AGENDA - Whanganui District Health Board · 2019. 7. 26. · Agenda Public session Meeting of the...

AGENDA

Community Public Health Advisory Committee/Disability Support Advisory

Committee (CPHAC/DSAC) Meeting date

Friday 16 September 2016

Start time 9.30am – CPHAC/DSAC

Venue Board Room Fourth Floor Ward and Administration Building Wanganui Hospital 100 Heads Road Whanganui

Embargoed until Saturday 17 September 2016

Contact Phone 06 348 3393 Also available on website Fax 06 345 9390 www.wdhb.org.nz

Community Public Health Advisory Committee/ Disability Support Advisory Committee

Page 1 16 September 2016

http://www.wdhb.org.nz/

Distribution Board members (full copy)

Ms D McKinnon, Board Chair Mr P Sunderland, Deputy Board Chair Mr A Anderson Mrs P Baker-Hogan Mrs J Duncan Ms H Hipango Mr S Hylton Mrs K Joblin Mrs J MacDonald Mr R Stevens External committee members (full copy)

Mr F Bristol Dr A Mangan Mr M Rayner Mr D Hull Mrs J Nitschke Mrs S Osborne Ms G Taiaroa Executive Management Team and others (full copy)

Mrs J Patterson, Chief Executive Mrs S Blake, Director of Nursing, Patient Safety and Quality Mrs S Campion, Communications Manager Mr H Cilliers, Regional Manager, Human Resources and Organisational Development Ms K Fry, Director Allied Health Mrs R Kui, Director Māori Health Mr F Rawlinson, Chief Medical Officer Ms T Schiebli, General Manager, Service and Business Planning Mr B Walden, General Manager, Corporate Mr M Power, Funding Manager Service and Business Planning Team Others (public section only)

Mrs K Anderson, Chief Executive Officer, Hospice Wanganui Dr B Douglas, GP, Jabulani Medical Practice Hauora a Iwi Wanganui Public Library Wanganui Chronicle Rivercity Press

Agendas are available at www.wdhb.org.nz one week prior to the meeting.




Agenda Public session

Meeting of the Community and Public Health/ Disability Support Advisory Committee

to be held in the Board Room, Fourth Floor, Ward/Administration Building

Wanganui Hospital, 100 Heads Road, Whanganui on Friday 16 September 2016, commencing at 9.30am

Community and Public Health Advisory/Disability Support Advisory Committee members Mrs Kate Joblin, Committee Chair Mr Frank Bristol Ms Jenny Duncan Ms Harete Hipango Mr Stuart Hylton Mrs Judith MacDonald Dr Alan Mangan Mr Matthew Rayner Ms Grace Taiaroa Ms Dot McKinnon, Board Chair (ex officio) 1 Apologies

2 Conflict and register of interests update

2.1 Amendments to the register of interests 2.2 Declaration of conflicts in relation to business at this meeting

3 Late items

Registration of minor items only. No resolution, decision or recommendation may be made except

to refer the item to a future meeting for further discussion.



4 Minutes of the previous CPHAC/DSAC meeting

Page 13

Recommendation That the minutes of the public session of the meeting of the Community and Public Health/Disability Support Advisory Committee held on 22 July 2016 be approved as a true and correct record.

5 Matters arising Nil

6 Committee Chair’s report

A verbal report may be given at the meeting 7 Presentation

There is no presentation at this meeting

8 General Manager, Service and Business Planning’s report 8.1 Whanganui DHB – Annual Planning for 2016/17

Page 19

8.2 Health Targets and indicators of DHB performance 8.3 Integrated approach to health promotion across the Whanganui district 8.4 Integrated performance and incentive framework (IPIF)

8.5 Whanganui Rising to the Challenge 8.6 Financial and IDF report

Combined committee interest commences at 10.30am 9 Items of mutual interest to CPHAC and HAC Page 47 9.1 Health of Older People – Special topics 9.2 Mental health and addictions services 9.3 Faster Cancer Treatment (FCT) Monthly Reporting Data 9.4 Maori Health report 9.5 Next combined strategy committee meeting 9.6 Whanganui District Health Board minutes, 17 June – for info only 9.7 Glossary and terms of reference – for info only



10 Information Section

Attachment Description Page

General Manager, Service and Business planning report - attachments

1 Whanganui DHB 2016/17 Annual Plan – letter of advice 71

2 Health targets – overall target performance

A dashboard of Whanganui DHB performance against the quarter four targets

*

3 Health Families Panui July 2016 *

4 Bay of Plenty position statement on ‘Health in all Policies’ *

5 Integrated Performance and Incentive Framework (IPIF) - PHO performance *

6 Active assisted living presentation *

7 Dementia care in the Netherlands – study tour presentation *

Director Māori Health’s report – attachments

8 Appendix one – Funding to Māori health providers by district health boards 2010/11 to 2014/15

9 Appendix two - WDHB Māori Health Dashboard YTD – June 2016

10 Appendix three - Human resources KPI DHB benchmarking - Maori representation in the workforce

11 Date of next meeting Friday, 28 October – combined workshop between CPHAC/DSAC and HAC to start at 9.30am

12 Exclusion of public

Recommendation

That the public be excluded from the remainder of this meeting under clause 32, Schedule 3 of the New Zealand Public Health and Disability Act 2000 on the grounds that the conduct of the following agenda items in public would be likely to result in the disclosure of information for which good reason for withholding exists under sections 6, 7 or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982.

Agenda item Reason OIA reference Community and Public Health/Disability Support Advisory Committee minutes of meeting held on 22 July 2016 (public-excluded session)

For the reasons set out in the committee’s agenda of 15 April 2016

As per the committee’s agenda of 22 July 2016

Service and Business Planning – risk register

To protect the privacy of natural persons, including that of deceased natural persons

To protect information where the making available of the information would be likely unreasonably to prejudice the

Section 9(2)(a)

Section 9(2)(b)(ii)



Note *: These documents are available on request from the WDHB board secretary - phone 06 348 3393

*

*

*

Agenda item Reason OIA reference commercial position of the person who supplied or who is the subject of the information

To enable the district health board to carry out, without prejudice or disadvantage, commercial activities or negotiations (including commercial and industrial negotiations)

Section 9(2)(i) and 9(2)(j)

Persons permitted to remain during the public excluded session

That the following person(s) may be permitted to remain after the public has been excluded because the committee considers that they have knowledge that will help it. The knowledge is possessed by the following persons and relevance of that knowledge to the matters to be discussed follows.

Person(s) Knowledge possessed Relevance to discussion Chief executive and senior managers and clinicians present

Management and operational information about Whanganui District Health Board

Management and operational reporting and advice to the board

Committee secretary Minute taking Recording minutes of meetings



WHANGANUI DISTRICT HEALTH BOARD

REGISTER OF CURRENT CONFLICTS AND DECLARATIONS OF INTEREST

Up to and including 10 August 2016 BOARD MEMBERS

NAME DATE NOTIFIED CONFLICT/DECLARATIONS Allan Anderson 20 December 2007 Advised that he is a trustee of Air Ambulance Trust. 6 March 2009 & 3 April

2009 Advised that he is a member of Wanganui Air Ambulance Trust which provides medical equipment for moving patients by air transport

1 May 2009 & 10 July 2009 Advised that his son is a partner of Chapman Tripp, who are lawyers to the Board’s insurers

Barbara Ball 21 January 2016 Declared her interest as:

Hauora A Iwi: Mokai Patea iwi rep Whanganui Regional Health Network: Rangitikei iwi rep and board

member Taihape Health Limited (a subsidiary of Whanganui Regional Health

Network delivering primary and community health services in the Taihape District): Iwi rep and director

Te Runanga O Ngati Whitikaupeka (Iwi authority for the people of Ngati Whitikaupeka): Iwi delegate

Mokai Patea Waitangi Claims Trust (Trust mandated to settle Waitangi claims within the Mokai Patea rohe): Whitikaupeka iwi delegate and deputy chair

Te Roopu Ahi Kaa (Standing committee of Rangitikei District Council providing cultural and iwi advice): Whitikaupeka iwi delegate and deputy chair

Nga iwi o Mokai Patea Services Trust (Iwi and community service provider): Whitikaupeka iwi delegate and chairman

Kaupeka ki Runanga Trust (Operational arm of Te Runanga o Ngati Whitikaupeka): Trustee and treasurer

Nga Pae o Rangitikei: Whitikaupeka iwi delegate Philippa Baker-Hogan 10 March 2006 Advised that she is an elected member of the Wanganui District Council. 8 June 2007 Partner in Hogan Osteo Plus Partnership. 24 April 2008 Advised that her husband is an osteopath who works with some surgeons in

the hospital on a non paid basis but some of those patients sometimes come to his private practice Hogan Osteo Plus and that she is a partner in that business.

25 September 2009 Appointed to Wanganui Community Foundation from 1 October 2009 29 November 2013 Advised that she is Chair of the Future Champions Trust, which supports

promising young athletes. 7 November 2014 Philippa Baker-Hogan declared her interest as:

A member of the Wanganui District Council District Licensing Committee; and

Chairman of The New Zealand Masters Games Limited Jenny Duncan 18 October 2013 Advised that she:

Is a member of the Whanganui Community Foundation Is an elected member of the Wanganui District Council

1 August 2014 Advised that she is an appointed member of the Castlecliff Community Charitable Trust

Harete Hipango 7 March 2014 Advised that she acts as lawyer for clients who may be consumers of

services from WDHB. Stuart Hylton 4 July 2014 Advised that he is:

Executive member of the Wanganui-Waimarino Cancer Society. District Licensing Commissioner, which is a judicial role and in that role

he receives reports from the Medical Officer of Health and others. 13 November 2015 Advised that he is an executive member of the Central Districts Cancer



Society. Kate Joblin 11 May 2007 Confirmed that she is a Trustee of ‘Life to the Max Trust’. 23 May 2008 Declared that she is a director and shareholder of Kate Joblin & Co Limited,

which company has a number of clients that have contracts with WDHB. 17 December 2010 Advised that she is an appointed Director of MidCentral District Health

Board. 17 February 2012 Advised that Kate Joblin & Co Limited acts for some medical practitioners

who are members of the Primary Health Organisation. 12 December 2012 Advised that Kate Joblin & Co Limited acts for a client who owns a

pharmacy. 20 November 2013 Advised Kate Joblin & Co Limited provides accountancy services for

Whanganui Youth Services Trust 11 & 16 April 2014 Advised that her daughter-in-law is about to commence working for WDHB

and is a registered nurse on the NETP (Nursing Entry To Practice) programme.

29 January 2016 Advised that her niece works for Te Awhina Mental Health Unit. Judith MacDonald 22 September 2006 Advised that she is:

Chief Executive Officer, Whanganui Regional Primary Health Organisation

Director, Whanganui Accident and Medical Member of Providing Access to Health Solutions (PATHS) Whanganui

steering group 20 December 2007 Advised that she is a trustee of Life to the Max 11 April 2008 Advised that she is a director of Gonville Health Centre 4 February 2011 Declared her interest as director of Taihape Health Limited, a wholly owned

subsidiary of Whanganui Regional Primary Health Organisation, delivering health services in Taihape.

31 July 2015 Advised that she is a Member of Children’s Action Plan (CAP) Governance Group

27 May 2016 Advised that she has been appointed Chair of the Children’s Action Team Dot McKinnon 3 December 2013 Advised that she is:

An associate of Moore Law, Lawyers, Wanganui Chair, Powerco Wanganui Trust Wife of the Chair of the Wanganui Eye Care and Medical Trust

4 December 2013 Advised that she is Cousin of Brian Walden 23 May 2014 Advised that she is a member of the Health Sector Relationship Agreement

Committee. 31 July 2015 and 10

August 2015 Advised that she is appointed to the NZ Health Practitioners Disciplinary Tribunal

2 March 2016 Advised that she is a member of the Institute of Directors Ray Stevens 17 December 2010 Advised that he is a Councillor on the Wanganui District Council Phillip Sunderland 24 November 2009

26 June 2015

Declared his interest as Chairman of the MidCentral District Health Board effective from the 1st of January 2010 Declared his appointment as a director of NZ Health Partnerships Ltd

BOARD ADVISORS

NAME DATE NOTIFIED CONFLICT/DECLARATIONS Peter Brown No current interests. HOSPITAL ADVISORY COMMITTEE MEMBERS

NAME DATE NOTIFIED CONFLICT/DECLARATIONS Darren Hull 28 March 2014 Advised that he acts for clients who may be consumers of services from

WDHB. 27 May 2014 Advised that he:

is a director & shareholder of Venter & Hull Chartered Accountants Ltd



which has clients who have contracts with WDHB acts for some medical practitioners who are members of the Primary

Health Organisation acts for some clients who own and operate a pharmacy is chair of Whanganui Living Without Violence Trust is a director of Gonville Medical Ltd

20 June 2014 Advised he is on the Whanganui Regional Health Network Risk & Audit Committee.

23 May 2016 Advised he is no longer on the Whanganui Regional Health Network Risk & Audit Committee.

Julie Nitschke May 2007 Strategic Development Manager, Whanganui Regional Primary Health

Organisation that negotiates contracts directly with the district health board

Manawatu Sheltered Housing (MASH) Board member (Palmerston North)

Participation in operational working parties. 6 July 2012 Advised that her title at Whanganui Regional Primary Health Organisation

has changed to Clinical Director Primary Care. 29 November 2013 Advised that she is a member of the WAM/WDHB Steering Group 15 April 2016 Advised that she is a board member on the Whanganui Accident and

Medical Board Susan Osborne 25 February 2014 Advised the following conflicts/interests:

Hauora a Iwi (Whanganui Representative) Governance Te Oranganui Iwi Health Authority Board of Trustees Jigsaw Whanganui Board of Trustee Tupoho Runanga Whanganui Health portfolio representative.

20 June 2014 Advised that she is on the Te Oranganui Iwi Health Authority Risk & Audit Committee.

31 July 2015 Advised she is a trustee of Nga Tangata Tiaki. COMMUNITY AND PUBLIC HEALTH ADVISORY AND DISABILITY SUPPORT ADVISORY COMMITTEE MEMBERS

NAME DATE NOTIFIED CONFLICT/DECLARATIONS Frank Bristol 8 April 2011 Declared his interest as the Manager of Balance Wanganui – An

organisation which holds a contract with Whanganui DHB. 1 July 2011 Advised that Balance Whanganui now has a consumer leadership,

consultation and liaison contract with the Whanganui District Health Board 23 September 2011 Advised that he is:

appointed to the Mental Health and Addictions Network Group (MHAN) a Trustee of the Well Beyond Recovery Inc – US a Trustee of the Wanganui Disability Resources Centre

26 July 2013 Advised that he has been appointed to the Mental Health Strategic Planning Group.

18 October 2013 Advised that he has been appointed to: the Mental Health and Addictions Network Group (MHAN) work

streams – 1) high prevalence, high needs, and 2) Workforce development.

the WDHB Mental Health and Addiction (MH&A) Strategic Planning Group leading a workstream for low need, high prevalence, mental health.

the Care Capacity Demand Management Council of the Whanganui DHB.

29 November 2013 Advised that he is an executive member of the National Early Intervention for Psychosis Team.

28 March 2014 Advised that he is: a member on the National Mental Health & Addiction Information

Reference Group - Te Pou/Ministry of Health a member on the Central Region Mental Health & Addiction Clinical

Network Working Groups for Central TAS including: a. Regional Youth Forensic b. Regional Adult Forensic c. Workforce Development

12 September 2014 Advised that he is is on the Steering Group of ‘On Track’ project which is a



24 October 2014

joint initiative between Te Pou and Platform Trust Advised that he is a consultant for the MidCentral DHB Mental Health Review Group

19 June 2015 Declared he is chairing the Whanganui Regional Health Network ‘manage my health’ steering group

26 February 2016 Advised that he is a consumer adviser to the MidCentral District Health Board

27 May 2016 Advised that he is a member of the governing party for the Director General for Mental Health which is testing the Bill of Human Rights and this work includes the Children’s Action Team

Dr Alan Mangan 27 April 2007 Advised that he is a director of Aramoho Health Centre 20 December 2007 Advised that:

he is a trustee of Eye Care Trust his wife is employed by Whanganui District Health Board as a dental

Therapist 11 April 2008 Advised that he is a director of Gonville Health Centre 22 March 2013 Advised that he is Chairman of the Gonville Health Board 29 November 2013 Advised that he is a trustee of River City Trust, which has an interest in

health initiatives 9 May 2014 Advised that he is a Clinical Director of the Whanganui Regional Primary

Health Network Matt Rayner 11 October 2012 Advised that:

He is an employee of Whanganui Regional PHO – 2006 to present His fiancée, Karli Kaea-Norman, is an Employee of Gonville Health

Limited 26 October 2012 Advised that he is a member on the Diabetes Governance Group 31 July 2015 Advised that he is:

employed by the Whanganui Regional Health Network (WRHN) a trustee of the group “Life to the Max”

27 May 2016 Advised that he is a member of the Health Solutions Trust Grace Taiaroa 31 July 2015 Advised that she is:

The Operation Manager for Te Runanga o Ngati Apa (as part of the work she manages the health and social services - Te Kotuku Hauora)

a member of Children’s Action Plan (CAP) Governance Group a member of the Mental Health and Addiction Strategic Planning Group a member of the Whanganui Alliance Leadership Team (WALT).

RISK AND AUDIT COMMITTEE MEMBERS

NAME DATE NOTIFIED CONFLICT/DECLARATIONS Anne Kolbe 26 August 2010 Medical Council of NZ – Vocational medical registration – Pays

registration fee Royal Australasian College of Surgeons – Fellow by Examination – Pays

subscription fee Private Paediatric Surgical Practice (Kolbe Medical Services Limited) –

Director – Joint owner Communio, NZ – Senior Consultant - Contractor Siggins Miller, Australia – Senior Consultant - Contractor Hospital Advisory Committee ADHB – Member – Receives fee for

service Risk and Audit Committee Whanganui DHB – Member – Receives fee

for service South Island Neurosurgical Services Expert Panel on behalf of the DGH

– Chair – Receives fee for service 18 April 2012 Advised that she is an employee of Auckland University but no longer draws

a salary. 20 June 2012 Advised that she holds an adjunct appointment at Associate Professor level

to the University of Auckland and is paid a small retainer (not salary). 17 April 2013 Advised that her husband John Kolbe is:

Professor of Medicine, FMHS, University of Auckland Chair, Health Research Council of New Zealand, Clinical Trials Advisory

Committee (advisory to the council) Member Australian Medical Council (AMC) Medical School Advisory

Committee (advisory to the board of AMC)



Lead, Australian Medical Council, Medical Specialties Advisory Committee Accreditation Team, Royal Australian College of General Practitioners

Member, Executive Committee, International Society for Internal Medicine

Chair, RACP (Royal Australasian College of Physicians) Re-validation Working Party

Member, RACP (Royal Australasian College of Physicians) Governance Working Party

12 February 2014 Advised that she is a Member of the Australian Institute of Directors – pays membership fee

18 February 2016 Joined the inaugural board of EXCITE International, an international joint venture sponsored by the Canadian Government, to consider how to pull useful new technology into the marketplace. No fee for service, although costs would be met by EXCITE International.

13 April 2016 Advised that she: is an observer to the Medicare Benefits Schedule Review Taskforce

(Australia). 10 August 2016 Advised that:

Transition of the National Health Committee business functions into the NZ Ministry of Health was completed on 9 May 2016. The Director-General has since disbanded the NHC executive team.

Emma Kolbe, her daughter, has taken up a position at ESR (Institute of Environmental Science and Research), Auckland as a forensic scientist working in the national drugs chemistry team.

She is chair, Advisory Council, EXCITE International. She is member of MidCentral District Health Board’s Finance, Risk and

Audit Committee. Darren Hull (Refer to interests noted for Hospital Advisory Committee members above)



Minutes Public session

Meeting of the Community and Public Health/

Disability Support Advisory Committee

held in the Board Room, Fourth Floor, Ward/Administration Building Whanganui Hospital, 100 Heads Road, Whanganui

on Friday 22 July 2016, commencing at 9.40am

Present Mr Frank Bristol Ms Jenny Duncan Ms Harete Hipango Mr Stuart Hylton Ms Kate Joblin, Committee Chair Mrs Judith MacDonald Mrs Dot McKinnon, Board Chair Mr Matt Rayner In attendance Mrs Andrea Bunn, Senior Portfolio Manager, Health of Older People and Mental Health Ms Sue Campion, Communications Manager Mr Hentie Cilliers, Manager Human Resources Mrs Jevada Haitana, Associate Director of Nursing Mr Bruce Jones, Public Health Nurse Ms Deborah Mansor, Executive Assistant (minutes) Mrs Eileen O’Leary, Project Manager, Service and Business Planning Mr Matt Power, Funding Manager, Service and Business Planning Ms Tracey Schiebli, General Manager, Service and Business Planning Mrs Louise Torr, Business Manager Media There was no media in attendance. Public Four members of the public attended this meeting. Karakia/reflection Mr Matt Rayner provided a karakia.



1 Apologies Apologies were received and accepted from Mrs Philippa Baker-Hogan and Ms Grace Taiaroa. 2 Conflict and register of interests update 2.1 Amendments to the register of interests Mr Matt Rayner advised that a conflict noted for him on 27 May 2016 should read Health Solutions Trust instead of the Tobacco Advisory Group. Mr Frank Bristol advised a change to his conflict noted on 27 May 2016, and said he would e-mail through his amendment. The update had not been received at the time of including these minutes for the board agenda. 2.2 Declaration of conflicts in relation to business at this meeting No conflicts were declared. 3 Late items No late items were advised. 4 Minutes of the previous meeting It was resolved that: The minutes of the public session of the meeting of the Community and Public Health/Disability Support Advisory Committee held on 27 May 2016 are approved as a true and correct record.

All agreed/carried

5 Matters arising The minutes were agreed with the following noted: Clarification around the funding for smokefree – the MoH has agreed to retain the funding under

the RFP at the original amount. This funding goes directly from the MoH to the PHO. The DHB also receives smokefree funding which arose from a government budget, and DHBs have been in receipt of this for the last four years. There is uncertainty around whether this funding will continue post 2016/17. A Tobacco Control Plan investment plan is being developed for discussion with committees at the September meeting.

Unpublished framework for mental health – a member noted that this will be a useful framework

for the committees to consider. This framework has key result areas which can apply to any aspect of health. The timeline for the document to be finalised is still to be determined. Mr Bristol advised he is on the health informatics section of the framework working committee. Action: Management to provide an update at the September committee meeting.



The next joint strategy committee meeting is scheduled for 28 October 2016. A number of reports were flagged to be provided at this meeting; the committee asked that these

be presented at the next meeting scheduled for 16 September 2016. 6 Committee chair’s verbal report No report was provided. 7 Presentation There was no presentation at this meeting. 8 General Manager Service and Business Planning’s report There was no general manager, service and business planning report at this meeting. 9 Date of next meeting The next meeting is scheduled for Friday 16 September 2016. 10 Exclusion of public It was unanimously resolved that: The public be excluded from the remainder of this meeting under clause 32, Schedule 3 of the New Zealand Public Health and Disability Act 2000 on the grounds that the conduct of the following agenda items in public would be likely to result in the disclosure of information for which good reason for withholding exists under sections 6, 7 or 9 (except section 9(2) (g) (i)) of the Official Information Act 1982. Agenda item Reason OIA reference

Community and Public Health/Disability Support Advisory Committee minutes of meeting held on 27 May 2016 (public-excluded session)

For the reasons set out in the committee’s agenda of 27 May 2016

As per the committee’s agenda of 27 May 2016

Service and Business Planning risk register

To protect the privacy of natural persons, including that of deceased natural persons To protect information where the making available of the information would be likely unreasonably to prejudice the commercial position of the person who supplied or who is the subject of the information To enable the district health board to carry out, without prejudice or disadvantage, commercial activities or negotiations (including commercial and industrial negotiations)

Section 9(2)(a) Section 9(2)(b)(ii) Section 9(2)(i) and 9(2)(j)

Persons permitted to remain during the public excluded session



The following person(s) may be permitted to remain after the public has been excluded because the board considers that they have knowledge that will help it. The knowledge possessed by the following persons and relevance of that knowledge to the matters to be discussed follows.

Person(s) Knowledge possessed Relevance to discussion

Chief executive and senior managers and clinicians present

Management and operational information about Whanganui District Health Board

Management and operational reporting and advice to the board

Committee secretary Minute taking Recording minutes of committee meeting

This meeting finished at 10.00am.



5 Matters arising from previous meetings There are no matters arising from the last meeting.

6 Committee Chair’s report A verbal report may be provided at the meeting.

7 Presentation There is no presentation scheduled for this meeting.



8 General Manager, Service and Business Planning’s report The purpose of this section is to report on Whanganui DHB integration activity at all levels including national, regional, sub-regional and local. Items requiring more robust discussion and/or decision are included in those respective sections of this agenda. 8.1 Whanganui DHB – Annual Planning for 2016/17 The Whanganui DHB 2016/17 Annual Plan has been approved by the Minister of Health. A copy of the letter of advice is included in the Information Section. Whanganui DHB is one of the first to have its plan approved by the Minister. The plan is available on the Whanganui DHB website at www.wdhb.org.nz. 8.2 Health Targets and indicators of DHB performance A summary of 2015/16 overall performance against the DHB indicators is included in the Information Section. Whanganui continues to perform consistently well against the targets over time due to the efforts of dedicated staff in the district health board, Whanganui Regional Health Network, and NGO providers. 8.2.1 Health Target Four - Immunisation Whanganui DHB immunisation coverage has increased from 92% to 93.8% coverage of fully immunised for eight-month-old children during quarter four of 2015/16. This represents an improvement in our aim of achieving the national 95% coverage target for children turning eight months of age. The approach used to achieve this improvement remains unchanged. The immunisation coordinator based within primary care continues to case manage each child with overdue immunisations and support practices with delivering best practice and effectively ‘catch up’ children who have fallen behind. The table below indicates an ongoing improvement in the ‘not declined but late’ column which is very reassuring and demonstrates the effective systems in place to ensure children of parents wanting immunisation for their children do receive them in a timely manner. It is pleasing that the proportion of our population continuing to decline or opt off from immunisations has reduced.

Profile of Whanganui DHB’s immunisation coverage for children turning 8 month

Table one

Year Period Total eligible population

Total fully immunised

Imms courses incompleted

Opt off & Declined

Not declined but late

Whanganui completed imms at eight months

Quarter 1 189 173 16 10 6 92%

Quarter 2 200 192 8 5 3 96%

Quarter 3 204 176 28 15 13 86%

Quarter 4 209 184 25 15 10 88%Quarter 1 217 198 19 15 4 91%

Quarter 2 223 201 22 15 7 90%Quarter 3 189 174 15 11 4 92%Quarter 4 210 197 13 8 5 93%

2014

/15

2015

/16




Immunisation coverage trends over the previous two reporting years

Table two

Table three As the tables above indicate, equity of coverage between NZE and Māori is still proving a challenge. The differences between each group is typically only a handful of children, in this period the difference being 65/64 and 110/101 ‘total eligible’ to ‘fully immunised’ for NZE and Māori respectively. Factors that may be influencing may include antenatal education and persistent positive reinforcement of the vaccination messaging. Strategies to improve our performance continue with Well Child Tamariki Ora nurses and the Immunisation Outreach Service being fundamental to this. With this in mind, all these staff have attended/had the opportunity to attend ‘Healthy conversations’ training provided by Gravida. This has supported these staff to structure their discussions with families in an improved way when discussing immunisations. Each child continues to be monitored at an individual level to ensure everything that can be done is done to complete immunisations. This continues beyond the 8-month target and this is reflected in the 24-month PP21 immunisation target.



8.2.2 Health Target Five - Better help for smokers to quit Smoking kills an estimated 5000 people in New Zealand every year, and smoking-related diseases are a significant opportunity cost to the health sector. Most smokers want to quit, and there are simple effective interventions that can be routinely provided in both primary and secondary care. The better help for smokers to quit target is designed to prompt providers to routinely ask about smoking status as a clinical ‘vital sign’ and then to provide brief advice and offer quit support to current smokers. 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. From quarter one of 2015/16, the primary care target shifted its focus to the entire enrolled population of people who smoke and not only those seen in primary care, and covers advice provided over 15 months, instead of 12 months. The targets are: 90% of PHO enrolled patients who smoke have been offered help to quit smoking by a health

care practitioner in the last 15 months. 95% of hospital patients who smoke and are seen by a health practitioner in a public hospital

are offered brief advice and support to quit smoking. 90% of pregnant women who identify as smokers upon registration with a DHB-employed

midwife or Lead Maternity Carer are offered brief advice and support to quit smoking. Target results for the 2015/16 year are outlined below:

2015-16 Target Q1 15/16 Q2 15/16 Q3 15/16 Q4 15/16 Primary care 90% 87% 84% 86% 88%

Hospital 95% 96% 96% 95% 92% Maternity 90% 92% 97% 100% 96%

Maternity target The maternity target has been met across the year with a reduction in the last quarter. Socioeconomic conditions of pregnant smokers in New Zealand are a significant issue with the majority of smokers coming from disadvantaged settings (Ministry of Health, 2015). The Whanganui district’s high level of deprivation is a significant health factor with almost one in five (18%) of residents lining in a decile 10 area. Low income, poor education, unemployment, domestic violence, lack of adequate housing and poor health status are experiences of some pregnant women who smoke. Often, these conditions are described as stressors that are managed through smoking. Additionally, immediate needs such as funding food, clothing and healthcare are prioritised ahead of smoking cessation in disadvantaged settings, such as Whanganui. Ensuring the midwife (independent and DHB-employed) have the necessary skills, knowledge and cultural awareness to provide brief advice and support pregnant smokers to appropriate stop-smoking services is paramount and smoking cessation training is delivered regularly for all midwives. Hospital target The hospital component reached the target for the first three quarters with a decline in the last quarter. Further analysis has identified that overall nearly every department had a reduction in patients given brief intervention. Support and ongoing training continues to be offered to staff to encourage improved performance.



Primary care target While the 90% target has not been achieved by quarter four, there continues to be an improvement. A number of factors have contributed to the target results including an updated smoking target numerator and denominator that require all current smokers to be given cessation support or brief advice in the last 15 months. This change will more accurately align with IPIF results. A data extraction issue was also identified which may have contributed to the overall decrease in performance.

General practice continues to be supported to achieve the targets including active clinical leadership through Clinical champion support, dedicated support to embed ABC activity within practice and facilitate referrals to other services, patient outreach service, increased awareness of coding and clinical practice housekeeping with practices and training including tailored sessions for general practice teams.

8.2.3 Health Target Six – More heart and diabetes checks Long-term conditions comprise the major health burden for New Zealand now and into the foreseeable future and are the leading cause of morbidity. It disproportionately affects Māori, Pacific and South Asian peoples and as the population ages, and lifestyles change, these conditions are likely to increase significantly. Cardiovascular disease (CVD) includes heart attacks and strokes – which are both substantially preventable with lifestyle advice and treatment for those at moderate or higher risk. The indicator monitors the proportion of the eligible population who have had the blood tests for CVD risk assessment (including the blood tests to screen for diabetes) in the preceding five year period. The more heart and diabetes check target is 90 percent of the eligible population will have had their cardiovascular risk assessed in the last five years. The results for 2015/16 as outlined below show achievement of the target across all four quarters.

2015-16 Q1 Q2 Q3 Q4 National goal More heart & diabetes checks 92% 92% 92% 91% 90%

A number of service activities are undertaken by the Whanganui Regional Health Network (WRHN) to achieve and maintain the target including: Monthly reports distributed to each general practice to show progress against the target and

the total number of patients that remain to have risk assessments completed Monthly population health meetings attended by nearly all practices are held to maintain focus

and commitment and include discussion around data and sharing of initiatives from practice teams

WRHN population health support nurses continue to support practices by reviewing patient notes and running risk assessments for patients that have relevant data recorded

A phlebotomist continues to work alongside population health support nurses Population health support nurses and phlebotomist actively contact patients that have not had

CVD risk assessments completed to arrange appointments at no cost to the patient Enhancement of IT systems including Dr Info, Appointment Scanner Tool and Patient

Dashboard While the target has been met, the risk that this achievement may not be maintained is due to patients who completed a CVD risk assessment five years ago are now being added to the current list of patients who require an assessment. To mitigate this risk, IT systems have been updated to identify these patients which prompt clinicians to follow up.



Other issues identified are patients can be difficult to contact due to contact details not being current and patients who work daytime hours are often difficult to contact and are unable to attend clinics due to work commitments. Attempting to contact patients outside of hours is proving successful, and the possibility of after-hours services is being considered in some areas. 8.2.4 New health target - Raising Healthy Children The purpose of this paper is to update the committee of the activity occurring within the Whanganui DHB relating to childhood obesity and healthy living. Additionally, this paper aims to increase the committee members understanding of the Raising Healthy Children Health Target, the WDHB’s current standing against the target, and the next steps. Why focus on childhood obesity? Obesity is particularly concerning in children as it is associated with a wide range of health conditions and increased risk of premature onset of illness. It can also affect a child’s immediate health, educational attainment and quality of life. The Ministry of Health has identified childhood obesity as a priority and developed a national childhood obesity plan. The plan consists of a package of initiatives that aim to prevent and manage obesity in children and young people up to 18 years of age by focusing on: Targeted interventions for those who are obese Increased support for those at risk of becoming obese Broad approaches to make healthier choices easier for all New Zealanders

The emphasis is on food, behaviour change, the environment and being active at each life stage, starting during pregnancy and early childhood. The package brings together initiatives across government agencies, the private sector, communities, schools, families and whānau. Aren’t we focusing on this already? Yes we are. Within our DHB many initiatives focusing on reducing childhood obesity are in place being led by NGO’s, Iwi, Primary care and Public Health, including: Healthy Families B4SC referral pathways Healthy Families which has a focus on our rural communities Water only schools initiative Food mapping (in conjunction with the University of Auckland) Takeaway shop mapping Schools surveying canteens Health need assessments within Trail of community based health and nutrition courses Healthy start workshop for Early Childhood Education teachers Sugar workshops in rural and urban centres

Many other health, exercise and nutritional based programmes exist within our community but are not directly health sector linked although are every bit as important in supporting our population to remain a healthy weight. These groups all link in together and coordinate at an operational level but historically have limited formal overarching structures in place to coordinate and be responsive to specific needs. The introduction of the healthy families programme led by TOIHA has increased the level of coordination and cooperation among services. WDHB believes actively supporting this established programme to take the lead with obesity within our community will lead to grass roots identification of areas for improvement and effective means to invest in a coordinated manner. This approach is anticipated to identify the best way to identify and overcome barriers and to invest most wisely to maximise



improvement and outcomes. A copy of the latest Healthy Families newsletter is included in the Information Section. What is the new Raising Health Children Health Target? This target aims ensure four year olds identified as obese while getting their B4 School Check will be offered a referral to manage any medical complication and any services they and their family may find helpful to support healthy eating and activity. By December 2017, 95% of obese children identified in the Before School Check (B4 School Check) programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. As of 1 July 2016 the denominator and numerators for the health target have changed slightly to the following: Denominator: The number of children who had a B4SC and were identified as obese (BMI > 98th percentile) Numerator: The number of children who had a B4SC and were identified as obese (BMI > 98th percentile) and: Were referred from the B4SC to a registered health professional Or were already under care of a service Or the parent/caregiver declined the referral

Within our DHB the B4SC service is delivered by practice nurses within primary care completing the checks after the child turns four and before their fifth birthday. A central coordinator based within WRHN monitors performance, coverage, data entry and provides training for nurses. This model lends its self-well to meeting the Health Target where the key requirement is to be monitored by health professional (typically general practice). This compares with other models around the country where Plunket and Public Health provide the checks and then need to link obese children into primary care to monitor the child and exclude medical causes/complications of the excess weight. How is our DHB currently performing against the health target? WDHB is currently looking very favourable compared to other DHB’s (based on the B4SC data set). As the B4SC graph below indicates, of those checks between January and June 2016 48% of children locally met the Health Target. Note: the HT and B4SC measurement definitions vary slightly.

Graph to indicate our current performance based on the B4SC data and definitions



Based on the data supplied from the MoH over the previous three quarters and demonstrated on the graphs below we can track the performance of WDHB against the total population and by ethnicity. Overall the performance WDHB is of consistent improvement. Māori are receiving an increased level of referral. Data for pacific and other ethnicities is not available due to the small numbers of these ethnicities being check each quarter.

Graph tracking Whanganui’s performance (note new definitions introduced 1 July 2016, significant changes are unlikely) Based on the new 2016/17 definitions the results for quarter four 2015/16 would be:

The actual number of children involved for this this quarter is shown below, the yellow headed boxes indicate groups that contribute towards achieving the target while the light blue colour reflect groups that do not contribute to achieving the target.

Factors that may be influencing the result may include: Data entry of the referral acknowledgement by the practice nurse as this is done manually Nurses not feeling confident to broach the subject of obesity with families

The B4SC coordinator based within Whanganui Regional Health Network is monitoring performance and has been working with practices to identify barriers to achieving the target. The total population graph above indicates this is having an effective impact with a steadily increasing percentage of children achieving the expected target. Next Steps Utilise the cross sector forum ‘Healthy Families Prevention Partnership’ to umbrella activity

around childhood obesity. Continue to work with the B4SC coordinator to ensure B4SC providers complete data collection,

and ensure B4SC providers are equipped and supported to hold ’tough conversations’ with parents about obesity with the aim of reducing declines and ensure all parents are made aware of the extent and risks relating to the obesity of their child.

Referral Sent and Acknowledged

Referral Sent

Whanganui 53% 62%National 28% 41%

Referral Sent and Acknowledged

Referral Sent but not Acknowledged

Already Under Care Referral Declined Not Referred

Sum of children 12 5 8 9 21



8.3 Integrated approach to health promotion across the Whanganui health district

In July 2016, the committee held a workshop to hear about the integrated approach being taken to health promotion across the Whanganui health district. The workshop was led by members of the Healthy Families Prevention Partnership, which includes the district health board, Te Oranganui Iwi Health Authority, Nga Tai o Te Awa, Sport Whanganui, Whanganui Regional Health Network, and local Councils. Following the workshop, members of this committee requested that the notes from the workshop be included in the September committee agenda, to highlight publicly the importance and gains being made through this approach. The general manager, service and business planning opened the workshop with the following comments: Why focus on health promotion? Responsibility for planning and funding of health promotion not devolved to DHBs (still sits with

MoH) The Minister is not required to sign our DHB Health Promotion Plan (or the Māori Health Plan) –

the two most important strategic documents The funding is less than 1% of our total DHB budget Because It fits with our strategic intent – to improve health and reduce inequalities (advance Māori

health) To do this we need to focus on the determinants of health The definition of health promotion is “the process of enabling people to increase control over

the determinants of health and thereby improve their health” (Based on Ottawa Charter, 1986) We also know that medical interventions alone cannot guarantee better health, health and

wellbeing are influenced by things outside the health sector, and health promotion is holistic. However Results take time, sometimes generations, and effort because we have to work across sectors.

Therefore we need a joined up approach to lift the profile of health promotion, so health promotion is everyone’s business

The associate director of nursing introduced herself and welcomed all to the meeting. She has been working with the health promotion teams this year and acknowledged the work across the sector which has enabled the team to reach this point, she said she is excited about future projects in health promotion. The health promotion team manager introduced herself, and talked about the health promotion portfolios and work underway. Healthy Families NZ is one of ten sites across New Zealand. This initiative supports the creation of healthy environments in places such as schools, workplaces and marae to make these areas more supportive of health and wellbeing and to look at intervention points to help create healthy environments. Health promotion resources are located in rural areas to provide extra strength to those areas. The WRHN health promotion team was introduced by Mr Matt Rayner who spoke about the scope of their work. The group introduced themselves individually.



Mrs Haitana spoke about the key points of the presentation which were based on the Quigley and Watts Ltd report, 2013. Prevention Partnership members were welcomed to the meeting and Mrs Haitana spoke about work currently underway. The broad nature of health promotion requires a multi-organisation, integrated approach and this was highlighted in the mapping the healthiness of the local food environment project organised in conjunction with University of Auckland. The Whanganui team have been proactive in undertaking this project which is nearly complete. Initially the project was to cover the city area only, however it was noted that good information would be provided by participation with the wider district. Mr Rayner spoke about the WorkWell initiative and said that WRHN had adopted these principles in support. It is timely that the new Health and Safety Act has prompted many businesses to undertake this and similar processes to ensure their workplace policies encompass the Act. A committee member spoke about the alcohol, drug and mental health issues that are not being addressed through health promotion. She spoke about unemployment and housing as factors that impact on health. She asked the groups if they could encompass these factors into their work. She said that health promotion material is not available in courthouses and asked if the groups could address this. A member of the group spoke about the work with young people that is being done to attempt to divert youth from unhealthy practices. The Water Only Schools project was outlined and the toolkit for schools was described. The schools themselves are actively involved and some had shared their stories which were incorporated into the toolkit as examples. Ten schools were initially targeted with the toolkit; these were schools who had healthy policies in place and the toolkit was readily accepted in those schools. The toolkit has now gone out to other schools and other DHBs are putting similar toolkits in place. The Dental Association has similar policies and sports facilities and early childhood centres are encompassed within this project. The next step is to continue collaboration, public health is a way of thinking and doing, and not just a service. Committee members spoke about how fundamental this work is to future healthcare and that it is encouraging to see how much work is underway. It was also noted how fundamental this joined up approach is to the success of the public health initiatives. The board chair told the groups that their messages would become widespread in the region due to the people attending this workshop who represent a number of communities. The CPHAC chair thanked the groups for their presentation, their commitment and professionalism. Looking to the future – Health in all Policies As indicated in the previous report on childhood obesity, the ‘Healthy Families Prevention Partnership’ provides the ideal mechanism to advance and support this cross sector work. The concept of ‘Health in all Policies’ has been raised previously within this committee. Health in All Policies (HiAP) is defined as “an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts, in order to improve population health and health equity.”



Bay of Plenty DHB has developed a set of position statements on key health issues, including health in all policies. The intention is that these are brief, high level documents that reflect Government policy where that has been laid out, and current best-evidenced practice, with an indication of how services deliver in that area. The information is published on their DHB website and is therefore available to the community, DHB staff and service providers. The Bay of Plenty position statement on ‘Health in all Policies’ is included in the Information Section. The committee may want to consider whether this is something that should be put forward to our Board for consideration, as a local positon statement would demonstrate the DHBs commitment to achieving our strategic objectives to improve health, recognising that to achieve this, every sector of community has a role to play. 8.4 Integrated Performance and Incentive Framework (IPIF) The 2015/16 quarter four Integrated Performance and Incentive Framework (IPIF) results for Whanganui DHB are as follows:

IPIF measure National target

Q4

More heart & diabetes checks 90% 91% Better help for smokers to quit 90% 88% Increased immunisation – eight month olds 95% 97% Increased immunisation – two year olds 95% 92% Cervical screening 80% 80%

While the target was not met for two of the measures, there has been a continued focus to provide the support required ensuring appropriate systems and training is in place to improve performance. The result for all primary health organisations (PHOs) is included in the Information Section. Whanganui Regional Health Network performs well against the range of measures across NZ. New System Level Measures (SLMs) are being implemented in 2016/17 which will replace the IPIF. While IPIF focused mainly on primary care delivered by PHOs, the focus has now been broadened to include the whole health system. This broader focus reflects the priorities of the updated New Zealand Health Strategy. Each DHB region needs to develop a System Level Measures (SLM) Plan, which will involve a range of primary and community providers, and specialist services. Two of the five 2015/16 IPIF measures will remain national health targets: better help for smokers to quit and increased immunisation at eight months old. The other three (more heart and diabetes checks, increased immunisation for two year olds and cervical screening coverage) are important measures that contribute to the system level measures of ambulatory sensitive hospitalisation (ASH) rates for 0-4 year olds and amenable mortality.



8.5 Whanganui Rising to the Challenge This report provides the committee with an update on activities to implement the Whanganui Rising to the Challenge framework. Background In late 2014, work began on a project applying the principles framed by ‘Whanganui Rising to the Challenge – The Mental Health and Addiction Service Framework 2014’. The framework was developed in 2013 and 2014 as a regional response to ‘Rising to the Challenge – The Ministry of Health Mental and Addiction Service Development Plan 2012 -2013’.

The vision proposed by the framework: ‘That the people of the Whanganui region understand, value and promote mental health and wellbeing, possess the knowledge and resilience to weather adversity and where necessary have access to excellent mental health and addiction services that are recovery focused and provide hope’ is significant in scope and aspiration and extends beyond Mental Health and Addiction services into a range of social, public health and general health services. The framework forms an interconnected improvement and change narrative with eight elements supported by various mechanisms for change. The Seamless Experience is one of four identified systems elements within the framework; these elements form part of an interconnected improvement and change narrative. Implementation There are three work streams each with 8–12 core members providing a mix of expertise and representation across DHB, community and patient/whanau stakeholders. These are - Adult Mental Health and Addictions (Triage), Older People (The confused adult patient), Child and Youth (Behavioural conditions). Each of the three work streams is guided by the Whanganui DHB Annual Plan. The project has actively used the framework as a way of giving the workgroups the permission and power to do the things that they want to do to effect change. Workgroups now know they are supported to take charge of the direction of change for their group. The objective has been to build a ‘shared purpose’ - consciously looking to build intrinsic motivation and values based change – while balancing the extrinsic motivators (targets, methods, policy etc). Effectively this has seen more human and authentic conversations framing the project in a way that focuses on the “why” of work rather than a singular focus on a top down diagnostic imperative to make improvements. Project Highlights The focus of the overall project for this period has been on refreshing the focus of two of the three work streams to build on the work undertaken up this point. The Whanganui Rising to the Challenge (WRTTC) Adult work stream has evolved since its inception in late 2014. The work stream objective is to enable the development of an environment where, “the primary point of contact for Adult Mental Health and Addiction patients is informed and responsive” and where triage is “a function to inform access to the right service at the right time”. Initially the work was based on developing and testing systems and processes enabling consumers to access appropriate primary care resources through improved assessment and referral to the ‘right resource at the right time’. Direct referral from general practice to peer support was also tested and a stepped-care based referral document to encourage appropriate screening and assessment was introduced. While this work demonstrated the benefits of increased knowledge and improved systems at a small scale, a revised approach is required to deliver the large scale change required to meet the needs of the Whanganui community. Recognising this, the workstream has been refreshed to formally incorporate three inter-dependent areas of work that have evolved from the original premise.



The evolved work stream direction is grounded in the recognition that the distinction between personal/general health and mental health is becoming increasingly blurred1 - inviting the development of novel models of practice2 3. The Three Interconnected parts of the Adult Work stream

The Future of wellbeing in Whanganui - Rethinking Community Mental Health From the time work commenced on the Adult Work stream part of the discussion has been an ongoing conversation about the role and scope of the WDHB Mental Health Liaison4 service and the options to reconfigure the current service model to be more effective and equitable for our community. Building on these conversations the Whanganui DHB Mental Health and Addiction Service is in the process of developing a proposal that reconfigures the current operational Model of Care to an expanded ‘one team’ network model delivering care ‘closer to home’ aligned to the themes of revised New Zealand Health Strategy. This model will work within the current stepped care model5 in partnership with general practice teams, DHB specialist community services and the wider community to provide support for people with mental health and addiction issues. The proposed service reconfiguration will test a model that links a specialist community mental health team to general practices and community organisations to deliver care and support in both clinical and non-clinical settings. These community teams will be supported by specialist nursing roles to bring care closer to home for consumers and support collaborative working across health and community services. In testing and evolving this approach the interaction of services and clinicians at the borders and seams of the stepped care model is critical. By developing a novel approach to working at this interface the intent is to ensure that people do not feel bounced around within the system and that primary care teams are supported to build confidence and capacity to deliver care. The model is designed from the outset to ensure service users have a ‘seamless experience’ whereby the bumps and seams between services and settings are smoothed. The network model provides a novel and innovative community based way to deliver the structural specialist service elements that strengthen and support a wellness approach to community mental health.

1 http://www.tepou.co.nz/news/a-city-wide-approach-to-mental-health/789 2 http://www.health.govt.nz/new-zealand-health-system/new-zealand-health-strategy-future-direction 3 http://www.health.govt.nz/new-zealand-health-system/new-zealand-health-strategy-roadmap-actions-2016 4 Mental Health Liaison staff work closely with general practice teams to deliver care for people experiencing mild to moderate mental health issues and has been in place across four practices since 2006. 5 Ministry of Health. 2009. Towards optimal primary mental health care in the new primary care environment: A draft guidance paper. Wellington: Ministry of Health.



http://www.tepou.co.nz/news/a-city-wide-approach-to-mental-health/789

Wellness Model Enabling and Embedding Primary Care Mental Health In taking a wellness approach and establishing decision support tools and improved assessment and screening, this aspect of the Adult Work stream has focused on providing a system level platform to lead and embed primary care practice change grounded within the stepped care model. Working under the shared vision of ‘Healthy Communities’ the project uses enablers such as MedTech ‘Advanced forms’, Eldernet and a collaborative Map of Medicine pathway as decision support and referral tools to embed primary mental health practice within the general practice environment . This project builds directly on the work undertaken in the initial phase of the WRTTC project that tested systems and process change to improve referral practices and enhance access to appropriate community based services. This work is being led by the Whanganui Regional Health Network supported by WDHB. The proposed structure includes the development of a new modular assessment format in the MedTech patient management system which while being flexible to practitioner workflow and the multiple entry points of patients; can ensure a structured and consistent approach to screening, referral and management. The development of the collaborative pathway will be supported by education content and resources. The approach being used in the collaborative pathway is one that addresses the administratively complex aspects of assessment and referral to appropriate services while supporting and enhancing holistic treatment and care. Aligning both the primary care based changes and network model for specialist services are shared language, screening tools, clear directories, pathways and navigation with the specialist team working alongside primary care and community teams in terms of shared cases/complex cases, shared education/development and support in a closer to home, one team approach. Build community capacity and improve health literacy This initiative focuses on the development of strategies to enhance ‘active citizenship’ and ‘self-management’ approaches by improving health literacy through active communication and engagement with the community. This is very much a process of sharing the ideas, context and possibilities underpinning Whanganui Rising to the Challenge to support the work being undertaken across both primary and secondary service settings using a public health - health promotion model of awareness raising and information sharing. This approach has a broad application across all of health and aligns to the wellness/wellbeing focus of the work stream. Child and Youth Work Stream Following meetings in February and April the Child and youth work stream has proposed a focus on child/youth resilience and self-management tools as the direction that would provide a collective focus for the group. Initial discussion on options to strengthen and build resilience of young people centred on Intermediate age children as a group who might benefit from such a programme. An approach using the introduction of student navigators in Intermediate school settings is already being developed between Supporting Families and ICAMHS, aligned with the direction of the Prime Ministers Youth Mental Health initiative. This work will be supported by the Child and Youth Work stream as a forum to provide advice around the development of the programme. In addition, the Child and Youth Work stream will join with the adult work stream to look at new ways of working, communication, and awareness raising and health literacy as these are key common themes across all work being undertaken by the work streams and associated projects. Older Peoples Workstream The older people’s work stream focus on the confused patient has continued with the delivery of organisational wide training on the ‘Care with Dignity’ programme. Further training is planned for November extending the current programme to a group of 30 Enrolled Nurses, new graduate Registered Nurses and Health Care Assistants. By delivering training on “Care with Dignity’ across all scopes of practice it is intended to ensure that the underlying values of the programme are embedded across the organisation.



Working collaboratively with Health Care Improvement Scotland the work stream is progressing the delivery of their recently developed ‘Think Delirium’ screening and intervention programme including free use of on line education tools for clinical staff beginning in late September. Whanganui DHB has recently appointed a dedicated role to work across the areas of dementia and delirium education and this role will support the delivery of staff training on the ‘Think Delirium’ package. Planning for the training approach includes rest home, Whanganui Regional Health Network and NGO representatives. The intent of introducing ‘Think Delirium’ is to ensure the approximately 30 percent of admitted patients suffering some form of cognitive impairment are identified and treated appropriately. At present less than 10 percent of patients admitted to the medical ward are identified as having some form of cognitive impairment. The work stream is also supporting two co-design projects one of which is focused on ensuring the Emergency Department experience for patients with delirium is improved and one working on developing the dementia design project on the medical ward. The dementia design project is progressing to the business plan stage. Co-Design The framework has, as a key principle, the adoption and use of co-design for service planning and improvement. Co-design is both a method to use in change and improvement and a philosophical methodological approach to change. In August 2016, Dr Lynne Maher presented a workshop on co-design sustainability as the final part of the facilitation of six co-design projects by Ko Awatea and supported by Whanganui Rising to the Challenge. Key learnings from the workshop and training programme were that co-design takes time and dedication by the teams doing the work – dedicated resource is critical to maintaining momentum along with the permission to challenge, flexibility to change on the journey, permission to live in the patient/client world, ability to look more broadly across the health sector. We do not know the full answer before we start. We may know our aim. Do not invest a lot of time and effort in a single idea early on. We want lots of ideas so that we

can find the best one You cannot come up with new ideas or the right ideas without involving people who deliver and

receive the services The shared experience of all six teams was that applying co-design principles was challenging initially and timeframes for undertaking the projects were longer than first predicted. All teams are actively using the experience based co-design as part of their work beyond the scope of the initial projects. Key aspects of the Fitness for Surgery project and the dementia friendly work being undertaken by general hospital teams are applying co-design approaches to wider service improvement and facility redesign as are Community Mental Health and Addiction Services and Child and Adolescent Mental Health and Addiction Services.



8.6 Financial Report The purpose of this report is to present the financial results for the period ending 31 July 2016. The report includes both the Service and Business Planning, and consolidated DHB position.



Month Comments The overall result for the month was $19k better than budget mainly due to lower than expected pharmaceutical expenditure partially offset by worse than budgeted inter-district flows.

Variance $000 Impact on forecast

Revenue $14 F

Crown revenue $14 F

Personal health side contract $14 F Mostly offset by expenditure

Inter District Inflow ($4) U

Other Income - better cash position producing more interest $4 F

Expenditure $5 F Payment to own Provider ($8) U

Personal Health - greater than budgeted adolescent dental demand ($8) U No impact – offset by provider internal revenue

Variance $000 Impact on

forecast Payment to External Provider $70 F

Personal Health Adolescent dental benefit – demand driven $19 F Expenditure mainly

in provider arm Primary practice services ($62) U Negative impact -

higher than expected demand

Community pharmaceuticals $150 F Positive impact - lower than expected demand

Disability Support Service Respite care and day programmes – demand driven ($34) U Long term home based support services demand driven $12 F Positive impact -

lower than expected demand

Aged related residential care – demand driven ($15) U Negative impact - higher than expected demand

Mental Health Community Service ($26) U Timing – no impact Inter-district Out Flow ($57) U

Tight budget IDF outflows



Expenditure trend The graphs below show the total external expenditure on a 12 month rolling average basis. Historical expenditure has been adjusted by the contribution to cost pressure to express past years expenditure in the current years equivalent value. The graph indicates personal health expenditure trends are relatively stable. The increased expenditure is mainly driven by Ministry of Health funded initiatives which have little impact on the net result.

Volume growth in aged residential care and long term home based support services is flattening. There is a level of risk in the Health of Older People budget based around savings achieved through increased focus on supporting people independence through increased focus on rehabilitation.



Inter-district Flows (IDFs) and Health of Older People Outflows The 2016/17 inpatient IDF outflow budget has been set at the same level indicated in the 2016/17 funding envelope which amounts to 3,948 caseweights or $19.047m. The distribution by DHB is shown in Figure 1. This represents an average of 329 caseweights a month. The 12 month rolling average caseweight at the year end of 2015/16 is 350 caseweights as shown in Figure 2. This represents a potential $1,216m annual unfavourable variance should IDF outflows continue at this level. A history of caseweight volume demand for Capital and Coast DHB and MidCentral DHB is shown in Figure 3 and Figure 4 respectively. Inflows The 2016/17 inpatient IDF outflow budget has been set at the same level indicated in the 2016/17 funding envelope which amounts to 637 caseweights or $3.073m. The distribution by DHB is shown in Figure 5. This represents an average of 53 caseweights a month. The 12 month rolling average caseweight at the year end of 2015/16 is 55 caseweights as shown in Figure 6. This represents a potential $120k favourable annual variance should IDF inflows continue at this level. Work completed for Waikato DHB in the June period as significantly impacted on the 12 month rolling average and cannot be relied upon. The long run trend is around 49 caseweights. This represents a potential $233k unfavourable annual variance. Health of Older People Budget The budget for external health of older people for 2016/17 has been set at $23.666m. A break-down of the budget is in Figure 7. The key areas of risk exist in resthome level and dementia level aged residential care and home based support services. All three areas have been experienced growth in 2015/16, however this seems to have stabilised over recent months. Hospital level aged residential care has been stable for some time. Expenditure for July 2017 is approximately in line with budget. Aged residential care risks taken in setting the 2016/17 budget Budget saving of $400k on current utilisation. The DHB has been placing increased focus on rehabilitation opportunities to assist clients in maximising their potential. The impact of the rehabilitation approach on future demand for aged residential care services is unknown. The utilisation has stabilising over the last six months, a potential arises that the current levels of expenditure may reduce. A $400k savings in this area represents a 2.5% reduction in late 2015/16 demand. The current expenditure trends for aged residential care are shown in Figure 8 . It appears that expenditure over the last six months is stable to slightly decreasing. The Low expenditure for July is a typical cycle and likely to be offset by higher expenditure in September as a result of timing of billing periods. Home based support risks taken in setting the 2016/17 budget Budget saving of $500k on current utilisation. Home based support services demand has grown 29% over the 18 months from September 2014. With the District Health Boards focus on maximising rehabilitation opportunities, including individual rehabilitation programmes for people who may need long-term home and community support. Initial indications are that this rehabilitation approach may already be having a positive impact for this client group resulting in less need for long-term formal



support. The extent of potential expenditure reductions in this area is unknown. A $500k reduction in expenditure represents a 6% reduction on late 2015/16 demand. Home based support expenditure trends are shown in Figure 9. Figure 1



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9 Items of mutual interest to CPHAC and HAC 9.1. Health of Older People – special topics Home and community support for older Māori and how they and their whanau are supported to navigate through the system This report follows a discussion at the May committee meeting which identified that Māori are not accessing age residential care which then generated the question of whether they are better represented in the WDHBs home and community support services and how whanau are supported to navigate the home and community support system. The data as outlined below confirms that Māori are better represented in the personal care hours that they receive than Non-Māori including average personal care hours per individual (the data includes the personal care delivered by whanau).



How are whanau supported through the home and community support system? All Māori patients on the acute ward, who requires a clinical assessment for either short term or long-term home and community support services (InterRAI), already have the Haumoana whānau involved with the patient /whānau and the multi- disciplinary team. This ensures that the cultural and social needs of the person are being addressed, as there has been feedback that some elderly Māori are reluctant to accept support services. The clinicians also provide patients and their whānau with the Haumoana whānau pamphlets. The WDHBs social work assessment is holistic and focuses on the physical, spiritual/cultural, family/whānau and emotional aspects of the person and the social worker will refer on and link to appropriate services as required. The WDHB social work team also employs Māori staff, male and female.



The rapid response team and the Haumoana whānau are actively involved in the emergency department, and the rapid response triage urgent referrals four times a day. The Haumoana attend the triage process. All Māori patients based in the community who require a clinical assessment for either short term or long-term support services (interRAI) are always asked if they want their whānau present during the assessment. Kaupapa home and community support services The WDHB is very fortunate to have a kaupapa Māori home and community support provider, Te Oranganui Trust Incorporated. The WDHB contracts Te Oranganui to provide home and community support as part of Whānau Ora. The service is known as Te Ara Toiora and is available across the whole WDHB region which the provider actively promotes through their iwi provider networks and is able to provide both short and long term support for both older people and people under 65 years who have long term conditions In addition and to ensure whānau access to home and community support the WDHB purchases a Māori Disability Liaison Service from Te Oranganui – this service is part of Te Ara Toiora and offers navigation and advocacy for whanau The WDHB has a Paid Family Carer Policy for Home-based Care. The policy sets out the circumstances in which the WDHB will pay an eligible family member for providing home-based services to an eligible person. This was a national led initiative and has been in place since May 2014. Iwi providers report that this policy has been an important enabler for improving access for Māori to home and community support services as it not only supports the cultural preferences but addresses the challenges of rurality. Te Ara Toiora actively utilise this opportunity. Te Ara Toiora also actively supporting kaumatua with a weekly luncheon programme – this initiative arose out of the observation that their kaumatua would benefit from this opportunity to socialise. The programme was presented at an indigenous conference earlier this year and committee members will be able to watch a video clip of the programme. Included with the committee papers is the story of the development of the programme. Melina Cropp, the Service Manager Disability Support Services at Te Oranganui Iwi Health Authority will be attending the committee meeting to talk to this item. 9.1.1 Living conditions and future housing opportunities for older people This report follows a discussion at the May committee meeting, where members asked what information we have through InterRAI about the living conditions of older people in Whanganui. InterRAI data Local interRAI data tells us that older people accessing district health formal funded support and their living conditions and the correlated with the two main InterRAI outcome scales CHESS (health instability) and MAPLE (risk adversity). This data supplied from the interRAI data warehouse is three years of data of completed home care assessments for the Whanganui District Health Board. The homecare assessment is complete for individuals living in the community for either supports in the home or as a clinical picture of the needs of the individual with looking at the reversible Clinical assessment protocols (CAP). The aim was to look at the environmental questions as outlined below and to compare them to their individual CHESS and Maple Outcome scores.



The Home environment questions are the following: a. Disrepair of the house - e.g. hazardous clutter, inadequate or no lighting in living room, sleeping

room, kitchen, toilet, corridors, holes in the floor, leaking pipes (28) b. Squalid condition - e.g. extremely dirty, infestation by rats or bugs (13) c. Inadequate heating or cooling - e.g. too hot in summer, too cold in winter (24) d. Lack of personal safety - e.g. fear of violence, safety problem in going to mailbox or visiting

neighbours, heavy traffic in street (60) e. Limited access to home or rooms in home - e.g. difficulty entering or leaving home, unable to

climb stairs, difficulty manoeuvring within rooms, no railings although needed (60) f. Because of limited funds, during the last 30 days made trade-offs among purchasing any of the

following: adequate food, shelter, clothing, prescribed medications, sufficient home heat or cooling, necessary health care (23)

Note: that these questions are only asked if someone is living at home at the tim

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AGENDA - Whanganui District Health Board · 2019. 7. 26. · Agenda Public session Meeting of the...

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