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Capital & Coast District Health Board

CAPITAL & COAST DISTRICT HEALTH BOARD

Public Agenda21 FEBRUARY 2018

11th Floor Board Room, Grace Neill Block, Wellington Regional Hospital, Riddiford Street, Wellington, 1pm.

ITEM ACTION PRESENTER MIN TIME PG

1 PROCEDURAL BUSINESS 10 1pm

1.1 Karakia

1.2 Apologies Record A Blair

1.3 Continuous Disclosure

- Interest Register

- Conflicts of InterestConfirm

Accept

A Blair

A Blair3

6

1.4 Confirmation of Draft Minutes 20 December2017

Approve A Blair 8

1.5 Matters Arising Note A Blair

1.6 Action List Note A Blair 13

1.7 CCDHB Work Plan 2018 Note A Blair 15

1.8 Chair’s Report

1.8.1 Chair’s CorrespondenceNote A Blair 10

17

1.9 Chief Executive’s Report

1.9.1 Financial Summary, December 2017

Note A Bloomfield 10 49

56

2 PRESENTATIONS

2.1 Sub Regional Disability Strategy Action Plan Note R Haggerty 10 64

2.2 Sub Regional Pacific Strategic Health Advisory Group

2.2.1 Patient story

Note T Fagaloa 15

3 DECISION3.1 Birthing Facilities and Models of Care Endorse R Haggerty 5 69

3.2 Recommendations from CPHAC

3.2.1 Draft letter to Minister of Health

3.2.2 Creating our CPHAC – HAC presentation

3.2.3 ELT Allocation of Functions to CPHAC HAC and FAC

Endorse R Haggerty 5 73

75

78

89

4 DISCUSSION4.1 Health and Safety Report Note T Davis 10 90

4.2 Bi-monthly Hospital and Health Services Update

Note C Lowry 10 97

4.3 Bi-monthly SIP Report Note R Haggerty 10 104

5 FOR INFORMATION5.1 Even Better Health Care Plan Update Note R Haggerty 10 115

6 OTHER

CCDHB Public 21 February 2018 - AGENDA

1

Capital & Coast District Health Board of 2

6.1 General Business Note A Blair 5

6.2 Resolution to Exclude the Public Approve A Blair 5 120

DATE OF NEXT MEETING 28 MARCH 2018 – BOARDROOM, LEVEL 11, GRACE NEILL BLOCK, WELLINGTON REGIONAL HOSPITAL

APPENDIX

1.9.2 Health Matters 121

CCDHB Public 21 February 2018 - AGENDA

2

Capital & Coast District Health Board 20 DECEMBER 2017


Interest Register

21 FEBRUARY 2018

Name Interest

Mr Andrew BlairChairperson

∑ Chair, Hutt Valley District Health Board (from 5 December 2016)∑ Advisor to the Board, Forte Health Limited, Christchurch∑ Owner and Director of Andrew Blair Consulting Limited, a Company which from

time to time provides governance and advisory services to various businesses and organisations, include those in the health sector

∑ Former Member of the Hawkes Bay District Health Board (2013-2016)∑ Former Chair, Cancer Control (2014-2015)∑ Former CEO Acurity Health Group Limited

Dame Fran WildeDeputy Chairperson

∑ Ambassador Cancer Society Hope Fellowship∑ Chief Crown Negotiator Ngati Mutunga and Moriori Treaty of Waitangi Claims∑ Chair, Remuneration Authority∑ Chair Wellington Lifelines Group∑ Chair National Military Heritage Trust∑ Deputy Chair, Capital & Coast District Health Board∑ Deputy Chair NZ Transport Agency∑ Director Museum of NZ Te Papa Tongarewa∑ Director Frequency Projects Ltd∑ Member Whitireia-Weltec Council

Mr Roger JarroldMember

∑ Member, Capital & Coast District Health Board∑ Chair, Capital & Coast DHB FRAC committee∑ Trustee, Auckland District Health Board Charitable Trust∑ Member, Finance and Risk Committee, Health Research Council∑ Past member, Ministry of Health Audit and Risk Committee (resigned 6

December 2013)∑ Requested to undertake some work at ADHB regarding cost management∑ CFO Fletcher Construction Division of Fletcher Building∑ Former employee of Downers Construction

Mr Darrin SykesMember

∑ Member, Capital & Coast District Health Board∑ Deputy Chair, Capital & Coast District Health Board, FRAC committee∑ Trustee, Wellington Regional; Sports Education Trust (trading as Sports

Wellington)∑ Member, Sport and Recreation New Zealand (trading as Sport NZ)∑ Chief Executive, Crown Forestry Rental Trust

Ms Sue KedgleyMember

∑ Member, Capital & Coast District Health Board∑ Member, CCDHB CPHAC/DSAC committee∑ Member, Greater Wellington Regional Council∑ Member, Consumer New Zealand Board∑ Deputy Chair, Consumer New Zealand∑ Environment spokesperson and Chair of Environment committee, Wellington

CCDHB Public 21 February 2018 - 1.3 Continuous Disclosure

3


Name Interest

Regional Council∑ Step son works in middle management of Fletcher Steel∑ Holds shares in Fisher and Paykel Healthcare

Dr Roger BlakeleyMember

∑ Member of Capital and Coast District Health Board∑ Deputy Chair, Wellington Regional Strategy Committee∑ Councillor, Greater Wellington Regional Council∑ Director, Port Investments Ltd∑ Director, Greater Wellington Rail Ltd∑ Economic Development and Infrastructure Portfolio Lead, Greater Wellington

Regional Council∑ Member, Harkness Fellowships Trust Board∑ Independent Consultant∑ Brother-in-law is a medical doctor (anaesthetist), and niece is a medical doctor,

both working in the health sector in Auckland∑ Son is Deputy Chief Executive (insights and Investment) of Ministry of Social

Development, Wellington∑ Invited to join the Board of the Wesley Community Action Group.

Ms Kim NgarimuMember

∑ Member of Capital and Coast District Health Board∑ Member, Medical Council of New Zealand (MCNZ)∑ Member, Māori Heritage Council∑ Board Member, Te Māngai Pāhō (Māori Broadcasting Agency)∑ Board Member Eastern Institute of Technology∑ Board Member Heritage New Zealand∑ Alternate Crown Trustee, Crown Forestry Rental Trust∑ Director, Taaua Ltd (Public policy and management consulting company)∑ Trustee, Judith and Taina Ngarimu Whānau Trust (has shareholdings in various

health related companies – share acquisition and sale is independently managed)

Ms ‘Ana CoffeyMember

∑ Member of Capital & Coast District Health Board∑ Councillor, Porirua City Council∑ Director, Dunstan Lake District Limited∑ Trustee, Whitireia Foundation∑ Brother is Team Coach for Pathways and Real Youth Counties Manukau District

Health Board∑ Father is Acting Director in the Office for Disability Issues, Ministry of Social

DevelopmentMs Eileen BrownMember

∑ Member of Capital & Coast District Health Board∑ Board member (until Feb. 2017), Newtown Union Health Service Board∑ Employee of New Zealand Council of Trade Unions∑ Senior Policy Analyst at the Council of Trade Unions (CTU). CTU affiliated

members include NZNO, PSA, E tū, ASMS, MERAS and First Union∑ Executive Committee Member of Healthcare Aotearoa.


4


Name Interest

Dr Kathryn AdamsMember

∑ Member, Capital & Coast District Health Board∑ Fellow, College of Nurses Aotearoa (NZ)∑ Reviewer, Editorial Board, Nursing Praxis in New Zealand∑ School Nurse Vaccinator (casual) Regional Public Health, HVDHB∑ Workplace Health Assessments and seasonal influenza vaccinator, Artemis

Health∑ Secretary, National Party Ohariu Electorate∑ Director, Agree Holdings Ltd, family owned small engineering business,

TokoroaMs Sue DriverMember

∑ Community representative, Australian and NZ College of Anaesthetists∑ Board Member of Kaibosh∑ Daughter, Policy Advisor, College of Physicians∑ Former Chair, Robinson Seismic (Base isolators, Wgtn Hospital)∑ Advisor to various NGOs


5

21 February 2018


Interest Register

EXECUTIVE LEADERSHIP TEAM21 FEBRUARY 2018

Ashley BloomfieldInterim Chief Executive Officer

∑ Trustee, AR and EL Bloomfield Trusts

∑ Fellow, NZ College of Public Health Medicine

∑ Board Member, Action on Smoking and Health (ASH) NZ Member

∑ Member, NZ College of Public Health Medicine Finance and Risk Committee

∑ Chair, HQSC Strategic Infection Prevention and Control Advisory Group

∑ Lead CE, NZ Improvement and Innovation Network being established by DHBs

∑ Healthy Families Lower Hutt Leadership Group member

Chris LowryGeneral Manager Hospital and Healthcare Services

∑ Trustee on Life Flight Trust Board

Rachel HaggertyGeneral Manager, Strategy Innovation & Performance

∑ Chair, Takanini Care Ltd

∑ Director, Haggerty & Associates

∑ Partner is an employee of CCDHB

Donna HickeyGeneral Manager, People and Capability

∑ Sister is a nurse, working for Plunket

Thomas DavisGeneral Manager, Corporate Services

∑ None

Nigel FairleyGeneral Manager of 3DHB Mental Health, Addictions and Intellectual Disability Services

∑ President, Australian and NZ Association of Psychiatry, Psychology and Law

∑ Trustee, Porirua Hospital Museum

∑ Fellow, NZ College of Clinical Psychologists

∑ Director and shareholder, Gerney Limited

Mr John TaitChief Medical Officer

∑ Vice President RANZCOG

∑ Chair, National Maternity Monitoring Group

∑ Co-Chair Maternity Morbidity Working Group

∑ Member, ACC taskforce neonatal encephalopathy

∑ Member, Waikato Women’s service taskforce

∑ Board member, Wellington Hospitals Foundation

∑ Board member Asia Oceanic Federation of Obstetrician and Gynaecology


6

Catherine EppsExecutive Director of Allied Health, Technical & Scientific

∑ Deputy Chair, National DHB Directors Allied Health

∑ Expert Advisor (Leadership) to New Zealand Speech-Language Therapists’ Association

∑ Brother is an ENT surgeon at Waikato and Waitemata DHBs

∑ Partner is contractor for the new Children’s Hospital, CCDHB

Andrea McCanceExecutive Director of Nursing & Midwifery

∑ Deputy Chair, Board of Trustees, Mary Potter Hospice

Roger PalairetChief Legal Counsel

∑ Chair and Trustee of Carers NZ (non-profit organisation promoting the interests of family carers; funders include MoH, MSD and Waitemata DHB)

∑ Sister-in-law is a paediatric nurse at CCDHB

Shayne HunterChief Information Officer Technology, 3 DHB

∑ Currently in transition from a role at the Ministry of Health and assisting Rillstone Wells on the RHIP/CRISP review

Dr Pauline BoylesDirector of Disability Strategy and Performance

∑ Member on the Ministry of Health National Advisory Group for Review of Behaviour Support Services

∑ Managing Director, Dream Achievers Ltd

∑ Past President/ Advisor to Board, Wellington Riding for the Disabled

Arawhetu GreyDirector Māori Health Services/Manager Planning & Funding Mental Health and Addiction Services

∑ Co-chair, Health Quality Safety Commission – Maternal Morbidity Working Group

∑ Director, Gray Partners

Taima FagaloaDirector of Pacific Peoples’ Health/Manager Planning & Funding, Child & Population

∑ Sister is a Registered Nurse for 3DHB MHAIDS

Jannel FisherCommunications Manager

∑ Mother-in-law and sister-in-law are a Bureau nurse and Healthcare assistant respectively

∑ Another sister-in-law is a nurse at CCDHB

Michael McCarthyChief Financial Officer

∑ Director/Trustee Prime Site Properties Ltd

∑ Consultant to Ahuriri Health Trust

∑ Consultant to TAS

∑ Business relationship with Teresa Wall/Lady Rei (Chair of CCDHB MPB) in primary care consulting

∑ Daughter works in cervical screening programme

Robyn FitzgeraldBoard Secretary

∑ Daughter is a nurse at HVDHB


7

1CCDHB Minutes – 20 December 2017

CAPITAL AND COAST DISTRICT HEALTH BOARDDRAFT Minutes of the Board

Held on Wednesday 20 December 2017 at 11.30amBoardroom, Level 11, Grace Neill Block, Wellington Regional Hospital

PUBLIC SECTION

PRESENT: Mr A Blair (Chair)BOARD Dame F Wilde (Deputy Chair)

Dr K AdamsMs E BrownDr R BlakeleyMr R JarroldMr D SykesMrs S DriverMs K NgarimuMs S Kedgley

STAFF: Mrs D Chin (Chief Executive)Ms C Epps (Executive Director, Allied Health, Technical and Scientific)Mrs R Fitzgerald (Board Secretary)Mr T Davis (General Manager, Corporate ServicesMs R Haggerty (Director, Strategy Innovation and Performance)Mr N Fairley (General Manager, 3DHB MHAIDS)Mr M McCarthy (Chief Financial Officer)Ms J Fisher (Communications Manager)Dr A Bloomfield (CEO HVDHB)

GENERAL PUBLIC: One member of the general public was in attendance.____________________________________________________________________________

1 PROCEDURAL BUSINESS

1.1 PROCEDURALKarakia was led by Darrin Sykes. Chair, Andrew Blair, welcomed the general public, Board members and the Executive team. Dr Ashley Bloomfield was welcomed and introduced as the Acting Chief Executive of CCDHB from January 2018.

1.2 APOLOGIESApologies were received from ‘Ana Coffey.

1.3 INTERESTS

1.3.1 REGISTER OF INTERESTSChanges were registered by Eileen Brown, Andrew Blair and Roger Jarrold.

CONFLICTS RELATED TO ITEMS ON THE AGENDANo other conflicts were foreshadowed in respect of items on the current agenda but there would be an additional opportunity at the beginning of each item for members to declare conflicts of interest.

Action:1. Board Secretary to update Interest Register.

CCDHB Public 21 February 2018 - Item 1.4 Draft Confirmation of Minutes 20 December 2017

8


1.4 MINUTES OF PREVIOUS MEETING 22 NOVEMBER 2017 RESOLVED THAT:The minutes of the CCDHB Board meeting held on 22 November 2017, taken with the public present are confirmed as a true and correct record.

Moved: Roger Jarrold Seconded: Fran Wilde CARRIED

1.5 MATTERS ARISING UPDATENil.

1.6 ACTION LISTThe reporting timeframes on the other open action items were noted.

Actions:2. P0026 to be deferred to February 2018.3. P0027 to be discussed by the Board at the 24 January workshop.4. Board members to email Chair generic issues that will be discussed at 24 January

workshop.

1.7 CCDHB WORK PLAN 2017Changes noted.

Action:5. Board Secretary to place CCDHB 2018 work plan and schedule into Resource Centre

on Diligent Board Books.

1.8 CHAIR’S REPORTThe Chair’s correspondence report was taken as read.

In addition to the correspondence listed, an email was received from the Parliamentary Health Select Committee informing CCDHB/HVDHB that a joint hearing will be held in 2018 where the answers to questions sent by the Health Select Committee will be heard.

The verbal report was received.

Action:6. Board Secretary to request a copy of the 2018 TAS work plan.

1.9 CEO’S REPORTThe paper was taken as read.

The Board:

(a) Noted the contents of the CEO’s report(b) Noted the February Financial summary and that CCDHB are on budget.

Action:7. Director of Allied Health, Technical and Scientific to bring more information on acute flow

measures to the next Board meeting in February.

Roger Jarrold left the room at 12.15pm.


9


2 FOR DISCUSSION

2.1 HEALTH AND SAFETY MONTHLY REPORTThe paper was taken as read.

The Board:

(a) Noted the number of reported health and safety incidents has decreased slightly this month(b) Noted that there were no reported Notifiable Events this month, continuing a 13 month

trend(c) Noted the number of incidents resulting in lost time injuries has declined slightly for General

incidents and MHAIDS (d) Noted the current health and safety risks.

Action:

8. Management to come back to the Board with details on bullying and physical attacks on and/or by staff.

2.2 3DHB MHAIDS BI-MONTHLY UPDATEThe paper was taken as read.

The Board:

(a) Noted there is a new application developed for Young people in Crisis

(b) Noted the Advisory Group for MHAIDS have now finished and updated is provided

(c) Noted the Balanced Score card update – highlights for Te Whare Ahuru

(d) Noted the appointment of a Director of Area Addictions Services for Substance Abuse Compulsory Assessment and Treatment Act (SACAT).

2.3 MINISTRY OF HEALTH QUARTERLY PERFORMANCE MONITORING REPORTSThe paper was taken as read.

The Board:

(a) Noted the performance of CCDHB in the quarter one report against the seven priority health targets with four achieved, two partially achieved and one not achieved (Shorter Stays in Emergency Departments)

(b) Noted that CCDHB achieved the Better Help for Smokers to Quit (Maternity), Improved Access to Electives and Faster Cancer Treatment targets, and the Better Help for Smokers to Quit (Primary) target

(c) Endorsed the revised action plans for CCDHB to achieve the remaining three priority health targets

(d) Noted that of the remaining 39 non-financial performance indicators reported against in quarter one 26 were achieved, 12 were partially achieved and 1 was not achieved (Better Help for Smokers to Quit (Hospital)) target.

Moved: Roger Jarrold Seconded: Sue Kedgley CARRIED


10


2.4 EVEN BETTER HEALTH CARE (SUSTAINABILITY) PLAN UPDATEThe paper was taken as read.

The Board:

(a) Noted the progress with establishing the Even Better Health Care Plan.

2.5 2016/17 AUDIT NZ FINAL MANAGEMENT REPORTThe paper was taken as read.

The Board:

(a) Noted the audit matters raised in the Audit New Zealand (ANZ) final management report

3 FOR INFORMATION

3.1 HEALTH AND ADVISORY COMMITTEE (CPHAC)The Board noted the verbal report and minutes.

Action:

9. CPHAC to discuss in committee about what action needs to occur to engage with Government on public health issues such as healthy eating and housing. Paper to be distributed to Central Regional meetings and report back to Board.

3.2 PUBLIC HEALTH UPDATEThe paper was taken as read.

The Board:

Roger Jarrold returned to the meeting at 1.10pm.

LATE PAPER 1.10 CLINICAL COUNCIL REPORTThe paper was taken as read.

The Board:

(a) Noted the contents of the update by the Clinical Council(b) Noted the discussions and support given by the Clinical Council to the Children’s Hospital

Project, the Replacement of integrated pulmonary function and cardiopulmonary exercise system and the Integrated oncology management system.

The report was received.

(a) Noted that CCDHB is working to collaborate more effectively with Regional Public Health to achieve common outcomes and, where appropriate, combine resources

(b) Noted the integration of RPH activity with the localities approach and the development of Community Health Networks.


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4 OTHER

4.1 GENERAL BUSINESS

4.2 RESOLUTION TO EXCLUDE THE PUBLIC

The Board NOTED and RESOLVED to:

(a) AGREE that as provided by Clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons:

SUBJECT REASON REFERENCE

Public Excluded Minutes For the reasons set out in the respective public excluded papers

Public Excluded Matters Arising from previous Public Excluded meeting

For the reasons set out in respective public excluded papers

Chair’s report

CEO’s reportFRAC Recommendations

Children’s Hospital Update

Clot Retrieval

Business Intelligence and Analytics – Even Better Health Care

CCDHB ICT Update

Transport and Car Parking Building

Papers contain information and advice that is likely to prejudice or disadvantage commercial activities and/or disadvantage negotiations

9(2)(b)(i)(j)

Litigation and Legal Risk Update Maintain legal professional privilege 9(2)(h)

Moved: Andrew Blair Seconded: Roger Blakeley CARRIED

The meeting closed at 1.20pm.

6 DATE OF NEXT MEETING

21 February 2018, 1pm, Level 11 Board Room, Grace Neill Block, Wellington Regional Hospital.

CONFIRMED that these minutes constitute a true and correct record of the proceedings of the meeting

DATED this ................................................day of...............................................2017

Andrew BlairCCDHB BOARD CHAIR


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Meeting Type: BOARD PUBLIC

SCHEDULE OF ACTION POINTS – FEBRUARY 2018 PUBLIC MEETING

Action No

Date of meeting

Agenda item

number

Topic Action Designated to How dealt with

Delivery date

P0035 20 December

3.1 Community and Public HealthAdvisory Committee (CPHAC)

CPHAC committee to discuss what action needs to occur to engage with Government on public health issues such as healthy eating and housing and report back to Board.

Chair CPHAC Discussion March 2018

P0034 20 December

2.1 Health and Safety Monthly Report

Provide further details on bullying and physical attacks on and/or by staff and how these are being addressed.

Management Paper February 2018

P0033 20 December

1.9 CEO’s Report Provide more information on the acute flow measures and actions underway to improve performance.

Ex Dir AHTS Paragraph Defer to CPHAC-HAC

meetingP0030 20

December1.6 Actions Board members to email generic issues that would be

discussed at 24 January workshop.Board members

Email January 2018

P0026 22 November

2.1 Health and Safety Monthly Report

Management to provide a presentation on Risk of Violence in the Workplace to the next Board meeting

GMCS Presentation February 2018

CCDHB Public 21 February 2018 - 1.6 Action List

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CLOSED since last meeting – 20 December 2017

Action No

Date of meeting

Agenda item

number

Topic Action Designated to

How dealt with Delivery date

P0029 20 December

1.3 Register of Interest Update interest register with changes. Board Secretary

Update register February 2018

P0032 20 December

1.8 Chair’s Report Obtain a copy of the 2018 TAS Workplan. Board Secretary

Place into Diligent February 2018

P0031 20 December

1.7 CCDHB Workplan 2017

Place 2018 Workplan and Meeting Schedule into Resource Centre on Diligent Board Books

Board Secretary

Place into Diligent January 2018

P0027 22 November

3.1 Health and Advisory Committee (CPHAC)

Board to organise workshops to consider some of the opportunities in which to improve outcomes

Chair Discuss with Board members at January Workshop

January 2018

P0028 22 November

3.1 Health and Advisory Committee (CPHAC)

Amend (public and file documents) – ‘Chair as member of CPHAC, and heading title error in item 3.1 should be DSAC not CPHAC.

Board Secretary

Amend files December 2017

P0025 22 November

1.11 Citizens Health Council Report

Management to include the Citizens Health Council Committee into the Governance Manual

CLO Add to Board Governance Manual

December 2017

P0022 25 October 3.1 Board Governance Manual

Management to check the consultation paragraph in the manual and report back to the Board

CLO Review and report back to Board members

December 2017

P0021 25 October 3.1 Board Governance Manual

Management to prepare a paragraph acknowledging Sign Language as an official language

CLO Add to Board Governance Manual

December 2017

CCDHB Public 21 February 2018 - 1.6 Action List

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V3

Capital & Coast Health District Health Board Workplan 2018

Regular monthly items: (Public) Chair’s Report; CEO’s Report; Health & Safety Report; Resolution to Exclude(Public Excluded): Chair’s Report; CEO’s Report; FRAC recommendations; FRAC minutes.

Month January February March April May June July August September October November DecemberLocation CCDHB CCDHB CCDHB CCDHB CCDHB Ratonga Rua o

PoriruaCCDHB CCDHB Kenepuru CCDHB Kapiti CCDHB

Strategic Sub Committees

PRES

ENTA

TIO

NS

WORKSHOP

IOD presentation

Annual Planning2018/19

Priorities and Investment

Opportunities

Sub Regional Disability Group

Sub Regional Strategic Pacific Health Advisory Group

Maori Partnership Board

Wellington Hospital Foundation update



Sub Regional Disability Group

Maori Partnership Board



Community Primary Health Organisation

Primary Health Organisation

Primary Health Organisation

Patient Stories Children End of Life Cancer Mental Health Long term conditions

Older Adult and Rehabilitation

‘Out of region’ patients

DEC

ISIO

N

Prioritisation of Initial Cases

Disability Strategy (Revised)

Draft Regional Services Plan

Final Draft Annual Plan 2018/19

Even Better Health Care Plan 17/20

Final Draft Regional Services Plan 2018/19

Final Budget

Annual Plan and Capital Budget 2018/19

Draft Financials Annual Report

Final Annual Report 2017/18

Final Disability Strategy

Board Governance Manual

Insurance renewals Mental Health Strategy Update

2019 Board Schedule and workplan

NZHPL Accountability documents

Allied Laundry AGMTAS AGM

Mental Health Strategy update

Planning

DIS

CUSS

ION

Annual Planning Draft Annual Plan Overview

Draft Budget Internal Audit External Audit

Even Better Health Care Plan Update






Regular Reporting

Feasibility Study –development of a primary birthing unit

Quarter 2 performance report

Quarterly Population Investment Performance Report






Bi-monthly Hospital and Health Services update including quality report

Bi-monthly SIP update

Bi-monthly 3DHB MHAIDS updateincluding quality report

Bi-monthly People & Capability

Bi-monthly Hospital and Health Services update


Bi-monthly 3DHB MHAIDS update








Bi-monthly 3DHB MHAIDS update








Health and Safety Monthly Report











INFO

RMAT

ION

3DHB Population Health update

CPHAC/DSAC update


CPHAC/DSAC update

CPHAC/DSAC update and meeting schedule


Legal quarterly update




3DHB ICT update 3DHB ICT update 3DHB ICT update 3DHB ICT update

CCDHB Public 21 February 2018 - 1.7 Workplan

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V3

Month January February March April May June July August September October November DecemberLocation CCDHB CCDHB CCDHB CCDHB CCDHB Ratonga Rua o

PoriruaCCDHB CCDHB Kenepuru CCDHB Kapiti CCDHB

BOARD SITE VISITS

11.45am-12.30pm

CCDHB Public 21 February 2018 - 1.7 Workplan

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CCDHB Public 21 February 2018 - 1.8 Chair's Report

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PUBLIC


BOARD PROCEDURAL

Date: 13 February 2018

Author Ashley Bloomfield, Interim Chief Executive

Subject CHIEF EXECUTIVE’S REPORT FEBRUARY 2018

RECOMMENDATION

It is recommended that the Board:

a) Notes that the DHB remains slightly ahead of budget year to date, so is on track to achieve the annual budget of ($21m);

b) Notes that interest in the DHB’s Facebook page continues to increase;

c) Notes that the Care Capacity Demand Management programme is making good progress;

d) Notes that Diana Crossan has been appointed the Interim Chair of the Citizen’s Health Council and Expressions of Interest for membership of the Council are open until the end of February;

e) Notes that options are being developed to increase the emergency water supply for the Keneperu Hospital and Ratonga Rua facilities and a business case for the preferred option will be presented to the Board in March;

f) Notes that Clinical Council members participated in the investment prioritisation workshop in lieu of their February meeting;

g) Notes that the MHAIDS Client Pathway goes live on 12 March.

APPENDICES

1. Financial Summary2. Health Matters.

1. FINANCIAL UPDATE

1.1 Financial Overview

The DHB has a deficit target of ($21m) for the 2017/18 financial year, which has now been approved by the Minister as part of the 2017/18 Annual Plan signoff.

The DHB result for the month of December 2017 was ($54k) unfavourable to budget and a deficit of ($3.05m) for the month. The year to date (YTD) result was $655k favourable to budget with deficit of ($10.31m) YTD.

Activity movement compared to last year

CCDHB Public 21 February 2018 - Item 1.9 Chief Executive's Report

49

PUBLIC


As reported in MoH MIF report Dec-17 Dec-16Variances Month

Months % change

YTD17/18

YTD 16/17

Variances YTD

YTD % change

Discharges 5,058 5,165 107 2.1% 31,955 31,667 (288) -0.9%Caseweights (Excl MH) 5,447 5,891 444 7.5% 35,286 35,220 (66) -0.2%Bed Days (calculated from Hours) 12,296 12,710 414 3.3% 77,158 76,888 (270) -0.4%Length of Stay (excluding day patients) 3.90 3.92 0.02 0.5% 3.90 3.88 (0.02) -0.5%ED Presentations 5,420 5,251 (169) -3.2% 32,845 31,907 (938) -2.9%ED Admissions 1,817 1,786 (31) -1.7% 11,335 11,131 (204) -1.8%Theatre Throughput (Hospital) 914 1,111 197 17.7% 7,209 7,399 190 2.6%

Financial Results

Net Result in $000s Actual Budget Variance Actual Budget Variance Surplus/(Deficit) (3,050) (2,996) (54) (10,307) (10,963) 656

Dec 2017 Year to Date

2 ACHIEVEMENT OF HEALTH TARGETS, QUALITY AND SAFETY, AND HEALTH AND SAFETY

The September-December 2017 quarter target results for DHBs are not yet finalised and published. Progress with key targets in the hospital is outlined in the Hospital and Healthcare Services (HHS) Report (Item 4.2).

Quality and Safety are also reported on as part of the HHS report, and there is a separate Health and Safety report on the Board agenda (Item 4.1)

3 COMMUNICATIONS

3.1 Media

Media enquiries and releases

There were 50 media enquiries in January. Around 44 percent related to patient condition updates. A key matter for the other media enquiries was around heat-related ED presentations.

Three ‘pitches’ and media releases were issued. Coverage includes:∑ Telestroke pilot sees stroke intervention rates double∑ Central region gets overhaul of alcohol and drug addiction services

3.2 OIA requests

Requests received in January 19

Requests sent in January 15

Responses sent on time 80%

3.3 CCDHB website

In January, the CCDHB website (www.ccdhb.org.nz) was visited 56,626 times by 29,300 people.


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http://issuu.com/the.star/docs/218025cs?mode=embed&layout=http%3A%2F%2Fskin.issuu.com%2Fv%2Flight%2Flayout.xml&backgroundColor=010101

https://www.stuff.co.nz/national/health/101074936/central-region-gets-overhaul-of-alcohol-and-drug-addiction-services

http://www.ccdhb.org.nz/

PUBLIC


The 5 most visited website pages in January were:

Website page Page views

Staff login 31,786

Home 26,931

Careers 5,394

Wellington Regional Hospital 3,490

Search 3,032

3.4 Mental Health, Addictions and Intellectual Disability Service (MHAIDS) website

The new MHAIDS website (www.mhaids.health.nz) went live on 2 October 2017. In January 2018, the site was visited 2,069 times by 1,480 people.

The 5 most visited website pages in January were:

Website page Page views

Home 1,271

Do you, or does someone you know, need help now? (Te Haika) 423

Community mental health teams (general adult) 362

Child and adolescent mental health services 354

How to contact our services 345

3.5 Social media

The number of people following us on Facebook continues to increase and is now 2,462. Our number of page likes rose by 7 percent during January.


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http://www.mhaids.health.nz/

PUBLIC


The post which reached the most people in January was welcoming nurses starting our Nurse Entry to Practice (NETP) programme at Wellington Regional Hospital.

3.6 Internal communications

2.6.1 Health Matters staff newsletter

The latest copy of the Health Matters staff newsletter is attached as Appendix 2. The December/January edition includes articles about:

∑ Photos from the Christmas staff feasts ∑ Helping staff address unacceptable behaviour


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∑ Nationwide nurses symposium held at Wellington Regional Hospital∑ Changes to staff parking ∑ MAPU’s Ambulatory Care Project increasing discharge rates

2.6.2 Internal campaigns

There were a number of internal campaigns during December and January. These included:∑ Changes to staff parking∑ Moving to one payroll∑ Shredding patient notes at handover∑ Paper cup free December.

4 CARE CAPACITY DEMAND MANAGEMENT (CCDM)

The CCDM programme, which seeks to better match nursing resources to demand within the hospital, continues to progress well with the Annual Work Plan being agreed by the CCDM Governance Group as well as the signing of the Letter of Agreement at the end of last year. The partnership between the Unions and CCDHB is functioning well.

A workstream has been established for implementing the Core Data Set that underpins the programme. The Core Data Set incorporates 23 data metrics from various sources including TrendCare, Payroll and SQUARE. Currently we have 19 of the 23 metrics readily available. The next step is to develop a dashboard for the Core Data Set to enable monthly CCDM Council review.

TrendCare continues to improve throughout the organisation with a significant improvement in our data validity. An external assessment of TrendCare was undertaken by the Safe Staffing Healthy Workplaces Unit in November. The report is awaiting review by the CCDM Council members.

The Variance Response Management work stream will be established by the end of February. This will begin to look at the standard operating procedures and the current suite of tools within the hospital’s Integrated Operations Centre.

CCDHB has received positive feedback from the Safe Staffing Healthy Workplaces Unit regarding our progress during 2017.

5 CITIZEN’S HEALTH COUNCIL UPDATE

In November 2017, the Board approved the establishment of the Citizens Health Council and endorsed the draft terms of reference. The intention to appoint an interim Chair to help guide the establishment of the Board was noted.

The interim Chair for the Citizen Health Council, Diana Crossan, has now been appointed. Diana will be supporting the development of the Council and has already met with staff. A call for Expressions of Interest inviting nominations for members to join the Council was drafted and agreed with Diana.

The invite was sent out to the organisations that the Citizens Health Council Working Group suggested were key contacts.


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The Strategy Innovation and Performance (SIP) Directorate is ensuring that the information and call for nominations is sent out as widely as possible, by distributing information through its networks. This includes ensuring that a diverse range of organisations is informed about the opportunity to become a member.

The Expression of Interest itself is not intended to be a long or off-putting process. It asks that people explain a bit about themselves and that they answer the following (within a word limit):

∑ Why you are interested in being a Citizen’s Health Council member∑ What you are hoping to achieve by being a member ∑ What do you think success would look like for the Citizen’s Health Council

The deadline for nominations to become a council member is the end of February 2018 and the Citizens Health Council Working Group will meet to shortlist nominations at the beginning of March 2018. The first meeting of the Citizens Health Council is expected to be in April 2018.

Secretariat support for during and after the establishment phase will be provided by the SIP team.

6 KENEPURU AND RATONGA RUA EMERGENCY WATER SUPPLY

Kenepuru Hospital and Ratonga Rua (including Te Whare Marae) require 1,014,700 litres for 7 days normal operation and currently have 212,220 litres storage capacity. Thus there is a storage shortfall of 802,480 litres that needs to be addressed. The majority of the shortfall is at the Kenepuru site (approx. 744,480 litres).

Evaluation of technical options for providing at least seven days water storage at Kenepuru has been completed. A business case will be provided to the March Board meeting.

7 CLINICAL COUNCIL UPDATE

The Clinical Council was fully involved in the planning prioritisation workshop in February in place ofits normal monthly meeting. SIP, Hospital Healthcare Services and Mental Health all put forward their priorities for investment. It was a very useful exercise with a further meeting to follow, which will also involve Clinical Council members.

8 UPDATE ON MHAIDS CLIENT PATHWAY

The Client Pathway and digital client record will go live across the service on 12 March.

MHAIDS staff who access and use the clinical record must attend training to learn about the pathway, and how to use the new digital records to support best practice and clinical care.

A major change is the shift from paper to digital progress notes (and 12 other note types). There are five new digital document templates to replace previous digital or paper-based records for intake, assessment and planning, and service exit. Previous electronic documents will still be available, but won’t be able to be amended or new ones created.


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Every team has an implementation leader and they’ll have up-to-date information about the pathway to guide teams through the next steps. Training for other staff begins on 20 February at Wairarapa, Hutt Valley, Porirua and Wellington.

There are scheduled open sessions being held in Wairarapa, Porirua, Wellington and Hutt Valley locations and named sessions for services that have particular requirements in common. Focus is on getting as many staff trained as possible before the launch in March.


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CCDHB Financial Overview Page 1 December 2017

Capital & Coast DHBBoard Financial OverviewDecember 2017

Ashley Bloomfield , Chief Executive OfficerMichael McCarthy, Chief Financial Officer


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FINANCIAL PERFORMANCE RESULT AND OVERVIEWSummary

The DHB has a board approved deficit target of ($21m) for the 2017/18 financial year.

The DHB result for the period ending December 2017 is ($54k) unfavourable to budget and a deficit of ($3.05m) for the month. The year to date (YTD) result was $655k favourable to budget with deficit of ($10.31m) YTD.

YTD Variances against Budget

Revenue is $1.24m favourable to budget for the month and $5m favourable YTD. Revenue has been favourable across most categories, and includes additional revenue related to recognition of $2.4m of additional IDF volumes, $295k of two quarterly IDF wash-up revenue in clinical genetics, ACC $870k, other DHB revenue (non IDF related) $785k and other MOH contracts. Favourable variances were offset by ($666k) of elective revenue and ARC pay parity revenue withheld due to lower than budgeted costs.

Labour costs, including Employee and Outsourced personnel, were unfavourable ($773k) against budget for the month. YTD the DHB was ($1.46m) unfavourable, due to increased medical staff costs offset by savings in Management/Admin. The increased costs in medical are partially related to lower than planned SMO vacancies in the first quarter, while increased outsourced locums have been used to maintain theatre utilisation and throughput.

Clinical Supplies were on budget for the month and unfavourable ($977k) YTD due to increased winter period volumes, and change in volume price and mix variations on supplies.

Result for Period ended Dec 20172017/18

Account Type in $000s Actual Budget Variance Actual Budget Variance Annual Budget

Revenue 90,802 89,567 1,235 543,721 538,723 4,997 1,076,515Labour Costs 40,206 39,434 (773) 235,142 233,685 (1,457) 471,935Outsourced Services 1,798 1,816 18 12,010 11,964 (45) 23,621Clinical Supplies 9,940 9,928 (12) 61,596 60,619 (977) 118,545Infrastructure & Non-Cl inical 10,019 9,269 (750) 59,219 56,987 (2,232) 113,260Other Providers 31,890 32,118 228 186,061 186,430 368 370,153

Total (3,050) (2,996) (54) (10,307) (10,963) 655 (21,000)

Dec 2017 Year to Date


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Infrastructure & Non Clinical were unfavourable ($750k) for the month and ($2.23m) year to date against budget, due to increased costs in hotel services (maintenance, cleaning, food and laundry costs), higher than budgeted spend of special funds, and spend on consulting costs related to various projects, such as acute flow improvement initiatives, new children’s hospital and site master planning.

External Providers Review

The external provider payments are $368k favourable YTD. The main drivers for these variances are:

The favourable variances are:

• Aged Residential Care rest home and hospital with $1.40m due to better NASC management and pay parity costs not as high as the original forecast.

The unfavourable variances offsetting these amounts are:

• PHO Capitation unfavourable variation of ($556k) and is timing variance only

• Other Health of Older Persons unfavourable variance of ($349k) mainly due to higher in-between travel claims for carers and additional costs for respite care related to pay equity. Additional revenue will be received from the Ministry to match these claims.

• Mental Health costs unfavourable ($111k) is mainly related to Whitby and packages of care

Capital & Coast DHB - Funder Ext Provider Payments - $000s

Actual Budget Last yearActual vs Budget

Actual vs Last year

YTD December 2017Actual Budget Last year

Actual vs Budget

Actual vs Last year

External Provider Payments:6,303 6,269 5,825 (34) (478) - Pharmaceuticals 35,397 35,369 35,383 (27) (14)6,011 6,033 5,606 22 (404) - Capitation 33,082 32,527 29,766 (556) (3,316)1,680 1,740 1,503 60 (177) - ARC-Rest Home Level 10,381 10,249 9,003 (133) (1,379)3,560 3,872 3,170 312 (390) - ARC-Hospital Level 21,387 22,918 21,380 1,531 (7)1,834 1,617 1,540 (217) (294) - Other HoP 10,049 9,700 11,242 (349) 1,1931,925 1,886 1,852 (40) (72) - Mental Health 11,424 11,313 11,231 (111) (192)

744 697 791 (48) 47 - Palliative Care/Fertility/Comm Rad 4,447 4,180 4,744 (267) 2971,846 2,010 1,860 164 14 - Other 11,955 12,202 11,850 246 (105)7,986 7,995 7,813 9 (173) - IDF Outflows 47,938 47,971 44,990 34 (2,948)

31,890 32,118 29,961 228 (1,928) Total Expenditure 186,061 186,430 179,589 368 (6,471)

Month - December 2017 Year to DateVariance Variance


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• Community Radiology and other costs have an unfavourable variance of ($267k). This is mainly due to higher demand driven dental claims processed, some of which relate to the prior year

Employee FTE Financial Reporting to Ministry of Health (MOH Accrued FTE)

For financial accounting purposes MOH require an accrued FTE measure (as shown in the table below). This measure includes all hours on an accrual basis including leave accruals, overtime and casual hours. As an FTE measure this is highly volatile for a 24/7 facility due to the divisor being set based on the number of working days in the month. The Year to Date total is an average for the year. The average $ per FTE is impacted by MECA increases year on year.


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CCDHB STATEMENTS OF FINANCIAL POSITIONNov -17 Capital & Coast DHB

Balance Sheet

Actual Actual BudgetAt Dec 2016

At June 2017

Actual vs Budget

Actual vs Dec 2016 Notes

YTD December 2017

104 19 101 97 101 (82) (78) 1 Bank

49,761 60,974 14,194 27,094 20,302 46,780 33,880 1 Bank NZHP

8,773 9,141 8,409 7,830 8,409 732 1,312 1 Trust funds

34,635 34,864 45,190 36,491 43,962 (10,326) (1,626) 2 Accounts receivable

9,498 11,027 8,602 8,589 8,602 2,425 2,438 Inventory/Stock

6,503 6,451 5,632 4,170 5,632 818 2,281 2 Prepayments

109,274 122,476 82,129 84,271 87,009 40,347 38,205 Total current assets

457,995 452,938 463,386 465,737 466,278 (10,448) (12,800) Fixed assets

9,859 10,245 10,245 8,615 9,859 0 1,630 Work in Progress - CRISP

8,421 10,581 19,897 19,938 5,613 (9,317) (9,357) Work in progress

476,275 473,763 493,528 494,290 481,750 (19,764) (20,527) 3 Total fixed assets

6,468 6,468 6,468 6,468 6,468 (0) (0) Investments in New Zealand Health Partnership

1,150 1,150 1,150 1,150 1,150 (0) (0) Investment in All ied Laundry

7,618 7,617 7,618 7,618 7,618 (1) (1) Total investments593,167 603,856 583,275 586,179 576,377 20,582 17,678 Total Assets

0 0 0 0 0 0 0 1 Bank overdraft HBL76,187 99,201 69,631 72,082 66,065 (29,569) (27,119) 4 Accounts payable, Accruals and provisions

244 163 326 62,163 326 163 62,000 7 Loans - Current portion

8,234 0 14,670 3,269 0 14,670 3,269 6 Capital Charge payable

593 593 593 0 593 0 (593) Insurance l iabi lity

27,903 36,618 20,969 22,425 20,969 (15,649) (14,193) 5 Current Employee Provisions44,951 44,220 45,507 41,652 45,507 1,287 (2,567) 5 Accrued Employee Leave

9,868 2,303 11,819 9,232 11,819 9,516 6,929 5 Accrued Employee salary & Wages

167,980 183,098 163,515 210,823 145,279 (19,583) 27,725 Total current liabilities

302 302 302 277,628 302 0 277,326 7 Crown loans

8,850 9,191 8,488 7,982 8,488 (703) (1,209) Restricted special funds

605 605 605 229 605 0 (376) Insurance l iabi lity

5,868 5,868 5,868 5,765 5,868 0 (103) Long-term employee provisions

15,625 15,966 15,263 291,604 15,263 (703) 275,638 Total non-current liabilities

183,605 199,063 178,778 502,427 160,542 (20,286) 303,364 Total Liabilities

409,562 404,793 404,497 83,752 415,835 296 321,041 Net Assets

769,463 769,178 769,751 424,157 773,235 (573) 345,021 7 Crown Equity

0 0 0 0 (3,484) 0 0 Capital repaid

23,601 23,518 23,677 24,104 23,677 (159) (586) Reserves

(383,503) (387,903) (388,931) (364,509) (377,593) 1,028 (23,394) Retained earnings

409,561 404,793 404,497 83,752 415,835 296 321,041 Total Equity

Month : December 17

Variance


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Capital & Coast DHB

Statement of Cashflows

Actual Budget Last yearActual vs Budget

Actual vs Last year Notes

YTD December 2017Actual Budget Last year

Actual vs Budget

Actual vs Last year

Operating Activities

94,445 88,554 93,660 5,891 786 Receipts 567,154 538,822 546,315 28,332 20,839

Payments

35,155 37,570 35,533 2,414 378 Payments to employees 222,099 225,417 214,899 3,318 (7,200)

50,423 49,509 53,738 (915) 3,315 Payments to suppliers 302,513 303,050 302,822 537 309

0 0 0 0 0 Capital Charge paid 0 0 0 0 0

(6,005) 258 (5,510) 6,263 495 GST (net) (6,852) 1,550 (4,175) 8,402 2,677

79,573 87,337 83,762 7,763 4,188 Payments - total 517,760 530,017 513,546 12,256 (4,214)

14,872 1,218 9,898 13,654 4,974 8 Net cash flow from operating Activities 49,394 8,805 32,769 40,588 16,624

Investing Activities

317 120 57 (197) (260) Receipts - Interest 848 718 676 (130) (171)

0 (70) 0 (70) 0 Receipts - Other 0 (420) 0 (420) 0

317 50 57 (267) (260) Receipts - total 848 298 676 (550) (171)

Payments

386 (70) 762 (456) 376 Investment in associates 386 (420) 508 (806) 122

1,233 2,500 858 1,267 (375) Purchase of fixed assets 8,534 15,000 11,241 6,466 2,707

1,619 2,430 1,620 811 1 Payments - total 8,920 14,580 11,749 5,660 2,829

(1,302) (2,380) (1,563) 543 (259) 9 Net cash flow from investing Activities (8,072) (14,282) (11,073) 5,110 2,657

Financing Activities

0 0 0 0 0 Equity - Capital 0 0 0 0 0

0 0 0 0 0 Other Equity Movement 0 0 0 0 00 (27) 0 (27) 0 Other 0 (163) 0 (163) 0

0 (27) 0 27 0 Receipts - total 0 (163) 0 163 0

Payments

0 8 0 8 0 Interest payments 0 50 6,776 50 6,776

0 8 0 8 0 Payments - total 0 50 6,776 50 6,776

0 (35) 0 35 0 10 Net cash flow from financing Activities 0 (213) (6,776) 213 6,776

13,570 (1,268) 8,335 14,233 4,715 Net inflow/(outflow) of CCDHB funds 41,321 (6,109) 14,920 45,911 26,058

56,564 23,972 26,685 (32,593) (29,879) Opening cash 28,812 28,812 20,100 0 (8,712)94,762 88,577 93,717 5,651 526 Net inflow funds 568,002 538,958 546,992 27,944 20,667

81,193 89,845 85,382 8,582 4,189 Net (outflow) funds 526,680 545,067 532,071 17,966 5,39113,570 (1,268) 8,335 14,233 4,715 Net inflow/(outflow) of CCDHB funds 41,321 (6,109) 14,920 45,911 26,058

70,134 22,703 35,020 47,431 35,113 Closing cash 70,134 22,703 35,020 47,430 35,113

Variance

Year to DateMonth : December 17

Variance


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Notes to the Balance Sheet and Cashflows

A) Notes to Balance Sheet:

1. The DHB’s cash balance at the end of December is significantly higher than budget mainly due to additional 2016-17 wash-up funding for electives and IDF received in October and less than expected capital spend. All surplus funds are invested by New Zealand Health Partnerships in short term investments;

2. Accounts receivable is less than budget due to timing differences. Some of the main customers include Ministry of Health $5.2m, Hutt Valley DHB $1.9m, ACC $0.4m;

3. Total non-current assets is less than budget due to less than expected capital spend;

4. Accounts payable, accruals and provisions is higher than budget due to timing differences. Some of main suppliers include various SIDU related accruals $27.3m mainly due to NGO providers paid a month in arrears, Healthcare Logistics $0.4m, Baxter Healthcare $0.3m,;

5. Crown loans and equity are in line with budget. The comparative previous year balances are different due to the conversion of all Crown loans to equity in February 2017.

B) Notes to Cash flow statement:

6. The net cash flow from operating activities is higher than budget due to timing differences and additional funding received as noted in point 1 above;

7. The net cash flow from investment activities is less than budget due to less than expected capital spend;

8. There is not much movement in financing activities;

C) Ratios

1. Current Ratio – This ratio determines the DHB’s ability to pay back its short term liabilities. DHB’s current ratio is 0.67 (June 17: 0.62);

2. Debt to Equity Ratio - This ratio determines how the DHB has financed the asset base. DHB’s total liability to equity ratio is 33:67 (June 17 27:73).


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Cash Forecast

We have projected our cash position based on the proposed capital budget and a forecast deficit of $21m for 2017/18. However, any deterioration in these forecasts may put the facility limit at risk and we continue to monitor this closely. The working capital facility limit is approximately $55m.

-70-60-50-40-30-20-10

0102030405060708090

100110120130140

01/0

7/17

08/0

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15/0

7/17

22/0

7/17

29/0

7/17

05/0

8/17

12/0

8/17

19/0

8/17

26/0

8/17

02/0

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16/0

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23/0

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30/0

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07/1

0/17

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21/1

0/17

28/1

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04/1

1/17

11/1

1/17

18/1

1/17

25/1

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02/1

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09/1

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16/1

2/17

23/1

2/17

30/1

2/17

06/0

1/18

13/0

1/18

20/0

1/18

27/0

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2/18

10/0

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17/0

2/18

24/0

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03/0

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10/0

3/18

17/0

3/18

24/0

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31/0

3/18

07/0

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$m

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Borrowing Limit Danger Zone Weekly Actual Cash Balance Weekly Forecasted Cash Balance


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Wairarapa, Hutt Valley and Capital & Coast District Health Board

BOARD DISCUSSION


Author Gillian Miller, Senior System Development Manager

From: Bob Francis, Chair of Sub Regional Disability Advisory Group

Rachel Haggerty, Director Strategy Innovation and Performance

Endorsed By Ashley Bloomfield, Interim Chief Executive, Capital and Coast DHB

Subject SUB REGIONAL DISABILITY STRATEGY (2017-22) UPDATE ON WORK PROGRAMME

RECOMMENDATIONS


a) Notes that a review of the use of Disability Alerts in the DHB’s provider arm is about to commence with a view to informing appropriate training in its use and measure the impact of the Alert;

b) Notes that review of disability education function across CCDHB has recently been completed, which considered the effectiveness of current training and identified measures of improved disability responsiveness; proposed next steps are being developed;

c) Notes the work is progressing on strengthening and improving the use of NZ Sign Language (NZSL) in collaboration the ‘NZSL in Health’ Taskforce, which is made up of the local deaf community including a NZSL interpreter, a parent of a Deaf child and representation from Deaf Aotearoa of New Zealand;

d) Notes the development of a Māori and Pacific Disability Collaborative to ensure the needs of Māori and Pacific people with disabilities are fully reflected in the implementation of the Disability Strategy.

1. PURPOSE

To update the Board on the work that has been undertaken to advance the actions set out in the Sub Regional Disability Strategy 2017 – 2022.

2. DISABILITY ALERTS INVESTIGATION

The New Zealand Disability Strategy's vision is of a society that highly values the lives and continually enhances the full participation of disabled people. It provides a framework to guide government agencies making policy and services impacting on disabled people and to influence the attitudes and behaviour of society as a whole.

The Sub-Regional Disability Implementation Plan (based on the New Zealand Disability Strategy) states the need for the development of a dataset based on the identified support needs of people using services through methods such as Disability Alerts data.

At an operational level, the Disability Alerts are a tool for partnership between patients and clinicians. This is achieved by patients identifying their support needs in summary within the Alert, which may also be supported by the Health Passport. For planning and governance purposes the Disability Alert can

CCDHB Public 21 February 2018 - Item 2.1 Sub Regional Disability Strategy Action Plan

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enable measurement and monitoring of hospital performance for patients who have registered a disability support need, are Disability Support Service (DSS) funded and/or have self-identified on admission to the emergency department.

The Disability Alert is able to record a self-identified disability support need that a person may have. A lack of understanding of a patients’ support need may result in clinical or service barriers, the exacerbation of illness, and delayed or unplanned discharges due to unmet support needs or a lack of responsiveness from Disability Support Services.

There is a need to explore the access and utilisation of secondary care services in CCDHB by people with a disability to inform future activities for disability services. If we are to understand our population we need to be sure that the Disability Alert is working effectively. The current Disability Alert requires review to look into:

a) Service access and utilisation: People with disability experience inequitable outcomes from their utilisation of secondary care services

b) Quality of Disability Alerts: The absence of quality Disability Alerts and solutions for patients’ support needs may result in clinical or service barriers, the exacerbation of illness, and delayed or unplanned discharges due to unmet support needs or a lack of responsiveness from Disability Support Services

The objectives of the review are to:

a) Characterise and define the population with Disability Alerts at Capital & Coast DHB.

b) Understand the current level of secondary care service access and utilisation, as well as inequities experienced, by people with Disability Alerts.

c) Understand the quality of Disability Alerts.

d) Build a quality framework and process around Disability Alerts to support the consumer, clinicians and improved health outcomes.

e) Design a model of education delivery services to find solutions to health needs of the population and support clinicians in responding to the health needs of the population.

This review will inform how we refine the Disability Alert, help us to design and develop appropriate training and measure the impact of the Alert. The Board will be presented with the findings and actions resulting from the investigation.

3. REVIEW OF THE DISABILITY EDUCATION FUNCTION ACROSS CCDHB

A Disability Learning needs and workforce development assessment report was undertaken by an independent contractor with previous experience in disability services, disability rights, and health was contracted to assess the learning needs of staff at CCDHB, consistent with the “Enabling Partnerships” strategy.

The purpose of the report was to make recommendations on the scope and uptake of education for staff, improve the effectiveness of disability education in CCDHB, and establish requirements for thekey educator role (which has been vacant since April 2017) in programme delivery.

Feedback on the current disability education work was received from clinicians, consumers, disability team and capability and development was sought. The programme is well supported and nobody contested the need for an education programme to improve disability responsiveness. People suggested ways to improve the effectiveness of the programme, including through contributing more


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in- depth disability content knowledge and through education delivery to create knowledge uptake and behaviour change. The latter received the most attention.

A sample of what clinicians said:

a) There is a strong will to learn more and do better for disabled people

b) Everybody comes to work with good intent, and we want to learn how to do better.

The Board will be updated on the final report and implementations of the recommendations.

4. NEW ZEALAND SIGN LANGUAGE (NZSL) IN HEALTH PROGRAMME OF WORK UPDATE

The NZSL in Health Task Force is made up of 8 members of the local deaf community including a NZSL interpreter, a parent of a Deaf child and representation from Deaf Aotearoa of New Zealand, and the video Interpreting Service (NZVIS).

This group meets quarterly, advises on the work programme and is involved in or running a number of projects that received external funding from the New Zealand Sign Language (NZSL) board. The next meeting is on 14 February and agenda items include setting the work programme for the coming year based on the five-year programme of work. This will include discussing 2018 applications to the NZSL Board for external funding for potential projects.

Recent work completed is outlined below.

An article titled ‘Deaf New Zealand sign Language users’ access to healthcare’ was published in the NZ Medical Journal in Dec 2017. This article summarized the research that was completed within the 3DHBs in 2015 detailing the experiences of Deaf people accessing healthcare services. This information is currently being used to update the ‘Use of Interpreting Services’ policy.

Variations in NZSL workshop:

A workshop was held in September 2017 involving members of the deaf community with poor health literacy, NZSL interpreters and medical staff. There were a number of objectives:

a) increase the confidence/relationship between deaf community and NZSL interpreters

b) improve awareness of medical staff working with deaf people

c) improve health literacy of deaf community member with poor health literacy

This workshop was coordinated by a member of the NZSL in Health Taskforce.

Further outcomes of this workshop are a partnership between Deaf Aotearoa NZ and the DHB to provide ongoing workshop for the deaf community on common health issues.

In collaboration with Victoria University and Auckland University of Technology (AUT), a proposal has been submitted to the Health Research Council for a three-year project for ‘Deaf navigator services’. The first EOI phase was successful.

Website information project:

Filming of two short films one for the deaf community about useful information to know when coming to hospital and another film for DHB staff about working with deaf people. Filming completed 18th Jan. First cut of the film to be reviewed by the NZSL in Health Task Force on the 14th Feb.

Other projects for the 2018 work plan will be decided with the NZSL in Health task force in February and the Board will be updated.


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5. DEVELOPMENT OF MAORI AND PACIFIC DISABILITY COLLABORATIVE

Capital & Coast, Wairarapa and Hutt Valley District Health Boards are committed to the goal of improving the responsiveness of health services to people who experience disability. Further, committed to achieve equitable health and wellbeing outcomes for Māori and Pacific who experience disability.

A Sub-Regional Disability Strategy 2017 – 2022 was established to guide action in the sub-region that draws on Whāia Te Ao Marama and Faiva Ora. The intention is that the implementation plan of the Sub Regional Disability Strategy address inequities by ensuring that Māori and Pacific perspectives are reflected in the priorities, actions and approach to implementation of the Sub Regional Disability Strategy.

The purpose of the group is to:

a) To provide leadership and to ensure the needs of Māori and Pacific people with disabilities are reflected in the implementation and is at the forefront of the Strategy and delivery approaches.

b) To provide perspectives and practical ways to strengthen the implementation from a Maori and Pacific cultural world view.

c) To provide a forum to support aligned action across all localities for Māori and Pacific peoples who experience disability.

The Strategy implementation is the responsibility of the Strategy Innovation and Performance Group.

The role of the Group is primarily about driving change and action but members may be called on at different times to provide advice on service delivery/operations. All members will ensure that other group members are informed of any activities they are undertaking related to the collaborative priorities and actions.

The functions of the Maori and Pacific Disability Collaborative are:

a) To establish Strategy implementation priorities and initiatives that have sector support

b) To strengthen Māori and Pacific cultural worldviews in the Strategy implementation

c) To ensure monitoring and measurement of the priorities and initiatives

d) To set-up and support action groups as necessary for targeted work

e) To identify opportunities and priorities for addressing inequities for Māori and Pacific disability peoples

f) To influence and be an advocate within the various groups in the Sub Region and beyond to advice equity for Māori and Pacific disability

g) To communicate and form connections in the Sub Region and beyond to effect change

h) To contribute to the development, implementation and monitoring of Māori and Pacific disability health outcomes for the Sub-Region.

Members will be selected on the basis of a range of skills and current community disability work. Appointment to the Group is by invitation from the Sub Regional DHB lead advisors for Disability, Māori Health, and Pacific Health.

The group aims to an agile, informed group who are decision makers connected with operational delivery of services for disability. The group will be between 8 – 12 members who reflect the sub-region


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localities, cover the age groups and diversity of impairments, and include the key health providers. We hope that the group will have its first meeting in April 2018.


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Capital & Coast District Health Board Page 1 February 2018

BOARD DECISION

9 February 2018

AuthorLauren Webster, Systems Development Manager, Child & Youth

Taima Fagaloa, Manager, Child & Youth / Director, Pacific Health Directorate

Endorsed byRachel Haggerty, Director, Strategy, Innovation & Performance

Ashley Bloomfield, Interim Chief Executive

Subject BIRTHING FACILITIES AND MODELS OF CARE

RECOMMENDATIONS


a) Notes a Steering Group was established consisting of key CCDHB staff and clinicians, Pasifika and Māorilead maternity carers, consumer and midwifery representatives from Birth Hub, and a Well Child Tamariki Ora provider representative to oversee and inform work on a feasibility study for a possible primary birthing unit closer to Wellington Regional Hospital;

b) Notes the Steering Group has developed a project plan and terms of reference for this work

c) Notes the three key issues identified that have resulted in a request to alter the timeline for this feasibility study:

a. An agreed understanding of what success looks like for the project, including a wider focus on service improvements beyond a possible primary birthing facility;

b. The importance of robust stakeholder engagement and the need to ensure accurate and consistent information about birthing options as part of the consultation process;

c. The need to explore the opportunities for existing facilities in Kenepuru and Paraparaumu, including why people do/don’t use our current services, and to ensure any new facility does not compromise sustainability and access to appropriate services for different communities.

d) Endorses the proposed revised timeline to report to the Board in August 2018, instead of February 2018, and the additional work will be accommodated within existing SIP funding.

1. PURPOSE

The purpose of this paper is to update the Board on progress with the feasibility study being undertaken as part of the investigation into the development of a primary birthing unit closer to the Wellington Regional Hospital.

2. INTRODUCTION

At its August 2017 meeting, the Board endorsed an investigation into the development and feasibility of a primary birthing unit closer to the Wellington Regional Hospital. Recommendations and a report on this work were initially intended for consideration by the Board in February 2018.

3. PROGRESS TO DATE

A Steering Group was established comprising key CCDHB staff and clinicians, Pasifika and Maori lead maternity carers, consumer and midwifery representatives from Birth Hub, and a Well Child Tamariki Ora provider representative.

CCDHB Public 21 February 2018 - Item 3.1 Birthing Facilities and Models of Care

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The Steering Group has developed a project plan and terms of reference for this work. Three key issues have been identified by the Group that would extend the proposed timeline for this feasibility study:

a. An agreed understanding of what success looks like for the project, including a wider focus on service improvements beyond a possible primary birthing facility;

b. The importance of robust stakeholder engagement and the need to ensure accurate and consistent information about birthing options as part of the consultation process;

c. The need to explore the opportunities for existing facilities in Kenepuru and Paraparaumu, including why people do/don’t use our current services, and to ensure any new facility does not compromise sustainability and access to appropriate services for different communities.

3.1 What success looks like?

At the January meeting of the Steering Group, members identified what success looks like for this project.

∑ Ensuring women and their families have choice in where they give birth and receive post-natal care, in keeping with the intensify/simplify element of the Health System Plan 2030.

∑ Ensuring vulnerable women and families with complex social/health needs are well-supported to care for themselves and their baby/ children. This means taking a life-course approach that addresses inequities in social determinants (supporting the first 1000 days of life).

∑ Ensuring postnatal respite care options are available.

∑ Ensuring the maternity system promotes equitable outcomes by not disadvantaging groups.

∑ A robust engagement process that allowed time for broad and deep consumer and workforce input. Workforce engagement critical to ensuring they are willing and prepared to drive any changes or new services, and to improve long-term workforce sustainability and satisfaction.

∑ A good analytical process based on all available data to support decision making.

∑ Ensuring primary birthing units/centres (new/existing) are well used by appropriate women by having clear rules around who can safely birth there. This includes clear referral guidelines around transfer to/from other facilities.

∑ Obstetricians, LMCs, and other clinical staff working with mothers, babies and their families working as a team as part of a cohesive regional system.

∑ All women are able to give informed-consent about where they birth. This means availability and provision of good information about place of birth and increased health literacy.

∑ Increase in the rate of physiological birth as a result of increased appropriate use of primary birthing facilities / homebirth.

∑ Connecting work around primary birthing with other CCDHB work streams to achieve system change.

∑ Increasing the capability of our current primary facilities.

As noted above, the Group is clear that success includes opportunity to improve birthing experiences froma much wider perspective than just developing a new facility.

3.2 Engagement with women, their families and our communities

The Steering Group has also proposed a much broader consumer and workforce engagement than had initially been suggested. This broader focus will take more time but provide a clearer direction on what needs to be considered and what will be required for women and their families to have their birthing needs met.

The expanded proposed cohorts for the focus groups are listed in the table below.


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Consumers Workforce

∑ Women and families in need of support services(complex care/social needs)

∑ Women and families with uncomplicated pregnancies who are unlikely to need support services

∑ Māori mothers and whānau ∑ Pacific mothers and families ∑ Refugee-background mothers and families∑ Women with a disability∑ Women with pre-existing mental health conditions ∑ Incarcerated women ∑ Women and families from Porirua, Kāpiti and Wellington

localities

∑ LMCs∑ Employed (core) workforce∑ The future workforce (LMC

undergraduates)∑ Providers of antenatal, postnatal,

and child health services∑ Obstetricians

Engagement would take the form of consumer and workforce surveys, open forums, as well as targeted focus groups across consumer cohorts, workforce and provider groups. A preliminary draft survey has been developed based on learnings from MidCentral DHB and Waitemata consultations that had a similar purpose. The targeted focus groups provide an essential input into a feasibility study.

An Engagement Lead would be appointed to further develop and support the engagement process, with oversight from the Project Lead and support from the CCDHB Child and Youth Team.

4. REVISED TIMELINE

While the speed of activity has been slower than originally expected, there is now a clear vision for primary birthing in CCDHB. A robust engagement process is being developed with appropriate support and achievable timelines to determine what is necessary from a clinical, consumer, and logistical perspective to achieve this vision. The work and process has strong guidance from a well-balanced Steering Group.

Incorporating these three key opportunities into the project plan requires a revision of the timeline to report to the Board to August 2018 rather than February 2018. The additional work required would beusing SIP budgeted resources and does not require any additional resource.

The proposed timeline is outlined below:

Oct

-D

ec

Jan

Feb

Mar

Apr

May

Jun

July

Aug

Project Planning

Engagement strategy updated

Engagement Lead appointed

Consultation set-up: public birthing information improved, focus groups set up, survey refined, consult promotion methods set upSteering Group update and endorsement of plans

Consultation

System, consultation and dataAnalysis


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Options analysis and report development

Report stakeholder review

Paper and recommendations go to the CCDHB Board


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BOARD DECISION


Author Rachel Haggerty, Director - Strategy, Innovation & Performance

Endorsed by Ashley Bloomfield, Interim Chief Executive - CCDHB

Subject CPHAC RECOMMENDATIONS TO THE BOARD

The full papers and recommendations of the 12 February CPHAC meeting are available on Boardbooks for Board members to review.

RECOMMENDATIONS

It is recommended that the Board receives the advice of CPHAC as considered at their meeting on 12 February, and:

General Business

a) Endorses the sending of the attached letter to the Minister of Health, by the Chair, on behalf of CCDHB

b) Endorse the introduction of a tax on sugar-sweetened beverages (SSBs)

c) Notes that the Bowel Screening commencement date for CCDHB has been delayed to the 2019/20 financial year.

d) Notes the discussion by CPHAC on advice regarding fluoridation and that CPHAC has requested that it be appraised of any emergent evidence that could impact on the current policy position.

Analytical Insights from Integrated Data

e) Endorses the SIP approach to developing whole-of-system analytics to support strategic, planning and value for money.

f) Endorses CCDHB data sharing arrangements to support the development of integrated data models and support the continued focus on data quality including ethnicity.

g) Endorses efforts to share data across all health providers.

Healthcare Home – Progressing into 2018

h) Notes by the end of 2017/18 the Healthcare Home model will reach 51% of the overall CCDHB enrolled population with a focus on reaching at least 80% of the overall population in 2018/19.

i) Notes that CPHAC supports continued investment in Healthcare Homes.

System Level Measures (SLM) Update – progressing into 2018

j) Endorses a greater focus on improving equity in partnership with our Pacific and Māori teams to continue improvement for Pacific and improve the result for Māori.

k) Notes that inequality needs to be clearly defined as closing the gap between Maori, Pacific and non-Maori and non-Pacific (other).

l) Endorses a greater focus on social determinants through connecting to the localities approach and the work of our public health service.

CCDHB Public 21 February 2018 - Item 3.2 Recommendations from CPHAC

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Performance Dashboard – Health of Older Person Contracted Services

m) Endorses the development of the proposed Older Persons Service Dashboard with its focus on structure, system level performance and impact measures.

n) Endorses working with the interRAI programme to develop the impact measures for individuals.

Discussion on future role of CPHAC / HAC

o) Notes the draft allocation of functions to CHPAC/HAC, FAC and the Board developed by ELT.

p) Notes that CPHAC discussed the future role of a combined CPHAC / HAC including the attached presentation.

q) Endorses the recommendation that this Committee be known as the Health System Advice Committee.

r) Notes that this Committee would focus on health system development, health system performance provider performance oversight and service planning.

s) Notes this Committee would receive advice from the Clinical Council and Citizens Health Council andwork with the Māori Partnership Board, Sub-regional Pacific Advisory Group and Sub-regional Disability Advisory Group.

t) Notes this Committee would provide advice to the Finance Advisory Committee (FAC) and the full Board.

APPENDICES

1. Draft Letter to Minister of Health

2. Creating our CPHAC HAC – Presentation

3. ELT Allocation of Functions to CPHAC HAC and FAC.


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Capital & Coast DHB | Private Bag 7902, Newtown, Wellington 6242Wellington Regional Hospital, Riddiford Street, Newtown, Wellington 6021

www.ccdhb.org.nz | Phone: 04 385 5999 | Fax: 04 385 5856

February 2018

Hon. Dr David ClarkMinister of HealthPrivate Bag 18041Parliament BuildingsWellington 6160

Email: [email protected]

Dear Minister

Re: Implementation of a tax on sugar-sweetened beverages as part of a suite of measures to improve child health especially child oral health

I am writing in my capacity as Chair of Capital & Coast District Health Board on behalf of the Board.

Our DHB has been concerned for some time now regarding rising obesity rates amongst NZ children with a third of NZ children having an unhealthy weight, and over 10% being obese. For the first time in history, NZ children could live shorter lives than their parents as a result of excess weight and obesity. The burden of obesity and its impacts is greatest on our Pacific, and Māori children and those from the deprived communities. We are equally concerned about the poor oral health of some groups of children in our population, particularly Māori and Pacific kids, despite a consistent investment in school dental programmes.

Obesity is a major cause of increasing demand and rising costs, straining our hospitals and health services. The risk factors related to obesity can lead to chronic disease and/or limit a person’s ability to work or take part in family and community activities. As a DHB, our efforts and resources are heavily invested in working with adults who already have the consequences of established lifestyle patterns that adversely affect their health. We are also seeing a significant rise in the number of children and young people with obesity related disease, including type 2 diabetes. This is not only distressing for the young person and their families it is preventable and an avoidable cost to our public health system.

CCDHB does invest in a number of primary prevention activities including: Project Energize, a successful programme that reduces childhood obesity; Green Prescription, supporting individuals and families to make lifestyle changes, supporting oral health in schools; and a range of public health initiatives including water in schools. These are important investments.

However, the Board believes these efforts need to be supported by a far more proactive policy stance at a central government level, particularly regarding sugar-sweetened beverages (SSBs). There is now sufficient evidence supporting the impact of a tax on reducing the consumption of SSBs and the benefits this will have on child health and particularly child oral health.

The World Health Organization (WHO) has recently stated there is clear evidence that taxes and subsidies influence purchasing behavior, and that this could be used to curb consumption of sugar-sweetened drinks and hence fight obesity and diabetes. WHO notes in a 2015 report titled Fiscal Policies for Diet and Prevention of No communicable Diseases, that if retail prices of sugar-sweetened drinks are increased by 20 percent through taxation, there will be proportional drop in consumption.

A SSB tax is supported by the NZ dental profession, with the NZ Dental Association and partner organisations’ Consensus Statement - Sugary Drinks calling for a tax on SSBs consistent with the WHO


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Capital & Coast DHB | Private Bag 7902, Wellington SouthWellington Hospital, Riddiford Street, Newtown, Wellington 6021

Phone: 04 385 5999 | Fax: 04 385 5856

guidelines. In addition, the Australian Medical Association has recently publicised its support for a tax on SSBs and urged the Australian Government to act (http://www.smh.com.au/federal-politics/political-news/advertising-banned-drinks-taxed-vending-machines-removed-doctors-plan-for-war-on-sugar-20180105-h0duw0.html).

At its February 2018 Board meeting, that Capital and Coast Board agreed to:

a) Endorse the introduction of a tax on sugar-sweetened beverages (SSBs);

b) Write to you and request that the Government move swiftly to implement a tax on SSBs, and strongly consider including artificially-sweetened beverages given that they are also harmful to oral health, as part of a wider set of measures to improve and protect child health;

c) Communicate this position publicly and practically support the Government to develop and implement such a tax.

As a health system we touch the lives of many families and continue to identify and implement ways to support healthy communities. Your commitment to school based clinics and ensuring the strength of our health services will also assist us to support healthy communities and families. This would be more effective when the environment supports fewer unnecessary sugar-sweetened beverages and energy drinks.

I trust you will give this request serious consideration. I can assure you that the DHB will fully support you and the Government and please do get in touch if we can assist in any way.

Yours sincerely

Andrew BlairChairCapital and Coast District Health Board


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http://www.smh.com.au/federal-politics/political-news/advertising-banned-drinks-taxed-vending-machines-removed-doctors-plan-for-war-on-sugar-20180105-h0duw0.html



Capital & Coast DHB | Private Bag 7902, Wellington SouthWellington Hospital, Riddiford Street, Newtown, Wellington 6021

Phone: 04 385 5999 | Fax: 04 385 5856


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