Community & Public Health and Disability Support Advisory ... · 10/5/2020 · Support Advisory Committees Meeting Board Room, Level 2, Main Block, Wakari Hospital Campus, 371 Taieri

Community & Public Health and Disability Support Advisory Committees MeetingBoard Room, Level 2, Main Block, Wakari Hospital Campus, 371 Taieri Road, Dunedin

05/10/2020 01:30 PM - 04:30 PM

Agenda Topic Presenter Page

1. Opening Karakia

2. Apologies 3

3. Interests Register 4

4. Minutes of Previous Meeting 13

5. Chairs’ Update 19

6. Matters Arising from Previous Minutes (not covered by action sheet)

7. Review of Action Sheet EDSP&C 20

8. A Snapshot of Disability Services at Southern DHB EDQ&CGS 24

9. Community Health Council Update Karen Browne 33

10. Presentation: Ministry of Health Funder Doug Funnell 41

11. Presentation: Southern Health Needs Assessment Katherine Graham 42

12. Verbal Update – Māori Health CMHS&IO

13. Verbal Update – WellSouth PHO CEO WellSouth

14. Primary Maternity - Update on Consultation EDSP&C 51

15. Items for Noting 54

15.1 Strategy, Primary and Community Report EDSP&C 54

15.1.1 Attachment 1 – Alliance Leadership Team Minutes EDSP&C 75

15.1.2 Attachment 2 - WellSouth Performance Dashboard EDSP&C 83

15.2 Finance Report EDSP&C 100

Community & Public Health and Disability Support Advisory Committees Meeting - Agenda

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15.3 Final ARC Covid-19 Preparedness Report EDSP&C 109

16. Reference Items 125

16.1 Community and Public Health Advisory Committee Terms of Reference

125

16.2 Disability Support Advisory Committee Terms of Reference 128

Community & Public Health and Disability Support Advisory Committees Meeting - Agenda

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APOLOGIES

An apology has been received from Dr Kim Ma'ia'i.

2Community & Public Health and Disability Support Advisory Committees Meeting - Apologies

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SOUTHERN DISTRICT HEALTH BOARD

Title: INTERESTS REGISTERS

Report to: Community and Public Health and Disability Support Advisory Committees

Date of Meeting: 5 October 2020

Summary:

Board, Committee and Executive Team members are required to declare any potential conflicts (pecuniary or non-pecuniary) and agree how these will be managed. A member who makes a disclosure must not take part in any decision relating to their declared interest.

Interest declarations, and how they are to be managed, are required to be recorded in the minutes and separate interests register (s36, Schedule 3, NZ Public Health and Disability Act 2000).

Changes to Interests Registers over the last month:

ß Dave Cull – no longer President, Local Government New Zealand;

ß Moana Theodore – sister-in-law no longer employed by Southern DHB;

ß Tuari Potiki – appointed to the District Licensing Committee, Dunedin City Council;

ß Chris Fleming – sister works for Arvida Group (aged residential care provider, North Island only). No longer Deputy Chair, InterRAI NZ;

ß Julie Rickman – Shareholder and Director, Inversionne Ltd (clothing wholesaler).

Specific implications for consideration (financial/workforce/risk/legal etc):

Financial: n/a

Workforce: n/a

Other:

Prepared by:

Jeanette KloostermanBoard Secretary

Date: 23/09/2020

RECOMMENDATION:

1. That the Interests Registers be received and noted.

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Community & Public Health and Disability Support Advisory Committees Meeting - Interests Register

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SOUTHERN DISTRICT HEALTH BOARDINTERESTS REGISTER

Member Date of Entry Interest Disclosed Nature of Potential Interest with Southern DHB Management Approach

Dave Cull (Board Chair) 09.12.2019 Daughter-in-law employed as a nurse by Southern

DHB25.02.2020 Board Member, Cosy Homes Trust

25.02.2020 President, Local Government New Zealand (until July 2020) Removed 23.09.2020.

25.02.2020 Trustee, Weller Trust (Property investment)

25.02.2020 Director, Popaway Ltd (Property investment)

David Perez (Deputy Chair) 13.05.2019 Director, Mercy Hospital, Dunedin SDHB holds contracts with Mercy Hospital. Step aside from decision making.

13.05.2019 Fellow, Royal Australasian College of Physicians13.05.2019 Trustee for several private trusts

Ilka Beekhuis 09.12.2019 Patient Advisor, Primary Birthing FiT Group for Dunedin Hospital Rebuild

09.12.2019 Member, Otago Property Investors Association

09.12.2019 Secretary, Spokes Dunedin (cycling advocacy group)

15.01.2019 Paid member, Green Party

15.01.2019 Former employee of University of Otago (April 2012-February 2020)

07.07.2020 Trustee, HealthCare Otago Charitable Trust12.09.2020 Co-Director, OffTrack MTB Ltd No conflict (Husband's bike tourism company(.

John Chambers 09.12.2019 Employed as an Emergency Medicine Specialist, Dunedin Hospital

09.12.2019 Employed as Honorary Senior Clinical Lecturer, Dunedin School of Medicine

Possible conflicts between SDHB and University interests.

09.12.2019 Elected Vice President, Otago Branch, Association of Salaried Medical Specialists

Union (ASMS) role involves representing members (salaried senior doctors and dentists employed in the Otago region including by SDHB) on matters concerning their employment and, at a national level, contributing to strategies to assist the recruitment and retention of specialists in New Zealand public hospitals

09.12.2019 Wife is employed as Co-ordinator, National Immunisation Register for Southern DHB

09.12.2019 Daughter is employed as MRT, Dunedin HospitalKaye Crowther 09.12.2019 Life Member, Plunket Trust Nil

09.12.2019 Trustee, No 10 Youth One Stop Shop Possible conflict with funding requests.

09.12.2019 Employee, Findex NZ

14.01.2020 Trustee, Director/Secretary, Rotary Club of Invercargill South and Charitable Trust

14.01.2020 Member, National Council of Women, Southland Branch


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Lyndell Kelly09.12.2019 Employed as Specialist, Radiation Oncology,

Southern DHB

Involved in Oncology job size and service size exercise and may be involved in employment contract negotiations with Southern DHB.

18.01.2020 Honorary Senior Lecturer, Otago University School of Medicine

18.01.2020 Daughter is Medical Student at Dunedin Hospital

Terry King 28.01.2020 Member, Grey Power Southland Association Inc Executive Committee

28.01.2020 Life Member, Grey Power NZ Federation Inc

28.01.2020 Member, Southland Iwi Community Panel

ICP is a community-led alternative to court for low-level offenders. The service is provided by Nga Kete Matauranga Pounamu Charitable Trust in partnership with police, local iwi and the wider community.

14.02.2020 Receive personal treatment from SDHB clinicians and allied health.

03.04.2020 Client, Royal District Nursing Service NZ Ltd

Jean O'Callaghan 13.05.2019 Employee of Geneva Health Provides care in the community; supports one long term client but has no financial or management input.

13.05.2019 St John Volunteer, Lakes District Hospital No involvement in any decision making. Taking six months' leave. Recommencing 22.08.2020.

Tuari Potiki 09.12.2019 Employee, Otago University09.12.2019 Chair, NZ Drug Foundation09.12.2019 Chair, Te Rūnaka Ōtākou Ltd*

09.12.2019 Member, Independent Whānau Ora Reference Group

08.09.2020 Member, District Licensing Committee, Dunedin City Council (1 September 2020 to 31 May 2023)

09.12.2019 *Shareholder in Te KaikaLesley Soper 09.12.2019 Elected Member, Invercargill City Council

09.12.2019 Board Member, Southland Warm Homes Trust09.12.2019 Employee, Southland ACC Advocacy Trust

16.01.2020 Chair, Breathing Space Southland (Emergency Housing)

16.01.2020 Trust Secretary/Treasurer, Omaui Tracks Trust

19.03.2020 Niece, Civil Engineer, Holmes Consulting Holmes Consulting may do some work on new Dunedin Hospital.

21.07.2020 Trustee, Food Rescue Trust

21.07.2020 Shareholder 1%, Piermont Holdings ltd Coporate Body for apartment, WellingtonMoana Theodore 15.01.2019 Employee, University of Otago

15.01.2019 Co-director, National Centre for Lifecourse Research, University of Otago

15.01.2019 Member, Royal Society Te Apārangi Council

15.01.2019Sister‐in‐law, Employee of SDHB (Clinical Nurse Specialist Acute Mental Health)

Removed 07/09/2020

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15.01.2019 Shareholder, RST Ventures Limited

27.04.2020 Nephew, Casual Mental Health Assistant, Southern DHB (Wakari)

17.08.2020 Health Research Council FellowAndrew Connolly (Crown Monitor)

21.01.2020 Employee, Counties Manukau DHB

21.01.2020 Deputy Commissioner, Waikato DHB21.01.2020 Southern Partnership Group21.01.2020 Health Quality and Safety Commission21.01.2020 Health Workforce Advisory Board21.01.2020 Fellow Royal Australasian College of Surgeons

21.01.2020 Member, NZ Association of General Surgeons

21.01.2020 Member, ASMS

05.05.2020 Member, Ministry of Health's Planned Care Advisory Group

Will be monitoring planned care recovery programmes.

Roger Jarrold (Crown Monitor)

16.01.2020 CFO, Fletcher Construction Company Limited Have had interaction with CEO of Warren and Mahoney, head designers for ICU upgrade.

16.01.2020 Member, Audit and Risk Committee, Health Research Council

16.01.2020 Trustee, Auckland District Health Board A+ Charitable Trust

16.01.2020Former Member of Ministry of Health Audit Committee and Capital & Coast District Health Board

23.01.2020 Nephew - Partner, Deloitte, Christchurch

16.08.2020 Son - Auditor, PwC, Auckland PwC periodically undertake work for SDHB, eg valuations


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EXECUTIVE LEADERSHIP TEAM

Employee NameDate of Entry

Interest Disclosed Nature of Potential Interest with Southern District Health Board

Hamish BROWN 22.09.2020 Nil

Kaye CHEETHAM 08.07.2019 Ministry of Health Appointed Member of the Occupational Therapy Board (05/08/2020 - Stood down from the Occupational Therapy Board)

Mike COLLINS 15.09.2016 Wife, NICU Nurse

01.07.2019 Capable NZ Assessor Asked from time to time to assess students, bachelor and masters students final presentation for Capable NZ.

21.05.2020 Director, New Zealand Institute of Skills and Technology

Matapura ELLISON 12.02.2018 Director, Otākou Health Ltd Possible conflict when contracts with Southern DHB come up for renewal.

12.02.2018 Deputy Kaiwhakahaere, Te Rūnanga o Ngai Tahu Nil

12.02.2018Chairperson, Kati Huirapa Rūnaka ki Puketeraki (Note: Kāti Huirapa Rūnaka ki Puketeraki Inc owns Pūketeraki Ltd - 100% share).

Nil

12.02.2018 Trustee, Araiteuru Kokiri Trust Nil

12.02.2018 National Māori Equity Group (National Screening Unit)

12.02.2018 SDHB Child and Youth Health Service Level Alliance Team

12.02.2018 Otago Museum Māori Advisory Committee Nil12.02.2018 Trustee, Section 20, BLK 12 Church & Hall Trust Nil

12.02.2018 Trustee, Waikouaiti Maori Foreshore Reserve Trust Nil

29.05.2018 Director & Shareholder (jointly held) - Arai Te Uru Whare Hauora Ltd Possible conflict when contracts with Southern DHB come up for renewal.

Chris FLEMING 25.09.2016 Lead Chief Executive for Health of Older People, both nationally and for the South Island

25.09.2016 Chair, South Island Alliance Leadership Team

25.09.2016 Lead Chief Executive South Island Palliative Care Workstream

25.09.2016 Deputy Chair, InterRAI NZ Removed 23.09.202010.02.2017 Director, South Island Shared Service Agency Shelf company owned by South Island DHBs

10.02.2017 Director & Shareholder, Carlisle Hobson Properties Ltd Nil

26.10.2017 Nephew, Tax Advisor, Treasury

Management of staff conflicts of interest is covered by SDHB’s Conflict of Interest Policy and Guidelines.

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18.12.2017 Ex-officio Member, Southern Partnership Group

30.01.2018 CostPro (costing tool) Developer is a personal friend.

30.01.2018 Francis Group Sister is a consultant with the Francis Group.20.02.2020 Member, Otago Aero Club Shares space with rescue helicopter.23.09.2020 Arvida Group (aged residential care provider) Sister works for Arvida Group (North Island only)

Lisa GESTRO 06.06.2018 Lead GM National Travel and Accommodation Programme

This group works on behalf of all DHBs nationally and may not align with SDHB on occasions.

04.04.2019 NASO Governance Group Member This group works on behalf of all DHBs nationally and may not align with SDHB on occasions.

04.04.2019 Lead GM Perinatal Pathology This group works on behalf of all DHBs nationally and may not align with SDHB on occasions.

Nigel MILLAR 04.07.2016 Member of South Island IS Alliance group This group works on behalf of all the SI DHBs and may not align with the SDHB on occasions.

04.07.2016 Fellow of the Royal Australasian College of Physicians Obligations to the College may conflict on occasion where the college for example reviews training in services.

04.07.2016 NZ InterRAI Fellow InterRAI supplies the protocols for aged care assessment in SDHB via a licence with the MoH.

04.07.2016 Son - employed by Orion Health Orion Health supplies Health Connect South.

29.05.2018 Council Member of Otago Medical Research Foundation Incorporated

12.12.2019 Daughter employed by Harrison-Grierson A NZ construction and civil engineering consultancy - may be involved in tenders for DHB or new Dunedin Hospital rebuild work

Nicola MUTCH Chair, Dunedin Fringe Trust Nil

02.04.2019 Husband - Registrar and Secretary to the Council, Vice-Chancellor's Advisory Group, University of Otago

Possible conflict relating to matters of policies, partnership or governance with the University of Otago.

Patrick NG 17.11.2017 Member, SI IS SLA Nil17.11.2017 Wife works for key technology supplier CCL Nil

18.12.2017 Daughter, medical student at Auckland University.


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23.07.2020 Wife, Chief Data Architect, Inde TechnologyJulie RICKMAN 31.10.2017 Director, JER Limited Nil, own consulting company

31.10.2017 Director, Joyce & Mervyn Leach Trust Trustee Company Limited

Nil, Trustee

31.10.2017 Trustee, The Julie Rickman Trust Nil, own trust31.10.2017 Trustee, M R & S L Burnell Trust Nil, sister's family trust

23.10.2018 Shareholder and Director, Barr Burgess & Stewart Limited

Accounting services

04.08.2020 Shareholder and Director, Inversionne Limited Nil, clothing wholesaler.Specified contractor for JER Limited in respect of:

31.10.2017 H G Leach Company Limited to termination Nil, Quarry and Contracting.21.10.2019 Member, Chartered Accountants Advisory Group

Gilbert TAURUA 05.12.2018 Prostate Cancer Outcomes Registry (New Zealand) - Steering Committee Nil

05.04.2019 South Island HepC Steering Group Nil03.05.2019 Member of WellSouth's Senior Management Team Reports to Chief Executives of SDHB and WellSouth.

Gail THOMSON 19.10.2018 Member Chartered Management Institute UK Nil

22.11.2019 Deputy Chair Otago Civil Defence Emergency Management Group, Coordinating Executive Group

Jane WILSON 16.08.2017 Member of New Zealand Nurses Organisation (NZNO) No perceived conflict. Member for the purposes of indemnity cover.

16.08.2017 Member of College of Nurses Aotearoa (NZ) Inc. Professional membership.

16.08.2017Husband - Consultant Radiologist employed fulltime by Southern DHB and currently Clinical Leader Radiology, Otago site.

Possible conflict with any negotiations regarding new or existing radiology service contracts. Possible conflict between Southern DHB and SMO employment issues.

16.08.2017 Member National Lead Directors of Nursing and Nurse Executives of New Zealand.

Nil

Greer HARPER 24.08.2020 Paul Harper (father) is the current Chair of HealthSource NZ which is owned by the four northern DHBs.

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COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEE EXTERNAL APPOINTEES

Committee Member Date of Entry Interest Disclosed Nature of Potential Interest with Southern DHB Management Approach

Kim Ma'ia'I (External Appointee) 03.08.2020 Medical Director, Te Kaika Clinic, CavershamOdele STEHLIN 01.11.2010 Waihopai Rūnaka General Manager Possible conflict with contract funding.

01.11.2010 Waihopai Rūnaka Social Services Manager Possible conflict with contract funding. 01.11.2010 WellSouth Iwi Governance Group Nil01.11.2010 Recognised Whānau Ora site Nil24.05.2016 Healthy Families Leadership Group member Nil23.02.2017 Te Rūnanga alternative representative for WaihopaiNil09.06.2017 Director, Waihopai Runaka Holdings Ltd Possible conflict with contract funding.07.06.2018 Director of Waihopai Hauora. Possible conflict with contract funding.


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DISABILITY SUPPORT ADVISORY COMMITTEE EXTERNAL APPOINTEES

Committee Member Date of Entry Interest Disclosed Nature of Potential Interest with Southern DHB Management ApproachKiringāua Cassidy (External Appointee) 10.07.2020 NilPaula Waby (External Appointee) 18.07.2020 Board Member, Association of Blind Citizens NZ

18.07.2020Adaptive Communications Adaptive Technology Trainer, Blind Low Vision NZ

18.07.2020 Business Owner of Blind-Sight Limited

18.07.2020 World Blind Union Representative for Blind Citizens NZ18.07.2020 Disabled Persons' Assembly Committee

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Minutes of DSAC & CPHAC, 3 August 2020 Page 1

Southern District Health Board

Minutes of the Joint Meeting of the Community & Public Health Advisory Committee and Disability Support Advisory Committee held on Monday, 3 August 2020, commencing at 1.30 pm, in the Board Room, Southland Hospital Campus, Invercargill

Present: Mr Tuari Potiki Chair, Community & Public Health Advisory Committee (CPHAC) (Meeting Chair)

Dr Moana Theodore Chair, Disability Support Advisory Committee (DSAC) (by Zoom)

Ms Ilka Beekhuis Deputy Chair, CPHACMrs Kaye Crowther Deputy Chair, DSACMr Dave Cull Member, DSACDr John Chambers Member, DSACMr Terry King Member, CPHACDr Lyndell Kelly Member, CPHACDr Kim Ma’ia’i Member, CPHAC (by Zoom)Ms Paula Waby Member, DSAC (by Zoom)

In Attendance: Miss Lesley Soper Board MemberMr Andrew Connolly Crown Monitor (by Zoom)Mr Chris Fleming Chief Executive OfficerMrs Lisa Gestro Executive Director Strategy, Primary and

CommunityMs Kaye Cheetham Chief Allied Health, Scientific and

Technical Officer Dr Nigel Millar Chief Medical OfficerDr Nicola Mutch Executive Director CommunicationsMr Andrew Swanson-Dobbs Chief Executive Officer, WellSouth Primary

Health NetworkMr Gilbert Taurua Chief Māori Health Strategy and

Improvement OfficerMs Gail Thomson Executive Director Quality & Clinical

Governance Solutions (by Zoom)Mrs Jane Wilson Chief Nursing and Midwifery OfficerMs Jeanette Kloosterman Board Secretary

1.0 WELCOME AND KARAKIA

The Chair welcomed everyone, in particular the newly appointed Committee members, Dr Kim Ma’ia’i and Ms Paula Waby, and members of the public. The meeting was then opened with a karakia.

2.0 APOLOGIES

Apologies were received from Mr Kiringāua Cassidy, DSAC Member, Ms Odele Stehlin, DSAC and CPHAC Member, and Mr Roger Jarrold, Crown Monitor.

3.0 DECLARATION OF INTERESTS

The Interests Registers were circulated with the agenda (tab 3) and noted.

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Community & Public Health and Disability Support Advisory Committees Meeting - Minutes of Previous Meeting

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The Chair asked for any changes to the registers and reminded everyone of their obligation to advise the meeting should any potential conflict arise during discussions.

It was resolved:

“That the Interests Registers be received and noted.”

4.0 PREVIOUS MINUTES

It was resolved:

“That the minutes of the meeting held on 2 June 2020 be approved and adopted as a correct record.”

T Potiki/D Cull

5.0 CHAIRS’ UPDATE

Disability Support Advisory Committee (DSAC)

Dr Moana Theodore, DSAC Chair, extended a warm welcome to the two new Committee members, Paula Waby and Kim Ma’ia’i, then:

ß Briefly backgrounded the process followed in co-designing the draft Disability Strategy;

ß Reported that the next meeting would cover disability workforce data and plans, analysis of training and data capture, and an invitation would be extended tothe Ministry of Health, as funder of disability services, to present to the Committees;

ß Signalled that a DSAC planning workshop would be held post the October meeting;

ß Encouraged DSAC members to contact her if they had any priorities or matters they wished to raise.

Community and Public Health Advisory Committee (CPHAC)

Mr Tuari Potiki, CPHAC Chair, endorsed Dr Theodore’s welcome to the new Committee members and introduced Dr Kim Ma’ia’i, newly appointed CPHAC member.

6.0 REVIEW OF ACTION SHEET

The Committees received the action sheet updates (tab 7).

Southern Health Entities

A diagram depicting the Southern Health system configuration was circulated with the action sheet.

The Committees requested:

ß Further information on each Southern Health entity’s role, respective responsibilities and accountabilities, and that the diagram be broadened, eg to include SIAPO, and that this information be circulated to all Board Members.

ß That the Committees’ terms of reference be included in future agenda books for information.


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7.0 PRESENTATION: WELLSOUTH

Andrew Swanson-Dobbs, Chief Executive Officer (CEO) of WellSouth presented an overview of the WellSouth Primary Health Network, COVID-19 activity and reflections, General Practice today and its future direction, the HealthCare Home (HCH) model, and the next steps for WellSouth (tab 16), then responded to members’ questions.

In thanking Mr Swanson-Dobbs for his overview, the Chair acknowledged the collaborative relationship between SDHB and WellSouth.

8.0 DISABILITY STRATEGY AND ACTION PLAN CONSULTATION FEEDBACK

Dr Brigit Mirfin-Veitch and Dr Jenny Condor from the Donald Beasley Institute presented (via Zoom) a summary of feedback on the Draft Disability Strategy and recommended revisions to the Strategy as a result of public consultation (tab 11), then responded to questions.

The Executive Director Quality and Clinical Governance Solutions (EDQ&CGS) advised that following formal endorsement by the Committees, the Disability Strategy would be published and communicated in various formats and an implementation timeline developed.

During discussion the Committees noted that the next step was to develop an action plan, with milestones and a budget, to implement the Strategy. The CEO advised that this should be developed alongside Southern DHB’s overarching plans and would be impacted by decisions made nationally in response to the Simpson Report.

It was resolved:

“That the Committees approve the following recommended revisions to the draft Southern DHB Disability Strategy following the public consultation process:

1. The title be reviewed to reflect that it is not inclusive of a detailed action plan, eg by changing it to SDHB Disability Strategy and Actions;

2. Disability Strategy Steering Committee members to be added to page 3 of the document;

3. Details regarding the consultation process to be appended to the document and referred to on page 3;

4. Sentence to be added to page 7 in relation to the Treaty of Waitangi and WAI 2575;

5. Further clarity in the actions related to the first goal in relation to “by Māori for Māori”;

6. Ensure that the Strategy is available in all formats noted in the community feedback;

7. Liaise with the Community Health Council to ascertain what information would be most helpful to include in their suggested one page summary of the Strategy, for development by the Southern DHB design and communications teams.”

T Potiki/J Chambers

Drs Mirfin-Veitch and Condor were thanked for their work and presentation.

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9.0 MĀORI HEALTH

The Chief Māori Health Strategy and Improvement Officer (CMHS&IO) presented a report on the provision of contracted kaupapa Māori health services (tab 9), which was provided in response to a request from the Committees for an overview.

The CMHS&IO noted that there were some gaps in the provision of services, particularly in the Central Otago and North Otago areas, and in the provision of Mental Health services in the community.

The CMHS&IO then responded to questions from members on Mauri Ora, the contracting process and investment in the sector, the definition of a kaupapa Māori provider, bowel screening uptake, immunisation rates, and WellSouth’s reducing inequality voucher programme.

The Committees requested:

ß That a copy of Whakamaua Māori Health Action Plan be added to the Diligent Resource Centre;

ß Further information on how the work of the Māori Health providers connects to the Māori Health priorities in Southern DHB’s Annual Plan, along withopportunities for improving collaboration and delivery.

The CMHS&IO was thanked for his report and it was noted that he would be providing updates on progress.

10.0 PRIMARY MATERNITY UPDATE

The Committees considered a report on possible options for the location of a new primary maternity facility in the Central Otago/Wanaka area (tab 10).

The Executive Director Strategy, Primary and Community reported that:

ß Subsequent to the publication of the paper, two consultation meetings had been held in Cromwell with: (1) stakeholders and workforce, and (2) the general public;

ß The options were out for consultation until 22 August 2020 and a recommendation would be made to the October 2020 meeting of the Committees.

Management then responded to questions on the proposed options.

It was resolved:

“That the Committees note:

ß The options presented to stakeholders on 15 July 2020 in Cromwell;

ß An options paper for the location of primary maternity facilities in Central Otago/Wanaka was made public on 21 July 2020;

ß The options were the subject of a public meeting on 23 July 2020 in Cromwell;

ß The Central Lakes Locality Network and the DHB Project Team will make a joint recommendation in September/October 2020, taking into account public feedback, on the best option.”


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11.0 STRATEGY, PRIMARY AND COMMUNITY REPORT

The Strategy, Primary and Community Report (tab 12) was taken as read and the EDSP&C took questions. The following items were highlighted during discussion.

Mental Health

The EDSP&C reported that a procurement process was about to be undertaken for an extensive review of the continuum of Mental Health services delivered by secondary, primary and NGO providers. This process would involve a number of stakeholder engagement sessions across the district.

Housing - Kia Haumaru Te Kaika

Miss Soper reminded the Committees that Southland Warm Homes Trust was one of her declared interests and informed them that the Trust had discussed and supported the Kia Haumaru Te Kaika programme.

Aged Care

The Committees requested further information on care home waiting lists and whether the situation was getting better or worse, and home support services.

B4 School Checks Programme

The EDSP&C reported that B4 School Checks were back to business as usual but if there was a resurgence of COVID-19 the Population Health Team would be pulled back into contact tracing.

The EDSP&C was asked to report back on when B4 School Checks would be caught up.

District Oral Health

The Committees requested further information on the placement of drop-in varnish clinics and equity of access to these.

It was resolved:

“That the report be received.”

12.0 FINANCIAL REPORT

In presenting the Strategy, Primary and Community (SP&C) financial results for June 2020 (tab 13), the EDSP&C advised that the report was complicated by the fact SP&C was both a funder and provider of services, and offered to provide members with a session to explain the report in detail.

The Committees requested that the financial tables be presented in a clearer format.

It was resolved:

“That the report be received.”

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13.0 ALLIANCE WORK PROGRAMME 2020/21

The EDSP&C presented a revised work plan for implementation of the Primary and Community Strategy (tab 14), then responded to questions.

It was suggested that the Committees be provided with the minutes of Alliance Leadership Team meetings.

It was resolved:

“That the Committees note the revised Alliance Leadership Team work plan.”

14.0 IMMUNISATION PERFORMANCE

The Committees received a letter from the Director-General of Health on the low rate of influenza vaccination in the Southern district for Māori over the age of 65 (tab 15).

15.0 GENERAL

In closing the meeting, the Chair advised now that the Committees had received an overview of Māori Health, WellSouth and the Alliance, they could start monitoring priorities within each of those areas.

The CEO informed the Committees that planning for the 2021/22 year would commence in October 2020.

The meeting closed with a karakia at 4.00 pm.

Confirmed as a true and correct record:

Chair: ______________________________

Date: ___________________


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Chairs' Update

Verbal report from the Chairs of the Disability Support and Community & Public Health Advisory Committees

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Community & Public Health and Disability Support Advisory Committees Meeting - Chairs’ Update

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Southern District Health Board

DISABILITY SUPPORT AND COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEES MEETING

ACTION SHEET

As at 24 September 2020

DATE SUBJECT ACTION REQUIRED BY STATUS EXPECTED COMPLETION

DATEOct 2019 Pēhea Tou Kāinga?

How is Your Home? Central Otago Housing: The Human Story(Minute item 9.0)

An overarching strategy to be developed prior to drafting an action plan.

EDSP&C Public Health met with Central Otago District Council in September. Housing was covered as part of discussions about CODC’s long term plan. Council are currently preparing a quantitative report that will be presented to Council in the new year. This covers the status of housing and the housing need.

Feb 2020 Strategy, Primary and Community Report(Minute item 10.0)

Report to be more focused by tying activity to the goals or targets that were trying to be achieved.

EDSP&C A new reporting template, informed by the new DAP will be used from quarter 1, 2020/21. The remaining format will be used for the remainder of the 19/20 year, but key goals will be highlighted.

December 2020

June 2020 Disability Services(Minute item 6.0)

Ministry of Health, as funder of disability services, to be invited to present to DSAC.

EDQCGS Scheduled for this meeting. Complete

June 2020

August 2020

Southern Health Entities(Minute item 10.0)

(Minute item 6.0)

Slide explaining the different Southern Health entities (incl. the Alliance Leadership Team), and how they assist Board to achieve its objectives, to be submitted to Board.

ß Further information to be provided on each entity’s role, responsibilities and

EDSP&C Under way. December 2020

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Community & Public Health and Disability Support Advisory Committees Meeting - Review of Action Sheet

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DATEaccountabilities and the diagram to be broadened, eg to include SIAPO, and to be circulated to all Board Members

ß The Committees’ terms of reference to be appended to each agenda for info.

Board Secretary

Included. Complete

June 2020FAR 593

Invercargill Primary Care Access(FAR Committee Minute item 9.0)

Paper on the issues, with clear action steps and accountabilities, to be submitted to CPHAC.

EDSP&C Terms of reference for this project are included in the Strategy, Primary and Community Monthly report, and a verbal update will be provided during the WellSouth update.

October 2020

August 2020

Disability Strategy and Action Plan(Minute item 8.0)

Timeline to be submitted to DSAC.

EDQ&CGS Included in the briefing paper in today’s agenda.

Complete

August 2020

Whakamaua Māori Health Plan(Minute item 9.0)

To be added to the Resource Centre on Diligent

BS Actioned. Complete

August 2020

Māori Health(Minute item 9.0)

Further information to be provided on how the work of the Māori Health providers connects to the Māori Health priorities in Southern DHB’s Annual Plan, along with opportunities for improving collaboration and delivery.

CMHS&IO Will be reported on as part of the Māori Health Chief Improvement Officer’s update at the meeting.

Complete

August 2020

Aged Care(Minute item 11.0)

Information to be provided on care home waiting lists (incl whether the situation is improving or not) and home support services.

EDSP&C Provided to last month's CPHAC meeting.

Complete


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DATEAugust 2020

B4 School Checks Programme(Minute item 11.0)

Management to report back on when B4 School Checks would be caught up.

EDSP&C The vision hearing component of the check has been completed for all priority populations that were missed during COVID-19 lockdown. The remaining children will receive their vision hearing check at school over the year. Information has been provided to all parents regarding the missed nursing component of the check,offering them the opportunity to see a Public Health Nurse if they have concerns about their child/ Tamariki.

Complete

August 2020

Oral Health(Minute item 11.0)

Information to be provided on the placement of drop-in varnish clinics and equity of access to these.

EDSP&C Drop-in fluoride varnish clinics have yet to be established, currently we already place fluoride varnish at appointments routinely and have fluoride varnish programmes going in a number of early childhood centres in high risk areas such as Oamaru and Milton.

The Oral Health Service is developing a fluoride varnishing training programme for the Dental Assistants, the goal is to create greater capacity within the service to target those areas of high need, for example Pacific Islanders, Māori populations, to stem the rate of decay in children across the Southern district. F.V is also used a preventative treatment, applied on a yearly basis it reduces the risk of decay.

Complete

August 2020

Financial Report(Minute item 12.0)

ß Financial tables to be presented in a clearer format.

EDSP&C Noted and amended. Complete

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DATEß Session explaining Financial

Report to be arranged for members.

Scheduled for October 22. Complete

August 2020

Alliance Work Programme 2020/21(Minute item 13.0)

Committees to be provided with minutes of the Alliance Leadership Team (ALT).

EDSP&C These are included as part of the Strategy, Primary and Community monthly report.

Complete


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Title: Disability Initiatives Underway at Southern DHB and Future Plans

Report to: DSAC/ CPHAC


Summary:

In 2017/18 the Ministry of Health (MoH) stated that Disability Support Services wouldbe a new government priority. The guidance included:

∑ Disabled people experience significant health inequalities and they should be able to access the same range of health services as the general population.

∑ DHB’s should look for opportunities to increase employment of disabled people to improve the competency and awareness of DHB workforce in matters regarding disabled people and to advance social inclusion more generally.

∑ DHBs need to provide a barrier-free environment, including information and communications for the independence, convenience and safety of a diverse range of people. This includes people who may have access needs, including disabled people, older people, parents and carers of young children and travellers.

∑ DHBs need to enable disabled people to access health services and ensure all key public health information and alerts are translated into NZ Sign Language. Consulting with disabled people on their preferred means of communication for appointment notifications needs to be investigated.

∑ Fully Implement the United Nations Convention on the Rights of Persons with Disabilities.

∑ DHBS needs to implement policies and procedures to collect information about disabled people within your patient population. DHBs should ensure contracts with providers reflect the requirement to either ensure accessibility or put in place a transition to a more accessible service.

A Disability Strategy has been developed, in partnership with the Donald Beasley Institute, over the last year to guide the future direction for the DHB. In order to know where we are going we need to understand where the DHB is currently positioned with activities, systems and processes relating to disabled people.This paper provides a high-level overview of what disability initiatives are currently occurring and underway within the DHB to support the strategy. It also provides a roadmap of what needs to be done in the coming year to achieve the goals of the strategy.

Specific implications for consideration (financial/workforce/risk/legal etc.):Financial: Financial implications are to be determined following development of an

action plan that will support the disability strategy deliveryWorkforce: As above

Equity: Providing a snapshot of disability services gives us a glimpse of how we are addressing equity within the disabled community

Other:

Approved by Acting Chief Executive Officer:

Date: 28/9/2020

Prepared by: Presented by:

Charlotte Adank Community Health and Clinical Council’s Facilitator

Gail ThomsonExecutive Director Quality and Clinical Governance

Date: 22 September 2020

RECOMMENDATION:

That CPHAC/DSAC members note the content of this paper and make any recommendations.

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Community & Public Health and Disability Support Advisory Committees Meeting - A Snapshot of Disability Services at Southern DHB

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2

Background

Statistics New Zealand surveys consistently show that disabled people experience poorer outcomes across multiple domains, including income, employment and health compared with non-disabled people. Disabled people are generally at higher risk of illness than non-disabled people. People with intellectual disabilities and Māori with disability have some of the poorest health outcomes of any group in the country, and are at higher risk of illness, disease, disability and early death. This highlights the importance of having a strategy focussed on the needs of disabled people.

The importance of having a clear vision of where the DHB is going to address issues for this population group is needed.

Purpose

This purpose of this paper is to:

(a) Provide a high-level overview of what initiatives are currently underway or planned within the DHB to support the Disability Strategy,

(b) Provide a brief summary of Disability Support Services and providers and

(c) To provide a roadmap of what needs to happen to implement the Disability Strategy actions.

(a) OVERVIEW OF INITATIVES UNDERWAY OR PLANNED IN THE DHB

DATA TO INFORM DECISION MAKING

∑ To better understand what and where to implement programmes of work the DHB needs to understand local population needs. The Health Needs Assessment (HNA) was expected to be completed at the end of 2020 but there may now be some delays with this. The most current data available on disabled people was collected in the 2013 New Zealand Census. This estimates that 26 percent of the Southern population has a disability, this is slightly higher than the New Zealand average of 23 percent.

∑ The largest proportion of the Southern population who have identified as having a disability stated these were mobility issues, followed by hearing problems. Appendix 1 provides a more detailed summary for the Southern district, noting this is reflective of 2013 data.

∑ IT systems do not currently collect information on patients that want to have it identified on their health record that they have a disability. There have been discussions about setting up an ‘alert system’ whereby members of the public could complete a form providing information about their disability and what support they might need during their hospital visit – ‘a patient-led initiative’. Work still needs to be done to prioritise this.

EMPLOYMENT OPPORTUNITIES – equal opportunities for people with disabilities

∑ The Southern Health Workforce Strategy (2019) has a focus area onWorkforce Diversity and Inclusion. Initial work in this area is to complete a gap analysis across the workforce for succession planning (by locality) and update workforce data across the whole of system e.g. ethnicity, disability, gender and age.

∑ Since June 2019, new staff working at the DHB are asked to record if they have a disability. The DHB does not have a complete picture of all staff but is beginning to build a picture of the workforce and their individual needs. Currently, eleven staff have reported having a disability.

Table 1. Disability Confident Organisations

A disability confident organisation:∑ has managers and staff who understand disability

and know what people with disability can do∑ has managers who know it is important to their

organisation to employ people with disability∑ has in place inclusive policies and practices∑ has plans in place to ensure a diverse workplace∑ addresses barriers to employment and promotion

for people with disability∑ thinks about the needs of people with disability

when designing products and services∑ is more likely to retain talented employees with

disability.∑ thinks about the needs of people with disability

when hiring staff∑ can attract a wider pool of job applicantsSource: www.employment.govt.nz


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∑ The DHB does have policy around Equal Employment Opportunities (EEO) and is committed to the principle of equality of opportunities in fulfilling its dual role as an employer and as a provider of services. One of the organisation's key objectives is to be a ‘good employer’. Therefore, no applicant or employee should receive more or less favourable treatment through discrimination on such grounds as age, marital status, nationality or other criteria identified by the Human Rights Commission as illegal or unfair.

∑ Lakes Hospital – recent renovation work has been undertaken at the Lakes Hospital site to ensure the site is accessible for disabled people.

∑ Dunedin, Wakari and Southland Hospital sites – currently, work around ensuring facilities are accessible for people with disabilities occurs via a ‘piecemeal approach’. Going forward a plan to ensure facilities are barrier free and inclusive access to health services needs to be developed and fed into the Disability Action Plan. It will be imperative to involve community, whānau and patients in this process to help improve access.

∑ New Dunedin HospitalThe design and planning stages of the new Dunedin Hospital has engagement of Community Health Council advisors working with the architects and Project Management Office team to ensure it meets accessibility needs for disabled people.

∑ Signage – way findingThere is signage on building sites but to get a true understanding of whether this is useful or there are gaps community, whānau and patients need to be involved with this. Encourage use of symbols and pictograms in signage and way finding.

∑ TransportTransporting patients between hospital sites in the Southern district is done via a number avenues, but patients must take responsibility where possible. Currently, St Johns provides a discountedtransport service Monday to Friday between Queenstown and Invercargill, Dunedin and Oamaru and Dunedin and Cromwell.The National Travel Assistance (NTA) is in place to provide some financial assistance to people for whom the cost of travel is a barrier to accessing treatment. There is a process to go through at the DHB to see if patients meet the criteria for this.

∑ Disability Awareness TrainingIn 2019, an online disability awareness training module was added to other training via the Ko Awatea platform. All new employees are instructed to complete this online disability training. The table provides a summary of the numbers of staff who have completed the course, this is unable to be presented by health professional. The training is very basic and is optional for other staff members to complete. There have been requests for more meaningful training to be provided forstaff.

Table 2. Number of new employees that have completed trainingAug-Dec 2019 Jan-Jul 2020 Total

New Employees 367 477 844Module completion 228 450 678

Module completion % 62% 94% 80%

∑ Administrators SymposiumOver the last two years the DHB have had members of the disability community present about their experiences accessing health services at the Administrators Symposium which has been well attended.

PHYSICAL ACCESS – Ability to access all places, services and information with ease and dignity

DISABILITY RESPONSIVENESS - Educating staff and challenging stereotypes and assumptions

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∑ Patient StoriesPatient Stories has been discussed as an empowering tool for all staff to learn from patients and whānau who have disabilities. The aim is to try and produce some of these stories for the launch of the Disability Strategy.

COMMUNITY AND CONSUMER ENGAGEMENT- working from a community, whānau and patient framework

∑ Community Health Council Engagement Framework and RoadmapThe Community Health Council (CHC) Framework and Roadmap provides the opportunity to engage with people with a range of disabilities. The CHC has contacts across the district and a number of CHC advisors are people with disabilities.

The disability community need to be involved with being a part of the solution and are respected as the experts in themselves.

COMMUNICATION AND ACCESS TO INFORMATION - empowering people through knowledge and understanding

∑ Health & Disability Commission- My Health PassportThe Health and Disability Commission recently revised ‘My Health Passport1’ and provided the document in a long format as well as an abridged format. There are a number of logistical issues to work through before this is launched at Southern DHB. The DHB has been in contact with Capital Coast DHB who are doing a relaunch and plan to learn from their processes.

∑ Information on the Southern health website Web content on the Southern health website is accessible and is able to be seen in increased format sizes. There is a limited amount of information is on the website for people with disabilities but more work is planned for this area i.e. sign language videos being installed and more relevant information for people with disabilities such as transport that is available, needing assistance getting to appointment or any requirements at appointment. The Southern health website was developed with input from the disability community to ensure it would be accessible.

∑ Text/Email CommunicationCommunication with patients about appointments is currently done via a mixture of text and hard copy letters being sent out. There is not a consistent approach across the DHB. A review is underway around how services communicate with patients and the exploring whether patient letters can be emailed and text communication utilised across all services.

∑ Interpreter ServicesAny patient requiring a New Zealand Sign Language (NZSL) interpreter at their appointmentshould be able to access this service. SDHB is responsible for booking NZSL interpreters which iscoordinated through the Patient Affairs office and the Duty manager outside of regular working hours.

1 https://www.hdc.org.nz/news-resources/search-resources/disability/my-health-passport/


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(b) SUMMARY OF PROVIDERS OF DISABILITY SUPPORT SERVICES

A brief summary of the providers of Disability Support Services (DSS) is provided.

Ministry of Health

The Ministry of Health (MoH) funds a range of DSS. These are available to people who have a physical, intellectual or sensory disability (or a combination of these) which:

∑ is likely to continue for at least 6 months∑ limits their ability to function independently, to the extent that ongoing support is required.

These are mainly younger people under the age of 65 years.

This link provides a link to all contracts funded by the MoH relating to disability support.https://www.health.govt.nz/our-work/disability-services/contracting-and-working-disability-support-

services/contracts-and-service-specifications

The Ministry will also fund DSS for people with:∑ some neurological conditions that result in permanent disabilities∑ some developmental disabilities in children and young people, such as autism∑ physical, intellectual or sensory disability that co-exists with a health condition and/or injury.

Southern DHB

∑ Health and support services for people over 65 years

The DHB contracts services people over 65 year with age-related disabilities. Services funded by DHBs will include, but will not be limited to:

- information, advice and education for older people and their families, whānau and carers about, but not limited to, available services, access to services, health promotion and self-management, and needs assessment of older people,2 including assessment of carer needs

- service co-ordination3 to assist the older person to have their needs met from all appropriate supports available in the community. This may include liaising with other government agencies such as Ministry of Social Development and Housing New Zealand

- support to live at home, including personal care (eg, assistance with dressing, bathing, eating and toileting), household management (eg, assistance with meal preparation, laundry and cleaning) and, where appropriate, restorative and rehabilitative approaches to support older people to regain independence and remain part of their community

- support for informal carers including carer support subsidy and respite care (eg, carer training, residential respite, dementia respite care and day programmes for older people, in-home respite care)

- specialist health of older people services providing support to residential and home-based support services for older people as well as to acute hospital, primary health care and NASC services

- a stroke service- AT&R services

∑ Child Development Services (0-14 years)

There are currently three service providers of Child Development Services (CDS) in SDHB. All services are provided in accordance with Ministry of Health DSS Child Development Service Specifications. An implementation plan has been developed for the South Island region. A proposal has been included for how CDS 2019/20 Budget funding will be used in this district to grow capability, achieve a more integrated regional

2 A comprehensive clinical assessment (with either the interRAI Contact Assessment, Community Health Assessment or Home Care Assessments or Long-Term Care Facility Assesment tools) will identify risk factors, if present, and allow for the care and support of clients at all levels of complexity.3 Service co-ordination should include goal setting, and, where appropriate, their family, whānau and carers. Service coordination decisions take account of individual circumstances including current supports available (informal and formal) and support needs that can be met by other services. Decision-making may also use prioritisation and resource allocation tools.

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https://www.health.govt.nz/our-work/disability-services/contracting-and-working-disability-support-services/contracts-and-service-specifications

https://www.health.govt.nz/our-work/disability-services/contracting-and-working-disability-support-services/contracts-and-service-specifications

6

CDS approach and lead initiatives that support the progressive implementation of the CDS operating model described by the Ministry of Health.

Table 3. Child Development Service Providers in the Southern DistrictService Geographic boundaries

Coastal Otago (Provider Arm) Covers the DHB boundaries except the Central Otago regions (see below). Service coverage includes Greater Dunedin, North Otago and South Otago, including Oamaru, Balclutha andDunedin City

Central Otago Health Services The service is funded along Ministry of Education boundaries and includes Queenstown, Wanaka, Hawea, Cromwell, Alexandra, Maniototo, Ranfurly and Arrowtown.

Southland (Provider Arm) Southland Provider Arm boundaries which covers the historic DHB boundaries except Queenstown and Arrowtown.

∑ Refugee Support Services

Refugees arriving into the Southern district are provided with a free primary care assessment. If there are any existing disabilities, these people are connected into the relevant disability support services.

Other government support

ACCIf a disability is caused by an injury, ACC provides support services.

Work and IncomeWork and Income provides financial help to families and individuals who need it.

Ministry of EducationThe Ministry of Education provides extra support for children with disabilities.


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https://www.acc.co.nz/

http://www.workandincome.govt.nz/eligibility/health-and-disability/index.html

https://www.education.govt.nz/quick-links/special-education/

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(c) WHAT NEEDS TO HAPPEN TO IMPLEMEMENT THE DISABILITY STRATEGY?

The table below provides a roadmap of the next steps to implementing actions outlined in the Disability Strategy over 2020/21, with more detail followed on next page.2020 2021Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Oct Nov

Final Disability Strategy Local images collected

DSSAC Update

DSAC workshop

DSSAC Update Final doc

Official launch

Disability Steering group (DSG)- Leadership Establish

DSG

AP finalised

Engagement with Disability Community

Stories collected

Doc circulated

Community invited

Communications Plan developed

collecting images

collecting patient stories

comms team ensure DS in other formats

Support launch

Comms Comms Comms

Data Information Processes

Employment Opportunities Data collection of employees

Physical Access

Disability Responsiveness

Communication with patients

Future work streams

Collection of patient stories

Develop Action Plan – mapping actions identified in strategy and how implemented

Online disability training platform available

Work priorities to be determined by Steering Group and AP



Reviewing patient letters and formats of communication Work priorities to be determined by Steering Group and AP


Finalising work at Lakes Hospital

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TOPIC DISCUSSION

Final Disability Strategy

There are still a number of actions to be done to finalise the Disability Strategy. It is thought it would be best to launch the final document at the beginning of 2021. This will need to be communicated with the disability community.

Employment Opportunities

The DHB has the ability to monitor new employees and whether there is an increasing trend of people with disabilities being recruited

∑ Sep 20 Inclusion of Treaty of Waitangi actions identified ∑ Sep-Nov 20 Collection of local images of people with

disabilities to be incorporated in final version∑ Oct 20 Executive summary to be finalised with input

from CHC∑ Oct 20 Comms to make available in different formats∑ Nov20 DSAC workshop

∑ DSG will identify future actions.

Disability Steering Group (DSG) – Leadership

Establishing a Steering group to lead the prioritisation and promotion of this work will be key. Membership will need to include at the least community disability representatives, Iwi representatives, HR, Building and Property, IT systems, comms, clinical services, quality. The executive Sponsorship will sit with the ED of Quality and Clinical Governance

Physical Access

Completion of recommendations for Lakes Hospital to be accessible for all people, some examples include widening of main door for wheelchair access, accessible ramp installed.

∑ Jan 21 DSG formed with ToR∑ Feb-Mar 21 An AP to be developed with key actions

outlined

∑ DSG will identify future priorities

Engagement with Disability Community

Engaging with the Disability Community is key to ensuring improved health outcomes for the people with disabilities comes out of this strategy.

Disability Responsiveness

Online training is available for new staff but is very basic.

∑ Oct-Nov 20 Patient Stories will be collected over the coming months

∑ Sep 20-Jan21∑ Communication with the community around timeframes∑ Apr 21 Engagement with community final strategy

launched∑ Continued engagement and partnership throughout

implementation.

∑ Begin development of some patient stories by disabled people

Communication Plan developed

The Communications Team will be connected throughout development and implementation of the Strategy and Action Plan.

Communication with patients

Ensuring that communication is done consistently by departments using email and text where possible.

∑ A communication plan developed of how information will be communicated to the community and staff.

∑ A key stakeholders list will be developed and added to as required.

∑ Newsletters will go out as needed with developments∑ CHC/ DSAC will be part of the process of being updated

on developments.

∑ Dec 20 Review of how patients are communicated is completed

Data Information Processes

We are aware of the issues with data collection and work n

∑ Priorities and process of auctioning these will be done via the DSG.

∑ Information will be also come from the HNA when completed


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Appendix 1. Summary of Southern District - 2013

Selected measures of disability for people in private households for (1)

Detailed impairment type(2) Otago Southland Southern Population

Hearing 20,000 11,000 * 31,000Seeing 7,000 * 6,000 * 13,000Mobility 26,000 15,000 41,000Agility 16,000 10,000 * 26,000Intellectual 4,000 * S 4,000Psychiatric/psychological 13,000 5,000 * 18,000Speaking 5,000 * 4,000 * 9,000Learning 10,000 * 4,000 * 14,000Memory(3) 7,000 * 4,000 * 11,000Developmental delay(4) S STotal 52,000 27,000 79,000Single/multiple impairments

Single 25,000 10,000 35,000Multiple 28,000 17,000 45,000Cause of impairment(5)

Disease or illness 22,000 11,000 33,000Accident or injury 15,000 * 10,000 * 25,000Existed at birth 7,000 * S 7,000Ageing(6) 17,000 8,000 * 25,000Other 8,000 * 7,000 * 15,000Not specified S S STotal 52,000 27,000 79,000

1. Includes adults and children surveyed in the Household Disability Survey. This does not include people living in residential care facilities.

2. Any individual may appear in more than one detailed level impairment type.3. 'Remembering' is only asked of adults aged 15+ years.\4. 'Developmental delay' is only asked of children aged 0–14 years.5. Any individual may appear in more than one cause of impairment group. Percentages for these groups exclude individuals who did not specify a cause of impairment.6. 'Ageing' is only asked of adults aged 15+ years.

Note: Numbers may not sum to the stated totals because: a) individuals were counted in each applicable detailed level impairment type and cause of impairment, and b) numbers are rounded

Symbols: S Suppressed * Relative sampling error is 30 percent or more, and less than 50 percent

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Title: Community Health Council Quarterly Report

Report to: Disability Support and Community & Public Health Advisory Committees

Date of Meeting: October 2020

Summary:

The Community Health Council (CHC) is an advisory council to the Southern DHB and WellSouth PHN. The Council brings together people from diverse backgrounds, ages, health and social experiences to give our communities, whānau and patients a stronger voice into decision-making within the Southern health system.

This quarterly report is to provide DHB Board members with an update of activities that have occurred at the Community Health Council over the last quarter.

Specific implications for consideration (FINANCIAL/WORKFORCE/RISK/LEGAL ETC.):

Financial: There are financial implications with engaging community members, these expenses should be built into service planning.

Workforce: There are implications with community engagement work as it is about changing the culture of staff across the organisation and enabling staff/ clinicians, community, whānau and patients to work in partnership.

Other: The work undertaken by the CHC is focused on quality improvement.

Equity: One of the principles of the CHC Engagement Framework is a respectful and equal process. Equity in terms of representation, equity in decision-making and underlying the Framework is the Treaty of Waitangi.

Document previously submitted to:

CHC Quarterly Update DATE: May 2020

Approved by Chief Executive Officer:

N/A DATE:


Karen BrowneChair of Community Health Council

Charlotte Adank Community Health & Clinical Council’s Facilitator

Karen BrowneChair of Community Health Council

Gail ThomsonExecutive Director Quality & Clinical Governance Solutions

DATE: 24 August 2020

RECOMMENDATION:

That the Committees note the content of this paper.

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Community & Public Health and Disability Support Advisory Committees Meeting - Community Health Council Update

33

Overview

The Community Health Council (CHC)1 has been in place for 3 years and achieved a number of milestones including:

a) The development of the CHC Engagement Community, Whānau and Patient EngagementFramework and Roadmap2 which has allowed staff to have community engagement in projects they are undertaking;

b) Hosting the CHC Symposium for all registered CHC advisors in October 2019 with the purpose of sharing and learning what has been achieved from both staff and CHC advisors through engagement projects;

c) The creation of a CHC database with connections to over 300 persons/ organisations. This is an asset to the Southern health system when it needs to engage and /or communicate with the community on specific issues;

c) The CHC, through processes set up with the CHC Engagement Framework and Roadmap has empowered CHC advisors to be involved in the new hospital build and contribute to the design process, and

d) Allowing CHC Members/Advisors the opportunity to feed into multiple projects occurring across the Southern health system.

Updates for this Quarter

Before the August CHC meeting commenced, there was a session held to allow members to take stock of where the CHC is at with enabling engagement between staff, patients and whānau occurring within the Southern health system. CHC members were provided with a profile of currently registered CHC advisors and a summary of services that have come forward to engage with CHC advisors. From here the CHC identified priorities to focus on in the 2020/21 year, these include:

∑ Continue raising the profile of the CHC Engagement Framework and Roadmap across the Southern health system. Community, whānau and patient engagement may be increasingly seen as the “right thing to do”, but without systematic evaluation how do we stop good intentions becoming tick-box tokenism?

∑ Continue evaluating what difference engaging CHC advisors on projects is making, and ask the questions are staff genuinely engaging, listening and acting to what CHC advisors are raising on projects. A similar evaluation occurs with staff members.

∑ The CHC needs to continue to work closely with the Clinical Council and key clinicians across the Southern health system to raise the profile and ensure consistent messaging is going out about the CHC Engagement Framework.

∑ Profiling Clinical Champions who support engagement between staff, patients and whānau was delayed with Covid but will commence in the coming weeks.

1https://www.southernhealth.nz/sites/default/files/2019-05/Community%20Health%20Council%20%20ToR%202019.pdf

2https://www.southernhealth.nz/about-us/about-southern-health/community-health-council/chc-engagement-framework-road-map


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https://www.southernhealth.nz/sites/default/files/2019-05/Community%20Health%20Council%20%20ToR%202019.pdf

https://www.southernhealth.nz/about-us/about-southern-health/community-health-council/chc-engagement-framework-road-map

https://www.southernhealth.nz/about-us/about-southern-health/community-health-council/chc-engagement-framework-road-map

∑ Profile services where engagement has occurred with CHC advisors, identify what has been learnt, what could have been done better and what improvements have been made to service delivery.

∑ The Health Quality and Safety Commission (HQSC) has recently launched the Quality Safety Marker (QSM) for Consumer Engagement3 and as stated this will require the support and partnership of Clinical Council. The CHC Chair and Facilitator will present on this at the next Clinical Council meeting. A meeting will occur with HQSC representatives, DHB staff and CHC members in October.

∑ The CHC undertook a large amount of work around understanding the feedback process at the DHB and had developed some initiatives for change. The CHC is still keen to progress this work as believe that there are valuable lessons to be learnt from the feedback process and also potentially services where engagement with CHC advisors could be encouraged.

∑ Patient Stories is again something the CHC believes provides a powerful and meaningful tool for allowing people/staff to listen about people’s experiences.

∑ Community engagement with the new Dunedin Hospital is underway. It has been an avenue for some services to be introduced to the CHC and CHC Advisors. This work will continue to be a big priority over the coming year.

∑ The CHC Annual Report is in the process of being developed and will be shared at the next update.

∑ A CHC plan on a page (Appendix 1) for the 20/21 year has been drafted up incorporating some of the above work streams but also allowing flexibility for items to flow into the CHC from services as needed. This will be a living document with changes made throughout the year.

∑ Covid -19 and the community

When the global pandemic arrived in New Zealand, CHC members grappled with issues arising in their various communities. With the diverse range of members, CHC began to hear early on about poor communication as we entered the lockdown e.g. issues were raised around what services were still operating and at what capacity. The CHC Facilitator tried to keep all CHC members, CHC advisors and the wider CHC database updated with information of relevance that came through the DHB system.

As the nation moved through the different alert levels, some CHC members have been actively working with WellSouth and DHB staff. Some members have assisted with advising on the establishment of the CBACs and most recently those with Pacifica connections have assisted with how and when to do the pop-up clinics for covid testing. The CHC has definitely had a role to play with connecting with communities during these uncertain times.

∑ New Dunedin Hospital

The CHC Chair recently sent a letter to the CEO outlining the process of engaging CHC advisors with the new Dunedin hospital project. Feedback received to date has been mostly positive. The CHC Chair, CHC Facilitator and Project Management Office (PMO) team are expected to meet with all CHC advisors engaged with this project before the end of September.

All CHC members recently engaged with the PMO team on a particular issue of public amenities in the new Dunedin Hospital. The CHC is conscious that it represents only 11 members and is therefore not representative of the Southern district. The suggestion was made to do a short survey of all CHC contacts. The response to the survey exceeded 300 responses and reinforced that the CHC does have a resource

3 https://www.hqsc.govt.nz/our-programmes/partners-in-care/news-and-events/news/3909/

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that can be utilised by the system when required. This feedback was presented at the September CHC meeting and was supported by CHC members and will now go to the Clinical Leadership Group.

∑ Disability Strategy

The Donald Beasley Institute presented the feedback received during the consultation process of the Disability Strategy at the August meeting. The CHC, along with a number of other organisations, provided independent feedback on the draft strategy. A number of CHC members raised concerns around the small numbers of people that have fed back from both the Māori and Pacifica communities. CHC members stated that better engagement with these communities could have been undertaken.Other feedback from the CHC included the consultation process online was challenging for some community people to do in terms of ability to access online and ability to review feedback submitted.CHC members are keen for work to commence around this important piece of work and look forward to following what is achieved.

∑ Rainbow tick

The CHC has been investigating the process for obtaining the ‘Rainbow Tick’ for the SDHB and WellSouth Staff. This is about ensuring the organisation is open to diversity in our workforce and guides organisations of how to provide supportive environments to attract people to work here. The Otago Polytechnic has recently achieved the Rainbow Tick and the DCC is also in the process of investigating this. The CHC will work with the Executive Director People Culture & Technology around a pathway forward, if this is achievable.

∑ After-Hours Access in Southland

Two CHC members are on the steering group that is investigating after-hours primary care access in Southland. Both these members had raised concerns around access to primary care in the Southland region when they joined the CHC mid-2019. CHC members living outside of Invercargill, were shocked by the cost of accessing primary care after-hours in Invercargill and how inequitable this is across the district. The work of this steering group has been delayed due to Covid-19 but must be a priority going forward.

∑ DSAC/CPHAC representation of CHC members

Paula Waby (CHC member) has been appointed to the DSAC/CPHAC committee as a member of the community with lived experience of disability.

∑ HQSC – QSM for Consumer Engagement

The QSM Framework for consumer engagement has been available since July 2020, and it is anticipated that by December all DHBs will have taken part. The goal of this QSM is to address ‘what does successfulconsumer engagement look like, and (how) does it improve the quality and safety of services?’ The datawill be collected bi-annually.With the work that has occurred around developing the CHC Engagement Framework & Roadmap, the Southern health system is in a relatively good position of collating a picture of where engagement with community, whānau and patients is occurring.

∑ CHC Engagement Framework and Roadmap

For the June - August 2020 period there were 31 CHC advisors working alongside staff on 20 projects across the Southern health system - Appendix 2 outlines engagement activities. The majority of these projects were at a strategic partnership level and not so many projects occurring at a service level. This may change with the incorporation of QSM for consumer engagement and roll-out of the Service Level Accountability Framework. Information about the CHC engagement is incorporated into service planning so we will monitor how this progresses. Appendix 3 provides a summary of other work the CHC have fed into over the last four months.


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∑ Feedback

Feedback collected from both staff and CHC advisors engaged in projects is important to help us focus on what changes we need to make with the programme of work around engagement with patients, whānau and community. Below is a snapshot of some of the feedback received from both staff and CHC Advisors. The information collected helps to identify strengths and weaknesses of the programme and what support needs to wrapped around things.

Feedback from Staff Members

Feedback from CHC Advisors

“It was challenging to Chair the meetings as they were held via zoom and without

pre formed relationships this can be hard but it did not

seem to phase the CHC Advisor.”

“Having the input from a CHC Advisor to the project was

extremely valuable.”“…… it felt like there was no real structure and expectations for both consumers and SDHB staff. In many ways this felt like a ‘box ticking’ exercise, rather than a deliberate attempt to work constructively with the consumers.”

“I frequently felt the CHC Advisors weren’t taken

seriously, but at the same time I’m not sure I ever saw them being asked

about their specific views. It was also unclear

whether they were to offer their own

experience, or to be more of a consumer

representative role.”

“Timeliness of papers was

certainly something that could have been improved. Plans are in place to

sharpen up in this area in the

future.”

“A pity the promised updates after the

group had completed its work were not held.

Not sure if the work done by the base

group is visible anywhere.”

“It has provided me with invaluable understanding of issues that need to be considered in the New Dunedin Hospital design and build.”

“... I was able to raise concerns and suggestions about ways to improve

the patient journey and support staff with changes….”

“I found this a positive experience. Involvement as a CHC Advisor enabled

me to appreciate the complexities of improving the patient journey and the challenges faced by

staff working in a suboptimal environment.”

“One or two points I believe were strongly listened to from the

consumer point of view included information – too much, in a format clearly understood by patients

and their support/family, need for relevant forms to be completed and sent at the time of admission so that all supports can be

activated.”

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Appendix 1. Draft CHC Plan on a Page 2020-21

Patients, whānau and community Staff and Community

StaffDHB and WellSouth Reporting

HQ

SC Q

SM

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CHC

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/DSA

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CHC

Annu

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2020 Aug C R C CSept C R C C C I U E R I D XOct C R D E U D I D D X XNov C U U C U D XDec C U

2021 Jan C E E C E E XFeb C E E E L EMar E E E CApr C E E X XMay R R EJun CJul C X

C-Connected R- Review I - Investigate D- Develop U –Updates E-Event/and or Launch

CHC Representation on Southern DHB/ WellSouth CommitteesCHC member CHC Advisors

Clinical Council Karen BrowneCPHAC/DSAC Paula WabyAlliance South Bronnie GrantCentral Otago Lakes Locality Network Jason SearleClinical Leadership Group Sarah Derrett, Jo MillerIT Governance Group Jason Searle

Key

System wideWellSouthSouthern DHB


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Appendix 2 . Summary of CHC advisors engaged with projects June-August 2020

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Appendix 3. Items the Community Health Council has been updated or consulted on since June 2020

Month Topic Person responsible

JuneCommunity Health Hubs Lisa GestroUpdate on Covid-19 response to Maori Health Nancy Todd

July

Clinical Council Tim MacKayTelehealth Simon DonlevyMental Health Review Louise TraversCEO Updates Chris Fleming

August

Update on Disability strategy and feedback Jenny Conder - DBI

New Dunedin Hospital- public amenitiesSimon Crack, Kalhari Weerasinghe, Emily Gill

CEO Updates Chris FlemingPatient letters Gail Thomson

September

New Dunedin Hospital- public amenities Simon Crack, Emily GillPrimary Birthing Maternity Lisa Gestro

ED and mental health patients Lisa Gestro

Community Health Hubs Lisa GestroPatient Handbook Charlotte AdankHealth Care Homes Stuart BarsonCEO Updates Andrew Swanson-Dobbs

Chris Fleming


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PRESENTATION: MINISTRY OF HEALTH FUNDER

Doug Funnell Portfolio Manager

Disability Directorate Ministry of Health

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Community & Public Health and Disability Support Advisory Committees Meeting - Presentation: Ministry of Health Funder

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Title: Southern Health Needs Assessment 2020

Report to: The Community & Public Health Advisory Committee


Summary:

A district-wide Southern Health Needs Assessment (HNA), overseen by Alliance South, is being led by Southern DHB in 2020 to provide an up-to-date, and comprehensive picture of the health and needs of the Southern population. A similar HNA was last done in 2013, therefore this information now needs updating.

This current assessment will help inform and guide future decision making about how health care will be delivered across the district, as new models and ways of providing health care (particularly those envisaged in the Southern Primary and Community Care Strategy (2018)) are developed and introduced to improve population health. The COVID-19 pandemic has highlighted further the value of having an updated HNA, serving as a valuable baseline and easily accessible data repository for health services across the District to monitor and respond to the potential impact of the pandemic on health outcomes.

The findings of the HNA will be made publicly available, via a web-based format, and presented and explained in a way that is understandable to a wide audience. The information will also be updated at regular intervals to provide the transparent monitoring and evaluation of service delivery required for accountability. This will ensure any changes or new models of care (whether planned prior to the COVID-19 pandemic or adapted as a consequence) continue to meet the needs of the Southern population and that the focus on health equity and improvement is maintained overtime.

An overview of the project will also be presented at this meeting, along with a tangible example of an indicator to illustrate the progress being made.

Equity: A key focus of the HNA is to also provide an accurate picture of where health inequities lie across the district. It will seek more detailed information where-ever possible around aspects of health that can be measured, to help inform this picture, looking at factors such as age, sex, ethnicity, deprivation and geographical location. The HNA will provide an opportunity to use robust, evidence-based information to objectively inform the prioritisation of resources and services in the best way possible to achieve health equity, so that everyone can enjoy the same level of health and wellbeing. It is hoped the project will especially benefit population groups, including Māori, who might have previously been underserved, because their needs were not accurately known. The Ministry of Health’s Health Equity Assessment Tool will ensure that achieving health equity is a key area of focus.

Specific implications for consideration (financial/workforce/legal etc.):

The main risks of the project relate to the impact of staffing capacity on its timeline, predominantly as a consequence of the ongoing COVID-19 pandemic and its response. This has delayed the initial timeline and may delay it further, depending on its evolution.


Lisa Gestro, Project Sponsor Date:15/09/2020


Date: 28/09/2020

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Community & Public Health and Disability Support Advisory Committees Meeting - Presentation: Southern Health Needs Assessment

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Prepared by: Katherine Graham, Public Health Registrar, Southern DHB

Presented by: Katherine Graham, Public Health Registrar, Southern DHB


RECOMMENDATION:

For the Committee to please note that a Southern HNA is being undertaken by Southern DHB over the course of 2020, and it will be duly informed of its findings when the project is completed.


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Southern Health Needs Assessment

BackgroundAs required by legislation, Southern DHB must regularly investigate, assess and monitor the health status and needs of its resident population for health care services, and its performance and delivery of the latter, so it can best meet local needs and therefore improve, promote and protect the health of its people and communities, and achieve health equity for Māori and other population groups.1

PurposeThe Southern Health Needs Assessment (HNA) will facilitate this process by providing a snapshot of the population’s health and needs at a certain period in time; which can also serve as a baseline for future monitoring. It will therefore also serve to inform, monitor and evaluate the concurrent implementation of the Southern Primary and Community Care Strategy (2018).

The main objectives of the HNA are to:1. Provide an up-to-date, comprehensive, health needs assessment of the Southern population;2. Provide an accurate picture of health inequity across the district;3. Establish an easily accessible repository of data to be used as a comparative baseline for the future and

ongoing monitoring of a set of chosen health measures and indicators;4. Present findings via an easily accessible, engaging, and readily updatable web-based format,

understandable to a wide audience to maximise stakeholder and consumer engagement.

ScopeThe HNA will be district wide in its scope, but limited to looking at an agreed set of health measures and indicators,2 for which robust, up to date, data will be sought from national and local databases. This data will be disaggregated wherever possible by age, ethnicity, sex, deprivation index (or quintile) and geographical location to objectively inform Southern DHB in its future provision of health service delivery, particularly to attain health equity for Māori and any other population groups elicited. A list of these indicators is provided below.

Approach The project is being led by the Strategy and Planning section of Southern DHB’s Strategy, Primary and Community Directorate, with internal and external stakeholder consultation as appropriate. Published and grey literature, and prior practice have been used to guide project development. The Health Equity Assessment Tool3

will guide the focus on achieving equity throughout.The data will be accessed and stored in a format to assist Southern DHB and other stakeholders in their planning (and monitoring) of future health care service delivery, with the main findings presented in a web-based format, to facilitate the display of trends over time. To ensure this opportunity is maximised, a plan is to be embedded for the regular updating of the HNA following project transition.

1 Sections 22(1)(a)(b)(ba)(e)(f) and 23(1)(g)(i) New Zealand Public Health and Disability Act 20002 Proposed measures and indicators commonly used to assess: a population’s health status; factors influencing their health; and their interaction with local health services were presented to ALT in December 2019 3 Health Equity Assessment Tool, 2008, Ministry of Health, Wellington: New Zealand

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The initial planned approach was for the HNA to be conducted in three phases: (1) Phase One – the specification, acquisition, analysis, and presentation of the data relevant to each

indicator, with proof of the content, and testing of access, undertaken prior to its on-line launch;(2) Phase Two – the development of interactive web-based technology to display trends and data; and(3) Phase Three – the proposed automation of datasets to assist the future monitoring of the HNA.

Although the initial phase of project has now been nearly completed (stakeholder engagement, data acquisition and analysis), and narrative writing commenced, the overall proposed initial project timeline has required adjustment. This has been due to challenges and delays that have occurred as a result of the ongoing COVID-19 pandemic, particularly their effect on data acquisition and project staff capacity. An amended project timeline is included for the Committees’ reference below:

Amended major project milestones following the initial Southern COVID-19 response

PROJECT MANAGEMENT Date to be completed (end of)Project sign off February 2020Project review points March, June, September, December 2020 Stakeholder engagement (initial) October 2020 Stakeholder engagement (final) Early 2021- prior to launchTransition of monitoring and reporting (plan) Early 2021 (review timing near project completion) Process evaluation of project (planned for) January/February 2021 (review timing near launch)

PROJECT TASKS Date to be completed (end of)PHASE ONE: Indicator data – specification development, extraction, analysis (graphs/tables), reporting and static website pages

Late 2020

PHASE TWO: Website development, indicator selection and datasets for interactive dashboards, presentation – dynamic proofs, risk review and test of concept

Late 2020 (in parallel with phase one)

PHASE THREE: Automation of datasets for future monitoring and reporting

To be reviewed near the end of phases one and two

Launch of website 2021 Outcome evaluation of project 2021 to review timing near to project launch

Stakeholder engagement: The following list of stakeholders includes those identified by the project team initially. Of note, this is not an exclusive list and other stakeholders are being engaged with, where appropriate, as the project progresses


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Area Name Role in ProjectInternal – SDHBStrategy and Planning Lisa Gestro

Executive Director Strategy Primary & CommunitySponsor and Governance. Accountability for output

Rory Dowding Manager Strategy and Planning (S&P)

Project lead and steering group member

Talis Liepins Support and Intelligence Analyst, S&P

Data acquisition and analysis

Lynette BattSenior Analyst, S&P

Data acquisition and analysis

Public Health Susan JackPublic Health Physician

Project lead and steering group member

Katherine Graham - Public Health Registrar Project manager, writer, steering group memberInformation Systems Lance Elder

Digital Solutions Manager / ArchitectProject lead and steering group member

Communications Nicola MutchExecutive Director Communications

Communications / risk and steering group member (phase 2)

Governance SDHB Board Accountability for outputSDHB ELT Accountability for output

Māori Health Directorate SDHB Gilbert Taurua Chief Māori Health Strategy & Improvement Officer

Collaborative guidance on reporting; provision of disaggregated data from the project to assist directorate’s service planning

Nancy Todd Associate Māori Health Officer-Secondary/Tertiary

Collaborative guidance on reporting; provision of disaggregated data from the project to assist directorate’s service planning

Advisory SDHB Clinical Council (some external members) Potential advisoryDisability Support Advisory Committee (DSAC) and Community and Public Health Advisory Committee (CPHAC)

Potential advisory

Iwi Governance Committee Potential advisory. Accountability for ensuring equity lensCommunity Health Council Potential advisory. High interest in output regarding informing future

planning and models of care. Future contact point for any potential expansion of needs assessment at community level

External to / Partnership with DHBAlliance South – mixture external / internal Accountability (for output)Primary Health Care (PHC) WellSouth

Kyle Forde – Chief Information OfficerCollaboration regarding shared indicators and data provision and steering group member

Well South/Southern DHB – Stuart Barson – Project Lead Southern Health Care Home model

Potential advisory and collaboration regarding shared indicators and engagement PHO practices

PHC practices outside PHO e.g. Student Health Potential provision of data for planningRural Hospital Alliance Potential advisory. High interest in output for service planning

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Southern Health Needs Assessment – Approved Indicator specifications August 2020

Measure Indicator1.0 Demography1.1 Population demographics 1.1.1 SDHB population estimates (and projections to 2025) disaggregated by ethnicity, gender and age, locality 1.2 Family types 1.2.1 Household structure: Number of adults/children/sole/elderly living in households in SDHB

1.2.2 Percentage of the population (75+ years) living in their own home2.0 Health Drivers (determinants)2.1 Deprivation 2.1.1 Population disaggregated by NZ Deprivation Index 20182.2 Household income 2.2.1 Households by income brackets compared to NZ

2.2.2 Entry onto benefit2.2.3 Housing affordability

2.3 Household crowding 2.3.1 Housing crowding by as measured by insufficient bedrooms for household2.3.2 Household Dampness in private occupied dwellings, by TA and Tenure of dwelling – TBC

2.3.3 Household Visible mould in private occupied dwellings by TA and Tenure of dwelling- TBC

2.4 Educational attainment 2.4.1 NZQF levels: 0 (no attainment); 1-3 (NCEA secondary school); 4-7 (certificate/diploma); >7 (university degree and postgraduate)

2.5 Te Reo Māori (use of) 2.5.1 % of population able to use te reo Māori – conversational; use regularly at home; main language spoken2.6 Smoking 2.6.1 % population 15+ who smoke compared to NZ, disaggregated by age, sex, ethnicity, deprivation level

2.6.2 % Pregnant women who identify as smokers upon registration PH042.6.3 % of babies who live in a smoke-free household at six weeks2.6.4 % of hospital patients who smoke and are offered brief advice and support to quit smoking by ethnicity

2.6.5 % of enrolled patients who smoke and are seen by a health practitioner in primary care and offered brief advice and support to quit smoking (PS-O) by ethnicity

2.7 Overweight or obese - children 2.7.1 % of obese or overweight children 0-14 years disaggregated by age group, sex, ethnicity2.7.2 % of 4 year old children receiving a B4 School Check 2.7.3 % of obese children identified in the B4 School Check programme offered a referral to a health professional for clinical assessment and family-based nutrition, activity and lifestyle interventions

2.8 Overweight or obese - adults 2.8.1 % of the population 15+ who are overweight and obese by sex, deprivation and ethnicity

2.9 Infants exclusively breastfed 2.9.1 % or number of infants who are exclusively or fully breastfed at six weeks2.9.2 % of infants exclusively or fully breastfeeding at 3 months, 4 months and 6 months

2.10 Fruit and vegetable intake in children 2.10.1 % of children aged 2-14 years who have an ‘adequate intake’ of at least of 2-3 servings of vegetables and at least 2 servings of fruit per day

2.11 Fruit and vegetable intake in adults 2.11.1 % of adults >15 years who have an ‘adequate intake’ of at least of 3 servings of vegetables and at least 2 servings offruit per day


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Measure Indicator2.12 Consumption of fizzy drinks in children 2.12.1 % of children aged 2 to 14 years old, who consume three or more fizzy† or energy drinks per week2.13 Physical activity among adults 2.13.1 % of adults who are physically active. A person is considered ‘physically active’ if they did at least 30 minutes of

moderate-intensity (or equivalent) physical activity a day on five or more days of the last week.

2.14 Physical activity among Children 2.14.1 % of children (aged 5 -14 years) who participate in ‘active transport’ i.e. who walk, cycle or travel with non-motorised modes to get to and from school; and the % of children (aged 2 - 14 years) who watch two or more hours of television a day. These measures are used as a proxy for overall physical activity in children.

2.15 Hazardous alcohol use 2.15.1 % of youth and young adults 10-24 years with alcohol related ED attendances3.0 Health Status3.1 Life Expectancy 3.1.1 Life expectancy at birth disaggregated by ethnicity compared to NZ

3.1.2 Life expectancy at age 65 years disaggregated by ethnicity compared to NZ3.2 Mortality 3.2.1 All-cause mortality rate for people aged under 65 (age standardised per 100,000)

3.2.2 Top 10 causes of mortality by age group and ethnicity

3.3 Amenable mortality 3.3.1 Age 0-75 years amenable mortality rates per 100,000 population compared to NZ

3.3.2 PHO enrolled women aged 25 to 69 years who have received a cervical smear in the past 3 years

3.3.3 Percentage of eligible women (50-69 years) having a breast cancer screen in the last 2 years

3.3.4 Bowel Cancer Screening – Percentage of 60-74 year olds being screened for bowel cancer in the last two years 3.3.5 Incidence of bowel cancer type (or stage) detected at screening per 1000 screened 3.3.6 Faster Cancer Treatment

3.4 Parent reported health status for children 3.4.1 % of children, aged 0-14 years, whose parents or caregivers rated their health as ‘excellent’, ‘very good’ or ‘good’.

3.5 Self-reported health status of adults 3.5.1 % of adults, aged 15 years and over, who reported their health as ‘excellent’, ‘very good’ or ‘good’.

3.6 ASH rates 3.6.1 Ambulatory Sensitive Hospitalisation rates per 100,000 enrolled patients for top ten conditions disaggregated by age group, ethnicity, deprivation

3.7 Oral health status 3.7.1 % 5-year-olds caries free3.7.2 % eligible pre-schoolers enrolled in community oral health services 3.7.3 % of youth aged 9-17 years using SDHB funded dental services

3.8 Mental Health 3.8.1 Self-harm hospitalisations per 100,000 for 10-24 years3.8.2 % >15 years experiencing mental health disorders; including psychological distress, depression, bipolar disorder, anxiety disorder and other mood disorders.

3.9 Diabetes 3.9.1 % of the adult population (aged 15 years and older), who have been diagnosed and are living with diabetes

3.10 Cardiac disease 3.10.1 Incidence of cardiac disease hospitalisations compared to NZ3.11 Stroke 3.11.1 Incidence of stroke hospitalisations compared to NZ

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Measure Indicator3.12 Dementia 3.12.1 Prevalence of adults living with dementia

3.13 Cancer 3.13.1 Rate of new cancer registrations per 100,000 of adults3.14 Disability 3.14.1 % of adults living with disability by ethnicity (% of adults on a Disability allowance might be a sub-indicator here)

4.0 Health Services4.1 Unmet need for primary health care 4.1.1 % of unmet need for primary care for children, aged 0-15 years compared to NZ

4.1.2 % of unmet need for primary care for adults (aged 15 years and older) compared to NZ

4.2 Barriers to accessing primary health care Due to cost visitDue to prescription costDue to appointment availability (24 hours)Due to lack of transport

4.2.1 Prevalence of main reasons for unmet need in primary care for children (aged 0-15 years)

4.2.2 Prevalence of main reasons for unmet need in primary care for adults (aged 15 years and older)

4.2.3 Prevalence of main reasons for unmet need in primary care for adults by ethnicity

4.3 Immunisation 4.3.1 % children fully immunised at age 8 months 4.3.2 % people (≥ 65 years) received flu vaccination (PS-O)

4.4 Patient Experience of care 4.4.1 Inpatient: Did a member of staff tell you about medication side effects to watch for when you went home

4.4.2 Polypharmacy. % of >65 years on polypharmacy 11+ medications

4.4.3 % people who have a transition (discharge) plan

4.4.4 % presenting at ED who are admitted, discharged or transferred within 6 hours

4.4.5 % eligible population who have had a CVD Risk Assessment in last 5 years (EDM-O)

4.4.6 % people waiting no more than 6 weeks for CT scan4.4.7 % people waiting no more than 6 weeks for MRI4.4.8 % people receiving their specialist assessment or agreed treatment (ESPI 5) in < 4 months

4.4.9 Faster Cancer Treatment (also under 3.3.4 above)

4.4.10 ED use by TLA, ethnicity, age group, triage level, presentation4.5 Acute services 4.5.1 Acute bed days per 1,000 population (age standardised)

4.5.2 Acute readmissions to hospital (28 days discharge) per 1,000 admissions

4.5.4 % population (75 years and over) admitted to hospital as a result of a fall

4.6 Maternity services 4.6.1 Pregnant women registered with a Lead Maternity Carer within first trimester of pregnancy


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Measure Indicator4.7 Older Persons Health 4.7.1 % of 65+ years supported by home and community support services (HCSS)4.8 Mental Health 4.8.1 % of population with severe mental health illness seen in Southern Mental Health Services in the previous 12 months

4.8.2 Waiting times for non-urgent Southern Mental Health and Addiction services for 0-19 year olds 4.8.3 The rate of people made subject to the Mental Health Act 1992, Section 29 community treatment orders, by ethnicity

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Title: Options Paper: Where should we locate primary maternity facilities in Central Otago/ Wanaka?

Report to: Community & Public Health Advisory Committees


Summary: The second phase of consultation addressing the question: “Where should we locate Primary Maternity Facilities in Central Otago/ Wanaka” is now complete. This has included receipt of 270 online submissions, engagement with a wide range of stakeholders’ face to face or by teleconferencing and 2 public meetings. The Central Lakes Locality Network and the DHB project team are working through the findings and will present a recommendation to the Board at their meeting in November 2020.

Specific implications for consideration (financial/workforce/risk/legal etc.):

Financial: The project will result in capital expenditure to develop a new facility or facilities depending on the outcome. Potential impact on operating expenditure depending on the final option selected.

Workforce: Recruitment/retention of an LMC workforce to staff current/new facilities. LMC preference is for a 24/7 staffed model.

Equity: Reduction of and more equitable rural travel times to primary birthing facilities


Alliance Leadership Team

Executive Leadership Team


16 September 2020



Prepared by:

Demelza Halley, Primary Maternity Project Manager and,Mary Cleary-LyonsGM, Primary Care and Population Health

Presented by:

Lisa GestroED Strategy, Primary & Community


RECOMMENDATION:

DSAC-CPHAC Committee to note the completion of the second round of public consultation on the question “Where should we locate primary maternity facilities in Central Otago/ Wanaka?”.

Note that the Central Lakes Locality Network and the DHB Project Team will make a joint recommendation, taking into account public feedback, on the best option in November.

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Community & Public Health and Disability Support Advisory Committees Meeting - Primary Maternity - Update on Consultation

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Primary Maternity Facilities Consultation Update – September 2020

The second phase of consultation addressing the question: “Where should we locate Primary Maternity Facilities in Central Otago/ Wanaka” is now complete.

An options paper was publicly released in July 2020 detailing four possible configurations of services for stakeholder and public feedback. These options were developed after considering stakeholder and public feedback during the first round of consultation:

Option 1: Single new facility in Cromwell

Option 2: Single new facility at Dunstan Hospital in Clyde

Option 3: Two facilities – retain Charlotte Jean and a new facility in Wanaka

Option 4: Two facilities – relocate Charlotte Jean to Dunstan Hospital and a new facility in Wanaka

Across both consultation periods the DHB has heard from or met with a wide range of interested and affected groups including:

∑ Otago Rescue Helicopters ∑ Charlotte Jean Maternity Hospital Staff ∑ Maternity Quality and Safety Programme ∑ Representatives (clinical and management) of Dunstan Hospital ∑ Wanaka based Lead Maternity Carers and colleagues ∑ Alexandra/Cromwell based Lead Maternity Carers ∑ Central Otago Mothers Group ∑ St John ∑ Paediatrics/Obstetricians ∑ New Zealand College of Midwives∑ Roxburgh Medical Services Trust ∑ Uruuruwhenua Health∑ Queenstown Lakes District council∑ Members of the public

The key themes the SDHB project team has heard throughout the consultation are:

• 24/7 midwifery availability at birthing facilities is preferred by LMCs as this provides additional back up in remote rural areas

• Rapid access to urgent transport, especially a helicopter, is essential. A significant proportion of the online feedback focused on safety and the importance for women and whānau to know that there are excellent arrangements to deal with emergency situations

• Equity of travel times and access to primary birthing facilities for all parts of the region is important


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• Co-location with other health services especially medical support is highly valued by public and professionals

• Need to take account of pace and locations of population growth and develop a future proofed proposal

• Quality of the whole pathway of maternal care emerged as a key theme. While people want to know facilities are available, many respondents focused on care quality and availability of a highly skilled workforce

• Feedback from Māori respondents noted that Māori have experienced care in the community (not birthing unit) that was not respectful e.g. ‘being talked down to’ and in particular have not always received supportive care in the weeks following birth

• Charlotte Jean Maternity Hospital is highly valued by women and the community

• It is important that this work progresses as quickly as possible

• We need to enhance public understanding of what is available at a Primary facility vs a Secondary facility

• There is enhanced understanding of the decision making trade-offs i.e. financial sustainability and 24/7 staffing vs shorter drive times

• Wanaka residents strongly prefer a facility based in Wanaka

The SDHB Project Team is now considering the feedback received and working through a decision making process. As part of the decision making process the following areas will be considered:

∑ Stakeholder and public feedback∑ The requirements of the Service Schedule∑ Safety and Quality∑ Workforce availability∑ Sustainability∑ Affordability

A recommendation on a preferred option is due to the Board in November 2020.

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Title: Strategy, Primary & Community Report

Report to: Disability Support and Community & Public Health Advisory Committees


Summary:

Monthly report on the Strategy, Primary & Community Directorate activity.

Specific implications for consideration (FINANCIAL/WORKFORCE/RISK/LEGAL ETC.):

Financial: The monthly finance report for the Directorate is submitted as a separate paper for consideration

Workforce: Workforce issues have been identified, where they are present in each of the respective service updates.

Equity: Equity remains a key driver of the work of the directorate, and we look forward to being informed by the health needs analysis, which is being presented to the committee today and is due for completion and release during quarter three. Equity continues to be a strong focus for our Covid resurgence planning and the development of our sustainable testing strategy.

Other: As identified by the service, as per the report


Lisa Gestro DATE: 8 September 2020


Chris Fleming DATE: 9 September 2020


Strategy, Primary & Community Team Lisa Gestro

Executive Director Strategy, Primary & Community


RECOMMENDATION:

That the Committees note the content of this paper.

15.1

Community & Public Health and Disability Support Advisory Committees Meeting - Items for Noting

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Strategy Primary and Community – Monthly Report for June 2020 Page 2 of 21

STRATEGIC HIGHLIGHTS

Our Ongoing Coronavirus Management Response

There is currently (as of 24 September) no transmission of Covid-19 in the community. A significant amount of work continues in this area, which is outlined in the following sections.

Isolation Hotels

During August a large amount of energy was expended supporting national conversations to inform a decision about the suitability of our District to host Managed Isolation facilities. During July a visit toSouthern took place by Minister Megan Woods and Air Commodore Darryn Webb to review suitability for placement of a Managed Isolation facility (MIF) for people returning from overseas. This was subsequently discounted due to a national decision to limit the placement of these facilities a small number of large cities. Subsequently, in August there was a high level of interest in Queenstown as a potential site for a Sporting-MIF, which was being sought by various sporting codes as a quarantine site upon entry into the country for international teams in advance of international tournaments. Despite the likelihood of this looking very probable at one point, a cabinet decision around quarantine requirements saw SANZAAR award the Rugby Championship hosting rights to Australia rather New Zealand, hence removing the need for quarantine facilities. Most recently, a Ministry/MBIE led discussion has been instigated with several DHB’s (those greater than 2.5 hours away from a border quarantine facility) to investigate what suitable accommodation would look like locally in the event that COVID -19 positive are detected in the community in the future. These conversations are ongoing.

A focus on recovery – Queenstown

This group was established as part of the COVID response during the first wave, recognising the impact on COVID on wellbeing in the Central-Lakes area. Established by Southern Health Mental Health Network Leadership Group, and the Central Lakes Mental Health and Addictions Network working to national psychosocial response plan. The group has representation from QLDC, Southern DHB, WellSouth, Central Lakes Family Service, Central Lakes Mental Health and Addictions Network (chaired by Emily Nelson, has a wide representation), Central Lakes Locality Network (chaired by Helen Telford, established to ensure key agencies aware of each other’s activity, and wider initiatives in the community)The group is purposed to maintain visibility of how mental health and wellbeing services in the community are managing, and identify areas where additional support is neededInitially focused on urgent needs; the group is now preparing for ongoing role with COVID part of ongoing reality. The group is premised on the idea that this challenge requires a whole of community response, and we all have a part to play. The group monitors the demand on services in the district through our weekly updates

The main highlights from the group reported for August are as follows:

∑ Mental health services continue to be busy, although waiting times for appointments have not increased

∑ The impact of unemployment is becoming more apparent. Referrals in the community for children with anxiety symptoms seem to be increasing, and the services are dealing with issues arising out of parental separation and financial stress. The Central Lakes Family Service is looking to dedicate 2 staff to youth services, as a response to the rise in referrals. There has been an increase in referrals for Family Services in Dunstan but not from Queenstown at this stage

∑ There does appear to be an impact in respect of maternal and post-natal situations; it is thought this is compounded by absence of support traditionally that would have been in place (family members etc). The impact is seen as an increase in anxiety and panic, and there have been a higher than expected number of referrals this month (compared to the same time last year)

∑ There has been no change to the wait time for secondary/tertiary services; urgent patients can be seen immediately, and within 2-3 weeks for less acute situations.

∑ Secondary services are fully staffed.∑ WellSouth Brief Intervention Service have reported a 40% increase in referrals compared to last

year at the same time. The month of August saw an 87% increase in referrals in the Central


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Otago Lakes District. Referrals from Alexandra and Wanaka show the largest increase. To date the wait times for the service have been consistent and maintained with those pre COVID.

∑ The “Health Improvement Practitioners (HIPS)” are now in place at Queenstown Medical Centre, Wanaka and Aspiring Medical Centres. The increased accessibility of support and the impact will not be able to be reviewed for at least 3 months social worker available to see anyone of any age.

∑ Central lakes family Services (NGO) has commenced a social worker in schools programme, with a social worker working across Queenstown’s seven primary schools. This is making a real difference in supporting children.

∑ There was a waiting list with Thrive during a period of a staff vacancy, but this has now been filled

∑ PACT have reported that their community support workers do have capacity for additional clients, and that additional workers might be available if the need is there.

∑ Reminder that free counselling is available 24/7 by calling or texting 1737∑ The message to share is that services are available for those who need to reach out for support.∑ Reinforce the importance of resilience-building resources – All Right/ Getting Thru Together,

Mentemia, Just a Thought, GoodYarn

Public Health Response

On 18 August 2020 the Ministry of Health advised that all Public Health Units (PHUs) should reprioritise their work and defer all non-essential activity over the following two weeks to ensure we have capacity available to respond to Covid19. The requirement from the Ministry is that the service must be prepared to contact trace up to 24 cases a day with a surge capacity of up to 34 cases a day.

There have also been a number of requests from the Ministry of Health to provide assistance to the Auckland Regional Public Health Service Response. During August:

- We have provided a National Contact Tracing Solution (NCTS) super-user to provide on-site training in Auckland. NCTS is the national information system for Covid19 cases and contacts. We have received extremely positive feedback about the staff member who went to Auckland and how helpful this was to the Auckland team

- We have also agreed to manage cases in Managed Isolation Facilities in Auckland. This work is being shared with Community and Public Health (Canterbury) and will be reassessed after a two-week period

- Teams have also been on standby to assist with follow up of symptomatic close contacts should the need arise.

- Alongside this work all protocols and documentation is being reviewed and updated to ensure that our Public Health Unit is prepared.

More recently we have responded to a request for additional Medical Officer of Health support for the Auckland Regional Public Health service, and have agreed that Dr Susan Jack will cover a two week period in November, subject to our own District remaining COVID free.

Locally a lot of work has been underway to ensure that there are the appropriate number of people within teams to be able to escalate quickly to cope with a second wave of cases. There continues to be extensive NCTS training across the Public Health Unit. Training is being progressed for 20 Public Health Nurses for case management and monitoring roles. Work is also underway with Human Resources (HR) and recruitment to identify other District Health Board (DHB) staff who would be unavailable to work in a clinical setting and could be made available for training so they could assist with response work if required. This is ongoing, and is a challenge given the organisations competing demands with recovery of activity lost during the first wave.Meetings have been held with the Māori Health Directorate and Pacific community providers to discuss how we can support each other in the event of further Covid19 cases.

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Maritime Border Response

There has been Covid19 testing of maritime workers at South Port, Port Otago and Tiwai across August in line with advice from the Ministry, which continues to evolve. We hope to receive clear information about whether testing of border workers is mandatory, and what frequency of testing required as we attempt to incorporate these requirements into a more sustainable longer term testing strategy.

Primary Care Response

Both the Primary Care and Community Services Emergency Operating Centres (EOC’s) have ceased to formally operate, although significant work continues to ensure we are prepared for new cases of Covid-19 in our district. For Primary Care, the focus is to work closely with general practice around operating a different model of care given the success of telemedicine during lockdown.

General Practice in all areas continue to provide assessment and testing as required, although the volumes in primary care continue to abate as less flu like symptoms present in the community. Access to swabbing, particularly outside of routine hours and weekends continues to be problematic in Invercargill, and close monitoring around access is needing to be maintained to ensure we are compliant with the Ministers expectation that swabbing facilities are available 7 days per week.

Plans are in place to be able to mobilise Community Based Assessment Centres (CBACs) in the future if required.

Swabbing

Current volumes of swabbing undertaken in primary care since 1st July to 8th September include 18,264 simple, 583 virtual and 59 full assessments.

Latest data from CBAC and General Practice Covid-19 activity at 28-08-2020:

Level of activity through GP assessment for August


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Assessment type through August

Testing trends over the month of August

Key

Population Health

Resurgence planning has been the main focus of the service over the previous month. Within our core Public Health Nursing service - School and Pre School Health Services, there is the requirement to provide surge capacity to the local Public Health Unit in the event of an outbreak, whilst maintaining cover for urgent work such as Child Protection. The total FTE for this component of the service across the whole district is 18.6FTE. Following the community outbreak in Auckland, it has been identified that 20 FTE of clinical staff would be required as a minimum to case manage and monitor 24 cases per day. This level of provision without the region being in Lockdown 4 will have a significant impact on the Population Health Service ability to meet other contractual requirement and targets. Increasing risks of negative downstream effects on child and youth health outcomes. Staff continue training for future responses while management look at stand up planning and staff training involved with this.

Public Health Nursing

The longer-term impacts of the first Covid-19 outbreak are being seen, the team are receiving more complex referrals with some children experiencing separation anxiety post Covid-19 lockdown. Additionally, phone calls and emails for Early Childhood Centres and schools requesting Public Health Nurse support has increased. With feedback being received from some Principals that they feel they have hardly seen their Public Health Nurse this year. This is likely to continue as nineteen Public Health

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Nurses have been required to cancel normal service delivery for a week, in order to prepare for a phase 1 public health response and train on the National Contact Tracing Solutions (NCTS) system.

Lakes District Hospital and the Rural Hospital Response

Lakes District Hospital has escalated its preparedness for new presentations of COVID-19. This includes:

∑ Screening all people presenting to the hospital∑ Using the Covid QR codes∑ Implementing security at the main hospital entrance∑ Limiting visitors to one per patient∑ Limiting support people in Emergency Department∑ Facilitating 1 metre social distancing∑ Reviewing the Resurgence Workforce Plan∑ Screening Outpatient attendees, with instructions to wait in their car until ready to be seen.

Rural Hospital Trusts

Gore Health, Clutha Health First, Waitaki District Health Services Ltd, Central Otago District Health Services Ltd and Maniototo Health Services Ltd have all their Level 2 plans, screening all people presenting to the facilities, having QR codes available for scanning, limiting visiting numbers and hours, encouraging social distancing and screening all outpatient attendees prior to appointments.All hospitals have developed Workforce Resurgence Plans, to identify their vulnerable staff, and to plan for redeployment if required.

Aged Residential Care (ARC)

The ARC Steering Group continues to meet weekly as the conduit between the DHB and our 65 aged residential care facilities as we move up and down Alert Levels, with the resulting challenges for their staff, residents, visitors and relationships with acute hospitals. There continues to be conflicting guidance to the sector from Ministry of Health and the Aged Care Association which we are working to mitigate on a local level through our Locality Groups, finding agreement where possible, respecting differences, but focussing on resident-centred principles. Differences between ARC facilities exist in visiting policies and the need for new or returning residents to isolate for fourteen days. The new Infection Prevention and Control (IPC) resource for ARC will make a significant difference to facilities negotiating these challenges.

The Influenza like Illness (ILI) Health Pathway has been finalised and used a number of times, as under the new definitions, three ARCs had ILI Outbreaks this month. Another four had gastroenteritis outbreaks, all supported by Public Health South.

Aged Residential Care is embracing the Health Quality & Safety Commission’s (HQSC) Shared Goals of Care document, and, with the support of our Hospice Nurse Practitioners and Clinical Nurse Specialists who support ARC, implementing it widely as time allows. Staff are finding the Shared Goals of Care document well-suited to the aged residential care population, who are often too unwell or cognitively impaired to fully participate in the Advance Care Planning process. However, the Advance Care Planning training is excellent in giving staff the skills to have difficult conversations and translate them into clinically interpretable instructions. This work is ongoing. Southland Hospice developed a similar document, COAST (Clinical Order Articulating Scope of Treatment), two years ago, which is intended for all patients who are believed to be in their final year of life. There are synergies between the COAST, Shared Goals of Care and Advance Care Plan documentation, and all can be uploaded to the Acute Plan in Health Connect South.

All aged care facilities have been given the opportunity to ‘onboard’ one of their Registered Nurses to Health One/Health Connect South. Thirty of the 65 facilities are on their way to having access shared information about their residents. This will be a significant step towards integrated care.

Resurgence Planning continues with further efforts to identify staff required in the event of covid-positive residents in ARC and the support and information required for replacement staff to work successfully.


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All facilities have been asked to have a weeks’ supply of Personal Protective Equipment (PPE) on hand. PPE that is not able to be sourced by the facility is provided by Southern DHB.

In an effort to bridge understanding between the hospital and ARC Sector, eight senior nurses spent a morning touring two aged residential care facilities, to gain a better understanding of the care and support long term aged care residents receive at different levels of care (Rest Home, Secure Dementia, Hospital and Psychogeriatric). The tour was very successful and will be repeated in Dunedin and organised in Southland when Covid Alert Levels allow.

Mental Health Addiction and Intellectual Disability (MHAID)All teams responded promptly as Level 2 plans were well prepared. The weekly meetings with NGOs have reconvened and provide an opportunity for NGOs to identify issues and collectively and collaboratively share problem solving. All NGOs have alert Level 2 plans in place and are ready to implement higher alert level plans should these be necessary.

The main topics of conversation with the NGO community have been the supply of PPE and in particular the use of masks. Consideration has included the possibilities of shared workforce across the sector and the establishment of a shared isolation facility for residential services, rather than each provider having to make provision for themselves.

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Other Emerging Issues

Senior Medical Officer cover to Rural Hospitals throughout the District

The shortage of Rural Hospital senior medical cover persists within the Southern District. This is creating a financial burden for Rural Hospital Trusts in particular. Initial discussions to support the workforce, whilst exploring models of care that may enhance integrated community services and reduce the dependence on this scarce workforce have commenced.

Radiology A project to explore the options available to provide a sustainable and accessible Radiology service across the District has been commenced. The terms of reference are under development, so timelines are yet to be agreed, however, the key issues have been identified.

Primary Care/Health Care Home reconfiguration

Health Care Home (HCH) has operated since July 2018, with 14 practices at a mix of one or two years in the programme. There are discussions around how the HCH model can best respond to the learnings from Covid19. The recommendation, which is currently awaiting endorsement is to offer all practices a programme that is shorter (two years, not three, per practice), simpler and more flexible in implementation, using processes and activities proven in the programme to date. The principles and core elements of the HCH model of care will stay. Based on practice feedback, the HCH team is confident significant benefit will still accrue to individual practices, and the overall benefit of the programme to the system will increase with more practices in it. This approach is consistent with that being undertaken by other New Zealand HCH programmes.

Independent review of the Southern Mental Health and Addiction System Continuum of Care

The RFP to select a consultancy for the provider to undertake the review has now closed with a good number of viable and high-quality submissions received. We are currently finalising the local steering group, which will oversee the undertaking of the review, including the marking of submissions and selection of provider. Clive Bensemann, a consultant Psychiatrist from Counties Manukau DHB has agreed to be the Independent Chair and spokesperson for the steering group.

Transition Plans

This has been identified as a National priority for Mental Health services.

Compliance across our services continued to improve across August with Open referrals longer than one year with three or more face to face contacts is 84% compliance a significant improvement over the last year. We are advised that national compliance across all DHBs is currently 75%. The national target is 95%.

Otago Specialist Teams have maintained gains in compliance although increased workloads have slowed progress towards the 95% compliance rate- work continues to achieve this.

Adult (Otago) services are also maintaining the compliance achieved although are down very slightly to 75 % this month. As reported previously until the service resolves the single clinician model the Adult service will find it challenging to reach the 95% target.

Southland based services experienced a slight drop off and the team continues to maintain their focus on sustaining improvement, drilling down to individual teams and staff performance and identifying variables and opportunities for improvement.


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STRATEGY AND PLANNING

Statement of Service Performance

The 2019/20 Statement of Service Performance (SSP), which is a key component of the DHB Annual Report has been drafted, with a working draft being submitted to ELT and the Board for review. The creation of the SSP for the 19/20 year has been complicated by COVID-19 and the Strategy and Planning team worked with individual services to ensure that performance for the “pre COVID-19” , “COVID-19” and “post COVID-19” periods are reflected. During September the SSP will be refined and submitted for review to Audit NZ and the MoH before being submitted to the Board as part of the Annual Report.

The System Level Measures Improvement Plan has been approved by the Alliance Leadership team. The SLM Improvement Plan will now be appended to the Annual Plan and the full DAP will be submitted to the Board for approval at the next Board meeting.

Operational Issues

Refugee Health

Quota Refugee Programme Update – Mangere Resettlement Centre

Immigration New Zealand is working with agencies and international partners, including the United Nations (UN) refugee agency (UNHCR) and the International Organisation for Migration (IOM), to develop advice to Government on requirements for resuming the Programme. No firm date of resumption has been provided.

Components involve ensuring that international travel routes are available for safe refugee movements, and that appropriate health measures and controls are in place, so resettlement can resume in a manner that is safe for quota refugees and our communities.

From 1 July 2020 the annual refugee quota set by the Government has increased from 1,000 to 1,500. However, due to the impact of Covid-19 globally, it is unlikely that this increase will be reached this year.

While the programme is on hold, Immigration New Zealand, as the responsible agency, is partnering with the Ministry of Health to develop a new health model. The model will provide a continuum of health support and services for quota refugees through all stages of resettlement in New Zealand, including offshore healthcare and screening.

Community Pharmacy

All Integrated Community Pharmacy Service Agreement (ICPSA) holders have been sent their contract variation for the 2020-21 year. We are expecting that all will sign and return these over the next month. The ICPSA is an evergreen contract and Southern DHB expects that there will be no impact on continuity for our community pharmacy services.

Diabetes

The diabetic foot protection service has gone live during August. The Multidisciplinary Team (MDT) service in Invercargill has begun on a weekly basis, supported by Jo Krysa and her team based in Dunedin. Jo attends in person once every month and virtually on all other weeks.

The Local Diabetes Team will reconvene in the first week of September. This group has been formed in response to the Ministry of Health (MoH) assessment of Southern DHB diabetes services and will address all aspects of the model of care for diabetics in Southern DHB. Initial focus will be to implement the aspects of the annual plan that relate to diabetes and address the critical issues raised in our self-assessment of the service.

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Public Health Service

Food Security

Following the identification of improved and sustainable food security as a post-Covid focus, we have been partnering with Emergency Management Southland. A food security meeting was held with groups interested in food security and provision. Our contribution was to identify some potential improvements to enhancing sustainability moving forwards. Some food parcels contained food such as a whole pumpkin – not everyone would have the kitchen utensils to deal effectively with some foods delivered (for example a suitable large knife, peeler, can-opener, grater). Community funders are discussing how they might assist with this. Some recipients may value assistance with ideas and simple recipes to use less familiar foods. The Salvation Army will provide a list of contents of a standard food parcel and we will identify suitable resources to accompany them. The Professional Leader for health promotion now attends Emergency Management’s Planning for Supporting Communities and Expanded Welfare Coordination Group meetings.

Communicable Disease

The total number of enteric diseases notified continues to be lower than what was reported this time last year. It is likely that the lockdown and subsequent extra hygiene measures were responsible for the reduction in the number of diseases reported.

Significant work is also going into ensuring that the processes to support Aged Residential Care Facilities are sufficient and appropriate especially around Influenza-like illness (ILI) outbreaks which are very common over winter (there have been a number of ILI outbreaks in rest homes over the last month). This is being done in conjunction with Infection Prevention and Control, Health Protection Officers, Medical Officers of Health and rest home managers to ensure this work is done in a collaborative way.

Drinking Water

The Annual Survey period which started on 1 July has now ended. All registered Drinking Water supplies that have a population of over 100 people have been audited in regards to their supply. The surveyaddresses and summarises any treatment, monitoring and any changes to the supply in the last year.

World Breastfeeding Week 1-7 August

World Breastfeeding Week is held every year and aims to promote breastfeeding, inform mothers of local breastfeeding support and help normalise breastfeeding in the community. This year the focus of the week was supporting breastfeeding for a healthier planet. Public Health staff were involved in a number of promotions that took place in the district including:

- Staff worked with the Dunedin Breastfeeding Network to promote breastfeeding with displays in public places, promoting breastfeeding online and through the media. A breastfeeding video was produced which featured local people presenting positive breastfeeding messages. The video was promoted in Facebook groups, in an online article published by the Otago Daily times and shown in a number of venues (for example, Dunedin, Waikouaiti and Port Chalmers libraries, and Otago University).

- Due to Covid19 this year the Big Latch On event was held virtually using zoom

- In Southland Public Health Service presented on safe sleep at an event called ‘Baby and You’ which was organised by Breastfeeding Peer Supporters

- Public Health staff were involved in the Southland Breastfeeding Advocacy Group organised event ‘The Early Years’ seminar presented by Dr Tabith Leuker from The Brainwave Trust

- Public Health South provided cardboard cut-outs of mothers breastfeeding for public spaces in Dunedin, Invercargill, Queenstown and Te Anau as a visual cue for normalising breastfeeding.


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Measles Plan catch up for 15 to 29 year olds July 2020 – August 2021

Positive feedback was received from the Ministry on Southern DHB’s Measles Plan ‘He Waka Eke Noa‘ We are all in this together. Final clarification has been provided. An implementation group will be established in early September 2020.

B4 School Checks Programme (B4SC)

The service is currently exploring options different ways of working to maintain service delivery and achieve targets whilst preparing to support a Public Health Response to resurgence of COVID-19.

We have been exploring options of providing some of the lower priority checks (i.e. parents and early childhood teachers haven’t identified any concerns in the child health or development through there questionnaires) via telehealth. The challenge with this that height and weight needs to be measured using calibrated scales and an appropriate height chart therefore not something we can ask parents to do. With support from the Chief Allied Health Officer and the Oral Health service we are looking at the dental assistants being trained to do this via a Clinical Task Instruction. This would be a reciprocation with the longer term aim for public health nurses picking up some of the fluoride varnish work.

Universal Newborn Hearing Screening Programme (UNHSEIP)

The HECTOR project has been fully implemented for the National Screening Unit (NSU) with raw data from Southern DHB’s screening laptops now being sent directly to the Ministry on a weekly basis. This will enable NSU to pick up unscreened or incomplete screenings of babies during the Covid lockdown period and on an ongoing basis.

Cervical Screening

The new Sexual and Reproductive Health Governance Group envelop Cervical Screening thus replacing the need for a separate Cervical Screening Steering group. The planned introduction of Human Papillomavirus (HPV) as the Primary screening is now scheduled for roll out 2024. The National Cervical Screening Programme implemented immediate guideline changes April 2020. This created concerns within the General Practices relating to follow up Test of Cure at 6 months and 12 months, which is currently being worked through.

District Oral Health Service

All clinics are operating to full capacity with a new Oral Health Therapist transferred and starting full time at the Wanaka Clinic. The patient arrears are still high with staff working through the backlog in order of due date, prioritising those with the highest need. Patient cancellations due to illness and staff sickness is impacting on appointment numbers. The Council have issued revised Covid-19 Alert Level 2 guidelines for screening patients prior to appointment and all staff are adhering to these and are increasing their vigilance with Infection Control.

The Dental Unit is working to capacity but are carrying a vacancy which is impacting on workload. Advertising for this vacancy should commence shortly. We have had some patients through Saturday lists but have also had some lists cancelled so the waiting list for General Anaesthetic (GA) in Southland is still high.

We have had one Oral Health Therapy student on placement and the interviews for the House Surgeon for the Dental Unit for next year have taken place.

We have awarded three Dental Assistants their Level 3 Health and Wellbeing Certificate which they completed earlier this year, Kaye Cheetham attended the Cardiopulmonary resuscitation (CPR) courses to award the badges, certificates and flowers to each staff member. This is a real achievement for the staff and we now have most Assistant staff qualified.

All staff have now completed their Core Level 4 Basic Life Support Training, some of these sessions were

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cancelled prior to the Alert Level 4 lockdown and an extension was granted by Dental Council as all therapists were due in March.

Regular meetings with the Dental Faculty and Oral Health Service continue as we work to develop a joint management plan for GA waiting lists and look at equity of access to Oral Health service across Southern. There is an opportunity for more lists on the Mobile Surgical Bus and the priority cases would be those waiting the longest from the Faculty.Some staff who worked contact tracing over the last lockdown have received training and are ready to support if required. We have staff members who have completed their training at the Community-based assessment centre (CBAC) and have been working some shifts there. The remainder of staff will be trained in either contact tracing to support Public Health or CBAC to support Well South should Alert Levels be changed.

The Unit Managers and Professional Lead continue to work hard supporting staff there is a strong focus on service equity in Oral Health.

Tooth brushing and fluoride varnish training programmes have now recommenced. The Health Promotion team are working on establishing new preschool brushing and varnish programmes, we now have 19 fluoride varnish programmes and 26 tooth brushing programmes across the district. We have had a good response to the fulltime vacancy and the shortlisting and interview process will be worked through over the week.

Child Health (0-5years)

Child and Youth Network

The Child and Youth Network continues to meet two monthly with good interagency engagement especially from Oranga Tamariki, Ministries of Education and Social Development.

The last meeting focussed on the launch of the Measles, Mumps and Rubella (MMR) campaign and how other organisations can support the identification of young people aged 15 to 30 years, especially Maori, Pacific, those with disabilities and those disengaged from health and social services. The focus is on identifying “out of the box” ideas to increase engagement in the MMR programme and also other health and social services, including primary care.

Excellent support was offered by Network members to help with identification and engagement to overcome any access barriers.

Well Child Tamariki Ora (WCTO) and Sudden Unexplained Deaths in Infants (SUDI)

There is ongoing focus on quality improvement projects for WCTO Quality Indicators. For example, WCTO providers have been requested to provide lists of late referrals into the programme so contact can be made with persistent late Lead Maternity Carer (LMC) referrers. This aligns to Quality Indicator number 1 – referral by 28 days.

The South Island Alliance Programme Office WCTO/SUDI Coordinator is working with us on identification of quality improvement projects to inform South Island DHBs Quality Indicator priorities and the Southern district’s WCTO and SUDI plans.

The South Island SUDI regional coordinator and WCTO quality improvement manager roles have recently been combined. There are now two roles jointly working on both SUDI and WCTO across the South Island. The rationale for this was:

∑ Improved relationship development with individual DHB’s and WCTO providers

∑ Identification of projects that are relevant to individual DHB’s and WCTO providers

∑ Reduces stakeholder overlap as both programmes of work attract a similar membership.


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Safe Sleep

The newly developed Safe Sleep Policy is being considered with safe sleep champions in maternity, neo-natal and children’s wards. Once this is reviewed the existing Midas policies will be up updated and the changes socialised both within the DHB and community providers to support the SUDI Safe Sleep Programme of work.

Mental Health

NursingOverall, the nursing workforce vacancies are low. Vacancies are mainly in the Intellectual Disability service. Ward 9b is emerging as a likely area for future short staffing. Weekly meetings are attempting to intervene early with proactive planning. Recruiting to vacancies is going well with a target now the United States and Auckland markets. The focus continues on local recruitment planning for the 2020 Enrolled Nurse new graduate programme and the 2021 Registered Nurse (RN) new graduate programme. A 2021 midyear intake being considered for the RN programme.

Trendcare/CCDM MHAID continue to be well engaged and this programme of work is progressing well. The national data suggests we are progressing favourably when compared to other similar sized DHBs. A CCDM steering group has been established and all areas now have Local Data Councils . The after hours nursing leadership and resource team has proven invaluable in supporting the ability to flex up to meet clinical demand.

Double shiftsProactive attention continues to decrease the number of double shifts and the impact of double shifts for individual staff and the organisation.

Senior Medical Officer (SMO) The Adult service (Otago) has had it confirmed an SMO is planning to commence in late October. The current locum finishes in mid September and this will create a service delivery gap from mid-Septemberto late October. Work is underway to minimise the risk associated with this, but these rely on our SMO’s being flexible and supporting this service need. This planning included actively seeking locum cover. There is also a 0.2 FTE vacancy with the Oamaru Community Mental Health team that is now affecting the service there. Another hot spot is the Clutha Community Mental Health team where the 0.2 FTE Psychiatrist has indicated for some time now his desire to no longer continue with the rural part of his overall role for a number of reasons. An appointee is now in New Zealand and is on track to start with the Forensic Service mid-September as planned. An Older Persons SMO is still on target to join Southland in October.

AddictionsA small NLG working group has been considering the current resources across the system in the addiction space and is preparing an aspirational prioritisation plan for future development. This draft paper has already proved useful in discussions with the Ministry of Health in regard to the emerging crisis situation emerging with all services particularly youth receiving increased referrals.

Youth Primary Mental Health RFPThis RFP was released in February of this year. It requested proposals for the provision of services to youth (12-24 years old inclusive) to address the needs of young people experiencing mild to moderate levels of distress. The RFP indicated that proposals could fall into the following categories:

- an expansion of existing youth primary mental health and addiction services within the same geographical area.

- Be a replication of existing services to a new geographical area.

- Be a completely new service.

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We are aware that there were (at least) three proposals put forward by our NGO provider community. The MoH has advised us that, to date, one of these proposals has been successful. This proposal from Adventure Development Ltd proposed an expansion of their existing service so that the age range of their clients has been extended from 12-19 to 12-24 as well as being allocated funding for “wellbeing coaches”.

The contract for service, between MoH and Adventure Development Ltd, is currently being finalised.

Mental Health Crises Support for Emergency DepartmentsRecruitment is underway for the roles associated with this programme (programme was described in some depth in last month’s report). Planning for securing a contractor to complete the capability plan is underway, somewhat delayed with Covid 19 changes in Alert Level status and our requirement to respond to this.

Primary Mental Health and Addiction Services for Pacific Peoples This nationally organised RFP closed on Friday 31 July. We have yet to hear any official advice from the MoH about whether any of our local providers submitted proposals and whether or not they were successful.

Kaupapa Māori Primary Mental Health and Addiction Services ROI

This nationally organised RFP closed on Monday 10th August. We would expect that all proposals are presently being assessed by the MoH and we would expect to be able to provide a more detailed response in the next monthly report.

Integrated Mental Health and Addiction Primary Mental Health and Addiction System (Access and choice)The contract for this service has now been received by us from the Ministry of Health. The MoH’s expectation is that the DHB will contract with the WellSouth Primary Health Network for this programme, rather than a direct contract between the MoH and WellSouth.

Planning for implementation by WellSouth is well advanced as evident in regular stakeholder meetings.

The detail below describes how the Primary Access and Choice programme will work in practice:

1.1 Key Features

All components of service described in this service specification will have the following key features:

∑ The services will be free of charge for the service user (no co-payment or full payment)∑ Services are available for anyone of any age who is eligible to use publicly funded

health services in New Zealand∑ Services are available for individuals, family/whanau or groups∑ Service responses will be individually tailored to the needs of the person

or family/whanau – without pre-defined packages of care.

2. Core Elements of the ModelThe following core elements are included in this service:

2.1 Health CoachesHealth Coaches are people with relevant lived experience/support work experience who have received training within a recognised Health Coach training programme in New Zealand and have satisfied all other necessary requirements for working with vulnerable children and adults including requirements in relation to police vetting.

The key role of the Health Coach is to partner with people experiencing issues that impact on their health and wellbeing to support them to identify their own priorities, set goals for change and to develop a plan to address those goals through developing self-management


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skills and linking them to resources and supports. The five key roles of the Health Coaches are:

∑ Self-management support∑ Acting as a bridge between clinician and person/whanau∑ Navigation of the health and social services system – including linking to appropriate

community supports∑ Emotional support∑ Providing continuity within a busy general practice team.

Health Coaches are either members of the general practice team or work within partner organisations such as Non-Government Organisations (NGOs) and have close links with the general practice team.

Providers will ensure there are systems in place to enable seamless service delivery between the Health Coach, General Practice team and any other service the person and their whanau are working with. This includes but is not limited to: an integrated system for record keeping/notes and a seamless process for introducing the person/whanau to the Health Coach (without formal referral processes, long waits, entry criteria).

The person /whanau will be seen at the General Practice or in a community setting mutually agreed with the health coach.

2.2 Health Improvement PractitionersHealth Improvement Practitioners (HIPs) are mental health clinicians subject to regulation under the Health Practitioner Competence and Assurance Act who have received phase 1 and phase 2 HIP training delivered by a trainer accredited by Mountain View Consulting. They come from a variety of backgrounds including, nursing, social work, occupational therapy, psychology and psychotherapy.

HIPs are embedded as members of the general practice team and will see anyone whose thoughts, feelings or actions are impacting on their health and wellbeing. They work with

individuals (of all ages), whanau, and groups to provide rapid access to evidence based brief interventions – to help people make changes to enhance their health and wellbeing.

In addition to working with people and their whanau HIPs have a key role in building the confidence and capability of the general practice team to meet the needs of people experiencing mental health and/or alcohol and other drug (AOD) concerns. They work with the general practice team to build routine pathways for high impact problems commonly experienced by people in that practice.

HIPs work closely with:

∑ Health Coaches and NGO Support Workers to provide timely access to natural community supports.

∑ Local community mental health teams to ensure timely access to advice and services for people who need this level of support.

HIP appointments are in general 30 minutes duration. Around 50 percent of people will choose to be seen just once, but there are no limits to the number of times they can be seen (no pre-prescribed “packages of care”) people can return as needed for a same-day or booked appointment.

HIPs are responsible for screening risk during the initial visit and at all visits thereafter. If risk is identified, the HIP will then conduct a brief but thorough risk assessment. They will coordinate care to address the risk with the patient’s GP and collaborate with external services as necessary.

2.3 Key features of HIP and Health Coach Roles HIPs and Health Coaches will:

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∑ Actively seek work rather than waiting for “referrals”∑ See on average 8-10 people per day∑ write clear and concise notes within the practice management system that comply

with established standards∑ be able to demonstrate skills, knowledge and attitudes that ensures culturally

safe practice∑ Use agreed outcome measurement tools and session rating scales each time they see

a person∑ Review performance reports with their professional leaders and colleagues in order

to develop their own practice/assess fidelity to the model and further develop services

∑ Receive regular supervision and ongoing professional development

2.4 Access to Cultural and Social SupportsWithin this model of care, people will have seamless access to cultural and social supports within their local community including services that support emotional wellbeing. Support Workers will work closely with General Practice staff including HIPs and Health Coaches to jointly agree roles and responsibilities in addressing the goals outlined by the person and their whanau.

Providers will ensure there are systems in place to enable seamless service delivery between the NGO support worker the general practice team, including the HIP and Health Coach, the person and their whanau, this includes an integrated system for record keeping/notes and a seamless process for introducing the person/whanau to the NGO support worker (without formal referral processes, long waits, entry criteria).

2.5 Combined Health Coach and Support Worker (SW) rolesYou in partnership with your contracted PHOs and NGOs will decide whether these services are delivered by separate and distinct Health Coach and Support Worker roles or whether these two functions will be combined into one role. If you choose to have separate Health Coach and Support Worker roles you will report against these separately. If you choose to have combined Health Coach and Support Worker roles you will ensure that all aspects of service delivery described in 3.1, 3.3 and 3.4 above are provided by this combined Health Coach/Support Worker role.

3. Workforce training and development3.1 HIP training will be funded separately by the Ministry of Health and led by Te Pou o

Whakāaro Nui at no cost to the Provider.3.2 Outlined below is the current planned timing and volumes for your HIP and HC training,

and your funded FTE relevant to the training. Please note the (+) indicates roles already in place.

Southern DHB - Phased IPMHA FTE & Training

Month

HC Trainer: Health Literacy NZ

HIPs HCs SW

Training Places

Funded FTE

Training Places

Funded FTE

Funded FTE

July (+1) 9 1 (+2) 3 3

August 8 9 10 5.2

September 10.1 7 10 5.2

October 2 10.1 10 5.2


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November 10.1 10 5.2

December 10.1 10 5.2

January 10.1 10 5.2

February 10.1 10 5.2

March 10.1 10 5.2

April 10.1 10 5.2

May 10.1 10 5.2

June 10.1 10 5.2

Funded FTE 10.1 10 5.2

TOTAL FTE 25.3

3.3 Health Coach training will be provided by a suitably qualified provider at no cost to the Provider and organised through Te Pou o Whakāaro Nui.

3.4 Where possible HIP and Health Coach training will be made available within or close to your geographical area. Where trainings are combined for two or more geographical areas and travel is required to attend the training, all travel and accommodation are to be met by the Provider, using the additional Implementation Funding.

3.5 Training of other roles within primary care settings will be identified in due course and with opportunity for Providers and key stakeholders to contribute to the development of these. Once these are completed priorities will then be identified for any training which will be made available.

The Southland based Specialist Addiction Service hosted a ‘learn more about methadone’ day workshop for General Practitioners.

Invercargill Community Mental Health Team Outpatient psychology groups continue to be well attended. This is a good example of an initiative that commenced during Covid lock down and has continued on and is becoming embedded as business as usual.

Recruitment continues for a Child and Youth vacancy in the Southern Rivers team (Gore and Balclutha).

Specialist ServicesInpatient areas are busy with high acuity necessitating one to one, and higher nursing interventions and nursing staff levels. Registered Nurse vacancies remain an issue on Ward 10A and in the Central-Lakes Child and Youth and Addiction services. The rural team positions have been filled but commencement dates are longer than usual due to Covid-19 travel restrictions.

Community workloads are high, particularly in Addiction and Child and Youth services. Teams have been working on the Covid-19 planning with the move to Level 2 and the possibility of the Level increasing to Level 3 or 4.

Sole Clinician Caseloads This work continues with the main priority being how we can ensure there is greater robustness in the Multi Disciplinary Team review and ensuring discharge planning is a feature.

Health Quality Safety Commission (HQSC) Mental Health and Addiction Quality Improvement Programme:

Zero Seclusion: Towards eliminating seclusion by 2020The Clinical Project group continues to meet regularly while providing support to the clinical areas. Workshops with some of the areas continue and this month one was held with the Invercargill teams with very encouraging participation. Teams continue to be encouraged to develop new Plan Do Study Action cycles which most are finding challenging due to the busyness of their work places. Seclusion event reviews are held most mornings of the week in the Intensive Care ward 9b, attended by the Service Manager and Quality lead. These reviews highlight the level of acuity our services are managing and the risks we place our staff at while managing this acuity.

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Connecting Care: Improving TransitionsThis project work continues, with PDSA cycles being completed. The Family Advisor has now completed an information leaflet for short stay inpatients and whanau. Handover processes are being refined through PDSA cycles. Testing of improvement ideas is underway with a focus of improving transitions between inpatient and community.

Learning from adverse events and consumer, family and whanau experienceThis work stream continues to make good progress- co-design input is being finalised and PDSA cycles are being prioritised. Staff participated in a Health quality Safety Commission learning session via zoom. A workshop is planned late October-November to feedback to parties who have provided information as part of the co-design consultation process.

Health Connect South (HCS) Steering Group The work on developing the mental health tree has made good progress in the last few weeks-once completed the next phase is to trial with Southern Rivers before rolling out across the district. The wellness transition plans have been progressed with SIAPO (this is a collaborative approach with NMDHB) and is now awaiting Orion’s action.

Telehealth – Increasing use post Covid Our current focus is progressing the development of implementing the rural child and youth SMO proposal to increase the use of telehealth for this rural patient group. Work to maintain gains in the use of telehealth during the last lockdown continues

Rural Health

Lakes District Hospital

The Emergency Department is seeing an average of 38 patients each day, with a daily peak of 58. 1,185 patients were seen during August. Of these, 882 were local, 59 SDHB area domiciled, 234 IDF and 10 from overseas.

In August there were 96 inpatients, 183 bed days with an average length of stay of 2.04 days.

There were 949 plain films taken in Radiology and 179 CT scans.

The Senior Medical Officer (SMO) roster is down by 2 FTE, resulting in additional shifts for the rest of the team. Significant overtime has also been required to meet the clinical demands. Recruitment has now taken place for casual, fixed term and permanent SMOs. This will ease the pressure over the coming months.

The Birthing Pool has been installed in Maternity which is a wonderful addition to the service. A blessing and celebration were held, in accordance with Level 2 restrictions. The pool has been put to good use since then, to the delight of labouring women and their Lead Maternity Carers.

Four women birthed at Lakes in August and 13 spent their postnatal stays there

The Radiology control room renovations have been completed

Primary Care

Community Pharmacy

The Client Led Integrated Care – Long Term Conditions (CLIC_LTC) pilot is progressing well in Gore. General Practices (GP) and local community pharmacies in Gore have been engaged in this project and are now able to implement the new model of care. This work is supported by a small team of Southern DHB and WellSouth staff.


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The main objectives are to ensure that Medicines support for our LTC patients is provided through Community pharmacy integrated into the wider Multi-Disciplinary Team (MDT).

The Ministry of Health has made funding available to DHBs to support critical pharmacies if they areimminently going to have to close and/or cease services that are deemed critical, due to the impact of Covid-19. The Southern DHB pharmacy portfolio manager will work closely with any pharmacy that apply for access to this resource. Any applicant will have to demonstrate that their financial position is critical as well as demonstrating that their services are critical to the community, and that access will be significantly compromised for their population on closure.

Southern Community Laboratories (SCL)

SCL has performed extremely well through the Covid period. Covid testing volumes have exceeded 140,000 for the entire group while maintaining turnaround times. Their capacity to scale up if required has been increased with additional capability being established within the laboratory.

The Community Operational Advisory Group has continued its work supporting the two DHB contracts. Projects progressing include;

∑ Electronic Lab ordering

∑ Collection centres

∑ New test requesting process

SCL continue to be a part of the New Dunedin Hospital (NDH) process through the Super Fit and Fit groups. There are concerns that the space allocated within the NDH design will not allow for the delivery of an integrated laboratory service supporting the Southern DHB services.

Tobacco control

The Southern DHB has received a rollover of the tobacco control Crown Funding Agreement (CFA) for 2020-21. We will continue to support the WellSouth General Practice (GP) champion and the Public Health team with this funding. In addition the Vape to Quit pilot will be funded through this revenue contract. The implementation of this pilot has been delayed due to Covid, however, it is expected that the pilot will go live in late 2020. The aim is to support smokers over 18yrs to quit using a vape device, supplied through community pharmacies. Key stakeholders involved in this pilot include the Southern Stop Smoking Service, Public Health South, Southern DHB Mental Health services, Maori Non-Government Organisations (NGOs) and General Practices.

Older Persons Health and AT&R

In Dunedin work continues in relation to creating a joined up approach to Allied Health working and bringing the ISIS and AT&R teams together at Wakari. This model will provide us with greater economies of scale and support improved cross cover within the two teams as well as enhancing skill sharing and learning. In general staff are keen to make the changes work on the ground, however we are starting to see some change burnout amongst the teams.

The OPAL Unit has reopened on the 6th floor. There are 8 beds currently open, with a move to 12 beds in the coming weeks. Patients are transferring directly from ED once again, avoiding long stays on the internal medicine wards. With the OPAL unit back up and running, the Allied Health, Nursing and Medical teams are working well together. We should be in a position to open the exercise group sessions to other wards the week beginning 22 June 2020.

Community Rehabilitation

The community rehab teams have returned to its core function of intensive rehabilitation and we are back to normal business delivery. The Dunedin community rehab team has taken its first ACC NAR patient to explore how we can deliver this work into the future.

The teams are transitioning to Health Connect South (HCS) and a paper light approach and the team requires support from IT and HCS to embed this way of working. Access to laptops/tablets to support

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remote working for this team is essential. Access to cars remains problematic as the team continues to grow, this is resulting in increased use of the pool fleet with associated costs.

Recruitment to a number of historically hard to fill roles at DPH is looking promising. This includes senior medical/acute stroke occupational therapy and physiotherapy roles, and senior orthopaedic physiotherapist.

Aged Residential Care Occupancy/Volume Analysis

SDHB has historically had one of the highest rates of Aged Related Residential Care (ARRC) utilisation in New Zealand over a sustained period. The reduction over the last couple of years in funded Rest Home level care utilisation as outlined below can be attributed to multiple factors, including the current work programmes “Home as my First Choice” and the “Home Team” but also due to the increase in Residential Property prices. Residents admitted to ARRC can apply for a Residential Care subsidy, which is both asset and income tested. The increase in residential property prices will have seen a reduction in the number of residents being able to access the subsidy, this reduces our funded bed utilisation at the Rest Home level of care.


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Attachment 1 – Alliance Leadership Team Minutes – 18 September 2020

Attachment 2 - WellSouth Performance Dashboard

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Alliance Leadership Meeting – 18 September 2020 Page 1 of 8

ALLIANCE LEADERSHIP TEAM MEETING

Meeting MinutesDate: 18 September 2020Meeting start time: 9.00amMeeting Finish Time: 12.30pmLocation: Zoom Link Join URL: https://zoom.us/j/232329130, Password: 135227

Attendees: Stuart Heal (Chair), Andrew Swanson-Dobbs, Dr Andrew McLeod, Susan Jack, Dr Stephen Graham, Dr Hywel Lloyd, Bronnie Grant, Lisa Gestro, Wendy Findlay, Dr Liza Edmonds, Bernie McKone, Emma Wyeth, Tracy Hicks

Apologies: Chris Fleming, Clive McArthurIn Attendance: Gilbert Taurua, Mary Cleary-Lyons, Michelle Norman, Patti Napier (observing)

Agenda Item Discussion Points Actions

1. Draft Minutes & Actions

The minutes of the last ALT meeting held on 21 August 2020 be accepted as a true and accurate record.

Matters arising:∑ COVID funding – waiting to hear on the next tranche of funding.∑ Sports Managed Isolation facility not going ahead.∑ Chair for Invercargill After Hours group not yet been identified.

2. Interest Register ∑ Bernie McKone noted possible conflict on discussions on Maternity.

∑ Andrew McLeod noted conflict with the discussions on Wanaka After Hours.

3. Finalised work programme for2020/21

Mary Cleary-Lyons updated on the work plan and the three outstanding templates from the last meeting.

∑ Outstanding actions from last meeting has not yet been progressed as waiting for SIG (Strategy Implementation Group) to reconvene and will discuss with that group.

∑ Bernie enquired the criteria for prioritisation re. impact of COVID on the summary page and if this was planning for the now or for the future.

o Mary confirmed this was the immediate work to mitigate long term impact on the population and also the impact of COVID on workforces but it could be altered for any pandemic that may arise.

∑ First 1000 dayso Planning to establish a strategic leadership governance

group, led by Mary Cleary-Lyons and Gilbert Taurua by

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30th October and will identify the work streams forSDHB and WellSouth.

o Chair raised if the timeline was achievable. Mary confirmed the date of 15 January was achievable as there was already a lot of work progressing.

∑ Discussions noted:o A 1000 days Trust was established in Invercargill and to

try and approach somebody to discuss their learnings. Tracy added he was the Chair of the Trust that funded the organisation and funding was an issue and to ensure all the pieces fit together around the community as there is risk that this will not get traction.

o Add physical and mental health of mothers, post-natal and the impact of their timely access to surgeries, referrals etc. be added to the document as this will have significant impact on the family and the wider whanau.

o Data requirements - investigate how have betterconnections with stakeholders and access to child health data to better understand the needs.

ß Andrew S-Dobbs noted this should be investigated and perhaps raise it with the South Island IT Alliance to find a solution.

o Include parent centre in the stakeholders (as not mentioned in the document).

∑ Vaccinationso Call for interests for a joint governance group has been

sent and investigating how to get all systems connected i.e. NIR, data collection, cold chain management etc.

o Bernie noted that the stakeholders list should include pharmacies.

o Emma noted to understand the barriers to the community on immunisation and when a COVID vaccine is available, to start thinking about how to deliver it, who to deliver it to (i.e. high priority individuals etc.)

o Bronnie enquired if immunisation is part of the Health Care Home matrix. Andrew S-D stated not at present .

∑ Rural Healtho Currently looking at how the funding is being utilised in

the rural population and investigate developing different contract negotiations as needs are different for each rural location.

o Andrew McLeod noted there was no direct primary care/central lakes network/primary practioners on this.


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o Chair noted that he has met with people from Balclutha and Dunstan Board and encouraging them to have a representative on the Alliance group. He also noted there appears to be a disconnect between the Central Lakes Locality Network and Dunstan and to think about a connection.

o Tracy raised that the rural trusts are individuals and private businesses and with the funding predominately coming from the SDHB what are their incentives to work together.

ß Mary stated there is a rural group where the CEOs attend regularly and encourage the clinical leaders to attend. They are investigating different issues i.e. recruitment and retention of rural doctors. Central Lakes and Dunstan don’t have this issue and investigating possibility of a shared resource model.

o Bronnie noted on the project objective to look at what services the rural trust can provide and look at aligning some of the services with the Dunedin hospital re-build.

o Chair noted this is an extremely important work for the DHB and Alliance work plan. Mary will provide an update at the next meeting.

∑ SDHB and WellSouth to meet to discuss work programme, prioritisation criteria and leads.

David Murray joined the meeting at 10.00am

4. Plan to improve smoking target performance

Andrew Swanson-Dobbs updated on the smoking target.

∑ Rate has gone down and investigating on how to re-start and re-fresh this to achieve the target.

∑ Target was achieved when a dedicated staff member was working on this and this has been added as a plan for the WellSouth call centre.

∑ Bernie noted that pharmacies were funded for nicotine replacement therapy prescriptions and a trial was done to connect some of the data back to GP/PHO to get those people in their numbers. Bernie will investigate how to get the data on to the PHO.

∑ It should also be noted that Southern Health system has the highest successful cessation rate in the country.

∑ Wendy added to look at the Health Coaches to also provide support as part of those role.

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∑ Chair noted to get a report on the data and investigate how to connect the dots.

5. Rural Radiology Project

David Murray presented the radiology project to review the sustainability and model of radiology for all of the rural hospitals.

∑ Visited all the locations and the CEs are all in agreement and supportive of the project.

∑ Lisa clarified that this should be framed around the need for right diagnostics solution for the rural population and not framed around the rural hospitals.

∑ Chair noted the tight deadline. David stated one of the key stakeholders has indicated their willingness to exit by June 2021, which means a solution will need to be implemented by that date.

∑ Discussions noted:o Andrew S-D asked whether the paper was a re-

configuration of delivery of radiology services. David noted he couldn’t answer the question but possibly.

o Andrew S-D asked that GPs be added as a consultation stakeholder as this could impact on them negatively/positively.

o Chair noted to understand what we can and can do from a primary perspective.

o Andrew S-D noted the ACC has a tender out for access to MRI for GP direct access (which WellSouth will be tendering for) and should this be a separate exercise. David confirmed this should be separate as this project is specifically for rural hospitals.

∑ David to add interdependencies and report back to ALT.∑ David to present the agreed options for recommendation to ALT

in December meeting.

Susan Jack joined the meeting at 10.30am.

DavidDavid

6. RFP for Health Hubs

Lisa provided an update to get recommendation from ALT on the RFP and going direct to market rather than engaging with Primary care.

∑ Agreement to market for a RFP around 2 critical areas around Dunedin:

o Finding something that fits the bill for high needs/whanau in South Dunedin


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o Provision with ACC on urgent care centre to offset demand for ED in Central Dunedin.

∑ Bronnie noted she is happy to see this going forward but stated concern it is Dunedin centric, but added this has been off-set with the discussions on the rural trust etc.

∑ Chair noted to discuss with Balclutha and/or Gore to get a rural model started at the same time to show it is not a one size fits solution and it is about service delivery.

o Andrew S-D added that discussions with ACC was also around other regions.

∑ Wendy noted there is an after hours and acute care issue in Invercargill and a new city centre re-build and would be an opportunity to have discussions with ACC to see if it can be added to the first tranche.

o Lisa noted that ACC are looking at providing an after hours care in Invercargill but there is a solution in Invercargill with GPs providing this service and unsure how to progress with this.

∑ Andrew noted the conflict of interest with WellSouth working with either/and/or Mornington and DUDAC on the RFP and suggest that the RFP be from SHB only.

∑ Lisa will draft the paper proposal for the high needs/whanau in South Dunedin and circulate to ALT.

ALT recommended the Dunedin proposal and process and for theRFP to come from the SDHB.

Carol Atmore and Patrick Ng joined the meeting at 11am.

7. PCCS Implementation Evaluation Report

Carol Atmore provided an update on the evaluation report which is now 15months in to a 3 year project.

∑ Discussions noted:o Community Engagement – scope is focused on the

community council but should include looking at how we have engaged with stakeholders on the ongoing discussions on primary maternity and locality network.

o Look at the different engagements with general meetings with the public and with the locality network.

o Susan Jack noted establishment of locality network and Heath Hubs were not on track from the beginning but would still need to understand why and the learnings.

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o Bronnie noted she would like to see the evolution of the locality network when it was established in December and how it has evolved and any learnings.

ALT recommended the paper and agreed that the evaluation plan should not change due to the work programme changes since the evaluation report started.

8. Planned Care Patrick Ng, Executive Director of Specialist Services joined the meeting to discuss the Innovation proposal to the Ministry for a portion of the $252m recovery funding set aside by the Ministry forCOVID and general improvement of hospital performance.

∑ Funding is divided into specific buckets intended for specific things.

o First year - $50m intended to enable capital initiatives across DHB that will lead to planned care submissions.

o $7m identified for improvement initiatives (with certain criteria) for submission.

o Rest of the funding is for operational improvements (distributed over 3 years).

o Each DHB will get an PPF share of the money; $5.2m per annum tagged to improving planned care performance.

∑ The submission was submitted last week which included year 1 trajectory (year 2 and 3 will be separate submissions) whichoutlined what specialties to recover and how to achieve this recovery. Waiting for further dialogue with Ministry to finalise details. Once received confirmation and funding released, then work through a process on how to use the money that has a budget, bring in resources, demonstrate performance against trajectory and achieve the trajectories and evidence we have achieved those trajectories and then will get funded accordingly.

∑ Additional submission on the capital funding for:o a 5th theatre in Southland to boost surgery capacity.o CT scan (agreed in principle by the SDHB board) for

Dunedin.∑ Innovation funding included endocrin, renal and respiratory

intiatives and added a specific request around project resources to implement the Ministry’s prioritisation tool methodology for all surgical outpatients and use it to enable the change in using telehealth better.

∑ Funding does not recover any historic outpatient/inpatient and imaging waitlists so have devised criterias and been selective in the areas to use the funding, concentrating on:


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o Orthopaedics in Dunedin and Invercargill.o Urology inpatient waitlist surgery.o Rheumatology serviceo Skin lesionso Gynecology in Dunedin and Southland

∑ If there are other ways identified in delivering some of this recovery (i.e. primary care involvement that will free up some of the secondary resources) then provided it achieves the same timeframe and comes into the same cost, the plans are flexible and can be adapted as further input is received.

∑ Andrew McLeod noted that he was involved in a shared consultation as part of this telehealth initiative and it saved the patient a 7 hour trip for a 30mins consultation and the patient felt she received good value and Andrew felt it was a very successful first trial.

Gilbert left the meeting at 11.30am.

9. Verbal Update ∑ Invercargill after hours.o Discussions prior Covid was progressing between GPs

and ED. Meeting re-started on Tuesday. o SLAT and ToR has been drafted.

∑ Primary Maternity Consultationo Public meeting in Wanaka on to 9th September.

Approximately 40 people attended.o A DHB board workshop in October including the Central

Lakes Locality Network to fully understand the different issues raised. A final paper with recommendations will be submitted in November and Mary will update at the next ALT meeting.

∑ Wanaka After Hourso 2 general practices in Wanaka signalled the difficulty of

covering the 11pm-8am shift.o Meeting held this week and exploring moving the

location of Dunstan Hospital providing the after hours for Alex and Cromwell to an after hours facility in the Cromwell region. Paul Rowe is working with providers.

o Mary raised the Wanaka population is a growing community and they are a very strong voice and noted to ask the community what their expectations on primary care are and how acceptable they find it.

o Andrew S-D noted the same arrangements will still be in place on 1st October.

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10. Papers for Information

∑ Strategic refresho Plans underway to update the Strategic plan (developed in

2016). Developed more action pieces. o Chair noted that he found the document to be restrictive

and focuses more on DHB funding and would like to broaden the services and include NGOs etc.

11. AOB ∑ Mental Health Services review o Went to tender and received 3 submissions to undertake

the work. Steering Group being put together and an individual has been approached to Chair.

o Lisa to circulate to ALT the roles of the steering groupindividuals.

Next meeting: 9.00am-12.00pm Friday 16 October 2020


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MHSDashboard Covid-Dash Covid Dash P HCH1 HCH2 CLIC HIPS After Hours Equity

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ED Presentations

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Quarter Four 19/20WellSouth PHO Non-Financial performance

As part ofSouthern DHB Non-Financial Quarterly Reporting


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Overview of metrics• The following measures are a subset of the measures in Southern DHB’s Statement

of Performance Expectations (SPE) which we report against in our Statement of Service Performance (SSP) in our 19/20 Annual Report.

• WellSouth PHO is heavily or exclusively involved in activity relating to these measures.

• Other providers do influence outcomes (for example, mental health brief interventions for <19s are delivered by an NGO, but volumes are included in the overall target).

• Some of the measures are reporting at quarterly intervals, others annually

• There are four groups of measures in Southern’s SPE and SSP. WellSouth targets are in three of them:• Prevention (includes WellSouth)• Early Detection and Management (includes WellSouth)• Intensive Assessment and Treatment• Rehab and Support (includes WellSouth)

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Measures under “Prevention” (1/2)

1In 2018, the HPV vaccine coverage was expanded from girls to also include boys. This accounts for the 2018/19 drop as the denominator increased.


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Measures under “Prevention” (2/2)

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Measures under “Early Detection” (1/1)

2There have been changes in the Ministry of Health’s method for determining the denominator for CVD Assessment and Management for Primary Care (CVDRAMPC) compared to past years. This includes expanding the number of included population cohorts. Additionally, as the implementation of the CVDRAMPC has been progressive, with calculations based on the new algorithms implemented over time, results must be interpreted with caution and comparison between those years with inconsistent denominators is not recommended.


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Measures under “Rehab and support” (1/1)

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Title: FINANCIAL REPORT

Report to: Disability Support Advisory Committee and Community & Public Health Advisory Committee


Summary:

The issues considered in this paper are:

ß August 2020 Funds Result


Financial: As set out in report.

Workforce: No specific implications

Other: n/a


Lisa GestroChris Fleming



Strategy, Primary & Community Team Lisa Gestro

Executive Director Planning & Funding


RECOMMENDATION:

1. That the report be received.

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Southern District Health Board – Monthly Financial ReportFor the month ended 31 August 2020


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SummaryStrategy, Primary and Community report a provisional favourable bottom line variance of $0.29m for August and $0.84m YTD.

Significant contributors to the favourable/unfavourable variances for August and YTD are:Revenue

∑ IBT $130k favourable and $87k YTD∑ CSC $78k favourable for August and $75k YTD∑ Mental Health $167k favourable for August and $220k YTD

Workforce∑ SMO’s $108k unfavourable for August and $54k YTD∑ Nursing $18k unfavourable for August and $241k YTD ∑ Allied Health $49k unfavourable for August and $153k favourable YTD∑ Management Admin $82k unfavourable August and $106k favourable YTD

Non personnel∑ Clinical Supplies $236k unfavourable for August and $489k YTD

Personal Health∑ PHO’s $345k unfavourable for August and $492k YTD∑ Community Pharms $242k favourable for August and $482k YTD∑ IDF’s $313k favourable for August and $45k YTD∑ Haemophilia $77k unfavourable for August and $154k YTD

Disability Support∑ ARRC $21k unfavourable for August and $89k YTD∑ Pay Equity $5k favourable for August and $35k YTD∑ Comm. Health Services $65k favourable for August and $126k YTD

Comments for discussion∑ Please see Pharms section for all Pharms commentary.∑ Unfavourable capitation variance will moderate in future months.∑ Rural Maternity sustainability payments in August of $85k included payments for the 19/20

year 18/19 years. As at end of August payments in the current year for 18/19 & 19/20 are already $46k more than the June 20 accrual.

∑ IDF wash-ups for 19/20 have been expensed against 19/20, leaving no impact in 20/21 year, August unfavourable variance in IDF revenue offset by favourable variance in expenditure.

∑ Based on August ARRC utilisation data our best estimate is that 19/20 was under accrued by $150k (noting accrual was greater than $5.5m).

∑ Stat leave revaluation impact of $83k in August for SMO’s.∑ Community Services directorate has only minimal favourable Allied FTE variance, which is a

change from the last 12-18 months.∑ No Planned Care adjustment has been made as to the best of our knowledge, no agreement

has been reached with MoH as to targets for 20/21 year.∑ Significant Dental accruals remain due to University claiming lag.

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RevenueExternal Revenue –

Category Aug Variance YTD variance Comment

IBT $131k f $87k f Expenditure offset

Careplus $11k f $5k f Expenditure offset

VLCA U 14’s $28k f $10kf Expenditure offset

CSC $78k f $75k f Expenditure offset

MH &A Crisis Support $48k f $96k f New Contract

Disability contracts $69k f 69kf ID FFS beds

Other $119k u $32k f

Total $413kf $ 498k f

IDF’s

The 19/20 financial period was re-opened to attribute the full impact of the 19/20 IDF wash-ups (based on Final MoH files for all categories except PCT). In short this means that there will be no financial impact in the 20/21 year.

SI IDF coordinator has not been able to furnish 20/21 IDF washup estimates for August. We have calculated Inpatient impact (as this is the most material).

Workforce Costs

YTD Variance - FTE

Workforce

Community Services

Primary Care & Population Health

Mental Health

StrategyPrimary & Community Other

Total

Medical -1.0 2.9 -1.3 0.7 1.3

Nursing 3.9 -10.5 -21.2 0.0 -27.7

Allied Health 6.1 6.8 -3.7 1.0 10.3

Support 0.4 0.0 -0.0 0.0 0.4

Mgt/Admin 0.2 4.6 -1.3 -1.9 1.6

Total 9.6 3.8 -27.5 -0.2 -14.2

Medical SMO –

∑ 2.3 FTE favourable YTD. ∑ Ordinary time and training are the main drivers offset by overtime.∑ Lakes Medical includes $69k of revaluation of statutory leave that relates to 2019/20. This

expenditure was inadvertently left in 2020/21 when the same expense for other area’s of the DHB was transferred to 2019/20.

Medical RMO –

∑ 1.1 FTE unfavourable to budget YTD. ∑ Ordinary time unfavourable by 1.8 FTE offset by training (0.5 fav) and overtime(0.29 fav)


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Nursing –

∑ 28 FTE unfavourable YTD∑ YTD FTE variance mainly driven by Ordinary (10 FTE), Accident leave (8 FTE), sick leave (4FTE)

and overtime (3FTE) unfavourable.∑ YTD $246k unfavourable variance is mainly due to Accident leave ($77k u), annual leave

accrued ($78k f), overtime ($55k u), back pays ($60k u) and unpaid days accrual ($87k u).∑ Skill mix and Annual leave revaluation favourable to budget is contributing to low $ per FTE

variance.

Allied Health –

∑ 10 FTE favourable YTD. YTD expenditure is $153k favourable.∑ YTD FTE variance is mainly driven by Ordinary (12 FTE f) offset by overtime (1 FTE u)∑ YTD expenditure is $153k favourable and is mainly due to ordinary time ($245k fav) and

unpaid days ($59k fav offset by Annual leave accrued ($62k unfav), and overtime ($30k unfav).

Management/Admin –

∑ 1.6 FTE favourable in August is mainly driven by sick leave (1.38 FTE) and other leave (0.94 f) and training (0.75FTE) offset by ordinary (1.78FTE u).

∑ YTD expenditure is $106k fav and is mainly driven by annual leave accrued ($85k) and sickleave ($21k)

PharmaceuticalsPharmac sent correspondence to CFO’s and GM’s P&F on 07/08/20 relating to the June 20 Forecast for CPB and related matters.

∑ There is a significant level of uncertainty with the CPB due to COVID related costs.∑ The CPB forecast for 20/21 is materially higher than the previous forecast (the basis of

SDHB’s budget before expense management plans were applied), although there is nationally $74m of unbudgeted revenue. Based on the analysis completed to date on the new forecast, there does not appear to be any increased risk.

∑ There is an estimated $2.5m of expenditure for SDHB, where Pharmac are unable to state the timing of the expenditure and as a default forecast the expenditure to be incurred in June 2021. We have altered the rebate accrual methodology so that there is an offsetting$2.5m of rebate being recognised in June 21. This will be re-evaluated when the next Pharmac forecast is available or new information is made available.

∑ At the time of writing, Clinical Supplies variance is not thought to be correctly attributed to directorates (although the overall quantum is correct). Finance team are working on improving this in conjunction with the implementation of the E-Pharmacy system. Consolidated monthly variance shows:

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Clinical Supplies (excluding Pharms)

∑ Clinical Supplies – Ostomy ($53k) and Continence ($23k) main driver of the unfavourable YTD variance.

Infrastructure & Non-Clinical SuppliesYTD expenditure $90k favourable with the main variances being:

∑ Consultants Fees $65k favourable∑ Patient meals $49k favourable∑ Electricity $22k favourable ∑ Mobile phones $20k unfavourable

Provider Payments (NGO’s)Personal Health

∑ Dental - $106k favourable in YTD - The University of Otago Dental School is significantly behind with invoicing in both Funder and Provider Arm contracts (invoicing going back to 2018/19). Accruals at the end of 19/20 and for August across both arms were very difficult to ascertain,but based on latest information received there are sufficient accruals to cover expected invoices. There may however be some movement of expense between the two arms compared to where the accruals currently sit.

∑ Primary Health Care Services – Services are $492k unfavourable to budget YTD. The majority of this is due to First Contact services ($350k unfav) and Community Services Card ($74k unfav). This extra expenditure is offset by a favourable variance in GMS ($90k YTD) and matching revenue for CSC.

∑ Pharmaceuticals - $482k favourable YTD. See previous comments.∑ Travel & Accommodation - $169k favourable YTD. Demand driven.∑ Immunisation – YTD expenditure $49k fav.∑ Medical Outpatients - $152k unfavourable YTD due to haemophilia national pool expenditure.∑ IDF expense $45k favourable YTD


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Mental Health

∑ Community Residential Beds ($48 k f YTD) and Other Home Based Residential Support ($32k f YTD).

Public Health

∑ The 59k unfavourable variance YTD is due to budgeted savings of $56k that have not been achieved.

Disability Support

∑ Pay Equity - $35k favourable to budget YTD.∑ Home Support - $22k unfavourable to budget for the month, due to IBT expenditure∑ ARRC $89K unfavourable – Due to client mix between Rest Home and Hospital.

Maori Health

∑ No significant variances.

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Expenditure Management Plans – current performance and future actions

Savings Target

Variance to

budgetSavings category Annual YTD CommentPharmaceuticals 1,300k 216k 103k f YTD savings fully achieved

ARRC 1,400k 234k 89k uYTD savings partiallyachieved

Public Health2 331k 56k 166k f YTD savings fully achievedMental Health 3,418k 588k 115k f YTD savings fully achievedTotal 6,449k 1,094k 295k

.2includes both Funder and Provider


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The below table has been generated based on request from DSAC/CPHAC committees to have additional breakdown of Provider Payments.

Funder services $000's

Strategy Primary & Community as at Jul 20

Month YTD

Actual Budget variance Actual Budget variance

Personal Health

Labs 1,464 1,484 20 2,962 2,967 5Pharms 6,180 6,422 242 12,446 12,928 482Primary Care 6,891 6,546 (345) 13,585 13,094 (491)Dental 1,399 1,472 73 2,736 2,844 108Travel & Accommodation 360 511 151 793 962 169IDF 2,797 3,110 313 6,175 6,220 45Internal expenditure 43,266 43,266 0 86,532 86,532 0Other 3,996 3,945 (51) 8,038 7,981 (57)Total Personal Health 66,353 66,756 403 133,267 133,528 261

Change Initiative 0 0 0 0 0 0

Disability Support Services

Pay Equity 1,592 1,597 5 3,137 3,172 35Home & Community Support 2,469 2,447 (22) 4,881 4,893 12Aged Residential Care 8,213 8,191 (22) 16,384 16,295 (89)Respite 153 129 (24) 276 301 25Carer Support 164 165 1 272 317 45IDF 389 389 0 777 777 0Internal expenditure 2,547 2,547 0 5,093 5,093 0Other 439 551 112 954 1,106 152Total Disability Support Services 15,966 16,016 50 31,774 31,954 180

Mental Health

Alcohol & Drugs 468 470 2 938 942 4Child & Youth 1,092 1,108 16 2,196 2,215 19IDF 463 463 0 925 925 0Internal expenditure 5,926 5,926 0 11,853 11,853 0Other 420 529 109 939 1,058 119Total Mental Health 8,369 8,496 127 16,851 16,993 142

Public Health 115 83 (32) 227 168 (59)Maori Health 179 175 (4) 374 381 7

Total Funder 90,982 91,526 544 182,493 183,024 531

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Title: Covid-19 Preparedness Assessments: ARC Facilities Findings Report

Report to: CPHAC/DSAC


Summary

This report shows the results of the ARC Facilities’ Covid-19 Preparedness Assessments following the Director General of Health’s 11 April 2020 request to DHBs to, “assess the actual readiness and status of each of the ARC, respite and other residential facilities.” Southern DHB took a quality improvement approach to this exercise, with a highly skilled group of clinicians conducting the assessments.


Financial:

Implementing recommendations will require:New or redistributed resource for Infection Prevention and Control (IPC) Specialist Nursing Resource

Workforce:Implementing recommendations will require:New or redistributed resource for Infection Prevention and Control (IPC) Specialist Nursing Resource

Equity: None

Other:


SDHB Executive Leadership Team Date: 16 July 2020

Approved by CEO: Date: 28 September 2020

Prepared by:

Sharon Adler, Portfolio Manager – Health of Older People

Sally O’Connor, Director of Nursing, Strategy, Primary & Community

Abigale Noone, Palliative Care Advanced Nursing Trainee

Presented by:

Lisa GestroExecutive Director Strategy, Primary & Community


RECOMMENDATION:

That the Committees:

∑ Note the attached report

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Southern DHB

COVID-19 Preparedness Assessments: Age Residential Care Facilities

Findings Report


110

111 August 2020 Version 1.1

ACKNOWLEDGEMENTS The Southern District Health Board (SDHB) Assessment Group would like to acknowledge all Aged Residential Care (ARC) facilities within the district for their willingness to be involved in the process during this challenging and unprecedented time.

Also, to acknowledge the Otago Hospice, the SDHB Mental Health Addictions and Intellectual Disability (MHAID) Directorate, and the SDHB Releasing Time to Care (RTC) team for their support, and readily releasing their senior staff to assist in the process.

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Contents1. Executive Summary............................................................................................................................................3

2. Introduction .......................................................................................................................................................4

3. ARC Sector Background......................................................................................................................................4

4. Method...............................................................................................................................................................6

4.1. Screening Survey........................................................................................................................................6

4.2. Assessment Process ...................................................................................................................................6

4.3. Virtual Interview Analysis...........................................................................................................................7

4.3.1. Daily Reviews .....................................................................................................................................7

4.4. Inclusions and Exclusions ...........................................................................................................................7

4.5. Limitations..................................................................................................................................................8

5. Findings ..............................................................................................................................................................8

5.1. Staffing ability in a COVID-19 situation......................................................................................................8

5.2. Environmental capability ...........................................................................................................................9

5.3. General Practitioner / Nurse Practitioner support ....................................................................................9

5.4. COVID-19 Planning and Processes .............................................................................................................9

5.5. PPE and Infection Prevention and Control (IPC) ......................................................................................10

5.6. Communication........................................................................................................................................10

5.7. For Further Consideration........................................................................................................................10

6. Recommendations ...........................................................................................................................................11

7. References........................................................................................................................................................13

Appendix 1: Covid-10 Outbreak Preparedness Checklist.........................................................................................14


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1. Executive SummaryPurpose In response to the global COVID-19 pandemic, and five aged residential care (ARC) facilities across New Zealand becoming significant COVID-19 clusters, the Director General of Health contacted all District Health Boards (11 April, 2020) asking for a systematic assessment of the “actual readiness of each aged residential care providers, respite and other residential facilities” in their district. The Southern District Health Board (SDHB) used the assessment process to identify areas where additional support was required or if there was a need to strengthencurrent responses.

MethodThe process included:

∑ An initial online self-assessment to screen for risk, creating a priority list of ARC facility interviews for the Assessment Group;

∑ 1-2 hour virtual interviews with 65 ARC facilities, undertaken between 17 April and 30 April 2020 by a number of Nurse Practitioners and senior nurses;

∑ A review of assessed risk following virtual interviews utilising a wider group of SDHB Strategy, Primary and Community Leadership;

∑ Site visits undertaken by two SDHB clinical leaders where risk was deemed high; and∑ Virtual interviews with Facility Managers and SDHB Strategy, Primary and Community Leadership for high

risk facilities; and∑ Review of two reports related to aged residential care COVID-19 responses in New Zealand.

Key FindingsThe ARC Assessment Group wishes to acknowledge each ARC facility for the significant amount of work they have done for their residents and staff to maintain their safety during COVID-19. The findings established are based on a moment in time, at an early stage in an unprecedented health event, with changes in situation and advice occurring daily.

Based on the evidence obtained from this assessment process the following conclusions were made:1. The assessment process highlighted gaps in plans and policies related to COVID-19 preparation; this has

provided an opportunity for ARC facilities and SDHB to work together to focus on improvements to manage and minimise harm from a COVID-19 outbreak. This work is substantive and ongoing.

2. The majority of facilities reported a limited ability to staff a facility safely in a COVID-19 outbreak situationwithout significant additional staffing support;

3. Facility environmental capability challenges were evident, with likely impacts on infection control ability, highlighting some possible gaps in the HealthCert process;

4. There was variable General Practitioner support/afterhours access for advice, active management, and testing in a COVID-19 outbreak;

5. Facilities have limited access to Infection Prevention and Control specialist nursing advice to develop facility plans and help embed clinical capability;

6. Changes in the pandemic situation and ongoing changes in advice from the Ministry of Health caused significant concern for the sector; however, relationships were reported as strengthened with the SDHB (Portfolio Manager) due to enhanced communication throughout COVID-19;

7. As part of care planning preparedness, the majority of residents had received influenza vaccinations (92%) (except those who declined); and

8. Most facilities (98%) had a staff dedicated to implementing communication plans both internally and externally, including updating families.

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2. IntroductionDue to advanced age, co-morbidity, and shared environments, aged residential care (ARC) residents are at high risk of poor outcomes if they become infected with COVID-19; this has been clearly demonstrated internationally.

In response to the global COVID-19 pandemic, and five ARC facilities becoming significant COVID-19 clusters in New Zealand, the Director General of Health contacted all District Health Boards asking for a systematicassessment of the “actual readiness of each aged residential care providers, respite and other residential facilities” in their district. The Director General considered there to be an urgent need for policies, procedures and plans at ARC facilities to be “watertight”, both to protect staff and residents, and as part of the preparation to move to Alert Level Three and beyond.

Comprehensive COVID-19 preparedness assessments were carried out using 1-2 hour virtual platform interviews with each of the 65 ARC facilities.

The 1-2 hour virtual interviews with 65 facilities, encompassed the following:

∑ Screening processes for residents and staff;∑ General Practitioner / Nurse Practitioner support;∑ Infection control prevention including review of facilities cleaning, equipment and personal protection

equipment (PPE) supply;∑ PPE processes including appropriate use of PPE and donning and doffing of PPE;∑ Equipment for monitoring and isolation safe practice;∑ Environmental capability and isolation plans;∑ Staffing arrangements to minimise the spread of any infection; and∑ Outbreak management plans including staff management plans.

The Southern District Health Board (SDHB) used the above assessment process to identify areas where additional support was required or if there was a need to strengthen current resources to prevent, manage and mitigate risk of a COVID-19 outbreak.

3. ARC Sector BackgroundThere are 65 ARC facilities across the Southern District, providing long-term placement and limited short-term residential beds for people who no longer are able to safely live in their own home (most of whom are aged 65 years and over).

The following provides a SDHB ARC sector profile:

∑ Southern DHB serves the largest geographic region of all New Zealand's health boards; serving a total of 3181 SDHB certified ARC beds across 65 facilities;

∑ Aged residential care facilities operate across four levels of care: rest home (1085 beds), hospital (1602), dementia (409) and psychogeriatric (97) (see Table 1 for the geographic spread of beds across the district).Facilities can have one level of care, or a combination of two or more; each of which require different levels of clinical support and equipment;

∑ Registered Nurse (RN) clinical support varies by level of care, for example, unlike hospital level care, exclusive rest home level care does not require an RN on site 24 hours a day;

∑ The turnover rate for Registered Nurses, nationally, in aged care is 42% (New Zealand Aged Care Association, 2019);

∑ Minimum staffing is governed by the Age-Related Residential Care Services Agreement. The New Zealand Handbook Indicators for Safe Aged-care and Dementia-care for Consumers (Ministry of Health, 2005)provides non-legislated guidance for safe staffing, last updated in 2005.


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∑ Caregivers account for the largest proportion of care staff in 2017 (71% for NZ wide sector), RNs made up 16% of the care workforce, followed by diversional therapists, accounting for 6% of the care workforce (New Zealand Aged Care Association, 2018); the number of caregivers provides an added challenge in ensuring infection control principles are met, when RN cover is limited.

∑ Environments and equipment vary significantly between facilities; for example, facilities that provide exclusive rest home level care often do not have equipment such as, hospital level beds (adjustable beds for safe bed-based care). Availability of ensuites is generally limited across the sector.

∑ Average occupancy was 90% at the time of interview; with 74% of facilities district wide had between 90% – 100% occupancy at the time of interview;

∑ There is significant variation in ownership structures: individual/charitable, individual/private company; major group/charitable; and major group/listed company. This report classifies facilities as eitherindependent (42%) or a group structure (58%);

∑ ARC facilities provide services to both subsidised and private paying residents (within SDHB 27% are privately paying the maximum contribution for rest home level, and 35% for hospital level);

∑ Variation in facility size by bed numbers: 19 facilities have 40 beds or less. There are 6 facilities with 100 or more beds;

∑ Variation in GP support: some facilities have a dedicated GP, some have multiple GPs, some have 24-hour GP support, limited after-hours support (e.g. until 10pm weekdays, but not over the weekend), or no after-hours support. A number of facilities have no contracted GP.

Due to the variation within the sector, including business structure, levels of care, number of residents, and location (rural isolation vs. urban support), this creates a range of challenges to support aged care, particularly in a pandemic situation. Understanding ARC facility COVID-19 readiness is critical to understand what support planning is required, and for such planning to be realistic and robust.

Table 1: SDHB Total Certified ARC bed numbers by Level of Care and Territorial Local Authorities (TLA)

Dementia beds Rest Home beds Hospital/dual beds

Psychogeriatricbeds

Total ARC beds

Central Otago District 30 69 139 0 226

Clutha District 29 38 90 0 157

Dunedin City 158 478 651 77 1364

Gore District 28 63 98 189

Invercargill City 108 264 419 20 811

Queenstown-Lakes District 0 0 35 0 35

Southland District 0 43 52 0 95

Waitaki District 56 130 118 0 304

Grand Total 409 1085 1602 97 3181

Table 1 provides an overview of the geographical spread of SDHB certified ARC bed numbers across the district.

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Table 2: SDHB ARC funded beds by population & Non-ARC rural beds available

TLA TLA Pop ARC Beds Non-ARC SDHB beds Total ARC Facilities

Central Otago District 21,763 226 Dunstan Hospital: 24 general; Maniototo Health: 6 beds

7

Clutha District 18,549 157 Clutha Hospital: 14 general beds 5

Dunedin City 135,795 1364 Dunedin Hospital: 380 beds (not MH) 26

Gore District 13,237 189 Gore Health: 16 general beds 4

Invercargill City 58,406 811 Invercargill Hospital: Total 183 beds (not MH) 13

Lakes District 40,694 35 Lakes Hospital: 10 general beds 1

Southland District 33,037 95 NIL 3

Waitaki District 23,519 304 Oamaru Hospital: 20 general beds 8

Table 2 provides a summary of SDHB non-ARC beds that could be utilised in the event of a COVID outbreak within the respective locality. Low non-ARC bed numbers demonstrate a limited local capacity within secondary services to support transfer of residents locally.

4. Method4.1. Screening Survey

An initial online ‘self-assessment’ survey (Survey Monkey) was completed by ARC Facility Managers or Clinical Managers to provide a framework to screen providers for readiness and provide a list of facilities for priorityassessment. The survey was based on a Health Quality and Safety Commission (HQSC) COVID-19 Outbreak Preparedness Checklist for Aged Care Providers (Appendix 1).

∑ Facilities could self-assess by answering yes/no to questions, and provide detail where required;

∑ Important questions were then given a weighted risk score, which was summed to provide an overall priority for the interview programme (i.e. those with high scores were deemed at highest risk).

4.2. Assessment Process The virtual interviews were based on structured questions developed by the Northern Region Health Coordination Centre (NRHCC) (Northland and Auckland DHBs regional COVID-19 response).

∑ A 1-2 hour virtual assessment interview was carried out with each ARC facility utilising a team of 2 clinical assessors.

∑ The Assessment Group consisted of 7 Nurse Practitioners, all of whom work with the Aged Care Sector, 1 Clinical Nurse Specialist, and 1 senior Registered Nurse. The team utilised support and advice from Infection Prevention and Control, the Health of Older Persons Portfolio Manager, and the Community Services Leadership Team. Other SDHB Directorates (Mental Health) and organisations (Hospices) readily released their senior staff to assist;

∑ While the assessments were based on structured questions, they incorporated process which allowed for collaborative problem solving and advice throughout, to formulate bespoke solutions;

∑ The assessments were transcribed by administrative staff in real time;∑ Following the virtual assessment interview ARC facilities received a written ‘Assessment Summary’

documenting the discussed recommendations and actions required;∑ The Assessment Group reviewed plans, policies and rosters for most facilities;


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∑ Facilities identified as high risk had prompt follow-up site visits from an Infection Prevention and Control Specialist Nurse and a Nurse Practitioner to provide support and assistance to develop their localised response.

Reports related to aged residential care COVID-19 responses in New Zealand (Ministry of Health, 2020; Waitemata District Health Board, 2020) were published post assessment process; the documents were reviewed to understand the responses and challenges for other DHBs.

4.3. Virtual Interview Analysis 4.3.1. Daily Reviews

A daily review of the virtual interviews was held at the end of each day with interview teams and senior management, which determined whether a facility was deemed ‘high risk’ in the case of a COVID-19 outbreak,therefore requiring an immediate site visit and support to bolster preparedness (or if they were a medium or low risk) (Image 1). This process was based on clinical and critical judgement, and the context and individualisms of each facility were taken into consideration (i.e. not a standardised process).

Where required, a facility site visit was carried out within 1-5 days with an Infection Prevention and Control nurse, and a Nurse Practitioner. A virtual meeting was also held with the Director of Nursing for Strategy, Primary and Community and the General Manager Community Services and the Facility Manager of each facility deemed at high risk.

Image 1: ARC preparedness initial risk scoring from Assessment Team daily review process

4.4. Inclusions and ExclusionsIncluded were, all SDHB funded ARC facilities (65) located in the Southern District Health Board.

Excluded were, independent living units including serviced apartments and retirement villages located on the same campus as ARC facilities. This is an area requiring further review and an appropriate integrated response to ARC COVID-19 prevention and outbreak management.

There has been a parallel preparedness assessment process within the Mental Health Addictions and Intellectual Disability (MHAID) Directorate addressing mental health and addiction residential facilities, and Ministry of Health funded disability residential facilities.

11%

29%60%

ARC Preparedness Assessment Initial Risk Scoring

High Risk: Site visit required

Med Risk: Corrective action required

Low Risk: Limited or non-urgent actions

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4.5. LimitationsThe data and analysis process were limited by a number of considerations:

∑ The virtual assessment process provided important information on the COVID-19 readiness of individual ARC facilities at a point in time. Due to the complexity and diversity of the sector, findings cannot be generalised, however with caution, themes (strengths and gaps) are noted.

∑ The process used the NRHCC set of questions, therefore questions were pre-determined, however themes by categories can still be observed.

∑ Rich and nuanced information was received by those involved in the interviews, but due to the coding process this was not reflected in in the transcriptions;

∑ Three teams of clinicians undertook the virtual assessments with members rotating across different teams and assessments, thus some inconsistencies can be expected; and

∑ There was no formal moderation of assessor rankings across facility assessments, however the daily review process provided an informal moderation process.

5. FindingsThe ARC preparedness assessment process highlighted gaps in COVID-19 related process, policies and practices for many facilities. This has provided an opportunity for ARC facilities and SDHB to work together to focus on improvements to manage and minimise harm from a COVID-19 outbreak. This work is substantive and ongoing.

Facilities have been presented with an extremely challenging task, and have worked extremely hard to prepare, while trying to continue with their day to day work of providing excellent care to residents and managing family and staff expectations. It is acknowledged that the findings cannot be generalised across all facilities. The picture established was a moment in time, at an early stage of an unprecedented health event, with changes in situation and advice occurring daily.

It is also acknowledged that facilities are not comparable due to vast differences between each setting outlined in the background of this report. For example, there are differences in business structures and support networks, different numbers of residents, different levels of care provided, different levels of clinical support (i.e. rest home with 15 residents may have 1x RN 3 days a week, vs. a hospital level care facility which will have 24-hour RN support), different levels of GP commitment, and rurality.

5.1. Staffing ability in a COVID-19 situationThe ability to call on additional staffing resources if a facility lost a minimum of 30% of care staff (due to immediate COVID-19 related stand-downs) was generally reported to be problematic in the case of a COVID-19 outbreak. This may be more troublesome in rural localities, where reduced population bases further limit access to additional staff. The majority of facilities reported they will be highly unlikely to sustain function in a COVID-19 outbreak without significant SDHB staffing support. Some large group structures report having access to additional staffing through their corporate head offices. Many facilities had staff that were unable to work during the COVID-19 period due to age (>70yr) and health vulnerabilities, which further puts facilities in a strained position.

The assessment established that 97% of ARC facilities considered they had adequate current staffing (i.e. staffing meets MOH standards) with two facilities reporting current staffing as inadequate; this may be a response bias due to the nature of the interviews. ARC facilities have a history of high RN turnover (42% for NZ sector) (NZ Aged Care Association, 2019); difficulties attracting and retaining staff can be in part attributed to disparities in remuneration between ARC and DHBs, as well as the higher demands of nursing in aged care. Where RN cover is


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limited, it may provide challenges for comprehensive COVID-19 preparations, as well as clinical support for suspected or confirmed COVID-19 cases.

5.2. Environmental capabilityIt is difficult to conclude the appropriateness of a facility environment without a site visit, however a majority of facilities appear to have some challenges environmentally. A facility’s ‘red zone’ plans were often complex due to due to size and configuration of the building, and many reported there would likely be a need to relocate residents within the facility. Challenges were noted where some facilities have corridors that are too narrow to don and doff PPE outside a resident’s room.

Many facilities lack single rooms with dedicated bathroom facilities; 43% of facilities have 0-2 ensuites within their facility, 22% have no ensuites on site. Mitigation plans to minimise possible infection breaches due to shared bathrooms were variable. Difficulties were noted where a shared bathroom could be dedicated to an isolation room, however other residents were not able to recognize they could no longer use this bathroom or alternative bathrooms were too far away.

Providers acknowledged the environmental challenges with dementia units and reported that they would have to do the best they could and maintain strict bubbles. Most facilities (97%) had behavioural plans and close monitoring of residents that were non-compliant with remaining on site (non-dementia unit residents).

5.3. General Practitioner / Nurse Practitioner support58% of facilities reported having 24-hour access to a general practitioner (GP) during the COVID-19 period, 32% had limited access, and 8% (5 facilities) have no afterhours access. While many facilities have contracted GPs or GP practices, a number have no contract, and rely on a resident’s own GP to continue medical support. GP services provided to ARC facilities is a known complex and multifaceted issue, the virtual assessment was only able to capture a limited perspective on this important and ongoing issue.

Most facilities reported the importance of ongoing relationships with Nurse Practitioners and Clinical Nurse Specialists for their provision of care (Hospices, and SDHB Older Person’s Health and Mental Health Services for Older Person’s). Hospice based Nurse Practitioners and Clinical Nurse Specialists had provided and helped embedspecific short-term care plan templates which could be individualised for the management of a resident who hadtested positive for COVID-19.

Virtual assessment platforms were successfully used by most GPs, Nurse Practitioners, and Clinical Nurse Specialists during the COVID-19 lockdown period; many facilities reported these platforms as significantly beneficial, and something that could be used in a non-COVID-19 setting.

5.4. COVID-19 Planning and Processes Documented planning to manage COVID-19 pandemic outbreaks was variable. 58% of facilities had done a thorough job of their COVID-19 pandemic plans, however 28% required significant improvements to their pandemic plans, and 12% did not have pandemic plans in place. The Assessment Group was able to support facilities to bolster their plans to help reflect their individual realities.

Six facilities were deemed high risk due to inadequate COVID-19 preparation, requiring immediate site visits from SDHB Infection Prevention and Control Specialist Nurse and a Nurse Practitioner to provide support and assistance to develop their localised COVID-19 planning response (2 additional facilities were visited to assist with less urgent issues).

Facilities reported initiating new methods of communication with families, using Zoom, newsletters, and emails. 98% of facilities had a specific person assigned responsibility for communications with staff, residents and their families.

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As part of care planning preparedness, 92% of all residents had received influenza vaccinations, except those who declined.

5.5. PPE and Infection Prevention and Control (IPC)ARC generally obtained personal protection equipment (PPE) supplies from the usual commercial suppliers or SDHB, however supply was variable. The majority of facilities reported frustrations and uncertainties with PPE access, and also significant price increases from commercial suppliers. There was frustration and confusion around PPE recommendations differing for ARC providers (vs. hospital inpatient settings), for example, aprons were recommended for COVID-19 positive residents in an ARC setting, and yellow fluid resistant gowns for a COVID-19 positive patient in an inpatient hospital setting. This was stressful for ARC staff and resulted in confusion about what was best practice.

Screening processes for residents and staff were varied; 37% did not have a documented screening process for staff, and 58% had either no documented process for screening residents or an incomplete process. Both staff and resident screening processes were largely resolved after advice from the Assessment Group. 22% of facilities had limited or no evidence of training staff in the safe use and disposal of PPE. While many facilities have an Infection Prevention and Control (IPC) representative, it became evident that ARC facilities had limited access tospecialist IPC nursing advice to help develop localised plans, support clinical decisions and education.

5.6. Communication A significant amount of apprehension was evident across the sector, with rapidly changing advice, and different platforms for information. Documents and often conflicting advice were received from the MOH, Public Health South, Health Quality and Safety Commission, SDHB, the Aged Care Association, and their own corporate affiliation. The Assessment Group acknowledges the challenging nature of the situation, with rapidly changing evidence and advice being given.

The SDHB HOP Portfolio Manager facilitated a group of ARC locality leaders, with regular meetings (initially everyday) to clarify information where possible and discuss issues and concerns for the sector. The feedback was that these sessions added significant value to the sector and to the SDHB relationship, as well as timely problem solving.

5.7. For Further Consideration 1. Waitakere Hospital Incident Report Review (Waitemata District Health Board, 2020) relating to DHB

nursing staff infections after transferring several ARC residents to an acute hospital setting, highlighted:∑ A last minute decision to transfer was mainly attributed to the rapidly changing staff availability

with ARC staff standing down due to contact with COVID-19 patients;∑ The high acuity and significant increase in care required for the residents that acquired COVID-

19. Thus, it could be assumed that existing ARC staffing ratios would be inadequate to cope with a COVID-19 outbreak;

∑ Due to the high patient acuity, and rapid deterioration, nurses were in the rooms for long periodsrequiring care staff to don and doff PPE multiple times a shift, each an opportunity for PPE breach. The report emphasises the importance of PPE buddy system checks, adequate face to face education, ensuring supply of PPE is consistent, and that expert advice is sought around what PPE is to be used. It is recognised that donning and doffing PPE, particularly doffing, is high risk for viral transmission, and it is therefore important to try and minimise the number of times this occurs; and

∑ There was a number of changes made to the supply of the PPE from the regional provider, which made it challenging and stressful for staff having to learn ways to fit and use various brands of PPE.


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2. An independent report was commissioned by the Director-General of Health in April to learn from clusters of COVID-19 in New Zealand based Aged Care facilities (Ministry of Health, 2020) highlighted:

∑ The most notable adverse impact of a positive test was the stand down of a high proportion of the ARC facility’s staff, and the limited prospects of backfilling;

∑ Staff suffered considerable stress due to:ß Extra vigilance and longer working hours;ß Isolation from family, and having accommodation threatened by landlords/housemates;ß Antagonistic social and conventional media;ß The report recommends providing psychosocial support for both staff and residents.

∑ Communications and resources provided to ARC providers and management were at times confusing and not always clear or consistent; and

∑ ARC facilities who experienced a COVID-19 cluster reported they felt there was a “takeover” by PHUs and/or DHB IPC experts who had little understanding of the work required in an ARC setting.

6. RecommendationsARC facilities have amended a number of the modifiable issues since the assessment process and site visits have taken place. The Assessment Group has the following recommendations to improve issues highlighted during the assessment process:

1. Escalation Planning/Emergency ResponseSDHB to develop a robust and pragmatic plan for managing a COVID-19 outbreak in any locality, with a clear decision tree and principles around when to care in place, and when to transfer. Including:∑ Relevant clinical advisors and stakeholders to be involved in planning;∑ Identify roles involved (leadership, staffing, logistics); and∑ Regular and ongoing simulation practice of COVID-19 response plan.

2. Infection Prevention and Control (IPC) Specialist Nursing Resource Recommend 2.0 FTE for additional SDHB Infection Prevention and Control nursing resource (1.0FTE for Dunedin/Waitaki, 0.5FTE Southland, 0.5 FTE for Central Otago/Lakes/Clutha) to specifically support the ARC sector. The IPC nursing resources support the sector by:∑ Embedding skills and providing relevant practical advice to the sector in preparation for second wave

of COVID-19 (and other infectious diseases);∑ Face-to-face training by way of a teach and learn method;∑ Ensuring meticulous PPE use and understanding of IPC principles;∑ Assisting with bespoke IPC mitigation plans for challenging environments;∑ To supporting providers;∑ Supporting Public Health South and the Facility IPC lead during outbreaks.

3. LeadershipSDHB to ensure sufficient resourcing of leadership roles to support the ARC sector, including:∑ Adequate Nursing Leadership and Portfolio Management positions to support the current Portfolio

Manager and the Director of Nursing for Strategy, Primary and Community with comprehensive and proactive planning for the sector, and active sector leadership support; and

∑ Providing sufficient resourcing, prioritising appropriate senior staff to support the sector during a COVID-19 outbreak.

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4. ARC Steering GroupSDHB to develop an ongoing platform for effective feedback loops from the ARC sector, with appropriate SDHB leadership to develop solutions in partnership. The group to consider:∑ How to best support quality improvement for the sector, focusing on understanding what is required

to support excellent clinical care;∑ Sector requirements for clinical/medical support, e.g. Afterhours GP access, NP support etc.; and∑ Exploring application of virtual assessments for external clinician access.

5. Communication PlatformsSDHB to ensure provision of COVID-19 information is timely, clear, consistent and controlled:∑ To embed Health Pathways platform as the primary source of truth for the sector for assessment and

management of COVID-19 (and other conditions); ∑ To work with Public Health to align relevant COVID-19 pathways; and∑ Where possible, changes in information are minimised;

6. Health Certification

SDHB to feedback concerns around the certification/surveillance audit process, suggesting facilities should meet a higher standard for infection prevention and control.

∑ Recommend to the Ministry of Health the strengthening of the Health and Disability Standards, especially in relation to infection prevention and control

∑ Feedback to audit team regarding issues identified during the preparedness assessment process that are aligned with Certification Audits, for example, IPC plans and practices, and environmental issues.


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7. References

Health Quality and Safety Commission New Zealand. (2020). Guidance for preventing and controlling COVID-19 outbreaks in New Zealand aged residential care. Retrieved from (13 April, 2020) https://www.hqsc.govt.nz/assets/ARC/PR/COVID-19/ARC_COVID-19_guide_final_v11.pdf

Ministry of Health. (2005). New Zealand Handbook Indicators for Safe Aged-care and Dementia-care for Consumers. New Zealand: Standards New Zealand.

Ministry of Health. (2020). Independent Review of COVID-19 Clusters in Aged Residential Care Facilities. Retrieved from (14 June, 2020): https://www.health.govt.nz/publication/independent-review-covid-19-clusters-aged-residential-care-facilities

New Zealand Aged Care Association. (2018). Aged Residential Care Industry Profile 2017-18. New Zealand: Author. Retrieved from (26 May, 2020): https://www.nzaca.org.nz/assets/Uploads/1f049406b8/ARC-Industry-Profile-2017-18.pdf

New Zealand Aged Care Association. (2019). Personal Correspondence NZACA (John McDougall) 28 August 2019.

Waitemata District Health Board. (2020). Incident Review Report COVID-19 Staff Infections Waitakere Hospital April 2020. Waitemata, New Zealand: Author. Retrieved from (26 May, 2020): https://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2020/Waitemata-DHB-Incident-Review-Report-WTK-Hospital-April-2020.pdf

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https://www.hqsc.govt.nz/assets/ARC/PR/COVID-19/ARC_COVID-19_guide_final_v11.pdf

https://www.health.govt.nz/publication/independent-review-covid-19-clusters-aged-residential-care-facilities

https://www.health.govt.nz/publication/independent-review-covid-19-clusters-aged-residential-care-facilities

https://www.nzaca.org.nz/assets/Uploads/1f049406b8/ARC-Industry-Profile-2017-18.pdf

https://www.nzaca.org.nz/assets/Uploads/1f049406b8/ARC-Industry-Profile-2017-18.pdf

https://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2020/Waitemata-DHB-Incident-Review-Report-WTK-Hospital-April-2020.pdf

https://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2020/Waitemata-DHB-Incident-Review-Report-WTK-Hospital-April-2020.pdf


Appendix 1: Covid-10 Outbreak Preparedness Checklist

HQSC Covid-10 Outbreak Preparedness Checklist (Health Quality and Safety Commission New Zealand, 2020).


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Southern District Health Board – Community & Public Health Advisory Committee Page 1 of 3 Approved by Board 7 July 2020

COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE (CPHAC)

Terms of Reference

Accountability The Community and Public Health Advisory Committee (CPHAC) is constituted by section 34, part 3, of The New Zealand Public Health and Disability Act 2000 (The Act). The procedures of the Committee shall also comply with Schedule 4 of the Act. The Committee is to further comply with the standing orders of the Southern DHB which may not be inconsistent with the Act. Function and Scope 1) The statutory functions of CPHAC are to give the Board advice on:

a) the needs, and any factors that the Committee believes may adversely affect the health status, of the resident population of the Southern DHB; and

b) priorities for use of the limited health funding provided.

2) The statutory aim of CPHAC’s advice is to ensure that the following maximise the overall

health gain for the population the Committee serves:

a) all service interventions the Southern DHB has provided or funded or could provide or fund for that population;

b) all policies the DHB has adopted or could adopt for that population.

3) CPHAC’s advice may not be inconsistent with the New Zealand Health Strategy.

Responsibilities The Committee is responsible for: 1) Taking an overview of the population and health improvement; 2) Providing recommendations for new initiatives in community and public health

improvement; 3) Addressing the prevention of inappropriate hospital admissions through health promotion

and community care interventions;

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Community & Public Health and Disability Support Advisory Committees Meeting - Reference Items

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4) Examining the role that primary care, disability support, public health and other community services - as well as hospital services - can play in achieving health improvement;

5) Ensuring better co-ordination across the interface between services and providers; 6) Focusing on the needs of the populations and developing principles on which to

determine priorities for using finite health funding; 7) Interpreting the local implications of the nation-wide and sector-wide health goals and

performance expectations; 8) Providing advice, in collaboration with the Iwi Governance Committee, on strategies to

reduce the disparities in health status; especially relating to Māori and Pacific Island peoples;

9) Providing advice on priorities for health improvement and independence as part of the

strategic planning process; 10) Ensuring the processes and systems are put in place for effective and efficient

management of health information in the Southern DHB district, including policies regarding data ownership and security;

11) Ensuring the priorities of the community are reflected in the Annual Plan of the Southern

DHB, and to ensure that appropriate processes are followed in preparation of the plan; 12) Ensuring that recommendations for significant change or strategic issues have noted

input from key stakeholders and consultation has occurred in accordance with statutory requirements and Ministry guidelines.

Membership All members of the Committee are to be appointed by the Board. The Board will appoint the chairperson. The Committee is to comprise of a number of Board members as determined by the Board Chair, supplemented with external appointees as required. Membership will provide for Māori representation on the Committee. The Committee may obtain additional advice as and when required. Where a person, who is not a Board member, is appointed to the Committee, the person must give the Board Chair a statement that discloses any present or future conflict of interest, or a statement that no such conflicts exist or are likely to exist in the future, prior to appointment. Conflicts of Interest Where a potential conflict of interest exists with an agenda item, these are to be declared by members and staff. A register of interests shall form part of each Committee meeting agenda, and it is the responsibility of each member to disclose any new interests which may give rise to a conflict.


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Quorum The quorum of members of a committee is — (a) if the total number of members of the committee is an even number, half that number; but (b) if the total number of members of the committee is an odd number, a majority of the

members. Meetings Bi-monthly meetings, held collectively with the Disability Support Advisory Committee (DSAC) will be scheduled, however the Committee may determine to hold additional meetings if deemed necessary by the Chair, with or without DSAC, up to a maximum of ten meetings per year. Review The Terms of Reference for this Committee shall be reviewed as and when required. Management Support The Chief Executive Officer shall ensure adequate provision of management and administrative support to the Committee.

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Southern District Health Board – Disability Support Advisory Committee Page 1 of 2 Approved by Board 7 July 2020

DISABILITY SUPPORT ADVISORY COMMITTEE (DSAC)

Terms of Reference

Accountability The Disability Support Advisory Committee (DSAC) is constituted by section 35, part 3, of The New Zealand Public Health and Disability Act 2000 (The Act). The procedures of the Committee shall also comply with Schedule 4 of the Act. The Committee is to further comply with the standing orders of the Southern DHB which may not be inconsistent with the Act. Function and Scope 1) The statutory functions of DSAC are to give the Board advice on:

a) The disability support needs of the resident population of the Southern DHB

b) Priorities for use of the disability support funding provided. 2) The aim of the Committee’s advice will be to ensure that the following promote the

inclusion and participation in society, and maximise the independence, of disabled people within the Southern DHB’s resident population:

a) the kinds of disability support services the Southern DHB has provided or funded or could provide or fund for disabled people;

b) all policies the Southern DHB has adopted or could adopt for disabled people. 3) The Committee’s advice may not be inconsistent with the New Zealand Disability

Strategy. Responsibilities The Committee is responsible for: 1) Providing advice on the overall performance of the disability support services delivered

by or through the Southern DHB; 2) Providing advice on strategic issues related to the delivery of disability support services

delivered by or through the Southern DHB; 3) Focusing on the disability support needs of the population and developing principles on

which to determine priorities for using finite disability support funding; 4) Ensuring that the District Annual Plans (DAPs) of the Southern DHB demonstrate how

people with disability will access health services and how the Southern DHB will ensure that the disability support services they fund or provide are co-ordinated with the services of other providers to meet the needs of disabled people;

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Southern District Health Board – Disability Support Advisory Committee Page 2 of 2 Approved by Board 7 July 2020

5) Assessing the disability support services’ performance against expectations set in the

relevant accountability documents, documented standards and legislation; 6) Ensuring that recommendations for significant change or strategic issues have noted

input from key stakeholders and consultation has occurred in accordance with statutory requirements and Ministry guidelines.

Membership All members of the Committee are to be appointed by the Board. The Board will appoint the chairperson. The Committee is to comprise a number of Board members as determined by the Board Chair, supplemented with external appointees as required. Membership will provide for Māori representation on the Committee. The Committee may obtain additional advice as and when required. Where a person, who is not a Board member, is appointed to the Committee, the person must give the Board Chair a statement that discloses any present or future conflict of interest, or a statement that no such conflicts exist or are likely to exist in the future, prior to appointment. Conflicts of Interest Where a potential conflict of interest exists with an agenda item, these are to be declared by members and staff. A register of interests shall form part of each Committee meeting agenda, and it is the responsibility of each member to disclose any new interests which may give rise to a conflict. Quorum The quorum of members of a committee is —

(a) if the total number of members of the committee is an even number, half that number; but

(b) if the total number of members of the committee is an odd number, a majority of the members.

Meetings Bi-monthly meetings, held collectively with the Community and Public Health Advisory Committee (CPHAC) will be scheduled, however the committee may determine to hold additional meetings if deemed necessary by the Chair, with or without CPHAC, up to a maximum of ten meetings per year. Review The Terms of Reference for this Committee shall be reviewed as and when required. Management Support The Chief Executive Officer shall ensure adequate provision of management and administrative support to the Committee.


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