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Agenda

Bay of Plenty District Health Board

Venue: Tawa Room, Education Centre, 889 Cameron Road,Tauranga Date and Time: Wednesday 19 July 2017 at 9:30am

Board only time: 8:30am

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

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

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

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

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

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

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

Bay of Plenty District Health Board Agenda

Item No. Item Page

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Karakia

2

Apologies

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Presentations 3.1 Patient Story – 9:30am 3.2 Family Violence – Raewyn Butler – 9:50am 3.3 Importance and Safety of Immunisation – Toi Te Ora – 10:10am

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Interests Register

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Minutes and Chair Report Back 5.1 Minutes of Board Meeting – 21.06.17 5.2 Matters Arising

5.3 Minutes of BOP ALT - 14.06.17 5.4 Minutes of BOPHAC - 05.07.17

5.5 Member’s reports from Regional/National Forums – Verbal update

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

6.3 Bay of Plenty District Health Board adoption of Public Health Position

Statements 6.4 Quarterly Employee Health and Safety Report

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Papers for Noting (Items for this area will only be discussed if the Chair has been notified via GMGQ) 7.1 Work Plan 7.2 Board Drop In Visit Report

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Bay of Plenty District Health Board Agenda

Item No. Item Page

7.3 6 Monthly Board Attendance Report 7.4 E-Cigarettes

7.5 BOP Integrated Healthcare Strategy 2020

7.6 Correspondence for Noting

• Letter from Whakatane District Council re Acknowledgment of Contribution to Emergency Response dated 6 July 2017

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General Business

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Resolution to Exclude the Public

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Next Meeting – Wednesday 16 August 2017.

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Raewyn Butler, Deb Fielding and Sally Crisford – FVIP Coordinator BOPDHB

Funded VIP coordinators in DHB

Family Violence Intervention Guidelines

Technical advice & national meetings National VIP Manager for DHB, National Network VIP Coordinator meetings

VIP training contracts

Monitoring and evaluation National evaluation of DHB, Quality Improvement Activity resource kit

Resources MoH Family Violence website, HIIRC website, posters, cue cards, pamphlets

National VIP

http://www.health.govt.nz/our-work/preventative-health-wellness/family-violence

Senior management support & community collaboration

Policies, standardised documentation peer-support

VIP Coordinator Service reorientation Clinical Champions

Staff training core, in-service and refresher

Quality improvement: monitoring, audit & evaluation

Resources Posters, cue cards, pamphlets

DHB VIP

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Clinical Leadership

Charge Nurse Manager, Clinical head of Department, Nurse Educator, Nurse Practitioner

Policy and procedures Documentation Department assessment forms Disclosure & referral forms

Peer-support

Service reorientation Clinical Champions

Staff training Core, in-service and refresher

Quality improvement: Clinical audit & feedback

Resources Posters, cue cards, pamphlets

Service VIP

CHILD PROTECTION CHECKLIST to be completed for ALL children under the age of 2 presenting to ED COMPLETE a) – d) FOR ALL PATIENTS UNDER 2 YEARS OF AGE

a) Is there any concern about the child and/or family’s BEHAVIOUR? Yes No

b) Is there a past history of PREVIOUS INJURIES or does a CHILD PROTECTION ALERT exist? Yes No

c) On examination, does the child have any UNEXPLAINED INJURIES? Yes No

d) Any other concern? Yes No

ALSO COMPLETE e) – g) FOR ALL PATIENTS UNDER 2 YEARS PRESENTING WITH AN INJURY

e) Has there been a DELAY between the injury and seeking medical advice, for which there is no satisfactory explanation? Yes No

f) Is the HISTORY INCONSISTENT with the injury and/or with the child’s developmental level? Yes No

g) Is the child UNDER 12 MONTHS of age? Yes No

ANY SUSPICION of non-accidental Injury (NAI)? Uncertain or Possible (“Yes” to any answer above)

Discuss with ED Senior Doctor & ensure intimate partner violence routine enquiry is completed

No suspicion of NAI

Name: _________________________________ Signature: ____________________________ Date: ____________

Memorandum of Understanding, DHB, CYF, Police and BOPDHB

• Collaborate front line Child Protection Practice.

• Consultation on areas of agreed mutual interest such as policy development and initiatives that will impact any party.

• Service planning and development.

• Developing a register of all agreements between all parties.

• Information Sharing.

• Shared training and other services.

• Management of Disputes.

National Child Protection Alerts (CPAS Alerts)

Why have a Child Protection Alert system

• Child abuse and neglect are common

• Acts of child abuse are frequently not single events

• Abuse can be missed because symptoms are vague or due to lack of diagnostic suspicion

• Families are mobile

• Children who are abused can have transient placements within families

• Systems reviews of child abuse deaths recommend improved information sharing

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Alert Application Process

Rep

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Request for alert form completed and a copy of the CYF Report of Concern , are reviewed by the FVIP Coordinator, Information is collected and completed.

Case is presented to the CPAS Multidisciplinary Team Meeting

MDT decide if CPAS Alert is Warranted

Alert Completed with Time Frames if Appropriate and review dates

CPAS Alert is Placed on Child’s Electronic file.

Working with At Risk Pregnant Women

WHO are identified with “High Risk & Vulnerable Pregnancies”

Notifications need to be made as early as possible when these issues are identified:

• Mental Health / Drug and Alcohol / Intellectual capacity

• Serious domestic violence

• Previous history with CYF (for other children or as a child or young person)

• Previous children removed from the parents care (as per the CYF Subaqueous Child )

• Transience

• Avoiding or / not working with services

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Need for a multiagency safety plan on hospital medical file's (mothers and new-born's)

• A copy of the safety pan will be placed in the mother and child’s file, this will be visible for all medical staff

• A copy of any Court Orders will be placed in the mother and child’s file

• CYFS / BOPDHB information sheet will be completed by the CYF key Social worker and the BOPDHB Maternal Social Worker

This will include • Safety of mother and unborn.

• What are the care and protection concerns.

• Who needs to be contacted when baby is born.

• Who can visit while in the unit.

• Who is taking baby home.

• Feeding.

• Who will be following up family and when.

STRANGULATION DOCUMENTATION FORM Look for strangulation injuries behind the ears, back of neck, chest and shoulder areas, eyelids (above and under), jaw and upper chin.

•No injury noted/visible

•Neck pain

•Sore throat

•Scratch marks

•Voice changes (e.g. raspy or hoarse)

•Difficulty swallowing

•Nausea or vomiting, Bruising

•Red spots/petechiae haemorrhages

•Fainting or unconsciousness

•Light headed

•Incontinence (urination and/or defecation)

•Red eyes, Rope or cord burns

•Neck swelling, Miscarriage

•Breathing changes

•Loss of memory/headaches, Coughing

•Photographs taken

Audio tape taken of voice

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Thank you

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Immunisation Safety SUBMITTED TO: Bay of Plenty District Health Board Board Meeting 19 July 2017 Prepared by: Dr Jim Miller Medical Officer of Health Endorsed by: Simon Everitt, General Manger, Planning and Funding Submitted by: Toi Te Ora – Public Health Service RECOMMENDED RESOLUTION: That:

1. That the Board notes the extensive measures in place to assure the safety of vaccines in the NZ Immunisation Schedule.

2. That the Board continues to support the immunisation programme, and provides

information to the public and patients to improve confidence in the benefits and safety of immunisations for individuals and the community.

ATTACHMENTS: Pages 5-15 Chapter 3.2 - Ministry of Health 2017 Immunisation Handbook BACKGROUND: This update is in response to recent anti-vaccination publicity and questions from the public. ANALYSIS: Immunisation Safety – A Brief Overview The New Zealand Immunisation Schedule The current NZ vaccination schedule protects against the illnesses caused by fourteen different infectious viruses and bacteria. The range of illness and disability which can be averted is wide, ranging across gastroenteritis, pneumonia, meningitis, epiglottitis, septicaemia, congenital damage, deafness, blindness, paralysis, cirrhosis, and cancers. Premature deaths are also prevented. For example, from 2010-2013 nearly 900 (898) infants caught whooping cough (pertussis), 75% were hospitalised, and two infants died. The Purpose of Community Immunisation The vaccination schedule is complex, and aims to achieve a number of outcomes, which vary from age to age, and vaccine to vaccine. The MMR (Measles, Mumps and Rubella) vaccine is a good example of this.

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Measles is only found in humans, is a serious illness with significant risk to young children, and is highly contagious. However, the vaccine is extremely effective, so it is possible to eradicate measles entirely. Achieving 95% uptake for this vaccine would protect individuals, especially children, protect people who cannot be vaccinated, and contribute to the global effort to eradicate measles. Rubella, on the other hand, is a fairly mild illness in most children and adults. However, rubella in early pregnancy can have devastating effects on the developing child resulting in learning disabilities, cataracts, deafness, and organ damage. The main purpose of rubella vaccination is to prevent infections in women in order to prevent congenital rubella. In the case of tetanus vaccine, the aim is strictly individual protection. This illness is caused by common soil bacteria which produces a potent nerve toxin. The tetanus vaccine only protects a vaccinated person from the toxin. The Importance of High Uptake Immunisation protects individuals who choose to accept vaccination from a range of diseases; however, unlike most treatments, there is a wider family and community dimension to vaccination. A vaccinated family member is unlikely to become ill and infect their closest contacts. A vaccinated individual is unlikely to catch rubella and unwittingly infect a pregnant woman. At the wider community or national level, another issue arises. Where most people are immune to an infection such as measles (either through previous illness, or immunisation), a case of measles is very unlikely to spread, despite being very contagious. This is called community (or herd) immunity and protects individuals who can’t be immunised for medical reasons, such as those receiving cancer treatments. Vaccine Safety The safety of all medicines is important in healthcare, however it is particularly crucial for immunisations, which are actively offered to well individuals to prevent rather than treat illness. They are also offered to individuals, at least in part, to protect others. An example of this is rubella vaccine being offered to boys, largely to protect pregnant women. Vaccines have to be, and be seen to be, as safe as possible. Process for Testing, Licensing, and Safety Monitoring of Vaccines in New Zealand Bringing a vaccine to the stage of routine use in a national programme takes many years. In a similar way to any new medicine, new vaccines progress through three stages of clinical trials assessing safety, immune response, and efficacy. The manufacturer then must satisfy Medsafe before a vaccine can be licensed for use in New Zealand. Once in use any clinically significant events are reported to the NZ Centre for Adverse Reactions Monitoring, and thoroughly investigated. Generally, vaccines will be licensed in many countries all of which will have similar requirements for safety and monitoring, therefore increasing the chances of detecting and assessing any rare and unforeseen issues.

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Safety Record of Vaccines Although minor side effects such a local tenderness at the vaccine site and mild fever are common, vaccines are well tolerated. Anaphylaxis, which is a severe allergic reaction, although rare, is a foreseeable and potentially fatal side effect, vaccinators are trained regularly in managing anaphylaxis, and vaccinate in controlled settings. Training of Vaccinators Most vaccines in the routine schedule are given by nurses in primary care. It is recommended that they have undergone the training and assessment to vaccinate as an authorised vaccinator and in practice most do. This means that in our area, each authorised vaccinator has had their training and assessment personally approved by one of the Medical Officers of Health. In addition, vaccinators are required to attend professional development for reauthorisation every two years. Concerns about Vaccines Despite the fact that vaccines are very safe, and are delivered by knowledgeable, trained health professionals, many people have understandable concerns, which may lead them to be hesitant to vaccinate their young children. As noted previously, vaccination is an intervention in healthy individuals, which may cause some discomfort or mild side effects. Parents are protective of their children’s comfort and safety. Some parents may not have had accurate information on the benefits of immunisation, or have seen or been given misinformation. Well trained healthcare staff can help by taking concerns seriously and providing credible advice on the risks and benefits of childhood vaccination. Informed consent is vital, and parents can decline immunisation. There is however organised opposition to immunisation. Anti-vaccination sentiment has been a feature of immunisation since shortly after its introduction in the 1770s in the United Kingdom. Early smallpox vaccination was subject to religious objections, for example. Anti-vaccination is rather more than simply vaccine refusal, as it includes a desire to ensure that others also refuse. The underlying reasons may well have little to do with the reality of immunisation, but rather about religious or spiritual beliefs, nature vs science, mistrust of medicine or the ‘establishment’, or even a perception that there is a conspiracy to profit at the expense of people’s health. There are a number of currently common (and often very longstanding) misconceptions which healthcare staff should be confident in addressing with patients. Some of these question the need for and effectiveness of vaccines or the underlying motives of the pharmaceutical industry and medical profession; however a few safety issues are often raised and are addressed here. Vaccines cause idiopathic illnesses Some illnesses are as yet not fully understood, or are difficult to manage. It is claimed that vaccines are the cause of these. Examples are: the MMR vaccine and autism, the HPV vaccine and autoimmune diseases, and childhood immunisations and sudden infant death syndrome (SUDI). All have been thoroughly studied worldwide and vaccination does not cause any of these conditions.

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Vaccines overload infants’ immune systems Infants encounter many more ‘foreign’ substances each day, than are ever present in vaccines. Dealing with antigens is what the human immune system does (and it is why immunisation works). Infants are exposed to more than a million bacterial proteins at and shortly after birth compared with the ~50 antigens in the entire immunisation schedule. Vaccines contain toxic chemicals, viruses, and cells Vaccine production is strictly controlled, but there have been a small number of contamination episodes in the past. The additives that are meant to be there such as aluminium are in miniscule amounts in comparison to exposure through daily living. For example we consume some 10-15 mg of aluminium daily in food and drink, 20-30 times more than that in one vaccine dose. The trace amounts of aluminium have been in vaccines for more than 70 years. Concern about the trace amounts of mercury in some vaccines is also a moot point as there is no mercury in any of the vaccines in childhood immunisations.

Dr Jim Miller Medical Officer of Health June 2017

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Attachment: Chapter 3.2, Ministry of Health 2017 Immunisation Handbook Page 95 Immunisation Handbook 2017 3.2 Addressing myths and concerns about immunisation Myths about immunisation have existed since the first use of smallpox vaccine over 200 years ago and have resulted in the loss of confidence in immunisation programmes. Misconceptions about vaccines contribute to vaccine hesitancy, which is an issue of global concern. This section provides information to assist providers with addressing concerns about immunisation. Page 96 Immunisation Handbook 2017 3.2.1 Background Concerns about immunisation should be taken seriously and responded to appropriately, with as much information as possible. Individuals have the right to make informed decisions for themselves and those in their care, and to accept responsibility for their decisions. It is important to respect this right. Globally, including in New Zealand, there are many groups of people and individuals who actively campaign against immunisation. Their reasons for doing so may include personal experience, such as an adverse event they have attributed to immunisation, philosophical beliefs, conspiratorial beliefs or dissatisfaction with inadequate or superficial responses from health professionals, who can seem at times to be dismissive of people’s concerns. It is important for all health professionals to be able to provide accurate information about the benefits and risks of immunisation and to respond with as much information as possible to parent/guardian concerns, or refer people appropriately. It is not always possible to change people’s position by way of scientific argument or presentation of evidence. Anti-immunisation arguments are almost exclusively based on fallacies of fact or logic, or on historical information that is no longer applicable in the current context. Often these arguments can be challenging for the health professional, particularly if they are unfamiliar with the particular argument and when they are complicated by logical flaws. In any discussion, it may help to acknowledge that science does not always have all the answers, but that it provides a tool with which to answer questions and evaluate the evidence. It is important to point out that an event that follows immunisation is not necessarily caused by the immunisation. Finally, it is always helpful to inform parents/guardians about additional sources of information (see section 2.1.2 on informed consent and section 1.6 on the safety monitoring of vaccines in New Zealand). Page 97 Immunisation Handbook 2017 Vaccination questions and addressing concerns 3.2.2 Understanding anti-immunisation People tend to take on board information that supports their belief system and to ignore information that does not. The internet makes it very easy to access material that is appealing. Most people usually make logical decisions based on their perception of risk. Therefore, if a person has the perception that the risk of disease is real and that

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vaccines are reasonably safe and work, then they are more likely to vaccinate. People are unlikely to vaccinate if they perceive that there is little risk of disease and that vaccines are not safe and do not work.4 3.2.3 Addressing concerns If a parent is concerned about immunising their child, determining their concerns and addressing them can be helpful. Most often these concerns are around vaccine safety. As a health professional, you should challenge poor information, in a respectful way. There are three steps you can take when addressing a parent’s or a vaccinee’s concerns.5 1. Understand the specific concerns. Not every parent or vaccinee has the same concerns, so it is important to first establish what they are worried about. Ask them. It may be helpful to get them to describe what they know about disease risk and vaccine benefit. If they have misconceptions, you can correct them. Evidence has demonstrated that it can be helpful to relay stories of children harmed by vaccine-preventable diseases. Using a vignette can be powerful. If you have no experience of a particular vaccine-preventable disease, see the IMAC website (www.immune.org.nz), or websites such as the Centers for Disease Control and Prevention, the Immunization Action Coalition and the National Centre for Immunisation Research and Surveillance (see Appendix 9). 2. Stay on message. Keep your messages clear and focused on the concern at hand. Page 98 Immunisation Handbook 2017 3. Discuss the rigours of global vaccine research, such as safety systems. Many vaccine safety myths focus on the limitations of passive reporting systems for adverse events, such as CARM. The many active safety systems and hypothesis-driven research are overlooked. You can highlight that when studies compare the risk for an adverse event in vaccinated children with the risk in unvaccinated children, they support the safety of vaccines. 3.2.4 Debunking a myth Debunking myths can be very challenging and can also backfire. When you are addressing a myth, there are three important points to remember.6 1. Try not to repeat the myth. Focus on the core facts. This is because people cannot remember if what they hear was a myth or a fact later on. Debunking can serve to strengthen the myth in people’s minds as either familiar or a threat to their world view. Begin with the core facts. 2. Precede a myth with a warning. Let them know that ‘this is untrue’, because you often cannot avoid mentioning the myth.

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3. Include an alternative explanation that accounts for how the myth misleads. Do not leave a void but rather replace the myth with accurate information. You can highlight the problems with cherry picking, conspiracy theories and fake experts. If you have them, graphics can be extremely helpful, such as pictures of vaccine-preventable diseases or even a graph showing the impact of vaccination – if you feel it appropriate.

Page 99 Immunisation Handbook 2017 Facts and myths about immunisation Core fact: Measles and rubella have been eliminated in some countries. The WHO has set targets for global eradication. Myth: MMR vaccine causes autism. Explanation: There is no evidence that the MMR vaccine causes autism.7, 8 In 1998 a British physician announced he had found an association between the receipt of MMR vaccine and the development of a new disorder that included autism in a study of 12 children. No subsequent studies following his study have been able to reproduce his results. In 2004 The Lancet retracted the original 1998 study from the scientific literature on the grounds that it was the product of dishonest and irresponsible research and the British authorities revoked the doctor’s licence to practise medicine.9 In 2008 a press investigation revealed that the doctor had falsified patient data and relied on laboratory reports that he had been warned were incorrect. Studies exonerating the MMR vaccine continue to be published. Core fact: The incidence of allergic diseases has been increasing. It is thought that lack of exposure to microbes may play a role. Myth: Vaccines cause allergic diseases. Explanation: Extensive research shows that, if anything, vaccines may have a protective effect against allergic disease. Many studies have explored this issue. A few have shown a positive association, but the majority show no association or a negative association. The international scientific community generally accepts that vaccines do not lead to allergies and in fact have a small protective effect against the development of allergy.2 It is especially important that children with asthma be given all recommended vaccines, as catching a disease like pertussis or influenza can worsen asthma.10 In New Zealand, influenza vaccination is particularly recommended for children with asthma because of this risk. Page 100 Immunisation Handbook 2017 The 2012 Institute of Medicine review of adverse events rejected any causal relationship between inactivated influenza vaccine and asthma exacerbation or reactive airway disease episodes in children and adults.8

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Core fact: On-time vaccination is associated with a reduced risk of hospitalisation for diseases such as pertussis and pneumococcal disease in children under 1 year of age. Myth: Vaccines cause cot death. Explanation: Vaccines may reduce the risk for cot death. Sudden unexpected death in infancy (SUDI), also known as cot death, usually occurs in children aged under 12 months and is most common around age 3 months, when many immunisations are given. SUDI may occur by chance within a day or so of immunisation.11 There is no evidence that vaccination causes SUDI. Despite solid evidence against a link, the claims continue to be made. There have been many studies that have conclusively shown that SUDI is not caused by immunisation.11 Some studies, including the New Zealand Cot Death Study, found a lower rate of SUDI in immunised children.12 This is consistent with a Scandinavian study, which found that some cases of SUDI were probably caused by undiagnosed pertussis.13 A large case-control study showed no increased risk of SUDI associated with immunisation,14 and a meta-analysis of nine case-control studies further suggested that immunisation is protective against SUDI.15 Consistent findings from several studies using a range of methods invalidate claims that associate vaccination with SUDI or cot death.16 Core fact: At birth the infant is exposed to thousands of microbes. Myth: Vaccines ‘overload’ or ‘overwhelm’ the infant immune system. Explanation: It is estimated that the infant immune system could respond to over 10,000 vaccines all at once. There is no evidence of immune system ‘overload’, either theoretical or actual. The immune system is able to deal with an extraordinarily large number of different antigens at any one time. Page 101 Immunisation Handbook 2017 Vaccination questions and addressing concerns Every day we all come into contact with viruses, bacteria and other agents to which the immune system responds. Any demands placed on the immune system by vaccines are minuscule compared to its ability to respond. Vaccines have very few antigens in them. The number of immunogenic proteins and polysaccharides in modern vaccines has decreased dramatically compared with early vaccines because of advances in vaccine technology. For example, early whole-cell pertussis vaccines contained around 3,000 immunogenic proteins, compared with two to five in the modern acellular pertussis vaccines. In spite of an increase in the number of vaccines on the Schedule, an infant now receives far fewer immunogenic proteins and polysaccharides than with earlier vaccines.17 There are considerably more antigens in the organisms that cause disease than in the vaccines.

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Explanation: Delaying immunisation for fear that an infant is too young leaves the infant vulnerable to disease, particularly pertussis and pneumococcal diseases. Infants delayed for their pertussis vaccinations are 4–6 times more likely to be hospitalised with the disease.18 On-time vaccination is important. Core fact: Vaccines induce immunity through natural processes. Myth: It is better to get ‘natural immunity’ than get vaccinated. Explanation: Some vaccines induce better protection than that resulting from natural disease. Examples are tetanus, HepB and HPV, and protein conjugate polysaccharide vaccines administered to children aged under 2 years (Hib and PCV). There is no evidence that experiencing vaccine-preventable diseases has any benefit on health; on the contrary, these diseases are serious and sometimes fatal. Vaccinated people have fewer diseases than unvaccinated people. Page 102 Immunisation Handbook 2017 Core fact: The scientific evidence shows there is no association between HPV vaccines and autoimmune conditions. Myth: HPV vaccines cause autoimmune conditions. Explanation: Several large cohort studies have been conducted to investigate the link between HPV vaccine and autoimmune conditions.19, 20, 21, 22, 23 No association has been found in these studies. Core fact: The quadrivalent human papillomavirus vaccine has reduced cervical disease in countries using the vaccine, and Australia has almost eliminated genital warts. Myth: HPV vaccines cause postural orthostatic tachycardia syndrome (POTS), complex regional pain syndrome (CRPS) and chronic fatigue syndrome (CFS). Explanation: There is no scientific evidence that links POTS, CRPS or CFS with HPV vaccination. POTS is a condition in which tachycardia occurs when a patient moves from a supine position to upright. The condition is associated with a collection of other symptoms, which include palpitations, light-headedness, weakness, blurred vision, headache, extreme fatigue, nausea, syncope and sleep disturbance. Up to 50 percent of people with POTS have an antecedent viral illness and 25 percent have a family history of similar complaints. There is an overlap between POTS and CFS.24 CRPS describes a variety of disorders characterised by pain that is disproportional to the inciting event. In children and adolescents it often presents as a painful mottled swollen limb with allodynia and hyperalgesia. Girls are six times more likely to be affected than boys and the peak age of onset is at age 12–13 years. Often minor trauma is the inciting event, but around one-third of people with CRPS are unable to recall an inciting injury or trauma.25

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CFS is a disorder characterised by extreme fatigue that cannot be explained by an underlying medical condition. The causes are unknown but it has been linked to infection with Epstein–Barr virus and human herpesvirus 6. Page 103 Immunisation Handbook 2017 Vaccination questions and addressing concerns Cases of these disorders have been reported in association with HPV vaccination, particularly in the media, and social media. The variable time between vaccination and onset of symptoms, lack of consistent symptoms and a reporting rate that remains below the expected rate for these syndromes all point to HPV vaccine not being the cause of these conditions.26 Post-marketing surveillance systems globally continue to monitor the safety of HPV vaccination programmes.27, 28, 29 The WHO’s Global Advisory Committee on Vaccine Safety has systematically reviewed HPV vaccine safety and has not found any safety issue that would alter its recommendations for use.30 The main challenge with HPV vaccine is communicating its excellent safety profile.31 Core fact: Everything is made of chemicals and any chemical can be toxic, even water. Myth: Vaccines contain toxic chemicals, viruses and cells. Explanation: Vaccine ingredients are not toxic in the amounts present in a vaccine. It is the dose that differentiates a poison from a harmless substance, essential substance or a medicine. Most of the ingredients in vaccines are present already in our bodies and we consume them in some way every day. For example, aluminium is the most common metallic element on earth, and the body makes and uses formaldehyde for synthesising deoxyribonucleic acid (DNA). • There is approximately 60 times more formaldehyde in a pear than a vaccine. • Polysorbate 80 is used in many foods, including ice cream. • Vaccines do not contain extraneous cells or viruses. • Aluminium compounds administered via vaccination do not contributesignificantly to the general aluminium exposure and do not raise human serum aluminium levels. Based on 80 years of experience, the use of aluminium adjuvants in vaccines has proven to be extremely safe and effective.32, 33 For more information, see the IMAC factsheet Vaccine Ingredients (available at www.immune.org.nz/resources/written-resources). 104 Immunisation Handbook 2017 Core fact: With the exception of safe water, no other modality, not even antibiotics, has had such a major effect on mortality reduction. – Stanley Plotkin34 Myth: Vaccination has played little role in controlling disease. Explanation: Vaccine programmes have controlled or eliminated polio, tetanus, diphtheria, pertussis, Haemophilus influenzae type b, hepatitis B, pneumococcal

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disease, meningococcal disease, rotavirus, human papillomavirus, varicella, hepatitis, yellow fever, measles, mumps, rubella and others, in populations where vaccines have been used. Improvements in living conditions and medical care have reduced the chances of dying from infectious disease, but without immunisation most people will still acquire vaccine-preventable infections. For example, measles, which spreads through the air, is largely unaffected by improvements in living conditions other than reduced overcrowding. Indigenous cases of measles, mumps and rubella have been eliminated from Finland over a 12-year period using a two-dose MMR vaccine schedule given between 14 and 16 months and at age 6 years.35 In September 2016, the Region of the Americas was the first WHO region to be declared free of measles. Core fact: No vaccine is 100 percent effective and some immunised children will get the disease. Myth: Vaccines do not work, as most cases of disease are in immunised children. Explanation: As immunisation coverage increases, the proportion of cases that occur in children who have been immunised compared with those who are unimmunised increases. There is a mathematical relationship between vaccine effectiveness, immunisation coverage and the proportion of cases that are immunised. To see this clearly, imagine a group of 100 children. If 90 percent of children are given a vaccine with 90 percent efficacy, then: • 81 of the 100 children will be immune Page 105 Immunisation Handbook 2017 Vaccination questions and addressing concerns • 10 children will be susceptible because of not having the vaccine, and another 9 because of vaccine failure. This means that in the situation of exposure to the infection in a community, we expect that nearly half the cases of disease will be in immunised children, even though only 10 percent of immunised children were susceptible. Of course, if all 100 children had been vaccinated only 10 would be susceptible to disease. As vaccine uptake rises, the proportion of cases of disease that occur in vaccinated people increases dramatically, but the absolute number of cases of disease falls to very low levels. Failing to provide the denominators (how many vaccinated and how many unvaccinated) can lead to misunderstanding. For pertussis, where the protection following immunisation lasts only four to six years, immunised children can be infected but the resultant illness is usually milder, with fewer serious consequences and at an older age than if they had not received vaccine. The disease is most severe in infants, but adolescents and adults contribute to the carriage and spread of the disease (see sections 14.2 and 14.3).

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For further details on the effectiveness of vaccines, see the ‘Written resources’ section of the IMAC website (www.immune.org.nz/resources/written-resources). 3.3 Addressing immunisation issues in a constantly changing environment In the past few years the internet has exploded with a variety of forums that disseminate anti-immunisation material effectively. It is no longer practical to prepare official rebuttals to each new article. Fortunately, the internet also facilitates the rapid communication of scientific commentary on new myths as they appear. There are several scientists who regularly address immunisation myths in the form of regular blogs. In addition, some organisations provide position statements and discussion forums. Page 106 Immunisation Handbook 2017 Below are some organisations and individuals who write and provide information related to immunisation scares, myths and pseudoscience that can help you to understand the myth. They can be a source of new information that may help to address a concern and ask a question, and may be useful resources for parents. While the format is often colloquial, the writers are respected scientists who volunteer commentary against the abuse of science and evidence-based medicine. 3.3.1 Science blogs Below are science blogs that frequently deal with immunisation issues. • Respectful Insolence (http://scienceblogs.com/insolence/) is the blog of ORAC, aka American oncology surgeon Professor David Gorsky, who provides insight into recent vaccine issues, sometimes daily. This blog is hosted by ScienceBlogs, an invitation-only blog set up to enhance public understanding of science. • Science-based Medicine (www.sciencebasedmedicine.org) is a blog site established by scientists and medical professionals to discuss medical treatments and products of public interest in a scientific light. All contributors are medically trained. • Diplomatic Immunity (http://sciblogs.co.nz/diplomaticimmunity/) is a New Zealand Science Media Centre blog dedicated to immunisation issues of particular relevance for New Zealand vaccinators. The contributor is based at the Immunisation Advisory Centre, University of Auckland. References 1. Department of Health and Ageing. 2016. Rotavirus. In: The Australian Immunisation Handbook (10th edition; updated August 2016). URL: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home~handbook10part4~handbook10-4-17 (accessed 29 September 2016). 2. Offit PA, Hackett CJ. 2003. Addressing parents’ concerns: do vaccines cause allergic or autoimmune diseases? Pediatrics 111(3): 653–9. URL: http://pediatrics.aappublications.org/content/111/3/653 (accessed 7 November 2013). Immunisation Handbook 2017 107 Vaccination questions and addressing concerns 3. American Academy of Pediatrics. 2015. Varicella-zoster virus infections. In: Kimberlin DW, Brady MT, Jackson MA, et al (eds). Red Book: 2015 Report of the Committee on

20

http://www.immune.org.nz/resources/written-resources

13

Infectious Diseases (30th edition). Elk Grove Village, IL: American Academy of Pediatrics. 4. Hilton S, Petticrew M, Hunt K. 2006. ‘Combined vaccines are like a sudden onslaught to the body’s immune system’: parental concerns about vaccine ‘overload’ and ‘immune-vulnerability’. Vaccine 24(20): 4321–7. 5. MacDonald N, Finlay J, Canadian Paediatric Society – Infectious Diseases and Immunization Committee. 2013 (reaffirmed 1 February 2016). Position Statement: Working with vaccine hesitant parents. Paediatrics and Child Health 18(6): 265–7. URL http://www.cps.ca/documents/position/working-with-vaccine-hesitant-parents (accessed 25 January 2017). 6. Cook J, Lewandowsky S. 2011. The Debunking Handbook. URL: https://skepticalscience.com/docs/Debunking_Handbook.pdf (accessed 25 January 2017). 7. Demicheli V, Rivetti A, Debalini MG, et al. Vaccines for measles, mumps and rubella in children. Cochrane Database of Systematic Reviews 2012, Issue 2, Art. No. CD004407. DOI: 10.1002/14651858.CD004407.pub3 (accessed 27 August 2013). 8. Institute of Medicine: Committee to Review Adverse Effects of Vaccines. 2012. Adverse Effects of Vaccines: Evidence and causality. URL: http://www.nap.edu/catalog.php?record_id=13164 (accessed 29 October 2013). 9. Immunize Action Coalition. 2010. Evidence shows vaccines unrelated to autism. Vaccine Concerns: Autism. URL: www.immunize.org/catg.d/p4028.pdf (accessed 31 October 2013). 10. Department of Health and Ageing. 2013. Myths and Realities: Responding to arguments against vaccination. URL: www.health.gov.au/internet/immunise/publishing.nsf/content/uci-myths-guideprov (accessed 7 November 2013). 11. Brotherton JML, Hull BP, Hayen A, et al. 2005. Probability of coincident vaccination in the 24 or 48 hours preceding sudden infant death syndrome death in Australia. Pediatrics 115(6): e643–6. DOI: 10.1542/peds.2004-2185 (accessed 4 February 2014). 12. Mitchell EA, Stewart AW, Clements M. 1995. Immunisation and the sudden infant death syndrome: New Zealand Cot Death Study Group. Archives of Disease in Childhood 73(6): 498–501. 108 Immunisation Handbook 2017 13. Lindgren C, Milerad J, Lagercrantz H. 1997. Sudden infant death and prevalence of whooping cough in the Swedish and Norwegian communities. European Journal of Pediatrics 156(5): 405–9. 14. Vennemann MMT, Butterfass-Bahloul T, Jorch G, et al. 2007. Sudden infant death syndrome: no increased risk after immunisation. Vaccine 25(2): 336–40. 15. Vennemann MMT, Hoffgen M, Bajanowski T, et al. 2007. Do immunisations reduce the risk for SIDS? A meta-analysis. Vaccine 25(26): 4875–9. 16. Medsafe. 2016. Sudden unexpected death in infants (SUDI): no causal link to vaccination. Prescriber Update 37(4): 56–7 URL: http://www.medsafe.govt.nz/profs/PUArticles/PDF/Prescriber%20Update%20December%202016.pdf (accessed 27 January 2017). 17. Offit PA, Quarles J, Gerber MA, et al. 2002. Addressing parents’ concerns: do multiple vaccines overwhelm or weaken the infant’s immune system? Pediatrics 109(1): 124–9.

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18. Grant CC, Roberts M, Scragg R, et al. 2003. Delayed immunisation and risk of pertussis in infants: unmatched case-control study. British Medical Journal 326(7394): 852–3. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC153471/pdf/852.pdf (accessed 21 October 2013). 19. Chao C, Klein NP, Velicer CM, et al. 2012. Surveillance of autoimmune conditions following routine use of quadrivalent human papillomavirus vaccine. Journal of Internal Medicine 271(2): 193–203. DOI: 10.1111/j.1365-2796.2011.02467.x (accessed 29 October 2012). 20. Arnheim-Dahlstroem L, Pasternak B, Svanstroem H, et al. 2013. Autoimmune, neurological and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: cohort study. British Medical Journal 247: f5906. DOI: 10.1136/bmj.f5906 (accessed 10 December 2016). 21. Grimaldi-Bensouda L, Guillemot D, Godeau B, et al. 2014. Autoimmune disorders and quadrivalent human papillomavirus vaccination of young female subjects. Journal of Internal Medicine 275(4): 398–408. DOI: 10.1111/joim.12155 (accessed 10 December 2016). 22. Langer-Gould A, Qian L, Tartof SY, et al. 2014. Vaccines and the risk of multiple sclerosis and other central nervous system demyelinating disease. JAMA Neurology 71(12): 1506–13. DOI: 10.1001/jamaneurol.2014.2633 (accessed 10 December 2016). Immunisation Handbook 2017 109 Vaccination questions and addressing concerns 23. Scheller NM, Svanström H, Pasternak B, et al. 2015. Quadrivalent HPV vaccination and risk of multiple sclerosis and other demyelinating disease of the central nervous system. Journal of the American Medical Association 313(1): 54–61. DOI: 10.1001/jama.2014.16946 (accessed 10 December 2016). 24. Benarroch EE. 2012. Postural Tachycardia Syndrome: a heterogeneous and multifactorial disorder. Mayo Clinic Proceedings 87(12): 1214–25. DOI: http://dx.doi.org/10.1016/j.mayocp.2012.08.013 (accessed 9 December 2016). 25. Borucki AN, Grecko CD. 2015. An update on complex regional pain syndromes in children and adolescents. Current Opinion in Pediatrics 27(4): 448–52. 26. European Medicines Agency. 2015. Pharmacovigilance Risk Assessment Committee (PRAC): Assessment Report: Human papillomavirus (HPV) vaccines (EMA/762033/2015). URL: http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/HPV_vaccines_20/Opinion_provided_by_Committee_for_Medicinal_Products_for_Human_Use/WC500197129.pdf (accessed 18 October 2016). 27. Nguyen M, Ball R, Midthun K, et al. 2012. The Food and Drug Administration’s post-licensure rapid immunization safety monitoring program: strengthening the federal vaccine safety enterprise. Pharmacoepidemiology and Drug Safety 21(Suppl 1): 291–7. DOI: 10.1002/pds.2323 (accessed 26 December 2012). 28. Kliewer EV, Demers AA, Brisson M, et al. 2010. The Manitoba human papillomavirus vaccine surveillance and evaluation system. [Erratum appears in Health Reports 2010; 21(3): 77.] Health Reports 21(2): 37–42. 29. Gold MS, McIntyre P. 2010. Human papillomavirus vaccine safety in Australia: experience to date and issues for surveillance. Sexual Health 7(3): 320–4.

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30. World Health Organization. 2015. Global Advisory Committee on Vaccine Safety, 2–3 December 2015. Weekly Epidemiological Record 91(3): 21–31. URL: http://www.who.int/vaccine_safety/committee/reports/wer9103.pdf?ua=1 (accessed 12 October 2016). 31. World Health Organization. 2016. Meeting of the Strategic Advisory Group of Experts on Immunization, April 2016 – conclusions and recommendations 32.Eickhoff TC, Myers M. 2002. Workshop summary: aluminum in vaccines. Vaccine 20(Suppl 3): 1–4. 33. Petrovsky N. 2015. Comparative safety of vaccine adjuvants: a summary of current evidence and future needs. Drug Safety 38(11): 1059–74. DOI: 10.1007/s40264-015-0350-4 (accessed 25 January 2017). 34. Plotkin SA, Mortimer EA. 1988. Vaccines. Philadelphia, PA: Saunders. 35. Peltola H, Heinonen OP, Valle M, et al. 1994. The elimination of indigenous measles mumps and rubella from Finland by a 12-year, two-dose vaccination program. New England Journal of Medicine 331(21): 1397–1402.

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1

Bay of Plenty District Health Board Board Members Interests Register

(Last updated 21/04/17)

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

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

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

01/12/2001

Pharmaceutical Society of New Zealand

Member Professional Body NIL 1980

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

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

Magic Netball/Waikato BOP Netball

Board Member Sports Administration LOW March 2015

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

Governance LOW 10/3/2011

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

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

24

2


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

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

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

28/11/2013

Western Bay of Plenty Primary Care Provider Incorporated Boad

Board Member Primary Healthcare LOW 28/11/2013

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

28/11/2013

GM and P Esterman Family Trust

Trustee Family Trust NIL 28/11/2013

Gate Pa Developments Ltd Director Property & Kiwifruit NIL 28/11/2013 Waterview Buildings Ltd Director Property NIL 28/11/2013 BOP Sexual Assault Services Wife is a part time Nurse Health NIL 17/3/2015 GUY, Marion Western Bay of Plenty PHO Board Member Health LOW: WBOPPHO has a contract

with the DHB but as a Board Member Marion is not in a position to influence the contract

28/01/205

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

Employee Health LOW 03/10/2016

McCAUSLAND, Punohu Maori Health Runanga Chair DHB Health Partner LOW 25/02/2005

25

3


Midland Iwi Relationship Board

Chair Health NIL 2017

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

13/12/2007

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

13/12/2007

Waitaha Hauora Trust Trustee (Voluntary Chair Co ordinator)

Health Provider LOW – No influence and no contract involvement

13/12/2007

Te Kotahitanga o Te Arawa Fisheries Council / Companies

Director Fisheries/Commercial NIL 13/12/2007

Te Puna Hauora Chair BOP Iwi Governance Health Body

NIL 2017

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

(mainly outside NZ) NIL 01/01/2007

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

Board Trustee School Board NIL 01/06/2015

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

Contractor Advisory body to overseas central Banks

NIL 01/02/2005

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

Director NIL NIL

REAL Coaching Director Coaching LOW 2015 REAL Guest Speaker Director Education NIL 2015 REAL Food Production Director Food production LOW 2015

26

4


ROLLESTON, Anna The Cardiac Clinic Ltd Director/Principal Health LOW 09/2015 University of Auckland Senior Research Fellow Health LOW 09/2015 NZ Heart Foundation Grant recipient

Primary Investigator Health LOW 10/2015

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

Project Manager Health LOW 01/2016

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

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

LOW 2006

Stellaris Ltd and Stellaris PTE Ltd

Director Business Education and Training organisation

LOW 2005

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

July 2013

TURNER, Judy Whakatane District Council Deputy Mayor Local Authority 2017 WEBB, Sally Capital Investment Committee Member Health Capital

Allocation Minimal 24/1/2011

SallyW Ltd Director Consulting & Coaching

Nil 2001

Central Regional Governance Group

Independent Chair Governance LOW

01/08/2014

Waikato DHB Deputy Chair Health LOW 2017

27

Bay of Plenty District Health Board (open) Minutes

Minutes


Venue: Conference Hall, Clinical School, Whakatane Hospital Date and time: Wednesday 21 June 2017 at 9:00am

Board: Sally Webb (Chair), Ron Scott, Anna Rolleston, Peter Nicholl, Beverly Edlin, Geoff

Esterman, Judy Turner, Marion Guy, Mark Arundel, Matua Parkinson, Yvonne Boyes, Punohu McCausland (Runanga Rep)

Attendees: Helen Mason (Chief Executive), Gail Bingham (GM Governance & Quality), Letham

White (GM Corporate Services), Hugh Lees (Chief Medical Director), Simon Everitt (GM Planning and Funding), Jeff Hodson (GM Property Services), Martin Chadwick (Director Allied Health, Science and Technical).

Item No.

Item Action

1

Karakia

2

Apologies

There were no apologies

3

Interests Register

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

4

Minutes of Previous Meetings

4.1 Minutes of Board Meeting Resolved that the Board receive the minutes of the meeting held on 17 May 2017 and confirm as a true and correct record.

Moved: Y Boyes Seconded: J Turner

28


Item No.

Item Action

4.2 Matters Arising

Y Boyes noted that BOPALT’s decision about access to Clinical School resources was short sighted and failed to address the value and failed to recognise the needs of nursing and allied health. Chair will bring up at Chairs and CEs meeting (SPG). H & S Act action: remove Adolescent Health: exploration of adolescent care has been added to Annual Plan. Board Statements: Board statements must conform with Government policy

4.5 4.6

Minutes of Maori Health Runanga Resolved that the Board note the minutes of the Maori Health Runanga meeting held on 8 March 2017.

Moved: P McCausland Seconded: S Webb

Member’s reports from Regional/National Forums - verbal updates M Arundel – Waikato HSC- 1 of 24 priority plans improving Maori Health was on the agenda

5

Strategic Areas

5.1 Chief Executive’s Report The Board discussed the report:

• Good to Great – 22 % improvement in Maori flu immunisation figures, for over 65 Maori in small test of change with NMOPHO, using IHI methodology

• Discussed replacement of smoking with vaping. DHB policy does not endorse vaping. Is it time to review this approach? A number of organisations are supporting vaping because it is the smoke that causes the health issues not nicotine.

• Issues have been identified with funding differences for after hours funding. Solutions may create some noise. Looking at making

MD/GMPF: Draft report on vaping as a means for reducing smoking rates, especially in relation to Maori. Including whether vaping is a gateway to smoking. Reflect clinical and Public Health aspects. Paper to address broader issue of reducing impact

29


Item No.

Item Action

some step changes to even things up. • Practice staffing issues in Eastern Bay are

being resolved by recent recruitments.

• Marion Guy and Jeff Esterman declared their membership on the WBOPPHO Board prior to the discussion on immunisation changes.

• M Guy raised concerns about recent changes

and felt the new model would not work and immunisation rates are at risk.

There has been a change to the way immunisation is being facilitated. Process went to RFP. Noted that PHOs were given an opportunity to develop combined approach. The three PHOs could not reach agreement.

• Date for Board H & S training not set yet.

There is a level of concern with progress against the requirements of the Act.

• DNAs – looking at how Te Kaha achieves its high attendance rate and apply to other areas.

• Working on methods to track remote workers. Pilot is looking at coverage. Staff will have satellite distress buttons. Transport aim is to have GPS trackers in all DHB vehicles. Working with the Unions on this.

• $10m project to upgrade B24 to seismic standards is progressing.

• BOP is being seen by medical staff as a place to come to advance your career.

Financials: still heading for a break even position with greater comfort now that this can be achieved than earlier in the year. Achieving this would be a considerable effort in the context of the quantum of extra services delivered and unbudgeted one off costs incurred.

Resolved that the Board receive the report.

Moved: S Webb

Seconded: Y Boyes

of smoking in Bay of Plenty.

5.2 Dashboard – circulated via email

30


Item No.

Item Action

The Board discussed the report as circulated with the agenda. The Members had no specific questions, however the Chair noted the overall improvements in many areas. COO noted that the change in pre-school dental enrolment numbers was due to a different tracking system.


Moved: R Scott

Seconded: M Arundel

5.3 2017-20 Midland Regional Service Plan The Board discussed the report as circulated with the agenda. Advanced Care Planning has been added back into the plan. The Chair commented on the increase in the amount and quality of regional work. Resolved that the Board: 1. NOTE the updated regional Maori health content

in the 2017-20 Midland Regional Services Plan - Initiatives & Activities document (second draft).

2. NOTE the request to update Regional Objective No.1 from ‘Improving Māori Health Outcomes’ to ‘Health Equity for Māori’ – as proposed by the Midland Iwi Relationship Board and Nga Toka Hauora (Midland GMs Māori Health) to the Midland Region Governance Group and Midland DHB CEs Group for consideration, 1-2 June 2017 (outcome awaited).

3. APPROVE the 2017-20 Midland Regional Services

Plan – Strategic Directions document (second draft), subject to further MoH feedback, and

4. APPROVE the 2017-20 Midland Regional Services

Plan – Initiatives & Activities document (second draft), subject to further drafting required by the MoH via informal and final feedback.

31


Item No.

Item Action

Moved: Y Boyes Seconded: B Edlin

5.4 Waikato appointments to Statutory Committees

The Board discussed the report as circulated with the agenda.


Moved: M Guy

Seconded: R Scott

GMGQ: draft letter to Waikato confirming appointments

5.5 BOPDHB Consumer Council Proposal The Board discussed the report as circulated with the agenda: The Board was informed that the establishment of a Consumer Council is both a HQSC and MoH Annual Plan requirement for DHB’s. The Board supported the idea of the Consumer Council having a region wide whole of system focus. The Board was advised that the Council will be an operational not a governance body and that it will form part of the quality/clinical governance for the DHB. The establishment of the Consumer council will have no effect on existing Board and Committee structures; however it is proposed that members of the Consumer Council will be invited to participate in Committee meetings. The Board asked specific questions around the recruitment process as they wished to ensure that the appropriate people were appointed. They also requested that management give some thought as to what parameters of success will be measured. Resolved that the Board:

1. endorse the concept of a Consumer Council reporting to the CEO

2. that the CEO be responsible for approving the Terms of Reference for the Consumer Council

3. that the CEO keep the Board informed about the agreed Term of Reference

GMGQ: Report back to Board on adopted ToR for the Consumer Council GMGQ: Get Hawkes Bay to meeting to discuss Hawkes Bay approach

32


Item No.

Item Action

Moved: S Webb

Seconded: R Scott Peter Nicholl abstained from the vote.

5.6 Community Members on Committee – discussion Question raised in response to questions about disability awareness and presence at governance level. Invite Paul Curry to be a member of CPHAC/DSAC and revisit other community representation as part of Consumer Council program.

GMGQ: Draft invitation letter to Paul Curry

5.7 Draft Strategic Health Services Plan The Board discussed the report as circulated with the agenda.

Resolved that the Board:

1. Notes the action tables within the draft Strategic Health Service Plan are now complete.

2. Approves the final draft Strategic Health Services Plan.

Moved: Y Boyes Seconded: J Turner

GMPF: draft short paper for SHC on major implementation risks of the HSP

5.8 Committee Change of Name The Board discussed the report as circulated with the agenda.

Resolved that the Board amend the current name of the Health Strategic Committee to Strategic Health Committee.

Moved: M Arundel Seconded: J Turner

6

Information for Noting

6.1 Work Plan The Board noted the information.

33


Item No.

Item Action

6.2 Correspondence for noting

The Board noted the correspondence.

6.3 Eastern Bay of Plenty Flooding Recovery Effort Update The Board noted the information.

6.4 6.5 6.6

Second Draft Annual Plan 2017/18 The Board noted the information. Risk Report The Board reviewed and discussed the report. Progress around the 8 identified key risks were outlined in particular impairment (drug and alcohol), seismic resilience, asbestos and measure to prevent or respond to violence against staff. Indicators of DHB Performance Q3 Summary for 2016/17 The Board noted the information.

7

Presentations

7.1 BOPDHB Consumer Council Proposal The Board thanked Debbie Brown and Averil Boon for the informative presentation.

8

General Business

8.1 Changes to Maori Health Services Consultation has been undertaken with the Runanga. Currently out for consultation with staff and stakeholders. Looking at ways to do things better and best use available resources. Looking at bridging the disconnects/gaps between Maori services. Repositioning Maori Health to make it stronger. An observation was made about the lack of appropriate consultation with Maori.

34


Item No.

Item Action

Peter Gilling The Board noted and congratulated Peter Gilling on receiving his Queen’s Birthday honour.

GMGQ: Draft letter of congratulations from the Board

9

Resolution to Exclude the Public

Resolved that Pursuant to s 9 of the Official Information Act 1982 and Schedule 3, clause 33 of the New Zealand Health and Disability Act 2000 the public be excluded from the following portions of the meeting because public release of the contents of the reports is likely to affect the privacy of a natural person or unreasonably prejudice the commercial position of the organisation: Confidential Minutes of last meeting AFRM Minutes Chief Executive’s report New Zealand Health Partnerships Limited: Q3 Statement of Performance Expectations Report, Shareholder Meeting May 2017 Summary and National Oracle Solution Update. That the following persons be permitted to remain at this meeting, after the public have been excluded, because of their knowledge as to organisational matters or for the purpose of legal records. This knowledge will be of assistance in relation to the matter to be discussed: Helen Mason Gail Bingham Letham White Helen Mason Simon Everitt Resolved that the Board move in to confidential.

Moved: S Webb Seconded: M Arundel

The open section of the meeting closed at 12:15pm.

35


The minutes will be confirmed as a true and correct record at the next meeting.

36


Matters Arising (open) – July 2017

Meeting Date Item Action required Action Taken

15.03.17 7.2 Adolescent Health COO: Draft possible response to Kendall’s requests for assistance

Completed

15.03.17

Board Statements GMGQ: Government policy directions – DHBs must give effect to government policy when directed by the responsible Minister (ie the Minister of Health) (s.103)

Completed

19.04.17 5.6

Committees Terms of Ref GMGQ: TOR for AFRM should be reviewed to ensure other clinical quality matters are appropriately captured

Completed - ToR circulated to Exec for feedback

17.05.17 5.2

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

17.05.17 5.4

BOPDHB Consumer Council Proposal GMGQ: to prepare paper for the Board

Completed

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

In progress

21.06.17 6 Peter Gilling GMGQ: Draft letter of congratulations from the Board

Completed

37

21.06.17 5.7

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

21.06.17 5.6

Committee Members on Committee GMGQ: draft invitation letter to Paul Curry

Completed

21.06.16 5.5

BOPDHB Consumer Council Proposal GMGQ: Get Hawkes Bay to meeting to discuss Hawkes Bay approach

Completed

21.06.16 5.5

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

21.06.17 5.4

Waikato Appointments to Statutory Committees GMGQ: draft letter to Waikato confirming appointments

Completed

21.06.17 5.1

CE’s Report GMPF: Draft report on vaping as a means for reducing smoking rates, especially in relation to Maori. Including whether vaping is a gateway to smoking. Reflect clinical and Public Health aspects. Paper to address broader issue of reducing impact of smoking in Bay of Plenty

Completed

21.06.17 2.5 HPL GMGQ: issue a second invite to HPL to talk with the Board

Completed

38

1

BOP ALT Minutes of the Health Alliance (BOP) Alliance Leadership Team, held in the Board Room at the Planning and Funding Offices

Corner of 2nd Ave and Cameron Road, Tauranga at 8.30am on Wednesday, 14 June 2017.

Item No.

Item Discussions/Commentary Actions/Outcomes

1. Opening of meeting The meeting was opened with a shared reading of ‘Karakia Timatanga’.

2. In attendance:

Independent Chair: Robin Milne. ALT members: Roger Taylor (left 10am), Dr Mark Haywood, Helen Mason, Michelle Murray, Janice Kuka, Dr John Gemming, Dr David Spear, Dr Phil Shoemack, Simon Everitt, Pete Chandler, Dr Hugh Lees Secretariat: Andrea Baker & Jackie Davis. Apologies: Kiri Peita

• No conflicts of interest reported. In attendance: Sarah Davey on behalf of BOPIS for SLM and Dillon Te Kani for Maori Health Steering Group review

Nil

3. Minutes of previous meeting:

Minutes adopted as true and correct. Michelle Murray added (in relation to patient portals) that Andy Wittington had passed away. Andy was acknowledged as the Guru driving patient portals.

Nil

4. Actions arising from previous meetings 12 April 2017.

• BOPDHB is still working through with ACC the contract requirements for falls prevention including agreement on what’s in and what’s out.

• Rural SLAT. Currently working around the logistics of RSLAT membership and meetings given RSLAT membership spans from Waihi Beach to Opotiki. The first meeting is scheduled for the last week of June 2017...

• System Level Measures plan progress and working group structure.

Ongoing. Probably July 2017, TBA next meeting. Being finalised at this meeting.

39

2

5. MURIAL-How do we approach this and representation.

• Discussion on how BOP engages with MURIAL whether it is collectively as an Alliance or represented of individual organisations.

• Suggestion that a common position is adopted but need to ensure our “own house is in order” before any engagement with MURIAL. Need to ensure we have a collective understanding and common position on MURIAL matters.

• The DHB CE’s have tabled $1m at MURIAL and currently asking where this Child Health funding is to be spent. The expectation, following the CE sign off, was for the funding to go to initiatives for 0-4 yrs. children with upper respiratory conditions. This funding was signed off over 12 months ago but the process going forward has been unclear.

• BOP had put forward a proposal around housing but BOP is only 20% of the MURIAL DHBs. Funding based on a Population Based Funding Formula (PBFF) suggests BOP receive 25% of the funding however the CEs have agreed this funding be allocated according to need and not PBFF. An example of a good initiative was the introduction of pepe pods that required minimal funding and was a hand on practical initiative.

• BOP to clarify funding disbursement mechanism at the next MURIAL meeting. BOPALT advised that BOPIS is represented at MURIAL.

• ESPACE is processing well but improved DHB engagement is important.

Follow up re: funding mechanism process for vulnerable children.

Decision to be finalised about BOP representation at MURIAL.

6.

Final Draft System Level Measures (SLMs)

• Simon gave an overview of the System Level Measure (SLM) plan process to date and acknowledged the tension around e-referral to primary care.

• EBPHA said that the SLM plan was now simple, the format improved, equity coverage improved and preamble good. E-referrals remain an issue and why aren’t they being prioritised? Why couldn’t there be some local resource for these smaller/non regional projects.

• Acknowledged as an important enabler was the need to support IT infrastructure and resourcing.

• CEO BOPDHB explained the funding flow for IT services, whereby a national price was paid to the Provider Arm (Pete) and a top slice of this funding paid for Information Technology services (Owen).The resource funded by the Provider Arm for IT was already operating outside its general guidelines,

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therefore the issue was about additional resource and where did this money come from.

• The CEO suggested that consideration be given for primary care to contribute to primary care e-referral development. Some members were concerned that this contribution included the responsibility of the Provider Arm to provide e-documentation to general practice, for example discharge letters which they believed should not be funded by primary care.

• BOPALT advised that the BOPIS group has provided input to the SLM. • Final SLM draft plan accepted by all parties and signed off for release to the

Ministry of Health.

Complete.

7. System Level Measure Structure for Work Groups and Reporting.

• Option one of SLM structure paper that includes the establishment of a SLM SLAT was agreed along with reporting processes and responsibilities. Portfolio Managers to be included in the SLAT work streams in order to coordinate activity.

• Agreement that work streams are to be productive and not just another layer of BOPALT

• Sarah Davey (Planning and Funding) to pull together membership on the SLAT and work streams.

• Accountability for the SLM activity to be collated by Phil Back at WBoPPHO for reporting purposes.

Complete.

8. Health Round Table (HRT) • Pete Chandler provided information on the Health Round table and its potential advantages for BOPALT. The Health Round Table uses comparable data and provides clinical benchmarking within health facilities in Australia and NZ. It is not a “blame tool” but a tool to inspire change.

• The COO would like to fund an add- on module to benchmark BOP further and to include ethnicity in all benchmarking. All supported this with the caveat it is not used as a punitive exercise as it was in the UK.

9. Maori Health Plan Steering Group Review

• Dillon Te Kani presented an overview of the Maori Health Steering Group (MHSG) review. The Ministry of Health (MoH) has relinquished the requirement for DHBs to write separate Maori Health Plans, however there is now the need to demonstrate an equity focus throughout the annual plans.

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• Nine of the fourteen Maori health targets have been included in the SLM plan. Concern that the some of the targets could be removed from the SLM by the Ministry of Health. BOPALT agreement that should the MoH takes targets off the list it was agreed that we should still aspire to them.

• With the disestablishment of the MHSG it was proposed that future target performance be reported to BOPALT.

• BOPALT advised that February 2018 is the deadline for meeting the targets and turning the Maori Trendly data from red to orange or better.

• Agreement that good leadership and champions are necessary to achieve this and the right leadership in needed in each group.

• Preliminary feedback is that the additional effort going into improving Maori influenza rates by the DHB and Ng Mataapuna Oranga is going well.

• Agreed that the SLM work streams will be very important for this work. Noted that some of the indictors do not naturally align with the agreed SLM work streams. Dillon and Jackie to tweak the activity in the work streams to align with the agreed SLM structure.

• Agreement that target performance for Maori Health indicators become a standing agenda item for BOPALT and entail a summary at each BOPALT meeting.

Jackie and Dillon to tweak workgroups to align with agreed (option one) SLM structure. Dillon to provide a progress summary of the Maori Health indicators to each BOPALT meeting.

10. General Business • Nil

11. Next Meeting • Wednesday 12 July 2017.

12. Closing BOPALT members recited ‘Karakia Whakamutunga.’

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Bay of Plenty Hospital Advisory Committee (open) Minutes

Minutes

Bay of Plenty Hospital Advisory Committee

Venue: 889 Cameron Road, Tauranga Date and time: Wednesday 5 July 2017 at 10:30am

Committee: Geoff Esterman (Chair), Peter Nicholl, Matua Parkinson, Ron Scott, Sally Webb,

Stewart Ngatai (Runanga Rep) Attendees: Helen Mason (Chief Executive), Gail Bingham (GM Governance & Quality), Letham

White (GM Corporate Services), Julie Robinson (Director of Nursing), Hugh Lees (Medical Director)

Item No.

Item Action

1

Apologies

Apologies were received from Clyde Wade and Yvonne Boyes. Resolved that the apologies be received.

Moved: R Scott Seconded: G Esterman

2

Minutes

Resolved that the minutes of the meeting held 5 April 2017 be confirmed as a true and correct record.

Moved: G Esterman Seconded: R Scott

3

Matters Arising The Chair congratulated the Provider Arm on the positive results obtained from its Acute Demand project.

4

Reports requiring decision

4.1 Chief Operating Officers Report

43


Item No.

Item Action

The Committee discussed the report as circulated with the agenda.

Working safely while planning for retirement: gradual move into retirement is in place for nurses. Older doctors want to stop doing on call; however this is unfair for younger staff who have to take up the slack. A number of employees reduce hours; however need to consider the requirements of the job. Resolved that the Committee receive the report.

Moved: S Webb

Seconded: P Nicholl

4.2 Renewing Work Plan - discussion Discussion on work plan was postponed

5

Reports for Noting

5.1 Work Plan The Committee noted the information.

5.2 Provider Arm Balanced Scorecard The Committee noted the information.

6

Presentations

6.1 Health Services Plan Strategic Objective 3 Walkthrough The Committee thanked Trevor Richardson and Pete Chandler for the informative presentation. Trevor demonstrated the decline in average bed days from the previous 6 years and the increase in triage 2 and 3 presentations to the ED. Success is due to the cumulative effect of everyone’s effort. The Committee recommended that this approach be

COO: presentation on

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Item No.

Item Action

presented to the SHC to see if it can be applied across the sector. Pete discussed the implementation plan for SO3.

Provider Arm approach to improvement to SHC – All I’ve done is…..

7

General Business There was no general business

8

Next Meeting – Wednesday 4 October 2017.

The open section of the meeting closed at 12:15pm. The minutes will be confirmed as a true and correct record at the next meeting.

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CEOs Report (Open) – June2017 INTEGRATION / COMMUNITY Te Teo Herenga Waka Influenza Vaccination Influenza vaccination by pharmacies has provided increased coverage for older people and pregnant women during this flu season; anecdotal feedback from one pharmacy reports 300 vaccinations which are double that provided last year. Raising Healthy Kids Target result to date is 74% for acknowledged referrals and is on track to meet Health target of 95% by Dec 2017.

Better Help for Smokers to Quit Contracting is being finalised for 2017/18 with a rollover of Ministry funding at same levels as previous years. New services are being developed with the limited funding available for the priority groups of Pacific and people with mental health conditions and addictions, as well as scoping a project “to improve the percentage of households who are smokefree at 6 weeks post-natal”. This is a new target under the System Level Measures Framework, although the baseline and actual performance target are yet to be determined. One approach being explored is to undertake this activity in conjunction with social housing providers, where a number of families can be reached for health promotion work, including possibly policy development. Increased Immunisation The DHB is working with the PHOs to develop a HPV vaccination service in BOP’s main tertiary education facilities. From 1 January 2017, free HPV vaccination was extended to males and females up to their 27th birthday. With support from the tertiary education facilities, it is possible to provide information to a significant number of people in the 18 to 26 year age group, and provide the vaccinations on site. The first two doses can be given in this education year, with the third dose to be given through their normal GP. This will also enhance engagement of this age group in general practice, and for other preventive health measures applicable to that age group. Eastern Bay Primary Health Alliance Key achievements for this month • EBPHA has in-sourced two mental health services which have strengthened the

integration for the Integrated Case Management (ICM) service. EBPHA has been asked to present their ICM model at the next Primary Health Alliance conference in October.

• EBPHA are moving into a new building in July to support the organization’s growth. An official opening will occur at the end of July.

Key Challenges for this month • The impact of the floods (Edgecumbe and a practices internal flood) and cyclone has

impacted on EBPHAs resource including IT, practice support and health counselling service. This in turn has impacted on the health targets.

• EBPHA’s performance against the 8 month immunisation target has dropped to 78% (the lowest yet). The DHB has responded with additional vaccinator and recall resource.

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Nga Mataapuna Oranga Key Achievements for this month • The PHO has achieved a 20% improvement in seasonal influenza vaccination rates in

the 65 years and over age group for the period March-May 2016 compared with March-May 2017. This result was achieved through a collaborative performance improvement effort between the PHO and Planning & Funding along with systematic application of IHI methodology. The PHO vaccinated 55% of its Total Population during March to May 2017, compared with 46% for the same period in 2017 (Source: NIR). The national target for this indicator is 75%.

• For the third consecutive quarter NMO has achieved status as the top performing PHO nationally for smoking.

Key Challenges for this month • As part of the Immunisation Collective, competing priorities have emerged with the PHO

involved in the establishment of a new working model for immunisation and ongoing maintenance of the PHO’s own immunisation rates.

• Methamphetamine continues to cause disruption for many families with health workers feeling the day to day effects of domestic violence in households they visit.

• Mental health issues (in particular suicide) are beginning to emerge across all age groups in the Western Bay.

Western Bay of Plenty Primary Health Organisation Key Achievements for this month • WBoP PHO is working with Careerforce to develop a level four accredited course which

will support community health workers including home based support workers to support a new restorative model. There is significant level interest in this course which should commence in Semester two 2017 with workshops led by WBoP PHO.

• 38 general practice care practitioners have completed a full day workshop on COPD management and have commenced structured management of high needs patients with COPD. This already appears to be making a difference.

• Discussion have commenced with DHB SMOs, to enable direct referral from SMOs into WBoP PHO self management groups. This may be particularly helpful for sleep apnoea referrals who generally need to lose weight and need support to do so.

Key Challenges for this month • School based health services are stretched as a consequence of the large volume of high

school students in WBoP. There is significant potential to make a difference with greater resource for the service.

• The immunisation coordination position at WBoP PHO is to be discontinued from 30th June 2017 as the subcontract offered to WBoP PHO by the new contract holders does not include immunisation co-ordination.

Integrated Healthcare Strategy – Systems Integration Housing • The interagency group for homelessness in the western BOP is close to finalising an

application for central government funding to adopt a Housing First hub to identify, triage and case manage individuals and families who are currently or likely to shortly become homeless. New funding was announced in the Budget and discussions have been held with Associate Minister for Social Housing Alfred Ngaro to access this funding. Local social housing providers are establishing more emergency houses in the western BOP with further announcements likely.

• It is recognised that homeless is a growing issue in Whakatane, with 20 individuals identified who are sleeping rough in the area. Planning and Funding staff are working

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with local agencies including Councillor Judy Turner and Tauranga Community Housing Trust to explore the establishment of a men’s shelter in Whakatane.

SmartGrowth On 21 June we gave a presentation to city leaders at the SmartGrowth Leadership Forum on the future of health services in the BOP. Received a pleasing reception and seemed to be a very good level of engagement. We fielded a number of questions from the Councilors and members indicating connections being made between the factors that influence our health and the things that can be influenced by SmartGrowth (i.e. the things that fall largely within Strategic Objective 1 of the SHSP) e.g. housing, transport, urban design. Some other questions about health literacy, inequalities, mental health services, and the collaborative planning space we are in with Tauranga City Council. He Ritenga Audits • He Ritenga Provider Arm Audits led by the He Ritenga Steering Group members have

highlighted in their response to a paper seeking to make changes to the process for Provider Arm He Ritenga audits, the need to address accountability for He Ritenga audits as a priority. The paper proposed; o Increased focus on progress of recommendations and follow-up with services. o Improved accountability for He Ritenga audit recommendations. o Increased leadership from services on He Ritenga audit outcomes.

• He Ritenga Midland Region Audits in partnership with HealthShare Ltd have highlighted the results of a limited implementation review and evaluation. The report finds the HealthShare/He Ritenga-enhanced audits are fit for purpose in the Midland Region primary NGO sector. Minor changes to the audit methodology were proposed and endorsement was received from the Midland GMs Planning and Funding, for full roll-out in January 2018.

BOPDHB Suicide Prevention Postvention Plan District wide immediate response to suspected suicide process is implemented An interagency meeting with Police, MOE, MVOT, Child & Adult DHB Mental Health Services and Victim Support was held in the EBOP on 18 May to finalise the district wide Youth SIRT (Suicide Immediate Response Team) protocol which is now operational. Based on the number of suspected suicides in EBOP from July 2014 – April 2017: Youth (4) and Adult (15) it was acknowledged from the team that this protocol could be extended to all ages over time with the possibly of including response to significant suicide attempts. As Community Intervention Response Teams are developed across the region and the Lead Agency on each is identified it is expected they will become members of the Youth SIRT. Kawerau has a well-established Community IRT protocol that is coordinated alongside their local police and Lead Agency Tuwharetoa Ki Kawerau. Tuwharetoa organise interagency meetings as required. It was agreed that their process would continue. The EBOP Youth SIRT protocol was presented at the Maori Mental Health Providers Forum in Whakatāne on 24 May to socialise stakeholders to the process and the development of local community IRTs. Integration and Coordination As part of socialising the BOPDHB Plan and forming relationships with community stakeholders the SPP coordinator co-presented alongside Kia Piki Te Ora and Safer Communities at the Population in Aging Technical Advisory Group meeting on 31 May.

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Workforce development, training and Education Le Va, the MOH National Trainers for Suicide Prevention, have recently announced their “life keepers” training programme due to roll out from September 2017. There will be the option of workshops or online training. Life Keeper’s “home grown”, free and specifically designed for individuals who are likely to interact with those potentially at risk of suicide. In particular, people in community organisations and frontline workers who are not formally trained in suicide prevention – e.g. support workers, sports coaches, ambulance drivers, church leaders, school counsellors, youth workers, Māori wardens, caregivers, Kaumatua, and community leaders. It is expected that Le Va will collaborate with DHB SPP Coordinators when it comes to implementing this training in the respective regions. Clinical School Students A local advisory group meeting was held with key stakeholders for the Rural Immersion programme (RHIP) in Whakatane with good representation from tertiary institutions. An ongoing challenge is to source student for cohorts from the various professions and institutions to coincide for the same 5 week block period. January, in particular is difficult to manage with most tertiary institutions starting back in February but the medical students commencing in January. The other challenge is sourcing 4 bedroom accommodations for the students in Whakatane. The Coordinators from the tertiary institutions were positive in regards to the programme and helping with solutions. The Head of the BOP Clinical School, Professor Peter Gilling was recently appointed as a Companion of the New Zealand Order of Merit in recognition of his services to Urology in the Queen’s Birthday Honours list 2017. This is a significant and commendable award that adds to the positive reputation of Professor Gilling and the BOPDHB. Research New Zealand Health Research Strategy New Zealand’s first health research strategy was launched by the Health Minister and Science and Innovation Minister in June at the Clinical Trials Unit at Wellington Hospital. Please see link for more details and a copy of the strategy: http://www.health.govt.nz/publication/new-zealand-health-research-strategy-2017-2027 The New Zealand Health Research Strategy 2017-2027 sets a vision that, by 2027, New Zealand will have a world-leading health research and innovation system. It is interesting to note that the Clinical Trials Unit at Wellington Hospital was chosen as the location to launch the strategy, reflecting the importance of clinical research within the public health sector. The strategy sets out four strategy priorities to meet this vision, and whilst all are important, the second priority, to create a vibrant research environment in the health sector, stands out. This priority has two main action points: • ACTION 5: Strengthen health sector participation in research and innovation • ACTION 6: Strengthen the clinical research environment and health services

research

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http://www.health.govt.nz/publication/new-zealand-health-research-strategy-2017-2027

http://www.health.govt.nz/publication/new-zealand-health-research-strategy-2017-2027

5

Information Management Regional eSPACE • The first major part of the eSPACE programme, Midland Clinical Portal Foundation

Project (MCPFP) has reached testing stage. Over the last month there was a delay caused by the need to reconstitute the Regional Privacy Group which has oversight of the regional privacy framework and processes followed in this foundation project.

• Testing for BOP will commence in the first week of July. BOP and Taranaki DHBs are likely to be the first DHBs to begin uploading clinical documents into the shared regional repository.

• The delivery of Regional Results Management system within eSPACE is proceeding on a phased basis with the first phase, Regional Results Foundation project, being the transition of the BOP Éclair system into regional environment. This part of the eSPACE programme is being led by BOPDHB in association with Lakes DHB.

Electronic Orders - Laboratory • Eclair eOrders implementation successfully passed the testing stage and has been put

into production at the end of June. From Monday 3rd July, the proof of concept of e-Orders will commence in earnest with the Paediatrics Service at Whakatane Hospital.

• Observers from Lakes and Waikato DHBs are invited to participate in this proof of concept process through reviewing the approach, documentation and outcomes. The purpose of external reviewers is to understand the applicability of the BOP proof of concept to the wider region.

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Management and Admin FTE Tracking

Quarter Paid Total Org Paid

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

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Quarterly data graphed

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DISTRICT HEALTH BOARD Corporate Services People and Capability Risk, Health and Safety: Substantial improvement work is underway with a focus on “closing the loop” on several items which is relatively time consuming. A workshop was be held to consider the next steps in developing a culturally embedded approach to this area. Improving the process and reporting outputs for decision makers and through to governance is also to be considered. The outcome of the workshop was to configure a resourced project around Health and Safety compliace improvement including a sub working group on risk specifically. The project governance has been separated from Health and Safety governance to better aid progress. General Communications Most members of the Communications Team were involved in the launch of the evolved CARE values on Friday 30 June. Concept design, graphic design, filming, editing, printing the signage and preparing the on-line materials for staff to use, like desktop wallpaper, all ‘went live’ with a video from the CE. The day ended with an enthusiastic rendition of the Hokey Tokey appropriately reworded to be about the CARE values and Manaakitanga. Governance & Quality Patient Experience My mother June has recently been in Tauranga hospital for a shoulder replacement, then again a couple of days later with medication issues. I spent a bit of time with mum, and the staff could not have been nicer. From the admin staff and nurses and doctors, and all the support staff, everybody was very pleasant, polite and helpful. It just made mums stay all the easier and at 81 years old this was greatly appreciated. On Friday evening when mum was re-admitted, I arrived to visit her at around 8.00 pm, and was keen for a cup of tea having travelled direct from work. A wonderful nurse made me a cup of tea and brought it in, its these little details that make the difference. The nurses were also dealing really professionally with one or two "difficult" patients at the time but were still making my mums stay as pleasant as possible. I know people are more inclined to submit complaints than positive comments but well done to the entire organisation, faultless service. The nurses in ward 4b in particular. submitted via the MoH On the 28th of May, Our respective father, grandfather and father in law was placed in your care. Ron aged 91 1/2, unfortunately, passed away the following month on June 10 th Now that we have had a chance to gather ourselves and reflect, we would like as collective group to express our extreme gratitude to the nursing staff in ward 2 A for the excellent care given to him

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At all times he was treated with the ultimate respect care and compassion. With special mention to nurses, Aroha and Wiki, to some nursing is just a job to these two especially it is a calling and it shone thru in their efforts. To observe such grace made his passing easier to bear. Document Control We have now achieved 89.14% approved rate for documents in the system. This has been achieved by increased support to Stewarts to up-date their documents and removing documents from the system that are no longer required. There is some risk here however as to whether full assessment of need is being made before documents are withdrawn. Provider Arm Creating our Culture The main activities include planning for the values launch commencing Monday 26th with the formal soft launch on Friday 30 June. A calendar of events over July will make it a month of celebration. In addition tangible programme deliverables, measurable and timeframes have been submitted to the Executive leadership team for endorsement. Table activities from the “One Year On” reunion are underway around the place, e.g. consistent name badge for all staff, blackboards with messages of positivity, re-filming of the Hoki Toki for our launch! Outputs from the May week of workshops are returning and discussions are underway about testing the interview guides for staff groups and how to integrate this into our full recruitment process. The new values sheet is provided to Board members in Appendix 1. Chief Medical Officer Adult and Paediatric Exams Thanks were received from our Local Organizers who organised hosting of the Adult and Paediatric Examinations for the Royal Australasian College of Physicians. The Paediatric exam took place on 27 May and the Adult exam on 9 June. Tauranga Hospital has a reputation as an excellent training centre and our ability to host these exams only enhances this. The organizers noted that they “felt privileged and enjoy working in a DHB that provides full collegial support”. All five of our Medical Registrar candidates were successful in the Medical Speciality Exams. To have all five pass is a wonderful result and testament to the mammoth effort that they and their Tutors put in. Special thanks were given to Graeme Porter, Fred Anthony, Jeca Bowker, Phil Asquith, Kate Grimwade and the extended team for their hard work in making the exams such a success and a huge credit to the department and great for us as a DHB. We also had eight Alumni Registrars from our Paediatric Department sitting the Paediatric Specialty Exams, of whom seven passed. Again a great result, with a number of our Paediatric SMO’s involved as Examiners and in hosting the Paediatric Exam.

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MCNZ Accreditation Visit A draft accreditation report was received from the Medical Council of New Zealand (MCNZ) following the recent accreditation assessment of the BOPDHB as a training provider of prevocational medical training. The DHB met 18 of the 22 sets of standards of Council’s Accreditation standards for training providers. There were four sets of standard which were substantially met, and five required actions identified which were; 1. The DHBs Intern in Difficulty policy must be finalized, publicised widely and

implemented. 2. The process of obtaining informed consent at the DHB must be taught, supervised and

adhered to Council’s standards. 3. The DHB must review the night handover at Whakatāne, and ensure that the handover

process is supported and consistent. 4. Attendance at the formal education sessions must be effectively protected by the DHB. 5. Processes need to be in place to address all inappropriate behaviours, including bullying,

with monitoring to ensure effectiveness.

Of particular note were the highly praised commendations within the report which were; • The documentation and commitment expressed by the senior management team in

support of prevocational education and training is excellent. • There is widespread intern representation on committees throughout the DHB, including

RMO and SMO forums, and the RMO Leadership and Education committee. • The Quality Improvement Residency is an innovative experience that allows interns to

identify and lead a quality improvement project within the DHB. • A comprehensive and interactive postgraduate year 2 formal teaching programme is

provided to interns at Tauranga Hospital. • Interns who start part way through the year receive comprehensive orientation to the

DHB. • The prevocational educational supervisors at the DHB provide excellent support to

interns and play a key role in ensuring the delivery of the intern training programme. • The DHB has excellent facilities to ensure quality delivery of the intern training program. Under Strategic Priorities, the Council also made particular comments relating to our Culture:

“There were widespread positive comments from interns, clinical supervisors and prevocational educational supervisors about the senior management team and the initiatives underway to improve the organisation's culture.”

Tauranga Hospital featured in popular UK BBC television show Tauranga Hospital has been showcased on the popular UK BBC television series “Wanted Down Under”. The show takes UK families looking to migrate to Australia or New Zealand for a week in their favoured destination to test out housing, lifestyle and job prospects and, ultimately, to see if they will make the move. UK Paediatrician Dr Angus Goodson talked with Medical Director Dr Hugh Lees about job opportunities in Tauranga. Grand Rounds Grand Rounds at Tauranga Hospital have been increasing in popularity with full houses, and in June we commenced with these now being linked by videoconference to Whakatane and also being filmed on a regular basis. Of note we had Dr Carl Horsley, the Clinical Lead, Critical Care Complex at Middlemore Hospital come and talk on “Resilience in

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Healthcare” as well as spending the day meeting with other staff groups sharing his teachings and learnings on resilient healthcare (RHC) and the application of resilience engineering principles to the healthcare system and the effects this new approach has on the delivery of patient care. Dr Carol McAllum spoke on “Palliative medicine – it’s a matter of time”. Dr John Henley shared his experiences “Life in the Top End” – Healthcare in Northern Australia, and Pete Chandler chaired a special documentary on “Resilience” The Biology of Stress & the Science of Hope”, which focused on early childhood trauma and the often lasting and significant impact on mental and physical health throughout a person’s life. Director of Nursing and Midwifery Nursing Honours Programme The Nursing Honours Programme is run in conjunction with the University of Auckland. The Bay of Plenty DHB’s first student, Leigh Youngman, has completed her Masters gaining First Class Honours. Leigh has also been offered a scholarship to go on and complete her PhD if she wishes to continue her study. Leigh was also the recipient of the Health Quality and Safety Commission Young Leaders award recently. Leigh’s research was looking at evidence based strategies to manage post-operative delirium in orthopaedic patients. Leigh works in the orthopaedic ward at Tauranga Hospital SURGERY High volume of Fractured Neck of Femur (# NOF) patients This month Ward 4b has experienced a high volume of patients with a # NOF requiring surgery. On average there are usually 5-7 patients per week. This month up to 18 patients per week are in the ward with this condition and a proportion of these patients are from residential care dementia units requiring a high level of inpatient care. 4B will monitor for trends. Ministry of Health Supported Projects BOPDHB has been successful in having the following two proposals selected to be supported by Ministry of Health initiative funding and have now commenced: Eye Health Service Improvement Project This project supports

• immediate addressing of any existing backlogs • establishment of sustainable improvements to the way the ophthalmology plans and

delivers services Production Planning Service Improvement Project

This project supports • Implementing agreed theatre list construction principles • Identification of current production planning resources and undertake a gap analysis

to determine the most meaningful production planning information for clinicians • Implementation of weekly tracking plans to mitigate risks and track performance

against targets

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Mental Health Services: Strengthening primary/secondary relationships A training exercise with Tuhoe Hauora (who provide Mental Health and advocacy for the people of Tuhoe) has been delivered by Jeff Symonds, Nurse Practitioner, with a view to offer more to help strengthen the primary/secondary alliance. This initially was an in service delivered around differing mental health diagnosis and the some practical solutions around successful engagement of Tangata Whai Ora. Feedback from Tuhoe Hauora was that people gleaned a broader working knowledge of some of the Mental Health system (Community Mental Health staff and Tuhoe Hauora staff generally share care of clients, so this training will help cement relationships with the two). Going forward as a service, we all believe that a more collaborative/transparent model of care for all the service users that we provide support too, can not only align ourselves with national strategic planning around integration of care, but also provide a seamless ‘any door is the right door’ attitude for improved health outcomes for mental health clients across the Bay. Regional Maori Health Clinics: Gynaecology clinic performance has been reviewed after the retirement of Dr Speed. Clinics commenced for Te Puna Hauora in February 1996 with approximately six clinics being held a year for Māori wahine. Evaluation of the poor DHB Māori DNA for Gynaecology has provided the catalyst to continue RMH Gynaecology clinics at Tauranga to support a reduction in waiting lists, an increase in access for Maori and an opportunity for Maori women to have access to a Whanau Ora approach to their care. Māori Health is working in partnership with Dr Aparna Basu (SMO Locum) to develop the wider Gynaecology service. In future there will be two clinics a month, a total of 12 patients monthly. The first clinic commenced 07 June 2017 with ZERO DNA. Regional Maori Health Service Requests Improvements are being made to the management of the increasing amounts of cultural service requests coming to RMHS, which are exceeding the team’s capacity. A new tracking system for requests for Māori Health Service cultural input has been developed to ensure that requestors have confirmation of whether support can be provided, and the RMHS team can plan ahead in allocating resource. Since commencing it is evident the requests for mihi whakatau have very significantly increased in recent months and whilst this is encouraging, it will require some thought on how the limited leadership capacity can be extended and prioritised. Leading Together Programme Over the last few months final amendments and preparations for launch have been made on the new Leading Together programme. This comprehensive programme for managers and leaders is intended to build on other foundational cultural training by supporting an increased, in depth understanding of how Maori and Non-Maori can work together effectively to culturally safe and effective services. Because of the range of other intensive demands on organisational time the start of this programme has been delayed by about six months and is intended to commence in the Spring. ‘Take Care of Coughs’ campaign The 'Take Care of Coughs' campaign development was finalised during May. Of note, the campaign aims to raise awareness among Bay of Plenty parents and caregivers of the

56

importance of taking care of their child’s cough, and seeking medical advice when necessary. Media channels being used include a media release, radio advertising, targeted social media advertising on Facebook and Instagram, fridge magnets for community health workers to give to parents and caregivers, our digital platforms (Bay of Plenty DHB and Toi Te Ora websites and social media), and articles in Bay of Plenty DHB and Toi Te Ora publications. Key Lakes stakeholders have also been supplied with web banners and the radio advert to add to their phone hold message. The campaign is being rolled out over the month of June.

57

Appendix 1: CARE Values

58

Financial Results and Forecast The draft May result is a negative variance to the Annual Plan (AP) budget of $0.817m. The year to date surplus stands at $0.364m compared to a draft AP budgeted surplus of $1.577m, a negative variance to budget of $1.213m. The Annual Plan budget stands at a surplus of $3.1m which includes a further $1m of challenge. The DHB has signalled to the Ministry that it is not able to reach this target and has signalled a forecast of breakeven which is $3.1m worse than Annual Plan budget.

59

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

KEY MEASURES Actual AP Budget Variance

Operating Result 363 1,577 1,213

PROVIDER VOLUMES Case Weights (CWD) 38,588 37,254 1,334

CASH & BANK ($000) Net Operating Cash Flow 26,224 26,653 (429) Balance 16,988 25,207 (8,219) Days Cash 8.45 12.73 (4.28)

WORKING CAPITAL ($000) (23,305) (23,659) 355

TERM LOANS ($000) 0 152,200 152,200

CROWN EQUITY ($000) 270,422 122,094 148,328

Actual Plan VarianceFTE Numbers Accrued 2,679 2,516 (163)

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

KEY ACTIVITY DRIVERS SUMMARY

KEY STAFF FIGURES

KEY FINANCIAL RESULTS SUMMARY

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

07/14

08/14

09/14

10/14

11/14

12/14

01/15

02/15

03/15

04/15

05/15

06/15

07/15

08/15

09/15

10/15

11/15

12/15

01/16

02/16

03/16

04/16

05/16

06/16

07/16

08/16

09/16

10/16

11/16

12/16

01/17

02/17

03/17

04/17

05/17

Cash ($000s)

Cash Budget

$256,425

$17,704

$561

$4,134

$3,362

$8,906

$3,181

Assets Actual (Total = $294,273)

Land & Buildings Clinical Equipment Other EquipmentInformation Technology Motor Vehicles WIPInvestments

FTE by Staff Group

341.37

338.94

1,201.51

1,114.09

510.19

483.41

117.5

114.51

508.38

465.14

0 500 1000 1500 2000 2500 3000

Actual FTE

Plan FTE

Medical Nursing Allied Health Support Management & Admin

(2,000)

(1,500)

(1,000)

(500)

0

500

1,000

1,500

2,000

2,500

3,000

Quarterly Financial Performance

Actual

Plan

25.21

16.99

Bank Balance Plan

Bank Balance Actual($m)

12.73

8.45

Days Cash Plan

Days Cash Actual

0

5000

10000

15000

20000

25000

ED Attendances per Quarter

TGA WHK

0

1,000

2,000

3,000

4,000

5,000

Jul‐1

4

Aug‐14

Sep‐14

Oct‐14

Nov‐14

Dec‐14

Jan‐15

Feb‐15

Mar‐15

Apr‐15

May‐15

Jun‐15

Jul‐1

5

Aug‐15

Sep‐15

Oct‐15

Nov‐15

Dec‐15

Jan‐16

Feb‐16

Mar‐16

Apr‐16

May‐16

Jun‐16

Jul‐1

6

Aug‐16

Sep‐16

Oct‐16

Nov‐16

Dec‐16

Jan‐17

Feb‐17

Mar‐17

Apr‐17

May‐17

Caseweights

CWD CWD Plan

© Bay of Plenty District Health Board 2017 1 of 1 10/07/2017

60

Bay of Plenty District Health Board adoption of Public Health Position Statements SUBMITTED TO: Board Meeting July 2017 Submitted by: Janet Hanvey, Business Manager, Toi Te Ora – Public Health Service Simon Everitt, General Manager, Planning & Funding Endorsed by: Helen Mason, Chief Executive Officer RECOMMENDED RESOLUTION: That the Board endorses the Toi Te Ora – Public Health Service (Toi Te Ora) Position Statement on Food Security (as attached) as the Position Statement for the Bay of Plenty District Health Board (DHB). ATTACHMENTS: Bay of Plenty DHB Food Security Position Statement for endorsement. BACKGROUND: A position statement examines a health issue facing the population and describes appropriate response, approaches and states the organisation’s stance on the issue. A well-constructed position statement is an invaluable means of bringing focus and clarity to the development of an organisational response. The Bay of Plenty DHB is working more closely with other agencies, and in particular with local government, as part of adopting its Health in All Policies approach. A single set of position statements is important in this regard to assist with other agencies’ understanding of the Bay of Plenty DHB and its position on important health issues affecting the community. Historically, Planning and Funding and Toi Te Ora have developed separate position statements, some on the same issue and some on separate issues. In August 2016 the Board approved the two services’ recommendation to move to a single set of position statements for the Bay of Plenty DHB. The two services have now jointly reviewed their respective processes and will be developing a single set of position statements as and when existing statements come up for review. The position statement format of the merged documents has also been reviewed and takes into consideration both the existing formats and those identified across other DHBs, the Public Health Association and the New Zealand College of Public Health Medicine.

61

As a number of current Toi Te Ora position statements are not due for review for some time, it was proposed in the interim that these statements are transferred to the new format, and reviewed at the due date. This paper recommends that the attached which is the existing Toi Te Ora position statement is adopted by the Bay of Plenty DHB. DEFINITIONS USED: Term

Definition

Position Statement A position statement examines an issue facing the population and describes appropriate approaches and states the organisation’s stance on the issue. A well-constructed position statement is an invaluable means of bringing focus and clarity to the development of an organisational response.

62

Bay or Plenty District Health Board is committed to improving and protecting the health of the communities in the Bay of Plenty district.

Position Statement – Food Security

As a basic human right all New Zealanders should have sufficient access to healthy food that is

affordable and safe to eat.

Bay of Plenty District Health Board supports and advocates for the collective responsibility of central and local government, agriculture and the food industry, and community groups to address

and to improve affordable access to healthy, safe, and nutritious food.

The World Food Summit of 1996 defined food security as existing “when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life.”

Food security is built on four pillars (Committee on World Food Security, 2015):

1. Food availability: sufficient quantities of food available on a consistent basis

2. Food access: having sufficient resources to obtain appropriate foods for a nutritious diet

3. Food use: appropriate use based on knowledge of basic nutrition and care, as well as adequate water and sanitation.

4. Food stability: Stable access to foods at all times, without the risk of running out of food as a result of unexpected external circumstances

A New Zealand national nutrition survey in 2008 indicated that only three out of five households were classified as almost or fully food secure. Households in neighbourhoods with higher levels of deprivation were less likely to be food secure, as were Māori and Pacific households. A 2016 survey of the Bay of Plenty district indicated that 16% of the local population, including about 30% of Maori, worried about not having enough money to buy food. Activities that help to improve food security range from short-term relief such as school breakfast programmes, to local government policies such as urban edible planting, and national policies on nutrition, food prices, income, and agriculture. Food insecurity in the developed world is not a new phenomenon. However, approaching food security from a cross-sectoral and policy level is fairly new in New Zealand. There is strong evidence to support the formation of collaborative groups, typically referred to as Food Policy Councils, to undertake research, strategies and activities to improve food security. A Food Policy Council should include local representatives from public health, local government, Iwi, education, growers, manufacturers, distributors, food sellers, waste management operators and the community.

63

Bay of Plenty District Health Board advocates for, and supports: Access to affordable healthy, safe and nutritious food The establishment of local Food Policy Councils Food security issues being considered in local government policies and activities Research on the access and impact of the local food environment on food security Initiatives that promote community food resilience and support local food economies Emergency planning that ensures the availability of adequate and safe food and water Initiatives that promote safe and nutritious food gathering and preparation (including of wild foods

and kaimoana) Initiatives to make fresh food and vegetables more affordable Initiatives that promote nutritionally adequate dietary intake Breastfeeding friendly environments. References and further information Committee on World Food Security. (2015). Global Strategic Framework for Food Security and Nutrition. Committee on World Food Security. Toi Te Ora – Public Health Service (2011). Edible Impact: Food Security Policy Literature Review Toi Te Ora – Public Health Service (2013). Food Security Policy Toolkit for Local Government. Toi Te Ora - Public Health Service (2012). Breastfeeding Position Statement, Retrieved from: http://www.toiteorapublichealth.govt.nz/vdb/document/554. Toi Te Ora - Public Health Service (2012). Issues of Health and Wellbeing 2012 Population Survey, Toi Te Ora – Public Health Service. United Nations, (1989, web accessed Sept 2012), Convention on the Rights of the Child http://www2.ohchr.org/english/law/crc.htm#art24. University of Otago and Ministry of Health (2011). A Focus on Nutrition: Key Findings of the 2008/2009 NZ Adult Nutrition Survey- revised. World Health Organisation Food Security: http://www.who.int/trade/glossary/story028/en/.

Adopted by: the Bay of Plenty District Health Board at its meeting on Review Date: 29 November 2019.

64

http://www.toiteorapublichealth.govt.nz/vdb/document/554

http://www2.ohchr.org/english/law/crc.htm#art24

http://www.health.govt.nz/publication/focus-nutrition-key-findings-2008-09-nz-adult-nutrition-survey

http://www.who.int/trade/glossary/story028/en/

QUARTERLY BOARD REPORT

Corporate Services - Health and Safety SUBMIT TO: Board Meeting

Date of Report: 10 July 2017

Prepared by: Ted Harper: Health and Safety Service Manager

Endorsed by: Letham White: General Manager Corporate Services Submitted by: Helen Mason: Chief Executive

RECOMMENDED RESOLUTION:

That the Board receives the following Health and Safety report for the quarterly period ending 30 June 2016.

Key Activities / Highlights

The Influenza figures are provided below compared to last year figures. There has been a significant improvement in the uptake at Whakatane.

Totals for 2017

Occ Code Total staff # vaccinated % Tga Whk Registered Doctors 389 305 78.4%

Nurses 1344 896 66.7%

Midwives 79 30 38.0%

Allied Staff 612 352 57.5%

Other Employees 733 459 62.6% Health Care Assistants

168

97

57.7%

Totals 3325 2139 64.3% 65.9% 64.0%

Totals for 2016

Occupation Code Total staff # vaccinated % Tga Whk Registered Doctors 365 282 77.3% Nurses 1326 855 64.5% Midwives 67 24 35.8% Allied Staff 605 349 57.7% Other Employees 701 411 58.6% Health Care Assistants

158

90

57.0%

Totals 3222 2011 62.4% 66.9% 53.0%

65

A further graph, below, provides a breakdown by division for this year.

100% 90% 80% 70% 60% 50% 40% 30% 20% 10%

0%

% of Staff Vaccinated by Division

Health and Safety Governance Group

The Health and Safety Governance Group has been meeting monthly and have progressed the H&S Plan including setting and progressing actions for the following:

• H&S Improvement Project is well underway with PID completed and a Project manager assigned to manage the project.

• Considering an alternative Hazard Register for the DHB • Contractor management - Online training for contractors other than those working for

Property Services has gone live • H&S Training provider being considered for the Board and the Exec Team training • Updating the Asbestos/ Hazardous Substance Management Program

Key Performance indicators

Healthy Living Activity

TGA & WHK 69 clinics this quarter including further influenza vaccinations with 8GP referrals.

H&S Activity Graphs

Monthly Reporting on Health and Safety Activity

The following graph indicates the percentage of H&S Plans and tasks that have been completed for each month. These tasks include monitoring of annual health and safety plans and reports on what hazard and emergency topics have been provided and monthly housekeeping inspections been conducted. There is still a downward trend in reporting of H&S activity which is of concern.

66

100%

80%

60%

Completed EH&S Tasks % 2016 - 2017

95% 100% 96% 93% 97% 100% 92% 93% 96% 93% 91%

89% 87%

75%

40%

20%

0%

Lost Time Accidents and H&S Risks Data to End of June 2017

The following Dashboard covers the top four H&S risks identified by the H&S Governance Group using the ACC Claims and Costs along with the Lost Time Accidents (LTA’s). The Dashboard tracks reactive trends of incidents only. Hours lost have remained lower than those recorded for the past 12 months. Note: May this year is the red dot in the graph below

67

ACC Claims by Cause and Costs Incurred for Past 12 Months ACC Annual Report

The following report is provided by ACC on the BOPDHB ACC performance for the last year along with information on how this compares with previous years. In the last year, ending March 31 2017, shows a significant reduction in ACC claims and associated costs.

68

ACC Partnership Programme Claim Data Summary Report


Breakdown of Registered Claims

Note: This report is capturing claim activity for month of March 2017.This report may also contain April 2017 data if received prior to 13 May 2017. Note: Liable Earnings and Levy figures are estimated for 2017 cover period(s). Other figures for 2018 are year-to-date.

Information produced by ACC Business Intelligence Services

No

of C

laim

s

Claim Category Cover Period

2013 2014 2015 2016 2017

Registered 165 180 194 162 185

Declined 38 41 48 41 27

Held-cover decision 0 0 0 0 10

Accepted 127 139 146 121 148

Accepted - Entitlement 24 32 36 37 32

Accepted - Medical Fees Only 103 107 110 84 116

200

160

120

80

40

0 2013 2014 2015 2016 2017 2018

Cover Period

Declined Held-cover decision

Accepted - Entitlement Accepted - Med Fees Only

69





Costs by Claim Cover Period

Cos

t (ex

cl o

f GST

)

Type of Cost Cover Period

2013 2014 2015 2016 2017

Reopened claim costs $0 $0 $0 $0 $0

Claim handback costs $0 $0 $0 $0 $0

Claim costs $323,892 $261,191 $437,173 $595,308 $187,379

Total ACC Partnership Programme levy (excl. GST)

$114,028

$99,589

$114,770

$122,411

$136,051

Group standard levy - after audit discount (excl. GST)

$827,839

$771,530

$642,970

$615,222

$904,074

Group standard levy (excl. GST) $1,034,799 $964,412 $803,713 $769,028 $1,130,093

1,500,000

1,200,000

900,000

600,000

300,000

0 2013 2014 2015 2016 2017 2018

Cover Period

Total ACC Partnership Programme levy Claim costs

Claim handback costs Reopened claim costs

Group standard levy - after audit discount Group standard levy

70





Claim Costs by Category

Cos

t

Claim Costs by Category

Cover Period

2013 2014 2015 2016 2017

Weekly Compensation $202,224 $156,946 $321,772 $401,553 $138,063

Vocational Rehabilitation $9,492 $11,025 $16,302 $21,858 $5,734

Social Rehabilitation $2,790 $3,565 $5,886 $6,832 $1,070

Medical Fees $109,386 $89,655 $93,213 $165,065 $42,513

Other $0 $0 $0 $0 $0

Total Claim Costs $323,892 $261,191 $437,173 $595,308 $187,379

600,000

480,000

360,000

240,000

120,000

0 2013 2014 2015 2016 2017 2018

Cover Period

Weekly Compensation Vocational Rehabilitation

Social Rehabilitation Medical Fees

Other

71





Clai

ms

per $

1milli

on L

iable

Earn

ings

Claims per $1million Liable Earnings Cover Period

2013 2014 2015 2016 2017

Total Liable Earnings ($million) $172.47 $178.59 $186.91 $197.19 $201.80

All Claims Bay of Plenty District Health Board

0.74

0.78

0.78

0.61

0.73

Levy Risk Group 0.84 0.87 0.85 0.81 0.82

ACC Work Account 1.77 1.71 1.67 1.56 1.58

Weekly Compensation Claims


0.13

0.17

0.18

0.18

0.16

Levy Risk Group 0.14 0.16 0.15 0.16 0.14

ACC Work Account 0.20 0.20 0.21 0.20 0.20

1.80

1.46

1.12

0.78

0.44

0.10 2013 2014 2015 2016 2017 2018

Cover Period

All Claims - Bay of Plenty District Heal... Weekly Compensation Claims - Bay of Plen...

All Claims - Levy Risk Group Weekly Compensation Claims - Levy Risk Group

All Claims - ACC Work Account Weekly Compensation Claims - ACC Work Account

72

Updated 27 January 2017

Bay of Plenty District Health Board Work Plan – 2017

Month Activity Documentation

Source Meeting Date and

Venue January • CEO Monthly Report

• Approve committee Resolutions • Monitor Member’s Interest

Declarations • Dashboard Report • Patient Experience • Strategic Partnership Group

Minutes • BOP Health Alliance Minutes • Quarterly Employee Health and

Safety Report • – drop in (1-2pm)

• CEO • GMGQ • GMGQ

• GMPF • GMGQ • CEO • GMPF • GMGQ

• GMGQ

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

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

Declarations • Dashboard Report • Midland Chairs/CE Meeting

Minutes • Quarterly Health Excellence

Report • Quarterly Maori Health Plan

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

Report (July – Dec)


• GMPF • GMGQ

• GMGQ

• GMMHPF

• GMPF • GMGQ • GMPF

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

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


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

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

Minutes • BOP Health Alliance Minutes • Health and Safety Training

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

• Q2 IDP Ratings • – drop-in (1-2pm)


• GMPF • GMGQ

• GMGQ • GMPF

• CEO • GMPF • GMGQ • GMPF • GMGQ

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

April • CEO Monthly Report • Monitor Member’s Interest

Declarations • Dashboard Report

• CEO • GMGQ

• GMPF

19 April 2017 Board Only Time

73


Month Activity Documentation Source

Meeting Date and Venue

• Midland Chairs/CE Meeting Minutes

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

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

Safety Report

• GMGQ • GMGQ • GMPF • GMPF • GMCS

Conference Hall, Clinical School, Whakatane Hospital

May • CEO Monthly Report • Monitor Member’s Interest

Declarations • Dashboard Report • Quarterly Maori Health Plan

Dashboard Report • Midland Chairs/CE Meeting

Minutes • Final Annual Plan 17/18

Approval • Strategic Partnership Group

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

Regional/National Forums

• CEO • GMGQ

• GMPF • GMMHPF

• GMPF

• GMPF • CEO • GMPF

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

June • CEO Monthly Report • Monitor Member’s Interest


Minutes • Quarterly Risk Report • Quarterly Health Excellence,

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

Presentation • Member’s reports from


• CEO

• GMGQ • GMGQ

• GMPF

• GMGQ • GMPF

• GMPF • GMGQ

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

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


Minutes • 6 Monthly Board Attendance

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

Minutes • BOP Health Alliance Minutes • Presentation: NMO

• CEO • GMGQ

• GMPF • GMGQ

• GMGQ

• GMGQ • GMGQ • CEO • GMPF

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

74




• Quarterly Employee Health and Safety Report

• Quarterly update on HIS • Member’s reports from


• GMCS

• GMPF

August • CEO Monthly Report • Monitor Member’s Interest

Declarations • Dashboard Report • Quarterly Health Excellence,

Quality & Patient Safety Report • Quarterly Maori Health Plan

Dashboard Report • Midland Chairs/CE Meeting

Minutes • Member’s reports from


• CEO • GMGQ

• GMPF • GMGQ

• GMMHPF

• GMGQ

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

September

• CEO Monthly Report • Monitor Member’s Interest


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

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


• CEO • GMGQ

• GMPF • GMGQ

• GMCS • GMPF • GMGQ • GMGQ • • CEO

• GMPF

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

October

• CEO Monthly Report • Monitor Member’s Interest


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

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

progress report) • Quarterly Employee Health and

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


• CEO • GMGQ

• GMPF • GMGQ

• GMPF • CEO • GMPF • GMPF

• GMCS

• GMPF

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

November • CEO Monthly Report • Monitor Member’s Interest

• CEO • GMGQ

15 November 2017

75





Minutes • Quarterly Health Excellence,

Quality & Patient Safety Report • Quarterly Maori Health Plan

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


• GMPF • GMGQ

• GMGQ

• GMMHPF • GMPF • GMGQ

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

December No meeting

76

BOPDHB Board drop In Visits – 2017

DATE 21/06/2016 LOCATION Ward 8, Whakatane.

MEMBERS BOARD MEMBERS: R Scott, B Edlin, Yvonne Boyes

QUALITY & PATIENT SAFETY: Chris Angus

VOLUNTEER PATIENT ADVISOR:

HOSTS: Joanne Olsen, Team leader Ward 8

DISCUSSION SUMMARY

Following the Board meeting on 21 June 2017 Board members Yvonne Boyes, Ron Scott and Bev Edlin attended a drop-in visit to Ward 8 (Te Toki Maurere). The board members were hosted by Mental Health & Addiction Services staff members Chris Angus and Joanne Olsen, Team leader Ward 8.

The drop-in visit started with a walk through of the patient amenities area- dining room, kitchen, recreation room and patient laundry. Discussions centred around the role of patients in self- determination activity with regard to food preparation (assessment prior and training to discharge) and laundry chores. A patient activity programme outline was also sited and discussed along with the role of the Te Pou Korkiri in ward 8.

The patient amenities area, reception and bedroom wing have all been recently refurbished and upgraded. Previous ligature hazards were assessed and mitigated in the refurbishment.

The visit moved in to the low stimulus area (intensive psychiatric care) wing. This wing included a patient lounge, 2 bedrooms and de-escalation rooms. The wing was noted to be old and in need of renovation and thus the board members were shown the new plans for the Ward 8 renovation.

The funding has been approved and the plans are at architectural finalization stage. It is anticipated that building works will commence in late 2017. The renovation of the Ward 8 low stimulus area will close off several recommendations from previous external audits of ward (Ombudsman’s Office and Certification Corrective Actions).

As Ward 8 has been undertaking the Productive Mental Health Ward (Releasing Time to Care) project Various improvements and efficiencies arising from the project (e.g. the treatment room) were cited and discussed. Board members asked many questions and these were around patient mix and admission trends, resourcing, staffing, health and safety and treatment provided on the ward as well as discharge readiness planning. Mental Health & Addiction Services staff were appreciative of the opportunity to show case the Ward and of the interest shown in their area of professional endeavour.

SPECIAL NOTES

ACTION ITEMS PERSON RESPONSIBLE DUE DATE

77

6 Monthly Board Attendance Report

SUBMITTED TO:

Board Meeting 19 July 2017

Prepared by: Gail Bingham, GM Governance and Quality

Submitted by: Helen Mason, Chief Executive

RECOMMENDED RESOLUTION

That the Board note the information

BACKGROUND:

Attendance report are requested by the Board for the period January 2017 – June 2017

Board Members Board AFRM CPHAC/DSC BOPHAC SHC A DNA A DNA A DNA A DNA A DNA Mark Arundel 6 0 2* 0 1 1 1 0 Yvonne Boyes 6 0 1 0 1 0 Beverley Edlin 5 1 4* 0 2 0 1 0 Geoff Esterman 4 2 4* 0 1 0 1 0 Marion Guy 6 0 1 1 1 0 Punohu McCausland 6 0 1 0 Peter Nicholl 4 2 4* 0 1 0 0 1 Matua Parkinson 4 2 0 1 Anna Rolleston 6 0 2 0 1 0 Ron Scott 6 0 6 0 2 0 1 0 1 0 Judy Turner 6 0 2 0 1 0 Sally Webb 5 1 5 1 1 1 1 0 1 0 Total number of scheduled meetings

6

6

2

1

1

*In March 2017 Mark Arundel stepped down from AFRM as he is no longer Chair of BOPHAC. Peter Nicholl, Beverley Edlin and Geoff Esterman were appointed to AFRM in Feb. Mark Arundel has been appointed Chair of Strategic Health Committee and will recommence on AFRM from July 2017.

78

E-cigarettes

SUBMITTED TO: Board Meeting: 19 July 2017 Prepared by: Brian Pointon, Portfolio Manager, Population Health Endorsed by: Simon Everitt, GM Planning and Funding Submitted by: Helen Mason, Chief Executive RECOMMENDED RESOLUTION: That the Board receives this report. ATTACHMENTS: Ministry of Health’s “Electronic Cigarettes: Information for health care workers”. October 2016. (Appendix 1)

BOPDHB Smokefree / Auahi Kore (Appendix 2)

BACKGROUND: This report has been prepared by DHB staff at the request of Board members at their meeting on 21 June. Input has been received from Dr Pierre de Villiers, respiratory physician at Tauranga Hospital, and tobacco control lead staff at Toi Te Ora-Public Health Service. Board members have also shared key research papers and these have been drawn on when preparing this paper. Information was also sought from the regional specialist stop smoking service “Hapainga”, managed by Eastern Bay PHA, and from the Ministry of Health website.

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ANALYSIS: There is a wide divergence of views across the public health sector internationally and in NZ. Some see e-cigarettes as a way to rapidly reduce the number of smokers in order to achieve national smokefree targets. Others though see e-cigarettes as a way of renormalizing tobacco smoking by increasing the visibility of smoking/vaping behaviours, and therefore a risk of destabilising established tobacco control programmes. While there is general consensus that e-cigarettes are chemically less harmful than tobacco, there are still some concerns, particularly in the long term, about the safety of vaping using nicotine and other flavoured liquids. Many public health practitioners are concerned that e-cigarettes do not remove the nicotine addiction, and may encourage new users of a nicotine product if it is seen as being more socially acceptable. There is also suspicion of tobacco company motives in their large scale purchasing of e-cigarette producers, given their bad track history. The research is yet to be sufficiently clear-cut to resolve these divergent views, and develop sound and supported public policy. The United Kingdom has taken a largely harm reduction approach, which is more supportive of the use of e-cigarettes as a quitting tool. In the UK, longer term vaping is almost entirely amongst current smokers and ex-smokers. Conversely, the United States has taken a harm elimination approach under a strong regulatory framework. There is more recreational vaping among younger people, not necessarily with nicotine based e-liquids. The Federal Secretary of Health and Human Services has stated,”As cigarette smoking among those under 18 has fallen, the use of other nicotine products, including e-cigarettes, has taken a drastic leap. All of this is creating a new generation of Americans who are at risk of nicotine addiction1.” Note that this use may have ranged from only short term ‘experimental’ use to daily vaping. An excellent summary on e-cigarettes from a United States perspective is available from this link. https://www.uptodate.com/contents/e-cigarettes?source=search_result&search=e%20cigarettes&selectedTitle=1~29%20-%20H1032355223 Research mainly comes from these quite different UK and USA settings, with little research yet in NZ which did not take up vaping until later. A study by Auckland University, called Ascend-II, is currently underway which aims to measure the effectiveness of e-cigarettes as a cessation aid. However, its expected results will be available only in 2020 (https://ascend2.nihi.auckland.ac.nz/content/funding-support ). A 2017 study was conducted into the real-world impact of the regulatory environment on quitting success through the use of e-cigarettes. The study2 compared quit rates in UK and USA, which have a more permissive regulatory environment for e-cigarettes, with Canada and Australia, which have a harsher regulatory environment. The study showed that smokers who used e-cigarettes for quitting from countries with less restrictive policy environments were significantly more likely (OR = 1.95, 95%CI = 1.19-3.20, p<0.01) to report sustained abstinence for at least 30 days. Smokers who used e-cigarettes for quitting from countries with more restrictive policy environments were significantly less likely (OR = 0.36, 95%CI = 0.18-0.72, p<0.01) to report sustained abstinence for at least 30 days. The comparison group was smokers who

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https://www.uptodate.com/contents/e-cigarettes?source=search_result&search=e%20cigarettes&selectedTitle=1~29%20-%20H1032355223



https://ascend2.nihi.auckland.ac.nz/content/funding-support

attempted to quit without using Nicotine Replacement Therapy, prescription medicines e.g. Varenicline (Champix®) or e-cigarettes. The difference was attributed to ease of access and advice on use of e-cigarettes, availability of more effective products (third generation e-cigarettes), and greater social support. The Cochrane Library is a recognised database of independent systematic research reviews. Their second review into “E-cigarettes for smoking cessation” 2 in 2016 (co-authored by Professor Hayden McRobbie, Clinical Advisor Tobacco Control, Ministry of Health, and Chris Bullen, Professor of Public Health and Director, National Institute for Health Innovation, School of Population Health, University of Auckland) concluded that “none of the studies found that smokers who used e-cigarettes short- to mid-term (for two years or less) had an increased health risk compared to smokers who did not use e-cigarettes.” “Using an e-cigarette containing nicotine increased the chances of stopping smoking in the long term compared to using an e-cigarette without nicotine.” They “could not determine if e-cigarette was better than a nicotine patch in helping people stop smoking.” “More studies of e-cigarettes are needed. Some are already underway.” A New Zealand randomised controlled trial4 conducted between 2011 and 2013, compared 6 month quit rates for smokers using e-cigarettes containing nicotine, nicotine patches and placebo e-cigarettes. Verified abstinence was only 7.3% for the group using e-cigarettes containing nicotine, not statistically greater than using nicotine patches or placebo e-cigarettes. While the technology in e-cigarettes has improved since that period, so that quit rates are likely to increase over time, it seems likely that although useful numbers of individual smokers will be able to quit tobacco smoking using e-cigarettes, use of e-cigarettes may not achieve large enough numbers of ex-smokers at a population level, so that the Government’s goal of Smokefree Aotearoa 2025 can be achieved with use of e-cigarettes as a sole strategy. There is therefore a difficulty in coming to an agreed consensus at this time, particularly within the New Zealand setting. This paper therefore takes a measured approach, relying predominantly on current Ministry of Health guidance. New legislation to legalise the importation of nicotine-based e-cigarettes for sale, but with greater regulatory control on sales to minors, product safety and advertising, is expected to be taken to Parliament this year, and come into effect in 2018. That will provide a clearer framework for how health services respond to this issue. In the meantime, there is no strong evidence in place to advise the BOPDHB Board that it should depart from current Ministry of Health advice. BOPDHB Policy The current BOPDHB policy 5.4.2 Smokefree/Auahi Kore5 does not specifically mention e-cigarettes, but does list the Ministry of Health advice amongst its references. The accompanying Protocol 1 Smokefree- Facilities Standards6 states: “The above standards {for tobacco smoking in Board buildings, vehicles and grounds} also apply to the use of e-cigarettes and vaping, which are not currently supported by the Ministry of Health as a quitting tool. The Ministry of Health encourages people to avoid using e-cigarettes in areas where smoking is not permitted.”

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Ministry of Health advice The following is the current advice from the Ministry of Health on the use of e-cigarettes to stop smoking. “There is a good rationale for people to use e-cigarettes to help them stop smoking as e-cigarettes can provide nicotine, which is what people desire from smoking. Research into the effectiveness of e-cigarettes in smoking cessation is growing, but the findings from these studies are somewhat mixed and the quality of the evidence is low overall. This is an active area of research and more findings will become available over the next few years. At this stage, the Ministry of Health does not have enough evidence to recommend e-cigarettes confidently as a smoking-cessation tool. Smokers should use approved smoking-cessation medicines, such as NRT, to support them to stop smoking and seek behavioural support from stop-smoking services. People who choose to use e-cigarettes (to vape), should aim to stop smoking completely to reduce the harm from smoking. Ideally, they should eventually stop vaping as well.” All BOPDHB and Ministry of Health stop smoking services adhere to this advice. For instance, this is the policy and practice adopted by the Hapainga regional stop smoking service funded by the Ministry and delivered by EBPHA in conjunction with NMO Ltd. “…we do see vaping as a positive cessation choice, however totally follow MoH guidelines. Rather than 'supporting vaping', we are happy to offer cessation support to people choosing vaping as their cessation aid. However we do give them all the info we know at present, e.g. not regulated so be careful where you buy juices; little evidence at present of possible future issues but are 95% better than smoking. Allows an informed choice. If someone is not currently vaping, we offer the traditional NRT or prescription medicines. We only really discuss vaping if the client raises the subject. We also advise those vaping to not do so in areas currently seen as Smokefree, and to have as a goal setting a time when they will also quit vaping.” Non-funded providers of stop smoking services such as quit card providers, who are based in a wide range of community services, may more actively support e-cigarettes as a quitting tool. Further information from the Ministry on e-cigarettes for health care workers is attached as Appendix 1. REFERENCES 1. “Message from Sylvia Burwell” from E-Cigarette Use Among Youth and

Young Adults: A Report of the Surgeon General. 2016. 2. Hua-Hie Yong, Sara C. Hitchman, K. Michael Cummings, Ron Borland,

Shannon M.L. Gravely, Ann McNeill, Geoffrey T. Fong. Does the Regulatory

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Environment for E-Cigarettes Influence the Effectiveness of E-Cigarettes for Smoking Cessation? Longitudinal Findings From the ITC Four Country Survey.Nicotine & Tobacco Research, 2017, 1-9.

3. Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation. Cochrane database of Systematic Reviews 2016, Issue 9. Accessible from www.cochranelibrary.com

4. Christopher Bullen, Colin Howe, Murray Laugesen, Hayden McRobbie, Varsha Parag, Jonathan Williman, Natalie Walker. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet 2013: 382: 1629

5. BOPDHB Policy 5.4.2 Smokefree/Auahi Kore 6. BOPDHB Policy 5.4.2 Protocol 1 Smokefree – Facilities Standards.

Standards to be met.

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http://www.cochranelibrary.com/

Appendix 1

Electronic Cigarettes: Information for health care workers The following information can be useful when talking about electronic cigarettes (e-cigarettes) with patients.

The information does not replace the e-cigarette advice provided on the Ministry of Health’s (the Ministry’s) website. Rather, it aims to support that advice with more specific details relating to particular common issues.

This information will be updated regularly.

Main users of e-cigarettes There are two distinct groups of e-cigarette user: those who have ‘ever used’, that is, they have tried or experimented with e-cigarettes, and those who use e-cigarettes regularly.

An increasing number of people, young and old, smokers and non-smokers, report having ever used an e- cigarette (ie, taken even one puff). However, regular use is largely confined to current or ex-smokers.

In New Zealand, the Health Promotion Agency’s Health and Lifestyles Survey (HLS) found that 1 percent of adults (around 30,000 adults (Li et al 2015) currently use e-cigarettes at least monthly.

Components of e-cigarettes E-cigarettes are electrical devices that heat a solution (or e-liquid) to produce a vapour that the user inhales or ‘vapes’. The ingredients of the e-liquid may vary, but currently, most e-liquids contain propylene glycol (also used in asthma inhalers and nebulisers) and flavouring agents.

Some, but not all, e-liquids contain nicotine.

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Types of e-cigarette E-cigarettes come in a range of styles, from devices that look similar to traditional cigarettes (first generation or cig-a-like) to refillable-cartridge ‘tank’ systems (second generation) to highly advanced appliances with larger batteries that allow the power to be adjusted to meet an individual’s specific vapour requirements (third generation) – see Figure 1 below.

Second and third generation e-cigarettes generally deliver more nicotine than first generation e-cigarettes. Figure 1: The three generations of electronic cigarettes

First generation Second generation Third generation

Images courtesy of Anna Phillips

Smoking cessation products available in New Zealand In New Zealand, it is illegal to sell a smoking cessation product that contains nicotine unless the product has been approved by Medsafe for use as a medicine.

Nicotine gum, lozenges and patches to help people stop smoking have been assessed and approved by Medsafe for sale in New Zealand. Manufacturers of nicotine-containing e-cigarettes can apply to Medsafe for an assessment of their e- cigarettes as medicines for sale in New Zealand.

No e-cigarette has yet been approved as a stop-smoking medicine in this country.1 However, nicotine-containing e-cigarettes can be purchased online for personal use.

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Smoking cessation support options for vapers Combining behavioural support with stop-smoking medication has been associated with the greatest chance of quitting smoking. Using behavioural support with e-cigarettes is likely to have a similar result.

Both Quitline and local face-to-face stop-smoking services can support people who wish to use e-cigarettes in their smoking cessation attempt.

These services cannot provide e-cigarettes. 1 E-voke is a device that delivers nicotine in the same way as an e-cigarette. This device has been approved for the purposes of helping people to stop smoking, cut down to quit, temporary abstinence and smoking reduction by the United Kingdom's Medical and Healthcare Products Regulatory Agency (MHRA)

Effectiveness of e-cigarettes in smoking cessation Research into the effectiveness of e-cigarettes in smoking cessation is growing, but the findings from these studies are somewhat mixed.

There is a good rationale for people to use e-cigarettes to help them stop smoking. E-cigarettes can provide nicotine, which is what people desire from smoking. They can also replace some of the sensorimotor aspects of smoking.

Some types of e-cigarettes are better than others at delivering nicotine (ie, second/third generation e- cigarettes are generally better than first generation products). Practice also makes a difference, and experience has been shown to improve a vaper’s ability to retrieve nicotine from an e-cigarette (RCP 2016).

The strongest evidence for the effectiveness of e-cigarettes in aiding smoking cessation comes from randomised controlled trials (RCTs) that compare the long-term outcomes (at least 6 months) in vapers using e-cigarettes against a control or comparison group.

Internationally to date, only two RCTs have been published that report on long-term abstinence rates as a result of e-cigarette use. These RCTs show that e-cigarettes containing nicotine have had better results at helping smokers quit for at least 6 months compared with e-cigarettes without nicotine (risk ratio = 2.29, 95% CI: 1.05–4.96; Absolute abstinence rates: 9% versus 4%) (McRobbie et al 2014). More studies are required to confirm these findings.

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At this stage, the Ministry does not have enough evidence to recommend these products confidently as a smoking cessation tool. The Ministry advises smokers to use approved smoking cessation medicines in combination with behavioural support from stop-smoking services (face-to-face providers and/or Quitline).

E-cigarette use

Combining smoking with vaping The greatest health benefits are seen when people stop smoking completely, and this should be the goal in any smoking cessation effort.

Some people manage to switch completely to vaping quickly. Others can take some time to adjust and may need to try a number of different e-cigarettes and e-liquids before finding one that can help them stop smoking.

Ideally, people would eventually stop vaping as well. Combining vaping with stop smoking medicines Some people may choose to use e-cigarettes in addition to approved stop-smoking medicines. This is OK – people should not be discouraged from using e-cigarettes; rather, they should be encouraged to stop smoking completely.

Health risks

Nicotine The nicotine found in tobacco does not cause the negative health effects associated with smoking. It is the other chemicals found in tobacco smoke that are harmful (RCP 2016). However, nicotine is an addictive chemical that encourages smoking. For smokers, the nicotine in e-cigarettes poses little danger, however, in excessive amounts, it can be lethal, especially for children. In order to prevent accidental poisoning, especially of children, e-cigarettes and e- liquids should be stored where they cannot be accessed by others.

E-cigarettes People who smoke are already dependent on nicotine, so e-cigarettes will not create a new addiction. Many vapers feel less dependent on e-cigarettes than they do on traditional cigarettes. They often choose to reduce the strength of nicotine they use over time and may eventually stop vaping altogether.

Short-term use of e-cigarettes has been associated with mild adverse effects such as headaches, dry mouth or throat, and throat or mouth irritation. The health risks

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associated with the long-term use of e-cigarettes are unknown. It is only known that the risks of smoking are likely to be much greater (RCP 2016 and McNeill et al 2015).

There is evidence that e-cigarettes pose fewer health risks to smokers who switch completely from tobacco smoking to e-cigarette use.

E-cigarette vapour A number of toxins have been found in e-cigarette vapour. However, when e-cigarettes are used within normal operating levels (ie, not overheated), these toxins are present at very low levels – many times lower than in tobacco smoke (RCP 2016).

Second-hand vapour The risks from second-hand vapour are unknown at this stage. However, second-hand vapour is known to be less harmful than second-hand smoke.

Where e-cigarettes can be used The Smoke-free Environments Act 1990 does not prohibit e-cigarette use in smoke-free places. However, individual organisations can ban e-cigarettes as part of their own smoke-free policies.

The Ministry encourages people to avoid using e-cigarettes in areas where smoking is not permitted.

Classifying smokers and vapers E-cigarettes are not a combustible tobacco product and therefore should not be coded as such. • If a smoker has switched completely from cigarettes to e-cigarettes, they should be coded as an ex- smoker.

• If a smoker is still smoking cigarettes, even as little as one cigarette per day, they should be coded as a current smoker.

For more information See the Ministry of Health’s website information about e-cigarettes Here are some links and documents from the United Kingdom. Note that legislation in the United Kingdom is different from here in New Zealand.

• Cancer Research UK – Our policy on harm reduction and e-cigarettes

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http://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/advice-use-e-cigarettes

http://www.cancerresearchuk.org/about-us/we-develop-policy/our-policy-on-tobacco-control-and-cancer/our-policy-on-harm-reduction-and-e-cigarettes

• United Kingdom National Centre for Smoking Cessation and Training– Electronic Cigarette Briefing.

References Li J, Newcombe R, Walton D. 2015. The prevalence, correlates and reasons for using electronic cigarettes among New Zealand adults. Addict Behav 2015;45C: 245–51. doi:10.1016/j.addbeh.2015.02.006

McNeill A, Brose LS, Calder R, et al. 2015. E-cigarettes: An evidence update. A report commissioned by Public Health England. London, UK: Public Health England. www.gov.uk/government/publications/e- cigarettes-an-evidence-update (accessed 10 September 2015).

McRobbie H, Bullen C, Hartmann-Boyce J, et al. 2014. Electronic cigarettes for smoking cessation and reduction. Cochrane Database Syst Rev 2014, 12:CD010216. DOI:10.1002/14651858.CD010216.pub2 (accessed 20 September 2016).

RCP. 2016. Nicotine without smoke: Tobacco harm reduction: A report by the Tobacco Advisory Group of the Royal College of Physicians. London: Royal College of Physicians. URL: www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0 (accessed 23 September 2016). HP6502 October 2016 An upgrade of this information is expected to be issued by the Ministry of Health on their website in July 2017.

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http://www.ncsct.co.uk/publication_electronic_cigarette_briefing.php

http://www.ncsct.co.uk/publication_electronic_cigarette_briefing.php

http://www.gov.uk/government/publications/e-

http://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0

http://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0

BOP Integrated Healthcare Strategy 2020

Closing Report SUBMITTED TO: Board Meeting 19 July 2017 Prepared by: Sarah Davey, Programme Manager, Integrated Healthcare Endorsed by: Simon Everitt, General Manager, Planning and Funding Kiri Peita, Acting General Manager, Planning and Funding Submitted by: Helen Mason, Chief Executive RECOMMENDED RESOLUTION: That the Board notes this report. BACKGROUND: At its meeting on 19 April 2017, the Board received a detailed report showing progress against the delivery of the BOP Integrated Healthcare Strategy 2020 (IHS). Three years into implementation of a seven year strategy, that paper reported that of the total 38 headline actions in the IHS, 12 are fully complete or now considered business as usual, 20 actions are currently being worked on (e.g. are incorporated into Service Level Alliance Team or departmental work plans) and 6 actions have not yet started but are still considered relevant. A copy of the IHS progress report to the end of March 2017 is embedded below. Printed copies are available on request.

IHS Progress report against actions - detai

The Board has now approved the final BOP Strategic Health Services Plan, which builds on and reflects progress made under the IHS. The IHS is strongly reflected in Strategic Objectives One and Two and in Section 5: Infrastructure. Table 1 below demonstrates the alignment between the IHS and the SHSP. It’s now appropriate to formally close off the IHS. The IHS has provided an excellent platform to deliver change towards achieving a shared vision of integrated care, develop our understanding and experience of what integrated care means; and provided us with experience in what it takes

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to make improvements and deliver real results for our population. The Strategic Health Services Plan builds on this, reflecting our changing environment and provides a clear vision for the next 10 years and is strongly evidence based, built on the BOP Health and Service Profile 2016. Table 1: Summary of the alignment between the IHS and the Strategic Health Services Plan

IHS Theme Strategic Health Services Plan Reference

1. Patient and Family Centred Care/Whanau Ora

Section 5 Infrastructure: 5.1 Embedding patient and family centred care/Whanau Ora

2. Health Literacy Section 5 Infrastructure 5.1 Embedding patient and family centred care/Whanau Ora

3. Access to patient information Section 5 Infrastructure: 5.3 Using information to improve value 5.4 Making the most of new Technologies

4. Co-ordinated Care Strategic Objective 2: Develop a smart, fully integrated system to provide care closer to where people live, learn, work and play

5. Creating an environment for integration Strategic Objective 2: Develop a smart, fully integrated system to provide care closer to where people live, learn, work and play Section 5 Infrastructure; 5.2 Building Effective Partnerships

6. Contracting for Outcomes and flexibility of funding

Section 5 Infrastructure: 5.7 Using funding and contracting to better match resources with need; Strategic Objective 1: Target Investment to improve the lives of the most vulnerable

7. Health in All Policies Strategic Objective 1: Empower our population to live healthy lives; work more collaboratively to quicken the pace and scale of health in all policies

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Detailed progress report to March 2017

1

Progress Key:

Complete

Action is completed and improvements are now either on going and business as usual, or a decision has been made not to progress it (reasons provided).

Working on it

Progressing according to organisational time frames. Activity has been prioritised and resourced either through a formal Project Initiation Document and/or included in Service Level Alliance Team work plans and/or Annual Plan. Progress reporting through quarterly reporting.

Not started

No significant progress or activity has not been prioritised for resourcing. Still considered to be relevant.

Total Headline actions: 38 Completed: 12

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2

Working on it: 20 Not started: 6

Theme 1: Patient and family-centred care/Whanau Ora:

Total Headline actions: 6 Completed: 1 Working on it: 4 Not started: 1

1 Actions Expected

timeframe for completion

Indicator of success Responsibility and partners

Links Progress

1.1 1.1.1 Identify or develop training for providing patient and family centred care (PFCC);

Short

Suitable training will be identified.

Governance & Quality

Corporate Services – People and Capability Programme of

Patient Experience Survey

Creating our Culture

Community Nursing

Working on it

Embedding patient and family centred

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3

1.1.2 Incorporate PFCC values and principles into core training for all staff, new and existing.

Long All staff will have completed training

work (Creating our Culture)

TTHW (Te Teo Herenga Waka – combined Planning and Funding teams)

care into the ‘way we do things around here’ demonstrated through:

1.1.2 – Orientation for new staff includes section on what it means to provide patient and family centred care; Education Committee and nurse educators develop ways that we can embedded PFCC into core training for all DHB staff;

CARE Values implementation incorporated into Exec priorities work stream for DHB staff, Creating our Culture programme included ‘in your shoes’ sessions which provided patients and families to give feedback on their experience of healthcare services. Data gathered through these sessions is being collated to inform improvements.

Improvement projects and Bay Navigator include requirement to seek consumer feedback and input e.g. Community Nursing Integration project included patients in design of the model

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4

of care.

System Level Measures Framework includes Patient Experience indicators.

Discussions underway with HSQC on delivering a 7 month co-design course within BOPDHB commencing September 2017.

1.2 1.2.1 Identify and develop training for providing Whānau Ora care.

1.2.2 Incorporate Whānau Ora values and principles into core training for all staff, new and existing.

Short

Long

Suitable training will be identified

All staff will have completed training

BOPALT/NMOPHO

NMO Whānau Ora training package

Te Tumu Whānau Ora Framework

Improving Maori Health- Good to Great

1.2.1 is Complete

A range of cultural training options are identified and provided including Whanau Tu Whanau Ora Training through Nga Mataapuna Oranga PHO and Engaging Effectively with Maori

1.2.1 Working on it

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Participation on the ‘Whānau Tū Whānau Ora’ training continues to increase from 7 in 2014/15 to 46 in 2015/16 to 90 in the current 16/17 period. We incorporate the training into improvement project work, for example, all members of the Whanau Ora Access Pathway working group have undertaken the training.

As one of the 4 Exec priorities ‘Good to Great-Improving Maori Health’ Plans underway to review Maori Cultural training. ‘Engaging Effectively with Maori’ training delivered by Hone Hurihanganui has been resourced and will be delivered to DHB staff commencing April 2017.

A programme manager to oversee

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implementation of the ‘Good to Great-Improving Maori Health’ has been resourced.

1.3 1.3.1 Identify and develop care planning approaches that include patient’s preferences and goals.

1.3.2 Develop policies and protocols that support and embed care planning approaches that include and support patient’s preferences and goals for all

Short

Short

Medium

Care Planning approaches are identified

All providers have policies and protocols in place

All patients care plans record patient’s preferences

Provider Arm

NMOPHO

TTHW

Governance and Quality

Future Care Planning Project

Whānau Ora Pathway project

Whanau Tahi Connected care trial

Patient Experience Survey

System Level Measures

Working on it

A number of care planning approaches are being implemented including:

Future Care Planning : Actions include development of Future Care Plan template, enabling care plans to be uploaded into hospital data bases, staff training, establishment of a project manager role within P & F to further implement FCP within BOP.

Whanau Ora: WO collectives and providers have identified care planning approaches in a WO setting and all

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providers.

1.3.3 Enhance care planning systems to include patients’ preferences.

patients’ care plans record patient, family and whanau goals and preferences.

The Whanau Ora Access Pathway project is underway that aims to improve access, co-ordination and transfer of care for high need Maori between primary and secondary care setting.

Within the Whanau Ora Access Pathway project, a trial of Whanau Tahi Connected Care is underway to test a shared care platform that enables multi-disciplinary teams to share information and actively input to a shared care plan electronically across multiple settings. The test of change is expected to be completed by June 2017 and an evaluation will determine whether to invest in this platform.

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1.4 1.4.1 Explore mechanisms that incentivise and promote PFCC and Whānau Ora care delivery and incorporate these mechanisms into service design and contracting processes.

Medium Mechanisms are identified and incorporated into core service design and contracting processes

TTHW Link to Themes 5 & 6

Links to Whanau Ora Pathway project and will likely be progressed through that work.

1.5 1.5.1 Enhance systems and processes to incorporate the patient’s voice and view into all future service design and development.

Short All service design processes capture the patient’s view

All Bay Navigator pathways have method of capturing the patients view

Service Improvement Unit

TTHW

Bay Navigator

Co-design

Working on it

See above 1.1

1.6 Identify effective components for supporting patients

Long Components are identified and endorsed to inform

BOPALT Whānau Ora Service provision

Not commenced

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and Whānau to take greater responsibility for their health. This action would inform our longer term approach towards health promotion and policy development that prevents people developing long term conditions and promotes self-care. Options such as social marketing, incentives and policy drivers should be explored.

future health education activities, policy development and service design

Theme 2

Theme 7

Likely to be progressed through Whanau Ora service provision.

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Theme 2: Health literacy


2 Actions Expected time frame for completion

Indicator of success Responsibility and partners

Links Progress

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2.1 2.1.1 Undertake an evaluation and gap analysis of the current services in the Bay of Plenty that provide electronic health information to meet the needs of populations and maximise technology.

2.1.2 Implement recommendations from 2.1.1

2.1.3 Establish a leading source of web-based electronic health information for patients, family and Whānau in the Bay

Short

Medium

Long

Evaluation and gap analysis complete.

Recommendations from 2.1.1 implemented

Lead website identified.

BOPALT

Provider Arm (SIU)

Communications Team

Planning and Funding

BOPDHB website

Health Navigator

Toi Te Ora Public Health

Krames

WebHealth

All PHO Websites

Bay Navigator

Completed

A work plan for Health Literacy was developed and agreed with BOPALT. Recognising that not all actions in the IHS can be progressed at the same time due to other priorities and resources, the plan identifies a small number of achievable actions. There is progress being made in all areas but it is recognised that progress is very limited and that improving health literacy demands a continuous improvement process and is not a number of projects that can be completed and then left.

A review and stock-take of Health Literacy initiatives has since been completed (March 2017). It shows the complexity and integrative nature of health literacy improvements and has highlighted the importance of focussed

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of Plenty. efforts in this work stream.

Other progress to date includes:

Increased investment in Health Navigator: This website provides one place for New Zealanders to find reliable and trustworthy health information and self-care resources. It focuses on promoting clear, consistent messages that enable users to get the information they need at the time they need it. Based on the findings in the national business case for DHBs for Health Navigator we have increased our investment in this national website to enable the site to be developed further as a leading source for all New Zealanders. The use of HN is increasing with more than 1million views a year.

The Provider Arm is continuing to progress the Patient Education Resource Centre using Krames Staywell products as a foundation. The evaluation of 12 month trial of Krames has been completed and a number of

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recommendations made. The decision to renew the Krames Staywell licence was supported and will continue use for another 12 months. Work is underway to foster increased usage and further embed the resource into discharge planning. Further work includes analysis of the Patient Experience Survey results with respect to information provided on discharge.

Investigation of options to establish a directory of community health provider information. Health Point is being promoted as a solution and a trial of this platform is being nationally progressed through Mental Health.

2.2 2.2.1 Identify best practice approaches that effectively promote and improve health literacy for different age groups and

Medium

Best practice approaches are identified for different groups and populations.

BOPALT

Provider Arm (SIU)

Communications Team

Planning and Funding

Various projects

Not commenced

We will align with best practice and

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populations.

2.2.2 Development of new health information services and products in the future is undertaken incorporating recommendations from 2.2.1.

Long

All new health information is developed in line with best practice

national developments.

2.3 2.3.1 Establish expected competencies for health literacy for all health care workers.

2.3.2 Create

Short

Long

Competencies identified

BOPALT



Governance and

Working on it

Links with 2.1 above. Recommendations from the Health Literacy review of

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expectations for providers to implement agreed competencies for health literacy for all staff.

All providers have implemented competencies for all new and existing staff

Quality

March 2017 includes identifying suitable training for staff in health literacy and developing competencies.

2.4 Create expectations for all providers to review their processes to ensure a health literacy approach is incorporated in service delivery

Short All providers incorporate health literacy approach to service delivery

TTHW Theme 6

Midland Region Training Network

Working on it

Links with Theme 6 – Contracting for Outcomes.

We have made progressing in shifting our contracting system to be outcomes focussed, starting with Adult Mental Health services. Outcomes expected of providers include patient and family experience on communication and

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patient’s ability to self-manage. In time, it is intended that Outcomes-based agreements with link with System Level Measures framework indicators.

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Theme 3: Access to patient information



Indicator of success Lead /support Links Progress

3.1 3.1.1 Identify systems and protocols for information sharing, identify minimum standards of IT capability desired for all providers and develop appropriate contractual clauses.

Short

Systems and protocols for sharing agreed to.

Contract clauses developed .

BOPALT/BOPIS Group (BOP Information Systems Group)

TTHW

Working on it

Systems and protocols for information sharing have been identified through the work of the BOP Information Systems Group. Significant progress with development and signing of an MOU for data sharing between the DHB

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3.1.2 Include contract clauses in all provider contracts to specify requirements to share information and set a minimum standard of IT capability for all service providers, including appropriate stakeholder engagement processes. (Note: contractual requirements to share to take into account legal obligations).

3.1.3 All providers undertake a review

Medium

Medium

All contracts for all services will contain clauses specifying provider standards and requirements.

All patient enrolment information will reflect rights and obligations

BOPIS

and 3 PHOs providing a platform for future information sharing initiatives. Data governance framework approved and available on Bay Navigator.

Patient information sharing initiatives completed include CHIP, BOP Medcheck.

Significant progress on developing an agreed set of primary care data to be shared with the hospital and other community providers will be made available through the fruition of the Primary Care Data Set project. Expected date of delivery is mid 2017.

Complete

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of patient consent and enrolment information to ensure it reflects providers’ information sharing requirements and is within the provisions of the Privacy Act.

3.1.3 Review of consent and enrolment information has been undertaken through this process. Privacy Impact Assessment is currently being undertaken.

3.2 Investigate options to provide patient access to and the ability to interact with their health record(s). Implement options as part of a district wide roll out of recommendations from pilots.

Medium

Recommended options identified

All patients have access to electronic health records

BOPIS

National Health IT Board

National Health IT Board

National Patient Portal project

Complete

Patient Portals implementation progressing in general practice as part of national implementation project and nation-wide roll out.

Uptake status as at Nov 2016 (data to March 2017 not yet available):

Approximately 10,000 patients total BOP registered users. Implementation programme progressing as part of

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national roll out.

3.3 Develop a set of core clinical information for all patients available electronically to providers. In addition define those providers that have access.

[Investigate enhanced use of Bay Navigator pathway development process as a solution to define core information needs for specified patient groups]

Short Core clinical electronic information defined and agreed.

BOPIS CHIP

BOPMedcheck

Primary Care Data Set

Complete

Actions include:

Business as usual: More than 700 community health care professionals can access patient information stored in hospital records through CHIP.

Business as usual: 100% of pharmacies in BOP signed up to BOP Medcheck to upload pharmacy dispensing information into Éclair.

In progress and on-track: Primary Care Data Set agreed and technical work to build data warehouse will be completed by June 207.

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3.4 Enhance a governance body to advise and inform strategic direction for all IT development for BOP health care providers

[Note: revise Bay Navigator IT GG TOR]

Short Governance Body agreed and TOR established

BOPALT/BOPIS Group

Complete

BOP Information Systems Group established to provide governance and foster safe information sharing initiatives.

3.5

3.5.1 Provide training on the Privacy Act and Health Privacy Code to improve knowledge of rights and obligations of health care workers with respect to protection of privacy

3.5.2 Socialise key

Short

Short and on-going

All staff are aware of the provisions of the Privacy Act and interface with health information

BOPDHB Governance and Quality/BOPIS Group

Privacy Commissioner

BOPDHB Staff Training programmes

Complete

On –line training available through the Privacy Commissioner and promoted with DHB staff and PHOs and NGOs.

Key messages on understanding of sharing patient information are included in DHB and PHO publications and

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messages through media and other mechanisms to increase public’s awareness and understanding of sharing patient information

newsletters and specific project communications e.g. BOPMedCheck.

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Theme 4: Co-ordinated care



Indicator of success Responsibility

Lead /support

Links Progress

4.1

4.1.1 Trial (including evaluation of) sites for extended multi-disciplinary primary health care teams including use of new technologies available.

Medium

Long

Evaluation of trial sites completed

Recommendations for alternative models of general practice are

All PHOs

Provider Arm

Telehealth Project

Working on it

Although various telehealth initiatives were progressed under the Telehealth project during 2014-15, no further funding is

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4.1.2 Review models of general practice and make recommendations for alternative models that will better support integrated healthcare.

developed that better support integrated healthcare.

All front line staff are competent in multi-disciplinary team work

available to continue.

Recommendations for integrated health and social service hubs, extended general practice and multi-disciplinary teams have been picked up under Strategic Health Services Plan.

4.2

4.2.1 Identify appropriate predictive risk assessment tools to identify specified patient groups for co-ordinated care planning implementation in

Short

Mediu

Predictive Risk Assessment Tools are identified in priority population groups.

BOPALT

BOPIS Group

Acute Demand Network

NASC

Children’s Team

Home and Community Support Services Project

Service Level Measures Framework

Children’s Action Plan

Working on it

Three main streams of work:

Use of interRAi data central to new Restorative model of care for Home and

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priority population groups.

4.2.2 Embed use of tools in a range of settings to inform service mix and allocation and maximise efficiencies of resource allocation.

m Predictive risk methodologies underpin all service assessment and allocation

Community Support Services Redesign. New model commenced September 2016 and will be rolled out over the next 3 years.

System Level Measures Framework includes decision on use of predictive risk tool. BOPIS Group is progressing the technical work to support this. Action is supported by research undertaken by summer student to Planning and funding during 2015 identified predictive risk tools and methodologies used in NZ to identify high risk/high need patients. Acute Demand Management Network to progress practical application of this work in 2017.

Children’s Team using standardised assessment tools to identify vulnerable children and eligibility for co-ordinated, multi-agency approach.

4.3

4.3.1 Develop processes and practices which identify clinical co-ordinators for adults

Short

All care plans identify a clinical care co-ordinator

BOPALT/Community Nursing Integration SLAT

Provider Arm

Community Nursing Integration Project

Not commenced

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with complex health needs that cross specialties.

(Note: Potential for this to be built into Bay Navigator pathway development)

4.3.2 Identify support requirements and review practices and protocols to enhance multidisciplinary team work across environments e.g. including hospital based care teams and community based care teams. This could include promoting use of new technologies

Medium

Reduced re-admission rates

Improved transitions e.g. hospital discharges

Improved access to specialist advice

Likely to be picked up under Francis Group work within the Provider Arm.

Community Nursing Integration Project encompasses elements of these actions.

4.3.2 – See comments under 4.1

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such as telemedicine.

4.4

Support patients to identify their own key coordinator or navigator of care to co-ordinate services among multiple providers of care including social and support services.

Short All care plans identify a lead navigator

NMOPHO Whānau Ora

SupportNet

Children’s Team

Working on it

Whanau Ora – encompassed within Whanau Ora Service delivery model is a Whanau Ora navigator whose role it is to co-ordinate services among multiple providers of care including health and social support services.

See also under Action 1.3 above.

4.5

Review standardised service responses to requests for referral to ensure all responses advance a patients care.

Medium

All service responses are reviewed

Provider Arm Health Literacy work

Not commenced

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Likely this will be progressed as part of a suite of activity to improve e-referrals and discharge planning.

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Theme 5: Creating an environment for integration




Lead/Support

Links Progress

5.1 5.1.1 The Partners will work together to explore options and approaches to education and training that promotes integration, healthcare improvement and innovation across the Bay of Plenty workforce.

Medium

Whole-of-system approach developed

BOPALT/Provider Arm


BOPDHB Clinical School

BOPDHB Clinical School and Education Centre;

Ko Awatea

IHI Open School

Working on it

General awareness is increasing about the approach to quality improvement programmes promoted internationally by the Institute for Healthcare Improvement (IHI). Adopting a Triple Aim approach to healthcare improvement, IHI is

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5.1.2 Explore development of strategic partnerships with leading healthcare improvement organisations (local, nationally and/or internationally) to support Action 5.1.1

Short transforming health care around the world.

BOPDHB has adopted the IHI Model for Improvement methodology and is promoting staff to undertake training through IHIs online training programmes, Open School. Training is available to PHOs and General Practice.

By February 2017, the number of people who have commenced the training has increased to 352.

BOPDHB is trailing the LifeQI platform, a collaboration platform for people working to improve health and social care. It allows people across the system to share improvement projects and methodology.

5.1.2. Executive has signalled intent to explore collaboration with Ko Awatea in 2017.

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5.2 5.2.1 Review local and regional workforce training and education strategies to identify training requirements needed to embody the vision and principles of integrated healthcare and to inform Action 5.1.1.

Short Review completed and recommendations considered.


BOPALT

Corporate Services – People and Capability.

Education Centre

Exec Priorities – CARE Values, Creating our Culture.

Community Nursing Integration Project

Working on it

Project activity:

Community Nursing Integration Project has a work stream on workforce practices to implement the integrated model of care.

Within the DHB workforce a major programme of work is underway within the Creating our Culture programme to embed our CARE values and create an engaged workforce ready to lead and embody values based service delivery.

5.3 5.3.1 Develop clinical leadership required to engage staff in the vision and principles of integrated healthcare and support the change

Short and ongoing

Clinical leads are identified, supported and trained.

Change management



Midland Advanced Leadership Programme

Working on it

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management required.

5.3.2 Provide resources, training to support the change management process required to implement actions identified in this Strategy

Short and ongoing

is undertaken and able to be demonstrated

All PHOS

PHO CME and CNE programmes

IHI Open School

Clinical staff are prioritised for inclusion in the Midland Advanced leadership programme.

The Leadership in Practice programme will be offered to community providers in 2017. The programme includes a model on Change Leadership and is tailored to suit our local strategic priorities.

Links also to Action 5.1 above re Model for Improvement methodology.

In 2015 a cohort of 4 staff, 3 of whom are clinical staff and one member of the Planning and Funding team, completed the Waikato Management School L3 leadership programme. The L3 programme adopts an Action Learning approach where participants work on a project that benefits the organisation. The Capstone Project contributed to progressing Theme 6 of the Integrated Healthcare Strategy, Contracting for Outcomes and Flexibility of Funding, with a focus on developing an outcomes

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framework and performance incentives for providers.

5.4 Explore levers available through human resource and recruitment policies and protocols to incentivise staff to embody the vision and principles of integrated healthcare e.g. create Key Performance Indicators that reflect progress towards achievement of actions identified in the Integrated Healthcare Strategy.

Short Recruitment and human resource policies are reviewed and recommendations considered and implemented where appropriate.

BOPDHB

BOPALT

Corporate Services

TTHW

Working on it

All Planning and Funding staff have KPIs that reflect the IHS.

The People and Capability functions of the DHB have been reviewed with a new structure in place. A People and Capability manager has been recruited. Priorities identified for improvement include performance appraisals and KPI processes for all staff including nursing and medical. This work is linked to the CARE Values and improvement capability work streams. Expected that this action will be progressed under this work stream.

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5.5 5.5.1 Identify components (e.g. processes, protocols, mechanisms and organisational structures) to enhance inter-sector and intra-sector alliances and partnerships to provide joined-up care for specified patient groups (e.g. medically and socially complex).

5.5.2 Provide support (e.g. facilitate sharing of current resources) and/or develop resources for providers to encourage development of alliances and partnerships such as

Short

Medium

Short

Components are identified and barriers reduced e.g. standard referral protocols; shared goals across services and agencies

Increased number of alliances and partnerships are in place

Contracted outcome measures include the outcome of the

BOPDHB

All PHOs

Children’s Team

CYSA

Children’s Action Plan

Whanau Ora services

Complete

A number of activities have been completed or are underway to progress these actions to promote inter-sector alliances including:

The BOP Child and Youth Strategic Alliance (CYSA) now includes membership from the Ministries of Education and Social Development. The objectives of CYSA include sharing accountabilities for implementing the BOP Child and Youth Health and Wellbeing Strategy.

Children’s Team is an inter-sectorial initiative in the Eastern BOP provides joined-up care for vulnerable children. Results and outcomes are reported through Children’s Team. Processes and protocols have been documented.

Local Authorities – BOPDHB has

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opportunities for networking and relationship development; Tool kits, policies and protocols, templated forms, instructions and guidelines.

5.5.3 Identify mechanisms that incentivise collaboration and create expectations for providers to formally collaborate.

collaboration/alliance e.g. reduced admissions to hospital

prioritised collaboration with local authorities through the Health in all Policies workstream. See under theme 7.

Complete

A suite tools and templates to support cross-sector collaboration has been developed by Planning and Funding and is available on our Docman site.

Working on it

Linked to Contracting for Outcomes work-stream. See under theme 6.

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5.6 5.6.1 Develop a communications plan to promote integrated healthcare.

5.6.2 Identify and promote a common language, based on international best practice, which supports the communications plan.

Short

Short

Communications Plan developed

Common language identified

BOPDHB Communications Team/TTHW

Complete

A communications plan was developed but not progressed in its entirety due to funding constraints.

Our pictorial image of integrated care has been promoted in several publications including the cover of the published version of the HIS, the 2015/16 Annual Plan, Community Nursing Integrated Model of Care Report, various posters, presentations and on the intranet. It’s become a way of sharing our vision for what integrated care means to us in the BOP.

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5.7 Undertake a stock take and review of existing committees, governance and advisory groups (excluding those that are required by legislation), to determine optimum structures to:

• support progression of the governments’ priorities and local priorities and initiatives;

• clarify roles and functions;

• reduce duplication and streamline accountabilities

Short Review completed and recommendations agreed.

BOPDHB Planning and Funding/ Governance and Quality

Complete

Planning and Funding have undertaken a review of existing governance, implementation and advisory groups, at this stage, limited in scope to progressing implementation of the Integrated Healthcare Strategy , and in the context of the BOP Alliance Leadership Team.

As a result, changes have been made to existing structures and some new ones have been developed for example, BOPALT has appointed Service Level Alliance Teams to progress and implement whole of system projects. Current SLATs that report through to BOPALT are the BOP Information Systems Group, Community Nursing SLAT, Community Pharmacy SLAT, and the Rural SLAT.

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. The Child and Youth Strategic Alliance underwent a review of its form and function in 2015 and has a stronger focus on implementation of the Child and Youth Wellbeing Strategy.

Governance and Quality are leading a broader review of all committees and governance groups within the DHB which will also feed into this work.

A System Level Measures Plan has been approved by BOPALT, with a review for 2017/18 underway. The SLMP progresses integrated care and demonstrates the need to have a good structure to progress improvements and results.

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Theme 6: Contracting for Outcomes and flexibility of funding




Lead/support

Links Progress

6.1 6.1.1 Redefine the role and function of the hospital based services and community based services.

1.1.2 Review purchasing and contracting

Short

Short

Every Bay Navigator pathway aligns with the Bay Navigator Framework

Strategies and policies promote and enable integrated healthcare

Provider Arm/ Bay Navigator

TTHW

Frances Group

Contracting for Outcomes work stream

Working on it

6.1.1 The provider arm is undertaking a major initiative with the Frances Group to improve acute flow in the hospital which will lead to a reframing of core hospital

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mechanisms and strategies to remove barriers and ensure alignment with principles of integrated healthcare.

1.1.3 Explore alternatives to the price volume method of purchasing services.

Short

Alternatives are identified

Pilot services are identified and agreed

TTHW/Provider Arm

functions. Further activity will be picked up under the Strategic Health Services Planning implementation.

6.1.2 See further under 6.2 below.

6.1.3 – Being progressed under Contracting for Outcomes work stream

6.2 6.2.1 Develop an outcomes framework and measures for contracts that is aligned with the

Medium

Framework developed

BOPDHB/BOPALT/TTHW MBIE Streamlined Contracting

System Level Measures

Working on it

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Triple Aim.

This work should include developing a set of core outcomes for all contracts including requirements to reduce inequalities.

6.2.2 Review all contracts to align with outcomes framework

Medium All contracts will be aligned

Framework The Ministry of Business, Innovation and Employment, as part of a cross government initiative to streamline contracting for the NGO sector, has implemented a new process for contracting across the major government departments including Social Development, ACC, Corrections, Justice and Health. The new system is based on Outcomes and uses Results Based Accountability Framework to develop Outcomes Agreements. BOPDHB trialled the new process during 2016 as the first DHB in NZ in Phase 1 of IHS Contracting for Outcomes project.

Phase 2 of the Project is aimed at system-wide roll out over the next 2 years commencing November 2016 through to June 2018.

The price volume schedule is out of scope for Phase 2 and will be completed in phase 3.

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6.3 6.3.1 Integrated performance measures across community and hospital based care

Medium Health target achievement is integrated across hospital care and community care

Performance measures are aligned.

BOPALT System Level Measures Framework

Complete

The Ministry of Health’s System Level Measures Framework has been developed which integrates performance measures and health target achievement across community and hospital based care. A suite of indicators and local contributory measures have been developed in 2016 as a collaborative process involving clinicians from across the system. The System Level Measures Plan for BOPDHB has been approved by the Ministry of Health.

Work is underway to develop a suite of indicators and measures to monitor the performance and outcomes for the wider health and well-being of the Community. BOPDHB is collaborating with SmartGrowth to develop a Scorecard.

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6.4 6.4.1 Undertake stocktake of contracts to ensure alignment of services and maximising available resource, and opportunities to collaborate.

Short Stocktake completed

All Bay Navigator pathways identify relevant providers

TTHW Bay Navigator

MOH DSS contracts


Working on it

This action is incorporated into the Contracting for Outcomes work stream

Planning and Funding are incorporating systems to reduce duplication and seek alignment of contracts and services into business as usual. Mental health and addictions are continuing with their programme to consolidate and combine contracts and services to reduce duplication and strengthen capacity across providers.

6.5 Collaborate with other key funders to undertake funding and asset mapping to determine collective investment in

Long Asset mapping completed

Increased number of Integrated Contracts

TTHW MBIE

Completed

This action is now picked up under the national work through the MBIE

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defined geographical areas.

Advance integrated contracts across multiple sectors.

Streamlined Contracting for NGOs project as part of the cross-government work.

A register of contracts has been developed by MBIE. All outcomes agreements are lodged in the register. Funders can view providers and identify where there are joint providers.

BOPDHB is in the process of becoming a registered user with MBIE to be able to upload and view provider contracts.

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Theme 7: Health in all policies



Indicator of success

Responsibility

Lead/ Support

Links Progress

7.1 Advocate and promote the key messages of the NZMA Position Statement on ‘Health Equity’ and the Helsinki Statement of ‘Health in all Policies’

Assist other sectors in developing

Short Increased awareness and overt promotion of the key messages

BOPDHB/Toi Te Ora Public Health

SmartGrowth

Eastern Bay-Beyond Today

Healthy Policies Team, Toi Te Ora-Public Health

Working on it

A Health in All Policies Work plan has been agreed and prioritized by the Board and a team established to lead implementation.

Toi Te Ora and BOPDHB promoting key messages through a number of streams including SmartGrowth Strategy actions,

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mechanisms to assess health impacts of their policies (e.g. Health Impact Assessment and/or Health Equity Assessment Tool).

Maori Health Plan implementation, Child and Youth Strategic Alliance, and the Population Ageing Technical Advisory Group. There have been a number of engagement opportunities that have taken place with Councils over the last 12 months that have provided opportunities to advocate key messages.

A health impact assessment was completed on the Eastern Bay-Beyond Today spatial Plan. We are currently progressing further opportunities to undertake Health Impact Assessments with BOP Regional Council.

7.2 Participate at governance level in cross sector partnerships and alliances to formalise collaborative action to align activity to address social

Medium

Cross sector partnerships are formalised with agreed goals.

Outcome measures

BOPDHB Board

TTHW

Toi Te Ora-Public Health

Various initiatives including:

Healthy Homes

Children’s Team

SmartGrowth Strategy

Working on it

See also narrative under actions 5.5 and 6.5 above.

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determinants of health that have the most impact on the Bay of Plenty population.

Develop outcome measures that capture the effectiveness and benefits of cross sector collaboration.

Medium developed and agreed.

Implementation

Eastern Bay-Beyond Today

Whanau Ora Service delivery

Progress in developing cross-sector partnership with local government through SmartGrowth.

Governance to Governance engagement plan developed and approved by BOPDHB Board.

Health in All Policies work plan approved and team established to lead implementation.

Health Impact Assessment work underway. Completed HIA undertaken to date are the Western BOP Public Transport Blueprint and the Eastern Bay of Plenty spatial plan – Beyond Today.

We are working with SmartGrowth on scorecard measures that assess the impact and effectiveness of the SmartGrowth Partnership. A broader suite of measures to assess community well-being is underway for the Western BOP.

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7.3 Explore levers (e.g. contractual, HR policies, education strategies) to incentivise contracted providers to incorporate policies that seek to address broader determinants of health into all health service delivery.

Medium Levers are identified and supported and incorporated into contracts where applicable

BOPDHB/TTHW, Corporate Services, TTO

Not commenced

Links with 7.5 below.

7.4 Support contracted providers to develop policies that address the social determinants of health in all service delivery.

Medium All contracted providers have policies developed

TTHW

Working on it

Community Nursing Integration Project identified as first test of change to include a public health approach to service delivery.

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7.5 Develop competencies and educational goals for all health care workers to incorporate training that considers the impacts of the social determinants of health, where they are not currently developed.

Medium Competencies are identified and incorporated into core training requirements.

BOPDHB Clinical School/Toi Te Ora Public Health

Not commenced

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Correspondence for Noting

SUBMITTED TO: Board Meeting: 19 July 2017 Submitted by: Sally Webb, Board Chair RECOMMENDED RESOLUTION: That the Board note the correspondence ATTACHMENTS: Letter from Whakatane District Council re Acknowledgment of Contribution to Emergency Response dated 6 July 2017

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agenda bay of plenty district health board€¦ · bay of plenty district health board agenda item...

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