public board meeting · 1.8.1 communications memo 111 1.8.2 vip programme 114 1.8.3 national health...

Public Board Meeting

Meeting Date: February 2020

Meeting Time: 9:30am

Venue: Board RoomCSSB BuildingWairarapa DHB

2020 02 27 Wairarapa Board Meeting PUBLIC - Agenda

1

Wairarapa District Health Board

Government Priorities 2019/20“Improving the wellbeing of New Zealanders and their families“

Improving child wellbeing Improving mental wellbeing

Improving wellbeing through preventionBetter population health outcomes

supported by a strong and equitable public health and disability system

Strong fiscal managementBetter population health outcomes supported by primary health care


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AGENDAHeld on 27th February 2020

Lecture Room, CSSB Building, Wairarapa DHB, MastertonCommencing at 9:30am

BOARD PUBLIC SESSIONItem Action Lead Minute Time PG

1. Procedural Business

1.1 Karakia

20 9:30am

5

1.2 Apologies Accept

Chair

1.3 Interest/Conflict register Accept Confirm 6

1.4 Previous Minutes Accept Confirm 8

1.5 Previous Actions Accept Confirm 11

1.6 Draft 2020 Board Work Plan Accept 12

1.7 Chairperson Report Verbal

1.8 Chief Executive Report Note D Oliff 13

2. Consumer Story VerbalM Thomas

C Matthews15 9:50am 15

3. Presentation

3.1 Regional Public Health Population Receive P Gush 15 10:05am 254. Visit

4.1 Older Persons’ Services – Lyndale Villa Receive M Leighton 40 10:20am

Morning Tea 11:00am

5. Discussion

5.1 5 Equity Priorities Update Receive D Oliff 25 11:30am 30

5.2 Māori Health Receive J Kerehi 5 11:55am 38

5.3 Finance Report Receive F van Ham 5 12:00pm 41

5.4 People & Capability Receive S McKay 5 12:05pm 65

6. Information

6.1 Quality, Risk & Innovation Quarterly Report Receive D Oliff 5 12:10pm 69

6.2 Planning & Funding Receive S Williams 5 12:15pm 83

6.3 MHAIDs Update Receive N Fairley 5 12:20pm 88

6.4 Hospital & Community Services Receive K McCann 10 12:25pm 937. Other

7.1 General Business5 107

7.2 Resolution to Exclude the Public Agree Chair


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8. Committee Minutes

8.1Community & Public Health Advisory Committee December 2019 Receive 108

Lunch 12:40pmDate of next meeting: Monday 30th March 2020

Appendices# Item PG

1.8.1 Communications Memo 1111.8.2 VIP Programme 1141.8.3 National Health Advisory Updated 1231.8.4 Faculty of Dentistry 1256.3.1 Guide to MHAIDs service for Board Members 1366.4.1 Planned Care Performance 148


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Wairarapa District Hutt Board

Karakia

Tuia ki runga,

Tuia ki raro

Tuia ki roto,

Tuia ki waho

Ka rongo te ao,

Ka rongo te pō

Haumi e, Hui e

Taiki e

---------------Unite aboveUnite below

Unite withoutUnite within

Listen to the nightListen to the world

Now we come togetherAs one.

2020 02 27 Wairarapa Board Meeting PUBLIC - Procedual Business

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Updated: 2020-02-20 1

Wairarapa Board INTEREST REGISTER

Name Interest

Sir Paul CollinsChair

∑ Director of: Active Equity Holdings Limited (Chair)Hurricanes GP LimitedIdes LimitedShott Beverages LimitedTechnical Advisory Services Limited

∑ Director and shareholder of: AEL Managers LimitedBeverage Holdings LimitedCohiba Traders LimitedEcopoint LimitedTofino Trustee Limited

∑ Member of shareholders Review Group for New Zealand Health Partnerships Limited∑ Trustee of the Malaghan Institute of Medical Research∑ Member to Governance Board for Health Finance, Procurement & information Management

System Programme (FPIM)

Dr Tony BeckerDeputy Chair

∑ Shareholder and Director (Clinical) Masterton Medical Limited∑ Shareholder and Director Wairarapa Skin Clinic∑ Wife contracts to Wairarapa District Health Board∑ Trustee, Hau Kainga∑ Member Alliance Leadership Team

Mrs Leanne SoutheyMember

∑ Chair, Wairarapa District Health Board, Finance Risk & Audit Committee∑ Chair of Lands Trust Masterton (15 February 2016)∑ Director, Southey Sayer Limited∑ Chartered Accountant to Health Professionals including Selina Sutherland Hospital and Selina

Sutherland Trust∑ Trustee, Wairarapa Community Health Trust∑ Shareholder of Mangan Graphics Ltd∑ Member of UCOL Council

Mr Ronald KaraitianaMember

∑ Member, Wairarapa District Health Board∑ Member, Wairarapa Te Iwi Kainga Committee∑ Member, Wairarapa District Health Board, Finance Risk & Audit Committee∑ Akura Lands Trust Chairman∑ Extended family members work in varying roles at DHB∑ Chair of WrDHB Hospital Advisory Committee∑ CE Te Hauora Runanga o Wairarapa∑ RK Consulting Ltd, Business owner∑ Whanau ora Collective Member Te Hauora and Whaiora via Te Pou Matakana

Helen PocknallMember

∑ Contractor with Ministry of Health

Ryan SorianoMember

∑ Community Coordinator for FOCUS, Disability Support Services at Wairarapa DHB∑ Member, Board Trustee for Saint Patrick School Board, Masterton∑ Wife Employed as Senior Caregiver at Lansdowne Park Aged Care Facility

Joy CooperMember

∑ Chairperson Wharekaka Trust Board Incorporated


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Updated: 2020-02-20 2

Norman GrayMember

∑ Association of Salaried Medical Specialists (ASMS) Branch Representative for Wairarapa∑ Emergency Consultant and Clinical Lead, Wairarapa DHB∑ Member, Mid Central DHB

Jill StringerMember

∑ Director, Touchwood Services Limited∑ Husband employed by Rigg-Zschokke Ltd

Yvette GraceMember

∑ General Manager, Rangitāne Tu Mai Rā Treaty Settlement Trust ∑ Member, Hutt Valley District Health Board ∑ Husband is a Family Violence Intervention Coordinator at Wairarapa District Health Board ∑ Sister-in-law is a Nurse at Hutt Hospital∑ Sister-in-law is a Private Physiotherapist in Upper Hutt

Jill PettisMember

∑ Nil Interests declared


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Wairarapa DHB December 2019 Board Meeting Page 1 of 3

Minutes: Kadeen Williams , Board Secretary

Held on 16th December 2019Lecture Room, CSSB Building, Wairarapa Hospital, Masterton

Board Meeting Public

Board Members PresentSir Paul Collins Board ChairDr Tony Becker Deputy ChairLeanne Southey MemberRon Karaitiana MemberDr Norman Gray MemberJoy Cooper MemberHelen Pocknall MemberRyan Soriano MemberJill Stringer MemberJill Pettis MemberApologiesYvette Grace MemberExecutive Leadership Team PresentDale Oliff CEO WrDHBChris Stewart Executive leader Quality, Risk & InnovationSusan Flavin Acting Executive Financial OfficerKieran McCann Executive Leader, OperationsSandra Williams Acting Executive Leader, Planning & PerformanceMichele Halford Director NursingAnna Cardno Communication ManagerJason Kerehi Executive Leader Maori HealthShawn Sturland Chief Medical Officer

1. Procedural Business

1.2 Apologies As noted above

1.3 Minutes from previous meeting: November 2019

∑ The Board RESOLVED to approve the minutes of the Members’ (Excluded) meeting held in September 2019 as a true and accurate record of the meeting.

∑ Minor changes with spelling and words to be updated

Moved L.Southey Seconded R. Karaitiana Carried

1.4 Action Items Register

∑ All actions completed and updated

∑ Check spelling with names

1.5 Interest/Conflict Register

∑ The Board NOTED that a number of changes to the interest register were declared in the meeting and to be sent through to the Board Secretary for updates

∑ The Board CONFIRMED that two matters (including matters reported to, and decisions made, by the Board at this meeting) that require disclosure and that there would be an opportunity to declare any conflicts prior to discussion on each item of the agenda


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1.6 Chairperson reports

a. No update

1.7 Chief Executive Reports

The report was taken as READ

NOTES this paper and discusses as appropriate

The Board:

∑ NOTED Welcome to the new Board Members

∑ NOTED PHO collaboration for specific projects and getting a better relationship. Quarter one GPS, PHO and DHB collaborative work on ED projects

∑ NOTED Quarterly Senior Leadership session held with Leaders where we discuss the wider healthcare system in the Wairarapa

∑ NOTED 3DHB have agree to extend the consultation period of the MHAIDs Consultation. Wairarapa will have local leadership with Clinical input

∑ NOTED There are some vacancies within the dental department for Wairarapa however recruitment effort is being made through direct contact with Otago University

∑ NOTED Immunisation, percentage rate for Maori at 6months is a concern for a Board member. This is part of the

ACTION D.Oliff Further details to be provided to the Board on statistics of the Dental bus

D.Oliff Further information for Māori six month immunisation rates to be provided from the PHO

2 Patient Story

The Board received a VERBAL update from C.Stewart for the Patient Survey

∑ NOTED No update at the December meeting

3 Decision

Wairarapa DHB 2019/20 Tobacco Control Plan



The Board:

∑ NOTED Updates to address equity concerns raised at November 2019 Board meeting have been made

∑ NOTED The Board liked the approach and noted that this is similar to the Pacifica style to become more inclusive and addresses the barriers and intimidation of the “corporate” environment

∑ NOTED The project team are looking to multiple areas to assist with addressing the tabacco plan which will provide a good foundation to move forwards

∑ AGREED to the key focus areas of kainga & hapūtanga, Māori health promotion and equity

∑ ENDORSE the 2019/20 Tobacco Control Plan.

Moved R.Karaitiana Seconded J.Stringer Carried

ICT Cloud Services




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The Board:

∑ NOTED The Wairarapa Executive Team have endorsed the Cloud Services

∑ NOTED Due diligence will be completed on preferred provider and data to be used

∑ NOTED Further discussions on “social license” and guidance for where the information is to be kept will occur. Currently we do not have permissions to put information on the “Cloud”. Guidance from Ministry will provide clarity from a National scale

∑ NOTED Costs have been considered and accounted for within budget

∑ NOTED Letter T.Voice received from Ministry regarding the Government and Ministry’s position on use of public cloud services

∑ AGREED The use of cloud computing subject to the right security and privacy assessments which will require Digital and Data Intelligence Governance Group signoff

Moved J.Stringer Seconded H.Pocknall Carried

5. Other

General Business

∑ No further updates

Resolution to Exclude the PublicSUBJECT REASON REFERENCE

Public Excluded Minutes For the reasons set out in the public Board agenda

Chief Executive’s report

Information contained in the paper may be subject to change as the information has not yet been reviewed by the FRACPaper contains information and advice that is likely to prejudice or disadvantage negotiations

Section9(2)(f)(iv)Section 9(2)(j)

CostPro Upgrade Project Any department or organisation holding the information to carry out, without prejudice or disadvantage, commercial activities

Section 9(2)(i)DRAFT 2020 Schedule

DRAFT 2020 Workplan

Wairarapa Executive Introductions

Protect the privacy of natural persons, including that of deceased natural persons

Section 9(2)(a

CPHAC Minutes 2019 Sub Committee Excluded Minutes Section 9(2)(j)

Correspondence Commercially sensitive information Section9(2)(i)

Moved Sir P.Collins Seconded R. Karaitiana Carried

Meeting Closed: 1:05pm

CONFIRMED that these minutes constitute a true and accurate record Dated Thursday 27th February 2020

Sir Paul CollinsChair, Wairarapa District Health Board


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PUBLIC WrDHB MEETING ACTION

Wairarapa DHB Excluded Action Register# Lead Action How Dealt with Completed Date

1. D Oliff Further details to be provided to the Board on statistics of the Dental bus

Information included in the February CEO Report February 2020

2. D Oliff Further information for Māori six month immunisation rates to be provided from the PHO

Further details to be included in PHO Report at March 2020 Board Meeting


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Updated: 6/02/2020 7:54 p.m.

Wairarapa DHB Work Plan 2020

Financial Quarter 3 Financial Quarter 4 Financial Quarter 1 Financial Quarter 2

27th

January27th

February30th

March28th

April25th

May26th

June27th

July31st

August28th

September27th

October30th

November14th

December

Dec

isio

n

Draft AP and Budget

FunderCommitments

National Agreements & Negotiations

National Agreements & Negotiations

Draft 2019/20 Report

Final Annual Plan 2019/20

MHAIDs Consultation

DocumentFinal Draft AP Food and

Catering ContractFinal Financial Plan 2019/20

3DHB Sub Regional Pacific

Health & Wellbeing

Strategic Plan 2020/25

Dis

cuss

ion

Draft Annual Plan 2020/21

Draft Financial Plan 2020/21

Māori Health ICT Reporting Māori Health Pacifica Health ICT Reporting Māori Health Pacifica Health ICT Reporting Māori Health Pacifica Health

“5” Equities Update

Consumer Council Clinical Board Iwi Kainga Consumer

Council Clinical Board Iwi Kainga Consumer Council Clinical Board Iwi Kainga Consumer

Council

Pres

enta

tion

Regional Public Health

Population

Primary Health Care

Public Health Organisation


Population

“5” Equities Update

Public Health Organisation


PopulationMidwifery Public Health

OrganisationFamily Violence & Partner Abuse


Population

Visi

ts Older Persons’ Services

Lyndale Care

Allied Health Services

Nicky RiversWhaiora Marae

Mental Health Acute Respite &

Community Services

Palliative Care & Hospice

Carter CourtMarae Maternity &

Pediatric ServicesSelina Sutherland

Hospital Taku Wahi WrDHB Executives

Regular public monthly items:Chair report CEO report Hospital & Community ServicesFinance Resolution to exclude the public People & CapabilityQuality & Risk Patient Story Planning & Funding


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PUBLIC

Wairarapa District Health Board Page 1 of 2

BOARD INFORMATION PAPER

Date: January 2020

Author Dale Oliff, Chief Executive Wairarapa District Health Board

Subject Chief Executive Public Report to the Board

RECOMMENDATION It is recommended that the Board:a. Notes this paper and discusses as appropriate

APPENDICIES1. Communications update January 20202. Violence Intervention Programme3. Coronavirus National Health Advisory Update 7th February 20204. Faculty of Dentistry December 2019

1 PURPOSE

The purpose of this paper is to provide the Board with updates from across the hospital and wider Wairarapa Health Community. It highlights work that is occurring at the District Health Board

2 WAIRARARAPA DISTRICT HEALTH BOARD 2020

The Wairarapa District Health Board has started 2020 with great momentum and future planning for providing a health service to the Wairarapa Community. The Teams have been working on the Strategic Plan, following the town hall session late 2019. The Annual Plan and Budgets are also in transit to be presented to the Board at the March or April meeting.

3 COMMUNICATION

We have provided a brief outline of the media coverage of interest through appendix 1.

Coronavirus

While we have had no confirmed cases of the Coronavirus in New Zealand we are keeping a close eye on the International circumstances. From Thursday 30th January 2020 any person who requires services relating to a notifiable disease (or quarantinalbe disease) is covered as part of the publicly funded health services. Further details have been provided under appendix 3 from the National Health Advisory Update 7th February 2020. The Regional Public Health team presenting to the Board will be able to provide further details regarding this.

Violence Intervention Programme (VIP)

We have provided the Violence Intervention Programme Evaluation: 2018/19 for your information under appendix 2 of this report.

The Ministry of Health (MoH) programme seeks to reduce and prevent health impacts of violence and abuse through early intervention, assessment and referrals. The report shows an increase with Delphi self-audit and exceeds targets for system developments through 2019.

I would like to acknowledge the VIP team for contributing to the Wairarapa evaluation results.


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PUBLIC


Dentistry student note with Maori and Pacific oral Health Providers

Professor John R Broughton spent five weeks at the end of 2019 in Masterton and has expressed that it was a great experience. Professor Broughton worked with Whaiora Runanga O Wairarapa and Dr Kevin Wong to enhance experience in restorative and extraction dentistry. We see this as a great piece of advertising for the wider Wairarapa Community and one of the great advantages we would like to push; Wairarapa is a great destination for training and offering opportunities to Health Professionals. We have included the full newsletter for your information as appendix 4.

4 UPDATES

Dental Bus

The Wairarapa District Health Board will be in a position to replace two dental buses and purchase a new mobile bus to work with our rural communities towards developing our neighbourhood services.

Immunisation rates

Primary Health will be presenting to the Board at the March meeting to provide further details regarding the Boards request for further details around the Maori six month immunisation rates.


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Consumer Improvement

Presented by:Michelle Thomas, Director of Midwifery & MQSP CoordinatorClare Matthews, Patient Experience Coordinator

2020 02 27 Wairarapa Board Meeting PUBLIC - Patient Story

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Situation• 20yr old Māori wahine miscarried (15 weeks)

• Presented to the Emergency Department 5th

February and admitted overnight

• Discharged 6th February to return the following day

• 7th February informed that there was tissue but further scans required

• Follow up resulted in gynaecologist appointment 8th February and plan organised


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Consumer Concerns

• No self-care plan

• Confined to home for two days and unsure what to do

• Information on expectations and cause for concern

• Isolated with no medical support

• Grieving the loss of her baby while still carrying ‘tissue’


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WrDHB Actions

• MQSP Coordinator lead a project for change

• Difficulty with supporting women experiencing miscarriage

• Project team developed with representation from a Consumer, Maternity, Maori Health Directorate, Social Work, Obstetrics/Gynaecology and Emergency Department


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Early Miscarriage Themes2020 02 27 Wairarapa Board Meeting PUBLIC - Patient Story

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Environment & Pathway

• Process for immediate point of contact for triage, consultation, plan of care and support

• Appropriate assessment environment

• Referral pathway for Health Staff

• Community support and shared information


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Outcome• Referrals for triage with all non-urgent cases

(urgent to ED)

• 3DHB Health Pathways referrals updated

• Ability to phone women, plan care and options following consultations

• Option for women of expectant / medical / surgical treatment

• Guidelines drafted for early bleeding in pregnancy and miscarriage management


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Consumer Leaflet2020 02 27 Wairarapa Board Meeting PUBLIC - Patient Story

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Impact

• Women feel cared for, supported and heard

• Women have the option of medical management and miscarrying supported at home with whanau

• Follow up care

• Reduction in the number of D&C’s being undertaken as a result of early management


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Feedback Received

“OMG that is so gorgeous makes me cry with joy

xxx”

Thank you for your care!

“This is a crappy situation to be in and

it’s extremely heartwarming to know there is someone like

you there to assist in a time like this. I don’t

know what I otherwise would have done.”


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PUBLIC

Chief Executive Report to Board February 2020 1

WRDHB BOARD PAPER

Date: 18 February 2020

Author Peter Gush, General Manager, Regional Public Health

Endorsed By Dale Oliff, Chief Executive, Wairarapa District Health Board

Subject Regional Public Health Board Update

RECOMMENDATION It is recommended that the Board:

Notes this update and discusses as appropriate

1. Purpose

This paper provides an overview of the Coronavirus (COVID-19) situation and an update of recent activity within Regional Public Health.

2. COVID19 Update

The current situation regarding preparedness for Coronavirus (COVID-19) provides information on the accountabilities for leading New Zealand through the virus.

Risk Assessment

The World Health Organisation’s (WHO) risk assessment of the COVID-19 situation is: very high in China; high at the regional level; high at the global level.

ESR (Crown Science Research Institute) published a risk assessment summary for 18 February 2020 and has determined:

∑ Importation risk: with the containment measures in place in mainland China and the border measures currently in place for arrivals from mainland China, the likelihood of one or more cases being imported into New Zealand from China remains HIGH.

∑ Given our geographic accessibility to other countries where there are confirmed cases but only limited transmission and considering the varied public health capacity amongst other countries, the likelihood of one or more cases being imported to New Zealand from outside of China is currently LOW-MODERATE. However, if transmission increases outside of China, the importation risk for New Zealand will need to be reassessed.

∑ Transmission risk: Based on the current situation outside of mainland China and on the available evidence, including limited evidence of pre-symptomatic spread and super spreader events the likelihood of limited transmission in New Zealand is HIGH, the likelihood of sustained transmission is MODERATE and the likelihood of widespread outbreaks is LOW. This assessment assumes that cases are detected in a timely manner and that infection prevention and control measures are implemented promptly.

∑ Public health impact: The impact on the sector and the public from this emerging issue and preparedness work for COVID-19 is already significant. The public health impact of one or more cases in New Zealand would be HIGH both for public health staff, the wider health sector and the community.

2020 02 27 Wairarapa Board Meeting PUBLIC - Presentation

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PUBLIC


∑ Public health risk: Given the assessment of the likelihood of importation, the likelihood of transmission in New Zealand and the public health impact, the overall public health risk from this event is considered HIGH.

Outbreak Situation

As of 18 February 2020, there are no confirmed cases of COVID-19 in New Zealand. The Ministry of Health Situation Reports continue to emphasise that it (the Ministry) is the “single point of contact” regarding COVID-19. The Ministry website is updated daily with amended information and advice; https://www.health.govt.nz/our-work/diseases-and-conditions/novel-coronavirus-2019-ncov

National Response

The Ministry is operating the National Health Coordination Centre (NHCC) and is the lead agency, and have skilled and experienced incident controllers. It is their role to determine when the current level of response is revised to escalate or de-escalate. They work with other Agencies across Government to agree what changes may be required to current practises to protect the people in New Zealand. This includes a wide range of activities to protect our borders and screen and manage communities that may be at risk.

The Ministry is continuing to work with border agencies to ensure recent arrivals from mainland China are provided with health information and are aware of the need to self-isolate for 14 days and register with Healthline.

Passengers have the opportunity to discuss any concerns with public health staff at the border. Most arrivals are already aware of the need to self-isolate and have strong knowledge of the virus overall. There's been an encouraging response to the Healthline self-isolation register. As at midnight 17 February 4,561 people registered as being in self-isolation. The Ministry is leading the manual identification of all people who have arrived from China to ensure they are in self-managed isolation.

District-wide Response

The District response to COVID-19 is being overseen by an Incident Management Team at Regional Public Health (RPH) supported by Watch Groups at CCDHB, HVDHB and the Wairarapa DHB. The Watch Groups are staffed by clinical leaders, senior managers, and representatives from the infectious diseases services, occupational health, the communications unit, and emergency management.

These teams work closely with:

∑ The NHCC including daily teleconferences and situation reports ensure planning is up to date and complies with national requirements.

∑ RPH to ensure messaging across the health sector and with the public is consistent, and to be prepared to support the care of any cases that may arise. RPH are participating in the regular 3DHBs meetings.

∑ Other organisations with a role in the response to outbreaks – for example border control agencies and civil defence welfare groups.

If the situation escalates a formal incident management team will be established. This will be a joint venture between the three DHBs and RPH and will be led by trained incident controllers from across the three organisations.


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https://www.health.govt.nz/our-work/diseases-and-conditions/novel-coronavirus-2019-ncov

PUBLIC


Key Focus

3DHBs are working on:

∑ The measures needed to manage any local presentations of COVID-19 and the equipment required. ∑ Providing training and advice for frontline staff in hospitals and primary health.∑ Maintaining up-to-date communications with staff, the public and the wider health service

(including primary and private services).∑ Part of the national response being coordinated by the National Health Coordination Centre at the

Ministry.∑ The planning to ensure a well-coordinated response across the greater Wellington region.

RPH activity in response to and preparedness for COVID-19 includes:

∑ Since 7 January we have issued seven Public Health Advisories and two Latest Information Summaries to Primary Care and the wider health sector; these are all available via the RPH website.

∑ Participate in the various daily Ministry teleconferences; DHB’s / Public Health Units / Border agencies.

∑ We have been working closely with our border partners at both Wellington International Airport and Centreport; including multiple briefings for different shifts.

∑ Meet the twice weekly direct flights from Fiji (Wednesday and Sunday), given the potential for this route to be used for travellers from mainland China. Our Health Room at the airport has been checked and restocked with all the appropriate resources we may need.

∑ Working with the hotels we have a Memorandum of Understanding with as potential quarantine facilities; and investigating other facilities that could be used.

∑ Refresher training regarding our border response protocol for staff who are, or could be involved.

Individual District Health Board Response

Our hospitals are being led by local Incident Control teams. These teams are meeting frequently each week to ensure that the teams are well briefed and that resources are available across our provider network and that the health and safety of staff is well managed.

Our position is that standard (or universal) precautions underpin all healthcare workers interactions with patients and in addition to these COVID-19 requires droplet and contact precautions to be used for patient care, and when a patient is requiring high acuity care involving oxygen support (nebulisers, high flow oxygen, non-invasive ventilation), airborne precautions will be added.

3. Greytown Drinking Water Supply

On 19 December 2019 one of our Drinking Water Assessor’s (DWA), visited the Greytown Memorial Park municipal drinking water treatment plant that provides water to approximately 2,600 people in Greytown. Our DWA observed the recently installed Ultra Violet (UV) disinfection reactor (UV reactor, and UV sensor) that will provide consumers with an important barrier against pathogenic protozoacontaminants that might exist in the raw source water.

4. Recreational Water Risks

Significant toxic algae bloom now exists involving the whole region from Otaki, Waikanae, Hutt, Ruamahanga, Waingawa Rivers and notably a very significant bloom involving the Waipoua River through Masterton (now associated with two dog deaths). The response from RPH has involved


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http://www.rph.org.nz/public-health-topics/illness-and-disease/coronavirus-covid-19/

PUBLIC


significant liaison with Wellington Water and Greater Wellington Regional Council (GWRC). Our Health Protection Officer and Medical Officer of Health met with the new GWRC Recreational Water programme lead to discuss the interagency response and recreational sites of concern that require further consideration around investigation and risk communication.

5. Hazardous Substances Notification of Isocyanate Sensitisation in Residence Adjacent To Spray-Paint Business

The follow-up of this notification continues with an interview of the case being completed and an initial meeting with Greater Wellington Regional Council (GWRC) and Worksafe in December 2019. Our Medical Officer of Health has asked the GP to follow-up some further clinical assessment and we have utilised the environmental health contract to seek technical air quality expertise. A meeting is now planned with GWRC air quality scientists and GWRC compliance team to agree the best way forward to determine if there are issues of hazardous substances beyond the boundary of the business. Worksafe has also completed an initial assessment of the spray-paint business processes.

6. School Based Immunisation Programme

With the transition year completed, 2020 will see the first year of the Year 7 Co-delivery programme.

2019 School year, immunisation data.

WDHB Eligible Returned Consented Declined Non returned Immunised

Y7 Boostrix 607 606 496 110 1 482

Y7 HPV D1 599 598 464 134 1 440

Y8 HPV D1 650 643 469 174 7 461

WDHB Eligible Returned Consented Declined Non returned Immunised

Y7 HPV D2 599 598 461 137 1 233

Y8 HPV D2 644 643 463 174 7 437

7. Public Health Nurses In Schools - Top 5 Presenting Conditions

Social Concern

11

Eczema

5

Head lice

12

Behavioural

7

Encopresis

6


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8. Alcohol Special Licence Application for Large Event March 2020

Since opposing the alcohol licence application for a three day rave at Tauherenikau Racecourse, the applicant has met with our staff and addressed the majority of our concerns regarding the need to minimise potential alcohol related harm associated with this event. The final details are awaited before a decision is made whether to withdraw our opposition. Given this event is the first of its kind in this venue, it has been agreed that we will monitor the event.

9. Alcohol Licences Received For December/January

WDHB

11On-Licence

WDHB

3Off-Licence

WDHB

11Special Licence

The number of licence applications received for this period is similar to the last period.

10. Youth Oral Health

In September 2019 one of our Public Health Advisors approached the Wairarapa Oral Health Co-ordinator (WOHC) to offer her support to reduce the DNA rate for students about to turn 18 in the Wairarapa. Our Advisor devised a promotional strategy to offer two free movie tickets to any student about to turn 18 who attended both the appointment and completed any required treatment. The WOHC was motivated to reduce DNA rates for oral health treatment for young people who are about to turn 18 because once they are 18, they are no longer eligible for free treatment; the highest proportion of DNA was amongst young Māori.

The number of young people at the time was approximately 60 and the aim was to reduce this by 50 per cent. Following the promotion via a poster within one month, eight young people had attended an appointment and completed treatment.

Due to the easy uptake achieved through this promotional strategy the WOHC requested our Advisor’s support to design a poster targeted at year 9 students.


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PRIORITY NAME:

WHY IS THIS AN EQUITY PRIORITY:

CURRENT PERFORMANCE:

The prevalence of diabetes is higher in Māori than in non-Māori [provide data ]. Māori are less likely than non-Māori to have a regular diabetes check and are more likely to have poorly controlled diabetes.

Increase the percentage of Māori diagnosed with diabetes who have HbA1c recorded in the past 12 months to equal Non-Māori, Non-Pacific people with diabetes.

Reduce the proportion of Māori with HbA1c >100 and >80 and >64 to equal non-Māori and non-Pacific.

Our longer term goal is to reduce the incidence of diabetes among Māori to equal the incidence among non-Māori and non-Pacific.

Insert stats

EQUITY PRIORITY AREAS IN 2019/20 ANNUAL PLAN

Diabetes: improve diabetes management for Māori.

DESCRIPTION:

Phase 1: Increase the proportion of Māori with diabetes who are receiving regular care in their general practice.

Phase 2: Investigate options for lessening the long-term impact of diabetes on Māori individuals and whanau, through prevention, early detection, and improved glycaemic control in the 5 years following diagnosis.

GOAL / OUTCOME(S) EXPECTED:

C:\Users\SA-BB-~1\AppData\Local\Temp\BCL Technologies\easyPDF 7\@BCL@14C1EA5C\@[email protected] 2/20/20207:00 PM

2020 02 27 Wairarapa Board Meeting PUBLIC - Discussion

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MEASURES:

ANNUAL PLAN/SLM REFERENCE:

ANNUAL BUDGET (per phased workplan)

$8,000

ACTIONS:

Support Whaiora to develop an integrated diabetes care model between the General Practice and Pae Ora Service that can be replicated in other practice during 2020/2021.

Work with the 7 practices to identify options for engaging with Māori who have not had HbA1c in last 12 months.Undertake detailed, anonymised demographic analysis of Māori newly diagnosed with diabetes to identify trends and opportunities for improved care.Develop Te Ao Māori Stanford self-management courses for Māori.

Undertake consultation/co-design hui to identify service gaps and options for service development.

AP diabetes (pg 60). Note: not in SLM

MOH Measures: diabetes management, CVDRA, smoking prevalence, quit rates. Other Measures: CVD risk,



31

ProjectQUARTER 1

Activity

Resources

Budget $

QUARTER 2

Resources

Budget $

QUARTER 3

Resources

Budget $

QUARTER 4

ResourcesBudget $

Ongoing Annual Budget: Not knownDescription:

Diabetes: Improve diabetes management for Māori

$0

2019/20 PHASED WORKPLAN

Establish working group. Undertake data analysis of gaps.

Project Sponsor (Director of Nursing), Project Team members – Lisa Burch, Justine Thorpe, Tu Ora Compass Health analysts

Activity

Support Whaiora to develop an integrated diabetes care model between the General Practice and Pae Ora Service that can be replicated in other practice during 2020/2021.

Provide .2FTE secondment to Whaiora practice nurse to work alongside Diabetes CNS from March 2020 until March 2021

$0

Activity

Undertake NHI level analysis of Māori missing HbA1c or no consult in previous 12 months.

Data match between “missing patient list” and DHB records (CNS, ED outpatient, allied health, FOCUS).Communication with practices developing year 2 Healthcare Home Plans re Māori with diabetes (in particular those who are not well engaged in care) being a focus for year of care plans.Identify the extent to which current diabetes and LTC funding streams are supporting equity objectives.Discussions with Whaiora to better understand their diabetes project.Refine project plan according to above.

Project Sponsor (Director of Nursing), Project Team, Whaiora/Pai Ora team, Community Health Diabetes CNS

Implementation of any contractual changes as appropriate.

$0

Project Sponsor (Michele), TOCH data analysts, Project Manager (Person X), TOCH Practice Support, Project Team members.

Project Sponsor (Director of Nursing), Project Team

Total Annual Budget $0

TBC

Consultation hui (x4)



32

The first 1000 Days

The period from conception until a child’s second birthday, have a far-reaching impact on their health, educational, and social outcomes. We rank poorly compared to other high-income countries against several key measures of child health and

wellbeing, and our rate of public spending on our tamariki is fairly low, despite evidence that prevention and intervention strategies, especially culturally driven programmes in early childhood – work

extremely well


33

ApproachUtilising hapū wānanga as a comprehensive child health coordination service that engages the mother and her whānau from conception through to the first thousand days of a child’s life is the best start in life. The hapū wānanga includes cultural activities, health promotion, health education, social support, ante-natal education, and early intervention. The value proposition is embedded in its comprehensive nature which greatly improves access for mothers to be and their whānau, to high quality advice, support, or treatment when they need it


34

Approach cont

Hospital admissions per year for grommet insertions among Māori children (at a rate 79% higher than

non-Māori) and admissions per year for serious skin infections (with the

rate 2.4 times that of non-Māori children

Half of Wairarapa Māori children aged 5 years and a quarter of non-

Māori children had caries. At Year 8 of school, three in five Māori children and two in five non-Māori children had caries. Māori children under 15

years were 65% more likely than non-Māori to be hospitalised for tooth and

gum disease

We know that being involved in Māori culture is important (very, quite, or somewhat) to the majority (76%) of Wairarapa and Hutt Māori adults. Spirituality is important to two-thirds (66%) of Māori. Almost all Māori in Wairarapa and Hutt (99%) have been to a marae at some time with a majority (61%) having been in the last 12 months. Sixty-eight percent have been to at least one of their ancestral marae, with 31% having been in the previous year, but 76% report that they would like to go more often.


35

WĀNANGA TĀPEKA How the model will run

24 month programnmefrom start to finish

Run as protoype to co-design, kaupapa Māori

and the impact and effectiveness of the

intervention

Includes a KaupapaMāori Framework

designed in conjunction with local iwi

Co-design of the programme alongside

whānau with the intent of “whānau teaching

whānau”

Communications plan guides the process and

the effort

Comprehensive child health co-ordination

designed and delivered alongside antenatal

education.

Co-ordination of services included through Tūranga Matua

navigation services

Purchases cultural ftededicated to supporting

the project

Provides fee for service for all non-health sector facilitators and expertise

Includes a formal evaluation component


36

ProgressDate Task Nov Complete final draft Business Case for Hapū Wānanga PDec Share the final draft with COO & EL P&P for feedback PDec Prep Business Case for submission & submit PJan Secure funding for Hapū Wānanga PFeb Sub-contract with Maori Provider to deliver the project In

progress

Feb Complete consultation process with iwi to design Kaupapa Māori Framework

March Secure Cultural Expertise for the implementation of the project March Complete wider co-design alongside whānau March Complete comprehensive project plan, includes communications plan,

expenditure and evaluationMarch Secure all resources needed for the project including venue, catering,

evaluation and activitiesApril Launch the Hapū Wānanga


37

PUBLIC

BOARD DISCUSSION PAPER

Date: February 2020

Author Jason Kerehi, Executive Lead Māori Health

Endorsed By Dale Oliff, Chief Executive Officer, Wairarapa DHB

Subject Māori Health Report, February 2020


a. Notes this report this report as appropriate

1 MĀORI HEALTH DIRECTORATE

The Māori Health Directorate has a full work plan for 2020 including:

1. Initiation of Te Oranga o Te Iwi Kainga

2. Developing the Māori Health Strategy 2020-2025

3. Developing the next Kia Ora Hauora Business Plan 2021-2025

4. Hosting Tū Kaha 2020

5. Leading the Oral Health Equity Project and supporting the Kaupapa Māori Ante-Natal Equity Project

Another key activity for the Directorate is to review and recruit a new kaumātua by expanding the role to support the Board, Chief Executive Officer, Iwi Kainga, Māori Health and the organisation as a whole. The role will increase to a 0.5 FTE while the remaining 0.5 FTE is a proposed kaumātua role within Mental Health Addictions and Intellectual Disability Service (MHAIDs). New appointments in Planning and Funding and potentially Human Resource will strengthen our responsiveness to Iwi/Māori.

2 IWI KAINGA

The Wairarapa District Health Board (WrDHB) has been working with our Iwi leaders to select members for Te Oranga o Te Iwi Kainga (Iwi Kainga). Iwi were asked to consider new members with ahealthy response of 15 candidates for consideration. The Terms of Reference dictates iwi have the responsibility to select members, this was an opportunity to review the membership, relationships and reviewing effective future engagement with the Board and the DHB.

Given the breadth of candidates it was an ideal opportunity to seek wider and more diverse representation e.g. age, geography, reach and gender.

Kim Smith and Kristina Perry will not be continuing as members of Te Iwi Kainga but have agreed to mentor the new members. Both Rangitane and Kahungunu acknowledge their contributions to Iwi Kainga specifically Kim Smith’s commitment to the DHB engagement for over a decade.

The new Te Oranga o Te Iwi Kainga members are:

Deborah Davidson – (Papawai Marae) – Deborah has great experience with governance including a recent spell as Councillor for Masterton District Council. Deborah also has connections to Te Kura Kaupapa Māori and Wairarapa Moana. Accepted with iwi leader’s recommendation to become the new Chair of Te Oranga o Te Iwi Kainga and continue the commitment to engage well with the DHB Chair and Board.


38

PUBLICMihi Keita Namana – (Hurunuiorangi Marae) – “Aunty Mihi” is the only member to continue on Iwi Kainga and takes the role as a kaumātua.

Carlene Te Tau – (Papawai Marae) –Chosen as our second kaumātua. Carlene is on the Papawai Board and connected to Makirikiri Aggregate Trust.

Holly Jackson – (Hurunuiorangi Marae) – Holly has been the Practice Manager at Whaiora since it was created. Her experience and engagement with whānau has inspired her to advocate for our whānau through Iwi Kainga.

Hera Edwards – (Papawai Marae) – A Registered Nurse currently with our Medical Surgical Ward team. With clinical knowledge Hera is also part of the Whanau Ora team in the Wairarapa. Involved in the fitness community and the current Chair of Kahungunu ki Wairarapa.

Raihania Tipoki – (Kohunui Marae) – Raihania is from Onoke Moana (Lake Ferry). With a farming background and is a qualified Ecologist. Raihania is passionate about te reo Māori, Māori navigation and the environment. He is keen to bring his community health issues to the table.

Ririwai Fox – (Hurunuiorangi) – Currently in a second year of PHD study to become a qualified Psychologist. Alongside Hera he brings his clinical focus to the Iwi Kainga korero. He brings a youthful focus to the discussion. Ririwai lives in Wellington and is working part-time for Te Puni Kokiri.

Beauche McGregor – (Te Oreore Marae) – Beauche is studying to become a Social Worker. Beauche is well connected into the youth sector and whanau here in Masterton. Living with a disability and has represented Wairarapa iwi on the 3DHB Māori Disabilities Forum.

Sophronia Mete-Smith – (Papawai Marae) – Sophronia lives in Featherston and is keen to bring the issues and voice of Pae Tu Mokai (Featherston Māori) to the table. With a strong background in Education and interest in rongoa Māori and Te reo.

The Māori Health Directorate will work with Iwi Kainga to on board and orientate them to the DHB and Health arena. Their focus will be on forming as a group; building a relationship with the DHB Board and engaging in their work plan. The immediate focus will be to review their terms of reference, choosing how they wish to conduct and to review the partnership agreement between iwi and DHB. Once in place, they will determine Iwi Kainga representation for the sub-committees.

3 DEVELOPMENT OF MĀORI HEALTH STRATEGY 2020-2025

One of the key priorities for Māori Health this year is to develop the next iteration of a Māori Health Strategy for Wairarapa. Once the Wairarapa District Health Board Strategic Direction has been set it the WrDHB Māori Health Strategy will be developed alongside the Clinical Services Plan and Wellbeing Plan for the Wairarapa.

We will engage an external contractor to write this plan with consultation being led by the Māori Health Directorate and community providers. The plan is an opportunity to focus on key health issues affecting our communities and to set objectives for the next five years. Our aim is to have this plan completed by 30 June 2020.

4 KIA ORA HAUORA

Kia Ora Hauora (KOH) is a National programme funded by Ministry of Health (MoH) to promote and support Māori into health careers. The programme has run successfully for 10 years, withachievements including over 3,500 Māori in the database either interested in a health career or studying towards one. Last year 100 Māori Doctors graduated from Otago University, supported byKia Ora Hauora.

Wairarapa is the regional (DHB) host for KOH across the Central Region. We are meeting and/or exceeding all of our targets. Given the increasing demand for Māori across all workforce areas it is anticipated that the next National Contract will be a significant increase into the recruitment and retention of Māori into the Health workforce. The Regional and National leads (including Wairarapa DHB) are working on the business case due to Ministry of Health by June 2020.


39

PUBLIC5 TU KAHA 2020

Wairarapa District Health Board is set to host Tū Kaha for the second event in New Zealand. Tū Kaha is the pre-eminent showcase for best practice in Māori Health in New Zealand. The Central Region is the only region to host such an event which runs every two years and attracts up to 300 participants. The Māori Health Directorate is working with Rangitāne, Ngāti Kahungunu, Whaiora and Te Hauora to organise the event from the hosts’ perspective. Wairarapa DHB will then work with the other Central Region teams to ensure we attract the best and most relevant speakers and ensure there is representation across the Board.

We have confirmed that the event will be held at Copthorne Solway from 23rd to the 25th September 2020. We will keep you informed of the progress and as the programme comes together as it would be great to see strong representation from our Board Members and Senior Managers.

6 VIOLENCE INTERVENTION PROGRAMME

Our Violence Intervention Programme (VIP) team are getting into a good stride for 2020 and have renewed our call to our hospital based teams, particularly staff that have face-to-face interaction with patients to complete training. We will also be promoting the training to our Executive Team as this is one of the contractual expectations. Research supports having a strong focus on dealing with violence in our community as a positive enforcement and tool. The impact of violence within whānaus has life-long impacts particularly on their physical and mental wellbeing.


40

Wairarapa District Health BoardFinancial Report

January 2020

Dale Oliff Frank van HamChief Executive Executive Leader Finance


41

2

GENERAL NOTEPlease also refer to the notes made in CFO FRAC briefing paper re January 2020 results and in particular the release of accruals, Oracle / stock issues and uncertainty re provision for Holidays Act remediation process.

1 FINANCIAL PERFORMANCE OVERVIEW

The month of January is favourable variance to budget of $951k and a favourable $1,953k year to date.

The key points January;

∑ Release of accruals and provisions $775k;o $334k vacancy factor accrual releaseo $305k IDF outflow wash-up provisions released as CCDHB behind in their targetso $94k Chairman stock adjustment for old purchase orderso $22k Prior period consumer council and oral health outsource accruals

∑ Overspends continues in Nursing and Outsourced Locums∑ Leave liability savings of $183k in December and $204k in January due to hospital shutdown over this

period

We have reduced the forecast deficit with $0.71m to ($8,04m) as a result of:

∑ Improved IDF outflow forecast $262k∑ Expected Aged Residential Care costs forecasted $229k favourable to budget∑ Other Health of Older People costs are $121k favourable because of lower than expected utilisation∑ Increased provision for Holidays Act remediation; annual impact is ($342k)

Month $000s Year to Date AnnualActual Budget Variance Actual Budget Variance Forecast Budget Variance

127 (263) 390 Funder (488) (1,855) 1,367 (1,625) (2,875) 1,25076 6 70 Governance 36 (48) 85 50 (0) 50

(96) (586) 491 Provider (3,228) (3,729) 502 (6,465) (6,666) 202107 (843) 951 Net Result (3,679) (5,633) 1,953 (8,039) (9,541) 1,502


42

3

Operating Report for the month of January 2020

1.1 Revenue

Revenue is favourable against budget by $237k for the month and favourable $256k year to date, this mainly relates to other revenue for Donations $124k, rental income from SSH $34k and Interest $27k. Increased Devolved MoH Revenue for Pharmaceuticals and PHO Capitations services, yet an offset for Kia Ora Hauora and the decreased IDF inflows.

1.2 Workforce expenses

Total employee and outsourced workforce expense is $275k favourable to budget for the month and $360kyear to date. Adjustment has been made across the board to increase the year to date Holiday Act Provision, the total provision $4,185m. This includes the year to date addition of $404k.

The Holiday Act provision is at risk and could be significantly understated. We will only know the true impact when we progress through to remediation.

This month’s results are positively impacted by the release of year to date vacancy savings to budget (that are not actual costs incurred), back to the cost centres, amounted to $333.5k and the impact of the Christmas/New Year shutdown netting a reduction in the leave liability of $183k in December and $204k in January.


Revenue13,539 13,503 37 Devolved MoH Revenue 94,638 94,385 253 162,167 161,725 442

178 168 10 Non Devolved MoH Revenue 1,030 1,178 (149) 1,822 1,970 (149)248 196 52 ACC Revenue 1,365 1,374 (9) 2,346 2,355 (9)397 372 24 Other Revenue 2,948 2,704 244 4,814 4,565 249392 381 11 IDF Inflow 2,459 2,667 (207) 4,206 4,572 (365)183 80 104 Inter DHB Provider Revenue 723 600 123 1,121 999 123

14,937 14,700 237 Total Revenue 103,163 102,908 256 176,476 176,185 291

Expenditure

Employee Expenses731 1,144 413 Medical Employees 6,736 7,710 974 11,197 13,114 1,917

2,077 2,034 (44) Nursing Employees 13,843 13,632 (212) 23,480 23,143 (337)451 554 103 Allied Health Employees 3,641 3,691 50 6,238 6,272 3384 94 10 Support Employees 603 639 36 1,044 1,077 33

550 777 228 Management and Admin Employees 4,802 5,146 345 8,411 8,776 3653,894 4,603 710 Total Employee Expenses 29,625 30,818 1,192 50,370 52,381 2,011

Outsourced Personnel Expenses733 280 (453) Medical Personnel 2,836 1,960 (875) 5,196 3,361 (1,835)

9 16 7 Nursing Personnel 102 114 12 183 195 121 10 10 Allied Health Personnel 34 72 38 85 123 380 0 0 Support Personnel 1 0 (1) 1 0 (1)

66 68 2 Management and Admin Personnel 481 475 (6) 782 807 25809 374 (435) Total Outsourced Personnel Expenses 3,453 2,621 (832) 6,247 4,485 (1,762)

327 325 (3) Outsourced Other Expenses 2,250 2,272 22 3,878 3,895 171,032 1,053 20 Treatment Related Costs 7,473 7,198 (274) 12,572 12,296 (276)

712 779 68 Non Treatment Related Costs 5,325 5,803 477 9,530 9,949 4193,230 3,524 294 IDF Outflow 24,404 24,666 262 42,022 42,284 2624,618 4,658 41 Other External Provider Costs 31,895 32,683 788 55,221 55,636 416

208 227 19 Interest, Depreciation & Capital Charge 2,416 2,480 64 4,675 4,799 124

14,830 15,544 714 Total Expenditure 106,842 108,540 1,698 184,516 185,726 1,211

107 (843) 951 Net Result (3,679) (5,633) 1,953 (8,039) (9,541) 1,502


43

4

The variance by employee type is explained by:

• Medical workforce costs are ($41k) unfavourable for the month due to vacancies, year to date is $99kfavourable due to vacancies in Acute Services, General Medicine and Mental Health. Savings in employed personnel are off set with higher costs for locums and external staff.

• Nursing costs are unfavourable to budget by ($37k) for the month and adverse ($200k) year to date;the areas which are experiencing higher nursing requirements are Acutes, Duty nurse team, MSW and Palliative Care.

• Allied Health costs are unfavourable ($88k) year to date due to timing and staff mix in the budget.

• Management and administration costs are $339k favourable year to date due to vacancies mainly in planning & funding and corporate services.

1.3 Outsourced Other Expenses

Outsourced other costs are $22k favourable to budget year to date due to phasing and reduced services over December and January for Clinics held, offset in part by radiology MRI costs.

1.4 Treatment related costs

Treatment related costs are ($274k) unfavourable year to date largely due to gastro-intestinal and malignant disease pharms and treatment disposables offset in implants and prostheses costs.

Non Treatment related costs

Non-treatment related costs are $477k favourable to budget year to date mainly due to stock accountingadjustments $80k favourable relating to Oracle processes, currently under review.Kia Ora Hauora initiatives delayed, due to resourcing which has now been resolved, $100k these costs offset with revenue in advance. IT $65k due to Central TAS 18/19 wash up. In Consultancy $72k mainly due to the adjustment to the Nursing Advisory Board arrangement.

IDF OutflowsIDF outflows are ($262k) unfavourable to budget year to date. Please refer to the comments in the funder section.

1.5 Other External Provider costs These are $788k favourable year to date and forecast to be $416k favourable to budget, see funder section for more detail.

1.6 Interest, Capital Charge & DepreciationThe year to date position is favourable against budget by $64k this is due to depreciation phasing and rate adjustment, offset by increased capital charge due to late change in building valuation after budgets set($65k).


44

5

2 STATEMENT OF FINANCIAL POSITION

$000sActual31-Dec

BudgetVariance to

BudgetPrevious Year End

Movement from 30

JuneExplanation of Variances Between Actual and Budget

AssetsCurrent AssetsBank 1,235 1,289 (54) 9 1,226Accounts Receivable 6,102 4,289 1,813 6,435 (333) Variance is because of higher accruals for funder revenue

which was not factored into the phasing of the budget.

Stock 1,121 1,039 82 1,039 82Prepayments 547 550 (3) 320 226Total Current Assets 9,004 7,167 1,837 7,803 1,201

Fixed AssetsFixed Assets 47,597 47,842 (245) 50,588 (2,992)Work in Progress 7,601 7,496 105 6,490 1,110Total Fixed Assets 55,197 55,338 (141) 57,078 (1,881)

InvestmentsTrust Funds Invested 187 185 2 185 2

Total Investments 187 185 2 185 2

Total Assets 64,388 62,690 1,698 65,067 (678)

Liabilities

Current LiabilitiesBank 0 0 0 1,799 (1,799)

Accounts Payable and Accruals 13,802 11,132 (2,670) 14,212 (410) Phasing of budgets for payrol l accruals was incorrect and level of accrued costs is higher than expected.

Income in Advance 7,190 0 (7,190) 240 6,950 Variance is because of $7m cash advance received not budgeted for.

Crown Loans and Other Loans 0 85 85 85 (85)

Current Employee Provisions 10,777 7,842 (2,935) 10,844 (67) Higher accrued annual leave than expected - impacted by provision relating to Holiday Pay Act.

Total Current Liabilities 31,769 19,059 (12,710) 27,179 4,590

Non Current LiabilitiesOther Loans 0 2 2 54 (54)

Long Term Employee Provisions 639 639 (0) 639 0

Trust Funds 187 185 (2) 185 2

Total Non Current Liabilities 826 826 (0) 878 (52)

Total Liabilities 32,595 19,885 (12,711) 28,057 4,539

Net Assets 31,793 42,805 (11,012) 37,010 (5,217)

EquityCrown Equity 90,573 103,869 (13,296) 90,573 (0) $7m equity funding budgeted for September and $6m equity

budgeted for January - $7m received as cash in advance instead.

Revaluation Reserve 11,234 11,234 0 13,012 (1,778)

Opening Retained Earnings (66,335) (66,632) 297 (51,937) (14,398)

Net Surplus / (Deficit) (3,679) (5,666) 1,987 (14,398) 10,719Total Equity 31,793 42,805 (11,012) 37,250 (5,457)


45

6

3 TREASURY MANAGEMENT

3.1 Cash Flow Statement & Forecast

This table indicates the forecast position at the end of each month.

This cashflow forecast includes funding in advance received in October of $7m and now assumes the Ministry will provide us with a $13m equity funding in May 2010 at which time the cash advance will be repaid.

3.2 Borrowing Schedule

The following table shows the borrowing facilities currently available to the DHB and the amounts drawn against each facility.

The bank account was not overdrawn during the month. The loan with Selina Sutherland was repaid in January saving $3K interest over 2020.

Funding and Equity Changes

There have been no changes during the month.

Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20

Actual Actual Actual Forecast Forecast Forecast Forecast Forecast

$'000 $'000 $'000 $'000 $'000 $'000 $'000 $'000

Cash flow from operating activities

Operating receipts 16,728 17,939 15,883 16,251 16,244 15,869 7,819 16,444

Payment to suppliers (12,674) (11,691) (12,926) (12,214) (12,175) (11,865) (12,860) (11,941)

Payments to employees (3,965) (5,216) (4,370) (4,063) (4,220) (4,210) (4,290) (4,185)

Capital charge 0 (1,036) 0 0 0 0 0 (1,036)

GST (net) (634) 0 (1,115) (500) (500) 0 (1,000) (500)

Net cash flow from operating activities (545) (3) (2,528) (526) (651) (206) (10,331) (1,218)

Cash flows from investing activities

Purhase of property, plant & equipment (442) (125) (125) (528) (327) (459) (263) (259)

Net cash flow from investing activities (442) (125) (125) (528) (327) (459) (263) (259)

Cash flows from financing activities

Capital contribution from the Crown 0 0 0 0 0 0 13,000 0

Repayment of loan (7) (7) (7) (7) (7) (7) (7) (7)

Net cash flow from financing activites (7) (7) (7) (7) (7) (7) 12,994 (7)

Net Cash Flows (993) (135) (2,660) (1,061) (984) (671) 2,399 (1,483)

Opening cash balance 5,025 4,032 3,897 1,237 176 (808) (1,479) 920

Closing cash balance 4,032 3,897 1,237 176 (808) (1,479) 920 (563)

Available Overdraft with NZHP (5,642) (5,642) (5,642) (5,642) (5,642) (5,642) (5,642) (5,642)

Balance Available (9,674) (9,539) (6,879) (5,818) (4,834) (4,163) (6,562) (5,079)

Facility Limit Maturity Date Balance 31-Jan OCR

$000 $000

Working Capital - NZ Health Partnerships Sweep arrangement ( 5,642) - 1.00%

Selina Sutherland ( 700) -$ 7% Fixed Margin plus OCR

Total Borrowing ( 6,255) -$

Interest Rate Paid/Payable

Wairarapa DHBBorrowing Scheduleas at 31 January 2020


46

7

3.3 Foreign Exchange Transactions

The following table shows the transactions involving foreign currencies, and is provided for the purposes of monitoring risk.

The above transactions are for normal operating and capex costs. These stand-alone transactions were all done at the spot rate on the day.

Amount(excl GST)

$000 Received

MOH Income in Advance

- Cash Disbursement Funding 7,000$ 1-Oct-19 May-20

Wairarapa DHBEquity / Funding Changes

as at 31 January 2020

Expected Date of Repayment

Foreign Currency Amount NZD Cost

Foreign Currency Amount NZD Cost

Range of Exchange Rates

Total No. of Transactions

Currency

AUD $7,888 $8,231 $58,556 $61,765 0.9250 to 0.9556 11

USD $31,729 $47,432 $35,533 $53,366 0.6379 to 0.6458 5

GBP $0 $0 $1,816 $3,657 0.4964 2

EUR $0 $0 $0 $0 0

Totals $55,663 $118,788 18

Wairarapa DHBForeign Exchange Transactions

as at 31 January 2020

Month Year to Date


47

9

4 CAPITAL EXPENDITURE

The following table shows the capital expenditure for the year to date.

In preparation for the 2020/21 budgets a capex wish list has been started to help improve visibility, planning and governance of capex going forward.

Project description WIP Balance Brought Forward

Committed Costs from 2018/19

Budget for 2019/20

Expected Capitalisation

Budgeted Closing Balance

Year to Date Costs

Year to Date Budget

Year to Date Variance

Full Year Forecast

Amounts Capitalised

Current WIP Balances

($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000)

BASELINE CAPEX - WIP - INTANGIBLESRegional and 3DHB

Regional - Central TAS - RDHS 4,416 - 324 (1,591) 3,149 151 189 38 324 - 4,567 Regional - Central TAS BAU 469 - 192 - 661 69 112 43 192 - 538

LocalOracle Project 800 243 - (1,043) - 518 243 (275) 518 - 1,318

Gynae Plus Project 17 - - - 17 - - - - (17) -

NCAMP - 373 - - - 373 - -

Webpas Project 538 - 250 (570) 218 163 147 (16) 250 - 701

Diagnostic Sign-offs (Radiology and Lab) - transferred to In Tune - - 67 - 67 42 42 - - -

Software Licensing (Citrix, Microsoft) - Growth - - 50 - 28 28 50 - -

Software - Cyclical Maintenance & Upgrade - - 25 - 14 14 25 - -

Security Improvement Programme - - 25 - 14 14 25 - -

Concerto Transition & Enhancements - $25K carried over to 20/21 - - 100 - 56 56 75 - -

National Screening Solution - - 25 - 14 14 25 - -

CostPro Upgrade - - 250 - 147 147 250 - -

In Tune - MDM Implementation - - - - - - 132 - -

TOTAL WIP PROJECTS 6,240 616 1,308 (3,204) 4,112 901 1,006 105 2,239 (17) 7,124

BASELINE CAPEX - NON WIP

Buildings - Capex < $100k 187 20 50 30 187 - 20

- Seismic Remediation - Front Canopy 250 68 250 182 320 - 77

- Seismic Remediation - Additional Prior Year Costs - 19 - (19) 19 - 19

Clinical Equipment - Capex < $100k 266 116 150 34 100 - 7

- Theatre Lights (approved last year) - 33 - (33) 139 - 33

- DDR and Fluoroscopy (Total of 2) 1,300 - - - 1,200 - -

- Lease Switching 200 - - - - - -

Other Equipment - Capex < $100k 60 9 60 51 60 - 6

IT - Hardware - IT Server Upgrade 250 - (250) - (21) - 21 - - 228

- Capex < $100k 150 21 150 129 75 - 19

TOTAL NON-WIP CAPEX 250 2,413 (250) 265 660 395 2,100 - 409

TOTAL CAPITAL EXPENDITURE (excl GST) 6,490 616 3,721 (3,454) 4,112 1,166 1,666 500 4,339 (17) 7,533

Forecast Overspend 2

Budgeted Expenditure and Balances Actual Expenditure WIP Balances


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5 FUNDER FINANCIAL RESULT

5.1 Financial Statement of Performance

Financial Summary for the month of January 2020

Month $000s Year to Date Annual

Actual Budget Variance Actual Budget Variance Forecast Budget Variance

Revenue

12,425 12,425 (0) Base Funding 86,975 86,975 (0) 149,100 149,100 (0)1,112 1,076 36 Other MOH Revenue 7,652 7,400 252 13,050 12,609 441

27 27 (0) Other Revenue 205 190 15 341 326 15 392 381 11 IDF Inflows 2,459 2,667 (207) 4,206 4,572 (365)

13,957 13,910 47 Total Revenue 97,292 97,232 60 166,697 166,607 90

Expenditure

183 188 4 DHB Governance & Administration 1,306 1,315 9 2,226 2,255 29 5,799 5,803 4 DHB Provider Arm 40,174 40,423 249 68,853 69,306 453

External Provider Payments1,152 1,109 (43) Pharmaceuticals 7,180 7,597 417 12,419 12,620 201

2 2 (0) Laboratory 10 12 2 18 20 2 1,001 973 (27) Capitation 7,141 6,962 (178) 12,192 11,890 (302)

540 591 51 ARC-Rest Home Level 3,827 4,098 271 6,686 6,957 271 483 467 (17) ARC-Hospital Level 3,278 3,236 (42) 5,536 5,494 (42)440 495 55 Other HoP 3,514 3,665 151 6,064 6,185 121 265 265 0 Pay Equity 1,854 1,854 0 3,178 3,178 0 319 335 16 Mental Health 2,137 2,354 216 3,821 4,038 216

15 18 3 Palliative Care / Fertility / Comm Radiology 137 139 2 229 231 2 401 403 3 Other External Provider Payments 2,817 2,766 (51) 5,078 5,025 (53)

3,230 3,524 294 IDF Outflows 24,404 24,666 262 42,022 42,284 262

13,830 14,173 343 Total Expenditure 97,780 99,087 1,308 168,322 169,482 1,160

127 (263) 390 Net Result (488) (1,855) 1,367 (1,625) (2,875) 1,250

Overall, the result for Wairarapa DHB Funder for the month of January is $390k favourable and $1,367k favourable for the year to date. The main reasons for the year to date favourable variance are lower than expected utilisation in ARC services, the favourable Pharmac rebates and Mental Health services for the 2018/19 financial year.

We are forecasting a deficit of ($1,625k) which is $1,250k favourable to the budgeted deficit of ($2,875k) due the one-off benefit resulted from 18/19 IDF outflows wash-up and Pharmac rebates.


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Other MOH revenue is $36k favourable for the month and $252k favourable for the year to date. The Other MOH revenue is forecasted to be $441k favourable for the full year and the details are presented in the table below:

Jan-20

MOH Revenue Variance to budget

$000s Month $ YTD $ Forecast $

In Between Travel wash-up revenue 2016/17 & 2017/18 0 (49) (49)

2019/20 MERAS Settlements (2) (9) (14)

System Level Measure Capability Funding -19/20 (Budget phasing variance) 0 0 0

System Level Measure Capability Funding 18/19 0 0 0

B4 School Checks 0 0 0

Electives Revenue 18/19 0 4 4

Reduce Pressure on Fees Total Annual Funding 0 18 18

Well Child Tamaraki Ora (WCTO) 2 12 18

Pay Equity Wash-up revenue 18/19 0 30 30

In Between Travel minimum wage increase 19/20 6 42 72

Primary Care initiatives -(Community Service Card holders, Under 14s, VLCA) 12 76 143

Additional Funding for Combined Pharmaceutical Budget 2019/20 18 128 219

Sub-Total 36 252 441

Other MOH revenue includes $4,007k revenue for additional planned care services for 2019/20. As at Jan-20, this revenue being accrued to budget. To receive this revenue in full, the DHB is required to deliver 95%CWDs in the year ended 30 June 2020. As at Dec-19 we have achieved 90.7% of the required values based on the phased budget. If there is under delivery in planed care services, funding will only be made for the actual additional volumes delivered over and above the agreed DHB level base.

Other Revenue is $15k favourable for the year to date. This revenue was received from the Accident Compensation Corporation (ACC) for the falls injury prevention programme and is off-set by the additional expenditure in the other external provider payments expenditure line.

IDF Inflows are $11k favourable for the month and ($207k) unfavourable for the year to date. The main reason for the unfavourable variance is due to ($297k) under delivery for inpatient services which has been clawed back from the DHB Provider Arm. The IDF Inflows revenue is forecast to be ($365k) unfavourable forthe full year for inpatients services due to the incapacity. The details are presented in the table below:

Jan-20

IDF Inflows Variance to budget


Inpatient IDF Inflows 19/20 (9) (297) (494)

PHO Capitation / FFS

Inpatient IDF Inflows 18/19

20

0

39

51

78

51

Sub-Total 11 (207) (365)

DHB Governance & Administration expenditure line shows $4k favourable variance for the month and $9k favourable for the year to date. This is because of the reduction in payment for the Smoke-free Coordinator who was previously employed by the Planning & Performance team and has been transferred to Compass Health since December 2019. This payment is now included in the local services agreement with Compass Health and captured in the Other External provider payments.


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Provider Arm payments are $4k favourable for the month and $249k favourable for the year to date. The reduction in payments for under delivery in inpatient IDF activity for 2019/20 financial year is the main reason for the favourable variance in the provider arm payments. Provider arm payments are forecast to be $453k favourable for the year. The details are as follows:

PROVIDER ARM FUNDING CHANGES Jan-20

Funding Changes Variance to budget

$000 Month YTD Forecast

Activity Based Wash-up

IDF Wash-ups:

- Inpatient IDF Inflows 2018/19 0 (51) (51)

- Inpatient IDF Inflows 2019/20 9 297 494

Agreed Changes

2019/20 MERAS Settlements 1 9 16

Palliative Care Educator funding (6) (6) (6)

Total Changes 4 249 453

Pharmaceutical costs are ($43k) unfavourable for the month and $417k favourable for the year to date.These are demand driven costs based on actual claims. The main reason for the year to date favourable variance is because of $398k higher than expected Pharmac rebate received in December for the 2 previous years (2017/18 & 2018/19). The year to date result also includes a $45k GST credit claimed in relation to the WrDHB share of expenses incurred by Pharmac on behalf of all DHBs. The latest Pharmac forecast released in October 2019 indicated that the annual rebates receivable for 2019/20 would be ($107k) or ($62k) year to date less than the budgeted rebates of $4,015k. The year to date result reflects this change in rebates receivable.

In the 2019/20 financial year we will receive $219k of additional funding for the Combined Pharmaceuticals budget ($128k for the year to date). This funding is targeted for newly subsidised Pharmaceutical Cancer Treatment (PCT) drugs for 2019/20. This service is provided by Capital and Coast DHB for Wairarapa patients. Therefore the additional costs are included in the IDF Outflows expenditure line. The year to date result also includes ($37k) higher than budgeted payments to the National Haemophilia Management Group (NHMG). The costs for this service for 2019/20 are likely to be up to $5.5 million more than anticipated nationally of which Wairarapa DHB’s share will be 1.1% or approximately ($61k).

Community Pharmaceuticals Expenditure Jan-20

$000 Variance to budget

Month YTD Forecast

Actual claims (Based on cash payments) (29) 70 (200)

Rebates 19/20 (9) (60) (107)

Rebates 18/19 0 398 398

Pharmac GST Credits 0 45 45

New Services 0 0 0

National Haemophilia Management Group (5) (38) (61)

Pharmac Operating cost 0 (0) (0)

Medi-Map 0 2 0

Miscellaneous -other 0 0 0

Total (43) 417 75

The October Pharmac forecast also indicated that the net full year community pharmacies cost would be ($198k) or (1.57%) higher than the budgeted cost of $12,620k. However, in the 2019/20 financial year wehave received an additional $398k rebates wash-up payment from Pharmac relating to prior years. This is reflected in the December forecast and overall Pharmaceuticals costs are expected to be within the budget for the 2019/20 financial year.

The following graph compares the current year actual costs (blue bar) to the current year budget and the actuals for the last two previous years. The actual costs in this graph are net of Pharmac rebates and include GST Credits, Pharmac’s Discretionary Pharmaceutical Fund (DPF) and Pharmac operating costs. The graph


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shows a significant reduction in actual costs in March 2019. This is because of a one-off adjustment torecognise higher rebates receivable in March for 2018-19.

The graph below shows the community pharmaceuticals spending over the past 7 years by month and illustrates seasonality. This graph includes only gross drug costs (cash expenditure) and the accruals (excludes rebates and other Pharmac operating costs).


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Capitation costs are ($27k) unfavourable for the month and ($178k) unfavourable for the year to date. Of the year to date result, $76k is off-set by additional MOH revenue received for PHO Capitation services (Care Plus, VLCA, Community Services Card and Under 14s) and $39k off-set by additional IDF Inflow revenue for patients who are enrolled with a Wairarapa General Practice but not Wairarapa residents. The balance ($63k)is related to higher than budgeted enrolments. The table below shows the movements in enrolment by quarter for the last five quarters.

We are forecasting the Capitation costs to be ($302k) unfavourable to budget of which ($221k) is off-set by the additional revenue for PHO capitation services. The balance ($81k) is for DHB funded services for the higher than budgeted enrolments.

Aged Residential Care (ARC) costs are $34k favourable for the month and $229k favourable for the year to date ($271k rest home & ($42k) hospital level). These are demand driven services. ARC Services costs have been favourable mainly due to an increase in the proportion of private payers and fewer than expected new entries to ARC. We expect the ARC costs for the full year to be favourable at least by $229k to budget for 2019/20.

The graph below shows the percentage of ARC Residents who are maximum contributors. Maximum contributors are the people who do not meet the Ministry of Social Development’s financial criteria for a DHB subsidy meaning that the DHB pays a lower proportion of the total ARC costs. This reflects a socio-economic impact beyond the influence of the DHB. The graph below shows an upward trend of maximum contributors in quarter one of 2019/20 financial year, particularly for hospital and dementia beds.

PHO Enrolment Jan-19 Apr-19 Jul-19 Oct-19 Jan-20

Wairarapa Residents 43,807 43,731 44,173 44,434 44,708

Non-Wairarapa Residents (inflows) 1,109 1,563 1,584 1,586 1,565

Total Enrolled in Wairarapa PHOs 44,916 45,294 45,757 46,020 46,273Wairarapa resident enrolled elsewhere (outflows) 1,596 2,021 1,906 1,943 1,943Total Wairarapa Population Enrolled 45,403 45,752 46,079 46,377 46,651

Change from previous quarter 35 349 327 298 274Change from same time last year 908 810 885 1,009 1,248

%Change from same time last year 2.04% 1.80% 1.96% 2.22% 2.75%

Net IDF Volumes 487 458 322 357 378

Statistics NZ Population estimate 45,880 45,880 46,445 46,445 46,445Population Enrolled 99.0% 99.7% 99.2% 99.9% 100%


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The following graph shows the number of new entries to ARC each month for 2019-20 financial year.

The graph shows an increase in the proportion of the private payers NOT the actual number of people. Private payers are taking more share of the overall residents in Aged Residential Care facilities.

The graph below shows the number of new entries to ARC for the last six years and the forecast for 2019-20.

With the exception of the 2018-19 year, the proportion of older people entering residential care has been decreasing. Based on data from July to December 2019, the forecast for the 2019-20 year is expected to be about 185.

216196

180 172 173194 185

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

0

50

100

150

200

250

2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20Forecast

No

of n

ew e

ntrie

s

Wairarapa Entry to ARC

New to ARC % pop 65+ Entering ARC


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The following graph compares the current year ARC actual costs (blue bar) to the current year budget and the actuals for the last three previous years.

Other HOP costs are $55k favourable for the month and $151k favourable for the year to date. The main reason for the favourable variance in the month and the year to date is because of lower utilisation in Home and Community Support Services (HCSS). This favourable variance is largely off-set by higher utilisation in Residential Care: Community- Under 65s. This service is for adults (65 year old) who have a long term condition (not disability) and need residential care services. The increase in allocation of this service should reduce the costs for Health Recovery and Chronically Medically Ill services in the long term. Pay equity costs are included in the HCSS contracts and reported in the pay equity expenditure line.

Other services included in this line are the community based demand driven services. The year to date variance includes underspend in Respite Care and Carer Support Services. Respite Care services provide support to informal family carers. Most of these clients would otherwise be at risk of needing full time residential care. Respite care and Carer support service lines show favourable variance for the year to date; however the allocation for these services are for the full year and the clients can choose to use their allocated hours anytime during the year. The favourable variance in this service is partially off-set by the adverse variance in the Day Programmes expenditure line. The table below shows the different types of services that are included in the Other HOP expenditure line. We are forecasting the Other HOP costs to be favourable by $121k to budget for the full year.

Jan-20

Health of Older People (HOP) Expenditure 2019/20 Variance to budget

$000Month $ YTD $

Forecast Variance $

Residential Care: Community -Under 65s (19) (110) (189)

Day Programmes (11) (49) (84)

Community Health Services and Support 0 8 0

Residential Care: Loans Adjustment (1) 23 23

Carer Support 6 44 75

Respite Care 7 50 86

Home and Community Support Services 73 185 209

Total 55 151 121


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Pay Equity costs show no variance to budget. The MOH is responsible for providing data on pay equity costs. Pay equity costs are currently being accrued to budget as we expect a wash-up on pay equity funding at the end of this financial year. Pay Equity costs are $156k less than budget as at January 20.

Mental Health expenses are $16k favourable for the month and $216k favourable for the year to date. The reason for the favourable variance for the year to date is the release of prior year accruals for pay equity wash-up payments and acute mental health bed usage wash-up with Capital and Coast DHB and Hutt Valley DHB which are no longer required.

Other External Provider Payments are $3k favourable for the month and ($51k) unfavourable for the yearto date. The year to date result includes ($58k) for planning costs and is largely off-set by a refund received from Hutt Valley DHB for mental health acute beds wash-up payment for the 2017/18 financial year and the favourable variance in General Medical Subsidy (GMS). The table below shows the different types of services that are included in the Other External Provider Payments expenditure line.

Jan-20

Description Variance to budget

Month $ YTD $ Forecast $ Comments

Planning Costs 0 (58) (58) Sappere contract -Not budgeted in 19/20ACC Falls prevention injury prevention programme

0 (15) (15)Off-set by the additional ACC Revenue

Well Child Tamaraki Ora Services (6) (11) (18) Off-set by additional MOH Revenue

Tobacco Control services(4) (10) (23) Smoke-free coordinator salary costs- Off-set by the favourable

variance in Governance costs

Dental services 2 (6) 0 Demand driven services

Other 4 2 0 Other demand driven services

Advance Care Planning costs 1 7 12 Off-set by the favourable variance in IDF Outflow

General Medical Subsidy 1 11 11 Demand driven services

MH Acute beds wash-up 17/18 0 14 14 Credit note received in 19/20

Immunisation services 5 15 24 Demand driven services (Prior year claims were less than accrued)

Total 3 (51) (53)

IDF Outflows are ($294k) favourable for the month and ($262k) favourable for the year to date. The main reason for the favourable variance in the month is because of $305k IDF wash-up provisions released as the latest information on IDF activities suggest that the Capital and Coast DHB is unlikely to catch up with its target for 2019/20 financial year. The year to date result includes a favourable IDF Outflows wash-up for the 2018/19 financial year. The overall IDF Outflows wash-up result for the 2018/19 financial year against the year-end accrual was $1,153k favourable. Of which ($829k) has been accrued as IDF risks provision for the 19/20 financial year based on the information available as at Jan-20 and ($19k) accrued for mental health acute beds wash-up with Hutt Valley DHB. The year to date result also includes ($128k) costs accrued for new PCT drugs (Funded by the MOH) and ($35k) for the PHO Capitation wash-up for the first quarter. The following table shows the components that are reflected in this expenditure line.


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IDF Wash-ups and Service Changes Jan-20

Variance to Budget


IDF Inflows

Activity Based Wash-ups

- Inpatient IDF Inflows 2018/19 0 51 51

- Inpatient IDF Inflows 2019/20 (9) (297) (494)

- PHO Capitation / FFS 20 39 78

Total IDF Inflow Changes 11 (207) (365)

IDF Outflows

Activity Based Wash-up

- Inpatients 181 (861) (861)

- Outpatients 37 257 257

-PCTs 71 (414) (414)

- AT&R Inpatients 55 383 383

- Community Pharms (28) (194) (194)

- Mental Health Acute Beds -Hutt Valley DHB (3) (19) (19)

2018/19 IDF Wash-up

- Inpatients ADHB 0 732 732

- Inpatients Other DHBs 0 266 266

- Outpatients / Non- DRG 0 113 113

- AT & R 0 42 42

Other Wash-ups and service changes

- PHO Capitation / FFS (18) (35) (35)

IDF Service Changes

- CCDHB - Advance Care Planning (2) (8) (8)

- ADHB - National Services Q4 2018/19 1 0 0

Total IDF Outflow Changes 294 262 262

We expect the IDF Outflows to be favourable to budget at least by the year to date favourable variance for 2019/20 financial year.


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6 PROVIDER FINANCIAL RESULT

Financial Statement for the month of January 2020

The Provider Arm shows a net deficit of ($3,228k) for year to date January. This is favourable to budget by $502k. The full year forecast is deficit of ($6,465) which is a $202k positive variance to budget.

6.1 Revenue

Total revenue for the Provider year to date is $46,003, which is unfavourable to budget by ($53k).

∑ ACC Revenue is ($24k) unfavourable year to date, despite income of $87k coming from staff claim reimbursements, which offsets against payroll expenditure. For non-staff related ACC income, patient related claims showed favourable recoveries in AT&R $30k though under recoveries in Community Nursing ($48k) and MSW ($26k). An increase in the annual targeted revenue of $100k has yet to be achieved, with an adverse impact year to date of ($58k).

∑ Revenue from Other DHBs favourable $123k year to date, mainly in Radiology accrued income to budget with higher values realised in January.

Month $000s Year to Date AnnualActual Budget Variance Last Year Actual Budget Variance Budget Forecast

Revenue

Government and Crown Agency2 1 1 210 MoH - Devolved Funding (Funds arm) 10 9 1 16 174 4 0 4 MoH - Personal Health 28 28 0 49 493 8 (4) 3 MoH - Public Health 42 55 (13) 94 81

70 71 (1) 70 MoH - Disability Support Services 489 496 (7) 851 84357 38 19 21 MoH - Maori Health 182 263 (80) 400 32044 48 (4) 30 Clinicial Training Revenue 289 336 (48) 577 529

183 80 104 58 Revenue From Other DHBs 681 558 123 956 1,079221 169 52 165 ACC Revenue 1,160 1,183 (24) 2,029 2,005

3 3 0 4 Other Government Revenue 24 24 0 41 41588 422 166 565 Total Government and Crown Agency 2,904 2,953 (48) 5,012 4,964

Non Government Revenue3 4 (1) 5 Patient Revenue 13 31 (18) 52 35

390 364 26 179 Other Income 2,911 2,650 262 4,472 4,7385,799 5,803 (4) 5,236 DHB Internal Revenue 40,174 40,423 (249) 69,306 68,8536,192 6,171 20 5,420 Total Non Government Revenue 43,099 43,103 (5) 73,830 73,626

6,779 6,593 186 5,985 Total Revenue 46,003 46,056 (53) 78,842 78,590

Expenditure

Employee Expenses731 1,144 413 850 Medical Employees 6,736 7,710 974 13,114 11,197

2,077 2,034 (44) 1,971 Nursing Employees 13,843 13,632 (212) 23,143 23,480451 554 103 482 Allied Health Employees 3,641 3,691 50 6,272 6,23884 94 10 101 Support Employees 603 639 36 1,077 1,044

545 727 182 589 Management and Admin Employees 4,531 4,809 278 8,205 7,9063,889 4,553 664 3,993 Total Employee Expenses 29,354 30,480 1,126 51,810 49,866

Outsourced Personnel Expenses733 280 (453) 376 Medical Personnel 2,836 1,960 (875) 3,361 5,196

9 16 7 14 Nursing Personnel 102 114 12 195 1831 10 10 5 Allied Health Personnel 34 72 38 123 850 0 0 0 Support Personnel 1 0 (1) 0 1

55 57 2 50 Management and Admin Personnel 400 399 (2) 676 643799 364 (435) 444 Total Outsourced Personnel Expenses 3,373 2,545 (828) 4,355 6,108

308 305 (3) 326 Outsourced Other Expenses 2,116 2,138 22 3,665 3,6481,032 1,053 20 815 Clinical Supplies 7,473 7,198 (274) 12,296 12,571

922 981 59 800 Non Clinical Expenses 6,410 6,989 579 12,301 11,7101 1 (1) 1 Financing Expenses 1,044 975 (69) 2,005 2,074

(77) (77) 0 (0) Internal Allocations (539) (539) 0 (924) (924)

6,875 7,180 305 6,380 Total Expenditure 49,231 49,786 555 85,509 85,054

(96) (586) 491 (395) Net Surplus / (Deficit) (3,228) (3,729) 502 (6,666) (6,465)


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∑ MoH revenue for Kia Ora Hauora ($80k) has been transferred to revenue in advance pending the programme structure setup. This is offset by a reduction in cost.

∑ Other Income is favourable to budget by $262k year to date because of a donation from Wairarapa Community Health Trust for an Image Intensifier $110k and Countdown Kids Charity Ball $40k. SSH cost recovery income favourable by $130k which due to volume which has associated costs in implants and prostheses and phasing of budget this is offset by Nursing Advisory Board cost recovery income ($99k) which is offset by cost as this contract was negotiated with a different provider.

∑ DHB Internal revenue is ($249k) adverse to budget for the year to date, and this trend has been forecast out to year end. This may be due to reduced IDF inflows as advised by the MOH.

6.2 Expenditure

Total Expenditure for the Provider is $49.2m for January year to date; underspent against budget of $555k.

Total personnel expenses (employed and outsourced) were $229k favourable in January, and $298k year to date. A decrease in the leave due to the Christmas/New Year closed by $387k for December and January, along with the release of the provision for vacancies year to date of $334k back to the cost centres being the main contributors to this favourable outcome. An increase in the Holiday Act provision in line with Board recommendation, has added to the YTD position as well as being included in the out months of the forecast across all employment groups.

Medical costs (including outsourced) are favourable to budget for year to date of $99k due to vacancies in Mental Health 1.2FTE, Acute 0.8 and General Medicine 0.9FTE,. There are SMO vacancies in general surgery with outsourced recruitment to commence in Feb and March. Mental health also has 1.5 employed with locums to cover the 1.6 vacancies. Resignations have left the Orthopaedic department with only one SMO after April 2020.

The Psychogeriatrician was budgeted as employee SMO, but has been provided as Outsourced.

Nursing (including mental health and midwifery) costs are unfavourable to budget for the year to date by ($200k); FTE are over budget by (2.8) year to date.

Registered nurses over budget of (1.7) mainly in Acutes (2.5) FTE due to non-budgeted pm to midnight shiftand January was impacted by bereavement and sick leave which was difficult to cover therefore casual staff used on the base line roster. Outpatients (0.9) though offset by senior nurses FTE, Palliative Care (0.8) and Perioperative (0.5). SSH is positive by 1 FTE due to a staff resignation which will not be recruited too and Mental Health will vacancies showing favourable variance of 3.3 FTE.

HCA’s over budget of (3.2) this is mainly due to MSW HCA’s for patient watches (3.6) due to two watch room in January and Acutes (1.0) offset by vacancies in AT&R 1 FTE.

Midwives over budget by (0.3) FTE. High sickness leave impacted on extra shift covered by staff and casualuse. The ward utilisation over capacity at times in January.

This is offset by senior nurses which are favourable 2.5FTE in the following departments, Mental Health 1.3, Periop 0.7, Outpatients 0.9 though this is offset by RN as a senior nurse is being classified as a RN and Clinical Nurse specialists.

There are also positive FTE variances in Mental Health and Focus due to changes of staffing mix between nursing allied and management.

Allied Health personnel expenses, employed and outsourced, were favourable by $88k to budget year to date, FTE favourable by 1.5 year to date. Mental Health professionals budgeted as nurses but paid as Allied is the main contributor to the unfavourable variance. FTE’s favourable in CAMHS, due to timing and staff mix. Other vacancies in Oral Health, Therapies and Imaging, are covered within the service or by casual and outsourced staff.

Management & Admin workforce, employed and outsourced year to date were $276k favourable to budget, with earlier vacancies in the executive team covered by outsourced. Vacancies in Clinical Services Management and Finance currently under recruitment.

Other Outsourced Expenses were favourable $22k year to date. There are underspends in other outsourced


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services, including Ophthalmology $17k. Other clinical services, gastro services, ENT, Audiology, Halter readings, outsourced surgical procedures, tracking below budget due to timing of services, year to date favourable by $20k which is offset by Radiology Services, ($9k) unfavourable year to date, due to additional MRI services provided by the Hutt Valley DHB.

Clinical Supplies costs were ($274k) unfavourable year to date January.

Treatment disposables ($107k) this includes Blood costs ($76k) unfavourable mainly due increased demand for Intragam products. Infusion injection supplies ($39k) and Procedure Packs ($35k), offset by underspendsin Community Nursing continence & hygiene supplies, protective equipment and blades and knives.

Patient Appliances $42k favourable year to date. Ostomy supplies in community nursing $20k underspent, due to current demand. Other patient appliances favourable by 27k mainly in acute department.

Implants and Prostheses are $117k favourable due to first week in January in shutdown and the public holidays and the budget is phased evenly over the twelve months.

Pharmaceutical spend is ($242k) unfavourable largely due to gastro-intestinal pharms and malignant disease pharms.

Clinical and Client Related costs (38k) due to Outpatients ($40k) budget savings for plastic clinics will not be realised; this has been adjusted in the forecast.

Non Clinical Expenses were $579k favourable to budget for January year to date.

Hotel and laundry expenses were $44k favourable year to date due to the omission of patient meals for the January accounts. This will be caught up in February.

Facilities costs are $59k favourable, an improvement over previous months, due to last month’s position, by $22k as maintenance compliance work tails off. Painting maintenance for the exterior of the Hospital has been deferred till later in the summer months.

Business related travel ($22k) unfavourable, additional travel for the Imaging team making site visits to assess radiology equipment, unbudgeted secondment travel and accommodate for acting CFO and general to timing of travel against an evenly allocated budget.

ITC expenses are $74k favourable, mostly due to Central TAS 18/19 wash-up $57k and budget phasing.

Compliance costs are $68k favourable year to date mainly due to the release of a provision for Nursing Advisory Board expense $106k no longer required. This also offset revenue from other DHB’s who would have not been on charged ($98k).

Stock Adjustments have been under review and corrections have been actioned leaving a favourable variance to budget of $80k. Review and monitoring of the Oracle transactions are ongoing.

Kia Ora Hauora extension programme set up due to timing shows an underspend of $100k year to date, offsets by additional funding transferred to revenue in advance. The team is now fully resourced and expected to see the initiatives coming on board in coming months.

Depreciation $132k favourable year to date this is due to $50k for seismic asset rate recalculation, IT capitalization phasing $55k and Oracle implementation delay $17k.

Capital Charge increased to budget by ($65k) due to late change in building valuation after budgets set.


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Employment costs - analysis and trends (excluding outsourced)

∑ Medical FTEs is 6.8 favourable MTD to budget due to vacancies and a sabbatical in General Medicine, vacancies in General Surgery 2.0, Community Mental Health 1.8 and Anaesthetics 1.5 this due to long-term leave and reduction in FTE for a fellowship.

∑ Nursing FTEs is 0.5 favourable MTD; this is due to vacancies in Community Mental Health Team, AT&R and SSH offset by additional staff in MSW, Acutes, Focus and CNS.

∑ Allied Health FTE is 1.0 favourable MTD, vacancies in Focus Management, Language Therapy and Community Nursing offset by additional staff in Community Mental Health Team and Radiology.

∑ Support Staff is 1.1 FTE favourable MTD to budget mainly in Building & Property and Procurement Services.

∑ Management and Administration Staff is 7.6 FTE favourable to budget due to vacancies in Planning & Funding, HR, Finance, Kia Ora Hauora, Ward Admin, Smoke free and CE office.

Wairarapa DHB$000s

Actual Budget Last yearActual vs Budget

Actual vs Last year

December 2019Actual Budget Last year

Actual vs Budget

Actual vs Last year

Annual Budget

Personnel731 1,144 850 413 119 Medical Employees 6,736 7,710 7,013 974 277 13,114

2,077 2,034 1,971 (44) (107) Nursing Employees 13,843 13,632 12,882 (212) (962) 23,143

451 554 482 103 31 Allied Health Employees 3,641 3,691 3,357 50 (284) 6,272

84 94 101 10 17 Support Employees 603 639 578 36 (25) 1,077

550 777 616 228 66 Management and Admin Employees 4,802 5,146 4,530 345 (272) 8,776

3,894 4,603 4,019 710 125 Total Employee Expenses 29,625 30,818 28,360 1,192 (1,266) 52,381

Wairarapa DHBFTE

Actual Budget Last yearActual vs Budget

Actual vs Last year

December 2019Actual Budget Last year

Actual vs Budget

Actual vs Last year

Annual Budget

FTE39.9 46.7 42.2 6.8 2.3 Medical 43.6 46.7 45.3 3.1 1.7 46.7

250.3 250.8 255.6 0.5 5.3 Nursing 253.6 250.8 250.4 (2.8) (3.2) 250.874.3 75.3 70.2 1.0 (4.1) Allied Health 73.8 75.3 71.9 1.5 (2.0) 75.314.5 15.6 15.4 1.1 0.9 Support 15.0 16.0 15.2 1.0 0.2 15.9

108.2 115.8 109.1 7.6 0.9 Management & Administration 108.2 116.2 110.8 8.1 2.7 116.0487.3 504.2 492.5 17.0 5.2 Total FTE 494.3 505.1 493.7 10.8 (0.6) 504.7

Average $ cost per FTE ($000)18,323 24,496 20,146 6,174 1,824 Medical 154,497 165,131 154,700 10,634 203 280,883

8,298 8,109 7,710 (189) (588) Nursing 54,579 54,352 51,440 (226) (3,139) 92,2776,076 7,360 6,869 1,284 793 Allied Health 49,306 48,992 46,697 (314) (2,610) 83,2545,797 6,022 6,547 225 749 Support 40,100 39,870 38,007 (230) (2,094) 67,9425,082 6,714 5,643 1,632 561 Management & Administration 44,392 44,279 40,874 (113) (3,518) 75,6197,991 9,130 8,161 1,138 170 Cost per FTE all Staff 59,935 61,016 57,445 1,081 (2,489) 103,783

Variance Variance

Month Year to Date

Month Year to Date

Variance Variance


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FTE Trends (from June 2013)

Actual FTE for Month (not year to date)

Jun 13 Jun 14 Jun 15 Jun 16 Jun 17 Jun 18 Jun 19 Jul 19 Aug 19 Sep 19 Oct 19 Nov 19 Dec 19 Jan 20Medical 39 39 40 42 44 46 43 43 44 45 46 46 42 40Nursing 204 209 226 218 241 243 258 257 254 254 257 255 249 250Allied Health 69 69 71 71 70 71 72 72 73 74 73 76 74 74Support 14 14 13 17 16 17 16 16 16 15 15 15 15 15Mgmt/Admin 101 89 90 93 100 109 105 108 107 108 109 108 109 108Actual FTE 426 421 440 440 471 486 495 495 493 495 499 499 488 487Budget 437 428 423 452 453 468 494 505 505 505 505 505 505 505

Act

ua

lT

ota

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Annual Leave Accrual $000s

Provider Arm Delivery

This graph shows the value of activity delivered in the provider arm (blue line) compared to the revenue passed through from the funder (blue bar). The yellow bar is other revenue, such as health workforce New Zealand and ACC. The pink bar shows the expenditure.

Note that activity for the current month is likely to be understated until coding is completed.

Annual Leave Accrual in $'000'sJul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

2013 2,745 2,765 2,833 2,720 2,787 2,809 2,642 2,653 2,694 2,660 2,775 2,7872014 2,838 2,938 2,907 2,863 2,928 2,887 2,773 2,800 2,793 2,891 2,911 3,0252015 3,045 3,090 3,043 3,030 3,033 3,001 3,050 3,020 2,937 2,984 3,019 3,0242016 3,105 3,173 3,057 3,024 3,097 3,093 2,950 2,961 2,902 2,929 3,004 3,1152017 3,152 3,038 3,128 3,101 3,167 2,993 2,853 2,936 2,984 3,047 3,165 3,3272018 3,213 3,348 3,434 3,454 3,524 3,350 3,294 3,320 3,474 3,535 3,617 3,6822019 3,541 3,584 3,697 3,755 3,837 3,752 3,521 3,626 3,717 3,820 3,949 3,9902020 3,925 3,993 4,087 4,114 4,132 3,949 3,745


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7 GOVERNANCE

The following table shows the governance position for January 2020.

Governance for year to date is a net surplus of $85k to budget.

Revenue for Governance is ($9k) adverse due to reassignment of Smoke Free funding to the community.

Management and Admin employed costs were favourable by $67k due to early year vacancies for adviser positions in Planning and Performance. These positions have now been filled with the exception of the final 0.4 FTE Mental Health advisor commencing soon.

Outsourced Personnel year to date is ($4k) unfavourable due to increased charges for the Hutt based advisor.

Non Clinical costs are within budget due to the release of a prior period provision for Consumer Council fees.


Revenue

Government and Crown Agency183 188 (4) MoH - Devolved Funding (Funds arm) 1,306 1,315 (9) 2,226 2,255 (29)

(0) (0) 0 Revenue From Other DHBs 42 42 0 42 42 0183 188 (4) Total Government and Crown Agency 1,349 1,358 (9) 2,268 2,297 (29)

Non Government Revenue(0) (0) 0 Other Income (0) (0) 0 (0) (0) 0(0) (0) 0 Total Non Government Revenue (0) (0) 0 (0) (0) 0

183 188 (4) Total Revenue 1,349 1,358 (9) 2,268 2,297 (29)

Expenditure

Employee Expenses5 50 45 Management and Admin Employees 271 338 67 504 571 675 50 45 Total Employee Expenses 271 338 67 504 571 67

Outsourced Personnel Expenses11 11 0 Management and Admin Personnel 80 76 (4) 139 131 (9)11 11 0 Total Outsourced Personnel Expenses 80 76 (4) 139 131 (9)

19 19 (0) Outsourced Other Expenses 134 134 (0) 230 230 (0)(4) 25 29 Non Clinical Expenses 288 319 31 421 442 2177 77 0 Internal Allocations 539 539 0 924 924 0

107 182 74 Total Expenditure 1,312 1,406 94 2,218 2,297 79

76 6 70 Net Surplus / (Deficit) 36 (48) 85 50 (0) 50


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BOARD DISCUSSION PAPER

Date: February 2020

Author Selena McKay, Executive Leader, People & Capability

Endorsed By Dale Oliff, Chief Executive Officer, Wairarapa District Health Board

Subject People & Capability Update


a. Notes this paper and discusses as appropriate

b. Notes the Holiday’s Act project outline document is being put through the Wairarapa Financial, Risk and Audit Committee

c. Notes the Holiday’s Act project documents will be endorsed across 3DHBs

APPENDICIES

1. Board September 2019 paper

1. PURPOSE

The purpose of this report is to provide information and updates to the Board in relation to activity relating to People and Capability within the Wairarapa DHB. This includes people metrics and general work stream updates.

2. GENERAL PEOPLE & CAPABILITY UPDATE

Legislative Changes

Holidays Act Review: Compliance is a focus for DHB’s Nationally. A review is happening on the dollar provision allocated for remediation and resources required for system changes and remediation process (refer appendix 1).

A project implementation plan has been developed with emphasis on a 3DHB approach to minimise cost and ensure non-duplication of resources.

The Holidays Act project will been undertaken in three phases:

1. Review - of the payroll system to identify any areas of non-compliance with the Holidays Act.

2. Rectifying - the payroll system and associated processes, to ensure compliance.

3. Remediation – assessment of all individual ex-employee and employee payments back to 1 May 2010, contacting any ex-employee or employee who is owed money, and paying that money to them.

The three phases will take at least two years depending on the issues identified. The review phase is about identifying a specific sample to review and is expected to commence at the start of March 2020.

A national communications plan is being developed by the Central Region Technical Advisory Services Limited (TAS) as current staff and previous employees need to be aware of the processes.


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3. GENERAL HUMAN RESOURCES ACTIVITY

Values

Following work completed over the last 12 to 18 months we have confirmed our organisational values. A soft launch was undertaken in December 2019 present the new values.

The confirmed values are being integrated into documents used across the organisation. Currently the recruitment processes are being aligned to recruiting with our values and this will see a refressed recruitment package for managers. The next phase of work will focus on wellbeing and equity dependent on availability of resources.

Recruitment

Recruitment is a key focus with a number of resignations from within our Senior Medical Officer (SMO)team and ongoing vacancies in other key workforces’ i.e. Dental and Imaging.

At this time we have had a Speech Language Therapist and Magnetic Resonance Tomography (MRT)commence in February. We have also made an offer for a Dental Therapist role.

From a vacancy perspective the key focus is with our SMO roles. While Locum cover has beenprovided in the General Surgeon and Anaesthetist space (with some permanent offers) we have not been able to confirm longer term locums or permanent placements for Orthopaedics.

We are currently interviewing for an Emergency Preparedness Co-ordinator.

A new role is currently being advertised for Clinical Coach NetP in a fixed term capacity.

The Adult Mental Health Services a Nurse Practioner position which will be advertised over the next few weeks.

4. PAYROLL SERVICES AND SYSTEM

Over the December 2019/ January 2020 period the payroll services have been busy with adjustments and public holidays. The Hutt Valley DHB payroll team have had the added pressure of staff changes and on boarding which has resulted in pressure on business as usual timeframes and data entry.

The implementation of the MRT multi employer collective agreement in February has included back pay for changes to salary and on call.

From a system perspective we have rolled out an online leave application system with over 50% of the organisation using this. This has led to in less paper being used and better tracking for managers. In March the next Leader kiosk upgrade will be loaded into production along with the required IRD updates.

5. MECA BARGAINING AND NATIONAL ACTIVITY

With the concluding of the MRT bargaining the focus is moving to upcoming agreements for this year. At this time data requests have been worked on for the Association of Salaried Medical Specialists (ASMO) and New Zealand Nurses Organisation (NZNO) agreements.

The SMO agreement is due to expire 31 March 2020 and the bargaining program has been confirmed between the DHB’s and ASMS.

The NZNO document is due to 31 July 2020 and planning is underway around this with the NZNO to hold member meetings in March 2020.

The PSA Allied, Scientific Technical agreement is due to expire 31 October 2020 and the PSA is in planning mode for this with member meetings.

Nationally there is ongoing activity in relation to Pay Equity claims in regards to Nurses, Midwifery and Administration.


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Metric Actual Target Comments

Turn Over 13.6% 13% The turnover rate has remained at around the 14% level.

Sick Leave Usage

2.4% 2.5% Sick leave is tracking to just under the 2.5% usage level.


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Metric Actual Target Comments

Annual LeaveLeave Owed

Refer to the relevant Finance Report

Annual leave is being monitored with a focus on those with a balance of over two years.

The levels have dropped due to the holiday period and the Operations team are reviewing needs for the Easter period.

% of Completed Appraisals

43% Based on headcount of 502excl’s SMO and RMO


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WrDHB Quality, Risk and Innovation Public Quarterly Report to Board – February 2020 Page 1 of 14


Date: February 2020

Author Chris Stewart, Executive Leader Quality, Risk and Innovation


Subject Quality, Risk & Innovation Quarterly Report, February 2020


a. Notes reporting is for the months of November, December 2019 and January 2020

b. Notes that there were no Work Safe notifiable events during the reporting period

1. INTRODUCTION

As a DHB we are working towards meeting our quality goals by working together at all levels of the DHB to achieve patient centred care, openness and transparency, learning from error or harm and ensuring that the contributions of staff for quality improvement and innovation are valued. All of our goals are in line with the Triple Aim, national and regional priorities as identified by the Wairarapa DHB Annual Plan, Regional Services Plan, Health Quality and Safety Commission (HQSC) and the Health and Disability Services Standards. They are outlined in the Quality Improvement and Patient Safety Strategy, which guides our focus and local service quality improvement and work plans.

The Quality Team continues to provide support and leadership to clinical staff and develop and build on the systems, processes and capability required to maximise quality and patient safety.

Highlights

∑ Two staff members being accepted on the nine month, HQSC sponsored Ko Awatea Improvement Advisor course

∑ The development of a Tracer Audit process/programme by Clinical Quality Facilitators which will enable more thorough and effective across service auditing

∑ Completion of Quality Improvement project around the review and learning from SAC 3 and 4 events in SQuARE

∑ Significant improvement in Communication domain of Adult in-Patient Experience Survey

2. CONSUMER VALUE

Focussing on consumer value encourages us to involve our communities in improving current performance and planning for the future, and to achieve improved health outcomes and equity for our population. The Consumer Council is another way that we ensure our services are patient and family/whānau centred. We currently receive consumer information through our complaints and compliments feedback and the National Patient Experience Survey.

2020 02 27 Wairarapa Board Meeting PUBLIC - Information

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National Adult In-Patient Experience Survey

Ipsos has recently been awarded the contract to administrate the National Adult In-patient Survey. DHBs are required by the MOH to participate in this quarterly survey which surveys adult inpatient’s over 15 years of ages, excluding mental health patients.

Previously participation rates and completion rates have remained low at WrDHB and across the country with many DHBs funding separate in-house patient experience surveys. We look forward to new methodologies and reporting that will be provided by Ipsos and there has been a recent notification that the current Picker question set will also be replaced. There is currently a consultation process across the sector taking place and it is expected that next data collection period will not take place until May 2020 quarter.

As Q4 was the last round contracted by Cemplicity we did not employ the additional resource intensive methods to increase participation, results showed a slightly decreased response rate of 23% (national average 24%) compared with the previous quarter’s response rate of 26%.

Communication in Q4 has improved with an overall result of 8.8 (national average 8.3), the highest result received since Q2 2016. This correlates with a decrease in communication complaints received year to date.

Equity reporting – Adult Inpatient Experience for Maori/Pacifica and Comments

The small cohort of participants (Māori make up 6 out of the total 83 participants for this period) makes it difficult to make assumptions and continues to raise the question of how we can get a better representation of Māori patient experience – something National Quality Leaders have highlighted as a key issue with the new provider.


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3. COMMUNICATION

Filter set one - European & other: Filter set two – Maori

Patient Comments - Communication

They would inform me that they'd talked to the next person on shift about what was happening with meetc.

The doctor and nurse explained quite clearly what was needed. However lack of communication at reception as to how long the wait would be in A&E. I waited 5 hours before the doctor saw me. In that time several attempts were made by myself with reception as to how long would it be before a doctor could see me. No answer was given and was told to wait further. In the end I walked out before seen to. When I got home I got a phone message to say the doctor would see me now if I was too return. Came back to the hospital and had to wait another 20 minutes before the doctor saw me.

I had dislocated my artificial hip which was successfully manipulated back into place and put in a splint -all I was told was to leave it on for 6 days by the surgeon and told that I would be given an appt with Mr Denholm for about 5 weeks’ time. The physio who saw me prior to discharge made sure I could manage crutches/walker & seat for shower & said I could go home.

Explained what I had done. What was going to happen now? What happens over the next month - follow up with GP and Practice Nurse.

Partnership


Patient Comments - Partnership

They explained to me about the necessity of the treatment. As I was pregnant (35 weeks), I was prescribed antibiotics. I would prefer to clarify and explain for me that this grade of antibiotics are quite safe for pregnant woman. Sometimes I got worried about it and had to ask the name of antibiotics to search and figure it out.


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We had requested transfers to Wellington on a number of occasions but it was only finally actioned on near death. Pain medication was very slow to give relief and often took longer than 30 minutes after requested. My Dad had a fall in the toilet and was left for over an hour waiting for help. When questioned the following day we were told staffing was limited.

Around 2:30 am I woke not feeling well and didn't know what was wrong. The night nurse came and recommended an ECG. That done the nurses went to get a doctor to read the test. In no time at all 5 doctors and nurses were at the end of my bed. They set about, as they said, to get my heart rate down. They were busy attending to my condition. The next morning I was told my heart rate was high and they wanted to put me on PRADAXA, I was not told that I'd need to be on that tablet for the rest of my life.

District nurse different instruction to hospital staff.

4. COORDINATION


Patient Comments - Coordination

My treatment (an angioplasty) took place in Wellington Hospital, but up to the point where I was transported to Wellington, the care was exemplary.

Staff too busy to attend to needs. No time to talk.

The staff in the emergency department were superb and really kept me informed as to what was going on and why

I only needed personal care showering, dressing etc.

The general information was piecemeal. The doctor, 2 days later, did talk to me about the change to my heart condition.

Physical and Emotional Needs



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Patient Comments – Physical and Emotional Needs

Across the board, all patients and staff treated each other with respect, were fair and extremely friendly.

Thank you to all staff - all very caring & professional making my stay as comfortable as possible.

The staff are wonderful - very caring, sympathetic and capable.

When I was transferred into a Paed ward from maternity (son was in SCBU), I felt like my care was forgotten. There was only one midwife that came and gave me pain meds when I was due - otherwise I had to ask the nurse in Paeds to then get a midwife to come. I am incredibly glad it was my second birth as if it was my first I would have felt very insecure and anxious and neglected.

I was mostly treated well. The hospital meals were not very good. Bland in taste.

High and Low Rated Questions


5. COMPLAINTS AND COMPLIMENTS

A summary of Health and Disability (HDC) Complaints is provided in the Public Excluded Quality, Risk and Innovation Quarterly Report.


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Patient VoiceThe words below are extracted from November 2019 to January 2020 complaints and compliments, with the more frequently repeated words being largest.

Compliments

Complaints


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6. EFFECTIVENESS

Effectiveness focuses on monitoring and evaluation of patient care and performance in relation to our peers to ensure focused quality improvement. Our data is pulled form SQuARE our electronic reporting system (that we share with CCDHB, and HVDHB) – accurate data relies on timely and accurate reporting and reviews, which can be a challenge. We are currently reviewing the Medication Errors, Patient Falls, Hospital Acquired Pressure Areas data that is also reported within the WrDHB Balanced Scorecard to ensure accuracy and usefulness.

General Adverse Events

Learning and improving from incidents remains an important safety improvement strategy. Reported incident data is not necessarily an indicator to monitor organisational safety performance. Reporting constitutes one component of a broad range of conversations and activities focused on safety and risk.

The top four reported adverse event categories for the hospital are usually Staff and Others Health & Safety, Patient Falls, Clinical Care and Medication. This reporting period sees Safety/Security/Privacy events within the top three. Further discussion/insight into this is provided within the Health and Safety report.

General Events 1 November 2019 to 31 January 2020


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General Events YTD 1 February 2019 to 31 January 2020

General Events Previous YTD 1 February 2018 to 31 January 2019


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7. HQSC – QUALITY SAFETY MARKERS (QSMS)

DHBs are expected to collect data to support the QSMs which include both process markers and outcome measures, to monitor the progress of its priority programmes. The HQSC monitors and publishes these on their website. The current programmes include Falls, Hand Hygiene, Patient Deterioration, Pressure Injuries, Opioids, Safe Surgery, with a new Consumer Engagement QSM being introduced in July 2020.

WrDHB meets the requirements of collection on a quarterly basis, however the work required to do continues to be significant due to most data needing to be extracted manually from paper files.

8. OCCUPATIONAL HEALTH & SAFETY

The role of Occupational Health & Safety is to support a progressive and continuous improvement philosophy within the WrDHB by providing health and safety advisory services and facilitating change aimed at improving the work environment to reduce risk.

Initiatives and Improvements

∑ People of Size Manual Handling Survey developed by Manual Handling Coordinator - ongoing surveying to occur.

Positive Performance Indicators

∑ Staff & Others Health and Safety SQUARE reporting continues to be the highest reported event type across all categories.

∑ New Health & Safety Representatives secured for Focus.

∑ Engaging Leaders in Health and Safety training for Managers held November 2019 with positive feedback on training delivered.

∑ Formal end of year thanks, coffee voucher and chocolate fish provided to all Health and Safety Representatives for voluntary work undertaken throughout year.

Priorities undertaken in line with health and safety & emergency annual plans

∑ Nurses Core update Health and Safety training delivered on Health and Safety.

∑ SQUARE - Staff and Others Health and Safety Events - Reviewed and managed.

Notifiable/major events since last report

∑ Nil Work Safe notifiable events.

Health and Safety Reportable Events


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Health and Safety Events 1 November 2019 to 31 January 2020

Safety/Security Events 1 November 2019 to 31 January 2020


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Health and Safety Events YTD 1 February 2019 to 31 January 2020

Comparison of previous 12 month period 1 February 2018 to 31 January 2019

Commentary: Over the course of 2019 there was an increase in reporting of Health and Safety Events by 26% on the previous year. Inappropriate behaviour has now made an appearance in the top 5 reported category along with slip, trips and falls with a significant increase in Violence (physical assault). This has almost doubled compared to the previous year whilst threatening behaviour has almost halved.


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Hazards of Significance (new, emerging or requiring escalation – also on Risk Register)

Violence and Aggression

There continues to be higher levels of reportable events of violence (physical assault), verbal abuse, vandalism and inappropriate behaviour impacting staff, visitors and other patients and their family/whānau and on an increasing basis resulting in harm and requiring considerable support to staff.

Moving and Handling

Remains a static risk for staff particularly in relation to patient handling and access to adequate equipment e.g. track hoists etc.

High Heat Remains a static risk over summer months for staff, patients and contractor health and wellbeing due to increasingly high summer temperatures and ineffective controls to mitigate to an acceptable level in buildings with no air conditioning available. An options paper has been submitted to ELT.

Potable Water Storage

An updated information paper went up to ELT December 2019.∑ On the 11th October 2019 MDC notified that they believe they have been

successful in their design of an emergency water treatment plant with capability of meeting WrDHB’s average flowrates.

∑ A meeting was subsequently held with WrDHB Building and Facilities Manager and MDC Water Treatment Plant Manager to establish the best way to integrate the DHBs existing systems with MDC’s containerised treatment plant. Following this site visit MDC representative advised workup on suitable approach would be undertaken and reported back. To date investigation into this innovative option has resulted in nil cost to the DHB.

Insufficient Decontamination Equipment and training

A decontamination guideline is in draft. Additionally a regional approach is being taken with DHBs in greater Wellington area meeting together and agreeing to work collaboratively to address common issues faced by all three DHBs around effective PPE, training, facilities and best practice guidance

Manual Handling

Coordinator role has now been in place for 6 months, initial review completed:

∑ Practices - including techniques, use of equipment and practical implications of using equipment.

∑ Current training provision – new and existing employees, clinical and non-clinical.

∑ Options for future training provision investigated including other DHB’s and how they meet requirements of legislation.

∑ Equipment stocktake completed and review of variety and availability.

∑ Injuries sustained as a result of moving and handling over a one year period undertaken.

∑ Feedback sought - Employee perspective of manual handling risks and benefits via comprehensive staff survey.

∑ Focus areas for 2020:

- M&H for Bariatric Patients.

- Measuring MH competence and measurement tools.

- Policy and Procedure reviews specific to Wairarapa DHB.

Occupational Health

Update of clinical staff whooping cough vaccinations has begun, targeting areas where contact with babies and children is common.


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In 2019 67% of WrDHB healthcare workers were vaccinated against influenza, the same total coverage as for 2018 (MOH goal 80%). We continue aim to improve on vaccination rate and have begun preparations with a commencement date of 1 April.

9. RISK

The moment in time Risk Report is generated from the WrDHB SharePoint Risk Register and presented to FRAC on a bi-monthly basis, which is then shared to Clinical Board and Board via the Quality Public Excluded quarterly report. At any stage a ‘real time’ report is available on SharePoint.

Risk review is a standing item on the ELT agenda with ELT members responsible for reviewing and managing risks at an operational level and providing summaries and updates to ELT.

Top 5 Risks of Significance

For a more detailed report refer to Appendix A of the Quality Public Excluded Quarterly Report.

Risk Category Risk Name Risk Description RACPatient Care;Operational

Surgical Staff Vacancies (Gen Surg/Ortho and Anaesthetics)

General Surgery - We have received 2 General Surgeon resignations within the space of a month. Lack of Substantive positions after September 2019 leaves only one General Surgeon on staff. Inability to provide roster cover leaves Hospital unable to provide access to acute surgeon. Reduced access to planned General Surgical cases. Has flow on implications for support and management of afterhours Urology, ENT and support for Gynaecology.

Orthopaedics - Long term locum for Orthopaedics left abruptly and pending retirement in Jan 2020 leaves department 2 Ortho Surgeons down.

Anaesthetics - One resignation and reduced hours from two other Anaesthetists reduces staffing by 1 FTE till mid-December and 1.5 FTE from that point forward. Transition to retirement for further 0.5 FTE leaves 2 substantive FTE in Anaesthetics vacant by mid-2020.

1

Financial;Legal;Governance;Reputational

Financial Sustainability Financial sustainability of the WrDHB. 1

Patient Care;Legal;Reputational

Electronic sign off laboratory results system not in place for all medical staff

The inability to have an electronic sign off for laboratory and radiology results represents a major clinical risk for patient safety due to results being missed.

2

Health & Safety;Operational;Financial;Legal;Reputational

Seismic Compliance Risk of:

- Injury to staff/patients from falling or damaged non-structural elements of the building and from connected structures (walkways and canopies) in the event of a significant earthquake

- Inability to stand up a business continuity plan for emergency health service provision

- Disruption to service whilst detailed surveying and remedial work is being undertaken

- Significant and immediate financial impacts

1

Health & Safety Physical and Verbal Assault

Increased presentation of violent and aggressive patients and visitors poses a risk to the personal safety of staff, contractors and other patients and visitors.

1


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Summary of all Risks by category currently on Risk Register as at 7th February 2020

RISK CATEGORY Total RAC1 RAC2 RAC3 RAC4

Financial 15 5 7 1 2

Governance 3 1 1 1 0

Health and Safety 24 8 6 9 1

Legal 11 3 5 3 0

Operational 26 8 11 4 3

Patient Care 21 5 13 3 0

Reputational 20 4 9 6 1

Total 121 34 52 27 7

10. CERTIFICATION/CORRECTIVE ACTIONS

We have been notified of our next full Certification audit by MOH which will take place 15th – 21st June 2020.

There is currently a review taking place of the 2008 Health and Disability Services Standards, with Standards NZ and the MOH working closely together on these with much sector consultation, will not impact WrDHB until 2023 Certification.

11. INFECTION PREVENTION AND CONTROL AND EMERGENCY PREPAREDNESS

COVID-19∑ Our Infectious Diseases is the lead clinical service working sub-regionally with CCDHB and

HVDBs developing necessary resources that will be required should cases present locally.

∑ We have a local Incident Management Team who are liaising with the MOH, coordinated by our Emergency Preparedness.

∑ WrDHB are involved in weekly 3DHB planning meetings and WrDHB is circulating weekly SitReps to all relevant parties.

∑ The MOH continues to work closely with DHBs and Public Health Units around the country and there are daily teleconferences that focus on emerging issues and ensuring open communication, and WrDHB have been monitoring and providing all data and Information as requested.

∑ On Feb 13, one-on-one teleconferences with DHBs commenced. These are focussing on readiness, response and future planning with support from clinical leaders. These are opportunities for DB to ask for support as required.

∑ The MOH continues to receive updates on suspected cases and is developing FAQs for health professionals and working with DHBs on a stocktake of personal protective equipment available in their districts.


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Date: February 2020

Author Sandra Williams, Executive Leader, Planning & Performance


Subject Planning and Performance Report for February 2020


a. Notes this paper and discusses as appropriate.

1 PURPOSE

This paper provides an update to the Board on the work being progressed by Planning &Performance.

2 STRATEGIC DIRECTION FOR HEALTH SERVICES IN THE WAIRARAPA

We are continuing this work and plan to close out the work done for us by Sapere this month. The key themes emerging from the engagement process were:


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The draft document is being updated following the January Board workshop.

3 ACCOUNTABILITY

The Annual Plan, Statement of Service Performance and System Level Measures Improvement Plan 2020/21 are under development and the first draft is due to the Ministry of Health (MoH) for their review on the 2 March 2020. An initial draft has been prepared for the Board.

The Minister’s Letter of Expectation to District Health Boards is expected imminently. We are still waiting for information on the funding envelope for 2020/21 and any new annual panning guidance.

On the 12 February the Minister of Finance announced the budget day to be 14 May 2020. Budget 2020 priorities from that announcement are:

∑ Just Transition – Supporting New Zealanders in the transition to a climate-resilient, sustainable, and low-emissions economy

∑ Future of Work – Enabling all New Zealanders to benefit from new technologies and lift productivity through innovation

∑ Māori and Pacific – Lifting Māori and Pacific incomes, skills, and opportunities

∑ Child Wellbeing – Reducing child poverty and improving child wellbeing

∑ Physical and Mental Wellbeing – Supporting improved health outcomes for all New Zealanders.

New Population Projections

On the 10 February the Ministry of Health sent out new population projection data for 20/21. This data shows that the Wairarapa population has continued to grow faster (4.38%; 2035 people) than the national average (0.25%). Most of the increases are in the adult and older adult populations. Several DHBs had higher increases than Wairarapa including Auckland, Bay of Plenty, and Northland. Whilst this increase will have a positive impact on our funding it is unclear how beneficial this will be until we know the size of the funding envelope and the impact of the population based funding formula.


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Recent announcements on the $300m capital investment in health included two new mobile dental vehicles for the Wairarapa area.

Hutt Valley DHB provides our inpatient mental health beds and has received funding for a new acute mental health unit.

The neonatal care facility investments at Hutt Valley and Capital & Coast DHB will benefit our babies who need that level of care.

5 YOUTH MENTAL HEALTH SERVICES

The Ministry of Health released a new request for proposals on the 4 February 2020. This time forprimary Mental Health and Addictions services for primary mental health and addictions services for youth experiencing mild to moderate distress aged 12 to 24 years. The due date for the submission of proposals is 9 March 2020. Staff are working with our local Non-Government Organisations (NGOs)and Tū Ora Compass Health to respond to the request.

6 FUNDED FAMILY CARE CHANGES

District Health Boards across New Zealand are aligning with changes being implemented by the Ministry of Health Disability Support Services by June 2020 for funded Family Care. In order to do that, a national policy is being drafted.

Currently Wairarapa DHB applies the sub-regional policy whereby family members are funded through existing home and community support services funding arrangements. Family members are employed as carers on merit by the home and community support services provider using their usual employment processes.

The main changes are in ∑ extending the eligibility of who can be a Paid Family Carer to include:

o Partners and spouses o Parents of children under 18 years

∑ lowering the minimum age of carers from 18 years to 16 years

All DHB processes for assessing and allocating home and community support services remain unchanged. The proposal is that paid family care would only be for support that would otherwise be allocated (i.e. substitution of carer). It is not proposed to increase expectations for more funded supports. The potential impact of Wairarapa DHB is unknown but expected to be minimal. The DHB funded amount would not change, but would go to the employed family member instead of a support worker.

7 MASTERTON REFUGEE SETTLEMENT

The DHB is closely involved with the planning for the first intake of refugees, due to arrive in June 2020.

Up to 100 people will be settled in Masterton per annum, in groups of up to ten people (probably twoto three families), who will be leaving the Mangere centre every two months.

The refugees coming to Masterton in 2020 will be from Syria. The information we have to date is that these people are generally from rural areas and are likely to be bigger families. All refugees spend two months in Mangere and during that time a detailed health assessment is completed. More specific profiles and information on specific needs will be provided once it is available.

Connecting Communities Wairarapa and Red Cross will be providing settlement services in Masterton through a contract commencing in April. Seven new jobs have been advertised. Connecting Communities will be employing a Volunteer Coordinator and a Volunteer Trainer. Red Cross will be employing a Manager and a Case Manager (both social work roles), and a Settlement Lead with a refugee background and two cross cultural workers.


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PUBLICThe two main issues that have been raised from a health perspective are access to primary care and specialist trauma recovery services. Tū Ora Compass Health are working with the Masterton practices to ensure that all refugees are able to enrol with a practice on arrival. A specialist refugee trauma recovery service is provided by Red Cross in the Wellington region. Management are in discussion with Red Cross about the provision of services locally. This is likely to include clinical practice support and education and training of clinicians. Budget provision has been made for this purpose.

There has been some public discussion and concern about the availability of housing for the settling families. The refugees have the same rights as any other New Zealand citizen. They are able to access income and housing support (and are eligible for publicly funded health services), but will not get preferential access to rental accommodation. The District Council is involved in discussions with housing providers. No-one will be settled without suitable housing being arranged.

8 FEATHERSTON MEDICAL CENTRE BUILD UPDATE

∑ The construction of the new Featherston Medical Centre is progressing at 34 Fox Street. The building has been designed, financed and will be owned by Dr Harsha Dias and his wife Aruni Dias who is the Practice Manager. The opening date is expected to be May 2020.

∑ In September 2019, management agreed to lease a room in the new building for a period of fiveyears.

∑ Since then, we have been working with various DHB department managers to establish how the room can best be used by the DHB.

∑ Internal discussions to date have suggested that space in the new build could be used by the DHB for several purposes including (but not limited to) District Nurses, Outpatients department (e.g. for visiting specialists), allied health clinicians and mental health services.

∑ Other NGO providers have also showed an interest in utilising the room including Pathways and Hauora.

∑ The Practice is very excited to have the DHB presence in their building and can see the enormous potential of having DHB services provided on-site. Not only will South Wairarapa patients get improved access to care that is closer to home but there is also the added benefit of the various health professionals interacting in person on a daily basis. This is acknowledged as being both highly efficient and is also expected to provide improved outcomes for patients by being able to discuss individual patient care in real time, face to face.

Aruni Dias (Practice Manager), in front of the new Featherston Medical Centre building expected to be completed in April 2020.


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An online medication chart for palliative care patients in the community is being timed to roll out for use on 1 March by general practitioners, community pharmacists, community nursing, hospital specialists and ambulance services. The online chart will avoid the multiple charts in use by the various care providers, and is being welcomed as a measure that will improve safety and reduce the time taken to manage medications for complex patients.


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Date: February 2020

Author Nigel Fairley, General Manager Mental Health Addictions and Intellectual Disability Service 3DHB

Endorsed By Dale Oliff, Chief Executive, Wairarapa District Health Board

Subject Mental Health Addictions and Intellectual Disability Service 3DHB Update


a. Notes this paper as appropriate

APPENDICIES

1. Referee guide to teams

1 MENTAL HEALTH, ADDICTIONS AND INTELLECTUAL DISABILITY SERVICE (MHAIDS) 3DHB

The Mental Health, Addictions and Intellectual Disability Service (MHAIDS) provides services Wairarapa, Hutt Valley, and Capital & Coast DHBs and has regional and national services.

MHAIDS officially became a 3DHB service on 9 February 2015, with an intention to eventually, fully integrate. A Board Advisory group was appointed in 2017. They recommended an urgent integration of all services, under a lead DHB model for MHAIDS. This went through the three Boards for consideration, and Capital & Coast DHB (CCDHB) was signed off to be the single employer for all MHAIDS staff of CCDHB, Hutt Valley DHB (HVDHB) and Wairarapa DHB. A consultation and engagement process has been underway since then; most recently an external company Allen and Clarke were engaged to run phase two of this process. There is currently a consultation underway on a proposed Clinical Governance and Leadership for MHAIDS under a single employer; feedback closed for this on 31 January and the feedback is being themed. We are expecting an outcome by the end of February.

Services MHAIDS provides:

MHAIDS has three arms:

1. Intellectual Disability Services (National)

2. Forensic and Rehabilitation Services (Central Regional and National)

3. Mental Health and Addiction services (3DHB)

Each arm has different client demographics, stakeholders, funding arrangements, reporting lines, and even operates under different laws.

Local MHAID services are provided from multiple sites within the 3DHB sub-region – Greater Wellington, Porirua, Kapiti, Hutt Valley, and Wairarapa. The regional services have staff throughout the central region and the national services staff throughout the country. The inpatient part of the regional and national services are at Kenepuru and Rātonga o Rua Porirua Hospitals.

Te Haika (based in Porirua) is the telephone call centre that triages crisis and acute calls 24 hours per day, seven hours per week. Clients phone in on a specific phone number – 0800 745 477. The call centre is staffed by registered health professionals who manage referrals to MHAID Services for 3DHBs. Prior to July 2015, this service only covered CCDHB. In July 2015, the service was expanded to Wairarapa and Hutt Valley DHBs during normal work hours. Since 1 July 2016, the service has covered the region 24/7.

Please see appendix 1 – MHAIDS Board reference guide to teams


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2 HEALTH QUALITY & SAFETY COMMISSION MHA QUALITY IMPROVEMENT PROGRAMME

The Health Quality & Safety Commission (HQSC) is coordinating a national five-year MHA quality improvement programme to ensure people that experience mental health and addiction issues, receive high-quality care and support. The five priority areas identified by the MHA sector are included in the quality improvement programme during 2017/20.

HQSC-Towards Zero Seclusion:

The Towards Zero Seclusion project is a national collaborative between District Health Board (DHB) teams, mental health and addiction service consumers, the Health Quality & Safety Commission and Te Pou o te Whakaaro Nui (Te Pou). The project aims to eliminate seclusion by the end of 2020. Project teams are established in Tawhirimatea and TWA, and work is now commencing in TWOM.

HQSC-Connecting Care:

The Connecting Care project aims to ensure that mental health and addiction service consumers receive continuous quality care between providers.

The project focuses on service transitions, and the coordinated transfer of care between one health care andsocial service provider, to another.

Three specific service transitions have been identified as a priority under Connecting Care, and each DHB-led team will target one of the following transitions:

• from DHB specialist services to DHB community teams – completed;

• from DHB specialist services to primary care and/or NGO services – underway; and

• from youth to adult services.We have completed one project on transfer between the Crisis Resolution Service (CRS) and Community, and are now focused on the two other areas listed above. We are working with the Hutt network group first and will then roll it over to CCDHB.

HQSC-Learning from Adverse Events

The Learning from Adverse Events project centres around creating safety through practice and improving the way we learn from adverse events.

The main aim of this project is to engage all stakeholders and improve the experience of consumers, family/whānau and staff involved in an adverse event. We’re also focused on supporting District Health Boards (DHBs) to define a consistent approach to responding to events which result in harm or have the potential to.

Our emphasis so far has been on improving the review process to ensure we review events appropriately and in a timely way. We will also be looking at how we action any resulting recommendations.

The final two projects – Maximising Physical Health and Improving Medication Management and Prescribing, have not commenced.

3 SERVICE DEVELOPMENT

Acute Demand

Acute demand is growing, not only across the three DHBs, but also nationally. The demand on the two acute inpatient units is significant and we’re running at full occupancy consistently.

We have set up an internal working group to look at the options and solutions for acute bed development. The ongoing issue is a shortage of high needs acute beds (approx. five to seven beds).


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PUBLICThere are several important contextual factors that need to be understood;

∑ The increase in admissions from the Wairarapa over the past year (see attached papers)

∑ The fact that the Wellington region has the least number of acute MH beds per capita in the country

∑ Since the formation of MHAIDS, the number of contacts has increased from 2014/15 until now by 13.4% with the largest increase in Māori (24%). This translates to the service seeing 2500 more people of which more than a 1000 are Māori;

∑ In 2018/19 there were over 4000 more MHAIDS referrals created than in 2015/16; and

∑ Referral numbers have increased by over 20% across ethnicity groups, with Asian and Māori showing the largest percentage increases. Similarly, referral numbers have increased across age groups.

The Acute bed development group includes the Medical Director, Clinical leads/Lead clinicians, Senior Medical Officers (SMOs) from the acute units and Wairarapa Adult Team, MHAIDS directors, Intensive Recovery Sector Operations Manager and Team Leaders, Kaumatua and Consumer Advisors.

The group is now looking at the data to inform outcomes for a paper to facilitate discussion and establish an MHAIDS position for wider consultation, particularly in the high needs secure beds within the acute services.

One working stream is looking at how the Crisis Respite in Wairarapa can be converted into an Acute Alternative to hospital. In the past year there have been 57 acute admissions from the Wairarapa to the two adult acute units in the Hutt Valley and Wellington. We have seen a significant increase over several years, it is expected to increase further particularly with police now dropping people directly to Emergency Department (ED). There is a separate working group who is currently analysing data. A proposal paper will go to the respective Executives and on track to be presented to the next Board meeting.

Mārama Real-time feedback (MFRT)

We're embarking on a project to introduce a digital survey for service users and their whānau to tell us about their experience with our services. The tool, called Mārama Real-time Feedback, operates as an application on a touchscreen device, and contains questions for service users and their whānau to complete anonymously about their experience.

The anonymous survey results will be uploaded automatically when connected to Wi-Fi and will be uploaded to Qlik, allowing the data to be visible for each MHAIDS team. The survey will provide an additional avenue for service users and their whānau to share their feedback with us, which will be used by Quality and teams across the service for continuous quality improvement.

MRTF was launched on Monday 27 January.

Quality coordinators are visiting service areas this week to get everyone set up with a touch screen device, and go over the guidelines for use.

Smoke Free Project MHAIDS Acute units

A Smoke free project is underway for our Adult Acute units.

From Monday 21 October 2019, lighting devices were no longer be permitted on our adult acute inpatient wards, Te Whare Ahuru and Te Whare O Matairangi. All clients and visitors are now asked to place matches, lighters and any other lighting devices with reception while on the ward.

This new restriction will enable staff to ensure that the ward is a safe environment for clients, staff and visitors. Nicotine Replacement Treatment (NRT) is being offered to clients to assist in the transition.

These changes are part of an overall smoke free initiative, where our adult acute inpatient wards are working towards becoming smoke free environments. This has already been successfully implemented in our Forensic and Rehabilitation Units at Rātonga Rua o Porirua Campus.


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PUBLICGeneral Practitioner Liaison service

MHAIDS is in the process of setting up new General Practice (GP) Liaison Consultant position in order to build stronger and more efficient links with our GPs across the Wairarapa, Hutt valley and Capital & Coast DHB.

The GP Liaison Consultant will work to link primary care and secondary mental health services by providing advice, consultation, and liaison. This includes primary care being able to access timely advice from secondary mental health services (including phone advice).

Emergency Department Liaison Nurse

In April 2019 MHAIDS piloted having a Mental Health Nurse based in ED, to assist in the acute demand on emergency departments and the crisis resolution service.

The MHAIDS ED Response Nurse is based in Wellington Hospital Emergency Department, but reports to the Team Leader, Te Haika. They determine those who need to be seen urgently, while being able to safely defer less urgent referrals to non-crisis parts of the mental health and addiction services. They have a critical role in both formal and informal training/support of ED staff around mental health presentations. Since April 2019, we have had a 0.8FTE registered nurse acting in this position.

The MHAIDS Consult Attendance Discharge time reports shows a reduction in wait times when the MHAIDS ED Liaison Nurse is on shift, this is also a key Ministry of Health target - we report on waiting times for MH presentations in ED quarterly. The increase in RN staffing will enable a wider availability of the role in times of high demand during the day and coverage for leave.

We now have the opportunity to employ another three Registered Nurses (RN) permanently into ED Liaison Nursing roles. We have received extremely positive feedback about this role in Wellington Hospital from ED staff and Senior ED Management, as well as NZ Police. We are extending this pilot and trial in Hutt Valley ED also. We will complete a more formal evaluation this year.

Wellington Co-Response Team (CRT)

A pilot is underway, to operate a Mental Health co-response service in the Wellington District (excluding the Wairarapa for now) for people who ring 111 requiring a mental health response. Similar models operate in many overseas jurisdictions and have been extensively evaluated with overwhelming positive outcomes for service users and agencies.

The co-response service will have staff from Wellington District Police, Wellington Free Ambulance (WFA) and District Health Board (DHB) Mental Health services jointly deploying together to events requiring mental health intervention, including attempted suicides. In many instances, this may be as a priority emergency response.

The aim of the co-response service is to enable patients presenting with mental health crisis to receive the most appropriate response in the right setting for their needs. The service will mean more patients can be assessed and provided therapeutic care in a home or community setting, rather than being transported to an emergency department or police station.

Te Whare Ahuru rebuild

Late last month we received the excellent news that the Government has confirmed capital funding for the Te Whare Ahuru project. The Government has allocated $25 million for the unit, which means we can now focus our efforts on a full rebuild as part of the project, which has been ongoing for 18 months.

This funding will assist with the development of a fit for purpose facility to provide a safe, more therapeutic and culturally appropriate environment.

As a result of this new funding, we are now finalising the business case and working through the implications and new planning requirements.


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PUBLICImproving our communication – automated documents

From Tuesday 18 February, all finalised MHAIDS Intake, Initial Assessment and Service Exit plans are now automatically sent to service users’ GPs from the Digital Client Record in Concerto/MAP. This also means that clients may be able to view this information through online portals, such as ManageMyHealth.

Within the next month, GPs will also automatically receive a copy of a client’s Whānau Tahi wellness plan, if ‘yes’ has been ticked on the service exit plan.

4 MHAIDS STRATEGIC WORKFORCE PLANNING

Recruitment of MHAIDS nurses is a challenge locally and nationally. We are also mindful of the aging workforce and the need to mitigate both of these issues. We are also aware of Māori and Pacific people being over represented in MHAID services.

We have a couple of ongoing projects to address this, whilst also focusing on ‘growing our own’ to meet needs.

Over the last few years we have increased the number of New Entry to Specialist Practice (NESPs) nurses. For the February intake we have 24 nurses recruited to this. We aim to recruit 50 in any one year.

We also have an Allied Health NESP programme focused on occupational therapy and social work (2 each, per year).

As well as this, we support Clinical Psychology interns, (up to 5 per year) and the RANZCP Psychiatry Registrar Training Programme.

To further support us ‘growing our own’, we also provide up to 10 yearly scholarship to MH support workers and admin staff currently working with us. The scholarship supports these staff to complete the Bachelor of Nursing or Social Work degree. We have eight successful applicants beginning their scholarships in 2020, and seven progressing through the programme beyond first year.

Index:

∑ TWOM – Acute Adult Inpatient unit - Wellington Hospital

∑ TWA – Acute Adult Inpatient Unit - Hutt Hospital

∑ Rangatahi – Regional Acute Adolescent unit, Kenepuru Hospital (RRAIU)

∑ Te Whare Ra Uta – Older Persons Mental Health inpatient unit, Kenepuru Hospital

∑ Hikitia – National Intellectual Disability Secure Youth unit

∑ Haumietiketike – National Intellectual Disability Secure Adult unit

∑ Manawanui and Whakaruru – Intellectual Disability Step down Cottages

∑ Purehurehu and Rangipapa – Regional Forensic Secure units

∑ Pukeko and Saunders House – Forensic Service Step Down Cottages

∑ Tane Mahuta, Tawhirimatea and 7 Cottages – Regional Inpatient Rehabilitation and Extended Care.

∑ CRS – Crisis Resolution Service (2DHB)

∑ CREDS – Central Regional Eating Disorder Service

∑ TACT – Team for Assertive Community Treatment

∑ RPDS – Regional Personality Disorder Service

∑ CAG – Consumer Advisory Group

∑ DNA – Did not Attend

∑ CAMHS – Child and Adolescent Mental Health Services

∑ CMHT – Community Mental Health Team


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Date: February 2020

Author Kieran McCann, Executive Leader Operations


Subject Hospital & Community Services Report for January 2020


a. Notes this paper and discusses as appropriate

APPENDICIES1. Planned Care Performance

1. PROVIDER OVERVIEW

Operationally January has seen the hospital delivering 807 inpatient discharges and 1,488 Emergency Department attendances. For the last seven months of 2019 to January 2020, inpatient discharges were 5,794, resulting in 13,422 bed days with the average length of stay being 2.32 days. Comparable to the same period in the previous year, there is a decrease in inpatient discharges of 273 patients. But with patients staying longer over the year to date this has increased by 0.18 average days stayed. The Average Length of Stay (ALOS) has reduced over the summer period.

Outpatients have seen 1,893 attendances for January with Community Nursing services providing 5,500 domiciliary contact visits for the month. Overall volumes are tracking similar to last year with a small increase in District Nurse volumes. Planned increase in First Assessments with a reduction in follow up appointments are noted in the Outpatient Department.

Maternity has continued to see spikes in activity over the last few months and are tracking 44 births ahead of the same period last year. Some complex secondary care deliveries particularly in January have seen the ALOS increase with some outliers into Paediatrics and the Medical Surgical Ward (MSW) which has been historically an uncommon situation.

Surgical activity has been reduced recently due to the close downs over the December holiday period andwith surgeon vacancy. The use of General Surgical Locums has seen outpatient clinic activity maintained and good progress on wait times for First Specialist Assessment (FSA). The first time in over two years where we have achieved Ministry targets on Outpatient waiting times. Limited progress has been made on Surgical Wait times due to availability of Locums in orthopaedics, this situation is likely to continue until surgeon capacity can be addressed.

The key area of challenge for the Provider arm has been the exacerbation of Senior Medical Officer (SMO)vacancies particularly in Orthopaedics. We have been working closely with our counterparts in neighbouring DHBs to look at contingency plans for providing access to services but also by way of expanding the approach to addressing critical workforce shortages and recruitment strategies for SMO staffing.


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2. STAFFING

a. Sick Leave

The DHB’s sick leave rate sits at 2.7% of worked hours for January. Perioperative has decreased this month to 3.3% and averaging 4.6% so far this financial year. MSW is at 3.2% this month averaging 3.5% this financial year. Maternity has increased this month to 6.5% and Radiology is at 3.6%.

0.0%

2.0%

4.0%

6.0%

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12.0%

Jan

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eJu

lyA

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n2016 2017 2018 2019 2020

Perioperative - Sick Leave as % of Worked Hours

Sick as a % of Worked - DHB Wide Sick as a % of Worked - Periop Linear ( Sick as a % of Worked - DHB Wide) Linear (Sick as a % of Worked - Periop)

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2016 2017 2018 2019 2020

Maternity - Sick Leave as % of Worked Hours

Sick as a % of Worked - DHB Wide Sick as a % of Worked - Maty Linear ( Sick as a % of Worked - DHB Wide) Linear (Sick as a % of Worked - Maty)

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MSW - Sick Leave as % of Worked Hours

Sick as a % of Worked - DHB Wide Sick as a % of Worked - MSW Linear ( Sick as a % of Worked - DHB Wide) Linear (Sick as a % of Worked - MSW)

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Radiology - Sick Leave as % of Worked HoursSick as a % of Worked - radiology Sick as a % of Worked - DHB Wide Linear (Sick as a % of Worked - radiology) Linear ( Sick as a % of Worked - DHB Wide)

b. Annual Leave

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Annual Leave and Anticipated annual leave Hours Coded in Payroll - by employee category

Allied Medical Mgmt & Admin Nursing Support

Annual leave for January levels remains relatively consistent with previous trends during school holidays.


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c. Key changes Staff and recruitment (New recruitment updates)

Key Staff Monthly ChangesMedical Imaging Technologist (MIT)

MIT vacancy (1.0FTE) has been recruited to, with an overseas applicantstarting late January. The NZ Medical Radiation Technologist Board requires MIT staff to work under supervision for a six week period beforepracticing independently; early March.

Speech Therapy Speech-language therapy recruitment has been successful, with an overseas therapist starting on beginning February. This will cover a 0.6FTE Allied Health role and the 0.2FTE Child Development Services role.

Child Development Service (CDS)

New CDS funding (announced in the 2019 Government Budget) has resulted in recruitment of an additional 0.4FTE Clinical Psychologist resource (fixed term for five months; end June 2020). This is being directed to cognitive assessment for children who have been on the wait list for an extended time.

Oral Health Successful recruitment to an Oral Health Therapist position occurred during late January, confirmed to start in a 1.0FTE position beginning of March 2020. This leaves a significant gap of 1.8FTE vacant in a team of 6.4FTE Oral Health Therapists.

d. Existing recruitment actions

Key Staff ExistingGeneral Surgeon 0.0FTE

∑ General Surgeon vacancies are offset by offers made for permanent and fixed terms positions.

∑ Interim locum started in February for six months∑ Extended locum secured starting 20 March for one year with a view to

permanent employment.∑ Two permanent offers made currently awaiting immigration and

registration clearance with the Medical Council of New Zealand.∑ Co-ordination and continuity challenges with high dependency on

locum use mitigated with Senior Clinical Nurse co-ordinator supporting Surgeons.

Orthopaedic Surgeon 3.0 FTE

∑ A resignation received end of January has resulted in three active vacancies and one Orthopaedic Surgeon on staff post March 2020.

∑ One offer has been declined and another is subject to immigration and registration requirements.

∑ Agreement with CCDHB to cover all acute patients two days per weekwhere existing roster gaps occur on a regular basis.

Anaesthetist 1.5 FTE ∑ 1.5FTE vacancies at the end of 2019 with early notification of changes from current staff.

∑ Active Locum procurement, some long term contracts offered to cover between permanent recruitment. Three further interviews booked.

∑ Two confirmed overseas Locum appointments have fallen through causing scheduling difficulties for post roster confirmation.

MOSS AT&R 0.8 FTE ∑ Assessment, Treatment and rehabilitation (AT&R) role under offer.∑ Locum cover available for interim during configuration and

recruitment.MIT ∑ Proposal submitted for a pilot of an Imaging Assistant role to support

Imaging Team and MITs.Dental Therapist ∑ 1.8FTE Vacancies historically difficult to recruit for.

∑ Active recruitment continues, includes recruitment agencies and an international audience.


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3. ACTIVITY & OPERATIONAL PERFORMANCE

3.1 Emergency Department waiting times

Wait time performance for the six-hour Emergency Department (ED) target overall for quarter two was not achieved at 90.4%, due to high number of presentations during the end of 2019. Wait time performancefor January was just below the 95% target at 93.9%.

Month Total Presentations

Within 6 hours Result

Jul-18 1,446 1,338 92.5%Aug-18 1,536 1,425 92.8%Sep-18 1,502 1,383 92.1%Oct-18 1,521 1,365 89.7%Nov-18 1,439 1,340 93.1%Dec-18 1,548 1,408 91.0%Jan-19 1,598 1,477 92.4%Feb-19 1,395 1,327 95.1%Mar-19 1,537 1,394 90.7%Apr-19 1,359 1,289 94.8%May-19 1,499 1,391 92.8%Jun-19 1,392 1,307 93.9%Jul-19 1,503 1,370 91.2%Aug-19 1,418 1,300 91.7%Sep-19 1,365 1,219 89.3%Oct-19 1,516 1,393 91.9%Nov-19 1,514 1,352 89.3%Dec-19 1,560 1,404 90.0%Jan-20 1,480 1,390 93.9%

Quarter Total Presentations

Within 6 hours Result

QRT1 18/19 4,484 4,146 92.5%QRT2 18/19 4,508 4,113 91.2%QRT3 18/19 4,530 4,198 92.7%QRT4 18/19 4,250 3,987 93.8%QRT1 19/20 4,286 3,889 90.7%QRT2 19/20 4,590 4,149 90.4%

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun2020 1,513 1,423 1,378 1,513 1,526 1,576 1,4882018 1,515 1,548 1,463 1,538 1,492 1,680 1,634 1,435 1,502 1,438 1,431 1,4522019 1,451 1,548 1,509 1,528 1,442 1,559 1,600 1,397 1,542 1,363 1,503 1,394

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

Total ED Presentations2020 2018 2019

0

100

200

300

400

500

600

700

800

Jul

Aug

Sep

Oct

Nov De

c

Jan

Feb

Mar

Apr

May Jun Jul

Aug

Sep

Oct

Nov De

c

Jan

Feb

Mar

Apr

May Jun Jul

Aug

Sep

Oct

Nov De

c

Jan

2018 2019 2020

ED Attendances By Triage1 2 3 4 5


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0

200

400

600

800

1,000

1,200

1,400

Jul

Au

g

Sep

Oct

No

v

Dec Ja

n

Feb

Mar

Ap

r

May Ju

n

Jul

Au

g

Sep

Oct

No

v

Dec Ja

n

Feb

Mar

Ap

r

May Ju

n

Jul

Au

g

Sep

Oct

No

v

Dec Ja

n

2018 2019 2020

ED Presentations by Referral Source

Ambulance Other GP Self Referral

3.2 Maternity Services

Maternity continues to be demanding with 44 births ahead of the previous year and almost 30% of all the births booked through the additional Team Midwife Role. This reflects the national picture of seasonal shortages of Lead Maternity Carer (LMC) and declining trend in caseloads to ensure manageable workloads.Forecasts for this year indicate around 35 women will access this service due to LMC availability. The Wairarapa has planned well and access to midwifery services are available to women throughout.

The caesarean-section rate sits at 20.7% during January and 32.9% year to date, with September 2019peaking at 45.2%, 19 caesarean-sections of 42 total births.


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4. AVERAGE LENGTH OF STAY & AVERAGE CASE WEIGHTED DISCHARGES

4.1 Medical & Rehab

General Medical ALOS and Average Case Weighted Discharge (ACWD) has remained relatively static for the last year. Overflow of acute Medical patients into AT&R for shorter stay (non-rehab patient’s i.e. medical boarders) has seen ALOS for AT&R reduce to 12.8 days during January comparable to 17.2 days last year.30 non-rehab patients have been admitted to AT&R with an ALOS of 4.17 days.

0

50

100

150

200

250

300

0.000.501.001.502.002.503.003.504.004.50

Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20

General Medicine ALOS & ACWD July 18 - Jan 20Avg Length Of Stay Avg CaseWeighted Discharges

Inpatient Caseweighted Discharges 2 per. Mov. Avg. (Avg Length Of Stay)

2 per. Mov. Avg. (Avg CaseWeighted Discharges)

0

5

10

15

20

25

30

0.00

5.00

10.00

15.00

20.00

25.00


ATR ALOS Jul 18 - Jan 20

Avg Length Of Stay Inpatient Discharges 2 per. Mov. Avg. (Avg Length Of Stay)

4.2 Surgical

Orthopaedic average length of stay similar to previous year at 2.64 days, with acute patients at 3.83 days and planned patients at 1.78 days. Long stay patients have affected the General Surgery ALOS at times. Early reporting of data for this report will impact results which may change as coding is completed on patients through the month.


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0

20

40

60

80

100

120

0.00

1.00

2.00

3.00

4.00

5.00

6.00


General Surgery ALOS & ACWD July 18 - Jan 20

Avg Length Of Stay Avg CaseWeighted Discharges Inpatient Caseweighted Discharges

2 per. Mov. Avg. (Avg Length Of Stay) 2 per. Mov. Avg. (Avg CaseWeighted Discharges)

0

20

40

60

80

100

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00


Orthopaedics ALOS & ACWD July 18 - Jan 20

Avg Length Of Stay Avg CaseWeighted Discharges Inpatient Caseweighted Discharges

2 per. Mov. Avg. (Avg Length Of Stay) 2 per. Mov. Avg. (Avg CaseWeighted Discharges)

Key Issues Key actions underwayIncreased length of stay and flow blocks

∑ Development of early checklists and engagement for proactive identification and management for complex social patients.

∑ Weekly monitoring and initiation of long stay patients in review.∑ Medical rounding on General surgical patients with LOA > seven days.∑ Discharge Navigator role recruited beginning end of February reduction of

readmission rates and ALOS with more forward planning of discharge.

Fiscal Year 2020

Fiscal Month Desc 07 - Jan

Purchase Unit code MTD Actual

VolumeMTD Contract

VolumeMTD Volume

VarianceYTD Actual

VolumeYTD Contract

VolumeYTD Volume

VarianceCaseweight Acute 293.7 418.8 (125.1) 2,894.5 2,931.8 (37.3)

M00001.a - General Internal Medical Services - acute 163.2 195.5 (32.2) 1,398.5 1,368.2 30.3M05001.a - Emergency - Inpatient Services acute 25.5 39.7 (14.2) 236.4 278.0 (41.6)M55001.a - Paediatric Medical - Inpatient Services acute 11.3 20.2 (8.9) 161.5 141.2 20.3S00001.a - General Surgery - Inpatient Services acute 32.4 55.8 (23.4) 345.9 390.8 (45.0)S30001.a - Gynaecology - Inpatient Services acute 4.6 7.8 (3.2) 23.6 54.8 (31.2)S45001.a - Orthopaedics - Inpatient Services acute 20.7 59.1 (38.4) 332.2 413.6 (81.4)W06003.a - Neonatal - Inpatient Services acute 5.1 7.8 (2.7) 92.4 54.8 37.6W10001.a - Maternity - Inpatient Services acute 30.8 32.9 (2.2) 304.0 230.4 73.6

Grand Total 293.7 418.8 (125.1) 2,894.5 2,931.8 (37.3)

Local Acute CWDs volumes are tracking behind contract by 37.3 YTD. This number will continue to change due to coding being finalised.

3.4. Planned Care (including Electives)

NB* Appendix 1 corresponds to the Planned Care performance as reported to the Ministry of Health (MoH) and is aligned to the MoH dashboard for the activity delivered as December 2019.


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Key Performance Area CommentaryPlanned Care Interventions Delivery (case weights, discharges and minor procedures)

The MoH has split the 2019/20 planned care initiative into three components (replacing the electives and ambulatory initiatives of the past)∑ Inpatient surgical discharge∑ minor procedures both inpatients and outpatient∑ non-surgical interventions

December 2019 positive with 188 (111.2%) additional interventions. Positive overall, 111.2% at year-end we need to maintain > 95% of agreed total expectations by type of intervention, each intervention to be looked at separately andbroken down by: ∑ Inpatient Surgical discharges sitting adverse at 92.6%,

which equates to 60 less discharges than planned. Case Weight Delivery (CWD) is adverse at 90.7% or 164.5.

∑ Minor procedures positive at 174.6%, with 285 more interventions delivered than planned.

∑ A break down by main surgical specialities discharges and case weights are below to December 2019:

1. Ear, Nose & Throat (ENT), 11 discharges (3.2 CWD’s) ahead; HVDHB provide this service.

2. Gynaecology, 15 patients ahead of discharge targets and 12.8 CWD’s ahead

3. General Surgery, 44 behind of contracted discharge targets (84.9%) and 87.9 CWD’s behind contract (78.6%).

4. Ophthalmology is a deficit of 7.5 CWD. Discharges, 95.0% (9behind). Complex surgeries are performed at Capital and Coast DHB (CCDHB) with cataracts at WrDHB. Theatre schedules have been altered to accommodate

5. Orthopaedics are 69.7 CWD’s under delivered 87.3%. Similarly, discharges are 56 patients behind. Orthopaedic surgery has been impacted by strikes and SMO vacancies. Use of Locums has impacted on case selection relating to clinical continuity and procedural familiarisation.

6. Urology, 98.5% of overall discharges (one patient).7. Minor procedures delivered to December 2019 are 667 on a

plan of 382, 174.6%. This is due to 152 more skin lesions than planned, 33 more Gynaecology, 102 more Avastin and eye procedures

Planned Care Interventions Delivery Actions∑ Implementation of Production Plan monitoring and reporting is completed and now monitored.∑ Restricted access to planned services for Non-Wairarapa DHB domiciled patients.∑ An interdisciplinary meeting comprising of Orthopaedic Clinicians, Nursing, Theatre staff and Primary

Health Organisation (PHO) liaison is currently being set up to discuss patient options and management of Orthopaedic referrals.

∑ Theatre utilisation project around Orthopaedics is being undertaken to ensure optimum theatre capacity.


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Key Performance Area CommentaryElective Service Patient Flow Indicators (ESPIs) – breakdown of ESPI 2 and 5

To December 2019 the DHB performance has been in red for both ESPI 2 and 5. January 2020; ESPI 2 there were no patients waiting longer than four months therefore the DHB will achieve.Non-compliance services ESPI 5 January 2020:

∑ Orthopaedics 88 patients

Ophthalmology ∑ All referrals are now seen at FSA and treated within the four month timeframe. Dependent on locum availability.

∑ Ophthalmology is a service at risk as we use locums to provide local service of which all are coming up to retirement.

ENT ∑ Hutt Valley DHB (HVDHB) was unable to provide clinics during December 2019 and January 2020.

∑ WrDHB was unable to secure a locum in December 2019but have secured a locum in January to backfill clinics.

∑ We remain compliant for all patients being seen at FSA within four months.

∑ Audiology remains an area of concern for WrDHB. HVDHB is still unable to provide an Audiologist to attend clinics with SMO’s. Community Audiology services are providing this service at present however one provider has opted not continue due to capacity. This has resulted in all patients needing hearing aids or hearing aid reviews from the ages of 0-15 years old being transferred to HVDHB.

Orthopaedics & General Surgery ∑ General Surgery is now compliant for both FSA and Surgery. It is anticipate this will remain compliant given long term locums have now been secured.

∑ Orthopaedics is currently compliant for FSA but 88 non-compliant for surgery (as at end of January). This is liable to deteriorate for both FSA and planned services given the staffing shortage of SMO’s.

Gynaecology ∑ Compliant in both FSA and Surgery, therefore no patients waiting longer than four months for assessment or treatment.

Diagnostics performance (Computed Tomography (CT) &Magnetic Resonance Imaging (MRI))

∑ MRI wait times continue to underperforming against the 90% waiting time targets. Currently sitting at 56.4% in January 2020 which is significant drop from the improvement leading up to 71.8% in December 2019.

∑ CT performance has not achieved the 95% target set for the DHB for the last two months. December 2019 and January 2020 at 93.7% and 89.1% respectively. Predominantly a result of staff vacancies.

∑ CT impacted by MIT vacancies. A targeted overseas recruitment process has been undertaken and an MIT has been appointed. Achievements for wait time targets will improve in March.


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Key Performance Area CommentaryDiagnostics performance (Computed Tomography (CT) &Magnetic Resonance Imaging (MRI))

MRI-Scanning∑ HVDHB provided additional sessions to assistant with

increased volumes.∑ HVDHB outsourcing to supplement capacity.∑ Ongoing recruitment of MITs and Radiologists.∑ WrDHB meeting with Radiology Providers to look at future

capacity and planning.Cardiac Surgery – Delivery & wait list

∑ Cardiac Surgery and management is provided by CCDHB.

3.5. First Specialist Assessment /Follow Up volumes to contract

First Assessments shows an over delivery of 78 attendances and under delivery of 98 follow-ups to October 2019 with variations by specialty provided in the table below. Variation is managed through the Electives Process and production planning.

Fiscal Year 2020



VolumeMTD Contract

VolumeMTD Volume

VarianceYTD Actual

VolumeYTD Contract

VolumeYTD Volume

VarianceOutpatients - First Assessments 659 714 -55 5,075 4,997 78

D01002 - Dental - 1st attendance 0 9 -9 48 60 -12M00002 - General Medicine - 1st attendance 75 67 8 544 466 78M00010 - Virtual FSA - Medical 49 26 23 289 183 106M10002 - Cardiology - 1st attendance 0 13 -13 0 93 -93M20002 - Endocrinology - 1st attendance 5 6 -1 45 44 1M20004 - Diabetes - 1st attendance 1 4 -3 11 25 -14M25002 - Gastroenterology - 1st attendance 5 9 -4 64 61 3M55002 - Paediatric Medical Outpatient - 1st attendance 34 44 -10 362 309 53MS01001 - Nurse Led Outpatient Clinics 55 50 5 388 350 38MS02002 - Botulinum toxin therapy 2 7 -5 41 49 -8S00002 - General Surgery - 1st attendance 100 125 -25 843 875 -32S00011 - Virtual FSA - Surgical 62 62 0 482 437 45S25002 - ENT - 1st attendance 54 37 17 267 256 11S30002 - Gynaecology - 1st attendance 52 66 -14 325 461 -136S40002 - Ophthalmology - 1st attendance 35 58 -23 470 408 62S45002 - Orthopaedics - 1st attendance 72 58 14 438 403 35S45004 - Fracture Clinic - 1st attendance 8 7 1 71 49 22S60002 - Plastics (inc Burns & Maxillofacial) - 1st attend. 36 43 -7 247 303 -56S70002 - Urology - 1st attendance 14 24 -10 140 167 -27

Outpatients - Subsequent Assessments 849 861 -12 5,932 6,030 -98M00003 - General Medicine - Subsequent attendance 74 100 -26 526 700 -174M10003 - Cardiology - Subsequent attendance 0 0 0 0 2 -2M20003 - Endocrinology - Subsequent attendance 7 7 0 67 47 20M20005 - Diabetes - Subsequent attendance 9 12 -3 88 83 5M25003 - Gastroenterology - Subsequent attendance 30 47 -17 99 330 -231M55003 - Paediatric Medical Outpatient - Subsequent attend. 127 133 -6 895 934 -39S00003 - General Surgery - Subsequent attendance 106 133 -27 879 933 -54S25003 - ENT - Susequent attendance 39 45 -6 283 314 -31S30003 - Gynaecology - Subsequent attendance 49 71 -22 386 498 -112S40003 - Ophthalmology - Subsequent attendance 228 165 63 1,510 1,155 355S45003 - Orthopaedics - Subsequent attendance 88 72 16 544 506 38S45005 - Fracture Clinic - Subsequent attendance 23 34 -11 161 241 -80S60003 - Plastics (inc Burns & Maxillofacial) - Sub attend. 21 19 2 135 130 5


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3.6. Elective Case Weighted Discharge volumes to contract

Fiscal Year 2020



VolumeMTD Contract

VolumeMTD Volume

VarianceYTD Actual

VolumeYTD Contract

VolumeYTD Volume

VarianceCaseweight Elective 141.1 110.1 30.9 893.6 936.1 (42.5)

S00001.e - General Surgery - Inpatient Services elective 22.7 24.5 (1.7) 173.2 207.8 (34.6)S30001.e - Gynaecology - Inpatient Services elective 11.2 12.0 (0.8) 111.1 101.9 9.2S40001.e - Ophthalmology - Inpatient Services elective 14.5 6.8 7.6 80.2 58.0 22.2S45001.e - Orthopaedics - Inpatient Services elective 86.4 57.2 29.1 465.8 486.5 (20.7)S60001.e - Plastic & Burns - Inpatient Services elective 0.0 2.5 (2.5) 8.2 21.6 (13.4)S70001.e - Urology - Inpatient Services elective 6.3 7.1 (0.8) 55.1 60.3 (5.2)

Grand Total 141.1 110.1 30.9 893.6 936.1 (42.5)

Elective CWDs are behind plan by 42.5 YTD. Variation is referenced in the Planned Services report in the previous section. Note that this number will continue to change due to coding for the current month being finalised.

3.7. Theatre Utilisation / Cancellation Rate

There were 21 day of surgery cancellation in January, or 6.3% of total theatre events.

Cancellation Rate9- Orthopaedic 7- Endoscopy 4- General Surgery 1- Gynaecology

0%

2%

4%

6%

8%

10%

12%

0

5

10

15

20

25

30

35

40

Jul

Aug

Sep

Oct

Nov Dec

Jan

Feb

Mar

Apr

May Jun Jul

Aug

Sep

Oct

Nov Dec

Jan

2018 2019 2019

No. of DOS Cancellations

No. of DOS Cxl as % of theatre events

The reasons for cancellations were seven acute substitution, three for overruns/overbooking, five for patient reasons including unfit and patient cancelled, one for not required and five were miscellaneous/admin errors.

Theatre utilisation for January 2020 was 75% combined, 69% theatre 1, 87% theatre 2 and 71% theatre 3. Utilisation performance is being impacted by surgeon vacancies and this is anticipated to continue in the short term. Work undertaken by the theatre services team to improve utilisation including better visibility and access under utilised list sapce to accommodate acutes and maximise usage has buffered the surgeon vacancies impact on utilisation.


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0%10%20%30%40%50%60%70%80%90%

Jan-

18

Feb-

18M

ar-1

8

Apr-

18M

ay-1

8

Jun-

18Ju

l-18

Aug-

18

Sep-

18O

ct-1

8

Nov

-18

Dec

-18

Jan-

19Fe

b-19

Mar

-19

Apr-

19M

ay-1

9

Jun-

19Ju

l-19

Aug-

19Se

p-19

Oct

-19

Nov

-19

Dec

-19

Jan-

20

Theatre Utilisation All theatres

Combined Target

0%10%20%30%40%50%60%70%80%90%

100%

Jan-

18Fe

b-18

Mar

-18

Apr-

18M

ay-1

8Ju

n-18

Jul-1

8Au

g-18

Sep-

18O

ct-1

8N

ov-1

8D

ec-1

8Ja

n-19

Feb-

19M

ar-1

9Ap

r-19

May

-19

Jun-

19Ju

l-19

Aug-

19Se

p-19

Oct

-19

Nov

-19

Dec

-19

Jan-

20

Theatre Utilisation - theatre 1

TH1 Target

0%10%20%30%40%50%60%70%80%90%

100%

Jan-

18Fe

b-18

Mar

-18

Apr-

18M

ay-1

8Ju

n-18

Jul-1

8Au

g-18

Sep-

18O

ct-1

8N

ov-1

8D

ec-1

8Ja

n-19

Feb-

19M

ar-1

9Ap

r-19

May

-19

Jun-

19Ju

l-19

Aug-

19Se

p-19

Oct

-19

Nov

-19

Dec

-19

Jan-

20


TH2 Target

0%10%20%30%40%50%60%70%80%90%

100%

Jan-

18Fe

b-18

Mar

-18

Apr-

18M

ay-1

8Ju

n-18

Jul-1

8Au

g-18

Sep-

18O

ct-1

8N

ov-1

8D

ec-1

8Ja

n-19

Feb-

19M

ar-1

9Ap

r-19

May

-19

Jun-

19Ju

l-19

Aug-

19Se

p-19

Oct

-19

Nov

-19

Dec

-19

Jan-

20


TH3 Target

3.5. Community Services

District Nursing

Monthly patient volumes for Community Nursing continues to be in excess of planned activity and similar to previous year’s volumes in palliative but ahead particularly for District Nursing services. Home help and personal care are conversely below plan and previous year activity for both the month and YTD.

0

200

400

600

800

1,000

Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun

DOM101.pc contacts - Community Services - palliative care services

This Yr Last Yr Actual Budget / SLA

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500


DOM101.ps contacts - Community Services - professional services


0

20

40

60

80

100

120

140

160


DOM105 Community Services - home help


0

500

1,000

1,500

2,000


DOM107 Community Services - personal care



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Child Development Services

We are utilising new funding from the Government’s 2019 budget to deliver additional Clinical Psychologist services targeted to children on the waiting list for cognitive assessment (as outlined in section 2.c).

Work is underway across the Central Region on innovative initiatives within Chid Development Services (CDS) that will be scoped and piloted in the larger DHBs with potential to roll out locally and regionally. This includes a regional feeding services, a regional programme for pre-term infant follow up and a regional approach to a point of entry coordination for CDS services.

The Ministry are funding Autism Diagnostic Observation Schedule (ADOS) training across the country for CDS Clinicians, three WrDHB clinicians will be attending ADOS training workshops in March.

FOCUS

Focus have seen a relatively steady start to the year. The service continues to have some minor issues in telephony and communciations resulting from a transition into their new location, Lincoln Road.

3.8. Diagnostics

Commentary on Diagnostics wait time performance is included in the Planned Section of this report in relation to MRI. All other performance metrics and targets have been met for the month from the Imaging department. Community Referred Radiology volumes exceeded the monthly contracted by 963.

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Jul-1

6

Sep-

16

No

v-16

Jan

-17

Mar

-17

May

-17

Jul-1

7

Sep-

17

No

v-17

Jan

-18

Mar

-18

May

-18

Jul-1

8

Sep-

18

No

v-18

Jan

-19

Mar

-19

May

-19

Jul-1

9

Sep-

19

No

v-19

Jan

-20

CT Wait Times

Wai Result Target Hutt Result

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Jul-1

6

Sep-

16

Nov

-16

Jan-

17

Mar

-17

May

-17

Jul-1

7

Sep-

17

Nov

-17

Jan-

18

Mar

-18

May

-18

Jul-1

8

Sep-

18

Nov

-18

Jan-

19

Mar

-19

May

-19

Jul-1

9

Sep-

19

Nov

-19

Jan-

20

MRI Wait TimesWai Result Target Hutt Result

Fiscal Year 2020


Values


VolumeMTD Contract

VolumeMTD Volume

VarianceYTD Actual

VolumeYTD Contract

VolumeYTD Volume

VarianceCS01001 - Community-referred radiology 1,321.0 1,291.7 29.3 10,005.0 9,041.7 963.3


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3.9. Endoscopy waiting times

Urgent 89%, Semi Urgent 67% and Surveillance Colonoscopy 62% targets were not achieved. Impact of surgeon availability and the December holiday shut down has impacted on these results. This is anticipated to improve as move into the second part of the year and surgeons become available.

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Jul-1

6

Sep-

16

Nov

-16

Jan-

17

Mar

-17

May

-17

Jul-1

7

Sep-

17

Nov

-17

Jan-

18

Mar

-18

May

-18

Jul-1

8

Sep-

18

Nov

-18

Jan-

19

Mar

-19

May

-19

Jul-1

9

Sep-

19

Nov

-19

Jan-

20

Urgent Colonoscopy

Result Target

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Jul-1

6

Sep-

16

Nov

-16

Jan-

17

Mar

-17

May

-17

Jul-1

7

Sep-

17

Nov

-17

Jan-

18

Mar

-18

May

-18

Jul-1

8

Sep-

18

Nov

-18

Jan-

19

Mar

-19

May

-19

Jul-1

9

Sep-

19

Nov

-19

Jan-

20

Semi-Urgent Colonoscopy

Result Target

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Jul-1

6

Sep-

16

Nov

-16

Jan-

17

Mar

-17

May

-17

Jul-1

7

Sep-

17

Nov

-17

Jan-

18

Mar

-18

May

-18

Jul-1

8

Sep-

18

Nov

-18

Jan-

19

Mar

-19

May

-19

Jul-1

9

Sep-

19

Nov

-19

Jan-

20Surveillance Colonoscopy

Result Target


106


BOARD DECISION PAPER

Date: February 2020

Author Sir Paul Collins, Wairarapa District Health Board Chair

Subject Resolution to Exclude the Public

RECOMMENDATION It is recommended that the Board

a. Agrees that Public be excluded from the following parts of the of the Meeting of the Board in accordance with the NZ Public Health and Disability Act 2000 (“the Act”) where the Board is considering subject matter in the following table.

b. Notes The grounds for the resolution is the Board, relying on Clause 32(a) of Schedule 3 of the Act believes the public conduct of the meeting would be likely to result in the disclosure of information for which good reason exists under the Official Information Act 1982 (OIA) to withhold, in particular:

SUBJECT REASON REFERENCE

Public Excluded Minutes For the reasons set out in the public Board agenda

Chief Executive’s report

Information contained in the paper may be subject to change as the information has not yet been reviewed by the FRACPaper contains information and advice that is likely to prejudice or disadvantage negotiations

Section9(2)(f)(iv)Section 9(2)(j)

DRAFT 2020 Schedule Any department or organisation holding the information to carry out, without prejudice or disadvantage, commercial activities

Section 9(2)(i)DRAFT 2020 Work plan

Community & Public Health Advisory Committee December 2019 Minutes

Draft Minutes from sub-committees. Papers contain information and advice that is likely to prejudice or disadvantage negotiations.

Section 9(2)(b)

Financial, Risk & Audit Committee November 2019 Minutes

Crown Funding Agreement for Planned Care Initiatives for 2019/20

Any department or organisation holding information to carry out prejudice or disadvantage, negotiations(including commercial and industrial negotiations

Section 9(2)(j)

Mental Health Solutions Limited Contract Variation

Wairarapa Radiology Services

Te Tiriti o Waitangi Policy Information on change processes that may enable affected individuals to be identifiedPrevent collection of information for improper use

Section 9(2)(a)Section 9(2)(k)

Orthopaedic Vacancies and Services

MHAIDs Integration Project

Quality, Risk & Innovation Quarterly Report, February 2020

Clinical Board Update

2020 02 27 Wairarapa Board Meeting PUBLIC - Other

107

2020 02 27 Wairarapa Board Meeting PUBLIC - Committee Minutes

108


109


110

Wairarapa District Health Board | Te Ore Ore Road | P O Box 96 | Masterton 5840 | P: 06 946 9800 | www.wairarapa.dhb.org.nz

Internal Memorandum

To: Wairarapa Board Members

From: Dale Oliff, Chief Executive Officer

Date: 7th February 2020

Subject: Media of Interest for January 2020To: Wairarapa Board Members


New hospice outreach on the way for FeatherstonFrom Wairarapa Times-Age Published 12:30 30/01/2020 In the last three months of 2019, it had 60 new patient and family referrals. ... It did 47 baking deliveries, 51 touch massage sessions, 49 home visits, 47 counselling sessions and 32 patient transports. ... "The Masterton shop is doing well, and our charity events bring funds, but we would like to attract more bequests and donations," Adamson said.

Funding sought so all PHOs, practices can go with health care homeFrom NZ Doctor Published 18:25 24/01/2020 A Budget bid of about $200,000 is sought by the Health Care Home Collaborative to widen access to its general-practice model of care. ... The Budget bid proposal reflects the cost of some of the key health care home projects run by the collaborative, including a data intelligence dataset demonstrating the impact of the model, shared care planning resources, and stratification tools. ... The collaborative doesn’t want to see some of the smallest PHOs, which could benefit most, not adopting the health care home approach because they can’t afford to. Drug decision may ‘pave way’From Otago Daily Times Published 05:06 25/01/2020 The announcement was welcomed by Health Minister David Clark, who said he was delighted by the news. Exclusive: Ministry of Health considering proposal to fund struggling suicide prevention helplinesFrom TVNZ Published 19:18 24/01/2020 1 NEWS can reveal the Ministry of Health is considering a proposal for Lifeline and Youthline to be Government funded - which could help keep the charity-run services afloat. ... Relating to mental health helplines the three organisations submitted some documents outlining our thinking to the Ministry of Health prior to Christmas and we are in a process with them to clarify elements of this. ... Health

2020 02 27 Wairarapa Board Meeting PUBLIC - Appendices

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https://urldefense.com/v3/__https:/www.nzdoctor.co.nz/article/news/funding-sought-so-all-phos-practices-can-go-health-care-home__;!!A3teau8g8Q!Hf2x_2Bfl92RxnF9OUf-pdBxdTMEb1eker5N57d-fbDAOWQwrryAb_bCjXJHdVmHV3QRgqnZFw$

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https://urldefense.com/v3/__https:/www.tvnz.co.nz/one-news/new-zealand/exclusive-ministry-health-considering-proposal-fund-struggling-suicide-prevention-helplines__;!!A3teau8g8Q!Hf2x_2Bfl92RxnF9OUf-pdBxdTMEb1eker5N57d-fbDAOWQwrryAb_bCjXJHdVmHV3Qfnqe11w$



Minister David Clark referred questions from 1 NEWS to the Ministry of Health, who also refused to share any detail. Exclusive: Hawke's Bay DHB scrambling to check up on 300 patients caught in data blunderFrom TVNZ Published 18:28 24/01/2020 More than 300 renal patients in Hawke's Bay have had to be recalled for appointments and one patient may have been affected due to a "data issue" at the Hawke's Bay DHB. ... The issue dates back to March last year and the District Health Board says the error is affecting the visibility of patients due for recall appointments after their "first specialist assessment in clinic". ... Dr Russell Wills, acting chief medical officer at the DHB, told 1 NEWS in a statement the incident has been logged as an "adverse event" and says they believe one patient's health may have deteriorated as a result of the delay.

Newsletter: Hāpai Trending News 23 January 2020From Hapai Te Hauora Published 16:00 23/01/2020 Reports that DHB deficits are set to blow out even further this year are yet more proof that underfunding is bringing hospitals to their knees, says the new Executive Director of the Association of Salaried Medical Specialists, Sarah Dalton. ... Investigations are ongoing after an estimated 90,000 litres of partially treated wastewater leaked into the Ruamahanga River in Martinborough. It’s the latest water problem to beset the South Wairarapa town.

Wahine creating healthy futures for whanauFrom Wairarapa Times-Age Published 09:00 23/01/2020 A small group of passionate Wairarapa wahine are helping whanau improve their health and well-being. ... Community health worker Marlene Whaanga-Dean said the programme was all about "breaking down barriers" to make the health system more accessible. ... Wairarapa had a high needs population of Māori and Pacific Islanders, with literacy, inequality, and transport being huge barriers for people, Marlene said. Mike King's '1000 Letters' suicide study taken offline after Ministry of Health complaintsFrom TVNZ Published 10:45 23/01/2020 A spokesperson for the Health and Disabilities Commissioner confirmed a formal complaint had been received about 1000 Letters.

Integrated primary and community care to get a shove-along at sector meetingFrom NZ Doctor Published 23:06 16/01/2020 Mr Hefford says the health care home initiative is an example of expanding the general practice team to include additional roles such as clinical pharmacy and health coaches, but he envisages something broader than that for the future primary and community sector.


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https://urldefense.com/v3/__https:/times-age.co.nz/wahine-creating-healthy-futures-for-whanau/__;!!A3teau8g8Q!FYlI9T3w-fDu6NlElRvpNnEQgPkRlH_CrQGJSaGhutMynwKY_rmDx-xo4--hOINIRjvp_St1_Q$

https://urldefense.com/v3/__https:/www.tvnz.co.nz/one-news/new-zealand/mike-kings-1000-letters-suicide-study-taken-offline-after-ministry-health-complaints__;!!A3teau8g8Q!FYlI9T3w-fDu6NlElRvpNnEQgPkRlH_CrQGJSaGhutMynwKY_rmDx-xo4--hOINIRjvBgqVU2A$


https://urldefense.com/v3/__https:/www.nzdoctor.co.nz/article/news/integrated-primary-and-community-care-get-shove-along-sector-meeting__;!!A3teau8g8Q!GZHRvxsGYyhJ7R_BkLAsToZ4826-oWb7Q7Bwri0pXV9WakqfxbUJPx5AgNgEXYICs5PrkEOMBQ$



Former Medical Council chair keeps clinical eye on new Southern boardFrom NZ Doctor Published 23:06 16/01/2020 When Southern DHB early next month holds its first board meeting in nearly five years, former Medical Council chair Andrew Connolly will be there to keep a clinical eye on proceedings. ... In a rare move, health minister David Clark in December appointed two Crown monitors to keep an eye on the first elected board since former minister Jonathan Coleman sacked the last board in mid-2015. ... Auckland DHB’s former chief financial officer Roger Jarrold was appointed alongside Mr Connolly.

Car v truck: woman dies, man in critical conditionFrom Wairarapa Times-Age Published 11:30 15/01/2020 Wairarapa District Health Board communications manager Anna Cardno said the passenger - a 42-year-old man - was taken to Wairarapa Hospital in a critical condition before being transferred to Wellington Hospital by Life Flight. DHBs offering fewer smokers help with quittingFrom New Zealand Herald Published 17:54 15/01/2020 Also from New Zealand Herald, NZ Herald PoliticsNew data published by the Ministry of Health shows while in the middle of 2017 about 89 per cent of patients registered as smokers had been offered help by health professionals in the previous 15 months, that figure had slumped to 82.9 per cent by September last year. ... A year ago, nine of the country's DHBs were hitting a target set by the previous Government to help 90 per cent of patients who were smokers, while only three - West Coast, Whanganui and Wairarapa - met that goal in the most recent figures. ... Health Minister David Clark in 2018 announced he had asked health officials to come up with a new set of measurements to replace the previous Government's set of six - which include the smoking target - saying they created perverse incentives. Minister dithers as health service slips - Michael WoodhouseFrom Olivia O'Malley, National Party Published 09:40 15/01/2020 Also from VoxyHealth Minister David Clark’s refusal to set health targets is seeing standards slip nationwide and patients are suffering, National’s Health spokesperson Michael Woodhouse says. ... "All 20 DHBsbecame worse at managing emergency department waiting times, 18 of the 20 DHBs were worse at getting smokers to quit and efforts to provide faster cancer treatment slipped in 14 DHBs. ... "In elective surgeries, we know that there were nearly 6000 fewer procedures last year, the first decrease in a decade, but Dr Clark has stopped publishing data on the number of surgeries performed so we don’t even have first-quarter figures available.

Medical centre up by 2021From Wairarapa Times-Age Published 10:30 13/01/2020


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https://urldefense.com/v3/__https:/times-age.co.nz/car-v-truck-woman-dies-man-in-critical-condition/__;!!A3teau8g8Q!DhKci38jWvbXt7DdoUG9qhFD3sZAfkDQGxBm5PMno8X8ZuK55sawoyKOIkW3uDkclv-hMH2OaQ$

https://urldefense.com/v3/__https:/www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12300734__;!!A3teau8g8Q!DhKci38jWvbXt7DdoUG9qhFD3sZAfkDQGxBm5PMno8X8ZuK55sawoyKOIkW3uDkclv9QWIh23A$

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https://urldefense.com/v3/__https:/www.nzherald.co.nz/politics/news/article.cfm?c_id=280&objectid=12300734__;!!A3teau8g8Q!DhKci38jWvbXt7DdoUG9qhFD3sZAfkDQGxBm5PMno8X8ZuK55sawoyKOIkW3uDkclv82GJ-kiA$

https://urldefense.com/v3/__https:/news.fuseworksmedia.com/fc073710-61d4-491c-8f45-d44709b06e8a__;!!A3teau8g8Q!DhKci38jWvbXt7DdoUG9qhFD3sZAfkDQGxBm5PMno8X8ZuK55sawoyKOIkW3uDkclv_dNW_e0A$

https://urldefense.com/v3/__http:/www.voxy.co.nz/politics/5/356331__;!!A3teau8g8Q!DhKci38jWvbXt7DdoUG9qhFD3sZAfkDQGxBm5PMno8X8ZuK55sawoyKOIkW3uDkclv-nuB3PQg$

https://urldefense.com/v3/__https:/times-age.co.nz/medical-centre-up-by-2021/__;!!A3teau8g8Q!BRbzlEC7Ae51hmOn65Yiz-ThiEzYWb70aKi6JEX09BxcJ8WQNwmM2ygDidhR-_4Aqj3l2oNPeg$

Wairarapa District Health Board Violence Intervention Programme Evaluation: 2018-2019

Attention:

Dale Oliff, Chief Executive Officer Nicky Rivers, Director Allied Health, Scientific and Technical Jenny Milne, Social Work & Violence Intervention Programme Team Leader

Family Violence Intervention Coordinators (FVIC):

Narina Sewell Brad Martin

Date:

10 January 2020

Introduction

The Ministry of Health’s Violence Intervention Programme (VIP) seeks to reduce and prevent the health impacts of violence and abuse through early identification, assessment and referral of victims presenting to health services. This report reviews evaluation documents submitted to the AUT evaluators by Wairarapa DHB VIP team.

The evaluation period was 1st July 2018 – 30st June 2019. This report addresses the following evaluation activities:

1. Delphi self audit of programme infrastructure (inputs) assessed against criteria for an ideal programme;

2. VIP Snapshot clinical audits (outputs) to measure programme delivery in the Ministry of Health designated services; and

3. Model for Improvement Plan-Do-Study-Act (PDSA) cycles to foster system learning and quality improvement.

Evaluation methods and national evaluation reports are available at www.aut.ac.nz/vipevaluation. 1. Delphi programme infrastructure results

This is the second year collecting infrastructure data using the revised Delphi audit tool. The revised tool integrates both child protection and intimate partner violence (IPV) response system indicators. The Delphi includes an overall score, and scores across nine domains. Scores can range from 0 (no indicator achieved) to 100 (all indicators achieved).

• In 2019, Wairarapa DHB total Delphi score was 84, an increase from 72 in 2018 (Figure 1) – well done. The 2019 score is higher than the Ministry target of 80 and the national median of 80 (based on the 95% of DHBs who have submitted data to date).

• In 2019, scores in six of the nine domains exceeded the target of 80: Training & Support, Resource Funding, Cultural Responsiveness, Policies & Procedures, Collaboration and Documentation. Important improvements in system development were evident in 2019, particularly in VIP Practices and Cultural Responsiveness.


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2

Figure 1. Wairarapa DHB Delphi (programme infrastructure) total and domain scores 2018 and 2019

2. Clinical Snapshot results

2019 Clinical Audit Snapshot Notes Snapshot sample size. While snapshot data is from random samples of eligible children and women, the annual sample size per service is relatively small (25). The limited sample size reduces audit burden, but means that caution is warranted in interpreting concern (disclosure) and consultation (referral) rates, particularly when assessment rates are low. Snapshot National Estimates. The 2019 national estimates of assessment (enquiry) and concern (disclosure) rates provided in the following graphs and tables are likely to be updated as final data submissions and corrections are made. Snapshot Concern and Disclosure Rate Adjustments. Due to the pattern of consistently higher rates of child protection concern and intimate partner violence disclosure over time, concern and disclosure benchmarks were adjusted for 2019 (see 2018 Evaluation Report1 and Appendix Table 2). IPV disclosure rates between 5% (in postnatal maternity) and 25% (in community mental health) are expected. Child Protection Assessment and Concerns The national 2016 Guideline2 supports the use of a child protection checklist to increase the quality of child protection assessment and documentation for all children under 2 years of age presenting to emergency departments. Results from random samples of 25 charts during the April to June quarter 2014 to 2019 for Wairarapa Hospital emergency department are presented in Figure 2 and in the Appendix (Table 3). • The Ministry expects the child protection assessment rate to be ≥ 80% as indicative of consistent

rather than ad hoc service delivery. The Wairarapa Hospital emergency department snapshot sample evidences continuing improvement in child protection assessment, increasing from 64% in 2018 to 72% in 2019 – well done. While not yet achieving the target rate, the Wairarapa assessment rates in 2018 and 2019 are above the national median.

1 Koziol-McLain J, Howson M, Shun BV, Garrett N. (2019). Health response to family violence: 2018 violence intervention programme evaluation. Auckland: Centre for Interdisciplinary Trauma Research, Auckland University of Technology. 2 Fanslow, J., & Kelly, P. (2016). Family violence assessment and intervention guideline: Child abuse and intimate partner violence (2nd ed.). Wellington: Ministry of Health.

56

100

78

14

66 70

100

73

100

7260

100 98

57

100

70

100

81

100

84

0

20

40

60

80

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2018

2019


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3

• The national average of identifying a child protection concern, among those who have been assessed, has ranged from 5% to 13% over the time period 2014 – 2019. The Wairarapa Hospital emergency department concern identification rate has been zero across the last four snapshot audits. With increasing assessment rates (providing a larger sample of children assessed), we would expect to be able to detect child protection concerns in the clinical audit. Investigating what is needed to support health providers to identify child protection concerns (with subsequent specialist consultation) is warranted.

Figure 2. Wairarapa Hospital Emergency Department Child Protection Assessment and Concern Rates for Children under Two Years (April-June, 2014-2019) Notes: Based on a random sample of 25 charts for each audit period. Includes children under two years of age presenting to the ED for any reason. IPV Routine Enquiry and Disclosure Successive services have been added to the IPV Snapshot clinical audit between 2014 and 2016. Four of the six Ministry of Health designated services are provided by Wairarapa DHB (sexual health and alcohol and drug services contracted out). Wairarapa DHB IPV routine enquiry and disclosure rates based on clinical audits of random samples of 25 charts per service during the April to June quarter 2014 to 2019 are shown below (Figures 3-6) with details in Appendix Table 4. • The Ministry target indicative of reliable IPV enquiry is ≥ 80%. While not yet achieving the target,

the IPV assessment rate increased in 2019 compared to 2018 in three of the four Wairarapa DHB services (postnatal maternity, emergency department and community mental health). The 2019 assessment rate in these three services was also in the top 50% of DHBs nationally (rate higher than the national median).

• Research indicates that the quality of IPV screening influences women’s decision whether or not to disclose IPV to a health worker.3 2019 IPV disclosure rates among women assessed for IPV decreased in 2019 compared to 2018 and ranged from 0% (emergency department) to 17% (community mental health). The IPV disclosure rates were commensurate with the expected rate (see Appendix Table 2) in postnatal maternity and child health.

3 See Spangaro J, Koziol-McLain J, Zwi A, Rutherford A, Frail MA, Ruane J. Deciding to tell: Qualitative configurational analysis of decisions to disclose experience of intimate partner violence in antenatal care. Soc Sci Med. 2016;154:45-53; and Feder G, Hutson M, Ramsay J, Taket AR. Women exposed to intimate partner violence: expectations and experiences when they encounter health care professionals: a meta-analysis of qualitative studies. Arch Intern Med. 2006;166(1):22-37.

3%

16%4%

16%

64%72%

27% 26% 26%

39%48%

55%

0%

20%

40%

60%

80%

100%

2014 2015 2016 2017 2018 2019

ED Child Protection Assessment

Wairarapa National Mean Target

0%

75%

0% 0% 0% 0%

13% 9% 12% 10% 9% 5%0%

20%

40%

60%

80%

100%

2014 2015 2016 2017 2018 2019

ED Child Protection Concern

Wairarapa National Mean


116

4

Figure 3. Wairarapa DHB Postnatal Maternity IPV Routine Enquiry & Disclosure rates April-June 2014-2019

Figure 4. Wairarapa Child Health Inpatients IPV Routine Enquiry & Disclosure rates April-June 2014-2019

68%

80%

44% 44% 48%

68%

33%

48% 52% 53%62%

53%

0%

20%

40%

60%

80%

100%

2014 2015 2016 2017 2018 2019

Postnatal Maternity IPV Routine Enquiry


6% 5%0% 0%

17%6%

9% 4% 3% 4% 3%8%

0%

20%

40%

60%

80%

100%

2014 2015 2016 2017 2018 2019

Postnatal Maternity IPV Disclosure


26%

40%

20%28%

68%

40%

39% 35%42% 39% 43% 44%

0%

20%

40%

60%

80%

100%

2014 2015 2016 2017 2018 2019

Child Health Inpatient IPV Routine Enquiry


15%20%

0%

14% 18%

10%6% 4% 4% 7% 11% 11%

0%

20%

40%

60%

80%

100%

2014 2015 2016 2017 2018 2019

Child Health Inpatient IPV Disclosure



117

5

Figure 5. Wairarapa DHB Emergency Department IPV Routine Enquiry & Disclosure rates April-June 2015-2019

Figure 6. Wairarapa Community Mental Health IPV Routine Enquiry & Disclosure rates 2016-2019 3. Model for Improvement

Two PDSA plans were submitted in October 2019. The first cycle is a learning cycle to gather information about barriers to IPV routine enquiry in the emergency department. This is timely given the emergency services snapshot findings noted above (low rate of child protection concern identification and IPV disclosure). This learning will be achieved by gathering data about explanations for not asking about IPV. This learning cycle should inform future change actions to overcome barriers to family violence responsiveness. The second cycle aims to improve executive and clinical leader and staff participation in VIP training by providing training participation data and engaging in discussion with clinical and executive leaders. The evaluation team look forward to receiving the completed PDSA cycles for system learning.

24%

4%

16%8%

48%

23% 27% 30% 32% 28%

0%

20%

40%

60%

80%

100%

2015 2016 2017 2018 2019

Emergency Department IPV Routine Enquiry


0% 0% 0% 0% 0%6%

14% 12%22%

7%0%

20%

40%

60%

80%

100%

2015 2016 2017 2018 2019

Emergency Department IPV Disclosure


24%

72%

41%

72%

52%

40% 43%

59%

0%

20%

40%

60%

80%

100%

2016 2017 2018 2019

Community Mental Health IPV Routine Enquiry


0%

39%

78%

17%24% 28%

20%30%

0%

20%

40%

60%

80%

100%

2016 2017 2018 2019

Community Mental Health IPV Disclosure



118

6

Summary The Violence Intervention Programme team is to be congratulated on (a) increasing system infrastructure support evidenced by improved Delphi scores and (b) ongoing improvements in child protection and intimate partner violence assessment. While assessment has improved, identification of child protection concern and in some services, disclosure of IPV, have decreased in 2019 compared to 2018. This indicates a need to explore with teams the context and confidence of health providers in responding to family violence within their services and what system supports are needed. Improvement experts advocate emergent local learning at the coalface, recognising the importance of building relationships4 among those involved in the response pathway. We congratulate the VIP coordinators, managers, clinical champions and staff who are contributing to the Wairarapa DHB evaluation results for assessing and responding to women and children experiencing family violence. Please do not hesitate to contact me if you have any questions or comments. Respectfully submitted, Jane Koziol-McLain, PhD, RN VIP Evaluation Principal Investigator [email protected] cc: Helen Fraser (Portfolio Manager, Ministry of Health), Miranda Ritchie (National VIP Manager for DHBs, Health Networks Limited), Kara-Dee Morden (VIP National Trainer, SHINE), Helen Garrick (VIP Education & Training Manager, SHINE)

4 You may find the following article useful: Braithwaite J. Changing how we think about healthcare improvement. BMJ. 2018;361:k2014.


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mailto:[email protected]

7

Appendix Table 1: 2019 Delphi domain definitions

Domain Definition Weight # items

Organisational leadership

Ownership, leadership and support evidenced through participation, communication and connection

14 9

Training and support

Staff receive the appropriate training, reinforcement and support to effectively implement VIP

11.8 8

Resource funding

VIP funding is fully allocated, supporting continuous and sustained coordinator/s with dedicated cultural resource

11.5 3

VIP practices Intervention services including routine enquiry, health and risk assessment, safety planning, referrals and support, follow the Ministry of Health Family Violence Assessment and Intervention Guideline (FVAIG) procedures and are implemented at all levels of the DHB

11 8

Cultural Responsiveness

The programme includes education, support and services informed by people’s diverse needs: Maori, multicultural, disabled and gender identity when living with family violence

10.9 7

Quality improvement

Strategic and continuous monitoring to ensure effective programme delivery

10.8 10

Policies and procedures

Policies and procedures exist, are reviewed, aligned to guidelines and legislation and are culturally responsive

10.6 5

Collaboration Internal and external collaboration throughout programme and practice

10.5 5

Documentation Easily accessible standardised documentation tools, aligned with FVAIG, are used

8.8 3

Total

100 58


120

8

Table 2. Clinical audit snapshot benchmarks for child protection concern and intimate partner violence disclosure rate BENCHMARK Through 2018 2019 IPV Disclosure Rates

Postnatal Maternity 5% 5%

Child Health Inpatient 5% 10%

Alcohol & Drug 5% 15%

Emergency Department 5% 15%

Sexual Health 5% 15%

Community Mental Health 5% 25%

CAN Concern Rates

Child Abuse & Neglect 5% 15%

See: Koziol-McLain J, Howson M, Shun BV, Garrett N. (2019). Health response to family violence: 2018 violence intervention programme evaluation. Auckland: Centre for Interdisciplinary Trauma Research, Auckland University of Technology, page 19. Report available at www.aut.ac.nz/vipevaluation

Table 3. Child protection assessment for children under two years of age presenting to Wairarapa Hospital emergency department for any reason* (April – June, 2014-2019).

2014 2015 2016 2017 2018 2019 Child

Protection Assessment

Wairarapa DHB National Mean National Range

3% 27%

0-61%

16% 26%

0-76%

4% 26%

0-96%

16% 39%

4-88%

64% 48%

0-100%

72% 55%

0-100% Child

Protection Concern


0% 13%

0-100%

75% 9%

0-75%

0% 12%

0-100%

0% 10%

0-50%

0% 9%

0-50%

0% 5%

0-67% Specialist

Consultation Wairarapa DHB National Mean

0% 89%

100% 100%

0% 93%

0% 100%

0% 96%

- 90%

*Based on a random sample of 25 charts for each audit period.


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Table 4. Intimate partner violence (IPV) routine enquiry, disclosure and referral of women presenting to Wairarapa DHB Ministry of Health VIP designated services* (April - June, 2014-2019)

*Based on a random sample of 25 charts for each audit period.

Service 2014 2015 2016 2017 2018 2019 Postnatal Maternity

IPV Assessment


68% 33%

0-72%

80% 48%

0-100%

44% 52%

16-96%

44% 53%

24-96%

48% 62%

36-96%

68% 53%

8-80% IPV

Disclosure Wairarapa DHB National Mean National Range

6% 9%

0-25%

5% 4%

0-33%

0% 3%

0-17%

0% 4%

0-21%

17% 3%

0-17%

6% 8%

0-100% IPV Referral Wairarapa DHB

National Mean 0%

75% 100% 100%

0% 83%

0% 60%

100% 82%

0% 78%

Child Health Inpatient IPV

Assessment Wairarapa DHB National Mean

National Range

26% 39%

0-100%

40% 35%

12-92%

20% 42%

12-96%

28% 39%

0-80%

68% 43%

12-84%

40% 44%

4-92% IPV

Disclosure Wairarapa DHB National Mean

National Range

15% 6%

0-32%

20% 4%

0-33%

0% 4%

0-33%

14% 7%

0-62%

18% 11%

0-33%

10% 11%


National Mean 0%

54% 100% 100%

0% 75%

100% 69%

100% 72%

100% 90%

Emergency Department IPV


National Range

NA

24% 23%

0-68%

4% 27%

0-64%

16% 30%

4-64%

8% 32%

4-80%

48% 28%

0-56% IPV


National Range

0% 6%

0-100%

0% 14%

0-33%

0% 12%

0-100%

0% 22%

0-100%

0% 7%


National Mean

0% 75%

0% 94%

0% 78%

0% 88%

- 80%

Community Mental Health IPV


National Range

NA

NA

24% 52%

0-84%

72% 40%

0-92%

41% 43%

0-90%

72% 59%

0-100% IPV


National Range

0% 24%

0-100%

39% 28%

0-50%

78% 20%

0-100%

17% 30%


National Mean

0% 64%

86% 90%

100% 82%

100% 64%


122

NATIONAL HEALTH ADVISORY 7 February 2020 - Page 1 of 2

Regional Public Health, Community Health Building, Hutt Hospital, Private Bag 31907, Lower Hutt

Phone: 04 570 9002 Fax: 04 570 9211 Email: [email protected]

To: General Practices, Pharmacists, After-Hours Centres and Emergency Departments in the

greater Wellington and Wairarapa regions

From: Dr Annette Nesdale, Medical Officer of Health

Date: 07/02/2020

Title: National Health Advisory: Update on Coronavirus response 8

Please distribute the following information from the Ministry of Health to relevant staff in your

organisation.

UPDATE ON CORONAVIRUS RESPONSE 8

ADVISORY SUMMARY:

This advisory is to update you on the response to the coronavirus outbreak in China. As at 1500hrs

6 February 2020, there have been 28,149 cases confirmed worldwide, with 565 deaths.

27,902 of these cases have been in Mainland China.

Below is some updated guidance for the sector; please distribute as you see fit.

Confirmation of Eligibility for Publicly Funded Health Services for Non New Zealand Residents

Impacted by 2019-nCoV

Introduction

From Thursday 30 January 2020, novel coronavirus capable of causing severe respiratory illness was made a

notifiable infectious disease under the Health Act 1956. In addition to allowing the Health Act provisions

for the management of infectious diseases to be used for this new disease, its inclusion also triggers

changes in eligibility for publicly funded services.

Eligibility

Any person who requires services relating to a notifiable disease (or quarantinable disease) is covered as

part of publicly funded health services. These services include surveillance, diagnosis, treatment, follow up

and contact tracing of an infectious disease. This means that a person who would normally have to pay the

full cost of health services in New Zealand, for example a tourist at a public hospital or in a general practice,

is now eligible to receive the same publicly funded services as a New Zealand resident.


123

NATIONAL HEALTH ADVISORY 7 February 2020 - Page 2 of 2

Additional clarification for primary care for non-residents

When a person ineligible for health services presents to primary care they are initially treated and charged

as any ineligible casual patient.

1. If they meet the epidemiological and clinical definition of a ‘suspected case’, ‘probable case’, or

‘confirmed case’: a. the clinician will notify the Medical Officer of Health on call b. they will then be eligible for care as if they were a New Zealand resident c. they will still incur the usual co-payment (if appropriate) as per an eligible patient at that

practice.

Note: Eligibility only relates to health care associated with the Notifiable Disease and not to any

other health condition.

2. If they do not meet the epidemiological and clinical case definitions, they will continue to be

charged as an ineligible casual patient.

Where a suspected case is confirmed as not having a notifiable disease, then any subsequent visit or follow

up care required by primary care will be treated as if they were ineligible for New Zealand subsidised health

services (the patient should not retrospectively be charged for the original consultation).

The details of the processes around reimbursement to practices and pharmacies for service delivery have

yet to be arranged. The Ministry of Health will provide further communication when this has

occurred. Case definitions change, so please go to our website for the latest definition -

https://www.health.govt.nz/our-work/diseases-and-conditions/novel-coronavirus-2019-ncov for latest case

definitions

Guidance on self-isolation

The guidance on self-isolation has been updated and can be found here: https://www.health.govt.nz/our-

work/diseases-and-conditions/novel-coronavirus-2019-ncov/novel-coronavirus-self-isolation

Dedicated 0800 number for health advice and information

Healthline has set up a dedicated 0800 number specifically for health-related calls about the coronavirus.

The number is 0800 358 5453

Or for international SIMs +64 9 358 5453

People calling that line will be able to talk with a member of the National Telehealth Service and

interpreters will be on hand. The number is staffed by nurses, paramedics and health advisors.

Healthline’s existing number is still the main number to calls for non-coronavirus health concerns.


124

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https://urldefense.com/v3/__https:/www.health.govt.nz/our-work/diseases-and-conditions/novel-coronavirus-2019-ncov/novel-coronavirus-self-isolation__;!!A3teau8g8Q!Dq5VMIsowMTX5rIgQMPiBQg9Q-zKxDSORvtyKJsVkN66Su1WB6PsBSj0vRDP3jjVWMFE1iRc1SU$

https://urldefense.com/v3/__https:/www.health.govt.nz/our-work/diseases-and-conditions/novel-coronavirus-2019-ncov/novel-coronavirus-self-isolation__;!!A3teau8g8Q!Dq5VMIsowMTX5rIgQMPiBQg9Q-zKxDSORvtyKJsVkN66Su1WB6PsBSj0vRDP3jjVWMFE1iRc1SU$


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132


Internal Memorandum

To: Wairarapa Board Members


Date: 7th February 2020

Subject: Media of Interest for January 2020To: Wairarapa Board Members


New hospice outreach on the way for FeatherstonFrom Wairarapa Times-Age Published 12:30 30/01/2020 In the last three months of 2019, it had 60 new patient and family referrals. ... It did 47 baking deliveries, 51 touch massage sessions, 49 home visits, 47 counselling sessions and 32 patient transports. ... "The Masterton shop is doing well, and our charity events bring funds, but we would like to attract more bequests and donations," Adamson said.

Funding sought so all PHOs, practices can go with health care homeFrom NZ Doctor Published 18:25 24/01/2020 A Budget bid of about $200,000 is sought by the Health Care Home Collaborative to widen access to its general-practice model of care. ... The Budget bid proposal reflects the cost of some of the key health care home projects run by the collaborative, including a data intelligence dataset demonstrating the impact of the model, shared care planning resources, and stratification tools. ... The collaborative doesn’t want to see some of the smallest PHOs, which could benefit most, not adopting the health care home approach because they can’t afford to. Drug decision may ‘pave way’From Otago Daily Times Published 05:06 25/01/2020 The announcement was welcomed by Health Minister David Clark, who said he was delighted by the news. Exclusive: Ministry of Health considering proposal to fund struggling suicide prevention helplinesFrom TVNZ Published 19:18 24/01/2020 1 NEWS can reveal the Ministry of Health is considering a proposal for Lifeline and Youthline to be Government funded - which could help keep the charity-run services afloat. ... Relating to mental health helplines the three organisations submitted some documents outlining our thinking to the Ministry of Health prior to Christmas and we are in a process with them to clarify elements of this. ... Health


133

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https://urldefense.com/v3/__https:/www.nzdoctor.co.nz/article/news/funding-sought-so-all-phos-practices-can-go-health-care-home__;!!A3teau8g8Q!Hf2x_2Bfl92RxnF9OUf-pdBxdTMEb1eker5N57d-fbDAOWQwrryAb_bCjXJHdVmHV3QRgqnZFw$

https://urldefense.com/v3/__https:/www.odt.co.nz/news/dunedin/health/drug-decision-may-**Bpave-way**B__;4oCY4oCZ!!A3teau8g8Q!Hf2x_2Bfl92RxnF9OUf-pdBxdTMEb1eker5N57d-fbDAOWQwrryAb_bCjXJHdVmHV3QGxOxjIw$




Minister David Clark referred questions from 1 NEWS to the Ministry of Health, who also refused to share any detail. Exclusive: Hawke's Bay DHB scrambling to check up on 300 patients caught in data blunderFrom TVNZ Published 18:28 24/01/2020 More than 300 renal patients in Hawke's Bay have had to be recalled for appointments and one patient may have been affected due to a "data issue" at the Hawke's Bay DHB. ... The issue dates back to March last year and the District Health Board says the error is affecting the visibility of patients due for recall appointments after their "first specialist assessment in clinic". ... Dr Russell Wills, acting chief medical officer at the DHB, told 1 NEWS in a statement the incident has been logged as an "adverse event" and says they believe one patient's health may have deteriorated as a result of the delay.

Newsletter: Hāpai Trending News 23 January 2020From Hapai Te Hauora Published 16:00 23/01/2020 Reports that DHB deficits are set to blow out even further this year are yet more proof that underfunding is bringing hospitals to their knees, says the new Executive Director of the Association of Salaried Medical Specialists, Sarah Dalton. ... Investigations are ongoing after an estimated 90,000 litres of partially treated wastewater leaked into the Ruamahanga River in Martinborough. It’s the latest water problem to beset the South Wairarapa town.

Wahine creating healthy futures for whanauFrom Wairarapa Times-Age Published 09:00 23/01/2020 A small group of passionate Wairarapa wahine are helping whanau improve their health and well-being. ... Community health worker Marlene Whaanga-Dean said the programme was all about "breaking down barriers" to make the health system more accessible. ... Wairarapa had a high needs population of Māori and Pacific Islanders, with literacy, inequality, and transport being huge barriers for people, Marlene said. Mike King's '1000 Letters' suicide study taken offline after Ministry of Health complaintsFrom TVNZ Published 10:45 23/01/2020 A spokesperson for the Health and Disabilities Commissioner confirmed a formal complaint had been received about 1000 Letters.

Integrated primary and community care to get a shove-along at sector meetingFrom NZ Doctor Published 23:06 16/01/2020 Mr Hefford says the health care home initiative is an example of expanding the general practice team to include additional roles such as clinical pharmacy and health coaches, but he envisages something broader than that for the future primary and community sector.


134



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https://urldefense.com/v3/__https:/times-age.co.nz/wahine-creating-healthy-futures-for-whanau/__;!!A3teau8g8Q!FYlI9T3w-fDu6NlElRvpNnEQgPkRlH_CrQGJSaGhutMynwKY_rmDx-xo4--hOINIRjvp_St1_Q$






Former Medical Council chair keeps clinical eye on new Southern boardFrom NZ Doctor Published 23:06 16/01/2020 When Southern DHB early next month holds its first board meeting in nearly five years, former Medical Council chair Andrew Connolly will be there to keep a clinical eye on proceedings. ... In a rare move, health minister David Clark in December appointed two Crown monitors to keep an eye on the first elected board since former minister Jonathan Coleman sacked the last board in mid-2015. ... Auckland DHB’s former chief financial officer Roger Jarrold was appointed alongside Mr Connolly.

Car v truck: woman dies, man in critical conditionFrom Wairarapa Times-Age Published 11:30 15/01/2020 Wairarapa District Health Board communications manager Anna Cardno said the passenger - a 42-year-old man - was taken to Wairarapa Hospital in a critical condition before being transferred to Wellington Hospital by Life Flight. DHBs offering fewer smokers help with quittingFrom New Zealand Herald Published 17:54 15/01/2020 Also from New Zealand Herald, NZ Herald PoliticsNew data published by the Ministry of Health shows while in the middle of 2017 about 89 per cent of patients registered as smokers had been offered help by health professionals in the previous 15 months, that figure had slumped to 82.9 per cent by September last year. ... A year ago, nine of the country's DHBs were hitting a target set by the previous Government to help 90 per cent of patients who were smokers, while only three - West Coast, Whanganui and Wairarapa - met that goal in the most recent figures. ... Health Minister David Clark in 2018 announced he had asked health officials to come up with a new set of measurements to replace the previous Government's set of six - which include the smoking target - saying they created perverse incentives. Minister dithers as health service slips - Michael WoodhouseFrom Olivia O'Malley, National Party Published 09:40 15/01/2020 Also from VoxyHealth Minister David Clark’s refusal to set health targets is seeing standards slip nationwide and patients are suffering, National’s Health spokesperson Michael Woodhouse says. ... "All 20 DHBsbecame worse at managing emergency department waiting times, 18 of the 20 DHBs were worse at getting smokers to quit and efforts to provide faster cancer treatment slipped in 14 DHBs. ... "In elective surgeries, we know that there were nearly 6000 fewer procedures last year, the first decrease in a decade, but Dr Clark has stopped publishing data on the number of surgeries performed so we don’t even have first-quarter figures available.

Medical centre up by 2021From Wairarapa Times-Age Published 10:30 13/01/2020


135

https://urldefense.com/v3/__https:/www.nzdoctor.co.nz/article/news/former-medical-council-chair-keeps-clinical-eye-new-southern-board__;!!A3teau8g8Q!GZHRvxsGYyhJ7R_BkLAsToZ4826-oWb7Q7Bwri0pXV9WakqfxbUJPx5AgNgEXYICs5MaFtJe2A$

https://urldefense.com/v3/__https:/times-age.co.nz/car-v-truck-woman-dies-man-in-critical-condition/__;!!A3teau8g8Q!DhKci38jWvbXt7DdoUG9qhFD3sZAfkDQGxBm5PMno8X8ZuK55sawoyKOIkW3uDkclv-hMH2OaQ$

https://urldefense.com/v3/__https:/www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12300734__;!!A3teau8g8Q!DhKci38jWvbXt7DdoUG9qhFD3sZAfkDQGxBm5PMno8X8ZuK55sawoyKOIkW3uDkclv9QWIh23A$

https://urldefense.com/v3/__https:/www.nzherald.co.nz/health/news/article.cfm?c_id=204&objectid=12300734__;!!A3teau8g8Q!DhKci38jWvbXt7DdoUG9qhFD3sZAfkDQGxBm5PMno8X8ZuK55sawoyKOIkW3uDkclv898ML6Ww$

https://urldefense.com/v3/__https:/www.nzherald.co.nz/politics/news/article.cfm?c_id=280&objectid=12300734__;!!A3teau8g8Q!DhKci38jWvbXt7DdoUG9qhFD3sZAfkDQGxBm5PMno8X8ZuK55sawoyKOIkW3uDkclv82GJ-kiA$

https://urldefense.com/v3/__https:/news.fuseworksmedia.com/fc073710-61d4-491c-8f45-d44709b06e8a__;!!A3teau8g8Q!DhKci38jWvbXt7DdoUG9qhFD3sZAfkDQGxBm5PMno8X8ZuK55sawoyKOIkW3uDkclv_dNW_e0A$

https://urldefense.com/v3/__http:/www.voxy.co.nz/politics/5/356331__;!!A3teau8g8Q!DhKci38jWvbXt7DdoUG9qhFD3sZAfkDQGxBm5PMno8X8ZuK55sawoyKOIkW3uDkclv-nuB3PQg$

https://urldefense.com/v3/__https:/times-age.co.nz/medical-centre-up-by-2021/__;!!A3teau8g8Q!BRbzlEC7Ae51hmOn65Yiz-ThiEzYWb70aKi6JEX09BxcJ8WQNwmM2ygDidhR-_4Aqj3l2oNPeg$

Mental Health Addictions andIntellectual Disability Service

Guide to MHAIDS services for Board members


136

ß We provide Mental Health Addictions and Intellectual Disability services across Wellington, Porirua, Kapiti, the Hutt Valley and the Wairarapa,

ß We provide central region (including Tairawhiti)ß We provide national services.

What we do

Our Values – An MHA&ID Service Culture that values

Leadership that is visible, engaging, honest and accessibleEngagement of staff, clients, partners, families, Maori and PacificaCooperation in achieving better outcomes for clients and their familiesEvidenced service development and continuous quality improvementMulti-disciplinary collaboration that supports both clients and staff.


137

MHAIDS ELT


138

The MHAID Service 3 DHB has five clinical sector groups, an Operations Centre and comprehensive shared services which operate across the clinical sector groups;

ÿ Adult Community and Addictionsÿ Intensive Recovery Sectorÿ Younger Persons Community & Addictionsÿ Operations Centreÿ Intellectual Disabilities Servicesÿ Te Korowai-Whariki- Regional Forensic & Inpatient Rehabilitation ÿ Shared Services (DAMHS, Learning and Development, Quality, Kaunihera,

Clinical Governance, Research, Consumer Advisory group, Family/whanau, Information Management, HR, Communications, Legal)


139

Intensive Recovery Sector The Intensive Recovery Sector is made up of the following services;• Two Adult Acute inpatient units; Te Whare Ahuru (Hutt Hospital) and Te Whare o Matairangi

(Wellington Hospital) 24 hour mental health assessment and treatment service for adults aged from 18 upwards who are experiencing serious mental health concerns.

• Crisis Resolution Service (2DHB) for people experiencing a mental health crisis; provides assessment and short-term treatment services 24 hours a day, 7 days a week.

• Treatment for Assertive Treatment (TACT) - The service is for people with persistent, long-term mental health and/or substance dependency problems, many of whom may be homeless and/or do not have any family support, working along side Homeless Team; CCDHB

• Te Whare Ra Uta; Older persons Mental Health –located Kenepuru Hospital – HVHDHB , CCDHB

• Two Consult Liaison teams – Hutt Hospital and Wellington Hospital, advice and treatment recommendations to hospital staff for people under their care

• Wairarapa MH Respite (based WrDHB Hospital)


140

Younger Persons Community Mental Health and Addictions

Child and Adolescent Mental Health Services (CAMHS and ICAFS);

• Wellington CAMHS

• Porirua CAMHS

• Kāpiti CAMHS

• Wairarapa CAMHS Te Rātonga Aranga Mokopuna Arangi (TE R.A.M.A)

• Hutt Infant, Child, Adolescent and Family Service (ICAFS)

• Regional Rangatahi Adolescent Inpatient Service - (RRAIS) is the acute adolescent inpatient unit for the central region. The service is for youth aged 12 to 17 who are experiencing acute mental health problems.

• Central Eating Disorder Service; Based at Johnsonville (Inpatient & day service) treatment and support services for people with eating disorders, from dietetic support right through to residential care.

• Early intervention service - Based at Hania Street, Wellington, provide support, treatment and information to people aged between 13 and 25 who are experiencing psychosis for the first time or who have not previously had treatment for psychosis.

• Maternal Mental Health -Based at Hania Street, Wellington


141

Adult Community Mental Health and Addictions Sector

Community Mental Health Teams (General Adult)• Wellington Community Mental Health Team• Wellington South Community Mental Health Team• Porirua Community Mental Health Team• Kāpiti Community Mental Health Team• Hutt South Community Mental Health Team• Hutt North Community Mental Health Team• Wairarapa Community Mental Health Team• Te Whare Marie, Specialist Maori Mental health (Kenepuru)• Health Pasifika, Specialist Pasifika Community MH (Kenepuru)• Older Persons MH; Community MH team; Kenepuru Hospital, CCDHB• Regional Personality disorder Service (based in Wellington)


142

Adult Community Mental Health and Addictions Sector continued

Addictions services - community alcohol and drug assessment and treatment for adults, they may have moderate to severe mental health and substance use disorders;

• Wairarapa- addiction services are delivered through Pathways - a community-based provider of mental health and wellbeing services.

• Upper and Lower Hutt - addiction services are delivered through our community mental health service

• Wellington, Porirua and Kāpiti – Addiction Service (based in Wellington)

• Opioid Treatment Service - opioid substitution therapy

• Managed withdrawal service


143

Forensics & Rehabilitation Service The role of the Regional Forensic and Rehabilitation Inpatient Mental Health Service at Te Korowai Whāriki is to provide inpatient and outpatient care for both youth and adult clients.The service’s inpatient buildings are mainly located on the grounds of what was once Porirua Hospital, and have been given the name of Rātonga-Rua-O-Porirua, translating to “The Two Services of Porirua”

Sub Regional/Regional• Forensic MH service – Rātonga Rua o Porirua hospital, Palmerston North, Napier, Gisborne,

Masterton, Whanganui, (Auckland) • Inpatient Rehabilitation & extended beds: Rātonga Rua o Porirua hospital

National• Nga Taiohi (Youth Forensic Secure Service) – Kenepuru Hospital


144

Intellectual Disability Service The National Intellectual Disability (ID) Service holds a number of contracts funded directly by the Ministry of Health. These contracts are part of a framework of interconnected services for people with an ID.

One of the contracts we hold is for services for clients that are placed under the Intellectual Disability (Compulsory Care & Rehabilitation) Act 2003 (IDCC&R). These services include:

• Regional ID Secure Service (RIDSS)• National Youth ID Secure Service • Community Consultation Liaison ID Team• Behaviour Support (Specialist Assessments)

We also hold the Complex Youth Assessment and Co-ordination (MVCOT) contract with the Ministry for Vulnerable Children (Oranga Tamariki).

In addition to the above regional and national contracts, the Mental Health, Addictions and Intellectual Disability (MHAID) service also holds the contract for the National Intellectual Disability Care Agency (NIDCA) and the Community Mental Health ID Team.


145

MHAIDS Operations Centre

• Te Haika – telephone call centre that triages crisis and acute calls 24 hours per day, seven hours per week. • Mental Health Needs Assessment Service Coordination (MHNASC) – Based in

Porirua, covers Hutt & CCDHB. Provides assessment of people’s MH, support needs and refers them to services in the community, may include community based supports, home based support & accommodation with MH support.• Casual Pool (Nursing, Admin)• RMO/SMO rostering • TrendCare/CCDM • After hours Duty Managers • Acute resource support workers (providing watches in ED)


146

Learning & Development MHAIDS MHAID Service 3DHB is committed to the on-going learning and development of all staff. Our learning and development team is responsible for the organisation, coordination, development and delivery of programmes to support workforce capability, and meet sector goals and requirements.

This is achieved through

• a comprehensive range of in-house programmes and other activities

• externally delivered professional development opportunities (study, workshops, conferences) – in-house and off-site

We also work with services to design and develop on-the-job guides to embed learning in practice e.g. related to new policy and other initiatives.

The Team

• is lead by the MHAIDS 3DHB Learning and Development Manager, and

includes specialist educators and administration staff

• collectively develops, administers, and delivers activities across the region,

in collaboration with facilitators within our services

The Centre

• The team is based at Ngā Wāhi Akonga, a purpose-built centre on the Ratonga Rua o Porirua campus

• includes modern technology, including videoconferencing facilities and multi-functional spaces

• is also the base for the Lower Central North Island psychiatric registrar training programme

Connect Me Learning management system (LMS)

• all staff have a learning plan populated with core requirements for their role and service area

• includes all our face-to-face sessions, and a growing number of eLearning

activities and other information and resources


147

a) Ask what is important to you?

b) Tell you about treatment choices in ways you could understand?

c) Involve you in decisions about your care or treatment as much as you wanted to be?

Colume look up ESPI colum lookup ESPI colum lookup

# 0

Y

Ophthalmology ESPI 2 Colour

Cardiac Provider: Capital and Coast DHB

Ophthalmology ESPI 2 %

Ophthalmology ESPI 5 % 1

#

0

0

0

Report to: Dec 19 Data Extracted on: 03/02/20

2019 2019

2019

2019 2019 2019

Inpatient Experience Survey questions:

Response

(% Yes, completely / Yes, always)

Did hospital staff include your family/whānau or someone close to you in discussions about your care?

Feb 19 Aug 19May 19

84.8 91.287.0

71.9 82.6 82.9

61.8 64.0 54.9

Before the operation did staff explain the risks and benefits in a way you could understand?

Did staff tell you how the operation went in a way you could understand? 74.3

60.8

ND 0.0%

Primary Care Patient Experience Survey questions:

1. How long did you wait to see the specialist doctor? 37.3 39.2 9.8 13.7

Feb 19 May 19 Aug 19

56 81 770 0 Waiting list

1-3 months > 3 months

019

76

0.0%100% Overdue 32OverTimeframe 21 9 20 17 280.0% 0.0% 0.0% 0.0%0.0%

0.0%

0.0% 0.0%

TIM

EL

INE

SS

MRI 71.8%

Jan

0.0% 0.0%

76 76

680 0 0 0 0 0

0.0% 0.0%

50% Overdue ND 0.0%

Overdue Followups 0 0 0 0

0.0% Max Waiting 760.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%0.0%

66 63

76 76

64.3% 60.1% 60.0%Delivery 47.1% 59.7% 63.0%0.0% 14.9% 14.3%4.3% 9.8%71.8% ESPI 5 1.8% 1.8% 0.0% 0.0%

CT 98.0% 97.0% 98.9% 97.2% 96.8% 97.9%

49.0% 51.7% 64.0% 66.7% 56.0% 65.7%MRI 35.3% 53.4% 53.7% 52.4% 55.3%

ESPI 2 55.3% 58.4% 64.7% 65.0% 58.9%

26

Ap

rNov

96.9% 98.3% 97.1% 97.1% 95.5% 93.7% 43.5% 32.7% 20.0% 17.9% 2.9%

Nov Dec Jan Feb Mar

29

Ma

r

ESPI 2 0.0% ESPI 5

Dec

28

Ju

l

25

Au

g

29

Se

pApr

27

Oc

t

0.0%

May Jun Jul Aug Sep

14.2%

32

2019

14.3% FUA (50%) 0.0% CARDIAC SURGERY DELIVERY 60.0%

24

No

v

29

De

c

26

Ja

n

23

Fe

b

DIAGNOSTICS PERFORMANCE CT 93.7%

31

Ma

yFeb Mar Jun Jul Aug Sep Oct

WAITING OVER TIMEFRAME

Oct

2020

28

Ju

nApr May

Angiography OPHTHALMOLOGY WAITING TIMES

5 15 165 6 7 8 19 19 1915 018 18 18 189 10 11 12 18 19 1913 14 15 16 5 6 8 189 00 0 0 0 0 07 8 9 10 11 12 13 14 0 0 0 1910 11 12 13 144 5 6 7

25 15 28 19Level 21 19 15 15▼

90.5%FCT % 87.5% 90.5% 83.3% 93.8% 96.2% 93.8% 100.0%

3 month

trendAug Sep Oct Nov Dec

▬ 00 0

Faster Cancer

Treatment May Jun Jul

Level 0 1 0 0 0

100.0% 100.0% 100.0%0

0

ESPI 8 100.0% 99.4% 100.0% 100.0% 100.0%

▲ #105Level 77 77 77 76 91

24.5% 29.0% 27.4%26

116 107

ESPI 5 17.3% 16.2% 15.9% 16.3% 20.3%

▬ 0Level 0 0 0 0 0

0.0% 0.0% 0.0%0

0 0 0

ESPI 3 0.0% 0.0% 0.0% 0.0% 0.0%

▼2.1% 1.9% 1 ▼

Level 194 103 87 53 51

28.4% 21.7% 25.9% 13.5% 10.4% 5.6%General Surgery2.0% 2.9% 0.8%0 0

18 22 7

14.9% 14.3% 11 ▲

ESPI 2 24.4% 15.3% 10.5% 5.8% 5.6%

0.0% 0.0% 0.0% 0.0% 4.3% 9.8%

ESPI 1 100.0% 100.0% 100.0% 100.0% 100.0%

Jul

Ophthalmology0

95 ▲

Level 0 0 0 0 0

16.7% 19.3% 22.9% 27.7% 35.7% 42.4%12.2% 0.0% 6.8% 48.1% 45.2%

Imp Req3 mth

TrendMay Jun Jul Aug SepImp Req

Oct Nov Dec May

12.6% 12.0%100.0% 100.0% 100.0%0 ▬ 0

0 0

7 ▼ OrthopaedicsEar, Nose & Throat 1.1% 0.0% 10.3%

#REF! #REF! #REF! #REF!#REF! #REF! #REF! #REF! #REF! #REF!Consecutiv

e months

red ESPI to

Dec 19

3 month

trend

#REF! #REF! #REF! #REF!

Jun Jul Aug Aug Sep Oct Nov DecSep Oct Nov Dec May Jun

3 mth

Trend

#REF! #REF! #REF! #REF! #REF! #REF!

AC

CE

SS

, T

IME

LIN

ES

S

ESPI 2 - BY SERVICE 1 Non Compliant Service ESPI 5 - BY SERVICE 3 Non Compliant Services

#REF! #REF! #REF! #REF!

Year to Sep 2018

15 4 17 20 238 9 10 11 12 13 14 2338

97011.3%

40

67.3 66.0 69.4

26 29 32 35 384 17 2026 29 32 35

10.1% For more information regarding the patient experience surveys please contact your DHB’s System Level Measure

(SLM) team or visit your DHB’s patient experience survey reporting portals.

3. Does your GP/nurse seem informed about the care you get from specialist doctors? 69.0

Non Surgical Interventions 2 0 0.0%

Acute Readmission Measure (0 -

28 days)

Agreed AR

Target Rate

801

Number of

Readmissions

Standardized Acute

Readmission Rate

10.6%Year to Sep 2019

Inpatient Minor Procedures 38 58 152.6%

Total 1,673 1,861 111.2% 74.0 71.4 60.8

70.9 71.4 59.2

2. When you received care or treatment from specialist doctors, did they do the following: Nov 18

44.4

78.8

70.7

Response

(% Yes, always)

55.9 46.652.2

Response (% , Aug 2019)

< 1 week 1-4 weeks

Minor Procedures 382 667 174.6%

Outpatient Minor Procedures Community 0 0 #DIV/0!

Outpatient Minor Procedures Hospital 344 609 177.0%

Mar Apr

%Achievement 149% 122% 116% 112% 108% 111%

1,289 1,194 92.6% 1,774.2 1,609.7 90.7%

PERIOD: August 2019

Actual

37 43 116.2% 79.5 113.7 143.1%2,143 2,444 2,669 2,976 3,232 Non Surgical PUC with Surgical DRG

1,252 1,151979 1,281 1,569 1,861

85.3

Nov 18Jun

237 550

%Jan Feb

1,673 1,915

354 670

Inpatient Surgical DischargesVariance 117 120 135 139 120 188

PATIENT EXPERIENCE SURVEYS

2019 2020 Interventions Caseweights

Plan Actual % Plan Actual

Wairarapa DHB Planned Care Performance for December 19A

CC

ES

S,

QU

AL

ITY

, E

XP

ER

IEN

CE

PLANNED CARE INTERVENTIONS ▲ 111.2% PLANNED CARE INTERVENTIONS / ACUTE READMISSION AR ▼ 10.6%

5 6

91.9% 1,694.7 1,496.0 88.3%

90.5%ESPI RESULTS 26 Consecutive Months Red FCT (31 DAY)

11 12 13 14 15 16 Planned volumeActual volume Planned caseweightsActual caseweights7 8 9 10

Planned

Jul Aug Sep Oct Nov Dec

844 1,142 1,449

Surgical PUC

May

0

500

1,000

1,500

2,000

2,500

3,000

3,500

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

Non Surgical Intervention Minor Procedures Inpatient Surgical Discharges Planned 2019/20

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

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

2019

CT MRI Angiography CT and Angiography Indicator (95%) MRI Indicator (90%)

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

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

2019

ESPI 2 ESPI 5 50% Over Due 100% Over Due

50%

60%

70%

80%

90%

100%

110%

120%

0

10

20

30

40

50

60

70

80

90

28 Jul 25 Aug 29 Sep 27 Oct 24 Nov 29 Dec 26 Jan 23 Feb 29 Mar 26 Apr 31 May 28 Jun

2019 2020

De

live

ry

Waitin

g li

st

Waiting list Outside timeframe Max Waiting Delivery


148

(https://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/patient-experience)

NOTES:

Red DHB not met 85% Indicator for the latest month.

Green

Red Less than 100%

Data Source - Acute Readmissions

This data is sourced from the quarterly Acute Readmission (AR) reporting. The figures are the most recent

quarter's Standardised Acute Readmission rate and number of Observed Readmissions for the 0-28 days

measure, and the same numbers for the same period 12 months ago.

What do the colours mean?

In the top right hand corner of this box next to the title is the % result for the latest period, the colour code below

determines whether the performance meets expectations (green) or does not (red).

Green Less than or equal to planned AR rate ▬, ▲,

or ▼

Change from previous period's standardised

rateRed Greater than planned AR rate

This data is sourced from the DHB Final ESPI Reports. Also included is the Total number of consecutive months of

Red ESPI performance, and a 3 month trend of ESPI performance for each ESPI.

In the top right hand corner of this box next to the title is the period of Red level ESPIs non compliance.

Orange The first month of the DHB having a Red ESPI at a DHB Level

> 0% but < 0.4%

From July 2012 onwards Prior to July 2013 the definition of ESPI 2 is the number of patients waiting

over 6 months for FSA. Between July 2013 and December 2014 the

definition of ESPI 2 is the number of patients waiting over 5 months for FSA,

and from January 2015 the definition of ESPI 2 is the number of patients

waiting over 4 months for FSA.

DHB not met 85% Indicator for the month.

Orange Equal to or less than 3 services non compliant

Change from previous month


The colour code below determines whether the performance meets expectations (green) or does not (red). This

is the same as in the Planned Care Interventions reports.

Green Greater than or equal to 100% ▬, ▲,

or ▼

For more information regarding the patient experience surveys please contact your DHB's System Level

Measure (SLM) team; visit your DHB's patient experience survey reporting portals; or visit the Commission’s

website

What other information is available regarding the patient experience surveys?

These data are sourced from the Health Quality and Safety Commission’s (the Commission) quarterly national

adult inpatient and primary care patient experience surveys. Selected questions from both surveys have been

chosen to recognise the Experience and Equity principles within the Planned Care Programme. A rolling four

quarters of data are displayed.

What do the colours mean in the title bar?


Red Less than 100%

Green Greater than or equal to 100%

Less than 90% Red Less than 95%

Yellow

Yellow > 0% but < 0.4% Yellow > 0% but < 1% Red > 0%

ESPI 5 Follow up (50% and 100%)

Green

Red Greater than 3 services are non compliant

DHB met 85% Indicator for the latest month.

> = 0.4%

This data is sourced from the DHB monthly Planned Care Interventions (PCI) report summary page. This table and

graph shows monthly YTD delivery against the planned YTD delivery.

Change from previous month

Orange Equal to or less than 3 services non compliant

The colour code below determines whether the performance meets expectations (green) or does not (red). This is

the same as in the Planned Care Interventions reports.

▬, ▲,

or ▼

TIM

EL

INE

SS

DIAGNOSTICS PERFORMANCE OPHTHALMOLOGY WAITING TIMES CARDIAC SURGERY

Data Source Data Source Data Source

The data is sourced from the monthly Diagnotics Reporting, the table and graph show the DHB % for a 12 month

trend for CT, MRI and Angiography against the respective national indicator percentage expectations.

This data is sourced for FSA and Treatment waiting times from the monthly DHB ESPI reporting, and the follow

up information is sourced from the collection used through the Ophthalmology service improvement

programme.

This data is sourced from the weekly reporting supplied from each of the five DHB cardiac units (Auckland,

Waikato, Capital & Coast, Canterbury, and Southern).

CT MRI Angiography ESPI 2

Green 100% Green 0 patients

= 0%

In the top right hand corner of this box next to the title is the DHB % result for the latest month for CT, MRI and

Angiography. This is also shown in the table below with the % by month for the 12 month period, the colour code

below determines whether the performance meets expectations (green) or does not (red). This is the same as in

the Diagnostics reporting.

Waiting over timeframe

Red Less than 95% Red

NAThe measure is a DHB of service measure, where NA is present this means the DHB is not the provider for

the service and other DHB provides this service.

Green = 0 % Green = 0 %

Red > = 1%

ND This indicates that no data is currently available, as the DHB has been unable to supply this.

The colours show whether a DHB is compliant (green) or non compliant (yellow and red) for each ESPI.

Data Source - Faster Cancer Treatment (FCT) 31 Day Indicator

This data is sourced from the DHB Faster Cancer Treatment (FCT) Reporting Database. This measure indicates whether 85% of

patients receive their first cancer treatment (or other management) within 31 days from date of decision-to-treat. Please note that

the FCT data may vary from the SS01 Quarterly Reporting measure due to the date of extraction.


From July 2012 onwards Prior to July 2013 the definition of ESPI 5 is the number of patients waiting

over 6 months for Treatment. Between July 2013 and December 2014 the

definition of ESPI 5 is the number of patients waiting over 5 months for

Treatment, and from January 2015 ESPI 5 is the number of patients waiting

over 4 months for Treatment.

Green = 0% Green = 0 %

Red Less than 100% Red Greater than 0

Red > = 0.4%

Greater than or equal

to 95%Green

Greater than or

equal to 90%Green

Greater than or equal

to 95%

Green

What does the coloured cells mean in the title bar and in the table?

What does the coloured traffic light mean? In the top right hand corner of this box next to the title is the regional provider % delivery for the latest week and

the national number of patients waiting greater than the 90 day expectation for surgery. This is also shown in the

table below with the % every four weeks, the colour code below determines whether the performance meets

expectations (green) or does not (red).

The graph shows the total waiting list, the number on the waiting list for greater than the expected timeframe, the

maximum acceptable waitlist and the delivery.

What does the coloured cells mean in the title bar and in the table?In the top right hand corner of this box next to the title is the DHB % result for the latest month for waiting time

results for Ophthalmology for ESPI 2, ESPI 5 and % of patients waiting longer than 50% overdue for their follow

up appointment or treatment. This is also shown in the table below with the % for a 12 month period, the colour

code below determines whether the performance meets expectations (green) or does not (red). This is the

same as in the ESPI reports for ESPI 2 and ESPI 5.

What do the colours mean in the table?

Green

% delivery

Red


In the top right hand corner of this box next to the title is the number of non compliant services for ESPI2 for the

current month.

In the top right hand corner of this box next to the title is the number of non compliant services for ESPI5 for the

current month.

AC

CE

SS

, T

IME

LIN

ES

S

ESPI - DHB LEVEL / FCT (31 DAY) ESPI 2 - BY SERVICE ESPI 5 - BY SERVICE

Data Source - Elective Services Patient Flow Indicator (ESPIs) Data Source Data Source

This data is sourced from the DHB monthly Final ESPI Reports, including the Improvement Required, and a 3

month trend arrow. The ESPI result in this report is for an 8 month period, and only services which are currently

non compliant, or have been non compliant at least once in the last 4 months will appear on this report.

This data is sourced from the DHB monthly Final ESPI Reports, including the Improvement Required, and a 3

month trend arrow. The ESPI result in this report is for an 8 month period, and only services which are currently

non compliant, or have been non compliant at least once in the last 4 months will appear on this report.

Greater than 3 services are non compliant

What do the colours mean in the table? What do the colours mean in the table?

The colours for each cell show whether a DHB is compliant (green) or non compliant (yellow or red) for each

service. A warning light (box will turn orange) for the 3 Month Trend arrow when a service if the three month

trend is worsening.

The colours for each cell show whether a DHB is compliant (green) or non compliant (yellow or red) for each

service. A warning light (box will turn orange) for the 3 Month Trend arrow when a service if the three month

trend is worsening.

What do the colours mean in the table?

Green All ESPI Results at a DHB Level are either Green or Yellow

Green All services are compliant Green All services are compliant

Red The DHB has had 2 or more consecutive months with a Red ESPI at a DHB Level

Yellow > 0% but < 1%

Red Red > = 1%

This data is sourced from the DHB monthly PCI report and YTD performance against plan for the Planned Care

Intervention Groups, YTD Caseweight Summary for Inpatient Surgical Discharges


For the wait time to see a specialist question, the percent of respondents who selected each response option in

the latest quarter is provided. For all other questions, the percentage displayed is the percentage providing the

most positive response to the question.

Definitions & InformationA

CC

ES

S,

QU

AL

ITY

, E

XP

ER

IEN

CE

PLANNED CARE INTERVENTIONS PLANNED CARE INTERVENTIONS / ACUTE READMISSION PATIENT EXPERIENCE SURVEYS

Data Source - Planned Care Interventions Data Source Data Source

Red

DHB met 85% Indicator for the month.


149

https://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/patient-experience

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