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Hauora Tairāwhiti
Agenda
HAUORA TAIRĀWHITI BOARD
Tuesday, 30 April 2019, Boardroom, Corporate Offices, Hauora Tairāwhiti
9.00am Meeting Commences
9.05am Presentation: Ko te Pae tawhiti whaia Kia tata ko te Pae tata whakamaua kia tina’ Seek our distant horizons and cherish those you attain (Whiti Timutimu - Chairperson, Atawhai Charitable Trust; TWON member)
Page
APOLOGIES
1.1. As advised
INTERESTS
2.1 Committee Members’ schedule of interests for review
2.2 Conflicts in relation to Agenda items
PREVIOUS MEETING
3.1 Previous Minutes for approval: 26/03/2019
3.2 Matters Arising
ACTION ITEMS
4.1 Actions from previous meeting
CORRESPONDENCE
5.0 Nil
REPORTS
6.1 Performance Dashboard
6.2 Chair’s Report
6.3 Te Waiora o Nukutaimemeha Chair’s Report
6.4 Chief Executive’s Report
6.5 Finance Report
6.6 Organisational Performance Graphs
6.7 Board Sub-Committee Reports
INFORMATION ITEMS
7.1 Nil
DECISION ITEMS
8.1 Nil
GENERAL BUSINESS
10.0 Nil
Hauora Tairāwhiti
RESOLUTION TO EXCLUDE THE PUBLIC
RESOLVED that: In accordance with the provisions of Schedule 3, of the NZ Public Health and Disability Act 2000, that the public be excluded from the next part of the proceedings of this meeting. The reason for passing this resolution and the grounds on which the resolution is based, together with the particular interest or interests protected by the Official Information Act 1982 which would be prejudiced by the holding of the whole or the relevant part of the proceedings of the meeting in public areas are as follows:
11.1-2 12.1
As shown on resolution to exclude the public in Minutes.
13.1 14.1
Negotiations or Commercial Activities – The disclosure of that information would not be in the public interest because of the greater need to enable Hauora Tairāwhiti to carry on, without prejudice or disadvantage, negotiations or activities. [OIA 1982 S.9 (2) (j) & (i)]
Ground(s) under Clause 32 for passing this resolution: That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32(a)]
PREVIOUS IN COMMITTEE MEETING
11.1 Previous Minutes for approval: 26/03/2019
11.2 Action Items (nil)
IN COMMITTEE REPORTS FROM HAUORA TAIRĀWHITI ADVISORY COMMITTEES
12.1 For noting and/or adoption
INFORMATION ITEMS
13.1 Te Kūwatawata Evaluation draft Final Report
DECISION ITEMS
14.1 Home & Community Support Services Procurement
14.2 Morris Adair Building
STAFFING & GOVERNANCE
15.0 Report tabled
DATE OF NEXT MEETING: Tuesday, 28 May 2019
Member Interest Declared RoleDavid Scott Three Rivers Medical Centre Wife an employee
Treescape Farm Partnership Partner in BusinessTreescape Consultancy Business ConsultantTe Kuri a Tuatae Marae TrusteeEast Coast Rural Support Trust Rural Support Co-ordinatorGisborne District Council Civil Defence Shift Volunteer/Media Liaison OfficerGisborne Herald Casual non-paid columnistMiddle Mount Company Ltd DirectorCONNEXT Charitable Trust Trustee
Geoff Milner Ngati Hine Health Trust Chief ExecutiveTerenga Paraoa Lmited DirectorManaia PHO Limited DirectorTairāwhiti Laundry Services Limited DirectorTairāwhiti Laundry Services Limited Director
Gavin Murphy Tlab Limited DirectorEastland Community Trust Chief ExecutivePersonal friend of the Minister of Health 0Activate Tairāwhiti Limited Director
Eastland Development Fund Limited Director
WET Gisborne Limited Director
Prudence Younger Forest Industry Contractors Assoc Chief ExecutivePublic Impressions Limited Director
Kathy Sheldrake Motu Trails Charitable Trust ChairRehette Stoltz Gisborne District Council Deputy Mayor
Sport Gisborne Tairāwhiti TrusteeTairāwhiti Positive Aging Trust TrusteeE Tu Elgin Community Group MemberHusband employed by Hauora Tairāwhiti Deon Stoltz (Senior Medical Officer)Deon Stoltz Medical Services DirectorArt in Public Places TrusteeManaaki Tairāwhiti Governance Group memberSunshine Service Managment Team memberGisborne Walking & Cycling Trust TrusteeTairawhiti Laundry Services Limited DirectorTe Ha 1769 Sestercentennial Trust. TrusteeHealthy Families East Cape Strategic Leadership
Group
Member
Hiki Pihema Hauora Tairāwhiti Team Leader, DietitiansDietitians Board Board Member Otago University Supervisor, Dietetics ProgrammeNgati Porou Hauora Dietitian via Hauora Tairāwhiti roleDietitians NZ MemberTe Runanganui o Ngati Porou Registered BeneficiaryTe Whaihanga ki Uawa MemberElgin Rangatahi Oral Health Project Daughter is Co-OrdinatingNational Heart Foundation Daughter is Nutrition Advisor
Na Raihania Whanau Trusts TrusteeHawkes’ Bay DHB Iwi Relationship Board MemberTRONPnui Board Trustee
Niece (Albie Raihania) employed on nursing staff 0
Brian Wilson B & P Wilson Family Trust TrusteeGisborne District Council CouncillorYMCA PresidentGisborne Surf Lifesaving Charitable Trust TrusteeTLab Director
Board Members’ Register of Interests
Josh Wharehinga Gisborne District Council CouncillorTe Wananga o Aotearoa Board memberGisborne Intermediate School Board memberMother employed by Hauora Tairāwhiti Maraea Cookson (Cultural Response Team)Ex Partner employed by Hauora Tairāwhiti Richelle Tarsau (Children’s Ward)Aotearoa Scholarships Trust TrusteeHorouta Waka Hoe Waka Ama Club Board member
Meredith Akuhata-Brown Gisborne District Council CouncillorCampion College Board memberTairawhiti Youth Workers Collective MemberPapawhariki Inc Board memberGisborne Herald Casual unpaid columnist
Jim Green (Chief Executive) Health Partnerships Limited (CE Sponsor – Food
Services Programme)
Appointed by National CEs. First responsibility is to
Hauora Tairāwhiti but there may be an occasion when
this conflicts with the national programme.
Chief Executive Representative, Midland Alliance
Leadership Team (Midland Health Network
Trust)
Potential conflict exists in relation to decisions made by
the Midland ALT which conflict with the interests of
Hauora Tairāwhiti.
Interim Chair/Director, HealthShare Limited First responsibility is to Hauora Tairāwhiti but there
may be an occasion where this conflicts with the needs
of HSL.
Wife employed by Tūranga Health as Tamariki
Ora Nurse and Team Coordinator for Tamariki
Ora
Potential conflict exists over decisions related to
funding of services provided by Tūranga Health
affecting the employment status of his wife.
Son is employed as a Medical Registrar at
Waikato DHB.
Potential conflict regarding decisions on terms and
conditions of employment for Medical Registrars.
Daughter in-law is currently working in a
community Pharmacy in the Waikato.
Potential conflict regarding my involvement with the
national Community Pharmacy Agreement which could
impact on her employment.
Manaaki Tairāwhiti member Decisions at Manaaki Tairāwhiti may conflict with those
in my role as CE of Hauora Tairāwhiti. The management
is that decisions around funding are required to come
back to Hauora Tairāwhiti.
National Oracle Solution Executive Steering
Committee as CE representative
A possible conflict of interest arises for me in this role
as opposed to my role as CE of Hauora Tairāwhiti.
Management of the possible conflict can be effected by
the fact that I have a responsibility to Hauora Tairāwhiti
and the Midland Region ahead of the commitment to
the NOS programme.
Member, National BiPartite Action Group Appointed by National CEs. First responsibility is to
Hauora Tairāwhiti but there may be an occasion when
this conflicts with the group programme.Pay Equity Workstream Co-Lead, Employment
Relations Strategy Group (ERSG),
Appointed by National CEs. First responsibility is to
Hauora Tairāwhiti but there may be an occasion when
this conflicts with the work programme.
National CE Lead, Holidays Act Appointed by National CEs. First responsibility is to
Hauora Tairāwhiti but there may be an occasion when
this conflicts with the work programme.
Midland Regional DHBs CE Lead, Child Health
Action Group
Appointed by Midland DHBs. First responsibility is to
Hauora Tairāwhiti but there may be an occasion when
this conflicts with the work programme of Midland.
Management Attendees
Midland Regional DHBs CE Lead, Māori Health Appointed by Midland DHBs. First responsibility is to
Hauora Tairāwhiti but there may be an occasion when
this conflicts with the work programme of Midland.
Kolbe, Anne (Acting CMO
temporary)
Kolbe Medical Services Ltd Director and Joint Owner
Communio, NZ Senior Consultant & ContractorWhanganui DHB Member, Risk & Audit CommitteeHealth Research Council of NZ Husband chairs the clinical trials advisory committee
Auckland University Holds an adjunct appointment (Associate Professor
level)
Husband is an employee (Professor of Medicine, FMHS)
Australian Medical Council Husband is a member of the Medical School Advisory
Committee, and leads the Medical Specialties Advisory
Committee Accreditation Team
Royal Australasian College of Physicians Husband is a member of the College’s governance
working party, and chairs the revalidation working
partyEXCITE International Board Member, and Chair of Advisory CouncilMedicare Benefits Schedule Review Taskforce
(Australia)
Senior Advisor/Government taskforce to review the
Medicare Benefits
ScheduleInstitute of Environmental Science & Research
(ESR)
Daughter an employee – forensic scientist
Tairawhiti DHB Consultant (strategic services)Siggins Miller, Australia Senior Advisor & Associate
Serita Karauria (Acting DoN) Nil 0
Craig Green (Chief Financial
Officer)
Chamber of Commerce (Mentor) Possible conflict if mentored party is providing services
to Hauora Tairāwhiti.Mother employee of Compass Medirest Food
Services
A conflict of interest exists in relation to negotiations
with Compass Medirest Food services Tairāwhiti
conflict where it affects or could affect staffing.
Nicola Ehau (Planning,
Funding & Population
Health)
Husband an employee of the Health Quality &
Safety Commission
Low likelihood of conflict.
Manaaki Tairāwhiti Decisions at Manaaki Tairāwhiti may interest with
those in my role as GM Planning & Funding in Hauora
Tairāwhiti. The management is that decisions around
funding require to come back to Hauora Tairāwhiti.
Fraser Hopkins
(Communications)
Wife is employed by Hauora Tairāwhiti as Team
Leader Community Services Admin.
Possible conflict depending on decisions made at
leadership and committee level regarding community
services administration.
Lynsey Bartlett (Surgical
Services)
Company Director: Yesteryear Limos Low likelihood of conflicts.
Alternate Director, HealthShare Limited Appointed by Hauora Tairāwhiti. First responsibility is
to Hauora Tairāwhiti but there may be an occasion
where this conflicts with the needs of HSL.
1
Minutes
Hauora Tairāwhiti Board
26 March 2019, commencing 9.00am
Present David Scott (Board Chair) Meredith Akuhata-Brown Kathy Sheldrake Josh Wharehinga Brian Wilson Na Raihania Hiki Pihema Rehette Stoltz Geoff Milner (via videoconference) Prue Younger Geoff Milner
Attending
Jim Green (Chief Executive) Nicola Ehau (Group Manager Planning, Funding and Population Health) Briar Hunter (Communications Advisor) Craig Green (Chief Financial Officer) Joyce O’Donnell (Minutes)
Public Nil
Karakia Rev Patsy Ngata (In Commemoration of the victims of the terrorist shooting in Christchurch on 15 March.)
The Board members visited Radiology to view the new CT scanner.
Item 1 Apologies
Gavin Murphy
Item 2 Interests 5.1 Changes to Register Noted 5.2 Conflicts Related to Any Item on the Agenda Nil
Item 3 Minutes of Previous Meeting ADOPTED
The public minutes of the Tairāwhiti District Health Board meeting held on 26 February 2019 confirmed as a true and accurate record.
Matters Arising from Minutes Nil
Item 4 Action Items Noted
2
Item 5 Correspondence Nil
Item 6 Patient Safety & Quality Nil
Item 7 Reports 7.1 Performance Dashboard Noted 7.2 Chair’s Report Noted
7.3 Te Waiora o Nukutaimemeha Report Noted. 7.4 Chief Executive’s Report The Chief Executive expanded on his report throughout.
Noted the low coverage rate pacific adolescent dental of 26% against a national rate of 73% which Funder were looking into. Their review would include investigating ways of better communicating/socialising the pathway to adolescent dental services and improving uptake overall.
7.5 Finance Report Noted and the Chief Financial Officer expanded throughout.
7.6 Board Sub-Committee reports
Noted
Item 8 Information Items Nil
Item 9 Decision Items 09.1 Te Waiora o Nukutaimemeha (TWON) membership change
ADOPTED
The appointment of Ngahuia Ngata to TWON effective 15 March 2019
Accepts the appointment of Josh Wharehinga to HAC effective 16 April 2019.
Item 10 General Business Nil
RESOLUTION TO EXCLUDE THE PUBLIC
RESOLVED that: In accordance with the provisions of Schedule 3, of the NZ Public Health and Disability Act 2000, that the public be excluded from the next part of the proceedings of this meeting.
3
The reason for passing this resolution and the grounds on which the resolution is based, together with the particular interest or interests protected by the Official Information Act 1982 which would be prejudiced by the holding of the whole or the relevant part of the proceedings of the meeting in public areas are as follows:
11-12 As shown on resolution to exclude the public in Minutes.
13.1-3 Negotiations or Commercial Activities – The disclosure of that information would not be in the public interest because of the greater need to enable Hauora Tairāwhiti to carry on, without prejudice or disadvantage, negotiations or activities. [OIA 1982 S.9 (2) (j) & (i)]
Ground(s) under Clause 32 for passing this resolution: That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32(a)]
11.1 Previous Minutes for approval 26.2.19
11.2 Action Items
12.1 Sub Committee Reports
13.1 Hauora Tairāwhiti draft Annual Plan 2019/2020 and draft Population Health Plan
13.2 Letter: Hauora Tairāwhiti to Director General re Capital Requirements for Hauora Tairāwhiti
13.3 Draft Funding Envelope 2019/20
13.4 Community Pharmacy
14.1 All of Government (AoG) Electricity Contract
14.2 Draft Ministry of Health Assurance Report
14.3 Savings and Return to Budget
14.4 Midland Clinical Platform Stage 2.1.1 Business Case
The Chief Executive, Chief Financial Officer, Group Manager, Planning, Funding & Population Health, the Communications Advisor and the Minute Secretary were invited to remain for facilitation of Board discussion and recording.
PUBLIC RELEASE OF IN COMMITTEE ITEMS
15.0 No In Committee decision items were released.
Meeting closed: 11.57am Date of Next Meeting: 30 April 2019
………………………………………….. ………………………………………. Chair Date
Action Items HAUORA TAIRĀWHITI BOARD
Item Description Who Deadline
Carried over
Ambulatory Sensitive Hospitalisation (ASH) 45-64 Rate Increase
An update to the ASH 45-64 report in a year to gauge progress.
Carried over as scheduled
Nicola July 2019
26.3.19
Nil
Mar-19 Mar-19
Ethnicity This Month Target Last Month 3 Month Average
Māori 96.3% 93.3% 94.9%
Total Pop 94.5% 95.7% 95.3%
Total Pop 80%** ≥ 90% Nil 84%
Māori 73% 80% 78%
Total Pop 82% 86% 84%
Māori 79% 79% 79%
Total Pop 82% 82% 82%
Māori 100% 100% 100%
Total Pop 100% 100% 100%
Ethnicity This Month* Target Last Month 6 Month Average
Māori 97% 97% 96%
Total Pop 94% 95% 94%
Ethnicity Total This Month Monthly Target YTD Year to Date
Target
Māori 67 96 655 722
Total Pop 201 252 1,878 1,887
Ethnicity This Month Target Last Month 3 Month Average
9 ≤ 6 9 10
5 1 3
11 11 12
12 6 10
Māori 92% 91% 92%
Total Pop 92% 88% 91%
This Month Target Last Month 3 Month Average
75% ≥ 80% 79% 74%
1,045 ≤ 836 917 979
2.30 ≤ 3.21 days 2.60 2.50
1,704 ≤ 1,523 1,589 1,744
67% ≤ 70% 72% 69%
*Target number of discharges and number of ED attendances is based on 5% reduction from 2015/16 year and displayed as 1/12 of that amount
This Month Target Last Month 3 Month Average
99 115 113
321 301 321
This Month Target 3 Month Average YTD Average
% 6.9% ≤ 6.1% 4.6% 4.4%
# 38 N/A 41.3 40.2
% 9.9% ≤ 7.8% 7.3% 6.3%
# 11 N/A 9.7 9.0
# of Enrolled Patients# of Māori
Enrolled
PHO % of enrolled
population
8,831 7,887 18%
39,165 16,784 89%
98% 100%
Ethnicity12 months to 31 December
2018Target Last Year (Dec 17)
Māori 8,282 7,791
Total Pop 6,925 7,320Māori 7,805 6,548Total Pop 3,897 4,280
Key
≤ Less Than or equal to ≥ Greater than or equal to
≥ 95%
12 Month Trend
≥ 95%
N/A
12 Month Trend
43%
PHO Enrolments (Jan - March 19)
Patient Falls
Severity Assessment Code 1 and 2 Events
Complaints
Number of Medication Events
≥ 90% Primary Care
Better help for Smokers to Quit - Secondary
Care
Better help for
Smokers to Quit**Maternity *Currently only Hospital Maternity Dept
Stats
≥ 90%
Raising Healthy Kids*
Improved Access to Elective Surgery
Indicator
Patient Safety and Quality - Hospital
Hauora Tairāwhiti
Health Targets
Indicator
Shorter Stays in Emergency Departments
Shorter waits for Cancer Treatment - 62 day
target
Increased Immunisation
(8 Months) ≥ 95%
12 Month Trend
≥ 95%
Hospital Events
* only available on 8th of the Month following service.
** 1 of the 5 events are yet to be coded.
12 Month Trend
Age Group
00-04
Number of Emergency Department Attendances*
12 Month Trend
Surgical Events
Percentage of Tairāwhiti Māori Population enrolled in a PHO
≤ 6,512
Percentage of Triage 4-5 attendances
82%
12 Month Trend
PHO
Midlands Health Network - Tairāwhiti
Percentage of Tairāwhiti Population enrolled in a PHO
45-64
Acute Readmission Rate
Indicator
Indicator
Bed Utilisation
Number of discharges*
Average Length Stay (days)
≤ 3,490
Indicator
Number of Acute Surgeries
Total Number of Surgeries
12 Month Trend
Acute Readmission
Rate
Total Population
75+ population
N/A
Ngāti Porou Hauora
Percentage of PHO Population who are Māori
Ambulatory Sensitive Hospitalisations per 100,000 population
7,2536,330 6,053
7,3206,738 6,479 6,854 6925
4,031 4,197
2,163
4,280 4,164 3,992 3,967 3897
01,0002,0003,0004,0005,0006,0007,0008,000
03/2017 06/2017 09/2017 12/2017 03/2018 06/2018 09/2018 12/2018
twleve months to
Ambulatory sensitive hospitalisations per 100,000 population00-04 year olds 45-64 year olds
Mar-19 Mar-19
Indicator Ethnicity This Month Target Last Month 3 Month Average
Māori 85% 86% 85%
Total Pop 88% 86% 86%
Māori 281 256 268
Total Pop 727 697 662
Māori 18% 15% 18%
Total Pop 10% 8% 10%
2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
5 6 2 1 4 0
12 months to Dec 2018 Target 12 months to Sep 2018Last year
12 m to Dec 2017
95% 95% 68%
67% 77% 55%
*Waiting times are sourced through National reporting (PP8), which reflect activity in the previously reported quarter.
Feb-19 Target Jan-19 3 Month Average
Computed Tomography (CT) < 42 days 95% ≥ 95% 95% 95%
Magnetic Resonance Imaging (MRI) < 42 days 62% ≥ 90% 53% 65%
Urgent Colonoscopy < 14 days 100% ≥ 90% 100% 100%
Non Urgent Colonoscopy < 42 days 55% ≥ 70% 28% 47%
Surveillance Colonoscopy < 84 days 75% ≥ 70% 71% 64%
This Month Target Last Month 3 Month Average
10% ≤ 10% 1% 4%
3 ≤ 7.6 0 2
Month Actual Month Budget Last Month Actual YTD Actual YTD Budget YTD Variance
$16,659 $16,167 $17,051 $149,222 $145,511 $3,711
$18,522 $17,163 $16,801 $157,028 $152,114 $4,914
($1,863) ($996) $250 ($7,806) ($6,603) ($1,203)
($2,667) ($995) $1,267 ($7,412) ($6,610) ($802)
$815 $0 ($1,024) ($394) $0 ($394)
($12) ($3) $7 ($1) $6 ($7)
Diagnostic Waiting Times * 1 month behind due to data being collated Nationally
12 Month Trend
Addiction Services Waiting times (< 3 weeks)≥ 80% < 3 Weeks
Indicator
Governance Result
Trend
Missed Appointments
Staff Injury (per 1m hours worked)
Finance ($'000)
Consolidated Revenue
12 Month Trend
Indicator
Trend
Rheumatic Fever Hospitalisations (Financial Year, First episode hospitalisation numbers)
Non-urgent Mental Health & Addiction waiting times for Child and Youth 0-19 (data reported Quarterly*)
Indicator
Mental Health waiting times (< 3 weeks)
Consolidated Expenditure
Staff Turnover
Consolidated Result
Provider Result
Funder Result
Hauora Tairāwhiti
≥ 95%
N/A
Patient Safety and Quality - Community
12 Month Trend
Immunisation at 2 years
First Specialist Assessments
Human Resources
Indicator
≤10%
$12$160 $109
$357 $441
-$65 -$185
-$1,209
-$394
$275 $376
$7 $106
-$245
-$728 -$649
$870
-$802-$741
-$1,551
-$2,023
-$2,893
-$3,721
-$4,507
-$5,363-$5,615
-$6,610
$321$567
$142$464
$189
-$811 -$826
-$336
-$1,203
($7,000)
($6,000)
($5,000)
($4,000)
($3,000)
($2,000)
($1,000)
$0
$1,000
$2,000
Jul-
18
Au
g-1
8
Sep
-18
Oct
-18
No
v-1
8
De
c-1
8
Jan
-19
Feb
-19
Mar
-19
Ap
r-1
9
May
-19
Jun
-19
Re
sult
($
00
0's
)
Hauora Tairāwhiti Financial Performance 2018 /19
Funder variance Provider variance Governance variance Provider Actual Consolidated Variance
Funder and Governance Budgets are set to zero. Provider Budget is set to a deficit of $6.610m The new Provider Variance reflects the difference between Actual and Budgetted results while Provider Actual reflects net actual result.
Chair’s Report – April 2019
- The major events this month was the Wellington visit for a session with the Minister of Health &
the Director General of Health at the Beehive, as well as attending the extra-ordinary meeting of the NZDHB Chairs and Chief Executives, the notes of which have already been circulated.
- The Minister was very pleased with the preliminary Māori health outcomes for children engaged with the E Tipu E Rea programme where there appears to be a lower rate of hospitalisation for these children. The Minister is particularly interested (given his emphasis on equity) why our programmes are so successful and would like our Chief Executive to provide him with further information.
- We discussed the proposed Bowel screening programme and the approach that Hauora Tairāwhiti intended to take.
- The Chairs and Chief Executives agreed to transfer the responsibility for the FPIM (Health Finance Procurement & Information Management System) programme from our company New Zealand Health Partnerships to the Ministry of Health.
That the Board notes the report. David Scott, MNZM, JP Chair Hauora Tairāwhiti
TWON April Report Tena koutou e te Poari Matua. Easter is known as Te Aranga o te Atua or the resurrection of Jesus in reference to his rising 3 days post being placed in the cave. It’s perhaps a sign that after trauma there can be hope and joy. On behalf of TWON we wish all families a happy Easter.
a. The key objective of the terms of reference for TWON is to accelerate Maori Health gain by positioning Maori Health at the very fore of planning, funding, and service delivery activities within Hauora Tairawhiti DHB and wider community. With this in mind TWON has undertaken to improve the timing of the papers to this table so as to enact the above objective as the Maori Equity Champion to the Board: Twon is looking to be an integral part of the consultation processes for papers going through the approval mechanisms of HT. Of particular interest are matters that directly address Maori health issues, rurality and youth.
b. We received a presentation from Nicolette Pomana, Portfolio Manager Child, Youth and
Population Health. TWON notes and supports the work undertaken to provide oral care for the Ngati Porou under 18 population and would like to see a whole of rural population oral care service. Also the question of fluoride care for those outside of Gisborne town centres was raised and how that might be progressed.
c. Eru Findlay, Kia Ora Hauora and Hauora Maori Training Fund. Twon notes the steps being
undertaken to grow Maori into health based careers through years 11, 12, 13 and also offering scholarships to further assist in those pathways. Two gaps were identified as more work required in the Kura kaupapa schools and the Coast schools generally but also all schools providing the sciences in their curriculum to help stimulate that knowledge, interest and growth. As reported across Midlands 2019, of the 120 grads 54 were employed whilst that is less than half the question remains what were the barriers for grads not gaining employment. Work is being undertaken for their interview process to help at that critical point which we hope will increase numbers coming through.
d. An interesting question was raised as to the status of “in committee” discussions e.g TWON
representatives on CPHAC could they in turn report “in committee” discussions to an “in committee” session at TWON? It would be good to have a the Board’s perspective for consistency purposes.
e. In regards to the various population health issues raised and how to communicate those to
the wider Maori community it was suggested that Iwi Facebook pages “friend” the Hauora Tairawhiti Facebook page or visa versa in an effort to get wider coverage of health issues.
Recommendations: That Hauora Tairawhiti: a. notes this report in particular the focus on Maori health gain, rurality, youth and workforce
development b. discusses point d and provide direction
Naku te iti nei, Na Raihania Te Waiora o Nukutaimemeha
Chief Executive’s Board Report March 2019
Health Targets Better Help for Smokers to Quit For the month of March, we only offered support to 92% of smokers admitted to hospital and 92% for Māori. This was an improvement on last month however. Missed opportunities were halved to 14 and there was a much-improved rate from ED. Faster Cancer Treatment (FCT) 62 day February – 1 out of 1 – 100% 31 day pathway – 8 out of 8 – 100%
The FCT steering group have invited participation from primary care and the Cancer Society on a three monthly basis to review efforts to reach all people at risk of cancer and all people with cancer at the earliest possible stage in order to improve outcomes. On a monthly basis, the pathway for all people on the 31-day pathway is being reviewed in conjunction with primary care in order to understand and improve. The commitment of primary care to this, plus the Cancer Society, has been exceptional.
Elective Production Elective discharges are slightly behind of target at 99.5%. This equates to -9 discharges. Case weights are currently sitting at 96.6% this is -83.2 CWDs behind planned. First Specialist Assessments (FSA) are ahead of target at 120.1%, with an additional 957 FSAs delivered against a target of 4756. Elective Services Performance Indicators (ESPI) remains non-compliant at an organisational level in ESPI 2 – First Specialist Assessments and ESPI 5 – Time to treatment. An exemption is in place for Orthopaedics, Otorhinolaryngology and Urology. Additional specialities currently breaching elective waiting timeframes consist of:
Cardiology - ESPI 2
Dermatology – ESPI 2
General Surgery – ESPI 2 and 5
Gynaecology – ESPI 2 and 5
Neurology – ESPI 2
Plastics – ESPI 2 and 5
Renal – ESPI 2
Rheumatology – ESPI 2 The key drivers for our current situation are due in part to strike action and the ensuing negative impact on elective activity. This is coupled with a growing demand for visiting specialities where capacity and clinical resources are scarce. Emergency Department 6 Hours ED did not achieve the ED target of 95% this month coming in at 93.6% with the primary reasons for this result related to delays due to clerk in periods and delays in transfer to wards. A working group has been pulled together to review the key reasons for the delays in people being transferred to the wards and to develop a plan in response.
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Janu
ary
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Ap
ril
May
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e
Triage 1-3
Triage 1-3 2013-2014 Triage 1-3 2014-2015 Triage 1-3 2015-2016
Triage 1-3 2016-2017 Triage 1-3 2017-2018 Triage 1-3 2018-2019
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Triage 4-5
Triage 4-5 2012-2013 Triage 4-5 2013-2014 Triage 4-5 2014-2015 Triage 4-5 2015-2016
Triage 4-5 2016-2017 Triage 4-5 2017-2018 Triage 4-5 2018-2019
Immunisation 8 months - Overall is 82%, (↓4%) Māori 73% (↓7%) and an overall decline rate of 10% (↑3%) (18 children) 2 years - Overall is 88% (↑2%) Māori 85% (↓1%) and an overall decline rate of 8% (↓1%) (14 children) 5 years – Overall is 86% (≈) Māori 87% (↑1%) and an overall decline rate of 8.1% (≈) (16 children) The decline rate continues to fluctuate and the Outreach immunisation service continue to have discussions with families concerning the safety of the NZ vaccination programme. The measles outbreak in Christchurch has put all practices on alert and we are seeing an increase in MMR vaccination particularly in the older at risk population which has led to a shortage in vaccine supply. The vaccine supply has been limited to the scheduled immunisation events at 15mths and 4yrs and to people eligible for MMR vaccine going into affected areas. Immunisation Steering group meeting to be held on Thursday 4 March 2019 to discuss the call for action on immunisation from the Ministry of Health. Raising Healthy Kids 93% for total population and for Māori at 97%, against the target of 95%. Continuing the good performance.
Financial Mar 19
Actual Mar 19
Var YTD Var
Feb 19 Actual
Feb 19 Var
Provider ($2,667k) ($1,672k) ($803k) $1,267k $1,519k Governance ($11k) ($9k) $0k $7k ($5k)
Funder $815k $815k ($394k) ($1,024k) ($1,024k)
Consolidated ($1,864k) ($867k) ($1,203k) $250k $490K The management accounts result to March includes $360k of the non-specific expense accrual. The Provider Arm operating result for the month was a deficit of $2,667k – negative variance $1,673k. A significant contribution to this is the partial reversal of the Pharmac rebate of February back to Funder, of $673k, after discussion between the two divisions of what the overall treatment should be and confirmation of what was already included within the ISLA. The result being an improvement in the Funder results and a decline in the Provider. However, this still leaves a $1m negative variance for the month. Almost half of this was one off events related to accruals in February and to the cost of unpaid days in February being lower than actual. This is likely to be caused by the strike cost effect. Expenditure is now up on last year $9.5% or $7,455k and this is an increase in rate form 8.7% last month. While staff costs are under budget they are 9.1% up on last year, although this is affected by the Cleaning, Orderly and Security services move. That aside and allowing for the additional revenue for pay increases above the agreed 2.43% to be funded by DHBs, plus the funded additional positions, on balance between insourced, outsourced plus additional revenue, staff costs are under budget. Acute admissions were up in March. The admissions were up 19.8% on March last year and the highest in the six years of data compared. The hospital loading for acute admissions was similar to a winter month and this is not a good portent for winter. Staff costs were overspent for the month by $570k, and as noted above, while significantly up on last year this is mainly related to the change in cost centres, the higher than usual salary increases and the additional FTEs. Staff costs are also inflated this month and YTD through the effect of cover payments for the strikes by RDA members. They year to date bottom line effect of the strikes on salary costs is estimated at $350k, not counting the cost of re-scheduling and catch up. Outsourced staff cost
increased in the month, medical ($160k) over budget, and overall up 11.2% on last year which is actually an improvement from 15.1% last month. Clinical supplies costs are up 12.5% on last year and this has increased f rom 12.2% last month with the boost in electives combined with notable additional cost in medication (17% up on cancer drugs) and air ambulance costs (up 23.1% on last year). The Funder arm result was a surplus of $815k, a positive variance $815k, and year to date ($394k), negative variance ($394k). IDFs for the month increased by $162k based on updated figures from Waikato. The most significant change to March’s result was the previously mentioned transfer of the hospital pharmaceutical rebate from Pharmac. Overall the ($394k) negative variance to budget YTD is made up of the following components:- - IDFs – outflows to Waikato are up according to their figures. Still to reconcile with MoH figures. Negative
effect $426k Comparisons to 2017/18 (YTD)
Result Actual Variance
2017/18 ($3,164k) ($3,587k)
2018/19 ($7,807k) ($1,203k)
Result Drivers Provider Revenue
Under budget for the month by ($797k) with YTD $1,580K ahead of budget. The major contributor is the reversal of the Pharmac rebate of ($673k). Adding to the position was the reversal of an over accrual in relation to pay settlements, the additional staffing and smaller amounts for new service, $450k overall. Health Workforce NZ receipts are over this month $14k making YTD under ($24k). ACC income improved significantly in the month being over budget $56k for the month making YTD under by ($130k).
Expenditure
Overspent ($876k) for the month compared with overspend of ($74k) last month, YTD overspend ($2,382k)
Staff costs were overspent by ($570k) for the month, this includes a gap of $280k in the accrual for unpaid days. The calculation for unpaid days has been made difficult due to the number of settlements, lump sums and strike payments made in the year to date. Work will be undertaken to resolve any ongoing issues during April. The leave liability decreased from last month by $35k. Medical Staff were over spent ($129k) (including $76k in strike costs) and YTD outsourced medical staff is over-budget by ($338k) more than Medical staff costs are under. Nursing staff costs were over budget by ($214k), ($923k) YTD. This part funded. Allied Health was ($51k) over budget, Support over by ($149k). Sick leave was 2.2% for the month, up from 1.8% last month. Sick leave is up on last year when it was 2% in March 2018.
Paid FTE was up for the month at 771, which is over budget.
Outsourced services were overspent ($203k) for the month. Year to date this is ($547k) more than last year. Recruitment and cover remains problematic in psychiatry, orthopaedics, anaesthetics and ED.
Clinical supplies were overspent by ($84k) for the month. Usage of blood was ($13k) over for the month. Cancer treatment costs were ($41k) over budget for month and are ($226k) or 17% higher than last year. Air transport expenditure was $7k under for the month and is ($267k) or 23.1% higher year to date than last year. Patient transport and lodging is overspent YTD by ($154k) and is 12.9% more than last year.
Infrastructure and non-clinical supplies costs were overspent ($19k) for the month. The non-specific accrual is $360k.
A reversal of last month’s performance in General Medicine admissions but still a definite downward trend.
Sharp upswing in March results in Paediatric medicine acute admissions but still an overall declining trend.
General Surgery admissions show a slight reveral on last months sharp decline but more in line with trend.
Orthopaedic admissions continue to defy the saw tooth this month
ED arrivals are up on last month, and are another five year high for a month. This data is of prime action for the Demand Management group. The corresponding period of admissions shows a better trend. However, this implies that of the people attending a larger proportion do not end up being admitted. Therefore is there opportunity for primary care management?
Governance and Administration Revenue On budget for the month. Expenditure Overspent $9k for the month and under $7k YTD. Staff costs under budget $2k for the month and $26k YTD. Non-staff expenses are in line with budget for the month. HealthShare is $12k over budget and will
continue to be as the year progresses due to budgeting error. Democracy costs are $9k over budget and under budget $29k YTD.
Funder Revenue
Positive $2,090k for the month. Driven by additional income for Pay Equity, NZNO Settlement and Te Kūwatawata and the transfer of hospital pharmaceutical rebate from the provider
Expenditure Overspent ($1,275k) for the month, includes offsetting expenditure for pay equity and Te Kūwatawata and
adjustments for IDFs and Pharmaceutical Cancer Treatments.
Better Outcomes for People Not a good picture this month but displaying more work to be done. We have a comparatively high proportion of people diagnosed with bowel cancel in the ED, when they present with acute bowel obstruction. We need to work with people and services to prevent this from occurring because outcomes are significantly worse for people with bowel tumours the later they are identified. This data is a statistical picture of what we see on a regular basis through the Faster Cancer Treatment programme where people seek help late, and treatment options are limited or the first treatment is palliation.
To counter this we have put together a group between primary and secondary care to review the actual stories of people who arrive late to diagnosis and care. We intend through systematic review to isolate the factors to lead to the late intervention, so that we can modify those factors. Once we have seen a pattern for one person that will inevitably lead to improved outcomes for those to come later. With cancer, the opportunities to improve come each day, we just need to harness them between the various care providers, and to improve the acceptability of care so that people experience no barriers to seeking it.
Primary & Community Health Services
Te Rūnanganui o Ngāti Porou Accord In November 2018, Te Rūnanganui on Ngāti Porou, Ngāti Porou Hauora and the MoH met to progress work on support to the business case, and an approach was agreed regarding the business case. In January 2019 Te Rūnanganui o Ngāti Porou and Ngāti Porou Hauora met with the MoH to review and support a high level work plan, whilst Hauora Tairāwhiti was not present the draft high level plan was provided to us for review. In early April, we met with Te Rūnanganui o Ngāti Porou, Ngāti Porou Hauora and Ernst and Young (agreed consultants to progress a business case) who took the group through a detailed process regarding what was needed in a business case. The work helped clarify and refine the joint work needed so that a clearly thought through approach can be agreed. There was a high level of support for the approach considered, the next stages for the whole group will be to undertake an Investment Logic Mapping exercise that tests and prioritises the pieces of work needed to select in or out. Kia Ora Self-Management Programme We recently secured the opportunity to have Health Hawkes Bay PHO come and present their successful self -management Kia Ora programme for long-term conditions they have implemented in the Hawkes Bay. This is a community driven tool that supports whānau with long-term conditions. It is an adaptation of the Stanford model of Self-management. We had a morning presentation to local service providers that was well attended and an afternoon presentation with DHB/PHO leadership. We are now progressing this initiative within our DHB and with our PHOs. NES Switch Over Go-Live Date 1 April 2019 On 1 April 2019, people with enrolments in the National Enrolment System (NES) are funded for PHO capitation payment from April 2019. Practices no longer have to do a PHO import. Funding status is set from the NES enrolment details.
Child, Youth and Population Health Dental Health Work is progressing in this service development, contracts are finalised for the Provider service to deliver service to young people living on the coast. Rheumatic Fever Programme The new campaign is under way in readiness for Winter.
Mental Health, Alcohol and other Drugs Te Kūwatawata The extension to the Te Kūwatawata contract ends of June 2019. Discussions are underway regarding how we will embed this service going forward. We are also exploring how the service can be better supported formally, going forward. Mental health and employment - Work broker Work is underway to develop the role of a work broker to facilitate whaiora into work. Work has been a positive tool to assist whaiora to manage their mental disorder and strengthen the statement “employment is a health intervention”. Local Mental health review The appointment of a project manager to oversee this review is imminent, and will enable this project to get traction.
Health of Older People and Disability Support Services Advance Care Planning The Quality Health and Safety Commission are now further embedding the campaign for ACP into communities. Needs Assessment Service Coordination (NASC) Aged care occupancy remains lower than usual, particularly for people with dementia Te Wiremu are going to use 10 dedicated for people with dementia beds for people with hospital level care needs. Individualised Funding is working well for younger people.
Population Health Tobacco Control Taki Tahi Toa Mano have been informed that Council owned parks and reserves are soon to have smokefree bilingual signes erected. Further, Taki Tahi Toa Mano are supporting the National Smokefree Cars working group position statement to Minister Salesa to exclude punitive action into the Smokefree Cars legislation Te Whare Awhiora (Mental Health) celebrated one month of being Smokefree on 28 March 2019. Physical activity and Nutrition We are supporting Gisborne District Council (GDC) in regards to safe drinking water at GDC parks and recreational reserves. The Midlands water and milk only policy survey in schools is nearing completion Healthy Workplaces Three new workplaces are registered for WorkWell (Inline Group, Aborcare Tree Company and Te Kura Reo Rua o Waikirikiri). We have completed two WorkWell inductions for management and staff lead for WorkWell
A Mental Wellbeing Workshop is being planned for WorkWell workplaces in Tairāwhiti with the Hauora Tairāwhiti Suicide Prevention Coordinator. We continue efforts to collaborate with Plus Business NZ, Hauora Tairāwhiti Suicide Prevention Coordinator
and WorkWell regarding Mates in Tairāwhiti – Suicide prevention workshop for workplaces in Tairāwhiti. Suicide Prevention/Postvention We attended the Waka Hourua, Fono hui which was a collaboration between Te Rau Ora (Te Rau Matatini) and Pacific Organisation LeVa. The kaupapa was grounded in the past, strengthened for the future. Road Ahead for Suicide Prevention hui on 8 March was a great success and from that hui a Suicide Prevention Steering group was created and has met for the first time. The development of web pages dedicated to Suicide Prevention Tairāwhiti is in the making and these pages will sit within the Hauora Tairāwhiti website. Sexual and Reproductive Health We are connecting with managers from local MSD to support “Hauora Wall” to promote free health services to whānau who access support within their service. We are supporting the Aids Foundations HIV Hauora programme to community and health professionals. We are promoting the importance of cervical screening at MSD and local community groups.
Health Protection We are working with water suppliers to support Interval Pre-verification training with GDC. The Gisborne District gambling policy is being reviewed. Public Health (PH) have collected data, looked at national research and met with community groups. PH will put forward their submission, mostly in support of the reviewed gambling policy. We are DrainWise Awareness and Education planning with GDC. General Health Promotion Advisor –the Mokopuna Ora SUDI Prevention and Safe-Sleep Coordinator role has been filled. We are extremely pleased to welcome Kaniwa Kupenga-Tamarama who brings to the role over seven years of clinical experience as a community midwife, and hospital-based midwife, working at Counties Health, Waikato DHB and currently sharing the LMC representative role on the Maternity Quality and Safety Programme, here at Hauora Tairāwhiti. She is also currently tutoring two student midwives through WINTEC. She is the North Island representative for Ngā Maia o Aotearoa, and Deputy Chairperson for Ngā Maia ki Tamaki Makaurau. Kaniwa brings with her a strong passion for Māori whānau, reducing Māori health inequities and developing Māori workforce. Her start date is 4 June 2019. We are very pleased to advise that Tomairangi Chaffey-Aupouri is the recipient of the Rotary Young Leaders Award, which is a week-long leadership and training session being held at Karapiro from 13-18 April 2019.
Hauora Tairāwhiti Board Title: Summary Financial Report
Prepared By: Craig Green, GM Finance
Date: Tuesday, 16 April 2019
Information Item
1. GM FINANCE COMMENTS
Financial Performance Result and Overview The DHB has a Board approved $9.5 million deficit budget for the 2018/19 financial year. The DHB result for the period ending 31 March 2019 is $867k unfavourable to budget for the month with a deficit of $1,864k. For the month, the:
Provider Arm is $1,673k unfavourable
Funder Arm is $ 815k favourable, and
Governance Arm is $ 9k unfavourable
Provider Arm: For the month, the Provider Arm’s unfavourable variance of $1,673k driven by:
Revenue: $797k unfavourable for the month; driven by $600k transfer of PHARMAC rebates for Hospital medications back to Funder Arm; $450k over accrual in CCDM offset by favourable ACC revenue $56k, 17/18 PHARMAC rebate of $56k.
Expenditure: $876k adverse. Key variances: o Personnel costs: $570k unfavourable to budget of $6,408k (medical $129k; nursing $214; allied
health $51k, support personnel $49k - $86k related to MECA increase backpay and $9k pay correction) o Outsourced Services: $203k adverse (Medical personnel $160k; Allied $30k; Clinical Services $16k) o Clinical Supplies: $120k unfavourable (Treatment disposables $44k and Pharmaceuticals $58k).
Funder Arm: For the month, the Funder Arm’s favourable variance of $815k driven by:
Revenue: $2,090k favourable; $1,736 PHARMAC ($1,023 transfer back from Provider Arm, $512k PHARMAC rebate, $224k 17/18 PHARMAC rebate); $244k MECA settlements (NZNO, PSA Nurses & Allied); $194k pay equity
Expenditure: $1,275k adverse; driven by: o Personal Health: $840k unfavourable; Pharmaceuticals $31k, Primary Care Strategy (capitation)
$435k, IDF Outflows $145k and price adjusters $283k o Mental Health: $204k unfavourable; Te Kuwatawata $146k, $37k minor MH expenses o Disability Support: $200k unfavourable; aged residential care $255k, respite care $15k offset by
Day relief programmes $42k favourable and $33k community care services
2. CONSOLIDATED FINANCIAL PERFORMANCE SUMMARY
Note: The Waikato DHB IDF accrual YTD March 2019 sits at $426k; which is a $142k cost increase on YTD February 2019.
2. STATEMENT OF FINANCIAL PERFORMANCE – CONSOLIDATED
4. FINANCIAL POSITION - SUMMARY The financial position as at March 2019 is below. This indicates a weak balance sheet, with $11.8m in negative working capital and a net worth of $52.2m. Working capital improved with $11m equity injection in January 2019.
5. CASH FLOW POSITION
Cash Position The cash balance was in credit by $4,499k with the DHB pool at month end; being $8k favourable to forecast credit balance of $4,494k. Operating cash was $355k adverse to forecast; Investing in capital equipment $291k favourable to budget and Financing in-line with expectations.
Inwards: Inward cash was $1,858k favourable to forecast, driven by: very low cost access & under 6s $256.2k, nursing settlements $243.6k, safe nursing $52.7k, pay equity $194.0k and 2018/19 Q1 elective and ambulatory initiative $781.4k.
Outwards: Operating Cash outflow adverse $1,787k to forecast; driven by payroll costs $556k ($102k back pay for Housekeeping, Orderlies & security; $74k strike costs) payments to non-DHB providers $1.056k.
Capital Expenditure: $291k favourable to budget.
Outlook: Closing cash projected $5,394k cash positive in April net cash expected to be $894k positive.
6. CAPITAL EXPENDITURE (CAPEX) Depreciation funded capital expenditure planned for the 2018/19 year is $2.821m. The table below summarises spend against budget (depreciation funded and Carry Forward from prior year) for the month and year-to-date.
CAPEX spend is favourable $289k MTD March 2019; and adverse $356k YTD to the revised linear budget.
7. YEAR-END FORECAST
Risks to our Year End Forecast:
5 day RMO strike costs $350k
NZRDA bargaining
Support MECA bargaining
IDF Wash-up (outflow)
8. VALUE RELEASE PROGRAMME – SAVINGS PLAN
9. PERFORMANCE GRAPHS
Hauora Tairāwhiti Board Sub-Committee Reports
AGENDA ITEM
AGED & DISABILITY SUPPORT ADVISORY COMMITTEE 9.4.19
No public included decision items
COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE 9.4.19
No public included decision items
HOSPITAL ADVISORY COMMITTEE 16.4.19
No public included decision items
FINANCE, AUDIT & IT COMMITTEE 16.4.19
No public included decision items
