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Quarter 1 2018-19

Table of ContentsClinical Services 3

Southern Cancer Network 3

Child Health SLA (not included this quarter as SLA facilitator vacancy has meant work has been on hold through much of Q1)

Mental Health and Addiction SLA 6

Health of Older People SLA 7

Palliative Care Workstream 8

Cardiac Services Workstream 9

Elective Services Workstream 12

Major Trauma Workstream 13

Public Health Partnership 15

Stroke Services Workstream 16

Key Enablers 18

Quality and Safety SLA 18

Information Services SLA 19

Workforce Development Hub 20

KEY AREAS DELIVERABLES

Faster Cancer Treatment Programme

1Support DHBs to deliver the FCT target including systematic approach to monitoring and acting on 62 day pathway breaches.

Q1,2,3,4

2

Support clinical staff to gain visibility of cancer patients on both, 62-day and 31-day FCT pathways. This will include the development of a business case for the implementation of an FCT indicator on patients’ records.

Q1,2,3,4

3

Continue to support performance against the 31 day Indicator: proportion of patients with a confirmed diagnosis of cancer who receive their first cancer treatment within 31 days (85% for PP30 31 day indicator).

Q1,2,3,4

Regional Cancer Pathways

4Comparable, timely cancer pathways for the South Island to support improved equity of access and outcomes for all patients across the South Island.

Q1,2,3,4

5Undertake implementation of Oncology patient management and treatment system MOSAIQ in CDHB and fully implement in NMDHB.

Q1,2,3,4

6

Undertake an annual assessment of the Cancer Clinical & Service Priorities, by the South Island/SCN Cancer Clinical Leads Group, with a focus on understanding and addressing disparities, including for Māori (the group meets six monthly).

Q1,2,3,4

7Supporting DHBs in preparation for and implementation of the national bowel screening programme – focus on services to support the delivery of additional cancer cases.

Q1,2,3,4

8Support DHBs with the implementation of the Early Lung Cancer Guidance, once published to support improved equity of access and outcomes for all patients across the South Island.

Q1,2,3,4

Service co-ordination and quality improvement

9

Further implementation, and development for the SI MDM System (SIMMS), including support for South Island alignment of tumour specific work; long term planning for SIMMS resourcing and future requirements; and develop local and regional reporting from SIMMS.

Q1,2

Survivorship 10

Explore options for an end of treatment regional service initiative to improve quality of life for people who have recently completed cancer treatment. This will include engagement with stakeholders, drawing on existing evidence, with a view to developing a trial initiative.

Q1,2,3,4

South Island Radiation Oncology

11 Support implementation of the National Radiation Oncology Plan through reviewing and evaluating heterogeneity of practice within radiation oncology, and implementing strategies to reduce variation

Q1,2,3,4

Services and maximise available capacity.

Reducing inequities

12An equity assessment framework is confirmed and applied across the development of new regional initiatives, with a particular focus on Māori and Pacific.

Q1,2,3,4

13

Support the collaborative regional working of both Te Waipounamu Māori Leadership Group (TWMLG) and South Island Cancer Consumer Group (SICCG) and integrate as co-partners into the regional plan implementation.

Q1,2,3,4

14

Utilise the findings from the 2017/18 Routes to Diagnosis FCT project to target improved access to detection, diagnosis and treatment for high needs and high risk patient groups, particularly Māori.

Q1,2,3,4

Cancer Intelligence service

15Develop a plan to support and implement the NZ Cancer Health Information Strategy across the South Island (note – content still to be finalised, waiting on MOH guidance).

Q1,2,3,4

16

Further develop quarterly South Island Cancer Dashboard to understand progress against cancer standards and targets, and report and track service improvement initiatives and progress on reducing inequities.

Q1,2,3,4

Cancer Strategy

17Support DHBs in their implementation of the prostate cancer decision support tool in the South Island to improve the referral pathway across primary and secondary services.

Q1,2,3,4

18Undertake stocktake of cancer services regional clinical leadership arrangements across the South Island with recommendations for improvement.

Q1,2,3,4

19Support for the Psychosocial and Supportive Care Initiative across the South Island.

KEY PROGRESS IN QUARTER 1Faster Cancer Treatment Programme

1 -3 Please note that data for Q1 18/19 is not yet available from the Ministry, so this report is based on Q4 17/18 data. SCN and the South Island DHBs await confirmation from the Ministry of Health regarding the status of the Cancer Health Targets. This includes both the requirements for public reporting and what change in emphasis, if any, is to be given to service improvement nationally. In the meantime SCN continues to support DHBs to improve the timeliness of diagnosis and treatment for cancer.

Overall, the South Island achieved 89% for the 62-day health target (the health target is 90% of patients referred in with a high suspicion of cancer and triaged as

STATUS KEY: Not Started Critical Caution On target Complete

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SOUTHERN CANCER NETWORK

urgent must receive their first definitive cancer treatment within 62 days of the date of receipt of referral). The health target was achieved by Canterbury, but was not met by the other SI DHBs. For the 31-day indicator (85% of all patients with a new cancer diagnosis should receive their first definitive cancer treatment within 31 days of the date of decision to treat), the South Island met the target, achieving 88%. Canterbury DHB, Nelson Marlborough DHB, South Canterbury DHB and Southern DHB individually met the 31-day indicator.

A patient pathway mapping template has been shared with all SI DHBs and is continuing to be refined. It is a way of mapping a patient’s journey from receipt of referral to first definitive treatment, represented graphically. Milestones include FSA, biopsies, requests and reporting of complex imaging, MDMs, decision to treat and first definitive treatment. The SI FCT leads have agreed to focus on three key areas for 2018/19:

Maintaining focus on urgency throughout inter-departmental and/or inter-DHB referral processes

Impact of diagnostics pathways on timeliness of cancer treatment Review of capacity constraint breaches

Each DHB has agreed to take a lead on one of these areas of focus and reports back at monthly meetings and share with other SI DHBs.

Regional Cancer Pathways

4-8

A document is currently being prepared to determine the business and system requirements of each DHB with regard to MOSAIQ. Site visits to DHBs are being organised in October and November 2018 to talk to the different staff who use MOSAIQ and to do a stocktake of the various other electronic systems that they currently use/intend to use in the future. The interoperability of these systems shall then be investigated with input from Elekta and Orion. This shall aim to minimise duplication of work e.g. scheduling in multiple systems and improved workflow for staff. Visibility of patients across multiple instances of MOSAIQ shall also be investigated, particularly for DHBs where patients are required to have treatment in another DHB that is not their DHB of domicile e.g. radiation for patients in NMDHB, SCDHB and WCDHB. Once this work is complete the final project plan covering off all further planning and the subsequent implementation of this rollout (once approved) will be finalised, including resubmission to the SI Alliance Operational Group (SIAOG) and the Alliance Leadership team (ALT).

The annual assessment of the Cancer Clinical & Service Priorities, by the South Island/SCN Cancer Clinical Leads Group, will be undertaken at its meeting in November 2018.

Q1 has seen the successful commencement of the bowel screening programme in Nelson Marlborough DHB, along with further consolidation of the programme in Southern DHB. The impact of the programme on referrals to DHBs for cancer

treatment in care will continue to be monitored, noting that there has been impact on colonoscopy services relative to the polyp detection rate. This will continue to be monitored as other DHB’s programmes roll out.

While the rollout of the early Lung Cancer Guidance was featured in Regional Plans for 2017/18, the absence of dedicated resource to support this work nationally has led to a considerable delay. A toolkit and resources to support the roll out of the Early Lung Cancer Guidance is being developed within Midland Region and is likely to be available for use by the end of Q3 2018/19. Implementation will follow.

Service co-ordination and quality improvement

9

The remaining MDMs in CDHB and NMDHB will adopt the SIMMS over 18/19. SDHB MDMs will then be moved across to the Health Connect South (HCS) version with the ultimate aim to have all cancer MDMs on a single platform accessed via HCS. Supporting processes will be aligned as part of this work.

Following support from SCN, it has been agreed that SDHB Gynae-onc MDM will meet weekly with the CDHB MDM from February 2019, thus directly improving access and timeliness of patient discussions and treatment recommendations/resultant actions for SDHB Gynae-onc patients.

Survivorship

10

A national survivorship statement has recently been developed by Cancer Society, CCN and Cancer Nurses College. The final statement was released on 24 September 2018. Following on from this work, the Ministry of Health has developed a draft Standard of Care chapter for (post-treatment) survivorship. This will inform the development of a regional end of treatment initiative. Preliminary discussions have been held around the benefits of supporting the transition from specialist follow-up to community/self-care, and the opportunity for this as a nurse led initiative. This work will be further advanced over coming months.

Radiation Oncology Services

11

Treatments for early stage breast cancer have been compared across the South Island with regard to fractionation and recommendations on the standard fractionation course have been made. The data set is about to be run again to see if the previous work has led to further alignment of practice in early stage breast cancer. In addition, stage II and III breast cancer data are now going to be looked at, with preliminary discussions underway regarding variation in rectal cancer radiation oncology treatment.

The data shall be presented in December to clinicians and should lead for further heterogeneity of practice within radiation oncology for these cancers. It may also help to maximise the capacity of radiation oncology resource throughout the South Island.


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Reducing inequities

12-14

The project brief for the development of an equity assessment framework has been endorsed by the SCN Steering Group. Te Waipounamu Māori Leadership Group have workshopped the framework. Next steps include the working group developing a draft framework based on guidance and evidence, which will be circulated to TWMLGC and SCN Stakeholder groups for feedback. The planned next steps are for the working group to meet and confirm a draft for consultation as per timeline. As part of the framework, a pilot/worked example is to be completed and training needs confirmed.

Support to Te Waipounamu Māori Leadership Group for Cancer and the SI Cancer Consumer Group continue to partner with the SCN team in ensuring Māori and consumer perspectives are incorporated and addressed throughout our work.

Over past months, presentations have been made on the Routes to Diagnosis project at national conferences, including Cancer Nurse Coordinator, Faster Cancer Treatment and Radiation Oncology / Radiology conferences. The findings are also being presented to Local Cancer Network Meetings in DHBs, as these include primary care, consumer, and hospice representation. This is a key step to explore how improving detection, diagnosis and treatment for high risk and high needs groups, in particular Māori can be undertaken.

Cancer Intelligence service

15-16

DHBs have been consulted in the last month for feedback on the FCT quarterly dashboard and it is being further developed. There is also to be more of an equity focus, with graphs displaying capacity breaches by tumour stream, treatment modality and ethnicity, to enable DHBs to target areas where service improvements will have the most impact. The dashboard is being repurposed to be more of a tool for those in the sector wanting to drill down for information, in the interests of service improvement.

Cancer Strategy

17-19

The prostate decision support tool has been developed by the Ministry of Health in response to the Prostate Cancer Management and Referral Guidelines published in 2015. Its implementation awaits the finalisation of technology solution to support its integration with primary care practice management software. Once resolved an implementation plan will be finalised.

The stocktake of cancer services regional clinical leadership arrangements across the South Island will be developed in Q2 and will be undertaken in early 2019.

The two South Island Psychological & Supportive Care Service ‘hubs’ continue to provide an overview of service delivery, improvement activity and regional integration to the regional steering group. The outcome of the review of this national initiative is expected to be known in January 2019.

Other – Development of Urological Cancer Tumour StandardsIn March 2018, the Ministry of Health invited submission of a proposal for the development of National Urological Cancer Tumours Standards. The need for prostate, kidney and bladder tumour standards has long been identified. SCN was successful in securing this work (with funding across 18 months). We will project manage the development of standards of service provision, supporting a working group of clinicians, consumer, Māori, and Pasifika established by the Ministry of Health. In order to incorporate this work into our overall activities, the funding is supporting the employment of an additional full time project manager, who will back fill existing team members undertaking the urological standards work. A programme status report is attached that details progress as at 30 September 2018.

CHALLENGESTopic/key area

1-3

With media reports a few months ago that national health targets are no longer to be published in the public domain, some clinicians have understood this to mean that this means that FCT is no longer reportable. Some have commented that they are not sure whether FCT is still a focus. SCN awaits guidance from MoH on whether the FCT reporting may change in the future.

The development of a SI-wide FCT flag has been difficult due to the many different patient management systems currently used. Health Connect South is now used universally and SI-PICS has been successfully implemented in NMDHB and CDHB, so implementation will be further explored to take advantage of DHBs as they come online.


First 1000 Days 1Support the DHBs to develop district pathways to address the needs of people identified under Supporting Parents Healthy Children

Q4

Equitable 2 Support the direction of the Government Inquiry into Mental Health Q4


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MENTAL HEALTH & ADDICTIONS SLA

access and outcomes

and Addiction where regional collaboration can assist DHBs (it is expected the Inquiry will identify actions and priorities to address inequities in mental health and addiction services)

Clinical leadership

3 Consolidate the South Island AOD Model of Care Q4

Quality 4MHASLA will collaborate with Health Quality and Safety Commission and South Island Quality and Safety Service Level Alliance regarding the national work pursued by HQSC MHAQI team

Q4

One team 5

In line with the SI MHA Workforce Development Plan, develop new “whole of systems” regional strategies and activities to build capacity and capability. (HWNZ funded regional workforce development resource will be required to pursue this work)

Q4

Pathways

6Working group of experts to make pathway recommendations based on a gap analysis of transitions between adult forensic community services and general adult community mental health services.

7Explore pathways for infant mental health integration with child and adolescent mental health services and links to regional maternal mental health services

KEY PROGRESS IN QUARTER 1Supporting Parents Healthy Children

1

This item has become a national programme since drafted by MHASLA. Te Pou are rolling the programme out nationally with a target of guidelines in place in all services by 2020. Te Pou report there has been good traction with local champions in the South Island and a national meeting was held in Wellington in early August.

Clinical Leadership

3SACAT refresher courses are being held in Christchurch and Dunedin. The face-to-face meeting for Area Directors will be held in Wellington on 24 October. Area Director for Christchurch sits on MHASLA. Use of the act – 15 cases for the first six months.

Quality

4

MHAQI and Matua Raki are addressing the challenges to the seclusion item from smoking policy/withdrawal and methamphetamine intoxication. Connecting Care has commenced (Service Transitions is now called “Connecting Care”). Other items have been delayed slightly as there is a focus on the current work and acknowledgement of the workload in the sector.

One Team

5Health Workforce NZ have informed SI Workforce Development Hub that the SI Regional Workforce Development Lead Role has gone to the desk of the Director General for sign-off.

Pathways

6

A working group of experts has developed recommendations based on a gap analysis of transitions between adult forensic community services and general adult community mental health services. MHASLA have recommended the paper to the SI DHB MHA GMs Group.

Pathways

7Clinical Leads from CHSLA and regional Mothers and Babies services will be pulling together a working group to pursue this item.

MONITORING / BUSINESS AS USUAL ACTIVITYForensic Mental Health Service

Report prison screening data is collected in line with the schedule of the NZ Forensic Psychiatry Advisory Group.Response within 14 days from referrals:SDHB May 88%, June 97%, July 80%CDHB May 89%, June 72%, July 75%


Dementia 1

Support progress of NZ Dementia Framework. The regional approach to implementing the Framework is articulated in the South Island Dementia Model of Care The focus for 2018/19 will be: Embed the South Island Dementia Model of Care, including

socialising the model of care with the wider health sector and supporting implementation.

Support implementation of navigation approach. In particular

Q1,2,3,4


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HEALTH OF OLDER PEOPLE SLA

this will involve activities including:o support to South Island dementia initiatives meetingso mapping the role of the navigator, where it fits in the

system and what dementia services are availableo describing this on health pathwayso amending IT systems so that dementia care plan signals

who is navigator. Streamline and enhance the South Island Cognitive

Impairment pathways with regard to navigation role.

interRAI

2

Encourage collaboration across DHBs and promote South Island health professions to use the information from comprehensive clinical assessment (interRAI) proactively in the planning of care and in service development.

Q1,2,3,4

3Monitor interRAI reports to identify trends including any trends or differences that may exist between Māori and non- Māori

Q1,2,3,4

Restorative Care

4Support MOH work to embed provision of restorative care in home based support.

Q1,3

5Raise awareness of Person Centred (Restorative Care) across the SI continuum of care

Q1,3

Advance Care Planning

6

Support SI DHBs to develop broadly consistent ACP system implementation with processes to embed electronic ACP (across the continuum of providers) as standard practice for those who will benefit. This includes: – Develop the Regional Quality Verification Process with

clinicians from each SI DHB participating– Provide support for SI DHBs to develop local change

management– Support each SI DHB to finalise their ACP Health Pathway.

Q2,4

Delirium 7

Strengthening Delirium Pathways by encouraging the development of delirium pathways in all South Island DHBs, including aged residential care, to assist in the prevention, assessment and management of delirium across the care continuum and create consistencies in care.

Q4

KEY PROGRESS IN QUARTER 1Dementia

1

MOH have laid out the expectation to progress the NZ Dementia Framework, however detail on next steps is not available.The current process in SI is reinvigorating Dementia stakeholder groups to knit together what is already in existence to develop a map of services. HOPSLA member and Clinical Director Matthew Croucher has led a meeting with all DHBs in attendance to encourage the development of a ‘navigation map’. Matthew

Croucher is also in the process of visiting each SI DHB for discussions across the continuum – he visited NMDHB this quarter.

Advance Care Planning

6

The ACP Electronic form is now available on HCS/H1 from 28 July 2018. CDHB has transitioned to this form but other DHBs are not yet ready to use it widely. All the minor IT issues are now resolved, and work is continuing to update the ACP health pathways in each DHB (nearing completion) and prepare a small team in each DHB to embed the change management and support each user to assist the consumer to complete their ACP.

Delirium

7

Meetings have been held with Quality teams in each DHB and a small group of Age Residential Care providers (ARC) to get ideas for improving uptake of Delirium ‘system of care’ in inpatient wards and ARC. HOPSLA is attending ARC forums to raise awareness. HOPSLA is keen to have SI participating in World Delirium Day March 2019.


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South Island model of palliative care

1

Use information from the hospital and hospice surveys and the evaluation of palliative care in primary care (PHOs ARC and P&F) to promote regional consistency and access to resources for all communities. Inform and influence South Island DHBs so services are aligned to the Resource and Capability Framework for Adult Palliative Care and the work of the National Adult Palliative Care Review.Based on the survey findings and best practice, provide the model of care that reflects the integration of specialist, secondary and primary care and skills and resources required for a seamless palliative care service in the South Island.

Q1,2,3,4

2

Inform and influence the development of information systems within the South Island that will deliver a more efficient and safer transfer of patient information between Palliative Care Providers (including Hospice services) across the South Island while reducing costs and risk

Q1,2,3,4

VOICES

3

Views of Informal Carers’ Evaluation of Services (VOICEs) completed (University of Canterbury contracted to undertake the survey to assess the perceived quality of the final three months of life and assess variations in care).

Q2

4

Drawing on the data collected through VOICES, determine what and where improvements are called for. Use this information, in conjunction with the Hospital Hospice and Primary Care survey recommendations, to improve performance and equity in the delivery of palliative care in the South Island.

Q2,3,4

Allied Health workforce

5Establish an Allied Health working group to design a framework where the Allied Health workforce is prepared, educated and supported to deliver Palliative Care.

Q1,2,3,4

Paediatric Palliative Care

6

Provide high level guidance within the South Island to those providing Paediatric palliative care, including cultural care, to all communities (working within the National Paediatric Palliative care Guidelines)Identify progress against implementation plan milestones

Q1,2,3,4

KEY PROGRESS IN QUARTER 1South Island model of palliative care

1

The Workstream has initiated a Roadshow across the region to discuss challenges and potential solutions in palliative care, using the survey findings as a basis for discussion. Sessions drawing health professionals and managers from across health services have been held in Nelson Marlborough and Southern DHBs. The engagement has been very positive, and bringing together a range of professional groups to share ideas about service improvement has been invaluable.The Roadshow will continue in the remaining DHBs in November. This work will culminate in a regional workshop intended to develop agreed actions at both a local and regional level.

2(&7)

Workstream members have been involved in a teleconference to discuss Medimap. There is work underway to have pre-populated requests, with HealthPathways guidance. Work will progress over next 2-3 months to build a solution, which will be shared with the Workstream to review.

VOICES3 University of Canterbury is on track to deliver a draft paper in December.

Allied Health workforce

5

Expressions of interest have been sought from allied health professionals to be part of a working group that will evaluate the current situation in both the acute setting and in the community (including ARC) and then to design a framework where the Allied Health workforce is prepared, educated and supported to assist with the delivery of quality palliative care. Membership will be confirmed in November and the group is expected to meet for the first time prior to the end of the year.

MONITORING / BUSINESS AS USUAL ACTIVITY7 E prescribing – monitor the roll out across South Island

8 Palliative Care InterRai - following the completion and evaluation of the current pilot, support the development and the roll out of PC interRAI across the South Island

9 HealthPathways - Te Ara Whakapiri support the development of PC HPW in SI DHBs and advise on any updates

10 Lippincott Palliative Care Clinical Expert Group - Provide an annual review and update of palliative care procedures for the South Island.

11St John - continue the partnership to understand how palliative and end of life care is provided through St John in order to understand and advise how the experience for the patient, whanau and St John personnel can be improved


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PALLIATIVE CARE WORKSTREAM


South Island Model of CarePlan

1

Implementation strategy for South Island Cardiac Model of Care agreed and actioned (a key outcome of this model is to understand and address any inequities across all communities in the South Island).

Q1

Model of Care work underway

2aImplement and audit National Guidelines including the Echo Appropriateness Guidelines, 2017 and the Trans Catheter Aortic Valve Implementation (TAVI) Guidelines, May 2017

Q3

2bBuild on Heart Failure initiatives as identified in the regional stocktake 2017

Q4

2c Support DHBs to improve access to cardiac tests Q4

2d Update Minimum Guidelines paper Q1

2e Audit of Cardiac Tests Repository Programme (ECG Project) Q3

Pathways

3aAgreement and implementation of out of hospital STEMI pathways to ensure a consistent approach across the region, in conjunction with St John

Q2

3bAdoption of St John guidelines for transporting patients consistent with out of hospital STEMI pathways

Q2

3cClinical HealthPathways on line and accessed across the primary, secondary and tertiary sector

Q3

Workforce

4

Work with SI Workforce Development Hub to confirm the current workforce across the SI as it relates to cardiac care and services, identify gaps, and make recommendations for what it would take for the SI to achieve workforce sustainability.

Q1,2,3,4

5Assist national plans including supporting echocardiography and the value of frailty scoring

Q1,2,3,4

KEY PROGRESS IN QUARTER 1SI model of care

1

2d

Draft model shared with Alliance Operational Group (AOG) who have appointed a sponsor to assist with the next stages. Consultation held with Wellsouth Maori Health director. Attendance and involvement at SI Alliance’s Planning for Equity day.

Updating of the minimum guidelines paper is subject to confirmation of the model of care.

STEMI pathway

3a

Out-of-hospital STEMI pathways for the South Island have been developed in conjunction with St John to apply across three agreed (but flexible) zones. STEMI coordinators at each PCI capable hospital will play a key role and pre hospital fibrinolysis will be administered in accordance with St John protocols, with rapid retrieval to PCI capable centres. Meetings with all relevant parties from St John and DHBs have been held in Christchurch and in Westport, with a further meeting planned for Dunedin.

Workforce

4

The cardiac physiology professional leaders from across the South Island came together via VC to look at establishing a regional network. There was overall agreement that the network would be beneficial and there was a number of items discussed that we could build into a work plan. One of the first areas of interest was the possible establishment of a regional trainer role. The group is currently gathering data (survey monkey) from the current and recently trained physiologists and technicians around the South Island to get an idea of status quo. They are also undertaking an up to date stock take of the workforce. The other items highlighted as areas of interest were: stock taking current education/training opportunities (ie rhythm meetings with the electrophysiologists in Christchurch) and making them available to the wider south island workforce: developing audit/benchmarking tools and KPI’s for the region: looking at pathways for those interested in research and possible development of a physiology assistant role.

MONITORING / BUSINESS AS USUAL ACTIVITY

6a The Accelerated Chest Pain pathway will be reviewed/audited, which will include gaining an understanding of how Māori, Pacific and rural people are using the pathway

6b Provide quarterly reporting at regional and DHB level utilising the ANZACS-QI and Cardiac Surgery registers (see below)

6c Identify service improvements from the visibility of data, including analysis of and acting on matters of equity

6dContinue to work with and support regional cardiac clinical networks, cardiothoracic surgical units, the New Zealand Cardiac Network, and the New Zealand Cardiac Surgery Clinical Network


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CARDIAC SERVICES WORKSTREAM

South Island Region Acute Coronary Syndrome Reporting Targets Data obtained from the ANZACS QI Registry

Quarter 1 2018/19

Indicator 3: ACS LVEF assessment- ≥85% of ACS patients who undergo coronary angiogram have pre-discharge assessment of LVEF (ie have had an echocardiogram or LVgram)

NM C SC S WC AllJun 9/15 31/45 5/7 31/42 3/3Jul 11/20 41/61 6/8 27/30 2/5Aug 8/10 34/52 6/7 29/32 1/3

28/45 (62.2%)

106/158 (67.1%)

17/22 (77.3%)

87/104 (83.7%)

6/11 (54.5%)

244/340 (71.8%)


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Indicator 4: Composite Post ACS Secondary Prevention Medication Indicator

- in the absence of a documented contraindication/intolerance >85% of ACS patients who undergo coronary angiogram should be prescribed, at discharge -

- Aspirin*, a 2nd anti-platelet agent*, statin and an ACEI/ARB (4 classes), and- LVEF<40% should also be on a beta-blocker (5-classes).

NM C SC S WC AllJun 15/17 52/63 8/10 47/50 7/9Jul 22/22 66/80 9/11 37/37 6/6Aug 13/14 62/72 9/10 34/37 4/5

50/53 (94.3%)

180/215 (83.7%)

26/31 (83.9%)

118/124 (95.2%)

17/20 (85.0%)

391/443 (88.3%)


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Cardiology and Cardiothoracic Procedures: Intervention rates per 10,000 to 30 June 2018. Posted on MoH Quickr site September 2018

Nelson Marlborough

West Coast Canterbury South Canterbury

Southern

AngiographyNational Intervention Target Rate per 10,000

33.91 33.91 33.91 33.91 33.91

Standardised Intervention Rate per 10,000

33.94 33.80 33.42 25.24 34.21

Expected discharges

652 149 1789 263 1148

Actual discharges 663 149 1816 196 1158Variance from National target

Not Significantly different



Significantly below


AngioplastyNational Intervention Target Rate per 10,000

12.56 12.56 12.56 12.56 12.56


11.58 11.42 12.90 9.76 12.75

Expected discharges

245 56 676 99 432





Significantly below


Cardiac surgeryNational Intervention Target Rate per 10,000

5.81 5.81 5.81 5.81 5.81


5.89 6.67 5.63 5.81 7.34

Expected discharges

109 25 296 44 192




Significantly below



DHB ranked out of 20Region ranked out of 71 is highest ranking

Ranked for Angiography Ranked for Angioplasty Ranked for Cardiac Surgery

Nelson Marlborough 9 13 8

West Coast 10 14 5

Canterbury 7 5 13

South Canterbury 20 19 10Southern 8 6 1

South Island excl NM 7 2 5South Island incl NM 2 3 1


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Access to elective services

1Work with SI DHBs to improve equity of access, health system quality and practice in selected service areas, utilising data and evidence to inform service change.

Q1,2,3,4

2Support South Island DHB management of regional electives volumes (if included in Letter of Expectations)

Q1,2,3,4

Clinical leadership to achieve regional consistency

3Implement the nationally agreed Vascular Services model of care in the South Island

Q2,4

4Engage with the national service improvement programme for breast reconstruction as actions are developed and support regional implementation as required.

Q2,4

5

Share innovations and lessons to achieve consistent Ophthalmology pathways for Age-Related Macular Degeneration and Glaucoma across South Island DHBs, reducing variations in patterns of care and improving health equity

Q2,4

6

Explore the option of South Island DHBs adopting consistent evidence-based early intervention programmes to support patients in the community prior to surgical intervention, for example, Mobility Action Plan

Q3

Colonoscopy 7Support South Island DHBs to meet Colonoscopy Waiting Times Indicators

Q2,4

Vulnerable services

8

Orthopaedics: (with SIWDH) Review current orthopaedic workforce resources,

including subspecialty capability, future requirements to meet demand, gap analysis

Develop regional implementation plan (to be confirmed) Identify progress against implementation plan

milestones

Q2

Q2

Q4

9Work with SI DHBs to plan and implement sustainable vulnerable services, including workforce e.g. Maxillofacial, Dermatology, ICU

Q4

KEY PROGRESS IN QUARTER 1Vascular

3Vascular services: DHBs and St John are working to agree patient pathways for acute and non-acute vascular conditions (primary-secondary-tertiary)

Colonoscopy/Bowel Screening Programme

7

Support for SI DHBs to manage symptomatic Colonoscopy pressures (average increase in referrals ~ 20%)Working with NMDHB to roll out the Bowel Screening ProgrammeFocus on equity for SDHB, NMDHB and CDHB BSP rollouts – to increase participation for priority groups

Maxillofacial

9

SDHB has approved recruitment of a MaxFacs registrar and other service changes to assist with more sustainable service. Process mapping and pathway development underway to create more sustainable services across the SI. Contact with HVDHB (provider to NMDHB) showed Central region services are equally fragile


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ELECTIVE SERVICES


Understanding South Island trauma

1aAll South Island hospitals providing complete and accurate major trauma data to the national registry

Q1,2,3,4

1bAll South Island DHBs using a common regional dataset and recording non major admitted trauma cases in a consistent manner

Q1,2,3,4

1cNational annual reports include complete South Island major trauma data

Q1,2,3,4

1dRenewed agreement with Midland or other for submitting data to the national registry

Q1

Feasibility of South Island Trauma Service

2

Prepare a case investigating the feasibility of establishing a South Island trauma service. The case would seek to recognise the value of a trauma service and justify provision of further resourcing to improve trauma services

Q4

Workforce

3aTrauma Nurse Coordinators (TNCs) and training and development needs are supported

Q1,2,3,4

3bWork with DHBs to encourage administration hours being provided or increased in all DHBs to assist the TNCs achieve their tasks

Q1,2,3,4

3cTNCs importance to improving trauma services is acknowledged and they are more able to provide input through representation on the Workstream

Q1,2,3,4

3d Further TNC education provided (using the ACC incentive fund) Q1,2,3,4

3ePrepare a case for a regional trauma conference to be organised and held in the South Island

Q2

Networks and relationships

4aRegional destination policies agreed with all SI hospitals and St John implemented

Q2

4bAdminister the ACC incentive funding provided according to the proportion of data submitted to the national registry

Q1,2,3,4

4cStrengthen the Workstream by further developing relationships and increasing engagement with the National Network, St John, ACC and others as appropriate.

Q1,2,3,4

KEY PROGRESS IN QUARTER 1National registry

1d Agreement rolled over for the next two years, but other options still being explored for the longer term.

Destination policies

4a The Workstream and St John are working closely to confirm the most appropriate destination policies to take into account local variations.

National

4c

The region has provided the requested feedback to the National Network regarding the recommendations of the Royal Australasian College of Surgeons (RACS) review of major trauma in NZ.The Workstream is looking forward to the potential opportunities associated with the approval of the national business case.

MONITORING / BUSINESS AS USUAL ACTIVITY

5Support each DHB to have a well governed trauma system, and to track progress (facilitated by a trauma committee meeting on a regular basis)

6Education sessions and initiatives planned and delivered in DHBs will be communicated to others offering participation


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MAJOR TRAUMA WORKSTREAM

Major Trauma 30 Day target report: Patients discharged 1 Apr - 30 Jun 2018 Data qualifications: Includes all patients with ISS* > 12. Does not include patients who died† (any ISS). Region indicates region of Arrival Facility for all individual admissions in that region (data are not by entry person/entry Facility but for every admission by facility of arrival within each region). Days from discharge to record closure were computed for each individual admission and compared with the 30-day target.

For patients discharged 1 Apr, 2018 – 30 Jun, 2018:

Region No. patients ISS>12 discharged

Records created AND closed within 30 days of discharge date

Northern 145 78

Midland 120 94

Central 119 69

Canterbury 90 85Nelson Marlb. 20 8 South Canterbury 11 10 Southern 34 26 West Coast 5 4 South Island 160 133

Notes: Each day the Midland Trauma System interrogates the entire trauma registry database. It compares record status (Open or closed) for that day to the record status for the previous day and logs any change in status. A date/time stamp is also applied to that change in record status. While a record may be re-opened at some time in the future, only the first change from an open to a closed status is retained and used for purposes of this report. *ISS – Injury Severity Score (at admission level). †Where a patient dies, Coroner’s reports are required before records can be closed, it may take several months before these are received.


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Collective impact and partnerships

1Actively contribute public health expertise, leadership, programme facilitation and project management (backbone support/hosting) to the development of the Hauora Alliance.

Q4

2Actively contribute to the collaborative development of a cross-sector initiative/s to address adaptive public health challenges during the first 1,000 days of life.

Q4

Māori equity

3Support Te Herenga Hauora to integrate public health indicators into their plans.

Q1,2,3,4

4 Partner with Te Herenga Hauora in promoting position statements. Q1,2,3,4

Health promoting system

5Develop and promote position statements for healthy housing, environmental sustainability and sweetened beverages. Q3

Regional alignment

6Develop and implement a consistent and coordinated regional approach to drinking water issues, including/ and community fluoridation

Q3,4

7Develop a coordinated approach to community resilience and psycho-social well being Q3,4

8Identify and implement a sustainable on call /after- hours system for South Island health protection services Q1,2

9Identify and implement regional approaches to alcohol harm reduction

Q1,2,3,4

10Develop and implement regional approaches to promote healthy eating and active lifestyles Q1,2

KEY PROGRESS IN QUARTER 1Collective impacts and partnerships

1

The Hauora Alliance steering group has met with providers of the Mokopuna Ora pilots contracted by Te Pūtahitanga o Te Waipounamu to strengthen understanding and identify ways to support the initiatives. The Ministry of Social Development has joined the steering group.

2The South Island report The First 1000 days was prepared by the Information Team at Community and Public Health with the guidance and leadership of a SI PHP Steering Group.

Health Promoting system

5The Housing position statement was completed and subsequently endorsed by the Partnership at their September meeting.

Regional Alignment

8The Alliance Operations Group endorsed a proposal to initiate a formal co-design process to develop a regional approach to improve the systems supporting out-of-hours health protection services.

10

The Healthy Streets scheme promoted by Dr Lucy Saunders during her visit in August has been endorsed as a new addition to our regional approach. A work plan is being developed based on the newly released WHO action plan More Active People for a Healthier World.

MONITORING / BUSINESS AS USUAL ACTIVITYA proposal to evaluate the value of the South Island Hauora Alliance has been received from Dr Kate Morgaine from the Dept. of Prevention and Social Medicine, University of Otago. It is proposed that the evaluation follows the natural life of the Alliance, therefore it would encompass evaluation of the PHP ‘s role in its formation. Regional workgroups and networks continue to be active in the areas of: environmental sustainability; alcohol harm reduction; healthy eating and active lifestyles; workforce development; health intelligence and annual planning.


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PUBLIC HEALTH PARTNERSHIP


Organisation of Stroke services

1aSupport DHBs to ensure stroke patients are admitted to an organised stroke service (defined by National Stroke Network)

Q1,2,3,4

1b

Support and advocate for each South Island DHB to establish the clinical leadership through having Lead Stroke Physician and Lead Stroke Nurse in place (with protected non-clinical hours); and fostering an inter-disciplinary approach, in particular considering the role of allied health

Q4

2

Support DHBs to ensure each South Island designated stroke hospital: is confirmed on the St John destination policy has imaging access (in and out of hours); has thrombolysis expertise.

Q2,4

3Support DHBs and St John to ensure all stroke patients are be managed as a time critical emergency.

Q2,4

Thrombolysis4

Support DHBs to ensure Thrombolysis is available at designated stroke hospitals

Q1,2,3,4

5 Thrombolysis education is available across the South Island. Q1,3,4

Acute Stroke Services

6a

SI DHBs participate in Acute Stroke Telehealth project for out of hours acute stroke service, including: finalise an implementation plan; organise telestroke resources; and ensure training across the South Island.An evaluation post project will inform further work and the addition of other telestoke spoke centres in the South Island.

Q1,4

6bExplore opportunities for other telehealth support to stroke patients, such as rehabilitation (potential to provide services in a new way that addresses disparities in access that occur across the region).

Q4

7aDevelop and agree a plan for a South Island clot retrieval service for suitable patients that is sustainable and considers future demand and workforce requirements.

Q2, Q4

7bHealth Pathways reviewed and updated to reflect progress in implementing telehealth and acute stroke services

Q4

8

Acute stroke destination policies: Embed transport protocol for acute stroke patients from the

community directly to the most appropriate stroke hospital Agree the transport protocol for eligible patients from stroke

hospitals to clot retrieval centre (CDHB). Document in HealthPathways.

Q2,Q4

Rehabilitation

9a

Support DHBs to ensure all eligible people with stroke receive early active rehabilitation services and equitable access to community stroke services (as defined by the National Stroke Network), supported by an interdisciplinary stroke team. This includes all DHBs having rehab services that meet the National Stroke Network service specifications.National measures will be used to indicate progress.

Q1,3

9b

Utilise Australasian Rehabilitation Outcome Centre (AROC) monitoring to understand regional rehabilitation needs and identify action to address inequities or service gaps.Encourage each DHB to extend AROC monitoring to community-based rehabilitation services.

Q2,4

Quality and consistency

10

Support each DHB to undertake some form of stroke audit each year and utilise the findings to inform service improvement across the South Island.Promote uptake in South Island DHBs of the electronic audit tool for stroke rehabilitation

Q4

11Provide advice on the findings of the nation-wide REGIONS Care audit project, which will measure some aspects of care provision and patient outcome.

Q2,4

12

Support national service improvement initiatives, including: - Participation in National Stroke Network- Any national work to identify and understand workforce

requirements for stroke services- Embedding national initiatives across the SI region.

Q1,2,3,4

Stroke specific education

13All members of the interdisciplinary stroke team participate in ongoing education, training (a minimum of 8 hours stroke specific education per year (minimum standard) and service improvement programmes.

Q1,2,3,4

14

Regional telestroke / thrombolysis training session provided to support DHB staff to be confident selecting and managing patients who need to be thrombolysed (undertaken annually via VC across 9 sites).

Q4

KEY PROGRESS IN QUARTER 1Organisation of Stroke Services

1b SDHB has made progress and LSN is appointed. NMDHB has made no progress with LSN appointment.

Thrombolysis

4 Thrombolysis rates are review each quarter – it is pleasing to see the progress in Invercargill where thrombolysis has now commenced.


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STROKE SERVICES WORKSTREAM

Acute Stroke Services

6-8

The Telestroke project is progressing – approval has been given for Christchurch as hub; Grey Base, Timaru, Dunedin, Invercargill, Oamaru and Dunstan as spokes. Once there is sign off from SDHB hardware to support Telestroke will be ordered.

The South Island participated in the first national day to develop the Stroke Clot Retrieval strategy in August 2018.

9 CDHB, SCDHB & WCDHB are reporting on Community Stroke Measure. SDHB & NMDHB have not developed this report yet.

13,14Planning for the South Island Stroke Study Day is well progressed with all speakers confirmed, for the event on 1 November 2018. This year 3 additional VC sites will be added for a total of 12 VC sites.

MONITORING / BUSINESS AS USUAL ACTIVITYStroke services reporting

Problems with producing SI reporting on national stroke measures are being addressed. A new format and simpler collection process will commence with Q1 2018-19 data (reported in Q2 2018-19). Q4 data is available below, but NMDHB data is not available due to a large number of uncoded stroke cases.

CHALLENGESOrganisation of Stroke Services

1bThere is no LSN appointment in NMDHB. SI Stroke workstream is reviewing what action can be taken to support progress in NMDHB.

Proportion of patients admitted with acute stroke who are transferred to inpatient rehabilitation services are transferred within 7 days of acute admission. National measure - target 80%DHB Hospital Numerator DenominatorSDHB Dunedin 32 77 42%

Invercargill 13 67 19%Dunstan 0 15 0%Oamaru 0 8 0%

CDHB Christchurch 64 237 27.00%Ashburton 3 19 15.79%

WCDHB Grey Base 6 15 43%NMDHB Nelson 0 -

Blenheim 0 -SCDHB Timaru 11 24 45.8%Proportion of patients referred for community rehabilitation are seen face to face by a member of the community rehabilitation team within 7 calendar days of hospital discharge. National measure - target 60%DHB Hospital Numerator DenominatorSDHB Dunedin 0 0 0

Invercargill 0 1 0Dunstan 0 0 0Oamaru 0 0 0

CDHB Christchurch 19 94 20%Ashburton 0 0 0

WCDHB Grey Base 6 8 0NMDHB Nelson 0 -

Blenheim 0 -SCDHB Timaru 12 14 85.7%


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8 % of acute ischaemic stroke patients thrombolysedDHB Hospital Numerator Denominator %

SDHB Dunedin 4 59 7%Invercargill 2 58 3%Dunstan 0 14 0%Oamaru 0 8 0%

CDHB Christchurch 23 211 10.90%Ashburton 0 16 0.00%

WCDHB Grey Base TBC 14 TBCNMDHB

Nelson 0 -Blenheim 0 -

SCDHB Timaru 3 23 13.0%

South Island Stroke Service Measures Q4 2017-1880% of all stroke patients to be cared for in organised stroke unit (for smaller DHBs with demonstrated stroke pathway as ascertained by lead Stroke Clinician using definition by National Stroke Network).DHB Hospital Numerator Denominator %

Total number I61

(Bleeds)

Number of patientsI63 (clot) and I64

(unspecified)SDHB Dunedin 56 18 59 72.73%

Invercargill 59 9 58 88%Dunstan 0 1 14 0.00%Oamaru 0 0 8 0.00%

CDHB Christchurch 192 26 211 81.01%Ashburton 0 3 16 0.00%

WCDHB Grey Base 15 1 14 1NMDHB

Nelson -Blenheim -

SCDHB Timaru 20 1 23 83.3%


Serious Adverse Events

1 Continue to support application of the new national reportable events policy

Q3

2 Support capability in DHB approaches to investigations of serious adverse events

Q4

Deteriorating patient programme

3 Continue to support DHB approaches to the deteriorating patient programme

Q4

Pressure injury prevention

4Support the South Island DHBs in their work on the HQSC Pressure Injury Prevention work by sharing experiences and learnings across all SI DHBs

Q4

Safety 1st 5 Support ongoing development and review of Safety1st Q4

Learnings and quality improvement

6 SI DHBs share learnings and quality improvement initiatives.Q4

KEY PROGRESS IN QUARTER 1Serious Adverse Events

2

Recruitment to the CDHB centralised serious adverse events role commences in November.Further consideration will be given to the training trialled in WCDHB. The package and materials were well received.

Deteriorating patient programme3 Quality Managers report that parameters for planning, ward rounds and contact

points ‘in the event of…’ are areas in the deteriorating patient programme which need some more work.SDHB Patientrack is on the way and SDHB continue to work on 24/7 nurse expertise especially in Dunedin, rollout is scheduled for Q1 next year. In SCDHB, the Recognition and Response Policy has been updated and the escalation pathway agreed. Communication and education planning underway for roll-out of NZ EWS. Patientrack is to be rolled out in SCDHB2018/19. The next steps include roll out of

NZEWZS to four key areas in DHB.CDHB have an electronic observation system in all secondary care sites and record 3,500 sets of vital signs a day. The NZEWS team are reviewing high numbers of red triggers (80% of which relate to single red triggers rather than aggregate scores) and are considering their location in the response path. This work is being done in conjunction with the HQSC Clinical Lead. West Coast DHB will go live with Patientrack before Christmas.

Pressure injury prevention

4

SDHB have recruited to a pressure injury role and Kirsty Mann is linking in from St John clinical leaders re pressure injury clinical pathways. This could be a national programme but managing acute demand will be a local matter.SCDHB are reviewing collection tools for pressure injury audits and have undertaken an audit of one area to review actual pressure injury against recorded pressure injury. The admission to discharge care plan will be changing the pressure injury assessment tool from Waterlow to Braden scale, and education has commenced regarding this change. When PatienTrack is introduced next year the pressure injury assessments will be undertaken as part of this change. CDHB and WCDHB hospital acquired pressure injury work continues to be a priority. All injuries stage >/ 3 are reviewed and reported as serious adverse events. At CDHB a panel moderates the reports, and a consumer recently joined this team. The Patientrack business case to support translating the interRAI pressure injury risk assessment into tools for injury tracking and wound management has been provided to ACC. 52 nurses (8 on West Coast) have been selected to be link nurses – change agents for practice development in their practice settings across both districts (L3 on PDRP). Otago University will assist with evaluating the model.

Safety 1st

5The Regional Safety 1st Coordinator role has been formally approved for a 2 year contract. Shortlisting for the post has been completed. Interviews will take place late October. It is anticipated the appointee will be in place by January 2019.

Learnings and quality improvement

6

Risk training for quality improvement staff held in September went well. More training-for-trainers resource and clarity on roles and responsibilities would be needed to extend this work. The event was considered a good start.In SCDHB, Clinical Counsel have also undertaken a disability stocktake and subsequently developed an action plan, including input into the phone message to the DHB. Patient Safety week planning is well underway, Patient Stories continue to be developed for use in staff training and communication messaging is being developed for staff contacting consumers regarding changes to their surgery (eg cancellation).


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QUALITY & SAFETY SLA


1ePM: Implementation of one instance of ePharmacy completed across SDHB and SCDHB Q4

2ePM: Implementation of CDHB instance of ePharmacy completed across NMH and WCDHB Q4

E Referrals

3 Complete SCDHB eTriage implementation Q4

4 Complete SDHB eTriage implementation Q4

5 Complete NMDHB eTriage implementation Q4

7 eRequests: Direction for create eRequests regionally agreed Q2

8 eRequests: Business Case approvals progressed Q4

South Island Patient Information Care System (SIPICS)

9Complete the implementation of SI PICS into the remaining CDHB sites Q2

10Commence and complete the implementation of SI PICS Project go-live for West Coast DHB Q4

11Commence and complete the implementation of SI PICS Project go-live for South Canterbury DHB Q4

12Complete the development of SDHB implementation business case for SI PICS Q4

Regional service provider index

13Support MoH to progress upgrade and extensions to the national HPI Q3

14Commence roll-out of extended HPI functionality to the agreed applications Q4

eOrdering of radiology tests

15Implementation of eOrdering Radiology tests completed for hospital radiology services Q2

Mental health

16 Progress agreed direction for the SI Mental Health Solution Q4

17 Implement agreed single SI Mental Health Risk form Q2

18 Implement agreed SI Regional Mental Health Care plan Q4

19Continue to support SCDHB, WCDHB, NMDHB and SDHB to progress a paper-lite strategy for transitioning paper mental health records into the electronic health record

Q4

Clinical workflow 20Scope, agree and commence the implementation of the processes and structures to enable the SI DHBs to create, configure and manage automated clinical workflow

Q4

Alerts and warnings

21 Identify the preferred South Island solution Q4

22 Progress business case/implementation planning Q4

KEY PROGRESS IN QUARTER 1ePharmacy

1 & 2

The SI DHBs have commenced an Implementation Planning Study with DXC and are currently finalising the Project Definition Reports. On completion and agreement of the project definition report, DXC will be in the position to provide a detailed statement of works and pricing for the Southern/South Canterbury DHBs instance and for the on-boarding of Nelson Marlborough and West Coast DHBs to the Canterbury DHB. SI DHBs to progress a project workshop to define SI programme and governance structures.

South Island Patients Information Care System (SIPICS)

9

The SI DHBs achieved another key step towards a shared patient administration system across the entire South Island with the successful go-live of the South Island Patient Information Care System (SI PICS) at both Christchurch Hospital and Ashburton Hospital on 5th October. This step sees SI PICS now live in two of the SI DHBs with South Canterbury, West Coast project implementations to commence in the coming months.Following from a Gateway Review recommendation the SI DHBs have formed the Operational Governance Group which met formally for the first time in September. This group will be the owners of the production SI PICS system.

Regional Service Provider Index

13

Formal approval has been received for the business case from the SI DHBs. South Island Business case to be submitted to the Ministry of Health for approval. Ministry of Health have received full approval and sign off for their contribution towards the HPI upgrade.

Mental Health

18

The SI hosted a successful workshop in late September with SI DHBs, NGO and consumers to begin initial discussions regarding requirements for the South Island Shared Mental Health care plan. The workshop identified the values and philosophy of the electronic shared care plan and agreed that the tool will be known as the Mental Health Wellbeing tool.


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INFORMATION SERVICES SLA

SOUTH ISLAND WORKFORCE DEVELOPMENT HUB


Workforce planning

1a

Skill Sharing & Skill Delegation ( Calderdale Framework)Projects include skill delegation to Allied Health Assistants (AHAs) and skill sharing with other health professionals.This includes the training of more CF practitioners (2) and facilitators (10—12).Collaboration with Central & Northern Regions continues.Evaluation of the projects is presented

Q1,2,3,4

1b

Allied Health: ENABLE equipment accreditationRegional approach to development of resources to support ENABLE accreditation for equipment issue - mobility aids & Activities of Daily Living equipment

Q1,2,3,4

1c

Medicine: new graduates (PGY1s)Support the South Island DHBs to integrate the increased number of PGY1s (NZ citizens and permanent residents) into the workforce for 2018 graduates

Q1,2,3,4

1d

Medicine: General medicine vocational trainingCoordination of general medical vocational training regionally is explored in conjunction with the Royal Australasian College of Physicians.

Q1,2,3,4

1e

NursingRegistered Nurse (RN) Prescribing implementation is coordinated across the South Island. This includes a SI policy, framework and communication plan.

Q1,2,3,4

1f

Interprofessional Learning/Working is supportedA coordinated clinical simulation network for the South Island is supported with particular focus on rural & Primary care2-3 South Island teams participate in the Health Care Challenge

Q1,2,3,4

1g

Health LiteracyThe Workforce Development Hub will support DHBs with any activities that DHBs have identified from their Health Literacy Review as being beneficial across the South Island.

Q1,2,3,4

1hRural Health MedicineThe opportunity of a South Island rural health medicine clinical placement programme is explored to support vocational training

Q4

Clinical Leadership

2a

Regional clinical/professional leadership Networks that are currently supported are:

– Speech language therapy– Audiology– Cardiac physiologistsFurther networks will be established in 2018/19

Q1,2,3,4

2bSouth Island AHS&T Career FrameworkSupport the regional development & implementation of the SI AHS&T Career Framework

Q1,2,3,4

Workforce 3aCultural Competence EducationIn conjunction with the GMs Māori & GMs HR support a framework

Q1,2,3,4

diversity

for Cultural Competence education which ensures it is embedded into practice for the workforce.

3b

Experience of Māori in the South Island DHBsEvaluation of the experiences of Māori who have recently entered the South Island DHB health workforce in conjunction with Ass Prof Joanne Baxter, University of Otago

Q4

3c

Maori workforce dataPresent ethnicity data (including trend analysis) annually to the South Island DHB clinical leaders, working towards the clinical workforce reflecting the South Island population.

Q3

Workforce enablers

4a

NZ Instance of Lippincott (Clinical Procedures)The South Island and 8 North Island DHBs are working in partnership to implement a framework for the management of New Zealand instanceAll changed procedures are reviewedOncology & renal clinical expert groups have reviewed relevant procedures

Q1,3

4b

Elearning platform:Work with the sector, which is using similar technology, to collaborate on alignment of design, content sharing & learning community activities.

Q1,2,3,4

Workforce data and intelligence

5aWorkforce Data and intelligenceHealth Workforce data and intelligence is collected to support planning

Q3

5b

Workforce pipelinePriority workforces are identified and plans developed to ensure adequate supply in conjunction with the education providers and HWNZ.

Q1,2,3,4

KEY PROGRESS IN QUARTER 1Skill Sharing & Skill Delegation ( Calderdale Framework)

1aCentral Region now have 10 credentialed facilitators trained by the South Island. South Island CF Practitioners will begin training a cohort of facilitators for Northland DHB in Feb 2019.

Allied Health: ENABLE equipment accreditation

1b 4 Regional Clinical Task Instructions have been developed to support issue of ENABLE Activities of Daily Living equipment.

Clinical Simulation

1f

Planning is underway for running a pilot rural simulation in South Canterbury in primary care focusing on a deteriorating patient scenario. To grow the capacity and capability in enabling sustainable clinical simulation in primary care.Clinical Simulation fundamentals are being developed as an online course which will be accessible across the sector in the South Island.


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Rural Hospital Medicine (RHM) Training

1h

South Island Alliance operational group has supported the regionalisation of the South Island training programme. Work is now underway to create relevant DHB runs for the trainees. This will result in a timely training pathway for RHM trainees to complete their training and be available to work in rural South Island.

Regional clinical/professional networks2a Social Work has now been added to the professional networks in the South Island.

National eLearning content

4b

A national workshop with 40 participants was held in August. There was agreement reached for the governance and operational structure of developing national content. A second outcome was the identification of the first 8 courses to be developed/reviewed nationally to create a standardised course. This will result in many efficiencies.

South Island Rural Health Workforce WorkshopA workshop was held in August with over 60 participants from across the sector. There was agreement to develop a rural workplan with a particular piece of work around rural maternity services to commence immediately.

MONITORING / BUSINESS AS USUAL ACTIVITYWorkforce planning

6aKaiāwhina workforceAllied Health Assistants (AHAs) working across the South Island health system have access to appropriate NZQA level 3 training

6bMedicine: new graduatesCommunity based attachments (CBAs)are in place to meet requirements of new Medical Council curriculum

Priority (vulnerable) workforces

6cSonographySupport for the training of Sonographers to meet the identified South Island need

6d Imaging Workforce is fit for purpose. Contribute to the national work being undertaken by DHBSS.

E Learning

6e Elearning An increased number of eLearning packages are co-designed which can be shared nationally


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