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Counties Manukau District Health Board Agenda

Counties Manukau District Health Board Board Meeting Agenda Wednesday, 29 July 2015 at 1.30 – 4.30pm, Room 101, Ko Awatea, Middlemore Hospital, Hospital Road, Otahuhu, Auckland Time Item

1.00 – 1.30pm Board Only Session

1. Welcome

1.30 – 1.35pm 2. Governance

2.1. Attendance & Apologies 2.2. Conflicts of Interest/Specific Interests 2.3. Confirmation of Public Minutes – 17 June 2015 2.4. Action Items Register

1.35 – 1.45pm 1.45 – 1.55pm

3. Strategy

3.1. Chair’s Report (Verbal Update) 3.2. Chief Executive’s Report

4. General Business

1.55 – 2.00pm 5. Resolution to Exclude the Public

2.00 – 2.05pm 2.05 – 2.10pm 2.10 – 2.30pm 2.30 – 2.40pm 2.40 – 2.50pm

6. Confidential

6.1. Confirmation of Confidential Minutes – 17 June 2015 6.2. Action Items Register 6.3. Strategy & Values Refresh (Margie Apa/Marianne Scott) 6.4. Health Targets - 2014/15 Quarter 1 Progress Report (Pauline Hanna) 6.5. Perioperative Clinical Information System Business Case Sign Off (Phillip Balmer)

Afternoon Tea Break

3.00 – 3.20pm 3.20 – 3.30pm 3.30 – 3.40pm

3.40 – 3.45pm 3.45 – 3.50pm

6.6. Project SWIFT Update (Sarah Thirlwall) 6.7. Strategic ICT Monthly Update (Sarah Thirlwall) 6.8. Treasury Policy – Investment Management & Asset Performance in State

Services (Ron Pearson) 6.9. Director’s Appointment to FPSC (Ron Pearson) 6.10. Joint Statement of Representation (Ron Pearson)

Next Meeting: 9 September 2015 Room 101, Ko Awatea, Middlemore Hospital, Otahuhu

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Counties Manukau District Health Board Agenda 29 July 2015

Board Member Attendance Schedule 2015

Name

Jan 11 Feb 25 Mar 6 May 17 June 29 July 9 Sept 21 Oct 2 Dec

Lee Mathias (Chair)

No

Mee

ting

Wendy Lai (Deputy Chair)

Arthur Anae

Colleen Brown

Sandra Alofivae

Lyn Murphy

David Collings

Kathy Maxwell

George Ngatai

Dianne Glenn

Reece Autagavaia

* Attended part meeting only

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BOARD MEMBERS’ DISCLOSURE OF INTERESTS

July 2015 Member Disclosure of Interest

Dr Lee Mathias, Chair • Chair Health Promotion Agency

• Chairman, Unitec • Deputy Chair, Auckland District Health Board • Director, Health Innovation Hub • Director, healthAlliance NZ Ltd • Director, New Zealand Health Partners Ltd • External Advisor, National Health Committee • Director, Pictor Limited • Director, iAC Limited • Advisory Chair, Company of Women Limited • Director, John Seabrook Holdings Limited • MD, Lee Mathias Limited • Trustee, Lee Mathias Family Trust • Trustee, Awamoana Family Trust • Trustee, Mathias Martin Family Trust

Wendy Lai, Deputy Chair • Board Member and Partner at Deloitte

• Board Member Te Papa Tongarewa, the Museum of New Zealand

• Chair, Ziera Shoes • Board Member, Avanti Finance

Arthur Anae

• Councillor, Auckland Council • Member The John Walker ‘Find Your Field of

Dreams’

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

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

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

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

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Dr Lyn Murphy • Senior lecturer in management and leadership at Manukau Institute of Technology

• Member, ACT NZ • Director, Bizness Synergy Training Ltd • Director, Synergex Holdings Ltd • Associate Editor NZ Journal of Applied Business

Research • Member Franklin Local Board

Sandra Alofivae

• Member, Fonua Ola Board • Board Member, Pasefika Futures • Board Member, Housing New Zealand

David Collings

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

Kathy Maxwell • Director, Kathy the Chemist Ltd

• Regional Pharmacy Advisory Group, Propharma (Pharmacy Retailing (NZ) Ltd)

• Editorial Advisory Board, New Zealand Formulary • Member Pharmaceutical Society of NZ • Trustee, Maxwell Family Trust • Member Manukau Locality Leadership Group,

CMDHB • Board Member, Pharmacy Guild of New Zealand

Dianne Glenn • Member – NZ Institute of Directors

• Member – District Licensing Committee of Auckland Council

• Life Member – Business and Professional Women Franklin

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

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

Therapy Inc. • CMDHB Representative - Franklin Health

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

Zealand • Justice of the Peace • Member, Pacific Women’s Watch (NZ) • Member, Auckland Disabled Women’s Group

George Ngatai • Arthritis NZ – Kaiwhakahaere

• Chair Safer Aotearoa Family Violence Prevention Network

• Director Transitioning Out Aotearoa • Director BDO Marketing • Board Member, Manurewa Marae

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• Conservation Volunteers New Zealand • Maori Gout Action Group • Nga Ngaru Rautahi o Aotearoa Board

Reece Autagavaia • Member, Pacific Lawyers’ Association

• Member, Labour Party • Member, Auckland Council Pacific People’s Advisory

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

Amata Preschool

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BOARD MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS

Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 17 June 2015 Director having interest

Interest in Particulars of interest Disclosure date Board Action

David Collings

Potential Botany Land Development

Mr Collings declared a specific interest in relation to the Potential Botany Land Development, being a member of the Howick Local Board.

4 September 2013 That Mr Collings’ specific interest be noted and that the Board agree that he may remain in the room and participate in any deliberations or decisions.

David Collings Innovation Hub Mr David Collings has a conflict of interest in regard to ATEED (being a member of the Local Community Board, which is part of the Auckland Council) and will be involved in the Innovation Hub.

5 October 2011 The Board notes that Mr Collings has a conflict of interest in regard to the Innovation Hub. He may participate in the deliberations of the Board in relation to this matter because he is able to assist the Board with relevant information, but is not permitted to participate in decision making.

Wendy Lai

HBL – Food & Laundry & FPSC Programme

Ms Lai declared a specific interest in regard to Deloitte providing support to HBL in the food and laundry and FPSC Programme. Deloitte has mainly been providing Oracle implementation resources to FPSC. Ms Lai is not directly involved with this work.

12 February 2014 That Ms Lai’s specific interest be noted and that the Board agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

George Ngatai Community Services Pharmacy Funding Policy

Mr Ngatai declared a specific interest in terms of their GP Service being like to use a local Pharmacy.

13 August 2014 That Mr Ngatai’s specific interest be noted and that the Board agree that he may remain in the room and participate in any deliberations, but be excluded from any voting.

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Wendy Lai HBL Business Cases Ms Lai declared a specific interest

in regard to Deloitte’s involvement with HBL on this work.

13 August 2014 That Ms Lai’s specific interest be noted and that she may not participate in either the deliberations or determination of the Board in relation to this matter and is asked to leave the room.

Wendy Lai Ko Awatea Panel Advisory Services

Ms Lai advised that Deloitte have been shortlisted to provide Panel Advisory Services to Ko Awatea. This work does not have any involvement with the APAC Business Case

5 November 2014 Noted. Ms Lai advised on the 3 December 2014 that Deloitte have now been selected to work with the Ko Awatea team to improve commercial awareness and increase income levels.

Lee Mathias Otahuhu Boundary Change The Chair noted her Specific Conflict of Interest, being Deputy Chair at ADHB.

25 March 2015

That Dr Mathias’ specific interest be noted and that the Board agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

Lee Mathias Northern Region Electronic Health Record (NEHR) Project & Regional Information Strategy (RIS 10-20) Refresh

The Chair declared her specific interest as a Director of HealthAlliance.

25 March 2015 That Dr Mathias’ specific interest be noted and that the Board agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

Wendy Lai

FPSC Ms Lai advised that Deloitte is involved with FPSC, but confirmed that she personally does not have any involvement.

6 May 2015 That Ms Lai’s specific interest be noted and that the Board agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

Wendy Lai

EPIC Ms Lai noted that a Deloitte colleague worked with EPIC in the US. Mr Pearson and Mrs Zacest have met with him for his independent expertise on EPIC.

6 May 2015 That Ms Lai’s specific interest be noted and that the Board agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

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Wendy Lai Botany Land Discussions Ms Lai advised that Deloitte

has been appointed by the three parties involved in the Botany Land discussions (CMDHB, BUPA & East Health). She is not personally involved in this work.

17 June 2015 That Ms Lai’s specific interest be noted and that the Board agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

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Minutes of Counties Manukau District Health Board Held on Wednesday, 17 June 2015 at 1.30 – 4.30pm, Innovation Lab, Ko Awatea, Middlemore Hospital, Hospital Road, Otahuhu, Auckland Present: Dr Lee Mathias (Chair), Ms Wendy Lai, Mrs Dianne Glenn, Mrs Kathy Maxwell, Mr Reece Autagavaia, Dr Lyn Murphy, Mrs Colleen Brown, Mrs Sandra Alofivae, Anae Arthur Anae, Mr George Ngatai In attendance: Mr Geraint Martin (Chief Executive), Mrs Lyn Butler (Board Secretary), Mrs Margaret White (Acting Chief Financial Officer) Apologies: 1. Welcome

The Chair welcomed everyone to the meeting. A Reporter from the Manukau Courier, was also present at the meeting.

2. Governance 2.1. Attendance & Apologies

Noted.

2.2. Conflicts of Interest/Specific Interests Noted. Ms Lai advised that Deloitte have been appointed by the three parties involved in the Botany Land Discussions (CMDHB, Bupa & East Health), noting that she is not personally involved in this work.

2.3. Confirmation of Public Minutes – 6 May 2015 Resolution That the public Minutes of the Board Meeting held on Wednesday, 6 May 2015, were taken as read and confirmed as a true and correct record. Moved: Wendy Lai Seconded: Dianne Glenn Carried: Unanimously

2.4. Action Items Register

Noted.

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3. Strategy 3.1. Chair’s Report (verbal update) (Lee Mathias)

The Chair advised that her visit to Turkey presenting on ‘Health System Innovation & Improvement’ at the New Zealand-Turkey Health Sector at Ciragan Palace had gone well. 120 people had confirmed their attendance, but only 65 actually attended. The health system there is very different to New Zealand, with a lot of buildings and more planned. Feedback has been provided to Ko Awatea on their sales and marketing material, and a blog has been written on the visit.

3.2. Chief Executive’s Report The report was taken as read. Mr Martin provided a summary as follows: Budget setting and focused strategy thinking is continuing. Staff are working with GPs to link with better population health outcomes, as well as community hubs and the AH+ initiative in Mangere. Risk stratification work is being done on ARI. CMDHB are also looking to be a pilot for the work being done by Mr Graham Scott, Health Economist. Sapere have provided a draft paper on their work to date, which is currently being reviewed. Health targets are now all either green or amber, with no red. The team are working on achieving a position of sustainability in all areas. There has been some dialogue with MoH on some targets, as some areas do not have waiting lists, so these cannot be improved upon. Peer reviewed articles on System Level Measures (NZ Medical Journal) and Community Organising (Australasian Psychiatry) have been accepted for publication as noted. An OIA has been received requesting surgical rates for individual surgeons. This will be a significant release of data including named individuals, so it is important that the data is released in a proper context. Prof Jonathon Gray, Dr Margaret Aimer and Ms Alexandra Nicholas presented on Community Organising. Prof Gray provided a background to the Board on how this initiative started with Harie Hahn in the US. Ms Nicholas presented to the Board, giving a personal account of how an eating disorder experienced when she was younger, and had driven her to find services for Pacific youth in similar circumstances.

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Agenda for Counties Manukau District Health Board

The campaign started off by training 25 youth at a Pacific Youth Mental Health Workshop. 96 people were invited and 76 turned up. Five teams of five people were set up to be mobilized through the community. A workshop of 150 youth was then held, with attendees including Ministers, Churches, parents, etc. Handle the Jandal was established in 2014. The initial five groups were then expanded to 12, who meet weekly at Ko Awatea. Three sub campaigns were launched: • Brown Touchdown – partnered with the Pacific Development Team. • Reach Out – high school based and led by the youngest team member at 16 years old. • The Big D – focus on school bullying and depressed – led by three boys.

In April 2015, 70 new youth were trained by Ms Nicholas. None of these people are paid – they do this work voluntarily to help others. Data is being collected to see what outcomes can be determined to date. Dr Aimer advised that there are currently three methods of measuring outcomes: • Number of individual people through training. • Building capability and spread & mapping network growth. • Changing World goal. Mr Ngatai asked whether this work could be transferred across other cultures. Ms Nicholas advised that she has discussed this work with the Workforce Co-ordinator to look at applying this work elsewhere. The Board thanked the team for an excellent presentation.

3.2.1. 2014/15 Quarter 3 Summary Report (Dawn Kelly)

The report was taken as read. Five out of six targets have currently been achieved. Four have been met as per the date of this report, with the Immunisation target having been achieved in May, which will show in the Quarter 4 report. All six targets will be met by the end of the financial year, for the third year in a row. Mr Martin advised that a lot of work has been continuing on the health targets, with the team very focused on a successful and sustained delivery.

Resolution That the Board note the 2014/15 Quarter 3 Summary Report. Moved: Lee Mathias Seconded: Kathy Maxwell Carried: Unanimously

Resolution That the Chief Executive’s Report be received. Moved: Lee Mathias Seconded: Wendy Lai Carried: Unanimously

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Agenda for Counties Manukau District Health Board

4. General Business

None.

5. Resolution to Exclude the Public Individual reasons to exclude the public were noted. Resolution That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health & Disability Act 2000, that the public now be excluded from the meeting as detailed in the above paper. Moved: George Ngatai Seconded: Arthur Anae Carried: Unanimously

The meeting was re-opened to the public. The meeting closed at 5.00pm. The next Meeting of the Board will be Wednesday, 29 July 2015 at Ko Awatea, Middlemore Hospital. The Minutes of the Meeting of the Counties Manukau District Health Board of Wednesday, 17 June 2015 are approved.

Signed as a true and correct record on Wednesday, 29 July 2015. Chair ______________________________ Dr Lee Mathias (Chair) Recommendation (moved / seconded )

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Counties Manukau District Health Board Action Items Register (Public)

DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

1 October CE Strategic

Discussion Mr David Moore of Sapere Group, one of the leading research agencies, has been engaged to look at economic models, datasets, etc. A report will be provided to the Board when the work has been completed. A new Health Services Plan will be worked on over the next few months, with the Plan coming to the Board when finalised.

November Benedict Hefford

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Counties Manukau District Health Board Chief Executive’s Report

Recommendation It is recommended that the Board receive the Chief Executive’s Report. Prepared and submitted by: Geraint Martin, Chief Executive 1.0 Introduction

1.1 As routine, my report is set out in three sections:

- Strategic – with a special focus on planning for 2015/16.

- Operational – including the reports from the Director of Strategic Development,

Director of Corporate & Business Services and Director of Ko Awatea.

- Compliance – no issues to report this month.

2.0 Strategic 2.1 As the strategic refresh gathers momentum, it is becoming clear that an important part

will be played by the identification of key objectives, which will act as ‘switches’ for transforming our health system to fit the present and future needs of patients. Through the strategic refresh process, we will: - refine each of the objectives to become quantifiable system level measures that will

in turn form the focus of the work of the DHB.

- bring them to the Board for discussion and agreement.

- Formulate strategic work plans to deliver them.

Included for approval by the Board is the proposed Strategic Plan & Values Framework.

2.2 As part of this, we will need to define an objective that will bring together the work of the health system and give it a clear defined purpose that will stretch and inspire the organisation. For the end of 2015, this has been to demonstrate we are amongst, if not the best, in Australasia, as defined by our 16 system level measures. We know need to reset these for 2020. Through the consultation process, addressing health inequity has emerged as the leading issue – best reflected in debate at the Maori Health Advisory Committee.

During my report to the Board, Doone Winnard and I would propose to lead a discussion with the Board on refining the specific target and actions that will underpin the strategy to address inequity.

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2.3 At the September Board Meeting, two further major components of the strategic refresh will be presented for approval following agreement by ELT in August. They are:

- The Infrastructure Plan - The Community Health Integration Business Case In addition to this, the Board will see other component parts over the next few Board Meetings, so that on completion with a full presentation of the refresh for approval in November, the Board will have shaped its development in depth.

2.4 An important step will be the integration of our programmes to ensure economy of effect, alignment and impact. A special focus will be on improving quality, outcome and financial sustainability. Currently, 2% of our community (10,000 people) drive 49% of our costs (see Appendix 1 for detailed paper). We are in the process of breaking this down by locality and case mix. This will, in turn, give us some granularity to develop approaches to reduce cost, but improve quality.

This will be central to our financial sustainability as we need to move away from a focus on technical efficiency (i.e. doing things right) to one that focusses on allocative efficiency too (i.e. doing the right thing). The work of SWIFT in re-designing our business processes has already begun this process in earnest.

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3.0 Operational 3.1 I am very pleased to be able to report to the Board that provisional results for year end:

- Show we will achieve all six major health targets for the third year running. The performance for each target was:

National Health Targets: Results at 30 June 2015 Target RESULT at 30 JUNE 2015

Shorter Stays in Emergency Department

95% of patients will be admitted, discharged, or transferred from an Emergency Department within six hours.

Improved Access to Elective Surgery

Improved access to Elective Surgery for all populations measured against individual DHB target

Final submissions for coding are not due at the Ministry of Health until 31 July 2015 but our own calculations put our performance at +100% of our Discharge target agreed with the Ministry of Health

Faster Cancer Treatment 62 Day Target: 85% of patients receive their first cancer treatment within 62 days of being referred with a high suspicion of Cancer. National Target: By 1 July 2016 Counties Manukau Health Target (revised) to 1 October 2015.

We are well on the way to achieving this target nine (9) months ahead of the national date. Please refer separate report.

97.0%

74.0%

Actual result yet to be advised by

Ministry of Health

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Immunisation 95% of all eligible children eight months to have completed their scheduled course of immunisation

Performance by Ethnicity: Eight month old children: Excellent results by ethnicity with 91.0% Maaori and 97.3% for Pacific.

Target RESULT at 30 JUNE 2015

Better help for Smokers to quit - Hospitals

95% of hospitalised smokers will be provided with advice and help to quit.

Better help for Smokers to quit – Primary Care

90% of patients who smoke and are seen by a health practitioner in primary care are offered brief advice and support to quit smoking Actual result yet to

be advised by Ministry of Health

Although official Ministry of Health data is not yet to hand indications from PHO data show this result in the vicinity of 95.0%

More heart and diabetes checks

90% of the eligible population will have had their cardiovascular risk assessed in the last five years.

Although official Ministry of Health data is not yet to hand, indications from PHO data show this result

in the vicinity of 90.0%

All Population 94.9%

95.0%

Actual result yet to be advised by

Ministry of Health

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- Show we have met our financial target of $3.4M surplus. Delivering this consistent level of performance, given the challenges we face, is a major achievement. We have, for instance, maintained the ED target for six years – the only DHB to have done so, and our Maori immunisation rate is now at 91%, and 97.3% for Pacific.

3.2 In addition, we are now making significant progress in the areas of Faster Cancer Treatment & Diagnostics. We reached 71.8% on the 30 May 2015, and indications for June are that we are in the vicinity of 74.0%, an important achievement in Quarter 3. We are on course to achieve 85% of patients receiving their first treatment within 62 days of being referred with a high suspicion of cancer by June 2016.

3.3 I would like to acknowledge the immense hard work of the team in delivering this year’s

performance. Pride is not too strong a statement.

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3.4 Strategic Development

Highlights There are seven teams that provide ‘corporate services’ and two direct patient support services (Maaori and Pacific cultural support) in the Strategic Development Directorate. The table below highlights progress on key business as usual or initiatives as at end June. The table also highlights risks that are of organisation concern.

Team Highlights Risks Community relevant…

Population Health

Presentations/Papers work in progress: • PHO enrolment by ethnicity paper has been accepted for

publication by NZMJ – this is important in getting a published reference source for health sector work in relation to data and targets by ethnicity

• Update on Life Expectancy changes and NZ Health Survey results 2011 - 2014 completed and submitted to ELT and CPHAC for discussion

• ‘Using Systems Dynamics Modelling to Improve Outpatient Services’ paper submitted and accepted for poster presentation for international System Dynamics conference

• Language competencies for Pacific and Asian populations paper distributed to Regional Asian Health Planning Group, SWIFT, Outpatient and Interpreting Services Manager, Integration Manager

• Identifying sources of evidence for review of non-pharmacological interventions to improve mental health

• Writing up of the production planning model as a basis for wider role out in other services

Maaori Health Development

ISA – CMH aim to restructure this agreement with NHC to repatriate contract management functions and scale back the expectations of service change in 15/16. This is to better reflect the existing capabilities of NHC to deliver the outcomes agreed under the ISA. Te Rapunga Paeora (Review of Te Kaahui Ora Services) – We are now in the implementation phase of service change effective from 1 July of the Maaori inpatient support service. The service is transitioning to being a Whaanau Ora service for high risk Maaori inpatients.

Delays to the role out of year two deliverables of the ISA

Pacific Health Development

Fanau Ola. The Pacific Health Team have completed two evaluations of the first year of Fanau Ola service and will submit conclusions to the Board for information. This evaluation suggests some positive impact on hospital admissions, EC presentations and length of stay for patients and their Fanau whom are supported by Fanau Ola. Total registration is nearing 1000 patients and 2,800 fanau member with follow up to 12 months post discharge by 30 June 2015. The top 6 issues social reported as reasons contributing to hospitalization were: • Housing issues e.g. cold houses, maintenance and over-

crowding • Families not coping with significant changes in their

household/family life e.g. grief and loss from death, initial diagnosis of chronic illnesses, changes of living and family

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situations including loss of jobs and death • Lifestyle issues e.g. smoking, substance abuse, non-

compliances with diet, medication, and appointments • Financial issues e.g. managing on a benefit, unable to work

due to illness, temporary benefits or accessing ACC due to injuries, lack of money management skills and how to prioritise money

LotuMoui Refresh – community consultation is underway to review the LotuMoui programme and gather community feedback on improvement opportunities. 20 consultations across Lotu Moui churches and community groups have been completed by end of May. A plan for refresh is to be finalised during August in preparation for 206 Calendar year implementation.

Strategically aligned ….

Strategic Planning

2nd draft 2015/16 Annual Plan was submitted to the Ministry 28th of May following endorsement of the break even budget by the Finance and Audit Committee. Final 2015/16 Maaori Health Plan has been approved with two ‘Outstanding Ratings’ in relation to SUDI and Cervical Screening (only 4 Outstanding ratings have been awarded over 350 sections over 20 DHBs so this is a fantastic achievement). 2nd draft Pacific Health Plan was tabled for final review and input by the Alliance Leadership Team prior to Board final review and approval. Early coordination activities have begun for the 2014/15 Annual Report and Quality Accounts to process improve efficiency of data collation and key stakeholder engagement. Auditing dates are now set. Strategy and Values Refresh reported separately.

Change enabled

SPMO Daptiv Implementation: Daptiv is CMH preferred system for project and programme management. An estimated 80 projects have been logged on Daptiv to varying degrees of completeness (e.g. projects, reports and issues/risks updating). The next steps are to establish a prioritization process for new projects

Comms CM Health Website: The total number of visitors to the corporate website for May 2015 was 33,072 which included:

• New visitors – 20,181 (61%) • Returning visitors – 12,891 (39%)

Total number for page hits 72,826 with the top 10 pages being; Staff login, Our Services, A-Z Service Directory, For patients and visitors, Contact us, Middlemore Hospital, For health professionals, Manukau SuperClinic, About CM Health Social Media: All social media pages are experiencing increased reach: • Facebook: Total page likes 1410. Organic post reach has

increased over the past month from an average of 942 to 1569. The best post reach in May was 12.2k people – Waikato mum’s experience with flu.

• Twitter: 1396 followers Linkedin: 2679 followers Youtube: 7 subscribers, 2241 views

Operational Campaigns in progress: Appropriate use of EC, Best for Baby, Flu

HR See deep dive below.

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Deep Dive – Workforce Update This section will take a ‘deep dive’ or focus in depth on activities in the work programme. This month we focus on a recently updated analysis of workforce at CMH. Two reports have been produced – DHBSS Workforce report and CMH’s update of the 2011 Workforce Projections. A summary of changes are presented below. A summary of the CMH 2015 workforce analysis suggests that, since 2010: • The employed workforce has grown: As at April 2015, there are 7,390 people or 5,550 FTEs employed

at CMH in more than 100 roles, across more than 20 sites serving 520,000 people resident in the District. The 2011 report forecast that CMH would need 5135 FTEs to meet population needs by 2015.

• Proportion of casual and part timer workers increased: in 2010, casual and part time workers represented a third of the workforce. In 2015 over half of staff are on casual and part time contracts. This is the highest proportion when compared with all DHBs:

• Growth of clinical staff has been in nursing: Nursing is by far the largest workforce group when compared with both All Staff (42%) and as a proportion of Clinical staff (56%). When compared with 2010, nursing has increased in proportion from 36% of All staff and 46% of Clinical Staff.

• Staff who identify as Asian has increased at a faster rate: In 2010, staff who identified as Asia made up

24% of the workforce compared with 27% of All staff and 30% of All Clinical Staff in 2015. There has been significant growth in this workforce while Maaori has remained stagnant (6% identified as Maaori in 2010) and slight growth in Pacific (10%). Ethnicity information should be interpreted with caution as anecdotally many staff choose not to identify their ethnicity

• Staff are staying longer: A third of CM Health’s employees have been employed between 1-4 years. This is a smaller size when compared to 2010 where 43% All Staff and 41% Clinical Staff to 35% had tenures of 1-4yrs – staff are staying longer. Those that were in this group 4 years ago have stayed with us and have helped to increase the 5-9 year length of service group. This is also supported by our turnover decreasing from 9.3% to 7.8% since 2011. When compared nationally, the average tenure is 8.5 years, compared to CMH’s 6.2 years. It should be noted that Waitemata District Health Board

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(WDHB) have an average length of service of 6.6 years and Auckland District Health Board (ADHB) have an average length of service of 8.6 years (possibly due to greater degree of sub-specialisation).

Further analysis with more in depth focus on particular occupation groups and skills, turnover and implications for service developments will be explored as part of a People and Culture Action Plan that will support Strategy implementation. The high level strategic objectives are to ensure that we have a workforce that is fit for an integrated delivery setting, we are attracting and recruiting people who fit our values and service needs while keeping talent we have. The Board may wish to comment on specific issues and/or workforce development questions they wish to have considered as part of this work. The final analysis will be released on our website as per normal practice.

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3.5 Finance

FINANCIAL POSITION at May and June 2015 June High Level Draft (Month Closed Monday 12th) Statement of Performance by Operating Arm

Month June 15

Net Result YTD June 15

Full year

Act $000 Var. $000 Act Bud Var. Last year

Bud Forecast

2,541 688 1,853 Hospital Provider 18,760 15,886 2,874 17,035 15,886 17,931

(848) (805) (43) Integrated Care (9,154) (9,661) 507 (5,228) (9,661) (9,626)

(1,548) (1,119) (429) Ko Awatea (13,499) (13,500) 1 (13,397) (13,500) (13,490)

(668) 87 (755) HBL (2,346) 285 (2,631) (1,607) 285 (1,738) (523) (1,149) 626 Provider (6,239) (6,990) 751 (3,197) (6,990) (6,923)

2,612 581 2,031 Funder 12,025 6,996 5,029 8,618 6,996 7,644

88 - 88 Governance (2,769) 1 (2,770) (2,367) 1 (724)

- 3,000 (3,000) Gain on Sale - 3,000 (3,000) 3,000 3,007

2,177 2,432 (255) Surplus (deficit) 3,017 3,007 10 3,054 3,007 3,004

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Statement of Performance (Draft June 2015)

Month

Year to Date

Full Year

Act Bud Var. $000 Act Bud Var. Last year Bud Forecast

Revenue

133,167 121,255 11,912 Crown 1,464,379 1,455,667 8,712 1,414,040 1,455,667 1,455,400

4,968 3,070 1,898 Other 39,863 33,697 6,166 39,769 33,697 32,597

138,135 124,325 13,810 Total Revenue 1,504,242 1,489,364 14,878 1,453,809 1,489,364 1,487,996

Expenses

52,069 46,418 (5,651) Personnel 547,554 547,728 174 526,819 547,728 541,174

7,368 4,611 (2,757) Outsourced 69,314 56,217 (13,097) 65,483 56,217 59,503

54,121 54,855 734 Funder Provider payments

647,220 658,246 11,026 637,384 658,246 653,550

14,462 8,218 (6,244) Clinical Sup. 110,679 97,040 (13,639) 101,192 97,040 104,019

4,040 5,568 1,528 Infrastructure 68,646 67,470 (1,176) 67,447 67,470 67,307

132,060 119,670 (12,390) Operating Exp 1,443,413 1,426,701 (16,712) 1,398,325 1,426,701 1,425,553

6,075 4,655 1,420 Surplus after operating Exp.

60,829 62,663 (1,834) 55,484 62,663 62,443

975 2,848 1,873 Depn. 30,032 34,156 4,124 29,923 34,156 34,157

954 1,280 326 Interest 12,506 15,360 2,854 8,822 15,360 14,539

1,969 1,095 (874) Capital Chg. 15,274 13,140 (2,134) 13,685 13,140 13,751

- 3,000 - Gain on Sale - 3,000 - 3,000 3,007

2,177 2,432 (255) Net Surplus 3,017 3,007 10 3,054 3,007 3,004

MAY 2015 Summary: The month produced a small positive variance of $75k, with an equally small favourable variance of $265k year to date. The outlook for the final month will be challenging, as with only a very minor favourable variance in any one month it makes it hard to absorb any cost fluctuations within the organisation. At this point in time the organisation is still on target to come in on budget (subject to the anticipated gain on sale of land at Botany ($3.0m). Month / Year to date The consolidated result for the month as stated above was a slight favourable variance $75k, with the actual result being a deficit of $(642)k v’s budget $(717)k. The year to date result is a favourable variance of $265k, with actual $840k v’s budget $575k surplus. The Funder Arm was $368k favourable to month budget and year to date $2,998k favourable. Community pharmacy continues to produce an unfavourable variance to budget (see details later in report). As per the previous months the trend is for Aged Residential Care (over 65s) demand to continue to be below budget which is the main driver for the months and year to dates favourable

24


result. This trend is contrary to previous history and forecast projections with no specific driver apparent but can reverse just as quickly (see details later in report).

The Provider Arm consolidated, produced a result that was unfavourable to budget by $2k, with year to date is favourable $125k. The Hospital side of the provider arm was favourable for the month by $365k and year to date $1,021k favourable. HBL saving for linen and laundry have not been achieved and are likely to be delayed until the start of the new Financial Year, costing the organisation over $1m in lost savings. Governance was unfavourable for the month by $(291)k and year to date $(2,858)k unfavourable, primarily driven by continuing costs related to Project SWIFT, (which at this point in time are unable to be capitalised), Planning and Funding, DHB management personnel and consultancy. Statement of Performance by Operating Arm

Month May 15

Net Result YTD May 15

Full year

Act $000 Var. $000 Act Bud Var. Last year

Bud Forecast

909 544 365 Hospital Provider 16,219 15,198 1,021 14,010 16,713 17,931

(879) (805) (74) Integrated Care (8,306) (8,856) 550 (4,817) (9,590) (9,626)

(1,178) (1,122) (56) Ko Awatea (11,951) (12,381) 430 (12,081) (13,413) (13,490)

(150) 87 (237) HBL (1,678) 198 (1,876) (1,487) (714) (1,738)

(1,298) (1,296) (2) Provider (5,716) (5,841) 125 (4,375) (7,004) (6,923)

947 579 368 Funder 9,413 6,415 2,998 8,025 6,996 7,644

(291) - (291) Governance (2,857) 1 (2,858) (316) 1 (724)

- - - Gain on Sale - - - - 3,007 3,007

(642) (717) 75 Surplus (deficit) 840 575 265 3,334 3,000 3,004

Volume Summary (May 2015)

Total WIES Month Year to date Act Bud Var. % Last.

Yr. Act Bud Var. % Last. Yr.

5,542 5,438 104 1.91% 5,539 Acute 62,972 60,673 2,299 3.79% 61,043

1,631 1,674 (43) (2.6)% 1,804 Elective 16,245 16,625 (380) (2.3)% 16,681

7,173 7,112 61 0.86% 7,343 Total 79,217 77,298 1,919 2.48% 77,724

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WIES volumes have been affected by the delay in the refurbishment project of four Manukau theatres that concluded on 7 April 2015. With all ten Manukau theatres now fully fit for purpose, increased emphasis has been put on ensuring optimal efficiency of the theatre lists and on increasing the rate of day case surgery. Substantial elective work has been done to maintain the 120 day waiting time target, however, due to the loss of elective theatre capacity (due to closures), this KPI has not been met in May (3 patients). YTD WIES elective volumes are below contract offset by the favourable acute volume variance. Expectation for balance of year is to meet both WIES and discharge contract volumes and to achieve MoH targets set for CMDHB. Discharges Month Year to date

Act Last Yr. Var. % Act Last Yr. Var. %

7,237 7,074 163 2.3% Acute 79,310 77,768 1,542 1.98%

1,534 1,643 (109) (6.6)% Elective 15,345 15,770 (425) (2.7)%

8,771 8,717 54 0.6% Total 94,655 93,538 1117 1.19%

0.82 0.84 0.02 2.9% Ratio WIES to discharges

0.84 0.83 (0.01) (1.3)%

Volumes Other Month Year to date

Act Last Yr. Var. % Act Last Yr. Var. %

626 640 (14) (2.2)% Birth Numbers 6,691 6,715 (24) (0.4)%

8,995 8,623 372 4.31% ED Volumes 99,923 95,515 4,408 4.61%

4,509 4,567 (58) (1.3)% Renal Dialysis

50,305 47,951 2,354 4.91%

64,918 75,917 (10,999) (14.5)%

Outpatient Summary*

733,920 766,631 (32,711) (4.3)%

2.4 2.3 0.1 4.35%

ALOS 2.3 2.4 (0.1) (4.2)%

*NOTE: Outpatient Summary data now reflects Mental Health and Clinical Support data, hence the marked increase from March report The table has therefore been corrected for Act and Last Year.

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Statement of Performance (May 2015)

Month

Year to Date

Full Year

Act Bud Var. $000 Act Bud Var. Last year Bud Forecast

Revenue 122,619 121,231 1,388 Crown 1,331,212 1,334,412 (3,200) 1,290,177 1,456,397 1,455,400

3,151 2,686 465 Other 34,895 30,627 4,268 34,676 32,246 32,597

125,770 123,917 1,853 Total Revenue 1,366,107 1,365,039 1,068 1,324,853 1,488,643 1,487,996

Expenses

44,725 45,814 1,089 Personnel 495,485 501,310 5,825 482,711 556,961 541,174

6,894 4,626 (2,268) Outsourced 61,946 51,606 (10,340) 59,534 46,607 59,503

55,264 54,855 (409) Funder Provider payments

593,099 603,391 10,292 579,397 657,917 653,550

8,968 8,561 (407) Clinical Sup. 96,217 88,822 (7,395) 92,582 97,038 104,019

6,582 5,558 (1,024) Infrastructure 64,606 61,902 (2,704) 58,952 67,471 67,307

122,433 119,414 (3,019) Operating Exp 1,311,353 1,307,031 (4,322) 1,273,176 1,425,994 1,425,553

3,337 4,503 (1,166) Surplus after operating Exp.

54,754 58,008 (3,254) 51,677 62,649 62,443

1,837 2,845 1,008 Depn. 29,057 31,308 2,251 28,094 34,156 34,157

983 1,280 297 Interest 11,552 14,080 2,528 7,774 15,360 14,539

1,159 1,095 (64) Capital Chg. 13,305 12,045 (1,260) 12,475 13,140 13,751

- - - Gain on Sale - - - 3,007 3,007

(642) (717) 75 Net Surplus 840 575 265 3,334 3,000 3,004

Better than 5%

Worse than 5%

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Revenue

Month YTD Full Yr.

Act Bud Var. $000 Act Bud Var. Bud

68,426 67,448 978 Provider 751,882 743,857 8,025 778,434

118,941 117,286 1,655 Funder 1,286,791 1,290,160 (3,369) 1,363,247

(62,730) (61,852) (878) Elimination (684,279) (680,354) (3,925) (715,366)

1,133 1,035 98 Governance 11,713 11,376 337 15,085 125,770 123,917 1,853 Total 1,366,107 1,365,039 1,068 1,441,400

Provider: favourable for the month of May. The main drivers for the current month’s variance are: • Government Revenue; CTA Nursing timing of revenue to budget, ACC revenue phasing reflects a

favourable variance for the month; Acute spines revenue; Outsourced Gastro MoH funding; integrated Care (offset by costs); Personal Health (incl. breast screening revenue).

• Patient/Consumer Sourced; Tahitian burns; Non-resident additional billings for the month (offset by bad debts).

• Other Income Interest Received is above budget for the month; donation revenue; Bad debt recovery; Pacific revenue offset against costs; Training course fees.

• Funder Payments; Variation in revenue phasing from Funder for contracts outside base funding ie: 20k days, localities, IDF inflow revenue

Funder:

Staff Costs

Month

YTD Full Yr.

Act Bud Var. $000 Act Bud Var. Bud 43,944 45,140 1,196 Provider 487,101 493,894 6,793 519,227 781 674 (107) Governance 8,384 7,416 (968) 9,898 44,725 45,814 1,089 Total 495,485 501,310 5,825 529,125

14,302 14,846 544 Medical 155,535 160,659 5,124 169,096

16,634 16,864 230 Nursing 187,408 184,249 (3,159) 197,975

6,219 6,554 335 Allied Health 70,606 73,475 2,869 77,878

2,160 2,026 (134) Support Personnel 22,584 22,121 (463) 21,966

5,410 5,524 114 Management Admin 59,352 60,806 1,454 62,210

44,725 45,814 1,089 495,485 501,310 5,825 529,125

Provider: Favourable personnel costs reflects a deliberate strategy to balance overall 2014/15 budget expectations. Key variances include delayed realisation of Practicing Sustainable Health Care procurement savings for the month. A measure of these costs has been offset by planned management of vacancies and annual leave. Outsourcing to cover key vacancies (e.g. Mental Health) and clinical services where we are short on specialist capacity, for the month. Medical Personnel costs for the month, reflects existing vacancies, offset by outsourced services. Nursing personnel costs for the month; reflects realised underspend on nursing course fees (partly offset by other costs); target savings that have not been met due to the level of clinical demand within the hospital; Vacancies part offset by bureau. Please refer to Director of Nursing report for update on the Sustainable Nursing Workforce Strategy. Note that the Personnel cost variance above includes costs incurred in delivering additional unbudgeted revenue.

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Outsourced Services

Month YTD Full Yr.


1,080 466 (614) Medical 7,704 5,095 (2,609) 4,860

245 47 (198) Nursing 1,735 433 (1,302) 549

44 71 27 Allied Health 585 774 189 768

64 38 (26) Support 491 415 (76) 444

409 155 (254) Management/Administration 3,304 1,741 (1,563) 1,486

1,842 777 (1,065) Total Personnel 13,819 8,458 (5,361) 8,107

3,098 2,542 (556) Corporate & Funder Services 29,765 28,004 (1,761) 28,296 1,954 1,307 (647) Clinical Service 18,362 15,144 (3,218) 18,864 6,894 4,626 (2,268) Total 61,946 51,606 (10,340) 55,267

• Provider: unfavourable for May (includes personnel, clinical and other). Clinical Support: Additional outsourcing of MRI scans to meet MOH targets. Medicine: Outsourced gastro colonoscopies required to meet MOH targets. Surgical: Outsourced surgical procedures continue to maintain MoH ESPI 120 day targets. Mental Health: Vacancies covered by locums. Non-Clinical Outsourcing: Unbudgeted inventory management costs and Pharmac Device contract, hA additional supply chain costs, exec/finance outsourcing. HBL: National Procurement, FPSC, Regional Food services unbudgeted costs. Integrated Care: Additional outsourcing costs offset by revenue. Kidz and Womens Health: UoA/AUT additional cost and external bureau usage in WH services.

Independent Service Provider (Demand driven expenditure)

Month Major Categories YTD Full Yr.


Personal Health

20,318 20,856 538 IDF Personal Health 227,216 229,423 2,207 245,784

8,216 8,350 134 Pharmaceuticals 93,453 91,845 (1,608) 99,096

7,201 6,976 (225) Primary Practice Services – Capitated 78,051 76,734 (1,317) 81,144

573 575 2 Child and Youth 6,346 6,331 (15) 5,767

482 465 (17) Adolescent Dental Benefit 5,218 5,117 (101) 5,664

329 247 (82) Chronic Disease Management and Education

2,881 2,715 (166) 5,772

374 362 (12) Palliative Care 4,117 3,973 (144) 4,332

344 427 83 General Medical Subsidy 3,774 4,691 917 4,176

1,284 1,993 709 Other 16,589 21,920 5,331 16,603

39,121 40,251 1,130 Total Personal Health 437,645 442,749 5,104 468,338

Pharmaceuticals; 40% of the $100m budget consists of pharmacy funding relating to drug dispensing and added value services. This expenditure has been under constant change over the last couple of years as the sector move from a pure volume dispensing arrangement to a hybrid of volume dispensing coupled

29


with greater patient health management. This transition has been a complex programme of 1) ensuring consistent pharmacy income, 2) maintaining access to appropriate drugs and 3) implementing greater managed healthcare for patients with long term conditions. Under the implementation, managed by the Ministry the total country dispensing cost has been controlled and capped but that has not prevented variation at DHB level. CMH is one DHB with forecasted dispensing growth greater than average and greater than our budget. Complexity of the changes have meant forecast detail was not being available at budget time and consequently dispensing budget has been under estimated by $2m or 5%. Actual charges being incurred are also greater than forecasted by $0.275m Changes in co-pays and rebates net the variances down to a $1.974m overspend by year end. Reasons why CMH differs from the average DHB are complex but relate to the extent how well DHBs have managed their pharmacies dispensing activity. DHB’s with pharmacies with historically excessive repeat dispensing’s having seen their costs reduce as the incentive for dispensing volume decreases. Consequently, DHBs like CMH with well managed dispensing have had to take an increased share in maintaining the total capped dispensing budget.

Mental Health

1,226 1,226 - IDF Mental Health 13,483 13,483 - 13,824

817 917 100 Community Residential Beds & Services

9,323 10,081 758 11,232

692 688 (4) Other Home Based Residential Support 7,701 7,574 (127) 8,280

319 320 1 Dual Diagnosis – Alcohol & Other Drugs

3,508 3,525 17 3,636

272 271 (1) Crisis Respite 2,986 2,990 4 3,267

357 327 (30) Child & Youth Mental Health Services

3,911 3,598 (313) 3,561

176 163 (13)

Kaupapa Maori Mental Health Services - Community

1,924 1,803 (121) 1,975

162 185 23 Mental Health Community Service 1,729 2,036 307 1,785

2,218 742 (1,476) Other 6,065 8,144 2,079 13,086

6,239 4,839 (1,400) Total Mental Health 50,630 53,234 2,604 60,646

As in previous years the Mental Health ring fenced funding faces a full year underspend of about $3.4m. This surplus will remain within the ring fence for future mental health capital facility projects.

Disability Support Services

4,407 4,341 (66) Residential Care: Hospitals 46,561 47,749 1,188 49,707

1,972 2,035 63 Residential Care: Rest Homes 21,111 22,384 1,273 23,076

1,771 1,731 (40) Home Support 18,726 19,038 312 20,116

1,455 1,422 (33) Other 15,679 15,631 (48) 15,808

9,605 9,529 (76) Total Disability Support Services 102,077 104,802 2,725 108,707

These costs include Home Based Support and Aged Residential Care for over 65s. CMH over 65s population is growing at over 4% pa and HoP budgets have been fixed to this growth. Recent forecasts have revealed

30


growth utilisations of these services are below population growth and on current trends will result in a cost under spend of $3,555m for the year. Reasons why this is happening are a combination of controllable and uncontrollable variables. Variables like;

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

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

Service cost.

177 113 (64) Total Public Health 1,419 1,262 (157) 852

122 123 1 Total Maori Health 1,328 1,344 16 1,308

55,264 54,855 (409) Funder 593,099 603,391 10,292 639,851

Clinical Supplies

Month YTD Full Yr. Act Bud Var. $000 Act Bud Var. Bud 3,642 3,621 (21) Treatment Disposables 39,815 37,095 (2,720) 40,569

728 601 (127) Diagnostic Supplies & Other Clinical Supplies 7,854 6,748 (1,106) 7,345

1,133 1,039 (94) Instruments & Equipment 11,690 10,783 (907) 11,786

345 286 (59) Patient Appliances 3,334 2,942 (392) 3,217 1,250 1,486 236 Implants & Prostheses 15,087 14,589 (498) 15,983 1,592 1,232 (360) Pharmaceuticals 15,458 13,404 (2,054) 14,582 278 296 18 Other Clinical Supplies 2,979 3,261 282 3,558 8,968 8,561 (407) Total 96,217 88,822 (7,395) 97,040 Made up of:

184 (184) Procurement Savings not achieved 2,923 (2,923)

473 (473) Volume increases in Labs, Pharms and Radiology

2,748 (2,748)

38 (38) AR HOP 472 (472) - Cath. Lab Volumes (298) 298 Offset by Revenue 1,819 (1,819)

- Clinical Engineering R&M (413) 413

(288) 288 Other minor 144 (144) 407 (407) Total 7,395 (7,395)

Provider: Delayed target procurement savings across the services are partially offset in other cost and revenue areas. Clinical Support: Volume increase in Labs, Pharms and radiology based on surgical services volumes. Surgical Services: A reduction in the ACC electives workload, the absence of Tahitian burns patients and realised procurement savings has impacted favourable on the service in May. ARHOP: Community continence, ostomy and bandages & dressing overspend. Other, minor underspends across divisions.

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Non-Clinical / Infrastructure (excluding Interest and Capital Charge)

Month YTD Full Yr. Act Bud Var. $000 Act Bud Var. Bud 6,094 5,262 (832) Provider 59,379 58,663 (716) 89,056 488 296 (192) Governance 5,227 3,239 (1,988) 4,053 6,582 5,558 (1,024) Total 64,606 61,902 (2,704) 93,109 Provider: unfavourable for May explained by delayed target laundry procurement savings across the services; Utilities underspend; Bad Debts offset by revenue; R&M Overspend; Consultants part Clinical Support National Patient Flow Project cost offset by revenue and kA additional course fees. •

Interest and Capital Charge

Month YTD Full Yr. Act Bud Var. $000 Act Bud Var. Bud 267 100 167 Interest - Received 2,921 1,100 1,821 1,200

983 1,280 297 Interest Paid - Debt 11,552 14,080 2,528 13,450

716 1,180 464 Net Interest Paid 8,631 12,980 4,349 12,250 1,159 1,095 (64) Capital Charge 13,305 12,045 (1,260) 12,996

- Interest cost: CMDHB level of borrowings lower than budget delivering a favourable interest cost variance for the month.

- Capital Charge: unfavourable variance reflects the actual cost of capital charged by MoH against budget.

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Ratios Provider Arm (only) Costs to Revenue (%) last six months

May 15

Apr 15

Mar 15

Feb 15

Jan 15

Dec 14

Nov 14

Medical 20.83 20.37 21.08 20.29 20.85 20.81 20.05 Nursing 24.27 27.25 24.47 23.62 25.68 24.89 24.66 Allied 9.09 9.49 9.09 9.29 9.23 9.61 9.33 Support 3.16 3.15 2.94 2.86 3.11 3.13 2.96 Management 6.88 7.00 7.13 6.56 6.52 7.18 6.60 Personnel 64.22 67.25 64.72 62.62 65.39 65.62 63.60 Outsourced Pers. 2.71 1.78 2.18 1.83 1.85 2.10 2.01 Total Personnel 66.93 69.03 66.90 64.45 67.23 67.72 65.61 Outsourced Clinical Services 2.86 2.25 3.01 2.17 2.97 2.15 2.21

Outsourced Corp (hA) 4.28 3.64 3.59 3.69 3.70 3.61 3.72

Clinical Supplies 13.14 13.46 14.81 13.18 12.99 14.38 13.95 Infrastructure 14.69 14.13 13.91 13.31 13.77 13.21 13.74 Total 101.90 102.51 102.23 96.81 100.66 101.09 99.23

Provider cost as a percentage of revenue over the last four years and year to date

2015 YTD 2014 2013 2012 2011 Medical 20.6 20.7 21.2 20.5 20 Nursing 24.9 25.1 25.5 24.7 24.3 Allied Health 9.4 9.7 9.7 9.5 9.2 Support 3.0 2.9 2.7 2.7 2.6 Man/Admin 6.9 6.8 7.2 7.8 7.7 Personnel 64.8 65.2 66.3 65.2 64.0 Outsourced Personnel 2.0 1.8 1.8 1.7 1.9 Total Personnel 66.7 67.0 68.1 66.9 65.9 Outsourced Clinical Supplies 2.4 2.7 2.9 2.8 3.4 Outsourced Corporate 3.7 3.7 3.4 3.3 2.4 Clinical supplies 14.0 14.0 14.4 14.7 14.6 Infrastructure 13.9 13.0 12.4 13.2 13.8 Total 100.8 100.4 101.2 100.9 100.0 Depn 3.9 3.8 3.1 2.8 3.6 Interest 1.5 1.1 1.5 1.3 1.4 Capital Charge 1.8 1.7 1.7 1.7 1.7

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34


Balance Sheet Actual Budget Variance Opening

1st July 14 YTD Movement

Current Assets Petty Cash 10 10 - 10 - Bank 36,504 10,854 25,650 20,705 15,799 Trust 885 860 25 865 20 Prepayments (347) 500 (847) 1,196 (1,543) Debtors 35,423 42,000 (6,577) 32,887 2,536 Inventory 1,984 4,490 (2,506) 1,434 550 Assets Held for Sale 12,503 12,503 - 12,503 - Total current Assets 86,962 71,217 15,745 69,600 17,362 Fixed Assets Land 110,020 62,430 47,590 110,020 - Buildings & Plant 624,205 738,934 (114,729) 710,607 (86,402) Investment Property 1,360 1,360 - 1,360 - Information Technology 2,770 2,995 (225) 4,145 (1,375) Information Software 323 980 (657) 4,391 (4,068) Motor Vehicles 3,932 4,588 (656) 4,292 (360) Total Cost 742,610 811,287 (68,677) 834,815 (92,205) Accum. Depreciation (149,494) (228,849) 79,355 (195,671) 46,177 Net Cost 593,116 582,438 10,678 639,144 (46,028) Work In-progress 2,119 10,000 (7,881) 1,851 268 Total Fixed Assets 595,235 592,438 2,797 640,995 (45,760) Investments (hA IT / HBL) 29,349 29,250 99 27,127 2,222 Total Assets 711,546 692,905 18,641 737,722 (26,176) Current Liabilities Creditors 84,459 95,365 (10,906) 91,817 (7,358) Income in Advance 14,305 1,300 13,005 3,192 11,113 GST and PAYE 6,413 5,000 1,413 6,761 (348)

Loans (Crown and HBL shared banking) 40,000 - 40,000 40,000 -

Payroll Accrual & Clearing 43,025 31,049 11,976 32,452 10,573 Employee Provisions 80,384 84,200 (3,816) 81,249 (865) Total Current Liabilities 268,586 216,914 51,672 255,471 13,115 Working Capital (181,624) (145,697) (35,927) (185,871) 4,247 Net Funds Employed $442,960 $475,991 $(33,031) $482,251 $(39,291) Non-Current Liabilities Term Loans 227,600 267,600 (40,000) 227,600 -

Employee Provisions (non-current) 17,494 15,300 2,194 16,984 510

Trust and Special Funds 881 860 21 864 17 Insurance Liability- Non Current 1,337 1,300 37 1,337 - Total Non-Current Liabilities 247,312 285,060 (37,748) 246,785 527 Crown Equity Crown Equity 124,497 124,498 (1) 124,497 124,498 Revaluation Reserve 134,373 127,443 6,930 134,373 127,443 Retained Earnings – Provider (80,227) (79,584) (643) (80,227) (79,584)

Retained Earnings – Govern. (21,008) (16,643) (4,365) (21,008) (16,643)

Retained Earnings - Funder 38,013 35,217 2,796 38,013 35,217 Total Crown Equity 195,648 190,931 4,717 235,466 (39,818) Net Funds Employed $442,960 $475,991 $(33,031) $482,251 $(39,291)

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Commentary:

Net borrowings: Long and short term debt less bank balance is $25.6m lower than budget. Stronger closing cash position, opening position $32.6m higher than budgeted and not drawing down on the final $30m facility for CSB ($24.1m will be drawn on 30th June 2015).

Debtors: $6.6m lower than budget, $2.5 higher than June 14, due to timing of payments mainly by Crown organisations (MOH ACC and other DHBs).

MOH Debtors $000

Total Current 30 day +

Invoiced 3,871 2,945 926

Accrued 345

Total 4,216

Accounts payable: $10.9m lower than budget and $7.3m lower than June 2014. Net Fixed Assets: Are $2.8m higher than budget. Due to the revaluation on Buildings, there is movement between accumulated depreciation and Buildings Plant and Equipment of $72m. Also buildings were devalued by $40m in June 2014. Investments in Associates: Health Benefits Ltd $ 5.7m for the FPSC project Note: we will need to continue to ensure that these investments have underlying value through the future success of HBL or its successors. healthAlliance $23.6m for ICT capital investment.

Payroll Accrual & Clearing: due to timing of payroll cut offs.

There are no other significant issues regarding the Balance Sheet.

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Cash flow

Month YTD Actual Budget Variance Actual Budget Variance Cash flows from operating activities: Crown Revenue 120,269 121,052 (783) 1,340,120 1,330,682 9,438 Other 2,884 2,441 443 31,974 26,878 5,096 Interest rec. 267 100 167 2,921 1,100 1,821 Expenses Suppliers 91,528 77,354 (14,174) 836,217 806,608 (29,609) Employees 40,133 41,194 1,061 485,267 494,326 9,059 Interest paid 983 1,280 297 11,552 14,084 2,532 Capital charge - - - Net cash from Operations (9,224) 3,765 (12,989) 41,979 43,642 (1,663)

Fixed Assets (1,739) (1,970) 231 (23,955) (23,695) (260) Investments (hA & HBL) - (499) 499 (2,222) (4,766) 2,544

Restricted & Trust Funds 6 (1) 7 17 1 16

Net cash from Investing (1,733) (2,470) 737 (26,160) (28,460) 2,300

Debt - - - - - - Other non-current liability - - - - - -

Net cash from Financing - - - - - -

Net increase / (decrease) (10,957) 1,295 (12,252) 15,819 15,182 637

Opening cash 2,205 10,429 (8,224) 21,580 (3,458) 25,038 Closing cash (8,752) 11,724 (20,476) 37,399 11,724 25,675 Summary Month YTD Actual Budget Variance Actual Budget Variance Opening cash 48,356 10,429 37,927 21,580 (3,458) 25,038 Operating (9,224) 3,765 (12,989) 41,979 43,642 (1,663) Investing (1,733) (2,470) 737 (26,160) (28,460) 2,300 Financing - - - - - - Closing cash 37,399 11,724 25,675 37,399 11,724 25,675 Commentary: Crown Revenue: Increased Revenue is offset by additional costs below lower Debtors (collections). Suppliers $(29.6)m: higher Outsourced ($10.0m), Clinical Supplies ($7.4m), and Infrastructure cost ($2.7m) along with reduced creditors ($9.5m) Employee $9.1m: Lower salary and wages, and timing of wage payments. Some of the above is offset by additional Crown revenue. Interest reflects better borrowing rates.

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Treasury All term debt facilities are now through the MOH, with interest rates “locked in” at fixed rates. Working capital facilities remain with Westpac via Health Benefits Ltd ($64.4m). Both ASB/Commonwealth Bank ($10.0m) and Westpac ($10.0m) lease facilities are allowable by the Crown. Crown Debt

Drawn ($ millions)

Date of Advance

Maturity Interest rate Rate

5.0 16-Jul-12 15-Apr-17 3.32% Fixed, Semi-Annual 15.0 15-Jul-08 15-Dec-17 6.36% Fixed, Semi-Annual 10.0 28-Jan-09 15-Dec-17 4.41% Fixed, Semi-Annual 5.0 03-Feb-09 15-Dec-17 4.41% Fixed, Semi-Annual 5.0 20-May-09 15-Dec-17 5.65% Fixed, Semi-Annual 10.0 30-Apr-10 15-Dec-18 5.88% Fixed, Semi-Annual 20.0 20-Mar-13 15-Dec-18 3.30% Fixed, Semi-Annual 5.0 15-Nov-11 15-Mar-19 5.13% Fixed, Semi-Annual 13.0 27-Oct-09 15-Dec-19 6.10% Fixed, Semi-Annual 7.0 27-Oct-09 15-Dec-19 6.10% Fixed, Semi-Annual 5.0 20-Jun-12 15-May-21 3.45% Fixed, Semi-Annual 42.6 29-Jun-12 15-May-21 4.22% Fixed, Semi-Annual 20.0 18-Dec-12 15-May-21 3.56% Fixed, Semi-Annual 30.0 15-Apr-13 15-Apr-22 3.45% Fixed, Semi-Annual 30.0 20-Dec-13 15-Apr-23 4.91% Fixed, Semi-Annual 5.0 20-May-09 15-Apr-23 4.74% Fixed, Semi-Annual 40.0 15-Apr-15 15-Apr-25 3.40% Fixed, Semi-Annual

$267.6 4.33% Weighted Average

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FTE Reporting Provider Arm

Actual Budget Variance Comparative Actual Budget Variance

FTE FTE FTEVariance to Prev Mnth FTE FTE FTE

Medical Personnel 772 788 16 F 773 788 15 F

Nursing Personnel 2,787 2,533 (254) U 2,625 2,541 (84) U

Allied Health Personnel 1,128 1,122 (6) U 1,088 1,124 36 F

Support Personnel 523 482 (41) U 484 474 (10) U

Management/Administration Personnel 828 828 0 F 782 828 46 F

Total (before Outsourced Personnel) 6,038 5,753 (285) U 5,752 5,756 3 F

Outsourced Medical 39 16 (23) U 25 16 (9) U

Outsourced Nursing 22 4 (17) U 14 3 (11) U

Outsourced Allied Health 3 5 2 F 4 5 1 F

Outsourced Support 12 7 (5) U 9 7 (1) U

Outsourced Mangement/Admin 52 36 (16) U 47 36 (11) UTotal Outsourced Personnel 128 69 (59) U 99 68 (30) UTotal Personnel 6,165 5,821 (344) U 5,851 5,824 (27) U

Month Year to Date

FTE By Professional GroupMay 2015

Total FTE (including outsourced) for May is 6,165 which is (344) FTE unfavourable to budget and 190 FTE higher than last month. The May FTE variance reflects high levels of vacancies, 184 FTE within the services due to the absence of available skilled workforce within some specialities. Cover has been provided in overtime (54)FTE, bureau (72)FTE, casuals (75)FTE and external outsourcing (128)FTE. Annual leave (117)FTE, sick leave (51)FTE and study leave (17)FTE, Other miscellaneous movements for the month 33FTE. CMH have employed an additional (47)FTE, which are unbudgeted but have been funded externally. Personnel Costs per FTE (Rolling average)

May 15

Apr 15

Mar 15

Feb 15

Jan 15

Dec 14

Nov 14

Oct 14

Medical 169,992 169,497 168,840 167,474 166,122 166,148 166,418 166,387

Nursing 77,352 77,748 77,494 77,248 76,784 76,853 77,041 77,028 Allied Health 70,444 70,903 70,724 70,823 70,776 70,790 70,538 70,320

Mgmt/Admin/Clerical 73,360 73,911 73,657 73,403 73,223 73,120 72,714 72,318

Support 50,677 50,581 50,366 50,444 50,351 50,570 50,259 50,206

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The table below shows the Management Admin cap return to the MoH each month. Counties Manukau May 15 Apr 15 Mar 15 Feb 15 Jan 15 Dec 14 Accrued FTE (as per MOH template) 849.0 845.7 865.5 865.1 760.7 818.8 Annual Leave loading (76.4) (76.7) (76.3) (76.0) (75.9) (75.8) FTE’s on holiday 35.8 (82.8) 59.0 55.6 158.6 98.8 Payroll FTE’s 849.0 851.8 848.2 844.7 843.4 841.8 Contractors / Consultants (FTE equivalent) 11.0 11.0 11.0 11.0 11.0 11.0 Vacancy 6.5 4.7 8.3 11.8 13.1 14.7 Total 867.5 867.5 867.5 867.5 867.5 867.5 Number submitted Jan 09 for 31 Dec 08 867.5 867.5 867.5 867.5 867.5 867.5 Variance - - - - - -

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3.6 Ko Awatea

Ko Awatea delivers a comprehensive portfolio of organisational support functions including data analysis and support, Learning and Development, Workforce, Libraries, Quality Improvement, Research Office and research support, digital services, clinical simulation, evaluation and knowledge management. Ko Awatea has created a very significant change capability, locally, regionally and nationally. Over 750 frontline staff have trained in the model for improvement and had experience in a change project. We have also delivered core leadership training to 80 emerging clinical and non-clinical leaders in our staff and in depth leadership training for 16 Counties emerging leaders. We are in discussions with the Leadership Institute led by Dr Lester Levy to develop a joint program for leadership for Doctors. Regionally and nationally we have led training of Improvement Advisors in every DHB, and engaged them in an active network. Additionally, we have built capability and capacity for change and improvement through regional and national campaigns (see below). Ko Awatea acts as an engine for transformation primarily locally, but also regionally and nationally, with a strategy of building ‘will’, harvesting and generating ‘ideas’, and efficiently ‘executing change’. The vision for Ko Awatea is ‘Learning globally, impacting locally’ and our mission is to ‘improve together to ensure Counties has the best healthcare system in Australasia by December 2015’. Key themes of this transformation work currently include: • Education and capacity/capability building • Collaborative improvement • Networking resources • Spreading organising skills and practice to support our community • Reshaping knowledge, data and decision support infrastructure to be fit for 21st

century • Building rapid improvement skills and discipline into frontline • Building leadership • Community organising • Creating an education centre that provides a space conducive to learning • Building a workplace that reflects our community In addition to these functions, Ko Awatea is also charged with generating revenue for the District Health Board.

We will highlight one key area of our activity in each report. This month we would like to focus on Health Intelligence and Informatics.

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The Health Intelligence and Informatics team are a multi-disciplinary group of analysts, technical IT experts, researchers, evaluators and others whose collective purpose is: ‘to transform information into knowledge, for positive evidence-based change’. The people within the team form four broad areas of expertise: Management and interpretation of data; Research and evaluation; Managing knowledge, and; Dissemination. The team has been configured to work so that all these areas combine, and we can support pieces of work all the way through from design to dissemination.

1. Managing and interpreting data The largest part of the team by number is the Analyst team. This in turn comprises 3 different sets of competencies: Clinical analysis; Business Intelligence, and; Data warehousing. The ‘Clinical Analyst’ team are often referred to as ‘Decision Support’ (this was the name of the team at the point Ko Awatea was set up). As with many equivalent teams at other DHBs, their focus has been on analyzing and interpreting operational and costing data, in order to inform the decision-making of clinicians and managers. This team deals with around 150 ad hoc requests per month. They have expertise in understanding both our data, and our operating environment, so they can answer questions such as ‘what is the workload of EC clinicians?’, ‘how many vulnerable women utilize our services?’ and provide detailed costings around the financial impact of different models of care. A significant amount of work has gone into shifting this team away from historically poor morale and high turnover, by introducing competency-based position descriptions and appraisals, and a restructure offering a development pathway for analysts. The team has also worked hard on developing more transparency and accountability around their workload, and it is now possible for anyone in the organization to view the whole team workload at any given time, and provide direct feedback electronically on the service they have received.

The Business Intelligence team are a group of three staff with significantly greater technical IT skills. They are able to construct interactive dashboards and reports, and set up automatic notifications. A large piece of work nearing completion is a request for clinicians to be directly notified via email whenever there are ‘unaccepted’ lab results. This kind of work delivers a direct contribution to improving safety and efficiency. This team manages around 1000 such reports, and during the last fiscal year more than 370,000 reports under their management were executed. Given their skill and experience, this team will be able to make effective use of QlikView, a new visualization tool Ko Awatea has procured. This promises to let us reach the next level of sophistication in what we can deliver, and provide greater access directly to data for users.

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Finally, the Data Warehouse team is also a relatively new unit comprising three developers. We have procured modelling software which will let us rapidly implement ‘datamarts’ (with thanks to Waitemata DHB for agreeing to share intellectual property which will significantly reduce lead-in time), and move closer towards a single source of truth. The first project will be to establish an ED ‘datamart’, following which all of the PIMS data will be warehoused within around six months. Combining the power of QlikView with this development work will allow us to move rapidly forward in this important area.

2. Research and Evaluation

A small restructure at the end of 2014 led to the creation of the Ko Awatea Research and Evaluation office; a team of four skilled and experienced researchers and evaluators. The team manager, Dr Luis Villa, is a physician who has worked for many years for NGOs in the developing world and has a breadth of expertise the team can call on. Their mandate is explicitly to build capacity and capability, and to develop an ‘evaluation culture’ within the organization. A recent training programme around Evaluation attracted 21 staff from across the organization, and at least five of these will go on to be supported to carry out full evaluations of initiatives within their own work areas. The team has also received interest from other DHBs to host training sessions on site. In terms of research and evaluation output, the team has already made several key contributions: • Evaluation of a Physician Assistant pilot in Medicine. This report went on to form

the basis of a half-day seminar on the role of Physician Assistants, which featured international guest speakers and was well attended by stakeholders from across New Zealand. This event was designed and hosted at Ko Awatea

• Evaluation of the Medical Assessment Unit, Middlemore Hospital • Evaluation of the 20,000 days campaign (with Victoria University) • Evaluation of APAC 2014. The team has strong links with our academic partners, and are using these to develop other opportunities to generate revenue and enhance our reputation. The team has already been accepted onto the ACC provider panel for Research and Evaluation services, and secured a contract for evaluation of an MOH health literacy project. It is also important to note that the team have committed to completion of six major literature reviews for the SWIFT ‘Solutions Design’ business cases, and have done so on time within a very short time timeframe.

3. Managing knowledge

Knowledge Management is a relatively new capability for Ko Awatea. Our Knowledge Manager has a wealth of international experience and, in a relatively short time, has both developed applications with significant benefits for front-line clinicians in CMH and has worked to instill a discipline within Ko Awatea around how knowledge is managed and how it helps us join it together to make dissemination that much easier. One of the tools employed is the Sharepoint platform, which is a collaboration platform that can be considered as the knowledge ‘glue’. This is being used in diverse ways across the organization – for example as a team wiki for Human Resources, to host the analyst workload queue (referred to in section 1 above), and to direct and coordinate requests for Library services. Two important pieces of work have been delivered to the business. Firstly, an application which centralizes our patient safety reporting, replacing multiple access databases and permitting more streamlined and managed reporting of results. Secondly, some work to record and report on key ED

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data for new quality initiatives (Patient Airway registry). Whilst these last two items are examples of low cost wins that can be delivered to CMH, the Knowledge Manager focus is on ensuring that Ko Awatea’s knowledge, learnings and outputs can be stored, managed and accessed in such a way as to make dissemination much easier.

4. Dissemination

Something we are focusing on as an organization is how to more readily demonstrate all the excellent improvement work being done across the whole of CMH; dissemination is an important building block of being a ‘learning organisation’. If we can demonstrate what we have done and how we did it, then others can learn from the example we set and the profile and reputation of the entire organization will be lifted. The Writer working in the team is focused on increasing our publication output, and translating work activities into written pieces. The Writer naturally collaborates widely with people all over the organization. Despite having this expert resource, a dissemination focus is the responsibility of everyone – if we undertake important work without appropriate frameworks surrounding it which enable us to present results in peer-reviewed journals then we have failed. The Writer is working with others across Ko Awatea to ensure that these frameworks and processes are in place, so that a ‘dissemination culture’ can be created and the transaction costs of publication are minimized. APAC Board report The APAC forum is on track to deliver another successful forum for 2015. Programme: We have 16 confirmed Intensives on the Wednesday of the conference with 292 registered delegates registered to these to date. The 2 day programme has 46 sessions over the two days with the welcome addition of the WISH foundation to lead out two of those sessions in the Oncology /cancer service sectors and patient safety networks. Read about both WISH presenters here: Professor Bob Thomas http://eepurl.com/br9t4j Egbert Schillings http://eepurl.com/br9Apr Sponsorship and Exhibition:

We have several sponsors on board - those to date include: • Royal Australian district nurses • HPA- Health promotion advisory • CEC- Clinical Excellence Commission Australia • ACI- NSW Agency for Clinical Innovation • HSQC- Health Quality and safety commission New Zealand • Fisher and Paykel healthcare- • NZ Health and disability Commission • Atlantis healthcare • NZ Tourism With sponsorship still to be confirmed with the MOH and IBM, we will hopefully see these two confirmed over the next week.

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https://webmail.hanz.health.nz/owa/redir.aspx?C=JPdApqD37E2nhcFLLPn39bW1sUBWjtIIpyWrtpiWPeY8bCS3WjXktFwbWUycLgYzk8ymO1wqop4.&URL=http%3a%2f%2feepurl.com%2fbr9t4j

https://webmail.hanz.health.nz/owa/redir.aspx?C=JPdApqD37E2nhcFLLPn39bW1sUBWjtIIpyWrtpiWPeY8bCS3WjXktFwbWUycLgYzk8ymO1wqop4.&URL=http%3a%2f%2feepurl.com%2fbr9Apr


We have 22 exhibition stands sold with another 10-15 expected to confirm over the next couple of weeks. Registrations: Registrations are tracking well at 780 to our target line and we are looking at how we raise the marketing profile both here and in Australia over the next 9 weeks. Intensives are at 292 and the dinner tickets at 173. The APAC team is happy with the progress to date and there are no concerns about not being able to deliver a successful APAC conference in September 2015.

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4.0 Compliance 4.1 No issues to report this month.

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Appendix 1

Targeting people with the highest health care costs Wing Cheuk Chan, Dean Papa, Doone Winnard July 2015 Background In recent discussions in the UK, the notion that a small number of people account for a very high percentage of health system costs was again raised, with a figure cited of 2% of a population generating 50% of the costs for their local health system. The potential discussed was that even a small change at an individual level in this group of people could produce substantial reduction in their system costs, freeing up that investment for other use in the wider local health system. The CM Health Population Health Team have been asked for some analysis and thinking about what this might mean in the CM Health context. Analysis 1. Principles:

a) Undertaking analyses of the people with the highest health care costs can provide a better understanding of the potential cost drivers in a district health board.

b) However, it is important to differentiate the issue of understanding the cost drivers from the issue of how best to target people for interventions to both reduce costs and improve health outcomes. The pattern of cost drivers may be more stable than the cost associated with an individual in a given year.

c) Identifying cost drivers is different from identifying cost savings; consideration of the

amenability of the reasons people generate high health care costs and the value of potential health care interventions to address those conditions and circumstances are needed.

d) The conditions and circumstances identified for those individuals with very high health

system costs can identify system improvements which could/should be implemented across appropriately identified populations, rather than a small group with transient high health care costs.

e) At the system level, a systematic prioritisation approach across services would give

opportunity to more explicitly understand the trade-offs from high cost interventions compared to other interventions along the pathway from prevention to palliation.

2. Previous analysis of the ‘Top 5,000’ people with the highest health care costs in CM Health in

2010 and 2012 has been reviewed to try to frame the results in the terms raised by the example in the UK – what % of total costs does x group account for. As in the table below the figures for CM Health, for the costs captured in our analysis, are not dissimilar to the UK figures, and the percentages are relatively consistent in two different years. (Note the analysis captured a substantial proportion of the CM Health budget but not all of it). 2010 2012 Total costs captured 945,140,810 883,737,510 Costs of top 1% of patients 327,294,320

(34.6% of captured costs) 323,211,790 (36.6% of captured costs)

Costs of top 2% of patients 433,931,540 (45.9% of captured costs)

429,314,290 (48.6% of captured costs)

Top 1,000 patients 144,474,180 (15.3% of captured costs)


Top 5,000 patients 321,740,270 (34% of captured costs)


% of Top 5,000 patients in 2010 who died prior to the end of 2012 29.5% % of Top 5,000 patients in 2010 still in Top 5,000 in 2012 18%

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3. The challenges of intervening to address the groups with very high health care costs include:

a) People with highest health care costs are often different individuals from year to year. The health care cost of people with the highest health care cost fall rapidly within the current system settings - without additional interventions, also noting that in fact nearly 30% of those in the Top 5,000 high cost group died within 2-3 years. Therefore, it is more valuable to have better understanding of the high cost drivers, rather than following individuals with transient high costs.

b) There are only a small proportion of people with persistently high health care costs (18% in our analysis of 2010 and 2012).

c) Amenability is key - a resource intensive clinical review or notes review is required to determine if there is opportunity for interventions or improvements. Unfortunately, having high health care costs doesn’t necessarily equate to indications for proven interventions and international literature that we have read supports our local analysis, that many of these high cost health care events have limited amenability at the time of event. There may be system solutions that could change the trajectory if implemented earlier in the pathway (e.g. clinical thresholds for high cost interventions).

d) Where events may be potentially amendable (estimated to be <10%), the time frame of benefits being realised is likely to be in terms of years rather than days or months.

e) Use of the tools to predict future health service utilisation have yet to be shown to improve outcomes or lead to cost savings because of their inability to predict amenability.

4. Our analysis suggests that solutions often require wider systems approaches rather than being targeted at an individual level after the health event. For example

a) High mortality rate among the subgroup with highest health care cost emphasises the importance of advanced care planning, and the overall quality of health care and engagement at the level decision-making, with patients/family/whaanau.

b) At the system level, a systematic prioritisation approach across services would give opportunity to more explicitly understand the trade-off from high cost interventions towards the end of life compared to other interventions across the life cycle. For example, could we consider funding more systematic, high quality primary and community management for people with long term conditions, or adult oral health services, rather than some of the current high cost interventions with limited benefits?

c) Setting affordable and clinically acceptable thresholds for high cost interventions are ways to provide safe guards for equity and affordability. Many high cost interventions at an individual level are provided by the current health system without formal considerations of affordability and cost effectiveness, and they are often ethically challenging clinical scenarios.

d) For the small proportions of people (18%) with persistently high health care cost, areas identified that may merit whole of system approach include: prevention and management of renal disease, support for people with long term inpatient stays in acute mental health unit, auditing the possible underuse and over-use of chemotherapy and radiotherapy for

oncology patients.

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Counties Manukau Health Board Meeting Resolution to Exclude the Public

Resolution:

That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000:

The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

1. Minutes of 17 June 2015 That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

Confirmation of Minutes For reasons given in the previous meeting.

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

For reasons given in the previous meeting.

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

Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S9(2)(i)]

4. Health Targets 2014/15 Quarter 1 Progress Report

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


5. Perioperative Clinical Information System Business Case Sign Off

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section

Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities.

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9(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

[Official Information Act 1982 S9(2)(i)]

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


7. Strategic ICT Update



8. Treasury Policy – Investment Management & Asset Performance in State Services



9. Director’s Appointment to FPSC



10. Statement of Representation



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