MidCentral District Health Board Health & Disability ... · Venue: Boardroom, Gate 2 Heretaunga...

MidCentral District Health Board Health & Disability Advisory Committee

Venue: Boardroom, Gate 2 Heretaunga Street, Palmerston North

When: Tuesday 4 February 2020, 9.00am

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

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

In Attendance: Item 2.1 Lyn Horgan, Sarah Fenwick, Dr Jeff Brown, Cushla Lucas, Dr Claire

Hardie, Debbie Davies, Scott Ambridge, Dr Vanessa Caldwell, Andrew Nwosu, Dr Syed Zaman – Operations & Clinical Executives

Item 2.2. Scott Ambridge, Operations Executive Item 3.4 Celina Eves, Executive Director Nursing & Midwifery Item 4.1 Angela Rainham, Locality & Population Health Manager Strategy, Planning

& Performance

AGENDA – Part 1 1. KARAKIA 09.00

2. ADMINISTRATIVE MATTERS PAGES

2.1 Apologies – Karen Naylor, Member 2.2 Late Items 2.3 Conflicts and / or Register or Interests Update 3-42.4 Minutes of the Previous Meeting 5-102.5 Schedule of Matters Arising 11

3. PERFORMANCE REPORTING 09.15

3.1 Cluster Update for November and December 2019 12-463.2 Enable New Zealand Report to 31 December 2019 47-51

REFRESHMENT BREAK 10.40

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3. PERFORMANCE REPORTING CONTINUED

3.3 Pae Ora Paiaka Whaiora Progress Update 52-623.4 Clinical and Professional Report: Nursing and Midwifery 63-753.5 Manawatū District Health and Wellbeing Plan Update 76-91

4. INFORMATION PAPERS PAGES 11.35

Information papers for the Committee to note

4.1 Committee’s Work Programme 2019/20 92-954.2 2020/21 Annual Plan Approach and Priorities 96-104

5. LATE ITEMS

6. DATE OF NEXT MEETING

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

7. EXCLUSION OF PUBLIC

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

Item Reason Ref “In committee” minutes of the Health & Disability Committee meeting

For the reasons set out in the order paper of 26.11.19 meeting held with the public present

KARAKIA He Karakia Timata

Kia hora te marino Kia whakapapa pounamu te moana Hei huarahi ma tatou I te rangi nei

Aroha atu, aroha mai Tatou I a tatou I nga wa katoa

Hui e taiki e

May peace be widespread May the sea be smooth like greenstone

A pathway for us all this day Give love, receive love

Let us show respect for each other

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Board Members Register of Interests: Summary, January 2020

(Full Register of Interests available on Governance SharedNet Site)

Name Date Nature of Interest / Company/Organisation Browning, Heather 4.11.19 Director - HB Partners Limited

Member - MidCentral Governance Group Mana Whaikaha Board Member and Chair, HR Committee - Workbridge

Duffy, Brendan 3.8.17 8.9.19

Chair & Commissioner - Local Government Commission Trustee - Electra Trust Member - Environmental Legal Assistance Fund, Ministry for the Environment Chairperson - Business Kapiti Horowhenua Inc (BKH) Member - Representation Commission

Dennison, Vaughan

To be advised.

Findlay, Lew 1.11.19

President, Manawatu Branch and Director Central District - Grey Power Councillor - Palmerston North City Council Treasurer - Abbeyfield

Gray, Norman 10.12.19

Employee - Wairarapa DHB Branch Representative - Association of Salaried Medical Specialists

Hancock, Muriel 4.11.19 Sister is casual employee (Registered Nurse, ICU) - MidCentral DHB Volunteer, MidCentral DHB Medical Museum

Mar, Materoa 16.12.19

Te Tihi o Ruahine Whanaui Ora Alliance EMERGE Aotearoa Matanga Mauri Ora Etipu Rea Science Challenge

Naylor, Karen 6.12.10 9.10.16

Employee - MidCentral DHB Member & Workplace Delegate - NZ Nurses’ Organisation Councillor - Palmerston North City Council

Paewai, Oriana 1.5.10 13.6.17 30.8.18

CEO - Rangitane o Tamaki nui a Rua Member - Te Runanga o Raukawa Governance Group Chair - Manawhenua Hauora Member - Child Health Tamariki Ora District Group Co-ordinating Chair - Te Whiti ki te Uru Trustee - Tararua Hauora Services Charitable Trust Member Alliance Leadership Team (Central PHO Board) - Central Primary Health Organisation Member Clinical Governance Group - Feilding Health Care Member Nga Manu Taiko, a standing committee of the Council - Manawatu District Council Member Governance Board - Te Ohu Auahi Mutunga (TOAM) Member - Before School Checks (B4SC) Collective Committee Member - Nga Kaitiaki o Ngati Kauwhata Inc Member - Te Tihi o Ruahine Whanau Ora Alliance Board Member - Cancer Society Manawatu

Waldon, John 22.11.18

Co-director and co-owner - Churchyard Physiotherapy Ltd

Co-director and researcher - 2 Tama Limited

Manawatu District President – Cancer Society Executive Committee Central Districts (rep for Manawatu, 1 of 2) - Cancer Society Member Clinical Board - MidCentral DHB

Warren, Jenny 6.11.19

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

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Committee Members

Hartevelt, Tony 14.8.16 14.8.16 14.8.16 7.10.19

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

Management Cook, Kathryn 1.7.16 Director - Central Region’s Technical Advisory Services Ambridge, Scott 20.8.10 Nil Anjaria, Keyur 17.7.17 Wife is a user of the Needs Assessment & Service Co-ordination Service -

MidCentral DHB Brown, Jeff Caldwell, Vanessa

7.5.18 Nil

Catherwood, Judith

1.5.18 Nil

Davies, Deborah 18.5.18

Member, Alliance Leadership Team -Central PHO Daughter is an employee and works within hospital services - MidCentral DHB

Eves, Celina 14.5.18

Owner personal consulting company, UK - Celina Eves Limited Trustee midwifery charity in UK - Iolanthe Midwifery Trust

Fenwick, Sarah 13.8.18 Nil Hansen, Chiquita 9.2.16

Employed by MDHB and seconded to Central PHO 8/10ths - MidCentral DHB CEO - Central PHO

Hardie, Claire 13.8.18 13.8.18 13.8.18

Member -Royal Australian & NZ College of Radiologists Trustee - Palmerston North Hospital Regional Cancer Treatment Trust Inc Member, Medical Advisory Committee - NZ Breast Cancer Foundation

Horgan, Lyn 1.5.17 18.5.18

Sister is Coroner based in Wellington - Coronial Services Member, Alliance Leadership Team - Central PHO

Lucas, Cushla 1.5.18 Nil Johnston, Craig 19.2.16

19.4.16 Member, Alliance Leadership Team - Central PHO Son is an employee and works within hospital services - MidCentral DHB

Miller, Steve 18.4.17 26.2.19 6.3.19 1.10.19

Director. Farming business - Puriri Trust & Puriri Farm Partnerships Board Member, Member, Conporto Health Board Patient’s First trading arm - Patients First Member, Alliance Leadership Team, Member, Information Governance Group - Central PHO Chair - National DHB Digital Investment Board

Nwosu, Andrew 10.8.18 Director UK health consulting company - AB Therapy Services Sapsford, David 18.5.18 Nil Scott, Gabrielle 19.8.16 Son is a casual employee and works within various hospital services - MidCentral DHB Te Huia, Tracee 19.11.19 Nil Wanden, Neil Feb 19 Nil Zaman, Syed 1.5.18 Nil Matthews, Jill 1.3.16 Nil Amoore, Anne 23.8.04 Nil Russell, Greig 3.10.16 Minority shareholder - City Doctors

Member, Education Committee - NZ Medical Council Bradnock, Barb 26.8.10 Nil Ayres, Vivienne 26.8.10 Nil Ratana, Darryl 29.5.19 Nil Tanner, Steve 16.2.16 Nil Brogden, Greg 16.2.16 Nil Howe, Jonathon 1.8.19 Nil

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Unconfirmed minutes

MIDCENTRAL DISTRICT HEALTH BOARD

Minutes of the Health & Disability Advisory Committee meeting held on 26 November 2019 at 9.00am at MidCentral District Heath Board, Board Room,

Gate 2, Heretaunga Street, Palmerston North

PART 1 PRESENT Karen Naylor (Chair) Dot McKinnon Ann Chapman Michael Feyen Barbara Cameron Oriana Paewai Barbara Robson John Waldon Brendan Duffy Vicki Beagley Diane Anderson IN ATTENDANCE Kathryn Cook, Chief Executive Andrew Nwosu, Operations Executive, Healthy Ageing & Rehabilitation Celina Eves, ED, Nursing & Midwifery Claire Hardie, Clinical Executive, Cancer Screening Treatment & Support Cushla Lucas, Operations Executive, Cancer Screening, Treatment & Support David Sapsford, CE Acute & Elective Specialist Services Debbie Davies, OE, Primary, Public, Community Health Gabrielle Scott, ED, Allied Health Jeff Brown, Acting Chief Medical Officer/Clinical Executive, Women, Children & Youth Judith Catherwood, General Manager, Quality & Innovation Lyn Horgan, Operations Executive, Acute and Elective Services Sarah Fenwick, Operations Executive, Women, Children & Youth Scott Ambridge, Acting Operations Executive, Mental Health & Addictions Syed Zaman, Clinical Executive, Healthy Ageing & Rehabilitation Tracee Te Huia, GM, Maori Health Carolyn Donaldson, Committee Secretary Allison Russell, Planning & Integration Lead, Primary Public & Community Health (part meeting) Angela Rainham, Locality & Population Manager (part meeting) Barbara Ruby, Planning & Integration Lead, Acute & Elective Services (part meeting) Denise Mallon, Planning & Integration Lead, Cancer Screening, Treatment & Support (part meeting) Vivienne Ayres, Manager DHB Planning & Accountability (part meeting) Communications (1) Public: 5 Media: 1

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Unconfirmed minutes

1. ADMINISTRATIVE MATTERS

The Chair made special mention to each retiring member, acknowledging and sincerely thanking them for the contribution over many years. She also passed on appreciation from Dr Manoharan to retiring members. Other members joined in acknowledging the contribution from retiring members and staff, and wishing them well. The Board Chair advised this was her last meeting as she was stepping down from the role. The Chair acknowledged the attendance of Mr & Mrs Hume and the contribution they had made to the mental health service. 1.1 Apologies

Apologies were received from Members Adrian Broad and Nadarajah Manoharan. 1.2 Late Items There were no late items. 1.3 Conflicts and/or Register of Interests Update Barbara Cameron advised she was no longer a member of the Manawatu District Council. 1.4 Minutes of the Previous Meeting

It was resolved: that the minutes of the previous meeting be approved as a true and correct

record. (Moved Karen Naylor; seconded Brendan Duffy) 1.5 Matters Arising from the Minutes John Waldon noted his name had been spelt wrong in paragraph 3.1, 5th paragraph. 2. HEALTH AND DISABILITY STRATEGIC PLANNING a. Tararua Health and Wellbeing Plan The Locality and Population Health Manager spoke to this report touching on the various highlights set out in the report. In addition she advised arrangements had been made for the first annual public forum to be held in conjunction with the Age on the Go Expo, planned for 26 March 2020. There was discussion on the use of methamphetamine and other drugs and gangs in the region. Members were advised of a group in the Tararua district (Anti P Lab Group) who were really passionate and active about the matter. The Locality Manager advised that Oranga Tamariki and the District Council were to have further discussions around this issue following it being raised at a Health & Wellbeing Committee meeting. The establishment of a training hub was another initiative for supporting young people. Other issues discussed included the difficulty of transport given the issues with the Manawatu gorge, reduced road access due to building the wind farms and rising fuel costs; whether mental health teams were providing services in the more southern parts

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Unconfirmed minutes

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

note the progress that has been made in relation to the Tararua Health and Wellbeing Plan.

b. Status Update Report – Implementation of the 2019/20 Regional

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

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

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

The Acting Operations Director, Mental Health & Addictions (former General Manager, Enable NZ) spoke to this report because the Acting General Manager Enable New Zealand was unavailable. It was noted Te Tihi would be facilitating progress following the formation of the Collective Impact Group. It was resolved that the Committee notes the enable New Zealand report to 31 October 2019. b. Cluster update for September/October 2019 The presentation from Uru Whakamauora Healthy Ageing and Rehabilitation was taken at this stage. The Operations Executive and Clinical Executive, Uru Whakamauora Healthy Ageing and Rehabilitation and four staff spoke to the presentation. The presentation covered progress and challenges for the Cluster including an increasing aged population and care resources required. A review of the recently commissioned OPAL unit focussed on 2-week milestones and future direction. Discussion following the presentation covered the organisation’s current move to recruiting and retaining a more solid nursing workforce rather than using short term overseas nurses, the need to be careful when families say there is really good family support, as such statements could mask inequity problems for Maori, and caring for the carer.

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Unconfirmed minutes

Following the presentation and discussion, the individual Cluster reports were considered. It was noted there would be further information provided in relation to referrals declined in future reporting. An explanation on what minimising the requirement for a patient to come to an appointment was given. It was noted the Mental Health single stage business case should be presented to the Committee and Board in the first quarter of next year. It was resolved that the Committee: note the progress made by the Services for September and October 2019

note the workforce challenges across Te Uru Arotau, Te Uru Pā Harakeke and Te Uru Rauhī note the progress towards achieving ESPI targets note a number of requests for proposals have been issued by the Ministry for Primary Mental Health, Māori and Pasifika services.

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

4. QUALITY IMPROVEMENT a. Clinical Governance & Quality Improvement update The Manager Quality Improvement and Assurance and Consumer Experience Manager spoke to this report, noting that the Quality Account had been published on the same day as the national and local Adverse Events annual reports. It was noted that the current set of inpatient experience questions were being revamped. The domains should remain unchanged. It was also noted that the survey only covered inpatients, and that there would be consistency between the inpatient and primary care surveys. As a result of this work, there would not be any inpatient surveys undertaken in the first quarter of 2020. The issue of credentialing recommendations was raised. The Acting Chief Medical Officer advised an improved process was in place to ensure the recommendations were addressed in a timely way. He advised the Clinical Board had been looking at having a three tier approach where each recommendation was identified as being at a medical lead/line manager or cluster or executive leadership team level to address. Using that

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Unconfirmed minutes

method it would be possible to have owners of the actions and reporting back on progress. The General Manager Quality & Innovation advised the clinical governance dashboard, previously approved by HDCA, was being developed. Feedback on that was welcomed. It was also noted that the Quality Account would be published quarterly in future. Management were cautioned in respect to the time taken to close complaints, as in major events the patient/family may not have had time to understand all the issues in ten days. In some events it had taken months before the patient/family was able to talk about the event. The diversity of work covered by this group was raised as it covered many different areas, eg workforce, customer liaison, patient incidents, clinical issues. The CEO clarified explaining there was a connection between staff and consumer/client/patient experience and bringing them closer together. It was resolved: that the content of the Clinical Governance and Quality Improvement report be

noted, and progress in delivering improvements in Clinical Governance and Quality

Improvement be endorsed.

b. Adverse Events (Incidents) Policy It was suggested that consumer participation could be extended to include involving them in the action plan and advice on when it was completed. Management clarified that the organisation collaborated with patients/whanau in adverse events, and that event reports were shared with the family. It was resolved that: the changes to the Adverse Events (Incident) Policy be endorsed.

5. POLICY & GOVERNANCE a. Committee’s Work Programme, 2019/20 The General Manager Quality and Innovation presented this report. The report was taken as read. It was resolved: that the update on the 2019/20 work programme be noted.

6. LATE ITEMS There were no late items.

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Unconfirmed minutes

7. DATE OF NEXT MEETING 4 February 2020. 8. EXCLUSION OF PUBLIC It was resolved:

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

Item Reason Reference “In committee” minutes of the Health & Disability Committee meeting

For the reasons set out in the order paper of 15.10.19 meeting held with the public present

Potential and Actual Serious adverse Events for August 2019 to October 2019

To protect personal privacy 9(2)(a)

Health & Disability Commissioner Complaints for August 2019 to October 2019

To protect personal privacy 9(2)(a)

Confirmed this 4th day of February 2020. ………………………………. Chairperson

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

Matter Raised Scheduled Responsibility Form Status Update re Treaty of Waitangi Policy review process Bd July 19 6-weekly T Te Huia Inc in HP report Ongoing Consumer feedback re Choices, particularly intensive wrap-around services

Oct 19 Apr 20 GMENZ Inc in ENZ report Scheduled

Mental Health Single Stage Business Case Nov 19 Apr 20 S Ambridge/V Caldwell

Report Scheduled

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For:

Decision

X Endorsement

Noting

To Health and Disability Advisory Committee

Author Cluster Leadership Group

Endorsed by Kathryn Cook, Chief Executive

Date 22 January 2020

Subject Cluster Update for November and December 2019

RECOMMENDATION

It is recommended that the Committee:

• endorse the progress made by the Services for November & December 2019

• note the conclusion date of Te Uru Whakamauora intermediate care bed initiative with Ranfurly Residential Care Centre is on 31 January 2020.

• endorse the progress towards achieving Planned Care

• note the workforce challenges within Te Uru Pā Harakeke

Strategic Alignment

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

1. PURPOSE The purpose of this report is provide the Health and Disability Advisory Committee with a summary of the performance against plans, budget and targets and to advise any current and emerging matters in: • Te Uru Whakamauora - Healthy Ageing and Rehabilitation • Te Uru Arotau - Acute and Elective Specialist Services • Te Uru Kiriora - Primary Public and Community • Te Uru Rauhi - Mental Health and Addictions • Te Uru Pā Harakeke - Healthy Women Children and Youth • Te Uru Mātai Matengau - Cancer Screening, Treatment and Support

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

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A SUMMARY OF THE SIX HEALTH AND DISABILITY SERVICE CLUSTERS

Te Uru Arotau – Acute and Elective Specialist Services

Te Uru Kiriora – Primary, Public and Community Health

Te Uru Arotau is responsible for the planning, funding and provision of secondary care (hospital level) services: • Medical services and subspecialties • Surgical services and subspecialties • Anaesthetics and Intensive Care Unit • Medical/Surgical inpatient wards • Medical Imaging and Hospital Pharmacy • Emergency services

Te Uru Kiriora is responsible for the planning, funding and provision of: • Primary and community based services

via a range of contracted partners’ Public health services spanning health promotion, protection, regulation, and clinical care delivery

• Specialist sexual health services • Child and adolescent dental services for

0-18 year olds across the district • Community based nursing services

including District Nursing and Primary Health Care nursing in partnership with Primary Care and the Central Primary Health Organisation

Te Uru Pā Harakeke – Healthy Women Children and Youth

Te Uru Rauhī – Mental Health and Addictions

Te Uru Pā Harakeke is responsible for the planning, funding, commissioning and provision of: • Primary and secondary maternity care,

secondary obstetrics and gynaecology services, including antenatal day unit, inpatients, outpatient clinics, community midwifery services and lactation services;

• Family centred inpatient, outpatient and community care for neonates (including neonatal intensive care), children (including high dependency care) and young people - up to their 16th birthday as inpatients and until end of school for ongoing ambulatory care.

• The commissioning of appropriate services to help improve the local population’s health needs with a particular focus on the first 1000 days and youth oriented care.

Te Uru Rauhī is responsible for the planning, funding and provision of: • General adult mental health in

community (moderate to severe and inclusive of co-existing problems)

• Primary Mental Health & Addictions • Mental Health Acute Inpatient services • Eating disorders • Maternal Mental Health • Community Rehabilitation • Child Adolescent and Family • Alcohol & other Drug Specialist Services • Maori Mental Health • Older Adult Mental Health Services

(Community and Inpatient) • 24 hour Mental Health Acute Care Team

Te Uru Mātai Matengau – Cancer Screening, Treatment & Support

Te Uru Whakamauora – Healthy Ageing and Rehabilitation

Te Uru Mātai Matengau is responsible for the planning, funding and provision of: • Prevention and early detection (screening)

programmes • Cancer diagnostic and treatment services • Cancer support services • Palliative care services • Non-malignant haematology services • Regional services for treatment and screening

Te Uru Whakamauora is responsible for the planning, funding and provision of specialist services for people over the age of 65 years (55 years for Maori) and those between the ages of 16-64 with a physical disability, with a focus on assessment, treatment and rehabilitation. Services are structured into: • ElderHealth • Rehabilitation • Therapy Services • Supportlinks

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COPY TO: Healthy Ageing and Rehabilitation MidCentral DHB

Heretaunga Street PO Box 2056

Palmerston North 4440 Phone: +64 (6) 350 8372

SERVICE: Te Uru Whakamauora

Healthy Ageing and Rehabilitation

FOR PERIOD: November & December 2019

PREPARED BY: Andrew Nwosu, Operations Executive

Syed Zaman, Clinical Executive Rehabilitation

Pauline Holland, Planning & Integration Lead

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

Initiative Rating

& Trend

A Increase uptake of integrated falls and fracture liaison service G ↑

A Improve consistency, quality and efficiency of Home and Community Support G ↑

A Improve process for the management of PPPR applications G ↑

A Increase support for older people managing their long term conditions G ●

P Implementation of “Red to Green” on wards G ↑

P Develop Complex patient pathway Plans for improved Discharge Planning G ●

P Implement an Intermediate Care Bed Pilot to improve Flow G ↑

P Develop Escalation Plans to manage surge G

P Timely transfers of care: Improving Acute to Rehab pathways G ↑

O Improve patient flow throughout the hospital, reducing barriers and delays G ↑

O Improve models of care for the older person with frailty G ↑

O Refine models of care for Older Persons (acute) Assessment and Liaison G ↑

O Support regional improvements for people and whānau living with dementia G ●

O Enhance orthogeriatric and general surgical models of care G ↑

O Promote wellness and age friendly environments for older people G ●

O Develop a more responsive and effective rehabilitation model G ↑

Rating & Trend Legend G On track,

progressing as planned.

A Behind plan – remedial action plan in place.

R Behind plan – major risks and exception report required.

D Not completed as planned.

↑ Improved from last report.

↓ Regressed from last report.

● No change from last report.

Plan Legend A Annual Plan P Performance

Improvement Plan O Operational Plan

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1.1 Performance Indicators – December 2019

Te Uru Whakamauora continues to focus on improved compliance and monitoring of key performance indicators. Work continues with the business intelligence teams to ensure the underlying data powering the dashboard is accurate and reflective of activity especially in relation to key metrics such as complaints and bed day usage. Staff turnover for December exceeded targets, however variables such as staff retirement and changes in circumstance were significant contibutors to staff attrition.

YTD Actual

YTD Actual

YTD Actual

0.0% 7.5%

Description Month Actual

Month Target

Month Variance

YTD Target

YTD Variance KPI Trend(13 month)

5.0

(5.6%)

CP25r - Occurrence Rate of Medication Incidents 1.0 3.5 (2.5) 3.3 3.5 (0.2)

(7.5%) 1.9% 7.5%CP21 - Acute readmissions within 28 days

1.4

CP28p - Hospital acquired UTI rate (%) (provisional) 0.00% 0.50% (0.50%) 1.53% 0.50% 1.03%

(1.2) 6.4 5.0CP26r - Occurrence Rate of Patient Falls 3.8

(0.31%) 0.29% 0.50%CP30p - Inpatients developing Pressure Ulcers (%) 0.19% 0.50%

Internal Process and OperationsDescription Month

ActualMonth Target

Month Variance

YTD Target


(0.22%)

CP41 - Complaints responded to within 15 days (%) 0.0% 95.0% (95.0%) 100.0% 95.0% 5.0%

IP18 - Outpatient appointment DNAs 3.9% 6.0% (2.1%) 4.4% 6.0% (1.6%)

(25.7%) 66.1% 85.0%IP07 - Bed Day Usage (by Health Specialty) 59.3% 85.0% (18.9%)

IP22 - Hospitalised smokers provided with help to quit 100.0% 95.0% 5.0% 96.8% 95.0% 1.8%

4,384

Organisational Health and LearningDescription Month

ActualMonth Target

Month Variance

YTD Target


529 4,384 0IP28 - One to One Hours 529 0

(2.2%)

OH02 - Staff Turnover 2.59% 1.00% 1.59% 3.61% 1.00% 2.61%

1.0% 96.8% 99.0%OH01 - Staff Stability 100.0% 99.0%

1.60%

LegendAchievedPartial AchievementNot Achieved

(0.49%) 4.80% 3.20%OH03 - Sick Leave Rate 2.71% 3.20%

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2. SIGNIFICANT MATTERS 2.1 OPAL Inpatient Unit The OPAL (Older People’s Acute Assessment and Liaison) unit continues to deliver positive patient outcomes with improved discharge rates, reduced Length of Stay (LOS), direct admissions and reduced waiting times. An evaluation of the service outputs and impact on other areas is being undertaken to mitigate any unexpected consequences. 2.2 STAR 2 The Red to Green initiative continues to produce positive patient and system outcomes, identifying and minimising potential delays and wasted days where possible. The partnership between the Te Uru Arotau and Te Uru Whakamauora in relation to the management of uncomplicated hip fractures continues to produce positive outcomes and has been extended until 5 March 2020. It will now include patients who reside in Horowhenua. From an equity standpoint the service will be conducting an audit to ensure that the increased throughput of orthopaedic patients is not disadvantaging other patient groups. Plans for further discussions with the Acute and Elective Specialist Services are intended to better provision the pre operative element of the patient journey. 2.4 Community Rehabilitation Te Uru Whakamauora has approved a Pilot with Lavender Blue, supporting the delivery of MidCentral DHB’s Accident Compensation Compensation funded In Home Strength and Balance Programme (IHSB). Support staff will receive education so they can support IHSB programme with selected clients in their home. It is due to commence March 2020. 2.5 Creating Hospital Capacity Te Uru Whakamauora’s draft OPAL Community Service business case that looks to implement a locality based and partnership focussed approach to the management of fraility was agreed in principle by the Organisational Leadership Team in December. Further financial modelling is currently taking place and the proposal will be re-presented in February. It is expected that with the arrival of two new geriatricians in New Year, Te Uru Whakamauora will implement a 8.00am-4.00pm Monday to Friday interface geriatrics service in the Emergency Department to support elderly patients to be seen at presentation. The Development of Guidelines and Resources related to Protection of Personal and Property Right, Enduring Power of Attorney, Welfare Guardian and Property Management, Administration and Personal Order Applications concluded in December, 2019. The service is currently working with the communications team to ensure appropriate dissemination to MidCentral DHB Staff, Iwi and Community Partners.

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2.6 Health Recovery Beds Te Uru Whakamauora’s intermediate care bed initiative with Ranfurly Residential Care Centre is due to end on 31 January 2020 following an analysis of cost-benefits. One months’ notice of conclusion has been given, a review of outcomes and learnings will take place and be disseminated in due course. 2.7 Improving Health of People with Complex Presentations Te Uru Whakamauora continues to demonstrate its commitment to reducing health inequities and has commenced the development of a cross cluster complex patient pathway, bringing together stakeholders across the health and care continuum. Initial focus will be around reducing readmissions, timelier and safer discharge and the management of patients with complex social and behavioural issues. 2.8 Non Acute Rehabilitation Progress continues to be made around meeting the specifications required to deliver community based Non Acute Rehabilitation (NAR). A meeting was held in November 2019 with Home and Community Support Services providers to review options to support community rehabilitation for NAR patients.

A follow on from these discussions has been a trial with one of the facilities, Ranfurly Residential Care, of an education program to prevent, as well as minimise, the likelihood of patients deconditioning during their stay. 2.9 Improving Rehabilitation Services in the MidCentral District Following on from the outputs of the cross sector Rehabilitation Hui on 13 November, 2019 workstreams are being set up to create a roadmap for rehabilitation services that straddle the health and care continuum and reflect the needs of served communities.

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COPY TO:

Te Uru Arotau

Acute & Elective Specialist Services MidCentral DHB


Palmerston North 4440 Phone: +64 (6) 350 8825

SERVICE: Te Uru Arotau

Acute & Elective Specialist Services


PREPARED BY: Lyn Horgan, Operations Executive

Dr David Sapsford, Clinical Executive

Barbara Ruby, Planning & Integration Lead

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

Trend A

Improve delivery of planned care interventions to meet prioritised population health needs and timely access – utilising outsourcing and outplacing options to maximise capacity for planned surgical interventions.

G ●

A

Reduce variation and improve access to cardiac care services – access to echocardiography and local interventional cardiology service. G ●

A

Improve planned care services across the system through an agreed system wide three year improvement plan for planned care. G ↑

A Sustain achievement of the minimum requirements for colonoscopy wait times. G ↑ A

Zero patients waiting longer than four months for a first specialist assessment – streamline referral management and triaging processes. A ↑

O

Develop and pilot a community-based model of care for musculoskeletal services. G ●

O Refurbish current building footprint to enable extra theatre capacity. G ↑

O Partner with Pae Ora and Healthy Women Children and Youth to pilot an engagement conduit for proactive engagement with Māori Whānau to support attendances for planned assessment.

G ↑

O

Minimise avoidable repeat hospital admissions for people with COPD through triaged follow up and intervention. G ●

O

Establish Clinical Pharmacist support service to patients presenting to ED who have long term health condition where medicines management may have, or did, contribute to hospital presentation.

G ↑

O

Improve patient flow throughout the hospital, reducing barriers and delays to assessment, treatment and discharge through Timely Care programme. A ↑

P Planned Care Improvement, ESPI 5 compliance. R ↑ P Outpatient ESPI 2 compliance. A ↑ P Takatu, Emergency Department Performance. R ● P Medimorph (General Medicine). A ● P Surgical Acute Care Improvement. A ●

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












YTD Actual

YTD Actual

YTD Actual

Non-financial KPI results are PROVISIONAL*

Acute and Elective Specialties Cluster Scorecard

For the period ending December 2019. Cluster: C20 - Acute & Elective Specialists; Service: (All); RC: (All).

Customer Patient


CP21 - Ac ute readmissions within 28

9.8% 6.9% 7.5% (0.6%) 10.6%

Description Previous Month

Month Actual

Month Target

Month Variance

YTD Target

7.5% 3.1%

CP25r - Oc c urrenc e Rate of Medic ation

1.6 4.0 3.5

CP26r - Oc c urrenc e Rate of Patient Falls

3.5 3.2 5.0 (1.8) 3.6

0.5 3.0 3.5 (0.5)

5.0 (1.4)

CP28p - Hospital ac quired UTI rate (%)

0.00% 0.00% 0.50%

CP30p - Inpatients dev eloping Pressure

0.19% 0.22% 0.50% (0.28%) 0.21%

(0.50%) 0.21% 0.50% (0.29%)

0.50% (0.29%)

CP41 - Complaints responded to within 15

95.2% 100.0% 95.0%

Internal Process and Operations


Month Actual

Month Target

Month Variance

YTD Target

YTD Variance

5.0% 99.4% 95.0% 4.4%

KPI Trend(13 month)

IP00a - ED Presentations Hospital-

3,754 3,951 0 3,951 23,739 0 23,739

IP00d - ED Presentations (by

3,615 3,828 0 3,828

IP00ma - ED Presentations, Maori (by

652 708 0 708 4,232 0

22,745 0 22,745

4,232

IP00nm - ED Presentations, Non-

2,963 3,120 0 3,120

IP00-04 - ED Presentations 0-4 years

205 213 0 213 1,429 0

18,513 0 18,513

1,429

IP00-16 - ED Presentations 5-16

319 337 0 337

IP00-64 - ED Presentations 17-64

2,022 2,148 0 2,148 12,553 0

1,935 0 1,935

12,553

IP00-65 - ED Presentations 65+ years

995 1,069 0 1,069

IP02 - ED stays less than 6 hours

75.7% 71.3% 95.0% (23.7%) 73.2% 95.0%

6,290 0 6,290

(21.8%)

IP03a - Av erage LoS: Ac ute Inpatient

4.7 4.4 4.0 0.4

IP03e - Av erage LoS: Elec tiv e Inpatient

3.2 3.4 4.0 (0.6) 2.9 4.0

4.5 4.0 0.5

(1.1)

IP07 - Bed Day Usage (by Health Spec ialty)

123.9% 117.0% 85.0% 32.0%

IP18 - Outpatient appointment DNAs

6.0% 6.5% 6.0% 0.5% 6.5% 6.0%

125.7% 85.0% 40.7%

0.5%

IP18ma - Outpatient appointment DNAs,

12.7% 14.8% 6.0% 8.8%

IP18nm - Outpatient appointment DNAs, Non-

4.4% 4.9% 6.0% (1.1%) 5.2% 6.0%

12.5% 6.0% 6.5%

(0.8%)

Organisational Health and Learning


Month Actual

Month Target

Month Variance

IP28 - One to One Hours

2,508 2,016 0 2,016 14,562 0

OH01 - Staff Stability 99.0% 99.7% 99.0% 0.7%

14,562

98.5% 99.0% (0.5%)

YTD Target


OH03 - Sic k Leav e Rate 3.17% 2.08% 3.20% (1.12%) 3.84% 3.20%

1.32% 1.00% 0.32%OH02 - Staff Turnov er 1.63% 1.30% 1.00% 0.30%

0.64%

Legend * Non-financial KPI results for Dec-2017 to date are subject to data-quality and completeness checks relating to the WebPAS transition.

Achieved

Partial Achievement

Not Achieved

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Work continues to improve compliance and enhance monitoring, including: • A higher occurrence rate of medication incidents in December can be attributed

to some missed doses and prescribing errors which correlate to the new intake of house officers. The Pharmacy department has undertaken additional education sessions which have been well received. There have been no serious medication related incidents.

• Reviewing the acute readmission metrics. • Continuing the patient flow programme which in turn will improve the Shorter

Stays in Emergency Department (SSIED) result. • A focused programme for outpatient services (commenced in January 2019)

which includes improving Did Not Attend (DNA) rates. • Action plans are in place for all areas to increase the giving of brief advice to

smokers. • Leave plans in place for all staff with leave in excess of two years. 2. SIGNIFICANT MATTERS 2.1 Planned Care Michelle Arrowsmith, Deputy Director-General DHB Performance Support & Infrastructure, accompanied by two team members, visited the District Health Board (DHB) on Wednesday, 15 January 2020. The Ministry of Health (MoH) was briefed on the DHB’s medium-term SPIRE (Surgical Procedural Interventional Recovery Expansion) proposal. This programme of work will deliver two additional theatres, additional perioperative and procedure rooms and a cardiac catheterisation laboratory. We are seeking Government funding support from the recently announced $300m DHB infrastructure funding. We are also seeking support to establish additional Emergency Department (ED) and assessment capacity. Planned Care Performance

MidCentral DHB (MDHB) is delivering to our internal budgeted planned care Case Weighted Discharges (CWDs). • Planned Care Strategies Ongoing strategies to achieve Planned Care targets include: • Outsourcing procedures to CREST • Additional outpatient clinics being held where appropriate • Ensuring patients have access to clinical assessment/advice if required and are

kept well informed of any delays. • Three Year Planned Care Improvement Plan As part of the new MoH Planned Care Strategy, it is a requirement for all DHBs to formulate a three year improvement plan for planned care. The draft plan continues to evolve following on the Planned Care Hui and further internal engagement.

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

with ongoing lower back pain. • provide an effective assessment and triaging service to identify patients

requiring specialist support or multi-disciplinary rehabilitation. • provide functional rehabilitation and self-management education to improve

quality of life and independence for MDHB patients. • reduce disparities in health status within the community. Te Uru Arotau, Te Uru Pā Harakeke and Pae Ora Paiaka Whaiora have partnered for the introduction of a Whānau Equity Facilitator role. This role will support a direct focus on Māori Equity and system engagement to support attendances for planned assessments. • ESPI 2 and 5 Performance

Steady progress is being made in recovering Elective Services Patient Flow Indicator (ESPI) 2 and 5 performances. Work continues on being ESPI 2 compliant. ESPI 5 compliance was required by 30 November 2019 (except for Orthopaedics for which compliance was required by 31 December) and this was not achieved. Orthopaedics and General Surgery were not expected to achieve target and a revised recovery plan for these is with the MoH. MDHB have received verbal approval and are awaiting this in writing. • Referrals Accepted or Declined by Specialty At the Health and Disability Advisory Committee (HDAC) meeting on 15 October 2019 members requested a breakdown of the number of referrals received, numbers accepted and numbers declined by specialty. There are a number of categories for which a referral is declined including available capacity, insufficient information on referral, not eligible or advice is provided to referrer negating the need for an appointment. The majority of declined referrals are attributed to capacity. This information can be seen in Appendix 1. 2.2 Shorter Stays in the ED (SSIED) and Patient Flow The organisational SSIED result for November 2019 was 78 percent and December 2019 was 74 percent.

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Major programmes continue, focused on improving the flow of patients throughout the hospital and into the community and a number of new strategies are being applied to support improved performance: • Takatū – Emergency Department (ED) Performance. • Medimorph and Frailty – Acute Medicine Performance. • Surgical Acute Care – Acute Surgical Performance. • Rationalising Acute Demand – Avoidable Presentations. • Escalation Planning. • Improving staff and patient safety. • ED surge capacity. Current initiatives to improve patient flow include; opening all available inpatient beds, focusing on proactively identifying two patients before 10 a.m. who can be appropriately discharged from the medical wards, revised home-based warding following the opening of the Older Person’s Assessment Liaison (OPAL) Unit and utilisation of the patient journey boards. There has been a reduction in the number of patients waiting overnight in the ED for an inpatient bed. Primary Options for Acute Care (POAC) ED redirections began 27 May 2019. There have been 1,008 patients that have presented at ED appropriate for POAC ED redirection. Of these, 83 patients declined the service for various reasons and 925 patients accepted the service. As the acute demand and number of presentations to the ED have increased over the previous 12 months, there has been a rising trend in the number and therefore percentage of people who did not wait to be seen. This is outlined in the table below with both November and December data.

Month/Year Did Not Wait

(DNW) Number of

Presentations Percentage

(DNW) 01/01/2019 370 3,961 9%

01/02/2019 378 3,628 10%

01/03/2019 407 4,104 10%

01/04/2019 406 3,847 11%

01/05/2019 354 3,945 9%

01/06/2019 392 4,002 10%

01/07/2019 334 4,065 8%

01/08/2019 411 4,142 9%

01/09/2019 440 3,929 11%

01/10/2019 359 3,891 9%

01/11/2019 361 3,773 10%

01/12/2019 459 3,946 12%

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

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Prescribing Pharmacist Prescribing pharmacists work within a clinical team and may prescribe most medicines. MDHB’s Chief Pharmacist undertook the prescribing pharmacist post-graduate certificate in 2019, passed and is now registered as a pharmacist prescriber with the scope of practice of emergency medicine. The prescribing pharmacist works approximately 12 hours a week in the ED and prescribes medicines to patients presenting with musculoskeletal injuries and assists with prescribing this group of patients’ usual medicines should they be admitted to hospital. 2.3 Diagnostic Wait Times December results are below, with angiography services achieving target.

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

>95% within 3 months 100% 100% 100% 100%

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

The Magnetic Resonance Imaging (MRI) result improved slightly following the MRI quenching and the MIT industrial action. Additional staff commence at the end of January; the target is expected to improve from then. The MRI is currently working more than eight hours each day. An increase in acute cases for both modalities is being experienced with MRI having to postpone sessions of routine appointments booked in January to accommodate the acute referrals. 2.4 Cardiac Care Services

Computed Tomography Cardiac Angiography (CTCA) – Sub-Regional Joint Initiative CTCA takes x-ray pictures of cross-sections of the heart (like slices of bread) very quickly. These images are re-assembled by the computer to produce a detailed picture of the heart. The investigation of cardiac ischaemia is becoming more dependent on CTCA. Currently MDHB does not have the software to perform CTCA on site. The purchase of the second CT machine will include CTCA functionality. In the meantime, the MDHB Cardiology service in partnership with Whanganui DHB (WDHB) is establishing a sub-regional CTCA service. WDHB has CTCA software on their machine and a medical imaging technician able to perform the study. This will be supervised by an MDHB Cardiologist trained in CTCA who will also triage the

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patients eligible for this test and report the studies. Patients from both DHBs will be able to receive this study at Wanganui Hospital supported by the MDHB cardiac diagnostic nursing staff. This is a cost neutral initiative. Two additional SMOs will train in CTCA in 2020. It is expected that this service will commence in the next few months. 3. EMERGING/CURRENT RISKS Anaesthetics with three Senior Medical Officer (SMO) vacancies and Orthopaedics continue to be areas of concern for Te Uru Arotau. Two Orthopaedic Surgeons have required long periods of leave unexpectedly with one continuing on leave for the foreseeable future. A further Orthopaedic Surgeon also retired in September. Unfortunately, this will continue to impact on internal capacity and outsourcing arrangements as staff work across both providers. Recruitment for both locum and permanent Orthopaedic Surgeons has been under way for some time. One locum surgeon has commenced in December 2019 for six months and we have one offer out to an Orthopaedic Surgeon. Nationally recruitment is a challenge. Ongoing work continues to ensure a full staffing complement. Risk 805 – Follow-up process and procedures A request for explanation of this risk (to be made to the HDAC) was made at the Finance, Risk and Audit Committee (FRAC) meeting on 19 November 2019. When MDHB moved to WebPAS, a number of patients who had been seen at an outpatient clinic were inadvertently transferred as patients awaiting a first specialist assessment, i.e. an open referral. This was identified at the time. The Regional Health Informatics Programme (RHIP) Remediation Team enacted a system change, amending the status of these patients to requiring a “follow-up”. However, some of these patients do not require a follow-up appointment and should have been “closed”. One of the other mitigating factors is a lack of clear outcome from clinics leading to staff entering data without an outcome, i.e. follow up required or discharged back to General Practitioner (GP), and not closing the referral. The focus for the remediation team is on new referrals in the first instance. A “follow-ups” project has been established and forms part of the Performance Improvement Plan (PIP) to enable focus and resources to be dedicated to remediating this matter. It is expected to take 16 weeks to work through all the open referrals involved.

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APPENDIX 1 Table 1: Referrals Accepted and Declined

Specialty November 2019 December 2019

Total Received

Accepted Declined Below

Threshold/ Capacity

Percentage Declined

Total Received

Accepted Declined Below

Threshold/ Capacity

Percentage Declined

Cardiology 104 67 16 15% 79 36 22 28% Dental 91 41 0 0% 97 56 0 0% Diabetes 12 12 0 0% 4 4 0 0% Ear Nose Throat 290 288 0 0% 248 246 0 0% Endocrinology 6 6 0 0% 4 4 0 0% Gastroenterology 83 82 0 0% 95 94 0 0% General Medicine 79 79 0 0% 69 69 0 0%

General Surgery 366 316 0 0% 244 215 0 0% Gynaecology 144 135 0 0% 98 75 0 0% Haematology 49 49 0 0% 42 42 0 0% Maxillo-Facial 11 10 0 0% 8 8 0 0% Dermatology 51 40 0 0% 50 42 0 0% Infectious Diseases 7 7 0 0% 5 5 0 0% Neurology 59 58 0 0% 52 50 1 2% Ophthalmology 202 175 11 5% 219 196 9 4% Orthopaedics 300 298 0 0% 298 296 0 0% Paediatric Medicine 101 100 0 0% 64 62 0 0% Respiratory 55 51 0 0% 48 46 0 0% Urology 172 131 39 23% 84 45 37 44% Rheumatology 14 0 0 0% 13 7 0 0% Total 2,196 1,940 66 3% 1,821 1,598 69 4%

NB: The process to review and triage referrals is a continous one across rolling

months. For example; a referral may be received at the end of one month and is processed early in the following month.

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COPY TO: Te Uru Kiriora Primary, Public and Community Health

MidCentral DHB Heretaunga Street

PO Box 2056 Palmerston North 4440

Phone: +64 (6) 350 8074

CLUSTER: Te Uru Kiriora

Primary, Public and Community Health

FOR PERIOD: November and December 2019

PREPARED BY: Deborah Davies - Operations Executive,

Alison Russell - Planning and Integration Lead 1. PERFORMANCE OVERVIEW Te Uru Kiriora is generally on track with all initiatives under the Annual, Operational and Performance Improvement Plans. An emerging risk is the novel Coronavirus. Items of note are discussed under Emerging/Current Risks. Items of note are discussed under Significant Matters. Plan Initiative Rating

& Trend

Better Population Health Outcomes Supported by Primary Health Care A Increase enrolment numbers across the MidCentral District with a focus on Māori G ● O Drive effective integrated Locality based care delivery through locality team

prototype development and workforce planning G ●

P Pharmacy Improvement Programme G ● P Improve management of Long Term Conditions with a focus on Chronic Pain,

Diabetes and Respiratory Care G ●

Improving Child Wellbeing

A Improve access to youth friendly and appropriate primary health care services to improve health outcomes

G ●

O Achieve equity in immunisation coverage rates across priority groups of infants and children

A ●

Improving Wellbeing Through Prevention A Increase Cervical Screening coverage rates for Māori, Asian and Pacific women to

achieve and sustain equity A ●

A Reduce the prevalence of smoking, particularly for Māori and increase uptake of smoking cessation support services

A ●

A Promote and enable wellbeing in communities through health policy initiatives G ● Better Population Health Outcomes Supported by a Strong and Equitable Public

Health and Disability Strategy P Strengthen community based Acute and Urgent Demand model of care and

delivery G ●

O Improve patient health care outcomes and experience in primary care and community settings through scaling of Health Care Home

G ●

A Strengthen delivery of Whānau Ora “closer to home” increasing number of whānau who benefit from collective impact participation

G ●











26

1.1 Performance Indicators

THINK Hauora enrolment for Māori are slowly increasing and a focus is on utilising all potential initiatives to connect. An example is the notification of unenrolled people attending Emergency Department (ED), with consent, to the THINK Hauora for follow up to facilitate enrolment. The focus remains on recalling all under five year olds that have not completed scheduled vaccinations (which includes Measles, Mumps, Rubella (MMR)), and THINK Hauora are working closely with General Practice (GP)Teams. To further improve cervical screening the review of the current range of providers and access is a key focus alongside communication with Māori wāhine and increasing access to free cervical smears.

27

Child and Adolescent Oral Health arrears are 4.7 percent adverse, and remain a key focus area particularly adolescent Māori. Māori 0-4 year old arrears remain below the target of 10 percent. (See 2.1 for an update on the service dashboard and reconfiguration progress). Leave plans are in place for all staff with leave in excess of two years, and are monitored monthly. There has been a significant reduction in sick leave over the reporting period. Challenges remain in planned sick leave. 2. SIGNIFICANT MATTERS 2.1 Child Adolescent Oral Health The majority of the Service Dashboard is in place (as reported in the scorecard), with the implementation of the revised geographical teams set to commence with term one delivery. Following a leadership restructure, recruitment for a Manager of Dental Services is underway, with the service looking to commence the year with potentially one full time position vacant in dental therapists. A full revision of service orientation has been completed, and a ‘pulse check’ providing a sense of the staff culture is being undertaken to be reported to the Committee next meeting. 2.2 Acute Demand and LTC Over 1000 patients have been redirected from ED to Primary Options for Acute Care (POAC) providers in the past seven months. A current focus is on improved information for consumers presenting to ED regarding their options for their current and subsequent requirements for acute care. Improving the management and community based support of people presenting with acute Chronic Obstructive Pulmonary Disease to the ED is to commence February in two phases. Phase One is proactive transfer to primary health care team providers (where appropriate) of people presenting to ED with pre-arranged GP Team follow up (including aligned Long Term Conditions nursing input) within 2-3 days. The aim is to ensure the patient is actively managing with appropriate supports in place. Under the POAC model this is at no cost to the patient. Phase Two will support inpatients discharged to community utilising the same POAC model to ensure the timely follow-up and wrap around of appropriate services. The management pathway to support this has been co-designed with stakeholders with a focus on transition of care and the consumer experience. A key aim is to utilise the POAC model to increase home based management of these people supported by the GP Team. Continuing to increase community communication and engagement is concurrently being advanced with joint MDHB and THINK Hauora working group. Key elements will be agreed to commence with pre winter messaging in March. 2.3 Pharmacy Improvement Programme The Pharmacy Improvement Programme has completed its first year and is tracking well. There have been periods of reduced capacity with vacancies with active recruitment underway.

28

This quarter the Primary Care Support Pharmacists team provided Medicines Management Services to 263 patients. This brought the calendar year total to 1509 patients (Table 1). Table 1 Total number of Patients Quarter Jan - March April - June July - Sept Oct- Dec Year

total Number of Patients 411 419 416 263 1509

To ensure there is access for our communities, patients are able to self-refer and request to see the practice pharmacist. The source of patient referrals have always been significantly diversified, this quarter has seen a continued focus on high-risk polypharmacy patients. Reducing medication related harm focussed on avoidable Adverse Drug Events (ADEs) originating in primary care continues in collaboration with primary health care teams. In this quarter, 50 patients were identified as having an ADE. This is comparable to last quarter. Working in collaboration with the primary healthcare teams, they were jointly able to resolve the ADE and help prevent and manage further occurrences in the future. Table 4 Trend of Adverse Drug Events

Quarter

Jan - March April - June July – Sept Oct-Dec Year total

Number of Patients Presenting with Preventable ADEs

90 72 49 50 261

2.4 Move to 200 Broadway

On Friday 13 December 2019 staff from Te Tihi, THINK Hauora, the Diabetes Lifestyle Trust and MDHB’s Public Health and Community Child Health Teams moved into the new premises at 200 Broadway. The move represents the coming together of some of key community based providers. It offers the opportunity to further strengthen relationships between the various organisations, whose focus is working in and with our communities. The building project was undertaken by the Vining Group, who refurbished the back section of the old Returned Servicemans Association (RSA) premises, adding a new area to accommodate the combined workforce of almost 200 staff. The Whakatūwheratanga (Dawn Ceremony), held on Monday 2 December 2019 was well attended, with staff and invited guests attending the blessing, and having a look around the new building.

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2.5 Measles From 1 January 2019 to 15 January 2020 there have been 2,191 confirmed cases of measles notified across New Zealand (as at 1500hrs 15 January 2020) based on ESR reporting. The past two weeks has seen six cases confirmed nationally. This is much lower than was the case in the last report. Most people who have caught measles have been unvaccinated or with uncertain vaccination status. There have been ten people confirmed with measles in the MidCentral District Health Board (MDHB) district since the beginning of the 2019. Additional stocks of vaccine have arrived in New Zealand with a further 70,000 doses scheduled to arrive in January. The Ministry of Health has amended the ordering system so that individual providers are once again able to order MMR vaccine directly from the supplier, along with their other schedule vaccines. 2.6 Manawatu River Leaders forum The Manawatū River Leaders' Forum has welcomed the MDHB as a new member at their December meeting.

MDHB’s General Manager Māori, Medical Officer of Health and Public Health Manager attended the meeting.

Tracee noted that the Accord's vision, "if the water is healthy, the land and the people are nourished", aligns well with the MDHB vision and mission. It will be advantageous for the MDHB to partner with the Accord in addressing the issues of the awa.

3. EMERGING/CURRENT RISKS Cluster of Pneumonia in Wuhan City, China An outbreak of pneumonia of unknown aetiology in Wuhan City, China was initially reported to World Health Organisation (WHO) on 31 December 2019. Most patients had links to the Huanan South China Seafood Market. At time of writing this update there have been 2011 confirmed cases, including forty two cases beyond China. The majority having reported travel to Wuhan.

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Person-to-person spread is now considered to be occurring, however, the mode and readiness of transmission, clinical spectrum of disease, true geographic extent of human infection, and source, are yet to be confirmed. The Ministry of Health (MoH) Public Health Team has established an Incident Management Team to respond to this event. MDHB has a combined response planned for any suspect case that is identified in the area. Primary Care has confirmed sites for seeing suspect cases, and key public health actions to include isolation of the suspect case, identification and quarantine of appropriate contacts are business as usual. The MoH will act as the key point of contact for general media enquiries and the DHB will respond to specific local enquiries.

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COPY TO: Te Uru Rauhī Mental Health & Addictions



Phone: +64 (6) 350 8358

SERVICE: Te Uru Rauhī

Mental Health & Addictions Service


PREPARED BY: Scott Ambridge, Operations Executive

Dr Vanessa Caldwell, Clinical Executive

Richard Hodgson, Planning & Integration Lead

1. PERFORMANCE OVERVIEW

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

Trend Inquiry into mental health & addiction – He Ara Oranga

(also read in conjunction with sections below) A Work with the Service Alliance Group to implement a district wide plan that

supports increased access and capacity to adopt early intervention models of care and recovery.

G ●

A Work with the PHO, NGOs, Iwi and Kaupapa Māori services on establishing a range of low threshold community based services that support resilience, connection and wellbeing.

G

A Partner with the public health service and the sector to expand capability and capacity in suicide prevention and develop high profile campaigns focused on prevention.

G ●

A Develop the acute model of care and progress initiatives to address the critical gaps for those experiencing psychiatric distress (ie home based treatment teams, multi-function planned respite).

G ●

Population Mental health A Develop Iwi and community partnerships that support a purposeful focus on

addressing the inequities for Maori and prioritise investment towards improving Maori outcomes.

G

A Work in partnership with the community to develop and pilot community-based services that expand access in the Horowhenua and Tararua areas. G ●

A Work with the PHO to improve the overall physical health outcomes for people with mental health and addictions conditions. G ●

A Develop initiatives to increase the diversity of the workforce and work in partnership with Pae Ora to improve the cultural competency. G ●

Mental Health & Addictions improvement activities A Drive whole of system improvement across the six domains of quality and

against the HSQC quality improvement programmes (incl. zero seclusion). G ●

A Commence transitioning to a person centred model of practice and explore ways to use data and technology to increase workforce effectiveness and mobility.

G ●

A Complete business case to Government to secure funding for progressing redevelopment of acute mental health inpatient (Ward 21) facility. G ●

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Maternal Mental Health / Addictions A Improve equity of access and reduce waiting times for young people and

pregnant Māori women and their whanau. G ●






Improved from last report.

Regressed from last report.





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

KPI # Description Target Jan‐19 Feb‐19 Mar‐19 Apr‐19 May‐19 Jun‐19 Jul‐19 Aug‐19 Sep‐19 Oct‐19 Nov‐19 Dec‐19vs. Last

Month

KPI 228 day acute inpatient readmission

rate0‐10% 25% 19% 18% 20% 16% 13% 25% 20% 15% 22% 21% ↓

KPI 8Average length of acute inpatient

stay (days)14‐21 days 10.2 10.4 8.4 8.3 8.9 13.1 11.4 15.6 8.1 10.5 11.1 8.9 ↓

KPI 18

Pre‐admission community care

(Seen in 7 days before ward

admission)

75‐100% 45% 57% 54% 56% 60% 32% 51% 45% 35% 48% 42% 56% ↑

KPI 19

Post‐discharge community care

(Seen in 7 days following ward

discharge)

90‐100% 68% 66% 64% 67% 59% 46% 65% 51% 50% 57% 63% 47% ↓

KPI 33Percentage of contact time with

client participation80‐90% 89% 87% 87% 87% 89% 89% 86% 86% 85% 86% 85% 86% ↑

KPI 34Community service‐user‐related

time35‐40% 18% 18% 18% 18% 20% 18% 22% 20% 19% 20% 19% 16% ↓

% Current clients in a service for

more than 91 days after first seen

with no diagnosis

0% 25% ↑

% HoNOS/CA/65+ within previous

3 months ‐ Community Teams

(excl. A&OD)

80% 60.7% 61.5% 68.1% 63.5% 66.5% 66.0% 67.7% 70.4% 70.4% 71.6% 71.6% 74.1% ↑

% HoNOS/CA/65+ within previous

3 months ‐ Inpatient Teams (Ward

21 and STAR 1)

80% 83.1% 84.7% 87.7% 93.4% 94.9% 93.8% 95.4% 96.1% 97.6% 98.5% 98.3% 97.6% ↓

Seclusion ‐ Ward 21 0 12 10 3 5 9 17 6 5 20 12 3 5 ↑

PP26

Acute Care Team Police referrals

Face‐to‐Face Contact within 3

hours

68% 51% 54% 74% 67% 57% 46% 64% 67% 64% 75% 64% ↓

Ministry of Health Alert or Significantly below target

LEGENDMeets Ministry of Health Target

Does not meet Ministry of Health Target

33

It is pleasing to see the positive result for complaints due to a concerted effort by the team to be more responsive to feedback from our customers. All managers are working on plans for their staff with leave in excess of two years. 2. SIGNIFICANT MATTERS

2.1 Request for Proposals (RFP) – Ministry of Health Access and Choice Primary Mental Health & Addictions Services On 3 December we received notification by the Ministry that our proposal was shortlisted for implementation in the first tranche (January through June 2020) of this RFP. The Ministry was very impressed with the strength of our response and in particular the collaboration demonstrated between the DHB, THINK Hauora and Te Tihi o Rauhine Alliance. On the 19 December we met with the Ministry to discuss details regarding our proposal. The Ministry advised that as the tender had been oversubscribed, the funding allocation had been based on the MH Population based funding formula. As such, we have been approved for 1/3 of the proposed funding to a total of $1.9m which has been prescribed for 7.1FTE Health Improvement Practitioners and 10.7FTE Support workers/wellbeing coaches. The Ministry did indicate that there will be further funding increases in the out years without a need to re-tender. We are pleased that we have the opportunity to increase the capacity of workforce in the primary care setting however did express our disappointment to the Ministry given this allocation will be insufficient to create a critical mass to enable the transition of our model of care to be largely focused in the community and in early intervention by itself. We will of course, continue to work with our key partners to achieve this. Subject to confirmation of some details we hope to receive contract by the end of January.

34

Expansion and/or Replication of Existing Māori and Pacific Primary Mental Health and Addiction Services Te Tihi o Ruahine Alliance led the response in conjunction with the DHB that was submitted on the 26 November. We have since been told that this tender is over-subscribed and we should expect a response from the Ministry in January. A decision was made not to submit a response for the specific Pasifika RFP as we did not meet the tender criteria. We do expect further RFPs focused on youth in February. 2.2 Older Adult Model of Care The official project kick off meeting to identify the best practice model of care for Older Adult psychogeriatric care in this region was held in December. Annette Carse the Current Clinical Manager for Star 1 and OACMH will be the Project lead. A project scope has been agreed and work has commenced on researching what current models exist both in New Zealand and internationally. Regular updates will be provided to this committee. 2.3 Acute Alternatives Services which provide 24 hour supported living environments in the community to facilitate both planned and unplanned respite are needed in priority locations (Horowhenua and Tararua). Ideally these are services operated by peers, kaupapa Māori and those focused on young people to have real alternatives to manage their wellness in the community, get back on track quickly and prevent unnecessary ward admission (through lack of other options). They will be supported as required by secondary teams for specialist clinical review. We are currently working with Housing New Zealand to investigate options in the Horowhenua area that will support a multi-function, planned and unplanned respite service including providing support for those discharged from inpatient care as a “step down” to support supported re-integration for those who may need extra time. We have also initiated an informal initiative with an Aged Care facility to provide support for people who may be ready for discharge from the ward and could benefit from a little extra time to ensure better integration back into the community. Overall the initiative was successful with the majority of people transitioning quickly through the facility. This initiative has concluded and will now review evaluations to decide whether formal arrangements will be put in place. 2.4 Inpatient facility redevelopment As previously reported, workshops and consultations have been held over his past year to engage stakeholders in the design of a new inpatient facility. Aligned to this, work on a new model of care, work with Unison, Iwi and Kaupapa Māori provider’s network, and leadership workshop sessions have contributed to this development. We have been keeping relevant government departments updated with our progress and we were delighted that during their visit in November, the

35

Prime Minister, Jacinda Ardern and the Health Minister, Dr David Clark announced the $30m funding package for the inpatient redevelopment. The single stage business case is due to be presented to HDAC and the Board in the first quarter of 2020. 2.5 Demand The graph below shows the number of people presenting by day to the Emergency Department who are seen by the Acute Care team.

50 percent of the presentations are seen between 4pm and 11pm at night and 20 percent seen between 2am and 5am in the morning. It is also important to note ACT is a mobile team that attends assessment at people homes and at police cells sometimes is very difficult and challenging situations. Over a five-month period (July to November) the ACT team saw 423 people, 82 percent of those within six hours. Other acute alternatives remain limited in the community and access to appropriate housing options for people remains the biggest problem, particularly those who might require a more personalised response. 2.6 Financial Sustainability Financial sustainability remains a significant challenge for Te Uru Rauhī which are predominately being driven by staffing costs. Whilst these cost pressures remain any opportunities to reinvest in the new model of care will remain extremely challenging. Request for Proposals from the Ministry will provide new opportunities to invest, however these do little to change the current pressures on secondary services in the short to medium term. Work is continuing on a number of initiatives aimed at stabilising the current situation.

0

5

10

15

20

25

30

35

40

Mon Tues Wed Thurs Fri Sat Sun

Presentations to ED by Day

July October November

36

3. EMERGING/CURRENT RISKS 3.1 Workforce While the majority of teams are near fully recruited we are focused on Registered Nurse (RN) vacancies in Ward 21 and Senior Medical roles. It is anticipated that a fully staffed ward will reduce security costs. A number of strategies are being pursued on an ongoing basis in regards to recruitment for SMOs and in particular, our Medical Lead role. A microsite to promote our area and SMO vacancies went live in December as a landing point to direct people to our information. This will also allow us to engage google analytics to highlight this site when people access information about relevant targeted conferences as a ‘google ad’. Joint advertising in relevant professional journals will also be investigated. We have engaged a recruitment specialist to support our efforts.

37

COPY TO: Uru Pā Harakeke Healthy Women Children and Youth


PO Box 2056 Palmerston North 4440 Phone: +64 350 8928

CLUSTER: Te Uru Pā Harakeke

Healthy Women Children and Youth


PREPARED BY: Sarah Fenwick, Operations Executive

Dr Jeff Brown, Clinical Executive

Barb Bradnock, Planning & Integration Lead

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

Trend A Increase number of Māori women registered with a Lead Maternity Carer within

the first trimester of pregnancy G ●

A Reduce equity gap between Māori and non-Māori babies who are exclusively or fully breastfeeding

G ●

A Reduce rate of Māori sudden unexpected death in infancy G ● A Promote the “5 things to do in the first 10 weeks of pregnancy” initiative G ● A Increase support to first time parents requiring education, advice and guidance

as they transition to parenthood following the birth of their baby G ●

A Deliver district wide breast feeding strategic plan A A Identification of infants with an unhealthy weight enabling access to appropriate

interventions through referrals G ●

A Increase engagement with family harm training G ● A Cross cluster development of Child Health Nurse Practitioners G ● A Support Housing NZ client families to access and engage with health and social

services through one point of contact G ●

A Support a sustainable midwifery workforce G ● A Develop the nurse practitioner workforce G ● A Strengthen the P2A transition programme - complete evaluation of programme G ● A Improve understanding around service options for transgender young people G ● A Scope opportunities to develop a connected early intervention approach for

learning and behaviour with Ministry of Education and CAFMHS G ●

A Implement findings of Massey research into childhood obesity engagement G ● O Develop strong relationships with Iwi across the district G ● O In partnership with Pae Ora new names are gifted to the cluster G ● O Develop a cross cluster collaborative approach with Te Uru Arotau and Paiaka

Whaiora to better support whanau who do not engage with services G ●

O Identify and evaluate opportunities for RNs to increase scope in Gynaecology G ● O Increase clinical procedures in the outpatient setting G ● O Investigate POAC opportunities to provide care closer to home G ● O Improve experience for women experiencing miscarriage A O Increase access to SUDI prevention activities, education and parenting support to

rangatahi and their whānau G ●

O Cross cluster collaboration with Te Uru Rauhī to improve maternal mental health G

38

O Increase the number of midwifery students on clinical placement and quality of the practicum experience

G ●

O Sustain appointment of midwives to established positions employed by DHB A

O Increase participation in formal training in leadership positions G ●

P Planned Care ESPI 2 compliance A P Planned Care ESPI 5 compliance A P Reduce shorter stays in the Emergency Department A


progressing as planned

A Behind plan - remedial action plan in place

R Behind plan - major risks and exception report required

D Not completed as planned

N Action not commenced yet





Improvement Plan

O Operational Plan


39

Work is continuing to create a dashboard that meets clinical governance and operational reporting requirements. Exception reporting is noted as follows: Acute readmissions within 28 days for November and December have all been

reviewed and were appropriately readmitted Emergency Department (ED) stays less than six hours compliance deteriorated

in December 2019. Each breach is investigated and some adjustments have been made to correct the data as required.

Slow progress continues to be made with annual leave balances over two years with leave plans in place for staff with the high balances, actual number reduced by three this month

Outpatient Did Not Attends (DNAs) have breached, however have improved from the previous month by 1.9 percent to 7.2 percent. This has been supported by the introduction of a text messaging service in Colposcopy and Gynaecology Continence services which has reduced DNAs significantly, by 20 percent of baseline for Colposcopy and by 50 percent of baseline for Continence.

2. SIGNIFICANT MATTERS 2.1 Breast Feeding Strategic Plan MidCentral District Health Board (MDHB) Breast Feeding Strategic Plan has been delayed due to the plethera of feedback received regarding the draft plan and the need to incorporate this into the document. Positive feedback regarding the draft plan was received from the Breast Feeding Hopsital Initaitve audit team. The final document will be signed off by governance at the next meeting. 2.2 Women Experiencing Miscarriage MDHB are at the early stages of work to improve services for women experiencing miscarriage or early foetal demise. Work with the gynaecology team has commenced regarding appropriate clinical pathways and positive progress is being made to ensure women have the best experience at this difficult time. 2.3 Planned Care ESPI 2 Gynaecology is compliant with achieving FSA (ESPI 2) target. Close monitoring is in place to ensure on-going compliance. Paediatrics was noncompliant at end of December 2019 due to a 4 FTE gap in their Resident Medical Staff roster, necessitating the cancelling of outpatient work. The staff shortage continues until the end of February. Locum cover is being sourced where possible, alongside the use of Nurse Practitioner clinics to help recover the position as soon as possible. 2.4 Planned Care ESPI 5 The Gynaecology team has continued to utilise additional available theatre sessions. Long-wait patients are being compromised by the significant number of elective caesarean sections bookings. A number of urgent patients have been referred for surgery this month that have also displaced the long-wait patients for routine surgeries. CREST had been engaged to perform 15 Gynaecology surgeries to ensure compliance by the end of November, but have not delivered this number

40

to date due to availability of staff. As of the end of December 2019 twelve patients are waiting longer than four months for their surgery. 2.5 Shorter Stays in ED (SSIED) ED stays less than six hours compliance deteriorated in December 2019. Each breach is investigated by the Charge Nurses and some adjustments have been made to correct the data as required. The team are working to ensure transfers to the Department are undertaken as soon as possible. 2.6 Te Papaioea Primary Birthing Unit In December MDHB jointly announced an agreement with the Wright Foundation for MidCentral DHB to take over the operational management of Te Papaioea Primary Birthing Unit. Staff on both sites have been informed and reassured that MidCentral are fully committed to primary birthing. The model of care will be co-designed in preparation for a 1 April 2020 start. 2.7 BFHI Accreditation The Baby Friendly reaccreditation audit occurred on 28 November 2019 with a positive outcome and only two remedial actions required for reaccreditation, which must be completed within six months. These are: a plan to provide appropriate on-going education for staff monthly audits of partially fed babies for the next three months. 2.8 Child Development Service The Budget 2019 announced additional funding to Child Development Service (CDS) to improve the health and social outcomes of children who are not meeting their developmental milestones and have additional needs. Additional funding has been allocated by the Ministry of Health to increase access to CDS and ensure the appropriate mix of allied health staff are available to meet service demand. Budget 2019 funding is being administered through Shared Support Agencies who are acting as fund holders and will administer funds in accordance with approved implementation plans submitted to and approved by the Ministry of Health each financial year. Central TAS will manage the Central region funding allocation. Following a transparent RFP process MDHB was successful in their proposal to improve point of entry co-ordination and integration of early intervention services for children aged zero to eight years. The funding will flow in January 2020 and, pending sign off of the contract, project management and experienced resource has been secured. This is an exciting piece of work that will scope, design and develop systems and pathways to coordinate the receipt of all referrals received into Early Intervention Providers across the DHB and Ministry of Education in order to improve timely access and reduce multiplicity of referrals and services. Underpinning the work will be the Enabling Good Lives (EGL) principles and the Good Start in Life practice guidance. It is anticipated that some of the funding allocation will be utilised to reduce the Psychology wait list and options are being explored.

41

3. EMERGING/CURRENT RISKS 3.1 Workforce Previous HDAC reports have highlighted gaps in the Paediatric RMO roster from December 2019. Whilst the Medical Administration Unit has worked hard to try and secure locums for as many shifts as possible significant gaps remain. Work has been undertaken with the SMO workforce to prioritise safe cover for all services during this period and to ensure their health and wellbeing is maintained. The workforce position is impacting on the ESPI performance for the department. 3.2 Midwifery In August 2019 a Midwifery Trendcare report highlighted 792 shifts over the previous financial year with insufficient care hours. This led to discussion with the Chief Executive regarding clinical risk within the service and an additional six Full Time Equivalent (FTE) midwifery posts (in excess of budget) was agreed to. Four new graduate midwives have been recruited to commence January 2020, however despite local, national and international recruitment efforts MDHB has not been able to recruit sufficient midwives to begin appointing to this additional FTE, with the four additional staff filling existing vacancies. Risk controls, mitigations and actions are in place (discussed in previous Health and Disability Advisory Committee (HDAC) meetings) to ensure safe service delivery. An on call arrangement was trialled with staff, however this has not been successful due to lack of interest from midwives due to risk of fatigue and burn out. Acuity within the service remains high, deeming it necessary to consider short term measures to ensure clinical safety within the service. It is proposed that the additional six midwifery FTE be utilised in an alternate way for the next 12 months. This would entail recruiting additional Registered Nurses (RNs), Health Care Assistants (HCAs) and extending clerical hours for a 12 month period. Specific tasks within appropriate scope of practice would be allocated to RNs and HCAs. This will free up time to ensure midwives can be prioritised to care for antenatal, labour, birth and immediate postnatal (first two hours after birth) care for women. Engagement with the unions regarding these proposals is underway.

42

COPY TO: Te Uru Mātai Matengau Cancer Screening, Treatment and Support



Phone: +64 (6) 3569169

CLUSTER: Te Uru Mātai Matengau

Cancer Screening, Treatment and Support


PREPARED BY: Cushla Lucas, Operations Executive

Dr Claire Hardie, Clinical Executive

Denise Mallon, Planning & Integration Lead 1. PERFORMANCE OVERVIEW Te Uru Mātai Matengau is generally on track with all initiatives under the Annual, Operational and Performance Improvement Plans. There are no emerging risks or areas of concern. Items of note are discussed under Significant Matters. Initiative Rating &

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











43


Twenty eight patients attended the Emergency Department (ED) in December, of which fifteen exceeded the six hour wait time; all breeches occurred during times where the Inpatient Unit was at capacity and/or managing high volumes of arranged admissions. Work is continuing on redirecting acutely unwell patients directly to the service rather than the ED. Acute length of stay is above target, the cases in question have been reviewed and there was no significant or action noted for the month. Staff turnover was marginally above target due to two staff retirements, but below target year to date. Sick leave has been reviewed; higher rates than expected are due to a small number of staff experiencing major illness/injury. Slow progress is being made with annual leave in excess of two years, while the number of staff is not decreasing there has been a reduction in hours owing (now 1,246 from 1,327 in November), with further improvements expected as leave is taken over the Holiday Season.

44

2. SIGNIFICANT MATTERS 2.1 Cancer Action Plan In December 2019 the National Cancer Control Agency was launched. The Agency is situated within the Ministry of Health but operates autonomously with its own Chief Executive, reporting report directly to the Minister of Health. The Agency will have a strong focus on eliminating inequitable outcomes from cancer. The four Regional Cancer Networks will be consumed within the Agency; however a regional presence will be maintained. The structure of the Agency is yet to be released. 2.2 National Bowel Screening

Invitations sent Kits returned Positive results

2,272 785 44 Bowel Screening is proceeding as planned. Thirty five per cent of the invited population has returned a kit to the National Centre, of which 44 out of 785 individuals have tested positive. Health promotion activity continues, with the team attending a number of community events scheduled over the summer. Other promotions include further posters to be circulated, displays at local library, pod casts, large bill boards and developing relationships with local champions to add depth to the current strategy. While the coverage is low it remains early days. Whanganui coverage is slightly ahead of MDHB at 39 per cent reflecting their roll out the month earlier. Also of note (as at 10 January 2020) 28 positive tests had been identified locally which increased to 44 the following week. 2.3 Linear Accelerator Replacements – Palmerston North The installation and commissioning of the new linacs has begun. The first outgoing linac treated its last patient on 10 January 2020. This machine had been operational since 2003 and delivered 130,000 doses of radiation in its lifetime. It was craned out the bunker on the 18 January 2020. The first new machine arrives on the 8th February. After which an extensive technical and clinical commissioning programme will be undertaken led by the Medical Physics team, and will conclude by the end of May 2020. The staff has volunteered to work extended hours (7 a.m. to 8.p.m) during this time to ensure all patients are treated on the three remaining linacs. The welfare of the team, as well as the patients, is critical and close monitoring is in place to ensure staff wellbeing. The staffing plan during this period has been agreed with the relevant unions as part of the project preparation The regional project, focusing on the new outreach sites in Hastings and New Plymouth, has also commenced with a startup meting to occur in early February. This work will continued over the next 36 months, with the expectation that the Hastings site will be opened within the next 12 months.

45

2.4 Blood Stewardship (Performance Improvement Plan) The aim of this work is to ensure the optimal stewardship of blood and blood products, with a particular focus on patient safety. In the first half of 2020 MDHB will launch a hospital wide safety initiative that has been successfully used in other DHBs to reduce labelling errors and the number of re-tests re-sampling. The campaign focusses on correct patient identification and transcription of this information to samples and request forms. Ongoing audit continues including monitoring of wastage, appropriate ordering and use, optimal haemoglobin management and refinement of pre-transfusion sampling and testing processes. Year to date blood expenditure is $98k favourable. 2.5 Category B Radiation Treatment All patients ready for treatment continue to start within 14 days, although there are challenges managing Statutory Holidays which shorten turnaround times. New systems are being trialled to accommodate this, but remain work in progress. 2.6 Tumour Stream Framework Development Five of the nine Tumour Streams have been established with Quality Improvement Plans in place for each group. A notable achievement has been the in-house development of electronic referral templates for Multi-Disciplinary Meetings (MDM). MDMs are a core part of treatment planning for all cancer patients and involve a structured discussion between the treating specialists, including pathology and radiology, to formulate the best set of treatment options for each individual’s condition and prognosis. The previous paper based referral system has been transformed into a web based form, accessible online across the region. This process makes the MDM more efficient administratively and has improved data collection. The need for transcription services is eliminated and the MDM outcome report is available on Clinical Portal almost immediately after the meeting. The MDM data is available for clinicians on a QLIK dashboard, which will be a significant addition to supporting clinical audit and service planning. Key performance indicators and significant outcomes from the overarching clinical governance programme, representing all tumour streams, will be noted in future reports. The remaining four tumour streams will be rolled out later this year.

46

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

For:

Decision

X Endorsement

Noting


Author Greg Brogden, Acting General Manager, Enable New Zealand



Subject Enable New Zealand Report to 31 December 2019

RECOMMENDATION


endorses the Enable New Zealand Report to 31 December 2019.

Strategic Alignment

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

47

1. PURPOSE The purpose of this report is to set out Enable New Zealand’s performance against its Operational Plan and advice of any current and emerging matters. 2. SERVICE OVERVIEW Enable New Zealand is a semi-autonomous business unit of MidCentral District Health Board. It provides local, regional and national disability support services to over 75,000 disabled people and whānau across New Zealand through a range of contracts managed on behalf of the Ministry of Health (MoH), Accident Compensation Corporation (ACC) and District Health Boards (DHBs). 3. AIM AND PRIORITIES The aim of Enable New Zealand is encapsulated within its shared purpose:

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

This statement embodies why Enable New Zealand exists and guides the decisions it makes and the priorities it sets. 4. PERFORMANCE OVERVIEW Initiative Rating &

Trend Strengthen and enhance existing services to provide a quality customer experience O Actively seek feedback, measure, monitor and interpret our performance G ● O Deliver responsive and accessible customer services across all areas of the

organisation aligned to the customer’s requirements G ●

O Partner with key stakeholders to deliver long term sustainable outcomes for the customer G ●

Employ efficient delivery practices and maintain a culture of effectiveness and responsiveness in all areas of work

O Develop a quality driven practice model to drive service excellence G ● O Our infrastructure is healthy and our technology drives enhanced performance

in the delivery of services to our customers A ●

O We nuture a positive and diverse workforce culture and a healthy workplace that reflects our values and respects the dignity and privacy of all stakeholders G ●

O We cultivate competency and capability in our workforce that is flexible and responsive to the current and future needs of the business and service requirements

G ●

We aggressively pursue opportunities to grow and develop sustainable services O Meet a broader range of customer needs to remain competitive in the changing

market G ●

O Increase the total number of customers that purchase services directly from Enable New Zealand G ●

O Increase the number of primary customer contracts G ● O Grow diversified revenue streams G ● O Ownership and Governance G ●

48











4.1 Performance Indicators Regional

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

90% 85%

Percentage of Complex Housing Modifications completed within 120 working days (MoH).

60% 79%

Percentage of Equipment provided to Service Users supplied from refurbished stock (MoH).

35% 29%

Grabrails Installation Non-Urgent (ACC) 95% 90% Enablement Programme –Exiting RTL platform 100% 100%

The table below sets out the number of customers accessing Enable New Zealand’s contracted services, for the financial year to date at 31 December 2019. Client volumes by Service MDHB Region All Service Regions Housing Service 101 1,080 Equipment Service 1,731 20,880 Hearing Aids Service 606 12,876 Spectacles Service 850 12,701

Mana Whaikaha Regional Results

Launch of Prototype to 30 November 2019

Total number November

2019 Launch of

Prototype to 31 December 2019

Total December

2019

Total Disabled People active in the database

2186 40 2210 30

People who have had a financial outcome

686 100 782 135

People allocated to a MoH connector (and are still allocated to a MoH Connector)

862 56 870 19

People allocated to their own / Independent Connector

103 15 111 10

People in queue (awaiting allocation to a connector)

274 52 289 26

Total, completed, allocated to connector or in queue

1,239 123 1,270 55

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December results for the MidCentral region continued to see Complex Housing requests average between 13-18 requests per month. Due to the roll out of the new Equipment app at the end of October we saw a spike in requests of 336 for the month of November as Occupational Therapists were asked hold requests until the new system became live. December showed the numbers return to normal with 273 requests received. Hearing requests for December were also up by 44 percent. At this point in time it is unclear if this is a trend or one off incident due to Audiologists proactively sending requests through before the commencement of the holiday period. 5. SIGNIFICANT MATTERS 5.1 Mana Whaikaha Prototype The MoH has invited organisations to register attendance at Notice of Information sessions being held in February. Mana Whaikaha and Enable New Zealand representatives have registered to attend the presentations. The aim is to identify what alternative models might be available to deliver a transformed disability support system in the MidCentral DHB region including whether any other organisation could deliver the key components of a transformed system and/or whether there are other ways of delivering the key components of a transformed system i.e. what other operating models could look like. The sessions will provide organisations with the background and current operating model of Mana Whaikaha; the key components of a transformed system; the outcomes that Mana Whaikaha want to achieve through a future operating model; “Try, learn and adjust” report recommendations and the next steps to the information gathering process. Enable New Zealand’s two year contract with the MoH ends on 30 June 2020 and the future of the prototype beyond this date is uncertain. 5.2 Enablement Programme The Enablement Programme, approved by the Board in November 2018, outlines a five to seven year programme of work that will transform Enable New Zealand into a highly-personalised customer-led organisation. It built on work undertaken over the previous four years identifying a powerful case for change based on four key areas of customer experience, workforce, processes and technology. Stage one of the technology plan has been completed moving services off Round Trip Logistics (RTL) successfully before the RTL agreement expired. Ongoing work will continue to enhance the portal for both customers and internal users. The Enablement Programme Leads and Senior Management Team will now focus on implementing a Contact Centre management system and retiring the end of life Enterprise resource planning (JD Edwards) technology system. Progress on the Programme will continue to be monitored by Finance Risk and Audit Committee, via the Enablement Programme Steering Group.

50

Enable New Zealand’s planned timing for the Enablement Programme slipped slightly. Completion of the RTL was finished in December 2019. Historical data has been retrieved from RTL but is yet to be transferred across into a new system. Enable New Zealand maintains read only access of the old system until 28 February 2020. 5.3 Contract Matters Enable New Zealand has been advised by the MoH that the Equipment and Modification Service contract, due to expire 31 March 2020, will be rolled over for another 2-3 years. This is a significant contract for the organisation. 5.4. Community Initiatives Enable New Zealand continues to develop initiatives to engage and support the disability community. A new pilot programme sees one of our professional advisors based in our EASIE Living Centre where they advise customers on different solutions that enhance and facilitate independent living, as well as running workshops for health professionals and the public. Our Firstport website has collected and shared stories from the disability community for its “In My Own Words” series this year. Videos of these stories have reached more than 88,000 people across social media. We will shortly be launching the “Accessible Day Out” library. Mana Whaikaha, has held numerous events around the region as well as co-hosting an International Day of Persons with a disabilities event in Palmerston North, and sponsoring three young people to attend the inaugural I.Lead conference in Wellington.

51

COPY TO

Pae Ora – Paiaka Whaiora


PO Box 2056, Palmerston North Phone: +64 (6) 350 8913

For:

Decision

X Endorsement

Noting


Authors Wayne Blissett, Operations Executive – Pae Ora Paiaka Whaiora Hauora Māori Directorate

Tracee Te Huia, GM Māori Health



Subject Pae Ora Paiaka Whaiora Progress Update

RECOMMENDATION


endorses the Pae Ora Paiaka Whaiora progress report

Strategic Alignment

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

52

1. OVERVIEW MANAWHENUA HAUORA BOARD WORK PROGRAMME 2019/2020

(Appendix 1) RATING

THOUGHT LEADERSHIP MWAP

1. To provide clear and cohesive governance leadership for Māori health across the DHB region A

MWAP

2. To provide direction, investment priorities and focus areas to MDHB on Māori health needs and priorities to support equity of outcomes for Maori G

MWAP

3. To provide strategic advice on the priorities and focus areas to MDHB across all strategic planning processes G ●

MONITORING AND REPORTING MWAP

4. To provide a clear direction and purposeful strategies for Māori health gains across the district G ●

MWAP

5. To monitor Māori health gains in the district through impacts of MDHB's health service delivery and investment A ●

STEWARDSHIP MWAP

6. Provide expert advice, direction and counsel on important issues that impact on Māori at a governance level G









Plan Legend AP Annual Plan P Performance

Improvement Plan O Operational Plan MW Manawhenua

Hauora

1.1 Thought Leadership Paiaka Whaiora Hauora Māori Cluster

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

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

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Applications closed on the 19 January with shortlisting now completed. The panel expect to appoint to the role in early February. Relevant Māori Health Priorities Our mission is simple: Māori in the MidCentral region have the best health status in Aotearoa. To guide MidCentral DHB to achieving the mission we are aligning our efforts to the Māori Health Strategic Framework; Ka Ao Ka Awatea 2017 - 2022, our Kaimahi Ora Whānau Ora - Māori Workforce Strategy and Implementation Plan 2017 - 2022, and the Manawhenua Hauora Boards work programme. We are currently engaging all Iwi to ascertain their planning priorities and where these have not been established, we are providing capacity for Iwi to do so. This will further inform DHBs planning into the future. Iwi engaged so far have supported this direction of travel. These are Rangitāne ki Tamaki Nui a Rua, Muaūpoko, Kahungunu ki Tamaki Nui a Rua and Ngāti Raukawa ki te Tonga. As we move into Annual Planning for 2020/21 the organisation has agreed we will continue to develop one plan ensuring we can lift out the Maori component of the plan for the purposes of meeting the Ministry of Health’s expectations. For this Annual Plan we will ensure we include the Maori health priorities listed in Ka Ao Ka Awatea which are, Whānau free of violence, Women’s health, Mental Health and Addictions, Older People, Child Health particularly 0-4 year olds, Workforce Development and Investment and Development into Iwi and Māori providers. Planning will be a key focus for the next six weeks. (Appendix 2) 2. MONITORING AND REPORTING Equity and its Application into DHB A draft Terms of Reference has been agreed between the Internal Auditor Service and DHB for the internal audit on equity across the system. This is an internal deep dive on where we are situated with our response to the issue of Māori health inequity. It’s a brave approach for the organisation and one the executive team is not taking lightly. Once we have the results of the audit we will bring the recommendations to HDAC and the Board for endorsement before implementation. Equity Monitored Across the System A Māori Health Dashboard for monitoring inequity is being developed with the expectation to have a draft completed for the March HDAC meeting for endorsement. Once we agree the measures for monitoring these will become the new structure for reporting Māori health at the governance level of DHB. We will partner with PHO and Manawhenua Hauora Board to ensure we are well aligned with their identified priorities so that there is buy-in to the finalised dashboard. This will be reported through to the HDAC, Manawhenua Hauora Board and DHB Board six monthly. Equity of Funding for Māori Providers The Manawhenua Hauora Board has a work programme (which forms the template for this reporting) that priorities the increase in Māori funding for services from 17/18 forward. Analysis is being completed to assist the commissioners to understand the current baseline. Once complete an agreement will need to be reached with the commissioners about how increase is achieved over time.

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Moreover, work is being undertaken to ensure Māori health provider contracts are conducive to population needs. Planning Services and Integration and Pae Ora are in early discussions on how the DHB move to outcomes contracting and how we become early adopters to the findings of WAI 2575 – the Hauora Claim. 3. STEWARDSHIP Māori Workforce Development Kia Ora Hauora is a national Māori Workforce Development programme designed to increase the number of Māori into the Health workforce. This is a Ministry funded programme designed to support DHBs and other sectors in employing more Māori into the health sector. Currently there are 3,354 people engaged in the programme with 532 people registered from within the Central Region. There are 97 people registered from within the MidCentral DHB district with Universal College of Learning (UCOL) being the top tertiary institution of enrolment for Kia Ora Hauora students. It’s particularly exciting to see that 31 students are enrolled into a midwifery course in Central Region, as we have just one Māori midwife in MDHB. Pae Ora has worked in partnership with Kia Ora Hauora to sponsor two Summer internships. Xavier Bowe and Davis Ferguson commenced in the DHB on the 8 January 2020 and is with us for six weeks being exposed to all aspects of health from a Māori context. This builds on the internships we hosted in 2019 as part of the Kia Ora Hauora programme. In line with the national Chief Executive Key Performance Indicators for Māori Workforce Development, the Māori Health Service is working with Human Resources to identify the statistics for the Māori workforce and where they are employed. This coupled with the report on Māori utilisation of services in DHB, will help us to identify where the gaps are and will support us to grow the workforce in the right places. Of the total DHB workforce 9 percent or 261 staff identify as Māori with Acute and Elective and Mental Health and Addiction clusters employing 45 percent of these. We are currently seeking information from UCOL and Massey on the numbers of Māori within the three year nursing programme to ascertain the pipeline of potential staff recruits over the next three years. Next month we will be reaching out to the Kia Ora Hauora students who whakapapa to the iwi of this district to build relationships with the intent to employ them once qualified.

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Strategic Advice within DHB Manawhenua Hauora members are cascaded into committees and alliance groups of clusters to ensure strong advice and support is provided to cluster development, strategic planning and commissioning of services. While this development is in its infancy there is a willingness to get it right for Maori across the services. The Maori Alliance Group has been established to ensure consistency and clarity across all strategic imperatives. Ensuring a Treaty partnership is enacted is key for the DHB and this is one initiative to support strong partnership. DHBs Tiriti o Waitangi Policy Update The MDHB Te Tiriti o Waitangi Policy is due for review. The Ministry of Health is currently updating their policy position on the Treaty of Waitangi opting to use the Articles of Te Tiriti and moving away from the Principles approach of previous years. Therefore, MDHB is working with the Ministry of Health to align our policy position. The above information outlines the priority work currently being undertaken by Pae Ora Paiaka Whaiora.

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52

22 21 20 17 15 15 14 114 3 1 1

0

10

20

30

40

50

60

70

Kaimahi Māori by Cluster/Enabler

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

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

Objective Focus Area Measures Responsibility

MidCentral DHB Manawhenua Hauora

THOUGHT LEAD

ERSHIP

To provide clear and cohesive governance leadership for Māori health across the DHB region

Identification of local Māori health priorities to direct investment and focus from the DHB

Paiaka Whaiora – Hauora Māori Cluster is established in synchronicity with other Clusters

All Kaupapa Māori contracts sit with Paiaka Whaiora by June 19

Relevant Māori health priorities are identified across all Clusters and Enablers as part of the 5 year planning process.

Incorporate local Māori health priorities into AP, budget planning and portfolio work‐plans as advised by Manawhenua Hauora

Agree a framework for service specification review and redevelopment in of Iwi/Maori provider contracts by June 30 2019.

Consider and Endorse all MDHB Cluster and Enabler 5 year Plans prior to MDHB Board Approval

Support the Establishment of Paiaka Whaiora in accordance with the recommendations provided by Manawhenua Hauora in September 2018

To provide direction, investment priorities and focus areas to MDHB on Māori health needs and priorities to support equity of outcomes for Maori

Equity assessment

Cluster and Enabler Plan Reporting

How equity is being applied in MCDHB is reported quarterly to Manawhenua Hauora

Equity results in respect of Māori Health, including trends and emerging trends, reported to Manawhenua Hauora and MidCentral DHB’s Board six monthly

Equity of funding for Māori Providers is addressed moving from the 17/18 baseline of 1% of total revenue to 3% by 19/20

Provide Cluster and Enabler specific measures of success in addressing Māori Health Equity actions as identified in the 5 Year Plan

Provide advice on Equity needs from Māori perspectives, identifying key issues for consideration in determining local Māori health priorities and strategies in context with the Locality Plans

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Actively support the development of the Paiaka Whaiora Alliance Group

To provide strategic advice on the priorities and focus areas to MDHB across all strategic planning processes.

Strategic Imperatives

Cluster development

Community integration and cohesion

Strategic imperatives will deliver on Manawhenua Hauora aspirations

Consistently obtain Manawhenua Hauora input across strategic imperative development.

Ensure the monitoring and reporting of progress against the strategic imperatives is provided to Manawhenua Hauora.

Work in partnership with the MDHB Board to ensure the Treaty Partnership is enacted at Governance level to provide clear leadership and direction for the organisation to give effect to the Treaty of Waitangi

MONITO

RING AN

D

REPORTIN

G

To provide a clear direction and purposeful strategies for Māori health gains across the district

Development of a Māori health strategy

Monitoring and reporting against Ka Ao Ka Awatea, clearly identifies the performance of Clusters and Enablers in meeting the health and wellbeing aspirations of the Māori communities across the district.

Position Statement of Whānau Ora is adopted to provide a clear governance expectation of MDHB’s commitment and delivery methodology for health’s contribution to Whānau Ora across the District

Quarterly reporting against Ka Ao Ka Awatea is provided to Manawhenua Hauora from Clusters

Clusters and Enablers identify key actions quarterly that can address the health inequities currently experienced by Māori across the district

Receive quarterly report from MCDHB as to how whanau ora is being implemented by the DHB.

Monitor and review performance as governance Iwi partner

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To monitor Māori health gains in the district through impacts of MDHB's health service delivery and investment

Equity and Health Needs Assessment (as above)

Monitor trends in Māori Health via the Locality Plans (as above) and health equity tools

All Clusters and Enablers to report against their identified equity actions quarterly to Manawhenua Hauora

Provide quarterly report as to how Locality Plans are addressing Maori Health

As above

Local, regional and national priority measures (as attached)

Quarterly review of results against local, regional and national Māori Health measures reported to Manawhenua Hauora and MidCentral DHB's Board (NB: this includes Whānau Ora.)

Manawhenua Hauora will monitor implementation of Māori workforce development against the MDHB Kaimahi Ora Whānau Ora – Workforce Development Strategy and Implementation Plan 2017 ‐ 2022

Provide quarterly reports

Accurate and meaningful data profiles are provided as part of the reporting process to Manawhenua Hauora

Provide direction and advice on reports

Manawhenua Hauora will monitor Whānau Ora position paper and assist to hold the organisation to account.

Monitor investment in Iwi/Māori providers workforce development and Whānau Ora

Annual Report of results against Ka Ao Ka Awatea is reported to Manawhenua Hauora and MidCentral DHB’s Board as part of MDHBs Annual Report

Provide annual reporting of performance against Ka Ao Ka Awatea

Provide advice on report and assist to identify priorities for the following year

Support and monitor the Regional Māori Health Priorities identified via Te Whiti Ki Te Uru and Board’s Annual Forum, i.e.:

Use of the national Māori indicator report to drive improvements in the health outcomes of Māori in our region.

Provide quarterly reports

Provide advice on reports

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STEWARD

SHIP

Provide expert advice, direction and counsel on important issues that impact on Māori at a governance level

Major service changes

Any potential Major service change proposals are actively considered by Manawhenua Hauora during the design phase to ensure any likely impact on Māori Health and Equity Issues considered at the earliest possible point

Provide report on any potential or major service proposals prior to a final position

Provide critique, direction and considerations on any major proposal for change with a specific focus on health gains for Māori and any potential impacts

Significant service plans, e.g. site redevelopment and central Alliance

Manawhenua Hauora views are sought regarding the Long Term Investment Plan being developed for MidCentral DHB as a Treaty Partner,

All significant investment plans are submitted to Manawhenua Hauora for consideration at the earliest possible time

Provide direction. Advice, guidance and critique across all aspects of design, development and implementation of the Long Term Investment Plan.

Manawhenua Hauora views sought on the Central

Alliance Strategy being developed by MidCentral and Whanganui DHBs

Develop Strategic Plan for Central Alliance that actively considers both Iwi Relationship Boards perspectives as part of the Alliance

Provide advice and direction on Central Alliance Strategic Plan in partnership with Hauora A Iwi.

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

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Appendix Two:

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COPY TO:

Nursing & Midwifery



Phone +64 (6) 365 9140

For:

Decision

X Endorsement

Noting

To Health and Disability Advisory Group

Author Celina Eves, Executive Director of Nursing & Midwifery

Yvonne Stillwell, Associate Director of Nursing, Educational and Professional Practice

Paula Spargo, Midwifery Director



Subject Clinical and Professional Report: Nursing and Midwifery

RECOMMENDATION


endorse the progress Nursing and Midwifery has made in the 2019/2021 work plan initiatives

Strategic Alignment This paper supports the MidCentral District Health Boards (MDHBs) strategic imperatives: Achieve quality and excellence by design Partner with people and Whānau to support health and wellbeing Connect and transform primary, community and specialist care Achieve equity of outcomes across the communities

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1. PURPOSE

This report is to inform the Committee of the Nursing and Midwifery workforce initiatives in the draft Nursing and Midwifery Workforce Plan (2020-2023), due to be finalised in February 2020. It is for the Committee’s information. No decision is required. 2. SUMMARY Our ability to meet immediate and growing demand and to continue to transform our health system relies heavily on having the right people, with the right skills, in the right place. The generalist nature of the nursing workforce will continue to be a core strength, as it enables the flexible deployment of nurses within and across care settings. However, our nursing population is ageing, particularly in specialities such as sexual health, midwifery, district nursing and public health, with concern over the availability of this workforce to meet predicted increases in demand by the year 2035. In addition, the prediction of increasing medical workforce pressures will require advanced nursing practice roles, programmes and funding streams to ensure the stability of the wider health workforce. Changing workforce patterns, the expectations of newly registered health professionals, new technology and changing community expectations also put pressure on traditional service delivery models. Average Age in Nursing and Midwifery March – September 2019 October 2018 – March 2019 Nursing 45.2 years of age 45.4 years of age Midwifery 49.8 years of age 49.1 years of age

Nationally the midwifery workforce is greatly under pressure. There is a recognised lack of midwives, problems with understaffed maternity units struggling to meet demand for midwifery services, as well as difficulty retaining and recruiting midwives. In addition, the maternity population has increased in complexity over the last decade. Most women give birth at a secondary or tertiary facility (approximately 86 percent), whilst 10 percent will birth in a primary facility and four percent choose to homebirth. The draft Nursing and Midwifery Workforce Plan (2020-2023) identifies four strategic priorities that will help us address these emerging issues: A workforce that is the right size and skill mix A workforce that is competent and capable A workforce that is focused on people and improved outcomes A workforce that is integrated and connected across the continuum

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3. NURSING AND MIDWIFERY WORKFORCE Nurses and midwives at MidCentral District Health Board (MDHB) strive to provide exceptional patient care in an environment that continues to challenge. An aging population and workforce, increasing complexity of individual health needs and recruitment challenges continue to put pressure on our ability to meet safe staffing expectations. One response to these challenges is the Nursing Council of New Zealand (NCNZ) Expanded Practice Guidelines for Registered Nurses (RNs). This means RNs who have developed their expertise may expand their practice beyond the established contemporary or ‘traditional’ scope of practice to include new technology and management of health consumers with long term conditions including prescribing and other activities previously considered the scope of other health professionals. 3.1 Care Capacity Demand Management (CCDM) The CCDM programme is a set of tools and processes developed by the Safe Staffing Healthy Workplaces Unit in partnership with the 20 DHBs and health unions. The programme focuses on achieving quality patient care, in quality work environments, with the best use of health resources. The Government's Nursing and Midwifery Accords, signed with the New Zealand Nursing Organisation, Midwifery Employee Representation and Advisory Services and DHBs in 2018 and 2019, puts safe staffing levels as a top priority for nurses, midwives and DHBs. MDHB has overall achieved 60 percent implementation so far, making excellent progress over the last 18 months with an action plan for final implementation by June 2021. Our Variance Response Management protocols are being developed, led by four working groups: 1. The Essential Care and Reallocation of Staff Working Group 2. The Variance Indicator Score Working Group 3. Integrated Operations Centre working group 4. Escalation Pathway Working Group 3.2 TrendCare Fundamental to the success of the CCDM programme is each DHB having access to a validated patient acuity tool. MDHB uses the TrendCare platform as our acuity repository. The validated acuity data provides the basis for the calculation of nursing full-time equivalents (FTEs), recommended skill mix, forecasting, planning and funding. The Improvement Plan for the Validated Acuity Tool (2017) contains 12 outcomes. As of December 2019, MDHB had met 96 percent of these outcomes with a plan established to achieve the remainder.

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

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

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

Due to national and local midwifery shortages, nursing now makes up 33 percent of the Midwifery and Nursing workforce with Uru Pā Harakeke maternity services, with a mix of permanent and temporary nursing contracts. 3.4 Turnover July – Dec 2019 Turnover of Staff March – September 2019 October 2018 – March 2019 Nursing 9.4 % 8.4 % Midwifery 5.9 % 3.85 %

3.5 Recruitment Our aim is that our workforce will be the right size and skill mix, reflective of our community demographics, sustainable, highly qualified, appropriately credentialed and responsive to the changing needs of our communities. Developed in partnership with Human Resources and Paiaka Whaiora Hauora Māori, the Nursing and Midwifery Recruitment and Retention Plan (2019 – 2021) outlines the initiatives MDHB is undertaking, linked to the Nursing and Midwifery Accords, MDHBs People Strategy and our Kaimahi Ora, Whānau Ora Māori Health Workforce Development Strategy and Implementation Plan (2017 – 2022). These initiatives include the Career Force Gateway Programme, nurse and midwifery entry to practice programme recruitment, career expos, ongoing recruitment campaigns (local/national/international), reinstatement of the Voluntary Bonding Scheme for employed midwives, promoting the Year of the Nurse and Midwife (2020) and return to nursing programmes. 3.5.1 Career Force Gateway Programme In our district we have 27 secondary schools with 11,397 students. In partnership with Allied Health, we are participating in this programme that will see thirteen Year 12 and Year 13 high school students come on site to observe/assist as appropriate in areas that they are interested pursuing a career in, including

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nursing and midwifery, allied health, administration, domestic services and business support. The students will complete unit standards towards their National Certificate of Educational Achievement qualification during the 10-12 weeks at the DHB. The programme will align with the Kia Ora Hauora Programme also offered by MDHB. 3.6 Undergraduate and Postgraduate Training 3.6.1 Undergraduate Nursing Students We have two large tertiary providers in our district that offer undergraduate and postgraduate nursing programmes. There are three intakes per annum in the Bachelor of Nursing (BN) programmes of up to 150 students with an attrition rate of approximately eight percent. We provide placements for 50 weeks of the year, in a 24/7 model, to Massey and Universal College of Learning (UCOL). 3.6.2 Undergraduate Midwifery Students There are no local tertiary providers for midwifery in MDHB. Currently Otago Polytechnic provides a satellite midwifery student support hub to the Manawatu/ Whanganui areas. There is one intake per annum. In 2015-2017 the annual enrolments for Otago Midwifery were approximately 150 students across New Zealand (averaging 12 students in year one for Palmerston North/Whanganui). From 2008-2016 the Otago Polytechnic Midwifery course had a 21 percent completion rate across all its five satellite centres. In 2020 Victoria University (Wellington) commences its Midwifery Undergraduate program with 40 places per annum. MDHB midwifery will offer places for first, second and third year students. In 2020, in partnership with Paiaka Whaiora Hauora Māori, we will work with our tertiary providers to ensure Māori students have priority access to our clinical placements and the support of MDHBs Nurse Entry to Practice Programme (NETP) and Nurse Entry to Specialist Practice (NESP: Mental Health) Programme. 3.6.3 NETP Programme The NETP programme is accredited by the NCNZ and meets the national NETP Programme specifications. The programme is delivered through practice experience, self-directed learning, e-learning and classroom based study days. The Programme is completed over a period of 10 – 12 months and results in the achievement of a competent Professional Development and Recognition Programme (PDRP) Portfolio. Health Workforce New Zealand (HWNZ) provides $374,400 over an 18-month period to support the newly registered nurses in their first year of practice in the NETP programme, which includes hospital and community settings. MidCentral also supports CREST and the New Zealand Defence Force new graduate nurses in the programme. From January 2018 and December 2019 we recruited 101 new graduate nurses to MidCentral.

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3.6.4 NESP Programme (Mental Health) The Mental Health Nursing and its Future discussion document (2006, Ministry of Health) recommended all nurses entering the mental health field undertake a Post Graduate Certificate in Nursing. This 40-week Programme is funded by Te Pou o te Whakaaro Nui (Te Pou), the national centre of evidence based workforce development for the mental health, addiction and disability sectors in New Zealand. Each year up to 140 places are funded nationally. While MDHB is funded for five placements per annum, over the last three years we have enrolled 35 RNs new to mental health into the NESP programme. Of these, 15 have been funded by Te Pou and the rest through the Nursing External Education and Development (NEED) Committee, HWNZ post-graduate nursing funding and the Palmerston North Medical Trust. 3.6.5 Midwifery First Year of Practice Programme (MYFP) All new graduate midwives must complete the New Zealand MYFP. The New Zealand College of Midwives is contracted by HWNZ to provide the programme nationally in accordance with the Programme Specification. We have successfully recruited four new graduate midwives who will start their first year of practice with us in February 2020. 3.6.6 Postgraduate Education HWNZ post-graduate nursing funding supports nurses across the district to gain qualifications that meet Nursing Council of New Zealand specifications. Allocation of HWNZ funding of $542,904 needs to meet our strategic nursing workforce priorities. In 2020 we received 112 applications, all of which were funded as follows:

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

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

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

4.1 Professional Standards and Behaviour A number of tools and processes are available to monitor the performance of clinical staff from peer review, clinical audits, supervision, credentialing, appraisals and PDRP. The refresh of the clinical governance framework will further refine how the quality of care is monitored. The Professional Presentation/Behaviour and Dress Standards (MDHB-2862) Policy has been implemented that sets the standard and expectation of professional dress, presentation and behaviour for the organisation. 5. WORKFORCE DEVELOPMENT: ADVANCING PRACTICE Extended and Advanced Practice Roles The Nursing and Midwifery Service supports staff to advance their nursing and midwifery practice.

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5.1 Professional Development To support the organisational development plan to deliver “Happy, Healthy and High-performing” staff, MDHB has various approval committees to manage staff training applications and funding. The Nursing External Education Development (NEED) and Midwifery External Education Development (MEED) committees have oversight of professional development funds for nurses and midwives. In this current financial year, NEED has funding of $156,000 for allocation and MEED has $16,000. Approximately $20,000 contestable funding is also available from the Palmerston North Hospital Medical Trust for nursing and midwifery education purposes, including annual research prizes. Other smaller trust funds are also available, on a case by case basis. Nursing and midwifery share a NEED and MEED policy and procedure to ensure transparency and equity of available funding. In the 2018-2019 financial year, the NEED and MEED Committees allocated funds as follows:

Funding Committee

Designation Number Amount

NEED RN/Enrolled Nurse (EN) 44 $41,333 Senior Nurses 31 $51,163 All Nurses: Mandatory

External Training 30 $23,614

Overseas Conference 10 $30,428 TOTAL 115 $146,538 MEED RM 10 $2,055

No applications were declined. Overseas conferences in Australia included Quality and Safety in Healthcare, Delirium Clinical and Research update, Transplant Nurses National Conference and Sleep Association conference. Other courses and conferences attended include National pre-admission conference, Sexual Health Congress, New Zealand Triage Course, Trauma Meeting and TOPIC Course, Advanced Care Planning, Health Informatics New Zealand Conference and eHealth Workshop and the Perioperative Nurses Conference. 5.2 Career Framework Once qualified, nurses are required to maintain their competence and must complete a minimum of 60 hours professional development every three years including short courses and seminars, conferences, continuing professional development offered online and/or post-graduate (level eight) studies. MDHB provides a career framework for nurses to guide them in their career development and aspirations, as well as providing a means to recognise their level of expertise and additional roles available in the workplace.

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Figure 1: Primary health nursing career pathway 5.3 Credentialed Activities Credentialing is required when RNs expand their practice and expertise beyond their traditional scope of practice. In April 2016 a Credentialing Framework for RNs was established with the following outcomes: Nurse Led Intravitreal Injection Service The focus of this work stream is to further develop the nurse led service that has shown promising results to date by increasing the number of credentialed RNs. The driver for this development at MDHB is the rapidly increasing demand for intravitreal injections of anti-vascular endothelial growth factor to treat neovascular age-related macular degeneration. The number of injections delivered has increased significantly since the development of this RN led service. Prior to the nurse injection service 519 injections were delivered in 2015. By 2018 with the addition of nurse injectors but no additional medical staff, 1,459 injections were delivered and the wait time has decreased. Nurse Led Macular Review Clinic The focus of this work stream is to ensure that a robust clinical review process is in place to complement gains made in the nurse led intravitreal injection service. The clinical workload associated with the frequent follow-up required for people with macular degeneration is substantial.

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As more new patients are diagnosed and the population continues to age, the patient population will continue to increase. It is thus vital that clinical services continue to adapt so that they can provide a fast and efficient service. Cataract Service: Nurse Led Biometry The focus of this work stream is to look at the future of service provision for people with cataracts, with nurses contributing to better patient flow. When patients agree to have cataract surgery it is important that they are fully assessed to determine their fitness for surgery. Essential components of the assessment include obtaining consent and performing biometry - the process by which the power of an intraocular lens implant is calculated prior to cataract surgery. Nurse led biometry has been shown to improve the quality and efficiency of the patient's 'journey'.

Peripherally Inserted Central Catheter (PICC) Insertion Service PICC insertion is a procedure that is traditionally undertaken by medical staff, so a registered nurse performing the same procedure needs to be credentialed to do the activity with the same level of knowledge and skill as their medical colleagues. The MDHB credentialing programme enables suitably trained registered nurses to perform ultrasound-guided PICC insertions and electrocardiograph - visual positioning system rhythm. Since starting in July 2018, 156 nurse-led PICCs have been inserted by four nurses, including the Clinical Nurse Specialist (CNS) IV therapy, two RNs in Transitory Care Unit and the Nurse Educator Ward 23/Oncology. Seventy–five percent of PICCs were inserted within 48 hours or less of the referral being made. 5.4 Registered Nurse Prescribing There are four levels of prescribing authority for registered nurses in New Zealand and each has its own educational requirements: Registered Nurse Prescribing in Community Health We are leading a pilot of this with our community partners in 2020, including Tamariki Ora Nurses, District Nursing, Public Health and Integrated Family Health Centres. Nurses prescribing in community health will be prescribing for normally healthy people using decision support tools, current best practice information and with the support of colleagues. They will be responsible for asking for help when they need it and referring patients who have health problems beyond their abilities. Registered Nurse prescribing in Diabetes Health Nurses prescribing in diabetes health are designated prescribers with a condition in their scope of practice.

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The condition states “may only prescribe in diabetes health under supervision of a medical practitioner”. They may also prescribe in diabetes health from the medicines list for registered nurses practising in primary health and specialty teams (2016). There are 303 nurses in New Zealand, with five of these in the MidCentral district. Registered Nurse Prescribing in Primary Health and Specialty Teams Nurses are designated prescribers and can prescribe from a schedule of common medicines for common and long-term conditions. Ten nurses in the district have this qualification. CNSs will be required to engage in this pathway, and each is in the process of developing a plan for achieving prescribing. Nurse Practitioners (NPs) are authorised to prescribe any prescription medicine, and there are 36 NPs in the district across primary and secondary services. 5.5 Nurse Practitioners NPs are endorsed by NCNZ. This endorsement requires a Master in Clinical Nursing and evidence of significant clinical supervision demonstrating generalist expert knowledge within a specialty. There are 422 registered NPs in New Zealand, with 36 of these in the MidCentral District. There are a further eight Nurse Practitioner Candidates (NPCs) on the pathway to NP. MDHBs NPs and NPCs are working in Te Uru Arotau (Acute and Elective Specialist Services), Te Uru Matāi Matengau (Cancer Treatment, Screening and Support), Te Uru Pā Harakeke (Healthy Women, Children and Youth), Te Uru Kiriora (Primary, Public and Community Health), Te Uru Rauhī (Mental Health and Addictions) and Te Uru Whakamauora (Healthy Aging and Rehabilitation). There is a nationally recognised need to increase. 5.6 Leadership Development 5.6.1 Transformational Leadership Programme (TLP) Leadership development is well recognised as an essential component of safe and effective care, improved staff satisfaction, succession planning and staff retention. The TLP, established in 2009, blends theory and experiential learning so that staff are equipped with the knowledge and skills to apply models and frameworks in their workplace at the end of the programme. As of December 2019, 500 participants have completed the programme. A further two programmes are planned for 2020.

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5.6.2 Leading and Empowered Organisation (LEO) The LEO programme is used worldwide and is a mixture of evidence-based input, practical exercises, storytelling and reflection, most of which are discipline specific. It is an intense three day programme with a one-day follow-up about two to three months after completion of the course for reflections and presentation of a clinical improvement project. Over 40,000 nurses and midwives have completed the course worldwide. In our district, the programme commenced in January 2019 and 140 nurses and midwives completed this as of December 2019. A further four programmes are planned for 2020. 5.6.3 He Pōkai Koko He Pōkai Koko Leadership Programme offer a unique experience that will develop a cohort of future nursing leaders in Aotearoa New Zealand. The MDHB cohort will come together for a one-day orientation in January 2020 and then engage in leadership workshops throughout the year, drawing on the expertise of the programme facilitator, the wisdom and knowledge of their peers, mentorship and monthly meetings with a coach. The programme will emphasize inquiry, continuous learning and the importance of evidence-based leadership. Eight MDHB nurses are participating in this inaugural programme. 5.7 Reward and Recognition Programmes Recognising and rewarding employees for their contribution to quality patient care and peer relationships is integral to any retention programme, affirming that staff that are making a positive difference. 5.7.1 DAISY Awards 2020 The DAISY Foundation works to recognise and celebrate the exemplary work of nurses and midwives, with recipients recognized in a public ceremony within their workplace and provided with a certificate, a DAISY award pin and a hand-carved stone sculpture from Zimbabwe entitled “A Healer’s Touch.” This will commence in February 2020. 6. MODELS OF CARE INITIATIVES 6.1 Nursing Professional Practice Model We are developing a Professional Practice Model, following consultation with nursing on how we should practice, collaborate, communicate and develop professionally to ensure the provision of the highest quality care for people, whānau and our communities.

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Whānau centred partnership is the centre of the model, with the aim of ensuring Māori ownership and management of their own health conditions and the delivery of services, in a way that empowers whānau with the necessary knowledge and skills to be able to do that. It will be enabled by the implementation of Ngā Pou o Te Oranga: Fundamentals of Health, which are embedded in Te Whare Tapa Whā. This will be socialised in 2020, supported by cultural competence training and support. 6.2 Midwifery: A Partnership Model The word midwife means ‘with woman’ and is reflective of the midwife’s role in accompanying the woman on her journey through pregnancy and childbirth into motherhood. The midwife has a responsibility to share all the available information with the woman and to respect her values and beliefs and also acknowledges the woman’s autonomy in her own life and respects the decisions she makes for her childbearing experience Midwives work in partnership with the woman and her family/whānau, providing or supporting continuity of midwifery care throughout the woman’s maternity experience. This partnership is based on a relationship of trust, shared decision making and responsibility, negotiation and shared understanding. 6.3 MDHB Bicultural Model of Care: Kaitiaki Pae Ora Working in partnership with Paiaka Whaiora Hauora Māori, nursing and midwifery are integrating the Bicultural Model of Care into all job description key performance indicators and activities. The Bicultural Model of Care has been specifically designed for use in the New Zealand context. It has been developed by integrating Pae Ora (Healthy Futures) and Te Whare Tapa Whā concepts. Culturally responsive practice integrates the above elements to reinforce and further strengthen the strategic direction for Māori health and the advancement of healthcare for all New Zealanders.

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COPY TO: Strategy, Planning & Performance



Phone +64 (6) 350 8928

For:

Decision

X Endorsement

Noting


Author Angela Rainham, Locality and Population Health Manager

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


Subject Manawatū District Health and Wellbeing Plan Update

RECOMMENDATION

It is recommended that the Committee: endorse the progress that has been made in relation to the Manawatū

Health and Wellbeing Plan.

Strategic Alignment

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

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1. PURPOSE The purpose of this report is to update Committee members on progress with MidCentral DHB’s locality approach in the Manawatū District. It is for noting. No decision is required. 2. BACKGROUND Health and Wellbeing Plans have been developed for five different localities (Territorial Local Authority areas) across the MidCentral district. The Plans aim to make a positive contribution to the health outcomes of the locality and will be used to make changes necessary to continuously improve our health system, as part of the wider heath sector and social services network. The Plans place residents and their families/whānau at the centre of planning decisions and design to best meet the needs of the community. Plans for Horowhenua, Manawatū, Ōtaki, Tararua, and Palmerston North City have been completed and presented back to their communities. A copy of these plans can be found at: http://www.midcentraldhb.govt.nz/Planning/localPlan/Pages/LocalityPlanning.aspx Each Plan identifies priority areas in relation to the health and wellbeing of the community, as identified by the community. The top four community priority areas identified for Manawatū were: Access to Healthcare Easy access to Healthcare when people need it Mental Health and Addiction Improved Mental Health and Addiction support in communities Healthy Living A well community where everyone is supported to have quality living and healthy and active lives Better Communication and Connection A district that has quality communications and connections between health services, people, whānau and communities 3. PLAN OF ACTION PROGRESS The graphs on the following page summarise pictorially the progress of action points in each priority area. Generally there has been good progress, with many actions completed or progressing well. Some of the actions will be ongoing, so will never be ‘completed’. The detailed dashboard report for the Plan of Action is attached as Appendix 1.

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Access to Healthcare

Mental Health and Addictions

Healthy Living Communication and Connections

16 Actions

10 Actions

13 Actions

14 Actions

3.1 Additional Actions Since the Plan was Developed Since this plan was developed, five additional actions have been added - four relating to Access to Healthcare and one relating to Healthy Living. These appear at the end of the detailed report in Appendix 1. 4. HIGHLIGHTS IN IMPROVING ACCESS TO HEALTHCARE 4.1 Improving Access to Primary Care Feilding Health Care (FHC) has implemented new systems which are proving successful in reducing barriers to accessing primary care. These include: Providing the option of video consults – saving people travel time General Practitioner (GP) phone triaging – 60 percent of GP triaging calls are

resolved over the phone which helps reduce the waiting time for face to face appointments

An online tool (patient portal) which enables patients to book appointments, send secure messages to FHC staff, order repeat prescription requests and see test results – 40 percent of FHC patients have registered with the patient portal with an average of 100 registrations per month in 2019

Establishing after school children’s clinics and winter ills and chills clinics. 4.2 Feilding Health Care Equity Focus Work FHC has had a strong equity focus in 2019. Work in this area has included: Reducing debt as a barrier – the Integrated Family Health Centre changed

digital messaging and ways of communicating and helped people to work out plans to reduce their debt

Focusing on increasing cardiovascular risk assessments for 33- 44 year old Māori men - this resulted in an increase from approx 60 percent to 90 percent and the rate now sits at approximately 85 percent.

Focusing on improving screening rates to reduce differences between Māori and non-Māori - this has been successful with rates now being similar between Māori and non-Māori for cervical screening, breast screening and immunisation.

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5. HIGHLIGHTS IN MENTAL HEALTH AND ADDICTIONS 5.1 Te Ara Rau Based at Feilding Health Care Te Ara Rau aims to improve mental health and wellbeing through having a mental health team based at Feilding Health Care. The programme was implemented in Feilding in October 2018 and saw 422 referrals received during its first six months. This equated to a 354 percent increase in utilisation of Mental Health support in the Feilding community. 5.2 Support for Local Youth and Rural Communities The Public Health team continue to provide support to different communities in the Manawatū District in the area of Mental Health. Examples of this include: Working with the Manawatū Youth Ambassadors on a Preventing Youth Suicide

Event Supporting rural communities through events such as the ‘5 Ways to Wellbeing’

presentation delivered in Apiti in June Planning to deliver an anxiety and depression workshop for teachers in Feilding

in 2020. 6. HIGHLIGHTS IN HEALTHY LIVING 6.1 Supporting Adults to Make Good Lifestyle Choices MidCentral DHB contract Sport Manawatū to deliver Green Prescription programmes for adults in the Manawatū District. This programme supports people to make healthy lifestyle choices, particularly in relation to physical activity and nutrition. Twenty nine people graduated from the Feilding Green Prescription programmes in 2019. One programme participant said: “My confidence in managing my health conditions has increased due to the support and information I received while on the Green Prescription programme.” The Green Prescription programme also organised a ‘Workplace Wellness Challenge’ at Manawatū District Council in April 2019. Ten teams registered for the challenge (approx. 30 participants). A variety of activity opportunities were offered and information/education sessions were provided, including: heart health, diabetes, eating well, and engagement with your general practice team. 6.2 Collaborative Approach to New Active Teens Programme The DHB also fund Sport Manawatū to run Active Teens programmes. A new Active Teens programme was co-designed with Feilding High School and ran in the second half of 2019. The purpose of this programme was to engage students in different types of physical activity they aren’t normally exposed to at school in the hope they would find one they liked and would want to continue to engage in. This resulted in the programme consisting of activities such as ultimate frisbee, multisport, boxing and turbo touch; sports they wouldn’t normally get to play within the school setting. There were also general physical activities and a nutrition session for the students.

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7. HIGHLIGHTS IN BETTER COMMUNICATION AND CONNECTION 7.1 Manawatū Health and Wellbeing Group The development of a Health and Wellbeing Group in Manawatū was a key outcome of the Locality Planning process. We are already seeing the benefits of bringing representatives from health, local iwi, local council, Ministry of Social Development, Non-Goverment Organisations and the community around one table - with resulting collaboration on local issues. The group has been in place since June 2019 and has evolved over the first six months with a representative from the Education sector being the latest addition to the group. The group is also looking at adding an additional iwi representative, alongside Dennis Emery from Ngāti Kauwhata), and will approach the Ngā Manu Tāiko forum to suggest a representative of other iwi in the area. This group is chaired by local Councillor Alison Short and meetings are held quarterly with a key theme for each meeting. The DHB is represented on this group by a member of the Te Uru Kiriora Primary, Public and Community Health) leadership team and the Locality and Population Health Manager. 7.2 Improving Communication The first Annual Locality Forum, held at St John Hall in Feilding on Tuesday 7 May, was an opportunity to get further feedback from the community and to give an update to community members on progress in each of the community priority areas within the Manawatū Health and Wellbeing Plan. The Forum was attended by 26 local people. Regular communications from the DHB are also being sent out to a database of community groups and providers on a quarterly basis. These are done in an email newsletter format. 8. FEEDBACK FROM ANNUAL FORUM There were a lot of individual comments made, however the common themes were: increasing cost of living and growing poverty the ageing population and potential social isolation a shortage of housing timely access to local health services lack of transport – affecting ability to access services and also social isolation We need to acknowledge that, whilst this feedback was gathered from people who are very passionate about the health and wellbeing of their community, it was only a small group and is not representative of all of the population groups within the Manawatū District.

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9. FEEDBACK FROM OTHER ENGAGEMENT The feedback below was gathered during the 2019 year and disseminated to the Organisational Leadership Team at the DHB to ensure they are aware of issues for different population groups in the Manawatū District. Further engagement will take place this year with iwi representatives and other population groups within the Manawatū community. The information will again be shared with members of the Organisational Leadership Team to ensure they are aware of current health and wellbeing issues in the Manawatū District and can use that information to inform their planning going forward. 9.1 Manawatū Youth Ambassadors Prior to the Annual Locality Forum in May, the Locality Manager attended a Manawatū Youth Ambassador meeting to get their perspectives on the key issues affecting the health and wellbeing of young people and their whānau in Manawatū District. The youth highlighted the key issues as: not knowing where to go for help too much use of electronics – limits physical activity and socialising expense of sports fees and gyms/fitness facilities being afraid or too shy to ask family or friends for help people under stress and pressure – caused by school, jobs, friends affordability of healthcare dentist is expensive for over 18s. 9.2 Ngā Kaitiaki o Ngāti Kauwhata At Health and Wellbeing Group meetings during the year key issues raised for Ngāti Kauwhata iwi members were: For the 5,000 Māori in Feilding poverty is a huge issue The main issues affecting access to health services for iwi members are

transport and fees Housing is also an issue - iwi are working on a healthy homes project in

Feilding.

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Appendix 1 Priority Area Progress Action Points in Tararua Plan Impact seen Comments re progress General Comments Access To Healthcare

People being able to get help when they need it

Started People (particularly in rural communities) will be able to connect more with health services through improved technology (eg virtual consults).

FHC are in final stages of implementing as business as usual. 50 Video consults now completed. Patients can book VC using patient portal. All GPs will be delivering Video Consultations by March 2020.

Complete People in need will be able to get appointments easier through new systems, which include GP triaging.

60 percent of GP triaging calls are resolved over phone – reduces waiting times for appointments.

FHC is implementing as part of Health Care Home. FHC has achieved certification in April - is first MidCentral practice to achieve certification.

8,000 episodes of GP triage completed between October 2017 and October2019.

Progressing well General Practices will increase the number of patient consultations over the phone or online, which will save people time and travel costs.

In 2019 FHC GPs sent 15,389 online messages and received 14,047. Nurses sent a further 515 messages. This service allows people to communicate with their GP team without needing a face to face or phone appointment.

Since 2016 there have been: 7,180 appointments made online, 175000 patient logins and 27250 secure messages sent to FHC staff from patients.

Complete Communities will be able to use an online tool to get repeat prescriptions, make appointments and receive test results through a patient portal

7611 FHC patients registered on Manage My Health.

Feilding Healthcare implementing as part of Health Care Home

Numbers growing all the time. 11,558 prescriptions have been requested online since 2016.

Progressing well People with complex conditions will have a care coordinator to help build a trusted relationship and have continuity of care.

Almost 1000 Care Plans in place for people with complex conditions. All patients with Care plans have care coordinator. GPs also offer continuity of care – patients see their own GP unless they are unavailable.

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Started People will have more choice by increasing awareness of what different health professionals can do and which service to choose when. Eg your pharmacist may be able to give your flu shot.

2018 Flu Campaign promoted pharmacy flu shots. In 2019 Consumer Council and Think Hauora Clinical Board have formed a small working group to begin scoping this.

Series of articles outlining the roles and abilities of primary clinicians is under development.

Started People will be more aware of how to access the right health service to get the help they need. The “Right Choice” campaign will help this.

THINK Hauora are continuing to work on campaigns with input from Consumer Council and DHB staff.

Improving people’s access to hospital

and specialist care

Behind/challenges People’s circumstances (such as locality and family/ whānau responsibilities) will be taken into consideration by more flexible hospital booking systems.

There have been issues identified regarding the integration of the electronic system and solutions are being sought.

All booking staff have been reminded to ensure they are not giving early morning or late afternoon appointments to people from Tararua or other outer areas.

Started People will be provided with options of a consult over the phone or online, where appropriate, for follow-up specialist appointments. This will be piloted in some hospital specialist areas first.

This is happening in some areas and the DHB is working hard to ensure we have the technology to roll it our further.

Complete People attending Palmerston North Hospital’s Emergency Department will find a more welcoming environment as the reception and waiting areas are improved.

Feedback received about the new improvements has been positive.

Reception complete.

Complete Patients will have improved privacy in redeveloped Emergency Department triage rooms.

This has been achieved with the introduction of designated triage areas for ambulance patients and those who self present to the waiting area, enabling private consultation without the risk of breaching confidentiality.

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Health working together as one team

Started People will be better supported by health providers who can access the notes they need via improved IT systems.

Feilding Health Care have shared electronic health records so essential information is available to hospital staff when their patients attend.

Part of the new digital health strategy

Yet to start Locality based teams will be put in place to help address the unique needs of the community.

There are already small locality teams in place. The goal is to further develop these based on local needs.

Complete A DHB digital strategy is being developed to identify priority areas for improvement, ensuring people and whānau have a more connected health journey by services working together as one team.

The Digital Health Strategy has been developed

Progressing well People feel better informed about their health by making it easier for them to access to their health information through improved technology.

Feilding Health Care have a good uptake of the patient portal which gives people access to lab results.

Part of the new digital health strategy

Started There will be more opportunities to provide feedback, which will be used to constantly improve health services. The Consumer Council will be involved in the design of this.

Consumer Council members are part of Service Cluster Alliancing Groups. Also a database of consumers who are keen to be part of future service development programmes has been developed.

Manawatū Health and Wellbeing Group also provides a good forum for getting feedback from a locality perspective.

Mental Health and Addiction

People are able to get help when they need it

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Started People will receive help and support within their General Practice Team in a timely manner. Mental Health teams will be based on site with GPs and Nurse Practitioners to offer free accessible help for people with mental health issues.

Six month data post implementation of Te Ara Rau at FHC showed 422 referrals were received during October 2018 - March 2019 = 354% increase in utilisation of Mental Health support in the Feilding Community.

Te Ara Rau are based in FHC for people with mild to moderate mental health conditions. Telephone support service is also ongoing.

Community mental health team operate from FHC to support people who have had secondary service mental health intervention, including addiction support. New roles likely to bring 2FTE Primary Mental Health support workers to FHC early 2020.

Yet to start Better support for communities locally by having a Suicide Prevention Local Response team in place in the district in 2019. This will involve local agencies working collectively as one team.

This is planned for 2020

Yet to start Mental Health and Addiction Services will be more visible in our community as the DHB develop a relevant and modern communications strategy.

Progressing well Promote an online directory of Mental Health and Addiction Services, linking services and people to what is available in the community and how to access them.

Health Point is the online directory being promoted by Mental Health Services.

Started People will be more easily able to find information on alcohol and drugs through a more coordinated and modern approach to how information is distributed.

Public Health is working with other agencies to distribute information re Fetal Alcohol syndrome. Social media channels are used in particular for getting the message out to young woman who may be drinking and not knowing they are pregnant.

Progressing well People will be able to see how all services work and where they should seek help and support through the promotion of a service mapping document.

‘Unison’ is the service mapping document. It has been promoted widely.

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Support for our Youth

Started The Mates and Dates programmes will be available and promoted to local secondary schools, helping our youth build healthy relationships.

Public Health are working with WellStop and Youthline to promote the Mates and Dates programme.

Progressing well Manawatū Youth Ambassadors are focusing on increasing awareness of services available locally for youth. Guidance is provided to support them with their project where needed.

Public Health has worked with Youth Ambassadors on Preventing Youth Suicide Event.

Started Health will work with other agencies in linking our vulnerable youth to employment opportunities and work experience.

A subcommittee of 'Unison' is working on this - includes DHB, MSD, Chamber of Commerce.

Rural Mental Health

Started People who visit rural communities in their jobs will receive training and support to help them recognising the signs of depression and help isolated and vulnerable people to seek help when needed. Health will work in partnership with Rural Services to achieve this.

Public Health have been working in conjunction with Rural Support Trust on this.

A presentation on 5 Ways to Wellbeing was delivered to approx 12 members of the Apiti network in June.

Healthy Living Quality living for older adults

Started People working with older adults in the community will be kept up-to-date with the different types of support, service and community activities available for older adults through an annual workshop. They will then be able to link the people they are working with to relevant things in the community.

Manchester House delivered a Super Seniors Expo on 1st November 2019. DHB staff offered support with planning and also promoted the event.

Progressing well Older adults will be assisted to maintain their strength and balance and remain independent through in home strength and balance exercise support starting in the Manawatū District in 2018.

After a poor start a big increase was seen and now there is a waitlist. Now working on a joint programme with Lavender Blue where they take over the second 12 weeks of the programme.

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Progressing well Community groups will be better supported to provide strength and balance classes for older people.

Progressing well as reported by Sport Manawatū

Progressing well Support older adults to easily access their test results, book appointments online and see their health information through the patient portal by running two free workshops in 2018 on how to use the portal.

THINK Hauora report this work is progressing well, however there will be a change of software rolled out which will supersede the current software.

Wider determinants of health

Yet to start A training programme for screening patients for family violence will be offered to all GP practices who will support people to talk about and seek help for family violence.

Training is yet to happen in Feilding

Started People will be more aware of the financial support that is available to them and how to access it, through workshops run in partnership with other organisations in Manawatū.

In conjunction with MSD, information sessions for community groups and individuals were offered in May/June 2019.

Complete Identify and increase support for adult literacy programmes, including computer literacy skills within the Manawatū.

Adult literacy programmes available through Literacy Aotearoa who also offer computer skills and driver licence training as well as help with developing Curriculum Vitaes.

Started The DHB will advocate, where appropriate, for positive changes in areas outside of health which have a fundamental impact on people's health and wellbeing within the Manawatū district.

The Health and Wellbeing Group provides a forum to do this.

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Complete The DHB will advocate for change in the National Travel Assistance Policy to help make the process for registering and claiming travel expenses easier.

Submission to National Travel Assistance Review asked for a simplified system. The review has recently been released and recommendations have been made to improve the scheme and make it more accessible.

Started Actively lead connecting community groups and services; as collectively they can have a greater impact on the wellbeing of community members.

The DHB led the development of a Health and Wellbeing Group in partnership with MDC. There is representation from a variety of sectors with education recently being added.

Link local people to local activities

Started Support people to eat well, be active and lead a healthy lifestyle through increased promotion of the Green Prescription programme in the Manawatū.

In first 6 months of 2019 Feilding classes were attended by 25 people and 51 others were supported via phone.

A "Workplace Wellness Challenge" was also run at MDC with approx 30 participants.

Complete Encourage more kids to ride bikes, by advocating to Council for a bike in schools programme and encourage schools to adopt it.

Put into 2019 annual plan submission.

Started Promote the “Health Promoting School” programmes where schools partner with their community to make positive steps to improve the health and wellbeing of students.

Offered to all schools annually. A workshop is being offered on how to recognise and assist with students coping with anxiety and depression.

Communications and Connections

Improving Communications

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Started Community members and the Consumer Council will be involved in the redesign of correspondence so communications are clear and friendly.

The Acute and Elective cluster will work with Consumer Council members on this.

The Consumer Council are working on a number of projects to improve communications.

Started People will receive more relevant information when attending a hospital appointment, including parking and shuttle services.

The new external MidCentral DHB website will have this kind of information easily accessible.

The Consumer Council are working on a number of projects to improve communications.

Started People will be able to access the new PN Hospital Navigation App through increased promotion of the App; helping people to navigate their way around the hospital.

The app has been promoted through social media and the latest newsletter out to communities.

Started To ensure our communities are receiving clear and people-friendly messaging, the DHB will continue to find new and innovative ways to communicate.

A Communications Strategy was completed in 2018.

People are aware of their choices and

what's available

Started Share local success stories, promoting programmes and initiatives that are working well in the Manawatū District.

The annual forum and the quarterly communications are ways this is being done.

Started Identify opportunities to work with other health agencies to increase awareness of what’s available in the community.

THINK Hauora is developing a plan of how to engage with people and whānau to ensure they know how to access the services they need.

Started People will be more up-to date with what’s happening in the Manawatū community by ensuring communication is distributed through: local newspapers, social media channels, community committees and other key groups.

Press releases about matters of interest to the community are ongoing.

Information has been distributed about the formation of the Health and Wellbeing Group through all channels.

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Started It will be easier for people to choose a service appropriate to their needs through a website which offers reliable information on local and district health services.

Two clusters have signed up to Health Point. The development a new MidCentral DHB external website, which will be much easier for people to navigate and find the information they need, is also underway. It is planned to have easy access to HealthPoint information through the new website.

HealthPoint has much info but the DHB are not fully subscribed to it yet.

Progressing well Communication will be sent out on a more regular basis, with opportunities for people to provide suggestions and feedback.

Quarterly newsletters are being sent out.

Increasing engagement and visibility

Yet to start When designing a new health service in the Manawatū District, people, families/whānau will be placed at the centre of planning decisions and design to best meet the needs of the community.

Manawatu District has representation on the Consumer Council through Hilary Humphrey.

Other consumer representatives are also on project teams and Cluster Alliancing Groups.

Progressing well Continue to engage and seek feedback from Manawatū District residents about strengths, challenges and areas of priority, with an annual forum.

The first forum was held in May - it was reasonably well attended and good feedback was gathered.

Started Feedback from the Manawatū community locality project will be used to help shape and support DHB’s planning and future services.

Locality information is being used in current planning for clusters.

Progressing well Develop a health and wellbeing group for the Manawatū District, or connect to an existing group, where we all work together on a common agenda to tackle the bigger issues.

The group has been developed and is functioning well.

Started Health will be aware of key issues for the Manawatū by having a greater presence at key meetings.

Being part of the Manawatū Health and Wellbeing Group is keeping DHB representatives abreast of

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issues in the Manawatū District.

Additional Actions since the plan was developed

Access To Healthcare

People are able to get help when they need it

Started Children aged Under 14 will be able to access GP services at no cost (previously Under 13).

Started Dec18

Started Finance is less likely to be a barrier to access for Community Service Card holders who can now visit a General Practice team member for $18.50

THG practices have opted into this scheme. Dr Short's Surgery has not

Started Dec18

Improving people’s access to hospital

and specialist care

Started Young people with long term conditions will be better prepared to move to adult health services through a Transition Programme being implemented.

19 Manawatū District young people and their whānau benefitted from this programme in 2019. General feedback indicated they are very pleased with the transition process.

Started A review of outpatient gynaecology services will be undertaken to make these services more person centred.

Work has commenced on this.

Healthy Living Quality Living for Older Adults

Started An OPAL unit will be opened within Palmerston North Hospital - providing specialist multidisciplinary geriatric care for frail patients with acute illness.

The unit has been officially opened on 11 November

A phased implementation is being implemented with full implementation expected in March 2020.

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COPY TO:

Quality and Innovation MidCentral DHB


Palmerston North 4440 Phone +64 (6) 350 8030

For:

Decision

X Endorsement

Noting

To Health & Disability Advisory Committee

Author Judith Catherwood, General Manager, Quality & Innovation



Subject Committee’s Work Programme, 2019/20

RECOMMENDATION


endorses the update on the 2019/20 work programme.

Strategic Alignment

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

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1. PURPOSE This report updates the Committee on the 2019/20 work programme. The report is for the Committee’s consideration and no decision is required. 2. BACKGROUND The Board has established the 2019/20 governance reporting framework to ensure the Board and its Committees will receive appropriate information at the right time to enable members to carry out their duties. Work programmes for all Committees, including the Health & Disability Advisory Committee (HDAC), have been developed from the framework and approved by the Board. 3. 2019/20 WORK PROGRAMME 3.1 General A copy of the Committee’s work programme for 2019/20 is attached. It focuses on the planning, delivery, quality and performance of health and disability services across the district and continuum of care. A schedule of matters arising from committee meetings is maintained for the Committee and this is reported separately. 3.2 Progress Reporting is occurring in line with the work programme. Pae Ora Paiaka Whaiora Health and Wellbeing Plan is in progress and currently being consulted on with key stakeholders. It will be presented at the next meeting. This meeting, a presentation will be provided by Enable New Zealand. The work programme is currently under review, under the overall leadership of the Board Chair, and further work to update this is anticipated.

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

Strategy/Planning Health Needs Assessment & Equity Snapshot to consider the health needs assessment of the district and sub-region

Triennial Nov 21

GMSPP & GMP&P

Ka Ao Ka Awatea – Maori Health Strategic Framework on a three-yearly basis, review/refresh the strategy to ensure it remains relevant and

reflects the DHB’s Strategy

Triennial Oct 20

GMM

Disability Roadmap to determine a disability strategy and roadmap for the district, and thereafter how it has

been advanced, changes, and priorities/investments for the future (3-5 years).

One-off (Aug 19) then triennial

X GMENZ EDAH

Locality Health & Wellbeing Plans to determine how the locality plans have been advanced, what’s changed & priority

initiatives/investments for the future (3-5 years), and to receive community feedback

Triennial Apr 21

OEs & CEs

Cluster Health & Wellbeing Plans to determine each cluster’s planned outcomes, priorities & targets for the next three

years, and the roadmap for achieving these, including required investment & resources

Triennial X X (Pae Ora)

X OEs & CEs

Quality Improvement Clinical governance & quality improvement framework – progress & trends to monitor the quality and safety of health care services in the district, including trends,

performance against dashboard and markers, and confirm the adequacy of the programme planned or established to advance or address issues.

to monitor serious and sentinel events, and HDC complaints

Qtrly X X X X GMQ&I

Clinical Professions to monitor the quality and standard of care and processes from a professional perspective to monitor the implementation of workforce strategies from a professional perspective,

and the health of the professional workforce group across the district

Annual X AH

X N&M

X Med

EDAH, CMO & EDN&M

Consumer Stories to hear direct from consumers of health and disability services about their experience

3/year Wkshop

X X X GMQ&I

Quality account to determine the Quality Account for the financial year

Annual X GMQ&I

Research to receive details of research activity underway within MidCentral DHB

Annual X CMO

Performance Cluster Reports & Health & Wellbeing Plans to monitor each Cluster’s performance, including the implementation of their Health &

Wellbeing Plans, including progress against key targets, initiatives and outcomes. to monitor current and emerging matters, including quality & safety, opportunities and

challenges, and the adequacy of any mitigations

6-wkly X X X X X X X X X OE & CEs 6-mthly deep dive

MHA PPCH

HWCY CSTS HAR ENZ

AESS PW MHA

PPCH

Locality Health & Wellbeing Plans to determine how the locality plans have been advanced, what has changed, and priority

initiatives/investments for the future (3-5 years), and to receive community feedback

Annual Otaki Horo Tara Man PN OE & CEs & GMSPP

Ward 21 Business Case to determine the most appropriate means of ensuring an effective mental health inpatient

facility is provided.

One-off X OEMH&A GMF&CS

2018/19 Regional Service plan (implementation) One-off X GMSPP

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

to monitor the implementation of the Plan and achievement of stated outcomes. (NB: detailed report to be provided from Governance SharedNet site.) 1/4 to 6/12 Nov18

2019/20 Regional Service plan (implementation) to monitor the implementation of the Plan and achievement of stated outcomes.

Quarterly X X X GMSPP

Equity Ka Ao Ka Awatea – Maori Health Strategic Framework to monitor progress being made in achieving the Framework, including the

appropriateness of initiatives and investment planned/established.

Annual X GM

Equity Targets – Progress to monitor progress being made in achieving the national Maori health targets, including

the appropriateness of initiatives planned/established

6-mthly X X GM

Disability Disability Strategy to monitor progress in implementing the Disability Strategy, including opportunities and

challenges, and confirming the priorities and initiatives/investment for years ahead

Annual X GMENZ EDAH

Governance Policies to determine governance and significant quality & improvement policies

Triennial

Serious & Sentinel Event Reporting Policy X GMQ&I

Key: AESS Acute & Elective Specialist Services EDN&M Executive Director, Nursing & Midwifery GMQ&I General Manager, Quality & Innovation CE Clinical Executive EHR Elder Health & Rehabilitation GMSPP General Manager, Strategy, Planning &

Performance CEO Chief Executive Officer GMENZ General Manager, Enable New Zealand MHA Mental Health & Addictions CMO Chief Medical Officer GMF&CS General Manager, Finance & Corporate Services OE Operations Executive CPHO Central Primary Health Organisation GMM General Manager, Māori PPCH Primary Public & Community Health CSTS Cancer Screening, Treatment & Support GMP&C General Manager, People & Culture W&CS Women and Children’s Health EDAH Executive Director, Allied Health

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COPY TO:

Strategy, Planning & Performance MidCentral DHB


Palmerston North 4440 Phone +64 (6) 350 8928

For:

Decision

X Endorsement

Noting


Author Bronwyn White, – Strategy and Planning Advisor

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


Subject 2020/21 Annual Plan Approach and Priorities

RECOMMENDATION


endorse the 2020/21 Annual Plan Approach and Priorities

Strategic Alignment

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

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1. PURPOSE This report provides background material for the planning workshop to be held after the Health and Disability Advisory Committee meeting. The purpose of the workshop is to provide an opportunity for the Committee to have input to the priorities and directions for the 2020/21 Operational and Annual Plan. 2. BACKGROUND MidCentral DHB’s Planning and the Integrated Service Model

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

Planning and the Integration Service Model

The roles of the strategy and plans are as follows: MDHB Strategy (10 years): The MidCentral Strategy has a ten-year outlook and it drives shared direction and aspirations for health and disability services across the district. Now three years in, a Strategy refresh is currently underway. Cluster and Enabler Plans (three to five years): These plans have a three to five-year outlook; they drive decision processes which are designed to identify the key priorities of the Cluster or Enabler to best achieve our strategy.

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

Statement of Intent (SOI): DHBs are required to publish an SOI triennially. The SOI sets out the Board’s strategic intentions, the nature and scope of the District Health Board’s functions and operations and how these will be managed. MidCentral’s SOI was last refreshed and published in 2019, as required by the Minister of Health. Annual Plan: The Annual Plan is a key element of the DHB’s accountability to the Minister of Health. The Annual Plan is a concise document that outlines how the DHB will achieve the Government priorities and targets. The table of contents, format and timelines for the Annual Plan are determined by the Ministry of Health and are in accordance with the New Zealand Health and Disability (Planning) Regulations 2011. The Annual Plan also contains:

The Statement of Performance Expectations (SPE) that provides financial and non-financial expectations for the planning year, with four-year outlook, and demonstrates accountability to Parliament and the public annually (Section 149C of the Crown Entities Act 2004)

The System Level Measures (SLM) Improvement Plan is based on the national SLM Framework for continuous quality improvement and requires collaboration across the health system and across government agencies. It is completed as part of the annual planning process, geared to the six system-wide measures and contributory performance measures.

3. PLANNING PRIORITIES The purpose of the workshop with the Committee is to consider the priorities for the 2020/21 year. As always, the first thing to consider is our people, our whānau, our communities and their needs. The official demographic data from the 2018 Census has not yet been provided by the Ministry, however we know our population is growing and aging. In particular, Manawatū and Horowhenua have been growing at a faster pace than other localities. Demographic change is driving increased need for health services. The profile of our communities is well understood and has been detailed in our locality Health and Wellbeing Plans. There is unequal distribution of resources and health need across our district. In particular, Ōtaki, Horowhenua and Tararua are areas of high need. There are enduring inequities for Māori and Pacific people. This includes inequities in access, experience and health outcomes. There is also significant amenable mortality and morbidity in our district, generally requiring primary and community level activity. It is also pertinent to consider changing Government priorities, particularly the emphasis on working across Government and including wellbeing, particularly with

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respect to children and mental health. Within the health and disability sector, we anticipate more emphasis on regional and national health system planning. DHB performance will continue to have increased focus of attention in 2020/21. The Minister has been clear with Board Chairs and Chief Executives about the need to address financial and service performance. The Ministry is developing a formalised DHB performance monitoring system using a balanced scorecard approach. There are two main influences on the DHB’s 2020/21 planning priorities. These are: 1. The Government’s priorities, and

2. Priorities identified through the Cluster, Enabler and Localities Health and Wellbeing plans.

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

accelerating the spread and delivery of Kaupapa Māori services shifting cultural and social norms reducing health inequities – the burden of disease for Māori strengthening system setting

New section on Improving Sustainability

out year planning processes savings plans sector partnerships to sustain system improvements

For the first time, the Public Health Unit (PHU) Plan is to be integrated into the

DHB Annual Plan demonstrating collaboration and integration with PHUs and DHBs (primary, community, other sectors and Iwi). The Annual Plan is to include the five public health core functions (health promotion, health protection, health assessment and surveillance, public health capacity development, and preventive interventions).

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

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3.2 Priorities Identified Through MidCentral’s Strategy 3.2.1 MidCentral DHB Planning Priorities Throughout the Integrated Service model planning activities, from the 10 year Strategic planning, and through the Cluster, Enabler and Locality Health and Wellbeing three to five year planning, a number key themes stand out. These are: Commitment to Te Tiriti O Waitangi Working towards equity and reducing inequities Providing quality and excellent care Partnering with people and whānau in planning, designing and delivering care Developing the workforce and our culture Strengthening care in the community Priority Programmes The Organisational Leadership Team (OLT) discussed the priority programmes for 2020/21 based around the four themes from the Locality planning engagement. These are programmes that need to be done (The Vital Few). OLT see that Clusters continue to implement their Health and Wellbeing plans, and that the Priority Programmes are applied to the DHB as a whole. See below for the resulting list. i Access to Health Care Improve access to first contact health care services through General Practice

teams Establish locality-based, trans-disciplinary teams across the district, based

around Integrated Family Health Centres to support whānau to meet their health and wellbeing needs

Digital business Coordinated ‘Personalised’ care for people with high and complex needs,

including primary, specialist and community services Improve access to timely, responsive, quality specialist and hospital services by

addressing patient flow, planned care programme, revised models of care in key specialties and workforce

ii Building Healthy Whānau, Communicating and Connecting Work with schools to improve health and wellbeing of children and communities Communicate with the community about health services, with particular

reference to new models of care, and use of acute and urgent services, what to expect from general practice

Intersectoral work in localities, for example, with Councils, Housing organisations, Police, Justice and Corrections

Co design ‘my health myself’ programme with a Kaupapa Māori approach

iii Mental Health and Addictions Implement new Primary Mental Health initiatives and leverage off the

anticipated new funding Develop an Older Adult Mental Health Model of Care to support our older

population Ward 21 re-build

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iv Infrastructure Developments Implement the next horizon of the Digital Strategy Progressively invest in the facilities MidCentral DHB needs to meet the needs of

its community Continue implementation of the Workforce strategy Further develop data/analytics, including performance measurement v Overarching Priorities Taking concrete steps to improve equity of access, equity of outcome, equity of

experience, with a particular emphasis on health and wellbeing gains for Māori Improving our financial sustainability – sticking to our commitments 4. ANNUAL PLAN APPROACH FOR 2020/21 The first tranche of planning guidance was received from the Ministry in late December 2019. We are awaiting the Minister’s Letter of Expectations and funding envelope. The key timelines have been set (see Appendix 2) and the first draft of the Annual Plan and budget, are due with the Ministry by 2 March. The Ministry will progressively release planning guidance throughout the planning period. This includes updates to the Service Coverage Schedule and the Operational Policy Framework, which underpin the activities of all DHBs. There will also be changes to the Non-Financial Monitoring and Performance Measures Framework which set out DHBs’ performance expectations and reporting obligations and are aligned to the Government’s annual planning priorities. Planning Assumptions were approved by Finance, Risk and Audit Committee (FRAC) and the Board in late 2019. These include an anticipated bottom-line result as per the Statement of Intent – ie, a deficit of $5.504 million for 2020/21. However it should be noted that this deficit was not endorsed by the Minister when the 2019/20 Annual Plan was signed. A planning steering group is being established and budgeting is underway. Regular planning updates will be provided to the Board and the Board Committees. 5. NEXT STEPS Following the input from the Committee, management will work on the preparation of the first draft of the Annual Plan. The first draft of the Annual Plan is expected to be tabled at the February FRAC meeting and the March Board meeting, prior to submission to the Ministry.

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APPENDIX 1. Summary of the Government’s planning priorities from the from the Ministry of Health’s Annual Planning Guidance as at 18 December 2019

Specific section on giving practical effect to He Korowai Oranga o engagement and obligations as a Treaty partner (similar to 2019/20) o Māori Health Action Plan (new) – further guidance when interim plan is

released and when final plan is completed accelerating the spread and delivery of Kaupapa Māori services shifting cultural and social norms reducing health inequities – the burden of disease for Māori strengthening system setting

Specific (new) section on Improving Sustainability – o out year planning processes – financial and workforce focus areas o savings plans – in year and out year gains, including workforce planning,

models of care o sector partnerships to sustain system improvements (that also support

Māori health outcomes)

Improving child wellbeing (maternal, child and youth) (similar to 2019/20) – Child and Youth Wellbeing Strategy o maternity and midwifery workforce o maternity and early years (some different areas of focus – strong

prevention and early intervention focus) o immunisation o school based health services o family violence and sexual violence

Improving mental wellbeing (similar to 2019/20, but different emphases)

o Mental Health and Addiction system transformation o Mental Health and addictions improvement activities o Addiction o Maternal Mental Health

Improving wellbeing through prevention (note below re inclusion of PHU

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

Population health outcomes – strong and equitable public health and

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

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

Population health outcomes – primary health care

o Primary health care integration o Pharmacy o Long term conditions, including diabetes

Public Health Unit Annual Plan The Public Health Unit Plan is expected to be integrated into the DHB’s Annual

Plan, demonstrating collaboration and integration with PHUs and DHBs (primary, community, other sectors and Iwi). The Annual Plan is to include the 5 public health core functions (health promotion, health protection, health assessment and surveillance, public health capacity development, and preventive interventions).

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APPENDIX 2. Annual Planning Timelines as Advised by the Ministry (December 2019) Requirements item MoH Timeline Date received Initial Guidance issued Dec 2019/Jan2020 18 Dec. 2019 Minister's Letter of Expectations Approx Jan Population demographics issued Approx. late Jan Non Financial Monitoring Framework and Performance measures -consultation draft issued

Approx. late Jan

Indicative Funding guidance issued Approx. Feb Strategic conversation with DHBs From February DHBs advise of service change proposals tbc Submit first draft of Annual Plan, Statement of Performance Expectations, financial templates, Regional Service Plans to MoH

2 March

Feedback to DHBs on first draft Plans and release of guidance for any additional confirmed Government priorities

9 April

Budget 2020 Late May (tbc) Final draft SOI/SPE signed by the Board to be made publically available on the DHB website

Before 30 June

Final draft SLM plan submitted to Ministry By 30 June Ministry approval of SLM plan 31July Any outstanding 2020/21 SPEs tabled with 2019/20 Annual Reports

December

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Glossary of Terms

ACC Accident Compensation CorporationThe New Zealand Crown entity responsible for administering the country's no fault accidental injury compensation scheme.

ADON Associate Director of Nursing

Anti- VEGF Anti-Vascular Endothelial Growth Factor

AP Annual PlanThe organisation's plan for the year.

BN Bachelor of Nursing

CAG Cluster Alliance GroupA group or 10-12 members from across the health and wider sector supporting the Cluster Leadership Team to identify population health needs, planning, commissioning and evaluating services and developing models of care. Members include consumer and Māori representatives.

CCDM Care Capacity Demand ManagementA programme that helps the organisation better match the capacity to care with patient demand.

CLAB Central Line Associated Bacteraemia

CNS Clinical Nurse Specialist

COPD Chronic Obstructive Pulmonary DiseaseA common lung disease which makes breathing difficult. There are two main forms, Chronic bronchitis - a long term cough with mucus. Emphysema - which involves damage to the lungs over time.

CT Computed TomographyA CT scan combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images of the bones, blood vessels and soft tissues inside your body.

CTCA Computed Tomography Coronary AngiographyA CT scan that looks at the arteries that supply blood to the heart. Can be used to diagnose the cuase of chest pain or other symptons.

CWDs Cost Weighted DischargesCase weights measure the relative complexity of the treatment given to each patient. For example, a cataract operation will receive a case weight of approximately 0.5, while a hip replacement will receive 4 case weights. This difference reflects the resources needed for each operation, in terms of theatre time, number of days in hospital, etc.

DHB District Health Board

DIVA Difficult Intravenous Access

DNA Did Not Attend

DNW Did Not Wait

ED Emergency Department

EDG-VPSR Electrocadiograph – Visual Positioning System Rhythm

EN Enrolled Nurse

ENT Ear Nose and Throat

ESPI Elective Services Patient Flow IndicatorPerformance measures that provide information on how well the District Health Board is managing key steps in the electives patient journey.

FHC Feilding Health Care

FRAC Finance Risk and Audit Committee

FTE Full Time EquivalentThe hours worked by one employee on a full-time basis.

GP General Practitioner

HDAC Health & Disability Advisory Committee

HQSC Health Quality & Safety Commission

HWNZ Health Workforce New Zealand

ICU Intensive Care Unit

IDF Inter District FlowThe default way that funding follows a patient around the health system irrespective of where the are treated.

IFHC Integrated Family Health CentreGeneral practice teams with the patient at the centre, providing quality health care when, where and how patients need it.

IOC Integrated Operations Centre

IOL Intraocular Lens

IT Information Technology / Digital Services

KPI Key Performance IndicatorA measurable value that demonstrates how effectively an objective is being achieved.

LEO Leading an Empowered Organisation

MDHB MidCentral District Health Board

MEED Midwifery External Education and Development Committee

MERA Midwifery Employee Representation and Advisory Service

MIT Medical Imaging TechnologistA radiographer who works with technology to produce X-rays, CT scans, MRI scans and other medical images.

MoH Ministry of Health

MRI Magnetic Resonance ImagingA medical imaging technique used in radiology to form pictures of the anatomy using strong magnetic fields and radio waves.

MSD Ministry of Social Development

MYFP Midwifery First Year of Practice Programme

NAMD Neovascular Age-Related Macular Degeneration

NCEA National Certificate of Educational Achievement

NCNZ Nursing Council of New Zealand

NEED Nursing External Education and Development Committee

NESP Nurse Entry to Specialty Practice Programme (Mental Health)

NETP Nurse Entry to Practice Programme

NGO Non Government Organisation

NP Nurse Practitioner

NPC Nurse Practitioner Candidate

NPTP Nurse Practitioner Training Programme

NZ New Zealand

NZCOM New Zealand College of Midwives

NZCPHCN New Zealand College of Primary Health Care Nurses

NZNO New Zealand Nurses Organisation

OLT Organisational Leadership TeamOLT comprises all General Managers, Chief Medical Officer, Executive Directors - Nursing & Midwifer and Allied Health, General Manager of Enable NZ, all Operations Executives and Clinical Executives.

OPAL Older Peoples Acute Assessment and Liaison Unit

PDRP Professional Development and Recognition Programme

PHU Public Health Unit

PICC Peripherally Inserted Central Catheter

PIP Performance Improvement PlanThis plan is designed to support the OLT in the prioritisation and optimisation of system wide efforts to achieve our vision. The plan was presented to the MoH as part of MDHBs 2019/20 strategic discussion.

POAC Primary Options for Acute Care

PPA Promoting Professional Accountability

RHIP Regional Health Infometrics ProgrammeProvides a centralised platform to improve access to patient data in the Central Region.

RM Registered Midwife

RN Registered Nurse

RSP Regional Service Plan

RTL Round Trip LogisticsA technology platform.

SLM System Level Measures

SMO Senior Medical Officer

SOI Statement of Intent

SPE Statement of Performance Expectations

SPIRE Surgical Procedural Interventional Recovery ExpansionA project to establish additional procedural, interventional and surgical resources within MDHB.

SSHW Safe Staffing, Healthy Workplaces

SSIED Shorter Stays in Emergency Department

SUG Space Utilisation Group

TLP Transformational Leadership Programme

UCOL Universal College of Learning

VRM Variance Response Management

WDHB Whanganui District Health Board

WHEI Whole Hospital Escalation Indicators

YTD Year To Date

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