Counties Manukau District Health Board Community & Public ...€¦ · Wednesday, 27 May 2015 at 1.30pm – 4.30pm, Manukau Boardroom, Lambie Drive. Time Item Page No 1.30pm – 1.35pm

Counties Manukau District Health Board Community & Public Health Advisory Committee Meeting Agenda

Wednesday, 27 May 2015 at 1.30pm – 4.30pm, Manukau Boardroom, Lambie Drive

Time Item Page No

1.30pm – 1.35pm 1.0 Welcome

1.35pm – 1.45pm 2.0 Governance 2.1 Attendance & Apologies 2.2 Disclosure of Interests/Specific Interest 2.3 Acronyms 2.4 Confirmation of Public Minutes (15 April 2015) 2.5 Action Items Register Public

2 3-7 8 9-15 16-17

1.45pm – 2.15pm 2.15pm – 2.45pm

3.0 Presentations 3.1 St John’s 111 Clinical Hub Update – Jo Goodfellow 3.2 Community Health Presentation - Franklin Nurses

- -

2.45pm – 3.00pm Afternoon Tea

3.00pm – 3.45pm

3.05pm – 3.15pm

4.0 Director of Primary Health & Community Services Report – Lynda Irvine Glossary/Contents / Executive Summary/Actions from previous CPHAC meeting/s 4.1 National Health Targets/Cervical Screening Action Plan –

Louise McCarthy 4.2 Primary Health 4.3 Child Youth & Maternity 4.4 Mental Health & Addictions 4.5 Adult Rehabilitation & Health of Older People 4.6 Intersectoral Initiatives 4.7 Progress with Systems Integration 4.8 Locality Reports – Lynda Irvine 4.9 Financial Report

18-20

21-32

33-37 38-41 42-44 45-49 50-51 52-54 55-61 62-63

3.45pm – 4.15pm

5.0 Presentations (contd) 5.1 Contraception Pathway Vasectomy Pilot – Dr Sarah

Tout & Anna-Maree Harris

-

6.0 Resolution to Exclude the Public 64

4.15pm –4.20pm 7.0 Confidential Items 7.1 Confirmation of Confidential Minutes (15 April 2015)

65-71

Next Meeting: Wednesday 8 July 2015, Lambie Drive

Counties Manukau District Health Board – Community & Public Health Advisory Committee Agenda

2

BOARD MEMBER ATTENDANCE SCHEDULE 2015 – CPHAC

Name

21 Jan Feb 4 Mar 15 Apr 27 May June 8 July 19 Aug 30 Sept Oct 11 Nov 16 Dec

Lee Mathias (Board Chair)

No

Mee

ting

No

Mee

ting

No

Mee

ting

Colleen Brown

Sandra Alofivae (CPHAC Chair)

X

David Collings

George Ngatai

X X X

Dianne Glenn

Reece Autagavaia

Mr Sefita Hao’uli

Ms Wendy Bremner

X

Mr Ezekiel Robson

Mr John Wong

3

COMMITTEE MEMBERS’ DISCLOSURE OF INTERESTS

27 May 2015

Member Disclosure of Interest

Dr Lee Mathias, Chair • Chair Health Promotion Agency • Deputy Chair Auckland District Health Board • Director, Pictor Limited • Director, iAC Limited • Advisory Chair, Company of Women Limited • Director, John Seabrook Holdings Limited • Chairman, Unitec • External Advisor, National Health Committee • Director, Health Innovation Hub • Director, healthAlliance Ltd • Director, healthAlliance (FPSC) Ltd • MD Lee Mathias Limited • Trustee, Lee Mathias Family Trust • Trustee, Awamoana Family Trust • Trustee, Mathias Martin Family Trust

Colleen Brown • Chair, Disability Connect (Auckland Metropolitan Area)

• Member of Advisory Committee for Disability Programme Manukau Institute of Technology

• Member NZ Down Syndrome Association • Husband, Determination Referee for Department of

Building and Housing • Chair IIMuch Trust • Director, Charlie Starling Production Ltd • Member, Auckland Council Disability Advisory Panel

Sandra Alofivae

• Member, Fonua Ola Board • Board Member, Pasefika Futures

David Collings

• Chair, Howick Local Board of Auckland Council • Member Auckland Council Southern Initiative

Dianne Glenn

• Member – NZ Institute of Directors • Member – District Licensing Committee of Auckland

Council • Life Member – Business and Professional Women

Franklin • Member – UN Women Aotearoa/NZ • Vice President – Friends of Auckland Botanic

Gardens and Member of the Friends Trust • Life Member – Ambury Park Centre for Riding

4

Therapy Inc. • CMDHB Representative - Franklin Health

Forum/Franklin Locality Clinical Partnership • Vice President, National Council of Women of New

Zealand George Ngatai

• Arthritis NZ – Kaiwhakahaere • Chair Safer Aotearoa Family Violence Prevention

Network • Director Transitioning Out Aotearoa • Director BDO Marketing • Board Member, Manurewa Marae • Conservation Volunteers New Zealand • Maori Gout Action Group • Nga Ngaru Rautahi o Aotearoa Board

Reece Autagavaia • Member, Pacific Lawyers’ Association • Member, Labour Party • Member, Auckland Council Pacific People’s Advisory

Panel • Member, Tangata o le Moana Steering Group • Employed by Tamaki Legal • Board Member, Governance Board, Fatugatiti Aoga

Amata Preschool Sefita Hao’uli

• Trustee Te Papapa Pre-school Trust Board • Member Tonga Business Association & Tonga

Business Council • Member ASH Board • Board member, Pacific Education Centre Advisory roles: • Tongan Community Suicide Prevention Project (MoH) • Tala Pasifika (NZ Heart Foundation Pacific Tobacco

Control) • Member Pacific People’s Advisory Panel, Auckland

Council Consultant: • Government of Tonga: Manage RSE scheme in NZ • NZ Translation Centre: Translates government and

health provider documents. • Promotus GSL on Rheumatic Fever campaign (HPA) • Taulanga U Society Rheumatic Fever Innovation

project (MoH) Ezekiel Robson

• Department of Internal Affairs Community Organisation Grants Scheme Papakura/Franklin Local Distribution Committee

• Be.Institute/Be.Accessible ‘Be.Leadership 2011’ Alumni

• Member, CM Health Patient & Whaanau Centred Care Consumer Council

Wendy Bremner

• CEO Age Concern Counties Manukau Inc • Member of Health Promotion Advisory Group (7 Age

Concerns funded by MOH)

5

John Wong

• Director, Asian Family Services at The Problem Gambling Foundation of New Zealand (PGF), also part of the PGF national management team

• Member, National Minimising Gambling Harm Advisory Group

• Chairman and Trustee, Chinese Positive Ageing Charitable

• Chairman, Chinese Social Workers Interest Group of the Aotearoa New Zealand Association of Social Workers

• Chairman, The Asian Health network of East Health Trust

• Founding member and council member, Asian Network Incorporation (TANI)

• Board member, Auckland District Police Asian Advisory Board

• Member, Auckland and Waitemata DHBs Suicide Prevention Advisory Group

• Board member, Manukau Institute of Technology (MIT) Chinese Community Advisory Group

• Member, CADS Asian Counselling Service Reference Group

• Member, Waitemata DHB Asian Mental Health & Addiction Governance Group

• Member, Older People Advisory Group (ACC) • Member, University of Auckland Social Work Advisory

Group • Member, Community Advisory Group of Health Care

New Zealand • Member, Auckland Regional Public Health Service –

Asian Public Health External Reference Group

6

COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE MEMBERS REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS

Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 27 May 2015 Director having interest Interest in Particulars of interest Disclosure date Board Action Mr George Ngatai

CMH Quit Bus Mr Ngatai is a Director of Transitioning Out Aotearoa who is a partner provider along with CMDHB and Waitemata PHO in the Quit Bus.

26 March 2014 That Mr Ngatai’s specific interest is noted and the Committee agree that he may remain in the room and participate in any deliberations of the Committee but is not permitted to participate in any decision making.

Mr Sefita Hao’uli

Rheumatic Fever national campaign

Mr Hao’uli is currently undertaking some work with the Ministry of Health on the Pacific campaign on Rheumatic Fever.

Updated 21 January 2015

That Mr Hao’uli’s specific interest is noted and the Committee agree that he may remain in the room and participate in any deliberations of the Committee but is not permitted to participate in any decision making.

Mr Geraint Martin

Renewal of the Regional After Hours Agreement

Mr Martin’s wife is the Executive Director of Takanini Care Medical Services Limited Partnership. The company comprises 2 A&M clinics and 2 general practices at the same location.

21 May 2014 and 20 August 2014

That Mr Martin’s specific interest is noted and the Committee agree that he may participate in the deliberations of the Committee in relation to this matter because he is able to assist the Committee with relevant information, but is not permitted to participate in any decision making.

Ms Colleen Brown Richmond NZ Trust Ltd Ms Colleen Brown has been involved with the family involved with this Trust.

22 October 2014 That Ms Brown’s specific interest is noted and the Committee agree that she may remain in the room and participate in any deliberations of the Committee in relation to this matter because she is able to assist the Committee with relevant information, but is not permitted to participate in any decision making.

7

Director having interest Interest in Particulars of interest Disclosure date Board Action Mr Sefita Hao’uli Alliance Health+

Mr Hao’uli is currently undertaking some work for AH+.

4 March 2015 That Mr Hao’uli’s specific interest is noted and the Committee agree that he may remain in the room and participate in any deliberations of the Committee but is not permitted to participate in any decision making.

Dr Lee Mathias Otahuhu Boundary Change Dr Mathias is the Deputy Chair of ADHB.

4 March 2015 That Dr Mathias’ specific interest is noted and the Committee agree that she may remain in the room and participate in any deliberations of the Committee but is not permitted to participate in any decision making.

Ms Dianne Glenn

Auckland Region Public Health Service update report

Ms Glenn is a member of the District Licensing Committee of Auckland Council

15 April 2015 That Ms Glenn’s specific interest is noted and the Committee agree that she may remain in the room and participate in any deliberations of the Committee but is not permitted to participate in any decision making.

8

Glossary

ACC Accident Compensation Commission ADU Assessment and Diagnostic Unit ARDS Auckland Regional Dental Service CADS Community Alcohol, Drug and Addictions Service CAMHS Child, Adolescent Mental Health Service CNM Charge Nurse Manager CT Computerised Tomography CW&F Child, Women and Family service DNA Did not attend ESPI Elective Services Performance Indicators FSA First Specialist Assessment (outpatients) FTE Full Time Equivalent ICU Intensive Care Unit MHSG Mental Health service group MoH Ministry of Health MTD Month To Date MOSS Medical Officer Special Scale OHBC Oral health business case ORL Otorhinolaryngology (ear, nose, and throat) PACU Post-operative Acute Care Unit PHO Primary Health Organisation PoC Point of Care SCBU Special care baby unit SMO Senior Medical Officer SSU Sterile Services Unit TLA Territorial Locality Areas WIES Weighted Inlier Equivalent Separations YTD Year To Date

9

Minutes of the meeting of the Counties Manukau District Health Board

Community & Public Health Advisory Committee Wednesday 15 April 2015

held at Counties Manukau Health Boardroom, 19 Lambie Drive, Manukau

commencing 1.30pm

COMMITTEE MEMBERS PRESENT: Dr Lee Mathias (Board Chair) Ms Colleen Brown (acting Committee Chair) Mr David Collings Ms Dianne Glenn Mr Apulu Reece Autagavaia Mr Sefita Hao’uli Ms Wendy Bremner Mr Ezekiel Robson Mr John Wong

ALSO PRESENT:

Mr Geraint Martin (Chief Executive) Ms Margie Apa (Director, Strategic Development) Mr Benedict Hefford (Director, Primary Health & Community Services Dr Campbell Brebner (Chief Medical Advisor, Primary Care) Ms Karyn Sangster (Chief Nurse Advisor, Primary & Integrated Care) Charlie Saunders, Franklin Family Support attended the Public section of the meeting.

APOLOGIES: Apologies were received and accepted from Mr George Ngatai, Ms Sandra Alofivae and Ms Margie Apa (for lateness). WELCOME The Chair opened the meeting with some reflections on everyone who has been

in the field of war in relation to a number of conflicts that New Zealand has been involved in and the upcoming commemorations for Anzac Day.

2.2 DISCLOSURE OF INTERESTS The Disclosures of Interest were noted with no amendments. 2.2 SPECIFIC INTERESTS The Committee noted Ms Dianne Glenn’s specific interest in relation to Item 5.1 on this agenda. 2.3 ACRONYMS The acronym list was noted with no amendments.

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2.4 CONFIRMATION OF PREVIOUS MINUTES Confirmation of the public minutes of the Counties Manukau Community & Public Health Advisory Committee meeting held 4th March 2015. Resolution (Moved Ms Colleen Brown/Seconded Mr David Collings) That the public minutes of the Counties Manukau Health Community & Public Health Advisory Committee meeting held on 4th March be approved. Carried 2.5 ACTION ITEMS REGISTER Resolution (Moved Ms Colleen Brown/Seconded Dr Lee Mathias) That the Action Items Register of the Counties Manukau Health Community & Public Health Advisory Committee be received. Carried 3. PRESENTATION 3.1 Strategy Refresh Update Ms Marianne Scott took the Committee through her presentation. A copy of the presentation is available on the CMH website. Healthy Together • Risk that priorities get lost in the desire to ‘be fair to everyone’ Healthy Communities • This is not a mission that clinicians and primary care in isolation can achieve; but do need

to understand their unique position in relation to healthy communities • How health partners with communities is important, as their leadership is key to

successful outcomes • Some communities are more ready than others to take a leadership role in this • Health’s role may be in bring different social sectors agencies together to support

communities to lead • How do we engage communities to get their input – need to target this 3.2 Integrated Care - Tahuna Pa Marae Clinic Ms Joanne Eustace, Practice Nurse, Waiuku Health Centre took the Committee through her presentation; Ms Jackie Burton, Practice Manager and Ms Pam Morley, Nurse Manager also attended. A copy of the presentation is available on the CMH website. In 2009, the Waiuku Health Centre was successful in an application for a grant from the Rural Innovation Fund for $50k to develop and establish a free marae-based service at the Tahuna Pa Marae. The Tahuna Pa Marae is the hub of the Iwi - people live, work and congregate there.

11

The aims of the clinic are to improve health literacy, immunisation rates, cervical and breast screening rates and to forge stronger ties with the local Iwi. Clinics are now held one morning a week on a Thursday, there are no pre-booked closed door 15 minute consultations, the doors are kept open whilst the clinic is running and people are always welcome. The clinics sees approximately 600 patients per year (17-20 consultations per clinic); perform 100 smears per year and between 200-300 CVD risk assessments. CVD assessments rates for women aged >45years is 78% and men aged >35years 87%. The clinic is currently planning a Tamariki Pamper Day to get immunisation rates up. The Chair thanked the presenters for their very informative presentation. 4.0 DIRECTOR’S REPORT Mr Hefford took the Committee through the Director’s report. (Ms Margie Apa arrived at 2.34pm) 4.1 National Health & IPIF Targets Mr Hefford took the Committee through this section of the Director’s report. Cervical Screening –we now have a regional action plan, a DHB action plan was agreed by the Alliance at their last meeting and all PHOs are submitting their own individual action plans which follow out of that. We are appointing a cervical screening coordinator and have additional screening smears funded and looking at putting screening clinics back into the hospital. The data-flows from NSU have been an issue in the past but they have now caught up to where they need to be. 3rd quarter results (to end March) are due within the next week. 4.2 Primary Health Mr Hefford took the Committee through this section of the Director’s report. Regional After Hours Network – a draft procurement plan is in the final stages of approval by the members of the PHO and DHB subgroup and their relevant organisations. We are moving through very carefully with full legal and probity advice. Requests for proposals close 1st May which will result in some decisions being made in May for implementation within six months depending on which providers are selected and where. In the meantime we need to implement the free under 13year consultations from 1 July which applies to after hours and pharmacy as well. Pharmacy – the new community pharmacy services contract is moving to a new model where the emphasis is on Medicine & Caring Support (ie) helping people with long term chronic conditions to understand their medications, make sure they are taking them and put a plan in place if they are not. We are trying to move the entire country from the old model to the new model - the impact overall is effectively zero financially but for some individual pharmacies it can make quite a difference depending on the population they serve and how many prescriptions they used to give out. The new contract is in place and well embedded and looks like we have settled on a 1% increase for the new financial year. The Committee asked for an in-depth update on the new Community Pharmacy Services Agreement at its next meeting on 27th May.

12

4.3 Child Youth & Maternity Ms Carmel Ellis, Project Manager took the Committee through this section of the Director’s Report. Safe Sleep Devices –Ms Mulligan, Safe Sleep Coordinator brought along a pepi pod and a whahakura for the Committee to view. The pepi-pods are given out to mums that meet a certain criteria with a new baby and the whahakura are individually hand woven and are made by the mum during her antenatal period. Rheumatic Fever –it was noted that the latest census shows our population numbers are down in some areas from the previous census (the high socio-economic deprivation areas) and this is where a lot of our Rheumatic Fever support is going. Mr Martin undertook to talk with the Population Health team about undertaking a correlation between the census data and the numbers of children in the school data and report back to the Committee. 4.4 Mental Health & Addictions Ms Tess Ahern, General Manager, Mental Health took the Committee through this section of the Director’s Report. Suicide Prevention Planning – a new suicide prevention plan for 2016 is being formulated utilising current statistical data and evidence based practice to ensure the plan has a clear intervention logic. The Committee asked for the updated Plan to be presented to CPHAC when available. Intake & Assessment After Hours Consultant Roster – this new initiative continues to operate successfully and has now become standard practice. The advantages include being able to conduct mental health assessments with senior medical staff in the evenings which has led to better quality decision making with fewer admissions to Tiaho Mai solely for assessment purposes. 4.5 Adult Rehabilitation & Health of Older People The report was taken as read. 4.6 Intersectoral Initiatives Ms Jude Woolston, Project Manager took the Committee through this section of the Director’s Report. Warm Up Counties Manukau – the number of referrals has exceeded our target (1000) by 123 with 859 of those homes already insulated. We target deprivation 9 and 10 areas in order to reach low income families with high health needs. The home visit is voluntary and separate to the automatic post-installation audit which assesses the quality of every installation. (Mr David Collings left at 3.43pm) 4.7 Progress with Systems Integration Mr Hefford took the Committee through this section of the Director’s report. Community Health Service Integration – the focus this month has been on completing the draft of a Case for Change document that outlines the new model of care for community services. Will be looking to bring the Business Case through CPHAC to the Board in the next couple of months.

13

At Risk Individuals – since the last report, another 2000 patients have enrolled. We are now just touching on 7000 enrolled patients which is getting close to where we wanted to be. A development plan has been agreed to expand the programme to specifically incorporate diabetes care. 4.8 Locality Reports The report was taken as read. 4.9 Financial Report Mr Hefford took the Committee through this section of the Director’s report. There was a brief discussion on the reduction of rest home admissions and whether this was because of the Inter- Rai assessment or whether it is because there is better support being provided sooner in people’s homes. The Committee asked that some time be set aside at the next meeting to discuss Aged Residential Care in more detail. Resolution That the Community & Public Health Advisory Committee receive the report of the Director Primary Health & Community Services Carried 5.0 FOR INFORMATION 5.1 Auckland Region Public Health Service Update Ms Jane McEntee and Ms Julia Peters, ARPHs took the Committee through their report. This report gave an update since the last ARPHs report on 9th September 2014 and provided a brief on a range of work currently underway covering:

1. Input to the draft Auckland Unitary Plan 2. Policy submissions made by ARPHS 3. Action on Alcohol - Regional Plan 4. Healthy Eating and Physical Activity in the Auckland region – update on the Healthy

Auckland Together project 5. Smokefree Intersectoral Project update 6. Tobacco programme – Controlled Purchase Operations (CPOs) 7. Social and Emergency Housing Stocktake

After some discussion in relation to the immunisation of migrants coming into New Zealand who are not immunised for chickenpox and therefore may be at risk, Ms Peters confirmed that this was not currently on the ARHPs schedule of work however, she undertook to raise the topic with the Ministry of Health at their next scheduled meeting. The Committee asked ARPHs if they would provide for a further update in six months’ time. Resolution (Moved Ms Colleen Brown/Seconded Apulu Reece Autagavaia)

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That the Community & Public Health Advisory Committee receive the report of the Auckland Region Public Health Service Carried 6.0 RESOLUTION TO EXCLUDE THE PUBLIC Resolution (Moved Ms Colleen Brown/Seconded Dr Lee Mathias) That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

7.1 Minutes of the CPHAC Meeting with public excluded 4 March 2015

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

Confirmation of Minutes For the reasons given in the previous meeting.

7.2 Action Items Register Confidential

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32 (a)]

Action Items Register For the reasons given in the previous meeting.

Carried 4.37pm Public excluded session. 4.39pm Open meeting resumed. The meeting concluded at 4.40pm.

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The minutes of the Counties Manukau Community & Public Health Advisory Committee meeting held 15th April 2015 be approved. (Moved /Seconded ) Acting Chair Ms Colleen Brown Date

Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.

16

Community & Public Health Advisory Committee Meeting – Action Items Register – 27 May 2015 DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

26.2.2014 4.0 Update from Auckland Regional Public Health

Service every 6 months on current issues. 30 September Mr Hefford

20.8.2014 3.1 Follow-up presentation on the St John’s 111 Clinical Hub

27 May Mr Hefford

22.10.14 4.0 Director’s Report –The Committee would like to hear from some of the staff/people out in the community at the cutting end of change who are actually doing the work (ie) where they’re at with their refreshed job descriptions, the changes in the traditional models, the authority and accountability that’s come with this change - 20min presentations spread over a few months. Some examples given were: a nurse practitioner doing work on a marae, a district nurse, a practice nurse doing care coordination and how things are different in practices now.

27 May

Mr Hefford/Ms Sangster

26.11.2014 5.0 Mr Nia Nia to provide an update on the NHC integrated service agreement work.

Date TBC Mr Hefford/Ms Apa

Deferred pending further work being undertaken.

15.4.2015 4.2 Primary Health – update on the new Community Pharmacy Services Agreement.

27 May/8 July Mr Hefford

15.4.2015 4.3 Rheumatic Fever – Pop. Health to undertake a correlation of the children involved in our RF programme to see if the data for those children in the low decile schools matches the census data.

8 July Mr Martin/Dr Winnard

15.4.2014 4.4 Mental Health & Addictions – new 2016 suicide prevention plan to be presented to CPHAC when available.

Date TBC Mr Hefford/Ms Ahern

15.4.2015 4.5 ARHoP – Aged Residential care deep dive discussion.

27 May/8 July

Mr Hefford

Transferred from HAC 25.3.15

Patient Safety Report – VHIU – Discuss with Dr Harry Rea and report back on how many of the

Pending

Mr Martin This item transferred from HAC - Mr Martin has met with Dr

Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.

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DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

2000 patients in top section of the triangle would no longer be there now due to them moving down into the ARI category.

Rea. A report will come to CPHAC on this issue.


Mr Martin to report back on whether Ward 9 has achieved a world record by having no CLAB for over 1392 days.

Pending Mr Martin/Prof. Gray

This item transferred from HAC - this has been referred to Ko Awatea (Prof. Jonathon Gray) for a response back to CPHAC.


Birth numbers over the last 2 years and the impact this is having on our services & access; teenage pregnancy numbers increasing/decreasing?

8 July Dr Winnard This item transferred from HAC – this has been referred to Pop Health for a response back to CPHAC.


Contraception Pathway presentation including the Vasectomy pilot.

27 May Ms Knetsch, Dr Sarah Tout, Anna-Maree Harris

This item transferred from HAC – Ms Knetsch to follow up and report back to CPHAC.

Sheri-Lyn Purdy - Clinical Manager – Clinical Control Services

Jo Goodfellow – Clinical Development Manager

St John Historical Service Delivery Model

111 Call

Handler -

ProQA

Dispatcher-

Available

Resource &

Skill Match

ED

Purple Calls - Cardiac Arrest (8min urban, 12min rural)

Red Calls - Life threatening (8min urban, 12min rural)

Orange Calls – Potentially Serious (20min urban, 30min rural)

Green Calls – Not Life Threatening (up to 2 hours)

Grey Calls – low acuity (up to 2 hours)

Ambulance

Self-Care

GP

A & M

St John New Service Delivery Model

111

Call Handler

Assesses Call

using - ProQA

Dispatcher-

Available

Resource &

Skill Match

Clinical Hub Nurse Call

Patient back

within 30min

Nurse conducts

Clinical Telephone

Assessment using

Odyssey Tool

Self-Care

GP

A & M

Purple Calls - Cardiac Arrest (8min urban, 12min rural)

Red Calls - Life threatening (8min urban, 12min rural)

Orange Calls – Potentially Serious (20min urban, 30min rural)

Green Calls – Not Life Threatening (>2 hours)

All Grey/ Some Green Calls within the Auckland DHB– low acuity

(called back within 30min)

Clinical Advisors Review/Reprioritise higher

acuity calls

Ambulance

sent

Clinical

Advisor Calls

Patient back Clinical Hub

Clinical Advisor

Reprioritises as

necessary

Clinical Advisor

conducts Clinical

Telephone

Assessment using

MTS Toll

111 Clinical Hub

Right Care/Right Time

24/7 Ambulance 111 Clinical Hub with paramedics

and registered nurses

Provide enhanced clinical telephone assessment of

low acuity calls within Auckland’s DHB region

Assigns a clinically determined response which

reflects clinical priority and skill mix required

Robust clinical governance activities

1/07/2014 – 1/04/2015 - 3684 patients have been

referred to GP/A&M clinic – average 13.5/day

Undergoing clinical audit with DHBs and primary care

external stakeholders

Performance to Date

Clinical Hub Operational Effectiveness Summary

Since July 1, within Auckland Clinical Hub

Mobilised ED Transports 9628 44.18%

32.57% Incidents without

moblised dispatch

67.43%Incidents with

mobilised

responses Self transport to ED 629 2.89%

Total ED 10257 47.07%

23.27%Total Managed

by CTA 13.00%

Total

unmanaged

outcomes 14.21%Total Treated on

scene 2.45%

Total

Transported to

non-ED facilities

Response

mobilised

21791

Incidents

7097

No response sent

14694

534Transported to

non-ED5071Clinical

Redirection 2833Outcomes

unmanaged 3096Treated on

scene

Call Volume through the Clinical Hub

Call back

Clinical TelephoneAdvice Responded

Mobilised responseTransported Emergency

Department

Clinical HubRedirected

Redirection notmanaged (e.g. cancellations, refused)

See & treat on scene

Transport to non-Emergency Department

Currently +103 against trajectory towards 6,000 MOH targets for ED reduction by ambulance

• 1298 incidents triaged to Clinical Hub.

• 331 self care.

• 782 transported to ED

• 36 transported to non ED

• 171 treat on scene.

• 78 cancelled

Clinical Hub – Referral to

GP/A&M

0

50

100

150

200

250

300

350

400

450

500

Jul Aug Sep Oct Nov Dec Jan Feb Mar

Clinical Hubs - Patients Referred to GP/A&M

105 CTA Routine GP Visit

104 CTA Care within 24 hours




Patient Case Study 82 year old male, long-term Indwelling Catheter

• History of urinary discomfort

• Called 3 times in 3 months for same complaint

unscheduled ED presentation each time by

ambulance

• Underwent Clinical Telephone Assessment by

RN

• RN contacted District Nurse service

• DN attended

– Replaced IDC

– Opportunity to provide needed face-to-

face clinical education to patient

– Planned follow up negated unscheduled

hospital attendance

There when you really need us

Summary of Impact

98,300 Incidents received within

Auckland

98,000 responses to scene

66,100 responses transported to ED

2,200 more than

forecast

18,000 incidents contacted

18% of calls

1. Released capacity2. Assisting to improve responses to high acuity calls3. LTSA break compliance improvement

1. Improved collaboration with DHB, Primary Care and A&Ms on systems, access and pathways2. Reduced actual ED attendance3. Enhanced patient-centric management plans for frequent users

Quality Systems for Clinical Hub • Clinical Audit in progress

– 101 patients who were managed in clinical hub without a response but

presented in ED up to 7 days afterwards

– Co-ordinated with Tom Robinson (WDHB/ADHB) and Wing Cheuk Chan( CMH)

and Sapere Research Group.

– 2 DHB representatives + Primary Care Representative

• Routine clinical reviews and monitoring of incidents, with

call audits completed against all complaints and 10%

sample.

• Patient satisfaction survey conducted weekly with

consumerlink on 3% of patients

Experience.

All Users: YTD

n = 362

Supporters’ Scheme: YTD

n = 110

Medical Alarm: YTD

n = 21

Ambulance sent: YTD

n = 212

Ambulance not sent: YTD

n = 150

Q13 [cont’d]: On a scale of 1-5, overall, how satisfied were you with your experience with the

St John Clinical Hub? Year-to-Date

St John Clinical Hub Users’ Satisfaction Monitor – April 2015

54%

22%

9%

4% 10%

1%

Very Satisfied

Satisfied

Neutral

Dissatisfied

Very Dissatisfied

Not sure/Can't remember

58% 24%

10%

2% 5% 1%

48%

19%

9%

6%

17%

1%

54%

17%

14%

5% 8%

2%

58% 13%

8%

4% 17%

Electronic Patient Records

ePRF – The outcomes

• Reliable, electronic capture of all emergency ambulance patient information in

one place

• St John ambulance officers with access to relevant patient and clinical

information in the field

• Improved sharing of case information with health partners (GPs, DHBs)

• Easier and more comprehensive analysis of case information

• Improved continuing clinical education for St John’s staff

ePRF will provide

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ePRF – Drivers for Change

Hard copy documentation is

outdated

We currently use a paper Patient Report Form:

• Ambulance officers hand write clinical and administrative details

There are a number of challenges and limitations with this:

• Lack of information at the ‘point of care’ – St John staff don’t have access to

any patient records or clinical information (e.g. allergies) when they attend a

job

• Poor communication with health partners – our manual system doesn’t link to

their electronic ones

• It is very difficult to retrieve case information for investigation or analysis or

learning

16

ePRF – Drivers for Change 2

Sharing electronic health information is best for patients

and for health

Electronic patient report forms are a key enabler to:

• Providing the right patient care as a result of having access to better patient

information at the point of care

• Helping us link our patients with alternative care pathways and other health

organisations

• Providing our first patient centric data repository to help inform our

performance and planning

• Having clear clinical data and being able to run robust systematic clinical

audits

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ePRF

The Benefits

A new ePRF system will address all of these problems and provide these

benefits:

• Improved patient outcomes – because of ‘joined up’, visible and full patient

information supporting better care at each visit

• Better professional development of our ambulance workforce – we can

learn from the anonymised case information we record; ambulance officers will

be able to access information on cases they have attended and skills they have

used, to support their own professional development

• More efficient ambulance operations – ambulance officers will no longer

need to hand write ACC forms

• A more effective health system – if we have more information about a patient,

we are better placed to link them to alternative pathways, and to reduce ED

admissions – and we’ll make better clinical decisions

• Value and solutions for our health partners – the population health data that

we collect over time will be valuable to health planning and budgeting

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ePRF

• ePRF will improve the quality and safety of our care and services and

patients’ experiences – because we’ll have better information that we can link

up with other health providers

• Other healthcare providers will also have access to our ePRF through their

own clinical information systems – they won’t need to use a new system

To summarise

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Clinical Developments

• Patient management plans

• Alternative Pathways

• Trained workforce

• Professional Registration

• ePRF

• ROSC – 33%

• Clinical Audit – Out of Hosp Cardiac Arrest Survival rates- 15%

• Maori Health

• Fallers - 8% of the EAS workload 4% of which is over 65 yrs

Thank you for your time

ePRF Screenshot

ePRF Screenshot

ePRF Screenshot

Franklin Primary Care Practices

May 2015

Positives: Patient perspective Appreciate the extra time

Feel more listened to & heard

Sharing of more in depth information - normally not time to discuss

Enjoy having a particular nurse to relate to

Care Coordinator is their point of contact

Builds trust

Grateful for the offer of support

Spread by word of mouth (patients already enrolled make recommendations about their friends/relatives/neighbours)

Positives: Nurse perspective Increased knowledge of patient story/Building a good

relationship Ability not only to identify but also offer support to vulnerable

cohorts Time to look at people holistically Improved patient outcomes e.g. HBA1C, health literacy Coordination of care, referrals, pivotal role MDT meetings: sharing of information, expertise, building

collegiality ARI has provided more focus and support from locality Networking with other disciplines & practices, sharing of

knowledge and resources e.g. assessment tools, useful care contacts.

Recognition of nurse input/time financially.

Practice Numbers Practice Total

population Target 3% Current

numbers Number needed

Pukekohe 19,500 605 531 74

Tuakau 7000 206 122 84

Waiuku 12,300 370 238 132

Pukekohe Family Health Care Some Successes in ARI at PFHC

Patient One: Diabetes support (Hba1c was 112 ) recent Hba1c was 89. Seeing nurse more frequently for education; taking medications 80% of the time; testing blood sugars ’s more frequently; has attended local SME course.

Patient Two: For support for various things but also had large debt at

practice. WINZ involved; patient has now paid off debt to practice -makes her feel less uncomfortable - reduced stress for her; more engaged with the primary care team.

Patient Three: Uncontrolled diabetes (HbA1C >100). Now taking insulin

after years of refusing; improved diet ; lost small amount of weight. –also support from external agency for housing that her Care-Coordinator arranged.

Further examples PFHC more ‘complex’

Patient One: 66 yr female; caregiver; lives alone. Severe COPD; high anxiety; neglects her early warning signs. Attending health psychologist sessions; better breathing course. Different perspective on family and health issues, anxiety reduced. We will see what winter brings..! Patient Two: Female Youth, self harming, high risk behaviors, socially isolated. Interventions: Whirinaki, counseling, sexual health input, parenting courses for family. Outcome: Positive & more happy, attending different school and has developed strong friendships, passing all subjects. No longer self harming and engaging with nurse and GP for her health needs

Tuakau Health Centre Case 1: 33yr old male lives with his partner, works long hours as a driver

of heavy machinery

Sept 2014 diagnosed T2DM – HbA1c 90; weight 112kg

Nov 2014 HbA1c 66; weight 109

May 2015 HbA1c 57; weight 109

Case 2: 64yr old male, married. Motivational speaker.

T2DM 2006. HbA1c steadily increasing along with weight. Recommended for insulin August/Sept 2014.

Resistant to change.

Oct 2014 agreed to enrol on ARI. Wanted to try and improve health without insulin.

THC cont’d Case 2

Date HbA1c Weight Waist Circ.

3/10/14 65 107 126

11/2/15 54 103 117

1/5/15 46 100 110

THC other 22 patients ‘graduated’ of these:

5 fragile elderly supported transition into long term care, & resulted in transfer to another practice.

15 palliative care patients supported in their last months/weeks/days

combined team from the practice/hospice/pharmacy.

funded GP & nurse home visits

care co-ordination through phone calls etc.

Case 3 Waiuku 76 year old male European Diabetes Mellitus Type 2 diagnosed 2004 Never smoked Regular medication Weight 85 BMI 26 HBA1C 73 Micro albumin 356 Elevated Lipids Enrolled ARI September 2014 Goal “To see my sugar graph go down by end of November”

Case 4 Waiuku 82 year old male European

Diabetes Mellitus Type 2 diagnosed 2007

Previous MI

AF

IHD

Ex smoker

Weight 76.5,

BMI 24.4

Enrolled ARI September 2014

Goal “To have two cooked meals a week”

ARI Cons Time constraints in and around all other practice nursing

responsibilities

Administration time and associated costs i.e. Set up/research history with new enrolment

Recalls/follow up appointments/keeping track

Engaging new patients to enrol

Quality Control/care plans and interventions

IT issues: Shared care not working at times, time wasting when already

pushed for time, entering goals & plans and they ‘disappear’.

Initial plan was not user friendly – now much improved but still some frustrating ‘outages’.

Future plans/goals for ARI Increase collaboration with GP’s

More sharing of care plans with other professionals/teams

Individual Case Loads, what is achievable and acceptable?

High Risk groups/complex families/children

Prevention of long term conditions i.e. diabetes/pre-diabetes

Ongoing training to up skill nurses

Palliative Care Model

18

Counties Manukau District Health Board Community & Public Health Advisory Committee

Recommendation It is recommended that the Community & Public Health Advisory Committee receive the report of the Director Primary Health & Community Services. Prepared and submitted by Benedict Hefford, Director Primary Health & Community Services Glossary of Terms

Acronyms Description A&D / AOD Alcohol and Drug ACP Advanced Care Plan AH+ Alliance Health Plus ARDS Auckland Regional Dental Service ARI At Risk Individuals ARPHS Auckland Regional Public Health Service ARRC Aged Related Residential Care AT&R Assessment, Treatment and Rehabilitation AWHHI Auckland Wide Healthy Housing Initiative B4SC Before School Checks CCM Chronic Care Management COPD Chronic Obstructive Pulmonary Disease CSW Community Support Worker DHS Director Hospital Services DNA Did Not Attend EOI Expression of Interest GAS+ Group A Streptococcal Positive GP General Practitioner hA healthAlliance HBSS Home Based Support Services HBT Home Based Community Team HHC Home Health Care HOP Health of Older People IDF Inter District Flows IFHC Integrated Family Health Centre IPIF Integrated Performance & Incentives Framework LTCF Long Term Conditions Facilities MOH Ministry of Health NGO Non-government organisation PHN Public Health Nurse POAC Primary Options to Acute Care PRIMHD Project for the integration of mental health data PSAAP Primary Services Agreement Amendment Protocol SUDI Sudden Unexplained Death of Infant VHIU Very High Intensive User VLCA Very Low Cost Access

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Contents 1. Actions from Previous CPHAC Meetings 2. National Health and Integrated Performance & Incentives Framework Targets 3. Primary Health 4. Child, Youth and Maternity 5. Mental Health and Addictions 6. Adult Rehabilitation & Health of Older People 7. Intersectoral Initiatives 8. Progress with Systems Integration 9. Locality Reports 10. Financial Report

Executive Summary • We remain largely on track for delivery of National Health Targets with focused activity in all

areas to ensure targets are met by June 2015. The cervical screening target for CM Health has been adjusted to 75% for June 2015, with achievement of the 80% target by June 2016. This was agreed by the Alliance Leadership team in recognition of the significant challenges involved in screening the approximately 11,000 women required to meet the 80% target. PHO’s and CM Health are working together on focused activity detailed in the Cervical Screening action plan to ensure this is achieved.

• The procurement process for the provision of the Auckland Metro After Hours service is well underway. A shortlist of providers is currently being selected by the evaluation panel. It is anticipated that the new service will be in place in late 2015, with the final timelines being determined by whether a closed request for proposals process is required. Approval from the Board is being sought to extend the contract with the current providers to February 2016 with the inclusion of a clause allowing for an earlier exit if required.

• The terms for extension of the Community Pharmacy Services Agreement have been finalised, with agreement to extend the existing contract by 12 months, and an option to extend it by a further 12 months if required. The contract is essentially the same except for the inclusion of zero fees for under 13’s. Funding will increase by 1.07% however Sector Agents have signalled they do not believe that this is sufficient to off-set cost pressures. As a consequence there is concern that pharmacies may not sign or may delay signing the contract extension. This is being closely monitored.

• An early engagement media campaign to socialise the importance of early pregnancy care started this month. The Maternity Consumer panel has been actively involved in the development of the strategies for this campaign, and providers and stakeholders have been engaged to ensure their participation and awareness. There are a vast array of promotional activities that have commenced including the launch of the www.bestforbaby.co.nz website, radio and newspaper promotions, social media advertising, and the engagement of midwives and primary care practices.

• The three year Oral Health Pilot for Women with Diabetes in Pregnancy is due to be completed in December this year. It has targeted high risk women with high deprivation, who are medically compromised and have complex social circumstances. Early evaluation suggests that there has been a noted improvement in oral health, and a positive impact on women’s own oral health knowledge and habits which has extended to their children and families.

• There are almost 8,000 patients now enrolled in the At Risk Individuals programme. 92 practices have transitioned to the programme with seven practices scheduled to transition this month. It is anticipated that the 3% minimum contracted volumes in the first year of implementation will be reached. Phase two of the programme being rolled out in 2015/16 has an increased focus on quality improvement within general practice.

http://www.bestforbaby.co.nz/

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1. Actions from Previous CPHAC Meetings Nil

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4.1 National Health and Integrated Performance & Incentives Framework Targets INDICATOR TABLE

Target

14/15 14/15 14/15 14/15

On Track Target Q1 Q2 Q3 More Heart and Diabetes Checks 90% 91.1% 91.3% 91.2% Yes

Better Help for Smokers to Quit 90% 98.0% 95.5% 95.1% Yes

Increased immunisations - 8 months 95% 95.0% 94.0% 93.0% Yes

Increased immunisations - 24 months 95% 96.0% 96.0% 95.0% Yes

Cervical Screening Coverage 75% 70.0% 71.5% N/A Improvement

required

Note: Monthly PHO cervical screening data is not available and Q3 National Cervical Screening Programme data is not available until late May 2015

Note: 14/15 Q3 Immunisation results are provisional only - Final Q3 Results expected 20 May 2015 PROGRESS Performance against the Integrated Performance & Incentives Framework targets (including National Health Targets) shows that focused activity is required to meet the target Cervical Screening Coverage by June 2015. PHOs are also currently applying additional coordination resource and capacity into cervical screening coverage. At the March 2015 CM Health Alliance Leadership Team meeting there was agreement that the CM Health target for three yearly cervical screening coverage is set at 75% for June 2015, with achievement of the 80% target by June 2016. This is in recognition of the significant challenges involved in screening the approximately 11,000 women in Counties Manukau required to meet the 80% target. PHOs, CM Health and other stakeholders are working closely together to make the best use of resources in the system to close the gap in cervical screening coverage, with a particular focus on Maaori, Asian and other high needs women. Activities to support this work are outlined in the CM Health Cervical Screening Action Plan which is attached as Appendix A to this report.

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More Heart and Diabetes Checks

Graph One: CM Health Cardiovascular Disease Risk Assessment Performance to April 2015

*Note that this data is preliminary only, based on calculation from PHO data

Historical Quarters Current Month

PHO 2015-Q1

2015-Q2

2015-Q3 Apr-15

Alliance Health Plus 90.5 89.9 92.0 89.0 East Health 90.8 91.1 90.4 90.3 NHC 89.4 88.6 87.7 87.4 ProCare 91.2 91.1 92.3 91.0 Total Healthcare 87.7 88.5 89.3 87.3 CMDHB 91.1 91.3 91.2 89.5 National 84.7 87.0 87.7 Target 90.0 90.0 90.0 90.0

Table Two: More Heart and Diabetes Checks Performance to April 2015 *Note that this data is preliminary only, based on PHO reporting

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Progress • The preliminary CM Health result for More Heart and Diabetes Checks for April is 89.5% • PHOs received additional funding earlier in the year to maintain and increase the skills of

practice nurses in phlebotomy to enhance collection of blood results for Cardio Vascular Disease Risk Assessment (HBA1c and Lipids).

• PHOs analyse the practice data weekly to determine which practices require assistance with the Cardio Vascular Disease Risk Assessment target and practice facilitators then connect with the practice to assist them to improve performance.

• A Continuing Medical Education session for primary care clinicians on all Integrated Performance & Incentives Framework targets including Cardio Vascular Disease Risk Assessment was held in March with a good turnout of General Practitioners from CM Health.

• Cell group education sessions are held for all PHOs. Benchmarking of performance is used as a learning opportunity for practices by PHOs.

• The CM Health monthly Integrated Performance & Incentives Framework meetings include a focus on the National Cardio Vascular Disease Risk Assessment target, where PHOs share issues and learning to assist each other to achieve the targets.

• PHOs also actively facilitate sharing of successful initiatives with other practices to assist poorer performing practices.

• PHOs continue to use practice advisors to assist practice staff to use the decision support tools and to collect data for Cardio Vascular Disease Risk Assessment.

• Non face-to- face assessments are conducted with the assistance of test safe (laboratory results) data.

• Initiatives including after-hours clinics, nurse led clinics, weekend clinics and the provision of transport for high needs patients are being offered by general practices.

• Improved data collection with systems enhancements such as ”Dr Info” – one click and appointment scanner functions, queries and recall systems enable more accurate reporting of data and identification of patients who are overdue for an assessment.

• CM Health has two clinical champions who assist PHOs and practices with initiatives to meet Integrated Performance & Incentives Framework targets.

• Exploration of the possibility of offering Cardio Vascular Disease Risk Assessment through pharmacies has begun. This would involve the use of Point of Care testing.

• PHOs frequently link with Non-Government Organisations e.g. The National Heart Foundation for resources and advice re Cardio Vascular Disease Risk Assessment.

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Better Help For Smokers To Quit

Historical Quarters

PHO 2015-Q1 2015-Q2 2015-Q3

Alliance Health Plus 91.0 89.0 94.7

East Health 100.0 98.0 95.5

NHC 91.0 89.0 81.4

ProCare 102.0 99.0 99.7

Total Healthcare 93.0 93.0 90.1

CMDHB 98.0 95.5 95.1

National 88.0 89.0 88.6

Target 90.0 90.0 90.0 Table three: Smoking Brief Advice and Cessation Support Total Population Performance Q3 2015 Progress PHOs are putting in extra resource and effort to offer brief advice to smokers during the months of May and June in order to reach the 90% target by the end of June. This is due to early indications of a drop off in the beginning of quarter four. This was expected as it is common for all indicators to drop at the beginning of the quarter. ProCare has noted that 2-3 times the volume needed this year was successfully delivered in Q4 last year to meet the 90% target. An outline of current activity to support smoking cessation and brief advice is provided below:

• There is continued focus on provision of cessation support by general practice teams, PHOs and other key stakeholders, in particular to refer smokers to local cessation support services tailored to the CM Health population.

• During the May – June months, PHOs have increased call centre activity and have put extra staff resource into supporting achievement of the target.

• A Primary Care smoking cessation coordinator position has been filled. This position will strengthen current work in practices to improve results and up-skill general practice staff in all areas of smoking cessation.

• PHOs received additional funding earlier in the year to assist them with call centre functions to offer brief advice and cessation support to current smokers.

• Face-to-face consultations and group cessation sessions are being offered to patients through general practice and PHO support services.

• Practice facilitators and PHO Smokefree Target Champions identify low performing practices and encourage these practices to implement quality processes that will ensure sustainable activity towards the 90% target.

• The CM Health Integrated Performance & Incentives Framework clinical champion continues to collaborate with and support the PHOs and practices to achieve the Smokefree target.

• All PHOs have representatives who attend the monthly CM Health Integrated Performance & Incentives Framework meetings where the targets are discussed. This is a forum where issues and initiatives can be shared amongst PHOs and the DHB, with the clinical champions, to improve results for the Smokefree target.

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• The Smokefree target was included in the March Continuing Medical Educantion session for primary care clinicians which covered all Integrated Performance & Incentives Framework targets. The turnout of GPs was encouraging, with around 40 attending.

Immunisations Childhood Immunisation – 8 months The 8-month immunisation target for 2014/15 requires 95% of all eligible children eight months of age to have completed their scheduled course of immunisation. Progress At the end of April, overall coverage was 95.3%. The following strategies have been implemented to ensure maintenance of coverage:-

• Introduction of free Saturday clinics at Manukau Superclinic, leveraging off Before School Clinics.

• Introduction of a traffic light system for children approaching their eight month milestone who have not been fully immunised

• Addressing the increased decline rate; decline Outreach Immunisation Service versus actual immunisation event.

• Ensure families are aware of the current measles and impending pertussis outbreaks. Childhood Immunisation – 8 months

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PHO 2015-Q1

2015-Q2

2015-Q3 Apr-15

Alliance Health Plus 96.0 96.0 95.3 East Health 97.0 97.0 95.7 NHC 95.0 96.0 87.2 ProCare 94.0 94.0 94.4 Total Healthcare 96.0 94.0 97.6 CMDHB 95.0 95.0 93.0 95.3 National 92.0 94.0 93.0 Target 95.0 95.0 95.0 95.0

Table Four: CM Health PHO 8 Month Immunisations Performance Total Population to April 2015 * 3 month data lag on National Performance due to national data assurance requirements. This data is provisional only. Final results are expected on 20 May. Childhood Immunisation – 24 months The 24-month child immunisations Integrated Performance & Incentives Framework Indicator requires 95% of all eligible children 24 months of age to have completed their scheduled course of immunisation. Progress At the end of April, overall coverage was 94.0%. The Outreach Immunisations Service teams have been redirected to concentrate on the eight month target and as a result we have seen a slight reduction in the 24 month coverage. Of note are the declines, which are up by 1.8%.

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PHO 2015-Q1

2015-Q2

2015-Q3 Apr-15

Alliance Health Plus 95.0 95.0 92.8 East Health 95.0 96.0 94.1 NHC 95.0 96.0 88.1 ProCare 93.0 94.0 94.9 Total Healthcare 95.0 95.0 94.0 CMDHB 96.0 96.0 95.0 94.0 National 92.0 94.0 93.0 Target 95.0 95.0 95.0 95.0

Table Five: CM Health PHO 24 Month Immunisations Performance Total Population to April 2015 * 3 month data lag on National Performance due to national data assurance requirements. This data is provisional only. Final results are expected on 20 May. Cervical Screening

Total 3 year

coverage Maori Pacific Asian European/Other

CMDHB 71.5% 62.0% 73.2% 61.3% 80.3% National 76.5% 62.5% 72.6% 62.2% 82.5% Table Six CM Health 3 Yearly Cervical Screening Coverage to Dec 2014

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Source: National Cervical Screening Programme Register – women aged 25-69 years Note: Monthly reporting on cervical screening coverage at PHO level is not able to be provided due to the inability of the National Screening Unit to provide the data. The National Screening Unit is also unable to provide a current report for the January – March 2015 period. Progress At the March 2015 CM Health Alliance Leadership Team meeting there was agreement that the CM Health target for three yearly cervical screening coverage is set at 75% for June 2015, with achievement of the 80% target by June 2016. This is in recognition of the challenges involved in screening the approximately 11,000 women in Counties Manukau needed to meet the 80% target. PHOs, CM Health and other stakeholders are working closely together to make the best use of resources in the system to close the gap in cervical screening coverage, with a particular focus on Maaori, Asian and other high needs women. A summary of current planning and activities is provided below: • CM Health has agreed to provide PHOs with funding to support achievement of the agreed

targets. The funding is attached to ‘cervical screening coordination’ contracts which include the following:

o Requirement for PHOs to meet cervical screening targets. o All PHOs to develop and implement a cervical screening action plan. This plan must align

with the CM Health Cervical Screening Action Plan which has been developed with input from PHOs, the DHB and other stakeholders. The plan is attached as Appendix A to this report.

o Requirement for PHOs to implement a range of activities to support improved uptake of smears for women who are overdue for their smears, including:

- Better systems in the practice team for identifying if a women who attends for another health issue, is overdue for a smear, then offering a smear or setting an appointment.

- Promotions, weekend and after hours clinics, incentives, prizes and other community-based clinics, e.g. marae, community centres, churches etc.

- Improved systems to identify women who are overdue for their smear or who have never had a smear, then targeting activity at those women.

- Referral pathways between general practice teams and community providers to engage women who have difficulty in attending a clinic to complete a smear.

• CM Health has employed a Nurse who will work with PHOs and low-performing practices to support quality improvement and recalls and invites for women who are overdue for a smear, with a focus on Maaori, Asian and high needs women.

CM Health is working closely with the National Screening Unit to improve primary care access to cervical screening data, which will help PHOs to more accurately and proactively identify enrolled, eligible women who are overdue for a smear.

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4.1 Counties Manukau Health Cervical Screening Action Plan

1 April 2015 – 30 June 2016

Introduction

The Counties Manukau Health (CM Health) Cervical Screening Action Plan has been developed with input from primary care and DHB stakeholders. The plan is aligned with Metro Auckland Cervical Screening Advisory Group (MACSAG) strategic objectives and the Auckland Regional Cervical Screening Coordination Service work programme. The CM Health Cervical Screening Action Plan will inform development of CM Health PHO-level Cervical Screening Action Plans. The plans in turn will support achievement of quarterly targets to meet the 80 per cent three yearly cervical screening coverage targets for both Total Population and High Needs groups in CM Health by June 2016 (Table 1). The targets were agreed by the CM Health Alliance Leadership Team in March 2015 and will be included in each PHO’s cervical screening action plan. In addition, PHO plans will be required to identify the number of women that currently need to be screened to meet the 80% targets. Targets will also need to be set for achievement of actual numbers to be screened on a quarterly basis. Table 1 CMDHB Cervical Screening Interim Targets to meet the 80% Three Yearly Coverage Target by June 2016 Q4 14-15 Q1 15-16 Q2 15-16 Q3 15-16 Q4 15-16 Total Population 75.0% 75.5% 77.5% 79.0% 80.0% High Needs 68.0% 72.0% 75.0% 78.5% 80.0% Objective Action Milestone Responsibility 1. Enhance

accountabilities, coordination and planning amongst PHOs, CMDHB and other relevant stakeholders to achieve the 80% cervical screening coverage targets in CM Health by June 2016.

CM Health Cervical Screening Action Plan is aligned with the MACSAG Strategic Plan and the Auckland Regional Cervical Screening Coordination Service Operational Plan.

Regional cervical screening priorities and actions are met.

CMDHB (Primary Care Team)

PHOs to produce detailed plans for the April 2015 – June 2016 period to include:

(a) interim targets to achieve 80% coverage for total population and high needs in line with CM Health interim targets

(b) actions to improve cervical screening coverage which demonstrate alignment with actions and milestones in the CM Health Cervical Screening Action Plan.

(c) actions specifically focused on improving cervical screening coverage rates for Maaori and Asian groups

PHO cervical screening action plans submitted to CMDHB for review by 10 May 2015. Interim targets to achieve 80% are met Improved coverage rates compared to baseline Improved screening coverage rates for Asian and Maaori groups.

CM Health PHOs CMDHB review, approval and monitoring

Deliver an ‘Excellence Forum’ on best practice activities to reach and engage Maaori women in the cervical screening

Excellence Forum completed by September 2015 with strong participation from CM

CMDHB

30

pathway Health primary and community stakeholders

2. Improve cervical screening data accuracy and availability to primary care, in particular to enable more timely and accurate identification of un-screened and under-screened women.

Work with MOH, National Screening Unit (NSU) and MACSAG to ensure the National Cervical Screening Programme (NCSP) provides timely:

(a) Monthly NHI level lists of overdue women via Connex

(b) 6 monthly data matches for primary care.

PHOs have monthly access to lists of NHI level data to identify enrolled, eligible women who are overdue for three yearly screens All CM Health PHOs have registered for NCSP data match by March 27 2015 All PHOs are completing 6 monthly data matches against the NCSP Register.

CMDHB lead PHOs

All PHOs to register1 with NSCP for monthly NHI data lists to enable identification of unscreened and overdue women from enrolled, eligible population.

All CM Health PHOs have registered for NCSP monthly lists by 1 May 2015.

PHOs

All PHOs to register for a regional data match with the Auckland Regional CSP Register.

Regional data match completed for all CM Health PHOs by Dec 2015.

PHOs Regional Cervical Screening Programme Register

PHOs have a dedicated, named lead / FTE with responsibility for managing and analysing cervical screening data. PHOs identify their 5 lowest performing practices (cervical screening coverage) and prioritise / target resource and support toward those practices.

Unscreened and overdue women are identified post data match and on a monthly basis Improved screening coverage in low performing practices

PHOs

PHOs to ensure that standardised cervical screening codes are used in the Practice Management System (PMS). Standardised codes (in line with the work completed through the Auckland Regional Cervical Screening Coordination Service) are now available for PHOs to use.

All PHOs and their practices are using standardised codes by June 2015 Accurate cervical screening coding, records and data

PHOs with support from CMDHB and Auckland Regional Cervical Screening Coordination Service

3. Improve access to cervical screening services for CM Health women, particularly those who are Maaori, Asian, high needs, un-screened and under-

PHOs ensure that practices have access to regular (e.g. weekly or monthly) updated lists of unscreened and overdue women and that these are being actioned.

Enrolled women who are unscreened or overdue are identified, contacted and invited / recalled for cervical screening

PHOs

Employ the MoH ethnicity data audit tool (EDAT), in line with the CM Health Maaori Health Plan, to improve the way ethnicity is recorded in PHO enrolment forms.

EDAT implementation per CM Health Maaori Health Plan Improved accuracy of ethnicity recording and reporting

CM Health PHOs

PHOs ensure that self-identified ethnicity is asked of a woman at the time each

Improved accuracy of ethnicity recording and

PHOs

1 Note that at April 13 2015 the NSU, PHOs and DHB Shared Services were still working on improved systems for monthly NHI level data availability to PHOs. The outcome of this work will be known by May 2015. This may result in PHOs not needing to register with the NSU for access to the monthly lists via Connex.

31

screened. smear is taken (as per the NCSP Policy and Quality Standards) and that this ethnicity / ethnicities is recorded on the laboratory form.

reporting Practice staff

Recruit a nurse with cultural and cervical screening competencies to work directly with PHOs and practices to recall / invite unscreened and overdue women (especially those who are hard to reach). Prioritise the resource to PHOs with lowest screening coverage, in particular for Maaori, Asian and other high needs women.

Recruitment completed by April 30 2015 Nurse working with Total Healthcare by mid-May 2015 Access to cervical screening is strengthened, particularly for Maaori and Asian women.

CMDHB lead PHOs

PHOs ensure that practice staff with a responsibility related to cervical screening have had training on the ‘How To’ Guide for cervical screening and that quality systems and processes are in place.

All CM Health general practice and PHO staff with a responsibility related to cervical screening are competently providing best practice cervical screening services by December 2015

Auckland Regional Coordination Service PHOs

PHOs and practices implement a range of options to incentivise screening uptake and to improve access to screening including: • Specific strategies to target and

engage Maaori and Asian women • CME / CNE and cell group education • Evening and weekend clinics • Incentives and prizes • Promotions • Mobile and / or satellite clinics, e.g.

marae and other community settings • Text reminders and personalised

phone calls • Use of Community Health Workers,

Family Navigators and other primary care team members to improve access for unscreened and overdue women, e.g. via transport provision.

Quality systems and processes are implemented by December 2015 Access to cervical screening is strengthened, particularly for Maaori and Asian women

PHOs CMDHB support

PHOs ensure that systems are in place in all practices to improve opportunistic screening. These include: • Setting up alerts in the practice

management system (PMS) • Receptionist role in asking about

cervical screening • All clinicians always check that eligible

women who attend for a consultation have completed their three yearly cervical screen and that if they are due / overdue, they are offered a cervical smear.

Quality systems and processes are implemented by December 2015 All members of the practice team have a role in supporting cervical screening Access to cervical screening is strengthened

PHOs Practice teams

Referral pathways are developed and implemented between Independent Service Providers (ISPs) of Support to Screening Service (i.e. outreach & smear

Effective referral pathways are operational between primary care and ISPs by July 2015

Auckland Regional Coordination Service

32

taker services funded by MoH), PHOs and general practices.

Access to cervical screening is strengthened

PHOs

Deliver training workshops for primary care staff who have responsibility for contacting women in relation to cervical screening to improve health literacy and ‘conversations about cervical screening’ skills and competencies.

Workshops completed by November 2015

Auckland Regional Coordination Service PHOs

Ensure CM Health has sufficient numbers of smear takers and that gaps in access to female smear takers such as single GP (male) clinics are addressed. Complete smear taker training for CM Health providers.

Smear taker stocktake completed by June 2015 Smear taker training session completed by June 2015

CMDHB PHOs

Provide free cervical smear clinics for CMDHB-employed staff and ensure effective communications are used to promote the benefits of cervical smears and the clinics including:

• Posters, Daily Dose • Announcements at team

meetings (hospital and planning and funding).

Free cervical smear clinics delivered by WONS on the 22 April and 14 May 2015

CMDHB

Work with CM Health mental health service providers to train staff to opportunistically ask female service users about cervical screening and to link women with general practice and community smear taker services.

Mental health services staff trained and systems in place by October 2015

CMDHB

Student nurses from University of Auckland (placed with CMDHB) to complete a literature search on barriers to access to cervical screening.

Literature search completed by September 2015 and circulated to CM Health stakeholders

CMDHB

Develop and implement communications strategies to raise awareness of cervical screening including:

• Use of Maaori and Pacific radio and community newspapers to communicate culturally appropriate key messages

• Daily Dose (CMDHB Intranet) information / messages regarding importance of cervical screening and access to free smear clinics for CMDHB staff

• PHO and practice communications to enrolled populations, e.g. displays in waiting rooms.

Radio and newspaper promotions completed by September 2015 Daily Dose messages circulated to support free smears clinics for CMDHB staff Promotions and awareness-raising material implemented in practice settings

CMDHB PHOs and practice teams

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4.2 Primary Health OBJECTIVE: To deliver comprehensive in and out of hours primary health care which is ‘Better, Sooner, and More Convenient’. PROGRESS PHO Services Agreement The national negotiation process for the PHO Services Agreement 2015-16 will take place at the PHO Services Agreement Amendment Protocol meeting in late May 2015. The key changes to be included in the Agreement for the next year are:

• Implementation of the Zero Fees for Under 13 year olds policy in general practice and after hours services

• Agreement on the Integrated Performance & Incentives Framework measures and incentive payments. These are likely to include the following:

o more heart and diabetes checks; o better help for smokers to quit; o increased immunisation rates for eight month olds; o registration with an LMC within 12 weeks; o cervical screening; o babies enrolled with a PHO within four weeks of birth; and o improving the care for over 64 year olds prescribed 11 or more medications.

• New location / cross-boundary provisions that set out the process that a PHO and a DHB must follow if the PHO wishes to provide services in another DHB's geographical area

• An e-enrolment initiative to enable more timely and accurate patient enrolment in general practice to reflect the rollout of the National Enrolment Service.

• Redrafted minimum requirements to make the requirements clearer.

Zero Fees for Under 13s PHOs are continuing to work with their general practice providers to plan for roll out of the Zero Fees for Under 13s scheme from 1 July 2015. This is a voluntary ‘opt in’ scheme, however it is expected that there will be a high level of uptake in the CM Health district. We are on track for successful implementation by the 1 July deadline. Auckland Regional After Hours Network The procurement process for the provision of Auckland Metro After Hours services is now well underway. This has included:

• Independent probity advice on the procurement process from the McHale Group who have had significant experience in providing probity advice of Government procurement programmes. John Hansen, Chief Legal Advisor CM Health, has also had oversight of all tender documents from a CM Health perspective.

• Release of a detailed procurement plan to the sector in late March to inform all potentially interested parties of the After Hours network context and the specific outcomes sought

• A face to face briefing session for all potentially interested parties on the 31st of March at Ko Awatea. This was hosted by CM Health as the lead DHB and supported by the independent probity advisors to the programme

• Preparation of expressions of interest for After Hours Service provision by interested parties and submission of expressions of interest by the closing date of 1 May 2015

• Evaluation of the expressions of interest by a panel including representation from DHB funders, PHOs, General Practitioners, emergency departments, St John, College of Urgent Care Physicians and the High Need population.

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A short list of providers is currently being selected by the evaluation panel and if necessary the expressions of interest process will be followed by a closed request for proposals with short listed providers. Despite best efforts it is unlikely that the new set of providers will be delivering the service from 1 July 2015. However it is anticipated that the new services will be in place later in the 2015 calendar year. The final timelines will be determined by whether a closed request for proposals process is required. Approval from the Board will be sought to extend the contract with the current providers of After Hours and overnight services to 28 February 2016, with inclusion in the contract of a clause that will allow for an earlier exit if the procurement process is concluded without the need to go out to a Request for Proposal. A termination notice period of 3 months will be included within this timeframe. The February 2016 timeframe has been recommended by the Auckland Regional After Hours Network in order to avoid undertaking new contractual arrangements during the Christmas / New Year period and to allow for a reasonable notice period if current providers are not successful in the procurement process. The contract variation will also include after hours coverage arrangements for Under 13s in line with Government policy. This is discussed further below. Zero fees for Under 13s A working group with representation from the Metro Auckland DHBs and other Auckland Regional After Hours Network members is currently working on arrangements for the provision of free after hours visits for under 13 year olds. The DHBs will then complete negotiations with existing providers of after hours services and the agreement for coverage will be included in the contract variation described above. GP deputising service The procurement process for the GP deputising service (telephone triage and disposition) has been deferred due to a number of potential respondents being involved in the Ministry of Health process for the provision of the National Telephone Advice Lines. It is not appropriate for potential responders to be responding to two significant procurement processes simultaneously. The Ministry of Health process was due to be completed in March 2015, however the timeframe has been extended and we have not been informed of a completion date. It is hoped that the GP deputising service Request for Proposal will be released no later than early June 2015 with the aim of having the new provider in place by the end of the 2015 calendar year. An extension of the contract with Homecare Medical Limited, the current provider of GP deputising services will be required. Although the timeframe for this has not yet been confirmed, it is likely to be late in the 2015 calendar year or early 2016. The revised Auckland Regional After Hours Network alliance will be constituted when the After Hours and GP deputising service providers have been confirmed. This alliance will report to the CM Health Alliance and the Auckland Waitemata Alliance. Quality and performance framework A clinical advisory group has been formed to develop a quality and performance framework for after hours service provision. The framework uses the Health Quality and Safety Commission approach and has six quality domains: safety, patient experience, effectiveness, equity, access / timeliness and efficiency. Providers to be included in the framework are emergency department, accident and medical, St Johns, telephone triage and general practice. The draft framework has been presented to and endorsed by the Metro Auckland Clinical Governance Forum. Next steps include presentation of the framework to the two district alliances for endorsement and implementation from 1 July 2015.

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Primary Care Nursing Update Over the past month the CM Health Primary Care Nursing team has been actively involved in supporting implementation of priority health initiatives and public health planning. A summary of key activity is provided below:

• Caregivers of Maaori babies who have declined immunisation or have not had a successful outreach contact are being phoned by Primary Health Care Nurse to follow up.

• The Influenza vaccination campaign is underway and includes a focus on six month - four year olds who have had a hospital admission with a respiratory condition. NHIs for these children have been supplied to practices via their PHO. This is resulting in children being contacted for funded influenza vaccination. Sometimes practices have not known of these admissions and they are taking the opportunity to wrap further services around these families.

• Primary Health Care Nurses have supported the CM Health staff vaccination programme at Lambie drive offices providing immunisation to over 80 individuals

• Both Clinical Nurse Specialists are supporting the localities with nursing advice and establishing networks of practices. They have also been part of SWIFT working groups: respiratory and cardiac. Advance Care Plan work continues with a successful Advance Care Plan Conversation Day and continued support is provided to nurses and General Practitioners in primary care.

• Cervical screening is an organisational priority. Our nurses are working with CM Health Occupational Health Nurses to support clinics for staff working at CM Health. The first clinic in April was full and further clinics are planned for May and June. The team is working at a regional and local level on planning to reach targets in negotiated time frames. There is a risk that we are overburdening the same work force for national health targets including smoking, cervical screening and immunisation as well as ARI care coordination.

• School nurse youth specialists have been supporting the Rheumatic Fever programme in secondary funded schools in collaboration with National Hauora Coalition Mana Kidz team. The withdrawal of whanau support workers in these schools to fund other services has increased the load on school nurses. The auditing of standing orders initiated by the school nurses will now be completed by National Hauora Coalition staff.

• Two practice nurses have completed their academic preparation for Nursing Council applications for Nurse Practitioner endorsement.

• Post graduate funding applications have closed for the second semester. There are 36 applications as well as 15 Plunket nurses seeking funding support

• Care coordinator training has taken place in two sessions with another two planned for 2015 for those new to the At Risk Individuals programme.

• The Nurse Entry to Practice Programme has a small intake in May with one nurse joining the programme from a practice in Manurewa.

• Initial scoping of the wound care project is underway. District nurses are assessing each patient for their ability to attend a General Practice for wound care for the next month. This data will be used for the business case currently underway.

Other current activities related to the primary care nursing workforce in Counties Manukau are highlighted below:

• We are working with Manukau Institute of Technology to commence level seven papers for primary health care nursing to link with the diabetes course to provide a completed qualification.

• All locality nurse lead positions have now been filled. Locality coordinator positions are in place to assist with the Front Door project.

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Regional Clinical Pathway Programme Work continues on the merging of the static regional clinical pathways (54) initiated under Greater Auckland Integrated Health Network with the HealthPathways platform to provide a comprehensive road map for the local management of patients under the “Northern HealthPathways” banner which is soon to be activated. Work is also underway to establish the Clinical Pathways Operational Group which will lead the work programme and an Evaluation Advisory Group has been established to ensure the programme delivers on its intentions through robust analysis of the measures of success. The “dynamic pathways” tool which includes nine key regional pathways now has 134 (113 of those trained in the last month)GPs trained on the system. Interestingly there are 145 (134 of those trained in the last month) clinicians using the tool with 612 (466 in the last month) patients being managed through 710 pathways. It should be noted that some patients are on more than one pathway.

Regional Data Sharing The Metro Auckland Data Stewardship group is continuing to work towards regionally agreed policies and processes for data sharing. The initiative has received clinical endorsement through the Metro Auckland Clinical Governance Group subject to a Privacy Impact Assessment and review in June. Initial procurement planning has started for a central data repository through a 3rd party, and the employment of a HealthSafe Manager to oversee the day to day operations of that facility and regional data sharing. Wider implementation plans and communications strategies are in development. Pharmacy Community Pharmacy Services Agreement Extension Terms for extension of the Community Pharmacy Services Agreement have been finalised. It has been agreed to extend the existing contract by 12 months with an option to extend it by a further 12 months if required. Apart from some unavoidable changes, e.g. accommodating zero fees for under 13s, the contract is essentially the same as the phase four version of the current Community Pharmacy Services Agreement. Funding will increase by 1.07% made up of 0.37% for Contribution to Cost Pressure with the remainder allowing for an increase in volume growth as well as increased volume growth attributable to zero fees for under 13s. The Sector Agents have signalled that they do not support the current proposal as they believe that the increase in funding offered is insufficient to off-set cost pressures. They believe this threatens the sustainability of community pharmacy. As a consequence there is some concern that pharmacies may not sign or may delay signing the contract extension. The number of pharmacies signing the contract will be monitored closely. If pharmacies delay signing they will put at risk their monthly case-mix fee payment until such time as they do sign their contract. The case-mix fee essentially makes up the bulk of pharmacy gross profit. The contract extension also allows for a one off national payment of $750k which is to be used to assist pharmacy to improve patient centric service. The funding will be divided amongst DHBs according to their Population Based Formula percentage of national funding. The current plan is to pool the Auckland region share (+/- $250k) and consult with the Metro Auckland Pharmacy Advisory Group on the best way to spend the money. Early indications suggest that it could be spent on an initiative(s) to support integration of pharmacy with primary care or for training to support lean

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business practices to deliver efficiency gains in pharmacy. A special Metro Auckland Pharmacy Advisory Group meeting has been scheduled for 28 May to discuss this matter. Pharmacy Margin The sector have raised concerns about the diminishing returns from medicine margin component of pharmacy funding and they are hoping to see, at least, an interim solution offered by DHBs together with the contract extension. The margin is extremely complex and involves numerous parties therefore it cannot be dealt with in conjunction with the contract extension. In a review undertaken by Deloittes, a financial consulting firm, it was determined that pharmacy receives on average 0.7% in margin from this portion of their funding, but that this is not equally distributed. There is currently a national postcard campaign underway, organised by the Pharmacy Guild, to raise awareness of the issue of the pharmacy margins and the impact it may have on the viability of pharmacy. Patients are encouraged to fill out a postcard raising the issue and their concern. These postcards are sent to the Minister of Health. The postcard states that pharmacy dispenses 50% of medicines at a loss. This refers mainly to medicines that cost less than $5 and in the case of these medicines pharmacy will invest up to 30c (ex GST) of the service fee paid per prescription item. This will not see the pharmacy making a loss, but a reduced profit. There are number of other situations where pharmacy may make a loss but these are a small by comparison and most likely to be off-set by other areas where gains are made. Community Pharmacy Anti-Coagulation Management Service CM Health currently has 13 pharmacies contracted to deliver the Community Pharmacy Anti-Coagulation Management Service to a maximum of 650 patients which would fully utilise CM Health’s share of the national funding. Currently around 66% of this capacity is being utilised in Counties which is below the national average. Some DHBs have decided to award sufficient contracts to put themselves in a position where they could exceed budget if all contracted pharmacies were operating at 100% of capacity and this has helped them to increase the number of enrolled patients. Three DHBs are currently delivering service above their budgeted maximum. Nationally Counties Manukau has the 4th highest number of enrolled patients, behind Canterbury, Waikato and only narrowly behind Waitemata.

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4.3 Child, Youth and Maternity Services OBJECTIVE(S) To integrate maternal and child health services; reduce perinatal mortality; improve care in the First 2,000 Days of life; intervene early to support vulnerable children; reduce Rheumatic Fever by two-thirds to 1.4 cases per 100,000; and improve youth services. 1st 2000 days-Maternity Early Engagement The Early engagement media campaign commenced on 4th May 2015.The messages are designed to reach whaanau and the wider community to socialise the importance of early pregnancy care. The Maternity Consumer panel has been actively involved in the development of the strategies. All Maternity providers/stakeholders have been engaged to ensure participation and awareness of the campaign. The following promotional activities are have commenced-

• Communique to all Self Employed and DHB Employed Midwives informing them about the campaign

• Primary care E update-has been sent out informing GPs and Practice Nurses • Meetings have been held with staff at CMH birthing units • Radio interview done by Margie Apa, launching the campaign • Launch of the www.bestforbaby.co.nz website • Flava radio station are undertaking a scripted narrative promoting the campaign • Bus shelter posters are up in Mangere, Otahuhu, and Otara (examples below) • Car bumper stickers are available with the best for baby best for you message on them, for

use on Board cars , community organisations or gifted to women • Ads in local newspapers • Facebook advertising • Coconet TV an internet based TV programme aimed at our Pacifica community, this will

feature “comedy based adverts”

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1st 2000 days - Improving Infant Nutrition Project The overarching aims of the Improving Infant Nutrition Project are to:

• Improve nutrition and promote healthy feeding of infants and toddlers (aged 0-2 year olds) through community based initiatives that engage with wider whaanau/family environments using a public health approach; and

• Enhance the way maternity, child health, primary and secondary care health professionals engage and communicate with parents and whaanau/families around infant and toddler nutrition through a workforce development initiative.

Community Initiative Activity in the last period has focused on confirming and finalising the service delivery model, consulting with stakeholders and community organisations regarding the delivery model, developing service specifications and working towards confirming the Providers we will contract with to deliver the services. The Programme Coordinator/Lactation Consultant position is currently being recruited and we will have someone in place in this role by the end of May. Health Workforce Development Workbase Education Trust have been contracted to develop and deliver the Health Workforce Development training and mentoring initiative. The Provider is on track and progressing as per the project plan. In the last period activity has focused on engaging with the health workforce, developing the key project messages, training framework and curriculum. 10 one day workshops for Well Child Tamariki Ora providers, LMC, General Practice and other health and social service providers are scheduled to take place in June and July. Following the workshops, Workbase will provide between one and three mentoring sessions for each participant as a follow up to the training to reinforce the learnings and application in practice. 1st 2000 days -Sudden Unexpected Death in Infancy Whaanau Hapu Waananga CM Health are being funded by the Ministry of Health for a Community based Sudden Unexpected Death in Infancy initiative which will aim to engage pregnant Maaori Women and their Whaanau in a series of “Whaanau Hapu Waananga”. This will include a comprehensive antenatal, childbirth and post-natal education programme which aims to reduce Sudden Unexpected Death in Infancy risk factors. The programme will maintain close linkages to existing programmes i.e. smoking cessation, breast feeding support services, and related initiatives which are being implemented within the localities. Safe Sleep Education The 2015 Safe Sleep Education online training for all stakeholders and staff was launched in late April. The two programmes have assessment and professional accreditation points.

• Ministry of Health website will host the online Sudden Unexpected Death in Infancy e-Toolkit

• Whakawhetu website will host their e-learning Safe Sleep Workshop.

Sudden Unexpected Death in Infancy hui CM Health hosted the quarterly Counties Manukau Community Network hui on 28th April with 30 participants from the community networks, with CM Health, Whakawhetu, Northern Regional Alliance, and TAHA Well Pacific Mother & Infant Service updates presented. Taonga teen parent unit also presented an update on Pepi-pod programme and activities to support prevention of Sudden Unexpected Death in Infancy. There was good community engagement from across Counties

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Manukau and very positive feedback resulting in invitations to meet with CYFS, Plunket team leaders to share information, education and resources. Protecting our Mokopuna day Whakawhetu hosted a Sudden Unexpected Death in Infancy Symposium in April with 158 participants from across the Auckland region health and community networks to discuss the most recent evidence.

Influenza vaccination campaign The Flu vaccine media campaign commenced in April with TV, radio, articles in local community papers, posters and pamphlets. A Local Counties Manukau initiative is identifying all children who have previously been admitted to hospital with respiratory conditions, children and adults with chronic illness, pregnant women and the elderly over 65 years, and recommending them for vaccination. Lists of eligible children have been distributed to PHOs for them to provide to practices. The flu vaccine arrived mid-April and distribution to practices started immediately. Oral Health Child Oral Health – aged 0 up to and including year 8 of school (12/13 years) Data is not currently available from the Auckland Regional Dental Service for the school dental service. Adolescent Oral Health – from year 9 of school up to and including 17 years The interim data update from the Ministry of Health for Oral Health Services for Adolescents has achieved utilisation of 75% and 26,786 adolescent patients, versus the target of 80%. However late claims for 2014 are being processed up to end of June so final achievement will not be confirmed until August. Oral Health Pilot for Women with Diabetes in Pregnancy The Oral Health Pilot for Women with Diabetes in Pregnancy is a three year Ministry of Health funded pilot for 400 women due to be completed by 31 Dec 2015. The results have shown high levels of clinical need in dentistry and periodontal disease, that is, high levels of unmet need in women who are medically compromised with diabetes in pregnancy. Early evaluation results suggests:-

● Noted improvement in oral health - positive impact on the women’s own oral health knowledge and habits and that of their children and families, evaluated by entry and exit surveys.

● The Oral Health Pilot for Women with Diabetes in Pregnancy cohort comprises Pacific (50%), Maaori (25%), Indian, European and Asian. The age range is 19 to 44 years (average age 31 years) and comprises mainly of women with high deprivation, who are medically compromised, and have complex social circumstances.

● These women have experienced negative emotional impact as a result of problems with their teeth, mouth and gums.

● There is a high incidence of dental and periodontal pain, infection and discomfort, affecting all aspects of life including social behaviour and nutrition.

● Clinical treatments are higher than expected More than 90% of participants have had one or more new fillings placed, 14% have had root canal treatment, 57% have had one or more new extractions,

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5% have required full or partial clearance of teeth, fitting and supply of dentures, 1 woman referred for oral carcinoma

Youth Health Representatives for the revised Youth Health Leadership Group have now been confirmed. The group includes representatives from Planning & Funding (Youth Health, Maaori Health, Locality General Manager), Youth Health clinicians & academics, Mental Health representatives (Psychiatrist & Clinical Director), School nurse specialist, School Principal, General Practice, Public Health clinician, PHOs, a MSD representative and a youth advocate. A comprehensive service stocktake has nearly been completed. First and foremost, the focus for the Youth Health Leadership Group will be on school-based health services, ensuring CM Health is providing an appropriate service for the school community and meeting the Ministry of Health’s expectations. The group will focus on better alignment of school-based health services with general practice, localities and existing locality-based services in the primary care space. Other existing primary care based programmes, such as the At Risk Individual programme are being investigated to see how they can support our school population. The Youth Health Leadership Group is also considering its IT requirements for an integrated model of care and one that is appropriate for the school environment, with links to primary, secondary and other community providers as required. In the near future, the Leadership Group will look at how to join up youth services, in particular across specialist medical and surgical services, mental health and addictions and specialist sexual health services. This will include a stocktake of current hospital and specialist services and related resources utilised by young people and streamlining the service referral process (access criteria, intake triage, assessment and resource allocation). There will be a focus going forward on locality-driven youth care, working across traditional silos and building on existing local community and sector relationships, and the work already underway in the four Counties Manukau locality partnerships.

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4.4 Mental Health and Addictions VISION: That the communities of Counties Manukau will support mental health and wellbeing and be able to get support when they need it, quickly and easily, in their local community. PROGRESS Graph showing waiting times for NGO AOD services from February 2015 to January 2015 (NGO & DHB services). Note that there is a 3 month report lag due to national data assurance requirements

The nature of addictions means that low to no wait times are important. We also regard data accuracy as essential to enable clear demographic planning for our populations and to ensure we are meeting both our clients’ needs and health targets. Unfortunately occasionally we do have reports that indicate that we are not meeting our targets with regards to our Non-Government Organisation alcohol and drug wait times. Over the past 18 months much work has been undertaken in collaboration with the Northern Regional Alliance and our Non-Government Organisation partners to establish the root causes and ensure these are resolved as soon as is practical. To date the root causes have never been due to extended wait time – but have always been data error, data anomaly (often due to software upgrades), staff training need or lack of clarity with regards to input codes and business rules. However the continued work in the area has seen the continued significant improvements in our wait time data, with all areas above set targets. Non-Government Organisation Alcohol and Drug Services CADS is a major provider of Alcohol and Drug services across the Auckland region, including Counties Manukau. However, due the diverse population and needs thereof Counties Manukau fund a range of alcohol and drug services with other Non-Government Organisation’s to supplement the range of provision that is offered. A total of 28 beds to support people with alcohol and other drug addictions, and 50 staff members within the community are also funded, offering a range of interventions including:

• prevention and health promotion in schools • Short term residential support • Residential support for co-existing disorders

0%10%20%30%40%50%60%70%80%90%

100%

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

2014 2015

Counties Manukau DHB - NGO AOD: All Ages

> 8 weeks

>3 and <=8 weeks

< 3 weeks

No wait

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• Screening and brief intervention • Drug and alcohol treatment, therapy and case management • Ongoing monitoring of symptoms and regular review of progress and treatment • Development of cultural links • Working with family and whaanau and offering support and other interventions, and • Liaison, consultation and referral to other services as appropriate

Support is individualised to each person with the goals of engagement, modelling recovery and strengthening service user involvement in the wider community. Whole of Systems The programme of work to improve people’s experience of mental health and addictions through better integration is being led and supported by a new Integrated Mental Health and Addictions Leadership Group. Membership of the group reflects the range of stakeholders engaged in the agenda, with the group holding its inaugural meeting in late April. Members of the Leadership Group are excited by the challenging agenda ahead and the potential to improve health outcomes, enhance service user satisfaction, and improve the day to day working experience of professionals involved in mental health and addictions across primary care, Non-Government Organisation’s and secondary services. The Leadership Group confirmed its commitment to keeping the population of Counties Manukau at the centre of all that it does, making a difference for individuals and their family/whanau. The Group identified a range of factors that it considers central to success, including:

• Supporting consumers and family/whanau to get what they need through a system of simple and seamless support;

• Working to improve collaboration on a daily basis, developing services that are responsive to need;

• Ensuring that mental health and addictions is part of the wider health community. The Leadership Group will be focussing on developing the necessary evidence base to inform thinking around population need and models of care. A co-design engagement process is underway to hear stakeholders’ views, with their ideas and opinions helping to inform the development of an overall implementation plan by December 2015. Acute Mother and Baby Mental Health Services Forum – Launching the new regional service Background: The Acute Mother and Baby Mental Health Service is a new initiative designed to assist mothers and babies, and the people who support them, by significantly expanding acute maternal mental health and infant health services in the Northern Region. Funding from the Ministry of Health has enabled the Northern Region to:

• Enhance community maternal mental health services • Establish a three-bed mother / baby inpatient facility • Provide additional or enhanced community-based respite care facilities and packages of care • Invest in workforce development.

Most parts of the continuum of care have now been implemented and it is expected that the full continuum will be operational by mid-2015. An evaluation is being planned to assess implementation of the continuum of care and explore outcomes for users of the services. The Launch: Counties Manukau Health hosted a forum to celebrate the launch of the Northern Region’s Acute Mother and Baby Mental Health Service on May 8th 2015. The aim of the launch was to:

• Promote an understanding of the services provided in the continuum of care • Encourage development of a regional clinical network • Share knowledge and identify opportunities to collaborate

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The launch combined formal presentations, feedback from staff delivering services and users of services, and discussion groups (knowledge cafés) aimed at facilitating open conversation on key topics (Developing Clinical Networks, Partnership Working, Delivering Culturally Responsive Services, Lessons from Early Implementation). Over 80 people attended the event, with representation from all four of the Northern region District Health Boards and Non-Government Organisation providers in the region. A broad mix of people attended including newborn and Midwife Nurse Specialists, community Midwives, Obstetricians, Clinical Educators, mental health and maternal mental health teams, service and general managers, Occupational Therapists, Social Workers, and Psychologists. Initial feedback from the event was that it was well received, with many commenting on the opportunity to share experience and build networks. The knowledge cafés provided useful insight for the Clinical Governance Group on how well the services are currently operating and areas for further development. It is hoped that future, smaller events will be hosted regionally to support the ongoing development of a clinical network. Delivery of Services within Counties Manukau Health: The maternal mental health services within Counties Manukau Health have been evolving since 2009, with the establishment of a three-bedded respite service and a virtual workforce of four keyworkers with a focus on mothers and babies. Since then the service has expanded in terms of the services provided and the choices available for service users, alongside the establishment of two maternal mental health key workers and the subsequent evolution of the maternal mental health team. The increase in services available has included access to specialist assessments, multidisciplinary team working, pre-pregnancy consults and primary care and maternity services liaison and case consultation. The additional funding provided by the Ministry of Health has enabled the services provided by CM Health to expand further and include:

• Additional FTE to support delivery of maternal mental health services • Purchasing of an additional respite bed • Home-based packages of care • Increased liaison services, including a service for teen mums • Primary health care satellite clinics • Increased assessment services • Access to services provided by the Regional Mother and Baby Unit • Increased capacity to deliver training and supporting forums.

Practice Nurse Credentialing Development of the regional Practice Nurse Credentialing project is underway with the first ten practice nurses at Counties Manukau being supported with their education by the primary mental health leads in their respective PHOs. The training and education is due to begin in June 2015. TRANX Tranx was a small regional contract of four FTE’s offering regional alcohol and drug support. Recently this service ceased. Auckland DHB were the portfolio managers for the contract and planners and funders from Auckland DHB have worked with the service to ensure that service users’ care was continued and a smooth transition was made across to the regional Community Alcohol and Drug service.

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4.5 Adult Rehabilitation and Health of Older People OBJECTIVE: To support older people in their homes and communities with integrated, locality based services that maximise independence through rehabilitation and quality care. PROGRESS Home Health Care - Community District Nurses and Allied Health Teams The Home Health service is available to people in their own home or at a clinic facility at four sites aligned to the four localities. The Home Health teams consist of allied health, district nursing, care assistants and other locality based staff with professional, clinical and cultural skills. Home Health Care received 1,070 referrals; discharged 1,100 clients and completed 9,055 contacts across all bases for the month of April.

Community Allied Health - (delivered from Home Health Care) The occupational therapy waitlist at Orakau continues to decrease with additional assessments being completed by the advanced rotator. During the month of May, the Howick locality team will also see some of the clients on the Orakau / Howick border to further assist in reducing the Orakau Locality waitlist.

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Home Health Care Contacts

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Previous month Total Orakau Manukau Franklin Eastern

Waiting list Dietetics 26 28 3 9 4 12 Contacts Dietetics 73 81 34 22 17 8 Waiting list Occ Therapy 158 142 74 39 0 29 Contacts Occ Therapy 357 322 151 65 53 53 Waiting list Physiotherapy 36 19 6 0 0 13

Contacts Physiotherapy 262 294 39 125 78 52

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Waitlist - Acute Allied Health Outpatients Waitlist Activity Referrals remain high for musculoskeletal outpatient services who continue to operate with a parental leave vacancy. The women’s health waiting list has increased recently with some changes in staffing. The hyperventilation service continues to look at more group options to deal with the high waiting list in a small service. All other services are being delivered at close to or within the target waiting times.

Assessment and Coordination of Care for Older People At 15 April 2015 100% of facilities were either training or booked for InteRAI asessment training, with three of those facilities (7%) actively involved in training but whose Nurses are not yet competent. Early Supportive Discharge – Supporting Life after Stroke Early Supportive Discharge continues to operate at full capacity. Approved roles are being processed through the recruitment process. Work has commenced to determine changes required for transition to an amalgamated service and increase in geographical coverage. National and Regional Spinal Strategy There have been 57 patients through the Acute Spinal Service since 1 July 2014, with a continuing high number of complete cervical injuries. Work continues on the whole of system approach, through clinical pathways such as Urology, Psychology and Tracheostomy. The supra pubic catheter process has been signed off and training undertaken by staff. Management of tracheotomy skill levels have also been improved with training and support, and the Auckland Spinal Rehabilitation Unit is now able to support patients with tracheostomy, however there have been some challenges with the equipment as the current facility does not have oxygen and suction centrally supplied. Work continues with the Canterbury District Health Board and Burwood Spinal Unit on a consistent approach to service delivery, collaboration on patient experience and Accident Compensation Corporation contract review and redesign. Community Geriatric Services An important component of the Systems Integration/Locality development is to provide additional Geriatrician support to primary care practices and aged residential care. The Community Geriatric Services team continued to provide support to four GP practices and six residential care providers during the month of April. 35 aged residential care facility staff attended the April education forum. Target <100 Emergency Care presentations from residential facilities per month April 2015 saw 106 Aged Related Residential Care Clients present to Emergency Care. Of these, 11 presentations were falls related and 12 were potentially avoidable admissions.

Acute Allied Health Outpatients Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 41944 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15MSOP 296 304 314 346 380 407 421 397 431 416 464 440 419Gynae 253 214 196 168 127 128 130 79 71 49 105 78 121Obstetrics 35 50 37 29 27 25 37 19 18 11 40 50 45MORRSA (Rheumatology) 55 64 56 56 53 30 46 41 43 38 38 49 69Physio Hyperventilation Service 112 103 94 106 107 112 115 112 121 127 127 140 145Cardiac Rehabiliation 10 17 28 29 24 22 29 28 29 24 17 9 5Pulmonary Rehabilitation 80 56 49 33 94 99 112 133 168 186 128 126 130OT Rheumatology 18 15 25 22 18 42 38 37 30 30 22 15 24Total AAH waitlist 859 823 799 789 830 865 928 846 911 881 941 907 958

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Community Specialists Health of Older People Teams (reported quarterly) The Community Specialists Health of Older People Team continues to provide proactive support to aged related residential care and primary care with Gerontology Clinical Nurse Specialists and Geriatricians. The monthly Aged Related Care education session for facility staff continues to be well attended, with an additional 67 Registered nurses attending education forums during quarter three, bringing the year to date attendance to 221. The ATRACT education programme for Registered Nurses in facilities continues to be promoted by the CM Health Community Geriatric team. Targets: Provide 25 hours Gerontology Clinical Nurse Specialists and Geriatrician support per month to five primary care practices including clinics and education sessions with GPs

Provide 26 hours Geriatrician support per month to six Age Related Residential Care Providers for medication review case conferences

Needs Assessment and Service Coordination Demographic splits and access to Health of Older People services by Ethnicity, January – December 2014 is pictured in two graphs below. When looking at population size this seems to indicate that Other, Maaori and Pacific Island older people’s access to Health of Older People services is very similar, whereas there is a smaller portion of the Asian demographic accessing Health of Older People services.

Geriatrician Number of Primary Care Clinics Visited

Primary Care Hours

Quarter 1 5 31.5 hours



Geriatrician Number of ARRC Providers Visited

ARRC Provider Hours

Quarter 1 6 Average 42 hours per month



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Graph One: highlights the demographic distribution of older people, 65 years and older in the CM Health catchment by ethnicity.

Graph Two: highlights the distribution of people 65 years and older, who are accessing Health of Older People services by ethnicity.

67%

11%

7%

15%

65+ Demographic Distribution (number in CMH 2014 Calendar Year)

European/Other

Pacific Island

Maori

Asian

79%

10%

5%6%

Distribution of People aged 65+ Accessing HOP Services by Ethnicity

Other

Pacific Island

Maori

Asian

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Percentage of Home Based Support Services client interRAI assessments complete by locality Each of the locality teams continue to roll out interRAI assessments for all clients receiving home based support services. Between January and March 2015 (Q3), 85.6% of patients have had an InterRAI assessment at some point. Locality Clients # w/InterRAI Percentage

Eastern 1,057 834 78.9%

Franklin 677 613 90.5%

Mangere/Otara 598 536 89.6%

Manukau 1,501 1,299 86.5%

CMDHB 3,833 3,282 85.6%

Memory Team (Dementia Care Pathway) The Memory Team will be presenting at the High Performing Healthcare System Seminar this month. This will enable other District Health Boards to see the value of the team and also the opportunity for those team members attending to gain insight from other similar Services across New Zealand. The Memory Team Business Planning session for 2015 / 2016 is also scheduled for May. The focus will be on reviewing and validating current practices, documentation and data captures as well as improving links to other Services within Older Peoples Health. Long Term Support Chronic Health Conditions (LTS CHC) Update on service mix provided – (Reported Quarterly) Counties Manukau Health LTS-CHC utilisation as at 31 December 2014 There are 196 clients receiving long term supports for chronic health conditions and who are receiving the following services:

Service Number of clients Community Residential Services Dementia 5 Hospital and Specialised Continuing Care

22

Rest Home 18 Respite 3 Rehab and Community - Carer support 18 Household Management 46 Personal Care 70 Individualised Funding 13

Dementia Day Care 1 Total 196

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4.6 Intersectoral Initiatives

OBJECTIVE Target populations/communities with high health, housing, social, employment and education needs to improve the health status and reduce health inequalities. PROGRESS

Warm Up – Counties Manukau (Retrofitting Home Insulation Project) Warm Up Counties Manukau is a free home insulation programme that retrofits insulation into the homes of low income families with high health needs. This programme is funded and delivered through a working partnership between the Energy Efficiency Conservation Authority, Autex Industries Limited, The Insulation Company, CM Health and the Middlemore Foundation. We insulate the homes of low-income families with health issues that may be related to housing, creating ‘healthier homes’ which are more energy efficient, thus ensuring that the home contributes to the health of the family. In addition, we offer a comprehensive health and social assessment for participating families to ensure that they are accessing appropriate health and social services. This approach ensures that we can address both housing and health issues. Referral Generation CM Health is responsible for referral generation. Families/households can self-refer or may have the programme suggested to them by their health professional. We target the programme through information accompanying outpatient clinic appointments and by working in partnership with health professionals, government agencies, the non-government sector and the local community. Project Outcomes for the Warm up – Counties Manukau Project (1 July 2014 to 30 April 2015)

Month

Total Number of Referrals

Total Number of Homes Insulated

Total Number of Home Visits completed post install

July 2014 313 98 48 August 2014 251 107 47 September 2014 169 83 48 October 2014 148 139 27 November 2014 81 143 43 December 2014 64 116 15 January 2015 42 103 21 February 2015 55 70 56 March 2015 56 56 51 April 2015 62 42 46 Total number of referrals generated

1,241 957 402

Please note: There is a time delay between referrals being received and the completion of the insulation install. The home visit is voluntary and separate to the automatic post installation audit which assesses the quality of every installation.

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Self-identified ethnicity by household (total referrals received 1st July 2014 to 30th April 2015):

1. Ethnicity Group by referrals Ethnic Group Number of referrals Percentage of total referrals Asian 127 8% European 421 27% Indian 44 3% Maori 349 22% Other 55 4% Pacific 557 36% Total 1,553 100% The PATHS Programme PATHS is an intersectoral programme resulting from a partnership between Counties Manukau Health, and the Ministry of Social Development that was established in 2004 in an effort to help tackle the growing problem of long-term benefit dependency. The aim of the PATHS programme is to assist people in receipt of certain benefits to return to work (the programme is voluntary), using an intensive individualised case management model aimed at reducing health barriers to employment. The key objective of the PATHS programme is to reduce health barriers to employment by providing an appropriate health intervention, which enables participants to return to employment. Total Number of Voluntary Participant Enrolled onto the PATHS Programme

Month Total Number of Participants enrolled

July 2014 15 August 2014 20

September 2014 13

October 2014 19 November 2014 13 December 2014 13

January 2015 16 February 2015 14

March 2015 11 April 2015 13

Total Number 147

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4.7 Progress with Systems Integration At Risk Individuals 92 practices have transitioned to the At Risk Individuals programme, with seven practices scheduled to transition in May. Enrolment figures continue to increase, however rates have slowed in April due to the influenza workload within general practice. There are 7,894 patients enrolled in the programme, representing 1.7% of the CM Health population (as at 01.05.15). The current trajectory indicates the 3% minimum contracted volumes for year one of implementation is on track. PHO and locality performance is indicated below:

ARI Enrolment - Current enrolment percentage against Enrolled Population (PHO Register)

ARI Enrolment - Current performance against annual minimum contracted numbers

Phase two of the programme (scheduled for roll out in 15/16) has an increased focus on quality improvement within general practice. A quality, learning and development framework is currently being developed to enable practice staff to dedicate time to improving the quality of care planning, and invest in training and development for their staff.

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Quality and Safety – Safety in Practice We are pleased to announce the appointment of Dr Vikas Sethi to the role of Clinical Lead, Safety in Practice. Vikas comes to us with a vibrant exuberance from working in Primary Care and is committed to the values, improvements and patient safety the Safety in Practice programme can provide. Vikas is immersing himself in work surrounding Year two of the programme. We are thrilled to have Vikas as part of the Safety in Practice Team. The evaluation of the Year one Safety in Practice programme is currently underway and is on schedule to be completed by the end of May 2015. As reported last month our Safety in Practice Road Shows (March to May) are nearly finished and have been a great success both in attendance and interest in Year 2 of the programme. Expressions of Interest will be emailed out to PHO’s in late April to pass onto their practices for Year 2 of the programme. The practices have a choice of four care audit bundles – Medication Reconciliation, Results Handling, Warfarin Management and Opioids Prescribing. We are expecting a positive uptake for year two of the programme and practices will be confirmed into the programme prior to our 1st Learning Session for Year two on Wednesday 17 June. Community Health Service Integration A business case is currently being developed to consolidate existing case management, assessment, rehabilitation and community care services into four locality based integrated care teams based around general practice clusters. These teams will support the ‘healthcare home’ with proactive care planning and co-ordination through delivery of admission avoidance, early supported discharge and rehabilitation. The programme of work will be delivered through three project work streams, which have progressed as follows: 1. Reablement Workstream

The reablement workstream focus is on the development of locality community teams to assist people to be as well as they can be at home (“reablement”), particularly during and after an acute deterioration. This includes continuation of work commenced to refocus district nursing, allied health and NASC teams to work effectively within the locality model. The ongoing redesign of the locality based home healthcare teams is progressing, and work now focuses on development of a function within our community teams for early supported discharge, admission avoidance and the reablement approach across the continuum. In order to enable district nursing to focus on early supported discharge and more complex community interventions, the wound care workload is currently being analysed to identify opportunities for routine wound care to be delivered within general practice.

2. Restorative Workstream

This workstream will redesign and procure contracted long term home and community support services under a restorative services model. A detailed model of care has been developed, which will inform a planned EOI and competitive dialogue process, with implementation planned for July 2016.

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3. Community Central

Community Central will provide seamless access and intake for CM Health community services, enabled by a technology solution that supports a ‘first response’ request for services, triaging, allocation of resources and capacity planning. This is centrally organised, but locality driven. This workstream is supported by the SWIFT process, and current state mapping has been carried out – identifying a number of opportunities for streamlining of processes to provide a smoother, more visible patient journey and improving treatment responsiveness. Staff are now engaged in developing future state processes, which will inform a supplier brief enabling an approach to market for a technology solution. Manual implementation will begin from July 2015, with implementation of a technology solution planned for November 2015. A high level programme timeline is as follows:

Apr 15 Jun 15 Aug 15 Oct 15Current state

Dec 15 Feb 16

Reablement

Restorative

Future state Market test

Locality implementation planning

HHC realigned to locality boundaries

Manual implementation

Business case

Apr 16

Winter response ReaCH services

Full implementation

Mobility pilot

Workforce development

& change management

Communitycentral

Procurement

Full implementation

Aug 16Jun 16

DN redesign

Wound care to primary

care

NASC redesign

Board meeting

Consolidation of community teams to ReaCH

Business case development

Competitive dialogueEOI process

Board meeting

Roll out

Communications & engagement

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4.8 Locality Reports Eastern Locality

We have farewelled Lynda Bryant this month as General Manager for the Eastern Locality. The vacant post has been advertised and shortlisted. In the meantime the General Manager for the Franklin Locality is providing temporary management cover for the East Locality Home Health Care Team and the CEO of East Health Trust is covering for other Locality related matters.

1. Acute Demand

Indicator Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

CMDHB Avg Last 12 mths

1.1 Unplanned readmissions (28 days) 6.4% 5.1% 6.3% 5.8% 5.9% 3.9% 6.6%1.2 ASH rate (per 1,000 enrolled patients) 1.5 1.4 1.3 1.2 1.2 1.2 2.11.3 Average bed day usage in last 6 months of l ife 7.5 9.4 13.9 14.4 10.8 8.9 12.3Notes : Numbers for previous months may change as additional morta l i ty data i s received for 1.3 and as coding i s modi fied for 1.1 and 1.2.Aged Res identia l Care Bed Days in Pukehoke and Frankl in Memoria l Hospi ta ls are included in the figures for 1.3 - this wi l l primari ly a ffec Frankl in as ARC faci l i ties are independently located in a l l other loca l i ties .

2. Quality



2.1 Children fully immunised at 8 months (Target = 90%) 96.5% 96.8% 96.1% 95.4% 94.9% 95.1% 93.3%2.2 Children fully immunised at 24 months (Target = 95%) 97.4% 97.3% 96.7% 97.4% 96.7% 97.5% 95.3%2.3 Middlemore Radiology < 6 week wait time for GP Referrals 92.0% 96.7% 92.9% 87.0% 92.6% 92.2% 91.8%

3. Shared Accountability Services

Item Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15Last 12

Mths3.1 ED presentations not admitted 203 223 234 249 216 217 29113.2 Acute medical bed days 1278 1249 1267 1076 1094 1284 165203.3 Acute casemix-funded non-medical bed days 868 763 1097 780 729 972 110233.4 Medical outpatient attendances 2004 1713 1720 1625 1614 1993 24171Note : Al l SAS volumes for previous months may change as IDF updates are received and coding i s modi fied

4. Other



4.1 E-referrals as % of all referrals 18.4% 18.6% 18.0% 20.9% 24.6% 23.4% 16.9%4.2 Medical Outpatient DNA rate 2.2% 1.7% 1.0% 2.4% 1.9% 3.8% 8.5%Note : Numbers for previous months may change as coding i s modi fied for 4.2 , and additional referra ls are included for 4.1

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Mangere/Otara Locality

Locality leadership roles were filled in April and representatives joined the leadership team in May. Included were allied health clinical leads for Otara and Mangere, nurse lead for Otara, and the GP lead for Otara. Community network leaders, one from Otara and one from Mangere, also joined the leadership team. The community network leads have a dual responsibility to lead community networks and form a local network of social service providers. This activity will link with and draw from the all-of-dhb social service network group that will be meeting imminently. The purpose of the engagement is to meet local providers, teach and learn about local services and eligibility criteria, and co-design services so that gaps and overlaps are resolved in the future. A locality multidisciplinary clinical network group meeting was held in the Mangere Community Health Centre in May on the topic of “better integrated foot care”. The problem of high rates of lower limb amputations for people living in Otara-Mangere was presented. Attendee’s added their perspectives of the problem. The deliverable from the meeting was a named working group and a conceptual plan of action on reducing rates of lower limb amputation. Facility planning for the shared service hub in Mangere continues. Sapere have delivered a high level indication of service mix for the facility. The information will be communicated to the Integrated Infrastructure Investment Steering Group in May. Home Health Care Redesign A local initiative in the Orakau Road Home Health care redesign is to achieve better integration with primary care. District nurses and allied health are testing ways of working in a service level integrated teams in 3 out of 5 geographical clusters of general practices in Otara-Mangere. Roll-out

1. Acute Demand



1.1 Unplanned readmissions (28 days) 8.0% 6.5% 7.1% 8.7% 7.7% 5.7% 6.6%1.2 ASH rate (per 1,000 enrolled patients) 2.7 2.4 2.2 2.3 2.2 2.0 2.11.3 Average bed day usage in last 6 months of l ife 14.2 12.4 17.4 11.0 10.7 11.2 12.3Notes : Numbers for previous months may change as additional morta l i ty data i s received for 1.3 and as coding i s modi fied for 1.1 and 1.2.Aged Res identia l Care Bed Days in Pukehoke and Frankl in Memoria l Hospi ta ls are included in the figures for 1.3 - this wi l l primari ly a ffect Frankl in as ARC faci l i ties are independently located in a l l other loca l i ties .

2. Quality







4. Other




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to a further two clusters is being planned with a view to implementation in June / July depending on readiness of general practices. At Risk Individual Programme There continues to be ongoing enrolment of adults living with long term conditions into the At Risk Individuals programme. Multidisciplinary team ways of working continue to be developed. Manukau Locality

EXPO and Winter Wellness The locality supported a three day expo in April that was initiated by a local innovative accident and medical centre. The Manukau Locality Clinical team, found participation in the Manukau Wellness Expo a valuable experience, while it was time intensive, quite a number of positives were noted and provided the Locality Team with:

1. Opportunity to discuss expo attendees preferences for health care delivery services. 2. Opportunity to discuss Winter Wellness messages, promote Healthline and Flu

Immunization, in particular, the new criteria of free immunization for at risk children. 3. Opportunity to work collaboratively with Healthpoint in identifying GP Practices and specific

health services requested from some individuals – this initiative would not have been possible without the support of the Healthpoint stand where a neutral service supported individuals to link with culturally matched services near home.

4. An activity that involved expo visitors voting in their healthcare choices when unwell proved a good way to engage and provided opportunity to share health promotion messages. The

1. Acute Demand



1.1 Unplanned readmissions (28 days) 7.1% 5.8% 7.2% 6.6% 6.7% 5.2% 6.6%1.2 ASH rate (per 1,000 enrolled patients) 2.3 2.2 2.0 2.2 2.0 2.1 2.11.3 Average bed day usage in last 6 months of l ife 12.9 12.2 9.5 16.7 11.2 12.8 12.3Notes : Numbers for previous months may change as additional morta l i ty data i s received for 1.3 and as coding i s modi fied for 1.1 and 1.2.Aged Res identia l Care Bed Days in Pukehoke and Frankl in Memoria l Hospi ta ls are included in the figures for 1.3 - this wi l l primari ly a ffect Frankl in as ARC faci l i ties are independently located in a l l other loca l i ties .

2. Quality







4. Other




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sponsored prizes significantly improved the engagement with expo visitors (from a similar Expo in Sept 2014) and over 255 people visited the stand over two days.

5. The voting activity identified 71 % of participants would prefer to visit their GP face to face when seeking healthcare. No participants over the age of 65 chose Middlemore Hospital A&E or an After Hours Emergency service as their first option for healthcare delivery and few sought advice from the GP by phone or email.

6. Networking opportunities between health and social services at the expo and also the Pacific Media Network. A link between Pacific Media Network and the locality has paved the way for regular Pacific radio health promotion slots.

7. Information on where the expo attendees currently resided (through the voting process), this information can be used in future for Auckland City Council funding applications for similar expos.

Conversation snippets with Locality stand members: • Middle aged Samoan female suggested “this is great, should have one of these (expo) every

3 months”. When asked why, the participant explained that “my people don’t go to their doctor so much, it’s a language thing. If we can get our blood pressure checked here for free, it’s a good thing.”

• Pakeha female living in Manurewa has a GP in Mt Albert. When commenting that it was a long way to travel, the participant advised that she has an “awesome GP who has known me a long time”. It demonstrated that having a relationship with a practice was important.

• Several young women with children commented on the fact that Healthline had been a “life saver” in the early hours of the morning when needing advice on their sick child.

• Local After-hours A+E is too expensive for many participants. • Female with children described how their current GP practice previously had a direct debit

system ($16 per month for whole family) which worked really well for them as it meant they didn’t need to worry about whether they could afford to see the GP. According to the participant this has now changed to “pay as you go” system. She explained that she now found herself in the situation that she needed to wait for “pay day” before seeing her GP.

• A suggestion was made by a participant that we should include alternative therapists (specifically in our locality stand competition) as an option to seek health advice.

Winter Wellness Flier The locality GP lead has developed in partnership with PHO clinical directors a patient wellness flier that offers practical patient centred advice and support on how to stay well in the winter and options for care when unwell. This flier has been reviewed by Dr Doone Winnard and is now ready for wider distribution to practice rooms and key community sites where the public are likely to read fliers (ie. Labtests, pharmacies and community groups). Posters with the key messages are also in development and the Home Health Care team will also distribute when in patients homes. Enhanced Primary Care Teams The main activity for the locality in the last month has been undertaking initial practice visits to introduce key locality clinical team members to practice teams and offer support with their patients on the At Risk Individuals programme as a starting point. Patients identified in the Clinical Priorities group with uncontrolled diabetes will be the next subgroup of focus. The practice visits are going well and practices are very interested in working closely with Home Health Care team members. The visits continue to highlight the need for clinicians to have access to resources and options to support addressing patients’ social determinants of health. To date a third of the practices in the locality have had their first visit complete and some practices are on their second visit and achieved their first Multi-disciplinary team meeting.

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Clinical Priorities The locality clinical team including GP lead, senior medical officers and nurse lead continue to work with Ko Awatea on the clinical priority of patients with to review 200 patients with HBA1C over 100. Practices have been identified who wish to work within this initiative. The approach will be to facilitate the patient onto the At Risk Individuals programme if appropriate and the locality Senior Medical Officer’s and locality co-ordinators will support practices to achieve this when required. This may include home visits by the co-ordinators and clinic reviews by the SMO’s. The third meeting to confirm the approach is scheduled this week. These patients will also need strong links to the “At Risk Foot” project and this offers opportunity to test a cohesive approach to assessing for complications from poorly controlled diabetes and ensuring patients are linked into the right services at the right time. Franklin Locality

Home Health Care / Community re-design Workshops Work streams supporting the home health care team re-design have been established looking at: • Patient Journey • Service development and resourcing • Workforce development and training • System Integration and communication Volunteers across all health sectors have requested to be involved in the work stream of their interest. Planning meetings are well underway with work stream meeting commencing in early May.

1. Acute Demand



1.1 Unplanned readmissions (28 days) 6.1% 5.1% 7.3% 8.5% 5.2% 5.9% 6.6%1.2 ASH rate (per 1,000 enrolled patients) 1.8 1.8 2.0 1.5 1.7 1.5 2.11.3 Average bed day usage in last 6 months of l ife 16.1 15.8 15.3 27.6 17.7 30.4 12.3Notes : Numbers for previous months may change as additional morta l i ty data i s received for 1.3 and as coding i s modi fied for 1.1 and 1.2.Aged Res identia l Care Bed Days in Pukehoke and Frankl in Memoria l Hospi ta ls are included in the figures for 1.3 - this wi l l primari ly a ffec Frankl in as ARC faci l i ties are independently located in a l l other loca l i ties .

2. Quality







4. Other




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Help You, Help Me A workshop with Franklin local community groups yielded 17/24 groups committed to listing their services on the site. The first five loaded are Franklin Family Support, Adult Literacy Franklin, Pukekohe Community Action, Counties Manukau Homecare Trust, and Franklin Hospice. Community volunteers were identified to train community groups to upload and refresh their own information on the HealthPoint site. Winter Planning A multi organisational working group including representation from primary care, pharmacy, St Johns, Pukekohe Hospital and Home Health Care Team has been meeting regularly to develop a Franklin Locality Winter Plan. Three population cohorts to target were identified after detailed analysis of the data from last Winter’s Emergency Department admissions: Cohort one are those “vulnerable” persons aged 80 years and over Cohort two are infants/children aged zero to four years Cohort three are those persons aged between 55 and 79 years that have been admitted to hospital with a (primary) respiratory disease diagnosis since June 2014 Proposed Interventions/Initiatives * Information - Winter Wellness information pack include influenza vaccination, home insulation, and general guidance on self-care over winter. This will be distributed person to person principally to our target population cohorts via primary care, home-health care, St John etc. It will be augmented by distribution across multiple Franklin locations e.g. home-based support services, family support services, senior citizens clubs, child care centres, pharmacies, meals on wheels etc. In addition there will be inclusion in the regular General Manager newspaper article promoting key winter messages. * Rapid Response – extension of hours to include Saturday and additional hours during Monday to Friday to better align with primary care hours and busiest days. This will include working with primary care to case find patients from target cohorts who are not on the At Risk Individuals programme but considered at risk and/or attended the Emergency Department last year. * Influenza Vaccination - actively promote flu vaccination, especially for vulnerable groups, through the “Health Care Homes”. In addition we will publish winter wellness messages in both Franklin Newspapers, from all Franklin practices, headed “A winter message from your local practice health care team.” Regular updates from Practices on numbers vaccinated being shared. * POAC Use - There is a range of POAC utilisation by Franklin GP practices. This will be one of the topics covered in a planned series of visits to all Franklin practices to be conducted by the Locality Lead Senior Medical Officers and the Locality GP Lead. * Local Hospital Beds - Winter 2014 saw average occupancy of Pukekohe Hospital at around 70% and Franklin Memorial just under 90%. We have discussed the use of this capacity in winter 2015 by opening up for POAC respite-type admissions and this will be introduced, initially, at Franklin Memorial Hospital, building on that hospital’s greater experience with respite-care admissions. This

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will be evaluated prior to further consideration being given to extending POAC respite access to Pukekohe Hospital beds. In addition, a process map is being created for use by practices which will clearly describe the routes of access into our local hospital beds and confirm medical responsibility. * Blue Card/Care Plan – Already active in the Eastern Locality. Our plan is to introduce this in Franklin, led by our Locality SMO, for our cohort aged 55 to 79 years with a diagnosis of COPD. * Free Home Insulation – As of February 2015 1,051 Franklin Homes had been insulated under the CM Health sponsored scheme. It is estimated there are 4000+ homes which would benefit and the occupants of which would qualify. Target set to achieve n=400 homes insulated in 2015. Targeted mail out planned of home insulation scheme information together with a generic covering letter headed “Your GP has recommended we send this to you” to eligible population using GP Practices searching their enrolled population registers. *Information/knowledge on resources/services available to GP Practices has been identified as a barrier. A road show to all GP Practices – Lead GP, Locality SMO and Rapid Response service is planned over the next few weeks to raise awareness. In addition a post card has been developed containing key contact information for making referrals to Rapid response, POAC etc. to be circulated to all GPs in Franklin and loaded to desktops. Locality Leadership Group and Clinical Advisory Network These two groups had a combined meeting this month for an update on the At Risk Individuals programme and discussion on the next stage. At Risk Individuals Implementation Practices in Franklin continue to progress with the enrolment of patients on to this programme. Franklin had enrolled 844 persons at the end of March against a target of 841. Multi-Disciplinary Team meetings are operational in three of the GP practices with staff from Home Health Care including the Needs Assessment Service Coordination team attending. One GP Practice has declined to participate in the scheme.

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4.9 Primary & Community Finance Report This report highlights net exceptions from agreed budget with a focus on full year variances.

CPHAC Financial Report Mth Mth Mth YTD YTD YTD FY FY FY

As at 30 April 2015 Actual Budget Var. Actual Budget Var. Actual Budget Var.

$000 $000 $000 $000 $000 $000 $000 $000 $000 Total Revenue 32,848 32,513 335 324,517 325,131 (615) 391,670 390,158 1,512

Expenditure

Pharmaceuticals 8,808 8,337 (470) 85,155 83,375 (1,780) 102,024 100,050 (1,974)

PHO/GMS/Rural Retention 6,852 6,902 50 69,343 69,015 (328) 83,212 82,818 (393)

Primary Care & Service Development 369 318 (51) 3,398 3,177 (222) 4,078 3,812 (266)

Planning & Funding - Governance 306 138 (168) 1,805 1,382 (424) 2,166 1,658 (508)

Primary Care NGOs 1,136 914 (221) 9,279 9,144 (135) 11,135 10,972 (162)

Chronic Health Conditions Programme (CCM) 1,333 923 (410) 9,035 9,232 197 11,093 11,079 (14)

After Hours Regional Service 620 566 (53) 6,154 5,664 (490) 7,385 6,797 (588)

Child, Youth & Mortality 665 589 (76) 7,146 5,880 (1,266) 7,460 7,055 (405)

Oral Health 463 464 1 4,640 4,642 2 5,568 5,570 2

Localities/20k initiatives 436 575 139 5,780 5,752 (28) 7,208 6,902 (306)

LTS - Chronic Health Conditions 344 347 3 3,421 3,466 45 4,105 4,159 54

Immunisations 246 246 (1) 2,456 2,456 (0) 2,947 2,947 (0)

Primary Options for Acute Care (POAC) 178 181 3 1,715 1,815 100 2,057 2,178 120

Intersectorial 88 110 22 822 1,100 279 986 1,320 334

Healthy Lifestyles 76 91 15 685 909 224 822 1,091 269

> 65 Home Based Support Services 1,491 1,715 224 16,533 17,152 618 19,840 20,582 742

> 65 Aged Residential Care 5,689 6,038 349 58,674 60,377 1,703 71,323 72,452 1,130

> 65 Other 317 441 124 3,617 4,413 796 4,341 5,295 955

Mental Health NGOs 3,878 4,194 316 38,492 41,944 3,452 50,327 50,333 7 Other - incl. Budget Savings Target (716) (699) 17 (7,026) (6,989) 36 (8,540) (8,387) 153

Total Expenditure 32,578 32,391 (187) 321,126 323,905 2,779 389,537 388,686 (852)

Net contribution 270 122 148 3,391 1,227 2,164 2,132 1,472 660

The ten months of 14/15 Primary and Community budgets as a whole, are on target with a net favourable contribution variance of $2,164k and $660k favourable position as a full year forecast. Other than the two main variances highlighted below and in prior months, most unfavourable expense variances have corresponding and matching favourable revenue variances. A departure from this is a recent trend, as localities/integration implementation matures, for unbudgeted FTE and contractor costs to arise where previously these costs were budgeted as different expenditure types i.e. via PHO contracts or in the localities contingency budget line.

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Community Pharmaceuticals (FY $1.974m unfavourable variance) 40% of the $100m pharmaceuticals budget consists of pharmacy funding relating to drug dispensing and added value services. This expenditure has been under constant change over the last couple of years as we move from a pure volume dispensing arrangement to a hybrid of volume dispensing coupled with greater patient health management. This transition has been a complex programme of 1) ensuring consistent pharmacy income, 2) maintaining access to appropriate drugs and 3) implementing greater managed healthcare for patients with long term conditions. Under the implementation, managed by the Ministry the total country dispensing cost has been controlled and capped but that has not prevented variation at DHB level. CM Health is one DHB with forecasted dispensing growth greater than average and greater than our budget. Complexity of the changes have meant forecast detail was not being available at budget time and consequently dispensing budget has been under estimated by $2m or 5%. Actual charges being incurred are also greater than forecasted by $0.275m Changes in co-pays and rebates net the variances down to a $1.974m overspend. Reasons why CM Health differs from the average DHB are complex but relate to the extent how well DHBs have managed their pharmacies dispensing activity. DHB’s with pharmacies with historically excessive repeat dispensings have seen their costs reduce as the incentive for dispensing volume decreases. Consequently, DHBs like CM Health with well managed dispensing have had to take an increased share in maintaining the total capped dispensing budget. Health of Older People (FY $2.827m favourable variance) These costs include Home Based Support and Aged Residential Care for over 65s. CM Health over 65s population is growing at over 4% pa and Health of Older People budgets have been fixed to this growth. Recent forecasts have revealed utilisation of these services are below population growth and on current trends will result in a cost under spend of $3.416m. Reasons why this is happening are a combination of controllable and uncontrollable variables. Variables like;

- Winter severity - Net worth threshold for rest home subsidy has been impact by Auckland house price increases resulting

in reduced number of clients receiving a subsidy - Economic family hardship - Managed strategies to keep the aged well and more self-managing. - InterRAI assessments and reassessments have been resulting in reduced Home Based Support Service

cost.

Vasectomy service

Dr Sarah Tout, Clinical Director, Women’s Health

Anna-Maree Harris, Project Manager

Background

• Maternity External Review recommendation to increase access to contraception. Access, cost and information barriers identified.

• Recommendations focussed on female contraception, excluded men/families

• Contraception Sub-project group formed in April 2013 including members from: – primary care – Family Planning – school nurse – midwifery – nursing – medical

Project achievements

• Implemented a new service providing free postnatal contraception of woman’s choice at the bedside or at a new clinic

– Information and products available including: • Jadelles (arm implants)

• IUCDs more suitable for some women

• Education programme for 200+ staff

• Worked alongside Family Planning to support their services

• Tubal ligation performed while women in hospital

Rationale for a vasectomy service

• Vasectomy provides an alternative to female sterilisation for families that are complete

• Advantages – Clinically effective

– Cost effective and cheaper than tubal ligation

– Less invasive procedure than tubal ligation

Pilot vasectomy service

• Initial pilot to test demand – numbers, ethnicity

• Contracted 123 procedures to external provider

– Self referral by men

– No eligibility criteria apart from usual health eligibility

• All procedures completed within 5 months

• Further one-off project funding approved

– Clinical referral criteria introduced

• 188 total completed to date

Who chooses vasectomy?

n = 123

Asian

NZ European

Pacific Island

Maaori

Pilot II

Asian

NZ European

Pacific Island

Maaori

Pilot I

n = 49

What next?

Ongoing service offering free vasectomy to families that are complete on clinical referral where:

– Termination is sought; or

– Family has complex needs; or

– Female sterilisation (tubal ligation) is sought

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Counties Manukau District Health Board Community & Public Health Advisory Committee Meeting – (27 May 2015)

6.0 Resolution to Exclude the Public Resolution: That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

7.1 Minutes of the CPHAC Meeting with public excluded15 April 2015

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

Confirmation of Minutes For the reasons given in the previous meeting.

Documents

Counties Manukau District Health Board Community & Public ...€¦ · Wednesday, 27 May 2015 at 1.30pm – 4.30pm, Manukau Boardroom, Lambie Drive. Time Item Page No 1.30pm – 1.35pm