counties manukau district health board board meeting agenda...counties manukau district health board...

Counties Manukau District Health Board Agenda

Counties Manukau District Health Board Board Meeting Agenda Wednesday, 13 August 2014 at 1.30 – 4.30pm, Innovation Lab, Ko Awatea, Middlemore Hospital, Hospital Road, Otahuhu, Auckland Time Item

1.00 – 1.30pm Board Only Session

1. Welcome

1.30 – 1.35pm 2. Governance

2.1. Attendance & Apologies 2.2. Conflicts of Interest/Specific Interests 2.3. Confirmation of Public Minutes – 2 July 2014 2.4. Action Items Register

1.35 – 1.40pm 1.40 – 1.50pm

3. Monthly Reports

3.1. Chair’s Report (Verbal Update) 3.2. Chief Executive’s Report

4. Presentations

1.50 – 1.55pm 5. General Business

1.55 – 2.00pm 6. Resolution to Exclude the Public

2.00 – 2.05pm 2.05 – 2.10pm 2.10 – 2.20pm 2.20 – 2.40pm 2.40 – 2.50pm 2.50 – 3.05pm

7. Confidential

7.1. Confirmation of Confidential Minutes – 2 July 2014 7.2. Action Items Register 7.3. Community Labs Update (Geraint Martin) 7.4. Project Swift Update (Sarah Thirlwall) 7.5. IS Strategic Projects Update (Sarah Thirlwall) 7.6. National Infrastructure Platform (NIP) Programme Business Case (Ron

Pearson/HBL)

Afternoon Tea Break

3.10 – 3.30pm 3.30 – 3.50pm 3.50 – 4.10pm 4.10 – 4.20pm 4.20 – 4.30pm 4.30 – 4.40pm

7.7. Food Services Business Case (Ron Pearson/HBL) 7.8. Linen & Laundry Business Case (Ron Pearson/HBL) 7.9. Acute Mental Health Business Case Development (Louise Zacest) 7.10. Community Services Pharmacy Funding Policy (Benedict Hefford) 7.11. CCU Monitoring & Telemetry Replacement Project (Phillip Balmer) 7.12. Expansion of Haemodialysis Facilities Based Dialysis Capacity (Phillip Balmer)

Next Meeting: 10 September 2014

Innovation Lab, Ko Awatea, Middlemore Hospital, Otahuhu

Agenda for Counties Manukau District Health Board

BOARD MEMBER ATTENDANCE SCHEDULE 2014 Name

Jan 12 Feb 5 Mar 9 Apr 7 May 11 Jun 2 Jul 13 Aug 10 Sept 1 Oct 5 Nov 3 Dec

Lee Mathias (Chair)

No

Mee

ting

Wendy Lai (Deputy Chair)

Arthur Anae

Colleen Brown

Sandra Alofivae

Lyn Murphy

David Collings

Kathy Maxwell

George Ngatai

Dianne Glenn

Reece Autagavaia

* Attended part meeting only


BOARD MEMBERS’ DISCLOSURE OF INTERESTS

July 2014 Member Disclosure of Interest

Dr Lee Mathias, Chair • MD Lee Mathias Limited

• Trustee, Lee Mathias Family Trust • Trustee, Awamoana Family Trust • Chair Health Promotion Agency • Deputy Chair Auckland District Health Board • Director, Pictor Limited • Director, iAC Limited • Advisory Chair, Company of Women Limited • Director, John Seabrook Holdings Limited • Chairman, Unitec

Wendy Lai, Deputy Chair • Board member and partner at Deloitte • Board member Te Papa Tongarewa, the Museum of

New Zealand

Arthur Anae

• Councillor, Auckland Council • Board Member Phobic Trust • Member The John Walker ‘Find Your Field of

Dreams’ • Chairman, NZ Good Samaritan Heart Mission to

Samoa Trust

Colleen Brown • Chair Parent and Family Resource Centre Board (Auckland Metropolitan Area)

• Member of Advisory Committee for Disability Programme Manukau Institute of Technology

• Member NZ Down Syndrome Association • Husband, Determination Referee for Department of

Building and Housing • Chair, Early Childhood Education Taskforce for

COMET • Member, Manurewa Advisory Group • Member, Child Advocacy Group – Manukau • MSD Member, Auckland Social Policy Forum,

Auckland Council • Deputy Chair, Auckland City Council Disability

Strategic Advisory Group


• Chair ECE Implementation Team Auckland South • Chair IIMuch Trust

Dr Lyn Murphy • Member, International Society for

Pharmacoeconomics and Outcomes Research (ISPOR).

• Member of the New Zealand Association of Clinical Research (NZACRes)

• Senior lecturer in management and leadership at Manukau Institute of Technology

• Member, ACT NZ • Director, Bizness Synergy Training Ltd • Director, Synergex Holdings Ltd • Associate Editor NZ Journal of Applied Business

Research • Member Franklin Local Board

Sandra Alofivae

• Chair of the Auckland South Community Response Forum (MSD appointment)

• MSD Member, Auckland Social Policy Forum, Auckland Council

• Member, Fonua Ola Board • Appointed to the Ministerial Forum on Alcohol

Advertising & Sponsorship • Board Member, Pacifica Futures

David Collings

• Chair, Howick Local Board of Auckland Council • Member Auckland Council Southern Initiative

Kathy Maxwell • Director, Kathy the Chemist Ltd • Regional Pharmacy Advisory Group, Propharma

(Pharmacy Retailing (NZ) Ltd) • Editorial Advisory Board, New Zealand Formulary • Member Pharmaceutical Society of NZ • Trustee, Maxwell Family Trust • Member Manukau Locality Leadership Group,

CMDHB

Dianne Glenn • Member – NZ Institute of Directors • Member – District Licensing Committee of Auckland

Council • Life Member – Business and Professional Women

Franklin • President – National Council of Women

Papakura/Franklin Branch • Member – UN Women Aotearoa/NZ • Vice President – Friends of Auckland Botanic

Gardens and Member of the Friends Trust • Member – Friends of Regional Parks • Life Member – Ambury Park Centre for Riding


Therapy Inc. • CMDHB Representative - Franklin Health

Forum/Franklin Locality Clinical Partnership

George Ngatai • Arthritis NZ – Kaiwhakahaere • Chair Safer Aotearoa Family Violence Prevention

Network • Director Transitioning Out Aotearoa • Director BDO Marketing • Board Member, Manurewa Marae

Reece Autagavaia • Member, Pacific Lawyers’ Association • Member, Labour Party • Member, Auckland Council Pacific People’s Advisory

Panel • Board Member, United Otara Market


BOARD MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 2 July 2014 Director having interest Interest in Particulars of interest Disclosure date Board Action David Collings

Potential Botany Land Development

Mr Collings declared a specific interest in relation to the Potential Botany Land Development, being a member of the Howick Local Board.

4 September 2013 That Mr Collings’ specific interest be noted and that the Board agree that he may remain in the room and participate in any deliberations or decisions.

David Collings Innovation Hub Mr David Collings has a conflict of interest in regard to ATEED (being a member of the Local Community Board, which is part of the Auckland Council) and will be involved in the Innovation Hub.

5 October 2011 The Board notes that Mr Collings has a conflict of interest in regard to the Innovation Hub. He may participate in the deliberations of the Board in relation to this matter because he is able to assist the Board with relevant information, but is not permitted to participate in decision making.

Wendy Lai

HBL – Food & Laundry & FPSC Programme

Ms Lai declared a specific interest in regard to Deloitte providing support to HBL in the food and laundry and FPSC Programme. Deloitte has mainly been providing Oracle implementation resources to FPSC. Ms Lai is not directly involved with this work.

12 February 2014 That Ms Lai’s specific interest be noted and that the Board agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.


Minutes of Counties Manukau District Health Board Held on Wednesday, 2 July 2014 at 1.30pm at Ko Awatea, Middlemore Hospital, Otahuhu, Auckland. Present: Dr Lee Mathias (Chair), Ms Colleen Brown, Ms Sandra Alofivae, Ms Dianne Glenn, Ms

Kathy Maxwell, Apulu Reece Autagavaia, Mr George Ngatai, Anae Arthur Anae In attendance: Mr Geraint Martin (Chief Executive), Mr Ron Pearson (Deputy CEO), Ms Lyn Butler

(Board Secretary) Apologies: Dr Lyn Murphy, Ms Wendy Lai, Anae Arthur Anae (early departure) 1. Welcome

The Chair welcomed members to the meeting. 2. Governance

2.1 Attendance & Apologies Noted.

2.2 Conflicts of Interest/Specific Interests

Noted.

2.3 Confirmation of Minutes – 11 June 2014 Resolution That the Public Minutes of the Board Meeting held on Wednesday, 11 June 2014, were taken as read and confirmed as a true and correct record. Moved: Dianne Glenn Seconded: Sandra Alofivae Carried: Unanimously

2.4 Action Items Register

The Chair expressed her concern about rolling over the After Hours Contract for a further two years. Mr Martin advised that this was the best option at the time, but acknowledged that there are a number of issues across the Region that require addressing. Mr Martin is to discuss the strategic thinking around this with Ms Cathy O’Malley, MoH.

3. Monthly Reports 3.1 Chair’s Report (Verbal)

The Chair advised that the Northern Region DHB Board Members met on the 26 June 2014. Presenters included Mr David Wood, new Chief Executive of HBL, National Health Committee, Professor Des Gorman and HQSC.


3.2 Chief Executive’s Report

The Chief Executive took the paper as read, and highlighted the following: • Q3 Report – performance continues to improve, and are on track to achieve all targets

this year. Immunisation rates have increased, with the rate for Maaori now at 83% and Pacific 94%.

• Annual Plan – written feedback has now been received from MoH, raising three points.

Two have since been resolved and Mr Ron Pearson and Ms Louise Zacest are to meet with MoH to provide more information on the third - Project Swift.

The 2014/15 $3M surplus remains an issue. Mr Martin is to write to MoH.

Ms Brown sought clarity on the Rheumatic Fever Programme over the two week school holidays. Mr Martin advised that no swabbing would be carried out over this period, but children already in the system would continue to be monitored.

Ms Brown noted that no representative from a disability perspective was included in the Children’s Action Plan. The Chair asked Mr Martin to ensure that children with disabilities be recognised on these programmes. Mr Autagavaia asked about the Pacific Health Plan. Mr Martin confirmed that the Pacific and Asian Health Plans are coming to a future meeting. Mr Ngatai asked whether additional funding is received for the high number of ED presentations. Mr Martin confirmed no extra funding is received. Mr Martin advised that over 700 delegates have signed up to date for the 2014 APAC Conference in Melbourne.

Resolution That the Chief Executive’s Report be received. Moved: Lee Mathias Seconded: Sandra Alofivae Carried: Unanimously 3.2.1 Q3 Performance Report (Marianne Scott/Dawn Kelly)

Ms Scott took the paper as read. CMDHB remains a high performing DHB, with only two targets to achieve before the end of the quarter. Resolution That the Board note the Q3 Performance Report. Moved: Lee Mathias Seconded: Sandra Alofivae Carried: Unanimously

4. Presentation

4.1 At Risk Individuals (Benedict Hefford & Claire Garbutt) Mr Hefford advised that the programme went live yesterday, and is based on a number of programmes across the Localities. The target is to have 15,000 people in the first year, increasing to 30,000 by the second year, which will make it one of the biggest integrated healthcare programmes outside of North America. The Chair recommended that ‘GP Practice’ be renamed ‘General Practice’ 160,000 people are classified as obese, with approximately 100,000 having a pre-disposal to diabetes. Long term conditions patients are around 55,000, with 2,000 very high risk patients coming into hospital more than five times per year.


Mr Anae left the meeting at 2.15pm

A longitudinal assessment will be carried out at the start of the programme, with a questionnaire at the conclusion, to identify any shifts, what aspects have been successful, etc. Ms Brown commented that this was a mixture of both clinical and social needs, and thought funding would be coming from elsewhere. Mr Hefford advised that Mangere had started to cluster operational multi disciplinary teams, with pilots having shown that social issues such as housing are quite crucial. Ms Garbutt outlined some case studies to the Board. This project is starting with the Spinal and Memory teams, but will not be restricted to these. A patient portal will be available, which will be interactive, for patients to log into themselves. A Communications Package is being developed around this work. The Vision over the next year is to achieve pooling of funds from different agencies to improve patient care. The Chair thanked Mr Hefford and Ms Garbutt for their presentation.

5. General Business

None.

6. Resolution to Exclude the Public Individual reasons to exclude the public were noted. Resolution That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health & Disability Act 2000, that the public now be excluded from the meeting as detailed in the above paper. Moved: George Ngatai Seconded: Kathy Maxwell Carried: Unanimously

The meeting was re-opened to the public. The meeting closed at 3.40pm. The next meeting of the Board will be Wednesday, 13 August 2014 at Ko Awatea, Middlemore Hospital. The minutes of the meeting of the Counties Manukau District Health Board of 2 July 2014 are approved. Signed as a true and correct record on 2 July 2014. Chair ………………………………………… Dr Lee Mathias (Chair) Recommendation (moved /seconded )


CMDHB Board Summary of Actions (Public) – 11 June 2014

DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

3 July At Risk Individuals The Chair recommended that ‘GP Practice’ be

renamed ‘General Practice’ July B Hefford Noted.

3 July CE Report Ms Brown noted that no representative from a disability perspective was included in the Children’s Action Plan. The Chair asked Mr Martin to ensure that children with disabilities be recognised on these programmes. Mr Autagavaia asked about the Pacific Health Plan. Mr Martin confirmed that the Pacific and Asian Health Plans are coming to a future meeting.

July September

B Hefford M Apa

Noted. A presentation will be given to CPHAC on the Children’s Action Plan.

3 July Annual Plan The 2014/15 $3M surplus remains an issue. Mr Martin is to write to MoH.

July G Martin

3 July After Hours Mr Martin is to discuss the strategic thinking around this with Ms Cathy O’Malley, MoH.

September B Hefford

7 May Manukau Locality Clinical Partnership

Ms Lai referred to the diagram on resources and investment and asked that an update on this be brought back to a future meeting.

September B Hefford

7 May Chief Executive’s Report

Ms Lai requested that a paper come back on After Hours, including a Workplan, to avoid future rollover situations. Mr Hefford is to provide a one pager for the next meeting. The Chair confirmed that the same paper had gone to all DHB ELTs, and can be brought to Board.

September B Hefford This will be going to the August CPHAC, then to Board in September.


Counties Manukau District Health Board

Chief Executive’s Report Recommendation It is recommended that the Board receive the Chief Executive’s Report. Prepared and submitted by Geraint Martin, Chief Executive Non-Financial Performance Update National Health Targets & Non-Financial Performance I am pleased to advise that we have achieved all our major health targets and all of our support targets (e.g. ESPI Compliance and B4 School Checks, with the exception of the improving radiology target. We have delivered a $3M surplus for the 2013/14 financial year, which is the strongest financial performance in the health sector. Attached is a Scorecard illustrating CMDHB performance to 30 June 2014 summarised as follows: Shorter Stays in Emergency Departments In our Emergency Department for Quarter 4, 96% of patients were admitted to a ward, discharged, or transferred within 6 hours. This meets the Government’s 95% target. Improved Access to Elective Surgery CM Health has maintained compliance, and has exceeded the elective discharges in June by 11% (YTD Discharges - 111%). Shorter Waits for Cancer Treatment 100% of CM Health patients who were eligible for treatment continued to receive radiotherapy and chemotherapy in less than 4 weeks during June. Increased Immunisation At the end of Quarter 4, the coverage rate for all eight month old babies being vaccinated was 92% meeting the increased target (90%) for 2013/14. The rate for Maaori was 84%, whilst the Pacific rate was 95%. Better Help for Smokers to Quit CM Health performance for hospitalised patients continues to meet the national target (95%) with a 96% result for June. Quarter 4 results are 98.9%, compared to 76.7% for Quarter 3. Accessing monthly practice level data and providing support to PHOs and practice level has proved a successful initiative. The Maternity target remains under development.


More Heart and Diabetes Checks Preliminary Quarter 4 results suggest a result of 92.1% (total population) and if confirmed CMDHB will have achieved the target of 90%. Maaori population is 88.1% and Pacific 91.7%. Other Government Priority Indicators Rheumatic Fever The school based programme is fully implemented with throat infection rates remaining at 13%. Elective Service Productivity Indicators (ESPI): not exceeding 150 days waiting times and moving to not exceeding 120 days by June 2014.

At 30 June all services with the exception of Plastics (one breech) and Orthopaedics (one breech), met the 150 day commitment to treat target. For the new target to be achieved > 120 days: For FSA: 200 (May - 231) are waiting 120+ days For Treatment: 289 patients (May - 249) are waiting 120+ days

Diagnostic Access Reporting - Developmental target for Radiology and Medical Diagnostics MRI and CT scans have failed to meet the required target. MRI for June remained stable with a result of 66% within the 6 week target (target 75%); CT scans improved to 79% within 6 weeks (target 85%). Cardiology angiogram data is now been submitted to the Ministry of Health, and exceeds the target (target 85% within 90 days). Further work is needed to achieve the Gastroenterology Colonoscopy results.

At 30 June 2014: x For CT: Procedure carried out within 6 weeks x For MRI: Procedure carried out within 6 weeks For Coronary Angiogram: Procedure carried out within 3 months For Urgent Colonoscopy: Procedure carried out within 14 days x For Routine Colonoscopy: Procedure carried out within 6 weeks For Surveillance Colonoscopy: Procedure carried out within 12 weeks

Breastscreen coverage target 70% of eligible women aged 45-49 years have been screened in the last 24 months. Coverage reports from the national data base remain stable:

For 45-69 years: Total coverage 70.2%, Maaori 68.6% and Pacific 72.3% Other Annual Plan Priorities

Service Priority Areas

Progress against plan

1. Prime Minister’s Youth Mental Health Project

Baseline audit completed on follow-up care plans on youth discharged from Child Adolescent Mental Health Services and AOD into primary care. Primary/secondary MDTs established in Mangere. Wait-times remain below MOH targets, initiatives in place to improve performance.




2. Vulnerable Children

Immunisation: Refer to Health Target commentary. Rheumatic Fever: Refer Other Government Priority Indicator commentary. B4SC (B4 School Checks): currently 85% checks completed remaining just under target; weekend clinics & local advertising strategies proving successful.

3. Emergency Care

Refer also to Health Target commentary.

4. Access to Elective Services

Also refer to Health Target commentary. Delivery Redesign of Elective Services Programme (DRES): Stage Four progress report sent to MOH. Enhanced Recovery after Surgery (ERAS): Contract requirements have now been met; monthly nurse teleconferences are advancing daily ERAS principles.

5. Shorter waits for Cancer Treatment

Also refer to Health Target commentary.

6. Increased Immunisation

Refer to Health target commentary.

7. Smokefree Refer to Health Target commentary. 8. More Heart &

Diabetes Checks

Refer to Health Target commentary.

9. Primary Care

Refer also to Indicators #1, 13 & 15. ARI: Implementation plans for At Risk Individuals (ARI) have been confirmed within each locality and will be rolled out by 30 June 2015; Tranche 1 commencing July-Oct 2014 with 56 practices transitioning. Extra resource for value added practice interventions aimed at Maaori & Pacific. Clinical Pathways: Five pathways implemented with an electronic decision tool. eShared Care Plans: continued increase in the number of patients enrolled (200% increased from June 2013 to June 2014).

10. Maternal and Child Health

Access: Regional Maternal Mental Health acute pathway and model expected to be finalised by Sept.

11. Acute & Unplanned Care

Refer to Priority Indicators #9 Primary Care and #19 Cardiac commentaries.

12. General Medicine

Dialysis volumes exceed capacity, continuing to outsource.

13. Long Term Conditions

Refer also to Heart and Diabetes Health Target & #9 commentaries. Locality SMOs and VHIU (Very High Intensive Users) teams partnering to support localities.

14. Health of Older People

Dementia Pathway: Referrals have increased to the point where acceptance had been restricted due to waiting lists – 75 referrals, 20 cases on wait list. Next phase includes integration with GPs, PNs and Alzheimers Auckland. Pathway now accepted as BAU. ACE (Acute Care for the Elderly): Acute Care for Elderly Model complete – after one year targets have been met with 4% reduction in readmissions and rehab patients post acute phase staying 6 days less in hospital.

15. Mental Health and Addictions

Access: Total access rates not being met for older Maaori clients which is slowly increasing as well as young Maaori; strategies in place to increase access. Youth Teams transitioning to localities by mid-July; focus on school based services and improving cultural capability of staff. Drivers of Crime: School based alcohol and drug services have been extended into




Alternative Education settings. The Violence Intervention Programme (VIP) extended to include mental health clinical staff. Primary Secondary Integration: Redesign of adult acute pathway in progress with preparations for implementation underway.

16. Access to Diagnostics

Refer to Other Government Priority indicator commentary for Breast Screening and CT/MRI and Colonoscopy Diagnostic Access Reporting.

17. Cardiac services

Cardiac echo wait times continue; An additional trainee sonographer is in position and an additional sonographer approved.

18. Population Health

Refer to Priority Areas # 2, 6 and 10 for commentary on First 2,000 days.

19. Whaanau Ora A Fanau Ola Advocacy and Integrated Support Programme: since 1 July 2013 933 pacific patients and 3862 fanau members have been engaged via various channels. Main issues identified include housing, financial, lack of support once discharged home, safety (violence), health literacy, non-compliance of medications and caring for fanau. Intervention for 167 patients saw a reduction in EC presentations and transfer to wards, as well as a reduction in acute admissions, average length of stay and the number of inpatient events.


NOTES

Better help for smokers to quit - in pregnancy

Placeholder (TBC)

NATIONAL HEALTH TARGETS - CM Health and Northern Region Performance - to 30 June 20141. All health targets reflect MOH ratings for the previous 12 months to CM Health with confirmed MOH Quarter 3 (31 March 2014) results.

2. Northern regional health target information for Quarter 3 (31 March 2014) as per their quarterly report. 3. Financial performance data is provided by the Corporate and Business Services directorate and reflects how actual costs compare to budgeted. Refer to the Board Financial Report detail for further information and analyses. 4. CVD and Tobacco - Primary results are provided quarterly (Awaiting Quarter 4 results) . 5. CVD for June is based on preliminary results.

50%

60%

70%

80%

90%

100%Shorter stays in Emergency Departments

CM HEALTH REGION TARGET

50%60%70%80%90%

100%110%120%130%

Improved access to elective surgery YTD


50%

60%

70%

80%

90%

100%

Shorter waits for cancer treatment


50%

60%

70%

80%

90%

100%Increased immunisation


0%

20%

40%

60%

80%

100%

Better help for smokers to quit - primary care


50%

60%

70%

80%

90%

100%

Better help for smokers to quit - hospital


0%

20%

40%

60%

80%

100%More heart and diabetes checks


(2,000)(1,000)

-1,0002,0003,0004,0005,0006,0007,000

'$00

0

Living Within Our Means 2013/14 FY Surplus (Deficit) by Month & YTD

Consolidated Actual Mth Consolidated Budget Mth

Consolidated Actual YTD Consolidated Budget YTD


Organisation Performance – Hospital Services As we are now at the end of the financial year, it is timely to review how dynamic and diverse this organisation is. We have continued to maintain a balanced budget, encouraged and supported staff to look at new and different ways of delivering services while all the time kept the patient and our community firmly at the centre of all we do. We have delivered health and disability services, both in the community and in our hospitals within budget. Given the significant financial pressures, this was quite an achievement and only made possible through the collective efforts of everyone in the organisation. Some of the highlights are listed below. The healthcare achievements in 2013/14 have included improving our standing in the Government’s Health Targets: surpassing our planned elective surgery volumes, reducing wait times for acute care, providing more smokers with more opportunities to quit and delivering shorter waits for cancer treatment. Elective surgery achieved 111% of the elective discharge target, all cancer patients received their radiotherapy and chemotherapy within four weeks and despite having a very busy acute hospital less than 5% of patients waited more than 6 hours for treatment, admission or discharge throughout the year, and for our hospital teams 96% of smokers received advice and cessation support. Keeping patients safe when in our care is one of our most important goals. We are therefore pleased to see further reductions in our standardised hospital mortality rate. Key factors contributing to these improvements include improved clinical communication with initiatives such as Electronic Medication reconciliation and the Perioperative checklist, which is now being used in more than 90% of operations. We have sustained attention to achieved reduced harm from falls and from hospital-acquired infections. A key part of reducing harm from falls is identifying those at risk of falls. Counties has ranked top in the country with 98% of patients having a falls risk assessment on admission, and progress in improving the safety of the hospital environment with hourly patient checks, a revised falls prevention and education program, and more accurate reporting. Reducing Hospital infections is focused on increased compliance with the hand hygiene ‘5-moments’ campaign’ and lifting our compliance rate to 74% in the latest audit. There have been decreased perioperative infection rates and a reduced the incidence of Central Line Associated Bacteraemia (CLAB). Highlights in the last year include:

• Provision of 1,755 more elective operations than in the previous year, 4,172 more emergency care discharges, and 520 more acute discharges;

• Reduced length of stay for elective admissions due to a more coordinated care process and reduced the readmission rate, reduced ALOS for acute medical patients from 3.3 days to 3.1 days in medicine; and reduced ALOS for adult mental health inpatient services by 4.25 days and 2.88 days for the MHSOP inpatient ward;

• Increased the number of complex older patients admitted directly to the ward from Emergency Care or Medical Assessment as part of the Acute care of the elderly (ACE) program by 300% which has reduced the overall LOS for the patient and the readmission rate;

• the Enhanced Recovery After Surgery (ERAS) programme into our hospitals for people having bowel surgery, knee and hip replacement surgery. The purpose of the ERAS programme is to reduce the stress of surgery, improve pain relief and thereby enhance the patient’s recovery. Bowel surgery patients are now able to eat, drink, and are out of bed the day of their surgery, and start walking the following day. Patients feel better quicker and require less time in hospital following their operation;

• Implementation of the National Endoscopy Quality Improvement Programme with results indicating we are performing at a high level in terms of safe, patient-focused services that are efficient, accountable and sustainable;

• Continued attention to improving timeliness of access to diagnostics;


• Achieving international benchmarks for Stroke care and seen on-going improvements with our early supported discharge;

• Completion of the new Harley Gray Building on budget and on schedule; • Celebrated and recognised the invaluable contributions of our volunteers at the Manukau Super

Clinic (MSC) Minister of Health Volunteer Awards. In summary the past year has been a full and exciting year for staff with the introduction of many new initiatives to ensure better care for our patients, while remaining within budget. Our achievements mean we are in good shape as we move into 2014/15 year and to meet the challenges ahead. Month in review: June June saw all services busy with increasing winter service levels, and the commencement of the Winter Plan for Middlemore Hospital. Operationally, our Emergency Care team saw 8,996 presentations. This was 4.1% higher than last month and 4.4% higher than this time last year. Average daily volumes in Emergency Care were 300 with volumes fluctuating between 259 and 333. Despite this, the hospital met the 6 hour target for the month. There were a similar number of admissions in June compared to 2013, however we have been able to resource 200 less beds than last year. The table below shows we forecast requiring 21,788 bed days in June, but with responsive daily bed management we were able to only resource 21,763 bed days. The stable rate of admissions is attributable to the great work provided by the Emergency Care and Medical Assessment Unit, and Theatre Admissions Unit teams. The Medical Assessment Unit continues to function well with key benefits of co-location with EC in a single facility providing operational efficiencies. The majority of the patients (98%) admitted to MAU were discharged within 48 hours. In addition, a reduced average Length of Stay across the services has been enabled by the Discharge Lounge, and more effective hospital-wide coordination through daily capacity meetings facilitated by Middlemore Central. As part of CM Health’s planning for increased demand for beds over winter, a single Discharge Lounge servicing all of Middlemore Hospital opened on May 2014, during which time it has replaced a range of discharge lounges that were operating within the hospital including patient lounges on the wards. Patient satisfaction results, via a survey being completed by patients while in the lounge has been extremely positive on two counts; their experiences while in the discharge lounge and with what the lounge has to offer. Activity summary

a) Emergency Care (EC) presentations actual versus 2012/13 presentations

Volumes June '14 Year to date

Act Bud / Contract Var % var Act Bud /

Contract Var % var

EMERGENCY CARE

Presentations (against 2013) 8,996 8,616 380 4.41% 104,815 101,284 3,531 3.49%

Discharges (against contract) 8,911 8,532 379 4.44% 104,774 100,602 4,172 4.15%

N.B. Presentations refer to all people entering Emergency Care, while Discharges only include those that are treated (excludes a small number of cases that leave unseen, or are transferred).


The YTD WIES volumes are 2% above funded agreement (6% for Acute and 1% for Electives). June WIES volumes are 3% down for the month (4% down for Acute and 3% up for Electives). The YTD patient discharges are up 3% on last year (Elective up 3% and Acute 3%); June patient discharges are up 3% on last year (Elective down 1% and Acutes up 3%). Financials The Provider Arm produced a $1.8m favourable variance for the month, exceeding budget with a favourable year to date variance of $2m. The breakdown of overall variances for the CMDHB group are summarised below, with further analysis in in the Hospital Advisory Committee report.

Service Month YTD Hospital Provider $2,997 k $7,054 k Integrated Care $(850)k $(3,910)k Ko Awatea $(272)k $(502)k HBL $(33)k $(567)k Total Provider $1,842k $2,075 k CMDHB Funder $(102)k $633 k CMDHB Governance $(2,052)k $(2,658)k Total CMDHB $(311)k $52 k

Emerging Issues and highlights for June As detailed in the Hospital Advisory Committee report, the Directorate continued to have:

• An on-going increase in YTD WIES and discharge volumes compared with 2012/13 and against the 2013/14 funding agreement;

• A focus on supporting staff with excess annual leave owed to be able to take holidays, however there has been a small deterioration on excess leave rates due in part to winter workloads and also increased sick leave being required;

• Seen the positive impact of on-going attention to reducing serious patient harm which is seeing good trend results, which are further reported in the patient safety report;

• Achieved better than our internal target results for average length of stay, 7 day readmission rates and Theatre list utilisation.

A milder winter has impacted on seasonal influenza presentation patterns. These are being tracked and Middlemore Central continues to monitor and implement the Contingency Plans as needed. Below are the presentation rates to the end of July, showing a later than usual peak occurring this year. Other Highlights Alongside all the clinical activity, staff from across the organisation have been positively engaged in the Project Swift scoping process, and also enjoyed events such as Pasifika Week, Matariki celebrations, the conclusion of campaigns with Ko Awatea including the Beyond 20,000 and Patient Experience learning programme. Early July, saw a very successful Science Fest acknowledging the wealth of improvement and research occurring across the services. Science Fest 2014 was a great celebration of the quality, innovation and research that is occurring within Counties. Research breadth and volume has expanded enormously growing 25% in just the last 12 months from 187 research studies in 12/13 to 234 in 13/14. Prizes were awarded by the DHB Chair Lee Mathias. There was also a very lively medical debate on whether rugby, racing and beer are still the predominant part of the Kiwi psyche.


Cardiac Services - At the Cardiac Society annual scientific meeting in Dunedin, CM Health were awarded the main conference prizes. Our Cardiac Rehabilitation tracking tool was also presented at the conference. The team has improved uptake from 55% in 2010, 66% of all patients referred attended one of our Cardiac Rehabilitation options in 2013. It was great to see the cardiology team recognised for the exciting research and innovative projects underway at the moment. Mental Health After months of planning, dedication and determination, the Tamaki Oranga Recovery Centre teams’ completed the building their own whare. Named Te Rangimarie, the whare was blessed and completed on the eve of Matariki. Diversity and our workforce - On Wednesday 16 July, 90 year 11 students from Tangaroa College, James Cook, Aorere College, Manurewa High and De La Salle attended a hospital tour here at Middlemore. The students were able to meet different health professionals and observing what it is like to have a career in health. Students from these colleges also attended Niue day with a focus on workforce development. The students participated in exciting activities including the Handle the Jandal workshop about youth resilience and how to cope with stress. The Talanoa careers evening saw students and their parents come to Ko Awatea to hear from our tertiary partners; Otago Polytechnic, AUT, University of Auckland and MIT about the different courses that they offer and the support available at tertiary level.


Primary & Community Services Summary • Based on the latest preliminary data, we are now reasonably confident that all national health

targets will be met by 30 June. The increase in the rate of smoking brief advice in particular has been very impressive. Other important targets, including oral health and Before School Checks, have also been met as at 30 June. These achievements represent a great effort on the part of both PHO and the CMH teams.

• New primary and community contracts and service changes are being introduced with the start of the financial year, particularly in mental health and primary care. A new approach to Refugee Health is being put in place, with PHOs providing wrap around primary care services to enrolled refugee patients including assessment, interpreting, and linking patients to other sectors/services. The business case for after-hours provision beyond 2014 is being finalised and will be presented to CPHAC in August prior to Board consideration in September.

• Initial planning is underway to implement a Children’s Action Team in Manukau in 2015. These intersectoral teams are part of a national initiative to bring together social and health services around families with children at high risk of abuse/neglect. The experience of the initial pilot sites in Northland and Rotorua suggests that careful planning and change management is necessary to achieve the intended outcomes, hence our early attention to this initiative.

• Waiting times for access to Addiction Services are showing some improvement. Contractual changes have been made from 1 July to give providers greater flexibility to meet changing client needs. Two additional workers have been funded to help enable access to accommodation for mental health consumers.

• CMH will become the regional provider of acute spinal services in August 2014. A trial to use the eShared Care/CCMS care planning tool for spinal patients being discharged from the unit has commenced. The Memory Team is also piloting use of the tool.

• Intersectoral work has been very successful in 2013/14, with Warm-up Counties insulating over 2,000 homes and 3,000 referrals generated. A submission is being prepared on Auckland Council’s draft local alcohol policy, in collaboration with Auckland Regional Public Health service.

• The implementation of the At Risk Individuals Programme began on 1 July, with 14 practices beginning the transition. All practices are expected to implement ARI over the next 10 months. Locality leadership groups have been planning how best to re-align CMH teams, NGOs and social service providers with GP clusters so that practices are supported through multidisciplinary teams and case conferences.


National Health Targets

Target 13/14 Q1 Q2 Q3 May ‘04

Q4 On Track

More Heart and Diabetes Checks

90% 80% 83% 86% 90% Yes

Better Help for Smokers to Quit

90% 59% 69% 77% 85% Yes

Immunisations 90% 90% 91% 91% 91% Achieved Preliminary end of year data suggests that all national health targets were met for 2013/14. Final confirmed results are expected in mid-August. Intersectoral Warm Up Counties Manukau is a free home insulation programme that retrofits insulation into the homes of low income families with high health needs. There were 218 homes insulated in May bringing the total to over 2,000 for 13/14 financial year. The PATHS (Providing Access to Health Solutions) Programme PATHS is an intersectoral programme to tackle long-term benefit dependency resulting from a partnership between Counties Manukau Health and the Ministry of Social Development (MSD). The aim of the PATHS programme is to assist people in receipt of certain benefits, who have a Medical Certificate, to reduce barriers to employment over 200 clients were enrolled into the PATHS programme over 2013/14. Healthy Families New Zealand The Ministry of Health has issued a Registration of Interest (ROI) to identify locally-based providers to act as the lead for the implementation of Healthy Families New Zealand from October 2014. This new initiative is set to operate in the four local board areas that make up the catchment of the Auckland Council’s Southern Initiative and correspond to the Manukau and Manurewa/Papakura wards. We have encouraged our locally based community organisations to respond to the ROI and are now awaiting the outcome of the ROI. Prevention of Obesity A regional intersectoral approach to prevention of obesity is being led by ARPHS on behalf of the Auckland Health Intersectoral Group (AHIG) of which we are a part:

• Initially aiming to align current activities being led by health organisations then planning to engage more widely across sectors.

• A very successful Population Health Grand Round was held on 15th May with Professor Boyd Swinburn as guest speaker on the topic of Obesity Prevention (the same presentation was given the day before at ADHB.

• Collaborative work to improve the retail food environments across the three Auckland DHBs is underway.


Locality Dashboard

Indicator

CMH Average/ Target Planned

Manukau (May-14)

Franklin (May-14)

Otara/Mangere

(May-14)

Eastern

(May-14) ASH Rate 2.6 2.3 2.0 2.9 1.2

Immunisation (8-month)

90% 89% 83% 91% 94%

Acute Bed Days Projected actual (less) Planned

Projected total

143,881

Planned total

-2,971

Projected (less)

Planned

-148

Projected (less)

Planned

-3050

Projected (less)

Planned

-2,108

Projected (less)

Planned CVD % on therapy 89% 87% 100% 80% 67%

HBA1c <= 64 mmol/mol

73% 71% 87% 57% 88%

Finance Report For Primary Health and Community Services there is a net favourable full year forecast variance of $685k, made up mostly of underspends on integrated care initiatives and pharmaceuticals.


Financial Performance Report FINANCIAL POSITION at June 2014

Summary: A: Month / Year to date The draft unaudited result for the year was a very pleasing result, resulting in a landing slightly positive to budget despite all the pressures and changing circumstances during the year. The actual result was a small favourable positive variance of $23k (actual $3,054k v’s budget $3,031k) and the months result, an unfavourable variance of $323k (actual $(280)k v’s budget $43k). As earlier advised, there were significant movements (net positive) around year end account completions, as accruals were reassessed and MOH based annual charges such as Pharms and Pharms rebates advised and incorporated within the final figures. Note that in the interest of improved transparency and clarity, the previously advised stock movements within the Provider consolidation have been more correctly reallocated from “Integrated Care” to “Hospital Provider”. This gives a much more realistic picture of the Hospital Arm performance. The Funder Arm was $106k unfavourable to budget, but remains favourable to budget for the year by $588k. The Provider Arm consolidated produced a favourable variance of $1,838k for the month, and a favourable year to date variance of $2,093k a great achievement overall. The Hospital side of the provider arm was favourable for the month by $2,218k by reflecting year end movements in the month and $2,972k favourable year to date. Governance was unfavourable for the month of $2,055k, and year to date remains unfavourable by $2,658k. The main drivers are the provision of accruals around the contracted IBM underwrite and costs incurred for Project Swift (IBM due diligence) and to a much lesser extent cost for business cases (Mental Health and Rehab). Saving target (as advised/agreed with MOH)

Again another very pleasing result overall with what was at the time, an extraordinarily difficult target to achieve.

YTD Full year

$000 Act Bud Var. Bud 25,320 25,197 123 25,197


Statement of Performance by Operating Arm

Month

Net Result YTD

Full year

Act $000 Var. $000 Act Bud Var. Last year

Bud Forecast

3,025 807 2,218 Hospital Provider 17,035 14,063 2,972 16,719 10,009 11,045

(411) (336) (75) Integrated Care (5,228) (5,418) 190 (5,740) (1,317) (814)

(1,316) (1,044) (272) Ko Awatea (13,397) (12,895) (502) (16,119) (12,897) (13,499)

(120) (87) (33) HBL (1,607) (1,040) (567) (696) (1,040) (1,605) 1,178 (660) 1,838 Provider (3,197) (5,290) 2,093 (5,836) (5,245) (4,873)

593 699 (106) Funder 8,618 8,030 588 10,387 7,985 8,425

(2,051) 4 (2,055) Governance (2,367) 291 (2,658) (1,539) 291 (521)

(280) 43 (323) Surplus (deficit) 3,054 3,031 23 3,012 3,031 3,031

Monthly Result (not cumulative)


Volume Summary

Total WIES Month Year to date

Act Bud Var. % Last. Yr.

Act Bud Var. % Last. Yr.

4,681 4,889 (208) (4.3)% 4,934 Acute 59,432 58,636 796 1.4% 58,012

1,533 1,492 41 2.75% 1,543 Elective 18,227 17,263 964 5.6% 18,234

6,214 6,381 (167) (2.6)% 6,477 Total 77,659 75,899 1,760 2.3% 76,246 WIES volumes are 2.3% above contract year to date. This volume is driven by Acute being above contract by 1.4% and Electives up by 5.5%. It is interesting to note the Acute rise over last year at 2.4% is the lowest for many years. Equally despite having a record year last year for Elective funded by one off MOH additional incentives this year we have maintained virtually the same level. Year to date corresponding discharges are 3.1% up on last year with Acute 3.2% and Elective volumes 2.7%.

Discharges (note we don’t budget for discharges)

Month Year to date

Act Last Yr. Var. % Act Last Yr. Var. %

5,929 5,729 200 3.5% Acute 70,468 68,263 2,205 3.2%

1,246 1,262 (16) (1.3)% Elective 17,064 16,622 442 2.7%

7,175 6,991 184 2.6% Total 87,532 84,885 2647 3.1%

0.87 0.93 0.06 6.5% Ratio WIES to discharges 0.89 0.89 0.01 0.8%

1. Changes in WIES to Discharges (April 13 0.898, April 14 0.884) is driven largely by Elective Adult

Surgical Care. The ten month period is showing the same WIES value this year as last year 12,144, the Discharges are 420 higher than the same period last year (April 13 9,047, April 14 9,467) giving a reduction in the ratio of 0.060. Elective Adult Surgical Care accounts for 20% of our WIES production and 13% of the Discharges. When reviewing the mix of Elective Adult Surgical Care the type of surgery that had the greatest impact was in General Surgery. We have discussed this trend with the CFO Auckland who is experiencing the same issues, they have not found conclusive answer.

Volumes Other

(note we don’t budget for discharges) Month Year to date

Act Last Yr. Var. % Act Last Yr. Var. %

657 675 (18) (2.7)% Birth Numbers 7,372 8,097 (725) (9.0)%

8,911 8,532 379 4.44% ED Volumes 104,774 100,602 4,172 4.15%

4,260 4,073 187 4.59% Renal Dialysis1 52,169 48,870 3,299 6.75%

2,561 2,308 253 10.96% Outpatient Summary2 29,769 29,549 220 0.74%

28,345 26,636 1,709 6.42% Mental Health Days 367,474 338,745 28,729 8.48%

2.5 2.5 - - ALOS 2.5 2.5

- -


Again this year a number of key changes occurred with birth levels down an extraordinary 9% over the previous year and continuing to fall, offset by increases in critical areas such as ED up 4.15% and disturbingly Renal Dialysis up 6.75%, Mental Health days, where small previously are now up 8.48% on the previous year reflecting the increasing pressure on all related facilities.


Statement of Performance

Month

Year to Date

Full Year

Act Bud Var. $000 Act Bud Var. Last year

Bud Forecast

Revenue 123,863 117,487 6,376 Crown 1,414,040 1,411,051 2,989 1,349,2

36 1,411,0

51 1,414,7

64 5,093 2,530 2,563 Other 39,769 30,349 9,420 38,132 30,349 37,797

128,956 120,017 8,939 Total Revenue

1,453,809 1,441,400 12,409 1,387,368

1,441,400

1,452,561

Expenses

44,108 44,340 232 Personnel 526,819 529,125 2,306 511,125 529,125 526,561

5,949 4,493 (1,456) Outsourced 65,483 55,267 (10,216) 62,506 55,267 59,736

57,987 53,247 (4,740) Funder Provider

payments

637,384 639,851 2,467 605,413 639,851 647,336

8,610 7,680 (930) Clinical Sup. 101,192 94,571 (6,621) 101,481 94,571 106,750

8,495 5,263 (3,232) Infrastructure

67,447 62,593 (4,854) 58,945 62,593 54,589

125,149 115,023 (10,126)

Operating Exp

1,398,325 1,381,407 (16,918) 1,339,470

1,381,407

1,394,972

3,807 4,994 (1,187)

Surplus after operating

Exp.

55,484 59,993 (4,509) 47,898 59,993 57,589

1,829 2,543 714 Depn. 29,923 30,516 593 23,882 30,516 31,028

1,048 1,325 277 Interest 8,822 13,450 4,628 8,266 13,450 10,345

1,210 1,083 (127) Capital Chg. 13,685 12,996 (689) 12,738 12,996 13,185

(280) 43 (323) Net Surplus 3,054 3,031 23 3,012 3,031 3,031

Better than 5%

Worse than 5%

Monthly Result (not cumulative)


Revenue

Month YTD Full Yr.

Act Bud Var. $000 Act Bud Var. Bud

69,030 64,813 4,217 Provider 792,833 778,434 14,399 778,434

118,424 113,590 4,834 Funder 1,369,498 1,363,247 6,251 1,363,247

(59,844) (59,644) (200) Elimination (723,496) (715,366) (8,130) (715,366)

1,346 1258 88 Governance 14,974 15,085 (111) 15,085

128,956 120,017 8,939 Total 1,453,809 1,441,400 12,409 1,441,400 • Provider: favourable for the month of June and YTD. The main drivers for the current month’s variance

are: Government Revenue - Training fees - additional fees charged to UoA, and MIT at June 2014. - CTA – additional revenue at year end - Additional revenue received for gastro colonoscopies and PCT drugs Patient/Consumer Sourced - Non-residents income favourable against budget reflecting YTD and the additional hA resource

assigned to this area. This is significantly offset by doubtful debt. - Private Patients– Tahitian burns patient currently being treated, however, the absence of Tahitian

burns patients YTD has adversely affected revenue.

Other Income - Interest Received – actual interest received above budget for the month. - Donations– Donation expectation not realised for the month, and donations still down on budget

year to date.

Funder Payments - Receipts from funder for various contracts.

• Funder: Wash-up of Income in-advance totalling almost $5m • Haemophilia rebate released via revenue


Staff Costs

Month

YTD Full Yr.

Act Bud Var. $000 Act Bud Var. Bud 43,032 43,516 484 Provider 516,889 519,227 2,338 519,227

1,076 824 (252) Governance 9,930 9,898 (32) 9,898 44,108 44,340 232 Total 526,819 529,125 2,306 529,125

13,854 14,164 310 Medical 164,451 169,096 4,645 169,096

16,633 16,792 159 Nursing 199,649 197,975 (1,674) 197,975

6,257 6,430 173 Allied Health 76,835 77,878 1,043 77,878

1,943 1,935 (8) Support Personnel 22,918 21,966 (952) 21,966

5,421 5,019 (402) Management Admin 62,966 62,210 (756) 62,210

44,108 44,340 232 526,819 529,125 2,306 529,125 Commentary: • Medical Personnel Costs are favourable for the month due to ACC levy provision release. Annual leave

provision has been recalculated by Health Alliance for approximately 50 SMO’s due to an invalid pay type loading against their profiles. The incorrect employee type value accrued annual leave at the salary base rate which is non-compliant with the Holidays Act as employees are entitled to be paid at a 52 week average. A back pay exercise will be required to recognise the incorrect pay treatment for leave taken. A high level provision has been made to compensate.

• Nursing Personnel Costs are favourable due to ACC levy provision release and unfavourable YTD. A high training cost during June has been offset by additional revenue received through CTA and third party course charges. Initiatives funded by other divisions are identified unbudgeted costs for the month.

• Allied Health Personnel Costs are favourable for the month and YTD due to ACC levy provision release.

Labs and Pharms have continued increased volume pressures reporting an unfavourable variance. • Support costs are unfavourable for June and YTD. The variance is driven by vacancies in “Cleaners &

Orderlies” and “Maintenance & Engineering” offset by ACC levy provision release. • Management Administration costs are unfavourable for the month and YTD. Unbudgeted “other leave”

costs are the drivers for the overspend, offset by ACC levy provision release.


Outsourced Services

Month YTD Full Yr.


1,099 405 (694) Medical 7,695 4,860 (2,835) 4,860 123 54 (69) Nursing 1,404 549 (855) 549

47 64 17 Allied Health 835 768 (67) 768 29 37 8 Support 387 444 57 444

266 122 (144) Management/Administration 2,464 1,486 (978) 1,486

1,564 682 (882) Total Personnel 12,785 8,107 (4,678) 8,107 2,481 2,358 (123) Corporate & Funder Services 31,009 28,296 (2,713) 28,296 1,904 1,453 (451) Clinical Service 21,689 18,864 (2,825) 18,864 5,949 4,493 (1,456) Total 65,483 55,267 (10,216) 55,267 Commentary • Unfavourable for the month and YTD, represented by:

Non-Clinical - HBL phased increased cost for FPSC project. - hA costs adjusted after the budget had been finalised for 2013/14. - Pacific Health offset by MFAT revenue. Clinical - Outsourcing of surgical procedures (carried out by private organisations) continues in order to

maintain the ESPI (Elective Service Performance Indicator) targets. Surgical vacancies have been covered by outsourcing personnel

- Mental Health - Locum medical staff partially offset by medical staff salaries. - Additional outsourced Gastro procedures offset by MoH additional funding.


Independent Service Provider (Demand driven expenditure)

Month Major Categories YTD Full Yr.


Personal Health

20,440 20,482 42 IDF Personal Health 242,128 245,784 3,656 245,784

9,039 8,258 (781) Pharmaceuticals 100,384 99,096 (1,288) 99,096

7,409 6,762 (647) Primary Practice

Services – Capitated

84,508 81,144 (3,364) 81,144

1,309 423 (886) Child and Youth 7,656 5,767 (1,889) 5,767

230 472 242 Adolescent Dental Benefit 5,440 5,664 224 5,664

580 481 (99) Chronic Disease

Management and Education

5,830 5,772 (58) 5,772

362 361 (1) Palliative Care 4,344 4,332 (12) 4,332

9 348 339 General Medical Subsidy 3,835 4,176 341 4,176

3,478 1,393 (2,085) Other 10,588 16,603 6,015 16,603

42,856 38,980 (3,876) Total Personal Health 464,713 468,338 3,625 468,338

Mental Health

1,152 1,152 - IDF Mental Health 13,824 13,824 - 13,824

868 936 68 Community

Residential Beds & Services

10,158 11,232 1,074 11,232

685 690 5 Other Home

Based Residential Support

8,434 8,280 (154) 8,280

318 303 (15) Dual Diagnosis – Alcohol & Other

Drugs 3,755 3,636 (119) 3,636

267 273 6 Crisis Respite 3,227 3,267 40 3,267

332 296 (36) Child & Youth Mental Health

Services 3,845 3,561 (284) 3,561

164 164 -

Kaupapa Maori Mental Health

Services - Community

1,956 1,975 19 1,975

173 135 (38) Mental Health

Community Service

1,954 1,785 (169) 1,785

1,274 1,079 (195) Other 13,277 13,086 (191) 13,086

5,233 5,028 (205) Total Mental Health 60,430 60,646 216 60,646


Disability Support Services

3,858 4,143 285 Residential Care: Hospitals 50,003 49,707 (296) 49,707

1,405 1,923 518 Residential Care: Rest Homes 20,855 23,076 2,221 23,076

1,537 1,677 140 Home Support 19,677 20,116 439 20,116 1,338 1,316 (22) Other 17,349 15,808 (1,541) 15,808

8,138 9,059 921 Total Disability Support Services 107,884 108,707 823 108,707

1,583 71 (1,512) Total Public Health 2,806 852 (1,954) 852

177 109 (68) Total Maori Health 1,551 1,308 (243) 1,308

57,987 53,247 (4,740) Funder 637,384 639,851 2,467 639,851 Clinical Supplies

Month YTD Full Yr. Act Bud Var. $000 Act Bud Var. Bud

8,610 7,680 (930) Provider 101,192 94,571 (6,621) 94,571

3,376 2,916 (460) Treatment Disposables 42,266 38,800 (3,466) 38,800

688 583 (105) Diagnostic

Supplies & Other Clinical Supplies

7,914 7,061 (853) 7,061

1,048 1,004 (44) Instruments & Equipment 12,099 11,604 (495) 11,604

276 285 9 Patient Appliances 3,533 3,302 (231) 3,302

1,449 1,382 (67) Implants & Prostheses 16,171 15,662 (509) 15,662

1,296 1,233 (63) Pharmaceuticals 15,573 14,836 (737) 14,836

477 277 (200) Other Clinical Supplies 3,636 3,306 (330) 3,306

8,610 7,680 (930) Total 101,192 94,571 (6,621) 94,571 Commentary:

Clinical Supplies are unfavourable for the month and YTD), mainly due to costs associated with the accounting adjustment to release haemophilia funds (Revenue) in favour of payment to the Provider for additional Elective surgical claims for June.


Non-Clinical / Infrastructure (excluding Interest and Capital Charge)

Month YTD Full Yr. Act Bud Var. $000 Act Bud Var. Bud

6,108 4,903 (1,205) Provider 60,548 58,540 (2,008) 89,056 2,387 360 (2,027) Governance 6,899 4,053 (2,846) 4,053 8,495 5,263 (3,232) Total 67,447 62,593 (4,854) 93,109

Commentary • Provider: Other Expenses are unfavourable for June and YTD. An increase in non-resident billings has

increased the bad debt provision, resulting in an unfavourable variance. Expense recoveries represent additional costs offset by additional revenue, unbudgeted consultants costs for June.

• Governance: Costs incurred for Project Swift (IBM due diligence) and business cases relating to Mental Health and Rehab are the main drivers.

-


Interest and Capital Charge

Month YTD Full Yr. Act Bud Var. $000 Act Bud Var. Bud 322 100 222 Interest - Received 2,240 1,200 1,040 1,200

1,048 1,325 277 Interest Paid - Debt 8,822 13,450 4,628 13,450

726 1,225 499 Net Interest Paid 6,582 12,250 5,668 12,250 1,210 1,083 (127) Capital Charge 13,685 12,996 (689) 12,996

- Interest cost: The level of borrowings is lower than budgeted delivering a $277k favourable interest cost variance for the month.

- Capital Charge: unfavourable variance reflects the actual cost of capital charged by MoH but is offset by revenue to cover capital charges on revaluations. However we are paying approximately $240k pa additional charge cumulative for each / every annual $3.0 m surplus declared.


Ratios Provider Arm (only) Costs to Revenue (%) last six months

June 14

May 14

Apr 14

Mar 14

Feb 14

Jan 14

Medical 20.00 20.70 20.97 20.82 19.98 21.31 Nursing 24.03 24.19 27.06 25.24 23.69 26.52 Allied 9.05 9.48 10.09 9.96 9.49 9.61 Support 2.81 2.68 2.97 3.11 2.77 3.10 Management 6.44 6.90 7.09 7.07 6.47 6.54 Personnel 62.34 63.94 66.20 62.40 67.08 67.15 Outsourced Pers. 2.44 1.62 1.37 1.73 2.26 1.89 Total Personnel 64.78 65.56 67.57 64.13 69.34 69.05 Outsourced Clinical Services 2.76 2.90 2.72 2.69 2.46 2.58

Outsourced Corp (hA) 3.52 3.41 3.71 3.67 3.76 3.73

Clinical Supplies 13.65 17.83 13.88 12.99 12.22 12.28 Infrastructure 13.59 12.89 12.93 12.26 12.97 13.05 Total 98.29 102.59 100.81 95.74 100.75 100.69

Provider cost as a percentage of revenue over the last four years and year to date

2014 YTD

2013

2012

2011

2010

Medical 20.7 21.2 20.5 20 19.5 Nursing 25.1 25.5 24.7 24.3 25.0 Allied Health 9.7 9.7 9.5 9.2 9.0 Support 2.9 2.7 2.7 2.6 2.5 Man/Admin 6.8 7.2 7.8 7.7 7.4 Personnel 65.2 66.3 65.2 64.0 63.5 Outsourced Personnel 1.8 1.8 1.7 1.9 1.7

Total Personnel 67.0 68.1 66.9 65.9 65.2 Outsourced Clinical Supplies 2.7 2.9 2.8 3.4 3.4

Outsourced Corporate 3.7 3.4 3.3 2.4 2.4

Clinical supplies 14.0 14.4 14.7 14.6 14.2 Infrastructure 13.0 12.4 13.2 13.8 13.7 Total 100.4 101.2 100.9 100.0 98.9 Depn 3.8 3.1 2.8 3.6 3.5 Int 1.1 1.5 1.3 1.4 1.3 Capital Charge 1.7 1.7 1.7 1.7 1.9


Balance Sheet

Actual Budget Variance Opening

1st July 13 YTD

Movement Current Assets Petty Cash 10 10 - 10 - Bank (includes 20,705 (4,587) 25,292 (7,186) 27,891 Trust 865 856 9 854 11 Prepayments 646 450 196 (59) 705 Debtors 30,390 29,147 1,243 35,442 (5,052) Inventory 1,434 3,990 (2,556) 946 488 Total current Assets 54,050 29,866 24,184 30,007 24,043 Fixed Assets Land 72,753 72,753 - 72,753 - Buildings & Plant 680,602 715,590 (34,988) 529,900 150,702 Investment Property 1,360 1,300 60 1,199 161 Information Technology 2,745 2,549 196 2,635 110 Information Software 180 - 180 180 - Motor Vehicles 3,934 4,684 (750) 4,028 (94) Total Cost 761,574 796,876 (35,302) 610,695 150,879 Accum. Depreciation (191,958) (187,188) (4,770) (166,678) (25,280) Net Cost 569,616 609,688 (40,072) 444,017 125,599 Work In-progress 40,489 10,218 30,271 146,067 (105,578) Total Fixed Assets 610,105 619,906 (9,801) 590,084 20,021 Investments (hA IT / HBL) 27,127 29,990 (2,863) 19,620 7,507 Total Assets 691,282 679,762 14,383 639,711 44,064 Current Liabilities Creditors 93,517 81,860 11,657 76,125 17,392 Income in Advance 3,192 1,300 1,892 1,448 1,744 GST and PAYE 9,502 14,000 (4,498) 13,668 (4,166)

Loans (Crown and HBL shared banking) 40,000 5,000 35,000 5,000 35,000

Payroll Accrual & Clearing 29,648 30,527 (879) 27,667 1,981 Employee Provisions 80,759 84,001 (3,242) 79,392 1,367 Total Current Liabilities 256,618 216,688 39,931 203,300 53,318 Working Capital (202,568) (186,822) (15,747) (173,293) (29,275) Net Funds Employed $434,664 $463,075 $(28,410) $436,411 $(1,747) Non-Current Liabilities Term Loans 227,600 270,600 (43,000) 232,600 (5,000)

Employee Provisions (non-current) 16,984 15,300 1,684 16,376 608

Trust and Special Funds 864 856 8 854 10

Insurance Liability- Non Current 1,337 1,300 37 1,337 -

Total Non-Current Liabilities 246,785 288,056 (41,271) 251,167 (4,382) Crown Equity Crown Equity 124,498 128,792 (4,294) 124,917 (419) Revaluation Reserve 127,443 107,798 19,645 127,443 -


Retained Earnings – Provider (74,511) (73,750) (761) (71,314) (3,197)

Retained Earnings – Govern. (18,151) (14,583) (3,568) (15,784) (2,367)

Retained Earnings - Funder 28,600 26,761 1,839 19,982 8,618 Total Crown Equity 187,879 175,018 12,861 185,244 2,635 Net Funds Employed $434,664 $463,074 $(28,410) $436,411 $(1,747) Commentary Net borrowings: Long and short term debt less bank balance is $33.3m lower than budget as the June 2013 closing position was $20m lower than the budgeted starting position. i.e. true net movement $13.0m. Debtors: $1.2m higher than budget, $5.1m lower than June 13 (the opening budget assumed a higher starting position $36.6m actual year end was $35.4m). Also note below that MOH debtor are mostly current.

MOH Debtors $000 Tot Curren 30 day

Invoiced 3,24 2,44 79

Accrued 53

Total 3,77

Accounts payable: $11.7m higher than budget and $17.4m higher than June 2013. Accounts payable where $7.7m lower than the budgeted starting position. Net Fixed Assets: This level is $5.7m lower than budget, lower spending than planned on the CSB and non FMP. Investments in Associates: Health Benefits Ltd, $ 5.5m for the FPSC project. Note: we will need to continue to ensure that these investments have underlying value through the future success of HBL. healthAlliance, $21.6m for IC capital investment. Payroll Accrual & Clearing: due to timing of payroll cut offs. Income in Advance: Timing There are no other significant issues regarding the Balance Sheet


Cash flow

Month YTD Actual Budget Variance Actual Budget Variance Cash flows from operating activities: Crown Revenue 118,643 123,623 (4,980) 1,420,177 1,417,967 2,210

Other 4,771 2,530 2,241 37,529 30,349 7,180

Interest rec. 322 100 222 2,240 1,200 1,040 Expenses Suppliers 79,676 84,320 4,644 860,128 860,822 693 Employees 43,412 43,379 (33) 522,863 521,015 (1,848) Interest paid 1,048 1,325 277 8,822 13,450 4,628 Capital charge - - 7,250 7,250 - Net cash from Operations (400) (2,771) 2,371 60,883 46,980 13,904

Cash flows from investing activities: Fixed Assets (822) (3,450) 2,628 (55,065) (69,818) 14,753 Investments (hA & HBL) (1,269) (113) (1,156) (7,507) (1,716) (5,791)

Restricted & Trust Funds 1 (1) 2 10 1 9

Net cash from Investing (2,090) (3,564) 1,474 (62,562) (71,533) 8,971

Debt - - - 30,000 18,000 12,000 Other non-current liability (419) 1,728 (2,147) (419) 1,728 (2,147)

Net cash from Financing (419) 1,728 (2,147) 29,581 19,728 9,853

Net increase / (decrease) (2,909) (4,607) 1,698 27,902 (4,825) 32,727

Opening cash 24,489 886 23,603 (6,322) 1,104 (7,426) Closing cash 21,580 (3,721) 25,301 21,580 (3,721) 25,301 Summary Month YTD Actual Budget Variance Actual Budget Variance Opening cash 24,489 886 23,603 (6,322) 1,104 (7,426) Operating (400) (2,771) 2,371 60,883 46,980 13,904 Investing (2,090) (3,564) 1,474 (62,562) (71,533) 8,971 Financing (419) 1,728 (2,147) 29,581 19,728 9,853 Closing cash 21,580 (3,721) 25,301 21,580 (3,721) 25,301 Commentary : Investment: Include shares in hA for Windows 7 upgrade $4.2m and IT transfer of $1.6m.


Treasury All term debt facilities are now through the MOH, with interest rates “locked in” at fixed rates. Working capital facilities remain with Westpac via Health Benefits Ltd ($64.4m). Both ASB/Commonwealth Bank ($10.0m) and Westpac ($10.0m) lease facilities are allowable by the Crown. CHFA Debt

Drawn ($ millions)

Date of Advance

Maturity Interest rate Rate

40.0* 17-Sep-07 15-Apr-15 6.33% Fixed, Semi-Annual 5.0 16-Jul-12 15-Apr-17 3.32% Fixed, Semi-Annual

15.0 15-Jul-08 15-Dec-17 6.36% Fixed, Semi-Annual 10.0 28-Jan-09 15-Dec-17 4.41% Fixed, Semi-Annual

5.0 03-Feb-09 15-Dec-17 4.41% Fixed, Semi-Annual 5.0 20-May-09 15-Dec-17 5.65% Fixed, Semi-Annual

10.0 30-Apr-10 15-Dec-18 5.88% Fixed, Semi-Annual 20.0 20-Mar-13 15-Dec-18 3.30% Fixed, Semi-Annual

5.0 15-Nov-11 15-Mar-19 5.13% Fixed, Semi-Annual 13.0 27-Oct-09 15-Dec-19 6.10% Fixed, Semi-Annual

7.0 27-Oct-09 15-Dec-19 6.10% Fixed, Semi-Annual 5.0 20-Jun-12 15-May-21 3.45% Fixed, Semi-Annual

42.6 29-Jun-12 15-May-21 4.22% Fixed, Semi-Annual 20.0 18-Dec-12 15-May-21 3.56% Fixed, Semi-Annual 30.0 15-Apr-13 15-Apr-22 3.45% Fixed, Semi-Annual 30.0 20-Dec-13 15-Apr-23 4.91% Fixed, Semi-Annual

5.0 20-May-09 15-Apr-23 4.74% Fixed, Semi-Annual

$267.6 4.76% Weighted Average

* We are unable to implement a Forward Rate Agreement until six months from maturity.


FTE Reporting CMDHB Provider FTE Summary Provider Medical Staff are unfavourable by

(0.78) FTE, reflecting SMO vacancies offset by high net annual leave.

Nursing is unfavourable (174) FTE. This is attributable to net annual leave (84) FTE, stat days in lieu (47) FTE, funded FTE (31)FTE, vacancies 64 FTE, internal bureau (43) FTE. External bureau (12) FTE were employed during the month reflecting high clinical demand during the month of June as well as unplanned leave cover.

Allied Health staff is favourable by 9.65FTE reflecting vacancies 63 FTE offset by net annual leave (27) FTE, funded FTE (21) FTE and overtime (11) FTE.

Support Staff unfavourable variance of (27) FTE reflects overtime and casuals partially offset by vacancies during the month.

Management and admin staff are 17 FTE favourable due to existing vacancies partially offset by net annual leave.

Budget June 2014 5,744.27 Net Annual Leave (accrued - taken) (173.96) Stat days in lieu (58.08) Unpaid days accrual (2.35) Funded FTE (59.35) Vacancies 228.15 Transfers in and out 16.03 Overtime (39.21) Bureau - Internal (42.97) Casuals (35.05) Other (provide detail) (7.31) TOTAL Cause of Change (174.10)

Actual FTE June 2014 5,918.37

External Bureau (12.00) Personnel Costs per FTE (Rolling average)

June 14

May 14

Apr 14

Mar 14

Feb 14

Jan 14

Dec 13

Medical 165,536 167,870 167,369 166,995 166,995 168,043 168,534

Nursing 76,560 76,363 77,414 76,012 76,012 75,995 76,189

Allied Health 70,141 69,779 69,631 69,213 69,213 68,935 68,973

Mgmt/Admin/Clerical 71,629 72,633 72,431 72,067 72,067 71,823 71,889

Support 50,369 50,210 50,465 50,136 50,136 50,061 49,727


The table below shows the Management Admin cap return to the MoH each month. Counties Manukau Only June 14 May 14 Apr 14 Mar 14 Feb 14 Jan 14 Accrued FTE (as per MOH template) 851.5 835.2 833.4 851.2 837.6 747.3 Annual Leave loading (75.1) (75.2) (75.0) (75.4) (75.2) (74.9) FTE’s on holiday 58.1 74.9 75.4 61.6 73.5 159.6 Payroll FTE’s 834.5 835.0 833.7 837.4 835.9 832.0 Contractors / Consultants (FTE equivalent)

11.0 11.0 11.0 11.0 11.0 11.0

Vacancy 22.0 21.5 22.8 19.1 20.6 24.5 Total 867.5 867.5 867.5 867.5 867.5 867.5 Number submitted Jan 09 for 31 Dec 08 867.5 867.5 867.5 867.5 867.5 867.5 Variance - - - - - -

healthAlliance (CMDHB portion only) June 13 May 14 Apr 14 Mar 14 Feb 14 Jan 14

140 140 140 140 140 140

Number submitted June 2012 140 140 140 140 140 140

Variance (under) - - - - - -

Note: healthAlliance uses an average FTE and will therefore fluctuate around the number submitted. There are three national drivers occurring, which will become even larger in variance in future months: 1. hA staff are being seconded to HBL assisting in the rollout of FPSC .This means hA are backing them up in

a small way currently that will become larger as the rollout occurs by hA and we are not reducing our hA FTE calculation as they are still hA employees reimbursed by HBL. This will become an even larger issue as the FPSC rollout occurs fully transferring responsibility to hA from other DHB's .WE cannot correct for this ...this is an action that must occur between MOH/HBL and the DHBs ultimately lifting hA’s cap. There will be a period of transition where the caps on all sides will be exceeded before settling to achieve the stated HBL objectives.

2. We are commencing the mandatory rollout of Windows 7 to the northern region and this will occur by

use of ultimately significant third party resource given there are virtually no spare resources in hA to free up for this .This contracted resource has been initiated but will increase for the mandatory national rollout/upgrade as its fully implemented.

3. Currently the total FTEs of hA are allocated against the existing four northern region DHB shareholders on

a % basis and this is still occurring despite the transition described above ,this will have to change given the above but at the moment there is no methodology to allow this.

Shared Agencies Cap Jun 14 May 14 Apr 14 Mar 14 Feb 14 Jan 14 North 33.0 36.0 36.0 36.0 37.7 34.4 35.4 NDSA 57.0 47.0 47.0 47.0 47.0 47.5 43.5


Inter District Flows (IDFs) - Hospital Services

Fiscal Year 2014 Non ADHB IDF Activity The current year end estimated position is $1.5million unfavourable to CMDHB. This is a significant deterioration from the expected year end position at May. 2 complex cases noted in our outflow acute activity added unanticipated $100K year-end cost. Both have been returned to our care. Despite this, total outflows are expected to end the year well below plan as shown in Table 1 below. This result is similar to the level reported in May As has been the position throughout the year, the predominant influence on this result has been lower levels of inflow activity from other DHBs both in terms of discharges and complexity. For the non-northern region, activity this month was 94 WIES below plan. This equates to $440K impact on result. Discharges remained at the lower levels seen throughout the second half of the year but this was further compounded by having the lowest complexity of the year. This pattern of lower discharges and lower complexity was also evident in activity from the Waitemata and Northland regions with both showing deterioration in position of over $100K At the time of reporting, internal IDF coding was very close to complete. Data audits and corrections of NMDS are also nearing completion. Thus the final inflow result is not anticipated to alter markedly from the result presented below. There may however still be uncoded activity from other DHBs which could alter the outflow result further. Monthly PositionNet variance ($000)

Admit TypeInflow Outflow

Net Variance Inflow Outflow



Net Variance

Acute (614) 155 (459) (18) 223 205 (1,662) 63 (1,598) (2,294) 442 (1,852)Elective 370 44 414 14 5 19 (235) 132 (103) 149 181 330Cancer and Renal 5 2 8 (6) 6 (0) 17 37 54 17 45 62Grand Total (239) 202 (37) (11) 235 224 (1,879) 232 (1,647) (2,129) 668 (1,460)

Total (excl ADHB)WDHB NDHB Other June 2014

Table1 – Non ADHB IDF Activity With Auckland DHB (ADHB) The overall year end position with ADHB for hospital services is expected to be $1.9m favourable to Counties Manukau DHB.


Net IDF Result ADHB YTD Var$DRG Elective $1,493,715DRG - Acute $86,309DRG Maternity ($810,707)

HOP Inpatient ($81,714)

Non DRG $1,521,171Non DRG -Maternity $29,141

Adjuster Estimate for Uncoded Outflows ($116,386)

PCT ($107,783)Payment for Community Evogram ($85,572)

Total $1,928,175

Inflow Variance to Plan ($ 2,293,191)Outflow Variance to Plan $ 4,214,372

TABLE 2 INFLOWS Activity for the Auckland population remains under plan for the year to date for both acute and elective activity. There is no observable change to activity patterns from previous months which have been relatively stable from month to month. As with above, coding is almost totally complete as are data audits and corrections. Outpatient activity appears unchanged for the month. OUTFLOWS Overall activity by Auckland DHB (ADHB) for our population remains under plan. Although most events are now coded, a small adjuster estimate remains in place to account for a small number of cases that are expected to code out over the average Total numbers of CMDHB patients on current Inpatient Waiting Lists at ADHB is stable on last month. 8 are waiting over 150 days and all are booked. Both acute and elective discharge volumes were in line with the average throughput experienced this year for our population. An error was discovered in payment for products for a small group of patients. Invoicing had been charged to and paid by Auckland DHB for a small number of patients receiving Evogram in the community. A single line has been added to the year-end position to address this error. As this particular activity does not fit within the IDF framework, work is ongoing with NZ Blood to ensure that future invoices for this group are sent directly to the patients DHB of domicile. There have been no observed activity changes within the outpatient group for this final month of the year. PCT (Pharmaceutical Cancer Treatments) are presented as estimates based on last known data (as at March). The final position will not be known until the final release of IDF position from the Ministry of Health next month.


Further to the position above. ADHB alerted on 17th July that a decision had been made to alter the management capture of some acutely presenting Ophthalmology patients. Currently these patients are captured as outpatient attendances and funded at the relevant national price. The intended alteration would see any of these patients that stay over 3 hours administratively admitted allowing them to be coded and thus attract a WIES reimbursement which is significantly more that the current payment. This change was discussed in-house at ADHB and deemed to be in line with national business rules. As such the recoding of patients occurred within the last week with no formal notification to the affected DHBs. The impact of this change is a further approximately $250k cost for the 2013/14 year. Of further concern is that many of these may have been sitting as First Specialist Assessment originally and will be removed from our volume counts As per the below, we have advised ADHB that whilst we are open to addressing this issue going forward into the new year, we do not agree with the retrospective coding and associated additional cost occurring after the financial year has ended. We have also noted concern of the potential impact of such a change on First Specialist Assessment (FSA) volumes that have already been agreed with the Ministry of Health. Response to ADHB 17th July 2014 Can I confirm that my understanding of the issue is correct? These are patients being referred acutely to Ophthalmology services at Greenlane who are currently being managed administratively as outpatients. These are patients who stay longer than 3 hours and as such would have been admitted if they had gone through the EC process at ACH. Has this always been the process for patients going out to Greenlane? If this is indeed in line with business rules then going forward into the new year we can address. However I am not in agreement with retrospectively coding this activity and expecting funders to accept such a significant shift in cost at this very late stage in the year, especially considering financials are closed for the year and the financial returns to the Ministry have been submitted. There is also another potential impact here. Are these events currently FSAs or follow ups? If FSAs then by altering these events we will be reducing the Ophthalmology FSA counts that we have already agreed with the MoH for both the year just ended and the new year just begun. We have additional funding assigned to these and this change is potentially putting this at risk.


Strategic Development Maternity Review Highlights Maternity Review Recommendations

Progress

Early Engagement and Assessment

Draft Antenatal Guidelines for general practice and a Referral Pathway for LMC Coordination complete. The majority of pregnant women engage with general practice (even those who are unknown to maternity services). The guidelines are designed to establish more consistent 1st trimester care by general practice care and ensure women also engage with LMC services. The referral pathway enables general practice to refer women to an LMC Coordination Service operated by CMH and outlines the responsibilities of general practice. Ongoing development of extending the concept of a maternity resource centre into clinical hubs for maternity/Well Child services with a view to testing the concept in Otara as part of the Otara Integration Project.

Ultrasound Scanning Analysis of maternity ultrasound utilisation by Counties Manukau domiciled women in progress.

Vulnerable and High Needs Women

Continuing focus to facilitate relationships between midwives and general practice or to co-locate services. New midwifery clinics established in Manurewa.

Workforce Workforce development plan in draft for sector feedback. Communication pathways completed and implemented. Internal planning on initiatives to improve organisational culture across maternity services and linked to wider organisational development initiatives.

Family Planning and Contraception

Contraception training: Ongoing training for midwives and medical registrars. Vasectomy pilot scheduled for completion in early August when 123 men will have received the procedure at no direct cost to them. Initial information indicates good uptake for European and Maori men but less in other ethnic groups. 44% of men were domiciled in Quintile 4 or 5 areas. Planning underway with PHOs on general practice training and education.

Human Resources The first round of new graduate nurse recruitment for 2014 - Maaori and Pacific made up 44% of the talent hired. A proposal of the new Mental Health nursing strategy has been accepted to address the skill shortage and a work plan is to be prepared for consultation with Mental Health Service.

Pacific Health Development A successful Pasifika Week 2014 was held across Middlemore Hospital and Manukau Super Clinic. Record numbers of wards/clinics entered this year’s Ward Decoration competition (over 15 entries) as well as providers participating in setting up displays in and around the main reception area and Ko Awatea. The week packed in a value added programme. 123 new Fanau Ola patients were entered into our Fanau Ola programme register in June. This included 34 children under the age of 18 years identified by our senior social workers as being vulnerable and at high risk of negative health and social events. The year end total Fanau Ola assessments for the 13/14 year totalled more than 930 Pacific patients and involved more than 3,500 family members as part of assessment and care planning. Regional Pacific • Samoa: Contract for Samoa Institutional Linkage Programme still under negotiation with budget

confirmed at NZ $1 million for 2014/15. • Samoa: UN Small Islands Developing States (SIDS) Conference is being held in Apia in

August/September 2014. Pacific Health Development will attend/participate. This will provide an


excellent opportunity to showcase the international health systems and services support work and programmes undertaken by CMDHB/PHD in partnership with Pacific nations.

• Cook Islands: Initial visit undertaken in June • Fiji: Per contract - I.N.F.A.N.T.S. Neonatal Education Development Programme being developed for

delivery in Fiji (first training visit scheduled for August 2014) • Kiribati: Opportunity to dialogue about further health systems development required in Kiribati • Niue: Business as usual. Population Health CM Health submission on the Auckland Council Local Alcohol Policy formulated in conjunction with the CM Health Community Panel. Maternity Quality and Safety Annual Report (including draft MQ&S Plan for 2014/15) revised, reviewed and submitted to MoH. Top cost 5,000 patients paper completed and ready for peer review and circulation. Smokefree Dashboard

Measure Definition Baseline Current Change Graphs Reporting Freq.

CMDHB adult

smoking prevalence

Prevalence of regular

smoking for those aged

15 years and over by

total responses

Overall 22.1% 15.9% 6.2%

5 years. Baseline is 2006 and Current is

2013.

Maaori 46.8% 36.0% 10.8%

Pacific 30.3% 23.2% 7.1%

Measure Definition Q1 Q2 Q3 Q4

Tobacco health target (maternity)*

Progress towards 90% of pregnant women who identify as smokers at the time of confirmation of

pregnancy in general practice or booking with Lead Maternity Carer are offered advice and support to quit

Overall N/A N/A 75.0% - Not avail

Maaori N/A N/A 71.7% -

Pacific Not reported

Referrals All referrals received by CMDHB smoking cessation service

Total 543 530 476 653

Maaori 239 (44%)

247 (46.6%)

229 (48.1%)

274 (42%)

Pacific 136 (25%)

118 (22.3%)

132 (27.7%)

169 (25.9%)

Quit Bus - all client engagements

Quarter 3

Brief engagements

One-off support

Intensive support(QB

Advisors)

Intensive support

(referred)

Total 714 232 7 179

Maaori 403 (56.4%) 137 (59.1%) 3

Pacific 179 (25%) 60 (25.9%) 3

Pregnant 14 (2%) 9 (3.9%) -

Under 30 268 (37.5%) 94 (40.5%) -


Stoptober - October 2014 will be deemed “Stoptober” where smokers will be encouraged to quit smoking for the 31 days of October. The likelihood of smokers attempting to quit again and staying smokefree is more likely where they have already made an attempt and are well supported by community and family contexts. The national campaign is to be launched in Mangere and a significant campaign is planned locally for CMH to complement the national campaign. The local campaign will include the DHB with our employer hat on promoting all employers to encourage a smokefree workforce. Strategic Planning The 2013/14 Annual Report development is on track for a first set of draft performance statements due for ELT review and submission in early August. The Maaori Health plan has been approved subject to former sign off of CM Health’s second draft Annual Plan by the Minister. Although not a statutory requirement, work is in progress to complete a 2014/15 Pacific Health Plan and Asian Health approaches in July/August 2014 for ELT and then Board review and endorsement. Quarter 4 MOH reporting underway with initial ratings and feedback due 1 August. Strategic PMO Triple Aim Programme

Strategy Update Status

Improve health and equity of all populations

Better Health Outcomes For All

Smokefree DHB by 2025 o 2014-16 Tobacco Control Revenue Agreement received

from MOH, currently awaiting CMDHB sign off. o Portfolio structure is currently being realigned to support

shift in focus from secondary care target to primary care and community.

Minimise harm from poor quality Housing - Warm-up Counties being managed from BAU.

Reported at CPHAC

First 2000 Days Infant Nutrition - The team is working through and analysing the Needs Assessment report and currently planning the implementation phase. The proposal is to implement via localities. The team is developing a needs assessment plan and is now using the Evaluation provider to assist with the Service Needs Assessment.

Health Literacy Oral Health - A draft Health Literacy Action Plan developed and discussed with Oral Health Expert Advisory Group. Wider strategy for health literacy to be submitted to ELT in September for discussion.

Improve experience and safety of care for patients

First Do No Harm

Reported via HAC and System Integration. Reported in HAC

Patient & Whaanau Centred Care

Advance Care Planning – Work plan for phase 2 is being developed by the project team and project board – key aims are to implement in primary care/localities, Renal and other key chronic condition groups. Middlemore way finding and signage o Rainbow additions have been approved and have been

manufactured. There are still some signs being put up, however these are more related to change requests after the new signs were installed.

o The phase 2 Business Case has been completed. This will cover new signage for all the non-Middlemore sites.

Consumer Experience project (HQSC Patient survey) – A Governance Board has been formed to lead the project through its next stages. The team is focussing promoting the capturing of


email addresses and increasing survey responses Patient and whaanau experience – Programme was wrapped up in July and a celebration event was held to thank all participants. Embedding AI2DET as BAU - AI2DET training is being delivered as part of CALM training. Project to close. Keeping you informed - Patients receiving copies of letters as part of normal business. Project to close. Partners in Care – working on finalising the strategic plan. A one page feedback on PiC staying overnight has been prepared for distribution.

Best value for public health resources

System Integration

Reported via CPHAC

Ensuring Financial Sustainability

Reported via Board and FARC

Enabling High Performing People

• Leadership Academy is now core business (BAU) • Maaori and Pacific Workforce Development, recruitment

and retention Ethnicity project is still continuing. The team is working through how best to communicate the request to update personal records along with how to measure success.

• Workforce planning and modelling The feedback from PHO, Regional, and Diabetes Network Forum has been very well received. Next phase is applying project management methodology to the project and working closely with the Workforce Manager, GM HR Strategy, and ELT to progress the work.

• Allied Health assistant training – 4 of 7 work packages in progress (scope of practice, core competencies, job descriptions and training)

• Organisational competencies is now core business for HR (BAU)


Ko Awatea Ko Awatea delivers a comprehensive portfolio of organisational support functions including data analysis and support, Learning and Development, Workforce, Libraries, Quality Improvement, Research Office and research support, Digital services, clinical simulation, evaluation and knowledge management. In addition to these functions Ko Awatea is also charged with generating revenue for the District Health Board. I am very pleased to recognize that in its 3rd year Ko Awatea generated $4.8 million of revenue for Counties Manukau DHB. Ko Awatea acts as an engine for transformation primarily locally, but also regionally and nationally, building ‘will’, harvesting and generating ‘ideas’, and efficiently “executing change”. The vision for Ko Awatea is “Tomorrows transformation today” and our mission is to ensure Counties has the best healthcare system in Australasia by December 2015. Key themes of this transformation work currently include:

• Education and capacity/capability building • Collaborative improvement • Networking resources • Spreading organising skills and practice to support our community • Reshaping knowledge, data and decision support infrastructure to be fit for 21st century • Building rapid improvement skills and discipline into frontline • Building leadership • Community organising • Creating an education centre that provides a space conducive to learning • Building a workplace that reflects our community

Patient and Whaanau Experience Programme In this report I would like to highlight some specific pieces of our work. Ko Awatea has supported Counties Manukau Health’s Triple Aim and the Patient & Whaanau Centred Care, an executable strategy led by Denise Kivell, Director of Nursing. This work stream consists of thirteen teams, we have supported, with projects from across the Counties Manukau Health (CMH) system. Methods and tools have been used to engage patients and whaanau; this includes capturing the experience of the services received. The findings informed and defined what is good experience provision and opportunities where additional improvements might be implemented. Focus areas:

• Working with consumers to improve recovery planning and self-management in the Mental Health Services

• Understanding the challenges of people at risk of rheumatic fever and helping to ensure they receive their prophylactic penicillin

• Exploring the needs of patients and relatives following critical care experiences at Middlemore

• Working in partnership with transgender youth to develop improved service delivery • Review and redesign of the outpatient intravenous antibiotic programme • Manaakitanga Whanau Ora - understanding how people are better able to manage their own

care

Themes that emerged included the value of listening to patients; patient stories provide a wealth of information about user experience of care; importance of communication and the impact our interactions with patients. Feedback validated that CMH does provide an outstanding service and


that our consumers feel well supported. Consumer feedback conveyed the joy of being involved. Consumer and staff comments have been captured within a short 3 minute film. Asia Pacific (APAC) Forum Currently 920 delegates are registered for the programme. The APAC registrations are well on target to achieve expected delegate numbers. In addition, the Victorian Commission for Hospital Improvement has set aside additional registrations to supplement Victorian public health group bookings with an offer of “register three delegates and get one free registration”. Over 230 posters have been submitted. This number of poster presentations is a resounding success providing an opportunity for many organisations and individuals to share their improvement strategies and celebrate successes with other attendees. Approximately thirty CMH presenters are sponsored by Fisher and Paykel to attend APAC to present their work at this international showcasing event. Health Intelligence & Informatics Health Intelligence and Informatics have implemented the new National Patient Flow extract routine, a formal MoH requirement from 1 July 2014. The CMH site has been central to implementation and testing of that application, in concert with the other Northern DHBs.

A formalised handover process of the report writing capability from healthAlliance to decision support has been highly successful having cleared 71 tickets within the first month, using a prioritisation process which allocates resources to high priority information requests. This newly relocated in-house capability has increased execution of data reporting writing requests.

Decision support has development of a daily scorecard for Emergency Care, which has been a very successful and triggered request for similar products across different services and divisions. It shows an overview of performance across different time points in a care pathway, and points to where ‘blockages’ may be occurring.

Development & Delivery A very positive external evaluation report for the 20,000 Days Campaign has been completed by Victoria University. The final report will be completed and circulated in August 2014.

The “Safety in General Practice Collaborative” gains further momentum with a successful learning session attended by 95 people representative of the 23 General Practices. The key focus of the learning session was the trigger tool adapted for primary health. The customised tool draws from Manaia Health Primary Care Trigger and the Scottish Patient Safety Programme trigger tool development. Three practices shared presentations regarding progress to date in each of the three bundles areas: warfarin management, medicines reconciliation and results handing. Health Science Academies The Health Science Academy programme in two South Auckland schools (run in partnership with CMH) focuses on supporting Maaori and Pacific students who have an ambition to enter tertiary health study and a career in health. The first cohort has resulted in twenty-one students from South Auckland secondary schools going onto tertiary level health studies. In June, the selection process for the three newly Ministry of Health funded Health Science Academies occurred with nine schools from across Auckland attending interviews. The selection panels included representatives from workforce development, Pacific teams and external education experts. The successful schools will be announced in July.


Ko Awatea at a Glance

JUNE 2014

Projects Campaign Community Organising External Contracts

2 campaigns 15 projects 4 initiatives 2

Compliance Health & Safety Audit: 100%

Ko Awatea Centre Utilisation

% 2012 % 2013 % 2014 61% 61% 61%

APAC Forum Registrations Intensives

927 307

Training for CMH during 2013/14

L& D Activities 88,893 hours of development activity Delivered across 180 learning events

E-Learn Courses 12,000 hours completed 4700 active users with an average of 260 people accessing the system per day, every day.

Patient Safety Training 3,000 completions

JVP / KA Centre 1,500 nursing, midwifery and medical learning sessions for our JVP students

Knowledge & Information Sharing

during 2013/14

Library Services 995 literature searches 2,272 document requests 63 tutorial sessions

Health Intelligence & Informatics

1000 interactive reports provided to business users 370,000 reports ran, average of around 1000 per day! 200 bespoke data queries delivered per month on average 71 report request tickets closed in June 234 Research projects approved – an increase of 87% since 2011/12 and 25% since 2012/13 16 evaluation projects underway since February, 2 already complete


Counties Manukau Health Board Meeting Resolution to Exclude the Public

Resolution:

That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000:

The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

1. Minutes of 2 July 2014 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(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

Confirmation of Minutes For reasons given in the previous meeting.

2. Recommendations from Board Sub-Committees

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(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S9(2)(i)]

3. Action Items 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(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

For reasons given in the previous meeting.

4. Community Labs Update 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(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]



5. Project Swift 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(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]


6. IS Strategic Projects Update 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(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]


7. National Infrastructure Platform (NIP) Programme Business Case



8. Food Services Business Case 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(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]


9. Linen & Laundry Business Case



10. Acute Mental Health Business Case

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

Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities.


9(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

[Official Information Act 1982 S9(2)(i)]

11. Pharmacy Funding Policy 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(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]


12. CCU Monitoring & Telemetry Replacement



13. Expansion of Haemodialysis Facilities Based Dialysis Capacity



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