Public Agenda - CCDHB...2015/12/11 · ITEM 1.4 MINUTES OF PREVIOUS MEETING 14 AUGUST 2015 RESOLVED THAT: The minutes of the CCDHB Board meeting held on 14 August 2015, taken with

Capital & Coast District Health Board

CAPITAL & COAST DISTRICT HEALTH BOARD

Public Agenda11 DECEMBER 2015

Boardroom, level 11, Grace Neill Block, Wellington Regional Hospital, 9.30 am

ITEM ACTION PRESENTER MIN TIME PG

1 PROCEDURAL BUSINESS 10 9.30 am

1.1 Karakia

1.2 Apologies RECORD V Hope

1.3 Continuous Disclosure

- Interest Register

- Conflict of Interest

CONFIRM

ACCEPT

V Hope

V Hope

2

5

1.4 Confirmation of Minutes 9 October 2015 APPROVE V Hope 7

1.5 Matters Arising NOTE D Chin 12

1.6 Action list NOTE D Chin 16

2 FOR DISCUSSION

2.1 Chair report NOTE V Hope 20 9.40 am 18

2.2 Chief Executive’s report NOTE D Chin 15 10.00 am 22

MORNING TEA 10.15 – 10.30 AM

3 PRESENTATIONS

3.1 Sub Regional Disability Action Group NOTE M Faulkner 30 10.30 am 44

3.2 University of Otago NOTE Prof. S Collings 60 11.00 am -

3.3 Wellington Hospital’s Foundation NOTE B Day 20 12.00 pm -

LUNCH 12.30 – 1.30 PM

OTHER

4 General Business 5 1.30 pm -

5 Resolution to Exclude the Public APPROVE V Hope 5 1.35 pm 58

ADJOURN 1.40 pm

APPENDICES

2.1 Chair report∑ Letter from Ministers of Health and Finance approving 2015/16 annual plan 59

2.2 CEO report∑ CCDHB participation in the national ShakeOut national earthquake drill 62

3.1 Sub-Regional Disability Action Group∑ Overview of sub regional disability population∑ Health priorities for people with learning disabilities

6468

MHAID scorecard glossary 69

CCDHB PUBLIC AGENDA, 11 DECEMBER 2015 - AGENDA 11 DECEMBER 2015

1



Interest Register

11 DECEMBER 2015

Name Interest

Dr Virginia HopeChairperson

∑ Chair, Capital & Coast District Health Board∑ Chair, Hutt Valley District Health Board∑ Deputy Chair, 3 DHB CPHAC/DSAC committee∑ Chair, 3 DHB Hospital Advisory Committee∑ Member, Finance Risk & Audit Committees, Hutt Valley and Capital & Coast

District Health Board∑ Member, 3 DHB FRAC committee∑ Medical Director, Institute of Environmental Science & Research∑ Director & Shareholder, Jacaranda Limited∑ Fellow, Royal Australasian College of Medical Administrators∑ Fellow and New Zealand Committee Member, Australasian Faculty of Public

Health Medicine∑ Fellow, New Zealand College of Public Health Medicine∑ Member, Territorial Forces Employer Support Council∑ Member, National Roundtable to Strengthen Pathology & Laboratory Services∑ Member, Regional Governance Group, Central Region DHBs∑ Brother and sister work in health sector in the Wairarapa (disability support

and laboratory respectively)∑ Member, Gillies McIndoe Research Institute∑ Member, DHB Shared Services Executive Team (governance/oversight role)

Mr Derek MilneDeputy Chairperson

∑ Deputy Chair, Capital & Coast District Health Board∑ Chair, Wairarapa District Health Board∑ Chair, 3 DHB CPHAC/DSAC committee∑ Deputy Chair, 3 DHB HAC committee∑ Member, Wairarapa and Capital & Coast DHBs FRAC committees∑ Member, 3 DHB FRAC committee∑ Central Region representative, HBL Transition Group∑ Brother-in-law is on the Board of Healthcare Ltd∑ Daughter is a GP registrar at Masterton Medical Centre

Dr Judith AitkenMember

∑ Member, Capital & Coast District Health Board∑ Member, Finance Risk & Audit Committee, Capital & Coast District Health

Board∑ Member, 3 DHB FRAC committee∑ Member, 3 DHB HAC committee∑ Councillor, Greater Wellington Regional Council∑ Chair, Audit, Risk & Assurance Committee, Greater Wellington Regional Council∑ Member, Strategy and Policy Committee, Greater Wellington Regional Council∑ Chair, Parliamentary Sector Advisory Board∑ Trustee, Carter Observatory Trust

CCDHB PUBLIC AGENDA, 11 DECEMBER 2015 - PROCEDURAL BUSINESS

2


Name Interest

∑ Board member, Citizenship Trust ∑ Board member, Holocaust Centre of New Zealand

Mr David ChoatMember

∑ Member, Capital & Coast District Health Board∑ Member, 3 DHB CPHAC/DSAC committee∑ Partner employed as Solicitor, New Zealand Public Service Association∑ Chief Policy Analyst, Ministry of Education

Mr Peter DouglasMember

∑ Member, Capital & Coast District Health Board∑ Member, Hutt Valley District Health Board∑ Member, Capital & Coast DHB FRAC committee∑ Member, Hutt Valley DHB FRAC committee∑ Member, 3 DHB FRAC committee∑ Chair, Hato Paora College Board of Trustees∑ Chair, Hato Paora College Proprietors Trust Board∑ Director, Te Ohu Kaimoana Custodian Limited∑ Director, Charisma Developments Limited∑ Chief Executive, Te Ohu Kaimoana, Māori Fisheries Trust∑ Chairman, Ruapuha Uekaha Hapu Trust∑ Member, expert panel modernising Child Youth & Family

Ms Helene RitchieMember

∑ Member, Capital & Coast District Health Board∑ Member, 3 DHB CPHAC/DSAC committee∑ Councillor, Wellington City Council∑ Registered Psychologist, Private Practice∑ Son is an emergency department doctor, Dunedin Hospital

Mr Darrin SykesMember

∑ Member, Capital & Coast District Health Board∑ Member, Capital & Coast District Health Board, FRAC committee∑ Member, 3 DHB FRAC committee∑ Director, New Zealand Touch Board of Directors∑ Trustee, Wellington Regional; Sports Education Trust (trading as Sports

Wellington)∑ Member, Sport and Recreation New Zealand (trading as Sport NZ)∑ Chief Executive, Crown Forestry Rental Trust

Ms Sue KedgleyMember

∑ Member, Capital & Coast District Health Board∑ Member, 3 DHB HAC committee∑ Member, Technical Expert Advisory Committee on Natural Health Regulation∑ Member, Greater Wellington Regional Council∑ Member, Consumer New Zealand Board

Mr Chris LaidlawMember

∑ Member, Capital & Coast District Health Board∑ Member, 3 DHB CPHAC/DSAC committee∑ Chair, Natural Resource Planning Committee, Greater Wellington Regional

Council∑ Trustee, ANEW Foundation∑ Trustee, Citizenship Education Trust∑ Advisory Board Member, Leadership New Zealand∑ Board Member, NZ Foundation for Progress and Wellbeing∑ Patron, Association of Blind Citizens of New Zealand∑ Vice Chairman, Oxfam


3


Name Interest

∑ Councillor, Greater Wellington Regional CouncilMr Nick LeggettMember

∑ Member, Capital & Coast District Health Board∑ Board representative, Sub Regional Pacific Strategic Health Advisory Group∑ Mayor, Porirua City Council∑ Trustee, Telecom Foundation∑ Chairperson, Wellington Regional Emergency Management Committee,

Greater Wellington Regional Council∑ Member, Wellington Regional Transport Committee, Greater Wellington

Regional CouncilMr Roger JarroldMember

∑ Member, Capital & Coast District Health Board∑ Chair, Capital & Coast DHB and Hutt Valley DHB FRAC committees∑ Chair, 3 DHB FRAC committee∑ Trustee, Auckland District Health Board Charitable Trust∑ Employee CFO, Downer New Zealand Ltd∑ Director, Downer New Zealand Ltd∑ Director, Works Infrastructure Cortex Resources JV Ltd∑ Director, Works Infrastructure Harker Underground Construction JV Ltd∑ Director, Works Finance (NZ) Ltd∑ Director, DGL Investments Ltd∑ Director, TSE Wall Arlidge Ltd∑ Director, Waste Solutions Ltd∑ Director, Underground Locators Ltd∑ Trustee, Works Superannuation Scheme∑ Past member, Ministry of Health Audit and Risk Committee (resigned 6

December 2013)∑ Partner of Downer CIO is working for Spark in a senior role

Dr Margaret WilsherCrown Monitor

∑ Crown Monitor, Capital & Coast District Health Board∑ Chief Medical Officer, Auckland District Health Board∑ Clinical Associate Professor, University of Auckland∑ Member, National Health Board∑ Member, Capital Investment Committee, NHB∑ Member, Hospital Redevelopment Partnership Group∑ Director, New Zealand Health Innovation Hub∑ Independent Physician, Auckland Medical Specialists∑ CMO lead, Auckland Metro Laboratory Transition project∑ Fellow, Royal Australasian College of Medical Administrators∑ Fellow, Royal Australasian College of Physicians∑ Member, Laboratory Round Table∑ Member, ASMS


4


Interest Register

EXECUTIVE LEADERSHIP TEAM9 OCTOBER 2015

Debbie ChinChief Executive Officer

∑ Member, Rotary

∑ Member, HBL FPSC Procurement Steering Group (regional Chief Executive representative)

∑ Member, HBL Shared Services Council (regional Chief Executive representative)

Chris LowryChief Operating Officer

∑ Son works at HVDHB

Ms Sandra WilliamsActing Director, Service Integration & Development Unit, 3 DHB

∑

Donna HickeyDirector, Human Resources, 3 DHB

∑ Sister is a nurse, working for Plunket

Tony HickmottActing Executive Director, Corporate Services, 3 DHB

∑ Wife is employed by CCDHB as a midwifeSister-in-law in Medical Director for Student Health Services at Victoria University

Hiranthi Abeygoonesekera Chief Legal Counsel

∑ National HBL/DHB Legal Advisory Group

Nigel FairleyGeneral Manager, Mental Health Addictions & Intellectual Disability Service, 3 DHB

∑ Fellow, NZ College of Clinical Psychologists

∑ President, Australian and NZ Association of Psychiatry, Psychology and Law

∑ Trustee, Porirua Hospital Museum

Shayne HunterActing Chief Information OfficerTechnology, 3 DHB

∑

Cheryl GoodyerCapability Manager, Māori Health Development Group

∑ Director, Otarere Māori Arts and Crafts

∑ Director, C A Goodyer Ltd

∑ Member, Goodyer family/whanau trust

∑ Various family members working across the DHB health sector –HV/Auckland/Canterbury DHBs

Taima FagaloaDirector, Pacific Health Directorate

∑ Cousin works as a community health worker for Ora Toa Health

∑ Director, TCF Consulting Limited

Dr Geoff RobinsonChief Medical Officer

∑ Chair, Medical Research Institute of NZ

∑ Trustee, Wellington Hospital & Health Foundation

Catherine EppsDirector of Allied Health, Technical & Scientific

∑ Nil


5

Andrea McCanceDirector, Nursing & Midwifery

∑ Trustee, Mary Potter Hospice

Dr Pauline BoylesSenior Disability Advisor

∑ Past President/ Advisor to Board, Wellington Riding for the Disabled

∑ Managing Director, Dream Achievers Ltd

∑ Member on the Ministry of Health National Advisory Group for Review of Behaviour Support Services

Jannel FisherCommunications Manager

∑ Nil

Jennifer AshmanBoard Secretary

∑ Director, Team Ashman Ltd

∑ Husband is Operations Manager, Northpower, Wellington


6

CAPITAL AND COAST DISTRICT HEALTH BOARDDRAFT Minutes of the Board

Held on Friday 9 October 2015, 10.35 amKapiti District Council Chambers, 175 Rimu Road, Paraparaumu

PUBLIC SECTION

PRESENT: Dr V Hope (Chair)Mr D Milne (Deputy Chair)Mr P Douglas Ms H RitchieMr N LeggettMs S KedgleyMr D SykesMr C Laidlaw

APOLOGIES: Dr J AitkenMr R JarroldMr D Choat

IN ATTENDANCE: Ms D Chin (Chief Executive)Mr T Hickmott (Chief Financial Officer/Acting Executive Director 3DHB Corporate Services)Dr A Bloomfield (Director Service Integration & Development Unit 3 DHB) arrived 11.05 amMs C Lowry (Chief Operating Officer)Mr N Fairley (General Manager, Mental Health, Addictions & Intellectual Disability 3 DHB)Ms C Epps (Executive Director, Allied Health, Technical & Scientific)Ms A McCance (Director of Nursing & Midwifery)Ms E Hickson (Director of Nursing, Primary Health & Integrated Care)Mrs J Fisher (Communications Manager)Ms J Ashman (Board Secretary)

One member of the public/media_____________________________________________________________________________________

1 PROCEDURAL BUSINESS

ITEM 1.1 PROCEDURAL

Mr P Douglas opened the meeting with a Karakia. Mr Douglas expressed the Board’s deepest condolences to the Kapiti Mayor on the very recent passing of his wife. Mr Douglas thanked the Deputy Mayor for the Council’s hospitality in providing their premises for today’s CCDHB Board meeting and Ms E Hickson was welcomed as the new Director of Nursing, Primary Health and Integrated Care.

ITEM 1.2 APOLOGIES

The Board NOTED and RESOLVED that apologies from Dr J Aitken, Messrs R Jarrold and D Choat be accepted. Apologies from T Pereira were also received and accepted.


7

Moved: Nick Leggett Seconded: Derek Milne CARRIED

ITEM 1.3 INTERESTS

1.3.1 REGISTER OF INTERESTS

There were no changes notified to any members’ register of interest.

1.3.2 CONFLICTS RELATED TO ITEMS ON THE AGENDA

No conflicts were foreshadowed in respect of items on the current agenda but there would be an opportunity at the beginning of each item for members to declare conflicts of interest.

ITEM 1.4 MINUTES OF PREVIOUS MEETING 14 AUGUST 2015

RESOLVED THAT:

The minutes of the CCDHB Board meeting held on 14 August 2015, taken with the public present be confirmed as a true and correct record.

Moved: Derek Milne Seconded: Darrin Sykes CARRIED

ITEM 1.5 MATTERS ARISING UPDATE

The update was NOTED.

ACTION:∑ The Board requested that the Compass Health analysis of ED presentations be

discussed at HAC with the findings summarised for the December Board meeting.

ITEM 1.6 ACTION LIST

The reporting timeframes on the open action items were NOTED.

2 FOR DISCUSSION

ITEM 2.1 OBESITY INITIATIVES AND OPPORTUNITIES, HUTT VALLEY AND CAPITAL & COAST DISTRICT HEALTH BOARDS

The paper showcases initiatives to address obesity across the sub region and provides an update on activity. The paper provides background on Project Energize which is running within the Waikato DHB area with excellent results. CCDHB is taking up this initiative and is looking for a strategic partner to ensure it links into current activities within the DHB region, without duplicating any programmes that are already running.The model that CCDHB will run is a ‘train the trainer’ model where trainers go into schools to establish the programme, and train the staff to continue it and scale up local trainers in this way.


8

The Board reiterated its support of the obesity initiatives including Project Energize, and preferred to endorse rather than note the recommendations. The resolutions were addressed and amendments made (bold and italicised), and the Board NOTED and RESOLVED to:

(a) NOTE that the Board has approved a number of initiatives relating to obesity prevention in its 2015/16 Annual Plan

(b) Note and endorse the implementation of Project Energize with nine schools within CCDHB including project evaluation

(c) Note and endorse that participating schools will be requested to implement a healthy food policy as part of the implementation of Project Energize

(d) Note and endorse the work of Healthy Families Lower Hutt(e) Note and endorse the implementation of the 3DHBs Healthy Food and Beverage

Guidelines focused on supporting hospitals to model a healthy food and drink environment for staff, patients and visitors to the hospitals

(f) Note and endorse that the annual plan includes the development of Maternal Green Prescriptions across the 3DHBs

(g) Note and endorse that the annual plan includes the development of an obesity governance group (localised or 3DHB) that will produce a work plan that is multifaceted, has a cross-government approach and involves a range of interventions.

Moved: Sue Kedgley Seconded: Nick Leggett CARRIED

ITEM 2.2 CHAIR REPORT

The report was taken as read. The Chair advised that the DHB’s decision to remove sugar sweetened beverages from its premises has resulted in very positive attention and noted that she had been advised by the MoH oral health champion that removing soft drinks per se was a world first for a health entity.

The report was NOTED.

ITEM 2.3 CHIEF EXECUTIVE REPORT

The report was taken as read and the Board:

NOTED the phased approach to the development of the CCDHB consumer council and the DHB’s commitment to strengthen the consumer voice and engagement at an executive level across the DHB.NOTED the recent discussions held with the Ministry of Health outlining the challenge for our DHB (and mirrored by all DHBs) in relation to the strain on the SSiED target due to the pressure of higher ED presentations and hospital admissions relating to flu and flu-like illnessNOTED its request to agenda the mental health dashboard for discussion at CPHAC/DSAC.

The report was NOTED.

ACTION:∑ Management are to consider suicide prevention and postvention support for families

as the 2015-2017 plan develops.


9

3 GENERAL BUSINESS

The Board MOVED a formal vote of thanks to the Kapiti District Council for hosting the October CCDHB Board meeting.

Moved: Virginia Hope Seconded: Helene Ritchie CARRIED

The Resolution to Exclude the Public was discussed and was not resolved. It was agreed that the Board’s vision and strategy paper would be moved to the public section of the meeting and the public meeting then adjourned at 11.33 am, and reconvened at 1.15 pm to address this item.

4 BOARD VISION AND STRATEGY (MOVED FROM PUBLIC EXCLUDED)

The Board confirmed that the paper outlines its high level vision and strategy however recent amendments had not been included in the version before the Board today.

The Board NOTED and RESOLVED that:

(a) The Board’s intentions around mental health and reducing suicides and achieving equity be incorporated into the previous version of the Vision and Strategy document endorsed by the Board

(b) The Board ADOPT the Vision and Strategy document and that the Board make the document publicly available.

Moved: Derek Milne Seconded: Sue Kedgley CARRIED

5 RESOLUTION TO EXCLUDE THE PUBLIC

ITEM 5.1 RECOMMENDATION

The Board NOTED and RESOLVED to:

AGREE that except for the CCDHB Vision and Strategy paper, that as provided by Clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons:

SUBJECT REASON REFERENCE

Public Excluded Minutes For the reasons set out in the respective public excluded papers

Public Excluded Matters Arising from previous Public Excluded meeting

For the reasons set out in the respective public excluded papers

Recommendations from CCDHB FRAC August and September meetings

Papers contain information and advice that is likely to prejudice or disadvantage commercial activities and/or disadvantage negotiations

9(2)(i)(j)Managing Demand for Beds

CCDHB Vision and Strategy

Draft Annual Report 2014/15

Chair report


10

CEO report

Sub Committee minutes Papers contain information and advice that is likely to prejudice or disadvantage negotiations

9(2)(j)

Moved: Helene Ritchie Seconded: Derek Milne CARRIED

The meeting closed at 1.25 pm.

6 DATE OF NEXT MEETING

Friday 11 December 2015 at 10.30 am, Boardroom, level 11, Grace Neill Block, Wellington Regional Hospital

CONFIRMED that these minutes constitute a true and correct record of the proceedings of the meeting

DATED this ................................................day of...............................................2014

VIRGINIA HOPECCDHB BOARD CHAIR


11

PUBLIC


BOARD NOTING PAPER

Date: 11 December 2015

Author S Williams, Acting Director SIDU

Endorsed By Debbie Chin, Chief Executive CCDHB

Subject Matters arising update

RECOMMENDATION

It is recommended that the Boards

a. Note the matters arising update.

Action 1.4 ex FRAC meeting 24 July 2015FRAC requested the Board receive an update on Ambulatory Sensitive Hospital (ASH) actions. The 2014/15 quarter 4 target results including an update on progress against the targets is shown below,and will be useful as background information when considering planning capacity and capability for next winter.Table 1. CCDHB Q4 2014/15 ASH performance against target

Age-group 2014/15 target Actual (12 months to

March 2015)

Target achieved?

0-74 years 95 93 ¸

0-4 years 95 89 ¸

45-64 years 95 94 ¸

Figure 1. CCDHB ASH rates per 100,000, 0-74 years


12

PUBLIC


CCDHB has achieved its ASH target for 0-74 year olds. The rate for Māori has decreased slightly in the most recent period whereas the rate for Pacific has increased. This is due to an increase in dental conditions (+49 events from last year), pneumonia (+26), and asthma (+15).Figure 2. CCDHB ASH rates per 100,000, 0-4 years

CCDHB has achieved its ASH target for 0-4 year olds. The rate for Pacific has increased in the most recent period. This is almost entirely due to an increase in dental conditions (+23 events from last year).Figure 3. CCDHB ASH rates per 100,000, 45-64 years

CCDHB has achieved its ASH target for 45-64 year olds. The rate for Māori had been trending upwards however has decreased in the most recent period whereas the rate for Pacific has increased. This is due to an increase in pneumonia (+13 events), nutrition and anaemia (+6), and cellulitis (+5).MoH feedback:“The 0-74 group for both Māori and non-Māori is now not required to be reported.The targets 0-4 and 45-65 age groups for total population have been met, well done.The 0-4 Māori group has shown improvement and is achieved, however as stated in the report, Pacific children's ASH has significantly increased over the last two quarters and there needs to be a clear focus on improving the rates of dental admissions for this group in the intervention planning, this target is not achieved.


13

PUBLIC


The 45-64 Māori group has shown a decreased trend for ASH conditions in this age group, however over time there has been an increase, so it will be important to keep a focus on planning for this group to ensure these trends do not rise again. The 45-64 Pacific group has increased significantly, so this is of concern. The top conditions for this group are respiratory illness and skin conditions, so a focus on more preventative planning for this group is needed. Overall your intervention logic within your planning has improved significantly, so well done on this work.”DHB Actions:Dental - The Community Dental Service has been working on initiatives to increase Pacific and Māori preschool enrolments in the service. In November 2014, the service developed a plan to increase all preschool enrolment to meet the Ministry of Health target of 85 per cent in 2015. This plan includes PHO data-match initiatives, new-born enrolments, the service Early Intervention and Prevention teams work with selected early childhood centres, community groups and at community-based events, and improved administration processes. These are all underway currently.This year the data-match has been extended into other areas and combined with the other initiatives preschool enrolment has increased markedly – as at 30 June 2015 CCDHB preschool enrolment is 71per cent and HVDHB is 64 per cent. In July 2015 a three month project was implemented with members of the Hutt Valley Governance Group (HVGG) to use their organisational networks and staff to assist Bee Healthy Regional Dental Service in disseminating key oral health messages and improving engagement with the dental service amongst their communities throughout the Hutt Valley. As a result of these initiatives pacific preschool enrolment has increased significantly .The data for April 2015 has CCDHB doubling in the percentage of Pacific pre-schoolers enrolled, now at 64 per cent and higher than any other ethnic group. Hutt was at 51 per cent. As these initiatives are ongoing we expect Pacific preschool enrolments to continue to increase.The service Early Intervention and Prevention team has developed a two year plan that involves visiting 20 targeted Pacifica early education centres across both the DHB’s. The visits to these centres include enrolling children who are not accessing the service and a dental therapist providing knee to knee dental checks. The team also work with the centre to implement policy changes to improve oral health.45-64 years – The DHB is working with PHOs to ensure an increased focus on addressing ASH for this age group. The ICC Long term conditions group has a focus on respiratory conditions and improving self-management.The Health Care Home practices selected in the recent EOI process include several practices with high ASH rates and/or high numbers of ASH. It is expected that the Health Care Home will reduce the numbers of ASH and this is one of the indicators.The Porirua Social Sector Trial continues to have positive impact on ASH in the Porirua area. The trial aims to reduce the number of children hospitalised with preventable conditions such as asthma, respiratory tract infections, dental problems and skin infections.From July 2012 to March 2015 there was a 61 per cent decrease, from 44 to 27 annual presentations of cellulitis (a bacterial skin infection), for children aged 0-4 years, and a 32 per cent decrease, from 34 to 11 annual presentations, for children aged 5-14 years.School facilities have been improved to ensure children can properly wash their hands and have cuts treated effectively to reduce the risk of skin infections.As a result of the trial there has also been a 52 per cent increase in the number of children enrolled with the Wellington region’s Bee Healthy dental service, and more than 9,000 school children have been provided with dental packs.There is a nurse available at the Porirua WINZ office and at the District Court. The Porirua Asthma Service is also providing free swimming lessons to asthmatic children from low socio-economic families.


14

PUBLIC



15

Meeting Type: BOARD PUBLIC

SCHEDULE OF ACTION POINTS – OCTOBER 2015 PUBLIC MEETING

Board Meeting 9 October 20151.5 Matters arising The Board requested that the Compass Health analysis of ED

presentations be discussed at HAC with the findings summarised for the December Board meeting

CEO/COO Discuss at HAC then provide summary for the Board

October 2015 √

2.3 CEO report Management were requested to consider suicide prevention and postvention support for families as the 2015-2017 plan develops

Acting Dir SIDU Consider and include in 2015-2017 plan

Noted and ongoing

Board Meeting 14 August 20153.2 Draft Wellington

region suicide prevention and postvention action plan 2016/17

Provide information to the November CPHAC/DSAC meeting and then to December Board:

∑ on zero suicides including from the UK and USA regarding approach, evidence and implementation

∑ illustrating community initiatives that could be added into the report

Provide the NZ based systematic review/report on the relationship between suicide and sexual abuse

Dir SIDU

Dir SIDU

Information paper to CPHAC/DSAC and then to Board

House in resource centre

WIP / February 2016

When available

3.2 Draft Wellington region suicide prevention and postvention action plan 2016/16

Include in the CEO report regular updates on the coroner’s suicide statistics, taken from the mental health nationalreporting cycle

GM MHAIDS Include in CE report Noted and ongoing

4.2 CEO report Work with Porirua City Council Mayor to coordinate and further discussions on the Kenepuru Accident & Medical

COO Coordinate meeting COO has had verbal discussions with

Porirua Mayor/WIP

4.2 CEO report Include obesity prevention as a topic for a strategic workshop or future Board meeting to link this into the Board’s strategy paper and to discuss how to pilot a project within the region

Secretary Schedule into work plan 2016, date to be confirmed

Board Meeting 12 June 20153.1 Primary Care

presentation and The Board requested that capitation and funding rates for the CCDHB PHOs be included in the next PHO presentation

Dir SIDU Include in next PHO presentation

2016, date to be confirmed

AP No.

Topic Action Responsible How Dealt with Delivery date Complete


16

update3.1 Primary Care

presentation and update

The Board requested a workshop on funding for high needs populations, including through primary health, be scheduled into the Board workplan

SecretarySchedule into the workplan

2016, date to be confirmed

3.1 Primary Care presentation and update

The Board requested management to include the issues raised in the SRPSHAG update be included the wider organisational activity on integrated care and as part of future PHO reporting to the Board

Dir SIDU Reported to CPHAC, and all PHOs met with directly with SRPSHAG

November 2015 √

4.1 Chair report The Board requested management to arrange a workshop to discuss the availability and adequacy of geriatric and palliative care and to include an invitation to clinicians

CEO Schedule into the 2015 workplan

Discussed at Board workshop July 2015. Further discussion

planned at November 2015 Board workshop

√

5.1 Echo screening for rheumatic heart disease

The Board requested a workshop on rheumatic fever prevention activities to include echo screening be scheduled into the 2015 workplan and that:∑ Relevant clinicians and other specialists be invited to

participate in the workshop∑ A report is received prior to the workshop∑ The result of the national evaluation of the rheumatic

fever prevention programme be included

Dir SIDU Schedule into the 2016workplan

2016 date to be confirmed

3DHB HAC meeting 15 May 2015H77 Operational Services

ReportFollowing the presentation to HAC, the committee requested that Dr Anne O’Donnell be invited to present/speak at a Board workshop

Chair Present at Board workshop

Deferred from 2015. 2016, date to be

confirmedBoard Meeting 8 November 20134.1 CEO report Schedule a presentation to the Board by HWFNZ Chair Chair and new CEO Invitation extended;

2016 date to be confirmed


17

PUBLIC


BOARD DISCUSSION PAPER

Date: December 2015

Author Virginia Hope, CCDHB Chair

Subject Chair report, December 2015

RECOMMENDATION:

It is recommended that the Board:

a. NOTES this report

b. ENDORSES the recommendations arising from the recent Palliative Care presentation to the Board:

i. That the Level 1 ACP training course be made available to those Board Members interested in completing it.

ii. That the Board and/or regional submission on the refreshed health strategy include ‘dying well’ as a key direction and the Board and Board members promote this view opportunistically.

iii. That this presentation be shared with other DHBs and further conversations in this area be sub-regional.

iv. That the view of informed carers be reported to the executive, Integrated Care Collaborative and Board on at least a two yearly basis.

v. That the Board support legislative and policy moves towards greater observance of expressed patient wishes especially in the context of ACP.

vi. That the Board Chair and Chief Executive investigate regional and sub-regional options for more consistent Level 2 training to be available.

vii. That management be asked to investigate the possibilities for sharing relevant patient information between primary care, hospitals and hospices.

viii. That the Lower North Island (LNI) Palliative Clinical Care network be continued through the regional plans.

ix. That management develop a systematic and robust approach to the implementation of Palliative ACP for CCDHB. This could be sub-regional or regional if DHBs share their priority.

x. That the Chair formally thank the Palliative Care team (Dr Jonathan Adler, Alison Rowe, Helen Rigby and Catherine Epps) for their well-structured, informative and thought-provoking presentation.

c. NOTES the Minister’s approval of the 2015/16 annual plan.

APPENDIX:Letter from the Ministers of Health and Finance approving the 2015/16 annual plan

The Board held a workshop on palliative care and research on 13 November.1.1 Palliative Care

An excellent presentation was received on the palliative care system including palliative clinical care and advanced care planning (ACP). Palliative care is helping people live well with incurable illness and helping people tolerate the possibility of dying.

CCDHB PUBLIC AGENDA, 11 DECEMBER 2015 - FOR DISCUSSION

18

PUBLIC


Recommendations arising from that session include:

∑ That the Level 1 ACP training course be made available to those Board Members interested in completing it.

∑ That the Board and/or regional submission on the refreshed health strategy include ‘dying well’ as a key direction and the Board and Board members promote this view opportunistically.

∑ That this presentation be shared with other DHBs and further conversations in this area be sub-regional.

∑ That the view of informed carers be reported to the executive, Integrated Care Collaborative and Board on at least a two yearly basis.

∑ That the Board support legislative and policy moves towards greater observance of expressed patient wishes especially in the context of ACP.

∑ That the Board Chair and Chief Executive investigate regional and sub-regional options for more consistent Level 2 training to be available.

∑ That management be asked to investigate the possibilities for sharing relevant patient informationbetween primary care, hospitals and hospices.

∑ That the Lower North Island (LNI) Palliative Clinical Care network be continued through theregional plans.

∑ That management develop a systematic and robust approach to the implementation of Palliative ACP for CCDHB. This could be sub-regional or regional if DHBs share their priority.

∑ That the Chair formally thank the Palliative Care team (Dr Jonathan Adler, Alison Rowe, Helen Rigby and Catherine Epps) for their well-structured, informative and thought-provoking presentation.

Since the workshop, the Programme Director for ACP (Leigh Manson) has confirmed there may be a need to review the role of the Enduring Power of Attorney in relation to an ACP. This will be raised at a National Roundtable. Board member, Sue Kedgley, was thanked for raising such a pertinent point.

1.2 Research presentationDr Geoff Robinson led a presentation by Drs Andrew Harrison, Richard Beasley, Paul Young and Marina Dzhelali, Service Leader, Research, on research activity at CCDHB, and recent publications in internationally renowned medical journals.The Board was extremely impressed with the quality of applied clinical research as illustrated by Dr Beasley (Medical Research Institute of New Zealand).Dr Young described the heightened research activity in ICU with nearly half of our patients involved in many clinical trials. He highlighted the very low standardised mortality ratio of the CCDHB ICU, with the lowest rate in Australasia at the 99th percentile. Recent research includes whether paracetamol is of benefit in managing fevers.The Board was left with a strong impression that CCDHB clinicians “punch well above their weight” in reviewing, through their research, time-honoured and more recent treatment where the evidence for those treatment benefits has previously been thought to be strong, but this has been untested.

1.3 CCDHB plan 2015/16Attached for the Board’s information is a letter dated 23 October 2015 confirming sign off of the CCDHB 2015/16 annual plan by the Ministers of Health and Finance. It is extremely pleasing to have the plan signed off so early in the year.

1.4 Equity1.4.1 Meeting with D Leyland and J Cody (UCAN)A very useful discussion was held with UCAN representatives on a range of subjects (patient access, community resilience and healthcare policy). A number of initiatives to improve access, equity and consumer input were discussed and I have agreed to meet quarterly to stay in touch while we move forward on these initiatives.


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1.4.2 Grand RoundA recent Grand Round on “Income inequality and illness, several birds with one stone” indicates that activity and focus in this area is occurring at the clinical level as well as in SIDU planning.

1.5 Wellington Hospital’s Foundation (WHF)A Melbourne Cup fundraiser was held at Rydges Hotel for the WHF Wellington Children’s Hospital fund, which now exceeds $600,000.

1.6 Health Lives national science challengeThis challenge was launched at Otakou Marae, Dunedin, on 4 December 2015.

1.7 Telecommunications announcementThe Ministry of Business, Innovation and Employment (MBIE) recently announced to all DHBs and Government departments that contracts have been signed with a number of suppliers for MBIE’s Telecommunications as a Service (TaaS) panel. Their announcement is below for the Board’s information.“Dear colleagues, We are delighted to announce that contracts have been signed with twelve suppliers for our innovative new Telecommunications as a Service (TaaS) panel. TaaS is designed to make it easier and cheaper for you to access communications and managed security services, and we estimate it will drive cost savings to government of $20-30 million over the next two years. We’ve done the hard yards to establish very competitive pricing based on fit-for-purpose terms and conditions so you can simply consume what and how much of these services you need to run your business. TaaS will help us establish strong platforms for developing customer-centric integrated public services. It also gives our suppliers the opportunity to work with government to effect real change for New Zealanders. TaaS creates an open, competitive market giving you choice and will continue to drive value through service innovation and price point. TaaS is a significant transformation of this telecommunications and managed security services market. TaaS has a range of services categories delivered through a standardised technology approach, supplied and managed by several providers. You will have the choice of providers and service solutions from the panel, to give you flexibility to meet your business and customer needs. We would like to thank the eight other government agencies who have contributed significant time and effort to develop this programme of work, and who are committed to taking up the new services as soon as possible. It is through their continued commitment to establish this transformational change, and engagement of the market on the basis of government as a single client, that we have been able to achieve this outcome for us all. This collaboration needs to continue in order to realise the value through consumption of this new service set. We need to be a single client, driving our aggregated demand into the services and suppliers as quickly as possible to be able to realise its benefits. The key features of the TaaS approach are:

∑ TaaS is designed to make it easier and cheaper for government to access communications and managed security services. Through very competitive pricing based on fit-for-purpose terms and conditions, you can simply consume the services you need to run your business.

∑ The TaaS services are delivered through a standardised technology approach, supplied and managed by several providers. With the choice of providers and service solutions, you have the flexibility to meet your business and customer needs and maximise your investment in technology services.

∑ The TaaS panel is open, allowing services to evolve as technology, delivery models and requirements change. This means the services and providers remain innovative, relevant and competitive, in an area that is constantly changing.

The value of the TaaS services and the financial benefits for us will be realised through:

∑ Use of consistent and interoperable service sets


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∑ Removal of costly individual procurement activities

∑ Competitive tension the TaaS open market approach creates, and

∑ Quickly delivering the aggregate of government’s requirements to the market by your consumption of the services.

This is an exciting opportunity to take advantage of innovative new telecommunications and managed security services, as soon as your current contracts allow. Transition options will be available for you to move to TaaS services according to your investment plans and business needs. Tim Occleshaw, Government Chief Technology Officer, is writing to your senior ICT leaders with more details of the services and take-up options. More information can also be found on the ict.govt.nz website at:https://www.ict.govt.nz/services/show/TaaS.”


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BOARD DISCUSSION PAPER

Date: 11 December 2015

Author Debbie Chin, Chief Executive

Subject CHIEF EXECUTIVE’S REPORT

RECOMMENDATIONIt is recommended that the Board:

a. NOTES the contents of this reportb. NOTES the financial results for October 2015 and the year ot date unfavourable variance of ($1,940k).

APPENDICES1. Detailed financial summary, October 20152. 3 DHB balanced scorecards (hospital provider and MHAIDS), October 20153. CCDHB participation in ShakeOut national earthquake drill

1 – FINANCIAL UPDATE1.1 Financial Overview

The DHB result is unfavourable to budget by ($329k) for October 2015 and unfavourable by ($1,940k) YTD to budget. The DHB has a deficit of $1,123k) for the month and YTD deficit of ($7,076k).

Net resultOct 15

Actual $Oct 15

Budget $Month

Variance $YTD

Actual $YTD

Budget $YTD

Variance $

Total DHB (1,123,000) (794,000) (329,000) (7,076,000) (5,136,000) (1,940,000)

The unfavourable variance of ($329k) includes an adjustment of ($187k) for a lower payment receivedof 14/15 inter-district flows (IDF) and elective wash up and a write off of ($200k) being a partial release of the loss on disposal of the Linac Accelerator. The monthly deficit of ($1,123k) includes a provision of $700k for payment of lieu leave and penals for the Labour Day public holiday at the end of October. The winter flu season started earlier than last year and has significantly impacted the activity of the hospital and NGO providers in the first quarter. Although the activity is slightly higher than the same period last year the high volumes are reducing. The bed days are 0.2% higher; discharges are 0.5 per cent higher, and case weight throughput is higher by 1.7 per cent. In house theatre activity is showing an increase of 5 per cent due to a focus of more procedures done in the hospital theatres and less outsourcing of elective procedures. IDF elective case weights discharges (CWDs) are 320 higher than budget to end of October 2015 The October 2015 detailed financial summary is attached for the Board’s information. It is worth noting that activity has been higher than for the same period last year due to a longer ‘winter flu’ season, however the high volumes are reducing.

2 – SUB REGIONAL ACTIVITY (“WORKING WITH OUR NEIGHBOURS”)2.1 Provision of Ophthalmology services at HVDHB

Hutt Valley and Capital & Coast district health board management and clinicians have worked up a proposal to shift approximately half of elective ophthalmology surgery and associated outpatient appointments for Hutt Valley residents to Hutt Hospital. This will improve the patient journey for Hutt Valley residents, many of whom make several trips to Wellington or Kenepuru for pre-assessment, the


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day surgery and a post op check the following day. Most of these patients are either elderly or children. This proposal will result in a reduction in IDF-funded procedures undertaken by CCDHB resulting in a net saving for HVDHB.The proposal, which is strongly supported by both Chief Executives was presented to the 27 November HVDHB FRAC meeting by the CCDHB Executive Director, Surgery Women’s & Children’s Directorate and was unanimously supported by the committee, who commended the team on a paper that underlined the 2 DHBs’ joint commitment supported by clinical engagement.

2.2 Sub-Regional Clinical Leadership GroupClinical governance has been strengthened across the sub-region with the establishment of a clinical governance group to oversee services that are integrated across the Wairarapa, Hutt Valley and Capital & Coast district health boards. The group held its first meeting on 3 December.

3 – BUSINESS ACTIVITY

3.1 Shorter stays in EDCompliance with the Shorter Stays in ED target has reduced over the winter months as a result of high presentations to ED and high admission rates. These factors have resulted in high occupancy levels across the organisation which has impacted on patient flow. Results for September and October were 86.6 and 88.9 percent respectively. A comprehensive winter plan was in place however this was not able to address the increase in acute demand that was experienced. There has been a small improvement in November with the result being 90.6 percent for the month. Weekly compliance is detailed in the graph below.

Now that the demand is starting to ease performance is improving and the teams are refocusing to ensure flow improves. Priority areas of work in progress include:

∑ Surgical Assessment & Planning Unit (SAPU) trialling pulling appropriate GP referrals directly from ED to SAPU for review.

∑ The management of acute mental health patients presenting to ED.

∑ Duty Nurse Managers facilitating the daily hospital status meeting seven days a week, giving better oversight of the situation in the hospital.

∑ Hospital at Night meetings are continuing and provide an overview of patients likely needing admission and / or needing review by specialities.

Work has progressed on the development of the business case for additional beds which is being submitted to the December Board meeting.


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3.2 CCDHB Theatre Project - Get SMARTHow can we make the best use of the theatre resources we have and meet future demand?

Theatre productivity and throughput is one of the key priorities for CCDHB. Late September, a project sponsored by the Chief Operating Officer, was launched to look at how we might make the best use of our theatre resources and meet the future demand. The Theatre Leadership Group (TLG) has been established to govern the project and has spent time over the last eight weeks reviewing the data showing how we are currently using theatre time, and listening to ideas put forward by a range of people working in the perioperative environment. Seven priority themes have now been identified and include:

∑ Patient Cancellations

∑ Culture

∑ Data and reporting

∑ Future requirements

∑ Patient flow

∑ Planning and scheduling

∑ Unused lists.Multi-disciplinary teams have been established for each of the themes and will progress work over the next few months to identify improvements to ensure we are making the best use of all resources.Other priority areas include Orthopaedics, ophthalmology and cardiothoracic services.

∑ The implementation of the Orthopaedic project continues to support increased Orthopaedic surgery at Kenepuru. This has improved Orthopaedic capacity throughput as a whole to better meet the demands on the service. The elective discharge targets are now being met each month on a regular basis.

∑ The Ophthalmology project with Hutt Valley DHB continues and is on track to move approximately 10 theatre sessions per month from CCDHB to Hutt theatres. A new national scoring tool for cataract procedures is also being implemented. Planning is also in progress to transfer some other specialties from Wellington to Kenepuru to backfill the gaps created by ophthalmology moving to Hutt. Once this is finalised planning will commence to support the resourcing of the vacated Wellington sessions by Orthopaedics, which will in turn reduce the level of outsourcing.

∑ There is also a project looking at cardiothoracic volumes and throughput. The focus is on improving pre assessment processes to reduce the number of patient cancellations on the day of surgery, and scheduling of theatre lists to ensure the resourced lists are well utilised. Work to date has seen a definite improvement in scheduling of cases and managing patients within the clinically determined treat by dates.

3.3 Linear Accelerator ReplacementThe linear accelerator (linac) replacement project in the Wellington Blood and Cancer Services is progressing well against the project plan. The replacement linac was delivered on 12 September, installation was completed on 27 September and clinical use commenced on 3 November. This was achieved with significant effort from the staff of the radiation therapy service - both those who were involved in the clinical commissioning of the replacement linac and those involved in keeping the service operational on the two remaining linacs. The impact of the replacement linac has been apparent immediately as it now provides us with matching capability to the linac purchased in 2011.


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This has already made for improved patient management and scheduling. The new linac also allows more accurate positioning of patients for treatment and this is already making a difference for some patients. The overall project also included an upgrade to the 2011 linac and this should be completed before Christmas, leaving only some software upgrades to be finally completed in 2016.

3.4 ShakeOut National Earthquake DrillThe national ShakeOut drill was held throughout New Zealand on 15 October 2015. It was part of an international programme of drills to promote earthquake preparedness among populations in earthquake-prone countries – largely those around the Pacific Rim. This was the second drill NewZealand has participated in (the first was in 2012). 1.3 million people registered their intention to take part. The drill was sponsored by the Ministry of Civil Defence and Emergency Management, and the focus was on personal preparedness, and on promoting the actions to take before, during, and after earthquakes.3.4.1 CCDHB’s participationCCDHB arranged a number of activities intended to reinforce the key shakeout messages to staff. In the lead up to the day the Emergency Management team provided a series of information sheets and emailed these to all staff. The drill was promoted during regular emergency management staff training sessions. Six lunchtime ‘drop in sessions’ were held at Wellington, Kenepuru and the Kapiti Health Centre.On 15 October 2015 a display was mounted in the Atrium at Wellington Hospital. The start of the ‘drop cover and hold’ exercise at 9:15hrs was signalled with an emergency management email and group text messaging and a report outlining the exercise is attached.

3.5 Occupational Health & Safety update3.5.1 ACC accredited employer auditThe ACC Accredited Employer Audit was completed 8-10 September 2015. The DHB achieved tertiary standard for the 2014-2015 year. This is the highest level on the programme and provides an objective measure of our health and safety system performance. The audit findings were supported by three site visits, three focus group interviews (involving separate groups of employees and managers) and the review of eight staff injury claim files. Suggested actions to support our continuous health and safety improvement initiatives were tabled at the DHB Health and Safety Committee meeting in October. 3.5.2 Legislative trainingA review of training for managers to include an introduction to new legislation and responsibilities has begun. Training will be included as part of the core competency programme for managers and given priority by Learning and Development for progression.3.5.3 Staff vaccination programmeThe DHB Staff ‘flu vaccination programme overseen and resourced by the Occupational Safety & Health Directorate finished this month achieving a 7 percent increase in the percentage of staff vaccinated. This figure more than meets the current DHB H&S Plan objective “to increase by 5 percentthe number of staff overall vaccinated against seasonal influenza virus…” The improvement plan for next year involves collecting staff flu vaccination data through the payroll system so all services can monitor their own staff coverage and support uptake appropriately. 3.5.4 Injuries reported to WorkSafeNZOne incident met the current legislative definition of serious harm; on 2 September 2015 a staff member fell on stairs to the main entrance to new regional hospital and fractured a thumb. The incident was investigated and no modifiable contributing causes were identified. 3.5.5 Quarterly reportThe full report was presented to the November Hospital Advisory Committee and is included in the committee papers.


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3.6 Balanced scorecardsThe Provider Arm and Mental Health Addictions & Intellectual Disability Service (MHAIDS) September balanced scorecards are attached for the Board’s information. The glossary for the definitions of the service provision relating to the MHAIDS scorecard is attached as an appendix to the CEO report.

3.7 Pacific health: overview of service funding, service access and Pacific health outcomesThe paper on Pacific Health: Overview of Service Funding, Service Access and Pacific Health Outcomeswas presented to CPHAC/DSAC in September 2015. The Committee agreed to recommend to the Boards and the Sub-Regional Pacific Strategic Health Group (SRPSHG) the following next steps:

∑ Work with PHOs to ensure primary care funding streams continue to target the Pacific population particularly:

∑ i. Smoking rates with a focus on young mothers∑ ii. Obesity rates for both children and adults ∑ iii. Respiratory conditions such as Asthma and Chronic Obstructive Respiratory Disease (COPD)

where the disparities are not improving. ∑ Ensure investments by PHOs in each DHB target areas where disparity is not improving or is

deteriorating

∑ Work with Hutt Valley PHOs to improve overall access to general practice and particularly high needs populations including Pacific

∑ Report to CPHAC six-monthly using the equity indicator report and ' Ala mo'ui Progress ReportThe Chair SRPSHG thanked the Director and her team for this paper. He also extended his thanks to the Chief Executive, CCDHB and stated it was a good start on addressing the challenges facing Pacific people.The Director, SIDU noted that the amendable mortality rates were chosen deliberately because it looks at conditions that are amenable to health care. Rate of decline is the highest seen so encouraging but it also shows where to focus the efforts.The Chief Executive, CCDHB noted that there have been workshops at the CCDHB around the CCDHB Pacific Plan which was being consulted on.It was commented that other data around the improving levels of enrollment and GP consultations were positive; however the issues still exist around the access to these services. ED presentations are high. There is still a gap between Pacific and mainstream.The Director Pacific responded to the discussion and noted that she works closely with the SIDU team. Resources are limited and it is important that the teams work together. It was noted that in order to curb the inevitable outcomes for Pacific people, that the Pacific team focus on improving child health and long term conditions. These outcomes are consistent with the SRPSHG priorities but also include Do Not Attend and reducing Ambulatory Sensitive Hospitalisations (ASH) rates. Both the Pacific Directorate and SIDU will continue to work together and ensure that PHOs were monitored on their performance particularly in respect to Pacific health outcome improvements. A meeting with the Directors Pacific for Hutt Valley, Wairarapa and Capital and Coast, and the Acting Director of Service Integration and Development to discuss this further will be reported on to theCPHAC/DSAC committee at its January meeting. The Director noted the Members comments and the importance of intervention logics, including how they attribute outputs and outcomes to individual services. There is a need for clear descriptions of services and what we will be monitoring.The Deputy Chair asked about comparing our Pacific Health needs data to other DHBs. Advice was that we are dealing with small numbers and there are interesting patterns and some DHBs are improving and some are not. The team will consider further what has worked elsewhere and what can be incorporated into the local work.Capital and Coast DHB are in the process of finalising the draft Pacific Action plan of which the Ministry of Health Ala Moui: Pathways to Pacific Health and Wellbeing 2014-2018 key performance indicators and the 3DHB Equity indicators are incorporated into the plan. The Ala Moui key


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performance indicators measure the performance of eight DHBs including Hutt Valley and Capital and Coast. A meeting with the CCDHB PHOs and SRPSHG was held on 22 October. Compass, Ora Toa and Well Health presented to the SRPSHG on how they were meeting the needs of their Pacific populations. The presentations were well received and the SRPSHG acknowledged the work that is currently being undertaken.

3.8 2016/17 annual planWork has commenced on the 2016/15 annual planning including engagement with our advisory/partnership groups.

3.9 Laboratory updateSouthern Community Laboratory Wellington (WSCL) formally took over the management of the hospital laboratory on 1 November 2015. Community laboratory services have been under the stewardship of SCL since it took over Aotea Community Laboratories earlier this year.

4 – OTHER MATTERS OF INTEREST4.1 The CCDHB chief executive and executive team members recently hosted a visit from senior officials

from Beijing Hospital, and the Chinese Ambassador and his wife. The delegation’s focus was on aging population and their care and how, as a provider, CCDHB implements policies and provides services; what works, and what improvement opportunities are defined. The delegation had visited facilities in the South Island prior to the CCDHB visit and was visiting further facilities in the North Island before leaving New Zealand.A full programme saw the delegation visit CCHDB’s emergency department, intensive care unit, and integrated operations centre. This was followed by presentations on the health system in New Zealand including examples of elder care working together within the hospital and community settings, together with projects that showcased CCDHB in terms of its initiatives for elder care and research. The delegation then toured Te Hopai and Malvina Major retirement homes before day’s end. The delegation was very appreciative of the time taken to show them around and the free exchange of information that assisted them to further understand how elder care is delivered in New Zealand.

4.2 Public Health PostThe October update is attached for the Board’s interest.


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CCDHB Financial Overview Page 1 3 December 2015

Capital & Coast DHB

Financial Overview

October 2015

Chief Executive OfficerDebbie Chin

Chief Financial OfficerTony Hickmott


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FINANCIAL PERFORMANCE OVERVIEW

The DHB result is unfavourable to budget by ($329k) for Oct 2015 and unfavourable by ($1,940k) YTD to budget.

The DHB has a deficit of ($1,123k) for the month and YTD deficit of ($7,076k).

The unfavourable variance of ($329k) includes an adjustment of ($187k) for a lower payment received of 14/15 IDF and elective wash up and a write off of ($200k) being a partial release of the loss on disposal of the Linac Accelerator. The monthly deficit of ($1,123k) includes a provision of $700k for payment of lieu leave and penals for the Labour Day public holiday at the end of October.

The winter flu season started earlier than last year and has significantly impacted the activity of the hospital and NGO providers in the first quarter. Although the activity is slightly higher than the same period last year the high volumes are reducing. The bed days are 0.2% higher;discharges are 0.5% higher, and case weight throughput is higher by 1.7%. In house theatre activity is showing an increase of 5% due to a focus of more procedures done in the hospital theatres and less outsourcing of elective procedures. IDF elective CWDs are 320 higher than budget to end of October 2015

Note additional pressure for the following

∑ IDF revenue pressure for the year of $2m due to the change in WIES valuation∑ Cost pressures due to MECA settlements of 2% increases are higher than funded cost pressure of 0.37% ∑ Continuing costs of National and Regional programmes


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The contribution to the year to date variance is across the board as shown below:

Mental Health is slightly favourable YTD against budget and is forecasting to remain so.

SIDU external payments for capitation and aged residential care have followed the higher winter activity trend seen in the hospital and are also adverse to budget.

The DHB has significantly changed the phasing profile of revenue from the MoH for the 15/16 year. Revenue is now recognised on a 1/12th basis instead of phased based on “notionally” earned. The revenue is also now centralised in the Chief Executive’s cost centre. This is to focus managers on cost control and allow greater transparency of the base funding.

Headline Activities in October 2015 Compared to October 2014

Directo ra teYT D

VarianceProvider HHS (2,686,929)Mental Health 74,752SIDU (1,571,561)Corporate/Other 2,243,472Total DHB Variance (1,940,266)

Oct-15 Oct-14 Variances

1st Four Months15/16

1st Four Months 14/15 Variances % change

Discharges 5482 5614 (132) 22014 21898 116 0.5%Caseweights 5751 6043 (292) 23579 23181 398 1.7%Bed day hours 12165 13644 (1,479) 52537 52451 86 0.2%Length of Stay (excluding day patients) 3.7 3.9 (0.2) 3.9 3.8 0.1 2.9%ED Presentations 5190 5082 108 21254 20764 490 2.4%ED Admissions 1799 1838 (39) 7344 7660 (316) -4.1%Theatre Throughput 1499 1421 78 5764 5488 276 5.0%Productive FTE (Medical, Nursing, Allied excl MH) 2490 2479 -0.44% 2500 2415 3.52% 3.5%


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CCDHB Material Variances YTD October 2015 (also refer to variance detail discussion in the report)

The key variances to budget were:

ß Revenue $3,354k favourable mainly due to additional MoH funding and IDFs $2,537k, ACC revenue $353k and other income $464k;ß Personnel costs are favourable by $111k. Allied and management/admin are all favourable and offset the unfavourable variances in

medical, nursing and support staff. Nursing costs are impacted by lieu days and penal costs for the statutory holiday at the end of October;ß Outsourced personnel are ($522k) unfavourable. This offsets vacancies mainly in medical and allied personnel;ß Treatment related costs – Clinical Supplies ($2,485k) unfavourable. Higher hospital activity has resulted in increased usage of clinical

supplies in all categories. Savings opportunities in clinical supplies cost is an ongoing focus. Some clinical supplies have offsetting revenue in the revenue line;

ß Treatment related costs – Outsourced costs are $387k favourable due to phasing of outsourced elective procedures;ß Non-treatment related expenses are ($1,461k) unfavourable and partially impacted by winter demand on hospital services as well as

ongoing facility maintenance costs and facility project fees;ß IDF Outflows are $2k favourable;ß External Provider payments are ($1,574k) unfavourable due to higher Capitation and Aged Care costs, all of which are demand driven.

Some external provider costs have offsetting additional revenue of $1,052k from MoH;ß Interest, depreciation and capital charge have a $247k favourable variance due to savings in depreciation and capital charge.


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CCDHB Operating Results at the End of October 2015Capital & Coast DHB

Operating Results

Actual Budget Last yearActual vs Budget

Actual vs Last year

YTD October 2015Actual Budget Last year

Actual vs Budget

Actual vs Last year

Year end forecast

Annual Budget Last year

Forecast vs Annual Budget

Forecast vs Last year

61,012 60,169 61,203 843 (191) Devolved MoH Revenue 243,344 241,650 245,734 1,694 (2,391) 725,252 725,252 714,539 0 10,7133,912 3,245 2,808 667 1,104 Non-Devolved MoH Revenue 13,648 12,805 12,794 843 854 38,377 38,377 39,291 0 (914)2,332 2,355 6,377 (23) (4,045) Other Revenue 10,523 9,537 14,859 986 (4,335) 29,676 29,676 40,949 0 (11,273)

16,665 16,747 15,895 (82) 770 IDF Inflow 66,908 67,239 60,552 (330) 6,356 201,216 201,216 193,715 0 7,501768 764 746 4 22 Inter DHB Provider Revenue 3,227 3,066 2,639 161 587 8,418 8,418 7,784 0 634

84,690 83,281 87,029 1,409 (2,339) Total Revenue 337,650 334,296 336,578 3,354 1,072 1,002,940 1,002,940 996,278 0 6,662

Personnel11,624 11,653 11,487 28 (137) Medical 46,871 46,701 44,617 (170) (2,253) 137,061 137,061 133,207 0 (3,854)14,412 13,905 13,370 (507) (1,042) Nursing 55,945 55,509 52,165 (436) (3,780) 167,282 167,282 159,156 0 (8,126)

4,865 5,000 4,841 135 (24) Allied Health 19,483 19,963 18,749 480 (734) 54,819 54,819 56,120 0 1,301682 717 759 35 76 Support 2,894 2,845 2,763 (50) (132) 8,547 8,547 8,359 0 (188)

4,887 5,013 5,023 127 136 Management & Administration 19,844 20,130 18,983 286 (861) 58,924 58,924 56,517 0 (2,407)36,470 36,288 35,480 (182) (991) Total Employee Cost 145,037 145,148 137,277 111 (7,760) 426,632 426,632 413,359 0 (13,273)

Outsourced Personnel437 273 393 (164) (45) Medical 1,352 1,091 1,489 (260) 137 3,257 3,257 3,789 0 531

7 8 14 1 7 Nursing 42 32 38 (9) (4) 97 97 88 0 (8)166 50 52 (116) (113) Allied Health 411 203 195 (209) (216) 597 597 665 0 69156 158 157 1 0 Support 623 652 632 29 10 1,882 1,882 2,012 0 130120 84 134 (36) 13 Management & Administration 412 340 806 (72) 393 1,013 1,013 2,570 0 1,557887 573 750 (314) (137) Total Outsourced Personnel Cost 2,840 2,318 3,160 (522) 320 6,846 6,846 9,124 0 2,278

9,732 8,735 11,244 (997) 1,512 Treatment related costs - Clinical Supp 38,150 35,665 39,789 (2,485) 1,639 98,207 98,207 112,892 0 14,6851,096 1,110 1,609 14 513 Treatment related costs - Outsourced 4,444 4,832 4,588 387 143 19,898 19,898 16,661 0 (3,238)5,154 4,844 5,257 (310) 103 Non Treatment Related Costs 21,512 20,052 21,246 (1,461) (266) 57,654 57,654 59,980 0 2,3265,758 5,962 7,030 205 1,272 IDF Outflow 23,776 23,778 23,512 2 (264) 71,348 71,348 67,682 0 (3,667)

21,851 21,615 22,244 (235) 394 Other External Provider Costs 89,501 87,927 86,951 (1,574) (2,549) 262,674 262,674 258,257 0 (4,417)4,865 4,946 5,194 82 330 Interest Depreciation & Capital Charge 19,465 19,712 20,992 247 1,527 58,240 58,240 62,307 0 4,067

48,455 47,213 52,579 (1,242) 4,124 Total Other Expenditure 196,849 191,966 197,078 (4,883) 229 568,022 568,022 577,778 0 9,75685,812 84,074 88,808 (1,738) 2,996 Total Expenditure 344,726 339,432 337,515 (5,294) (7,211) 1,001,500 1,001,500 1,000,261 0 (1,239)

(1,123) (794) (1,779) (329) 656 Net result (7,076) (5,136) (936) (1,940) (6,140) 1,440 1,440 (3,983) 0 5,423

(27,609) (27,578) 1,669 (31) (29,277) Funder (113,277) (111,706) 7,289 (1,571) (120,565) (334,023) (334,023) 25,606 0 (359,629)(703) (672) (31) (31) (672) Governance (2,712) (2,645) (43) (67) (2,668) (7,851) (7,851) 0 0 (7,851)

27,188 27,456 (3,417) (268) 30,605 Provider 108,912 109,215 (8,181) (303) 117,094 343,313 343,313 (29,589) 0 372,902(1,123) (794) (1,779) (329) 656 Net result (7,076) (5,136) (936) (1,940) (6,140) 1,440 1,440 (3,983) 0 5,423

AnnualVariance

Month -October 2015Variance

Year to DateVariance


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Volumes/Activities

Capital & Coast DHBHospital Throughput


Actual vs Last year

YTD October 2015


Actual vs Last year


Discharges1,846 1,910 (64) Surgical 7,129 7,220 (91) 21,1052,621 2,659 (38) Medical 10,687 10,544 143 29,9771,015 1,045 (30) Other 4,198 4,134 64 11,6935,482 5,614 (132) Total 22,014 21,898 116 62,775

CWD2,894 2,930 3,136 (36) (242) Surgical 11,417 11,641 11,299 (224) 118 34,422 33,3322,018 1,999 1,991 19 27 Medical 8,517 8,176 8,188 341 329 23,618 23,511

839 897 916 (58) (77) Other 3,645 3,624 3,694 21 (50) 10,135 10,0855,751 5,826 6,043 (75) (292) Total 23,579 23,441 23,181 138 398 68,176 66,928

Other5,190 5,082 108 ED Presentations 21,254 20,764 490 60,2493,391 3,244 147 ED Non-Admitted 13,910 13,104 806 38,8621,799 1,838 (39) ED Admissions 7,344 7,660 (316) 21,3871,499 1,421 78 Theatre Throughput 5,764 5,488 276 15,988

12,165 13,644 (1,479) Bed Days on discharge 52,537 52,451 86 149,3483.72 3.89 (0.2) ALOS Inpatient 3.89 3.78 0.1 3.902.22 2.52 (0.3) ALOS Including Day Patients 2.39 2.49 (0.1) 2.40

Month Year to DateVariance Variance

Annual


33


DHB Employee FTE Measures

Personnel costs are the DHB’s single largest expenditure category, budgeted at $426m. For this reason, we monitor and report several different measures for personnel which allow for different insights into our performance.

Contracted FTE

The contracted FTE is the permanent hours each employee is contracted to work as set up in payroll (note capped at 1FTE per employee).

Increased Contracted FTE from 1 July to 31 October

The growth in Contracted FTE has been classified into categories as shown in the table above. All FTE continue to be approved via the approval to appoint (ATA) process requiring approval by the CEO and Board Chair.

Although an increase in permanent FTE the below categories are deemed to not adversely impact the DHB bottom line.

Externally funded - Positions directly offset with additional revenue – 8.56 FTE

Casual to Permanent – This is budgeted expenditure which is converted to permanent FTE with no additional costs – 5.5 FTE

Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15Medical 604 597 603 602 620 614 630 630 614 628 624 623 622 624 633 630Nursing 1,861 1,858 1,859 1,842 1,840 1,840 1,889 1,889 1,876 1,893 1,903 1,908 1,897 1,908 1,916 1,928Allied Health 740 743 736 743 746 745 741 742 741 735 741 739 747 747 758 754Non Health Support 159 156 155 153 158 156 158 156 157 158 161 160 161 164 164 163Managemt/Admin 808 813 821 818 823 813 807 818 821 819 825 830 833 840 842 837Actual Contracted FTE 4,172 4,167 4,173 4,158 4,187 4,167 4,225 4,235 4,209 4,233 4,254 4,260 4,260 4,283 4,313 4,312

Actu

alTo

tal

No bottom line impact Increases bottom linePersonnel Category Externally Funded Position Casual to Permanent Business Improvement Compliance/Safe staffing Activity/Demand TotalALLIED HEALTH PERSONNEL 4.9 0 1 2 2 9.9MANAGEMENT/ADMINISTRATION PERSONNEL 0.8 0 0 0 3.3 4.1MEDICAL PERSONNEL 0.5 0 6.74 1 5.94 14.18NURSING PERSONNEL 2.36 5.5 2 3.4 5.8 19.06SUPPORT PERSONNEL 0 0 0 1 0.3 1.3Total CCDHB 8.56 5.5 9.74 7.4 17.34 48.54


34


Business Improvement – FTE associated with signed off Business cases which have a verified payback – 9.74 FTE

The two categories below have been deemed to adversely impact on the DHB bottom line.

Compliance and Safe staffing – Roles required to maintain patient safety or compliance with appropriate standard 7.4 FTE

Activity /Demand- Roles which have been required to support additional workload / activity (note some of this activity may be funded by IDF) 17.34 FTE Some of the roles classified as Activity Demand are fixed term roles to cover peaks in workload.

The remaining balance relates to vacancy rates which fluctuate up and down with staff turnover

Employee FTE Financial Reporting to Ministry of Health (MoH)

For financial accounting purposes, the MoH require an accrued FTE measure (as shown in the table below). This measure includes all hours on an accrual basis, including leave accruals, overtime and casual hours. As an FTE measure, this is highly volatile for a 24/7 facility due to the divisor being set based on the number of working days in the month.

Capital & Coast DHBFTE


Actual vs Last year


Actual vs Budget

Actual vs Last year

Year end forecast




FTE793 792 809 (1) 16 Medical 834 816 813 (18) (21) 820 819 827 (1) 7

2,083 2,029 1,994 (54) (89) Nursing 2,099 2,090 2,016 (9) (84) 2,120 2,120 2,099 0 (21)771 754 765 (16) (6) Allied Health 782 780 760 (2) (23) 723 723 763 0 40166 172 168 6 1 Support 179 177 169 (1) (9) 180 180 176 (0) (5)814 833 842 18 28 Management & Administration 855 867 841 12 (14) 872 872 841 (0) (31)

4,627 4,580 4,578 (47) (50) Total FTE 4,749 4,730 4,598 (20) (151) 4,715 4,715 4,705 (0) (10)Average $ per FTE

14,656 14,709 14,193 54 (463) Medical 56,208 57,259 54,906 1,051 (1,302) 167,147 167,306 161,030 159 (6,277)6,919 6,855 6,706 (64) (213) Nursing 26,649 26,559 25,878 (90) (771) 78,906 78,895 75,826 (12) (3,068)6,314 6,628 6,329 315 16 Allied Health 24,902 25,596 24,682 693 (221) 75,821 75,774 73,560 (47) (2,215)4,100 4,157 4,521 57 422 Support 16,187 16,029 16,305 (158) 117 47,444 47,445 47,607 1 1636,002 6,021 5,966 20 (36) Management & Administration 23,211 23,226 22,580 15 (631) 67,574 67,610 67,219 36 (391)7,881 7,923 7,750 42 (131) Cost per FTE all Staff 30,539 30,688 29,855 150 (684) 90,481 90,490 87,846 9 (2,635)

AnnualVariance Variance Variance

Month -October 2015 Year to Date


35


Treatment Related costs - Clinical Supplies and Outsourced Clinical ServicesTreatment Related costs show an unfavourable YTD variance of ($2,098k). This is due to an adverse variance for clinical supplies of ($2,485) and a favourable variance of $387k for outsourced services.

Increased throughput volumes, due to winter demand, is impacting all categories of spend in Clinical Supplies. Intragam blood, catheters,implants, knee prosthesis and dispensed oncology drugs continue to have high demand usage. Some of the increased volume is related to more theatre procedures done in the hospital. This is in line with the reduction of outsourced electives.

Capital & Coast DHBTreatment related Costs


Actual vs Last year


Actual vs Budget

Actual vs Last year

3,468 3,435 5,400 (33) 1,933 Treatment Disposables 14,046 13,556 17,092 (490) 3,0471,001 845 1,048 (156) 47 Diagnostic and Other Clinical Supplies 3,241 3,291 3,447 50 2061,007 925 891 (83) (117) Instruments and Equipment 4,079 3,695 3,651 (384) (428)

299 334 383 35 84 Patient Appliances 1,464 1,294 1,380 (170) (84)1,732 1,455 1,311 (277) (421) Implants and Prostheses 6,538 5,879 5,564 (658) (973)1,891 1,727 1,838 (164) (52) Pharmaceuticals 7,310 6,935 7,107 (375) (204)

334 15 373 (319) 39 Other Clinical and Client Costs 1,472 1,014 1,547 (457) 751,096 1,110 1,609 14 513 Outsourced Clinical Services 4,444 4,832 4,588 387 143

10,828 9,845 12,854 (983) 2,026 Total Clinical Supplies 42,594 40,497 44,376 (2,098) 1,782

Month -October 2015 Year to DateVariance Variance


36


External Provider Payments

The YTD adverse result of ($1,572k) is partially offset by additional revenue of $1,052k received from MoH. This additional revenue is recorded with the centralised DHB revenue:

∑ Pharmaceuticals expenses are ($9k) adverse year to date based on the latest Pharmac forecast offset by an adverse claim variance;∑ Lab costs ($11k) adverse. These costs are mainly related to the 3DHB Lab project expenses;∑ Capitation costs are ($630k) adverse mainly due to expenditure for Free Under-13 Services for which additional MoH funding has been

received;∑ Aged residential care costs are ($560k) unfavourable (rest home and hospital level) with other Health of Older People (HoP) costs $3k

favourable due to timing of claims. Both services are demand driven and have had increased volumes over the winter period;∑ Mental Health are $119k favourable mainly due to savings achieved;∑ Other expenditure costs are $11k favourable mainly due to savings in sexual health contracts. The savings offset MoH unbudgeted

programmes for After Hours Under 13s and B4 School Checks for which additional revenue has been received;∑ IDF Outflows are $2k surplus year to date and are expected to be on budget, see table below with agreed service changes.

Capital & Coast DHBOperating Results


Actual vs Last year


Actual vs Budget

Actual vs Last year

Year end forecast




External Provider Payments:5,393 5,435 5,557 42 164 - Pharmaceuticals 22,245 22,236 21,697 (9) (548) 65,759 65,759 64,854 0 (905)

82 87 35 5 (47) - Laboratory 359 348 85 (11) (274) 1,383 1,383 1,259 0 (124)4,619 4,472 4,417 (147) (202) - Capitation 18,931 18,301 18,005 (630) (926) 55,458 55,458 54,495 0 (963)1,448 1,358 1,345 (90) (103) - ARC-Rest Home Level 5,647 5,387 5,061 (260) (586) 16,031 16,031 15,500 0 (531)3,655 3,614 3,631 (41) (24) - ARC-Hospital Level 14,638 14,338 14,485 (300) (153) 42,664 42,664 42,459 0 (205)2,326 2,262 2,378 (64) 52 - Other HoP 9,028 9,031 9,433 3 405 27,057 27,057 27,661 0 6041,837 1,864 1,912 27 75 - Mental Health 7,538 7,657 8,174 119 636 22,537 22,537 22,390 0 (147)

713 699 595 (14) (118) - Palliative Care/Fertility/Comm Rad 2,803 2,817 2,437 14 (366) 8,410 8,410 7,423 0 (987)0 0 83 0 83 - Models of Care Risk Pool 0 0 333 0 333 0 0 150 0 1500 30 53 30 53 - EI Increase 0 122 213 122 213 366 366 0 0 (366)0 (158) 948 (158) 948 - Savings Plan 0 (633) 192 (633) 192 (1,900) (1,900) 0 0 1,900

1,778 1,954 1,282 176 (496) - Other 8,312 8,323 6,771 11 (1,541) 24,909 24,909 22,066 0 (2,843)5,758 5,961 7,038 203 1,280 - IDF Outflows 23,776 23,778 23,586 2 (190) 71,349 71,349 67,682 0 (3,667)

27,609 27,578 29,274 (32) 1,666 Total Expenditure 113,277 111,705 110,472 (1,572) (2,805) 334,023 334,023 325,939 0 (8,084)

Variance Variance VarianceMonth -October 2015 Year to Date Annual


37


Statement of Financial Position

Capital & Coast DHB

Balance Sheet

Actual BudgetAt June 2015

Actual vs Budget

Actual vs June 2015 Notes

YTD October 2015

101 87 87 14 14 1 Bank

25,507 20,691 19,014 4,816 6,494 1 Bank HBL

7,241 7,619 7,619 (379) (379) 1 Trust funds

35,877 41,238 41,238 (5,361) (5,361) 2 Accounts Receivable

7,545 7,471 7,471 73 73 Inventory/Stock

4,036 4,232 4,232 (196) (196) 2 Prepayments

80,307 81,339 79,662 (1,032) 645 Total current assets

480,038 492,674 496,785 (12,636) (16,747) Fixed assets

20,478 7,906 7,906 12,572 12,572 Work in progress

500,516 500,580 504,691 (64) (4,175) 3 Total fixed assets

0 0 0 0 0 Investments in associates

6,468 6,468 6,468 0 0 Investments in HBL

6,468 6,468 6,468 0 0 Total investments

587,291 588,387 590,820 (1,096) (3,530) Total Assets

0 0 0 0 0 1 Bank Overdraft HBL

62,337 59,718 59,815 (2,619) (2,522) 4 Accounts Payable, Accruals and Provisions

34,244 34,326 34,326 81 81 5 Loans - Current Portion

2,759 2,069 0 (690) (2,759) Capital Charge payable

66,260 68,672 70,741 2,412 4,481 Current employee provisions

165,600 164,785 164,883 (815) (718) Total current liabilities

305,954 305,954 305,954 0 0 Crown loans

7,426 7,776 7,776 350 350 Restricted Special funds

292 292 292 0 0 Insurance Liability

6,236 6,236 6,236 0 0 Long-term employee provisions

319,908 320,258 320,258 350 350 Total non-current liabilities

485,509 485,044 485,141 (465) (368) Total Liabilities

101,782 103,343 105,679 (1,561) (3,897) Net Assets

426,030 425,779 422,979 251 3,051 Crown Equity

0 0 0 0 0 Capital repaid

0 0 0 0 0 Deficit support

23,734 23,606 23,606 129 128 Reserves

(347,982) (346,041) (340,906) (1,941) (7,076) Retained earnings

101,782 103,344 105,679 (1,561) (3,897) Total Equity

Month : October 15

Variance


38


Statement of CashflowsCapital & Coast DHB

Statement of Cashflows


Actual vs Last year Notes YTD October 2015 Actual Budget Last year

Actual vs Budget

Actual vs Last year

Operating activities

96,632 83,147 92,202 13,485 4,430 Receipts 349,917 332,588 342,147 17,329 7,770

Payments

35,477 35,436 36,188 (41) 711 Payments to employees 144,016 141,746 135,501 (2,270) (8,515)

44,114 41,782 45,400 (2,331) 1,286 6 Payments to suppliers 191,869 176,973 187,604 (14,896) (4,265)

0 0 0 0 0 Capital Charge paid 0 0 4,197 0 4,197

(2,737) 91 91 2,828 2,828 GST (net) (1,765) 382 382 2,147 2,147

76,854 77,310 81,679 456 4,825 Payments - total 334,120 319,101 327,684 (15,019) (6,436)

19,778 5,837 10,523 13,941 9,255 Net cash flow from operating activities 15,797 13,487 14,464 2,309 1,333

Investing activities

115 143 143 28 28 Receipts - Interest 612 446 446 (166) (166)

115 143 143 (28) (28) Receipts - total 612 446 446 166 166

Payments

0 0 0 0 0 Investment in associates 0 0 0 0 0

1,551 2,271 1,110 720 (441) 7 Purchase of fixed assets 7,026 9,083 5,245 2,056 (1,781)

1,551 2,271 1,110 720 (441) Payments - total 7,026 9,083 5,245 2,056 (1,781)

(1,436) (2,128) (967) 692 (469) Net cash flow from investing activities (6,414) (8,637) (4,799) 2,222 (1,615)

Financing activities

0 0 0 0 0 Equity - Capital 2,800 2,800 0 0 2,800

0 0 0 0 0 Other Equity Movement 0 0 0 0 0

0 0 0 0 0 Other 0 0 (26) 0 (26)

0 0 0 0 0 Receipts - total 2,800 2,800 (26) 0 2,826

Payments

3,500 3,500 5,283 0 1,783 Interest payments 6,054 5,973 7,285 (81) 1,231

3,500 3,500 5,283 0 1,783 Payments - total 6,054 5,973 7,285 (81) 1,231

(3,500) (3,500) (5,283) 0 1,783 Net cash flow from financing activities (3,254) (3,173) (7,311) (81) 4,057

14,843 210 4,273 14,633 10,569 Net inflow/(outflow) of CCDHB funds 6,129 1,678 2,353 4,451 3,776

18,007 28,190 17,293 10,183 (714) Opening cash 26,721 26,722 19,213 1 (7,508)

96,747 83,290 92,345 13,457 4,402 Net inflow funds 353,329 335,834 342,567 17,495 10,762

81,904 83,080 88,072 1,176 6,167 Net (outflow) funds 347,200 334,157 340,214 (13,044) (6,986)

14,843 210 4,273 14,633 10,569 Net inflow/(outflow) of CCDHB funds 6,129 1,678 2,353 4,451 3,776

32,849 28,400 21,566 4,450 11,283 Closing cash 32,849 28,400 21,566 4,450 11,283

Variance

Year to DateMonth : October 15

Variance


39


Notes to the Balance Sheet and Cashflows

A) Notes to Balance Sheet:

1. The DHB’s cash balance at the end of October is higher than budget. This is mainly due to the receipt of the 2014/15 IDF and Electives wash up of approx. $13m. All surplus funds are invested by NZHP in short term investments;

2. Accounts Receivable is lower than budget due to the receipt of the Electives and IDF’s wash up as noted above. These were accrued for in the MoH accrued debtors at June 15;

3. Total non-current assets are in line with budget;

4. Total current liabilities are in line with budget;

5. Term loans are in line with budget;

B) Notes to Cash flow statement:

6. The net cash flow from Operating activities is higher than budget. This is due to the receipt of the Electives and IDF wash up as noted above;

7. The net cash flow from Investment activities is in line with the budget;

8. The net cash flow from Financing activities is in line with the budget;

C) Ratios

1. Current Ratio – This ratio determines the DHB’s ability to pay back its short term liabilities.DHB’s current ratio is 0.48 (2014/15: 0.49);

2. Debt to Equity Ratio - This ratio determines how the DHB has financed the asset base. DHB’s total liability to equity ratio is 82:18 (2014/15: 82:18);


40

Target Month Target QTR1 Target Actual Target QTR1 Target Actual Target QTR2

Shorter Stays in Emergency Departments 95% 95% 95% 95% 95% 90% 95% 90% 95% 89% 95% 87%

Improved Access to Elective Surgery 100% 96% 100% 96% 100% 97% 100% 97% 100% 113% 100% 103%

Better Help for Smokers to Quit 95% 97% 95% 97% 95% 90% 95% 90% 95% 91% 95% 92%

Target Month Target YTD Target Month Target YTD Target Month Target YTD

Number of Patient Deaths U/D 7 U/D 42 U/D 16 U/D 68 65 218

Severity 1 & 2 (Confirmed) U/D 0 U/D 0 U/D 2 (0.3) U/D 6 (0.2) 28 (3) 126 (15)

Bed Days due to Cellulitis (Avg LOS) 3.0 5.0 3.0 3.5 U/D U/D

All Reported Events 0% 680 3054

Surgical Site Infections Reported U/D 0 U/D 0 1 N/A 4 N/A U/D U/D

Hospital Acquired Pressure Areas 0.65 1 3 4 3 0 12 10 U/D 12 U/D 29

Patient Falls Causing Harm (per 1000 bed days) 2 (1.1) 4 (2.1) 8 (1.0) 9 (1.2) 12 (1.6) 13 (1.7) 48 (1.6) 66 (2.2) 0 83 (1.2) 0.0 321 (1.4)

Medication Errors (per 1000 bed days) 0.7 (0.4) 2 (1.0) 2.8 (0.4) 2 (0.3) 20 (2.7) 23 (3.1) 80 (2.6) 95 (3.1) 0.0% 58 (0.8) 0.0 285 (1.1)

Complaints (per 1000 bed days) U/D 4 (2.0) U/D 21 (2.7) U/D 26 (3.5) U/D 131 (4.3) 0.0% 65 (2.9) 0.0 300 (3.4)

Compliments (per 1000 bed days) U/D 9 (4.6) U/D 27 (3.5) U/D 11 (1.5) U/D 100 (3.3) 0.0% 99 (5.0) 0.0 349 (4.3)

Acute Readmission Rate Sep 15 8.0% 7.6% 8.0% 8.0% 7.0% 7.5% 7.0% 7.8% 0.0% 314 (14.2%) 0.0% 1091 (15.6%)

Target Month Booked Unbooked Target Month Booked Unbooked Target Month Booked Unbooked

Waiting >120 days for Treatment (ESPI5) 0 16 11 5 10 5 1 4 0 2 U/D U/D

Waiting >120 days for Outpatient FSA (ESPI2) 0 0 0 0 10 N/A 0 0 0 0 U/D U/D


Staff Turnover % (Headcount) 10.0% 13.2% 10.0% 11.7% 0.8% 1.3% 3.3% 3.6% 15.6% 10.8% 15.6% 15.5%

Sickness Absence - % Paid Hours Worked 2.5% 2.7% 2.5% 3.6% 2.3% 3.0% 2.3% 3.7% 2.3% 3.5% 2.3% 3.6%

Number of Staff having >24 Mths O/S Leave 54 57 226 NA 226 195 1,564 1,586

Physical Assaults U/D 1 U/D 3 U/D 3 U/D 18 25 136

Blood and Body Fluid Exposure U/D 0 U/D 3 U/D 6 U/D 13 15 59

Slips, trips and falls U/D 0 U/D 4 U/D 3 U/D 8 8 36

Staff Appraisals (Non Medical Staff) 50% 35% 80% N/A 80% N/A

MOH Targets Key: N/A = Not Available U/D = Under Development

MOH Performance Measure Ward Utilisation is General Wards Only: Surgical, Medical, Rehab, Orthapaedic, Plastics Wards

Calculations Amended to exclude RMOs FOR CCDHB:

Target Month Target Actual

Hospital Staff Turnover % (Headcount) 15.6% 10.8% 15.6% 18.1%

Hospital FTEs - Contracted 3,982 3,965

HEALTHY WORKPLACESep-15 YTD

3 DHB Monthly Balanced Scorecard October 2015KEY PERFORMANCE INDICATORS 2015/2016

Wairarapa Hutt Valley CCDHB

Oct-15 YTD

WAITLISTSWaitlist Patients (ESPI5 & ESPI2) Waitlist Patients (ESPI5 & ESPI2) Waitlist Patients (ESPI5 & ESPI2)

PATIENT EXPERIENCEOct-15 Period Oct-15 YTD

YTD

Key Issue

Oct-15 YTD Oct-15

Alert

Good News

HEALTHY WORKPLACEOct-15 YTD

m

kk

k

k

k

k

k

m

m

APPENDIX 2.1.3 HOSPITAL ADVISORY COMMITTEE


41


Acute Inpatient Length of Stay 3.69 3.12 3.69 3.15 2.47 2.39 2.47 2.53 3.66 3.80 3.66 3.90

Elective Inpatient Length of Stay (Surgical) 3.43 3.69 3.43 3.23 1.66 1.39 1.66 1.43 4.00 3.10 4.00 3.20

Elective/Arranged Day Surgery Rate 58% 54% 58% 58% 58% 60% 58% 58% 58% 57% 58% 53%

Elective/Arranged Day of Surgery Admission 95% 97% 95% 97% 95% 97% 95% 94% 75% 72% 75% 72%

Ward Bed Utilisation - Daily (Incl Weekends) 85% 81% 85% 86% 85% 83% 85% 86% 90% 96% 90% 96%

Ward Bed Utilisation - Weekdays Only 85% 96% 85% 97% 85% 85% 85% 88% 90% 97% 90% 97%

Funded Theatre Sessions Utilised 90% 83% 90% 89% 85% 97% 85% 97%

Theatre Session utilisation (Time in Theatre) 85% 71% 85% 70% 85% 85% 85% 85% 85% 84% 85% 84%

Theatre Sessions Starting on Time 90% 96% 90% 97% 90% 91% 90% 90% U/D

Acute Patients impacting on Elective Sessions 2 52 64 208 200 20 20

Cancelled on Day of Surgery - Patient 5 4 19 15 10 70 50 25 106

Cancelled on Day of surgery - Hospital 11 4 45 10 10 47 31 67 304

Cancelled on Day of Surgery - Percentage 5.0% 1.6% 5.0% 5.0% 3.9% 5.0% 3.5% 5.0% 7.9% 5.0% 9.2%

Outpatient DNA (FSA & Followup) - DNA Rate 6.2% 7.0% 6.2% 7.1% 9.0% 7.9% 9.0% 7.8% 6.0% 6.0% 6.3% 6.0%

Outpatient DNA (FSA & Followup) - Maori 6.2% 15.1% 6.2% 14.1% 17.0% 17.8% 17.0% 16.3% 6.0% 14.5% 6.0% 15.2%

Outpatient DNA (FSA & Followup) - Pacific 6.2% 8.0% 6.2% 11.6% 19.0% 13.3% 19.0% 14.4% 6.0% 13.9% 6.0% 15.4%


Total Caseweight 518 495 2,072 2,169 2,011 2,162 8,007 8,676 5,826 5,590 23,441 23,424

Local Acute Caseweights 390 398 1,562 1,715 1,214 1,314 4,816 5,451 2,831 2,648 11,401 11,532

Local Elective Caseweights 128 97 510 454 416 437 1,665 1,667 1,014 1,018 4,045 3,824

IDF Acute Caseweights 184 202 736 782 1,327 1,196 5,244 5,005

IDF Elective Caseweights 197 209 790 776 654 729 2,751 3,063

Outpatient FSA Volumes 584 595 2,337 2,421 1,099 1,134 4,396 4,785 3,736 3,537 15,225 15,298

Outpatient FU Volumes 624 594 2,494 2,461 2,533 3,029 10,133 12,332 8,960 9,243 36,854 40,079

Hospital FTEs inc overtime 451 446 450 446 N/A N/A N/A N/A 4,312 4,295

Hospital Operating Costs ($'000) N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Hospital Personnel inc outsourced ($'000) N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

MOH Targets Key Issue Key: N/A = Not Available U/D = Under Development

MOH Performance Measure Alert Ward Utilisation is General Wards Only: Surgical, Medical, Rehab, Orthapaedic, Plastics Wards

3 DHB Monthly Balanced Scorecard October 2015KEY PERFORMANCE INDICATORS 2015/2016

Wairarapa Hutt Valley CCDHB

Good News

Oct-15 YTD

VALUE FOR MONEYOct-15 YTD Oct-15 YTD Oct-15 YTD

PROCESS & EFFICIENCYOct-15 YTD Oct-15 YTD

m

k

kk

k

k

mm

m

mmmmmm

APPENDIX 2.1.3 HOSPITAL ADVISORY COMMITTEE


42

MHAID Service 3DHB 2015/16 FY Balanced Score Card - September


43

PUBLIC

Wairarapa, Hutt Valley and Capital & Coast District Health Board

BOARD INFORMATION PAPER

Date: 1/12/15

Author Dr Pauline Boyles - Senior Advisor Disability Responsiveness Service Integration and Development Unit

Endorsed By Debbie Chin - Chief Executive, Capital and Coast District Health Board

Subject CELEBRATING IMPROVEMENTS IN DISABILITY RESPONSIVENESS AND SERVICES ATCCDHB IN 2015

RECOMMENDATION:

It is recommended that the Board NOTE:

a. Leadership by CCDHB on sub regional initiatives.

b. Development of education resources to support mandatory staff training around disability.

c. Level of collaboration with people with disabilities and their Whanau/family on improving quality of information and service using available tools.

d. Collaboration with Ministry of Health, Health Quality and Safety Commission and Health and Disability Commissioner to work with Sub Regional DHBs as a demonstration site for a whole of system response.

e. Celebration of achievements of CCDHB front line Disability Services.

f. The significant community engagement by SRDAG members to the community sphere and to national initiatives.

APPENDICES:

1. Demographic breakdown of each local population and local services

2. Triple Aim approach to improving health outcomes for people with learning disabilities

PURPOSEa. To demonstrate the contribution of CCDHB to the sub regional and national leadership around

disability responsivenessb. To describe key components of the education toolkits being developedc. To demonstrate quality improvement initiatives in partnership with people with disabilities who

use health services d. To describe the working relationships developing with key national bodiese. To celebrate the work of CCDHB front line services.f. To highlight the progress and significant contribution of Sub Regional Disability Advisory members

particularly in the Wellington locality

1. SUB-REGIONAL WORK: INITIATIVES THAT ARE BENEFICIAL ACROSS ALL COMMUNITIES1.1 Disability Responsiveness Team

∑ Over the year the team has grown to address the targets within the Disability plan and Annual plan across the sub region.

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∑ One position that has been added is the Youth Facilitator. This position 1.0 FTE and is funded by MSD for 24 months starting in March 2015. The position has focused on the child and youth work streams of the Sub Regional Disability Implementation Plan. Notable working on the Child – Adult transition work stream that has been operating since 2011 and increasing youth engagement with health through the use of social media.

∑ A Disability Advisor/Educator started within Learning and Development in January 2015. The position is 0.6 FTE and is critically placed to take advantage of educational and technical resources available in the CCDHB L and D. The role also works alongside Hutt Valley and Wairarapa team members to create many new and exciting resources.

∑ Prue Poata the Programme Coordinator moved on to a new role in November and the position has been filled temporarily.

∑ The team represents a good mix of clinical and professional expertise (all with experience in the disability sector) creating a matrix of complementary skills within the sub region.

1.2 Partnerships in Action: Sub Regional Disability Advisory Group (SRDAG)

∑ SRDAG has been running for two years now. In 2016 members will reconfirm their commitment to working in partnership with the DHBs to improve health outcome for people with Disabilities in the region.

∑ In October this year the group produced a submission on the New Zealand Disability Action Plan to the Office of Disability Issues. Their submission highlighted heath as an area the Action Plan needs to focus on. Highlights of the submission are below: - Priority 1: additional action (may require changing the wording for the priority itself)- Implement a programme to ensure disabled children and young people are confident when

engaging with health services (access, information, engagement) - This action requires input from DHBs and PHOs particularly from disabled individuals who are

active within Health Services- Yes however priority 8 has a very high focus on disabled people themselves. Suggest it be adapted

to reflect environmental and/or systemic initiatives which lead to disabled people having more control and choice.

- Additional priority: create smoother transactional interactions between Disability Support Services and mainstream health services (to be less onerous on disabled people)


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- Modify Priority 10 to increase the capability of mainstream health services to be of service to disabled people in order for Disability Support Services outcomes to be achieved successfully

∑ The group has consulted on the current Transport Review, Vision 2020 and the Sub Regional Allied Health Strategy. They provide valuable grassroots community feedback on DHB plans, adding the Disability lens to many projects.

∑ Members also play a role in educating staff and work in partnership with the Disability Responsiveness team to deliver staff training. Some individuals are participating in or have advised on the new video resource 1

∑ Sue Emirali joined SRDAG this year as the Kāpiti representative. Since joining Sue has been a real champion for Kāpiti2. She is working with the local community on gathering information on perceptions and use of the Kapiti Health Centre. She is also working with the Youth representatives in SRDAG to build the capacity of young disabled people in the region.

∑ The group has a critical role in building community linkages. Three members are also part of the Wellington Regional Accessibility Advisory Group (Kapiti Wellington and Wairarapa). A presentation on the role of the range of initiatives in improving access to health services was given at a recent meeting. There is also a proposal to improve access to the patient portal through public libraries and other council facilities.

∑ Many members have volunteered their valuable time on the passport and alert help desks in the different local areas. In the process they are engaging with the public, supporting people to navigate the services and systems and improve linkages to the champions and disability by raising issues.

∑ This year SRDAG completed a series of leadership workshops, facilitated by Helen Emmerson. The workshops were targeted at growing their capacity as leaders in the Disable community. It is essential to grow the capacity consumers as it results in better partnership with the DHB.

1 Filming occurs 18th and 19th December in partnership with Massey University visual arts department

2 Has also been invited to be a member of the MOH Low Vision Rehabilitation Services Reference Group.


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1.2 Disability Responsiveness Education

∑ The Disability Responsiveness and Learning and Development teams have been working on a revision of the current e Learning module which is currently used across two DHBs with a plan to use within Wairarapa. The revised version has universal potential for use in community and hospital health services. The tool takes the learner on a journey explaining the need for improved disability responsiveness and uses interactive techniques to provide clear pathways for learners. An emphasis on attitudinal and behavioural change is achieved through visual communication and interactive learning.

∑ Key messages are based on the diagram below and examples give practical tips to improve responsiveness

∑ Disability experiences are presented in the context of the wider community and the learning focuses on creating partnerships with people with impairments/disabilities. The review and design of the e Learning module involves partnerships with the Sub Regional Disability Advisory group members to ensure it reflects the views and priorities of the disability communities to include the multiple voices and experiences.

∑ Making both staff and community educational resources accessible and easy to follow has been a priority for 2015. Meeting this target has lead to the development of several new resources.

∑ A set of complementary resources have been developed o The postcard aims to reduce wasted resource through a more targeted approach to delivering the

Health Passport to the Disabled Community. Consumers can easily decide if the Health Passport is a communication tool they need.

o Another resource is the development of the Education Tool Kit. This resource has been developed to be used across the 3DHBs. Within it there different exemplar patients all of whom have an:

o example Disability Alerto example Health Passporto health related scenarioso Teaching activities.


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The scenarios reflect common issues disabled people face when in hospital. The teaching activities give staff the space to think about the small changes they could do to improve the patient experience. These are used to teach staff, from clinicians to front line. Changing attitudes and behaviour can only be achieved in positive and productive partnershipsThe new resource has been developed with people from all age groups and seeks to inform and support staff while challenging them to be self critical in their responses. It uses visual images to reinforce the messages. Follow up training is also offered.E learning is now mandatory for all disciplines based on the overarching Disability Responsiveness Policy in place at CCDHB and proposed for Hutt and Wairarapa DHBs.

o The Disability Support Needs form that is used to by patients to complete their Disability Alert has been redesigned in order to be more user friendly for community members. (see appendix)

o Through out the year numerous education sessions have been delivered. Some of the groups these sessions have been with include: undergrads, ward staff, nurses, frontline staff and junior doctors.

o Another project due for completion in early 2016 is an ambitious educational video project. This project aims to create a series of scenarios and situational snapshots that can be used in staff training. The project is aiming to produce 3 scenarios videos, consumer interviews and clinician interviews, all highlighting both barriers and solutions both staff and patients with disabilities experience


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1.3 Health Passport Review

∑ The way the Disability Responsiveness program operates, especially in relation to the use the Health Passport across the 3DHBs has gained national interest. The Health Quality Commission, the Ministry of Health and the Health and Disability Commissioner are now working with the sub regional team to strengthen existing linkages and to ensure the health passport is up to date and useable by clinicians and passport users in all aspects of health care. 116 people have now responded to the phone and face to face survey ensuring that long awaited feedback on utilization is now available.

∑ The research and community engagement continues on the health passport and alerts. The phone surveys include feedback on health system utilization and findings will be reported in the New Year. Help desks and community presentations are proving an excellent point of entry to engage with communities as below:

1.4 Child – Adult Transition Pathway

∑ Development is currently underway of an electronic Child - Adult Transition Health Pathway. The pathway is being developed by a multi disciplinary team from hospital and Primary Care. It is the first non disease pathway in the region and is designed to guide General Practice staff teams to better support children and their families who are no longer supported by child health or child development clinicians. The tool is designed to guide the transition process for children and young people with disabilities and long term health conditions from Child Development Services and Child Health Services into the care of their GP. A small multi disciplinary team is working on developing the content for this pathway with expert form across child services and Primary Care.

∑ A transition tool kit is being developed alongside families to work alongside this pathway. A project lead with clinical experience working with children with disabilities will be working alongside Hutt Valley families and clinicians.

∑ After the pathway is completed, tested and launched a 3DHB guideline around transition for children and young people with disabilities and long term health conditions will be developed. Local Hutt Valley and CCDHB guidelines have been developed in the interim.

1.5 New Zealand Sign Language Review

∑ A New Zealand Sign Language (NZSL) project lead 3started Monday 2 February, working 2 days. The project has emerged from an existing collaboration between the disability responsiveness team and the SIDU mental health team to fulfil commitments made in the 2014/15 Annual Plan. The NZSL programme of work covers a two year period. Phase one has almost been completed, with a paper about the research being ready for the board by February next year. During Phase one the following has been addressed:

∑ A review of current access to New Zealand Language Interpreters including feedback from the New Zealand Sign Language Interpreters Union (SLIANZ). This will include practice in other Government Departments

3 The Project Lead is seconded from the child and adolescent mental health unit and is fluent in New Zealand Sign Language having grown up with Deaf parents

Health Board Number of Consumers

CCDHB 440

HVDHB 342

WDHB 459

No Address 105

TOTAL 1346


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∑ Identification of good practice use of NZSL interpreters across all health services including community services. To draw on other models including the NHS UK model described in the Deaf Mental Health section in the second paper before the Committee4

∑ Gathering feedback on specific experiences of staff use of NZSL, feedback from Deaf on both positive and negative in the context of use of heath services and access to Interpreters

∑ The report from Phase One will offer a range of options for SIDU and the three District Health Boards to consider:

o A plan for development of an NZSL Policy 5 and implementation over a five year periodo Feedback on a range of options to maximise current use of interpreters and to increase access

across the sub regiono Availability of overall Dear Awareness education of staff and safety of services for Deaf.o Specific recommendations for Phase Two of this review to be considered by SIDU

Management Team1.6 Disability Action Group and Champions Network

∑ Champion networks are in place across three District Health Boards (supported by Combined Disability Action Group).

∑ The Disability Action Group is now aiming to ensure a shared regional policy is in place to guide shared regional and sub regional initiatives. No clear policy on disability responsiveness exists within DHBs and it appears the one at CCDHB is unique. A high level policy shared with other DHBs allows for collaboration and sharing of resources. Examples of this would be New Zealand Sign Language planning and rehabilitation options for younger people not well served due to the relatively small numbers funded within District Health Boards. The Disability Action Group meetings are held quarterly and now have a strategic focus only.

∑ A Disability Champions network across the District Health Boards is evolving and strengthening to improve support for staff and patients dealing with complex systems and issues. There are 36 Champions all with different areas of expertise. They include leaders in community and inpatient support services. Access to the network is being improved by a single point of entry and a 0800 linked to the disability responsiveness team. A website to improve access to information for people with disabilities is also being developed to answer common questions asked by staff and patients

∑ Local and sub regional meetings are held to share information and support staff. All local champions recently supported the access audits at Wairarapa and Hutt Valley DHBs and are well represented at the follow up workshops.

4 Steve Carney and the Deaf Mental Health Unit visit and return visit documented in the March paper on the England trip by the Senior Disability Advisor

55 DHB Module three Annual Plan operational obligation of all DHBS since 2006


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1.7 3DHB Champions

2. PARTNERSHIP WITH MINISTRY OF HEALTH OF HEALTH ON NATIONAL INITIATIVES 2.1 Ministry of Health Working Group on Improving Health Outcomes for people with learning

disabilities

2.2. Appendix - Triple aim approach to improving health outcomes for people with learning disabilities outcomes framework


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3. SYSTEM AND SERVICE IMPROVEMENT FOR THE CCDHB3.1 Population Overview

∑ Within the boundaries of CCDHB there are 69,207 people who identify as having a disability. Of those around a third are from the 65+ population. This information comes from Stats NZ population data and Disability Survey data. 49% experience disability due to ongoing long term conditions and 42% have multiple impairments. The complexity of this population is a challenge for health services who are known to be high health service users

3.2 How and what is being done to build a foundation at CCDHB?3.2.1 Health Passport Help Desk

∑ In July 2015 a Health Passport Help Desk was launched at Kenepuru Hospital. It was initially set up on a trail bases till 17th August. Due to the success of the desk its presence was extended till December 2015 and is not continuing into the New Year.

∑ Since its inception the Kenepuru Help Desk has gathered the details of 207 patients. These patients have taken a Health Passport and have consented to being follow up so we can see how the Health Passport is working for them, plus offer any help in completing it.

∑ As the result of a pop up Help Desk at the Disability Expo in Kāpiti Nicky Wagner, the Minster for Disability Issues, has taken an interest in the Disability Alerts. She has shared information about the alerts with Canterbury DHB and visit to show her how the alerts work in with the wider work program is being planned for next year. She will also attend the Sub Regional Disability Forum in April next year.


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3.3 CCDHB Disability Alert and Health Passport Update

∑ As of November 2015 there are 782 people at CCDHB who have taken a Health Passport and consented to participate in follow up research. Gaining follow up details means the Disability Responsiveness Team can work with the community to ensure the understand the nation wide communication tool and get the support they need. There are many more taken up in the community but this method of personal engagement allows the team to evaluate its utilization by consumers and staff. Integral evaluation allows improvement in approaches to target different communities and health needs.

∑ The numbers of Alerts at CCDHB continues to grow due to the good work and willingness of the staff in the Emergency Department, help desk volunteers and ward and departmental champions. To date over 5000 people have disability alerts identifying their type of impairment and whether they have a health passport. . The alerts are more useful in improving quality of care once the needs information is more fully completed. 20% of alerts have completed information provided by people themselves or in partnership with staff and/or family.

∑ A dashboard of indicators has now been developed to include:o Average length of stay for inpatientso Readmissions o Maori and Pacific people with disabilities utilisation of acute beds


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o Outpatient attendanceo Percentage of ASHo Numbers of health passports being presented

∑ Data matching for children within primary care has been completed and all children using Child Development Services are flagged in the Primary Care system across CCDHB area

∑ An average of 150 people per month are identifying as having disability support needs on admission to ED. This adds to the 3200 people who are funded and who were entered into the system first in 2013.

∑ Early results show a trend for a longer length of stay for those who have disabilities than the average population as well as a higher rate on average of Maori and Pacific people with disabilities. As the trends are measured over a longer period, targeting around discharge for this population will become possible

3.4 Patient Experiences

∑ Following on from some feedback provided by a recent patient with impairments/disabilities the Disability Responsiveness Team worked in conjunction with the patient and the Nurse Educators on two wards to deliver some education for Ward Staff. A training exercise was created in which staff could engage with real life scenarios in relation to people with impairments/disabilities and problem-solve how to improve their practice and their team communication. This education received positive feedback from staff on the wards and achieved some operational and well as behavioral change. The patient in question was particularly satisfied with the way the DHB had responded and engaged her with their response.

∑ Other patients who have expressed concern have made constructive suggestions for improvement and staff across the sub region have collaborated to deliver tailored training to ensure improved responsiveness especially in the area of discharge planning

∑ Overall there is evidence that inpatient treatment and attentiveness to support is improving. Congratulations to all staff who have extended themselves to achieve this outcome

3.5 Wheel Chair Scales

∑ In September 2015 Wheel Chair scales were purchased for Wellington Regional Hospital thanks to funds from the Wellington Hospital foundation. These scales are located in the Clinical Measurements Unit (CMU). Previously patients had to visit the mortuary to access accurate weight.

∑ The purchase of these scales is fantastic as patients who would not normally be able to weigh themselves can.


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∑ Special thanks to the Health and Hospital Foundation and to the staff of CMU who are generous with their time, space and support for people who wish to be weighed. GPs will also be informed these scales are in place.

3.6 Echo Mini Techs

∑ Six Echo mini techs6 were purchased by the Health & Hospital Foundation. A plan was implemented to enable use on six wards at CCDHB. Feedback has been given that they have already significantly improved engagement with patients with hearing impairment. Clinicians report improved ability to communicate with older people during clinical assessments.

4. CELEBRATING FRONT LINE DISABILITY SERVICES CCDHBStaff teams within Child development and the Needs Assessment Services at CCDHB are doing a sterling job of working with children and adults with the highest levels of complexity living in the

6Mini techs are hearing devices with headphones to allow easier communication with people who are "hard of hearing”. Significant work was required

to ensure infection control and safety of use on the wards.


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community. The national picture for Disability Support Services is very difficult due to an operating deficit, no increase in resources and an emerging Autism Spectrum Disorder (ASD) population 7

4.1 Child Development Services It is important to highlight the work of front line disability services at CCDHB. The local Child Development Services team has undergone many changes and improvements over the last three years. Service access has been significantly improved after an improvement project and they are now more closely engaged with Primary Care services. A role to manage intake and transition has begun to create a key point of contact. Referral and declines rates are summarized below. Work on early and improved transition out of the service continues (See Appendix One for CDS three year referral trends in general). A new service leader was appointed in 2015 allowing a fresh look at service development and provision. Year to date figures are as follows (see Appendix One for more detail on ASD referral pathway∑ 63 percent increase in referrals for ASD diagnostic assessments for children aged 6 years 2013-14 and

80 percent increase 2014-15 (again, on referrals to date).

∑ 5 percent increase in total referrals for ASD diagnostic assessments 2013-14 and 35 percent increase 2014-15 (so far).

∑ 73 percent increase in referrals to ASD Coordinator 2013-14 and 28 percent increase 2014-15.

∑ ASD Coordinator currently has 74 active cases.Congratulations to the dedicated teams at Puketiro Centre and Wellington who partner in the process of improving disability responsiveness

4.2 Inter Disciplinary Development to Improve service responses to ASD A Service Level Agreement between Mental Health (child and adult), Child Development and Needs Assessment Services is now being developed facilitated by the Disability Responsiveness Team. Issues around diagnosis assessment intervention and community support are complex and difficult to address.However the process of cross disciplinary collaboration is giving insight into the pressures all services are under. All agree early intervention should be prioritised including training for psychologists on ASD diagnosis by those who are experienced in this area. A plan to ensure a stocktake of skills will lead to a training proposal in the New Year.

4.3 Capital Support: Access to Services and Funding

∑ Capital Support is the Under 65 Needs Assessment Service for the CCDHB area. Appendix Onedescribes the demographics of the funded population.

∑ The NASC is a critical entry point into the system and services and CCDHB disability responsiveness is often measured by the performance of its front line services. For this reason the Senior Disability Advisor and the team have been working closely with Capital Support staff and Service Leader to ensure the Disability Implementation plan included quality measures for the NASC

∑ In 2014 the Needs Assessment Service was failing to meet any of the five KPIs set by the Ministry of Health causing a great deal of concern to Management and the Ministry... As of October 2015 the NASC is meeting all five of its KPIs and is operating well within the MOH budget and the CCDHB budget

∑ Community and client feedback is positive and in the last quarter 17 compliments have been given. Over 12 months complaints reduced to three which have been analyzed and followed up. All clients of capital Support have a disability alert and are offered a passport.

∑ There are now three staff members at Capital Support with clinical backgrounds two nursing and one social work. Two have Annual practicing Certificates. The increase of clinical competence is

7 People with ASD (People with Autism Spectrum Disorder under DSM V) became eligible for Disability Services in April 2014. A significant increase in teenagers requiring a high level of support has placed considerable pressure on NASCS, child services and mental health services


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essential where the level of complexity experienced by individuals, particularly those with chronic health conditions.

4.4 Challenges

∑ As for Child development Services the eligibility for people with ASD since April 2014 has placed huge pressure on services. No extra funding has been offered and available services do not cater well for those with ASD as the only diagnosis.

∑ Where people have a robust diagnosis they are accepted for support but the service coordination process is significantly extended. This is due to the need to work creatively with current providers who do not feel confident about their ability to cope. Issues around Services for this group are being raised with the Ministry of Health by all NASCS

Pressure on staff has coincided with the increase in referrals above. However it is notable that in spite of this extra pressure the NASC is now a high performing NASC working within its set timeframes. The interface between NASCs has also been improved and there is growing respect for the level of skillrequired to work with this vulnerable population

CONGRATULATIONS TO CAPITAL SUPPORT STAFF FOR OUTSTANDING EFFORTS IN QUALITY IMPROVEMENT!


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BOARD DECISION PAPER

Date: December 2015

Author Virginia Hope, CCDHB Chair

Subject Resolution to Exclude the Public

RECOMMENDATION

It is recommended that the Board

a. AGREE that as provided by Clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons:

SUBJECT REASON REFERENCE

Public Excluded Minutes For the reasons set out in the respective public excluded papers

Public Excluded Matters Arising from previous Public Excluded meeting

For the reasons set out in respective public excluded papers

Recommendations from CCDHB FRAC October and November meetings

Papers contain information and advice that is likely to prejudice or disadvantage commercial activities and/or disadvantage negotiations

9(2)(i)(j)Reconfiguration to allow additional inpatient beds at Wellington Hospital to support increased demand

November CPHAC/DSAC recommendations to Board

Proposed Deed of Lease: Wellington Free Ambulance/CCDHB

Committee meeting dates and membership 2016

Chair report

CEO report

Sub Committee draft minutes Papers contain information and advice that is likely to prejudice or disadvantage negotiations

9(2)(j)

* Official Information Act 1982.

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ShakeOut national earthquake drill 15 October 2015

The national ShakeOut drill was held throughout New Zealand on 15 October.

It was part of an international programme of drills to promote earthquake preparedness among populations in earthquake-prone countries – largely those around the Pacific Rim.

It was the second drill New Zealand has participated in (the first was in 2012). 1.3 million peopleregistered their intention to take part.

The drill was sponsored by the Ministry of Civil Defence and Emergency Management, and the focus was on personal preparedness, and on promoting the actions to take before, during, and after earthquakes.

CCDHB’s participation

The DHB activities were intended to reinforce the key shakeout messages. In the lead up to the day:

∑ A series of information sheets were emailed to all staff ∑ The drill was promoted during regular emergency management staff training sessions∑ Six lunchtime ‘drop in sessions’ were held at Wellington, Kenepuru and the Kapiti Health

Centre

Attendance at the first ‘drop in sessions’ was low - but numbers grew as more staff became aware of the programme.

On 15 October:

∑ A display was mounted in the Atrium at Wellington Hospital ∑ The start of the ‘drop cover and hold’ exercise at 9:15hrs was signalled with an emergency

management email and group text messaging.

It is unclear how many staff actually followed the ‘duck, cover and hold’ procedure at 09:15 on the day, but anecdotal feedback was encouraging and following the drill, there were approaches from some services seeking further assistance with post-earthquake response planning.

The DHB’s participation in the exercise received higher than expected media interest when the Director of the Ministry of Civil Defence and Emergency Management (Sarah Stuart-Black) asked if she could take part in the drill at Wellington Hospital. She and Chris Lowry (as acting CEO) participated in the Ward 7 North response, and both were interviewed afterwards by TVNZ and TV3.

Overall the drill was considered to be worthwhile – the level of participation and feedback indicated it did heighten awareness among staff of the need to be prepared for damaging earthquakes.

Wider regional participation

The Hutt Valley and Wairarapa DHBs and a number of other health services in the region also registered for the drill, but few details have emerged regarding their level of involvement. Compass Health did advise early on in the project that their staff (and most general practices) would be unlikely to have any more than a token involvement because they would be changing offices on the same day.

Greg PhillipsService LeaderEmergency Management

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Appendix 1 - Overview

∑ This graph shows the total and disabled populations of the 3 DHBS in the Greater Wellington Region. The disabled population is broken down into two. The first is the Age Addition rate. This is the addition of all the totals for each age bracket, calculated using each age brackets disability rate. The second is the Disability Rate, this is calculated using the national total disability rate (24 percent) and applying it to the total population of each DHB.

∑ The graph shows that the disability rates in CCDHB and WAIDHB are slightly higher than the national Disability Rate, while HVDHB’s disability rate is slightly lower. This will be due to the population make up within each DHB. For example one reason why WAIDHB may have a higher disability rate in total is its high proportion of the older population (the older population has a higher disability rate).

CDS Referral Figures 2013 to 2015

2013 2014 2015

New 383 437 478

Add-on 330 446 422

Total Accepted 713 883 900

Declines 155 182 144

Total Processed 868 1065 1044

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Notes:

∑ ‘New’ captures referrals for children new to CDS. Note that due to the way that data has been captured, this is an underestimate and relates to number of children rather than number of referrals. For example, a child allocated to developmental paediatrics, occupational therapy and physiotherapy simultaneously has historically been captured as one rather than three referrals on our intake spread-sheet. This will change in 2016.

∑ Also, referrals to groups and seminars are still not being effectively captured.

∑ ‘Add-on’ referrals are for an additional piece of work (e.g. group or equipment), or for a new clinician to become involved for a child already known to CDS.

∑ The majority of declines are triaged and sent an individualised letter with recommendations regarding other supports and services which the family may be able to access.

∑ When interpreting the 2015 January to late November figures, it is important to acknowledge that December often has a high number of referrals as children in NICU are discharged for Xmas and other services complete paperwork and onward refer in end of year ‘tidy up.

Referrals to Clinical Psychology for a Cognitive Assessment

2013 2014 2015

External 7 11 21

Internal 20 34 42

Totals 27 45 63

*Note that above includes referrals allocated to the paed/psych joint pathway where the query is around ID +/- PD +/-medical issues rather than ID+/- ASD. It does not include requests for either individual or group intervention.

∑ 66% increase in referrals for cognitive assessments over 2013-15 and 40% increase 2014-15 (again, on referrals to date).

Active Referrals

∑ Currently 1398 active referrals within CDS and 219 waiting (as above this will equate to less children as many children have more than one active referral).

∑ In regard to pressure points, the following are most significant for our current ability to respond to need:

o Requests for ASD assessment/diagnosis, over 6 years of ageo Requests for cognitive assessmento Children requiring support from the ASD Coordinator (who works .5FTE)o Paediatrician only appointments (new and reviews)o 24% increase in accepted referrals 2013-14 and 2% increase 2014-15 (to date). o 17% increase in declined referrals 2013-14 and 21% decrease 2014-15; hopefully a

reflection of increased referrer awareness of CDS remit.o 23% increase in total number of requests for service processed 2013-14.


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ASD Pathway work

∑ Includes referrals for ASD diagnostic assessments and referrals to ASD Coordinator

Pathway 2013 (new/add-on) 2014 2015

6 years and under 79 (70/9) 77 (63/14) 73 (58/15)

6 years and over 27 (20/7) 44 (41/3) 79 (57/12)

Totals 106 111 150

ASD Coordinator (new/add-on)

33 (7/26) 57 (11/46) 73 (17/56)

*Note that 6 year olds may have been directed to either of the above pathways based on clinical presentation.

Referrals for ASD diagnostic assessments for younger children has remained relatively static; however, this and the increase in referral numbers for older children may be somewhat skewed by more 6 year olds now being directed to the over 6 joint pathway whilst in previous years they would have been offered an MDT. Regardless, there has been a significant increase in the referral rate for older children and for ASD diagnostic assessment overall.


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Balanced Score Card Inpatient Units, Community Teams and Indicator Definitions

The MHAID Service 3DHB is comprises two main parts:

The local/sub-regional mental health and addiction services.

Te Korowai-Whāriki which consists of adult rehabilitation and forensic (mental health and addiction) and intellectual disability services. A range of age specific community and inpatient services are delivered to meet population needs. Eleven inpatient units provide service and age specific assessment and treatment for the most severely unwell consumers. Services are either local, sub-regional regional or national (see table 1). The balanced score card inpatient measures are divided by DHB for the local/sub-regional services. For Te Korowai- Whāriki the inpatient measures split is by Forensic & Inpatient Rehabilitation and Intellectual Disability. There is additional split by age-based facilities for forensic and intellectual disability services. Table 1. MHAID Service 3DHB Inpatient Units

MHAIDS 3DHB

Group Provision*

Service & Age Focus** Hutt Valley DHB Capital and Coast DHB

Loca

l / S

ub

-Re

gio

nal

Intensive Recovery Sector

Sub-regional Mental Health - Adult Te Whare Ahuru Te Whare o Matairangi

Managed Withdrawal Service beds

Central region Mental Health - Adolescent

Regional Rangatahi Acute Inpatient Unit

Sub-regional Mental Health - Psychogeriatric

Te Whare Ra Uta

Younger Persons Community & Addictions

Central region Eating Disorders - Mixed Central Region Eating Disorder Service

Te K

oro

wai

-Whāriki Forensic &

Inpatient Rehabilitation

Central region Regional Rehabilitation - Adult

Tawhirmatea

Tane Mahuta

Central region Forensic - Adult

Puraehuraehu

Rangipapa

National Forensic - Youth

Nga Taiohi Build in progress

Intellectual Disability Services

Central and South Island

Intellectual Disability - Adult

Haumietiketike

National Intellectual Disability - Youth

Hikitia Te Wairua

*

Sub-Regional Wairarapa, Hutt Valley, Capital and Coast DHBs; Central Sub-Regional DHBs plus Mid-Central, Hawkes Bay, Wanganui DHBs plus Tairawhiti DHB; National All DHBs

** Youth Population aged 12 – 18 years; Adult Population aged 18 – 65 years; Psychogeriatric Population aged 18 – 65 years; Mixed Population aged 16 plus years


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There are 61 community based provider arm teams (see table 2). The majority are local or sub-regional services providing primarily assessment and treatment. Some teams also provide consultation liaison and education services. The balance score card community indicators report performance for these teams. Given varying indicator definitions not all teams are reported in all the measures (MHAID Service 3DHB, 2015).

Table 2. MHAID Service 3DHB Community Provider Arm Services

MHAIDS 3DHB

Group WDHB HVDHB CCDHB

Loca

l / S

ub

-Re

gio

nal

Younger Persons Community & Addictions

CAMHSa

CAMHS teams: Child Speciality Service and Youth Speciality Service

a

Intensive Clinical Service Teamb

Central Region Eating Disorder Service – Community

C

CAMHS teams: Kapiti, Porirua, Wellington, Primary Liaison Service, Pasifika and

Maoria

Early Intervention Serviceb

Specialist Maternal Mental Health ServiceC

Adult Community & Addictions

Adult CMHTa CMHTs: 1, 2, 3 and 4

a

Detoxa

Older Persons Mental Health Service

a

CMHTs: Kapiti, Porirua, South and Wellington, Adult Maori, Adult Pasifikaa

Co-Existing Disorder Service b

Community Alcohol and Drug Servicea

GP Liaison: Kapiti, Poriruaa

GP Opioid Serviceb

ECTa

Managed Withdrawal Serviceb

Psychogeriatric teama

Opioid Treatment Service

Regional Personality Disorder ServiceC

Intensive Recovery Sector

Acute Day Servicea

CATTa

Consultation Liaisona

CATTa

Consultation Liaisona

Home-based Treatmenta

Rangatahi Day Servicea

Rangatuhi Day Servicea

TACTa

Operations Centre

Intake Teama

MH NASCa

Te Haikaa

Service Coordinationa

Te K

oro

wai

-

Whāriki

Forensic & Inpatient Rehabilitation

Adult Forensic Community ServiceC

Regional Adult Forensic Community ServiceC

Youth Forensic Community ServiceC

Intellectual Disability Services

Co-existing Mental Health & Intellectual Disability Serviceb

Behavioural Support Service b

National Intellectual Disability Care Agencyd

aLocal: Primarily delivered to respective DHB population.

bSub-Regional Wairarapa, Hutt Valley, Capital and Coast DHBs (some services only contract delivery to Hutt Valley and Capital and Coast DHBs);

cCentral Sub-Regional DHBs and Mid-Central, Hawkes Bay, Wanganui DHBs (some contracts also include Tairawhiti DHB);

dNational All DHBs


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Table 3. MHAID Service 3DHB Balanced Score Card Indicator Definitions

No. Measure Target Definition Purpose and utility of indicator Reporting capability

1.1 28 day readmission rate

(Adult IP units only)

Target - 10%

Alert - ≥20%

Total number of in-scope overnight referral closures by the participant’s acute mental health and addiction services inpatient unit during the reference period that are followed by a readmission within 28 days to the organisation’s acute mental health and addiction services inpatient unit. Excludes transfers, deaths & readmissions from same day event (Northern DHB Support Agency, 2010).

Unplanned readmission to an inpatient service following a recent discharge may indicate that inpatient treatment was either incomplete or ineffective or that follow-up care was inadequate to maintain the person out of hospital.

WDHB: N/A as no IP unit.

1.2 Long-term consumers with current wellness plan (%)

95% The percentage of long-term consumers with a wellness plan. Long-term consumers are adults and older people (20 years plus) whose episode of care is two or more years, and children and youth whose episode of care is for one or more years. The episode of care is measured from the inpatient admission or primary community referral start date (Ministry of Health, 2014a).

A proxy measure for quality of care. Wellness plan (relapse prevention plans) identify early relapse warning signs of clients. The plan identifies the support required by the tangata whaiora/consumer to promote resilience and recovery when early warning signs are present. Each client will know of (and ideally have a copy of) their plan.

WDHB: manual quality audit

HVDHB: Report on current electronic risk plans

CCDHB: Report on electronic wellness plans

1.3 Held for indicator under development

1.4 Better help for inpatient smokers to quit

95% The percentage of hospitalised patients who smoke and are seen by a health practitioner in public hospitals and percentage of enrolled patients who smoke and are seen by a health practitioner in general practice are offered brief advice and support to quit smoking (Ministry of Health, 2014b).

There is strong evidence that brief advice is effective at prompting quit attempts and long-term quit success. The quit rate is improved further by the provision of effective cessation therapies – pharmaceuticals, in particular nicotine replacement therapy (NRT), and telephone or face-to-face support.


1.5 HoNOS compliant inpatient discharges - matched pairs

≥80% The percentage of in scope discharges that have both an admission and discharge HoNOS. In scope discharges: LOS >3 days and the consumer was discharged routinely or to another healthcare facility OR to other service within the same facility. The consumer was not discharged to another psychiatric inpatient unit or an accident and emergency service (Northern DHB Support Agency, 2010; Te Pou, 2012).

Provides information about the effectiveness of inpatient treatment in aiding recovery by measuring if change occurs between the admission and discharge HoNOS.


HVDHB: Snapshot

CCDHB: New measure – covers the reference period. Data validation still required.


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1.6 HoNOS collection compliance - community

≥80% Number of community consumers with a current HoNOS collection. In-scope collections are within the current episode of care. For new referrals the collection must be within 14 days of the first face-to-face appointment. Thereafter a 91 day review is required. The 91 day reviews are required to be completed within 14 days either side of the review date (Te Pou, 2012).

Provides information about the effectiveness of community treatment in aiding recovery by measuring if change occurs overtime.

WDHB/HVDHB: Snapshot

CCDHB: New measure – covers the reference period. Data validation still required.

1.7 Consumer death by suspected suicide (community and inpatient)

N/A Count of suspected community suicides by current mental health consumer within 28 days of contact with service and all suspected suicides as inpatient (Health Quality and Safety Commission New Zealand, 2012).

1.8 Severity 1 & 2 (Confirmed SAC 1&2)

N/A Count of the number of SAC 1&2 events that have been reviewed and reported by the CCDHB Patient Safety Office per month (Health Quality and Safety Commission New Zealand, 2012).

Serious Adverse Events are events which have generally resulted in harm to patients. When adverse incidents occur, it’s important these events are reported, investigated and reviewed so we can learn from them and improve the way we do things. Systematic review of and learning from adverse events should see a reduction in serious adverse events over time, reflecting improved safety for people using services (Mental Health Commission, 2014).

1.9 All reportable events

N/A Count of the number of all reported events reported in the reportable events database prior to any review.

1.10 Medication errors (n)

Count of the number of all medication errors reported in the Reportable Events system.

1.11 Complaints (n) Count of the number of complaints received and recorded per week by the Quality & Risk team and reported in the reportable events database.

1.12 Complaints resolved/closed within 30 days (%)

100% complaints resolved within 30 days

The percentage of all complaints that were received in the reference period and resolved in 30days. This excludes HDC complaints or where the complainants have been notified within 10 working days that an extension is required by the DHB which received the


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complaint (HDC Code of Health and Disability Services Consumers’ Rights Regulation 1996, n.d).

1.13 Health & Disability Commissioner Complaints

Count of all HDC complaints in the reference period and year to date

1.14 Compliments (n) Count of the number of compliments received and recorded per month by the Quality & Risk team in the reportable events database.

1.15 Restraints (n) Count of the number of all restraints reported in the Reportable Events system.

1.16 Consumers required to undergo MH Act assessment

Count unique consumers required undergo assessment subject to sections 11 or section 13 or section 14(4) of the Mental Health Act during the reference period. Consumers transferred between sections in the reference period are only counted once. If section 11 has occurred more than once in the reference period, the person is counted twice.

WDHB: Manual data

All DHBs: Data quality issues that each DHB is working on may impact numbers. Data quality project underway.

1.17 Consumers subject to compulsory treatment order

Count of unique consumers subject to an inpatient or community compulsory treatment order during the reference period. This includes extensions and indefinite orders. Consumers transferred between sections in the reference period are only counted once. For example an inpatient treatment order transferred to an outpatient treatment order or when an order is extended or made indefinite. Per the national health target and DHB Maori Health Plans, this indicator also reports the number of Maori subject to section 29 community treatment orders (Capital and Coast District Health Board, 2014; Hutt Valley District Health Board, 2014; Wairarapa District Health Board, 2014).

As above

1.18 Number of seclusion hours

Count of the hours that are attributed to seclusion activity in the reference period. This measure excludes

As above


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the hours attributed to an event that occur before or after the reference period. The divisor is DHB catchment projected population divided by 100,000. Also report by Maori and Pacific ethnicity.

2.1 Access rate The average total number of people domiciled in the DHB region, seen per year rolling every three months being reported (the period is lagged by three months) for the projected population of the DHB region (Ministry of Health, 2014c).

This indicator will provide a means of monitoring rates of access to assessment and treatment services and to compare these with what is known about the distribution of mental disorders and what is aimed for in policy and in funding agreements.

It is known that there are significant levels of unmet need in mental health and addiction. A measure Is required to monitor population treatment rates and assess these against what is known about the distribution of mental disorders in the community (Mental Health Commission, 2014).

Ministry of Health data, incudes NGOs. Rolling year, 3 month lag (PP6).

2.2 Average length of acute inpatient stay (days)

14-21 days

Alert - ≥30 days.

Total number of inpatient bed nights for discharges that occurred in the reference period – excludes transfer, deaths and leave days (Northern DHB Support Agency, 2010).

Mental health & addiction services aim to provide care in the least restrictive environment. This KPI provides some information about the extent to which this is being achieved and promotes a more complete picture of an organisation’s overall model of care (Northern DHB Support Agency, 2012).

2.3 Inpatient occupancy

85% Average level of occupancy in acute inpatient units managed by the mental health and addiction service over the reference period (Northern DHB Support Agency, 2010).

Most acute inpatient units run at or close to 100%. Experience suggests that acute inpatient units operating above 90% occupancy on an ongoing basis are stressed, compromising the provision of optimal care during the inpatient period including discharge planning.

Benchmarking will help to understand variations between DHBs, the drivers of high occupancy, and may support movement toward lower occupancy rates (Mental Health Commission, 2014; Northern DHB Support Agency, 2010).

2.4 Pre-admission community care

75% Number of in-scope acute inpatient referrals to the mental health and addiction service organisation’s acute

Provides a measure of the quality of care, efficiency of resource use and the extent to which a service has

HVDHB/CCDHB: New measure. Data validation


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inpatient team, occurring during the reference period for which a face-to-face community mental health contact was recorded in the seven days immediately preceding that admission by community care services managed by the organisation (Northern DHB Support Agency, 2010).

engaged with consumers and attempted to support them within their natural environment (Northern DHB Support Agency, 2012).

still required

2.5 Post-discharge community care

90% Number of overnight referral closures from acute inpatient units to the organisation’s community catchment during the reference period for which a community mental health contact with client participation was recorded in the seven days immediately following that discharge (Mental Health Commission, 2014; Northern DHB Support Agency, 2010).

A responsive community support system for people who have experienced an acute psychiatric episode requiring hospitalisation is essential to maintain clinical and functional stability and to minimise the need for hospital readmission (Northern DHB Support Agency, 2012).

Refer to comment 2.4.

2.6 Consumer related time

30-40% The percentage of recorded community clinical activity that is attributed to paid direct-care clinical FTE in the reference period. The numerator is the total recorded clinical activity for both consumer participation time (telephone & face-to-face) and non-consumer participation time (liaison/care coordination with other agency or family contact without the consumer present). The denominator 'paid direct-care clinical FTE' is all paid hours for staff (excludes support and management/administration staff) minus any recorded leave (Northern DHB Support Agency, 2010).

Number of contact hours with service user participation plus the number of contact hours without service user participation (Northern DHB Support Agency, 2012).

WDHB/HVDHB: Indicator under development.

2.7 Community treatment days per quarter

10-12 days Total number of community treatment days provided by the mental health and addiction service organisation’s community mental health and addictions services within a three month reference period. (A treatment day is a day on which a service user received some clinical input; it could be one contact or many). This is a three monthly average (Northern DHB Support Agency, 2010).

Provides a measure of the intensity of treatment within the community (Northern DHB Support Agency, 2012).

WDHB/HVDHB: Indicator under development.

2.8 Wait-time to first face-to-face contact

80% < 3 weeks

95% < 8

Measures Wait-time from the referral received date to the first face-to-face appointment.

The MHAID 3DHB calculation differs slightly to the MoH

Provides a measure of service efficiency (Ministry of Health, 2014c).

Ministry of Health data, Rolling year, 3 month lag (PP8).


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weeks PP8 measure as we measure the wait-time for all referrals. The MoH calculation measures wait times for those consumers who have not access MH&AS in the past year.

2.9 Community DNA rate

Count of DNA activity. The count divided by all DNA activity plus all face-to-face activity in the reference period provides the DNA rate.

Note: In MHAID mental health & addiction services did not attend activity (DNA) is mainly collected as an activity, rather than an appointment as used by the 3-DHB general outpatients measure This means that the general out patients and MHAID measure is not comparable.

Provides a measure of the quality of care (safety and risk for consumers who do not attend) and efficient use of community FTE resource.

HVDHB/CCDHB: New indicator.

2.10 Caseload with consumer participation in the last 90 days (%)

All unique community consumers at month end, with an episode of care 90 days or over, that have had a service user participation contact recorded during the previous 90 days.

An indicator of service delivery timeliness and proxy measure to consider if active treatment is being delivered to consumers accessing community teams (Mental Health Commission, 2014).

3.1 Staff turnover (%) 8-10% Number of employed staff who voluntarily resign from mental health and addiction services within the reference period (Northern DHB Support Agency, 2010).

Provides an indicator of the effectiveness of staff recruitment, orientation, engagement and support. Overall it is generally seen as an indicator of the health of the organisation (Northern DHB Support Agency, 2012).

3.2 Sick leave (%) 2-4% Total number of sick leave hours claimed by all employed mental health and addiction staff during the reference period (Northern DHB Support Agency, 2010).

Provides an indicator of a healthy, sustainable workforce (Northern DHB Support Agency, 2012).

3.3 Number of staff with annual leave > 200 hours (n)

0

(Coop, 2006)

Total number of MHAID staff who have annual leave owing greater than 200 hours during the reference period (Coop, 2006).

Provides measure and control on annual leave liability. Staff are encouraged to take leave for their better wellbeing, in turn this reduces the liability carried by the organisation (Coop, 2006).

3.4 Physical assaults on staff

Count of assaults.


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3.5 Percentage of performance appraisals completed

100%

(Coop, 2006)

Percentage of performance appraisals completed in the last year excluding causal, fixed term, medical.

This indicator signals the significance of staff career development and progress towards high quality service delivery (Coop, 2006).

CCDHB: Under development

4.1 Operating (actual) costs ($'000)

Total MHAID costs including personnel, outsourced, clinical costs, infrastructure costs and recharging during the reference period (Coop, 2006).

Provides measure on total cost over total revenue. In general a good indicator to have some controlled measures by percentages etc.

4.2 Personnel including outsourced ($'000)

Total MHAID personnel and outsourced costs during the reference period (Coop, 2006).

Provides an indicator of personnel costs and outsourced costs percentages to total revenue. Good indicator to measure performance on budget.

4.3 Overtime (total hours versus overtime hours)

Total overtime hours costs over total hours of personnel costs (Coop, 2006).

An indicator of total overtime hours spent compared to total personnel hours costs. This gives a good picture on the use of overtime hours and puts control measures as percentage to total hours. In general a good tool to control overtime costs over budget.

4.4 FTEs - actual Total MHAID personnel and outsourced FTE’s (contracted), excluding vacancies during the reference period (Coop, 2006).

Measure the performance vs budget.

4.5 FTEs - vacancies Manual count of vacancies provided on a monthly basis, one month lag.


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References

Capital and Coast District Health Board. (2014). Capital & Coast District Health Board Maori Health Action Plan 2014/15. Retrieved from http://www.ccdhb.org.nz/planning/Maori_Health/CCDHB Maori Health Plan 2014_15_FINAL.PDF

Coop, C. F. (2006). Balancing the balanced scorecard for a New Zealand mental health service. Australian Health Review : A Publication of the Australian Hospital Association, 30(2), 174–80. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16646766

Health Quality and Safety Commission New Zealand. (2012). Serious Incidents involving users of Mental Health services. Retrieved February 02, 2015, from http://www.hqsc.govt.nz/assets/Reportable-Events/Publications/Reporting-reviewing-adverse-events-MH-Dec-2012.pdf

Hutt Valley District Health Board. (2014). Hutt Valley District Health Board Maori Health Plan 2014/15. Retrieved July 15, 2015, from http://www.huttvalleydhb.org.nz/content/3e4af01f-de2c-426a-80a5-dc0ffbcf43a7.cmr

Mental Health Commission. (2014). MHC (Rising to the Challenge) Outcomes Framework - Outcomes Framework Indicators Definition Draft V3.0 (20th June 2014).

MHAID Service 3DHB. (2015). Mental Health, Addictions & Intellectual Disability Service 3DHB: Balanced Score Card - Technical Specifications (in draft).

Ministry of Health. (2014a). 2013/14 DHB non-financial monitoring framework and performance measures. Retrieved February 02, 2015, from http://www.nsfl.health.govt.nz/apps/nsfl.nsf/pagesmh/508

Ministry of Health. (2014b). 2014/15 DHB Health Targets. Retrieved February 02, 2015, from http://www.nsfl.health.govt.nz/apps/nsfl.nsf/menumh/Accountability+Documents

Ministry of Health. (2014c). 2014/15 DHB non-financial monitoring framework and performance measures. Retrieved February 02, 2015, from http://www.nsfl.health.govt.nz/apps/nsfl.nsf/menumh/Accountability+Documents

Northern DHB Support Agency. (2010). Key Performance Indicator Framework for New Zealand Mental Health and Addiction Services Phase III: Implementation of the Framework Benchmarking Participation Manual Part 3. Technical Specifications for participating organisations July 2010. Retrieved February 02, 2015, from http://www.ndsa.co.nz/LinkClick.aspx?fileticket=oBs7TAI8s_Q=&tabid=95

Northern DHB Support Agency. (2012). KPI Framework for New Zealand Mental Health And Addiction Services. Phase III - Implementation of the framework in adult mental health services. June 2012. Retrieved December 11, 2014, from http://www.ndsa.co.nz/OurServicesWhatWeDo/MentalHealth/KPIFramework.aspx

Te Pou. (2012). Mental Health Outcomes Information Collection Protocol - HoNOS Family (Version 2.1). Retrieved February 02, 2015, from http://www.tepou.co.nz/library/tepou/mental-health-outcomes---information-collection-protocol

Wairarapa District Health Board. (2014). Wairarapa District Health Board Maori Health Action Plan 2014/15. Retrieved from http://www.huttvalleydhb.org.nz/content/df930e87-ed92-404d-a0d0-dc2d30a31d34.cmr


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