Pae tū, pae ora Pathways to pae ora

This work is licensed under the Creative Commons Attribution 4.0

International licence. In essence, you are free to: share ie, copy and redistribute the material in any medium or format; adapt ie, remix, transform and build upon the material. You must give appropriate credit, provide a link to the licence and indicate if changes were made.

Cover: Members of the Silverline team, left to right: Ryan Pilat, Maddi Mitchell, Arthur Hon and Haowei Yu. Credit Silverline

Citation: Pae tū, pae ora – Pathways to pae ora

Published in January 2020 by the Ministry of Health PO Box 5013, Wellington 6140, New Zealand

ISBN 978-1-98-859738-6 (online) ISBN 978-1-98-859737-9 (print) HP 7167

This document is available at www.health.govt.nz

This work is licensed under the Creative Commons Attribution 4.0

International licence. In essence, you are free to: share ie, copy and redistribute the material in any medium or format; adapt ie, remix, transform and build upon the material. You must give appropriate credit, provide a link to the licence and indicate if changes were made.

Cover: Members of the Silverline team, left to right: Ryan Pilat, Maddi Mitchell, Arthur Hon and Haowei Yu. Credit Silverline

Citation: Pae tū, pae ora – Pathways to pae ora

Published in January 2020 by the Ministry of Health PO Box 5013, Wellington 6140, New Zealand

ISBN 978-1-98-859738-6 (online) ISBN 978-1-98-859737-9 (print) HP 7167

This document is available at www.health.govt.nz

Delivering equity of health and wellbeing in Aotearoa Te tuku oranga hauora e orite ana i roto i Aotearoa

ContentsPae tū, pae ora . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

We stand together along pathways to healthy futures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Putting paid to hep C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Catching cancer early . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Shining a light on mental health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

‘Caring for our people’: encouraging Māori into health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Hapū Wānanga: for māmā and pēpi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Realising a dream for Pacific peoples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Pharmacy: at the heart of community health care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Nurse practitioners: the ‘no-hierarchy model’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Investing in infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

From garden to plate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Taking takeaways out of sport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

The ripple effect: communities going fizz-free . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

1737: supporting Kiwis 24/7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Digital health: power to the people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Digital hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Greening the health sector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

‘Anything is possible’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

– 2 –

Tēnā koutou, tēna koutou, tēna tātou katoa

I’m delighted to introduce the stories of Pae tū, pae ora as snapshots of exciting activity happening in our public health sector.

These stories are important because they highlight the leadership, innovation and local solutions being developed which together will help drive better health outcomes across Aotearoa New Zealand.

This Government’s priority is to strengthen, improve and invest in our public health system. Clearly that’s a priority shared by the people across the sector who you’ll read about here.

Recently, one of our district health boards received a letter from a patient’s family that it shared with me.

‘I wanted you to know how special you all are and also how much of an impact your care, professionalism, and your day to day interactions impact on those around you. Thank you for what you did for me and for my Mum.’

The health and disability sector will always face challenges, but that patient story, and many others like it, reinforces the positive work described in Pae tū, pae ora.

I know that like me, other New Zealanders will value and appreciate the commitment and hard work of the people highlighted in these stories.

Hon Dr David Clark Minister of Health

Pae tū, pae oraPae tū, pae hinga We stand and fall together. We stand together along pathways to healthy futures.

– 2 –

Kia ora koutou katoa

As Director-General of Health, I recognise the importance of knowing about and understanding the work happening across the New Zealand health and disability sector.

On behalf of the Ministry of Health, I wish to sincerely thank the participants who’ve spoken so enthusiastically about their work or experience for this publication.

I believe the Ministry is in a strong position to provide active stewardship and leadership across the system. It’s also well placed to prioritise and deliver greater equity in health

outcomes so everyone has fair access to, experience of and outcomes from health care.

But whether it’s inside the Ministry, in the broader health and disability sector or in the community, we should all be part of telling the stories of health. Many good and exciting things are happening and we all have so much we can learn from each other.

Nāu te rourou nāku te rourou, ka ora ai te iwi.

With my basket and your basket, the people will live.

Dr Ashley Bloomfield Director-General of Health

– 3 –

– 4 –

We stand together along pathways to healthy futuresThe New Zealand health and disability system has a proud history of innovation and forward thinking, often in the face of resistance from the powers that be.

During World War I, Ettie Rout was a pioneer in sexual health work among our troops. Around the same time, Sir Harold Gillies developed early plastic surgery techniques and his protégé Sir Archibald McIndoe refined that work further during World War II. In the post-war period, Sir Brian Barratt-Boyes led a revolution in heart surgery.

In 2020, that proud streak of innovation continues.

Right now, Wellington’s Malaghan Institute is conducting advanced research in pursuit of new cancer treatments, while Auckland University’s Professor Alan Barber has refined clot retrieval techniques which offer stroke victims a high chance of complete recovery.

These are just two snapshots – this publication is a further celebration of a proud history, the workforces which make it happen and the pride with which we as a country can celebrate a world-leading public health and disability system.

These pages contain stories of innovation and excellence up and down New Zealand. It is imperative that we continue to recognise those who push boundaries to improve the way in which we deliver health care for the public we serve.

We acknowledge here both unity and diversity: the combined efforts of Professor Ed Gane, PHARMAC and the Ministry of Health around Maviret in the fight against hep C; the mahi of local communities and Healthy Families NZ driving outcomes for better health and wellbeing. We see in Hapū Wānanga the reclaiming of traditional Māori birthing practices unique to this country.

Other examples are nurse practitioners and pharmacists, New Zealand workforces which operate at top of scope and in areas of high need, delivering services to communities who may have traditionally been underserved.

Throughout Pae tū, pae ora, these strands of innovation and excellence continue to inspire Aotearoa’s world-leading health care.

And yet we know we will always have to overcome challenges to achieve our goals. For instance, we have avoidable and unjust differences in health and wellbeing outcomes for some people, particularly Māori and Pacific peoples, people living in poverty and people living rurally.

We must address these, and we must improve equity across our entire population. The Government and the Ministry must prioritise working together with the health and disability sector to find the best possible solutions to the many challenges we face.

Congratulations to all who accept these challenges in the spirit of Ettie Rout, Sir Harold, Sir Archibald and Sir Brian. Through your efforts, we will deliver on our aims of better health care for all New Zealanders.

– 4 – – 5 –

– 6 –

Putting paid to hep CA drug that PHARMAC has funded since February 2019 is proving a real game-changer for New Zealanders with hepatitis C.

Aucklander Lyneese Dunshea, had been living with hepatitis C since the mid-1980s. Symptoms crept up on her gradually – ‘It’s something that comes along slowly and you just learn to live with it’ – but her fatigue got so bad she was having morning and afternoon naps and then heading for bed by 7 pm. ‘I had pain in my liver towards the end – and depression too. I think the fatigue was the worst bit.’

Lyneese began her course of Maviret in February 2019 and felt an immediate difference.

‘By the time I was finished it, the pain in the liver had gone. I’ve got so much energy and the brain fog is slowly going away.’ She’d previously avoided treatment after seeing friends suffering the side effects of interferon.

‘Maviret is simple to take, it’s short duration, it’s really well tolerated without any specific side-effects, and it has close to a 100 percent success rate,’ says Ed Gane, professor of medicine at Auckland University and deputy director of the Liver Transplant Unit at Auckland City Hospital.

Ed’s been involved in developing some of the new generation of hepatitis C drugs and says Maviret is exceptional. ‘It’s unprecedented in medicine that you can have a disease that has such a high cure rate. It’s fabulous.’

Previously available treatments included anti-viral drugs that were only effective for one type

of hepatitis C – meaning they only worked for about half of New Zealanders with the condition. Before that, interferon (a course of injections over six to twelve months) had debilitating side effects and a success rate of just 20 percent.

Hepatitis C is a blood-borne disease that causes liver inflammation and can lead to serious conditions, including cirrhosis of the liver and liver cancer. It’s the leading cause of liver transplants in New Zealand.

In the six months after Maviret began to be funded, about 2,500 New Zealanders were treated, rewarding the Government’s investment in the drug. It’s estimated that some 50,000 people here have hepatitis C – but only half of them know they do.

‘That’s the biggest challenge we face,’ says Ed Gane. ‘The potentially thousands of people who don’t know they have it can’t be treated until they’ve been diagnosed.’

Ed has been chairing a cross-sector working group that is developing a National Hepatitis C Action Plan supported by

the Ministry of Health. The group is using a collaborative approach which includes health professionals, consumer representatives, service providers and cross agencies including PHARMAC and Department of Corrections.

The Action Plan aims to raise awareness of hepatitis C and increase testing and treatment in the community, as well as to

prevent new infections.The World Health Organization’s

Global Health Sector

Strategy on Viral Hepatitis – which New Zealand adopted in

2016 – aims to eliminate

hepatitis as a major public

health threat by 2030. ‘The national plan

is the missing link for us getting there,’ says Ed. ‘If we’re able to increase testing and increase treatment in the community, then I’m sure we’ll achieve it.

‘PHARMAC funding Maviret has given us the simple tool we need to achieve that. I think this is something the Ministry of Health and PHARMAC can both be incredibly proud of, that they’ve facilitated this.’

‘I’ve travelled all round the world and spoken at meetings

It’s unprecedented in medicine, that you can have a disease that has

such a high cure rate. It’s fabulous.

– 6 – – 7 –

and listened to what other people are doing, and I think what we plan to do here is really the right approach.’

Ed adds that he expects New Zealand’s liver transplant rate to drop rapidly – as it has in Australia, which has had the drugs for a year longer.

And for Lyneese, Maviret has meant a new lease on life. She’s completed training in addiction and mental health peer support and is looking for work.

‘Previously I just couldn’t do a full-time job, it wouldn’t have been possible. It’s incredible to be looking for something and being quite excited about it.’

Top: Ed Gane, Auckland University professor of medicine and deputy director of Auckland City Hospital’s Liver Transplant Unit. Credit: Ed Gane

Right: Auckland woman Lyneese Dunshea, who has a new lease on life after taking Maviret. Credit: Lyneese Dunshea

– 8 –

Catching cancer earlyMataura Presbyterian pastor Tau Ben-Unu is just one of thousands of New Zealanders who is hugely grateful to the National Bowel Screening Programme (NBSP).

Currently being rolled out around the country, the NBSP offers free bowel screening to people aged 60 to 74. It helps find bowel cancer before it spreads, so gives people a much better chance of successful treatment.

The programme’s faecal immunochemical test (FIT) detects tiny traces of blood in poo. People take the test for themselves at home and then post off the sample. If a test comes back positive, it’s followed up with a colonoscopy to look for pre-cancerous polyps or for bowel cancer itself.

But Tau Ben-Unu admits that when his test arrived in the mail, his first instinct was not to do it.

‘Men don’t want to do anything we don’t have to do,’ he says, ‘and I don’t like to visit doctors unless I have to.’

But he thought about his wife and family, and had a change of heart.

‘I want to be around for my grandchildren and to be there to meet my great-grandchildren,’ he says. ‘I did the test for my family.’

He was diagnosed with a cancerous growth, which was removed in a straightforward operation.

‘The screening test meant we found the cancer early,’ he says. ‘I didn’t need any other treatment at all. It’s a great feeling that I can now put it behind me.’

The programme’s clinical director, Dr Susan Parry, says the programme is putting a lot of effort into encouraging Māori and Pacific peoples to do the test when it arrives in the mail.

‘We want to make sure there are no barriers, cultural or otherwise, to people taking advantage of this great programme and getting the benefits.’

She stresses the importance of early detection in treating bowel cancer.

‘When the programme’s fully rolled out nationwide, we expect to find around 500 to 700 cancers each year in the first few years. Over a third of these cancers will be early stage, which is why screening is so important. If cancers are caught early and people receive treatment, they have a 90 percent chance of long-term survival.’

Neuroscience researcher Jacqueline Bews also feels fortunate to have been part of the screening programme. And, like Tau Ben-Unu she almost didn’t do her test.

‘I thought, “Do I really need to do this?”, because basically I’m very healthy. But although I knew very little about it, when I read the statistics, I thought, “Well, you’ve got to be sensible, it looks a very simple test” – which it was.

‘So I did it, sent it away, and then it came back positive, which was a huge shock, because I had no symptoms at all.’

Jacqueline’s follow-up colonoscopy found she

had bowel cancer. She’s since had

successful surgery, and

now has a stoma bag for life, but thinks it’s a small price to

pay for having her

life saved.‘I was very

fortunate they caught it, because I

wouldn’t have gone near a doctor. There were no signs of anything – no bleeding, no feeling crook, nothing at all.

‘It was just one of those fortunate things – an unfortunate outcome, but fortunate as far as finding it.’

Dr Parry says the programme is really making a difference.

We want to make sure there

are no barriers, cultural or otherwise, to people

taking advantage of this great programme.

– 8 – – 9 –

‘New Zealand has one of the highest bowel cancer rates in the world, so it’s hugely satisfying to see this programme under way and making a real difference to people’s lives.

‘For every person diagnosed with bowel cancer, there are many others affected – partners, siblings, children, close friends. Just one life saved has a huge impact.’

Top: Presbyterian pastor Tau Ben-Unu outside his Mataura church, with a bowel screening test. Credit: Southern DHB

Right: Neuroscience researcher Jacqueline Bews sports a T-shirt advertising the National Bowel Screening Programme. Credit: Wairarapa DHB

– 10 –

Shining a light on mental health‘It’s fun, creative and unexpected, which is what I love about it.’

That’s the simple yet effective strategy behind Silverline, a student-led initiative at Otago University that’s promoting mental health and wellbeing for students through a fresh and creative approach.

Silverline began as a one-semester experiment in 2017. Since then, it has gone from strength to strength, encouraging students to connect with one another and talk openly about mental health.

It pitches activities as diverse as making dumplings, surfing, learn-to-knit sessions and fish and chips on the beach. Annual festivals with speakers on mental health and wellbeing are another popular feature of the initiative.

‘The conversation on mental health can often be a hard and dark one that forgets to look at the positives,’ says Silverline student lead Maddi Mitchell. ‘This is a more positive way of approaching it – really organic, fun, creative events and conversations.’

Maddi, a fourth-year public health student, got involved with Silverline after attending a couple of its events.

‘Everyone was so welcoming and the community was so lovely. For the first two years of my uni, I really didn’t have that

community. So it was really comforting and refreshing. Especially being away from home at Otago, it was nice to know that there was a group on campus that wanted to support you.’

‘Silverline began as a community for students who wanted to talk about mental health and wellbeing and who wanted to create invitations for other students to be part of that,’ says Sze-En Watts, manager of the university’s Social Impact Studio.

‘And to do so in a way that was inclusive and safe.’

Silverline has developed and distributed some 9,000 wellbeing resources. Staff and campus clubs often request them so that they can pass them on to students.

The first festival, held in 2017, drew 400 students to take part in workshops and listen to speakers on topics such as suicide awareness and prevention, anxiety, depression,

alcohol and relationships. The 2019 festival extended its

focus to belonging, inclusion and racism as well.

‘Those kinds of topics are quite prevalent across the campus at the moment, so we tailored it based on what our students need right now,’ says Sze-En.

Silverline has received $52,000 of funding from the Ministry of Education to enhance

international students’ wellbeing.

‘It’s a really good push for us to

widen our understanding of mental health and wellbeing from the perspective

of students from a

different cultural background,

especially if they come from cultures where

mental health and wellbeing is a taboo subject, or it’s not really acknowledged,’ says Sze-En.

International student lead Amal Abdullahi is working with a team to create a wellbeing guide aimed at international students. International and domestic students have got together on

This is a more positive

way of approaching it – really organic, fun, creative events and

conversations.

– 10 – – 11 –

the beach to eat fish and chips and play games. They’ve taken part in a sandcastle competition, in which they each created something that signified home to them.

‘It was a classic Kiwi way of getting to know each other,’ says Maddi. ‘A lot of our events are just giving people the opportunity to connect with other people that they usually wouldn’t – with like-minded people that are comfortable talking about mental health.’

Silverline is also developing a mental health campaign aimed at male students.

‘We’re trialling challenging some of the stigmas and stereotypes around male mental health, what that would look like,’ says Sze-En. She adds that there’s a ‘strong lad culture’ at Otago. ‘Guys and international students both represent communities where it has been more challenging to connect with or open up the conversation

around mental health and wellbeing.’

In June 2019, Silverline was the joint winner of the Youth Health Volunteer Team Award at the Minister of Health Volunteer Awards.

‘We were very proud to be recognised for that,’ says Maddi.

‘Silverline has grown so much over the last two years, and continues to grow, which is really exciting.’

Top: Students get together at the beach for Silverline’s Fluoro Friday event. Credit: Silverline.

Right: Members of the Silverline team, left to right: Ryan Pilat, Maddi Mitchell and Arthur Hon. Credit Silverline

– 12 –

‘Caring for our people’: encouraging Māori into healthA ground-breaking Taranaki programme supports young Māori into careers in the health sector.

WhyOra takes a kaupapa Māori approach to encourage rangatahi to consider training for a career in health.

WhyOra holds pūtaiao (science) expos for Māori students in years 9 and 10. With older students, it brings them into a hospital setting to have a look at career opportunities, both clinical and non-clinical.

‘We have professionals talk to them about their roles and how they got there, and the barriers they’ve overcome,’ says WhyOra general manager Tanya Anaha (Ngāti Kahungunu).

‘Then when students go into tertiary education, we keep in contact with them and provide support.’ That support can include linking students up with scholarships, internships and job opportunities.

Tanya says many of the students who go through the WhyOra programme are the first in their whānau to have a tertiary education.

‘So we might connect them with some of our students down at Otago to welcome them.’

Josh Manukonga of Taranaki hapū Te Māhanga is in the final year of a medical degree.

‘I wouldn’t have thought I could do this, until I did it

and had the support and encouragement of WhyOra,’ Josh says.

WhyOra also helped him to connect with his whakapapa and start learning te reo Māori, as well as to realise ‘that I can do something for Māori people – my people’.

He finds it gratifying working with Māori patients. ‘People really do appreciate a Māori health professional. I think pronouncing someone’s name right makes the biggest difference. And people really appreciate a sense of cultural understanding. When you see that on people’s faces, it makes it all worth it.’

WhyOra also supports adult students – which might mean, for example, buying books for a solo mum who’s choosing between putting kai on the table and paying for textbooks.

‘It’s not always a linear pathway for our Māori kids,’ says Tanya. ‘It’s not always

secondary school, tertiary, job. There are quite a few who have gravitated back into health a couple of years after leaving school.’

Te Haupai Korewha credits WhyOra with helping her move from unemployment to a role as a health promoter at New Plymouth’s Tui Ora medical centre.

‘WhyOra gave me something credible to my name.

I’d had no previous background in

work, and I was able to

come into an organisation without any of that and be in the job

that I’m in today.’In 2019

WhyOra was involved with

almost 600 secondary students, while supporting 82 Māori tertiary students training for health careers. That includes 12 currently studying medicine, most of whom are the first generation of their family to go to university.

Tanya is proud that all of the students graduating at the end

WhyOra gave me something credible to

my name.

– 12 – – 13 –

of 2019 already had jobs to go to.

And she’s also really proud of the first doctor to emerge from WhyOra. ‘We’ve had our first doctor graduate in 2018 – we supported them from secondary school right through to medical.’

At the time of writing, 105 WhyOra participants were in the health workforce, including doctors, nurses, midwives, allied health care staff and health care assistants.

That achievement is great for those people and their whānau – ‘we want to increase the earning potential for Māori’, says Tanya. More than that, it will also help address health inequities for Māori more broadly. ‘More Māori working in health will obviously provide better services for Māori who come through the doors at the DHB.’

At Taranaki DHB, the numbers of Māori staff have already

increased from 6 percent to almost 10 percent. With another 80-odd students on the way to completing qualifications, that percentage is set to rise further.

‘It’s not rocket science,’ says Tanya. ‘It’s caring for our people and reducing the barriers as and when needed.’

Top: From left, WhyOra general manager Tanya Anaha with student co-ordinator Michelle Martin, former WhyOra cadet Te Haupai Korewha with her son Luca, WhyOra administrator Olivia Ratana-Walkinton and programme co-ordinator Carla Davis-Jones. Credit: WhyOra

Right: Medical student Josh Manukonga. Credit: WhyOra

– 14 –

Hapū Wānanga: for māmā and pēpiTraditional Māori birthing practices thrive at Hapū Wānanga, a kaupapa antenatal education programme in Taranaki.

Initially developed in Waikato, Hapū Wānanga is now run in a number of locations around New Zealand. The Taranaki programme was launched in mid-2018, and since then over 140 people have taken part.

‘We base it on kaupapa Māori practices and principles,’ says midwife and facilitator Tawera Trinder (Te Āti Awa, Te Āti Haunui-a-Pāpārangi). She runs the programme along with fellow midwife Sharron Wipiti and doctor Moerangi Tamati.

Tawera says that some Māori women experience barriers in coming to mainstream antenatal classes, which they can find intimidating.

Hapū Wānanga is all about breaking down those barriers and creating a safe space for expectant mums. The two-day wānanga, held at marae and marae-like venues around Taranaki, covers labour and birth, breastfeeding, smoking

and quitting, immunisation and dental health for young children.

‘A big one is our tikanga session, which is Māori birthing traditions before colonisation,’ says Tawera. ‘We’re reclaiming our birthing traditions and adapting them to today’s world.’

Wānanga participants make an ipu whenua, a clay vessel to

hold the placenta so they can bury it, and a

muka (flax fibre) tie for tying off

the umbilical cord instead of using a plastic clamp.

Upcoming wānanga will also

include making a

porotiti, a musical instrument

that can be played during pregnancy, labour and birth, and afterwards for the baby.

The programme takes a real whānau approach – everyone’s welcome. ‘We’re teaching that not only is the mum the centre of attention, everybody plays a crucial role in raising tamariki.’ Women are encouraged to bring

their partners along. If partners can’t come, then friends, mums and nanas are all welcome.

Tawera says they love having the older women there. ‘They bring insight, and they bring their experiences of birth, when they were hospitalised and had to stay in for 10 days. Everybody’s kōrero goes a long way.’

She’s also developed a Mana Tāne session, where Māori fathers come in and tell their story, to provide a role model for young dads.

As reunions and get-togethers keep going after the babies are born, bonds formed during the wānanga can continue and participants can keep supporting each other.

For Taylor Hina (Ngāti Apa), who lives in the small rural settlement of Huirangi, Hapū Wānanga was ‘awesome’ when she was expecting her daughter Emmerson, now 11 months old.

‘Since I was a first-time mum, I had no real idea what was going to happen to me. They covered everything, so when it came to labour and birth I knew what was going to happen to my body. It helped me go in with a better mind set.’

She says the kaupapa Māori approach was really

Hapū Wānanga is all about breaking

down those barriers and creating a safe space for

expectant mums

– 14 – – 15 –

important to her. A fan of natural approaches to health, she appreciated having the muka tie to use for Emmerson’s umbilical cord. ‘It was so much easier than a plastic clamp.’

She even made a new best friend at the wānanga – and plans to attend again for her next baby, ‘just to refresh everything’.

In terms of long-term impacts, Tawera says they’ll be working to analyse data from the programme.

‘But from what we’ve already seen on the [hospital] wards, it has huge impacts, especially the tikanga birthing, and how empowered they felt when they gave birth. We get that a lot from the midwives, and the women themselves. It’s a huge improvement.’

Top: Hapū Wānanga participant Aroha Healion making a clay ipu whenua. Credit: Hapū Wānanga

Right: Hapū Wānanga participants at the Tahu Pōtiki Centre, Hāwera; Tawera Trinder at front right in dark green hoodie. Credit: Hapū Wānanga

– 16 –

Realising a dream for Pacific peoplesFrom small beginnings 20 years ago, a Waikato-based charitable trust is set to make a splash and extend its services for Pacific peoples.

K’aute Pasifika Trust’s Pan Pasifika Hub in central Hamilton will be a first for New Zealand. Purpose-built, it’ll include an integrated health centre, an early childhood learning facility and an open fale-style community space for larger programmes as well as community and cultural events.

‘We’ve dreamed of this for 20 years,’ says Trust chief executive Leaupepe Rachel Karalus. ‘A centralised and accessible Pasifika community hub will mean we can better support the holistic wellbeing of Pacific families, increase our connectedness and cultural identities, and celebrate and support academic, sporting, creative and leadership potential and achievements.’

K’aute Pasifika provides free health, education, social and employment services to Pacific and other communities

in Hamilton. Set up by a small group of Pacific women in 1999 to improve access to health and social services, with support from a group of Māori women health workers, the Trust has come a long way in its two decades.

Initially staffed by two volunteer nurses, with the first funded part-time position

in 2001, it now has 25 full-time staff and

runs an array of programmes

including early childhood education, primary health services, family wellbeing

and violence prevention,

quitting smoking and

breast screening. The staff use Pacific models of care and practice but the services are available to people of all ethnicities and communities.

K’aute Pasifika is the lead provider for the Aere Tai Collective, which consists of seven Pacific providers across

the Midlands region.Its 20th-birthday celebration

in Hamilton Gardens – ‘the feeling was magical,’ says Rachel – brought together a diverse group of more than 300 people, including government ministers, city councillors, chief executives of large institutions and smaller community groups. It was a testament to K’aute Pasifika’s focus on partnering with different organisations.

To develop the Hub, K’aute Pasifika is partnering with Primary Health Care and Creators Educational Trust. It’s also working with Orchestras Central to accommodate practice and storage space for three big orchestras.

‘One of the things we’re really excited about is an image of an orchestra playing in the evening, in an open fale-style building across the road from the city stadium – exposing orchestral music to communities that wouldn’t necessarily ordinarily be exposed to it,’ Rachel says.

At the moment, K’aute Pasifika’s programmes are delivered from several different locations – playgroups and the elderly day programme run off-site due to limited space.

A centralised

and accessible Pasifika community

hub will mean we can better support the

holistic wellbeing of Pacific families

– 16 – – 17 –

But the Hub will bring everything together as a one-stop shop with purpose-built spaces.

With Trust Waikato having approved $2.1 million of funding for construction of the Hub – it’s expected to cost $11 million in total – K’aute Pasifika is working on its design and regulatory compliance. Construction is expected to start in late 2020.

‘The whole premise of the Hub really goes back to the original vision,’ says Rachel, ‘which was to be able to offer whole-of-family wrap-around support services for fanau/whānau, utilising Pacific models of care and practice.

‘One of the big things from a wellbeing perspective is the need for Pacific peoples in the Waikato to have a space in which we can celebrate and maintain our languages, our practices and our traditions, and the ability to do that from a culturally appropriate and significant space.’

She says the Hub represents more than just a building. ‘It’s part of a much bigger strategy for Pacific peoples in the Waikato region – a converging of community, culture and commerciality, working together to deliver improved outcomes for Pacific and other high-needs communities.

‘It’s going to be a game-changer for us.’

Top: At K’aute Pasifika’s 20th birthday celebration, from left, Leaupepe Rachel Karalus, chief executive of K’aute Pasifika; Leaupepe Peta Karalus, former chief executive; Edgar Wilson, chair of K’aute Pasifika Trust Board; Hon. Aupito William Sio, Minister for Pacific Peoples; former Hamilton mayor Andrew King. Credit: K’aute Pasifika Trust

Right: An architect’s vision of K’aute Pasifika’s proposed Pan Pasifika Hub. Credit: K’aute Pasifika Trust

– 18 –

Pharmacy: at the heart of community health care When they’re looking for health care that’s close to home, millions of New Zealanders know they can count on their local pharmacy.

New Zealand pharmacies, along with their highly trained staff, are at the heart of innovation in delivering health care to their communities.

Ian McMichael, current president of the Pharmaceutical Society of New Zealand and a pharmacy owner in Hamilton, speaks proudly of the way his profession strives to keep its workforce at the top of scope.

‘For some people, pharmacies are more accessible, from a physical perspective and also often from a social perspective,’ says Ian. ‘People find it easier to go into the pharmacy. For flu vaccinations, as an example, we don’t have appointments; people come in when it’s convenient for them.

‘If you go to Placemakers for your home hardware, you do it in the weekend or after work. And maybe that’s what health needs to do as well, so people don’t have to come to you when it’s most convenient for

you as a practitioner, but when it’s most convenient for them.’

As an example, Ian’s goal is for pharmacies to be able to offer the full suite of vaccinations by 2025. The service is particularly important, he thinks, in high-needs areas.

‘I’d like to be able to go from six-week-old babies up. If there’s a need, and you’re more accessible, then community pharmacies should be enabled to do these things.’

He’s also introduced pharmacy-based services aimed at mental health. Now pharmacies offer counselling to people starting on anti-

depressants and provide intramuscular anti-psychotic injections, which can be needed monthly or fortnightly.

‘For me, the most logical place for a person to get

their injections is from a community pharmacy.

People are already coming in

here picking up other medication, they’re used to coming in here, used to a relationship

with the staff. It’s all

about turning to face the public

and making the most of every point of contact.’

Pharmacy services were at the forefront last year, as more than a million New Zealanders staved off winter ills with a flu vaccination. As the demand for flu vaccinations grows,

For me, the most logical place for a

person to get their injections is from a

community pharmacy.

– 18 – – 19 –

more people are choosing to get vaccinated at their local pharmacy. It’s a trend that Ian’s Hamilton pharmacy helped to set when it became the first in New Zealand to offer flu vaccinations in 2009.

‘I think we did about 500 flu vaccinations that year,’ says Ian. Pharmacy did about 75,000 in 2019. ‘It’s still only a modest proportion of the total, but if you were to graph it, the growth would be exponential.’

In 2009, Ian and his team piloted the Community Pharmacy Anti-Coagulation Management Service (CPAMS), in which pharmacists manage an individual’s warfarin (a medicine used to treat blood clots). The programme is now nationally funded and operating in pharmacies around the country.

Caroline, 48, a former registered nurse, gets her injections for a neurological condition at Ian’s Hamilton

East pharmacy. She says that, in the after-care and support they provide, pharmacy teams go above and beyond what’s expected.

‘They work with the person to ensure everything’s done to keep people well in the community. And the doctor is next door, so it’s a one-stop shop.

‘They cover all the bases they can for each individual client – they’re awesome. It should be copied throughout New Zealand as far as mental health care goes.’

To Ian, it’s important to work with general practices and other providers to provide integrated health services. He laughs when asked if he has more initiatives in the pipeline.

‘There are always lots of initiatives. For me, the future needs to be around pharmacists being able to prescribe more from community pharmacies. At

the moment, pharmacists can prescribe some vaccinations, they can prescribe for CPAMS, they can prescribe things like Viagra.

‘I’d like to see an expansion of the range of medications that pharmacists can prescribe, and for pharmacists to be able to provide more and more specialised services, especially around the management of things like COPD [chronic obstructive pulmonary disease, which involves breathing difficulties] and asthma.

‘There’s a whole range of new areas where pharmacy is able to add value.’

Top: Pharmaceutical Society of New Zealand president Ian McMichael in his Hamilton pharmacy. Credit: Ian McMichael

– 20 –

Nurse practitioners: the ‘no-hierarchy model’One quiet South Canterbury town is home to a ground-breaking health initiative: Pleasant Point Health Centre is the first general practice in New Zealand to have all its patients registered to a nurse practitioner.

The centre’s director and lead clinician, nurse practitioner Tania Kemp, bought the practice in 2014 and hasn’t looked back.

‘It’s been a dream come true,’ she says. ‘We’ve grown it for the last five years – and it’s a successful model, it’s still growing.’

She’s had part-time general practitioners (GPs) work at the centre ‘off and on’, but most of its health care services are provided by nurse practitioners and registered nurses.

‘There’s very little now that I can’t do, if I feel it’s within my scope. I can do the same prescribing as a GP, I can order the same tests as a GP.

‘South Canterbury DHB [District Health Board] have been incredibly good with me, because they know it’s a new model of care. They’ve opened up opportunities. I have exactly the same access to services as a GP does.’

She draws on the expertise of specialists when needed, with a ‘go-to person’ in each area of medicine who she can email or call for advice. ‘If you haven’t got a GP on site, then you’ve got to have good access to other medical expertise.’

Tania, who’s of Ngā Māhanga a Tairi descent, grew up on Pitt Island (where the current population is about 40) in the Chathams. Since then, she has worked in a number of remote places, including on the West Coast, Chatham Island and back home on Pitt.

On Pitt, she was the only health care provider and relied on fishing boats to evacuate seriously ill patients to Chatham Island, often in rough seas. One time, very severe weather made even that impossible. When huge swells prevented a fisherman from landing, he threw the IV antibiotics and other medication he’d brought from Chatham onto

the wharf in a container.‘It was a bit of an eye-opener

coming back to New Zealand,’ she says, laughing about her relocation to what Chatham Islanders see as ‘mainland’ New Zealand.

‘In fact, the practice I’ve got now is the most urban I’ve ever worked at – there’s a hospital 25 minutes down the road.’

All that experience in remote places has given her confidence in running the Pleasant Point practice. ‘I was used to working on my own, so running a practice on my own wasn’t that nerve-wracking. All the way through I’ve worked remotely, where access to my medical back-up has been by phone.’

She says that with the shortage of GPs, the nurse-practitioner-led model makes sense. A Nursing Council board member, she’s a keen advocate of nurses taking on more responsibility.

‘There’s so much work that can be, and should be, done by nurse

– 20 – – 21 –

practitioners. I believe nurses are so much more capable than what the role has allowed them.’

Supporting and training nurse practitioners is another strong focus for her. Interns and students come to the practice for work experience and clinical supervision.

Tania sees the centre as operating from a nursing base. ‘I practise medicine, but my point of difference is that it’s based in a nursing philosophy. We have a softer model – we look at the bigger picture. For example, I do a lot of mental health. Rather than just treating something, I spend a lot of time on talk therapy.’

And it’s all a team effort.‘We have an amazing team –

there’s no person that we can do without. The receptionist is as important as the nurse practitioner. I have this no-hierarchy model. So there’s no difference between me making a cup of tea or doing the dishes or anybody else doing it.

‘We can’t work without that team approach.’

Top: The Pleasant Point Health Centre team, from left, receptionist Carolyn Honeywell, registered nurse Jessica Haar, nurse practitioner Christine Kippax, registered nurse Rebecca Butler, manager Kerri Sharp, nurse practitioner Tania Kemp and managing director Darcy Kemp. Credit: Pleasant Point Health Centre

Right: Flowerpot Bay on remote Pitt Island. Credit: Tania Kemp

‘There’s very little now that I can’t do, if I feel it’s

within my scope.

– 22 –

Investing in infrastructure New Zealand’s most modern hospital will rise in the centre of Dunedin over the next decade.

The New Dunedin Hospital is set to be the city’s biggest building. It will also be the highest-value vertical construction project ever undertaken in New Zealand, at a cost coming in between $1.2 and $1.4 billion.

Dunedin stands out as a target of the Government’s prioritisation of capital investment in public health. On top of that, Budget 2019 delivered an additional $1.7 billion for infrastructure and facilities over the next two years, a move that allows district health boards (DHBs) to plan for the future.

‘We’re excited about Dunedin, it’s the largest complex project we’ve undertaken,’ says Michelle Arrowsmith, the Ministry of Health’s Deputy Director-General, DHB Performance, Support and Infrastructure.

‘Health systems are continually evolving. The New Dunedin Hospital will support more contemporary models of care to better meet the future health needs of people in the region.’

The Ministry of Health is delivering the Dunedin build, with oversight from the Southern Partnership Group (SPG) – reflecting how, as Michelle says, health infrastructure plays a vital role

in making sure people get the care they need. With an ageing population in Otago, that’s particularly important.

The state-of-the-art hospital will be digitally enabled, using new and emerging technologies to provide improved patient care. It’ll also have a stronger role as a teaching and clinical training facility for medical, nursing and allied health staff.

Its location is on the old Cadbury factory site, as well as on a neighbouring block of land. That makes it central, close to

Otago University Medical School and the

existing hospital, and easy to

reach via public transport.

‘It’ll be a lot more than just a new hospital,’ says Pete

Hodgson, chair of the SPG. ‘Some call it a

place-shaping project, one that will alter the nature

of the city, the way health is delivered in Dunedin and across the region, and even the way tomorrow’s health professionals are taught.’

He says the new hospital will be ‘a place where new digital health technologies can be trialled, which opens up new economic opportunities for our city. Dunedin’s aspiration to become a centre of digital excellence should be materially advanced by

the arrival of New Zealand’s first digital hospital.’

‘In Dunedin, we’re all committed to working closely with the construction sector to deliver a fantastic new hospital,’ says Michelle.

The hospital’s construction will have a big economic impact on the city – and on New Zealand’s construction industry – with up to 1,000 workers on site at its peak.

The building will be built as two main structures and they’ll construct the hospital in two stages. The smaller outpatients and day surgery facility is expected to be completed in 2023/24, so some services can start operating earlier and take pressure off the existing hospital. The acute inpatients building is scheduled to be finished in 2028.

‘With the Government investing more into health capital, there’s a number of projects coming up right across the country,’ says Michelle Arrowsmith. ‘It’s the start of a long-term programme around New Zealand’s health infrastructure.’

Other projects due to come on line include fantastic new hospitals in Christchurch and on the West Coast. A number of projects are also under way as a result of Budget 2018 investment of $750 million in Northland, Auckland and Wellington.

‘It’s an exciting time for health infrastructure in New Zealand,’ says Michelle.

We’re excited about

Dunedin, it’s the largest complex

project we’ve undertaken

– 22 – – 23 –

– 24 –

From garden to plate Initiatives in South Auckland and Waitākere draw on traditional Māori and Pacific knowledge to connect communities and encourage healthy eating.

More than 50 Māngere families started their own boxed garden as part of the One Love Māngere programme in 2018. It has seen them growing everything from taro and herbs to cabbages and cauliflower.

‘Many in this neighbourhood were experienced growers, hunters and gatherers back in their Pacific Island homelands, but may have struggled to adapt their knowledge and crops to the New Zealand climate and lifestyle,’ says Kelly Francis of Whenua Warrior.

‘By introducing a simple garden box and indigenous gardening techniques, we’ve seen a resurgence in the traditional food practices. We love watching families and their gardens thrive.’

Each household started with one basic box and a selection of vegetable punnets. As the crops took off, the abundant summer harvest, paired with increased confidence and skill among residents, led several households to add up to three more boxes to their garden.

As a result, families are

eating healthier, home-grown produce and relying less on the commercial food industry. It’s a positive trend for a neighbourhood with more than 120 takeaway and liquor outlets within three kilometres.

‘We noticed many families being empowered by their

gardens,’ says Kelly. ‘It’s saying to them,

“These new skills, these crops,

all of the associated benefits, they all belong to you.”’

The One Love

Gardens initiative is

delivered by Healthy Families

South Auckland in partnership with Do Good Feel Good, My Backyard Garden and Whenua Warrior.

And there’s more. In just six months of 2019, 20 tonnes of waste were diverted from landfill and upcycled by community to create garden hubs across West Auckland. Pallet extensions are being crafted into raised garden beds, Auckland Council rubbish bins removed from circulation have found a new life as compost bins, and daily food scraps are being turned into nutrient-

dense fertiliser. Behind the movement

is a robust steering group, backboned by Healthy Families Waitākere, including Enviroschools, EcoMatters, Community Waitākere, Compost Collective, local gardening champions, schools, community hubs and Auckland Council.

In 2019, the collective facilitated 19 workshops and working bees, with over 200 garden beds and composting systems distributed to community groups and whānau.

From this initiative, many families are regularly using produce from their gardens, and extending their beds to grow more.

The collective has also supported the development of three new community gardens, including the Glenavon Community Hub and Wai o Te Ora Garden.

Glenavon Backyard Garden Project Hub Coordinator, Eva Wongchiu is delighted.

‘Gardening teaches lessons beyond the fundamentals of how to grow and harvest vegetables. While harvesting from a Hub garden, a younger member discovered a large marrow growing in the garden bed. Rather than keep it for himself, he offered the marrow to a family in the community. It was a joyful experience for everyone.’

We love watching families and their

gardens thrive

– 24 – – 25 –

Healthy food was also the focus at Te Mata o Rehua market, a Matariki celebration aiming to improve Māori wellbeing in Manukau.

The market, held at Matariki in 2018 and 2019, featured Māori-inspired crafts and rongoā (traditional medicine). Healthy kai included kūmara chips and vegetarian curry made with organic kūmara from Papatūānuku Kōkiri Marae, and free smoothies from Do Good Feel Good.

‘A food court at any local mall can be a drawcard, but the options there are mostly big-branded fast-food outlets,’ says Mason Ngawhika of Healthy Families South Auckland.

‘Yet we know Manukau was historically a pātaka kai o te ora – the centre of healthy, organic, locally grown food.’

He says Te Mata o Rehua has been a successful way to showcase a Māori approach to what a healthy food system

could look like in ManukauA stone carving symposium

held alongside the market in 2018 saw 10 local carvers create 12 sculptured pou from Ōamaru stone. These form a portable stone maramataka (Māori lunar calendar) compass –another way of revitalising traditional Māori practices.

‘Our tīpuna [ancestors] developed the maramataka based on their close relationship and understanding of their environment and the interconnectedness of the whenua, rangi and moana [land, sky and seas],’says Mason.

Top: Māngere gardener Maria Misilele with her One Love Garden. Credit: Healthy Families South Auckland

Right: Limestone sculptures and healthy food on offer at Te Mata o Rehua market in Manukau. Credit: Healthy Families South Auckland

– 26 –

Taking takeaways out of sportKids all around New Zealand enjoy playing sport. It’s fun, and also great for health and wellbeing – with benefits ranging from the physical rewards of being active to the social gains of belonging to a team.

There’s a contradiction, then, that these sporty youngsters have traditionally been rewarded for their effort with a Player of the Day certificate that comes with a serve of fast-food vouchers on the side.

That’s changing in Lower Hutt, where Healthy Families Lower Hutt is working with sports clubs and codes to ‘take the takeaways out of sport’ by providing a healthy alternative.

Instead of the fast-food vouchers, young sportspeople in Lower Hutt now receive a free pass to a council-owned pool. It’s a chance to enjoy themselves and still be physically active, away from food-based rewards.

Leading the initiative are Hutt City Council and Healthy Families Lower Hutt, with support from four other councils in the Wellington region. To take part, sports groups have to demonstrate their pro-water kaupapa – promoting water as the drink of choice and having no unhealthy sponsorship for their juniors.

Matt Reid, General Manager of City and Community Services at Hutt City Council and chair of Healthy Families Lower Hutt, says the initiative has been a huge success.

‘The pool passes offer a double benefit: breaking the link between traditional takeaway

vouchers and junior sport while also providing a new opportunity for the player, and their whānau, to be physically active at our pools.’

Wellington, Upper Hutt and Porirua City Councils and Kāpiti District Council have also joined the movement, so the passes can be used at the 19 council pools right across the region. Collectively the councils have invested $100,000 in supporting this initiative through free passes.

By June 2019, 30,000 ‘Go the H2O’ Player of the Day certificates with pool passes had been given out and were reaching 16,000 young people every year. And the impact was clear: 42 local sports clubs and four regional sports codes were actively promoting drinking water, and 21,000 fewer fast-food vouchers were in circulation.

Total Touch Wellington was the first sports organisation to use the Go the H2O certificates. Total Touch reaches more than 2,000 young people twice each year

through its Hutt-based touch rugby modules.

‘We know big change starts small, and this was a change we wanted to make,’ says Bronwyn Jahnke from Total Touch Wellington. ‘We now give our junior players a fun experience at a local pool, and the opportunity to be active again – this time with their families. The feedback from parents has been

overwhelmingly positive.‘We’re going to

continue making Total Touch

a healthier way to experience sport. Our next focus is making sure there are

healthier food and

drink options available at local

parks.’Another organisation

now giving out the passes is Wellington Rugby League. WRL runs the Wellington region’s junior league competition, involving around 470 junior players. With its ‘Be a Sport’ programme, sidelines are family-friendly and healthy places. Water is the drink on offer and venues are free of

Providing a new opportunity

for the player, and their whānau, to be physically active at

our pools.

– 26 – – 27 –

alcohol and cigarette smoke. It seems Go the H20 is on a

roll: Wellington Rugby Union is the latest regional sports code to join the movement. Its 19 clubs now promote water as the drink of choice for their 5,000 junior players.

It’s a win–win situation in which sports clubs are promoting healthy behaviours, young players are enjoying themselves at pools instead of eating unhealthy food – and sport sponsorship is moving towards a focus on health and wellbeing.

Top: Lara Andrews and players Toko, Dante and Rakaia from Te Aroha Softball Club with their Player of the Day certificates. Credit: Healthy Families

Right: Tainui from the Randwick Kingfishers under-nines proudly displays his Player of the Day certificate. Credit: Healthy Families

– 28 –

The ripple effect: communities going fizz-freeRight across Auckland, schools, communities and events are turning away from sugary drinks and making water their first choice.

Understanding schools as unique places where healthy habits can be established to last a lifetime, Healthy Families Waitākere worked alongside local champions including school students, teachers, BoT members and kaumātua to understand why students weren’t drinking water during school hours.

Guided by Healthy Families Waitākere, students interviewed peers about their water drinking habits, a process which highlighted common barriers in schools across the region. Insights included limited access to drinking water through a lack of water infrastructure (not enough water fountains), current fountains not operating correctly, alongside the perception current water fountains were not clean.

Understanding the role which increasing access and affordability of water can play as a catalyst for healthy change, Healthy Families Waitākere secured investment on behalf of a large number of West Auckland schools to increase water infrastructure in schools across the region. After seeing the impact a single fountain can have, a number of schools reallocated budget for additional fountains on school grounds. Over the past three years, this

has led to 90 modern drinking fountains providing clean water to over 26,000 students, totalling 66% of the regions school student population.

At Te Kura Kaupapa Māori o Hoani Waititi, the move to water was the starting point on the kura’s journey to becoming fully self-sustainable. Since installing the first water fountain with support from Healthy Families Waitākere, the kura has invested in a further six, alongside composing a wai (water) haka, to wero (challenge) others to choose water and instilling the mauri (life-force) of wai. Its healthy focus has not stopped there either – it has also developed a māra kai (veggie garden), beehives and adopted heihei (chickens). The kura describes this approach as the Wai Māori movement.

In early 2019, Wai Māori was extended to Hoani Waititi Marae, next to the kura. As a result, events such as the popular Oratia Markets held at the marae are

now Wai Māori, seeing the water only message reach a broad cross-section of community.

Healthy Families Waitākere Manager, Kerry Allan, says the team takes a dynamic systems approach to better understand and respond to the complex challenges communities face

in Waitākere. ‘To combat issues like obesity

and preventable chronic disease,

we all need to make significant change. A simple start is making water as the

first choice of drink.’Healthy

Families Waitākere is also

trialling mobile hydration stations, which offer drinking water at places where it isn’t readily accessible. These stations are available for events which are promoted as water-only. The stations have proved popular locally, including at Auckland’s largest Waitangi celebration, Waitangi @ Waititi, with over 200,000 attendees – keeping the crowds hydrated throughout the festivities.

I think the water-only day is a great

next step in our move to be a water-promoting

school.

– 28 – – 29 –

Since 2017, more than 55 schools and sports clubs across West Auckland have taken the pledge to make water’s the first choice – making the healthy choice, the easy choice for community.

While the Ministries of Health and Education encourage schools to adopt a policy in support of water, the student voice is another powerful driver. That’s certainly the case at Māngere College in South Auckland.

The high school’s student-run health council is mobilising teachers and students to make water the first choice of drink at school. Students voted for a monthly water-only day, which they are now working on.

Principal Tom Webb is impressed with their passion and commitment.

‘I think the water-only day is a great next step in our move to be a water-promoting school. It really highlights the issues around healthy drinking.’

Māngere College installed a water cooler in the gymnasium, and student leaders have designed a pro-water logo and slogan, ‘H2O is the way to go’. That’s now proudly displayed on reusable water bottles sold at the school.

And it seems the move to water is a happening thing right across Māngere. The annual Portage Crossing – a 20-kilometre paddle-and-walk route re-enacting the journey of the Tainui waka on the shores of Manukau Harbour – has also declared itself ‘fizz free’.

Water stations were set up along the Portage route, and food vendors had to be aligned to Auckland Council’s bronze standard of the Food & Beverage Guidelines, meaning they couldn’t sell sugary drinks or high-fat foods. Smokefree messages were also promoted.

Healthy Families South Auckland’s strategic intent is pro-water, and to work with South Auckland secondary schools and early childhood centres to adopt

water as their first choice of drink.Healthy Families South

Auckland Manager George Makatapatama says it’s important to take every opportunity to increase healthy food and drink choices, given the high rates of serious chronic diseases in the area.

‘We have some gnarly issues in South Auckland with chronic disease caused by unhealthy diets and lifestyle choices. But one simple response we can take is to create events which effectively influence behaviour change in a common-sense way, without ruining people’s fun.

‘A healthier future starts with Aucklanders making healthier choices in all the places they live, learn, work and play – including at our amazing summer events.’

Top: Tiraroa Hetaraka and Javan Rivers, students at Te Kura Kaupapa Māori o Hoani Waititi, proudly display their water bottles. Credit: Healthy Families Waitākere

– 30 –

1737: supporting Kiwis 24/7 In the wake of the 15 March terror attacks in Christchurch, thousands of New Zealanders turned to the 1737 helpline for support and counselling.

1737, need to talk? is the national mental health and addictions helpline. Launched in 2017, it allows people to talk or text with a trained counsellor, 24 hours a day, seven days a week.

The number of people contacting 1737 soared in the weeks after the Christchurch attacks.

‘There was phenomenal extra demand – it was one of the biggest spikes we’ve ever had,’ says Dylan Norton, service delivery manager of the mental health and addictions team at the National Telehealth Service, which runs 1737.

In response, an additional 120 counsellors, psychiatrists and psychologists were brought on board to boost staff numbers. More than 61,000 counselling sessions were provided in the five months after 15 March.

Dylan says initially a lot of the contacts were from people who’d been directly impacted – ‘people who were actually in the mosque, family members of people who were in the mosque’ – as well as from first responders, including paramedics and police.

But 1737 also supported people from the wider Christchurch community who had lived through the quakes and were re-traumatised by the 15 March events.

‘And right across New Zealand we were providing support to the Muslim community. There were

Kiwis from all around the country that were too scared to go outside because they’re Muslim. So we did some amazing work to support and validate them.’

People from the wider community also contacted 1737, feeling unsafe, struggling to understand how the attacks could have happened here, or having existing anxiety or depression triggered. ‘It was such a significant impact for all of New Zealand,’ says Dylan.

With its memorable four-digit number, 1737 aims to reduce barriers to reaching out for mental health support when it’s needed. In a research study, the National Telehealth Service team found some people struggle to remember 0800 numbers. Having a name that includes a word like ‘depression’ or ‘gambling’ can also put people off accessing services – so 1737 is an easy-to-grasp ‘brandless brand’ that aims to include everybody. That also means anyone can promote the service. In the weeks after the attacks, Christchurch Police handed out 1737 flyers.

The Press newspaper ran a free full-page 1737 ad in a Saturday edition, which included the words ‘Need to talk?’ in Arabic, Urdu, Hindi, Malay and Bahasa Indonesia. Radio stations also promoted 1737.

As a nationwide helpline, 1737 is part of the free and 24/7 National Telehealth Service. Set up in 2015, it also operates a number of other services, including the

health advice service Healthline, Quitline

(which provides free services to

help people quit smoking) and lines giving advice on poisons and immunisation. Since

November 2015 Homecare Medical

has run these helplines. With over 450

staff in four contact centres and in home offices – including registered nurses, psychologists, mental health nurses and doctors – the lines receive more than 2,400 contacts a day.

Users of 1737 describe its counsellors as ‘articulate, sensitive and wise’ and ‘the kindest people in the world’. ‘People like me need 1737,’ wrote one user, ‘it’s really helped turn my life and my mental wellbeing around’. Another was grateful

There was phenomenal extra

demand – it was one of the biggest spikes

we’ve ever had

– 30 – – 31 –

that they could text with a counsellor at the weekend when other services were closed.

‘I would definitely use the service again,’ noted another user. ‘Thank you for being there. It really made a difference in my life.’

And Dylan Norton says he’s particularly proud of his team and their response to the Christchurch attacks.

‘I don’t think we could have done too much differently to deliver the best support we could to the community. It’s always really key for us to get feedback, and the feedback we got from people was really positive.’

Top: Melissa Grant, the National Telehealth Service’s service delivery manager – mental health programmes, on a call. Credit: National Telehealth Service

Right: 1737, need to talk?. Credit: National Telehealth Service

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Digital health: power to the peopleDigital innovations in health have the potential to change lives, whether it’s by increasing safety or by improving patient outcomes through 21st-century solutions.

And one thing’s absolutely clear: these digital health care initiatives aren’t about replacing people in the health care equation. What they will do is free up health workers’ time, energy and commitment to provide even better service to those who need it.

‘A digitally enabled sector will transform health care delivery, it’ll give people the power to better manage their own health and wellbeing and it’ll improve care for all New Zealanders,’ says Shayne Hunter, the Ministry of Health’s Deputy Director-General, Data & Digital.

As an example, Shayne and his team point to the New Zealand Electronic Prescription Service (NZePS). This initiative already helps practitioners manage medicines more efficiently and effectively, while reducing errors and making the health system safer.

What is it all about? NZePS is a secure messaging channel that general practices and pharmacies can use to exchange information about prescriptions electronically.

All pharmacies in the country are now connected to NZePS, as are general practices in

increasing numbers. Some district health boards are also able to securely access the service’s data, helping clinicians make more informed decisions.

Whāngārei pharmacist Shane Heswall, a big fan of innovation, says the secure electronic prescription service improves outcomes for both patients and pharmacy staff. He says NZePS prescriptions are more accurate and quicker and easier to dispense, so the wait time for patients is shorter.

Previously, if a practitioner faxed through a prescription for non-controlled drugs, they had to send the original to the pharmacy afterwards. But that requirement no longer applies, provided the barcoded prescription is scanned and downloaded from NZePS. At a busy pharmacy, that’s a real time-saver.

‘Under the old system, the fax wasn’t a legal document so you had to wait for the original to be sent from the GP and match it all up,’ says Shayne. ‘We were charging a fax fee, because it took hours of time to meet legal and audit standards. So, that’s gone. Now you’ve got NZePS,

and it’s legal, downloaded, encrypted, and there’s

no fax fee to the patient.

‘It’s time and motion solved via IT enablement. Brilliant!’

He says NZePS

saves his pharmacies

time and his patients money.

‘There’s no downside – it’s very innovative.’

In 2019, the Ministry’s also trialled MyMeds, an app for digital devices such as smartphones that draws on NZePS data. It’s designed to display the medicines dispensed to a patient, with links to patient information leaflets.

‘People should be in charge of their own health information,’

It’ll give people the power to better manage

their own health and wellbeing.

– 32 – – 33 –

says Jon Herries, group manager, emerging health technology & innovation. ‘We want to help them take more control of their health care.’

Jon says digital initiatives like MyMeds can let technology do what it does best in terms of repetitive tasks, while giving clinicians more time to care for people.

If a patient changes provider, they can use the app to show their new provider a record of their medicines on their phone, reducing risks to safety. Jon says the app will also be useful when travelling.

‘It enables any treating health professional to easily access a

trusted current list of medicines for the people they are caring for,’ says Andi Shirtcliffe, chief advisor pharmacy.

MyMeds is a proof-of-concept app. It allows the Ministry to test if it is possible to create a secure, reusable digital health identity that gives people access to their own health information, initially the medicines, and allowing them to engage with a range of digital services.

Other options that could be added in the future include providing information on immunisations or allergies, medicine recall notifications and reports on side effects.

Jon says one digital heath

goal is to give New Zealanders a complete picture of their health information, helping them to keep well. They’ll be able to control their information and choose who they share it with securely.

‘There are so many opportunities. Work is ongoing but MyMeds is shaping up as a way to demonstrate what’s possible if everything comes together.’

Top: Andi Shirtcliffe, the Ministry’s chief advisor pharmacy, and Jon Herries, group manager, emerging health technology & innovation, check out the MyMeds app

– 34 –

Digital hospitalsHospital patients using voice-activated technology to call a nurse; outpatients checking in at a touchscreen kiosk; seeing a specialist remotely from the comfort of your own home – these are just a few of the innovations district health boards (DHBs) are adopting to improve health outcomes and make life easier and better for both staff and patients.

Canterbury DHB has been trialling a voice-activated patient request tool at Burwood Hospital. It’s the first use of such a tool in New Zealand and only the second in the world.

Similar to ‘smart speakers’, which allow users to ask for a weather forecast or change the TV channel, the DeloitteASSIST devices can recognise specific requests, such as for help to use the toilet or for a glass of water. The system prioritises requests and sends them to a tablet at the nurses’ station.

Burwood Hospital General Manager Dan Coward says the system makes things quicker and simpler for both patients and nurses.

‘Nurses responding to a request will have a better idea of what the patient needs and be able to come prepared, rather than responding to a call

bell, then having to go off to get what’s needed before returning to the patient.

‘We’re excited to be part of this pilot, which uses technology to help patients get the support they need sooner.’

To lighten what might be a difficult day, patients can also request music, weather

forecasts and even jokes from the device.

Over at the Christchurch

Health Precinct, touchscreen check-in kiosks make arrival at their clinics

easier for outpatients.

After scanning the barcode on their

appointment letter – much like checking in for a

flight – outpatients are directed to the correct floor and waiting room.

‘Our patients’ time is valuable, so we mustn’t waste it,’ says Canterbury DHB’s chief digital officer Stella Ward. ‘Digital solutions such as kiosks reduce queuing, help the patient feel more in charge and streamline

our appointment processes.’At Waitematā DHB, a raft

of innovations make up the Leapfrog programme, which won the Business Transformation through Digital and IT category of the NZ CIO Awards in mid-2019.

Leapfrog fast-tracks digital projects that will make a big impact quickly. It’s helped DHB staff reduce the amount of time they spend on administration – giving them more time to focus on caring for patients.

One project is eVitals, where nurses can enter a patient’s vital signs in an iPad mini at the bedside. Not only does this approach eliminate the need for paper charts, which sometimes were difficult to read or got lost, it also makes patient data easily available to the health professionals who need it.

Paper is a thing of the past with eReferrals, an electronic patient referral system that replaces paper forms. It allows hospital clinicians and general practitioners to quickly refer patients, confirm that referrals have been made or get an instant picture of a patient’s referral history, saving time and avoiding mistakes.

Telehealth is another

Our patients’ time is valuable, we mustn’t

waste it

– 34 – – 35 –

Leapfrog innovation that’s making life easier and health care more convenient for patients. Instead of travelling to see a specialist, patients can have a consultation via video link. Trialled by selected departments since late 2018, Telehealth has been so successful that it’s expected to be rolled out more widely.

One person who’s benefited from the innovation is 75-year-old Richard Harris of Wellsford, a survivor of three heart attacks and a quadruple bypass. He’s avoided the 142-kilometre round trip to North Shore Hospital for his regular check-ups by having Telehealth appointments instead.

Although he doesn’t have a computer, he’s used one at Te Ha Oranga clinic in Wellsford, just seven minutes from his house.

‘No travelling and no waiting around. It was an easy option for me,’ he says.

CEO of Waitematā DHB, Dr Dale Bramley, says these innovative digital initiatives help the DHB achieve its two main priorities of maximising community health outcomes and giving patients and families the best possible experience.

‘This kind of thinking ticks both boxes and helps us, as the largest DHB in the country, to keep pace with the expectations of a fast-growing and digital-savvy population.’

Top: A Burwood Hospital nurse, right, with orthopaedic rehab patient Neil Milne during testing of the new voice-activated patient call system. Credit: Canterbury DHB

Right: Gaye Meffan makes use of one of the new self-check-in kiosks before her outpatients appointment at the Christchurch Health Precinct. Credit: Canterbury DHB

– 36 –

Greening the health sectorA guide on sustainability and the health sector, which the Ministry of Health launched in mid-2019, encourages organisations to go green, cut carbon emissions and implement sustainable practices.

The health sector is responsible for an estimated 3 to 8 percent of carbon emissions, making it the public sector’s largest emitter. Yet several district health boards (DHBs) are already making great strides towards sustainability.

In 2016 Northland DHB began measuring its carbon footprint and set a goal of reducing emissions by 15 percent by 2025. It’s well on track to get there, after achieving a reduction of 10 percent in the first two years.

One big win is that all three of the district’s hospitals have gone fully electric by converting all diesel boilers to heat pumps. Transport is another important focus.

‘We cover a large geographical area, so we’ve got a lot of transport going around,’ says sustainability development manager Margriet Geesink.

To help lower carbon emissions from its fleet, Northland DHB has bought seven electric vehicles. That’s been a good start and it’s now working to reduce travel overall.

‘Our videoconferencing use is increasing substantially, which means a lot less travel. We also have more versatile tools and increased support for this growth,’ says Margriet.

For shorter trips, staff are encouraged to use the bikes and e-bikes that the DHB has added to its fleet.

‘The uptake has been good.

You always have the really keen cyclists, but there are also a few nurses in districts like Kaitāia that use them now for their work around town and for patient visits in the area.’

Margriet says measuring emissions is ‘such a good tool, giving us insights into the impact of different areas, so we can make decisions and a plan based on that’.

In Hawke’s Bay, the DHB developed a Go Well travel plan to improve access to health care, promote exercise and reduce emissions. Since 2015, that’s seen a big increase in patients, visitors and staff using public transport to get to Hawke’s Bay Hospital.

Previously, those heading for the hospital had little choice other than driving. Now, a Napier–Hastings express bus stops at the hospital, and bus trips are free for outpatients and caregivers. Between 2016 and 2017, patients’ use of buses doubled.

Staff bus trips are also subsidised, and the timetable has been adjusted to fit with staff coming on and off shift.

Staff who carpool can access free parking spaces, and bike parking and maps for cyclists and walkers encourage staff and patients to get active.

Another health organisation with a strong commitment to sustainability is Canterbury

– 36 – – 37 –

DHB. In 2018, Canterbury received an Enviromark award as one of New Zealand’s top 20 reducers of carbon emissions.

It followed that up by achieving Energy-Mark gold certification for energy management in 2019, becoming only the second New Zealand organisation to reach this top level.

‘We’re really proud of that,’ says the DHB’s energy manager, Tim Emson.

Canterbury’s hospitals at Hillmorton and Burwood replaced ageing coal-fuelled boilers with boilers that burn woody biomass, considered carbon-neutral.

Coal is still the DHB’s main source of emissions, accounting

for 50 percent of the total, but that’s set to change. Drawing on lessons learnt from the two other hospitals, the new Christchurch Hospital Energy Centre – currently in design

phase – will also fuel its boilers with sustainably

produced woody biomass rather

than coal. Christchurch

Hospital uses almost 12 times as much fuel as Hillmorton, and

more than four times as much

as Burwood, so the potential savings in

emissions are great. ‘It’s a big step forward,’ says

Tim, ‘and it’s now a proven technology.’

That just leaves Ashburton Hospital using coal – and a programme is in place to replace those boilers with heat

pumps. Heat-pump technology has advanced to the stage where it can produce the 80-degree water the hospital needs.

‘With the heat pumps at Ashburton and the biomass here, we won’t be burning any coal in a few years’ time.’

That’s good news for the DHB – and for the planet.

Top: Northland DHB staff on their electric bikes – from left, sustainability development manager Margriet Geesink, mental health services service development manager Joe Crowley and chief medical officer Michael Roberts. Credit: Northland DHB

Left: Tim Emson, Canterbury DHB energy manager. Credit: Canterbury DHB

Northland DHB began measuring its carbon footprint and set a goal of reducing

emissions by 15 percent by 2025.

– 38 –

‘Anything is possible’Around New Zealand, great services and pockets of innovation demonstrate ways to transform the health system so people with disability and their families and whānau can control the supports and services they access.

As key partnerships between the disability sector and government agencies, Enabling Good Lives (EGL) and Mana Whaikaha are at the forefront of that charge for change.

Both programmes are underpinned by the EGL principles of self-determination, beginning early, ordinary life outcomes, mainstream first, mana enhancing, easy to use and relationship building.

All of these ideas make Ministry of Health Deputy Director-General Adri Isbister genuinely excited about the future.

‘At the moment, we’re trialling these programmes in different parts of the country and monitoring the outcomes they’re delivering – and we’re already seeing real positives,’ Adri says.

‘These pilots can reinforce that working together with disabled people and communities isn’t window washing – it’s something that delivers better outcomes for people. We’re genuinely committed to embedding this

into everything we do.’At EGL in Christchurch, that’s

echoed by a team working with young people leaving school.

‘Our school leavers now have more self-determination than ever, and we’re privileged to be part of the journey,’ says EGL lead Hannah Perry.

‘The mana of our young people and their

families is enhanced.

They’re pursuing outcomes that contribute to a good life for any young

person. They’re

engaging in further education,

beginning careers, moving out of home, building friendships and relationships, having fun and learning skills.’

As if that isn’t enough, Hannah and the crew have a special showcase to look forward to each year: the annual Next Steps expo. This collaborative event runs on an impressive $0 budget.

‘The highlight of Next Steps is always the people who run their own businesses,’ says Hannah. ‘We had 11 social enterprises present this year, including

DJ Ramanui (who gigged at a Canterbury Charity Hospital event) and artist Harini.’ To find out more, search for DJ Ramanui on Facebook and Harini’s ‘colour explosion’ website.

Having choice and flexibility gives people with disability the building blocks they need for a good life.

Briar and Hazel Elliott are part of EGL Waikato, a demonstration set up to do disability support differently.

They flat together in Hamilton and, with the support of their mum Jude, lead full and busy lives.

For the past three years, Hazel and Briar have taken control of their disability support through a personal budget. Jude, who lives in another area, helps her daughters employ people who they want to spend time with and who have similar interests or skills that are important to them. Before now, Briar and Hazel received home-based disability supports from service providers and attended a day service five days a week. They were bored and found their supports inflexible and unmotivating.

Jude describes the change: ‘It’s been a huge

transformation. It’s gone from the girls being passively involved in a programme with limited choices, to being able to make

These pilots can reinforce that

working together with disabled people and

communities isn’t window washing

– 38 – – 39 –

their choices about what they want to do in life and what’s got meaning to them. There’s a sense anything is possible.’

Hazel and Briar now volunteer every week at the SPCA and are valued members of the team there. They attend the university gym, working with a personal trainer, and are fitter and healthier as a result. They enjoy a weekly time at Riding for the Disabled and go to a range of places and events in the Hamilton community, which includes going to their local to enjoy a cider. They’re currently learning to snorkel, so they can achieve a life-time goal of swimming with manta rays next year.

‘It’s opened up life. It’s incredible with my two daughters, what their lives are like in comparison,’ says Jude.

Hazel and Briar agree. ‘We love EGL. We have the freedom to do anything we want basically, within reason. We live together in our own place and we love it.’

Right: Harini Weeratunga, ‘Art has allowed me to communicate my ideas and gives me a sense of pride and accomplishment. I am always trying new ideas ... this is an ongoing journey of expansion and expression that I am really excited about.’

Credit: Aruni Weeratunga

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