Agenda Bay of Plenty District Health Board · 2017-09-15 · Agenda . Bay of Plenty District Health Board. Venue: Waipuna Hospice, 43 Te Puna Station Road, R D 6, Tauranga . Date

Agenda

Bay of Plenty District Health Board

Venue: Waipuna Hospice, 43 Te Puna Station Road, R D 6, Tauranga Date and Time: Wednesday 20 September 2017 at 9:30am

Health Targets Shorter Stays in Emergency Departments Improved Access to Elective Surgery Shorter Waits for Cancer

Treatment/Radiotherapy Increased Immunisation Better Help for Smokers to Quit Raising Healthy Kids

Minister’s Expectations National Health Targets Care Closer to Home Regional and Clinical Integration Living Within our Means Working Across Government Tackling Obesity Shifting Integration Services Health IT Programme 2015-2020

Board Priorities Maori Health / Achieving Equity Health of Older People Long Term Conditions Child and Youth

The Quality Safety Markers Falls Healthcare Associated Infections Hand Hygiene Surgical Site Infection Perioperative Harm Medication Safety

HSP Objectives Strategic Objective 1: Empower our populations to live healthy lives Strategic Objective 2: Develop a smart, fully integrated system to provide care close to

where people live, learn, work and play Strategic Ojective 3: Evolve models of excellence across all of our hospital services

Bay of Plenty District Health Board Agenda

Item No. Item Page

1

Karakia

2

Apologies

3

Presentations 3.1 Cognitive Institute – Promoting Professional Accountability Board Seminar

- 9:30am – 11:30am

4

4

Interests Register

5

5 Minutes and Chair Report Back 5.1 Minutes of Board Meeting – 16.08.17 5.2 Matters Arising 5.3 Minutes of CPHAC/DSAC – 06.09.17 5.4 Minutes of Maori Health Runanga – 12.07.17 5.5 Member’s reports from Regional/National Forums – Verbal update

10

21

23

26

6

Papers for Decision (Any items that are not standing reports must go via the Committees and will include the Chair’s report and Committee recommendation) 6.1 Chief Executive’s Report 6.2 Dashboard Report – to be tabled

36

7

Papers for Noting (Items for this area will only be discussed if the Chair has been notified via GMGQ) 7.1 Work Plan 7.2 Indicators of District Health Board Performance (IDP) Quarter Four

Summary for 2016/17

7.3 Strategic Health Services Plan Implementation

7.4 Board Patient Safety Visit Report 7.5 Eastern Bay of Plenty Flooding Recovery Effort Updated

58

62

75

80

82

Bay of Plenty District Health Board Agenda

Item No. Item Page

7.6 Correspondence for Noting • Letter from Minister of Health dated 04.09.17 • Letter from Toi Te Ora dated 15.09.17 Plans for Maramatanga Park

104

8

General Business

9

Resolution to Exclude the Public

10

Next Meeting – Wednesday 18 October 2017

PROMOTING PROFESSIONAL ACCOUNTABILITY BOARD SEMINAR Workshop duration 2 hours

Timetable Building our ‘speaking up’ culture 20mins

Define the behaviours 20mins

Explore the impacts 10mins

Examine the barriers to action 10mins

Look at the elements of the Promoting Professional Accountability Programme

35mins

The role of the Board 5 mins

Summary and questions 20mins

Close

4

1

Bay of Plenty District Health Board Board Members Interests Register

(Last updated 11/09/17)

INTEREST NATURE OF INTEREST CORE BUSINESS RISK OF CONFLICT DATE OF INTEREST

ARUNDEL, Mark BOP Pharmacy Services Employee Pharmacy LOW: DHB does contract with

Pharmacies but as Board member Mark is not in a position to influence the contract.

01/12/2001

Pharmaceutical Society of New Zealand

Member Professional Body NIL 1980

Armey Holdings Director Property NIL 28/07/2005 Armey Family Trust Trustee Family Trust NIL 28/07/2005 Toi te Ora Wife is an employee Health Minor to Nil. No direct influence. 03/02/2014 EDLIN, Bev Institute of Directors – BOP Branch

Chair Membership Body LOW Member since 1999/Chair since Dec 2016

Magic Netball/Waikato BOP Netball

Board Chair Sports Administration LOW March 2015

Valeo International Limited Co-owner/director Education LOW 20/12/2007 Boardroom360 Limited Co-owner/director Education –

Governance LOW 10/3/2011

Edlin Enterprises Limited Owner/director Business Consultancy LOW 17/03/1987 Alleyne Trust Trustee Family Trust LOW Phae – non trading Director Education LOW 07/12/2005 NJ Family Trust Trustee Trustee LOW BOYES, Yvonne Boyes Family Trust Trustee Family Trust NIL 1999 Nautilus Trust Director Property NIL 1999 Riesling Holdings Ltd Director Property NIL 1999 Eastern Bay PHA Clinical Nurse Leader Health LOW: EBPHA has a contract

with the DHB but as a staff 01/07/13

5

2


member Yvonne is not in a position to influence the contract’ to be consistent with the other disclosures

Rural Immersion Program Academic Advisor Health Moderate 04/2014 ESTERMAN, Geoff Western Bay of Plenty PHO Board Member Health LOW – WBOP PHO has contract

with the DHB but as a Board Member Geoff is not in a position to influence contracts

28/11/2013

Western Bay of Plenty Primary Care Provider Incorporated Boad

Board Member Primary Healthcare LOW 28/11/2013

Gate Pa Medical Centre Ltd Director, Manager & GP Health LOW – DHB does not contract directly with General Practices and as a Board Member Geoff is not in a position to influence contracts.

28/11/2013

GM and P Esterman Family Trust

Trustee Family Trust NIL 28/11/2013

Gate Pa Developments Ltd Director Property & Kiwifruit NIL 28/11/2013 Waterview Buildings Ltd Director Property NIL 28/11/2013 BOP Sexual Assault Services Wife is a part time Nurse Health NIL 17/3/2015 GILL, Mary Anne Waikato DHB Board Member Health NIL Waikato DHB, Performance Monitoring Committee

Member Health NIL

Waikato DHB, Sustainability Advisory Committee

Member Health NIL

Life Unlimited Charitable Trust Employee Health Perceived 09/2016 Hongkong and Shanghai Banking Corp Lrd (NZ)

Son is employee Financial NIL

GUY, Marion

6

3


Western Bay of Plenty PHO Board Member Health LOW: WBOPPHO has a contract with the DHB but as a Board Member Marion is not in a position to influence the contract

28/01/205

South City Medical Centre Employee Health NIL 06/1996 Bay of Plenty District Health Board

Employee Health LOW 03/10/2016

McCAUSLAND, Punohu Maori Health Runanga Chair DHB Health Partner LOW 25/02/2005 Midland Iwi Relationship Board

Chair Health NIL 2017

Nga Mataapuna Oranga PHO Director Health LOW – No influence and no contract involvement

13/12/2007

Te Manu Toroa Board Member Health LOW – No influence and no contract involvement

13/12/2007

Waitaha Hauora Trust Trustee (Voluntary Chair Co ordinator)

Health Provider LOW – No influence and no contract involvement

13/12/2007

Te Kotahitanga o Te Arawa Fisheries Council / Companies

Director Fisheries/Commercial NIL 13/12/2007

Te Puna Hauora Chair BOP Iwi Governance Health Body

NIL 2017

Hei Marae Committee Chair Iwi / Whanau / Health NIL 12/02/2008 NICHOLL, Peter Nicholl Consulting Ltd Director Economic advice

(mainly outside NZ) NIL 01/01/2007

NZ Association of Economists Member Professional Body NIL 01/03/2015 NZ Institute of Directors Member Professional Body NIL 06/06/2014 Lily’s Trust Trustee Family Trust NIL 01/01/2007 Otumoetai Intermediate School

Board Trustee School Board NIL 01/06/2015

KidzNeedDads Board Trustee NGO Charity NIL 01/06/2015 Office of Technical Assistances, US Treasury

Contractor Advisory body to overseas central

NIL 01/02/2005

7

4


Banks PARKINSON, Matua Hunters Club Limited Director xxxxx xxxx 2015 Parkinson Whanau Trust Trustee NIL NIL 2015 Matua Parkinson Trading as REAL

Director NIL NIL

REAL Coaching Director Coaching LOW 2015 REAL Guest Speaker Director Education NIL 2015 REAL Food Production Director Food production LOW 2015 ROLLESTON, Anna The Cardiac Clinic Ltd Director/Principal Health LOW 09/2015 University of Auckland Senior Research Fellow Health LOW 09/2015 NZ Heart Foundation Grant recipient

Primary Investigator Health LOW 10/2015

Midland Cardiac Network Member Health LOW 11/2015 Planning and Funding contract for FCT Target Project

Project Manager Health LOW 01/2016

Poutiri Trust Acting Chair University of Waikato Senior Research Fellow Health LOW 09/2016 SCOTT, Ron Tauranga Energy Consumers Trust and Director of associated entities

Trustee Manages $800 million of funds on behalf of beneficiaries of the Trust

LOW 2006

Stellaris Ltd and Stellaris PTE Ltd

Director Business Education and Training organisation

LOW 2005

SILC Charitable Trust Chair Disabled Care Low – As a Board Member Ron is not it the position to influence funding decisions.

July 2013

TURNER, Judy Whakatane District Council Deputy Mayor Local Authority 2017 WEBB, Sally

8

5


Capital Investment Committee Member Health Capital Allocation

Minimal 24/1/2011

SallyW Ltd Director Consulting & Coaching

Nil 2001

Central Regional Governance Group

Independent Chair Governance LOW

01/08/2014

Waikato DHB Deputy Chair Health LOW 2017 Eeastern Bayof Plenty Hospice

Consultancy Health LOW 08/2016

9

Bay of Plenty District Health Board (open) Minutes

Minutes


Venue: Te Manuka Tutahi Marae, 105 Muriwai Drive, Whakatane Date and time: Wednesday 16 August 2017 at 9:30am

Board: Ron Scott (Acting Chair), Beverley Edlin, Mark Arundel, Matua Parkinson, Peter

Nicholl, Geoff Esterman, Judy Turner, Marion Guy, Yvonne Boyes, Punohu McCausland (Runanga Rep)

Attendees: Helen Mason (Chief Executive), Letham White (GM Corporate Services), Simon

Everitt, (GM Planning & Funding), Pete Chandler (Chief Operating Officer), Jeff Hodson (GM Property Services), Kiri Peita (Acting GM Maori Health Planning and Funding), Martin Chadwick (Executive Director of Allied Health, Scientific and Technical) and Hugh Lees (Medical Director), Maxine Griffiths (Minutes)

Public Attendees:

Item No.

Item Action

1

Karakia Prior to commencement of the Board meeting, the Board, Runanga and other guests had been welcomed onto the Te Manuka Tutahi Marae and treated to a wonderful light show presentation of the history of the Whare and iwi.

2

Apologies

Apologies were received from Sally Webb and Anna Rolleston Resolved that the apologies from Sally Webb and Anna Rolleston be received.

Moved: J Turner Seconded: B Edlin

3

Presentations 3.1 Allied Health Update – Martin Chadwick

Martin presented to the Board, outlining the history and origins of Allied Health in various countries.

10


Item No.

Item Action

He commented that a simplistic term for Allied Health Professionals is often given as all other health professionals who are not a Doctor or a Nurse. Martin gave an outline of the services he leads both in EBOP and WBOP, a review of his findings and experiences in the first 6 months in his role and the aspirations and challenges for the future pathways of BOPDHB Allied Health – “ In Pursuit of Excellence”. The Board thanked Martin for his informative presentation.

4 Interests Register

The Board was asked if there were any conflicts in relation to items on the agenda.

5

Minutes of Previous Meetings

5.1 Minutes of Board Meeting Resolved that the Board receive the minutes of the meeting held on 19 July 2017 and confirm as a true and correct record.

Moved: R Scott Seconded: M Guy

5.2 Matters Arising 3.1 – Patient Story • How have the communication gaps been filled • Letter of thanks and apology to the family from

the Board

The CEO advised that a letter had been sent to the family and a family meeting had taken place with members of the Oncology team. She also advised that mention in the CEO Chatsheet about the presentation the family had made, elicited some proactive enquiry from SMOs and others in other services who wondered if there had been indication of any concerns relative to their service with this case and if there was anything that could have been done differently or better, if so.

11


Item No.

Item Action

Board Members commented that the Board appreciates and supports the sometimes difficult work of BOPDHB employees and does not jump to conclusions when matters such as those rightfully raised by the family are presented. Discussion was had around oncology services and the recent withdrawal of secondary services palliative care co-ordination by Waipuna Hospice. The Board noted that the September meeting will be held at Waipuna Hospice. The COO and GM P&F advised that they are currently looking at the whole picture which is a big piece of work. There are medium and long term plans being worked on and the COO is working on the immediate issues that arose from the patient story. The Chair advised of the Board’s desire to close the loops where indicated in such patient stories. The COO reported that he is collating information with regard to the recent patient story and will feedback to the Board when available. Item 5.2, 17.05.17 - complete

GMP&F and COO to provide update to the

Board on Palliative Care, prior to Sept meeting

5.3 Minutes of CPHAC/DSAC Resolved that the Board receive the minutes of the committee meeting held on 7 June 2017.

Moved: B Edlin Seconded: M Arundel

5.4 Minutes of SHC Resolved that the Board receive the minutes of the committee meeting held on 2 August 2017. The Committee Chair noted the value of having more time to discuss presentations in the future.

12


Item No.

Item Action

The CEO advised that for next SHC committee a 30 minute period would be placed on the agenda to discuss the presentation given by Sam Johnson.

Moved: M Arundel Seconded: J Turner

GM P&F to agenda

5.5 Member’s reports from Regional/National Forums Some Board members advised of their attendance at a recent Waikato DHB forum.

6

Papers for Decision

6.1 Chief Executive’s Report The Board discussed the report as circulated with the agenda. The Chief Executive drew attention to the following: Pg 31 – Procurement Benefit Realisation Discussion was had around a recent workshop facilitated as a first test of collaboration between Waikato DHB and BOPDHB procurement, its success in achieving an outcome that was clinican-led, patient focused and the implicated financial benefits as part of the collaborative effort. Pg 32 – Analytics Roadshow Presentation: Members of the Corporate Services Analytics team had been nationally recognised for their Emergency Operation Centre work, recently presenting at the NZ Qlik Global Roadshow in Wellington and Auckland. Pg 33 – Progress with enabling St John to access DHB systems to allow them to look up relevant patient details at their attendances. Pg 33- Education Centre – Innovations Awards There have been a record 29 applications received for the 2017 awards to be held in October. Pg 34 – What can we do differently? ASD (Autism Spectrum Disorder) and Incredible Years.

13


Item No.

Item Action

The CMA mentioned the envisaged change with regard to parents accessing the Incredible Years Parenting Program while their children are being assessed, rather than the current situation of awaiting diagnosis, which will be of great benefit to parents of children with ASD. Pg 39 – Santon Block, Whakatane Hospital GM Property Services advised that the Core Refurbishment is nearing completion and a planning for a blessing is underway. This building holds great interest for both present and past employees and a celebration of staff and interested parties is also being planned for. Pg 40 – Hazardous Substances Manager GM Property Services advised that he was pleased to have made appointment to this position with a well qualified person. Recent changes to Health & Safety in the Workplace (Hazardous Substances) 2016 has profiled the need for sound management of hazardous substances, in particular asbestos, which will form part of this role. Pg 43 – Hand Hygiene The Surgical ward at Whakatane hospital achieved 100% in the last audit. Pg 46 – Pharmacy Advice received in the recent Provider Arm certification that the Pharmacy Service was one of the best ever seen. Comment was made that Pharmacy had a well organised and efficient team approach to service delivery. The CMA confirmed that the Cognitive Institute will hold a workshop with the Board at the September meeting, briefing them on the approach to Speaking up for Safety. Financial Results The GMCS advised that end of year results will come to the Board in October, to allow for certainty of addressing outstanding items such as IDFs and Leave Entitlements.

14


Item No.

Item Action

June result saw a negative variance to the Annual Plan budget of $.151 m. End of year draft result still stands at a surplus of $0.373m to a budgeted surplus of $3.1m, which the DHB had signalled to the Ministry was not achievable. Resolved that the Board receive the report.

Moved:R Scott Seconded: J Turner

6.2 Dashboard

The Board discussed the report as circulated via email to Members. Resolved that the Board receive the report.

Moved: P Nicholl

Seconded: Y Boyes

6.3 Quarterly Maori Health Plan Dashboard Report The Board noted the report as circulated with the agenda. It was also noted that the Dashboard Report is included in the Joint Runanga/Board agenda. Any discussion could be held over for that forum.

7

Papers for Noting

7.1 Work Plan The Board noted the information.

7.2 Board Drop In Visit Report The Board noted the information.

7.3 Memorandum of Understanding – Tauranga and Western Bay of Plenty Collaborative Planning and Implementation Board members had reviewed the paper and endorsed the BOPDHB entering into a Memorandum of Understanding for Collaborative Planning and Implementation in Tauranga and the Western Bay of Plenty and approves the MOU for signature by the Chief Executive.

CEO to sign on behalf of BOPDHB

15


Item No.

Item Action

In doing so, the Board wished to note the following: • The Board is very supportive of working

collaboratively with other partners and agencies on joint planning initiatives as this approach closely aligns with its ‘Health in All Policies’ focus (partnering with other agencies to achieve health and wellness for our population).

• The Board were interested in which agency will

take the lead noting that the MOU describes the parties as being equal partners. It may be that the lead agency may change dependant on the work programme of this collective. One party will need to be responsible for facilitating meeting, coordinating logistics, taking minutes etc.

There was also comment on the omission of the Justice Department as a partner to the MOU and whether this needed to be considered.

7.4

Correspondence for Noting Letter from the Minister re PHARMAC The Board noted the correspondence

8

General Business

There was no general business

9

Resolution to Exclude the Public

Resolved that Pursuant to s 9 of the Official Information Act 1982 and Schedule 3, clause 33 of the New Zealand Health and Disability Act 2000 the public be excluded from the following portions of the meeting because public release of the contents of the reports is likely to affect the privacy of a natural person or unreasonably prejudice the commercial position of the organisation: Confidential Minutes of last meeting AFRM Minutes Chief Executive’s report

16


Item No.

Item Action

That the following persons be permitted to remain at this meeting, after the public have been excluded, because of their knowledge as to organisational matters or for the purpose of legal records. This knowledge will be of assistance in relation to the matter to be discussed: Helen Mason Simon Everitt Letham White Pete Chandler Hugh Lees Jeff Hodson Kiri Peita Martin Chadwick Resolved that the Board move in to confidential.

Moved: R Scott Seconded: P Nicholl

10

Next Meeting – Wednesday 20 September 2017.

The open section of the meeting closed at 12.20 pm. The minutes will be confirmed as a true and correct record at the next meeting.

17


Minutes

Joint Bay of Plenty District Health Board and Runanga Meeting

Venue: Te Manuka Tutahi Marae, 105 Muriwai Drive, Whakatane Date and time: Wednesday 16 August 2017 at 12.30 pm

Present Iwi:

Waitaha Punohu McCausland Ngai Tai Linda Steel Ngati Whakaue ki Maketu Manu Pene Ngati Makino Stewart Ngatai Te Whanau Apanui/Te Ehutu Astrid Tawhai Ngai Te Rangi Kipouaka Parekura-Marsden Ngati Pukenga Titihuia Pakeho Ngati Manawa John Porima Ngati Ranginui Phillip Hikairo Ngati Whakahemo Marilynn Williams (Alternate) Ngati Awa (left hui early) Amohaere Tangitu (Proxy) Ngati Rangitihi Mere Butler & Linda Schuster Ngati Whare Wikitoria Hona Waitaha Apologies: Tuhoe Ngati Awa Tuwharetoa ki Kawerau Whakatohea Tapuika Ngati Whakahemo

Punohu McCausland Taane Rakuraku Pouroto Ngaropo Karilyn Te Riini Dickie Farrar Rutu Maxwell-Swinton Margaret Williams

Board: Ron Scott (Acting Chair), Bev Edlin, Peter Nicholl, Judy Turner, Marion Guy, Mark

Arundel, Matua Parkinson, Yvonne Boyes, Punohu McCausland (Runanga Rep) Attendees: Helen Mason (Chief Executive), Hugh Lees (Chief Medical Director), Pete Chandler

(Chief Operating Officer), Simon Everitt (GM Planning and Funding), Jeff Hodson, (GM Property Services), Kiri Peita (Acting GM Maori Health Planning and Funding), Maxine Griffiths (Minutes), Sandy Potaka (Runanga Secretary)

Apologies: Sally Webb (Chair), Anna Rolleston

18


Item No.

Item Action

1

He Pou Oranga Tangata Whenua /CARE, facilitated by Ron Scott and Punohu McCausland Ron facilitated a workshop whereby members from the Runanga, the Board and Executive/Staff participated. Teams consisting of members of each group, were each given a question to consider, and develop an agreed answer, which was then presented to the forum. The session was thoroughly enjoyed by participants and all agreed that the ability to be able to work together in such a setting was very beneficial.

2

Iwi Strategic Updates Ngati Whare Iwi – Health Strategy presentation Presenter – Wikitoria Hona, Social Development Manager New Entity 4 goals Seeking support and funding from DHB and other agencies to progress aspirations for the community of Minginui village – infrastructure has stood still since once being a thriving community with forestry work. Houses requiring upgrade / insulation. A query was raised as to how many houses, which was advised as 80. Belief in treating the causes and the health problems will go away, e.g. diabetes. Suggestion was made to pursue approach to other agencies e.g. for progressing development of the park for children, Whakatane District Council may be able to assist. The COO advised that he would welcome the opportunity to korero to see where assistance may be able to be given for health related matters within the community.

3.

Good to Great Progress - update Acting GM MH P&F advised that Marama Tauranga had been appointed to the position of Health Equity Programme Manager to fill the vacancy left with the departure of Dillon Te Kani. Initiating series of small tests of change. It is recognised that the dashboard is currently not reflecting progress but with time and benefit from tests of change, this will improve.

19


Item No.

Item Action In partnership with Nga Mataapuna Oranga PHO, effort has been applied particularly to Over 65s influenza vaccination and reducing inequalities at the PHO. The latter resulting in reducing the gap between New Zealand Pakeha and Maori from 4% to 1%

4.

Funding to Maori Health Providers by the Ministry of Health and District Health Boards 2011/12 to 2015/16 The Board and Runanga noted the paper. Prior to presenting the Karakia, Phillip Hikairo mentioned the Runanga would be further discussing the Executive GM Maori Health position at a number of hui over the next month.

5.

Karakia / Whakamutunga Phillip Hikairo closed the meeting with a karakia

The meeting closed at 3.20 pm

20


Matters Arising (open) – August 2017

Meeting Date Item Action required Action Taken

17.05.17 5.2

Dashboard GMPF: of the proportion of smokefree quitters is there data to support those that remain smokefree?

17.05.17 5.6 Board Road Trips 2017 GMGQ: to prepare schedule and agendas, in conjunction with GMPF

In progress

21.06.17 5.7

Draft Strategic Health Services Plan GMPF: Draft short paper for SHC on major implementation risks of the HSP

Completed – paper completed for the 2nd August Strategic Health Committee meeting

21.06.16 5.5

BOPDHB Consumer Council Proposal GMGQ: Report back to Board on adopted ToR for the Consumer Council

Process has been put on hold as it is clearly related to the upcoming clinical governance and quality consultation

19.07.17 3.1

Patient Story COO: Report back to the Board on how the communication gaps voiced by the B family have been filled

19.07.17 3.1

Patient Story GMGQ: Letter of thanks and apology to the family from the Board

Completed

19.07.17 3.1 Patient Story GMGQ: Circulate presentation to the Board Members

Completed

21

19.07.17 6.2

Dashboard GMPF: Presentation to CPHAC/DSAC on new immunisation model

19.07.17 6.4

Quarterly Employee Health & Safety Report GMCS: Advance H & S training for board

Set down for 6 December 2017

16.08.17 5.2

Minutes of AFRM -Oncology Services GMP&F and COO to provide update to the Board on Palliative Care, prior to Sept meeting

16.08.17 7.3

Memorandum of Understanding – Tauranga and Western Bay of Plenty Collaborative Planning and Implementation

CEO to sign on behalf of BOPDHB

Completed

22

Combined CPHAC / DSAC Minutes

Minutes

Combined Community & Public Health Advisory Committee/ Disability Advisory Services Committee Members

Venue: Tawa Room Education Centre Date: Wednesday 6 September 2017 at 10:30am

Committee: Bev Edlin (Chair), Anna Rolleston, Ron Scott, Judy Turner, Sally Webb, Matua Parkinson,

Marion Guy, Mary-Anne Gill (Waikato DHB), Jennet Horton (Lakes DHB), Paul Curry, Mark Arundel, Margaret Williams (Runanga Rep) and Punohu McCausland (Runanga Rep)

Attendees: Mike Agnew (Planning and Funding), Gail Bingham ( GM Governance & Quality), Sarah

Davey (Planning & Funding), Janet Hanvey (Toi Te Ora)

Item No.

Item Action

1

Apologies

Apologies were received from Judy Turner Resolved that the apology from Judy Turner be received.

Moved: S Webb Seconded: R Scott

2

Interests Register

The Committee was asked if there were any conflicts in relation to the items on the agenda.

3

Minutes

Resolved that the Minutes of the meeting held 7 June 2017 be confirmed as a true and correct record.

Moved: R Scott Seconded: A Rolleston

Lakes CPHAC minutes were noted

23

CPHAC / DSAC Minutes

Item No.

Item Action

4

Matters Arising 6.4 Update provided on community nursing program.

5

5.1 Workplan The question was asked what is occuring with the assessment of

disability access.

GMGQ: What is the DHB doing to make the facilities and services accessible to disability clients – secondary and primary

6

Reports for Review and Discussion Strategic Objective 1: Empower our population to live healthy lives Strategic Objective 2: Develop a smart, fully integrated system of care to provide care close to where people live, learn work and play Childhood Immunisations new model of care

Michelle Murray and her team gave a presentation on the immunisation collective operational plan to increase immunisation compliance. Agencies working as one team in a new regional approach across the PHO populations. Using a single IT system. Monitoring the use of existing tools and making people in the system accountable. National enrolment service is making it easier to locate children. The Committee thanked the presenters for their informative presentation. BOP Healthcare Home Model of Care

Mike Agnew presented to the Committee on the concept of the health care home. It is not about a physical facility but the way practices work. Dimensions: virtual patient contact, front footing

24

CPHAC / DSAC Minutes

Item No.

Item Action

care (being proactive), integrated model of care. The Committee noted that technology is key to efficiency.

Community Care Coordination update Routine Care changes will commence this month. Based on referring patients back to their GP for post discharge follow-up for routine wound care. It was noted that the program has had a slow start; however it is now gathering support.

Toi Te Ora Population Health update Neil DeWet presented to the Committee on Health for all. Looked at the effects of environment pollution on health. People are doing well at the expense of the environment. Discusses sustainable dietary patterns that support health and the environment. Discussed the development of biophilic cities. Janet Hanvey spoke to her report that was included in the agenda. COBOP has established a working group looking into development environmental friendly practices in BOP business community. Advised the Committee that Toi Te Ora now reports into Planning and Funding. The Committee discussed the increasing rate of smoking among Maori women.

Matters to be referred to SHC: Suicide prevention Muscular dystrophy prevalence

GMPF: Place on SHC agenda. Investigate the possibility of developing the DHB site into a biophilic site as a means of being a community leader in this development.

7

General Business Planning & Funding Report Taken as read

Next Meeting: Wednesday 6th December The meeting closed at 1:00 pm These minutes will be confirmed as true and correct at the next meeting.

25

Page 1

MAORI HEALTH RUNANGA

MINUTES

Venue: The Orchard Church 20 MacLoughlin Drive TE PUKE

Date &Time: Wednesday 12 July 2017 at 9:30am

PRESENT:

Iwi: Waitaha Punohu McCausland Ngai Tai Linda Steel Ngati Whakaue ki Maketu Manu Pene Ngati Makino Stewart Ngatai Te Whanau Apanui/Te Ehutu Astrid Tawhai Tuhoe Taane Rakuraku Ngai Te Rangi Kipouaka Parekura-Marsden Ngati Pukenga Titihuia Pakeho & Verna Gates Ngati Manawa John Porima Ngati Ranginui Phillip Hikairo Ngati Whakahemo Margaret Williams Ngati Awa Pouroto Ngaropo Ngati Rangitihi Mere Butler Tapuika Rutu Maxwell-Swinton In Attendance: Kiri Peita, Acting GM, MHP&F Ron Scott Deputy Chair BOPDHB Board Helen Mason, CE, BOPDHB (arrived 10:45am) Sandra Potaka (Secretary)

Item Discussion Action Person Responsible

1. Karakia – Phillip Hikairo

2. Mihi – Manu Pene

3. Apologies Ngati Whare Wikitoria Hona Tuwharetoa ki Kawerau Karilyn Te Riini Whakatohea Dickie Farrar

Motion: that the Apologies are received Moved: Whanau Apanui Seconded: Ngati Whakaue ki Maketu Carried

4. MHR Interest Register

Amend with MHR Secretary

5. MHR Minutes – 14 June 2017

26

Page 2

Amendments: Item 14/Item 15: Te Teo Herenga Waka and Regional Maori Health Services – Proposed organisational changes Ngai Te Rangi, Ngati Ranginui and Ngati Pukenga asked that the stance of the 3 Iwi of Tauranga Moana that was stated at the June MHR hui be recorded in the minutes; i.e. that the proposed restructure is rejected, and that Maori Health Planning & Funding and Regional Maori Health Services remain independent

6. Matters Arising Item 10: Maori Provider Quarterly Hui – referred to Agenda item 13

Item 14/Item 15: Te Teo Herenga Waka and Regional Maori Health Services – Proposed organisational changes Discussion with CE MHR discussed the original proposal

document; the consensus was that the document should have reflected four key points: o Retention of Maori representation at all

levels of the organisation including the DHB Executive

o No dilution of Maori health services o Separation of functions – MHP&F as a

funding and policy unit and RMHS as an operational unit

o Contribute to improving Maori health outcomes

Consultation on the document included staff/internal stakeholders, MHR, Kaupapa Maori providers and others

CE, BOP DHB advised that the original proposal reflected conversations over past 9 months; it appears that the intent of the proposal has been poorly communicated; the role of MHP&F and RMHS was always intended to be strengthened not diminished or diluted; focus is on working to improve Maori health outcome

CE advised a revised proposal based on feedback from everyone consulted will be circulated to MHR, Maori providers and others within next couple of weeks

MHR stated that wider consultation is required and that consultation should be consistent with nga Tikanga Maori; important to understand that while some Iwi have provider services, not all do; each Iwi also have their own reporting systems and consultation processes.

27

Page 3

CE explained that there is strong support to retain the GM at the Executive level; a new job description is being drafted.

CE would like a Rūnanga member to review the DRAFT JD.

MHR raised the recent signing of the MOU between the DHB and MHR and the need for DHB and MHR and Iwi to keep the relationships intact; processes have to be improved in order for that to occur

Discussed at length the alignment with He Pou Oranga, the need for He Pou Oranga and He Ritenga to be reflected appropriately in the Annual Plan; needs to be explicit; CE advised He Pou Oranga is included in the front of the document; Māori Health plans are now included in the Annual Plans. This MOH requirement.

Ngati Whakahemo explained their process for consulting with Iwi members included circulating information as widely as possible and reporting at monthly hui; the results of that korero was that their Iwi raised some key points: o Historically there are reasons why the

Maori units were put in place and that needs to be considered

o Maori need to have a voice at all levels and that voice needs to penetrate through to other levels

o Ngati Whakahemo does not have an Iwi provider, but Iwi members receive services from all providers including from other Iwi; need to know they can get health services whenever they need it

o New proposed structure isn’t doing what it should

o What is the guarantee that a changed structure will work better

o Will Maori providers be able to contract through mainstream funding

o Need to focus on the Treaty relationship in particular Article 3

o The process has been reactive; Iwi prefer to be involved earlier on and have a proactive role

o Need to ensure the Maori voice is not lost

o Ensure the Treaty relationship remains intact

o Respect for the mahi that has been done

o What is the evidence that there needed to be a change

Concerns raised about the ability of Iwi/Maori providers to contract with the DHB

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and Ministry of Health; discussed how some contracts have been let by invitation only and that kaupapa Maori providers have not been able to participate in tender processes

Research tells us that assimilating indigenous populations/services has not worked; our preferred model is He Pou Oranga

Item 11: Signing of Memorandum of Understanding – refer to Agenda Item 10

Item 19: MHR Election process – referred to agenda item 11

7. DHB Minutes Note that because of the recent changes to quarterly meetings of the Statutory Committees, there will be further delays to receiving the minutes; confirmed that there is now a Health Strategic Committee meeting which includes all members attending the Statutory Committees e.g. BOPHAC and DSAC/CPHAC Matters arising

The COO has been going out to meetings with Iwi; would be useful to have reports from those visits tabled at the Board meetings and included in the minutes

Item 5.4 Consumer Council Deputy Chair, DHB advised that the Board

has agreed to a concept to gather a user/consumer group together to give feedback through e.g. patient stories

Important to ensure Maori are represented on committees/groups such as this

It is in the early stages, terms of reference have yet to be developed; possibly will include an amalgamation of some existing groups

GM Governance and Compliance (Gail Bingham) will be leading this project

Motion: that the BOP DHB includes the Maori Health Runanga in the process to establish the proposed Consumer Council to ensure appropriate Maori representation in the membership of this group Moved: Ngati Makino Seconded: Ngai Te Rangi Carried

8. Motion: that the minutes of the Maori Health Runanga meeting held 12 June 2017 are confirmed; and the minutes of the DHB meeting

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held 17 May 2017 are noted Moved: Ngati Whakaue Seconded: Te Whanau Te Ehutu Carried

9. Correspondence Inward a. Letter from Ngai Te Rangi confirming

appointment of Kipouaka Pukekura as their Iwi representative to the Maori Health Runanga

b. Email from Dr Margaret Williams seeking support for proposed postdoctoral research which will have a focus on Muscular Dystrophy.

Outward - nil Motion: To receive inwards correspondence Moved: Ngati Whakahemo Seconded: Ngati Ranginui Carried Motion: To provide a letter of support to Dr Margaret Williams from the Maori Health Runanga for her postdoctoral research proposal Moved: Ngati Rangitihi Seconded: Ngai Tai Carried

Letter of support to be written

MHR Chair to sign

10. MHR Workplan MHPF Focus area: Primary Care Primary care update – Alliance and PHO Performance with an equity focus – GM, MHP&F Report circulated New Systems Level Measures developed Previously discussed at Maori Health Plan

Steering Group level Important to align to He Pou Oranga

Motion: to receive the Primary Care update report Moved: Ngai Tai Seconded: Ngati Awa Carried

11. Preparation for DHB/MHR Hikoi/ Combined DHB/MHR Hui 16 August 2017 at Te Manuka Tutahi Marae, Whakatane

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Invitations to stakeholders a. Iwi representatives to ensure Iwi members

and organisations are invited to the hui b. Acting GM, MHP&F to inform Iwi/Maori

providers Proposed agenda c. He Pou Oranga d. Good to Great Programme update e. What’s on the Radar – strategic update from

Iwi f. Ngati Whare have offered to present on their

Iwi Health Plan – MHR agreed that Ngati Whare will give the presentation from the Eastern Iwi

g. At Combined hui, it was suggested to have small group discussions on a specific topic rather than too many presentations so that the time available can be utilised more effectively; a suggested topic for August 2017 is “How to adopt and implement Values”

MHR preparation for the hui h. Suggestion that the MHR meet at Te

Puawairua Marae for a wananga to prepare for the hui the following day; workshop He Pou Oranga; discuss our revised restructure proposal amendments to the MHR Terms of Reference document; and to cover business items that the MHR need to complete

Motion: that the MHR hold a wananga at Whakatane on Tuesday 15 August 2017 to prepare for the Combined DHB/MHR hui and Hikoi Moved: Ngai Tai Seconded: Ngati Rangitihi Carried

12. Presentation: Maori Health Runanga Workplan focus area: Child and Youth; Connie Hui, Tim Slow (deferred from June Hui) The powerpoint presentation has been circulated to all MHR members covering: a. First 1,000 days; Unbroken Chain of Care b. Raising Healthy Kids

Explained about the services pathway;

noted that Maori clients are more likely to engage with midwives later in pregnancy than non-Maori

Workforce development/training is required to ensure clients are referred to the most appropriate services

Need for support for mothers and pepi when

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they return home Gaps in Trendly data as it is accessed from

Ministry of Health data and is generally 3-6 months behind

Importance of engaging with fathers/males and not just mothers – concept of Mana Wahine/Mana Tane discussed

Problems with breastfeeding in the workplace where mothers have to return to the work-force early; in factories and pack houses, there are no facilities available for babies or breastfeeding

Breastfeeding champions are the Well Child/ Tamariki Ora providers

Priority area of child obesity; need to look at lifestyle changes including links between diet/nutrition and sleep and sedentary or inactive lifestyles

High statistics reflecting overweight or obese 4 year olds drawn from the Before School programmes

Poor oral health linked to poor nutrition and low numbers enrolled with before school dental services

Bay Navigator – on-line toolkit available for whanau

Providers and PHO’s are working on targets together

MHR want to ensure we don’t lose momentum on what has already been gained and to ensure that we are able to monitor Maori health gain more effectively

Important to include all of whanau, especially kuia and koroua; Maori have own way of intervening within a whanau environment; a populations-based approach does not always work with Maori whanau; Maori have had success through leadership and role modelling eg at Marae

Some progress has been made with individuals, MHR interested in how this can be improved for whanau/hapu

Iwi/Maori providers have to be fully engaged and able to deliver services to Maori

13. GM, MHP&F Report

The report was taken as read. Motion: that the GM, MHP&F Report is received Moved: Ngati Pukenga Seconded: Ngati Whakaue ki Maketu Carried

MHR recommends that Iwi and providers are given an opportunity to discuss the CE’s revised proposal for the restructure of

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MHP&F and RMHS Ngai Te Rangi will host a consultation hui in

Tauranga Te Whanau Apanui will arrange a second

consultation hui in Whakatane Motion: that two (2) consultation hui be held, one in the east and one in the western BOP to discuss the revised proposal; both hui to be held before the Combined DHB/MHR hui on 16 August 2017 Moved: Ngati Pukenga Seconded: Ngati Whakaue Carried

14. MHR Chair Report Signing of Memorandum of Understanding Tapuika and Ngati Manawa were not

present at the signing ceremony but signed the document today; Tuwharetoa ki Kawerau and Whakatohea signed previously

The original document will be copied and sent out to each Iwi

Distribute copies of original document

Acting GM, MHP&F

15. MHR Election process

The clauses for the election of the MHR Executive need to be clarified in terms of a process

Ngai Tai circulated text for proposed amendments to the current MHR Terms of Reference document; these are in addition to clauses 35-43

This item will be on the agenda at the next MHR hui

Motion: That the current MHR Chair and MHR Deputy Chair remain in place until such time as the Terms of Reference document is updated with the process to appoint the MHR Executive Moved: Ngai Tai Seconded: Ngati Makino Carried

16. Iwi Reporting Templates a. Discussed incorporating He Pou Oranga

framework (page 16 of document) as a basis for the reporting format

b. Will discuss at the MHR wananga in August

17. Iwi/Maori Provider Forum Quarterly hui Margaret Williams, Kipouaka Pukekura and

Verna Gate attended on behalf of the MHR the agenda for the hui was amended at

short notice to a discussion on the proposed

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organisational changes the MHR invited to attend the September

22nd Quarterly hui to be held at the Taneatua Room, Regional Maori Health Services, Whakatane Hospital

Discussion The role and function of the MHR needs to

be clarified for the providers; this could be done at the Combined DHB/MHR hui and hikoi to be held in Whakatane 16 August 2017 and also in Tauranga in 2018

The consultation with the Iwi/Maori providers led to a response being made on behalf of that forum; MHR members were asked to support the document; some Iwi were able to respond straight away, others had to consult with Iwi members

The responses from Iwi were specific to the document circulated on behalf of the Provider forum; and were generally in favour of the points raised

18. Confidential Agenda Resolution to move into confidential Moved: Ngai Tai Seconded: Ngati Pukenga Carried

The meeting closed at 2:30pm Karakia – Manu Pene

19. Next Meetings Maori Health Runanga Noho Marae 4:30pm, Tuesday 15 August 2017 Puawairua Marae State Highway 35 WHAKATANE Maori Health Runanga Hui 12:30pm, Wednesday 16 August 2017 Te Manuka Tutahi Marae 105 Muriwai Drive WHAKATANE Combined MHR/DHB Hui 9:00am, Wednesday 16 August 2017 Te Manuka Tutahi Marae 105 Muriwai Drive

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WHAKATANE Alternative venue (to be confirmed): Taneatua Room Māori Health Services Whakatane Hospital Stewart Street WHAKATANE

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CEOs Report (Open) – August 2017 INTEGRATION / COMMUNITY Te Teo Herenga Waka (Combined P&F and Maori Health P&F Teams) Routine Wound Care Registration of interest process as part of the integrated community nursing project commenced 9 August 2017 with 14 General Practices expressing interest in participating in a 4 month test of change where routine wound care services will be shifted to primary practice nurses to manage. Applications close 31 August, with the trial set to commence 1 October 2017. Pharmacy Planning and Funding are engaging with community pharmacy sector for a pharmacy-based stop smoking support service for their clients. This would enable them to provide Nicotine Replacement Therapy products to clients, and support them for a minimum of 4 weeks to remain quit. Increased Immunisation • The new model of care for childhood immunisation support services is being

implemented with all new key roles filled albeit with some delays due to the extended employment vetting process.

• New positions filled include: Western Bay Imms Coordinator; Eastern Bay Imms Coordinator; Childhood Imms Liaison (Baby Tracker).

• Workplace assessment training being organised with IMAC for vaccinators. • A cold chain management plan is being implemented which includes relevant

pharmacies. • More user friendly practice reporting is being developed. • Relevant IT maternity software systems have been requested to be upgraded and

improved around birth nominations. • A casual vaccinator has been engaged in the Eastern Bay. • Childhood immunisation promotion being is being developed for a November launch. • After a period of worsening performance against the target monthly result are

showing a sustained improvement (sitting at 86%) during the transition process. Primary Care Overview Eastern Bay Primary Health Alliance Key achievements for this month • There is an increase in diabetes for Maori males however the diabetes self-

management groups have seen a 10% increase in Maori attendances. This in part due to word of mouth in the community which is a positive sign.

• Synthetic drug use appears to be increasing in the East and more clients with this problem are being seen by EBPHA counselling services. The EBPHA Primary Health Counselling Educator provides education about synthetic drug use including on what to do is someone is demonstrating problems from synthetic drug use. As a direct result of this education a student contacted emergency services when their sibling was convulsing from taking synthetic drugs. This resulted in a life saved and two other students in the house being treated.

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Key Challenges for this month • The general practice environment is challenging due to a number of changes

including but not limited to: the aftermath of the Edgecumbe flooding with a practice still temporarily relocated; potential change of ownership of three Eastern Bay practices; the potential co-location of two GP practices in Opotiki and the constant changing of GP practice staff in general. This has put additional burden on EBPHA staff and resources.

• The time taken to embed the new Collective childhood immunisation service support model has exceeded prediction but the result against the eight month target has stabilised and all key positions have been filled Bay wide albeit some to be started.

Nga Mataapuna Oranga Key Achievements for this month • NMO are continuing to maintain excellent performance against the smoking target. • There has been a 20% increase in the influenza uptake for 65+ years. • Wellness Project is on track with referral into the programme available in Q2. • Whanau Tahi (connected care) pilot is underway with NMO’s clinical Governance

group supporting the project as a means to improving Maori health outcome. Key Challenges for this month • Since June NMO has reported no missed children for Immunisation, however the

declines continue to bring the vaccination percentages down. • Key challenge is the increased demand from the DHB to either provide information

and/or participation on various working groups. As a smaller PHO, NMO has limited capacity to do this and business as usual.

Western Bay of Plenty Public Health Organisation Key Achievements for this month • WBoPPHO has undertaken the progressive roll out of the Opioid Substitution

Therapy GP Shared Care initiative across WBoPPHO and NMO PHO Practices where clients have been identified via the BOPDHB Specialist Mental Health Services as being ready for this transition.

• WBoPPHO dedicated one of its quarterly forums to host the NZ Electronic Prescription Service Change Manager and Principal Advisor in presenting the overview and live demonstration of this recently developed resource. 80 health professionals attended and watched a local GP and Community Pharmacist demonstrate the use of the software.

• WBoPPHO is appreciative that the DHB has assumed the full cost of the Afterhours Telephone Triage service from 2017. This service will come under the Acute Demand cluster (new) contract along with Community Primary Options.

Key Challenges for this month • Community Primary Options (CPO) is undergoing a change / refocus with a proposed

new model of care being developed with the DHB for 2017 going forward under the Acute Demand cluster contract.

Integrated Healthcare Strategy – System Integration The System level measure Youth Health Working Group held its first meeting on 8 August, with an initial focus this year on implementation of the Sexual and Reproductive Health Review 2016 and reducing chlamydia infection, while exploring areas of youth mental health and addictions services. Planning and Funding are finalising a pharmacy-based service to improve access for young people to free Emergency Contraceptive Pills as a way to address unintended teenage pregnancy. Future work this year will include improving access to Long Acting Reversible

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Contraception, with associated workforce development and education for clients, and developing a pathway of care for transgender people services. Mental Health and Addictions Mental Health Social Investment funding announced across 17 projects including Enhancing Mental Health and Neurodevelopmental Capacity in Gateway Assessment teams and associated service pathways for which BOPDHB CAMHS has been chosen as a pilot site alongside Waitemata DHB. This will involve the direct purchasing of some services plus some funding for Business as Usual components. Another Mental Health Social Investment Fund pilot (led by Ministry of Education) is to pilot frontline mental health provision in schools which BOPDHB has already begun with a CAMHS clinician about to start with the Otumoetai Community of Learning (COL). BOPDHB along with Lakes DHB is working with the BOP/Waiariki MoE office to promote the area as a site to roll out a wider pilot under the Social Investment Unit. WHĀNAU ORA (Healthy Families/Communities) Area of Activity: Agency/service support and coverage Action: Communities are engaged & supported to institute local Governance arrangements. Action: Communities are supported in Plan development. Suicide Prevention Co-Cordinator The SPP Coordinator is currently engaged with community stakeholders to roll out the WBOP Suicide Action Plan. There have been two meetings so far with next meeting scheduled on 4 September to confirm geographical boundaries for Intervention Response Teams (IRT) and development of core generic training components and operational TOR. In addition to this the SPP Coordinator is also working with the Murupara Community in developing a local SP Plan and IRT. Next community providers Hui scheduled for 31 August. Area of Activity: Workforce Development, Training & Education Action: Training opportunities for workforce, community & whanau are identified & communicated. Life Keepers National Suicide Prevention Training will be officially launched on 8 September. Ahead of this, Le Va have announced the first wave of training locations. No trainings are scheduled for the BOPDHB area at this stage. The SPP Coordinator has widely promoted the Life Keepers trainings in Rotorua & Hamilton to her local networks and is in touch with the national coordinator around BOP needs. On 2 September there will be a Suicide Awareness Concert held at QEII, Memorial Park. This is a whanau/community led initiative. In response to this, led by Kia Piki o Te Ora under the umbrella of Te Ao Hou there will be a “Hands of Care” community providers exhibition. The DHB were approached to support this event and through Planning & Funding approval the SPP Coordinator has been involved in the providers’ exhibition committee. What would usually take months of preparation has occurred in a matter of weeks, in order to lead up to International Suicide Prevention Day on 10 September. The providers’ exhibition will host agencies from Economics, Education, Environment, Social and Health. Noting that such suicide awareness events can attract those already vulnerable, the SPP Coordinator gave safety guidelines to the event committee. From this she has subsequently organised a support team to response to any urgent mental health needs during the event.

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Strategic Health Services Plan The final Strategic Health Services Plan and Bay of Plenty Health Service Profile have now been published on the BOPDHB’s website and in hard copy. Summary documents of both publications have also been produced. Copies of all documents have been sent to the Minister of Health, Director-General of Health, the Ministry of Health, the BOPDHB Board, and the PHOs. It is intended that the Plan will be presented to Grand Rounds at both Tauranga and Whakatane. A set of presentation slides have been prepared on the plan with the intention that anyone can use them to help communicate and publicise the plan. A paper is being prepared for the Board on overall implementation and an extended session is being arranged with the Exec Team to discuss details of implementation planning. Information Management St John Ambulance Service Following on from last month’s report, an Access Agreement has been entered into between the DHB and St John’s to enable access to DHB systems to enable St Johns staff attending call outs to look up relevant patient details in DHB systems. Primary Care Access The role of CHIP as a shared data access source for primary and community users has been the subject of debate over the last month due to changes made with some secondary care clinical processes and notification of primary care. The debate has centred on what information is held in CHIP or Éclair and how should primary and community care providers be notified of data relevant to their clinical workflows.

The general approach that has been adopted to date has been that the value of CHIP/Éclair access is as a source of information not already held by primary/community providers. It has not been designed to be a replacement for communication between secondary care and primary/community referrers – ie it is a repository of data not a messaging system. Data related to activity requested from secondary care by primary/community providers should be messaged back to those providers – this has included laboratory tests, radiology examinations, transfer of care notifications (eg discharge summaries), clinic letters, etc. Statistics for the month of July show that in the 31 days, over 550 primary and community providers used the CHIP/Éclair system during that period, accessing the data for 6854 individual patients. That reflects between 60% and 65% of authorised users.

Role No. % Nurse / Midwife 328 38% General Practitioners – incl Locums 317 37% Pharmacist – incl Locums 149 17% Other 66 8% Total 860 100%

Telehealth In 2013 the DHB embarked on a 2.5 year Pilot Project funded by BOPDHB, MBIE, MoH and later Tairawhiti DHB (TDH) to test the use of video based communications to support health service delivery – initially within BOP but subsequently in Tairawhiti DHB. The pilot, involving installing basic video cameras into primary and community providers, was aimed at identifying the opportunities, barriers and success factors to using VC to support isolated healthcare provision. At the end of the pilot period the funding provided via MBIE and MoH was discontinued and the pilot was closed down.

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Equipment funded via the pilot remains in a number of the pilot sites and has continued to be used by some health providers - typically to support long term conditions management and support for some isolated services - eg

o the use of video for more efficient use of clinicians’ time in treating patients by BoPDHB, TDH and Waikato – such as renal clinics, mental health services

o support for clinics in isolated locations (BoPDHB, TDH and Ngati Porou Hauora) A review undertaken at start of 2017 indicated that while a majority of deployments are only sporadically used, approximately 40% continue to have regular use – albeit less than they potentially could be. Key points raised in the report highlighted:

o Need for strategic commitment – the pilot was not intended to be an all-encompassing programme. To take it further requires telehealth to be a strategic priority rather than an additional layer of technology overlaid on existing health delivery models. The draft IS strategy has Telehealth as a key strategy to support the priorities and actions outlined in the BOP Strategic health Services Plan.

o Oversight – a formal level of local oversight is required to ensure deployments are focused on strategic gain and leveraged appropriately - this requires committed clinical and management leadership.

o Promotion & Support – to be successful a dedicated resource is required within the DHB to support deployments and the operationalising of telehealth for clinicians. Current approach is dependent on champions which limits the strategic gain.

o Sustainability – a major contributor to survival of pilot deployments has been the continued involvement of “champions” within the consuming entities. Where there have been personnel changes the pilots have languished. This links to Promotion and Support but is focused on building sustainability within the consuming agency.

o Building out from pilot – the pilot tested a range of uses in primary and community care. Other opportunities exist and if the above 4 factors are addressed the ability to extend use to include home based services could be pursued.

In summary – the pilot project demonstrated the potential for greater use of telehealth but also demonstrated that in the absence of a properly resourced, strategically focused programme to change service delivery models he gains will only be sporadic. It should be noted that at the time of undertaking the project, the DHB did not have a strategic framework to “hang” a telehealth programme from – the recently Strategic Health Services Plan provides that and has identified telehealth as a major opportunity. Regional eSPACE - MCPFP After some delays, progress on the regional clinical portal is being demonstrated. The Midland Clinical Portal Foundation Project (MCPFP) went live to the first group of clinicians from Waikato DHB in August, with expectations that other DHB clinicians will come on line as more records are uploaded from all DHBs. During August, the eSPACE team also established a Midland Clinical Portal (MCP) website to provide information on the overall programme and its progress and the inaugural eSPACE Programme Board meeting was held. By the end of August, MCP contained information about 406,526 patients, including

o 274,569 emergency events o 310,560 inpatient events o 1,207,053 outpatient events; and o 126,169 documents

Electronic Orders - Laboratory Eclair eOrders project pilot continues. A number of issues have been encountered which need resolution prior to further roll out of the functionality to other services. The major

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issues to address include system performance (slowness) that relates to the integration of Éclair and CHIP and Pathlab workflow changes. BOP Clinical School Research New Zealand Clinical Research Environment Charlie Stratton, Clinical Research Development Manager, has attended several meetings in July where the “health” of the clinical research environment within New Zealand has been discussed. The meetings have involved a wide range of stakeholders including researchers, representatives from the Ministry of Health, HRC, patients and patient organisations, DHBs, Private Research providers, Sponsor Companies and Clinical Research Organisations. The general feeling amongst many of the stakeholders is that medical research is a critical part of healthcare within NZ. It was the view of several stakeholders however that medical research, and in particular participation in clinical research, was “dwindling” in New Zealand. Whilst this isn’t currently the case for BOPDHB it is important for us to be aware of what is happening nationally and internationally. In order for BOPDHB to remain active in research we need a healthy research environment nationally. There was reference to the recently announced NZ Health Research Strategy. There was a feeling that whilst the release of the strategy was a positive thing, the strategy lacked detail on strategy and how measures would be implemented to ensure the goals of the strategy are achieved. Many stakeholders viewed DHBs as integral to the success of medical research in NZ. Whilst no comment was given about what the Heath Research Strategy means for DHBs, many stakeholders believed that more clarity was needed surrounding the involvement of DHBs, and its employees, in medical research. Education Finalists for the 2017 Innovation awards are as follows. We had a record number of 29 applications. The awards evening is being held on Wednesday, 4 October 2017.

Finalist Topic Fiona Hewerdine and Brandon Hitchcock

Sword swallowing in the DHB

APU and PARIS Inter-professional team

Identify and reduce unnecessary waiting time for acute medical patients

Louise Fowler Clinical Nurse Specialist in Aged Residential Care - reducing hospitalisations and improving care to residents

Adele Dreadon, Chris Bark and Tracey Balsom

Patient Information Centre - journey from fledgling to flourishing

Liz Thomas and team – Toi Te Ora

Hapu Hauora – supporting Hapu and marae whanau health

Deb Brierley-Broad Healthy Me programme – reaching target groups Learning Technology The final Pain Service online course – Patient Controlled Analgesia – was released in July and learner feedback has been positive. All three Pain Service courses now have the

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theory component online, reducing the amount of time spent in face to face training. This allows the Pain Service team to spend more time with patients. In September, delivery of our moving and handling refreshers will change to a blended option. A new online course has been created to provide the theory, allowing more time for the practical session so that all topics can be thoroughly covered. Following the success of the Medication Administration WoF, we are working with nurse educators in ED and Paediatrics to develop similar courses for ED Medication Standing Orders and Paediatric Medication SO’s. The Medication Administration WoF was created to address an identified audit issue and is now part of new nurses’ orientation training. Development continues with the “Onboard with Allied Health” orientation programme. This course is specific to new Allied Health staff and links in with their paper-based orientation booklet. Orderlies – Health and Safety Refresher Compliance Learning Technology Trainer Kim Brown has been working with Orderlies Team Leader Ewan Robertson to ensure all orderlies complete the online Health and Safety Refresher. Ewan had discovered that a total of 128 Support Services staff were overdue for their compulsory refreshers. To accommodate this urgency, Trainer supported workshops were organised at both Tauranga and Whakatane Hospitals and timed to accommodate shifts. Ewan rostered staff to attend at specific times during each 2 hour session and he attended each session to reassure staff. This involved considerable planning considering how many people needed to complete the compulsory assessment. To help with record keeping and planning for further sessions, individual results were forwarded to Ewan at the end of each day and a report was exported and sent showing progress and to show those still needing to take the assessment. Outcomes: From an initial cohort of 128 there are now only 18 people remaining to complete the training. Governance and Quality Co-design We have had a good response to the request for expressions of interest with seven teams ready to commence the programme in September. Improvement Advisor Toni Fitzpatrick has commenced her training and is working with the Deteriorating Patient team as part of her learning and application Internal Audit Tracer Methodology Audits A new audit tool has been developed that includes corrective actions from the Certification audit, He Ritenga standards, and contact of GP and other primary health providers to determine discharge and results communication is meeting standards. The Clinical Auditor is working with the MD and the Clinical Director of Improvement and Innovation to improve engagement with senior medical staff with regard to Improvement Planning from the Tracer results.

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Emergency Planning Planning is underway with TCC, Police, Fire and St John re New Years’ Eve Planning. The format is likely to be similar to last year with an EOC at Police to monitor activity. Provider Arm Surgery Outreach Kawerau Clinics Outreach clinics for ENT, Paediatrics and Dental are continuing to be held at Tuwharetoa Ki Kawerau. These clinics are well supported by DHB clinicians working in a partnership that has formed with Tuwharetoa Ki Kawerau staff led by Jayne Beeching the Health Services Manager. For example at a recent clinic the two Tuwharetoa Ki Kawerau staff members worked with and alongside us to ensure efficient flow of patients and ultimately good attendance. General feedback from clinicians after this clinic was of incredible satisfaction as all these children had very real ENT conditions requiring intervention whether it be prescriptive therapy, Otomicroscopy and aural toileting, surgery or a further follow up. “Being able to make a positive difference to health outcomes exemplifies the purpose of our employment enabling positive outcomes for these children. Interestingly our working relationship with this community and Tuwharetoa has shown to us the trust upheld in our team by these parents as they are coming to clinic and all showing for theatre on scheduled dates.” Radiology Improvements Waiting times for Ultrasound Over the last 3 months there has been a significant improvement in Ultrasound with 98.23% of patients receiving their scan within 42 days. This improvement has been enabled by the successful recruitment of sonographers, including the appointment of a training position. Sonographers are a scarce resource within New Zealand and we are extremely lucky to have been able to recruit and make an immediate improvement in our waiting times. Eye Health Service Improvement Project The BOPDHB, in partnership with Park Street Eye Hospital, has commenced a Ministry of Health supported Eye Health Service Improvement project with the goal of improving eye health services for our community. The specific actions are as follows:

• Improve management and timeliness of follow-up care for eye health services. This will include managing backlog, developing consistent standards across the specialty, and investigating alternative options to deliver services. To date this work has achieved excellent progress as shown in the following table

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• Create an alternative to specialist delivery of Avastin injections to reduce cost and capacity constraints. A registered nurse has commenced specific training to enable this role to provide this service.

• To improve the care model for high-risk patients with Macular Degeneration

(MD) by ensuring a shorter wait time from referral to treatment, thus reducing the risk of further loss of sight and potentially reduction in number of treatments required. Changes to the care model will include patient representatives providing input to ensure that the new model best meets their needs and that services delivered are appropriate for Maori.

Career Pathway Evening The Mount Maunganui College School held a Career Pathway Evening on 8 of August for their students. The Adult Community Mental Health and Addiction Service (ACMHAS) was invited to support and attend this event. This was a great opportunity for both parents and students to explore a variety of occupations through the eyes of people who are in the roles and have the knowledge of the skills required for these roles. The experience of talking with people who are actively working in the occupations that students are considering is a positive and extremely important approach for them and assisted students with their study choices and ultimately their career decisions. Community Networking Community service in action: on Tuesday the BOPAS Court Assessor and BOPAS Clinical Team Leader attended a “Brave Hearts” community support meeting for families affected by a loved one who is addicted to Methamphetamine. The presentation was from 7-9pm at Tauranga Boys Colleague and 20 – 30 family members attended this meeting to find out more about the work being undertaken by the court addictions assessor. This was a great opportunity for families to hear about DHB mental health and addiction services in general and gain more understanding about the judicial system.

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Also during August BOPAS new grad RN and clinical team leader attended a Methamphetamine seminar at the Maungatapu Maree in support of the organisers “Brave Hearts” and providing members of the public information regarding local services and treatment of Methamphetamine problems. BOP Addiction Service had a stand pre and post the seminar where staff were positioned to interact and provide information.

Joint initiative with Oranga Tamariki The management of both Maternal Infant & Child Mental Health Service (MICAMHS) and Oranga Tamariki met to discuss possibilities of working together more closely. Both services focus on vulnerable children and young people but often there is misunderstanding between the two teams and frustration about the perceived lack of action. As a result it was decided that we will launch a series of “interventions” to enhance co-working and improve relationships between the services. A meeting was organised and the Oranga Tamariki team joined the MICAMHS team for a formal welcome and morning tea. Over the next few months staff will spend some time in each other’s service and a fortnightly case management meeting’s where joint cases are discussed in person will be trialled. Regional Maori Health Outpatient Clinics (OPC) Since June 2017, the Regional Maori Health team has been working in partnership with clinical specialty schedulers, admin and Kaupapa community services to expand cultural clinics in Regional Maori Health facilities. These have been extremely successful with high patient satisfaction and a significantly improved attendance rate as demonstrated in the chart below.

Community Health 4 Kids The new childhood immunisation liaison role has been recruited to the National Immunisation Register (NIR) team. The primary purpose of this role is to track children aged from birth to 5 years of age to ensure no child is missed for immunisation events. They will be part of a wider multidisciplinary team under the BOP Childhood Immunisation Collective and will work with nurses and advocates. A core component of their role will be to receive Outreach Immunisation Service (OIS) referrals from GP Practices, screen these, find

5

3

5

4

2 5

7

1 3

7

3

4

12 4

3

7

2

4

4

7

1

6

1

29%

23%

0%

14% 17% 17%

12% 15%

27%

6%

11%

24% 20% 21%

39%

22%

8%

21%

17% 13%

10%

18%

5%

13%

3%

7% 5

10

15

20

25

30

35

40

45

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Jul-1

5

Aug-

15

Sep-

15

Oct

-15

Nov

-15

Dec-

15

Jan-

16

Feb-

16

Mar

-16

Apr-

16

May

-16

Jun-

16

Jul-1

6

Aug-

16

Sep-

16

Oct

-16

Nov

-16

Dec-

16

Jan-

17

Feb-

17

Mar

-17

Apr-

17

May

-17

Jun-

17

Jul-1

7

Aug-

17

Atte

ndan

ces

DNW

rate

Maori Health Clinics

Attendances DNW's DNW rate DNW Target

45

11

additional contact information on the child, contact the families to advocate for them to have the child immunised at their GP Practice plus establish any barriers they may be facing and looking to assist in removing the barriers. Children will be referred to OIS two weeks out from missing a core immunisation. The 8 month immunisation target priority is a core focus. Toi Te Ora Public Health Services Childhood Obesity Prevention 5-2-1-0 Toolkit: An overarching brand has been developed to allow for the 5-2-1-0 approach to be used across a wider range of settings and reach audiences beyond children and their caregivers. This comprehensive approach will ensure the material developed will be consistent with the many 5-2-1-0 campaigns developed globally. Toi Te Ora’s draft 5-2-1-0 messaging and tools continue to be trialled and have been used with good effect in media interviews. All the material was presented to Western Bay of Plenty GPs in August for their final feedback before finalising the material for publication and dissemination. Breastfeeding Toi Te Ora provided Breastfeeding Friendly Accreditation training to two further Plunket Community Coordinators and eleven Eastern Bay of Plenty Ukaipo Coalition members. A formal partnership agreement will be put in place between Toi Te Ora and each of the organisations attending. Regular teleconferences with all the Breastfeeding Friendly Accreditors are being held to share experiences and challenges, and to provide support and advice. Toi Te Ora assisted with the planning for the World Breastfeeding Week and the Big Latch On events held by the Eastern and Western Bay Ukaipo Breastfeeding Coalitions across the Bay of Plenty. The Eastern Bay of Plenty Coalition held two Big Latch On events in Whakatane and Opotiki. The Western Bay of Plenty coalition held three Big Latch On events in Tauranga, Mount Maunganui and Te Puke.

46

12

Management and Admin FTE Tracking

Quarter Paid Total Org Paid

Dec-08 471.29 21.37%Mar-09 473.56 20.53%Jun-09 467.40 20.40%Sep-09 472.65 19.92%Dec-09 478.56 19.89%Mar-10 462.14 19.26%Jun-10 445.25 19.16%Sep-10 436.71 18.75%Dec-10 443.51 17.51%Mar-11 439.07 18.68%Jun-11 441.10 18.69%Sep-11 446.70 18.67%Dec-11 447.13 18.65%Mar-12 451.26 18.78%Jun-12 443.85 18.70%Sep-12 444.97 18.88%Dec-12 438.46 18.47%Mar-13 443.01 18.61%Jun-13 452.05 18.87%Sep-13 449.45 18.83%Dec-13 454.11 18.77%Mar-14 458.87 18.75%Jun-14 471.95 19.19%Sep-14 472.85 19.05%Dec-14 482.64 19.21%Jan-15 487.14 19.42%Feb-15 485.17 19.12%Mar-15 481.43 18.92%Jun-15 486.80 19.11%Sep-15 487.73 19.07%Dec-15 486.12 19.15%Mar-16 485.64 19.14%Jun-16 486.67 18.92%Sep-16 491.56 19.12%Dec-16 491.37 18.92%Mar-17 497.71 18.97%

10.00%

12.00%

14.00%

16.00%

18.00%

20.00%

22.00%

Dec-

08

Mar

-09

Jun-

09

Sep-

09

Dec-

09

Mar

-10

Jun-

10

Sep-

10

Dec-

10

Mar

-11

Jun-

11

Sep-

11

Dec-

11

Mar

-12

Jun-

12

Sep-

12

Dec-

12

Mar

-13

Jun-

13

Sep-

13

Dec-

13

Mar

-14

Jun-

14

Sep-

14

Dec-

14

Mar

-15

Jun-

15

Sep-

15

Dec-

15

Mar

-16

Jun-

16

Sep-

16

Dec-

16

Quarterly data graphed

Paid

47

DISTRICT HEALTH BOARD Property Services Cold Chain Management The testing of the pilot system is underway, and so far we have received positive feedback. Santon Core Refurbishment The blessing of the core was held on 1 September 2017. The Maori panels will be reinstalled.

The teams due to relocate into the core will delay their move until their manager returns from leave on 11 September 2017.

Tauranga Hospital Fire Sprinkler System Upgrade Works This highly invasive work is scheduled for 8/9 September 2017. Detailed planning has been completed to manage the fire and patient risk. Seismic Performance of Our Building Beca, our structural consultants, have developed a seismic event monitoring system for use by their major clients.

The software automatically monitors seismic events relative to the location of a given portfolio of buildings then generates a text and email message advising when a pre-determined level is exceeded.

Upon receipt of the warning message, Beca will mobilise a team of structural engineers to immediately inspect the buildings for structural damage. This has the advantage to the BOPDHB that typically within 24 hours we will have consultants advice as to the structural condition status of the building.

At the demonstration, we discussed preparation to minimise the effects of seismic events.

Tauranga Transfer Lift Following numerous failures of the lift, we commissioned a consultant’s report.

The report has indicated the lift (part of Project Leo) was never fit for use, and has now reached the end of it’s physical life.

Replacement cost is $300,000 and will take approximately 9 – 12 months to specify procurement, and install.

In the meantime, the lift cannot be used for the transfer of patients to the heli-pad. Alternative arrangements have been put in place. New Hazardous Substance Legislation New legislation comes into effect in December 2017. The main impact for the DHB is that the legislation creates a new group of “trained handlers”. This has both financial and resource implications.

48

Governance and Quality Patient Experience - social media

Certification We received the DRAFT Certification audit report to validate. It was pleasing to see we received our first ever CI (continuous improvement) rating. Name Description Attainment Finding Criterion 1.2.3.6

Quality improvement data are collected,

CI Across the organisation there were numerous examples noted and

49

Name Description Attainment Finding analysed, and evaluated and the results communicated to service providers and, where appropriate, consumers.

discussed of quality improvement activities and projects where data has been collected, analysed and evaluated to analyse areas for improvement and show improvements in patient outcomes and patient satisfaction as a result of projects/initiatives. There has been a significant commitment to staff education around quality improvement methodology and the use of a planned process to improvement work, including measurement of outcomes. This data was visible throughout the clinical areas and public spaces, and in some cases presented at conferences and in publications. Staff interviewed were engaged in activities and conversant with outcomes measures.

Corporate Services Lindsay’s Ultra Effort Lindsay Hyslop has completed a terrific personal milestone in finishing the Naseby Ultra-marathon – 160 kilometres of running in Central Otago winter. Go Lindsay!

50

Programme Manager – People and Capability Projects Monthly Report for August 2017 Summary of work stream activity for staff engagement and culture programme: Staff Engagement and Culture - Programme Deliverables Key: (on track), (some concern) Tackling inappropriate behaviour pathway - On Track Table 10 will be the behaviours pathway development group. The concept is to create a portal that will be used by staff to raise their issues and will then, if the person wishes, be passed onto a “Care Navigator”. Table 10 are making good progress towards a test site. Next steps are to complete a stocktake of current support strategies already available for staff to ensure we incorporate those that is already working/established into the portal. A formal implementation plan will then be developed and incorporate decision making around integration of Cognitive Institute speaking up for safety. Values based recruitment “end to end” pathway - In progress In partnership with the P&C and CS administration teams, a successful VBR workshop was held with 81 recruiting managers. Phase two of the VBR project team is now about populating the website with resources and readying the candidate interview record for regular use. This phase should be ready to transition into BAU by 30 September, i.e. ongoing training days for recruiting managers are scheduled, ongoing training day content agreed and recruiting resources substantively reflective of a values based process. Launch and cascade of evolved CARE values – In progress Together with a personal letter from the CE, a simple CARE values resource has been produced that will be distributed to all staff. It was suggested that a copy of Shared Expectation accompany the values resource which has triggered an update of SE prior to being sent out. This will cause a delay of a couple of weeks whilst this is being updated before sending out the resource As part the launch and the outcome of Table 8’s initiative, individual staff name badges will be produced and issued over three months from August – October 17. The current protocol is out for consultation at present and badge manufacturers have been asked for quotes. Stocktake and action plan of future focused performance appraisal process – Not Started Work will commence on this activity following the VBR project. A likely strategy will be how the “success profile” of a role, produced as part of VB recruitment process, can be carried forward to the performance development and appraisal process. Next step is to revisit the work stream bridge and deliverables and plan the work going forward. Determine ongoing programme governance and reporting process – In progress Currently the programme formally reports into Executive via the GM Corporate Services. To manage information flow to Exec and speed up decision making, an exec sub-group meet monthly to assist with operationalising the programme. Some concern about sustainable reporting going forward. Recommendation is that of staff engagement measures and impact on patient outcomes should be incorporated in the Quality framework and committee structure. In summary - monthly exec governance update, monthly report to GM corporate services,

51

Programme Manager – People and Capability Projects continue with steering group meeting every two weeks form the reporting mechanism for the programme. Re-survey of staff and patients as a measure of staff engagement – In progress Recommendation to Executive team will be for a re-survey of staff and patients annually for 3 years commencing November 2017. This will be using April strategy’s platform and process accessible via on-line dashboards to service level (awaiting firm proposal). Following telecom from April, awaiting survey proposal Version 3 from Tim Keogh before putting this final recommendation to Exec. Develop a quality improvement plan for 2018 activities – Not started This plan will evolve as each work stream matures. Way forward will be to transition onto “live QI” quality improvement platform for 2018. Agree on transition process of programme from “project” to “sustain” – Not Started Secondment period for leadership of the staff engagement and culture programme ends in November 2017. Accountability and some FTE resource for the programme’s 2018 activities will need to be allocated. From the 2016 P&C decision document, it was proposed that this would predominantly sit with the P&C team although the mechanism for this has not been decided.

Provider Arm

Introduction to Connexion Week During July 2017, the BOP community were invited, via the DHB website and Facebook page, to tell the DHB how they wanted to receive appointments from Tauranga and Whakatane Hospital. The results indicated text (59%), email (29%), letter (8%), phone call (4%), and private message on Facebook (0%). Combined with the information gathered from the new Preferred Method of Contact field in the patients demographics area in Webpas, the results indicated that there is not one way that patients prefer to be communicated with. However, primarily, text followed by email were the preferred options. At the DHB the predominant communication method currently used is a combination of letter and text. Purpose This project is intended to accelerate the implementation of a patient communication system driven by the preferred method of contact across all services in the DHB.

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Aim To develop and deliver by 24 November 2017, 90% of DHB services via a responsive communication system between the DHB and the patient, driven by the patient’s preferred method of contact Director of Nursing and Midwifery

Care Capacity Demand Management (CCDM) One of the measures for the CCDM dashboard is the nursing hours per patient day variance between the hours required by patient acuity against the hours provided. As noted for July 2017 the medical and mental health service were not able to match demand. The impact for medical service was particularly at Whakatane. With the higher rate of staff sickness the pool of casual staff was insufficient to meet the need.

Values Based Recruitment Workshop Why recruit for CARE values? Engaged teams deliver better care. 85 hiring managers participated in a values based recruitment workshop with Tim Keogh. Such was the interest in this workshop the available places were filled in two days and a bigger venue was required. This work comes under the performance development work stream. The graphic below identifies the phases of recruitment currently under revision to align recruitment processes with our values. This is quite a different approach to hiring staff and all managers will be required to complete the training. When a staff member's values, and the DHB's values are a good 'fit,' staff are more likely to feel more comfortable, more energised, and get greater satisfaction from their work. Also new staff settle quicker, stay longer and demonstrate our CARE values more consistently.

Surgical Site Infection Summary Report There were no surgical site infections for June. It was also pleasing to note there were no incomplete records at Tauranga which is an area that has been a challenge to meet to date.

53

Child and Adolescent Mental Health Services Dialectical Behavioural Therapy (DBT) workshop The service has made a commitment to developing a DBT Service in the Bay of Plenty DHB. DBT is an intensive therapy that works with people with a diagnosis of borderline personality disorder; this will enable the service to respond more effectively to clients with severe emotional dysregulation. In order to meet the needs across the age range, staff from both the Maternal Infant & Child Mental Health Service (MICAMHS) and the Adult Mental Health & Addictions Service (AMH&AS) have sent ten clinicians on the intensive DBT training. The ten therapists have formed a working group and a series of meetings with relevant stakeholders are planned in order to develop pathways, ensure co-working, and sharing or resources across the services. Seclusion reduction Te Whare Maiangiangi (Mental Health In-Patient Unit) has formed a group to address the issues around the use of seclusion with a focus on seclusion reduction. This work stream included consumer participation and involvement from Regional Maori Health Services working together in this complex and challenging area of improvement. The Terms of Reference have been agreed with a focus on actions such as the initial decision to transform and use one of the three seclusion rooms into a de-escalation space. The Director of Area Mental Health Services has accordingly decommissioned one seclusion room for that purpose. A Team Leader and Occupational Therapist visited the Forensic Unit at the Henry Rongomau Bennett Centre in Hamilton to view the sensory environment and gain an understanding of the sensory profiles that are in use. The team will present their learnings from this at the Te Whare Maiangiangi leadership and staff meetings. Cervical Screening The latest screening rates below to 30 June show another increase in Maori rates and a reduction in the disparity gap, while Asian screening rates continue to decline. Common reasons are that Asian women often return to country of origin for smears, so are not recorded locally, that it is culturally inappropriate to be screened prior to marriage and there is often no suitable translator (usually children) if language is a barrier. We are looking for ways to address this. DHB Community Dental Services Community Dental is currently scoping how to roll out a fluoride varnish treatment programme to target pre-schoolers and primary age children who are at a higher risk of dental decay. This is a programme that can be carried out by non-clinical staff under the supervision of dental therapists. It only applies to the child’s deciduous teeth (baby teeth). We are looking to second a dental therapist one day per week to set up this project and train staff. It will result in our caries free age 5 and Year 8 students increasing in the longer term. Issues around parental consent will need working through. Volunteering meaningful and rewarding “I wanted to do something meaningful with my time and helping others has given me that and more,” says mother-of-two, and volunteer, Lynne Riddle. Lynne has been volunteering at Tauranga Hospital’s Ward 2B for three-and-a-half years and loves what she does.

54

“With my daughters getting older I had more time on my hands and thought it was something I’d like to do.” She describes her role as ‘hands off, hearts on’; as volunteers do not move patients or do jobs paid staff would normally perform. “It’s about doing those little things the nurses simply don’t have time to do,” said Lynne. “Like making cups of tea for the patients and visitors, general tidying, chatting to people, making them more comfortable, welcoming them and taking their minds off things. Every day is different and it’s very sociable.” Bethlehem resident Tony Waters, originally from the Kapiti Coast, said volunteers like Lynne performed a very important role. “I have been in hospital elsewhere and have never experienced this level of volunteers, it’s wonderful,” said Tony. “Hospital can be quite a daunting place and to have a friendly face dropping by is very important. Sometimes people don’t have visitors, so seeing that regular friendly face and being able to offload to them, it’s an extremely valuable contribution.” If you would like to volunteer at Tauranga Hospital you must be over 18 and be able to commit to a minimum of six months reliable service. Contact Volunteer Manager Lesley Grant on 027 807 0258 or [email protected] for more details. PROVIDER ARM ANNUAL RECORD HOW WE’VE MADE A DIFFERENCE (2017/18)

FOCUS AREA WHAT WE’VE ACHIEVED

People-Powered

Capability and Capacity for Change

Over 200 staff involved in training on Quality Improvement methodology

Closer to Home

Kawarau ENT Clinic New clinic resulting in attendance by some frequent non-attenders

Homecare Medical After hours GP practice triage nurse service for in Western Bay

Regular data tracking to show progress

Value and high performance

Patient Information Centre Amalgamated with Regional Call Centre so there is a better service

for patients

6 hour target Achieving 95% of ED attendances out or admitted within 6 hours

Hospital overnight beds used

Significant reduction in overnight inpatient beds used at Tauranga Hospital

Transient Ischaemic Attack (TIA)

Reduced median time (days) referral to clinic consult from 10 days to 1 day from first audit in Oct-Nov 2016 to May-June 2017. TIA clinic attendances up from 18 to 52. Prevented 14 hospital admissions in May-June 2017.

One team

55

FOCUS AREA WHAT WE’VE ACHIEVED

Quality Improvement Good engagement and high level of passion for Quality

Improvement. This spreads through clinical groups as they become more involved in change.

Smart system

Provation Implemented Endoscopy software reducing reporting from 1 week to 1 day

Tauranga Community Allied Health Team going electronic

Completing electronic initial assessments and uploading them to CHIP within 1 working day 80% of the time

Financial Results and Forecast The draft July monthly result is a positive variance to the Annual Plan (AP) budget of $0.054m. The draft result stands at a deficit of $0.548m compared to an AP budgeted deficit of $0.602m, a positive variance to budget of $0.054m. The draft Annual Plan budget stands at a deficit of $2.7m and is at this point unapproved by the Ministry of Health.

56

All amounts are $000s unless otherwise stated. Surplus/(Deficit)

KEY MEASURES Actual AP Budget Variance

Operating Result (548) (602) (54)

PROVIDER VOLUMES Case Weights (CWD) n/a 0 #VALUE!

CASH & BANK ($000) Net Operating Cash Flow 1,256 694 562 Balance 14,597 12,074 2,523 Days Cash 6.89 5.75 1.14TERM LOANS ($000) 0 0 0

CROWN EQUITY ($000) 269,884 269,453 430

Actual Plan VarianceFTE Numbers Accrued 2,624 2,619 (5)

BAY OF PLENTY DISTRICT HEALTH BOARDPRELIMINARY RESULTS FOR THE MONTH ENDED 31 JULY 2017

KEY ACTIVITY DRIVERS SUMMARY

KEY STAFF FIGURES

KEY FINANCIAL RESULTS SUMMARY

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

07/14

08/14

09/14

10/14

11/14

12/14

01/15

02/15

03/15

04/15

05/15

06/15

07/15

08/15

09/15

10/15

11/15

12/15

01/16

02/16

03/16

04/16

05/16

06/16

07/16

08/16

09/16

10/16

11/16

12/16

01/17

02/17

03/17

04/17

05/17

06/17

07/17

Cash ($000s)

Cash Budget

$260,375$17,286

$584

$4,104

$3,206

$4,795

$3,181

Assets Actual (Total = $293,531)

Land & Buildings Clinical Equipment Other EquipmentInformation Technology Motor Vehicles WIPInvestments

FTE by Staff Group

326.39

353.97

1,170.55

1,143.30

493.63

512.61

116.16

120.28

517.45

488.74

0 500 1000 1500 2000 2500 3000

Actual FTE

Plan FTE

Medical Nursing Allied Health Support Management & Admin

12.07

14.60

Bank Balance Plan

Bank Balance Actual($m)

5.75

6.89

Days Cash Plan

Days Cash Actual

01,0002,0003,0004,0005,0006,000

TGA WHK

July ED Attendances by Year

2013 2014 2015 2016 2017

1,000

2,000

3,000

4,000

5,000

July Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

2016 2017

Caseweights (July 2017 n/a)

CWD Actual CWD Plan

$54

$56

$58

$60

$62

$64

$66

$68

Jul15

Aug15

Sep15

Oct15

Nov

15

Dec15

Jan16

Feb16

Mar

16

Apr1

6

May

16

Jun16

Jul16

Aug16

Sep16

Oct16

Nov

16

Dec16

Jan17

Feb17

Mar

17

Apr1

7

May

17

Jun17

Jul17

Millions

Monthly Revenue and Expenses

Expenses Revenue

© Bay of Plenty District Health Board 2017 1 of 8 28/08/2017

57

Updated 27 January 2017

Bay of Plenty District Health Board Work Plan – 2017

Month Activity Documentation

Source Meeting Date and

Venue January • CEO Monthly Report

• Approve committee Resolutions • Monitor Member’s Interest

Declarations • Dashboard Report • Patient Experience • Strategic Partnership Group

Minutes • BOP Health Alliance Minutes • Quarterly Employee Health and

Safety Report • – drop in (1-2pm)

• CEO • GMGQ • GMGQ

• GMPF • GMGQ • CEO • GMPF • GMGQ

• GMGQ

18 January 2017 Board Only Time Tawa Room, Education Centre, 889 Cameron Road, Tauranga

February • CEO Monthly Report • Approve committee Resolutions • Monitor Member’s Interest

Declarations • Dashboard Report • Midland Chairs/CE Meeting

Minutes • Quarterly Health Excellence

Report • Quarterly Maori Health Plan

Dashboard Report • Draft Annual Plan/SOI 17/18 • 6 Monthly Board Attendance

Report (July – Dec)


• GMPF • GMGQ

• GMGQ

• GMMHPF

• GMPF • GMGQ • GMPF

15 February 2017 Board Only Time Conference Hall, Clinical School, Whakatane Hospital Full day - Combined Board/Runanga Day

March • CEO Monthly Report • Approve Committee Resolutions • Monitor Member’s Interest


Minutes • Quarterly Risk Report • Annual Plan – 17/18 Approve

draft to Minister • Presentation: Eastern Bay PHA • Strategic Partnership Group

Minutes • BOP Health Alliance Minutes • Health and Safety Training

(estimated date – actual date to be after enactment of new legislation)

• Q2 IDP Ratings • – drop-in (1-2pm)


• GMPF • GMGQ

• GMGQ • GMPF

• CEO • GMPF • GMGQ • GMPF • GMGQ

15 March 2017 Board Only Time Tawa Room, Education Centre, 889 Cameron Road, Tauranga

April • CEO Monthly Report • Monitor Member’s Interest

Declarations • Dashboard Report

• CEO • GMGQ

• GMPF

19 April 2017 Board Only Time

58


Month Activity Documentation Source

Meeting Date and Venue

• Midland Chairs/CE Meeting Minutes

• Patient Experience • 16/17 AP Report (6 month

progress report) • Quarterly update on IHS • Quarterly Employee Health and

Safety Report

• GMGQ • GMGQ • GMPF • GMPF • GMCS

Conference Hall, Clinical School, Whakatane Hospital

May • CEO Monthly Report • Monitor Member’s Interest

Declarations • Dashboard Report • Quarterly Maori Health Plan

Dashboard Report • Midland Chairs/CE Meeting

Minutes • Final Annual Plan 17/18

Approval • Strategic Partnership Group

Minutes • BOP Health Alliance Minutes • Member’s reports from

Regional/National Forums

• CEO • GMGQ

• GMPF • GMMHPF

• GMPF

• GMPF • CEO • GMPF

17 May 2017 Board Only Time Tawa Room, Education Centre, 889 Cameron Road, Tauranga Full day - Combined Board/Runanga Day

June • CEO Monthly Report • Monitor Member’s Interest


Minutes • Quarterly Risk Report • Quarterly Health Excellence,

Quality & Patient Safety Report • Annual Plan 16/17 – Signature • Regionalisation • Q3 IDP Ratings • Patient Experience –

Presentation • Member’s reports from


• CEO

• GMGQ • GMGQ

• GMPF

• GMGQ • GMPF

• GMPF • GMGQ

21 June 2017 Board Only Time Conference Hall, Clinical School, Whakatane Hospital

• July • CEO Monthly Report • Monitor Member’s Interest


Minutes • 6 Monthly Board Attendance

Report (Jan – June) • Regionalisation • Patient Experience/Story • Strategic Partnership Group

Minutes • BOP Health Alliance Minutes • Presentation: NMO

• CEO • GMGQ

• GMPF • GMGQ

• GMGQ

• GMGQ • GMGQ • CEO • GMPF

19 July 2017 Board Only Time Tawa Room, Education Centre, 889 Cameron Road, Tauranga

59




• Quarterly Employee Health and Safety Report

• Quarterly update on HIS • Member’s reports from


• GMCS

• GMPF

August • CEO Monthly Report • Monitor Member’s Interest

Declarations • Dashboard Report • Quarterly Health Excellence,

Quality & Patient Safety Report • Quarterly Maori Health Plan

Dashboard Report • Midland Chairs/CE Meeting

Minutes • Member’s reports from


• CEO • GMGQ

• GMPF • GMGQ

• GMMHPF

• GMGQ

16 August 2017 Conference Hall, Clinical School, Whakatane Hospital Full day - Combined Board/Runanga Day

September

• CEO Monthly Report • Monitor Member’s Interest


Minutes • Quarterly Risk Report • Annual Report • Patient Experience/Story • Strategic Partnership Group

Minutes • BOP Health Alliance Minutes • – drop-in (1-2pm) • Q4 IDP Ratings • Member’s reports from


• CEO • GMGQ

• GMPF • GMGQ

• GMCS • GMPF • GMGQ • GMGQ • • CEO

• GMPF

20 September 2017 Tawa Room, Education Centre, 889 Cameron Road, Tauranga

October

• CEO Monthly Report • Monitor Member’s Interest


Minutes • Exec/Board/Runanga Workshop • Presentation: WBOPPHO • Strategic Partnership Group

Minutes • BOP Health Alliance Minutes • 16/17 AP Report (12 month

progress report) • Quarterly Employee Health and

Safety Report • Quarterly update on HIS • Member’s reports from


• CEO • GMGQ

• GMPF • GMGQ

• GMPF • CEO • GMPF • GMPF

• GMCS

• GMPF

18 October 2017 Board Only Time Conference Hall, Clinical School, Whakatane Hospital

November • CEO Monthly Report • Monitor Member’s Interest

• CEO • GMGQ

15 November 2017

60





Minutes • Quarterly Health Excellence,

Quality & Patient Safety Report • Quarterly Maori Health Plan

Dashboard Report • Patient Experience/Story • Member’s reports from


• GMPF • GMGQ

• GMGQ

• GMMHPF • GMPF • GMGQ

Tawa Room, Education Centre, 889 Cameron Road, Tauranga Full day - Combined Board/Runanga Day

December No meeting

61

Indicators of District Health Board Performance (IDP) Quarter Four Summary for 2016/17

SUBMITTED TO: Board Meeting: 20 September 2017 Prepared by: Sharlene Pardy – Planning and Project Manager, Planning and Funding Endorsed by: Simon Everitt – General Manager, Planning and Funding Submitted by: Helen Mason, Chief Executive RECOMMENDED RESOLUTION: That the Board:

1. Receives the following report outlining quarter four Indicators of DHB Performance (IDPs) for 2016/17.

ATTACHMENTS: Appendix 1 – Ministry of Health Performance Measures Ratings Report

Appendix 2 – Performance Measures Ratings Descriptor (Key/Legend)

Appendix 3 – Crown Funding Agreement (CFA) Variation Ratings Descriptor

BACKGROUND: District Health Boards (DHBs) are required to provide quarterly reports to the Ministry of Health (MOH) under the Crown Funding Agreement (CFA). The reporting includes a number of non-financial measures like the Health Targets and other measures agreed with DHBs in their Annual Plans (APs). Section 13.3 of the Ministry’s Operational Policy Framework 2016/171 sets out the requirement to provide these reports and the process by which reports are submitted and assessed. The MOH provides a consolidated assessment of the measures referred to as the Indicators of DHB Performance Report to the Minister of Health. Final ratings and feedback were received from the Ministry of Health on 1 August6 2017. 1 http://nsfl.health.govt.nz/accountability/operational-policy-framework-0/operational-policy-framework-201617

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ANALYSIS: This section sets out a brief analysis of the results, showing highlights and areas for improvement, a summary of the Health Target results and the Crown Funding Agreement results. The MOH Performance Measures Ratings Report, the CFA (Crown Funding Agreement) Variation Reporting, the Performance Measures Ratings Descriptors and the CFA Variation Ratings Descriptors are set out in Appendices 1, 2 and 3. 1. Highlights Positive results have been achieved in this quarter across the majority of the performance measures with 75% of targets met. These results include three health targets being achieved – the Shorter Stays in Emergency Department, Better Help for Smokers to Quit (Primary), and Improved Access to Elective Surgery. The highlights are described below:

HT1 Shorter Stays in the Emergency Department – The 95% target was exceeded

again this quarter with a great result of 95.4%. This result is the culmination of a lot of hard work over the last three years, in particular quicker patient assessments and ensuring patients are in the right place at the right time.

HT2 Improved Access to Elective Surgery – The target for improved access to elective surgery has been exceeded for this quarter at 106.6% taking the results for the full 12 months to 30 June 2017 to 11,315 residents receiving surgery treatment.

HT5 Better Help for Smokers to Quit – Primary – The result for this quarter was 90%

of smoking patients in contact with their GP or practice nurse received advice to quit smoking. This achieves the 90% target. This result recognises the efforts put in by the PHOs.

HT6 Raising Healthy Kids - Performance of this target has improved from 55% to 75% over the last quarter, placing the DHB on track to achieve the target of 95% of children assessed at their four year old Before School Check as having significant weight problems, are referred to their general practice, by 31 December 2017. The parents of about 40 children each quarter are being offered the opportunity of a referral for clinical assessment, and then going onto a physical activity, nutrition and family lifestyle programme to better manage the child’s weight.

OS10: Data submitted to National Collections – Focus 1 - NHI – The Ministry has congratulated the DHB for continued efforts to improve data quality, leading to an overall Outstanding rating.

2. Areas Partially or Not Meeting Target There were four health target areas that did not achieve, or only partially achieved, their targets for this quarter: Faster Cancer Treatment, Raising Healthy Kids, Better Help for Smokers to Quit – Maternity and Increasing Immunisations. There were also three other measures that did not

achieve their targets: PP12 Utilisation of DHB funded dental services by adolescents from 13 – 17 years, PP21 Immunisation coverage, and PP29 Improving waiting times for colonoscopies. Faster Cancer Treatment (partially achieved)

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While a result of 77.1% this quarter is a decrease from the previous quarter, changes are being made to improve the support for patients making decisions regarding their cancer treatment. The DHB has adjusted specific processes to reduce delays (in particular where patients are being referred for treatment from the tertiary hospitals like Waikato and Auckland) resulting in an improved situation for Bay of Plenty residents accessing their first cancer treatment closer to home. With these changes the BOPDHB is now on track to achieve the target of 85% of patients to receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer. Raising Healthy Kids (partially achieved) As mentioned above the BOPDHB has made excellent progress with this health target with a result of 75%, an improvement of 20% from last quarter and expects to meet the target by the end of the year. The target is that by 31 December 2017, 95% of children assessed at their four year old Before School Check as having significant weight problems, are referred to their general practice. The Ministry of Health has acknowledged the DHB’s multi-faceted approach to reducing childhood obesity. Better Help for Smokers to Quit - Maternity (partially achieved) This quarter 86.8% of pregnant women were given brief advice and/or support to stop smoking against a target of 90%. It is anticipated that the collaboration between primary and secondary care through the development of the ‘Pathways to Positive Outcomes’ initiatives will impact positively on this result. Increased Immunisations (not achieved) Coverage for immunisations of eight-month-olds in the Bay of Plenty has dropped slightly to 83% against the target of 95%. There has also been a further drop in Māori immunisation coverage to 79%. This is an area of concern and it is anticipated that as the new immunisation service model is implemented there will be improvement. PP12 Utilisation of DHB-funded dental services by adolescents from School Year 9 up to and including age 17 years (not achieved) With a result of 67%, the utilisation of DHB-funded dental services by adolescents from school Year 9 up to and including 17 years did not meet the 85% target this quarter. In response to these low results, the Mobile Adolescent Dental service is now identifying and actively enrolling students in schools with low utilisation rates with the intention of rolling this out to additional colleges throughout the year. PP21 Immunisation coverage (not achieved) Immunisation coverage has increased for two year olds and decreased by 2.1% for five year olds, and both remain well below the 95% target. Coverage for two year olds sits at 90% and coverage for children aged five years sits at 81%. There was a 6.6% increase in coverage of HPV immunisation up to 64%, however, this is still below the 70% target. As noted above, the new immunisation service model is expected to improve these results. PP29 Improving waiting times for colonoscopies (not achieved) While the 85% target for urgent diagnostic colonoscopy was met with a result for the quarter of 90%, non-urgent diagnostic colonoscopy achieved a result of only 46% against a target of 70% and only 19% of people waiting for a surveillance colonoscopy waited no more than twelve weeks against a target of 70%. There has been a considerable increase in the number of colonoscopies performed over the last quarter and a drop in the number of people waiting over

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the recommended time so it is expected that this will translate into an improvement in these indicator results.

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Performance Measures Rating

Final ratings of all measures in Q4 Q4 %

Outstanding 1 2%

Achieved 41 73%

Partial achievement 9 16%

Not achieved 5 9%

Not applicable - -

No rating given - -

Total 56 100%

As shown in the table above, there were 56 IDPs reported in this quarter with an achievement rate of 75%. This compares to 70% of measures achieved for the same period last year. 3. Health Target Performance The health target performance for the fourth quarter of 2016/17 has produced mixed results with overall progress slightly down on Quarter 3 (see table below). The Shorter Stays in Emergency Departments, Better Help for Smokers to Quit (Primary), and Improved Access to Elective Surgery have resulted in very pleasing results and achieved target. As noted above, Increasing Immunisations, Faster Cancer Treatment, Better Help for Smokers to Quit (Maternity) and Raising Healthy Kids are sitting below target.

Health Target Ratings (includes 2 Smokefree targets) Q3 (Final ratings)

Q4 (Final ratings)

Outstanding - -

Achieved 4 3

Partially Achieved 2 3

Not achieved 1 1

No rating given - -

Total 7 7

4. Summary of Crown Funding Agreement Results

Final ratings of all CFA measures

Crown Funding Agreement (CFA) Variation Reporting Q4

Satisfactory 9

Further work required -

Not acceptable -

No rating given (NR) 1

Total 10

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Appendix 1: Ministry of Health Performance Measures Ratings Report

Count Health Target Q4 MoH Rating Final results Q4

1 HT1 Shorter Stays in Emergency Departments Achieved

Result 95.4%; Target 95%

2 HT2 Improved Access to Elective Surgery Achieved Result 106.6%; Target 100%.

3 HT3a Faster Cancer Treatment Partially Achieved Result 76.6%; Target 85%

4 HT4 Increased Immunisation Not Achieved Result: 83.1%; Target 95%.

5 (i) HT5 Better help for smokers to quit – Maternity Partially Achieved

Result 86.8%; Target 90%.

5(ii) HT5 Better help for smokers to quit – Primary Care Achieved

Result 90% Target 90%.

6 HT6 Raising Healthy Kids Partially Achieved

Result 75%; Target 90%

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Count Performance Measure Q4 MOH Final Ratings

Q4

1 OP1 - Mental Health Output delivery against plan Achieved

2 OS3 – Inpatient average Length of Stay (ALOS) – Acute Partially Achieved

3 OS3 – Inpatient average Length of Stay (ALOS) – Elective Achieved

4 OS8 Acute readmissions – 75+ Indicator Not Required INR

5 OS8 Acute readmissions – Total Population Indicator Not Required INR

6 OS10 Data submitted to National Collections – Focus 1 – NHI Outstanding

7 OS10 Data submitted to National Collections – Focus 2 – National Collections Achieved

8 OS10 Data submitted to National Collections – Focus 3 – PRIMHD Achieved

9 PP6 Improving health status of people with severe mental illness Achieved

10 PP7 Improving mental health services using relapse prevention planning Achieved

11 PP8 Shorter waits for non-urgent mental health and addiction services Partially Achieved

12 PP10 Oral Health – Mean DMFT score at year 8 Indicator Not Required INR

13 PP11 – Children caries free at 5 years of age Indicator Not Required INR

14 PP12 – utilisation of DHB-funded dental services by adolescents from school Year 9 up to and including age 17 years Not Achieved

15 PP13 – Improving number of children enrolled in DHB funded dental services Indicator Not Required INR

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Q4

16 PP20 Improved management for long term conditions (CVD, diabetes and stroke) – Focus Area 1 Long Term Conditions/Diabetes Care Improvement Packages Achieved

17 PP20 Improved management for long term conditions (CVD, diabetes and stroke) – Focus Area 2 Diabetes Management (HbA1c) Achieved

18 PP20 Improved management for long term conditions (CVD, diabetes and stroke) – Focus Area 3 Cardiovascular Health Achieved

19 PP20 Improved management for long term conditions (CVD, diabetes and stroke) – Focus Area 4 Acute Heart Services Achieved

20 PP20 Improved management for long term conditions (CVD, diabetes and stroke) – Focus Area 5 Stroke services Partially Achieved

21 PP21 Immunisation coverage – Focus Area 1: Imms at 24 months and 5 years Not Achieved

22 PP21 Immunisation coverage – Focus Area 2: Human Papilloma Virus Not Achieved

23 PP22 Improving System Integration Achieved

24 PP23 Improving wrap around services – Health of Older People Achieved

25 PP25 Prime Minister’s youth mental health project Achieved

26 PP26 Rising to the Challenge: Mental Health & addiction Service Dev Plan – Focus 1 Achieved




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Q4


31 PP27 Supporting Vulnerable Children Achieved

32 PP28 Reducing Rheumatic Fever – Focus Area 1 Achieved

33 PP28 Reducing Rheumatic Fever – Focus Area 2 Achieved

34 PP29 Improving waiting times for diagnostic services – Coronary Angiography Achieved

35 PP29 Improving waiting times for diagnostic services - Colonoscopy Not Achieved

36 PP29 Improving waiting times for diagnostic services – Computed Tomography (CT)/Magnetic Response Imaging (MRI) Achieved

37 PP30 Faster Cancer Treatment – Shorter waits for Cancer treatment Part A Achieved

38 PP30 Faster Cancer Treatment – Shorter waits for Cancer treatment Part B Achieved

39 PP31 Better Help for Smokers to Quit in Public Hospitals Achieved

40 SI1 Ambulatory sensitive (avoidable) hospital admissions (ASH) Partially Achieved

41 SI2 Regional Services Planning (Note that this is reported by HealthShare) Partially Achieved

42 SI3 Service coverage Achieved

43 SI4 Elective Services standardised intervention rates Partially Achieved

44 SI5 Delivery of Whanau Ora Achieved

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Q4

45 DV4 Improving patient experience Achieved

46 Supporting Delivery of the NZ Health Strategy Achieved

CFA (Crown Funding Agreement) Variation Reporting

Count Performance Measure Q4 MoH Final Ratings Q4

1 CFA – Appoint cancer nurse coordinators Satisfactory

2 CFA – Appoint cancer psychological and social support workers Satisfactory

3 CFA – B4 School Check funding Satisfactory

4 CFA – DSS – Disability Support Services funding increase – 2016/17 Satisfactory

5 CFA – Electives initiative and ambulatory initiative variation Satisfactory

6 CFA – Establishment of Green Prescription Initiative Satisfactory

7 CFA – Immunisation Coordination Service Satisfactory

8 CFA - National Immunisation Register (NIR) Ongoing Administration Services Satisfactory 9 CFA – Well Child Tamariki Ora Services Satisfactory

10 CFA – Palliative Innovations Indicator Not Required INR

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Appendix 2: Performance Measures Ratings Descriptor

MoH Rating Icon Criterion Outstanding performer/sector leader

1. Applied in the fourth quarter only —this rating indicates that the DHB achieved a level of performance considerably better than the agreed DHB and/or sector expectations.

Achieved

1. Deliverable demonstrates targets / expectations have been met in full. 2. In the case of deliverables with multiple requirements, all requirements are met. 3. Data, or a report confirming expectations have been met, has been provided through a

mechanism outside the Quarterly Reporting process, and the assessor can confirm.

Partial achievement

1. Target/expectation not fully met, but the resolution plan satisfies the assessor that the DHB is on track to compliance.

2. A deliverable has been received, but some clarification is required. 3. In the case of deliverables with multi-requirements, where all requirements have not been met

at least 50% of the requirements have been achieved.

Not achieved – escalation required

1. The deliverable is not met. 2. There is no resolution plan if deliverable indicates non-compliance. 3. A resolution plan is included, but it is significantly deficient. 4. A report is provided, but it does not answer the criteria of the performance indicator. 5. There are significant gaps in delivery. 6. It cannot be confirmed that data or a report has been provided through channels other than

the quarterly process.

Indicator not required – This indicator was not required in this quarter INR 1. This is given to indicators that were not required in the previous quarter

No rating given – This indicator was required in this quarter NR

1. The indicator received no rating 2. Contact will be made with the Ministry of Health to seek further guidance and information

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Appendix 3: CFA Variation MoH Ratings Descriptor Category Icon Criterion

Satisfactory

1. The report is assessed as up to expectations 2. Information as requested has been submitted in full

Further work required

1. Although the report has been received, clarification is required 2. Some expectations are not fully met

Not Acceptable

1. There is no report 2. The explanation for no report is not considered valid.

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Strategic Health Services Plan Implementation SUBMITTED TO: Board Meeting 20 September 2017 Prepared by: Sharlene Pardy, Planning and Project Manager Endorsed by: Simon Everitt, General Manager Planning and Funding Submitted by: Helen Mason, Chief Executive RECOMMENDED RESOLUTION: That the Board notes this report. ATTACHMENTS:

1. Strategic Health Services Plan Implementation Risk Register BACKGROUND: The Strategic Health Services Plan (SHSP) was endorsed by the Board at their June meeting. This plan provides a clear long term vision for the Bay of Plenty health system to be a sector leading, high performing health system. It will guide us over the next 10 years to provide health services which better support people to stay well and manage their own health. The plan will assist the DHB to strengthen its focus on providing integrated health services, intervening as early as possible, bringing health services closer to the patient, and providing the right mix of health support in the right place. The following diagram illustrates this fresh new approach of the SHSP.

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IMPLEMENTATION: The SHSP is now ready for implementation. Even though the plan has been developed with a 10-year horizon, its focus is on implementation in the first three years with momentum being built from Year One (2017/18). There are a number of components to the overall implementation of the plan: actions/budget, reporting, risks and communications. Year One Actions There are a number of actions scheduled for Year One of the SHSP (2017/18). Some of these are already underway, some are in the planning stages and some are yet to get underway. Four templates are being prepared to assist with managing implementation of the actions, one for each of the three Strategic Objectives and one for the Infrastructure section. Each template sets out the actions, timing, budget, progress made to date, and also the action owner/leader. A

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session will be held with the Executive Team to confirm these templates and our approach to implementation in year one. The emphasis for Year One actions is on: Increasing our focus and investment in smoking cessation, childhood obesity and housing initiatives; defining and trialling health care homes; developing care coordination for community nursing; reviewing a number of hospital services including outpatients and renal care; reviewing mental health and addictions services; improving patient flow through the hospital; and scoping future health services in the Wairakei/Te Tumu area. SHSP Reporting It is proposed that reporting on the SHSP will be on a quarterly basis. Actions pertaining to Strategic Objectives one and two will be reported through to CPHAC/DSAC and actions under Strategic Objective three will be reported through to BOPHAC. Implementation Risks A table of implementation risks was reported to the Strategic Health Committee at their August meeting. It was suggested at this meeting that mitigation measures be added and also that the risks were colour coded according to their level of risk. These changes have now been made and the updated risk table is included in Attachment 1 to this report. Communications A communications plan is being developed for the SHSP. In the first instance, the SHSP and the Bay of Plenty Health Service Profile and summary documents have been published on the BOPDHB’s website and are printed in hard copy. Copies of all documents have been sent to the Minister of Health, Director-General of Health, the Ministry of Health, the BOPDHB Board, and the PHOs. It is intended that the Plan will be presented to Grand Rounds at both Tauranga and Whakatane. A set of presentation slides has been prepared on the plan with the intention that staff from across the organisation can use them to help communicate and publicise the plan. Further opportunities are being worked on to help socialise the plan as much as possible over the coming months.

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Attachment 1:

Strategic Health Services Plan 2017-27 IMPLEMENTATION RISKS

Identified Risk Factor Rationale

Prob

abili

ty

Impa

ct

Ris

k Sc

ore

Measures to Mitigate Risk

1. There is insufficient funding available to deliver the actions in the SHSP. Other work pressures taking priority. 3 2 6

Frequent communication between the Board and the Executive Team to assist with budget iterations during the annual planning process.

2. There is insufficient dedicated staff resourcing available to deliver the actions in the SHSP

Other work pressures taking priority. 3 2 6 Escalate to the Executive Team to prioritise.

3. There is a lack of provider support and buy-in for redesigning services and delivering services in different ways.

There are a large number of providers and they have their own priorities. 3 2 6 Frequent communication and engagement with

providers to redesign and deliver services.

4.

Partner organisations and the clinical community are not engaged in the delivery of the actions either making delivery difficult or sub-standard.

There are a large number of people involved and they have their own priorities.

3 2 6 Frequent communication and engagement with partner organisations and the clinical community in the work programme.

5.

Corporate governance commitment to the SHSP does not remain strong and the Executive Team are not supported to ensure staff time is focussed on delivering the actions.

Other work pressures take priority 2 2 4 Frequent communication (including progress reporting) with Board and Runanga Chairs.

6. The Bay of Plenty population grows faster than projected placing pressure on services and constraining resources.

Statistics NZ’s expectations do not align with the local environment. 3 2 6 Continuous monitoring of actual population statistics

and keeping the Health and Service Profile updated.

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Identified Risk Factor Rationale

Prob

abili

ty

Impa

ct

Ris

k Sc

ore

Measures to Mitigate Risk

7.

There are too many actions in the SHSP and resourcing goes to the ‘nice to haves’ and not to those which are essential and will take us forward.

‘Nice to haves’ may be more popular and result in short-term gains so easier to obtain resourcing.

2 2 4 Board and the Executive Team to identify essential actions each year.

8. There is a change in Government resulting in different ministerial priorities and therefore different DHB priorities.

Government election will be held this year which may result in a new Minister of Health. A new Minister may have different priorities impacting on how the funding envelope is allocated.

3 2 6 Frequent communication with Board.

9.

There are significant changes in patient expectations regarding demand for services or levels of service from those planned.

Patient expectations are continuously increasing. 2 2 4 Regular patient and provider surveys and proactive

communication with communities.

Key Terms Risk: The risk stated in a complete sentence which states the cause of the risk, the risk, and the effect that the risk causes to the project. Rationale: The justification and reason for the risk. Probability: The likelihood that a risk or opportunity will occur (on a scale from 0 to 5 with 5 being the highest). Impact: The impact of the risk on the project if the risk occurs (scale from 0 to 5 with 5 being the highest). Risk Score: Determined by multiplying probability and impact (scale from 0 to 25). Management of Risk: The action which is to be taken if this risk occurs. Risk Owner: The person who the project manager assigns to watch for triggers, and manage the risk response if the risk occurs.

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BOPDHB Board drop In Visits – 2017

DATE 06 September 2017 LOCATION Medical Daystay Unit - Tauranga

MEMBERS BOARD MEMBERS: Matua Parkinson and Marion Guy

QUALITY & PATIENT SAFETY: Toni Fitzpatrick

VOLUNTEER PATIENT ADVISOR: -

HOSTS: Tiffany Floyd and Ainsley Cunliffe

DISCUSSION SUMMARY

I met and welcomed BOPDHB board members Matua Parkinson and Marion Guy yesterday morning (6th September 2017). I escorted them to the Medical Daystay Unit - Tauranga Hospital.

There was no scope lists booked as BOPDHB representatives were at a “The Endoscopy Governance Group for New Zealand: Workshop on Endoscopy”.

Ainsley welcomed the BOPDHB board members to the MDSU. Ainsley gave a guided tour of the area giving details as to the type of patients that are admitted for day stay procedures within this area. The focus of this visit was to give an overview of “scopes”.

We were given access to the room that is dedicated to cleaning the different types of scopes. We discussed and viewed the quality control measures that have been implemented to ensure patient safety and the compliance aspects related to the cleaning process.

The tour included viewing the procedure rooms where scopes occurred along with the area which patients were admitted, cared for post procedure and discharged from.

Ainsley discussed the amount of work the entire team (Medical, Nursing, and Clerical members) had completed to ensure that the BOPDHB endoscopy surveillance waiting lists were reduced. Additional lists were introduced within Rotorua, Eastern Bay and Grace Hospital facilities, along with the implementation of Saturday lists held within MSDU. This approach has allowed for the successful completion of our 1200 overdue surveillance colonoscopy procedures from the beginning of 2017. A total of 1600 acute, elective and surveillance colonoscopy procedures were completed within a 5 month period (March to July 2017). The waiting list is now up to date. Both board members were impressed with the reduction of patients on BOPDHB waiting list.

Further improvements have been made which includes:

• The information regarding the scope, findings and follow-up actions are inputted into an electronic system immediately following the procedure

• Patient’s receive a copy of the above information before they leave hospital • The patients GP receives this information on the same day as the scope occurred • To ensure that patients are receiving the correct “follow-up” treatment. Laboratory results are

reviewed in consultation with the planned follow-up actions to ensure patients are receiving the appropriate treatment or negating the need to repeat an endoscopy if it is not required.

Tiffany explained the current practice involving gaining informed consent from the endoscopy patients. MDSU has embarked on a quality initiative that improves this process with the development of a patient centred video. Tiffany explained that this practice is not common within Australasia but is used widely in other worldwide regions. If this initiative gains full consent then BOPDHB will be the first in NZ to use this type of method to gain patient informed consent. We were able to view this video – both Marion and Matua were very impressed. Tiffany explained that she is going to speak and present her project at the NZ Gastroenterology Annual Scientific Meeting scheduled in November 2017. Ainsley is also representing BOPDHB at this conference with the submission of a “conference poster presentation”.

Ainsley also spoke about other initiatives that were occuring within MDSU.

• Annual patient satisfaction surveys • Data extraction and auditing of endoscopy reports from the Electronic reporting system –

Provation • 30-day post procedure endoscopy process, reporting of mortality rates • Translation of procedure books into Mandarin, Punjab and Cantonese • Post endoscopy pathology pathway • Competency review • Emergency management of inter endoscopy procedure crisis • MDSU operation policy

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• Bowel prep and advice on the use of sedation for breastfeeding mums • Endoscopy procedure booklets • Endoscopy wait time coordination

Both staff members highlighted that working within MDSU was a privilege and that it was a really exciting time to be working within this area.

At the conclusion of our visit the board members spoke highly of the whole team, praised the area for their efforts in reducing the scope waiting lists and acknowledge the extra efforts staff members are making in regard to the quality improvements which will have a positive effect on all patients admitted to this service.

SPECIAL NOTES

ACTION ITEMS PERSON RESPONSIBLE DUE DATE

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EASTERN BAY OF PLENTY FLOODING RECOVERY EFFORT UPDATE

SUBMITTED TO: Board Meeting 20 September 2107 Submitted by: Karen Smith, Recovery Manager Endorsed by: Helen Mason, Chief Executive Officer RECOMMENDED RESOLUTION: That the Bay of Plenty District Health Board (BOPDHB) notes the ongoing activity in the psychosocial recovery for the Eastern Bay of Plenty flooding event of April 2017 outlined in this paper. ATTACHMENTS:

• Eastern Bay of Plenty Flooding April 2017 Psychosocial Support Implementation Plan BACKGROUND: Ex-tropical cyclones Debbie and Cook resulted in significant regional flooding. A stop bank breached at Edgecumbe causing all residents having to evacuate their homes. Farms and rural lifestyle blocks suffered severe flooding on pastures and damage to shelter belts. Slips caused road closures and isolation for communities at Ruatahuna, Te Mahoe, Ruatoki and Te Whatai. Bay of Plenty District Health Board has responsibility for the Psychosocial Response and Recovery and we are working closely with the Whakatane District Council Recovery Team, in particular with the Community Group Recovery led by Barbara Dempsey on the Recovery effort. A Psychosocial Response Implementation Plan has been developed (Attachment 1). There are 7 work streams which outline the key tasks and activities. It is a living document with progress reported on a monthly basis. It is 4 months into the recovery phase and many residents, farms and businesses continue to face significant challenges. The major issues are financial hardship, access to affordable temporary housing, insurance and rebuilding. As expected some of the stresses are beginning to manifest as people’s insurance for accommodation runs out, and frustration grows as repairs or rebuild takes longer.

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Navigators As part of the recovery effort a Navigator service has been established. This service is based on a partnership relationship between NGOs, Government Departments and Community and is based on strengthening the individual or whanau so they can move forward in their lives. The service has been based on the Canterbury and Kaikoura recovery experiences and BOPDHB are contributing to the funding of the service. The primary goal of the Navigators is to ensure that:

• Every individual / family affected by the April 2017 flooding events can have support to plan their recovery and be connected to services they may need. This is achieved by facilitating timely and coordinated access and referral to information / support services.

They will:

• Conduct an assessment of individual households, and identify their needs and develop a comprehensive recovery plan with the individual householder that ensures maximum access to quality services.

There have been three Navigators appointed. They are:

• Dorothy Gilliland part –time (former Allied Health Leader with the BOPDHB with extensive community connections in the Eastern Bay)

• Vicky Richards part-time (seconded from Sport Bay of Plenty , also event co-ordinator to the flood recovery and Flood affected resident of Edgecumbe

• Cheryl Wilson fulltime (Seconded from NASH ,10 years social work experience ) Cheryl will have the team leader role

The team are operating from the hub on a roster and will also meet and make phone contact with people as needed. We have established a Navigation Service oversight committee, the membership being made up of the stakeholders who are providing funding to support the service. BOPDHB’s initial commitment is for 3 months with a review depending on evaluation of ongoing need and effectiveness of the service.

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CORRESPONDENCE FOR NOTING SEPTEMBER 2017

SUBMITTED TO: Board Meeting 20 September 2017 Submitted by: Sally Webb, Board Chair RECOMMENDATION: That the Board note the contents of the paper ATTACHMENTS: Letter from the Minister of Health dated 4 September 2017. Letter from Toi Te Ora dated 15 September 2017 Plans for Maramatanga Park

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Toi Te Ora – Public Health PO Box 2120 TAURANGA 3140 Ph: 0800 221 555 Website: www.ttophs.govt.nz 15 September 2017 Chief Executive Officer Western Bay of Plenty District Council Private bag 12803 Tauranga 3143 Plans for Maramatanga Park Health begins where we live, learn, work and play. Many of the crucial underlying factors that affect the health of people and communities are directly influenced by the decisions and activities of councils. The Bay of Plenty District Health Board (BOPDHB) is required under legislation to improve, promote, and protect the health of people and communities; to promote the inclusion and participation in society and independence of people with disabilities; and to reduce health disparities by improving health outcomes for Maori and other population groups. For these reasons, the BOPDHB is committed to working collaboratively with councils and welcomes the opportunity to comment on the plan for Maramatanga Park. This submission has been prepared by Toi Te Ora Public Health (Toi Te Ora) which is the public health unit of the BOPDHB. Open Space and Health and Wellbeing ‘Healthy Open Spaces: A summary of the Impact of Open Spaces on Health and Wellbeing’ is an information paper produced in 2010 by Regional Public Health1, a unit of the Hutt Valley District Health Board. The definition of open spaces contained in this report includes green spaces such as regional and local parks and reserves, sports fields and other recreation areas. Toi Te Ora has used this paper as a primary information source in the preparation of this submission. Two useful aspects of the report include a summary of the connections between open spaces and health and wellbeing, and a list of features of healthy open spaces. The connections between open spaces and health and wellbeing include: open spaces increase people’s contact with nature and spaces of cultural significance (cultural

or spiritual wellbeing/te taha wairua) open spaces promote social interaction and cohesion (social wellbeing/te taha whanau) open spaces promote physical activity (physical wellbeing/te taha tinana) open spaces reduce stress and promote relaxation (mental wellbeing/te taha hinengaro). Healthy open spaces are those that: are of high quality, readily accessible, culturally appropriate, and well connected to streets and

amenities are developed in partnership with the community provide variety of functions including opportunities for physical activity, access to the natural

environment, and play for children respect and provide for a diverse range of cultures, ages, abilities and socio-economic status

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http://www.ttophs.govt.nz/

conserve and promote cultural heritage build on natural features to inspire a deep connection to place provide diverse habitats for appropriate species to enhance biodiversity create safe and healthy places for connecting with others, recreation and mental relaxation. Health Impacts of the Maramatanga Park Plan Element of the Plan Impact on health and wellbeing Recommendations Upgrading or providing new sports facilities

Increases quality of the park, provides opportunities for physical activity and social interaction.

As physical activity increases thirst, provide water fountains, safely sourced from the council supply, to encourage healthy beverage choices and waste minimisation practices.

Increased parking Increases accessibility to the park for people who drive, but also contributes to the overall car dependency of the transport system, which has a negative effect on health and health inequalities.

Provide bicycle parking at the park to encourage and enable park users to access the park using the Omokoroa/Tauranga Cycle Trail, and promote Child Independent Mobility which is important for children’s healthy development. Consider need to improve footpath infrastructure to increase access for local communities.

A potential community building

Depends on the services offered by the community centre. However, in general, community centres improve health and reduce health inequalities by positively contributing to a wide range of health determinants, including providing a sense of place and belonging if designed with local residents, especially tangata whenua.

Work with the Te Puna community and Kai Western Bay to identify if a community garden may be of interest alongside the community centre. Design the community centre in partnership with tangata whenua to promote cultural wellbeing. Apply universal design principles to ensure accessibility for people with disabilities. Connect with Toi Te Ora to identify ways the centre could create health promoting environments.

New playgrounds Provides opportunities for play and social interaction, particularly among young children and their families/whanau. However, research exists suggesting many playgrounds are bland and boring and may be developed more as a service for adults (by keeping kids out of the way) rather than children.

Involve local kids in the playground design as encouraged by the Children’s Commissioner on their “Listening2Kids” website. Design playgrounds to be suitable for a range of ages and abilities, and consider the design principles for children’s outdoor space identified in the literature to promote children’s healthy development (Toi Te Ora is able to assist with this if required). Provide shade and fruit trees near the playground to promote sun safety and increase access to healthy food. Consider planting options that support native species and biodiversity.

Potential skatepark Provides opportunities for physical activity and social interaction, particularly popular among youth

As undertaken when designing the Omokoroa skate park, involve local youth in the Maramatanga skatepark

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http://www.occ.org.nz/listening2kids/

which is important in the ‘screen’ age.

design. Consider the planning and design elements that have successfully contributed to the community and amenity value of the Omokoroa skate park.

Toilet facilities Increases the quality and accessibility of the park.

Fitness stations Provides opportunities for physical activity

Consider fitness stations that will appeal to the widest range of users possible, in particular consider the needs of people who are trying to get into fitness, older people and people with disabilities.

In addition to the above recommendations related to specific elements of the plan, the following comments and general recommendations are offered: A recent community survey2 undertaken by Toi Te Ora showed that people are concerned about

the loss of native species in terms of the impact that it has on their health and wellbeing. There is also emerging evidence that development approaches that support connection with native species, healthy ecosystems and biodiversity are beneficial for health and wellbeing3. Therefore it is recommended that consideration is given to looking at how the development of Maramatanga Park can support local ecosystems and biodiversity such as with native plantings supporting native birds and other native species.

To help ensure safety and encourage community use of all facilities, it is recommended that the

plan is reviewed in terms of the principles of Crime Prevention Through Environmental Design (CPTED). This would include, for example, considering elements such as lighting, natural surveillance and visibility, and building design.

It is recommended that universal design principles are applied to ensure accessibility to the range of park facilities and amenities for people with disabilities.

Overall, the BOPDHB is in support of the Maramatanga Park plan as in general it will have a positive impact on health and wellbeing. The recommendations provided above will further enhance the health and wellbeing benefits and help mitigate or reduce any potential negative impacts. We do not wish to speak in support of this submission at a public hearing. Helen Mason Chief Executive Officer Bay of Plenty District Health Board The primary contact for this submission is: Dr Neil de Wet Medical Officer of Health Toi Te Ora Public Health Phone: 0800 221 555 [email protected]

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mailto:[email protected]

References: 1. Regional Public Health (2010). Healthy Open Spaces: A summary of the Impact of Open Spaces

on Health and Wellbeing. http://www.rph.org.nz/content/d893f45e-9d35-4906-bde7-c4912036c97e.cmr.

2. Toi Te Ora – Public Health Service (2016). Issues of Health and Wellbeing Population Survey

2016. http://www.ttophs.govt.nz/vdb/document/1765.

3. Medical Officer of Health Report (June 2017). Health for All – an essential transition in our thinking. https://www.ttophs.govt.nz/vdb/document/1821.

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http://www.rph.org.nz/content/d893f45e-9d35-4906-bde7-c4912036c97e.cmr

http://www.rph.org.nz/content/d893f45e-9d35-4906-bde7-c4912036c97e.cmr

http://www.ttophs.govt.nz/vdb/document/1765

https://www.ttophs.govt.nz/vdb/document/1821

Documents

Agenda Bay of Plenty District Health Board · 2017-09-15 · Agenda . Bay of Plenty District Health Board. Venue: Waipuna Hospice, 43 Te Puna Station Road, R D 6, Tauranga . Date