counties manukau district health board board meeting...

Counties Manukau District Health Board Agenda

Counties Manukau District Health Board Board Meeting Agenda Wednesday, 9 April 2014 at 1.30 – 4.30pm, Innovation Lab, Ko Awatea, Middlemore Hospital, Hospital Road, Otahuhu, Auckland Time Item Page No

1.00 – 1.30pm Board Only Session

1. Welcome

1.30 – 1.35pm 2. Governance

2.1. Attendance & Apologies – Arthur Anae 2.2. Conflicts of Interest/Specific Interests 2.3. Confirmation of Public Minutes – 5 March 2014

1 – 4 5 - 7

1.35 – 1.45pm 3. Monthly Reports

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

8 - 42

1.45 – 2.05pm 2.05 – 2.25pm

4. Presentations

4.1. Whanau & Patient Centred Care (Denise Kivell/Renee Greaves) 4.2. Mangere Locality Clinical Partnership (Sarah Marshall)

43 - 65

2.25 – 2.30pm 5. General Business

5.1. State Services Commission – Statutory Crown Entities & the 2014 Election

66

2.30 – 2.35pm 6. Resolution to Exclude the Public 67 - 69

Afternoon Break

2.45 – 2.50pm 2.50 – 2.55pm 2.55 – 3.00pm 3.00 – 3.10pm 3.10 – 3.20pm 3.20 – 3.25pm 3.25 – 3.40pm 3.40 – 3.50pm 3.50 – 4.00pm 4.00 – 4.20pm 4.20 – 4.30pm

7. Confidential

7.1. Confirmation of Confidential Minutes – 5 March 2014 7.2. Recommendations from Board Sub Committees 7.3. Action Items 7.4. Emerging Issues (Geraint Martin) 7.5. Qatar Engagement – Ko Awatea (Katie Latimer) 7.6. Community Labs Update (Geraint Martin) 7.7. Project Swift (Louise Zacest/Sarah Thirlwall) 7.8. IS Strategic Projects Update (Sarah Thirlwall) 7.9. Regional Password Policy (Sarah Thirlwall) 7.10. Draft Maori Health Plan (Margie Apa/Tuhakia Keepa) 7.11. Treatment of Biological Infertility (Tim Wood) 7.12. Information – HBL Programme Update – March 2014

70 – 75

76

77 – 78 79 – 91 92 – 97

98 – 103 104 – 109 110 – 115 116 – 136 137 – 147 148 - 154

Next Meeting: 7 May 2014

Innovation Lab, Ko Awatea, Middlemore Hospital, Otahuhu

Agenda for Counties Manukau District Health Board

BOARD MEMBERS’ DISCLOSURE OF INTERESTS

March 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

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

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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

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 • Maxwell Family Trust Share in Orion House leased

to Orion Health through Oyster Management Ltd • Member Manukau Locality Leadership Group,

CMDHB

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

Council • Member – Auckland Conservation Board • 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.

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• 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

Reece Autagavaia • Executive Member, Pacific Lawyers’ Association • Member, Labour Party

3


BOARD MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 5 March 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 UnotedU and that the Board UagreeU 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 UnotesU 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 UnotedU and that the Board UagreeU that she may remain in the room and participate in any deliberations, but be excluded from any voting.

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Minutes of Counties Manukau District Health Board Held on Wednesday, 5 March 2014 at 1.30pm at the Ko Awatea, Middlemore Hospital, Otahuhu, Auckland. Present: Dr Lee Mathias (Chair), Ms Colleen Brown, Anae Arthur Anae, Dr Lyn Murphy, Ms Sandra

Alofivae, Mr David Collings, Ms Wendy Lai, Ms Dianne Glenn, Ms Kathy Maxwell, Apulu Reece Autagavaia, Mr George Ngatai

In attendance: Mr Geraint Martin, Mr Ron Pearson, Ms Lyn Butler (Board Secretary) Apologies: 1. Welcome

The Chair welcomed members to the meeting. 2. Governance

2.1 Attendance & Apologies Noted.

2.2 Conflicts of Interest/Specific Interests

Ms Sandra Alofivae noted a new conflict of interest.

2.3 Confirmation of Minutes – 12 February 2014 Resolution That the Public Minutes of the Board Meeting held on Wednesday, 12 February 2014, were taken as read and confirmed as a true and correct record. Moved: Dianne Glenn Seconded: Kathy Maxwell Carried: Unanimously

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

The Chair advised that the Internal Audit document has been sent to the Board, to provide an understanding of what they do. The Interim CEO of healthAlliance, Mr Mike Schubert, is finishing his contract in the next few months and will return to PwC. A PHARMAC update on medical devices has been received, advising they are taking over the catalogue.

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3.2 Chief Executive’s Report

The Chief Executive took the paper as read, and commented on the following:

Dr Neil Houston, GP & Healthcare Improvement Scotland’s national clinical lead for patient safety in primary care attended the launch of the Patient Safety Programme at Ko Awatea. He also attended APAC last year. Mr Brown requested an update on ‘Smokers to Quit’. Mr Benedict Hefford advised that the rate is 69% against a target of 90% for Quarter 2, with CMDHB being the best performing of the large DHBs. Work is continuing with PHO Chief Executives and Clinical Directors to improve targets, and is being actively monitored. Ms Maxwell sought clarity on staff costs and the process for taking leave. Mr Pearson advised that it is a very sophisticated process, which is adjusting constantly. Ms Lai thought the current methodology to be an issue. Mr Pearson said that the methodology on FTEs is that leave is accrued each month, so there are no costs when taken. There are costs, however, when positions are required to be filled. The Chair believed these costs could be budgeted for. Mr Pearson responded that it is difficult to predict when staff will take their leave, particularly clinical staff, who are sometimes unable to take leave, it builds up, then they take a large amount of leave. There is a lot of focus on managing leave. Mr Martin confirmed he is comfortable with the current process. Resolution That the Chief Executive’s Report be received. Moved: Lee Mathias Seconded: Arthur Anae Carried: Unanimously

4. Presentations 4.1 Eastern Locality Clinical Partnership (Benedict Hefford/Linda Bryant)

Ms Bryant provided an update on the Localities work in the Eastern area. The focus of the work is patient centred care, with healthy lifestyles covering self management concepts, health checks and convenient access to a patient portal, together with after hours care. The Eastern localities population is 29% of the Counties Manukau population, with an enrolled population of 107,000, and a growing older and younger population. Approximately 5,000 people per year account for 15,000 admissions, 40% of which are self referrals. The locality work has identified the following aspects as being key; cost effective continuity of care, convenience, communication and collaboration, co-ordination of services, consistency of information, clinical competence and culturally appropriate, with a choice of caring providers. The Chair thanked Mr Hefford and Ms Bryant for their informative presentation.

4.2 Clinical Quality Challenges at CM Health in 2014: the CMO’s Perspective (Dr Gloria Johnson)

Dr Johnson gave a presentation on the above, which summarised the financial constraints and system integration changes for the year ahead. Work is continuing on improving patient and documentation flows, clinical pathways, patient centredness and literacy, public confidence and managing obesity and diabetes.

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Hospital service specific issues being reviewed are Medicine targets, Mental Health, inpatient and workforce, elective targets, early maternity engagement, Child Health outpatients, Radiology demand and histopathology demand. More focus is being put into allergies and alerts, ECG telemetry, mis-identification, lost/delayed referrals and responses. Good results continue with the reduction of falls, pressure injuries, CLAB, etc. Length of stay, re-admissions, after hours care and HDC complaints are not considered to be an issue. CMDHB has a high calibre of Clinicians and Clinical Leaders, who have a tradition of focus on quality within clinical teams in hospital services. The Chair thanked Dr Johnson for her excellent presentation. Both presentations will be e-mailed to the Board.

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: Colleen Brown Seconded: Wendy Lai Carried: Unanimously

The meeting closed at 4.45pm. The next meeting of the Board will be Wednesday, 9 April 2014 at Ko Awatea, Middlemore Hospital. The minutes of the meeting of the Counties Manukau District Health Board of 5 March 2014 are approved. Signed as a true and correct record on 9 April 2014. Chair ………………………………………… Dr Lee Mathias (Chair) Recommendation (moved /seconded )

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Counties Manukau District Health Board

Chief Executive’s Report Recommendation It is recommended that the Board UreceiveU the Chief Executive’s Report. Prepared and submitted by Geraint Martin, Chief Executive Non-Financial Performance Update UNational Health Targets & Non-Financial Performance Attached is a Scorecard illustrating CMDHB performance to 28 February 2014 summarised as follows: Shorter Stays in Emergency Departments In our Emergency Department for February, 95% 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 CMDHB has maintained compliance, and has exceeded the elective discharges in February by 15% (YTD Discharges - 115%). Shorter Waits for Cancer Treatment 100% of CMDHB patients who were eligible for treatment received radiotherapy and chemotherapy in less than 4 weeks for February. Increased Immunisation At the end of February, the coverage rate for all eight month old babies being vaccinated was 91% meeting the increased target (90%) for 2013/14. The rate for Maaori decreased by 1% to 83% and for Pacific the rate remained constant at 93%. Better Help for Smokers to Quit CMDHB performance for hospitalised patients continued to meet the national target (95%) with a 97% result for February. Results for Primary care show a significant improvement of 10% for Quarter 2 with a total of 69%. 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 Quarter 2 result of 83% (total population) as CMDHB continues to progress towards the increased 2013/14 target of 90%. The Quarter 2 result reflects a 2.7% increase from the previous quarter. Maaori population has also increased from 74% to 78%.

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UOther Government Priority Indicators Rheumatic Fever Kidz Programme: School based programme is fully implemented with throat infection (GAS+) rates down to 9% at the end of February. Concern around the completion of the required 10 day antibiotic regime is currently being discussed with MOH. Elective Service Productivity Indicators (ESPI): not exceeding 150 days waiting times and moving to not exceeding 120 days by June 2014.

At 28 February all services except Paediatric Medicine (2 breaches) met the 150 day target; there was a marked increase in cases. For the new target to be achieved > 120 days: For FSA: 391 patients (December - 410) are waiting 120+ days For Treatment: 316 patients (last month 369) are waiting 120+ days

Diagnostic Access Reporting - Developmental target for Radiology and Medical Diagnostics Both MRI and CT have failed to meet the required target. MRI for February remained similar to the previous month with a result of 64% within the 6 week target; CT scans also remained stable at 60% within 6 weeks (target 85%). Cardiology angiogram data is now been submitted to the Ministry of Health, and exceeds the target at 97% (target 85% within 90 days). Further work is needed to achieve the Gastroenterology Colonoscopy results.

At 28 February 2014: x For CT & MRI: Procedure carried out within 6 weeks For Coronary Angiogram: Procedure carried out within 3 months For Urgent Colonoscopy: Procedure carried out within 6 weeks x For Routine Colonoscopy: Procedure carried out within 6 weeks For Surveillance Colonoscopy: Procedure carried out within 12 weeks

Breastscreen coverage target 70% women 50-69 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%, Maaori 68.6% and Pacific 73.1% UOther Annual Plan Priorities

Service Priority Areas

Progress against plan

1. Prime Minister’s Youth Mental Health Project

Collaboration between Child and Adolescent Mental Health Services (CAMHS) and Alcohol & Other Drugs (AOD) to determine working group priority areas is underway. Multi-family Groups in Schools: two schools have agreed to pilot this model aimed at children at risk of exclusion.

2. Vulnerable Children

Immunisation: Refer to Health Target commentary. Rheumatic Fever: Refer Other Government Priority Indicator commentary. Safe Sleep/SUDI (Sudden Unexpected Death of an Infant): Scoping to develop a wahakura (Maaori flax woven baby bed) and weaving programme alongside Maaori provider antenatal classes is underway. B4SC (B4 School Checks): currently 6% below target; aiming to meet incremental target of 75% by end of March. Children’s Action Plan (CAP): a stocktake is underway with a violence intervention programme in place at Middlemore Hospital.

3. Emergency Care

Refer also to Health Target commentary.

4. Access to Also refer to Health Target commentary.

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Elective Services

Delivery Redesign of Elective Services Programme (DRES) continues with progress on redesign projects after review of Canterbury Health Pathway. GP liaisons engaged for feedback on ORL and orthopaedics pathways; plastic pathway includes collaboration with Waitemata DHB to ensure consistency across region. Enhanced Recovery after Surgery (ERAS): ERAS in orthopedics at CM Health is assisting other DHBS to rollout; continuing with the National ERAS collaborative.

5. Shorter waits for Cancer Treatment

Also refer to Health Target commentary. Data collection processes have been established to measure against the Faster Cancer Treatment (FCT) target which will commence 1 July 2014. Awaiting finalisation of contract from healthAlliance before installation of videoconferencing equipment for multidisciplinary Meetings (MDMs); establishing baseline MDM performance to align with MOH MDM guidance.

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

After Hours Services: Progress on the business case has been stalled due to the Consortium Accident and Emergency Medical members requesting significant additional funds for ongoing services beyond 1 July. Board CEOs and Chairs have been briefed. System Integration: refer to Director of Primary Community report for details of System Integration Programme.

10. Maternal and Child Health

Maternity Review: Implementation of nine review action plan recommendations continues. A draft annual report is due April 2014. Oral Health: Preschool dental and school dental enrolments continue to grow. Caries free has increased to 51% with a reduction of DMFT (Decayed, Missing or Filled teeth). Newborn hearing screening is ahead of target to meet 90% by year end. YTD February coverage is 91%.

11. Acute & Unplanned Care

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

12. General Medicine

Dialysis volumes continue to exceed capacity. Outsourcing continues as patients attend Nephrocare (private facility).

13. Long Term Conditions

Refer also to Heart and Diabetes Health Target commentary. Pacific SME Facilitator is working closely with large workplaces such as KiwiRail to provide group SME education. CM Health is partnering with ADHB and WDHB to implement a new podiatry governance structure for diabetic patients. A Primary Mental Health Steering Group is being established in regards to Chronic Care Management (CCM) Depression KPIs.

14. Health of Older People

Dementia Pathway: 92% of patients referred with dementia were seen by Dementia Care (target 25%). A Shared Care Plan trial will commence with a general practice in Manurewa. Fracture Liaison Service: Data gathering commenced to review current state; areas identified to begin trial. Elder Abuse & Neglect (EAN): Policy procedure document to be finalised shortly and sent out for wider feedback and Clinical Governance Group approval. NASC InterRAI: 64% of clients receiving Home Based Support (HBSS) have completed an InterRAI assessment, this exceeds the 50% target.

15. Mental Health and Addictions

Access: Total access rates are being met except for older clients which is slowly increasing; focus on young Maaori (0-19yrs) includes training and inclusion of cultural advisors Whaanau ora/fanau ola: sponsorship of a peer support specialist and a service user in the CM Health and Whaanau Experience programme has taken place.

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Drivers of Crime: School based alcohol and drug services have been extended into Alternative Education settings. The Violence Intervention Programme (VIP) is on track to have service delivery plans by end of June. Primary Secondary Integration: Draft protocols are being developed between GPs and pharmacies for shared care of identified people on dozapoine and tracking well. Peri-natal and Infant Mental Health (PIMH): CMH has signed a revenue agreement with MOH to develop 3 inpatient beds, respite options and extended ‘wrap’ support to mothers and infants in maternity services and as well as at home. A regional implementation plan aims to have key services in place by August/Sept 2014.

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 to increase due to referral volumes, inpatient demand and staff leave. Saturday lists have recommenced since January. An additional trainee sonographer is in position.

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 continues. This engages Pasifika fanau in a process including fanau engagement, assessment, planning, and support.

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NOTES

Better help for smokers to quit - in pregnancy

Placeholder (TBC)

NATIONAL HEALTH TARGETS - CM Health and Northern Region Performance - to 28 February 20141. All health targets reflect the MOH final ratings for the previous 12 months to CM Health.

2. Northern regional health target information for Quarter 2 (31 Dec 2013) as per their quarterly report.

3. CVD results are on a quarterly basis. 4. 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.

Shorter stays in Emergency Departments

50%

60%

70%

80%

90%

100%

Mar-13

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14Fe

b-14

CM HEALTH REGION TARGET

Improved access to elective surgery YTD

50%60%70%80%90%

100%110%120%130%

Mar-13

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14


Shorter waits for cancer treatment

50%

60%

70%

80%

90%

100%

Mar-13

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14


Increased immunisation

50%

60%

70%

80%

90%

100%

Mar-13

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14


Better help for smokers to quit - primary care

0%

20%

40%

60%

80%

100%

Mar-13

Apr-13

May-13

Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14


Better help for smokers to quit - hospital

50%

60%

70%

80%

90%

100%

Mar-13

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14


More heart and diabetes checks

0%

20%

40%

60%

80%

100%

Mar-13

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14


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

(4,000)

(2,000)

-

2,000

4,000

6,000

Mar-13

Apr-13

May-13

Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14

'$00

0

Consolidated Actual Mth Consolidated Budget Mth

Consolidated Actual YTD Consolidated Budget YTD

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Organisation Performance – Hospital Services Financials Overall the month result for the Provider Arm was a net surplus of $2,753k, a $19k favourable variance. YTD the Provider Arm had a $469k favourable variance. The breakdown of overall variances for the CMDHB group are summarised below:

Month YTD Hospital Provider $120k $278 k Integrated Care $(49)k $677 k Ko Awatea $(21)k $(47)k HBL $(31)k $(439)k Total Provider $19k $469 k CMDHB Funder $(121) k $361 k CMDHB Governance $117 k $(510)k Total CMDHB $15 k $320k

For the month, clinical services revenue was unfavourable against budget by $(292) k primarily due to the absence of Tahitian burns patients and a reduction in ACC cases for the month. Expenditure of $312k favourable is driven by the impact of the unpaid days and statutory day credits applied in January, partially offset against outsourced costs within the services. Clinical supply savings were achieved due to the consumption of inventory stock piled in previous months. Non clinical revenue and expenses were $(106) k due to bad debt and capital charges, largely offset by interest and favourable infrastructure costs. Activity summary WIES volumes are <1% above contract for the month. This volume is driven by Acutes being up on contract by 5% and Electives down by 10%.

Acute ServicesThis Yr Act Funder

agreement

% Var to funder

agreementThis Yr Act Funder

agreement

% Var to funder

agreement - WIES 4,408 4,214 5% 39,823 39,072 2%

Elective Services - WIES 1,267 1,409 -10% 11,688 11,047 6%

TOTAL (includes other DHB's) - WIES 5,674 5,623 1% 51,510 50,119 3%

TOTAL - all patientsMonth February 14 YTD February 14

CMDHB-Provider Arm Volume Summary - February 14

Discharge volumes (i.e. patients) are 4% up on last year with both Elective and Acute volumes showing a 4% increase on last year.

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Acute ServicesThis Yr Act Last Yr Act % Var to

Last Yr This Yr Act Last Yr Act % Var to Last Yr

- WIES 4,408 4,164 6% 39,823 38,502 3% - Patients 5,322 5,034 6% 47,062 45,404 4%Elective Services - WIES 1,267 1,498 -15% 11,688 11,810 -1% - Patients 1,150 1,203 -4% 11,117 10,739 4%TOTAL (includes other DHB's) - WIES 5,674 5,662 0% 51,510 50,313 2% - Patients 6,472 6,237 4% 58,179 56,143 4%

CMDHB-Provider Arm Volume Summary - February 14

TOTAL - all patientsMonth February 14 YTD February 14

FTEs FTEs are above budget. To resolve fluctuation of FTE month on month, WDHB and CMDHB have agreed with healthAlliance to delay the payroll close for month end to capture data from pay runs closing in the week of each new month. This process commenced in February. • Nursing is reporting an unfavourable variance. There are approximately 22 unbudgeted but

funded positions that currently exist in the services for specific initiatives; for example Cancer Care Nurses. There was additional FTE for orientation for new graduates during February (19 FTE), and overtime for the renal service (7 FTE).

• The Support staff unfavourable variance of 27 FTE reflects additional cleaning and orderly service requests; this was offset by favourable infra-structure costs in Medical Waste Removal, Patient Meals.

• Management and Administration Staff are below budget by 15. This represents vacancies yet to be filled across the organisation.

Highlights The Building Naming Ceremony for the Middlemore site was a very positive event, with celebration involving families highlighting the historical changes to the Middlemore campus and to it’s role in meeting the needs of the community. It was also an opportunity to acknowledge the significant contributions from a range of people over the decades. The new facilities have been a tremendous boost to all staff with widespread engagement in the planning and commissioning process. Migration of services to the Harley Gray Building was successfully completed in mid February with the Middlemore Theatres relocated to the Harley Gray Building on 14/15 February and Neonatal beds, Sterile Supply and TADU also relocated. Early February included 2 weeks of formal facility orientation for over 300 theatre staff prior to migration on 15/16 February. The transfer to the new facilities by the theatre and neonatal teams went very smoothly because of the dedication of many and effective teamwork across the organisation including radiology, orderlies, non-clinical support, emergency response, clinical engineering, CSSD, Women’s Health, ICU, wards, and EC. The robust planning meant there has been a high level of satisfaction with the new clinical working environment. The associated way finding signage has proven effective in enabling patients to easily find their way around the very large hospital campus. Specific recognition for the incredible effort above and beyond expectations great team leadership was shown by Catherine Larsen (Service Manager, Theatre and CSSD), Terri England (Service Manager, Anaesthetics) and Patrick Long (Service Improvement Manager) and Gillian Cossey (General Manager). A special mention is due for the Anaesthesia staff, Robyn Hughes (theatre), Robert Hawke (PACU), Olivia Woodman (TADU), David Farmer (CSSD) and Jackie Reid who have all done a remarkable job. From Neonatal and Women’s Health special

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acknowledgements should go to Kirsten Kent, project manager, Nicky Brougham (CNM for Neonates), Lindsay Mildenhall, (Clinical Leader for Neonates), Gail McIver (Midwife Manager), Nettie Knetsch (General Manager). Good progress has been made in the Whole of System Planning process in a range of areas including Health of Older People, Mental Health, First 2000 days, and with the Maternity Action plan. Whole of system planning for disease systems including Cardiovascular, Respiratory and Musculoskeletal are also making progress. Ian Sturgess, Geriatrician and Physician from the Improvement Directorate in the NHS led a workshop on how to improve the acute patient journey. As a result of these discussions each service has spent time redefining what are the quality standards or principles they set for themselves as their part of the acute journey. The goal will be to work to ensure we can meet these standards 24/7, 365 days a year. Emerging issues There has been continued higher than forecast Emergency Care and acute surgical volumes and hospital occupancy; particularly in the mental health and medical wards, the response to which has been effective in meeting the clinical demand and in keeping a ward closed. The operational planning is well advanced for the opening of the new Medical Assessment Unit at the end of March. Winter Planning and contingency development work continues. Demand management work continues on response times in Gastroenterology, Echo-cardiology, and for surgery and outpatients particularly in plastics and ophthalmology. The significant volume growth in renal dialysis is creating pressure on available capacity and other options are actively being sought.

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UPrimary & Community Services Highlights • Steady progress continues to be made with achievement of the National Primary Health

Targets. Quarter three results will be available and updated in the April report, but interim indications appear to suggest that we remain on track with expected progress.

• After Hours services remain a concern for the region with negotiations still unresolved between members of the regional After Hours Alliance. Whilst we remain hopeful for a remedy that will provide a seamless transition into 14/15 from July, alternatives are currently being developed should they be required. Any solution reached for the continuation of the service will be time limited, as all metro DHBs have signaled the need to enter a contestable process for longer term procurement of after Hours arrangements.

• The implementation of the At Risk Individuals (ARI) programme has been finalised and is ready to begin implementation according to a phased locality uptake from 1 July.

• Progress on the Whole of Systems workstreams is also concluding with the interface between secondary and primary care services in several of our key population areas (namely, Mental Health and Health of Older People) now beginning to take shape.

• Financial performance is on track for a $1.2M surplus in 2013/14 in Primary and Community Services, however, 2014/15 is looking increasingly challenging.

Quality and Safety – Safety in Practice The Safety in Practice initiative was launched on 4 March by Dr Neil Houston. Dr Houston has successfully led the Scottish primary care patient safety programme. This launch forms the completion of phase one of its Quality and Safety in Primary care programme (Workstream three of the clinical framework) to support primary care providers to develop their patient safety systems and processes. This uses the collaborative improvement methodology. There has been significant involvement and interest also from practices outside Counties, who have been encouraged to join in the initiative. National Health Targets

Target

13/14 Q1 Q2 Q3 Q4 On Track

More Heart and Diabetes Checks 90% 80% 83% Yes

Better Help for Smokers to Quit 90% 59% 69% Yes

Immunisations 90% 90% 91% Achieved

Locality Dashboard

Indicator

CMH Average/ Target Planned

Manukau (Jan-14)

Franklin (Jan-14)

Otara/Mangere

(Jan-14)

Eastern (Jan-14)

ASH Rate 2.6 3.1 1.9 3.9 1.4

Immunisation (8-month)

90% 90% 84% 87% 96%

Acute Bed Days Projected actual (less) Planned

Projected total 69,846

1,830 Projected

(less)

828 Projected

(less)

32,816 Projected

(less)

-1,459 Projected

(less)

16


Planned total 123,881

Planned

Planned Planned Planned

CVD % on therapy 89% 91% 100% 100% 81%

HBA1c <= 64 mmol/mol

73% 75% 80% 63% 86%

Locality Projects Highlights East • Significant strands of Integration work continue, with a large workshop to progress the Health

of Older People pathway hosted in March as part of the whole of system work, as well as further development on the Palliative Care pathway, which will fold into the At Risk Individual roll out when it commences from July.

Manukau • Recruitment is underway for clinical lead roles for medical and nursing to support practice

engagement with locality development initiatives. The clinical leads will support the implementation of the Active Clinical Network group for the locality.

Mangere/Otara • A framework to guide community engagement is under consideration by both LLGs with a

view to getting local community and health service consumers actively involved in the work plans. This will assist with creation and selection of tools for communicating the vision of System Integration to key stakeholders are being designed by two groups of community and health sector representatives in a workshop forum.

• The inaugural meeting of the pharmacy clinical network was well attended by local pharmacists and DHB pharmacy service representatives. The Social Workers’ Network is in the planning stages with the National Hauora Coalition so that the network will be inclusive of Whaanau Ora service providers, NGO social service providers and DHB social workers.

Franklin • A large stakeholder workshop has recently been held to design and agree the implementation

plan for the roll out of ARI, which has been piloted in Franklin for the past few months using Palliative Care clients, in a similar model to that being trialled in the Eastern locality.

17


Financial Performance Report FINANCIAL POSITION AT FEBRUARY 2014

Summary:

A: Month / Year to date The month produced a slight favourable result with a positive variance of $15k (actual $3,471k v’s budget $3,456k) for the month and the year to date result remains a favourable small variance of $320k (actual $5,555k v’s budget $5,235k).

The Funder Arm is $121k unfavourable to budget, and but remains favourable to budget year to date by $ 361k.

The Provider Arm produced a favourable variance of $19k for the month, thus still maintaining a favourable year to date variance of $469k. The Hospital side of the provider arm was favourable for the month by $120k. WIES volumes are up by 2.8% YTD which puts pressure on clinical supplies costs given that the provider arm is only funded to the agreed/capped volume levels. The unbudgeted “buffer” (one off) of lower interest costs around the capitalisation of CDB borrowing continues to materially assist the current year’s position. Governance was favourable for the month of $117k, and but year to date remains unfavourable by $510k. Costs incurred for Project Swift and business cases (Mental Health and Rehab) are the main drivers here.

Saving target (as advised/agreed with MOH)

Although we still remain slightly behind of target, the major variance year to date is the lack of Tahitian Burns patients. This was budgeted for a movement in pricing $(550)k. B: Forecast / update While CMDHB has had a respectable eight months, the outlook for the full 13-14 year will be very challenging over the last third of the year in regard to meeting all of our planned saving targets and absorbing the costs of the new CSB building. In addition, we are incurring HBL costs with continuing lack of evidence of the expected implementation and as a result, returns in the current year. CMDHB will continue to manage the finances across the whole organisation to ensure an operating surplus of $3m for the year. The year will require a united approach by the entire organisation and all the agencies it works with. We remain essentially on target for year end but the challenge just keeps getting that little bit harder each month.

YTD February 14

Full year

$000 Act Bud Var. Bud

13,129 13,219 (90) 25,197

18


C: Budget 2014-15 CMDHB is still working hard on multiple fronts with the committed objective of reducing the current draft budget deficit to the targeted break-even. A more detailed update on progress will be given at the Board meeting. D: Capital 14-15 Currently the organisation has received 498 submissions ($44.1m) for new capital for 14/15. The requests range from $9.8m (hA ICT Infrastructure) to $1,000 (Handheld Pulse Oximeter). Management currently are prioritising the items note that above are the requests for the hospital only. In additional re are currently finalising Localities capital requests are on top of this we still have our strategic capital project (Mental Health, Rehab, and others).

Statement of Performance by Operating Arm Month

February 14 Net Result YTD

February 14 Full year

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

Bud Forecast

3,557 3,437 120 Hospital Provider

11,315 11,037 278 13,413 10,009 11,045

323 372 (49) Integrated Care (1,337) (2,014) 677 (3,538) (1,317) (814)

(1,009) (988) (21) Ko Awatea (8,658) (8,611) (47) (9,540) (12,897) (13,499)

(118) (87) (31) HBL (1,132) (693) (439) - (1,040) (1,605)

2,753 2,734 19 Provider 188 (281) 469 335 (5,245) (4,873)

577 698 (121) Funder 5,595 5,234 361 3,315 7,985 8,425

141 24 117 Governance (228) 282 (510) (38) 291 (521)

3,471 3,456 15 Surplus (deficit) 5,555 5,235 320 3,612 3,031 3,031

19


Volume Summary

Total WIES Month Year to date

Act Bud Var. % Last. Yr.

Act Bud Var. % Last. Yr.

4,408 4,214 193 4.6% 4,164 Acute 39,823 39,072 751 1.9% 38,502

1,267 1,409 (142) (10.1)% 1,498 Elective 11,688 11,047 641 5.8% 11,810

5,675 5,623 51 0.9% 5,662 Total 51,511 50,119 1,392 2.8% 50,312 Elective volumes year to date are 6.3% ahead of plan. Surgery increased the elective procedures so that it can maintain the 150 days waiting time target during (planned Acute theatre closures!) the opening of CSB.

Discharges

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

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

5,322 5,034 288 5.7% Acute 47,062 45,404 1,658 3.65%

1,150 1,203 (53) (4.4)% Elective 11,117 10,739 378 3.52%

6,472 6,237 235 3.8% Total 58,179 56,143 2036 3.63%

0.88 0.91 0.03 3.4% Ratio WIES to discharges 0.89 0.89 0.01 0.82%

Volumes Other

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

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

526 629 (103) (16.4)% Birth Numbers 4,832 5,382 (550) (10.2)%

7,652 7,479 173 2.31% ED Volumes 69,955 67,629 2,326 3.44%

4,022 3,929 93 2.37% Renal DialysisP

1 34,417 32,505 1,912 5.88%

27,145 29,112 (1,967) (6.8)% Outpatient SummaryP

2 242,659 240,351 2,308 242,659

2.6 2.4 0.2 8.33% ALOS 2.5 2.5 - 2.5

20

Statement of Performance Month

Year to Date

Full Year

Act Bud Var. $000 Act Bud Var. Last Yr Bud Forecast

Revenue

117,571 117,608 (37) Crown 936,805 940,801 (3,996) 916,311 1,411,051 1,414,764

2,691 2,569 122 Other 24,668 20,172 4,496 25,195 30,349 37,797

120,262 120,177 85 Total Revenue 961,473 960,973 500 941,506 1,441,400 1,452,561

Expenses

41,122 41,686 564 Personnel 347,556 349,798 2,242 333,984 529,125 526,561

5,213 4,633 (580) Outsourced 43,447 37,270 (6,177) 38,452 55,267 59,736

53,833 53,295 (538) Funder Provider payments 423,059 427,003 3,944 427,533 639,851 647,336

7,577 7,392 (185) Clinical Sup. 64,374 62,643 (1,731) 65,375 94,571 106,750

4,712 4,764 52 Infrastructure 43,419 41,866 (1,553) 41,652 62,593 54,589

112,457 111,770 (687) Operating Exp 921,855 918,580 (3,275) 906,996 1,381,407 1,394,972

7,805 8,407 (602) Surplus after operating Exp. 39,618 42,393 (2,775) 34,510 59,993 57,589

2,370 2,543 173 Depn. 20,342 20,344 2 14,856 30,516 31,028

756 1,325 569 Interest 4,870 8,150 3,280 7,546 13,450 10,345

1,208 1,083 (125) Capital Chg. 8,851 8,664 (187) 8,496 12,996 13,185

3,471 3,456 15 Net Surplus 5,555 5,235 320 3,612 3,031 3,031 Better

Than 5% Worse

than 5%

-

5,000

10,000

Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14

'$00

0

Operating Surplus

Budget Actual

(2,000)

-

2,000

4,000

Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14

'$00

0

Net Surplus

Budget Actual

21

Revenue

Month YTD Full Yr.

Act Bud Var. $000 Act Bud Var. Bud

64,635 64,927 (292) Provider 522,917 518,680 4,237 778,434

114,238 113,592 646 Funder 909,321 908,881 440 1,363,247

(59,828) (59,599) (229) Elimination (480,667) (476,644) (4,023) (715,366)

1,217 1257 (40) Governance 9,902 10,056 (154) 15,085

120,262 120,177 85 Total 961,473 960,973 500 1,441,400 • Provider: Revenue is unfavourable for the month of February – Ko Awatea revenue targets, plus

Integrated Care (Smokefree) – SLA has not been signed (timing). Staff Costs

Month

YTD Full Yr.

Act Bud Var. $000 Act Bud Var. Bud 40,332 40,861 529 Provider 341,138 343,199 2,061 519,227

790 825 35 Governance 6,418 6,599 181 9,898 41,122 41,686 564 Total 347,556 349,798 2,242 529,125

12,961 13,276 315 Medical 108,610 111,600 2,990 169,096

15,344 15,707 363 Nursing 131,762 130,492 (1,270) 197,975

6,142 6,192 50 Allied Health 50,794 51,715 921 77,878

1,789 1,719 (70) Support Personnel 15,118 14,225 (893) 21,966

4,886 4,792 (94) Management Admin 41,272 41,766 494 62,210

41,122 41,686 564 347,556 349,798 2,242 529,125 Commentary: • Medical Personnel Costs favourable due to existing vacancies within the organisation, offset by outsourc

services.

• Nursing Personnel Costs favourable for the month reflecting a partial offset of heavily negative result month (timing) plus reduced cost of claims for courses and study fees.

• Allied Health Personnel Costs favourable for the month, high level of existing vacancies for the

psychologists.

• Support costs unfavourable for the month. Casual staff hours have increased for cleaners, orderlies and cover the high incidence of annual leave and sick leave. In addition, the high penal rates applied over th days impacted adversely on budget.

• Admin costs are unfavourable for the month due to the impact of unpaid and statutory day credit

accruals from January.

22

Outsourced Services

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

691 405 (286) Medical 4,992 3,240 (1,752) - 83 43 (40) Nursing 949 344 (605) 4,860 60 64 4 Allied Health 591 512 (79) 549 33 37 4 Support 274 296 22 768 61 124 63 Management/Administration 1,470 992 (478) 444

928 673 (255) Total Personnel 8,276 5,384 (2,892) 6,621 2,544 2,358 (186) Corporate & Funder Services 20,801 18,864 (1,937) 47,160 1,741 1,602 (139) Clinical Service 14,370 13,022 (1,348) 1,486 5,213 4,633 (580) Total 43,447 37,270 (6,177) 55,267 Commentary

Outsourced Costs: Non-Clinical - HBL phased increased cost for FPSC project. - hA increased costs during the year that have been agreed with hA. Clinical - Medical outsourcing is offset in full with medical personnel. - Outsourced procedures have increased in Surgical Services, particularly in orthopaedics and plastics

to maintain the 150 day waiting time MoH target. In addition MMH Theatres were closed for 4 days during the CSB move, with consequent favourable offsets.

Independent Service Provider (Demand driven expenditure)

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

Personal Health

19,578 20,482 904 IDF Personal Health 162,372 163,856 1,484 245,784

8,607 8,258 (349) Pharmaceuticals 66,715 66,064 (651) 99,096

7,324 6,762 (562) Primary Practice

Services – Capitated *

55,658 54,096 (1,562) 81,144

539 509 (30) Child and Youth 4,403 4,076 (327) 5,767

464 472 8 Adolescent Dental Benefit 3,773 3,776 3 5,664

352 481 129 Chronic Disease

Management and Education

3,990 3,848 (142) 5,772

386 361 (25) Palliative Care 2,919 2,888 (31) 4,332

349 348 (1) General Medical Subsidy 2,781 2,784 3 4,176

718 1,338 620 Other 5,901 11,225 5,324 16,603

38,317 39,011 694 Total Personal Health 308,512 312,613 4,101 468,338

23

Mental Health

1,152 1,152 - IDF Mental Health 9,216 9,216 - 13,824

795 936 141 Community

Residential Beds & Services

6,774 7,488 714 11,232

677 690 13 Other Home

Based Residential Support

5,576 5,520 (56) 8,280

314 303 (11) Dual Diagnosis – Alcohol & Other

Drugs 2,482 2,424 (58) 3,636

269 272 3 Crisis Respite 2,156 2,176 20 3,267

326 297 (29) Child & Youth Mental Health

Services 2,540 2,376 (164) 3,561

161 164 3

Kaupapa Maori Mental Health

Services - Community

1,301 1,319 18 1,975

144 150 6 Mental Health

Community Service

1,319 1,200 (119) 1,785

2,198 1,083 (1,115) Other 8,421 8,762 341 13,086

6,036 5,047 (989) Total Mental Health 39,785 40,481 696 60,646

Disability Support Services

4,484 4,142 (342) Residential Care: Hospitals 33,541 33,136 (405) 49,707

1,630 1,923 293 Residential Care: Rest Homes 14,067 15,384 1,317 23,076

1,570 1,676 106 Home Support 13,502 13,408 (94) 20,116 1,501 1,316 (185) Other 11,571 10,541 (1,030) 15,808

9,185 9,057 (128) Total Disability Support Services 72,681 72,469 (212) 108,707

150 71 (79) Total Public Health 972 568 (404) 852

145 109 (36) Total Maori Health 1,109 872 (237) 1,308

53,833 53,295 (538) Funder 423,059 427,003 3,944 639,851

24

Clinical Supplies


7,577 7,392 (185) Provider 64,374 62,643 (1,731) 94,571

2,945 2,854 (91) Treatment Disposables 26,328 26,107 (221) 38,800

640 596 (44) Diagnostic

Supplies & Other Clinical Supplies

5,310 4,706 (604) 7,061

968 962 (6) Instruments & Equipment 7,996 7,572 (424) 11,604

273 272 (1) Patient Appliances 2,379 2,156 (223) 3,302

1,160 1,287 127 Implants & Prostheses 10,222 10,078 (144) 15,662

1,276 1,147 (129) Pharmaceuticals 10,074 9,828 (246) 14,836

315 274 (41) Other Clinical Supplies 2,065 2,196 131 3,306

7,577 7,392 (185) Total 64,374 62,643 (1,731) 94,571 Commentary • Clinical Supplies are unfavourable for the month, explained as follows:

- Medical & Clinical Support – reduced Renal supply usage partly offset by PCT drugs cost (offset by revenue)

- Surgical and Ambulatory – continued stock provisioned for the opening of CSB theatres in February.

- Patient Transport – timing variance for claims paid by MOH

25

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


4,410 4,426 16 Provider 40,147 39,253 (894) 89,056 302 338 36 Governance 3,272 2,613 (659) 4,053

4,712 4,764 52 Total 43,419 41,866 (1,553) 93,109 Commentary • Provider: Other Expenses are favourable. Includes Training costs (Ko Awatea reductions), Laundry

(saving initiatives & timing), Transportation (reduced usage) with partial offsets in Bad debts (with revenue to offset) and Consultants. There are other favourable variances across a range of other account lines.

Interest and Capital Charge

Month YTD Full Yr. Act Bud Var. $000 Act Bud Var. Bud 102 100 2 Interest - Received 1,234 800 434 1,200

756 1,325 569 Interest Paid - Debt 4,870 8,150 3,280 13,450

654 1,225 571 Net Interest Paid 3,636 7,350 3,714 12,250 1,208 1,083 (125) Capital Charge 8,851 8,664 (187) 12,996

Interest cost: Capitalisation of interest for the CSB building project until completed has driven the favourable variance here and for the next few months.

26

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

Feb 13

Jan 13

Dec 13

Nov 13

Oct 13

Sep 13

Aug 13

Medical 19.98 21.31 20.67 20.50 20.96 20.37 21.18 Nursing 23.69 26.52 26.97 24.40 25.06 24.48 24.89 Allied 9.49 9.61 9.61 9.42 9.92 9.64 9.80 Support 2.77 3.10 2.91 2.98 2.95 2.77 2.82 Management 6.47 6.54 6.99 6.52 7.11 6.69 6.98 Personnel 62.40 67.08 67.15 63.82 65.99 63.95 65.68 Outsourced Pers. 1.73 2.26 1.89 1.80 1.79 1.49 1.69 Total Personnel 64.13 69.34 69.05 65.62 67.78 65.44 67.37 Outsourced Clinical Services 2.69 2.46 2.58 3.57 2.67 2.90 2.70

Outsourced Corp (hA) 3.67 3.76 3.73 3.77 3.69 3.98 3.51

Clinical Supplies 12.99 12.22 12.28 14.12 14.26 14.06 14.51 Infrastructure 12.26 12.97 13.05 12.75 12.89 13.31 13.12 Total 95.74 100.75 100.69 99.83 101.29 99.69 101.21

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

2010

2011

2012

2013

2014 YTD

Medical 19.5 20 20.5 21.2 20.7 Nursing 25.0 24.3 24.7 25.5 25.1 Allied Health 9.0 9.2 9.5 9.7 9.7 Support 2.5 2.6 2.7 2.7 2.9 Man/Admin 7.4 7.7 7.8 7.2 6.8 Personnel 63.5 64.0 65.2 66.3 65.2 Outsourced Personnel 1.7 1.9 1.7 1.8 1.8 Total Personnel 65.2 65.9 66.9 68.1 67.0 Outsourced Clinical Supplies 3.4 3.4 2.8 2.9 2.7

Outsourced Corporate 2.4 2.4 3.3 3.4 3.7 Clinical supplies 14.2 14.6 14.7 14.4 13.6 Infrastructure 13.7 13.8 13.2 12.4 12.9 Total 98.9 100.0 100.9 101.2 100.0 Depn 3.5 3.6 2.8 3.1 3.9 Int 1.3 1.4 1.3 1.5 0.9 Capital Charge 1.9 1.7 1.7 1.7 1.7

27


Balance Sheet As at 28 February 14 Actual Budget Variance Opening

1P

stP July 13

YTD Movement

Current Assets Petty Cash 10 10 - 10 - Bank (includes 16,191 (1,273) 17,464 (7,186) 23,377 Trust 860 856 4 854 6 Prepayments (1,696) 450 (2,146) (59) (1,637) Debtors 33,865 44,673 (10,808) 35,442 (1,577) Inventory 3,213 1,990 1,223 946 2,267 Total current Assets 52,443 46,706 5,737 30,007 22,436 Fixed Assets Land 72,753 72,753 - 72,753 - Buildings & Plant 539,348 528,057 11,291 529,900 9,448 Investment Property 1,277 1,300 (23) 1,199 78 Information Technology 2,696 2,549 147 2,635 61 Information Software 180 - 180 180 - Motor Vehicles 3,933 4,514 (581) 4,028 (95) Total Cost 620,187 609,173 11,014 610,695 9,492 Accum. Depreciation (182,298) (179,010) (3,288) (166,678) (15,620) Net Cost 437,889 430,163 7,726 444,017 (6,128) Work In-progress 172,025 189,001 (16,976) 146,067 25,958 Total Fixed Assets 609,914 619,164 (9,250) 590,084 19,830 Investments (hA IT / HBL) 22,072 26,832 (4,760) 19,620 2,452 Total Assets 684,429 692,702 (3,513) 639,711 42,266 Current Liabilities Creditors 82,490 95,875 (13,385) 76,125 6,365 Income in Advance 6,750 6,542 208 1,448 5,302 GST and PAYE 12,714 13,821 (1,107) 13,668 (954)

Loans (Crown and HBL shared banking) 5,000 5,000 - 5,000 -

Payroll Accrual & Clearing 26,862 26,057 806 27,667 (805) Employee Provisions 78,817 81,932 (3,115) 79,392 (575) Total Current Liabilities 212,633 229,227 (16,594) 203,300 9,333 Working Capital (160,190) (182,521) 22,331 (173,293) 13,103 Net Funds Employed $471,796 $463,475 $8,321 $436,411 $35,385 Non-Current Liabilities Term Loans 262,600 270,600 (8,000) 232,600 30,000

Employee Provisions (non-current) 16,201 15,249 952 16,376 (175)

Trust and Special Funds 859 856 3 854 5 Insurance Liability- Non Current 1,337 1,276 61 1,337 - Total Non-Current Liabilities 280,997 287,981 (6,984) 251,167 29,830 Crown Equity Crown Equity 124,917 127,064 (2,147) 124,917 - Revaluation Reserve 127,443 107,798 19,645 127,443 - Retained Earnings – Provider (71,126) (68,741) (2,385) (71,314) 188

Retained Earnings – Govern. (16,012) (14,592) (1,420) (15,784) (228)

Retained Earnings - Funder 25,577 23,965 1,612 19,982 5,595 Total Crown Equity 190,799 175,494 15,305 185,244 5,555 Net Funds Employed $471,796 $463,475 $8,321 $436,411 $35,385

28


Commentary

Net borrowings: Long and short term debt less bank balance is $35.8m lower than budget as the June 2013 closing position was $20m lower than the budgeted starting position. Debtors: $10.8m lower than budget, $1.5m 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

Total Current 30 day +

Invoiced 2,501 2,198 303

Accrued 411

Total 2,912

Accounts payable: $13.4m lower than budget and $6.3m higher than June 2013. Accounts payable where $7.7m lower than the budgeted starting position. Net Fixed Assets: This level is $9.2m lower than budget, lower spending than planned on the CSB and non FMP. Investments in Associates: Health Benefits Ltd, $ 4.3m 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, $17.7m for IC capital investment.

Payroll Accrual & Clearing: due to timing of payroll cut offs. Income in Advance: on budget There are no other significant issues regarding the Balance Sheet

29


Cash flow Month YTD Actual Budget Variance Actual Budget Variance Cash flows from operating activities: Crown Revenue 117,553 121,302 (3,749) 943,478 937,361 6,117 Other 2,589 2,569 20 23,434 20,172 3,262 Interest rec. 102 100 2 1,234 800 434 Suppliers 73,324 70,584 (2,740) 565,792 560,591 (5,201) Employees 42,452 40,999 (1,453) 349,111 344,200 (4,911) Interest paid 756 1,325 569 4,870 8,150 3,280 Capital charge - - 7,250 7,250 - Net cash from Operations 3,712 11,063 (7,351) 41,123 38,142 2,981

Cash flows from investing activities: Fixed assets - Non FMP (323) (3,336) 3,013 (18,919) (26,908) 7,989

FMP (6,616) (477) (6,139) (26,374) (29,488) 3,114 Investments (hA & HBL) 0 (113) 113 (2,452) (1,258) (1,194)

Restricted & Trust Funds 1 (1) 2 5 1 4

Net cash from Investing (6,938) (3,927) (3,011) (47,740) (57,653) 9,913

Cash flows from financing activities: Debt - - - 30,000 18,000 12,000 Other non-current liability - - - - - -

Net cash from Financing - - - 30,000 18,000 12,000

Net increase / (decrease) (3,226) 7,136 (10,362) 23,383 (1,511) 24,894

Opening cash 20,287 (7,543) 27,830 (6,322) 1,104 (7,426) Closing cash 17,061 (407) 17,468 17,061 (407) 17,468 Summary Month YTD Actual Budget Variance Actual Budget Variance Opening cash 20,287 (7,543) 27,830 (6,322) 1,104 (7,426) Operating 712 11,063 (10,351) 38,123 38,142 (19) Investing (3,938) (3,927) (11) (44,740) (57,653) 12,913 Financing - - - 30,000 18,000 12,000 Closing cash 17,061 (407) 17,468 17,061 (407) 17,468 Commentary Cash flow from the Crown is very hard to predict while the month was behind by $3.7m year to date we are ahead by $6.1m. Note as mentioned under the interest and Capital Charge area Interest on the CSB project is being capitalised and therefore being shown under FMP.

30


Capital (greater than $200k) Project $000 Budget Spend to date Variance

Board Approved Is Kidz First Data Centre Expansion 2,636 2,452 184 Lab Histology Expansion 1,664 1,654 10 EC Front Door Reconfiguration 1,168 1,128 40 Management Approved Corporate Information Programme (CIP) 831 835 (3) Computer Replacement Program (PC'S) 596 (8) 605 Mobile Digital Mammography Unit Upgrade 542 531 11 Wards 23 & 24 Ensuite Development 422 33 389 Philips Digital Diagnostic For EC X-Ray 419 412 6 Work Area Modifications Blood Bank 335 2 333 Kidz First Data Centre Ext – Yr. 3 Funding 311 - 311 Middlemore Central Engineering Requirements 309 302 7 Cardax Swipe Card Access Sys Stage 2 300 294 6 Desktop & Laptop Replacements 298 265 34 Beds, Electrix X 75 296 296 - Replace Air Handler - Manukau 295 288 7 Building 31 Refurbishment 280 41 239 Ko Awatea ICT Project – Stage 3 of 3 264 7 257 Pharmacy Dispensing Records 263 - 263 Manukau Theatre Air Handler Unit Replacement 250 188 62 ALBU Medical Air 250 122 128 Bed Management (Aka Patient At A Glance) 250 189 61 Electronic Laboratory Orders 235 - 235 Steriliser Pre Vac For SSU At MSC 220 166 54 Image Intensifiers Ziehm Vision 215 215 - Regional Clinical Documents ( 205 102 103 Computer Replacement Program (Laptops) 204 204 Dr Mobile Unit - Digital Mobile X Ray System 201 200 1 Replace Manukau Electric Reheat System In Air Con 200 55 145 Diesel Fuel Tank - Support Building 200 28 172 Enterprise Storage Solution 200 192 8 Shared Care Plan Programme 200 197 3 National Shared Care Plan P2 Prog. 200 - 200 Total 14,259 10,186 4,075 Note: This excludes FMP projects reported separately i.e. CSB Stage 1

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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

5.0 20-May-09 15-Apr-14 4.88% Fixed, Semi-Annual 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

$267.6 4.77% Weighted Average Debt expiring: $5m of debt is due for repayment on 15 April 2014, we have advised MOH that the debt will be rolled over for a period of nine years (15-April -2014) at an indicative rate of 4.68% which is currently below our weighted average rate.

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FTE Reporting FTE Numbers (Worked)

Feb 14 Jan 14 Dec 13

Actual % Budget % Var. Short (over) Actual % Actual %

396.7 6.90% 425.9 7.48% 29.2 Medical –SMO 371.4 6.88% 384.6 6.87%

372.7 6.48% 343.9 6.04% (28.8) RMO 373.0 6.91% 353.9 6.32% 2,591.1 45.07% 2,542.6 44.63% (48.5) NursingP

1 2,488.7 46.11% 2,539.4 45.35%

1,089.3 18.95% 1,095.0 19.22% 5.7 Allied Health 989.0 18.33% 1,070.0 19.11%

461.1 8.02% 434.2 7.62% (26.9) Support P

2 427.4 7.92% 446.7 7.98%

837.6 14.57% 855.4 15.01% 17.8 Mgmt/Adm/

Clerical 747.3 13.85% 804.8 14.37%

5,748.5 5,697.0 (51.5) Total 5,396.8 5,599.4 1. Nursing Sick leave in the month was 18,318 hours compared to 9,403 hours in January. The person on sick

leave and the backfill both count as FTE’s. There were two statutory holidays in the pay month, which has an impact on FTE counts, as those people who worked those days are counted as two FTEs, instead of one.

2. The Support staff unfavourable variance of 26.9 reflects additional orderly service requests (15.0 FTE), Cleaners s (9.6FTE).

Support Variance

Actual

Budget

Variance

Orderlies 119.2 104.2 (15.0) Cleaners 183.7 174.1 (9.6) Total 302.9 278.3 (24.6)

Personnel Costs per FTE (Rolling average)

Feb 14

Jan 14

Dec 13

Nov 13

Oct 13

Sep 13

Aug 13

Medical 166,995 168,043 168,534 168,741 168,935 167,934 166,942

Nursing 76,012 75,995 76,189 75,382 75,609 74,679 74,277

Allied Health 69,213 68,935 68,973 68,712 68,910 68,620 68,234

Mgmt/Admin/Clerical 72,067 71,823 71,889 71,394 72,326 71,968 71,602

Support 50,136 50,061 49,727 49,493 49,601 48,962 48,662

The table below shows the Management Admin cap return to the MoH each month.

Counties Manukau Only Feb 14 Jan 14 Dec 13 Nov 13 Oct 13 Sep 13

Accrued FTE (as per MOH template) 837.6 747.3 804.8 843.4 810.0 829.4 Annual Leave loading (75.2) (74.9) (74.8) (74.5) (74.6) (74.8) FTE’s on holiday 73.5 159.6 101.6 59.2 93.3 76.1 Payroll FTE’s 835.9 832.0 831.6 828.1 828.7 830.7 Contractors / Consultants (FTE equivalent) 11.0 11.0 11.0 11.0 11.0 12.0

Vacancy 20.6 24.5 24.9 28.4 27.8 24.8 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 - - -

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healthAlliance (CMDHB portion only) Feb 13 Jan 13 Dec 13 Nov 13 Oct 13 Sep 13

Total 140 140 140 140.0 140.0 140.0

Number submitted June 2012 140 140 140 140.0 140.0 140.0

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 Feb 14 Jan 14 Dec 13 Nov 13 Oct 13 Sep 13 North 33.0 34.4 35.4 35.4 36.4 35.3 36.4 NDSA 57.0 47.5 43.5 43.5 43.7 42.2 41.9

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Inter District Flows (IDFs) - Hospital Services Fiscal Year 2014

A. Non ADHB IDF Activity This month’s currently position is $505k unfavourable to Counties Manukau DHB which is relatively stable on the previous month’s position. We remain under planned volume for our activity outside the region and there was nil of note in the activity reported for our population. Activity for our population within the region (excluding ADHB) also remains within planned volumes and relatively stable Our activity for other populations continues below plan for acute activity. For the non-northern region, discharge levels and complexity are higher than the same period last year, but this is below the year previous which is what the volume plan was based on. Monthly PositionNet variance ($000)

Admit TypeInflow Outflow

Net Variance Inflow Outflow



Net Variance

Acute (325) 41 (284) (52) 169 117 (898) 264 (633) (1,275) 474 (800)Elective 176 47 222 42 3 46 (146) 105 (41) 72 155 227Cancer and Renal 4 1 5 (4) 5 0 17 46 63 17 51 68Grand Total (145) 88 (57) (14) 177 163 (1,027) 415 (611) (1,185) 680 (505)

Total (excl ADHB)WDHB NDHB Other February 2014

Table1 – Non ADHB

B. IDF Activity with Auckland DHB (ADHB) The overall position with ADHB for is $1.6m favourable to Counties Manukau Health but as noted previously, IDFs do not follow a predictable or flat pattern and this situation can easily change. i.e. since this report was completed a negative $338k movement has occurred Net IDF Result ADHB YTD Var$DRG Elective $1,113,651DRG - Acute $1,311,909DRG Maternity ($707,833)

HOP Inpatient ($52,535)

Non DRG $407,238Non DRG -Maternity ($91,309)

Adjuster Estimate for Uncoded Outflows ($325,880)

PCT ($14,201)

Total $1,641,040

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TABLE 2 INFLOWS Activity for the Auckland population remains under plan for the year to date for both acute and elective activity. Both continue to show similar patterns of activity to previous months. Acute discharge levels are in line with last year’s activity with complexity slightly lower. Elective activity is lower in both discharge and complexity levels. OUTFLOWS Overall activity by Auckland DHB (ADHB) for our population remains under plan. Acute Discharges remain higher than last year though overall complexity is lower. Elective activity is lower than last year in both discharges and overall complexity. Overall most services remain under plan with the exception of General Surgery and Urology. Total numbers on current Inpatient Waiting Lists at ADHB are relatively stable. Numbers waiting over 5 months rose slightly but the majority of these are noted to have booking dates for the coming months. Outpatient activity remains stable and to date there are no significant areas of concern. Outpatient FSA waiting lists are also stable and the few waiting outside ministry maximum waiting times all appear to have appointments in the near future. There are 6 current inpatient s with a length of stay of greater than 30 days. 3 of these are complex neonates. 3 are adults. 2 long stay patients were discharged during the month and are expected to show high complexity. An estimate of their expected WIES has been built into the adjuster estimate for uncoded outflows in Table 2. It should be noted that Hyperbaric Health (that we fund via IDF to Auckland) ceased operation suddenly at the beginning of March. Formal communication is expected regarding this but in the interim any CMDHB patients utilising this service have been transferred into the care of the Waitemata Hyperbaric service and any future patients requiring this service will be directed there also. Any required change to funding process is in discussion but in the interim Waitemata DHB will invoice Auckland DHB for our population activity to access the IDF funding that we pay for this care. It is not currently anticipated that there will be any barriers to access for our patients during this transition period.

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Strategic Development Maternity Review Highlights Maternity Review Recommendations

Progress

Early Engagement and Assessment

Internal consultation is progress to extend the “maternity resource centre” function that Pukekohe Hospital has to the primary birthing units in Botany and Papakura. If progressed, it will provide women with another option to have pregnancy confirmed for free and access to information on LMC options. As at end of February 61% of women are now booking with self employed LMCs compared to 44% during 2012. 39% of women are booking by 14 weeks. While an improvement, the target is to increase bookings by 10 weeks which currently sits at 16.8%.

Ultrasound Scanning Ultrasound Radiology working group is working on ensuring consistency of referrals with clinical guidelines. This enables the sector’s limited capacity to be focussed on women who would most benefit.

Vulnerable and High Needs Women

The 3 Family Start providers in the CMH District are implementing workshops to enable direct access between LMCs to Family Start services for vulnerable women. NHC are exploring a Mana Pepe Tamariki Whaanau Ora approach service in the Manukau Locality. This will focus on vulnerable women who are most likely present unbooked (Maaori, living in Manurewa, young).

Workforce A new Midwife Liaison role is to be established – consultation on a position description is underway including self employed LMC groups to inform the scope of the role. Midwifery care pathways identifying roles and responsibilities for LMCs and DHB midwives have been completed for clinical care areas where women’s experiences and quality can be significantly improved. LMC/midwifery led implementation is now being planned. An evaluation of the support provided to self employed LMC graduates has been completed showing significant benefit for LMCs. The conclusions for continuing the current support package to support newly graduated midwives into independent practice is being considered within context of budget priorities for 14/15.

Family Planning and Contraception

A total of 123 women have received the Jadelle implant contraceptive postnatally since December 2013. The service is dependent on the specialist nurse. More staff are being trained to insert the implant to provide greater service continuity. Women choosing non-hormonal contraception are referred to a clinic at Manukau Superclinic. A total of 25 women (out of 42 booked appointments) have attended this clinic, all receiving a form of contraception. Training on contraception options is progressing with 18 sessions scheduled between December 2013 and May 2015. To date, 58 midwives have participated including 8 LMCs. Training is planned for a further 220 midwives.

Triple Aim - Executable Strategy Updates Triple Aim Programme Strategy Update Improve health and equity of all populations

Better Health Outcomes For All

Smokefree DHB by 2025 - Cessation figures updated using Census 2013 data. Substantial decrease in overall CM smoking prevalence (22.1% in 2006 to 15.9% in 2012) as well as Maaori (46.8% to 36.0%), and Pacific (30.3% to 23.2%). Health Literacy - Successful Health Literacy Symposium held on 27 and 28 February. 64 attendees from across the region attended. Next steps to be developed based on Symposium learnings and presented to April ELT. First 2000 Days - Planned Healthy Pregnancy: see Maternity Review above. Improved Maternal and Infant Nutrition: The Infant Nutrition Project contract negotiations have been completed following

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completion of literature review Community Action and Health Service Development needs assessment activities are in progress. Healthy Attachment: A detailed project brief is to be agreed in April that will focus on how access to services that support women with postnatal depression. Regional work on aligning maternal and infant mental health is in progress.

Improve experience and safety of care for patients

First Do No Harm Reported via HAC and System Integration. Patient & Whaanau Centred Care

Best value for public health resources

System Integration Reported separately via Director, Primary and Community. Ensuring Financial Sustainability

Reported separately via Director, Corporate Services and Finance

Enabling High Performing People

This programme has undergone progressive refinement and it is proposed that the programme focuses on 2 strategic pieces of work – workforce metrics and measurement and workforce business analysis and modelling. The remaining pieces of work could be considered core business for HR and/or Ko Awatea.

Human Resources National collective bargaining talks have broken down for EPMU (wanting 4% increase). Contingency planning underway across whole of system for potential strike by members of the EPMU (trades staff). Strategic Planning Whole of System Planning WoS programme groups were established over Jan-March 2014 and charged with challenging all current service models. Whole of System planning is occurring in the following areas:

Services Health of Older People and Rehabilitation Mental Health and Addictions First 2000 Days and Child Services Youth Health

Diagnostic Groups Metabolic Syndromes Cardiovascular Respiratory Digestive/Gastrointestinal Musculoskeletal

Population Health priorities

Alcohol Obesity Smokefree

The most advanced is the Mental Health Whole of System that is now proceeding to high level costing and analysis of what is feasible within the group’s recommendations. The least advanced are digestive/gastrointestinal and Metabolic Syndrome/Diabetes. 2014/15 Annual Planning District Annual Plan: The first draft DAP has been submitted to NHB. Maaori Health Plan: The first draft Maaori Health Plan will be submitted to NHB following CPHAC’s deliberations on the 27P

thP March.

Pacific Annual Plan: The Pacific Health Plan refresh for 14/15 will be submitted to May CPHAC. This is on a different timeframe because effort has been prioritised on submitting the statutory plans.

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Asian Health Plan: An opportunity to work will be discussed regionally with ADHB and WDHB on determining the priorities and subsequent actions for improving the health of vulnerable Asian communities in our District.

39


Ko Awatea The Health Science Academy, winner of the outstanding Supreme Winner of the ANZ New Zealand & EEO Trust Work & Life Awards (2012), is a driving force in supporting the workforce pipeline, particularly in the recruitment and retention of secondary Māori and Pacific students to pursuing a career in health. This programme has been awarded funding from the Tindall Foundation to continue the support of the development of a Māori ‘virtual’ health science academy through 25 tertiary scholarships for 2014 and 2015. LM note- I think given the focus on funding it would be good to provide ‘just enough’ info about the money and mainly point to the scholarships as the resource user The “Safety in Practice” collaborative in primary care was successfully established in February, to support 10-15 general practices to prevent and/or reduce harm and improve the quality of care for patients through safer management of medications. Ko Awatea are supporting a partnership with PHO’s and DHBs in the Auckland region. Safety expert Dr. Neil Houston, GP and Clinical Lead for Patient Safety in Primary Care, NHS in Scotland, visited Counties Manukau Health in February to share learning gained over the last 5 years from the country wide initiative on patient safety. CM Health are at the leading edge in building awareness and capability about customer focus and experience. In addition to leading a national programme on improving patient experience commissioned by the Health, Quality and Safety Commission Ko Awatea are supporting The Patient and Whaanau Experience programme which is formed of 19 active projects involving staff, patients and families together to co-design a range of services and exceptional experiences across our health system. The Business Intelligence / Data Warehouse project has made significant initial progress, including evaluating two products from an end user perspective with clinicians, and specifying and costing hardware infrastructure. A business case will be presented to IS Governance Group in April. In addition, Decision Support is responding to new work from the Director of Hospital Services arising from the Whole of System programme in the particular organisational / departmental balanced score card. The Research Office is actively managing 78 new research project proposals, as well as providing research training to registrars across CMH clinical services. The total number of registered research projects is 31 for the period between December 2013 and February 2014 (an increase from 26 in the previous year).

9 Dec – 17 Feb 2014

Clinical Audit

Observational Study

Qualitative Research

Quality Improvement Project

Randomised Clinical

Trial

Randomised Clinical

Trial – Sponsored

CMH Staff 7 5 1 4

External Collaborat

or 5 3 2 4

Breakdown of types of registered research projects UKo Awatea Centre The Ko Awatea centre provides learning for all the Joint Venture Partners (CMH, AUT, MIT, UoA). Demand for space continues to rise. We have welcomed two research teams and paramedicine academic programme from AUT. Satisfaction with the centre is extremely high. Careful management of this increasing demand is in place, but we are starting to see limits to what can be accommodated

40


in the existing building. We carefully track requests and unfortunately now see instances when we cannot meet new demand for space (42 times in past months when we could not accommodate CMH requests, and 3 occasions when we could not meet external or JVP requests). CMH continues to be the major user of the Ko Awatea centre, all partners pay in relation to their usage. UAPAC The planning for 3rd APAC Forum is well underway, and the programme outline and themes confirmed. The first three keynote speakers include: Maureen Bisognano, CEO of IHI, David Williams, CEO of Southlakes Healthcare Canada and former Astronaut, and Tim Costello, CEO of WorldVision Australia. The full APAC website with programme details will launch at the same time registrations open on Monday 7th April. Sponsors are already applying to support the event and exhibitor bookings have started. Eight proposals have been received for the APAC event management services (RFP). A vigorous selection processing has identified a professional congress organiser. The RFP contract is currently under negotiation. Ko Awatea has sought internal and external legal advice regarding compliance with the Australian legal and tax framework requirements. The final positions from the Ko Awatea Review have been recruited and appointed strengthening our skills in Evaluation, Event Management and Data Warehousing. The newly appointed Engagement Manager will specifically support the identification of new commercial opportunities, driving growth and commercial development across the business and programme activities for Ko Awatea. The secondment of the External Programme Manager (to MOH), has been filled by an internal candidate to ensure consistency with the APAC Forum and external delivery of training. UFinance & Budget Ko Awatea has met the first half year’s savings target through the use of unfilled vacancies. Moving forward our key agenda is to maintain our revenue targets. UKo Awatea KPIs 2013 Ko Awatea 2013 KPIs included: • Establishment of the Leadership Academy, this included the development and pilot of the

fundamental and core leadership course. The evaluation of the fundamental leadership course is currently underway.

• Development of high level measures for a high performing system, namely System Level Measures to underpin our aspiration to be the best healthcare system in Australasia.

• Building on the success of the first APAC forum, with delivery of APAC 2013, which featured 1040 delegates from 23 counties, seven full day intensives, 20 workshops and 23 exhibitors.

• Drawing on the expertise of our staff, expertise from the New Zealand health sector and our national and international partners Ko Awatea hosted the internal ‘think tank’ – to produce solutions to our challenges at the 75P

thP Anniversary conference and celebration of the national

healthcare system. • Development of number of core innovation capability offerings based on patient experience and

co-design, creativity and innovation and the sustainability and spread of improvement. UKo Awatea 2014 KPIs Ko Awatea KPIs for 2014 include the following: APAC 2014/15; supporting localities and hospital improvements; transition project; quality improvement network development; data warehousing

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project; leadership academy phase 2; building evaluation capability; system level measures; advancing academic and publications about our work; and the development of an innovation academy. UKo Awatea At A Glance

FEBRUARY 2014

Projects

Campaign Community Organising External Contracts 3 campaigns

with 23 sub programmes 3 2

Supporting Improvement in hospital Strategic Innovation KPI s

9 5 6 Research

New Ideas Pipeline Building

Capability Training Mandatory Professional Other

Innovation

Compliance Health & Safety Audit Cultural Competency Performance Reviews

100% XX% XX%

APAC

Ko Awatea Centre Utilisation

% 2012 % 2013 % 2014 63.6% 70.9% 51.3%*

Revenue Generating Health Science Academy

• sponsorship of tertiary scholarships. • spread of programme to other schools.

*represents total bookings received for all 2014 periods at this time, booking continue to be received on a daily basis. This figure is expected to exceed last year’s utilisation rates based on current booking volumes.

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Board Presentation

Patient and Whaanau Centred Care Programme

Presented by: Denise Kivell [Director of Nursing], Peter Gow [Clinical Director] & Renee Greaves [Patient & Whaanau Care Advisor]

43

Patient & Whaanau / Family Centred Care: ‘a’ definition

“Patient- and family-centred care redefines relationships in health care. It places an emphasis on collaborating

with patients and families of all ages, at all levels of care, and in all health care settings. Further, it acknowledges that families, however they are defined, are essential to patients’ health and well-being and are crucial allies for

quality and safety within the health care system.”

(Partnering with Patients and Families, 2006)

44

Our whakatauki

Kia whai kaha, whai mana painga ki ngaa kawenga oranga iwi ki tua o rangi. Whaanau inspired, enabled, resourced and in control of their own health.

46

Policy statement & signage

Visitors and Family/Whaanau Family Policy Statement

Counties Manukau Health recognises and reinforces the significant role family/whaanau play as partners in care and essential members

of the health care team, and is therefore making a distinction between family/whaanau, and

other visitors.

Key family/whaanau, as partners in care, are welcome to be with the patient at any time

during their hospital stay, according to patient preference and acknowledging safety.

Visitors are welcome between 2pm and 8pm.

Signage will be updated to reflect our new focus on partners in care

The following policy statement has been adopted for the DHB

47

Improved face to face engagement

Work Completed

• Embedding AI2DET

• Survey of consumer engagement groups currently accessed by CM Health Services

Work Planned for 2014

• Distribute observation tool

• Provide training sessions to staff on observation tool

• Explore recommendations from consumer engagement groups survey • Consumer Advisory Group / Panel • Community Panel(s)

48

A picture says a 1000 words project

These are examples of patient and family lounges, which are also discharge lounges

Do they look welcoming?

The lights are off, chairs on tables or hardly anything at all? 49

Improved capture of and response to patient and whaanau feedback

Work Completed

• Development and user acceptance testing of patient survey system (HQSC)


• Review and respond to CM Health patient/consumer experience data extract

• Build and implement survey portal

• Manage and control survey performance

• Use insights from Health Excellence Framework ‘Customer Focus’ submission to inform process improvement and re-design, data capture and reporting

50

Do I belong here?

We should be encouraging

feedback as a whole

Visual Hazards

51

Engagement

These are an example of cultural representation & awareness

52

Keeping family and whaanau informed and as partners in care planning

Work Completed • Support for implementation of Health Passport

• Liverpool Care Pathway implementation embedded

• Ongoing conversations with individuals and their families about Advance Care planning

• Progressive roll out of patient focussed wayfinding and signage

Work Planned for 2014 • Installation of Rainbow and all internal and external signage

• Implementation of re-formatted outpatient clinic letters

• Enable patient access to their health information e.g. implementation of Keeping You Informed project (patients receive a copy of their clinic letter or access to personal health information via patient portals )

• Complete implementation of Advance Care Planning project

• Championing electronic IT systems that enable patients and whaanau to be partners in care planning (e.g. shared care plans)

53

Experience questionnaire - developed by the NHS Institute for Innovation and Improvement adapted by many

© NHS Institute for Innovation and Improvement 2009

54

Patients and whaanau are members of key decision making groups

Work Completed • Development of experience based co-design programme for CM Health staff

to develop our own internal patient centred capability • Appointment of patient and whaanau advisor

• Consumer representation on Programme Board and other project / service working groups


• Patient and whaanau advisor to support and advise divisions, departments and services on capturing patient experience

• Provide support and advice to the organisation on using consumer experience to inform and direct strategy, action, policy and operations

• Further involvement of patients in organisational design, governance and policy making (Carman et al., 2013)

55

Patient and Whaanau Experience Programme

Participation

Dignity/Respect

Info

rmat

ion

Shar

ing

Collaborat

ionPartnership

Participation

Dignity/Respect

Info

rmat

ion

Shar

ing

Collaborat

ionPartnership

56

How patients felt about care after improvements

www.wordle.net 57

Capability building

Developing tools

and methods

to capture experienc

e Metrics

and measure-

ment

Use insights

from HEF submission to inform

future work

Framework for 2014

58

1. Capability Building

• Series of 1 day Masterclasses

• Provision of 8 month patient and whaanau experience programme for CM Health staff, including secondary care and community services

• Building capacity of staff with training in patient and whaanau centred care and using patient experience to transform service delivery

• Development of Experience Based Co-Design booklet with examples from New Zealand planned

59

2. Developing tools and methods to capture experience

HQSC consumer experience indicators

CM Health system level measures

Organisational measurements e.g. compliments and complaints

Service / ward specific measures

60

3. Metrics and Measurement

• PWCC programme dashboard currently under development by SPMO business analyst

• Will reference relevant System Level Measure and HQSC indicators

62

Measures (KPIs) Status System Level Measure

Patient Experience of Care • Number of complaints received by CM Health (proxy measure) – under development e.g if we have complaints, then

could be compliments to complaints ratio (as in some NHS hospitals) Measured

Programme Measures

Patient Experience of Care • Communication (5 indicator drivers) • Partnership (5 indicator drivers) • Co-ordination (5 indicator drivers) • Physical and emotional needs (5 indicator drivers) Capability building • Number of staff trained in experience based co-design • Number of projects or staff engaged in research, with patient and whaanau centred care as a central focus

Dashboard under development and awaiting Programme Board review

Project measures (not exhaustive)

Keeping you informed Patient and whaanau experience programme Re-formatting clinic letters

100% of all services send a copy of the clinic letter to patients by 30/11/14

100% of participants reporting project progress Patients/whaanau and staff agree together that the new state is an improvement Patients/whaanau and staff use a range of measures that show a positive change form the baseline state

100% of all clinic letters have new location name and format for MMH based clinics

Benefit Measures (KPIs)

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4. Use insights from Health Excellence Framework ‘Customer Focus’ submission to inform future work

• Create a summary document highlighting the important learning and initial proposals for improvement

• Activate a communication and engagement plan to ensure widespread understanding of engagement with the learning

• Create an action plan to improve the co-ordination of capturing, understanding and acting on patient experience feedback at every level of the system

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Key messages

“Don't think you're different to Mid Staffs staff, …” (Professor Berwick - leading the government’s post

Francis review of patient safety)

A patient and whaanau centred organisation that cares for you and

about you

Work with, rather than do to or for

65


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 5 March 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. Emerging Issues



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5. Qatar Engagement – Ko Awatea



6. 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)]


7. 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)]


8. 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)]


9. Regional Password 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)]


10. Draft Maori Health Plan 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.

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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. Treatment of Biological Infertility



12. Information – HBL Programme Update – March 2014



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