“Hapaitia te Waiora o te whānau, hapū, Iwi.” NOTICE OF MEETING IWI HEALTH BOARD MEETING AGENDA A meeting of the Iwi Health Board will be held on 4 June, 2015 10.00 am – 1.00 pm Board Office, Nelson Ngā Hihi o te Rā Kei kōnei mātou ngā iwi e I raro i te maru o Onetahua Kei waenganui ngā tamariki O Tanemahuta e moemoe a kihi ana ngā hihi o te rā Hei oranga mō ngā iwi Māori e Piki te kaha, hapai te wairua Homai te aroha aue Kei waenganui ngā tamariki O Tanemahuta e moemoe a E kihi ana ngā hihi o te rā Hei oranga mō ngā iwi Māori e Hei oranga mō ngā iwi Māori e Waiata: composed by the IHB March 04
Transcript
“Hapaitia te Waiora o te whānau, hapū, Iwi.”
NOTICE OF MEETING
IWI HEALTH BOARD
MEETING AGENDA
A meeting of the Iwi Health Board will be held on 4 June, 2015 10.00 am – 1.00 pm
Board Office, Nelson
Ngā Hihi o te Rā
Kei kōnei mātou ngā iwi e I raro i te maru o Onetahua Kei waenganui ngā tamariki O Tanemahuta e moemoe a
kihi ana ngā hihi o te rā Hei oranga mō ngā iwi Māori e
Piki te kaha, hapai te wairua
Homai te aroha aue
Kei waenganui ngā tamariki O Tanemahuta e moemoe a
E kihi ana ngā hihi o te rā Hei oranga mō ngā iwi Māori e Hei oranga mō ngā iwi Māori e
Waiata: composed by the IHB March 04
Iwi Health Board Open Agenda – 4 June 2015 2
Iwi Health Board Open Agenda – 4 June 2015 3
IWI HEALTH BOARD AGENDA
4 June 2015
TIME SECTION ITEM Page
10.00 Mihi mihi, karakia
1 Apologies 4
2 Registrations of Interest 5
3 Inwards/Outwards Correspondence 8
Minutes
10.10 4 30 April 2015 16
4.1 - Matters Arising 19
4.2 - Action Points 20
For Discussion
10.30 5 Proposal for Strategic Framework for Iwi and Agency Collaboration – Ronnie Gibson (MSD)
23
11.00 5.1 GM‟s Report 26
5.2 Chair‟s Report 32
11.30 5.3 CPHAC/DiSAC Report 36
5.4 IHB Executive Recommendations 37
5.5 CEs Report 40
12.00 5.6 Oral Health – Roby Beaglehole 63
LUNCH
Move into Closed meeting
Appendix 1 Standard Operating Procedures
SECTION 1: APOLOGIES
Iwi Health Board Open Agenda – 4 June 2015 4
SECTION 2: REGISTRATIONS OF INTEREST
Iwi Health Board Open Agenda – 4 June 2015 5
Name Existing – Health
Existing – Other Interest Relates To
Possible Future Conflicts
Judi Billens
NZ Health Care Advisory
Trust Member, Ngāti Tama Iwi
CYFS ( Care and Protection Review Group)
May receive contracts from DHB
Governance, Women‟s Refuge Nelson
Board of Age Concern
Contracts held
Dawn McConnell
Board member, Kimi Hauora Wairau PHO
Contracts held
Director, Te Hauora o Ngati Rarua
Contracts held
Board member, NMDHB (Ministerial Appointment)
Contracts held
Trustee, Waikawa Marae
Regional Representative, Internal Affairs
Rebecca Mason
Employee, NMDHB
Sonny Alesana Alliance Group PHO
Aroha Bond
Dayveen Stephens
Committee member, Whakatu Marae
Whakatu marae have a health arm who has DHB contracts
Patrick Smith
Board member, NMDHB (Ministerial Appointment)
Co-oped member, Iwi Health Board
Board member, Nelson Tasman
SECTION 2: REGISTRATIONS OF INTEREST
Iwi Health Board Open Agenda – 4 June 2015 6
Chamber of Commerce
Managing Director, Patrick Smith HR Ltd
Consultancy services
Focus on primary sector and Maori working with Maori Health Providers who hold contracts
Lee Luke Director, Mokowhiti Ltd
Contracts held
Trustee, Ngati Rarua Iwi Board
Contracts Iwi has a health business
Member, Mana Tane Ora o Aotearoa
MOH contract
Ngati Rarua, Ngati Toarangatira
Tribal Interest
Luke Katu Employee, Nelson Bays Primary Health
Contracts held
Board member, Te Hauora o Te Awhina Marae
Contracts held
Kaunihera representative on NMIT Kawa Whakaruruhau
Nursing students and tutors future workforce of DHB
Iwi memberships; Ngati Toarangatira, Ngati Rarua and Ngati Koata
Iwi have health business arm which have MOH contracts
Harold Wereta Ngati Toarangatira, Ngati Koata
Tribal interest
Interim trustee, Hei Manaaki Nga Kaumatua Charitable Trust
May receive health contracts
Claire McKenzie
Employee, NMDHB
Graeme Grennell
Provider of Chaplaincy Services to Wairau Hospital
Kaumatua;
SECTION 2: REGISTRATIONS OF INTEREST
Iwi Health Board Open Agenda – 4 June 2015 7
Marlborough Probation Service, Marlborough Police
Mabel Grennell Provider of Chaplaincy Services to Wairau Hospital
Andy Joseph Board of Age Concern
Provider of Chaplaincy Services to Nelson Hospital
Mike Angell
SECTION 3: CORRESPONDENCE - OUTWARDS
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SECTION 3: CORRESPONDENCE - OUTWARDS
Iwi Health Board Open Agenda – 4 June 2015 9
SECTION 3: CORRESPONDENCE - OUTWARDS
Iwi Health Board Open Agenda – 4 June 2015 10
SECTION 3: CORRESPONDENCE - OUTWARDS
Iwi Health Board Open Agenda – 4 June 2015 11
SECTION 3: CORRESPONDENCE - OUTWARDS
Iwi Health Board Open Agenda – 4 June 2015 12
SECTION 3: CORRESPONDENCE - OUTWARDS
Iwi Health Board Open Agenda – 4 June 2015 13
SECTION 3: CORRESPONDENCE - INWARDS
Iwi Health Board Open Agenda – 4 June 2015 14
SECTION 3: CORRESPONDENCE - INWARDS
Iwi Health Board Open Agenda – 4 June 2015 15
SECTION 4: MINUTES – 30 APRIL 2015
Iwi Health Board Open Agenda – 4 June 2015 16
Minutes of Iwi Health Board
Meeting Held 30 April 2015
Present: Luke Katu (Ngāti Toa Rangatira); Dawn McConnell, (Te Atiawa); Rebecca Mason (Ngāti Kuia); Sonny Alesana (Pacifica) , Lee Luke (Ngāti Rarua) arrived 11:30; Dayveen Stephens (Maataa Waka); Mabel Grennell (Kaumatua); Harold Wereta, Caroline Sainty (NMDHB)
Apologies: Judi Billens (Ngāti Tama); Aroha Bond (Ngati Apa); Patrick Smith
In Attendance: Josephine Faragher
SECTION 1: APOLOGIES
Received.
SECTION 2: HE PUKENGA HAUORA
Presentation from Josephine Faragher, Kaiwhakahaera o Nga Hohipera on the objectives and service priorities of the service and how engagement occurs with whanau.
The service began in 2004 to provide quality hauora Maori support to patients accessing hospital services and be an advocate and liaison between the patient, clinician and hospital services. Therefore creating an environment that enables greater participation by whanau during the admission, treatment care and discharge phases.
For the last three quarters engagement occurred with 43% of Māori patients. 28% of Māori patients were discharged before engagement could occur, 12.5% declining service and contact not occurring with 16.5% which are either babies or children.
It was felt that better visibility of the service would assist with increased contacts with whanau, and that improved knowledge of the service by staff on the wards who offer the service would be beneficial. A challenge with internal DHB services not referring was highlighted. The IHB requested; data split between Wairau and Nelson, a further explanation on any other barriers to service access identified, and to elevate any roadblocks to input into CONCERTO and PICS
Agreement
Received the presentation
Agreed to the following actions:
o Note it was the first time HPH had trialled Key Performance Indicators for the service
o Note IHB want to be kept updated on Whanau Ora Plan integration between concerto and SI PICs
o Note aspirations to have a social worker aligned to HPH
o Note the presentation should highlight challenges for the service
o Note DHB needs to profile HPH through its website and health expos.
Recommend that He Pukenga Hauora present their report to ELT/HAC
SECTION 4: MINUTES – 30 APRIL 2015
Iwi Health Board Open Agenda – 4 June 2015 17
A profile on the NMDHB website was suggested, and will be followed up by GM Māori Health Action. It was further recommended that He Pukenga Hauora provide a presentation to ELT and HAC on the service.
Issues that were identified that would benefit Māori utilising hospital services were; increased health literacy, better access to oral health services, reduction in DNAs, support at FSA outpatient clinics, and a qualified Māori social worker to work with whanau.
Feedback on the service is good, however while this is given directly to the service information is not provided from the General Patient Feedback form. It was recommended that the Quality Service Team provide the IHB; how is feedback channelled from the General Patient Feedback, what information is being gathered and analysed, what improvements have occurred as a result of feedback received Action.
SECTION 3: DECISIONS, ADVICE AND GUIDANCE TO DHB
One of the vexing questions often raised by IHB is by what mechanism does it advise or guide the DHB Board. Activities to date include the IHB Chairs report, CPHAC/DiSAC and HAC representation. In addition, the IHB/DHB Chairs may meet and there is the regular Board to Board meeting. However, when IHB want to offer is own thoughts or advice or raise a topic for discussion these tend to happen at the six-month meetings.
The paper was received, and the recommendation that requests submitted to the DHB will be in writing appended to the Chairs monthly report to the Board was agreed, and where required an IHB member be present to assist, and that the Chair‟s report be circulated to IHB for input/feedback.
Agreements
Receive the report
Approve the recommendations in the paper and that IHB will report to the DHB through the Chairpersons report
Recommend to the DHB Board the change in process
Note that a template to the DHB Board covering advice, guidance or recommendations needs to have a template that gives a summary to IHB topic and recommendation made to the DHB Board
Note IHB Chairperson will talk to the DHB Board chairperson about IHB attendance
Note IHB Chairs report to be circulated to IHB members before being submitted to the DHB Board
SECTION 4: MOH REVIEW OF IWI RELATIONSHIP BOARDS
The Ministry of Health will conduct a national review on Iwi Relationship Board partnership arrangements, and will visit each DHB. This will be completed against the Crown Maori Relationship Instrument developed by the Ministry of Justice and Te Puni Kokiri in 2006.
The MOH have been asked which checklists might be used to complete its review, and whether the Iwi‟s perspective about the relationship be sought during the review.
Agreements
Receive the report
SECTION 4: MINUTES – 30 APRIL 2015
Iwi Health Board Open Agenda – 4 June 2015 18
Note DHB will distribute the Crown Maori Relationship Instrument
SECTION 5: IHB WORKPLAN
15/16 Workplan is received and approved and will be tabled at the next DHB Board meeting Action.
The workplan will form the basis of a monthly progress monitoring dashboard report and this will be incorporated into the Chair‟s monthly report.
Agreements
Received the final work plan
Approved the work plan
Recommend to the DHB Board the final IHB Work Plan
Recommend the DHB prepare a dash-board to report progress against the plan
SECTION 6: PACIFIKA KIDPOWER PROJECT
The report on the domestic violence prevention programme „Famalosi Aiga – The Pasifika Kidpower Project – positive safety skills with children‟ is received, and a letter from the IHB supporting the funding application to JR McKenzie Trust for the project is agreed Action.
Agreement
Received the report
Note the first phase is to roll out to the Samoan community and other local Pacific communities
Approved the IHB chairperson signs a letter of support to JR McKenzie Trust seeking funding.
SECTION 7: GM MĀORI HEALTH REPORT
RECOMMENDATION: THAT THE GM MĀORI HEALTH REPORT IS RECEIVED
Moved: Sonny
Seconded: Lee
AGREED
While the IHB is formed under statutory obligation to provide advice to the DHB there may need to be broader mechanism than the IHB for the DHB to consult and work with Iwi. The IHB is a starting point, but in terms of growth and progression as each Iwi‟s capacity grows the DHB could strengthen their relationship with Iwi outside of this forum. Discussions with Iwi may highlight other issues they want to discuss directly with the DHB. Feedback from IHB members on Iwi investing in Healthy-Homes project is that it is not appropriate at this time.
Agreement
Received the report and taken as read
Recommend and note to DHB Board:
o The Iwi are still in post settlement and establishment phase; and
SECTION 4: MINUTES – 30 APRIL 2015
Iwi Health Board Open Agenda – 4 June 2015 19
o Any investment into healthy homes be delayed for 12 months until Iwi have investment strategies in place
SECTION 8: ToSHA DASHBOARD
Rebecca Mason noted a conflict as author of one report.
Agreement
Received the report
SECTION 9: CE’S REPORT
Agreement
Received the report
Meeting finished for lunch, and will move into closed.
SECTION 4.1: MATTERS ARISING
SECTION 4.2: ACTION POINTS
Iwi Health Board Open Agenda – 4 June 2015 20
IHB ACTION POINTS
Action Item #
Meeting Raised O = Open
C = Closed E =
Executive
Action Discussed
Action Requested Person Responsibl
e
Due Date
Status
1. C = 30 Sept IHB Workplan NMIT be approached to provide data on the number of Maori enrolled in degree programmes, broken down by course and year, including attrition rates, to be reviewed at the next meeting.
Workforce becomes a standard agenda item.
Harold Some data received
2. C = 6 Nov Workforce Development Plan
A draft plan to be presented to the IHB early 2015.
Helen Telford
At ELT awaiting approval
3. C = 29 January
Minutes 29 January
The IHB requested that more detail be supplied regularly to the IHB on how the ToSHA projects address health and services issues for Maori and the impact they have on Maori Health.
Harold
4. C = 2 April Oral Health 1) Review data by ethnicity, data on service utilisation and DNA by location/tla
2) Report back on current referral pathways from Oral health services to community service.
3) Oral Health business casepresented to IHB for input.
4) Dr Rob Beaglehole will present evidence and a policy position paper to IHB on fluoridation.
Harold
Agenda item
SECTION 4.2: ACTION POINTS
Iwi Health Board Open Agenda – 4 June 2015 21
5. C = 2 April GM Māori Health Report
A desktop summary on Maori Health Workforce Action Plan (5-6 categories) be provided.
Harold Under Action
6. C = 2 April CE‟s Report Request DNA rates for theatre, and more data on mental health seclusion rates (pg 51).
Harold Under actioin
7. C = 2 April IHB Executive Recommendations
Harold will look at trending data for Maori in aged care, and indicators of utilisation of home based services.
Harold Under action
8. O = 30 April He Pukenga Hauora
Request for; data split between Wairau and Nelson, a further explanation on any other barriers to service access identified, and to elevate any roadblocks to input into CONCERTO and PICS.
He Pukenga Hauora profile be included on the NMDHB website
It was recommended that He Pukenga Hauora provide a presentation to ELT and HAC on their service.
It was recommended that the Quality Service Team provide to the IHB; how is feedback channelled from the General Patient Feedback, what information is being gathered and analysed, what improvements have occurred as a result of feedback received.
Harold/
Josephine
Harold
Harold
Harold
To be presented mid June
9. E =12 May Matters Arising – Research models of care for Kaumatua
It was suggested that a stocktake of ARRC services nationally and regionally occur, including a survey of local Kaumatua needs, matched against population trends.
Harold TOR being drafted, contractor to be engaged
10. E = 12 May General Inclusion of Ngati Rarua‟s profile on DHB/Māori health website to be discussed with IHB
To be discussed
SECTION 4.2: ACTION POINTS
Iwi Health Board Open Agenda – 4 June 2015 22
11. E = 12 May General Appointment of Deputy Chair to be discussed with IHB
To be discussed
Red – Achieved
SECTION 5: PROPOSAL FOR STRATEGIC FRAMEWORK FOR IWI AND AGENCY COLLABORATION
Iwi Health Board Open Agenda – 4 June 2015 23
Status This report contains: For decision Update √ For information &
feedback
MEMO
To: Iwi Health Board
From: Harold Wereta, General Manager
Date: 26 May 2015
Subject: Proposal for Strategic Framework for Iwi and Agency Collaboration
A presentation from the working group of the Regional Intersectorial Forum will be provided on a proposed structure for a Strategic Framework for Iwi and Agency Collaboration. At this stage the work is formative and seeks feedback from the IHB.
There are four suggested working parties or sub-committees under the main forum. They are social, economic, environmental, and culture. You may want to comment on:
a) Are there any other forums that replicate any of the four suggested working parties?
b) Does the IHB see itself as being particularly aligned to any of the four areas of work?
The working group will take feedback or recommendations from the IHB to the main Iwi agency forum.
SECTION 5: PROPOSAL FOR STRATEGIC FRAMEWORK FOR IWI AND AGENCY COLLABORATION
Iwi Health Board Open Agenda – 4 June 2015 24
SECTION 5: PROPOSAL FOR STRATEGIC FRAMEWORK FOR IWI AND AGENCY COLLABORATION
Iwi Health Board Open Agenda – 4 June 2015 25
SECTION 5.1: GMs REPORT
Iwi Health Board Open Agenda – 4 June 2015 26
Status This report contains: For decision Update Regular report For information
MEMO
To: Chris Fleming, CE
From: Harold Wereta, General Manager
Date: 26 May 2015
Subject: GM Māori Report
1. RECOMMENDATION
IHB is asked to:
Receive this report
Approve the minor word changes to the IHB work plan in section 4
Approve the change in time frame for the Maori Health Framework (4.3)
2. PURPOSE
This paper submits the General Managers report to IHB covering quarter three for 2014/15 and the most recent month to month activity. A new format is provided and this links directly to my key performance areas.
3. PROGRESS REPORT
3.1 Service Provision
3.1.1 Te Piki Oranga
(a). Enrolments
Enrolments for the third quarter were slightly down. This is partly to do with due to a plateau in referrals to the service and discharges.
The unmet need in blue is an averaged estimate on what the service should be working towards to build its enrolled population living in NZ Dep 7 – 9 communities.
It‟s important to note that client registrations for Tamariki Ora and Maori Mental Health have not been included as they operate under separate data bases. These clients/ whanau will be transitioned to the new Athena Penelope database.
(b). Ethnicity
Maori continue to be the main population group enrolling with Te Piki Oranga. This is followed by NZ European. We have used the total enrolled population for this service to establish a baseline to compare ethnicities for the service.
SECTION 5.1: GMs REPORT
Iwi Health Board Open Agenda – 4 June 2015 27
Given that Te Piki Oranga is a specialised Maori health provider, you would expect their focus to be towards the Maori community. However, they do access NZ European and other communities if they live in low domicile communities or who are partners to Maori who are enrolled with the service.
(c). Age Distribution
Those aged between 25 – 59 years account for the higher percentage of the enrolled population.
Based on the graph, it may suggest that within this same age group this is where the highest percentage of enrolments reduced for the service.
The DHB will monitor the quarter four result to see if there is a continuing trend.
3.1.2 Information Technologies
(a) Progress
The Te Piki Oranga Board has given approval to move forward and start the implementation of Athena Penelope. The IT system is expected to be implemented by 30 June 2015.
Athena Penelope (or Penelope) is a client management solution designed for mid-sized or larger mental and social service agencies. The system allows an organisation to manage patient referrals, scheduling, clinical documentation and financial performance/ position and more. The technology offers a secured i-cloud client service.
Penelope centralises care management, social work, human and disability services. The case file structure is able to support individual and family case files that receive services by multiple providers.
This new IT platform will replace IMAP which was found to have its limitations especially in regards of clinical requirements for Te Piki Oranga.
The DHB has worked with Te Piki Oranga to free funds to allow the implementation to happen.
Te Piki Oranga advises they will implement the system in three phases:
IT software/ hardware implementation between May/ June 2015. This includes system checks and IT compatibility
Phased training to all staff members across Te Piki Oranga covering June/ July 2015
Specialised training to Te Piki Oranga management to become „IT experts‟ in the system and undertake quality control and train the training.
(b) Exit from Existing IT Systems
Te Piki Oranga presently utilises IMAP (Integrated Management Assessment Programme) and MedTech. Licenses for both systems have been extended to about September to allow for data extraction and transition to Athena Penelope.
SECTION 5.1: GMs REPORT
Iwi Health Board Open Agenda – 4 June 2015 28
(c) Ministry of Health
As part of the Maori Health Provider Development Scheme (MPDS), Te Piki Oranga made submission to support the implementation and roll out of the Athena Penelope system.
The DHB was advised that the policy arm within the Ministry, the Maori Business Unit had instructed the operational arm of the Ministry responsible for MPDS funding, Sector Capability and Implementation, to stop all IT application request.
The Ministry of Health, alongside Te Puni Kokiri and the Ministry of Development in 2014 contracted IBM to design and develop a new IT platform known as the Whanau Ora Information System. The tool is now in the testing phase with three large providers who are part of the nationally funded Whanau Ora Collectives.
The DHB has asked the Ministry to provide policy clarification on its position. We understand they do not want to fund duplicate systems and this tool will be the only one used nationally. However, there has been no confirmation. The Ministry has been asked to:
Confirm if the Whanau Ora IS system will be used nationally?
Clarify what impact this decision has for providers like Te Piki Oranga who are outside the nationally funded collectives?
Clarify what impact the Ministry‟s position might have on market forces if providers are asked to accept a nationally developed tool and have their own system? The position maybe viewed as ant-competitive?
Clarify their policy intentions with regards to Whanau Ora and the impacts this might have to providers who are not Whanau Ora aligned?
These questions have been elevated to Sector Capability and Implementation and the National Maori General Managers Reference Group for discussion and clarification.
4. IHB WORK PLAN This section recommends minor amendments to the IHB work plan. In summary: Description Current Plan Wording Recommended
Wording Reason for Change
Te Piki Oranga Receive and review quarterly reports
Receive quarterly updates on performance against outcomes
The previous wording was considered to be operational and linked to their contract.
Iwi Health Monitoring Framework
Endorse by IHB Recommend to DHB and PHOs Receive and review regular monitoring framework reports
Refer to section 6.3 to this report
DHB/ IHB would need to go through a process to consult and get buy-in to framework
5. MAORI HEALTH PLAN 2014/15 IMPLEMENTATION A draft report was submitted on 30 April covering DHB progress. The next up date will be provided in June/ July for your information.
SECTION 5.1: GMs REPORT
Iwi Health Board Open Agenda – 4 June 2015 29
6. DHB PROJECT WORK 6.1 Maori & Pacific Oral Health Project Through the budgeting process for 2015/16, an Oral Health project for Maori and Pacific has been approved. The project was proposed because there are significant inequalities in oral health status for Maori compared to the whole population. This shows up in key childhood oral health status indicators, for example: Less than half of Maori 5 year olds have no caries
Maori children in Year 8 at school have a higher average number of decayed, missing and filled teeth than the rest of the Year 8 population
A lower proportion of Maori pre-school children are enrolled with the Community Oral Health Service.
A project plan will be presented to the Oral Health Advisory Group for advice. The plan is focused on implementation and not about researching the cause issue. One point the CE raised with me was the balance between „what the project expectations might bring up versus existing community health services being able to respond.‟ This question will be considered as part of the implementation pathway. Work is also underway looking at community action/ involvement (Pacific/ Maori) and using known forums to improve service promotional messages across the district. 6.2 A Project to Improve the Cancer Pathway for Maori patients in Te Tau Ihu o te
Waka a Maui. The objectives of the project were to: better understand the incidence and impact of cancer for Maori in Te Tau Ihu
better understand what stands in the way of Maori getting timely diagnosis and treatment when they have cancer
develop improvements that support and enhance the patient journey for Maori, so they have the best chance of improved health outcomes.
Te Piki Oranga was engaged to manage the project and appointed Dr Melissa Cragg to undertake the project work. The process has included a range of stakeholders, including significant input from people and whanau/families that have experienced cancer. Preliminary findings were presented to a Ministry of Health-organised workshop in April along with information from a range of other initiatives underway in other part of NZ. These preliminary findings included: Data available not of a high quality and difficult to use for effective analysis Maori appear to be presenting late or not at all for diagnosis and treatment Small numbers of Maori on FCT register Small numbers of Maori accessing hospice/palliative services Often Maori patients have co-morbidities that make their case complex The project built on some work that had already commenced in early 2014, where key stakeholders in Nelson Marlborough for Maori health cancer services had begun to map the pathway for cancer patients and identified a number of issues for Maori that contribute to delays in accessing treatment with resulting inequity in outcomes.
SECTION 5.1: GMs REPORT
Iwi Health Board Open Agenda – 4 June 2015 30
The DHB is now working on a programme of action to implement the recommendations. We have made submission to the Southern Cancer Network trying to secure funding covering the next two years. SCN are screening/ vetting applications as part of the Ministry process. The plan is to recruit a Nurse Educator. Their role is to work and build awareness of Maori cancer pathways with Senior Medical and nursing staff and coordinate actions/ activities that impact of Maori patients/ whanau that are on a journey with cancer. The outcome is to improve diagnostic pathways and to lessen the burden of stress on Maori. 6.3 IHB Monitoring Framework IHB is asked to approve an amendment to the work plan timetable for IHB/Maori Health Monitoring Framework. The timeframes need to be reviewed and we suggest the following: Description Action By When
Maori Health Monitoring Framework is endorsed
Paper to IHB May
A consultation report is drafted and agreed to by ELT/ IHB
Report drafted for IHB/ ELT June
Consultation on the framework happens with Clinical Governance Groups, PHOs, community groups and wider sector
Group forms are coordinated across the district e.g. PHO, Public Health, Maori providers, and community groups/ providers
June - August
Consultation report completed and framework updated to reflect changes
Report submitted to ELT/IHB/DHB September
Final version of Framework completed for approval
Board paper to ELT/ IHB/DHB for sign off October
7. WHANAU ORA ANNUAL PLAN PROGRESS Annual plan reporting is tracking to plan. A copy of the DHB assessment is attached. The third quarter results will be updated in April 2015.
Outcome Improved Health Outcomes for Maori in Te Tau Ihu
Theme Building Capacity and Capability Maori Health Plan Review Under action as part of Annual Plan
Reallocation of non-frontline funding to Te Piki Oranga
Completed
E-learning packages on Tikanga Maori
These have been developed and awaiting to go live through pilot sites.
Te Piki Oranga targeting deprivation 7 – 9 populations
Until the new IT system is in place which will be July/August this will not be met.
Theme Being Outcomes Focused New outcomes contract framework for Te Piki Oranga
Agreement in place and on-track.
Embed Maori health outcomes frameworks
Partially achieved. A framework is being established.
SECTION 5.1: GMs REPORT
Iwi Health Board Open Agenda – 4 June 2015 31
Embed recommendations of 2013 coalition business case
Completed.
Engage Te Piki Oranga in Annual Planning
Completed
Implement Māori Health Plan with PHOs, Te Piki Oranga and other providers
Completed
Theme Supporting Strategic Change Support Te Piki Oranga to joint Te Waipounamu Whanau Ora collective
Partially Achieved. MOU being negotiated and most likely to be achieved in 2015/16.
Start discussions with Te Pūtahitanga on opportunities
Achieved. There have been communications with the CE Sue Turner. DHB is awaiting Te Pūtahitanga direction so we can align activity 2016/17 planning year.
Strengthen the relationship between DHB and IHB Boards
Ongoing.
Maori health perspectives are part of ToSHA
Te Piki Oranga is a member of the group and delivers a Maori perspective from a services point of view. Although the issue of Iwi keeps popping up, this is an operational group and would not involve IHB.
Milestones Dashboard
Legend On target Caution Critical Complete Not Started
SECTION 5.2: CHAIRs REPORT
Iwi Health Board Open Agenda – 4 June 2015 32
Status This report contains: Regular report For decision For information
MEMO
To: NMDHB
From: Dawn McConnell
Chair, Iwi Health Board
Date: 18 May 2015
Subject: Iwi Health Board Chairs Report
Purpose
This paper submits an update to the DHB Board about the activities of the Iwi Health Board (IHB).
I. HE PUKENGA HAUORA (NMDHB MĀORI INPATIENT SERVICES)
A presentation from Josephine Faragher, Kaiwhakahaere o Nga Hohipera on the objectives and priorities of the service and how engagement occurs with whanau was provided. The service began in 2004 to provide quality hauora Maori support to patients admitted to hospital services and be an advocate and liaison between the patient, clinician and hospital services. Therefore creating an environment that enables greater participation by whanau during the admission, treatment care and discharge phases.
Feedback on the presentation was positive and it was recognised that the service key performance indicators where being trailed for 2014/15. However it was felt that better visibility of the service would assist with increased engagement with Māori patients (currently 43%). The IHB provided several recommendations including that He Pukenga Hauora provide a presentation to ELT and HAC on the service.
II. DECISIONS, ADVICE AND GUIDANCE TO NMDHB BOARD
The mechanism for the IHB to provide advice or guidance to the DHB Board has mainly been through the IHB Chairs report, CPHAC/DiSAC, HAC representation, and when the IHB want to offer its own thoughts or advice or raise a topic for discussion these tend to happen at the six-month meetings.
The IHB have agreed to provide formal recommendations to the Board for approval appended to the Chairpersons report, with the expectation that those recommendations be directed to the CE and onto the relevant General Manager for a response or action.
It is expected that a template will be developed to provide a summary of the topic and recommendations being made to the DHB Board.
III. IHB WORKPLAN 2015/16
The workplan has been approved and will provide a strategic direction for the activity of the IHB. It is appended for your information.
IV. MOH REVIEW OF IWI RELATIONSHIP BOARDS
The MOH is conducting a national review on Iwi Relationship Board partnership arrangements, and will visit each DHB. This will be completed against the Crown Maori Relationship Instrument developed by the Ministry of Justice and Te Puni Kokiri in 2006. It is expected that the MOH would meet with both the IHB and Chair of NMDHB.
SECTION 5.2: CHAIRs REPORT
Iwi Health Board Open Agenda – 4 June 2015 33
V. PACIFIKA KIDPOWER PROJECT
The IHB agreed to provide a letter of recommendation for the Nelson Tasman Pasifika Community Trust to a funding application to JR McKenzie Trust to develop ‘Famalosi Aiga – The Pasifika Kidpower Project - positive safety skills with children as part of a domestic violence prevention programme.
The project is geared towards the Pasifika community and will begin with the Samoan community first. The Samoan elders, church leaders and youth have identified domestic violence as an issue in the community. This project will give the Samoan community the opportunity to create and deliver a culturally appropriate and independently evaluated (by a Pasifika researcher) programme that will be adapted and assimilated by other Pasifika communities.
VI. AGED RELATED RESIDENTIAL CARE
The question of what the ARRC funding covers, and the lack of equity if limited numbers of Maori are accessing services is being discussed by the IHB. Planning for the future, can the current system support other models of care for elderly Māori?
It has been recommended and agreed by the IHB that a review of models of residential care for elderly Māori be undertaken to inform future planning.
VII. ORAL HEALTH
A presentation on the oral health status for children, service enrolment, and service utilisation, current and planned initiatives was provided by Rob Beaglehole. The health status of Māori children is poorer than non-Māori. A lower proportion of Māori children are caries-free at 5 years and the % caries-free has declined over the last 3 years, Māori children at 5 years have almost twice as many decayed missing and filled teeth as non-Māori and higher presentations at the Emergency Department particularly Marlborough which is three times higher than Nelson. Every year over 200 children undergo general anaesthetic dental procedures of which around 60 (or 30%) are Māori children.
The IHB will receive another presentation from Rob with additional data and is expecting at some time to receive a policy position paper on fluoridisation.
The IHB would like oral health/fluoridisation as an agenda item with a further presentation from Rob when the two boards meeting 30 July.
RECOMMENDATION:
THAT THE IHB CHAIR’S REPORT BE RECEIVED.
SECTION 5.2: CHAIRs REPORT
Iwi Health Board Open Agenda – 4 June 2015 34
IWI HEALTH BOARD WORK PLAN
2015/16
Strategic Focus Action/ Activity Milestone
Partnership/Relationships
DHB Board Board to Board meetings
Agenda items suggested by IHB and agreed by both Chairs
Monitor Board to Board health priorities
Maori Cancer Pathway
Oral Health Project
Healthy Homes
Workforce Implementation
Obesity
6 monthly
2015/16
DHB Committees
CPHAC/DiSAC
HAC
Executive meetings to review agendas for Maori content and agree on feedback
Committee members report back to the IHB, preferably with a written report, on issues arising and impact on/for Maori
As per meeting timeframes
As per meeting timeframes
He Kawenata Reviewed, signed by Iwi
3 yearly
Iwi Chairs Forum IHB advocate for Health to become a regular agenda item
Ongoing
Te Piki Oranga Board Receive and review quarterly reports (Standing agenda item)
6 monthly face to face meetings
From May 2015
From September 2015
PHO Boards Develop a relationship with PHO Boards and Iwi/Maori reps
Agree engagement and communication
Meet with Marlborough PHO Board
Meet with Nelson Bays PHO Board
Receive quarterly reports on highlights and areas of concern from PHO reports
Ensure that the key principles of the Whanau Ora approach to health are incorporated into models of care
Ongoing
Māori Health & Wellness Strategic Framework
Approve project scope for refresh
Provide input to the refresh
Recommend final draft to DHB Board
May 2016
Annual Plan Receive and review Annual Plan updates from DHB
Participate in the planning cycle, e.g. Annual Plan workshops
Quarterly
As per timeframes
Maori Health Plan Approve plan development process
Provide input to the development of the plan
Approve the plan and recommend to DHB Board
Monitor Maori Health Plan targets and progress on initiatives
November – May
As per timeframes
As per timeframes
Quarterly
District Workforce planning Measure/monitoring workforce action plan implementation
Receive Maori workforce data by role and department
Six Monthly
Six Monthly
ToSHA Updates of progress of ToSHA workstreams/SLATS
Monthly reports
Delivery
Hospital Services Reports from Maori Inpatient Services
Presentation from Maori Inpatient Services (service performance)
Quarterly
Quarterly
SECTION 5.2: CHAIRs REPORT
Iwi Health Board Open Agenda – 4 June 2015 36
IWI HEALTH BOARD WORK PLAN
2015/16
Strategic Focus Action/ Activity Milestone
Public Health Receive updates on progress on the implementation of the Public Health Plan
Quarterly
NMDHB Disability Support Service (DSS)
Receive data comparing:
No. & % of Maori/non-Maori working in services
No. & % of Maori/non-Maori receiving services
Quarterly
Health of Older People Develop understanding of the needs of an the ageing Maori population and associated service needs and use
March 2016
Ways of Working
Communication Plan Annual communication plan completed
May 2015
Standard Operating Procedures (SOP)
Review SOP 3 yearly
Annual Performance Review of IHB
Undertake a self-assessment of IHB performance
May annually
Key
Quarterly = October, January, April and July
Six Month = November and June
SECTION 5.3: CPHAC/DiSAC REPORT Verbal update of meeting held 26 May 2015
SECTION 5.4: IHB EXECUTIVE RECOMMENDATIONS
Iwi Health Board Open Agenda – 4 June 2015 37
Status This report contains: For discussion Update Regular report For information
MEMO
To: Iwi Health Board Members
From: Harold Wereta, General Manager
Date: 29 May 2015
Subject: IHB Executive Recommendations
The IHB Executive met on 12 May, 2015, the following is a summary of discussions and items for the attention of the IHB.
1. PUBLIC HEALTH PLAN
The plan was reviewed and returned to Public Health with the expectation that the final plan will come back to the IHB. Peter Burton has confirmed that the feedback along with MOH recommendations is being reviewed by the team and a final copy will be sent to the IHB when it has been completed.
2. RESEARCH REQUESTS
The following research requests were approved by the Executive;
i. INVESTIGATING MAORI AND POLYNESIAN CHILDREN WITH AUTOIMMUNE NEUROLOGICAL DISEASE IN NEW ZEALAND: A PARALLEL STUDY OF ANTI-N-METHYL-D-ASPARTATE RECEPTOR ENCEPHALITIS AND SYDENHAM’S CHOREA
ii. OPTIMAL GLYCAEMIC TARGETS FOR GESTATIONAL DIABETES: THE RANDOMISED TRIAL – TARGET
3. ENGAGEMENT AND COMMUNICATION PLAN
The plan is endorsed (attachment 1), and agreed that additional NGOs not be added at this time.
4. NMDHB WEBSITE/MĀORI HEALTH PROFILE
The question of including the profile of te Hauora o Ngati Rarua as a provider of health services on the DHB website was raised, but requires a decision by the full IHB.
5. IHB DEPUTY CHAIR
The matter of appointing a Deputy Chair who would also participate on the IHB Executive is raised for discussion.
SECTION 5.4: IHB EXECUTIVE RECOMMENDATIONS
Iwi Health Board Open Agenda – 4 June 2015 38
WHO DOES THE IHB NEED TO TALK AND MEET WITH?
Iwi Kaumatua DHB Board / CE
DHB / PHOs
Te Piki Oranga
NGOs General Public
WH
AT
DO
ES
TH
E I
HB
NE
ED
TO
TA
LK
/ C
OM
MU
NIC
AT
E A
BO
UT
?
Profile – Background and mandate
Link from Iwi website to DHB website
F2F session
Letter/ memo
DHB Website
Link from PHO website to DHB website
F2F session
DHB website
Link from NGO website to DHB website
DHB website
Meeting dates/times, minutes
E-mail Newspaper Board papers
Link from PHO website to DHB website
E-mail
DHB website
Link from NGO website to DHB website
NGO newsletters
Newspaper
DHB website
What’s been happening?
IHB
Others
Electronic newsletter
Newsletter Chairs Report
Link from PHO website to DHB website
F2F session
Link from NGO website to DHB website
+ F2F sessions
NGO newsletters
DHB website
IHB position/strategy on topics of interest
e.g.workforce development
F2F sessions Newsletter Chairs Report
Board papers
Link from PHO website to DHB website
F2F sessions
Link from NGO website to DHB website
NGO newsletters
DHB website
Education / Information sharing
F2F sessions F2F sessions
F2F sessions
F2F sessions
F2F sessions
F2F sessions Not essential
Te Tau Ihu health Link from Iwi DHB website Not Not Not Link from NGO DHB website
SECTION 5.4: IHB EXECUTIVE RECOMMENDATIONS
Iwi Health Board Open Agenda – 4 June 2015 39
system website to DHB website
essential essential essential website to DHB website
Library / Links to websites and documents e.g. Maori Health Action Plan
Link from Iwi website to DHB website
DHB website DHB website
Link from PHO website to DHB website
DHB website
Link from NGO website to DHB website
DHB website
Come talk with us / got a good idea?
E-mail Newsletter Board to Board meetings
Link from PHO website to DHB website
DHB website
Link from NGO website to DHB website
NGO newsletters
DHB website
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 40
Status This report contains: For decision Update Regular report For information
MEMO
To: Board Members
From: Chris Fleming, Chief Executive
Date: 20 May 2015
Subject: Chief Executive’s Report
INTRODUCTORY COMMENTS The financial performance for the month of March saw a $282k deficit against a planned deficit of $221k. This was a small deterioration of $62k against plan. On a year to date basis the DHB is now running at a $2.5m surplus compared to a planned surplus of $1.9m, so $591k ahead of plan. A detailed forecast for year-end has not been completed, however we remain confident of exceeding the $1.5m budget surplus, while ensuring that we meet, and exceed, overall service volumes and health targets. Elective surgical performance was virtually on plan for the month with a plan of 493 and total delivery of 510, or 17 favourable for the month. On a year to date basis total health target discharges are estimated at 5,157 compared to a plan of 5,005. This represents a favourable result of 152 discharges or 103% of the plan. IDF numbers incorporated into these results are estimated for April as reporting is always a month delayed.
MATTERS ARISING Mental Health and ERMS. Mental Health referrals were excluded from the scope of ERMS as they were being managed through the Single Point of Entry (SPOE) and, more recently, CARES (Mental Health). SPOE/CARES is used more frequently by Nelson general practitioners as nearly all practices use the MedTech practice management system. The current CARES referral is an Advanced Form available from MedTech. ERMS is now available for use in all practices, irrespective of practice management system
Marlborough general practitioners have requested to be able to use ERMS to generate and send mental health referrals. There is an existing Mental Health referral template in ERMS and a preliminary discussion has been had with hospital mental health services about the minimum referral data set needed to make triaging decisions and what, if any, changes need to be made to the referral template in ERMS.
To ensure district-wide consistency in approach, there is a meeting on 22 May with the Mental Health GM and Services Managers, Kimi Hauroa Wairau scheduled to ensure that any developments are aligned.
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 41
I) FLUORIDATION
During the month we presented to both the Tasman District and the Nelson City Councils on their long term plan. We have also given a written submission for the Marlborough District Council plan and are awaiting the hearing for that submission. In our submissions we are urging the Councils to include fluoridation as a priority. Despite the information that the anti-fluoride lobbyists portray, the evidence demonstrates that community water fluoridation is safe, cost effective, equitable, and an appropriate measure in preventing tooth decay. The incidence of tooth decay within our local community is rapidly rising, and is contributing to widening the gap between the health outcomes of different population groups, particularly the most deprived. As an example the children of the Nelson Marlborough district with tooth decay, at the age of five, has increased from 33% in 2011 to 45% in 2013. Of those, Maori children have seen the most significant increase from 50% in 2011 to 69% in 2013. Some of this increase will be attributable to the introduction of the Community Oral Health Service new models of care. In the new model all children are x-rayed whereas previously they were not and, as such, detection is earlier.
Tooth decay is reported to be the single most common chronic disease among New Zealanders of all ages, and is responsible for significant health loss with „costs‟ in terms of lost years of healthy life being equivalent to 3/4 that of prostate cancer and 2/5 that of breast cancer. Fluoridation of water supplies is shown to be a safe and effective preventative measure against tooth decay that reaches all population groups. In a report on behalf of the Royal Society of New Zealand and the Office of the Prime Minister‟s Chief Science Advisor, which reviewed the scientific evidence for and against the efficacy and safety of fluoridation of public water supplies, the conclusion was that the levels of fluoridation used in New Zealand create no health risks, and that it is appropriate that fluoridation of water supplies is expanded to assist those New Zealand communities that currently do not benefit from this public health measure, particularly those with high rates of tooth decay. Its effectiveness is also highlighted by the results of another MOH led study which showed 40% less tooth decay on average for children in fluoridated areas. While the anti-fluoride lobbyists will undoubtedly raise many objections, we must listen to organisations like the World Health Organisation, New Zealand and American Dental Associations, the American Academy of Paediatrics, the Royal Society of New Zealand and the Chief Science Advisor and do the right thing for our population. Ironically if the Dental Association was being driven by a self serving agenda it would not support fluoridation as it will actually reduce demand for dental services over time. For those people who have such strong views simply buying a water filter, which are readily available, will remove the fluoride from their drinking supplies.
II) CLINICAL SERVICES SUMMARY OUTPUT PERFORMANCE
Overall clinical service volume performance is summarised in the tables below. Under delivery of acute activity has reduced on a year to date basis from 6.19% last month to 5.38%. This, however, is represented by a continued under delivery of acute surgical activity, but with a 13% over provision (against target) of acute medicine and a 30% over
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 42
delivery in neonatal / medicine. Caution needs to be taken in interpreting the specific timing of the changes as we have shortages in coding staff, and this could impact on the timeliness of accurate coding information. The busyness of acute activity does, however, support the concern over the increased nursing costs during the month. The reduction in bed nights has also significantly reduced from 844 last month to 380 on a year to date basis this month. The increased bed night pressure has been in both Nelson and Wairau. Ironically ED attendances have fallen during the month, largely in Nelson, however this is a seasonal trend and the reductions were very clearly in-patients who were not admitted (triage 4 and 5). Overall ED attendances are 0.2% less than the same year to date as last year. Overall ED numbers are higher in Nelson, while lower in Wairau. All of these are signs of a system (hospitals and primary care) working well. The elective caseweight discharge under-provision has continued to reduce, and we are now 0.52% behind plan, but 2.79% ahead of the same time last year. This caseweight discharge number excludes IDFs for our population accessing services in other DHBs. Outpatient first specialist attendances are 2.6% behind plan, but 2.5% ahead of last year. However, follow up assessments are 3.9% ahead of plan or 5.6% ahead of the same time last year. This is a deliberate change within a number of specialties who have expressed concern about the lengthening of follow up times with the focus on first specialist assessments.
April 2014
YTD
Last Month
Variance YTD
Actual Planned # % # %
Caseweighted Discharges
Acute
Medical 6,089 6,273 (184) (2.93%) 5,860 229 3.91% (4.54%)
Total ED Attendances 39,945 40,007 (62) (0.15%) (0.50%)
Bed Nights
- Nelson 33,409 32,830 579 1.76% 0.46%
- Wairau 13,565 14,524 (959) (6.60%) (7.87%)
Total Bed Nights 46,974 47,354 (380) (0.80%) (2.07%)
April 2015 YTD Variance
Variance To Last
Year
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 43
III) MENTAL HEALTH SUMMARY OUTPUT PERFORMANCE
Mental Health inpatient activity has continued at the higher level experienced in March and the length of stay reduction has equally continued. Seclusion hours are considerably lower. Caution needs to be taken over interpreting the community crisis contacts as reporting of these numbers appear to have a lag time.
(a) Activity – Specialist
NB: Seclusion for the month is very low, the lowest since January 2014, there were both less events and shorter durations for these events.
(b) Activity – NGO
Te Whare Mahana Residential contract finished in February 2015 with the DBT program being Nationally funded by MOH
for one year pilot with a fee for service basis paid by any DHB for utilisation. Currently there are 3 people there. Care Solutions – no Support Worker training being held currently hence nil to report.
Last 12 months Year End 13/14
Feb-15 Mar-15 Apr-15 Monthly Average Monthly Average
Inpatient Acute Admissions 17 24 25 28 33
Inpatient Acute LOS (days) 17.4 11.7 12.4 12.1 10.3
Inpatient Seclusion Use (hours)* 242.5 175.0 51.6 233.5 277.7
Community Caseload Numbers 2880 2846 2758 2908 2890
Psychogeriatric IP Admissions* 6 6 5 5.3 4.9
Psychogeriatric IP Occupancy (%)* 73.2% 87.8% 90.6% 88.3% 110.8%
*Provisional @ 8 May 2015
Last Three Months
Service Last 12 months Year End 13/14
Feb-15 Mar-15 Apr-15 Monthly Average Monthly Average
Richmond NZ* 30 29 0 34 32
Gateway Housing Trust 170 170 154 172 168
MHSS 37 36 38 37 37
Te Whare Mahana 53 42 41 45 51
Te Ara Mahi 96 95 93 90 77
Health Action Trust (Kotuku) 17 18 22 22 23
Care Marlborough - day activity
(average clients per day)18 17 15 15 16
The White House (average clients
per day)13 15 16.4 16 18
Care Solutions 0 0 0 12 21
SF Nelson (contact hours) 64 64 72 63 55
SF Blenheim (contact hours) 92 120 113 93 92
St. Marks 33 33 24 32 44
Te Piki Oranga# 225 231 227 157
Last Three Months
*Reports directly to PRiMD, which has a reporting timeframe of the 20th of the month, so numbers are provisional only.
# Te Piki Oranga is still unable to report to PRiMD and have provided provisional data that is incomplete in the interim.
IV) IDSS – SUMMARY OUTPUT PERFORMANCE
IDSS performance remains relatively consistent with a year to date occupancy of 96%, although the month of March saw occupancy at 98%.
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 44
Intellectual & Physical Disabilities
Contracted Services IDSS PDSS Total ID & PD Total ID & PD
Current Moh
Contract
As per Contracts at month
end 138 13 151
Beds – Individual
contracts
As per Contracts at month
end 43 2 45
Beds – P&F -
Chronic Health
Conditions
As per Contracts at month
end 3 8 11
Beds – Individual
contracts with ACC
As per Contracts at month
end 1 1 2
Total number of
clients contracted
Residential contracts -
Actual at month end 185 24 209
Vacant Beds Actual at month end 6 1 7
Total available beds 191 25 216 0
Total number of
clients supported
Residential clients - Actual at
month end 186 23 209
Beds – Respite
clients As per clients at month end 0 1 1
** PD beds 1
respite client
Personal Cares clients -
Actual at month end 1 1 2
Total clients supported 187 25 212
Total available bed days 5,760 690 6,450 67,002
Total Occupied Bed
days
Actual for full month -
includes respite 5,571 720 6,291 64,260
** ** Tasman St using
7th room
Total Occupied Beds
Based on actual bed days
for full month (includes
respite volumes) 97% 104% 98% 96%
Service provided
YTD April 2015Current April 2015
V) TOP OF THE SOUTH HEALTH ALLIANCE
Progress on the key priorities in TOSHA are:
Cardiovascular and Diabetes. Work has begun developing the project brief for supporting the clinical specialist diabetes nurses to work in the community across General Practice and Maori Health providers. A workforce development plan is being drafted; engagement with CME coordinators and assessing knowledge and skills frameworks has been undertaken to inform the plan. A gaps analysis of self management programmes has been undertaken with the next steps to determine what needs to be implemented locally. A process for data sharing is being worked on to better understand the local diabetic and those at risk of CVD population. Work is beginning on understanding the requirements locally to implement the new standards for diabetes care
Rural Funding. Implementation of the new funding model is under way. The Allied Health Service Manager is being approached to look at the feasibility of an integrated model of physiotherapy services in Wakefield. This will feed into the wider paper and recommendations on integrated rural services. There is also activity looking at point of care testing in rural areas. Work is continuing looking at PRIME services in Marlborough
Health Pathways. The site was visited by 765 users in April 2015, who viewed an average of 5 pages per visit. The website user survey has closed and is currently being analysed. Consideration is being given to “what next” for pathways development
Primary and Community Nursing. A subgroup has been formed to look at making recommendations on the interface and shape of district nursing, public health nursing and primary care nursing. Work on a joint training calendar has been undertaken by the PHOs.
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 45
An approach has been made to the Director of Nursing to support access to the Lipincott manual in primary care. Work on identifying and regionalising knowledge and skills frameworks has begun
Primary Health Care Targets. The primary care 'better help for smokers to quit' target continues to be achieved. The immunisation target has slipped from a high around target in November 2014 to being around 90% currently with slightly worse performance in the Maori population. Work from the immunisation operational group is working on understanding the reasons for the high decliner rate which is driving the low performance. Discussions have also been had with TPO to strengthen the OIS service which has suffered from staff changes. Progress against the 'more heart and diabetes checks' target is still progressing well, with performance currently at around 88.5%. PHOs are focusing on achieving this target through multiple means and it should be achieved this quarter
Acute Demand Management. Implementation of the COPD Pathway initiative continues and it is expected that both the spriometry and acute exacerbation pilots will be launched in July. The GP Capacity and Engagement survey has been finalised and results from the one to one discussions in Wairau will be compared with existing NBPH quarterly data. Selected patients have been contacted and surveyed by the GP Follow-up Research team. Results from both sets of patient research will be used to inform a patient communications strategy and the scope of the Options for Care initiative, which has agreed its working group membership and is planning to meet in May. The ED Frequent Presenters initiative is now business as usual within Clinical Services.
The ToSHA dashboard and update are attached as item 7.1
VI) HEALTH TARGET PROVISIONAL INFORMATION
Appendix A
Appendix B Target
Appendix C December
2014 Quarter
Appendix D April
Appendix E Shorter Stays in Emergency Department
Appendix F 95%
Appendix G 97.0%
Appendix H 96.4%
Appendix I Improved Access to Elective Surgery
Appendix J 100%
Appendix K 103%
Appendix L 103%
Appendix M Faster Cancer Treatment 62 Days
Appendix N 85%
Appendix O 70%
Appendix P 75%
Appendix Q (87% third quarter)
Appendix R Increased Immunisation
Appendix S 95%
Appendix T 92%
Appendix U 89%
Appendix V Better Help For Smokers to Quit
- Hospital - Primary Care
Appendix W Appendix X 9
5% Appendix Y 9
0%
Appendix Z Appendix AA 9
6% Appendix BB 9
7%
Appendix CC Appendix DD 9
7.8%
Appendix EE More Heart & Diabetes Checks
Appendix FF 90%
Appendix GG 85%
Appendix HH Not avail
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 46
VII) NON FINANCIAL PERFORMANCE SUMMARY
We have developed a quarterly table to show our non financial performance summary, of areas that we are accountable through our plan, across the year. This is attached as item 7.2. In essence we are achieving in the majority (12) of areas, partial achievement in 3, however are not meeting the target in Increased Immunisation, and our Inpatient Average Length of Stay has risen over the 3.47 target to 3.57.
VIII) EMERGENCY DEPARTMENT PRESENTATIONS
There has been a marked reduction in ED presentations in both Nelson and Wairau in the month of April. Looking at the data this is not an unexpected trend as similar reductions have occurred in the previous year, although the reduction in the previous year in Nelson has been more progressive than a sudden drop off. The reductions on both sites have, however, largely been in triage 4 & 5.
90.0%
92.0%
94.0%
96.0%
98.0%
100.0%
120.00
125.00
130.00
135.00
140.00
145.00
NMDHB ED Performance
Presentations Per Day NMDHB 6 Hr Target Results ED 6 Hour Target
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
% of ED Attendances Admitted
Total ED Admissions Nelson ED Admissions Wairau ED Admissions
90.0%
92.0%
94.0%
96.0%
98.0%
100.0%
64.00
66.00
68.00
70.00
72.00
74.00
76.00
78.00
80.00
Nelson ED Performance
Presentations Per Day NMDHB 6 Hr Target Results ED 6 Hour Target
92.0%
93.0%
94.0%
95.0%
96.0%
97.0%
98.0%
50.00
52.00
54.00
56.00
58.00
60.00
62.00
64.00
Wairau ED Performance
Presentations Per Day NMDHB 6 Hr Target Results ED 6 Hour Target
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 47
0
500
1000
1500
2000
2500
3000Ja
n-1
4
Feb
-14
Mar
-14
Ap
r-1
4
May
-14
Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
De
c-1
4
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
Nelson ED Attendances by Triage Category
Triage 5
Triage 4
Triage 3
Triage 2
Triage 10
500
1000
1500
2000
2500
Wairau ED Attendances by Triage Category
Triage 5
Triage 4
Triage 3
Triage 2
Triage 1
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Nelson ED Attendances by Triage Category - %
Triage 5
Triage 4
Triage 3
Triage 2
Triage 10.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Jan
-14
Feb
-14
Mar
-14
Ap
r-1
4
May
-14
Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
De
c-1
4
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
Wairau ED Attendances by Triage Category - %
Triage 5
Triage 4
Triage 3
Triage 2
Triage 1
IX) ACUITY / WORKLOAD Acuity and workload is presented in the following graphs. The acute activity has clearly picked up in both Nelson and Wairau during the month of April reflecting on workload pressures.
Medical Acute Discharges Surgical Acute Discharges Neonatal & Maternity Discharges
0
100
200
300
400
500
600
700
Oct
-13
No
v-1
3
De
c-1
3
Jan
-14
Feb
-14
Mar
-14
Ap
r-1
4
May
-14
Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
De
c-1
4
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
Elective Discharges (Raw) - Wairau
Medical Elective Discharges Surgical Elective Discharges
-
0.20
0.40
0.60
0.80
1.00
1.20
1.40
Oct
-13
No
v-1
3
De
c-1
3
Jan
-14
Feb
-14
Mar
-14
Ap
r-1
4
May
-14
Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
De
c-1
4
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
Acute CWDs Per Discharge - Wairau(Excl Emergency)
Medical Acute Surgical Acute Neonatal & Maternity Acute
-0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1.80
Oct
-13
No
v-1
3
De
c-1
3
Jan
-14
Feb
-14
Mar
-14
Ap
r-1
4
May
-14
Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
De
c-1
4
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
Elective CWDs Per Discharge - Wairau
Medical Elective CWDs Surgical Elective CWDs
The Trendcare bed utilisation data below is not based on the more traditional midnight census, but rather it measures whether the bed has been utilised in any 24 hour period. There was an error in the previous month‟s data for Wairau which has now been corrected. Overall this data indicates relatively stable utilisation, however any utilisation over approximately 85% would indicate that the system will be under pressure during the month. Clearly the data indicates average utilisation across the month and does not reflect the natural peaks and troughs.
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 49
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Oct
-13
No
v-1
3
De
c-1
3
Jan
-14
Feb
-14
Mar
-14
Ap
r-1
4
May
-14
Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
De
c-1
4
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
Bed Utilisation - Trendcare
Nelson Hospital Utilisation Wairau Hospital Utilisation
Mental Health & Alex Utilisation
The Trendcare hours below show the difference between nursing hours required and nursing hours available. The positive picture below is that the majority of departments are operating within appropriate clinical hours being available. An emerging issue appears to be in HDU and the Day Stay Unit in Wairau. We are following through with these areas to understand the causes. There continues to be significantly higher levels of resources in both paediatrics, post natal and maternity. We continue to work with the professional leaders on this front to try and address wherever possible, however these are impacted by both the small size of these departments and the mixture of nursing and midwifery involved.
15,000
17,000
19,000
21,000
23,000
Oct
-13
No
v-1
3
De
c-1
3
Jan
-14
Feb
-14
Mar
-14
Ap
r-1
4
May
-14
Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
De
c-1
4
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
Trendcare Hours Clinical Hours -Nelson
Nelson Hospital HPPD Required Nelson Hospital HPPD Provided
The elective service performance is presented in four components: (a) MOH Elective Discharges
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 50
(b) Production Plan Discharges (c) Caseweighted Discharges (d) ESPI Performance (a) MOH Elective Discharges This table has been modified to include IDF activity for NMDHB residents provided in other hospitals. NMDHBMoH Elective Discharges
April 2015 Y-T-D NB. Note that these are Elective Discharges as per the MoH Elective Discharges definitions
These are NMDHB-domiciled cases within the specified Purchase Unit Codes and exclude inflows from other DHBs
ServiceUnit Code Description Annual Plan Budget YTD Actual YTD Vol Variance
Actual %
Complete vs
YTD Plan
SubSpec S25001 Ear, Nose and Throat - Elective Discharges 676 554 590 36 106%
W C & Y S30001 Gynaecology - Elective Discharges 764 626 726 100 116%
W C & Y Total 764 626 726 100 116%
NMDHB Internal Production (Incl Outsourced) 5460 4518 4638 120 103%
Inter District Flows (NMDHB residents receiving surgery in other DHBs) * 569 487 519 32 107%
GRAND TOTAL 6029 5005 5157 152 103%
* April IDF's assumed to equal budget for month as 1 month delay in provision of information. Actual results may vary
(b) Production Plan Discharges
NMDHB
Production Plan Elective DischargesApril 2015 Y-T-DNote that these are elective discharges that align with the caseweights above - ie publically-funded cases where NMDHB is DHB of service
These overlap the dataset shown above in the MoH Elective Discharges but are not an exact fit
Service
Unit
CodeDescription Annual Plan Budget YTD Actual YTD Vol Variance
Actual %
Complete vs
YTD Plan
Medical M10001 Cardiology - Discharges 323 264 336 72 127%
(d) Elective Service Performance Indicators ESPI performance remains broadly under control, however there are a couple of hot spots in ESPI 2 with ENT, General Surgery, Orthopaedic and Urology having a small number of patients (9 in total) waiting in excess of 4 months.
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 52
XI) THEATRE CANCELLATIONS
Theatre cancellations fell to 32 during the month of April. This is the lowest number this year, however we continue to focus on reducing further wherever possible. Almost 50% of the cancellations were either due to the patient being too unwell or the patient not turning up.
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 53
XII) OPHTHALMOLOGY
As noted in previous months, Ophthalmology is 22%, or 140 discharges, behind plan on an elective discharge basis. Looking at further information, the following compares 2014/15 activity with plan, and then also looks at last years comparative performance. The budget appears to have been broadly set at similar levels to last year‟s performance, but with the exception of Avastin and Nurse Clinics, the throughput has been less than the same period last year.
2014/15
YTD
Actual
2014/15
YTD
Budget Variance %
Ophthalmology
DRGs 298 345 47- -15.8%
1st Specialist Attendances 1,364 1,476 112- -8.2%
Follow Ups 5,308 5,242 66 1.2%
Minor Eye Procedures 3 16 13- -433.3%
Avaston 1,547 1,310 237 15.3%
Eye - Argon Laser 98 164 66- -67.3%
Ophthalmology Nurse Clinics 1,828 1,720 108 5.9%
2013/14
YTD
Actual
2014/15
YTD
Actual Variance %
Ophthalmology
DRGs 332 298 34- -10.2%
1st Specialist Attendances 1,487 1,364 123- -8.3%
Follow Ups 5,468 5,308 160- -2.9%
Minor Eye Procedures 5 3 2- -40.0%
Avaston 1,338 1,547 209 15.6%
Eye - Argon Laser 150 98 52- -34.7%
Ophthalmology Nurse Clinics 1,734 1,828 94 5.4%
The negative position relative to the contract is a somewhat complex issue compounded by:
In 2013/14 we outsourced a number of cataracts with the aim to catch up on the health target and also because we had additional MOH funding for electives
For the 2014/15 plan we increased discharge delivery for the cataract initiative by approximately 60 discharges, however we have struggled to deliver this and so have gone backwards
The split of Nelson / Wairau SMO targets is 2/3rd – 1/3rd for population, however 75% of the resource is Nelson based. There remains interpersonal issues within the Ophthalmology workforce which has seen a reluctance of a single service two site model being embraced
Lists have been under-booked in Nelson due to multiple theatre issues and admin issues including: o Use of Theatre 6 prevents fully booked lists
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 54
o Insufficient instrumentation to fully book lists o Insufficient staffing requiring SMOs having to carry out some activity which should
be undertaken by other staff which slows throughput in theatre o Short notice changes in General Anaesthetic to Local Anaesthetic or vice versa o Lists not fully booked.
Cataract lists being changed to General Anaesthetic lists for ESPI issues, therefore less patients booked
Lists unable to be backfilled by Ophthalmology due to pressure of follow-ups
Avastins need completing, especially when Registrar is away. Therefore lists with Avastins on do not count towards caseweights or Health Target. Avastins are time dependent
When Wairau SMO is away no cataracts are completed as no staff are available for post-op clinics, which leads to an overall drop in delivery.
Actions planned to address some of these issues are to:
Order additional cataract sets
Confirm lists over next three months
Identify space outside of Theatre 6 to allow Ophthalmology work to be carried out
Ensure additional theatre sessions for new Ophthalmologist replacing retiring surgeon
Locum support as able, although constrained by facilities
Confirm booking process with admin team to ensure full utilisation of lists
Ensure theatre team / staffing allocated to ensure efficient theatre running of lists. To address Follow-ups:
Review overdue patients and prioritise appropriately
Locum support as able, although constrained by facilities
Look for 0.2 FTE Optometrist to support clinics
Continue push towards district wide process for more equitable use of resources
Progress CAPEX for room alteration
Explore workforce development resource to support new model of nursing for Avastin delivery, thus freeing up Registrar and SMO resource and maximising theatre time.
XIII) ENHANCED ACCESS TO DIAGNOSTICS
There has been a spike in urgent diagnostic colonoscopies this month, however it should be noted that they are all current referrals. Numbers of patients waiting continue to decline overall.
Patients waiting for CT, MRI and for CT Colonography (CTC) are continuing to climb. One of the key challenges is shortage of Radiologist resources. We currently have vacancies which we are actively recruiting for, however this market is very challenging. The commissioning of the new MRI in Wairau in early June, along with outsourcing of 90 CTCs in May, should assist in improving these results. The other area of significant concern is Marlborough breast screening where delivery of the service is having to be directed through Nelson due to lack of staffing. We are actively working on recruiting on this front as well.
0
100
200
300
400
500
Diagnostic Reporting Template - MRI Total Number accepted referrals waiting outside 6 weeks (excluding referrals for scans that are
planned patient events)
Diagnostic Reporting Template -MRI Total Number accepted referrals waiting outside 6 weeks
(excluding referrals for scans that are planned patient events)
0
50
100
150
200
250
300
350
400
Diagnostic Reporting Template - CT (DHB wide) Total Number accepted referrals waiting outside
6 weeks (excluding referrals for scans that are
planned patient events)
Diagnostic Reporting Template -CT (DHB wide) Total Number accepted referrals waiting outside
6 weeks (excluding referrals for scans that are planned patient events)
0
20
40
60
80
100
120
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
De
c-1
4
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Diagnostic Reporting Template - CTCTotal number accepted referrals waiting outside
6 weeks (excluding referrals for scans that are planned patient events
Diagnostic Reporting Template -CTC. Total number accepted referrals waiting outside 6 weeks
(excluding referrals for planned patient events)
XIV) OUTPATIENT – FIRST SPECIALIST ASSESSMENTS
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 56
Outpatient Attendances
First Specialist Assessments
NMDHBApril 2015 Y-T-D
ServiceUnit
CodeDescription Annual Plan Budget YTD Actual YTD
Vol
Variance
Act %
Complete
vs YTD Plan
Medical M00002 General Medicine - 1st attendance 1700 1391 1227 -164 88%
Oral health arrears remain a challenge. Concerns have been raised with regards to how the service is operating, and the significant performance difference in terms of arrears across the district. We are working with the team to try and bring about some change which will more effectively utilise resources. The service is currently impacted by a number of vacancies where active recruitment is in progress. The arrears have increased to 18% this month which is extremely concerning.
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 57
45%45%
40%40%
34%34%
30%30%
25%
22%
21%21%
22%
24% 23%22%
20%18%
15%
13%
15%
19%18%
18%17% 16%
16%14%
15%17%
18%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Jan
-12
Feb
-12
Mar
-12
Ap
r-1
2
May
-12
Jun
-12
Jul-
12
Au
g-1
2
Sep
-12
Oct
-12
No
v-1
2
De
c-1
2
Jan
-13
Feb
-13
Mar
-13
Ap
r-1
3
May
-13
Jun
-13
Jul-
13
Au
g-1
3
Sep
-13
Oct
-13
No
v-1
3
De
c-1
3
Jan
-14
Feb
-14
Mar
-14
Ap
r-1
4
May
-14
Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
De
c-1
4
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
Arr
ear
s &
DN
As
Ave
rage
Community Oral Health Service - Arrears & DNAs
Arrears Arrears Target DNAs
XVI) SPECIALS AND WATCHES
Specials and watches have remained high in April. This increase is entirely attributable to the Medical Unit who had a total of 1,849 hours of specials and watches in the month. This compares to an average in this unit over the past 9 months of 1,011.
0
500
1000
1500
2000
2500
Jan
-14
Feb
-14
Mar
-14
Ap
r-1
4
May
-14
Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
De
c-1
4
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
Specials & Watches (Med / Surg / AT&R)
Nelson
Wairau
0
500
1000
1500
2000
2500
3000
3500
4000
Jan
-14
Feb
-14
Mar
-14
Ap
r-1
4
May
-…
Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
De
c-1
4
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
Specials & Watches Mental Health & Alex
MHAU
Alex
XVII) FCT ONCOLOGY
The latest results for FCT are noted in the table below. It is becoming obvious that the timing of reporting is materially impacting the results. For example, last month the total number of records reported for March were 4. This has now increased to 10 records. There appears to be an error in the table for quarter 3 results. The report is indicating 87% within the 62 days, however this clearly should be 68%. We were unable to change the table prior to completion of reporting.
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 58
XVIII) ELECTRONIC REFERRALS (ERMS)
There have been 2,752 requests to all providers generated using ERMS in April 2015. This figure includes requests for outpatient assessment, referrals to private providers, and requests for specialist advice and radiology services. The chart below shows ERMS requests as a percentage of all outpatient medical and surgical assessment referrals received by the DHB year to date for 2014/15 and recorded in the Oracare patient administration system. Development work is in planning for using ERMS to deliver referrals to Mental Health Services. Installation remains to be completed in two Nelson practices in May 2015, which will mark the completion of Stage 1 of the electronic referrals project. Planning is underway to align the continued roll-out of electronic referral delivery to hospital services with the migrations to Health Connect South and PICS.
XX) ALLIED HEALTH SERVICES
XXI) RADIOLOGY
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 59
(XIX) MATERNAL CHILD HEALTH INTEGRATION PROJECT
Updates from the Maternal Child Health Integration project follows: a) Core Health Team:
The Health Pathway has been published to support vaccination in pregnancy and engagement in general practice
The Newborn Enrolment Form has been updated, now in duplicate, with improved faxing efficiency
The Newborn Enrolment process being reviewed to make improvements on the current proportion of babies enrolled by four weeks
Successful Wairau GP/LMC meeting supported more open communication pathways between the different professional groups
NBPHO and KHW are working with general practice to encourage women to access a free whooping cough and flu vaccine in late pregnancy at their general practice
Some project funding was utilised to support the development of the vulnerable women and infants care pathway
A presentation for all health professionals interested in being updated on the project is being planned for May in both Nelson and Wairau.
b) Tools for Coordinated Care:
The project team is working with Medtech to ensure the needs of what the project is wanting from coordinated care can be met by the Manage My Health tool. The benefit of this is that the majority of practices do use Medtech and this will make the adoption of this new tool easier for the majority of practices
An LMC, a Client and a GP willing to participate in the trial have been identified, with the aim to begin the trial in May 2015. This will trial using “Manage My Health‟ as a portal to facilitate a coordinated care approach to managing pregnant women.
c) Child Health Calendar:
A joint venture between NMDHB and NMIT to develop a calendar APP is underway with a goal of completion date in June
Planning for a wallet sized care plan is in process as well as a hard copy pamphlet of the calendar.
d) Resource Centres:
Options for how to support the development of „Resource Centres‟ in Wairau are currently being discussed, with good support from LMCs. The Service Manager and DOM met with Beth Tester in Wairau who expressed an interest in responding to a proposal for how this could be achieved for the Wairau communities
Presentation was given by Lakes DHB on how they have established their resource centre.
e) Family Friendly Accreditation:
Standards have been agreed for a trial phase. Motueka is the site for the trial, currently in process.
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 60
f) Targets:
The project team have identified that the milestones and timeframes for the project are one quarter behind. There have been a number of reasons for this, some delay at the start and some key personnel resigning etc. The project team will be raising this with the MOH to seek a three month extension to the initial project plan.
XX) ALLIED HEALTH
XXI) EXERCISE WAIPUKE
Exercise Waipuke participants descended onto the Braemar campus and into the seminar centre for the DHB‟s annual exercise, which was also partnered up with Civil Defence as the Emergency Services exercise for the Nelson Tasman region on 6 April. Overall there were 81 exercise players and exercise control staff that participated in this event. Participants were from the Ministry of Health, DHB Corporate, Hospitals, Public Health, Support Works, Mental Health, community health centres, DSS, and Facilities staff, along with members from Nelson Bays Primary Health, Police, Fire, Ambulance, Civil Defence, and Nelson and Tasman Councils. The exercise was based on a severe weather event in the Nelson region with a mass casualty incident thrown in for good measure. This scenario was designed to trigger an activation of not only the hospital and DHB incident management response, but also a wider Civil Defence and Emergency services response.
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 61
A primary objective of the exercise was to simulate an event that would require inter agency cooperation and coordination to an event that would impact on the region and get agencies to activate and respond. This was not only achieved, but under the pressure of a second objective to move all of the agencies out of their normal Emergency Operational Centres (EOCs) and into an alternative EOC. This activity had the teams working to not only become operational, but start dealing with the incident under less than normal conditions – a true test of processes and training. This is a major exercise for the DHB which also incorporated the bi annual Emergo training exercise, which is sponsored by the Ministry of Health and is a part of the DHB‟s Operational Policy Framework requirements. Initial reports from the evaluators are that the DHB and agencies were not only able to meet the objectives of the exercise, but also performed exceptionally well. The recent earthquakes and weather events are testament to how important it is for agencies to do these exercises to ensure that we are ready, and can continue to provide essential services following a disaster.
XXII) HUMAN RESOURCES
(a) Performance Appraisals The month of March has seen performance appraisals step up from 1,131 to 1,221 or 49.9%. Each of the ELT members have been given a target of 90% by the end of this calendar year. IT & Infrastructure and Maori Health are now achieving this target, with Human Resources and Disability Support Services achieving in the 80‟s.
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 62
(b) Staff Cultural Survey The staff cultural survey has now closed. A total of 1,428 staff participated in the survey. The report has just been received from the Health Round Table and we are now planning the next steps, including how we release the information. A commitment has been given that the results will be shared widely, and we have also indicated that we are interested in working directly with the unions and staff to find sustainable solutions to address the top issues raised. A more substantive report will be provided to the Board meeting in June. (c) Management and Administration FTE Cap
Cap April 2015 Variance
Established 371 355 16
Surrendered to support DHBSS priorities 2012/13
3 (3)
Surrendered to support SIAPO 2013/14 1 (1)
367 355 11
XXIII) NMDHB AT A GLANCE
The NMDHB at a Glance for March is attached as item 7.3.
XXIV) MEDIA ACTIVITY FOR MONTH
With the new Communications Manager on board she is now producing a monthly report which shows activity with respect to the media. Board members are likely to be aware of most of these stories, however further information can be provided if requested.
Patient condition updates
Hospital transport for heart patient
SECTION 5.5: CEs REPORT
Iwi Health Board Open Agenda – 4 June 2015 63
Hospital Transport Options
Midwife lead who is no longer working in Nelson and not a staff member
STEMI Pathway Launch – proactive release from Cardiologists
Nelson and Wairau ED Patients – how many – Easter Holidays
Planned NMDHB surplus of $2.13m
D3 Level Care Dementia Care
Nelson Hospital Chaplaincy – proactive
Wairau Hospital Surgeon
Health Disability Commissioner Decision on unnamed surgeon
ANZAC Quilt in Emergency Dept – proactive from ED Nurse
Influenza vaccination for pregnant mothers – proactive
MRI scanner development at Wairau Hospital
Marlborough Health Hub – proactive
Governance of ERMS PIA – NZ Doctor
Plans for over-the-counter contraception
ANZAC Wairau Hospital Service – proactive
DHB Zero Hour Contracts
DHB Methadone Programme
Pain relief alternatives to opioids
Ebola transport arrangements
Cockroach in McDonald‟s burger – referred to MPI
Marlborough Toothbrushing Training with Teachers Session – proactive
NZ Nurses Assoc Organiser Reaction to DHB Zero-Hour Contracts
NMDHB Mental Health patient suicide
Earthquake hospital update (24 April)
Board meeting information – general and then more specific later
CEO Chris Fleming – peer support to SDHB
Wairau Hospital's new obstetrician
Pharmacy Today enquiry about pharmacies on hospital site
Development on Richmond Health Hub
Electives Caseweight tables in Board paper
Pregnant mother charged by GP for vaccination
Nelson Hospital Radiology Office Supervisor retiring
Opioids Use and Alternatives in the Nelson Marlborough region
Wairau Hospital admission/presentations arising from GrapeRide event
Air quality in Nelson -wood burners and Southern Link issues. Chris Fleming CHIEF EXECUTIVE RECOMMENDATION: THAT THE CHIEF EXECUTIVE’S REPORT BE RECEIVED.
SECTION 5.6: ORAL HEALTH Rob Beaglehole to attend.
NELSON MARLBOROUGH DISTRICT HEALTH BOARD
IWI HEALTH BOARD
STANDARD OPERATING PROCEDURES FOR IWI HEALTH BOARD
64 | P a g e
Standard Operating Procedures for Iwi Health Board Committees Nelson Marlborough District Health Board (NMDHB) has agreed with tangata whenua Iwi in
Te Tau Ihu o te Waka a Maui (Tasman, Nelson, Marlborough regions) to establish the Iwi Health Board (IHB) as a partnership board in accordance with the NZ Public Health and Disability Act 2000. The functions, aims, core activities and key relationships for the IHB are set out below and in the appendices as noted.
Membership Up to eight members of the IHB are appointed by Iwi holding Manawhenua in Te Tau Ihu o te
Waka a Maui, namely Ngāti Apa, Rangitane, Ngāti Kuia, Ngāti Kōata, Ngāti Rarua, Ngāti Tama, Te Atiawa, and Ngāti Toarangatira. A ninth member will be selected to represent Maata Waka (those Maori who have manawhenua links to other parts of Aotearoa). The maximum number of members who make up IHB is nine, except in the case of the appointment of one NMDHB Maori Board member and one Pacifica representative. The membership is then made up of 11 members in total. Iwi membership One member to be selected on the IHB per Manawhenua Iwi; A member can only represent one Iwi on the IHB. Maata Waka membership One member to be elected on the IHB from Maata Waka; The nomination and selection process is outlined in Appendix II; This member will act in the best known interests of the wider Maori community. Maori NMDHB Board members An invitation will be extended to the two Ministerial appointees on the NMDHB Board (the Board) to appoint one member to join the IHB during their term; This member will act in the best known interests of the wider Maori community. Pacifica membership One member to be elected on the IHB from Pacific Nations (Pacifica); The nomination and selection process is outlined in Appendix III; This member will act in the best known interests of the wider Pacifica community. The IHB is made up of mandated representatives of Iwi and the wider Maori community. Once a person becomes a member of the IHB they become responsible collectively for all Maori residents in Te Tau Ihu o te Waka a Maui to act in the interests of all.
The IHB members are entitled to receive copies of Board open meeting papers, all committee agendas and meeting papers, and draft planning documents. IHB members are required to complete a declaration of interests in accordance with the Conflicts of Interest Policy and comply with that policy. Any members and/ or their spouse/ partner who may have a conflict are required to declare it and comply with the terms set out in the
NELSON MARLBOROUGH DISTRICT HEALTH BOARD
IWI HEALTH BOARD
STANDARD OPERATING PROCEDURES FOR IWI HEALTH BOARD
65 | P a g e
Conflicts of Interest Policy. Members are subject to the Code of Conduct as set out in the NMDHB Governance Handbook for Board and Committee Members.
The IHB will advise the Board of the appointment of members, and any subsequent change to its membership.
Attributes for membership (for all members)
Members of the IHB will display some or all of the following attributes:
Committed to the time required and the kaupapa;
Have standing in the community and in the Maori Community;
Have expertise required for governance role, (this will include but not be limited to, being a director or board member of Iwi trusts, organisations requiring boards of governors, school boards etc, it may also include training received relative to governance such as Manu Whakahiato, or directorship training);
Broad knowledge of health and disability sector;
Business acumen;
Be politically astute;
Have a sound understanding of the New Zealand Public Health & Disability Act 2000;
A strong tikanga Maori base and Te Reo Rangatira;
Excellent communication skills;
Strong knowledge and understanding of the Tiriti o Waitangi/Treaty of Waitangi and its application at a governance level;
Strong understanding and experience of inter-sectoral relationships; and
Have networks and networking ability.
Tenure
Procedures associated with nomination and selection for members:
The term of office/appointment will be for 3 years consistent with the Board tenure;
A person can be nominated to office for more than one term;
Nominations will be advised in writing by the Iwi;
At the next available IHB meeting nominations will be confirmed;
At the end of each term, confirmation in writing will be sought from Iwi for: o Representation for a new member, or o Confirmation that incumbent member will be reappointed for a consecutive term;
Replacement or resignation of a member will require two weeks written notice (the nominating body of the member is requested to replace the member as soon as possible);
A member may remove themselves before the term if: o They are unable to perform duties; o The member dies notwithstanding the death, a proxy/interim member can attend
until further notice; o Is replaced by the group the person represents.
NELSON MARLBOROUGH DISTRICT HEALTH BOARD
IWI HEALTH BOARD
STANDARD OPERATING PROCEDURES FOR IWI HEALTH BOARD
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Chairperson
The Chairperson and Deputy Chairperson of the IHB are elected by the IHB from within their ranks for a specified term. The election of Chair and Deputy Chair will occur at the commencement of each term. The term of the Chair or Deputy Chair is not limited to one term.
Relationships
The IHB provides its own direction and workload but is responsive to requests from the Board. It is supported in its work by the Director of Maori Health (DMH) and such members of the Executive Leadership Team (ELT) of the DHB as may be required.
The key relationship with ELT is through the Maori Health Directorate, who may at the invitation of the IHB invite management. The Board may seek advice from IHB. Such advice will be through the Board to Board forums or as part of the one to one meetings between the Chairs. The IHB provides advice to the Board after considering and debating information provided to it by the Board, Chief Executive or Management, and statutory committees. The IHB is to be cognisant of the work being undertaken by the statutory committees through members appointed to these committees. In accordance with the principles of tikanga, Manawhenua will manaaki all whanau, hapu and Iwi residing in Te Tau Ihu o te Waka a Maui. To ensure the IHB has effective relationships with the Maori and wider community, those wanting to be heard by the IHB are, on a pre-arranged basis, to be given a reasonable opportunity to be heard in person. Each open meeting of the IHB will have a 15 minute public forum where members of the public may raise concerns. There will be no media or other statements on IHB matters except via the IHB Chair, Board Chair, Director of Maori Health or Chief Executive. All public comment pertaining to IHB operational matters will be made by the DMH with the Chief Executive’s agreement. The IHB will develop a Communications and Consultation Plan (see Appendix IV).
Support The IHB will be serviced by NMDHB resources. Maori Health Directorate will service the IHB
including the provision of secretarial support. The Maori Health Directorate will prepare agendas, reports and minutes in conjunction with the Chairperson.
The DMH has a functional responsibility to the IHB.
Parameters
The IHB provides advice to the Board and holds the Board accountable for gains in Maori health. The IHB’s advice should take into account the possible impacts of recommendations on all parts of NMDHB. The IHB has no delegated authority or decision-making power, other than that which may be specifically delegated by the Board. The IHB’s advice should be consistent with government strategies and policies, particularly the New Zealand Health Strategy, He Korowai Oranga National Maori Health Strategy,
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NMDHB Maori Health Strategic and Wellness Framework, NMDHB Maori Health Plan, and the South Island Health Services Plan. The IHB must operate in accordance with these Standing Orders and IHB Terms of Reference (Appendix I). The IHB may regulate its procedure at its meetings in any manner not inconsistent with tikanga Maori and the NZPHD Act 2000 as it thinks fit.
Accountability The IHB and its members are accountable to the Board, and to their appointing Iwi organisations.
Scope The IHB focus will be to monitor the performance of services to Maori people through data collected by PHO’s, Maori health NGO providers, the hospital and other health services owned or provided by NMDHB that will affect positive outcomes for Maori health and the achievement of the 30-year vision for NMDHB and Maori health.
The IHB may consider and provide advice on the impact of any proposed changes to the models of service delivery under a South Island Health Services Plan, Annual Plan, Maori Health Plan and Maori Health Strategic and Wellness Framework on the operational capability of the hospital and other health services owned or contracted by NMDHB.
Activity The IHB has mandate for the following complementary activities that will be discussed as required within auspices of the IHB meetings. The following are included but not limited to:
Provide mandated representatives for the required advisory committees - Community and Public Health Advisory Committee, Disability Support Advisory Committee and Hospital Advisory Committee.
Strengthen the position of roles on DHB advisory committees and Board by reviewing agendas and providing advice on the view and approach to be taken by the IHB representative.
Ensure appropriate cultural advice is available to the Board. The IHB will work on planning issues, these include but are not limited to:
Progress activities in the IHB annual work plan;
Hui-a- iwi annually;
Workshops with DHB;
NMDHB Maori policies; and
Research proposals The IHB will develop an annual work plan that aligns to the NMDHB annual plan, Maori Health Plan, and all other core activities.
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Process The IHB meets monthly on such days and time as the IHB may decide, up to a maximum of
12 meetings or workshops per year. The planning year is from July to June. Meetings will be open to the public unless otherwise stated. Where the IHB deem it necessary, meetings may be closed to the public. Open agendas and reports will be made available on NMDHB website.
Closed meetings will be deemed private under section 9 (2) (g) (i) of the Official Information Act 1985 to enable free and frank discussion by officials of the IHB and NMDHB. The IHB will meet with the Board twice a year. To enable free and frank discussion by members of the IHB and the Board these meetings will be deemed private under section 9 (2) (g) (i) of the Official Information Act 1985. The IHB may from time to time hold workshops that do not constitute a meeting (i.e. no decisions or resolutions of the IHB are to be made). In these cases a report or notes from the session/s may be presented in open meeting at the next formal meeting of the IHB. The IHB with the agreement of the Board, may from time to time form, and operate under its auspices, focus groups, working parties, consultation teams, project teams or similar groups to progress the work of the IHB. These groups will need to have terms of reference, clear expectations and timeframes to work within. The Board may delegate the appointment of members of these groups to the IHB. The groups will be short-term and task oriented.
Conduct of IHB members
Be diligent, attend meetings and become as knowledgeable as possible about the activities and processes of the IHB and the physical and social environment in which it operates; Be punctual to meetings; Be prepared by reading the agenda and any other supplied information; Base judgement and actions on best outcomes for Iwi/Maori communities; To be strategic; Be respectful of each other particularly when there are differences expressed related to key issues. Conflicts of Interest Declaration of conflict of interests will be announced at the beginning of each meeting; In representing the IHB, an IHB Member must not allow the interests of business or pecuniary interests, associates, societies, friends or family to conflict with those of the IHB. If conflict does arise, the IHB Member must consider immediately whether to refrain from participating in the debate, and any consequent decision by declaring the conflict and identifying whether the conflict excludes participation at debate or decision or both. While it is the responsibility of the individual member other IHB members should be prepared to challenge should they believe that a conflict exists and has not been declared. Objections An IHB member, who believes that a course of action proposed by, or already undertaken by the IHB is against the best interests of the Iwi / Maori community, must be prepared to oppose that course of action and insist that his/her objection be fully documented and noted.
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Privacy of Information IHB members may acquire information not generally known. This information is property that does not belong to the IHB member individually and it is improper, whether deliberately or carelessly, to disclose it to any other person unless the disclosure has first been authorised by the rightful owner. It is improper for any IHB member(s) to use information for their own personal advantage.
Attendance at Meetings
Generally, IHB meetings are open to interested members of the community. Attendance by people external to the IHB: Generally IHB meetings are open to interested members of the community: NMDHB Kaumatua may attend any IHB meetings. An invitation will be extended to
Kaumatua for the attendance of at least one Kaumatua at IHB meetings. Kaumatua provide guidance and direction to IHB on matters of tikanga Maori. Kaumatua have speaking rights on any take on the table;
The Board and management members under the appropriate delegation are invited to attend IHB meetings. Others may attend at the discretion of the IHB Chairperson;
Where meetings are held within Maori environments (such as Marae), the kawa of Manawhenua will be followed.
Meeting Guidelines
The Chairperson shall have the discretion and authority to rule on meeting guidelines with respect to the meeting process and procedures. Resolutions require the identification or recording of a mover and seconder; Votes for and against will not be recorded unless requested; Amendments to motions shall be accepted and any opposition to a particular motion shall be accommodated by further discussion; Previous resolutions may not be re-visited unless new or significant information emerges.
Quorum A quorum is required to accept and pass recommendations; A quorum is a majority of members, or more than half of the current membership (six); The quorum must have 4 manawhenua Iwi appointed members present.
Voting The IHB intends to reach decisions by consensus. In the event that an agreement cannot be made by consensus each member will be asked to cast a vote.
Voting at board meetings is by all members.
Consensus agreement and voting can occur through properly supported (minuted) teleconference and by appropriately recorded email (electronic).
Agenda The agenda will be prepared by the DMH together with the Chairperson or deputy
Chairperson. NMDHB or the Board may through the IHB request that specific items be considered by the IHB.
Agendas will be received by members at least 3 working days prior to meetings.
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Minutes The IHB secretary will prepare Minutes together with the Chairperson.
Minutes will have draft status and can be amended at any time until they are confirmed. The Minutes will note all decisions made by the IHB and will carry enough detail to inform those who did not attend the meeting.
Reporting Requirements
The IHB will report to the Board regularly through a report of its meetings being provided to the Board by the Chairperson of the IHB. The Board may require specific reports from the IHB to inform the Board at particular decision points (e.g. funding allocations, annual plans, regional planning) in a timeframe to meet the requirements of the annual funding cycle with the Ministry of Health. The IHB may be required to submit a summary of the year’s activities to contribute to the Board’s annual report each year.
Performance The IHB reviews its performance annually. These terms of reference are in force until amended by the IHB and ratified by the Board. The Board may recommend modifications at its discretion (in so far as they remain consistent with the Act).
Remuneration In accordance with advice received from the Minister of Health (7 Dec 2000), committee members are remunerated as follows: All IHB members receive a meeting fee for their attendances at the rate of $250-00 per
person, excepting that the fee for the Chair is $350-00; Reasonable attendance expenses (i.e. reasonable travel-related costs) for IHB meetings
may be paid. This is to be based on a conservative policy established by the Board; The same fee is payable to IHB members and non-IHB members serving on committees.
However, any officer or elected representative of an organisation that would expect their officers or elected representatives to attend committee meetings as a normal part of their duties and who is paid by them for that, is not eligible to be paid committee fees;
Workshops are deemed to be meetings for the purposes of remuneration.
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Appendix I These Terms of Reference should be read in conjunction with He Kawenata between NMDHB and Manawhenua O Te Tau Ihu O Te Waka A Maui, the New Zealand Public Health and Disability Act 2000, particularly Schedule 4, the Amendment Bill 2010 and the IHB Standard Operating Procedures.
Functions To give the Board advice on:
Reducing health disparities by improving the health outcomes of Maori [S. 3(1)(b) & S.
22(1)(e)] NZPHD Act 2000.; Recognising and respecting the principles of the Treaty of Waitangi with a view to
improving health outcomes for Maori [S. 4]; Maori representation on Boards and committees [S. 5(3)(a), S. 29(4), S. 34, S. 35, S. 36
& Schedule 3 S. 38(2)]; Establishing and maintaining processes to enable Maori to participate in, and contribute
to, strategies for Maori health improvement [S. 23(1)(d)]; Fostering the development of Maori capacity for participating in the health and disability
sector and for providing for the needs of Maori [S. 23(1)(e)]; The relevant information to be provided to Maori for the purposes of paragraphs (d) and
(e) [S. 23(1)(f)]; and The training of Board members on Maori health issues, Treaty of Waitangi issues, or
Maori groups and organisations in the district [Schedule 3 S. 5(1)]. And (Section 24, NZ Public Health and Disability Amendment Bill 2010) the IHB also gives Nelson Marlborough DHB and the Board advice on: The optimum arrangements for the most effective and efficient delivery of health services
in order to meet local, regional, and national needs; Ensuring collaboration takes place with relevant organisations to plan and co-ordinate at
local, regional and national levels for the most effective and efficient delivery of health services.
Statutory Aims The New Zealand Public Health and Disability Act 2000 seeks to have a population health focus including reducing health inequalities for Maori. The overall aims of the Maori provisions within the Act are to: Recognise and respect the principles of the Treaty; Ensure Maori representation; Establish relationships to ensure participation to contribute to strategies for Maori health
improvement; Build on strengths to reduce inequalities. The statutory delegations remain with the Board and the appointed statutory committees.
Core Activities The IHB will provide advice on Maori health to Annual Planning programmes that relate to community, public health, and disability support services in Nelson Marlborough. The IHB will provide strategic advice on regional service planning as part of the redesign of
services and service delivery models across the South Island. At times the IHB may be asked to provide advice on matters already considered by the Statutory Committees or on work in progress by the Chief Executive or management. To monitor the planning and funding of health and disability support services in the Nelson Marlborough district including delivery against the statement of forecasted service performance for Maori. The IHB shall focus on the following: Performance at all service directorate level against national or best practice benchmarks; Comparative reporting; Maximising the overall health gain for Maori in our district, by
Being aware of their health and disability needs Identifying areas for improvement to address gaps in services being purchased or
provided; Input to operational and regional strategic planning; Consultation outcomes; Promoting the inclusion and participation in society, and maximising the independence, of
people with disabilities in our district; Input to the South Island strategic direction for integration of providers and refocusing
service delivery models to ensure the optimal use of health resources; Monitor service provision for people with disabilities and the progress of key initiatives
such as the older person’s network implementation plan.
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Appendix II
Process for the Appointment of a Maata Waka representative on the Iwi Health Board
Membership Maata Waka will elect one member to represent Maata Waka on the IHB.
Selection Process
The Maata Waka organisations will be notified in writing of a vacancy on the IHB: Where there is more than one Maata Waka organisation each organisation will be notified
and asked to submit their preferred candidate.
Maata Waka organisations will be asked to go through a selection process and forward to the IHB their preferred candidate, the selection process will be at the discretion of the Maata Waka organisation. The IHB at their next available meeting will: Consider the nominations; May consider a short list; All nominees shortlisted may be interviewed by the IHB; Endorsement will be confirmed by the IHB; If the IHB are unable to appoint from the nominees put forward the process will begin
again.
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Appendix III
Process for the Appointment of a Pacifica representative on the Iwi Health Board
Membership Pacifica health reference groups will elect one member to represent Pacifica on the IHB.
Selection Process
The Pacifica health reference groups (Nelson and Marlborough) will be notified in writing of a vacancy on the IHB for a Pacific representative on the IHB: The Pacifica health reference groups will be asked to go through a selection process and
forward to the IHB their preferred candidate; The selection process will be at the discretion of the Pacifica health reference groups.
The IHB at their next available meeting will: Consider the nominations; May consider a short list; All nominees shortlisted may be interviewed by the IHB; Endorsement will be confirmed by the IHB; If the IHB are unable to appoint from the nominees put forward the process will begin
again.
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Appendix IV
Purpose The IHB as the Maori partnership board to the NMDHB is the mechanism through which the Nelson Marlborough DHB and the Board consult with Iwi. The purpose of this plan is to describe the consultation method and process. This includes the communication plan.
Definition of consultation
The definition of consultation is drawn from He Kawenata 2010:
“Consultation is a statement of a proposal not yet decided upon, listening to what others have to say. Considering their responses and then deciding what will be done. To consult is not merely to tell or present. Nor at the other extreme is it to agree, consultation does not necessarily involve negotiation towards an agreement, although the latter not uncommonly can follow, as is the tendency in consultation to seek at least consensus.”
Limitation Nelson Marlborough DHB and the Board have many needs at various levels for consultation. This plan is specific to the IHB at a governance level as the consultation point for key strategic decisions by the Board. Consultation at other levels of the organisation (individual units e.g. planning and funding, public health, mental health, child and family services etc) will be determined by the Director Maori Health in partnership with the Chief Executive or their delegate.
Focus of consultation
The focus of IHB consultation is with whanau, hapu, Iwi and Maori communities within Te Tau Ihu o te Waka a Maui.
Relevant documents
He Kawenata 2010 He Korowai Oranga – National Maori Health Strategy District Strategic Plan District Annual Plan (DAP) Maori Health & Wellness Strategic Framework WASSUP!!! Maori Health Plan
Considerations of consultation
Resourcing
Consideration must be given to the resource needs of the consultation request. These could include meeting or travel fees.
Preparation
Before the consultation request is made, consider the priority and relevance to Iwi / Maori community. Consultation and communication will be honest and genuine. Staff should not expect to arrive at a meeting or hui and expect immediate response. Iwi / Maori communities should be given time to absorb information. Many individuals may need to take information back to their Iwi for further consultation or comment.
Time
Adequate time is required to consider issues, particularly issues of major significance that will
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warrant in-depth analysis and further discussion. The time required for discussion and debate depends on the complexity of the topic and impact of the policy. Preference is for kanohi ki te kanohi (face to face) communication and to hear an explanation of an issue by a person with some knowledge of the topic. This gives the opportunity to consider the wisdom, sincerity and motives of the presenters.
Genuine communication
The communication process must give Iwi and Maori the opportunity for effective input. If Maori are presented with a proposal which has been developed without their input then it is likely to meet with resistance. Feedback on the way in which consultation has been incorporated is necessary.
Effective consultation
The elements of effective consultation include: Sufficient information is provided, so that intelligent and informed advice or decisions can
be made. It should be written or given in language that is easily understandable with summary and or analysis provided;
Sufficient time for participation and consideration of any advice given; Genuine consideration of that advice, including an open mind and a willingness to
change.
Consultation method and process
Requests for consultation will initially be made through the DHM. The DMH will discuss the request with the Chair of the IHB to determine its relevance and priority for the IHB agenda. Other consultation processes may be recommended. The IHB will be consulted on: The Board agenda: Consultation requirements with the IHB on any relevant agenda item/s will be completed
before appearing in the Board agenda; The Board’s agenda will be mailed to IHB members; An IHB meeting will occur shortly after the Board meetings; The Chair will compile feedback from members and represent the IHB at Board meetings
when requested; Formal written feedback may also occur.
Advisory committees, expert and reference groups: The IHB will appoint a representative to the advisory committees of the Nelson
Marlborough DHB; The IHB will appoint representatives to other advisory, expert and reference groups as
appropriate; The representative will be the consultation point for IHB; The representative will formally report to the IHB; Consultation requests and needs will be discussed with the Chair and the DMH.
District strategic plan (DSP): The IHB will be participants with the Nelson Marlborough DHB in setting the Board’s
priorities;
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The Board will include the IHB in planning workshops; Consultation and focus groups with Iwi and the Maori community will be hosted by the
IHB / the Board. District annual plan (DAP): The IHB will be participants with the Board in planning the DAP; The Nelson Marlborough DHB and the Board will include the IHB in planning workshops.
Maori Health & Wellness Strategic Framework (MHWSF): The MHWSF planning will be undertaken by the DMH; Input at the appropriate time will be sought from the IHB.
Ministry of Health strategy and plans: The Board will inform the IHB of consultation needs emerging from any MOH strategies
and plans; Input at the appropriate time will be sought from the IHB.
Maori Health Plans (Associated indicators and health targets): Nelson Marlborough DHB annual Maori Plan will be undertaken by the DMH; Input at the appropriate time will be sought from the IHB.
Communication Plan
Effective communication is recognised as the most important mechanism for including Maori in health services design and delivery. The process of communicating will be transparent. IHB meetings; All open meetings will be advertised; All agenda and open minutes will be available on the NMDHB website.
Panui / newsletters; A IHB panui / newsletter will be developed and sent to an e-network of Iwi and Maori
within Te Tau Ihu o te Waka a Maui (i.e. Maori health providers, other providers, interests groups, Te Puawai Hauora – NMDHB Maori staff network, units and services within the Nelson Marlborough DHB, the Primary Health Organisations, Iwi trusts and organisations, other Maori organisations, individuals, mainstream organisations).
It is the responsibility of all IHB members to update their mandated groups after each IHB meeting of relevant health information and requests for consultation.
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Aotearoa Maori name for New Zealand
Hapu Sub tribe of a large tribe
He Kawenata Covenant, agreement, treaty, promise
Hui a Iwi Gathering, meeting, assembly of Iwi
Iwi A nation of people with shared identity and genealogy, tribe
Kawa Local tikanga practice
Kanohi ki te kanohi Face to face
Kaumatua Elder
Kaupapa Policy, protocols
Maata Waka Maori who have mana whenua links to other parts of Aotearoa
Marae Often comprising a carved meeting house, marae atea
(sacred space in front of the meeting house), dining room and
ablution blocks
Manaaki Support, hospitality
Mana whenua Has authority over land
Manu Whakahiato Maori governance training
Take Reason, purpose cause
Tangata whenua Local people, hosts, indigenous people of the land
Te Reo Rangatira Abilities in Maori oratory
Te Tau Ihu o te Waka a Maui The waka (canoe) of Maui, refers to Tasman, Nelson,
Marlborough regions
Tikanga Issues of principle, integrity of intent, values and respect,
