Hutt Māori adults in 2013 were finding it hard to keep warm (23%), needing repairs (17%), and damp (16%).

• Just over half of children in Wairarapa Māori households were living in rented accommodation, almost twice the proportion of children in other households.

• Wairarapa residents living in Māori households were three times as likely as others to be in crowded homes (i.e. requiring at least one additional bedroom) (14% compared to 5%).

Area deprivation

• Using the NZDep2013 index of small area deprivation, 65% of Wairarapa Māori lived in the four most deprived decile areas compared to 44% of non-Māori. Conversely 8% of Māori lived in the two least deprived deciles compared to 17% of non-Māori.

Mauri ora – Healthy individuals

Pepi, tamariki – Infants and children

• On average, 186 Māori infants were born per year during 2009–2013, 53% of all live births in Wairarapa DHB. Six percent of Māori and 5% of non-Māori babies had low birth weight.

• In 2013, 67% of Māori babies in Wairarapa were fully breastfed at 6 weeks.• Nine in ten Māori infants were enrolled with a Primary Health Organisation by three

months of age.• In 2014, 94% of Māori children were fully immunised at 8 months of age, and 97% at 24

months.• In 2013 half of Wairarapa Māori children aged 5 years and a quarter of non-Māori children

had caries. At Year 8 of school, three in five Māori children and two in five non-Māori children had caries. Māori children under 15 years were 65% more likely than non-Māori to be hospitalised for tooth and gum disease.

• During 2011–2013, on average there were 17 hospital admissions per year for grommet insertions among Māori children (at a rate 79% higher than non-Māori) and 10 admissions per year for serious skin infections (with the rate 2.4 times that of non-Māori children).

• On average, 142 hospitalisations per year of Māori children were potentially avoidable through population-based health promotion and intersectoral actions, at a rate 52% higher than that of non-Māori.


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• Just over 100 hospitalisations per year of Māori children were potentially avoidable through preventive or treatment intervention in primary care (ambulatory care sensitive hospitalisations, or ASH), with a rate 54% higher than for non-Māori children.

Rangatahi – Young adults• There has been a significant decrease in the proportion of Wairarapa Māori aged 15–17

years who smoke regularly, but no change in smoking rates among Māori aged 20–24 years. In 2013 48% in this age group were smoking cigarettes daily, compared to 27% of non-Māori.

• By September 2014, 57% of Māori girls aged 17 years and 77% of those aged 14 years had received all three doses of the human papilloma virus (HPV) vaccine. Māori aged 16 years had the highest coverage at 93%.

• Among Māori aged 15–24 years there was an average of nine hospitalisations per year for serious injury from self-harm during 2011–2013.

Pakeke – Adults• Just under half of Māori adults in Wairarapa and Hutt DHBs reported having excellent or

very good health in 2013, and just over a third reported having good health. One in six (17%) reported having fair or poor health.

• Smoking rates are decreasing, but remained twice as high for Māori (38%) as for non-Māori (19%) in 2013.

Circulatory system diseases

• Māori adults aged 25 years and over were 49% more likely than non-Māori to be hospitalised for circulatory system diseases (including heart disease and stroke) during 2011–2013, with 73 admissions per year.

• Wairarapa Māori were 57% more likely than non-Māori to be admitted with acute coronary syndrome, 48% more likely to have angiography, and just as likely to have angioplasty or a coronary artery bypass and graft.

• Heart failure admission rates were 3 times as high for Māori as for non-Māori.• Stroke admission rates were similar for Māori and non-Māori, with seven Māori admitted

per year.• On average, one Māori per year was admitted to hospital with chronic rheumatic heart

disease.• Māori under 75 years were 3 times as likely as non-Māori to die from circulatory system

diseases during 2007–2011, with an average of six Māori deaths per year.

Diabetes

• In 2013, 4% of Māori and 5% of non-Māori were estimated to have diabetes. Half of Māori aged 25 years and over who had diabetes were regularly receiving metformin or insulin, four-fifths were having their blood sugar monitored regularly, and two-thirds were being screened regularly for renal disease.

• In 2011–2013 Māori with diabetes were over 4 times as likely as non-Māori to have a lower limb amputated (with one person per year having an amputation).

Cancer

• Compared to non-Māori, cancer incidence was two-thirds higher for Māori females while cancer mortality was just over twice as high.


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• Breast, lung, genital organs, and colorectal cancers were the most commonly registered cancers among Wairarapa Māori women in 2008–2012. The rate of lung cancer was fourfold the non-Māori rate, and cancers of the genital organs were 2.5 times the rate for non-Māori women.

• Breast screening coverage of Māori women aged 45–69 years was 66% compared to 69% of non-Māori women during the two years to December 2014.

• Cervical screening coverage of Māori women aged 25–69 years was 69% over 3 years and 86% over five years (compared to 76% and 90% of non-Māori respectively).

• Cancers of the digestive organs and of the breast were the most common causes of cancer death for Māori women in 2007–2011. Māori mortality rates for these cancers were 3 times the non-Māori rates.

• Among Wairarapa males, overall cancer incidence was 49% higher for Māori than for non-Māori, while the cancer mortality rate was similar.

• Colorectal, lung, and prostate cancers were the most frequent cancers among Wairarapa Māori males. The colorectal cancer rate was 2.5 times the rate for non-Māori men, and lung cancer was 3 times the non-Māori rate.

• Cancers of the digestive organs and of the lung were the most common causes of death from cancer among Māori males.

Respiratory disease

• Māori aged 45 years and over were 2.7 times as likely as non-Māori to be admitted to hospital for chronic obstructive pulmonary disease (COPD) during 2007–2011.

• Asthma hospitalisation rates were more than twice as high for Māori as for non-Māori in each age group, particularly for males. Among Māori aged 35–64 years the rate was notably 10.5 times the non-Māori rate.

• Māori under 75 years of age had 10 times the non-Māori rate of death from respiratory disease in 2007–2011.

Mental disorders

• Māori were 63% more likely than non-Māori to be admitted to hospital for a mental disorder during 2011–2013. Schizophrenia related disorders were the most common disorders, followed by substance use disorders. The rate of admission for schizophrenia disorders was 4.2 times the non-Māori rate.

Gout

• In 2011 the prevalence of gout among Wairarapa Māori was estimated to be 6%, higher than the prevalence among non-Māori (4%).

• Thirty-nine percent of Māori with gout regularly received allopurinol, a preventive therapy to lower urate levels. Of those who received allopurinol, only 25% had a lab test for serum urate levels in the following six months. Forty-eight percent of Māori with gout were using non-steroidal anti-inflammatory medication.

• In 2011–2013 the rate of hospitalisations for gout was 3.6 times as high for Māori as for non-Māori, indicating a higher rate of flare-ups.

All ages

Hospitalisations

• The all-cause rate of hospital admissions was 21% higher for Māori than for non-Māori during 2011–2013.


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• On average, 418 Māori hospital admissions per year were potentially avoidable, with the rate 40% higher for Māori than for non-Māori. The ASH rate was 62% higher.

Mortality

• In 2012–2014, life expectancy at birth for Māori in the greater Wellington Region was 78.6 years for females (5.3 years lower than for non-Māori females) and 74.7 years for males (5.6 years lower than for non-Māori).

• The all-cause mortality rate for Wairarapa Māori in 2008–2012 was 87% higher than the rate for non-Māori.

• Leading causes of death for Māori females during 2004–2011 were COPD, diabetes, ischaemic heart disease (IHD), stroke, and lung cancer.

• Leading causes of death for Māori males were IHD, diabetes, accidents, COPD, and lung cancer.

• Potentially avoidable mortality and mortality amenable to health care were over twice as high for Māori as for non-Māori in Wairarapa during 2007–2011.

Amenable MortalityAmenable mortality is defined as premature deaths from those conditions for which variation in mortality rates reflects variation in the coverage and quality of health care. From an equity perspective it is possible to use the amenable mortality construct to ask what contribution to social inequality in health is currently being made by inequality in access to and quality of health care. Premature deaths have been defined as deaths under 75 years of age. The conditions included in amenable mortality fall within six categories: infections, maternal and infant conditions, injuries, cancers, cardiovascular disease and diabetes, other chronic diseases.

Amenable mortality rates in the Wairarapa DHB area decreased by 30% between 2000-02 and 2009-11. Amenable mortality for Māori in Wairarapa has declined by 44% alongside a 32% decline in the amendable morality for Other. However, there remains a significant disparity between the Māori and Other populations. The amenable mortality rate for Māori females (123.65) was significantly lower than males (175.92). There has been a 55% decrease in the amendable mortality rate for Māori males between 2000-02 and 2009-11 and a 34% decrease for Māori women. Amenable mortality declined by 37% and 26% for Other males and females, respectively, over the same period.

Wairarapa DHB amenable mortality by ethnicity, 0-74 years (HNA, 2015)

0

50

100

150

200

250

300

2000-02 2005-07 2009-11

Age-

stan

dard

ised

rate

r per

100

,000

Māori Other


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Injuries

• The rate of hospitalisation due to injury was 25% higher for Māori than for non-Māori during 2011–2013.

• The most common causes of injury resulting in hospitalisations among Māori were falls, exposure to mechanical forces, complications of medical and surgical care, transport accidents, and assault.

• Māori rates of hospital admission for injury caused by assault were almost treble those of non-Māori.

• Injury mortality was similar for Māori and non-Māori in Wairarapa DHB, with four Māori per year dying from injuries during 2007–2011.

ASH: 0–4 and 45–64 years[0-74 years no longer reported]For Wairarapa DHB, ASH rates for children 0-4 years of age are higher than the national ASH rates for children. Although historically higher, ASH rates for adults 45-64 years of age are currently lower than the national ASH rate for adults. Over the last five years, ASH rates for children in Wairarapa DHB have increased by 14% compared to a national increase in ASH rates of 3%. For Wairarapa DHB, the ASH rate for adults has increased by 16% compared to five years previous, whereas the national ASH rate for adults increased by 3% over the same period.

There are disparities in the ASH rate for Māori children and adults in Wairarapa DHB, compared to Other children and adults. Māori children are significantly more likely to be admitted for an ASH condition than Other children. For the year ending September 2015, there was a 58% difference between the ASH rates for Māori children and Other children. Māori adults are also significantly more likely to be admitted for an ASH condition compared to Other adults. Over time, there has been some reduction in the disparity between the Māori population and Other population in Wairarapa DHB.

For Wairarapa DHB, some ASH conditions are of particular concern for Māori children and Māori adults:

Māori children (0-4 years)1. Upper respiratory & ENT infections

In the year up to September 2015, upper respiratory and ENT infections were the leading cause of ASH admissions amongst Māori children. In 2014-2015, 21 Māori children were admitted with upper respiratory and ENT infections. Over a five year period from September 2011 to September 2015, 14 Māori children are, on average, admitted each year. In the last five years there has been a 91% increase in ASH admissions for these conditions amongst Māori children, compared to a 56% increase amongst Other children. There has also been a 133% increase in ASH admissions for this condition for Māori children from the lowest count in 2013 to 2015, compared to 34% for Other children.

2. Asthma

In the year up to September 2015, five Māori children were admitted for asthma. These admissions accounted for 20% of ASH admissions amongst Māori children. Over a five year period from September 2011 to 2015, 11 Māori children are, on average, admitted each year for asthma compared to 12 Other children. There has been a 350% increase in ASH admissions for asthma for Māori children from September 2011 to 2015. However, asthma admissions for Māori children also decreased by 74% between September 2012 and 2014, and significantly increased by 260% in 2015 from


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2014. For Other children, there has been a 32% decrease in ASH admissions for asthma.

3. Cellulitis

For Wairarapa DHB area, cellulitis was the third leading ASH condition amongst Māori children for the year up to September 2015. In 2015, 14 Māori children were admitted for this condition. Over the five year period ending September 2015, seven Māori children are, on average, admitted each year for cellulitis. For Māori children, ASH admissions for cellulitis increased by 40% between September 2011 and 2015, compared to a 250% increase for Other children. Although, the count of cellulitis admissions for Other children were 2 and 7 for these years. There was, however, a 250% increase in cellulitis admissions for Māori children between 2014 and 2015.

Māori adults (45-64 years)1. Angina & chest pain

In the year up to September 2015, angina and chest pain was the leading ASH condition resulting in admission for Māori adults. Eighteen Māori adults were admitted for angina and chest pain for the year 2014-2015, which equates to 26% of ASH conditions. On average, 19 adults are admitted each year for angina and chest pain. In the last five years, ASH admissions for angina and chest pains amongst Māori adultsincreased by 13%. ASH admissions for angina and chest pain amongst Other adults also increased by 13% over the same period. However, ASH conditions have also observed a significant decrease of 33% from a peak of 27 admissions in the year ending September 2013.

2. Respiratory infections - COPD

COPD was the second leading cause of ASH admissions amongst Māori adults. In the year ending September 2015, ten Māori adults were admitted for COPD accounting for 14% of Māori adult ASH admissions. On average, ten Māori adults are admitted annually for COPD with a variance of ± 2 admissions each year. ASH admissions for COPD amongst Māori adults has decreased by 9% over a five year period for the years ending Septemeber 2011 to 2015. ASH admissions for Other adults decreased by 19% over the same period.

3. Cellulitis

Cellulitis was the third leading ASH condition leading to admission in the year ending September 2015 for Māori adults. Nine Māori adults were admitted for cellulitis, accounting for 16% of total ASH admissions. Nine Māori adults are, on average, admitted for cellulitis each year. Over a five year period from September 2011 to September 2015, cellulitis admissions increased by 50% for Māori adults, however this is only a nominal increase of 3 admissions in the Wairarapa. In comparison, Other adults’ admissions for cellulitis increased by 40% over the same period; this was a nominal increase of 6 admissions.


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Top 5 ASH diagnoses for Māori 0-4 years, 12 months to September 2015

Rank Wairarapa

1Upper respiratory & ENT infections

24%

2 Asthma 20%

3 Cellulitis 16%

4 Dental conditions 15%

5 Asthma – wheeze 8%

Wairarapa ASH rates by ethnicity, 0-4 years(SOURCE)

0

2,000

4,000

6,000

8,000

10,000

12,000

12 months to endSep 2011





ASH

rat

e pe

r 10

0,00

0 do

mic

ile p

opul

atio

n

Wairarapa DHB, ASH 0-4 yrs

Wairarapa Other Wairarapa Maori Wairarapa Total National Total

ASH rates for children 0-4 years of age in Wairarapa demonstrate a marked variation to national trends. In the last five years, there has been a 14% increase in total ASH admissions for the Wairarapa, compared to a 3% increase in National ASH admissions. The ASH rate for Other children in Wairarapa has increased by 7% over the same period. ASH admissions for Māori children have, however, increased by 23% in the last five years. The ASH rate for Māori children has increased by 57% from the year ending September 2013 to September 2015. This follows a 34% decrease between years ending September 2012 and September 2013.

Top 5 ASH diagnoses for Māori 45-64 years, 12 months to September 2015

Rank Wairarapa

1 Angina & chest pain 26%

2Respiratory infections –COPD

14%

3 Cellulitis 13%

4 Diabetes 10%

5 Congestive heart failure 9%

Wairarapa ASH rates by ethnicity, 45-64 years

(SOURCE)

0

1,000

2,000

3,000

4,000

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8,000

9,000

10,000






ASH

rat

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Wairarapa DHB, ASH 45-64 yrs

Wairarapa Other Wairarapa Maori Wairarapa Total National Total

ASH rates for adults 45-64 years of age in Wairarapa follow similar trends to ASH rates for adults nationally. However, over the last five years the ASH rate for all adults in Wairarapa has increased by 16%. ASH rates for Other adults in Wairarapa are currently slightly below the national rate, although ASH rates for Other adults follow a similar trend to the ASH rate for all adults and have increased by 17% in the last five years. Māori ASH rates are, however, higher in comparison to other adults. While Māori ASH rates have increased by 3% over a five year period, Māori adult ASH admissions have decreased by 27% in 2015 from September 2012 to 3,776 for the year ending September 2015. This decrease represents a 27% decrease in ASH admission for Māori adults from 2012 to 2015 and a 20% decrease between 2014 and 2015.


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NATIONAL INDICATORS

Indicator 1: Ethnicity Data Quality

Accuracy of ethnicity reporting in PHO registers

Outcome Sought Greater accuracy of ethnicity data in PHO enrolment databases.

Measures At the time of patient enrolment / re-enrolment, General Practice administration requires patients to confirm / re-confirm their ethnicity. Any anomalies are investigated to ensure accurate ethnicity recording.

Notes It is important to note that where there are commonalities of work programmes between CCDHB, HVDHB and WairDHB; one programme of work will be developed and agreed as a combined 3DHB approach.

Current Status

EthnicityCurrent Baseline Target

Variance to Target

Māori 100% 100.0% 0.0%

Other 100% 100.0% 0.0%

Planned Actions Owner Timeframe

Support hospital projects, programmes and services to improve quality of ethnicity data collection

DHB Q1-4

Review ethnicity data collection protocols in selected services and ensure ethnicity reporting by provider arm service area and included in the quarterly Māori Health Indicators reporting framework.

DHB Q1-4

PHO to work with General Practices to undertake self audits to ensure the ethnicity is recorded accurately, and as per protocol, on:

Enrolment; and, Reconfirmation

This work will include increasing General Practices understanding of the necessity to record accurate ethnicity data to identify and address the inequalities and health needs of Māori.

Report at the end of Q1 an update on DHB activity in Data Quality

Monitor and report PHO Enrolment indicator performance by ethnicity including improvement in accuracy and enrolment gaps on a quarterly basis to:

Iwi Kainga Māori Relationship Board CPHAC (Equity report)

DHB Q1-4


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Indicator 2: Access to Care

Percentage of Māori enrolled in PHOs

Outcome Sought Increased access for the Māori population to primary health care services.

Measures 100% of Māori in WairDHB will be enrolled with a PHO.

Current Status


Variance to Target

Māori 95.0% 100.0% -5.0%

Other 99.0% 100.0% -1.0%


Work with PHOs and NIR to identify children not enrolled with a PHO.

DHBPHONIR

Q1-2

PHOs to work with NIR, General Practice, WCTO and other community health providers to locate and encourage PHO enrolment.

PHONIR

Q3-4

Continue to deliver the 3DHB triple newborn enrolment programme

All Q1-2

Work with Tihei Wairarapa Leadership and Whānau Ora Providers in the Wairarapa to identify and enrol whānau

All Q1-4

Track PHO enrolment, by Ethnicity, Age Band and Gender, on a quarterly basis

DHB/PHO Q1-4

Monitor and report indicator performance by ethnicity on a quarterly basis to:


DHB Q1-4

Ambulatory sensitive hospitalisation rates per 100,000 for the age groups of 0–4 and 45–64 years.

Outcome Sought

ASH accounts for nearly a fifth of acute and arranged hospital admissions. However, determining the reasons for high or low ASH rates is complex, as it is in part a whole-of-system measure.

This indicator can also highlight variation between different population groups that will assist with DHB planning to reduce disparities.

Wairarapa DHB is very close to the national level of ASH rates however a gap still exists. ASH rates for 0-4 years will be a priority


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Measures Reduce ASH rates for Wairarapa Māori equal to the national average.

Current Status

Ethnicity

Current BaselineNon-standardised ASH Rate Target

Māori rate relative to National Total rate as at March 2016

0-4 Other 6,050

≤8,218Māori 9,647 42.1%Pacific n/aTotal 7,211

Ethnicity

Current BaselineStandardised ASH Rate Target

Māori rate relative to National Total rate as at March 2016

45-64 Other 2,970

≤4311Māori 5,061 42.2%Pacific n/aTotal 3,210


Hold Whānau Education workshops with a focus on Māori children, 0-4 years, in the areas of:

Respiratory; and, Skin Conditions

PHOProvider

Q1-4

Deliver a Whānau resource pack focused on: Respiratory; and, Skin Conditions

PHOProvider

Q1-4

Collaboratively develop and implement initiatives to support improved Māori health with a range of organisations including, yet not limited to:

- PHO- Māori Community Providers- Māori Women’s Welfare League

PHOProvider

Q1-4

PHO to provide General Practices with patient analysis focused on:

- Risk of hospitalisation- CVDRA- Influenza immunisation- Smoking cessation- Cervical Screening- Diabetes

This work will be undertaken to identify unmet need, develop and implement appropriate interventions.

PHO Q1-4

Trained PHO staff will promote Stanford Self-Management tools to support patients with multiple Long Term Conditions.

PHO Q3-4

PHO to support Stanford Self Management Facilitators from Whaiora to implement self management programmes focused on Māori and high needs patients with long term conditions.

PHO Q4


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DHB to work with Primary Care and WCTO providers to use the ‘Lift the Lip’ protocol at each scheduled WCTO visit and each GP/Nurse appointment (as appropriate). Appropriate referrals will be made as required for enrolment or specialist work.

PHODHB

Q1-4

DiabetesAssess services against the 20 Diabetes quality standards

Develop a service improvement plan to address gaps.This work will reference the Atlas of Healthcare Variation, the 20 quality standards and the Quality Standards for Diabetes Care Toolkit 2014.

DHB

DHB

Q1-2

Q3

Implement revised annual practice plans and monitor quality indicators at a practice level

DHB Q1-4

Wairarapa DHB will report and update on each planned activity in the ASH section of this Māori Health Plan, by ethnicity at the end of each Quarter. The report will include performance against any contractual measures highlighting Māori participation and service utilisation.

This will be reported to the Iwi Kainga Māori Relationship Boardquarterly.

DHB Q1


PHO Board Tihei Wairarapa/Alliance Leadership Team Iwi Kainga Māori Relationship Board CPHAC (Equity report)

DHB/PHO Q1-4

Indicator 3: Child Health – Tamariki

Breastfeeding∑ Exclusive or fully breastfed at LMC discharge (4-6 weeks)∑ Exclusive or fully breastfed at 3 months ∑ Receiving breast-milk at 6 months

Outcome Sought Breast milk is considered the most complete food for babies and it gives children a healthy start in life. The lack of breastfeeding is implicated in childhood obesity, the onset of Type II Diabetes later in life, and many other negative health outcomes.

Research also shows that children who are exclusively breastfed in the early months are less likely to suffer adverse effects from common childhood illnesses like gastroenteritis, otitis media and respiratory tract infections.

Measures 75% Exclusive or fully breastfed at LMC discharge (4-6 weeks)60% Exclusive or fully breastfed at 3 months 65% Receiving breast-milk at 6 months


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Current Status Breastfeeding: Exclusive or Fully breastfed at LMC discharge


Variance to Target

Māori 59% 75% -16%

Pacific 71% 75% -4%

Total 66% 75% -9%

Breastfeeding: Exclusive or Fully breastfed at 3 months


Variance to Target

Māori 49% 60% -11%

Pacific n/a 60%

Total 57% 60% -3%

Breastfeeding: Exclusive, Fully or Partially breastfed at 6 months


Variance to Target

Māori 49% 65% -16%

Pacific n/a 65%

Total 63% 65% -2%Data for this indicator has been sourced from the Indicators for the Well Child/Tamariki Ora Quality Improvement Framework 1.


Universal ActivitiesWairarapa DHB will continue to fund and support ‘Well Child -Tamariki Ora’ (WCTO) providers to deliver the Well Child schedule with a particular focus on improving Māori breastfeeding rates. Each WCTO provider is directly aligned to a PHO. They will support PHOs to implement initiatives aimed at promoting and raising the awareness of breastfeeding.

DHB Q1-4

Maintain BFHI accreditation. DHB Q2

Targeted ActivitiesWork with Maternity Governance Groups to ensure the inclusion of breastfeeding support within the maternity sector and the continuum to primary care as an important clinical focus

All Q1-4

Implement a local community forum to support the provision of breast feeding education:

- In group; - In home; and,- Discuss and identify key areas to improve Māori

breastfeeding rates.

PHO Q1-4

Encourage and support Māori to undertake Peer Counselling training (Breastfeeding) and run two courses in 16/17

DHBPHORPH

Q1-4

Monitoring

Monitor and report indicator performance by ethnicity of Well Child/Tamariki Ora provider data and Plunket data (where

DHB Q1-4

1 http://www.health.govt.nz/publication/indicators-well-child-tamariki-ora-quality-improvement-framework-september-2015


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available) on a quarterly basis to:

Iwi Kainga Māori Relationship Board

CPHAC (Equity report)

Indicator 4: Cancer Screening

Cervical screening: percentage of women (Statistics NZ Census projection adjusted for prevalence of hysterectomies) aged 25–69 years who have had a cervical screening event in the past 36 months.

Outcome Sought Lower cervical cancer morbidity and mortality among Māori women through better utilisation of the national cervical screening programme for women aged 25-69 years

Measures Cervical screening rates for Māori women will have reached the national target of 80%.

Current Status NCSP coverage (%) in the three years ending February 2016 by ethnicity, women aged 25–69 years


Variance to Target

Māori 68.3% 80% -11.7%

Total 74.5% 80% -5.5%

Planned Actions Timeframe

Engage with primary care through the Regional Screening Coordination Group to identify women who currently don’t get screened. Target promotion of screening services to these women.

RSS Q1-2

Provide free cervical smear vouchers to practices to screen priority group women, in particular Maori.

PHO Q1-4

Assist practices to establish systems that will enable them to reach the targeted population and to establish an efficient and robust recall system.

RSS Q1-4

Continue to support Primary Care in identifying Māori clients through an evolving data-matching process between the PHO register and the NCSP register with the aim to decreasing the number of women who are unscreened or under screened (not screened in the last 5 years). Provide dedicated resources to follow up with women and audit and update patient records as required. A minimum of four practices per annum.

This work will be linked to Indicator 1: Accuracy of Ethnicity Reporting

RSSPHO

Q1-4

HVDHB will support collaborative working relationships between providers to actively engage and support hard to reach Māori women through the cervical screening pathway including colposcopy.

Two WDHB NCSP and Colposcopy Clinic meetings per year.

Monitor colposcopy DNA’s , share learning and support

DHBRSS

Q1-4


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initiatives aimed at reducing DNA’s 1x meeting per annum with five specialist Colposcopy

Clinics in greater Wellington Region offering support if required

Support Primary Care and other relevant providers through providing:

- Annual colposcopy training- Two (2) education evenings

RSS Q1-4

Q4Six monthly

Monitor and report indicator performance by ethnicity on a quarterly basis to the Iwi Kainga Māori Relationship Board

DHB Q1-4

Breast screening: 70 percent of eligible women, aged 50 to 69 will have a BSA mammogram every two years.

Outcome Sought Lower breast cancer morbidity and mortality among Māori women through better utilisation of the national breast screening programme for women aged 50-69 years.

Measures Screening rates for Māori women (50-69 years) will have reached the national target of 70%.

Current Status BSA coverage (%) in the two years ending 31 March 2016 by ethnicity, women aged 50–69 years [NB: this data as at Dec 2015]


Variance to Target

Māori 72.5% 70% +2.5%

Total 78.7% 70% +8.7%


Engage PHO’s to data match General Practices (GP’s) with high numbers of priority women in WDHB

RSSPHO

Q2-3

Identify and target BSA eligible women not enrolled or overdue for breast screening

RSSPHO

Q2-3

Promote and support the breast screening mobile unit visits as per the BSC mobile schedule.

DHB Q1-4

Wairarapa DHB will support collaborative working relationships between providers across the breast screening network:

Attend Regional Coordination Group meetings as required.

Work with Outreach Services, Regional Screening Services and Primary Care to ensure smooth referral processes for BSA priority women.

DHBRSS

Q1-4



DHB Q1-4


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Indicator 5: Smoking

Smoking cessation: Percentage of pregnant Māori women who are smoke-free at two weeks postnatal.

Outcome Sought The percentage of Māori women who were pregnant and were offered smoking cessation advice and support and who are smoke-free at two weeks postnatal will increase over 2015/16 as a result of our efforts.

Measures 95% of pregnant Māori women who are smoke-free at two weeks postnatal.

Current Status Baseline to be determined


Continue to offer ABC and NRT Competency training to Health professionals with a particular focus on LMCs

DHB Ongoing

Deliver ABC and provide NRT options to pregnant Māori women at

First contact registration 2 weeks post-partum Each of the first two Well Child core contacts

PHODHB

Ongoing

Provide bulk access to Nicotine Replacement Therapy (NRT) for health service providers offering cessation services to Māori and Pacific communities within the greater Wellington Region, where at least three providers are accessing the bulk supply of Nicotine Replacement Therapy (NRT) through RPH

DHB Ongoing

Monitor Smokefree status of pregnant Māori women and, where relevant, provide cessation advice at each antenatal appointment: General Practice and Specialist Appointments

PHO Ongoing

Monitor and report by ethnicity smoking cessation advice provision performance and smokefree rates at two weeks postnatal on a quarterly basis to the Iwi Kainga Māori Relationship Board

DHB Quarterly

Indicator 6: Immunisation

Percentage of infants fully immunised by eight months of age (ht)

Outcome Sought Reduced immunisation-preventable morbidity and mortality.

Measures 95% of infants fully immunised by eight months of age

Current Status


Variance to Target

Māori 95%

Other 95%


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Sub-Regional ActionMaintain an immunisation alliance steering group that includes all the relevant stakeholders for the DHB’s immunisation services including the Public Health Unit; that identifies service delivery gaps, participates in regional and national forums and takes the lead on monitoring and evaluating immunisation coverage at DHB, PHO and practice level.

DHB Q1-4

Identify immunisation status of children presenting at hospital and refer for immunisation if not up to date.

DHB Q1-4

Local ActionContinue with the 3DHB newborn triple enrolment programme DHB

PHOQ1-4

Datamart reports are reviewed monthly and overdue reports fortnightly with OIS receiving referrals when required.

NIRPHO

Q1-4

Concerto database to be checked each day for inpatients and also checks NIR to see if there are any children due or overdue for immunisation and action as requited.

NIRPHO

Q1-4

IMAC sessions will continue to be held annually for Nurses and Midwives, in addition the DIF goes to Wellington to present at VTC sessions. Additional educational sessions on immunisations will be held if required.

DHB Q1-4

Monitor immunisation performance on a monthly basis within SIDU

DHBPHO

Q1-4



DHB Q1-4

Seasonal influenza immunisation rates in the eligible population (65 years and over)

Outcome Sought Reduced influenza morbidity through increased seasonal influenza vaccination rates in the eligible population (65 years and over).

Measures 75% of the eligible population (65 years and over) completed Seasonal influenza immunisation.

Current Status


Variance to Target

Māori 66.0% 75% -9%

Other 67.0% 75% -8%


HHS, PHO and NGO services to undertake a minimum of two promotional activities to encourage the uptake of influenza immunisation for 65+ with a particular focus on elderly Māori.

HHSPHO NGO

Q1Q3


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Promote Kaumatua / Kuia wellness with a focus on Influenza Immunisation. Promote to Wairarapa Kaumātua Council

This work will link with the General Practice flu campaigns

DHBPHO

Q1-2 & 4



DHB Q1-4

Indicator 7: Rheumatic fever

Number and rate of first episode rheumatic fever hospitalisations for the total population

Outcome Sought In 2014 a sub-regional rheumatic fever plan was developed. The aim is to reduce the incidence of Rheumatic Fever in the region through a programme of work focussed on prevention, treatment and follow-up of rheumatic fever. The plan is part of the Government’s Rheumatic Fever Prevention Programme (RFPP) which is working to improve outcomes for vulnerable children and achieve the goal of reducing the incidence of rheumatic fever in New Zealand by two thirds to a rate of 1.4 cases per 100,000 people by June 2017.

Wairarapa DHB, along with our sub-regional DHBs partners, are committed to achieving our DHB-specific rheumatic fever targets by delivering the actions outlined in our prevention plan. The governance of this plan will continue to be provided by the sub-regional RFPP Steering Group, who will oversee the implementation of the updated plan.

The refreshed Rheumatic Fever Prevention Plan can be accessed at http://www.ccdhb.org.nz/initiatives/FINAL%20Refreshed%20Sub-regional%20RFPP%20-%2027%20November%202015%20Updated%20Section%203.pdf

Measures First episode rheumatic fever hospitalisation rate two-thirds below baseline (3 year average rate 2009/10-2011/12)

Current Status Rates at baseline and target rates for rheumatic fever hospitalisations (cases/100,000 population) for Wairarapa DHB

DHB2009/10-2011/12

2016/17

Wairarapa

Baseline year (3 year average rate)0.0

Target

0.0


1. To prevent the transmission of Group A Streptococcal throat infections in the Wairarapa, Hutt Valley and Capital & Coast DHB region, through:- The implementation of a pathway across the sub-region to

identify and refer high risk children to comprehensive

DHBPHORPH

Q4


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housing, health assessment and referrals services- The development of the Housing and Health Capability

Building Programme throughout 2016/17 and implementation of insulation referral process for high-risk patients

- Raising community awareness throughout 2016/17

2. Actions to treat Group A Streptococcal infections quickly and effectively. This will be achieved through:- The provision of training and information for primary care

providers, throughout 2015/16 and on-going. - Development and implementation of an audit tool for the

treatment of sore throats in primary care

DHBPHO

Q4

3. Actions to facilitate effective follow-up of identified rheumatic fever cases. This will be achieved through:- The tracking of the timeliness of antibiotics through the

rheumatic fever register with annual audit and stakeholder meetings

- Appropriate mechanisms for annual training of hospital medical staff to be explored and implemented

- The implementation of an audit process to follow up on all cases of rheumatic fever (root cause analysis process undertaken) by Regional Public Health.

- The development and implementation of a clinical pathway from diagnosis through to the end of bicillin course

DHBPHO

Q4

4. In 2016/17 there will be increased focus on consistent communication messages to the public and health professionals, education of health professionals in primary and secondary care and antibiotic adherence.

DHB Q1-Q4

5. RPH will continue to strengthen the sub-regional healthy housing coordination service and interventions programmes to improve housing and health for our most vulnerable communities. This will reduce functional and structural overcrowding, and improve in home warmth and dryness

RPH Q1-Q4

Indicator 8: Oral health

Percentage of pre-school children enrolled in the community oral health service (preschool enrolments, PP13a).

Outcome Sought Improved oral health outcomes for Māori children.

Measures Percentage of Māori pre-school children enrolled in the community oral health service

Target 95% of Māori pre-school children enrolled in the community oral health service


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Current Status


Variance to Target

Māori 81% 95% -14%Other 83% 95% -12%


Continue with the DHB enrolment programme (Oral Health) DHB Q1-4

Improving oral health in our tamariki∑ Run regular “Baby Talk” sessions with all babies/pepi

aged six-weeks and their whānau ∑ See every pre-schooler (from birth) annually with a focus

on low-decile, high-deprivation communities∑ Hub and mobile planning based on high-need

Wairarapa Oral Health Service (WOHS)

Q1-4

Deliver oral health education and support to health professionals and ECE providers to ensure consistent, high-quality and wide-reaching advice around oral health care

WOHS Q1-4

Work with and support the Waha Pai, Waha Ora (Māori Oral Health project) based at Te Hauora Runanga o Wairarapa

Te HauoraAll

Q1-4

Monitor and report indicator performance: Monthly reporting on key indicators [Internally DHB] Annual data to Iwi Kainga Māori Relationship Board Annual data to CPHAC

DHBSIDU

Q 3

Indicator 9: Mental health

Mental Health (Compulsory Assessment and Treatment) Act 1992: section 29 community treatment order. Reduce the rate of Māori on the mental health Act: section 29 community treatment orders relative to other ethnicities.

Outcome Sought Appropriate rates of use of Section 29 of the Mental Health Act (community treatment order).

Measures No targets set for 2016/17

Current Status As at March 2016

Ethnicity Current Baseline2

Māori 284

Non-Māori 76


Support the targeting of Primary Mental Health Services to Māoricommunities, especially Māori young people 10-24 years

PHOsDHB

Develop and implement packages of care for Māori Mental Health with a focus on community early interventions, including Rongoa Māori

PHODHB

Q2-4

2 Rate per 100,000


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Analyse the degree of variance in use of Section 29 within the DHB by reviewing the rationale for its use

DHB Q2

Report findings of analyses to practitioners and a clinically-led multidisciplinary mental health forum.

DHB Q2

Monitor guidelines and regular auditing processes to support standardised application of Section 29

DHB Q2-4

Develop short and long term recovery plans (Client and Clinician based) for Extension and Indefinite clients, under the Mental Health Act, to support Māori to receive non-compulsory treatment.

DHB Q1-4

Monitor and report indicator performance by ethnicity on a quarterly basis to Iwi Kainga Māori Relationship Board

DHB Q1-4

OTHER KEY INDICATORS

Did Not AttendOutcome Sought Decrease in DNA rates for Māori via increased attendance to Hospital

appointments


Ensure literacy and system review for OPD letters and reminders is completed

DHB Q1-2

Develop media campaign for Wairarapa DHB DNA DHB Q1-2

RespiratoryOutcome Sought Reduced admissions / re-admissions for respiratory conditions


Develop and implement a ‘Follow Out to Community’ referral process specifically targeted at Paediatric Respiratory

DHB Q1-2

Three respiratory pathways will be completed and implemented;COPD, Cough, Pneumonia and OSA, with additional pathways will be prioritised by the ALT

DHB Q1-4

Improving and embedding pathways for primary care access to specialist nurse and/or doctor advice, by progressing the Sub-regional alignment of respiratory pathways

DHB Q1-4

Cardiovascular disease

Percentage of the eligible population who have had their CVD risk assessed within the past five years

Outcome Sought Reduced cardiovascular disease mortality and morbidity through cardiovascular risk assessment (CVDRA) and appropriate management.


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Measures 90% of the eligible population will have had their cardiovascular risk assessed in the last five years.

Current Status


Variance to Target

Māori 84.1% 90.0% -5.9%

Other 92.1% 90.0% +2.1%


Ensure the expertise, training and tools needed are available to successfully complete the CVD risk assessment and management to meet clinical guidelines

PHO Q1-4

Ensure that IT systems that have patient prompts, decision support and audit tools exist, are used and fully report performance.

PHO Q1-4

Work with Māori Women’s Welfare League to identify and locate at risk men to undertake CVRA

DHBPHO

Q1-4

Support Health Promotion Agency in its work on CVD awareness and publicity campaigns

PHODHB

Q1-4

PHO will continue current approach which includes: - Provision of patient dashboard to all practices - Provision of weekly lists of patients requiring checks - Unblended Peer group comparison reports - Quarterly site visits and review of performance with each

practice - Financial incentives for performance - Patient information campaign - Provision of technical assistance

PHO Q1-4

PHO to provide subsidy for Māori, Pacific and High Needs patients to receive free CVDRA

PHO Q1-4

PHO to fund a CVD Risk Assessment programme specifically targeted at increasing the number of Māori men aged 35-44 years

PHO Q2-3



DHB Q1-4

LOCAL PRIORITIESThis section will mirror the priorities identified by Iwi Kainga and include actions agreed to by the Wairarapa DHB and Te Oranga o Te Iwi Kainga.

Population PrioritiesOutcome Sought Identify actions that focus on the three key populations identified by

Iwi Kainga. They being: tamariki (children), rangatahi (youth) and tane (men).


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Focus on health for tamariki (children)- Reduced immunisation-preventable morbidity and

mortality (Indicator 6)- Improved oral health outcomes (Indicator 8)

DHB Q1-4

Focus on health for rangatahi (youth)- Ensure all rangatahi have access to health services- Taonga Takoro programme to be run with rangatahi

through Whaiora

PHO

Whaiora

Q1-4

Focus on health for tane (men)- Māori NGO provider programme to focus on Māori Men’s

health- Whaiora to run wellness sessions for Māori men- Whaiora to lead men’s focus groups on diabetes- WaiWaiA (Te Hauora and Whaiora to run hunting/fishing

programme for Tane and Tama

PHOWhaioraTe Hauora

Q2-4

Priority Disease FocusOutcome Sought Iwi Kainga identified four priority diseases. These are:

Mental Health and AOD; smoking, obesity andoral health. Improved health outcomes for Wairarapa Māori


Mental Health – reduction in the number of Section 29 referrals -refer to National Indicator 9 and Māori Mental Health in (Other Key Priorities) Earlier presentation of Māori to Mental Health Services

DHBMHAIDS

Q1-4

AOD – refer to Māori Mental Health in (Other Key Priorities) TBC DHBMHAIDS

Smoking – 95% of pregnant Māori women are smoke free at two weeks post-natal – refer to National Indicator 5

DHB Q1-4

Obesity – By December 2017, 95% of obese children identified in the B4SC programme will be referred to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions - refer to Obesity provisions in DAP and Whānau Ora section

DHB Q1-4

Oral Health – Increase in the number of children aged 5 caries free - refer to National Indicator 8

DHBWOHS

Q1-4

AccessOutcome Sought Improved access to services for Māori


Health Literacy - work with Outpatients Department (OPD) to review

appointment letters and reminders

DHB Q1-2


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Cultural Competency- work with three Provider Arm service units to implement

the Wairarapa District Health Board Tikanga Best Practice model

DHB Q1-3

Self-determination – See 2020 Project below

Improved whānau care outside of region- identify appropriate accommodation options and key

contacts in HVDHB, CCDHB and MCDHB

DHB Q 4

Sooner, Better, More convenient services including opening hours of service

- provide cultural input into the review of Acute Services

DHB Q1-3

QualityOutcome Sought Improved quality of service


Workforce Development initiatives- active recruiting to increase % Māori workforce (+1%)- ensure a culturally competent workforce (targeted training

across the health workforce)

DHBPHO

Q1-4

Māori Provider Development- full allocation of MPDS funding in 16/17

DHB Q 3

Social DeterminantsOutcome Sought Improved wellness of whānau through an intersectoral approach to

wellbeing


Focus on whānau with the most need:2020 Project

- Work with the PHO and other stakeholders to identify the whānau with the greatest health and social needs and highest chance for change and implement a longer-term intersectoral approach to improve wellness

- Provisionally called the 2020 project where we focus on 20 whānau over the next four years

- Develop a Multi-Disciplinary Team across sectors to work alongside these whānau

- Follow the principles of whānau ora including whānau determining their pathway to wellness

DHBPHO

Q1-4

The DHB will take a lead role in driving Wairarapa intersectoral discussions around reducing inequities for high-need populations including Māori

DHB Q1-4


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PreventionOutcome Sought Prevention of disease through a targeted campaign aimed at

reducing Māori


Reduce the uptake of smoking – promotion amongst whānau, hapu, iwi

DHBPHOWhaiora

Q1-4

Increasing physical activity and supporting healthy eating DHB Q3-4

Good oral healthcare and promoting fluoridationSupport the Waha Ora Waha Pai Initiative

DHBTe Hauora

Q1-4

Child protection and family safety TBC


94

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PUBLIC



Date: 10 August 16

Authors Marty De Boer, Programme Manager, Planning & Accountability, SIDU

Wayne Skipage, GM – Strategy, Planning and Intelligence, SIDU

From Sandra Williams, Acting Director, SIDU

Endorsed By Adri Isbister, Chief Executive, Wairarapa DHB

Subject Proposed Approach to 2017/18 Annual Planning

RECOMMENDATION

It is recommended that the Boards

a. Note the proposed processes for a more inclusive approach to 2017/18 Annual Planning for Wairarapa DHB, including greater involvement of Te Iwi Kainga

ADDENDUMS

1 APPROACH TO 2017/18 ANNUAL PLANNING

This paper proposes a more inclusive and integrated approach to 2017/18 Annual Planning for the Wairarapa DHB. The below proposals are based on experience from and feedback on the production of the 2016/17 Annual Plan and other associated plans.

1.1 Earlier Development and Regular Engagement Processes

Earlier engagement, in the first quarter of the 2016/17 Financial Year, with the Board and other stakeholders is proposed to:∑ Discuss the environment and to endorse, or amend, the Vision/Mission/Values of the DHB and the

proposed strategic direction and local priorities for 2017/18∑ Agree the process for co-development of and/or input and linkages into:

o The 2017/18 Wairarapa DHB Maori Health Plano Sub-regional planning processeso Regional planning processeso Tihei Wairarapa planning processeso Provider Arm and Hospital planning processeso Other relevant plans, e.g. Regional Public Health Business Plan and Pacific Health Plan.

The first draft planning package from the Ministry of Health is usually consulted on with DHBs in the second quarter of the Financial Year before the first formal package is released around the start of December. As policy development is usually on-going, it is common for updates to be released as details are finalised over the following six months.

To ensure regular iterative updates on planning and draft documents, a standing item could be established in bi-monthly Board meetings to provide updates on planning requirements, processes


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and draft plans. To supplement this beyond a governance level, monthly meetings of a nominated group of key DHB Executive staff and external stakeholders to further facilitate oversight and information sharing is proposed.

1.2 Sensitive Information

In the course of developing the draft plans for 2017/18, there is sensitive information that DHBs do not share in the public domain until the plans have been finalised and approved by the Board and the Minister of Health. These include the financials (often information is government budget sensitive)and proposed service changes. Careful consideration of these elements can still mean that a significant portion of the Annual Plan can be shared with strategic partners.

1.3 Integrated Planning

Improved integration and joined up planning processes are proposed to facilitate the linkages and consistency between plans and to maximise the input of the right groups of stakeholders (internal and external). It is proposed that Service Area Groups are identified at the time initial draft planning guidance is being consulted on to facilitate the input of all relevant key stakeholders. Staff within the DHB who are likely to be responsible for drafting planned actions will be identified along with their in accountability. This would help to ensure alignment between different plans and to get agreement on the relative responsibilities of different groups for implementing agreed actions.

The role of the groups would include review of current progress of existing plans, the current and developing environment (e.g. Strengths, Weaknesses, Opportunities and Threats) and to identify the key value-add actions required to progress strategic priority areas. Responsibility for the drafting of actions, within the framework and format of national, regional, sub-regional and local requirements, can then be allocated to the most appropriate individuals into draft plans for iterative sharing with and feedback from the Executive team, Board and other agreed stakeholders groups.

The SharePoint tool has previously been used to share draft iterations of the 2016/17 Annual Plan with staff across the DHB. It also has the functionality to be used as a tool for the shared drafting of plan sections and actions by different staff, with moderation/overview maintained by the staff member(s) with overall accountability for the production of the different plans.

While the range of Service Area Groups required will need to be confirmed (and it may be that sub-groups beneath some of these may be needed to focus on specific topics), options include a mixture of the following approaches:∑ Population-based (e.g. Maori, Pacific, Disabled people)∑ Life-course based (e.g. Pregnancy & Childbirth, Babies, Children, Youth, Adults, Older people)∑ Condition-based (e.g. Long Term Conditions, Cancer, Mental Health & Addictions, Acute Demand)∑ Settings-based (e.g. Hospital, Primary care, Community care)∑ Partnership-based (e.g. Te Iwi Kainga, Tihei Wairarapa, Intersectoral Group).

1.4 Strategic Partnerships and Our Planning Approach

Moving forward, the DHB will only be able to significantly improve health outcomes by leveraging off the significant and mutually important relationships and partnerships we have in the community. It is proposed that SIDU and the CEO run a number of active planning workshops with key partners. We would propose the following:


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Key Strategic Partner(s) Session Date

Te Iwi Kainga Workshop 1

Key information and DHB performance overview

Linking DHB activity to Te Iwi Kainga Strategic Framework

Insights – what is working / what isn’t working

Priority and Goal Setting for 2017/ 2018

Maori Health Plan Development

Ensuring the Maori Health Plan is well supported by the Annual plan

November 2016

Organiser: SIDU, MH Director

Workshop 2

Joint Workshop with new Board

Reviewing what has been developed in workshop one

Resetting the relationship with a clear set of principles for Board and Iwi Kainga working together for the next 3 year term

December 2016 / January 2017


Workshop 3

Review of Annual Plan and MHP Drafts

Alignment and testing against Iwi Kainga’s strategic framework

February 2017

Organiser: SIDU, MH DIrector

Workshop 4

Agreement of final Annual Plans and Maori Health Plans with Iwi Kainga

Apr 2017


Masterton, Carterton and South Wairarapa Councils

Workshop 1

Key Health Information Sharing

December 2017

Organiser: CEO, SIDU


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Opportunities for partnership discussionOverview of the DHB planning process

Opportunities to link planning approaches

Workshop 2

Overview of DHB Planned Activities for 2017/2018

Feedback

Opportunities Discussion

March 2017


Social Services GroupMSD, ACC, MOE, Housing NZ, Trust House (potentially)

Workshop 1

Key Health Information Sharing

Opportunities for partnership discussionOverview of the DHB planning process

Opportunities to link planning approaches

December 2016


Workshop 2

Overview of DHB Planned Activities for 2017/2018

Feedback

Opportunities Discussion

March 2017



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Wairarapa Alliance Leadership TeamMeeting DRAFT Minutes

Tuesday 9th August 2016, 5.30 pm – 7pmCSSB Lecture Room, DHB Offices, Blair Street, Masterton

Quorum – For a meeting to progress, at least 50% of the ALT membership is required to be present.

Members: Bob Francis (Chair ) Bob Sahakian Hera EdwardsAndrea Rutene Dale Coles Tony BeckerBrad Martin Adri Isbister Helen PocknallRoger Morris Martin Hefford Shayne Hunter

Present: Dale Coles Brad Martin Tony Becker

Martin Hefford Bob Frances Shayne Hunter

Adri Isbister

Ex-officio: Jill Stringer, Justine Thorpe, Wayne Skipage, Yvette Grace (minutes), Megan Wyeth, Martin de Boer

Apologies: Roger Morris, Andrea Rutene, Sarah Martin, Hera Edwards, Helen Pocknall

Absent Bob Sahakian

AGENDA ITEMS ACTION

1. Welcome/ApologiesMeeting opened at 5.35 pm

2. Conflicts of Interest RegisterThere was one change noted on the Conflicts of Interest Register

∑ Add- Tony Becker-Trustee – Wairarapa Children’s Trust

∑ Take off Brad Martin – Stopping Violence Services Wairarapa

∑ Take off Brad Martin – Wife member of Te Oranga O Te Iwi Kainga (Maori Relationship Board to the Wairarapa DHB)

3. ALT Membership Update

Bob informed the ALT of resignations that he had received from Hamish Duncan and Sarah Martin.

Justine updated ALT membership going forward, noting that some ALT members had already moved on since their membership expired in January. To align with the Alliance contracting Adri and Martin have agreed to roll over current membership for another 12 months. Letters to current ALT members have been drafted and are ready for signing by Bob Francis.

Dale enquired whether the roll over applied to Iwi representatives. Justine responded by stating that letters had been sent to Iwi Chairs earlier in the year and had not been responded to yet. Justine also stated that an EOI process would have to be run for the Community Pharmacist appointment. Justine also stated that she needed to discuss the Allied Health appointment with Adri and Martin. It was noted that the current ALT

Wairarapa Board Public 23 August 2016 - MEETING REPORTS AND MINUTES

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membership was light on GP’s and given that there is no Southern Wairarapa or rural GPs, Justine may have to do some shoulder tapping to appoint these members.

ACTION: Dale to follow up with Iwi on Iwi RepresentativesDale Coles

4. Confirmation of Minutes from previous meetingThe Team approved the minutes of the meeting held 17th May 2016.

Moved: Dales Coles Seconded: Tony Becker

5. Action register

Justine presented the register to the group.

The Group noted the following update:

Updates of note

∑ ID 1 & 2 are ok

∑ ID 3 access to concerto is complete. Hospital clinicians are able to send notes to GPs using concerto

∑ ID 4 membership is being rolled over until 30th June 2016 and this is being progressed.

∑ ID 5 accessible prescriptions will continue to be progressed, however it looks likely that we may have to wait until the Hutt pilot and evaluation is complete to progress any further. In the meantime, we have received information from the Porirua Social Sector Trial. Justine reminded that they had agreed to give the pharmacists a slight increase this year and that this was being progressed.

All completed actions will be removed.

6. 3DHB Disability Framework Presentation

Bob welcomed Erikka, Cathy and Ann who were presenting on the Disability responsiveness planning and forum outcomes on behalf of Pauline Boyles.

HDC is supporting a review of the Health passport, with the team leading the review in partnership with HDC. It will be rolled out sub-regionally andthen nationally. The chair acknowledged the significance of the work that the team was achieving.

The specific quality improvement initiatives for the Wairarapa are disability alerts and dashboard development. These will help to track the patient journey and target improvements. Erikka went on to explain that because of IT issues in the Wairarapa that the initiative was not possible but they think they may have found a solution to move forward with the project.

Adri advised that the Ministry hold national data for under 65 year olds through the NASC process and that the Wairarapa DHB could assist in obtaining the data. Erica acknowledged the Wairarapa NASC and the single point of entry, and would like to see something similar nationally


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Four main themes from the planning workshop emerged;

1. Creating a dashboard

2. Co-design

3. Education

4. ICT and disability integration/data sharing

The Group endorse the draft plan emerging from the sub regional disability forum with particular reference to:

1. An interim and long-term commitment to ensure all current and new IT developments can incorporate the specific support needs alongside health records for people who live with long-termdisability.

2. Support the creation of a 3DHB data sharing group to achieve the above, and

3. The development of a disability education programme for all staff with patient contact across primary and secondary services.

Moved: Dale Coles Second: Tony Becker

The chair enquired whether Shayne had been in discussions with Pauline Boyles around their aspirations for IT development. Shayne confirmed that he had talked to them about a couple of things in the portal as well as what they could be doing with the Health passport; which fits in with shared care planning. Shayne cautioned the group about creating a disability system when we have a shared care system and suggested that some thinking needed to occur about the need for data. The chair asked Justine to pickthe data up as an issue for the November meeting. Shayne also suggested that if we are going to pick up the recommendations, we need to formulate a plan and avoid re-inventing the wheel. If there is existing capability that can assist with the data, we need to be working with them.

We also need to make sure that we put the right measures in the dashboard.

ACTION: Justine to go away with the 3 recommendations that we have endorsed and work out how we can do them and bring it back to the November meeting. Justine Thorpe

7. System Level Measures (SLM) presentation – Peter Jones and Kanchan Harman, Ministry of Health.

Bob welcomed Peter and Kanchan to the meeting to present on the System Level Measures.

Justine sought clarification on the payment structure, whether it was for the 16/17 year or whether it was on going. Peter clarified that the intent was for the 75% capability funding and the 25% performance based funding to be on going.


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The Group noted that the next ALT meeting is on the 8th of November 2016 and that the Improvement Plan needs to be submitted to the Ministry of Health by 30 September 2016.

The Alliance Leadership Team:

∑ Noted the contents of this report and the attached draft System Level Measures Improvement Plan

∑ Agree to appoint the Alliance Executive Team to sign off the final Improvement Plan to be submitted to the Ministry of Health by 20th

October 2016.

Moved: Bob Francis Second: Tony Becker

8. Tihei Wairarapa programme progress report

The Group noted that we have started a new programme as from 1 July 2016.

Justine presented the final report for last year which included the following highlights:

- Health Navigator has been launched however; more promotion of it is required.

- Twelve new Self-Management facilitators have been trained. There needs to be a focus on getting more referrals from General practice

- All seven Wairarapa Practices have completed their Annual Plans.

- Youth Kinex had its first year anniversary

- Wairarapa celebrated 200 Health Pathways going live.

- Maternal Mental Health pathways were launched.

- 50% (4 LMCs)of LMCs in the Wairarapa are now integrated or co-located into General practice

- We have successfully trained six Practice Nurses to deliver the B4 School Check into their Medical Centre.

- Patient portal numbers have gone up with Masterton Medical leading the way. Masterton Medical is now enrolling new patients onto patient portal when they come into Masterton Medical to enrol.

ACTION: Put Patient Portal/Manage My Health and new enrolments on the next Practice Managers agenda.

- The ED patient survey was reviewed and we have updated that. It now includes a question about whether they had considered calling their GP before they went to ED.

- We had the first meeting of the Community Radiology oversite group last week. They are going to start going through the central region radiology criteria.

- The Obesity strategic plan for the Wairarapa is being progressed by

Yvette Grace


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the local team who are also linking it to the wider Compass Health team. In particular, we are looking at childhood obesity especially with the B4 School Check target. Tony and Tom have been asked to lead the process so we get a consistent way of dealing with this issue.

- Mana Wahine service is ending. Working with Practices on a quality initiative, which includes the incentivised initiative for women that are very overdue for their smear.

Shayne updated the ALT that they have talked today about what they need to do for access to concerto. They have also had discussion with Tom who is comfortable with what has been proposed. They just need to get the Privacy Commission to sign off on the PIA.

Justine stated that we are working on getting more frequent ASH and ED data. Justine action from EAT is to follow up with Leanne Dale about receiving more up to date data.

Adri stated that a lot of work has to be done with the IT system and Data because there has been no investment into IT for the Wairarapa.

Moved- Dale Coles Seconded Bob Frances

9. System Level Measures

The Group noted that the Annual Practice Plan align with the SLM

This paper was noted by the Group.

10. General Business

11. SCR Audit Results Jan-March

This paper was noted by the Group.

12. Integrated Care Conference and UK Study Tour Reports

Bob congratulated Justine for the report

This paper was noted by the Group

ACTION: Bob is going to work with Justine to see where the opportunities are in the report for Wairarapa.

Bob Francis and Justine Thorpe

The meeting closed at pm.

Next meeting is on Tuesday 08 November 2016

Signed: __________________________ Bob Francis (ALT Chairperson)

Date: ____________________________


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Wairarapa, Hutt Valley and Capital & Coast District Health Boards DRAFT JULY 2016

WAIRARAPA, HUTT VALLEY AND CAPITAL & COAST DISTRICT HEALTH BOARDS COMMUNITY PUBLIC HEALTH ADVISORY AND DISABILITY SUPPORT ADVISORY COMMITTEES

MINUTES

9.00am Friday, 15 July 2016 Board Room, Pilmuir House, Hutt Valley District Health Board

PRESENT: IN ATTENDANCE:

Committee Management & Externals

Nick Leggett (Chair) Virginia Hope (Deputy Chair) Derek Milne (Member) Katy Austin (Member) Wayne Guppy (Member) Leanne Southey (Member) Sandra Greig (Member) Margaret Faulkner (Member) Jane Hopkirk (Member) Kim Smith (Member) Alan Shirley (Member)

Adri Isbister (CEO, Wairarapa DHB) Sandra Williams (Acting-Director, SIDU) Dr Pauline Boyles (Senior Disability Advisor, SIDU) Doris Tuifao (Minute Secretary) Debbie Chin (CEO, CCDHB) Tom Gibson (Chief Medical Offcier, Wairarapa – via Videoconference)

Board Members Presenters

Liz Faulker (Wairarapa)

Bob Francis (Agenda Item 2.1) Emma Hickson (Agenda Item 2.2) Helen Rigby (Agenda Item 2.2) Wayne Skipage (Agenda Item 2.3) Rachel Haggerty (Agenda Item 2.3)

APOLOGIES: Tino Pereira (Member) Helene Ritchie (Member) Dr Ashley Bloomfield (CEO, Hutt Valley DHB) Chris Laidlaw (Member) Dr Tristram Ingham (Member)

1.0 PROCEDURAL BUSINESS

Committee member opened the meeting up with a karakia.

1.1 Apologies

Tino Pereira, Helene Ritchie, Dr Ashley Bloomfield, Chris Laidlaw, Dr Tristram Ingham

Moved: Nick Leggett Seconded: Margaret Faulkner CARRIED


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1.2 Conflicts of Interest:

Noted and updated to include Kim Smith’s declarations of interest.

1.3 Confirmation of Minutes

The Committees noted the minutes as read.

Action: Secretariat to check that Liz Faulker is noted as an attendee in the Public and Public Excluded minutes for Friday 20 May 2016. Action: Amendment to 2.6 Manage My Health Presentation – Shared Electronic Care Records. Member added a cautionary note on releasing Concerto to community private providers, and would like this noted as an amendment to the minutes. Moved: Nick Leggett Seconded: Jane Hopkirk CARRIED

1.4 Schedule of Action Points:

Noted and updates will be provided at next meeting as scheduled.

2.0 DISCUSSION PAPERS

2.1 Update on Sub Regional Disability Implementation Plan

Purpose

• To present a summary of outcomes from the Sub Regional Disability Forum held 3rd June 2016. • To indicate areas for short, medium and long term actions as a result of the overlapping themes

emerging • To explain and gain support from the three district health boards for addressing where other

government agencies are critical to the change process • To provide progress update on fourth quarter implementation of the Sub Regional Disability Plan. Recommendations The Committees: 1. Noted progress on sub regional plan and the local developments:

a. The updated disability responsiveness tools b. The agreement on cross sector collaboration of the Child/Adult Transition (CAT) projects. c. Bridget McLaren and her mobility dog Goldie won the national Ministry of Health Youth Volunteer

Award d. The disability responsiveness initiatives being implemented in Hutt ED and Ward 5 e. Capital Support Quality Award winners 2016 CCDHB f. The updated Generic Orientation for new staff; and g. Friday 3 June 2016, the third Sub Regional Disability Forum took place at Silverstream Retreat in

Upper Hutt.

2. Recommended to the Boards that they endorse the outline of the draft action plan in Section Three emerging from the forum to include following areas for further development a. The development of a performance monitoring framework during 16/18 with meaningful

indicators to measure health equity for people with disabilities b. Support for the development of a high level plan for community and intersectoral engagement

across funders of inter-dependent services c. The development of disability literacy as a competency in conjunction with national work force

agencies


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d. Promotion and commitment of integration of disability support needs in all new IT development and gradual integration into current platforms

e. Endorse in principle a whole of life approach to improve access to funding pathways for staff and people using services

f. An approach to the Ministry of Health at Executive level to discuss the impact of decreased DSS funding, increasing health complexity within the disability population, and the impact of the funding gap on access to services for persons with disabilities DHBs.

3. Noted accolades that have been recognised from the wider sector as well as Paul Gibson the Disability

Rights Commissioner to Pauline and the Disability Responsiveness Team for their hard work. 4. Noted the Chair suggested development of some guiding principles to be present in every paper, to

guide every decision a Committee member makes in this group.

The Committee NOTED the contents of this report.

Moved: Nick Leggett Seconded: Liz Faulker/Jane Hopkirk CARRIED

2.2 Palliative Care Update – Advanced Care Planning Presentation - Update

Helen Rigby and Emma Hickson presented to the Committee on Palliative Care – Advanced Care Planning.

The Committee NOTED the content of the report and the presentation.

Moved: Nick Leggett Seconded: Dr Virgnia Hope CARRIED

2.3 Draft Health System Planning Report - Presentation

Rachel Haggerty and Wayne Skipage presented to the Committee on the Draft Health System Planning Report. The Committee NOTED the presentation and the next steps as outlined: Next steps in this process:

a. Complete modelling for patient flows, and investment and disinvestment choices; b. Aligning Maori and Pacific Plans and a stronger focus on equity; c. Completing a draft plan for Executive and Board discussion prior to wider consultation; and d. Engagement and consultation.

Moved: Nick Leggett Seconded: Katy Austin CARRIED


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2.5 Director, SIDU Report

The Committee NOTED the contents of this report. Moved: Nick Leggett Seconded: Sandra Greig CARRIED

3.0 GENERAL BUSINESS Fluoride in drinking water The CCDHB and Hutt Valley DHB Chair noted , there is no legislation yet. DHBs will continue to monitor the development and will look at a national response. 4.0 RESOLUTION TO EXCLUDE THE PUBLIC

It is recommended that the Community & Public Health and Disability Advisory Services Committees:

(a) Agree that as provided by Clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons:

Subject Reason Reference* Public Excluded Minutes

For the reasons set out in the respective public excluded papers

PHO Performance Reporting Papers contain information and advice that is likely to prejudice or disadvantage commercial activities and/or disadvantage negotiations why are these here as there is no item on the PE agenda.

9(2)(i)(j)

Overview of Maori Health Outcomes, Service Access and Service Funding

Papers contain information and advice that is likely to prejudice or disadvantage commercial activities and/or disadvantage negotiations why are these here as there is no item on the PE agenda

9(2)(i)(j)

* Official Information Act 1982.

Moved: Virginia Hope Seconded: Margaret Faulkner CARRIED

The meeting concluded at 11.50am

CONFIRMED that these minutes constitute a true and correct record of the proceedings of the meeting.

DATED this day of 2016

Nick Leggett CHAIR


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BOARD DECISION PAPER

Date: August 2016

Author Derek Milne, Wairarapa District Health Board Chair

Subject Resolution to Exclude the Public

RECOMMENDATION

IT IS RECOMMENDED that the Board AGREES that Public be excluded from the following parts of the of the Meeting of the Board in accordance with the NZ Public Health and Disability Act 2000 (“the Act”) where the Board is considering subject matter in the following table.The grounds for the resolution is the Board, relying on Clause 32(a) of Schedule 3 of the Act believes the public conduct of the meeting would be likely to result in the disclosure of information for which good reason exists under the Official Information Act 1982 (OIA), in particular:

SUBJECT REASON REFERENCE

Public Excluded Minutes For the reasons set out in the 16 June 2015 Board Agendas

Financial matters; Service Contracts, Risk Reporting

Papers contain information and advice that is likely to prejudice or disadvantage commercial activities and/or disadvantage negotiations.

Section 9(2)(i)(j)

Wairarapa Board Public 23 August 2016 - RESOLUTION TO EXCLUDE THE PUBLIC

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AGENDA - Ministry of Health NZ€¦ · 8. PRESENTATION 2:00pm Rachel Haggerty– Health Needs...

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