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Hauora Tairāwhiti
Agenda
HAUORA TAIRĀWHITI BOARD
Tuesday, 26 November 2019, Boardroom, Corporate Offices, Hauora Tairāwhiti Videoconferencing: Tairāwhiti VMR Teleconferencing: 0800 633 866: Conference Code: 2045365521 Leader Pin: 6618
9.00am Meeting Commences
Page
APOLOGIES
1.1.
INTERESTS 2.1 Committee Members’ schedule of interests for review 3 2.2 Conflicts in relation to Agenda items verbal
PREVIOUS MEETING 3.1 Previous Minutes for approval: 29/10/2019 6 3.2 Matters Arising n/a
ACTION ITEMS 4.1 Actions from previous meeting 10
CORRESPONDENCE 5.1 Ltr- Hon Dr David Clark – Minister of Health 11
REPORTS 6.1 Performance Dashboard 12 6.2 Chair’s Report 14 6.3 Te Waiora o Nukutaimemeha Chair’s Report 15 6.4 Chief Executive’s Report 24 6.5 Finance Report 41 6.6 Board Sub-Committee Reports 48
INFORMATION ITEMS Nil
DECISION ITEMS Nil
Hauora Tairāwhiti
GENERAL BUSINESS Nil
RESOLUTION TO EXCLUDE THE PUBLIC RESOLVED that: In accordance with the provisions of Schedule 3, of the NZ Public Health and Disability Act 2000, that the public be excluded from the next part of the proceedings of this meeting. The reason for passing this resolution and the grounds on which the resolution is based, together with the particular interest or interests protected by the Official Information Act 1982 which would be prejudiced by the holding of the whole or the relevant part of the proceedings of the meeting in public areas are as follows:
10.1-2 11.1
As shown on resolution to exclude the public in Minutes.
12.1-12.2 13.1-13.7
Negotiations or Commercial Activities – The disclosure of that information would not be in the public interest because of the greater need to enable Hauora Tairāwhiti to carry on, without prejudice or disadvantage, negotiations or activities. [OIA 1982 S.9 (2) (j) & (i)]
Ground(s) under Clause 32 for passing this resolution: That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32(a)]
PREVIOUS IN COMMITTEE MEETING 10.1 Previous Minutes for approval: 29/10/2019 49 10.2 Action Items 52
IN COMMITTEE REPORTS FROM HAUORA TAIRĀWHITI ADVISORY COMMITTEES 11.1 For noting and/or adoption 53
INFORMATION ITEMS 12.1 Update regarding Wai 2575 54 12.2 Site Planning Deliberations 67
DECISION ITEMS 13.1 Operating Theatre Department – CAPEX Request 68
STAFFING & GOVERNANCE 14.0 Report from Staffing and Governance Committee verbal
DATE OF NEXT MEETING: Tuesday, 17 December 2019
Member Interest Declared RoleDavid Scott Three Rivers Medical Centre Wife an employee
Treescape Farm Partnership Partner in BusinessTreescape Consultancy Business ConsultantTe Kuri a Tuatae Marae TrusteeEast Coast Rural Support Trust Rural Support Co-ordinatorGisborne District Council Civil Defence Shift Volunteer/Media Liaison OfficerGisborne Herald Casual non-paid columnistMiddle Mount Company Ltd DirectorCONNEXT Charitable Trust Trustee
Geoff Milner Ngati Hine Health Trust Chief ExecutiveTerenga Paraoa Lmited DirectorManaia PHO Limited DirectorTairāwhiti Laundry Services Limited DirectorTairāwhiti Laundry Services Limited Director
Gavin Murphy Tlab Limited DirectorTrust Tairāwhiti Chief ExecutivePersonal friend of the Minister of HealthEastland Development Fund Limited Director
WET Gisborne Limited Director
Prudence Younger Forest Industry Contractors Assoc Chief ExecutivePublic Impressions Limited Director
Kathy Sheldrake Motu Trails Charitable Trust ChairHealth Consumer Service Mediator
Rehette Stoltz Gisborne District Council MayorSport Gisborne Tairāwhiti TrusteeTairāwhiti Positive Aging Trust TrusteeE Tu Elgin Community Group MemberHusband employed by Hauora Tairāwhiti Deon Stoltz (Senior Medical Officer)Deon Stoltz Medical Services DirectorArt in Public Places TrusteeManaaki Tairāwhiti Governance Group memberSunshine Service Managment Team memberGisborne Walking & Cycling Trust TrusteeTairawhiti Laundry Services Limited DirectorTe Ha 1769 Sestercentennial Trust. TrusteeHealthy Families East Cape Strategic Leadership
Group
Member
Hiki Pihema Hauora Tairāwhiti Team Leader, DietitiansDietitians Board Board Member Otago University Supervisor, Dietetics ProgrammeEastland Community Trust Daughter Sharon Pihema is contractorDietitians NZ MemberNational Heart Foundation Daughter is Nutrition AdvisorOtago University External Advisory Group
Na Raihania Whanau Trusts TrusteeHawkes’ Bay DHB Iwi Relationship Board MemberTRONPnui Board Trustee
Niece (Albie Raihania) employed on nursing staff
Brian Wilson B & P Wilson Family Trust TrusteeYMCA PresidentGisborne Surf Lifesaving Charitable Trust TrusteeTLab Director
Josh Wharehinga Gisborne District Council Deputy MayorTe Wananga o Aotearoa Board memberGisborne Intermediate School Board memberMother employed by Hauora Tairāwhiti Maraea Cookson (Cultural Response Team)Ex Partner employed by Hauora Tairāwhiti Richelle Tarsau (Children’s Ward)Aotearoa Scholarships Trust TrusteeHorouta Waka Hoe Waka Ama Club Board member
Board Members’ Register of Interests
3
Meredith Akuhata-Brown Gisborne District Council CouncillorTairawhiti Youth Workers Collective MemberPapawhariki Inc Board memberGisborne Herald Casual unpaid columnistSuicide Postvention Group MemberTairāwhiti Rail Limited Director
Jim Green (Chief Executive) Chief Executive Representative, Midland Alliance
Leadership Team (Midland Health Network
Trust)
Potential conflict exists in relation to decisions made by
the Midland ALT which conflict with the interests of
Hauora Tairāwhiti.
Interim Chair/Director, HealthShare Limited First responsibility is to Hauora Tairāwhiti but there
may be an occasion where this conflicts with the needs
of HSL.
Wife employed by Tūranga Health as Tamariki
Ora Nurse and Team Coordinator for Tamariki
Ora
Potential conflict exists over decisions related to
funding of services provided by Tūranga Health
affecting the employment status of his wife.
Son is employed as a Medical Registrar at Hauora
Tairāwhiti
Potential conflict regarding decisions on terms and
conditions of employment for Medical Registrars as a
member of staff. Separation on decision making in
place.
Manaaki Tairāwhiti (Member) Decisions at Manaaki Tairāwhiti may conflict with those
in my role as CE of Hauora Tairāwhiti. The management
is that decisions around funding are required to come
back to Hauora Tairāwhiti.
Health Partnerships Limited (CE Sponsor - Food
Services Programme)
Appointed by National CEs. First responsibility is to
Hauora Tairāwhiti but there may be an occasion when
this conflicts with the national programme.
Pay Equity Workstream Co-Lead, Employment
Relations Strategy Group (ERSG),
Appointed by National CEs. First responsibility is to
Hauora Tairāwhiti but there may be an occasion when
this conflicts with the work programme.
Midland Regional DHBs CE Lead, Child Health
Action Group
Appointed by Midland DHBs. First responsibility is to
Hauora Tairāwhiti but there may be an occasion when
this conflicts with the work programme of Midland.
Midland Regional DHBs CE Lead, Māori Health Appointed by Midland DHBs. First responsibility is to
Hauora Tairāwhiti but there may be an occasion when
this conflicts with the work programme of Midland.
National Workforce Strategy Group Appointed by Midland DHBs. First responsibility is to
Hauora Tairāwhiti but there may be an occasion when
this conflicts with the work programme of Midland.
Daughter employed with Counties Manukau DHB
as a Registered Nurse
The potential conflict to record is that this might raise a
conflict in decisions on terms and conditions of
employment for Registered Nurses.
Management Attendees
4
Professional AdvisersKolbe, Anne (Acting CMO
temporary)
Kolbe Medical Services Ltd Director and Joint Owner
Communio, NZ Senior Consultant & ContractorWhanganui DHB Member, Risk & Audit Committee
Health Research Council of NZ Husband chairs the clinical trials advisory committee
Auckland University Holds an adjunct appointment (Associate Professor
level)
Husband is an employee (Professor of Medicine, FMHS)
Australian Medical Council Husband is a member of the Medical School Advisory
Committee, and leads the Medical Specialties Advisory
Committee Accreditation Team
Royal Australasian College of Physicians Husband is a member of the College’s governance
working party, and chairs the revalidation working party
EXCITE International Board Member, and Chair of Advisory Council
MidCentral DHB Member, Finance Risk & Audit Committee
Member, Hospital Advisory CommitteeTairawhiti DHB Consultant (strategic services)Siggins Miller, Australia Senior Advisor & Associate
Serita Karauria (Acting DoN) Nil
Craig Green (Chief Financial
Officer)
Chamber of Commerce (Mentor) Possible conflict if mentored party is providing services
to Hauora Tairāwhiti.
Mother employee of Compass Medirest Food
Services
A conflict of interest exists in relation to negotiations
with Compass Medirest Food services Tairāwhiti
conflict where it affects or could affect staffing.
National CFO representative, Employee Relations
Strategic Group (ERSG)
Appointed by National CFOs. First responsibility is to
Hauora Tairāwhiti but there may be an occasion when
this conflicts with the work programme.
Chair, CFO Review Group (CRG) First responsibility is to Hauora Tairāwhiti but there
may be an occasion when this conflicts with MECA
costing reviews.
Midland CFO representative, eSPACE Programme
Board member
Nominated by SRO, appointed by Midland CFOs. First
responsibility is to Hauora Tairāwhiti but there may be
an occasion where this conflicts with the needs of
eSPACE.
Member, Health Asset Management
Improvement Group (HAMI)
First responsibility is to Hauora Tairāwhiti but there
may be an occasion when this conflicts with the work
programme.
Nicola Ehau (Planning,
Funding & Population
Health)
Husband an employee of the Health Quality &
Safety Commission
Low likelihood of conflict.
Manaaki Tairāwhiti Decisions at Manaaki Tairāwhiti may interest with those
in my role as GM Planning & Funding in Hauora
Tairāwhiti. The management is that decisions around
funding require to come back to Hauora Tairāwhiti.
Toni Lexmond
(Communications Manager)
Sister works at TLab as a courier A potential conflict exists if Leadership Team (of which I
am a member) is required to decide over future
contract arrangements that affect TLab and the
employment of my sister.
Lynsey Bartlett (Surgical
Services)
Company Director: Yesteryear Limos Low likelihood of conflicts.
Alternate Director, HealthShare Limited Appointed by Hauora Tairāwhiti. First responsibility is to
Hauora Tairāwhiti but there may be an occasion where
this conflicts with the needs of HSL.
5
Minutes Hauora Tairāwhiti Board 29 October 2019, commencing 9.00am
Present David Scott (Board Chair) Geoff Milner Hiki Pihema Prue Younger (via teleconference) Na Raihania Gavin Murphy Kathy Sheldrake Josh Wharehinga
Attending Jim Green (Chief Executive) Iain Diamond (Team Leader – Information Analyst, Planning and Funding) Craig Green (Chief Financial Officer) Toni Lexmond (Communications Manager) Rachel Phillips (Minutes)
Karakia Hiki Pihema
Public Wynsley Wrigley (Gisborne Herald)
Item 1 ApologiesRehette Stoltz, Meredith Akuhata-Brown, Brian Wilson
Item 2 Interests 5.1 Changes to Register Gavin Murphy – Trust Tairāwhiti
5.2 Conflicts Related to Any Item on the Agenda Nil
Item 3 Minutes of Previous Meeting ADOPTED The public minutes of the Tairāwhiti District Health Board meeting held on 24 September 2019 confirmed as a true and accurate record.
Matters Arising from Minutes Nil
Item 4 Action Items Frequently Asked Questions and Supports available to Whānau of Deceased People
6
ADOPT the recommendations to:- 1. Note the report and the documents in current use.2. Provide feedback and any suggestions for improvement that can either be passed to theJustice Department or used locally.
Item 5 Correspondence 5.1 Ltr – Ashley Bloomfield, Director-General of Health - Prioritisation of Health
Capital Projects against Budget 2019 funding (for 2019/20 and 2020/21 financial years)
Noted
5.1.1 Ltr - Hon Dr David Clark, Minister of Health - National Bowel Screening Programme
Noted
5.2 Ltr – Hon Dr David Clark, Minister of Health – Sugary Drinks – Possible Tax Noted
5.3 Ltr – Peter Hughes, State Services Commissioner - Code of Professional Conduct for Crown Entity Board Members
Noted
Item 6 Reports 6.1 Performance Dashboard Noted
6.2 Chair’s Report Noted
6.3 Te Waiora o Nukutaimemeha Report Noted - Board recommended implementing Wai2575 recommendations from first phase, with the upcoming new DHB board members, that time is dedicated to the Treaty and its Principles, start using the basic recommendations and that what are the basic metrics that can be advanced inside of Tairāwhiti
6.4 Chief Executive’s Report Noted - the Chief Executive responded to questions throughout. The Board noted the Acute admissions dropping off, large growth 22% increase of cost of medication, clinical supplies up 10%. Newborn unit has 7 babies, which is geared up for 5 or 6 with some having to be transferred to Waikato due to lack of capacity. Consultation around Model of Care for Acute Mental Health facility, proposed model to be presented to the board in February.
6.5 Finance Report Noted and the Chief Financial Officer elaborated on his report.
The Chief Financial Officer advised that $14m equity injection to be applied for to be paid in February, Capital programme paper to be approved, Savings Plan is progressing. There was also discussion around how the Lean process could be applied to Hauora Tairāwhiti
6.6 Board Sub-Committee reports Noted
7
Item 7 Information Items 7.1 Schedule of Interests – Chief Executive and Direct Reports to the Chief Executive Noted
Item 8 Decision Items 8.1 2018-2019 Financial Reconciliation to Board Notes the reconciliation of the 2019-2020 consolidated financial result.
8.2 MRGG Regional Partnership Equity Action Plan 2019-2021 Noted – with the Board endorsing the Equity Action Plan for 2019-2021
8.3 2019-20 Capital Expenditure Budget Parameters Recommended that: The Board APPROVES: the figure of $7.941 million as the maximum available capital expenditure budget for the 2019-20 financial year.
Item 9 General Business Nil
RESOLUTION TO EXCLUDE THE PUBLIC RESOLVED that: In accordance with the provisions of Schedule 3, of the NZ Public Health and Disability Act 2000, that the public be excluded from the next part of the proceedings of this meeting. The reason for passing this resolution and the grounds on which the resolution is based, together with the particular interest or interests protected by the Official Information Act 1982 which would be prejudiced by the holding of the whole or the relevant part of the proceedings of the meeting in public areas are as follows: 10-1-2 11.1
As shown on resolution to exclude the public in Minutes.
13.1-2 Negotiations or Commercial Activities – The disclosure of that information would not be in the public interest because of the greater need to enable Hauora Tairāwhiti to carry on, without prejudice or disadvantage, negotiations or activities. [OIA 1982 S.9 (2) (j) & (i)]
Ground(s) under Clause 32 for passing this resolution: That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32(a)] 10.1 Previous Minutes for approval 30.7.19 10.2 Action Items (Nil) 11.1 Sub Committee Reports 13.1 New Zealand Health Partnerships Resolution 13.2 2019-20 Annual Plan final draft for approval
The Acting Chief Executive, the Group Managers, Communications Manager and the Minute Secretary were invited to remain for facilitation of Board discussion and recording.
PUBLIC RELEASE OF IN COMMITTEE ITEMS
8
15.0 No In Committee decision items were released.
Meeting closed: 12.05pm Date of Next Meeting: 26 November 2019
………………………………………….. ………………………………………. Chair Date
9
Action Items HAUORA TAIRĀWHITI BOARD
Item Description Who Deadline
Carried over October 2019 Nil
10
11
Oct-19 Oct-19
Ethnicity This month Target Last month 3 Month Average
Māori 86% 87% 87%
Total Pop 83% 84% 85%
Māori 86% 85% 84%
Total Pop 89% 87% 87%
Ethnicity Last quarter Target Previous quarter 2018/19 estimate
Māori 51% 52% 42%
Total Pop 53% 52% 43%
Ethnicity This Month* Target Last Month 6 Month Average
Māori 86% 86% 92%
Total Pop 87% 86% 92%
Ethnicity Last quarter Target Previous quarter 12 Month average
Māori 84% 84% 83%
Total Pop 86% 86% 85%
Māori 100% 100% 97%
Total Pop 100% 100% 98%
Māori New indicator to be reported from
Total Pop
12 months to June
2019Target
12 months to March
2019
Last year
to June 18
Mental Health 89% 90% 82%
Addiction 76% 87% 70%
Māori 66 ≤ 58 64 57
Ethnicity This Month Target Last Month 3 Month Average
1,789 ≤ 1,523 1,653 1,746
66% ≤ 64% 67% 67%
Māori 93.8% 94.3% 93.8%
Total Pop 93.1% 93.4% 93.0%
Total Pop 3.6% <2.6% 0.7% 2.0%
Aug-19 Target Jul-19 3 Month Average
< 42 days 81% ≥ 95% 82% 83%
< 42 days 82% ≥ 90% 81% 82%
< 14 days 100% ≥ 90% 82% 94%
Non Urgent
Colonoscopy < 42 days 90% ≥ 70% 60% 68%
< 84 days 85% ≥ 70% 85% 82%
* 1 month behind due to data being collated Nationally
This Month Target 3 Month Average YTD Average
% 5.5% ≤ 5% 3.8% 4.2%
# 48 N/A 37.7 41.0
% 4.2% ≤ 6.3% 4.1% 5.2%
# 6 N/A 6.0 7.8
Ethnicity12 months to
30/6/2019Target Last Year (June 18)
Māori 7,598 7,205
Total Pop 6,778 6,479
Māori 6,580 6,271
Total Pop 3,898 3,992
* target to be confirmed
# of Enrolled Patients # of Māori Enrolled PHO % of enrolled
population
8,979 7,840 18%
39,893 16,806 82%
99% 99%
Key
Sparkles for quarterly data
Sparkles for monthly data
Hauora Tairāwhiti
Patient Safety and Quality - Community
Indicator 12 Month Trend
Referral of obese children ≥ 95%
≥ 95%Immunisation
Emergency Department
Indicator 12 Month Trend
Number of Māori under Compulsory
Treatment Order
≥ 90%Better help for
Smokers to Quit
Mental Health & Addiction services
Indicator
Percentage of youth (0-19) seen within 3
weeks after non urgent referral
Trend
Percentage of people with assessed high
cardiovascular risk who have had an
annual review
Indicator
Indicator 12 Month Trend
at 8 Months
at 2 years
Indicator 12 Month Trend
Newborn
enrolment in
General Practice≥ 55%at 6 weeks
12 Month Trend
Diagnostic Waiting Times
Indicator 12 Month Trend
Urgent Colonoscopy
Shorter Stay in Emergency Department
(<6 hours)
Percentage of Triage 4-5 attendances
Primary Care
Maternity
- Currently only Hospital
Maternity Dept Stats
≥ 80%
≥ 95%
Total Pop
Number of Emergency Department
Attendances
Acute Readmission Rate
Indicator
Acute Readmission
Rate
Total Population
75+ population
12 Month Trend
Percentage of alcohol related ED
presentations in Youth (10-24)
Surveillance Colonoscopy
≤ Less Than or equal to
≥ Greater than or equal to
Ambulatory Sensitive Hospitalisations per 100,000 population
Age Group
87%
42%
Magnetic Resonance Imaging (MRI)
Computed Tomography (CT)
Midlands Health Network - Tairāwhiti
Percentage of Tairāwhiti Population enrolled in a PHO Percentage of Tairāwhiti Māori Population enrolled in a PHO
00-04
45-64
≤ 5,730
≤ 3,490*
PHO Enrolments (Oct 19)
PHO Percentage of PHO Population who are Māori
Ngāti Porou Hauora
6330 6053
7320 6738 6479
6854 6925 6818 6778
4197
2163
4280 4164 3992 3967 3897 4320
3898
0
1000
2000
3000
4000
5000
6000
7000
8000
Jun-17 Sep-17 Dec-17 Mar-18 Jun-18 Sep-18 Dec-18 Mar-19 Jun-19
Ambulatory sensitive hospitalisations per 100,000 population
00-04 year olds 45-64 year olds
12
Oct-19 Oct-19
Ethnicity This Month Target Last Month 3 Month Average 12 Month Trend
62 day target 100% ≥ 90% 100% 89%
31 day target 100% ≥ 85% 100% 100%
4 ≤ 6 12 7
3 5 4
16 18 14
5 7 7
33% >70% 33% 33%
10% ≥ 10% 10% 10%
Māori 92% 88% 93%
Total Pop 91% 91% 91%
Ethnicity This Month Target Last Month 3 Month Average
83% ≥ 80% 77% 78%
1,001 ≤ 836 994 1033
2.70 ≤ 3.21 days 2.50 2.57
Māori 284 298 299
Total Pop 685 727 724
Māori 13% 16% 14%
Total Pop 9% 9% 8%
Māori 1207 <1040 970 1106
Total Pop 2474 <2028 2069 2398
Ethnicity This Month Target Last Month 3 Month Average
107 95 100
331 337 347
Ethnicity Total This Month Monthly Target YTD Year to Date Target
Māori 104 78 246 239
Total Pop 156 206 602 630
This Month Target Last Month 3 Month Average
6% ≤ 10% 13% 10%
0 < 4 0% 1
148 N/A 147 147
0
Month Actual Month Budget Last Month Actual YTD Actual YTD Budget YTD Variance
$18,001 $16,995 $17,514 $69,783 $67,951 $1,832
$18,799 $18,031 $18,746 $73,892 $71,672 $2,220
($794) ($1,035) ($1,408) ($4,109) ($3,720) ($389)
($1,088) ($1,090) ($1,401) ($4,667) ($3,949) ($718)
$270 $63 $13 $559 $244 $315
$23 ($8) ($18) ($1) ($15) $14
This Month Target (pm) Last Month 3 Month Average
$2.142 M ≥ $1.450M $1.475 M $1.694 M
Hauora Tairāwhiti
Patient Safety and Quality - Hospital
≥ 95%
Faster Cancer
Treatment
Number of Medication incidents
Stroke patients thrombolised 24/7
Acute Coronary Syndrome patients
undergoing angiogram (<3 days)
Average Length Stay (days)
Indicator
Hospital Events
Indicator
Better help for Smokers to Quit -
Secondary Care
Total Pop
Acute Hospital Bed days
≤10%
Total Pop
12 Month Trend
Bed Utilisation
Number of discharges
Access to Planned Surgery
Surgical Events
Indicator
Indicator
Total Pop N/A
N/AFirst Specialist Assessments
12 Month Trend
12 Month Trend
Missed Appointments
Number of Acute Surgeries
Complaints
Patient Falls
Severity Assessment Code 1 and 2
Events
N/A
Total Number of Surgeries
12 Month Trend
Management/Admin FTE's
Staff Injuries
Human Resources
Indicator
Staff Turnover
Consolidated Expenditure
Consolidated Revenue
Consolidated Result
Provider Result
Funder Result
Governance Result
Indicator
Mental Health Ring Fence ($M) $6.545 M
Finance ($'000)
Indicator
YTD
-$121
$123
-$891
-$2,178
-$3,579
-$4,667
-$5,500
-$4,500
-$3,500
-$2,500
-$1,500
-$500
$500
Jul-
19
Au
g-1
9
Sep
-19
Oct
-19
No
v-1
9
Dec
-19
Jan
-20
Feb
-20
Mar
-20
Ap
r-2
0
May
-20
Jun
-20
Re
sult
($
00
0's
)
Hauora Tairāwhiti Financial Performance 2019/20
Funder variance Provider variance Governance variance Provider Actual Consolidated Variance
Budget has been reset to the new 2019/20 annual budget The Provider Variance reflects the difference between Actual and Budgetted results
13
Chair’s Report – NOVEMBER 2019
- Attended the NZDHB Chairs /CEOS Mtg Wellington. Rough notes already circulated. The Minister told the meeting that the official appointment notifications for DHB appointments (Chairs, Deputy Chairs and members) would be slightly delayed this time.
- It was interesting to note that there was a general consensus that MoH and DHBs needed to accelerate the transition to 2019 IT usage. The Health system lagged far behind other large organisations that required similar efficient and effective connectivity.
- Attended the Meeting of Midland CEOs/CHAIRS in Hamilton via Video. Rough notes already circulated. We finalised the induction programme for Midland (newly appointed Chairs). This programme will be delivered in Hamilton on the 6th December.
- As this is my final report as Chair I will take the opportunity of thanking all the members who participated in the various Boards from 2011 to the present day. It has been a pleasure and a privilege to facilitate such a talented group of people who constantly believed in achieving the best health outcomes for the people of Tairāwhiti.
- A special thankyou and farewell to current Board members Rehette Stoltz, Brian Wilson, Kathy Sheldrake, Prue Younger and my Deputy Geoff Milner who are also retiring on the 9th December. You have served our district well and can be rightly proud of your endeavours.
- Tino pai koutou rawa atu ki au. That the Board notes the report. David Scott, MNZM, JP Chair Hauora Tairāwhiti
14
Te Waiora o Nukutaimemeha November Report
Tēnā tatau e te Poari Matua
Te Waiora of Nukutaimemeha discussed at length the outcomes from our recent wānanga as previously reported (and attached).
The data was interesting and certainly gave an insight into where our community is in regard to some of the issues particularly with mate Hinengaro and whakamomori. There is a clear link between the two.
With the current community engagement process with mental health and addictions by Hauora Tairāwhiti, we hope that this info can be included as feedback to help inform the process.
Ngā mihi
Na Raihania Tiamana Te Waiora o Nukutaimemeha
15
16
17
18
19
20
21
22
Chief Executive’s Report October 2019
Financial Oct 19
Actual Oct 19
Var YTD Var
Sept 19 Actual
Sept 19 Var
Provider ($1,088k) $2k ($718k) ($1,402k) ($528k) Governance $23k $31k $14k ($18k) ($21k) Funder $271k $207k $315k $12k ($42k) Consolidated ($795k) $241k ($389k) ($1,407k) ($592k) The management accounts result to October includes $600k of non-specific expense accrual. The Provider Arm operating result for the month was a deficit of $1,088k – positive variance $2k. Favourable variances included Income $150k, staffing $7k and Infrastructure $18k were offset by outsourced services ($12K), Clinical supplies ($26k) and the non-specific accrual of $150k. Expenditure is up on last year by $9.8% or $3,626k. This rate has dropped back from 10.2% YTD last month. Staff costs are over budget YTD $18k and they are 12% or $2,865k up on last year mainly due to the pay increases for clinical staff, increased staffing for CCDM and conversion of outsourced to employed positions. The costs are in part offset by the additional revenue for pay increases above the agreed 2.43% to be funded by DHBs, plus the funded additional positions. The rate of increase has dropped marginally from 12.2% last month. Acute admissions were up in October and below the trend line, the increase in numbers only related to the extra day in the month. The admissions were down 26 or 5.8% on October 2018. This continues the trend of the last three months and for the first 10 months of this calendar year compared to last there is an overall 4.6% increase in acute admissions, which compares with 5.4% after 9 months. In the last four months where admissions have been down on last year the reduction is now 4.3%. The people of Tairāwhiti have had a better winter admissions wise. Compare this with ED attendances though, which are up 7.3% in the corresponding 10 month period with attendances in October 2019 up 4% on October 2018. The ED numbers are up but the situation is improving there also. Case weight production shows a positive variance of 116 against plan for the year. Translated in $ terms that amounts to $600k in “production” in excess of our plan. As noted previously, this represents our squeezing of the likely production into the funding available. Comparisons to 2018/19 (YTD)
Result Actual Variance 2018/19 ($2,794k) $106k 2019/20 ($4,668k) ($718k)
The comparison doesn’t allow for the $440k additional non-specific accrual in 19/20. Staff costs were underspent for the month by $7k and include a higher spend in nursing and support staff which was offset by lower spend in other areas. Outsourced staff cost was overspent in the month by ($12k) a significant improvement on recent months and overall down 12.4% on last year. Our conversion of outsourced to employed roles appears to be having an effect. Clinical supplies costs are up 8.1% on last year and this has decreased from 10.5% last month but with a notable additional cost in patient appliances, up 28.9% on last October. Cancer drugs are now only
23
$1622.k or 2.2% up on last year with overall pharmaceutical costs reducing in cost growth from 22.4% YTD last month, now at 16.8%.
Result Drivers Provider Revenue • Over budget for the month by $116k. The major contributor to the result for the month is continuing higher
levels for Pharmaceutical Cancer Treatments. Health Workforce NZ receipts are under this month ($20k) which is a timing issue and the expectation is that it will be caught up by the end of December. ACC income is above budget $21k for the month.
Expenditure • Overspent ($148k) for the month compared with overspend of ($578k) last month.• Staff costs were underspent by $7k for the month. Medical Staff were underspent $5k and outsourced
medical staff is over-budget by ($43k). Nursing staff costs were over budget by ($34k). Allied Health was$49k under budget, Support over by ($14k) and Management/Admin under $16k. Sick leave was 2.2% forthe month, down from 4.2% last month. Sick leave is up on last year when it was 1.7% in October 2018.
• Paid FTE was up for the month at 776 and is under budget of 784.• Outsourced services were overspent ($12k) for the month. Year to date this is $344k less than last year.
Recruitment and cover remains problematic in psychiatry, orthopaedics and anaesthetics.• Clinical supplies were overspent by ($26k) for the month. Usage of blood was ($21k) over for the month.
Cancer treatment costs were ($11k) over budget for month and ($16K) or 2.2% higher than last year. Airtransport expenditure was ($101k) over for the month and is now ($166k) or 20.2% higher this year thanlast year. Patient transport and lodging is overspent YTD by ($58k) and is 11.3% more than last year.
• Infrastructure and non-clinical supplies costs were overspent ($117k) for the month. The non-specificaccrual is $577k YTD noting that this is $150k per month this year compared to $40k last year.
Flat on acute admissions and good to see this below the trend.
General medicine admissions definitely reducing. Total throughput in the first four months of the year is down 2.0% on last year.
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Winter peak has now passed.
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General Surgery admissions are really on a very good trend now.
Much lower admissions this year.
ED arrivals are up in October by 137 and this is more than the effect of one more day in the month. They are up 4% on last year. Admissions from ED in the last four months are down 5% compared to the 4.9% increase in attendances. These figures are also still improving.
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The graph below updated for medicine over the first ten months of each year and continuing to show the reducing trend for growth.
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Growth in service delivery is also occurring in non-acute admission terms as well. The current capacity of the Satellite Dialysis Unit has been reached with 16 individuals dialysing. The unit has 8 beds and each person must dialyse three times a week. Eight people dialyse Monday, Wednesday and Friday and 8 more on Tuesday, Thursday and Saturday.
It is estimated that over the next 3 to 6 months a further 8 people will commence on in-centre haemodialysis, including one person transferring back from Waikato. There may be some offset to home haemo or peritoneal dialysis but there is a need to increase capacity now.
As these figures indicate we need to open a “glide” shift on Monday, Wednesday and Friday (12pm-8.30pm) to accommodate a third group of people to dialyse. Target opening 27th January 2020.
This is requiring a developed case for the increase in cover, with the associated costs and a recruitment plan.
Governance and Funds Administration Revenue • In line with budget for the month.
Expenditure • Underspent $31k for the month.• Staff costs under budget $21k for the month.• Non-staff expenses are $10k under budget for the month due to a transfer to funder of HealthShare costs
of $20k. Affiliations fees which include TAs fee ePrescription are $6k over budget• Democracy costs are $3k under budget.
Funder Revenue • Positive $856k for the month and YTD is $1,547k positive to budget. Driven by additional income for Te
Kūwatawata $600k and Pay Equity $950k
Expenditure • Overspent ($648k) for the month, relates to offsetting expenditure for Pay Equity and Te Kūwatawata.
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Health Targets Better Help for Smokers to Quit For the month of October we offered support to 91% of smokers admitted to hospital and 92% for Māori. Faster Cancer Treatment (FCT) 3 out of 3 people (100%) on the 62 day pathway. 3 out of 3 people (100%) on the 31 day pathway. Elective Production
The impact of ongoing industrial action coupled with an anaesthetist shortage is reflected in the provisional month end results that show we did not achieve our planned surgical discharge target of 206 discharges. At this stage, data reflects that 156 cases have been delivered, 50 discharges below our target or 91.3% YTD.
Case weight delivery for the month is additionally below target. A total of 218.1 cwds were delivered against a
target of 330.3, which equates to 81.1% YTD.
We are ahead year to date in relation to First Specialist Assessments (FSA). Delivering 496 FSAs against a target of 485 or 109.3% YTD.
Elective Services Performance Indicators (ESPI) remain non-compliant at an organisational level in ESPI 2 – First Specialist Assessments and ESPI 5 – Time to treatment. An exemption has previously been in place for Otorhinolaryngology and Urology which continue to remain non-compliant in both ESPI 2 and 5 respectively. A request for an extension is being progressed.
Additional specialities currently breaching maximum waiting timeframes consist of:
• Dermatology – ESPI 2 • Dental – ESPI 5 • General Surgery – ESPI 5 • Gynaecology – ESPI 2 • Ophthalmology - ESPI 2 and 5 • Orthopaedics – ESPI 5 • Paediatric Surgery – ESPI 5 • Plastic Surgery – ESPI 5 • Renal Medicine – ESPI 2
The key driver is increasing demand for services against a background of limited clinical resources. Emergency Department 6 Hours
ED did not achieve the ED 6 target of 95% this month coming in at 93.1%. Reasons for this result relate in part to high acuity, patient flow and high hospital occupancy. This October period continues the trend of an increasing volume of ED presentations.
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Immunisation 8 months - Overall is 83%, (↓1%) Māori 86% (↓1%) and an overall decline rate of 9% (↑1%)(14 children) 2 years - Overall is 89% (↑1% ) Māori 86%(↑1%) and an overall decline rate of 7% (↑1%)(13 children) 5 years – Overall is 89% (↑2%) Māori 88% (↑3%) and an overall decline rate of 7% (↓2%)(13 children) A lot of work continues with the immunisation sector to get good clear messages out to the community around risk of measles, particularly around the current measles outbreak. We have had one person with measles that has come into Tairāwhiti this month. Vaccine stock within the district is stable with more MMR vaccine supply coming into the country in November. The vaccine remains rationed to under 5 yr olds – (15mth and 4 yr scheduled events) and opportunistic vaccination to under 15 year olds that come in to GP practice. We have also now opened it up to people travelling to affected areas. The DHB and PHOs are working closely together to ensure the MMR vaccine is going to the most vulnerable. Declines continue to impact on how overall immunisation rates. It is also worth noting the positive comment made by the Ministry of Health Quarter 1’s report. “Your DHB has total coverage of 84.5% and Māori coverage of 86.9% at age 8 months and total coverage of 86.5% and Māori coverage of 85.4% at five years. Your DHB has total coverage of 88.2% and Māori coverage of 85.4% at age two years. Congratulations on achieving significant increases for all children at two years this quarter.” Raising Healthy Kids The rate picked up to 87% of children identified in B4 School checks as “obese” referred to intervention services, compared to 82% last month. The rate for Māori is similar.
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Better Outcomes for People
The regional Child Health Action Group provides a quarterly update on a very comprehensive set of data, from which DHBs are able to compare and contrast their relative performance across a range of child health indictors. In most instances these are provided on an ethnicity basis so that there is clear information on equity issues DHBs can target through their services. The following is a series of graphs and commentary from the latest data set.
Planning is already underway for this projected reduction in births over the next 20 years in Tairāwhiti, and the flow on reduction in projected utilisation of children’s services in hospital and the community. There are real issues for maintaining the competency of the workforce across the whole health sector in working with mokopuna, tamariki and whānau.
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This mortality data appears to be the most recently available. It shows surprisingly low rates for Tairāwhiti across all three indices. Further years may show trends.
Also surprising is the comparatively lower smoking rate on registration with an LMC for pregnant women in Tairāwhiti. There is a good trend for non-Māori, but the same change for Māori yet. The actions in our Mokopuna Ora plan are designed to improve this, most especially the work with iwi providers.
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There is definite improvement showing in the post-natal rates. It would be useful to transfer this back to the start (or even better, before) of pregnancies. We are merging with the other DHBs but still a pronounced ethnic gap.
Accountability Ministry of Health (MoH) Annual Report for the year ended 30 June 2019 The annual report highlights the Ministry’s achievements against their statement of strategic intentions 2017/18-2020/21 and reports back on the activities undertaken to show the Ministry’s financial and non-financial performance. This report also demonstrates how the Ministry is progressing to deliver on its strategic priorities and shows progress made against targets and outcomes for the 2018/2019 financial year. The full report can be read at https://www.health.govt.nz/publication/annual-report-year-ended-30-june-2019
Wai 2575 Māori Health Trends Report
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The Ministry of Health’s Māori Health Insights team has produced the Māori Health Trends Report, including several subject-specific modules, to inform the Wai 2575 Health Services and Outcomes Kaupapa Inquiry (Wai 2575). The report shows changes of Māori health over the years 1990–2015.
Most of the data used for trend analysis of Māori and non-Māori in this report starts from 1996. This reporting period was chosen based on the availability of reliable data. Before this period, the quality of ethnicity data was not reliable and Māori tend to be undercounted due to inconsistent ethnicity classification on death registration, birth registration and census forms. The full 370 page report can be seen at https://www.health.govt.nz/publication/wai-2575-Māori-health-trends-report
Ministry of Health and Ministry of Education agree joint approach to help prevent spread of Measles There have been more than 1800 cases of Measles in Aotearoa since the start of 2019, and most of these cases have been in unvaccinated people, or in those who do not know their vaccination status.
The Memorandum of Understanding will allow information on schools' overall vaccination rates - the number and percentage of students in schools who are fully vaccinated against Measles - to be calculated by the Ministry of Health, using the National Immunisation Register and shared with local public health officers. This will give them a better understanding of schools' overall rates of immunity against Measles.
If a school or schools are directly affected by the outbreak, for example, a student has contracted Measles, the agreement will also allow for information on the individual student’s vaccination status to be provided to local public health officers. This information will only be shared as requested by public health officers, and will be used to help reduce the spread of Measles in schools.
Primary & Community Health Services Pharmacy From 1 November Measles, Mumps & Rubella (MMR) vaccination will be added to the Pharmaceutical Schedule. However, it will be up to individual District Health Boards to contract with community pharmacies in their regions to deliver the MMR vaccine.
The changes to the Pharmaceutical Schedule and the Ministry of Health announcements last week are aimed at enabling community pharmacies to be part of the workforce managing a coordinated response at a future stage. This will likely be part of the local decision-making processes in 2020.
School Based Health Service Update The service provided through DeLautour Medical Centre into our three large secondary schools in Gisborne will come to an end at the end of December 2019. We had signalled at the end of last year that we would be reconsidering our options, and we thank DeLautour Medical Centre for their ongoing provision of the service and their General Practice teams who have worked with rangatahi. The decision to exit the service reached a mutual agreement and we are pleased to note that one of the GPs will continue to be involved with our Mahi Tahi Rangatahi rōpū, which will inform new service opportunities. In addition, we are meeting with the Principals of the three schools involved, to advise them of the changes in this service. We will also be updating them on what future options there are for rangatahi regarding their health needs. A full paper with future indicative direction will be provided in December.
Child, Youth and Population Health Oral and Dental Health Three key activities in October have transpired within this area of health:
Māori Oral Health Equity Symposium – Wellington After attending this symposium, it is abundantly clear that the Ministry of Health has elevated the Oral Health needs of our populations. The development of the National Oral Health Action Plan and Framework is currently underway, and participants were involved in workshops to inform this plan.
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Equity and Mana were two points presented, not in comparison, but highlighting how what they mean for Māori and what they mean for others is significantly different. This was within a strong presentation by the new MoH Deputy Director General Māori Health, John Whaanga. He provided a Treaty of Waitangi framework that they are embodying in the new Māori Health Action Plan.
The symposium presented the challenges of improving the oral health outcomes for all New Zealanders, and particularly for Māori and for adolescents. The national Oral Health Plan will come out to the sectors for consultation in the new year. Challenges going forward include private versus public oral health services, ‘free for all’ debate, workforce, systems and information, leadership, fluoridation, sustainable business models outside of main cities, international dental company influences, etc.
Tairāwhiti Dental – Mahi Tahi Rōpū There has been continued engagement with local dentists to involve them in planning of services and informing shared opportunities to improve local delivery. There is interest in looking at how adolescent dental needs are met, and where we are challenged rurally to provide coverage of dental services.
Tairāwhiti Adolescent Coastal Service The short-term intervention for Hauora Tairāwhiti Oral Health Team to provide mobile dental services for adolescents within the five secondary schools on the coast from May - November 2019 has proven to be a success. Reporting to date reflects that the mobile service on site at each school was well received by students, school principals, teachers, parents and the wider communities. We are in the process of determining what sustainable services for the coast will look like and considering a proposal by the team to continue.
Mental Health, Alcohol and other Drugs Gambling minimisation Recruitment is underway for the two positions.
Mental Health Review Consultation with the public is continuing. During October, consultation was held with service providers such as the Police, Oranga Tamariki, as well as youth and community groups. Each of these encounters has proved to be enlightening and has produced very good feedback.
Work Broker This role has settled in and is supporting whaiora to regain confidence to enable their vocational work goals to be realised. Significant support is needed in preparation for job readiness.
Health of Older People and Disability Support Services
Home and Community Support Services (HCSS) The next stage of integration is underway with discussions occurring with provider services. Te Kāhui Whakahaere will consider what is entailed and support next stages if supported.
Advance Care Planning 6 people attended the Level 1 ACP training in October. Waka Northland ACP booklets, which are more culturally appropriate to this community, have been ordered. Attended a national videoconference to talk about “Closing the Loop in Tairāwhiti” now that we have a provider to follow up those who require support with their ACP.
Whānau Falls Prevention
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The Hauora Tairāwhiti Falls policy has been redeveloped and is ready for sign off by the Clinical Governance Committee. Need to explore Ko Awatea online education on falls prevention. Currently checking those presenting to ED as a result of a fall against those under the Fracture Liaison Service. Needs Assessment Support Coordination (NASC) NASC are moving back to the hospital campus Friday 15th November. This is a long awaited move which brings some of the core work of the team closer to the needs of patients requiring supportive home / residential environments on discharge.
Population Health Health Promotion Tobacco Control Taki Tahi Toa Mano (Tairāwhiti Smokefree Coalition) membership extended to MSD, Healthy Families East Cape, Sport Gisborne and GP Clinical Practice lead. The Vape Consultation bill and Smokefree Cars legislation to be tabled in Parliament before Christmas 2019. Until vape/e-cigarettes are regulated, Ministry of Health will not support their contracted Stop Smoking Providers to purchase vape for clients. However for DHBs, this is discretionary. An Invitation has been extended to local vape store to attend next Taki Tahi Toa Mano meeting to provide an update on sales, products, customer perceptions, etc. Suicide Prevention/Postvention The last Moko Turongo Wānanga for the year was attended by over 30 whānau in Whatatutu at Whetu Ariki Marae. The implementation of GVPR (Gisborne Vulnerable Persons Register) has been updated. Suicide Prevention Information Brochure completed and ready to share with services, community and whānau. Mokopuna Ora We are developing Safe Sleep Day Activities 6 December 2019. They will be Rongoā focused and in rural and urban settings. Advancing with Stop Smoking Programme for Health Professional Training. We have committed to support Parenting and Pepi Education classes at Tūranga Health, promote Tapu whilst Hapū and looking at smoking cessation education being delivered. We have established Tairāwhiti Ukaipo Group (Breastfeeding) We are still to engage with MWWL Ngāti Uepohatu Branch to seek interest in collaboration to support rural peer support BF group. We are working on Breastfeeding education for the workforce – Nov 2019 and planning Immunisation and SUDI Prevention workshop day in 2020.
Mahi Tahi Rangatahi A successful Mau Rakau Wānanga held on local marae with 30+ rangatahi (Māori males). Healthy nutrition, physical activity, mental health, wellbeing and identity/whakapapa were key elements of the wānanga. Building resilience and strength within our Māori males. Exploring options to run weekly wānanga. We are supporting the change in behaviour for local rugby club through changing club culture. All coaching positions are now being advertised. This new approach has seen the development of an appointment policy and procedure. We are in discussions with E Tu Whānau seeking possible 3 year funding for rangatahi within the club. An event/workshop is taking place shortly for rangatahi to determine what they want in regards to behaviour and club culture. Health in Schools Schools hauora survey ongoing with western rural and town schools. We provided support to Kaiti School in the areas of Sexuality Education (Family Planning - planning for Y7-8 sexuality education / professional development for staff in 2020, and information regarding Te Whariki
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Takapou kaupapa Māori Sexuality Education resources for Y7-8 : Te Ira Tangata), and healthy kai (the National Heart Foundation Promoter – Food For Thought programme). Te Kura Kaupapa Māori o Whatatutu in the areas of Sexuality Education (Te Whariki Takapou kaupapa Māori Sexuality Education resources for Y7-8: Te Ira Tangata, as well as information regarding Family Planning sexuality education / professional development for staff), and mental health and wellbeing education resource: Te Ara Whakamana. Our Health Promotion team attended the WellChild nurses hui to clarify Health Promotion action in schools and how we can all work in schools in a more cohesive way. We attended Aniwaniwa o Tairāwhiti Open Day to connect with kaupapa Māori Diversity LGBTQI rōpū to gather more information for schools.
Schools hauora survey has a section dedicated to capturing information regarding school food and water promotion behaviour. This will give us a picture of what support schools need in these areas.
Physical Activity and Nutrition We are supporting Enihau Water Board and Mangahauini Farms Ltd in the final stages of completing the Enihau water supply survey. This includes:
• Supporting Enihau Water Board with gutter and tank maintenance education before the wintermonths.
- includes more education around ‘boil water notices”. • Enihau Water Board are planning drinking water wānanga moving into the new year.• Peter McDonald (MoH Drinking Water Advisor) is supporting Enihau Water Board and Mangahauini
Farms Ltd to create a Risk Management plan.Supporting Waiparapara Marae committee to purchase flush diverters and a new water tank to help maintain clean and fresh water.
• Waiparapara Marae interested in exploring water only option. They hope to work towards the sameoutcome for healthy food options.
• To ensure water in tanks are safe and clean, the community of Tokomaru Bay are setting up a group ofwhānau who can help pakeke and kaumātua by cleaning their gutters before the winter.
We continue to work in collaboration with Heart Foundation Gisborne and the NZ Heart Foundation Project Manager – Food Service & Hospitality in creating a unique PD programme for the East Coast schools.
Healthy Workplaces Two new workplaces have enquired about workplace wellness - Cedenco and Te Karaka Area School. Meetings organised for Nov.
• Eastland Port & ISO - establish working groups for both sites at Nov meeting.• Fulton Hogan - prepare for bronze accreditation end Nov 2019.• Ovation - progress silver accreditation Feb 2020.• Downer Communications - progress silver accreditation Feb 2020.• Downer Transport - prepare for bronze accreditation end Nov 2019.
Sexual and Reproductive Health Tūturu wāhine project – Dr Ngahuia Murphy will be showcasing Te Awa Atua; ‘The wise blood of the womb’ to be held at Te Hiringa Matua. Mere Boynton co-presenter will screen “Hinekura” a short film on menstruation pre-colonisation.
We have completed an environmental scan to identify schools/kura that have access to sanitary items, also sharing a link to those who want to be connected to free puberty and menstruation teaching resources and packs. Working alongside the Health in Schools Health Promotion Advisor to link and share SRH resources.
Health Protection Tobacco Control We organised a Controlled Purchase Operation for the alleged offending premise. We did not get a sale.
Te Puia Springs water supply
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We met with the CEO and operational staff during the month. They have indicated their desire to move forward with developing a water safety plan so they can choose to comply with Section 10 of the DWSNZ. They have contacted Josh Takao to help with this and he has indicated he will be here before Christmas. We are hopeful we will have a plan from them before the end of June 2020. NPH have asked us to support their endeavours to renew the water take consent for the supply. Communicable Disease We have had 18 notifiable diseases, including Shigellosis, Giardia and Salmonellosis. Environmental Health We undertook an inspection of Early Childhood Centre for the Ministry of Education sign-off for a new day-care. We completed a desktop exercise based around border health and a crew member with a possible infectious disease on the ship. Eastland Port members attended, along with the ship’s agents. This tested all of Border Health plans and was very successful. We opposed a liquor licence for a city sports bar, as Health Protection have evidence to show that this premises may be more of a gaming venue, rather than sport bar. Under the Sale and Supply of Alcohol Act a premises must have a higher revenue from alcohol and food rather than pokies. Preparation is underway for planning New Year monitoring of R&V, looking at water, alcohol and camping ground hygiene.
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Hauora Tairāwhiti BoardTitle: SUMMARY FINANCIAL REPORT
Prepared By: Craig Green, CFO / GM Finance, Procurement and Facilities
Date: Thursday, 7 November 2019
Information Item1. CFO COMMENTSFinancial Performance Result and Overview The DHB has a Board approved $12.0 million deficit budget for the 2019/20 financial year. The DHB result for the period ending 30 October 2019 is $241k Favourable to budget for the month with a deficit of $795k.
For the month, the: • Provider Arm is $ 2k Favourable • Funder Arm is $208k Favourable, and • Governance Arm is $ 31k Favourable ($21k in management/admin staff and $12k in Healthshare)
Provider Arm: For the month, the Provider Arm’s Favourable variance of $2k driven by: • Revenue: $150k Favourable for the month; Personal Health side contracts $113k and ACC $21k.• Expenditure: $148k Unfavourable. Key variances:
o Personnel costs: $7k Favourable to budget of $6,788k for the montho Outsourced Services: $12k Unfavourable against a budget of $507k for the montho Clinical Supplies: $26k Unfavourable; air ambulance adverse $101k and patient transport $15k offset by favourable
implants and prosthesis $57k and clinical equipment $35k• Infrastructure and Non-clinical Supplies: $117k adverse to budget; audit and legal fees adverse $56k, non-specific
accrual up $90k offset by favourable facility expenses $30k (outsourced maintenance $26k, internal maintenance $7kand compliance costs $5k offset by utilities $5k non-medical waste removal $5k.
Funder Arm: For the month, the Funder Arm’s Favourable variance of $208k driven by: • Revenue: $856k Favourable; driven by 2019-20 Pay Equity funding $239k, Te Kuwatawata $667k• Expenditure: $648k Unfavourable; driven by:
o Personal Health Expenditure – Favourable by $86k, driven by IDF outflows of $156k offset by travel andaccommodation $40k and Pharmaceutical Cancer Treatment Drugs $31ko Mental Health Expenditure – $661k unfavourable to budget; $667k Te Kuwatawata $667k funding offset
o Disability Support – in-line with budgeto Public Health – in-line with budgeto Māori Health – $92k adverse with $109k of unbudgeted expenditure for Maori workforce development
2. CONSOLIDATED FINANCIAL PERFORMANCE SUMMARY
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3. STATEMENT OF FINANCIAL PERFORMANCE – CONSOLIDATED
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4. FINANCIAL POSITION - SUMMARYThe financial position as at October 2019 is below. This indicates a weak balance sheet, with $21.9m in negative working capital and a net worth of $32.5m.
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5. CASH FLOW POSITION
Cash Position The cash balance was in debit by $1,800k with the DHB pool at month end; being $2.3m favourable to forecast debit balance of $4.1m. Operating cash was $1.8m favourable to forecast; Investing in capital equipment $86k favourable to budget and Financing in-line with expectations.
Inwards: Inward cash was $1.436m favourable to forecast; driven by 2018/19 Q4 electives and ambulatory receipts of $1.2m and $85k in additional funding for Combined Pharmaceutical Budget (CPB) and GST $200k.
Outwards: Operating Cash outflow favourable $342k to forecast; driven by: payroll $239k, payments to suppliers of $187k
Capital Expenditure: $86k favourable to budget. Outlook: Net cash flow for the month expected to be negative $96k and closing cash to be negative by $1,897k.
6. CAPITAL EXPENDITURE (CAPEX) Depreciation funded capital expenditure planned for the 2019/20 year is $7.9 million. The table below summarises spend against budget (depreciation funded and Carry Forward from prior year) for the month and year-to-date.
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7. YEAR END FORECAST
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8. VALUE RELEASE PROGRAMME – SAVINGS PLAN
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9. PERFORMANCE GRAPHS
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Hauora Tairāwhiti Board Sub-Committee Reports
AGENDA ITEM
AGED & DISABILITY SUPPORT ADVISORY COMMITTEE November 2019
Tairāwhiti Healthy Ageing Forum - No public included decision items.
COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE November 2019
Tairāwhiti Healthy Ageing Forum - No public included decision items.
HOSPITAL ADVISORY COMMITTEE 19 November 2019
No public included decision items
FINANCE, AUDIT & IT COMMITTEE 19 November 2019
No public included decision items
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