Auckland District Health Board Board Meeting - · PDF fileAuckland District Health Board Board...

Auckland District Health Board

Board Meeting

Wednesday 4 May 2011

2:00pm

A+ Trust Room Clinical Education Centre

Level 5 Auckland City Hospital

Grafton

Hei Oranga Tika Mo Te Iti Me Te Rahi Healthy Communities, Quality Healthcare

1

KARAKIA

1

Karakia E te Kaihanga e te Wahingaro E mihi ana mo te ha o to koutou oranga Kia kotahi ai o matou whakaaro i roto i te tu waatea. Kia U ai matou ki te pono me te tika I runga i to ingoa tapu Kia haumie kia huie Taiki eee.

Creator and Spirit of life. To the ancient realms of the Creator Thank you for the life we each breathe to help us be of one mind As we seek to be of service to those in need. Give us the courage to do what is right and help us to always be aware Of the need to be fair and transparent in all we do. We ask this in the name of Creation and the Living Earth. Well Being to All.

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2

ATTENDANCE AND APOLOGIES

5


Board Member Attendance Schedule 2011

NAME JAN FEB MAR APR MAY JUNE JULY AUG SEPT OCT NOV

Dr Lester Levy (Chair)

Jo Agnew

Peter Aitken

Judith Bassett

Susan Buckland

Chris Chambers

Rob Cooper # # #

Lee Mathias (Deputy Chair)

Robyn Northey

Gwen Tepania-Palmer

Ian Ward

* attended part of the meeting only # leave of absence

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3

CONFLICTS OF INTEREST

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Conf l ic ts o f In terest Quick Reference Guide Under the NZ Public Health and Disability Act Board members must disclose all interests, and the full nature of the interest, as soon as practicable after the relevant facts come to his or her knowledge. An “interest” can include, but is not limited to:

Being a party to, or deriving a financial benefit from, a transaction. Having a financial interest in another party to a transaction. Being a director, member, official, partner or trustee of another party to a transaction or a

person who will or may derive a financial benefit from it. Being the parent, child, spouse or partner of another person or party who will or may derive a

financial benefit from the transaction. Being otherwise directly or indirectly interested in the transaction.

If the interest is so remote or insignificant that it cannot reasonably be regarded as likely to influence the Board member in carrying out duties under the Act then he or she may not be “interested in the transaction”. The Board should generally make this decision, not the individual concerned. Gifts and offers of hospitality or sponsorship could be perceived as influencing your activities as a Board member and are unlikely to be appropriate in any circumstances.

When a disclosure is made the Board member concerned must not take part in any deliberation or decision of the Board relating to the transaction, or be included in any quorum or decision, or sign any documents related to the transaction.

The disclosure must be recorded in the minutes of the next meeting and entered into the interests register.

The member can take part in deliberations (but not any decision) of the Board in relation to the transaction if the majority of other members of the Board permit the member to do so.

If this occurs, the minutes of the meeting must record the permission given and the majority’s reasons for doing so, along with what the member said during any deliberation of the Board relating to the transaction concerned.

IMPORTANT If in doubt – declare. Ensure the full nature of the interest is disclosed, not just the existence of the interest. This sheet provides summary information only - refer to clause 36, schedule 3 of the New Zealand Public Health and Disability Act 2000 and the Crown Entities Act 2004 for further information (available at www.legisaltion.govt.nz) and “Managing Conflicts of Interest – Guidance for Public Entities” (www.oag.govt.nz ).

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http://www.legisaltion.govt.nz/

http://www.oag.govt.nz/

Date: 27/04/2011

3.0 Board Interests Schedule.doc Page 1 of 5

ADHB BOARD INTERESTS REGISTER

NAME OF BOARD

MEMBER ORGANISATION ROLE FINANCIAL

INTEREST NATURE OF INTEREST DATE OF LATEST

DISCLOSURE

Lester LEVY (Chair) 1. University of Auckland Business School

2. New Zealand Leadership Institute

3. Health Benefits Limited

4. Tonkin & Taylor

5. Waitemata District Health Board

Professor of Leadership Chief Executive Deputy Chair Independent Chairman Chairman

1 February 2011

Jo AGNEW 1. Senior Lecturer Nursing, Auckland University

2. Casual Staff Nurse ADHB

Salary

Salary

21 April 2010

Peter AITKEN 1. Pharmacist

2. Pharmacy Care Systems Ltd

Pharmacy Locum

Shareholder/Director, Consultant

Hourly Fee

Medical Centre development and pharmacy lease

10 December 2010

Judith BASSETT 1. Nil 9 December 2010

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Date: 27/04/2011

R

NAME OF BOARD

MEMBER ORGANISATION OLE FINANCIAL


DISCLOSURE

Susan BUCKLAND 1. Writing, editing and public relations services

2. Medical Council of NZ

3. Occupational Therapy Board

Self-employed

Professional Conduct Committee member

Professional Conduct Committee member

Fees

Hourly fee

Hourly fee

Writer, editor and public relations services

Lay member of PCC set up to hear complaints brought to Medical Council and to determine outcomes

Lay member of PCC to assess complaints and determine outcomes

7 August 2009

Dr Chris CHAMBERS 1. Employee, Auckland District Health Board

2. Wife employed by Starship Trauma Service

3. Clinical Senior Lecturer in Anaesthesia Auckland Clinical School

4. Associate, Epsom Anaesthetic Group

5. Member, ASMS

6. Shareholder, Ormiston Surgical

20 April 2011


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Date: 27/04/2011

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NAME OF BOARD



DISCLOSURE

Rob COOPER 1. Ngati Hine Health Trust

2. James Henare Research Centre, University of Auckland

3. Whanau Ora Governance Group

4. National Health Board


Chief Executive

Board Member

Chair

Member

Member

Salary

No fee

Fee (to Ngati Hine Health Trust)



Management of a Health, Disabilities, Social & Education Services Trust

Advisory

Assists in the development of Government’s Whanau Ora policy

25 February 2011


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Date: 27/04/2011

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NAME OF BOARD



DISCLOSURE

Lee MATHIAS 1. Lee Mathias Limited

2. Iris Limited

3. Midwifery and Maternity Providers Organisation Limited

4. Pictor Limited

5. John Seabrook Holdings Limited

6. AuPairlink Limited

7. NZ Council of Midwifes

Managing Director

Director

Director

Shareholder, Director

Director

Governance Advisor

Council member

Fee

Fee

Fee paid to Lee Mathias Limited

Fee

No fee

Fee

Fee

Shareholder, director, independent directorships and healthcare services consulting

Director, company provides services to people with multiple physical disabilities especially

cerebral Palsy

Provider of business and professional services to

midwives and other maternity services providers

Biotech start-up focussing on diagnostic products

Estate of late husband

Provider of early childhood

education services contracted to the MoE.

Statutory Authority

1 February 2011

Robyn NORTHEY 1. Self employed Contractor

2. Hope Foundation

3. Northern Region Ethics Committee

Project management, service review, planning etc.

Board member

Member

Fee

Nil

Fee

Some clients are contractors to ADHB

Research and Education into Aging in NZ, Deliver Seminars and awards scholarships

16 December 2010


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Date: 27/04/2011


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NAME OF BOARD



DISCLOSURE

Gwen TEPANIA-PALMER


2. Manaia PHO

3. Ngati Hine Health Trust

4. Awanmarangi Waonangi

5. Te TAitokerau Whanau Ora

Board member

Board member

Chair

Committee member

Committee member

Fee

Fee paid to NHHT

Fee

2 February 2011

Ian WARD 1. Chair, Advisory Board, Healthvision Limited

2. Principal/Director C -4 Consulting Limited

Fee

Tender to National Shared Services

3 February 2010

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4

CONFIRMATION OF MINUTES

- WEDNESDAY 6 APRIL 2011

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M i n u t e s

MEETING DETAILS

Time and Date 2:00 pm, Wednesday, 6 April 2011

Venue A+ Trust Room, Clinical Education Centre, Level 5, Auckland City Hospital, Grafton

1 KARAKIA

The Chair declared the meeting open at 2:08pm. Naida Glavish led the meeting with the karakia.

2 ATTENDANCE AND APOLOGIES

Board Members

Dr Lester Levy (Chair) Jo Agnew Peter Aitken Judith Bassett Susan Buckland Dr Chris Chambers Dr Lee Mathias Robyn Northey Gwen Tepania-Palmer Ian Ward

Management in Attendance

Garry Smith – Chief Executive Dr Denis Jury – Chief Planning & Funding Officer Dr Margaret Wilsher – Chief Medical Officer Brent Wiseman - Chief Financial Officer Greg Balla – Director Performance & Innovation Taima Campbell – Executive Director Nursing Naida Glavish – Chief Advisor Tikanga, GM Maori Health Janice Mueller – Director Allied Health Vivienne Rawlings – General Manager Human Resources Ian Bell - Board Administrator

Apologies

Rob Cooper had been granted leave of absence.

3 CONFLICTS OF INTEREST

There were no declarations of conflicts of interest for any item on the agenda.

4 CONFIRMATION OF MINUTES 2 MARCH 2011

Moved Gwen Tepania-Palmer; seconded Jo Agnew

That the minutes of the Auckland District Health Board meeting held on 2 March 2011 be confirmed as a true and correct record.

Carried

5 ACTION POINTS 2 MARCH 2011

The budget 2011 - 2012 would be considered in public exclusion.

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6 CHAIRMAN’S REPORT

Ministerial permission had been obtained to have joint committees with Waitemata DHB for Community and Public Health Advisory Committee, Disability Support Advisory Committee and Maori Health Gain Advisory Committee. The Chair proposed moving to a six week meeting cycle having 8 Board, Finance and Hospital Advisory Committee meetings and 4 meetings for the Disability Support Advisory Committee, Maori Health Gain Advisory Committee and Pacific Health Advisory Committee. The Chair also allocated Board members as points of accountability to each of the Board’s 10 priorities.

There will be an iPad trial to determine whether the Board can make a full move to electronic Board papers.

7.1 Chief Executive’s Summary

The Annual Plan had been delivered to the National Health Board ahead of time although there were last minute changes to the indicators following new advice. Feedback was expected by the end of April. Work was continuing on the Plan, particularly section 3, reformatting and focusing on measures and numbers.

There had been a valuable meeting with the National Hauora Coalition establishing a point of contact for the relationship.

The failure of the continuous power supply when it underwent its six monthly test caused very short-term disruption to electives and a post event review would be undertaken. There is to be an increase in the frequency of testing.

Regional Shared Services had been established with transfer of staff and the work of Vivienne Rawlings and Brent Wiseman was acknowledged.

The overall forecast to year end was breakeven with planning and actions to deliver the results although there was pressure in the provider arm to achieve the elective target, which affects revenue as well as costs of labour and direct treatment costs.

7.2 Better Sooner More Convenient

There was increased confidence in the Access to Diagnostics Radiology target being met. With the consolidation of PHOs, rather than each PHO having contracts with each DHB, the mechanism to have a single point of contact for each PHO had been developed on the basis of a host DHB, which dealt with transactional issues and contracts, and partner DHBs which participated in strategic directions.

There was increased confidence that the Minor Surgery Skin Lesions target would be met.

Bernard Te Paa (Counties Manukau District Health Board) was responsible for Maori Service Development and it was suggested that he be invited to the CPHAC meeting to talk to the lack of progress around this target.

7.3 Regional Service Planning Progress Summary

The Northern Region’s Health Plan was provided under separate cover and Margaret Wilsher’s leadership was acknowledged as was the strong clinical engagement across the region. The Plan was bold but had been developed in collaboration with clinical managers and had been strongly challenged in workshops, which had been an important process. There was a willingness to focus on the patient and take a big picture view. While the Plan identified areas as requested by the National Health Board other services were not ignored but were business as usual. The budget for the Plan was approximately $1.3m across the region, plus staff time, and governance would be through the Steering Committee with the ultimate point of authority being the Regional Governance Group comprised of Chairs, CEOs and CMOs. There were defined

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outcomes for the first year.

This plan demonstrated the DHBs ability to work together, however, there was a need to understand more clearly the connections between the Minister of Health’s expectations, the National Health Boards priorities, the Northern Region’s Health Plan and how they informed the individual District Health Boards Annual Plans. The next piece of work would be on an implementation plan and a matrix to work against.

Moved Ian Ward; seconded Susan Buckland

That the ADHB endorses the Northern Region’s Health Plan acknowledging that the budget is yet to be developed.

Carried

7.4 Minister’s Six Health Priorities 2010 - 2011

Work was being undertaken on diabetes with an increase in access through coordinators working at the practice level. In terms of self management, percentages had not changed over two years and there was a risk that as access improved the percentage may in fact decrease. There had been a slight increase in immunisation rates and, with audits of practice records, a further increase was expected and there was more confidence that the target would be met by year end.

9.1 DAP Projects Report

This was an overarching summary. The Tamaki project was being rescoped.

10.1 Finance Committee Recommendations

Crown Health Financing Agency

Moved Lee Mathias; seconded Gwen Tepania-Palmer

That the Auckland District Health Board agrees that the proposed repayment of $10.5m to CHFA due in March 2011, as contained in the District Annual Plan 2010 - 2011, be suspended and that the amount be lodged in an amortisation fund.

Carried

Supply of Standard Catalogue Office Furniture

Moved Robyn Northey; seconded Lee Mathias

That the ADHB approves Gregory Commercial Furniture NZ Ltd (GCF) as the preferred supplier for purchase of all standard catalogue office furniture.

Carried

Direct Negotiations Outsourced Surgical Procedures

Moved Gwen Tepania-Palmer; seconded Ian Ward

That the ADHB grants a dispensation to enter into direct negotiation with MercyAscot, Southern Cross, Gillies Hospital, St Marks Hospital, Laparoscopy Auckland and Auckland City Surgical Services, for the provision of outsourced surgical procedures.

Carried

Auckland Region DHB Electronic Referrals – Phase 1

This had been approved by the Finance Committee however they expressed serious concern at having to provide more funding and also the change of project management part way through the project.

Moved Lee Mathias; seconded Robyn Northey

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That the ADHB endorses that the Auckland DHB, Counties Manukau DHB and Waitemata DHB Boards approve additional capital funding of $165K to ensure full implementation of the Auckland Regional Electronic Referrals solution. This additional funding is required to cover a forecasted shortfall in the current capital budget of $1,380K. ADHB’s share of the additional capital funding is $55K and it is suggested that this is funded from the IMTS capital budget through substitution of capital funds assigned to projects that have been or will be delayed.

Carried

Duel Energy Linear Accelerator

Moved Ian Ward; seconded Robyn Northey

That the ADHB approves the dispensation from tender and purchase of a linear accelerator from Varian Medical Systems. The estimated price is $2.9m (dependent on US$ exchange rate). $463,000 is budgeted in 2010/11 for the deposit, with the remainder budgeted in 2011/12. A full capital expenditure proposal is still required to be presented to the Board.

Carried

Lease 99 Grafton Road

Moved Lee Mathias; seconded Gwen Tepania-Palmer

That the ADHB approves the Variation of Lease and Rent Review for the property at 99 Grafton Road, Grafton for an initial 6 year period with 2 Rights of Renewal of 3 years each and delegates authority to the Chief Executive Officer to execute the Deed.

Carried

Implementing a Metro Auckland Regional After-Hours Network

Moved Ian Ward; seconded Lee Mathias

That the Finance Committee recommends that the ADHB Board:

1. Approves the issuing of an regional request for proposals (RFP) for the development of the Auckland Regional After-hours Network;

2. Notes that the overall objective of this RFP is to implement an affordable, sustainable, integrated After-hours network for the Auckland region that reflect locality needs;

3. Notes that Counties Manukau District Health Board will manage the RFP process on behalf of the Metro Auckland DHBs;

4. Notes Ministerial support for the RFP approach and timeframes committed to through our District Annual Plan.

Carried

10.2 Finance Report

The surplus for the month was $4.7m and year to date $5.2m which was favourable to budget and provided a base to move forward with an expectation to break even at year end. Pressure points were elective revenue and the costs of labour and direct treatment costs.

11 GENERAL BUSINESS

There were no items of General Business.

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12 PUBLIC EXCLUSION

Moved Susan Buckland; seconded Jo Agnew

That, in accordance with the provisions of Schedule 3, Clauses 32 and 33, of the New Zealand Public Health and Disability Act 2000, the public be excluded for consideration of Item 12.

The general subject of the matters to be considered while the public is excluded, the reason for passing this resolution in relation to each matter, and the specific grounds under the above clause for the passing of this resolution are as follows:

General subject of each matter to be considered:

Reason for passing this resolution in relation to each matter:

Ground(s) under clause 34 for the passing of this resolution:

12.1 Confidential Board Minutes

2 March 2011 12.2 Shared Services Steering Group Update 12.3 Budget 2011 - 2012

To enable the Board to carry on without prejudice or disadvantage commercial activities and negotiations: Official Information Act 1982 s.9(2)(i) and s.9(2)(j)

That the public conduct of the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under s 9 of the Official Information Act 1982.

Carried

The items discussed in public exclusion were the Confidential Board Minutes 2 March 2011, Shared Services Steering Group Update and the Budget 2011 - 12.

Moved Robyn Northey; seconded Jo Agnew

That the meeting resume in public.

Carried

NEXT MEETING

The meeting closed at 3:48 pm

The next scheduled meeting is : 2:00pm, Wednesday 4 May 2011 A+ Trust Room Clinical Education Centre Level 5, Auckland City Hospital Grafton

CONFIRMED CHAIR: DATE:

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5

ACTION POINTS

- WEDNESDAY 6 APRIL 2011

27

Board Action Points from the meeting on Wednesday 6 April 2011

Item Detail Designated Action

7.2 Bernard Te Paa responsible for Maori service development to be invited to CPHAC Denis Jury Attended 7.4 The draft Annual Plan sent to Wellington to be distributed to Board Garry Smith

Ian Bell Actioned

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6

CHAIRMAN’S REPORT

6.1 Report 6.2 Chairman's Recommendations

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6.1 Report

33

6.2 Chairman's Recommendations

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ADHB Board Author: Ian Bell (8077) Subject: Starship Foundation Recommendation

That the Auckland District Health Board appoints Susan Buckland as the ADHB representative on the Starship Foundation.

Background

The ADHB has, under the Starship Foundation Deed of Trust, the Chair or his/her nominee appointed as a member on the Starship Foundation Board of Trustees. Susan Buckland has represented the previous Board and I propose that she continue to represent our Board.

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ADHB Board Author: Ian Bell (8077) Subject: A+ Charitable Trust Recommendation

Nil.

Background

The Deed of Trust of the A+ Charitable Trust provides that the Chair of ADHB is a Trustee ex officio or his/her nominee. The Chair, Lester Levy will represent ADHB on the A+ Trust.

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7

CHIEF EXECUTIVE’S REPORT

7.1 Chief Executive’s Summary

7.2 Minister’s Six Health Priorities 2009/10

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7 .1 Chief Execut ive ’s Summary

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Chief Execut ive Of f icer ’s Summary Traffic Light Comment Mitigation

Goal 1 Lift the Health of the People of Auckland Annual Plan and District Annual Plan Green Deadlines met, awaiting feedback Implementation Plan being developed

particularly FTE#s and Savings / Productivity requirements. Ensuring measurable deliverables on all objectives.

Better Sooner More Convenient Green Two day workshop for GAIHN has increased confidence.

Clear accountability of delivering 2010/11 DAP. Looking forward simplified focus on Acute Demand, Child Health, embedding locality approach and linking to Integrated Family Health Centres.

Goal 2 Improve Performance Elective Surgery Orange Plan is in place to deliver required result. Daily / weekly monitoring required over the

remaining months of the year.

ESPI Compliance Green ESPI 2 (outpatient) at 31 March 2011 was 462. This is the lowest position since June 2010 and prior to that January 2009. ESPI 5 (surgery) at 31 March 2011 was 413. This is the lowest position since December 2009.

Patients waiting over 12 months 31 March 2011. Of the 51 patients waiting over 12 months 20 have booking date 6 removed for (medical or other) reasons 4 neurosurgery cases cleared for

outsourcing. 13 awaiting review 8 patients not booked.

National and Regional Services / Centres of Excellence

Green Increased focus following board discussion to drive improved service configuration.

Priority and resource applied to gain traction.

Staff Engagement Orange Understanding requirements and priorities.

‘Vital Signs’ sessions during May.

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Goal 3 Live Within Our Means healthAlliance Green Formation well advanced.

2nd Tier Management appointed. Johan Vendrig successful in attaining GM IS Role.

Form Information Management role to complement new regional structure.

Financial Results and Budget Orange While the forecast overall is producing the required result, cost line variances are unacceptable.

Strong intervention in FTE management. Clinical review of direct treatment costs. Embedding productivity gains and ‘banking’ them. Reviewing models of care.

Employment Relations Orange Close support to National Agreements currently in discussion.

Proactive engagement.

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7 .2 Min is ter ’s S ix Heal th Pr ior i t ies 2009 /10

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Project: Primary Objective: That at least 95% of patients will be admitted, discharged or transferred from Auckland Emergency Departments within 6 hours

Date of Delivery: 30 June 2011

Project Risks / Comments:Performance to achieve Shorter Stays in ED for both Adults and Children’s services continues to demonstrate

improvement . Overall performance for month of February was 86%. This has further improved in March ( 1

March to 25 March) to 94.2% of patients admitted, discharged or transferred within 6 hours.

Acute Patient Flow, Actual vs Target, July 2009 - Dec 2011

0%

20%

40%

60%

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100%Ju

l-200

9

Aug

-200

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Sep

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Jan-

2010

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2010

Jul-2

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Jan-

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Feb

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Jun-

2011

Actual Goal MOH Target

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Adult Acute Patient Flow, Actual vs Target, July 2009 - June 2011

0%

20%

40%

60%

80%

100%

Jul-2

009

Aug

-200

9

Sep

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Oct

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9

Nov

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Dec

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Jan-

2010

Feb

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Mar

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Apr

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Jun-

2010

Jul-2

010

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Nov

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Jan-

2011

Feb

-201

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Mar

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1

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May

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Jun-

2011


Project: Adult Acute Patient FlowPrimary Objective: That at least 95% of patients will be admitted, discharged or transferred from Auckland Adult Emergency Department

within 6 hoursDate of Delivery: 30 June 2011Clinical Leads: Nurse Director Margaret Dotchin , Dr Tim ParkeProject Sponsor: Nurse Director Margaret DotchinSteering Group: Nurse Director Margaret Dotchin, General Manager Ngaire Buchanan,Dr Tim Parke, Dr Art Nahill, Dr Wayne Jones, Dr Andrew Old, Nurse Advisor Mark Entwistle.

Improvements to date:Streamlined AED processes and measurement and manage the challenge of

growing demandReviewed Medical / Nursing requirements for AED and approved business case for

resource increase to match increased workload.Charge nurse patient flow coordinator introducedImproved access to Radiology Streamlined documentation required for safe transfer Improved triage processes.Managing bed block with additional resources58 Additional beds opened 2009‐2010 Winter Ward 31 General Medicine 10 additional beds August – October 2010Managing bed block & reducing the time patients wait through improved processes

and teamworkDaily Rapid Rounds introduced in General Medicine (Feb 2010) and

Orthopaedics

(July 2010)Nurse Facilitated Discharging in General Medicine (April 2010)Improved Bed Management Communication via Estimated Discharge Dates, CMS

upgrades, improved visual management, more efficient bed management meetings,

earlier time of day discharging.Daily breech review meetings to understand root causes and implement short term

solutions.Immediate actions to improve performance:1.

Increased engagement of Senior Leadership Team to support improvement

activities and reduce road blocks to improvement.Increase communication and engagement of Clinical Directors, SMO’s, RMO’s Increase communication and engagement of Charge Nurses and RN’s after hours

to further reduce wait times for patient transfer from Emergency

DepartmentEngage with SMO’s, RMO’s and nurses one to one, by CD, Nurse Advisor

or Level 2 clinical leader where resistance to required behaviour is

demonstrated.Valuing patient time poster campaign

2.

Establish ED short stay unitImplement APU flex beds Improve measurement of Ready to Go patients in EDComplete recruitment of remaining ED resource to improve weekend

coverageSupport General Medicine by diversion of patients to subspecialtiesImplement general surgery acute flow team initiatives to improve

response timeCMO to attend Orthopaedic SMO meeting to increase engagement.Relocate bed manager to ED after hours Implement ED discharge nurse on weekendHands on support of ED flow Charge Nurse to reduce roadblocks to

timely review and transfer of patientsCommence physiotherapy facilitated discharge in Orthopaedics.Establish discharge co‐ordination responsibility in Gen Med ward nursing team.Further increase timely overnight transfers from ED to inpatient

wards once bed

allocated.3.

Five day rapid improvement event planned for April to focus on improvement of

process from decision to admit to patient transfer complete.Improve elective scheduling.

Project Risks / Comments:Significant improvement noted in March with 95% of patient discharged or transferred from ED within 6 hours. A 5‐day Rapid Improvement event is planned for 11‐15 April to identify and implement further solutions from decision to

admit to leaving ED. Further work is also underway on weekend resourcing to meet variable demand, establishment of Short Stay Unit,

understanding triggers and escalation process to accommodate increasing admissions to APU and manage bed block in

winter months.

11

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48

Project: Children’s Acute Patient FlowPrimary Objective: That at least 95% of patients will be admitted, discharged or transferred from Auckland Children’s Emergency

Department within 6 hoursDate of Delivery: 30 June 2011Clinical Lead: Richard AickinProject Sponsor: Ngaire BuchananSteering Group: Ngaire Buchanan, Richard Aickin, Michael Shepherd, Janet Campbell, Stuart Dalziel

Improvements to date:Business Case to develop CED Nurse Practitioners –2x Nurse

Specialist (in training for NP) appointed in January

Improved Measurement systems to better identify clinical

short stay patients

Development of weekly dashboard reporting for CED to

better track performance

Daily reviews to identify specific reasons for delays on a

case‐by‐case basis and to communicate findings with

relevant teams

Weekly communications of performance to ward levelDevelopment of ‘full hospital plan’

to improve

responsiveness when indicators of ‘bed block’

developing

Enhancement of electronic tracking systems for acute

patient flow – going live in March

Immediate Actions to Lift PerformanceOpening of 4 additional beds Increase use of transition lounge to improve bed availabilityAdditional CNA to assist wards receiving patients to stop

delays on patient transfer.

Two nurse specialists to immediately take case load in CEDGreater Starship CD engagement, Enhance communications

to Charge nurses

Longer term projectsLean Six Sigma Green Belt projects in progress:

a) Patient Transfers from CED to a ward where a bed

is availableb) Bed turnaround time in ward 24B ‐

time to

discharge from Doctor’s clearancec) Inter‐hospital Paediatric transfersd) Estimated Discharge Date accuracy in Paediatric

Orthopaedics:

Project Risks / Comments: While the March performance of 93% was

short of the target, the

result represented a further improvement over prior months and 6% over the same month last

year. There were some 12 days at 95% or better which comfortably surpassed the performance

of all prior months. The improving results continue to reflect a

number of activities and projects

within Starship. Of particular note in March was: Increased Management focus and engagement.

Daily review of all 6 hour breaches with feedback

and improvement actions being taken in the

relevant areas. Heightened staff awareness brought about by Valuing our Patients Time Campaign

which publishes results on a weekly basis. The importance meeting the 6 hour target and results

achieved have been on the agenda at meetings throughout Starship. Implementation of an

Electronic Whiteboard in CED. This has resulted in a greater level of transparency as to where

patients are in their CED journey to enable prioritisation of patients that may breach the 6 hour

time. The transfer time from CED to ward (relative to the 1 hour

recommendation) made a

significant improvement with the mean falling by 34% over February’s results. All wards are now

using the Estimated Dates of Discharge

.

Children's Acute Patient Flow, Actual vs Target, July 2009 - June 2011

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20%

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Jul-2

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Aug

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Jan-

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Mar

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2011


49

Project: Improved access to elective surgeryPrimary Objective: Increase ADHB Elective Surgical Discharges from 9,425 to 11149Date of Delivery: 30 June 2011Clinical Lead: Vanessa Beavis, Ian CivilProject Sponsor: Peter LowrySteering Group: Ngaire Buchanan, Dr Vanessa Beavis, Margaret Dotchin, Fionnagh Dougan, Ian Civil.

Risks / Comments: (Amber)At approximately 7,500 discharges ADHB is on target per the work-out plan sent to the Ministry in February 2011 and is 93% of the annual phased plan against which we will be reported for the 3rd quarter.The Forecast to 30 June 2011 is still to meet the elective health target of 11,149 discharges.

Planned activities:

1. Operationalising 2 new OR at Greenlane Surgical Centre

during April. Official opening 27th

April2. Other internal includes additional ophthalmology lists at

GSU in the last quarter and “longer days”

at ACH & GSU.3. Outsourcing across a range of specialties, 4. Activity is targetting high volume, low complexity

volumes.5. We are also reviewing some relevant data issues e.g.

•review of patient discharge data for electives coded as

acutes and •surgical discharges allocated to a medical specialty and

not therefore not counted as an elective discharge and•coding practices for short cases which are inconsistent

across different theatre settings.

Contributors to Elective Health Target

-

2 , 0 0 0

4 , 0 0 0

6 , 0 0 0

8 , 0 0 0

10 , 0 0 0

12 , 0 0 0

Jul-10 Aug-10 Sep-10 Oct -10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11

Production July to March Base Production April to June Greenlane Other Internal Ini

he a l t h t a r ge t

11, 14 9 di sc ha r ge s

50

Project: Shorter waits for Radiation TherapyPrimary Objective: That 100% of eligible patients requiring radiation treatment will commence treatment within 4 weeks by 31

December 2011 Date of Delivery: 31 December 2010 (4 weeks)Clinical Lead: Andrew MacannProject Sponsor: Fionnagh DouganSteering Group: Fionnagh Dougan, Andrew Macann, Margaret White,

Robyn Dunningham

Radiation Oncology Wait times – March 2011In March 100% of eligible patients were treated within the

4 week target timeline.

Further improvements in progress to sustain delivery:•

Pantak replacement is planned from early May to

July 2011

•

Replacement of MV6: Decommissioning commences

mid‐July until late November 2011. Evening shifts will

be reinstated during this period to mitigate lost

capacity

•

Introduction of HDR for Gynaecological patients

is

scheduled for May 2011.

•

A

public/private Model of care

has been developed

to enable our clinicians to treat public patients at

ARO. Effective from March 2011 and progressing

well.

•

Breast hypo‐fractionation implemented: Emerging

clinical evidence supports the use of reduced

fractions in a higher % of breast patients. This has

reduced treatment time and freed up capacity on the

linear accelerators.

•

Introduction of new technology: The introduction of

V‐Mat prostate treatment has the potential to

reduce treatment times by 50% when fully

implemented. This is now in progress.

•

Aria project: A project is underway to develop a full

electronic record within the LINAC machine’s

operating system.

•

A weekly capacity modelling tool

has been

developed and is now being used for future LINAC

capacity planning, improved forecasting capability

and management of workload.

•

An “Operational team”

has been established whose

key accountability is to measure KPI’s to prioritise the

waitlist and analyse performance on a weekly basis.

•

A daily Waitlist report

enables daily monitoring and

immediate remedial action if required.

Risks / Comments: The service is 100% compliant to the 4 week target for Quarter 3.Key risks which may impact capacity to deliver to the target:•MV6 Linear Accelerator replacement – the service expects some loss of capacity during the period

of decommissioning and replacement July – November 2011. •Sustained demand – the service on average is receiving 5 more referrals pw as compared to the

same period last year. •RT staff vacancies and skill mix – pending resignations will impact staffing ratios during May –and

flexi shifts cannot operate.•The implementation of HDR treatment within an existing bunker may reduce capacity.•Introduction of new technology transiently reduces capacity e.g.

V‐Mat, IMRT, HDR Gynae

treatment, QA testing of new technology.

Radiation Therapy - % patients commencing treatment w ithin 4 weeks of FSA, Actual vs Target, July 2010 - Dec 2011

0%

20%

40%

60%

80%

100%

120%

Jul-2

010

Aug

-201

0

Sep

-201

0

Oct

-201

0

Nov

-201

0

Dec

-201

0

Jan-

2011

Feb

-201

1

Mar

-201

1

Apr

-201

1

May

-201

1

Jun-

2011

Jul-2

011

Aug

-201

1

Sep

-201

1

Oct

-201

1

Nov

-201

1

Dec

-201

1


51

Better help for smokers -% of hospitalised smokers provided advice and help to quit, Actual vs Target, July 2010 - Dec 2011

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

100%

Jul-2

010

Aug

-201

0

Sep

-201

0

Oct

-201

0

Nov

-201

0

Dec

-201

0

Jan-

2011

Feb

-201

1

Mar

-201

1

Apr

-201

1

May

-201

1

Jun-

2011

Jul-2

011

Aug

-201

1

Sep

-201

1

Oct

-201

1

Nov

-201

1

Dec

-201

1


Project: Better help for smokers to quit

Primary Objective : % of hospitalised smokers provided advice and help to quit

Date of Delivery: 90% by 1/07/2011, 95% by 1/07/2012

Clinical Lead: Stephen Child

Project Sponsor: Taima Campbell

Steering Group: Di Roud, Anna Schofield, Pam Hewlett, Stephen Child, George Laking, Jim Kriechbaum, Paul Bohmer, Arun Kulkarni, Michelle Stevens,

Kristen Nicol, Bernadette Rehman, Paul Birch, Anne‐Marie Pickering, Victoria Child, Jan Marshall

Improvements to date:•

Direct follow up with wards/services underperforming in

ward audits.

•

ABC Training and coaching of staff in AED & APU.•

ABC chart reminders placed all in AED & APU folders•

Better Help for Smokers to Quit included in Releasing Time

to Care KPIs.

•

New intake of House Officers on 28th February trained on

documentation of ABC.

Immediate Actions to improve performance:A.

Focus on short stay and high volume areas:•

1:1 ABC staff coaching to commence in General Medicine

and General Surgery and AED and APU

•

Negotiation with Women’s Health to identify best options to

improve target performance using funded resources.

B.

Improve engagement with clinical workforce:•

Campaign for a Call to Action to Senior Medical staff to

encourage Registrars and House Officers to routinely assess

smoking with patients and document the ABC.

•

Monthly publication of results of Senior Medical Officer’s

Better Help for Smokers to Quit performance.

•

Details of all Quit Card Providers to be included in monthly

reports to services.

•

Better Help for Smokers to Quit Steering group Terms of

Reference and membership revised.

•

Clinical research strategy under development C.

Data collection systems and processes:•

Meet with Clinical Coding team to review coding practise

and identify areas for improvement.

•

Monthly reports and data analysis to identify areas of

improvement and address areas of underperformance with

services.

•

Electronic Discharge Summary data to be audited for

consistency and accuracy against patient clinical records

Project Risks and CommentsOf the 9221 events coded in March, 1208 (13.1%) of patients were

identified as smokers and

853 (71%) of the smokers were documented as receiving advice to quit. While the number

given brief advice is the highest ever the percentage was lower due to the high number of

events coded in the period. The key areas for improvement remain

the high volume areas of

AED and APU. It has been identified that the “first aid”

–

type cases are currently being missed.

Key staff AED staff are being trained in giving brief advice and

supported with a Quit Smoking

booklet and short letter to handed out to patients on discharge.

The junior doctors are another

key to lifting the target by recording the ABC in the clinical notes and accurately in the

Electronic Discharge Summary. Direct feedback is being given to junior doctors where

documentation is missing during the regular ward audits. National Women’s Health has

instigated a weekly check of ABC documentation and liaising with

the coding team to ensure all

brief advice given is captured. NWH are also monitoring systems and advising clinicians to

record the ABC.

C

AB

52

Project: Cardiac Bypass SurgeryPrimary Objectives: To enable timely access to cardiac bypass surgery the waiting list should be no greater than 80.

To support the national cardiac bypass intervention target, 916 bypass will be completed in 2009/10Date of Delivery: 31 December 2011Clinical Lead: Paget MilsomProject Sponsor: Garry Smith, Fionnagh DouganSteering Group: Marian Hussey, Paget Milsom, Andrew McKee, Peter Ruygrok, Elizabeth Shaw, Pam McCormack, Greg Balla, Gordon Davies

Completed Improvement Activities:

Developed and implemented electronic scheduling system

Initiated pre‐admit process

Developed detailed operational reporting

Set up development production process

Approved business case for CVICU bed capacity

Built capacity planning model for CVICU and Ward 42

Developed patient load planning tool

Initiated daily bed management meeting

Further improvements in progress:

Standard theatre rosterProvide greater weekly standardisation in supply of theatre

resource, to improve planning and co‐ordination. 3 in a row bypass (productive list)

Optimise the theatre schedule by planning a productive list

ECMO – Resource planning processTo improve resource planning and day to day processes to

reduce the impact of high ECMO demand

The Productive Operating Room (NHS Programme)To increase productivity and improve safety in theatre through

better co‐ordination and removal of waste and

frustrations

CVICU/HDU MergeTo increase the overall skill mix so that staff can work in both

units, adding flexibility and reducing cancellations

Enhanced recovery initiativeTo provide a pathway for suitable patients, reducing average LOS

and cancellations

Delay to discharge – ward 42To reduce LOS for patients who are delayed during the discharge

process, reducing theatre cancellations

Delay to discharge CVICUTo reduce LOS for patients who are delayed during the discharge

process, reducing theatre cancellations

Project Risks / Comments:There are 39 patients on the waiting list as at the end of March 2011. YTD throughput is 37 patients less than planned as at end January 2011. Opportunities for additional capacity have been built into the production plan however catch up on the throughput target of 916 is constrained by a shortfall of additions to the waiting list. Work continues on improving the reliability and productivity of the service. The service has currently completed 80 more bypass (through the ACH facility) than last year (19% improvement)

Reduce Cardiac Waiting List, Actual vs Target, Jan 2010 - Dec 2011

0

20

40

60

80

100

120

Jan-

2010

Feb

-201

0

Mar

-201

0

Apr

-201

0

May

-201

0

Jun-

2010

Jul-2

010

Aug

-201

0

Sep

-201

0

Oct

-201

0

Nov

-201

0

Dec

-201

0

Jan-

2011

Feb

-201

1

Mar

-201

1

Apr

-201

1

May

-201

1

Jun-

2011

Jul-2

011

Aug

-201

1

Sep

-201

1

Oct

-201

1

Nov

-201

1

Dec

-201

1


53

Project: Diabetes

Primary Objectives: Increase the percentage of people with diabetes accessing and attending their free annual diabetes get

check

Date of Delivery: 55% June 2011

Clinical Lead: Gayl Humphrey

Project Sponsor: Dr Denis Jury

Steering Group:

Primary Care Clinical Advisory Group, Auckland Diabetes Advisory

Team

Recent and Current activities:

1) Increase awareness project with PHOs driving information share

2) Practise based data (results) feedback

2a) Increase other feedback options

3) Improved understanding of IT linkages in Practice systems

4) Paper from the Auckland Diabetes Advisory Team to CPHAC requesting funding to implement improvements in diabetes care and management that will impact on National Health Targets.

5) Routine reports to clinical advisory leadership meetings

6) CPHAC initiatives for long term conditions quality improvement coordinators and population audit tool beginning to be implemented.

7) Regional shared care pathway work

8) Regional shared target setting and service outcomes

Project Risks / Comments:Q2 shows we are now meeting target for DGC, however this is primarily due to the MOH decreasing the denominator for the expected

number of people

with diabetes. The number of Diabetes Annual Reviews for the Pacific and Indian populations are performing over 20% above target, with reviews for

Maori now also above target under the revised prevalence. However, the performance for the Other group continues to underperform against target

(42% against a target of 58%). In order to improve performance,

the DHB is working with primary care to implement a comprehensive range of activities

to improve DGC numbers and initiate an overall quality improvement framework. One initiative is a contract with the PHO’s (through Auckland PHO) to

employ long term condition quality improvement coordinators to work with all our priority practices to improve get checked performance. The first two

coordinators start in February 2011. Another initiative is the funding of a Population audit tool for each practice to enable them to better interrogate

their practice management system to identify and manage their population with long term conditions. This contract will be signed shortly. [Please note that the activity from Tongan Health Society has been estimated due to their data not being received in time for this report].

Diabetes Annual ChecksTarget vs Actual Mar 2008-Jun2011

0%

10%

20%

30%

40%

50%

60%

70%

Mar

-200

8

Jun-

2008

Sep

-200

8

Dec

-200

8

Mar

-200

9

Jun-

2009

Sep

-200

9

Dec

-200

9

Mar

-201

0

Jun-

2010

Sep

-201

0

Dec

-201

0

Mar

-201

1

Jun-

2011


1

2

3

24

5

6

7

8

2

2

08/09 Prevalence 18.79709/10 Prevalence 21,802

10/11 Prevalence 25,008

reduced to 21,342

54

Project:

Diabetes

Primary Objectives: Increase the percentage of people with diabetes having satisfactory or better diabetes management

Date of Delivery: 79% of people with diabetes will have a HbA1c ≤8%



Steering Group: Primary Care Clinical Advisory Group, Auckland Diabetes Advisory Team

Recent and Current activities:1)

Increase awareness project with PHOs

driving information share

1a) reinforce awareness 2) Practise based data (results) feedback via

various mediums including Health point

2a) increase feedback processes 3) Direct Secondary Service phone support for

GPs

4) Increased community shared clinics with

secondary care

5) Increased SEAsian Nurse Specialist access 6) Widened opportunity for self management to

include greater than 2 year or less

diagnosed people with diabetes

7) Improved culturally appropriate self

management courses

8) Improved understanding of IT linkages in

Practice systems (linking PPP)

9) Auckland Diabetes Advisory Team –

structured

agreed district plan of action

10) Redesign the supported self management to

meet needs of population

11) Developing shared care pathway for Diabetes12) Regional shared care pathway work including

clinical workshop

13)Implementation plan being developed for

diabetes coordinators (quality

improvement roles) and population audit

tools for each practice.

Project Risks / Comments:Q2 of 2010/11 performance continues in the same trend as the previous quarter, and we have only achieved

73% against a target of 84% of people having an HbA1C <8. The

main areas of underperformance are in our

diabetic management of Maori and Pacific populations. As noted in the DGC report, the activities currently

being put in place to improve the DGC targets should impact on management in the long term. Additionally a

new contract is being signed with Te Hononga O Tamaki Me Hoturoa

to provide Diabetes Self Management

Education for the ADHB region. With their focus on providing to

our high needs populations, we look to see

improvement in the self management capacity of our high needs populations with diabetes.

Get Checked patients w ith HBA1C<8Actual vs Target Mar2008 - Jun 2011

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Mar

-200

8

Jun-

2008

Sep

-200

8

Dec

-200

8

Mar

-200

9

Jun-

2009

Sep

-200

9

Dec

-200

9

Mar

-201

0

Jun-

2010

Sep

-201

0

Dec

-201

0

Mar

-201

1

Jun-

2011


12

3 4

5

6

7

81a

2a

9

1011

1213

55

Project:

Cardiovascular Risk Assessment

Primary Objectives: Increase the percentage of our eligible population who have had their CVD risk, assessed in the last five years

Date of Delivery: Overall goal is to have 80% of eligible population CVD risk assessed every five years.



Steering Group:

Primary Care Clinical Advisory Team Recent and Current activities:

1) Support the uptake of an electronic CVD tool

2) Training and information system support for

electronic tool

3) IT help line for GPs for risk assessment tool

4) Increase the cumulative incentive payments

for achieving both good assessment and good

management together

5) Review and reshape incentives to link with PPP

targets

6) Enhance links to Green Rx and maximise

primary care uptake

7) Continue to work in various workplaces to

enhance CVD risk assessment for men

8) Link in with research looking at ways to

optimise Pacific males participation in health self

management

9) Work regionally to have similar focus on

incentive goals

Project Risks / Comments:The Q2 CVD data from the MOH shows that we have now meet this target (79.4% against a target of 79%).

Individual targets for each ethnicity have also been meet.

We continue to support primary care in CVD screening and management through funding the license of the

Predict tool and an incentive based contract, which we will be reviewing in the coming months to ensure that

incentives are properly aligned.

Cardiovascular Risk Screening - Actual vs Target Sept 2008-Jun 2011

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Sep

-200

8

Dec

-200

8

Mar

-200

9

Jun-

2009

Sep

-200

9

Dec

-200

9

Mar

-201

0

Jun-

2010

Sep

-201

0

Dec

-201

0

Mar

-201

1

Jun-

2011


12

3

45

67

8

9

56

Project: Increased Immunisation

Primary goal: That 85% of two‐year olds will be fully immunised by July 2010, 91% by July 2011

and 95% by July 2012

Date of Delivery: 1 July 2010, 1 July 2011 and 1 July 2012

Clinical Lead: Richard Aickin

Project Sponsor: Richard Aickin

Steering Group: Richard Aickin, Carol Stott, Aroha Haggie, Hilda Faasalele, Ruth Bijl, Alison Leversha, IMAC, Auckland PHO, Public Health, Plunket,

Commissioner for Children Office, Ministry of Health

Current activities

1.

Practice level reporting available2.

Primary care Immunisation Co‐

ordinators funded ‐

ongoing3.

ADHB Immunisation Strategy approved4.

Funding application made to Starship

Foundation to fund social marketing

programme5.

Data cleansing project in primary care

approved and funded6.

Scoping project for multi‐agency

engagement in promoting

immunisation to high needs families7.

Data cleansing and practice nurse

education project by NIR team and

Immunisation Coordinators in all

practices begins with final results

expected by June 2011.8.

Letters sent to all parents who are

noted on the NIR as having declined

immunisation for their child to check

that this is correct.

Project Risks / Comments:Coverage for Quarter 3, 2010/11 (2 years olds full immunised all

ethnicities) is 88% (regional target 90%, ADHB target 91%). Maori coverage at 18

months increased by 4% in February. The data quality and practice nurse education project targeting systems issues is well underway with so far 2426

missing doses entered manually on the NIR including 214 children

who will turn 2 in the next 3 months. In addition, all children turning 2 in the next 3

months who are currently overdue for a scheduled immunisation are being automatically referred to the Outreach Service for follow up and as of 1

April 63 children had been referred. ‘Courtesy’

letters to check ‘decline’

status on the NIR have been sent 554 parents to check that they

had

intended to decline immunisation. Of 95 responses received so far 31% did not intend to decline immunisation and these children

will be followed up.

Together, it is expected that these initiatives will result in at least a 2‐3% increase in coverage by 30 June 2011.

Percentage of two year olds immunisedActual vs Target Sept 2007-Jun 2011

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sep

-200

7

Dec

-200

7

Mar

-200

8

Jun-

2008

Sep

-200

8

Dec

-200

8

Mar

-200

9

Jun-

2009

Sep

-200

9

Dec

-200

9

Mar

-201

0

Jun-

2010

Sep

-201

0

Dec

-201

0

Mar

-201

1

Jun-

2011


2

3

4 5 7

68

1

57

8

LIFT THE HEALTH OF PEOPLE IN

AUCKLAND CITY

8.1 Committee Recommendations

59

8.1 Commit tee Recommendat ions Community and Public Health Advisory Committee Recommendations Maori Health Advisory Committee Recommendations Pacific Health Advisory Committee Recommendations Disabled Support Advisory Committee Recommendations

61

9

PERFORMANCE IMPROVEMENT


63

Agenda Item

BRIEFING PAPER TO THE BOARD Date: 4 May 2011 To: Auckland District Health Board – Board Meeting Subject: District Annual Plan Progress Report The attached report shows the progress of the 107 improvement activities ADHB committed to in our 2010/11 District Annual Plan. For over half of these activities we are currently implementing the developed solution or have completed the activity and are monitoring to ensure a sustained solution. We have been pleased with the significant change in performance for the acute flow (ED 6hr target) project. While we are behind schedule for 19 of the activities the sponsors have appropriate plans going forward to mitigate the risk for 10 of these. The nine activities listed as exceptions in this report, mainly due to being behind schedule, are the activities that the sponsor believes still have potential risk associated with them and significant management focus is still required to ensure delivery of the activities objective.

65

Goal Level Summary

Goal: 1 Lift the Health of the people in Auckland City

Legend: Red - , Orange - , Green -

Group Pack Report Group/Committee: Board

DAP Projects - total projects: 107

Goal

Num

ber

Started

Current Phase On Time On BudgetExpected Outcome

Finished

Post Implementation Benefits

PlanDo/

Check Act Cancelled

Green

Orange

Red

Green

Orange

Red

Green

Orange

Red

Green

Orange

Red

Define

Measure

Analyse

Improve

Control

1 Lift the Health of the people in Auckland City 40 40 11 9 3 13 3 0 34 3 2 38 0 1 37 1 1 1 1 0 0

2 Performance improvement 56 56 7 6 6 29 4 0 40 11 1 49 2 1 48 3 1 4 4 0 0

3 Live within our means 11 10 1 1 3 1 3 0 8 2 0 10 0 0 10 0 0 1 1 0 0

Total # 107 106 19 16 12 43 10 0 82 16 3 97 2 2 95 4 2 6 6 0 0

Total % 100% 99% 18% 15% 11% 40% 9% 0% 77% 15% 3% 91% 2% 2% 89% 4% 2% 6% 6% 0% 0%

Exceptions

Project Coverage PhaseOn Time

On Budget

Expected Outcome Sponsor Review Committee

Develop Care Pathways for people with Long Term Conditions

National Define The original pathways have been incorporated into the BSMC plan and the Diabetes pathway is included in the regional health plan. The 5 pathways under development will meet the DAP target.

CPHAC

Increase access and capacity to community diabetic eye screening

National Analyse Loads of activity happening. Good progress on volumes etc. ,Need to keep aware of the timelines and the implications of them being delayed.

CPHAC

Māori Service Development Regional Define Merger activity to date has been complex and time consuming. Progress has been made although slow. A project framework is under consideration. Additional activty is planned to ensure the project gets back on track.

CPHAC

Palliative Care Redesign ADHB Analyse Delays - clarity around the way forward expected from steering group meeting scheduled for the end of March.

CPHAC

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27/04/2011http://dap.adhb.govt.nz/2010/Pages/Reports/HighLevel/GroupPack.aspx?IMF=Board&ReportType=BoardException

67

Goal: 2 Performance improvement

Legend: Red - , Orange - , Green -

Goal: 3 Live within our means

There are no projects that have been marked as an exception

Exceptions

Project Coverage PhaseOn Time

On Budget

Expected Outcome Sponsor Review Committee

Better help for smokers to quit

National Improve A range of improvement strategies are in the process of being implemented with the assistance of the new steering group. Results remain unsatisfactory due to the high volumes of short stay patients to whom advice is not being routinely offered or documented. Confirmation of funding for Smokefree services for the 11/12 year has not been confirmed. Funding expires 30 June.

HAC

Skin Lesions Regional Improve Project is now back on track. Contracting arrangements are currently being finalised and transition plan from ADHB provider to GP's is being developed.

CPHAC

Pharmaceuticals Regional Measure Original benefits idetified may not be delivered although work is underway to forcast benefits likely for the end of the financial year.

CPHAC

Starship 6 hour project

National Improve While the March performance of 93% was short of the target, the result represented a further improvement over prior months and 6% over the same month last year. There were some 12 days at 95% or better which comfortably surpassed the performance of all prior months. The improving results continue to reflect a number of activities and projects within Starship. Of particular note in March was: Increased Management focus and engagement. Daily review of all 6 hour breaches with feedback and improvement actions being taken in the relevant areas. Heightened staff awareness brought about by Valuing our Patients Time Campaign which publishes results on a weekly basis. The importance meeting the 6 hour target and results achieved have been on the agenda at meetings throughout Starship. Implementation of an Electronic Whiteboard in CED. This has resulted in a greater level of transparency as to where patients are in their CED journey to enable prioritisation of patients that may breach the 6 hour time. The transfer time from CED to ward (relative to the 1 hour recommendation) made a significant improvement with the mean falling by 34% over February’s results. All wards are now using the Estimated Dates of Discharge.

HAC

Tamaki P2HC project

Regional Analyse A revised programme design and costings has been developed and agreed to by the SLT subject to funding. Funding for training for eligible Maori trainees has been transfered from He Kamaka Oranga to offset some of the cost

BOARD

Exceptions

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68

10

LIVE WITHIN OUR MEANS

10.1 Finance Committee Recommendations

10.2 Finance Report

69

10.1 F inance Commit tee Recommendat ions

71

ADHB Board Author: Ian Bell (8077) Subject: Fluoroscopy Room Radiology Recommendation

That the Auckland District Health Board approves the budget based business case for the replacement of fluoroscopy equipment with associated installation costs at a cost of $1m subject to tender for the equipment.

Background This will be discussed by the Finance Committee at their meeting on 3 May 2011.

73

ADHB Board Author: Ian Bell (8077) Subject: Replace 2 Angiography/DSA Rooms Recommendation

That the Auckland District Health Board approves the budget based business case for the replacement of a bi-plane and single plane DSA/Angiography equipment with associated installation costs and approves the purchase of pendants for carrying anaesthetic gases as specified by Anaesthetic clinical staff, subject to tender for the equipment, with the project not to exceed $3.5m.

Background This will be discussed by the Finance Committee at their meeting on 3 May 2011.

74

ADHB Board Author: Ian Bell (8077) Subject: Clinical Records Scanning Solution Recommendation That the Auckland District Health Board approves the purchase and implementation of the 3M Health Information Systems (3M) solution for a clinical record scanning system at a capital cost of $3,259,722 and ongoing annual operating costs of $180,000 subject to a further budget of $1.3m being found through reprioritisation of the capital budget. Background This will be discussed by the Finance Committee at their meeting on 3 May 2011.

75

10.2 F inance Repor t

77


Board Financial Report

March 2011

79

Performance Graphs by Month & YTD

‐10

‐8

‐6

‐4

‐2

0

2

4

6

8

10

12

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

$ Millions

Net Results

Net Results for 09/10 Act Net Results for 10/11 Bud Net Results for 10/11 Act

‐14

‐12

‐10

‐8

‐6

‐4

‐2

0

2

4

6

8

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

$ Millions

Cumulative Net Results

Cumulative Net Results for 09/10 Act Cumulative Net Results for 10/11 Bud Cumulative Net Results for 10/11 Act

80

Auckland District Health BoardSummary ResultMonth of Mar-11

$000s Month Month Month YTD YTD YTDA B Var A B Var

IncomePBF - AKL Population 80,124 79,701 423 F 721,022 717,311 3,711 F

Inter District Inflows 52,626 47,891 4,736 F 453,496 431,016 22,481 F

132,750 127,592 5,158 F 1,174,518 1,148,326 26,192 F

MOH Sub-contracts 9,931 7,515 2,416 F 67,456 67,019 437 F

Other Patient Care 5,055 2,670 2,385 F 28,590 24,207 4,382 F

Services & Products 4,443 4,548 105 U

67 U 482 U

145 F 718 F

153 U

,323 F

228 U

549 U 3,021 U122 U 1,371 F

10 U 306 U

151 U 29 U

313 U 585 U

766 U 2,799 U

3,602 U 15,243 U

227 U 2,672 U

6,249 U 17,206 U

54 U 1,100 F

64 F

183 U

(80) 281 U

116 51 U 989 F

10,778 U 35,283 U

455 U 472 U

(2,536) (2,656) (1,569)

40,306 40,173 133 F

CTA 1,618 1,685 14,480 14,961

Trust & Donation Income 572 428 4,606 3,888

Financial Income 1,375 830 545 F 6,979 3,775 3,205 F

Other Income 414 567 4,987 4,762 225 F

156,159 145,836 10 1,341,922 1,307,111 34,811 F

ExpenditureEmployee Costs Medical 20,174 20,554 380 F 175,325 175,097

Nursing 20,653 20,104 179,788 176,767 Technical 10,836 10,714 90,326 91,697

Hotel Services 843 833 7,507 7,200

Administration 8,366 8,215 70,004 69,975

Other 3,816 3,503 31,831 31,247

Total Employee Costs 64,689 63,923 554,781 551,982

Direct Treatment Costs 21,735 18,133 172,852 157,609

Indirect Treatment Costs 3,508 3,280 32,061 29,388

Funder Payments 45,715 39,465 372,277 355,070

Inter District Outflows 8,426 8,372 74,251 75,351

Prop, Equip. & Transport 3,867 3,931 36,174 37,199 1,025 F

Maintenance 107 133 26 F 1,383 1,200

Building Compliance 0 0 0 F 0 0 0 F

Loss on Sale of Fixed Assets 1 82 F 293 12

Administration Costs 2, 2,065 17,023 18,012

Total Operating Expenditure 150,083 139,304 1,261,108 1,225,826

Operating Contribution 6,077 6,532 80,814 81,285

Depreciation 4,215 4,422 207 F 38,637 40,448 1,810 F

Finance Costs 1,514 1,714 199 F 13,739 15,100 1,361 F

Capital Charge 2,883 3,051 168 F 25,744 27,307 1,563 F

Total Non Operating Costs 8,612 9,187 575 F 78,120 82,855 4,734 F

Net Surplus / (Deficit) 120 F 2,693 4,262 F

81

Auckland District Health BoardStatement of Financial PositionAs at Mar 2011

Mar-11 Mar-11 Feb-11 Jun-10Actual Budget Actual Actual$ 000s $ 000s $ 000s $ 000s

Crown EquityOpening Balance 569,409 569,304 569,409 566,089 Equity Injections/(Repayments) 1,144 3,044 1,144 3,320 Closing Balance 570,553 572,348 570,553 569,409

Revaluation reserveOpening BalanceRevaluation AdjustmentsClosing Balance 353,537 381,278 353,537 353,538

Retained EarningsOpening Balance (468,367) (468,437) (468,367) (468,645)Surplus/(Deficit) Current YearClosing Balance

Total Crown Equity 458,418 483,618 460,953 454,578

Represented by:Fixed AssetsLand 181,497 201,337 181,497 181,497 Buildings 573,241 583,301 574,862 586,094 Clinical, Other Equipment & Motor Vehicles 81,373 121,848 81,207 79,856 Work in Progress 32,938 28,168 29,745 23,166 Total Fixed Assets 869,048 934,654 867,311 870,612

Derivative Financial Instruments 4,772 4,399 5,321 7,061

InvestmentsAssociated Company Investments 95 386 95 470 Trust Deposits 6,326 8,000 6,326 10,078 Total Investments 6,421 8,386 6,421 10,547

Current AssetsCash & Short Term Deposits 80,787 36,195 77,246 56,815 Trust Deposits 15,679 11,508 15,564 11,747 Debtors 30,181 24,435 19,132 25,691 Accrued Income 25,538 26,591 32,567 31,221 Prepayments 3,454 2,320 3,912 2,245 Inventor

353,538 381,278 353,538 381,278 (0) - (0) (27,740)

2,693 (1,571) 5,229 279 (465,673) (470,008) (463,138) (468,367)

y 12,202 12,106 12,286 11,220 Total Current Assets 167,842 113,155 160,706 138,938

Current LiabilitiesBorrowings 25,640 25,787 26,086 75,027 Trade & Other Creditors, Provisions 226,004 218,318 222,646 222,910 Income Received in Advance 27,939 18,647 24,523 20,087 Taxes Payable 23,128 19,153 18,640 18,040 Funds Held in Trust 1,086 1,108 1,088 1,067 Total Current Liabilities 303,796 283,012 292,984 337,132

Working Capital (135,954) (169,856) (132,278) (198,193)

Non Current LiabilitiesBorrowings 263,086 273,086 263,078 213,014 Employee Entitlements 22,782 20,880 22,744 22,435

Total Non Current Liabilities 285,868 293,965 285,822 235,449

NET ASSETS 458,418 483,618 460,952 454,578

82

Statement of Cashflows for the Year ended 30 June 2011

Actual Budget Variance Actual Budget VarianceOperationsRevenue Received 154,894 143,732 11,162 1,344,751 1,314,312 30,439Payments (145,944) (135,839) (10,105) (1,291,445) (1,267,838) (23,607)

Net Operating Cashflows 8,950 7,893 1,057 53,306 46,474 6,832

InvestingIncome 660 370 290 5,287 3,327 1,960

Capital Sale of Assets 0 1 (1) 17 12 5Purchase Fixed Assets (5,951) (6,460) 509 (37,684) (58,146) 20,462

Net Investing Cashflows (5,291) (6,089) 798 (32,380) (54,807) 22,427

Financing Equity Injections 0 1,014 (1,014) 1,145 3,043 (1,898)New Loans 0 0 0 70,000 91,000 (21,000)Loans Repaid 0 0 0 0 375 (375)Equity Repayment 0 0 0 0 0 0Loans Repaid 0 0 0 (70,000) (70,000) 0

Net Financing Cashflows 0 1,014 (1,014) 1,145 24,418 (23,273)

Total Net Cashflows 3,659 2,818 841 22,071 16,085 5,986

Opening Cash 48,441 43,296 5,145 30,029 30,029 0Closing Cash 52,100 46,114 5,986 52,100 46,114 5,986

Mar-11 Year to Date

83

Financial Commentary for March 2011 Financial Performance The result for March was a favourable variance with a deficit of $(2.5)m compared to a budgeted deficit of $(2.6)m. The result year to date is a surplus of $2.7m compared to a budgeted deficit of $(1.5)m, a favourable variance to budget of $4.3m.

The result year to date, is driven by higher revenue of $34.8m compared with higher expenditure of $(30.6)m. This was the result of:-

a) Favourable Base Revenue $26.2m is driven by higher base contract variations,

which are primarily for additional Herceptin funding $6.4m, PHO realignment funding $13.6m, Oral Health funding $1.2m and a provision for FY11 IDF wash up’s $3.0m.

b) Higher MoH Subcontract revenue $0.4m, is driven by higher SCI funding $3.4m, Mental Health (Eating Disorder) funding and other MoH Subcontract revenue $7.3m, lower Herceptin funding (now in base revenue above) $(6.2)m and lower Additional Elective revenue $(4.1)m as a result of lower year to date volume delivery than budgeted.

c) Higher volumes of non resident activity $3.5m. d) Higher levels of inter DHB side contracts $2.2m to meet additional PHO costs. e) The timing of donations $0.7m. f) Higher interest received on term deposits $2.0m.

g) A realised gain on Interest Rate Swap Instruments $1.2m.

Year to date expenditure was higher than budgeted by $(30.6)m. The unfavourable variance in employee costs of $(2.8)m was driven by vacancies

and annual leave taken in Mental Health $2.7m, Adult Health $1.8m, Operations $2.1m and Cancer $0.9m, and increased employee costs in Child Health ($3.1)m, Cardiac $(1.8)m, Operating Theatres $(2.0)m, Ambulatory $(0.9)m, driven by increased volume and complexity. In addition, provision has been made for potential MECA settlements $(1.8)m and long service and gratuity payments $(0.9)m.

Direct Treatment costs are $(15.2)m unfavourable to budget in the following services – Adult Health $(1.6)m, Child Health $(4.5)m, Cardiac Services $(5.5)m, OR & Anaesthesia $(2.3)m, Laboratories $(2.8)m, Imaging $(1.7)m and Ambulatory $(0.6)m. The increase is due to increases in Drugs $(0.8)m driven by high usage in immunology and paediatric oncology, Chemicals & Media $(1.9)m driven by higher test volumes and higher reagent prices, Clinical Supplies & Implants $(7.8)m driven by higher volumes in OR & A, Cardiac and Child Health and Outsourcing $(6.0)m primarily to cover operational vacancies, manage cardiac waiting lists and increase elective volumes. There were also various initiatives that have not delivered the treatment cost savings to the planned levels. Further analysis is also provided within the Hospital Advisory Committee agenda.

Funder Payments (excluding IDF Outflows) are over budget $(17.2)m due to

increased PHO costs following a process of realigning PHO’s $(16.3)m. Additional IDF revenue is being received to cover this additional expenditure. There are also unfavourable variances in Laboratory costs following revised contracts with LTA and DML $(1.8)m, costs arising from settlement of prior year’s pharmaceutical claims $(0.7)m and additional Mental Health (Eating Disorder) expenditure $(1.0)m for which additional revenue has been received as described above.

Inter District Outflows are favourable to budget $1.1m driven by the finalisation of

the FY 2010 outflows provision.

84

Indirect Treatment Costs are $(2.7)m unfavourable primarily due to the provisioning for doubtful non resident debts in relation to the increased non resident revenue described above ($2.1)m and the higher cost of sales for retail pharmacies for which additional revenue has been received $(0.4)m.

Property costs are favourable to budget $1.0m driven by lower utilities, lower property

and vehicle maintenance costs and lower computer maintenance costs.

Administration Costs are lower than budget $1.0m due to lower consulting fees for improvement projects $0.9m.

Loss on Sale of Fixed Assets is higher than budget $(0.3)m following review of the

fixed asset register.

Depreciation is lower than budget $1.9m driven by lower levels of capital expenditure.

Finance Costs are lower than budget $1.4m driven by lower than planned interest

rates and CHFA loans not having to be drawn down.

The Capital Charge is lower than budget $1.6m driven by the revaluation of Land & Buildings downwards at balance date.

Financial Position

The opening balance of fixed assets was $(39.5)m below budget principally due to the

downward revaluation of land & buildings $(27.8) m as at 30 June 2010 and FY10 full year capital spending being $(28.7) m lower than forecast.

YTD Capital spending is $32.9m, under budget by $(20.8) m. Baseline and Facilities

projects are behind budget by $(10.3) m driven by slower spending on the Greenlane Surgical Unit $(6.0) m, Oral Heath Clinics $(2.8) m and a reduction in spending through reprioritisation $(4.8) m. Information Systems projects are behind budget by $(10.5) m driven by the pace at which business cases are completed, approved and implemented.

At month end there is an unused overdraft facility of $44.1m.

85

1υ

GENERAL BUSINESS

87

12

PUBLIC EXCLUSION

89

AUCKLAND DISTRICT HEALTH BOARD

RESOLUTION TO EXCLUDE THE PUBLIC

FROM A MEETING OF THE BOARD

Clauses 32 and 33, Schedule 3, New Zealand Public Health and Disability Act 2000 (“ Act”)

That, in accordance with the provisions of Schedule 3, Clauses 32 and 33, of the New Zealand Public Health and Disability Act 2000, the public be excluded for consideration of Item 12. The general subject of the matters to be considered while the public is excluded, the reason for passing this resolution in relation to each matter, and the specific grounds under the above clause for the passing of this resolution are as follows: General subject of each matter to be considered:

Reason for passing this resolution in relation to each matter:

Ground(s) under clause 34 for the passing of this resolution:

12.1 Confidential Board Minutes

6 April 2011 12.2 Governance Committee Structure and Meeting Cycle 12.3 Committee Structure Quality, Risk and Audit Committee 12.4 Appointment to the Audit and Finance Committee 12.5 Northern Region Shared Services Organisation

To enable the Board to carry on without prejudice or disadvantage commercial activities and negotiations: Official Information Act 1982 s.9(2)(i) and s.9(2)(j)

That the public conduct of the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under s 9 of the Official Information Act 1982.

91

ADHB Board

A g e n d a

MEETING DETAILS

Time and Date 2:00pm, Wednesday, 4 May 2011

Venue A+ Trust Room, Clinical Education Centre, Level 5, Auckland City Hospital, Grafton

Members Dr Lester Levy (Chair), Jo Agnew, Peter Aitken, Judith Bassett, Susan Buckland, Dr Chris Chambers, Rob Cooper, Dr Lee Mathias, Robyn Northey, Gwen Tepania-Palmer, Ian Ward.

Apologies Rob Cooper (Leave of Absence)

In Attendance Garry Smith, Dr Denis Jury, Dr Margaret Wilsher, Brent Wiseman, Greg Balla, Taima Campbell, Naida Glavish, Paul Green, Janice Mueller, Vivienne Rawlings, Ian Bell.

Item Page No

1 2m to 2:02pm

Karakia 001

2 3m to 2:05pm

Attendance and Apologies 005

3 2m to 2:07pm

Conflicts of Interest 009

4 5m to 2:12pm

Confirmation of Minutes Wednesday 6 April 2011 019

5 3m to 2:15

Action Points Wednesday 6 April 2011 027

6

5m 5m to 2:25pm

Chairman’s Report

6.1 Report 6.2 Chairman’s Recommendations

031

7

10m 15m to 2:50pm

Chief Executive’s Report

7.1 Chief Executive’s Summary 7.2 Minister’s Six Health Priorities 2009/10

039

8

5m to 2:55pm

Lift the Health of People in Auckland City

8.1 Committee Recommendations

059

9

5m to 3:00pm

Performance Improvement


063

ADHB Board

A g e n d a

Item Page No

10

5m 10m to 3:15pm

Live Within Our Means

10.1 Finance Committee Recommendations 10.2 Finance Report

069

11

5m to 3:20pm

General Business 087

11

1h 10m to 4:30pm

PUBLIC EXCLUSION 089

NEXT MEETING

Time and Date: 2:00pm, Wednesday, 1 June 2011

Venue: A+ Trust Room, Clinical Education Centre, Level 5, Auckland City Hospital, Grafton

Hei Oranga Tika Mo Te Iti Me Te Rahi Healthy Communities, Quality Healthcare

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