COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEE … · 005 . 006 . 012 3. PRESENTATIONS 9.20am 3.1 South Seas Whaanau Ora Approach (Silao Vaisola -Sefo, Chief Executive Officer) Presentation

Counties Manukau District Health Board – Community and Public Health Advisory Committee

COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEE MEETING (CPHAC) Wednesday, 15 August 2018

Venue: Manukau Boardroom, CM Health Board Office, 19 Lambie Drive, Manukau, Auckland Time: 9.00am Committee Members Colleen Brown – Committee Chair Dr Ashraf Choudhary – CMDHB Board Member George Ngatai – CMDHB Board Member Dianne Glenn – CMDHB Board Member Katrina Bungard – CMDHB Board Member Apulu Reece Autagavaia – CMDHB Board Member John Wong – Community Representative

CMDHB Management Dr Gloria Johnson – Acting Chief Executive Benedict Hefford – Director Primary Community & Integrated Care Margie Apa – Director Population Health & Strategy Jenny Parr – Director of Patient Care, Chief Nurse & Allied Health Professions Officer Dr Campbell Brebner – Chief Medical Advisor, Primary Care Vicky Tafau - Secretariat

PART I – Items to be considered in public meeting AGENDA

9.00am 1. AGENDA ORDER AND TIMING Page No. 2. GOVERNANCE

9.00am

9.05am

9.10am

2.1 Apologies 2.2 Register of Interests

2.2.1 Does any member have an interest they have not previously disclosed? 2.2.2 Does any member have an interest that may give rise to a conflict of

interest with a matter on the agenda? 2.3 Confirmation of Public Minutes of the Community and Public Health Advisory

Committee Meeting – 4 July 2018 2.4 Action Items Register

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003 005

006

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3. PRESENTATIONS

9.20am 3.1 South Seas Whaanau Ora Approach (Silao Vaisola-Sefo, Chief Executive Officer) Presentation to be tabled.

Morning Tea (10.05am – 10.15am)

10.15am 3.2 Hospital in the Home (Penny Magud) 015 4. BRIEFING PAPER

10.35am 4.1 Healthy Weight Action Plan for Children Update (Pippa Van Paauwe) 4.1.1 Populated Healthy Weight Action Plan for Children Reporting Template

CMDHB– August 2018 4.1.2 Metro-Auckland Healthy Weight Action Plan for Children 2017-2020

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5. DISCUSSION

10.55am 5.1 CM Health Expenditure in Primary & Community Health 2017/2018 (Benedict Hefford)

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6. INFORMATION

6.1 CPHAC Update on Locality Clinic Hubs (copy of tabled presentation from 4 July 2018)

125

11.25am 7. RESOLUTION TO EXCLUDE THE PUBLIC 152

Next Meeting: Wednesday, 26 September 2018

Counties Manukau District Health Board – Community & Public Health Advisory Committee 15 August 2018

BOARD MEMBER ATTENDANCE SCHEDULE 2018 – CPHAC

Name Jan 21 Feb Mar 11 Apr 23 May June 4 Jul 15 Aug 26 Set Oct 7 Nov 5 Dec

Colleen Brown (Chair) N

o M

eetin

g

No

Mee

ting

No

Mee

ting

No

Mee

ting

Ashraf Choudhary (Deputy Chair)

Dianne Glenn

George Ngatai Apologies

Katrina Bungard Apologies

Rabin Rabindran Apologies

Apulu Reece Autagavaia Apologies

John Wong - External Appointee (appointed 13/9/17)

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CPHAC MEMBERS DISCLOSURE OF INTERESTS

15 August 2018 Member Disclosure of Interest Colleen Brown (CPHAC Chair)

• Chair, Disability Connect (Auckland Metropolitan Area) • Chair, Rawiri Residents Association • Member, Advisory Committee for Disability Programme

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

Building and Housing • Director, Charlie Starling Production Ltd • Member, Auckland Council Disability Advisory Panel • Member, NZ Disability Strategy Reference Group • District Representative, Neighbourhood Support NZ

Dr Ashraf Choudhary (CPHAC Deputy Chair)

• Board Member, Otara-Papatoetoe Local Board • Member, NZ Labour Party • Chairperson, Advisory Board Pearl of Island Foundation • Co-Patron, Bharatiya Samaj Charitable Trust

Dianne Glenn • Member, NZ Institute of Directors • Life Member, Business and Professional Women NZ • Life Member, Business and Professional Women Franklin • Member, UN Women Aotearoa/NZ • President, Friends of Auckland Botanic Gardens and Chair

of the Friends Trust • Life Member, Ambury Park Centre for Riding Therapy Inc. • Member, National Council of Women of New Zealand • Justice of the Peace • Member, Pacific Women’s Watch (NZ) • Member, Auckland Disabled Women’s Group

George Ngatai • Director, Transitioning Out Aotearoa • Director, The Whanau Ora Community Clinic • Chair, Safer Aotearoa Family Violence Prevention

Network • Huakina Development Trust (Partnership Clinic) • Community Organisation Grants Scheme (Auckland) • Lotteries Community (Auckland) • Board Member, Counties Manukau Rugby League Zone • Member, NZ Maori Council

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Katrina Bungard • Chairperson MECOSS – Manukau East Council of Social Services.

• Deputy Chair Howick Local Board • Member of Amputee Society • Member of Parafed Disability Sports • Member of NZ National Party

Apulu Reece Autagavaia • Member, Pacific Lawyers’ Association • Member, Labour Party • Trustee, Epiphany Pacific Trust • Trustee, The Good The Bad Trust • Member, Otara-Papatoetoe Local Board • Member, District Licensing Committee of Auckland

Council

• Member, Pacific Advisory Group for Mapu Maia – Problem Gambling Foundation

John Wong • Board member, Asian Family Services (a subsidiary of Problem Gambling Foundation of NZ).

• Chair and Trustee, Chinese Positive Ageing Charitable Trust.

• Founding member and council member, Asian Network Incorporation (TANI).

• Board member, Auckland District Police Asian Advisory Board.

• Board member, Chinese Mental Health Consultation Service Trust.

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COMMUNITY and PUBLIC HEALTH ADVISORY COMMITTEE MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS

Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 4 July 2018 Director having interest Interest in Particulars of interest Disclosure date Board Action Ms Margie Apa

Item 3.1 on the CPHAC agenda – Aged Related Residential Care Overview

Ms Apa is Chair of Presbyterian North who provide older people services.

3 May 2017 That Ms Apa’s specific interest is noted and the Committee agreed that she may remain in the room and participate in any deliberations of the Committee but is not permitted to participate in any decision making, if applicable.

Mr Reece Autagavaia

Item 4.1 on the CPHAC agenda – New Government’s health Policies & Priorities

Mr Autagavia is a member of the District Licensing Committee of Auckland Council

21 February 2018 That Mr Autagavaia’s specific interest is noted and the Committee agreed that he may remain in the room and participate in any deliberations of the Committee but is not permitted to participate in any decision making, if applicable.

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Minutes of Counties Manukau District Health Board Community and Public Health Advisory Committee

Held on Wednesday, 4 July 2018 at 9.00am – 12.00pm Manukau Boardroom, CM Health Board Office, 19 Lambie Drive, Manukau, Auckland

PART II – Items considered in Public Meeting

BOARD MEMBERS PRESENT

Colleen Brown (Committee Chair) Dr Ashraf Choudary Dianne Glenn George Ngatai John Wong

ALSO PRESENT

Dr Gloria Johnson (acting Chief Executive) Benedict Hefford (Director Primary, Community and Integrated Care) Jenny Parr (Director of Patient Care, Chief Nurse & Allied Health Professions Officer) Margie Apa (Director, Population Health & Strategy and Acting GM, Maaori Health) Vicky Tafau (Secretariat) (Staff members who attended for a particular item are named at the start of the minute for that item)

PUBLIC AND MEDIA REPRESENTATIVES PRESENT

There were no public or media representatives present at this meeting. APOLOGIES

Apologies were received and accepted from Benedict Hefford (Kathryn DeLuc attended on his behalf) and Jenny Parr (Karyn Sangster attended on her behalf).

NOTE This meeting of 4 July 2018 commenced with a Committee Member only session from 0900 to

0930. At 0930 the agenda resumed its normal order. WELCOME

The Chair welcomed all those present to the meeting.

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DISCLOSURE OF INTEREST/SPECIFIC INTERESTS

The Disclosures of Interest amendments were noted. Ms Tafau to amend items for Mr Wong.

1. AGENDA ORDER AND TIMING Items were taken in the same order as listed on the agenda.

2. COMMITTEE MINUTES 2.1 Confirmation of the Minutes of the Community and Public Health Advisory Committee

meeting held on 23 May 2018. Resolution (Moved: Dianne Glenn /Seconded: Dr Ashraf Choudhary) That the minutes of the Community and Public Health Advisory Committee meeting held on 23 May 2018 be approved. Carried

2.2 Action Items Register/Response to Action Items Noted. Population Health Plans – CPHAC would like to receive this differently and will advise via email to Margie Apa. One Stop Shop CPHAC would like a high level understanding of how aligning to the current government strategies will affect CM Health, in particular School Based Health Services (provide a list of One Stop Shops currently providing services and give clarity around the pathways into these services). Transition from school to community/adult services: work is being undertaken with General Practice in order to make them more youth friendly. Action Provide basic information/data around the youth in this community and what services they are accessing and how they are accessing them. Oranga Tamariki – provide information around how many youth are in vulnerable situations that may lead to them being adults that are unaware around how to navigate health services. Action Community Meeting - Youth: Invite youth from the Youth Councils across Manukau to participate in a meeting and give feedback around their concerns and their needs. Explain to youth the principles behind a YOSS in order for them to have greater understanding. CPHAC noted that within the MoH report there is no information around Pacific/Maaori/vulnerable and hard to reach populations. CM Health need to ensure it is capture these populations. The challenge with YOSS is the transition of youth into adulthood. Also, place based. Youth need to be able to access services quickly and these services need to be able to deal not just with Youth, but whaanau as a whole. CPHAC was advised that Youth feel that virtual services would best suit their needs.

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3. BRIEFING PAPERS

3.1 Child Healthy Policy Considerations Discussion (Carmel Ellis, Dr Philippa Anderson) CPHAC were advised that the email received in October 2017 hasn’t received the considered response mentioned and the email response has yet to be received. The issues in the letter that was sent to Dr Tuohy still stand and CM Health are not waiting for the Ministry to implement any changes and have been advocating for change. Action A second letter is to be drafted. The next stage of this letter needs to be an escalation. We are wanting to get a response that allows for CM Health/Social Wellbeing Board (SWB) to continue testing while the overall strategy is still being looked at. There is a definite need to get that official authorisation. Craft a letter to the three metro-Auckland CE’s asking for support from the Director General advising that CM Health are happy to do this on our own, but require funding to assist with resourcing. Please be clear that if we carry on as we are we are actually increasing inequities. Be clear around our treaty obligations. Include the wording that this letter has been sent with the support of both CPHAC committees. Advise that we will be expecting a response prior to the next CPHAC on 15 August. Dr Anderson advised CPHAC that the Wellbeing strategy is currently sitting with cabinet. The Design Authority within the Ministry of Health is feeding into that strategy from a health point of view. Child & Youth Wellbeing strategy includes youth up to 18, may encompass older youth in the future. Proposed vision: NZ is the best place in the world to be a child. The current review of the health system has halted the review of Child Health. CPHAC asked for clarity around what are our treaty obligations and reiterated the need to focus our reports on cultural contribution – Maaori, Pacific, Asian. Dr Anderson advised not all changes require resource, it’s about organising ourselves differently. Conversations are being held with the Design Authority and the engagement is going both ways. CPHAC was advised that via SWB and Child Health we are quite influential. Wellchild framework has yet to be evaluated and therefore we are unaware of how this is working for our whaanau. It is likely that the framework is no longer fit for purpose. In regard to the Wellchild programme, the MoH is still collecting critical data in an excel spreadsheet. Dr Anderson advised that IT is an issue across the sector. And investment will be required to create a fit for purpose system, where different databases can talk to each other and to Education as well. This needs to be national. CPHAC asked if we are able to look at other countries that have systems where across-sector communication works well and adapt a model for ourselves? Dr Anderson talked about Scandinavian countries whereby individuals have a unique identifier that works across all sectors. CPHAC thanked Ms Ellis and Dr Anderson for their time.

3.2 After Hours Urgent Care (Kathryn de Luc) The report was taken as read. Subsequent to Board approval we have concluded negotiations with the preferred providers. As part of these negotiations, the three DHBs kept some key elements in common across the region, including:

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• Subsidised population groups targeting equity (High User Health Cards or Community Services Cards, low income residents, and people aged 65 or over);

• $39 maximum co-payment for the subsidised population groups; • Free after hours care for under 13 year olds; • Attainment of urgent care accreditation standards, and • Appropriate data collection to support the on-going performance and quality framework

of the Auckland Regional After Hours Network. There are however some differences across the region. As previously agreed by the Board, we have not proceeded with the overnight component (8pm to 8am) and have instead established an interim solution with four providers (one in each locality) to provide extended hours services from 8pm to 11pm. The extended hours services will remain consistent with the common after hours elements described above. CPHAC advised that from a communications perspective: the language needs to be clear however the table (in the paper) is the best form of communication. Another idea would be to direct community to access HealthPoint for the latest version of information. Resolution The Community & Public Health Advisory Committee: Noted that negotiations with the preferred providers have now been concluded and 120,000 patient visits per annum will now be subsidised for low income patients at clinics spread across the localities, with a maximum co-payment of $39 for adults in the target group, and free access for all under 13’s until 11pm. Supported communications to the public and other interested parties of the new arrangements, which represent a doubling of access to subsidised urgent after hours care in Counties Manukau. Moved: Dr Ashraf Choudhary/Seconded: Dianne Glenn Passed: Unanimously

4. PRESENTATION 4.1 Mangere/Otara Community Health Hubs Presentation (Alan Greenslade)

Mr Greenslade advised that the Mangere radiology equipment needs updating and he is considering outsourcing of all the services in the unit. Planning to have an after-hours clinic in the future at both Mangere and Otara. CPHAC talked to the possibility of being able to immunise/screen people at both of these locations. Is it possible to consider training for nurses in terms of being able to immunise is a two day course or online plus a half day training course. CPHAC was advised that this may not be an easy fix as there are many factors to take into consideration. Vaccinations are wrapped up by so much legislation, this is the reason why it’s primarily left to General Practise. Action Karyn Sangster to make some investigations into this area of vaccinating in community hubs. The Respiratory Clinics that are provided have meant that waitlists are dramatically reduced. This is due primarily to having these hubs close to whaanau homes. The hubs are being developed all around the Counties Manukau area. Services will differ between hubs dependent on what the community requires.

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Action CPHAC would be interested to know if the staff working in these hubs are reflective of the community? Do they live in the community? Are they Pacific, Maaori? Next Steps • Increase #10 Mangere clinic rooms from 7 to 10 • Either:

- a)Develop #6 Mangere Clinic Hub – 7 clinic rooms - b)See if we can secure the 5 Toto Ora clinic rooms adjacent to #10

• After-hours clinics in Mangere & Otara • Ongoing model of care development through collaboration between services with primary

care providers CPHAC advised Mr Greenslade they would like to receive an update in 6 months’ time.

5. RESOLUTION TO EXCLUDE THE PUBLIC Resolution (Moved: Colleen Brown/Seconded: Ashraf Choudhary) That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

3.1 Mental Health & Addictions Update

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

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

Carried RESOLUTION TO INCLUDE THE PUBLIC Resolution (Moved: George Ngatai /Seconded: Katrina Bungard) Carried The Committee returned to the Public section after ratifying the Public Excluded minutes of 23 May 2018.

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6. GENERAL BUSINESS Maaori Health Gains Committee CPHAC were provided with a copy of the Terms of Reference. Mr Ngatai provided background as to how the committee was formed and the reasons for this. Balancing the needs of the community with Providers and MWiTM was a factor. The direction of the committee will potentially be duplicated for the Pacific and Asian communities. The main focus for many Maaori providers is toward Waikato rather than Auckland. CM Health need to have an awareness around this. Mr Ngatai advised that if there is regionalisation of MHAC then this committee would be a local feed into the new committee. This committee would drive local initiatives to that regional committee. Action CPHAC queried a pot of funding from the last government for the formation of Pacific Providers network (nationally). Ms Apa advised she will follow up on where this network is at. Meeting closed at midday. SIGNED AS A CORRECT RECORD OF THE COUNTIES MANUKAU DISTRICT HEALTH BOARD COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEE MEETING OF 4 JULY 2018.

Colleen Brown Committee Chair

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Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.


Community & Public Health Advisory Committee Meeting – Action Items/Resolution Register – 15 August 2018

DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

Standing Items

19.8.15 Locality Updates:

Otara/Mangere

Franklin

Eastern

4 July

26 September

5 December

Kathryn de Luc

Kathryn de Luc

Penny Magud

14.6.17 ARPHS – six-monthly update. 5 December Benedict Hefford

29.11.2017 Population Health Plans (Asian, Pacific & Maaori) – quarterly update including a local picture as well as national data on the Healthy Mums & Babies target.

26 September Margie Apa Please be advised that this report will be presented to ELT on 28 August for approval for forwarding to CPHAC.

29.11.2017 17/18 Metro Auckland SLM Improvement Plan – quarterly report.

26 September Benedict Hefford

29.11.2017 3.1 Every $ Counts – Project team to present an update on this project.

26 September Sarah Sharpe

29.11.2017 4.1 School Based Health Services

Undertake an investigation into a model for a ‘one-stop’ shop in Mangere/Otara and report back.

4 July

Benedict Hefford

Item 3.4.1 on 4 July

18.10.2017 3.4 Healthy Weight Action Plan for Children

Arrange a presentation from Healthy Families NZ.

Provide a six-monthly update on the Action Plan.

26 September

15 August

Benedict Hefford

Benedict Hefford

Confirmed attendance.

6.9.2017 3.1 Owning my Gout – the project team were asked to return in 6 months’ time to update the Committee on their progress, particularly how they have got on working with A/WDHB as they have the balance of the

26 September Trevor Lloyd/ Benedict Hefford

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31,000 Gout sufferers.

21.2.2018 3.1 Green Prescriptions in Counties Manukau - The CPHAC committee would like Ms van Paauwe to return in the latter half of year to provide an update on progress.

7 November Carmel Ellis

11.4.2018 4.2 Letter sent to Chief Health Advisor, MoH. Mr Hefford to send letter to Ms Brown for her information.

4 July Benedict Hefford Item 4.1.1 on 4 July

23.5.2018 2.2 B4SC: CPHAC would like a further B4 School Update (regional concern) Ministry of Health so we can have a discussion around concerns. Mr Hefford is to ask for a more substantive response from the Ministry of Health.

26 September Benedict Hefford Dr Pat Tuohy has agreed to hopefully attend the September CPHAC meeting.

23.5.18 3.1 Mental Health & Addictions Update: with regard to homelessness for MH&A whaanau, Housing First to be invited to present to CPHAC.

7 November Dr Pete Watson/ Benedict Hefford

4.7.2018 Youth One Stop Shop:

Provide basic information/data around the youth in this community and what services they are accessing and how they are accessing them. Oranga Tamariki – provide information around how many youth are in vulnerable situations that may lead to them being adults that are unaware around how to navigate health services.

Community Meeting - Youth: Invite youth from the Youth Councils across Manukau to participate in a meeting and ask for feedback around their concerns and their needs.

7 November

5 December

Benedict Hefford

Benedict Heffort

4.7.2018 3.1 Child Healthy Policy Considerations Discussion: A second letter is to be drafted and forwarded to the Director General. Craft a letter to the three metro-Auckland CE’s asking for support from the Director General advising that CM Health are happy to do this on our own, but require funding to assist with

15 August Margie Apa No response received to date.

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resourcing.

4.7.2018 5.1 Mangere/Otara Community Hubs:

Karyn Sangster to make some investigations into the area of vaccinating in community hubs and report back to CPHAC.

Mr Greenslade to return to CPHAC with a community hub update.

26 September

Early 2019

Karyn Sangster

Benedict Hefford

4.7.2018 6 National Pacific Providers Network: Ms Apa advised she will follow up on where this network is at.

26 September Margie Apa

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CPHAC

Hospital in the Home Counties Manukau Health

15th August 2018 26 June 2018

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Hospital in the Home

“Hospital in the Home (HiTH) involves the provision of acute, sub-acute and post-acute treatments by health care professional at a

patients’ usual place of residence as a substitute for inpatient care received at a hospital”

Deloitte Access Economics - Economic analysis of Hospital in the Home, Hospital in the Home Society of Australasia 2011

The defining feature of Hospital in the Home is that if the patient were not to receive clinical intervention through this pathway, the patient would require hospitalisation

or a longer stay in hospital

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Range of conditions Urinary Tract infections Falls & reduced mobility Chest infection Chronic obstructive pulmonary disease Heart failure Cellulitis Deep vein thrombosis Pain management Frail elderly Social issues

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What are we proposing To develop HiTH as a suite of initiatives to operate across the district Phase 1: Supported Discharge An enhanced transition pathway enabling greater opportunity to provide

clinical treatment and monitoring within the patients home. Stepping patients down into non bedded rehabilitation/reablement in the

community Development of a discharge to assess model where a patients long term care

needs are assessed within their own communities Admission avoidance in reaching into Emergency Department & short Stay Unit Phase 2 Rapid Response - Wider Admission Avoidance Options for Primary care for

patients in crisis or at urgent risk of hospital admission Development of Step up rapid access services such as increased rapid access

clinics in the community

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What are we proposing Community Health Services are working in conjunction with the Division of General Medicine to establish a supported discharge pathway for patients admitted to Middlemore Hospital. The pathway will support the established System Level Measures (SLM) work for COPD, CHF, Cellulitis, COPD As well as Frail Elderly General medical patients to be discharged to their own home or alternative

temporary address at least one day earlier than usual.

This pathway aims to transition patients to Hospital in the Home as soon as they are medically fit for discharge and no longer require intensive clinical investigation or treatment. Under Hospital in the Home the patient will remain under the clinical care of a consultant physician and will receive daily home visits by a district nurse &/or other members of the Community Health Teams such as Community Health Assistants and Physiotherapists

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IT Enablers to Support Hospital in the Home (HiTH) ‘HiTH Ward’ created in iPM, mapped to Interim Care with

30 beds Transfer Summary –HiTH Electronic Discharge Summary – HiTH SMO Chart Review – published to the Concerto Document

Viewer – folder HiTH. Structured notes captured within Community Forms on

Line and published to the Concerto Document Viewer in a folder called ‘HiTH’.

E-Vitals & associated Community Early Warning Score and Escalation Guideline.

Proposal to implement MedChart to electronic prescriptions and administration of medications within the patient’s clinical record (Phase Two, HiTH).

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A patient centric view of HiTH

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Dashboard & Key Performance Indicators

No. of referrals & where from No. of visits per patient & cost of each visit No. of Bed days saved No. of admission avoidance via ED & MAU No. of ED presentations appropriately avoided Travel time Average length of stay within HiTH Readmission to hospital or HiTH Patient reported experience measures Patient reported outcome measures Carer burden

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Counties Manukau District Health Board – Community & Public Health Advisory Committee

Counties Manukau District Health Board Community & Public Health Advisory Committee

Metro-Auckland District Health Board Healthy Weight Action Plan for Children: First Report on Actions

Recommendation It is recommended that the Community & Public Health Advisory Committee: Note progress on the first report of action plan indicators.

Prepared and submitted by: Pippa van Paauwe, Service Development Manager, Child Health CPHAC Community and Public Health Advisory Committee DHB District Health Board HAT Healthy Auckland Together WCTO Well Child Tamariki Ora LMC Lead Maternity Carer Purpose The following reporting has been presented to CPHAC to provide an opportunity for members review progress, and provide feedback. Executive Summary The Metro-Auckland DHB Healthy Weight Action Plan for Children was developed in alignment with the vision of ‘Healthy Together’, taking a life course approach and as per our Maaori Health Plan, noting these impacts start in pregnancy. Our action plan is therefore focused on the reduction of potentially avoidable diseases to address childhood weight management. Health sector led actions were established in the plan which contributes to a cross-sectorial response. This is the first report on action plan indicators (Appendix 1), which inform progress made in the implementation of the plan. Actions and indicators are presented by DHB and target population: women of childbearing age, pregnant women, pre-school and school aged children and adolescents. Some indicators are also reported by ethnicity, to ensure we are meeting the needs of our Maaori and Pacific populations. This first report on action plan indicators is being presented to CPHAC to provide an update on progress and an opportunity for feedback. The finalised plan is also provided in Appendix 2, for reference purposes. Highlights From this first report on action plan indicators the following highlights related to Counties Manukau Health, have emerged: • Three randomised controlled trials (TARGET, GEMS and HUMBA studies) related to healthy eating

during pregnancy, including women with Gestational Diabetes Mellitus, are progressing well and are on track

• The National Healthy Food and Drink Policy is being successfully implemented across the 3 metro-Auckland DHBs; the implementation plan is 50% complete

• 702 home visits have been completed through the intensive post-natal support service, Te Rito Ora • Otara Health Charitable Trust deliver a healthy lifestyles programme (Active Futures) for pre-schoolers

and their whaanau which exceeds the target to reach priority populations: Target - 75%, Achieved - 84% • 369 General Practitioners, primary care nurses and Well Child Tamariki Ora staff have been trained

across the region on having conversations about healthy weight with families with overweight children; 97% of participants identified reported themselves as ‘very’ or ‘quite confident’ with having conversations about healthy weight.

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Counties Manukau District Health Board – Community & Public Health Advisory Committee

• A gap analysis of healthy food environments in and around Kohanga Reo, Pacific Language nests and ECEs has been completed to determine areas for future DHB support.

Risks/Issues The following actions are currently off-track: • The feasibility of scoping for a pilot to assess growth (height and weight) at the year 8 dental check has

not occurred due to insufficient staffing resource this action. The priority is preventative restorative dental treatment.

• 59% of women accessing the Te Rito Ora are fully/exclusively breastfeeding at 6 weeks. Comparative to the WCTO Quality Indicators (Indicator #5: Breastfed at discharge from LMC) WCTO Provider data reports a 66% rate across the CMH region (March 2018), and their target is 70%. However, Breastfeeding rates in Te Rito Ora increase to 60% at 12 weeks and 71% if women have been enrolled in the programme antenatally, compared to WCTO Provider rates of 51% in the CMH region (March 2018) at the same point (WCTO Quality Indicator #6: Breastfed at 3 Months).

Report on Action Plan Indicators Please see Appendix 1

Conclusion Monitoring and evaluation is critical to any new programme or activity. It allows us to assess whether we have delivered on the goals, aims and objectives of the programme, whether we have achieved the desired outcome and to assess the relative contribution of different components or processes. Monitoring and reporting on the Healthy Weight Action Plan for Children will occur at 6-monthly intervals. For indicators that are already reported on elsewhere, information on progress toward meeting the indicator(s) is provided. For some individual programmes instituted as part of the plan, more rigorous monitoring and evaluation plans have been developed. Previously the plan was intended to be responsible to the Northern Region Child Health Network but following feedback responsibility for the implementation of the plan has been devolved to the DHBs directly. The first report on action plan indicators for the Metro-Auckland DHB Healthy Weight Action Plan for Children has been presented to CPHAC to provide an opportunity for members review progress, and provide feedback on the reporting. The action plan indicators have been developed collaboratively across the region, with consistency in data collection and reporting, where appropriate. Accountability for the plan now sits with the DHBs. There will be 6-monthly updates to CPHAC on progress on actions outlined in the plan. Appendices Appendix 1 Populated Healthy Weight Action Plan for Children Reporting Template CMDHB– August 2018 Appendix 2 Metro-Auckland Healthy Weight Action Plan for Children 2017-2020

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Appendix 1 Populated Healthy Weight Action Plan for Children Reporting Template CMDHB– August 2018

Women of Childbearing Age

Actions Time- frame Responsibility Measures

Priority Populations ADHB WDHB CMDHB Notes

Survey Pacific women and men who have maintained weight loss from the Aiga challenge for three years regarding enablers to weight loss maintenance by December 2016 and utilise survey findings in a review of the Aiga challenge. Dec-17 Fili Tupu

% who have maintained weight loss in past three years; narrative enablers to weight loss/maintenance complete (Y/N) 46% 38%

Narrative enables to weight loss/maintenance complete. Aiming for new Pacific objective for next round of reporting

Investigate access barriers to bariatric surgery for Maaori and Pacific women of child bearing age Jun-18 Sarah Masson

# of Bariatric surgeries in 2017/18:

Maaori 17 18 Total surgeries 2016/17, ADHB: 82; WDHB: 98; CMDHB: 156 Total surgeries 30 Jun 17 - 30 Jun 18 ADHB: 70; WDHB: 95 Pacific 22 10

Scope what an Adult Obesity Service (intensive lifestyle intervention Tier2-3 service) might look like as part of the bariatric pathway Dec-17

Karen Bartholomew Complete (Y/N) On hold On hold

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Promote Green Prescription to primary care and identify and address barriers to primary care referrals

Jul-18, Jul-19, Jul-20

Leanne Catchpole (WDHB/ADHB) Rochell Bastion Primary Care Portfolio Manager (CM Health)

# of adults enrolled in Green Prescription by ethnicity

Maaori 579 609 1481

Reporting measures are different across the region ADHB/WDHB: Full year total of 'engaged' CMDHB: Full Year total of 'referred'

Pacific 857 565 1788

Healthy Food Environments

Implement the National Healthy Food and Drink Policy in DHB-owned sites Complete baseline audit Complete follow-up audits

Jul-18, Jul-19

Rebecca McCarroll and Roslyn Norrie (ADHB/WDHB); Stella Walsh (CM Health)

50% compliant 100% compliant

50% Compliance

50% Compliance

50% Compliance

Policy implementation is slightly behind time.

Work with ARPHS and Healthy Families NZ through Healthy Auckland Together (HAT) to implement the National Healthy Food and Drink Policy for Organisations in the community. Dec-18

Jacqui Yip (ARPHS) Rebecca McCarroll (ADHB/WDHB); Doone Winnard, Clinical Director Population Health (CM

# of organisations who have begun implementing the Policy See notes

n=1 implementation across whole site See notes

Some HAT organisations have begun implementation across all 3 DHB catchment areas (n=3) - this implementation is however partial, i.e. across 'some' of the organisation's sites

026


Work with DHB contracted providers to support implementation of aligned healthy food and drink policies

Health)

# of providers who have the Policy in their contract 97 114

>95% of all local contracts had the policy included in 2017/18 contract renewals (n=~300 contracts)

Pregnant Women

Actions Time-frame Responsibility Measures

Priority Population ADHB WDHB CMDHB Notes

Ensure culturally appropriate antenatal education available to promote and support breastfeeding On-going

Ruth Bijl (Jesse) (WDHB/ADHB); Pippa van Paauwe/Amanda Hinks (CMDHB)

Deliver contracted volumes of breastfeeding related programmes with 80% of services delivered to the priority populations (Maaori, Pacific and Quintile 5)

Maaori At Risk At Risk Achieved/Completed

ADHB/WDHB: Culturally appropriate antenatal education is available which supports and promotes breastfeeding. However, the delivery of programmes is not reaching and 80% to the priority groups identified here. With higher uptake amongst Asian mothers, for Pacific At Risk At Risk

Achieved/Completed

027


Quintile 5 At Risk At Risk Achieved/Completed

example, falling outside this priority framework. CMDHB: 80% is the total percentage of priority populations accessing 4 separate programmes delivered by 4 providers.

Continue to support the implementation of the Healthy Babies Healthy Futures (HBHF) programme:

Providing women and their families with key breastfeeding messages through textMATCH messaging, community promotion, and teaching practical skills for better nutrition and increased physical activity On-going

% of target (1000) and of people receiving textMATCH service 93.6%

Data not reported per DHB. HBHF will be looking into this in 2019

Working with partners to engage with specific vulnerable community groups (Maaori, Pacific, Asian, and South Asian) Jun-18

% of target (1000) and of mothers engaged in healthy conversations

Maaori 102%

Pacific 136%

Asian 104%

South Asian 104%

028


Further strengthen HBHF connections with maternity services, Kohanga Reo, Churches and ECEs to increase access to the HBHF programme Dec-17

# of Community Learning Programme (CLP) groups held within community settings 13/49

Promoting HBHF to pregnant mothers at the earliest possible stage when engaging with DHB services Dec-17

Nelson Wahanui (ADHB/WDHB)

% of target (1650) and of mothers given the opportunity to engage with a HBHF provider 98%

Continue the development of Te Rito Ora service and B4 baby services which engage with women in antenatal period to support breastfeeding Jun-18

Pippa van Paauwe (CMH)

70% women accessing the service will be fully/exclusive breastfeeding at 6 weeks (aligned to the WCTO indicator targets) Not Achieved

Te Rito Ora has a 59% breastfeeding rate at 6 weeks, and this is comparative to an overall rate of 66% across CMH region's Well Child providers using the same indicator (SOURCE: March 2018, WCTO data set). Breastfeeding rates increase in Te Rito Ora to 60% at 12 weeks and to 71% if women have been enrolled in the programme antenatally, compared to 51% across the CMH region within the Well Child providers (SOURCE: March 2018, WCTO data set).

029


Collaborate with primary care, Green Prescription providers, LMCs, DHB maternity services and HBHF; to enhance referrals to Green Prescription and ensure tailored advice for pregnant women on optimal weight gain: Promote and facilitate the adoption of MoH Guidelines for Healthy Weight Gain in Pregnancy (e.g. weight gain charts)

Incorporate referrals to Green Prescription and healthy weight gain in pregnancy conversations into existing Auckland Regional Health Pathways Dec-18

Leanne Catchpole; (WDHB/ ADHB); Rochelle Bastion, Portfolio Manger, Primary Care

Health Pathways updated to include referral options for pregnant women, e.g. Green Prescription (Y/N)

Not Achieved

Not Achieved Not Achieved

Feedback has been incorporated and pathway changes drafted. This is not yet live on the Health Pathways website.

Establish a baseline(1) and increase(2) referrals of pregnant women into Green Prescription for healthy weight management Dec-18

# pregnant women enrolled in Green Prescription

Baseline (2016-17): n=24 2017-18: n=52

Baseline (2016-17): n=3 2017-18: n=13

2017-18: n=20

CMDHB: new reporting indicator in system, so no baseline available and relies on accuracy of use as this is new.

Develop Pathway for management of pregnant women with high BMI Dec-18

Debra Fenton/Obstetric Clinical Forum (CM Health)

Pathway developed and implemented (Y/N) Achieved

Antenatal Management of Obesity/Morbid Obesity Guideline' needs reviewing. - Last Updated: 15/03/2016 Date First Issued: 26/11/2012

030


Undertake research on related to healthy eating during pregnancy and Gestational Diabetes Mellitus Dec-20

Feedback from study Principle Investigator of the progress of the 3 studies:

Target: neonatal data being cleaned; 6-mo data collection near complete GEMS: recruitment phase HUMBA: recruitment complete; 12-mo data collection to finish Dec '18



Undertake quality research TARGET* Recruit women for multisite study

TARGET: to complete recruitment by Oct 2017

Achieved/Completed

Achieved/Completed

Achieved/Completed

Gestational Diabetes Mellitus Study of diagnostic thresholds (GEMS)* Recruit women for multisite study

GEMS: to have 50% recruitment by Dec 2018 On Track On Track On Track

031


Healthy Mums and Babies Study (HUMBA)**-Undertake the study in partnership with UoA, Recruit women into the HUMBA study, Implement findings into practice

Chris McKinley (TARGET & GEMS) & Kara Okesene-Gafa (HUMBA) Principal investigators CM Health/Principal Investigator ADHB/WDHB

HUMBA: to finish data collection by Dec 2018 On Track On Track On Track

Infancy



Ensure culturally appropriate postnatal and community support available to promote and support breastfeeding Enhance the pregnancy and parenting education smartphone app and website to encourage all women, particularly Maaori, Pacific and Asian, to breastfeed for at least the first 6 months of their baby’s life

Jun-18 Jesse Solomon (WDHB/ADHB)

% of Māori and Pacific women who breastfeed at 3 months (Target of 70% of babies are exclusively or fully breastfed at 3 months)

Maaori Off Track Off Track PP37. Note: website and app available, good feedback regarding utilisation from target groups for website. However, content and promotion of resource due for review. Pacific Off Track Off Track

Postnatal support through Titifaitama and Wahakura Wananga including peer support and breastfeeding support groups

# who attend support groups

Maaori Achieved Achieved PP37.

Pacific Not achieved. Achieved

PP37. No specific Pacific breastfeeding support groups in place postnatally

032


Intensive post-natal support through Te Rito Ora service including peer support and home visits

Jun-18, Dec-18, 6-monthly reporting

Pippa van Paauwe, CMH

# of visits in 6 month period (Target - Kaitipu Ora Workers will engage with clients a minimum of 3x in Week 1 postnatally, and then weekly until Week 12). 702

n=127 Lactation Consultant visits + 575 Kaitipu Ora visits

Evaluate effectiveness of Auckland DHB breastfeeding community clinic and home visiting approach and integrate learnings into future efforts. Mar-18

Jesse Solomon (Gaylene)

Build findings from evaluation into contract for the 17/18 financial year (Y/N)

Achieved/Completed

Note: programme is continuing

Community cooking courses to support pregnant woman and parents and whānau of 0-2 year olds to make healthy, affordable and culturally appropriate meals which meet the nutrition needs of pregnant women and infants and toddlers Ongoing

Pippa van Paauwe, Service Development Manager Child Health

# of participants that complete the course 28

Note: 34 total women attended 1 or more sessions, 28 completed the full series

Evaluate the community peer/mentor support breastfeeding programme pilot to ascertain its success with Māori, Pacific and low-SES women. Dec-17

Jesse Solomon (Gaylene)

Evaluation outcome report complete (Y/N)

Achieved/Completed

Achieved/Completed

Note: programme was discontinued as did not successfully reach target population

Training and Education

033


Enhance the training plan for GPs, nurses and other relevant health professionals to increase their confidence in having culturally appropriate conversations about child weight and healthy lifestyles with families. Engage with families to identify solutions that work for them. Opportunities to do this include: providing CME/CNE sessions;promote the use of the Child Weight Management Health Pathway included in the Auckland Regional Health Pathways; webinar and podcasts developed with the Goodfellow unit; regular primary care e-updates Ongoing

Natalie Desmond (Hannah) (WDHB/ADHB); Pippa van Paauwe, Service Development Manager Child Health (CM Health)

90% of participants who identified an increase in confidence with having conversations about healthy weight following the sessions* base Achieved Achieved Achieved

ADHB/WDHB: 95% of participants identified an increase in confidence with having conversations about healthy weight following the Raising Healthy Kids training sessions. CMDHB: 23% of staff had an increase in their baseline confidence, and 83% had no change in confidence. 97% of those who had no change in confidence said that they were either 'very' or 'quite confident'.

Children & Adolescents



Schools and ECEs

034


Strengthen support for schools to implement healthy food and beverage policies by achieving an 80% adherance Dec-19

Rebecca McCarroll, Rebecca Willams (WDHB/ADHB); Phil Light, Project Manager Mana Kidz (CM Health)

WDHB/ADHB: 80% of contracted schools have a healthy food and drink policy. CM Health: Introduce a healthy food and drink policy in Mana Kids schools On Track On Track At Risk

ADHB/WDHB: Youth Health Programme Manager is working with Enhanced School Based Health Services (ESBHS) schools to ensure they have a policy in place CMDHB: Initial interest to implement policy with Mana Kidz schools as a priority, follow up to be had with Mana Kidz.

In collaboration with HAT and Healthy Families NZ , engage intersectorally to support a gap analysis of healthy food environments in and around Kohanga reo, Pacific Language nests and ECEs to determine areas for future DHB support Jun-18

Rebecca McCarroll (WDHB/ADHB) Gap analysis complete

Achieved/Completed

Achieved/Completed At Risk

CMDHB: Establishing relationship with Healthy Families NZ in CMH region

Utilise INFORMAS survey results, along with information from the Heart Foundation, ARPHS and Healthy Families NZ sites to engage with high-priority ECEs and schools to support development and implementation of food policies and healthy food environments. Jun-19

Rebecca McCarroll (WDHB/ADHB); Phil Light, Mana Kidz project office (CM Health) Katarina Komene Programme Manager, Maaori Child Health (CM Health)

# of ECEs and schools prioritised for support; # of ECEs and schools supported 0 0 0

ADHB/WDHB: Work beginning in Aug-18 CMDHB: awaiting the commencement of Programme Manager, Maaori Child Health role to progress initial business proposals within/alongside Maaori Health and other providers looking at engaging in this space i.e. Mana Kidz

Obesity Intervention

035


Contract a provider to deliver a comprehensive, multi-component whānau-focused physical activity, nutrition and parenting programme for pre-school children identified as being ≥98th centile, including a psychological component and development of specific approaches for Māori and Pacific populations (PPAL & Active Futures)

WDHB/ADHB Dec-18 CM Health Jun-18

Natalie Desmond (Hannah) (WDHB/ ADHB); Pippa van Paauwe, Service Development Manager Child Health (CM Health)

# of children enrolled; # of Māori and Pacific children enrolled (baseline)

Maaori On Track On Track Achieved/Completed

ADHB/WDHB: Service will commence Aug-18. Contracts with selected providers have been finalised following an RFP process and development of a co-designed model. CMDHB: Otara Health Charitable Trust deliver Active Futures to priority population groups - 84% of children engaged in the programme are Maaori or Pacific. Pacific On Track On Track

Achieved/Completed

Contract a provider to deliver a comprehensive, multi-component whānau-focused physical activity and nutrition programme for overweight/obese school aged children and adolescents, including specific approaches for Maaori and Pacific communities (Active Families) Jun-18

Leanne Catchpole (WDHB/ADHB); Pippa van Paauwe, Service Development Manager Child Health (CM Health)

# of children enrolled; of Maaori and Pacific children enrolled

Maaori 34 51 59 ADHB/WDHB: # referred provided as opposed to # enrolled CMDHB: # referred provided as opposed to # enrolled. Total number of referrals (all ethnicities) = 286. Of this total, 140 children were enrolled (49%). Pacific 132 63 170

Ensure ’Raising Healthy Kids’ health target is met through a suite of initiatives:

Undertake communication activities to promote and familiarise primary care / WCTO partners with target On-going

Natalie Desmond (Hannah) (WDHB/ ADHB); Pippa van Paauwe, Service Development Manager Child Health (CM

By December 2017, 95% of obese children identified in the B4SC programme will be referred to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions Achieved Achieved Achieved

036


Ensure referral process for referrals from B4 school provider to primary care for children with BMI>98th centile is in place and all obese children are referred to primary care and that referral is acknowledged (electronic referral process in CM Health, paper based in ADHB/WDHB). On-going

Health)

Percentage of declined referrals to primary care programmes

Maaori 31% 11.0% 31% The total percentage of declines for ADHB: 17%, WDHB: 14% CMDHB: 27% SOURCE: Before School Checks Monthly Report to end of June 2018 Pacific 10% 11% 23%

Provide community, primary and secondary care training by dietitian on use of Be Smarter brief intervention and goal setting healthy lifestyles tool and other resources so health professionals are confident to initiate conversations with families and talk about healthy weight to enable families to be as healthy as they can be On-going

# of training sessions delivered

Jan-18 to Jul-18: 31 people trained. Jul-16 to Jul-18: 83/138 GP practices received training

Jan-18 to Jul-18: 42 people trained. Jul-16 to Jul-18: 74/107 GP practices received training

1 July 2017 - 31 Jun 2018 = 369 individuals

Staff trained include: GPs, primary care nurses, Well Child Tamariki Ora staff, Mana Kidz staff, school nurses, outreach health & immunisation staff, health coaches, nurse educators and a mental health coodinator

Design and implement an evaluation of families and health professional engagement with Raising Healthy Kids referral pathway. Dec-18

Evaluation plan complete with recommendations (Y/N) On Track On Track On Track

037


Support the implementation of the regional growth chart solution for use in secondary care in metro Auckland DHBs Dec-18

Regional Healthy Weight Working Group; ADHB - Mike Shepherd

An electronic growth chart is implemented in the metro Auckland DHBs On Track On Track On Track

ADHB/WDHB & CMDHB - user acceptance testing completed successfully; planned to go live date: 1 Aug 2018

Work with ARDS and the Northern Region DHBs to develop consistent health promotion messages using the common risk factor approach for obesity and oral health Investigate translation into priority languages Jun-18

Natalie Desmond (Corina/Maha)/Pippa van Paauwe

Message alignment complete with 5 key messages agreed upon. Priority languages identified and translation services costed. On Track On Track On Track

038


Scope the feasibility for a pilot to assess measuring weight and height at the year eight dental check. The aim is to facilitate collection of data for population level monitoring of trends and to feedback to parents information on their child’s weight and growth. This pilot could potentially assess: - Consenting of children - Impacts on clinic flow and staffing - Scalability - Data collection requirements and utility - Communication of outcomes to parents - Staff and consumer perspectives - Identification of any adverse or unexpected outcomes This would inform the assessment of whether this could be implemented across the region and the trade-off of costs compared to the potential impact of the information gained for children, their families and the sector as a whole. Dec-18

Regional Healthy Weight Working Group and Public Health Physician (oral health) Pilot complete (Y/N) At Risk

The feasibility of scoping for a pilot to assess growth (height and weight) at the year 8 dental check has not occurred due to insufficient staffing resource this action. The priority is preventative restorative dental treatment.

039

Metro-Auckland DHB

Healthy Weight Action Plan

for Children

2017-2020

040

2

Foreword

The three Auckland metro DHBs – Auckland, Waitemata and Counties Manukau - have

worked together to develop this Healthy Weight Action Plan for Children. While it is

recognised that a range of activity across a range of sectors will be needed to impact on

unhealthy weight this plan is primarily focused on describing the contribution the health

sector can make to larger societal efforts.

We believe that the actions outlined within this Action Plan will contribute towards the

cross-sectoral response required to address childhood weight management. Taking a life-

course approach, and collaborating with our external partners to improve the nutrition and

physical activity environments of our populations, is critical to enable a meaningful impact

on childhood weight management. We place particular importance on ensuring the actions

of this plan meet the needs of our Māori and Pacific populations who are disproportionately

affected by this issue.

We acknowledge and thank all our external partners who have collaborated with us to

develop this plan.

041

3

Acknowledgements

It is a privilege to present the Metro-Auckland DHB Healthy Weight Action Plan for Children

2017-2020, the first joint child healthy weight action plan for Auckland, Counties and

Waitemata DHBs.

Firstly, at the centre of this plan, we would like to acknowledge the Tamariki of the Auckland

Region of New Zealand. Ko te ahurei o te tamaiti arahia o tatou mahi – let the uniqueness of

the child guide our work.

The plan has been developed collaboratively across the region with input from multiple

stakeholders. We would like to thank the following organisations who, along with

colleagues from Auckland DHB, Counties Manukau Health and Waitemata DHB, provided

feedback on the plan:

Aktive

Auckland Regional Public Health Service

Harbour Sport

Heart Foundation and Pacific Heartbeat

Healthy Auckland Together (HAT) Interagency Group

Healthy Families Waitakere

Metro Auckland Clinical Governance Forum

Northern Region Child Health Network

Northern Region Child Health Network Healthy Weight Working Group

Te Whanau O Waipareira

The University of Auckland

Toi Tangata

We know that we cannot achieve this alone. We look forward to working in partnership with

communities, key stakeholders, providers and other sectors to learn new ways of achieving

better health outcomes for our Tamariki.

042

4

Vision

“All Tamariki in the Auckland Region of New Zealand are of a healthy weight”

043

5

Contents

Foreword ......................................................................................................................... 2

Acknowledgements .......................................................................................................... 3

Vision .............................................................................................................................. 4

Glossary ........................................................................................................................... 6

Executive summary .......................................................................................................... 7

Introduction .................................................................................................................. 20

Taking Action on Unhealthy Weight - a way forward for the metro-Auckland region ........ 25

The Role of Health Services ................................................................................................. 26

Culturally appropriate, tailored and targeted delivery ....................................................... 28

Working with our partners .................................................................................................. 29

Appendix 1: Evidence for Actions.................................................................................... 34

Appendix 2: Stocktake .................................................................................................... 50

Appendix 3: Population demography and Obesity data ................................................... 76

Appendix 4: Health Equity Campaign .............................................................................. 78

Appendix 5: Monitoring and Evaluation .......................................................................... 79

044

6

Glossary

ARDS - Auckland Regional Dental Service

ARHP Auckland Regional Health Pathways

ARPHS - Auckland Regional Public Health Service

Auckland DHB - Auckland District Health Board

B4SC

BFHI

-

-

B4 School Check

Baby Friendly Hospital Initiative

BMI

CM Health

-

-

Body Mass Index

Counties Manukau Health (Counties Manukau DHB)

ECE - Early Childhood Education

Enua Ola - Enua Ola project aims to increase levels of physical activity and

improve nutrition amongst Pacific adults using a community action

approach

GP

GDM

-

-

General Practitioner

Gestational Diabetes Mellitus

HFW - Healthy Families NZ Waitakere

HFMMP - Healthy Families NZ Manukau, Manurewa-Papakura

HIC - High income countries

HVAZ - Healthy Village Action Zones

HBHF

HPS

-

-

Healthy Babies Healthy Futures programme

Health Promoting Schools

LC - Lactation Consultant

LMCs - Lead Maternity Carers

LMIC - Low and middle income countries

Lotu Mo’ui

- Partnership between CM Health and Pacific churches and

communities in Counties Manukau to work together to improve

health outcomes for Pacific people.

MoH -

Ministry of Health

NGO - Non-Government Organisation

PHO - Primary Health Organisation

Waitemata DHB - Waitemata District Health Board

WCTO - Well Child Tamariki Ora provider

Whānau ora

WHO

-

-

An approach that places families/whānau at the center of service

delivery

World Health Organisation

045

7

Executive summary Supporting children to maintain a healthy weight throughout childhood is an important part

of giving them the best start to life. In order to achieve this we must work with families and

communities to address the environments and behaviours that can make it difficult for both

children and adults to eat healthily and keep active across their lifetime. This includes

encouraging mothers prior to and during their pregnancy to achieve a healthy weight,

encouraging breastfeeding and healthy infant feeding, and identifying and working with

children and families who are struggling to maintain a healthy weight in childhood and

adolescence.

As District Health Boards1 (which includes community, primary care and secondary services),

we have two important roles:

Firstly to collaborate with other partners across systems and communities to

address the pervasive environmental influences that make it harder to make healthy

choices. A number of factors including the built, transport and physical activity

environments, the constitution, supply and marketing of food and the wider political

and socio-cultural context, can encourage behaviours and choices that may not be in

the best interests of a child’s health. It is essential that we collaborate and advocate

for policies and processes that work towards making the healthy choice the easy

choice for individuals. This work is being led out of the Auckland Regional Public

Health Service (ARPHS) through Healthy Auckland Together (HAT).

Secondly we have a specific role and responsibility to promote individual and

population health. Through primary care, community and secondary services we

encounter many opportunities to provide health information and create supportive

environments to enable staff and the communities we serve to be healthier. This can

include where services are directly provided, and where we fund and work with

others to provide health care services.

This plan is focused on articulating the role health services have in contributing to children

maintaining a healthy weight. The plan should be considered as describing one segment of a

range of activity that is needed to achieve the vision that “All Tamariki in the Auckland

Region of New Zealand are of a healthy weight”. Importantly the work of HAT is referenced,

however, detail is not provided in this plan. It is intended that the HAT Plan 2015-2020 be

read in conjunction with this plan. Consideration needs to be given to the changes required

outside the health sector in order to see health gains for our population.

The Northern Regional Child Health Network will co-ordinate, support and monitor the

implementation of the plan with ultimate accountability sitting with District Health Boards.

1 A brief summary of the health status and health needs of our populations, across the three metro-

Auckland DHBs, will be available in a separate document (metro-Auckland DHB Healthy Weight Strategic Plan).

046

8

Summary of Actions This Action Plan is a living document that will continue to be developed in the coming months and years. There is an expectation that as the plan matures there will be greater harmonisation across the region. 1. Women of Childbearing Age Scientific research confirms that the influences that alter risk of obesity in childhood begin prior to conception and persist throughout growth and development into adulthood. As many pregnancies are unplanned it is important that the total population is of a healthy weight.

Women of Childbearing Age

Adult Obesity and Co-morbidities

Actions Timeframe Responsibility Measures DHB Additional resource required

Survey Pacific women and men who have maintained weight loss from the Aiga challenge for three years regarding enablers to weight loss maintenance by December 2016 and utilise survey findings in a review of the Aiga challenge.

Dec 2017 Pacific Health Portfolio Manager

% who have maintained weight loss in past 3 years; narrative enablers to weight loss/maintenance documented (Y/N)

WDHB/ ADHB

N

Investigate access barriers to bariatric surgery for Māori and Pacific women of child bearing age Scope what an Adult Obesity Service (intensive lifestyle intervention Tier 2-3 service) might look like as part of the bariatric pathway

Jun 2018 Dec 2017

Director Health Outcomes Director Health Outcomes

Bariatric surgeries in 2017/18 by ethnicity (Maori/Pacific) Complete (Y/N)

ADHB/ WDHB ADHB/ WDHB

N N

047

9


Promote Green Prescription to primary care and identify and address barriers to primary care referrals

Jul 2018, Jul 2019, Jul 2020

Public Health Registrar (WDHB/ADHB); Primary Care Portfolio Manager (CM Health)

# of adults enrolled in Green Prescription by ethnicity (Maori/Pacific)

All N

Healthy Food Environments

Implement the National Healthy Food and Drink Policy in DHB-owned sites Complete baseline audit Complete follow-up audits

Jul 2018, Jul 2019

Public Health Dietitian and Food Service Manager (WDHB/ ADHB); Food Service Manager & Clinical Director Population Health (CM Health)

50% compliance 100% compliance

All N

Work with ARPHS and Healthy Families NZ through Healthy Auckland Together (HAT) to implement the National Healthy Food and Drink Policy for Organisations in the community. Work with DHB contracted providers to support implementation of aligned healthy food and drink policies

Dec 2018 Public Health Dietitian (ARPHS); Clinical Director Population Health (CM Health) As above

# of community organisations who have implemented the Policy # of providers who have implemented the Policy

All All

N N

048

10

2. Pregnant Women and Infants We know that the risk of obesity can be passed from parents to children. Babies whose mothers begin pregnancy already obese or suffering from diabetes, or whom develop Gestational Diabetes (GDM) pre-dispose the child to develop increased fat deposits which are associated with future metabolic disease and obesity. The way that children are fed early in life will further influence their risk of developing obesity and the balance of evidence suggests breastfeeding confers some protection against this.

Pregnant Women and Infants

Pregnancy

Actions Timeframe Responsibility Measures DHB Additional Resource Required

Ensure culturally appropriate antenatal education available to promote and support breastfeeding WDHB/ADHB Continue to support the implementation of the Healthy Babies Healthy Futures (HBHF) programme:

Providing women and their families with key breastfeeding messages through textMATCH messaging, community promotion, and teaching practical skills for better nutrition and increased physical activity

Working with partners to engage with specific vulnerable community groups (Māori, Pacific, Asian, and South Asian)

Further strengthen HBHF connections with

On-going On-going Jun 2018 Dec 2017

Child, Youth and Women Team Leader (WDHB/ADHB); Maternity Integration Manager (CM Health) HBHF Programme Manager HBHF Programme Manager HBHF Programme

Deliver contracted volumes of breastfeeding related programmes with 80% of services delivered to priority populations (Maori, Pacific, Q5) % of target (1000) and # of people receiving textMATCH service % of target (1000) and # of mothers engaged in healthy conversations # of Community Learning

All WDHB/ ADHB WDHB/ ADHB WDHB/

N N N N

049

11


maternity services, Kohanga reo, Churches and ECEs to increase access to the HBHF programme

Promoting HBHF to pregnant mothers at the earliest possible stage when engaging with DHB services

CM Health Continue the development of Te Rito Ora service and B4 baby services, which engage with women in antenatal period to support breastfeeding

Dec 2017 Jun 2018

Manager HBHF Programme Manager Child Health Service Development Manager

Programme (CLP) groups held within community settings % of target (2000) and # of mothers given the opportunity to engage with a HBHF provider 70% women accessing the service will be fully/exclusive breastfeeding at 6 weeks (aligned to the WCTO indicator targets)

ADHB WDHB/ADHB CM Health

N N

Work with Lead Maternity Carers (LMCs) to ensure heights and weights are recorded on booking form. Education to ensure this is measured rather than self-reported.

On-going

Women’s Health Senior Programme Manager (ADHB/ WDHB); Maternity Quality and Safety Co-ordinator (CM Health)

100% of booked women have height and weight recorded in clinical records

All

N

050

12


Collaborate with primary care, Green Prescription providers, LMCs, DHB maternity services and HBHF to enhance referrals to Green Prescription and ensure tailored advice for pregnant women on optimal weight gain. Promote and facilitate the adoption of MoH Guidelines for Healthy Weight Gain in Pregnancy (e.g. weight gain charts)

Incorporate referrals to Green Prescription and healthy weight gain in pregnancy conversations into existing Auckland Regional Health Pathways

Establish a baseline(1) and increase(2) referrals of pregnant women into Green Prescription for healthy weight management

Dec 2018 Dec 2018

Programme Manager Primary Care; (WDHB/ ADHB); Manager/ Maternity Quality and Safety Co-ordinator (CM Health)

Health Pathways updated to include referral options for pregnant women, e.g. Green Prescription (Y/N) # pregnant women enrolled in Green Prescription

All All

N N

Develop Pathway for management of pregnant women with high BMI

Dec 2018 Maternity Quality and Safety co-ordinator (CM Health)

Pathway developed and implemented (Y/N)

CM Health

N

051

13


Undertake quality research

TARGET *-Recruit women for multisite study

Gestational Diabetes Mellitus Study of diagnostic thresholds (GEMS)*- Recruit women for multisite study

Healthy Mums and Babies Study (HUMBA)**-Undertake the study in partnership with UoA, Recruit women into the HUMBA study, Implement findings into practice

Dec 2020

Principal Investigators of TARGET, GEMS and HUMBA studies

Feedback from study Principal Investigator of the progress of the 2 studies: TARGET: to complete recruitment by Oct 2017 GEMS: to have 50% recruitment by Dec 2018 HUMBA: to finish data collection by Dec 2018

All N

* TARGET is a study to investigate how gestational diabetes Mellitus (GDM) should be treated. It is a multisite study currently underway through the Liggins Institute. **GEMS is a multisite study currently underway through the Liggins Institute. CM Health is a contributing site. The study aims to determine the appropriate thresholds for diagnosing gestational diabetes in pregnancy. **HUMBA is a research study underway to trial a nutritional intervention during pregnancy to study whether it can impact on outcomes for both mother and baby

052

14

Infancy


Ensure culturally appropriate postnatal and community support available to promote and support breastfeeding

Enhance the pregnancy and parenting education smartphone app and website to encourage all women, particularly Māori, Pacific and Asian, to breastfeed for at least the first 6 months of their baby’s life

Postnatal support through Titifaitama and Wahakura Wananga including peer support and breastfeeding support groups

Intensive post-natal support through Te Rito Ora service including peers support and home visits

Jun 2018

Women’s Health Senior Programme Manager Women’s Health Senior Programme Manager Service Development Manager Child Health

% of Māori and Pacific women who breastfeed at 3 months (Target: 70% babies exclusively or fully breastfed at 3 months) # who attend support groups # of visits in 6 month period (Target: Kaitipu Ora workers will engage with clients a min of 3x in week 1 post-natally, and then weekly until week 12)

All ADHB/ WDHB WDHB CM Health

Y N N

Evaluate effectiveness of Auckland DHB breastfeeding community clinic and home visiting approach and integrate learnings into future efforts.

Mar 2018 Women’s Health Senior Programme Manager

Build findings from evaluation into contract for the 17/18 financial year (Y/N)

ADHB N

053

15


Community cooking courses to support pregnant woman and parents and whānau of 0-2 year olds to make healthy, affordable and culturally appropriate meals which meet the nutrition needs of pregnant women and infants and toddlers

On-going Service Development Manager Child Health

# participants will complete the course

CM Health

N

Evaluate the community peer/mentor support breastfeeding programme pilot to ascertain its success with Māori, Pacific and low-SES women.

Dec 2017 Women’s Health Senior Programme Manager

Evaluation outcome report complete (Y/N)

ADHB/ WDHB

N

Training and Education

Enhance the training plan for GPs, nurses and other relevant health professionals to increase their confidence in having culturally appropriate conversations about child weight and healthy lifestyles with families. Engage with families to identify solutions that work for them. Opportunities to do this include:

Providing CME /CNE sessions

Promote the use of the Child Weight Management Health Pathway, included in the Auckland Regional Health Pathways

Webinar and podcasts developed with the Goodfellow unit

Regular primary care e-updates

On-going Child Health Senior Programme Manager (WDHB/ADHB); Service Development Manager Child Health (CM Health)

% of participants who identified an increase in confidence with having conversations about healthy weight following the sessions

All

N N

054

16

3. Children and Adolescents The prevention and treatment of childhood obesity requires influence regarding healthy diets and healthy movement alongside individual level approaches to enable behaviour change for children, young people, caregivers and families.

Children and Adolescents

Schools and ECEs


Strengthen support for schools to implement healthy food and beverage policies

Dec 2019 Public Health Dietitian (WDHB/ADHB); Project Manager Mana Kidz (CM Health)

WDHB/ADHB: 80% of contracted schools have a healthy food and drink policy. CM Health: 80% of Mana Kidz schools have a healthy food and drink policy

All N

In collaboration with HAT and Healthy Families NZ, engage intersectorally to support a gap analysis of healthy food environments in and around Kohanga reo, Pacific Language nests and ECEs to determine areas for future DHB support

Jun 2018 Public Health Dietitian

Gap analysis complete # of Kohanga reo, Pacific Language nests, ECEs requiring support

All N

Utilise INFORMAS survey results, along with information from the Heart Foundation, ARPHS and Healthy Families NZ sites to engage with high-priority ECEs and schools to support development and implementation of food policies and healthy food environments.

Jun 2019 Public Health Dietitian (WDHB/ADHB); Mana Kidz project office (CM Health)

# of ECEs and schools prioritised for support; # of ECEs and schools supported

All N

055

17


Obesity Intervention

Contract a provider to deliver a comprehensive, multi-component whānau-focused physical activity, nutrition and parenting programme for pre-school children identified as being ≥98th centile, including a psychological component and development of specific approaches for Māori and Pacific populations

WDHB/ADHB Dec 2018 CM Health Mar 2017

Programme Manager Primary Care (WDHB/ ADHB); Service Development Manager Child Health (CM Health)

# of children enrolled; # of Māori and Pacific children enrolled (baseline)

All N

Contract a provider to deliver a comprehensive, multi-component whānau-focused physical activity and nutrition programme for overweight/obese school aged children and adolescents, including specific approaches for Māori and Pacific communities

Dec 2017 Programme Manager Primary Care (WDHB/ ADHB); Service Development Manager Child Health (CM Health)

# of children enrolled; # of Māori and Pacific children enrolled

All N

Ensure ’Raising Healthy Kids’ health target is met through a suite of initiatives:

Undertake communication activities to promote and familiarise primary care / WCTO partners with target

On-going

Child Health Senior Programme Manager (WDHB/ ADHB) Service Development Manager Child Health (CM Health)

By December 2017, 95% of obese children identified in the B4SC programme will be referred to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions

All

N N

056

18


Ensure referral process for referrals from B4 school provider to primary care for children with BMI>98th centile is in place and all obese children are referred to primary care and that referral is acknowledged (electronic referral process in CM Health, paper based in ADHB/WDHB).

Provide community, primary and secondary care training by dietitian on use of Be Smarter brief intervention and goal setting healthy lifestyles tool and other resources so health professionals are confident to initiate conversations with families and talk about healthy weight to enable families to be as healthy as they can be

Design and implement an evaluation of families and health professional engagement with Raising Healthy Kids referral pathway.

On-going Jul 2018 Dec 2018

Child Health Senior Programme Manager (WDHB/ ADHB) Service Development Manager Child Health (CM Health)

% of declined referrals to PC programmes # of health professionals trained Evaluation plan complete with recommendations

All N N N

Support the implementation of the regional growth chart solution for use in secondary care in metro Auckland DHBs

Dec 2018 Regional Healthy Weight Working Group

An electronic growth chart is implemented in the metro Auckland DHBs

All Y

Work with ARDS and the Northern Region DHBs to develop consistent health promotion messages using the common risk factor approach for obesity and oral health

Investigate translation into priority languages

Jan 2018 Child Health Senior Programme Manager & Public Health Physician (oral health)

Message alignment complete with 5 key messages agreed upon. Priority languages identified and translation services costed

All N

057

19


Scope the feasibility for a pilot to assess measuring weight and height at the year eight dental check. The aim is to facilitate collection of data for population level monitoring of trends and to feedback to parents information on their child’s weight and growth. This pilot could potentially assess: • Consenting of children. • Impacts on clinic flow and staffing. • Resource requirements. • Scalability. • Data collection requirements and utility. • Communication of outcomes to parents. • Staff and consumer perspectives. • Identification of any adverse or unexpected

outcomes. This would inform the assessment of whether this could be implemented across the region and the trade-off of costs compared to the potential impact of the information gained for children, their families and t

Documents

COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEE … · 005 . 006 . 012 3. PRESENTATIONS 9.20am 3.1 South Seas Whaanau Ora Approach (Silao Vaisola -Sefo, Chief Executive Officer) Presentation