1 midcentral district health board health and disability ... · 13 october 2020, boardroom...

Next Meeting: Deadline for Agenda Items:

13 October 2020 29 September 2020

Copies to: HDAC Chair Committee Secretary Corporate Records

MidCentral District Health Board Health and Disability Advisory Committee

Venue: Boardroom, Gate 2 Heretaunga Street, Palmerston North

When: Tuesday 1 September 2020, from 9.00am

AGENDA – Part 1 Members: John Waldon (Committee Chair), Brendan Duffy (Board Chair), Heather Browning, Vaughan Dennison, Lew Findlay, Norman Gray, Muriel Hancock, Materoa Mar, Karen Naylor, Oriana Paewai, Jenny Warren.

Attendees: Kathryn Cook, Chief Executive; Tracee Te Huia, General Manager Māori Health; Gabrielle Scott, Executive Director Allied Health; Judith Catherwood, General Manager, Quality and Innovation; Craig Johnston, General Manager, Strategy, Planning and Performance; Jennifer Free, Committee Secretary.

In attendance (part meeting): Item 3.1 Scott Ambridge, Dr Kelvin Billinghurst, Dr Jeff Brown, Dr Vanessa

Caldwell, Debbie Davies, Sarah Fenwick, Dr Claire Hardie, Lyn Horgan, Cushla Lucas, Andrew Nwosu, Dr Syed Zaman – Operations and Clinical Executives

Item 3.2 Michelle Riwai, General Manager, Enable New Zealand Item 4.1 Angela Rainham, Locality and Population Health Manager Item 4.2 Graeme Gillespie, Advisor, Commissioning and Contracts

1. KARAKIAHe 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

9.00

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2. ADMINISTRATIVE MATTERS PAGE

2.1 Apologies

2.2 Late items

2.3 Register or Interests Update 4-6

2.4 Minutes of the Previous Meeting 7-11

2.5 Schedule of Matters Arising 12

3. PERFORMANCE REPORTING 9.10

3.1 Update for July 2020 13-48

A presentation regarding Te Uru Kiriora, Primary, Public and Community Health will be provided by the service’s executives [30 minutes]

3.2 Enable New Zealand Report to 31 July 2020 49-55 10.20

REFRESHMENT BREAK 10.30

3. PERFORMANCE REPORTING (continued) 10.45

3.3 Pae Ora Paiaka Wahiora Progress Report 56-60

4. DECISION/DISCUSSION PAPERS 11.00

4.1 Ōtaki Health and Wellbeing Plan Update 61-76

4.2 Community Pharmacy Services Commissioning 77-95

5. INFORMATION PAPERSFor the Committee to note

11.30

5.1 Committee’s Schedule and Work Programme 96-101

Register of Interests Update 4-6

Glossary of Terms 102-110

6. LATE ITEMS

7. DATE OF NEXT MEETING

13 October 2020, Boardroom MidCentral District Health Board, Gate 2Heretaunga Street, Palmerston North.

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8. 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 and Disability Committee meeting

For the reasons set out in the order paper of 21.07.20 meeting held with the public present

Serious Adverse Events (SAC 1) To protect patient privacy 9(2)(a)

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Board Members Register of Interests: Summary, 21 August 2020

(Full Register of Interests available on Governance SharedNet Site)

Name Date Nature of Interest / Company/Organisation Browning, Heather 4.11.19

26.7.20

Director – HB Partners Limited Member – MidCentral Governance Group Mana Whaikaha Board Member and Chair, HR Committee – Workbridge Director and Shareholder – Mana Whaikaha Ltd

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

4.2.20 Councillor – Palmerston North City Council

Findlay, Lew 1.11.19

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

11.2.20 5.8.20

Upoko Whakarae Te Tihi O Ruahine Whānau Ora Alliance Chair – EMERGE Aotearoa Matanga Mauri Ora MoH Mental Health and Addiction Chair, ‘A Better Start – E Tipu Rea’, National Science Challenge, Liggins Institute, University of Auckland Whanganui District Health Board – Appointed Member Member of MDHB Cluster Member of local Child & Youth Mortality Review Group (CYMRG) No longer a member of Whanganui District Health Board Member of MDHB’s Māori Alliance Leadership Team (MALT)

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 Whānau Ora Alliance Board Member – Cancer Society Manawatu

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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

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

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)

Allan, Simon 2.6.20 Deputy Chair – Manawatu Branch of Cancer Society MDHB Rep – THINK Hauora Palliative Care Advisory Panel (MoH advisory body) Director of Palliative Care – Arohanui Hospice Chair of Board – Manawatu Badminton Association

Celeita Williams 30.7.20 Employee, Lecturer – AUT University Dept of Paramedicine Employee, Intensive and extended care paramedic – St John Ambulance NZ Founding Member and Trustee – Vivere New Zealand Trust Doctoral Candidate – AUT University Caregiver – Oranga Tamariki Member – Australasian College of Paramedicine

Management

Cook, Kathryn 1.7.16 Director – Central Region’s Technical Advisory Services Ambridge, Scott 20.8.10 Nil Amoore, Anne 23.8.04 Nil Anjaria, Keyur 17.7.17 Wife is a user of the Needs Assessment & Service Co-ordination Service – MDHB Ayres, Vivienne 26.8.10 Nil Bell, Margaret 28.7.20 Nil Billinghurst, Kelvin 6.8.20 Fellow of the Royal College of Medical Administration (RACMA)

Coordinator for the Indigenous Health Programme – RACMA Member of the Rural Policy Advisory Group – RACMA Fellow of the Australasian College of Health Service Managers (ACHSM)

Bradnock, Barb 26.8.10 Nil Brogden, Greg 16.2.16 Nil Brown, Jeff TBA 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 20.4.20

Owner personal consulting company, UK – Celina Eves Limited (2020 moved into dormancy) Trustee – Palmerston North Medical Trust

Fenwick, Sarah 13.8.18 Nil Free, Jennifer 6.8.20 Nil Friend, Karyn 14.12.19 Cousin works as a nurse in the renal unit

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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

Howe, Jonathon 1.8.19 Nil 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

Kirk, Chris Feb 20 Partner now works for MidCentral DHB Matthews, Jill 1.3.16 Nil Matthews, Rory 20.8.20 Managing Partner, FGI (NZ) Ltd trading as Francis Health

Trustee/Director Te Hopai Home and Hospital Ltd

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 Ratana, Darryl 29.5.19 Nil Russell, Greig 3.10.16 Minority shareholder – City Doctors

Member, Education Committee – NZ Medical Council Sapsford, David 18.5.18 Nil Scott, Gabrielle Dec 19 Son is a permanent MDHB employee and works within Digital Services Tanner, Steve 16.2.16 Nil Te Huia, Tracee 19.11.19 Nil Wanden, Neil Feb 19 Nil Williamson, Nicki Mar 20 Nil Walker, Barbara Feb 20 Partner is a permanent MDHB employee and works in finance Zaman, Syed 1.5.18 Nil

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Unconfirmed Minutes

MIDCENTRAL DISTRICT HEALTH BOARD Minutes of the Health & Disability Advisory Committee meeting held on 21 July

2020 at 9.00am Boardroom, Gate 2, Heretaunga Street, Palmerston North

PART 1 PRESENT: John Waldon (Chair) Karen Naylor Brendan Duffy Oriana Paewai Heather Browning Jenny Warren Vaughan Dennison Materoa Mar Lew Findlay (via Zoom) Norman Gray (Absent) Muriel Hancock Gail Munro ATTENDEES: Kathryn Cook, Chief Executive Dr Kelvin Billinghurst, Chief Medical Officer. Tracee Te Huia, General Manager, Māori Health Gabrielle Scott, Executive Director, Allied Health Celina Eves, Executive Director Nursing & Midwifery Judith Catherwood, General Manager, Quality & Innovation Tracee Te Huia, General Manager, Māori Health Jennifer Free, Committee Secretary IN ATTENDANCE – PART MEETING: Lyn Horgan, Operations Executive, Acute and Elective Services Sarah Fenwick, Operations Executive, Women, Children & Youth Dr Jeff Brown, Acting Chief Executive Officer/ Acting Chief Medical Officer/Clinical Executive, Women, Children & Youth Dr Claire Hardie, Clinical Executive, Cancer Screening Treatment & Support Alison Russell on behalf of Debbie Davies, OE, Primary, Public, Community Health Scott Ambridge, Acting Operations Executive, Mental Health & Addictions Dr Vanessa Caldwell, Clinical Executive Mental Health & Addictions Wayne Blissett, Manager, Māori Health Strategy & Support Andrew Nwosu, Operations Executive, Healthy Ageing & Rehabilitation Dr Syed Zaman, Clinical Executive Healthy Ageing & Rehabilitation Michelle Riwai, General Manager, Enable NZ 1 x Media 2 x Public 2 x Comms 1. KARAKIA The meeting opened with the Organisational Karakia. 2. ADMINISTRATIVE MATTERS 2.1 Apologies

The Board Chair asked that Norman Gray be recorded as an apology.

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Unconfirmed Minutes

2.2 Late Items There were no late items. 2.3 Conflicts and/or Register of Interests Update No conflicts were declared. 2.4 Minutes of the Previous Meeting

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

record. (Moved John Waldon; seconded Vaughan Dennison) 2.5 Matters Arising from the Previous Minutes There were no matters arising. 3. PERFORMANCE REPORTING 3.1 Cluster Update for April/May 2020 The individual cluster reports were considered and the following points were discussed: Te Uru Rauhī, Mental Health & Addictions: The report was taken as read. There was a brief discussion on the unsuccessful request for funding for the expansion of the existing Māori and Pacific Primary Mental Health and Addiction Services. There had been a small increase in funding for a role in the Mental Health capacity within the Emergency Department and the redevelopment of the inpatient facility had been approved but waiting for the Ministry of Health and Ministry of Finance to sign off. Te Uru Whakamauora, Healthy Ageing & Rehabilitation: The report was taken as read. Overall progress was on track with no immediate concerns. There was a discussion on the significant work that has begun on reducing the number of expired personal orders and welfare guardians in ARC, the role of the DHB, the aged providers and the impact of community engagement. Stronger focus on reporting and monitoring was intended for expired orders. Te Uru Kiriora, Public, Primary & Community Health: The report was taken as read. The Planning and Integration lead reported on behalf of the Operations Executive, Primary, Public and Community Health. The lead reported that the COVID-19 draft resurgence plan had been completed and was out for consultation. Developing surveillance testing programme which would be commencing shortly to increase the amount of testing in the community and working alongside the Ministry of Health. The continuation of the pandemic response was expected to be required for a significant period of time. COVID-19 testing had moved into general practice. It was noted there was an increase in Māori enrolment with General Practice Teams and that the Primary Care consultations were back to pre-COVID levels. Te Uru Pā Harakeke, Healthy Women Children and Youth: The report was taken as read. The Clinical and Operational Executives reported that the Women’s Assessment and Surgical Unit (WASU) opened on 3 June and occupancy had been approximately 98 percent since opening. Postnatal transfers had now commenced to Te Papaioea Primary Birthing Unit. Ethnicity data was requested as part of the reporting for this unit.

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Unconfirmed Minutes

Staffing issues remained a risk within midwifery due to the lack of available midwives across the country. Annual leave levels over two years within midwifery were high due to the staffing levels, which was a risk. The attrition rate on midwifery courses was very high. Last year 12 first year students were welcomed and only five had continued on the course. A verbal report was made about uncovering unmet need from some community child health services not being provided during COVID-19, with staff deployed elsewhere such as testing centres. The service was now finding young children with complex issues which could have been amenable to earlier intervention. These situations would be audited. Te Uru Mātai Matengau, Cancer Screening, Treatment and Support: The report was taken as read. Overall progress was on track with no emerging risks or areas of concern. Te Uru Arotau, Acute & Elective Services: The report was taken as read. The Operations Executive Te Uru Arotau, Acute & Elective Services reported on the planned care recovery of waiting lists and the number of areas focused on patient flow, workshops happening, ED attending and non-attending data. Reference to Appendix One of the report was made and the process to review was a continuous one. The electronic mail house, the move to electronic based communication was also discussed. It was resolved that the Committee

endorse the progress made by the Directorates in April/May 2020 note the impact to operational plans and performance due to the COVID-19 response note the innovations in service delivery which are subject to evaluation in the COVID-19 Recovery Planning process. (Moved John Waldon; seconded Karen Naylor)

3.2 Enable New Zealand Report to 31 May 2020 The General Manager, Enable New Zealand presented this report. The report was taken as read. COVID-19 proved a real challenge to the organisation but within 24 hours of lockdown (Level 4) all staff were able to work remotely and post COVID-19 work was back on track. It had been confirmed the Mana Whaikaha contract had been extended to 30 September 2020 and further extension beyond needed to be negotiated. It was resolved that the Committee:

endorse the Enable New Zealand Report to 31 March 2020. (Moved John Waldon; seconded Materoa Mar)

3.3 Clinical Governance and Quality Improvement Report The General Manager, Quality & Innovation presented this report on behalf of the Manager, Quality & Assurance. The report was taken as read. It was resolved that the Committee:

note the content of the Clinical Governance and Quality Improvement report endorse progress in delivering improvements in Clinical Governance and Quality Improvement. (Moved Karen Naylor; seconded Vaughan Dennison)

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Unconfirmed Minutes

4 INFORMATION PAPERS 4.1 Palmerston North Health and Wellbeing Plan Update

The Project Manager, Strategy Planning & Performance presented this report. The report was taken as read. It was acknowledged by the Committee the work that had gone into this project. It was resolved that the Committee:

endorse the progress that has been made in relation to the Te Papaioea Te Mahere Hauora (The Palmerston North Health and Wellbeing Plan) (Moved Karen Naylor; seconded Muriel Hancock)

4.2 Analysis of Annual Leave balances over two years The General Manager, People and Culture presented this report. The report was taken as read. The complexities of leave entitlements were discussed and the two-year threshold was clarified and that there would always be staff with two year leave balances.

It was resolved the Committee:

note the trend analysis report of staff with Annual Leave balances over two years note various factors that influence the accrual of Annual Leave across various workforce groups. (Moved Karen Naylor; seconded Vaughan Dennison)

4.3 Committee’s Work Programme 2019/20 The General Manager, Quality & Innovation presented this report. The report was taken as read.

It was resolved that the Committee:

endorse the update on the 2019/20 work programme (Moved Muriel Hancock; seconded Vaughan Dennison)

5 LATE ITEMS There were no late items.

6. DATE OF NEXT MEETING 1 September 2020, Boardroom MidCentral District Health Board, Gate 2 Heretaunga Street, Palmerston North.

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Unconfirmed Minutes

7. 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: (Moved John Waldon; seconded Brendan Duffy) Part 1 of the meeting closed at 11.56am Confirmed this 1st day of September 2020. ………………………………. Chairperson

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

Reason For reasons set out in the order paper of 26.05.20

Ref

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i:\ceo\admincs\hdsac\reports signed off\part 1\2020\1 september\2.5 hdac matters arising august 2020.docx

Board of MidCentral DHB Schedule of Matters Arising, 2020/21 as at 27 August 2020 Matter Raised Scheduled Responsibility Form Status Update re Treaty of Waitangi Policy review process Bd July 19 Six-weekly D Andrews

M Riwai Report Postponed due to

COVID-19 Update re Treaty of Waitangi Policy review process Board July

19 Six-weekly T Te Huia Inc in HP report Ongoing

Consumer feedback re Choices, particularly intensive wrap-around services

Oct 19 Apr 20 Oct 20

G Brogden M Riwai

Inc in ENZ repor Scheduled

Consider if annual report on the disability strategy is enough focus in this area when preparing the next Committee work programme

Feb 20 April 20 B Duffy Not a report – for Chair consideration

To be considered

Enable NZ – was any ethnicity data recorded which could be included in Māori dashboard? Acting CE to discuss with ENZ GM

May 20 N/A J Brown Discussion

COMPLETED Provide trend analysis on holiday levels above two years

Feb 20 July 20 K Anjaria Report Completed

Investigate why MDHB has second highest polypharmacy rates in NZ and review with similar sized DHBs

Mar 20 Sept 20 D Davies In cluster report Completed

KPI-19 – Business case on improving technology contact with clients

Mar 20 Sept 20 S Ambridge Report Completed

Consider how to include more key recommendations and trend based analysis of actions completed in future ‘Potential and Actual Serious Adverse Event’

Mar 20 TBC J Catherwood Included in Potential and Actual Serious Adverse Event report

Completed

Cluster updates annual leave reporting – all reporting to be consistent with all percentages or all numbers reports

May 20 July 20 Cluster Execs In cluster report Completed

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For:

Decision

X Endorsement

Noting

To Health and Disability Advisory Committee

Authors Operations Executives

Endorsed by Kathryn Cook, Chief Executive

Date 19 August 2020

Subject Update for July 2020 RECOMMENDATION

It is recommended that the Committee:

endorse the progress made by the Directorates in June / July 2020

note the changes to the performance overview reflecting the transition from 2019/20 plans to the 2020/21 financial year

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 Rauhi - Mental Health and Addictions Te Uru Whakamauora - Healthy Ageing and Rehabilitation Te Uru Kiriora - Primary Public and Community Te Uru Pā Harakeke - Healthy Women Children and Youth Te Uru Mātai Matengau - Cancer Screening, Treatment and Support Te Uru Arotau - Acute and Elective Specialist Services The data provided in the appended reports relate to the period to end of July 2020, however where relevant and appropriate, comments and data that relates to August 2020. A presentation regarding Primary, Public and Community Health will be provided by the Te Uru Kiriora leadership at this meeting .

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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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SERVICE: Te Uru Rauhī

Mental Health & Addictions Service

FOR PERIOD: June / July 2020

PREPARED BY: Scott Ambridge, Operations Executive Dr

Vanessa Caldwell, Clinical Executive

Richard Hodgson, Planning & Integration Lead

1 PERFORMANCE OVERVIEW Te Uru Rauhī has now moved to the 20/21 planning cycle and all initiatives have been updated accordingly under the Annual and Sustainability Plans. Whilst there are no emerging risks or areas of concern, initiatives rated as ‘behind plan’ have remedial action plans in place which are described below. Initiative Rating

& Trend

A-E Increase access and equity of care for Māori whānau engaging with Mental Health and Addiction Services. G

A-E Work in partnership with Te Uru Pā Harakeke to improve mental health and wellbeing for children and youth. G ●

A-E Partner with THINK Hauora to implement Access and Choice initiative within Primary Care. G

A-E Increase the participation of Iwi, people and whānau in the development and design of services. G ●

A-E Develop initiatives to increase the diversity and cultural competency of the workforce. G ●

A-E Develop a responsive, innovative and flexible workforce that supports people and whānau across the continuum of care. G ●

A-S Implement mental health service changes aligned to enhanced models of care (FACT, Older Adult). G ●

A Expand capability and capacity in suicide prevention, develop high profile campaigns and training focused on prevention. G

A Reconfigure the model of service delivery for secondary community teams. G

A Develop and pilot community-based services that expand access in the Horowhenua and Tararua areas. A ●

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

A Deliver clinically safe and effective health care in a less restrictive environment and ensure a better quality of experience by service users. G

A Improve equity of access to alcohol and drug addiction services across the district. G ●

A Progress key capital work (i.e. new inpatient redevelopment). G ●

A Progress digital enhancements to support integrated models of care and improve workforce effectiveness and mobility. A

A Work in conjunction with Te Uru Pā Harakeke to develop to improve access for hapu mama accessing mental health services.

G ●

A Work with Te Uru Arotau to better support Emergency Department (ED) staff when interacting with individuals presenting with mental health needs. 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 S Sustainability Plan E Equity Indicator

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The service specification for a sub-acute community based facility in Horowhenua as an alternative to an inpatient admission has been developed. This was originally planned for completion by the end of the first quarter of the 2020/2021 year was delayed as a result of COVID-19. A Request for Proposal (RFP) for the service will be published in the second quarter of 2020/2021. The Shared Care programme, developed in 2015 between Secondary Services and Primary Care, is to be reviewed. The initial aim of the programme was to reduce dependency on secondary mental health services by improving primary / secondary integration and supporting General Practice to provide this care in the community setting. The programme has had some success during the past five years but, given the changes in mental health services during this time, it is timely to reconsider the arrangement in the context of the wider programme of community based mental health services and how these are supported. The review is a key component of the Annual Plan initiative to work with THINK Hauora to improve the overall physical health outcomes for people with mental health and addictions conditions and was to be completed by August. This has not occurred and is now timetabled as a priority for the third quarter of the 2020/2021 year. The review will include a broad range of stakeholder engagement and a draft terms of reference will be completed by October. A project team is progressing the development of a single electronic shared care record that will be critical to success of the changes proposed for community-based mental health services i.e. Flexible Assertive Community Treatment teams. The first phase, an analysis of the high level requirements, has been completed and the next step will to be to compare these requirements with existing platforms currently in use by organisations within our Rohe.

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1.1 Performance Indicators – July 2020 Te Uru Rauhī is generally on track with all indicators. Exceptions and plans for improvement are noted below.

The comments below relate to Key Performance Indicators (KPIs) that are off target (month or year to date) that have not already been covered under the performance overview: Acute readmissions within 28 days continue to reduce and are 18 percent for July, compared with 19.4 percent the month prior. This is a result of improving the inpatient discharge processes by focussing on a more collaborative and inclusive approach to safety and discharge. This remains a priority and work in progress. Six complaints were received this month; given the complex nature of two of the complaints extensions were requested. The remaining four complaints were resolved within 15 days as required. Extensions are treated as an exception and must be approved by the Operations Executive.

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Ward 21 high bed day usage was 150 percent of the month. Whilst there was not a notable increase in admissions, a proportion of long stay patients have impacted the unit’s ability to maintain a sufficient level of patient flow within the bed capacity. Strategies to improve patient flow include close monitoring of the unit with a focus on staff and patient safety and utilising community respite services. This also included monitoring of acuity and patient need relative to patient numbers; during the month of July whilst occupancy was high lower overall average acuity of patients admitted partly mitigated this risk. A review of the Community Service User Time indicator (KPI 34) has shown inconsistencies in data entry, resulting in an under representation of the work undertaken in this area. As a consequence, process improvement is underway to support clinicians to better capture work completed, including better monitoring and regular feedback mechanisms to ensure ongoing data quality and professional development. A joint project with the Inpatient, Acute Care and Community Teams is being developed to implement criteria led discharges (that encompass agreed admission goals) to support pre-admission from the community into the inpatient unit (KPI 18). This is planned to commence in September 2020. The initial focus is to ensure care is coordinated, is person/whānau centred and enables improved transition for people through community and inpatient services. The transition to community care post discharge (KPI 19) remains a priority for the Palmerston North and Feilding Community Mental Health teams. A working group has been established to improve engagement and uptake of the first appointment post discharge. This includes more flexible appointment hours and use of technology. Sick Leave rates have been higher than target in both June and July 2020, reflecting the winter season and some specific support provided for staff needing medical procedures or to care for family. All cases have been individually reviewed. There are no issues or trends to note. 2 SIGNIFICANT MATTERS

2.1 Reduction in Suicide Statistics 2020 The Chief Coroner released the provisional national suicide statistics in August 2020. The figures show a reduction in suicides nationally from 685 deaths in 2019 (year ending June 30) to 654 in 2020 for the same period. MidCentral DHB statistics also shows a reduction from 37 in 2019 to 27 in 2020. 2.2 Primary Care and Intervening Early 2.2.1 Status of Funding Proposals Contract negotiations with the Ministry of Health, to progress the Youth Primary Mental Health service expansion, have commenced and a contract is expected by September.

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2.2.2 New funding – Roles The table below shows the new roles funded for the Primary Mental Health Access and Choice Programme (Te Ara Rau) awarded to Iwi and Māori providers: Role FTE Provider Maori Cultural Leadership Providing Takarangi Cultural Competency training Pasifika Cultural Leadership 0.2 THINK Hauora Health Coaches (non-clinical) 11 THINK Hauora through the Iwi and Maori Providers Health Improvement Practitioners 1.5 Maori MH providers

Recruitment of 11 Kaiwhakapuaki Waiora (non-clinical Health Coaches) is

underway across the rohe. These roles are being appointed into ten Iwi and Maori providers.

67 percent of the new funding received to date has gone directly to Iwi and Māori providers.

Regional Alcohol and Other Drug (AOD) funding allocated for pay parity has been passed through to the Māori Non-Government Organisations AOD providers.

The overall new investment (including regional AOD funding) direct to Iwi and Māori providers is 61 percent.

2.2.3 Te Ara Rau Access and Choice (Primary Mental Health Initiative)

To support the immediate development of Te Ara Rau with specialist support the District Health Board (DHB) teams are offering opportunities for 12 week secondments to build relationships and grow knowledge across the system. We received an enthusiastic response from staff keen to participate and both the DHB and THINK Hauora will be progressing the initiative over the next month. 2.2.4 NGO Partnerships From the week of 10 August 2020, two nurses from the secondary community mental health team will join the BestCare Whakapai Hauora mental health and addictions programme. This pilot is for clinics to be held for half a day each week with the aim of building cross sector relationships and provide specialist support into the team and for people accessing help where they want it. 2.3 Long Term Conditions 2.3.1 Older Adult Model of Care The proposal on the future of Older Adult Services across our District was formally released to staff on 2 July. We received 32 submissions providing valuable feedback; based on this we have amended the staff mix, increased rostered staff and added an allied health and psychology role. The final decision will be realised to staff on the 18 August. The integration of the current Older Adult Community Mental Health team with the Older People’s Assessment and Liaison (OPAL) Community Service will be progressed as part of the second phase of implementation which is planned for the third quarter of the 2020/2021 year.

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The Services for Treatment and Rehabilitation (STAR) 1 team successfully transitioned patients to the new area (previously STAR 3) and work is continuing to complete any final works (such as courtyard). 2.3.2 Flexible Assertive Community Treatment Teams (FACT) Since endorsement of the Board discussion paper in June work is underway to develop the detailed service change paper. We have continued to socialise the FACT model broadly across the services, including an organised meeting (via zoom) with NSW Illawarra mental health services that have implemented FACT. 2.4 Other matters 2.4.1 COVID-19 Resurgence Plan Te Uru Rauhī has initiated its resurgence plan for Level 2 (be aware and vigilant) and continued planning for possible escalation of alert levels. To inform the resurgence planning, a district wide evaluation of the sector’s response to COVID-19 during the Level four lockdown was carried out. The final report has been shared with the community and NGO sector and staff. The evaluation highlighted the key role that NGO and Iwi providers played in supporting the community with practical solutions to meet their needs and in doing so likely reduced the anticipated surge of crisis calls and presentations throughout this time. The DHB teams experienced significant change and were challenged by lack of mobile technology to effectively work from home. Consumers gave feedback that they appreciated being contacted for check ins and also commented that they found out about changes late and could not always get through on the phone but liked having a person answer (rather than the automated response) when they did. 2.4.2 Clinical Pathways The pathway for youth in the oncology service who need additional mental health support has been endorsed through the Haematology/Oncology clinical governance group. There are some meet and greets coming up with the clinical staff in their services over late August and September. The pathway to support transgender young people is developing. Two mental health clinicians now join the monthly clinical reviews with the sexual health team and are identified as contact people for their services. 2.4.3 National Inquiry - Abuse in State Care A senior team member of Te Uru Rauhī has been tasked with identifying case files related of people admitted to Lake Alice for the purposes of supporting the National Inquiry into Abuse in State Care.

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SERVICE: Te Uru Whakamauora

Healthy Ageing and Rehabilitation

FOR PERIOD: June/July 2020

PREPARED BY: Andrew Nwosu, Operations Executive

Syed Zaman, Clinical Executive

Pauline Holland, Planning & Integration Lead

1. PERFORMANCE OVERVIEW Te Uru Whakamauora has now moved to the 2020/2021 planning cycle and all initiatives have been updated accordingly under the Annual, Operational and Sustainability Plans. Whilst there are no emerging risks or areas of concern, initiatives rated as ‘behind plan’ have remedial action plans in place which are described below.

Initiative Rating & Trend

A-E Improve Māori Health gains in line with the Regional Dementia Action Plan G ●

A-E Increase access and equity of care for Māori kaumātua and whānau G ●

A-E Enhance partnerships with Iwi for Māori health gain across the district G ●

A-S Short Term Loan Equipment Management G ●

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

A Develop a more responsive and effective rehabilitation model G ●

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

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

A Improve models of care for the older person with frailty G ●

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

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

A Improve patient flow throughout the hospital, reducing barriers and delays A ●

A Refine models of care for Older People’s Acute Assessment and Liaison (OPAL) A ●

A Enhance orthogeriatric and general surgical models of care A ●







Plan Legend

A Annual Plan S Sustainability Plan O Operational Plan E Equity

Te Uru Whakamauora has implemented a number of initiatives to create capacity and improve patient flow. This is a significant programme of work with 65-85 year olds making up 18 percent of the estimated MidCentral District Health Board (MDHB) population, but constituting 59.86 percent of all acute bed days. See tables below.

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The Red to Green initiative for identifying and minimising potential delays and wasted days in hospital is active on all Healthy Ageing and Rehabilitation (HAR) units and continues to facilitate more timely discharges. Te Uru Whakamauora will relaunch the “Get Up, Get Dressed, Get Moving” campaign which encourages hospitalised patients to get up, dressed and moving to prevent deconditioning especially for people over 80 for whom a ten day bed stay equates to a loss of ten percent muscle mass. The proposal on the future of Older Adult Services across the district was formally released to staff on 2 July 2020. 32 submissions were received, providing valuable feedback and informing future decisions around staff mix, increasing rostered staff and Allied Health inclusion. The final decision will be released to staff on 18 August 2020. The Older People’s Acute Assessment and Liaison (OPAL) unit Average Length of Stay (ALOS) outcomes have been tracking worse than expected, over June and July tracking at approximately 11 days. The increase in ALOS has been attributed to a number of reasons ranging from patient type, service ethos, criteria deviations and a lack of timely discharge. A retrospective audit has helped to understand the causes and required mitigations. Between 1 January 2020 and 1 August 2020, there were 797 discharges from the OPAL unit. 57 percent of these discharges (458) met the admission criteria for OPAL; the other 43 percent (339) were outliers. Of those that met the criteria, 54 percent had a stay of less than seven days whilst 45 percent had a stay of over seven days. In total for this period the ALOS for patients who met the admission criteria was 9.16 days. General Medical patients who did not meet the criteria (outliers) were 43 percent of total discharges (339), with 29 percent of this number staying greater than seven

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days. In total for this period the ALOS for patients who did not meet the admission criteria was 6.91 days. Most of the longer staying patients (outliers and accepted) had higher acuity and longer-term physical and social issues including dementia/delirium. Included in the audit mitigations: Developing ’criteria led discharging’ that reduces single person dependencies Reinforcing red to green criteria. Developing appropriate discharge to assess models. Working with Duty Nurse Managers to adopt a – ’right patient right place/bed’

approach rather than an ‘any bed is a good bed’ approach. Improved management of Delirium across wards. Initiatives to enhance the orthogeriatric and general surgical models of care for older people continue. While progress has been made with the fast-tracking of individual hip fracture patients to Services for Treatment and Rehabilitation (STAR) 2 and additional Senior Medical Officer liaison on the orthopaedic ward, work also continues to collaboratively develop an integrated pathway for the management of hip fracture patients with the orthopaedics, emergency medicine, anaesthetics and the ambulance service teams. Additionally, alternative ways of providing day to day clinical input are being considered to support patients on the orthopaedic ward, including utilising allied health professionals and nurse practitioners. Our aim is to apply the evidence-based principles of orthogeriatric care to the general surgical wards. Internationally, surgical-geriatric liaison has been shown to improve the quality of care for older adults undergoing emergency and elective surgery. Discussions with our surgical colleagues were postponed due to lockdown.

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1.1 Performance Indicators – July 2020

KPI Description Previous Month

Month Actual

Month Target

Month Variance

YTD Actual

YTD Target

YTD Variance

KPI Trend (13 month)

Customer Patient

Acute readmissions within 28 days

0.0% 0.0% 7.5% (7.5%) 0.0% 7.5% (7.5%)

Complaints resolved within 15 days

50.0% 0.0% 95.0% (95.0%) 0.0% 95.0% (95.0%)

Hospital acquired UTI rate 10.64% 0.00% 0.50% (0.50%) 0.00% 0.50% (0.50%)

Inpatients developing Pressure Ulcers

0.24% 0.42% 0.50% (0.08%) 0.42% 0.50% (0.08%)

Occurrence Rate of Medication Incidents

1.2 2.8 3.5 (0.7) 2.8 3.5 (0.7)

Patient Falls Rate 3.6 9.8 5.0 4.8 9.8 5.0 4.8

Internal Process and Operations

ALOS - Acute 12.1 12.9 21.0 (8.1) 12.9 21.0 (8.1)

Bed Day Usage 94.2% 91.2% 85.0% 6.2% 91.2% 85.0% 6.2%

DNA - Outpatient 3.5% 6.3% 6.0% 0.3% 6.3% 6.0% 0.3%

DNA - Outpatient, 17-64 years

4.5% 9.5% 6.0% 3.5% 9.5% 6.0% 3.5%

DNA - Outpatient, 65+ years

3.1% 5.2% 6.0% (0.8%) 5.2% 6.0% (0.8%)

DNA - Outpatient, Māori 3.1% 16.2% 6.0% 10.2% 16.2% 6.0% 10.2%

ED - Shorter Stays 0.0% 0.0% 95.0% (95.0%) 0.0% 95.0% (95.0%)

One to One Hours 961 3,004 0 3,004 3,004 0 3,004

Smoking Cessation - Hospital

100.0% 0.0% 95.0% (95.0%) 0.0% 95.0% (95.0%)

Organisational Health and Learning

Sick Leave Rate 4.69% 6.17% 3.20% 2.97% 6.17% 3.20% 2.97%

Staff Annual Leave balance > two years

11.6% 12.9% 9.0% 3.9% 12.9% 9.0% 3.9%

Staff Stability 99.1% 99.5% 99.0% 0.5% 99.5% 99.0% 0.5%

Staff Turnover 0.47% 0.46% 1.00% (0.54%) 0.46% 1.00% (0.54%)

Patient falls rate variances related to seven unsupervised falls on Te Uru Whakamauora’s two rehabilitation units. The management of patient falls continues to be a critical focus for the rehabilitation units and intention is to keep adverse patient events to a minimum. Measures relating to outpatient Did Not Attend (DNA) rates for 17 to 64 and all Māori outpatients showed negative variances to target. For ages 17 to 64, seven of the cases related to podiatry and botulism toxin clinics, whilst DNA for Māori related to podiatry clinics. Further investigation is being done to identify the reasons for these DNAs to ensure that access issues are not driving this result.

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Staff sickness for the months of June and July exceeded agreed tolerances with increased sickness in the nursing and clerical workforces, though it is possible that the higher numbers align with Ministry of Health and the District Health Board’s (DHB) guidance to not attend the workplace when unwell. Work continues with the staff to focus on health and wellbeing and the reduction of presenteeism. For June and July, staff annual leave balances over two years exceeded target. This continues to be a work in progress. Staff are routinely encouraged to take annual leave therefore focussing on the reduction of accrued leave balances. It is expected this metric will improve over the coming months. 2. SIGNIFICANT MATTERS 2.1 Healthy Ageing and Rehabilitation (HAR) Inpatient Units For the months of June - July post COVID-19 there has been an increase in patient acuity and dependency for rehabilitation units, compounded by increasing numbers of people with complex community situations. Allied Health teams have had some capacity issues secondary to attrition which has sometimes impacted on timely response. Allied Health teams have now stood up their prioritisation protocols as outlined in their business continuity plans. 2.2 Care in the Community Te Uru Whakamauora are developing an initiative to run a three-month pilot around supported discharge in which patients are followed-up routinely by telephone within one to two weeks of discharge to ensure the discharge was safe and effective. Evidence suggests this will enhance the discharge experience of older people from HAR inpatient service by helping alleviate patient/caregiver concerns while giving HAR the opportunity to connect our patients to services within the community and potentially minimising re-presentation into acute services. The patient experience information will also help the service to identify any equity themes which will contribute towards Te Uru Whakamauora’s commitment to improve outcomes for Māori. 2.3 COVID-19 Transition and Resurgence Planning Te Uru Whakamauora has produced a guideline document “Managing a COVID-19 Outbreak in the Aged Residential Care (ARC) in MDHB” setting out how MDHB will support the management of a COVID-19 outbreak in ARC facilities. The existence of the plan acknowledges the unique nature of an outbreak and the shared responsibility to collectively ensure the health and wellbeing of ARC facility residents, staff and the broader community is preserved to the greatest extent possible. 2.4 Locality Clinical Nurse Specialist (CNS) Roles In leveraging the positives of COVID-19 experience, Te Uru Whakamauora has now introduced Geriatrician-CNS pairing for each locality. When a referral is received, the CNS for that locality will complete the required home assessment and the corresponding geriatrician will see the patient in clinic. This initiative will enhance relationships between General Practitioner teams, ARC facilities, Needs Assessment

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and Service Coordination (Supportlinks) and the Elder Health team and provide better continuity of care for patients.

2.5 Personal Protection Property Rights (PPPR)

Te Uru Whakamauora’s working group has completed the PPPR procedure and the tool kit has been published and launched. There will be webinar and face-to-face education sessions into ARC, primary care and other partners. The next piece of work aligned with PPPR project that will need to be undertaken will be the need to agree competency assessment tools and processes to ensure that the DHB undertakes comprehensive and appropriate competency assessments that meet service users and Court requirements.

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SERVICE: Te Uru Kiriora

Primary, Public and Community Health

FOR PERIOD: June / July 2020

PREPARED BY: Deborah Davies - Operations Executive

Alison Russell - Planning and Integration Lead

1. PERFORMANCE OVERVIEW

Te Uru Kiriroa has now moved to the 2020/21 planning cycle and all initiatives have been updated accordingly under the Annual, Operational and Sustainability Plans. The risks and areas of concern with delivery of the new plans are detailed under significant matters. Te Uru Kiriora’s leadership teams and clinical teams of primary and public health continue to adapt to the rapidly changing environment with the unfolding global pandemic. They continued to be focussed on the outcomes required; whether this is within our communities or responses to the Ministry of Health (MoH). Plan Initiative Rating

& Trend

A-E Increase Cervical Screening coverage rates for Māori, Asian and Pacific women to achieve and sustain equity A

A-E Increase enrolment and engagement with primary health care services by Māori living in our district A

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

A-E Enable service users to access a health service associated with their place of learning, to improve health outcomes and reduce health inequities G ●

A-E Promote and enable wellbeing in communities through health policy initiatives G ●

A-E Reduce the equity gap in immunisation coverage rates across priority groups of infants and children at miestone ages up to 5 years A ●

A-E Improve management of Long Term Conditions (Chronic Pain, Diabetes and Respiratory Care) with a focus on improved outcomes for Māori G ●

A Drive effective integrated Locality based care delivery through locality team prototype development and workforce planning G ●

A Strengthen community based Acute and Urgent Demand model of care and delivery G ●

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


Improved from last report.

Regressed from last report.

● No change from last report.

Plan Legend A Annual Plan E Equity outcome

action S Sustainability Plan

The Cervical Screening Working Group has a number of actions that are entrain to increase opportunities for wahine to connect for cervical screening. The group is

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connecting up with other wellbeing measures e.g. bowel and breast screening, immunisation and smoking brief advice. It will take several months to catch up to pre COVID-19 screening rates before improvement can be expected. Enrolment for our Māori community has slightly decreased over the reporting period. Key areas for focus to be re-confirmed. There has been no change in the Smoking Brief Advice (SBA) for this quarter. Te Ohu Auahi Mutunga Stop Smoking Service (TOAM) is working actively with clients including wahine māori in the 15-29 age group with various initiatives for smoking cessation. Childhood immunisation completion rates have been steady over the last two reporting periods. The Outreach Immunisation Service (OIS) is now able to undertake routine immunisations with staff trained and have been holding on-site clinics. Letters from the Medical Officer of Health were sent to all General Practice Teams (GPTs) with their overdue childhood immunisation data to highlight their current immunisation performance and stress the need to focus on this as a priority area. 1.1 Performance Indicators July 2020


Month Actual

Month Target

Month Variance

YTD Actual

YTD Target

YTD Variance


Customer Patient Child & Adolescent Oral Health Total Arrears

36.5% 33.4% 10.0% 23.4% 33.4% 10.0% 23.4%

Maori Child & Adolescent Oral Health Arrears

50.6% 38.8% 10.0% 28.8% 38.8% 10.0% 28.8%

Child & Adolescent Oral Health Total Enrolments

72.9% 73.4% 95.0% (21.6%) 73.4% 95.0% (21.6%)


100.0% 0.0% 95.0% (95.0%) 0.0% 95.0% (95.0%)

Maori Child & Adolescent Oral Health Enrolments

38.9% 42.6% 95.0% (52.4%) 42.6% 95.0% (52.4%)

PHO Cervical Screening 70.5% 68.7% 80.0% (11.3%) 68.7% 80.0% (11.3%)

PHO Enrolment Maori 83.5% 80.5% 90.0% (9.5%) 80.5% 90.0% (9.5%)

PHO Enrolment Total 93.3% 93.3% 93.0% 0.3% 93.3% 93.0% 0.3%

PHO Infant Primary Immunisation

88.4% 88.4% 95.0% (6.7%) 88.4% 95.0% (6.7%)

PHO Quit Smoking Advice 69.0% 69.0% 90.0% (21.0%) 69.0% 90.0% (21.0%)


Sick Leave Rate 5.60% 5.51% 3.20% 2.31% 5.51% 3.20% 2.31%


7.4% 6.6% 9.0% (2.4%) 6.6% 9.0% (2.4%)

Staff Stability 98.9% 99.5% 99.0% 0.5% 99.5% 99.0% 0.5%

Staff Turnover 0.53% 1.57% 1.00% 0.57% 1.57% 1.00% 0.57%

The comments below relate to KPIs that are off target and not already covered under the performance overview section.

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Child and Adolescent Oral Health arrears are improving. Enrolment rates have increased as the service returns to near normal levels. Engagement with Te Awhina Kohanga Reo has occurred as part of the focus on Māori preschool arrear rates. The service is currently focussed on Māori enrolments and arrears. Sick leave rates are being impacted by seasonal illness and we expect these to increase as staff are required to have a test for any COVID-19 like symptoms and self isolate until results are received (and illness is resolved). 2. SIGNIFICANT MATTERS 2.1 Primary Care Service Delivery GPTs returned to Business As New (BAN) at Level 1 post the initial COVID-19 response, utilising telehealth triage to ensure continuation of separation between respiratory and non-respiratory streams. Most GPTs reported an increase of in-person consultations during the first half of the quarter, however most practices have continued to retain the efficiencies gained with offering telehealth consultations. Presentations to practices have increased back to expected levels (pre-lockdown). GPTs increased SBA and Cardiovascular Risk Assessment (CVRA) completion activity during the lockdown period of the previous quarter, however expected gains have not yet been evidenced due to an identified data conversion issue in the Indici Patient Management System. Once this issue is investigated and resolved, it is expected that SBA rates in particular, will increase significantly. Pressure on resource to catch up delayed presentations from the lockdown period continues, particularly for childhood immunisations and cervical screening. The announcement of community transmission of COVID-19 in mid-August 2020 saw a significant increase in COVID-19 surveillance testing, which is expected to last for several weeks. Scoping opportunities for planned care has commenced, with an initial investigation of the similarities between the general surgical ‘on active review’ waiting list and the THINK Hauora Risk Stratification Report. 2.2 Child Adolescent Oral Health Service delivery was significantly impacted by COVID-19 with the withdrawal of routine services at alert Level 4 and Level 3. There was a recovery period upon return however staff in mobile units are conducting routine work with a revised service schedule for the rest of the academic year. The foci on arrears and Māori are starting to show with modest improvements in the figures. 2.3 Strengthening acute and urgent demand A focus within this stream is the development and delivery of acute demand messaging across the system so that people have a good understanding of the many health services and options available in the wider MDHB region. THINK Hauora launched their updated website in July 2020 which includes a public facing banner on options for acute access to healthcare services as well as self-management options. The communications working group is looking at aligning

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this messaging across the system utilising multiple potential platforms. This can be viewed at https://www.thinkhauora.nz Emergency Department (ED) redirection for a range of conditions continues with 1863 patients having been deemed suitable for redirection and 1773 have accepted the service to date. During the months of June 2020 and July 2020 (post COVID-19 lockdown levels), numbers increased back to similar levels as this time last year. Ethnicity breakdown has changed slightly with European dropping by one percent to 60 percent, Māori increased by one percent to 24 percent and Pasifika people remaining the same at six percent. ED length of stay for low acuity patients (triage four and five) opting to be redirected is significantly lower than those patients who are not redirected. The top three reasons for attending ED continue to be described as cost, out of GPT hours, and unable to get an appointment with GPT. A 12 month evaluation of the programme has been completed in order to inform the ongoing continuation of the programme for another 12 months. The ED/Chronic Obstructive Pulmonary Disease (COPD) programme recommenced 6 July 2020 after being on hold due to the impact of COVID-19 lockdown levels. Initial numbers have been low, the working group is closely monitoring progress to ascertain strategies to improve this e.g. increased promotion of initiative in ED and review of criteria. Opportunities for further cross system work currently being explored with the MDHB Physiotherapy services and pharmacy. To support this work, the previous Map of Medicine COPD pathway which has provided a strong foundation for standardised COPD management in the community under POAC, has been prioritised for review as part of the new Health Pathways platform. 2.4 Pharmacy Improvement Programme The Primary Care Support Pharmacists have continued their work in aligned GPTs in the three key areas; reduction in medicine related harm, reduction in unwarranted variation and reduction in medication waste. In response to the question raised earlier in the year, the team focus of reducing medication related harm by reducing polypharmacy rates in the older population has continued. Dispensing data from the MoH for 2019, shows the MDHB polypharmacy rate (people aged 65 plus dispensed 11 or more unique long term medications) reduced from approximately 4.37 percent in quarter one, to approximately 2.52 percent in quarter four¹. This is a significant improvement. This compares to the Health Quality & Safety Commission’s most updated data from 2018, where the New Zealand average polypharmacy rate was 3.8 percent. Southern District Health Board (DHB) had the highest polypharmacy rate at 5.0 percent. Nelson Marlbourough and Capital & Coast DHB rates were 2.8 percent. In the analysis of the patient harm avoidance in the quarter April to June 2020 there were 56 grade three harms avoided, and one grade four harm avoided representing a total cost avoidance estimate of $147,675. ¹ Calculated using MoH pharmaceutical claims data and MoH primary health organisation enrolment data.

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2.5 Public Health Nursing and School Based Health Service

School Based Health Services (SBHS) continue to be embedded in the further schools, with catch-ups underway for school immunisation programmes and Year 9 HEeADSSS Assessments. Additional Registered Nurses employed to support the COVID-19 response are supporting Public Health Nurses (PHNs) with this work, when available. PHNs are also undertaking COVID-19 swabbing for Defence Force managed isolation staff from Linton Army Camp, and undertaking training on the new contact tracing database. 2.6 Measles Catch-Up Programme

The planning for the measles catch-up programme continues. The MDHB plan has been approved by the MoH and final planning is being complete. It has been noted by the MoH regarding the impact COVID-19 is having on this campaign as led by Public Health Unit’s (PHU). Our overall strategy for achieving the goal of the measles campaign involves a multipronged approach through partnership with Māori and Pasifika leaders, Iwi, THINK Hauora (including immunisation coordination), Public Health Services (School Based Immunisation Programs), Non-Governmental Organisations, tertiary education and training providers, occupational health providers, GPTs and services for youth to offer a measles campaign that produces equitable outcomes in 15 to 29 year olds. A governance group will be developed from leaders of the above groups, and will include youth representation (aligned to the Cluster Alliance Group of Te Uru Pā Harakeke Healthy Women Children and Youth Directorate). Alongside this we have well established Locality Health and Wellbeing groups that we will engage with to mobilise locality networks and engagement. We plan to work with as many organisations as possible that have established associations either with young people or with the organisations they have relationships with. 2.7 COVID-19 – Resurgence Planning and Preparedness As at 14 August 2020, the total number of people who have been diagnosed with COVID-19 across the MDHB rohe remains at 32. However the recent cases in Auckland and the Waikato and the subsequent increase in alert levels highlight the possibility that further cases may occur locally. 2.7.1 Testing approach

Over the last few weeks, COVID-19 testing has been undertaken by our primary care practices. Testing rates have been lower than those nationally. As a result, a sentinel testing programme was undertaken on Friday 7 August 2020. This included testing at a local supermarket (522 samples), a Pasifika event (27) and through GPTs testing asymptomatic patients on that day. Following the recent announcement regarding new cases in Auckland, and the associated publicity, there has been a surge in demand for COVID-19 testing. Initially this was managed through provision of support to primary care, but this was not sustainable. As a result, a community testing center has been established at 575 Main Street. It is proposed that this center be in place from Thursday 13

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August 2020 through to Wednesday 26 August 2020 inclusive. It is possible that this may need to be extended depending on testing requirements and any announcement following the cabinet review of the current alert levels. On Saturday 15 August 2020 we were notified that the Minister of Health had issued an order under the COVID-19 Public Health Response Act 2020 that requires people who have been working in managed isolation and quarantine centers to have a COVID-19 test undertaken by 11.59pm on 17 August 2020. This potentially applies to Defense staff at RNZAF Base Ohakea and at Linton and Waiouru Military Camps. MDHB’s Public Health Service are working through the logistics of this with the respective services. 2.7.2 Surge planning

A COVID-19 testing surge capacity plan is being used as the basis for the current testing regimen. Staff have been drawn from across MDHB and primary care to support the current and expected demand. Surge capacity is also an important consideration in terms of the case interview and contact management processes. We are required to be able to develop capacity to handle 18 to 25 cases per day. This is significantly higher than the greatest number of cases recorded on any day in the previous outbreak (six). Our capacity in this regard has been boosted by the arrival of eight additional SBHS nurses, and recruitment of a number of staff on casual and/or short-term contracts. These staff have received training around case investigation and contact management, with training and familiarity with the national NCTS software (Salesforce) on live cases underway. The MoH has made it clear that rapid and effective case investigation is critical, and that this is the priority for PHUs around the country. This is related to both our ability to respond to a local case, or in the event of request for provision of assistance to other PHUs. 2.7.3 Ethnicity

We are working to ensure that our responses to the COVID-19 pandemic are appropriate, with Māori involvement at all stages, from planning to delivery and evaluation. We have established a Māori Contact Management Team who will be available to follow up any notifications involving local whānau who would prefer to talk to a Māori staff member. We are ensuring Māori involvement in both the testing and case/contact management processes. Discussions continue around meeting the welfare needs of whānau in the event of an escalation of the alert levels, and/or should whānau be directly affected by COVID-19. 2.8 Recovery and revitalisation For our Public Health Service, the pandemic response is expected to be required for a significant period of time, with a key focus remaining on ensuring sufficient capacity is available to manage any surge requirements for case contact tracing and management. Keeping abreast of national information and direction remains critical.

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CLUSTER: Te Uru Mātai Matengau

Cancer Screening, Treatment and Support

FOR PERIOD: July 2020

PREPARED BY: Cushla Lucas, Operations Executive

Dr Claire Hardie, Clinical Executive

1. PERFORMANCE OVERVIEW Te Uru Mātai Matengau has now moved to the 2020 / 21 planning cycle and all initiatives have been updated accordingly under the Annual, Operational and Sustainability Plans. There are no emerging risks or areas of concern.


A - E Establish and embed an Equity Governance framework G ●

A - E Implemented whānau centred care guidelines within tumour streams G ●

A - E Establish a Māori Cancer research strategy G ●

A - E Achieve equity for screening programmes G ●

A - E Review pathways for populations at high risk of cancer G ●

A - E Increase referrals to Iwi Cancer Co-ordinators G ●

A - E Implement Cancer Prevention / Early Detection Governance framework G ●

A - S Accelerate telehealth for Outpatient Consulting G ●

A - S Deliver year two initiatives of the Blood Stewardship programme G ●

A Refresh Health and Wellbeing Plan in line with National Cancer Action Plan G ●

A Develop a cancer workforce strategy G ●

A Deliver to tumour stream work plans G ●

A Commission Linac replacements in Palmerston North G ●

A Continue projects for outreach radiation treatment G ●

A Minimise breaches of the 31 and 62 day Faster Cancer Treatment waiting times G ●

A Commission outreach chemotherapy at Whanganui Hospital G ●

A Complete detailed design for a new Cancer Centre G ●

A Refresh Te Korowai O Rongo, the district Palliative Care Strategic Plan G ●

A Deliver year one of the Regional Cancer Treatment Service Plan 2020-2025 G ●







Plan Legend A Annual Plan S Sustainability Plan E Equity Indicator

33

1.1 Performance Indicaors – July 2020 Te Uru Mātai Matengau is generally on track with all indicators. Exceptions and plans for improvement are noted below.


Month Actual

Month Target

Month Variance

YTD Actual

YTD Target

YTD Variance


Customer Patient


3.1% 5.3% 7.5% (2.2%) 5.3% 7.5% (2.2%)

Cancer treatment within 31 days of referral (FCT)

87.5% 90.3% 85.0% 5.3% 90.3% 85.0% 5.3%

Cancer treatment within 62 days of referral (FCT)

92.5% 93.1% 85.0% 8.1% 93.1% 85.0% 8.1%


0.0% 0.0% 95.0% (95.0%) 0.0% 95.0% (95.0%)

ESPI 2 - waiting < 4 months for FSA

99.3% 97.3% 99.0% (1.7%) 97.3% 99.0% (1.7%)

Hospital acquired UTI rate 0.00% 0.00% 0.50% (0.50%) 0.00% 0.50% (0.50%)


0.24% 0.00% 0.50% (0.50%) 0.00% 0.50% (0.50%)


4.7 3.9 3.5 0.4 3.9 3.5 0.4

Patient Falls Rate 4.7 5.9 5.0 0.9 5.9 5.0 0.9


ALOS - Acute 7.2 6.4 7.0 (0.6) 6.4 7.0 (0.6)

Bed Day Usage 96.2% 110.4% 85.0% 25.4% 110.4% 85.0% 25.4%

BreastScreen Coverage 69.6% 67.5% 70.0% (2.5%) 67.5% 70.0% (2.5%)

BreastScreen Coverage (Maori)

55.2% 54.2% 70.0% (15.8%) 54.2% 70.0% (15.8%)

DNA - Outpatient 1.7% 1.5% 6.0% (4.5%) 1.5% 6.0% (4.5%)

DNA - Outpatient, Maori 3.4% 3.0% 6.0% (3.0%) 3.0% 6.0% (3.0%)

ED - Shorter Stays 85.7% 67.9% 95.0% (27.1%) 67.9% 95.0% (27.1%)

ED Presentations 7 28 0 28 28 0 28

ED Presentations, Maori 0 7 0 7 7 0 7

One to One Hours 566 32 0 32 32 0 32


100.0% 66.7% 95.0% (28.3%) 66.7% 95.0% (28.3%)


Sick Leave Rate 5.08% 5.56% 3.20% 2.37% 5.57% 3.20% 2.37%


13.3% 13.5% 9.0% 4.5% 13.5% 9.0% 4.5%

Staff Stability 100.0% 100.0% 99.0% 1.0% 100.0% 99.0% 1.0%

Staff Turnover 0.57% 0.57% 1.00% (0.43%) 0.57% 1.00% (0.43%)

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ESPI 2 – waiting greater than four months for First Specialist Assessment has affected five patients for the month. Four of the patients were referred for non-cancer related blood conditions and had been appropriately deferred as part of the COVID response in April 2020. The fifth patient was undecided about proceeding with treatment and eventually declined treatment in August, outside of the reporting period. It is uncommon for the Regional Cancer Treatment Service to exceed this measure, given the urgency for the majority of patients, but this can occur on occasion as part of an overall plan of care. All wait lists are reviewed on a weekly basis and there are no issues or trends to note. Occurrence Rate of Medication Incidents is above target for the month and consequently year to date. Three medication incidents occurred in July, all of which related to the timing of medications rather than an incorrect medication or dose. All cases have been individually reviewed. There are no issues or trends to note. Patient Falls Rate is above target for the month and consequently year to date. Three falls occurred in July; all patients who fell experienced a deterioration in mobility as a consequence of treatment. It is not uncommon for patients, who are otherwise independent, to misjudge the rapid impact treatment can have on personal capability. Risk assessments were completed, and revisited, for each person as per standard procedure. All cases have been individually reviewed. There are no issues or trends to note. BreastScreen Coverage (all women and Māori wāhine) continues to be impacted by the COVID-19 lockdown. It will take many months to recover coverage, given the cumulative impact of large numbers of women who have now been screened outside of the 24-month interval. Recovery is ahead of plan however, and from September 2020 all screening invitations are within 24 months of the last screen. Emergency Department Shorter Stays performance was significantly impacted last month due to high demand for inpatient beds, noting bed day usage for cancer patients of 110 percent for the month. All late admissions have been reviewed and all were appropriate for admission, however there were simply no beds on the inpatient unit; nurse-led management of patients on treatment and the use of direct admission pathways continue. Smoking Cessation results are below target due to a process issue; all cancer patients receive quit smoking advice, however this has not been correctly recorded and a new process has now been implemented to address this issue. This result will recover from next month. Sick Leave rates have been higher than target in both June and July 2020, reflecting the winter season and some specific support provided for staff needing medical procedures or to care for family. All cases have been individually reviewed. There are no issues or trends to note. Staff Annual Leave balances greater than two years are regularly reviewed and individual leave plans are in place.

35

2. SIGNFICANT MATTERS 2.1 COVID-19 readiness and resurgence Te Uru Mātai Matengau continues to make good progress with recovery following the Level 4 lockdown and has seamlessly transitioned to its resurgence plan consistent with the national alert levels and previous planning. There is no impact to timely access to treatment. 2.2 Linear Accelerator Replacements The second of the new linear accelerators remains planned for this year although notification is yet to be received regarding travel exemptions for Australian rigging crews; this is currently with Immigration. Work continues as planned on the regional programme to build and implement new linear accelerators in Hastings and New Plymouth. 2.3 Te Hononga Te Hononga, as the MidCentral DHB Cancer Advisory Group, provides equity leadership and governance for the Te Uru Mātai Matengau cancer control programme. While Te Hononga has been established for many years this is an enhanced role for this group, and a key initiative under the 2020/21 Annual Plan to establish and embed an Equity Governance framework In July 2020 a multi-sectorial hui, with broad representation from Iwi and Māori providers, DHB staff and community was held to discuss how Te Hononga will develop in this new mahi. It was agreed that Te Hononga will apply a Māori equity lens to all initiatives across the Cancer Health and Wellbeing and Operational Plans to ensure these initiatives are designed to achieve equity as a priority and that this is delivered as the initiatives progress. Te Hononga will work in partnership with the Cluster Alliance Group in this function, with both groups collectively providing an equity, consumer and community assurance function to inform the overarching leadership and support future planning and service delivery. Te Hononga will also lead a programme of its own work, which includes holding demystifying cancer hui, education programmes for staff and whānau, health promotion, advocacy for Māori whānau, review of resources, and maintaining a link with Te Aho O Te Kahu. Next steps are to refresh the groups terms of reference, confirm membership and consolidate the relationship between Te Hononga, the Māori Alliance Leadership Team and Manawhenua Hauora. 2.4 Pro-Equity Programmes for Screening The BreastScreen Mobile Unit has finished its annual visit to Levin, and is now in Ōtaki. While the numbers screened in Levin were lower than the previous visit in 2018, all women due for rescreen and women enrolling for the first time were seen. The project implemented to support wāhine through kanohi ke te kanohi interaction and incentivisation did not see the numbers overall increase, but there was a considerable improvement (4 percent) in did not attend rates compared with the rates from 2018.

36

This visit was unique, given the lockdown immediately prior, however through the work a better understanding of this community and access issues has been gained which will inform future strategies when the unit returns in 2021. The pro-equity plan for bowel screening has been endorsed by the National Screening Unit and the Central Region Leadership team. The plan includes social media, radio advertising and billboards featuring local Māori and Pasifika as well as direct engagement with kaumatua and large hauora events across the rohe. The Bowel Screening Outreach programme is also making good progress. Outreach is a local approach that involves making direct contact with participants who have received a kit but are yet to respond. This programme is for all Māori and Pasifika people as well as all people living in deprivation nine and ten localities. Contacts are made by Iwi Cancer Coordinators, Pasifika staff at THINK Hauora and an Outreach Coordinator within the Bowel Screening team. There are 276 participants on the outreach list as at 18 August 2020, 67 less than the week prior. Contact is made via text message, phone and home visit, with the majority agreeing to proceed with testing. Those withdrawing from the programme are generally excluded due to ill health or personal preference. Other reasons for non-contact include no longer at known address or phone number. Engagement rates for the Outreach Programme are a key performance indicator for the programme nationally and, along with participation rates, will be included in the Performance Indicator dashboard from November 2020, aligning with a full year of the programme in the MidCentral district. 2.5 Regional Clinical Governance Group As part of the overarching project to implement the satellite radiation treatment units, the Regional Cancer Treatment Service (RCTS) has established a Regional Clinical Governance Group. The group has clinical representation from the Hawke's Bay, Taranaki, Whanganui, Wairarapa and MidCentral District Health Boards, and includes the Clinical Director of the Wellington Blood and Cancer Centre and representatives of Te Aho o Te Kahu. Representatives are from surgical and medical subspecialties, nursing and allied health, as well as the clinical leadership for the RCTS. Although developed as part of the radiation therapy project, this group will provide clinical governance beyond the implementation of the new sites and will span those cancer pathways that are shared across the central region. The members of the group will govern a programme of continuous quality improvement, quality assurance and quality control, as well as providing oversight and direction in identifying performance monitoring indicators. This is the first governance group for cancer pathways with this level of clinical representation and there was widespread enthusiasm for the concept at the first meeting in June 2020. There are a further two meetings scheduled for September and November this year.

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SERVICE: Te Uru Arotau

Acute & Elective Specialist Services


PREPARED BY: Lyn Horgan, Operations Executive

Barbara Ruby, Planning & Integration Lead

1. PERFORMANCE OVERVIEW Te Uru Arotau has now moved to the 2020/21 planning cycle and all initiatives have been updated accordingly under the Annual, Operational and Sustainability Plans. There are no emerging risks or areas of concern with delivery of the new plans.

Plan Initiative Rating & Trend

A-E Partner with Pae Ora Paiaka Whaiora Hauora Māori Directorate to evaluate and advance the identification of key utilisation areas for the Whānau Equity Facilitator to engage with Māori whānau to support earliest access possible for planned assessment and treatment.

G

A-S Improve clinical documentation and coding to capture appropriate data and revenue. G

A-S Progress development of Hospital Health Pathways G A Progress the Surgical Procedural Intervention Recovery Expansion programme

(SPIRE) facility. G

A Progress the EDOA and acute assessment PODs. G A Expand the community-based early intervention non-surgical programme for

musculoskeletal conditions. G

A Integrate the National Acuity Index Tool into MDHB digital technology to ensure a standardised approach to meet health needs and timely access. G

A Progress the ED and inpatient initiatives, as part of the Rationalising Acute Demand programme, to improve patient flow throughout the hospital. A

A Improving medicines management for Māori and Pasifika patients who present with co-morbidities for the treatment of gout. G

A Planned Care Waiting List Improvement Plan ESPI 2. A A Planned Care Waiting List Improvement Plan ESPI 5. R









Plan Legend A Annual Plan E Equity S Sustainability Plan

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Actions continue with the patient flow programme which will improve the Shorter Stays in Emergency Department (SSIED) and average length of stay (ALOS) results. Patient flow initiatives include: opening all available inpatient beds improved utilisation of the patient journey boards regular delayed discharge rounding to remove barriers holding orders completed for General Medicine, Orthopaedics and General

Surgery to support the transfer of care from Emergency Department (ED) to the inpatient wards

refreshed operational stand up meetings to prioritise activities to improve flow recruitment has commenced for additional ED Senior Medical Officers (SMOs). General Medical admissions continue to increase resulting in a number of inpatients on non-medical wards (outliers). There is correlation with the higher number of outliers and increased ALOS (approximately half a day). This increased acute length of stay impacts the ED on any ongoing improvement in the SSIED target. General Medicine and OPAL are working closely together to provide care to frail older adults and to reduce length of stay. Multi-disciplinary meetings are held twice weekly to review all delayed discharges. SMOs have noted an increase in the number of admitted patients with delirium and cardiac conditions. There has been an increase in the number of cardiac inpatients awaiting access to Capital & Coast District Health Board. Te Uru Arotau is working closely with the Central Region hospitals to ensure timely flow of patients. A new Acute Model of Care for General Surgery commenced in late July. This provides a dedicated General Surgeon during the week to improve the responsiveness and management of acute general surgical patients presenting via the ED. Initial feedback is positive. The organisational SSIED result for July was 70 percent. This has decreased due to the impact of the bed day occupancy for July at 110 percent and the increased number in ED presentations in June (3,825) and July (3,815) compared with May (3,167). Subsequently, as the number of presentations increased, the number of patients who did not wait has increased. The delivery of virtual outpatient clinic models such as increased use of Telehealth and a reduction of unnecessary follow-ups continues. Te Uru Arotau is piloting a new telehealth service model for pre-admissions services based on a model developed during the national COVID-19 response. Good progress is being made in the Elective Services Performance Indicators (ESPIs). As at the end of July, MidCentral District Health Board (MDHB) has a total of 116 patients waiting greater than four months for a First Specialist Assessment in ESPI 2. Of the 116 patients waiting, 100 patients have an appointment allocated. Seven services are compliant with no patients waiting greater than four months.

39

The impact of the COVID lockdown has seen a number of ESPI 5 Planned Care procedures waiting greater than four months. A total of 813 patients are waiting greater than four months for surgery with 123 of these patients allocated a date for surgery. Strategies to manage waiting lists are outlined in the MDHB Planned Care Waiting List Improvement Action Plan which was submitted to the Ministry of Health in June. These strategies include: an increase in the number of procedure types which can be outplaced and

outsourced to increase surgery capacity maximise the utilisation of all internal theatre sessions weekend lists and extended evening lists, where appropriate, are available and

voluntary for staff and have not yet been taken up as an option daily and weekly operational reporting against plan ongoing and regular clinical review and oversight of waiting lists all waiting lists for planned care are now provided by ethnicity. As a result of these strategies, the delivery of planned care surgical volumes exceeded target in July.

40

1.1 Performance Indicators – July 2020


Month Actual

Month Target

Month Variance

YTD Actual

YTD Target

YTD Variance


Customer Patient


9.3% 4.3% 7.5% (3.2%) 4.3% 7.5% (3.2%)


85.2% 70.0% 95.0% (25.0%) 70.0% 95.0% (25.0%)

Diagnostic Angiography < 90 Days

100.0% 100.0% 95.0% 5.0% 100.0% 95.0% 5.0%

Diagnostic CT< 42 Days 85.0% 87.9% 95.0% (7.1%) 87.9% 95.0% (7.1%)

Diagnostic MRI < 42 Days 52.0% 53.2% 90.0% (36.8%) 53.2% 90.0% (36.8%)

ESPI 2 - waiting < 4 months for FSA

86.6% 92.3% 99.0% (6.7%) 92.3% 99.0% (6.7%)

Referrals Accepted 2,725 2,953 * 2,953 * Referrals Accepted, Māori 386 426 * 426 * Referrals Declined due to capacity

229 191 * 191 *

Referrals Declined due to capacity, Māori

36 34 * 34 *

ESPI 5 - waiting < 4 months for treatment

47.0% 46.9% 99.0% (52.1%) 46.9% 99.0% (52.1%)

Hospital acquired UTI rate 0.43% 0.73% 0.50% 0.23% 0.73% 0.50% 0.23%


0.14% 0.27% 0.50% (0.23%) 0.27% 0.50% (0.23%)


4.0 3.2 3.5 (0.3) 3.2 3.5 (0.3)

Patient Falls Rate 2.4 3.0 5.0 (2.0) 3.0 5.0 (2.0)


ALOS - Acute 4.6 4.5 4.0 0.5 4.5 4.0 0.5

ALOS - Elective 2.8 2.4 4.0 (1.6) 2.4 4.0 (1.6)

Bed Day Usage 102.3% 110.5% 85.0% 25.5% 110.5% 85.0% 25.5%

DNA - Outpatient 5.4% 6.0% 6.0% 0.0% 6.0% 6.0% 0.0%

DNA - Outpatient, Māori 9.0% 10.8% 6.0% 4.8% 10.8% 6.0% 4.8%

ED - Shorter Stays 78.8% 69.6% 95.0% (26.4%) 68.6% 95.0% (26.4%)

ED Presentations 1,500 1,523 0 1,523 1,523 0 1,523

ED Presentations, Māori 723 758 0 758 758 0 758 ED - Did Not Wait 290 343 8.9% * 343 8.9% ED – Did Not Wait, Māori 71 103 11.6% * 103 11.6%

Specialing Hours 3,616 3,309 0 3,309 3,309 0 3,309


83.4% 78.2% 95.0% (16.8%) 78.2% 95.0% (16.8%)

* Target yet to be determined


Sick Leave Rate 4.25% 4.74% 3.20% 1.54% 4.74% 3.20% 1.54%


13.3% 14.8% 9.0% 5.8% 14.8% 9.0% 5.8%

Staff Stability 99.8% 99.9% 99.0% 0.9% 99.9% 99.0% 0.9%

Staff Turnover 0.11% 0.80% 1.00% (0.20%) 0.80% 1.00% (0.20%)

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The comments below relate to Key Performance Indicators that are off target (month or year to date) that have not already been covered under Performance Overview. In July, Te Uru Arotau had an average of 16 days to resolve a complaint which is just outside the target of 15 days. This has been reviewed and small changes have been made to the process to ensure complaints are resolved in a timely way. Computed Tomography performance has improved in July. During June and July, outpatients were booked for appointments on Saturdays and Sundays to assist with improving waiting times. The Magnetic Resonance Imaging (MRI) result for July has remained at a similar level at 53 percent. Acute referrals to the MRI Service from ED and inpatients were high in July. This meant that some outpatient and community specialist referred patients had to be postponed (only outpatient and community specialist referred patients contribute to this target). Overall, both June and July throughput was higher than previous months. The service is exceeding 10 hours of operation each day with 858 referrals received against 500 referrals expected each month. Additional weekend work and extension of hours during the week have been implemented which will assist with waiting times. Analysis is being undertaken to understand the increase in hospital acquired urinary tract infections. The bed day usage measure reflects that inpatient volumes have remained consistently high for the past 12 months, which is linked to an increase in acute ALOS. Inpatient Pharmacy dispensing has also increased which supports the high bed day usage. The Whānau Equity Facilitator Partnership with Pae Ora Paiaka Whaiora and Te Uru Pā Harakeke for proactive engagement with Māori whānau has identified system improvements to improve engagement for planned assessment. Audits have been completed in a number of Planned Care services to identify equity gaps. Work has commenced in the Orthopaedic Service where improvements can be made in Fracture Clinic services and Horowhenua clinics. Smoking Cessation action plans are in place for all areas to increase the provision of brief cessation advice to smokers. A programme of work to further refine the referral process continues. Sick leave rates across Te Uru Arotau remain high due to seasonal influences with an emphasis on staff not coming to work if they have any symptoms. All staff with leave plans were affected by the impact of the COVID-19 response. The number of staff with annual leave that has not been taken has continued to rise. Ongoing border restrictions are a contributory factor to this. Annual leave plans continue to be revised to encourage rest and relaxation time to support staff wellness.

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2. SIGNIFICANT MATTERS 2.1 COVID-19 A completed readiness resurgence plan is in place should the hospital be required to align with further national COVID-19 responses. 2.2 Medicines Management A new innovation to improve medicines management for Māori and Pasifika patients admitted to the hospital with co-morbidities or with adverse drug reactions to pain medicines to treat gout commenced in July 2020. Identified patients are reviewed and commenced on appropriate medicines to treat gout. The Hospital to Community Pharmacist works with the Primary Support Pharmacists to ensure patients continue to receive ongoing medicines management in community. 2.3 SPIRE Progress continues for the Surgical Procedural Intervention Recovery Expansion programme (SPIRE) facility upgrade. In preparation for the facility upgrade, several services will be relocated. Clinical Records moved to their new home, in June, which previously housed Broadway Radiology’s MRI service. Relocation of STAR 1 was completed in July and work continues on the facility for the relocation of the Renal Service. It is anticipated that the Renal Service will be relocated in mid-September. 2.4 EDOA and MAPU PODS Progress on the ED Observation Area and acute assessment PODs has commenced. Procurement of the prefabricated PODs is under way, with detailed design commencing shortly. It is anticipated that the PODs will be operational by winter 2021. Representatives from ED, medical and surgical specialties, nursing, allied health, Pae Ora Paiaka Whaiora, consumer as well as the clinical leadership for Te Uru Arotau form the steering committees overseeing both these programmes of work.

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SERVICE: Te Uru Pā Harakeke

Healthy Women Children and Youth


PREPARED BY: Sarah Fenwick, Operations Executive

Dr Jeff Brown, Clinical Executive

1. PERFORMANCE OVERVIEW

Te Uru Pā Harakeke has now moved to the 2020/21 planning cycle and all initiatives have been updated accordingly under the Annual, Operational and Sustainability Plans.


A Increase engagement with family harm training G

A P2A programme to be evaluated and enhanced to include those with disability G

A Support a sustainable midwifery workforce R

A All families are provided Sudden Unexpected death of Infant (SUDI) prevention information at a WCTO contact before 50 days of age. G

A Complete Ambulatory Sensitive Hospitalisation (ASH) project correlating data across primary and secondary care G

A Deliver district wide breast feeding strategic plan G

A Increase clinical procedures in the outpatient setting and explore opportunities alongside primary care for services closer to home. G

A Planned Care Waiting List Improvement Plan ESPI 2 A

A Planned Care Waiting List Improvement Plan ESPI 5 R

A Improve shorter stays in the Emergency Department A

A Complete CDS review and implement recommendations as appropriate G

A-E Reduce equity gap between Māori and non-Māori babies who are exclusively or fully breastfeeding at three months of age. A

A-E Babies who live in smoke free household at Well Child Tamariki Ora (WCTO) first core contact. A

A-E All women screened for family violence three times during babies first year of life. A

A-E Reduce the number ASH events for Māori children by at least five percent G

A-E Improve access for hapū māmā to maternal mental health support G

E Support whānau who do not engage with services G

S Explore and pilot opportunities for telemedicine across paediatrics G







Plan Legend

A Annual Plan E Equity S Sustainability Plan

44

Despite local, national and international recruitment campaigns the midwifery workforce at MidCentral District Health Board (MDHB) remains a significant risk. Data from TrendCare, which is the validated acuity tool used at MDHB and embedded in the four components of Care Capacity Demand Management (CCDM), show a significant care hours deficit for Delivery Suite in July 2020. Care hours deficit is occurring as acuity and Lead Maternity Carer (LMC) handover have increased to the level that historical staffing levels of two midwives and one Charge Midwife/Associate Charge Midwife on each shift is now inadequate. A robust workforce plan has meant the midwifery risk has been mitigated over the past two years. Examples of mitigation strategies include increasing full time equivalents (FTEs) and by using alternative roles, such as nurses and health care assistants. This has supported the Maternity Ward well, as they now show very few shifts with care hour deficits. However, these roles cannot help to mitigate the Birthing Suite risk. An urgent meeting is planned between Directorate and midwifery leads to develop a strategy to provide support to Birthing Suite staffing. An updated plan will be provided to the next Health and Disability Services Advisory Committee (HDAC) meeting. Progress has been made towards compliance with the First Specialist Appointment (ESPI 2) target. At the end of July 2020 three patients in Gynaecology and seven patients in Paediatrics waited greater than four months. It is expected that compliance will be regained prior to the date agreed with the Ministry of Health. Gynaecology was non-compliant with the Planned Care ESPI 5 treatment target at end of July 2020, with 16 patients waiting longer than four months for surgery. This number has reduced from 47 last month with staff working hard to achieve compliance. Increased repeat elective caesarean numbers continue to impact performance, by displacing elective gynaecology surgery cases. Long-wait patients are being reviewed by Senior Medical Officers to determine any clinical changes or further care required while waiting for surgery. Both Paediatrics and Gynaecology breached the shorter stays in the Emergency Department target for July 2020, with paediatrics achieving 89 percent compliance and Gynaecology 72 percent. Breach investigations are being undertaken by Charge Nurses and discussed at service quality meetings. Holding orders continue to be developed between Paediatrics, Gynaecology and the Emergency Department to allow for faster transfer of care. Gynaecology holding orders will be implemented once the Gynaecology Assessment Unit hours are expanded in conjunction with the relocation of this service. MDHB is working to reduce the equity gap between Māori and non-Māori babies who are exclusively or fully breastfed at three months of age. Currently the national target is 70 percent, rates for Māori are 51 percent, with all ethnicities reported at 59 percent. This information is provided by the Ministry of Health. The breastfeeding strategic plan implementation group are working on strategies to improve this inequity. MDHB is also working with Mokopuna Ora and through the wahakura workshops to provide support and culturally appropriate information for mothers and their whānau around breastfeeding and the supports available across communities. The percentage of babies who live in smoke free households in the MDHB district still falls short of the National target of 90 percent. MDHB rates are currently 59 percent for all ethnicities, compared to 42 percent Māori. The community provider

45

TOAM is helping support hapū māmā to stop smoking in pregnancy and have had success by using the vape to quit programme. The information for the new indicator “All women screened for family violence three times during baby’s first year of life” is derived from the Well Child Tamariki Ora report provided by the Ministry of Health. The target is 90 percent, MDHB results for non-Māori is 59 percent, for Māori women 47 percent. A quality improvement project will be created to work with the Well Child Nurses around this and to ensure the questions are being asked and recorded. 1.1 Performance Indicators – July 2020

The comments below relate to Key Performance Indicators that are off target that have not already been covered under the performance overview. The Lower Segment Caesarean Section (LSCS), rate saw an increase this month of 2.6 percent. These are elective repeat LSCS rather than acute LSCS. Quieter periods in both Neonates and Paediatrics across June and July are evidenced in the bed day usage indicator result. The Did Not Attend indicator for Colposcopy saw an increase of one percent in July 2020 to 17.9 percent. Outpatient and Outpatient Māori results improved by 1.3

46

percent and 5.2 percent respectively in July 2020. This is likely to be related to the commencement of the text messaging reminder service in Gynaecology and Paediatrics in July 2020. The Whānau Equity Facilitator role that supports Māori attending outpatient appointments is now back to normal processes post COVID-19 and improvement is expected across Gynaecology and Colposcopy in the coming months. Staff have been reminded of the requirement to ensure patients are asked smoking cessation assessment questions on admission. Internal monthly audits indicate that this is slowly improving; however this is not evident from the July result. Investigation has found there has been a delay in coding clinical notes which has resulted in a low reported result. Internal audits indicate that the actual figure should be 75 percent for July. Since July the Directorate has been in discussion with the Coding Department about how the timeframe for coding can be improved. Sick leave rates over the reporting period were high due to winter illnesses with an emphasis on staff not coming to work if they have any symptoms, even if mild. Rates are however lower than the same reporting period in 2019, which is positive. The number of staff with leave balances over two years decreased by 1.1 percent to 12.2 percent in July 2020. The midwifery shortage has contributed significantly to the build-up of annual leave over two years. Plans are in place with each staff member with leave over two years with the position expected to improve over coming months. 2. SIGNIFICANT MATTERS 2.1 COVID-19 Te Uru Pā Harakeke has reviewed its business continuity plan and pathways across clinical services as part of the COVID-19 resurgence planning. This is now complete and good progress is being made with recovery.

2.2 Naming Ceremony On 22 July 2020 Te Uru Pā Harakeke hosted a blessing to celebrate the gifting of new names for Block C by Pae Ora Paiaka Whaiora Māori Health Directorate. Te Whare Tangata (Gynaecology Clinic), Mana o Te Wāhine (Women’s Assessment and Surgical Unit), Hē Taonga Te Tamaiti (Children’s Ward), Te Whare Poipoi (Neonatal Unit), Hine Te Iwaiwa (Birthing Suite) and Te Aotōroa (Maternity) are the gifted names. Bilingual signage has been placed throughout C Block and at the front entrance. 2.3 Te Papaioea Birthing Centre Te Uru Pā Harakeke commenced operationally managing Te Papaioea Birthing Centre on 1 April 2020. Postnatal transfers from Palmerston North Hospital to Te Papaioea Birthing Centre commenced in May 2020. Postnatal transfers were delayed until May 2020 due to COVID-19 restrictions. Of the 68 women cared for at Te Papaioea in July, 11 identified as Māori. The service is refining transfer guidelines to aid the number of postnatal transfers and it is expected that these will increase over the next quarter.

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Month Labours Births at

Te Papaioea

Number of women who identify as Māori

Transfer to Te Papaioea for postnatal care

Number of women who transferred to Te Papaioea who identify as Māori

April 2020 31 25 No transfers May 2020 30 20 30 June 2020 30 22 9 26 2 July 2020 34 31 4 37 7

2.4 Child Development Strategic Analysis and Review The increased demand for services has continued to place pressure on a limited Child Development Service, both in terms of staffing and facilities. The service has responded to this increased demand and reviewed ways in which services are provided, however this has not addressed the overall issue of high demand within limited capacity and there are long wait lists for some services. Given this, a strategic analysis and review of the service is planned and will commence in August 2020. This work is in line with MDHB’s Annual Plan 2020/21 that identifies one of the key planning priorities as “Better population health outcomes supported by a strong and equitable public health and disability system”. The outcome of the review will be reported to HDAC’s November meeting. 2.5 Maternity Clinical Information System (MCIS) Global The Ministry of Health advised there would be a delay in the implementation of MCIS Global from the agreed September 2020 date, due to the COVID-19 pandemic. April 2021 is now confirmed as the new launch date. Preparations are underway with testing of the new systems. Digital Services, the Ministry of Health, Clevermed representatives and Directorate staff are working closely to have processes and training in place for go live. 2.6 Housing New Zealand Programme At the last HDAC meeting, additional information and equity data was requested in relation to the 2020/2021 operational plan initiative: “Housing New Zealand client families to access and engage with health and social services through one point of contact” The Community Child Health team and Housing New Zealand identified that many children in state rental housing were not accessing all the health care and Well Child support they were entitled to. A pilot was set up and a simple checklist developed for tenancy mangers with contact details for health services where gaps were found. A pilot programme identified 66 individuals not receiving the care they were entitled to. Of these 47 were under 16 years and all were Māori. Outcomes included enrolment with general practice, dental services and Well Child providers. The intersectoral relationships have been strengthened with potential to further explore innovative ways of connecting these children and their whānau to the community and primary care services they desire.

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For:

Approval

X Endorsement

Noting


Author Michelle Riwai, General Manager, Enable New Zealand


Date 1 September 2020

Subject Enable New Zealand Report to 31 July 2020

RECOMMENDATION


endorse the Enable New Zealand Report to 31 July 2020

Strategic Alignment

This report is aligned with the District Health Board’s (DHB) 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 several the DHB’s enablers. The report aligns to all three of the Strategic Goals embedded in Enable New Zealand’s Operational Plan.

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1. PURPOSE The purpose of this report is to set out Enable New Zealand’s performance against its Operational Plan and advise of any current and emerging matters. 2. SERVICE OVERVIEW Enable New Zealand is a semi-autonomous business unit of MidCentral District Health Board (MDHB). 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 (Ministry), Accident Compensation Corporation (ACC) and 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 Overall, performance across Enable New Zealand is tracking well. During the past month, there has been a considerable focus on getting the Enablement Programme back on track and reinvigorating the focus on the customer. As a result, significant progress has been achieved in several areas. This includes the development of a six week sprint cycle to improve assessor applications, progress on the development of a single Customer Relationship Management (CRM), a more cost efficient telephony system and the trial and testing of a “net promotor score” to monitor customer engagement levels across a number of services. In addition, several workforce development initiatives are also underway. This includes the development of a workforce competency framework to guide the development of job descriptions, performance management, staff development and progression planning. More recently there has also been a drive to get all Enable New Zealand staff to complete the MDHB online learning for Disability Responsiveness Training and to participate in Bullying Prevention Training which is held on site here at Enable New Zealand. 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 ●

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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

G ●

O We nurture 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 ●






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

4.1 Performance Indicators The data provided in this report relates to the period ending July 2020, however where relevant, comments relating to August 2020 have also been included.

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Regional

Mana Whaikaha Regional Results Launch of Prototype to 31 July 2020

Total disabled people active in the database 2288 People allocated to a MoH connector (and are still allocated to a MoH Connector)

973

People allocated to their own / Independent Connector

182

People in queue (awaiting allocation to a connector) 272 Total # of individuals under the age of 21 years 861

National Enable New Zealand’s operational performance remains within key contracted performance measures, except for non-urgent grabrails for ACC. During the initial restrictions COVID-19 all non-urgent handrails were put on hold to prevent installers from having to enter homes. As anticipated, the restrictions have eased, and performance is quickly improving for this KPI. This will be closely monitored as new alert levels are entered. The table below shows performance against contractual measures for July 2020: Key Performance Indicator/Measure (YTD 31 July) Target Achieved Percentage of Band 1 Equipment delivered within five working days. 90% 97%

Percentage of Complex Housing Modifications completed within 120 working days (MoH). 60% 60%

Percentage of Equipment provided to Service Users supplied from refurbished stock (MoH). 35% 35%

Grabrails Installation Non-Urgent (ACC) 95% 82%

Enablement Programme – Contact Centre Solution (Stage 1) 100% 40%

Complex housing has seen a significant drop (31 percent) decrease in timeframes compared to previous reports. This is due to the suspension of all complex housing modifications over the COVID-19 lockdown period. Our build network is now working on the backlog of modifications. However, pressure is still evident in the sector with many build start dates being pushed out by several months. The equipment KPI has seen an improvement this month due to the number of items being returned, refurbished, and reissued out to the community. We anticipate that this trend will continue with similar KPI results in the coming months. The table below sets out the number of customers accessing Enable New Zealand’s contracted services, for the financial year to date ending at 30 June 2020 and the commencement of the next financial year 2020/21.

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Client volumes by service

Year End for MDHB

Year End for All Serviced

Region

July 2020 MDHB Region

July 2020 All Serviced

Region Equipment 3130 39,902 350 4,316 Hearing 1038 23,074 93 2,484 Housing 166 1,962 11 204 Spectacles 1380 26,987 188 2,708

Requests for July 2020 saw an increase in all services in both the MDHB region and across the whole of ENZ’s service region. Significant increases for MDHB were seen in both the Equipment requests and Spectacle subsidies. Equipment requests received saw an 18 percent increase from MDHB assessors from June 2020 to July 2020. This increase was seen across the whole of the ENZ region with an additional 700 requests being received (19 percent) for the month of July. In comparison, MDHB requests for July 2019 and July 2020 requests are slightly lower than on the previous year (8.8 percent), which is not reflective of the other service regions which has seen a 3.7 percent growth across the services (mainly in equipment requests). The below chart is a high-level snapshot of some of the work volumes that Enable New Zealand has achieved in the month of July.

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5. SIGNIFICANT MATTERS 5.1 Mana Whaikaha Prototype The Prototype The Mana Whaikaha contract has been extended to 30 September 2020 while a change proposal from the Ministry of Health (the Ministry) is developed and implemented. A final decision, following consultation on the proposed structural change, is due mid-to late August. Any potential outcome from the change proposal will have an impact on the operational structure of Enable New Zealand’s Tari Whaikaha Team. Despite the challenges associated with any employment related change process, the team continue to operate in a timely manner, ensuring optimal workflow is maintained. Contract negotiations have been initiated with the Ministry for continuation of support services for the prototype for the period 1 October 2020 to 30 June 2021. Learnings from previous COVID-19 restrictions has meant Mana Whaikaha has been able to implement a number of systems in response to the recent increase in COVID-19 alert levels. Regular meetings with Ministry officials and national NASC managers have been re-established. The PPE supply chain has also been confirmed with MDHB and orders have been placed on behalf of local community-based providers and individual fund holders. 5.2 Enablement Programme Following the short review undertaken on the programme thus far, several recommendations were made and have been implemented. These include having a dedicated Programme Manager to oversee the programme direction and progress, re-establishing and enhancing programme governance and ensuring the decision-making framework is focused on the business and customer needs. Over the last four weeks, Enable has run a series of one-week development “sprint” cycles. These sprints focus on areas for system improvement based on user feedback and allow new functionality, and improved user experience, to be rolled out in weekly cycles. In addition, new functionality allows for users to provide real-time feedback so we can track feedback from users as the development sprints are implemented. Enable has a total of six short-cycle one-week sprints scheduled. Progress has also been made on the telephony and contact centre system, and options and technology solutions are currently being reviewed and considered. 5.3 COVID-19 Update – Alert Level 2 Following the return to Alert Level 2 COVID-19 restrictions, Enable New Zealand has reactivated its tactical response plan. More office-based staff are working from home to ensure one metre distancing can be maintained within our working environment.

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During the previous lock down period a noticeable drop in service requests for all areas (Hearing, Spectacles and Equipment and Modification Services) were experienced. Enable New Zealand is working extensively with assessors to try and avoid the decline in numbers while also maintaining the additional restrictions. A key focus for Enable New Zealand has been providing essential information to disabled people about COVID-19 restrictions. The Firstport website has recently been updated to include essential information about disability support services at Alert Levels 2 and 3. Included is a list of “Frequently Asked Questions” captured from disabled people during the previous lock down. These questions will be regularly updated based on feedback captured through various channels. 5.4 Community Initiatives Sensory Playroom The EASIE Living Demonstration Team within Enable New Zealand, has created a community Sensory Playroom. The purpose of the sensory playroom is to show an array of equipment and materials to stimulate or soothe the senses through light, sound and touch for children. While the project has been led by Enable New Zealand, feedback from people with lived experience was captured via several focus groups. Once the concept had been developed, Enable New Zealand then partnered with local organisations, Altogether Autism, Autism NZ, Parent to Parent and Mana Whaikaha for input on the types of features to include in the space. Support from suppliers was also provided, including Medix 21, Sensory Sam, Abecca Healthcare and more, who contributed products to the space. The finished room features comfortable seating, weighted blankets, a fidget kit, a soothing bubble tower, a texture wall, projectors and many other simple toys that disabled children with specific sensory needs can utilise for both play and learning. Demand for the Sensory Room has been greater than anticipated with the room being fully booked weeks in advance. To date, more than 100 parents have utilised the space. Work is now underway to encourage and assist other community-based organisations to provide similar facilities.

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For:

Approval

X Endorsement

Noting


Author Tracee Te Huia, General Manager, Māori Health


Date 27 August 2020

Subject Pae Ora Paiaka Whaiora Progress Report

RECOMMENDATION


endorses the progress report by Pae Ora Paiaka Whaiora

Strategic Alignment

This report is aligned to MidCentral DHB’s (MDHB) strategy and strategic imperatives, particularly Achieving Equity of Outcomes Across Communities and Ka Ao Ka Awatea the MDHBs Māori health strategic framework.

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1. OVERVIEW Pae Ora Paiaka Whaiora Hauora Māori RATING Engagement and obligations as a Treaty partner

AP

1. Build and review the training and induction process delivered for the newly constituted MDHB Board of 19/20, to further their understanding and knowledge of Te Tiriti o Waitangi, WAI 2575 developments, and local Iwi and Māori health aspirations EOA

G

AP 2. Provide support to Manawhenua Hauora to identify priorities and aspirations for Māori health across the organisation EOA G

AP 3. Provide Māori specific reporting on progress to achieve health equity to Manawhenua Hauora EOA G

Māori Health Action Plan – Accelerate the spread and delivery of Kaupapa Māori services

AP 4. Consolidate Kaupapa Māori Service provision within MDHB including the

amalgamation of Oranga Hinengaro – Specialist Kaupapa Māori Mental Health Service and Pae Ora Paiaka Whaiora Hauora Māori Directorate EOA

G

AP 5. Develop a Kaupapa Māori Commissioning Framework that leads to an Outcomes

approach across the district focussing on Kaupapa Māori measures of success and performance. EOA

G

AP 6. Prioritise new investment into Kaupapa Māori services across clusters EOA G ● Māori Health Action Plan – Reducing health inequities- the burden of disease for Māori O 7. Identify the opportunity to establish other Whānau Ora Link Nurses to focus on

key high utilisation areas in secondary care for Māori EOA G

Sustainability Plan Actions AP 8. Resource and implement the next phase of Kaimahi Ora Whānau Ora – Māori

Workforce Development Implementation Plan 2017 – 2022 to advance the pipeline of Māori recruitment EOA

G

AP 9. Prioritise the recruitment of Māori to key areas of high utilisation by Māori EOA G ● Working with sector partners to support sustainable system improvements AP 10. Pae Ora will continue to actively contribute and participate in the Kainga Whānau

Ora Collective Impact Initiative to support Māori into warmer dryer homes EOA G

AP 11. Investigate the establishment of a centralised hub across government agencies to empower families/whanau toward better health and wellbeing EOA G ●

O 12. Ensure Iwi aspirations are included in planning documentation and investment commissioning at MDHB EOA G ●

Delivery of Whānau Ora AP 13. Align the investment and commissioning framework to Whānau Ora Outcomes

and intermediary measures to actively support and complement the successes of Whānau Ora across the district EOA

G ●

O 14. Embed the MDHB Whānau Ora Position Statement and Implementation Framework into the planning and prioritisation material for FY 21/22 G

O 15. Actively support Cluster Areas and Enablers to participate in Te Ara Whānau Ora training as part of the integrated workforce development approach across MDHB G ●









Plan Legend AP Annual Plan P Performance

Improvement Plan O Operational Plan EOA Equity Outcome

Action

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2. PURPOSE This report provides the Committee with an update on progress by the Pae Ora Paiaka Whaiora Hauora Māori Directorate. In particular, it reports on the following: Manawhenua Hauora work plan Te Tiriti o Waitangi policy and training Establishment of the Māori Alliance Leadership Team (MALT) Iwi Health and Wellbeing Plans Ka Ao, Ka Awatea Māori Health Strategic Framework refresh Iwi and Māori provider commissioning Smokefree Services for Maori Māori Equity Dashboard and Equity of Outcome Areas. 2.1 Manawhenua Work Plan 20/21 The Manawhenua Hauora Work plan 2020/21 was tabled at the 10 August Manawhenua Hauora Board meeting. It was endorsed and will be tabled at the Board to Board workshop in September for approval by both parties. This work plan provides a strategic agenda for both parties DHB and Manawhenua Hauora to focus on over the next twelve months. In particular, it strengthens the focus on higher level governance issues related to iwi health matters. It’s also a practical means to supporting MDHB to live the Articles of Te Tiriti o Waitangi in partnership with iwi. The workplan will drive the agenda for Board to Board meetings in the future. 2.2 Te Tiriti o Waitangi Policy and Training The final working draft of MDHB Te Tiriti o Waitangi policy was endorsed by Manawhenua Hauora at their Board meeting in August. The Policy is being socialised through Organisation Leadership Team before being recommended to the Board at the Board to Board Hui in September. To actively support the MDHB Board to achieve the Ministers Expectation on understanding Te Tiriti and Māori Health Equity, Pae Ora Paiaka Whaiora is working with Manawhenua Hauora and Treaty consultant Jen Margaret, to design a second workshop. Content of the training required will also be discussed at the Board to Board meeting in September led by Manawhenua Hauora chair Oriana Paewai. Other potential Treaty or cultural training for the Board might need will also be ascertained at this workshop. 2.3 Establishment of the Māori Alliance Leadership Team (MALT) Pae Ora Paiaka Whaiora has established a MALT to support the achievement of the Integrated Service Model aspirations whilst ensuring Māori communities we serve achieve an equitable, high quality care experience with the best possible outcomes. Pae Ora Paiaka Whaiora is seeking to work with this group to achieve improved commissioning, service development and contracting with its kaupapa providers. To achieve this the MALT membership consists only of the Chief Executive Officers and General Managers of Iwi and Māori providers within the District Health Board (DHB) contracting system. This approach meets the Tiriti expectations of engaging Māori throughout all levels of strategy and service

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design and delivery. Directorates now have the mechanism for seeking operational advice on planning and delivery of services that work for Māori. In addition, it provides a clear process for Directorates to consult at an operational level using the MALT instead of Manawhenua Hauora. The first MALT meeting was held at Te Whare Rapuora in July. MALT members were pleased to see the establishment of MALT come to fruition. Following the first initial meeting the Terms of Reference to support the group was endorsed by the MDHB Chief Executive. MALT will meet bi-monthly with the Tumu Rautaki acting as the convener for the group. The meeting schedule will be shared with the Directorates to allow them to attend meetings where they require Māori specific critique and guidance. 2.4 Iwi Health and Wellbeing Plans Understanding what health and wellbeing means to Iwi is important to MDHB. MDHB is committed to finding alignment between the DHB’s direction and what Iwi want to achieve for their people, therefore ensuring Iwi aspirations and expectations are incorporated into DHB planning is a direct focus for the DHB this year. MDHB understand that Iwi are best placed to determine the actions that will ensure their people flourish and are of the view that such actions will support the DHB to advance Māori health outcomes and achieve equity of outcomes across communities. Pae Ora Paiaka Whaiora is in the process of engaging with five Iwi within the MDHB region, Ngāti Raukawa ki te Tonga, Muaūpoko, Rangitāne o Manawatū, Rangitāne o Tamaki Nui a Rua and Ngāti Kahungunu ki Tāmaki Nui a Rua. Planning is occurring throughout the months of August, September and October. Following this, Iwi health and wellbeing priorities will be incorporated into future MDHB planning. 2.5 Ka Ao, Ka Awatea Māori Health Strategic Framework refresh Ka Ao, Ka Awatea Māori Health Strategic Framework 2017-2022 is a collaborative approach between MDHB; THINK Hauora and Te Tihi o Ruahine Whānau Ora Alliance Charitable Trust (Te Tihi), to enhance the delivery of quality services to whānau Māori in order to contribute to accelerating improved health gains and equity of health outcomes. The strategic framework and action plan intends to contribute to the achievement of Whānau Ora across the MDHB region. While aspects of the document remain relevant, it requires refreshing in order to ensure it is reflective of the changing environment and echoes the priorities of Iwi and the commitment of the health sector to Te Tiriti o Waitangi. Ka Ao, Ka Awatea is in the process of being refreshed with the timeframe for completion being November 2020. The November timeframe has been set to ensure the refresh aligns with the wider DHB strategy refresh. 2.6 Iwi and Māori Provider Commissioning On 1 July 2020, Pae Ora Paiaka Whaiora assumed responsibility for all Iwi and Māori provider contracts with the exception of three services. Directorates continue to have responsibility for interrelated areas of activity. Consolidating the contracts of all MDHB Iwi and Māori providers under Pae Ora ensures a

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consistent approach for providers in how they deliver a holistic service to whānau within a kaupapa Māori context. The three services that Pae Ora Paiaka Whaiora have not yet assumed responsibility for are Well Child Tamariki Ora services, Oranga Tamariki Children’s Team Lead Professional and the Youth Justice Facility Health Service. Well Child Tamariki Ora services is a national contract which is undergoing a review. To date Pae Ora has completed a contract review of all services, a performance review of all services and a service mapping across localities. We are out meeting with providers to understand issues and areas of development. Meetings to date have been beneficial for both parties. We expect new service design to begin in October with the kaupapa smokefree services. 2.7 Smokefree services for Maori Following on from the TOAM Service Planning Hui in July 2019, Pae Ora Paiaka Whaiora facilitated a workshop with the governance of TOAM on 26 August to actively explore innovative approaches to supporting progress to Smokefree 2025 across MDHB. The movement to a more whānau ora approach drawing on the whole of the whānau to support new and fresh approaches is key to examining how we can increase our smoking cessation. This will require a review of the contract to ensure that there is the flexibility and space to adopt innovative approaches. Research evidences that directly servicing addiction in of itself doesn’t work. That past trauma and historical treatment of Māori is the root cause of poor decision making and illness. Therefore, the services we contract need to align with this evidence. We expect to have a completed revised contract for smokefree services for all localities by December 2020. 2.8 Māori Equity Dashboard and Equity of Outcome Areas Reporting against the dashboard is due to start in September with deep dives being completed by executives. These reports will be submitted to the Health and Disability Advisory Committee (HDAC) and Manawhenua Hauora. The intention for the deep dives is to get a better understanding on how to improve performance and provide accountability on reducing inequity in Maori health. Alongside the dashboard reporting will be quarterly reporting against the seventy-nine Equitable Outcome Actions to HDAC. These actions are also built into HDAC reporting six weekly to provide progress updates. There is a good sense now that structural reporting on equity is strong and is consistent. We look forward to more sustainable outcomes over the next twelve months.

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For:

Decision

X Endorsement

Noting


Author Angela Rainham, Locality and Population Health Manager

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

Vanessa Caldwell, Clinical Executive, Te Uru Rauhī

Date 17 August 2020

Subject Ōtaki Health and Wellbeing Plan Update

RECOMMENDATION

It is recommended that the Committee: endorse the progress that has been made in relation to the Ōtaki Te Mahere

Hauora (the Ōtaki 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 Ōtaki. It is for endorsement. No decision is required. 2. BACKGROUND The Ōtaki Health and Wellbeing Plan was completed in 2018 as one of the 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. All five plans (Horowhenua, Manawatū, Ōtaki, Tararua, and Palmerston North City) can be found at: http://www.midcentraldhb.govt.nz/Planning/localPlan/Pages/LocalityPlanning.aspx 3. IDENTIFIED COMMUNITY PRIORITIES The plan identifies priority areas in relation to the health and wellbeing of the community, as identified by the community. The community priority areas identified for Ōtaki were: Access to Healthcare Easy access to Healthcare when people need it Mental Health and Addiction Improved Mental Health and Addiction support in communities Better Communication and Connection A district that has quality communications and connections between health services, people, whānau and communities Healthy Living A well community where everyone is supported to have quality living and healthy and active lives There are three focus areas within each of the four community priority areas, which are shown in the table on the following page.

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Access to Healthcare

Mental Health and Addiction

Better Communication and Connections

Healthy Living

Improving access to General Practice Teams and community based services.

People being able to get help when they need it.

People friendly communication.

Wider determinants of health.

Improving access to hospital and specialist care.

Locally designed and operated services.

Raising awareness of what services are available and how to access them.

Supporting whānau to make good lifestyle choices.

Improving people’s experience of healthcare (health working together as one team).

Youth-friendly services.

Increasing engagement and visibility.

Quality living for older adults.

4. PLAN OF ACTION PROGRESS A detailed dashboard report for the Plan of Action is attached as Appendix 1. Generally there has been good progress, with many actions completed or progressing well. One is listed as ‘behind/challenges’ and two are ‘yet to start’ Some of the actions will be ongoing, so will never be ‘completed’. 4.1 Additional Actions since the Plan was Developed Since this plan was developed, six additional actions have been added – three relating to Access to Healthcare, two relating to Mental Health and Addictions and one relating to Healthy Living. These appear at the end of the detailed report in Appendix 1. 5. HIGHLIGHTS IN PRIORITY AREAS 5.1 Reducing the impact of boundary issues (Access to Health Care) There has been a significant reduction in complaints about Ōtaki referrals being rejected by Capital and Coast DHB services since the Memorandum of Understanding (MOU) was signed with Capital and Coast DHB in July 2019. Work was done with Ōtaki Medical Centre to add a paragraph to the bottom of their referral forms that refers to the MoU and this seems to have made a difference in stopping their referrals being declined.

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Following the signing of the MoU, a pamphlet was developed to help Ōtaki and Te Horo residents understand the available services, how to get to them, and why some boundary restrictions exist. 5,000 pamphlets were printed and distributed to every household in Ōtaki and Te Horo as well as being put in some community spaces. We have recently done a media release to local Ōtaki media reitierating some of the main points from the MoU pamphlet that were still causing confusion. 5.2 Increasing Access to Mental Health Support (Mental Health and

Addictions)

The THINK Hauora Te Ara Rau service has undergone changes in response to the mental health inquiry ‘He Ara Oranga’. At the beginning of 2020, the Ministry of Health initiated a national rollout of a new service delivery model ‘Access and Choice’. Following the success of the MidCentral Region Integrated Primary Mental Health and Addiction Services Request for Proposal (RFP) submission, Te Ara Rau Access & Choice is now blossoming into the full potential of the whakāro behind their name “The Path of Unlimited Opportunities”. Alongside the role of the Mātanga Whai Ora clinical kaimahi (Expert or Experienced in the Pursuit of Wellbeing), Te Ara Rau Access and Choice is moving from a predominantly mental health focus into the Holistic Wellbeing and Early Intervention space. This now truly aligns with the foundation model of Te Whare Tapa Whā. As well as improving access and choice for our tāngata whaiora within our rōhe, this innovative and exciting way of looking at healthcare will be exponential for continued wellbeing. In the first phase of this programme roll out, the new model will provide the following for the Ōtaki Community: A Mātanga Whai Ora (Health Improvement Practitioner) clinical kaimahi

(0.9FTE) working 0.5 FTE from the Ōtaki Medical Centre and 0.4FTE with the wider Ōtaki community. THINK Hauora are currently recruiting for this role.

A Kaiwhakapuaki Waiora (Heath Coach/community support worker) to work in the Ōtaki Community. Kaiwhakapuaki Waiora have lived experience of a health condition and are able to walk alongside Whānau Māori and others in their journey to wellness. Whaioro Trust are currently recruiting for this role.

5.3 Suicide Prevention (Mental Health and Addictions) MidCentral DHB staff members worked closely with members of the local Ōtaki community in establishing a Suicide Prevention/Postvention Response team that covers Horowhenua and Ōtaki. The team is now up and running and is functioning well. This group requested to have suicide prevention training held in the town so a free suicide prevention training course, ‘Mana Akiaki’, was run in Ōtaki on 30 October 2019. In the Mental Health space, the DHB also funds Kāpiti Youth Support (KYS) to provide counselling services for 10 to 24 year olds in the Ōtaki community. Having counsellors on site at the Matene Street clinic has improved access for local

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rangatahi. Young people are engaging better with the counselling which leads to better mental health outcomes. 5.4 Regular Locality Updates (Better Communication and Connections) “Well Communities” e-newsletters are being sent out regularly to a database of service providers and community groups and organisations in the city. These have been done quarterly since March 2020. In April a special COVID-19 communication was sent out to the database to explain how local services were being provided during Levels 4 and 3. Starting this month, we will also be doing a bimonthly article in the ‘Ōtaki Mail’ newspaper which is delivered to all households in the area. The first article will outline the provision of Women’s Health Services in the community as this issue has been raised after the recent closing of the Ōtaki Women’s Centre.

5.5 Quality Living for Older Adults (Healthy Living) In-home strength and balance and community strength and balance classes are now being provided in Ōtaki. These programmes help older people to maintain their independence and quality of life. A good number of referrals are being received in Ōtaki for the in-home strength and balance programme and there are three approved community strength and balance classes running in the town. In keeping with the DHB’s vision of providing locality-based services, Te Uru Whakamauora (Healthy Ageing & Rehabilitation cluster) has also recently introduced a system whereby a dedicated pairing of a Clinical Nurse Specialist and Consultant Physician for older people’s health will support GP teams and aged residential care facilities in the Ōtaki community. Having these dedicated staff means better continuity of care for older Ōtaki people who are needing health services. 6. ENGAGEMENT WITH THE LOCAL COMMUNITY Recent engagement has included a presentation of progress in relation to the plan to the Ōtaki Community Board and attendance at a Community Korero hosted by Ōtaki Medical Centre and Te Puna Oranga o Ōtaki. Further engagement is planned with local iwi representatives and other population groups, including older people and rangatahi. Information will be gathered regarding current health and wellbeing issues in the community and this will be shared with members of the Organisational Leadership Team so that they can use that information to inform their planning going forward. 6.1 Annual Locality Forum Planning is underway to hold to 2020 Annual Locality Forum in October (COVID-19 alert levels allowing). The venue will be the Ōtaki Rotary Lounge this year after we found that the Supper Room at the Community Centre used last year was not quite big enough.

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7. LOCAL HEALTH AND WELLBEING ADVISORY GROUP The Ōtaki Health and Wellbeing Advisory Group continues to be very active. Representatives from Kāpiti Coast District Council, Ministry of Social Development and the local Citizens Advice Bureau have been added to the group in the last year. The group is proving an effective means to get messaging out into the community and getting feedback from the community. During the COVID-19 response we learnt through the Health and Wellbeing Group chair that there were concerns from the community about Ōtaki MedLab being temporarily closed and face-to-face Mental Health appointments also being changed to virtual. Explanations of the reasons for these temporary changes (and reassurance that they were just temporary) were given to the Group Chair and information was also then communicated out through a locality e-newsletter. 8. OTHER RECENT LOCALITY WORK 8.1 Updated Population Snapshot A new population snapshot for Ōtaki has been developed, based on the 2018 Census data. This is included in reprints of the Ōtaki Health and Wellbeing Plan. 8.2 Supporting St John Ambulance Staff St John were having problems with their ambulance officers being challenged by patients who were wanting to be able to choose which hospital they would be taken to. We were approached by their District Operations Manager to help them by producing an official document that explains to patients that they cannot choose which hospital the ambulance takes them to. A one page document was developed and signed off by ourselves, Capital and Coast DHB and St John and this has now been distributed to ambulances in Ōtaki. 8.3 Improving relationships with Kāpiti Coast District Council On 10 July a meeting was held between our MidCentral DHB Chief Executive and Chair of the Board and the Mayor and Chief Executive of Kāpiti Coast District Council. The meeting was also attended by the Locality and Population Health Manager. The meeting provided the opportunity to discuss shared priorities and plans for the district and community. At an operational level, initial meetings have been held between Steve Flude, Kāpiti Coast District Council Senior Advisor Local Outcomes, and our Locality Manager and Psychosocial Welfare Response lead to discuss how our two organisations can work together more going forward to gain the best outcomes for Ōtaki residents (both in general and in the COVID-19 response phase). Recently the Locality Manager and Psychosocial Welfare Response lead also represented the DHB at a workshop hosted by Kāpiti District Council where key government agencies and the two local DHBs were brought together to discuss future partnerships.

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Appendix 1 Priority Area Progress Action Points in Plan Impact seen Comments re progress Access To Health Care

People are able to get help when they need it

Complete Ōtaki Medical Centre will develop a Communication Strategy to increase awareness of services and better connect with the local community.

Ōtaki Medical Centre’s Communication Strategy includes: development of a facebook page and a regular article in the local newspaper. They are also holding periodic Community Korero events to engage more with the community.

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

Patients appreciate the nurse practitioner service offering more patient contact time at reduced cost. 45 percent of GP phone triaging calls are being resolved over the phone – saving people the need to attend the clinic in person and reducing waiting times for appointments.

Ōtaki Medical Centre have engaged a nurse practitioner. GP telephone triage has also been introduced.

Progressing well People will be able to use online tools to get repeat prescriptions, make appointments and receive test results through a patient portal.

Ōtaki Medical Centre currently offer the patient portal. Also introducing e-prescribing.

Progressing well 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.

Work continues on increasing awareness - this will be included in winter wellness messaging over the next quarter. The THINK Hauora website has recently been updated, and includes a visual campaign ‘Where to go for care’.

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Progressing well People will have more choice by increasing awareness of what different health professionals can do and which service to choose when. Eg Raukawa Whānau Ora Health Services deliver Podiatry clinics from Taaringaroa.

As above. Work is also being conducted by Te Puna Oranga o Ōtaki. Articles outlining the roles and abilities of primary clinicians are also being included in locality newsletters.

Improving people’s access to hospital and

specialist care

Progressing well Health and its partners will work together to reduce the impact of boundaries on accessing healthcare to provide greater choice of which hospital to access.

An MOU has be signed between MidCentral and Capital and Coast. Education for service providers as well as the public is ongoing. An agreement has also been made with St John that STEMI patients in Ōtaki will automatically be taken to Wellington Hospital.

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.

Progressing well 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.

Increased utilisation of consults over the phone or online has occurred with the COVID-19 response.

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

Positive feedback has been received about the new spaces in the Emergency Department.

During the extensive building work the public were understanding and accommodating of the noise and disruptions that were occurring around them. Staff were grateful of their tolerance and understanding.

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

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

This is part of the Digital Health Strategy. The Indici system that Ōtaki Medical Centre are adopting will also enable this.

Yet to start

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

There is already a small locality team in place in Ōtaki. 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.

Ōtaki Medical Centre having a patient portal allows people to access results etc.

Progressing well 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 the Cluster Alliance Groups. Also a database of consumers who are keen to be part of future service development programmes has been developed.


People being able to access help when they need it

Progressing well 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.

Regular training workshops have been held in Ōtaki. This is not specifically for those working in rural communities but is open to them. The Rural Support Trust has been running the Good Yarns programme - all Fonterra tanker drivers have received this training.

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Progressing well Build Mental Health and Addiction Services visibility in communities by developing a relevant and modern communications strategy.

Considering: Television presentation in General Practices and A3 posters.

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

Public Health is distributing information re Fetal Alcohol Syndrome through social media channels linking to the campaign run through the Health Promotion Agency using Facebook and Instagram. 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.

Locally designed and operated services

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 set up and updated twice yearly. Unison may be looking at an online directory with shopping cart to personalise.

Progressing well A Suicide Prevention Local Response Team will be in place in the district in 2019. This will involve local agencies working collectively as one team to better support the community

Work with the community resulted in a Horowhenua/Ōtaki Local Suicide Prevention/Postvention Response team being established. This has good representation from Ōtaki and is functioning well.

Youth friendly services

Ongoing The Mates and Dates programme will be available at local secondary schools – helping youth to build healthy relationships.

This was provided by Public Health Unit in 2018. Contract is now with WellStop and Youthline. WellStop has been asked for feedback.

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Started Support and enhance Tangatahi Ora in collaboration with Te Kura-a-Iwi o Whakatupuranga Rua Mano. Focusing on strengthening whānau ora, healthy lifestyles, resilience and wellbeing.

Seeking more information about this programme.

Communications and Connections

Improving Communications

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

A working group (including Consumer Council members) is currently reviewing patient letters.

Progressing well 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.

Progressing well People will be able to access the new Palmerston North 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 newsletters out to communities.

Progressing well 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.

Progressing well Bi-lingual communications will be increased to better connect with Te Reo Maori speakers in the community.

The DHB updated its "Translation of written information into Māori" policy in 2019. This policy ensures that there is access to information in Te Reo Maori to improve services for those fluent speakers of Te Reo.

Raising awareness of what services are

available and how to access them

Progressing well People will be more up-to date with what’s happening in the Ōtaki 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 through multiple channels. The social media following increased significantly during COVID-19.

Progressing well Local success stories and programmes and initiatives that are working well will be shared with the community.

The profiling of new services and success stories has been, and continues

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to be, done through media releases and locality newsletters.

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

A working party (led by 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.

Progressing well 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 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.

Progressing well Communications from the DHB will be sent out to community groups and providers on a more regular basis, with opportunities for people to provide suggestions and feedback.

Quarterly newsletters are sent out to a database of local groups, organisations and stakeholders. Locality Manager produces these.

Increasing Engagement and visibility

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

Progressing well Feedback from Ōtaki residents about strengths, challenges and areas of priority within the community will be collected through at least one forum per year.

First forum was held in May 2019 and attended by 39 community members. The 2020 forum and other targeted engagements are currently being planned.

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

Locality information is being used in planning for clusters.

Complete A health and wellbeing group for Ōtaki will be developed or connect to an existing group, where we all work together on a common agenda to tackle the bigger issues.

Health and Wellbeing Group up and running.

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Progressing well Health will be aware of key issues for Ōtaki by having a greater presence at key meetings.

Having members on the Health and Wellbeing Group is a key part of this.

Healthy Living Play a role in tackling the wider determinants of health

Complete 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.

The training was some time ago so connection has been made between OMC and MDHB Family Violence Coordinator to look at retraining

Completed 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 Ōtaki.

This was delivered in October 2019. Attendance poor. However in response to community wishes a workshop was delivered in Feb 2020 in conjunction with the Ministry of Social Development and Inland Revenue.

Progressing well 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 Ōtaki.

The local Health and Wellbeing Group provides a vehicle for doing this.

Complete Feedback will be submitted to the 2018 National Travel Assistance Policy Review 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.

Local initiatives to help people make good

lifestyle choices

Complete An Active Teens programme will run in the community focusing on goal setting, increasing physical activity and better nutrition.

Participants learnt how to incorporate regular physical activity and healthy eating into their lives.

8 teens took part in the programme in 2018. Sport Manawatu will look at running again if community need is there.

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Complete An Active Families programme will run in the community focusing on goal setting, increasing physical activity and better nutrition.

Whānau participating in the programme will live healthier lifestyles going forward due to what they have learnt on the programme.

3 whānau took part in the programme in 2018. Sport Manawatu will look at running again if community need is there.

Ongoing Schools will be encouraged to be a “Health Promoting School” where they partner with their community to make positive steps to improve the health and wellbeing of students.

Health Promoting Schools has been replaced by "Healthy Active Learning" and expanded to include secondary schools and early learning centres. Offered to all schools annually.

Ongoing People will be more aware of the benefits of physical activity and healthy eating as physical activity and nutrition resources and information are distributed through a variety of local channels.

Resources distributed directly to individuals and organisations. Also through social media, website, Public Health Nurses in schools and the Health Promoting Schools Programme. Info also distributed to pregnant women through Lead Maternity Caregivers.

Complete More kids will be encouraged to ride bikes, by advocating to Council for a bike in schools programme and encouraging schools to adopt it.

Put into 2019 annual plan submission

Progressing well The DHB will play a more active leadership role in connecting community groups and services; as collectively they can have a greater impact on the wellbeing of community members

This has been done through facilitating the development of the Health and Wellbeing Group

This has been done through facilitating the development of the Health and Wellbeing Group

Quality Living for older adults

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 Ōtaki in 2018.

A good number of referrals are being received from Ōtaki

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Progressing well Community groups will have increased support to provide strength and balance classes for older people.

Underway by Sport Manawatu and going well.

Progressing well People working with older adults in the community will be kept up-to-date with the different types of support, services and community activities available for older adults through regular communications.

Regular communication occurs quarterly with e-newsletter updates and information disseminated through Ōtaki Health and Wellbeing Group.

Additional Actions since the plan was developed

Access to healthcare


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

Started December 2018

Improving people’s access to hospital and specialist care

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

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

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

In-clinic hysteroscopies are well underway. Alternate community arrangements are now available for some women who have miscarried.



Complete People will be given the tools to recognise, relate and respond to those who need support for their mental health and wellbeing, through attending a one-day workshop (MH101).

The 17 attendees have greater confidence in recognising signs and symptoms of different disorders and knowing how to respond.

Training held December 2018.

Complete Suicide Prevention Training will upskill agencies, professionals and schools in

Approx 50 people attended with 85 percent reporting

A suicide prevention training session was well attended in December 2018.

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detecting and managing those at risk of suicide.

increased awareness and knowledge about detecting and managing people at risk of suicide.

At the request of the community, another free suicide prevention training session (Mana Akiaki) was held in Ōtaki on 30 October 2019.

Healthy Living Quality Living for Older Adults

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

The unit was officially opened on 11 November 2019 and is now fully operational.

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For:

Approval

X Endorsement

Noting


Author Graeme Gillespie, Advisor, Commissioning and Contracts

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

Date 18 August 2020

Subject Community Pharmacy Services Commissioning

RECOMMENDATION


endorse for the Board’s consideration the Community Pharmacy Services Commissioning Policy for Board approval

note that approval by the Board of the Community Pharmacy Services Commissioning Policy ends the moratorium on issuing new contracts for community pharmacy providers.

Strategic Alignment

The Community Pharmacy Commissioning Policy is closely aligned to the key strategic priorities and enablers in the MidCentral DHBs Strategy. The themes are consistent with our desire to invest in services that support Quality Living, Healthy Lives and Well Communities. The purpose of the policy is to drive improved integration of primary care services and reinforce a strong equity focus, ensuring that we maximise our investment in areas that will improve equity of health outcomes for our priority populations, including those with financial barriers and those with complex health and social needs.

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1. PURPOSE This report seeks Committee endorsement of the final Community Pharmacy Commissioning Policy (“the Policy”) for MidCentral District Health Board (MDHB) approval. 2. SUMMARY The Community Pharmacy Services Commissioning Policy supports the Pharmacy in MidCentral Strategy, (“the Strategy”) which was approved by the MDHB Board in October 2019. The Strategy and Policy have been created to guide the future development of pharmacy services in the MidCentral district. The strategy incorporates local and national strategic priorities and was developed with extensive engagement with the pharmacy sector and other stakeholders, including Māori, Consumers and primary care. The Policy will enable MDHB to lift its current moratorium on new community pharmacy services contracts and start to take an active role in the commissioning of new and changed local pharmacy services. Such services are part of the Integrated Pharmacy Services Agreement, which all local pharmacies have signed up to.

3. BACKGROUND The strategic environment for community pharmacy is determined by the New Zealand Health Strategy, the Ministry of Health’s Pharmacy Action Plan 2016-2020 and Implementing Medicines in New Zealand 2015-2020 and the MDHB Strategy and Pharmacy in MidCentral Strategy. The practice in New Zealand has been for District Health Boards (DHBs) to automatically approve any application for a new Integrated Community Pharmacy Services Agreement (ICPSA). This allowed the market to determine the location of community pharmacies and the services they provided. This has resulted in an oversupply of services in some areas and shortage in others. The emergence of new entrants risks cherry picking more profitable services leading to reduced sustainability of critical services to vulnerable populations and increased inequity. The 2019 variation to the ICPSA introduced clauses relating to location, equity and audit. In order to apply the location provisions the DHB must have a policy relating to population access to community pharmacy services. This Policy fulfils that requirement. This Policy provides the opportunity to configure and shape our pharmacy services to ensure greater emphasis on access, targeting inequities and generate better health outcomes for our community. The policy provides greater influence on where new pharmacist services are located, and ensure the providers demonstrate a collaborative partnership with primary care. It will assist to ensure provision of community pharmacy services that best address our vision for quality pharmacist services.

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The Policy will drive the commissioning of services through Community Pharmacies that support the MDHB strategic imperatives and outcomes sought by the Ministry of Health Pharmacy Action Plan and MidCentral DHB Pharmacy in MidCentral Strategy. The criteria for decision making to determine applications will be based on the applicant’s ability to demonstrate the following: Alignment with national and local strategic priorities for pharmacy and

pharmacy services Good character and meets requirements to practice Provision of accessible services to a population in need of pharmacy services Sufficient qualified staff to deliver services Achieving better health outcomes through a holistic approach A focus on providing integrated patient care across Pharmacy in MidCentral and

primary care Suitable systems and processes to deliver quality, best practice services Addressing funding priorities as directed by the Board or the Ministry of Health. On 18 December 2018 the Board approved the imposition of a moratorium on issuing new contracts for community pharmacy providers from the 18 December 2018, until the adoption of a policy on contracting pharmacy services within MidCentral in 2019. 4. CONSULTATION Consultation with key stakeholders on the Community Pharmacy Services Commissioning Policy and Quality Framework was undertaken during December 2019 and January 2020. This was followed by a period of direct engagement to finalise the Policy. Submissions were received from Community Pharmacists, the Clinical Council, a Consumer Council member, a Community Wellbeing Committee and the Pharmacy Guild The strongest feedback related to the application of the Policy to existing Integrated Pharmacy Services Agreement holders in the sale of businesses and the membership of the Commissioning Panel. The provisions of the ICPSA in respect to amalgamation or sale and purchase of an existing pharmacy that the DHB not unreasonably withhold consent for the assignment or transfer of rights or obligations under the ICPSA is made clear. Membership of the Commissioning Panel will include an experienced community pharmacist. It is considered that this sector knowledge and experience will enhance the commissioning process and outcomes. Submitters also offered valuable suggestions for quality improvement in respect to errors, formatting, definitions and consistency.

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An area of contention is the co-location of community pharmacy services with the sale of tobacco products and alcohol. The Policy does not exclude this, however requires the applicant to identify how they will reduce or mitigate the adverse health impact of any co-located and nearby services and facilities relating to alcohol and tobacco sales, gambling facilities, or other services that contribute to poorer population health outcomes. It is felt any such restriction targets specific providers, who may also provide significant access benefits. Other issues raised included: provision of financial statements; lack of a defined review period; provision of an equity plan; membership of the Manawatu Community Pharmacy Group; and, managing conflicts of interest. The requirements in respect to these matters have been made clearer. 5. CONCLUSION Implementing the Community Pharmacy Commissioning Policy is the final element in a strategically led approach to community pharmacy in MDHB. It supports MDHB to determine the nature and location of community pharmacy services within the context of national and DHB strategic frameworks and community need. The Policy allows MDHB to lift its moratorium on new community pharmacy agreements.

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POLICY

Document No: MDHB-[Type No.] Page 1 of 15 Version: 1 Prepared by: [Type Author full name] Issue Date: [Type dd/mm/yyyy] Authorised by: [Type Designation/Committee] I:\FUNDING\Common\Board Reports and Committee Reports\Health & Disability Services Advisory Committee\2020\July\Community Pharmacy Commissioning Policy.docx

MidCentral District Health Board 2005. CONTROLLED DOCUMENT. The electronic version on the Controlled Documents site is the most up-to-date version. MDHB will not take any responsibility in case of any outdated paper or electronic copy being used and leading to any undesirable consequence.

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COMMUNITY PHARMACY SERVICES COMMISSIONING

Applicable to: Community Pharmacy Services Providers

Issued by: Strategy, Planning and Performance

Contact: Advisor Commissioning and Contracts

1. PURPOSE

The purpose of this policy is to outline an equitable and quality approach by which MDHB will commission new Community Pharmacy Services that achieve our statutory objectives and the national and DHB visions in a manner that best meets the needs of the MidCentral DHB district community in an equitable manner.

Commissioning is a continual and iterative cycle involving the development and implementation of services based on strategic planning, procurement, monitoring/reporting and evaluation. Commissioning describes a broad set of linked activities, including service overviews, priority setting, procurement and purchase through contracts, monitoring of service delivery and review and evaluation.

2. CONTEXT

MidCentral District Health Board (MDHB) has a statutory objective under the Public Health and Disability Act 2000:

‘..to seek the optimum arrangement for the most effective and efficient delivery of health services in order to meet local,……. needs.’

The Integrated Community Pharmacy Services Agreement (ICPSA) came into effect on 1 October 2018. The intent of this agreement is the provision of Integrated Pharmacy Services in the community delivered with greater flexibility that meet the needs of local populations, address inequities, promote pharmacists as experts in medicines management and encourage collaboration between consumers, their pharmacist and a broader multi-disciplinary team. A variation to ICPSA in 2019 provided DHBs ability to have control over the location of contract holders if it had a policy relating to population access to community pharmacy services. This policy serves that purpose. This policy guides how the DHB will achieve the intent of the Ministry of Health Pharmacy Action Plan 2016-2020 and the MidCentral DHB Pharmacy in MidCentral Strategy.

3. SCOPE Situations where this policy applies include:

All requests received for a new Integrated Community Pharmacy Services Agreement (ICPSA)

When existing ICPSA holders seek the partial or complete sale of a pharmacy or there is a change in control of the pharmacy

When an existing ICPSA holder: o Seeks to relocate the pharmacy; or,

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o Seeks to provide services from an additional premises (including through a satellite

pharmacy) or location; o Seeks to amalgamate with one or more providers; or, o Seeks to provide a new funded Pharmacy Service within existing contracts.

. This policy applies to:

All employees and Board Members of MDHB; All external personal; and Any other designated person or organisation dealing with the commissioning of

Community Pharmacy Services for, or on behalf of, MDHB.

4. POLICY STATEMENT

In 2018, all community pharmacies within MidCentral signed the Integrated Community Pharmacy Services Agreement (ICPSA). The contract placed emphasis on clinical services and enabled local DHBs to purchase locally focused and targeted services. In 2019, the Community Pharmacies all signed Variation 1A which introduced clauses relating to location, equity and audit. In order to enforce the location provisions the DHB must have a policy relating to population access to community pharmacy services.

This policy provides the opportunity to configure and shape our pharmacy services to ensure greater emphasis on access, targeting inequities and generate better health outcomes for our community. The policy provides greater influence on where new pharmacist services are located, and ensure the providers demonstrate a collaborative partnership with primary care. It will ensure community pharmacy services that best address our vision for quality pharmacist services. Providers must be capable of complying with the ICPSA and support the Pharmacy Action Plan and Pharmacy in MidCentral Strategy.

MidCentral DHB will continue to investigate and develop opportunities to commission services through Community Pharmacies that support the following:

MidCentral DHB Strategic Imperatives o Achieve quality and excellence by design o Connect and transform primary, community and specialist care o Partner with people and whānau to support health and wellbeing o Achieve equity of outcomes across communities

Pharmacy Action Plan 2016-2020 o Population and personal health o Medicines management services o Minor ailments and referral o Dispensing and supply services

Pharmacy in MidCentral Strategy o Systems o Services o Workforce

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This approach will take a quality improvement approach, with a focus on:

Delivery of services based on health need Equitable access to pharmacy services Fully informed patient self-care Integrated, multi-disciplinary co-ordination to patient services A focus on people centric collaboration between pharmacists – from Hospital to

Community. Increasing primary care capacity

5. PROCESS

The process for assessing applications for a new pharmacy, amalgamation of pharmacies, sale and purchase of existing pharmacies, or new pharmacy services will be as follows:

a. Applicants for new pharmacies, amalgamations, sale and purchase of existing pharmacies or new pharmacy services should complete the relevant application form and send it to: Advisor Commissioning and Contracts, Strategy, Planning and Performance, MidCentral DHB, Gate 2, Heretaunga St, Palmerston North 4414 or emailed to [email protected]

b. An email acknowledging your application will be sent within five (5) working days of receipt.

c. MidCentral DHB will convene the MidCentral DHB Community Pharmacy Commissioning Panel to consider the information provided in the application form, having regard to current access and quality of pharmacist services for the population in the proposed location.

d. The panel will make a recommendation to the General Manager, Strategy, Planning and Performance.

5.1 Applications for new Pharmacy Contracts

The applicant will be advised of the outcome of the application within 20 business days of making the application, unless a request for additional information is made.

Where the application is for a new contract for a pharmacy, applications that are granted will be subject to the pharmacy subsequently obtaining and maintaining a pharmacy licence through the Ministry of Health.

5.2 Applications for Relocations, Additional Premises or Locations, Amalgamations or Sale and Purchase of existing pharmacies

The applicant will be advised of the outcome of the application within 20 working days of making the application, unless a request for additional information is made.

Applications relating to existing pharmacies will be considered against the criteria outlined in clause 6.2 of this policy, consistent with the requirements of clause C.45 of the ICPSA.

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5.3 Applications for new funded national services within existing Pharmacy Contracts

These are newly funded national services. Local Commissioning will continue to be undertaken by the MidCentral Community Pharmacy Group in consultation with the DHB.

The applicant will be advised of the outcome of the application within three months of making the application.

If approved, the service may be initially tested through a short-term pilot programme with funding support (up to 12 months). Extensions after 12 months will be dependent on the performance of the pilot programme.

5.4 Applications not received

MidCentral DHB is not responsible for applications that are not received.

5.5 Requests for additional information

During the application process, the panel may require further information from an applicant additional to that contained in the application, for example in regard to: determining the nature of the interest held by any person in the pharmacy the requirement for a person to be a 'fit and proper' person or a body corporate to be of

'good repute' the ownership structure of the pharmacy

The applicant will be advised of the outcome of the application within 20 working days of providing the additional information.

If the applicant fails to supply the information within 30 days of the date of the request (or within any additional time given by the Panel) the application will lapse. This requires the applicant to submit a new application.

5.6 Once an application is approved

Applications for new Pharmacy Contracts and Relocations, Additional Premises or Locations, Amalgamations or Sale and Purchase of existing pharmacies.

Subject to the application being approved, the applicant will have ninety (90) days to begin the process of purchasing/leasing the pharmacy building and submit the application for a Ministry of Health Pharmacy Licence. If the applicant fails to begin the process within 90 days, the approval may be revoked and a new application may be required. New pharmacy operations must be completed within 12 months of approval. If the applicant fails to begin to complete the process within 12 months from approval, the approval may be revoked and a new application may be required.

Applications for new Pharmacy Services within existing Pharmacy Contracts

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Subject to the application being approved, the applicant will have ninety (90) days to begin the provision of service through a new pharmacy or existing pharmacy. If the applicant fails to complete providing the service within 90 days, the approval may be revoked and a new application may be required.

5.7 If an application is declined

In the event of the application being declined, the applicant will have a single right of appeal to the General Manager, Strategy, Planning and Performance within 30 days by providing additional information to support the original application. The decision of the General Manager, Strategy, Planning and Performance will be final.

If information presented is found to be fraudulent, incorrect, frivolous or vexatious the application will be declined.

This right of appeal does not derogate from any rights the applicant might have at law or under statute.

6. APPLICATION CRITERIA AND DECISION MAKING

The criteria for decision making (approving applications) will be based on the applicant’s ability to demonstrate the following:

Alignment with national and local strategic priorities for pharmacy and pharmacy services. Good character and meets requirements to practice. Provision of accessible services to a population in need of pharmacy services. Sufficient qualified staff to deliver services. Achieving better health outcomes through a holistic approach. A focus on providing integrated patient care across Pharmacy in MidCentral and primary

care. Suitable systems and processes to deliver quality, best practice services. Funding priorities as directed by the Board or the Ministry of Health

Each is explained in more detail below and the information requirements are set out.

6.1 New Contracts

Applications for new contracts will be assessed against the following criteria. The associated information requirements are also set out:

Criteria Information requirement

The applicant has demonstrated it is of good character and there are no unresolved issues concerning the pharmacist/s current or past Annual

Provide the following Applicant information – APC (including any conditions), police check and good character information.

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Practicing Certificate/s (APC) or Ministry of Health licence/s or conditions.

Details of community pharmacy experience

Details of any conditions imposed on an APC

Details if an APC has ever been cancelled

If the applicant has been a pharmacy owner previously, provide details if a Ministry of Health licence has had conditions applied or cancelled.

The applicant has demonstrated that the proposed services are consistent with relevant national and local strategic priorities for pharmacy and pharmacy services.

The applicant will contribute to providing best practice advice and service so that the people of MidCentral achieve better health outcomes – People Centric, Best Practice, Better Health Outcomes.

Explain how the proposed services will meet the relevant national and local strategic priorities for pharmacy and pharmacy services outlined in the Clause 4 Policy Statement and Pharmacy in MidCentral Strategy.

Provide a plan on how the proposed services will address inequity.

Provide details about how the applicant will contribute to providing best practice advice and service so that the people of MidCentral achieve better health outcomes – People Centric, Best Practice, Better Health Outcomes.

The applicant has demonstrated that it will provide services required by MDHB in an area or for a population in need of pharmacy services. Assessment of this criterion will include:

location population served proposed services opening days/hours

Pharmacy Information – location, proposed services, opening hours.

Confirmation that the applicant will provide all PHARMAC Schedule section B, C and D medications to patients if requested and required; including high cost medications (exemptions may apply as directed by MidCentral DHB or PHARMAC).

Provide information about existing pharmacy services in the proposed location and the different services that will be supplied from the existing services.

Distance to nearest existing pharmacies. Proximity to primary care services and

populations with special needs. Explanation of what the population

needs are of the proposed pharmacy

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location, how are they currently being met and how the services provided by the applicant will meet the unmet population health needs.

The applicant demonstrates that it has sufficient staff with relevant qualifications and accreditations to deliver the proposed services.

Provision of staffing plan and profile. Information on contingency planning to

ensure maintenance of acceptable minimum staffing levels.

The applicant will demonstrate how it will increase the impact of co-located and nearby services and facilities with positive health outcomes and how it will minimise and mitigate the impact of those with negative health outcomes.

Information on where the proposed pharmacy will be located, including information on co-located and nearby services and facilities relating to better population health outcomes, such as healthy eating, healthy exercise, social inclusion, etc. and how the pharmacy will leverage these to improve health outcomes.

Information on any co-located and nearby services and facilities relating to alcohol and tobacco sales, gambling facilities, or other services that contribute to poorer population health outcomes and how the pharmacy will reduce or eliminate their adverse impact on health outcomes.

The applicant has demonstrated that it will work in an integrated manner with primary care providers to ensure continuity of care to patients resulting in better health outcomes.

Explanation of how the applicant will work with primary care providers to support better health outcomes.

Evidence of engagement plan with primary care providers in the proposed location.

Information on how the applicant will engage with population groups with greater needs, including the elderly and those receiving mental health and addiction services.

The applicant has demonstrated it has suitable systems and processes in place to meet the Pharmacy in MidCentral Strategy and the Community Pharmacy Quality Standards.

Provide evidence of systems and processes relevant to meeting the Pharmacy in MidCentral Strategy and the Community Pharmacy Quality Standards.

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6.2 Relocations, Additional Premises or Locations, Amalgamations or Sale and Purchase of existing pharmacies

Applications for, relocations, additional premises or locations, amalgamations or sale and purchase of existing pharmacies, will be assessed against the following criteria, consistent with clause c.45 of the ICPSA. Whilst the DHB may not unreasonably withhold consent for the assignment or transfer of rights or obligations under the ICPSA it must be satisfied of the proposed transferee’s ability to perform its obligations under the agreement and request reasonable details to inform any consent. The DHB seeks to gain maximum quality improvement through any change. The associated information requirements are also set out:


The applicant has demonstrated it is of good character and there are no unresolved issues concerning the pharmacist/s current or past Annual Practicing Certificate/s (APC) or Ministry of Health licence/s or conditions.

Provide the following Applicant information – APC (including any conditions), police check and good character information.

Details of community pharmacy experience

Details of any conditions imposed on an APC

Details if an APC has ever been cancelled

If the applicant has been a pharmacy owner previously, provide details if a Ministry of Health licence has had conditions applied or cancelled.



Explain how the proposed services will meet the relevant national and local strategic priorities for pharmacy and pharmacy services outlines in the Clause 4 Policy Statement and Pharmacy in MidCentral Strategy.



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location population served proposed services opening days/hours


Confirmation that the applicant will provide all PHARMAC Schedule section B, C and D medications to patients if requested and required; including high cost medications (exemptions may apply as directed by MidCentral DHB or PHARMAC).


Explanation of what the population needs are of the proposed pharmacy location, how are they currently being met and how the services provided by the applicant will meet the unmet population health needs.


Provision of staffing plan and profile. Information on contingency planning to

ensure maintenance of acceptable minimum staffing levels.





The applicant will demonstrate how it will increase the impact of co-located and nearby services and facilities with positive health outcomes and how it will minimise and mitigate the impact of those with negative health outcomes.

Information on where the proposed pharmacy will be located, including information on co-located and nearby services and facilities relating to better population health outcomes, such as healthy eating, healthy exercise, social inclusion, etc. and how the pharmacy will leverage these to improve health outcomes.

Information on any co-located and nearby services and facilities relating to

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alcohol and tobacco sales, gambling facilities, or other services that contribute to poorer population health outcomes and how the pharmacy will reduce or eliminate their adverse impact on health outcomes.



6.3 Applications for new funded national services within existing Pharmacy Contracts




Explain how the proposed services will meet the relevant national and local strategic priorities for pharmacy and pharmacy services outlines in the Clause 4 Policy Statement and Pharmacy in MidCentral Strategy.




location

population served

proposed services

opening days/hours



Explanation of what the population needs are of the proposed pharmacy location, how are they currently being met and how the services provided by the applicant will meet the unmet population health needs.

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Provision of staffing plan and profile.

Information on contingency planning to ensure maintenance of acceptable minimum staffing levels.







7. MIDCENTRAL DHB COMMUNITY PHARMACY COMMISSIONING PANEL

The MidCentral DHB Community Pharmacy Commissioning Panel will assess applications against the criteria and provide an assessment on the extent an application meet the criteria. The MidCentral DHB Community Pharmacy Commissioning Panel will include the following roles:

Community Pharmacy Experience nominated by the MidCentral Community Pharmacy Group

Pae Ora Maori Health Directorate representative Primary Care Representative nominated by THINK Hauora Consumer or Community Representative nominated by the Consumer Council Chief Pharmacist Business Accountant

The Panel may seek additional information or advice, and/or co-opt additional members as required.

Panel members will be required to declare any conflicts of interest in respect to each application considered. The DHB will determine whether the conflict excludes the member from the Panel, or the conflict can be satisfactorily managed.

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Whilst the panel will strive for consistency in its approach to all applications, this policy relates to the provision of pharmacy services in the MidCentral Health District. MDHB will not be held accountable for the consistency of its decisions compared to those made in other DHBs.

8. POLICY REVIEW

This policy will be reviewed every three years.

9. REFERENCES

This policy acknowledges MDHB’s responsibilities under the following legislation: Public Health and Disability Act 2000; Commerce Act 1986; Employment Relations Act 2000; Fair Trading Act 1986; Health and Safety at Work Act 2015; Human Rights Act 1993; Medicines (Database of Medical Devices) Regulations 2003; Official Information Act 1982; Privacy Act 1993; Sale of Goods Act 1908 as amended by the Contractual Remedies Act 1979; Treaty of Waitangi Act 1975; Resource Management Act 1991; Ministry of Health, Health and Disability Services, Pharmacy Service Standards 2010.

10. DEFINITIONS

APC

The principal purpose of the Health Practitioners Competence Assurance (HPCA) Act 2003 is to protect the health and safety of members of the public by providing for mechanisms to ensure that pharmacists are competent and fit to practise. It requires pharmacists to be registered and hold a current Annual Practising Certificate (APC) to be able to practice, even if practising under supervision.

Consultant or Contractor

A person who provides services for a particular project or specified service, and is contracted to MidCentral DHB as an individual or through another entity (e.g. a company). Such persons usually manage themselves independently.

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Contract

An agreement between two or more persons or legal entities which is intended to be enforceable. Both parties must have capacity to contract. The essential elements of a contract are:

agreement between the parties as to the essential terms of their bargain; an intention by the parties to create a legally binding relationship; and the existence of consideration which means that each party gives the other something and each party gets something in return.

External Personnel Means:

authorised paid individuals or individuals from paid companies or other entities (non-employees) working within MidCentral DHB to meet staffing/service/project needs, e.g. external agency staff, locums, consultants and contractors; and authorised unpaid individuals or groups to observe (including clinical observers), gain experience, teach or provide support within agreed boundaries.

FTE An FTE is the hours worked by one employee on a full-time basis – full time equivalent. Full time is considered as 40hours per week.

Major Incident and Emergency Plan

A major incident and emergency plan is a plan that is appropriate to the Services being agreed and provided under the ICPSA. This is to ensure essential health services are able to continue to be delivered in times of Civil Defence events or other major incidents.

PHARMAC The Pharmaceutical Management Agency (PHARMAC) is the New Zealand Crown agency that decides, on behalf of District Health Boards, which medicines and related products are subsidised for use.

More recently, PHARMAC been appointed by Cabinet to be the future national shared procurement service for Medical Devices and will gradually begin to work on national contracts. The national contracts are optional for DHBs to use, but may offer significant benefits to the DHBs and where appropriate should be applied.

Priority Populations

Māori, Pasifika, LTC, Mental health, ARC and people living in the most deprived neighbourhoods.

Procurement Authority / Delegation

Refers to those persons given the authority to commit MidCentral DHB to procure an item/service of supply within a specified financial limit. Refer to the Delegations of Authority policy.

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Procurement and Purchasing Procedures and Templates

Various subordinate documents to this policy. Procedures prescribe various operational processes and specific functional roles in accordance with this policy. Templates are procurement-related documents with an approved format and content that must be used in DHB procurement.

Procurement All of the business processes associated with acquisition of goods and services, spanning the whole cycle from the identification of needs to the end of a service contract or the end of the useful life and subsequent disposal of an asset.

Purchase A transaction in which goods or services are acquired in exchange for payment.

Staff Means generally all people to whom this policy applies and who are involved in some capacity during a procurement process; and also

Means the person nominated to directly manage and be accountable for a particular procurement. Responsibilities include:

planning and documenting the procurement activity adequately;

engaging key stakeholders (including Procurement Services, Contract Services, Infection Control, Local and Regional Information Services, Health and Safety Services, where necessary);

development of requirements and specifications; obtaining necessary approvals and authorisation; providing originals of signed contracts to Contract Services;

and complying with regulatory requirements and relevant

MidCentral DHB policies.

11. RELATED MDHB DOCUMENTS

MDHB Policies: MDHB-1892 Health and Safety [Policy] [HR H3] MDHB-1963 Contracts Policy MDHB-2018 Conflict of Interest Policy MDHB-2022 Delegations Policy MDHB-5705 Procurement Policy

MDHB Guides:

Panel Assessment Template – New Pharmacy, Amalgamations or Sale and Purchase of existing Pharmacy Panel Assessment Template – New Pharmacy Services within existing Pharmacy Contracts

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MDHB Manuals:

Board Policies Manual Health and Safety Manual Procurement Manual

MDHB Strategy Documents:

MidCentral DHB Strategy Pharmacy in MidCentral Strategy

12. KEYWORDS

Contracts Government Rules of Sourcing Pricing / price reviews Procurement Community Pharmacy

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For:

Approval

Endorsement

X Noting

To Health & Disability Advisory Committee

Author Judith Catherwood, General Manager, Quality & Innovation


Date 24 August 2020

Subject Committee’s Schedule and Work Programme

RECOMMENDATION


notes the schedule for Committee meetings in 2021 which have beenapproved by the Board

notes the 2020/21 work programme is under review and will be presentedat the next meeting after approval by the Board

notes the review underway to develop a contemporary reporting and workprogramme commensurate with the role of the Health and DisabilityAdvisory Committee’s Terms of Reference.

Strategic Alignment

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

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1. PURPOSE This report updates the Committee on the development of the 2020/21 reporting schedule and work programme. The Committee is asked to note the meeting schedule for 2021 which is approved by the Board. The report is for the Committee’s consideration and no decision is required. 2. BACKGROUND The Board has asked the reporting schedule and work programmes for the Board, and the reporting Committees are substantially reviewed and a revised approach is presented to the Board for consideration at its next meeting. Board and Committee members have provided feedback that the previous approach was outdated, lack strategic focus, are too operational and have an excessive narrative. There is a desire to modernise and streamline the approach, creating contemporary and succinct reporting, whilst still ensuring the Board and Committees can undertake their governance functions effectively. The review is underway and until these are developed and approved, the Committee reporting will mirror the previous year’s schedule and approach as outlined below. 3. SCHEDULE AND WORK PROGRAMME The Committee’s previous work programme for 2019/20 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. During the COVID 19 response, the committee’s work programme and reporting framework was disrupted. A number of reports will be presented at the HDAC October 2020 meeting. These include a report on the outcomes of the 2019/20 regional planning programme including a revised regional plan for 2020/21, the MDHB Research report, the Clinical Governance and Quality Improvement, and the Maori Health Dashboard report. Reporting requirements from the health professional groups will be incorporated into the revised reporting schedule. Progress with the Cluster Health and Wellbeing Plans are reported in the regular Cluster performance reports at each meeting. The annual report on our Disability Strategy has also been delayed until later in 2020 as the original document was approved by the Board in December 2019. It will be provided to the Committee at the end of 2020. A presentation from Te Uru Kiriora will be provided to the Committee at this meeting. This was delayed from the previous work programme.

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The revised HDAC schedule of reporting and work programme for 2020/21 is under development and will be considered by the Board at the September 2020 meeting.

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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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2021 MEETING SCHEDULE FOR MDHB BOARD & ITS COMMITTEES

Meeting Time

HDAC 9am-1pm

FRAC 9am-1pm

Rem 1.00pm

Board 9am-1pm

Date of meeting

2 February 9 February

2 March

Deadline for reports

Reporting period 19 January

Nov/Dec 20

26 January

Nov/Dec 20 16 February

Nov/Dec 20 Jan 21 high level

Date of meeting

16 March 23 March

23 March 13 April


Reporting period

2 March

Jan 21

9 March

Jan/Feb 21

9 March

PE 31.12.20

30 March

Jan/Feb 21

Date of meeting

27 April 4 May

25 May


Reporting period 13 April

Feb & March

20 April

March/April 11 May

March/April

Date of meeting

8 June 15 June

6 July


Reporting period

25 May

April

1 June

May high level* 22 June

May

Date of meeting

20 July 27 July

27 July 17 August


Reporting period

6 July

May

13 July

May/June

13 July

YE 30.6.21

3 August

May/June

Date of meeting

31 August 7 September

28 September


Reporting period

17 August

June/July

24 August

July/Aug 14 September

July/Aug

Date of meeting

12 October 19 October

9 November


Reporting period

28 Sep

Aug/Sept

5 October

September 26 October

Sept Oct high level

Date of meeting

23 November 14 December

14 December


Reporting period 9 November

October

24 November

October 30 November

October

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Glossary of Terms

AC Assessment Centre

ACC Accident Compensation CorporationThe New Zealand Crown entity responsible for administering the country's nofault accidental injury compensation scheme.

ACCPP Accident Compensation Corporation Partnership Plan

ACE Advanced Choice of Employment

ACT Acute Crisis Team

ADL Activities of Daily Living

ADON Associate Director of Nursing

AESS Te Uru Arotau Acute and Elective Services

ALOS Average Length of Stay

Anti- VEGF Anti-Vascular Endothelial Growth Factor

AoG All of Government

AP Annual PlanThe organisation's plan for the year.

API Application Programming Interfaces

ARC Aged Residential Care

ASH Ambulatory Sensitive Hospitalisations

AS/NZS ISO 31000

2018 Risk Management Principles and Guidelines

B Block Wards, Laboratory, Admin, Out-Patients and Clinical Records

BAG Bipartite Action Group

BAU Business as Usual

BN Bachelor of Nursing

BSCC Breast Screen Coast to Coast

BYOD Bring Your Own Device

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.

CAPEX Capital Expenditure

CBAC(s) Community Based Assesment Centre(s)

CCDHB Capital and Coast District Health Board

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

CCTV Closed Circuit Television

CCU Critical Care Unit

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CDO Chief Digital Officer

CDS Core Data Set

CE Clinical Executive (of a service)

CEO Chief Executive Officer

CHF Congestive Heart Failure

CIMS Coordinated Incident Management System

CIO Chief Information Officer

CLAB Central Line Associated Bacteraemia

CME Continuing Medical Education

CN Charge Nurse(s)

CNM Clinical Nurse Manager

CNS Clinical Nurse Specialist

COI Committee of Inquiry

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.

COVID-19 Novel Coronavirus

CPHO Central Primary Health Organisation

CPOE Computer Physician Order Entry

CRM Cyber Risk Monitoring

CSB Clinical Services Block

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.

CTAS Central Technical Advisory Services (also TAS)

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

CVAD Central Venous Access Device

CWDs Case Weighted DischargesCase weights measure the relative complexity of the treatment given to eachpatient. 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

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DoN Director of Nursing

DS Digital Services

DSA Detailed Siesmic Assessment

DX Data ExchangeA data exchange software mechanism developed with the Social Investment Agency (SIA) to support encrypted data sharing between public services.

EAP Employee Assistance Programme

ECM Enterprise Content Management

ED Emergency Department

EDG-VPSR Electrocadiograph – Visual Positioning System Rhythm

EDOA Emergency Department Observation Area

EDON Executive Director of Nursing

EECA Energy and Efficiency Conservation Authority

ELT Executive Leadership Team

EMERGO Emergo Train System

EMR Electronic Medical Record

EN Enrolled Nurse

ENT Ear Nose and Throat

ENZ Enable New Zealand

EOC Emergency Operations Centre

EP Efficiency Priority

EPA Electronic Prescribing and Administration

EPMO Enterprise Project Management Office

ERCP Endoscopic Retrograde Cholangio Pancreatography

ERM Enterprise Risk Management

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.

EWS Early Warning System

FHC Feilding Health Care

FHIR Fast Healthcare Interoperability Resources

FIT Faecal Immunochemical Test

FM Facilities Management

FM Services Facilities maintenance and hotel services required by the DHBs

FPIM Finance and Procurement Information Management System

FRAC Finance, Risk and Audit Committee

FSA First Specialist Appointment

FSL Fire Service Levies

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

FU Follow Up

Gap Analysis used to examine current performance with desired, expected performance

GETS Government Electronic Tenders Service

GM General Manager

GMFCS General Manager, Finance and Corporate Services

GMPC General Manager, People and Culture

GMQI General Manager, Quality and Innovation

GMSPP General Manager, Strategy, Planning and Performance

GP General Practitioner

H&S Health and Safety

HaaG Hospital at a Glance

HAR Te Uru Whakamauora, Healthy Ageing and Rehabilitation

HBDHB Hawke's Bay District Health Board

HCA(s) Health Care Assistant(s)

HCSS Home and Community Support Services

HDAC Health and Disability Advisory Committee

HDU High Dependency Unit

HIP Health Infrastructure Programme

HQSC Health Quality & Safety Commission

HR Human Resources

HROD Human Resources and Organisational Development

HSWA Health and Safety at Work Act

Hui Formal meeting

HV High Voltage

HVAC Heating, Ventilation and Air Conditioning

HVDHB Hutt Valley District Health Board

HWIP Health Workforce Information Programme

HWNZ Health Workforce New Zealand

IA Internal Audit

IAAS Infrastructure as a Service

IAP Incident Action Plans

ICT Information and Communications Technology

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.

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IEA Individual Employment Agreement

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

IFM / IFM20

Integrated Facilities Management

IL Importance LevelSeismic assessment rating

IMT Incident Management Team

Insourced Delivered directly by the DHBs via its staff

IOC Integrated Operations Centre

IOL Intraocular Lens

IOT Internet of Things

IPSAS International Public Sector Accounting Standards

IS Information Systems

ISM Integrated Service Model

IT Information Technology/Digital Services

ITSM Integrated Service Module

IV Intravenous

IVP Improving Value Programme

JDE JD EdwardsName of software package

Ka Ao Ka Awatea

Māori Health Strategy for the MDHB District

KPI(s) Key Performance Indicator(s)A measurable value that demonstrates how effectively an objective is being achieved.

LDC Local Data Council

LEO Leading an Empowered Organisation

LMC Lead Maternity Carer

LOS Length of Stay

LTC Long Term Condition(s)

LV Low Voltage

MALT Māori Alliance Leadership Team

MAPU Medical Assessment and Planning Unit

MBIE Ministry of Business, Innovation and Employment

MCH MidCentral Health

MCIS Maternity Clinical Information Service

MDBI Material Damage and Business Interruption

MDHB MidCentral District Health Board

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MDM Master Data Management

MDT Multi-disciplinary Team

MECAs Multi Employer Collective Agreements

MEED Midwifery External Education and Development Committee

MERAS 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.

MIYA MIYA Precision Platform

MoH Ministry of Health

MOU Memorandum of Understanding

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

MRSO Medical Radiation Officer

MRT Medical Radiation Therapist(s)

MSD Ministry of Social Development

MWH Manawhenua Hauora

MYFP Midwifery First Year of Practice Programme

NAMD Neovascular Age-Related Macular Degeneration

NBSP National Bowel Screening Programme

NCAMP19 National Collections Annual Maintenance Programme 2019

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

NGO Non Government Organisation

NNU Neo Natal Unit

NOS National Oracle Solution

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

NZCRMP New Zealand Code of Radiology Management Practice

NZHP New Zealand Health Partnerships

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NZNO New Zealand Nurses Organisation

O&G Obstetrics and Gynaecology

OD Organisational Development

ODP Organisational Development Plan

OE Operations Executive (of a service)

OHS Occupational Health and Safety

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

OPAL Older People's Acute Assessment and Liaison Unit

OPERA Older People's Rapid Assessment

OPF Operational Policy Framework

Outsourced Contracted to a third-party provider to deliver

Pae Ora Paiaka Whaiora

(Base/Platform of health) Healthy Futures (DHB Māori Directorate)

PACS Picture Archiving Communication System

PBE Public Sector Benefit Entity

PCBU Person Conducting a Business or Undertaking

PCT Pharmacy Cancer Treatment

PDRP Professional Development and Recognition Programme

PDSA Plan Do Study Act

PEDAL Post Emergency Department Assessment Liaison

PET Positron Emission Tomography

PHC Primary Health Care

PHO Primary Health Organisation (Think Hauora)

PHU Public Health Unit

PICC Peripherally Inserted Central Catheter

PICU Paediatric Intensive Care Unit

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

PNCC Palmerston North City Council

POAC Primary Options for Acute Care

PPE Personal Protective Equipment

Powhiri Formal Māori Welcome

PPA Promoting Professional Accountability

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PPC Public, Primary and Community

PP&CH Public, Primary and Community Health

PPPR Protection of Personal and Property Rights

PR&RO Principal Risk and Resilience Officer

PSA Public Service Association

QHP Qualified Health Plan

Qlik Qlik Sense Data Visualisation Software (Dashboard Analytics)

Q&SM Quality and Safety Markers

RACMA Royal Australasian College of Medical Administrators

RDHS Regional Digital Health Services

RFP Request for Proposal

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

Risk ID Risk Identifier

RM Registered Midwife

RMO Resident Medical Officer

RN Registered Nurse(s)

RP Risk Priority

RSI Relative Stay Index

RSP Regional Service Plan

RTL Round Trip LogisticsA technology platform.

Rules Government Procurement Rules (4th Edition 2019)

SAC Severity Assessment Code

SFIA Skills Framework for the Information Age

SGOC Shared Goals of Care

SIEM Security Information Event Monitoring

SLA Service Level Agreement

SLMs System Level Measures

SME Subject Matter Expert(s)

SMO Senior Medical Officer

SNE Services Not Engaged

SOI Statement of Intent

SOR Standard Operating Responses

SPE Statement of Performance Expectations

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

Spotless Spotess Services (NZ) Limited

Spotless Contract

The DHB's contract with Spotless for facilities maintenance and hotel services

SRG Shareholder's Review Group

SSC State Services Commission

SSHW Safe Staffing, Healthy Workplaces

SSIED Shorter Stays in Emergency Department

SSU Sterile Supply Unit

SUDI Sudden Unexpected Death in Infancy

SUG Space Utilisation Group

STAR Services for Treatment, Assessment and Rehabiliation

TAS Technical Advisory Services (also CTAS)

TCO Total Cost of Ownership

TCU Transitional Care Unit

THG Tararua Health Group Limited

TLP Transformational Leadership Programme

Trendly A national database capture tool and dashboard that focuses on the measurement of DHBs to the National Māori Health Measures

TTOR Te Tihi o Ruahine Whānau Ora Alliance

UCOL Universal College of Learning

VBS Voluntary Bonding Scheme

VRM Variance Response Management

WDHB Whanganui District Health Board

WebPAS Web Based Patient Administration System

WebPASaas Web Based Patient Administration System as a Service

WHEI Whole Hospital Escalation Indicators

YTD Year To Date

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