ANNUAL REPORT - West Coast DHB · ... and to collaborate with agencies from local government ......

WWEESSTT CCOOAASSTT DDIISSTTRRIICCTT HHEEAALLTTHH BBOOAARRDD TTee PPooaarrii HHaauuoorraa aa RRoohhee oo TTaaii PPoouuttiinnii

AANNNNUUAALL RREEPPOORRTT FFOORR TTHHEE YYEEAARR EENNDDEEDD

3300 JJUUNNEE 22000088

22008 Annual Report

BOARD PROFILE & DIRECTORY

Front page photo of Coast Road Photographed by Wayne Burnett

BOARD MEMBERS

Mr Rex Williams, Chair Mrs Sharon Pugh Dr Christine Robertson, Deputy Chair Mr Mohammed Shahadat Mr Kevin Brown Mrs Elinor Stratford Mr Warren Gilbertson Mr David Tranter Mrs Helen Gillespie Ms Susan Wallace CHIEF EXECUTIVE Kevin Hague West Coast DHB email: [email protected] Corporate Office High Street Telephone: (03) 768 0499 Greymouth Facsimile: (03) 768 2791

POSTAL ADDRESS PO Box 387, Greymouth

WEBSITE www.westcoastdhb.org.nz

AUDITOR Audit New Zealand on behalf of the Auditor-General

BANKERS Crown Health Finance Agency Bank of New Zealand

SOLICITORS

Hannan & Seddon Chapman Tripp Guinness Street PO Box 22 06 Greymouth Auckland Telephone: (03) 768 4169 Telephone: (09) 357 9000

mailto:[email protected]�

West Coast District Health Board 3

TABLE OF CONTENTS CHAIR AND CHIEF EXECUTIVE’S REPORT ....................................................................................................... 4

VISION STATEMENT............................................................................................................................................. 7

GOVERNANCE AND ACCOUNTABILITY ............................................................................................................ 8 ROLE OF THE BOARD....................................................................................................................................... 8 STRUCTURE OF THE WEST COAST DHB ....................................................................................................... 8 WEST COAST DHB BOARD MEMBERS ........................................................................................................... 9 GOVERNANCE PHILOSOPHY ........................................................................................................................ 11 REPORT OF BOARD ADVISORY COMMITTEES ........................................................................................... 12

STATEMENT OF RESPONSIBILITY ................................................................................................................... 13

REPORT OF THE AUDITOR-GENERAL............................................................................................................. 14

STATEMENT OF ACCOUNTING POLICIES....................................................................................................... 16

STATUTORY INFORMATION.............................................................................................................................. 45 NEW ZEALAND PUBLIC HEALTH AND DISABILITY ACT 2000...................................................................... 45

PLANNING AND FUNDING REPORT ................................................................................................................. 54

MAORI HEALTH REPORT .................................................................................................................................. 55

MENTAL HEALTH REPORT ............................................................................................................................... 57

COMMUNITY SERVICES REPORT..................................................................................................................... 58

SECONDARY SERVICES REPORT.................................................................................................................... 59

ACTING CHIEF MEDICAL ADVISOR REPORT.................................................................................................. 59

NURSING AND MIDWIFERY REPORT ............................................................................................................... 60

INFORMATION TECHNOLOGY REPORT .......................................................................................................... 61

FACILITIES & SUPPORT SERVICES REPORT ................................................................................................. 62

STATEMENT OF OBJECTIVES AND SERVICE PERFORMANCE ................................................................... 63 NATURE AND SCOPE OF ACTIVITIES ........................................................................................................... 63 SERVICE PERFORMANCE ............................................................................................................................. 63

STATEMENT OF OBJECTIVES AND SERVICE PERFORMANCE ................................................................... 64 NATURE AND SCOPE OF ACTIVITIES ........................................................................................................... 64 SERVICE PERFORMANCE ............................................................................................................................. 64

42008 Annual Report

CCHHAAIIRR AANNDD CCHHIIEEFF EEXXEECCUUTTIIVVEE’’SS RREEPPOORRTT The 2007/08 year saw the West Coast District Health Board building upon the work that has been achieved previously. Excellent work by staff has continued to see West Coasters receive a high standard of healthcare. The District Health Board has faced challenges in providing healthcare in some areas due to the shortage of key clinical staff. Because the shortage is both national and international, recruitment to remedy this situation continues to be a problem.

CCeennttrree ooff EExxcceelllleennccee ffoorr RRuurraall HHeeaalltthh The West Coast District Health Board has set out to become a “Centre of Excellence for Rural Health”. Our district is the most rural in New Zealand and a traditional centre for innovation and independent thought. We wish to be a leader, and widely recognised as such, in providing solutions to the problems of rurality that large parts of New Zealand will increasingly face. The inaugural West Coast District Health Board Innovation Awards gave us the opportunity to showcase the excellence of thought and implementation that have gone into health projects on the West Coast. The presence of two West Coast project in the finals of the 2008 NZ Health Innovation awards is testament to the great ideas being developed here.

OOvveerraallll SSttrraatteeggyy The New Zealand Health Strategy aims to keep people well. This includes population health services intended to keep communities healthy, through primary and secondary care services, to the highly specialised tertiary hospital based services for the treatment and rehabilitation of the injured or unwell. Preventing illness and intervening as early and as effectively as possible will produce the greatest health outcomes and the best possible use of the resources available. During 2007/08 there has been a significant increase in the capacity to co-ordinate, develop and fund health promotion and community based services on the West Coast, particularly in the areas of Healthy Eating Healthy Action, smokefree and cancer control.

SSuussttaaiinnaabbiilliittyy PPrroojjeecctt The 2007/08 year saw the West Coast District Health Board undertake a significant amount of work on a joint Sustainability Project with the Ministry of Health. The project involved the development of a future model of care for the West Coast that is both clinically and financially viable. 2008/09 brings further implementation planning for the project, and a bid to the national capital committee for funding.

PPuubblliicc HHeeaalltthh The majority of public health services continues to be funded directly by the Ministry of Health. On the West Coast, Community and Public Health, a division of the Canterbury District Health Board, is funded to deliver many of these services. The West Coast District Health Board in 2007/08 is now funded to deliver an increasing range of public health services, and also funds the West Coast Primary Health Organisation, which delivers some services. Increasingly, all three organisations are planning together to maximise the effectiveness of the services that each provides. The employment of a public health analyst has increased the West Coast District Health Board’s capacity to contribute to forums and networks, and to collaborate with agencies from local government, education, social development, housing, Maori development, Police, economic development, sport and recreation and so on. This is valuable as most of the factors that contribute to the overall health of communities or individuals are determined outside the health sector.

MMaaoorrii HHeeaalltthh The West Coast District Health Board aims for Maori and non-Maori to have the same high health status. During 2007/08 the District Health Board has worked to implement of our second Maori Health Plan and to complete a Maori Health Needs Assessment to feed into future service planning and delivery. 2007/08 has seen an increase in Maori Health services funding, and an increase in staff providing services, which has improved access to services particularly in primary care.


PPrriimmaarryy CCaarree As the funder of primary health services throughout the West Coast, the West Coast District Health Board had a most rewarding year as the partner of the West Coast Primary Health Organisation, which has grown from strength to strength and has quickly become one of the top performing Primary Health Organisations in New Zealand. We are particularly excited about the solid progress that the Primary Health Organisation has made in primary care-based mental health interventions and in meeting the needs of people with chronic conditions (in partnership with the District Health Board’s secondary care and community health service staff). As a provider of primary care services (the West Coast District Health Board owns most of the general practices on the West Coast and employs most primary health professionals) we had a year of increasing stability, with a marked reduction in staff turnover and use of locums, and a corresponding increase in our capacity to develop more effective ways of providing care. The West Coast District Health Board practices all performed better than in the previous year on both clinical and financial indicators. The general practice at Buller Health has faced ongoing pressure as it deals with high patient numbers and limited resources. Good progress is being made in resolving these issues with increased staffing and innovative strategies designed to improve patient access to primary healthcare. Our network of Rural Nurse Specialists and their interactive team-based approach with General Practitioners in South Westland and other remote areas on the Coast has gained increasing recognition in recent years as a highly effective model that delivers very high quality services to rural New Zealanders. The wide range of community health services continues to assume greater importance and has performed very well.

SSeeccoonnddaarryy CCaarree The West Coast District Health Board finalised the development of its Secondary Care Plan, following extensive internal and external consultation processes. This plan sets a comprehensive set of directions for specialised medical and surgical services to be provided on the Coast. Despite frustrating workforce shortages in some departments in Grey Base Hospital – which placed great strain on hospital staff, whose dedication we particularly wish to acknowledge and express gratitude for – the year saw increasing stability and productivity in most areas. West Coasters continue to have better access to most secondary care services than other New Zealanders with similar need, and Grey Base Hospital continues to rate highly for patient satisfaction. We have appreciated the collaborative support from other District Health Boards, service providers, and individual clinicians, which has enabled us to provide a full range of services for West Coasters, by augmenting those services provided directly by the Board.

OOllddeerr PPeeooppllee aanndd MMeennttaall HHeeaalltthh For both older people and people who experience mental illness, the West Coast District Health Board has worked during the year to advance our service strategic direction. Where possible we wish to provide services in a person’s own home, in the community. For both groups we are working towards creating a wider range of options for what “home” might be, thereby reducing the need for people to receive care in more institutionalised settings like rest homes or the inpatient psychiatric unit. Significant further progress in these areas is expected over the next year. Closure of the last villa at Seaview in November 2007 saw the end of 135 years of mental health provision at that site. The new Dementia Care Unit, He Oranga Kahurangi on the Grey Base Hospital site, is providing a much more pleasant environment for both patients and staff.

WWoorrkkffoorrccee Recruitment and retention of staff in all areas of the West Coast District Health Board continue to be of extreme importance and, as such, also saw some of the most exciting developments. The West Coast District Health Board scholarships scheme continues to grow. In 2008 18 grants were awarded to young people studying towards careers in health, of whom eight had been previous recipients. We hope that this will encourage young people to return to work in the health field on the West Coast once fully qualified. The past year saw three more Rural Immersion Medical students from the University of Otago arrive on the West Coast. These three students will complete the same fifth year examinations and assignments as their metropolitan based counterparts but will do so while working and studying in Greymouth with support from West Coast District Health Board staff and the Dunedin and Christchurch Schools of Medicine.


VVIISSIIOONN SSTTAATTEEMMEENNTT

“To be the New Zealand centre of excellence for rural health services”

Kevin Hague, CEO, and WCDHB staff.

The new Ngakawau Clinic.

The Alternative Pathways for New Patients project won the Process Improvement category and Supreme Award in the 2007 West Coast Community Health Awards. The project is also a finalist in the Excellence in Process Improvement category for the 2008 New Zealand Health Innovation Awards. Pictured is Wayne Turp, GM Planning & Funding, Kevin Hague CEO, Alison McDougall, Elective Services Co-ordinator / CQI Facilitator (accepting her award) and Dr Carol Atmore, Primary/Secondary Liaison Officer.

82008 Annual Report

GGOOVVEERRNNAANNCCEE AANNDD AACCCCOOUUNNTTAABBIILLIITTYY

ROLE OF THE BOARD The Board’s governance responsibilities include: • Communicating with the Minister and other stakeholders to ensure their views are reflected in the West Coast

District Health Board’s (DHB’s) planning. • Delegating responsibility for achievement of specific objectives to the Chief Executive. • Monitoring organisational performance towards achieving its objectives. • Reporting to stakeholders on plans and progress against them. • Maintaining effective systems of internal control.

STRUCTURE OF THE WEST COAST DHB

WWeesstt CCooaasstt DDHHBB OOppeerraattiioonnss The Board has appointed a single employee, the Chief Executive to manage all West Coast DHB operations. The Chief Executive has appointed all other employees of the West Coast DHB. The Board directs the Chief Executive by delegating responsibility for the achievement of objectives and by setting policy.

BOARD

FINANCE PROFESSIONAL

NURSING

PROFESSIONAL MEDICAL

QUALITY AND RISK MANAGEMENT

FACILITIES MAORI HEALTH

HUMAN RESOURCES

INFORMATION TECHNOLOGY

CHIEF EXECUTIVE

PLANNING AND FUNDING

PRIMARY (COMMUNIT

MENTAL HEALTH

SECONDARY (HOSPITAL)

ADVISORY COMMITTEES AUDIT, RISK & FINANCE COMMITTEE


WEST COAST DHB BOARD MEMBERS

BBooaarrdd MMeemmbbeerr CCuurrrreenntt IInntteerreessttss SSppeecciiaall RReessppoonnssiibbiilliittiieess

Rex Williams Appointed 10 December 2007

• Council member – University of Canterbury • Adviser – H W Richardson Group Ltd • Trustee – Water Rights Trust • Trustee – Styx Living Laboratory

• WCDHB Chair • Member - HAC • Member - CPHAC • Member - DSAC • Member - Audit, Risk

& Finance Committee Christine Robertson Re- appointed 10 December 2007

A self employed person, who works on contract for: • Audit and Compliance Sector Accountability and

Funding Directorate, Ministry of Health Husband is Justice of the Peace who undertakes judicial duties in Court

• WCDHB Deputy Chair

• Chair - HAC • Chair - Audit, Risk &

Finance Committee

Kevin Brown Elected Member 10 December 2007

• Councillor – Grey District Council • Trustee – West Coast Electric Power Trust • Wife is Pharmacy Assistant at Grey Base Hospital

Warren Gilbertson Appointed 10 December 2007

• Employed as Regional Development Manager, Development West Coast

• Deputy Chair - HAC

Helen Gillespie Elected Member 10 December 2007

• Project Management Role – Active Westland • Board member - St Mary’s Primary School, Hokitika,

Board of Trustees

• Deputy Chair - Audit, Risk & Finance committee

Sharon Pugh Elected Member 10 December 2007

• West Coast DHB preferred accommodation provider • Shareholder – New River Bluegums Bed & Breakfast • West Coast/Marlborough/Nelson Community

Committee Lottery Grants Board

• Deputy Chair - CPHAC

Mohammed Shahadat Re-elected Member 10 December 2007

• Director – Asia Pacific Immigration Consultants Limited (trading as ASPAC Immigration Consultants)

Elinor Stratford Elected Member 10 December 2007

• Clinical Governance Committee – West Coast Primary Health Organisation

• Manager - West Coast Disability Information Service • Committee member – Active West Coast • Chairperson – West Coast Sub-branch-Canterbury

Neonatal Trust

• Deputy Chair - DSAC

David Tranter Elected Member 10 December 2007

• Health spokesperson - Democrats for Social Credit Party

• Trustee – Aotearoa Advocacy Service • Spokesperson – West Coast Fluoride Action Network • Committee member – New Zealand Fluoride Action

Network • Patient advocate for several DHBs’ patients • Co-organiser, Health Freedom New Zealand – West

Coast

• Member - Audit, Risk & Finance committee

John Vaile Re-elected Member 10 December 2007

• Director - Vaile Hardware Ltd • Chair - DSAC

Susan Wallace Re-appointed Member 10 December 2007

• Tumuaki -Te Runanga o Makaawhio • Member - Te Runanga o Makaawhio • Member – Te Runanga o Ngati Wae Wae • Director - Kati Mahaki ki Makaawhio Ltd • Mother is an employee of WCDHB • Father member of Hospital Advisory Committee

• Chair - CPHAC

102008 Annual Report

BBooaarrdd CCoommmmiitttteeeess The Board has set up several standing committees to provide a more detailed level of focus on particular issues. Each committee has been delegated responsibility for governance; that is advising the Board on policies and monitoring of the organisation’s progress towards meeting the West Coast DHB’s objectives. Committees do not involve themselves in operational matters. The Board’s standing committees (including the statutory permanent advisory committees) are:

AAddvviissoorryy CCoommmmiitttteeee MMeemmbbeerrss Hospital Advisory Committee

Christine Robertson, Chair Barbara Holland Mary Molloy Warren Gilbertson, Deputy Chair Glen Morgan Rex Williams Richard Wallace

Community & Public Health Advisory Committee

Susan Wallace, Chair Barbara Holland Sharon Ransom Sharon Pugh, Deputy Chair Elinor Stratford Helen Rasmussen Rex Williams Cheryl Brunton Barbara Greer

Disability Support Advisory Committee

John Vaile, Chair Mohammed Shahadat Lynnette Beirne Elinor Stratford, Deputy Chair Graeme Axford Kevin Brown Rex Williams Rick Barber Patricia Nolan

Audit, Risk and Finance Committee

Christine Robertson, Chair Rex Williams Helen Gillespie, Deputy Chair

David Tranter

FFrreeqquueennccyy ooff CCoommmmiitttteeee MMeeeettiinnggss Audit, Risk and Finance Committee Quarterly Hospital Advisory Committee 6 weekly Community & Public Health Advisory Committee 6 weekly Disability Support Advisory Committee Quarterly

QQuuaalliittyy AAssssuurraannccee The West Coast DHB continues to ensure the ongoing development of high quality care and service that will ensure continuous quality improvement is achieved throughout the organisation. • West Coast DHB has pursued clinical effectiveness and quality assurance gains for all its services. This has

been achieved through the development of an annual quality plan, which enables a focused approach to quality improvement to be facilitated throughout the organisation, and ensures the development of a supportive quality improvement culture and organisation-wide commitment to the principles of quality improvement.

• West Coast DHB has sought to ensure that clinical effectiveness and quality is promoted throughout the organisation, and that clinically acceptable standards are maintained.

• West Coast DHB has made available a designated resource to develop, implement and monitor the annual quality plan that takes account of the requirements for clinical effectiveness and quality improvement.

• West Coast DHB operates a system of patient satisfaction surveys that provide opportunities for seeking patient input and provides a means of linking organisational obligations with patient requirements.

AAssssoocciiaatteess The Board has a minority shareholding in: • The South Island Shared Services Agency Limited (which is owned by the six South Island DHBs and

provides them with support services around their health planning and funding roles).


GOVERNANCE PHILOSOPHY

BBooaarrdd MMeemmbbeerrsshhiipp All Board members are required to act in the best interests of the West Coast DHB. Members acknowledge that the Board must stand unified behind its decisions; individual members have no separate governing role outside the Boardroom.

CCoonnnneeccttiioonn wwiitthh SSttaakkeehhoollddeerrss The Board acknowledges its responsibility to keep in touch with stakeholders and in particular remain cognisant of the Minister’s expectations.

DDiivviissiioonn ooff RReessppoonnssiibbiilliittyy bbeettwweeeenn tthhee BBooaarrdd aanndd MMaannaaggeemmeenntt Key to the efficient running of the West Coast DHB is that there is a clear division between the roles of the Board and management. The Board concentrates on setting policy, approving strategy, and monitoring progress toward meeting objectives. Management is concerned with implementing policy and strategy. The Board has clearly distinguished these roles by ensuring that the delegation of responsibility and authority to the Chief Executive is concise and complete.

AAccccoouunnttaabbiilliittyy The Board holds six weekly meetings to monitor progress toward its strategic objectives and to ensure that the affairs of the West Coast DHB are being conducted in accordance with the West Coast DHB’s policies.

CCoonnfflliiccttss ooff IInntteerreesstt The Board maintains an interests’ register and ensures Board members are aware of their obligations to declare any potential conflicts of interest.

IInntteerrnnaall AAuuddiitt While many of the Board’s functions have been delegated, the overall responsibility for maintaining effective systems of internal control ultimately rests with the Board. Internal controls include the policies, systems and procedures established to provide assurance that specific objectives of the Board will be achieved. The Board and management have acknowledged their responsibility by signing the Statement of Responsibility on page 13 of this report. The West Coast DHB has an internal audit function, which is responsible for monitoring its systems of internal control and the quality and reliability of financial and non-financial information reported to the Board. Internal Audit operates independently of management and reports its findings directly to the Audit, Risk and Finance Committee. Internal Audit liaises closely with the external auditors, who review the systems of internal control to the extent necessary to support their audit opinion.

RRiisskk MMaannaaggeemmeenntt The Board acknowledges that it is ultimately responsible for the management of risks to the West Coast DHB. The Board has charged the Chief Executive through its risk management policy with establishing and operating a risk management programme in accordance with the “Guidelines for Managing Risk in the Australian and New Zealand Public Sector SAA / NZSHB 143:1999”.

LLeeggiissllaattiivvee CCoommpplliiaannccee The Board acknowledges its responsibility to ensure the organisation complies with all legislation. The Board has delegated responsibility to the Chief Executive for the development and operation of a programme to systematically identify compliance issues and ensure that all staff are aware of legislative requirements that are particularly relevant to them.


EEtthhiiccss The Board has adopted a code of ethics and regularly monitors whether staff maintain high standards of ethical behaviour and practice the principles of “good corporate citizenship.” Monitoring compliance with ethical standards is done through such means as monitoring trends in complaints and disciplinary actions; internal audit reports; or any reports or indications that show non-conformance with the principles espoused in the code of ethics. Good corporate citizenship involves this entity, including its employees, acknowledging that it is a member of one or more communities outside of itself, and making a commitment to act in a manner consistent with the social morals and accepted rights and responsibilities of all citizens of those communities.

REPORT OF BOARD ADVISORY COMMITTEES The West Coast DHB has three advisory committees, their existence being a requirement of the New Zealand Public Health and Disability Act 2000. These are the Hospital Advisory Committee (HAC), the Disability Support Advisory Committee (DSAC) and the Community and Public Health Advisory Committee (CPHAC). The functions of the statutory committees are as outlined in the New Zealand Public Health and Disability Act 2000. Essentially, the advisory committees are charged with providing advice on the health needs of the resident West Coast population with CPHAC having a focus on health status and DSAC focusing on the support needs of people with disabilities. The committees must also provide advice on prioritising the use of the health funding provided for the purpose of service provision. HAC has a more specific role in that it must monitor the financial and operational performance of the hospitals and related services, assess any strategic issues relating to the provision of these services, and provide advice as a result of the monitoring and assessment. All committees are advisory with the requirement that any advice given to the Board of the DHB must be consistent with the New Zealand Health Strategy. The Board remains the sole decision making body while taking cognisance of the recommendations and advice it receives from its committees. Membership of all committees comprises a mix of DHB Board members and community appointees. Board members were selected by their colleagues to sit on the committees. The Chair of the Board is a member of all advisory committees while other members have been appointed because of the particular skills and experience they bring to any committee. Community members were appointed, having been selected from people who had responded to Coast wide advertising for interested parties. Selection was on the basis of the skills and experience identified by the DHB as being necessary for such appointees and included the areas of finance, governance and health or related service provision. Where there were two or more applicants with similar qualities, selection then took account of geographic considerations. The Chairs of all committees recognise the considerable input from staff and wish to record their thanks for work well done.


SSTTAATTEEMMEENNTT OOFF RREESSPPOONNSSIIBBIILLIITTYY

FOR THE YEAR ENDED 30 JUNE 2008 In terms of the Crown Entities Act 2004, the Board is responsible for the preparation of the West Coast District Health Board’s financial statements and statement of service performance, and for the judgements made in them. The Board of the West Coast District Health Board has the responsibility for establishing, and has established a system of internal control designed to provide reasonable assurance as to the integrity and reliability of financial reporting. In the Board’s opinion, these financial statements and statement of service performance fairly reflect the financial position and operations of the West Coast District Health Board for the year ended 30 June 2008. Signed on behalf of the Board

Rex Williams Dr Christine Robertson Chair Deputy Chair 31 October 2008 31 October 2008

West Coast District Health Board

From left (back) Helen Gillespie, John Vaile, Susan Wallace, Warren Gilbertson. From left (front) Kevin Brown, David Tranter, Rex Williams, Christine Robertson, Mohammed Shahadat,

Sharon Pugh, Elinor Stratford.


RREEPPOORRTT OOFF TTHHEE AAUUDDIITTOORR--GGEENNEERRAALL

AUDIT REPORT

TO THE READERS OF WEST COAST DISTRICT HEALTH BOARD’S

FINANCIAL STATEMENTS AND STATEMENT OF SERVICE PERFORMANCE FOR THE YEAR ENDED 30 JUNE 2008

The Auditor-General is the auditor of West Coast District Health Board (the Health Board). The Auditor-General has appointed me, Andy Burns, using the staff and resources of Audit New Zealand, to carry out the audit on his behalf. The audit covers the financial statements and statement of service performance included in the annual report of the Health Board for the year ended 30 June 2008.

Unqualified Opinion

In our opinion:

• The financial statements of the Health Board on pages 16 to 44: comply with generally accepted accounting practice in New Zealand; and fairly reflect:

• the Health Board’s financial position as at 30 June 2008; and • the results of its operations and cash flows for the year ended on that date.

• The statement of service performance of the Health Board on pages 45 to 76 and 78 to 79: complies with generally accepted accounting practice in New Zealand; and fairly reflects for each class of outputs:

• its standards of delivery performance achieved, as compared with the forecast standards included in the statement of forecast service performance at the start of the financial year; and

• its actual revenue earned and output expenses incurred, as compared with the expected revenues and proposed output expenses included in the statement of forecast service performance at the start of the financial year.

The audit was completed on 31 October 2008, and is the date at which our opinion is expressed.

The basis of our opinion is explained below. In addition, we outline the responsibilities of the Board and the Auditor, and explain our independence.

Basis of Opinion

We carried out the audit in accordance with the Auditor-General’s Auditing Standards, which incorporate the New Zealand Auditing Standards.

We planned and performed the audit to obtain all the information and explanations we considered necessary in order to obtain reasonable assurance that the financial statements and statement of service performance did not have material misstatements, whether caused by fraud or error.

Material misstatements are differences or omissions of amounts and disclosures that would affect a reader’s overall understanding of the financial statements and statement of service performance. If we had found material misstatements that were not corrected, we would have referred to them in our opinion.

The audit involved performing procedures to test the information presented in the financial statements and statement of service performance. We assessed the results of those procedures in forming our opinion.


Audit procedures generally include:

• determining whether significant financial and management controls are working and can be relied on to produce complete and accurate data;

• verifying samples of transactions and account balances; • performing analyses to identify anomalies in the reported data; • reviewing significant estimates and judgements made by the Board; • confirming year-end balances; • determining whether accounting policies are appropriate and consistently applied; and • determining whether all financial statement and statement of service performance disclosures are

adequate. We did not examine every transaction, nor do we guarantee complete accuracy of the financial statements and statement of service performance.

We evaluated the overall adequacy of the presentation of information in the financial statements and statement of service performance. We obtained all the information and explanations we required to support our opinion above.

Responsibilities of the Board and the Auditor

The Board is responsible for preparing the financial statements and statement of service performance in accordance with generally accepted accounting practice in New Zealand. The financial statements must fairly reflect the financial position of the Health Board as at 30 June 2008 and the results of its operations and cash flows for the year ended on that date. The statement of service performance must fairly reflect, for each class of outputs, the Health Board’s standards of delivery performance achieved and revenue earned and expenses incurred, as compared with the forecast standards, revenue and expenses at the start of the financial year. The Board’s responsibilities arise from the New Zealand Public Health and Disability Act 2000 and the Crown Entities Act 2004.

We are responsible for expressing an independent opinion on the financial statements and statement of service performance and reporting that opinion to you. This responsibility arises from section 15 of the Public Audit Act 2001 and the Crown Entities Act 2004.

Independence

When carrying out the audit we followed the independence requirements of the Auditor-General, which incorporate the independence requirements of the Institute of Chartered Accountants of New Zealand.

Other than the audit, we have no relationship with or interests in the Health Board.

A P Burns Audit New Zealand On behalf of the Auditor-General Christchurch, New Zealand

Matters Relating to the Electronic Presentation of the Audited Financial Statements and Statement of Service Performance This audit report relates to the financial statements and statement of service performance of West Coast District Health Board (the DHB) for the year ended 30 June 2008 included on the DHB’s website. The DHB is responsible for the maintenance and integrity of the DHB’s website. We have not been engaged to report on the integrity of the DHB’s website. We accept no responsibility for any changes that may have occurred to the financial statements and statement of service performance since they were initially presented on the website. The audit report refers only to the financial statements and statement of service performance named above. It does not provide an opinion on any other information which may have been hyperlinked to or from the financial statements and statement of service performance. If readers of this report are concerned with the inherent risks arising from electronic data communication they should refer to the published hard copy of the audited financial statements and statement of service performance and related audit report dated 31 October 2008 to confirm the information included in the audited financial statements and statement of service performance presented on this website. Legislation in New Zealand governing the preparation and dissemination of financial information may differ from legislation in other jurisdictions.


SSTTAATTEEMMEENNTT OOFF AACCCCOOUUNNTTIINNGG PPOOLLIICCIIEESS

FOR THE YEAR ENDED 30 JUNE 2008

RREEPPOORRTTIINNGG EENNTTIITTYY The West Coast DHB (WCDHB) is a Health Board established by the New Zealand Public Health and Disability Act 2000. WCDHB is a Crown Entity in terms of the Crown Entities Act 2004, owned by the Crown and domiciled in New Zealand. WCDHB is a reporting entity for the purposes of the New Zealand Public Health and Disability Act 2000, the Financial Reporting Act 1993; and the Crown Entities Act 2004. WCDHB is a public benefit entity, as defined under NZIAS 1. WCDHB‘s activities involve the funding, planning and delivering of health and disability services and mental health services in a variety of ways to the community. The financial statements of the WCDHB have been prepared in accordance with the requirements of the New Zealand Public Health & Disability Act 2000, Public Finance Act 1989 and Crown Entities Act 2004. The financial statements for the WCDHB are for the year ended 30 June 2008, and were approved by the Board on 17 October 2008.

SSTTAATTEEMMEENNTT OOFF CCOOMMPPLLIIAANNCCEE The financial statements of the West Coast DHB have been prepared in accordance with Generally Accepted Accounting Practice in New Zealand (NZGAAP). They comply with New Zealand equivalents to International Financial Reporting Standards (NZIFRS), and other applicable Financial Reporting Standards, as appropriate for public benefit entities. These are the WCDHB’s first NZIFRS financial statements and NZIFRS 1 has been applied. An explanation of how the NZIFRS has affected the reported financial statements and financial performance of WCDHB is provided in note 27.

BBAASSIISS OOFF PPRREEPPAARRAATTIIOONN The financial statements are presented in New Zealand Dollars (NZD), rounded to the nearest thousand. The financial statements have been prepared on the historical cost basis, modified by the revaluation of land and buildings. The accounting policies set out below have been applied consistently to all periods presented in these financial statements and in preparing an opening NZ

IFRS statement of financial position as at 01 July 2006 for the purposes of the transition to NZ IFRS.

CCRRIITTIICCAALL AACCCCOOUUNNTTIINNGG EESSTTIIMMAATTEESS AANNDD AASSSSUUMMPPTTIIOONNSS In preparing these financial statements West Coast DHB has made estimates and assumptions concerning the future. These estimates and assumptions may differ from the subsequent actual results. Estimates and assumptions are continually evaluated and are based on historical experience and other factors, including expectations of future events that are believed to be reasonable under the circumstances. The estimates and assumptions that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year are discussed below: Property, plant and equipment useful lives and residual value

At each balance date West Coast DHB reviews the useful lives and residual values of its property, plant and equipment. Assessing the appropriateness of useful life and residual value estimates of property, plant and equipment requires West Coast DHB to consider a number of factors such as the physical condition of the asset, expected period of use of the asset by West Coast DHB, and expected disposal proceeds from the future sale of the asset. An incorrect estimate of the useful life or residual value will impact the depreciation expense recognised in the statement of financial performance, and carrying amount of the asset in the statement of financial position. West Coast DHB minimises the risk of this estimation uncertainty by: - physical inspection of assets; - asset replacement programs; - review of second hand market prices for similar assets; and - analysis of prior asset sales. West Coast DHB has not made significant changes to past assumptions concerning useful lives and residual values. The carrying amounts of property, plant and equipment are disclosed in note 7. Budget Figures The budget figures are those approved by the Board and published in its District Annual Plan and Statement of Intent. The budget figures have been prepared in accordance with generally accepted accounting practice and are consistent with the accounting policies adopted by the Board for the preparation of these financial statements. They comply with NZIFRS and other applicable Financial Reporting Standards as appropriate for public benefit


entities. Those standards are consistent with the accounting policies adopted by WCDHB for the preparation of these financial statements. Revenue Revenue is measured at the fair value of consideration received or receivable. Revenue from the Crown

WCDHB is primarily funded through revenue received from the Crown, which is restricted in its use for the purpose of the WCDHB meeting its objectives as specified in the statement of intent. Revenue from the Crown is recognised as revenue when earned and is reported in the financial period to which it relates. Other grants

Non-government grants are recognised as revenue when they become receivable unless there is an obligation to return the funds if conditions of the grant are not met. If there is such an obligation the grants are initially recorded as grants received in advance, and recognised as revenue when conditions of the grant are satisfied. Goods and Services Tax All items in the financial statements are exclusive of goods and services tax (GST) with the exception of receivables and payables, which are stated with GST included. Where GST is irrecoverable as an input tax, it is recognised as part of the related asset or expense. Taxation The WCDHB is a Crown Entity under the New Zealand Public Health and Disability Act 2000 and is exempt from income tax under the Income Tax Act 2004. Trust and Bequest Funds Donations and bequests to WCDHB are recognised as revenue when control over assets is obtained. A liability, rather than revenue, is recognised where fulfilment of any restrictions is not probable. Those donations and bequests with restrictive conditions are appropriated from retained earnings to the Trust Funds component of Equity. When expenditure is subsequently incurred in respect of these funds it is recognised in the Statement of Financial Performance and an equivalent amount is transferred from the Trust Funds component of Equity to Retained Earnings. Trade and other receivables Trade and other receivables are initially recognised at fair value and subsequently stated at amortised cost less impairment losses. Bad debts are written off during the period in which they are identified.

Inventories Inventories are held primarily for consumption in the provision of services, and are stated and the lower of cost and current replacement cost. Cost is principally determined on a weighted average cost basis. Full provision has been made for all defective and obsolete stocks. Cash and cash equivalents Cash and cash equivalents comprises cash balances, call deposits and deposits with a maturity of no more than three months from date of acquisition. Bank overdrafts that are repayable on demand and form an integral part of WCDHB’s cash management are included as a component of cash and cash equivalents for the purposes of the statement of cash flows. Impairment The carrying amounts in WCDHB’s assets other than inventories are reviewed at each balance date to determine whether there is any indication of impairment. If any such indication exists, the assets’ recoverable amounts are estimated. If an asset’s carrying amount exceeds its recoverable amount, the asset is impaired and the carrying amount is written down to the recoverable amount. For revalued assets the impairment loss is recognised against the revaluation reserve for that class of asset. Where that results in a debit balance in the revaluation reserve, the balance is recognised in the statement of financial performance. For assets not carried at a revalued amount, the total impairment loss is recognised in the statement of financial performance. The reversal of an impairment loss on a revalued asset is credited to the revaluation reserve. However, to the extent that an impairment loss for that class of asset was previously recognised in the statement of financial performance, a reversal of the impairment loss is also recognised in the statement of financial performance. For assets not carried at a revalued amount the reversal of an impairment loss is recognised in the statement of financial performance. Financial Instruments Financial instruments held for trading are classified as current assets and are stated at fair value, with any resultant gain or loss recognised in the statement of financial performance. Financial instruments held as being available-for-sale and are stated at fair value, with any resultant gain or loss recognised directly in equity. Loans and receivables are stated at fair value, using the effective interest method. Any gains or losses are recognised in the statement of financial performance.


Assets Classified as Held for Sale Non Current Assets classified as held for sale are measured at the lower of cost and fair value, less cost to sell, and are not amortised or depreciated.

PPRROOPPEERRTTYY,, PPLLAANNTT AANNDD EEQQUUIIPPMMEENNTT Under section 95(3) of the New Zealand Public Health and Disability Act 2000, the assets of Coast Health Care Limited (a Hospital and Health Service) were vested in WCDHB on 1 January 2001. Accordingly, assets were transferred to WCDHB at their net book values as recorded in the books of the Hospital and Health Service. In effecting this transfer, the Board has recognised the cost (or, in the case of land and buildings, the valuation) and accumulated depreciation amounts from the records of the Hospital and Health Service. The vested assets will continue to be depreciated over their remaining useful lives. Property, Plant and Equipment Acquired Since the Establishment of the District Health Board Assets, other than land and buildings, acquired by the Board since its establishment, and other than those vested from the Hospital and Health Service, are recorded at cost less accumulated depreciation. Cost includes all appropriate costs of acquisitions and installation including materials, labour, direct overheads, financing and transport costs. Revaluation of Land and Buildings Land and buildings are revalued every three years to their fair value as determined by an independent registered valuer. Additions between revaluations are recorded at cost. The results of revaluing land and buildings are credited or debited to an asset revaluation reserve for that class of asset. Where a revaluation results in a debit balance in the asset revaluation reserve, the debit balance will be expensed in the statement of financial performance. Assets subject to a revaluation cycle are reviewed with sufficient regularity to ensure that the carrying amount does not differ significantly from fair value at the balance sheet date. Disposal of Property, Plant and Equipment When an item of property, plant and equipment is disposed of, any gain or loss is recognised in the Statement of Financial Performance and is calculated at the difference between the net sale price and the carrying value of the asset. Depreciation Depreciation is provided on a straight-line basis on all assets with a cost or valuation above $2,000, at rates, which will write off the cost (or revaluation) of the assets to their estimated residual values over their useful lives. Assets below $2,000 are written off in the month of purchase. The estimated useful lives of major classes of assets are as follows:

Years Freehold Buildings 5 – 50 Fit Out Plant & Equipment 5 – 50 Plant and Equipment 2 – 20 Motor Vehicles 3 – 5 Capital work in progress is not depreciated. The total cost of a project is transferred to buildings and/or equipment on its completion and then depreciated. Intangible Assets Intangible assets that are acquired by the WCDHB are stated at cost less accumulated amortisation and impairment losses. Subsequent expenditure on intangible assets is capitalised only when it increases the service potential or future economic benefits embodied in the specific asset to which it relates. All other expenditure is expensed as incurred. Amortisation The carrying value of an intangible asset with a finite life is amortised on a straight-line basis over its useful life. Amortisation begins when the asset is available for use and ceases at the date that the asset is derecognised. The amortisation charge for each period is recognised in statement of financial performance. The useful lives and associated amortisation rates of major classes of intangible assets have been estimated as follows: Years Acquired computer software 2 - 10

Trade and other payables Trade and other payables are initially measured at fair value and subsequently measured at amortised cost using the effective interest method.

EEMMPPLLOOYYEEEE EENNTTIITTLLEEMMEENNTTSS

Superannuation Schemes Defined Contribution Schemes Obligations for contributions to defined contribution schemes are recognised as an expense in the statement of financial performance as incurred. Defined Benefit Schemes WCDHB belongs to the National Provident Fund, which is managed by the Board of Trustees of the National Provident Fund. The scheme is a multi-employer defined benefits scheme. Insufficient information is available to use defined benefit accounting, as it is not possible to determine from the terms of the scheme, the extent to which a surplus/deficit will affect future contributions by individual employers, as there is no prescribed basis for allocation. The scheme is accounted for as a defined contribution scheme. Further information on this scheme is disclosed in note 22.


Long Service Leave and Retirement Gratuities Entitlements that are payable beyond 12 months, have been calculated on an actuarial basis. The calculations are based on likely future entitlements accruing to staff, based on years of service, year’s entitlement the likelihood that staff will reach a point of entitlement and contractual entitlements information. The obligation is discounted to its present value. The discount rate is the market yield on relevant New Zealand government bonds at balance sheet date. Sabbatical Leave WCDHB’s obligation payable beyond 12 months that has been calculated on entitlements accruing to staff, based on years of service, years of entitlement and the likelihood that staff will reach the point of entitlement and contractual obligations. Annual Leave, Sick Leave and Medical Education Leave Annual Leave, Sick Leave and Medical Education Leave are short-term obligations and are calculated on an actual basis at the amount WCDHB expects to pay. WCDHB accrues the obligation for paid absences when the obligation both relates to employees’ past services and it accumulates. Bonuses WCDHB recognises a liability and an expense for bonuses where it is contractually obliged to pay them, or where there is a past practice that has created a constructive obligation Leased Assets Finance Leases

Leases which effectively transfer to the WCDHB substantially all the risks and benefits incident to ownership of the leased items are classified as finance leases. These are capitalised at the lower of the fair value of the asset or the present value of the minimum lease payments. The assets’ corresponding lease liabilities are recognised in the Statement of Financial Position. The leased assets are depreciated over the period the WCDHB is expected to benefit from their use. The Public Finance Act requires DHBs to obtain approval from the Minister of Health prior to entering a finance lease arrangement.

Operating Leases Leases where the lessor effectively retains substantially all the risks and benefits of ownership of the leased items are classified as operating leases. Operating lease expenses are recognised in the statement of performance on a systematic basis over the period of the lease. Interest-bearing Borrowings Interest-bearing borrowings are recognised initially at fair value less attributable transaction costs.

Subsequent to initial recognition, interest-bearing borrowings are stated at amortised costs with any difference between cost and redemption value recognised in the statement of financial performance over the period of the borrowings on an effective interest basis.

CCOOSSTT OOFF SSEERRVVIICCEE SSTTAATTEEMMEENNTTSS The cost of service statements presented in the statement of objectives and service performance report the net cost of services for the outputs of the WCDHB and represent the cost of providing the output less all the revenue that can be directly attributed to these activities. Cost Allocation WCDHB has arrived at the net cost of service for each significant activity using the cost allocation system outlined below. Cost Allocation Policy

Direct costs are charged directly to each output class. All indirect costs are charged to the provider, as they mostly relate to the costs of providing hospital and health service infrastructure. An estimation of the proportion of Governance activities that is attributed to the Provider is charged to the provider output class.

CCHHAANNGGEESS IINN AACCCCOOUUNNTTIINNGG PPOOLLIICCYY There have no changes in accounting policy during the year, which have been applied on a consistent with the prior year. Standards, amendments and interpretations issued that are not yet effective and have not been early adopted Standards, amendments and interpretations issued but not yet effective that have not been early adopted, and which are relevant to the West Coast DHB include: � NZ IAS 1 Presentation of Financial Statements

(revised 2007) replaces NZ IAS 1 Presentation of Financial Statements (issued 2004) and is effective for reporting periods beginning on or after 1 January 2009.

� NZ IAS 23 Borrowing Costs (revised 2007) replaces NZ IAS 23 Borrowing Costs (issued 2004) and is effective for reporting periods commencing on or after 1 January 2009.

� NZ specific amendment to NZ IAS 2 Inventories. In November 2007 the New Zealand Accounting Standards Review Board approved an amendment to NZ IAS 2 Inventories, which requires public benefit entities to measure inventory held for distribution at cost, adjusted when applicable for any loss of service potential.

West Coast DHB has not yet assessed the impact these statements and amendments will have on its financial statements, but does not believe any adjustment will be significant.


West Coast District Health BoardStatement of financial performance For the year ended 30 June 2008in thousands of New Zealand Dollars

Note 2008 2008 2007Actual Budget Actual

IncomeRevenue 1 109,525 105,731 101,323Other operating income 2 490 481 381Interest income 5a 1,034 300 961Total income 111,049 106,512 102,665

ExpenditureEmployee benefit costs 4a 45,104 44,179 41,292Other Personnel Costs 4b 1,330 1,609 1,658Depreciation and amortisation expense 7,8 4,486 3,365 3,027Outsourced services 3a 10,328 6,703 7,607Clinical supplies 5,979 5,611 5,770Infrastructure and non-clinical expenses 9,659 9,284 8,508Payments to other health service providers 3b 37,980 37,982 33,418Other operating expenses 3c 992 373 1,389Finance costs 5b 808 869 725Capital charge 6 671 1,177 1,659Total expenses 117,337 111,152 105,053

Net Deficit 13 (6,288) (4,640) (2,388)

West Coast District Health BoardStatement of recognised income and expenses For the year ended 30 June 2008in thousands of New Zealand Dollars


Revaluation of property, plant and equipment 13 0 0 (2,435)Other changes recognised directly in equity 13 0 0 1Net income recognised directly in equity 0 0 (2,434)

Deficit for the period 13 (6,288) (4,640) (2,388)

Total recognised income and expense for the period (6,288) (4,640) (4,822)

The accompanying notes form part of these financial statements


West Coast District Health BoardStatement of financial position As at 30 June 2008in thousands of New Zealand Dollars


AssetsNon-current assetsProperty, plant and equipment 7 27,107 34,281 26,344Intangible assets 8 1,043 0 979Other investments 10 1,589 1,587 1,589Total non-current assets 29,739 35,868 28,912

Current assetsInventories 9 663 600 605Other investments 10 3,500 0 3,500Debtors and other receivables 11 2,968 7,240 3,258Cash and cash equivalents 12 4,082 73 5,721Patient and restricted trust funds 21 65 6 63Assets classified as held for sale 19 246 264 252Total current assets 11,524 8,183 13,399Total assets 41,263 44,051 42,311

EquityCrown equity 13 45,060 49,687 45,116Other reserves 13 10,333 12,768 10,333Retained earnings/(losses) 13 (48,358) (47,785) (42,070)Trust funds 13 39 41 39Total equity 7,074 14,711 13,418

LiabilitiesNon-current liabilitiesInterest-bearing loans and borrowings 14 13,195 13,695 7,695Employee entitlements and benefits 15 2,446 2,531 2,200Total non-current liabilities 15,641 16,226 9,895

Current liabilitiesBank overdraft 12 1,267 0 0Interest-bearing loans and borrowings 14 250 0 3,500Creditors and other payables 17 9,365 9,240 8,820Employee entitlements and benefits 15 7,601 3,868 6,446Provisions 16 0 0 169Patient and restricted trust funds 21 65 6 63Total current liabilities 18,548 13,114 18,998Total liabilities 34,189 29,340 28,893Total equity and liabilities 41,263 44,051 42,311

For and on behalf of the Board

Chair Deputy Chair 31 October 2008 31 October 2008 The accompanying notes form part of these financial statements


West Coast District Health BoardStatement of cash flowsFor the year ended 30 June 2008in thousands of New Zealand Dollars


Cash flows from operating activitiesCash receipts from Ministry of Health, patients and other revenue 110,701 101,125 100,404Cash paid to suppliers (64,173) (59,951) (56,170)Cash paid to employees (44,665) (45,788) (41,182)Cash generated from operations 1,863 (4,614) 3,052

Interest received 1,096 300 571Interest paid (797) (869) (723)Goods and services tax (net) (47) 0 118Capital charge paid (1,456) (1,177) (992)Net cash flows from operating activities 12 659 (6,360) 2,026

Cash flows from investing activitiesProceeds from sale of property, plant and equipment 0 0 35Cost of disposal of assets 0 0 (91)Proceeds from sale of investments 0 3,500 0Acquisition of property, plant and equipment (5,499) (6,592) (2,356)Acquisition of intangible assets (248) 0 (321)Net cash flows from investing activities (5,747) (3,092) (2,733)

Cash flows from financing activitiesProceeds from equity injection 0 4,640 1,051Repayment of equity (68) 0 (68)Cash generated from equity transactions (68) 4,640 983

Borrowings raised 2,500 2,500 0Repayment of borrowings (250) 0 0Net cash flows from financing activities 2,182 7,140 983

Net increase in cash and cash equivalents (2,906) (2,312) 276Cash and cash equivalents at beginning of year 5,721 2,385 5,445Cash and cash equivalents at end of year 12 2,815 73 5,721

The accompanying notes form part of these financial statements


West Coast District Health BoardStatement of commitmentsAs at 30 June 2008in thousands of New Zealand Dollars

Note 2008 2007Actual Actual

Capital commitments 146 3,681

At year end WCDHB had partially completed a new primary care clinic at Ngakawau. The clinic was officially opened 21 August 2008. Non-cancellable commitments - contracted services 2008 2007

Actual Actual

Not more than one year 995 3,585One to two years 379 397Two to three years 89 280Three to four yeas 64 0Four to five years 64 0Over five years 295 0

1,886 4,262 WCDHB Funder arm holds fixed term contracts for the provision of health services. Non-cancellable commitments – operating lease commitments 2008 2007

Actual Actual

Not more than one year 336 524One to two years 246 449Two to three years 262 82Three to four yeas 0 26Four to five years 0 0Over five years 0 0

844 1,081 WCDHB leases most of its motor vehicles and has some short term accommodation leases. The accompanying notes form part of these financial statements


West Coast District Health BoardNotes to the financial statementsin thousands of New Zealand Dollars

2008 2007Actual Actual

MoH Crown Funding Agreement 97,093 90,057MoH (other) 3,277 3,606ACC 2,271 1,977Inter District Patient Inflows and other DHB 1,578 1,467Patients and Consumers 2,332 2,220Other Government Entities 14 22West Coast Primary Health Organisation (WCPHO) 23 2,960 1,974

109,525 101,323

1 Revenue Note

Revenue for health services includes all revenue received from the Crown (via the Ministry of Health), Accident Rehabilitation and Compensation Insurance Corporation (ACC) and other sources.


Gain on sale of property, plant and equipment 0 38Donations received 20 19Rental income 158 166Other 312 158

490 381


Outsourced personnelMedical and nursing services 6,641 5,005Allied health services 234 93Other services 350 355Outsourced servicesClinical services 3,103 2,154

10,328 7,607

2 Other operating income Note

Note3a Outsourced services

Outsourced personnel are costs incurred in purchasing contractors and locums, both as part of planned service delivery and to cover staff vacancies. Outsourced clinical services are costs incurred in purchasing diagnostic and treatment services. Staff vacancies during the past year resulted in some services, usually provided by WCDHB staff being provided under contract.



Personal health and Maori health services 15,148 13,180Mental health services 1,600 1,615Public health services 337 95Disability support services 6,901 6,267Inter District Patient Outflows 13,994 12,261

37,980 33,418

Note3b Other Health Service Providers

Personal and Maori health services include payments for primary health care, community pharmaceuticals, laboratory tests and patient travel (national travel assistance programme). Mental health services include payments for day activity centres, community residential care and primary health care initiatives. Public health services are payments for healthy lifestyles - nutrition and exercise. Disability support services include payments for aged related care in homes, rest homes and hospital level. 3c Other operating expenses 2008 2007

Actual Actual

Impairment of trade receivables (bad and doubtful debts) 11 41Loss on disposal of property, plant and equipment 44 271Audit fees (for the audit of the financial statements) 83 79Audit related fees for assurance and related services (IFRS assurance audit) 5 6Fees paid to auditor for other services (IFRS implementation assistance) 0 2Board and advisory members fees 24 228 196Community consultation 33 45Operating lease expenses 18 586 570Increase in provisions (restructuring) 16 0 169Donations made 2 2Restructuring expenses 0 8

992 1,389

4a Employee benefit costs 2008 2007Actual Actual

Wages and salaries 43,261 40,316Contributions to defined contribution plans 550 553Increase in employee benefit provisions 1,293 423

45,104 41,292

4b Other personnel costs 2008 2007Actual Actual

Other personnel costs 1,330 1,658

Note

These are costs incurred in relation to employees but not benefits paid directly to the employee, including costs of recruiting and training staff and costs of professional registration.


5a Interest income 2008 2007Actual Actual

Interest income 1,034 961

5b Finance costs 2008 2007Actual Actual

Interest expense 808 725

6 Capital charge 2008 2007Actual Actual

Capital charge 671 1,659

WCDHB pays a monthly capital charge to the Crown based on the greater of its actual or budgeted closing equity. The capital charge rate for the period ended 30 June 2008 was 8% (2007: 8%). The total capital charge expense for 2008 was $671,317 (this included a credit of $319,864 received from the Ministry of Health which related to the previous financial year (2007: $1,658,589 paid).


7 Property, plant and equipment

Freehold land (at

valuation)

Freehold buildings

(at valuation)

Plant, equipment

and vehicles

Leased assets

Fixtures and fittings

Work in progress Total

CostBalance at 1 July 2006 3,675 9,106 16,571 0 9,703 1,001 40,056Additions 0 0 1,475 0 22 1,276 2,773Disposals 0 (20) (2,813) 0 0 0 (2,833)Revaluations 50 (2,497) 0 0 (1,070) 0 (3,517)Assets reclassified 0 0 (28) 0 28 0 0Transfer to non-current assets held for sale 0 (51) 0 0 0 0 (51)Work in progress allocated 0 0 1,001 0 0 (1,001) 0Balance at 30 June 2007 3,725 6,538 16,206 0 8,683 1,276 36,428Balance at 1 July 2007 3,725 6,538 16,206 0 8,683 1,276 36,428

Additions 0 1,778 2,342 235 545 204 5,104Disposals 0 0 (803) 0 0 0 (803)Revaluations 0 0 0 0 0 0 0Work in progress allocated 0 1,258 0 18 0 (1,276) 0Balance at 30 June 2008 3,725 9,574 17,745 253 9,228 204 40,729

Depreciation and impairment lossesBalance at 1 July 2006 0 (37) (10,949) 0 (4) 0 (10,990)Depreciation charge for the year 0 (628) (1,319) 0 (944) 0 (2,891)Assets reclassified 0 0 23 0 (23) 0 0Transfer to non-current assets held for sale 0 80 0 0 0 0 80Disposals 0 0 2,635 0 0 0 2,635Revaluations 0 314 0 0 768 0 1,082Balance at 30 June 2007 0 (271) (9,610) 0 (203) 0 (10,084)Balance at 1 July 2007 0 (271) (9,610) 0 (203) 0 (10,084)Depreciation charge for the year 0 (1,022) (1,422) (99) (1,759) 0 (4,302)Transfer to non-current assets held for sale 0 6 0 0 0 0 6Disposals 0 0 758 0 0 0 758Revaluations 0 0 0 0 0 0 0Balance at 30 June 2008 0 (1,287) (10,274) (99) (1,962) 0 (13,622)Carrying amountsAt 1 July 2006 3,675 9,069 5,622 0 9,699 1,001 29,066At 30 June 2007 3,725 6,267 6,596 0 8,480 1,276 26,344

At 1 July 2007 3,725 6,267 6,596 0 8,480 1,276 26,344At 30 June 2008 3,725 8,287 7,471 154 7,266 204 27,107

Freehold land, buildings, fixtures and fittings Freehold land, buildings, fixtures and fittings at Grey Base Hospital were revalued 30 June 2007, by Coast Valuations (Registered Valuers). Buller and Reefton Hospitals were revalued 30 June 2006. Buller, Reefton and Greymouth Hospitals are stated at optimised depreciated replacement cost. Remaining core assets are stated at fair value (market based). The resulting movement in land, buildings, fixtures and fittings has been recognised in equity in an Asset Revaluation Reserve (refer to note 13). The economic life of Grey Base Hospital structural assets was revised from 14 years (June 2006) to 5 years (June 2007) in order to fairly reflect the facilities expected life. The useful life of Buller and Reefton Hospitals facilities reflects the WCDHB's intention to replace both of these facilities in the near future, being 7 years and 3 years respectively 1 June 2006. Restrictions Some of the WCDHB’s land is subject to the Ngai Tahu Claims Settlement Act 1998. This requires the land to be offered to Ngai Tahu at market value as part of any disposal process.


8 Intangible assets Software TotalCostBalance at 1 July 2006 1,270 1,270

Additions 341 341

Disposals (8) (8)Balance at 30 June 2007 1,603 1,603

Balance at 1 July 2007 1,603 1,603Additions 248 248Balance at 30 June 2008 1,851 1,851

Amortisation and impairment lossesBalance at 1 July 2006 (497) (497)

Amortisation charge for the year (135) (135)

Disposals 8 8Balance at 30 June 2007 (624) (624)

Balance at 1 July 2007 (624) (624)

Amortisation charge for the year (184) (184)Balance at 30 June 2008 (808) (620)

Carrying amountsAt 1 July 2006 773 773At 30 June 2007 979 979

At 1 July 2007 979 979At 30 June 2008 1,043 1,043

9 Inventories 2009 2008Actual Actual

Pharmaceuticals 117 97Surgical and Medical Supplies 327 341Other supplies 219 167

663 605

Write-down of inventories amounted to $3,465 for 2008 (2007: nil). There have been no reversals in write downs. The amount of inventories recognised as an expense during the year ended 30 June 2008 was $2,064,716 (2007: $1,831,334). No inventories are pledged as security for liabilities but some inventories are subject to retention of title clauses. The value of stocks subject to such clauses cannot be quantified due to the inherent difficulties in identifying the specific inventories affected at year-end.


10 Other investments 2008 2007Actual Actual

Non-currentEquity instrument 2 2Term deposits (maturing 1 November 2010 - 7.79%) 20 1,587 1,587

1,589 1,589CurrentTerm deposits (maturing 31 July 2008 - 8.82.%) 20 3,500 3,500

3,500 3,500Total investments 5,089 5,089

Note

WCDHB has a 4% share in South Island Shared Services Limited (SISSAL) (2007: 4%) WCDHB has funds deposited with ASB Bank Limited (2007: ASB Bank Limited). 11 Debtors and other receivables 2008 2007

Actual Actual

Trade receivables 20 215 204Ministry of Health receivables 1,185 1,120Other Crown receivables 692 1,112Accrued revenue 623 672Prepayments 253 150

2,968 3,258

Note

Trade receivables are shown net of provision for doubtful debts amounting to $54,346 (2007: $72,324) recognised in the current year and arising from patient debt and small balances uneconomic to pursue. 12 Cash and cash equivalents


Bank balances 20 22 521Petty cash and imprest 20 5 4Call deposits 20 4,055 5,196Cash and cash equivalents 4,082 5,721Bank overdrafts 20 (1,267) 0Cash and cash equivalents in the statement of cash flows 2,815 5,721

Note

West Coast DHB administers certain funds on behalf of patients. These funds are held in separate bank accounts (not included in the above) and interest earned is allocated to the individual patients. Working capital facility WCDHB has a working capital facility supplied by BNZ which was established in November 2003. The facility consists of a bank overdraft with a debit limit of $3,690,000. As at 30 June 2008 $835,585 had been drawn. The BNZ working capital facility is secured by a negative pledge. Without BNZ's prior written consent, WCDHB can not perform the following actions: • create or permit to exist any security interest over its assets except in certain circumstances agreed with the

lender, • lend money to another person or entity (except in the ordinary course of business and then only on commercial

terms) or give a guarantee, • make a substantial change in the nature or scope of its business as presently conducted, • dispose of any of its assets except disposals at full value in the ordinary course of business, and • raise, or increase the principal amount of a loan except with the Crown Financing Agency.


WCDHB must also meet certain bank covenants: • the Gearing Ratio will at all times be less than or equal to 65%, and • the Net Operating Deficit for each monthly period from the 1 July of each year shall not exceed the budgeted

Net Operating Deficit for that month by more than 10% or $500,000. During the year to 30 June 2008 there were periods when the WCDHB was in breach of these covenants, specifically relating to: • the gearing ratio (debt to debt plus equity of 65% or better) The WCDHB did not receive additional equity for deficit support during the year as the WCDHB had sufficient

cash and cash equivalents to meet its short term commitments. • Net operating deficit (within 10% or $500,000 of budgeted net operating deficit). The net operating deficit exceeded the budget due mainly to the revaluation of Grey Base Hospital in June

2007 and the decision to change its economic life from 14 years to 5 years which resulted in a higher depreciation expense and due to a higher outsourced services expense. These issues have been included in the budgeted net operating deficit for the 2008/09 financial year.

These breaches were reported to the BNZ in regular quarterly compliance certificates and have been discussed verbally with the BNZ. West Coast DHB intends to renegotiate its bank covenants in 2008-09 in order to remedy this issue and do not expect any issues in doing this.


Deficit for the period (6,288) (2,388)Add back non-cash items:Depreciation and amortrisation expense 4,486 3,027

Add back items classified as investing activity:Net loss/(gain) on disposal of property, plant and equipment 44 233

Add back items classified as financing activity: 0 0

Movements in working capital:(Increase)/decrease in debtors and other receivables 290 (1,333)(Increase)/decrease in inventories (58) (4)Increase/(decrease) in creditors and other payables 952 2,062Increase/(decrease) in employee benefits 1,402 423Increase/(decrease) in provisions (169) 6Net movement in working capital 2,417 1,154Net cash inflow/(outflow) from operating activities 659 2,026

Note

Reconciliation of deficit for the period with net cash flows from operating activities:


13 Equity and reservesReconciliation of movement in equity and reserves

Crown equity

Property revaluation

reserve

Trust/ Special

funds Retained earnings

Total equity

Balance at 1 July 2006 44,133 12,768 40 (39,683) 17,258Total recognised income and expense (2,388)Contribution from the Crown 1,051Equity repaid to the Crown (68)Movement in revaluation of land 50

Movement in revaluation of buildings, fixtures and fittings (2,369)Transfer to retained earnings (116) (1) 1Balance at 30 June 2007 45,116 10,333 39 (42,070) 13,418

Balance at 1 July 2007 45,116 10,333 39 (42,070) 13,418Total recognised income and expense (6,288)Contribution from the Crown 12Equity repaid to the Crown (68)Movement in revaluation of land 0

Movement in revaluation of buildings, fixtures and fittings 0Transfer from retained earnings 0 0 0Balance at 30 June 2008 45,060 10,333 39 (48,358) 7,074

The WCDHB's capital is its equity, which comprises accumulated funds and other reserves. Equity is represented by net assets. The WCDHB is subject to the financial management and accountability provisions of the Crown Entities Act 2004, which imposes restrictions in relation to borrowings, acquisition of securities, issuing guarantees and indemnities and the issue of derivatives. The WCDHB manages its equity as a by-product of prudently managing revenues, expenses, assets, liabilities, investments and general financial dealings to ensure WCDHB effectively achieves its objectives and purpose, whilst remaining a going concern. Property Revaluation Reserve The revaluation reserve relates to land and buildings. Freehold land, buildings, fixtures and fittings at Grey Base Hospital were revalued as at 30 June 2007, by Coast Valuations (Registered Valuers). Buller and Reefton Hospitals were revalued 30 June 2006. Buller, Reefton and Grey Base Hospitals are stated at optimised depreciated replacement cost, whilst remaining core assets were stated at fair value (market based). Trust funds 2008 2007

Actual Actual

Balance at beginning of year 39 40Transfer from retained earnings in respect of:Interest received 0 0Donations and funds received 0 0Transfer to retained earnings in respect of:Funds spent 0 (1)Balance at end of year 39 39

Trust funds are funds donated or bequeathed for a specific purpose. The use of these assets must comply with the specific terms of the sources from which the funds were derived. The revenue and expenditure in respect of these funds is included in the statement of financial performance. An amount equal to the expenditure is transferred from


the trust fund component of equity to retained earnings. An amount equal to the revenue is transferred from retained earnings to trust funds. 14 Interest-bearing loans and borrowings 2008 2007

Actual ActualNon-current Crown Health Financing Agency 20 13,195 7,695

13,195 7,695

Current Crown Health Financing Agency 20 250 3,500

250 3,500

Note

Secured bank loans West Coast DHB has a secured bank loan with the Crown Health Financing Agency. The details of terms and conditions are as follows: Interest rate summary 2008 2007

Actual Actual% %

Crown Health Financing Agency 20 6.11-7.69 6.11-6.31

Note

Repayable as follows: 2008 2007

Actual Actual

Within one year 20 250 3,500One to two years 20 250 0Two to three years 20 7,945 0Three to four years 20 1,500 7,695Four to five years 20 0 0Later than five years 20 3,500 0

13,445 11,195

Total loan facility limits 2008 2007Actual Actual

Crown Health Financing Agency 13,445 13,69513,445 13,695

Security and terms The Crown Health Finance Agency (CHFA) are secured by a negative pledge. This restricts the WCDHB's actions in the following areas without the CHFA's prior written consent: a Security Interest: Create any security interest over its assets except in certain defined circumstances, b Loans and Guarantees: Lend money to another person or entity (except in the normal course of business), or give a guarantee, c Change of Business: Make or threaten to make a substantial change in the nature or scope of its business as presently conducted, d Disposals: Dispose of any assets except in the normal course of business or disposals for full value, e Provide Services: Other than for proper value and on reasonable commercial terms.


15 Employee entitlements and benefits 2008 2007Actual Actual

Non-current liabilitiesLiability for long-service leave 286 226Liability for sabbatical leave 102 0Liability for retirement gratuities 2,058 1,974

2,446 2,200

2,008 2,007Actual Actual

Current liabilitiesLiability for long-service leave 261 32Liability for sabbatical leave 22 116Liability for retirement gratuities 451 357Liability for annual leave 2,915 2,484Liability for other leave 913 750Liability for sick leave 90 25Liability for continuing medical education leave 384 225Salary and wages accrued 2,565 2,457

7,601 6,446

Liability for defined benefit plan WCDHB makes contributions to the National Provident Fund, a defined benefit scheme that provides pension benefits for employees on retirement. The scheme is managed by the Board of Trustees of the National Provident Fund. The defined benefit plan is a multi-employer defined benefit scheme. Insufficient information is available to use defined benefit accounting as it is not possible to determine, from the terms of the scheme, the extent to which a deficit or surplus will affect future contributions by individual employers, as there is no prescribed basis for allocation. WCDHB have therefore accounted for defined benefit plan contributions as if they were to a defined contribution plan. Contributions to the scheme have therefore been recognised as an expense in the statement of financial performance as incurred. 16 Provisions Restructuring

Balance at 1 July 2007 169

Provisions made during the year 0

Provisions used during the year (135)

Provisions reversed during the year (34)Balance at 30 June 2008 0

Restructuring At 30 June 2007 a provision of $168,796 was made to cover the estimated staff cost of relocating Pyschogeriatic Mental Health Services into a new purpose built facility at Grey Base Hospital. The estimated costs were based on a detailed plan agreed by the Board. The move was completed by November 2007 at a cost of $134,503.


17 Creditors and other payables 2008 2007Actual Actual

Trade payables 6,855 6,332ACC levy payable 345 295GST and PAYE payable 1,429 1,027Income in advance relating to contracts with specific performance obligations 669 314Capital charge due to the Crown 67 852

9,365 8,820

Note

18 Operating leasesLeases as lessee 2008 2007Non-cancellable operating leases and rentals are payable as follows: Actual Actual

Less than one year 336 524Between one and five years 508 557More than five years 0 0

844 1,081

WCDHB leases most of its motor vehicles, the premises of Greymouth Medical Centre, office space from the WCPHO and other short term accommodation.

Motor vehicle leases run for a period of 45 months, whilst the other leases are for 3 years with rights of renewal. During the year ended 30 June 2008, $479,618 was recognised as an expense in the statement of financial performance in respect of operating leases for motor vehicles (2007: $511,279) and $105,540 was recognised in respect of property leases (2007: $58,540). 19 Non-current assets held for sale The WCDHB has identified land and buildings which it intends to sell and presented these as assets held for sale. These assets are measured at current book value $246,253 (2007: $251,757). 20 Financial instruments The WCDHB is party to financial instruments as part of its everyday operations. These include instruments such as bank balances, investments, trade accounts receivable and payable and loans. The Board has policies providing risk management for interest rates and the concentration of credit. The Board is risk averse and seeks to minimise exposure from its treasury activities. Its policies do not allow any transactions, which are speculative in nature to be entered into. The Boards' Audit, Risk, Finance Committee provides oversight for risk management. Credit Risk Credit risk is the risk that a third party will default on its obligation causing the Board to incur a loss. Financial instruments which potentially subject the WCDHB to risk consist of cash, term investments and trade receivables. The Board places its cash and term investments with high quality financial institutions and limits the amount of credit exposure to any one financial institution. Term deposits are held with ASB Bank Limited and day to day banking and call facilities with BNZ. Concentrations of credit risk with respect to accounts receivable are high due to the reliance on the Ministry of Health which comprises 38% (2007: 33%) of the debtors of the WCDHB. Together with Other Crown Receivables (ACC, Pharmac, other DHB's) total reliance on Government debtors is 68% (2007: 68%). The Ministry of Health, as the Government funder of health and disability support services for the West Coast region and other Crown entities are high credit quality entities and the Board considers the risk arising from this concentration of credit to be very low. The status of trade receivables at the reporting date is as follows:


Trade ReceivablesGross

Receivable Impairment NetGross

Receivable Impairment Net2008 2008 2008 2007 2007 2007

Not past due 159 0 159 196 0 196Past due 0-30 days 23 0 23 26 (18) 8Past due 31-60 days 30 0 30 18 (18) 0Past due 61-365 days 51 (48) 3 21 (21) 0Past due more than 1 year 6 (6) 0 15 (15) 0Total Gross Receivables 11 269 (54) 215 276 (72) 204

Note

There has been an of impairment of $54,346 (2007: $72,324) Trade receivables are due from patients and external parties to whom the WCDHB has provided health and disability services and other clinical supplies and services. Receivables due from the Ministry of Health, ACC, Pharmac, Crown entities and other DHB's are not included as trade receivables. At the balance sheet date there were no significant other concentrations of credit risk. The maximum exposure to credit risk is represented by the carrying amount of each financial asset in the statement of financial position. Interest Rate Risk Interest Rate Risk is the risk that the fair value of financial instruments will fluctuate or, the cash flows from a financial instrument will fluctuate, due to changes in market interest rates. WCDHB has term deposits with ASB Bank Limited invested on a fixed rate basis and secured term borrowings with the Crown Health Financing Agency on a fixed rate basis. WCDHB has a set-off arrangement with the BNZ on its operating accounts. The debit rate of interest is 8.88% to $3,690,000, excess at 11.658%, the credit rate is 2.25% (2007: 8.465% to $3,690,000, excess at 11.25%, credit rate 2.25%). Surplus funds for daily operations are held on call until required, when they are transferred to operating accounts the rate of interest for call funds at 30 June 2008 was 8.20% (2007: 7.95%). Effective interest rates and repricing analysis In respect of income-earning financial assets and interest-bearing financial liabilities, the following table indicates their effective interest rates at the balance sheet date and the periods in which they reprice.

NoteEffective

interest rate Total6 mths or

less 6-12 mths 1-2 yrs 2-5 yrsMore than

5 yrsEffective

interest rate Total6 mths or

less 6-12 mths 1-2 yrs 2-5 yrsMore than

5 yrs% %

Cash and cash equivalents 12 0 27 27 0 0 0 0 0 47 47 0 0 0 0Cash and cash equivalents 12 2.25 0 0 0 0 0 2.25 478 478 0 0 0 0Cash and cash equivalents 12 8.20 4,055 4,055 0 0 0 0 7.95 5,196 5,196 0 0 0 0Other investments* 10 8.82 3,500 3,500 0 0 0 0 7.62 3,500 3,500 0 0 0 0Other investments* 10 7.79 1,587 0 0 0 1,587 0 7.79 1,587 0 0 0 1,587 0Secured bank loans:NZD fixed rate loan* 14 6.58 3,500 0 0 0 0 3,500 6.31 3,500 3,500 0 0 0 0NZD fixed rate loan* 14 6.11 7,695 0 0 0 7,695 0 6.11 7,695 0 0 0 7,695 0NZD fixed rate loan* 14 7.69 250 0 250 0 0 0NZD fixed rate loan* 14 7.58 250 0 0 250 0 0NZD fixed rate loan* 14 7.44 250 0 0 0 250 0NZD fixed rate loan* 14 7.28 1,500 0 0 0 1,500 0 6.11 0 0 0 0 0 0Bank overdrafts (total facility) 8.88 3,690 3,690 0 0 0 0 8.465 3,690 3,690 0 0 0 0Bank overdrafts (drawn) 8.88 1,267 1,267 0 0 0 0 8.465 0 0 0 0 0 0

2008 Actual 2007 Actual

Liquidity Risk Liquidity risk represents the WCDHB's ability to meet its contractual obligations. The WCDHB evaluates its liquidity requirements on an ongoing basis. In general, the WCDHB generates sufficient cash flows from its operating activities to meets its obligations from its financial liabilities and has credit lines in place to cover potential shortfalls. The following table sets out the contractual cash flows for all financial liabilities that are settled on a gross cash flow basis.


Balance Sheet

Contractual cash flows

6 mths or less 6-12 mths 1-2 yrs 2-5 yrs

More than 5 yrs

2008Secured CHFA loans 13,445 16,783 564 680 1,097 10,529 3,913Unsecured bank loans 0 0 0 0 0 0 0Unsecured bank overdraft facility 0 0 0 0 0 0 0Trade and other payables 9,365 9,365 9,365 0 0 0 0Bank overdraft 1,267 1,267 1,267 0 0 0 0Total 24,077 27,415 11,196 680 1,097 10,529 3,913

2007Secured CHFA loans 11,195 13,009 3,985 234 470 8,320 0Unsecured bank loans 0 0 0 0 0 0 0Unsecured bank overdraft facility 0 0 0 0 0 0 0Trade and other payables 8,820 8,820 8,820 0 0 0 0Bank overdraft 0 0 0 0 0 0 0Total 20,015 21,829 12,805 234 470 8,320 0

Fair values The fair values together with the carrying amounts shown in the statement of financial position are as follows:

Carrying amount Fair value

Carrying amount Fair value

2008 2008 2007 2007Note Actual Actual Actual Actual

Equity securities available-for-sale 10 2 2 2 2Financial instruments held to maturity 10 5,087 5,087 5,087 5,087Debtors and other receivables 11 2,968 2,968 3,258 3,258Cash and cash equivalents 12 4,082 4,082 5,721 5,721Secured bank loans 14 13,445 13,541 11,195 11,027Creditors and other payables 17 9,365 9,365 8,820 8,820Bank overdraft 12 1,267 1,267 0 0

36,216 36,312 34,083 33,915

Unrecognised (losses)/gains 96 (168) Estimation of fair values analysis The following summarises the major methods and assumptions used in estimating the fair values of financial instruments reflected in the table. Interest bearing loans and borrowings Interest bearing loans are recognised initially at fair value less attributable transaction costs. Subsequent to initial recognition, interest bearing loans are stated at amortised costs with any differences between cost and redemption value recognised in the statement of financial performance over the period of the loan on an effective interest basis. Financial instruments held to maturity are classified as current assets and non-current assets depending on their maturity date. Interest, calculated using the effective interest method is recognised in the statement of financial performance. Receivables Debtors and other receivables are initially recognised at fair value and subsequently stated at amortised cost less impairment losses. Bad debts are written off in the period in which they are identified.


Categories of financial assets and liabilities


Loans and receivablesCash and cash equivalents 4,082 5,721

Debtors and other receivables 2,968 3,258

Investments-short term deposits 3,500 3,500

Investments-term deposits 1,587 1,58712,137 14,066

Financial assets at fair value through equityInvestments-equity instruments 2 2

2 2

Financial liabilities Bank overdraft 1,267 0

Creditors and other payables 9,365 8,820

Borrowings-secured loans 13,445 11,19524,077 20,015

21 Patient and restricted trust funds The WCDHB administers certain funds on behalf of patients. These funds are held in separate bank accounts and any interest earned is allocated to the individual patient balances.


Opening balance patients deposits 57 54

Monies received 3 13

Interest earned 4 2

Payments made (5) (12)

Closing balance 59 57

The WCDHB has trust funds donated for specific purposes which have not yet been met.


Opening balance restricted trust funds 6 6

Monies received 0 0

Interest earned 0 0

Payments made 0 0

Closing balance 6 6

22 Contingencies Contingent liabilities Employment lawsuit The WCDHB has a contingent liability related to legal action instigated by former employees. These claims are being defended by WCDHB. Superannuation schemes The WCDHB is a participating employer in a multi-employer defined benefit superannuation scheme. If the other participating employers ceased to participate in the scheme the WCDHB could be responsible for the entire deficit


of the scheme. Similarly, if a number of employers ceased to participate in the scheme the WCDHB could be responsible for an increased share of the deficit. As at 31 March 2007 (last available valuation), the scheme had a past service surplus of $33.7 million (11.4% of the liabilities). This amount is exclusive of Specified Superannuation Contribution Withholding Tax (SSCWT). This surplus was calculated using a discount rate equal to the expected return on the assets, but otherwise the assumptions and methodology were consistent with the requirements of NZ IAS 19. The Actuary to the Scheme has recommended the employer contribution reduces from 2.0 times contributors' contributions to 1.0 times contributors’ contributions. The 1.0 is inclusive of SSCWT. Contingent assets The WCDHB has no contingent assets (2007: nil) 23 Related parties Ownership WCDHB is a crown entity in terms of the Crown Entities Act 2004 and is wholly owned by the Crown. The government significantly influences the role of the WCDHB in addition to being its major source of revenue. Transactions with other entities controlled by the Crown The WCDHB enters into transactions with government departments, state-owned enterprises and other Crown entities. These transactions that occur within a normal supplier or client relationship on terms and conditions no more or less favourable than those which it is reasonable to expect the WCDHB would have adopted if dealing with that entity at arm's length in the same circumstances, have not been disclosed as related party transactions. Identity of related parties WCDHB has a related party relationship with its board members and executive management team. In addition to salaries WCDHB contributes to a post-employment defined benefit scheme and to a defined contribution scheme for some executive officers and board members. In accordance with the terms of the defined benefit scheme, on retirement the employees entitlement is based on the their average salary over the previous five years multiplied by a factor determined by the number of years they have contributed. All related parties transactions have been entered into on an arms length basis. The aggregate value of transactions and outstanding balances relating to key management personnel and entities over which they have control or significant influence were as follows:


Short-term employee benefits-executive management 1,598 1,318Short-term employee benefits-board members 240 618Post-employment benefits 37 56

1,875 1,992

Key management personnel compensations

Key management personnel include three employees who were members of the Board until 9 December 2007 (2007:3 for the full year), the Chief Executive and the remaining 10 members of the executive management team (2007: 9). Short-term employee benefits include all salary and leave payments and lump sum payments. Post-employment benefits are WCDHB contributions to superannuation schemes. Sales to related parties


WCPHO 2,960 1,9742,960 1,974

Elinor Stratford (board member from 10 December 2007 and member of the CPHAC advisory committee) is a member of the Clinical Governance Committee of the WCPHO. The WCDHB provides funding to and receives


funding from the WCPHO for primary medical services, including capitation, very low cost access and rural incentives. Purchases from related parties


WCPHO 7,486 4,434SISSAL 206 204Rata Te Awhina Trust 659 633

8,351 5,271% %

Olsens Pharmacy 24 23 The WCDHB has a 4% (2007: 4%) equity interest in SISSAL. SISSAL provide governance services including audit, contract management and analysis. Barbara Greer (a member of the CPHAC advisory committee) is a Tumuaki of Rata Te Awhina Trust. The WCDHB has contracts with Rata Te Awhina Trust for the provision of primary health services. Julie Kilkelly (a WCDHB Board member until 9 December 2007) is a director of Olsen's Pharmacy. The WCDHB has agreements with community pharmacies for the provision of pharmaceuticals and related services to the community. The table above shows the % of the total WCDHB funder arm spend on pharmaceuticals paid to Olsen’s Pharmacy. Leases from related parties


WCPHO 20 0Mawhera Incorporation 65 38

85 38

The WCDHB has entered fixed term agreements to lease premises and office space. The WCDHB leases office space from the WCPHO. The lease terminates August 2011, with two rights of renewal of two years each. Barbara Greer (a member of the CPHAC advisory committee) is a shareholder of the Mawhera Incorporation. The WCDHB leases the premises occupied by the Greymouth Medical Centre from the Mawhera Incorporation. The lease terminates December 2009 with two rights of renewal of one year each. Outstanding balances to related parties


WCPHO 515 63Rata Te Awhina Trust 55 53

570 116

Outstanding balances from related parties2008 2007

Actual Actual

WCPHO 91 20Rata Te Awhina Trust 0 67

91 87


24 Board member remuneration The total value of remuneration paid to each Board and Advisory Committee member during the year was:

2008 2008 2008 2007 2007 2007Board Advisory

CommitteeTotal Board Advisory

CommitteeTotal

Board members (full year)C Robertson (Deputy Chair) 20,000 4,375 24,375 19,167 5,188 24,355M Shahadat 16,000 1,000 17,000 6,250 875 7,125S Wallace 16,000 1,188 17,188 10,333 875 11,208W Vaile 16,000 1,250 17,250 15,333 1,250 16,583Board member from 10 December 2007R Williams (Chair) 17,893 1,750 19,643K Brown 8,946 0 8,946W Gilbertson 8,946 2,250 11,196H Gillespie 8,946 500 9,446 250 250S Pugh 8,946 1,000 9,946D Tranter 8,946 500 9,446E Stratford 8,946 1,750 10,696 1,250 1,250Board members to 9 December 2007G Coster (Chair) 14,108 3,750 17,858 30,667 4,750 35,417R Bryant 7,054 7,054 15,333 750 16,083J Kilkelly 7,054 7,054 15,333 250 15,583M Stuart 7,054 7,054 15,333 0 15,333B Wilkinson 7,054 1,000 8,054 15,333 2,250 17,583C Atmore 7,054 1,250 8,304 15,333 625 15,958G Baldick (to August 06) 3,210 250 3,460Advisory committee members (not Board)B Greer (CPHAC) 1,250 1,250 750 750K Cannan (HAC) 1,750 1,750 1,500 1,500S Ransom (CPHAC) 2,000 2,000 1,250 1,250R Wallace (HAC) 1,500 1,500 2,250 2,250B Holland (CPHAC, HAC) 4,000 4,000 3,750 3,750L Mason (CPHAC) 250 250 1,000 1,000N Tauwhare (DSAC) 500 500 250 250G Axford (DSAC) 1,250 1,250 750 750L Beirne (DSAC) 1,250 1,250 250 250M Molloy (HAC) 1,250 1,250 250 250R Barber (DSSAC) 250 250 2,000 2,000H Rasmussen (CPHAC) 1,250 1,250 250 250P Nolan (DSAC) 1,250 1,250 1,250 1,250

188,947 39,313 228,260 161,625 34,063 195,688

The WCDHB carries Directors and Officers Liability insurance and letters of indemnity have been arranged which cover the actions of Board members and employees of the WCDHB.


25 Employee remuneration 2008 2007

Actual Actual100,001 - 109,999 7 3110,000 - 119,999 5 1120,000 - 129,999 2 2130,000 - 139,999 3 3140,000 - 149,999 2 2150,000 - 159,999 3 2160,000 - 169,999 5 2170,000 - 170,999 3 0180,000 - 189,999 2 4190,000 - 199,999 1 0200,000 - 209,999 2 3210,000 - 219,999 2 3230,001 - 239,999 2 2240,000 - 249,999 2 2250,000 - 259,999 2 3260,000 - 269,999 4 0270,000 - 279,999 2 1290,000 - 299,999 1 0

320,000 - 329,999 1 0420,000 - 429,999 0 1440,000 - 449,999 0 1

490,000 - 499,999 1 0 500,000 - 509,999 0 1

Total Employees 52 36 Fifty two employees received total remuneration of greater than $ 100,000. The figure stated includes payment for additional duties and lump sum payments during the year including payment of backpay when collective agreements were settled and severance payments. The Chief Executive's remuneration is shown in the $290,001-300,000 band. Of the fifty two employees shown, forty four are clinical employees and eight are not clinical employees. If the remuneration of part time employees or employees who had not completed a full 12 months of employment was grossed up to a full time equivalent (FTE) basis the total number of employees with FTE salaries of $100,000 or more would be 60 compared with the actual number of employees of fifty two. All of these additional employees are clinical staff. During the year ended 30 June 2008 13 (2007: 0) employees received payments relating to the termination of their employment totalling $349,925 (2007: 0), excluding retiring gratuities paid out. No Board members received compensation or other benefits in relation to cessation (2007: 0). 26 Subsequent event There are no significant events subsequent to balance date.


27 Explanation of transition to NZ IFRS Transition to NZ IFRS As stated in the Statement of Accounting Policies, these are the WCDHB's first financial statements to be prepared in accordance with NZ IFRS. The WCDHB's transition date is 1 July 2006 and the opening NZ IFRS balance sheet has been prepared as at that date. The WCDHB's NZ IFRS adoption date is 1 July 2007. Reconciliation of equity The following table shows the changes in equity, resulting from the transition from previous NZ GAAP to NZ IFRS as at 1 July 2006 and 30 June 2007. West Coast District Health BoardNotes to the financial statementsin thousands of New Zealand Dollars

Previous GAAP

Effect of transition to

NZIFRS

NZIFRS Previous GAAP

Effect of transition

to NZIFRS

NZIFRS

AssetsProperty, plant and equipment a. 29,839 (773) 29,066 27,323 (979) 26,344Intangible assets b. 0 773 773 0 979 979Other investments 5,089 0 5089 1,589 0 1,589Total non-current assets 34,928 0 34,928 28,912 0 28,912

Inventories 601 0 601 605 0 605Other investments 0 0 0 3,500 0 3,500Trade and other receivables 1,931 0 1,931 3,258 0 3,258Cash and cash equivalents 5,445 0 5,445 5,721 0 5,721Patient and restricted trust funds 60 0 60 63 0 63Assets classified as held for sale 264 0 264 252 0 252Total current assets 8,301 0 8,301 13,399 0 13,399Total assets 43,229 0 43,229 42,311 0 42,311

EquityCrown equity f. 44,147 0 44,147 45,130 (14) 45,116Other reserves 12,768 0 12,768 10,333 0 10,333Retained earnings/(losses) g. (39,683) (14) (39,697) (42,059) (11) (42,070)Trust funds 40 0 40 39 0 39Total equity 17,272 (14) 17,258 13,443 (25) 13,418

LiabilitiesInterest-bearing loans and borrowings 11,195 0 11,195 7,695 7,695Employee benefits 2,297 0 2297 2,200 2,200Total non-current liabilities 13,492 0 13,492 9,895 0 9,895

Interest-bearing loans and borrowings 0 0 3,500 0 3,500Trade and other payables c. 8,950 0 8,950 11,446 (2,626) 8,820Employee benefits d. 3,455 14 3,469 3,964 2,482 6,446Provisions e. 0 169 169Patient and restricted trust funds 60 0 60 63 0 63Total current liabilities 12,465 14 12,479 18,973 25 18,998Total liabilities 25,957 14 25,971 28,868 25 28,893Total equity and liabilities 43,229 0 43,229 42,311 0 42,311

Note 01-Jul-06 30-Jun-07


Explanatory notes - Reconciliation of equity a. Property, plant and equipment Computer software has been reclassified as an intangible asset. It was previously classified as property, plant and equipment. b. Intangible assets Computer software has been reclassified as an intangible asset. It was previously classified as property, plant and equipment. c. Trade and other payables Payroll Accruals (unpaid days) has been reclassified as an employee benefit. It was previously classified as trade and other payables. d. Employee benefits The adjustments to employee entitlements are as follows: Payroll accruals (note c.) 2,626Provisions (note e.) (169)Sick Leave 25

2,482 Sick Leave was not recognised as a liability under previous NZ GAAP. NZ IAS 19 requires the WCDHB to recognise employees' unused sick leave entitlement that can be carried forward at balance sheet date, to the extent the WCDHB anticipates it will be used by staff to cover future absences. e. Provisions At 30 June 2007 a provision of $168,796 was made to cover the estimated cost of relocating Pyschogeriatic Mental Health Services into a new purpose built facility at Grey Base Hospital. The estimated costs were based on a detailed plan agreed by the Board. Restructuring was completed by November 2007. This provision has been reclassified as a provision. It was previously classified as employee benefits. f. Crown equity The adjustment to Crown Equity is for the sick leave provision (note d.) g. Retained earnings/(losses) The adjustment to retained earnings/losses is for the sick leave provision (note d.).


Reconciliation of deficit for year ending 30 June 2007 The following table shows the changes in the WCDHB's deficit, resulting from the transition from previous NZ GAAP to NZ IFRS for the year ending 30 June 2007.

West Coast District Health BoardNotes to the financial statementsin thousands of New Zealand Dollars

Note Previous GAAP

Effect of transition to

NZIFRS

NZIFRS

IncomeRevenue 101,303 0 101,303Other operating income b. 387 14 401Finance income 961 0 961Total income 102,651 14 102,665

ExpenditureEmployee benefit costs a. 41,281 11 41,292Other Personnel Costs 1,658 0 1,658Depreciation and amortisation expense 3,027 0 3,027Outsourced services 7,607 0 7,607Clinical supplies 5,770 0 5,770Infrastructure and non-clinical expenses b. 8,510 14 8,524Payments to other health service providers 33,418 0 33,418Other operating expenses 1,373 0 1,373Finance costs 725 0 725Capital charge 1,659 0 1,659Total expenses 105,028 25 105,053

Net Deficit (2,377) (11) (2,388)

30-Jun-07

Explanatory notes - Reconciliation of deficit

a. Employee benefit costs This represents the increase in sick leave provisions, which was not recognised under previous NZ GAAP. b. Gain on sale Gain on sale of fixed assets has been reclassified as other operating income. It was previously included under infrastructure and non-clinical expenses.

Statement of cash flows

On transition to NZ IFRS the statement of cash flows presents the increase in Other Investments with maturities of 4 - 12 months and short term deposits with maturities less than three months are now included as part of cash and cash equivalents. This reclassification of short term deposits and cash equivalents has impacted on the statement of cash flows by a net decrease of cash and cash equivalents of $3,500,000.


SSTTAATTUUTTOORRYY IINNFFOORRMMAATTIIOONN

NEW ZEALAND PUBLIC HEALTH AND DISABILITY ACT 2000 Section 42(3) of the New Zealand Public Health and Disability Act 2000 requires DHBs to provide the information outlined below in their annual reports. These requirements are in addition to those specified in Section 151 of the Crown Entities Act 2004. We have shown them here for ease of reference, but the information may be incorporated into other parts of the annual report, for example, the Board Members report, the statement of service performance or the notes to the accounts.

PPeerrssoonnnneell PPoolliicciieess The following Board policies contribute to and assist the Board in meeting its objectives as a good employer. The policies provide guidance and support to staff and management to ensure all employees are treated fairly and equitably: • Recruitment • Employee Assistance Programme • Equal Employment Opportunity • Good Employer Procedure • Orientation • Prevention Of Harassment • Smoke-Free Workplace Policy And Procedure • Staff Code Of Conduct • Staff Discipline, Suspension And Dismissal Procedure • Staff Guidelines On Cultural Safety • Training And Development • Performance Management • Leave

OOtthheerr OObbjjeeccttiivveess The DHB has consulted extensively during 2005/2006 with local communities (both geographic and communities of interest) during the development of the 2005-2015 District Strategic Plan, the WISE plan and Child and Youth Health Plans and has incorporated results of that consultation into the District Strategic Plan. This Plan identifies key health gain areas for the West Coast population upon which the DHB should focus its resources. The West Coast DHB has been consolidating this Plan during 2005-2006. The plans and other activities ensure the West Coast DHB has materially complied with all statutory objectives outlined on the following pages.


SSTTAATTUUTTOORRYY OOBBJJEECCTTIIVVEE EEXXTTEENNTT TTOO WWHHIICCHH IITT HHAASS BBEEEENN MMEETT

To improve, promote and protect the health of people and communities

Public Health

An increase in public health workforce capacity to plan and implement public health and health promotion initiatives was a significant development in the West Coast DHBs ability to improve, promote and protect the health of West Coast people and communities.

The addition of both a public health analyst and a joint initiative with Nelson Marlborough and South Canterbury DHBs to fund public health intelligence capacity, has increased the DHB’s capacity to:

• assess and monitor the population’s health status and health service needs

• improve the community’s understanding of population health

• engage with communities, community agencies and non government organisations, iwi and local government to identify and implement population health strategies and initiatives within their influence

• work across sectors on addressing the determinants of health e.g. housing

A Smokefree DHB Co-ordinator has also increased capacity, and the Smokefree DHB plan has resulted, with agencies across the health sectors working in the development and implementation of the plan. Smoking cessation service capacity improved and service utilisation has increased as a result.

Increased workforce capacity in the Healthy Eating Healthy Action team has also increased the focus on improving, promoting and protecting health. HEHA has focused on priority populations (children, youth and Māori), with co-ordinators for community, Māori and education resulting in cross-agency and cross-sector collaboration and expansion of the Tucking In initiatives, development of a Māori HEHA action plan and increasing uptake of the HEHA nutrition fund.

Other achievements include improved breastfeeding and immunisation rates. There was also significant amount of planning for the implementation of two new Population Health initiatives namely the B4 School Check programme, and the HPV Immunisation programme both which will begin in September 2008.

Primary Health

Primary health providers and primary health organisations play a key role in improving, promoting and protecting the health of individuals and communities. The West Coast PHO provides clinical programmes and health promotion activities that contribute to the implementation of the Primary Health Strategy and its objectives.

Progress has been made across a range of areas including chronic conditions screening and management, healthy lifestyles and green prescriptions programs, and promoting free access sexual health and contraceptive services for under 22s. 2007/08 has seen an increase in PHO enrolments, smoking cessation referrals, and immunisation coverage at age two years.

The most significant achievement in the area of primary


care, however, is the increased uptake by primary practices of Very Low Cost Access (VLCA) funding. All West Coast practices are now VLCA funded, and the benefits of reducing the costs of accessing primary care services and the impact on reducing inequalities cannot be underestimated.

Chronic Conditions Management – Cardiovascular Disease, Stroke Care Management, Cancer Control, Respiratory and Palliative Care

The West Coast DHB continued the roll-out of its Chronic Conditions Care Management Plan during 2007/08 (commenced in 2006/07). The Plan covers all stages of the health and illness continuum for people with chronic conditions in terms of optimising a healthy environment, providing for at risk populations, managing the acute event; initial management (first six months) of a chronic condition and the longer term management (over six months) of a chronic condition. Across each of these five major categories in the continuum, the plan looks towards improvement in the following seven elements over three years in the West Coast setting: healthy systems (organisation of health care), community resources and policy, delivery system redesign, decision support, clinical information systems, self-management and equity in health including access to and outcomes of health care.

In addition to active screening of risk factors in primary practice (obesity and improving nutrition, smoking reduction, annual diabetes checks, annual CVD reviews and risk assessments, etc.), and the HEHA and smokefree initiatives aimed at reducing the burden of chronic conditions, other specific activities included the following:

• The Patient Self Management programme was actively promoted, with a good take up rate by patients, and is proving extremely popular

• The Patient Held Record is being used at both primary (GP, pharmacy, etc.) and secondary settings to provide updated information and self-management information for patients

• The West Coast DHB is an active participant in the South Island Chronic Conditions Management Group, which is designed to share ideas, experiences and, where appropriate, joint inter-DHB planning for service delivery

• Smokefree DHB Co-ordinator commenced in January 2008

Cancer

In addition to the initiatives outlined above, other specific work around addressing cancer during 2007/08 included:

• Implementation of a new pilot Cancer Navigator Service on the West Coast in October 2007, including one specific Māori navigator, to provide direct help, guidance and liaison for people living with cancer on the West Coast

• The West Coast DHB Cancer Control Steering Group commenced (with multi-sector input along similar lines to the Local Diabetes Team), to help to prioritise and action the recommendations to bridge service gaps that were identified in the study on cancer and palliative care pathways “The Journey of Treatment and Care for People with Cancer on the West Coast”,


by Fiona Doolan-Noble et al. • The West Coast DHB commenced work in May 2008

with the Southern Cancer Network to promote inter-DHB collaboration in service planning and delivery of regional cancer services

• Provisional work was commenced to look at introducing the Liverpool Pathway of Care for the Dying on the West Coast

The West Coast DHB continues to support the national Cervical Screening and Breast screening programmes. The DHB also conducts colonoscopy screening services to provide proactive screening for people with high risk and / or family history of bowel cancer.

Diabetes

In addition to the initiatives outlined above aimed at tackling diabetes and other chronic conditions, the Local Diabetes Team met regularly and has been closely involved in implementation of diabetes service delivery initiatives and closer inter-sectoral collaboration during the year, as well as helping shape future planning ahead for 2008/09.

Healthy Eating – Healthy Action (HEHA)

Considerable work was undertaken in 2007/08 on determining a governance and leadership structure for HEHA, developing and implementing collaborative initiatives around improving nutrition, increasing physical activity and improving breastfeeding rates, and building capacity and capability to deliver the HEHA strategy. The 2007/08 HEHA Ministry Approved Plan was established and implemented with a focus on breastfeeding, schools and early childhood centres, capacity and capability, children, youth and their whānau, older West Coasters and individuals living in NZ Dep 8, 9 and 10.

A Health Promotion Governance Group was established and includes membership from the West Coast DHB, West Coast PHO, Community and Public Health and Māori Health. This group provides governance and expertise for HEHA, Smokefree and other health promotion activities. The HEHA Education Sub Group has also been established to administer the Nutrition Fund and co-ordinate service delivery in schools and early childhood centres.

There has been an increased emphasis on the evaluation and monitoring of HEHA initiatives and the importance of the West Coast DHB role modelling HEHA and ‘walking the talk’.

To promote the integration of health services, especially primary and secondary health services

There has been continued progress in increasing liaison and integration between primary and secondary care services, particularly between the West Coast DHB and the West Coast PHO; there has also been closer collaboration with other local NGO and volunteer health sector agencies, e.g. the Cancer Society and Home Hospice Trust.

Primary / Secondary Integration

A Primary Health liaison position has continued to improve primary and secondary health service integration and share collaborative information on a number of initiatives, particularly in chronic disease management and cancer control. Integration between primary and secondary mental health services has continued to develop through the primary mental health initiative liaison nurse and an increase in the number of primary / secondary interface meetings at


To promote effective care or support for those in need of personal health services or disability support services

To promote the inclusion and participation in society and independence of people with

practices.

Public Health Integration

Closer collaboration on the planning and provision of health promotion services between the West Coast DHB, West Coast PHO and Community and Public Health has advanced through the integrated Health Promotion Governance Group. The Health Promotion Governance Group comprises management level representation from the three organisations and serves as the stakeholder group for HEHA, Smokefree and other health promotion activities. Joint planning and collaboration on health promotion initiative is a key function of this group.

Integration with local NGO and volunteer health sector agencies, as well as across sectors, has also progressed with the amalgamation of Active West Coast and the Health Promotion Infrastructure Working Group. These two groups merged during 2007/08 with the establishment of the Health Promotion Governance Group. Clear lines of communication and reporting have been established between the enhanced Active West Coast Network and HP Governance Group.

In 2007 a significant initiative to inform future service provision commenced through a West Coast DHB and Ministry of Health joint planning partnership - the West Coast Sustainability Project. This is aimed at identifying and planning for an ongoing and fully sustainable model of care and clinical services for the district. There are four components of the sustainability project:

• Services

• Workforce (clinical and managerial)

• Facilities and

• Funding models.

This project was achieving all of its objectives and deadlines as of the financial year end and will lead to a business case for facilities and review of financial modelling for the DHB during 2008/2009.

In addition to the sustainability project, implementation of other service plans and reviews in 2007/08 included:

• Chronic Conditions Management Plan • Integrated Diabetes Service Plan • West Coast Improving Services for the Elderly • Primary Health Plan • Primary Mental Health Plan • Child Health Plan • Healthy Eating Healthy Action Plan • Disability Action Plan • Buller Health Plan • Cancer Control Strategy • Youth Health Plan • Māori Health Plan • Secondary Care Plan

A Smokefree DHB plan has been developed during the year and will be implemented from 2008-09 onwards.

The West Coast DHB, as a good employer, has a policy to support and promote equal employment opportunities for people with disabilities and to ensure the absence of


disabilities discrimination against individuals. The Disability Support Advisory Committee advises the Board on disability issues. The DHB also has a Disability Action Plan that promotes opportunity and access to facilities and services for people with disabilities. Throughout 2007/08 the DHB continued to fund the Disability Information Service to organise a bi-annual Health and Disability Services expo, and annual disability awareness training for health and other providers. 50 health and social service agency workers attended disability awareness training in the year to July 2008.

To reduce health disparities by improving health outcomes for Māori and other population groups

Consultation with Māori Communities

The West Coast District Health Board has regular meetings with Tatau Pounamu, the iwi-appointed Mana Whenua health committee to the West Coast DHB. This group comprises representatives from Poutini Ngai Tahu, Te Runanga O Ngati Waewae and Te Runanga O Makaawhio, as well as Nga Maata Waka o Mawhera and Nga Maata Waka o Kawatiri. A number of consultations have occurred with local Māori communities regarding the Māori Health Plan 2007-2011, the Cancer Strategy, the Healthy Eating Healthy Action Project, the Diabetes Awareness Hui and the restructure of Mäori Mental Health Services.

Health Needs Assessment

The West Coast-Te Tai O Poutini Māori Health Profile 2008 was released this year. The Health Needs Assessment was prepared by Community and Public Health for the DHB utilising ten years of aggregated data from the PHI Unit.

Māori Health Plan

The West Coast DHB Māori Health Plan 2007-2011 / Te Kaupapa Hauora Māori 2007-2011 was completed and ratified by the West Coast District Health Board in 2007. This plan sets the future direction for Māori health, and defines pathways that enable the utilisation of accessible and appropriate health services for all Māori who live on Te Tai O Poutini.

Increasing Staff and Community Awareness of the Importance of Reducing Disparities

Ongoing activities are in place to raise staff awareness of the importance of reducing disparities; these include Reducing Inequalities Training, which was provided to some Board and Advisory Committee members and Executive Managers in 2007/08.

Memorandum of Partnership with Local Māori

A Memorandum of Understanding between the West Coast District Health Board and Poutini Ngai Tahu was signed in October 2007. The purpose of the Memorandum of Understanding is to articulate agreed principles, consistent with the philosophy of the New Zealand Public Health and Disability Act 2000, and it sets the guidelines for an enduring collaborative relationship that aims to improve health outcomes for Māori.

To reduce, with a view to eliminating, health outcomes disparities between various population groups in New Zealand be developing and implementing, in consultation with the groups concerned, services and

Cultural Awareness Training

Te Pikorua Bi-Cultural Safety workshops and Te Tiriti o Waitangi workshops continue to be available for staff. An introduction to Māori Health and Inequalities is provided in


programmes designed to raise their health outcomes to those of other New Zealanders

To exhibit a sense of social responsibility by having regard to the interests of the people to whom it provides, or for whom it arranges the provision of, services

To foster community participation in health improvement, and in planning for the provision of services and for significant changes to the provision of services

To uphold the ethical and quality standards commonly expected of providers of services and of public sector organisations

To exhibit a sense of environmental responsibility by having regard to the environmental implications of its operations

the West Coast DHB Orientation Programme for new staff. Staff attendee evaluations show that these workshops are popular with staff. These workshops are also open to staff working in various non-government organisations (NGOs) on the West Coast.

The Health Equity Assessment Tool has been used in the development of health plans, business cases and new services. Services to Improve Access funding was utilised by the West Coast Primary Health Organisation focused on addressing areas where inequalities were more prominent. This resulted in the implementation of a Buller Kaihautu / Kaiawhina in the Buller Region where Māori enrolments in the Primary Health Organisation were low; this has since improved. Use of the Health Equity Assessment Tool has enabled a more efficient prioritisation process to occur and takes into account the need to reduce health inequalities for Māori.

The DHB continues to engage with the community and ensure participation in service planning where significant changes are likely to occur. The establishment of community health fora in Karamea, Reefton and Hari Hari during the year has improved planning and funding engagement with these communities and provided opportunities for regularly feedback on issues of specific interest to them.

The Board monitors ethical and quality standards performance and has met this objective fully.

The Board meets all requirements for the operation of its facilities including waste management and air discharge. It maintains its facilities to a good standard.


The New Zealand Health and Disability Act 2000 Section 23 defines the functions of a DHB. The West Coast DHB has given effect and intends to give effect to its statutory functions as listed below: STATUTORY FUNCTION 1. HOW IT HAS BEEN GIVEN EFFECT

2. HOW THE BOARD INTENDS TO EFFECT IT To ensure the provision of services for its resident population and for other people as specified in its Crown funding agreement To actively investigate, facilitate, sponsor and develop co-operative and collaborative arrangements with persons in the health and disability sector or in any other sector to improve, promote and protect the health of people and to promote the inclusion and participation in society and independence of people of disabilities To issue relevant information to the resident population, persons in the health and disability sector and persons in any other sector working to improve, promote and protect the health of people for the purposes of the two functions above To establish and maintain processes to enable Māori to participate in and contribute to strategies for Māori health improvement To continue to foster the development of Māori capacity for participating in the health and disability sector and for providing for the needs of Māori

1. Crown Funding Agreement deliverables met. 2. The Board intends to meet the requirements of all funding

agreements that it enters. 1. The Board continues to be actively involved in:

a. DHBNZ, an association of DHBs that acts for DHBs on matters of common interest;

b. South Island Shared Services Agency Limited, jointly owned by the South Island DHBs to assist with health planning and to provide support services to DHBs;

c. Management and staff are involved in numerous forums with the Minister of Health, other DHBs and local agencies;

d. Management and staff are actively involved in national policy advisory and review groups that relate to the health and disability sector.

2. Primary / secondary sector integration and inter-agency

collaboration continued as a key focus for the DHB during 2007/08. This included continuing participation in the Disability Information Network, the next phase of the Cancer Patient Journeys project, the Regional Intersectoral Forum and the ongoing development of a cancer navigator service.. During 2007/2008 the DHB provider arm explored collaborative working opportunities with Nelson Marlborough District Health Board and in 2008 a sub-regional initiative to develop collaborative service delivery between West Coast, Nelson Marlborough and Canterbury DHBs under the aegis of the Sustainability Project.

1. Via print and news media, website and public

consultation.

The West Coast DHB has maintained several process to enable Māori to participate and contribute to strategies for Māori Health Improvement during 2007/08 namely;

a. Regular meetings with Tatau Pounamu, the Mana Whenua Health Committee to the West Coast DHB

b. Māori representation on all of the advisory groups to the West Coast DHB. CPHAC has three Māori members. There are regular meetings with, and ongoing support of, Rata Te Awhina Trust, the local Māori Health provider

The West Coast DHB employed a Māori Health Portfolio Manager in June 2008 who is focusing on reviewing the Māori Workforce Development Plan and beginning implementation of some key strategies emerging from it. Initial meetings have been held with the Greymouth High School Principal and Gateway Co-ordinator to begin planning a programme to encourage and support Māori students into a career in health and provide Gateway opportunities within the DHB. A Māori staff hui is planned


for the end of October and will be used as a platform for discussion around training support and opportunities for staff. The Māori Mental Health Service has been launched with the recruitment of Pukenga Tiaki – Māori Mental Health positions currently underway. In addition the General Manager of Māori health has worked closely with the West Coast PHO to assist with the provision of Māori positions such as a Māori Cancer Navigator and the Kaiawhina working to enrol Māori into Primary Care Services in the Buller region.


PPLLAANNNNIINNGG AANNDD FFUUNNDDIINNGG RREEPPOORRTT

Planning for financially and clinically sustainable health and disability support services for the West Coast has been a significant focus for Planning and Funding during 2007/08. The joint Sustainability Project, being undertaken in partnership with the Ministry of Health, commenced in October 2007, resulting to date in the design for a West Coast model of care and business case for the National Capital Funding to allow facilities to be updated or rebuilt in order to allow a sustainable model of care to be implemented.

The model includes greater collaboration with other DHBs, particularly around clinical staffing, as well as increased integration between primary, community and secondary care services and providers. While implementation is still in its initial stages, components of the model not requiring physical building changes, such as strong, effective health promotion, education and primary health service delivery, all of which are central to the West Coast’s future strategic direction, have already begun.

Excellent working relationships with the West Coast PHO have enabled primary / secondary service integration to progress, particularly in the areas of mental health and chronic conditions management. Formal joint strategic planning processes between the West Coast PHO, West Coast DHB and Community and Public Health has facilitated effective planning, prioritisation and co-ordination of health promotion initiatives, and has aided development of the organisations’ respective plans, including appropriate sections of the DHB’s District Annual Plan.

The past year has also seen the West Coast DHB increase its capacity in working across sectors to address the determinants of health. In addition to continuing to lead regular intersectoral collaboration meetings (involving central and local government agencies, runanga and other sector leaders) the DHB is increasingly collaborating across sectors to address individual lifestyle factors, social and community influences, living and working conditions and general socio-economic condition. A particular focus has been set on the areas of healthy lifestyles (smoking, healthy eating and physical activity) family violence, transport (including active transport and road safety) and education.

The development of community health fora in Karamea, Reefton and Hari Hari has increased planning and funding connections with these communities and provided opportunities for community input and feedback. The DHB has plans to establish community in health fora in Greymouth, Westport and Hokitika in 2008/09.

In the last year the DHB has also made significant progress in implementing a number of key priorities within the New Zealand Health Strategy and the DHB’s District Strategic Plan.

Particular achievements have included: Very Low Cost Access (VLCA) funding Māori Health Needs Assessment

Māori Healthy Eating Healthy Action Plan Smokefree DHB Plan

Sustainability Project


MMAAOORRII HHEEAALLTTHH RREEPPOORRTT A Memorandum of Understanding (MOU) has now been signed between the West Coast DHB and Te Runanga o Ngati Wae Wae and Te Runanga O Makaawhio the purpose of which is to articulate agreed principles consistent with the philosophy of the New Zealand Public Health and Disability Act 2000. After the signing a hui involving Board and Papatipu Runanga members was held on Te Tauraka Waka Maui Marae in June 2008 to celebrate the signing. The West Coast District Health Board has regular six weekly meetings with Tatau Pounamu, the iwi-appointed Mana Whenua health committee to the West Coast DHB. This group comprises representatives from Poutini Ngai Tahu, Te Runanga O Ngati Waewae and Te Runanga O Makaawhio, Nga Maata Waka o Mawhera and Nga Maata Waka o Kawatiri. A number of consultations have occurred with local Mäori communities regarding the Māori Health Plan/ Te kaupapa Hauora Maori- 2007-2011, the Cancer Strategy, the Healthy Eating Healthy Action Project and Mäori Mental Health Services. Under the West Coast Maori Health plan the priority areas in Tai Poutini are Primary Health, Improving Chronic Conditions, Implementing the Cancer Control Strategy, Cardiovascular Disease, Diabetes, Healthy Lifestyles, Health Eating Health Action and Maori Workforce Development Whanau Ora is the theme of the West Coast Maori Health Plan. The District Annual Plan states the West Coast DHB will, through the Maori Health Plan work towards reducing health inequalities for Mäori and that all staff at the WCDHB will receive training in the Treaty of Waitangi and its implications and guidance for Mäori health gain and best practice. In addition the Te Pikorua training remains very popular particularly with clinical staff. In March 2008 Nadia Glavish a very well known and respected kuia from Ngati Whatua came to Te Tai Poutini to speak with staff from the Mäori provider the DHB and PHO and NGOS about Tikanga Maori in relation to providing treatment to Mäori. This was very well received with approx 90 people in attendance throughout the day and good publicity through local health communications.

CCAANNCCEERR The perspectives of West Coast Maori cancer patients and their whānau have been recorded and the findings included in a comprehensive report entitled ‘The journey of treatment and care of people with cancer on the West Coast’. Funding has been approved for a cancer navigator and co-ordinator roles, contracted to the PHO. The steering committee will include iwi representation. One of the navigators is Mäori and will be working with Maori and their whanau.

MMAAOORRII MMEENNTTAALL HHEEAALLTTHH A review of the Mäori mental health service has been undertaken to ascertain how the needs of Mäori with mental health issues can be best met. As a result of the review there has now been a reconfiguration of the Mäori mental health services this means that the service is now much more aligned with national priorities and strategies in Maori mental health.

MMAAOORRII RREECCRRUUIITTMMEENNTT Recent appointments aimed at improving Mäori health include a Kaihautu in Buller to support Mäori engagement with primary healthcare services, a cancer navigator working through the West Coast PHO with Mäori, a 0.5 FTE position working on the development of Falls Prevention programmes and Physical Activity initiatives for kaumatua, a 0.5 FTE position for Mäori Registered Nurse Smear Taker / Health Promoter and an Outreach Immunisation Service Mäori Community worker to improve childhood immunisation rates amongst tamariki Māori. In addition a new role of Kaiarahi /Maori mental health manager has been developed and now established and we are currently in the process of recruiting two Pukenga/ Mäori mental health support workers for the Maori mental services.

HHEEAALLTTHH NNEEEEDDSS PPRROOFFIILLEE A Health Needs Profile has now been completed by Community Public Health, the Mäori health department has assisted since this project began. This is an excellent and extremely comprehensive piece of work, with extensive statistics provided on demography and social data and how this relates to the health status of Tai Poutini Maori. In summary West Coast Maori have poorer health status than West Coast Non Mäori, as demonstrated by a range of indicators, including cardiovascular disease cancer, diabetes and respiratory disease indicators.


RREEGGIIOONNAALL AANNDD NNAATTIIOONNAALL NNEETTWWOORRKKSS Te Herenga Hauora / South Island DHB Māori health managers work closely to improve health outcomes for Māori throughout Te Wai Pounamu through collaboration and co-operation. The General Manager of Maori health for the West Coast DHB is now the Chairperson of Tumu Whakarae the National Maori health manager’s strategic group. Tumu Whakarae held their national hui in Greymouth in March 2008 the Powhiri was held at Arahura.

MMAAOORRII WWOORRKKFFOORRCCEE The Maori Workforce development plan has been rewritten. The broad aim of the plan is to increase the number and improve the skills of the Mäori Health and Disability workforce on the West Coast. Key components of the plan include working with Rangatahi in schools, having recruitment and retention strategies that include Rangatahi, second chance learners and Mäori already in the workforce. A review entitled Human Resources Cultural Responsiveness to Maori has been completed and the Maori health department is currently working with the HR department to develop an action plan for the recommendations from the review.

PPRRIIMMAARRYY The WCPHO has completed the writing of its Maori health plan with the assistance of the WCDHBs General Manager Maori Health. The plan has deliberate stretch targets for improving Maori health from a primary care perspective on Te Tai o Poutini. A series of hui called Oranga Pai that promotes wellness amongst Maori communities have been planned. The first of these hui was held in Hokitika in October 2008. The kaupapa is consistent with the objectives within the WCDHB Maori health plan. Cultural competency training has now been confirmed by the WCPHO this is to be done by Mauri Ora Associates and feedback from the practices has been positive re the provision of this training.

FFIINNAANNCCIIAALL IINNVVEESSTTMMEENNTT 22000066//0077 The DHB increased financial investment for the 2006/07 annual spend. This went into a part time position Tamariki Ora Immunisation Kaitautoko, in the Outreach Immunisation Service, a Cancer Navigator for Maori in the PHO cancer navigation pilot, a Māori HEHA co-ordinator and a Māori Health Portfolio Manager

The West Coast DHB continues its programme of introducing signage and carvings and other Maori taonga within its facilities. New carvings have been placed in the Lecture Theatre at Grey Base Hospital and new facilities will have Māori signage within them.


MMEENNTTAALL HHEEAALLTTHH RREEPPOORRTT

PPrrooggrraammmmee ffoorr IInntteeggrraattiioonn ffoorr MMeennttaall HHeeaalltthh DDaattaa ((PPRRIIMMHHDD)) The Programme for Integration for Mental Health Data (PRIMHD) is a national programme of work led and coordinated by the Ministry of Health. It extends and integrates the collection of information about mental health service delivery to consumers and consequent outcomes, and the exchange of that information with the Ministry of Helath for national reporting. The programme also supports the provision of local reporting, making information available to clinicians and management for the purpose of monitoring and improving service delivery outcomes. The PRIMHD programme within the West Coast DHB • integrated the Mental Health Information National Collection (MHINC) service delivery information and Mental

Health Standard Measures of Assessment and Recovery (MH-SMART) suite of consumer outcome measurement tools within District Health Board (DHB) mental health provider arms, to provide national and local reporting

• Joined the Mental Health Information Reporting System (MHIRS) project to develop a solution to enable extension of PRIMHD to include DHB - funded community mental health providers (MH NGOs), and promote sharing of information between providers.

At 12:00 midday on Wednesday 20th of August 2008 the NZHIS production environment of PRIMHD was switched on and processed its first live production Mental Health Teams Data File. Following the completion of their compliance testing that same day, the Ministry of Health processed the first live PRIMHD DHB production files for West Coast DHB. Congratulations went to the PRIMHD Team of West Coast DHB for the timeliness of their first production files and a great 100% initial processing result. This was the culmination of three years hard work to deliver the PRIMHD Project within the WCDHB on time, to meet national deadlines.

WWFFDD FFuunnddiinngg RReeppoorrtt 22000077--22000088 Over the past year the focus of the Workforce Development Committee has been on supporting personal development that is enhancing the development of core skills for Mental Health. There has been a considered plan to continue to deliver a greater percentage of training on site, to enhance the access to training and education. Overall this approach has resulted in more staff accessing some form of professional development activity over the financial year, which enables more staff to meet HPCA requirements.

KKaahhuurraannggii The new purpose built dementia unit opened as scheduled and is functioning very well. Residents of the unit settled into their new spacious surroundings rapidly and it is very pleasing to note that the number of falls and incidents has fallen dramatically. The key principle in designing a homely, comfortable yet practical unit was providing for the least restrictive yet safe environment and we have achieved that.

CClloossuurree ooff SSeeaavviieeww HHoossppiittaall The shift of dementia services from Hokitika marks the end of 135 years of providing psychiatric services from Seaview Hospital. Closure of Seaview has meant many people who previously lived in villas ‘on the hill’ now live independently in the community or in supported accommodation provided by the local NGO, PACT Group. Freeing resources from the hospital has meant we are able to provide a much wider range of mental health services in the community for people with serious mental health issues.


CCOOMMMMUUNNIITTYY SSEERRVVIICCEESS RREEPPOORRTT This DHB is unique in that it owns and operates most of the primary practices on the West Coast. This gives us the opportunity to protect the future provision of primary health services in this rural area. As with a number of rural areas in New Zealand, we are experiencing difficulties recruiting doctors to the region. With the help of the Human Resources department we have been actively recruiting General Practitioners, but are dependant on the services of locum doctors in the meantime. • The Buller Health Medical Centre is current working towards Cornerstone Accreditation. Reefton Medical

Centre has achieved accreditation prior to the DHB purchasing the practice in 2006. Greymouth Medical Centre will start the process in the near future.

• All DHB owned practices have a good working relationship with the West Coast PHO, attending training, utilising resources and working collaboratively with PHO staff.

• Otago GP Immersion Programme – hosting rotation of GP students; scheduling time in Westport, Karamea, Ngakawau

A feature of primary service provision on the West Coast is the provision of a significant quantum of primary or first contact services by rural nurse specialists, often in remote and sparsely populated parts of the region, working under standing orders. • Nurse Practitioner – currently the West Coast District Health Board has one staff member who has achieved

this qualification. There are also other nurses Rural Nurse Specialist working towards this qualification • Thrombolysis – the West Coast District Health Board has rolled this initiative out over the region. This is the

only region within New Zealand where independently working Rural Nurse Specialists are instigating treatment. • B4 School Check – the purpose of the check is to provide early identification of any behavioural, developmental

or health concerns that may adversely affect a child’s ability to learn in the school environment, and ensure that appropriate and timely referrals are made to support the child and their family, to improve child health and educational outcomes and reduce inequalities.

• The new Ngakawau Clinic was opened by the Associate Minister of Health during the year providing wonderful modern surroundings for the Rural Nurse Specialist based there. This is part of an ongoing programme to replace our numerous rural clinics.

As previously with Buller Health, Reefton Health connects inpatient, care of the elderly, community services and the primary practice into one entity. Rural Innovations Funding resulted in a project which, now implemented, will drive the integration of health services in Reefton and surrounding areas. Planned reconfiguration of the existing facility will mean improved efficiency in administration and improved clinical pathways. With the appointment of a Clinical Services Manager, services now have an integrated management structure which will drive the integration of clinical services in the district. Carelink is a new service of the West Coast DHB that provides Needs Assessment and Service Coordination for people who are over 65 and have an identified need for long term (over 6 months) support services. Carelink is working toward being a central point of referral for all community based services and will manage the Older Persons DSS budget. The establishment of Carelink is an exciting further step in the implementation of the WISE [West Coast Integrating Services for Older People] Plan.


SSEECCOONNDDAARRYY SSEERRVVIICCEESS RREEPPOORRTT Activity within Grey Base Hospital was affected at various times by industrial action and staffing shortages. Due to the efforts of our committed and dedicated staff the overall impact was minimised and we still achieved over 13,601 publicly funded specialist outpatient appointments and outpatient minor operations, 2,950 publicly funded case weighted discharges across medical and surgical services (these figures exclude surgical outpatient attendances and discharges funded by ACC), 433 endoscopy procedures and over 8,800 allied health appointments. Staffing issues continue to be the greatest issue facing the hospital and these are across all professional and occupational groups. Developing relationships with other District Health Boards to provide our staff with greater collegial support and strategies to recruit and retain staff are high on the priority list for the 2008/09 year.

AACCTTIINNGG CCHHIIEEFF MMEEDDIICCAALL AADDVVIISSOORR RREEPPOORRTT Since 16 April 2007 we have had the privilege of teaching the first intake of Rural Immersion fifth year medical students. We were delighted that they all successfully passed their end of year exams and wish them well in their future medical careers. Subsequent to the success of last years group we had many more applications than there were places for this year’s Rural Immersion Project and we welcome the three students’ selected for positions here. A new project called Incubator has also started which is looking to attract local students to careers in Health over a broad spectrum including careers in medicine. We are hopeful that initiatives such as this and the Rural Immersion Project will assist in the major issue of recruitment and retention of staff that all DHB’s face today. Unfortunately because of our small size we are more vulnerable than larger DHB’s however small size is also an advantage when looking to innovative new ways to solve these international issues. Difficulties in finding qualified practitioners at both Junior and Senior Medical staff levels have created many challenges this year in providing care for our communities. Again we have used these problems as opportunities to look at new ways of doing things. One of these is an initiative with the Nelson Marlborough District Health Board to look at collaboration to improve services to communities in the upper part of the South Island. We look forward to continuing progress in these areas, and discussions are being held between Senior clinicians from Nelson Marlborough and the West Coast. The medical staff are all committed to attendance at continuing medical education meetings held by their Colleges and other agencies. We hold regular Morbidity and Mortality meetings to discuss where we can make changes to improve the services our patients need. Our Credentialing programme continues to run with initial credentialing of new staff who work for the DHB for more than 6 months and re-credentialing on a 3 yearly basis, looking at general feedback from hospital staff and external peers along with requirements for regular practice audit processes and attendance at continuing medical education meetings.


NNUURRSSIINNGG AANNDD MMIIDDWWIIFFEERRYY RREEPPOORRTT While the year has been a productive and positive one for nursing and midwifery, nursing workforce shortages have provided considerable challenge. In order to provide a full range of patient services ward mergers between medical, surgery and paediatrics during the summer holidays and the winter peak have been necessary. To achieve service continuance, nurses have had to step outside their areas of speciality and care for a wider range of patients; a challenge they have ably accepted. A feature of the nursing and midwifery workforce, in line with international trends, is that many will retire in the next fifteen years. While this means nurses and midwives are very experienced it also means that a focus on recruitment is critical. An important source of the future workforce is the pool of students the WCDHB hosts from the regional polytechnic undergraduate programmes. Nursing and midwifery students enjoy not only the quality of clinical teaching they receive from WCDHB staff but also the variety of experiences that a West Coast placement offers. This year we attracted four nurses to the Nurse Entry to Practice Programme with three nurses based at Grey Base Hospital and one at the Buller Health Services. In 2008 the first of the distance midwifery programme was offered by Otago and Christchurch Polytechnics to South Island students with satellite centres in Nelson and Canterbury - training for a West Coast based centre is underway. The WCDHB’s vision to become a Training Centre for Rural Excellence has been supported by an extensive programme of nursing and midwifery education. Nurses and midwives have taken up opportunities to participate in a wide variety of professional development and clinical conference programmes off the Coast as well as locally. Locally provided workshops included: “Assessment of the Unwell Child” to 32 nurses; the New Zealand College of Midwives “Maternity Drills and Skills” programme in Westport, Greymouth and South Westland to local teams of midwives, nurses, general practitioners, obstetrician/ gynaecologist’s and ambulance drivers; and neonatal and adult resuscitation workshops. The numbers of nurses taking up Ministry of Health funded post graduate education continues to rise. This year the WCDHB supported the Christchurch School of Medicine to teach a new paper, the Post Graduate Certificate in Long Term Conditions Management, between Westport and Greymouth; an initiative that saw 11 nurses successfully complete masters level study without having to leave the coast. In early 2008 we were successful in achieving one-off Ministry of Health Nurse Practitioner Facilitation funding. With the funding we have enlisted the support of Mary Jo Gagan, a United States registered Nurse Practitioner and Senior lecturer at the Christchurch School of Medicine. Based on a population needs analysis Mary Jo has advised on the potential role of Nurse Practitioner’s to address gaps in services or strengthen existing services. It is anticipated that the next year will see the development of a process for deciding on numbers and types of Nurse Practitioner’s and a process for recruiting or “growing” our own. In July 2007 in an exciting first for the West Coast, Fox Glacier Rural Nurse Specialist, Anne Fitzwater achieved Nurse Practitioner status. The Department of Nursing and Midwifery had two significant staff changes this year with a farewell and heartfelt thanks to Michele Barber, Nurse Consultant, who finished five years of service to professional nursing and joined the Secondary Service as Nurse Manager and a welcome to Anne Tacon who was appointed to the newly established position of Associate Director of Nursing: Mental Health.


IINNFFOORRMMAATTIIOONN TTEECCHHNNOOLLOOGGYY RREEPPOORRTT 2007-08 has been a busy year for West Coast DHB’s Information Technology (IT) department. More and more clinical staff are regularly accessing the clinical information system (HealthViews) in their daily work. This is also generating more demand for clinical information within this system. Histology results from Canterbury DHB are now available within HealthViews. This has been a huge undertaking but has added significant value to our clinical information system. We have implemented secure email between Canterbury DHB and West Coast DHB. This has reduced the time it takes for organizing a clinic from Canterbury DHB, (e.g. respiratory, haematology, urology) from 7 days to 2 days or less. The Te Tai Poutini Maori Health PrISM implementation has been completed. Rata Te Awhina Trust now uses West Coast DHB’s PrISM system and West Coast DHB’s health information systems can now be accessed from Te Tauraka Waka a Maui Marae in South Westland. We have updated our intranet and internet sites with a focus on improving recruitment and access to information such as policies and procedures. We are one of two DHB’s leading the country with the Ministry of Health mental health outcomes data collection (called PrIMHED). A new multi-slice CT scanner has been implemented and integrated into the West Coast DHB’s health information systems. The next 12 months will bring many exciting opportunities within our clinical information systems to maximum value for our clinical staff, and to have a truly world leading health information system. Our plans for 2008-09 include increased content and functionality within the Health Views, a world first trial of the CISCO “Health Presence” diagnostic and telecommunications system and increased integration of health information between primary health and secondary care.

David Verrall (RN) with Jeremy Crestani (IT System Administrator) at A&E, Greymouth, testing

CICSO HealthPresence (telemedicine with clinical tools).


.

FFAACCIILLIITTIIEESS && SSUUPPPPOORRTT SSEERRVVIICCEESS RREEPPOORRTT 2007-08 has been a year of facilities renewal for the West Coast DHB.

• West Coast DHB’s specialist dementia service was relocated from Seaview Hospital in Hokitika to a purpose built Dementia Unit, in Greymouth, ending 135 years of health service provision from the Seaview Hospital site.

• West Coast DHB completed the construction of a new rural nursing clinic in Ngakawa, which opened early in the 2008/09 Financial Year.

• The West Coast DHB has commenced planning for facilities renewal projects at a number of its remote sites, including the replacement of rural nursing clinics in Franz Josef and Haast; and the redevelopment of the Moana Clinic.

• The DHB is also planning new health facilities for its three largest sites, Grey Base Hospital, Buller Health and Reefton Health. The scale of these facilities necessitates that the West Coast DHB seek Government funding or approval for these projects.

West Coast DHB Dementia Services – relocated from Ruru Villa, Seaview Hospital to a new purpose built facility, He Oranga Kahurangi, Grey Base Hospital.


SSTTAATTEEMMEENNTT OOFF OOBBJJEECCTTIIVVEESS AANNDD SSEERRVVIICCEE PPEERRFFOORRMMAANNCCEE

FOR THE 12 MONTHS ENDED 30 JUNE 2008 This report details our performance to our service objectives and performance targets, as stated in our 2005-08 Statement of Intent, the formal accountability document that set out the DHB’s plans and performance targets at the start of the financial year.

NATURE AND SCOPE OF ACTIVITIES The West Coast DHB was established under the New Zealand Public Health and Disability Act 2000, and is the principal funder and provider of health and disability services to the 31,3261 people living in the West Coast district. With its small resident population and large geographic area (8.5% of New Zealand’s land area) the West Coast DHB faces a number of challenges not faced by other DHBs. Our geography and rurality create significant diseconomies of scale in the delivery of services provided by the DHB. Notwithstanding, we both fund and provide a broad range of health services to our population. The West Coast DHB periodically conducts needs analyses, surveys, and collects other data in order to ascertain the health needs and priorities of the West Coast population. Initiatives aimed at meeting these needs and priorities form the basis of the West Coast DHB’s District Strategic Plan and are operationalised through their inclusion in the DHB’s District Annual Plan (outlining our objectives for the next 1 to 3 years) and the DHB’s Statement of Intent, which states our specific service objectives and performance targets for the current financial year.

SERVICE PERFORMANCE Objectives and performance targets have been divided up according to the functional areas that they relate to.

OObbjjeeccttiivveess aanndd PPeerrffoorrmmaannccee TTaarrggeettss –– DDHHBB GGoovveerrnnaannccee && MMaannaaggeemmeenntt The governance and management function is charged with monitoring, identifying factors adversely affecting, and implementing strategies to improve the health status of the West Coast population. The governance role of the West Coast DHB is also focussed on monitoring the delivery and performance of services, by the DHB and other parties engaged by the DHB in its strategies to improve health status. The role also encompasses activities that facilitate co-operative and collaborative arrangements with other organisations in the health and disability sector. Outputs reflecting the success in achieving these objectives are referred to as “DHB Governance Outputs”.

1 2006 NZ Census


SSTTAATTEEMMEENNTT OOFF OOBBJJEECCTTIIVVEESS AANNDD SSEERRVVIICCEE PPEERRFFOORRMMAANNCCEE

FOR THE 12 MONTHS ENDED 30 JUNE 2008 This report details our performance to our service objectives and performance targets, as stated in our 2005-08 Statement of Intent, the formal accountability document that sets out the DHB’s plans and performance targets at the start of the financial year.

NATURE AND SCOPE OF ACTIVITIES The West Coast DHB was established under the New Zealand Public Health and Disability Act 2000, and is the principal funder and provider of health and disability services to the 31,3262 people living in the West Coast district. With its small resident population and large geographic area (8.5% of New Zealand’s land area) the West Coast DHB faces a number of challenges not faced by other DHBs. Our geography and rurality create significant diseconomies of scale in the delivery of services provided by the DHB. Notwithstanding, we both fund and provide a broad range of health services to our population. The West Coast DHB periodically conducts needs analyses, surveys, and collects other data in order to ascertain the health needs and priorities of the West Coast population. Initiatives aimed at meeting these needs and priorities form the basis of the West Coast DHB’s District Strategic Plan and are operationalised through their inclusion in the DHB’s District Annual Plan (outlining our objectives for the next 1 to 3 years) and the DHB’s Statement of Intent, which states our specific service objectives and performance targets for the current financial year.

SERVICE PERFORMANCE Objectives and performance targets have been divided up according to the functional areas that they relate to.

OObbjjeeccttiivveess aanndd PPeerrffoorrmmaannccee TTaarrggeettss –– DDHHBB GGoovveerrnnaannccee && MMaannaaggeemmeenntt The governance and management function is charged with monitoring, identifying factors adversely affecting, and implementing strategies to improve the health status of the West Coast population. The governance role of the West Coast DHB is also focussed on monitoring the delivery and performance of services, by the DHB and other parties engaged by the DHB in its strategies to improve health status. The role also encompasses activities that facilitate co-operative and collaborative arrangements with other organisations in the health and disability sector. Outputs reflecting the success in achieving these objectives are referred to as “DHB Governance Outputs”.

2 2006 NZ Census


MĀORI HEALTH

Long-term outcome: reduced health inequalities and improved health outcomes for Māori

Measures:

• 10% of West Coast DHB staff will attend effective cultural training programmes in 2007/08 • One pathway of care focused on improving health outcomes and reducing health inequalities for Māori is

completed by June 2008 • Māori community initiatives that assist and enhance the provision of Whānau Ora services are identified • Tatau Pounamu (Mana Whenua health group) is informed and consulted regularly and effectively on Māori

kaupapa matters • Māori workforce and provider development is included in business plans and Māori Provider Development

Scheme (MPDS) priorities • An assessment / analysis of Māori health needs on the West Coast is completed • Opportunities for planning and working with providers and other funders are identified and implemented The West Coast DHB also set the following targets for Māori workforce development: • Establish an electronic database of employees established and current staff details updates by December

2007 • An increase in the number of Māori FTEs to 5% of total workforce in 2007/08 • Review of the Māori workforce development plan

Target Actual West Coast DHB Target 5% 6.8%

% of DHB Staff identifying as Māori

0%1%2%3%4%5%6%7%8%

Actual 05 Target 07/08 Actual 07/08

Comment:

Regular, comprehensive engagement processes with iwi / Māori, Māori communities, organisations and providers are maintained.

An accurate, informed position of the Māori health status as it relates to priority areas is provided to iwi / Māori and Māori stakeholders on a regular basis.

The West Coast DHB will support Māori health provider workforce development through initiatives undertaken by Te Herenga Hauora (South Island DHB Māori Managers Network) following final ratification of the South Island Māori Workforce Development Plan.

Early identification and intervention measures are supported through population health activities in collaboration with Community and Public Health to ensure effective communication of data available to the West Coast DHB and other services associated with client health.

Intersectoral relationships are enhanced with other funders who contract with Māori health and disability service providers, or train Māori health staff. Population health activities continue to focus on priority health gain areas for Māori.

The electronic database of employees has been completed and review of the Māori workforce development plan was also undertaken; however, this was not fully completed in 2007/08. The data obtained so far from 296 employees (28% of employees) indicates that 6.8% identify as Māori. This figure may not be representative of the DHB for several reasons, (for example those who identify as Māori may have been over represented in the replies we obtained); however in a similar survey completed in 2005 with a slightly smaller response rate, just over 2% of staff identified as Māori.


HEALTH OF OLDER PEOPLE

Long-term outcome: the proportion of older people entering rest home care is no higher than the national average.

Measure: the proportion of people aged 65+ who are living in long-term rest home care is reducing.

Number of rest home bed days used per head of West Coasters aged 80+ years

Actual

2004 43 2005 49 2006 52 2007 58

0

10

20

30

40

50

60

70

2004 2005 2006 2007

Comment:

The West Coast region has a 25% higher usage of rest home care compared to the national average. This reflects the lack of an effective NASC service, the under-development of community-based support services such as intensive home-based care, respite care, carer support, day-care and supportive housing, the lack of a community focused A&R specialist older person service, a dedicated stroke service or adequately resourced community allied health services, and the lack of a restorative or proactive / preventive model of care within the older person sector.

Changes to these factors, as described in the West Coast DHB’s WISE plan for older persons’ services, are expected to make a change in the rest home entry rate, as well as many other indicators of older persons’ health, such as falls rate, stroke rate, avoidable admissions to acute hospital, etc.

CHILD HEALTH

Long-term outcome: the West Coast DHB works towards 95% of two year olds being fully immunised

Measure: an increase in the number of children fully immunised, across all populations

Target Actual West Coast DHB Target Māori 70% 79% West Coast DHB Target NZE 91% 78% West Coast DHB Target Other 86% 59% West Coast DHB Target Total 91% 77%

* these figures are for the 18 month age group, as there were no children in the two year age cohort at the end of 2006/07

Comment:

91 referrals to the Outreach Immunisation Service were received over the year; 44% of these resulted in vaccination. 29% of referrals to OIS were Māori, with 35% of referrals resulting in vaccinations.

The Immunisation Interest Group continues to meet monthly to work collaboratively to improve immunisation coverage. This group includes: PHO representatives, practice nurse, practice administrators, Rata Te Awhina Trust, Plunket, Family Start, DHB maternity services and public health nurses and DHB Planning and Funding. In 2008/09 the scope of the group’s work will expand to include influenza and HPV vaccinations.


YOUTH HEALTH

Long-term outcome: the West Coast DHB works towards 85% adolescent oral health utilisation

Measure: increased numbers of adolescents utilising oral health services

Target Actual West Coast DHB Target 70% 68%

54%

56%

58%

60%

62%

64%

66%

68%

70%

72%

06 Actual 07 Target 07 Actual

Comment:

Improving utilisation of oral health services in 2007 reflects in part the improving provider circumstances, with provider shortages seen in previous years not being experienced in 2007/08. Dentists in Westport, Greymouth and Hokitika have renewed contracts for the provision of oral health services to adolescents during this period.

Increasing activity by the Regional Adolescent Oral Health Co-ordinator has also played a note, as has the extension of service provision for adolescents in rural areas. The School Dental Services extended services to adolescents attending Reefton Area Schools or residing in the Reefton rural areas in 2007/08. Planning for implementation at Karamea and South Westland Area schools commenced during the 2007/08 and enrolments are expected from February 2009.

LONG-TERM MENTAL HEALTH SERVICE USERS

Long-term outcome: at least 90% of the West Coast DHB’s long-term mental health clients have up-to-date relapse prevention plans (NMHSS criteria 16.4).

Measure: number of long-term clients with an up-to-date relapse prevention plan

Target Actual West Coast DHB Target 98% 98%

0%

20%

40%

60%

80%

100%

120%

07/08 Target 07/08 Actual

Comment:

The West Coast DHB continues to operate the Knowing the People Planning project, which collects detailed information on long-term secondary mental health service users’ (two plus years), mental and physical health, housing, education, employment, family and social situations. The information is used to focus services on improving the individual’s quality of life, ensure issues emerging from data collection are addressed at a service level by interagency planning and collaboration with other agencies, and to plan and collaborate on emerging issues.


89% of long term mental health service users are registered with a GP, 98% have up to date relapse prevention plans and 99% have satisfactory housing situations.

IMPROVING ELECTIVE SERVICES

Long-term outcome: the West Coast population has access to those core clinical elective services delivered on the West Coast within the national timeframes

Measures:

• the West Coast DHB maintains compliance in all Elective Services Patient Flow Indicators (ESPIs) • the West Coast DHB sets an agreed increase in the number of elective service discharges, and will

provide the level of service agreed

Measure Target Actual* 1. DHB services that

appropriately acknowledge and process all patient referrals within ten working days

> 90% 100%

2. Patients waiting longer than six months for their first specialist assessment (FSA)

< 2% 0%

3. Patients waiting without a commitment to treatment whose priorities are higher than actual treatment threshold (ATT)

< 5% 0%

4. Clarity of treatment status

< 5% 0%

5. Patients given a commitment to treatment but not treated within six months

< 5% 1.1%

6. Patients in active review who have not received a clinical assessment within the last six months

< 15% 0%

7. Patients who have not been managed according to their assigned status and who should have received treatment

< 5% 0.9%

8. The proportion of patients treated who were prioritised using nationally recognised processes or tools

> 90% 100%

9. Clarity of treatment status

> 90% 100%

*As at 30th June 2008

0%

20%

40%

60%

80%

100%

120%

1 8 9 6

Measure

TargetActual

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

2 3 4 5 7

Measure

TargetActual

Comment:

Where the DHB has not achieved 0.95 (Coronary Artery Bypass Graft, Total Hip Replacement and Tonsils and Adenoids) access to the services concerned has been reviewed. No issues have arisen from this review.


Procedure Target Actual 1. Coronary Artery

Bypass Graft > 0.95 0.82

2. Angioplasty > 0.95 1.01 3. Total hip replacement > 0.95 0.92 4. Total knee

replacement > 0.95 1.14

5. Prostatectomy > 0.95 1.58 6. Cataract > 0.95 1.28 7. Grommets > 0.95 0.97 8. Repair of hernia > 0.95 1.58 9. Tubal ligation > 0.95 1.08 10. Hysterectomy > 0.95 1.54 11. Cholecystectomy > 0.95 1.68 12. Tonsils and adenoids > 0.95 0.82 13. Carpal tunnel

procedure > 0.95 1.46

14. Heart valve replacement and repair

> 0.95 1.19

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

1 2 3 4 5 6 7 8 9 10 11 12 13 14

P r oc e dur e

Target

Act ual

Comment:

Standardised discharge ratios for West Coast DHB residents discharged from all New Zealand hospitals were above the 0.95 target in all but three of the 14 key surgical procedure indicators above (where a rate of 1.0 is the national average). Those below target in 2007/08 were total hip replacements, coronary artery bypass grafts and tonsil / adenoid procedures. The ratios are standardised to take into account the particular sex, age, ethnicity and social deprivation mix of the West coast DHB population.

REDUCING CANCER WAITING TIMES

Long-term outcome: all West Coast patients wait less than eight weeks between first specialist assessment and the start of radiation oncology treatment (excluding category D).

Measure: all West Coast patients wait less than eight weeks between first specialist assessment and the start of radiation oncology treatment (excluding category D).

West Coast Target : 100%

Results:

Category A (Urgent): 100% in all months. Longest average wait during the year – 1 week (in August 2007). Average wait in June 2008 = less than one week.

Category B (Curative): 100% in all months. Longest average wait during the year – 6 weeks (in July 2007). Average wait in June 2008 = less than one week.

Category C (Palliative and other radical): 100% in all months. Longest average wait during year – 6.1 weeks (in October 2007). Wait in June 2008 = 2 weeks. Comment:

Radiation oncology services are principally undertaken for the West Coast population in Christchurch. Data on radiotherapy waiting times and treatment volumes is made available by Canterbury DHB and this is reported through to the Ministry of Health quarterly as part of the Accountability Indicators quarterly report.

We are awaiting the development of reporting by Canterbury DHB to indicate waiting times for West Coast residents accessing chemotherapy services at tertiary facilities in Christchurch. There is no local waiting list for accessing prescribed chemotherapy treatment regimes which are able to be safely delivered here within the scope of practice of the oncology and palliative care nurse specialists, or our resident physicians.


REDUCING AMBULATORY SENSITIVE HOSPITAL ADMISSIONS

Long-term outcome: the West Coast DHB will work towards the national target of a decline in admissions to hospital that are avoidable or preventable by primary health care for 0-5 year olds and those aged 65 plus across all population groups

Measure: the West Coast DHB remains below the national average of ambulatory sensitive hospital admissions

Ambulatory Sensitive admissions for those aged under 5 years (rates per 1000 discharges*)

National Result

West Coast Result

Māori 67.3 43.9 Pacific Island 88.9 - All Others 53.3 44.8 TOTAL 61.1 45.4

0%

20%

40%

60%

80%

100%

Māori Pacif ic Island All Others Total

National Result West Coast Result

Ambulatory Sensitive admissions for those aged 65 - 74 years (rates per 1000 discharges*)

National Result

West Coast Result

Māori 120.1 56.0 Pacific Island 141.6 - All Others 56.3 63.9 TOTAL 63.1 63.1

* Data for 12 months period to 31 March 2008; the latest available nationally comparative data available from the Ministry of Health at the time this report was prepared. Ministry of Health does not monitor ambulatory sensitive admissions for people aged 75 and over.

0

20

40

60

80

100

120

140

160

Māori Pacif ic Island All Others Total

National Result West Coast Result

Comment:

West Coast DHB achieved its target to remain below the national rates for Ambulatory Sensitive hospitalisations in these measures, with the exception of “Other” populations among those aged 65-74. In comparison to other DHBs, West Coast DHB discharge rates per 1000 for ambulatory sensitive hospitalisations do not vary significantly from the overall national rates at the 99% confidence interval for any of the age band and ethnicity population cohorts.

The raw numbers of discharges for Pacific Island people on the West Coast during the period under review were too few to determine statistically meaningful discharge rates among the various age cohorts.

IMPROVING DIABETES SERVICES

Long-term outcome: an increase in the percentage of people in all population groups on the West Coast in the below categories, to improve equity in all population groups

Measure: an increase in the percentage of people in all population groups on the West Coast in the below categories, to improve equity in all population groups


Free Annual Diabetes Checks (by ethnicity)

Number of people accessing their free annual diabetes checks as a percentage of the estimated population having diabetes (based on Ministry of Health estimate for 2007)

Target Actual Māori 70% 38.16% Pacific Island 70% 100% All Others 70% 75.72% TOTAL 70% 70%

0%10%20%30%40%50%60%70%80%90%

100%

Māori Pacif ic Island All Others TOTAL

Target

Actual

Comment:

Free annual diabetes checks at practices by doctors and / or practice nurses are actively encouraged. The target for this measure for the Total Population was met at 70%. The overall results for this measure for 2007 were considered to be only partially achieved however, as not all population groups achieved the 70% target for receiving their annual checks.

West Coast PHO diabetes data is monitored by the Local Diabetes Team in order to provide input to service planning and initiatives aimed at improving diabetes detection and also responsiveness to individuals with diabetes. Particular emphasis has been placed on improving responsiveness for Māori within the West Coast community, as this was the only target group not to meet target.

Good Diabetes Management

Percentage of diabetes population with HBA1c levels at or below 8.0 at their annual checks

Target Actual Māori 80% 77.59% Pacific Island 80% 0% All Others 80% 81.76% TOTAL 80% 81.3%

0%10%20%30%40%50%60%70%80%90%

Māori Pacif ic Island All Others TOTAL

Target

Actual

Comment:

The target for this measure for Total Population was surpassed at 81.3%. Overall results for this measure for 2007 were considered to be only partially achieved however, as not all population groups achieved the 80% target for good diabetes management.

Retinal Screening

Percentage of people on the diabetes register who have had retinal screening or ophthalmologist examination in the past two years.

Target Actual Māori 90% 87.93% Pacific Island 100% 50% All Others 90% 89.68% TOTAL 90% 89.42%

0%10%20%30%40%50%60%70%80%90%

100%

Māori Pacif icIsland

All Others TOTAL

Target

Actual


Comment:

The target for this measure for the Total Population was effectively met at 89.4%. The overall results for this measure for 2007 were considered to be only partially achieved however, as not all population groups achieved the 90% target for receiving their two-yearly retinal screening checks.

IMPROVING NUTRITION, INCREASING PHYSICAL ACTIVITY AND REDUCING OBESITY

Long-term outcome: the West Coast DHB will support the HEHA strategy and reflect the priority population health objective to improve nutrition, increase physical activity and reduce obesity

Measure: there is an increase in the proportion of infants exclusively and fully breastfed at six weeks to 74% or greater, at three months to 57% or greater, and at six months to 27% or greater.

Target Actual 6-weeks Māori 50% 61% 6-weeks Total 70% 64% 6-months Māori 25% 18% 6 months Total 25% 26%

0%

10%

20%

30%

40%

50%

60%

70%

80%

6-w eeks Māori 6-w eeks Total 6-months Māori 6 months Total

Target

Actual

Comment:

A considerable amount of work has been undertaken to improve breastfeeding rates and create supportive environments for breastfeeding during 2007/08. Two workplaces (the West Coast DHB and Westland Milk Products) progressed towards receiving their Breastfeeding Friendly Workplace recognition during quarter four. Two Breastfeeding Education Workshops were provided by the Breastfeeding Advocates to health professionals and staff working in the social development and education sectors.

The HEHA Breastfeeding Initiative Lactation Consultation service saw 102 new visits, with 175 follow-up and 24 return visits. Mum4Mum Peer Support Training has resulted in 34 trained mums in the Grey, Westland and Buller districts for 2007/08. An evaluation of this initiative commenced in 2007/08 (funded through the HEHA Evaluation Fund).The West Coast had the highest number of women per capita participating in the Worldwide Latch-On.

Measures: • there is an increase in the proportion of adults (15 plus years) eating three or more servings of vegetables

per day to 70% or greater • there is an increase in the proportion of adults eating two or more servings of fruit per day to 62% or

greater

Comment:

The Fruit in Schools (FIS) contract has been transferred to the West Coast DHB. The Regional Interagency Group Meetings are held once per term where FIS principals and co-ordinators undertake professional development relating to the HPS framework. All eight of the “Fruit in Schools” schools are working towards Health Promoting Schools (HPS) status. An additional five schools are working with the HPS Advisor along this framework.

32% of West Coast schools have Health Promoting Schools status (all of these schools are part of the Fruit in Schools initiative); an additional 13% (n=4) schools are working towards Health Promoting Schools status. Promotion of Health Promoting Schools, the Food and Nutrition Guidelines and the Food and Beverage Classification System to West Coast schools is increasingly provided on a proactive basis and greater links between education and health established. Action plans around the HPS Framework have been established with each of the schools and updates are undertaken at each of the Cluster Meetings. To assist with this, training has been provided to schools on the HPS framework, Sun Smart Accreditation and Sustainability. The HEHA Nutrition Fund has provided a further incentive for West Coast schools to embrace the HPS framework. In 2007/08 67% of all schools and ECEs on the West Coast made an application to the NF (including 100% secondary and area schools, 54% of primary and 75% ECEs). Additionally 63% of schools and ECEs on the West Coast have received some funding through the Nutrition Fund.


The Spring into Action Physical Activity and Nutrition Challenge had a total of 1,491 participants in the open challenge and 21 schools and four ECEs in the education challenge. A part of this challenge the West Coast PHO provided free fruit for staff and customers in all four West Coast pharmacies. A total of 144kg of fruit was consumed over the four weeks of the challenge.

An assessment of the nutrition and physical activity behaviours and service needs of 234 West Coasters aged 65 years and over (including 114 completed by Māori West Coasters aged 55 years and over) was completed during 2007/08. An Older Persons Physical Activity, Nutrition and Falls Prevention Plan has been established to overcome the identified needs.

REDUCING THE HARM CAUSED BY TOBACCO

Long-term outcome: the West Coast DHB will support a reduction in the incidence of New Zealanders becoming addicted smokers and a reduction in the settings in which people are exposed to smoking or tobacco products

Measures: • there is an increase in the proportion of ‘never smokers’ among year 10 students by at least 2% (absolute

increase) • there is an increase in the proportion of homes, which contain one or more smokers and one or more

children, that have a smokefree policy to over 75%

2006 2007 Year 10 students ‘never smokers’ 49% 54%

Year 10 students Parental smoker 47% 49%

Year 10 students Parental smoker, smokes in home 39% 31%

Figures for Year 10 Students

0%

10%

20%

30%

40%

50%

60%

‘Never smokers’ Parental smoker Parental smoking in home

2006

2007

Comment:

A Smokefree DHB Co-ordinator commenced work in January 2008 and has developed a Smokefree DHB Plan for the West Coast. The plan has been signed of by Ministry of Health.

Smoking status is recorded by all primary practices on the West Coast. The West Coast PHO smoking cessation service has seen an increase in referrals over the year, with access to the smoking cessation programme being widened, although still targeting populations with high smoking rates, including people with chronic conditions (COPD, heart disease, diabetes, mental illness).

Hospital systems for improved education, advice and referral to appropriate health professional services for chronic conditions management are co-ordinated by the Cardiac Nurse and Diabetes Nurse Educator services of the West Coast DHB, with support from services such as the DHB's dietician, podiatry, smoking cessation, HEHA, and oncology nurse outreach services.

The West Coast DHB, CPH, West Coast PHO, Rata Te Awhina Trust and Tatau Pounamu are working collaboratively on Whānau Ora and Māori health initiatives including smoking cessation for Māori. A Māori Smokefree Plan will be developed over 2008/09.

INCREASING INVESTMENT IN MĀORI HEALTH

Long-term outcome: increased investment in Māori health

Measure: the DHB will continue actively to seek additional funding to improve Māori health and reduce Māori health and disability inequalities as it becomes available, and will work collaboratively with its iwi partners and other government agencies to achieve this


Target Actual 5% growth p.a. $1,184,222 $1,311,674

0%

2%

4%

6%

8%

10%

12%

14%

16%

Target Actual

Comment:

The West Coast DHB is committed to an increasing investment in Māori Health that is over the annual Future Funding Track (FFT) increase. During 2007/08 the DHB actively sought additional funding to improve Māori health through the Cancer Navigator pilot program and through HEHA funding. The DHB spend on Māori health services, and targeted services or positions within mainstream services, was $1,311,674, a 15% growth on the 2006/07 annual spend.

The increased financial investment went into a Tamariki Ora Immunisation Kaitautoko in the Outreach Immunisation Service, a Cancer Navigator for Māori in the PHO cancer navigation pilot, a Māori HEHA co-ordinator and a Māori Health Portfolio Manager.

IMPROVING CHILD ORAL HEALTH

Long-term outcome: the West Coast DHB has set a target to increase the number of 5 years olds dental caries-free

Measure: number of caries-free 5 year olds

Target Actual Māori 40% 18% Other 50% 46%

0%

10%

20%

30%

40%

50%

60%

06 Actual 07 Target 07 Actual

Māori

Other

Comment:

The DHB is working to increase the number of caries-free 5 year olds. Throughout 2007/08 this has included additional work on the Child and Adolescent Oral Health business case for resubmission to the Ministry of Health. The Business Case includes plans for the provision of a high fluoride varnish service.

Work through the HEHA initiative has also been undertaken to raise awareness of healthy snacks and drinks, particularly through early childhood education and well child providers. Please refer to the section on ‘Improving nutrition, increasing physical activity and reducing obesity’ for more details.

IMPROVING HOSPITAL RESPONSIVENESS TO FAMILY VIOLENCE, CHILD ABUSE AND NEGLECT

Long-term outcome: routine family violence screening implemented in maternity, emergency department, social work and mental health services by the end of 2007/08

Measure: all women aged 15 years plus are routinely screened for family violence, and all children presenting with indicators of abuse, violence or neglect are screened for family violence


Comment:

Routine family violence screening was implemented in emergency and social work departments during the year.

Screening rates in ED are 35.6% with 4.6% of women screening positive for family violence and a referral rate of 43%. Planning of core training sessions for Mental Health Services began in June 2008.

REDUCING INEQUALITIES

Long-term outcome: reduced health inequalities and improved health outcomes for Māori

Measures:

• increased awareness of, and increased skill in addressing, inequalities • increased awareness of Māori culture and its application in providing best practice care to Māori patients

and their whānau • reducing inequalities framework and HEAT tool or equity lens are used in the development of all DHB-

approved plans • improved recruitment and retention of Māori staff

Target Actual Reducing inequalities framework and HEAT tool or equity lens are used in the development of all DHB-approved plans

100% 100%

% of all DHB-approved plans developed using reducing inequalities framew ork and HEAT tool or equity lens

0%

20%

40%

60%

80%

100%

120%

Target Actual

Comment:

Mandatory training on Te Tiriti o Waitangi and Te Pikorua was attended throughout the year by 54 and 67 staff respectively. Te Pikorua training has a particular focus on increasing awareness of Māori culture and its application in providing best practice care to Māori patients and their whānau.

Tikanga Best Practice guidelines were further implemented in 2007/08 and an audit of the implementation of Tikanga Best Practice has been completed within the provider arm. Training on Tikanga Best Practice was provided with 40 DHB staff and 30 staff from other agencies including CPH, Disabilities Services, and Family Support, Te Rūnanga o Makaawhio, PHO and Rata Te Awhina Trust attending presentations given by Naida Glavish from Auckland DHB on Tikanga Best Practice guidelines.

A Reducing Inequalities training day held in July 2007 increased awareness of, and increased skill in addressing, inequalities. This was attended by a total of 42 people, made up of DHB staff and others working in the health and disability sector. The Reducing Inequalities Intervention Framework was utilised in the planning of the B4SC programme, Carelink, and HPV Immunisation planning to improve access and enhance pathways of care for groups suffering from inequalities, including children, older people, Māori and youth, as well as in the development of the DHB HEHA and Smokefree plans.

External consultants have undertaken an assessment and review of HR policies and procedures to ensure they are conducive to supporting the development of a sustainable Māori health workforce. Further work is planned in this area.

New Māori-specific positions have been developed, including the Tamariki Ora Immunisation Kaitautoko, a Cancer Navigator for Māori and a Māori Health Portfolio Manager.


DHB STAFF WORK-RELATED INJURY OR ILLNESS RATE

Long-term outcome: reduced rates of work-related injury or illness among DHB staff

Measures: • improved Health and Safety for employees • workplace incidents and accidents reviewed • mandatory education programme delivered • legislative requirements for Health and Safety achieved • tertiary level rating with ACC maintained

Work Hours Lost due to Work-related Illness or Injury (ACC)

2003/04 938 2004/05 671 2005/06 440 2006/07 309 2007/08 338

Hours Lost due to Work-related Illness or Injury (ACC)

0

100

200

300

400

500

600

700

800

900

1000

2003/04 2004/05 2005/06 2006/07 2007/08

Comment:

The DHB meets basic legislative requirements for health and safety within the DHB by the provision of its policies and procedures, training and education, health and safety committees, pre-employment health checks and other health and safety programmes.

The DHB commissioned a pre-audit process in early 2008 to ensure that the DHB met relevant standards when the ACC Audit for the Workplace Safety Management Practices Programme occurred in June 2008. The pre-audit illustrated that the DHB did not meet several of the elements at tertiary level. Since the report was published the Health and Safety department has been working in conjunction with Facilities Management, Quality and Risk Management and other significant partners to overhaul systems. The systems that were in place for incident and accident systems, hazard management systems, emergency management planning and contractor management systems were found to be significantly flawed. These systems had been in place for sometime and are now undergoing major changes. The DHB expects to be audited in due course to attain tertiary level with ACC.

The Health and Safety department worked throughout 2007/08 to improve health and safety for employees. Whilst several systems, as above, have failed the department recognised this in 2007 and has worked to review and overhaul those systems.

The workplace incident and accident system was reviewed by the Health and Safety Adviser in mid-2007. Recommendations were made in an internal report to improve the current system; however as a new national system was being developed for implementation during 2008/09 a decision was made to not put into action the recommendations in the report.

The mandatory training programme was reviewed by the learning and development co-ordinator at the end of 2007. Recommendations were made to introduce some changes around when the programmes were delivered and the frequency of the training; these recommendations were implemented in the 2008 programme.

The above statistics in relation to hours lost due to work related illness or injury are based on a very small number of employees. Usually the DHB would be reporting around two to five accidents / incidents per quarter; however from time to time a spike occurs, for example in March 2008, when nine accidents / incidents were reported for the quarter. Some incidents will require much more time away from work than others. If for example a knee injury required major surgery as a result of a fall then several weeks of work would be lost. Mandatory training around safe patient handling has recently occurred which should continue the work of educating staff about managing patients and reducing strains to the body, and the overhaul of the hazard management system, with training to be held in September 2008, will also help employees become more aware of potential hazards in the workplace.


OObbjjeeccttiivveess aanndd PPeerrffoorrmmaannccee TTaarrggeettss –– PPrroovviiddeerr AArrmm The provider arm of the West Coast DHB is responsible for the delivery of the services contracted by the purchasing arm of the West Coast DHB. The specific details of these services are detailed in the West Coast DHB Annual Plan.

The following statistics give an indication of the scope and scale of the West Coast DHB’s provider arm activities in 2007/08:

2007/08 2006/07 2005/06

5,949 5,906 5,876 Patient discharges from hospital (raw inpatients / day patients purchased on a WEIS and non-WEIS basis)

3.48 3.57 3.47 Average length of stay (days) for medical and surgical patients

2,341 2,247 2,107 Total surgical operations performed in theatre (of which 1,868 were non-acute)

17,414 16,935 17,972 Specialist outpatient attendances (of which 5,194 were first attendances)

14,611 13,477 12,179 Emergency Department attendances

35,558 33,988 35,600 Meals on Wheels delivered Coast-wide

9,125 8,337 11,959 Home help hours provided to personal health and maternity clients

349 278 308 Babies delivered in hospital

4,405 4,451 4,585 Children served by school dental service

27,182 24,067 28,488 Days of care for rest home and long stay patients

4,562 5,949 4,635 Inpatient mental health days of care

3,944 2,848 2,908 Assessment Treatment and Rehabilitation inpatient bed days

Services provided included surgical, medical, women’s health, child health, older persons’ health, disability support, mental health, public health, x-ray, laboratory, GP services, child development, stomal care, palliative care, aged care service co-ordination, personal care, lithotripsy, pharmacy, orthotics, cervical screening, etc.

The following resources were utilised in achieving these outputs:

2007/08 2006/07 2005/06

1,042 997 1,037 Number of people employed by the West Coast DHB (including casual call-on staff - 623 FTEs as at 30 June 2008)

$41m $42m $44m Of total assets

• Hospital services are provided at Westport, Reefton and Greymouth

• Rest homes are located at Westport and Reefton

• GP services are located at Ngakawau, Westport, Greymouth and South Westland (Whataroa)

• Rural nurse centres are located at Karamea, Moana / Otira, Whataroa, Franz Josef, Hari Hari, Fox Glacier, Haast and Reefton

Outputs reflecting the success in achieving this aim are referred to as ‘Provider arm Outputs’.


GGoovveerrnnaannccee OOppeerraattiinngg SSttaatteemmeenntt ffoorr tthhee 1122 mmoonntthhss eennddeedd 3300 JJuunnee 22000088 in thousands of New Zealand Dollars

Funding Operating Statement for the 12 months ended 30 June 2008 in thousands of New Zealand Dollars

Board Board Board Actual Budget Actual June 2008 June 2008 June 2007 Income PBF Vote Health - Funding Package (excluding Mental Health) 86,341 84,619 79,622 PBF Vote Health - Mental Health Ringfence 10,752 10,758 10,435 MOH - Funding Side contracts 1,387 0 1,153 IDF's Personal Health 1,417 1,465 1,364 Other 797 0 582 Total income 100,694 96,842 93,156 Expenditure Personal and Maori Health 64,129 63,229 59,811 Mental Health 11,803 11,843 10,427 Public Health 576 150 129 Disability Support 14,133 13,899 13,339 Governance 1,125 1,125 1,102 Total expenses 91,766 90,246 84,808 Net Surplus / (Deficit) 8,928 6,596 8,348

Board Board Board Actual Budget Actual June 2008 June 2008 June 2007 Income Revenue 1,125 1,162 1,102 Other Income 10 0 11 Internal Allocation 936 936 936 Total income 2,071 2,098 2,049 Expenditure Personnel 1,304 1,286 1,146 Outsourced Services 203 234 176 Other Operating Expenses 486 528 546 Democracy 300 276 206 Total expenses 2,293 2,324 2,074 Net Surplus / ( Deficit) (222) (226) (25)


Provider Operating Statement for the 12 months ended 30 June 2008 in thousands of New Zealand Dollars

Summary of Revenue and Expenditure by Output Class as at 30 June 2008 in thousands of New Zealand Dollars Provider Governance Funder Eliminations Result Revenue 63,138 2,071 100,694 54,854 111,049 Expenditure 78,132 2,293 91,766 54,854 117,337 Net Surplus / (Deficit) (14,994) (222) 8,928 0.00 (6,288)

Board Board Board Actual Budget Actual June 2008 June 2008 June 2007 Income Internal Revenue – Funder to Provider 47,201 51,139 45,706 Other Goverment 12,740 6,412 10,196 Patient and Consumer sourced 2,332 2,440 3,114 Other Income 865 781 731 Total income 63,138 60,772 59,747 Expenditure Personnel 45,130 44,502 41,970 Outsourced Services 10,124 6,469 7,432 Clinical Supplies 5,980 5,611 5,770 Infrastructure 9,957 8,788 8,643 Other Operating Expenses 40 65 40 Depreciation 4,486 3,365 3,082 Capital Charge 671 1,177 1,764 Finance Costs 808 869 810 Internal Allocation 936 936 936 Total expenses 78,132 71,782 70,447 Net Surplus / (Deficit) (14,994) (11,010) (10,700)

ANNUAL REPORT - West Coast DHB · ... and to collaborate with agencies from local government ......

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Transcript of ANNUAL REPORT - West Coast DHB · ... and to collaborate with agencies from local government ......